The images that women, especially in the middle classes, had of themselves were overwhelmingly the construction of men. Martha Vicinus suggests that the notion of the Perfect Lady is probably the best known. “Throughout the Victorian period, the Perfect Lady as an ideal of femininity was tenacious and all pervasive in spite of its distance from the objective situations of countless women.” Until the 1870s, this image was certainly dominant and its influence continued until the outbreak of the First World War and arguably beyond. It was a middle class or bourgeois view of the family and the woman's role within it: male breadwinner, dependent, home-based wife and dependent children. This paper seeks to unpack the notion of separate spheres, to understand what ideological principles lay at its core and to see how far it represented a social construct rather than the lived experience of most women. Essentially historians have to ask the question: how did men and women ‘see’ themselves and each other?
Female writers were at a major disadvantage as authorities on the female life cycle because of their lack of scientific training. Before the 1880s, women were largely excluded from the medical profession, except in secondary roles as nurses or midwives. The number of female doctors increased from 25 in 1881 to 101 in 1891 and 477 by 1911 but the overwhelming majority of doctors were male. Their religious beliefs, the medical education they received and the prevailing medical fashions conditioned even these women. Gynaecology remained a male specialisation, though the practices of the few women doctors consisted mainly of female patients and their children.
Contemporaries saw the nature of women in the nineteenth century in biological terms, expressed in the inevitable cycle of female life from menstruation to menopause. Different writers identified different phases and features of the female life cycle but the most important stages seemed self-evident. Birth and childhood were followed from the onset of menstruation by the years of puberty. Marriage was the social institution in which sexual experience and pregnancy were legitimated. Pregnancy, childbirth, nursing and child-care occupied the major functional period of a woman's life. The final part of the cycle was the process of ageing, the menopause and death. The personal and social significance of these developmental stages were not physiologically determined but socially constructed. This representation of women was the cultural invention of a particular time and place but was disguised as dogma and supported by the findings of biological, medical and other sciences. This represented ideological control, whose social function included the restriction of the social and economic activities of women in the public sphere. Science sought to define female ‘normality; and ‘deviance’. Many women accepted these arguments. They were used to justify a continuance of the status quo and formed an important focus for the anti-suffragist campaign in the decades before 1914. Lucy Cavendish, for example wrote in 1858 “Your idea that women’s absence of mental creative power is accounted for by their having so much of physical creation to do is splendid. Who can say how much of a mother’s mental power must go to a baby’s brain during those miraculous nine months, not to speak of all that she puts into the child during its first years…?” Henry Maudsley, an eminent psychiatrist, argued in 1874 that nature was given women a finite amount of energy and that this should be used in reproduction. To use this limited energy in other directions undermined their reason for being. Eliza Lynn Linton wrote in the early 1890s that “Be its pleasant or unpleasant, it is none the less an absolute truth --- the raison d'être of a woman is maternity. For this and this alone nature has differentiated her from man…this clamour for political rights is woman's confession of sexual enmity…No woman who loves her husband would wish to usurp his province…. It is a question of science...And science is dead against it. Science knows that to admit women -- that is, mothers -- into the heated arena of political life would be as destructive to the physical well-being of the future generations as it would be to the good conduct of affairs in the present...”
Analysis of female health, or more often female ill health, the notion of the 'conspicuous consumptive' played a central role in the economic and social evaluation and devaluation of women. Many doctors identified the stages of the female life cycle and women’s reproductive role as particular sources of ill health. An extreme view, expressed more often in America than Britain, was that woman's natural state was invalidism. Medical views were not, however, monolithic and their ambiguities arose from scientific ignorance and divided opinion. Sir Thomas Allbutt, consulting physician to the Leeds Hospital argued in 1884 that women were being systematically induced into sickness: “She is tangled in the net of the gynaecologists, who finds that her uterus, like her nose, is a little on one side…Her mind thus fastened to a more or less nasty mystery, becomes newly apprehensive and physically introspective, and the morbid chains are riveted more strongly than ever. Arraign the uterus, and you fix in the woman the arrow of hypochondria, it may be for life.”
