Isabel Emslie Hutton

Isabel Emslie Hutton (1887-1960)                                               

 Introduction

I recently met someone at a conference who shares an interest in Isabel Emslie. I was struck by the fact that in conversation, she invariably referred to her as ‘Lady Hutton’. It is true that in later years, Isabel Emslie did indeed become Lady Hutton, but it made me pause for thought. I do not think of her in this way at all. I have been ‘living with’ Isabel Emslie for so long, it feels as though we have become friends. Much has already been written about her service with the Scottish Women’s Hospitals for Foreign Service, and it is that part of her life with which people are most familiar. I wonder how many people are aware that she was such a significant figure in the history of psychiatry?

As she led such an eventful and varied life, I have decided to divide the blog into different parts, the first focussing on life up till the outbreak of WWI and the second examining her subsequent life. There may be a Part III, too, who can tell? The main source used in this first part is Emslie’s own account of her life, which despite the title, expands far beyond ‘Memories of a Doctor in War and Peace’. This is supplemented by further sources listed at the end of the piece.

 Childhood and Youth

 Despite coming from a privileged background, (her father was Keeper of the Privy Seal of Scotland, and she was educated at Edinburgh Ladies College), Emslie’s upbringing was perhaps more grounded than that of many of her future colleagues. Her parents were religious, and they did their best to instil both humility and charity into their children. An illustration of this is that in childhood, Isabel and her three brothers were only ever permitted to keep one Christmas gift each out of the many they received. The others were sent to needy children.

The Emslie children also attended Sunday School to inculcate Christian values, but they giggled, teased and fought each other instead. Isabel was as guilty of this as her brothers. Instead of learning Bible passages they were all far more interested in the tea and cake that was served afterwards.

Despite this, when the Bible teacher invited them to accompany her on visits to ‘incurables’ in hospital, though her brothers showed no interest, Isabel was soon enthralled. She enjoyed being fussed over and praised by the patients as this was a new experience. Though her parents loved their children dearly, their love was framed in the old Scots Calvinist tradition which valued discipline and deplored vanity, and which believed that praising children might cause them to get ‘above themselves’. They were quick to criticise and reluctant to praise.

It was in accompanying her mother on visits to collect money for the church, that Isabel learned about life in the poor parts of Edinburgh. Instead of asking those she was visiting for a donation, her mother would instead slip them some cash in an envelope. Isabel met children who were ‘feeble-minded, paralytic or tubercular’ and through her mother’s example, she learned to see them as people rather than ‘unfortunates’, something that later stood her in good stead.

I can sniff in retrospect the sour odour that pervaded the houses as soon as the door was opened – a mixed bouquet of the washing of clothes, the cooking of broth, of dampness, of the unwashed, or that sweetish body odour due to undernourishment and unsuitable diet.

As a medical student, I was to meet these very people in the hospital wards, where they found no difficulty in speaking to me easily and confidentially as they felt that I understood their way of life.

Edinburgh University

 When 18-year-old Emslie announced to her parents that she wished to study medicine, unusually for the time they had no objections. She was simply told to do her best and to take things day by day. They were not a family who did drama, preferring to be pragmatic and to deal with issues as they arose. When Isabel concluded that on commencing her studies she would need to give up music and dance, about which she was passionate, her mother responded by saying that she could please herself, but in her opinion, it would be foolish. Isabel was later grateful for that advice, since maintaining these interests enriched both her own life, and that of her patients in the following years. She danced for relaxation, and ahead of her time, she introduced a programme of music therapy for patients when working in psychiatry.

When Emslie knocked on the door of Minto House, then the Women’s Medical School in Edinburgh, in 1907, she could not have known that she was unlocking the door to a world that would bring her joy, exasperation, challenges and untold adventure; a journey that would take her further from her prim upper-class Edinburgh upbringing than she could ever have dreamed.

Having passed the University Entrance Exams, and given her name, she became a student. The secretary doing the enrolment was probably quite insightful, as she advised Emslie that, in order to look older, she should wear her hair up and lengthen her skirts to the ankle. She accepted the advice and later wrote, ‘This style added years to my age and inches to my height; so a delicious sense of freedom and power filled me’. Although almost 40 years had passed since the Edinburgh Surgeon’s Hall Riot, when male medical students attempted to prevent the early women students (The ‘Edinburgh Seven’) from accessing the examination hall by manhandling them and pelting them with filth, the secretary must have known that many challenges still faced women students.

