Raising the bar: Mary Elizabeth Garrett, M. Carey Thomas, and The Johns Hopkins Medical School

In his definitive history on the early days of the Johns Hopkins Medical School, Alan Chesney wrote of Mary Elizabeth Garrett as follows: “For to this lady, more than any other single person, save only Johns Hopkins himself, does the School of Medicine owe its being” (1). Strong words indeed, and doubly important because of the truth they convey.

Most knowledgeable individuals are vaguely aware of the storyline here. The long-awaited opening of the medical school called for in Mr. Hopkins' will had been delayed because of an economic downturn in the late 1880s, during which the Baltimore and Ohio (B&O) railroad stock, which comprised much of the financial underpinning of the school, had stopped paying dividends. The money to open the school simply wasn't there. This provided the perfect opportunity for Mary Garrett and her determined band of friends—perhaps accomplices is a better term here—to ride to the rescue, while exacting concessions which some trustees, and especially Hopkins President Daniel Coit Gilman, considered to be harsh and unreasonable in the extreme.

Who was Mary Elizabeth Garrett? Who were those able and determined friends who worked with her to accomplish their goals? What else did they accomplish in their lifetimes to set them apart from other women of their times? And, lest we think that this story dwells in the remote past and has no resonance in our modern era, consider that Mary Elizabeth Garrett garnered the third-highest vote in a recent Johns Hopkins poll to name the four “schools” in a proposed reorganization of the medical school curriculum. (Those names, incidentally, are to be Florence Sabin, Helen Taussig, Daniel Nathans, and Vivian Thomas.)

MARY ELIZABETH GARRETT, 1854–1915

Mary Garrett (Figure 1) was born into one of the wealthiest and most influential families in America. Her grandfather, Robert Garrett (1783–1857), immigrated to America from Northern Ireland in 1790. His father died during the long ocean voyage; it was not for nothing that they were called “coffin ships.” He eventually settled in Baltimore and established a commercial “house,” Robert Garrett and Sons. The firm was initially involved with trade and commerce with the Ohio Valley frontier and later became a major player in banking and finance. The firm established correspondence status with commercial houses abroad, most notably George Peabody's firm in London. Peabody later became a major financial benefactor in Baltimore, establishing the Peabody Institute, and perhaps even played a role in convincing Johns Hopkins of the wisdom of philanthropy. Peabody's partner in London, incidentally, was a Boston merchant named Junius Spencer Morgan, the father of James Pierpoint Morgan. So the Garrett family was extremely well connected and amassed a sizeable fortune in the course of the 19th century as Robert Garrett and Sons flourished.

Figure 1.

Mary Elizabeth Garrett, portrait by John Singer Sargent. Reprinted with permission of the Alan Mason Chesney Medical Archives of The Johns Hopkins Medical Institutions.

In the early 19th century, the port of Baltimore was competing with New York and Philadelphia for the upper hand in trade with the Midwest. It quickly became apparent that a railroad would be a great asset in this competition, and Baltimore authorized construction of America's first major railroad, the B&O, to connect the city with the Ohio River valley. The railroad opened in 1830, and Robert Garrett was an enthusiastic financial supporter and stockholder, as was Johns Hopkins. It was Hopkins' investment in B&O railroad stock that was to cause so much trouble for the medical school a half century later.

Robert Garrett's son, John Work Garrett, Mary's father, became the president of the railroad at age 38 and remained in this position for the rest of his life. He played a major role in the development of industrial America in the mid 19th century and became one of the wealthiest and most prominent citizens of Baltimore. The B&O played a vital role in transporting Union troops and vital supplies during the Civil War, for which John Garrett earned plaudits from Abraham Lincoln himself. John Garrett and Johns Hopkins were neighbors as well as business associates, and Hopkins chose Garrett as a trustee of his proposed new university and hospital. John's brother, Henry Garrett, was also a member of the B&O board but devoted most of his efforts and energy to the family firm.

