Medical Science as Pedagogy in Early Nineteenth-century Britain: Charles Bell and the Politics of London Medical Reform by Carin Berkowitz Caruso This thesis/dissertation document has been electronically approved by the following individuals: Seth,Suman (Chairperson) Hilgartner,Stephen H. (Minor Member) Dear,Peter Robert (Minor Member) MEDICAL SCIENCE AS PEDAGOGY IN EARLY NINETEENTH-CENTURY BRITAIN: CHARLES BELL AND THE POLITICS OF LONDON MEDICAL REFORM A Dissertation Presented to the Faculty of the Graduate School of Cornell University In Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy by Carin Berkowitz Caruso August 2010 © 2010 Carin Berkowitz Caruso MEDICAL SCIENCE AS PEDAGOGY IN EARLY NINETEENTH-CENTURY BRITAIN: CHARLES BELL AND THE POLITICS OF LONDON MEDICAL REFORM Carin Berkowitz Caruso, Ph. D. Cornell University 2010 In the early nineteenth century, Charles Bell and François Magendie became embroiled in a priority dispute over the discovery of the roots of motor and sensory nerves. I use this priority dispute to open an examination of pedagogy and medical reform, looking at the importance of visual displays in both the classroom and in print, the development of different audiences with the expansion of medical and scientific journals, the significance of experiment and practice in medical education, and the role of national and professional politics that were involved in practically every issue in the medical community. During the period in which the discovery was actively contested, 1823-1842, British medical audiences and communities were reconfigured by the simultaneous development of a new university and new hospital schools in London and by the birth of medical periodicals. Many medical periodicals declared their positions openly, representing particular political and professional factions. While other historians have documented the work of radical reformers, my dissertation focuses on another group of reformers, one that claimed to be preserving and enhancing what was “characteristically British.” These “conservative reformers” sought to improve medical education in Britain by creating more practical training for surgeons, physicians, and general practitioners. They proposed offering joint training in medicine and surgery, connecting lectures on fundamental subjects like anatomy to cases in London’s hospitals, and emphasizing the importance of ward-walking and clinical lectures in the hospital. Although these conservative reformers gave pedagogy pride of place, print culture grew increasingly important for organizing medical communities. The many medical journals founded in the 1820s relied for the bulk of their published material on classroom lectures and notes taken by students, while at the same time rendering such classrooms irrelevant by publishing the material of lectures themselves (sometimes against the wishes of the lecturer). Thus, even with the birth of medical journals, the classroom remained the center of British medical innovation and of attempts to reform and systematize it. It is to the classroom that we should look for the birth of British medical science. BIOGRAPHICAL SKETCH Carin Berkowitz Caruso graduated with honors from Johns Hopkins University, where she majored in English and minored in the history of science, medicine, and technology, with a Bachelor of Arts degree in 2001. She received her Master of Arts from the Science and Technology Studies Department at Cornell in 2005 and her PhD there in 2010. Carin is currently the Associate Director of the Beckman Center at the Chemical Heritage Foundation. iii For Theo iv ACKNOWLEDGMENTS Over eight years one builds up many debts of gratitude. First, I’d like to thank my advisor, Peter Dear, for inspiring me, for helping me to revise and improve each chapter, and for offering patience and understanding—for being a true mentor and friend through this long process. Thanks also are due to Suman Seth, who came to the department just in time for me to benefit from his presence on my committee, for providing kind words and enthusiasm when they were most needed and for his generous and valuable advice regarding how to contextualize my work. Stephen Hilgartner has always been a voice of reason and a source of good advice, as well as an attentive reader. All three, along with my outside reader, Michael Lynch, have provided immensely helpful criticism that has made this a better dissertation. I also want to thank Babak Ashrafi, the director of the Philadelphia Area Center for History of Science (PACHS), who has been generous with his time and counsel and insightful with his critiques. The faculty and staff of Cornell’s Science and Technology Studies Department have been very supportive over the years and have given me a real sense of community. Bonnie Clause, the executive assistant at PACHS, has kept things running smoothly while I’ve been at PACHS. Members of both the PACHS and Chemical Heritage Foundation writing groups, especially Anna Geltzer, Benjamin Gross, Evan Ragland, Matthew Shindell, Annalisa Solonius, Anke Timmerman, James Voelkel, and Audra