The politics of professionalization: MPs, medical men, and the 1858 medical act

Medical History

Volumn 53, Issue 1, 2009, Pages 37-56

  Roberts, M J D ^a  

^a MACQUARIE UNIVERSITY   (Australia)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE POLICY; HISTORY; HUMAN; LEGAL ASPECT; MEDICOLEGAL ASPECT; PHYSICIAN; POLITICS; STANDARD; UNITED KINGDOM;

GREAT BRITAIN; HEALTH CARE REFORM; HISTORY, 19TH CENTURY; HUMANS; LEGISLATION, MEDICAL; PHYSICIANS; POLITICS;

EID: 67650388167     PISSN: 00257273     EISSN: 09505571     Source Type: Journal    
DOI: 10.1017/S0025727300003306     Document Type: Article

References (131)

1. Dale H Porter, The Thames Embankment, Akron, Ohio, University of Akron Press, 1998, p. 71.
2. 21 & 22 Vict. c. 90, sections 34, 31, 3, 18, 20, 29 respectively.
3. Peter Bartrip, Themselves writ large: the British Medical Association 1832-1966, London, BMJ Publishing Group, 1996, pp. 97-8.
4. Penelope J Corfield, Power and the professions in Britain 1700-1850, London, Routledge, 1995, pp. 146-7, 164-5.
5. Irvine Loudon, Medical care and the general practitioner 1750-1850, Oxford, Clarendon Press, 1996, pp. 298-300.
6. Ivan Waddington, The medical profession in the industrial revolution, Dublin, Gill and Macmillan, 1984, p. 96.
7. Cf. Charles Newman, The evolution of medical education in the nineteenth century, London, Oxford University Press, 1957, pp. 192-3.
8. For Wakley on the Act, see Lancet, 14 Aug. 1858, ii: 175.
9. Ludmilla Jordanova, 'The social construction of medical knowledge', Soc. Hist. Med., 1995, 8 (3): 361-81, on p. 372;
10. See the extended review of the literature in John C Burnham, How the idea of profession changed the writing of medical history, London, Wellcome Institute for the History of Medicine, 1998, esp. p. 179.
11. Virginia Berridge, 'Health and medicine', in F M L Thompson (ed.), Cambridge social history of Britain, 1750-1950, vol. 3.
12. Social agencies and institutions, Cambridge University Press, 1990, pp. 171-242, on pp. 171-3.
13. Burnham, op. cit., note 4 above, pp. 114-16, 152-3.
14. Roger Cooter, '"Framing" the end of the social history of medicine', in Frank Huisman and John Harley Warner (eds), Locating medical history: the stories and their meanings, Baltimore, MD, and London, Johns Hopkins University Press, 2004, pp. 309-37, on pp. 314-15.
15. S E D Shortt, 'Physicians, science, and status: issues in the professionalization of Anglo-American medicine in the nineteenth century', Med. Hist., 1983, 27: 51-68, on pp. 59-60.
16. For more recent calls for a revisiting of the history of medical professionalization on a "reflexive" basis, see Cooter, op. cit., note 5 above, pp. 326-8.
17. John V Pickstone, 'Medical history as a way of life', Soc. Hist. Med., 2005, 18 (2): 307-23, on p. 321.
18. Lancet, 22 May 1858, i: 511-13, on p. 511.
19. For full exposition and evaluation of the argument, see Ian A Burney, 'Medicine in the age of reform', in Arthur Burns and Joanna Innes (eds), Rethinking the age of reform: Britain 1780-1850, Cambridge University Press, 2003, pp. 163-81, on pp. 163-4, 168, 176-81.
20. Bartrip, op. cit., note 3 above, pp. 71-2, 80, 82.
21. Hansard's Parliamentary Debates (hereafter PD) (series 3), vol. 150, cols. 1411-12 (Spencer Walpole, 1858); vol. 135, col. 95 (Lord Palmerston, 1854); vol. 146, col. 724 (Lord Elcho, 1857).
