Louisa Garrett Anderson and Flora Murray: Redefining gender roles in military medicine

Editor’s note: The American College of Surgeons (ACS) Surgical History Group (SHG) hosts an annual Poster Competition at the ACS Clinical Congress. The following article is based on the third-place winner of the SHG Poster Competition at Clinical Congress 2019 in Boston, MA. An article based on the second-place winning poster will be published in the May issue of the Bulletin.

In the early 20th century, women were trained as physicians with the intended purpose of taking care of female patients and children specifically.¹ However, Louisa Garrett Anderson, MD—the daughter of the first woman surgeon in England, Elizabeth Garrett Anderson, MD²—and her colleague, Flora Murray, MD, sought to change this practice.

With the onset of the first World War (WWI) in 1914, they founded the Women’s Hospital Corps (WHC), staffed entirely by women suffragists. With the support of their political allies at home and the French Red Cross, they established two military hospitals in Paris and Wimereux, France, on the Channel coast. The success of their endeavors received the attention of Lieutenant General Sir Alfred Keogh, Director General of the Royal Army Medical Corps (RAMC), who, as casualties began to flood the country from the war in France, asked Drs. Anderson and Murray to set up a facility in London, England, with the capacity to treat up to 1,000 patients. These two physicians established the Endell Street Military Hospital (ESMH), the only RAMC hospital entirely run by women physicians and staff.¹

Despite their lack of training in trauma and orthopaedics and with no previous experience in military medicine, they met the challenge of treating often horrific wartime casualties and returning battle-injured men to society. Drs. Anderson and Murray far exceeded expectations and earned Sir Alfred’s grudging praise. The success of the ESMH formed the foundation for future generations of women military physicians and surgeons.¹

Prior to WWI

Dr. Anderson qualified in medicine in 1900 at the London School of Medicine for Women (LSMW), the first British medical school to train women physicians. Its co-founders included Dr. Elizabeth Garrett Anderson and Elizabeth Blackwell, MD, the first woman to receive a medical degree in the U.S. Louisa Anderson practiced at the New Hospital for Women, which was also started by her mother. Less is known about Dr. Murray, who was four years older than Louisa Anderson. She began her medical studies at LSMW and completed her training in Durham, Scotland. Dr. Murray returned to London in 1905 as a medical officer and anesthetist.¹ Both Drs. Anderson and Murray were ardent suffragettes and members of the Women’s Social and Political Union (WSPU), the leading militant organization campaigning for women’s suffrage in the pre-war U.K. In fact, Dr. Anderson was imprisoned for a month for breaking the window of an anti-suffrage minister’s home in Kensington.^1,3

In 1912, Drs. Anderson and Murray co-founded the Women’s Hospital for Children in London. At that time, women physicians were barred from providing care to male patients. Their practices were limited to general practice and the inpatient care of women and children. The facility cared for otherwise underserved youths, but also provided training for woman physicians in pediatrics, an educational opportunity otherwise restricted to men.

WWI, WHC, and the ESMH

The RAMC did not anticipate the flood of casualties from mechanized warfare and was caught unprepared, with inadequate numbers of surgeons and facilities to accommodate these patients. With its medical staff limited to men, the RAMC and its French counterparts sought assistance from any source.

Just six weeks after Great Britain’s entry into WWI on August 4, 1914, and with the arrival of the British Expeditionary Force in France three days later, Drs. Anderson and Murray and the WHC traveled to Paris with the intent of assisting in the care of the wounded, despite their lack of experience in treating men and their limited experience with military surgery. They were able to provide their own staff and funding with financial support from sympathetic supporters and medical suffragists.^1,3 Drs. Anderson and Murray contacted the French government and offered to develop and support an autonomous surgical unit, staffed by women. The French Red Cross gave the WHC £2,000 to help open the makeshift hospital in the newly constructed Hôtel Claridge, which had been commandeered for their use.³ Just two months after their arrival in Paris, they were so successful that the RAMC asked that they open another hospital in Wimereux in the Pas-de-Calais, the first Women’s Hospital to be recognized by the Royal Army.¹

In a letter to her mother dated September 27, 1914, Louisa Anderson wrote, “I wish the whole organization for the care of the wounded…could be put into the hands of women. This is not military work. It is merely a matter of organization, common sense, attention to detail and a determination to avoid unnecessary suffering and loss of life.”³

By Christmas 1914, the sheer number of casualties overwhelmed British facilities near the Western Front. The RAMC began to evacuate patients across the Channel to hospitals in England and to close inpatient facilities in France. The effort required large numbers of hospital beds to be installed at home. The success that Drs. Anderson and Murray achieved at the Hôtel Claridge and in Wimereux was well known, so Sir Alfred offered them the opportunity to open a large hospital in London with the capacity to house 500 to 1,000 beds.

