[From Schenckius: Observationum medicarum, Francofurti, 1609.] ANNALS OF MEDICAL HISTORY New Series, Volume X July, 1938 Number 4 A SURVEY OF THE SOCIAL IMPLICATIONS OF THE HISTORY OF MEDICINE IN GREAT BRITAIN, 1742-1867* By WILLIAM WHITE LOS ANGELES, CALIFORNIA

HE aim of this paper is These words were written in 1904; to present, with as few today we may hope to achieve a better scientific technicalities bird's-eye view, although achievement as may be found con­ still goes on apace. But medical his­ sistent with a full un­ torians have been too much prone to derstanding, a study of regard the history of medicine as pecul­ the social effects and iar to its own special paddock, inap­ ramifications of the various events char­ plicable to other studies of social im­ acterizing the course of medical history portance. This attitude may perhaps from the period forming the immediate be an outgrowth of traditional custom background of the Victorian Era up to of the profession: that its own particu­ the results of the Medical Act of 1858. lar fund of knowledge shall be hoarded Ebe progress made by the profession for its use, and its alone. However that in scientific fields during the period may be, it occurred to the author of chosen for study was perhaps the most this paper that a study might well be remarkable to be observed in all his­ made along the lines outlined in the tory. Sir William Osler, in his “Science first paragraph. and Immortality,’’ says: Thus an attempt has been made to Within the lifetime of some of us, supplement and expand the material Science—physical, chemical, and biolog­ to be found in the articles on “Medi­ ical—has changed the aspect of the cine,’’ by Sir D’Arcy Power, written for world, changed it more effectively and Henry Duff Traill’s six-volume history, more permanently than all the efforts of “Social England.’’ Material taken from man in all preceding generations. Living in it, we cannot fully appreciate the trans­ the standard specialized histories of formation, and we are too close to the medicine (mainly Garrison and Baas) events to realize their tremendous signifi­ was then woven into the inadequate cance. articles of Power which were tised more * Read to Prof. Gilbert B. Benjamin’s seminar in Modern Britain, University of Southern California, Janu­ ary 9 and 16, 1937. or less as outlines. Splendid biblio­ Company but shed them by means of graphical data, and some factual mate­ a new charter from James 1 in 1617, rial, were furnished by the annotations after which time they had the College in Osler’s “Bibliotheca Osleriana.” of Physicians against them.7 The phy­ References have been included in sicians, despite the support of the men the footnotes of the first two sections of letters, Dr. Johnson8 and Pope,9 to such popular histories of medicine were beaten by the apothecaries, who as those of Clendening and Haggard in became practitioners to all intents and order to give the reader a lead should purposes. The social status of the phy­ he care to pursue into channels less sicians by the middle of the eighteenth erudite than those of standard writers century was high and they had, any of the material annotated. Having through the harsh College of Physi­ served their purpose, however, in giv­ cians, now gained control over the ing a view of the field, these citations Apothecaries’ Society.10 The standing were abandoned for the period 181 5- of the surgeon in 1742 was undefin- 1867. able, while that of the apothecaries and members of the Scotch Colleges was as The Period of Revolution and Reaction low as it could be.11 (1742-1802) The physician was especially satir­ The period which began in 1742 was ized by Tobias Smollett12 (Count a great one for both the science and the Fathom) and Laurence Sterne (Dr. art of medicine—the reasons for and Slop). In the former novel, “The Ad­ development of which I shall attempt ventures of Ferdinand Count Fathom’’ to point out briefly in this paper.1 As (1752), the adventurous knave takes the year 1742 dawned, England could it into his head to enroll himself among boast of but four outstanding men in “the sons of Paean’’ and his experiences the field of medicine: John Huxham,2 give an amusing picture of the “solem­ William Herberden,3 Sir Hans Sloane4 nities of dress and address,’’ the tricks and William Cullen.5 Only the first of the trade—being called out of church two of these were physicians, Sloane, or riding aimlessly about in a chariot ex-president of the Royal Society, being —which were resorted to even by prac­ more of a scientific man than a physi­ titioners of better repute.13 In Smol­ cian, while Cullen was a clinical teacher lett’s “The Adventures of Roderick whose reputation was gained in Scot­ Random’’ (1748) are described the low land. status of the medical profession on Since the days of Henry vm the sur­ board ship and the humbuggery and geons were connected with the barbers corruption which attended the com­ as a united company of Barber Sur­ petitive examinations for the position geons which was incorporated in 1540, of surgeon’s mate. Also significant is and the latter continued to be a thorn Smollett’s portrayal of M. Lallemant, in the side of the former until the sur­ the “shabby, nimble-shilling” apothe­ geons finally succeeded in divorcing cary.14 themselves from the barber-surgeons in Medicine consisted of an empirical 1745.6 Apart from the Barber Surgeons knowledge based on incorrect pathol­ was the Society of Apothecaries, who ogy.15 Until Morgagni (1682-1771) of were originally part of the Grocers the University of Padua published the results of his life work which consti­ ing a meeting to elect Cline24 its Master tuted the true foundation of modern in 1796. Reconstruction failed when the pathologic anatomy in 1761, doctors Bill was thrown out of the House of in England and elsewhere were, more Lords on July 17, 1797.25 Instead of by or less, in the dark.16 He made pathol­ Act of Parliament, the Corporation ogy a genuine branch of medicine. was rechartered by George 111 on March Surgery was founded on a very shallow 20, 1800, as the present Royal College knowledge of anatomy. Ebe barber­ of Surgeons in London.26 surgeons tried to teach anatomy and The rise in the social status of the surgery by public lectures; but subjects English surgeon has been remarkable.27 for dissection in demonstrations were The surgeon had always been subor­ difficult to obtain; so the lectures were dinate to the physician, the latter theoretical rather than practical.17 Mid­ usually being an ecclesiastic and the wifery was in the hands of women; former a layman, who operated at the the mechanism of labor was not known physician’s command28 and whose pre­ to more than two or three men in scriptions, until the nineteenth cen­ England.18 With these deplorable con­ tury, had to be countersigned by the ditions in medicine in England, the physician. Led by Abernethy, the sur­ surgeons, poor and penniless, seceded geons secured complete control over in a body from the Company of Bar­ their own patients. Because they bers and Stirgeons and formed their usually served as barbers, the surgeons, own Surgeons' Company in 1745.19 who in 134329 had had their own guild, The first master of the new company united with the Barbers’ Company in was John Ranby,20 the King’s Serjeant- 1540; but the “pure’’ surgeons, few in Surgeon, with Chelsea as one of its war­ number, were higher in the social scale dens, and the new Company was like than those who were barbers. Members the old united one except that mem­ of the United Company of Barbers and bers had fewer expenses and could Surgeons never held a high social posi­ teach privately.21 A hall in old Bailey22 tion—Clowes30 and Gale,31 Banister32 was secured, but as the barbers had and Woodall,33 great surgeons at the kept the revenues, library and plate end of Elizabeth’s reign—never hold­ of the united group, the income of the ing positions comparable to those of Surgeons’ Company was from extrane­ the physicians Cain,34 Butts,35 Harvey36 ous sources. Having incautiously ad­ or Theodore de Mayerne. Trouble in vanced money to its clerk, who went the united company came to a head bankrupt in 1760, the Company was because it was impossible to tell who almost insolvent. With better manag­ was a barber and who practiced sur­ ing, however, some progress was made gery. The great English surgeons of the and by 1790 the Company of Surgeons eighteenth century, Cheselden,37 Pott, had a new location; but Mr. Gunning, the Hunters,38 and the new Corpora­ its Master, reminded them that “Your tion of Surgeons apart from the bar­ theatre is without lectures, your li­ bers caused the social position of the brary room, without books, is con­ best men in this field of medicine in verted into an office for your clerk, and 1800 to be as high as that of the best your committee room is become his par­ physicians.39 lour.’’23 Disaster occurred when the Cor­ With the liberty to teach given, the poration was destroyed by illegally hold­ members of the Surgeons’ Company gave lectures, Percivall Pott (1713-88) nation, giving minute attention to de­ eventually becoming so celebrated that tail. Their names have become fixtures all distinguished English and many for­ in medical history. William made ad­ eign practitioners became his pupils. mirable contributions to anatomy, ob­ Even John Hunter audited in 1751. stetrics and surgery, became the out­ Started as private instruction in 1747 standing consultant and obstetrician in for his St. Bartholomew Hospital London. John, a born truth-seeker, was pupils, the lectures were at first given one of the earliest workers in