The invisible general practitioner: The careers of Scottish medical students in the late nineteenth century

Bulletin of the History of Medicine

Volumn 70, Issue 3, 1996, Pages 387-413

  Crowther, Anne ^a   Dupree, Marguerite ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; GENERAL PRACTITIONER; HISTORY; HUMAN; MEDICAL SCHOOL; MEDICAL STUDENT; UNITED KINGDOM;

HISTORY, 19TH CENTURY; HUMANS; PHYSICIANS, FAMILY; SCHOOLS, MEDICAL; SCOTLAND; STUDENTS, MEDICAL;

EID: 0030236580     PISSN: 00075140     EISSN: None     Source Type: Journal    
DOI: 10.1353/bhm.1996.0121     Document Type: Article

References (91)

1. Rosemary Stevens, Medical Practice in Modem England: The Impact of Specialization and State Medicine (New Haven: Yale University Press, 1966), p. 3.
2. Irvine Loudon, Death in Childbirth: An International Study of Maternal Care and Maternal Mortality, 1800-1950 (Oxford: Clarendon Press, 1992), pp. 192-93. Midwifery training, however, had been more thorough in Scotland than in England before 1886.
3. For an outline of twentieth-century divisions, see also Frank Honigsbaum, The Division in British Medicine: A History of the Separation of General Practice from Hospital Care, 1911-1968 (London: Kogan Page, 1979);
4. Daniel M. Fox, Health Policies, Health Politics: the British and American Experience, 1911-1965 (Princeton: Princeton University Press, 1986).
5. For the history of specialist hospitals, see particularly Lindsay Granshaw and Roy Porter, eds., The Hospital in History (London: Routledge, 1989);
6. M. Jeanne Peterson, The Medical Profession in Mid-Victorian London (Berkeley and Los Angeles: University of California Press, 1978), chap. 6.
7. The problems of self-ascription in the profession, and the association of elite status with specialization, are outlined by George Weisz, "Mapping Medical Specialization in Paris in the Nineteenth and Twentieth Centuries," Soc. Hist. Med., 1994, 7: 177-211.
8. For the earlier period see Peterson, Medical Profession (n. 4);
9. Irvine Loudon, Medical Care and the General Practitioner, 1750-1850 (Oxford: Oxford University Press, 1986);
10. Hilary Marland, Medicine and Society in Wakefield and Huddersfield, 1780-1870 (Cambridge: Cambridge University Press, 1987).
11. For the later period, see Anne Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720-1911 (Cambridge: Cambridge University Press, 1994);
12. Anne Digby and Nicholas Bosanquet, "Doctors and Patients in an Era of National Health Insurance and Private Practice, 1913-38," Econ. Hist. Rev., 1988, 41: 74-94;
13. Jacqueline Jenkinson, Scottish Medical Societies 1731-1939: Their History and Records (Edinburgh: Edinburgh University Press, 1993).
14. See, for example, British Parliamentary Papers, 1879 (320),
15. "Special Report of the Select Committee on the Medical Act (1858) Amendment (No. 3) Bill," [Lords]. . . Proceedings of the Committee, Minutes of Evidence, and Appendix 29 July 1879, Q.186, Q.362, Q.2056;
16. Charles Newman, The Evolution of Medical Education in the Nineteenth Century (Oxford: Oxford University Press, 1957), pp. 232, 236, 240-41.
17. Honigsbaum, Division in British Medicine (n. 3);
18. Bentley B. Gilbert, The Evolution of National Insurance in Great Britain: The Origins of the Welfare State (London: Michael Joseph, 1966), pp. 400-446;
19. Bentley B. Gilbert, idem, The Evolution of National Insurance in Great Britain: The Origins of the Welfare State ( British Social Policy, 1914-1939 (London: Batsford, 1970), pp. 255-84.
20. Particularly beloved Scottish general practitioners (hereafter also referred to as GPs) have attracted biographies: e.g., R. McNair Wilson, The Beloved Physician: Sir James Mackenzie, A Biography (London: John Murray, 1926);
21. Alex Mair, Sir James Mackenzie, M.D., 1853-1925: General Practitioner (Edinburgh: Churchill Livingstone, 1973).
22. Reminiscences by GPs who were also famous Scottish writers include Arthur Conan Doyle, Memories and Adventures (London: Hodder & Stoughton, 1924);
23. and A. J. Cronin, Adventures in Two Worlds (London: Gollancz, 1952).
24. Marguerite W. Dupree and M. Anne Crowther, "A Profile of the Medical Profession in Scotland in the Early Twentieth Century: The Medical Directory as a Historical Source," Bull. Hist. Med., 1991, 65: 209-33.
