A MEASURE OF THE ELITE: A HISTORY OF MEDICAL PRACTITIONERS IN HARLEY STREET, 1845-1914
MICHELE
STOKES
UNIVERSITY COLLEGE LONDON DOCTOR OF PHILOSOPHY
FOR DICK, TOM, JACQUES AND AMELIA.
ACKNOWLEDGEMENTS I wish to thank a number of people who have given me their time and professional advice during the preparation
of this thesis. Specific thanks
William Professor to must go my supervisor
Bynum whose scholarly rigour
encouraged me to constantly challenge my own intellectual deeply grateful for his unstinting
boundaries. I am
advice and support. Special mention must
for her be Dr Anne Hardy to valued advice, academic precision also made and editorial supervision. I have been fortunate in receiving help from librarians
and archivists,
in particular from Richard Bowden at the Howard de Walden Estates, Victoria North at the Royal Free Archives Centre and archivists at the RCS, RCP and the RSM.
I should like to thank my colleagues and the Library staff at the Wellcome Trust Centre for the History of Medicine at UCL for their help during
the course of my research. Dr Eileen Magnello
made valuable
her keen the thesis the and elements of eye was on numerical comments important during the proof reading stages. I should also like to thank Professor Christopher Lawrence for his enthusiasm for the project and Dr. Michael Neve for his editorial comments. As the foundation of this thesis in database I IT department, large to the am grateful my colleagues a was
in particular Gwyn Griffiths for his technical support and advice over the late Professor Roy Porter inspired me to study the Finally, the period.
history of medicine.
3
Thesis Abstract Though Harley Street has been viewed as the provenance of the medical 61ite in Britain,
no attempt has been made to systematically
examine this
61ite in its historical context or to consider the veracity of this view. Hence, this thesis reconstructs the totality of all the male (n = 657) and female (n = 24) medical practitioners
who arrived in Harley Street from 1845-1914 by
undertaking a prosopographical analysis and contextualising the historical background in which they lived and worked. Over the course of the Street became Harley a progressively more fashionable nineteenth century, for medical practitioners choice
wishing to establish a practice in London
and in most cases, this address represented the pinnacle of their career trajectory.
It is argued here that an 61ite medical enclave did, indeed,
during The in itself the this period. geographical area group's establish reputation
was assessed through their medical qualifications,
hospital teaching and posts, publications, prizes,
scholarships,
lectures public and their
role in medical societies. Harley Street medical practitioners differed from other London (85 because they published more material of the medical practitioners MD in 93 the cohort who qualified general and percent of published cohort their work, in contrast to up to 50 per cent of London medical practitioners), had more prestigious
qualifications
(86 per cent were qualified
FRCP, FRCS or MRCP in contrast to approximately
MD, MB,
25 per cent in Greater
London), were members of medical societies (almost 90 per cent of the cohort in contrast to between 40 and 50 per cent of GPs in Britain),
4
created new
hospitals, in took specialist established prominent roles medical specialities,
medical societies and delivered renowned public lectures that
were
published in the main medical journals. Moreover, this group wielded considerable collective editorial
in control a wide range of medical
facilitated Hence, the professionalisation their publications. efforts greatly of medicine in the late nineteenth and early twentieth centuries. Through their
senior hospital
influence
on the
and teaching
next
posts the cohort had an important of medical
generation
in were crucial connections attracting
practitioners,
new medical practitioners
as these to the
Street. This thesis, therefore, determines whether Harley Street can be 61ite. the of medical regarded as a measure
5
Table of contents THESIS ABSTRACT
4 ..................... .......................................................... . ............................... TABLE OF CONTENTS 6 ...........................................................................................................
TABLEOFPLATES 7 ..................................................................................................................... TABLEOFGRAPHS 7 .................................................................................................................... LIST OF ABBREVIATIONS 8 .................................................................................................... CHAPTER1
10 ..............................................................................................................................
INTRODUCTION ........................................................................................................................ SOURCESAND EVIDENCE ........................................................................................................ METHODOLOGY ...................................................................................................................... CHAPTER 2 .............................................................................................................................. THE BIRTH OF THE MEDICAL ELYSIUM ...................................................................... THE BIRTH OF HARLEY STREETAS A MEDICAL QUARTER .....................................................
10 22 29 44 44 64
CHAPTER 3
ill ............................................................................................................................ MEDICAL EDUCATION ............................... ...................................................................... ill CHAPTER 4
147 ............................................................................................................................ ESTABLISHING AND DEVELOPING A CAREER: HOSPITAL AND TEACHING POSTS 147 ...................................................................................................................................... CHAPTER 5 ............................................................................................................................ 208 PROFESSIONAL ADVANCEMENT AND THE TRANSMISSION OF MEDICAL KNOWLEDGE - PUBLIC LECTURES AND SOCIETY MEMBERSHIPS 208 ................ RITUALSANDPUBLICLECTURES 209 .......................................................................................... MEDICALSOCIETIES 226 ............................................................................................................. CHAPTER 6 267 ............................................................................................................................ PROFESSIONAL ADVANCEMENT AND THE TRANSMISSION OF MEDICAL 267 KNOWLEDGE - MEDICAL PUBLICATIONS ............................................................... 320 CHAPTER7 ............................................................................................................................ WOMEN MEDICAL PRACTITIONERS OF HARLEY STREET ..................................320 373 CHAPTER 8 ............................................................................................................................ 373 CONCLUSION ....................................................................................................................... 382 APPENDIX A .......................................................................................................................... 384 APPENDIX B .......................................................................................................................... 387 APPENDIX C .......................................................................................................................... 402 APPENDIX D .......................................................................................................................... APPENDIX
E
..........................................................................................................................
411
412 APPENDIX F .......................................................................................................................... 420 BIBLIOGRAPHY ................................................................................................................. .
6
Table of Plates PLATE 1.1, MAP OF THE HARLEY STREET AREA
13 ....................................................... PLATE 2.1, PLAN OF THE MARYLEBONE ESTATE 47 ...................................................... PLATE 2.2, 'MAP OF MARYLEBONE'BY JOHN PRINCE IN 1719 54 .............................. PLATE 2.3, TIMETABLE 1719 55 ..............................................................................................
PLATE 2.4, PART OF A MAP BY JOHN ROCQUE, 1747 62 ................................................. PLATE 2.5, POTTER'S MAP OF ST MARYLEBONE, 1832 71 ............................................. PLATE 2.6, SIR JAMES MCGRIGOR
107 ................................................................................ PLATE 2.7, SIR CHARLES MANSFIELD CLARKE ....................................................... 108 PLATE 2.9, DR. NATHANIEL EDWARD YORKE-DAVIES ..........................................110 371 PLATE 7.1, DR JANE HARRIET WALKER ..................................................................... 372 PLATE 7.2, DR MARY SCHARLIEB ..................................................................................
Table of Graphs GRAPH 1.1, HARLEY GRAPH 2.1, MULTIPLE
STREET
............................................................................................ OCCUPANCY ..............................................................................
7
28 78
List of Abbreviations BA
Batchelor of Arts
BAO
Batchelor of Obstetrics
BC., B. Ch., BS
Batchelor of Surgery
BMA
British Medical Association
BMJ
British Medical Journal
Cm., MS
Master of Surgery
DNB
Dictionary of National Biography
DPH.
Diploma in Public Health
FRCP
Fellow of the Royal College of Physicians
FRCS
Fellow of the Royal College of Surgeons
FRS
Fellow Royal Society
GMC
General Council of Medical Education and Registration Kingdom United the of
LAH
Licentiate Apothecaries Hall, Ireland.
LKQCPI
Licence of King's and Queen's College of Physicians of Ireland
LRCP
Licentiate of the Royal College of Physicians
LSA
Licentiate of the Society of Apothecaries
LSMW
London School of Medicine for Women
L (RFH) SMW
London (Royal Free Hospital) School of Medicine for Women
MD
Doctor of Medicine
8
MOH
Medical Officer of Health
MFW
Medical Women's Federation
MRCP
Member of the Royal College of Physicians
MRCS
Member of the Royal College of Surgeons
NHW
New Hospital for Women
RCP
Royal College of Physicians
RCS
Royal College of Surgeons
RFHSM PC
Royal Free Hospital School of Medicine Press Cuttings
Wellcome
Wellcome Library for the History and Understanding
Medicine
9
of
CHAPTER1 Introduction The Harley Street Area has long been a major centre of medical activity in Britain. Known locally as The Valley of the Shadow of Death or Pill Island, the doctors and surgeons who practice there are considered to be among the very best in their area of expertise. ' By the end of the twentieth
century
there were over 1,400 registered doctors, dentists and surgeons working in the Harley Street Area in one year alone, offering a variety of specialities A 3,000.2 survey undertaken plus support staff of some
by the health care
in in HCIS, 1995, that the area estimated private medical care analysts,
London's heath 1375 total while care market was said to million, was worth be Y.650 million. 3 The Harley Street Area accounts for more than 60 per cent
Harley Street Though the this much of scholarship on portrays market. of its medical practitioners
as being synonymous with medical pre-eminence,
been has yet made to systematically no attempt
examine their 61ite status. 4
For example, 31 out of the total 171 members of the Council of the RCS
I Someblack cab drivers in London refer to Harley Street as the valley of the shadow of death whilst Estate agents refer to the area as Pill Island see,Paul Ferris, The Doctors, (London, 1965), p. 25. 2Anon, 7he Marylebone Journal, 17, Winter 1998, p. 11. Dr Thomas Stuttaford, 'Cashing . in at Harley St.', The YYmes,November 19,1998, p. 22, stated that the doctors and dentists in practice in Harley Street had combined earnings of approximately 2 138 million. 3 Ibid 4 For examples, seeReginald Pound, Bazlt7 Street, (London, 1967),passim, Mrs Alec. Tweedie, (ed.) GeorgeHarley F.R.S. or the Life of a London Mysician, (London, 1899), p. 133, William Byam, The Road to Harley Stree4 (London, 1963), p. 227. M. Jeanne Peterson discussesthe 'Formation of a Professional Elite' in Chapter 4 of Tbe Medical Pi-ofessionin Mid-Vietoiian London, (London, 1978),pp. 136-194,however, there is no reference to Harley Street. 10
between
1845-1945
were
Harley
prominence and international
Street
men. 5 Despite
its
prestige,
reputation there has been no critical or
rigorous analysis of the development or inner working of the Street.
This thesis, therefore, aims to correct this lacuna in the historical literature and is a study of all the medical practitioners who arrived in Harley Street from 1845 to 1914, which comprised a total of 657 men and 24
women. These two dates were selected because the London and Provincial Medical Directory was first published in 1845 and the onset of the First World War inevitably changed the ambience and the day-to-day workings of these great family houses; moreover, the large number of staff needed to run them could no longer be sustained.6 The habit of multiple lettings that had taken off in the 1890s increased sharply from the start of the war. The hired a consultant a room with secretarial support, whilst whereby system maintaining inter-war
family a
established
in the
period and this system has been used ever since.
