:

LONDON SCHOOL OF MEDICINE FOR WOMEN,

HENRIETTA STREET, BRUNSWICK SQUARE, W.C.

DELIVEREEj^ BY

MRS. GARRETT ANDERSON, M.D.

October 1st, 1877.

I.

( Printed by request.)

LONDON
H. K. LEWIS, 136 GOWER STEEET.
1877.
KCL INSTITUTE OF PSY
Affty
LIBRARY

tef: 0207-848-0204
e-msll: [email protected]

Pressnted to the Ubrary by

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LONDON SCHOOL OF MEDICINE FOR WOMEN,

30 HENEIETTA STREET, BRUNSWICK SQUARE, W.C.

200702411 9

INST. PSYCH.

DELIVERED BY

MKS. GARRETT ANDERSON, M.D.

October 1st, 1877.

Printed hy request.)

"f Crespigny^

LONDON
H. K. LEWIS, 136 GOWER STEEET.
1877.
 C L INSTITUTE OF PSYCHIATRY'
LIBRARY
De Crespigny Park, London 8E5 SA''
B\: 0207-848-0204
 INAUGUEAL ADDEESS
DELIVERED AT THE

LONDON SCHOOL OF MEDICINE FOR WOMEN.

OCTOBER 1st, 1877.

The first word in an address such as this which I have been

asked to give to-day to those who are now entering our
School must be " Welcome." To give students new and
old, a hearty greeting, to begin the woi'k of the year with
something which shall remind them and us of our corporate
existence, of our fellowship and common hopes and aims,
this, I think, is the main purpose of an Inaugural Address.
But though this is the first, it is not the only object of an
Inaugural Address. Gathering the students together thus
at the beginning of the Session gives us an opportunity of
ofiering them a little advice as to the mode of arranging and
carrying out their work. Incidentally too it may be useful
in explaining to lay friends the scope and sequence of medical
studies, and perhaps also of sugoesting to them considera-
tions which may lead to their being better patients in future

than they have hitherto been. In reference to this point, I

must say that I have often thought it would be well if some of
the Inaugurals of which we read reports early every October
were addressed especially to patients, and if some serious
efiort were made on behalf of medical science to improve
people as patients, as well as to improve them as students.
This is, however, not my object now : I will address myself
at once to our students.
The first thing a student feels on looking through the lisfe

of subjects in a medical curriculum is probably bewilderment

at their number and variety, and an uncomfortable sense of
 —

not knowing where to begin first. Yery likely if left without

guidance^ his first attempt would be made in vain, and time
would be wasted in trying to understand a subject taken out
of its proper order. Nothing, I think, is of more importance
to students than that they should grasp the true order in

which the different divisions of medical education come, and

should follow it; that they should understand why every
subject is added, and what is its special place and its compa-
rative or relative importance. Everyone knows how much
time and labour are saved, if, before visiting a new town,
more especially when the town is full of interesting associa-
tions and objects, Rome for example, we carefully study the
map, get the main plan of the place clearly into our minds,

know the position of its most important monuments and

decide which are those which we will on no account miss.
So in entering upon the study of Medicine it will save you
much time if you will spend, say one good long evening in
studying the medical curriculum, reading prefaces, introduc-
tory chapters and indexes, and understanding the true order
of the subjects to be studied. To me it seems that the medi-
cal curriculum naturally divides itself into four parts :

