High Minds

by Simon Heffer

  VIII

  Cowper-Temple was not interested simply in getting women into universities: he knew the next step was for them to enter the professions. Foremost among these was medicine, not just because numerous women wished to become doctors, but because more women wanted their own sex to care for them when they fell ill. Cowper-Temple described the profession as one ‘for which they were by nature most peculiarly suited. A woman was in her best position by the side of the sick bed or in the hospital, and those whom nature had prepared to be nurses, art could easily make into doctors. A Petition had been presented to that House signed by above 16,000 women, declaring that they desired the opportunity of consulting good medical advisers or properly qualified persons of their own sex, and that they thought it a hardship that the laws of this country should lead to regulations that prevented any woman adopting medicine as a profession.’133

  He knew there was:

  a considerable objection to this in the medical profession as represented in the Universities; but he had observed that in cases of alterations or innovations proposed to be made in professions, whether military, naval, or legal, the public could not submit to professional opinion. The members of a profession were often unable to consider without bias innovations relating to themselves; and much as he respected the medical profession, he would still say that Parliament ought not to give undue attention to objections which they might raise in matters relating particularly to their own profession. Let them rather look to the needs and desire of the public at large, and they would see that female medical practitioners in London and Birmingham had met the wants of numerous patients.

  Cowper-Temple struggled for support among the reactionaries of the Commons, but was vigorously supported by the scientific and educational establishment. In 1869 Edinburgh University had broken the mould in Britain by accepting a twenty-nine-year-old woman, Sophia Jex-Blake, an alumna of Queen’s College and a former mathematics tutor there, to read medicine. Jex-Blake had argued the point Cowper-Temple subsequently made: that many women wanted medical attention from one of their own sex. When Jex-Blake was accepted by Edinburgh she advertised for other like-minded women to join her, and six did. They met serious opposition from elements in the university, being denied the right to attend lectures. They had to raise the money to pay lecturers to teach them separately, but even then Edinburgh would not award them degrees. In 1874 she was a founder of the London School of Medicine for Women, and campaigned for legislation that enabled, but did not compel, examining bodies to treat women medical students just as they treated men. Jex-Blake was not a beneficiary of this law, qualifying at the University of Berne first. The College of Physicians of Ireland was the first in the United Kingdom to admit women to medical degrees: Jex-Blake subsequently took the Licenciate’s examination there, which enabled her to be registered with the General Medical Council and to become only the third registered female doctor in the country. She set up a practice in Edinburgh and, in 1886, founded the Edinburgh School of Medicine for Women.

  Elizabeth Garrett had been the first on the register. In 1849 her father had been sufficiently enlightened to send her, aged thirteen, to a girls’ school in Blackheath run by Robert Browning’s step-aunts. The teaching was unimpressive – deportment was on the curriculum – but Elizabeth did pick up a love of reading and, with it, a profound intellectual curiosity. Once her education finished she continued to read, and studied Latin and mathematics more deeply in her own time. She read an article by Elizabeth Blackwell in the English Woman’s Journal, and conceived the idea of becoming a doctor. Emily Davies attended Blackwell’s London lectures with her and supported her. The obstacles were, though, formidable.

  Fortunately for Garrett, her father supported her financially. Her training began in the only way it practically could, with her working as a nurse at the Middlesex Hospital. After she had excelled in that vocation, and had been allowed to attend operations, she applied to join the medical school there. ‘It appears to me’, she wrote to Davies in October 1860, ‘that I should not go on receiving instruction as a pupil under the guise of a nurse, and that it will be right to ask the college authorities to allow me to pay the usual fees in these special departments and to have the run of the hospital as at present for medical observation.’134 Her application was rejected: but the hospital’s apothecary gave her private tuition while she continued her nursing duties, in return for a donation to the hospital.

  Her father hired her a tutor in anatomy and physiology during her evenings off; and eventually she was allowed to attend chemistry lectures and dissection. However, the last of these raised matters of delicacy, because of what Garrett described as ‘the general larkiness of the students’.135 Her sympathetic teacher, Mr Nunn, the dean of the school, tried to see whether a separate dissection room could be made available for women students: which prompted her and Davies to look for other potential female doctors. This, and her success in her study, caused some of the students to resent her. Sensing what might be about to happen, some men protested against her ever being admitted as a fellow student. In 1861 she had, therefore, to leave, though not without certificates in chemistry and materia medica, and despite having received encouragement from several eminent doctors at the medical school. ‘It is’, she told Davies, ‘very disagreeable, but I suppose one will overlive it somehow.’136

  She obtained, privately, certificates in anatomy and physiology, while applying to most medical schools in the country and being refused admission. Her father petitioned London University, which was seeking a new charter, to include in it the power to admit women. It failed by a small majority when voted upon in the Senate; a second attempt weeks later was lost only on the casting vote of the chancellor. Davies wrote a paper entitled Medicine as a Profession for Women that was delivered at the 1862 annual meeting of the National Association for the Promotion of Social Science, and subsequently published as a pamphlet. Thus a propaganda campaign was instigated, in which the columns of the English Woman’s Journal formed a main theatre of war.