Though Harley
that
home elsewhere became firmly
surround it
Street has become synonymous with those streets
and refers equally to Wimpole, Queen Anne and
Devonshire Streets, throughout the thesis "Harley Streee' will refer strictly
to the Street itself, whereas the streets bordering it will be referred to as the 5 Zachary Cope, The History of The Royal Collegeof Surgeons of England, (London, 1959), pp. 318-319 and 342-344.Andrew Morrice in'Honour and interests: Medical Ethics in Britain, and the work of the British Medical Association's Central Ethical Committee, 1902-1939',(MD thesis, University of London, 1999),p. 344, maintained, that the council of the GMC was composedof "36 members of the elite" of the profession, which were drawn from the licensing bodies in addition to persons nominated by the monarch and a number of these were Harley Street men. 6 Pound, HarlevStreet; p. 99, by the 1920sPound argued, few houses were family homes. In 1958,940 medical practitioners practiced in Harley Street and as there were only 144 housesin the street, multiple letting was common. Seealso Juanita Burnby, Caricatures (Staines, Comments, 1989),p. 19. and 11
"Harley Street Area". A recent map of the Harley Street Area is shown in
Plate 1.1.7 The Marylebone Road to the north and Oxford Street to the south, hem in this medical district. 8 Marylebone High Street forms a border
to the west and Portland Place delineates its boundary to the east. The red line shows the boundaries of the Howard de Walden Estate who have owned the freehold of these houses since 1889. The Crown is the main freeholder of the properties on Harley Street, which fall outside the red line.
7Map on the Harley Street Area was in an Information Pack on the area available from the Howard de Walden Estates Limited. 8 Upper Harley Street, recently renamed Brunswick Street lies to the north of the Marylebone Road.
12
Plate 1.1, Map of the Harley Street Area
Image removed due to third party copyright
13
The Medical Directory
first the contains
comprehensive
listing
of
by in includes brief Britain and a medical practitioners registered address to their profession. Apart from the short-lived
biography relating
Registers, which were published in 1779,1780
Medical
and 1783, the only other
source materials available were the eighteenth and nineteenth century trade directories, which provided the address of a person's practice. 9 These directories were not used in the database, as they did not list all addresses in Moreover, 1845 there were only eight they published annually. nor were medical practitioners
in Harley Street. registered
The Parameters of the Thesis Since the aim of this thesis was to reconstruct the totality medical practitioners undertaken
1845-1914, a prosopographical
analysis
was
in Street. Whilst the the total practised population who using
various statistical sampling
from
of Harley Street
sampling measures were considered, systematic random
procedures
were eliminated,
because it was not possible to
be in to list taken represent all could a systematic sample which construct a the medical practitioners
in Harley Street, especially since not all of them
had an obituary published in the main medical journals. 10If this method had been used, it would have skewed the data and produced unreliable (343 for dates death 50.37 The out of per cent only were available of results.
9Anon, TbeMedical Register for the Year 1779, (D)ndon, 1779),Anon, MeMedical Register for the Year 1780, (London, 1780),Anon, TI2&Medical Register for the Year 1783, (IA)ndon, 1783). 10A random sample has been defined by GeorgeA. Ferguson as "one such that every [italics in it included has being the population of an equal see, member mine] probability of GeorgeA. Ferguson, Sts tistical Analvsis in Ps:vchologxan d Education, (New York, 198 1), pp. 143-44.
14
681) of the cohort and this was not evenly spread throughout
the period
have been by the thesis, thus this representative covered sample would not As " the statistician, the of group.
George Ferguson cautioned, "on occasion,
do drawn from lists which not provide a complete record of the are samples
but the are viewed, perhaps erroneously, as of population, members representative
of the population". 12 Sorting the group alphabetically
chronologically
and then selecting a sample of, say, every tenth man or
or
have been decade an adequate representation of would also not every new the cohort. Having a complete data set of this population made it possible to
discussions findings the empirical confidence about with cohort, and present thus avoiding generalisations about the group based on a number of isolated studies. To make comparisons with two other groups of medically qualified
individuals in London, material was obtained from the Medical Directory for those who practiced in the Harley Street Area and for those who set up practice throughout
for in London the years 1845,1880 other areas
and
1914. These years were selected because they correspond to the start, for The those dates the thesis. examined geographic area of end middle and
in London extended as far north as Enfield, as far south as Lewisham, as far hereafter, Shepherds Bush; far to Woodford referred as as west and east as Greater as
London. A systematic random sample of 601 medical
Greater London the throughout was whole of practitioners who worked
11Datesof deathwereavailablefor 343and datesof birth availablefor 389,the datesof birth and death togetherwereavailablefor 308of the cohort. 12Ferguson,StatisticalAnalysis, p. 144.
15
undertaken.
To
practitioners
were selected from the Medical Directory for 1845 and 1880.
obtain
this
sample,
ten
percent
of
male
medical
As the population for 1914 was more than twice the size of 1845 and 1880
ten per cent would have doubled the sample size, instead, five per cent of the population was selected. The process involved selecting every 10th (for 1845 and 1880) or 20th person (for 1914), but if an entry only contained a if name with no address or qualifications, or the entry were a woman, these individuals were not used and instead the next person was included in the sample. medical men practicing in the Harley Street
The entire population'of
Area yielded a population size of 478. Since this was a smaller subset of the it The to taking too warrant was small a random sample. population, entire Street included for in Harley Area those the those streets geographic region parallel
and perpendicular
to Harley
Street
Wimpole such as
Street,
Devonshire Street, Welbeck Street, and etc., (see Map on page 13). Table 1.1 Appendix A shows the total population
and sample sizes of these groups
over the three selected years. Composition of the Chapters The thesis is divided into two main sections; the first section comprises Chapters One and Two. Chapter One elucidates the methodology employed in selecting the Harley Street cohort and outlines the status of the medical in Victorian profession
Britain.
The historiography
Street is Harley also of
in is to the consideration medicine that and given advances major examined took place from 1845 to 1914. Chapter Two discusses the birth
16
of the
medical elysium
and the topographical
background
from which
Harley
Street emerged as a medical district. It also addresses the growth and popularity
Street the of as a medical area up to the start of the First World
War. Topics that fall outside the prosopographical
analysis, such as the
Street behind Harley the cohort's selection of as a practice motivation discussed. The Harley Street, included social aspect of which address, were the cohort's appearance, their use of leisure time was also determined. Finally, those who managed to attain the pinnacle of social and professional
identified. becoming by The the court physicians and surgeons were success, Chapters includes Three Seven is largely thesis to the and of second section Street Harley female the of male and cohort a prosopographical examination in the medical profession. their of prominence and an assessment Chapter Three considers whether the Harley Street group were part 61ite. Medical qualifications of an educated or academic
by the cohort earned
The the the to calibre of group. academic establish results were analysed Street Area from Harley from to the the to those and sample were compared Greater London for the years, 1845,1880 and 1914. Indicators of academic pre eminence such as prizes, scholarships, and endowments awarded to the
Harley Street group were examined and the findings were evaluated against the Harley Street Area and Greater London sample. Finally, the medical school in which the cohort gained their medical training and the place of their post graduate study was assessedto test the group's homogeneity and the extent of their post graduate experience.
17
Chapter Four examines the variety hospital
and eminence of the cohort's
posts and the degree of specialisation
in a particular
branch of
be It medicine or surgery. will argued that these medical practitioners only elevated their
status to the rising
professional
not
in Victorian class
England, but that they facilitated the professionalisation of specialised branches of medicine, which may have, in turn, helped to promote the professionalisation
in Britain. of medicine
Chapters Five and Six together explore the means of professional
development knowledge the the of cohort's medical advancement and vis-aýis
post-medical
qualifications.
Memberships
of
to speak at public lectures and publications
invitations
medical
societies,
by the cohort were
light Of interest these to on matters. particular shed were the analysed following:
the methods Harley
Street men used to stay informed
about
by disseminated in the they the results of means which medicine, advances their work -
and their
either through medical publications, textbooks or monographs prominence
in communicating
their
medical
or surgical
knowledge to the rest of the medical community, through memorial orations or lectures. Chapter Five considers eponymous or memorial lectures and public by the group. 13It examines the extent and topics given orations on medical lectures these and evaluates their significance within the medical variety of
130ther societies such as the BMA also held annual lectures. In the BMXs case these were an Address in Medicine and an Address in Surgery. Seefor example, the Anon, 'The British Medical Association: The Address in Medicine', Lancet, Aug. 3,1001, pp. 294-05. The above however, is confined to eponymouslectures. analysis,
18
displays Lectures the most prominent arena. and public orations were one of
of success, experience and medical knowledge within the profession. They flourished from those academically or were which who were a platform eminent
field could impart
in their
knowledge to the rest of the
their
historians despite Yet, their of medicine significance, medical profession. have failed to systematically examine their role. 14 It is being argued that lectures were a valuable form of self-promotion for the group: announcements of forthcoming
important
lectures memorial
Gulstonian Croonian Oration Lectures Harveian the the and and such as YYmes in broad the newspapers such as and medical sheet were printed including press
the BMJ and the Lmcet,
in addition
to other specialist
journals where relevant, such as Erain or OPhthalmic RevieW, thus, in his field. for 15 to the the gain recognition speaker opportunity providing Occasionally,
contemporaries
commented on the originality
of the
New theories the methods or paper. nature of or scholarly matter subject his Lettsomian Barnes When Dr. proposed were often eagerly awaited.
Lectures on "The Physiology and Treatment of Flooding from Unnatural Position of the Placenta" the Lancet remarked that "the able lecturer is
14For a list of endowed lectures and bequests see William Munk, The Roll of the Royal (Pall Zachary East, Mall 1878), Vol. 111,1801 1825, College of Rbysicians, 17nd to edition, Cope, Tbe History of Tbe Royal College of Surgeons of England (London, 1959) and G. H. Brown, Ybe Lives of Me Feflows of the Royal College ofPbysicians ofLondon, 1826-1955, (London, 1955). 15See for example, Anon, Meeting of Societies During the Next Week, BMJ, Feb. 24,1866, p. 218 and Anon, 'Royal College of Physicians of London', Lancet, Aug. 9,1902, p. 596.
19
have to understood arrived at some new views on this important
looked is for exposition with considerable
intereSt.
"16
are analysed in Chapter
The cohort's publications
his subject,
Six. It will
be
fundamental in diffusion the that played a part argued medical publications ideas investigation knowledge, for the and results new of clinical of medical in Harley
the medical practitioners
Street. Most of the major medical
in journals transactions their ancillary medical and their societies published frequently meetings were Medical
Journal,
"reported, often fully, in the Lancet and Britisb
so providing
valuable
publicity
for
the
aspiring
Harley Street "17 Data had the on entire group collected who consultant. in Lancet BMJ, the the and various specialist medical published material journals were analysed to ascertain how prodigious the cohort were as a group
determine to and
the prominence
journals Medical published.
attained
founded or edited by the cohort were
investigated to determine the editorial authority printed material
by those who had
of the cohort. Other
dictionaries hospital reports, manuals, such as
and books
Street Harley by that the the view medical group corroborated edited practitioners
were leading
authorities
in their
area of expertise
and
frequently. published
Chapter Seven examines the lives and careers of women medical practitioners
who became established
in Harley
World War. It will be argued that the acquisition
Street before the First of consulting
rooms in
16Anon, 'The Lettsomian Lectures', Lancet, Apr. 18,1857, p. 416. 17A. M. Cooke, Sir R Farquhar Buzzard, Bt. KCV0., D.M, P R. 0 P. An Apprecia tion (London, 1975), p. 11.
20
Harley
Street not only represented
the apex of achievement
in private
practice for men, but that a number of women also shared that aspiration. Since this thesis examines the medical practitioners in the Street, women who worked in ancillary medical services such as nursing or midwifery
are
not included. 18 Despite the claims of Jeanne Peterson that, "few women managed to enter the profession during the Victorian era7 and since virtually
Street Harley has the on all of scholarship portrayed it as a male
bastion, there has been no attempt to assessthe position of female medical practitioners
within
it. 19 Thus, these conventional
views have completely
neglected the vital contribution that Harley Street women made to the practice
of medicine
and the inspiration
they
provided
for
the next
generation of women medical practitioners.
