Medicos on the move
- First Online:
- Cite this article as:
- Rollison, D. Metascience (2013) 22: 603. doi:10.1007/s11016-012-9736-4
- 45 Views
In the background of Performing Medicine is one of the great transformations in human history: the first Industrial Revolution. The population of England took off in historically unprecedented fashion. It virtually tripled from about 6 millions in 1750 to 18 millions in 1851. By the end of the nineteenth century, it had doubled again to 36 millions. In 1750 most people lived in villages and either combined a trade with agriculture or worked full-time on the land; by 1850 the nation’s most noticed—and feared—characteristic was the mushrooming growth of great manufacturing conurbations like Birmingham, Manchester, Leeds and Liverpool, making England the most heavily urbanised society in the world. The manufacturing of iron and steel, textiles and many other industries moved from small workshops to crowded, unsafe factories surrounded by desperately overcrowded, unsanitary slums. Previously, provincial regions were linked into a unified economy by an intensifying communications revolution: hard-surfaced roads, canals and, towards the end of the period, railways. Traffic (which disseminated information and disease as well as commodities of trade) grew geometrically. New technologies transformed manufacturing and “dark, satanic mills” made England the “workshop of the world.” Workers migrated from the countryside to the new cities in unprecedented numbers, supplemented by impoverished immigrants from overpopulated, rural Ireland. Michael Brown has written a tightly focused, lucid and rewarding social and cultural history of a local branch of a profession that has always been regarded as having played an important role in this period of relentless and confusing change.
Brown focuses on a city that had once been the capital of the North but was somewhat by-passed by the “great transformation.” His broad topic is the changing public self-representation of a profession that was clearly faced with new challenges. Those challenges—public health, the creation of new institutions, epidemic diseases like the cholera that periodically invaded York’s overcrowded working class districts—feature in his book, but are subordinated, even incidental, to the ways in which York’s physicians, surgeons and apothecaries used their changing public contexts to define social and, in time, professional identities for themselves. In other words, this book deals with a very significant conjuncture in the history of the modern profession. “Performing Medicine,” writes Brown, “is concerned to explore what the intellectual activities and epistemological forms in which [three generations of York] physicians, surgeons and apothecaries invested can tell us about the cultural values of medicine and the identity of its practitioners.”
His first three chapters effectively chronicle the formation and decline of a distinctive eighteenth-century model of “medical gentility,” in which, for the senior ranks of physicians, “the role of liberal learning in the elaboration of a medical identity [was] founded on the values of gentility and politeness.” In this phase, the leading physicians and medical practitioners of the town set out to cultivate a genteel self-presentation. “Physic is an honourable profession,” wrote one advocate, “but avarice sometimes makes it a disgraceful one.” Medicine’s traditional associations with trade militated against higher social respectability. In the high society of the eighteenth century, “civic culture” was open to tradesmen, but “gentility” was a function of “breeding.” Tradesmen were necessarily in business: they had to earn a living. The “benevolent and disinterested identity” cultivated by gentlemen born and bred was therefore beyond their reach. The activities of medical practitioners also carried overwhelming connotations of impurity: they dealt directly with bodies, delivered babies, conducted activities in ladies bedrooms and so on. In other words, Brown writes, “gentility, politeness and social identity” were more valued by “polite society” than “the vocationally specific nature of knowledge and practice.”
The road to “medical gentility” pursued by senior York practitioners like the apothecary Oswald Allen, and the physicians Alexander Hunter and William White, involved the cultivation of “genteel qualities,” especially “polite and ornamental knowledge,” that is to say, knowledge that was not specifically vocational but bespoke a broader, indeed universal view of the world. Hunter enhanced his reputation with a book on agricultural improvement, which happened to be a particular concern of the Whig gentry and aristocracy of the region. “Until the philosopher condescends to direct the plow,” he wrote, “husbandry must remain in a torpid state.” This was followed up by a book of sensible medical advice for genteel persons contemplating a healthful “sojourn at the baths” at spa-towns like nearby Harrogate. All this was presented in a style that embodied “a gentlemanlike communication of factual reports.” A gentleman had to be landed; Hunter did well enough to be able to purchase estates in Lincolnshire.
