IELTS Academic Reading Practice Test 358

In the middle of the nineteenth century, medicine was one of the most tightly guarded of British professions. A young man who wished to practise had to obtain a licence from one of the ancient corporations, attend lectures at a medical school and walk the wards of a teaching hospital. Every one of those institutions admitted men only. Women could work as nurses, but nursing was poorly paid, carried little status and offered no route to diagnosis or prescription. The belief that the female constitution was unsuited to medical study was repeated so often that it had come to seem a fact of nature.

Elizabeth Garrett was born in London in 1836 and grew up in Suffolk, where her father ran a successful business. She was intelligent, energetic and, by the standards of the day, unusually well educated. In 1859 a friend introduced her to Elizabeth Blackwell, an Englishwoman who had taken a medical degree in the United States ten years earlier, the first woman to do so. Blackwell's example convinced Garrett that the obstacle in her way was not nature but custom, and from that meeting onwards she pursued medicine with a determination that never wavered.

Garrett applied to several medical schools and was refused by all of them. She then entered a London hospital as a nurse, hoping at least to attend the lectures given to students. For a time the arrangement worked, but her presence in the lecture theatre provoked such hostility among the male students that she was asked to leave. She continued to study privately, reading textbooks, dissecting with sympathetic teachers and learning the practical skills of examination and prescription wherever a doctor was willing to teach her.

Her opportunity came through an obscure piece of legislation. The Apothecaries Act of 1815 gave the Society of Apothecaries the right to examine and license practitioners of medicine, and neither the Act nor the Society's charter said anything about the sex of candidates. In 1865 Garrett presented herself for the Society's examinations, passed them and received its licence, becoming the first woman qualified to practise medicine in Britain. The Society's members were less than delighted; within a year they had altered their regulations so that no other woman could follow her through the same gateway.

Qualification, however, did not mean employment. No hospital would appoint her to its staff, and no British university would grant her a higher degree. In 1866, therefore, she opened a dispensary in Marylebone, in London, where women and children could be treated by a woman doctor; it prospered, and in 1872 it moved to larger premises as the New Hospital for Women. In 1870 she travelled to Paris, where the university awarded her a doctorate in medicine, a qualification she had been unable to obtain at home.

Meanwhile other women were attempting the same journey. In 1869 Sophia Jex-Blake and six companions matriculated at the University of Edinburgh, an event that attracted national attention. They were taught by some sympathetic professors but confronted by hostile crowds and, eventually, by a court ruling that the university had no obligation to allow them to graduate. The Edinburgh experiment failed, although it produced a wave of public sympathy; several of the women later qualified in Switzerland or through the Irish colleges.

Parliament was eventually persuaded to act. In 1876 it amended the Medical Act so that every medical examining body in the country was permitted, though not obliged, to admit women to its examinations. In the same period the London School of Medicine for Women was founded, in 1874, by a group that included Jex-Blake; from 1877 its students received their clinical training at the Royal Free Hospital, which had agreed to admit them. For many years the school remained the only place in Britain where a woman could complete a full medical education.

Professional opinion remained divided. The British Medical Association admitted Garrett as its first woman member in 1873 and then resolved that it would admit no more, so that she remained its only female member for nearly twenty years. Medical journals debated whether women's health could withstand the demands of practice, and opponents claimed that patients would refuse to be treated by a woman.

Garrett combined clinical work with campaigning. She was Dean of the London School of Medicine for Women for many years and retired in 1902 to Aldeburgh, the Suffolk town where she had grown up. There she took part in local government and in 1908 was elected mayor, the first woman in England to hold that office. She died in December 1917, a few weeks before the law giving some women the vote received royal assent.

Her sister Millicent Garrett Fawcett became the leader of the constitutional campaign for women's suffrage, and the two causes were often spoken of together. Yet progress in medicine was slow. In 1900 women were still a small minority of British doctors, and some universities did not admit them to medical degrees until the twentieth century was well advanced. What Garrett had demonstrated was not that the profession would welcome women, but that the barriers were rules rather than laws of nature, and rules could be changed.

