No Man's Land

1

A Good Feeling

Victoria Station, London, September 15, 1914

Louisa Garrett Anderson and Flora Murray waited to board their train.¹ Tall, slim, and erect in the midst of the fourteen younger women who were going with them, they exuded calm authority. Everyone had come to see them off—family, friends, and comrades from the suffragette movement—and to ply them with gifts. One well-wisher had arrived with three boxes packed with provisions for the journey, while others had brought fruit, chocolates, or flowers. Surrounded by the luggage they would take onto the train, the women looked awkward in their stiff new uniforms. Their “short” skirts, grayish-brown, just covered the tops of their ankle boots, and their matching belted tunics were buttoned firmly up to their necks. Their main luggage had already been stowed and would be waiting for them upon arrival—or so they thought.

Victoria Station was bustling.² In the six weeks since war had been declared, the railway terminus had been transformed. Along with commuters pouring off the trains for their daily drudgery, there were now Belgian refugees, who had fled the invading German Army carrying pitiful bundles of belongings, their frightened children in tow. Traumatized and bewildered, they were met by women volunteers who had set up emergency canteens on the concourse. There were other British travelers, too, people who had found themselves stranded in Europe and farther afield when war broke out and who were only now straggling home.

Departures were relatively few. Thousands of soldiers had already passed through Victoria on their way to France and Flanders. Weighed down by kitbags and buoyed up by patriotic songs, they had exchanged farewells with their families and sweethearts before boarding their trains. One traveler, aware that many who said their goodbyes would never see each other again, called Victoria the “Palace of Tears.”³ More would follow in the ensuing weeks and months. While the soldiers of the British Expeditionary Force, made up of the regular army and reservists, were already mired in the thick of battle on the Western Front, hundreds of thousands more men had since enlisted in response to the “call to arms” declared by the new secretary of state for war, Lord Kitchener. So far, at least, the casualties which had begun to stream back from the first battles had arrived at London stations under cover of night.⁴ Many, indeed, had never returned at all; the army’s medical services had been so overwhelmed already by the sheer scale and severity of the injuries that thousands had perished before they could be treated.

Yet for all this, the atmosphere at Victoria Station that morning was predominantly cheerful—especially among the party of women waiting to board their train for France. For them, one war had ended as another had begun.

JUST AS POLITICIANS of all stripes had buried their differences to fight the common enemy on the outbreak of war, so, too, had a truce been declared between women and men. After years of escalating militancy in the battle for women’s voting rights, the leaders of the suffragists and suffragettes had put aside their demands immediately when war began.⁵ Millicent Fawcett, president of the nonmilitant National Union of Women’s Suffrage Societies (NUWSS), had led the way by calling on her supporters—the suffragists—to offer their services to their country. “Women, your country needs you,” she exhorted her members within days of war being declared, even before Kitchener’s iconic poster made the same appeal to men.⁶ Emmeline Pankhurst, the steely matriarch of the Women’s Social and Political Union (WSPU), had followed her example a few days later, urging her militant members—the suffragettes—to suspend all activism and divert their energies and organizational skills into supporting the war effort. In return, the government had announced an amnesty and released all suffragettes from prison—some several hundred women—within a week of declaring war.

Although some stalwarts of the women’s movement had joined pacifist campaigns, most women threw themselves into the new cause in a rush of patriotic fervor. One group of suffragettes had already launched the Women’s Emergency Corps to recruit women into jobs vacated by men who were now enlisting. Women had flocked to its headquarters to volunteer as drivers and motorcycle dispatch riders, or to run soup kitchens and refugee shelters.⁷ Aristocratic women and society ladies, until recently some of the loudest voices demanding the vote, were now offering their homes in London as convalescent hospitals for the wounded and raising funds to send medical units to France. And women everywhere, whether they identified themselves as suffragists or not, were signing up to play their part as volunteers at home and overseas.

Louisa Garrett Anderson and Flora Murray, who were waiting to board their train at Victoria that morning, had been among the first to recognize the unique opportunity that war presented to women. They knew that war with Germany posed a terrifying threat to Britain, but it also offered women a once-in-a-lifetime chance. Both Anderson and Murray were qualified doctors of many years’ standing. Anderson, forty-one, was a surgeon, and Murray, four years older, a physician and anesthetist. Yet despite the fact that each woman had more than ten years of experience in her chosen profession, neither had enjoyed a significant spell of work in a major general hospital. Hospital boards were almost entirely controlled by men, and women doctors were effectively excluded from training or working in mainstream hospitals or attaining high-status medical positions. Women were likewise barred from becoming army doctors regardless of the current need. Although their medical qualifications were exactly equivalent to those of their male colleagues, Murray and Anderson had been restricted to treating women and children. Through necessity as much as desire, they had worked in hospitals run by women for the treatment of women and children alone.

