A MEASURE OF THE ELITE: A HISTORY OF MEDICAL PRACTITIONERS IN HARLEY STREET, 1845-1914 MICHELE STOKES UNIVERSITY COLLEGE LONDON DOCTOR OF PHILOSOPHY ProQuest Number: 10015847 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10015847 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 FOR DICK, TOM, JACQUES AND AMELIA. ACKNOWLEDGEMENTS I wish to thank a number of people who have given me their time and professional advice during the preparation of this thesis. Specific thanks must go to my supervisor Professor William Bynum whose scholarly rigour encouraged me to constantly challenge my own intellectual boundaries. I am deeply grateful for his unstinting advice and support. Special mention must also be made to Dr Anne Hardy for her valued advice, academic precision and editorial supervision. I have been fortunate in receiving help from librarians and archivists, in particular from Richard Bowden at the Howard de Walden Estates, Victoria North at the Royal Free Archives Centre and archivists at the RCS, RCP and the RSM. I should like to thank my colleagues and the Library staff at the Wellcome Trust Centre for the History of Medicine at UCL for their help during the course of my research. Dr Eileen Magnello made valuable comments on the numerical elements of the thesis and her keen eye was important during the proof reading stages. I should also like to thank Professor Christopher Lawrence for his enthusiasm for the project and Dr. Michael Neve for his editorial comments. As the foundation of this thesis was a large database I am grateful to my colleagues in the IT department, in particular Gwyn Griffiths for his technical support and advice over the period. Finally, the late Professor Roy Porter inspired me to study the history of medicine. Thesis Abstract Though Harley Street has been viewed as the provenance of the medical élite in Britain, no attempt has been made to systematically examine this élite in its historical context or to consider the veracity of this view. Hence, this thesis reconstructs the totality of all the male {n = 657) and female (zz = 24) medical practitioners who arrived in Harley Street from 1845-1914 by undertaking a prosopographical analysis and contextualising the historical background in which they lived and worked. Over the course of the nineteenth century, Harley Street became a progressively more fashionable choice for medical practitioners wishing to establish a practice in London and in most cases, this address represented the pinnacle of their career trajectory. It is argued here that an élite medical enclave did, indeed, establish itself in this geographical area during the period. The group’s reputation was assessed through their medical qualifications, scholarships, prizes, teaching and hospital posts, publications, public lectures and their role in medical societies. Harley Street medical practitioners differed from other London medical practitioners because they published more material (85 of the cohort in general and 93 percent of the cohort who qualified MD published their work, in contrast to up to 50 per cent of London medical practitioners), had more prestigious qualifications (86 per cent were qualified MD, MB, FRCP, FRCS or MRCP in contrast to approximately 25 per cent in Greater London), were members of medical societies (almost 90 per cent of the cohort in contrast to between 40 and 50 per cent of GPs in Britain), created new medical specialities, established specialist hospitals, took prominent roles in medical societies and delivered renowned public lectures that were published in the main medical journals. Moreover, this group wielded considerable collective editorial control in a wide range of medical publications. Hence, their efforts greatly facilitated the professionalisation of medicine in the late nineteenth and early twentieth centuries. Through their senior hospital and teaching posts the cohort had an important influence on the next generation of medical practitioners, as these connections were crucial in attracting new medical practitioners to the Street. This thesis, therefore, determines whether Harley Street can be regarded as a measure of the medical élite. Table of contents THESIS ABSTRACT..................................................................................................................4 TABLE OF CONTENTS............................................................................................................6 Ta b l e of Pl a t e s ................................................................................................................................................ 7 Ta b l e of Gr a p h s ...............................................................................................................................................7 LIST OF ABBREVIATIONS.....................................................................................................8 CHAPTER 1............................................................................................................................... 10 Introduction .................................................................................................................................................... 10 So u r c es a n d Ev id e n c e ................................................................................................................................ 22 M e t h o d o l o g y ................................................................................................................................................. 29 CHAPTER 2...............................................................................................................................44 THE BIRTH OF THE MEDICAL ELYSIUM.......................................................................44 Th e B irth of Ha r l e y Street a s a M edical Qu a r t e r ..................................................................64 CHAPTER 3 ............................................................................................................................. I ll MEDICAL EDUCATION.......................................................................................................I ll CHAPTER 4............................................................................................................................. 147 ESTABLISHING AND DEVELOPING A CAREER: HOSPITAL AND TEACHING POSTS....................................................................................................................................... 147 CHAPTERS.............................................................................................................................208 PROFESSIONAL ADVANCEMENT AND THE TRANSMISSION OF MEDICAL KNOWLEDGE — PUBLIC LECTURES AND SOCIETY MEMBERSHIPS.................208 Rit u a l s a n d Pu blic Le c t u r e s ...............................................................................................................209 M edical So c ie t ie s ...................................................................................................................................... 226 CHAPTER 6.............................................................................................................................267 PROFESSIONAL ADVANCEMENT AND THE TRANSMISSION OF MEDICAL KNOWLEDGE — MEDICAL PUBLICATIONS................................................................267 CHAPTER 7 .............................................................................................................................320 WOMEN MEDICAL PRACTITIONERS OF HARLEY STREET...................................320 CHAPTER 8 .............................................................................................................................373 CONCLUSION........................................................................................................................373 APPENDIX A ...........................................................................................................................382 APPENDIX B ...........................................................................................................................384 APPENDIX C...........................................................................................................................387 APPENDIX D ...........................................................................................................................402 APPENDIX E ...........................................................................................................................411 APPENDIX F ...........................................................................................................................412 BIBLIOGRAPHY....................................................................................................................420 Table of Plates PLATE 1.1, MAP OF THE HARLEY STREET AREA........................................................13 PLATE 2.1, PLAN OF THE MARYLEBONE ESTATE.......................................................47