The Rise of the Medical Profession

By Judith Leask

The medical profession – that is, the role of physician – was one of the few ‘gentlemanly’ professions of the 18th-19th centuries[1]. Was it the prospect of attaining this status in society that attracted so many young men into the profession during this era? Was there an enthusiasm to practise the emerging powers to heal the sick that drew them in, or was it a desire for a place of public prominence at a charitable hospital? For some it may have been a philanthropic ambition to address the shameful living conditions of the poor, in both urban and rural locations; for others, no doubt, it was a hankering to gain access to the drawing-rooms of the wealthy and titled.

Dr Lydgate, the beautifully crafted character in George Eliot’s Middlemarch, was motivated by the need to view himself as a success, and to leave a legacy – to leave his name to some key piece of advancement in medical science; Dr Harrison in Elizabeth Gaskell’s The Cranford Chronicles wished to spread modern medical principles to the sleepy country town.

Whatever their varying motivations, young men were increasingly drawn to the study of this field – prominent centres of learning were London hospitals[2], as well as Edinburgh[3] and Glasgow[4]. In the later part of the 19th century, it was not only the young men who aspired to this profession – women began to question why they should be shut out, and began to break down the door (more on this later).

Anatomy

An improved knowledge in this area was essential for advancing medical science, and a continuous supply of cadavers was required to educate students of medicine, but the public were naturally averse. From the times of Henry VIII, dissection had been associated with the executed corpses of convicted felons or murderers, which were not permitted to be buried, and therefore did not receive the proper religious rites[5]. To have one’s body dissected was therefore an added punishment, and was a mark of an utter lack of respect, even ignominy. It’s easy to imagine, therefore, that doctors who pursued this form of study were held in suspicion – why would any person of respectability wish to do such a thing? Who could tell what such a doctor, so lacking in a sense of moral rectitude, may do to gain a further supply of cadavers to study?

The increasing demand for cadavers that outstripped the supply of executed bodies had somewhat ghoulish, if perhaps predictable, results – the practice of grave-robbing began to flourish. The trade of the Resurrectionists paid quite well: a gang of 15 grave robbers operated in the vicinity of Lambeth, using 30 burial grounds, until they were rounded up in 1795[6]. Families who were wealthy enough would have their deceased relative entombed in a metal coffin or had a mortsafe of iron bars placed around the grave.

Illustration of resurrectionists at work - Credit

While disturbing a grave was a criminal offence, the taking of the corpse was not – a corpse was not considered property, therefore could not be stolen[7]. However, engaging in this act was very ill-advised, given the strength of public feeling against dissection, and many medical students were lucky to escape with their lives from the angry crowds when suspected of being involved.

Others found a more direct source of cadavers to sell – famously Burke and Hare killed 15 of the lodgers who stayed at Hare’s Edinburgh lodging house over the course of about a year, until they were discovered in 1828. Before embarking on this killing spree they had taken the body of a man who had died of natural causes to the university and sold it for £7 10s; it seemed they could not resist engaging in a further trade[8].

This grisly trade resulted in the Anatomy Act of 1832, which gave physicians, surgeons and medical students the legal right to corpses that were unclaimed after death, in particular those who had died in a hospital, prison or workhouse [9].

Burke and Hare circa 1850 - Credit

Hospitals

The setting up of charitable hospitals also flourished through this period.

To take London as an example, in the early 18th Century St Thomas’s and St Bartholemew’s hospitals were the only two hospitals, endowed by Henry VIII and Edward VI respectively, and were supported by estates confiscated from the church at the time of the reformation. Then came Guy’s Hospital, founded in 1721 and supported by the large estate of Thomas Guy – these three ‘endowed’ hospitals could survive independently without the need for public donations[10] .

Further hospitals were set up in the 18th century via charitable associations. Coinciding with advancements in medical knowledge, hospitals became places where one might seek a cure, rather than simply receiving refuge and comfort. Many were also institutions for medical training, with some being set up specifically to serve close-by medical colleges.