As Emslie was soon to discover, the atmosphere remained toxic for naïve young women.

 ‘If we were feminine in attire or demeanour or had the effrontery to wear high heels, a dizzy hat or the charming curls then in vogue, it was deemed that we could not be serious; worse still, it was deemed that we were too pretty or too nice to be studying medicine and this was considered even more devastating’ The plain dowdy women were…preferred, for the men could then hoot with laughter and label them all as freaks, jokes or monsters…It was apparently impossible…to be just an ordinary young woman.  The men seemed annoyed that an attractive women could stay the course.

 Sex and Gender Issues

On commencing training, Emslie quickly became aware of issues facing women in the medical sphere. She observed that though the physiology lecturers were assisted by brilliant women demonstrators, unlike the men, these women could never become lecturers or professors.  She was smart enough however to see that not all women made suitable role models for female students. This insight arose from observing a ‘Brilliant, distinguished and pretty’ lecturer who looked down on women students, believing that they were incapable of achieving the level of knowledge required.

In Materia Medica, (teaching about the therapeutic properties of drugs and other substances) the lecturer specifically warned the women against prescribing abortifacients, especially if they were to be medical missionaries. Every time abortion was mentioned, the male medical students would stamp their feet and cry ‘shame’ to which the lecturer would concur. Meanwhile, many of the women, including Emslie, had no idea of how abortion was induced, or even why this was to be discouraged. They were much too ashamed and intimidated to ask about the subject.

On seeing the body of a young woman in the dissecting room, unclaimed by anyone, Emslie asked about her. She was informed that the corpse was likely ‘a puir wee lassie of the streets’ but Isabel did not understand the implication that the girl was a prostitute.

Then, as now, sexual harassment was an occupational hazard. (As I write, women surgeons are currently protesting about being groped by men in the operating room) and on a botany expedition Emslie was unexpectedly grabbed and picked up by a male student who pressed her close to his body.  She was shocked, ashamed and angry at him and simultaneously horrified to discover that the experience awoke ‘strange new emotions’ in her.

In retrospect she was amazed that at the age of seventeen, she knew nothing of sex or passion.

‘Though we were aware of the facts of life, as to the technique of lovemaking and its import, we were complete strangers’.

She put this down to her Calvinist upbringing with its emphasis on ‘the maximum of Christian terror and the minimum of Christian love’.  Showing some of the insight of the psychiatrist she would later become, she believed that this would leave some people with a legacy of guilt and melancholia.

As a result of these new experiences Emslie began to question both the way she had been raised and the nature of the suffering that she now observed, and she stopped going to church. Her parents were unhappy about this, but they accepted the decision, her mother more so than her father.

Edinburgh Royal Infirmary

Her surgical experience was undertaken at Edinburgh Royal Infirmary from 1906-7 and much to the disgust of some of the men, she won the class prize for surgery – a case of syringes that would later accompany her during two World Wars. She graduated from being a Dresser to a Clerk, taking case histories, describing operations and making progress notes. The woman who became her own Dresser was Russian and from her, Emslie learned a little Russian history and language, something that later stood her in good stead.

Part of Emslie’s duties involved becoming a ‘chloroform clerk’. As an unsupervised 18-year-old she administered the drug in the same way as had been done by James Simpson. The only instruction she received was that it was better to give too much than too little. Sometimes the patient would stop breathing, and as she had to hold her face very close to the patient there was a danger that she too might fall asleep. Judged by today’s standards this seems dangerous and hair-raising, but it was how the young doctors learned, becoming self-reliant and capable.

A spell working in Casualty and in the Edinburgh Medical Mission Dispensary in the Cowgate introduced her to the reality of domestic violence and its effects. On Saturday pay day, both men and women would drink too much and there would be fighting in the narrow streets of the Old Town. Through this work she met The Salvation Army and the Roman Catholic Jesuits, and she marvelled at their humanity and their kindness towards these ‘sinners’, something that was in marked contrast to the upright judgementalism of her Presbyterian childhood.

This was followed by a placement of several months at the John Street Dispensary in Canongate, something that proved invaluable. Established by the Sisters of St Vincent de Paul, the physician in charge was Dr Alice Hutchison, who proved to be a great role model.