1. The study of healthy function.

2. The study of disease.
3. The machinery for investigation or cure.
4. The art of healing.
Speaking roughly each of these subdivisions may be taken
to correspond with one year of student life, though, especially
after the first year, all will to some extent overlap and will

have to be worked at together. Still we may say in general

terms that the student should place before him as his goal

during the first year, the knowledge of the body in health ;

during the second year the knowledge of disease; during the

third year the machinery for investigation or cure ;
durmg
the fourth year, healing.
Now in the first year, for the study of Health, he must
 5

have^ first. Anatomy or structure;' second, Chemistry or tlie

knowledge of the elementary constitution of bodies, inor-

ganic and organic ; and third. Physiology or structure at
work; and I would advise new students to concentrate all

their time and energies on these three subjects, to allow of

no distractions except such as may be necessary for relaxa-
tion or refreshment. To this end I would myself, though on
this point many would not agree with me, advise them not
to go to a hospital, not to read medicine, and not to take
any lectures not directly bearing on these three subjects. A
year is all too short in which to master Anatomy, Chemistry,
and Physiology, you will need every moment. If unfortun-
ately,you cannot do without some change of scene and you
go into the hospital wards to find it, I should counsel you to
to do so deliberately as a relaxation, recognizing that you
are not yet prepared to work in them to any purpose, and
that the most you can do at present is to pick up scattered
and superficial notions about disease and treatment.
Now as Health should be the key note of your first yearns
work, so should Disease be the key note of the second one.
It will still be necessary to spend some time in dissecting.

But the main object of the year should be to understand

diseased' -processes ; and for this purpose you must live as
much as possible in the hospital wards, and in the out-pa-
tient room ; you must visit the post-mortem room and patho-
logical museums, and attend systematic lectures on Medicine,
Surgery, and Pathology. It is in this second year that you
will also begin to learn the art of taking clinical notes, and a
difficult art you will find it to be. Now too, you will have
to decide for yourselves by what method, if by any, you will
work in the hospital wards. Will you merely just follow the
physician or surgeon in his round, hearing his remarks,
understanding some, and missing many more, and getting a
few, more or less incoherent, notes into your This book?
is one method, if it deserve the name, and one very generally
 6

followed. Another is to search the wards for cases illustrating

the lectures on medicine or surgery you heard last or are to

hear next. For example, the lecturer's subject may have

been Rheumatic Fever. Find at least two or three cases,
watch and note them carefully, study them specially, read
them up in several authors, noting what you read, and keep
them under special observation till the end of the illness.
This kind of concentrated attention will lead to much more
accurate knowledge than many rapid runs round the wards
can do. There is, however, another method, a sort of com-
pound of the two. It is this. Take, say six cases, three surgical
and three medical, and fix your mind upon them. Read about
them, take notes, examine them for yourself as much as

possible, search in museums for specimens illustrating

them, think about them, try to understand them and don't

leave them till you do. Think of these six cases as specially

yours and try to exhaust them. While doing this, follow the

visits to other patients, and pick up all you can. As

relaxation, even, this is valuable, and after really study-

ing a few cases you will be ready to make use of even frag-
mentary hints which may bear upon the cases to which you
have given thought. Hospital practice is to my mind the

part of medical education which presents the great^t diffi-

culties to the student ; at first especially, too much is pre-

sented to him, and very much of what he sees is in advance

of his power of following or understanding. On the other

hand, the little he does pick up helps to make the systematic

lectures and reading more vivid and interesting, and, there-
fore, it is not to be desired that students should postpone
hospital study till they have been through their lectures.
What I would suggest is that they should always be study-

ing a few cases with a good deal of concentration, and along

with this should see a large number in the way that students
do see by merely following the physician's or surgeon's visit.
 It has often occurred to me that an index, a mere hst, of
the more important known and named diseases might be
used by students for the purpose of reminding them con-
stantly of what they have to see and recording what they
have seen. Such a list I have occupied myself during the leisure
of the recent holidays in drawing up in the hope that you may
find it of use_, and I am having it printed in the form of a
pocket book. You are meant to mark off in the column
'Seen' every disease you are able to study carefully, and
while studying it in the wards to work up in the post-mortem
room or museum and in your reading, its pathology and its
literature. In choosing what cases to study first, you will of
course be a good deal limited by what there is in the wards,
but within this hmit, I would give you two guiding hints,
1st, Begin whenever you can with the more general diseases
(those which affect the whole organism) 2nd, Never forget ;

