Alison Moulds is a second-year DPhil student at St Anne’s College, University of Oxford. Her thesis looks at the construction of the doctor/patient relationship in nineteenth-century medical writing and fiction. She is working with a collection of medical journals at the Royal College of Surgeons of England, under the auspices of the AHRC-funded project, Constructing Scientific Communities. Alison is also Peer Review Editor of Victorian Network. She Tweets on medical humanities via @alison_moulds and blogs (less than she should) at https://victorianclinic.wordpress.com/.
When the First Indian Medical Congress gathered in Calcutta (the then-capital of British India) in December 1894, its President extolled the way in which it had brought together ‘all sorts and conditions of medical men and women, European and Indian, official and non-official’, with the purpose of ‘establish[ing] a solidarity of interests and aims’.[i] Surgeon-Colonel Robert Harvey’s opening address – which imagined a complementary and collaborative role for doctors of both British and Indian descent, and for both medical men and women – may come as something of a surprise. Nineteenth-century women doctors are often imagined as occupying marginal roles, if they are even imagined at all.
Over the last year, however, the Victorian ‘lady doctor’ – as she was frequently called – has gained increasing visibility in popular culture. 2015 was the 150th anniversary of the first British woman (Elizabeth Garrett) qualifying as a practitioner and the occasion was marked with celebrations at the Royal Society for Medicine. Bodies of Light, Sarah Moss’s neo-Victorian novel depicting a young woman’s struggles to become a doctor in late-nineteenth century Manchester and London, was shortlisted for the Wellcome Book prize. Finally, the BBC’s revived Ripper Street introduced a Victorian medical woman to the small screen, in the shape of the ambivalent Dr. Amelia Frayne. These representations have arguably helped to augment our understanding of female medical practice in the nineteenth century. For this was a concerted movement, which gained considerable momentum between the late 1860s and the century’s close. In 1865, there were just two women on the Medical Register in Britain; by 1892, there were as many as 135.[ii]
Jumping on the proverbial bandwagon, I wanted to use my blogpost to raise the profile of the important role female practitioners played in colonial medicine in the Victorian period, particularly in India. Some of the earliest pioneers – including Edith Pechey (one of the first female medical students at the University of Edinburgh in 1869) – went out to work there from the early 1880s. Moreover, at the same time advances were underway in Britain, new opportunities were opening up in India – in 1875, Mary Scharlieb (later the first woman to receive an MD from the University of London) entered the Madras Medical College as part of its inaugural cohort of female students.
The medical-woman movement in India received a significant boost when Lady Dufferin, the Viceroy’s wife, instituted the National Association for Supplying Female Medical Aid to the Women of India. The ‘Dufferin Fund’, as it was commonly known, was nominally established in 1885 – though the idea had existed in embryo for several years – and enjoyed the patronage of Queen Victoria. It both supported European women doctors who wished to work in India and provided scholarships for Indian women to be trained in Western medicine. By 1888 there were eleven women employed by the Fund, six of whom were of Indian origin,[iii]and its role continued to expand in the following decades. Its primary purpose was to provide medical care to native women who observed zenana or purdah (i.e. those who practised veiling or segregation), through a network of single-sex hospitals and dispensaries as well as home visits.
The Dufferin Fund and the lady doctor in India garnered considerable support. Reports of the scheme and its successes received widespread coverage in both the popular and medical press, both in Britain and India. In 1884, the Lancet claimed that its previous misgivings about female practitioners emphatically did not apply to ‘those countries in which women are as a sex secluded’,[iv] while in 1892 the Medical Press and Circular declared that medical women’s ‘best sphere of labour is undoubtedly in India’, deeming it ‘necessary and useful work’.[v] The Fund was seen as playing a vital role in reaching native women who would otherwise be unwilling or unable to receive medical attendance, because social and religious custom prevented them from being examined or treated by male doctors and/or from sharing facilities with patients of the opposite sex.