She was a wise and observant physician and merely to watch her examination of a nervous, ailing child said volumes…. Tiny and pretty, she dared to be feminine, and her red-gold hair and gay attire brightened the wynds of the Canongate. She was loved and trusted…and her mantle fell upon us students, so that our advice was followed with a confidence that was scarcely deserved. We went unmolested at a time the police walked the Canongate beat in couples.

 The doctors dressed their patient’s wounds, gave them medication, listened to their fears and when no priest of minister was available in times of mortal illness or death, they sometimes prayed with them. This last embarrassed Emslie but on being asked, she duly mumbled her way through the 21^st Psalm. She was even more embarrassed when the patient was hale and hearty the following morning, and she was credited for the ‘miracle’.

Alice Hutchinson taught them to listen to the patients and to their unburdening of sorrow, fear and pain. Though Emslie saw the value of this, her heart sank when patients asked about sexual matters, as she had not been taught anything about ‘marital hygiene’ and she had no idea what was normal in married life. She was frequently asked for something to end pregnancy, and she found the teaching she had received to ‘piously refuse’ and to warn women against harming themselves, inadequate. She saw the living and social conditions of these women and found it hard to just outright refuse.

In similar vein, she was uncomfortable when asked for contraceptive advice as it seemed inadequate to simply say to women that there must be no ‘cohabitation’. She had begun to recognise that men do not have a monopoly on sexual desire. It was these formative experiences that later led her to publish a book on ‘The Hygiene of Marriage’ in an effort to address some of the issues. (This was a particularly daring publication that colleagues warned her might be career-ending. In it, she addressed not only the basics of anatomy and physiology, but also the issue of sexual desire, and particularly scandalously, the woman’s right to sexual pleasure as well as instructions to men as to how this could be achieved.)

Following community experience, Emslie studied gynaecology. Though she enjoyed the lectures, she found the standard of practical teaching poor and she quickly became aware that the subject was treated as ‘second class’. Perhaps by then her mother was menopausal, as something the young Emslie felt very strongly about was the lack of any input on the subject. She was also interested in couples with an inability to conceive. She was particularly struck that in the teaching, the subject of male infertility was never mentioned. It was always the women’s ‘fault’.

She found a period in The Royal Maternity Hospital in Rottenrow in Glasgow particularly horrific. She was sent there for practical experience in obstetrics since there was a high ‘abnormal’ birth rate in the city. She was astonished that the women received neither sedation nor pain relief, ‘as was now the norm in all the best hospitals’ and the first labour she observed was a protracted one that caused distress to the students who were present, as well as to the woman delivering.

This further tested her beliefs. She linked the denial of pain relief to old religious attitudes that held that it was necessary for a woman to suffer in childbirth. She was horrified that in the case of an unmarried woman, neither pain relief nor reassurance was given, ’in order to teach her a lesson’.

After delivering 20 women in their own homes in Glasgow, Emslie marvelled at their fortitude in the midst of poverty and squalor. Deprivation, anxiety about unemployment, housing and money were all-pervading, Overcrowding was common, and mothers feared incest among their children since they saw and heard sexual activity at an early age. This experience was overwhelming and though her childhood experience of visiting poor families had taught her how to communicate, and Alice Hutchinson had taught her to be a good listener, generally she felt unsupported, as the students were left to sink or swim according to their lights.

Life did not get any easier on her return to Edinburgh, as Emslie found further challenges in caring for those with venereal disease. There was a conspiracy of silence in the medical profession about the subject. Patients were never told their diagnosis. They were treated with mercury vapour which slowly poisoned them, and the side-effects were such that they usually gave up the treatment. Some appeared cured and they returned to sexual life spreading the disease to partners and children who bore the stigmata of congenital syphilis. Others who were afflicted developed General Paralysis of the Insane.

Much as with the unsympathetic treatment of unmarried mothers at Rottenrow in Glasgow, male surgeons in Edinburgh disliked having to deal with patients with venereal disease, and the women doctor’s presence embarrassed them so there was a ‘general air of hostility’.

Everything combined to make these occasions as repellent and shameful as possible. The theatre was a bare brown room with a rough wooden floor and the patients were examined on old deal trestle tables. The women wore long ugly uniforms, their hair was plaited and looking ill and degraded and hopeless, they dragged themselves in like mediaeval prisoners.