Trifling maladies were magnified into chronic diseases. This produced a climate in which some women doubted their own physical capability. Lucy Cavendish wrote in 1858 “I think those who insist on ignoring their own weakness…are running counter to Nature’s clearest indications and are perverse in wishing women to go at men’s work until they drop, or at any rate till their poor babies and homes comes to grief.” This climate affected some gifted women. Beatrice Webb talked about her constant doubts about her health in her diaries. In October 1901, she wrote, “Then we moved to Saltburn. Here my mental health improved, but physically, I remained ill-at ease and constantly fatigued…then the morbidness took another turn. I was overtaken with a presentiment of disease and death: I had some mortal complaint, the heart, the kidneys, were probably diseased.” Later, in December, she commented, “This year has been the most unsatisfactory of my life since I was married. How far I must apportion blame between a bad state of physical health and a rotten state of mind, I cannot tell…Doubtless the ‘waste products’ accumulated by wrong feeding have had largely to do with it, stimulating activity in some organs and clouding the brain. Until I took to the rigid diet, the sensual side of my nature seemed to be growing at the expense of the intellectual…” George Eliot despaired over her “want of health and strength”. Less common was the use of the invalid state by women to serve their own personal ends. Florence Nightingale used sickness to isolate herself from her family so she could continue her professional work and Elizabeth Barrett employed sickness as a means of escaping complex family tensions. Women writers strongly attacked the infirmity theory of female health. Its absurdity was well illustrated in the great bicycle debate in the early 1890s when the threatened physiological perils of cycling for women were exposed as nonsensical: “Let it at once be said, an organically sound woman can cycle with as much impunity as a man. Thank Heaven, we know now that this is not one more of the sexual problems of the day. Sex has nothing to do with it, beyond the adaptation of machine to dress and dress to machines. With cycles as now perfected, there is nothing in the anatomy or the physiology of a woman to prevent their fully and freely enjoyed within the limits of common sense.... It was expected that women specially might be exposed to injury from internal strains and from the effects and shaking and jarring when riding on the roads. In practice, this has been found to be nothing but a bogey.... Already thousands of women qualifying for general invalidism have been rescued by cycling...” The decisive argument was statistical: women had lower mortality rates and lived longer than men. Medical books and articles on female health usually focused on the peculiar biological features of women, especially menstruation, maternity and menopause. The common health problems of men and women were a separate territory of mainstream medicine. Doctors recognised that the medical approach to women often had a preoccupation with the womb (hysteria) and its effects.
The debate over anaesthetics in the 1850s and early 1860s, especially in relation to childbirth was of importance in the medical redefinition of women. In late 1847 Dr. James Young Simpson, professor of midwifery at Edinburgh University used chloroform successfully as an anaesthetic and strongly argued that other doctors should follow his lead. Others were less enthusiastic and between 1847 and the mid-1850s a vigorous debate took place in the Lancet, the London medical journal. In 1853, Queen Victoria was given chloroform during the birth of her eighth child and the debate declined. Some mothers opposed it at first on scriptural grounds that justified pain during childbirth. Most women, however, welcomed this clinical innovation and according to Simpson “set out like zealous missionaries to persuade other friends to avail themselves of the same measure of relief”. The significance of the debate lay in an ideological shift justifying the subordination of women. The authority of the Church based on woman’s fallen nature that linked woman’s pain in labour to Eve’s sin was gradually replaced by a scientific representation based upon biological difference.
Gynaecological attitudes formed an important part of the debate on feminism, the New Woman and the crisis in gender from the 1880s. Feminism was seen by some as a threat to the nation with declining birth rates among the better-educated middle classes while remaining high for the poorest, least-educated sections of the population. Eugenics, the science of race improvement saw women largely as mothers or as citizens involved in race reproduction. The raising of good quality children was an issue of national importance. It would seal the fate of the economy and even of the British Empire. Lord Rosebery wrote in The Times in 1900, “an empire such as ours requires as its first condition an Imperial Race – a race vigorous and industrious and intrepid.” Female calls for the vote, expanded education, greater economic and occupational opportunities as well as control over property, children and their sexuality called into question the nature of male authority, the stability of the family and, by extension the future of the race. Women’s activities especially the struggle for entry into universities and the professions led to a fall in marriages and a declining birth rate. Emancipated women, it was believed would not marry or, if they did would lack the capacity or desire to have children. Others might neglect their children and husbands for a career outside the home. Arabella Kinealy, a eugenics doctor thought that modern women were “all nerves and restless activity”. Many politicians believed feminists needed treatment rather than rights, a view echoed by William Barry in 1894 when he wrote that the New Woman “ought to be aware that her condition is morbid or at least hysterical”. The English anti-feminist novelist Eliza Lynn Linton coined the term ‘the shrieking sisterhood’ to caricature women who spoke out in public for women’s rights. Arnold Ward warned in 1910 that giving women the vote would ‘incorporate that hysterical activity permanently into the life of the nation”.
