Claire Fraser Becomes a Doctor: Medical Education and Developments from 18th Century Scotland to 20th Century America

Since the premiere of the Starz adaptation of Outlander in 2014, Diana Gabaldon’s series has become a global phenomenon. First published in 1991, the once niche group of readers has had to cope with sharing their love for Jamie Fraser with millions of other fans. My introduction to the series began with my friend’s insistence that a 600+ page book was worth reading. Although I was initially doubtful, I was eventually convinced to check it out at the library. Certainly there was something in her commendation given she could always be found sneaking in a chapter from under her desk while we sat next to each other in high school math class. Having read the entire core series of eight books more than once, the Lord John novellas, and Gabaldon’s recent short story collection, A Leaf on the Wind of All Hallows, I no longer question the value of my friend’s book recommendations.

At the forefront of the series is Gabaldon’s protagonist, Claire Beauchamp, whom readers get to know intimately through first-person perspective. Throughout the series she is defined by her integrity and compassion, which together translate into a career dedicated to healing. At the start of the story, Claire is a combat nurse during the Second World War. She supplements her knowledge of formal medicine through the study of botany and homeopathy, which later comes to use when she finds herself marooned in 18th century Scotland after time travelling through standing stones. A stranger both to the time and the country, Claire survives by the use of her wits and her sheer will to return home to her husband, Frank Randall. But fate has another path for her as she finds herself standing at the alter with a strapping Scot—Jamie Fraser—in order to escape the clutches of the depraved Captain Jonathan “Black Jack” Randall. The Outlander series shines as a passionate romance, but the true heart of Gabaldon’s work is her uncompromising faithfulness to historical fact and comprehension of holistic medicine. Together, these aspects comprise a captivating story and a believably perspicacious and multi-talented protagonist.

Claire(Claire Fraser played by Caitriona Balfe, Sony Pictures Television, Inc., 2014)

Claire’s surgical skills and ability to diagnose transcend time as she finds herself caring for the injured and ill in Britain during the 1940s, in Scotland during the 1700s, and finally in America as the country is involved in the Vietnam War. Of course, book readers know that Claire travels to America more than once, her second trip taking place during an entirely different conflict: the Revolutionary War. In this post, my aim is to explore the evolution of medicine in England, Scotland and the United States through the experiences of Diana Gabaldon’s fictional character, Claire Elizabeth Beauchamp Randall Fraser. Though the origins of certain medicinal practices differ, what remains largely the same throughout history is the sexism inherent in the field of science. Having worked as a nurse during a time where female intelligence was commonly overlooked, Claire is stunned when she is exposed to far more blatant condescension and misogyny in the year 1743. Despite the efforts to discredit her acumen in medicine, Claire preservers, which indisputably makes her a woman beyond her time—beyond all two centuries, in fact.

Nursing Training: London, England—1939-1945

Claire’s life in medicine begins at the outset of the Second World War. As men were called to lay down their lives in the fight, women, too, were called—by a sense of duty if not through a formal draft—to aid in the healing of the wounded. Within the first few pages of Outlander, Claire briefly refers to her training: “during the war years, I had, of course, lived in the nurses’ quarters, first at Pembroke Hospital, later at the field station in France.” 1 Traditionally, if a woman wanted to contribute to the war efforts as nurse, she would apply to a four-year program in which she learned the basic tenets of medical care, including how to treat diseases like Typhoid and Cholera, which ran rampant through military camps due to unsanitary conditions.

 

nurses(Dame Vera Lynn visits with English nurses in the Far East, 1944)

Claire was stationed in Amiens, which at the time was occupied by the Germans. Much like Claire, Margaret Ellis served as an army nurse during the war. In a story of her experience she writes:

Many of the reserves had been sent to France without careful selection in the first rush of troops. As the weather turned colder the troops succumbed to bronchitis and pneumonia. There were no antibiotics available in those days: we had to rely on M and B 693 together with kaolin poultices and inhalants. Not easy in tented wards during a very cold, severe winter. Then there was the mud. And the snow. Coal-burning stoves replaced the little Beatrice oil stoves, but these were of little use in cold, draughty tents.

I came home for ten days’ leave and then returned to France on a troop ship. I was the only female on board. I was taken to look all over the ship as we sailed to Cherbourg. This was on 10 May 1940, the day Hitler took Belgium and Holland.