22. 'STH', 'Medical legislation', The Times, 22 March 1856, p.10.
23. Cf. Avner Offer 'Between the gift and the market: the economy of regard', Econ. Hist. Rev., 1997, 50 (3): 450-76, esp. pp. 450-4, 462-3.
24. Jeffrey Lionel Berlant, Profession and monopoly: a study of medicine in the United States and Great Britain, Berkeley, University of California Press, 1975, pp. 18-25.
25. Eliot Freidson, Professionalism: the third logic, Cambridge, Polity Press, 2001, pp. 198-204, 213-22.
26. PD (series 3), vol. 146, col. 745 (Joseph Napier, MP for Dublin University, 1857). For analysis of the cultural background to medical recruitment at mid-century, see M Jeanne Peterson, 'Gentlemen and medical men: the problem of professional recruitment', Bull. Hist. Med., 1984, 58 (4): 457-73.
27. Lancet, 6 June 1857, i: 585. See also Br. med. J., 10 April 1858, i: 294-5.
28. Joseph Henry Green, Spiritual philosophy, ed. John Simon, 2 vols, London and Cambridge, Macmillan, 1865, vol. 1, p. xix. (Excerpt from lecture given by Green, 1832. Green was to become president of the General Medical Council in 1860.)
29. PD (series 3), vol. 133, col. 117 (Palmerston, 1854); vol. 146, col. 736 (Elcho, 1857); vol. 150, col. 1407 (William Cowper, 1858).
30. Br. med. J., 8 May 1858, i: 379-80, on p. 379;
31. G R Searle, Morality and the market in Victorian Britain, Oxford, Clarendon Press, 1998, pp. 126-7.
32. For "professional overcrowding" before mid-century, see Anne Digby, Making a medical living: doctors and patients in the English market for medicine, 1720-1911, Cambridge University Press, 1994, p. 137.
33. Lancet, 15 May 1858, i: 483-4, on p. 483. Contemporary observers estimated there were 5,000 to 6,000 offerers of medical services practising on the basis of inadequate or fraudulent qualifications in the mid-1850s, not counting the providers of "traditional remedies": Med. Times Gaz., 30 Oct. 1858, ii: 452.
34. [John Chapman], 'Medical education', Westminster Review, July 1858, 14 (n.s.): 107-62, on p. 107. This figure also did not include pharmacists, whose claims to state recognition had already achieved partial legislative endorsement in the Pharmacy Act of 1852 (15 & 16 Vict. c. 56) and were protected in the 1858 Act (section 55).
35. For an overview, see Roy Porter, The greatest benefit to mankind, London, HarperCollins, 1997, pp. 348-74.
36. For specific mid-century debates, see Logie Barrow, 'Why were most medical heretics at their most confident around the 1840s?: (the other side of mid-Victorian medicine)', in Roger French and Andrew Wear (eds), British medicine in an age of reform, London, Routledge, 1991, pp. 165-85.
37. Alison Winter, Mesmerized: powers of mind in Victorian Britain, University of Chicago Press, 1998, pp. 163-86.
38. [John Chapman], 'Medical despotism', Westminster Review, April 1856, 9 (n.s.): 530-62, on p. 536.
39. Royston Lambert, Sir John Simon 1816-1904 and English social administration, London, Macgibbon and Kee, 1963, pp. 230-31.
40. For Carlyle on sanitation, see Past and present [1843], Book III, ch. 2, Book IV, ch. 3.
41. For evaluation of the more complicated realities of mid-Victorian epidemic disease control, see Anne Hardy, The epidemic streets: infectious disease and the rise of preventive medicine, 1856-1900, Oxford, Clarendon Press, 1993, pp. 114-26, 191-203, 290-92.
42. Digby, op. cit., note 18 above, pp. 244-7.
43. PD (series 3), vol. 146, col. 736 (Elcho, 1857); vol. 146, col. 752 (Cowper, 1857). See also Wakley's earlier articulations of the same goal cited in Burney, op. cit., note 8 above, pp. 178-9.