War had changed everything. Despite their complete lack of experience in treating men or in dealing with war injuries, the two women had decided to set up their own emergency hospital to treat wounded soldiers plucked from the battlefields in France. Gathering together a team of young recruits, including three more women doctors, eight nurses, three women orderlies, and four male helpers, they were bound for Paris.⁸ It was a gamble. They were not only heading for unknown dangers in a war zone with eighteen young people under their command, but their medical inexperience meant they were seriously unprepared for the challenges ahead. Both, however, were as committed to the women’s cause as they were to each other. They saw the unfolding drama in France as their first chance to prove that women doctors were equal to men.

FOR ANDERSON, ENTERING the medical profession had always seemed a foregone conclusion. Born in 1873, the eldest child of Elizabeth Garrett Anderson, the first woman to qualify in Britain as a doctor, and James Skelton Anderson, a Scottish shipping owner from a family of medics, Louisa had grown up in a world suffused by medicine.⁹ Although she had been looked after by a nanny for much of her childhood, Louisa had vivid memories of riding in her mother’s carriage—holding out her hand to catch raindrops—when her mother made her doctor’s rounds from their house in London’s West End. Occasionally she had even accompanied her mother to the New Hospital for Women, which her mother had founded in a poor part of west London, where Louisa had romped on the beds. A lively and imaginative child, Louisa was described by her mother as a “bright, skipping little creature, full of character and intelligence.”¹⁰

Growing up with all the comforts of middle-class Victorian life, Louisa had enjoyed an idyllic childhood. While her parents worked long hours in London, Louisa ran wild with her younger brother, Alan, in the sprawling grounds of their family home near the seaside town of Aldeburgh in Suffolk, albeit with their nanny keeping a close eye.¹¹ In summer, they played in the sea and sailed paper boats in rock pools, and in winter they skated on frozen ponds. From the age of eight Louisa wrote fond letters to her parents, nicknamed “Moodle” and “Poodle,” relating tales of derring-do and make-believe while lamenting how much she missed them. The carefree childhood nurtured a rebellious streak, so that “Louie,” as she was known, became quietly determined to get her own way—in stubborn opposition to her mother, who fussed and worried over her children’s health.

After being tutored at home and briefly attending a day school in London, Louisa had been sent to a girls’ boarding school, St Leonard’s, in St Andrew’s on the east coast of Scotland, at fourteen.¹² One of the first big private schools for girls, St Leonard’s modeled itself on the country’s top boys’ schools. Although the girls wore long, demure skirts and long-sleeved blouses, they learned Greek, Latin, French, and mathematics and played cricket and tennis, just as their brothers might do at Eton or Rugby. Clever and bookish, with a pretty face, pale complexion, and auburn hair, Louisa made friends easily and chaffed at her mother’s fretting. “I must really expostulate against these sudden outbursts of excitement,” she replied pompously when her mother feared she was ill.¹³ At first, Louisa had been drawn to the arts: she edited the school magazine and took leading roles in school plays. Yet by the age of seventeen she had decided to follow in her mother’s footsteps and embark on a career in medicine. This, even for the daughter of Britain’s most famous medical woman, was no small feat.

LOUISA’S MOTHER, ELIZABETH Garrett Anderson, had succeeded in becoming the first woman qualified in Britain to join the Medical Register through a combination of iron will and stealth. In the mid-1800s, when Elizabeth was growing up, the daughters of middle-class families were raised with one ambition: to marry well. Since women were regarded as physically, intellectually, and emotionally inferior to men, a serious education was considered not only unnecessary but decidedly unfeminine. Most girls from well-to-do families were allowed only rudimentary instruction at home, followed by a few years at boarding school, if they were lucky, to prepare them for married life. If they remained single over the age of thirty, women were written off as “old maids” and regarded as a financial burden on their fathers or brothers. There were only two routes to paid employment for middle-class women—becoming a governess or a lady’s companion—and both were widely despised as scarcely above the rank of a servant.

