MEDICINE AS A PROFESSION FOR WOMEN.“The universe shall henceforth speak for youAnd witness, She who did this thing, was bornTo do it; claims her license in her work.And so with more works. Whoso cures the plague,Though twice a woman, shall be called a leech.”“Aurora Leigh.”Itis a very comfortable faith to hold that “whatever is, is best,” not only in the dispensations of Providence, but in the social order of daily life; but it is a faith which is perhaps best preserved by careful avoidance of too much inquiry into facts. The theory, if applied to past as well as to present times, would involve us in some startling contradictions, for there is hardly any act, habit, or custom which has not been held meritorious and commendable in one state of society, and detestable and evil in some other. If we believe that there are eternal principles of right and wrong, wisdom and equity, far above and greater than the “public opinion” of any one age or country, we must acknowledge the absolute obligation of inquiring, whenever matters of importance are at stake, on what grounds the popularopinions rest, and how far they are the result of habit, custom, and prejudice, or the real outgrowth of deep convictions and beliefs inherent in the most sacred recesses of human nature. While the latter command ever our deepest reverence, as the true “vox populi, vox Dei,” nothing can be more superficial, frivolous, and fallacious than the former.In a country where precedent has so much weight as in England, it doubly behoves us to make the distinction, and, while gratefully accepting the safeguard offered against inconsiderate and precipitate change, to beware that old custom is not suffered permanently to hide from our eyes any truth which may be struggling into the light. I suppose that no thinking man will pretend that the world has now reached the zenith of truth and knowledge, and that no further upward progress is possible; on the contrary, we must surely believe that each year will bring with it its new lesson; fresh lights will constantly be dawning above the horizon, and perhaps still oftener discoveries will be re-discovered, truths once acknowledged but gradually obscured or forgotten will emerge again into day, and a constantly recurring duty will lie before every one who believes in life as a responsible time of action, and not as a period of mere vegetative existence, to“prove all things, and hold fast that which is good.”The above considerations arise naturally in connexion with the subject of this paper, which is too often set aside by the general public, who, perhaps, hardly appreciate its scope, and are not yet fully aroused to the importance of the questions involved in the general issue. We are told so often that nature and custom have alike decided against the admission of women to the Medical Profession, and that there is in such admission something repugnant to the right order of things, that when we see growing evidences of a different opinion among a minority perhaps, but a minority which already includes many of our most earnest thinkers of both sexes, and increases daily, it surely becomes a duty for all who do not, in the quaint language of Sharpe, “have their thinking, like their washing, done out,” to test these statements by the above principles, and to see how far their truth is supported by evidence.In the first place, let us take the testimony of Nature in the matter. If we go back to primeval times, and try to imagine the first sickness or the first injury suffered by humanity, does one instinctively feel that it must have been theman’sbusiness to seek means of healing, to try the virtues of various herbs, or to apply such rude remedies as might occur to one unused to the strange spectacle of human suffering? I think that few would maintain that such ministrationwould come most naturally to the man, and be instinctively avoided by the woman; indeed, I fancy that the presumption would be rather in the other direction. And what is such ministration but the germ of the future profession of medicine?Nor, I think, would the inference be different if we appealed to the actual daily experience of domestic life. If a child falls down stairs, and is more or less seriously hurt, is it the father or the mother (where both are without medical training) who is most equal to the emergency, and who applies the needful remedies in the first instance? Or again, in the heart of the country, where no doctor is readily accessible, is it the squire and the parson, or their respective wives, who are usually consulted about the ailments of half the parish? Of course it may be said that such practice is by no means scientific, but merely empirical, and this I readily allow; but that fact in no way affects my argument that women arenaturallyinclined and fitted for medical practice. And if this be so, I do not know who has the right to say that they shall not be allowed to make their work scientific when they desire it, but shall be limited to merely the mechanical details and wearisome routine of nursing, while to men is reserved all intelligent knowledge of disease, and all study of the laws by which health may be preserved or restored.Again, imagine if you can that the world has reached its present standing point, that society exists as now in every respect but this,—that the art of healing has never been conceived as a separate profession, that no persons have been set apart to receive special education for it, and that in fact empirical “domestic medicine,” in the strictest sense, is the only thing of the kind existing. Suppose now that society suddenly awoke to the great want so long unnoticed, that it was recognized by all that a scientific knowledge of the human frame in health and in disease, and a study of the remedies of various kinds which might be employed as curative agents, would greatly lessen human suffering, and that it was therefore resolved at once to set apart some persons who should acquire such knowledge, and devote their lives to using it for the benefit of the rest of the race. In such case, would the natural idea be that members of each sex should be so set apart for the benefit of their own sex respectively,—that men should fit themselves to minister to the maladies of men, and women to those of women,—or that one sex only should undertake the care of the health of all, under all circumstances? For myself, I have no hesitation in saying that the former seems to me thenaturalcourse, and that to civilized society, if unaccustomed to the idea, the proposal that persons of one sex should in every case be consultedabout every disease incident to those of the other, would be very repugnant; nay, that were every other condition of society the same as now, it would probably be held wholly inadmissable. I maintain that not only is there nothing strange or unnatural in the idea that women are the fit physicians for women, and men for men; but on the contrary, that it is only custom and habit which blind society to the extreme strangeness and incongruity of any other notion.I am indeed far from pretending, as some have done, that it is morally wrong for men to be the medical attendants of women, and that grave mischiefs are the frequent and natural results of their being placed in that position. I believe that these statements not only materially injure the cause they profess to serve, but that they are in themselves false. In my own experience as a medical student, I have had far too much reason to acknowledge the honour and delicacy of feeling habitually shown by the gentlemen of the medical profession, not to protest warmly against any such injurious imputation. I am very sure that in the vast majority of cases, the motives and conduct of medical men in this respect are altogether above question, and that every physician who is also a gentleman is thoroughly able, when consulted by a patient in any case whatever, to remember only the human suffering brought before him and thescientific bearing of its details; for as was said not very long ago by a most eminent London surgeon, “Whoever is not able, in the course of practice, to put the idea of sex out of his mind, is not fit for the medical profession at all.” It will, however, occur to most people that the medical man is only one of the parties concerned, and that it is possible that a difficulty which may be of no importance from his scientific standpoint, may yet be very formidable indeed to the far more sensitive and delicately organized feelings of his patient, who has no such armour of proof as his own, and whose very condition of suffering may entail an even exaggerated condition of nervous susceptibility on such points.[1]At any rate, when we hear so many assertions about natural instincts and social propriety, I cannot but assert that their evidence, such as it is, is wholly for, and not against, the cause of women as physicians for their own sex.If we take next the ground of custom, I think the position of those who would oppose the medical education of women is far less tenable than is generally supposed; indeed, that a recent writer stated no more than the truth when he asserted that “the obloquy which attends innovation belongs to the men who exclude women from a profession in which they once had a recognised place.”[2]I believe that few people who have notcarefully considered the question from an historical point of view have any idea of the amount of evidence that may be brought to support this view of the case.[3]Referring to the earliest classical times, we find distinct mention in theIliadof a woman skilled in the science of medicine,[4]and a similar reference occurs also in theOdyssey.[5]Euripides is no less valuable a witness on this point. He describes Queen Phædra[6]as disturbed in mind and out of health, and represents the nurse as thus addressing her: “If thy complaint be anything of the more secret kind, here are women at hand to compose the disease. But if thy distress issuch as may be told to men, tell it, that it may be reported to the physicians;” thus indicating aprevailing public opinion that there were natural and rigid limits to the medical attendance of men and women, and that therefore some women were specially trained to do what the regular physicians must leave undone. It is at least remarkable to find such evidence of general feeling on this matter in a state of society supposed to possess much less delicacy and refinement than our own.We find records of several Grecian women who were renowned for their medical skill, among whom may be instanced Olympias of Thebes, whose medical learning is said to be mentioned by Pliny; and Aspasia, from whose writings on the diseases of women, quotations are preserved in the works of Aëtius, a Mesopotamian physician.[7]On the authority of Hyginus rests the history of Agnodice, the Athenian maiden whose skill and success in medicine was the cause of the legal opening of the medical profession to all the free-born women of the State.[8]In more modern times, when almost all learning was garnered into the religious houses, which were not only the libraries but the hospitals of the day, it seems evident that the care of the sick and wounded fell at least as often to the share of the Nunneries as of the Monasteries, and probably medical skill, such as it was, found place among the sisters quite as often as among the brethren of the various religious Orders.The old ballad of Sir Isumbras gives one illustration out of many of the prevailing state of things, relating how the nuns received the wounded knight, and how“Ilke a day they made salves new,And laid them on his wounds,They gafe hym metis and drynkes lythe,And heled the knyghte wonder swythe.”[9]It may be remembered that Sir Walter Scott,[10]after describing how Rebecca “proceeded, with her own hands, to examine and bind up the wounds,” goes on to remark, “The youngest reader of romances and romantic ballads must recollect how often the females, during the dark ages, as they are called, were initiated into the mysteries of surgery.... The Jews, both male and female, possessed and practised the medical science in all its branches.”In the fourteenth century, when the Medical School of Salerno enjoyed high reputation, we find record of a female physician named Abella, who lived there, and wrote in Latin various works on medicine.[11]Early in the next century an Italian lady, Dorotea Bocchi, was actually Professor of Medicineat the University of Bologna,[12]and among the traditions of the same University is preserved the name of Alessandra Gigliani, who, in even earlier times, was a learned student of anatomy.[13]In the sixteenth century, at Alcarez in Spain, lived Olivia Sabuco de Nantes, who “had a large knowledge of science and medicine,” and whose medical works were printed at Madrid in 1588.[14]It is clear that in Great Britain at an early period women were commonly found among the irregular practitioners of medicine; and it is equally clear that their male competitors greatly desired to deprive them of the right to practise. In 1421 a petition was presented to HenryV., praying that “no woman use the practyse of fisyk under payne of long emprisonment.”[15]Within a few years after the first incorporation of the Colleges of Physicians and Surgeons, an Act[16]was passed for the relief and protection of“Divers honest psones,as well men as women, whom God hathe endued with the knowledge of the nature, kind, and operaçon of certeyne herbes, rotes, and waters, and the using and ministering them to suche as be payned with customable diseases, for neighbourhode and Goddes sake, and of pitie and charytie,” because the “Companie and Fellowship of Surgeons of London, mynding onlie their owne lucres and nothing the profit or ease of the diseased or patient, have sued, vexed, and troubled,” the aforesaid “honest psones,” who were henceforth to be allowed “to practyse, use, and mynistre in and to any outwarde sore, swelling, or disease, any herbes, oyntements, bathes, pultes or emplasters, according to their cooning experience and knowledge ... without sute, vexation, penaltie, or losse of their goods.”[17]This provision clearly referred to general practice other than that of midwifery, which latter branch of the profession was then, as for centuries both before and after, almost exclusively in the hands of women. The very wordmidwife, with its Latin synonym “obstetrix,” is sufficiently significant on this point, for in neither language has it any masculine equivalent, and the clumsy term “Man-midwife” served, when first needed and used, to mark the general sense of what the writer in theAthenæumforcibly calls “masculine intrusion into that which natural instinct assigns to woman as her proper field of labour;” and thissame very suggestive title is the only one which at the present day in legal phraseology distinguishes the male practitioners of this branch of medical art.From the time of Moses onwards this part of the profession has always been mainly in the hands of women, and in many countries of Europe no other usage has ever prevailed. The first regular French medical society, “La confrairie de St Cosme and St Damien,” included within its organization the Company of Midwives,[18]and from that time down to the present it seems in France to have been the custom to give to these women a regular education, terminating in sufficient examinations, an example which England would have done well to follow.In this country, however, midwives appear to have held a most respectable position some centuries ago, and a curious idea of their importance, their duties, and their credit, may be gathered from aMS.volume (without date) now preserved in the British Museum,[19]which was evidentlywritten at a time when hardly any but women were employed in the “mysteries of the profession,” and when it was a comparatively rare thing, that needed to be specially advised in certain cases, for them to “make use of(i.e., call in)a physitien.” The writer remarks that “it is meet that the midwife be a woman well read and well experienced,” and gives a caution that “drunkenness is a sordid sin in any who use it, but is a blemish worthy greater blame in ministers, magistrates, midwives, physitiens, and chirurgeons.”Mrs Celleor, in her letter previously referred to,[20]tells us that in 1642, “the physitiens and chirurgeons contending about it, midwifery was adjudged a chirurgical operation, and midwives were licensed at Chirurgeon’s Hall, but not till they had passed three examinations before six skilful midwives, and as many chirurgeons;” but for some reason (connected probably with their occasional baptismal functions) the midwives were, in 1662, referred for their licence to Doctors’ Commons, thus losing their official connexion with the medical world.How it came that English midwives fell gradually from their high estate is partly explained by a very public-spirited book (with the appropriate motto “Non sibi sed aliis”) written by a surgeonin 1736.