44. See Berlant, op. cit., note 13 above, p. 147, for distinction between market liberalism, libertarianism, laissez faire.
45. PD (series 3), vol. 146, col. 722 (1857). For the tension between this version of radical reform and the more limited version promoted by Duncombe's companion in radical libertarian causes, Thomas Wakley, see Lancet, 21 Aug. 1858, ii: 205-8, on p. 205.
46. Also Burney, op. cit., note 8 above, pp. 178-81;
47. Searle, op. cit., note 18 above, pp. 123-4;
48. Berlant, op. cit., note 13 above, pp. 146-53.
49. Chapman, op. cit., note 21 above, pp. 545-7.
50. [John Chapman,] 'Medical reform', Westminster Review, April 1858, 8 (n.s.): 478-530, on p. 520.
51. PD (series 3), vol. 127, col. 1092 (Palmerston while home secretary, 1853).
52. G R Searle, Entrepreneurial politics in mid-Victorian Britain, Oxford University Press, 1993, pp. 112-25.
53. For full narrative of events of 1857-8 from the perspective of the chief medical lobby groups, see Waddington, op. cit., note 3 above, pp. 96-132, supplemented by Bartrip, op. cit., note 3 above, pp. 88-97.
54. Supplemented by Bartrip, op. cit., note 3 above, pp. 88-97. For evidence of Cowper's pre-December signals to the medical corporations of his intention to act, see Royal College of Physicians of London (hereafter RCP), Regent's Park, London, MS 2109 (Charter and conference committee minute book 1856-62), fols. 14-16, William Cowper to Dr Thomas Mayo PRCP, 17 Sept. 1857 (copy).
55. William Cowper, The medical practitioners' bill, London, James Ridgway, 1858, p. 4 (an expanded version of Cowper's speech on first reading in the Commons, PD [series 3] vol. 149, cols. 648-51 [1858]).
56. Special report from the select committee on the Medical Act (1858) amendment (No. 3) bill [Lords], PP 1878-79 (320), XII, p. 305.
57. PD (series 3) vol. 149, col. 651 (1858). For evidence of Walpole's previous record of interest in medical reform, see PD (series 3), vol. 135, cols. 97-9 (1854).
58. Lancet, 10 Apr. 1858, i: 368.
59. Br. med. J., 1 May 1858, i: 351-2.
60. Bartrip, op. cit., note 3 above, pp.75-7.
61. Br. med. J., 8 May 1858, i: 373-4, on p. 373. See Porter, op. cit., note 20 above, pp. 389-96 for explanation of terms.
62. For evidence of William Cowper's interest in, and support for "unorthodox medicine", see University of Southampton Library, Broadlands papers, BR43/22/15; also 44/19/7 (obituary press-clipping from Homeopathic World, 1 Nov. 1888). For denunciation of the homoeopathic sympathies of Lords Ebury and Elcho, see Br. med. J., 24 Apr. 1858, i: 337-8.
63. Also 44/19/7 (obituary press-clipping from Homeopathic World, 1 Nov. 1888). For denunciation of the homoeopathic sympathies of Lords Ebury and Elcho, see 24 Apr., i: 337-8.
64. Saturday Review, 10 July 1858, p. 30.
65. Cf. Porter, op. cit., note 20 above, p. 396.
66. PD (series 3) vol. 146, col. 750 (1857); vol. 149, col. 648 (1858). Cf. Br. med. J., 24 Apr. 1858, i: 337-8.
67. PD (series 3) vol. 151, cols. 999, 2277; Medical Act (1858), sections 23, 28.
68. PP 1878-79, XII, pp. 305-6, 309. For a jaundiced but informed review of contemporary levels of practical proficiency required at a range of medical licensing institutions
69. See Chapman, op. cit., note 19 above, pp. 111-14, 141-52.
70. For a modern review (casting doubt even on 1850s London University medical students), see Thomas Neville Bonner, Becoming a physician: medical education in Britain, France, Germany, and the United States, 1750-1945, Oxford University Press, 1995, pp. 193-5, 215.
