Prior to the Eighteenth Century, the answer to the question, “Who was allowed to practice medicine?” was relatively simple: Damn near anybody. While those who attended university were given a theory-based education in natural philosophy, it was left largely to the members of the community to carry out the day to day healing of the sick. A man possessing a doctorate might analyze a case and prescribe a regimen, but it was up to your barber to perform the actual surgery, your local apothecary to actually make the medicines he prescribed, and a whole network of experienced women to provide regular care.
In this world, the wife of a pastor was likely to have more practical experience of useful medical techniques than the most respected and betitled of university physicians, and was honored by the community accordingly as someone who prescribed what worked rather than what ought to work. In the Age of Enlightenment, however, these old roles were rapidly changing. States were centralizing, and countries like Prussia, where the maintenance of the army and robustness of the economy dominated government policy, began taking a serious interest in the haphazard practice of medicine throughout the land.
Sick people weren’t productive people, and so professional standards were necessary – approved university standards that clearly delineated who was allowed to practice medicine and who was not. Those standards ultimately worked to the overwhelming good of society, as they slowly ground out the superstition and quackery that run rampant in any decentralized medical system, but in the short term they had the effect of pushing a number of the nation’s greatest practical medical practitioners out of medicine.
One woman, however, refused to be pushed. Dorothea Leporin (1715-1762) was the daughter of a Quedlinburg doctor who had made his name in sensibly avoiding the extremes of the medical profession’s various fads, prescriptions, and theories. As a child, she was constantly falling ill, one disease leading to the next in an almost seamless progression. Weakened physically, the time in her bed gave her mind free range to roam where it would, inspired by the example of the polymath and proto-feminist Anna Maria van Schurman (1607-1678 ). She showed an early interest in science which her father was only too happy to guide and, as her body grew stronger, the passing interests of the sick bed became a central interest of her life as her father took his talented daughter under his wing and started teaching her the doctor’s trade.
She was educated side by side with the more talented of her brothers (the other siblings were wisely allowed by her parents to go their own ways as individuals Not Suited to Learning). In 1740 that brother, Christian Polycarp, was given leave by his regiment to carry out university studies in Halle, only to have that decision rescinded in the Fall as Frederick II needed all soldiers to report for duty in preparation for his invasion of Silesia. Christian left Halle, but did not rejoin his regiment. Meanwhile, his sister took the unprecedented step of writing to Frederick II directly, asking for permission for her brother to continue his studies and also the king’s leave for herself to attend the university to continue her medical education. Frederick, ever the archetypal Enlightenment monarch, approved both.
This should be the point in the story where brother and sister trot arm in arm to Halle to receive a thoroughly Prussian education, and so it would have had Christian rejoined his regiment when he had been ordered to. By ducking that command, Christian had technically been put down in the books as a deserter, which was a crime most dire in a country of such military character as 18th century Prussia. Sorting through the paperwork and counter-paperwork consumed time and in that time Dorothea Leporin met Johann Christian Erxleben, a local deacon who was entirely in tune with Dorothea’s continuing her medical work and who had children from a previous marriage who needed looking after.
They were married in 1742, and in 1744 Dorothea gave birth to the first of a string of children. The plans to attend university were dropped, but, as Erxleben later reflected, she didn’t feel it as a great loss at the time. To do the sort of medical work she wanted to do, no university degree was required, and the experience and knowledge she had gained at her father’s side were equal to those of any university educated practitioner. What good would an extra piece of paper possibly be to her patients?
All this while, however, she had been sitting on a manuscript which her father had urged her to write, but which she delayed publishing, whether out of modesty or a fresh author’s genuine need to not release their work until everything is polished to impossible perfection – the Grundliche Untersuchung der Ursachen, die das Weibliche Geschlecht vom Studiren abhalten (1742). It was, in the tradition of van Schurman, a call to self-study for women that tore through the traditional arguments against their education and substituted instead an impassioned belief that communities become better places when everybody is allowed to explore the full extent of their mental abilities. More than a possibility, it was a duty for each woman possessing the means to educate herself and so demonstrate the true universality of reason and understanding.
Erxleben’s father died in 1747, and she inherited not only his practice, but his various intellectual feuds as well. In life he had clashed with a Dr. Grasshoff, who came from a long established family and therefore had first claim to any positions within the local medical hierarchy no matter what his worth as an actual doctor. Dr. Leporin had called into question his use of prescriptions and, while Grasshoff couldn’t move against him directly, his backers could descend en masse to attack Leporin’s daughter when she stood alone, without his protection.
They seized their opportunity in February of 1753 when one of her patients died. Losing a patient in the Eighteenth Century was of course not uncommon, but the Grasshoff camp clutched the moment to accuse Erxleben of Quackery and demand of the government that she be stripped of her rights to practice medicine. Without missing a beat, Erxleben remembered that she had in her pocket the King’s permission to attend university. She duly enrolled and somehow managed to complete her dissertation by January of 1754, less than one year after the attack on her reputation, and only eight months after the birth of her last child.
She attended her oral examinations on the 6th of May that same year, a cross-examination carried out entirely in Latin, and in the estimation of her examiners showed accuracy and knowledge such as few had ever demonstrated. Grasshoff’s attack had backfired tremendously. In attempting what he thought would be an easy win against a lone deacon’s wife, he had in fact motivated her to attain a degree equal to his own, with a speed and ease that clearly demonstrated the mean-spirited vacuity of his claims, and had gained with it full protection against any future attacks he and his well-established coterie might concoct.
As much of a triumph and personal vindication the degree was for Dorothea Leporin Erxleben, it was to be the last of its kind. As with Laura Bassi, once one woman showed herself the equal of the system, that system swiftly moved to ensure that others would not be given similar opportunities. In fact, it would be a century and a half before another woman received a medical degree in Germany.
Dorothea’s husband died in 1759, and Dorothea herself followed three years later after a swift illness. She had by her words argued for women’s right and duty to educate themselves, and for a medical practice that utilized the experience of its best practitioners to provide moderate cures for illnesses rather than chasing every costly medical fad. And by her actions, in practicing and in attaining her degree, she had shown the strength that experienced community based medical care was capable of, even as that system was giving way to the steady centralizing professionalism of the modern era. Dorothea Leporin Erxleben was the first of her kind and the last of her kind, and who can say what medicine might have been had the Enlightenment allowed itself to follow its best principles more than just the once.
FURTHER READING: Dorothea Leporin Erxleben’s life is readily available in multiple scholarly biographies and novelizations in the German language, and in particular I like Eva Brinkschulte’s 2006 Dorothea Christiana Erxleben: Weibliche Gelehrsamkeit und medizinische Profession seit dem 18. Jahrhundert as not only a good guide to Erxleben but to the gradual shift in the medical profession generally in the 18th century. I don’t know of any standalone volumes in English, unfortunately, but if you do, lemme know!