It will be shown that there were, indeed, a number of female medical Street. Whilst Harley Mary Ann Dacomb Scharlieb became on practitioners the first qualified female medical practitioner
in 1888 to establish a practice
there, by 1914,24 women had established a practice in the Street. 20Despite
their small number, their entrance into the elite male enclave of Harley Street is of interest to the medical historian. To assess their professional
18For a history of Florence Nightingale and her nursing school in Harley Street, see H. Verney, ed. Korence Nigh tingale in Harley Stree4 (London, 1970). 19Pound, Harley Street, passim, William Evans, Journey to Harley Street, (London, 1968) (London, Stevenson, Goodbve Scott Harley Stree4 R. 1954), do not mention women to and (London, in Harley Street Graham, A London, Harvey Doctorýv practitioners at all. medical 1952), makes a short reference to Elizabeth Garrett Anderson only. Cyril Phillips Bryan, Roundabout Harley Street: The Story of Some Famous Streets, (London, 1932), devotes a (xv, (1848). Queen's College for 111-118) Women Although Bryan discusses to pp. chapter early 'pioneers' no reference is made to the female medical practitioners in Harley Street. Peterson, Medical Profession, P. 2. 20J. & A. Churchill, The London and ProtineialMedical Directory for England and Wales, (London), Vols. 1888-1914.
21
standing,
the
qualifications,
training,
professional
life
and
working
determine female to the of relationships cohort were examined and analysed whether
a commonalty
in Harley these existed among medical women
Street.
Sources and Evidence The primary sources used in this thesis were collected to create a database, so that
quantitative
systematically
methods could be used to analyse
and qualitative
the large cohort of medical practitioners.
The principal
database Medical Directory, for the the the the of were construction sources Medical Register and ffhoýg Who; these were supplemented by diaries, archival material,
autobiographies, biographies and obituaries. The Lancet
50.37 343 BMJ the which represented per cent of obituaries, provided and
the cohort. Additional
information was also obtained from eighteenth
directories. trade and street century If the predominant Lytton
image of Victorian
biography was, according to
Strachey, one of "concealment and sugar coating", this was also
largely true of Victorian
For 21 those obituarists obituarieS.
detail (some were only a paragraph
who went into
long), many eulogised their subject.
Even so, few were as hagiographic as Dr Reynolds of University College, Parkes: Edmund his Professor colleague, who wrote about White as a pillow on which his headwas resting, there was morethan ideal beauty in his face,for it was the real and still living clothing of the heart him had life blameless given and mind of one whosememoriesof past and 21Quoted in Michael Shortland and Richard Yeo, eds., Telling Lives in Se;ence.'Rksays on ScientiFic Biography (Cambridge, 1996),Introduction, p. 23.
22
perfect peace woman ... 22
...
Pure
as a sunbeam,
strong
as a man,
tender
as a
Occasionally negative comments were made, but this was unusual. 23 The biographer's
difficulties
were summed up by "R. C.", the obituarist
of
Norman Dalton, a Harley Street physician: only the would be biographer knows how difficult it is to breathe again the breath of life onto a dead man's self and give a fleeting resurrection to his personality. One is so apt to slip aside from the strait way of truth into the turgid eulogy of an apotheosis, or into a sterile catalogue of the material circumstances of his life, without regard to the spiritualities that make a study of the life profitable. 24
Obituaries were predominately
by written medical colleagues who generally
knew the deceased.Thus, the authors tended to concentrate on the subject's few interests to their references were made and schooling careers or medical distinguished Unless family, little they were members of a outside medicine. information
lives. their personal was given about
The archives at the Howard
de Walden Estates, the Royal Free
Hospital, the Royal Colleges of Physicians and Surgeons, the Royal Society of Medicine
Wellcome Trust the and
Library
were also consulted.
The
Howard de Walden archives hold the Rate Books, which contained details of the annual rent, and the premium mainly
to the twentieth
century,
for Freehold. They the paid related
as the earlier records were destroyed.
These archives also contained correspondence files dealing with the Estate Estate late From Leaseholders. the the the worked century, nineteenth and
22Anon, 'Professor Parkes', Lancet, Mar. 25,1876, p. 481. 23Comments were made such as 'he was not a particularly impressive teacher", see, P.R.E., 'Edward Alfred Cockayne',Lancet; Dec. 8,1956, p. 1220 and in Anon, Wilfred Trotter, BMJ, Nov. 21,1931, p. 969 "he was no virtuoso of the operating theatre, he was no profound scholar, he had openedup no new province of surgery", however, most negative comments were followed by a positive statement on the merits of the deceased. 24R. C., 'Norman Dalton, BMJ, Mar. 17,1923, p. 490.
23
in agreement with the Westminster
planning authority
to vet newcomers
rigorouSly. 25They were crucial in the tenant selection process. Those who could not produce evidence of their
qualifications
were, for example,
rejected. A licence was granted to "fully qualified! ' medical practitioners
only
by the early 1920s the standard number of plates, which were 5.5 x 2.5 and inches, were restricted to four per house.26 Occasionally the Estate, on application,
five licensees house, to allowed practice per which meant that
two practitioners shared a brass plate. 27A couple of houses in Harley Street in 1928 had six or more plates and the reason for such "exceptionar' houses had "a that these circumstances was much larger number of rooms than usual, or in some cases, the houses do not belong to this Estate". 28
The Medical Directory was the only source that contained a Street List of London practitioners
for the period, making it possible to locate all
Harley Street medical practitioners. This directory was used to determine the movement of medical practitioners
into and out of Harley Street from
1845 to 1914. To evaluate the fluctuation
in the number of arrivals
and
departures during the period, a comparison between consecutive years had
25Pound, Harley Street, p. 15, stated that the Howard de Walden family inherited the Estate in 1854, however, the historical evidence doesnot support this view. According to Charles Mosley, (ed.) BurkeývPeerage & Baronetage, 106thedition, Vol. II, (London, c1999), pp. 2285-2288,the sixth Earl of Portland and fifth Duke of Portland, William John Cavendish Cavendish-Scott-Bentinck, died in 1879, without issue and the estate passedto his three sisters; Charlotte, Mary and Lucy, Dowager Baroness Howard de Walden. Mary died in 1874 and Charlotte died in 1889 so the full estate went to Lucy. When Lucy died in 1899 the estate passedto the seventh Baron Howard de Walden. 26Letters to Dr Sloan Chesser,from the Howard de Walden Estate, 4 Oct. and 4 Nov. 1921, Archives of the Howard de Walden Estate. 27Letters to Dr Milligan, from the Howard de Walden Estate, 16 March 1922,Archives of the Howard de Walden Estate. 28Letters to Mrs E. M. Sloan Chesser,M. D., from the Howard de Walden Estate, 17 Jan., 1928, Archives of the Howard de Walden Estate.
24
to be undertaken to show the total number of arrivals, incumbents and departures both annually and cumulatively and a sample of the results can be seen in Appendix A.
The EnglishwomanýF Year-Ebok was important for Chapter Seven, "The Women Doctors of Harley Street", as it was the only directory that listed registered women doctors as a separate category from 1888 to 1910.29
Since this included many of the women examined in this thesis, it was a for tool useful quantitative
historical analyses. The archives of the Women's
Federation and the London (Royal Free Hospital) Medical School for Women
were also consulted to augment the Year-Book. The use of the MeAEcalDivectory as a Principal Source The Medical Directory contained some inconsistencies, especially when the Street did in List the not always correspond with those in the addresses biographical
section of the Directory. The biographical
section lists Harold
Theodore Thompson and Harry Beckett-Overy as arriving in 1906 and 1908 however, Street List does include the them until 1908 and not respectively,
1909 respectively. For these cases, the Medical Register, biographies and obituaries were used to ascertain whether a person was actually registered in Harley Street. In some cases, a small number of medical practitioners were still registered in the Street, although they had actually retired. For
29 Med(Cal
D'jMCtoryVols. 18451914,and TheMed(calRegister,(London,from 1859to , j 1914).Although, thesepublicationscontaineda list of registeredmedicalpractitioners,they do not accountfor womenseparately.
25
Peyton Blakiston who retired from practice in 1871 was still listed example, as practising in Harley Street until 1876.30 Marguerite biographies
Dupree and Anne Crowther have shown that the stYle of
in the Me&cal
Directory
changed over time. 31 The medical
school or university in which a person did his training, for example, was not 1860s. 32
entered in the Directory until the
For such individuals as Mary
Scharlieb and Jane Walker their personal histories stated they arrived in Harley Street in a particular until
the following
but it year, was not recorded in the Directory
year. However, as the date of departure
was usually
listed a year after they arrived, the calculation of the total number of years incumbent an
was registered in the Street remains, therefore, reasonably
accurate. Inconsistent practitioners
in
and contradictory Harley
Street
accounts of the number of medical
appear
quite
often
in
the
scholarly
literature. 33According to Zachary Cope, there were three doctors practicing there in 1840, whereas Harvey Graham, Gordon Wolstenholme Phillips
Bryan maintain
and Cyril
that there were six doctors in the same year. 34
Whilst Reginald Pound claimed that by 1873,36 medical men had a Harley
Street address, The Medical Directory for 1873 revealed, however, that 30Others include Violet Kelyack, Francis Bisset Hawkins, Peyton Blakiston who retired before they arrived in Harley Street. 31Marguerite W. Dupree and M. Anne Crowther, 'A Profile of the Medical Profession in Scotland in the Early Twentieth Century: The Medical Directory as a Historical Source', Bulletin of the History oMe&cine, Vol. 65,19 91, pp. 209-233. 32.1bid. 33It is possible that there were some unregistered medical practitioners practising in Harley Street, however, this thesis only deals with those who were registered. 34Sir Zachary Cope, "Harley Street," History ofMedicine, 4,2,1972, p. 7 and Graham, Doctorý; London, p. 25, Gordon A. Wolstenholme, 'Harley Street Address', Journal of the Raval Society ofMedicine, 92,8,1999, p. 426 and Bryan, p. 122.
26
there were 48 practitioners. 35 Although
the author of Samuel FenwicYs
in in BMJ Fenwick the that obituary stated correctly commenced practice Harley Street in 1862, he also claimed that at the time, the Street "only
boasted of one other medical man among its inhabitants". Again The Medical Directory indicated that there were, in fact, eight medical in Street in by Harley 1845 1862 there were and registered practitioners 37.36 Tabulating
in Graph it 1.1, the results made plotting possible to and
Street in Harley the of as a medical enclave. growth popularity examine
35Pound, Harley Street, p. 16 and Medical Directory, Vol. 1873, p. 31. The names were also in The Medical Register, individuals did Vol. the 1873, to appear not cross-checked six Register.* - G. Lawson, G. Gregson, G. Williams, I. B. Berkart, J. L. Clarke and F. B. Hawkins. This brings the total in Harley Street according to The Register to 42. This additional difference only compoundsthe need for a systematic collection of data. 36Anon, 'Samuel Fenwick', BMJ, December 27,1902, p. 1973.
27
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LO
I
The
shaded
area of the
graph
represents
the
numbers
of medical
practitioners registered at a Harley Street address from 1848 to 1914.37This shows the minimal increase in the number of medical men resident in the Street
until
1886. From
this
point,
the
acceleration
becomes more
pronounced and continues right up to the end of the period. The pink line, illustrates the the steady accumulation of newcomers representing arrivals, to this area over time. The gap between those arriving and those departing
(the black line) widens from 1889. In most cases from this point, there were more medical practitioners
arriving than departing from Harley Street.