that the commoner a disease is the more important it is that

you should understand it. At first especially do not run
about after curiosities, study the ailments of which the
wards give you most frequent examples. The Col-
lege of Physicians in Nomenclature enumerates 1146
its

diseases, medical and surgical; audit is no

exaggeration
to say that a well-educated student ought
to know the nature
and bearing of everyone of these, and that in
the case of the
more important ones he ought to have studied
and watched
each of them several times. The list that
I have drawn up
does not, however, profess to include
these 1146 conditions.
If it had, it would have been too
bulky for real pocket book
work. It includes almost everything
you will find in the
medical wards, and a small but important
part of what you
will see in the surgical wards.

If Physiology and its tributaries

(Anatomy and Chemistry)
were too much for the first year's work,
still more is Patho-
logy or the study of Disease too
much for the second year.
 8

A good student will, however, by diligence and method,

make some way in a year, and he may perhaps be ready to
change his ground to some extent during the third year.
It is at this stage I think that he should put before him,
as his chief object, to acquire a mastery of all that may be
described as the machinery for the investigation or the cure
of disease. I include under this head the use of the stetho-
scope, ophthalmoscope, laryngoscope, sphygmograph and
microscope, many of which instruments he will doubtless
have worked with in his second year.
need perhaps scarcely pause to point out to you how
I

desirable it is you should learn to use these instruments on

healthy subjects before applying them to the investigation
of disease. Much time is wasted by the students, and much
fatigue and even injury involved to the patient, if this rule is

not observed. Try to gain a firm knowledge of every instru-

ment of research upon healthy subjects (upon each other

for example), before applying it in the wards.

Under the head of " Machinery" I include also operative

Surgery, surgical dressings and appliances, operative mid-
wifery, the use of gyno3Cological instruments, materia medica
and pharmacy, the various kinds of electricity and the modes
of applying them, the use of baths, the influence of climate
and the therapeutic value of the best known mineral waters.
Perhaps you will dispute my right to include all this under

the head of Machinery:' I do not contend for the word

seems to me to answer the purpose fairly well. I
though it
good
want the student to be sure that he has obtained a
in the
working knowledge of all the instruments concerned
investigation of disease, and of all the weapons
surgi-
direct

cal or medical at his disposal.

some of you will say he should
I can suppose too that
machinery before and not after he
study this that I call

studies disease. Some knowledge of his instruments of in-

vestigation he must doubtless acquire in the year mainly de-

 9

voted to Pathology, some of them, as the stethoscope and

thermometer he will be in the daily habit of using, but on ^
the whole, I think time will be saved if he postpones their
complete and thorough study till he has gained a clear con-
ception of diseased processes in the organization. Having
gained this, he is then in a position to understand any infor-
mation his instrument of research may afford him, and in
studying practical surgery and pharmacy, and his other cura-
tive agents, he brings with him a clearer notion of what it is

he aims at effecting, and of what it is possible to effect. In

the fourth year, the student should I think, have for his special
aim the acquisition of the Art of Healing. In his second year
he studied Disease and learned to recognize and differentiate
diseases, his third year he devoted to familiarizing himself
with the material appliances of the art of medicine, in his
fourth, he must do what he can towards learning to apply them.
How great and difficult a step this is only those know who
have tried to take it ! It can be begun only in the fourth year,
for it involves all the difference between experience and in-
experience. To those who may not be fully aware of all that
is involved in this difference, I would say, "Think for a
moment The student knows
of the case of typhoid fever."
the natural history of the illness, he knows its risks, its
symptoms and its pathology. He knows the usual tempera-
ture curve, he can use the stethoscope, and appreciate the
signs given by the pulse, the intellectual condition, &c. He
knows too the effect of opium, wine, quinine, food, baths,
&c. But he is not a doctor till he knows how to interpret
all that he observes, when in a given case, or at a given
moment, to use any one remedial agent, and how to use it,