This sounds as though people who could not afford to pay for their chosen doctor to treat them at home were well catered for – that multiple hospitals that served the growing urban population would provide for their needs. The reality was unfortunately quite different; in most cases it took some time and effort to gain admission – and often time was not on the patient’s side. To receive charitable treatment a patient would have to seek a letter of recommendation from a governor, who would be limited to the number they could recommend, and could pick and choose who they agreed to support.

Admissions were also only possible on one or two days a week[11].  Imagine falling ill with a dangerous fever on a Tuesday, if admissions at your local hospital occurred on Mondays only. Fortunately from the 1820s, institutions began to appear that did not require such a recommendation, or any payment – they would treat in case of need. Prince Albert was the supporter of one such hospital.

In addition to general hospitals, a number of lying-in (or maternity) hospitals were established.

Initially these were for married women only; perhaps the controversy that arose from these hospitals related to taking this activity into a more public sphere rather than existing only in the domestic – certainly the attendants were women only at first. One can only imagine what was said by genteel folk of the General Lying-In Hospital’s policy of admitting single as well as married women, when it was established in London 1767[12] .

Women in Medicine

In the 18th and early part of the 19th century, women’s role in the medical world extended to midwifery only, an occupation for a skilled low-born female.

As far as education was concerned, schools that admitted girls equipped them to be considered ‘accomplished’ and to at least know a little history, and so on; after all, what genteel man would want a wife who could not hold a reasonably intelligent conversation with their dinner guests, or play the pianoforte in the drawing-room? The story of women educationalists is a fascinating one – of women who defied convention to set up schools that taught a full curriculum, such as the Cheltenham Ladies’ College, founded in 1858[13] .

No university in this country awarded degrees to women until the University of London in 1878[14]  – and the London School of Medicine for Women, established in 1874, formed an association with this university in the late 1800s[15]  to enable women to train as doctors. To put this into context – Oxford did not award degrees to women until 1920[16], and Cambridge in 1921 began to acknowledge the studies of women but only with a ‘diploma’[17] . The first woman doctor in this country (registered in 1859) did not gain her degree here – Elizabeth Blackwell studied in Geneva, New York, gaining her medical degree in 1849, the first woman in America to do so[18].

Elizabeth Blackwell Postage Stamp - Credit

Can you imagine what it must have been like, as a young woman with aspirations, to attempt to break through the beliefs so firmly rooted throughout society at the time? To persuade the world to break with the centuries-old convention that prohibited their having an education and a professional role?

Nursing

While this post is about medicine, I couldn’t possibly neglect to mention Florence Nightingale in a discussion on healthcare and women’s roles in the 19th Century. She is described as the founder of modern nursing, and after her famous role as ‘the lady with the lamp’ in the Crimean War, she set up the nursing school at St Thomas’s hospital in 1860[19]. At a time before germ theory was accepted as the cause of disease, Florence instilled more sanitary conditions in hospitals and transformed nursing care.

Florence Nightingale - Illustrated London News, 1855 - Credit

But it is her determination to pursue her passion despite her family’s opposition that fascinates me – her refusal to have her life shaped by the conventional roles dictated by society. It was my admiration for her approach that led me to preface my book with this quote:

‘The world is put back by the death of every one who has to sacrifice the development of his or her peculiar gifts to conventionality.’ – Florence Nightingale.

Notes

 [1] http://englishhistoryauthors.blogspot.co.uk/2015/09/gentlemanly-professions.html
 [2] https://www.medsci.ox.ac.uk/about/history/oxford-medical-sciences-through-the-centuries/1800s
 [3] http://www.electricscotland.com/history/medical/medicine8.pdf
 [4] https://en.wikipedia.org/wiki/List_of_historical_medical_schools_in_the_United_Kingdom
 [5] http://www.leeds.ac.uk/chb/lectures/anatomy1.html
 [6] http://onlinelibrary.wiley.com/doi/10.1046/j.1440-1622.2001.02127.x/pdf
 [7] https://en.wikipedia.org/wiki/Burial_Act_1857
 [8] https://en.wikipedia.org/wiki/Burke_and_Hare_murders
 [9] https://en.wikipedia.org/wiki/Anatomy_Act_1832
 [10] http://www.nhshistory.net/voluntary_hospitals.htm
 [11] ibid
 [12] https://en.wikipedia.org/wiki/General_Lying-In_Hospital
 [13] https://www.cheltladiescollege.org/about-clc/history-of-college/
 [14] https://en.wikipedia.org/wiki/Timeline_of_women%27s_education
 [15] https://en.wikipedia.org/wiki/London_School_of_Medicine_for_Women
 [16] http://www.telegraph.co.uk/only-in-britain/oxford-university-allows-women-to-graduate/
 [17] https://en.wikipedia.org/wiki/University_of_Cambridge#Women.27s_education
 [18] https://en.wikipedia.org/wiki/Elizabeth_Blackwell

