‘Too high a percentage of failures’? Cover-up at the New Hospital for Women

The first generations of women doctors were highly restricted in their career possibilities. Denied access to the examinations of the Royal Colleges in London and Edinburgh, and excluded from appointments in the teaching and district general hospitals in which postgraduate training took place, they were unable to obtain the patronage of senior figures that was essential to any young doctor wishing to forge a successful career. For a lucky few, however, there was an alternative to taking a low-status post such as lecturer in public health and hygiene, or medical officer for women in an institution – namely, to work in one of the women-run hospitals, where they could be assured both of a regular income and of gaining postgraduate experience.¹ The New Hospital for Women (NHW), established by Elizabeth Garrett Anderson in 1872, was the largest such hospital, and it was there that the first British woman doctor started to operate – although ironically the quality of her performance, had it been widely known, could have proved a serious setback to the cause of women in medicine.

When she founded the NHW, Anderson arranged for a number of established surgeons to join the consulting staff, to advise her and assist with difficult cases, but refused to appoint a man to the permanent visiting staff, insisting that she should do all the surgical work at the hospital² – despite the fact that her only exposure to surgery had been as a medical student. As Anderson saw it, part of a woman doctor's duty to women was to be able to treat the whole patient, that her ‘shirking the responsibility of an operation’ when it became necessary would be ‘cowardice’.³ She was not alone in holding this belief: Mary Scharlieb, another pioneer doctor, wrote ‘A woman doctor … cannot possibly say to her patients … “I cannot do surgical operations”’. This, she declared, would be tantamount to ‘a confession of impotence, and would justify those people who say that women doctors are of no use’.⁴

Anderson was adamant that she would not have a male surgeon (‘no men or no hospital’²), and despite her lack of experience, within a few years was tackling major operations herself – including ovariotomy, a highly controversial operation, frequently alleged by its critics to be a form of vivisection, which only 20 years or so previously had carried a mortality of nearly 45%.⁵ Her colleagues were alarmed. Dr Frances Hoggan, who had been at the hospital from the start, resigned abruptly in 1877 without giving her reasons. These seem to have been because she thought Anderson was incompetent,^6,7 but may also have been related to Hoggan's longstanding opposition to vivisection. The matter re-surfaced in 1888 when one of the consulting surgeons, a Mr Meredith, tendered his resignation – again, without explanation. Anderson reassured the Managing Committee that she could cope without his help if they appointed Mary Scharlieb as her assistant, and despite protests from her colleague Louisa Atkins, who did not think Scharlieb sufficiently experienced, the committee agreed. At the next meeting Atkins herself claimed that Anderson's operating posed unacceptable risks, and threatened to resign also, unless she was allowed to send her patients to be operated upon elsewhere:

I firmly believe that … the performance of abdominal sections at this Hospital will be injurious to the patients, to the cause of medical women and to the Hospital itself. … I could not justify it to my conscience to allow any patient of mine to be operated under the present system.⁸

Her request was turned down by the Managing Committee, but in an attempt to mollify her they agreed that an experienced male surgeon should attend the next five operations that Anderson performed in order to give an unbiased opinion of her technique. (In the event the man chosen refused to do so, and the matter appears to have been quietly dropped.⁹) Six weeks later, Atkins, who had previously agreed to postpone any decision about resigning, reported to the committee that she had ‘witnessed another operation performed by Mrs Anderson which did not in the least modify my opinion that she is not competent to undertake such operations singlehanded’. Realizing that no-one was going to look into her claims she resigned, together with the hospital's pathologist/chloroformist, Mary Dowson, who gave the same reasons for doing so as Atkins.¹⁰ Even when Meredith subsequently explained to the committee that the reason he had left five months earlier was because ‘he found that the record of Mrs Anderson's operations at which he had been present shewed too high a percentage of failures’,¹¹ the allegations against the hospital's founder still remained uninvestigated.

In a defensive speech given around the time that Atkins was expressing doubts about her competence, Anderson emphasized to a large lay audience the importance of practical experience in surgery and the difficulties experienced by women surgeons performing operations that they had only observed as students:

It is difficult for non-medical people to understand the immense value of Hospital practice to the young practitioner. Even in medical cases it is very precious, but in surgical work it is simply indispensable. … In surgery the nerve has to be trained too & that is only to be done by actual work of your own – looking on does not give it. … I believe it is impossible for any but those who have gone thro' it to realize what a tremendous tax upon one's nerve it is to attempt a great operation, especially of the kind where exact previous knowledge of the difficulties that will have to be met cannot possibly be had. I speak of this with feeling because I know … how heavy the burden of responsibility is.³