or when, and why not to use it. He needs too to know when
and why occasionally to depart from all ordinary rules, as to
dose, and to give what is necessary to attain a necessary end.
So again, in surgery, it is not enough to have acquired some
manual dexterity as an operator, the art lies in knowing how
 10

to Ileal the malady, if necessary by surgery, if possible with-

out it, and always with the least attainable cost of pain and
time. For example our student may know very well how to
cut off a limb, in his fourth year he must try to learn when
this is the only thing to be advised, when it can be avoided,
and how in either case to minimize the risk and suffering
and permanent damage to the patient. And in learning this
Art of Healing, in learning to apply with judgment and
skill the weapons in your armoury, you will need chiefly two
things, the first is time, and the second is a varied experience.
By this I do not mean your own experience, but a varied
experience of the practice of well trained masters of your art.

I think it of great importance towards the end of a student's

curriculum that he should see the practice of a good many of
his seniors. Incidentally I may say that one of the great
advantages of the Paris school is that there the students can
have this ;
they can follow the clinique of any physician or sur-
geon at any hospital, for as long as they like, taking work
under each in turn, instead of being, as in London, restricted
to the practice of one hospital. Till something like this is

possible to all students in London, I shall rejoice to hear that

those of our students, who can afibrd the time and cost it

involves are arranging to take at least one year in Paris

before entering upon practice. It may be said, however,
" this must be unnecessary as it is nob prescribed by the ex-
amining bodies ;
surely it is enough if we fulfil their require-

ments and pass their examinations." My answer to this is,

that one of the gravest mistakes a student or a school can

make, is to think too much of the requirements of the ex-
amining bodies. They must be fulfilled, no doubt, but hav-
ing fulfilled them, dismiss them from your minds, and keep
it clear that what you aim at is a sound knowledge of your

art, and that all must have, whether pre-

that this needs you
scribed by the examining bodies or not. The real test you
have to meet is not when sitting before the examiners, but
 11

when face to face with suffering for the relief of which you
are responsible. am not among those who decry
I examina-
tions. They seem to me immensely useful^ even to the best

students, but only if thought of as a means and not as an

end. Properly used, they help us to arrive at exact and clear

notions of the subjects we are studying, but if put before us

as the most important end of all our study, they probably do

infinitely more harm than good. I would even go so far as

to say " do not be too much afraid of failing in your examina-

tions,^^ and " do not be too much disheartened if you do." It

is of course desirable that women should do well, and should

brincf credit to our cause in examinations as elsewhere —but
I want you all to realize that important as this is, there is

behind it something of infinitely more importance, and that

is that you should really be ready for the responsibilities you
are about to undertake. Possibly failing in an examination
now and again, may help you more, in the long run, by kind-
ling zeal, stimulating industry, and encouraging accuracy,
than an unbroken run of success at examinations could have
done. At any rate it is not a thing to break your hearts
over. When the London University opens its doors to
women, I hope a large proportion of our students will try for
its degree, and in trying, they will probably all from tim.e to
time be plucked. It would not be the Honours Degree it is

if it could be had easily, and I understand there are not

many men who get it without, at one time or another, hav-
ing gone through the disagreeable experience I anticipate as
possible for you.
Having now explained to you what I think a medical edu-
cation should be, and how it should be arranged, you have a
right to ask " Can you give us, at the London School of
Medicine for Women, and complete education ?"
this orderly
In answering this question, I must speak separately of the
school proper, and of the Eoyal Free Hospital with which
now we are happily allied. And first, of the school. It is
 12