Methodology Prosopography as a Method of Historical Research A prosopographical
analysis, which provided the material for the database,
formed the foundation of this thesis. The etymology of prospopography is a Greek "pros5pon", "charactee' "person" the of meaning or combination and "graphien! ' from the verb to write. 38Lawrence Stone showed that this term
first was
applied to a method in 1743, which he defined as, "the
investigation of the common background characteristics of a group of actors in history by means of a collective study of their
lives".
39
Some historians
37The numbers for the years from 1845 to 1848 are so low as to be numerically insignificant for the purposes of the graph: there were 8 medical practitioners in the street in 1845,11 in 1846 and 13 in 1847. 38G. W. Bowersock, The Emperor of Roman History, The New York Reýiew, Mar. 6.1980, P. 8. 39Lawrence Stone, 'Prosopography' Daedalus, 100, p. 49. Stone referred to the term's 'first known use' in C. Nicolet, "Prosopographie et Histoire Sociale: Rome et Italie a I' tpoque Republicaine," Annales, no. 3 (1970). However, Steven Shapin and Arnold Thackray, in 'Prosopography as a ResearchTool in the History of Science:the British Scientific Community 1700-1900',History ofScience XII (1974), 1- 28, stated that the usage of the term dates from the 'late sixteenth century.
29
have described this method as a group or collective biography. 40By the midcentury, prosopography had, however, become more sophisticated
twentieth
and had moved beyond the simple process of collective political
or social elites analysed, by such historians
biographies
of
as Lewis Namier. In
1970, Steven Shapin and Arnold Thackray re-defined the principles underlying the new method when they argued that: is biography the not routine collected of analyses modem prosopographical. the Victorians, but a sophisticated tool for establishing links between action line to the'multiple career analysis of the SoCiologiStS.'41 and context, akin
Some 20 years later David Allen maintained that it was also: bundle brief life-histories: it involves together than a of putting much more hope in the these of uncovering evidence of shared outlooks or combining ties of loyalty indicative of otherwise hidden social groupings. 42
This thesis adopts the models outlined by Shapin and Thackray and Allen in establishing links between the cohort, which represents a summary Street Harley the medical practitioners of
based on the characteristics
constituent
Thus, the prosopographical members.
examination
W familial the group's professional, social and of
(ii) the inter-relationship
analysis
of its
includes
an
relations and
of the group's background, education, career, and
basic The the to was get analysis object of achievements. professional for data types each person so that comparisons within of similar
the group
could be made.
40Anne Digby, The Evolution ofBiitish General Practice, 1850-1948,(Oxford, 1999),p. 8. 41Shapin and Thackray, 'Prosopography',p. 3. 42David E. Allen, 'Arcana ex Multitudine: Prosopography as a ResearchTechnique', Arebives ofNatural History (1990), 17 (3): 349-359. For a comprehensive history of the use of Prosopography as a research tool, see Shapin and Thackray, 'Prosopography, passim.
30
Building the Database The database management system Microsoft Access was chosen because it a manageable
provided number
of different
information system of
methods of designing
There 43 are a retrieval.
a database for the historian
including the model-oriented approach. This method was used in this thesis and necessitated mapping out possible professional and social relationships between the group and building a set of tables. These were then interpreted
to allow a representation of the cohort to be determined. Biographical details including the date of birth
death, and education and career,
for individual by memberships were created each publications and society the use of the Access form. These details permitted the inclusion of information
from obituaries,
could not otherwise
biographies
have been included
and other printed
sources that
on the database due to their
disparate nature. Sources that were "simple, complete and regular in form! ' individuals data the to as possible about provide as much were chosen
who
44 this prosopography. made up Biographies,
obituaries
and the census were used as ancillary
Street Harley because practitioner not every material
have been known will
him; had have thus, these to a significant piece written about well enough information When have been could not used exclusively. sources could not be found in the Medical Directory, such as the dates of birth and death, it Plarr's Roll by MunE; for or other sources, example, was supplemented Lives for Fellows of the Royal Colleges of Physicians and Surgeons. The 43See Charles Harvey and Jon Press, Databases in Histmical Research (London, 1996). 44Harvey and Press, Databases, p. ii.
31
most reliable
method of encapsulating
the entire Harley
Street medical
population for the period was to work from the listings in the Directory and Register.
The Medical Profession and Advances in Medicine, 1845-1914 The early nineteenth century saw the arrival of hospital medicine or the "birth knowledge
hospitals becoming the of clinic" with centres of medical and
bastion a
of medical
power. 45 Microscopic
anatomy,
physiology, pathology and pharmacy provided the basis for innovations
Britain,
In 46 mid-Victorian medicine.
universities
in
received very little
for kind from The the any of medical state research. nineteenth support introduction the century saw
of new technologies, many of which were used
for physical examinations. The stethoscope was invented in 1816 whilst the mid-Victorian
ophthalmoscope
and the
laryngoscope
provided
greater
thoroughness. When George Harley
arrived
in Harley
Street in the 1850s, the
however, By 47 1870, the microscope then not used widely. microscope was
"which began to revolutionise science in 1830" had become easier and instrument it became to a standard use and subsequently cheaper
in
be By 48 1860s thermometers the compact could used to medical science. discovered in body 1835 temperatures and sphygmomanometers, measure
45W. F. Bynum, Scienceand the Practice ofMedicihe in the Nineteenth Century, (Cambridge, 1994), p. 25. 46Erwin Ackerknecht, A Sliort History ofMedicine, (New York, 1982), p. 159. 47Tweedie, Harle7, p. 316. 48Brian Bracegirdle, "The Microscopical Tradition7 in W. F. Bynum and Roy Porter, eds., Companion Encyclopedia of the History ofMedicine, (London, 1993), pp. 102-106.
32
but used more commonly in the 1890s, allowed for the testing of blood pressure. 49 Laboratory pharmacology nineteenth physiology
in studies physiology, experimental
led to increased clinical century
practitioners
of
and other science related
and diagnostic organic
disciplines
pathology and knowledge
chemistry,
and
microscopy,
were a part of a new
laboratory-based involving medicine. endeavour Before the introduction of anaesthetics such as ether in the 1840s and later
chloroform,
which
in discovered was
1831 and became popular
following its use by Queen Victoria during the birth of Prince Leopold in 1853, invasive surgery was limited to those operations that were small and it in thus, was not possible to undertake scope; regarded as safe
lengthy
those that required considerable precision. especially procedures, surgical Though the use of effective anaesthesia made unbearably traumatic did it feasible, not completely revolutionise procedures the abysmal post-operative infection
internal
surgery because of
death rate of invasive surgery: postoperative
in general, unavoidable. was,
Joseph Lister
developed effective antisepsis (to significantly
(1827-1912) first
infective in the agents reduce
the wound) and asepsis (prevention of infection in the wound) techniques. By 1890, aseptic surgery had established itself and coupled with the use of
infection was radically reduced and postsurgical masks, gloves and gowns, death 50 rates plummeted. operative
49 Roy Porter, Blood and 60 For a discussion of the Roy Porter, The Greatest Antiquity to the Present,
Guts, (IA)ndon, 2002), p. 84. sepsis and the debate on Lister's methods of its prevention, from Benefit to Mankind-'A Medical History of Humanity (London, 1999), pp. 360-374.
33
see
At
the beginning
of the nineteenth
century,
a unified
medical
profession did not exist; practitioners of medicine could be divided into three distinct
'estates' of physicians, surgeons and apothecaries. This tripartite
division of the medical profession was merely a formal construct, as the
boundaries were vague in practice. At the top of the hierarchy were the pure in liberal the usually university educated physicians who were arts such as the
classics. They were relatively
few in number,
but
they
wielded
considerable power in everyday medical affairs. 51Physicians were concerned
with the 'internal' treatment of the body; diagnosis and prescription, but not the provision of drugs. The surgeon dealt with the external care such as repairing
fractures and suturation
of wounds. The fluidity
of practice was
diseases by initially treatment the the the of of skin, which was evidenced responsibility within
the
by the end of the nineteenth century came the surgeon and of sphere
of the
physician
or
apothecaries compounded and administered visited patients
dermatologist.
In
principle,
drugs; in practice, the majority
and diagnosed their complaints.
They were restricted
to
for dispensed for drugs the visit so as not to encroach the and not charging 9 the on physicians remit.
By the mid-1880s when a unified medical profession developed, following the 1858 Medical Act and conjoint examinations in medicine and surgery, medical practitioners
had formed the modern bipartite
structure of
51Paul YL Underhill, 'Science,Professionalism and the Development of Medical Education in England: An Historical Sociology',(Phl), University of Edinburgh, 1987), p. 75.
34
elite consultant surgeons and physicians on the one hand and the main body
of general practitioners on the other. The Historiography of Harley Street No known books have been printed on the subject since Reginald Pound Street in A Harley 1967.52 wrote small number of articles have been written by Cope Gordon Zachary Wolstenholme, are the most those and and comprehensive.53 Of the books that have been published, Cyril Phillips Bryan's Roundabout Harley Street, Harvey Graham's A Doctorýg London, Pound's Harley Street and, in particular,
Percy Flemming's
flarlqy
Street
From Early YYmes to the Present Day provide useful background material
Street Harley building the of within the context of the Cavendish Estate. on 54A more extensive account of the pre-Harley Street period can be found in publications
on the history
of Marylebone. 55 The existing
scholarship
on
Harley Street lies in the genre of anecdotal accounts of the more colourful characters
who
autobiographies
were
registered
of former
in
the
medical residents
for qualitative material useful additional
Street. of Harley
Biographies
and
Street provided
analyseS. 56However, a reference to
Harley Street in the title does not always indicate that it will be the central feature of the book and it can often be a misleading. 52Pound, Harley Street, passim. 53Cope, 'Harley Street', passim and Wolstenholme, 'Harley Street Address', passim. 54Bryan, Harley Street, passim, Graham, A DoctorýgLondon, passim, Flemming, Rarlet7 Street from Early Y)mesto the Present Day, (London, 1939),passim. 55 The definitive recent work on Marylebone is Gordon Mackenzie, Marylehone: Great City North of Oxford Stree4 (London, 1972). See also Thomas Smith, A Topographical and HistmicalAccount of the Parish of St. Marylehone, (London, 1833) and Francis Henry Wollaston Sheppard, Local Government in St. Marylebone 1633-1835,(London, 1958). 56Seefor example William Byam, Doctor Eyam in Harley Street, an Autobiography, (London, 1962),passim, Tweedie, Harley, passim, and R. Stevenson,MoreflMackenzie, (London, 1946),passim.
35
Street image Harley the century, of
By the middle of the twentieth
in biographies Thus, the the and was well established minds of public. autobiographies
referring to the Street, impart an impression of the Harley
Street doctor without
describing what it was like to work in this area. For
Goodhye Scott Stevenson's, Street, is R. Harley to example, which an from Street doctor focused Harley 1920s the and on the autobiography of a impact of the National Health Service had on medical practice, contains few itself. A Street Likewise, Doctorýq Diary hy Harley 57 Barley to a references
Street Doctor, which may, indeed, have been written by a Harley Street doctor, does not include any references to the Street. 58Written in the style book, it contains the author's musings on topics such of a medical self-help "misunderstandings" between health the the and weather vis-a-vis as one's the sexes. Meanwhile, training
The Road to Harley Street describes another author's
in later his doctor the army, provides only a and position as a
in last Street, the to the which appear paragraph couple of scant references its Despite last 59 title, the page. of about Harley
The Harley Street Calendar, was not
Street, but was a collection of biographies
on 11 eminent
English speaking medical men spanning from the twelfth to the twentieth is interesting, This 60 usage century.
