A couple of years ago, I looked to buy a new home. Using various house perusal websites, I identified likely contenders and sought to arrange viewings. I telephoned one estate agent – they felt that the house in question was best viewed in daylight and offered a 10am Thursday appointment. Unfortunately, commitment to my job requires patient interaction on Thursdays and I had to decline said appointment, but I offered a weekend as an alternative date. The estate agent took my details and promised to look into the possibilities and return the call. A few days later with the absence of a phone call, I followed up my initial enquiry. The response came with the following phrase: “Oh, you’re the nurse that works for the NHS.” There was a clear intimation that as a nurse, my income would be well below the range required to purchase one of their houses. Now, I work with many brilliant nurses. My mother made a 40-year career out of nursing and she followed in the footsteps of two of her paternal aunts. I however, took a different career pathway: my gifts are more academic in nature and medicine suited this purpose. Whilst it would be easy to laugh off this assumption as an ill-informed one-off, in fact gender stereotypes are pervasive within the public. Many female doctors can recount stories of how they have been mistaken for nurses purely on account of gender. Despite the fact that doctors are just as likely to be men as women, a Canadian Medical Journal article found that only 5% of the public will presume that their doctor is a woman and this figure fell to 2% for patients over the age of 55 years. The stereotyping begins in childhood – seven out of ten children will identify that the surgeon is a man and the nurse is a woman and these viewpoints stick. A Harvard study found that seven out of ten people will think that “Jonathan” is a doctor and “Elizabeth” is a nurse and they will persist in this thinking even when they have been told that the reverse is true.

My experience prompted me to think about the early female medical pioneers. To suggest that women have not been involved in medicine would be a fallacy – women have served as healers throughout the centuries and as a consequence they have been revered as angels or decried (but still consulted) as witches. However, the 18^th century enlightenment ideas created a focus on empirical science and brought in new techniques. Medical schools and societies arose and with these came frameworks of legitimacy. The UK Medical Act (1858) noted that patients receiving medical aid should be enabled to distinguish qualified from unqualified practitioners and sought to register qualified personnel. No medical practitioner could register unless they held a licence, diploma or degree granted by a British examining body. This limited the opportunities for women as all 19 examining bodies refused to accept women.

Elizabeth Blackwell was born in Bristol in 1821, the 3^rd child of 9 surviving children. At the age of 11, the family moved to the USA, settling initially in New York, but moved to Cincinnati in 1838. In that same year, Elizabeth’s father died, leaving the family with $20 – as a consequence and in order to generate income to support the family, Elizabeth became a teacher – initially taking classes in her front parlour and subsequently at schools in Henderson and in Asheville in North Carolina. In 1844, one of Elizabeth’s female friends, who was terminally ill declared that, “if I could have been treated by a lady doctor, my worst sufferings could have spared me.” Elizabeth had been inspired by Margaret Fuller previously. Fuller had written, “humanity would achieve a moral awakening only when women enjoyed the same independence as men – a step women must claim for themselves rather than waiting for men to grant it.” Elizabeth believed that women could be anything that they wished according to the limits of individual talent and toil and in reaching their fullest potential, they would raise humanity closer to its ideal. At the school in Asheville, Elizabeth took the opportunity to study alongside John Dickson, the proprietor of the school and former doctor and later with Dr Samuel Dickson, John Dickson’s brother in Philadelphia. Additionally, Philadelphia offered the opportunity to study privately with other physicians notably Dr Jonathan Moses, who taught Elizabeth anatomy.

Notwithstanding the private arrangements for study, Elizabeth sought legitimacy in her chosen career and applied to study for an MD. Several prominent colleges in Philadelphia and New York refused the application on the grounds of gender. It was at this point that fate intervened. An application to Geneva Medical College in Western New York State fell into the hands of an equivocating administrate, Charles Lee. He put the issue of Elizabeth’s application to a student vote. The student body, thinking that this was an elaborate practical joke, voted overwhelmingly in favour of admission and thus Elizabeth was invited to join the ranks of the medical students at Geneva College. The study of medicine was not without difficulties – the townspeople regarded Elizabeth as either insane or wicked and lecturers tried to persuade Elizabeth to stay at home when matters of delicate conversation (the study of genitalia) were being debated. (Elizabeth continued to attend these lectures.) In between semesters, Elizabeth worked as the Chief Resident at Blockley Almshouse, treating patients with tertiary syphilis. The hard work paid off and Elizabeth Blackwell qualified with her MD in 1849.