Brief mention should be made of Mary's brothers, Robert Garrett (1847–1896) and T. Harrison Garrett (1849–1888), because of their importance in the Baltimore community and to Johns Hopkins. Robert graduated from Princeton, became associated with the family firm, and married Mary Sloan Frick, the daughter of a prominent Baltimore attorney. After his father's death he was the president of the B&O Railroad for a short period of time. He also was a Johns Hopkins trustee. Following his premature death, his widow established a dispensary for the poor of Baltimore in his name, and she later created the Robert Garrett Fund for the Surgical Treatment of Children. These funds helped support Alfred Blalock and Helen Taussig in their blue-baby research, and the chair of pediatric surgery at Hopkins is the Robert Garrett professorship. Mrs. Garrett later married a Hopkins physician, Henry Barton Jacobs, one of Osler's latchkeyers. At her death, her extensive collection of art, paintings, tapestries, jades, and porcelains was left to the Baltimore Museum of Art and is known as the Mary Frick Jacobs collection.

The other brother, T. Harrison Garrett, also attended Princeton and became involved with the family business. He and his wife, Alice Whitridge, lived in Evergreen House, an elegant mansion on Charles Street originally purchased by his father in 1878 and eventually donated to Johns Hopkins University. He was an enthusiastic collector of coins, books, prints, and manuscripts and had acquired his first Shakespeare folio while a student at Princeton. One of his sons, Robert Garrett (1875–1961), won the first Olympic gold medal in the 1896 Athens Olympic games while still a student at Princeton. T. Harrison was killed in a boating accident near Annapolis at age 39.

Mary, as a female, was not expected to engage in the family business, and she did not. But her father recognized that she possessed a sharp mind and good business sense. He often included her in his business travels, both in the United States and abroad, and through that experience she was exposed to the titans of the business world of the day. She watched her father negotiating with these men day after day and came to realize that the battle usually went to the side that knew exactly what goals it wanted to accomplish and had worked out a plan in advance to accomplish those goals. She employed those lessons with great effect in later years.

THE FRIDAY EVENING GROUP

In the late 1870s, a quintet of Baltimore ladies, then in their late teens and early 20s, began to meet on Friday evenings to revel in their mutual interests in art, painting, literature, and poetry. They called their group the “Friday Evening” (Figure 2). It was a most remarkable group of women who combined wealth and social position with a passion to improve the lot of women in America—and the know-how to do it. It didn't hurt that four of the five had fathers on the board of trustees of Johns Hopkins.

Figure 2.

The Friday Evening Group. In center, Mary Elizabeth Garrett; clockwise from lower left, M. Carey Thomas, Mamie Gwinn, Elizabeth (Bessie) King, and Julia Rogers. Reprinted with permission of Bryn Mawr College.

In addition to Mary Garrett, the other members of the Friday Evening Group were Martha Carey Thomas, Mary Mackall (Mamie) Gwinn, Elizabeth Tabor (Bessie) King, and Julia Rebecca Rogers.

M. Carey Thomas

Martha Carey Thomas (1857–1935) (Figure 3) was the eldest of ten children of Dr. James Carey Thomas, a respected Quaker physician in Baltimore and one of the original Johns Hopkins trustees. He was also a member of the board of trustees of the new women's college in Philadelphia, Bryn Mawr. Carey's uncle, James Whitall, was also a trustee of Bryn Mawr. Carey graduated from Cornell (one of the few colleges that then accepted women) and briefly enrolled in graduate school at Johns Hopkins in 1877 to study Greek. However, despite her father's influential position and his intimate friendship with the Hopkins president, Daniel Coit Gilman, she was not allowed to attend classes or seminars with the male students. Finding this eminently unsatisfactory, she withdrew and pursued her graduate degree in Europe, living with her close friend, Mamie Gwinn, for 4 years, first in Leipzig and then Zurich, where she obtained the first summa cum laude degree ever achieved by a woman in that university.

Figure 3.

M. Carey Thomas, portrait by John Singer Sargent. Reprinted with permission of Bryn Mawr College.

Returning to America in 1883, she was able to parlay her doctorate in literature and her family connections to secure a position at Bryn Mawr College. Although she had set her sights on the presidency of the new college (at age 27), she was appointed the founding dean of the college and later became its president, serving a total of 38 years at Bryn Mawr.

A strong-willed and forceful personality, Carey Thomas became the leading figure in women's education in the early 20th century and was a vocal spokesperson for the advancement of women in America. She was the very embodiment of the feminist movement. When Harvard's president suggested that the curriculum in women's colleges should radically diverge from that in men's colleges, she vehemently and publicly disagreed.