[21]The writer adverts to the accusations of ignorance then brought against the midwives, and remarks that “the only method by which this fatal distemper can be cured, is to put it in the power of midwomen to qualify themselves thoroughly and at a moderate expense.... To which method of qualifying themselves I doubt not the midwomen will object, and say that they would readily be at any reasonable expense and fatigue to be so thoroughly instructed, but it is not in their power. The midwomen cannot, and the midmen will not instruct them. The midmen will object and say that the midwomen want both capacity and strength (instruct them as ye please). To which I reply (ore rotundo, plenis buccis) that it is not want of capacity, docility, strength, or activity ... which is evident to a demonstration from the successful practice of women in theHôtel Dieu at Paris (the best school for midwifery now in Europe).... Would not any person then be deservedly laughed at who should assert that our women are not as capable of performing their office had they the same instruction as the French women?” This chivalrous surgeon then proposes that regular provision should be made for proper instruction, and for examinations by twosurgeons (who have lectured to the women), “and six or seven other persons appointed by His Majesty, because I don’t think it reasonable that so many people’s bread should depend on the humour or caprice of two men only;” adding that “If some such scheme was put in execution, I’m satisfied that in a very few years there would not be an ignorant midwife in England, and consequently the great agonies most women suffer at the very sight of a man would be almost entirely prevented,” and great expense and much life saved.However, we must suppose that these noble words of protest fell upon deaf ears, and the midwives, being left in their ignorance, their practice gradually passed into the hands of the medical men, who had every advantage of learning at their command.[22]It is, however, only very recently that men-midwives have been allowed to attend on royal patients in this country; indeed, I believe that the Princess Charlotte was the first to establishthe precedent, and that our present Sovereign was the first queen who followed it. In a very interesting series of papers, by Dr Aveling, recently published in theLancet,[23]accounts have been given of a number of the royal midwives whose names have been honourably preserved in history, such as Alice Dennis, who attended Anne of Denmark, and received a fee of £100 “for her pains and attendance upon the Queen, as of His Highness’s free gift and reward, without account, imprest, or other charge to be set on her for the same.”The same writer mentions that Margaret Mercer was sent express from England in 1603 to attend on “His Majesty’s dearest daughter, the Princess Electress Palatine.”It is also recorded that “Mrs Labany attended Mary of Modena, Queen of JamesII., when she was delivered, on June 10th, 1687, of James Francis Edward, afterwards called the Pretender.”[24]Mrs Wilkins, another midwife, seems also to have been present on this occasion, and it is stated that each of these persons received a fee of five hundred guineas for her services.It is well known that Queen Charlotte was always attended by a woman,[25]and the late Duchess of Kent employed the Frau von Siebold, of whom mention is made elsewhere.[26]Now that public attention is awaking to the subject, and educated women are once more desirous of undertaking this peculiarly womanly work, we may indeed anticipate, with the already quoted writer in theAthenæum, that a reactionary movement will soon make itself felt, and that the usage “which even up to the present time a large proportion of our English families, especially those of our northern towns and outlying country districts, have never adopted, will most likely be discontinued in all classes of English society before the end of the present century.”On the Continent of Europe, owing to their better education, the midwives retain much of the position that they have for a time lost in England; and we hear that in Russia“a medical man is very rarely called in; notwithstanding, fatal cases are of far less frequent occurrence in Russia than in England;” and the same authority tells us that ladies practising midwifery are admitted into society as doctors would be, and are well paid, both by the Government and by private fees.[27]While thus briefly tracing out the history of midwifery in modern times, and the causes which led to its practice passing from the hands of women into those of men, I have not paused to mention, in due chronological order, those women who, in the last three centuries, have been distinguished for a knowledge of the other branches of Medicine and Surgery. Of these I will now enumerate a few, though my time and space are far too limited either to give a complete list, or to relate any but the most prominent particulars of each case mentioned; but I can promise that any one who will consult the authorities quoted will be abundantly repaid by the long and interesting details that I am forced to pass over in almost every instance.In the seventeenth century, in England, one of the women most noted for medical skill was Lady Ann Halket,[28]born in 1622, daughter of the thenprovost of Eton College. “Next to the study of Divinity she seems to have taken most delight in those of Physick and Surgery, in which she was no mean proficient; nay, some of the best physicians in the kingdom did not think themselves slighted when persons of the greatest quality did consult her in their distempers, even when they attended them as their ordinary physicians. Many from England, Holland, and the remotest parts of the kingdom, have sent to her for things of her preparing; and many whose diseases have proved obstinate under all the methods of physicians, have at length, by the physicians’ own advice, been recommended and sent to her care, and have been recovered by her.”In 1644 was born Elizabeth Lawrence, afterwards wife of theRev.Samuel Bury, of Bristol, who wrote her life,[29]and who bears witness that “it was not possible there should be a more observant, tender, indulgent, and compassionate wife than she was; a more sympathising spirit is very rarely found.” He records that “she took much pleasure in Anatomy and Medicine, being led and prompted to it partly by her own ill health, and partly with a desire of being useful.” The difficulties that she encountered in her studies may be guessed, since“she would often regret that so many learned men should be so uncharitable to her sex, and be so loath to assist their feebler faculties when they were anywise disposed to an accurate search into things profitable and curious. Especially as they would all so readily own that souls were not distinguished by sexes. And therefore she thought it would have been an honourable pity in them to have offered something in condescension to their capacities, rather than have propagated a despair of their information to future ages.” Her husband, however, tells us that “she improved so much, that many of the great masters of the Faculty have often been startled by her stating the most nice and difficult cases in such proper terms;” and, remarking that, “How much knowledge and skill soever she attained in the practice of Physick, by long observation, conversation, and experience, yet she was very distrustful of herself,” he adds that the “instances of her successes in the preservation of human lives were not easily numbered.”As a contemporary of these Englishwomen, we find in Germany Elizabeth Keillen, who published several medical works, and died in 1699. She is said by Finauer to have had “great knowledge of medicine and chemistry.”In comparatively recent times, Bologna was remarkable as ever for its liberal encouragementof learned women, and about the middle of the last century the Chair of Anatomy at that University was filled by Anna Morandi Mazzolini, whose exquisitely delicate anatomical models, executed in wax, became the pride of the Museum at Bologna. She first became interested in the study of Anatomy in consequence of her wish to help her husband, who was a distinguished anatomist, and a maker of anatomical designs and models. He fell into ill-health and mental despondency, and therefore“his wife, loving him dearly, and fearing that he would desist from his work, gave herself up to his comfort; and for this purpose became herself an anatomical sculptor, reading works of anatomy, consulting anatomical tables and preparations, taking theoretical and practical lessons from her husband, and, marvellous to say, even dissecting dead bodies with resolute mind, and with incredible perseverance.... Too long to describe are the works executed in wax by the able hands of this illustrious woman. They were collected in five elegant cases in our Anatomical Museum.... The fourth case encloses delicate illustrations of all the parts belonging to the senses of sight, smell, hearing, taste, and touch—stupendous works in which she surpassed herself, and also her husband, and his colleague, Ercole Lelli.... These models were for some time kept in her own house, and each one who saw them spread her renown, so that through distant countries was spread the fame of her works, so that every learned and distinguished person passing through Bologna was solicitous to visit and know personally the maker of these wonders.”[30]Signora Mazzolini also made original discoveries in anatomical science, which obtained for her many marks of distinction from the learned colleges and societies of the day. She was offered a Chair at Milan, with increased revenues, but preferred to remain at Bologna, where she lived till her death in 1774. Medici, in his records of the Anatomical School of Bologna, speaks of this lady with profound respect, as distinguished alike by “rare powers, great erudition, gracious manners, and delicate and gentle temperament,” and relates that her fame reached the ears of the Emperor JosephII., who visited her in 1769, and “having seen her works and heard her conversation,” loaded her with public honours. Her example seems to have inspired others of her countrywomen to follow in the steps of one so honoured, alike in the stern duties of her profession, and in the sanctities of household life; for in the course of the next half century several Italian women availed themselves of the thorough medical education which the Italian Universities never refused.In 1788 Maria Petraccini[31]took a degree in medicine at Florence, and we find her, a little later, lecturing on anatomy at Ferrara, in presence of the medical professors. She married Signor Feretti, and has left several works on the physical education of children.Her daughter, Zaffira Feretti, seems to have inherited her mother’s talents, for she studied Surgery in the University of Bologna, and there received a medical degree[32]in May 1800. She obtained an appointment under the Italian Government, and for some time lived in Ancona acting as Director-General of the midwives in all parts of the country. She afterwards went to Turkey, and died at Patras in 1817.Maria Mastellari seems also to have been a woman of unusual talent, and “progressed diligently in the most rigid sciences.” She obtained a medical degree at Bologna in 1799. She subsequently became the wife of Signor Collizoli-Sega, and is described as possessing a “sweet and gentle temperament, with special love of silence and quiet. She centred her interests in her family, which she managed admirably.”[33]Still more distinguished in the annals of medicine was Maria delle Donne, who also studied in the University of Bologna, and“received the doctoral laurel” in 1806.[34]She “constantly practised both Medicine and Surgery,” and was appointed by Napoleon Bonaparte to the Chair of Midwifery at Bologna. TheGazette Medicale, quoting from the “Raccoglitore Medico,” gives the following account of her:—“Anna Maria delle Donne, docteur en médecine, auteur d’élégants vers latins, professeur d’obstetrique, à l’Université de Bologna, membre de l’Academie, bénédictine,&c., est décedée le 9 Janvier, 1842. Cette femme distinguée qui a succedé à Madame Mazzolini et à Madame Bassi, est une des gloires scientifiques de Bologna. Elle soutint en 1800, avec un très grand succès, une thèse de Philosophie, de Chirurgie, and de Medicine. Peu après, à la suite d’un examen public, on lui conféra le grade de docteur et de consultant. Napoleon en passant à Bologne fut frappé du savoir de cette dame, et institua pour elle une Chaire d’Obstetrique, où elle se fit une grande renommée.”[35]Nor was Italy alone noted as the birthplace of women skilled in Medicine. In Germany, early in this century, Frau von Siebold so greatly distinguished herself in the practice of midwifery that the degree of M.D. was conferred on her by the University of Giessen;[36]and her daughterMarianne, afterwards Frau von Heidenreich, studied in the Universities of both Göttingen and Giessen, and took her degree in the regular way in 1817. She is spoken of as “one of the most famed and eminent female scholars of Germany,” and as being “universally honoured as one of the first living authorities in her special branch of science.”