compara­ with hesitation and reserve. Soon, how­ tive physiology and became the more ever, the lecturer had gained con­ famous of the two despite his too few fidence and his style improved.40 literary productions. The phrase The reform of midwifery41 was due ‘‘Hunterian chancre,’’ descriptive of to William Smellie42 and James Doug­ the initial lesion of lues, manifests his las,43 a friend of John Hunter. Smellie, interest in venereal disease.49 Both a humble Lanarkshire practitioner, had brothers were collectors, William’s settled in 1739 as an apothecary in Pall museum50 being started to illustrate Mall and, imbibing the spirit of the his lectures and containing an art de­ younger Gregoire’s teachings44 while partment, books, coins and specimens in France, he successfully reproduced of natural history; and John’s museum this teaching in London. Around him being strictly scientific.51 the battle of man-midwifery raged, The systematic teaching of medicine with the men finally winning. and surgery to students is due in a large Ebe genius of one man, John degree to William Hunter, who started Hunter,45 created and took to its high­ a small school to teach a “Society of est position English pathology,40 forti­ Naval Surgeons.’’52 Originally intended fying it with unassailable clinical, as a continuation of the series started anatomical and experimental observa­ by Samuel Sharp,53 the surgeon at tions. This was the opening of the age Guy’s Hospital, Hunter’s lectures which gave England practical founda­ began in 1746 at Dr. James Douglas’s tions in three important branches of house, in the Piazza, Govent Garden. medicine: pathology, histology and This school, known as the Hunterian or physiology, in addition to embryology the Windmill Street School of Medi­ and clinical medicine. In the first half cine, became the most famous in the of the century pathology, the science world54 and its success was so pro­ of the cause of disease, did not exist; nounced there arose a whole group of morbid anatomy,47 the basis of pathol­ private schools whose object was to get ogy, was yet hardly known and the re­ the student through the medical exam­ sults of postmortem examinations were inations rather than to teach him scien­ neither recorded nor tabulated. Be­ tifically. Founded by eccentric teachers cause the physician knew little of the who liked the drudgery but were un­ normal appearances met with in dead able to get along with others, most of bodies, he made no advance in the the schools rose meteorically to fame knowledge of abnormal appearances.48 and died with their original founders.55 John and his brother William The prosperity and success of the Hunter had minds strikingly alike, the Hunterian School resulted in im­ former possessing greater concentra­ proved teaching methods in England, tion, depth of knowledge and determi­ the outline of medical education set by Hunter at the close of the century after 1740: Middlesex, 1745; Exeter, still being carried out, with, of course, 1745; Northampton, 1743. And dur­ certain necessary modifications.50 Hav­ ing the 125 years subsequent to 1700 ing begun at St. Bartholomew’s and no less than 154 hospitals and dispen­ St. Thomas’s Hospitals as early as 1680, saries were founded in the British medical schools attached to hospitals Isles.02 Voluntary subscriptions sup­ attained to great importance by the ported each, as none was endowed; but later years of the eighteenth century. once open none has been allowed to These two institutions, however, gave close its doors for want of funds. Al­ pupils nothing but bedside instruction though admission was theoretically and Pott’s lectures. Of later origin was free to the poor, “red tape’’ made it clinical instruction in physic, derived impossible for a poor man to gain from Scotland, where Dr. Rutherford, entry. At St. Bartholomew’s a letter Sir Walter Scott’s grandfather, a phy­ from the Governor of the hospital was sician to the infirmary at Edinburgh, necessary, even in the most urgent placed it on good footing.57 cases, or the patient had to deposit a Debating societies were formed in fee of nineteen shillings and six pence every hospital to which a medical for burial expenses, which were, of school was attached to make up for course, returned should he be fortu­ deficiencies in official training.58 They nate enough to recover. If he died the appear to have begun at St. Thomas’s beadle got one shilling for giving a and at Guy’s Hospitals, at that time death certificate, the bearers were paid situated side by side in Borough.59 The two shillings for carrying the body as Physical Society was founded there in far as the hospital gate; a shilling went 1771 and died in 1852 after a useful to the matron for the use of the pall career, its traditions carried on by its and the steward was paid a shilling successors in the hospitals, now sepa­ for certifying the patient had died. The rated. In 1774 the Middlesex Hospital scandal of these payments at last be­ Society was created and in 1795 the came so flagrant that the whole system Abernethian Society.00 was swept away.63 Philanthropy throughout England, Hygiene—the science of public in proportion to the rise in material health and preventive medicine— prosperity, took the practical form of arose during the last half of the cen­ hospitals and infirmaries for gratuitous tury.04 It origin was due to Sir John treatment of the poor.01 The London Pringle05 and Sir Gilbert Blane.06 Dr. Hospital in White Chapel, opened in Pringle, physician to the Earl of Stair 1740 in Featherstone Street as a small in charge of the British Army in Flan­ infirmary, early moved to Prescott ders, 1742, and later physician-general Street, Goodman’s Fields, a Jewish to His Majesty’s forces in the Low neighborhood, and buildings were Countries, eventually became Presi­ erected on its present site in 1757. dent of the Royal Society. His publica­ Every country town soon had its hos­ tions include “Observations of the Jail pital or infirmary. Some of the dates of or Hospital Fever’’ (1750), “Observa­ the openings of hospitals were (of those tions on the Diseases of the Army’’ before the London): York, 1710; Cam­ (first edition, 1752) and an account of bridge, 1719; Westminster, 1720; his method of preserving the health of Guy’s, 1725; St. George’s, 1733; and the crew of H.M.S. Resolution during Captain Cook’s voyage around the and disease. The Black Assize at Old world.07 Despite the curse of scurvy in Bailey in April, 175073 was a court ses­ the Navy, Pringle’s rules and Cook’s sion during which a disease called gaol interpretation of them resulted in the fever fatally and mysteriously (at least voyage of three years and eighteen days to them) crept into the crowded court­ costing but a single life in the crew of room to havoc as Sir Thomas Abney 118, and that not due to scurvy. The presided in robe and wig at the bar. use of “sweet wort,”68 attention to The Lord Mayor of London sat near cleanliness and diet, and preservation Abney, as did many famous judges and from wetness and injuries formed the lawyers. When the doors opened to ad­ principal part of Cook’s hygienic code. mit Mr. Clark, the prisoner from New­ Improved conditions among the gate prison, a foul odor assailed those army’s sick were doubtless introduced in the courtroom, the men near the at Pringle’s historic suggestion when, prisoner drawing back as the fetor of during the battle of Dettingen in 1742, the crowded jail clung to him. But there the Earl of Stair proposed to the Duke was little space to move in; the court­ of Noailles that both French and Eng­ room was packed and the newcomers lish military hospitals be neutral and pushed those spectators in front until immune from attack.69 This arrange­ they were forced close to the prisoner. ment was enforced during the cam­ The trial proceeded and was unevent­ paign in the Low Countries.70 Previ­ fully concluded. But within the week ously the sick were removed a consider­ all those who had been seated near the able distance away at the approach of prisoner—the Lord Mayor, three judges, the enemy, thus calling medical officers eight jurors and forty clerks and spec­ away from the fighting line and result­ tators—within the week all these were ing in death to many for want of timely dead of typhus, known then as the and skillful aid.71 dreaded jail fever.74 Blane, successively physician to Lord The window tax was another contrib­ Rodney’s fleet, physician to St. Thomas’s utor to the general filthiness and lack of Hospital and commissioner to the Ad­ proper sanitation. Pressed to find some miralty for the care of the sick and way to raise money, the English govern­ wounded, made arrangements for pro­ ment75 placed a tax on windows which visioning ships in foreign parts. He as­ resulted in skylights being roofed over certained a quantity of lemon juice was and windows bricked in. Great tene­ supplied, consulted about quarantine ments stood with hardly a window open­ and the arrangement of hulks and some ing and in some jails there were none— of the prisons on shore. His work and the English poor were crowded into that of Pringle mark the beginning of rooms where sunlight never came and a new science. Jail fever is unknown; in those days debtors were shoved into scurvy has disappeared and the English foul dark cells. Typhus ran rampant Navy has become healthy, much of until Reginald Orton, a surgeon of which is due to these two eighteenth Sunderland, was able to successfully century pioneers.72 agitate for replacement of the tax by a The sanitary conditions of jails duty on inhabited houses. throughout England and all Europe Public