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At the beginning of the 20th century, almost all Australian women had full citizenship rights and access to secondary and higher education, provided they or their families had the financial means to attend school or university. The women who had led the campaigns and battles to achieve these rights were still active and inspirational for a younger group of women beginning to savour the new possibilities. These rights in themselves, however, conferred little economic power. Women, when they were in the workforce, were paid considerably less than men, in line with the prevailing assumption, enshrined in the Harvester Judgment ofthat the basic male wage should include a component for a dependent wife and children.
While this judgement undoubtedly freed many working-class women from the drudgery of low-skilled work and allowed them to care better for their families, it condemned single, independent women to harsh stringencies. For middle-class women seeking entry to the profession of medicine, however, the issue was not so much lower wages as entrenched resistance from the male guardians of its privileges, practices and institutions.
Women seeking to enter the professions, especially medicine, challenged a deeply conservative view of the social and economic order and of the roles and abilities of women. The men guarding access sought to control entry as fiercely and stubbornly as any guild of skilled artisans. In such conditions, almost any woman seeking to become a doctor was, until well into the 20th century, of necessity, a leader. Or more precisely, she was a pioneer in a long, drawn-out battle to gain access to all areas and levels of the profession, and even now the fight is not fully over.
While some of these pioneers took advantage of gaps in service provision to make satisfying careers of great public utility, the battles to achieve genuine equality of opportunity often blunted or diverted the energy of highly talented and energetic women- energy that might otherwise have been applied to developing the profession of medicine itself.
Only when women were securely entrenched in a particular area of medicine could they apply the equivalent drive of their male colleagues to developments beyond normal, everyday medicine. Paradoxically, the social and institutional obstacles placed in the way of women in the early years ensured that they would make some sort of mark in the world, disproportionate to their s. Those women who completed medical training at university were usually among the top performers in their class, Pioneer male seeks younger ambitious woman exceptionally determined. As pioneers they had to be.
It was not a path for the faint-hearted, or for the struggling student. Then there was the challenge of securing the essential hospital training to be fully professionally accredited and, beyond that, to become a specialist. Most were acutely conscious of multiple responsibilities- to their patients, to their profession and to women generally in their quest for access to all areas of medical and surgical practice.
They found multiple ways around the obstacles Pioneer male seeks younger ambitious woman their path and, in the process, pioneered new forms of medical service provision, especially in the area of women and children's health, and public health more generally, before gradually penetrating the full range of specialities. In retrospect, the first groups of women doctors broke down the overt barriers to their entry to the profession quite quickly; it was the more subtle and covert barriers that proved more tenacious. So it is that, over the century, the pioneering or 'transformational' style of leadership remained a necessity in some areas, while, in others, women were able to develop leadership or management styles appropriate to advancing the profession, particular areas of medicine or public health, or administering aspects of the health care system.
Becoming a doctor at the turn of the 20th century in Australia was not easy. A degree in medicine was the longest and, in terms of fees and income foregone, the most expensive course available at a university. And such a degree could only be undertaken at the universities in Melbourne sinceSydney since or Adelaide since Entry to university required matriculation, but only a handful of schools, most of them fee-paying, offered a full course to that level.
The course was challenging, and the expectations high. The young men whose families supported them along this road felt very entitled to the income, personal autonomy and social power associated with membership of a profession that closely guarded the entrance to its ranks. Of necessity they were usually from the wealthier classes, above average academically, and inclined to be socially conservative. Though medicine has a long history, the medical profession was still in the process of consolidating its modern form.
Over the course of the 19th century, new institutions and formal mechanisms for training doctors and regulating medical practice had been gradually created. A key development in the United Kingdom, with a natural flow through to the colonies in Australia, was the passage of the Medical Act ofwhich established the Medical Register, a public list of all recognised practitioners.
Over the same period of time, doctors had also largely succeeded in establishing medicine as a body of scientific knowledge and practice of unique social utility over and beyond its potential benefits to individuals receiving treatment. Major developments in the scientific basis of medicine and in clinical practice- not the least being anaesthesia and asepsis- led to improved outcomes for patients that, in turn, greatly enhanced the reputation, incomes and social power of doctors generally.