Harley Street had indicates it that as
by then becomeassociated with eminent medical practitioners.
57R. Scott Stevenson, Goodbtre to Barle Street, (London, 1954), passim. .v 58Anon, A DoctorIr Diary ly, a Harley Street Doctor, (London, 192 5), passim. 59William Byam, Ybe Road to Harley Street; (London, 1963), p. 227. 60H. H. Bashford, The Harley Street Calendar, (Glasgow, 1929).
36
Critics of Harley Street Since the nineteenth
century, writers,
Harley Street medical practitioners for
their
avarice. 61 The
journalists
playwrights,
and non-
have pilloried Harley Street consultants
condemnation
made
by
Street
non-Harley
journalist in the 1960s, was because practitioners, remarked a the worst thing about Harley Street, the heart of private medicine, is its favour, be its In have to the to roguery supposed place can claim ... hundreds of 'personal physicians,' concentrated within a few streets in a way that's unequalled in the world. The real indictment, made by doctors who are not in private practice, is subtler: Harley Street takes the time and energy of skillful doctors who are not interested in advancing medicine, merely in practicing it for as much money as they can get their hands on.62
In his address to medical students at University
College London in 1903,
Ernest Starling characterised cynically the West-end consultant, epitomized by a Harley Street practitioner,
as more interested
in the appearance of
knowledge. He the than of advancement warned them not to success lucrative West-end to the practice: allure of a succumb he hospital man, when obtains a position on a conditions a present under staff, even if not before, engages his consulting rooms at a high rental in some fashionable quarter. He imagines it is more to his advantage to wait for the crumbs which fall from the great man's table than to spend his time in adding to our knowledge of medicine ... and ... maintaining the is supposed to be a necessary condition of appearance of affluence which West-end He become now a respected may as a consultant success ... consultant: he will never add anything to the scienceof medicine.63
It will be shown in Chapters 4 to 6 that Starling's
unwarranted
comments were
for the Harley Street cohort. Whilst Starling may have
little West to the contribute end medical consultant perceived
to the
61H de Vere Stacpoole, Harley Street, a Novel, (London, 1946), p. 39, the author referred to Harley Street as a" money racket", a place where specialists "cling together, " for mutual benefit. See also, Sydney Horler, The Formula, A Novel of Harley Street, (London, 1934), in Mathieson Wynne determined 15,19, the to consultant practice pp. as a student "fashionable7 Harley Street, as he was "determined to make money". 62Ferris, Doctors, p. 23. 63Ernest H. StarlingAddress to the Medical Students at University College London, BMJ Oct. 10,1903, p. 912.
37
advancement of medicine, the analysis of the cohort's achievements in this thesis makes his assessmenterroneous. Charles Dickens (1812-1870) refers to Harley
Although Little
Dorrit
(1857)
"distinguished as a
address"
and
Street in
"that
grand
destinatioW' inhabited by "Society" Dickens lamented upon the dreariness of the Street and described its layout as: like unexceptionable Society, the opposing rows of houses in Harley Street were very grim with one another ... the expressionless uniform twenty houses, all to be knocked at and rung at in the same form, all approachable by the same dull steps, all fended off by the same pattern of railing, all with the same impracticable fire-escapes,the same inconvenient fixtures in their heads, and everything without exception to be taken at high valuation. 64
The stereotype
of the avaricious
identified, though not actually satirised,
Harley
Street
consultant
was
in George Bernard Shaw's (1856-
1950) play, Tbe Doctorýg Dilemma (1906), at a time when, as Michael Neve "hostility argued,
to the medical profession [was] perhaps at its height",
though this later diminished because of the effectiveness of antibiotics and to a lesser extent the public-health movement.65 In Shaw's play, the dilemma for the socially esteemed doctor Sir Colenso Ridgeon, recognised by
(1861-1947), Sir Almroth based Wright have been the eminent to on many bacteriologist who had consulting rooms in the Harley Street Area, was Dubedat, life Louis he the the of amoral who was should save whether Jennifer from let him die; thereby, tuberculosis making or suffering
64CharlesDickens,Little Doni4 Angus Easson(ed.), (first edition 1857-58,this edition London,1999),pp. 243 and 251-252. 65Michael Neve,'Medicineand Literature', in W.F. Bynum and R.S. Porter, (ed.), Routledge (London,1993),p. 1533.GeorgeBernard Shaw, The Companionto the HistorXofMeaUcine, Doctorýg DDemma,(first edition 1911,this edition London,1926).SeealsoMartin Meisel, Sbawand the Nineteenth Centur Tbeatre,(NewYork, 1984),pp. 233-242and Harold .y (ed. ) George Bernard Shaw,(NewYork, 1987). Bloom, 38
available for him. Dubedat was the husband of Jennifer with whom Ridgeon was infatuated. Shaw had a derisory view of medical ethics and he condemned the medical elite's avidness and arrogance. A. J. Cronin made similar
observations about unscrupulous
consultants
in his popular novel
The Citadel (1937), and he applauded the social conscience of the ordinary family doctor.66 Harley Street medical practitioners Woolf's
novel
Dalloway
Mrs
were again criticised in Virginia
(1925). Woolf
found
an outlet
for
her
for her depression by a number the treatment she received condemnation of of consultants,
including
George Savage (later
Sir), Sir Maurice
Hyslop. 67 The prevailing intellectual contributed
pursuits,
the "eminent
Harley
Street nerve specialisV',
Craig and Theophilus
Bukeley
view amongst these physicians was that Woolfs
particularly
the solitary
nature
of her learning,
to her depression. Savage denounced the effect of "useless book
learning
[on] the weaker seie', whilst Hyslop argued that Woolf's choice of
modern
literature
her mental was proof of
illness. 68 Craig,
with
the
having husband Leonard, her Woolf's advised against children, agreement of Virginia deeply 69 decision resented. which a
66A. J. Cronin, The Citadel, (London, first published in 1937, this edition 1984). Seealso Neve, Medicine and Literature', p. 1530. 67Virginia Woolf, Mrs Dalloway, (London, first published 1925, this edition 1996), seealso Joanne Trautmann Banks, "Mrs Woolf in Harley Street", Lance4 Apr. 11,1998, pp. 1124. Although GeorgeSavage,Sir Maurice Craig and Theophilus Bulkeley Hyslop were referred to as Harley Street doctors they did not work in the Street itself but in the Harley Street Area, only Henry Head had a practice in Harley Street. 68Banks, "Mrs Woolf', p. 1126. r-9Woolf, Dalloway, p. 94. Also, seeNigel Nicolson and Joanne Trautmann, eds., The Letters (New Woolf, York, 1975-82),Vol. 1, p. 190. Virgida of
39
Leonard later called in Sir Henry Head, the famous Harley Street experimental
neurologist, after Virginia's
failed suicide attempt in 1913.70
Head was described as enlightened, as one "whose ideas were so far in advance of others that he is still cited today" and "a man who entertained Freudian ideas seriouSly'. 71However, his avant-garde approach did little to change Woof's condemnation of the Harley Street specialist. In her novel Mrs Daflowq7, the general practitioner Sir William Holmes
Dr. Holmes and the nerve specialist
Bradshaw were portrayed
suggested
to
Septimus
as vain, insensitive
Warren
Smith,
one of
and grasping. the
novel's
protagonists, that the antidote to his malaise was to take up a hobby. When this remedy failed to cure Septimus of his shell shock, Holmes said that if they had no confidence in him then Septimus and his wife Lucrezia should, The Warren Smiths later "if they were rich people to Harley Street. 1172 go ...
Bradshaw Sir William whose ostentatious car was parked outside called on his house in Harley Street: Bradshaw's Sir William motor car; low, powerful, grey with plain initials interlocked this on the panel, as if the pomps of heraldry were incongruous, helper, being the priest of science; and, as the motor car the ghostly man was grey, so, to match its sober suavity, grey furs, silver grey rugs were heaped in it, to keep her ladyship warm while she waited. For often Sir William would travel sixty miles or more down into the country to visit the rich, the afflicted, who could afford the very large fee which Sir William very properly charged for his advice. 73
Whilst her husband made house calls to his wealthy patients, Lady Bradshaw usually waited in the car and contemplated the "wall of gold,
70Amon, 'Henry Head', EMJ, Oct. 19,1940, p. 539. 71Banks, "Mrs Woolf', p. 1126. 72Woolf,. Dallowag p. 94. 73Jbid, pp. 94-95.
40
mounting
minute
by minute"
as the consultation
time
ticked
away. 74
Bradshaw's solution to Septimus's problem was rest, lots of rest; the very
treatment that Woolf s consultants had suggested to her and which she detested.75 Not all fictional accounts of the Harley Street medical practitioner, however, sought to denounce his image or practices: novels and romantic fiction tended to exaggerate the merits of the eminent consultants. 76Harley Street appears in the early nineteenth century literary
genre as a popular
London address for Society ladies who came to town. 77 In Jane Austen's Sense and Sensihility (1811), a couple of the novel's central characters, the Dashwoods, took a house in Harley Street for some of the winter months. There they later held a grand dinner with numerous servants in attendance inclination bespoke "everything the mistress's and where master's
ability
to support
for shew, and the
it. "78 This house was later the scene for Mrs John
Dashwood's hysteria. Austen was familiar
with the Street as her brother,
74Ibid, p. 95. 75Ibid, p. 151. 76For example, Anne Vinton, Lady in Harley Street, (London, 1965). See also, Philip Inman, Straight runs Haley Street, (London, 1942), p. 9, in which the author stated that "there is something magnetic about its [Harley Street] very name. To the lay mind, it suggests the best medical opinion that can be obtained... To the young medical student it represents the apotheosis of the profession". 77Francis Henry Wollaston Sheppard, Local Government in St. Marylehone 1633-1835, (London, 1958) and R.W. Chapman, The Novels ofJaneAusten, the Text based on Collation (first Editions, Mansfield Ear& Park, the of edition 1814, this edition Oxford, 1988). In this novel Maria Rushworth's adultery and elopement with Henry Crawford took place in Wimpole Street, see p. 440. 78Jane Austen, Sense and Sensibility, (first edition, 18 11, this edition London, 1994), p. 227.
41
Henry, married their cousin Eliza at St Marylebone Parish Church and the couple lived for a time in Harley Street. 79 Limitations of the Thesis This thesis is not a study of the comparative affluence of the Harley Street be Determining the the group. cohort would wealth of problematic as dates for death birth the entire cohort were not available and access to of and family archives was limited. Moreover, these archives, where extant, are not stored in one location therefore regional archives would have had to be investigated.
This was not practical
given the size of the Harley
Street
disparate the nature of this source and the variation moreover, population;
in the available material
have increased difficulty the would
Barbara English difficulties the outlined analysis. prosopographical family
in analysing probate records and archives
of a
in using
a person's wealth
and
"not find it from to the that net value was possible of an estate argued
for figures 1180 before Even 1881, no such were recorded. after probate records this period, the probate of a will only included goods and chattels but not land in the valuation. An alternative source, the death duty registers filed at the PRO from land However, 1853. the of and a valuation net of estate value contain for historian the the they and genealogist, are a valuable source although inspection for to a seventy-five year period and as a are closed registers
died be in 1927, the the used the cohort after registers could not number of 79Mary Cotton, 'Jane Austen in Marylebone? ', Yhe St. Marylebone Society Newsletter, Spring 1998, Number 292, p. 1. 80Barbara English, 'Probate Valuations and the Death Duty Registers', Buffetin ofthe Institute ofHistoricalResearch, Vol. LVII, 1984, pp. 82
42
prosopographical
analysis. 81 Moreover, they provide valuations of land and
in some cases personal property,
but do not give details of the annual
income accrued by an individual;
thus, it is not possible to establish the
by Since is the this thesis remuneration earned cohort. a study of the medical practitioners in Harley Street, other residents or institutions in the Street do not form part of the analysis, although they are referred to in the narrative. Before any statistical is
practitioners geographically.
presented,
he could practice.
development parish
of Harley
is
to
essential
locate
Harley
history century
Cavendish-Harley
used in determining
Street
The geographical
a suitable address from
location,
which
places the
Street in the context of the urbanisation
of St. Marylebone,
eighteenth
it
analysis of the Street's medical
By doing this, it is possible to deduce, in part, the rationale
that a medical practitioner where
or qualitative
is examined in the next chapter.
of the
The early
includes the projections by the the of parish
Estate for Cavendish Square and Harley Street.