health76 suffered a little de­ were deplorable and few minds rec­ cline in the last half of the eighteenth ognized any connection between filth century, although the deaths from still- prevalent smallpox varied from a mini­ may also be due to the fact that one at­ mum of 522 in 1797 to a 3582 maxi­ tack of smallpox renders the patient im­ mum in the 1763 epidemic. In July, mune. Too, it was learned after a re­ 1746 the Middlesex County Hospital currence of a virulent epidemic that for Smallpox was opened for the gratui­ the operation had to be repeated for tous inoculation of smallpox.77 The in­ complete protection. Thoroughly at­ oculation operation became fashionable tacked on scientific grounds to prove it —sometimes taking a month’s prepara­ useless, vaccination nevertheless has tion and a two-week detention—and be­ caused deaths from smallpox to drop to came lucrative for those who, like the vanishing point in vaccinated and Ranby, Hawkins and Middleton,78 per­ revaccinated communities while it flour­ formed the operation on patients of the ished elsewhere.83 upper and middle classes of society.79 Edward Jenner’s discovery of the pro­ The Period of England’s Struggle for tective effects of cowpox marks a dis­ Existence (1802-15) tinct epoch in the history of smallpox.80 Just after the opening of the nine­ First announced as a method of treat­ teenth century the medical profession ment in 1796, vaccination met with in England was in a gloomy, mediocre great and powerful support. Power says condition.84 William Hunter had died that allusions to vaccination have been in 1783, Percivall Pott in 1788 and John traced to “Sancteya Grantham,” a San­ Hunter in 1798, leaving Baillie,85 scrit work attributed to Dhanvantari, Brodie,86 and Abernethy87 as the only and he quotes Bruce and Humboldt as names left from the age of George hi saying vaccination was not unknown in which stood out above mediocrity. Persia and South America.81 Dairy farm­ In spite of the attempted reorganiza­ ers in England and Holstein held tra­ tion with a new charter granted in 1800, ditionally that cowpox was a protection the College of Surgeons had fallen into against smallpox. Jenner, who was en­ bad hands; the College of Physicians dowed by his teacher John Hunter with and the Apothecaries’ Society remained the “Don’t think, try” principle, put steady, however. Doctors were not ex­ the theory to test when he vaccinated amined before a permit to practice was eight-year-old James Phipps on May 14, given, but most of them in large towns 1796 with lymph taken from vesicles of belonged to one of the three societies. cowpox on the hand of Sarah Nelmes. The College of Physicians’ members The boy had cowpox, but after being were usually graduated from the older inoculated with smallpox on July 1 he universities, while the other two groups did not catch it. And from that day required potential members to be ap­ Jenner devoted his life to proving the prentices and to pass examinations.88 value of cowpox as a protective agent. A Society of Associated Apothecaries Taken up by the better classes, vaccina­ and Surgeon-Apothecaries was formed tion was extended among the poor by in 1813 with Dr. Mann Burrows89 at its workers led by John Ring82 and George head when the glass tax almost wiped Pearson. Although a drop in the vast out the profits of the apothecaries, who number of cases of smallpox occurred were paid for medicines they supplied after the epidemics of 1796, 1798 and and not for their advice.90 This Society 1800 this may have been not entirely and the two Colleges defeated a project due to the increase of vaccination, but to create an examining board inde­ pendent of all the existing corporations. rather than the real cause. Scarlet-fever The Associated Apothecaries eventually epidemics marked the beginning of the had introduced into Parliament a new nineteenth century,96 but not until later bill to establish the legal practice of in the century did the disease reach its medicine substantially on its present highest mortality. Dysentery greatly de­ basis; the College of Physicians ap­ creased, almost ceasing to be an epi­ proved the bill, while the College of demic after its fatal years 1758-62 and Surgeons stood aloof. The bill passed 1780-82.97 The large decrease in the on January 15, 1815. number of deaths due to typhus and Vaccination progressed in this period other continuous fevers98 in the 1802- in England, many persons being vac­ 1815 period was coincident with the cinated due to the enthusiasm of Ring prosperity caused by higher wages re­ and others. Deaths due to smallpox in sulting from war expenditures. London fell to 622 in 1804 and 751 in The Army Medical Service was reor­ 1811 at a time when the total number ganized in 1799. There was no interme­ of deaths from all causes was 17,000. diate grade between the members of This smallpox average compares favor­ the Medical Board and the Inspector- ably with the 1200 to 2000 annual aver­ General, usually civilians, and the regi­ age deaths of the 1761-1800 period. mental surgeons. Nominated by their Power seems to feel that “It is doubtful regiments after an examination first by whether or not the whole of this in­ the Surgeons’ Company and later by a crease, or even its major part, was not special board, the surgeons were even due to a natural decline in the course on some matters independent of their which marks the course of every en­ commanding officers. They deducted demic disease after a period of unusual four shillings a week from each sick activity.”91 soldier’s pay, this man in turn getting Dr. Edward Jenner92 was voted, after the best food and the freshest meat; a favorable investigation of vaccination wine and malt liquors were furnished by the House of Commons in 1802, a by the government. Hospital beds were sum of ten thousand pounds. Parlia­ provided for 4 per cent of the strength. ment voted twenty thousand pounds A nurse receiving a shilling a day was more on July 29, 1807; and one year secured to prepare slops and comforts later, on June 8, 1808, the National for the sick and injured, to wash and Vaccine Establishment was created.93 occasionally assist in the administration Although several fatal epidemics of of medicines and to cook their rations.99 measles were reported in the seven­ teenth and eighteenth centuries it was The Growth of Medical Education not until the end of the eighteenth that (1815-40) measles,94 whooping cough94 and scarlet There are many reasons for the fact fever95 assumed their deadly attitude to­ that the history of medicine during the ward children. Deaths from whooping nineteenth century is of interest. The cough rose from none in 1704 and 1705 restlessness of the first years of that pe­ to 573 in 1780, but this disease’s in­ riod was a fitting prelude to the great crease was due to more accurate check­ activity that was to come; and the dumps ing and nomenclature. It was not a new into which the profession found itself disease, convulsions from it having pre­ cast for the few years after the close of viously been set as the cause of death the preceding era of scientific ad­ vance100 served only to accentuate the in their profession; the great mass of magnificent achievements in the medi­ general practitioners worked on knowl­ cal field after 1815. edge gathered empirically from their The way was well prepared, then, for own narrow experience. The physicians, a great expansion. The immediate re­ surgeons and apothecaries worked un­ sult of the educational requirements be­ der rules laid down by their own Com­ ginning to be forced upon physicians panies, admission to which was gained and apothecaries was to foster a spirit by examination; but there was no na­ of criticism and careful evaluation of tional law preventing anyone from new and old ideas. Such a condition was practicing without the loose restrictions bound to accomplish much toward lib­ laid down by these Companies; a man eral examination of old interpretations had only to set himself up in business of medical facts and encourage a wealth in order to earn his livelihood healing of research to prove or disprove these other people. facts and uncover new ones. A new era in medicine, then, was Most of the advances in the pure opened in 1815 by the passage through sciences, and in the science, also, of Parliament of the Apothecaries’ Act. medicine, up to 1850 were made by the Some attempt had been made before in­ French.101 Thus England, while not troduction of the Act to secure the sup­ slower to take up the advances in scien­ port of the Physicians’ and the Sur­ tific procedures than were other coun­ geons’ Companies for a similar law tries, was not at this time making her applicable to their own branches of the full contribution of invention. Princi­ profession, but such support was not pal medical names which come down forthcoming. They apparently pre­ to us from this time are those connected ferred not to be interfered with, in deal­ immortally to certain morbid condi­ ing with their own affairs and admitting tions: Bright,102 Graves103 and Stokes.104 persons to their membership, by the As it began to be seen that medicine government.106 waited more and more upon fuller de­ Nevertheless, an act was sponsored by velopment of physics, chemistry and bi­ the apothecaries, and its result was to ology, there arose a demand for better prohibit from practicing as an apothe­ education of those who were to practice cary any person who had not served an medicine. Previous to this time, and apprenticeship to an apothecary of not well into the 1800’s, there were no re­ less than five years and could produce strictions upon