Some were prostitutes, some weaklings or mental defectives and a few were honest wives wondering why they found themselves in the ‘Lock Wards’ situated in the attics of Edinburgh Royal Infirmary and segregated from the world.

These experiences brought a realisation of the injustice that many women face simply by virtue of being women. Much later, she noticed that she had neatly underlined notes she made at the time, in green and purple. This was the period she became sympathetic to the militancy of the women’s suffrage movement despite being barred from taking part.  (It seems that Edinburgh medical students were officially banned from becoming suffragists and suffragettes, though we have plenty of examples of qualified women doctors who became suffrage activists).

The County Asylum in Stirlingshire (Also known as Stirling District Asylum, Larbert and later, Bellsdyke Hospital)

 

Stirling District Lunatic Asylum (also known as Larbert Asylum) was a psychiatric hospital which opened in 1869. It had originally been the local Poorhouse.

Twenty years later in 1889, when Dr John MacPherson was appointed Superintendent, he disapproved of the attitude that regarded residents as state prisoners and he pushed for them to be regarded as patients instead. He insisted that the wards be painted in soothing colours, and that there should be a dignified attitude towards clothing and hygiene.

 After a short period studying infectious diseases, something that she had no idea would later figure so highly in her life in Serbia and Russia, Emslie moved to the County Asylum to study ‘Insanity’. Her first impression was one of surprise.

The patients… convinced us that the popular conception of mental illness was a very false one, for we saw, instead of dangerous lunatics, sad, timid and frightened people. There was nothing in their behaviour that could not also be observed in the sane caught in temporary moods of sadness, tearfulness, despair, undue hilarity, garrulity, rage or sulkiness, though such phases in the insane were prolonged, whereas in the mentally healthy they were ephemeral…

 She was impressed that the hospital was run as a sanitorium, and patients were neither locked up nor restrained. Padded cells and shackles were seen as failure and an easy way out of dealing with challenging behaviour. The patients were well fed and many of them worked on the hospital Home Farm. Refreshingly, she found no hostility towards women doctors. She later declared that the experience taught her much about living with and accepting all kinds and conditions of people.

While most of her colleagues spent the summer working for final exams, Emslie worked on the wards and became progressively more fascinated by the psychological aspects of illness.

That she was able to work all summer while others were studying and yet still successfully graduate MBChB in 1910, tells us much about her formidable intellect. Now she faced the challenge of getting a job. While the men had no problem, it was much harder for the women. Major teaching hospitals were closed to them, and only unpaid posts rejected by men in industrial towns or in the Highlands were on offer.

Revealing both irritation and humour, Emslie wrote

 Conditions in those outposts could be gruelling and occasionally such that the unfortunate doctor was practically forced to swim to her patient through storm and tide, firmly gripping her medical bag in her teeth like some great St Bernard dog.

 Fortunately, her enthusiasm for psychiatry stood her in good stead, and she was offered a post at the Stirling District Asylum. This involved doing lab work, and she was to live in with a salary of £100 per annum. This made her financially independent, and her parents were very proud of her accomplishments.  Her mother was said to be a feminist who supported women doctors, and she ‘readily demolished the arguments of those who professed that they would rather die than be seen by one’.

Emslie wanted to thank her parents for their support by assisting in the education of her three younger brothers and with this in mind, and in an effort to increase her earning power, she embarked on a Higher Degree, achieving her Doctorate with Honours at the age of 24.

Meanwhile, a new Chief Medical Officer was appointed at the asylum and his coming heralded a new regime. He introduced strict rules about staff fraternising. Medical staff were to travel First Class to avoid mixing with nursing staff, and they were forbidden from being absent overnight or at weekends. They were also not permitted to mix with local people. Despite this. Isabel Emslie and the Matron became friends. They not only discussed the patients, allowing Emslie to relate her laboratory studies to the clinical condition of the patient, they also socialised together.

The hospital was considered advanced in that nurses required not only to be trained in psychiatry, but in general nursing. Emslie admitted that though ‘the Chief’ was not a devoted psychiatrist, he was excellent when it came to physical care. The patients had good food, flowers in the wards, and a beautiful garden with cricket pitches and tennis courts. Convalescent women in particular, benefitted from the rest so often denied them due to large families and poor living conditions.

Emslie was very aware that the social conditions of the patients affected their illness. The giving of contraceptive advice remained taboo, so on returning home women patients were soon pregnant again, exacerbating or precipitating a return of their mental illness. Men frequently discharged themselves early through fear of becoming unemployed..

