above raiding a ward sister's blanket store-with thebest of intentions.

Always a Bible Christian, Grenfell came to regret hisyouthful assertiveness and to recognise in others thepre-eminence of character over creed. By selecting forcompetence he created a health service that would passamenably into secular control long after his death in1940.

In 1911 work began on the King George V Institutein St John's, a building offering facilities to travellersand safe lodging for girls working as ships' cooks. Theking, connected by transatlantic cable, pressed abutton in Buckingham Palace to lay the foundation

stone on the day of his coronation. (A man wasconcealed under Grenfell's platform, ready to releasethe stone if the royal signal failed.) In 1912 theInternational Grenfell Association was founded andthis continues to fund research projects.The climax of Grenfell's career, and his knighthood,

came in 1927, with the rebuilding, in brick, of the StAnthony Hospital as a centre of excellence, with 80beds. When he retired there were six hospitals, sevennursing stations, four hospital ships, two orphanages,two large schools, 14 industrial centres, and a coopera-tive lumbermill in the region he served. And beri-berihad disappeared from Labrador.

- ~~~~z0

Elizabeth Garrett Anderson in1889 -"the essentiallyconservative pioneer whorepresented the acceptable face ofpractising women doctors to the(male) profession"

British MedicalAssociation, LondonWC1H 9JRTara Lamont, secretary,board ofscience and education

BMJ 1992;305:1529-32

The Amazons within: women in the BMA 100 years ago

Tara Lamont

Shall the Association decide to commit, in a moment ofreactionary excitement, an act ofhostility in itself uselessand sure to be hereafter regretted, against a movement thestrength and vitality ofwhich cannot be doubted?'

Elizabeth Garrett Anderson addressing theRepresentative Body in Bath, 1878

In 1892 the British Medical Association voted over-whelmingly to expunge a clause from its articles ofassociation that debarred membership to women.Elizabeth Garrett Anderson had for 19 years been thesole woman member of the association during a stormyperiod in which the objective of full membershipfor qualified women doctors often seemed elusive.Editorials in the British Medical Journal and theLancet had warned against the lowering in status thatwould ensue from the acceptance of women into theprofessional body of doctors. There were further fearsabout entry into the social networks provided by theBMA as the "club" for doctors. A Dr Wade, proposingthe motion to exclude women from the association atthe annual meeting in Nottingham in 1878, stated that"Even those persons who were most confident therewere ladies capable of practising medicine and surgerywould admit that it did not necessarily follow that theyshould become members of this Association, whichwas, in fact, a movable scientific and social club."'

Isolation and professional statusIn 1873 Elizabeth Garrett (afterwards Elizabeth

Garrett Anderson) was. accepted for membership bythe Paddington branch of the BMA, sponsored by aphysician at the Middlesex Hospital and another at StMary's Hospital. She was accepted by default, therebeing at that time no stipulation as to the sex ofmembers in the rules and regulations of the associationfor the simple reason that it was assumed that allmedical practitioners were men.2 Elizabeth Garrett hadbecome a qualified practitioner by a tortuous route,finally obtaining an MD from Paris in 1870, ten yearsafter attaching herself to Middlesex Hospital as anaspirant medical student. She was refused formaladmission to medical schools and instead pursued herstudies privately in Edinburgh, St Andrews andLondon with extensive financial support from herfather. The solitary mode of training was difficult: in1864 she wrote to Emily Davies (later the founderMistress ofGirton College, Cambridge): "Snubbing...is unpleasant and for a time hindering. You cannot atonce believe that personal effort can altogether makeup for the help that teaching and guidance give otherstudents... I must peg away alone and do as well as Ican."3

The sense of isolation experienced by ElizabethGarrett was not only personally difficult but alsopolitically weakening. In her letters to friends andcolleagues, Elizabeth Garrett stated the need to openthe way for other women doctors-"the cause" as sheonce called it-rather than just to achieve the individualobjective of her qualification. Similarly, she was awarethat the headway she made with individual physicianswould be no substitute for change in the institutionsand bodies that determined professional standards andrights. She wrote in 1862 that "The general feelingseems to be that each doctor is willing to help meprivately and singly, but they are afraid to countenancethe movement by helping me in their collectivecapacity.