practice. Says D’Arcy evidence of sufficient medical education Power: and good character. Druggists and The medical practitioners in England chemists were not included under the at the beginning of this century were the terms of the Act, and the licensing physicians, the surgeons, and the apothe­ powers of Oxford and Cambridge Uni­ caries; beneath these three recognized versities specifically were exempted classes were a group of nondescript per­ from its provisions.106 sons calling themselves surgeon-apothe­ The Apothecaries’ Act of 1815 defi­ caries, men-midwives, cuppers, tooth­ nitely introduced a new note into the drawers, compounders and dispensers of medical profession. Up to that time the medicines.105 state had required no one to produce Of all these only the first three had evidence of his ability to function well gained even the rudiments of learning as a practitioner. Only the Army and Navy required examinations of their the nose and mouth (“Burking”); the medical men. The new law resulted in bodies were then innocently taken to a great impetus to medical education. some anatomist who paid for them and The immediate result of the new de­ asked no questions. mand was the coming into being of a The public storm of horror which large number of private schools. Al­ broke over the Burke and Hare Case111 though these slowly died out again they served as a stimulus to Parliament, infused into British medical education which used up four years in an investi­ some much needed new blood. For the gation, finally passing the Act in 1832. conservatism of teachers in the hospital Subsequent to this act, although instruc­ schools which had reached nearly to tion in medicine improved little for a stagnation was stirred and set into a number of years, the teaching of sur­ current again by the progressive meth­ gery showed quick improvement. To a ods of private teachers.107 These schools large extent was this due to teaching of were, by the opposition of the hospital the great surgeon Sir Astley Paston schools, finally forced out of existence; Cooper, a pupil of John Hunter and but their methods and principles were surgeon at Guy’s Hospital.112 The field taken up later by the Colleges of Physi­ of pathology, also, began to be more cians and Surgeons.108 fully developed and taught, explored Despite these attempts, however, by such men as Wardrop,113 Bright,102 medical education in England fell far Hodgkin114 and Addison.115 These men behind even other parts of the British laid the way for the great period of sci­ Isles. Clinical methods of instruction entific development which followed were ancient109; students coming to Lon­ upon the Anatomy Act. don from Edinburgh or Dublin, where the clinical methods of Paris and Unification of the Profession (1840-67) Vienna were fully appreciated, stopped Subsequent to the Anatomy Act of to look as one would visit a museum 1815 came a period of great develop­ and then proceeded on their way to ment in the science of anatomy. With cities of the Continent to pursue their subjects for dissection more easily avail­ studies. Until the passage of the Anat­ able it eventually became the rule for omy Act in 1832, providing that all un­ each student to conduct his own dis­ claimed bodies should go to the medical section instead of attending upon dem­ schools, there was no provision for ob­ onstrations given by the instructor. taining cadavers. Teachers were forced Anatomy treatises achieved greater ac­ to pay high prices to wretches known as curacy and more complete results, and “resurrectionists” or “body snatchers,” their illustrations became more and who recovered bodies from gibbets and more perfect. Outstanding among the out of graves. This practice led to fright­ anatomists of the first half of the cen­ ful abuses, culminating, in 1827, in the tury was Sir Charles Bell,116 a surgeon, apprehension and arrest of two such anatomist and artist whose drawings of creatures, Burke and Hare, who were the brain and nervous system have never murdering various unimportant and been surpassed. unknown people and selling their Not only did the Act greatly benefit bodies to the medical schools.110 The the study of anatomy. Cadavers were victims were intoxicated and then suf­ now available in a sufficiently plentiful focated by holding a hand tightly over supply that they could begin to be used for purposes of instruction in surgery. fied to practice. Training in the funda­ Consequently there resulted a great ad­ mental sciences appeared to be neces­ vance in surgical procedures which cul­ sary not only for the advanced research minated at the time of the invention of workers but also for the ordinary run anesthesia; at that time operations were of practitioners, in order to train their being performed with remarkable minds to the more and more specialized speed.117 After the introduction of the lines of thought necessary for an under­ use of nitrous oxide and chloroform as standing of medical problems. Higher anesthetics operative procedure was de­ medical education, too, took new forms liberately slowed down to enable the which, with the amassing of intricate surgeon to achieve greater accuracy. and significant details of anatomy, pa­ Further impetus to the science of the thology and symptomology began to practice of medicine was given when take up greater amounts of time in ever physicians, through the use of accurate narrowing fields. instruments, were enabled to make The result of this, of course, was spe­ more scientific diagnoses than was pos­ cialism. As early as 1804 the Royal Lon­ sible in the days when it was necessary don Ophthalmic Hospital was founded, to determine the nature of the disease devoting its space exclusively to diseases from the aspect of the patient. Although of the eye.121 Excluding midwifery, the clinical thermometer had been used ophthalmology is probably the oldest of in the previous century and was rein­ the specialties121; following close upon troduced in 1844 by Dr. John Davy,118 it in the early nineteenth century came its function and usefulness were not ap­ orthopedic surgery (ca. 1830) and, al­ preciated until the publication of Wun­ though laryngology did not come into derlich’s book in 1868.119 The stetho­ existence until about i860, aural sur­ scope was being constantly improved, gery was a distinct specialty much ear­ and numerous treatises on its use were lier. published,120 insuring accuracy of diag­ Principal of the specialties which pri­ nosis in thoracic diseases thought im­ marily had been the concern of the possible in the previous century. A Army Medical Service during the wealth of new precision instruments, 1700’s was the public health. Certain the laryngoscope, the otoscope and such physicians had made, previous to 1800 other aids to effective diagnosis as the and even after that time, contributions various specula, were likewise added to to this field without fully recognizing the physician’s aids during this period. their significance. Epidemiology, how­ The result of all this embodiment of ever, became a serious study after the the element of certainty in the physi­ importance of Jenner’s work was appre­ cian’s work was to create in medicine a ciated and the Board of Health was cre­ new science. The old methods of snap ated, bringing into existence the new diagnosis slowly disappeared along with system of registering births, deaths and sleight-of-hand surgery, and art began marriages on July 1, 1837.122 Although to go hand in hand with the scientific the sciences of public health and state method. medicine were at this time undevel­ Contingent upon the development of oped, certain significant facts were being medicine as a science came, of course, remarked. The foundations for the the necessity for a better education in growth of the science were laid when order that men might be better quali­ Sir Edwin Chadwick, who, as Secretary to the Poor Law Commissioners, ad­ mously disproportionate to their func­ dressed a letter to Lord Russell, then tions.12’ It is certainly not surprising, Home Secretary, pointed out that pre­ then, that qualifications for practice ventable disease was a result of pauper­ varied widely among the different or­ ism.123 ganizations, and that standards suffered Thereafter laws concerning the pub­ greatly as a result. lic health began to be made. The state Taking the bull by the horns Parlia­ first recognized its responsibilities in ment passed, in 1858, the Medical this direction when, in 1840, a law was Act,126 which, although it did not by law passed prohibiting (and making a penal improve conditions of disorganization, offense) the inoculation of smallpox and did give a legal definition to the medical establishing a system of gratuitous vac­ profession, giving, in effect, a statutory cination for the poor.124 The real begin­ constitution to the medical bodies of the ning of public health measures was em­ United Kingdom. Under this Act, a bodied in the Act of 1846 “for the Medical Register was established by Removal of Nuisances and the Preven­ which the public and the courts might tion of Epidemic Disease.”124 From this distinguish between those properly time on, epidemiology and preventive qualified to practice and pretenders not medicine assumed significant roles in lawfully so qualified. A council was the development of state medicine, and created from among the recognized Parliament, suddenly imbued with a bodies (the two Colleges and the Apoth­ sense of responsibility for the health of ecaries’ Society) for the purposes of British subjects, turned to further work the Act and empowered to strike from in the field of medicine. the