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:--
(1.) That ladies be allowed to matriculate as medical students, and
to pass the usual preliminary examination for registration; (2.)
That ladies be allowed to attend medical classes, and to receive
certificates of attendance qualifying for examination, provided
the classes are confined entirely to ladies; (3.) That the medical
professors be allowed to have classes for ladies, but no professor
shall be compelled to give such course of lectures; (4.) That, in
conformity with the request of Miss Jex-Blake’s letter to the Dean,
ladies be permitted to arrange with the Medical Faculty, or with the
individual professors as to minimum fee for the classes.
At a meeting of the Senatus Academicus, July 2, 1869, the Report of
the Medical Faculty was read, agreed to, and ordered to be transmitted
to the University Court. At a meeting of the University Court, on 23d
July 1869, “Mr Gordon, on behalf of the Committee appointed at last
meeting to consider what course should be followed in order to give
effect to the resolution of the Senatus, reported that the Committee
were of opinion that the matter should be proceeded with under section
xii. 2, of the Universities Act, as an improvement in the internal
arrangements of the University. Mr Gordon then moved the following
resolution, which was adopted:--
“The Court entertain an opinion favourable to the resolutions of the
Medical Faculty in regard to the matriculation of ladies as medical
students, and direct these resolutions to be laid before the General
Council of the University for their consideration at next meeting.”
This resolution was approved by the General Council on October 29th,
1869, and was sanctioned by the Chancellor on November 12th, 1869. The
following regulations were officially issued at the same date, and
inserted in the Calendar of the University:--
(1.) Women shall be admitted to the study of medicine in the
University; (2.) The instruction of women for the profession of
medicine shall be conducted in separate classes, confined entirely
to women; (3.) The Professors of the Faculty of Medicine shall,
for this purpose, be permitted to have separate classes for women;
(4.) Women, not intending to study medicine professionally, may be
admitted to such of these classes, or to such part of the course of
instruction given in such classes, as the University Court may from
time to time think fit and approve; (5.) The fee for the full course
of instruction in such classes shall be four guineas; but in the event
of the number of students proposing to attend any such class being too
small to provide a reasonable remuneration at that rate, it shall be
in the power of the professor to make arrangements for a higher fee,
subject to the usual sanction of the University Court; (6.) All women
attending such classes shall be subject to all the regulations now or
at any future time in force in the University as to the matriculation
of students, their attendance on classes, Examination, or otherwise;
(7.) The above regulations shall take effect as from the commencement
of session 1869–70.[78]
In accordance with, the above resolutions, four other ladies and myself
were, in October 1869, admitted provisionally to the usual preliminary
examination in Arts, prescribed for medical students entering the
University. Having duly passed, and received certificates to that
effect from the Dean of the Medical Faculty, we, after the issue of
the regulations above cited, all matriculated in the ordinary manner
at the office of the Secretary of the University. We paid the usual
fee, inscribed our names in the University album, with the usual
particulars, including the Faculty in which we proposed to study, and
received the ordinary matriculation tickets, which bore our names, and
declared us to be “_Cives Academiæ Edinensis_.” We were at the same
time registered in due course as students of medicine, by the Registrar
of the Branch Council for Scotland, in the Government register kept by
order of the General Council of Medical Education and Registration of
the United Kingdom, such registration being obligatory on all medical
students, and affording the sole legal record of the date at which they
have commenced their studies.
It seemed now as if smooth water had at length been reached, after
seven months of almost incessant struggle. The temporary scheme
first suggested had been set aside, but its place had been taken by
one much more comprehensive, which had resulted from five months of
consideration and consultation, and which had ultimately received the
sanction of every one of the University authorities in succession. Not
only were women allowed the privilege of matriculation which we had
been told involved so much; but formal regulations, entitled “For the
Education of Women in Medicine in the University,” had been framed,
and have now for three years formed an integral part of the University
Calendar.