We were moved into very large huts holding 100 beds, with three sisters as well as men from the Royal Army Medical Corps (RAMC) staffing the ward. Casualties were being sent down from the clearing stations to base hospitals. 2

France(Claire in France, Sony Pictures Television Inc., 2014)

My mental image of nurses during World War Two England involves women in white habits and clunky brown Dockers. Dr. Patricia D’Antonio writes that women were not always employed as combat nurses, though, which is unsurprising:

Ironically, war nursing had always been a soldier’s responsibility. Until the end of the 19th century, military orderlies, some with formal training but more with years of experience, cared for sick and wounded comrades in UK and US armies. War nursing, like that in disasters and the recurring 19th century epidemics of cholera, typhus, and yellow fever, demanded what was seen as the best of masculine characteristics—courage, strength, tolerance for the inevitable hardships, and a certain stoicism in the face of unnerving pain and suffering. 12

Female nurses were categorized by stereotypes. They were either “loving wives whose deep attachments to their sick or wounded husbands helped them to transcend their sex’s natural revulsion” or were otherwise desexualized and made into sturdy matrons who served out of spiritual duty. 12 It seems as if the achievements women garnered did nothing to excuse them from belittlement and pigeonholing.

Penicillin

In her autobiographical article, Margaret Ellis mentions that at the time she worked as a nurse antibiotics weren’t available; however, in 1928, Alexander Fleming, Professor of Bacteriology at St. Mary’s Hospital in London, had grown mold in a number of petri dishes. Soon after he discovered that the “zone immediately around the mold—later identified as a rare strain of Penicillium notatum—was clear, as if the mold had secreted something that inhibited bacterial growth.” His discovery wouldn’t evolve into an active treatment against bacteria—such as streptococcus or meningococcus—until 1941 when Howard Florey, Ernst Chain and their colleagues at the Sir William Dunn School of Pathology at Oxford University tested the curative solution, penicillin, on a living human being with an infected facial wound. Though he died during testing due to a lack of supply, subsequent patients proved responsive to the purified “mold juice.” Thereafter, scientists hoped to distribute penicillin to British troops and nursing staff. Sadly, the constraints of war made mass production impossible and, therefore, nurses were forced to treat with whatever means were available. 3

In the third book, Voyager, Jamie is shot in the upper arm. When Claire comes back to 18th century Scotland from 20th century America (there’s a lot of timey wimey things in Outlander that are sometimes better understood through reading the series) she brings back a vile of penicillin. Knowing full well the dangers of infection, often caused by debris and bacteria entering the skin, she promptly treats her husband, despite his trepidation:

I laid the small, flat case on the table and flipped the latch.  “I’m not going to let you die this time either,” I informed him, “greatly as I may be tempted.”  I carefully extracted the roll of gray flannel and laid it on the table with a soft clicking noise.  I unrolled the flannel, displaying the gleaming row of syringes, and rummaged in the box for the small bottle of penicillin tablets.

“What in God’s name are those?” Jamie asked, eyeing the syringes with interest. “They look wicked sharp.”

I didn’t answer, occupied in dissolving the penicillin tablets in the vial of sterile water.  I selected a glass barrel, fitted a needle, and pressed the tip through the rubber covering the mouth of the bottle.  Holding it up to the light, I pulled back slowly on the plunger, watching the thick white liquid fill the barrel, checking for bubbles.  Then pulling the needle free, I depressed the plunger slightly until a drop of liquid pearled from the point and rolled slowly down the length of the spike.

“Roll onto your good side,” I said, turning to Jamie, “and pull up your shirt.” 4

In the fifth book, The Fiery Cross, Claire takes medical innovation further by creating a mixture of penicillin that can be effectively consumed as broth. She tests her concoction on twin brothers who require their tonsils to be removed:

There was no way of knowing exactly how much penicillin there might be in the broth; I might be giving them massive doses—or too little to matter. At least I was reasonably sure that whatever penicillin was in the broth was presently active. I had no means of stabilizing the antibiotic, and no notion how long it might be potent–but fresh as it was, the solution was bound to be medicinally active, and there was a good chance that the rest of the broth would remain usable for at least the next few days…

“Oh, so ye can drink the stuff, can ye?” Jamie was eyeing me cynically over Josiah’s head. I had injected him with penicillin following a gunshot injury a few years before, and he obviously now considered that I done so with purely sadistic intent. 5

penicillin(Penicillin shot, S3E11, Outlander: “Uncharted”)