[37]She died only in 1859.In France, the name of Madame Lachapelle[38]was known and honoured as that of one of the ablest teachers of Midwifery during the latter part of the last century. She has left several valuable works on subjects connected with her specialty. Her funeral in 1821 was followed by all the chief physicians of Paris. Her pupil and successor, Madame Boivin,[39]was still more distinguished for her medical knowledge and skill, and for her contributions to anatomical science. Her “Memoire de l’art des Accouchements” was approved by the highest medical authority, and was appointed as the text-book for students and midwives by the Minister of the Interior. She was invested with an Order of Merit by the King of Prussia in 1814, and in the same year was appointed co-director (with the Marquis de Belloy) of the General Hospital for Seine and Oise, andin 1815 was entrusted with the direction of a temporary Military Hospital, for her services in which latter capacity she received a public vote of thanks. She was also entrusted with the direction of theHospice de la Maternité, and of theMaison Royale de Santé, and was one of the most distinguished practitioners of the time. She made original discoveries in Anatomy, invented various surgical instruments, and obtained prizes for medical theses from the Société de Medicine.Her medical writings were distinguished by “precision et clarté, jugement sain, erudition choisie, et savoir solide.” In 1846 one of her books was eulogized by Jourdan as “ouvrage éminemment pratique, et le meilleur que nous possedions encore sur ce sujet,” with the additional remark that “tout se réunit pour lui mériter une des premières places parmi les productions de la littérature medicale moderne.” She was a member of the Medical Societies of Paris, Bordeaux, Berlin, Brussels, and Bruges, and was honoured with the degree of M.D. from the University of Marbourg. She died in 1841.These numerous instances of the successful practice of Medicine by women seem to have been little known, or else forgotten, to judge by the surprise expressed when, after surmounting many difficulties, an English lady, named ElizabethBlackwell, succeeded in obtaining medical education and the degree of M.D. from a medical school in America in 1849. The novelty, in truth, was not in the granting of the medical degree to a woman, but in its being received by an Englishwoman, for it is hardly gratifying to one’s national pride to find that England never has accorded such encouragement to female learning as was found in Italy, Germany, and France; and it is still more painful to realize that this country, almost alone, stands still aloof from the movement of liberal wisdom that has now in all these lands, as well as in Switzerland, and even in Russia, granted to woman the advantage of University education and degrees. English women are not behind others in desiring knowledge, but as yet they are forced to seek it on foreign shores, for hitherto no British University has ever fully admitted women to its educational advantages; and a few years ago, that of London, with all its professions of liberality, refused a woman’s petition even for examination for the degree of M.D.!So much for the historical evidence bearing on this question. I am indeed sorry to have paused so long on this part of the subject, but it seemed essential to a proper statement of the whole case.If, then, nature does not instinctively forbid the practice of the healing art by women, and if it cannot be denied that some at least of itsbranches have long been in their hands, we must go further to seek on what grounds their admission to the medical profession should be opposed.Probably the next argument will be that women do not require, and are not fitted to receive, the scientific education needful for a first-rate Physician, and that “for their own sakes” it is not desirable that they should pursue some of the studies indispensably necessary. To this the answer must be, that the wisest thinkers teach us to believe that each human being must be “a law unto himself,” and must decide what is and what is not suitable for his needs, what will and what will not contribute to his own development, and fit him best to fulfil the life-work most congenial to his tastes. If women claim that they do need and can appreciate instruction in any or all sciences, I do not know who has the right to deny the assertion.That this controversy is no new one may be proved by reference to a very curious black-letter volume now in the British Museum,[40]wherein the writer protests,“I mervayle gretely of the opynyon of some men that say they wolde not in no wyse that theyr doughters or wyves or kynneswomen sholde lerne scyences, and that it sholde apayre their cödycyons. This thing is not to say ne to sustayne. That the woman apayreth by connynge it is not well to beleve. As the proverbe sayeth, ‘that nature gyveth maye not be taken away.’”If it be argued that the study of Natural Science may injure a woman’s character, I would answer, in the words of one of the purest-minded women I know, that “if a woman’s womanliness is not deep enough in her nature to bear the brunt of any needful education, it is not worth guarding.” It is, I think, inconceivable that any one who considers the study of natural science to be but another word for earnest and reverent inquiry into the works of God, and who believes that, in David’s words, these are to be “sought out of all them that have pleasure therein,” can imagine that any such study can be otherwise than elevating and helpful to the moral, as well to the mental nature of every student who pursues it in a right spirit. In the words of Scripture, “To the pure, all things are pure,” and in the phrase of chivalry, “Honi soit qui mal y pense.”It has always struck me as a curious inconsistency, that while almost everybody applauds and respects Miss Nightingale and her followers for their brave disregard of conventionalities on behalf of suffering humanity, and while hardly any one would pretend that there was any want of femininedelicacy in their going among the foulest sights and most painful scenes, to succour, not their own sex, but the other, many people yet profess to be shocked when other women desire to fit themselves to take the medical care of those of their sisters who would gladly welcome their aid. Where is the real difference? If a woman is to be applauded for facing the horrors of an army hospital when she believes that she can there do good work, why is she to be condemned as indelicate when she professes her willingness to go through an ordeal, certainly no greater, to obtain the education necessary for a medical practitioner? Surely work is in no way degraded by being made scientific; it cannot be commendable to obey instructions as a nurse when it would be unseemly to learn the reasons for them as a student, or to give them as a doctor; more especially as the nurse’s duties may lead her, as they did in the Crimea, to attend on men with injuries and diseases of all kinds, whereas the woman who practises as a physician would confine her practice to women only. It is indeed hard to see any reason of delicacy, at least, which can be adduced in favour of women as nurses, and against them as physicians.Their natural capacity for the one sphere or the other is, of course, a wholly different matter, and is, indeed, a thing not to be argued about,but to be tested.[41]If women fail to pass the required examinations for the ordinary medical degree, or if, after their entrance into practice, they fail to succeed in it, the whole question is naturally and finally disposed of. But that is not the point now at issue.That the most thorough and scientific medical education need do no injury to any woman might safely be prophesied, even if the experiment had never been tried; but we have, moreover, the absolute confirmation of experience on the point, as I, for one, will gladly testify from personal acquaintance in America with many women who have made Medicine their profession; having had myself the advantage of studying under one who was characterized, by a medical gentleman known throughout the professional world, as “one of the best physicians in Boston,” and who, certainly, was more remarkable for thorough refinement of mind than most women I know,—Dr Lucy Sewall.Of course there may always be unfortunate exceptions, or rather there will always be those of both sexes who, whatever their profession may be, will be sure to disgrace it; but it is not of them that I speak, nor is it by such individual cases that the supporters of any great movement should be judged.The next argument usually advanced againstthe practice of medicine by women is that there is no demand for it; that women, as a rule, have little confidence in their own sex, and had rather be attended by a man. That everybody had rather be attended by a competent physician is no doubt true; that women have hitherto had little experience of competent physicians of their own sex is equally true; nor can it be denied that the education bestowed on most women is not one likely to inspire much confidence. It is probably a fact, that until lately there has been “no demand” for women doctors, because it does not occur to most people to demand what does not exist; but that very many women have wished that they could be medically attended by those of their own sex I am very sure, and I know of more than one case where ladies have habitually gone through one confinement after another without proper attendance, because the idea of employing a man was so extremely repugnant to them. I have indeed repeatedly found that even doctors, not altogether favourable to the present movement, allow that they consider men rather out of place in midwifery practice;[42]and an eminentAmerican practitioner once remarked to me that he never entered a lady’s room to attend her in confinement without wishing to apologize for what he felt to be an intrusion, though a necessary and beneficent intrusion, in one of his sex.I suppose that the real test of “demand” is not in the opinions expressed by those women who have never even seen a thoroughly educated female physician, but in the practice which flows in to any such physician when her qualifications are clearly satisfactory. In England there are at present but two women legally qualified to practise Medicine, and I understand that already their time is much more fully occupied, and their receipts much greater, than is usually the case with medical men who have been practising for so short a period. Dr Garrett Anderson’s Dispensary for poor women is also largely attended, and during the five years which have elapsed since it was opened, more than 40,000 visits have been made to it; 9000 new patients havebeen admitted, and 250 midwifery cases have been attended by the midwives attached to the charity, Dr Garrett Anderson being called in when necessary.When we turn to America, we find that a considerable number of women have very extensive practice and large professional incomes (more, indeed, than in some cases seems warranted by their medical qualifications). The Report of a little hospital, managed entirely by women, in Boston, U.S., relates that during 1867 the number of in-patients was 198; of persons visited at their homes, 281; and of those able to attend at the dispensary, 4,576; all these patients being women and children only. In fact, the attendance at the Dispensary became so excessive in proportion to the resources of the charity, that in 1868 a rule was passed by the Committee requiring each patient to pay twenty-five cents (or about ninepence) for medicines, at each visit, except when she brought “a certificate of her poverty, properly authenticated.” This regulation brought out still more strongly the distinctchoiceof poor women in this matter, for, though the General City Dispensary gave medicines gratuitously, the number of those who attended at the Woman’s Hospital was much less diminished than was expected, being still 3,236 in 1868. In New York also, where the Dispensary managed by women doctors is but one of many,the crowd of patients is very great, the numbers being, in 1867, no less than 6354, while 545 persons were attended at their homes either in confinement or during severe illness. Of course it will be understood that each patient thus entered on the books implies not one visit, but many, paid to the Dispensary, or often repeated attendance at the patient’s home.Of the Boston Hospital for Women and Children I can speak from lengthened experience in it as a student. When standing in its dispensary I have over and over again heard rough women of a very poor class say, when questioned why they had not had earlier treatment for certain diseases, “Oh, Icould notgo to a man with such a trouble, and I did not know till just now that ladies did this work;” and from others have repeatedly heard different expressions of the feeling that, “It’s so nice, isn’t it, to be able at last to ask ladies about such things?”As I am alluding to my own experience in this matter, I may perhaps be allowed to say how often in the same place I have been struck with thecontingentadvantages attendant on the medical care by women of women. How often I have seen cases connected with stories of shame or sorrow to which a woman’s hand could far most fittingly minister, and where sisterly help and counsel could give far more appropriate succour than couldbe expected from the average young medical man, however good his intentions. Perhaps we shall find the solution of some of our saddest social problems when educated and pure-minded women are brought more constantly in contact with their sinning and suffering sisters, in other relations as well as those of missionary effort.So far from there being no demand for women as physicians, I believe that there is at this moment a large amount of work actually awaiting them; that a large amount of suffering exists among women which never comes under the notice of medical men at all, and which will remain unmitigated till women are ready in sufficient numbers to attend medically to those of their own sex who need them, and this in all parts of the world. From India we hear urgent demands for “educating native women of good caste, so as to qualify them to treat female patients and children.”[43]We are informed that“this is a work which can only be carried on by women, as the native women in many cases will rather die than be seen by a man in times of sickness,”[44]and arrangements have already been made for a systematic “Female Medical Mission,” though perhaps the standard of medical knowledge required can, under existing circumstances, hardly be fixed as high as is desirable. To show, however, the eagerness with which the native women avail themselves of the aid thus offered, I may mention that when a lady (who had had some medical training, but possessed no degree,) was sent out by the Society[45]in December 1870, she, during the first three months of her stay, had occasion to pay no less than 313 professional visits to zenanas, and to treat 158 patients at her dispensary, which was arranged with a view to affording them the utmost privacy. Subsequently her visits to zenanas averaged as many as seventeen a day, while nearly twice as many patients came to her dispensary. Efforts are also being made to train native Hindoo women for some branches, at least, of the medical profession. Dr Corbyn of Bareilly, in 1870, wrote as follows:—“I am educating a number of native girls, and three have already passed as native doctors. They are of all castes,—Christians, Mahommedans, and Hindoos. My school is divided into three classes. The first-class pupils can read and write English and Urdee with accuracy. They are taught medicine, surgery, midwifery, diseases of women and children (especially the latter two). The second-class learn anatomy, materia medica, and physiology, in English and Urdee. The pupils of the other (preparatory) class are taught English and Urdee. We have a female ward attached to the dispensary for women and children, and these girls entirely attend to them, under my and the sub-assistants’ supervision. It is wonderful how they can manipulate; they have plenty of nerve.”[46]Even more recently we learn that “the Mahommedan Nawab of Rampoor has presented to the Bareilly mission a large building for the purpose of a medical school for women. Several women are now going through a scientific course of instruction.”[47]About eight or ten years ago,“several of the wild tribes of Russian Asia petitioned the Government to send them out properly qualified women to act as midwives. Their petition was granted, the Government undertaking all the expense of the education and maintenance of a certain number of women for this purpose. After a time one of these tribes, the Kirgesen, petitioned further, that the women thus sent to them should also be taught some branches of the art of Medicine. One of the women, then being trained as a midwife, hearing of this petition, wrote to the Kirgesen, proposing that she should study Medicine thoroughly, and go out to them as a qualified doctor. She suggested at the same time that they should try to get permission for her to enter the Academy of St Petersburg as a regular medical student. The Kirgesen welcomed the proposal, and, through an influential Russian general, obtained an official document, empowering their future doctor to attend the Academy as a student. They have regularly sent money for her education and maintenance, and from the first have taken the greatest interest in her progress and welfare, requiring, among other things, periodical bulletins of her health. Hearing last summer that she was not well, they sent money for her to go abroad for her holiday, and asked for an extra bulletin.”