 [19] https://en.wikipedia.org/wiki/Florence_Nightingale

~~~~~~~~~~

Judith Leask is a long-term reader of historical and classical novels, and began writing fiction when dared to do so by a fellow wordsmith in her project management office. Six years, many writing group sessions and several re-writes later, her first novel Her Peculiar Gifts has now been released – a contemplative tale of James, a shy doctor, and his daughter Laura, who possesses unused talents. A further historical novel, set in Jamaica, is underway, and for her dragon-loving children she wrote The Silver Shell, to be released soon. Her story about the ghost of Charles Dickens can be found in the anthology Haunted. She has discovered a passion and a talent for developmental editing, and is now a freelance book editor with Just Right Editing. This gives her the chance to read and help to refine all manner of books – which is heaven for a bookworm.

https://judithleask.wordpress.com/
https://judithleask.wordpress.com/just-right-editing/

Marginalized Healer to Revered Hospital Matron

by Peter Ardern

I had the privilege of commencing my nurse training at the time of the traditional matron and ward sister. I developed a huge respect and still hold fond memories of learning from these highly skilled ladies. Their demise in the 1970s led me to, in the late 1990s, meet with and write about many of their lives and subsequently to examine the history of women in nursing.

The Woman Healer

From pre-history women have been regarded as the passive healers. They succoured the child and mended the wounded-warrior husband. They were the gatherer while the husband was the hunter. Both views can be and should now be challenged.

This ‘passive role’ of women in health has been re-enforced throughout the last two millennia. Custom, practice, and forced exclusion from academic institutions prevented women from attaining a higher education and therefore excluded them from the opportunity to contribute to the science of medicine.

Instead there developed the tradition of the rural, untrained woman healer. Doctors practised mostly for the wealthy or in the larger cities. So to these people the woman healer was virtually the unlicensed doctor, and in the absence of a medical practitioner, healing became the essential responsibility for these mothers and wives.

The techniques these ladies used were learned from family, friends, or from observing other healers.
They were the midwives/abortionists, nurses, and advisors. They could be the equal of pharmacists in cultivating healing herbs and unguents. They travelled from home to home and village to village. These women were effectively doctors without degrees.

Untutored in medicine, they used therapies based on plants, empirics, traditional home remedies, purges, bloodletting, and minor surgery.

They had their own painkillers, digestive aids, and anti-inflammatory agents, using ergot for the pain of labour at a time when the church held that pain in labour was the Lord’s just punishment for Eve’s original sin.

For centuries the female healer performed a service virtually indistinguishable from that of the one so guarded and aggressively defended by academically trained physicians.

Over the centuries, the use of magic, amulets, and incantations were also popular. Unfortunately these proved to be the undoing of many of these healers in the 15th to 17th centuries. In those centuries they became known as witches and charlatans by the authorities. And with this title they were mercilessly persecuted. Many of these women healers were burned because they used ‘cures’ and it only took the accusation of one doctor for ‘the witch’ to be found guilty.

The eighteenth century saw a new tolerance of the healers so long as they did not infringe on the doctor’s territory.

The nurse as we know her

Hospitals and nursing, as we know them, began in the 18th century with the building of new hospitals. The reformation, which began in 1534, had sounded the death knell for the poor sick, by sweeping away the few hospitals there were. This proved so calamitous that Henry the VIII was compelled to open St Thomas in 1550.

In the middle of the seventeenth century larger hospitals were built and the first simple hierarchical structure was in operation in the leading hospitals. It was headed by a triad of medical staff, governors and untrained matrons; then came the sisters, nurses, and helpers. It was not until the nineteenth century that matron’s duties and responsibilities were more clearly defined.

In the early years of the early 19th century, a nurse was simply a woman who happened to be nursing someone – a sick child or an aging relative. There were hospitals, and they did employ nurses. But the hospitals of the time still served largely as refuges for the dying poor with only token care provided. Hospital nurses were often disreputable, prone to drunkenness, prostitution, and thievery; their living conditions were often scandalous.

The religious orders did play a continuous role in providing care for the sick and in improving conditions and were often the only source of care. One among many nursing orders was the Little Company of Mary founded by Mother Mary Potter.

Florence Nightingale

The Nightingale reforms

Florence Nightingale undoubtedly changed nursing. Her basic principles were to lay the foundation of nursing as we were to know it for over a hundred years;
1/ A trained matron to have undisputed authority.
2/ A planned course of theoretical and practical training.
3/ A nurses’ home to be established at every hospital.

With a matron in charge, there were clear lines of accountability that were to be the cornerstone of nursing for over a century. It was the trained matron who was now the respected leader of the hospital. And from her nursing staff she demanded a high commitment of care. The following pledge ensured that.

I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully.
I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug.
I will do all in my power to elaborate the standard of my profession, and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my knowledge in the practice of my calling.
With loyalty will I endeavour to aid the Physician in his work and devote myself to the welfare of those committed to my care.

This was the first of three pledges and avowed by nurses for over sixty years. (This is often mistakenly ascribed to Miss Nightingale; it was however created by the Farrand Nurse Training School in Detroit, in 1892, for Miss Nightingale.)

Dr. Jex-Blake

Through Miss Nightingale the middle-class lady began to have an influence on the working world. These ladies embodied the very spirit of femininity as defined by sexist Victorian society, where nursing was still seen as a natural vocation for women, second only to motherhood. It would take many years before the ladies of nursing stood on equal footing to the men of medicine. Sophia Jex-Blake was the first female English Physician to bridge this gap, but it would take many years before women in medicine could count themselves to be on an equal footing to men.

The departure of the traditional matron and traditional ward sister in the 1970s also saw the demise of the famed mobcap, white cuffs, dark blue uniform, and cape.