It was therefore important to Elizabeth Garrett tosecure professional status rather than simply to practiseas a doctor. She received the Licence of the Society ofApothecaries in October 1865, and in September 1866her name was placed on the Medical Register. Shestarted practising at the St Mary's Dispensary forWomen and Children in Marylebone, where sheworked until moving to Paris to 1869 a study for herMD. It was not until 1873 that she applied for ordinarymembership to the BMA through the Paddingtonbranch.

Storm over women membersTwo years passed before the fact of her membership

became widely known. At the annual representativesmeeting in Edinburgh in 1875 Elizabeth GarrettAnderson was due to read a paper in the obstetricalsection. The question ofwomen members of the BMAerupted into a unholy storm. Professor Christison waspresident at that time and declared his own antagonismtowards medical women. A motion was put by DrPemberton proposing a vote on the question of admit-ting women members to the association. In a letter toher husband Elizabeth Garrett Anderson wrote thatshe had been advised by Ernest Hart, editor ofthe British Medical Journal, to "be on the watch forPemberton's motion and be ready to speak against it."3Her earlier clashes with the medical profession in theyears leading up to qualification had not hardened herto the trials of intense scrutiny and even hostility: "Idon't want to fail as a leader even of a forlorn hope butit grates against my taste making anything of a self-defensive speech to such a body."3

In this climate, the act of reading a scientific paperon obstetrics became politically charged. This wasrecognised by Anderson herself: "I do hope it [herpaper] will be useful in a solid way to the cause."3 She

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hoped to defuse the political by establishing herscientific credentials. She wrote to her husband of the"great triumph" of her paper; it was very well receivedby a large audience, and a vote ofthanks was passed byacclamation.However, the triumph was short lived. A resolution

was carried by the annual meeting to hold a referendumon the question of women members: out of 4161replies, 3072 were against admitting qualified womenand 1051 were in favour. Despite a majority ofover twoto one, this vote had no legal force; however, the resultswere used in effect to prevent the future admission ofwomen to the BMA.

It was decided that Elizabeth Garrett Anderson'selection to the BMA was legal and could not beannulled. Her colleague Frances Hoggan, who was atthe time the only other women member of theassociation, was disenfranchised as she was not regis-tered at the time; a hundred men in the same plightwere re-elected.The political temperature was raised a few years later

when a letter appeared in the British Medical Journalfrom a Dr Wilson Fox, who had asked the secretary ofthe BMA whether women were to be admitted. He wasgiven the careful answer that "the Committee ofCouncil have no power to prevent ladies who aremembers of the Association from attending themeetings of the Association." Dr Fox resigned andasked that the constitution of the association bechanged to exclude women so that "the rules ofpropriety and delicacy... between the sexes" bemaintained.5 An editorial on 16 February 1878 advisedthe "two lady members" (Elizabeth Garrett Andersonand Frances Hoggan) to act on the results of theplebiscite and stated that they should "feel called uponto respect that voice and retire from the Society whichhad declared that their presence was unacceptable."6

Women excludedIn March 1878, an extraordinary general meeting of

the association was held in Birmingham to discussadmission ofwomen. A resolution was put forward to asecond special meeting in September 1878 during theannual meeting in Bath proposing to add a clause to thearticles of the association: that no female shall beeligible as a member of the Association." This wasmoved by Dr Wade and seconded by Dr Stewart "asthe original culprit"7 who had proposed ElizabethGarrett Anderson as a member of the Paddington

Soon to be doctors-and eligible to join the BMA. Women medical students at Glasgow Royal Infirmarybefore the turn ofthe century

Branch ofthe BMA. However, he bowed to "the strongpreponderance of feeling against the admission ofladies" in "the majority of the members."A lively account is given of the ensuing debate in the

BritishMedicalJournal of 17 August 1878. Dr Kerr wasgiven a fairly hostile reception for his short speech infavour of the admission ofwomen, stating "How couldthat be immodest in a female physician which wasmodest in a female nurse? [Cries of 'Question']" After afew more interjections, Elizabeth Garrett Andersonspoke and "was received with loud cheering."7 In anearlier letter to her husband, she had declared herintention to "lift the question on to a higher plane andto appeal to the best part of their minds."3 This she didby a careful and deliberately impersonal speech, whichseems from the reports to be punctuated by spon-taneous cheers.

