There are cases where the towering homogeneity of Victorian culture is exaggerated. The era of Prince Albert and Lord Palmerston was, after all, also the age of George Eliot, Charles Darwin, and Karl Marx. Beneath the deceptive appearance of total societal conformity were swirling currents of dissent and radicalism that would shape the twentieth century once the Great War decisively threw Europe’s staid self-confidence for a loop.
However, there are pockets of history where Victorianism’s reputation for ramrod inflexibility and rank injustice are well-earned, and the story of medical women in the nineteenth century is among the most frustrating tales of that magnificently aggravating era. I am hard-pressed to think of an entire profession acting with such regular hypocrisy and calculated unity to shamefully hinder its own best interests in the name of social convention and popular prejudice as did the British medical community of the 19th century when presented with the desire of women to become practicing doctors.
The pioneers in that movement suffered every imaginable indignity in their quest to learn and to work, a trial by fire that produced a vanguard of iron-willed practitioners who within decades summoned educational institutions, clinical associations, and key legislation from the blank ether. That vanguard included the first British woman doctor, Elizabeth Blackwell, the founder of the London School of Medicine for Women, Sophia Jex-Blake, and the doctor, instructor, surgeon, organizer, and administrator from whom all the movement’s great projects ultimately stemmed, Elizabeth Garrett Anderson (1836-1917).
No step of her path was easy. Where a man’s road to medical practice was smoothed by institutional regularity and strengthened by organizational membership, Garrett was compelled to act constantly in the shadows, snatching bits of learning and experience where she could, trying not to draw attention to herself lest her surreptitious learning sources get taken away as well. For a decade, she lived in the spaces of official doubt created by charter loopholes and bureaucratic disorganization, achieving significant personal milestones only to see them closed behind her as institutions, horrified by what she had managed to accomplish, begrudgingly stole away the opportunities for future students to achieve even her hard-fought sliver of success.
For her first twenty-four years, Garrett’s story was that of most daughters raised by tolerant, wealthy, and liberal-leaning fathers of the Victorian age. She had been given an education better than most, including studies in Latin, French, and German, and was regularly included in her father’s discussions about European politics, which lessons she attempted to then pass on to her many younger siblings. She was smart and politically aware, but heading into her early twenties, had no direction for her energies and talents until her path chanced to fall across those of two of England’s most remarkable women: Dr. Elizabeth Blackwell, who had broken all convention when she earned a medical degree in the United States, and Emily Davies, who devoted herself to championing promising young women in their efforts to break into the professions.
Blackwell inspired Garrett, and Davies relentlessly pushed her to act on that inspiration, to find a way to stay in England and force its institutions to recognize her as a practicing doctor. When her father heard of her plan, he was resistant at first but came around in quick order, and was her life-long ally in the cause of advancing women’s medical education. Her mother, on the other hand, locked herself away in her room, insisting that she was on the verge of dying of grief because of Garrett’s decision. Family members flooded Garrett with letters begging her to put an end to her plans before her stubbornness killed her poor mother.
She did not end her plans, and her mother, you will be no doubt surprised to hear, did not expire of grief. Since all formal educational institutions were closed to her, she decided to gain some experience and test her resolve by volunteering as a surgical nurse for six months as a preliminary step. This was in 1860, and Lister’s famous experiment using carbolic acid in surgery was five full years away, meaning that Garrett was to experience the full horror of pre-modern surgery. Doctors went from dissection theater to the operating hall failing to wash their hands in between, and patients died at startling rates from infections even after minor surgeries. Tending those infections and observing those surgeries was Garrett’s job, and it was taking the medical profession by the grizzliest end.
Her hospital had a medical school which of course refused her admittance but by virtue of her dedication and faultless record, she developed personal relationships with the doctors that opened subtle doors here and there. She was allowed into the dissecting rooms and given private lessons in materia medica and Greek by some of the profession’s more luminous names. She was even allowed to attend some of the foundational chemistry lectures until one day when the professor asked a question and none of the male students knew the answer.
Garrett knew, and made the fatal mistake of raising her hand and giving the correct response. This was considered an outrage by the students and they circulated a petition to bar her from every aspect of the college, to rescind every minor privilege she had clawed from the administration, an act of cowardly and selfish spite that is baffling still for its sheer smallness of spirit. Their motion carried, and Barrett was cut off from all avenues of official instruction.
She needed to show the country that a woman could be an effective doctor, and that many patients benefited tangibly from having the option of a woman doctor available to them.
Or very nearly. Through an oversight in its charter, the Society of Apothecaries had no clause that forebode women from receiving their medical credential. If she could find an apothecary to apprentice to, and pass the examination, there was legally nothing they could do to stop her from receiving their license to practice medicine. She found a doctor willing to take her on, studied every waking hour to cram in all the Greek and Latin and chemistry and biology that she had missed in her youth, and after three years, in 1865, she aced the Society’s exam with the highest score. She was to be a doctor after all.
