BREAKING THE MOULD - Matt Elsom

Print Email

BREAKING THE MOULD - THE ENTRY OF WOMEN INTO MEDICINE IN THE UK

Matt Elsom

HISTORY OF WOMEN AND THEIR ROLE IN VICTORIAN SOCIETY

Historically, women have faced a great deal of adversity in achieving equality with men. Examples of discrimination against and misrepresentation of women date back thousands of years. One particularly famous example can be found in Genesis. Whilst Adam was made in God's image, Eve, the first woman, is made from Adam, implying a degree of inferiority. Also, it is Eve who is responsible for the corruption of humanity when she is unable to resist temptation, by eating forbidden fruit and later convincing Adam to do the same, and is thus afflicted with the agony of childbirth. Though subtle, this portrayal is indicative of a school of thought that implies the natural order places men as superior to women. This perception of women as being unable to control their emotions is one that has persisted throughout history, across many cultures, and formed part of the basis of the argument against their empowerment. Witch hunting, the arrest and execution of women based on superstition as opposed to evidence or fair trial, provides not only an example of how they were perceived as emotionally inferior compared to men and potentially evil, but is a sickening demonstration of men's power over them.

Women did not even possess the right to vote in the United Kingdom until 1918, despite the advances they had made in the late nineteenth century by integrating themselves into various professional fields. Women's entry into medicine should be considered a significant advance, not only due to the elevated status in society held by doctors at the time, but because of the difficulty these pioneering females faced in accessing the training necessary to practise medicine.

In Victorian Britain, the most imposing barriers to a woman's education and ascension into any profession, let alone medicine, were mainly (but not exclusively) social factors. Put simply, it was not considered a woman's duty to enter the workforce. These social pressures were compounded by the fact that women had no legal rights. The Victorian bourgeoisie mindset was such that it was considered a mark of pride for a man to possess sufficient wealth so that his wife and daughters would never have to work. As a consequence most women with the opportunity and the money for education (those of the emerging middle class) were 'brought up to idleness' [1].

ELIZABETH BLACKWELL: FIRST WOMAN MD

The first woman to be added to the British Medical Register was a British born American MD named Elizabeth Blackwell (1821-1910). Graduating from New York's Geneva school of medicine in 1847, she is considered to be the first female doctor in the modern sense of the word. She was added to the Register in 1858, soon after it was formed.

Her father had been a keen anti-slavery activist and this earned her some favour in 'circles where abolitionist politics and Transcendental values held sway' [2], for example the medical community of Philadelphia. She was very fortunate to know such forward- thinking individuals, and she was able to convince many of the doctors in Philadelphia to provide her tuition. However, she found it difficult to get into a medical school in order to attain the all important qualifications needed to put what she knew into practice.
She was in fact refused access to 17 medical schools [2]. Some wanted absolutely nothing to do with her, refusing even to meet her to discuss the issue, whereas others were simply indifferent and did not want to be involved with the controversial issue of admitting a female student. One dean even admitted that he was afraid of 'feminine competition' [3]. Eventually she was successful. The Geneva School of Medicine decided to let the students vote on whether to accept her or not, conceivably so that the medical faculty could 'be spared the responsibility of making a decision on a request so revolutionary' [3].

Blackwell can hardly be said to have single-handedly overcome the prejudice that prevented women's entry to medicine. However, in order for women to get into the field, someone had to be the first. Perhaps Blackwell was the best choice in light of her dedication and the utmost conviction in her beliefs, exemplified by attaining her M.D in the most difficult of circumstances. She was certainly willing to make sacrifices. The animosity surrounding what she was doing meant it was difficult for her to make friends. Boyd comments that 'isolation was forced on her by social prejudice' because 'no one wanted anything to do with a woman doctor' [4].

Even after graduating, the progress of Blackwell's career was hindered by prejudice. Before attempting to practise in America, Blackwell sought clinical experience in London and Paris. In England, she did so with relative ease, probably due in part to the fact that any protests to her education were largely redundant, considering she had already attained her M.D. However, she had great difficulty finding a single hospital that would accept a woman in Paris and was forced to take a stint at a midwife training institute name La Maternité [5].

