Part 3

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 the name 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 will _not_ consult 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 rate _primâ facie_ grounds 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 doing _can_ in 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 women _are_ at 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 to women,--not only to refuse them instruction, but to refuse to examine them if they have acquired knowledge elsewhere,--_is_ most 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 “needs _very_ good 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 fit themselves 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, the _Daily News_ remarks:--“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 à Mons. 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.”

Since this Essay was first published, two women have obtained the degree of M.D. in Paris, after passing brilliant examinations in each case. The first graduate was our distinguished countrywoman, Miss Garrett, who, after passing the five examinations required, received her degree in June 1870. The _Lancet_ records that “her friends must have been highly gratified to hear how her judges congratulated her on her success, and to see what sympathy and respect was shown to her by all present.”[59]

The next lady who graduated was Miss Mary C. Putnam of New York, who, after quietly pursuing her studies (combined with original researches), like a second Archimedes, during both the sieges of Paris in 1870–71, took her degree with great honour in August 1871. The _Lancet_[60] remarked--“Miss Putnam has just been undergoing the very strict examinations for the doctor’s degree in Paris, and has passed very creditably. This is the second case in the Paris faculty, the innovation being made quietly, whilst elsewhere angry discussions intervene.”

At Lyons, also, two women have obtained degrees in Arts, in 1861 and 1869 respectively. At Montpellier a degree in Arts was also conferred on a woman in 1865, and another lady has passed the first two examinations in the _Ecole de Pharmacie Supérieure_ in that city.

For several years past the University of Zurich has been thrown open to women as freely as to men; a Russian woman, named Nadejda Suslowa, being the first to obtain a degree in Medicine, in 1867. Several more have since then graduated, and others are at present pursuing their studies there in the ordinary classes.[61]

In March 1870 it was announced, on the authority of the _Lancet_, that the University of Vienna had formally decided to admit women as students, and to confer on them the ordinary medical degrees.[62]

A month or two later the Swedish newspapers published in their official columns a royal decree, granting to Swedish women the right to study and practise medicine, and ordaining that the professors of the Universities should make arrangements for teaching and examining them in the usual way.[63]

Even Russia seems in advance of England in this matter. In 1869, “the Medico-Chirurgical Academy of St Petersburg conferred the degree of M.D. upon Madame Kaschewarow, the first female candidate for this honour. When her name was mentioned by the Dean, it was received with an immense storm of applause, which lasted for several minutes. The ceremony of investing her with the insignia of her dignity being over, her fellow-students and colleagues lifted her upon a chair, and carried her with triumphant shouts through the hall.”[64]

At Moscow, also, “the Faculty of Medicine, with the full concurrence of the Council of the University of Moscow, have decided to grant to women the right of being present at the educational courses and lectures of the Faculty, and to follow all the labours of the Medico-Chirurgical Academy. The tests of capacity will be precisely the same as for male students.”[65] Still more recently we hear from St Petersburg that “the success of the lady physicians is encouraging other ladies to devote themselves to medicine, and a considerable step has been made in this direction. ... A person who interests herself in the higher education of women has requested the Minister of State to accept the sum of £8000, and to devote it to the establishment of medical classes for women at the Imperial Academy of Medicine.”[66]