Colonizing Childbirth: The Adoption of Western Obstetrics in Hong Kong (1842-1910)

KANG Jong Hyuk David¹

1. The Education University of Hong Kong

OPEN ACCESS

PUBLISHED: 31 March 2025

CITATION: KANG, Jong Hyuk David. Colonizing Childbirth: The Adoption of Western Obstetrics in Hong Kong (1842-1910). Medical Research Archives, [S.l.], v. 13, n. 3, mar. 2025.  Available at: <https://esmed.org/MRA/mra/article/view/6303>. Date accessed: 17 oct. 2025. 

COPYRIGHT: © 2025 European Society of Medicine. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

DOI: https://doi.org/10.18103/mra.v13i3.6303.

ISSN 2375-1924

 

Introduction

In 1835, medical missionary Dr. Peter Parker established the first Western medical clinic in Guangzhou, introducing Western medicine to China. This group of early Protestant missionaries viewed Western medicine as a platform for entering China and a key to unlocking its doors: “When Western cannons could not lift a beam, he opened China’s doors with a scalpel.” Following the British victory in the Opium War, Western imperialism formally expanded in China, bringing not only political and economic exploitation but also significant impacts on Chinese traditions and culture. However, obstetrics remained an area where Western medicine struggled to penetrate China during the 19th century.

There has been considerable academic research on the history of obstetrics in China. As early as the 1980s, Charlotte Furth examined the social significance and cultural symbolism of childbirth during the Qing Dynasty. She later delved deeper into the evolution of obstetrics following the Song Dynasty, focusing particularly on the discourse surrounding women’s bodies, childbirth culture, and technological changes through the lens of “blood” theory. Her work highlighted the intricate connections between medical practices, cultural beliefs, and gender dynamics in historical contexts.

Francesca Bray analyzed the changing roles of women in childbirth while researching women’s contributions to technological development in China, examining the effects of the specialization of midwifery on Chinese society and women from various angles. Angela Ki Che Leung discussed women’s roles and social status, including midwives, within pre-modern medical practices. Recently, Yi-li Wu has also focused on midwifery during the Ming and Qing Dynasties, analyzing women’s childbirth behaviors from social, cultural, and medical perspectives.

Another group of scholars has examined the development of Western-style obstetrics in China during the late Qing and early Republican periods. Ka-che Yip analyzed the discourse on institutionalizing obstetrics within the public policies of the Nationalist government in his monograph. Zhou Chunyan explored how Western medicine challenged Chinese gynecology and obstetrics after the First Sino-Japanese War, as well as the role of the government in this process. Tina Johnson analyzed how modern medicine and technology influenced perceptions and cultural practices surrounding childbirth in modern China, as well as how government intervention transformed the professionalism and environment of midwifery. However, these works primarily focused on the impact and political significance of 20th-century Western obstetrics on Chinese society, neglecting to investigate the process through which Western obstetrics entered China in the 19th century. This oversight has created a disjunction between studies of traditional Chinese obstetrics and discussions of Western obstetrics’ development in 20th-century China.

In the research of missionaries, Sara Tucker and Connie Shemo have mentioned the issues surrounding Western medicine and Chinese women’s healthcare. However, they have not conducted an in-depth analysis of obstetrics as a unique medical domain. Hsiuyun Wang has pointed out that in the 19th century, many non-Western contexts, including colonial and semi-colonial China, were often constructed as backward and uncivilized, with “women oppressed by tradition” being a significant component of this construction, often serving as focal points for the civilizing missions of imperialism and nationalist discourses. In reality, when male-dominated Western medicine encountered the gendered body politics of Chinese women in the 19th century, both sides engaged in various levels of negotiation and concession. Women adopted various strategies to overcome gender barriers when seeking Western medical treatment, such as consulting male doctors through intermediaries like mosquito nets, maids, or dolls. However, unlike other branches of Western medicine, childbirth required immediate hands-on intervention from physicians, necessitating direct observation and

contact with women’s intimate areas. Thus, medical missionary Mary Brown reflected, “Indeed, many Chinese women sought male doctors; however, there were still areas they could not treat.” Obstetrics exemplified this “untreatable area.”