81English, 'Probate Valuations', pp. 86-91.
43
CHAPTER 2 The Birth of the Medical Elysium The Topography of Harley Street
The emergence and development of enclaves with their own particular identity, such as the synonymous character of medical practitioners and Harley
Street, tailors
and Savile Row or journalists
and Fleet Street,
in history development is relatively their reflects a period and medical
quarter
spontaneously;
of London's
rather
its growth
Harley
Street
did
was protracted.
to
life
its beginnings
in
not
From
slow. ' The
spring
1729, another 150 years were to elapse before the rise in the numbers of medical significant.
practitioners
registered
in
the
Street
could
be considered
The building of Upper Harley Street did not begin until
it was not until and
1866 that it was incorporated
into Harley
1770,
Street. 2
Upper Harley Street and Lower Harley Street were then renumbered with even numbers on the East Side and odd numbers on the West Side. 3 The region that has been known as Harley Street Area since the early St. Mary-le-bone eighteenth century was part of whose etymology provides its to geographical location. Mary-le-bone takes its name from us with a clue
I Though tailoring was practised in West End of London in the 16thcentury, Savile Row did not acquire its reputation for tailoring until the late 1790sand it was not until the beginning of the 19thcentury that the area becameidentified with bespokeclothing. Although Fleet Street was home to the printing press from the 1500s,it was not until London's first daily newspaper, Daily Courant was published in 1702 and other newspapers were created from the 1720sthat the Street becameestablished as the newspaper district in the eyes of the public. 2 Cyril Phillips Bryan, Roundabout Har*L7 Street: The Story of Some Famous Streets, (London, 1932),p. 92. 3 Sir Zachary Cope, "Harley Street," History ofMedicine, 4,2, p. 8. Information for the renumbering comesfrom the archives of the Howard de Walden Estate.
44
the former village of Ty-borne or Ty-bourne. The Anglo-Saxon word for
brook is 'bourne' and Ty-bourne was located on the east bank of a brook, Survey down from Thames. Hampstead 4A 1742 to the ofLondon which ran described the village
falling as
of Tyburn
into ruin
in the fourteenth
St. looted dedicated John Evangelist, its to the and century, church, Bishop London bare. The 5 the to prevailed upon of parishioners stripped location. He in acceded to their petition, granting a new erect a replacement
them a rebuilding licence in October 1400 to erect a new church. This dictated Blessed Virgin built to the the old chapel of an site on church, Mary, was renamed St. Mary at the Bourne. The nomenclature was partly due to its proximity to the Bourne and also to differentiate it from other in St. Islington Mary dedicated the to nearby of villages and churches Kensington. 6 By 1453 records indicated
that the Anglo-Saxon
name Ty-
bourne had begun to be replaced by Marylebone. 7 The church and the surrounding
area
have
Maryhone, Marj-la-hone,
been
referred
St. Mary-la
to
variously
bonne, Maryburn,
as Mar vbourne, . Marihone
and to
Marrowhone. 8 Pepys, Samuel echo
Accounts of the two manor houses, Tyburn and Lileston to the east Book in Domesday 1086. Marylebone the of respectively, appear and west of 4 Thomas Smith, A Topographical and HistozicalAccount of the Parish of Saint Marylehone, Undon, 1833) and Francis Henry Wollaston Sheppard, Saint Malylehone 1633-1835,(London, 1958),p. 3. 5Anon, A Newand Compleat SurvZ-yofLondon in Ten Parts. Vol. II, (London, 1742), p. 1225. 6 Smith, TopographicalAccount, p. 3 and E. B., Ashford, 2yburn Vfllage andStratford Place, (b)ndon, 1969), pp. 6 -7. 7 The Rev. H.J. Matthews, OldMarylebone andSome ofits Famous People, (London, 1941), P. 5. 8 Anon, Survey ofLondon, p. 1225 and quoted in, Anon, St. Marylebone: A Sketch ofits Histozical Development, (London, 1952),p. 5.
45
The Tyburn Manor encompassed the present RegenesPark,
the Howard de
Walden Estate and the Berners Estate. The Lilestone, manor included the School. Portman Estate, Eyre Estate Harrow 9 The Tyburn the present and
manor is of interest in this thesis, as it was on the grounds of this manor that the development of Cavendish Square and the adjoining streets was to take place in the early eighteenth century. Aubrey de Vere, second Earl of Oxford, who had been responsible for the building
of Marylebone's
first
in both had the thirteenth century. 10The manors manors acquired church, fourteenth fifteenth during hands the the of course and centuries. changed In 1544, Henry VIII procured the Tyburn Manor and the surrounding area from Thomas Hobson, in exchange for some church lands, so that he might indulge his passion of hunting
to hounds. " In 1583 Elizabeth
I granted
Edward Forset a 21 years' lease of the Tyburn Manor. King James later sold the Manor to Edward Forset in 1611, not including the park, for 8291.3s.4d. It remained in the Forset family until it passed to Edward's great-grandson,
John Austen, who in 1710 sold it to John Holles, Duke of Newcastle. 12A in is Plate Estate 2.1.13 Marylebone the reproduced plan of
9 Anon, Survey
ofLondon,
p. 4.
10GordonMackenzie,Marylehone:Great City North of OxfordStreet (London,1972),p. 20. 'I kid. had for land, Holles 9. 117,500 12Smith, A YopographicalAccount, the a which p. paid (London,
rental income of about 2900 per year, see Harvey Graham, A Doctorýv London, 1952), p. 16. 13Henry Pratt, Plan of the Marylebone Estate when purchased by the Duke ofNewcastle, 1708, British Library, the Crace Collection, port. XVI. 18.
46
Plate 2.1, Plan of the Marylebone Estate
T6 E4WA. -
ht
J1
11. Ni. A-
D-tllld IIp
Th, C,. Pw T-
XýlP,:1F.,w
PLAN OF THE MARYLEBONE ESTATE Who, purchisd by tite Dukeof NewwsUc, 1708,
47
This plan made in 1708, just
prior
to the Duke of Newcastle's
purchase of the land shows the village of Marylebone before development. Fields then surrounded
Cavendish Square, which was originally
called
Oxford Square. Marylebone Lane runs into Marylebone High Street and to
the East of the High Street stood the Bowling Green. This would later be the site of the Marylebone pleasure gardens.14 The map shows that Harley Street ran in a straight line, by the side of the Half-Way House Inn and between Cavendish Square and New Road. It traversed various fields: 'Brown fields', 'Broom field' and 'The Ten Acres! A village community was land. these plots of still working London was emerging as "a collection of autonomous villages, many
[of] which have been carefully planned within themselves but with little "15 Olsen Donald the to adjoining villages. emphasised that with reference
the exception of the City, London had been in the hands of a small group of landowners; moreover, the shape of these estates and villages dictated the boundaries of new developments. 16The Earl of Bedford undertook one of the developments he laid large-scale in Covent 1630, the when, out of earliest Garden and the connecting streets. Following this, the construction
of new
In London 17 the 1650s, the of gradually areas moved westward. residential Earl of Southampton built a vast London abode with Southampton Square (later Bloomsbury) at its frontispiece. A decade later, he granted building 14Anon, St. Marylehone, p. 6. 15Donald J. Olsen, Town Planning in London, (Undon, 1982), p. 5. 16For further details, see James Anderson, Warylebone Park and the New Street, A Study of the Development of Regent's Park and the Building of Regent Street, London, in the first Quarter of the Nineteenth Century, PhD, (London, 1998), pp. 181-183. 17Anderson, ' Marylebone Park', P. 7.
48
leases on his lands around the Square, with the proviso that the developers were to erect good quality brick housing. 18During the course of the 1660s, Henry Jermyn, the Earl of St. Albans, offered leases on sections of the 45acre plot he held near St James's Palace. Speculative developers, well aware
of the increasing demand by the courtiers and the aristocracy for suitable accommodation, were eager to take up the offer. Thus, St James's Square, St James's Street, the Haymarket,
Jermyn Street and Pall Mall all came into
being towards the end of the seventeenth century. 19
The expansion of the West End during this time was the result of a number of factors. The decline of the City as a residential district was becoming apparent in the 1660s, following "the most violent plague London
had ever known". 20The death toll reached 100,000 and no sooner had the inhabitants from raged
recovered than the City was engulfed in flames. The great fire Saturday
the Second of September
1666 to the following
Thursday, causing almost 111,000,000 worth of damage. 21Those who could West End because, it, to the out afford moved according to Roy Porter, "the West End was the finest place to live -a place to spend money, to entertain
or just bask in
being.
1122 By
the 1750s, Sir Walter Besant noted that
noblemen no longer lived within the City's boundaries; consequently, estates
in the West End expanded. 23Due to economies of scale, the conversion of
18Stephen Inwood, A History ofLondon, (London, 1998),p. 253. 19Inwood, London, p. 254. 20John William Abbott, A History ofLondon, from the EarYest Period to the Present, (London, 1821), p. 160. 21Abbott, A History ofLondon, pp. 163-166. 22Roy Porter, London, a Social History, (London, 1996),p. 93. 23Sir Walter Besant, London, (London, 1892),p. 353.
49
these estates into groups of town houses was financially Westminster's
viable. The Duke of
estates encompassed the vast area of Mayfair,
day Belgravia and Pimlico. The Marquis of Northampton
the present-
held the expanse
Cavendish Earl Oxford Clerkenwell, Islington the owned of and whereas of Square and the area around
it. 24
Landowners were keen to reap the
financial rewards of leasing the lands while maintaining a reversionary interest in them. In A History of London, Stephen Inwood indicated that investment in the West End of London was easier to obtain than Westminster St In 25 to this was close enough area and addition, elsewhere. James's Palace to attract the nobility. A spate of urbanisation
occurred early in the eighteenth
century,
Cavendish, Hanover Grosvenor designing the to of and which gave rise Squares. Cavendish Square lay to the North of the Tyborne Road
(later
Oxford Street): the name of this Square vacillated between Oxford Square Cyril According Phillips Bryan, by Square 1730s. to Cavendish the until and 1734 it was referred to exclusively as Cavendish Square. 26 The Surve Y of
London describes the "many streets of fine houses being lately erected in this neighbourhood", but also points out the name
"Tyborne is still
11 27This in in this the that association neighbourhood. gallows of preserv'd Cavendish Square Mayfair, fact in to that the the contrast gallows and with
24Olsen, Town Planning, p. 8. 26Inwood, A History ofLondon, p. 258. 2613ryan, HarlerStreet, p. 59. 27Amon, Survev arLondon, p. 1226.