Physicians, Surgeons, and Apothecaries in 18th Century Scotland

The 1700s in Scotland heralded in the age of enlightenment, which embodied academic advancement and emphasized humanist philosophy. The principal goal among academics was to think beyond accepted dogma and develop medical practices that improved society as a whole. With such an ambitious objective, it was crucial that the physicians at the head of the movement were well-trained in a number of scientific sectors. Caitlin S. MacLeod and Ron A. Keenan write:

At the beginning of the century medical teaching was inconsistent. Whilst surgeons were able to serve apprenticeships, and attend the occasional dissection of a convict’s body, instruction for future physicians at Scottish universities was more variable (Hamilton, 1981). Courses could include Greek, Latin, theology, Hebrew, Syriac, mathematics, ethical philosophy, physics, dialectics and the logic of Organon (Aristotle). It was not until fourth year that students were exposed to physical science, involving medicine (Selkirk, n.d.). Consequently, it was quite usual for aspiring physicians to travel to the Continent to study medicine. 6

Indeed, it was common for medical students to receive a general education in Scotland before expanding their horizons on the continent. The actual education of men—for men were the principal healthcare providers in this age—was all inclusive: men were physicians, surgeons, and apothecaries all at once. William Cullen, a native Scot, for example, practiced all three. His contributions to the field were numerous:

In medicine he taught that life was a function of nervous energy and that muscle was a continuation of nerve. He organized an influential classification of disease (nosology) consisting of four major divisions: pyrexiae, or febrile diseases; neuroses, or nervous diseases; cachexiae, diseases arising from bad bodily habits; and locales, or local diseases. This system, which Cullen described in his work Synopsis Nosologiae Methodicae (1769), was based on the observable symptoms that arise from disease and that are utilized for diagnosis.

cullen(William Cullen, Art UK)

Much like the modern man of the 18th century, Claire finds herself assuming a number of seemingly conflicting roles throughout the series: midwife, surgeon, apothecary, and general physician. Even during her nomadic existence before the Battle of Culloden, Claire tests her skills as a dentist. Her impressive intellect and execution of contemporary medicine both impresses and terrifies the people of 18th century Scotland. For example, in Outlander Claire is nearly burned as a witch because the community believes she uses plants and herbs to poison and curse people. At one point, Murtagh comments: “it’s men think there must be ill-wishes and magic in women, when it’s only the natural way of the creatures.” 1 The belief that the natural way of women was cunning diminishes Claire’s efforts in science. Her patients are inclined to assume her knowledge isn’t the result of study and hard work, but that is has been gained through the use of magic. For example, in the Drums of Autumn one man is hesitant to accept treatment from Claire because he distrusts her sex:

“That will ease ye,” he said, nodding at the cup. “My wife made it; she’s a verra fine healer.”

“Is she?” The boy took a deep, trembling breath of the steam, and touched a cautious tongue to the hot liquid. “I saw her—do things. With the Indian who died.” The accusation was clear; she’d done things, and the man had died anyway. 13

torture(Example of a torturing technique used on women accused of witchcraft in 17th-18th Scotland)

Herbal Medicine in Scotland

What makes Claire all the more impressive is her quick judgement in times of crises. When not equipped with the convenient medicine, she relies on her knowledge of herbs, which at the time were referred to as “domestic medicine.” According to Vivienne Gabrielle Hatfield, during the 1700s “little appears to have been published concerning the actual domestic use of herbs in rural Scotland in the past, when medical assistance was available only to the few and most ailments were treated with home remedies. Even a knowledge of the herbals was a privilege of the relatively rich and well-educated.” 8 Therefore, Claire’s knowledge was a rare commodity. She showcases her skills quite early on in the first book when she treats Jamie’s wound: “I threw several cloves of peeled garlic into the boiling water with some of the witch hazel, then added the cloth strips to the mixture.  The boneset, comfrey, and cherry bark were steeping in a small pan of hot water set by the fire.” 1 Sir John Hill wrote a guide for anyone who didn’t have someone like Claire Fraser at their disposal. Of course, this was useful to anyone who could read and had the money to purchase books, and the first copy was published a little after the time in which the Outlander story takes place. His purpose in writing The Family Herbal was to educate the masses so “that they may be able to supply this necessary assistance in places where apothecaries are not at hand; and that they may be able also to do it without putting themselves to the expense of medicines of price, when the common herbs that may be had for the gathering will answer the same purpose.” 9

The family herbal(The Family Herbal by Sir John Hill, 1812)

Starz put together an interesting “Apothecary’s Cabinet” for  Outlander fans to explore.