obviously very difficult and expensive in a small school where

there may perhaps be only five or six new students every
year, to provide for every student a complete and orderly
sequence of classes. Hitherto we have not done this. Now,
however, we have, as I think most wisely, resolved to take
one important step towards accomplishing it. We have
decided that at any rate the first year's course, viz.,
Anatomy, Chemistry, and Physiology, shall be given every
year. Every new student will thus, at any rate, begin
at the right end, and will get a good start towards being in
a position to understand the courses arranged for subse-
quent years. Though, as I have said, it seems to me most
desirable that after the first year's work is passed, the student
should master the history of disease before entering upon the
art of healing, still the order in which these departments are
taken is of less importance than that he should know healthy
structure and function before beginning to study disease and
the methods of curing it. If we succeed in giving students
an orderly course of instruction, as I confidently hope that
we shall, I see no reason, looking to the excellence of the
staff of teachers who have so kindly gathered round us why
our teaching here should not be at least as good as in any
of the smaller London Schools.

Then with regard to Hospital Practice, what have we to

offer you ? I need not speak again of the immense difficulty

we have had in getting any hospital at all of the required

size, for the use of our students. The difficulty till lately

seemed almost insuperable, and but for the zeal and skill

of our Treasurer, Mr. Stansfeld, it would have probably

proved to be so. Now, however, thanks to Mr. Stansfeld,
and through him to Mr. Hopgood, a large general hospital
has opened its doors to us, and the material for clinical
teaching is thus provided. The work of adequately organ-

izing this material for teaching purposes will, we are well

aware be one of great difficulty, and one which could under

 13

no circumstances be rapidly accomplished. As_, however, we

have happily the good will of the medical staff as well as of
the committee of the hospital, I hope there is no doubt that
with patience and tact, the work will gradually be brought
to a good issue, and that before very long we shall see the

hospital thoroughly organized for the instruction of students

in the art of healing, and in the perhaps more difficult art of
teaching clinical medicine. It is, however, no disparage-
ment of our hospital to say that a year spent in Paris where
the organization of medical teaching is brought to a per-
fection unknown in London will be most useful at the end
of each student's course of study, and especially to those
who look forward to becoming clinical teachers.

Up to this point I have said to you only what might with

equal truth be said to any other body of medical students in
London. But in the case of this School one other subject
claims consideration. For the first time in England an
address of this kind is given to women ; for the first time,
on this day, a complete medical school is open to English-
women in their own country, and it is perhaps not un-
reasonable if we are expected to say a word or two in excuse
for, or in defence of, our own existence. Any word from me
on this point will assuredly be a short one and for these two
reasons ; 1st. It is perfectly certain that no arguments will
influence the opinion of those who dislike the innovation,
and 2nd. That in my opinion the real defence of our position
cannot be found in argument but in experience. Whether
women can be trained into first rate doctors, and whether it
is a solid advantage to society to have them so trained are
questions which to my mind can only be answered by experi-
ence, and by experience on a somewhat large scale.
Many of the objections commonly brought against us may
no doubt be dismissed at once as trivial or imaginary. It is
quite certain that women, as students, can study every part
 14

of the medical curriculum as seriously and thoroughly as men

can ; the experience at Paris^ Edinburgh, Zurich, and Berne, and
at our own school proves this, and that they do quite as well, to
say the leasts in examinations. It is also certain that women
can bear fatigue and anxiety as well as men can. But while we
can thus dismiss a good many of the stock arguments of our
opponents^ I am afraid we must, on the other hand, deal in
somewhat the same way with not a few of the arguments of
our friends. I often feel an uncomfortable suspicion when I
hear our friends advocating our cause that some of the ad-
vantages they anticipate from medical women will not per-

haps be found. It is often said for instance, Women will

understand women's ailments so

•
much better than men do."
I fancy this is only true in a very partial and limited sense
and that it is most undesirable that medical women them-
selves should place much confidence in it. To understand
disease the possession of the special organization in which
the disease is found, is of very minor importance as com-
pared with the possession of brains and cultivation. No one
would say that a horse or a dog, for instance, could be made
a better veterinary surgeon than a man, or a child a better
child's doctor than Dr. West or Sir W. Jenner, or a deaf
man a specially good aurist, or an epileptic or paralytic a
specially good nerve doctor. No doubt in all these cases
certain facts or symptoms would be more completely realized
by one who had himself felt them than they can be by de-
scription, but there is an immense gulf between realizing
symptoms, and understanding them, or still more curing
them. It is, moreover, a very obvious fallacy in this argu-

ment, that it assumes that medical women, because they are

women, will have felt all or nearly all the symptoms that sick

women feel, the chances being that thoy will have felt

scarcely any more of them than a man know has. We all

for instance how common an ailment backache is among

women, so much so that some one has said they may be

 15

divided into women with backs and women without them.