[48]I cite the above facts to show that the demand for female physicians is no artificial or imaginary one, and that it does not spring out of any fanciful whim of an over-refined social state; but lest it should be supposed on the other hand to be confined to half-barbarous nations, I may quote the opinions expressed on this subject two years ago in one of the most thoughtful of our English journals:“We heartily admit that the only way to discriminate clearly what practical careers women are, and are not, fitted for, is to let them try. In many cases, as in the medical profession, we do not feel any doubt that they will find a special kind of work for which they are specially fitted, which has never been adequately done by men at all, and which never would be done but by women.... We have heard the opinion of one of the most eminent of our living physicians, that one of the new lady physicians is doing, in the most admirable manner, a work which medical men would never even have had the chance of doing.”[49]I am told by Catholic friends that a great many cases of special disease remain untreated in convents, because the nuns, with their extreme notions of feminine seclusion, think that it would be little short of profanation to submit to some kinds of medical treatment from a man.[50]Indeed, it is expressly laid down by a great Catholic authority, St Alphonsus,[51]that though monks and nuns are required to place themselves in the doctor’s care when commanded to do so by their superiors, a special exception is to be made in the case of nuns suffering from certain maladies, who can only be required to accept treatment from a skilled woman, if any such be available; as, under existing circumstances, is so rarely the case. I do not ask any reader to applaud or even justify these poor nuns, if they, esteeming themselves “the martyrs of holy purity,” sacrifice life to such scruples; but I do most emphatically ask, in thename of humanity, whether the state of things can be defended which may drive women, from the highest and most holy motives, to submit to the extremity of physical suffering and even death itself, because it is impossible for them to obtain the medical services of their own sex, and because they believe they can best fulfil the spirit of their vows by accepting no other?I am informed by a friend that Archbishop Manning, when expressing to her his strong interest in the question of the medical education of women, alluded to facts like those referred to above, as affording one of the strongest motives for such interest in the minds of Catholics. Nor, surely, need sympathy in such a case be limited within the bounds of any religious denomination.To pass to the consideration of other cases of a less exceptional kind, there can, I think, be little doubt that an enormous amount of preventible suffering arises from the unwillingness of very many girls on the verge of womanhood to consult a medical man on various points which are yet of vital importance, and to appeal to him in cases of apparently slight illness, which yet issue but too often in ultimately confirmed ill-health. I firmly believe that if a dozen competent women entered upon medical practice at this moment in different parts of England, they might, without withdrawing a single patient from her present medical attendant,find full and remunerative employment in attending simply to those cases which, in the present state of things, go without any adequate treatment whatever; for I believe that many suffering women would be willing to consult one of their own sex, if thoroughly qualified, when they refuse, except at some crisis of acute suffering, to call in a medical man.[52]Probably Queen Isabella of Castile[53]was neither the first nor the last woman whose life was sacrificed to her modesty. Even if such extreme instances are rare, I think it cannot be denied that very much needless pain, “and pain of a kind that ought not to be inflicted,” is caused, especially to young girls, by the necessity of consulting men on all occasions, and I believe that those who know most of the facts insist most strongly on this point.I do not know how far the Medical Profession would acknowledge the truth of the above statement; it is probable that they are really less competent to judge about it than women are themselves, for, as an eminent divine remarked that it was considered a point of politeness not to express theological doubts before a clergyman, it may probably be thought still more obligatory not to question the adequacy of the existing medical profession before one of its members. One can hardly imagine a lady sending for a doctor to tell him why she willnotconsult him; it is sufficient to know that many cases of disease among women go without treatment; it is surely open to any one at least to suggest the above as one of the possible reasons.And indeed, if no such special suffering were often involved in the idea of consulting a man on all points, it seems self-evident that a woman’s most natural adviser would be one of her own sex, who must surely be most able to understand and sympathise with her in times of sickness as well as of health, and who can often far more fully appreciate her state, both of mind and body, than any medical man would be likely to do.[54]Nor can I leave the subject without expressing a hope that, when women are once practising medicine in large numbers, great gain may accrue to medical science from the observations and discoveries which their sex will give them double facilities of making among other women. One of the most eminent of the so-called “ladies’ doctors” of the day writes:—“The principal reason why the knowledge of diseases of women has so little advanced, is the hitherto undisturbed belief that one sex only is qualified by education and powers of mind to investigate and to cure what the other sex alone has to suffer.” After alluding to women physicians of both ancient and modern times, Dr Tilt further remarks, that, “if well educated, they may greatly improve our knowledge of the diseases of women.”[55]Moreover, there is reason to hope that women doctors may do even more for the health of their own sex in the way of prevention than of cure, and surely this is the very noblest province of the true physician. Already it is being proved with what eagerness women will attend lectures on physiology and hygiene when delivered to them by a woman, though perhaps not one in ten would go to the same course of lectures if given by a medical man. I look forward to the day when a competent knowledge of these subjects shall be as general among women as it now is rare; and when that day arrives, I trust that the“poor health” which is now so sadly common in our sex, and which so frequently comes from sheer ignorance of sanitary laws, will become rather the exception than, as now too often, the rule. I hope that then we shall find far fewer instances of life-long illness entailed on herself by a girl’s thoughtless ignorance; I believe we shall see a generation of women far fitter in mind and body to take their share in the work of the world, and that the Registrar will have to record a much lower rate of infantile mortality when mothers themselves have learned to know something at least of the elementary laws of health. It has been well said that the noblest end of education is to make the educator no longer necessary; and I, at least, shall think it the highest proof of success if women doctors can in time succeed in so raising the standard of health among their sister women, that but half the present percentage of medical practitioners are required in comparison to the female population.Of course I do not expect that every reader will look at this question from my point of view, or will be able to arrive at the same conclusions respecting it. But I think that many who have never before seen the matter in the light in which I have tried to place it, will be ready to admit that there are at any rateprimâ faciegrounds for my argument, and that allowing even for considerable over-statement on my part, there may still remain subject for serious consideration.Even if I am wholly mistaken, and if all that needs doingcanin England be effectually done by men, we have still, I think, no reason for the exclusion of women from the medical profession;—there is still no ground on which it can be right to refuse to every patient the power of election between a physician of her own sex and of the other, when women as well as men are desirous of qualifying themselves for this work, seeing that it will after all be always a matter of choice; for we cannot suppose that the time will ever come when women will be arbitrarily prevented from employing men, as they now are arbitrarily prevented from employing women, as their medical attendants.The assertion that womenareat present “arbitrarily prevented from employing women as their medical attendants” may sound startling, but it is at this moment practically true in England, in the most literal sense. Since medical practice has, for the protection of the public, been made a matter of legislation, it has been absolutely illegal for any physician or surgeon to practise as such in this country, unless registered by the appointed Medical Board, and that Board is not obliged to register any one who has not a British medical degree. It is evident, then, that to deny all British medical degrees towomen,—not only to refuse them instruction, but to refuse to examine them if they have acquired knowledge elsewhere,—ismost arbitrarily to prohibit all women, whatever their qualification, from practising medicine in the United Kingdom, except under legal pains and penalties.Of course no such arbitrary action was even contemplated when the Act of 1858 was passed; and I think that when once the great practical injustice of the present state of things is fully understood by the public, a change is inevitable,—either British medical degrees will be thrown open to women, as is most desirable, or the legal conditions of practice will be modified to meet the case of those to whom such degrees are denied. It is perhaps hardly to be expected, though very much to be desired, that medical men as a body should themselves take the initiative in this matter, and throw open the doors to all women who desire worthily to join their fellowship, for it proverbially “needsverygood men to give up their own monopoly;” but the action of the general public in the matter can hardly be doubtful except as a question of time;—no English court could be expected to condemn to legal penalties a succession of highly-educated ladies who may have seized, often with great effort, every opportunity open to them to fitthemselves thoroughly for a work which they believe to be especially their own.The recent action taken in the matter by the authorities at Apothecaries’ Hall is exactly of the kind to outrage an Englishman’s sense of fairness, and therefore is sure before long to bring its own redress. As the facts may not be thoroughly understood in the non-medical world, I will briefly recapitulate them. When Miss Garrett first began to study medicine in 1860, she tried to obtain admittance to one School and University after another, and finally found that Apothecaries’ Hall was the only body which, from its charter, had no power to refuse to examine any candidate complying with its conditions. She accordingly went through the required five years’ apprenticeship, and obtained her diploma in 1865, having gone to very great additional expense in obtaining privately the required lectures by recognised Professors,—sometimes paying fifty guineas for a course when the usual fee, in the classes from which she was debarred, was but three or four. Not content, however, with indirectly imposing this enormous pecuniary tax on women, the authorities now bethought them to pass a rule forbidding students to receive any part of their medical education privately,—this course being publicly advised by one of the leading medical journals as a safe way of evading the obligations of the charter,and yet effectually shutting out the one chance left to the women![56]Of course the efficacy of this measure ceases the moment that any regular medical school fairly opens its doors to women; but till that day comes, it presents a formidable, if not insuperable, difficulty. Commenting on this proceeding, theDaily Newsremarks:—“We recommend these facts to the good people who think that coercion, restriction, and the tyranny of combination, are peculiar to any one class of society. It will be a great day in England when the right of every individual to make the most of the ability which God has given him, free from interested interference, is recognised, and to that goal we are surely advancing; but our progress is slow, and it is very clear that it is not only in the lower ranks of the community that the obstructive trades-union spirit is energetically operating.”While such is the state of affairs in England, other European nations have taken a very different position. We have already seen that the Italian Universities were, in fact, never closed to women, and that at Bologna no less than three women held Professors’ chairs in the Medical Faculty.[57]We have several instances of degrees granted to women in the Middle Ages by the Universities of Bologna, Padua, Milan, Pavia, and others; the earliest instance that I have found being that of Betisia Gozzadini,[58]who was made Doctor of Laws by the University of Bologna in 1209. In Germany also several such instances have occurred. At Paris no less than seven degrees in Arts and Sciences have been granted to women by the University of France within the last ten years, and a number of women are now studying in the Medical School there. In answer to my enquiries in 1868, the Secretary to the Minister of Public Instruction made the following communication:—“Paris, le 18 Août 1868,“Ministère de l’Instruction Publique.“Mademoiselle,—En réponse à la lettre que vous me faites l’honneur de m’adresser, en vous recommendant du nom de Lord Lyons, qui a écrit pour vous àMons.le Ministre, je m’empresse de vous faire savoir que le Ministre est disposé à vous autoriser, aussi que les autres dames Anglaises qui se destineraient à la médecine, à faire vos études à la Faculté de Paris, et a y subir des examens.“Il est bien entendu que vous devez être munie, par voie d’équivalence on autrement, des diplômes exigés pour l’inscription à la faculté de médecine.“Agreez, Mademoiselle l’assurance de mon respect,(Signed)“Danton.”
MEDICINE AS A PROFESSION FOR WOMEN.
“The universe shall henceforth speak for youAnd witness, She who did this thing, was bornTo do it; claims her license in her work.And so with more works. Whoso cures the plague,Though twice a woman, shall be called a leech.”“Aurora Leigh.”
“The universe shall henceforth speak for youAnd witness, She who did this thing, was bornTo do it; claims her license in her work.And so with more works. Whoso cures the plague,Though twice a woman, shall be called a leech.”“Aurora Leigh.”
“The universe shall henceforth speak for youAnd witness, She who did this thing, was bornTo do it; claims her license in her work.And so with more works. Whoso cures the plague,Though twice a woman, shall be called a leech.”“Aurora Leigh.”
“The universe shall henceforth speak for you
And witness, She who did this thing, was born
To do it; claims her license in her work.
And so with more works. Whoso cures the plague,
Though twice a woman, shall be called a leech.”
“Aurora Leigh.”