Success in the area of obtaining an MD meant that Elizabeth had to consider what to do next. In France, the combination of the Enlightenment and the French Revolution created the perfect conditions for the advancement of medical knowledge. Major hospitals were reorganised as state supported educational institutions rather than charitable refuges for the incurable. There was an abundant supply of patients ranging from victims of war to victims of industrial displacement. There was a meritocracy of innovative doctors who worked as professors and students who learned at the bedside. These conditions created an attractive learning opportunity and American students were frequent visitors to Paris.

Barriers to attendance (on the grounds of gender) at the Ecole de Medecine and the Jardin des Plantes saw Elizabeth enrol as a student midwife at La Maternite. The conditions here were tough. Patients at La Maternite were societal outcasts – only the most desperate who had been rejected by their families and friends gave birth in hospital. In an age before Semmelweis’ ideas had been accepted and before the advancement of germ theory, no-one washed their hands or aprons or instruments between patients, mattresses were soaked in the fluids of childbirth and puerperal fever was rife.

In amongst these conditions, Elizabeth befriended Claude Philibert Hippolyte Blot – a doctor who mentored Elizabeth. It was Blot who came to the rescue when tragedy happened: Elizabeth was washing the eyes of a baby with gonorrhoeal conjunctivitis when the contaminated liquid splashed into her face and infected both eyes. The illness persisted for several months and Elizabeth underwent multitudes of different treatment regimes, but ultimately, she required surgical removal of her left eye and used a prosthetic afterwards. The experience effectively ended Elizabeth’s career as a surgeon, although she continued to consult as a physician. In the period of recovery, Elizabeth travelled to the UK, where she worked at St Bartholomew’s Hospital in London under the tutelage of Sir James Paget. During this time, she met and became friends with Florence Nightingale. Within the UK Medical Act (1858) there was provision for doctors who had received their degree abroad and had worked in the UK to register with the GMC and thus, Elizabeth was able to register with the GMC.

Emily Blackwell was 5 years younger than Elizabeth. It had always been within the sister’s plan that Emily should follow her sister into medicine. To this end, Emily became a teacher at Henderson to raise the money required to study medicine. Despite Elizabeth’s passage through the glass ceiling and somewhat perversely, Elizabeth’s success on both sides of the Atlantic made Emily’s passage into medical school more difficult. Initially, Emily attended lectures at the Bellevue Hospital in New York before becoming a student in Dr Daniel Brainard’s office. Dr Brainard founded the Rush Medical College in Chicago and so Emily enrolled at the Rush College in order to complete her MD. However, prior to Emily’s second year, the Rush trustees decided that they would not allow Emily to return and complete her diploma. After a number of letters and applications, Emily completed a term at Cleveland Medical College and graduated in 1854. Following a period of training under Dr James Simpson in Edinburgh, Emily returned to New York to establish the Women’s Medical College in New York City. She became Professor of Obstetrics, and when Elizabeth moved to London to help form the London School of Medicine for Women, Emily became Dean of the College.

When Elizabeth returned from Europe, she sought to set herself up in practice. However, Elizabeth found it difficult to tread the fine line between establishing a practice and differentiating herself from abortionists and quacks. Consequently, Elizabeth opened a dispensary (the New York Infirmary for Women) with the aim of allowing poor women an opportunity of consulting with physicians of their own sex. To this end, she was aided by Marie Zakrewska, an American-Pole who had spent her formative years and trained as a midwife in Berlin, but had emigrated to America with her sister Anna. Marie had been introduced to Elizabeth via the Home for the Friendless, an institution well known for its support of immigrants. Following this meeting, Marie was offered a job at the dispensary and encouraged to undertake a medical degree at the Western Reserve University. Marie faced obstacles – not only did she encounter hostility from her male colleagues who petitioned to have her removed from the program, but she was required to learn sufficient English as to pursue her studies. Once qualified, and reflecting on the obstacles that she had encountered in her career, Marie founded the New England Hospital for Women and Children. The goals of the institution were to provide women with treatment from physicians of their own sex, to provide women with the opportunity to practice medicine and to train nurses. Marie was aided in this endeavour by Mary Putnam-Jacobi, a colleague of Emily Blackwell at the New England Hospital for women and children. Mary began her training initially at the New York College of Pharmacy and gained a Doctor of Medicine from the female College of Pennsylvania. However, she undertook further study at the Sorbonne. Mary participated in research studies, becoming the first female fellow at the New York Academy of Medicine in 1850 and was later admitted to the American Medical Association. Mary was committed to a tireless pursuit to change culture and allow the admission of women to the predominant medical schools in the area.