Now if the medical woman happily for herself belongs to the
class without backs^ I fail to see in what sense she can be
said to have any advantage over men in her power of under-
standing and curing the backaches of her fellows. If, on
the other hand^ she has a back herself^ it will no doubt make
her more keenly aware of the nuisance the pain is to others,

but by itself it would not do much towards teaching her to

cure it. we may draw any inference from what
Indeed_, if

we see among men, we may even suppose that being the

subject of certain symptoms often diminishes one's power

of reasoning intelligently upon them. Certainly doctors are

not usually specially wise over their own case, and it seems
to be more diflScult for them to be rational in the interpreta-
tion they put upon symptoms felt by themselves than when
they observe them in others.
That there' is a true side, amid much that is misleading in
this argument, I do not deny, but I would entreat you not to
mistake it. You will understand disease and the thousand
undefined steps which lead to it from perfect health, whe-
ther the disease occurs in man, woman, or child, in propor-
tion to your knowledge and intelligence and powers of
observation,and not by virtue of any occult or mysterious
sympathy with its subject. There is, however, as I have
said, a true side to this argument. In two directions I
think it is almost certain that our special experience as
women will help us in the practice of medicine. In the first
place we understand better than men can ever do the con-
ditions of which underlie a vast amount of feminine ill-
life

health. I speak now of chronic ill-health. Storms of acute

illness may come to anyone, though even in regard to them
the antecedent surroundings of the individual have a much
greater influence in creating the liabiHty to such storms
than is commonly suspected. But with regard to chronic
ailments, as e.g., dyspepsia, lateral spinal curvature, general
 16

debility, backache, neuralgia, uterine flexions, hysteria, kc,

the antecedent conditions are of the very highest impor-
tance as causative agents, and they are conditions into
which no one but a woman could ever thoroughly enter.
No young man, in England at any rate, knows what
it is to lead an indoor and idle life, without work and
quite as truly without play, a life in which the amusements
are not more dull and trifliug than the employments. It
needs a woman to sound the depths of dulness in this kind
of life and to see how destructive it is to nervous health.
I might almost venture to say, in spite of all that is written
about the nervous diseases of women, that it needs a woman
to say for all women that they are like men in this, that

they have a nervous system, and that the extreme nervous

tension, which at any rate, in all young creatures, results

from inactivity of mind and body, is incompatible with

health, and is the most common cause of chronic debility
and ill- health.

There is, too, another way in which I look forward to

-women, as women, being of some special use in medical
practice. I hope they will hate and resent chronic ill-health

in women more than men do. I hope they will be less re-

signed to it, and more inclined to protest against its being

accepted as almost as much the rule for women as fairly

good health is for men. The greatest barrier to progress is

contentment, and I cannot but hope that medical women

will be less contented with feminine delicacy than medical
men have been.
Another argument sometimes used by our friends, upon
which also I look with some suspicion, is that women will be
so much more sympathetic men are.
with invalids than
Probably the truth is that medical women will differ as much
with each other in this respect as medical men do. They
v^ill differ also in their mode of expressing sympathy. I