Women were not formally excluded from the register, but the prevailing assumption was that doctors were and should be male. These developments in medical practice were synonymous with modernity and progress-ideas that also encompassed greater access for girls to higher education and to participation in public life. In Australia, girls won admission to university in the s, but the medical schools balked. A host of objections, ranging from the impropriety of young woman looking at naked male cadavers to insufficient physical and mental stamina to undertake surgery, collapsed in Australia in the face of a few very determined young woman, but gaining the right to study in the medical school was only the beginning of a long road with obstacles encountered at nearly every turn.
Nevertheless, to the extent that women overcame these obstacles they have been publicly recognised and honoured almost disproportionately to their s practising medicine- at least until the last third of the century. The reasons for this lay partly in the women themselves and partly in the nature of the medical profession and its place in Australian society. Until recently, 'leadership' has received little explicit attention within the medical profession. In the contemporary context, much of the proliferating literature on 'leadership' is, at base, more about attracting doctors into the management of the highly bureaucratised and audited systems within which much health care is now delivered than considering the kind of transformational leadership that leaves a sufficiently ificant legacy for individuals to be celebrated and remembered by posterity.
Current discussions, which speak of 'doctors at the helm of change' and express dissatisfaction that 'the individual orientation that doctors were trained for does not fit with the demands of current healthcare systems' Chadiignore or oversimplify the developments in medical practice, public health services and the place of doctors within institutions that challenged and exercised many of them in the early years of the 20th century-and called for 'leaders'. It certainly overlooks a great of doctors- men and women- from earlier periods who can deservedly be labelled 'transformational'.
Such leaders, however, do not necessarily fit easily into the management paradigms that underlie much of the current discussion of leaders in medicine. Transformational or charismatic leaders see opportunities, take risks and demonstrate persistence and courage in the face of strong opposition. They are able to 'cope with change … set direction … align people to participate in that new direction' and motivate others.
Only recently has 'leadership' begun to be included formally in the medical curriculum. For much of the 20th century, the extent to which individual doctors became ificant leaders, honoured by their peers and posterity, depended more on opportunity and personality than training.
With the benefit of hindsight, it is possible to make assumptions about personality on the strength of achievement. The actions and achievements of leaders in the profession speak for themselves, even when they themselves were reticent or modest, or the personal record is sparse. While the practices and assumptions of medicine at the beginning of the 20th century were undoubtedly coded 'male', women doctors could not be denied the natural authority that went with their social ranking and their qualifications. Furthermore, as long as their s remained few, they constituted little real threat to the established order, either within the profession or in the community generally.
Indeed, they might well fill in some gaps where men preferred not to practise. So, given the barriers and level of resistance to women entering the profession, those women who succeeded in the first half of the 20th century were exceptional and, almost by definition, possessed what Jay Conger and J. In late Decemberthe influential Argus journalist Vesta, in her column 'Women to Women', declared that 'the natural leaders of women … are women. And already we have amongst us a very considerable body of women who are acting as leaders of more or less large groups of their own sex'.
These women, Vesta noted, 'have been forced to the front so often that they have gained confidence in themselves'. Vesta approved this response to 'what they have regarded as the call of duty', Pioneer male seeks younger ambitious woman above all, she argued, if women were to 'wield their power rightly', they must be 'guided and controlled by knowledge' 21 December, Twenty-five years later, this long-standing advocate of 'intellectual training for women' could look back with satisfaction on the of distinguished university graduates- foremost among them doctors- who had led the way in developing new health services, especially for women and children 23 January These women had taken up Vesta's challenge to be leaders of and for women.
Leadership in medicine generally can be exercised across a range of areas: institution building, clinical practice surgery, internal medicine physiologypathologyresearch, public health, administration, teaching and development of the profession. A survey of entries on women doctors in the Australian Dictionary of Biography ADB born in the last half of the 19th century reveals an extraordinary range of engagement across all of these areas, often by the same person.
Undoubtedly these women were pioneers, and have been honoured as such, but an emphasis on being the 'first' can undervalue the extent to which many of these women were 'leaders' in a broader sense- and would have been in any context. Pioneers display some of the characteristics of transformational leaders. They see opportunities and they take risks to blaze trails, but leaders bring others along with them and help to build new institutions or innovative practices and consolidate the newly revealed opportunities.