Elizabeth Garrett Anderson began her speech with areminder of the primary function of the association:

We have heard a good deal of this Association beingdescribed as a "club", a club for social purposes, and soon. But this is not what it states itself to be in its Articles ofAssociation. There we see that the object or purpose of theAssociation is twofold: 1. The promotion of medicalscience; and 2. The promotion of the interests of theprofession. With regard to the first ofthese objects, no onecan venture to say that medical science will be promotedby excluding from the Association a body of honest andpainstaking workers, who will bring to the study ofmanyimportant problems some experience of their own essen-tially different from that of male practitioners."'

The latter point was a key argument used by thosecampaigning for the rights ofwomen doctors. ElizabethBlackwell, the American MD, highlighted the functionof women doctors in improving the lot of womenpatients, sparing them the "indelicacy" of encounterswith their male counterparts. This argument was seenas politically acceptable, and there is much debate inthe letters of Elizabeth Garrett Anderson on thequestion of whether women should treat men. Thiswas seen as controversial, and an issue that Andersonoften avoided in public debate.

No joy at 1878 ARMAt the 1878 annual representatives meeting she

proceeded to argue the case for inclusion ofwomen onthe grounds that practising women doctors who werenot bound by professional codes and agreements onterms and conditions would weaken the negotiatingstance of the association. This is interesting, as corre-spondence and editorials in the Lancet and BritishMedicallJournal had cautioned against the inclusion ofwomen on the grounds that it would lead to diminishingstatus and remuneration for doctors. Anderson turnedthis argument on its head, emphasising the greatercontrol of women afforded by a decision to admitwomen members:

"You do not wantwomen to be willing to do any amount ofwork for the lowest prices; you do not want them to beinsensible to the general pecuniary interests of the pro-fession; you do not wish them to disregard the courtesiesof medical etiquette; and how can you look for a spirit inthem of comradeship and of regard for the common weal,ifyou refuse to let them remain in anything like fellowshipwith you as members of your Association, and if you goout of your way to create in them a spirit of antagonismand of self-assertion?"'

She played astutely on fears of an unregulated body ofwomen doctors not bound by any professional ethos.The London School of Medicine for Women hadopened in 1874 and, although its long term future wasstill somewhat uncertain at the time ofthe 1878 annualmeeting in Bath, there was in existence at least a body

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dedicated to the training of women. Elizabeth GarrettAnderson herself made mention of the great sum of£12 000, which had been raised as an endowment forthis school. Equally important, in 1876 RussellGurney's Enabling Bill, which permitted licensingbodies to examine women, was made law. Suchmilestones ensured that there were greater oppor-tunities for women to become qualified medicalpractitioners, regardless of being allowed to join theBMA.

Elizabeth Garrett Anderson completed her talk bydismissing the question of a loss of modesty indiscussing medical matters between the sexes, ridicul-ing her male colleagues who "find it impossible,without a shock to their moral refinement and sense ofdelicacy, to discuss pleuritic effusions in the presenceof a woman." She declares robustly, "I am not aware ofanything in the whole range of general medicine orgynaecology which I could not discuss with prac-titioners of medicine without any sense of embarrass-ment."'

She concluded with a rousing affirmation of thefounding principles ofthe British Medical Association,underlining the importance of "keeping true to itslargest purposes, which in our case are the promotionof science and the promotion of fellowship." Sheillustrated the fallacy of intolerance with the story ofCharles Lamb, who was pulled up by his friend forheaping abuse on the head of a man whom he did notknow. Lamb retorted: "My dear fellow, of course, I donot know him. How could I hate him at all if I did?"Elizabeth Garrett Anderson on this principle exhortedher fellow members to "let your prejudices meltaway."'Her speech was received rapturously; Mr Barrow

who followed on from this "confessed that, if anythingcould have made him change his views upon thissubject, it would have been the very pleasing addressof Mrs Anderson. There was no member of theAssociation but would be happy to meet Mrs Andersonin society, at dinner or in general meeting." Favourableimpressions notwithstanding, however, the vote to adda clause excluding women was passed by "an un-questionable majority. "''There followed a period of intense isolation for

Elizabeth Garrett Anderson; despite her solitary statusas the only woman member ofthe BMA, she continuedto go to branch, division, and annual meetings andusually spoke at such occasions, but she confessed toher husband that "Sometimes the feeling ofdisapprovalbecomes almost unbearable."3 However, changes in

the training and registration of women were slowlyhaving their effect on the medical establishment.

