Exploring the vexing case of medical women in history

What do Solitica of the 1190s, Jane Pemell in the 1680s, and Esther Neumane from the 1860s have in common? They are all women who practised medicine but, unlike pioneers such as Elizabeth Garrett Anderson (1836–1917) and Sophia Jex-Blake (1840–1912), they remain almost entirely unknown.

Selecting the second exhibition for our 500th anniversary year, the RCP museum team felt it was important to tackle a challenging issue from the RCP’s long history. While today the RCP champions women physicians, the institution has not always had such an enlightened attitude. Through the exhibition we wanted to recognise both the famous and the forgotten women who have worked as doctors, surgeons, apothecaries, nurses, midwives, recipe writers and carers, during the last five centuries. 

The title ‘This vexed question’ is taken from a letter written by a male medical student in Edinburgh in response to the ‘Surgeons’ Hall Riot’ on 18 November 1872. In this infamous incident, a group of women medical students, including Sophia Jex-Blake, were violently harassed by a crowd of several hundred people, while on their way to sit an anatomy exam. This was the culmination of months of abuse levelled at the women, prompted by their attempt to qualify as doctors. We thought the phrase ‘this vexed question’ seemed to encapsulate the heated debates which have surrounded women in medicine through to the present.

Our approach is to acknowledge that gender and medicine continues to raise complex and contested issues. The exhibition is structured around seven core themes, which show how many of the same challenges have faced women in medicine whether it’s 1518 or 2018.

Women and the RCP

Over its 500-year history, the RCP’s interactions with women medical practitioners have been complicated. The founding charter makes no specific reference to women practitioners, probably because an Act of Parliament in 1511 had already set the legal precedent with its declaration that:

‘Forasmuch as the Science and Cunning of Physick and Surgery … is daily within this realm exercised by a great multitude of ignorant persons … Women … take upon them great Cures, and things of great Difficulty, in the which they partly use Sorcery and Witchcraft ...’

From its foundation in 1518, the college used its authority to grant licences to effectively exclude women from the formal medical sphere. 

Although the college punished many women practitioners severely, it sometimes looked the other way. Within ‘This vexed question’ an extract from a college Comitia held on 15 March 1586 is on display, in which Alice Leevers was accused of practising medicine. She had previously received punishments from the college for the same crime. Fortunately for Leevers, she had influential friends – Lord Hunsdon, Lord Chamberlain to Queen Elizabeth I, wrote to the college requesting that Leevers be allowed continue practising. Despite asserting that she was ‘utterly ignorant’ in medicine, the college allowed her to continue to use ‘outward medicines’ and surgery in cases when it was ‘lesse daunger to the party affected’. In essence, an unofficial sanction to continue practising medicine.

In the 19th century, Elizabeth Garrett challenged the RCP bye-laws which excluded women. Writing to the president in 1864, she declared:

‘I believe that in the interest of the public and for the honour of the profession women should be subject to the severest tests open to men. It is no longer possible to exclude women from the profession; it is only possible to confine them to one and that a comparatively easy mode of entrance.’

She was referring to the Licence of the Society of Apothecaries which, after a significant battle, she gained in 1865. The Society of Apothecaries has kindly lent Garrett’s qualifying certificate for ‘This vexed question’. It was not until the early 20th century that the RCP eventually decided to change its restrictions on women members. Dr Dossibai Patell became the RCP’s first woman licentiate after passing the Conjoint Exam with the College of Surgeons in 1910.

‘Kitchin physic’

Despite being almost entirely excluded from formal practice for centuries, women have long been experienced and knowledgeable medical practitioners. They recorded and shared medical information through hand-written and published books, often known as ‘recipe books’, usually passed from mother to daughter. Robert Burton, writing in 1621, went as far to claim that: ‘Many an old wife or country woman doth often more good with a few known and common garden herbs than our bombast Physicians with all their prodigious, sumptuous, far-fetched, rare, conjectural medicines.’

A small number of women reached a wider audience with books or medicines bearing their name. The Royal Pharmaceutical Society Museum has lent a range of unusual ingredients used to make the Countess of Kent’s Powder. This cure-all medicine was made famous through the Countess’s publication of her recipes in A Choice Manuall of Rare Conceits in 1653, which will also be on display. 