~~~~~~~~~~~~~

In the late 1990s I spent a good two years seeking and interviewing a number of these traditional matrons and sisters. Hence I wrote, When Matron Ruled, The Nursing Sister, and paperback, When Sister Ruled.

My new novel, Dorothy’s Dream, combines many facets of the above history. Inspired by Hettie Ferris, a woman healer, and Aunt Annie, a Nightingale nurse in the Crimea, Dorothy achieves her dream of being a trained nurse. Then she discovers she is still a woman in a man’s world.

Dorothy’s Dream, A Historic Romance, is now available on Amazon.

Oh Those Victorians

by Enid Shomer

What does the phrase “Victorian Age” conjure for you? Hooped skirts and sexual repression? The industrial revolution? Darwin, Marx and Freud? Clearly it is a period rich in social change, and flavored with an air of moral supremacy that produced inevitable contradictions and hypocrisy. Because the era had such a profound impact on our own times, I have always found it fascinating. I thought I knew something about it before beginning my novel, The Twelve Rooms of the Nile, but nothing I had read prepared me for the cabinet of curiosities that I discovered.

In my novel, Florence Nightingale (the “Lady with the Lamp” and heroine of the Crimean War) and Gustave Flaubert (the author, most famously, of Madame Bovary) travel together through Egypt in 1850. In real life, they took separate, nearly-identical tours, sailing for months up and down the Nile, and visiting ancient monuments. We know that they were towed on the same boat and on the same day from Cairo to the navigable portion of the river. Flaubert records seeing an Englishwoman with a “hideous green eyeshade attached to her bonnet” and we know that Nightingale wore such a contraption.

