The Influence of Women
in the Profession of Medicine
1890 — Opening of Winter Session, London School of Medicine for Women, London, England
My Dear Young Friends,
In the short time that we meet together to-day, I will ask you to let me dwell upon the way in which the most beneficial influence of women in the medical profession may be exercised. I wish also to point out certain dangers, as well as advantages, with which medical study is now surrounded.
The avenues by which all may enter into the profession are now so much more widely thrown open, that there is little difficulty in the way of any man or woman who may wish to acquire a legal right to practise medicine. In Paris, all the public medical institutions, both college and hospital, are thrown open to students without distinction of sex. Not only as ordinary students, but as internes and externes, sex is no longer regarded there as a barrier to opportunity and position. The democratic principle is everywhere steadily gaining ground, and the individual allowed to try his strength in the great battle of life. Large numbers of women are taking advantage of this wider individual liberty to enter the medical profession. In Great Britain, our seventy-three registered lady-doctors are few compared with the 3,000 in the United States, yet the nine students who are now connected with our London school, with, in addition, the Edinburgh classes, the Dublin students, and the latest fact, that the Glasgow Medical College has just opened its doors to women, clearly indicate that the movement has taken sturdy root in our country, and when our English work has been carried on for forty years, there is every probability that our British lady-doctors will equal numerically our kinsfolk across the ocean.
I think, therefore, that all will see the importance of considering the future of this growing army of medical women; and I particularly desire that our students of medicine should realize the far-reaching character, the social effects of this medical career which they are entering on. It is quite certain that the wide adoption of the medical profession by women cannot continue to be an insignificant matter; it must exercise an appreciable effect on future society, for good or evil.
If we were children entering upon a course of education, it would be premature to take stock of the results of education, and cast a far-seeing glance into the future.
But it is different with adult women — women of education ¾ somewhat impatient of restraint, entering upon a larger liberty, and legitimately jealous of any interference with that liberty. It is therefore imperative upon us to consider very seriously this matter of self-guidance at the outset of medical education, to take in a large view of future responsibility, and ask ourselves that most important question respecting a medical training ¾ what will be its effect?
The flippant or stupid person may at once reply, our object is to gain money and pursue a remunerative calling by looking after sick people. Women find so much difficulty in honestly supporting themselves, that it is reason enough that they can in this way do so, and the labourer is worthy of his hire. But I say emphatically that anyone who makes pecuniary gain the chief motive of entering upon a medical career, is an unworthy student; he is not fit to become a doctor; and he will be a labourer not worthy of his hire. What should be thought of a statesman who aspired to the direction of national affairs on account of the salary of £10,000? The nobleness of motive must enlarge with the nobleness of occupation, or the unworthy occupier sinks to a degradation measured by the height to which his career should have raised him.
Now there is no career nobler than that of the physician. The progress and welfare of society is more intimately bound up with the prevailing tone and influence of the medical profession than with the status of any other class of men. This exceptional influence is not only due to the great importance of dealing with the issues of life and death in health and disease; but it is still more owing to the fact, that the body and the mind are so inseparably blended in the human constitution, that we cannot deal with one portion of this compound nature without, in more or less degree, affecting the other. Our ministrations to body and soul cannot be separated by a sharply defined line. The arbitrary distinction between the physician of the body and the physician of the soul — doctor and priest — tends to disappear as science advances. Every branch of medicine involves moral considerations, both as regards the practitioner and the patient. Even the amputation of a limb, the care of a case of fever, the birth of a child, all contain a moral element, which is evident to the clear understanding; and which cannot be neglected without injury to the doctor, to the individual, and to society. But probably it will be generally agreed that the hope of gaining money must not be the primary motive for choosing a medical career; but that interest in the line of study, and kind of life, with a perception of the wide and beneficent influence which it can exert, should form the determining motive for becoming a physician.
If, then, we recognize that although just reward for honest labor is fair, we must not enter upon medicine as a trade for getting money, but from a higher motive, this motive, as it influences conduct, becomes on that account a moral motive, or an ideal, which should guide our future practical life as physicians. Now this ideal necessitates a distinct conception of what is right and wrong for us, in medicine, both as human beings and as women. Simply sensuous life, without an ideal, or without higher principles of action than the limited needs of every day, tends to degrade the individual, and all who surround him.
