The Middle Ages
As barbarian tribes invaded the Roman Empire, art, literature and medical science declined. The work of healing fell to women in the home and in nunneries. St Bridget was one of several holy women who were canonised for their work in medicine and obstetrics. The education of women suffered in medieval times as the early church emphasised that women were inferior beings.
However, in Salerno, Italy, the medical school accepted women. The tolerant community
of Salerno allowed influences from Jewish, Roman, Greek and Middle Eastern origin to share their knowledge, including medical concepts. The most famous woman in this faculty was Trota, who wrote a text on obstetrics and gynaecology that was in use for more than 400 years.
Witch hunts swept through Europe in the Late Middle Ages. As it was forbidden for women to study medicine, any skills they possessed were considered the work of the devil. Widows, spinsters and other women who refused to conform, such as midwives, were the frequent target of such hunts. During the witch hunts from the 13th to the 18th century, women were denied access to medical training. Laws and guilds established in England and France further prevented women from practicing professionally, although many continued as nurses and midwives.
In 1313, women in Paris were banned from the practice of surgery unless they were examined by a jury. Widows were exempt and could assume the practices of their husbands. In 1540, Henry VIII granted the charter for the Company of Barber Surgeons but women were not allowed to join.
The Victorian era
The advent of anaesthesia, the establishment of hospital systems and the increase of campaigning for social and political rights all opened the door for women to enter the practice of medicine and surgery. No longer was surgery a barbaric practice where awake patients were held down for gross procedures such as amputations. The ‘pre-anaesthetic’ surgeon was often portrayed as a butcher. Surgery became a much more delicate and intellectual craft, providing greater opportunity for women to become involved.
Social attitudes still remained problematic, with men believing women would not be able to perform surgery for mental, physical and moral reasons.
Early British women in surgery
James Barry (1795–1865) was educated at the distinguished Edinburgh Medical School, the alma mater of many Australian surgeons prior to the establishment of RACS. He joined the army as a surgeon during the Napoleonic wars and performed one of the first successful Caesarean sections on the wife of a wealthy patron who was in obstructed labour.
At the time of his death, James Barry was found to have been a woman, and an autopsy suggested she had a pregnancy in the past. It had also been rumoured that he had been in at least one long-term ‘homosexual’ relationship. Dr Barry was Dr Miranda Stewart. Upon her death one of her friends commented that “She chose to be a military doctor. Not to fight for the right of a woman to become one, but simply to be one.”
Elizabeth Garrett Anderson (1836–1917) – the pawn broker’s daughter Garrett Anderson was the first woman to experience an operation not as a patient, but as a future surgeon, in 1860. She was the first woman to qualify as a surgeon in Britain. She opened the London School of Medicine for Women and paved the way for many women to follow. Elizabeth was the daughter of a pawn broker with 12 children.
Mary Scharlieb (1845–1930) – from the subcontinent to Harley Street Scharlieb married a London lawyer whom she accompanied to India where he practiced as a barrister. Here she was among the first four women to attend the Madras Medical College. On her return to London she studied at London School of Medicine for Women and in 1882, aged 37, Scharlieb received a Bachelor of Medicine and Surgery with honours in all subjects, the Gold Medal and an obstetric scholarship. In 1883 Mary returned to Madras, where she became the chief gynaecologist and a lecturer at the Madras Medical College. In India she worked with her sister as her anaesthetist and her maid as her surgical assistant. In 1887, she set up rooms in Harley Street with her medical-student son, where she practiced for the following 40 years.
Adelaide Knight was the first Australian woman to qualify in medicine, as a prize-winning student of the London School of Medicine for Women (LSMW). She was acknowledged as a talented house surgeon. When she suddenly died unexpectedly at the age of 25, many obituaries praised her qualities and lamented the end of her promising career.
The Tragic Tale of Helen Prideaux Knight’s death was a reminder of the death of another talented student of LMSW, Helen Prideaux, six years earlier. In a strange coincidence, Knight had been the recipient of the prize named in honour of Prideaux. She had used this prize money to travel to Vienna where she contracted the illness that killed her.
Prideaux died of Diphtheria contracted during her work at the Paddington Children’s Hospital. Her obituary describes her courageous and calm demeanour throughout her suffering, which included a tracheotomy and laryngotomy. She is said to have “vindicated the right of women to take the highest position in a difficult and intellectual profession. The leader of the committee to establish a fund in her name was Sir William Gull, previously an opponent of women entering medicine. He stated that by leading the honours list and obtaining the University of London’s Gold Medal in Anatomy, she had “swept away” prejudice “from the path of all who might follow her.”
The Royal College of Surgeons allows women entry
In 1908, the vote to allow women to join the Royal College of Surgeons (RCS) was finally won. Pressure had been increasing since 1895, when the vote was lost by only a small margin. The RCS’s council had favoured admission of women to its examination. Ironically, it was the Royal College of Physicians who denied the women entry in their capacity as conjoint decision makers! The first female fellow, Eleanor Davies-Colley, was admitted in 1911, although behind the scenes in operating theatres large and small, numerous women had been carrying out surgery for some years.