Only a minority of the world's snakes are venomous, but those that are include some of the most efficient chemical killers known. Venom is not a single substance but a mixture, sometimes containing hundreds of different proteins and peptides, each with a particular task. It is produced in a pair of glands behind the eyes, which in evolutionary terms are modified salivary glands, and it is delivered through fangs that are long and hinged in vipers, folding back when the mouth closes, but short and fixed in cobras and their relatives. Because the mixture is adjusted to the snake's prey, its composition varies greatly between species, and even between populations of the same species.

Venom serves the snake in two ways: it subdues prey and begins the process of digestion, and it deters animals that might attack. Human beings are not prey, but the same chemistry acts on human tissue. The result, snakebite envenoming, is a medical emergency that the World Health Organization classifies as a neglected tropical disease. The organization estimates that between 1.8 and 2.7 million people are envenomed each year, out of some 5.4 million bites, and that the bites cause between 81,000 and 138,000 deaths, chiefly in Africa and Asia.

Venom does not travel from the wound mainly in the blood. Its molecules are large, and most are carried away through the lymphatic system, the network of vessels that returns tissue fluid to the circulation. Movement along these vessels is slow, so the first symptoms may appear within minutes of a bite or only after an hour or more. Many bites inject little venom or none at all, but a bite that produces no symptoms at first may still have delivered a dangerous dose.

The venoms of cobras, kraits, mambas and most Australian elapids are dominated by neurotoxins. These attach to receptors on the muscle side of the neuromuscular junction, the point at which a nerve signal instructs a muscle fibre to contract, and block the transmitter acetylcholine. The signal never arrives, so the muscle cannot respond. The first signs are drooping eyelids, double vision and difficulty in swallowing, followed by a weakness that spreads to the muscles of breathing. Respiratory failure is the usual cause of death after such a bite, and it can develop within a few hours.

Viper venoms, by contrast, are rich in enzymes and in a family of proteins called metalloproteinases. These attack the walls of blood vessels, allowing blood and plasma to leak into the surrounding tissue, so that the limb swells, blisters and may darken as tissue dies. Other components interfere with clotting. Some activate the clotting cascade so powerfully that the factors are exhausted, leaving the blood unable to clot; the patient may then bleed from the gums or from the wound while clots form elsewhere. Others destroy muscle fibres, releasing proteins that can block the kidneys.

Not every bite is equally dangerous. A large viper may deliver a considerable volume of venom in a single strike, but the amount injected varies enormously, and the severity of the illness depends on the size and general health of the victim as well as on the species. Bites on a limb are usually less urgent than bites to the head or trunk, where venom reaches the circulation more quickly.

Treatment rests on antivenom, which has changed little in principle since the French physician Albert Calmette produced the first effective preparation against cobra venom in 1895. Small quantities of venom are injected into a horse or a sheep, whose immune system manufactures antibodies against the toxins; these antibodies are harvested from the animal's plasma, purified and given to the patient by infusion. The antibodies bind to the venom components and help the body to clear them. Antivenom can stop the damage from continuing, but it cannot repair damage already done, so a paralysed patient may still need a ventilator until the venom has been eliminated.

In practice, antivenom is difficult to supply. It must be kept cold, it is expensive, and it should match the species responsible, since serum raised against one snake may be less effective against another. Because it is a foreign protein, it can cause reactions ranging from a rash to a dangerous fall in blood pressure, and patients therefore need to be treated where such emergencies can be managed. In parts of sub-Saharan Africa and Asia supplies have repeatedly run short, and many victims reach a clinic only after a long journey, by which time the venom has had hours to act.

Research is now directed at treatments that could be carried easily and given before a patient reaches hospital. One candidate is varespladib, a small molecule that blocks phospholipase A2, an enzyme found in many venoms; it was originally developed for inflammatory disease, and early trials have explored whether it can limit the local destruction of tissue. Other groups are engineering antibodies or producing antivenom in animals other than horses. None of these approaches has yet replaced conventional treatment. Much also remains unexplained: why some patients deteriorate within hours while others with apparently similar bites recover, and how the mixture in a single species comes to differ so much between regions. Even the basic numbers are uncertain, because many bites are never reported to a clinic and deaths are often attributed to other causes.

