Sanctuary Fic Resource Page

Medical Training Pre-1958

This first period of medical training was a complexed system. Unlike today, there was no real syllabus and the length of your study very much depended on the level of doctor that you wished to be. Even with the level of physician, though many families preferred to pay for a five year apprenticeship, it was quite possible to qualify provided you could show evidence of three or four main areas.

Up until 1858, reasonably wealthy families would pay for their boys to be educated at well known institutions such as Eton, Harrow and Winchester. These schools provided the classical background suitable for further study and Oxford or Cambridge.

Though this was the more traditional route, many parents of the time were of the opinion that Oxford and Cambridge did not offer the practical experience necessary for their children and that the classical offerings were not suitable for those entering the medical profession. In these instances, parents would either send their children to London or Edinburgh or organise a five year apprenticeship for their offspring.

The benefits of attending Oxbridge over the more practical options were, however, great. Oxbridge graduates were the elite with access to the highest and most coveted positions in London and elsewhere as they became members of the Fellowship of the Royal College of Physicians.

Those who could afford an apprenticeship to a London hospital surgeon were instead granted the status of Member of the Royal College of Surgeons and could pursue this branch of the profession as a "pure" specialism.

Those of less fortunate background also had the means to enter the medical profession, though at the lower level of apothecary (responsible for medication but also low level doctor's duties) and at the end of their apprenticeship of six months were able to qualify as members of the Royal College of Apothecaries. Following this training, it was also possible for these men to do a six month surgeon's apprenticeship in order to qualify for status in the Royal College of Surgeons.

Despite the high cost of education and the difficulty in qualifying, physician was not considered an appropriate profession for a gentleman. The richest families instead pushed their sons into law.

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Legislation 1858 - 1866

This middle period of the Victorian era was complicated in terms of medical training. Much new legislation was passed (some of which is still in effect today).

Although it left the Royal Colleges with the same licensing and examination responsibilities as they previously had (And in someways defined them more clearly), a new body was set up in order to regulate practicioners. The General Medical Council (GMC) was created as a result of the 1858 Medical Reform and was responsible for creating a list of reputable practicioners.

The upshot was this: The Royal Colleges still set the entry requirements but without being on the GMC it was all but impossible to practice.

In 1859, Elizabeth Garrett Anderson attended a talk that was given by Elizabeth Blackwell (the first female physician who qualified in the US). With her father's backing, Garrett Anderson opened a dispensary in London in 1866, after passing her apothecary exams, at which point the legislation was changed to close any loopholes or ambiguities left by the 1858 reform that allowed women to qualify in the medical profession (more on Garrett Anderson in a moment!).

As a result, by 1866, it was not only impossible for a woman to receive training due to the new laws, but impossible for most middle class men to receive training due to the new requirements implemented post 1858 which requirement more stringent training and a background in the classics including the ability to speak a foreign language to study medicine.

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Women in Medicine

This is really the section that really applies to Helen Magnus and her training, or rather the restrictions placed on her by her age and so on.

First Off: Elizabeth Garrett Anderson. I mentioned briefly about her opening a dispensary in London (dispensaries were the responsibility of the apothecary, the low level medical professional).

Garrett Anderson is well known for the fact she enrolled at Middlesex as a nurse and attended doctors' classes until students complained. As the Royal College of Apothecaries had no legislation banning women from taking the final exams, she was able to sit them and qualify as a low level professional without having done a formal course. This as tightened in the 1866 legislation after Garrett Anderson qualified in 1865.

Determined to get an MD diploma, Garrett Anderson moved to France and studied at the prestigious Sarbonne university, where she gained her MD qualification in 1870. In spite of this, the British Medical Register refused to acknowledge the qualification.

In 1872, EGA founded the London Hospital for Women and Children, the only institution in which women were able to do practical training.

In a private rented house in London in 1874, Elizabeth Garrett Anderson, along with Elizabeth and Emily Blackwell and several other well known female figures of the day, invited a group of men and women for medical training. The women of this group became the first cohort of medical students at the London School of Medicine for Women.

It was in 1876 that women were permitted to take the medic's exams. By this time all students would have been obligated to have general knowledge in all fields including surgery and midwifery.

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How does this relate to Helen Magnus?

Many people have been talking about how Helen would have done all her training alongside her father, simply taking the final exams when she was ready. This would not have been the case.

Although Elizabeth Blackwell and Elizabeth Garrett Anderson were able to take this course of action, by the time Helen was old enough to study medicine, there would have been strict requirements imposed by the legislation of 1866 and 1858.

One could say that her full portfolio could have been completed in line with her father's work, including the midwifery and surgical elements. However, with Helen's own admission that society refuses to acknowledge the abnormals (therefore, presumably refusing to acknowledge her portfolio as the truth) as well as the fact that it would be apprenticeship with a family member rather than at a hospital, I would suggest it highly improbable that the full extent of her training took place at her father's side.

Having grown up around the time of Elizabeth Garrett Anderson's qualification, I feel that this would have been a story of inspiration for Helen, showing that women were able to become medics. As we have heard that Helen was among the first to gain membership with the Royal College (though we have not been told which of the colleges! It could be the Royal College of Dentistry for all we know!), and was too young at the time of EGA's qualification (1865, Helen was fifteen), I would love to see Helen as being one of the first cohorts in the London School of Medicine for Women. For her, it would be training in the presence of like minded people and being mentored by heroines.