Drs. Anderson and Murray closed their facilities in France and established the ESMH at the former St. Giles Union Workhouse, Covent Garden. Once again, the staff, from surgeons to orderlies, were all women. Its proximity to the railway stations ensured that Endell Street was among the first to receive patients when convoys arrived in the country. Between 30 to 50 soldiers arrived daily; there were sometimes as many as 80. Each day, Endell Street surgeons performed as many as 20 operations. From May 1915 through October 1919, ESMH treated nearly 50,000 patients.¹

Even though the hospital was part of the RAMC, Dr. Anderson, Dr. Murray, and the staff at Endell Street never received military commissions. They did, however, receive equal pay to RAMC physicians of equivalent rank: Dr. Murray with the honorary rank of Lieutenant Colonel and Dr. Anderson as an honorary Major. Neither physician, however, was a uniformed officer.⁴ Working at an RAMC facility and receiving pay from the Army, they were subject to military regulations, an arrangement that chafed women used to running their own hospitals. The RAMC provided insufficient financial support, leaving the two women on their own to raise money to recruit their own physicians (which eventually numbered 15, including surgeons, ophthalmologists, dentists, anesthesiologists, a bacteriologist, and a pathologist), and the necessary nonmedical support staff.⁴ Drs. Anderson and Murray adopted the motto of their political supporters, the WSPU: “Deeds, not words.”¹ Marion Dickerman, an Endell Street nursing orderly, later remembered, “We had this drilled into us: you not only have got to do a good job, but you have got to do a superior job. What would be accepted from a man will not be accepted from a woman. You have got to do better.”¹

To Drs. Anderson and Murray, “better” meant following a different model of care than the one used at traditional military hospitals. While mastering the surgical tasks previously restricted to men, they also addressed patients’ emotional and psychological needs. They furnished the rooms with mattresses softer than those issued by the military, houseplants, and table lamps—simple amenities that were a welcome relief from the filth of life in the trenches. Musical performances entertained the soldiers, who were provided scheduled leisure activities, such as sewing and embroidery. Soldiers who were hesitant to be treated by “lady doctors” came to prefer the care they received at Endell Street. Those troops who had requested to be transferred to traditional facilities run by men often refused to leave Endell Street when their requests came through.¹

After the War

When ESMH closed its doors in October 1919, it was the longest-running temporary military hospital of the war and the only one organized and staffed entirely by women.⁴ The building no longer exists, but the work accomplished within its walls has had a lasting impact. By providing exceptional care to wounded soldiers and meeting administrative challenges brought on by wartime scarcity, Drs. Anderson and Murray demonstrated that woman physicians were equal to their male counterparts. They broke the longstanding taboo of only men caring for men. They proved themselves the administrative and professional equivalent of male physicians.

The WHC and its Scottish counterpart, the Scottish Women’s Hospitals, emerged from the war with favorable public support. Although the British medical establishment would continue to yield its influence grudgingly, Dr. Anderson, Dr. Murray, and their colleagues set the stage for gender integration in medical schools, training programs, and all aspects of care—including the most gender-restricted field, military surgery, a specialty that only recently has started to yield.

References

1. Geddes JR. Deeds and words in the suffrage military hospital in Endell Street. Med Hist. 2007;51(1):79-98.
2. Anderson KD. Olga M. Jonasson, MD, Lecture: The quiet pioneer who started a revolution: Elizabeth Garrett Anderson. Bull Am Coll Surg. 2018;103(2):22-29.
3. National Archives. London University: London School of Economics, the Women’s Library. Papers of Louisa Garrett Anderson. Available at: http://discovery.nationalarchives.gov.uk/details/r/36b60fe6-c498-4554-a3c9-074242b53a76. Accessed January 15, 2019.
4. Woman and her sphere. Women and the first World War: The work of women doctors. Available at: https://womanandhersphere.com/2014/05/06/women-and-the-first-world-war-the-work-of-women-doctors/. Accessed January 10, 2019.