Itis a very comfortable faith to hold that “whatever is, is best,” not only in the dispensations of Providence, but in the social order of daily life; but it is a faith which is perhaps best preserved by careful avoidance of too much inquiry into facts. The theory, if applied to past as well as to present times, would involve us in some startling contradictions, for there is hardly any act, habit, or custom which has not been held meritorious and commendable in one state of society, and detestable and evil in some other. If we believe that there are eternal principles of right and wrong, wisdom and equity, far above and greater than the “public opinion” of any one age or country, we must acknowledge the absolute obligation of inquiring, whenever matters of importance are at stake, on what grounds the popularopinions rest, and how far they are the result of habit, custom, and prejudice, or the real outgrowth of deep convictions and beliefs inherent in the most sacred recesses of human nature. While the latter command ever our deepest reverence, as the true “vox populi, vox Dei,” nothing can be more superficial, frivolous, and fallacious than the former.
In a country where precedent has so much weight as in England, it doubly behoves us to make the distinction, and, while gratefully accepting the safeguard offered against inconsiderate and precipitate change, to beware that old custom is not suffered permanently to hide from our eyes any truth which may be struggling into the light. I suppose that no thinking man will pretend that the world has now reached the zenith of truth and knowledge, and that no further upward progress is possible; on the contrary, we must surely believe that each year will bring with it its new lesson; fresh lights will constantly be dawning above the horizon, and perhaps still oftener discoveries will be re-discovered, truths once acknowledged but gradually obscured or forgotten will emerge again into day, and a constantly recurring duty will lie before every one who believes in life as a responsible time of action, and not as a period of mere vegetative existence, to“prove all things, and hold fast that which is good.”
The above considerations arise naturally in connexion with the subject of this paper, which is too often set aside by the general public, who, perhaps, hardly appreciate its scope, and are not yet fully aroused to the importance of the questions involved in the general issue. We are told so often that nature and custom have alike decided against the admission of women to the Medical Profession, and that there is in such admission something repugnant to the right order of things, that when we see growing evidences of a different opinion among a minority perhaps, but a minority which already includes many of our most earnest thinkers of both sexes, and increases daily, it surely becomes a duty for all who do not, in the quaint language of Sharpe, “have their thinking, like their washing, done out,” to test these statements by the above principles, and to see how far their truth is supported by evidence.
In the first place, let us take the testimony of Nature in the matter. If we go back to primeval times, and try to imagine the first sickness or the first injury suffered by humanity, does one instinctively feel that it must have been theman’sbusiness to seek means of healing, to try the virtues of various herbs, or to apply such rude remedies as might occur to one unused to the strange spectacle of human suffering? I think that few would maintain that such ministrationwould come most naturally to the man, and be instinctively avoided by the woman; indeed, I fancy that the presumption would be rather in the other direction. And what is such ministration but the germ of the future profession of medicine?
Nor, I think, would the inference be different if we appealed to the actual daily experience of domestic life. If a child falls down stairs, and is more or less seriously hurt, is it the father or the mother (where both are without medical training) who is most equal to the emergency, and who applies the needful remedies in the first instance? Or again, in the heart of the country, where no doctor is readily accessible, is it the squire and the parson, or their respective wives, who are usually consulted about the ailments of half the parish? Of course it may be said that such practice is by no means scientific, but merely empirical, and this I readily allow; but that fact in no way affects my argument that women arenaturallyinclined and fitted for medical practice. And if this be so, I do not know who has the right to say that they shall not be allowed to make their work scientific when they desire it, but shall be limited to merely the mechanical details and wearisome routine of nursing, while to men is reserved all intelligent knowledge of disease, and all study of the laws by which health may be preserved or restored.
Again, imagine if you can that the world has reached its present standing point, that society exists as now in every respect but this,—that the art of healing has never been conceived as a separate profession, that no persons have been set apart to receive special education for it, and that in fact empirical “domestic medicine,” in the strictest sense, is the only thing of the kind existing. Suppose now that society suddenly awoke to the great want so long unnoticed, that it was recognized by all that a scientific knowledge of the human frame in health and in disease, and a study of the remedies of various kinds which might be employed as curative agents, would greatly lessen human suffering, and that it was therefore resolved at once to set apart some persons who should acquire such knowledge, and devote their lives to using it for the benefit of the rest of the race. In such case, would the natural idea be that members of each sex should be so set apart for the benefit of their own sex respectively,—that men should fit themselves to minister to the maladies of men, and women to those of women,—or that one sex only should undertake the care of the health of all, under all circumstances? For myself, I have no hesitation in saying that the former seems to me thenaturalcourse, and that to civilized society, if unaccustomed to the idea, the proposal that persons of one sex should in every case be consultedabout every disease incident to those of the other, would be very repugnant; nay, that were every other condition of society the same as now, it would probably be held wholly inadmissable. I maintain that not only is there nothing strange or unnatural in the idea that women are the fit physicians for women, and men for men; but on the contrary, that it is only custom and habit which blind society to the extreme strangeness and incongruity of any other notion.
I am indeed far from pretending, as some have done, that it is morally wrong for men to be the medical attendants of women, and that grave mischiefs are the frequent and natural results of their being placed in that position. I believe that these statements not only materially injure the cause they profess to serve, but that they are in themselves false. In my own experience as a medical student, I have had far too much reason to acknowledge the honour and delicacy of feeling habitually shown by the gentlemen of the medical profession, not to protest warmly against any such injurious imputation. I am very sure that in the vast majority of cases, the motives and conduct of medical men in this respect are altogether above question, and that every physician who is also a gentleman is thoroughly able, when consulted by a patient in any case whatever, to remember only the human suffering brought before him and thescientific bearing of its details; for as was said not very long ago by a most eminent London surgeon, “Whoever is not able, in the course of practice, to put the idea of sex out of his mind, is not fit for the medical profession at all.” It will, however, occur to most people that the medical man is only one of the parties concerned, and that it is possible that a difficulty which may be of no importance from his scientific standpoint, may yet be very formidable indeed to the far more sensitive and delicately organized feelings of his patient, who has no such armour of proof as his own, and whose very condition of suffering may entail an even exaggerated condition of nervous susceptibility on such points.[1]At any rate, when we hear so many assertions about natural instincts and social propriety, I cannot but assert that their evidence, such as it is, is wholly for, and not against, the cause of women as physicians for their own sex.
If we take next the ground of custom, I think the position of those who would oppose the medical education of women is far less tenable than is generally supposed; indeed, that a recent writer stated no more than the truth when he asserted that “the obloquy which attends innovation belongs to the men who exclude women from a profession in which they once had a recognised place.”[2]I believe that few people who have notcarefully considered the question from an historical point of view have any idea of the amount of evidence that may be brought to support this view of the case.[3]
Referring to the earliest classical times, we find distinct mention in theIliadof a woman skilled in the science of medicine,[4]and a similar reference occurs also in theOdyssey.[5]Euripides is no less valuable a witness on this point. He describes Queen Phædra[6]as disturbed in mind and out of health, and represents the nurse as thus addressing her: “If thy complaint be anything of the more secret kind, here are women at hand to compose the disease. But if thy distress issuch as may be told to men, tell it, that it may be reported to the physicians;” thus indicating aprevailing public opinion that there were natural and rigid limits to the medical attendance of men and women, and that therefore some women were specially trained to do what the regular physicians must leave undone. It is at least remarkable to find such evidence of general feeling on this matter in a state of society supposed to possess much less delicacy and refinement than our own.
We find records of several Grecian women who were renowned for their medical skill, among whom may be instanced Olympias of Thebes, whose medical learning is said to be mentioned by Pliny; and Aspasia, from whose writings on the diseases of women, quotations are preserved in the works of Aëtius, a Mesopotamian physician.[7]On the authority of Hyginus rests the history of Agnodice, the Athenian maiden whose skill and success in medicine was the cause of the legal opening of the medical profession to all the free-born women of the State.[8]
In more modern times, when almost all learning was garnered into the religious houses, which were not only the libraries but the hospitals of the day, it seems evident that the care of the sick and wounded fell at least as often to the share of the Nunneries as of the Monasteries, and probably medical skill, such as it was, found place among the sisters quite as often as among the brethren of the various religious Orders.
The old ballad of Sir Isumbras gives one illustration out of many of the prevailing state of things, relating how the nuns received the wounded knight, and how
“Ilke a day they made salves new,And laid them on his wounds,They gafe hym metis and drynkes lythe,And heled the knyghte wonder swythe.”[9]
“Ilke a day they made salves new,And laid them on his wounds,They gafe hym metis and drynkes lythe,And heled the knyghte wonder swythe.”[9]
“Ilke a day they made salves new,And laid them on his wounds,They gafe hym metis and drynkes lythe,And heled the knyghte wonder swythe.”[9]
“Ilke a day they made salves new,
And laid them on his wounds,
They gafe hym metis and drynkes lythe,
And heled the knyghte wonder swythe.”[9]
It may be remembered that Sir Walter Scott,[10]after describing how Rebecca “proceeded, with her own hands, to examine and bind up the wounds,” goes on to remark, “The youngest reader of romances and romantic ballads must recollect how often the females, during the dark ages, as they are called, were initiated into the mysteries of surgery.... The Jews, both male and female, possessed and practised the medical science in all its branches.”
In the fourteenth century, when the Medical School of Salerno enjoyed high reputation, we find record of a female physician named Abella, who lived there, and wrote in Latin various works on medicine.[11]
Early in the next century an Italian lady, Dorotea Bocchi, was actually Professor of Medicineat the University of Bologna,[12]and among the traditions of the same University is preserved the name of Alessandra Gigliani, who, in even earlier times, was a learned student of anatomy.[13]
In the sixteenth century, at Alcarez in Spain, lived Olivia Sabuco de Nantes, who “had a large knowledge of science and medicine,” and whose medical works were printed at Madrid in 1588.[14]
It is clear that in Great Britain at an early period women were commonly found among the irregular practitioners of medicine; and it is equally clear that their male competitors greatly desired to deprive them of the right to practise. In 1421 a petition was presented to HenryV., praying that “no woman use the practyse of fisyk under payne of long emprisonment.”[15]Within a few years after the first incorporation of the Colleges of Physicians and Surgeons, an Act[16]was passed for the relief and protection of“Divers honest psones,as well men as women, whom God hathe endued with the knowledge of the nature, kind, and operaçon of certeyne herbes, rotes, and waters, and the using and ministering them to suche as be payned with customable diseases, for neighbourhode and Goddes sake, and of pitie and charytie,” because the “Companie and Fellowship of Surgeons of London, mynding onlie their owne lucres and nothing the profit or ease of the diseased or patient, have sued, vexed, and troubled,” the aforesaid “honest psones,” who were henceforth to be allowed “to practyse, use, and mynistre in and to any outwarde sore, swelling, or disease, any herbes, oyntements, bathes, pultes or emplasters, according to their cooning experience and knowledge ... without sute, vexation, penaltie, or losse of their goods.”[17]
This provision clearly referred to general practice other than that of midwifery, which latter branch of the profession was then, as for centuries both before and after, almost exclusively in the hands of women. The very wordmidwife, with its Latin synonym “obstetrix,” is sufficiently significant on this point, for in neither language has it any masculine equivalent, and the clumsy term “Man-midwife” served, when first needed and used, to mark the general sense of what the writer in theAthenæumforcibly calls “masculine intrusion into that which natural instinct assigns to woman as her proper field of labour;” and thissame very suggestive title is the only one which at the present day in legal phraseology distinguishes the male practitioners of this branch of medical art.
From the time of Moses onwards this part of the profession has always been mainly in the hands of women, and in many countries of Europe no other usage has ever prevailed. The first regular French medical society, “La confrairie de St Cosme and St Damien,” included within its organization the Company of Midwives,[18]and from that time down to the present it seems in France to have been the custom to give to these women a regular education, terminating in sufficient examinations, an example which England would have done well to follow.
In this country, however, midwives appear to have held a most respectable position some centuries ago, and a curious idea of their importance, their duties, and their credit, may be gathered from aMS.volume (without date) now preserved in the British Museum,[19]which was evidentlywritten at a time when hardly any but women were employed in the “mysteries of the profession,” and when it was a comparatively rare thing, that needed to be specially advised in certain cases, for them to “make use of(i.e., call in)a physitien.” The writer remarks that “it is meet that the midwife be a woman well read and well experienced,” and gives a caution that “drunkenness is a sordid sin in any who use it, but is a blemish worthy greater blame in ministers, magistrates, midwives, physitiens, and chirurgeons.”