Gender norms

Much of the historical and recent debate about women doctors has centred on expectations of a ‘natural’ woman’s role.  For centuries, many people perceived the practice of medicine as inherently ‘manly’ – requiring physical strength, mental fortitude and discretion. Women doctors were often suggested to have a biological disadvantage, unable to cope with the demands of a medical role.

The real experiences of men and women challenged these stereotypes. ‘This vexed question’ will include adverts, letters and books showing that women were vital in family businesses and worked as apothecaries, surgeons and midwives.

The exhibition also explores the long-standing expectation that women should act as primary carers, within a domestic sphere, and with motherhood as their primary ambition and duty. A piece in The Lancet in 1878 claimed: ‘Woman as a doctor is a conceit contradictory to nature, and doomed to end in disappointment to both the physician and the sick.’ This sentiment is often echoed in the records of the RCP, with president Sir Richard Douglas Powell stating in 1907 that: ‘Women ought not to be encouraged to enter a profession for which they were constitutionally unfitted.’

The first woman doctor

‘This vexed question’ demonstrates that women have always worked in medicine, whether formally acknowledged by authorities like the RCP or not. It questions the assumption that Elizabeth Garrett Anderson was Britain’s first licensed woman doctor. The exhibition features testimonials from Lambeth Palace Library that supported Jane Pemell’s successful application for a medical licence from the Archbishop of Canterbury in 1695.  Esther Neumane presented herself as Madame Cavania in adverts from the 1860s, promoting her services and her medicines (also on display) as the first ‘doctress by diploma’, even before Garrett Anderson became the first woman to qualify as a doctor through official channels in England.

Midwifery

Midwifery has been a focus of debate for centuries. Traditionally considered a woman’s role, men were not allowed into the birthing chamber for many centuries. In the 18th century, man-midwives or accoucheurs approached birth differently, notably with the use of instruments such as forceps.

The exhibition includes forceps lent by the Royal College of Obstetricians and Gynaecologists which were designed by 18th-century physician William Smellie, known as the ‘father of midwifery’. Forceps were vehemently opposed by women midwives, including Elizabeth Nihell. In her 1760 pamphlet, Nihell criticised Smellie’s forceps, claiming they ‘pretended to be improved by Dr Smellie’, and that their innovative leather covering made them bulkier, more difficult to use, and more likely to harbour infection.

The exhibition brings the midwifery debate up to date with a contribution from a current male midwife, who is one of only 0.5% of the total working in Britain today.

Acceptable spheres

With the development of medical specialties in the 19th century, early women doctors identified spheres where it was more socially acceptable for them to practice. These spheres were typically less prestigious or palatable for male practitioners, such as paediatrics, palliative care or venereal disease. A bust of Cicely Saunders, the founder of the modern hospice movement, looks over a display case showing women first employed as surgeons at the London Lock Hospital in the 1920s. Women medical missionaries such as Ellen Farrer worked in India at a time when their role in the profession was still strongly questioned in Britain.

The First World War allowed women doctors, surgeons and nurses the chance to demonstrate their capabilities. The urgent need to treat the wounded broke down established boundaries between male and female areas of medical practice. The exhibition will feature a painting from the Imperial War Museum of an operation at Endell Street Military Hospital.

This military hospital, run entirely by women, was led by suffragette surgeons Flora Murray and Louisa Garrett Anderson. Begrudgingly supported by the Royal Army Medical Corps, the pioneering work of this hospital helped changed perceptions that women could not treat male patients.

Activism

The exhibition features a number of objects related to the suffragette cause, particularly fitting as we mark Vote100 – 100 years since some women were granted the right to vote. A letter from Louisa Garrett Anderson to the chair of her hospital board – reassuring him that she had all arrangements covered should she be arrested for her militant suffragette activities – was a wonderful discovery at London Metropolitan Archives. It is displayed alongside an embroidered handkerchief from the Sussex Archaeological Society marking the imprisonment of 66 women in Holloway Prison in 1912, including Liverpool GP Alice Ker. For many early doctors however, such political activism seemed to threaten their fragile place in the profession.

Briony Hudson is the guest curator for This vexed question: 500 years of women in medicine, which opens on the 19 September and runs until 18 January 2019. You can follow her on Twitter at @brionyhudson2

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This article features in the October issue of Commentary magazine.