Elizabeth Garrett and the progress of women in medicine

What the specification asks for

“Nightingale and continuing improvements in hospitals and nursing. Elizabeth Garrett and the progress of women in medicine.” — examined through change and continuity. Incandio is aligned to specification 4HI1; it is not published by, endorsed by or affiliated with Pearson.

1 · Understand it

The exclusion

Nursing had been made respectable by Nightingale and remained subordinate: nurses did not diagnose, prescribe or operate, and the profession was defined against medicine rather than as part of it. Medicine itself was closed. The Medical Act of 1858 created a register of qualified practitioners, and the bodies entitled to license — universities and corporations — did not admit women, so the register was closed to them by the composition of the licensing bodies rather than by an explicit prohibition.

That distinction matters, because it is the gap Garrett went through. A profession closed by explicit prohibition can only be opened by repealing the prohibition; a profession closed by the practices of its licensing bodies can be entered by finding a body whose own charter has not thought to exclude anybody.

Garrett's route

Elizabeth Garrett was inspired by Elizabeth Blackwell, an Englishwoman who had qualified in New York in 1849 and lectured in London in 1859. Garrett worked as a nursing student at the Middlesex Hospital, attended lectures until male students petitioned against her, and was refused by every medical school she applied to.

She then found the loophole. The Society of Apothecaries' charter obliged it to examine anyone who had completed the required apprenticeship and course of study, and contained no rule excluding women. She took private tuition, completed the requirements, and in 1865 the Society was legally compelled to examine her. She passed and was placed on the register.

The Society amended its regulations immediately afterwards to require attendance at an approved medical school, which no woman could enter. The door closed behind her, and for years she was one of only three women on the British medical register.

She continued anyway: she opened a dispensary for women in 1866, which became the New Hospital for Women; she obtained an MD from Paris in 1870 when the Sorbonne opened its examinations to women; she was admitted to the British Medical Association in 1873 and it then voted to exclude women, so that no other woman was admitted for nineteen years; and in 1908 she became the first woman mayor in England.

Jex-Blake's route, and which worked

Sophia Jex-Blake took the opposite approach. She and six others — the Edinburgh Seven — matriculated in medicine at Edinburgh in 1869, the first women to be admitted to any British university course. They were obstructed at every stage, excluded from anatomy demonstrations and clinical teaching, and in November 1870 a mob of students blocked their entry to an anatomy examination at Surgeons' Hall and threw mud and rubbish. The university eventually ruled that it could not graduate them.

Jex-Blake then campaigned for the law to be changed. She founded the London School of Medicine for Women in 1874, qualified abroad in Berne and Dublin in 1877, and lobbied Parliament. The Enabling Act of 1876 permitted, though did not require, medical licensing bodies to examine women; the Irish College of Physicians acted first, and the London School obtained clinical teaching at the Royal Free Hospital in 1877.

So the comparison is a real historical argument with a real answer. Garrett's individual exception secured one place and produced an immediate rule change to prevent repetition. Jex-Blake's confrontation was defeated at Edinburgh and produced a statute, a school and a teaching hospital, which is the machinery through which numbers actually grew. Individual exception gets one person through; institutional change opens the route — and this pair is the best available case study for a change/continuity question on the women's theme.

How slow it remained

In 1881 there were around 25 women on the medical register; by 1901 around 200; by 1911 around 500 out of a profession of some 35,000. Progress was real and it was a rounding error.

The barriers that remained were institutional: most medical schools stayed closed, hospital appointments went to men, married women were expected to leave, and specialties such as surgery remained effectively shut. The First World War opened medical schools because the men had gone, and several closed again afterwards, which is the sharpest single piece of evidence in the theme.

2 · Learn it — the notes

The dates that earn marks

1858

The Medical Act creates the register; the licensing bodies do not admit women. Why this date: Exclusion by institutional composition rather than by explicit rule — which is why a loophole existed.

1865

Garrett qualifies through the Society of Apothecaries, which then changes its rules. Why this date: The exception and its immediate closure in the same year is the strand's central fact.

1869–70

The Edinburgh Seven matriculate; the Surgeons' Hall riot; the university refuses to graduate them. Why this date: The confrontation route fails at first and produces the campaign that succeeds.

1874–77

The London School of Medicine for Women founded; the 1876 Enabling Act; clinical teaching at the Royal Free. Why this date: The institutional machinery through which numbers could actually grow.

The figures, and how far to trust them

• About 25 → about 200 → about 500 — Women on the British medical register in 1881, 1901 and 1911. (Against a profession of roughly 35,000 in 1911; the proportion is the point.)
• 19 years — Between Garrett's admission to the BMA in 1873 and the next woman's.
• 7 — The Edinburgh Seven, the first women to matriculate at a British university in medicine.