After the Opium War, Hong Kong officially became a British colony in 1842, establishing it as a distinctive locale where Eastern and Western cultures intersected. Initially, the colonial government adopted a laissez-faire medical policy towards the Chinese population. The government established the Civil Hospital, primarily aimed at providing medical services for European residents in the colony. Scholars Gauld and Gould pointed out that the colonial administration in London showed little interest in providing social services for Hong Kong. As a result, few Chinese people sought medical care at the Civil Hospital. The primary reasons for this avoidance included unfamiliarity with Western medicine—both in terms of medical practices and the hospital environment—and the high costs associated with treatment. This sense of alienation from Western medical institutions contributed to the persistence of traditional medical practices within the Chinese community, including childbirth, where cultural familiarity and lower costs made local remedies and practitioners more accessible. This dynamic reflected broader societal tensions between colonial authority and the lived realities of the colonized, illustrating the complexities of healthcare in a colonial context.

This paper will examine the development of Western obstetrics in Hong Kong to explore the impact of colonial medicine on Chinese childbirth practices. This paper contends that when Western medicine became a crucial rationale and tool for cultural imperialist aggression in the 19th Century, obstetrics proved to be a relatively “unsuccessful” domain, as Western midwifery practices failed to become mainstream in Hong Kong. To overcome this barrier, Western medicine made compromises in terms of “gender politics” and “medical spaces,” allowing Western obstetrics to become one of the options for Chinese women during childbirth. This process of compromise also indirectly transformed the gender politics of the Western medical community, fostering the emergence of female doctors in the United States and Europe, while providing Chinese women opportunities to participate in medical affairs, allowing them to take on roles as doctors and nurses, leading to the official implementation of maternity regulations by the colonial government in 1910.

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Obstetrics and Culture: Eastern and Western Practices

According to European obstetric traditions, prior to the 16th century, the majority of childbirths were attended by midwives, who predominantly came from the lower social classes. The rise of anatomy during the Renaissance provided men with a deeper understanding of the female body. However, male doctors were still unable to breach the domain of midwifery, as childbirth remained the purview of women and midwives in domestic settings.

In the 16th century, France began to see male doctors take on a leading role in the training of midwives. By the 17th century, physicians had more opportunities to observe childbirth, leading to the publication of various obstetric texts across Europe, and the medicalization of childbirth began to take shape. At the same time, male midwives emerged in European cities, partly due to upper-class women seeking to emphasize their social status by choosing male attendants. However, the acceptance of male midwives varied by city; for example, they gained acceptance in Paris earlier than in London, while most lower and middle-class families continued to rely on female attendants for childbirth.

Subsequently, male involvement in midwifery persisted, culminating in the 18th century with the development of obstetric instruments like forceps and discussions regarding relevant techniques (Forceps were developed by the Chamberlen family in London in the seventeenth century, but they were not publicly used for nearly a century).

only male midwives or doctors were permitted to use forceps, paving the way for men to access the most intimate aspects of women’s bodies and to intrude into the space of childbirth. Although the profit from midwifery was not exceptionally high for male doctors, it represented a significant market, as the families of postpartum women could become their clientele. Consequently, while female midwives were not entirely replaced, they gradually found themselves squeezed into subordinate roles, with their status in the field being redefined.