Mrs Celleor, in her letter previously referred to,[20]tells us that in 1642, “the physitiens and chirurgeons contending about it, midwifery was adjudged a chirurgical operation, and midwives were licensed at Chirurgeon’s Hall, but not till they had passed three examinations before six skilful midwives, and as many chirurgeons;” but for some reason (connected probably with their occasional baptismal functions) the midwives were, in 1662, referred for their licence to Doctors’ Commons, thus losing their official connexion with the medical world.
How it came that English midwives fell gradually from their high estate is partly explained by a very public-spirited book (with the appropriate motto “Non sibi sed aliis”) written by a surgeonin 1736.[21]The writer adverts to the accusations of ignorance then brought against the midwives, and remarks that “the only method by which this fatal distemper can be cured, is to put it in the power of midwomen to qualify themselves thoroughly and at a moderate expense.... To which method of qualifying themselves I doubt not the midwomen will object, and say that they would readily be at any reasonable expense and fatigue to be so thoroughly instructed, but it is not in their power. The midwomen cannot, and the midmen will not instruct them. The midmen will object and say that the midwomen want both capacity and strength (instruct them as ye please). To which I reply (ore rotundo, plenis buccis) that it is not want of capacity, docility, strength, or activity ... which is evident to a demonstration from the successful practice of women in theHôtel Dieu at Paris (the best school for midwifery now in Europe).... Would not any person then be deservedly laughed at who should assert that our women are not as capable of performing their office had they the same instruction as the French women?” This chivalrous surgeon then proposes that regular provision should be made for proper instruction, and for examinations by twosurgeons (who have lectured to the women), “and six or seven other persons appointed by His Majesty, because I don’t think it reasonable that so many people’s bread should depend on the humour or caprice of two men only;” adding that “If some such scheme was put in execution, I’m satisfied that in a very few years there would not be an ignorant midwife in England, and consequently the great agonies most women suffer at the very sight of a man would be almost entirely prevented,” and great expense and much life saved.
However, we must suppose that these noble words of protest fell upon deaf ears, and the midwives, being left in their ignorance, their practice gradually passed into the hands of the medical men, who had every advantage of learning at their command.[22]
It is, however, only very recently that men-midwives have been allowed to attend on royal patients in this country; indeed, I believe that the Princess Charlotte was the first to establishthe precedent, and that our present Sovereign was the first queen who followed it. In a very interesting series of papers, by Dr Aveling, recently published in theLancet,[23]accounts have been given of a number of the royal midwives whose names have been honourably preserved in history, such as Alice Dennis, who attended Anne of Denmark, and received a fee of £100 “for her pains and attendance upon the Queen, as of His Highness’s free gift and reward, without account, imprest, or other charge to be set on her for the same.”
The same writer mentions that Margaret Mercer was sent express from England in 1603 to attend on “His Majesty’s dearest daughter, the Princess Electress Palatine.”
It is also recorded that “Mrs Labany attended Mary of Modena, Queen of JamesII., when she was delivered, on June 10th, 1687, of James Francis Edward, afterwards called the Pretender.”[24]Mrs Wilkins, another midwife, seems also to have been present on this occasion, and it is stated that each of these persons received a fee of five hundred guineas for her services.
It is well known that Queen Charlotte was always attended by a woman,[25]and the late Duchess of Kent employed the Frau von Siebold, of whom mention is made elsewhere.[26]
Now that public attention is awaking to the subject, and educated women are once more desirous of undertaking this peculiarly womanly work, we may indeed anticipate, with the already quoted writer in theAthenæum, that a reactionary movement will soon make itself felt, and that the usage “which even up to the present time a large proportion of our English families, especially those of our northern towns and outlying country districts, have never adopted, will most likely be discontinued in all classes of English society before the end of the present century.”
On the Continent of Europe, owing to their better education, the midwives retain much of the position that they have for a time lost in England; and we hear that in Russia“a medical man is very rarely called in; notwithstanding, fatal cases are of far less frequent occurrence in Russia than in England;” and the same authority tells us that ladies practising midwifery are admitted into society as doctors would be, and are well paid, both by the Government and by private fees.[27]
While thus briefly tracing out the history of midwifery in modern times, and the causes which led to its practice passing from the hands of women into those of men, I have not paused to mention, in due chronological order, those women who, in the last three centuries, have been distinguished for a knowledge of the other branches of Medicine and Surgery. Of these I will now enumerate a few, though my time and space are far too limited either to give a complete list, or to relate any but the most prominent particulars of each case mentioned; but I can promise that any one who will consult the authorities quoted will be abundantly repaid by the long and interesting details that I am forced to pass over in almost every instance.
In the seventeenth century, in England, one of the women most noted for medical skill was Lady Ann Halket,[28]born in 1622, daughter of the thenprovost of Eton College. “Next to the study of Divinity she seems to have taken most delight in those of Physick and Surgery, in which she was no mean proficient; nay, some of the best physicians in the kingdom did not think themselves slighted when persons of the greatest quality did consult her in their distempers, even when they attended them as their ordinary physicians. Many from England, Holland, and the remotest parts of the kingdom, have sent to her for things of her preparing; and many whose diseases have proved obstinate under all the methods of physicians, have at length, by the physicians’ own advice, been recommended and sent to her care, and have been recovered by her.”
In 1644 was born Elizabeth Lawrence, afterwards wife of theRev.Samuel Bury, of Bristol, who wrote her life,[29]and who bears witness that “it was not possible there should be a more observant, tender, indulgent, and compassionate wife than she was; a more sympathising spirit is very rarely found.” He records that “she took much pleasure in Anatomy and Medicine, being led and prompted to it partly by her own ill health, and partly with a desire of being useful.” The difficulties that she encountered in her studies may be guessed, since“she would often regret that so many learned men should be so uncharitable to her sex, and be so loath to assist their feebler faculties when they were anywise disposed to an accurate search into things profitable and curious. Especially as they would all so readily own that souls were not distinguished by sexes. And therefore she thought it would have been an honourable pity in them to have offered something in condescension to their capacities, rather than have propagated a despair of their information to future ages.” Her husband, however, tells us that “she improved so much, that many of the great masters of the Faculty have often been startled by her stating the most nice and difficult cases in such proper terms;” and, remarking that, “How much knowledge and skill soever she attained in the practice of Physick, by long observation, conversation, and experience, yet she was very distrustful of herself,” he adds that the “instances of her successes in the preservation of human lives were not easily numbered.”
As a contemporary of these Englishwomen, we find in Germany Elizabeth Keillen, who published several medical works, and died in 1699. She is said by Finauer to have had “great knowledge of medicine and chemistry.”
In comparatively recent times, Bologna was remarkable as ever for its liberal encouragementof learned women, and about the middle of the last century the Chair of Anatomy at that University was filled by Anna Morandi Mazzolini, whose exquisitely delicate anatomical models, executed in wax, became the pride of the Museum at Bologna. She first became interested in the study of Anatomy in consequence of her wish to help her husband, who was a distinguished anatomist, and a maker of anatomical designs and models. He fell into ill-health and mental despondency, and therefore“his wife, loving him dearly, and fearing that he would desist from his work, gave herself up to his comfort; and for this purpose became herself an anatomical sculptor, reading works of anatomy, consulting anatomical tables and preparations, taking theoretical and practical lessons from her husband, and, marvellous to say, even dissecting dead bodies with resolute mind, and with incredible perseverance.... Too long to describe are the works executed in wax by the able hands of this illustrious woman. They were collected in five elegant cases in our Anatomical Museum.... The fourth case encloses delicate illustrations of all the parts belonging to the senses of sight, smell, hearing, taste, and touch—stupendous works in which she surpassed herself, and also her husband, and his colleague, Ercole Lelli.... These models were for some time kept in her own house, and each one who saw them spread her renown, so that through distant countries was spread the fame of her works, so that every learned and distinguished person passing through Bologna was solicitous to visit and know personally the maker of these wonders.”[30]Signora Mazzolini also made original discoveries in anatomical science, which obtained for her many marks of distinction from the learned colleges and societies of the day. She was offered a Chair at Milan, with increased revenues, but preferred to remain at Bologna, where she lived till her death in 1774. Medici, in his records of the Anatomical School of Bologna, speaks of this lady with profound respect, as distinguished alike by “rare powers, great erudition, gracious manners, and delicate and gentle temperament,” and relates that her fame reached the ears of the Emperor JosephII., who visited her in 1769, and “having seen her works and heard her conversation,” loaded her with public honours. Her example seems to have inspired others of her countrywomen to follow in the steps of one so honoured, alike in the stern duties of her profession, and in the sanctities of household life; for in the course of the next half century several Italian women availed themselves of the thorough medical education which the Italian Universities never refused.
In 1788 Maria Petraccini[31]took a degree in medicine at Florence, and we find her, a little later, lecturing on anatomy at Ferrara, in presence of the medical professors. She married Signor Feretti, and has left several works on the physical education of children.
Her daughter, Zaffira Feretti, seems to have inherited her mother’s talents, for she studied Surgery in the University of Bologna, and there received a medical degree[32]in May 1800. She obtained an appointment under the Italian Government, and for some time lived in Ancona acting as Director-General of the midwives in all parts of the country. She afterwards went to Turkey, and died at Patras in 1817.
Maria Mastellari seems also to have been a woman of unusual talent, and “progressed diligently in the most rigid sciences.” She obtained a medical degree at Bologna in 1799. She subsequently became the wife of Signor Collizoli-Sega, and is described as possessing a “sweet and gentle temperament, with special love of silence and quiet. She centred her interests in her family, which she managed admirably.”[33]
Still more distinguished in the annals of medicine was Maria delle Donne, who also studied in the University of Bologna, and“received the doctoral laurel” in 1806.[34]She “constantly practised both Medicine and Surgery,” and was appointed by Napoleon Bonaparte to the Chair of Midwifery at Bologna. TheGazette Medicale, quoting from the “Raccoglitore Medico,” gives the following account of her:—“Anna Maria delle Donne, docteur en médecine, auteur d’élégants vers latins, professeur d’obstetrique, à l’Université de Bologna, membre de l’Academie, bénédictine,&c., est décedée le 9 Janvier, 1842. Cette femme distinguée qui a succedé à Madame Mazzolini et à Madame Bassi, est une des gloires scientifiques de Bologna. Elle soutint en 1800, avec un très grand succès, une thèse de Philosophie, de Chirurgie, and de Medicine. Peu après, à la suite d’un examen public, on lui conféra le grade de docteur et de consultant. Napoleon en passant à Bologne fut frappé du savoir de cette dame, et institua pour elle une Chaire d’Obstetrique, où elle se fit une grande renommée.”[35]
Nor was Italy alone noted as the birthplace of women skilled in Medicine. In Germany, early in this century, Frau von Siebold so greatly distinguished herself in the practice of midwifery that the degree of M.D. was conferred on her by the University of Giessen;[36]and her daughterMarianne, afterwards Frau von Heidenreich, studied in the Universities of both Göttingen and Giessen, and took her degree in the regular way in 1817. She is spoken of as “one of the most famed and eminent female scholars of Germany,” and as being “universally honoured as one of the first living authorities in her special branch of science.”[37]She died only in 1859.
In France, the name of Madame Lachapelle[38]was known and honoured as that of one of the ablest teachers of Midwifery during the latter part of the last century. She has left several valuable works on subjects connected with her specialty. Her funeral in 1821 was followed by all the chief physicians of Paris. Her pupil and successor, Madame Boivin,[39]was still more distinguished for her medical knowledge and skill, and for her contributions to anatomical science. Her “Memoire de l’art des Accouchements” was approved by the highest medical authority, and was appointed as the text-book for students and midwives by the Minister of the Interior. She was invested with an Order of Merit by the King of Prussia in 1814, and in the same year was appointed co-director (with the Marquis de Belloy) of the General Hospital for Seine and Oise, andin 1815 was entrusted with the direction of a temporary Military Hospital, for her services in which latter capacity she received a public vote of thanks. She was also entrusted with the direction of theHospice de la Maternité, and of theMaison Royale de Santé, and was one of the most distinguished practitioners of the time. She made original discoveries in Anatomy, invented various surgical instruments, and obtained prizes for medical theses from the Société de Medicine.