What we need is a clear idea of what is really right or wrong with the reasons on which the judgment is based, instead of a confused notion, or a vague and ever shifting standard.
No woman student of medicine can safely ignore this subject. It is a vital one for us; and only a true answer to it will make our entrance into the profession a marked advance in social progress.
I do not attempt to disguise the difficulty of laying down the law of right and wrong in medicine; not only because medicine, as every other part of social life, is subject to the growth of evolution, but because in a state of society that has not yet succeeded in moulding itself on the fundamental principles of Christianity, we are involved in faulty social conditions, which absolutely prevent us from embodying our moral perceptions in every phase of practical life. But, remember, thought and endeavor may live a righteous life, no matter what faulty conditions surround us. When we have a clear view of right and wrong, we can mentally repudiate whatever appears to violate the moral law. We can strenuously resist the deadening force of habitual wrong-doing; and never cease the effort to find some way of shaping our mental protest into practical opposition to all forms of immorality.
You will see in the course of your medical studies — particularly if you study abroad — much to shock your enlightened intellect, and revolt your moral sense. In practice also you will be subjected to strong temptations of the most varied character. But just for the reason that as women we ought to see more clearly the broken bridge of approaching danger, in the onward rush of the male intellect, I now dwell on our special responsibility, and shall endeavor to give the reasons for it.
My object is not to limit, but to enlarge our work in medicine, when I seek to define our ideal. It is true that the great object of this human life of ours is essentially one for every human being, man or woman, barbarous or civilized. It is to become a nobler creature, and to help all others to a higher human status during this brief span of earthly life. But as variety in unity is a law of creation, so there are infinite methods of progress; producing harmony instead of monotony¾when the individual or classes of individuals are true to the guiding principles of their own nature.
For the ideal of every creature must be found in the relation of its own nature to the universe around it. Right and wrong are based upon the sound understanding of this positive foundation. It is this fact of variety in unity, in the progress of the race, which justifies the hope that the entrance of women into the medical profession will advance that profession.
In order to carry out this noble aspiration, we must understand what the special contribution is, that women may make to medicine, what the aspect of morality which they are called upon to emphasize.
It is not blind imitation of men; nor thoughtless acceptance of whatever may be taught by them that is required; for this would be to endorse the wide-spread error that the race is men. Our duty is loyalty to right, an opposition to wrong, in accordance with the essential principles of our own nature.
Now the great essential fact of women’s nature is the spiritual power or maternity.
We should do miserable injustice to this great fact, if looking at it with semi-blind eyes we only see the shallow material aspect of this remarkable speciality. It is the great spiritual life, underlying the physical, which gives us our true womanly ideal.
What are the spiritual principles necessarily involved in this special creation of one-half the race; principles which lie within the material facts of gestation, and the care of infancy and childhood, which constitute the distinctive material domain of women?
They are the subordination of self to the welfare of others; the recognition of the claim which helplessness and ignorance make upon the stronger and more intelligent; the joy of creation and bestowal of life; the pity and sympathy which tend to make every woman the born foe of cruelty and injustice; and hope, i.e., the realization of the unseen, which foresees the adult in the infant, the future in the present.
All these are great moral tendencies, and they are necessarily involved in the mighty potentiality of maternity. They lay upon women the mighty responsibility of becoming more and more the moral guides in life’s journey. Women are called upon very specially to judge all practical action as right or wrong, and to exercise influence for this high morality, in whatever direction it can be most powerfully exerted.
We see the indication of this providential inherited impulse to moral action, in the great and increasing devotion of women to the relief of social suffering, and their sturdy opposition to wrong-doing, which form a distinguishing characteristic of our age. These spiritual mothers of the race are often more truly incarnations of the grand maternal life, than those who are technically mothers in the lower physical sense.