50
from Court Westminster, the was relatively remote and
it was not as meant
attractive to the fashionable set, as the other areas had proved to
be. 28
In the early eighteenth century, Edward Harley decided to increase the prestige of his own holdings. He had been spurred on by the pecuniary
benefits that his noble neighbours accrued through the conversion of their first dwellings. In 29 into 1715, a plan was mooted to estates upmarket Cavendish in Square and the streets accommodation
provide residential
that emanated fromit. 30The Duke of Newcastle, John Holles, an extremely Manor "fortune his had bequeathed Y. 500,00W the to and a of wealthy man, daughter,
Henrietta
in-law, his and son
Edward
Harley. 31 Harley
later
became the second Earl of Oxford and Mortimer, and Baron Wigmore of Wigmore, in Hertfordshire. 32Henrietta had also inherited the vast estates of Welbeck in Nottinghamshire
and Wimpole
in Cambridgeshire
from her
father. She took the title Countess of Oxford following her marriage to Harley in 1713. Shortly after the death of the Duke's widow in 1715, the Harleys commissioned a survey of the Cavendish Square area. 33The task of surveying
the square and its environs was given to John Prince. It was
Harley's intention
to build elegant residential
homes that would appeal to
the tastes of the aristocracy and the upper classeS.34 He appointed the Harley father for his had Gibbs, James the on estate, who worked architect
28Inwood, History OfLondon, p. 260. 29Anon, St. Marylehone, p. 6.
Account,p. 154. 30Smith, Topographical
31Alison Plowden, Lords of the Land (London, 1984), p. 147. 32Sir Zachary Cope, 'Harley Street', Histor y ofMedidne, 4,2, p. 4. 33Mackenzie, MarXlehone, p. 21. 34Ibid., p. 23.
51
Wimpole Hall in Cambridgeshire and was acknowledged to be "the most considerable master of architecture since Wren" to supervise the building. 35 These new town houses were to be fashioned in the English Palladian style. It was the antithesis of seventeenth century Baroque grandeur and that was the key to its popularity. 36For estate owners such as the Earls of Shaftesbury and Burlington, and later the second Earl of Oxford, the Baroque style had lost its appeal. Sir Christopher Wren, Baroque's greatest
English exponent, had dominated architecture in England for nearly 70 in Jones 37 Following Inigo 1652 death 1720s. from to the the of years, Burlington's
Grand his he Tour, Italy to part of commissioned the as visit
remodelling
in Palladio home in Inigo his London 1719 the style of and of
JoneS.38 Around this time, the second Earl of Oxford had decided that the English
Palladian
style
in was
keeping
with
the
type
of classical
for houses his befitting the town upper classes. architecture A report
in
The Weekly Medle,7 of 13 September
1718, made a
Square. The latter, Cavendish it Square Hanover between and comparison
declared Noble is finer higher and spacious out a very marked and situation, seems a Square, and many streets that are to form avenues to it. This square, we hear, is to be called Oxford-Square, and that ground has been taken to build houses in it by the Right Honourable Iords, the Earl of Oxford, the Earl of Carnarvon, the Lord Harcourt, the Lord Harley, and several other Noble Peers of Great Britain. The ground sold at first for 2s. 6d. per foot, afterwards for 15S.39
35DNB,Vol. VIII, p. 1147and John Summerson,GeorgianLondon(Iondon, 1945),p. 90. Georgian London,
36 Summerson,
p. 24.
37 Stephen Parissien, Palladian Style, (London, 1994), p. 57. 39 Parissien, Palladian, p. 63. 39 Quoted in Smith, TopographicalAccount, p. 157.
52
The increase in price demonstrated the Square's increasing popularity.
In
fact, work began on the Square in 1717 and the first house was built in 1720. Edward
Harley
was a zealous collector
books, of manuscripts,
paintings and memorabilia. It was said that his "habitual indolence, rather than incapacity prevented him from taking part in public affairs; nor did he care for general
society", preferring
the company of those who were
Arts. Despite he derived from the planning 40 the the to pleasure connected building aspects of
landscaping, and
he was not interested
in their
he delegated Consequently, the supervision of the project to his execution.
Harley. Edward uncle, also called A copy of a plan dated 1719 and based on John Prince's survey of the Cavendish Estate is duplicated in Plate 2.2.41 Prince's survey indicates a grid
system of streets
northeast.
around
the Square with
Harley
Street
to the
The plan also provides for Oxford market and a chapel, called
Oxford Chapel until
1732, which later became a church dedicated to St.
Peter at Vere Street. 42The distance to Westminster from various areas such
(Plate is included This City Bloomsbury the timetable the plan. with or as 2.3) shows that the proximity
of Marylebone to Westminster
is relatively
is display The 43 thought to the timetable the than other areas. closer desirability of Marylebone as a residential district. 44
40'Edward Harley, (1689-1741),DNB, Vol. 8,1908, pp. 1278-1280. 41'Map of Marylebone'by John Prince in 1719, the British Library, Maps Crace, port. XIV. 20. 42Mackenzie, Marylebone, p. 40. 43Timetable on a'Map of Marylebone'by John Prince in 1719, the British Library, Maps Crace, port. XIV. 20. 44Summerson, Geoigian London, p. 90.
53
Plate 2.2, 'Map of Marylebone'by
54
John Prince in 1719
Plate 2.3, Timetable 1719
Image removed due to third party copyright
There
were certainly
a number
of prospective
buyers
its appeal: who saw
had land those served with who acquired plots of were men who amongst
55
Edward Harley's father Robert, in the Tory administration,
including
the
Earl of Carnarvon (who later became the Duke of Chandos), the Lords Dartmouth and Bathurst, and the Lord Chancellors Harcourt and Bingley. 45 Carnarvon,
who had amassed a huge fortune
as Paymaster
General to
Queen Anne, took a large plot on the north side of the square. There were in houses 1720. To the east of the Square, stood there only a couple of other Harcourt House built by Lord Harcourt, the ex-Tory Lord Chancellor. Lord Bingley, an ex-Chancellor of the Exchequer, commissioned Bingley House,
Square. 46When Bingley House the the west side of which was situated on in Harcourt's 1773, the grandson purchased it and the market came on Harcourt House. 47 to then changed name was The South Sea Company The augmentation
Cavendish Square later in the 1720s, partly stalled of
due to the lack of investment following the failure of the South Sea scheme. first
Robert Harley,
Earl of Oxford and Mortimer,
was instrumental
in
Chancellor He Exchequer joint-stock the company. was of setting up a new
(1702-1714). Harley's Queen Anne's Tory in Treasurer later Lord reign and incurred debts being by in At 1710. time, the the to power government came
the
Spanish War
(1702-1713) Succession were mounting. of
The
Government sought to reduce the debt by introducing a Land tax and Sea Company South from investors. loans The was private obtaining
45Anderson, 'Marylebone Park, p. 188.
41Smith, TqpqgrqpAicalAccoun4 pp. 155-156, and Mackenzie, Marylebone, p. 44. 47Mackenzie, Mar vlebone,p. 44.
.
56
established as a means of raising capital to discharge the national debt. 48 The scheme proved successful initially
and a total of 19,177,967, principally
Army debentures made up of and Navy bills, was subscribed. 49 In January 1720, a few of the company's directors proposed that they would take over the whole of the National Debt. 50The public, expecting fantastic returns on
their investments bid the stock price up from X130 per share in June 1720 to Y.1,000 per share by December. 51 Due to the over-inflated
share price,
investors began to get nervous. Panic ensued and on 8 December, the stock price fell from 21,000 to F.150 and the company collapsed. 52
The Duke of Chandos' shares were worth Y.300,000 at their height but following the crash, were worthlesS.53The Duke had completed two of the before South-Sea disaster his decimated his the mansion of wings wealth fruition. his thus never reached and project
It was said that the Duke died
Chandos's doubt heart; by broken the death of grief was no exacerbated of a his infant son and heir during his christening. 54It was left to the 3rd Duke of Chandos to build Chandos House between 1769 and 1770. Less ostentatious
than the original projections made by the first Duke, it was nevertheless beautifully
executed by the Adams brothers
using
the
decorative
48The Company took on 29,000,000 of the National Debt. See Sir George Clark, The Later Stuarts, (Oxford, first edition 1934, this edition 1965),pp. 249 -250. 49John Miller, An In teresting Account of the South Sea Scheme, 1720, (London, no date but (London, Capital, City late Bruce G. Carruthers, 181h 295-296 of century), pp. and probably 1999), p. 154. 50Miller, South Sea Scheme,pp. 298-299. 51John Cannon, ed. The Oxford Companion to Bzidsh History, (Oxford, 1997), pp. 879-880. 52Miller, South Sea Scheme,p. 13. 53Lee, Christopher., This Sceptred Isle, 55 BC to 1901, (London, 1997), p. 323 and Mackenzie, MarXlebone, p. 156. 54Anon, The Builder, May 10,1873, p. 363.
57
plasterwork,
which was to become their trademark.
This building
at 11
Chandos Street now houses the Medical Society of London.55 The disaster of the South Sea Company venture was not the only reason for estate owners to pause. The aftermath
(1688
of the Nine Years War
(1702 Spanish War Succession had 1713) 1697) the and of pushed -
interest up
for speculative building
rates making the return
appear less
from house building in 56Apart this, attractive. eighteenth century London did not surge ahead unabated. The elasticity of supply for housing was not Summerson demand: linked to maintained that construction came in simply Olsen for 57 and economic reasons. political, psychological pointed out waves, that periods of slow population growth did not necessarily result in a low He further
level of demand for new housing. building
that,
maintained
booms sometimes accompanied a period of relative
for ". In 58 the the of need urbanisation absence population. century London, a significant
"great
stability
in
in eighteenth
motive in encouraging estate owners to lease
their land may simply have been the twin desires of prestige and profit.
The hiatus was, however, brief and by 1740, sites had developed both be Square first Hanover The Tyburn. to these the of appears and sides of
George Street, which by 1717 housed a number of military Whig generals.69 Following this, the Earl of Burlington's Savile Row and Burlington Street
55Porter, London, p. 110 and Walter Rivington, Mngdom, (London, 1887), p. 452.
History ofLondon,p. 258. 561nwood, London,p. 81. 57Summerson,GeozWan 6801sen,TownPlanning,p. 14.
The me&cal Profession of the United
59Summerson, Geoigian London, p. 82. Summerson lists the Generals Evans, Carpenter and Pepper and Lord Cadogan,all of whom served in MarlborougWs military campaigns.
58
were planned in the
1720S.
60
During
the 1730s and 1740s, the Duke of
Devonshire had established Berkeley Square. The population of London had remained constant during this time, increasing by just under 0.3%, from approximately
674,000 in 1700 to approximately
676,000 in 1750.61
To rekindle interest and as an incentive to the investors, Edward Harley commissioned the building of the chapel at Vere Street together with the Oxford Square market in the 1720s. By 1724 the chapel designed by
Gibbs had been completed.62 Two years later, 34 houses had been built Cavendish around
Square, though just over a third
Charles Bridgman had already landscaped the square
were unoccupied. 63 itself.
64
London was,
dangerous live the time, to a place at and Marylebone was not exempt from
crime and mob unreSt.65 The vestry proceedings at Marylebone indicated that a night watchman was employed to guard the streets, whilst the Earl permitted
the use of the manorial court building
arrested were kept here until
as a watch-house.
