Reframed: Joseph Lister and women in surgery

So hello everyone and welcome to our Joseph Lister and Women in Surgery event. My name's Ross McGregor and I'm the Heritage Lead at the Royal College of Physicians and Surgeons of Glasgow. Yeah we have two really special guests with us tonight, so Marvin Fiona would you be able to introduce yourselves? Hi I'm Dr Marvin McElroy, I'm a Consultant Geriatrician at Glasgow Royal Infirmary and I'm Honorary Librarian of the Royal College of Physicians and Surgeons of Glasgow. And I'm Fiona Leach, I'm one of the Consultant Colorectal Surgeons at Glasgow Royal Infirmary and I am a Fellow of the Royal College of Physicians and Surgeons of Glasgow. Thanks very much both of you, just want to say thank you both so much for taking the time to join us in this event tonight. We know how busy and challenging things are for you both during this time in the pandemic right now so we really do appreciate you taking the time to join us in this event and I know Marvin you are actually on call so it's quite possible that you might get called away mid event which is absolutely fine of course. So this event is actually the first event in our reframing series, Conversations about Heritage and Inclusion. These events are all about helping us reveal our heritage in new ways, specifically to address inequalities. We're reframing our heritage by acknowledging that race and gender inequality is embedded in our history. Heritage practice, by that I mean museum displays, engagement activity, the celebrations we regularly do. This practice connects people to the past but it does often ignore the inequalities that are part of the story. So in terms of Lister, we celebrate Lister regularly for his world changing impact on medical science and how he's improved the health of people everywhere and will continue to do that. His story is amazing. His attitudes towards women in surgery are rarely discussed however. So the event tonight aims to open that discussion up and ultimately to lead us to change our heritage practice and how we interpret Lister in the 2020s. The event is also part of Lister Week. So Marvin, I don't know, could you say a few things about Lister Week in case no one has heard of it which is unlikely? Yeah, with the amount of tweeting that we've done, I'm sure they have heard of it. But as Ross was saying, we're here not only as part of our college reframed event but in conjunction with Friends of GRI Lister Week, which is a celebration of all things Lister, Glasgow Royal Infirmary and the city in which he worked during the 1860s. That was a decade where he did revolutionised surgery and medicine with his antiseptic theory and practice. He was professor at the University of Glasgow from 1860 to 1869 with wards in Glasgow Royal Infirmary for most of that time. As I said earlier, I have a foot in both camps a bit in that I'm obviously here as only librarian of our college but I'm also a trustee of Friends of Glasgow Royal Infirmary. So I'm hoping that this is the first of many more collaborations in the future as well. So I'm looking forward to the talk tonight. So back to you, Ross. Thanks very much, Marvin. I'll just give a wee bit of background before we kind of go into the discussion just about why we're doing this event from the college side of things because Lister is of course connected to the Royal College of Physicians and Surgeons of Glasgow as well. So yeah, Lister, he became a fellow of the in the 1860s while he was at the Glasgow Royal Infirmary and working in Glasgow. And what I'm going to do, I've got a couple of slides here just to show you some of the collections that we have. So yeah, he delivered lectures in the college's rooms. Hopefully you can see that's on the screen now. He delivered lectures in the college's rooms in the college building, St Vincent Street. He used the college library and we actually have records that record him not returning books to the library. And generally he was part of the community of physicians and surgeons who were active in the city at that time. So our collections then contain some significant items that help us tell the story of Lister and of the development of antiseptic surgery. And we use those collections to engage people with this story and to engage people with that part of medical history. We have a Lister room, which is pictured here, which contains quite a few objects relating to Lister and from his ward actually, wards at the GRI, including this fireplace that you can see there in the picture. Our collections also contain some pretty amazing archive material relating to Lister as well, containing notebooks and class cards such as this one here on the picture. And a lot of this material belonged to students who were taught by Lister in the 1860s. And the archive also contains correspondence between Lister and other doctors and surgeons, including William McEwan. And we also have some instruments that belong to Lister, an example of his carbolic spray. So that is just to give a bit of background really about that connection with Lister. So what we do in terms of the