With sound intellectual growth, the range of moral influence increases. But such sound growth can only take place under the guidance of moral principle; for moral perception becomes reason, as the intellectual faculties grow; and reason is the true light for all. It is in this high moral life, enlarged by intelligence, that the ideal of womanhood lies. It is through the moral, guiding the intellectual, that the beneficial influence of woman in any new sphere of activity will be felt.
Thus from their inherited tendencies, as well as from the existent individuality of their nature, women must seek a high moral standard as their ideal, and acknowledge the supremacy of right over every sphere of intellectual activity. The highest type of moral excellence which we can find in the age in which we live, the beneficence which it exerts, the means by which it has been attained, form so many landmarks to guide us in our search for the right.
This very important method of growth has been well stated by Huxley, that brave fighter in the past, for freedom of thought. He has laid down this weighty principle, that “the past must be explained by the present.”
This principle is of very wide application.
What produces the noblest human creature now in our nineteenth century? What inspires hope? What sustains us most bravely to fight the battle of life? What makes life most worth living?
When we have ascertained these facts in the present, they will explain the past, and give the foundations of right for guidance in the future.
It is a noteworthy feature of the present day that some of our best men, witnessing the failure of so many panaceas for the intolerable evils that afflict society, are longing for that untried force — the action and co-operation of good women. “Our only hope is in women!” is a cry that may sometimes be heard from the enlightened male conscience. But still more significant is the awakening of an increasing number of women themselves. They begin to realize that truth comes to us through imperfect human media, and is thus rendered imperfect; that every human teacher must be accepted for his suggestiveness only, not as absolute authority. Women are thus rising above the errors of the past, and blind acceptance of imperfect authority; and are earnestly striving to learn the will of the Creator, and walk solely according to what they themselves, diligently seeking, can learn of that divine will.
There is no line of practical work outside domestic life, so eminently suited to these noble aspirations as the legitimate study and practice of medicine. The legitimate study requires the preservation in full force of those beneficent moral qualities — tenderness, sympathy, guardianship — which form an indispensable spiritual element of maternity; whilst at the same time, the progress of the race demands that the intellectual horizon be enlarged, and the understanding strengthened by the observation and reasoning which will give increased efficiency to those moral qualities.
The true physician must possess the essential qualities of maternity. The sick are as helpless in his hands as the infant. They depend absolutely upon the insight and judgment, the honesty and hopefulness of the doctor.
The fact also, that every human being we are called on to treat, is, like the infant and the child, soul as well as body, must never be forgotten. Successful treatment requires the insight which comes from recognition of these facts, and the sympathy that they demand. In the infinite variety of human ailments, the physician will find that she must often be the confessor of her patient, and the consulting room should have the sacredness of the confessional; and she must always be the counsellor and guide.
In those two departments of medicine which seem to me peculiarly valuable to women physicians, which I shall refer to later, viz., midwifery and preventive medicine, it would be hard to say whether the moral or intellectual qualities of the physician were called most largely into play¾so inseparably are they blended. What patience and hopefulness also are demanded in the lingering trial of chronic illness; what discrimination and union of gentleness and firmness these cases require! Then think of the children in our families! To the girls and boys, the young women and men, who grow up under our ministrations, what an inspirer of nobleness and purity, what a guardian from temptation the true physician can be!
Again, in the treatment of the poor, an immense demand is made upon our pity, patience and courage. These poor victims of our social stupidity are often extremely trying! The faulty arrangements which compel us to see thirty, fifty even, in an hour, exhaust the nervous system of the doctor. It requires faith and courage to recognize the real equal human soul under the terrible mask of squalor and disease, in these crowded masses of poverty, and to resist the temptation to regard them as “clinical material.” The attitude of the student and doctor to the sick poor is a real test of the true physician.
Having thus realized the profound adaptation of the nature of women to the practice of the Art of Healing, let us consider in what way the intellectual faculties may be strengthened so as to give enlarged efficiency to the maternal qualities. In other words, how shall we become reliable doctors?
What I have hitherto dwelt on is the necessary attitude of mind, or the atmosphere and light in which women physicians must breathe and work if they are to attain to their distinctive efficiency; let me now refer more particularly to the method of training for our practical work.
