[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.