Female Doctors in America During the 1950s-1960s

At the end of the first novel, Claire is forced to travel back to America at the outset of the 1745 Battle of Culloden. In 1955, after settling in Boston, Massachusetts, Claire eventually enrolls in medical school to become a doctor. In the television series, the audience sees Claire enter a lecture hall, and at once the entire male student body peers at her with mingled expressions of disgust and disbelief. According to data collected by Staff Care, “today, over a third of the [American] physician workforce (36%) is comprised of women, while 47% of medical school matriculants, 48% of graduates, and 46% of residents were female for the 2013-14 year.” However, in the 1950s women only made up 6% of the medical workforce. 10 Despite her position as a minority, Claire soldiers on and proves herself a critical asset to the Boston hospital where she eventually works. She eases into her position with the help of Joe Abernathy, who is similarly judged, but because of his race and not his gender: he is an African-American man and Claire is a woman, and they are each required to work harder than the average white, male doctor:

I had known Joe since the beginning of my medical training. He stood out among the other interns at Boston General, just as I did. I was the only woman among the budding doctors; Joe was the only black intern. Our shared singularity gave us each a special awareness for the other; both of us sensed it clearly, though neither of us mentioned it. 4

Joe.jpg(Joe Abernathy, played by Wil Johnson, meets Claire at a lecture, Sony Television, Inc., 2017)

Many developments in medicine occurred in America as Claire worked to become a doctor, and subsequently earned her degree and began a career as a surgeon. In 1957, the American Cancer Society commissioned a study that proved that smoking significantly decreases lifespan. In 1960, modern contraception became available to the public as the birth control pill was sold to married women. Two years later, the U.S. Supreme Court, in Robinson v. California, ruled that drug addiction should be classified as a disease rather than a crime. 11 These advancements signified even greater developments to come in medicine.

Claire, although a fictional character, represents generations of women with passions to escape the limitations of gender. While her insistence to continue in her vocation is admirable, women throughout history have found it necessary and, perhaps, safer to conceal their ambition. Like Claire, women of the past have doubtless been confronted with misogyny manifested as physical aggression or emotional abuse. Today, this prejudice has not disappeared entirely, and women are still fighting for a future where barriers based on sex no longer exist. As we work further to advance medicine and produce research that also benefits those who may not have access to healthcare, we must also recognize those aspiring practitioners who have long been undervalued and ignored.

You learn it when you become a doctor. Not in school—that isn’t where you learn, in any case—but when you lay your hands on people and presume to heal them. There are so many there, beyond your reach. So many you can never touch, so many whose essence you can’t find, so many who slip through your fingers. But you can’t think about them. The only thing you can do—the only thing—is to try for the one who’s in front of you. Act as though this one patient is the only person in the world—because to do otherwise is to lose that one, too. One at a time, that’s all you can do. And you learn not to despair over all the ones you can’t help, but only to do what you can. 14

Works Cited:

  1. Outlander by Diana Gabaldon
  2. “Tented Hospital: An Army Nurse in France” by Margaret Ellis
  3. “Discovery and Development of Penicillin”
  4. Voyager by Diana Gabaldon
  5. The Fiery Cross by Diana Gabaldon
  6. “Lessons from Yesterday: A Student’s Reflection on Scottish Medical Education” by Caitlin S. MacLeod and Ron A.Keenan
  7. Encyclopedia Britannica: William Cullen
  8. “Domestic Medicine in 18th Century Scotland” by Vivienne Gabrielle Hatfield
  9. The Family Herbal by Sir John Hill
  10. Women in Medicine: A Review of Changing Physician Demographics, Female Physicians by Specialty, State and Related Data
  11. Milestones for Health in America–1900s
  12. “Nurses in War” by Patricia D’Antonio
  13. Drums of Autumn by Diana Gabaldon
  14. Dragonfly in Amber by Diana Gabaldon

2 Comments Add yours

  1. Vera says:

    This was very interesting and insightful, thank you!

    Like

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