Elizabeth Blackwell in the meantime had delivered a series of lectures. She felt that she could use her hard-won credentials to help women in their own homes rather than extorting them to follow her out of it. She believed that hygiene and exercise rather than pharmacology were the guardians of good health. Barbara Boudichon and Bessie Parkes were the founders of the English Women’s Journal and they featured an extensive profile of Elizabeth Blackwell. The article paved the way for Elizabeth to practice in England and additionally in 1859, she delivered a series of lectures, one of which was attended by Elizabeth Garrett Anderson.

Elizabeth Garrett Anderson was born in 1836, the second of ten surviving children. She was educated initially by a governess and later attended the Academy for the Daughters of Gentlemen, which was kept by the Misses Browning: two aunts of the poet Robert Browning. The pervading culture in the UK at this time was such that women could obtain acceptable paid work only as a governess. Men looking for a wife were thought to dislike “bluestockings.” There was a universal acceptance of the idea that women were morally, intellectually and physically inferior to men. Mary Wollstonecraft had begun to challenge this idea with her campaign for women to be educated. As the 19^th century progressed, a chorus of voices including Barbara Leigh Smith (later Madame Boudichon), Florence Nightingale, Emily Davies and Elizabeth Garrett Anderson added to this argument.

Eight years after the completion of her school education, Elizabeth Garrett Anderson was looking for something to attract her interest. She went to stay with friends in Gateshead and it was here that she was introduced to Emily Davies (who later founded Girton College, Cambridge). Emily resented her own lack of education and felt that greater access to education would provide more opportunities for women. It was whilst Elizabeth Garrett Anderson was on her way to Gateshead, that she attended Madame Boudichon’s lecture and met Elizabeth Blackwell. Thus, a seed was planted.

When Elizabeth indicated to her father her desire to study medicine, he arranged an introduction to Mr William Hawes. Hawes advised Elizabeth to gain experience on a surgical ward at the Middlesex hospital for 6 months. Conditions in the hospital were bad – bacteriology was still in its infancy and the connection between bacteria and wound infection had not yet been made. Lister’s principles (using antiseptic in theatre) had not yet evolved. Most operations were amputations following compound fractures and there was a high post-operative mortality. Elizabeth Garrett Anderson entered the ward on the 1^st August 1860. The nurses taught her how to dress wounds and to care for sick patients. In addition, Elizabeth received teaching from Mr Willis, the senior resident medical officer, who tutored Elizabeth 3 nights per week for the sum of 1 guinea per week. Mr Nunn, the Dean and assistant surgeon allowed Elizabeth to go into the dissecting room. Mr Plaskitt the resident medical officer taught Elizabeth chemistry but when he left to go into general practice, Elizabeth’s education was continued by Mr Taylor. However, dark clouds were on the horizon. One day, a visiting professor asked the class a question. No-one could provide a correct answer barring Elizabeth. Elizabeth was effectively blackballed and the students petitioned for dismissal in August 1861. Elizabeth was not content with a medical licence – she wished for a medical degree too. She applied to all the London hospitals, the University of St Andrews and the Universities of Oxford and Cambridge, but was refused admission. The University of Edinburgh allowed Elizabeth to matriculate, where she worked under Professor Simpson and Dr Keller, but her matriculation fee was returned by the senate. After repeated disappointments, Elizabeth was allowed to work at the London hospital as a nurse in February 1864, but she was expelled after 6 months and she returned to the Middlesex Hospital to work.

In 1861, Elizabeth received an undertaking from the Apothecaries Hall – she would be allowed to be admitted for their qualifying examinations when she had completed her studies according to the regulations of the court. A clause in the Act of Parliament made an apprenticeship of 5 years to a qualified medical practitioner imperative. The indentures were made out as soon as Elizabeth received the decision. By 1865, Elizabeth had completed her course of lectures by means of stitching one course of lectures to another. The Apothecaries Hall was the only medical governing body who, by terms of their charter, were unable to exclude Elizabeth as a woman. Elizabeth duly applied for the examinations; the board of examiners wished to refuse her admission, but were threatened with legal action. Elizabeth passed the examination with credit and the society altered their regulations subsequently. Future candidates were required to have worked in a registered medical school and all such medical schools refused to admit women. Elizabeth Garrett Anderson received a licence to practise medicine in 1866. Later, she obtained an MD from the Sorbonne University in Paris in 1870.