heritage side of things, we look after these collections and we also do things with them. We use them to tell the story. And that's where this event comes in as well, about a bit of that story that is rarely told by us, but is actually rarely told by anyone. So in terms of Lister and women in surgery, the story kind of moves beyond Glasgow a bit. If we go to 1869, when Lister took up his position in Edinburgh after a decade in Glasgow. In 1869, Sophia Jakes-Blake and a group of women in Edinburgh 7 enrolled to study medicine for the first time. When those women entered medical study for the first time, Lister didn't allow women to attend his surgical lectures at the infirmary in Edinburgh. So after women were allowed to study medicine in Edinburgh, Lister, along with many of his colleagues, he wasn't alone in this. He objected to their admission to clinical classes at Edinburgh Royal Infirmary. So therefore, that first cohort of female doctors who were overcoming so many barriers to try and study medicine were unable to access Lister's classes. So yeah, Lister wasn't alone in this at all. But Lister was openly opposed to the idea of female surgeons and openly opposed to women in surgery. In 1878, he wrote a letter to the British Medical Journal, pressing the British Medical Association to change its constitution and to prevent female membership. And actually, throughout his life, really, he resisted, and I'll use a quote here from the BMJ letter, he resisted the unseemliness and impropriety of having medical topics discussed without restriction in a mixed company of men and women. And later on, I'll pop reference for that little quote into the chat. So that's just a bit of background. So can I turn to Fiona and Morven? Now, your positions in surgery work so close to Lister's legacy at the Royal Infirmary, which must be so inspiring to work there with that history. And I just wanted to ask, how do you feel about discussing his approach to women in surgery at an event? It's actually quite exciting because while we do need to look back at how things were, it's giving us the opportunity to assess his behaviour in its time and to see whether it still applies to today and now, which is always so important, because we can see, have we really moved on? We do, and obviously, the way we need to phrase it is, what was going on at the time? And I was doing some calculations and looking that it was 30 years later than when we started to look at the vote for women. So he wasn't not of his time in not allowing equality at all. And indeed, it was 21 years after his death when women were actually, it took 21 years, and it was six years after his death when women were actually granted the vote, let alone being quite so improper as trying to compete in a man's world of medicine or surgery. And he did have a very strict upbringing, so it may be that quite literally it wasn't seemly to him whether that was acceptable or not. His upbringing may have had a lot to do with it, but it's exciting. Yeah, so I do feel inspired coming to work in the Royal. I can look out my window and see where his wards were and one of the stone memorials to him as well. So it's all around you all the time when you're working in the Royal Infirmary. But I agree, I'm torn, and I think we do have to recognise that it's wrong to impose our societal values on the society at the time, but that's different from looking at them and discussing them like we are going to do tonight. And we have to recognise his absolute remarkable achievements, but you can be a wee bit annoyed sometimes with things that you don't like so much. Fiona was talking about his upbringing, and I've also been doing some reading around about this, and there are discussions around indecency and discussing with women. I think the quote was the fleshy tabernacle, and as you mentioned the unseemliness of an impropriety of having discussions. But I think also there's other quotes just about general society at the time, and in the BMJ from a few years before your quote, Ross, which was round about women becoming doctors. And I'm just going to read the quote because I think it's quite interesting. So it's every guinea earned by a female is taken from the receipts of her male competitors, and the latter are thus rendered unable to support their wives and families. That's a natural society at the time. And you mentioned Sophia J.X. Blake, and she taught before she became a medical student and a doctor, but her father didn't think it was very proper to be paid as a woman. So he gave her some money, he gave her an allowance, he rallied her getting paid for her work before she went into medicine. So it was very reflective of society at the time in a lot of ways. Thanks, thanks, Morven and Fiona. Yeah, the discussion I think tonight mainly for me is about what we do with Lister now, and not just now, but actually for the past 50 or 60 or more years. For me, heritage definitely gets sometimes gets stuck in a particular approach. And I think for medical heritage, that's definitely the case. And quite often it feels like medical heritage hasn't moved