Part 5

“Nothing probably but the deadening force of habit, combined with the apparent necessity of the case, has induced us to endure that anomalous person against whose existence our language itself bears a perpetual protest--the man-midwife. And this single instance suggests a whole class of others in which the intervention of a man is scarcely less inappropriate.”--_Guardian_, Nov. 3, 1869.

[43] _Delhi Gazette_, 1866.

[44] “In many parts of India--I think I may say most parts--native ladies are entirely shut out from any medical assistance, however great may be their need, because no man who is not one of the family can enter their apartments or see them; and though thousands thus die from neglect and want of timely help, yet nothing can be done to assist them until we have ladies willing and able to act in a medical capacity.”--_The Queen_, June 8, 1872.

[45] _Treasurer_, T. B. WINTER, Esq., 28 Montpelier Road, Brighton.

[46] _Scotsman_, Oct. 26, 1870.

[47] _Brit. Med. Journal_, May 25, 1872.

[48] _Macmillan’s Magazine_, September 1868.

[49] _Spectator_, April 13, 1867.

[50] See _Note C_.

[51] “_Theologia Moralis_,” by St Alphonsus.

[52] A curious coincidence recently occurred which may illustrate this feeling. Not long ago I was attacked in the newspapers for having alluded to this subject, and a certain doctor published three letters in one week to prove that “ninety-nine out of every hundred Englishwomen suffering from female diseases freely consulted medical men.” During that very week no less than three women, in different classes of society, appealed to me for advice and treatment for sufferings about which they “did not like to ask a gentleman.” In each case I advised them to consult a medical man, as I was not yet myself in practice, and there were no women doctors in Edinburgh; but in each case I found that their feeling in the matter was too strong to allow them to do so.

[53] “Concerning her death, it was magnanimous and answerable to the courage of heroes,” &c.--_Gallerie of Heroick Women_, written in French by Pierre le Moyne, and translated by the Marquess of Winchester, 1652.

[54] See _Note D_.

[55] “_Handbook of Uterine Therapeutics_,” by Edward John Tilt, M.D.

[56] See _Note E_.

[57] Besides these we have, at Bologna,--Maddalena Buonsignori, Professor of Laws, 1380; Laura Bassi, Professor of Philosophy, 1733; Maria Gaetana Agnesi, Professor of Mathematics, 1750; Clothilde Tambroni, Professor of Greek, 1794; and also other instances in various Italian Universities.

[58] Ghirardacci, “Historia Bologna,” Bologna, 1605.

[59] _Lancet_, June 18, 1870.

[60] _Lancet_, August 26, 1871.

[61] See _Note F_.

[62] _Scotsman_, March 22, 1870.

[63] _Pall Mall Gazette_, August 1870.

[64] _Medical Gazette_, New York, February 27, 1869.

[65] _British Medical Journal_, October 1871.

[66] _British Medical Journal_, May 18, 1872.

[67] For a _reductio ad absurdum_ of the whole question, let me refer to Dr Henry Bennet’s letter, containing the above words, in the _Lancet_ of June 18, 1870. An answer to it occurs in the _Lancet_ of July 9, 1870, and is referred to in _Note B_.

[68] See _Note G_.

[69] _Medical Times and Gazette_, Feb. 23, 1867, and April 24, 1869.

[70] It would have been perfectly easy in Edinburgh, during 1871–72, to make complete arrangements for instruction, partly inside and partly outside the walls of the University, if only the authorities would have authorised the lady students to organize the necessary classes for themselves at their own expense. But the obstructive party took refuge behind the traditional non-possumus, and could not be driven from their position, though the Lord Advocate of Scotland gave a distinct opinion to the effect that any needful arrangements might legally be made, and though the more far-sighted Professors strongly deprecated such an abnegation of University power for the purpose of subserving a merely temporary object. In point of fact, the whole history of this struggle is one long illustration of the good old proverb,--“Where there’s a will, there’s a way.”

II.

Medical Education of Women,

THE SUBSTANCE OF A LECTURE

DELIVERED ON APRIL 26TH, 1872, IN ST GEORGE’S HALL, LONDON,

THE RIGHT HON. THE EARL OF SHAFTESBURY IN THE CHAIR.

“You misconceive the question like a man, Who sees a woman as the complement Of his sex merely. You forget too much That every creature, female as the male, Stands single in responsible act and thought, As also in birth and death.

. . . . .

----I would rather take my part With God’s Dead, who afford to walk in white, Yet spread His glory, than keep quiet here And gather up my feet from even a step For fear to soil my gown in so much dust. I choose to walk at all risks.”

“_Aurora Leigh._”

MEDICAL EDUCATION OF WOMEN.