Louisa was well aware of the obstacles her mother had battled. Born into a prosperous family in Suffolk, Elizabeth had enjoyed just two years of formal education at a girls’ school in London from the age of thirteen.¹⁴ But in her early twenties, she fixed on the idea of becoming a doctor after meeting Elizabeth Blackwell, an Englishwoman brought up in America who had obtained a medical degree at Geneva Medical College in New York State.¹⁵ When she returned briefly to England in 1858, Blackwell had become the first woman to enter her name on the newly established UK Medical Register. In a pattern that would become wearily familiar to women who dared to follow in her footsteps, this door was immediately closed as the General Medical Council (GMC) ruled that doctors who qualified overseas were ineligible for the register. When Elizabeth Garrett announced her ambition, her mother shut herself in her room crying. Her father, initially repulsed by the idea, became one of her strongest allies.

Over the next six years, Elizabeth had battled every conceivable medical organization and educational institution in her mission to achieve her aim. Initially, she trained as a nurse for six months at the Middlesex Hospital, London, where she persuaded the hospital apothecary to accept her as a pupil. She even attended medical lectures, until she angered the male students by answering a question nobody else could answer, and was barred from future classes. One by one, every medical school and university in England and Scotland refused to admit her. But after completing her five-year apothecary apprenticeship, in 1865 she passed the examination of the Society of Apothecaries and in that way added her name to the Medical Register, thus becoming the first woman qualified in Britain to do so. The society immediately amended its rules to prevent other women from following her example.

Having qualified to practice as a doctor in Great Britain, Elizabeth also obtained a medical degree in Paris—the first woman to do this—then slowly built up a viable practice in London. When Elizabeth married Louisa’s father, James Skelton Anderson, a partner in the Orient Steamship Line, friends assumed she would give up her career. Far from surrendering her independence, Elizabeth not only continued her private practice but opened ten beds above the dispensary she had founded, creating the New Hospital for Women. This infirmary would treat impoverished women and provide clinical experience for other would-be female doctors. Yet since every door that Elizabeth had pried open had just as quickly been slammed shut by the male medical establishment, other women who aspired to study medicine had been barred from following her—despite determined efforts.

Some women obtained medical degrees at universities on the Continent, which were gradually opening their doors to female students—but this did not permit them to practice in Britain. Refusing to be defeated, one enterprising woman, Sophia Jex-Blake, founded a medical school exclusively for women, the London School of Medicine for Women (LSMW), which opened in 1874. Elizabeth Garrett Anderson became the only woman on the otherwise entirely male teaching staff. Yet none of the nineteen medical examining bodies would grant the school accreditation.

Hostility to the idea of women becoming doctors intensified during the 1870s. One prominent doctor declared that he would rather follow his only daughter to the grave than allow her to study medicine.¹⁶ The British Medical Journal feared the “Temple of Medicine” was being “besieged by fair invaders,” and the leading medical journal, The Lancet, warned of a potential “invasion of Amazons.”¹⁷ The barriers were finally breached when Parliament passed the Medical Act of 1876, which enabled—though it did not compel—universities to admit women.¹⁸ That same year, the Royal College of Physicians of Ireland agreed to recognize the LSMW and examine its students, providing them with a route to qualify for the Medical Register. A year later, the LSMW struck a deal with the cash-strapped Royal Free Hospital to provide its students with clinical experience on the wards in return for handsome fees. Soon after that, the school was incorporated as a college of the University of London. Other British universities slowly followed suit in admitting women as medical students, although Oxford and Cambridge would continue to bar women from studying medicine even in 1914.

The battle for women’s entry into medicine had been won. By the time Louisa Garrett Anderson set her sights on becoming a doctor in 1890, women were theoretically permitted to study medicine and qualify to practice—albeit chiefly through the LSMW. Some one hundred women doctors had added their names to the Medical Register by 1891.¹⁹ Obtaining postgraduate training and hospital experience was another matter. The route for men who wished to climb the medical career ladder was generally straightforward. After training at a reputable medical school, they were normally offered a junior post in the hospital attached to that school. Given the right connections, they would then progress to a senior post in a specialty such as surgery or gynecology. Hospital jobs were honorary and unpaid—hospitals were charities that treated only the poor, while wealthier patients were attended at home or in private nursing homes—but they usually led to lucrative private practice in the chosen field. With no access to these male networks, women were denied this route.