Blackwell sacrificed countless hours and even wound up partially blind in the pursuit of the experience and skills to become more than just the first female doctor, but a good one at that. Her hopes of ever becoming a surgeon were dashed when she acquired a gonococcus infection in her eye [2] whilst syringing the eye of a child with purulent opthalmia. The infection was severe and the eye eventually had to be removed.

Returning to America in 1850, Elizabeth wanted to join one of New York's largest dispensaries but after facing what she described as 'a blank wall of social and professional antagonism' [6], she elected to open her own practice. The social stigma of the female physician, in those times believed to be synonymous with abortionist [4], was such that she found it difficult to find a landlord who would allow her to establish a practise. Eventually she focused her efforts on the poorest areas of New York, places where the occupants were grateful for any health care they received [7]. Some years later in 1857, with help from her sister, she was able to open the 'New York infirmary for women and children.' This establishment, again devoted to the treatment of the poor, employed only female medical staff, protégés of Blackwell. By running this clinic, Blackwell and her cohorts were able to dispel many of the myths that supported the scepticism of female physicians such as that female doctors required a police presence to be safe or that they would be unable to control male patients [2].

It seems that Blackwell spent at least as much time teaching and lecturing on the subject of female education as she did in the clinic. It has been said that she was always far more politically minded than she was medically [4], but in terms of acting as a figurehead for a movement, perhaps this was entirely appropriate. Her lectures on both sides of the Atlantic must have served as an inspiration to women of the time. A particularly important attendant was a young woman named Elizabeth Garrett (1836-1917), who would go on to become the first woman to receive medical training in the United Kingdom.

INTRODUCING FEMALE PHYSICIANS TO THE UNITED KINGDOM

While Blackwell's career path cannot be said to have been easy, for British women like Garrett it was harder still. Blackwell herself was added to the newly formed British Medical Register in 1858 only on account of a technicality which allowed the inclusion of anyone who (prior to October of that year) had practised in Britain, yet attained their degree from a foreign country [8]. Thereafter, anyone who wished to legally practise medicine in the UK needed a licence obtained from a qualified examining board [9]. This proved to be a major obstacle to the progression of women wishing to practise medicine. British pioneers like Garrett struggled to find a Board that would allow a woman to take an exam.

Garrett had always been ambitious, having been raised by a relatively forward thinking family [10]. Her father rejected outright the idea of the subjection of women. As with Blackwell and her abolitionist roots, this is likely to have been an important factor in her choosing to embark on such an unconventional career path.

Thanks to her father and with some indirect help from Blackwell, Garrett was introduced to a number of contacts including doctors who were sympathetic to the plight of aspiring female doctors [11]. Dr William Hawes was particularly helpful and was able to arrange for her to spend some time in a clinical environment. She was given what was essentially a nurse's position at Middlesex Hospital but she was able to gain valuable experience, shadowing doctors and observing life on the wards. Though she found the experience useful, she was dissatisfied with her status in the hospital [12] and made several unsuccessful attempts to join the medical school. Despite her eagerness and quiet dedication, she was never formerly accepted as a student and therefore was not eligible to sit exams.

A small victory was achieved in May 1861, when she was allowed to attend some lectures and demonstrations, but this served mainly to harden the resolve of the anti-feminists at the medical school. Though she was awarded a certificate of honour for each course she attended, this had to be kept a secret to ensure she was not forced out of the hospital. This proved to be too great a task and by June, she had been asked to leave, a decision welcomed by the male students.

Garrett had invested far too much in her ambition to be dissuaded so easily. She sought tuition at several other universities, including the University of London and St Andrews University [13], but no one was willing to admit a female student. This shows how little impact Blackwell's M.D. and her inclusion on the British Medical Register in 1858 had had on the medical community at large. This is not to say her actions were meaningless, but it neatly illustrates just how strongly the majority of males in the medical field, even young ones, were opposed to the entry of women into professional spheres, particularly medicine.