Register the name of any person The subject upon which the eyes of convicted of a crime or whose conduct the lawmakers now fell was one that was deemed improper; and the Council had long needed their attention. Up to was further authorized to impeach be­ 1858 the medical profession in Great fore the Privy Council any examining Britain had no legal status. The Apothe­ body which gave its diploma upon in­ caries’ Act of 1815 had fixed certain reg­ sufficient preparation.126 ulations intended to govern qualifica­ Although the Act failed to provide tions for the practice of that particular for a complete examination127 it did re­ branch; but by and large the physicians sult in an immediate unification of the and surgeons and the vast realm of profession and a noticeable rise in the pseudo-scientific practitioners beneath them were legally not existent. standards of education. The impeach­ The growth of specialism, the intro­ ment clause gave a power to the Coun­ duction into the profession of a vast new cil that showed response to a long-felt science which tremendously compli­ need; it now remained to define legally cated matters of education and proper what was meant by adequate prepara­ selection of practitioners for fitness, had tion, and this was done in the amend­ scattered the efforts of the various medi­ ment to the Act passed in 1870. cal governing bodies. There were, in Improvements in methods now pro­ England, by the middle of the century, gressed at an exciting rate. New observa­ twenty-two examining boards, each tions on the part of morbid anatomists with special privileges and powers in its and clinicians added vastly to the effec­ own field, some with powers enor­ tiveness of diagnosis, and new methods of treatment, largely the results of clin­ about the human body in normal and ical experimentation in Continental disease conditions that any mortal could centers, rapidly followed. Surgery, too, ever hope to know. The past century, was given a tremendous revival by the particularly up to 1870, was one of a discovery and improvement of anesthe­ great opening out of medicine's possi­ sia,128 and following the reports of Pas­ bilities which gave men of true scien­ teur and Lister129 upon their work on tific humility a glimpse of what yet re­ antisepsis, surgeons were able to open mained to be accomplished, a vast field the abdominal and thoracic cavities, whose horizon recedes ever farther with performing successfully previously im­ each new discovery. The fact that prog­ possible operations. ress was made during the fifty years The nineteenth century was so full after 1820 equal to all the progress of of amazing developments that few could medicine in recorded history before compass immediately their whole sig­ that time simply serves to show the nificance. On the eve of the discovery rapidity with which progress may con­ of the x-ray with its great possibilities tinue to be made with an always in­ for research and diagnosis men made creasing supply of unanswered ques­ bold to say that all was then known tions at hand.

References 1. The best accounts of eighteenth century portrayal of disease in “Commenta­ medicine of the entire Western world ries” (1809). This lifetime work put may be found in Garrison, An Age angina pectoris and other diseases on of Systems and Theories, “An Intro­ a scientific basis and his “Essay on duction to the History of Medicine,” Mithridatium and Theriaca” (1745) pp. 239-337 and Baas, “Outlines of dispelled current superstitions about the History of Medicine,” pp. 588- these curious concoctions and ban­ 828. For the period in England cf. ished them forever. Cf. ibid., pp. 389- Power, Medicine, in Traill, “Social 391 and Baas, op. cit., pp. 650-651. Cf. England,” pp. 419-429 and 554-557. also Heberden “Introduction to the 2. Huxham (1692-1768), one of Boer- Study of Physic,” published for the haave’s pupils, was the son of a first time in 1929 (N. Y., Hoeber). butcher. He often had himself sum­ 4. Sloane (1660-1753), the first physician moned out of conventicle at stated to be made a baronet, enjoyed the intervals, whereupon he would gal­ highest scientific and professional lop through the town to create the reputation, was a founder and later impression of an extensive practice. secretary and president of the Royal He usually stalked about in a scarlet Society, and his museum and library, coat, flourishing a golden headed cane, after his death, became the nucleus a footman bearing his gloves at a re­ of the present British Museum col­ spectful distance. In “Essays on lections. His generosity to the poor Fever” (1755), he distinguished be­ is shown by this example of a letter tween typhus and typhoid; and in to him from Samuel Garth: 1747 recommended that 1200 sailors disabled by scurvy be put on a vege­ “Dear Sir Hans: table diet. Cf. Garrison, op. cit., pp. “If you can recommend this mis­ 292-293, 316. erable slut to be fluxed, you’ll do an 3. Heberden (1710-1801), called by Dr. act of charity for, dear sir, Samuel Johnson “ultimus Romano- “Your obed‘ ser‘ rum, the last of our great physicians,” “S’ Garth” was a fine Greek and Latin scholar, Jbid., pp. 322-323. Cf. also Clenden- resembling the classical writers in his ing, “Behind the Doctor,” pp. 151-157, for an account of Sloan’s studies 196-204; Lambert and Goodwin, under the great Thomas Sydenham. “Medical Leaders from Hippocrates 5. Cullen (1712-90) was instrumental in to Osler,” pp. 197-210; Haggard, founding the medical school at Glas­ “Mystery, Magic and Medicine,” p. gow in 1744, held the chair of medi­ 171; Clendening, “The Human cine and chemistry at Glasgow and Body,” p. 328; Osler, “The Evolution Edinburgh, was the first to give clin­ of Modern Medicine,” pp. 185-189. ical lectures in the vernacular in­ 17. Power, op. cit., p. 420. For discussions stead of in Latin (1757) and was in the history of surgery cf. Haggard, greater as an inspiring teacher than “Devils, Drugs and Doctors,” pp. 127- as a clinician. He advocated many 199; Power, “Medicine in the British forms of water treatment, including Isles,” pp. 38-43; Clendening, “Be­ alternate and simultaneous use of hot hind the Doctor,” pp. 378-392; Hag­ and cold water, still called the “Scotch gard, “The Lame, the Halt and the douche.” Garrison, op. cit., p. 289, Blind,” pp. 311-354; Hartzog, “Tri­ and Clendening, op. cit., p. 297. Cf. umphs of Medicine,” pp. 39-88; Fish- also Baas, op. cit., pp. 616-618. bein, “Frontiers of Medicine,” pp. 6. Garrison, op. cit., p. 223; Power, op. cit., 186-1 go; Garrison, op. cit., pp. 270- p. 420; Tobey, “Riders of the 279; 325'329; Baas, op. cit., pp. 662- Plagues,” pp. 133-137. In the Middle 679; Billings, “History and Litera­ Ages the monks were shaved by bar­ ture of Surgery” (vol. 1 of Dennet’s bers who performed the operation “System”), pp. 1-444. of bloodletting and gradually as­ 18. Garrison, op. cit., p. 267 says, “In Lon­ sumed other surgical prerogatives. don the change from women to men The modern barber’s pole of red and midwives was mainly due to the white stripes is a relic of these old teaching and influence of two Lanark­ days as it represents the bandages ap­ shire men, William Smellie and his plied to bloody parts by the barbers pupil, William Hunter, to Sir Field­ of old. ing Ould in Dublin, and to Charles 7. Garrison, op. cit., p. 221; Powers, op. White in Manchester.” cit., p. 420. 19. The Surgeons formally separated as 8. Johnson described the battle as “on the “Masters, Governors and Common­ side of charity against the intrigues alty of the Art and Science of Lon­ of interest, and of the regular learn­ don,” and it was declared to be a ing against licentious usurpation of penal offense for anyone to practice medical authority.” surgery in London or within a seven- 9. Pope had a slap at: mile radius without being examined Modern pothecaries, taught the art and licensed by ten of their number. By doctors’ bills to play the doctor’s part, Garrison, op. cit., p. 326. Bold in the practice of mistaken rules. 20. Garrison, op. cit., p. 326. 10. Power, op. cit., p. 420. 21. Power, “Medicine” in Traill, “Social 11. Ibid., p. 420. Garrison, op. cit., p. 326, England,” 5:421. For a further dis­ says, “In eighteenth century England, cussion of lectures and medical edu­ there were no surgeons of first rank cation see below. before the time of Pott and Chesel- 22. William Cheselden, a good draughts­ den, Hunter and Abernethy.” 12. Himself a surgeon, he served on an man as well as a doctor, prepared English warship. the plans for Surgeons’ Hall in Old 13. Garrison, op. cit., p. 316. Bailey. Garrison, op. cit., p. 273. 14. Ibid., p. 317 23. Cited by Billings, op. cit., p. 83; also 15. Power, op. cit., p. 420. quoted by Power, “Medicine,” in 16. For good accounts of Morgagni see Gar­ Traill, op. cit., 5:422, and by Garri­ rison, op. cit., pp. 283-285; Seelig, son, op. cit., p. 327. “Medicine: An Historical Outline,” 24. Baas, op. cit., says: “Henry Cline (1750- pp. 142-143; Clendening, op. cit., pp. 1827), a famous surgeon of St. Thomas’s Hospital, was the teacher other man, proved that “the heart and predecessor of Sir Astley Cooper.” acts as a muscular force-pump in pro­ 25. Power, “Medicine,” in Traill, op. cit., pelling the blood along and the 5:423- blood’s motion is continual, continu­ 26. Loc. cit.; and Garrison, op. cit., p. 327. ous, and in a cycle or circle.” Garrison, Since 1843 the College has been op. cit., pp. 177-180. Cf. also Baas, known as the Royal College of Sur­ op. cit., pp. 527-530; Osler, op. cit., geons of England. pp. 163-174; Clendening, “Behind the 27. Power, “Medicine,” in Traill, op. cit., Doctor,” pp. 69-91; and many other 5:422, gives an excellent account of works, including D’Arcy Power, “Wil­ this. liam Harvey” (in “Masters of Medi­ 28. Ibid.., p. 421, cites an order of Council cine”); London, 1897. of June, 1.632 procured by the Col­ 37. William Cheselden (1688-1752), a patron lege of Physicians, which included a of boxing and a good draughtsman, clause that no chirurgeon “doe either became surgeon to St. Thomas’s Hos­ dismember [i. e. amputate], Trepan pital in 1718, wrote an atlas of osteol­ the head, open the Chest or Belly, ogy and was perhaps the most rapid cut for the stone, or doe any great of all the pre-anesthetic operators, operation but in the presence of a performing a lithotomy in fifty-four learned physician.” seconds. His social and professional 29. Cf. Garrison, op. cit., p. 116. status is embalmed in Pope’s couplet: 30. Ibid., pp. 159-160. William Clowes, con­ I ll do what Mead and Cheselden advise sulting surgeon at St. Bartholomew’s To keep these limbs and to preserve these Hospital and physician-in-ordinary to eyes. Queen Elizabeth in 1596, wrote on (Garrison, op. cit., pp. 272-273; Baas, syphilis and also on gunshot wounds. op. cit., p. 273; Power, “Medicine in Cf. Baas, op. cit., p. 418. the British Isles,” p. 32.) 31. Gale (1501-86), called the “English 38. For Percival Pott and William and John Pare,” was an army surgeon of Henry Hunter, cf. infra. vni and Elizabeth; he opposed the 39. Power, “Medicine,” in Traill, op. cit., opinion that gunshot wounds were 5T22. “poisoned” and advocated simple 40. Ibid., p. 423. Cf. Power, “Medicine in the treatment. (Ibid., p. 417.) British Isles,” p. 32; Seelig, op. cit., 32. John Banister (1575) was an eminent p. 145. (Pott is immortalized by the surgeon of Nottingham, who wrote fracture of the tibia, an injury that he several learned works. (Loc. cit.) himself sustained through a fall in 33. John Woodall was in 1589 surgeon of the street, and the tuberculous dis­ the troops Elizabeth sent to Henry iv ease of the spine, both named after of France, and after returning to Eng­ him. Cf. Haggard, “The Lame, the land wrote much and became surgeon Halt and the Blind,” pp. 297-307; Gar­ to the East India Company and St. rison, op. cit., pp. 273-274; Baas, op. Bartholomew’s Hospital in 1615. (Loc. cit., p. 674; Haggard, “Devils, Drugs cit.) and Doctors,” p. 317.) 34. Johannes Cains (John Kaye or Key, 1510- 41. Cf. Garrison, op. cit., p. 267; Baas, op. 73) was the first in England to hold cit., pp. 685-687; Clendening, “The public dissections of human bodies, Human Body,” pp. 308-314; Clenden­ doing so at Henry vm’s command. ing, “Behind the Doctor,” pp. 324-336; (Ibid., p. 372.) Power, “Medicine in the British Isles,” 35. Dr. Butts, ordinary physician to Henry pp. 38-40; Power, “Medicine,” in vni, was immortalized by Shakespeare. Traill, op. cit., 5:423; Haggard, “The (Ibid., p. 413.) Lame, the Halt and the Blind,” p. 36. William Harvey (1578-1657), the great­ 136; Haggard, “Devils, Drugs and Doc­ est man in all English medicine and tors,” pp. 3-43. whose work exerted a greater influ­ 42. Smellie (1697-1763), a Scotsman, came to ence on modern medicine than any London at a time when midwifery conditions were so bad it was seriously 50. Now in Glasgow. discussed throughout the country 51. Cared for by the Royal College of Sur­ whether Mary Tofts, the wife of a geons of England at Lincoln’s Inn laborer at Goclalming, had or had not Fields. given birth to litters of rabbits. Smel- 52. Cf. Power, “Medicine” in Traill, op. lie, in 1752, published “Theory and cit., 5:424; Garrison, op. cit., pp. 330- Practice of Midwifery,” the founda­ 331; Baas, op. cit., pp. 787-788; Osler, tion of scientific obstetric medicine op. cit., pp. 178-179; Power, “Medicine which discarded the old ideas and su­ in the British Isles,” pp. 24-38. perstitions. Cf. Power, “Medicine in 53. Sharp (1700-78) was eminent in almost the British Isles,” pp. 60-61; Baas, op. every department of surgical art and cit., p. 685; Garrison, op. cit., pp. 267- in his “Critical Inquiry into the Pres­ 268; Haggard, “Devils, Drugs and ent State of Surgery” (1750) he called Doctors,” pp. 46-48. attention of his English colleagues to 43. Douglas (1676-1742) discovered the peri­ the advances made by the French in toneal pouch and enjoys the question­ the science and art of surgery. It was able honor of having his name asso­ Sharp who began private medical ciated for all time with the most teaching at the request of some naval highly infective portions of the intes­ surgeons. Baas, op. cit., p. 674; Power, tinal tract. Cf. Seelig, op. cit., p. 131; “Medicine in the British Isles,” p. 32. Garrison, op. cit., p. 261; and Baas, 54. The first course netted Hunter seventy op. cit., pp. 676, 689. guineas, and when Matthew Baillie 44. The two Gregoire brothers improved retired from its management at the the “Palfyn’s hand” obstetrical for­ end of the century he received four ceps, adding to it a kind of lock and hundred pounds for his share in the above all fenestrated blades, also good will. The school continued until founding in 1720 the Hotel Dieu, the 1831. first obstetrical clinic for physicians. 55. Power, “Medicine in the British Isles,” Cf. Baas, op. cit., p. 680. P- 33- 45. On both John (1728-93) and William 56. Power, “Medicine,” in Traill, op. cit., Hunter (1718-83) cf. Baas, op. cit., pp. 5:425- 675, 686; Garrison, op. cit., pp. 268- 57. The first chair in clinical medicine in 269, 274-278; Seelig, op. cit., pp. 144- Great Britain was established in Edin­ 145; Power, “Medicine in the British burgh in 1741 with John Rutherford Isles,” pp. 61-62; Lambert and Good­ as its incumbent. Not until 1780 did win, op. cit., pp. 160-166; Clendening, Oxford obtain a similar chair. Baas, “Behind the Doctor,” pp. 249-258, and op. cit., p. 738; Osler, op. cit., p. 194, many others, including Stephen Paget, sets the Edinburgh date as 1747. “John Hunter” (in “Masters in Medi­ 58. Baas, op. cit., p. 600; Power, “Medicine,” cine,” London, 1897) and R. G. Fox, in Traill, op. cit., 5:425; Power, “William Hunter” (London, 1901). “Medicine in the British Isles,” pp. 46. On the whole field of pathology cf. E. 54-58. Plong, “A History of Pathology” 59. The London Bridge Railway station (Balt., Williams and Wilkins, 1928); now stands on this site. also on eighteenth century in Eng­ 60. Baas, op. cit., p. 600, says: “England re­ land cf. Baas, op. cit., pp. 700-702, ceived in 1757 a ‘Society of Phy­ Garrison, op. cit., 283-286, Osler, op. sicians’ of London and in Edinburgh cit., pp. 184-189, and Clendening, a society of similar name was formed “The Human Body,” pp. 323-384. as early as 1731,” and H. E. Hander- 47. Cf. Garrison, op. cit., pp. 259-266. son, the translator of Baas, adds in a 48. Power, “Medicine,” in Traill, op. cit., footnote, “I am not quite certain as 5:423- to what associations these titles refer. 49. There is annually delivered in his honor The only medical societies of note in London an oration on some surgi­ founded in Great Britain in the eight­ cal topic. eenth century of which I am ac­ quainted are ‘The Royal Medical 67. Clendening, “Behind the Doctor,” pp. Society of Edinburgh’ (1737), ‘The 225-236; Haggard, ‘The Lame, the Medical Society of London’ (1773) and Halt and the Blind,” pp. 355L; Power, ‘The Abernethian Society of London’ “Medicine,” in Traill, op. cit., 5:426. (>795)-” 68. An herb or plant of the cabbage kind. 61. Power, “Medicine in the British Isles,” 6g. Garrison, op. cit., p. 293; Power, “Medi­ pp. 14-24; Power, “Medicine,” in cine,” in Traill, op. cit., 5:427. Traill, op. cit., 5:425-426; Haggard, 70. The rule remained loosely in force and “Devils, Drugs and Doctors,” pp. 297- was placed on an absolute basis 298; Haggard, “The Lame, the Halt through Henri Dunant in the 1864 and the Blind,” pp. 118-128; Garri­ Geneva Convention. son, op. cit., pp. 331-332; Baas, op. cit., 71. Cf. Baas, op. cit., p. 798; Garrison, op. PP- 768-770. cit., p. 294. 62. These figures and dates are from Power, 72. Power, “Medicine,” in Traill, op. cit., “Medicine in the British Isles,” p. 19. 5:427- In his earlier work in Traill’s “Social 73. This was the fourth Black Assize; three England,” 5:425-426, his dates are dif­ were in the sixteenth century, one ferent: York, 1740; Exeter, 1741. each at Oxford, Cambridge and 63. Power, “Medicine in the British Isles,” Exeter. p. 21. Even as late as 1828 reforms 74. Haggard, “The Lame, the Halt and the had not come, as this story related by Blind,” pp. 186-194; Power, “Medi­ Powrer shows: One bitterly cold night cine,” in Traill, op. cit., 5:427. that year William Marsden, a pupil 75. The tax was originally imposed in 1696 of John Abernethy, found lying on the and in 1710 houses of twenty to thirty steps of St. Andrew’s Church a girl windows paid ten shillings, those with of eighteen, nearly dead of disease and more windows twenty shillings. Cf. starvation. She had been refused ad­ loc. cit.; and Haggard, op. cit., pp. mission to St. Bartholomew’s, hardly 189-192. a stone’s throw away, because she had 76. Cf. Baas, op. cit., p. 715; Power, “Medi­ neither money nor a governor’s letter. cine,” in Traill, op. cit., 5:428; Power, He cared for her, started agitation, “Medicine in the British Isles,” p. 23. had the whole system abolished and 77. In-patients were inoculated there until the “Royal Free Hospital” created. 