  Huxley opened his South Kensington lectures to women, and admitted Garrett to his classes. In 1865 she sat the examination of the Society of Apothecaries with six other candidates. Three, including Garrett, passed, and she obtained the highest marks: though she admitted to Davies that ‘the examination was too easy to feel elated about,’ which raises questions about the dismal standards expected of the men who took the course.137 This made her a Licenciate of the Society and allowed her to practise medicine. The Society marked her achievement by amending its rules to prevent other women doing what she had done: one of the more extreme examples of men trying to put the genie of equality back in its bottle. Five years later, once the Sorbonne in Paris had decided to admit women to medical degrees, Garrett learned French and took the higher qualification there. She then, in 1873, and having married Skelton Anderson, became the first and only female member of the British Medical Association, which promptly followed precedent and banned any other women from joining.

  In the interim, barred from any hospital post because of her gender, Garrett had set up her own dispensary for women outpatients in the West End of London. By 1872 her dispensary had become the New Hospital for Women and Children, later the Elizabeth Garrett Anderson Hospital; and she was co-founder with Jex-Blake of the London School of Medicine for Women in 1876, an institution that had the explicit support of Huxley. She would become dean of the school and hold that post for almost twenty years, the school eventually being incorporated into the medical school of University College, London.

  The Hospital for Women included female doctors who had qualified at European medical schools, but who because of restrictions placed on the General Medical Council’s acceptance of degrees could not register in Britain. In 1875 Cowper-Temple, one of the MPs behind the formation of the GMC as a means of protecting patients, urged the government to stop this discrimination. The GMC itself had proposed a separate examination for women of equal standard to that taken by m
en, which would enable a woman to be registered if she passed it. He said that if the government would not support this, he would introduce a private bill to force them to do so. Lord Sandon, who answered him, said that the government had consulted the GMC and was pondering what to do. Russell Gurney, another pro-feminist MP, observed that the GMC, ‘after long and anxious consideration, had expressed a decided opinion that women ought no longer to be excluded from the profession. After such a declaration one would hardly imagine that the existing state of things could remain unaltered.’138 The government took the hint, and another bar to women was soon lifted.

  Garrett Anderson sought to blow away the ignorance of male doctors about what were considered to be maladies of women caused by their inherent weakness. Well aware that most women still led sheltered lives of boredom and unfulfilment, she spoke out about the need for women to be allowed to expand their horizons just as men had, rubbishing notions that women could be over-educated to a point where they would suffer nervous and mental disorders. Although not active in the wider world of women’s political rights in the manner of her younger sister, Garrett Anderson was a supporter of women’s suffrage, regarding the progress she helped women to make in medicine as only one of the battles to be fought.

  IX

  Florence Nightingale had become a beacon for women’s advancement in mid-Victorian Britain, even though her own belief in feminism was ambiguous to say the least. She had returned from the Crimean War as one of the most celebrated women in Britain, but underneath her image lay a mass of contradictions, complexities and hysteria. She came from an affluent family, and her father (who funded several schools around his estates in Hampshire and Derbyshire) had extended his belief in education to include his daughters, unusually for that era. Florence was given a sound education in both modern and classical languages and in other subjects: had there been women at Oxford and Cambridge in the late 1830s, she would have given most men a run for their money.

  Her mother kept a salon, and Florence as a teenager met many of the leading men of the day. Fanny Nightingale also had the measure of her daughter early on. Writing when Florence was eighteen, she said that ‘Florence is much admired for her beauty and she, too, is reckoned very clever and amusing, but her stately manners keep people at a distance, so I do not expect that love passages will be frequent in her life.’139 Florence would never marry: but she was a tall, slim, austere beauty with admirers, the most notable of whom was the Whig politician and (among other things) proto-feminist Richard Monckton Milnes. He would have married her, and they had a courtship of sorts over about nine years. However, Florence only seemed to realise this was something she would like when it was too late, and Milnes was in the process of marrying someone else.

  Despite – or perhaps because of – her education, Florence became frustrated and depressed. In her writings there is the occasional note of hysterical despair, and of religious mania. Her principal problem was her only sibling, her sister Parthenope, a year older than her and also unmarried. Parthenope – known in the family as ‘Pop’ – had become obsessed with her sister, to the point where after a separation from her she had a mental breakdown. Florence took Pop’s collapse as a salutary warning about what could happen to women with overactive imaginations and native intelligence who were imprisoned in their lives and, in both their cases, still at home past the age of thirty. It seems, however, to have been a factor in Florence’s decision not to pursue marriage that she believed that, if she did marry, her chances of doing something great herself would be killed. Her part in the emancipation of women would be conspicuous, but required the sacrifice of her not having a husband and children.

