The Chester County Quaker community was ardently abolitionist and pro-temperance, and the Preston family farm, Prestonville, was known as safe harbor for escaped slaves as part of the Underground Railroad.

[3] While studying at the Female Medical College In 1851, Preston wrote to her friend and fellow Quaker activist Hannah Darlington: The joy of exploring a new field of knowledge, the rest from accustomed pursuits and cares, the stimulus of competition, the novelty of a new kind of life, are all mine, and all for the time possess a charm.

In 1864, a rift emerged among the faculty when dean Edwin Fussell tried to prevent student Mary Putnam Jacobi from graduating with a medical degree, feeling that she did not meet the required qualifications.

[4] Historian Steve Peitzman called Preston an "Institution builder," guiding the Woman's Medical College through its post- Civil War rebuilding and growth.

"[3] In addition to the hospital she founded before becoming dean, she opened a school of nursing, and continued to push for educational opportunities for the female students of Woman's Medical College, including more and better clinical experience.

Ann Preston's response in part was "...we must protest...against the injustice which places difficulties in our way, not because we are ignorant or incompetent or unmindful in the code of medical or Christian ethics, but because we are women.

[4][3] Anna Broomall, an 1871 graduate of the Woman's Medical College and future faculty member, recalled "the [male] students rushed in pell-mell, stood up in the seats, hooted, called us names and threw spitballs, trying in vain to dislodge us.

Preston never married, but reportedly led a rich and active social and professional life, including establishing a household "where dear friends live with me in harmonious relations, and do much to make this an orderly home circle.