“When free thoughts, like lightnings, are alive, And in each bosom of the multitude, Justice and Truth, with Custom’s hydra brood, Wage silent war.”

Starting, then, with the assumption that women may, with profit to themselves and to the community, become practitioners of medicine, it is clear that they must, in the first place, secure such an education as shall make them thoroughly competent to take their share of responsibility in the care of the national health; and, secondly, that they must obtain this education in accordance with the regulations prescribed by authority, so that they may be recognised by the State as having conformed to all its legal requirements, and may practise on terms of perfect equality with other qualified practitioners.

It is essential to the thorough comprehension of this last point that the laws regulating medical practice in this country should be clearly understood, as these can never be lost sight of by those who are engaged in the battle which we are now waging, and I will, before proceeding further, endeavour to state clearly the provisions of the Medical Act of 1858. For the protection of the public against ignorant and mischievous quacks, the Act provided that no person should be recognised as a legally-qualified practitioner of medicine in the United Kingdom unless registered in a Register appointed to be kept for that purpose. The Act provided that all persons possessing the degree of M.D. from any foreign or colonial University, and already practising in this country at the date of the passing of the Act, should be entitled to be so registered; but that, with this exception, (and a curious one in favour of those on whom the doctorate had been conferred by the Archbishop of Canterbury,) no medical practitioners could demand registration unless holding a licence, diploma, or degree, granted by one of the British Examining Boards specified in the schedule attached to the Act. It is, of course, self-evident that these provisions were intended solely to defend the public against incompetent practitioners, and, though it is perhaps to be regretted that the Act did not expressly require the Medical Council to examine, and, on proof of competency, to register the holders of foreign diplomas, and all others who had pursued a regular course of medical study, it could not be anticipated that any great injustice would be done by the omission of any such a clause; and still less, assuredly, was it intended by this Act to secure to one sex a monopoly of all medical practice. But, at the present moment, it is certain that great danger exists that the Act may be wrested from its original purpose and made an almost insurmountable barrier to the admission of women to the authorised practice of medicine; and this because the Act, as it at present stands, makes it obligatory on all candidates to comply with certain conditions, and yet leaves it in the power of the Medical Schools, collectively, arbitrarily to preclude women from such compliance.

The following clauses of the Act of 1858 will show the absolute necessity that now exists for the registration of all practitioners of respectability:--

... “After January 1, 1859, the words ‘legally qualified Medical Practitioner,’ or ‘duly qualified Medical Practitioner,’ or any words importing a Person recognised by Law as a Medical Practitioner or Member of the Medical Profession, when used in any Act of Parliament, shall be construed to mean a Person registered under this Act....

“After January 1, 1859, no Person shall be entitled to recover any Charge in any Court of Law for any Medical or Surgical Advice, Attendance, or for the Performance of any Operation, or for any Medicine which he shall have both prescribed and supplied, unless he shall prove upon the Trial that he is registered under this Act....

“After January 1, 1859, no Certificate required by any Act now in force, or that may hereafter be passed, from any Physician, Surgeon, Licentiate in Medicine and Surgery, or other Medical Practitioner, shall be valid unless the Person signing the same be registered under this Act.

“Any Person who shall wilfully and falsely pretend to be, or take or use the Name or Title of a Physician, Doctor of Medicine, Licentiate in Medicine and Surgery, ... or any Name, Title, Addition, or Description implying that he is registered under this Act, or that he is recognised by Law as a Physician, or Surgeon, ... shall, upon a summary Conviction for any such offence, pay a sum not exceeding Twenty Pounds.”

It is, then, sufficiently plain that any doctor practising in this country without the required registration, not only places himself in the position of a quack and a charlatan, but actually incurs legal penalties for assuming medical titles, however fairly they may have been won in the most eminent of foreign universities. It is therefore clear that it becomes a _sine quâ non_ that any women, desiring to practise medicine in this country, should obtain their education in such a way as will entitle them to demand registration.

There are at this moment two Englishwomen whose names appear on the Register as legally qualified medical practitioners; and it may be necessary for me now to explain how they came respectively to attain this position, and how it happens that no more women are able to avail themselves of the means that were open to them.

Though several English ladies are recorded in history as having studied medical science, I am not aware that any of our country-women ever graduated in medicine before the year 1849, when Miss Elizabeth Blackwell, after surmounting many difficulties, obtained the degree of M.D. from a college in the State of New York. Returning subsequently to England, she took advantage of the clause in the Act of 1858, which I have already mentioned, and demanded and obtained registration in the British Register. But the clause referred to was, as I have explained, retrospective only, and no one can now obtain an American degree, and in virtue of it claim registration in this country.

