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Content warning: This article may contain subject matter that some readers may find upsetting, including misogyny, discussions of non-consensual or coerced medical procedures related to women’s health, and medical abuse.

During the late nineteenth and early twentieth centuries it became common practice for female nurses to be present during pelvic examinations. This practice, which remains today, was (and is) intended to ensure propriety during the intimate examination. This was equally a matter of protecting the physician from false accusations of impropriety as it was a measure to protect female patients from potential abuse.

The compulsory medical examinations of the Contagious Diseases Acts (CD Acts) brought issues of consent, bodily autonomy, and medical abuse to the forefront of the Victorian political consciousness. As discussed in a previous blog post, a provision of the Contagious Diseases Acts of Britain (1864-1886) allowed police to compel women accused of prostitution to attend fortnightly vaginal examinations to search for signs of venereal disease. These exams, and particularly the use of the vaginal speculum during the exams, became a rallying point for the feminist-driven movement that called for the total repeal of the Acts.

The “repealers” formed various arguments against the use of the speculum which cast the tool as medically ineffective and unnecessary, physically painful, and morally corrupting for both patients and physicians. In much of their activism, the repealers depicted the male physicians conducting these examinations as cruel and licentious, possessing a “medical lust” for handling women. However, an article published on the cover page of an 1874 issue of The Shield, an anti-Contagious Diseases Acts journal published by the Ladies’ National Association, presents a surprising twist to this traditionally gendered narrative.

“THE TENDER MERCIES OF THE WICKED. TWO MORE CASES.”, written by an anonymous author presents the case of an unnamed widow, who following the sudden death of her husband, was traveling by foot to her parents in Cornwall. The woman stopped to rest somewhere in the district of Devonport and sought refuge in a boarding house occupied by other unnamed women. It was during this stay that the widow became the target of police who accused her of prostitution and demanded she attend medical examination at the Flora Lane inspection office. As the author recounts, the accusing officer threatened the woman and exaggerated the consequences of refusing to obey his orders. Out of fear, the woman attended an examination where, as the author describes, “[she] was examined by the State surgeon […], in the presence of ‘the thing in petticoats’ […] who is made undeservedly respectable by being called ‘the nurse!’” [1]

The “thing in petticoats” the author describes is an unnamed female nurse who attended patients and aided the military physician at the Flora Lane inspection office. Reportedly, as the widow “entered the surgeon’s den, weeping,” the attending nurse (or “thing in petticoats”) told her “not ‘to take it to heart so.’” While it may appear that this particular nurse was being singled out for her cruelty and dismissiveness toward her patients, the article in its entirety presents a surprisingly scathing attack on all the female nurses who participated in the CD Acts medical examinations.

[W]e ask what is the condition of a poor woman, pounced upon by a police-officer under these Acts, and by him bullied, cajoled, or threatened into the examination-room, where she is outraged by a surgeon with instruments of steel or glass, and where—may God forgive her!—a thing in petticoats (we deliberately refuse to call her a woman) stands by, looking on, and ready to assist the surgeon if the victim weeps, or struggles, or in any way shows unwillingness to submit to the “tender mercies” of the place? What is the position of such a woman? One of absolute helplessness and terror; a position that should never be possible; a position that should excite the greatest horror and indignation in the breast of every man and woman in the land, deserving of the name [2].

The above scenario laid out by the anonymous author begins by describing the circumstances in which a “poor woman,” like our unnamed widow, may be brought to the examination room. The repealers, who were themselves largely assembled from the middle and upper classes, emphasized a sense of sisterhood with the working-class and poor women who were depicted as victims of circumstance, being unjustly persecuted under the CD Acts.

Once inside the examination room, a woman is “outraged” (a word which implied an assault) by a surgeon with his “instruments of steel or glass;” a relatively accurate description of the tubular vaginal speculums popular with Victorian physicians at the time. It is during this violent act that the “thing in petticoats” watches the helpless victim, waiting for her to struggle or weep. This resembles other published accounts in which victims of the CD Acts described being held down or having their cries stifled with rags during examinations. While these accounts do not explicitly name nurses as the perpetrators of these atrocities, their complicity is certainly implied.