Following qualification, Elizabeth opened her own practice in London. However, she wished to open an outpatient dispensary to allow poor women to be treated by physicians of their own gender and, using money donated by her father, she opened St. Mary’s dispensary, which proved to be popular and grew into the New Hospital for Women. The aim of the hospital was that the professional work of the hospital should be carried out by qualified female professionals and it would be a showcase for what trained women could do.

Elizabeth Garrett Anderson wasn’t the only woman to see a medical education. Sophia Jex-Blake applied to Edinburgh University to study medicine, but although the Senatus academus told her that she could matriculate, they could not make provision for only one lady. Undeterred, in 1869, Sophia Jex-Blake advertised in the Scotsman and other newspapers for other women to join her. Thus, a group of 7 women (Sophia Jex-Blake, Mary Anderson, Emily Bovell, Matilda Chaplin, Helen Evans, Edith Pechey and Isabel Thorne) enrolled on a period of study. They faced obstacles – professors in the field of medicine, led by Sir Robert Christison refused to teach them. Discrimination continued – Edith Pechey won the top mark in Chemistry and should have won the Hope Scholarship, but the University refused to award the Scholarship to a woman and so picked the next placed man. The women cried injustice, but their protests fell on deaf ears. The opposition culminated in an event on the 18th November 1870. The women turned up for an examination at the Surgeons Hall in Edinburgh. They were greeted by a drunken mob who pelted them with mud and filth. The women were eventually admitted into the hall by janitors and sympathetic peers and were escorted home after the exam by a group of sympathetic Irish students. Sophia Jex-Blake maintained that the riot had been incited by Sir Robert Christison’s assistant: a stance that saw her being sued for libel. In the end, the Edinburgh 7 were denied the chance to graduate – a court action was brought against the Senatus which prayed to have it declared that the University was bound to enable the women to finish their education and sit for a qualifying degree. The women won the action initially in 1873, but the verdict was overturned by the Court of Appeal in 1874.

Following her experiences, Sophia Jex-Blake determined to create a school whose main purpose was to provide a medical education for women and to this end, she founded the London School of Medicine for Women (LSMW) in 1874. Sophia was the ruling spirit of the school, but as she was not a qualified medical professional, she could not work on the staff. The dean was initially Dr Anstie, but following his untimely death, Dr AT Norton took on the role for 9 years. In 1883, Dr Elizabeth Garrett Anderson was appointed Dean of LSMW with Julia Cook as subdean. One of Elizabeth’s early duties was to present the first female students to qualify at the University of London and these included Mary Scharlieb and Edith Shove. As with all things related to the medical education of women, the inauguration of LSMW met with opposition: the staff had great difficulty finding opportunities to provide qualifying hospital practice. Eventually, they appealed to the government and a bill brought by Russell Gurney MP. Thus, the UK Medical Act (1876) encompassed the bill that gave British Medical examining boards the right to admit women to examinations. The LSMW became the recognised medical school to be associated with the Royal Free Hospital.

Elizabeth Garrett Anderson’s example inspired others – in 1872, Birmingham and Midland Hospital became the first institution to appoint a female house officer (Louisa Atkins, who had qualified in Zurich). Such was the success of that appointment, that they made a further two appointments – Edith Pechey and Annie Reay Barker. Helen Prideaux was the first woman to obtain a surgical post in open competition – alas she died of diphtheria aged 28 years. Eleanor Davies-Colley became the first fellow of the Royal College of Surgeons in 1911. Following a bylaw change in 1928, Helen Mackay became the first female fellow of the Royal College of Physicians in 1934.

All doctors will tell you that the education merely begins with graduation from medical school – a career in medicine corresponds to a career of lifelong learning. Consequently, when Elizabeth Garrett Anderson submitted a nominating paper to the Paddington Branch (which was accepted) of the British Medical Association, she was working within the culture. However, at the 1875 AGM, where Professor Christison presided, this membership was criticised and at the AGM in 1878, a motion was passed to exclude women. The decision was finally overturned at a meeting in Nottingham in 1872. To facilitate cohesion between medical women, in 1879, female doctors developed the Association of Registered Medical Women. This alliance drew the support from women who had distinguished themselves as medics at the turn of the century not limited to and including Jane Walker, Ethel Williams, Catherine Chisholm, Florence Barratt and Louisa Blake-Aldrich and became the Medical Women’s Foundation, with Jane Walker as the first president. The Medical Women’s Foundation had strong roots in the women’s movement and sought contemporary debates on subjects such as venereal disease, prostitution and the principle of equal renumeration for medical women. Even today, these subjects continue to feature, alongside subjects such as abortion, rape and sexual assault, assisted reproduction and sex education.