With Mary Garrett's money and Carey Thomas' standing in the academy, the two comprised a formidable pair when they joined battle to open the Johns Hopkins Medical School to women.

Mary Mackall (Mamie) Gwinn

Mamie Gwinn was the daughter of Charles J. M. Gwinn, who was Mr. Johns Hopkins' personal lawyer; it was he who drew up the legal documents establishing The Johns Hopkins University and The Johns Hopkins Hospital. He was a member of the board of trustees of both institutions. Mamie's grandfather was Reverdy Johnson, a distinguished Maryland attorney who had served as a US senator, was at one time the attorney general of the United States, and argued the Dred Scott case before the US Supreme Court. Mamie's uncle, Reverdy Johnson Jr., was a member of the Johns Hopkins board of trustees.

Mamie Gwinn lived with Carey Thomas for 4 years while studying abroad but, unlike Thomas, was not granted a degree there. She later accompanied Thomas to Bryn Mawr where they lived together for another 20 years. She achieved a doctorate in English literature and taught at the school until 1904, when she married an English professor at Bryn Mawr, Alfred Hodder, who divorced his (common-law) wife to marry Mamie. Following this mini-scandal, Carey Thomas never spoke to or corresponded with Mamie again. She was the only one of this group of five to marry.

Elizabeth Tabor (Bessie) King

Bessie King was the daughter of Francis King, the chairman of the board of Johns Hopkins. Mr. King was also chairman of the board of Bryn Mawr College. The King family and the Thomas family were fellow Quakers and were cousins. Bessie King was active in the Maryland campaign for women's suffrage, as was Mary Garrett.

Julia Rebecca Rogers

Julia Rogers was the only Friday Evening member without strong Johns Hopkins connections. She dropped out of the group shortly after the formation of the Bryn Mawr School and played no role in the Hopkins medical school story. She left a sizeable sum of money to Goucher College in Baltimore, where the school library is named for her.

BOSTON MARRIAGE

The members of the Friday Evening Group all resolved never to marry. They felt that married women of that era were in bondage to their husbands, and they valued their freedom more than marriage. The only one to break this vow was Mamie Gwinn, but only after she and Carey Thomas had lived in a “Boston marriage” for some 25 years.

The term “Boston marriage” was coined to describe 19th-century romantic female friendships which also involved living together. Such a living arrangement among women was perfectly acceptable in 19th-century America and was not considered sinful or a mark of sexual aberration. The presence or absence of (homo)sexual activity in the Mamie-Carey relationship is not known and will never be known, but there can be no question of their strong emotional attachment to one another, as shown in their letters and personal correspondence.

When the Carey Thomas/Mamie Gwinn relationship foundered after the latter's marriage, Mary Garrett moved in with Thomas at Byrn Mawr and lived the rest of her life there. She donated thousands of dollars over the years to Bryn Mawr to support Thomas' presidency, and Thomas was the beneficiary of Garrett's fortune at her death in 1915. And, prior to her involvement with Carey Thomas, Mary Garrett and Julia Rogers had engaged in a similar “Boston marriage” relationship.

THE BRYN MAWR SCHOOL

When Mary's father, John Work Garrett, died in September 1884, Mary inherited one third of his estate and instantly became one of the wealthiest women in America. Her newly acquired fortune allowed her to indulge her taste for philanthropy, and the Bryn Mawr School became the first object of that philanthropy.

In 1885, just a few months after John Garrett's death, the Friday Evening Group decided to establish a school for the education of girls in Baltimore. They were perhaps motivated by the lack of such a school in the city during their own youth. Because of Carey Thomas' position at Byrn Mawr, it was decided to name the new school after the Philadelphia college. It was hoped that the Bryn Mawr School would steer many of its students to the college; indeed, the graduation requirements for Bryn Mawr School consisted of passing the entrance examinations to the college.

The Friday Evening Group functioned as the governing body of the new school. They located a vacant three-story building in downtown Baltimore, hired a headmistress and a faculty, and opened the new school in September 1885. Mary Garrett became the president of the committee running the school, and it soon became evident that this was her “baby.” After a few years in the original building, better facilities were needed. Garrett personally selected a New York architect, paid his salary, and eventually paid for the building as well. Garrett and Thomas made frequent trips to New York to review, as well as revise, the plans, and Mary Garrett personally oversaw its construction, as she lived only a few blocks away. She was a hands-on manager in every way. She became involved in the selection of exercise equipment for the gymnasium, and she selected statuary, lithographs of well-known European paintings, and even a copy of the Parthenon frieze to decorate the new building. All of the school's bills were sent to Mary Garrett to be paid. All told, she spent over a half-million dollars on the school. The main building on the school's Roland Park campus is named in her honor, and a “Founder's Arch” memorializes the five founding women.

