Bull.lnd.Inst.Ilist.Med. "01. XXX - 2000 pp 59 /064

HISTORY OF WOMEN IN SURGERY AN OVERVIEW

SISIR K.MAJUMDAR*

ABSTRACT

The history of women as medical and surgical practitioners stretches back to

atleast 3500 B.C. Wall painting in tombs and temples of ancient Egypt show them

performing surgical procedures and there is also evidence that women surgeons

were practicing in ancient Sumeria, Babylon, Greece and Rome.

During the middle ages as per a formal decree issued by the church in the

twelfth century monks werc prohibited from "blood-letting" or performing

operations. This effectively relegated wound treatment, bleeding and bone-sctting

to barbers and women. Women were particularly valued for their skill in obstetrics

and midwifery. In this wayan overview with regard to the history of women in

surgery is presented here in chronological order.

Sushruta (400 A.D.) of Ancient IndianAyurvedic ("Science of Life") System ofMedicine is universally known as the "Fatherof Surgery". "Susruta Samhita" - acomprehensive treatise on various aspects ofsurgery (between 800 B.C. to 1000 A.D.)contains 186 chapters in section withdescription of about 1,000 surgicalinstruments of various types 1.2. Surgery wasan integral part of Ayurvedic system, but bythe middle of the first millennium B.C. thepractice of surgery was abandoned by thedoctors of the higher priest class because ofreligious taboos and dogma; it was relegatedto the artisan classes of lower social caste,thus divaricating from the theoretical andscientific knowledge of the learned doctors.'In the West, Ambroise Pare (l51 0 - 1590) ofFrance is known as the "Father of ModernSurgery" as we understand today. Surgicalcontribution of Ancient Chinese Medicine isalso of great importance.

The history of women as medical and

surgical practitioners stretches back to at least3500 B.C. Wall paintings in tombs andtemples of ancient Egypt show themperforming surgical procedures, such asCaesarean section and the removal ofcancerous breasts, and there is also evidencethat women surgeons were practising inancient Sumeria, Babylon, Greece and Rome.A Roman medical encyclopaedist, AulusCornelius Celsus, around 40 A.D., a notablemedical writer of the first century A. D.' tellsof women physicians in Rome; later, Galen(c. A. D. 131-20 I) recounts the activities ofseveral women, including Margareta, anarmy surgeon.

During the Middle Ages, much of themedical care was carried out by members ofreligious orders, but a formal decree issuedby the church in the twelfth centuryprohibited monks from "blood-letting" orperforming operations. This effectivelyrelegated wound treatment, bleeding andbone-setting (the menial tasks) to barbers and

• 'Hasiniketan', 200, Summerhouse Drive, Wilmington, Dartford, Kent, DA2 7PB, England, U.K.

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women. In spite of this and the difficultieswhich women faced in attempting to obtaina formal education, they continued to practisesurgery, often in secret, and were particularlyvalued for their skill in obstetrics andmidwifery. In the fifteenth century laws werepassed in France to control the practice ofsurgery, wh ich resulted in further restrictionson women surgeons, although it waspermissible in law for women to inherit andcontinue their husband's surgical practice.

In the kingdom of Naples, Italy, between1273 - 1410 A.D., at least 23 women werelicensed by the authorities to practise surgeryin their region; a few female surgeons areknown from other parts of Europe, wherethey learned their craft as apprentices to afather or husband, taking over from themwhen they died 4.

The early sixteenth century saw theformation of surgeon's guilds in England,which limited the activities of women stillmore, although some continued to providemedical treatment for the community. Manyofthese women were of good social standingand well educated, with a strong sense ofpublic duty. The care of the sick poor wasconsidered to be one ofthe duties of a "personof quality", a tradition which continuedthroughout Tudor (1485 - 1603) and Stuart(1371 - 1688) times. Women who practisedsurgery still had to face the hostility of theirmale counterparts, however, and allegationsof witchcraft and sorcery werecommonplace, although there were somenotable exceptions to the prevailing maleprejudices. John Aubrey 5 in his "BriefLives" tells of a "rare shee surgeon," Mrs.Holder, who treated Charles II for a handinjury. Under her care, the hand wascompletely healed "to the great griefs of allthe Surgeons, who envy and hate her."

During the eighteenth century the statusof the women surgeon declined, asapothecaries; the vast majority of them men,

Bull.lnd.lnst.Hisl.Med. Vol XXX - 2000

assumed responsibility for the generalmedical attention which was increasinglydemanded by the public. It was not until thenineteenth century that women began toreturn to the medical profession, but even atthis time it was virtually impossible for themto acquire any medical training. There wasstill prejudice to be overcome, and a fewwomen even went to the extraordinarylengths of pretending to be men, the mostfamous example being Dr.James Barry (b.1797), a British army surgeon. Although ofsmall stature and with rather femininefeatures, she enjoyed a high reputation formany years as a skilful operator, serving atthe Battle of Waterloo (1815) and in theCrimean wars (1854 - 1856). The deceptionwas remarkably successful FlorenceNightingale in a letter to her sister 6 describedher as "the most hardened creature I evermet" - and her identity was only revealedwhen she died during an epidemic in 1865.The War Department and the medicalestablishment were so embarrassed by thediscovery that the findings were hidden andDr. Barry was officially buried as a man.

