Painting of the Edinburgh Seven by David Hutchinson

Could Dr. Watson have been female in late-Victorian England? 

Judging from the number of Victorian-set, gender-swapped Holmes & Watson stories that make Watson a nurse or the wife of a doctor, the answer would seem to be “NO.”

And history would, on first glance, seem to agree with them. Even though there is a long record of female physicians throughout the world, 19th century Britain was unusually hostile toward the idea—even more so than the rest of Europe. 

Before we can consider the case for a female Dr. Watson, we need to understand what the situation was for women medical students and doctors leading up to 1878 when canon Watson earned his MD from the University of London. 

Most of the hostility toward women doctors wasn’t really based on ideas of female inferiority and weakness or the Victorian “angel of the home” stereotype. Those were just the arguments various men used as an excuse to keep women out of medical training. 

Maybe a few actually believed women were mentally and physically inferior, but the loudest protests about women doctors were coming from male doctors and medical students themselves. And it wasn’t because they truly feared for the women’s mental health and safety. Quite the opposite: they felt economically and socially threatened. 

You see, up until the mid-1900’s in Britain, being a medical doctor in Georgian and early Victorian Britain was often (but not always) a bullshit job for second sons of wealthy families. All it really took to become a doctor was a lot of money (for university classes in Greek and Latin and botany and anatomy you might or might not actually attend)—or simply enough chutzpah to call yourself a doctor and the marketing skills to con people into thinking your toxic sludge of cow blood, opium, and mercury could cure a huge list of ailments. 

In addition to physicians, there were also two other kinds of male medical providers in Britain: surgeons and apothecaries. Both were lower class than physicians, and instead of attending university, their training was usually through apprenticeship. Surgeons sometimes operated on people, but mostly they functioned as general practitioners, doing the actual work of treating patients. Apothecaries were the forerunners of today’s pharmacists and also were able to give medical advice as well as provide medication.

And let’s not ignore the fact that a lot of real medical care was being provided by women in the form of midwifery, nursing, and herbal knowledge

So all in all, medicine was definitely not a prestige profession. In general, the pay was low unless you were lucky enough to have wealthy patients to support you on retainer or unless you were a good enough con artist to get people to buy your fraudulent remedies. 

Obviously, if you are a doctor or surgeon in that time, this is a problem for you. But how to go about raising the status of your profession? Well, there are a couple of options. 

First, you need to have some medical breakthroughs and scientific discoveries that help you improve patient outcomes. This was already starting to happen in the 1700’s, and it only kept accelerating in the 1800’s.

Second, you need to convince society that these advancements and breakthroughs that save lives are the achievements of superior, highly-trained minds. Not just anybody can become a Man of Science. You shouldn’t trust your body, your health, your very lives to some untrained hack who decided yesterday to call themselves a doctor!

I mean…some of that last bit is very fair. 

But there was also a concerted push to delegitimize female practitioners, especially midwives. Male doctors went to great lengths to convince pregnant women that having their babies delivered by a doctor was more civilized and safer than just sending for your local midwife. 

In truth, midwives tended to have more successful outcomes than most doctors, but mortality rates for both mothers and newborns were extremely high in either case. So the men were able to prey on those justifiable fears and convince a lot of families that doctors offered a better hope of survival.  

There was a concerted effort in the first part of the 19th century to improve medical training and make it longer and more rigorous (and, as a result, more expensive). It also became harder to get into. Even the surgeons and apothecaries became pickier about who could join their ranks. 

But it wasn’t until 1858 that there were any national regulations in Britain of who could call themselves doctors and practice medicine. A medical registry was created, and the only people who could be on the register were those who had obtained credentials and training and passed examinations from a set of nationally approved organizations, such as the Royal Colleges of Physicians/Surgeons or the Worshipful Society of Apothecaries, or various hospital-affiliated medical schools (such as Barts Hospital, of Holmesian fame). 

The goal was to root out quack doctors and make it more difficult for them to peddle their wares. But there was also a good deal of British nationalism involved because it meant that anyone who earned a medical degree from a non-British university, after 1858 when the law went into effect, could not be on the registry or practice medicine in Britain without also being credentialed by one of the approved British organizations. (Remember that point—it’s important. We’ll get back to it later.)

So…phew! It took over half a century, but there was finally some laws and a developing system of medical training. Our doctor dudes can kick back, pop open a cold one and celebrate, right?

Wrong! 

Just as they were starting to see possible dollar signs…er, pound signs (is that even a saying in British English? “Seeing pound signs”?), just as they were gaining some prestige, some status in society, some cultural power and respect, a new-old enemy rose up. 

Women.

