The Doctors Are In

Outlander Science Club

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A Dram of Outlander
Voyager Read-Along
Chapters 32-33

The Doctors Are In
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“Jenny Murray had been the nearest thing I had ever had to a sister, and by far the closest woman friend of my life. Owing to circumstance, most of my close friends in the last fifteen years had been men; there were no other female doctors, and the natural gulf between nursing staff and medical staff prevented more than casual acquaintance with other women working at the hospital.  As for the women in Frank’s circle, the departmental secretaries and university wives…”  From Voyager by Diana Gabaldon, Chapter 32.

The past 20 years have been lonely for Claire.  She lived her calling as a physician but no doubt she longs for the close personal connections she knew in 18th century Scotland. Of course she did have Brianna and a close confidant in  Joe Abernathy, but her marriage with Frank was not an emotionally intimate relationship. For the most part, she was without female friends with whom to share the joys, insecurities, failures, and triumphs of motherhood, career, and life.

Female Physicians in the 20th Century

Claire entered medical school in 1955, a time when women made up only about 5-6% of medical students in the US. Realizing her calling as a surgeon, she then found herself even more of the exception as a surgical resident and then as a practicing surgeon.  The American College of Surgeons admitted its first woman in 1913, and thereafter only admitted between 0 and 5 women each year until 1975. While she would have interacted with numerous female nurses in the hospital, the paternalistic dynamic between physicians and nurses during that era would have prevented anything beyond purely professional relationships between Claire and the nurses.

It wouldn’t be until the 1970s, with the passage of Title IX and the Public Health Service Act, as well as the changing cultural tide, that the number of female physicians would begin to increase significantly.  We now have nearly equal numbers of men and women entering medical school, though the percentage of women entering surgery remains disproportionately low. According to the American Medical Association, as of 2006, women accounted for 12% of general surgeons in the US.

It is no surprise our stubborn, brilliant, tenacious, and brave heroine chose this path. Claire finds herself in good company with the trailblazing women of modern medicine.

Brave Women Paving the Way

Throughout history, women have played a central role in caring for the ill and injured, providing remedies at home, and working as nurses, midwives, and herbalists.  They were also physicians, dating as far back as ancient Egypt through medieval Europe.  However, when the education of physicians became more formalized, with the establishment of universities in the 1400s and the development of licensure for physicians, women were excluded.

Margaret Ann Bulkley, AKA Dr. David Barry

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Prior to the admittance of women into medical schools and inclusion in the licensing programs, women of course still found a way to practice medicine, whether by practicing informally within their communities or in some cases, attending medical school and practicing medicine while disguised as a man!  Margaret Ann Bulkley, born at the end of the 18th century in Ireland, lived her life as James Barry in order to practice medicine.  After receiving a medical degree at University of Edinburgh, Dr. Barry became a military surgeon in the British Army and practiced medicine for over 50 years in India, South Africa, and the Caribbean.  It wasn’t until an examination after dying of dysentery that it was discovered that Dr. Barry was actually a woman!

Dr. Elizabeth Blackwell

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Elizabeth Blackwell was the first woman physician in the US.  Upon receiving her application, the dean of New York’s Geneva Medical College presented her application to the students.  He asked the all-male student body to vote on whether the college would accept a female student.  Thinking this a great joke, the students unanimously voted to admit Ms Blackwell and she graduated in 1849, passing the qualifying exam with the highest average.  She would go on to co-found the New York Infirmary for Women and Children.

Dr. Elizabeth Garrett

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Inspired by Dr. Blackwell, Elizabeth Garrett was working to gain acceptance to medical school.  After she was denied medical school admission, she entered Middlesex teaching hospital as a student nurse, and began attending medical school courses.  Despite receiving outstanding marks, just before it was time to graduate, she was dismissed.  None of the other universities in England would allow her to continue her studies and earn a medical degree.  Out of options for continuing her medical studies, she decided to focus her efforts on studying to become an apothecary.  She completed an apprenticeship, but following this, official university matriculation was necessary to complete her apothecary education.  Again, England’s universities were closed to her.  Likewise, she was rejected at St. Andrews University and University of Edinburgh in Scotland.  Undaunted, she continued on, attending rounds with a number of practitioners in London, accumulating the required proof of training for her application to the Society of Apothecaries and taking the qualifying examination. She passed and became the first woman licensed by the Society of Apothecaries, officially becoming a physician.  After building a large private practice and proving care to the impoverished, she taught herself French and was permitted to take the exam for a medical diploma in Paris, finally earning an MD in 1870.  Dr. Garrett went on to serve as the dean of the London School of Medicine for Women for twenty years and is thought to be the first women in history to perform an oophorectomy (surgical removal of the ovaries).

Dr. Sophia Jex-Blake

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Many women experienced similar road blocks in their journey to become physicians.  Sophia Jex-Blake was officially accepted to study medicine at the University of Edinburgh, though it appeared that she was accepted her in error. Quickly realizing the application was submitted by a woman, the university blocked her from entering classes.  Undeterred, Ms Jex-Blake, along with other physicians, created the London School of Medicine for Women in 1874.  However, women graduating from the new women’s medical college found that despite earning an MD, they were refused privileges to work at all of the reputable hospitals. These pioneering women therefore founded their own hospital, the New Hospital for Women.

Women in Europe and in the US founded women’s medical colleges and women’s hospitals and most women physicians in the late 19th century received their medical education and training in these institutions.  Public opinion did begin to change, finally, and by the early 20th century, women were accepted into traditional medical colleges and women’s medical colleges began to close.  It would be another century, however, until women and men attended medical school in equal rates, and women physicians are still fighting the gender gap in pay and academic promotion.

No doubt Claire would have fought similarly for the right to practice medicine, should she have found herself in the same situation.  She surely faced much discrimination on her own path to becoming a surgeon. However, once back in the 18th century, she generally finds herself practicing in areas in dire need of her help, and once her expertise is witnessed, roadblocks are few. Of course, she is not one to worry overmuch about the opinions of others!

Claire has found herself in the 18th century right back where she belongs: living her calling as a physician with the support and companionship of family and friends.

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References:
Lorber, J., & Ecker, M. (1983). Career development of female and male physicians. Academic Medicine, 58(6), 447-56
Lyons, A. (n.d.). Medical History — Women in Medicine – Health Guidance. Retrieved October 23, 2016, from http://www.healthguidance.org/entry/6355/1/Medical-History–Women-in-Medicine.html
Ulrich, B. (2010). Gender Diversity and Nurse-Physician Relationships. Virtual Mentor, 12(1), 41-45.
Young, A., Chaudhry, H., Pei, X., Halbesleben, K., Polk, D., & Dugan, M. (2015). A Census of Actively Licensed Physicians in the United States, 2014. Journal of Medical Regulation, 101(2), 8-23. Retrieved October 16, 2016.
14-086 Physician Specialty Databook 2014. (n.d.). Retrieved October 23, 2016, from https://members.aamc.org/eweb/upload/Physician Specialty Databook 2014.pdf
Header Image: STARZ, Other Photos: Public Domain
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