One of the first students to qualify from LSMW was Mary Scharlieb. Born in 1845, Mary underwent schooling in Manchester. Aged 19, she met William Scharlieb, a lawyer who was looking to practise his craft as a barrister in India. Whilst living in Madras, Mary became aware of the lack of gynaecological services for women experiencing childbirth, making practice dangerous. She became motivated to gain some experience and trained initially as a midwife. Mary’s desire to enter medical school met with opposition from her husband, who didn’t want her to leave her young family, so it wasn’t until 1878 that, when her children were old enough to travel back to England, Mary sought an interview with Elizabeth Garrett Anderson and enrolled at LSMW. She qualified in 1882, with Honours in all subjects and the Gold Medal in Obstetrics. Mary Scharlieb was described as being quiet, unassuming and modest with no attempt to trail blaze. She encouraged operating in the quiet and allowed her survival figures to speak for themselves. Her steady, common sense approach suggested that surgery is the most ordinary thing for a woman to do. Mary rose to become the senior surgeon at the New Hospital for Women and later became Head of Gynaecology at the Royal Free Hospital in 1902, where she was assisted by Ethel Vaughan Sawyer. Ethel Vaughan Sawyer took the pragmatic view that early female pioneers were never able to be pure physicians or pure surgeons. It was necessary to be willing to give advice to women with regard to their health whether the underlying cause be medical, surgical or obstetric. Ethel Vaughan Sawyer was one of the first people to study the patient experience.

Mary Scharlieb was succeeded at the New Hospital for Women by Louisa Aldrich-Blake. Louisa was born in 1865 to a clergyman and his wife in Essex and educated at Cheltenham Ladies College before her medical education at LSMW and graduation in 1894. She went on to sit the University’s higher degrees in surgery, becoming the first woman to obtain a Master’s in Surgery in 1895. Louisa was described as calm, confident and efficient with a common-sense attitude and brains in her fingertips. She had a willingness to adopt, adapt and experiment with different types of procedure depending on the patient – this allowed her to develop the Aldrich-Blake method for rectal cancer excision. During the first world war, Louisa used her influence to encourage women to serve in military hospitals, however she also served by example: Louisa used her holiday leave time to fill in for doctors on the frontline and provide respite.

At the turn of the twentieth century there was a distinct difference in the career routes of medical men and women. After training at a reputable medical school, men would be offered a junior post at that school before progressing to a senior post. As hospitals were charities, the jobs were honorary and unpaid, but the posts led to a lucrative private practice. Women had no option but to take low paid and low status jobs such as those in prisons, asylums, schools and in missionary settings. The argument with regard to women’s suffrage was at the forefront of public debate – clashes between protestors and police became ever more high profile and violent. Women were vilified and despised when they undertook protest and they were depicted as objects of public opprobrium and derision.

Louisa Garrett Anderson was one such suffragette. Born in 1873, the daughter of Elizabeth Garrett Anderson, Louisa enrolled at LSMW in 1892 and earned her BMBS in 1896. She earned her MD from the University of London in 1900. Louisa had been inspired by Mary Scharlieb to become a surgeon – she won a job as a junior doctor at the Royal Free Hospital in 1901 and later worked under William Osler at the Johns Hopkins Hospital School of Medicine in Baltimore. Following this, Louisa returned to work at the New Hospital for Women, initially as a surgical assistant and working her way up to senior surgeon. During one suffragette protest, Louisa was arrested and imprisoned for breaking a window.

One of Louisa’s fellow suffragettes was Flora Murray. Flora was the 4^th of 6 children and was born in 1869 in Dumfriesshire. Her father, a retired naval commander, died when she was 3 and her mother brought up all 6 children and managed the estate alone. Despite these hardships, Flora was given a private education in Edinburgh and attended girls boarding schools in London and Germany. Following her school education, Flora decided to undertake nurse training, however after six months, she decided she wanted to be a doctor, so she enrolled at LSMW in 1897. In 1900, Flora’s brother, Fergus, died in the Boer war, so Flora left LSMW to be closer to his grieving family and she completed her medical training at Durham University in 1903. Flora’s role within the suffragette movement was to tend to suffragettes who had been force fed in prison and at one point accused doctors of drugging prisoners with bromide to make them more docile for force feeding.

