Friday, April 3, 2020

The Rise of the Medical Profession

By Judith Leask

The medical profession – that is, the role of physician – was one of the few ‘gentlemanly’ professions of the 18th-19th centuries[1]. Was it the prospect of attaining this status in society that attracted so many young men into the profession during this era? Was there an enthusiasm to practise the emerging powers to heal the sick that drew them in, or was it a desire for a place of public prominence at a charitable hospital? For some it may have been a philanthropic ambition to address the shameful living conditions of the poor, in both urban and rural locations; for others, no doubt, it was a hankering to gain access to the drawing-rooms of the wealthy and titled.

Dr Lydgate, the beautifully crafted character in George Eliot’s Middlemarch, was motivated by the need to view himself as a success, and to leave a legacy – to leave his name to some key piece of advancement in medical science; Dr Harrison in Elizabeth Gaskell’s The Cranford Chronicles wished to spread modern medical principles to the sleepy country town.

Whatever their varying motivations, young men were increasingly drawn to the study of this field – prominent centres of learning were London hospitals[2], as well as Edinburgh[3] and Glasgow[4]. In the later part of the 19th century, it was not only the young men who aspired to this profession – women began to question why they should be shut out, and began to break down the door (more on this later).

Anatomy

An improved knowledge in this area was essential for advancing medical science, and a continuous supply of cadavers was required to educate students of medicine, but the public were naturally averse. From the times of Henry VIII, dissection had been associated with the executed corpses of convicted felons or murderers, which were not permitted to be buried, and therefore did not receive the proper religious rites[5]. To have one’s body dissected was therefore an added punishment, and was a mark of an utter lack of respect, even ignominy. It’s easy to imagine, therefore, that doctors who pursued this form of study were held in suspicion – why would any person of respectability wish to do such a thing? Who could tell what such a doctor, so lacking in a sense of moral rectitude, may do to gain a further supply of cadavers to study?

The increasing demand for cadavers that outstripped the supply of executed bodies had somewhat ghoulish, if perhaps predictable, results – the practice of grave-robbing began to flourish. The trade of the Resurrectionists paid quite well: a gang of 15 grave robbers operated in the vicinity of Lambeth, using 30 burial grounds, until they were rounded up in 1795[6]. Families who were wealthy enough would have their deceased relative entombed in a metal coffin or had a mortsafe of iron bars placed around the grave.

Illustration of resurrectionists at work - Credit

While disturbing a grave was a criminal offence, the taking of the corpse was not – a corpse was not considered property, therefore could not be stolen[7]. However, engaging in this act was very ill-advised, given the strength of public feeling against dissection, and many medical students were lucky to escape with their lives from the angry crowds when suspected of being involved.

Others found a more direct source of cadavers to sell – famously Burke and Hare killed 15 of the lodgers who stayed at Hare’s Edinburgh lodging house over the course of about a year, until they were discovered in 1828. Before embarking on this killing spree they had taken the body of a man who had died of natural causes to the university and sold it for £7 10s; it seemed they could not resist engaging in a further trade[8].

This grisly trade resulted in the Anatomy Act of 1832, which gave physicians, surgeons and medical students the legal right to corpses that were unclaimed after death, in particular those who had died in a hospital, prison or workhouse [9].

Burke and Hare circa 1850 - Credit


Hospitals

The setting up of charitable hospitals also flourished through this period.

To take London as an example, in the early 18th Century St Thomas’s and St Bartholemew’s hospitals were the only two hospitals, endowed by Henry VIII and Edward VI respectively, and were supported by estates confiscated from the church at the time of the reformation. Then came Guy’s Hospital, founded in 1721 and supported by the large estate of Thomas Guy – these three ‘endowed’ hospitals could survive independently without the need for public donations[10] .

Further hospitals were set up in the 18th century via charitable associations. Coinciding with advancements in medical knowledge, hospitals became places where one might seek a cure, rather than simply receiving refuge and comfort. Many were also institutions for medical training, with some being set up specifically to serve close-by medical colleges.

This sounds as though people who could not afford to pay for their chosen doctor to treat them at home were well catered for – that multiple hospitals that served the growing urban population would provide for their needs. The reality was unfortunately quite different; in most cases it took some time and effort to gain admission – and often time was not on the patient’s side. To receive charitable treatment a patient would have to seek a letter of recommendation from a governor, who would be limited to the number they could recommend, and could pick and choose who they agreed to support.

Admissions were also only possible on one or two days a week[11].  Imagine falling ill with a dangerous fever on a Tuesday, if admissions at your local hospital occurred on Mondays only. Fortunately from the 1820s, institutions began to appear that did not require such a recommendation, or any payment – they would treat in case of need. Prince Albert was the supporter of one such hospital.

In addition to general hospitals, a number of lying-in (or maternity) hospitals were established.