The people to place

• Elizabeth Garrett Anderson — Qualified in 1865 through the Apothecaries' loophole; founded the New Hospital for Women; first woman mayor in England in 1908.
• Sophia Jex-Blake — Led the Edinburgh Seven, founded the London School of Medicine for Women, and campaigned for the 1876 Enabling Act.
• Elizabeth Blackwell — Qualified in New York in 1849; her 1859 London lectures inspired Garrett.
• Florence Nightingale — Professionalised nursing and was ambivalent about women entering medicine, preferring a separate sphere.

How historians disagree

Attributed interpretations, never voiced — the AO4 seam.

• The 'individual pioneers' reading: Exceptional women broke through by determination, and Garrett's qualification in 1865 is the moment the profession opened. Contested by The reading that individual exceptions changed nothing structurally — the Apothecaries closed the route within months — and that numbers grew only after the London School, the Enabling Act and clinical teaching created an institutional path..

What students say — and what is actually the case

Not this: Garrett's qualification opened medicine to women.

This: The Society of Apothecaries changed its rules immediately afterwards. For years she was one of three women on the register, and the route was reopened by legislation and a new school a decade later.

Not this: Women were formally banned from medicine.

This: There was usually no explicit ban; the licensing bodies simply did not admit them, and the universities did not teach them. That is why a charter with no exclusion clause could be used, and why the 1876 Act was permissive rather than prohibitive of exclusion.

Two things students merge

Blurred: Nursing and medicine.

The distinction: Nightingale professionalised nursing as a separate, subordinate occupation; Garrett and Jex-Blake sought entry to the medical profession itself. The specification names both and they are different campaigns with different opponents.

Blurred: Individual exception and institutional change.

The distinction: Garrett got one woman onto the register; the London School, the Enabling Act and the Royal Free created a route others could take. Which counts as progress is exactly what a change/continuity question is asking.

What a Grade 9 answer holds here

A Grade 9 answer distinguishes an exception from an opening and uses the pair to make the point. Garrett went through a gap that was sealed behind her; Jex-Blake was defeated at Edinburgh and then built a school, won a statute and secured a teaching hospital — so the route that failed publicly is the one that produced the numbers, which is a claim about how institutions change rather than about two women's characters.

3 · How it is examined

This strand is genuinely set through: Paper 2 Section B (a) (6 marks — “Explain TWO ways in which … was different from ….”); Paper 2 Section B (b) (8 marks — “Explain TWO causes of ….”); Paper 2 Section B (c)(i) or (c)(ii) (16 marks — “How significant was … in …, in the years …? / How far were … responsible for …, in the years …? You may use the following in your answer: • [prompt] • [prompt]. You must also use information of your own.”).

What earns marks: The immediate rule change after 1865, and the contrast with Jex-Blake's institutional route. THEME TRACK: theme 4 (the changing role of women in medicine), whose long argument runs Nightingale and Seacole → Garrett and Jex-Blake → Curie and the First World War → the interwar closure → the Second World War and the NHS.

4 · Prove it — the questions

Answered inside Incandio, where a marker checks what a correct answer must contain and tells you which half was missing. The marking stays in the app; the questions are here.

1. Explain TWO ways in which the position of women in medicine in 1860 was different from their position in 1900. [6 marks · Paper 2 Section B (a)]
2. Explain TWO causes of the exclusion of women from medicine before 1876. [8 marks · Paper 2 Section B (b)]
3. Explain TWO causes of the increase in the number of women doctors after 1876. [8 marks · Paper 2 Section B (b)]
4. How significant was the changing role of women in improving medicine in the years c1848–c1948? You may use the following in your answer: • Florence Nightingale • Elizabeth Garrett Anderson. You must also use information of your own. [16 marks · Paper 2 Section B (c)(i) or (c)(ii)]
5. Explain TWO ways in which the training of doctors in 1850 was different from training in 1905. [6 marks · Paper 2 Section B (a)]

Carry on through the option

• Previous lesson: The 1875 Public Health Act
• Next lesson, in key topic 3: Koch and bacteriology
• Also in this key topic: Pasteur and the germ theory of disease · Lister and antiseptic surgery
• Key topic 2 · Discovery and development, 1860–75; Lister and Pasteur · Changes in medicine, c1848–c1948 · the option's timeline · Incandio History
• The other key topics of Changes in medicine: Progress in the mid-19th century; Nightingale, Chadwick, Snow and Simpson · Accelerating change, 1875–1905; Ehrlich, Koch and chemistry · Government action and war, 1905–20 · Advances in medicine, surgery and public health 1920–48; the NHS