When the first World War broke out in 1914, Garrett-Anderson and Murray thought that they would be turned down by the War Office owing to the prejudice with regard to female surgeons. Consequently, Garrett-Anderson and Murray bypassed the British Establishment and contacted the French Embassy directly, offering to raise and equip a surgical unit for service in France. It is thought that the French thought that the women intended to finance the hospital without realising the women intended to staff and run the institution, but nevertheless the Hotel Claridges in Paris was put at the women’s disposal.

The Hotel Claridge on the Champs Elysée in Paris was a newly built hotel containing a number of new conveniences for example gas ovens, sinks. Upon arrival, Garrett-Anderson and Murray found that the plaster on the walls was still wet and neither the lighting nor the central heating were working. Despite this, the large salons on the ground floor were structurally capable of making good wards for 100 patients and so became the wards, whilst the bedrooms on the first floor were used to house staff. The ladies cloakroom with an in-built hot water supply was converted into an operating theatre complete with a gas steriliser. On day 2, a doctor from the American hospital came to see the hospital for themselves and asked if the women were in a position to take patients. The answer: they would take 24 patients that afternoon and 26 later on that night. Thus, Louisa Garrett Anderson and Flora Murray became the commanding officers of the Women’s Hospital Corps in Paris. They were assisted by Hazel Cuthbert, Gertrude Gazdar and Grace Judge as well as experienced nurses and indefatigable orderlies. Later inspections of Hotel Claridges met with approval, and it was described as a model hospital. Many visitors found it incredulous that women were working as surgeons.

When the men arrived at Hotel Claridge, their dirty, half-fed state, with many soldiers unable to boast a change of clothes or shock elicited empathy from the staff and motivated the doctors to work. These men were exhausted, dehydrated, boasting mangled and shattered limbs, gaping head wounds and horrific flesh injuries. Furthermore, the filthy trench conditions promoted the rapid spread of disease with rats, lice and mosquitoes living side by side with humans. A criticism of the female surgeons within the first world war was that they faced wounds that were “hitherto undreamed of.” However, the first world war required surgeons of both genders to adapt their existing expertise and re-learn their craft as they managed severe and complex injuries. As the war progressed, there were scientific advances – notably the use of X-rays to identify shrapnel wounds and in the early identification of gas gangrene. Louisa Garrett Anderson had an X-ray facility installed at Claridges – the equipment was primitive and emitted X-rays in all directions, requiring several minutes for each exposure, but proved to be invaluable in locating bullets and shrapnel in wounds. Flora Stoney, another LSMW graduate was one of the early pioneers in radiology. She worked alongside the Women’s Imperial Service League and the Belgian Red Cross to help the troops in Antwerp, later working at Cherbourg. Stoney became experienced in identifying shrapnel, gas gangrene and osteonecrosis – this expertise enabled her to work at the Fulham Military Hospital and she became the first woman to work for the War Office.

As the first world war persisted, reports reached Paris of heavy fighting near Boulogne. The English hospitals in Paris made up a party of doctors and nurses to see if aid could be given to the hospitals in Boulogne – 3 doctors from Claridges participated in the party. Upon arrival, the group found the hospitals to be seriously overcrowded. The female doctors made friends with one of the matrons of the hospital – the hospital staff had been told not to show the doctors around the hospital, but the female doctors from Claridges were in uniform and could pass as nurses. They found patients whose dressings had not been changed in days. The next day the officer in charge asked for assistance from two doctors – Rosalie Jobson and Marjorie Blandy stayed for six months. Hotel Claridges had created a great reputation and on the back of this, Gertrude Gazdar offered an additional hospital in Boulogne – a proposition that was followed up by Flora Murray and Louisa Garrett Anderson. They identified Chateau Mauricien, a large house at Wimmereax to use as a hospital. Louisa Garrett Anderson remained in Boulogne to work whilst Flora Murray ran Claridges. The Chateau Mauricien ran until the 18^{th of} January 1915, when the building lease expired, and fuel shortages made running a hospital impossible.

