At the very outset, however, two rival decorums confronted each other. The same centuries of tradition which had, officially, reserved the practice of medicine for men, had assigned to women the exclusive control of the practice of midwifery. It was assumed that midwifery did not require the assistance of medical art,—that the woman in labor traversed a purely physiological crisis, and required only the attendance of kindness, patience, and native sagacity,—all obtainable without scientific knowledge, from her own sex. This being taken for granted, the propriety of limiting such attendance to women appeared so self-evident, that, from the beginning of the world till the eighteenth century A.D., the custom was not seriously questioned. There is an exact parallelism between the relations of men to midwifery and of women to medicine. The limitation of sex in each case was decided by a tradition so immense, as to be mistaken for a divinely implanted instinct, intended by Providence as one of the fundamental safeguards of society and of morals. In each case the invasion by one sex of a “sphere” hitherto monopolized by the other, aroused the coarsest antagonism of offended delicacy. In each case finally, a real basis existed for the traditional etiquette: there _was_ some reason for protesting against the introduction of the male accoucheur into the lying-in room, or of the ardent young girl into the medical school. But in each case, whatever reasons for protest existed, were outnumbered and outweighed by others, to whose greater importance they were finally compelled to give way. Other things being equal, it _was_ unpleasant for a woman to be attended in the crisis of her confinement by a man. But when the necessity for knowledge was recognized, when men became skilled while midwives remained ignorant,—the choice was no longer possible; the greater decorum of female midwifery was obliged to yield to the greater safety of enlightened masculine practice. Similarly, it _was_ occasionally unpleasant for young women students to find themselves engaged in certain subjects of medical study together with classes of young men. But in proportion as midwifery became enlarged by the new province of gynæcology, did occasions multiply on which it was extremely unpleasant for non-medical women to be medically treated by men. The difficulties of educating a relatively few women in medicine were compelled to be accepted, in order to avert the far greater difficulties of medical treatment for a very large number of women. The history of medical women in the United States, to which these pages exclusively apply, may be divided into seven periods, as follows: