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Capital, Profession and Medical Technology: the Electro-Therapeutic Institutes and the Royal College of Physicians, 1888-1922

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Capital, Profession and Medical Technology: the Electro-Therapeutic Institutes and the Royal College of Physicians, 1888-1922 Medical History, 1997, 41: 150-181 Capital, Profession and Medical Technology: The Electro-Therapeutic Institutes and the Royal College of Physicians, 1888-1922 TAKAHIRO UEYAMA* That it is undesirable that any Fellow or Member of the College should be officially connected with any Company having for its object the treatment of disease for profit. (Resolution of the Royal College of Physicians of London, 25 Oct. 1888.) That subject to the general provisions of Bye-law 190 the College desires so to interpret its Bye-law, Regulations, and Resolutions, as no longer to prohibit the official connection of Fellows and Members with medical institutes, though financed by a company, provided there be no other financial relation than the acceptance of a fixed salary or of fees for medical attendance on a fixed scale, irrespective of the total amount of the profits of the Company. (Resolution of the Royal College of Physicians of London, 1922, replacing the Resolution of 1888.) No Fellow or Member of the College shall be engaged in trade, or dispense medicines, or make any engagement with a Pharmacist [altered from Chemist] or any other person for the supply ofmedicines, or practise Medicine or Surgery in partnership, by deed or otherwise, or be a party to the transfer of patients or of the goodwill of a practice to or from himself for any pecuniary consideration. (Bye-law 178 of the Royal College of Physicians of London, 1922, alterations in italics.)l This paper examines the implications of an historical drama at the Censors' Board of the Royal College of Physicians of London (henceforth RCP) in the late 1880s and 1890s. In 1888 the Institute of Medical Electricity, Limited (henceforth IME), which British electrical engineers had founded to explore new electrical business in medicine, began to question the traditional professional ideology of the RCP. Four years later a more commercial enterprise, the Medical Battery Company (henceforth the MBC, later the Zander Institute) initiated a notorious electric belts business and created irksome disciplinary problems for the Censors' Board of the RCP. Supporting the IME were *Takahiro Ueyama, MA, History Department, 1 he Charter; Bye-laws, and Regulations ofthe Stanford University, Stanford CA, 94305, USA. Royal College ofPhysicians ofLondon and the Acts of Parliament especially relating thereto, London, My research for this paper was made possible by a Harridan and Sons, 1908, pp. 94-5. 'Second report fellowship financed by the Toyota Foundation to from the Censors' Board on the proposed alteration of which I wish to express my gratitude. I would like to a Resolution of the College and of Bye-law thank Derede Arthur, Bettina Bryan, W F Bynum, CLXXVIII', held by The Royal College of Physicians Christopher Lawrence, Tim Lenoir, Roy Porter, Peter of London (henceforth RCP), MSS., 835/51. For the Stansky and Akihito Suzuki for their comments, and Resolution and Bye-law, see the Annak ofRoyal three anonymous referees for their helpful criticism College ofPhysicians ofLondon (henceforth Annals), on the earlier draft. 19 Oct. 1922, vol. 51, f. 159-62. 150 The Electro-Therapeutic Institutes and the RCP medical electricians and the Institution of Electrical Engineers; while the MBC and its founder, C B Harness, were supported by Dr Herbert Tibbits, a licentiate of the RCP who wrote a laudatory certificate for the MBC's electric belt. Opposing both these groups were traditionalist physicians, and mainstream medical electricians within the IME who, seeking to advance the managerial possibilities of their Institute as well as electricity's practical applications to medicine, attempted to demolish the MBC and Tibbits in court battles. In investigating this struggle, I will show that the interaction between capital, technology, and medicine created in the late nineteenth century a new environment for the medical profession. Facing the challenges of these upstart Institutes, the RCP was determined to thwart the commercial ventures of such corporate-style medicine. However, as I will show, the conflict between these three groups reveals a new medico-social context in which, just before the tum of the century, the medical profession was experiencing pressure to remodel its ideology in the face of the growing commercialization of medical practice and increased public demand for speciasized and technological treatment. I will investigate how the RCP's enactment and amendment of its regulations in 1888 and 1922 was influenced by the two professional ideals of, on the one hand, the physician as gentleman, and, on the other, that ofpublic service, with the latter gradually gaining on the former in the early twentieth century.2 Historiographical Context: Medical Commerce and Professional Ideals The re-evaluation ofmedicine's relation to commerce and the marketplace, initiated largely by Roy Porter, has created an understanding of eighteenth-century medicine as client- dominated and market-oriented.3 In the free-for-all, regular practitioners had to compete with quack itinerants, nostrum-vendors, and empirics like James Graham, a sex-therapist who employed "magneto-electricity" for nervous ailments and sold "electrical medicaments". On the other hand, "early modem practitioners were involved in the drink trades at various levels". As Margaret Pelling emphasizes, it is difficult to split eighteenth-century medical practitioners into professionals and traders solely on the basis of their perfornance.4 By contrast, in the Victorian era the rise of professionalism via bureaucratic or state control gradually replaced market mechanisms,5 and the professionalization of medicine served to strengthen control and to rescue the profession from the undignified bogland of the medical market.6 State regulations such as the Apothecaries Act of 1815 and the 2 Harld Pein, The inse ofprofessional society, Bynum and R Porter (eds), Medicalfringe & medical London and New York, Routledge, 1989. For the orthodoxy 1750-1850, London, Croom Helm, 1987. incrased imotanc of the public service ideal for the 4 Margaret Pelling, 'Medical practice in early medical profession, see Andrew Morrice, "'The modern England: trade or profession?', in Wilfrid medical pundits": doctors and indirect advertising in the Prest (ed), The professions in early modern England, lay press 1922-1927', Med Hist., 1994, 38: 255-80. London, Croom Helm, 1987, p.104. Roy Porter, Health for sale: quackery in s Magali Larson, The rise ofprofessionalism: a England 1660-1850, Manchester and New York, sociological analysis, Berkeley and Los Angeles, Manchester University Press, 1989; Nicholas D University of California Press, 1977. Jewson, 'Medical knowledge and the patronage 6 For the occupational diversity in the eighteenth system in eighteenth-century England', Sociology, century, see Margaret Pelling, 'Occupational 1974, 8: 369-85; Michael Neve, 'Orthodoxy and diversity: barbersurgeons and the trades of Norwich, fringe: medicine in late Georgian Bristol', in W F 1550-1640', Bull. Hist. Med., 1982, 56: 484-511. 151 Takahiro Ueyama Medical Act of 1858, traditional historiography has argued, were introduced to reinforce the boundaries of the medical profession.7 On the doctor's side, an ethical or moral code of behaviour powerfully reinforced professional solidarity. According to Jeanne Peterson, London consultants used their patronage and posts in voluntary hospitals to acquire wealthy patients for their own lucrative private practices, while at the same time protecting the esprit de corps of the medical profession by insisting on gentlemanly professional standards for the large mass of practitioners. This created an ethos in which advertising or pecuniary ventures by a doctor were seen as unprofessional and unseemly.8 However, more recent historiography has viewed the effectiveness of state regulation as limited.9 The Medical Act of 1858, for example, was far less restrictive than it appeared on the surface, allowing doctors freedom to espouse any doctrines (quackish or not) that they wished.10 Even the professionalization scenario articulated by Peterson ironically brings into relief the intra-professional struggles in which non-6lite doctors found a way to break the monopoly of the elite by seeking other methods of financial gain.11 At the same time, many medical men, including such practitioners as Robert Abercrombie and Harry Lobb, used self-promotion to become medical entrepreneurs.12 Recent studies of the medical market show that harsh competition among a growing number of rank and file practitioners in the nineteenth century created "a significant downward pressure on medical incomes", which compelled them to pursue a more commercial approach, some even going so far as to endorse advertisements and join laymen's medical businesses.13 Such collaboration between commercial interests and medical professionals could not long go unchallenged. During the last quarter of the nineteenth centiry, extraordinary meetings of the Censors' Board, the RCP's disciplinary body, were frequently held to summon those Fellows, Members, and Licentiates whose names had appeared in public advertisements.'4 Various patent foods and accessories such as Van Houten Cocoa, Coleman's Liebig's Extract of Meat and Malt Wine, and The Ladies' New Sanitary Towel were advertised as having doctors' recommendations and thus medical virtues; all, as a result, incurred RCP censorship. But most controversial were the testimonials or 7 William Reader, Professional men: the rise of New York, Holmes &
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