Unlike Barry, Elizabeth Blackwell (1821- 1910), an Engl ish woman, refused to acceptthe advice of her tutor to don male clothingin order to obtain a medical qualification: "Itwas to my mind a moral crusade on which Ihad entered, a course of justice and commonsense" 7. And, indeed, after entering theGeneva College of Medicine in New York,she gained her M.D. in 1849. This pavedthe way for many more American women togain admittance to medical schools there,some of which, like the Female MedicalCollege of Pennsylvania, were foundedspecifically for women.

Meanwhile, the situation in England wasnot so easy and, when Blackwell visitedLondon in the 1850's she found that therewas s\,\) tremendous cpposuion 10 file \deaof medical training for women. Her courage

History of Women in Surgery - Majumdar

and tenacity had, however, inspired a wholegeneration of women, who began to demandaccess to the mind of medical educationenjoyed for so long by men. One of thesewomen, Elizabeth Garrett (1836 - 1917) hadheard Blackwell lecture in London in 1859,and this had influenced her decision to pursuea career in medicine. In spite of hostility,both from her mother and the medicalestablishment, she became a Licentiate of theSociety of Apothecaries in 1865, after herfather threatened the Society with a lawsuitif it refused to examine her. She thus becamethe first woman L.S.A. entered on theMedical Register. The first modern womandoctor in India was Kadambini Ganguly(M.B.B.S., 1880) trained at the MedicalCollege, Calcutta (Established 1835 - thisauthor's Alma Mater, as well). She later oncontinued her further medical education inEdinburgh and practised obstetric andgynaecological surgery in Calcutta 2.

Following this landmark victory forwomen, the Society of Apothecaries, andlater the British Medical Association, re-wrote their regulations in an attempt to barany further female examination candidates.But pressure for reform was now comingfrom many areas. One notable campaignerwas Sophia Lolita Jex-Blake (1840 - 1912)whose struggles were of great value informing and influencing public opinion. In1874 she founded the London School ofMedicine for Women, while still activelylobbying for a change in the law. Even nowthere were still influential pockets ofresistance, including the Board of Examinersof the Royal College of Surgeons of Englandwho, in January 1876, chose to resign ratherthan allow three women (including Jex-Blake) to sit the diploma in midwifery.Eventually, parliamentary legislation in 1876opened up medical and university education

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to women, and empowered all medicalexamining bodies to examine womencandidates.

By 1894, the situation for women hadimproved so much that the British MedicalJournal R commented: "It is almost as easyat this moment for a woman to get a completemedical education in England, Scotland orIreland as it is for a man." While this wascertainly an exaggeration, it is also true thatmore women were entering the medicalprofession than ever before, and by the endof the nineteenth century virtually all Britishuniversities were open to women for trainingand education in medicine.

Eleanor Davies-Colley became the firstwoman FRCS Eng. by examinnation, in1911. The daughter of a surgeon, she hadtrained at the London School of Medicineand in 1907 was appointed House Surgeonat the New Hospital for Women. Highlyregarded by both colleagues and students, herdistinguished career spanned thirty years,during which time she held several seniorappointments.

In 1919 there were only four womenFellows of the Royal College of Surgeons ofEngland; by 1990, this number had risen to320, still just five per cent of the total numberof Fellows worldwide. Many more womendoctors are now trained as surgeons invarious surgical specialities all over theglobe. Still male domination is predominant.While some might argue that the under-representation of women in the surgicalspecialties is attributable to lingeringprejudices and stereotypical roles of thesexes, the true reasons may be more complexthan this, and have at least as much to dowith career structures and the allocation oftime and responsibilities which render otherspecialties more attractive for women.

62 Bull.lnd.lnst.Hisl.Med. Vol XXX - 2000

REFERENCESI. Singhal, G.D. 1982 Notable Names in Medicine. Ayurvigyan

Pragati, I: 100.

2. Majumdar, S.K. 1994 Medicine Through the Ages. Bull.Ind.lnst.Hist.Med. 24 : 41 - 50.

3. Kurrzru, K.M.N. 1999 Surgical Instruments of Pre-Islamic AncientIndia. Historical Medical Equipment -Society Bulletin, London, No.6, p. 6 - 9.

4. Nutton, V. 1995 Medicine in Medieval Western Europe,1000 - 1500. In : The Western MedicalTradition, 800 B.C. to A.D. 1800. Eds.Lawrence, I.C. Neve, M., Nutton, V.,Porter, R. and Andrew, W. Ch.5, p. 170,Cambridge University Press, Cambridge,England.

5. Aubrey, John 1976 Brief Lives, Harmondsworth, Penguin,p.322.

6. Nightingale, F. (Undated, Letter to Parthenope, Lady Verney.after July Wellcome Institute for the History1865). of Medicine.

7. Blackwell, E. 1895 Pioneer Work in opening the MedicalProfession to Women. London, Longmans.

8. Anonymous 1894 Medical Education of Women BritishMedical Journal, 1894 2, 490.

H,,'tory of Women in Surgery - Majumdar 63

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