The major problem in the late nineteenth century was a subdivision of medical practice in relation to women. Obstetrics included the study of childbirth, ante and post-natal care rather than simply the ‘art of delivering women in labour’. Gynaecology was the study of the physiological functions and diseases of women and in Britain was largely approached through surgery. Most female diseases, contemporaries argued, were caused by some disorder of the reproductive system. Medical definitions of acceptable behaviour for women were reinforced by the ultimate threat of surgical intervention to reshape the female body, if the female mind could not be disciplined. Dr. Barnes called it vivisection of the noblest kind. It was effective in treating some conditions but represented a dangerous model for gynaecological practice. In 1866, Isaac Baker Brown, a London gynaecologist, reported a number of successes in curing various illnesses through clitoridectomy, or the removal of the clitoris. About 600 such operations were performed in Britain between 1860 and 1866 but then ceased. Ten years later, Dr. Robert Battey urged the removal of healthy ovaries as the most effective treatment for menstrual difficulties and other ailments generally grouped under the heading of ‘manias’. Surgical solutions could be sought inappropriately for nervous disorders like hysteria or for socially unacceptable or deviant practices. This could mean the failure of a woman to perform her duties as wife and mother or a tendency to show an unwarranted and unwomanly interest in sex. Several distinguished doctors were appalled by what in 1895 Sir William Priestley, consulting physician to King’s College Hospital called ‘over-operating in Gynaecology’. Neither the British Medical Journal nor the Lancet supported women’s rights opposing women’s suffrage and the opening of the medical profession to women. In 1876, the Lancet stated,  “We believe women’s work is to console and support man, not to usurp his functions.” Both, however, opposed unnecessary intrusive surgery on women. For many feminists like the doctor Elizabeth Blackwell, the prevailing image was of women as vivisected animals. The Anatomy Act of 1832 and Contagious Diseases Acts of the 1860s shaped working class attitudes to the medical profession. The first requisitioned the corpses of the poor instead of hanged murderers for dissection by surgeons transferring the penalty from murder to poverty. The second allowed women to be dragged off the streets and examined to see whether they had venereal disease. Anna Kingsford, the first Englishwoman to graduate with a medical degree from the Faculté de Médicine of Paris was disgusted at how poor patients were treated: “Paupers are thus classed with animals as fitting subjects for painful experiment, and no regard is show to the feelings of either, it is not surprising that the use of anaesthetics for the benefit of the patient is wholly rejected. Even the excruciating operation of cautery with a red-hot iron is performed without the alleviation of an anaesthetic…” The only difference between rich and poor women was that the poor could not always expect to be anaesthetised or the comfort of her own home when she was examined or operated on.
The historiography of women as patients has, until recently been polarised. Medical histories highlighted clinical progress, the efforts of male doctors and the ways in which treatment benefited women. Modern feminists initially focused on the sexual politics of illness and the nature of intervention by the medical profession as part of the cultural subjection of women. Recent work has offered a more balanced perspective. It emphasises that women were not simply victims or male doctors merely oppressors and that co-operation between women, usually middle class and their doctor was quite common.
 Martha Vicinus ‘The Perfect Victorian Lady’, in Martha Vicinus (ed.) Suffer and Be Still. Women in the Victorian Age, London, 1980, page xi.
 This paper was given at a conference on women and politics at Reading University in August 2000 though much of it was drafted in 1999.
 For developments in the early modern period see Anne Laurence Women in England 1500-1750: A Social History, London, 1994, Sara Mendelson and Patricia Crawford Women in Early Modern England, Oxford, 1998, Jacqueline Eales Women in early modern England 1500-1700, London, 1998 and Robert B. Shoemaker Gender in English Society 1650-1850, London, 1998
 Christopher Lawrence Medicine in the Making of Modern Britain 1700-1920, London, 1994 is a good, brief introduction to the issue of medicine and its gendered nature.
 Lucy Cavendish to Mary Gladstone Drew, 27th November 1858, British Library, Add MS. 46235, fos. 239-40.
 Eliza Lynn Linton ‘The Wild Women as Politicians’, The Nineteenth Century, (30), July 1891, pages 80-82, 86.