As childbirth practices became increasingly dominated by male physicians, the act of giving birth began to be “medicalized.” This medicalization was facilitated not only by advancements in obstetric techniques but also by evolving European societal perceptions of women’s bodies, leading to the development of obstetric theories. Male-led anatomical studies had begun to influence Europe, and scholars from various fields started to emphasize the differences between male and female bodies. Anatomists no longer viewed women as merely imperfect men; the emerging categories of male and female were biologically opposed—thereby regulating women’s social spaces and underscoring their subordinate status. For instance, scholars in the 17th century pointed to distinctions in the brain structures of women and men, claiming that women’s intellectual capacities were limited. By the 18th century, gender differences continued to dominate the development of European medicine, with women being perceived as physically and mentally vulnerable and labeled as “pathological,” including a greater predisposition to mental health issues. This period also witnessed the gradual emergence of gynecology as a specialized field in Europe. Within this framework, the process of childbirth was regarded as a high-risk endeavor, akin to a state of illness, leading to the medicalization of midwifery and emphasizing the importance of medical assistance during childbirth.

To mitigate maternal mortality, British physician Charles White highlighted the significance of “cleanliness” in his work, Treatise on the Management of Pregnant and Lying-in Women. This focus resulted in a gradual shift of childbirth from home settings to hospitals, further institutionalizing the birthing process (before the eighteenth century, the primary clientele of obstetric services in hospitals were the lower social classes who had no homes or could not afford the costs of childbirth). Additionally, in the context of the Enlightenment, many European governments became involved in public health matters, formulating obstetric systems and regulations.

Ironically, although some upper-class women opted for hospital births to alleviate the pain and risks associated with childbirth, the safety of mothers and infants in hospital settings during the 19th century was not guaranteed. With the medicalization of childbirth, doctors tended to intervene more actively in the birthing process, employing popular obstetric tools of the time, such as forceps and anesthesia. Forceps became a symbol of male authority, while anesthesia was celebrated as a significant invention in 19th-century European medicine. Judith Leavitt noted that in the records of hospital births in the United States during the 19th century, approximately half of the cases involved anesthesia. However, improper use of forceps (in terms of technique or timing) could harm both mothers and infants, and anesthesia posed its risks, whether through chloroform or ether, as there were no guidelines for dosage, making childbirth hazardous. Furthermore, hospitals in Europe still experienced outbreaks of puerperal fever, leading some scholars in the mid-19th century to advocate for the abolition of hospital maternity wards.

In China, records of knowledge related to childbirth can be traced back to the Warring States period, highlighting a rich history of understanding and practices surrounding pregnancy and childbirth. One of the most significant texts from this tradition is the Huangdi Neijing 黃帝內經 (Yellow Emperor’s Inner Canon), which includes various discussions on pregnancy and childbirth.

Charlotte Furth argued that truly “gendered” medicine did not emerge until the Song Dynasty. Lee Jen-der’s research indicates that there were significant discourses on the “female body” during the Tang Dynasty. Yates also posited that the discussions regarding women’s health in the Tang period profoundly influenced the Song Dynasty. During this time, the female body was increasingly alienated, leading to gynecology being recognized as a specialized field.

Childbirth was viewed as a contact with pollution, rendering it a “gendered” act predominantly led by midwives. Furth even notes that the obstetric knowledge of male doctors in the Song Dynasty derived from midwives. Although the social status of midwives declined after the 13th century, positioning them among the “three aunts and six mothers” who were often disparaged, scholarly critiques primarily targeted the ethics of midwives rather than questioning their technical skills. Moreover, unlike in Europe, critiques of midwives were not aimed at abolishing their roles. Given that childbirth was considered polluting, many Confucian physicians were reluctant to participate in the birthing process, with men only willing to intervene in emergencies.

According to the studies by Furth and Wu Yili, during the Ming and Qing periods, Confucian physicians no longer emphasized the differences in the female body beyond physical imbalances during childbirth. They ceased viewing childbirth or gynecology as unique diseases or ailments. Within this framework, Confucian physicians found justification to further discuss women’s bodies and childbirth techniques based on the theories of qi and blood. This was one method through which these male practitioners established authority, allowing them to deepen their understanding of the female body and exert a certain degree of power over childbirth theory. The process of childbirth was not deemed pathological but instead framed as a state of fragility or imbalance post-delivery, which could lead to harm due to negligence on the part of midwives or family members, necessitating the use of herbal remedies for recovery.

