A History of Sex, Gender, and Medical Expertise in the New England Journal of Medicine
By Ben Maldonado, Jamie Marsella, and Abigail Higgins
This week, members of the GenderSci Lab published a new piece in the New England Journal of Medicine, Malicious Midwives, Fruitful Vines, and Bearded Women — Sex, Gender, and Medical Expertise in the Journal, part of an ongoing series on Recognizing Historical Injustices in Medicine and the Journal.
Image Credit: National Library of Medicine
Authored by the Lab’s historians of medicine and science, Ben Maldonado, Jamie Marsella, Abbie Higgins, and Sarah Richardson, this piece traces how authors in the Journal articulated harmful ideas of innate sex difference. We focus on three themes: the exclusion of women from medical practice due to ideas of innate difference, the immense focus on womens’ reproductive organs as sites and causes of pathology, and the harmful treatment of intersex and sex/gender non-conforming individuals by medical science. The long and troubled history of ideas of sex difference in medicine, we argue, provides critical context for understanding what is at stake in current discussions about the study of sex-related variables in biomedicine.
While our discussion is constrained to the corpus of the New England Journal of Medicine, the Journal stands among the most elite venues for medical research, and by some counts is the longest continuously-publishing medical journal. In other words, it represents a strong index of the history of American medical science. In our contribution, we call for the Journal to not just reflect on its past but also change the future of medicine by incorporating contextualist methods for studying sex, considering the role of gender in medical outcomes, and including more voices of women, trans people, and sex/gender minorities.
Other pieces in this series have touched on the Journal’s history with slavery, its support for theories of medical racism, and its silence on Nazism. An essay following ours will expand on the Journal’s treatment of gender and sexual minorities.
Key Takeaways
For this piece, we surveyed hundreds of articles over the Journal’s two centuries of publication. We prioritized the discussion of articles that were representative of larger trends we discovered and offered vibrant, memorable examples of sex difference claims in the Journal. We found that the New England Journal of Medicine served as a site of immense discussion about innate differences between women and men, demonstrating how such views were entrenched in medical discourse. We focused on three key themes.
First, during the late 19th and early 20th centuries, the Journal featured debates on the role of women in medicine, with many articles denouncing women physicians with arguments that their physiology rendered them incapable of medical education and practice. An 1856 article, for example, argued that women were fundamentally unfit for medical education and practice due to their menstrual cycle: “their physiological condition, during a portion of every month, disqualifies them for such grave responsibilities.”
Second, through its first two centuries of publishing, the Journal approached the health of women as fundamentally tied to their ability to reproduce: a healthy woman was one that served as a fecund “fruitful vine,” and the afflictions of unhealthy women – especially those related to mental health – stemmed from faulty reproductive organs. One 1913 article claimed that, “An intimate relationship between the female genital organs and the nervous system has been recognized from the earliest times.” This relationship, the author argued, was due to “the important influence which the function of menstruation has on the general organism of a woman.”
Finally, the Journal treated intersex people as medical “monstrosities,” denied them necessary rights and dignity, and emphasized the innate and essential nature of sex differences. Physicians writing in the Journal tended to see people outside an understood sex/gender binary to be oddities in need of exploitative study and correction. The Journal published multiple accounts of nonconsensual examinations of people whose sex could not be determined, including two accounts of enslaved persons.
This survey captures how widespread and central ideas of essential sex difference have been to medical science over the past two centuries within the pages of top medical journals, as well as the harmful legacies of these ideas. Yet, while this article highlights several critical trends in the history of sex difference claims in the Journal, it is not comprehensive. Because of word count limitations, we were compelled to limit our scope and survey only a select few themes. Additional topics not addressed by this survey include sex and disease risk, gendered disbelief of symptoms, and trans medicine, for example. We hope this article will serve to provoke reflection by the Journal and its contributors, as a concise, teachable introduction to the medical history of sexism, and as a stepping stone for future discussion and investigation.
Statement of Intellectual Labor
Ben Maldonado, Abigail Higgins, and Jamie Marsella wrote and edited the blog post. Kelsey Ichikawa and Sarah Richardson provided edits.
SUGGESTED CITATION
Maldonado, B., Marsella, J., and Higgins, A. “A History of Sex, Gender, and Medical Expertise in the New England Journal of Medicine.” GenderSci Lab Blog. 2024 June 6. genderscilab.org/blog/sex-gender-and-medical-expertise-in-the-new-england-journal-of-medicine