The world view of Hunter’s colleague, William White, was shaped by that traditional master discipline, Chorography. In a contribution to Hunter’s Georgic Essays, he “used his eudiometrical equipment to measure the quantity of phlogiston in the atmosphere of [York], by rivers and marshes, at different times of the day and in different weather conditions.” He found that damp marshes and bogs gave off putrid exhalations “and were unsuitable for human habitation.” “Fresh vegetables and flowers were also shown to corrupt the air,” while “faeces … had little or no effect upon the quality of the atmosphere.” He also wrote Observations on the Bills of Mortality (1781), sang the praises of inoculation and breast-feeding of infants, and was a leader of the local antiquarian society. By means of extracurricular activities that emphasised the universality and gentlemanly dispassion of their interests, eighteenth-century physicians like Hunter, White and their lesser colleagues overcame the stain of trade and were “enabled to elaborate a provincial identity and … participate in a cosmopolitan scholarly discourse.” They epitomised the first phase (the attainment, in keeping with contemporary mores, of “medical gentility”) in the establishment of medicine as a high-status profession.
In Brown’s “social performance” model, the secret motivator is always the construction of a high-status identity; what changed, quite remarkably in many ways, was the nature of the identity. The sea change by which York’s medical profession was transformed by 1830 had several characteristics. While eighteenth-century medical practitioners projected themselves as highly individual gentlemen; their successors were definitively middle class, often actively hostile to gentility, and concerned above all with the creation of a collective, professional, identity. The former presented themselves as renaissance men: their intellectual pursuits, while broadly “scientific” and “liberal-progressive,” drew upon the full range of contemporary intellectual disciplines. The second generation was narrowly vocational in the knowledge its members pursued and, through their associations, communicated to the public. “Politeness, sociability, benevolence and liberality… underpinned the late eighteenth-century culture of medico-gentility.” In the “overcrowded medical marketplace” that emerged after the Napoleonic Wars, “the vocation of doctor alone,” not the individual physician, “was presented as being for the benefit of society.”
Brown’s reconstruction of the micropolitics of the transition is excellent and convincing; his weavings-in of the national and international contexts are usually deft, though perhaps, at times, too jargon-laden and theory-based for some tastes. “The asylum revolution” (Chapter 3) describes the public scandal by which the older generation was discredited by “Reformers” who were usually middle class, evangelical, utilitarian-progressive and, frequently, religious dissenters. The new men showed their mettle when faced with the body-snatching scare associated with the notorious Burke and Hare case in 1828. It “posed a very real threat to the public perception of medicine”; yet, the response of the professionals to “resurrectionism” was uncompromising: Brown shows they did not distance themselves from it, arguing that “dissection was fundamentally necessary for ensuring the “progress” of surgical science and the competence of its practitioners.” On the grounds that anatomy was useful to the poor, one commentator even suggested it would be “to the benefit of the living” that persons who had received poor relief within a year of their deaths “should be subject to dissection … and, after 7 days, returned by the surgeon to the parish officers” for a proper Anglican burial. Despite their aversion to public relations (another marked contrast to their predecessors), Brown shows that the new men emerged with some credit from the cholera epidemic of 1832, which took place against the backdrop of the First Reform Act. The cholera epidemic “provided a focus around which new forms of medical identity and activity coalesced.” The appointment of district medical officers under the Poor Law Amendment Act of 1834 helped to promote a conception of the medical officer as a salaried representative of the state, as opposed to a merely local parish contractor. This and the Civil Registration Act of 1836, which provided an opportunity to collect and collate more reliable social statistics, contributed to what Brown calls “the medicalisation of the social body.” The profession that emerged in the second third of the nineteenth century was peopled with fewer personalities than its predecessors of the eighteenth century, but it was considerably more disciplined, professional, and probably more beneficial to the general cause of public health.
Performing Medicine tells a surprisingly colourful tale economically and readably. It is a well-written book that illuminates many aspects of the social and cultural history of the greater transformation to which it was related. I recommend it.