Women doctors, living embodiments of challenge to the status quo, combined a dual commitment to the practice of medicine and the enlargement of opportunities for other women to follow in their footsteps. They also understood that they were initiating changes that could not be fully effected in a single generation. The contemporary concern that poor women and children should have more access to doctors, and women doctors in particular, allowed a space for them to train and practise where male doctors did not already have a strong foothold.
As Hutton Neve neatly summed it up: 'Here was an untouched field of vital importance which women doctors alone could handle: and by their tact, sympathetic understanding and clear explanations they performed invaluable service' Hutton Neve, And, since philanthropy was viewed as the natural province of middle-class women, this element in the provision of medical care 'worked well to draw attention away from the fundamental subversiveness of all-woman or women-only enterprises', and dampen lingering objections to the very idea of women doctors Bashford, The clustering of women doctors in this area can be construed as a form of ghettoisation forced on them by the intransigence Pioneer male seeks younger ambitious woman a male-dominated profession but, for the women at the time, it was not only an area in which many of them actively chose to work Bashford,; Hutton Neve, As Rosemary Pringle observes, even at the end of the 20th century:.
Before formal training programs are set in place, it is often possible to walk into positions at short notice, to work without formal training, and to have a hand in shaping new occupational identities Pringle, Leaders can make the most of those opportunities, rather than founder on the obstacles.
The history of women in medicine in 20th-century Australia is a tribute to the singular of women who demonstrated this capacity. While a duty to offer treatment irrespective of capacity to pay and public advocacy are inherent in the ideals of the medical profession, the philanthropic underpinning of women's work in medicine remained especially ificant until well into the 20th century.
It helps explain the disproportionately large of women who worked in medical missions in outback Australia, India and other parts of the British Empire Bashford, and who sought with great courage and dexterity to find ways to serve on the front lines during World War I. Back home, the coincidence of philanthropic and professional needs led to institution building.
The Queen Victoria Hospital, founded in in Melbourne by eleven women doctors lead by Dr Constance Stone, provides a singular example of transformational and strategically acute leadership.
This lit a spark of ambition to found a similar institution in Melbourne that burst into full flame when she found, first, that private practice bored her, second, that there was a huge unmet need for services to indigent women and, finally, that women doctors desired such a hospital to further facilitate their training and subsequent practice, even though the general hospitals were no longer formally closed to them. This was a project that demanded fund-raising and management skills as much as medical expertise.
First Stone hosted the meetings that led to the formation of the Victorian Medical Women's Society, an important milestone in the professional development of women doctors, then worked closely with prominent suffragist Annette Bear Crawford to develop an ingenious fund-raising campaign to build a hospital. The vision, and its subsequent achievement, were attributed by all to the 'inspired leadership' of Constance Stone ADB ; Hutton Neve, A similar hospital was not founded in Sydney untilperhaps because greater resistance to the appointment of women doctors to public hospitals forced them to move to Melbourne, Adelaide or Brisbane to complete their hospital experience Hutton Neve, chs 13, The Sydney Medical Mission, conceived by Dr Julie Carlile-Thomas later Foxwho enlisted the financial support of Mrs Hugh Dixson and then gathered about her a large group of volunteer helpers, had served the charitable functions of the Queen Victoria Hospital, but Carlile-Thomas withdrew when she married in and the mission closed in as the of volunteers dwindled Hutton Neve, Then Dr Lucy Gullett ADBone of a younger generation of doctors, emerged as the transformational leader who quickly garnered enough resources including her own to establish the New Hospital for Women, which opened in January Renamed the Rachel Forster Hospital when it moved to Redfern init proved as necessary and as successful as its Victorian counterpart Hutton Neve, Like Constance Stone, the kindly, gregarious but decisive Gullett also founded a professional body, the Association of Registered Medical Women inand remained involved in the development of the hospital until her death in Another area of ificant leadership by women doctors flowed naturally from their engagement with the health of women and children, their ready perception of evident need and dogged determination to implement reform.
All of these activities required the characteristics of transformational leadership- an ability to visualise the essential lines of the required new services, and then to set about implementing them with the right mix of tact, forthrightness and determination that ensured success. Many of these women doctors revealed a talent for administration, financial management and political advocacy far beyond that required of an average doctor. The narrow gate through which they had passed to achieve their qualifications apparently ensured that they were by most measures unusually talented. Nowhere is this more obvious than in the difficulty of asing any of these early women doctors to one area of activity.