on that much since, you know, the 1890s or the 1930s or right about that time. And this was particularly when prominent medical men were often elevated to this kind of heroic status. And Lister is the absolute apex of that. How do we introduce a more balanced view when we celebrate Lister's achievements then, and should we? So I think actually having discussions like this, highlighting and raising awareness are really useful and totally part of what you're talking about, Ross. As I said, we can't forget how amazing and what huge advances were made in the Victorian era in medicine and science and everything in general engineering, everything. So I think having discussions like we're having is an opportunity to do that. And also, as we've spoken about before, Ross, about curation and how you curate now with the viewpoints that were taken as well. And I don't want to mention the COVID word, but I'm going to mention it anyway. And pre-COVID we were discussing this, and I think that's an important part of it. I think there's other ways around that as well. For example, the Royal College of Surgeons in Ireland with being part of the Women on Walls campaign that we were talking about before too, Ross, and it's always embodies significant women in institutions, history. And I always remember when I became honorary librarian, we had our first ever female president with Professor Taylor. And I don't know if you remember, but we were looking through our artwork and the only portraits we had of women were the Queen, Princess Diana and Princess Alexandra. And I was reminded again by one of my colleagues, my consultant colleagues, Kirsty, just last week, we were talking about the 400th anniversary painting of College Council. And that was one of the celebrations of our 400th anniversary in 1999. And there's only one woman in that picture. And that's Professor Hazel Scott, who until recently was one of our vice presidents medical and who's very involved in the college. But it's round about having discussions, noting it, I think, and recognising it for what it is, curate that as well, though now looking at it from our eyes. But again, it's getting the balance between how we view things now and how society was viewed at the time. I was having a wee look at was there a power behind the throne and throw a curveball out there. Then he married the daughter of Professor Jane Syme, who was the professor of surgery in Edinburgh, who was his mentor, and he took over his post ultimately, when he moved back in 1969. And coming from this very strict upbringing, where clearly you were expected to he was a Quaker, you were not allowed to marry out with the Quakers, the Quakers, he moved to Edinburgh, and he met this amazing family who clearly, I think, opened his eyes. And he met Agnes, who clearly became the love of his life. But more importantly, maybe she was his research assistant. And she undertook all of the work within the experiments looking at different dilutions and concentrations of carbolic acid for his dressings. And he doesn't seem to minimize her impact. So it may be that he was open to having his eyes widened in some ways. And I suspect he probably had a very helping female hand in his experiments. So I think we could reframe it and see is there anything about her history that we could add to the list of collection just with a different name? Yeah, it's an interesting point. And in terms of Agnes's contribution to Lister, I know that some biographers and some historians have made reference to that as well. And actually, a few years ago, we commissioned an artist in residence in the college, a poet, Marianne McRae, who produced a pamphlet of poetry about Lister. And one of her poems was very much about Agnes. It was actually from Agnes's point of view. And it was a lovely, lovely poem. And we have that on the website. And so it's well worth checking out. And so yeah, I mean, kind of bringing the conversation back to how, you know, how we kind of deal with Lister's culture. And for me as a heritage professional, I'm not a historian. So it's not so much about the kind of reasons behind Lister's particular attitudes towards women, because those are big, complex things based on his environment, his upbringing, religious things, all sorts of things will feed into that. But what we do in heritage is, or should do anyway, is deal with the history that is there, that is there within the research and has been published and so on. And the history of Lister and the exclusion of women from his surgical training isn't a hidden history or anything. It's just an unspoken history. And that's kind of where I'm coming from with how we start to make it less unspoken, if that makes sense. But another thing about reading about medicine and surgery in the 19th and 20th century, one of the things that you come across a lot is this hero worship that seems to be instilled in the whole process across education, training, career progression. There's an element of hero worship of the person who's in charge, probably more so in surgery than with physicians, strangely enough. And this was