MARY ELIZABETH GARRETT AND THE JOHNS HOPKINS MEDICAL SCHOOL

In the extensive planning that went into the proposed new medical school over many years, there had never been any consideration of admitting women to the school. After all, there were a few medical schools around the country that were exclusively for women, and, except for the University of Michigan, no reputable school at the time accepted women medical students. But then financial disaster overtook Johns Hopkins. The B&O railroad stock, which had been paying out a handsome dividend of 8% to 10% yearly, first lowered the dividend in the late 1880s and then stopped dividend payments entirely, leaving the university devoid of funds with which to open the new school. The financial crisis offered a unique opportunity for Mary Garrett and her colleagues to advance the cause of women's education while at the same time rescuing Hopkins from its financial dilemma.

Because of their fathers' positions on the Hopkins board, these women knew full well the depth of the crisis; without an infusion of capital, the medical school might never open at all. Armed with this inside information, Mary Garrett and her Friday Evening colleagues organized a campaign that was breathtaking in its organization, scope, and eventual resounding success in achieving its goals.

The campaign began on May 2, 1890, when the Women's Medical Fund Campaign was organized at a meeting in Bessie King's house. Alan Chesney put the matter as follows: “The avowed purpose of the committee was to raise a sum of money sufficient to establish the School of Medicine and to offer it to the Trustees of the University on condition that women be admitted to the school on the same basis as men.” In other words, a bribe!

Ms. Nancy McCall, the current archivist at Johns Hopkins, has beautifully summarized the tactics employed by the Women's Medical Fund Committee to achieve its goals. It resembled nothing so much as a modern-day political campaign. They organized on a national scale, with committees in the major East Coast cities, plus Chicago, St. Louis, Milwaukee, and the Pacific Coast, with prominent women in charge of each local committee. They enlisted the wives of powerful national politicians, including the First Lady, Mrs. Benjamin Harrison, Mrs. John Quincy Adams, and Mrs. Leland Stanford, whose husband was a US senator from California. They attracted nationally prominent women to serve on the national committee, including social divas such as Mrs. John Wanamaker and Mrs. J. P. Morgan; prominent women physicians such as Emily Blackwell and Mary Putnam-Jacobi; plus leading cultural and literary figures and the leading feminists of the day. They took pains to see that the newspapers covered their activities and saw to it that Century Magazine published a series of articles favorable to their cause. Included among the authors of those articles were Cardinal Gibbons of Baltimore and Dr. William Osler himself. And they made good use of their ace-in-the-hole, all those trustee fathers. Mamie Gwinn's father, Charles J. M. Gwinn, served as a liaison between the Women's Medical Fund Committee and the board of trustees and was a strong advocate for the women's cause. He was also responsible for drafting the stipulations of the gift and provided legal assistance for Mary Garrett in her final negotiations with the trustees.

Because of her academic position at Bryn Mawr College and her reputation as a spokesperson for the advancement of women, M. Carey Thomas initially took the lead in negotiating with the Hopkins trustees and President Gilman. There was tremendous ill will involved, perhaps dating back to Thomas' ill-fated attempt to enroll as a graduate student at Hopkins in 1877. She later wrote that “many of the trustees, and Gilman above all, seemed to prefer not to open the school at all if it meant that women were to be admitted.” She claimed that the trustees did not fight openly, but “in the dark, with treachery, and false reasons. They became entangled in hatred, malice, detraction, that beggars description.” The fight also took its toll on longstanding friendships; Bessie King became estranged from the other members of the Friday Evening Group and withdrew from the efforts at Hopkins and the Bryn Mawr School, as had Julia Rogers before her.

By October 1890, a scant 6 months after it was formed, the committee had raised $100,000, almost half of which came from Mary Garrett. This sum was offered to the board of trustees on October 28, 1890, and they formally accepted both the money and the stipulation about admitting women on an equal basis with men. However, the trustees then upped the ante, telling the women that the medical school could not open until the sum of $500,000 had been raised.