Yes, those pesky women in the mid-1800s weren’t content to sit on their bustles and let the men control their bodies and their healthcare. They had Ideas. They had Notions. They had Ambitions. 

They wanted education too. 

Nurses and midwives had been making some of the most important advances in patient care during the time. We know some of their names, like Florence Nightingale, Mary Seacole, and Clara Barton. Their innovations in practicing hygiene and sanitation helped save countless lives.

But in Britain, they were limited in both training and what they were allowed to do because of the new medical license requirements and because male doctors had positioned themselves as the medical authority. 

Additionally, starting in the late 1840’s and into the 1850’s, both women and men began to argue that there was a need for women doctors, especially to tend to female patients and children. Yeah, I know—cringe. But also, a whole lot of us who identify as women would prefer seeing a woman gynecologist or women doctors in general, and I’m sure women of the 19th century felt the same. Even though they couched it in patriarchal terms, there was a genuine need for women doctors, and it wasn’t just women who were acknowledging this. 

But most universities and credentialing bodies in Britain resisted allowing women to join them. There were all the usual arguments: women are too delicate, this will tax their fragile, inferior minds; it’s unseemly for women to face the harsh realities of the human body (excuse me? Who’s bleeding every month and pushing babies out their vaginas and often dying from it all? Grrr…). 

So women resorted to other ways of getting their training. Several places in Europe, most notably Zurich and Paris, allowed women to attend classes and be trained alongside men. And in the United States, colleges and universities began opening their medical programs to women much sooner than in Britain. 

Going overseas for training was not a great solution. It was terribly expensive, and studying in Europe required fluency in a second language as well (something that women from less affluent households would have a more difficult time gaining). And even if one was able to attend classes, that wasn’t enough. Like today, medical students were required to also have hands-on experience with patients at a hospital. And many hospitals resisted allowing women students to train with them. Some of the earliest women doctors, and some male doctors who were supportive, solved this problem in the United States by opening charity hospitals specifically for women and then staffing them with women medical students and doctors.

But the Medical Act of 1858 in Britain barred those with foreign medical degrees from being on the medical registry. (Remember? I said we would come back to that.)

The members of parliament who pushed for that law later claimed that it was never meant to prevent women from becoming registered medical doctors. But because none of the British credentialing bodies were willing to allow women to study with them or sit the exams, that was the practical effect. 

And that suited many of the medical men of Britain just fine. They craved validation and status for their profession, as well as more money. If women were allowed into the medical profession, that would mean more competition for patients. It also would almost certainly result in lowered wages because of the low value placed on work done by women. 

There were two women doctors who managed to get onto the medical registry during this time. Elizabeth Blackwell earned her medical degree in the US before 1858, so she was able to qualify based on the fact that the law only applied to those earning foreign degrees after 1858. And Elizabeth Garrett Anderson exploited a loophole in the charter of the Worshipful Society of Apothecaries that allowed anyone with the proper training to become a member. She managed to get her training, had proof of it, and so they had to let her in. This allowed her to gain a medical license through them, even though she had a much higher medical degree from France as well. 

But the Apothecaries promptly closed that loophole to prevent other women from taking advantage of it. So for almost two decades, from 1858 to 1876, it seemed impossible for British women to practice medicine in Britain, even if they could earn a degree elsewhere. 

There was a group of women who gained permission in 1869 to study at Edinburgh University, but after one of them came in first in the chemistry examinations (over all the men), the male medical students rioted. Actually rioted, in order to prevent them from getting their degrees. In 1873, after a bunch of legal wrangling, the court declared that the college was in the wrong to have allowed the women to even enter the program, and the Edinburgh Seven were denied the ability to graduate.

The leader of the seven, Sophie Jex-Blake, went on to co-found, with Elizabeth Garrett Anderson, the London School of Medicine for Women. It opened in 1874 with good support from several men in the medical field as well as the broader community. 

But there still remained the issue of hospital training and being able to get onto the medical registry. Jex-Blake and others were able to lobby several MPs to bring forward a bill in 1876 that specifically gave permission to the credentialing bodies to allow women to sit their exams—if those organizations wanted to do so. 

There was still much hand-wringing and whining from various men both in and out of the medical world about what this would do to their precious profession (not to mention society as a whole—doomed, I tell you!), but the women were finally winning.

And in 1877, the King and Queen’s College of Physicians in Ireland was the first regulating body to admit women candidates for degrees, allowing women who had earned foreign degrees to sit the qualifying exams and gain entrance to the medical registry. 

Next time, we will look at how a woman Dr. Watson would fit into this history, particularly in terms of the University of London. 

(Photo Credit: Edinburgh Seven & the Surgeons’ Hall Riot of 18th Nov 1870, © David Hutchinson, acrylic on board)