particularly strong during the Lister years when his students and supporters were regarded as his disciples. And there was all this kind of language surrounding Lister. And do you think when we celebrate this kind of culture, do you think we need to kind of adjust that a bit? Or do we need to make more comment on the context of that rather than just kind of repeating it? Do you want me to go? So I think hero worship still exists today in wider society. I think it's more about celebrity than about scientists. And although there are some cults, but I think it's more about celebrity than science, which is quite interesting in itself, reflective of our society. But I think we all have people who have inspired us. I think that was quite pronounced during Lister's time. And, you know, we had Lister's men. But, you know, recently we also had Sophia Jack Blake's women. And, you know, so there's powerful characters there as well. But personally, we have mentors, as I said, which you could call heroes in another vein. And I don't think I would be doing what I did if it wasn't for them. You know, and I'm not, men and women, you know, have inspired me to do what I do, including people that are involved in the college as well at the moment. And so it still exists, but maybe not as much a degree or maybe it's just not documented as much. I'm not sure. I agree. I mean, it still exists. There's much more transparency before it was even within my history as a surgical trainee. Previously, there were jobs that you got because you knew the right person. That, I think, is very much being phased out both with national recruitment and transparency in terms of interview. But it's really in our very recent history that it was who you knew as much as what you knew and how good you were. And yeah, I think, though, if we look, are there cult people? I would say definitely we would all recognise Ruth McKee. I'm going to label her out because I have taken over her role as intestinal failure surgeon. She has trained pretty much most of the surgeons across the west of Scotland. We use her techniques. I, again, I have male mentors who are in living memory and probably would still work with me who would be embarrassed if I mentioned their name. So it's not gender specific, but there are certainly very cult role models. And I hope Ruth's not blushing too much at the moment. Thanks for that. One of the books that I've been looking at recently and I've got a few quotes from for tonight is a book called Medical Lives in the Age of Surgical Revolution. I've actually got it here. Hopefully you can see it, which I really recommend if anyone's interested in this period of history, that period from the 1860s and 70s for medical history. It's a social history of the medical lives that surrounded McEwen and Jax Blake. It was written by Anne Crowther and Marguerite Dupree from the Centre for the History of Medicine at the University of Glasgow. And one of the quotes from it is Blister's reputation was a complex construct involving both the scientific and the moral reputation of the medical profession. Do you think this is connected to why his attitude to women in surgery has been so rarely discussed over the past 100 years? And it clearly has been rarely discussed, even in the major biographies of Blister throughout all that time. It's hardly ever mentioned. And do you think by not discussing women's exclusion from surgery historically, do we risk perpetuating that discrimination? I think I just lost chicken there. I think the 21st century really has awoken everybody. We've all seen the pictures of statues being toppled and we have discussed this between us that that's not the point of today. It's not to topple Blister's statue. It is very much to have a discussion. But yes, the 21st century has made us question everything. Is it really that, and I think we probably have had our eyes opened, rather than an active minority, it's becoming a more prominent, not majority, but definitely a greater recognition amongst everybody across the world that there are people we maybe do need to take a fresh eye, hence tonight. In terms of do we risk discrimination? I'm going to come back, I'm going to take the fifth and I'm going to come back to that with one of our next questions where it leads in slightly better, because I think we do need to look at how things have changed and have they changed as much as we would like to believe. So I'm going to hand over to Morven because I'm going to come back to that. Yeah, and I think there wasn't a discussion at the time, or for a few years afterwards, because it just wasn't out of culture with other people's views at the time. And then when you look back at where we were, but only a few generations after things like the Goodenough report in the 1940s, where it stipulated that we had to have co-educational medical education. So that was in the 1940s. So we're not that far from that. And that's longer past from before. But we will definitely perpetuate it if we don't discuss it. We have to recognise it, own it and have discussions like we're having tonight. Thanks. And that