Moberly Bell reports that the medical profession was a 'strongly entrenched society' and therefore highly resistant to change [14]. Many doctors were quite fond of the gentlemen's club atmosphere that pervaded medicine at the time. Allowing female doctors to enter would jeopardise this culture, they thought. It is also likely that some genuinely believed that women would make incompetent doctors, or were somehow less able to cope with the gory nature of the operating room (an unfounded concern considering virtually all nurses in the country were female). The only way to prove their competency was by practising. Given that human lives were the potential cost, society was reluctant to give female doctors the chance to prove themselves.

Garrett began to realise that, given the rigidity of British Medical Schools at the time, getting onto the Medical Register by attaining an M.D. was an unrealistic ambition [9]. Fortunately, an alternative existed. The society of apothecaries, which comprised doctors who synthesised and dispensed drugs, was willing to grant a licence to 'any person' who took the required classes and passed its exam. While this did not carry as much weight as an M.D., it would allow her to join the Register and start practising. This goal was realised in 1865 and Elizabeth Garrett became the second woman to be put on the British Medical Register in 1866.

THE CONTINUING STRUGGLE OF WOMEN MEDICAL STUDENTS

Much to the misfortune of those who wanted to follow in her footsteps, Garrett's place on the Medical Register did not break the mould. The apothecaries banned private tuition (a large part of Garrett's education) as a means of getting the qualification [15], thus preventing other women from taking this route into medicine. But the impossible had been achieved and this gave hope to other ambitious women seeking a career in medicine.

A young woman named Sophia Jex-Blake (1840-1912) continued to push at the barrier for female physicians. Alongside four other prospective students, she joined Edinburgh University as an undergraduate in 1869 after several years of petitioning and pleading. The anti-feminists of the medical school were willing to allow this, only because they saw it as an experiment, one that would prove once and for all that women ought not to pursue a profession above their station [16]. They were disappointed when the five women excelled, scoring far above the average for male students in examinations. One, Edith Pechey, had ranked highest in the year for chemistry and was therefore technically entitled to a scholarship. She was, astonishingly, denied this on the grounds of her sex. The public backlash against this controversial decision served only to stimulate those opposed to their entry into the University to take action.

A man named Robert Christison was the women's staunchest opponent. After the scholarship incident, he launched a campaign to have them removed from the university. As well as all the objections he put forward in his role as a manager of the university, he did his part to incite male undergraduates. One particularly dramatic altercation occurred in November 1870 when a large crowd attempted to prevent the women from entering the exam hall [17]. The issue had polarised the community. While one side were disgusted at the behaviour of the male students, the other believed that it was to be expected given the audacious actions of these women.

Getting the necessary education became very difficult for Sophia and her fellow female students. As they had not been allowed to attend the same classes as male students, they had previously sought extra tuition from sympathetic academics. Now the anti-feminist campaign had been established and the debate raged on, fewer and fewer teachers were willing to risk antagonising faculty members like Christison. In 1873, after a long series of legal battles it was ruled that the acceptance of these women in 1869 was not legally binding and therefore the university was not obliged to give them the degrees they needed to practice.

THE LAW IS CHANGED

Despite this setback, the combined efforts of Blackwell, Garrett and the female medical students at Edinburgh had drawn much attention to the issue both within the field and beyond. The majority of the public saw no problem with the idea of female physicians. Many doctors were of the opinion that it was not in the interests of the profession to deny the public something it wanted [8]. In 1877 the General Medical Council put the issue to a vote and decreed that it was no longer acceptable for women to be excluded [8]. Russell Gurney, an MP, succeeded in introducing the Medical Act of 1876 [8], which prohibited the exclusion of women from universities and medical schools.