Her medical writings were distinguished by “precision et clarté, jugement sain, erudition choisie, et savoir solide.” In 1846 one of her books was eulogized by Jourdan as “ouvrage éminemment pratique, et le meilleur que nous possedions encore sur ce sujet,” with the additional remark that “tout se réunit pour lui mériter une des premières places parmi les productions de la littérature medicale moderne.” She was a member of the Medical Societies of Paris, Bordeaux, Berlin, Brussels, and Bruges, and was honoured with the degree of M.D. from the University of Marbourg. She died in 1841.
These numerous instances of the successful practice of Medicine by women seem to have been little known, or else forgotten, to judge by the surprise expressed when, after surmounting many difficulties, an English lady, named ElizabethBlackwell, succeeded in obtaining medical education and the degree of M.D. from a medical school in America in 1849. The novelty, in truth, was not in the granting of the medical degree to a woman, but in its being received by an Englishwoman, for it is hardly gratifying to one’s national pride to find that England never has accorded such encouragement to female learning as was found in Italy, Germany, and France; and it is still more painful to realize that this country, almost alone, stands still aloof from the movement of liberal wisdom that has now in all these lands, as well as in Switzerland, and even in Russia, granted to woman the advantage of University education and degrees. English women are not behind others in desiring knowledge, but as yet they are forced to seek it on foreign shores, for hitherto no British University has ever fully admitted women to its educational advantages; and a few years ago, that of London, with all its professions of liberality, refused a woman’s petition even for examination for the degree of M.D.!
So much for the historical evidence bearing on this question. I am indeed sorry to have paused so long on this part of the subject, but it seemed essential to a proper statement of the whole case.
If, then, nature does not instinctively forbid the practice of the healing art by women, and if it cannot be denied that some at least of itsbranches have long been in their hands, we must go further to seek on what grounds their admission to the medical profession should be opposed.
Probably the next argument will be that women do not require, and are not fitted to receive, the scientific education needful for a first-rate Physician, and that “for their own sakes” it is not desirable that they should pursue some of the studies indispensably necessary. To this the answer must be, that the wisest thinkers teach us to believe that each human being must be “a law unto himself,” and must decide what is and what is not suitable for his needs, what will and what will not contribute to his own development, and fit him best to fulfil the life-work most congenial to his tastes. If women claim that they do need and can appreciate instruction in any or all sciences, I do not know who has the right to deny the assertion.
That this controversy is no new one may be proved by reference to a very curious black-letter volume now in the British Museum,[40]wherein the writer protests,“I mervayle gretely of the opynyon of some men that say they wolde not in no wyse that theyr doughters or wyves or kynneswomen sholde lerne scyences, and that it sholde apayre their cödycyons. This thing is not to say ne to sustayne. That the woman apayreth by connynge it is not well to beleve. As the proverbe sayeth, ‘that nature gyveth maye not be taken away.’”
If it be argued that the study of Natural Science may injure a woman’s character, I would answer, in the words of one of the purest-minded women I know, that “if a woman’s womanliness is not deep enough in her nature to bear the brunt of any needful education, it is not worth guarding.” It is, I think, inconceivable that any one who considers the study of natural science to be but another word for earnest and reverent inquiry into the works of God, and who believes that, in David’s words, these are to be “sought out of all them that have pleasure therein,” can imagine that any such study can be otherwise than elevating and helpful to the moral, as well to the mental nature of every student who pursues it in a right spirit. In the words of Scripture, “To the pure, all things are pure,” and in the phrase of chivalry, “Honi soit qui mal y pense.”
It has always struck me as a curious inconsistency, that while almost everybody applauds and respects Miss Nightingale and her followers for their brave disregard of conventionalities on behalf of suffering humanity, and while hardly any one would pretend that there was any want of femininedelicacy in their going among the foulest sights and most painful scenes, to succour, not their own sex, but the other, many people yet profess to be shocked when other women desire to fit themselves to take the medical care of those of their sisters who would gladly welcome their aid. Where is the real difference? If a woman is to be applauded for facing the horrors of an army hospital when she believes that she can there do good work, why is she to be condemned as indelicate when she professes her willingness to go through an ordeal, certainly no greater, to obtain the education necessary for a medical practitioner? Surely work is in no way degraded by being made scientific; it cannot be commendable to obey instructions as a nurse when it would be unseemly to learn the reasons for them as a student, or to give them as a doctor; more especially as the nurse’s duties may lead her, as they did in the Crimea, to attend on men with injuries and diseases of all kinds, whereas the woman who practises as a physician would confine her practice to women only. It is indeed hard to see any reason of delicacy, at least, which can be adduced in favour of women as nurses, and against them as physicians.
Their natural capacity for the one sphere or the other is, of course, a wholly different matter, and is, indeed, a thing not to be argued about,but to be tested.[41]If women fail to pass the required examinations for the ordinary medical degree, or if, after their entrance into practice, they fail to succeed in it, the whole question is naturally and finally disposed of. But that is not the point now at issue.
That the most thorough and scientific medical education need do no injury to any woman might safely be prophesied, even if the experiment had never been tried; but we have, moreover, the absolute confirmation of experience on the point, as I, for one, will gladly testify from personal acquaintance in America with many women who have made Medicine their profession; having had myself the advantage of studying under one who was characterized, by a medical gentleman known throughout the professional world, as “one of the best physicians in Boston,” and who, certainly, was more remarkable for thorough refinement of mind than most women I know,—Dr Lucy Sewall.
Of course there may always be unfortunate exceptions, or rather there will always be those of both sexes who, whatever their profession may be, will be sure to disgrace it; but it is not of them that I speak, nor is it by such individual cases that the supporters of any great movement should be judged.
The next argument usually advanced againstthe practice of medicine by women is that there is no demand for it; that women, as a rule, have little confidence in their own sex, and had rather be attended by a man. That everybody had rather be attended by a competent physician is no doubt true; that women have hitherto had little experience of competent physicians of their own sex is equally true; nor can it be denied that the education bestowed on most women is not one likely to inspire much confidence. It is probably a fact, that until lately there has been “no demand” for women doctors, because it does not occur to most people to demand what does not exist; but that very many women have wished that they could be medically attended by those of their own sex I am very sure, and I know of more than one case where ladies have habitually gone through one confinement after another without proper attendance, because the idea of employing a man was so extremely repugnant to them. I have indeed repeatedly found that even doctors, not altogether favourable to the present movement, allow that they consider men rather out of place in midwifery practice;[42]and an eminentAmerican practitioner once remarked to me that he never entered a lady’s room to attend her in confinement without wishing to apologize for what he felt to be an intrusion, though a necessary and beneficent intrusion, in one of his sex.
I suppose that the real test of “demand” is not in the opinions expressed by those women who have never even seen a thoroughly educated female physician, but in the practice which flows in to any such physician when her qualifications are clearly satisfactory. In England there are at present but two women legally qualified to practise Medicine, and I understand that already their time is much more fully occupied, and their receipts much greater, than is usually the case with medical men who have been practising for so short a period. Dr Garrett Anderson’s Dispensary for poor women is also largely attended, and during the five years which have elapsed since it was opened, more than 40,000 visits have been made to it; 9000 new patients havebeen admitted, and 250 midwifery cases have been attended by the midwives attached to the charity, Dr Garrett Anderson being called in when necessary.
When we turn to America, we find that a considerable number of women have very extensive practice and large professional incomes (more, indeed, than in some cases seems warranted by their medical qualifications). The Report of a little hospital, managed entirely by women, in Boston, U.S., relates that during 1867 the number of in-patients was 198; of persons visited at their homes, 281; and of those able to attend at the dispensary, 4,576; all these patients being women and children only. In fact, the attendance at the Dispensary became so excessive in proportion to the resources of the charity, that in 1868 a rule was passed by the Committee requiring each patient to pay twenty-five cents (or about ninepence) for medicines, at each visit, except when she brought “a certificate of her poverty, properly authenticated.” This regulation brought out still more strongly the distinctchoiceof poor women in this matter, for, though the General City Dispensary gave medicines gratuitously, the number of those who attended at the Woman’s Hospital was much less diminished than was expected, being still 3,236 in 1868. In New York also, where the Dispensary managed by women doctors is but one of many,the crowd of patients is very great, the numbers being, in 1867, no less than 6354, while 545 persons were attended at their homes either in confinement or during severe illness. Of course it will be understood that each patient thus entered on the books implies not one visit, but many, paid to the Dispensary, or often repeated attendance at the patient’s home.
Of the Boston Hospital for Women and Children I can speak from lengthened experience in it as a student. When standing in its dispensary I have over and over again heard rough women of a very poor class say, when questioned why they had not had earlier treatment for certain diseases, “Oh, Icould notgo to a man with such a trouble, and I did not know till just now that ladies did this work;” and from others have repeatedly heard different expressions of the feeling that, “It’s so nice, isn’t it, to be able at last to ask ladies about such things?”
As I am alluding to my own experience in this matter, I may perhaps be allowed to say how often in the same place I have been struck with thecontingentadvantages attendant on the medical care by women of women. How often I have seen cases connected with stories of shame or sorrow to which a woman’s hand could far most fittingly minister, and where sisterly help and counsel could give far more appropriate succour than couldbe expected from the average young medical man, however good his intentions. Perhaps we shall find the solution of some of our saddest social problems when educated and pure-minded women are brought more constantly in contact with their sinning and suffering sisters, in other relations as well as those of missionary effort.
So far from there being no demand for women as physicians, I believe that there is at this moment a large amount of work actually awaiting them; that a large amount of suffering exists among women which never comes under the notice of medical men at all, and which will remain unmitigated till women are ready in sufficient numbers to attend medically to those of their own sex who need them, and this in all parts of the world. From India we hear urgent demands for “educating native women of good caste, so as to qualify them to treat female patients and children.”[43]We are informed that“this is a work which can only be carried on by women, as the native women in many cases will rather die than be seen by a man in times of sickness,”[44]and arrangements have already been made for a systematic “Female Medical Mission,” though perhaps the standard of medical knowledge required can, under existing circumstances, hardly be fixed as high as is desirable. To show, however, the eagerness with which the native women avail themselves of the aid thus offered, I may mention that when a lady (who had had some medical training, but possessed no degree,) was sent out by the Society[45]in December 1870, she, during the first three months of her stay, had occasion to pay no less than 313 professional visits to zenanas, and to treat 158 patients at her dispensary, which was arranged with a view to affording them the utmost privacy. Subsequently her visits to zenanas averaged as many as seventeen a day, while nearly twice as many patients came to her dispensary. Efforts are also being made to train native Hindoo women for some branches, at least, of the medical profession. Dr Corbyn of Bareilly, in 1870, wrote as follows:—“I am educating a number of native girls, and three have already passed as native doctors. They are of all castes,—Christians, Mahommedans, and Hindoos. My school is divided into three classes. The first-class pupils can read and write English and Urdee with accuracy. They are taught medicine, surgery, midwifery, diseases of women and children (especially the latter two). The second-class learn anatomy, materia medica, and physiology, in English and Urdee. The pupils of the other (preparatory) class are taught English and Urdee. We have a female ward attached to the dispensary for women and children, and these girls entirely attend to them, under my and the sub-assistants’ supervision. It is wonderful how they can manipulate; they have plenty of nerve.”[46]Even more recently we learn that “the Mahommedan Nawab of Rampoor has presented to the Bareilly mission a large building for the purpose of a medical school for women. Several women are now going through a scientific course of instruction.”[47]
About eight or ten years ago,“several of the wild tribes of Russian Asia petitioned the Government to send them out properly qualified women to act as midwives. Their petition was granted, the Government undertaking all the expense of the education and maintenance of a certain number of women for this purpose. After a time one of these tribes, the Kirgesen, petitioned further, that the women thus sent to them should also be taught some branches of the art of Medicine. One of the women, then being trained as a midwife, hearing of this petition, wrote to the Kirgesen, proposing that she should study Medicine thoroughly, and go out to them as a qualified doctor. She suggested at the same time that they should try to get permission for her to enter the Academy of St Petersburg as a regular medical student. The Kirgesen welcomed the proposal, and, through an influential Russian general, obtained an official document, empowering their future doctor to attend the Academy as a student. They have regularly sent money for her education and maintenance, and from the first have taken the greatest interest in her progress and welfare, requiring, among other things, periodical bulletins of her health. Hearing last summer that she was not well, they sent money for her to go abroad for her holiday, and asked for an extra bulletin.”[48]
I cite the above facts to show that the demand for female physicians is no artificial or imaginary one, and that it does not spring out of any fanciful whim of an over-refined social state; but lest it should be supposed on the other hand to be confined to half-barbarous nations, I may quote the opinions expressed on this subject two years ago in one of the most thoughtful of our English journals:“We heartily admit that the only way to discriminate clearly what practical careers women are, and are not, fitted for, is to let them try. In many cases, as in the medical profession, we do not feel any doubt that they will find a special kind of work for which they are specially fitted, which has never been adequately done by men at all, and which never would be done but by women.... We have heard the opinion of one of the most eminent of our living physicians, that one of the new lady physicians is doing, in the most admirable manner, a work which medical men would never even have had the chance of doing.”[49]
I am told by Catholic friends that a great many cases of special disease remain untreated in convents, because the nuns, with their extreme notions of feminine seclusion, think that it would be little short of profanation to submit to some kinds of medical treatment from a man.[50]Indeed, it is expressly laid down by a great Catholic authority, St Alphonsus,[51]that though monks and nuns are required to place themselves in the doctor’s care when commanded to do so by their superiors, a special exception is to be made in the case of nuns suffering from certain maladies, who can only be required to accept treatment from a skilled woman, if any such be available; as, under existing circumstances, is so rarely the case. I do not ask any reader to applaud or even justify these poor nuns, if they, esteeming themselves “the martyrs of holy purity,” sacrifice life to such scruples; but I do most emphatically ask, in thename of humanity, whether the state of things can be defended which may drive women, from the highest and most holy motives, to submit to the extremity of physical suffering and even death itself, because it is impossible for them to obtain the medical services of their own sex, and because they believe they can best fulfil the spirit of their vows by accepting no other?