With the development of printing technology in the 18th century, there was a surge in publishing opportunities and a growing readership, leading to the emergence of numerous medical texts in the late Qing period, including many popular books on midwifery. These texts were aimed at laypeople rather than medical professionals, including midwives. According to Ma Dazheng’s research, the Qing Dynasty produced the most literature on obstetrics and gynecology. Among the “Four Texts of Obstetrics 產科四書” of the period, Daseng Pian 達生篇 (Treatise on Easy Childbirth) was categorized as a popular work. Wu Yili described it as: despite its humble origins, this modest book by an obscure author became one of the most famous works on childbirth of late imperial China. The book later circulated widely in the Southern Regions of China, and Protestant missionaries took note of it, translating it into English.

A notable characteristic of these texts was their limited theoretical discourse, which lacked a cohesive perspective across the various works. The widespread circulation of these popular obstetric texts underscored the diversity and complexity inherent in Chinese medicine. As medical historian Volker Scheid observed, “Chinese medicine has been characterized from theory and diagnosis to prognosis, therapeutics, and the social organization of health care.” He argued that traditional Chinese medicine represents a composite healthcare system, formed from an array of components. This assertion applies equally to the theories and practices of childbirth that varied across different regions during the Qing Dynasty.

 

Colonial Hong Kong: A Convergence of Childbirth Cultures

American medical missionary Dr. Peter Parker established the first Western medical clinic in China, the Ophthalmic Hospital at Canton, in November 1835. This clinic quickly garnered attention from local officials seeking medical treatment, particularly for its surgical services. Notably, the hospital attracted a significant number of female patients, with statistics from the first quarter revealing that approximately 30% of patients were Chinese women. These women presented a diverse array of medical issues, including some specific to female health.

However, obstetrics posed a unique challenge for Dr. Parker. Tucker noted that childbirth was one of the most challenging areas for him to engage with, as Chinese women generally did not view childbirth as a medical situation requiring intervention. Consequently, they were unlikely to seek Dr. Parker’s assistance for obstetric care. Dr. Parker’s records indicate that his first obstetric case did not occur until 1843, when a woman named Li Mun was brought to the clinic by her husband following a boating accident. This case was marked by desperation, as Li Mun and her family sought medical help only under duress. Tragically, Li Mun died two days after giving birth, and her case remained the only recorded obstetric incident at the Western medical clinic in Guangzhou until 1855. This situation underscores the cultural barriers and perceptions surrounding childbirth at the time. Despite the presence of Western medical facilities, traditional beliefs and practices continued to dominate the approach to childbirth among Chinese women, illustrating the complexities of integrating Western obstetrics into a deeply rooted cultural context.

Following the Opium War, Hong Kong officially became a British colony in 1842. The colonial government felt reluctant to spend resources on the Chinese community and thus opted for a laissez-faire medical policy. Consequently, Western missionaries took on the responsibility of providing medical care for the Chinese, one of whom was Dr. William Lockhart. Arriving in Macau in 1839, he practiced in various locations and established Western hospitals. Although Shanghai later became his primary area of activity, Lockhart also left his mark on Hong Kong, overseeing the establishment of the first church hospital in the colony in 1843.

Shortly after arriving in China, Lockhart recognized the limitations in providing obstetric care to Chinese women. To understand traditional Chinese obstetrics, he translated a Chinese obstetric text published in 1825, A Treatise on Midwifery: A New Edition Published in the Fifth Year of Taou Kwong, which appeared in an Irish medical journal in 1842. This was the first Chinese obstetric book translated into English, serving as a rare resource for missionaries seeking to understand Chinese midwifery traditions. In his memoirs on medical missions in China, written in 1861, Lockhart expressed frustration at the complete dominance of childbirth by women in Chinese society.