Significantly, the colonial medical woman was regarded not simply as a necessity but also as an aspirational figure. In 1895, the Indian Medical Record published a full-page profile of a young Anglo-Indian practitioner named Florence Dissent. Speculating that ‘[t]he zenanas will remain closed to men physicians for another century’, it suggested that their female counterparts ‘ha[d] to themselves an unexplored field of service that is unsurpassed in its possibilities for doing good’.[vi] In a similar vein, the Indian Medical Gazette depicted medicine as ‘a promising career’ for women.[vii]
It would be erroneous to suppose that the medical-woman movement received unqualified or unanimous support, however. When such a scheme was first proposed, the Indian Medical Gazette called into question its utility, claiming that arguments in its favour were ‘one-sided and strained’. It doubted whether there was sufficient appetite for female practitioners, and suggested women would be better suited to ‘take the position of helpmates [i.e. nurses] rather than the attitude of equals and rivals’.[viii] (Similar arguments were also levelled against the movement in England.) Much of this opposition was assuaged in later years, due in part – perhaps – to the Fund receiving Victoria’s official stamp of approval. Nevertheless, some continued to deny that there was a role for women in India. One of the movement’s most prominent detractors was Sir Joseph Fayrer, a distinguished colonial surgeon. He maintained that, in his experience, ‘there was no difficulty in the way of medical men entering the most jealously guarded harem when there was need for their services’.[ix]
I am particularly interested in how both critics and advocates of the movement conceptualised the native female patient. Historian Samiksha Sehrawat emphasises how constructions of the zenana patient were inherently reductive and simplistic. The variations in how native women practised seclusion – dictated by class, caste, region and religion – were repeatedly erased by Victorian commentators. ‘[C]ollapsing this diversity […] resonated with imperial representations of colonial women,’ she argues.[x] Generalisations about female patients in India were widespread, as in one article in the Westminster Review, which asserted that ‘[n]o man, especially a European can, with propriety, see a native lady, even to prescribe for her in sickness’.[xi] In short, imperial ideologies both shaped and constrained understandings of the female patient.
In the medical press we continually encounter well-worn images of India as a passive child or as a nation consumed by ignorance and prejudice, in need of rescue and reform by British colonisers. In an article praising the progress of the medical-woman movement, the Lancet lingered over the ‘bodily sufferings’ of ‘the helpless native women of India’, barred from male medical attendance.[xii] The Indian Medical Record, meanwhile, envisaged the Fund as a ‘means of spreading the light and civilisation of the West into the darkest and most remote corners of the land’.[xiii] The supposed ‘darkness’ and ‘dependency’ of indigenous peoples were familiar tropes in imperialist rhetoric, though the dynamics of this relationship are complicated by the fact that those practising colonial medicine were of both British and Indian descent.
While recognising the ways in which the zenana patient was imagined in resolutely imperialist terms, I also wish to explore how she was conceived in relation to broader ideas about patient choice or preference emerging in this period. The notion that female patients might prefer to consult a practitioner of the same sex was also widely espoused by those sympathetic to the woman-doctor movement in Britain, as in Sophia Jex-Blake’s Medical Women: A Thesis and a History (1886). Of course, it would be misleading to suggest that the Indian female patient was assigned agency – as we have seen, she was all too often associated with passivity and vulnerability. Nevertheless, I would suggest that the discourse around her needs intersected in important ways with conceptions of female patienthood fashioned in the metropole. Indeed, her disinclination towards male medical attendance was not seen as solely symptomatic of her religious beliefs, but also as something more universal or fundamental. When she sketched out the idea for a female medical service for India in 1882, female practitioner Frances Elizabeth Hoggan reconceptualised native women’s ‘so-called prejudices’ as a ‘natural modest shrinking from doctors of the male sex – which religion and custom alike consecrate’. She called for these preferences to be ‘respected and not outraged’.[xiv]
[i] Robert Harvey, ‘The Medical Profession and Its Work in India, Past, Present and Future’, Indian Medical Record, 1 January 1895, pp. 1-7 (p.1).
[ii] ‘Extraordinary General Meeting’, British Medical Journal, 30 July 1892, pp. 262-4, (p. 262).
[iii] Margaret I. Balfour and Ruth Young, The Work of Medical Women in India (London: Oxford University Press, 1929), pp. 33-7.
[iv] ‘Women Doctors for Women’, Lancet, 29 March 1884, p. 580.
[v] ‘Medical Women in England’, Medical Press and Circular, 5 October 1892, p. 360.
[vi] ‘Our Picture Gallery: Miss Florence Dissent’, Indian Medical Record, 1 May 1895, p. 334.
[vii] ‘Current Medical Topics: Female Medical Students in Madras’, Indian Medical Gazette, August 1886, p. 246.
[viii] ‘Women Doctors for India’, Indian Medical Gazette, 1 July 1882, pp. 184-5.
[ix] ‘Royal College of Physicians of London: Debate on the Petition for Admission of Women to the Examinations and Diplomas’, Lancet, 2 November 1895, pp.1125-7 (p.1125).
[x] Samiksha Sehrawat, Colonial Medical Care in North India: Gender, State, and Society, c. 1830-1920 (Delhi: Oxford University Press, 2013), p. xxxv.
[xi] C.N. Barham, ‘Child Marriage in India’, Westminster Review, 135, 1, (January 1891), 113-123 (pp. 122-3).
[xii] ‘Annotations: Zenana Medical Work in India’, Lancet, 7 December 1889, pp. 1188-9 (p. 1188).
[xiii] ‘The Viceroy and the Dufferin Fund’, Indian Medical Record, 15 March 1899, pp. 335-336 (p. 336).
[xiv] Frances Elizabeth Hoggan, Medical Women for India (Bristol: J.W. Arrowsmith, 1882), p. 2.