The intellectual training required for the physician is admirably adapted to supply deficiencies in the ordinary experience of women.
The intellectual characteristics which must be especially gained during student life, are — the faculty of patient observation, exact statement of what is observed, and cautious deductions from these observations.
These qualities form the foundation of sound judgment and skilful medical practice. It is not a brilliant theorizer that the sick person requires, but the experience gained by careful observation and sound common sense, united to the kindly feeling and cheerfulness which make the very sight of the doctor a cordial to the sick. If these necessary results of intellectual training can be secured in harmony with the moral structure of womanhood, then a step of real social progress is made by our study of medicine.
This necessity for making the most painstaking observation of facts, the foundation to be laid by the student in every branch of her studies, is well illustrated in the life of Darwin, who writes thus to a friend: — “I have been hard at work for the last month in dissecting a little animal about the size of a pin’s head, from the Chronos Archipelago; and I could spend another month and daily see more beautiful structure.” Of the value of this method of persistent labor, his friend gives this noteworthy testimony: ¾ “Your sagacious father never did a wiser thing than devote himself to these years of patient toil. It is a remarkable instance of his scientific insight and courage that he saw the necessity of proper training, and did not shrink from the labour of acquiring it.”
In medicine, anatomy, physiology and chemistry are the primary studies where that foundation of conscientious exactitude must be laid, on which the skill of the future physician so largely depends.
The first and indispensable basis of medicine is anatomy, with which physiology is inseparably blended; for human physiology can only be properly studied in connection with the human structure, whose condition in health and disease forms the direct object of our profession. No student should be satisfied until she has most carefully followed out the structure of every region of that human body with whose life we shall have to deal. Careful anatomical study is the sure and indispensable preparation for that next advanced range of clinical observation, where pathology and therapeutics bring us into the direct study of the sick.
The more thoroughly the human organization is investigated, the more wonderful will the unapproachable mechanism for the use of human life be seen to be. We shall never regret any amount of time and care spent in acquiring the most intimate knowledge of human anatomy. For even if we never perform a surgical operation, the thorough knowledge of the human framework, with whose aberrations we have to deal, gives a firm foundation for practice that nothing else can supply.
The thoughtless slashing of the delicate and complicated structure of the body, of which untrained students are often guilty, is indicative of a careless, unconscientious future physician. If carelessness similar to what is often observed in the dissecting-room, were carried on in the chemical laboratory, life or limb would soon be sacrificed. Yet a thorough grounding in the structure of every vital organ is more indispensable to us than chemistry, important as the study of chemistry is. Let me here note how the moral element on which I have so strongly insisted comes into play in this, the first of our medical studies. Reverence for this physical structure of ours should always be shown in the use and arrangements of the anatomical rooms. Carelessness and irreverence in this department of study, exercise a really deteriorating influence on students of medicine. Respect for the material used ¾ care in its disposition ¾ and a decent covering for each work-table in the intervals of work, may seem small observances, but they exercise a large influence over the moral training of the student when persistently carried out.
It does not enter into my present purpose to enlarge upon the right method of studying each branch of medicine; for that would require a series of discourses. But I must give an emphatic warning against the strange neglect of human physiology which I observe. This seems to proceed from the mistaken idea that necessary knowledge can be obtained from other organisms, which bear a misleading resemblance to the human.
What I would insist upon is, that we should endeavour to make ourselves thoroughly acquainted with the nature and variations of healthy human physiology before we are perplexed with the changes of pathology.
Auscultation and percussion, observations of the healthy variations of the pulse, the tongue, the skin, and the various secretions, in as many healthy individuals, both adult and infant, as can be examined, compared, and recorded; the vital chemistry of the human tissues and secretions in health and disease; with the modifying effects of temperament, heredity, idiosyncrasy, etc., all this forms a department of human physiology, strangely neglected as a practical study, yet certainly of primary importance to the progress of medicine.
But I must pass on to what is my immediate purpose, viz., the relation of women to medicine. Having dwelt on the moral and intellectual advantages of medical study, I must refer to another aspect of the subject, viz., the dangers which meet our earnest students.