25. Loudon, Medical Care (n. 6).
26. See also Irvine Loudon, "2,000 Medical Men in 1847," Bull. Soc. Hist. Med., 1983, 33: 4-8.
27. The Medical Who's Who, published between 1912 and 1918 and in 1925 and 1927, gave practitioners an opportunity to indicate the nature of their practice and thus whether they were general practitioners and, if so, in what area they were particularly interested.
28. London Doctors and Dental Surgeons 1923-1924 (London: Grafton, 1923) also gave practitioners an opportunity to describe their practice, noting whether it was general, specialist, consultant, or in public health. These publications, however, include far fewer practitioners than the Medical Directory and were not successful in the long term.
29. All Scottish students "matriculate" every year at the beginning of the first term, by signing the university's register or filling in a form, and paying a fee. The Glasgow University cohort includes all students who first matriculated in the Medical Faculty between 1866/7 and 1874/5; the Edinburgh University cohort includes all students who first matriculated in the Medical Faculty between 1868/9 and 1872/3. For information on the method used to identify and select the individuals in the cohorts, see James Bradley and Marguerite Dupree, "Interpreting Datasets: The Experience of Third-Party Use of a Machine-Readable Source," Hist. Comput., 1993, 5: 169-78;
30. James Bradley Marguerite Dupree, idem, "Micros and Medical Students: Sources and Methods for Exploring the Educational Careers and Completing Rates of Scottish Medical Students in the Late Nineteenth and Early Twentieth Centuries," in Computing Techniques and the History of Universities, ed. Peter Denley (Göttingen: Max Planck Institute, in press). Once a student is identified from his (or, in the case of the Edinburgh University cohort, her) matriculation record, it is possible to link this basic information with many other types of record.
31. Edinburgh University accounted for 158 (or 13 percent) and Glasgow University accounted for 91 (or 7 percent) of the students beginning their medical studies in 1871. See General Medical Council, Report by the Statistical Committee of the General Medical Council, Containing a Summary of Statistics Regarding Medical Students . . . (London: Spottiswoode, 1885), pp. 26-27.
32. Those who go abroad to practice may disappear from the British publications - though colonial practitioners usually remained on the British register, and those who went to the United States could be traced from American equivalents.
33. The Scottish Calendar of Confirmations is equivalent to the English probate register, and is available in the Scottish Record Office, Edinburgh. The set we used is available in the University of Glasgow Archives, UGD 174/1-123. Also, see below, n. 64.
34. These assessments are based on their failure to appear in the Medical Register of 1885. The largest loss is accounted for by those who never intended a medical career, or who failed examinations (we have investigated these issues in James Bradley, Anne Crowther, and Marguerite Dupree, "Mobility and Selection in Scottish University Medical Education, 1858-1886," Med. Hist., 1996, 40: 1-24). In addition, a small number are known to have died; another small group may have gone abroad to practice without qualifying in Britain.
35. In the location of obituaries for our cohorts, we have been assisted by a data source that already exists on computer: some years ago the University of Glasgow Archives systematically sifted through the obituary columns of four major medical journals - the British Medical Journal, the Lancet, the Edinburgh Medical Journal, and the Glasgow Medical Journal - and collected references to the obituaries of all graduates from Scottish medical schools and licentiates of the Scottish Royal Colleges. We have been able to compare this with our cohorts of Glasgow and Edinburgh university students and collect their obituaries. An additional source was the Edinburgh Journal, the University's own magazine for graduates, which includes some obituaries: this appeared only from 1925, and it is not included in our calculations here because its obituaries are generally less informative than those in the medical journals; adding its information to the other sources did not appreciably alter the results. The Archives database has limitations in not identifying all obituaries of Edinburgh students who did not graduate, including most of the first women students (see below).