In horror, the Society of Apothecaries closed its loophole after her victory. There were then no institutions that gave qualifying medical examinations in Britain, meaning that women had to take their exams in other countries to have any sort of certification at all, which would have been something were it not for the fact that the British medical community refused to recognize foreign certifications as legitimate. By closing off the last domestic institution that offered certification and refusing to admit the legitimacy of foreign certifications, England had effectively walled itself off completely from the possibility that women might contribute to its medical life.
But Elizabeth Garrett had gotten through before the final gate had swung shut, and she was determined to make her unique position count for as much as possible. She needed to show the country that a woman could be an effective doctor, and that many patients benefited tangibly from having the option of a woman doctor available to them. In 1866 she was a founding figure for St. Mary’s Dispensary for Women and Children, an institution staffed entirely by women. Garrett was the central force there, being the only certified doctor on staff, but she gathered around herself a crew of foreign-credentialed women and aspiring students and the dispensary throve. Women packed the waiting room, attracted by the reputation for excellent care and the chance to finally see a woman doctor who might actually tell them things instead of patronizing them with Victorian obfuscations. Her dispensary proved that women benefited from access to women doctors, and proved that women doctors were efficient and capable of even the most complicated of surgical practices.
To bolster her credentials, Garrett went to Paris in 1870, took the medical examination there, in French, and overwhelmingly passed, adding another achievement to the cap of the British women’s medical movement, and increasing the prestige of her private practice, though of course doing nothing for her officially in the British medical community. When a restructuring of the British educational system was carried out that same year, it allowed women to stand for positions on school boards, and Garrett put her hat definitively in the ring, giving speeches to her constituency and winning the election in a landslide, earning 47,848 votes while her nearest competitor only pulled 13,494. Her chief strategist for that election was James Anderson, a steamship company owner who was intoxicated by her talent and drive and duly fell in love with her.
The two married in 1871 with the explicit understanding that Garrett would continue with her work. Anderson supported her efforts completely, even as their mad joint work schedule invited outside comment. Successfully established as a private doctor, with international and domestic certification, and a founding figure of an outrageously successful experimental hospital, Garrett had by no means expended her bag of tricks. She realized that membership in the British Medical Association would represent a massive advance for women doctors, so she obtained membership quietly through one of its more remote branches in 1873, remaining unobtrusively on the books for two years before arriving at meetings in London. Unable to deny her entrance, the Association nevertheless immediately moved that a statute be put on the books denying all future women applicants admission to the society.
Garrett, during the debates, rose and gave one of the great speeches of nineteenth century feminism, laying out all that had been done already by women doctors, demonstrating that their numbers would only grow, and outlining how refusing all communication with this growing crop of practitioners was a deep betrayal of the basic principles of the Association. The theretofore hostile crowd spontaneously erupted in cheers during several parts of her address, but it was not enough to turn the tide. She was allowed to remain in the BMA, but she would have to be the last. That policy remained in place for two decades.
Where a man’s road to medical practice was smoothed by institutional regularity and strengthened by organizational membership, Garrett was compelled to act constantly in the shadows, trying not to draw attention to herself lest her surreptitious learning sources get taken away as well.
Meanwhile, Sophia Jex-Blake had, after leading a group of women to study medicine at the University of Edinburgh only to be denied the fruits of their studies at the last moment, decided to take matters into her own hands and found a medical school exclusively for women. Distinguished doctors who were incensed at the behavior of the University of Edinburgh volunteered to teach the courses, and soon she had assembled a roster of talent that no accrediting board could deny. Garrett was initially hostile to the idea, thinking that a much more practical road was to have English women study abroad and to work for legislation to get those credentials recognized, but Jex-Blake ploughed through all difficulties, eventually sweeping Garrett into the organization as a lecturer and administrator.
That college, the London School of Medicine for Women, would become another runaway success, educating dozens of women to enter the profession. Once medical examinations were open to women in 1877, the students of Jex-Blake’s college were regular gold medal winners, sometimes scoring so much higher than their male counterparts that whole new categories of achievement needed to be created for them. Garrett served as dean and ultimately as president of the school in the late 19th and early 20th centuries, raising money to meet the needs of the quickly expanding student body.
By navigating the back alleys of institutional charters, she had put herself in a position to demonstrate what women were capable of, and by founding and supporting hospitals and schools that gave women unheard of options for the care of their bodies and the education of their minds, she had worked a revolution in England’s most conservative and mulish profession. When World War I came, Britain had a trained corps of women doctors ready to serve at the front, and Elizabeth Garrett was there to wave them off. As memory and health failed her, she held onto the knowledge that all the reversals she had known had made a tangible difference. Where she had to snatch knowledge from the shadows, her professional daughters and grand-daughters consumed it with relish in the full light of day, and in that realization there was satisfaction, and peace.
FURTHER READING: Garrett’s daughter, Louisa Garrett Anderson, wrote a wonderful biography of her mother in 1939 that benefits from access to Garrett’s letters and from Margaret Todd’s 1918 The Life of Sophia Jex-Blake. It’s one of those books I like so much that I just re-read it instead of trying Jo Manton’s biography or Elizabeth Crawford’s almost impossible to find Enterprising Women: The Garretts and their Circle of a decade or so ago. Which is terribly irresponsible of me, and for which I here beg pardon.