Dr. Carpenter has recorded the widespread recognition of this dangerous aspect of medical study when he says, — “There seems to be something in the process of training students for the medical profession which encourages in them a laxity of thought and expression that too frequently ends in a laxity of principle and of action;” and he further condemns the tone of some works issued by the medical press. Now this judgment of a very cautious teacher so many years ago, is worthy of the most serious consideration in the present day. The freedom of entrance now accorded to women into the medical profession, lays a very heavy responsibility upon us, to prove that this new and increasing movement will be a future blessing to society.
We are happy in drawing into our schools a large number of capable women, women who may not only be a gain as physicians, but who may exert a most beneficial influence on the profession itself, if they bring into it fresh and independent life.
It is much to be regretted that our students are now compelled to go abroad for the completion of their medical education; for methods of study injurious to morality are exaggerated abroad. The abuse of the poor as subjects of experimental investigation, in whose treatment all decent reserves of modesty are so often stripped away; the contempt felt for the mass of women where chastity is not recognized as an obligatory male virtue; the atrocious cruelty of their experiments on animals; all these results of active intellect, unguided by large morality, as seen in full force abroad, make me deplore the necessity which drives so many of our best but inexperienced students away, in search of more efficient training than they can obtain at home.
The two special dangers against which I would warn our students are ¾ 1st, the blind acceptance of what is called “authority” in medicine; 2nd, the narrow and superficial materialism which prevails so widely amongst scientific men.
In relation to the first point, viz., distrust of authority — although I fully recognize the respect which is always due to the position of the teacher, and the consideration to be shown to all who are called “heads of the profession” — I would very strongly urge you to remember that medicine is necessarily an uncertain science.
Life in its essence we cannot grasp. We understand it only through its effects; and all human judgment if fallible. Careful and wise observation bring us ever nearer to a knowledge of the conditions which are necessary for human well-being; but experience compels us to recognize the constant failure of theory or dogmatism in dealing with any of the infinitely varied phases of life. In medicine, we are forced to recognize the errors in diagnosis committed even by distinguished men; and to suffer grievous disappointment from the failure of remedies supposed to cure the sick. We cannot fail to note the contradictory results of experiments; the same facts differing according to the observer¾one fact upsetting another, and one theory driven out by a later one. This uncertainty resulting from experiment, is strikingly exemplified by the battle of experts about the effects of arsenic displayed in a late criminal trial. Or consider the frequent errors of statistics (a branch of knowledge that enters largely into medical science), owing to the imperfect data on which they are often based; important deductions being drawn from them which are logically indisputable, but entirely false, from the unsound premises on which they rest. Thus the death-rate of London, though commonly stated at 23 or 24 per 1,000, is really an unknown quantity, on account of the enormous influx of fresh life and the efflux of broken-down lives.
Our women students especially need caution as to the blind acceptance of authority. Young women come into such a new and stimulating intellectual atmosphere, when entering upon medical study, that they breathe it with keen delight; they are inclined to accept with enthusiasm the brilliant theory or statement which the active intellect of a clever teacher lays before them. They are accustomed to accept the government and instruction of men as final, and it hardly occurs to them to question it. It is not the custom to realize the positive fact, that methods and conclusions formed by one-half of the race only, must necessarily require revision, as the other half of humanity rises into conscious responsibility.
It is a difficult lesson, also, fully to recognize the limitations of the human intellect; which recognition nevertheless is necessary, before we can grasp this important and positive fact in human experience, viz., that the Moral must guide the Intellectual, or there is no halting-place in the rapid incline to error. The brilliant professor will always exercise an undue influence over the inexperienced student, and particularly over the woman student. I therefore strongly urge the necessity of cherishing a mild scepticism respecting the dicta of so-called medical science, during the period of student life; scepticism, not in relation to truth — that noble object which we hope to approach ever more nearly, — but scepticism in relation to the imperfect or erroneous statement of what is often presented as truth.