There were other similarities. They were both in their late twenties, considered themselves failures, and were desperately unhappy. Both left an extensive written record of their travels and of their inner turmoil. The more I read, the more convinced I became that despite their obvious and striking differences, they shared a deep connection. Why were they both in a state of despair and why did they consider Egypt a “cure” for their misery? If they had met, I thought, they might have had a life-altering relationship.

Research uncovered rare tidbits about them and the Victorian period. In order not to give away any of the novel, I‘ll focus here on minor characters, and on information that fell beyond the scope or timeline of my book but which is interesting in its own right.

Before Nightingale left for Egypt, much to her family’s dismay she refused her only serious marriage proposal. Richard Monckton Milnes, her suitor, was widely known for his poetry, for writing the first biography of Keats and for being a member of Parliament. His fashionable Sunday brunches attracted everyone of import in London. But he also had a secret obsessive life known to only a few confidants. He amassed England’s largest collection of pornography (now housed in the British Library) and was also part of a group of prominent Victorian men who wrote pornography together as a hobby. They composed it round-robin style and published it under pseudonyms, always attributing the books to fictitious publishers in exotic locales—Constantinople, Cairo or Aleppo in Syria. While Florence Nightingale was daring and open-minded, I feel certain she would have been appalled.

Two other characters are Selina and Charles Bracebridge, Florence’s actual traveling companions in Egypt. A childless couple, they were Florence’s best friends and staunchest supporters, conspiring to help her achieve her goals despite the opposition of her family. Only a year before they had taken her to Italy, plucking her from one of the worst of the Nightingale family wars. But there is more to the story of these loyal friends, facts that are rarely mentioned in retellings of the Nightingale legend. Most of us know that Nightingale went to the Crimea, worked herself to a nub, became ill, nearly died, and yet managed to cut the British mortality rate by two-thirds by inventing what we recognize today as modern nursing. But how many people know that the Bracebridges went with her, facing horrific conditions and constant danger, and doing whatever scutwork she asked of them? There is no doubt in my mind that they are unsung heroes of the Crimean War.

Finally, there is Trout, the maid who accompanied Nightingale to Egypt, often serving as her chaperone. Other than a few mentions in Nightingale’s diary, the real Trout left no footprints in the historical terrain. I had to invent her from scratch.

In the Victorian Age, nearly one in four persons was “in service,” though almost none of them wrote about it. Fortunately, the maidservant Hannah Cullwick, who lived a bit later, kept a diary of her working life. For the fictional Trout, I borrowed Cullwick’s unusual relationship with a gentleman poet whom she clandestinely married. Literature about the pair mentions foot fetishism, infantilism, mysophilia, erotic gaming, ageplay, and other psycho-pathological terms. Despite these modern diagnoses, in my novel, Trout’s is a poignant love story whose eccentricities gives pause to anyone who thinks they understand Victorian attitudes toward sex.

Still on the subject of sexuality, I found significant differences between France and Britain. In Britain, even the medical textbooks were coy about the female body, using blank spaces or rough cartoons instead of realistic and anatomically correct drawings. In France, the doctors were unfettered by such Puritanical squeamishness. Again and again, I discovered diversity where I expected uniformity. Because Flaubert was French and Nightingale was English, there were opportunities to dramatize these differences, sometimes humorously, in the novel.

However, as interesting as these details are, I don’t want to give the impression that I chose to write this book for rational or intellectual reasons. What caught me by the throat and kept me going during the seven years I worked on the novel were not the resonances of the Victorian Age in our time but this: I kept thinking how amazing it would have been if these two geniuses had met. In the end, I wrote the book because I wanted to see what would happen when they did.


--Copyright 2012 by Enid Shomer


Enid Shomer won the Iowa Fiction Prize for her first collection of stories Imaginary Men, and the Florida Gold Medal for her second, Tourist Season, which was selected for Barnes & Noble’s “Discover Great New Writers” series. She is also the author of four books of poetry. Her work has appeared in The New Yorker, The Atlantic, Paris Review, and many other publications. As Visiting Writer, she has taught at the University of Arkansas, Florida State University, and the Ohio State University among others. She lives in Tampa, Florida. The Twelve Rooms of the Nile is her first novel.