Medical Practice and Medical Profession

1. Medicine, Disease and Society in Britain, 1750 - 1950 Medical Practice and Medical Profession Lecture 5

2. The consolidation of a medical profession? • Definitions of ‘profession’ and criteria • The main changes in the C19th • - Medical education • - Licensing of practitioners • - Changes to medical practice e.g. GPs • Reform of medical practice • - 1815 Apothecaries Act • - 1858 Medical Act • The medical profession in the late C19th • - GPs, public offices, consultants • - Problems for the profession: overstocking, competition, public image Lecture themes and outline

3. Professionalisation, S.E. Shortt (1983) “A process by which a heterogenous collection of individuals is gradually recognised, by both themselves and other members of society, as constituting a relatively homogenous and distinct occupational group.”

4. A medical profession: relevant criteria • The possession of a body of highly specialized knowledge: we expect our doctors to have a deep knowledge of disease, acquired through a long training in medical school. A doctor’s qualifications prove that he or she has completed this training to the standards required of the profession. • Professional unity and a strong ethos of public service: we do not expect doctors to compete with one another for patients by advertising their services or by offering cut-price practice. We do expect practitioners to cooperate when caring for patients, and to always work for the patients’ best interests. • A monopoly of practice: only members of the medical profession can call themselves doctors. We distinguish between orthodox medical practitioners and those who offer alternative forms of medical treatment by calling them practitioners of ‘complementary’ or ‘alternative’ medicine. • Professional autonomy: medical practice is based on highly specialist knowledge, which is not shared with the general public. Therefore, only doctors can judge whether other doctors are trained to a suitable standard and are competent to practice. • High social status: doctors earn relatively high salaries and also enjoy a special social respect.

5. Situation c.1800 • 1. No collective power: divisions between physicians, surgeons and apothecaries • 2. Variety of routes to a medical licence • 3. Division within the medical profession • (General practitioners and consultants) • 4. Competitive medical marketplace • 5. Public perceptions varied- money grubbing or unskilled

6. Medical Reform 1815 Apothecaries Act License for the Society of Apothecaries needed to practice as an apothecary: apprenticeship, academic courses, hospital experience and examination By 1848 most practitioners held multiple qualifications: LSA, MRCS, medical degree and midwifery licence

7. Medical Journals: pressure for reform

8. Sir Astley Cooper, (1768-1841). Lancet attacked system for hospital appointments and consultant posts as corrupt. e.g. Bransby Cooper, appointed to Guys as nephew of Astley Cooper.

9. The Cooper’s Adz!! Versus the Lancet!!, 1828. Cooper is shown being stabbed in the bottom, not just for comic effect but also as an allusion to the operation to remove a bladder stone.

10. Sir Charles Hastings (1794-1866), founder of the British Medical Association (originally called the Provincial Medical and Surgical Association)

11. Medical Reform • 1858 Medical Act • Single medical register • Equal recognition of all practitioners • General Medical Council - uphold standards, education, ethics, practice • 1886 Medical Amendment Act – all medical students required to have qualifications in surgery, midwifery and medicine • Limitations: • Still multiple routes to qualification – Loudon, Waddington • Quacks and irregulars still practising

12. Irvine Loudon Medical Care and the General Practitioner (Oxford: Clarendon Press, 1986), pp. 298-301.

13. Ivan Waddington The Medical Profession in the Industrial Revolution (Dublin: Gill and Macmillan, Humanities Press, 1984), pp. 138-52.

14. A clinique of the Royal Infirmary of Edinburgh, c. 1895. A ‘clinique’, or ‘firm’ as it was known in England, was made up of the students working with the staff of a particular ward

15. Five career patterns for doctors (Anne Digby 1999): • The ‘classic’ GP who practised general medicine among a mix of social classes. • The GP/surgeon who practised general medicine and had a part-time appointment as a surgeon in a small hospital. • The GP/specialist, who worked as a general practitioner but also did some consulting work in one area of medicine, such as obstetrics or eye diseases. • GPs who became consultants, men who started their careers in general medicine but switched to full-time consulting. • The ‘pure’ consultants, who belonged to prestigious medical institutions, held posts in major hospitals and had a private practice.

16. Advertising for homeopathy in Britain in the nineteenth century

17. The BMA Secret Remedies Campaign, 1909

18. Elizabeth Garrett Anderson (1836-1917)

19. Conclusion The emergence of a modern profession? Yes • Meets many of criteria of a profession: unity, educational standards, GMC, register, medical press BUT • Mixed route to medical qualification • Intra-professional tensions e.g. hospital vs public posts, generalists vs specialists • Unqualified still practising and popular with the public – launch of campaigns e.g. secret remedies • Women – threat in overcrowded market and against patriarchy • Image – damaged by body snatching, Anatomy Act and public health interference NOT CONSOLIDATED PROFESSIONALISATION