would venture to assert, too, that in many cases it may be

 17

doubted whether the most obviously sympathetic doctor is

the best. Illness, especially when it is chronic, does so

much to demoralize the individual who suffers it, diminishes

to so great an extent his self-control, fosters to so lament-

able a degree his selfishness and egotism, that judgment
and firmness on the part of the doctor are often much more
valuable than a very sympathetic manner, and are occasion-
ally even opposed to this manner. As a rule, too, the
invalids who desire sympathy the most, deserve it the least
and abuse it the most. This is well seen in hysterical
women, the class who above all others demand and prize
sympathy, make the worst use of it^ and absolutely cannot
get well till it is withheld.
In saying this, however, I would not be misunderstood, of
true sympathy you cannot have too much. But it is easy to
concentrate it too much on those who demand it most and
still more easy to express it unwisely. Your best safeguard
will be to strive in this as in everything else to be sincere.
Let your sympathy flow out naturally, not because you feel
that your patient asks for it and because it is politic to please
her. Give it freely so long as it is spontaneous, but remem-
ber that your first duty is to cure and not to please, and
where the expression of sympathy will do barm, have the
courage to withhold it. There is one direction, however^ in
which the full expression of sympathy can scarcely ever do
harm, and that is towards the relatives who have to live with
chronic invalids. It is often possible to help and encourage
them very much, by kindly appreciation of the hourly self-
sacrifice of their lives, and by checking it when it tends to

become unwise or excessive.

Another very important argument which I feel bound to
—
mention is this. It is often said "It is of no use for women
to study medicine. They will marry and have children, and
the practice of medicine is incompatible with the duties of a
mother of a family. To this argument our friends have given
 18

various answers. " They wont marry" or

They have said
even " They wont have children/^ or " if they do, it wont
signify, they can practice just the same." Now for my part
I am not able to agree with anyone of these answers.
It seems to me certain that a considerable proportion
of medical women are sure to marry, and tbey will of
course have children just like other people. Nor can
I admit that this will not, to a very material extent
limit tbeir professional work. I am convinced it must
do so. If medical women are to be of no use unless they
can undertake as much work as men, in other respects their
equals, we shall have to give up our position as untenable.
I think it will be found that the distractions of domestic life

will not only very much limit the amount of work a medical
woman can undertake, bub will also entirely prevent her from
combining some departments of work with practice, as for
instance literary work, or research. Either of these might,
with management, be carried on along with the family life,

but not, I think, with it and an active professional life also.

It may probably be more frequently necessary for a woman,

than it is for a man, to choose her work, whether it is to be
practice, writing, or research ; to recognize that she is, to a

very great extent, limited to one or another, and that the

other pressing claims upon her time and thought forbid her
entering upon them all. The really important point is whe-
ther this limitation as to the area of work undertaken, seri-
ously interferes with the possible excellence of such work as
can be done. If medical women can do such work as, with
due regard to other claims, they are able to undertake, in

a trustworthy and creditable manner, the fact that they can-

not undertake twice as much is not of fundamental import-
ance. Society is concerned only with the quality of their
work, not with its quantity, and we, as their advocates, are, I
think, only called upon to show that the limitations as to

quantity (which in the case of married women with children

 19

I look upon as inevitable), do not, to any serious extent in-

volve a corresponding limitation as to quality. Some such
limitation, I think, we must in honesty admit that it does
involve. The art of medicine, like every other difficult work
a,;ks for concentration of thought and attention, and those
will do best who can give this. My Son, give me thine
Heart" is a demand with which the student of every difficult art
must comply as a condition of the highest success. I doubt,

therefore, whether in any but very exceptional cases a woman

weighted with the interruptions, the distractions, and the plea-
sures of family life, and conscientiously trying to do her duty
in this relation will succeed in reaching the first rank even in
any one department of professional work, because the first

rank demands a concentration which she is perforce unable

to give. But, on the other hand, it is certain that much of
the experience gained as a wife and mother helps to make a
medical woman not only a comfortable but a wise adviser to
other women. A very large proportion of the cases which
come before a doctor are not those which present any very
great difficulty to a well trained and well educated practi-
tioner. But they require judgment, and tact, and just the
sort of consideration in adapting the advice to the intel-
ligence and circumstances of the patient which the experience
of a married woman will specially help her to acquire. So
strongly do I feel this to be true that with regard to the
rank and file of medical women, those I mean who would
probably under no circumstances take the foremost place in
their profession, I could venture to say that on the whole
what they will gain through the experience of domestic life
will go far to counterbalance what they will lose from its
distractions.