Leadership came easily to them wherever they saw a need. Helen Mayo ADB might stand as an example of their range and reach. The second graduate in medicine from the University of Adelaide, after varied experience overseas she set up in private practice, combining midwifery with the medical problems of women and children while also acting as honorary anaesthetist at the Adelaide Children's Hospital. Inshe was appointed clinical bacteriologist at the Adelaide Pioneer male seeks younger ambitious woman, where she established the vaccine department, and submitted her findings on biological therapy for the award of MD in the first granted to a woman in Adelaide.
ly, she had published an influential paper on infant mortality calling for a range of measures to improve ante-natal and post-natal care. She worked to see the implementation of these measures in institutions such as the School for Mothers' Institute and Baby Health Centre inwhich grew into the state-wide Mothers and Babies Health Association. Mayo remained honorary chief medical officer until her death inactively engaged in bringing to the attention of doctors and nurses the latest developments in birth control, gynaecology and children's welfare.
Inin close collaboration with social worker Harriet Stirling, and against some opposition, she also opened a small hospital for babies. Though it was taken over by the government for financial reasons, Mayo dominated its policy formation and development untilensuring that the hospital was at the forefront of assessing and implementing new methods in infant feeding Pioneer male seeks younger ambitious woman the prevention of cross-infection.
During the four decades when Mayo was most active, infant mortality in South Australia fell by 60 per cent- ample evidence of the need for work such as hers. During World War I, Mayo had acted as a demonstrator in pathology at the University of Adelaide and, fromshe was clinical lecturer in medical diseases of children while also working as a physician at the Children's Hospital.
During World War II, she came out of retirement to organise the Red Cross donor transfusion service and instruction in infant feeding. Mayo was also Pioneer male seeks younger ambitious woman in the development of the profession through bodies such as the Australasian College of Physicians and the Australian Paediatric Association, and for twenty years sat on the State Advisory Committee on Health and Medical Services.
Clearly, Mayo made a notable contribution in every possible avenue for leadership open to a doctor: institution building, clinical practice, research, public health, administration, teaching and development of the profession. Mayo also accepted the imperative to lead, not just within her profession, but with regard to women in general. Inshe was elected to the University of Adelaide Council- the first woman in Australia- where she remained until Like so many of the early doctors, Mayo was appointed an OBE, due recognition, even celebration, of her leadership at the time.
The sad ravages of World War I opened up some new opportunities for women entering the medical profession but a good of the newly opened doors soon closed again- even in areas like children's health, where outstanding women doctors like Annie Jean Macnamara ADB and Kate Campbell ADB had strong claims. As an undergraduate in the s in Sydney, she recalled how much she had learnt from the pioneers who were still active, and felt the role of woman in the profession was well established.
Wing's view was rather rosy. Women doctors remained largely confined to women and children's health, general practice and emerging areas such as rehabilitation. If anything, the pressures on women to concentrate in these areas were more powerful than ever. Women doctors were, as Bashford points out, largely co-opted by this set of ideas in which women were defined as 'mothers in an all-encompassing way', enveloping all aspects of their lives, 'not simply childbirth itself'.
This newly elevated 'motherhood' was also increasingly constructed as 'scientific', thus enhancing the possibility of representing women doctors as 'even more effective scientific mothers' Bashford, and It would be a mistake however, to see this concentration of women doctors in women's health as entirely regressive. As Mackinnon has pointed out, inherent in the actual practice of medicine in this area was a subtle but ultimately effective 'critique of state and society.
While rational motherhood often legitimated women's domestication, it also provided the rationale for smaller families, a new career structure for professional women, and improved a woman's power to negotiate within marriage' Mackinnon, Nowhere was this clearer than in the development of family planning services, and the demonstration effect of larger s of women occupying professional and managerial positions.
Drawn mostly from the conservative ranks of Australian society, and rather more inclined than other professional women to marry and have children of their own, many women doctors felt less need to niggle and scratch at the male-dominated areas of medicine when a challenging enough career was available in women and children's health.
The activities within the women's hospitals soon extended well beyond gynaecology and obstetrics.Pioneer male seeks younger ambitious woman
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