Explicit descriptions of physical pain and mental terror experienced by patients during their compulsory examinations became a common tool used by repealers to rally support against the atrocities of the Acts. Both men, who were brothers, fathers and husbands of potential victims, as well as women, who could potentially find themselves in such a position, were meant to be horrified by these graphic accounts and to place blame on the men responsible: the police officers who accused innocent women, the surgeons who performed the medical outrages, and the members of parliament who allowed the Acts to remain in operation. Blaming men in positions of power was an important tactic used by the repealers to help foster empathy for their “fallen sisters.” But the participation of a female nurse during these examinations presented a complicating factor to the gender politics at play in the repealers’ campaign.

The female nurse, therefore, had to be unsexed. Through her complicity in this system of male domination, the nurse was betraying her sex, making her no longer worthy of the name “woman.” In fact, as the author of “TENDER MERCIES” continues, because of her work, the figure of the nurse was no longer human: “We have nothing to say to mere bundles of clothes with something alive inside, possessing no more tender moral feeling than the most withered mummy in Romish or Egyptian catacombs” [3].

With this in mind, it is worth considering the historical context in which this anonymous repealer wrote their attack on the nurses attending to the often unwilling patients undergoing the speculum examinations required by the Contagious Diseases Acts.

As our anonymous author points out, by the late nineteenth century, nursing was increasingly considered a respectable profession for women. Just as the Crimean War (1853-1856) had provided the impetus for the passage of the Contagious Diseases Acts, it had also given Florence Nightingale the opportunity to demonstrate the need for professional nursing, resulting in the education of the first “Nightingales” and the further establishment of schools for nursing.

At a time when British women were barred from entering most professions and were unable to receive a formal medical education as physicians, there were complicated gender dynamics at play as they increasingly entered the medical field as a professionalized nursing force. The Victorians had complicated views on femininity that often cast women into dichotomous categories as the embodiment of the Madonna or the whore, purity or pollution. As women, nurses faced similar typecasting into the competing identities of the “ministering angel” or the Dickensian portrayal of the slovenly, incompetent drunkard, Sairey (Sarah) Gamp.

“TENDER MERCIES” refers to the attending nurse at Flora Lane as a “Betsy Prig,” another of Dickens’ nurse characters from the same work, The Life and Adventures of Martin Chuzzlewit (1843-44). The character of Gamp was described as an overweight, androgenous alcoholic, lacking any sense of professionalism, and while the minor character of Prig shared many of these traits, her character had what was described as a more “sinister” quality [4]. She was especially noted for her short-temper and physical roughness with patients. While Gamp was a “home nurse,” Prig worked primarily in hospitals perhaps suggesting that her additional cruelty came from working in the harsh environment of the mid-Victorian era institution. Repealers often discussed the negative effects that participation in the CD Acts speculum examinations could have on physicians. They suggested that continuous exposure to the barbarity of the instrument could desensitize them to the horrors of the examination process. In creating the comparison between the Flora Lane nurse and the character of Betsy Prig, perhaps this author was drawing a similar conclusion— that her exposure to the cruelty of the exams had made her a willing accomplice.

Interestingly, Florence Nightingale was herself an advocate for repeal of the Contagious Diseases Acts. She participated in the 1858 Royal Commission on the Health of the Army arguing that examining women only could not be an effective solution to combat venereal disease. Years later, she would sign her name to the first petition against the Acts included alongside the “Ladies Manifesto” published by the Ladies’ National Association at the beginning of the repeal movement [5]. While it is unclear if Nightingale ever publicly commented on the role of the nurses who participated in the medical examinations under the Contagious Diseases Acts, we can’t help but wonder how she would have felt. Were these nurses just doing their professional duty? Or had they become callous participants in a cruel system of male-driven medical domination?

Special thanks to Ian M. Fraser and Janine M. Schweitzer for their generous support of the 2023 Margaret Angus Research Fellowship.