After admitting as much as this to those who oppose the

admission of women to the medical profession, it may per-
haps be asked, " Why then do you support it? Is it worth
while to make a great social change unless all the advantages
 20

that have been prophesied by its supporters are likely to flow

from it ?" Perhaps not, if there are no other and more solid
and enduring gains about which we can speak confidently
and not merely as possibilities. I must not now weary you
by dwelling on these, a mere word on one or two of those to
which I attach the most importance will suffice. Every
woman who undertakes the study of medicine, in at all
the right spirit, gains at once this solid advantage— she puts
aside frivoHty and accepts for herself a serious aim in life.

But this, precious as it is, and underlying as it does all other

gains, is not all. She accepts also freedom, not from parental
control so long as she is young enough to need it, but from
ennui and from an unnatural prolongation of the restraints of
childhood. In the important question of marriage, she is

free, no longer forced to marry as the only way of entering

upon adult life. She is also free from the fear of poverty.
Once having mastered her profession she is assured at least
against want, probably even she is certain of being able to
gain a respectable competence. And if, as I believe, these
gains flow to the individual, surely society shares them. It
is no trifling good to society to have, even here and there,
frivolity displaced by seriousness, unnatural childishness by
experience and the discipline which results from responsibil-
ity, an idle poverty by industrious competence.

In conclusion I would beg you to remember two points.

The first is that without indulging in any high flown estimates

of our own importance, it is impossible to deny that the future
success of our cause depends very much upon the judgment

and moderation, as well as upon the zeal of its earliest advo-

cates. In England, where the conservative instinct is so

strong and so general, it is of paramount importance, if we

would carry the community with us, not to put ourselves
needlessly in opposition to this instinct by any want of good
taste or even by want of deference to the taste of the com-
munity. " All things are lawful, but all things are not expe-
 21

dient/' and it is not for us who are in charge of this question

to endanger it by tilting against everything else capable of

being improved. Let us reserve ourselves for our own work

and peg away manfully at that, trying in all legitimate ways
to carry opinion with us.
The second is that you should bear in mind that from

this day forth, you are not mere isolated units in so-

ciety, you are not merely women who desire to help

the best interests of women, but that you are mem-

all

bers of a noble profession, and that you have the respon-

sibility which is Hnked with comradeship towards every

other medical person, man or woman. Let us strive to

enter into the common life, let us free ourselves from petty
jealousies, let us ignore all that is opposed to comradeship in
the attitude of others towards us, and never allow ourselves
to be guilty in the same way towards them, seeking in all

things to promote the highest aims and interests of the pro-

fession, to purge it of its flaws and to add to its honour.

r< C L INSTITUTE OF PSYCHIATRY

LIBRARY
Oe Crespigny Park, London 8£5 8A''
si: 0207-848^204

PRINTED BY H. K. LEWIS, I36 COWER STREET, W.C.

I
K C L INSTITUTE OF PSYCHIATRY
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 Nearly ready, /cap. long 8vo, cloth.

THE STUDENT'S POCKET BOOK

AKKA.NGED BY

MRS. GARRETT ANDERSON, M.D.

I-.

This is intended to supply medical students with a means of register-

ing some of the more important part of their clinical work, in such a way as
shall be easily available for after reference.
It is hoped that it will also serve to guide their reading and pathological
study in connexion with each disease as it comes under their notice in the
wards, and generally that it will help to keep before their minds the range of
subjects which they have to overtake.

LONDON: H. K. LEWIS, 136 GOWER STREET.