In rural districts of many low-income countries, the first person a sick family consults is often not a doctor but a traditional healer. Healers are frequently far more numerous than physicians, live in the same villages, speak the same language, charge modest fees and share their neighbours' understanding of what illness is. For a household with no vehicle and no money for a hospital bed, turning to a healer is not superstition; it is the only sensible calculation available. The question for health systems is whether such practitioners should be treated as colleagues, as obstacles, or as something in between.

The case for cooperation begins with arithmetic. Where a country has one doctor for tens of thousands of people, no expansion of medical education will close the gap within a generation. Public-health planners have therefore argued that healers, who are already in place, can be taught to recognise danger signs — a child who cannot be roused, a fever that will not settle, a pregnancy going wrong — and to send such patients to a clinic at once. Ministries in several countries have experimented with short courses covering hygiene, the limits of herbal treatment and the recognition of conditions, such as tuberculosis, that require laboratory diagnosis.

There is a cultural argument as well. Medical anthropologists point out that a consultation is never simply a transaction about pills. Patients want an account of why they, rather than their neighbour, have fallen ill, and in many societies the healer supplies one that fits the patient's world. A clinic that ignores such beliefs may be technically correct and practically useless, because the patient takes the tablets, notices no improvement and returns to the healer. Understanding local ideas about illness is not sentimentality; it is a condition of being trusted.

Healers themselves are not a single profession. Some are herbalists with detailed knowledge of local plants; some are diviners whose work is essentially religious; some are entrepreneurs selling expensive cures for AIDS, cancer or infertility. Their attitudes to the formal system vary just as widely. Many already refer patients whom they cannot help, and would welcome training and a recognised licence. Others suspect that registration is the first step towards being controlled, taxed or driven out of business.

Against all this stands the argument that the plural of anecdote is not evidence. Critics of integration contend that most traditional remedies have never been tested in a way that would satisfy a drug regulator, and that a number are actively dangerous: certain plants damage the liver or the kidneys, some preparations contain heavy metals, and unsterile blades spread infection. The harm, they add, is not only direct. A healer who promises to cure a treatable infection delays the treatment that would have worked, and by the time the patient reaches hospital the disease may be too advanced to remedy.

Regulators take a related view. To license a healer, they argue, is to lend that healer the authority of the state, and patients may reasonably conclude that the methods have been approved. No drug regulator would accept a mixture of unknown composition and variable strength that had been tested on nobody. To insist on evidence is not prejudice against other cultures; it is the same standard that protects patients from a fashionable surgeon or a fraudulent pill. The question, on this account, is not who the healer is but whether the treatment works.

Both sides, however, are tempted to exaggerate. The romantic picture of the healer as the guardian of ancient wisdom ignores the fact that much of the knowledge is unrecorded, unverifiable and sometimes simply wrong. The picture of the healer as a charlatan ignores the fact that many are the only clinicians within reach and behave conscientiously. Nor is the choice binary. India and China maintain licensed systems of traditional medicine alongside conventional care, staffed by practitioners trained in state-regulated colleges, and a health service can work with healers on referral, hygiene and prevention without endorsing their remedies.

The World Health Organization has generally encouraged cooperation. Its strategy on traditional medicine, and the global centre it established in India in 2022, rest on the belief that long-established systems deserve scientific study and, where they prove useful, a place in care. The organization has been criticised for appearing to give its name to unproven therapies, and the criticism has force; but so does the argument that research into such remedies will not happen unless somebody pays for it.

My own view is that collaboration is worth having, but only on terms that keep the boundary between the two systems visible. Healers should be trained, registered, insured and paid for what they can demonstrably provide: advice, referral, support for people with long-term illness, perhaps counselling. They should be forbidden to claim cures they cannot support, and their remedies should be investigated like any others, with the same standards and the same possibility of failure. Official endorsement of unproven treatment is not cultural respect; it is a way of making inequality permanent. What patients need is not one system of medicine or the other, but a system in which every practitioner, whatever the tradition, is honest about what is known.