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193 7 Forbidden Sights Women and the Visual Economy of Medicine THE CLINICAL LECTURE On November 6, 1869, a small group of students from the Woman’s Medical College quietly entered the new amphitheater of the Pennsylvania Hospital and took seats together.1 Their entry into these clinical lectures was a welcome turning point in the college’s struggle for acceptance. The Philadelphia County Medical Society had recently passed its most punitive resolution against the Woman’s Medical College, barring from membership graduates of the women’s college, professors at the college, and those who consulted with them. The Woman’s Medical College had been declared a pariah institution . Although the women faculty of the Woman’s Medical College had repeatedly petitioned for admission to Pennsylvania Hospital’s clinical lectures , beginning with a letter from Ann Preston in 1855, the managers only agreed to their request on October 25, 1869. The institution the women students entered was central to the teaching and practice of medicine in Philadelphia. The Pennsylvania Hospital was the oldest and best known Philadelphia hospital, entrusted particularly with the care of accident victims. Although it was called the Quaker hospital and most of the managers were Quakers, Pennsylvania had no official connection with the SocietyofFriends.TheheroicpaintinggiventothehospitalbyBenjaminWest, Christ Healing the Sick, expressed the ideology of the institution: healing is a divine work, undertaken in public for the benefit of the grateful people.2 Clinical lectures at the Pennsylvania Hospital were given by the attending staff of the institution. Like the house staff of other American hospitals, they battled for control of the institution for decades; the issues of hospital admissions and releases, of student access to patients, and of free and paying patients were all contested. Managers, responsible for the overall management, solvency, and good repute of the hospital, insisted on the right to screen patients for their moral fitness and desert, to restrict student access, and to control finances. They organized their own work meticulously, fining each 194 Forbidden Sights other for absences from meetings and providently organizing appeals for funds; they expected the same sober and businesslike behavior from the medical staff. (It is far easier to trace the records of decisions made by the board of managers in 1897 than it would be to trace those of, say, a twentiethcentury academic department.) The hospital’s attending doctors, however, wanted greater professional control over patient care, particularly hospital admissions, and greater student access to patients; the lay control of the hospital compromised their professional discretion.3 Although the Pennsylvania Hospital did not sponsor a medical school, its lectures were eagerly attended by students from Philadelphia’s university and proprietary medical schools throughout the early decades of the nineteenth century.4 Schools required students to show their tickets for hospital lectures, the sole clinical education required of a mid-nineteenth-century physician. Tickets were moderately priced, and the Pennsylvania Hospital donated the proceeds to its medical library, which was open to students. And the purchase of tickets could be a formality. Students were not examined on what they had seen; they might purchase a variety of tickets for different hospitals and attend whichever lectures proved interesting, or none at all. Many students, however, attended lectures regularly, sometimes at more than one institution, and kept careful notes on what they saw. In Philadelphia during the 1860s, clinical lectures would have been offered not only at the Pennsylvania Hospital but also at Jefferson, the Philadelphia Hospital associated with the Philadelphia Almshouse, called the Blockley, and in clinics attached to the University of Pennsylvania School of Medicine. Smaller, specialized hospitals sometimes offered clinical lectures, including, of course, the Woman’s Hospital associated with the Woman’s Medical College. Conventionally, lectures in medicine and surgery were scheduled for successive hours; two different lecturers publicly examined patients they considered interesting. In the surgery clinic, operations were performed on a table, often a revolving table, in the center of the amphitheater; at medical clinics, the patient would be treated, given medicine, and sometimes told to return. Students themselves do not seem to have had an opportunity to examine the patient or to ask questions. Notes of clinical lectures show five to ten cases being demonstrated in an hour of medical clinic; surgical clinics would feature as many operations as could be undertaken in the allotted time, with running commentary by the surgeon. At the Pennsylvania Hospital, the clinical amphitheater was itself a dramatic space. It was at once intimate (any word...

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