Following Lockhart, Dr. Benjamin Hobson was another influential medical missionary in Hong Kong. In 1843, he established the first hospital in Hong Kong. After arriving in China in 1839, Hobson served in hospitals in Macau, Guangzhou, and Hong Kong over a span of twenty years. According to his records, “I am happy to state that there has been no intermission, for a single day of the regular ministration to the sick… The number of new patients registered from June 1844 to July 1845 amounts to 3,307, making the total for the two years the hospital has been opened in Hong Kong, 7,221 patients.” Hobson noted that the hospital treated many patients, including women and children, yet no obstetric cases were recorded in the hospital.

While practicing medicine, Hobson also began translating Western medical texts. In 1851, he compiled the Quanti Xinlun 《全體新論》 in Guangzhou, which is considered the first comprehensive introduction of Western anatomy to China, introducing Harvey’s theory of blood circulation. It also conveyed the obstetric knowledge held by Western medicine at the time, including theories on fetuses, placenta, and lactation. In 1858, Hobson published the first Western obstetric book in China, Fuying Xinshuo 《婦嬰新說》. This work was one of Hobson’s five significant publications, written after he fled to Shanghai during the Second Opium War, primarily through translations of texts by Fleetwood Churchill. et al. and Francis Henry Ramsbotham. Hobson himself was not an obstetric expert and admitted his shortcomings in obstetric knowledge, stating that:

“I give my mornings and evenings chiefly in preparing the closing series of my medical works in Chinese, the one on medicine and principal diseases of women and children, with probably a condensed materia medica at the end. This, seeing how little I can do in the speaking way, seems my possible and appropriate work as a medical missionary, and therefore I do it, hoping they will stand and exert some influence for good, when I am long removed from the field.”

In the absence of permission to intervene in childbirth, Hobson attempted to convey the concept of medicalized obstetrics through the translation of Western medical texts.

Hobson aimed to demonstrate the superiority of Western internal medicine and prescriptions over traditional Chinese medicine in his writings. His work included numerous illustrations and anatomical diagrams, affirming that Western medicine viewed childbirth from a surgical perspective. Despite containing several inaccuracies (such as the number of eggs), Fuying Xinshuo attracted the attention of traditional Chinese medicine practitioners. For instance, in 1861, Shi Shoutang referenced Hobson’s text in Yiyuan 醫原, stating:

“Western scholars say that within a woman’s uterus, there are fifteen to eighteen pearl-like eggs, wrapped in a thin membrane and containing seminal fluid, known as yin essence. At the onset of menstruation, these eggs first appear, and when the moon cycle ends, they disappear. When a couple engages in sexual intercourse, the eggs burst, mingling yin and yang essences to achieve conception. This explanation aligns with the theories of Yuan Tai Yi and seems credible.”

Despite Hobson’s efforts to present Western obstetric theories in various ways, the medicalization of obstetrics proposed by Western medicine had little practical impact on most Chinese families. Early Western medical clinics in Hong Kong saw very few cases of childbirth.

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Colonial Medicine: The Establishment of Obstetrics in Government Hospital

Colonial medicine has become a significant area of scholarly inquiry, particularly concerning obstetrics within the context of imperial medicine. Much of the research has concentrated on birthing systems and policies in British colonies in Africa and Southeast Asia during the 20th century. These studies reveal that many colonial policies were influenced by Britain’s efforts to increase birth rates in the late 19th century, positioning the health of women and infants as a governmental priority. However, the approaches and policies of colonial governments regarding childbirth and maternal health varied widely across different regions. These variations were shaped by local medical cultures, existing health systems, and the specific sociopolitical dynamics at play.

As Li Shangren notes, “The public health measures adopted by the empire often involve factors such as governance capacity, the economic conditions of the colony, and the power dynamics between colonizers and the colonized.” This complexity illustrates that while there was a broader agenda tied to imperialism—such as controlling populations and improving labor productivity—local contexts significantly influenced the implementation and reception of these policies.