Initially these were for married women only; perhaps the controversy that arose from these hospitals related to taking this activity into a more public sphere rather than existing only in the domestic – certainly the attendants were women only at first. One can only imagine what was said by genteel folk of the General Lying-In Hospital’s policy of admitting single as well as married women, when it was established in London 1767[12] .

Women in Medicine

In the 18th and early part of the 19th century, women’s role in the medical world extended to midwifery only, an occupation for a skilled low-born female.

As far as education was concerned, schools that admitted girls equipped them to be considered ‘accomplished’ and to at least know a little history, and so on; after all, what genteel man would want a wife who could not hold a reasonably intelligent conversation with their dinner guests, or play the pianoforte in the drawing-room? The story of women educationalists is a fascinating one – of women who defied convention to set up schools that taught a full curriculum, such as the Cheltenham Ladies’ College, founded in 1858[13] .

No university in this country awarded degrees to women until the University of London in 1878[14]  – and the London School of Medicine for Women, established in 1874, formed an association with this university in the late 1800s[15]  to enable women to train as doctors. To put this into context – Oxford did not award degrees to women until 1920[16], and Cambridge in 1921 began to acknowledge the studies of women but only with a ‘diploma’[17] . The first woman doctor in this country (registered in 1859) did not gain her degree here – Elizabeth Blackwell studied in Geneva, New York, gaining her medical degree in 1849, the first woman in America to do so[18].

Elizabeth Blackwell Postage Stamp - Credit

Can you imagine what it must have been like, as a young woman with aspirations, to attempt to break through the beliefs so firmly rooted throughout society at the time? To persuade the world to break with the centuries-old convention that prohibited their having an education and a professional role?

Nursing

While this post is about medicine, I couldn’t possibly neglect to mention Florence Nightingale in a discussion on healthcare and women’s roles in the 19th Century. She is described as the founder of modern nursing, and after her famous role as ‘the lady with the lamp’ in the Crimean War, she set up the nursing school at St Thomas’s hospital in 1860[19]. At a time before germ theory was accepted as the cause of disease, Florence instilled more sanitary conditions in hospitals and transformed nursing care.

Florence Nightingale - Illustrated London News, 1855 - Credit

But it is her determination to pursue her passion despite her family’s opposition that fascinates me – her refusal to have her life shaped by the conventional roles dictated by society. It was my admiration for her approach that led me to preface my book with this quote:

‘The world is put back by the death of every one who has to sacrifice the development of his or her peculiar gifts to conventionality.’ – Florence Nightingale.

Notes

 [1] http://englishhistoryauthors.blogspot.co.uk/2015/09/gentlemanly-professions.html
 [2] https://www.medsci.ox.ac.uk/about/history/oxford-medical-sciences-through-the-centuries/1800s
 [3] http://www.electricscotland.com/history/medical/medicine8.pdf
 [4] https://en.wikipedia.org/wiki/List_of_historical_medical_schools_in_the_United_Kingdom
 [5] http://www.leeds.ac.uk/chb/lectures/anatomy1.html
 [6] http://onlinelibrary.wiley.com/doi/10.1046/j.1440-1622.2001.02127.x/pdf
 [7] https://en.wikipedia.org/wiki/Burial_Act_1857
 [8] https://en.wikipedia.org/wiki/Burke_and_Hare_murders
 [9] https://en.wikipedia.org/wiki/Anatomy_Act_1832
 [10] http://www.nhshistory.net/voluntary_hospitals.htm
 [11] ibid
 [12] https://en.wikipedia.org/wiki/General_Lying-In_Hospital
 [13] https://www.cheltladiescollege.org/about-clc/history-of-college/
 [14] https://en.wikipedia.org/wiki/Timeline_of_women%27s_education
 [15] https://en.wikipedia.org/wiki/London_School_of_Medicine_for_Women
 [16] http://www.telegraph.co.uk/only-in-britain/oxford-university-allows-women-to-graduate/
 [17] https://en.wikipedia.org/wiki/University_of_Cambridge#Women.27s_education
 [18] https://en.wikipedia.org/wiki/Elizabeth_Blackwell

 [19] https://en.wikipedia.org/wiki/Florence_Nightingale

~~~~~~~~~~

Judith Leask is a long-term reader of historical and classical novels, and began writing fiction when dared to do so by a fellow wordsmith in her project management office. Six years, many writing group sessions and several re-writes later, her first novel Her Peculiar Gifts has now been released – a contemplative tale of James, a shy doctor, and his daughter Laura, who possesses unused talents. A further historical novel, set in Jamaica, is underway, and for her dragon-loving children she wrote The Silver Shell, to be released soon. Her story about the ghost of Charles Dickens can be found in the anthology Haunted. She has discovered a passion and a talent for developmental editing, and is now a freelance book editor with Just Right Editing. This gives her the chance to read and help to refine all manner of books – which is heaven for a bookworm.

https://judithleask.wordpress.com/
https://judithleask.wordpress.com/just-right-editing/


2 comments:

  1. somewhat topical! :-) Very interesting article - thanks for sharing

    ReplyDelete

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