In February 1915, Louisa Garrett Anderson and Flora Murray were re-called to London to attend a meeting with Sir Alfred Keogh, the Director General of Army Medical Services. Keogh was renowned for his superlative organisational skills and contempt for red tape. Following on their successes in France, Garrett Anderson and Murray were offered the opportunity to run a 500 bedded facility in London and were offered a former workhouse (which is thought to have been a model for the workhouse in Oliver Twist) in Endell Street, Covent Garden as a site for said hospital. The building required major alterations to convert it from the grim Victorian institution into a smooth-running military hospital: the exercise pens, padded cells and iron chains were removed, electric lighting, modern cooking facilities and lifts capable of taking stretchers were installed and the entire building required cleaning and painting. Garrett Anderson and Murray recruited 180 staff, including 80 orderlies, 29 trained nurses and 14 doctors. The doctors were all graduates of LSMW and ranged from new graduate Eva White, who acted as the radiologist (when she left, she was replaced by Ethel Magill), to Helen Chambers, an expert in cancer research who acted as pathologist and Amy Sheppard, the ophthalmologist. In 1916, the hospital looked abroad to take on doctors – recruiting from Australia Eleanor Bourne, Rachel Champion and Elizabeth Hamilton-Browne (they were joined by Vera Scantlebury in February 1917) and from Canada, the anaesthetist Evelyn Windsor who had to be released from the British Army in 1918 due to “ill-health” (pregnancy). New recruits in 1918 included Winifred Kindness, Dorothy Daintree, Mary Philips and Octavia Lewin – the latter acted as ENT consultant. Over the course of 3 years, the hospital at Endell Street treated 26000 patients and a further 20000 men and women attended the casualty room as outpatients: the surgeons performed more than 7000 operations. In addition to injuries, the men suffered deteriorating health from long periods in the foul trench conditions. The staff were therefore called upon to manage diseases such as trench fever, dysentery, meningitis, diphtheria, measles, influenza and trench foot. In 1918, after 4 long hard years of managing war victims, the influenza epidemic increased the burden on Endell Street’s embattled and depleted staff.

In contrast to Garrett Anderson and Murray, Elsie Inglis offered her services to the War Office. She offered 1000 trained female nurses and doctors to work in the war zone as part of the Scottish Women’s Hospitals. In a patronising rebuff that probably defines the ultimate mansplain, Inglis was told to “Go home and sit still.” Elsie Inglis studied medicine in Edinburgh (initially under Sophia Jex Blake) and later at Glasgow. In particular, she treated diseases of bones and joints in Edinburgh. Inglis was described as unselfish but with lots of energy and it was using the latter that she stimulated her team to greater efforts. Inglis addressed a meeting entitled, “What Women Can Do to help the War” – exhorting her listeners, “the need is there, and too terrible to allow any haggling about who does the work.” Using contacts within the National Union of Women’s Suffrage Societies, the Scottish Women’s Hospitals raised money and were able to approach the Red Cross with an offer of a fully staffed hospital unit. The challenge having been set, one such unit was established at the Abbey at Royaumont and ran from January 1915 to the end of 1918. Subsequent units were established across the breadth of Europe in Russia, Romania, Serbia (where Inglis worked alongside Ruth Veney, who later worked with children after the end of the conflict), Slalonika in Greece and in Corsica. The “indomitable little figure” of Elsie Inglis was forced by ill-health to return to Britain in 1917. She died from rectal cancer in the November of that year.

Despite their successes in establishing and running military hospitals, female doctors were not granted equality with men: women were expected to report to military hospitals at the front wearing civilian clothes, they were paid an inferior flat rate on temporary monthly contracts, and they had no rights to living quarters (or billeting), rations or transport. Requests to grant medical women officer status were denied meaning that some women needed to use an intermediary in order to have instructions enacted.

The first world war enlisted so many medical men and students into the army that hospitals and practices in the UK were left dangerously understaffed. The drain on medical schools was so severe that the president of the GMC, Sir Donald McAlister asked the army to send back students so that they could finish their studies. Hard-line opponents of women in medicine were suddenly forced to change tack. At the turn of the 20^th century only 5% of medical students were female, but this had risen to 33% by 1918, although these figures did not necessarily translate into medical professionals.

Following the armistice and the return of soldiers to the UK, male doctors expected as a right to resume their former jobs and women found that their war service counted little – they were relegated to treating women and children only. Flora Murray and Louisa Garrett Anderson battled the government for retrospective review of the female doctors’ work – notably they requested equal rates of income tax and equal military rank. The latter was refused by Churchill who believed that women were not equal to men at performing medical tasks in war. Murray died in 1923 from rectal cancer. Louisa Garrett Anderson lived long enough to witness a second world war but did not match her achievements of the first world war. She died in 1943 from a retroperitoneal carcinoma.