36. The story of the non-GPs will be explored elsewhere: their careers are extremely complex, and require more analysis of medical specialties than is possible here.
37. Of the 96 in the Edinburgh cohort who were ever GPs and the 124 in the Glasgow cohort who were ever GPs, 11 appear in both cohorts, having matriculated for the first time in medicine at each university during the specified years; since the cohorts are treated separately in the discussion in the paper, these 11 have been left in both cohorts.
38. Four appear on both the Edinburgh and Glasgow lists, because they followed Lister from Glasgow to Edinburgh.
39. "William Caskie," Glasgow Medical Journal (hereafter GMJ), 1921, 96: 41.
40. Further thoughts on the interpretation of obituaries are to be found in Pierre Bourdieu, Homo Academicus, trans. Peter Collier (Cambridge: Polity Press, 1988), pp. 210-25.
41. Peterson, Medical Profession (n. 4), pp. 126-29.
42. This does not count the 15 at Glasgow and 7 at Edinburgh whose ages were not stated in the matriculation records.
43. Including the 16 who were previously GPs.
44. Including those mentioned above who moved with Lister from Glasgow to Edinburgh.
45. In addition, 65 fathers are simply listed as "deceased."
46. See Matriculation Album 1865-70, p. 186, University of Glasgow Archives; the entry is for William Smart from Renfrewshire. For a discussion of the difficulties of using this information for social analysis, see Robert D. Anderson, Education and Opportunity in Victorian Scotland: Schools and Universities, 2d ed. (Edinburgh: Edinburgh University Press, 1989), p. 308;
47. Paul Robertson, "Scottish Universities and Industry, 1860-1914," Scot. Econ. Soc. Hist., 1984, 4: 40-42;
48. Paul Robertson, idem, "The Development of an Urban University: Glasgow, 1860-1914," Hist. Educ. Quart., 1990, 30: 50.
49. Anderson, Education and Opportunity (n. 28), esp. chap. 8 and pp. 339-45.
50. Anderson, Education and Opportunity Ibid., pp. 310-11.
51. The obituaries cannot be relied on for full information on this subject; and these figures do not make an argument for an increase in medical endogamy.
52. "Sir Garrod Thomas, M.D.," Lancet, 14 February 1931, pp. 383-84.
53. Calendar of Confirmations and Inventories for 1931 (n. 15). This is the highest estate value left by any of the practitioners in the cohorts whose estate value at death we have been able to trace in the calendars of confirmation thus far.
54. "Samuel MacVie, M.D.," British Medical Journal (hereafter BMJ), 11 March 1916, p. 398.
55. "Charles Bagge Plowright, M.D.," BMJ, 7 May 1910, p. 1149
56. "Dr. George Skelton Stephenson," BMJ, 1 June 1929, pp. 1021-22.
57. "George Henry Whitaker," BMJ, 14 May 1910, p. 1208.
58. See Margaret Todd, The Life of Sophia Jex-Blake (London: Macmillan, 1918);
59. and Shirley Roberts, Sophia Jex-Blake: A Woman Pioneer in Nineteenth-Century Medical Reform (London: Routledge, 1993), who also mentions (p. 188) the subsequent careers of Agnes McLaren and Edith Pechey.
60. For an obituary and the value of the estate of Sophia Jex-Blake, see BMJ, 20 January 1912, p. 165, and 24 February 1912, p. 461.
61. For an obituary of Edith Pechey-Phipson, see BMJ, 25 April 1908, p. 1025.
62. For Alice Ker, see Lancet, 10 April 1943, p. 479. Further details of the 39 women in our cohort of Edinburgh students who matriculated and the 8 who qualified are to be found in Bradley, Crowther, and Dupree, "Mobility and Selection" (n. 16). For the careers of the first generation of women university graduates in medicine at Glasgow University,
63. see Wendy Alexander, First Ladies of Medicine: The Origins, Education, and Destination of Early Women Medical Graduates of Glasgow University (Glasgow: Wellcome Unit for the History of Medicine, 1987), esp. pp. 47-62.