She continued to operate at the NHW, with Scharlieb appointed as her assistant. Thereafter, at intervals the Managing Committee reported her operative successes in its minutes, in a rather blatant attempt to justify the committee's faith in her to subscribers of the hospital, who had been asking awkward questions about staff resignations. One such entry in the minutes records:

Mrs Anderson reported that she had performed a serious operation on the previous day (which could not have been postponed without injury to the patient). Mr Imlach, a specialist of Liverpool, was present at the operation and before leaving wrote the following opinion: ‘Have just witnessed as difficult an abdominal section as any surgeon could have to perform, and think that in technical skill and promptness I have never seen any thing much more perfect’.¹²

(As an enthusiastic ovariotomist Imlach could have been relied upon to support Anderson, but was a risky choice of endorser, since he himself had been much criticized by colleagues a couple of years earlier for carrying out unnecessary operations on his female patients, including removing normal ovaries.)⁵

So what sort of surgery was Anderson undertaking? From 1888, when the first questions were raised about her technical skill, the annual reports show that the cases she dealt with were increasingly varied, reflecting the fact that the NHW had been established as a general hospital, rather than purely for gynaecological patients. Figure 1 shows the procedures she performed in 1887. They include an operation for carcinoma of the breast (which would have been a mastectomy), an operation for bowel obstruction caused by a rectal tumour, an ovariotomy and two oöphorectomies. By contrast, data for 1901 from another women's hospital, the Bruntsfield Hospital in Edinburgh, show that although Anderson had been performing major surgery 14 years earlier, women surgeons at Bruntsfield were still only doing minor gynaecological procedures and a motley collection of small general surgical cases (abscesses, tuberculous joint disease, ulcers, haemorrhoids and hernias).¹³ While I cannot exclude the possibility that this discrepancy might have resulted from local circumstances in Edinburgh at the time, it is sufficiently striking to give an indication of just how surgically adventurous Anderson was.

Figure 1.

Operations performed by Elizabeth Garrett Anderson at the NHW in 1887 (NHW Annual Report for 1888; London Metropolitan Archives, London: H13/EGA/3/004, p.21. Reproduced with kind permission of the UCL Hospitals NHS Foundation Trust)

There is no way of gauging what her surgical deficiencies were, because up until the year of this extraordinary spat details of NHW operations were not published separately in the hospital annual reports. However, before 1888 the total numbers of deaths were given, and while a few are recorded as having occurred after surgery, there are others that were probably also postoperative. In the five year period 1883–1888, 32 patients died in the 26-bed hospital, several of whom, from their diagnoses, had almost certainly been operated on; there are no details of surgical complications. However, given the precarious professional status of women doctors at the time it is unlikely that Atkins would have impugned Anderson's competence, risking the dispute becoming widely known, without genuine cause. And it seems that others – Meredith, Dowson and possibly Hoggan – shared her view. After all, though inexperienced at the outset, Anderson had by then been operating at the hospital for 16 years, and should have acquired the necessary technical skills in that time. The fact that the first woman to become a doctor was unable to handle major surgery, and was possibly even dangerous, could have been catastrophic for the reputation of medical women if it became known. But most likely a combination of Anderson's forceful personality and the fact that the NHW Managing Committee was largely made up of her friends, supporters and relatives, guaranteed an unquestioning loyalty which prevented the information from becoming public.

Between 1 February 1888, when Louisa Atkins first expressed her unhappiness about her colleague's competence, and the middle of June that year, when the matter finally disappeared from the minutes, the NHW Managing Committee had up to 15 members, largely Anderson's supporters and younger doctors dependent on her patronage. A number of the members had been associated with Anderson and her work for many years: the Chairman John Llewellyn Davies was a brother of Emily Davies, the educational reformer, who was a great friend of Anderson's; Mary Llewellyn Davies, Alice Bonham-Carter and Alice Westlake were also longstanding friends; Anderson's sister-in-law, Mary Marshall, and her cousin Bessie Rawlings could have been expected to support her, as could Lucy Sotheby and Maude Stanley, who were members of the wider Garrett circle; finally, Julia Cock and Jane Walker, former students of Anderson's London School of Medicine for Women and newly appointed to the staff of the NHW, would also have sided with the majority in this matter. I can find little information about the remaining five members, but it is clear from its constitution that the committee would not have wanted to investigate Atkins' allegations further.

No further complaints were made, and the issue appears to have been effectively buried. Mary Scharlieb took over much of the surgical workload from Anderson, who retired from the hospital four years later. It was a near thing: if this attempt at whistleblowing had succeeded, it could only have reinforced the prejudice against women doctors that was still rife at the end of the 19th century. Anderson's successors, had they known, would have had good cause to celebrate the whistle being stifled.

Footnotes

DECLARATIONS —

Competing interests None

Funding Not applicable

Ethical approval None

Guarantor JFG

Contributorship JFG is the sole contributor