This book talks about late eighteenth- and early nineteenth-century English medical culture, a study of what it meant to be a doctor and how this changed over time. It presents a brief overview of the social, economic and cultural landscape of late eighteenth-century York. Medical culture and identity in late eighteenth-century York took shape within a social landscape shaped by the values of gentility, polite sociability and civic belonging. The book examines the role of intellectual liberality, demonstrating how public displays of polite and 'ornamental' learning were central to the performance of medico-gentility. It explores the incipient demise of this culture. Through a close reading of a scandal which enveloped the York Lunatic Asylum, it also explores the ways in which medical identities founded upon gentility and politeness were critically undermined by the political and social factionalism. The book looks at medical involvement in the provincial scientific movement, examining how local medical men positioned themselves relative to the so-called 'march of intellect', the cultural and ideological alignment between science and social reform. It continues this analysis in relation to the cholera epidemic of 1832 and other medico-political activities. The book considers how the professional dominion over healthcare was forged by the dual processes of inclusion and exclusion. It discusses the foundation of the Medical School in 1834 against the trial, in the same year, of a local salesman for James Morison's 'Universal Vegetable Medicine'.
This introduction presents an overview of the key concepts discussed in the subsequent chapters of this book. The book talks about late eighteenth- and early nineteenth-century English medical culture, a study of what it meant to be a doctor and how this changed over time. It presents a brief overview of the social, economic and cultural landscape of late eighteenth-century York. The book considers how forms of sociability, such as urban club and general social strategies such as marriage and cultivation of patronage, could allow physicians, surgeons and even seemingly lowly apothecaries to fashion themselves as genteel and upstanding local citizens. It looks at medical involvement in the provincial scientific movement, examining how local medical men positioned themselves relative to the so-called 'march of intellect', the cultural and ideological alignment between science and social reform.
Politeness, sociability and the culture of medico-gentility
Medical culture and identity in late eighteenth-century York took shape within a social landscape shaped by the values of gentility, polite sociability and civic belonging. The Doctors Club was the embodiment of a civic culture defined not by a guild-mentality of corporate exclusivity, but by the polite and civil values of cosmopolitan inclusivity and congenial clubability. The fraternal and convivial nature of the Doctors Club was evident in its two principal activities, eating and drinking. Relatively few eighteenth-century practitioners have left behind significant bodies of manuscript material which allow us to reconstruct the multidimensional aspects of lived experience. This is especially true for apothecaries whose relative lack of formal, scholastic education denied them access to some of the literary and cultural resources enjoyed by their medical colleagues. It is for this reason that the writings of Oswald Allen are so valuable.
This chapter explores the place of polite and ornamental learning in the social self-fashioning of the late eighteenth-century medical gentleman. It presents three case studies of local practitioners whose interests and publications spanned the spectrum of polite learning from what might be called 'natural' forms of knowledge, including botany and agricultural improvement. The chapter begins with Alexander Hunter, whose botanical and agricultural publications shaped his identity as a patriotic Whig of refined sensibilities. It considers how medicine intersected with the cultural politics of place in the work of his friend and fellow physician, William White. Hunter is portrayed not as a working practitioner but as a refined gentleman of letters and leisure. The chapter concludes with the work of Charles and James Atkinson, exploring how comedic writing could present medical practitioners as men of wit and literary imagination, at ease with the droll discourse of men and manners.
Politics, reform and the demise of medico-gentility
This chapter demonstrates how the scandal which engulfed the York Lunatic Asylum from 1813 to 1815 constituted a clash between competing notions of social power and public authority. It opens with a brief account of the early years of the York Lunatic Asylum under its first physician, Alexander Hunter. It examines an incident in the late 1780s, when a small group of governors tried unsuccessfully to challenge Hunter's authority. The reform of the Lunatic Asylum was the most visible, and perhaps the most aggressive, example of the subjection of charitable institutions and their medical officers to a lay 'public' authority, but it was not an isolated incident. Events at the Asylum can only be fully understood as constitutive of a much wider transformation in the cultures and politics of early nineteenth-century England.
Social progressivism and the transformation of provincial medicine
In York, many medical practitioners involved themselves in the provincial scientific movement, witnessed by the growth of literary and philosophical societies, provincial museums and mechanics' institutes. It begins by exploring the extent and significance of medical involvement in one of the city's most important cultural institutions, the Yorkshire Philosophical Society (YPS). In practice, the cultural and political profile of the YPS can be located somewhere between the alternative visions of science as socially progressive or as a polite, literary activity. The example of French medicine exerted a particularly forceful influence over debates about body-snatching and anatomical dissection in Britain. The disappearance of medicine from the British Association for the Advancement of Science (BAAS) was not so much an indication of the marginality of medical knowledge as it was the final marker in a process of intellectual disaggregation.
Cholera, collectivity and the care of the social body
This chapter demonstrates how, through co-ordinated activity, through the experience of the cholera epidemic and through the elaboration of statistics, the medical practitioners of York constructed the social as a legitimate sphere of interest and activity. The cholera epidemic did not guarantee a uniform or consistent involvement by medical practitioners in the field of public health. In the immediate aftermath of the epidemic, a large number of medical practitioners used their experiences of the disease to locate themselves within a pan-national discourse of cholera and to contribute to debates about its nature, management and treatment. To a great extent, the visions of medical service were channelled through new forms of social organisation and formulated within new ideological frameworks, for the medicalisation of the social body. This was matched by a commensurate process: the socialisation of the medical body.
Expertise, authority and the making of medical dominion
Claims about the supremacy of medical science were fundamentally rhetorical, designed to impress upon the public mind, the moral authority of orthodox medicine. The precise origins of the York Medical School are somewhat obscure, but the idea of establishing such an institution was first publicly mooted by the pseudonymous 'Medical Pupil' in a series of letters to the York Herald in 1832. By providing a single focus for medical education, the Medical School formalised and institutionalised hitherto diffuse and inchoate expressions of knowledge and expertise. The foundation of the York Medical School marked a key development in the elaboration of medical identity and authority on the local stage. Medical reformers therefore faced an extremely difficult task in squaring their vision of a state-sanctioned professional dominion with the dictates of political and economic liberalism.
The 1858 Medical Act was the signal achievement of medical reform. And yet even this proved to be a grave disappointment to many general and provincial practitioners, who continued to lack the representation and political authority they desired. Private practice, rather than public health and 'state medicine', continued to be the principal concern and source of income for most practitioners and 'quacks' continued to operate more or less unchecked by legislative interference. It is impossible to address the history of medical professionalism in England without an eye to the foundation of the National Health Service (NHS). While the British public may remain attached to the concept of the NHS, the stability of medical-professional expertise has also been undermined by changes in popular attitudes. The later nineteenth century saw an ever greater investment in scientific rationality and expert knowledge in the social and cultural configuration of medical identity and authority.