Towards the end of the first world war, in June 1918, Cicely Saunders was born. She was educated at Roedean School before attending the Society of Home Students (later St Anne’s college) in Oxford to read Politics, Philosophy and Economics in 1938. With the onset of the second world war, Saunders decided to interrupt her studies to help the war effort and with this in mind, she applied to St Thomas’ Hospital to train as nurse. Whilst awaiting the outcome of her application, she took red cross courses and worked as a VAD. Saunders began her training in November 1940, but a back injury disrupted her training. She decided to return to Oxford to finish her degree. In 1948, Saunders undertook training as an almoner, professionals who were engaged in organising the aftercare and convalescence of patients following a hospital admission. Almoners were the forerunners to the modern-day social workers. Saunders found herself mitigating the effects of poverty, poor housing and overcrowding. It was through her work as an almoner, Saunders came into contact with and developed a relationship with David Tasma, a Polish Jew who had an advanced bowel cancer.  Following Tasma’s death, Saunders volunteered at St Luke’s hospice – the experience confirmed to her a that her vocation should be to care for the dying. Following advice from mentor, Norman Barrett (a surgeon with whom Saunders was working), Saunders resolved to study medicine and achieved a place at St Thomas’ medical school. In her first academic publication (there were many subsequently), Saunders drew upon her experience of working homes for the care of the dying: she argued the importance of specialist attention to complex problems such as pain, fungating and eroding growths and psychological distress. Saunders undertook junior doctor posts at St Josephs’ hospice, and subsequently undertook a research post in which she studied management of pain towards the end of life. She learned the craft of end-of-life care and created a vision of how this might be developed in the future, thus being one of the forerunners of the speciality of palliative care. Medical innovations in pain and symptom control were utilised but within the context of patient-centred care, which took into account the personhood, suffering and identity of each patient. To facilitate this care, she opened St Christopher’s Hospice in 1967. Cicely Saunders built a movement of palliative care that extended beyond St Christopher’s Hospice and built national and international renown – as a result the care of the dying moved from the margins of medicine into a more central position of concern and recognition. Following her death, a national strategy for end-of-life care was formulated, with the desire to extend the principles of hospice care into mainstream settings where they benefit larger numbers of patients and families.

It would be remiss of me to write an essay on inspirational female doctors and not to mention Marjory Warren. Warren was born in 1897, educated at the North London Collegiate School and then read medicine at the Royal Free Hospital, graduating in 1923. In 1926, following junior doctor posts, Warren became the resident medical officer at the Isleworth Infirmary and rose through the ranks to the post of deputy medical director in 1931. In 1935, the Isleworth Infirmary took over the care of the adjacent workhouse. Warren undertook a systematic audit of the patients housed within the workhouse, finding a range of patients ranging from cohorts of patients with dementia, those with incontinence and those with that were mobile throughout the day. She developed a classification system, identifying those that might respond to rehabilitation and could therefore be housed within their own homes and those patients that may require long term care. In 1943 and 1946, Warren wrote two academic publications that advocated for the creation of a medical specialty devoted to the care of older patients. The strength of her arguments was such that the Ministry of Health responded with the creation of Geriatric Medicine as a recognised specialty in the NHS. In 1947 Warren, alongside Joseph Harold Sheldon, Trevor Howell and Lionel Cosin co-founded the Medical Society for the Care of the Elderly, which later became the British Geriatrics Society. Warren promoted multi-disciplinary care, early mobilisation and active engagement in the functional abilities of each patient.

As I wrote this essay, I thought that I’d start with a few names and consider their impact and the way that they inspired others. However, as I read, more and more names came out of the woodwork with incredible feats. Recent Twitter posts identified more names – Sheila Sherlock, the first female Professor of Medicine and pioneer in the field of liver diseases, Margery Turner-Warwick, Dame Carol Black, Dame Jane Dacre and Dr Sarah Clark, presidents of the Royal College of Physicians, Dame Parveen Kumar and Dame Clare Marx, the first female president of the Royal College of Surgeons. What started as one or two individuals turned into a stream, a river and then tsunami of names. Reading about the early pioneers, they had a vision that they saw through to the finish despite the prevailing societal prejudices. There was an understanding that the bar had to be set high in order to break through the glass ceiling, but this was aligned with a pragmatism with women picking up medical jobs that were available to them. We live in an age in which middle aged women complain of being invisible, as if the waning oestrogens diminish the pallor and it becomes impossible for such individuals to shine. The individuals described here spent time to develop a craft, such that middle age was the peak of expertise. I’m proud to be part of a team who seek to demonstrate what women of a certain age can do, although it is humbling to consider my own contribution when I read about the achievements of my professional forebears. If there’s one thing that I think I can take away from this experience – never underestimate the people around you: you may just find that there’s a brilliant inspiring woman in your vicinity.