71. PP 1878-79, XII, pp. 306-7.
72. For bill as amended, see PP 1857-58 (152), III, pp. 477-92. For sample record of lobbying
73. See RCP, MS 2109 (note 31 above), fols 14-43.
74. PD vol. 150: 1416 (Walpole); Med. Times Gaz., 22 May 1858, i: 533-4, on p. 534.
75. See ibid., 24 July 1858, ii: 90-1, on p. 90, for claims of the influence on government of Chapman's "free market" articles cited at notes 21 and 28 above. The conduit appears to have been Lord Stanley: Rosemary Ashton, 142 Strand: a radical address in Victorian London, London, Chatto & Windus, 2006, pp. 267-72.
76. Medical Act, s. 29; PP 1878-79, XII, p. 309: "And since the public esteem in which a profession is held must depend on the moral character of its members, not less than on their technical attainments". For the actual, highly technical, interpretation of the provision adopted after 1858
77. See Russell G Smith, 'The development of ethical guidance for medical practitioners by the General Medical Council', Med. Hist., 1993, 37: 56-67.
78. British Library (hereafter BL), Carnarvon papers, Add. MSS 60892, fol. 42.
79. Full narrative in Waddington, op. cit., note 3 above, pp. 113-23, esp. 121-2.
80. Bartrip, op. cit., note 3 above, pp. 101-2. For the underhand last-minute manoeuvre to retain 'Schedule D' (registration preserving hierarchy of professional status) as an option, and the furious anti-collegial response it evoked, see Carnarvon papers, BL Add. MSS 60850, fols. 52-113. For Cowper's advance warning to the government that this would happen, see fols. 16-17: William Cowper to Lord Carnarvon, 19 July 1858. The matter was finally resolved by the Medical Act Amendment Act, 22 Vict. c. 21, section 3.
81. Br. med. J., 14 Aug. 1858, ii: 682.
82. Ibid.; National Register of Archives (Scotland), Charteris family, Earls of Wemyss and March: letters of the tenth Earl of Wemyss (microfilm) (hereafter Wemyss papers), RH4/40/2, Dr J Y Simpson to Lord Elcho, 21 Aug. 1858. See also the recollection of disappointment of Dr Henry Acland (foundation GMC representative for Oxford) that the government had rejected his strong representations on behalf of lay Crown appointees in 1858: Royal commission to inquire into the Medical Acts, PP 1882 (C.3259-1), XXIX, p. 542 (Q. 42).
83. For acclamation of Cowper as an acceptable GMC chairman, see Br. med. J., 16 Oct 1858, ii: 875.
84. For hopes that any medical professional appointed chairman might be made a peer, see Med. Times Gaz., 13 Nov. 1858, ii: 499-501; 4 Dec. 1858, ii: 576-7.
85. Cf Searle, op. cit., note 30 above, pp. 133, 161.
86. Br. med. J., 23 Oct. 1858, ii: 888-9;
87. Lancet, 30 Oct. 1858, ii: 458-60, on p. 459.
88. Lancet, 4 Dec. 1858, ii: 583
89. Br. med. J., 4 Dec. 1858, ii: 1009-10.
90. Med. Times Gaz., 14 Dec 1858, ii: 577.
91. PD (series 3), vol. 146, col. 716 (John Hatchell, 1857).
92. Wemyss papers, RH4/40/2, Dr John Storrar to Lord Elcho, 29 Dec. 1858. See also Digby, op. cit., note 18 above, p. 28.
93. PP 1882 (C.3259-1), XXIX, p. 532.
94. Ibid., p. 533; Bartrip, op. cit., note 3 above, p. 100.
95. Jeanne L Brand, Doctors and the state: the British medical profession and government action in public health, 1870-1912, Baltimore MD, Johns Hopkins Press, 1965, pp. 100, 114, note 25.