Janet George highlighted that the situation in Hong Kong differed significantly from that of other British colonies. The British occupied Hong Kong primarily for trade, aiming to leverage its geographical advantages for commerce in China and Southeast Asia. Consequently, the colonial government directed most of its regulatory policies toward protecting European residents, maintaining a stance of mixed assertive and passive control over the Chinese population. Although the Colonial Surgeons proposed improvements in childbirth conditions for women in Hong Kong—driven by humanitarian concerns and population registration strategies to manage infectious disease spread—these recommendations were largely ignored by the colonial government. It was not until the bubonic plague outbreak in the late 19th century, which affected trade, that the colonial government began to pay more attention to infant mortality rates. However, health policies for Chinese women remained passive and underdeveloped, leading to an inadequate birthing space for Chinese mothers.

The Civil Hospital, established by the colonial government in 1850, primarily served European residents and focused its medical policies and resources on protecting colonizers and military personnel. With the colonial government prioritizing trade revenues, there was little desire or motivation to act as “saviors,” resulting in minimal Chinese utilization of the Civil Hospital. Patients were categorized into six groups: Police, Board of Trade, Private Paying Patients, Government Servants, Police Cases, and Destitutes. Although there was no explicit ban on Chinese seeking treatment at the Civil Hospital, the high costs deterred most, as noted by government medical officials: “Very few Chinese private paying patients sought admission. This may be that they do not yet appreciate western scientific medical treatment, but it is very probable that the fees charged have more to do with it.” For instance, in 1877, the hospital report indicated that 236 Chinese patients sought treatment, most of whom were Police Cases brought in under duress, highlighting the lack of voluntary admissions.

George asserts that “the private trouble of a difficult confinement as experienced by Chinese women did not appear on the public policy agenda until late in the nineteenth century.” The initial report from the colonial surgeon indicated that in 1853, only one Chinese woman sought treatment at the Civil Hospital. At that time, the hospital featured a small female ward with just 14 beds, primarily accommodating women engaged in sex work for colonial residents. In 1858, the colonial government established a venereal disease hospital (Lock Hospital) to control the spread of sexually transmitted diseases, requiring all women providing sexual services to register and undergo regular health check-ups.

The first recorded obstetric case in this hospital did not occur until 1876, when a pregnant woman was admitted for surgical intervention: “One woman in labour was brought to Hospital. As a rule such cases would not be admitted to an ordinary Hospital, but some cases which require operative interference are better in Hospital than in the filthy, ill-ventilated rooms of their own houses; at any rate the risk of a fatal termination is no greater, if so great.” This woman’s admission was necessitated by unsanitary conditions at home, which made it impossible to manage her case in a typical hospital setting.

By 1880, the situation had only marginally improved, with two obstetric cases reported: “They were Chinese women who were admitted on the application of the Police. One was an arm presentation requiring operative interference. The other is protracted labour delivered by forceps.” Both cases involved Chinese women who were brought to the hospital by the police due to complications during childbirth. These early cases illustrated the challenges and systemic issues within the colonial healthcare framework, where medical intervention for Chinese women was often reactive rather than proactive.

In the 1881 annual report, the colonial surgeon continued to address obstetric issues: “A lying-in ward is much required. At present cases admitted have to be treated in the female ward among the other patients.” In 1882, the number of childbirth cases increased to six, yet the reports indicated that most infants did not survive:

“Six cases of parturition are recorded, in two of which the mother died. The fate of the offspring is not recorded, but most of them, if not all, were born dead. I have in previous reports alluded to the fact that, in cases of difficult labour among…”

“the Chinese, the lives of both mother and child are invariably sacrificed unless European aid is called in. The Chinese so-called doctors know nothing of anatomy, and they admit their utter ignorance of the mechanism of child-birth, and their consequent powerlessness to render aid to parturient women.”

The cases admitted for childbirth were predominantly complicated deliveries; Chinese women were reluctant to choose the Civil Hospital for childbirth under normal circumstances.