Emslie appreciated the quality of the nursing staff but deplored that their wages were so low, though their living conditions were relatively good. The previous ‘Chief’ had ensured that a comfortable nurse’s home was built, with individual study bedrooms. Nurses of both genders worked in the hospital and they organised social events for the patients such as dances and concerts, often attending them too.

Her own lab, mortuary and post-mortem room made up Emslie’s work domain. She had noticed that that the balance of white blood cells was disturbed in certain psychiatric conditions and her MD thesis was on the Wasserman Reaction in the Blood and Cerebro-spinal fluid of patients with General Paralysis of the Insane. (Advanced syphilis of the brain). The Wassermann Test was regarded as a major breakthrough in early diagnosis of syphilis, though it was later shown to produce false positives.

Isabel Emslie was an ambitious young woman who wanted to advance in her career, but on discussing how she might achieve this with her superior, he responded by saying that women should never be promoted, and it would be absurd for a woman to be a medical superintendent as other doctors would revolt. She was hurt and angry at his response.

Disenchanted, she applied for a Resident post at the Royal Sick Children’s Hospital in Edinburgh (at that time a known male preserve). She was amazed to be given the job, though it was an honorary post with no salary, so she had to live on her savings.

The Royal Sick Children’s Hospital, Edinburgh.

 Most of the children in the hospital had illnesses resulting from poor diet and living condition. Pneumonia, gastro-enteritis, rickets, and marasmus (malnutrition) were common. Children with developmental issues had little treatment. Their mothers were just expected to take them home and cope.

Her passion for surgery was rekindled during her time at the RSCH and Emslie spent every available hour watching operations and imbibing ‘much that was to help her during the war years’. During her time there, Dr Charles Mayo visited the hospital and she was the first British person ever to be offered a post in the Mayo Clinic. At the same time, Dr Robertson, her first ‘Chief’ at Stirling, offered her the post of Physician in Charge of the women’s wards at the Royal Mental Hospital, Morningside. (Later the Royal Edinburgh Hospital.) This position was also a ‘first’ in that it had never previously been held by a woman.

After much consideration, she accepted the job at the Royal Mental Hospital.

The Royal Mental Hospital Edinburgh (later known as the Royal Edinburgh Hospital)

 On commencing her new post, Emslie found that some of the patients were nursed on the verandas in sanitorium conditions. The atmosphere was compassionate with an emphasis on recovery and rehabilitation. Some of the domestic and secretarial staff were ex-patients.

The institution was not run for profit and the patients paid about £50 a year. ‘Gentlefolk of slender means’ were assisted with the fee through a Samaritan Fund.

Dr Henry Yellowlees was her counterpart on the male wards, and they had a team of Final Year Students to assist. This young team all got on well and they had fun as well as working hard. They enjoyed such events as bicycle races in the corridors, and arranging concerts for patients, something that would never have been tolerated at Stirling.

A growing awareness of the work of Freud and Jung meant that following the acute phase of their illness, psychotherapy was commenced with many of the patients. The Chief Medical Officer was in favour of it, despite facing opposition from other leading psychiatrists who thought it ‘disgusting’.

Emslie was so engrossed in this work that she was oblivious to the growing crisis in the world. Even when Franz Ferdinand was assassinated, it did not impact on her consciousness, till suddenly on 04 August 1914, the world was at war. Many of the nursing and medical staff enlisted, including Dr Yellowlees, and Emslie was left in charge of both the female and male acute units.

She was initially told that she could not be spared, but once retired medical staff had returned to service, to replace those who enlisted, Dr Robertson consented to her going and 26-year-old Emslie joined the Scottish Women’s Hospital for Foreign Service.

Emslie recognised that her motives were mixed as not only did she want to serve, she wanted to experience the thrill of doing war surgery in different countries.

In August 1915, laden with knitted gifts from the patients, she donned her uniform and in the unsentimental way of her Calvinist family, she said goodbye to her parents on the telephone, and headed for France.

Resources

The Hygiene of Marriage (1929) Isabel E. Hutton

The Hygiene of The Change in Women (1936) Isabel E. Hutton

Mental Disorders in Modern Life (1940) Isabel E. Hutton

Memories of a Doctor in War and Peace (1960) Isabel E. Hutton