96. M Jeanne Peterson, The medical profession in mid-Victorian London, Berkeley, University of California Press, 1978, pp. 110-18.
97. For specialization and its (British) limits in overview during this period, see George Weisz, Divide and conquer: a comparative history of medical specialization, Oxford and New York, Oxford University Press, 2006, pp. 38, 41, 204;
98. Peterson, op. cit., note 59 above, pp. 259-72. For general practitioner attempts to insulate their status and income against specialist challenge by consultation fee schedules and referral conventions
99. see Anne Digby, The evolution of British general practice 1850-1948, Oxford University Press, 1999, pp. 94, 100, 290-91.
100. For pharmacists and patent medicines, see ibid., pp. 227-9.
101. PD (series 3), vol. 305, col. 236 (Sir Lyon Playfair, 3 May 1886).
102. Graeme J N Gooday, 'Playfair, Lyon', Oxford Dictionary of National Biography, Oxford University Press, 2004-7, article 22368, vol. 44, pp. 556-60.
103. PP 1882, XXIX, p. 509.
104. For evidence that not all GMC members regretted this situation, see PP 1878-9, XII, p. 31 (Q. 335).
105. See also Newman, op. cit., note 3 above, pp. 236-9; Lambert, op. cit., note 22 above, pp. 580-81.
106. PP 1882, XXIX, pp. 497 (recommendation 22), 542 (Q. 42), 572 (Q. 647).
107. PD (series 3), vol. 305, col. 247
108. Digby, op. cit., note 60 above, pp. 33-9.
109. PP 1878-79, XII, p. 36 (Qs. 240-43, 359, 382-6)
110. For British hesitancy to embrace professional specialization, see Christopher Lawrence, 'Incommunicable knowledge: science, technology and the clinical art in Britain 1850-1914', J. Contemp. Hist., 1985, 20 (4): 503-20.
111. Weisz, op. cit., note 60 above, pp. 32-43.
112. For generational patterns of professional overcrowding, see Digby, op. cit., note 18 above, pp. 43, 314.
113. Shortt, op. cit., note 6 above, pp. 58-63
114. Lawrence, op. cit., note 68 above.
115. Digby, op. cit., note 18 above, p. 315; and see references cited at note 20 above.
116. Winter, op. cit., note 20 above, pp. 255, 281;
117. Roger Luckhurst, The invention of telepathy, Oxford University Press, 2002, pp. 12-22.
118. Peterson, op. cit., note 59 above, pp. 281-2.
119. Martin J Wiener, Reconstructing the criminal: culture, law and policy in England, 1830-1914, Cambridge University Press, 1990, pp. 250-52.
120. Paul McHugh, Prostitution and Victorian social reform, London, Croom Helm, 1980, pp. 248-50.
121. see Stephanie J Snow, Operations without pain: the practice and science of anaesthesia in Victorian Britain, Basingstoke, Palgrave Macmillan, 2006, for persisting lay distrust of medical use of anaesthetics to the end of the century
122. Among those who came to think so was Spencer Walpole: see his History of England from the conclusion of the Great War in 1815, revised ed., 6 vols, London, Longmans, Green, 1890, vol. 6, pp. 397-8.
123. For shifts in interpretation of the meaning of suffering for the dying and the implications for medical management, see Pat Jalland, Death in the Victorian family, Oxford University Press, 1996, pp. 77-97.
124. For shifts in attitude towards infliction of pain, see, inter alia, Karen Halttunen, 'Humanitarianism and the pornography of pain in Anglo-American culture', Am. Hist. Rev., 1995, 100(2): 303-34.
125. Barrow, op. cit., note 20 above, pp. 166-8, 179-81.
126. Winter, op. cit., note 20 above, pp. 158-62.
127. PP 1878-79, XII, p. 45 (Q. 507).
128. Bonner, op. cit., note 42 above, 268-76.
129. Lawrence, op. cit., note 68 above, pp. 506-12.