The debate revivedIt was not until 1892 that the question was debated

again at the Nottingham annual meeting. An extra-ordinary general meeting was held on 28 July 1892 andDr Galton moved to expunge the clause of the articlesof the association excluding women for the sake of the"efficiency and harmony" of the association. He statedthat whereas in 1878 there were only eight practisingwomen doctors "who had gallantly struggled throughthe various portals into the profession" there were 135women doctors in 1892: "times were changed andwere, he hoped, changed for good."7 Dr Galton thenmade a vitriolic attack in fullblown rhetoric on "thisgutter policy" and those supporting it: "It was un-worthy of it [the association] and of their professionwhen its great leaders adopted such a policy, andshowed that their ill-fitting garments hung upon themlike full-grown clothes upon the shrunken shanks of apantaloon."7

His motion was seconded by Elizabeth GarrettAnderson, who made a fairly low-key speech echoingthe themes of her earlier address in 1878. She em-phasised the need to create a feeling of "solidarity"within the profession and, like Dr Galton, underlinedthe fact of the existence of 135 practising womendoctors as in itself a compelling argument for theirinclusion into the association. She concluded with anappeal to fellow members: "They were all disciples ofDarwin and his great theory of evolution, and herebefore their eyes was the great evolution ofwomen outof one stage into another, and if they were all reallygood Darwinians they would help this evolution."7

This point was reinforced by the next speaker, MrBrown, who betrayed the conflicts and tensions in-herent in the movement to "enfranchise" womendoctors. He stated that "they had now arrived at a timewhen the evolution of women demanded that theirposition be recognised in the medical profession"despite the fact that "there was no one who at the Bathmeeting worked harder to oppose the resolution fortheir admission that he did ... he still thought it wouldbe very much better for women themselves if womenwere not in the profession. He thought himself that hecould do the work of a surgeon or of an obstetricianvery much better than any woman who had ever tried."However, he lent his support to the admission ofwomen, albeit grudgingly: "Let them see what womencould do. He felt sure that they could not do muchharm."7

The 1892 decisionA vote was then taken, and the resolution carried by

297 to 4 to admit women to the association. This waslater contested by the vice president of the BMA, DrHolman, who wrote to the British MedicalJournal on13 August 1892 "to record my emphatic protest againsta hasty legislation by which a radically organic changein our laws is sought to be confirmed on August 24th, adate when so many medical men are compelled to beabsent on their hardly-earned holidays."s Notwith-standing this protest, the decision to admit womendoctors was confirmed in August 1892.

In 1896 the East Anglian branch of the BritishMedical Association elected Elizabeth GarrettAnderson as its president. Women-or, more accur-ately, a woman-had stormed the innermost sanctuar-ies of medical politics. The military analogy-onewhich Anderson herself would have eschewed-wasadopted earlier by the Lancet in describing the trainingofwomen in medical schools.

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"A lady has penetrated to the core of our hospital system,and is determined to effect a permanent lodgment. Theadvanced guard of the Amazonian army which has so oftenthreatened our ranks, on paper, has already carried theoutposts and entered the camp."9

The admission of women into the British MedicalAssociation marked an important stage in the enfran-chisement of women in medicine. The part played byElizabeth Garrett Anderson was significant, as theessentially conservative pioneer who represented theacceptable face of practising women doctors to the(male) profession. Indeed, the shift in policy by theprofession-if it can be seen as a concerted or collectiveendeavour at all-was characterised by the forces ofcircumstance and a desire to control the marginal

forces of unregulated doctors, whatever their sex. Inthe debate a hundred years ago on the admission ofwomen to the association, the march of progress wastempered by pragmatic self interest, a combinationwithout which no revolution is guaranteed success.

1 Forty-six annual meeting of the British Medical Association. BMJ 1878:ii:253.2 Muirhead-Little E. History of the BMA. Vol I. 1832-92. London: British

Medical Association, 1932.3 Anderson L G. Elizabeth GarrettAnderson. London: Faber, 1939.4 Blake C. The charge of the parasols: women's entry to the medical profession.

