A munificent gift from Mary Elizabeth Garrett, heir to the great Baltimore and Ohio Railroad fortune, enabled The Johns Hopkins University School of Medicine to open and to enroll its first class in October 1893. Her gift, however, provided much more than financial assistance to this fledgling institution. It carried conditions that led to the transformation of American medical education. Of her stipulations, the following three brought about the greatest educational changes:
That women be admitted to the school on equal terms as men and "enjoy all its advantages on the same terms as men" and be "admitted on the same terms as men to all prizes, dignities or honors that are awarded by competitive examination, or regarded as rewards of merit";
"That the Medical School of the university shall be exclusively a graduate school" and "that it shall provide a four years' course, leading to the degree of Doctor of Medicine";
That requirements for admission specify that applicants have a bachelor's degree and proof that they have satisfactorily completed courses in physics, chemistry and biology, and have a "good reading knowledge of French and German."
Garrett concluded her stipulations with the following proviso:
"That in the event of any violation of any of the aforesaid stipulations the said sum of $306,977 shall revert to me, or such person or persons, institution or institutions, as I by testament or otherwise may hereafter appoint." Historian Margaret Rossiter cites Garrett's gift with its stringent conditions as one of the earliest examples of "coercive philanthropy" among women philanthropists. Thus Garrett provided a model for other wealthy women to follow by using philanthropy as an agent for social change.
In the late 19th century, American medical schools were largely diploma mills that promoted apprenticeship as the principal mode of learning. They had few, if any, requirements for admission and low standards for completion of medical training. Their curricula essentially ignored the emerging importance of science in the study of medicine. American students interested in gaining the best possible medical education had to journey to European universities and research institutes, which offered lecture and laboratory courses with the most current findings in science and medicine.
Another drawback in America was that separate schools existed for the training of men and women physicians, and, in general, the medical schools for women were poorly funded and lacking in basic teaching resources. Garrett's conditional gift set precedents by elevating the standards and quality of American medical education and by providing new and greater opportunities for women to study medicine.
Shortly after The Johns Hopkins University opened in 1876, planning began for the hospital and a school of medicine. The trustees and their chief consultant, John Shaw Billings, intended that they be closely affiliated and serve as an "instrument for medical education." In 1884 university President Daniel Coit Gilman recruited William H. Welch, a promising young pathologist who had studied in Europe with some of the leading figures in "scientific medicine," as the first faculty member for the proposed school. Welch's assignment was to set up a state-of-the-art pathological laboratory and help assemble the core faculty, which included William S. Halsted, William Osler and Howard A. Kelly. In all the extensive planning for the school, there was never any provision for the admission of women students.
On Dec. 24, 1892, the university trustees voted to accept Garrett's gift and the rigorous conditions it carried.
However, the medical faculty balked because they felt that the proposed academic standards were too stringent and would discourage students from applying. Welch noted that the standards for admission that Garrett had stipulated were taken from a document that he had presented to the trustees shortly after he came to Baltimore in 1884. "It is one thing to build an educational castle in the air at your library table and another to face its actual appearance under the existing circumstance," he said. "We were alarmed, and wondered if any students would come or could meet the conditions, for we knew that we could not." Finally, on Feb. 4, 1893, the medical faculty unanimously approved the terms of admission that Garrett had stipulated.
Yet the medical faculty and other faculty within the university had lingering concerns that Garrett's conditions might threaten academic freedom. A special committee of trustees reviewed the terms of her gift and reported that the university still retained the rights to determine admission and graduation of students. Garrett agreed with the trustees' report and on Feb. 22, 1893, Commemoration Day, President Gilman announced that the School of Medicine would open in October of that year.
Garrett's hard-won negotiations with the trustees of the university and the medical faculty were the culmination of a long struggle that had begun six years earlier. In 1887, President Gilman and the trustees of the university had refused Garrett's offer to donate $35,000 annually to fund a coeducational school of science.