A NEW BEGINNING

Number of Registered female physicians in the United Kingdom [8]

Year

Number

1871

2

1881

25

1891

100

1901

200

1911

600

1921

1500

1931

3300

1951

7520

1971

12596

1991 [19]

44000

2011 (01/08) [20]

103,759

Sofia Jex-Blake and colleagues were finally awarded their M.D s in the late 1870s. Jex-Blake herself graduated from the University of Berne in 1877, after helping Blackwell and Garrett establish the London School of Medicine for Women in 1874.

The mould was now, if not yet broken, at least sufficiently damaged to make it easier for the women who followed. The number of female doctors steadily increased, as the table opposite illustrates. Female doctors were starting to become established members of the medical community and valuable contributors to society. 1879 saw the establishment of the 'Association of Registered Medical Women' (which would later become the Medical Women's Federation), an organisation which sought to 'speak on behalf of all medical women and represent their interests' [18].

The doors were now open for women with sufficient money, education and motivation. The path was still daunting but medicine had become a genuine possibility for women.

*Matt Elsom is a third year medical student at Kings College London. This essay was written during his second year, as a Special Study Module under the supervision of Professor John Fabre.

Bibliography

1. Moberly Bell, E. The Field Surveyed. In: Storming the Citadel: The rise of the Woman Doctor. London: Constable and Company Ltd. 1953. p12

2. Weissmann, G. "Women will not be what they are now"- Elizabeth Blackwell Breaks the Bonds. The FASEB Journal 2007; 21:1943-1947.

3. Moberly Bell, E. The First Breach - Elizabeth Blackwell. In: Storming the Citadel: The rise of the Woman Doctor. London: Constable and Company Ltd. 1953. p32

4. Boyd, J. The art of Medicine, Florence Nightingale and Elizabeth Blackwell. The Lancet 2009;373:1516-1517

5. Moberly Bell, E. First Breach - Elizabeth Blackwell. In: Storming the Citadel: The rise of the Woman Doctor. London: Constable and Company Ltd. 1953. p36

6. Ibid, Page 39

7. Ibid, Page 41

8. Scott, J. Women and the GMC. British Medical Journal 1984;289:1764-1767

9. http://pagerankstudio.com/Blog/2010/10/elizabeth-garrett-anderson-biography-life-and-career-facts-invented/ Accessed 4/3/2011

10. Moberly Bell, E. Sustained Assault – Elizabeth Garrett. In: Storming the Citadel: The rise of the Woman Doctor. London: Constable and Company Ltd. 1953. p53

11. http://www.spartacus.schoolnet.co.uk/Wcareer.htm. accessed 8/3/2011

12. Moberly Bell, E. Sustained Assault – Elizabeth Garrett. In: Storming the Citadel: The rise of the Woman Doctor. London: Constable and Company Ltd. 1953. p53

13. Ibid, Page 59

14. Ibid, Page 55

15 Moberly Bell, E. The Assault that failed – Sophia Jex-Blake. In: Storming the Citadel: The rise of the Woman Doctor. London: Constable and Company Ltd. 1953. p62

16. Ibid, Page 72

17. Ibid, Page 78

18. Hall, L. A. Eighty years of the Medical Women's Federation. Via http://www.medicalwomensfederation.org.uk/new/about/History.html accessed on 02/04/11

19. Bewely, B. A. Women doctors a review. Journal of the Royal Society of Medicine 1995; 88:399-405

20. http://www.gmc-uk.org/doctors/register/search_stats.asp accessed 17/08/11

Medical Women's Federation
Tavistock House North,
Tavistock Square, London,
WC1H 9HX
admin@medicalwomensfederation.co.uk
Tel: 020 7387 7765

Follow us on Twitter

@BAPIOUK MWF president Dame Prof Parveen Kumar is a featured speaker - free attendance for trainees, clinical fello… https://t.co/LLwiKiBQcz
14hreplyretweet
We look forward to celebrating “Women Leadership – Making A Difference” at the @BAPIOUK National Women’s Conference https://t.co/AdcrOAv0so
14hreplyretweet
Full details of the #MWF grants and prize openings are always updated on our website here: https://t.co/YhLOB8N0oz
16hreplyretweet