64. "Dr. T. Edgar Underhill," BMJ, 19 May 1917, p. 667.
65. "Dr. William Donald," BMJ, 13 February 1904, p. 404;
66. "Robert Davies Evans," BMJ, 16 August 1924, p. 301.
67. "George Middlemiss," BMJ, 30 August 1913, p. 582.
68. "Archibald Sloan," GMJ, 1923, 100: 326.
69. "Russell Elliot Wood," Edinburgh Medical Journal (hereafter EMJ), 1917, 18: 217.
70. "Peter MacGregor," BMJ, 8 December 1917, p. 779.
71. "E. O. Price," BMJ, 22 February 1919, p. 234.
72. "Russell Elliot Wood" (n. 44), pp. 216-18.
73. For a full history, see S. D. Slater and Derek A. Dow, eds., The Victoria Infirmary of Glasgow, 1890-1990: A Centenary History (Glasgow: Glasgow Victoria Infirmary Centenary Committee, 1990).
74. "Alexander Napier," GMJ, 1928, 110: 279-82.
75. "William Muir," GMJ, 1907, 68: 33-34.
76. "Archibald Brown," GMJ, 1904, 62: 103.
77. "Dove M'Calman," BMJ, 6 June 1908, p. 1400.
78. "Robert Thomson Forbes," GMJ, 1907, 67: 374.
79. Mair, Sir James Mackenzie (n. 9), chaps. 10, 11, 15, 16.
80. The total figure is based on the list of publications from four editions of the Medical Directory up to 1901, and thus includes only the articles that practitioners chose to list in their Directory entries.
81. For the breadth and depth of Scottish medical education in general, and midwifery in particular, relative to England, see Loudon, Death in Childbirth (n. 2), pp. 192-93.
82. A. Garrod Thomas, "Opening the Knee Joint," BMJ, 1 December 1883, pp. 1066-67.
83. "Henry Ambrose Lediard, M.D.," BMJ, 19 November 1932, p. 946.
84. "Charles Watson MacGillivray," EMJ, 1932, 39: 691.
85. "James Wilkie Smith, M.D.," BMJ, 8 December 1928, p. 1073.
86. "Sir George Thomas Beatson," BMJ, 25 February 1933, p. 344.
87. "Malcolm McMurrick," GMJ, 1898, 50: 364.
88. Dupree and Crowther, "Profile" (n. 10), p. 212.
89. The most widely used source for wealth in Scotland is the Calendar of Confirmations and Inventories, an index, printed annually from 1876, to all estates whose appointment of executors was ratified or "confirmed" by a court. The entries are arranged alphabetically; each gives the name and designation or occupation of the deceased, the date and place of death, whether testate or intestate, where and when the confirmation was granted, the name of the executor, and the value of the estate. The value of the estate is the sum of the deceased person's wealth as itemized on an inventory that includes movable property (e.g., cash, household goods, and furnishings), investments in partnerships, government stock, securities, bank deposits, and rents due - but not land, houses, or other buildings. For a definitive account of the Calendars' origins and content, see James Geddes Currie, The Confirmation of Executors in Scotland according to the Practice in the Commissariat of Edinburgh, 7th ed., ed. A. E. McRae (Edinburgh: W. Green and Son, 1973); for a critique of their use by historians,
90. see Nicholas Morgan and Michael Moss, "Listing the Wealthy in Scotland," Bull. Inst. Hist, Res., 1986, 59: 189-95.
91. We have found confirmations for 113 of 335, or 34 percent of all those in our cohorts with obituaries. Of the 113, 72 (64 percent) were GPs at the end of their careers, 11 (10 percent) were GPs at some time but did not end their careers as GPs, and 30 (26 percent) were never GPs. Thus, general practitioners are overrepresented among those in our cohorts with confirmations. The only medical representation among the wealthiest Scots (the ten highest-valued entries in the Calendar of Confirmations for each year between 1876 and 1913) was a surgeon with the East India Company; see Rachel Britton, "Wealthy Scots, 1876-1913," Bull. Inst. Hist. Res., 1985, 58: 78-94. The comparable figures for the average values of the personal estates of Scottish clergymen (£2,264) and lawyers (£40,464) come from the values of the confirmations for those occupations in 1901 extracted from the machine-readable database created by the University of Glasgow Archives. The lower value for Scottish clergymen is not surprising, as they had no equivalent of the value of a general practitioner's partnership or practice, which could be bought and sold.