does lead on to the next question, again, which comes from Crowther and Dupree's book in a way with the quotes. And they talk about how Blister wasn't necessarily against medical qualification for women. And that is the same with the medical profession at the time. It accepted that that was a possibility, I suppose, by allowing women to enrol in medical school. But because of the exclusion from most classes, the quote from Crowther and Dupree's book is it implied total segregation of women as students and practitioners and hence exclusion from the elite of the profession. And the women related to Jax Blake were always associated with Jax Blake, but their exclusion from Blister's classes was symbolic of a longer lasting exclusion from general surgery and the highest ranks of the profession. Now, that kind of links in to our college history and the gender history issues within the college, which we are certainly going to be addressing at a reframed event in May. The college didn't admit women to fellowship until 1912, which is a good 40 years or so after women were allowed to study medicine. So I mean, how does this relate, would you think, to the situation now with women's surgery in terms of leadership roles, gender pay gap, those kind of issues that are very, very current? So I'm going to have one non-controversial point, which is that we are slowly chipping away. Alison Lannigan has become our first female vice president, and that was groundbreaking. I'm very proud to have worked with her and to continue to do so. And if I'm allowed to very rudely mention another college, then of course, we have had our first female president of the Royal College of Surgeons, slightly further south than we are, with Dame Claire Marks. So we are slowly getting there. Both of these have been really quite revolutionary and very welcome appointments. So we're slowly getting there with leadership roles, but it's still viewed, and I think one of the big things holding back is who is responsible for looking after the household, who is responsible for looking after children? Do we have to look at the entirety of society? Because if women are still expected to take on any major role within childcare or running the house, such as maternity leave just morphing into taking more of that role, how do you do your 12 hour operations? How do you have the unpredictability of needing to take someone back to theatre? How do you have your eight o'clock ward rounds when your nursery doesn't open till eight o'clock? These are all very real 21st century barriers to women becoming surgeons. And I certainly will say that without the support of both my parents, who embarrassed me nicely already on the call, and certainly my husband taking very much a lion's share of the role, I wouldn't be where I am now. So until we address the societal bias of women being the child carers, then it's probably quite hard to address women in surgery as well. Yeah, I totally agree with you Fiona, and it works in the physician's specialties too. I think when we're talking about women in leadership roles, that's a really important thing for even our generation. And I think seeing previous female consultants in our specialty, having the work-life balance, whatever that may be, was really important as a way to, so having people to inspire you, who can do it, makes you think you can do it too. But it's been chipped away at, I think there's still work to do, and there's lots of statistics out there. I'm sure you can tell them more than me Fiona, I wouldn't steal your thunder about the stats, but I'll maybe pass over to you to talk about the sort of stats about women in surgery and medicine. Thank you very much, Morgan. Ross, could I possibly get my slides? Sure thing, just working on that now. I'm just noticing from the chat that David Blair Marks is not the trailblazer, so I do apologise to the Royal College of Ireland. I'm delighted there's more women. So this is a slide which has been developed by a student in Cambridge, and this is the screenshot in specifically of the surgeon. So this was a mind map undertaken by med students of what they thought the different specialties had as their personality characteristics. So Ross, if I could take the surgeon section. These were the words used, the red ones were deemed as negative aspects, the blue as neutral aspects, and the green as positive aspects for adjectives to describe what they thought a surgeon was. There is no mention of female, there are a lot of reds in there. Arrogant, overconfident, overconfident. I will just leave people to read. And if this is really what people think in the last few years of surgery, then we've got a long way to go. And I think it's why we do need to have normal female and male people who hopefully chip away at this very outdated attitude of what it is to be a surgeon. I've got some figures from Women in Surgery Scotland who have looked at in 1991, 3% of surgical consultants were female. And by 2019, this had increased to 12.9%. But this is in comparison with 35% of medical consultants being female and 51% of medical graduates. So there's