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Lastly, I would like to point out that I am slightly bewildered by the take on the "Royal College" issue we seem to have heard from the showrunners. So far, it is implied that the Royal College itself is a medical school, which it is not. The Royal Colleges are separate institutions each responsible for regulating entrance to its own profession.

The difference between the different medical professions in Victorian Britain:

Doctors
- Doctors were the highest on the social ladder
- Until the medical reform, no apprenticeship was required
- Doctors were allowed to dine with the family rather than staff
-Normal price for a doctor's visit was 5 shillings
- Doctors would keep one morning a week for charity cases
- A successful Doctor would earn £10,000 a year.

Surgeons
- Next rung down on the social ladder
- Surgeons did apprenticeships in their teens
- "infamous for their rowdiness"
- Surgeons set bones, stitched wounds and pulled teeth

Apothecaries
- sold drugs
- performed basic tasks (eg initial examination)
- Could obtain a medical license after 6 months on the wards

Nurses
- Nurses were considered worse than prostitutes
- Cooked, cleaned and were on 24 hour duty
- Nightingale glamourised the profession and opened a school

The Miasma Theory
This theory states that illness is caused by bad odours in the air. The theory started in the middle ages and was popular until the latter Victorian period.

Treatments reflected these beliefs. One example from the 17th Century, doctors wore hooked masks with flowers hidden in them to preven the black death reaching their noses.

In Victorian society, much was done to try and prevent these odours. Drains were built underneath cities to dispose of the sewage. and rubbish was cleared from the streets. Though the idea of the Miasmas was complete fiction, they inadvertently prevented a lot of disease. By removing the cause of the smell, the Victorians also removed the bacteria.

However, in some cases, such as in the case of the Cholera outbreak, they did more harm by tunneling the sewage into the water. In effect, the bacteria got into everyone's drinking water.

It was this type of behaviour that created the distinctions between east and west London. The river Thames flows to the east, so by the time it reached the east end, it was full of sewage.

Bacterial and Germ Theories

The bacterial theory was introduced by William Budd and John Snow in 1849, but rejected. This theory said that cholera was caused by a living organism that multiplied. Correct but thrown out by society.

Louis Pasteur introduced the Germ theory in 1861. It was, at first, rejected but some realised the importance of the theory. Joseph Lister sanitized his surgery and began performing "antiseptic surgery" in 1861. By the 1890s, it became widespread belief that unseen organisms were the cause of illness.

There was a wide range of birth control options available to women in the late 1800s from barrier methods through to chemical methods. However, due to various reasons, including mistrust of such devices and financial implications, many families chose to use less reliable forms of contraception.

Common Birth Control Measures

Many couples chose to make changes to their sex lives rather than to use anything we would consider to be contraception in today's society.

The first of these measures is "coitus interruptus" where the man withdraws before ejaculation. In the mid to late 20th century, doctors believed this to be an unsuccessful method of contraception due to pre-ejaculatory fluid. However, research undertaken in 2003 has shown that there is no viable sperm in pre-ejaculatory fluid, making this a relatively safe form of contraception, if properly executed. The problem, however, is the self control required by a man to pull out before ejaculation. It is this lack of self-control, rather than the scientific theory, that makes this form of birth control unreliable.

The second form of family planning used was the "rhythm method", which was advocated by the Roman Catholic Church as the only "morally acceptable form of family planning". Their Sacred Penitentiary decreed in 1853 that couples practising "periodic abstinence" were not sinning. The rhythm method, very simply, involves working out the dates when a woman is fertile and not having intercourse at that time, and its practice can be dated back to the year 388 when St. Augustine wrote to one of the churches about abstaining "shortly after a woman's purification". At present, the rhythm method is one of the most unreliable forms of birth control, with a failure rate of 10% (only the cervical cap and sponge are higher than this). This was worse in the 19th century as medical texts frequently disagreed on the time of ovulation.

Vaginal douching was also regularly used as a form of contraception. However, this was unlikely to be a reliable means of contraception, as it, for the mostpart, just encouraged the sperm further up the passage. Some women chose to use vinegar or lemon juice. If the liquid was particularly acidic, if could have some effect as a spermicide, though was not 100% effective.

The last common form of birth control was abstinence. In the early 1800s, there were 7 children per family on average. By 1900, this was reduced to approximately 3.5. As such, whenever pregnancy threatened the economic wellbeing of the family, it was the woman's duty to be shy, demure and coy and abstain from sex.

Other Available Measures

Whilst in Asia, women used oiled paper as cervical caps, European women often used beeswax for the same purpose. Some women would use a lemon cut in half and inserted, as the acidic properties of the fruit acted as a spermicide.

The condom was used as far back as Tudor times, with the sheath being made of animal intestine. However, in 1855, the first vulcanised rubber condom appeared (the process of vulcanisation was patented by Charles Goodyear in 1844). Strips of raw rubber would be wrapped around a penis mould, then dipped in a chemical solution to "cure" the rubber. These condoms had a shelf life of 3 months. Latex condoms (with a shelf life of 5 years) did not appear until 1912. 

Chemical contraceptives have been used as far backas the Egyptians. However, I have as yet been unable to find details of what methods are used.