This being the case, when, in the year 1860, Miss Garrett resolved to begin the study of medicine, with a view to practising in England, it was necessary that she should obtain her education under the auspices of some one of the medical corporations empowered to give registrable qualifications. After trying in vain to obtain admission to one School and College after another, she finally found entrance at Apothecaries’ Hall, which was, from its charter, taken, as I suppose, in conjunction with the provisions of the Apothecaries’ Act of 1815,[71] incapable of refusing to examine any candidate who complied with its conditions of study.

In order to observe the regulations of Apothecaries’ Hall, she was obliged to attend the lectures of certain specified teachers; and though she was, in some cases, admitted to the ordinary classes,[72] in others she was compelled to pay very heavy fees for separate and private tuition by the recognised lecturers. She had also considerable difficulty in obtaining adequate hospital teaching, though there was, in truth, hardly the slightest difference between the advantages she needed and those now habitually accorded to lady probationers and trained nurses, who are constantly present with the ordinary students at the bedside and in the operating theatre.[73] She obtained admission, however, to the Middlesex Hospital, and might, I suppose, have studied there as long as she pleased, had she not been unfortunate enough to acquit herself too well in some of the _vivâ-voce_ examinations in which she took part with the male students, thus arousing their manly wrath, which showed itself in a request that she should be required to leave the Hospital,[74] and this noble and magnanimous application was actually granted! She, however, completed her studies elsewhere, and especially at the London Hospital; being, it is to be presumed, too discreet to enter again on the field of competition. Thus, at length, she obtained her education, and, in 1865, received the licence to practise from Apothecaries’ Hall, which enabled her to place her name upon the British Register. But no sooner had she thus demonstrated the existence of at least a postern gate by which women might enter the profession, than the authorities took alarm, and, with the express object of preventing other women from following so terrible a precedent, a rule was passed, forbidding students henceforth to receive any part of their education privately, it being well known that women would be rigorously excluded from some at least of the public classes!

As, then, the different doors by which the two ladies above-mentioned entered the profession of medicine were both closed after them, it is evident that, when, three years ago, I looked round for the means of obtaining medical education in this country, it was necessary that some new way should be devised. It is true that in several of the European Universities women were at that moment studying medicine;--indeed, I am not aware that any of the Italian,[75] French, or German Universities have ever been closed against women who applied for admission. I might, no doubt, have obtained, at the world-renowned _Ecole de Médicine_ in Paris, a medical education at least equal, and, in some respects, probably superior, to anything that this country affords; and at the University of Zurich, also, a considerable number of women have, for some years, been receiving an excellent medical education. But it seemed to me radically unjust, and most discreditable to Great Britain, that all her daughters who desired a University education should be driven abroad to seek it; only a small number of women could be expected thus to expatriate themselves, and those who did so would have to incur the great additional difficulty and disadvantage of studying all the departments of medical science in a foreign language, and under teachers whose experience had been acquired in a different climate and under different social conditions from our own. And even if these difficulties could be overcome, another objection appeared to me absolutely insuperable. The Act of 1858 distinctly declares that only British licenses, diplomas, and degrees can now claim registration, and that without registration no practitioner can be considered as legally qualified. It is well known with what distinguished honour Miss Garrett lately passed her examinations in Paris, and with what brilliant success she gained one of the most valuable medical degrees in Europe, and yet in the official British Register her name appears only and solely as that of a licentiate of Apothecaries’ Hall. As no such license was now open to me and to other women, it was clear that those of us who went abroad for education might expect, after years of severe labour, to return to England to be refused official recognition on the Register, and, in fact, in the eye of the law, to hold a position exactly analogous to that of the most ignorant quack or herbalist who might open a penny stall for the sale of worthless nostrums. As such a position was hardly to my taste, it became necessary to try other means.

It seemed to me highly desirable that, if women studied medicine at all, they should at once aim at what is supposed to be a high standard of education, and that, to avoid the possibility of cavil at their attainments, they should forthwith aspire to the medical degree of a British University.

I first applied to the University of London, of whose liberality one hears so much, and was told by the Registrar that the present Charter had been purposely so worded as to exclude the possibility of examining women for medical degrees, and that under that Charter nothing whatever could be done in their favour. Knowing that at Oxford and Cambridge the whole question was complicated with regulations respecting residence, while, indeed, neither of these Universities furnished a complete medical education, my thoughts naturally turned to Scotland, to which so much credit is always given for its enlightened views respecting education, and where the Universities boast of their freedom from ecclesiastical and other trammels. In March 1869, therefore, I made my first application to the University of Edinburgh, and I hope in the following pages to give a rapid sketch of the chief events of the subsequent three years in connexion with that University, though time and space oblige me to make the sketch so brief that I must ask the reader’s indulgence if, in some points, it is less plain and distinct than it might be if I could enter more fully into details.