London: Women's Press, 1991.5 Admission of ladies to meetings of the British Medical Association. BMJ

1878;i: 175.6 The admission of ladies to the British Medical Association [editorial]. BM3'

1878;i:234.7 Extraordinary general meeting. BMJ 1892;ii:262.8 The admission ofwomen to the association. BMJ 1892;ii:383.9 A lady amongst the students. Lancet 1861 ;ii: 16.

Princess Vera as professor ofsurgery in Kiev, a post she heldfrom 1929 to 1932

Department of Ear, Nose,and Throat Surgery,Queen Elizabeth MilitaryHospital, LondonSE18 4QHJ D C Bennett, seniorspecialist

BMJ 1992;305:1532-4

Princess Vera Gedroits: military surgeon, poet, and author

J D C Bennett

The name of Princess Vera Gedroits is now no morethan an obscure reference in old surgical textbooks,'but her story deserves to be told.

She was born in Kiev on 7 April 1876 and her familylived on an estate in Slobodishche in the district ofBryansk. As was the custom, her early education was athome, followed by finishing school in St Petersburg.Well before the 1905 revolution the city was the sceneof various underground organisations. Vera took partin the illegal meetings ofV A Veinshtok, but after thiscircle was broken up in 1892 she was sent back home toremain under police supervision. She managed areprieve and made for Switzerland, a favourite refugeforwomen from Russia who wanted to study medicine.2She studied medicine in Lausanne, completing herstudies in 1898 at the age of 22, obtaining almost acomplete set of top marks in her final examinations.Perhaps still wary ofbeing tracked down, she had threedifferent addresses in three terms and altered hername.3

After qualification Vera worked for a while inProfessor Roux's clinic but did not settle, returning toRussia in 1900. In 1904 only 3-4% of Russian doctorswere women.4 She published a variety of medicalpapers but because of her previous connections shecame under the attention of the police (the dreadedOkhrana). Possibly because of this and from a sense ofadventure she volunteered as a surgeon for a hospital

Princess Doctor Vera Gedroits (right) in the company ofofficers of the Imperial Army (probably 1904 5)

train organised by the Red Cross. This supplementedthe Russian army's medical department and was wellsupported by wealthy Russians, acting partly throughaltruism or possibly for the hope of some reward. Thecentral committee was in St Petersburg and under thepatronage of the empress, who not only ensured thatthe staff was chosen from the city's best surgeons butalso gave over rooms in the Winter Palace for sewingbandages.The War Office's report on the Russo-Japanese war

said of Vera:Among those who went to the Front in the service of the RedCross as surgeons [was] the Princess Gedroits, chief surgeonof the hospital train furnished by the associated nobility of40 Russian "governments," who was always at the front,operating in a specially constructed car, till the enemy's firethreatened the train.5

This was no small risk. Dr Marcou, physician to theTroitzky Hospital, St Petersburg, cynically wrote ofthe field ambulances that "the most notable result oftheir employment has been that not a few of themedical officers in charge of them have been killed inaction."6 In this they were perhaps not best served bythe instructions for the Russian army: "Militaryambulances and hospitals are recognised to be neutralonly so long as sick and wounded may be therein. Theirneutrality ceases if they are defended by a militaryforce."7The conclusions of the joint reports written at the

end of the war were that healthy fit troops fightingunder modern conditions could expect a minimumannual rate of wastage through wounds or illnessamong the field army of 55%, exclusive of prisoners.5 Itis hard to see where the optimism with which theprotagonists approached the first world war eight yearslater was based. The infantry ofthe 1st army lost 96 7%of its officers and 67% of its men as killed and woundedduring the first 13 months of the war. These figureswere the result of the widespread use of modemdestructive instruments of war, in particular themachine gun. The surgeons lost 12 of their number(two killed, seven missing, and three suicides) and21 were wounded; 28 were taken prisoner, ofwhom 20were subsequently released by the Japanese.

Vera presented the results of her work to the Societyof Military Doctors on 27 July 1905, making thefollowing points, all of which have current militaryrelevance. The closer a hospital was to the battlefieldthe more productive was its work, and such a hospitalcould look after those patients who would be returned

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