Spurned but not defeated, Garrett and a group of progressive-minded friends soon rallied to another cause for coeducation at Johns Hopkins. Learning that the university had financial difficulties and would not be able to open the proposed School of Medicine when the hospital was scheduled to commence operations in May 1889, they were quick to seize upon the opportunity presented by these circumstances. M. Carey Thomas, one of Garrett's friends, met with President Gilman in December 1888 and presented him with a proposition for funding the School of Medicine: She and a committee of women were prepared to launch a campaign to raise the $100,000 needed to endow the school, provided that women be admitted on equal terms as men.
The committee included Garrett and three other friends: Julia Rogers, Mamie Gwinn and Elizabeth King. This group was still flush from the success of an earlier endeavor to establish a college preparatory school for young women in Baltimore. The Bryn Mawr School, which opened in 1885, gained both local and national prominence as a model of secondary education for young women. Through the experience of founding and developing this school, they honed their planning skills, becoming adept at setting realistic goals, implementing strategy and organizing a strong foundation of support. Garrett was the principal benefactor of the Bryn Mawr School, contributing a major portion of the funding for its establishment.
These five friends had been reared in privileged circumstances. All were daughters of Hopkins trustees and had grown up during the university's and hospital's formative years, when their trustee fathers were actively engaged in planning. Their fathers' high-minded ideals for education and health care seem to have left a lasting impression upon these young women and contributed to their later interest in medical education. Through the early medical faculty, they also were exposed to the formation of new ideas about incorporating science and research into the study of medicine.
Another influence was Emily Blackwell, Garrett's personal physician. Blackwell and her sister Elizabeth Blackwell, the first woman in the United States to receive a medical degree, were leaders in the late-19th-century movement to advance opportunities for women who wanted to study medicine. In summary, a confluence of many factors seems to have shaped their goals for medical education.
Of this group of friends, M. Carey Thomas had the most advanced education and one of the strongest personalities. She received a bachelor's degree from Cornell in 1877 and a doctorate from the University of Zurich in 1882. Before going abroad for graduate study, she had attempted to enroll at Johns Hopkins but was rejected on the grounds that the university did not admit women. In 1884, when she returned to the United States, she became a professor of English and dean of Bryn Mawr College.
When she called upon President Gilman in 1888, she was a serious professional woman with a mission. The university's refusals of her earlier attempt for admission and of Mary Elizabeth Garrett's offer to endow a coeducational scientific school seemed now to fuel their determination for establishing a medical school that would admit women on an equal basis with men.
Although Garrett was not as academically advanced as Thomas, she had a strong instinct for business and knew how to drive a hard bargain. For years she had served as assistant to her father, B & O Railroad scion John Work Garrett, and had gained extensive experience in his world of business.
On May 2, 1890, M. Carey Thomas and Mary Elizabeth Garrett, along with their three friends from the Bryn Mawr campaign, officially formed the Women's Fund Committee and quickly set up branches across the country. They persuaded nationally prominent women to chair the various regional groups, thus giving their campaign a stamp of acceptability and major significance.
Among the luminaries of society and trailblazers for social change who joined the efforts of the committee and made financial contributions as well were Caroline Harrison, wife of Benjamin Harrison, the sitting president; Jane Stanford, wife of Leland Stanford, founder of Stanford University and then a U.S. senator; Bertha Palmer, the queen of Chicago society, whose husband, Potter Palmer, had built the Palmer House Hotel; Louisa Adams, wife of President John Quincy Adams; Julia Ward Howe, the abolitionist who wrote "The Battle Hymn of the Republic"; Alice Longfellow, daughter of poet Henry Wadsworth Longfellow; Sarah Orne Jewett, who featured strong and independent women in her novels; physician Mary Putnam Jacobi, organizer of the Association for the Advancement of Medical Education for Women; and Emily Blackwell, who, with her sister Elizabeth Blackwell and Marie Zakrzewska, had opened in New York the first American hospital for and staffed by women.