definitely an attrition over the grades. And we do see that throughout the more junior levels of training. If we look at across the west of Scotland, then some regions have as few as 11% female consultant surgeons. Some individual units have as high as 44%. And certainly at GRI, I'm really proud that we now have four of our 20 consultant surgeons are female. And we are representing across all of the major domains. There's an esophagogastric surgeon, a pancreatic resectional surgeon, and two colorectal surgeons. I have an IF interest, intestinal failure, and a very up-and-coming pelvic exenterative surgeon. So hopefully we're continuing to show that we can do everything as well as our male counterparts, that gender really shouldn't play any role, and that with appropriate support strategies, both in terms of our personal lives and colleagues, that hopefully the playing field can be leveled with appropriate mentorship. And with more than 50% of medical students being female, and I think that's really important, it will filter through, but it's about encouragement as well. And we still have a long way to go, I think. I think we are making progress, but I think there still is progress to be made. And that's quite important. And I'm going to go back to your heritage about the college, because we looked extensively at women in the college as well. And I think looking at that, and owning that, in fact, as Ross said, we had our first fellow in 1912, but there were two other women before that who tried and were refused. So it's round about how we frame that moving forward for now, and not forget just 100 years ago, what the struggle was. But I think, obviously, we've still got a lot of work to do, but we are making progress. Thanks, thanks both of you for that answer to my question. But the question itself, I know, was a bit kind of convoluted, and probably all over the place. But thank you. And I think the fact that we can have this conversation like tonight around Lister, and just because of the magnitude of his role, and a part of his story that's not spoken of as so much. And the fact that we can have that conversation about that, and link it to the current situation with women in surgery and medicine, and some of the issues there, I think is a good thing, you know, and I connect this to that history in a slightly different way to how people have connected to it in the past. And that's for me, as a heritage professional, is a really good thing. It makes that heritage more alive and relevant. And I think that's certainly what we want to do. And the other thing as well is about the way that heritage has been told in the past, the stories have been told in the past, you know, are not a kind of passive or neutral approach. You know, there's always an ideology behind how stories have been told in the past. And that's one of the things that we have to try and I think, address as well through this series of events, of reframes, where we're focusing on and addressing those inequalities. I just wanted to say, obviously, I've looked through a few books, so there's another few books as well, looking about women's history. Because Scotland obviously had quite a lot of female medical students very early on, obviously Ireland had the first licences, but in Scotland, we did start quite early on. So if anyone wants to hear about those books as well, I'd happily share them, because I've used them as a few reference points myself. I think it's really important that we do things like this tonight, Ross, and all of our reframed events, so people, please come and join us. But yeah, and using Lister as an example is really good as well, because obviously, he was such a famous character in our history. So it's really important that we continue to talk. I think the last thing I want to do is just to thank Marvin and Fiona again, so, so much for coming and taking part in the event tonight and contributing so much to it. I think it's really made the event worthwhile and relevant, and it really helps us move our heritage and what we do in heritage into a different direction, having these kind of conversations, which is so valuable. So thank you both again, very, very much. Our next reframed event is on the 25th of March, at the same time, 6pm, and we have Zandra Yeaman, who is currently the Curator of Discomfort at the Hunterian Museum at Glasgow University, and we're discussing David Livingstone and how Scotland presents the White Saviour Complex. So if you have a look at our website, you'll see details of that, and you'll be able to sign up for that. So that's the 25th of March at 6pm, and you'll be able to see more of that on Twitter as well. And if you want to see more of Marvin, the final Lister Week event is on tomorrow at half past 12. So if you go to the GRI website or GRI Twitter, you'll be able to get access to that as well. So I'm really looking forward to that one. Marvin's going to summing up the phenomenon that has been Lister Week. So thank you again, Marvin and Fiona, and thanks to the audience for joining us. And we leave you all to have a nice evening. Thank you.