Early North American women in surgery
Elizabeth Blackwell (1821–1910) – overcoming rejection
Blackwell was the first female doctor in the US. While Miranda Stewart was impersonating
a man to practice surgery in the UK, Blackwell was rejected from 29 US medical schools. She was finally accepted to the Geneva Medical College. Despite graduating with a Gold Medal, she could not obtain a residency position anywhere and eventually served as an obstetric nurse. She had to give up her ambition to be a surgeon when she developed a suppurative eye infection and lost vision in one eye. Eventually Blackwell returned to the US and established the New York Infirmary for Women and Children. She later opened the Women’s Medical College of New York. In 1889, 40 years after graduating, she was recognised as the first female doctor in the USA and is now recognised by many awards named in her honour.
Mary Edwards Walker (1832–1919) – war heroine
Edwards Walker became the first female surgeon in the US and was the second female graduate of a US medical school, in 1855. She went into practice with her classmate and husband, Albert Miller. It was said that the practice failed because she failed to change her last name and practiced openly as a woman. She became the first female surgeon in the US Army after resorting to working as a nurse for several years. In 1865 she received the Congressional Medal of Honour for her work as an army surgeon during the Civil War, during which she spent time as a prisoner of war. The US Congress revoked this honour in 1917 for Edwards Walker and many recipients on the grounds that they had not served on the front line. She refused to return the medal and took it to her deathbed. The Medal was reinstated by President Carter in 1977. Of over 3,500 Medals of Honour awarded, Edwards Walker remains the sole female recipient.
Jennie Smillie Robertson (1878–1981) – a choice between surgery and marriage
Although Smillie Robertson graduated from the University of Toronto, no Canadian residency program would accept women, so she trained in Philadelphia. On her return to Canada, she established the Women’s College Hospital and was the chair of gynaecology for 30 years. She also established the Federation of Medical Women of Canada. Smillie Robertson married her childhood sweetheart at the age of 70. She noted that when she first met him many, many years prior, she was “planning for medicine not marriage and I didn’t think I could have both.”
Early twentieth century
Britain: more women in surgery at home and at the front
By the early 20th century, British women were performing the most complex of operations for malignant disease. WWI opened many professional opportunities for women both at home and near the battlefield. When offers of assistance were rejected by the War Office, women simply established their own hospitals in many European countries just as they had in Britain. The many Scottish Women’s Hospitals were some of the best-known examples. Here women not only gained increased confidence and surgical experience but often had their first real experience of operating on the opposite sex, having been largely confined to practice on women and children in the past.
At home, with male members at every level of the profession leaving their posts, there was an enormous growth of female students of medicine. Many hospital and university positions were open to women for the first time. Women were regularly reminded that these ‘locum tenens’ were for the period of the conflict only and that the status quo would resume after the war.
In 1860 there were no medical women. Fifty years later there were 1,000 women on the medical register. In 1918 there were 665 female entrants to medical schools, comprising nearly one third
of the total number.
USA: the rise and fall of women in medicine
Increasing numbers of women were admitted to medical schools during the mid to late 1800s. Financial forces assisted their entry as supporters of feminism made major contributions to schools accepting women. By the late 1800s, several previously all-male schools were accepting women and legislation was enacted to allow medical schools for women. Social acceptance grew as female doctors became more visible by giving public lectures on subjects such as hygiene.
The number of medical schools open to women rapidly decreased in the early 20th century, hastened by the Flexner Report. Reforms were underway when inadequate teaching was reported at many schools that coincidentally admitted the most women. Although these schools sought to keep high standards, they had limited financial resources, and many closed. Flexner himself, although stating “privileges must be granted to women . . . on the same terms as men,” believed that the declining numbers of women was due either to a lack of desire to be doctors or lack of demand for female doctors, as opposed to diminished opportunities.
Many women’s medical schools merged with men’s schools, anticipating greater equality. However, medical schools with higher numbers of women tended to have less prestige and they began reducing the number of women enrolled. By 1914, only four per cent of medical students were women. Aside from small increases during World War I and II, when there were fewer men to fill the slots, female enrolment was low. Even in the late 1960s, many medical school administrators openly stated preference for males and had internal quota systems that limited the entry of women. It was not until the rise of the feminist movement in the 1970s that the social atmosphere became more encouraging for women entering medicine.
It is interesting to ponder the marked differences in the plight of the female medical/surgical workforce between the UK and the US at this time in history. There is a profound difference between the female medical student numbers of four per cent in the US versus almost 33 per cent in the UK.
For those interested in the early history of Australian women in surgery, I would highly recommend the following articles by Associate Professor Susan Neuhau, an Adelaide general, oncological and military surgeon:
– 'Australia’s female military surgeons of World War 1’ (ANZ J Surg, August 2013)
– 'Surgery: No profession for a lady’ (ANZ J Surg, November 2015)s, an Adelaide general, oncological and military surgeon:
Bibliography on request.