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Author: Alannah Tomkins

Victorian medical men could suffer numerous setbacks on their individual paths to professionalisation, and Thomas Elkanah Hoyle's career offers a telling exemplar. This book addresses a range of the financial, professional, and personal challenges that faced and sometimes defeated the aspiring medical men of England and Wales. Spanning the decades 1780-1890, from the publication of the first medical directory to the second Medical Registration Act, it considers their careers in England and Wales, and in the Indian Medical Service. The book questions the existing picture of broad and rising medical prosperity across the nineteenth century to consider the men who did not keep up with professionalising trends. Financial difficulty was widespread in medical practice, and while there are only a few who underwent bankruptcy or insolvency identified among medical suicides, the fear of financial failure could prove a powerful motive for self-destruction. The book unpicks the life stories of men such as Henry Edwards, who could not sustain a professional persona of disinterested expertise. In doing so it uncovers the trials of the medical marketplace and the pressures of medical masculinity. The book also considers charges against practitioners that entailed their neglect, incompetence or questionable practice which occasioned a threat to patients' lives. The occurrence and reporting of violent crime by medical men, specifically serious sexual assault and murder is also discussed. A tiny proportion of medical practitioners also experienced life as a patient in an asylum.

Alannah Tomkins

This chapter looks at public perceptions of pawnbrokers and their likely clientele from contemporary printed sources. It presents a brief overview of George Fettes's career as a pawnbroker in York. A simple statistical breakdown and analysis of the rich source sheds new light on the place of pawnbroking in the lives and strategies of the urban poor. The chapter also presents a detailed consideration of strategies used by customers to exploit pawnshop credit. The role of the pawnshop in the process of either independent survival or decline into dependency can be charted, particularly in the case of individuals who went on to receive parish relief. The chapter finally provides a study of the income derived from both pawning and parishes by selected individuals, which gives some indication of the scale and function of the assistance offered by each.

in The poor in England 1700–1850
Narratives of the Indian Medical Service
Alannah Tomkins

Appointment to the Indian Medical Service (IMS) has been construed as instrumental in making individual fortunes or reputations, and in advancing medical professionalisation. The IMS originated in the early seventeenth century as an adjunct to the military and trading ambitions of the East India Company (EIC). This chapter explores three routes of narratives of the IMS. The first is through an analysis of the aggregate practitioner experience that may be gleaned from D.G. Crawford's Roll of the Indian Medical Service. The second strategy is to review the notice given to conditions of IMS in the lay and medical press. The third opportunity is offered by the letters, diaries, and memoirs written by men during or after their service in India. The chapter examines narratives from men in IMS service to reveal the same concerns that troubled their medical counterparts in Britain around professional opportunity, patronage, income, expenditure, and promotion.

in Medical misadventure in an age of professionalisation, 1780–1890
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Bankruptcy, insolvency, and medical charity
Alannah Tomkins

This chapter considers the impact of the law and legal change on medical men who fell into debt, and examines both bankruptcy and insolvency as discrete processes in more detail. The London Gazette was central to the implementation of both bankruptcy and insolvency law because it advertised notice of legal process to creditors. The chapter also considers an additional indicator of financial hardship: the need to draw on medical charity. It analyses what might be considered the most obvious indication of career turbulence in any occupation: the inability to make a financial living. The availability of money for men, in addition to widows or orphans, makes the Medical Benevolent Fund of particular interest and relevance to the consideration of medical hardship. Financial turbulence, hardship, and associated legal processes were a reality for a minority of all practitioners, and a recurrent one for the unfortunate few.

in Medical misadventure in an age of professionalisation, 1780–1890
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Alannah Tomkins

This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book addresses a range of the financial, professional, and personal challenges that faced and sometimes defeated the aspiring medical men of England and Wales. It establishes that there was certainly a new urgency to intra-professional relations and economic motivations by the 1830s, and that marketplace relations were not wholly superseded by 'professionalisation' at any point in the nineteenth century. The early nineteenth century saw masculinity become more strongly associated with privacy than sociability. The book analyses the fates of practitioners who struggled to manage their collegial duties in relation to their own and their patients' best interests. It considers the full span of years but the case studies of individual men are concentrated within 1805-55.

in Medical misadventure in an age of professionalisation, 1780–1890
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Lunacy and the asylum
Alannah Tomkins

