Part 1

Transcriber’s Note

In this text version of “Medical Women”: words in italics are marked with _underscores_ and words in small capitals are shown in UPPER CASE.

Footnotes have been moved to end of each essay.

Variant spelling and inconsistent hyphenation are retained.

A very few changes have been made to punctuation for consistency. Other changes are listed at the end of the book.

MEDICAL WOMEN

Two Essays

BY

SOPHIA JEX-BLAKE.

I.

Medicine as a Profession for Women.

II.

Medical Education of Women.

EDINBURGH:

WILLIAM OLIPHANT & Co., 57 FREDERICK STREET. LONDON: HAMILTON, ADAMS, & Co.

1872.

[_All Rights Reserved._]

JOHN LINDSAY, PRINTER, 104 HIGH STREET, EDINBURGH.

Dedicated

TO

DR LUCY SEWALL,

FROM WHOSE DAILY LIFE I FIRST LEARNED WHAT INCALCULABLE BLESSINGS MAY BE CONFERRED ON THE SICK AND SUFFERING OF HER OWN SEX BY A NOBLE AND PURE-MINDED WOMAN WHO IS ALSO A THOROUGHLY SCIENTIFIC PHYSICIAN.

I.

Medicine as a Profession for Women.

REPRINTED, WITH LARGE ADDITIONS, FROM “WOMAN’S WORK AND WOMAN’S CULTURE.”

“We deny the right of any portion of the species to decide for another portion, or any individual for another individual, what is and what is not their ‘proper sphere.’ The proper sphere for all human beings is the largest and highest which they are able to attain to. What this is cannot be ascertained without complete liberty of choice.”--Mrs J. S. MILL.

MEDICINE AS A PROFESSION FOR WOMEN.

“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._”

It is 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 popular opinions 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 the _man’s_ business 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 ministration would 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 are _naturally_ inclined 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 the _natural_ course, and that to civilized society, if unaccustomed to the idea, the proposal that persons of one sex should in every case be consulted about 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 the scientific 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 not carefully 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 the Iliad of a woman skilled in the science of medicine,[4] and a similar reference occurs also in the Odyssey.[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 is _such as may be told to men_, tell it, that it may be reported to the physicians;” thus indicating a prevailing 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 Medicine at 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 Henry V., 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 word _midwife_, 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 the _Athenæum_ forcibly calls “masculine intrusion into that which natural instinct assigns to woman as her proper field of labour;” and this same 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 a MS. volume (without date) now preserved in the British Museum,[19] which was evidently written 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 surgeon in 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 the Hôtel 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 two surgeons (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 establish the 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 the _Lancet_,[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 James II., 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 the _Athenæum_, 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.