1821, although vaccination had re­ 64. Cf. Garrison, op. cit., p. 251; Baas, op. placed this for out-patients in 1807. cit., pp. 706-711, 715; Haggard, “Dev­ 78. Garrison, op. cit., p. 326, mentions ils, Drugs and Doctors,” pp. 281-282; Ranby (see above); Hawkins is only Power, “Medicine,” in Traill, op. cit., mentioned by Power, “Medicine,” in Traill, op. cit., 5:428; Peter Middle­ 5:426®. ton (died 1781) is cited by Baas, op. 65. Pringle (1707-68) is the founder of mod­ cit., p. 808 as a native of Scotland who ern military medicine and the origi­ in 1750 with Dr. John Bard injected nator of the Red Cross idea. He also and dissected by public permission the named influenza and correlated the body of a criminal before a class of different forms of dysentery. Cf. Baas, students, and became later a profes­ op. cit., p. 650; Clendening, “Behind sor at Kings College, New York City. the Doctor,” p. 235; Garrison, op. cit., 79. Power, “Medicine,” in Traill, op. cit., p. 293; Haggard, “Devils, Drugs and 5:428. Doctors,” p. 133; Haggard, “The 80. Concerning smallpox, vaccination and Lame, the Halt and the Blind,” pp. Jenner cf. Seelig, op. cit., pp. 146-147; 187-189; Power, “Medicine,” in Traill, Baas, op. cit., pp. 709-711, 729-730; op. cit., 5:426-427. Garrison, op. cit., pp. 245, 303-306, 66. Blane (1749-1834) recommended lime 335; Power, “Medicine,” in Traill, op. juice for scurvy in his “Observations cit., 5:428-429; Power, “Medicine in on the Diseases of Seamen” (1785). the British Isles,” pp. 62-63; Haggard, Garrison, op. cit., p. 294. “The Lame, the Halt and the Blind,” pp. 216-226; Haggard, “Devils, Drugs ting him up as if he were any other and Doctors,” pp. 220-232; Osler, op. piece of flesh. Why not,” says Clen­ cit., pp. 198-200; Clendening, “Be­ dening. hind the Doctor,” pp. 204-224; Clen­ 86. Sir Benjamin Collins Brodie (1783- dening, “The Human Body,” pp. 340- 1862) acknowledged head of the medi­ 349; Lambert and Goodwin, op. cit., cal profession in London for over pp. 230-238; Hale-White, “Great Doc­ thirty years; his income often averaged tors of the Nineteenth Century,” pp. ten thousand pounds yearly; “his vo­ 1-22. cation was more to treat limbs than 81. Power, “Medicine,” in Traill, op. cit., remove them.” President of the Royal 5:428. College of Surgeons, he nevertheless 82. Ring (1752-1821) supplied the virus for once wrote to an almost unknown stu­ the first American vaccination in 1800. dent, “I hear you are ill; no one will Baas, op. cit., p. 711. take better care of you than I; come 83. The practice of vaccination has since to my country house till you are well,” become compulsory among all the making the student remain with him more highly civilized nations and al­ two months. Garrison, op. cit., pp. though absolute immunity is not con­ 427-428; Baas, op. cit., p. 1045. ferred, the individual is protected for 87. Abernethy (1764-1831), professor of a varying length of time from small­ anatomy and surgery at the R. C. S. pox’s worst effect or he escapes with and John Hunter’s successor in Lon­ a mild form of the disease. don maintained the propriety of the 84. For the whole period cf. Power, “Medi­ internal treatment of surgical lesions. cine,” in Traill, op. cit., 5:554-557; Although kind and generous at bot­ Baas, op. cit., pp. 1042-1049, 1087- tom he affected a brusque, downright 1093; Garrison, op. cit., pp. 350-361; manner with his patients on the Seelig, op. cit., pp. 146L; Haggard, ground that masterful rudeness wins “Mystery, Magic and Medicine,” pp. confidence where amiability suggests 92E weakness and so diminishes respect. 85. Matthew Baillie (1761-1823) was one of Cf. Baas, op. cit., p. 676; Garrison, op. five Englishmen (the others were John cit., pp. 278-279; Clendening, “Be­ Radcliffe, Richard Mead, Adam As­ hind the Doctor,” pp. 283-288. In kew, William Pitcairne) who were naming his prominent men Power made famous by “The Gold Headed includes only physicians, omitting the Cane,” essays by William Macmichael surgeons Jenner and Sir Astley Paston (1827). Osler, op. cit., p. 198; Clenden­ Cooper (1768-1841). Cf. Garrison, op. ing, “Behind the Doctor,” p. 328; cit., pp. 421-423; Hale-White, op. cit., Seelig, op. cit., p. 145; Garrison, op. pp. 22-41. cit., p. 270; Baas, op. cit., pp. 701-702. 88. Power, “Medicine in the British Isles,” Baillie, a son of Hunter’s sister, one PP- 9-ib 27-37. of the most eminent pathological anat­ 89. This is possibly G. M. Burrows (1771- omists, always kept in view the prac­ 1846), proprietor of a private asylum tical aims of medicine. He published at Clapham and writer on causes, in 1794 the “Atlas of Morbid An­ forms, treatments of insanity. Baas, atomy,” the first important book in op. cit., p. 920. the English language on the topic. 90. Power, “Medicine,” in Traill, op. cit., One of the plates represents a lung 5=555- and is an illustration of the disease 91. Ibid., p. 556. Figures quoted are from called “emphysema.” The lung, ac­ Power also. cording to Dr. Charles Singer, was 92. Cf. supra, p. 285. that of Dr. Samuel Johnson: its state 93. It is now part of the local government accounts for the “heavy form, rolling,” Board. and the “puffing” of Macaulay’s de­ 94. Cf. Garrison, op. cit., p. 335; Baas, op. scription. “So the great Cham is dead, cit., p. 730; Clendening, “Behind the and here is dry little Dr. Baillie cut­ Doctor,” pp. 156-240; Clendening, “The Human Body,” pp. 70, 340; Os­ his “statements and conjectures re­ ler, op. cit., p. 96; Power, “Medicine,” garding the dependence of a peculiar in Traill, op. cit., 5:556. class of dropsies on disease and irrita­ 95. Loc. cit.; cf. also Clendening, op. cit., tion of the Kidneys.” (Preface, p. p. 70; Clendening, “Behind the Doc­ viii). These furnish the first clinical tor,” p. 157; Baas, op. cit., p. 730. description of Bright’s disease. On the 96. One epidemic was preceded by a re­ life of Bright cf. Osler, op. cit., p. 204; markable one “of an apparently anal­ Garrison, op. cit., pp. 4 igf.; Baas, op. ogous disease which is said to have cit., gogff.; Hale-White, op. cit., pp. carried off ‘myriads’ of cats.” Power, 64-84. “Medicine,” in Traill, op. cit., 5:556. 103. Robert James Graves was chief physi­ 97. Cf. Osler, op. cit., p. 241; Haggard, “The cian to the Meath Hospital and one Lame, the Halt and the Blind,” p. of the founders of the Park Street 82; Clendening, “Behind the Doctor,” Medical School in Dublin. He was a p. 240; Garrison, op. cit., p. 293; Baas, leader, with Stokes, of the “Irish op. cit., p. 549, 729; Power, “Medi­ School” of physicians, and is chiefly cine,” in Traill, op. cit., 5:556-557; remembered for his admirable de­ Masters, “Conquest of Disease,” p. scription of exophthalmic goiter, 234- which disease now distinguishes his 98. Cf. Hartzog, “Triumphs of Medicine,” name. His “Clinical Lectures” (1848) p. 293; Osler, op. cit., p. 222; Baas, op. introduced many elements of diagno­ cit., pp. 548-549, 728; Power, “Medi­ sis now taken for granted, such as the cine,” in Traill, op. cit., 5:557. “pin-hole pupil,” timing the pulse by 99. Loc. cit. Cf. also Power, “Nursing,” in a watch and, in treatment, discarding “Medicine in the British Isles,” pp. 49- the old lowering or “antiphlogistic” 53; Haggard, “Devils, Drugs and Doc­ treatment of fevers. Cf. Garrison, op. tors,” pp. 167-168. cit., p. 419; Baas, op. cit., p. 721. 100. Cf. supra. 104. William Stokes, immortalized by his 101. Garrison, op. cit., p. 408; it was during description (1842) of the Cheyne- this period that the Frenchman Laen- Stokes respiration, was Graves’ col­ nec (1782-1825) invented the stetho­ league at Meath Hospital and Regius scope and wrote the two editions of his Professor of Medicine at Dublin. His classic work, “Traite de l’auscultation treatise on diseases of the chest (1832) mediate” (1819 and 1826) on its use and of the heart and aorta (1854) in the diagnosis of conditions of the have won him lasting fame. Cf. Hale- thoracic organs. Cf. Garrison, op. cit., White, op. cit., pp. 124-143. pp. 411-412; Baas, op. cit., pp. 1012- 105. Power, “Medicine,” in Traill, op. cit., 1013; Osler, op. cit., pp. 203-205. 6:64. 102. Richard Bright (1789-1858) was for 106. Cf. ibid.., p. 65. twenty-three years (1820-43) physician 107. Ibid., p. 66. at Guy’s where, besides his work in 108. The system of medical education and the wards and post-mortem room, he examination in Great Britain is ex­ tremely confusing. To this day, physi­ conducted lectures in materia medica cians and surgeons are licensed to and clinical medicine. He recorded, practice not by the government but without theorizing, a vast number of by their respective Colleges. The sys­ facts concerning pathological condi­ tem as it now stands is fundamentally tions which he described so clearly as the same as when it first was intro­ to leave an indelible impression on duced in 1494. For an excellent un­ the reader. In 1827 ar,d 1^31 he pub­ tangling of the way in which all this lished two volumes of “Reports of works cf. Baas, op. cit., pp. 787-791 Medical Cases, Selected with a View and Power, “Medicine in the British of Illustrating the Symptoms and Cure Isles,” pp. 24-37. Some history of med­ of Diseases by a Reference to Morbid ical education and a good description Anatomy.” Volume 1 begins with a of the system now current can be got series of cases on which Bright based from these works. 