I am informed by a friend that Archbishop Manning, when expressing to her his strong interest in the question of the medical education of women, alluded to facts like those referred to above, as affording one of the strongest motives for such interest in the minds of Catholics. Nor, surely, need sympathy in such a case be limited within the bounds of any religious denomination.
To pass to the consideration of other cases of a less exceptional kind, there can, I think, be little doubt that an enormous amount of preventible suffering arises from the unwillingness of very many girls on the verge of womanhood to consult a medical man on various points which are yet of vital importance, and to appeal to him in cases of apparently slight illness, which yet issue but too often in ultimately confirmed ill-health. I firmly believe that if a dozen competent women entered upon medical practice at this moment in different parts of England, they might, without withdrawing a single patient from her present medical attendant,find full and remunerative employment in attending simply to those cases which, in the present state of things, go without any adequate treatment whatever; for I believe that many suffering women would be willing to consult one of their own sex, if thoroughly qualified, when they refuse, except at some crisis of acute suffering, to call in a medical man.[52]Probably Queen Isabella of Castile[53]was neither the first nor the last woman whose life was sacrificed to her modesty. Even if such extreme instances are rare, I think it cannot be denied that very much needless pain, “and pain of a kind that ought not to be inflicted,” is caused, especially to young girls, by the necessity of consulting men on all occasions, and I believe that those who know most of the facts insist most strongly on this point.
I do not know how far the Medical Profession would acknowledge the truth of the above statement; it is probable that they are really less competent to judge about it than women are themselves, for, as an eminent divine remarked that it was considered a point of politeness not to express theological doubts before a clergyman, it may probably be thought still more obligatory not to question the adequacy of the existing medical profession before one of its members. One can hardly imagine a lady sending for a doctor to tell him why she willnotconsult him; it is sufficient to know that many cases of disease among women go without treatment; it is surely open to any one at least to suggest the above as one of the possible reasons.
And indeed, if no such special suffering were often involved in the idea of consulting a man on all points, it seems self-evident that a woman’s most natural adviser would be one of her own sex, who must surely be most able to understand and sympathise with her in times of sickness as well as of health, and who can often far more fully appreciate her state, both of mind and body, than any medical man would be likely to do.[54]
Nor can I leave the subject without expressing a hope that, when women are once practising medicine in large numbers, great gain may accrue to medical science from the observations and discoveries which their sex will give them double facilities of making among other women. One of the most eminent of the so-called “ladies’ doctors” of the day writes:—“The principal reason why the knowledge of diseases of women has so little advanced, is the hitherto undisturbed belief that one sex only is qualified by education and powers of mind to investigate and to cure what the other sex alone has to suffer.” After alluding to women physicians of both ancient and modern times, Dr Tilt further remarks, that, “if well educated, they may greatly improve our knowledge of the diseases of women.”[55]
Moreover, there is reason to hope that women doctors may do even more for the health of their own sex in the way of prevention than of cure, and surely this is the very noblest province of the true physician. Already it is being proved with what eagerness women will attend lectures on physiology and hygiene when delivered to them by a woman, though perhaps not one in ten would go to the same course of lectures if given by a medical man. I look forward to the day when a competent knowledge of these subjects shall be as general among women as it now is rare; and when that day arrives, I trust that the“poor health” which is now so sadly common in our sex, and which so frequently comes from sheer ignorance of sanitary laws, will become rather the exception than, as now too often, the rule. I hope that then we shall find far fewer instances of life-long illness entailed on herself by a girl’s thoughtless ignorance; I believe we shall see a generation of women far fitter in mind and body to take their share in the work of the world, and that the Registrar will have to record a much lower rate of infantile mortality when mothers themselves have learned to know something at least of the elementary laws of health. It has been well said that the noblest end of education is to make the educator no longer necessary; and I, at least, shall think it the highest proof of success if women doctors can in time succeed in so raising the standard of health among their sister women, that but half the present percentage of medical practitioners are required in comparison to the female population.
Of course I do not expect that every reader will look at this question from my point of view, or will be able to arrive at the same conclusions respecting it. But I think that many who have never before seen the matter in the light in which I have tried to place it, will be ready to admit that there are at any rateprimâ faciegrounds for my argument, and that allowing even for considerable over-statement on my part, there may still remain subject for serious consideration.
Even if I am wholly mistaken, and if all that needs doingcanin England be effectually done by men, we have still, I think, no reason for the exclusion of women from the medical profession;—there is still no ground on which it can be right to refuse to every patient the power of election between a physician of her own sex and of the other, when women as well as men are desirous of qualifying themselves for this work, seeing that it will after all be always a matter of choice; for we cannot suppose that the time will ever come when women will be arbitrarily prevented from employing men, as they now are arbitrarily prevented from employing women, as their medical attendants.
The assertion that womenareat present “arbitrarily prevented from employing women as their medical attendants” may sound startling, but it is at this moment practically true in England, in the most literal sense. Since medical practice has, for the protection of the public, been made a matter of legislation, it has been absolutely illegal for any physician or surgeon to practise as such in this country, unless registered by the appointed Medical Board, and that Board is not obliged to register any one who has not a British medical degree. It is evident, then, that to deny all British medical degrees towomen,—not only to refuse them instruction, but to refuse to examine them if they have acquired knowledge elsewhere,—ismost arbitrarily to prohibit all women, whatever their qualification, from practising medicine in the United Kingdom, except under legal pains and penalties.
Of course no such arbitrary action was even contemplated when the Act of 1858 was passed; and I think that when once the great practical injustice of the present state of things is fully understood by the public, a change is inevitable,—either British medical degrees will be thrown open to women, as is most desirable, or the legal conditions of practice will be modified to meet the case of those to whom such degrees are denied. It is perhaps hardly to be expected, though very much to be desired, that medical men as a body should themselves take the initiative in this matter, and throw open the doors to all women who desire worthily to join their fellowship, for it proverbially “needsverygood men to give up their own monopoly;” but the action of the general public in the matter can hardly be doubtful except as a question of time;—no English court could be expected to condemn to legal penalties a succession of highly-educated ladies who may have seized, often with great effort, every opportunity open to them to fitthemselves thoroughly for a work which they believe to be especially their own.
The recent action taken in the matter by the authorities at Apothecaries’ Hall is exactly of the kind to outrage an Englishman’s sense of fairness, and therefore is sure before long to bring its own redress. As the facts may not be thoroughly understood in the non-medical world, I will briefly recapitulate them. When Miss Garrett first began to study medicine in 1860, she tried to obtain admittance to one School and University after another, and finally found that Apothecaries’ Hall was the only body which, from its charter, had no power to refuse to examine any candidate complying with its conditions. She accordingly went through the required five years’ apprenticeship, and obtained her diploma in 1865, having gone to very great additional expense in obtaining privately the required lectures by recognised Professors,—sometimes paying fifty guineas for a course when the usual fee, in the classes from which she was debarred, was but three or four. Not content, however, with indirectly imposing this enormous pecuniary tax on women, the authorities now bethought them to pass a rule forbidding students to receive any part of their medical education privately,—this course being publicly advised by one of the leading medical journals as a safe way of evading the obligations of the charter,and yet effectually shutting out the one chance left to the women![56]
Of course the efficacy of this measure ceases the moment that any regular medical school fairly opens its doors to women; but till that day comes, it presents a formidable, if not insuperable, difficulty. Commenting on this proceeding, theDaily Newsremarks:—“We recommend these facts to the good people who think that coercion, restriction, and the tyranny of combination, are peculiar to any one class of society. It will be a great day in England when the right of every individual to make the most of the ability which God has given him, free from interested interference, is recognised, and to that goal we are surely advancing; but our progress is slow, and it is very clear that it is not only in the lower ranks of the community that the obstructive trades-union spirit is energetically operating.”
While such is the state of affairs in England, other European nations have taken a very different position. We have already seen that the Italian Universities were, in fact, never closed to women, and that at Bologna no less than three women held Professors’ chairs in the Medical Faculty.[57]We have several instances of degrees granted to women in the Middle Ages by the Universities of Bologna, Padua, Milan, Pavia, and others; the earliest instance that I have found being that of Betisia Gozzadini,[58]who was made Doctor of Laws by the University of Bologna in 1209. In Germany also several such instances have occurred. At Paris no less than seven degrees in Arts and Sciences have been granted to women by the University of France within the last ten years, and a number of women are now studying in the Medical School there. In answer to my enquiries in 1868, the Secretary to the Minister of Public Instruction made the following communication:—
“Paris, le 18 Août 1868,“Ministère de l’Instruction Publique.“Mademoiselle,—En réponse à la lettre que vous me faites l’honneur de m’adresser, en vous recommendant du nom de Lord Lyons, qui a écrit pour vous àMons.le Ministre, je m’empresse de vous faire savoir que le Ministre est disposé à vous autoriser, aussi que les autres dames Anglaises qui se destineraient à la médecine, à faire vos études à la Faculté de Paris, et a y subir des examens.“Il est bien entendu que vous devez être munie, par voie d’équivalence on autrement, des diplômes exigés pour l’inscription à la faculté de médecine.“Agreez, Mademoiselle l’assurance de mon respect,(Signed)“Danton.”
“Paris, le 18 Août 1868,“Ministère de l’Instruction Publique.
“Mademoiselle,—En réponse à la lettre que vous me faites l’honneur de m’adresser, en vous recommendant du nom de Lord Lyons, qui a écrit pour vous àMons.le Ministre, je m’empresse de vous faire savoir que le Ministre est disposé à vous autoriser, aussi que les autres dames Anglaises qui se destineraient à la médecine, à faire vos études à la Faculté de Paris, et a y subir des examens.
“Il est bien entendu que vous devez être munie, par voie d’équivalence on autrement, des diplômes exigés pour l’inscription à la faculté de médecine.
“Agreez, Mademoiselle l’assurance de mon respect,
(Signed)“Danton.”