For the sake of clearness, let me first explain, in few words, who constitute the different bodies that take a share in the government of Edinburgh University, taken in the order in which my application was considered by them. The Medical Faculty of course consists of Medical Professors only; the Senatus comprises all the Professors of every Faculty, and also the Principal; the University Court is composed of eight members only;[76] and lastly, the General Council of the University consists of all those graduates of Edinburgh who have registered their names as members. Each of these bodies had to be consulted, as also the Chancellor, before any important change could be made.

When I first went to Edinburgh, I found many most kind and liberal friends among the Professors. In the Medical Faculty itself, Sir James Simpson, Professor Hughes Bennett, and Professor Balfour, Dean of the Medical Faculty, at once espoused my cause; and I need not say that Professor Masson and other members of the non-medical Faculties were not a whit behind in kindness and help. I found, on the other hand, a few determined enemies who would listen to nothing I could urge on the ground of either justice or mercy, and one or two who seemed to think that the fact of a woman’s wishing to study medicine at all quite exempted them from the necessity of treating her even with ordinary courtesy. The majority, however, occupied a somewhat neutral position;--they did not wish arbitrarily to stretch their power to exclude women from education, and yet they were alarmed at what seemed to them the magnitude and novelty of the change proposed.

Several Professors were especially timid about the question of matriculation, and argued that, till they had some evidence of probable success, it would be premature to let women matriculate, since, by so doing, they would acquire rights and privileges of the most extensive kind. To meet this difficulty I gladly accepted a suggestion made to me privately by the Dean of the Medical Faculty, that I should, for the present, waive the question of matriculation, and should, during the summer months, attend his class in Botany and that of Professor Allman in Natural History, to see whether, as the _Spectator_ expressed it, “Scotch and English students were really so much more brutal than Frenchmen and Germans,” or whether a lady could, without discomfort, attend the ordinary classes. This plan met with much approval, and some of the Professors’ wives most kindly offered to accompany me to the classes when the time should come. The Medical Faculty and Senatus successively sanctioned this tentative plan, and, after a short stay in Edinburgh, I left for England to make preparations for returning to spend the summer session as arranged.

But two or three hostile Professors appealed to the University Court; some of the students also sent up a memorial against the arrangement proposed, and the question was reconsidered.

* * * * *

I am anxious, as far as possible, to avoid personalities in this matter, and yet, I think, I cannot properly tell my story without explaining at the outset that, in my opinion at least, the whole opposition to the medical education of women has in Edinburgh, been dictated by one man and his immediate followers. It is hardly necessary to say that that man is Sir Robert Christison,[77] whose great age and long tenure of office naturally give him unusual weight, both in the University and among the medical men of Edinburgh. Having said this, I need only remark further that Professor Christison has, ever since I came to Edinburgh, been the only professor and the only medical man who has had a seat in the University Court, and also the only person who has all along been a member of every body, without exception, by whom our interests have had to be decided, viz., of the Medical Faculty, the Senatus, the University Court, the University Council, and the Infirmary Board.

The question then was brought before the University Court in April 1869. The meetings of the Court are held in strict privacy, (against which the public and the members of the University Council have often protested,) and I can only state the result of their deliberation. On April 19th the following resolution was passed:--“The Court, considering the difficulties at present standing in the way of carrying out the resolution of the Senatus, as a temporary arrangement in the interest of one lady, and not being prepared to adjudicate finally on the question whether women should be educated, in the medical classes of the University, sustain the appeals, and recall the resolution of the Senatus.”

The very palpable invitation to other ladies to come forward, which appeared on the face of this resolution, bore fruit; for, in the course of the next month, or two, four more ladies expressed their wish to be admitted as students, and certain of the University authorities held out hopes that an application for _separate_ classes would be successful. Accordingly, in June 1869, I addressed a letter to the Rector of the University, who is also President of the University Court, enquiring whether the Court would “remove their present veto in case arrangements can be made for the instruction of women in separate classes; and whether, in that case, women will be allowed to matriculate in the usual way, and to undergo the ordinary Examination, with a view to obtain medical degrees in due course?”

I also wrote to the Senatus asking them to recommend the matriculation of women as medical students, on the understanding that separate classes should be formed; and, moreover, addressed a letter to the Dean of the Medical Faculty, offering, on behalf of my fellow-students and myself, to guarantee whatever minimum fee the Faculty might fix as remuneration for these separate classes.

On July 1st, 1869, at a meeting of the Medical Faculty of the University, it was resolved to recommend to the Senatus:--