109. Garrison, op. cit., pp. 407-558. (1837); and his great monograph: “On 110. Ibid., p. 447. the Constitutional and Local Effects 111. The two culprits were not the only ob­ of Disease of the Suprarenal Cap­ jects of public vituperation. The hap­ sules” paved the way for study of the less scientist to whom the last body diseases of the ductless glands and had been sold was Dr. Robert Knox, gave the name of “Addison’s disease” who was mobbed by a crowd during to the suprarenal syndrome. Cf. loc. the trial and whose name was so be­ cit.; Garrison, op. cit., p. 422; Hale- smirched in the press and pulpit that White, op. cit., pp. 106-123. his practice and teaching pursuits 116. Sir Charles Bell (1774-1842), the lead­ were ruined. Most historians incline ing British anatomist of his day, is to the belief that Knox was wholly now celebrated as a physiologist and innocent of any guilt in this case. Cf. neurologist as well. He had an un­ notes to items 3130 and 5470, Osler, common artistic gift and illustrated “Bibliotheca Osleriana.” his own “System of Dissections” 112. Sir Astley Paston Cooper (1768-1841) (1798), “Engravings of the Brain and was one of the pioneers in the surgery Nervous System” (1802) and his of the vascular system, in experimen­ Bridgewater treatise on the hand tal surgery and in the surgery of the (1833). In 1811 Bell published “A ear. A comprehensive account of his New Idea of the Anatomy of the life and accomplishments may be Brain and Nervous System” in which found in Hale-White, op. cit., pp. 22- for the first time was noted that stim­ 42. Cf. also Garrison, op. cit., p. 479. ulation of the nerves of the anterior 113. James Wardrop (1782-1869), graduate fasciculus along the spine would con­ of Edinburgh, is best known for his vulse the muscles of the back, while treatise on the pathology of the eye no such result could be produced by (1808) and his method of treating manipulation of the nerves of the pos­ aneurysm by ligating on the distal terior fasciculus. It was left, however, side of the tumor. Cf. Garrison, op. to someone else to draw the proper cit., p. 480. inferences from this experiment and 114. Thomas Hodgkin (1798-1866) was a distinguish between sensory and member of the Society of Friends, a motor nerves. Cf. Hale-White, op. philanthropist and reformer by na­ cit., pp. 43-63; Baas, op. cit., p. 1047. ture. He was driven away from Guy’s 117. It is reported (cf. note 37) that Chesel­ Hospital because of his eccentric in­ den, in 1723, performed a lithotomy dependence. His fame is derived from in fifty-four seconds. The average his description of lymphadenoma, a time then was three minutes, al­ condition previously vaguely out­ though some patients were kept lined (as he himself records) by Mal­ under the knife for as long as half an pighi in 1665, and later (by Wilks, hour for this procedure. Cf. Garrison, 1865) labelled “Hodgkin’s disease.” op. cit., p. 343. His “Lectures on the Morbid Anat­ 118. Power, “Medicine,” in Traill, op. cit., omy of the Serous and Mucous Mem­ 6:361. branes” is one of the first contri­ 119. Carl Reinhold August Wunderlich butions to English pathology. Cf. (1815-77) was a German physician, Garrison, op. cit., p. 423; Baas, op. professor of medicine at Leipzig. His cit., p. 916. treatise on the relation of animal heat 115. Thomas Addison (1793-1860), a col­ to disease (1868) exerted a profound league of Bright at Guy’s, was “more influence upon the whole science of the pathologic lecturer and diagnosti­ medicine, as profound, probably, as cian than successful practitioner.” Laennec’s work on auscultation. The He was extremely productive of sig­ German’s theory has an interesting nificant work: he was the first to use background in the mathematical and static electricity in the treatment of physical researches of Clausius, Helm­ spasmodic and convulsive diseases holtz and Sir William Thompson (Lord Kelvin) into the laws govern­ Bibliography ing heat transformations. Cf. Gar­ Baas, J. H. Outlines of the History of Medi­ rison. op. cit., p. 431. cine and the Medical Profession. Tr. by 120. Cf. Osler’s “Bibliotheca Osleriana,” H. E. Handerson. N. Y., Vail, 1889. Baas’s items 1318-1339, 1918, 2351, 2604- history, originally in German, has been 2606, 2718, 3989 and 7721-7724. greatly enhanced by Mr. Handerson’s 121. Power, “Medicine,” in Traill, op. cit., translation. The work was for long the 6:68. standard medical history, and still de­ 122. Ibid., 6:193. The Public Health Act of servedly enjoys an excellent reputation for 1848 amended this law and made pro­ accuracy and excellent organization of visions for sanitation in cities and materials carrying up to ca. 1887, shortly towns. Cf. Baas, op. cit., p. 921. before its publication. 123. Garrison, op. cit., p. 660; Baas, op. cit., Beaumont, G. E. Recent Advances in Medi­ p. 920. cine. Phila., Blakiston, 1928. 124. Power, “Medicine,” in Traill, op. cit., Berdoe, E. The Origin and Growth of the 6:194. Healing Art, A popular History of Medi­ 125. Despite acts of Parliament and attempts cine in All Ages and Countries. London, on the part of certain enlightened Sonnenschein, 1893. This work, shorter and but unfortunately isolated members less technical than the standard histories, is of the Colleges of Physicians and yet accurate and well fdled with significant Surgeons and of the Society of Apoth­ material. It is not popular in the sense ecaries, somewhat the same condition that word is now understood. prevails in England now. Cf. Power, Clendening, L. Behind the Doctor. N. Y., “Medicine in the British Isles," pp. Knopf, 1930. 24-37- The Human Body. N. Y., Garden City 126. Power, “Medicine,” in Traill, op. cit., Pub., 1930. Significant material is drowned 6=359- in a welter of more or less explanatory 127. It was amended in this respect by the verbiage for the benefit of the layman. Medical Acts of 1870 and 1886. Fishbein, M. Frontiers of Medicine. N. Y., 128. Nitrous oxide as an anesthetic was an­ Century, 1933. The editor of the Journal nounced by the American dentists of the American Medical Association Horace Wells and William Thomas writes for the layman. Green Morton in 1844. This was fol­ Garrison, F. H. An Introduction to the His­ lowed shortly (1847) by the discov­ tory of Medicine. Phila., Saunders, 1914. ery of the anesthetic properties of (Citations from chapters hi and iv are to chloroform by Sir James Young Simp­ the 4th edition, 1929.) The current stand­ son, professor of obstetrics at Edin­ ard work in the history of medicine. The burgh. Cf. Garrison, op. cit., pp. 505- best and most complete history available 506; cf. also the life of Simpson in in one volume. Hale-White, op. cit., pp. 143-158. Haggard, H. E. Devils, Drugs and Doctors, 129. Lister (1827-1912) probably is the great­ the Story of the Science of Healing from est name in English medicine. His Medicine Man to Doctor. N. Y., Harper, contribution of antisepsis to surgery, 1929- making possible the saving of count­ The Lame, the Halt and the Blind. N. Y., Harper, 1932. less lives, is only one among his nu­ Mystery, Magic and Medicine. N. Y., merous gifts to medicine. Cf. Garri­ Doubleday, Doran, 1933. son, op. cit., pp. 588-592; Baas, op. Dr. Haggard’s books are exactly what cit., pp. 921, 1006, 1030, 1049; Osler, their titles sound like, and are popular “Evolution of Modern Medicine,” presentations rather than scientific. pp. 240-242; and the short life in Hale-White, W. Great Doctors of the Nine­ Hale-White, op. cit., pp. 246-267. Cf. teenth Century. Lond., Arnold, 1935. A also for a bibliography of works by collection of well-conceived, short biog­ and about Lister, Osier’s “Bibliotheca raphies of twelve physicians and surgeons Osleriana,” items 1675-1685 and 7725. of the nineteenth century in England, this work gives much of the human side of the which succeeds in making scientific works profession. It is not particularly “popu­ literary. lar.” Power, Sir D’A. The Foundations of Med­ Hartzog, H. S. Triumphs of Medicine. ical History. Balt., Williams & Wilkins, N. Y., Doubleday, Doran, 1927. More pop­ 1931. Not adequate to serve as a foundation ular than scientific. for a weighty study of medical history. Lambert, S. W., and Goodwin, G. M. Med­ Medicine. In: Traill, H. D., Social Eng­ ical Leaders from Hippocrates to Osler. land. 6 vols. London, Cassell, 1896. A Indianapolis, Bobbs-Merrill, 1929. A col­ series of short articles taking up the his­ lection of short biographies which selects tory of medicine in different periods of a few outstanding men from all ages and British history illustrating the social im­ all nationalities. portance of the growth of the medical pro­ Long, E. R. A History of Pathology. Balt., fession. Williams & Wilkins, 1928. The standard Medicine in the British Isles. N. Y., work on pathology recommended by Gar­ Hoeber, 1930. A scanty outline of the his­ rison. Not too technical to be appreciated. tory of English medicine, together with a Masters, D. The Conquest of Disease. N. Y., very helpful treatment of the present insti­ Dodd, Mead. tutions and educational systems in Eng­ Osler, Sir W. An Alabama Student and land. Other Biographical Essays. N. Y., Oxford Rivers, W. H. R. Medicine, Magic and Re­ Univ. Press, 1908. ligion. N. Y., Harcourt Brace, 1924. Bibliotheca Osleriana. Oxford, Claren­ Seelig, Maj. G. Medicine: An Historical don Press, 1929. An enormous bibliog­ Outline. Balt., Williams & Wilkins, 1925. raphy of more than 7500 titles, being a A short history for the layman. catalogue of the library left by Dr. Osler to the McGill University. The most com­ Sigerist, H. E. Man and Medicine. N. Y., plete bibliography, well annotated, that is Norton, 1932. available in the history of medicine. Tobey, J. A. Riders of the Plagues. N. Y., The Evolution of Modern Medicine. Scribner, 1930. An exciting story of the New Haven, Yale Univ. Press, 1921. A parts played by physicians in the various series of lectures delivered at Yale Univer­ courses of historic plagues; in effect, a sity on the Silliman Foundation in April, sketchy history of epidemic disease, well 1913. Well illustrated, this 240 page his­ told and, though extremely short, accurate tory is written in Osier’s matchless style as far as it goes.