None of the major medical schools accepted women, and the royal medical colleges in London and Edinburgh barred women from taking the specialist examinations required to progress up the surgical and medical ladders.²⁰ Apart from at the Royal Free and one or two hospitals elsewhere, women were simply never considered for junior posts by the all-male appointment boards. Effectively blocked from working in surgical or medical specialties, and likewise prevented from treating men, women were unable to take the first step on the career path leading to prominent hospital positions and successful private careers. Women doctors, therefore, had little choice but to take low-paid and low-status jobs as medical officers in schools, prisons, and asylums, to work in hospitals set up and run by women to treat women and children, or to head overseas for jobs men did not want in medical missions—about a third of LSMW graduates went abroad. Committing herself to medicine at the age of seventeen, Louisa Garrett Anderson therefore knew that the obstacles would be considerable and the opportunities few.

LEAVING ST LEONARD’S at eighteen, Anderson had enjoyed a vacation in Paris with her mother and brother and then stayed on alone with a French family to brush up her French. Her mother was still fretting about her daughter’s health, remarking, “She will turn into a sweet, delightful woman if she lives, but I should much like to see her stronger.”²¹ Clearly more robust than her mother believed, Anderson survived her French leave and spent the next year at the women-only Bedford College in London, studying the sciences in preparation for medical school. The following year, in the autumn of 1892, she enrolled at the LSMW, where her mother was now dean, along with thirty other women students. She worked hard, winning several prizes, to qualify as Bachelor of Medicine at the end of the five-year course, and achieved Bachelor of Surgery the following year. Now legally entitled to practice as a doctor, she faced the scramble for her first hospital job.

Since there was no point in applying to a major general hospital, Anderson took junior posts at two charitable hospitals in poor areas of south London in 1898 and 1899.²² She gained her Doctor of Medicine degree from London University in 1900, aged twenty-seven. Already she had determined on becoming a surgeon. Her mother had never enjoyed operating, Anderson would later say, but Louisa was inspired by another woman doctor, Mary Scharlieb, who had worked in India. Watching her perform complex abdominal surgery at the New Hospital, Anderson was awed at seeing “her slender hands seeming to go everywhere with marvellous speed.”²³ The following year, when the Royal Free designated two of its six junior doctor posts for women, Anderson was appointed house surgeon there, becoming one of the first women to obtain a junior post in a general hospital—albeit still on the women’s wards and for just six months.

Eager for wider clinical experience, she was forced to look overseas. Earlier in 1901, she had spent a few weeks with a friend in Paris attending anatomy lectures and had even assisted at an operation—“both of us dressed up in Frenchman’s operating pinafores,” she told her mother.²⁴ In December, she and another friend sailed for the United States to attend lectures at two of America’s most prestigious medical schools.

Arriving in Baltimore, Louisa enrolled as a postgraduate student at the Johns Hopkins Hospital Medical School, which admitted women students on the same basis as men. Though she found Baltimore a “sleepy” town, she was impressed by the school’s professor of medicine, Dr. William Osler, who emphasized the importance of listening to patients—a novel concept—in forming a diagnosis.²⁵ It was a practice Louisa would take pains to follow. Moving on to Chicago, she was shocked at the “bustling and dirty” city with its seventeen-story “houses,” but the clinical lectures of Dr. Nicholas Senn, professor of surgery at Rush Medical School, made it all worthwhile. Crammed into the lecture theater with up to five hundred other students, Louisa was transfixed as Senn exhibited some thirty patients in turn and then—after downing a glass of milk and beaten eggs—performed five or six major operations and the same number of minor ones. Having served as a surgeon in Cuba in 1898 during the Spanish-American War, Senn was an expert in military surgery and wound management. It is possible he also instilled an appetite in Anderson for war surgery. Her experience in America confirmed her ambition to become a surgeon, and yet she was no nearer a permanent hospital post. In London, Paris, and Chicago, she had watched operations on men, women, and children—and even assisted at a few—but she lacked direct experience of performing operations herself.

ANDERSON RETURNED TO London in 1902 as the Victorian era gave way to the twentieth century, but her prospects were not promising. Her brother, Alan, had followed his father into the family shipping firm after studying at Eton, then Oxford. After Alan got married in 1902, his future was settled. Louisa was still living at home in London with a generous private income from her parents. Yet although her training and experience were equal to those of her male contemporaries, she had no chance of securing a post as a consultant surgeon in a major hospital to provide the professional status she craved. There were now more than two hundred women doctors on the Medical Register, but almost all of them worked in women-run hospitals or dispensaries treating only women and children. One enterprising female doctor ran two sanatoria, which treated both men and women for tuberculosis, and a handful of medical women had West End consulting rooms, where they attracted society ladies who chose to be examined by a woman rather than a man.²⁶