Medical practitioners who were deemed by their nineteenth-century contemporaries to be suffering from severe mental-health problems frequently warranted an asylum admission. This chapter considers the permeability of different institutions to medical patients across England and Wales by a simple count of asylum patients whose former occupation was listed as medical in the census of 1881. The case notes compiled by asylum superintendents provide one way to assess the reactions of doctors to mental fragility among their peers. The potential and pitfalls of case note scrutiny have been surveyed for Gartnavel Royal Asylum in Glasgow, and the generalities observed there are broadly applicable to the case notes of English county asylums. The chapter argues that case notes could sometimes achieve a particular pitch of poignancy when the medical author (frequently the asylum superintendent) was annotating the case of a fellow medical man.

in Medical misadventure in an age of professionalisation, 1780–1890
Causing harm
Alannah Tomkins

The proverbial Hippocratic injunction that medical practitioners must 'do no harm' makes accusations against doctors of crimes against the body particularly problematic. This chapter focuses on the occurrence and reporting of violent crime by medical men, specifically serious sexual assault and murder, where the latter includes all cases of suspected intentional, malicious killing rather than instances of incompetent treatment. It presents a case study of James Cockburn Belaney. The case of James Cockburn Belaney arguably went some way to create the discourse later satisfied by William Palmer as referent. It demonstrates that an acquittal in the 1840s was not necessarily sufficient to reassure a sceptical public that had already become convinced of a practitioner's guilt. Alfred William Warder's treatment by public opinion and the press in 1866 confirms in addition that the absence of a trial by jury was no protection against condemnation.

in Medical misadventure in an age of professionalisation, 1780–1890
Neglect, incompetence, and unintentional killing
Alannah Tomkins

Allegations of neglect or incompetence provided an evolving medical profession with a structured set of opportunities to set out the boundaries of acceptable practice. This chapter considers charges against practitioners that entailed their neglect, incompetence or questionable practice which occasioned a threat to patients' lives, and which were usually given public notice at the inquests on patients' bodies. As such it will cover allegations of unplanned or unintentional crimes against the body where the victim was a patient who died. Egregious cases of neglect and incompetence gave rise to charges of manslaughter by inquest juries, which were taken up by the police or others and could result in the criminal prosecution of a practitioner. Charges of neglect, manslaughter, and abortion collectively illustrate the risks and frustrations associated with rising expectations both inside and beyond the profession.

in Medical misadventure in an age of professionalisation, 1780–1890
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Alannah Tomkins

Medical misadventure was frequently a matter of public record, but some forms of career turbulence were more readily acknowledged than others. Medical suicide was the most problematic phenomenon for shaping professional conduct. Practitioners who served in India, for example, and who were later thought to suffer from unsoundness of mind, were in effect exonerated from personal culpability. Medical professionalism and masculinity would have been more gently guided by an acceptance of inadequacy or limitation, to 'counsel the adoption of what might be termed a "modest" approach to the affairs of life'. Medical misadventure is inevitable, but if the experience of nineteenth-century practitioners is at all illustrative, its deployment for setting professional boundaries has been misconceived. Medical reputations were further complicated by the Contagious Diseases Acts, which first appeared to endorse medical intervention for the good of public health but then attracted outspoken opposition to compulsory examination.

in Medical misadventure in an age of professionalisation, 1780–1890
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Professional stress and suicide
Alannah Tomkins

Mortality among the members of the nineteenth-century medical profession was high in relation to other professions and to non-professional occupations. This chapter examines the role and visibility of the inquest in determining acts of suicide in nineteenth-century England and Wales. It then looks in more detail at the 285 medical deaths investigated or reported as suicides between 1800 and 1890, with particular reference to the behavioural patterns, methods, and motives that emerged in inquest evidence. The chapter concludes with the case of William Whitfield Edwardes, whose suicide in 1883 generated intense social commentary and presented the consolidating medical profession with a quintessential dilemma. The generation of exceptionally high expectations within the profession about the acceptance and management of stress make practitioner suicide entirely comprehensible and even predictable. Narrative motifs in reporting suicides co-opted the language of shock, tragedy, pity, and melancholy rather than the available alternatives for framing a suicide.

in Medical misadventure in an age of professionalisation, 1780–1890