The new, higher goal of half a million dollars proved daunting; neither the university nor the Women's Medical Fund Committee was able to approach that figure over the next 2 years. At this point, Mary Elizabeth Garrett stepped into the breech. She offered to personally provide the difference, a sum of about $307,000, to open the medical school, but now the women had upped the ante and came forward with new demands of the school that went far beyond the question of admitting women.

The new stipulations included the following:

• That the school of medicine was to be a full-fledged graduate school with a 4-year course leading to the degree in medicine.

• That all applicants to the new school had to have a baccalaureate degree with courses in chemistry, biology, and physics. In addition, applicants had to have a reading knowledge of French and German, which were then the leading scientific languages.

Garrett also insisted that the university, in a show of its good faith, publish annually in the school catalogue the terms of the agreement. Furthermore, should the university violate the terms of the agreement in the future, the money was to be returned to her, with interest, or else be paid to Bryn Mawr College.

In actual fact, these new stipulations were even more radical than the initial proposal to admit women. The state of medical education at that time in America was dismal. The criteria for admission to medical school were very lax, much less rigorous than for admission to college. A college degree was not an admission requirement to medical school. Numerous “diploma mill” schools existed that offered a year-long lecture course for a fee; the second year consisted of the same lectures, again for a fee. Postgraduate training was usually acquired by serving an apprenticeship with an established physician, with marked variation in the quality of such training. Little attention was paid to the application of the newly emerging sciences to medicine. The academic standards of medical education in America were woeful indeed. The Women's Medical Fund Committee was destined to change all that.

The trustees, in a specially called meeting on Christmas Eve 1892, voted to accept Mary Garrett's proposals. There then ensued 6 weeks of frenzied back-and-forth negotiations and clarifications between Gilman, the board of trustees, the medical faculty, and Mary Garrett. Frequently she communicated by means of handwritten notes, in her own hand, in dealing with these worldly and powerful men.

The medical faculty, especially Osler and Welch, were concerned that the admission standards were being set too high and that few applicants could meet those standards. This is what prompted Osler's famous quip to Welch, “We were fortunate to get in as professors; we would never have made it as students.” For his part, Gilman was concerned that the language used by Garrett in framing her proposals might restrict any future changes that the university might deem necessary. He felt strongly that, ultimately, the university must retain the right to determine the conditions under which students would be admitted, discharged, and graduated, and the right to change them from time to time as the university saw fit.

Welch was sent as an intermediary to negotiate with Mary Garrett, but the lady wouldn't budge. He also met with Dr. James Carey Thomas, Carey's father and a Hopkins trustee, to outline the requirements for admission voted upon by the medical faculty on February 4, 1893; his son, Dr. Henry M. Thomas, was subsequently dispatched to Bryn Mawr to explain them to his sister and to convince her that those requirements satisfied the high admission standards demanded by the women. Finally, this time with apparent legal input, Garrett agreed in writing that the terms of her gift would not interfere with the operation of the university. This settled the matter to everyone's satisfaction, and on Founder's Day, February 22, 1893, it was announced that the long-awaited medical school would open that October.

Chesney stated that “Miss Garrett's contribution consisted in securing the adoption of these requirements through the use of force majeure, or, perhaps more correctly, force monnetaire.” He went on to state that “the adoption of a high standard of admission not only helped to gain a commanding position for the new institution, but also did much to lift the general level of American medicine.” Garrett's actions have been cited as an early example of coercive philanthropy, wherein a donor has used wealth as a weapon to force social change.

These events took place two decades before the Flexner Report of 1910, which excoriated the general status of medical education in America. In that report, Flexner pointed to the new Johns Hopkins school as the model that other schools would do well to emulate. How ironic that the new school's standards had been set by a group of women who were determined that the new school's graduates would be learned and scholarly men and women and not just mere technicians.

In 1904, in appreciation of Mary Elizabeth Garrett's role in opening the medical school, the Hopkins trustees commissioned John Singer Sargent to paint her portrait. (He had previously painted M. Carey Thomas, in 1899.) In return, Garrett commissioned the same artist to portray the founding faculty of Johns Hopkins, the famous “Big Four.” It is indeed fitting and proper that these two paintings hang side by side in the Welch Library at Hopkins.