Wolfe, provided close readings of, and suggestions regarding, one or more chapters. These groups reminded me why I love academic work and why I wanted to finish my dissertation. I also want to thank members of the Shryock Medal Committee of the AAHM, whose award provided me with much-needed encouragement halfway through my last year of writing. v I am fortunate enough to have received support from several funding agencies at various stages of research and writing. The College of Physicians of Philadelphia, Luigi Einaudi Fellowship for Graduate Research in Europe, and National Science Foundation Dissertation Improvement Grant SES-0646371 all funded the research upon which this dissertation is based, and PACHS has funded me over the past year, as I have finished writing. The Royal College Surgeons of Edinburgh generously provided the images of Charles Bell’s preserved specimens that are included in Chapter 4 of this dissertation. I want to thank my parents for their encouragement over the years and for droning on about “intellectual curiosity” when I was little—I guess some of that sank in. My mother proofread every chapter of this dissertation, and I have never been so glad for her pedantry before. There are many other important people in my life who provided support of one kind or another and who helped me to finish this dissertation. For that kindness, I am grateful to Joan Jacobs Brumberg, Francine and Tom Collins, Pauline Dear, Michael Dennis, Pauline Kusiak, Yael Manes, Dan Plafcan, Carrie Sewell Roberts, Jody Roberts, Nab Sharif, and Kathryn Vignone. Jen, Joe, and Thomas Lentz have made Swarthmore home for me and for Theo. Patricia Kozuch and Gerald Isenberg helped to make the final stages of dissertation-writing possible. Most of all, I want to thank my husband and my son. I hope that having finished this degree has made me a better mother and will continue to do so, despite hours away, because my son Theo will always be my most important commitment and my greatest source of pride. Being his mother has made writing this harder, but it makes everything in my life more worthwhile! David, my husband, whose determination that I finish my dissertation has sometimes exceeded my own, has been my biggest fan, my discussion partner, and, most importantly, my source of support vi and comfort through the last decade. He made this accomplishment possible and for that I am deeply grateful. vii TABLE OF CONTENTS Biographical Sketch iii Dedication iv Acknowledgments v Table of Contents vii List of Figures viii 1. Introduction 1 2. Defining a Discovery: Changes in British Medical Culture and the Priority 15 Dispute over the Discovery of the Roots of Motor and Sensory Nerves 3. Printing, Publishing, and Remaking Audiences 61 4. Rhetoric, Reform, and Revolution: Making “British Medicine” in Early 91 Nineteenth-Century London 5. Systematizing Medicine through Institutional Change, 1825-40: London 133 University and London’s Comprehensive Hospital Schools 6. The Aesthetics of Anatomy: Visual Displays and Surgical Education in 170 Early Nineteenth-Century London 7. Conclusion 215 Works Cited 220 viii LIST OF FIGURES Figure 1: Trigeminus, dissected out 46 Figure 2: Portion dura, dissected out 47 Figure 3: The Penny Magazine, “The Colleries—No. 1” 67 Figure 4: Hip joint, schematic 175 Figure 5: Hip joint fracture 176 Figure 6: Nerves of the neck 181 Figure 7: Plaster cast of the urinary bladder and rectum 184 Figure 8: Plaster cast of the torso 187 Figure 9: Gunshot wound of the clavicle and scapula 188 Figure 10: Skeleton distorted by rickets 189 Figure 11: Arteries of the head 209 Figure 12: Wounded soldier at Waterloo 210 ix 1. Introduction “Reform is the wish of many—revolution is the desire of the demagogue alone.” (Editor of the London Medical Gazette, 1831)1 During the early part of the nineteenth century, British medicine was transformed drastically. The center of British medical education shifted from Edinburgh to London; research and education moved from small, private institutions to large, all-encompassing schools; methodologies changed as the practice of vivisection became more widely accepted; an explosion in the printing and availability of periodical literature reconfigured audiences, professional communities, and the nature of research; and the professional prestige of various medical professions shifted. The most significant of these changes were tied to the classroom—pedagogy drove, and was driven by, other medical reforms. Because the small schools of anatomy that provided the basis of a London medical education at the turn of the nineteenth century were run and staffed by surgeons, surgeons found their own professional fate to be intimately bound up with that of the educational institutions and pedagogical practices at the center of new campaigns for reform. Charles Bell, one of a cohort of surgeons raised and trained in Edinburgh, moved to London for its comparatively open medical marketplace, and developed a career in London that survived the many changes in medical education and practice that took place between 1800 and 1840.