Also enlisting the support of distinguished men, the committee embarked upon a major public relations effort to promote medical education for women to the general public. In a series of essays published in Century Illustrated Monthly Magazine, a leading 19th-century periodical, Cardinal Gibbons, the primate of American Catholicism, and Osler, whose wife-to-be was on the Philadelphia branch of the Women's Medical Fund Committee, expounded on the merits of medical education for women. Cardinal Gibbons made one of the most profound statements, saying, "There is no obstacle in ecclesiastical or canon law to the education of women for the medical profession." Mary Putnam Jacobi and M. Carey Thomas also contributed essays to this series.
Back in Baltimore, the three living trustee fathers, Charles J. M. Gwinn, James Carey Thomas and Francis King, lent staunch political support to the campaign. Gwinn may have played one of the most crucial roles by helping Garrett draft her conditions. Having served as Johns Hopkins' personal attorney, he had earlier drafted the articles of incorporation for the university and hospital and had served as executor of Hopkins' will. Because of his prestige and years of service to the hospital and university, he held a position of great influence among his fellow trustees.
By the autumn of 1890, the Women's Fund committee had raised the requisite $100,000 and was able to make a formal offer to the university. Nearly 700 subscribers had contributed $52,212.50, and Mary Elizabeth Garrett made up the needed $47,787.50 from her personal fortune. The trustees voted on a resolution to accept the gift and stated that it would be invested as the Women's Medical School Fund, but the school could not be opened until a sum of $500,000 was obtained. Neither the university nor the Women's Medical Fund was successful in raising this total amount.
Once again Garrett stepped into the breach and salvaged the situation with her philanthropy. She made a gift of $306,977 to bring the endowment of the School of Medicine to the requisite $500,000. Thus, with her earlier gift of $47,787.50, she contributed a total of $354,764.50, which in today's currency would be worth approximately $6.5 million. Thanks to her generous gifts and her vision for medical education, the School of Medicine opened in October 1893 and soon became a leading institution of its kind.
In 1904, as a gesture of gratitude to Miss Garrett, the trustees of the university commissioned John Singer Sargent to paint her portrait. In return, Garrett commissioned Sargent to paint a monumental group portrait of the four founding members of the School of Medicine's faculty, Osler, Welch, Kelly and Halsted.
As with most of her undertakings, Garrett assumed a central role in managing the two commissions. She visited Sargent's London studio to sit for her portrait and returned frequently to observe progress. At a point when the portrait was nearly completed, she and M. Carey Thomas expressed their displeasure to Sargent, saying that he had made her look too dour. After a shopping expedition, they returned with an elegant white shawl, kid gloves and a bouquet of red roses, saying that these items were needed to brighten the painting. Sargent deferred to their wishes and added these sparkling bits of femininity to the portrait.
Garrett was just as diligent in directing the commission of the group portrait, visiting Sargent and corresponding with him. He sent sketches for her review and seems to have grown a bit exasperated; he wrote to Welch saying that he felt "like a rabbit in the presence of a boa constrictor" during the visits of Garrett and Thomas. Thanks to, or in spite of, Garrett's advice, the two paintings are critical successes.
Garrett went on to become involved in the suffragist movement and used her fortune to provide business and educational opportunities for women in all walks of life. Particularly interested in helping women to become self-sufficient and financially independent, she was one of the founders of the Woman's Industrial Exchange in Baltimore.
When Garrett, who was troubled with fragile health throughout her life, died of leukemia at the age of 62 in 1915, she left a remarkable legacy of personal philanthropy. The inscription on her tombstone in Green Mount cemetery provides a fitting epitaph to her life. It says:
"A woman of quiet realized enthusiasm she served her day and generation well and will be long remembered by those for whom she laboured."
Nancy McCall is archivist of the Johns Hopkins Medical Institutions. This is part of a series of historical pieces appearing in the year leading up to the 125th anniversary of the founding of Johns Hopkins. Previous biographical sketches can be found at http://www.jhu.edu/~125th.