Of this one guiding fact, as a basis of judgment, we may be quite sure, viz., that whatever revolts our moral sense as earnest women, is not in accordance with steady progress; it cannot be permanently true, and no amount of clever or logical sophistry can make it true. It will be a real service that we, as medical women, may render to the profession, if we search out — calmly, patiently, but resolutely — why what revolts our enlightened sense of right and wrong is not true. We shall thus bring to light the profound reason why the moral faculties are antecedent or superior to the intellectual faculties; and why the sense of right and wrong must govern medical research and practice, as well as all other lines of human effort.
As experience enlarges, we observe the immense separation in lines of conduct, which gradually results from an initial divergence between right and wrong, a divergence almost imperceptible at first. We are thus compelled to come to the conclusion in relation to our own profession, — that the worship of the intellect, or so-called knowledge, as an end in itself, entirely regardless of the character of the means by which we seek to gain it, is the most dangerous error that science can make. This false principle, if adopted by the medical profession, will degrade it, and inevitably produce distrust and contempt in the popular mind.
The second danger against which the student of medicine must guard, is the materialism which seems to arise from undue absorption in the physical aspect of nature, and which spreads like a blight in our profession.
The basis of materialism is the assertion that only sense is real.
Our medical studies necessarily begin with minute and prolonged study of what we term dead matter. If this study be carried on without reverence, it appears to blind the student to any reality except the material under his scalpel or in his crucible, i.e., the facts that the senses reveal. Proceeding logically from this false premiss, that only sense is real, mind is looked upon as a secretion of the brain, and life as the result of organization of matter, which is destroyed when the organization of the material body is broken up.
Some persons, successors of the materialistic ecclesiastics who condemned Galileo, cannot rise beyond the gross evidence of their senses. To such persons, reason, which transcends sense, is a vague unreality; and the clear teaching of reason may to them seem doubtful, or superstition. But the stout fight which the old Italian nobly began, and which has been so bravely carried on for freedom of thought in our own day, is beginning to tell, and reap a rich reward. Our senses, so far from being the boundary of real existence, are proved to be as untrustworthy guides now, as when Galileo’s accusers insisted that the sun moved round the earth in twenty-four hours. The relations of our senses to our consciousness change with biological differences, as one creature can see what is quite invisible to another. The boundary line which exists between our senses and our consciousness, is constantly changing; and realities are shown to exist, of which our ordinary consciousness connected with the senses has no knowledge. Thus life beyond, and independent of the senses, is being proved as positive and pregnant fact.
The great generalizations of modern science — the Conservation of Energy, the process of Evolution — are the products of Reason. They are metaphysical conceptions. Like the atomic theory, or the law of gravitation, they are practical formulæ, necessary to the advancement of science, from the structure of our minds; but they are the results of reason, not of sense.
Love, Hope, Reverence, are realities of a different order from the senses; but they are positive and constant facts, always active, always working out mighty changes in human life.
A thoughtful writer has characterized Materialism as an attempt to explain the Universe in terms of mass and motion, rather than in terms of Intelligence, Love, and Will; and it is a true criticism. Let me recall here the serious warning which Huxley gives to the shallow materialist who limits existence by the senses.
He says, “The great danger which besets the speculative faculty, is the temptation to deal with the accepted statement of facts, in natural science, as if they were not only correct but exhaustive; as if they might be dealt with exhaustively, in the same way as propositions of Euclid may be dealt with. In reality, every such statement, however true it may be, is true only relatively to the means of observation, and the point of view of those who have enunciated it. Whether it will bear every speculative conclusion that may be logically deduced from it, is quite another question.” “In the complexity of organic nature, there are multitudes of phenomena which are not deducible from any generalizations that we have yet reached — this is true of every other class of natural objects (as the moon’s motions, gravitation, &c.). All that should be attempted is a working hypothesis, assuming only such cases as can be proved to be actually at work.”
These are valuable warnings from our great naturalist.
The tendency of unprejudiced science in our day is to show the unsatisfactory character of the terms matter and spirit. For the exaltation of what we term matter, tends constantly to lose itself in what we call spirit.
