Gynaecological Proletarians

Anne Summers

  • The Charge of the Parasols: Women’s Entry to the Medical Profession by Catriona Blake
    Women’s Press, 254 pp, £6.95, October 1990, ISBN 0 7043 4239 1
  • Women under the Knife: A History of Surgery by Ann Dally
    Radius, 289 pp, £18.99, April 1991, ISBN 0 09 174508 X
  • The Science of Woman: Gynaecology and Gender in England, 1800-1929 by Ornella Moscucci
    Cambridge, 278 pp, £35.00, April 1991, ISBN 0 521 32741 5

Since the rebirth of the feminist movement in the Seventies, the theory and practice of medicine, and the role of women as patients and practitioners, have been strongly contested issues in sexual politics. Much recent feminist writing, especially in the United States, has interpreted the history of the modern medical profession as a succession of male impositions on women. The outlawing of folk (for which read female) medicine, the marginalisation of the traditional midwife, the medicalisation of childbirth, and the introduction of drastic surgical techniques for dealing with real or supposed dysfunctions of the reproductive organs, have all been characterised as examples of oppression and exploitation, inspired by greed, opportunism and, for good measure, possibly sadism and voyeurism.

Catriona Blake’s The Charge of the Parasols shows that these were all live issues for the 19th-century feminists on both sides of the Atlantic who campaigned for women’s entry into the medical profession. Ann Dally and Ornella Moscucci, who discuss British and American surgical practice in this period, address questions of feminist politics more obliquely: the former in a survey designed explicitly to dedemonise this history for the lay-person; the latter in a major work of research which fully explores the complexities of the subject. But neither Dally nor Moscucci can entirely lay to rest the disturbing questions which the 19th-century campaigners and their successors have raised.

The granting of formal medical qualifications to women such as Elizabeth Blackwell (1849) and Elizabeth Garrett (1859) signalled not so much the opening as the re-opening of the field of medicine to women: a first assault against a relatively recent exclusion. Before the 19th century, as all three authors show, the professional colleges had not been able to prevent a vast army of unlicensed women and men from making a livelihood out of treating the sick. Women may have had a near-monopoly on nursing and midwifery, but they were not confined to these areas: they could also be found, particularly in rural ‘family practices’, dispensing, bone-setting and practising minor surgery – the concept of a gender divide between curers and carers, or between scientifically-minded male medics and herb-and-simple-gathering female healers is an ahistorical sexual stereotype.

The expansion and restructuring of the medical profession from the middle of the 18th century onwards, designed to give practical effect to the colleges’ principles of exclusion, hit women hard. Training requirements increasingly favoured admission to institutions such as the newly-founded voluntary hospitals and anatomy schools – from which, as from the universities, women were debarred – over apprenticeship in the home and family of a practitioner, where wives and daughters had had opportunities for ‘learning by doing’. (Local historical studies furnish interesting examples of successful unlicensed husband-and-wife teams sending their sons to the new medical schools and grooming their daughters for a purely ornamental role as a professional man’s wife.) A more integrated procedure of registering medical qualification, introduced with the Medical Act of 1858, accelerated the marginalisation of unlicensed and informal practice.

From the viewpoint of these three studies, however, the most important aspect of this age of transition was the fact that licensed male practitioners, eager for work in an increasingly crowded profession, began to make inroads into previously all-female preserves. ‘Man-midwifery’ in Britain did not, as is sometimes implied, result in the elimination of the doctors’ female competitors in this area: but it did open the way to the development of surgical interventions in obstetric cases, which were pioneered in the new medical institutions controlled by male physicians and surgeons. Although the management of childbirth itself remained a predominantly domestic process, increasing numbers of women underwent ambitious abdominal operations – made easier by the advent of anaesthesia, and at least slightly safer by the adoption of anti- and aseptic procedures – which included Caesarian deliveries, reparative surgery and the removal of cysts and tumours.

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