 See in particular Lorna Duffin ‘The conspicuous consumptive: woman as invalid’ in S. Delamont and L. Duffin (eds.) The Nineteenth Century Woman, London, 1978, pages 26-56.
 British Medical Journal, 15 March 1884 quoted in H.D. Rolleston Sir Thomas Allbutt. A Memoir, London, 1929, page 87.
 Lucy Cavendish to Mary Drew, 27th November 1858 British Library, Add MS 46235, fo. 240 quoted in Anne Digby Making a medical living. Doctors and patients in the English market for medicine 1720-1911, Cambridge, 1994, page 277.
 Norman and Jeanne MacKenzie The Diaries of Beatrice Webb, volume 2 1892-1905, London, 1983, page 216.
 MacKenzie The Diaries of Beatrice Webb, pages 224-225.
 This is clearly evident in her letters: Sue M. Goldie (ed.) Florence Nightingale. Letters from the Crimea 1854-1856, Manchester, 1997 and especially in Martha Vicinus and Bea Nergaard (eds.) Ever yours, Florence Nightingale. Selected Letters, London, 1989, especially immediately after the Crimean War and in a letter to John Stuart Mill in 1867 where she says she is “an incurable invalid”. It is interesting to note that the nursing reforms for which she is remembered were seen by contemporaries as essentially ‘female’ and appropriate for a Victorian woman while her contribution to sanitary reform and as an unofficial government adviser, work in the ‘male’ sphere has been largely forgotten. Mary Poovey Uneven Developments, pages 164-198 examine the social construction of Florence Nightingale.
 W.H. Fenton ‘A Medical View of Cycling for Ladies’, The Nineteenth Century, (39), May 1896, pages 797, 800.
 What follows draws on Mary Poovey Uneven Developments, pages 24-50.
 Quoted in Digby Making a medical living, page 271.
 The writings of Elaine Showalter are of major importance on this theme especially her The Female Malady. Women, Madness and English Culture 1830-1980, London, 1987, pages 121-166 and Hystories. Hysterical Epidemics and the Modern Media, New York, 1997, pages 49-61.
 The debate on women and falling birth rates is best explored in Richard A. Soloway Birth Control and the Population Question in England 1877-1930, Chapel Hill, 1982, pages 133-158 and Demography and Degeneration. Eugenics and the Declining Birth Rate in Twentieth-Century Britain, Chapel Hill, 1990, pages 110-137. Simon Szreter Fertility, class and gender in Britain 1860-1940, Cambridge, 1996 provides a detailed statistical examination.
 Eugenics Review, 3, No 1 (April 1911) page 44.
 William Barry ‘The Strike of a Sex’, Quarterly Review, 179, (1984), page 312, quoted in Showalter Hystories, page 49.
 Quoted in Showalter Hystories, pages 49-50.
 Coral Lansbury The Old Brown Dog. Women, Workers and Vivisection in Edwardian England, Madison, 1985 provide a detailed analysis of the impact of vivisection on women in this period. It takes the antivivisection riots between feminists, working women and trade unions and medical students from London University that took place in Battersea in 1907 over the statue of a brown dog as its backdrop.
 Elizabeth Blackwell characterised Battey’s work as ‘the castration of women’ in her Essays in Medical Sociology, London, 1909, pages 119-120.
 Lancet, 16th October 1876.
 Ruth Richardson Death, Dissection and the Destitute, London, 1988 provides a detailed analysis of the 1832 Anatomy Act.
 Quoted in Edward Maitland Life of Anna Kingsford, London, 1913, volume 1, page 82.
 Digby Making a medical living, pages 259-279 provides an excellent summary of the historiographical debates through an examination of childbirth, surgery and invalidism.
 H.R. Spooner The History of British Midwifery 1650-1800, London, 1927 and J.M. Kerr et al Historical Review of British Obstetrics and Gynaecology 1800-1950, Edinburgh, 1954 fall into this category.
 Ludmilla Jordanova Sexual Visions. Images of Gender in Science and Medicine between the Eighteenth and Twentieth Centuries, New York, 1989, Ornella Moscucci The Science of Women: Gynaecology and Gender in England 1800-1929, Cambridge, 1990 and Roy Porter and Lesley Hall The Facts of Life. The Creation of Sexual Knowledge in Britain 1650-1950, London, 1995 examines the development of sexual and medical discourse.