Reality always transcends sense. As the vibrations of ether we only know as light and color, and the vibrations of the atmosphere are translated into sound, so in the careful observation of our own mental states, in the experiences of dreamland, in the study of clairvoyants and somnambulists, and the revelations of hypnotism, we gain an insight into states of consciousness independent of the senses ¾ states where the old distinctions between matter and spirit seem to become quite inapplicable.
One third of human life is spent in sleep, a condition of which at present we know little except that it entirely changes the life of conscious sense, and that it possesses a mysterious restorative power of the most precious significance to us as physicians. A study of all these mysterious conditions of human life itself, many of which, although occurring abnormally, have been presented again and again through all the ages, is surely the most important of all subjects for scientific medical investigation. Let us always bear in mind that, as has been well said, “the fact of illusion is not an illusory fact.” As an exception to a rule is the most suggestive fact for the investigator to grapple with, so those exceptional facts of human nature, which are nevertheless occurring in every age and in every nation, are the facts of all others the most worthy of investigation by the scientific medical intellect. This new realm of research, when legitimately pursued, promises results of the very highest importance.
I must not now dwell longer on this new and valuable department of medical investigation — psycho-physiology. But it is an inspiring thought, that true science supports the noblest intuitions of humanity; and its tendency is to furnish proof suited to our age of these intuitions. I have specially dwelt on this subject now, because the discouragement which results from the false reasoning of materialism, injuring hope, aspiration, and our sense of justice, is especially antagonistic to women, whose distinctive work is joyful creation.
In practical medicine the loss is immense, when recognition of the higher facts of consciousness is obscured, and the physician is unable to perceive life more real than the narrow limits of sensation.
The physician is called to stand by the death-bed of the most carefully tended patient. At that solemn moment, the clear glance that sees beyond the boundary of sense, the reverential hand-clasp which conveys hope to the mourner, is the seal of his noble art of healing, and the profoundest consolation he can offer to the bereaved. May the time come when every physician can convey this highest gift of healing with his ministrations!
I have now considered the fundamental reason why great advantage will result to society through the intellectual cultivation of the woman physician, unless the study of medicine be pursued in such a way as to do violence to our nature, by the destruction of sympathy, reverence, and hope.
I have also dwelt on the method of training, especially needful to our students, viz., patient, persistent drill in the fundamental studies of medical education, a training which will form the habit of close and careful observation at the commencement of medical life.
I would now offer a few words of counsel in relation to the work which lies before us when we enter upon the practical career of the physician, for which our medical studies should carefully prepare us.
I believe that the department of medicine, in which the great and beneficient influence of women may be especially exerted, is that of the family physician; and that not as specialists, but as the trusted guides and wise counsellors in all that concerns the physical welfare of the family, they will find their most congenial field of labour.
It is to fit ourselves for this most useful and influential position, viz., as the medical advisers of families, that, not limiting our education to any specialty, we have laboured, and must continue to labour, to remove all obstacles in the way of obtaining the fullest medical education. For this reason I have laid, so much stress upon the cultivation of habits of careful observation; and I now would give a warning against sensationalism in medical study.
The unreflecting student (not unnaturally) rushes alter novelties. There is certain excitement in witnessing a formidable surgical operation, or seeing a rare case of disease that may never again be presented to our observation. But these exceptional occurrences do not fit us for our future medical life, as does the careful study of the commoner forms of disease, for those are the cases that most nearly concern us. But because they are common, they cease to interest the unobservant student, who applies a routing treatment. But the physician, whose faculties of observation have been thoroughly drilled, has learned this lesson, viz., that no two cases of illness are exactly alike, and that it is of the utmost importance to our future success, as practitioners, to note these individual differences, their results, and why some die whilst others recover. It is far more important to our success, as practical physicians, to thoroughly master measles and whooping-cough, scarlet fever and porrigo, than to study an isolated case of hydrophobia or leprosy. Moreover, I hold it to be a special duty of our profession to extirpate these common diseases¾not to accept them hopelessly as necessary evils. And it is only by a profounder and more comprehensive clinical study of the ordinary diseases of domestic life, that we can hope to do this.
There are two great branches of medicine, whose importance will, I hope, more and more engage the attention of women physicians. These are midwifery, which introduces us to the precious position of the family physician; and sanitary or preventative medicine, which enables us to educate a healthy generation.