The colonial government in Hong Kong lacked strong motivations to provide obstetric services for Chinese women. Under the prevailing laissez-faire medical policy, it took nearly 40 years after the colony’s establishment before childbirth cases began to appear sporadically in medical records. Although there were continual discussions about establishing a maternity ward in the newly constructed Civil Hospital, these plans never materialized:

“Last November it was suggested to the Government that a small lying-in Hospital should be provided, and it was stated that the Directors of the Tung Wa Hospital were prepared to remunerate a Medical Officer for attendance on these cases. This proposition fell to the ground, and nothing came of it.”

This inaction reflected a broader reluctance to invest in maternal healthcare for the Chinese population. More viable alternatives, such as permitting the management of Tung Wah Hospital — a Chinese hospital established in 1872, initially run by Chinese staff and focused solely on traditional Chinese medicine — to set up a maternity ward for impoverished Chinese women, were also overlooked. The situation indicated a broader systemic indifference within the colonial administration regarding the health needs of the Chinese population, particularly in relation to maternal care.

In this context, the vast majority of Chinese women in Hong Kong continued to adhere to tradition, opting for the assistance of midwives at home for childbirth. This choice made them targets for criticism from the colonial medical authorities. In a report from 1885, the colonial surgeon recounted the situation of several Chinese women who were brought to the hospital after unsuccessful home births:

“Seven Chinese women in labour were brought to the Hospital for assistanc. They had all suffered in labour for several days and required instrumental aid. Three of them died. Some of these cases are hopeless when they arrive, from having delayed too long, and there is, duties considerable risk to the patients in treating such cases in a General Hospital. Their only hope, however, is to remain at home in the hands of their wise women, which means certain death.”

The report highlighted the increasing criticism from colonial surgeons towards Chinese midwives and practitioners. By 1889, the reports explicitly stated that:

“it is greatly to be regretted that these [laboring] cases do not come into the Hospital earlier as the Chinese Midwives are absolutely destitute of any obstetric skill.”

In this context, if the Civil Hospital wished to engage with more obstetric cases, the most direct approach would have been to hire female doctors. However, compared to American medical schools that began training female doctors in the mid-19th century, Britain was relatively conservative, resulting in a slower pace of training for women in medicine.

“British medical schools and universities were committed to excluding women, preventing them from obtaining practicing qualifications,” according to Waddington. It was not until around 1865 that Elizabeth Anderson, the first female doctor in Britain, began to receive recognition in the medical field. Later, the status of female doctors remained undervalued, and London did not allow them to serve in the colonies. Meanwhile, Florence Nightingale’s nursing reforms in Britain during this period solidified women’s roles in hospitals as nurses.

Under this context, the colonial surgeon proposed a plan in 1888 to recruit European professional female nurses:

“A scheme for the employment of European Female professional nurses in the Hospital has been drawn up by Dr. Atkinson at the request of the Government and is now under consideration. If on enquiry in England it is found feasible the scheme will undoubtedly be a very great benefit to the Hospital. It is not however entirely without some drawbacks for the nurses will have to reside on the premises and this will require a considerable increase of accommodation in the shape of an additional block of buildings which means considerable expenses. As usual it is a question of initial outlay.”

The following year, the colonial government officially began constructing dormitories and hired five French nuns as nurses. (However, a report the following year indicated that the nuns left after a year due to the demanding work at the hospital.) In 1889, the Civil Hospital decided to employ a Chinese nurse trained at John Kerr’s Hospital in Canton, although her role was limited to that of a general helper (amah) rather than a nurse. It was not until 1890 that the government successfully recruited Miss Eastmond, who had trained in London, along with five other trained nurses to join the service at the Civil Hospital. That same year, the hospital established several dedicated maternity beds. According to hospital reports, Eastmond’s arrival led to a slight increase in the number of Chinese women giving birth in the hospital.

Obstetrics Cases in the Civil Hospital (1897-1909)

Year	Chinese Cases	European Cases	Total Cases
1897	21	15	36
1898	4	4	8
1899	21	15	36
1900	29	21	50
1901	47	51	98
1902	36	29	65
1903	30	20	50
1904	20	12	32
1905	27	13	40
1906	25	15	40
1907	35	27	62
1908	40	20	60
1909	47	51	98

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