  She conceived nursing as a means of escape. She decided God had sent her a message to tend the sick. Like many thinkers of the age just before Darwin she had begun to reject the notion of the Bible as literal truth. She did, however, believe God gave people missions in life to accomplish His work, and she had unquestionably found hers. Her parents disapproved of the direction in which she believed God had sent her, hardly surprising in an age when nursing was deemed a calling followed largely by women of the servant class, and with a reputation for drunkenness and immorality. She went to Kaiserwerth in the Rhineland to see how modern nursing was done, and returned convinced she could devise a superior system. Through connections she became superintendent of the Establishment for Gentlewomen During Illness in Harley Street in 1853, quickly making a name in her new calling. Her decision to take the job was helped by the eventual acquiescence of her father, who made her an allowance of £500 a year, more than enough to support her. She also helped at the Middlesex Hospital when it became overwhelmed during the cholera epidemic of 1854: immensely useful training for the Crimea.

  Nightingale had been helped to develop her nursing career by Sidney Herbert, a family friend to whom she was devoted. He had the misfortune to be Secretary of State for War when British troops first went to the Crimea in the autumn of 1854. Word quickly got back to England that the sick and wounded were dying for want of proper nursing, and Herbert arranged for Nightingale to lead thirty-eight nurses to Scutari, where they arrived on 4 November. Nightingale immediately imposed her will and her personality on the situation. When Army doctors and other officers were obstructive, she made no bones about her direct line to the Secretary of State. Her first priority was to improve hygiene, and she succeeded, though not without sacking some of the nurses she had brought with her, whose standards she considered insufficiently high.

  Aside from saving the lives of many soldiers, Nightingale’s achievements were revolutionary in other respects. Women did not normally take the type of leadership role that she did (the Sovereign being considered something of an exception). A gentlewoman did not get her hands dirty, or go among the common soldiery, as she did. This helped create a legend around her, fed when she felt forced to broaden her remit in the Crimea, and lobby Herbert not just for better medical supplies, but also for better clothing, food and cooking. She even arranged for the head chef at the Reform Club to come out and shake up that side of the operation. The flood of casualties after Balaclava put her under severe stress: she coped, and raised standards not least by her dictatorial methods, but her health went to ruin.

  This was when, thanks to a line in The Times, she became known as ‘the Lady of the Lamp’, and her selflessness and heroism in the face of disease and appalling conditions cemented the legend. In thanks for her recovery a fund of £45,000 was raised, though she had no idea what to do with it. When the War ended in March 1856, Nightingale concluded that the alarming death and casualty rates had been largely preventable. One in five of the 94,000 men sent to the Crimea died of disease, only 4,000 of wounds, and another 13,000 were invalided. When John Bright said the Angel of Death was abroad throughout the land, he had omitted to say he was armed with infection, not a rifle.

  Arthur Hugh Clough, her cousin by marriage, wrote of the problems Nightingale had had to contend with in the Crimea: and they were not confined to disease and poor sanitation. He noted in a letter of 14 September 1855 to Ralph Waldo Emerson that ‘the Nurses in general have been only too faithful to their old metropolitan habits of drinking, thieving and the like – and numerous discharges have been necessary’.140 It was not least for reasons such as this that on her return to England she was urged to set up the Nightingale Training School for Nurses, using the £45,000 fund. She found the request a bore, and lower on her list of priorities than writing a long report for the government about what was wrong with medical care in the Army, and how it might best be put right.

  The woman who returned to England in the summer of 1856 was unrecognisable, in stature and personality, from the one who had left in October 1854. She was invited to Balmoral to share her experiences with the Queen and Prince Albert. She used her contacts with them to demand a Royal Commission into the Army Medical Service and, after much foot-stamping and the threat to publish her own report on the question (which would have embarrassed the adm
inistration hideously), one was set up. She wrote, and privately distributed, her own 830-page report, which showed how avoidable so many of the deaths in the Crimea would have been if only the standards of hospitals had been higher. As a result of the commission – and as a result of Nightingale’s insistence that there should be one – the AMS was reformed, which provided her with her first great triumph.

  The school was eventually set up, not least after the appointment of the devoted Clough as secretary of the fund. Nightingale was soon relied upon by the government to supply nurses of the highest calibre to fill significant posts in the superintendence of public health. Sir John Pakington, the Secretary for War, asked her to find ‘an official person to occupy the post now vacant of Superintendent General – and also Matron for Netley Hospital.’141 She replied that ‘I beg to say how glad I shall be to do everything in my power for procuring and training an efficient nursing staff for Her Majesty’s Hospitals according to the Secretary of State’s desire.’ She also found herself consulted on the building of hospitals, and the creation of more voluntary hospitals to care for people who would have languished at home or, worse, in workhouse hospitals where the standards of care were often abysmal.

  In the late summer of 1857, after months of relentless overwork writing her report, she went down with what she thought was typhus, but what subsequent medical authorities believe was Brucella melitensis, contracted in the Crimea. Her life was at risk but she recovered. All Britain waited on news of her, from the Queen downwards, and with widespread prayers for her. To add to her reputation as Britain’s most famous woman after the Queen, she assumed the mantle of Britain’s most famous invalid. There is no doubt that she endured agonising and debilitating bouts of illness, but she also became mildly hysterical about it, and seemed sometimes to milk it for all it was worth.