These two departments of the healing art will never cease from amongst us. I consider it a radical defect in our present system of medical education, that these subjects are not brought more prominently forward, and both of them raised into first-class professorial chairs.
Before closing, I must dwell for a few moments on the vital importance of midwifery to the future success of women physicians. This is the more necessary, because I observe a singular and growing disposition on the part of our students, whether in America, France or England, to despise or neglect midwifery. I do not know whether this proceeds from indolence, as midwifery is the most fatiguing and enchaining branch of the profession; or whether the neglect arises from failure to perceive the reason of our refusal to be simply midwives, for our insistance upon a complete education really means our determination to elevate, not repudiate midwifery.
But the curious fact remains, that many women doctors appear to look down upon this most important branch, and often state that they do not intend to undertake it. Yet it is through the confidence felt by the mother during our skilful attendance upon her, that we are called in to attend other ailments of the family, and thus secure the care of the family health. It is therefore of the utmost importance to our future position in medicine to establish our ability as thoroughly trustworthy obstetricians.
It is indispensable to the stability of our movement that very thorough provision be made for the obstetrical education of all our medical graduates. Dr. Huntley, in her prize essay of 1886, called attention to this subject, and our skilful obstetrician, Dr. McCall, is bravely carrying on a valuable work at Clapham, to which I would earnestly invite sympathy, and every other form of support. But I do not think that any young woman physician is properly equipped for her future difficult career, unless she has been to a great extent responsible for at least thirty midwifery patients, of whose cases she has made careful and discriminating records; and has had the opportunity of observing a great many more patients, in addition to the drill in all operative manœuvres that can be given in college. We need a great maternity department, thoroughly organized, which, whilst arranged with kindest consideration for the poor, will put our students through a severe drill, such as is considered necessary at La Maternite in Paris. That institution which receives annually an average of 2,500 patients, having over 10,000 applications in the year, is not only an invaluable practical school, but it has reduced the mortality amongst its patients to a minimum; and the searching method of instruction there pursued could be studied by us to great advantage as we try to secure a well organized maternity charity for our students in London. Such a charity, if humanely planned, would be a blessing to poor mothers; and it would to a great extent remove the reproach of being obliged to send our enterprizing young doctors abroad, because London does not afford them sufficient necessary practical training.
But time warns me to close these remarks, although I would gladly have enlarged upon the primary importance of preventive medicine¾the medicine of the future — for it is quite certain that the greater part of disease, even including many surgical operations, is preventable disease. It is now unfortunately the case, that unavoidable absorption in the treatment of disease, makes the practical physician too often ignore the yet larger duty of preventing it.
I have tried to show (1) That women from their constitutional adaptation to creation and guardianship, are thus fitted for a special and noble part in the advancement of the healing art.
(2) That the cultivation of the intellectual faculties necessary to secure their moral influence requires a long and patient training by methods that do not injure morality.
(3) That the noblest departments of medicine to which we can devote our energies, will be through that guardianship of the rising generation, which is the especial privilege of the family physician.
In conclusion, my dear young friends and fellow-workers, I would ask you all to join with me in the pledge which I gave more than forty years ago, to the Chancellor of the Western University, who handed to me our first Diploma of Doctor of Medicine. I then promised “that it would be the effort of my life to shed honour on that diploma.”
This is the pledge that we must all prepare for when entering the noble profession of medicine; in receiving honor, we must add lustre to it, or we become unworthy of it.
It is a difficult life that we enter upon, in entering upon a medical career; but if our Christianity is worth anything, it must be “a battle, not a dream.” We must be members of the church militant if we wish to enter the church triumphant. Life is a grand preparation for the exercise of ever larger powers, and I heartily welcome you to this winter’s course of study, hoping that it may be a little step forward, but a sure one, towards that grand ideal which must be ever before us!
Source: The Influence of Women in the Profession of Medicine, Address Given at the Opening of the Winter Session of the London School of Medicine for Women, by Elizabeth Blackwell, (Baltimore) 1890, pp. 1-32.