Those
they appeared before the Justices of the
Peace.66Parish officials in Marylebone were not, however, unique in taking measures to reduce the rate of crime, and coupled with the improvements
6-0.1bid,p. 83. 61Mabel Craven Buer, Health, Wealth, andPopulation, (London, 1926), p. 272. The first census of the British population was carried out in 1801. The demographic figures up to this point are estimates, principally based on parish records. SeeRobert Woods, Ybe Popula tion History ofBiitain in the Nineteenth Century, (Cambridge, 1992), pp. 9-10. E. A. Wrigley in Stephen Inwood's A History ofLondon, (18), p. 270, estimates the population of London in 1700 as 575,000 and in 1750 as 675,000.This would amount to an increase of approximately 0.148%. 1 have taken Buer's figures as the extreme case, which nevertheless amounts to a relatively slow expansion. 62Smith, YopographicalAccount, pp. 158-159. 63Bryan, Roundabout Hfirley Street, (26), p. 62. 64Summerson, Georgian London, p. go. 65Sheppard, Saint Mar7lehone, pp. 23-26. 66Ibid.
59
mentioned above, the parish became a more attractive
in which to place
reside.67 The Development of the Harley Street Area Following established tradition amongst the aristocratic landowners, many of the streets that were in the process of being constructed around Cavendish Square in the early eighteenth century took the Harley family names. These were from the Earl
and his wife's relations,
titles
and
Estates.68 Hence, Harley Street was named after the family; Henrietta Street named after Edward Harley's wife; Margaret Street was a tribute to Lady Margaret,
his daughter
Harley's father-in-law,
and heir; Holles Street after John Holles,
and Vere Street after the Veres, Earls of Oxford. 69
Street, Wigmore Street and Wimpole Street are all references to
Mortimer the Harley
country
Street Prince's estates. was so named in honour of
Harley's surveyor John Prince. Cavendish Street derives its name from Henrietta Cavendish Holles' (the Countess of Oxford) family. Mansfield Street's
appellation
from comes
the
Duke
of
Mansfield,
Margaret
Cavendish's uncle.70 In 1741, Edward Harley died and the estate passed to his daughter, Lady Margaret Cavendish Harley and her husband the second Duke of Portland. The Cavendish Estate thereby passed into the Portland family from Duchess Streets. Bentinck, Duke them the originate and names of and 67Westminster, for example, had a well established system of street protection. By 1799 according to Sheppard, Saint Mai)debone, p. 24, there were 155 night watchmen patrolling the area.
68Smith,TopographicalAccount, pp. 159-160. 69.1hid 70Cope,'Harley Street',p. 4.
60
Bulstrode Street is a reference to the Duke of Portland's family seat.71The second Duke of Portland and his wife persevered and enhanced the Estate begun by Edward Harley. 72 A map by the surveyor, John Rocque (part of the map is in Plate 2.4),
of the Marylebone district around Cavendish Square, dated 1747, depicts a configuration of streets, principally to the south and east of Cavendish Square. 73 This quarter was evidently with the named streets running Square. To the north,
formed Mortimer to well up
parallel
and perpendicular
Street
to Cavendish
the roads that were etched on the map appear
fields, lead topography to they of a rural criss-crossed by village nameless: lanes. To the north-west, march of Harley Unfortunately,
the Marylebone
Street, were reaching
Gardens that were to halt the the zenith
of their
popularity.
had be to the to pleasure gardens chaperoned by visitors
fields, for fear being their through the making way whilst of armed guards highwaymen. by 74 robbers and ambushed
7'Anon, The Builder, p. 363. 72Ann Saunders, Regentýv Park, A Study of the Development of theArea Irom 1086 to the Present Day, (London, first published 1969, this edition 1981), p. 47 73John Rocque, with introductory notes by Ralph Hyde, The A to Z of Georgian London: A Plan of the Cities of. London and Westminster, andBorough of Southward, with Contiguous Buddings, (London, 1747). 74Mollie Sands, The Eighteenth -Centur Pleasure Gardens ofMar viebone, (London, 1987), .v . p. 4.
61
Plate 2.4, Part of a map by John Rocque, 1747
Image removed due to third party copyright
62
The Cavendish-Harley development was, however, not an immediate demand for houses for be the the nobility and gentry could not success, as (1743Austrian Succession The the the consequencesof war of sustained. 1748) resulted in another slump in the building trade. There was a slight, but temporary shortage of up-market housing in the 1750s, but building was Peace Paris in the 1763.75 until after any vigour with of not resumed Nevertheless, construction did not come to an abrupt halt, and the Cavendish-Harley development inched its way slowly towards Marylebone Gardens. The New Road or the Marylebone/Euston Road was under construction
in 1757. It was built to relieve the traffic on Oxford Street and
to provide a route to the cattle markets at Smithfield. 76 The houses in Harley
Street and Wimpole
between 1740 and 1750. Dodsley, writing
Street were erected
in the 1760s, refers to Harley
Street's early incumbents as being present in 1752.77 Upper Harley Street came under construction
with the closing of the Marylebone Gardens. The
gardens went out with
fizzle rather a
finally they were postponements, extravagant
firework
than a bang. After
a number of
closed to the public in 1778. The
displays of the pyrotechnist,
Giovanni Battista
(d. 1780) and later his assistants were deemed a risk to the
publiC.
Torre 78
1820, Upper Harley Street was firmly established on the map.
75Summerson, Georgian London, pp. 93-94 and 146. Peacefollowed the cessation of The Seven Years War (1756 -1763). 76Anon, St. Marylehone, p. 7. 77Quoted in Cope, 'Harley Street, p. 4. 78Torre retired in 1774, seeSands, The Eigbteentb -Centurr Pleasure Gardens, pp. 111123.
63
By
The first residents in Harley Street were not medical practitioners. Due to the area's proximity
to Westminster,
Cavendish Square and Harley
Street proved to be popular with members of Parliament.
Cope maintained
that there were at least 20 MPs living at the Cavendish Square end in 1771. Whilst Wilkes found that by 1793, there were 16 MPs in Cavendish Square, Harley Street and Wimpole Street. The area was also heavily laced with families the aristocracy and members of of distinction. 79 It contained (bishops the the upper echelons of clergy, members of and archdeacons), the
Admiralty and the armed forces, (colonels and generals) as well as foreign diplomats. The Iron Duke, Wellington lived at number 11 Harley Street (1806-1807). The arrival of the medical men into these areas of Marylebone is discussed in the next section.
The Birth of Harley Street as a Medical Quarter Harley Street became an increasingly fashionable area in which to live beginning
in the 1770s.80 Until
the middle
of the nineteenth
century,
however, medical practitioners were still underrepresented amongst the Street's genteel residents. As was mentioned in Chapter 1, various have misrepresented the number of medical practitioners and commentators the presence of the first doctors and surgeons in Harley Street. Zachary Cope claimed that following the physician William Rowley's departure there
79John Wilkes, Directory of theNohiEty, Gentry and Families omstinction in London, Westminster & C, (London, 1793). soGordon Mackenzie, Marylebone: Great CitT North of Oxford Street, (London, 1972), p. 99.
64
was only one medical practitioner directories
reveal, however, that
in Harley Street until 1809.81 The trade the surgeon Benjamin
Humpage
was
registered at number 66 Harley Street in 1791, and by 1802 the surgeons, Michael Bowman and John Lewis were at 9 Harley Street and 15 Upper Harley Street respectively. 82 Whilst Cyril Phillips Bryan and Harvey Graham maintained that the first
medical practitioner
to establish
a practice in Harley
Street was,
indeed, William Rowley, they erroneously claimed that he remained the only medical practitioner
there until John Latham moved to Harley Street about
1800.83 William Rowley, a legendary self-publicist,
appeared in a newspaper
in the late 1780s, in which he was lauded "an eminent physiciae' article who cured a "gentleman of considerable fortune in Harley-street, Square". Dorothy
and Roy Porter
Cavendish
surmised that Rowley or his friends
drew undoubtedly up the article. 84 Whilst it is possible that there were more medical men practising Harley Street before 1800, this is difficult
to ascertain since The London
Medical Directory was not published until 1845.85 Although registration the Directory
was voluntary,
it provided,
in
nevertheless,
in
a particularly
81Cope, 'Harley Street', p. 8, he contends that for the first fifty years of its existence Harley Street only housed one medical practitioner; William Rowley and that following him the first doctor "of repute;" John Latham, did not practice in Harley Street until 1809. 82Wilke s, Directory of the Nohility, passim and Holden ýqDirectory 1799 quoted in Da ýid Wligh t, An Index ofLondon Surgical Practitioners, 1736-1811,(London, 1989), Vol. 1, p. 59 in ý? Directory Holden Wright Vol. II, p. 313. 1802, quoted and 83Bryan, Roundabout Harley Street, pp. 119-120and Harvey Graham, A DoctorývLondon, (IA)ndon, 1952),p. 25. 84Dorothy Porter and Roy Porter, Tktients'llivgmss, Doctors andDoctoring in Eighteenth Century England, (Oxford, 1989),p. 129. 8r,Medical Directory, 1845.
65
list comprehensive of qualified medical practitioners. 86Unlike the Directory, registration university
in The Medical Register was compulsory for those holding a medical degree or a licence from one of the recognised licencing
bodies in the United Kingdom or Ireland. 87 This register, however, belongs
to the middle of the nineteenth century with the first one dating from 1859. A short-lived publication entitled the Medical Register, appeared in 1779,1780 and 1783 only -
though registration
The was not compulsory. 158
1783 Register included 152 Physicians residing in London and 820 members Corporation the of
Surgeons, both inside and outside London. 89 In the of
Apothecaries Society's list the same year, of members amounted to 346; the majority
were based in London. 90 With
the inclusion
of the 'Medical
Establishment to the Royal Family", the total of all medical practitioners licensing bodies, these of members who were according to the 1783 Medical I An Register, 1,351. additional 337 physicians outside London had little was
to do with the London College of Physicians, as they generally held Scottish
861bid, A comparative study between The Medical Directory and The Medical Register demonstrated that of the medical practitioners registered in Harley Street between 1859 (from the first edition of The Registez)and 1914 only 2.38% appeared in the Directorybut not in the Register. The results of this sample suggest that the Directorycould therefore be 0.97 % accurate. approx. as viewed 87]bid., TheMedicalRegister, years 1859 to 1914 and Rivington, Medical Pxvfession,pp. 94 and 189. 88The MedicalRegister, (London, 1779,1780 and 1783).The only medical practitioners in Street in Harley these publications were Mr. Boys, an Apothecary and registered WiRiam Rowley, a physician. sq The MedicalRegister, vol., 1783, pp. 10-14, this calculation excludes the Physicians to the Royal family and household, 135 are listed as resident in London plus 17 from 'Alterations Appendix. The Additions'in the number of surgeons is made up of 753'Members' and listed, less 15 under omits in the Appendix, plus 82 additional members in Appendix, pp. 217-220. 90This is made up of 329 from the list of 'Members' and 'Apothecaries &c not included in the forgoing list, 'pp. 26-30, plus additions from the Appendix p. 220.
66
foreign or
degrees. 91 These numbers do not, of course, reflect the great
number of persons practising medicine without a medical qualification. 92 The eighteenth
trade directories
century
incomplete, listing of medical practitioners.
contain
a useful,
In An Index ofLondon
albeit
Surgical
Practitioners, 1736-1811,David Wright showed that prior to the publication in includes details directory 1763, Mortimer's which of the members of of the Corporation
Surgeons, references to surgical practitioners of
in the
infrequent. JUSt few 93 over 200 "examined were and
directories
in listed Mortimerýg Universal Directory approve&' surgeons are remained
publication
virtually
isolated
until
the
and
1763 This
emergence
of
The
Universal British Directory of n-adeand Commercein 1790, which contains list of qualified an extensive Wright, to surgeons, according
medical practitioners. 94 The entries for the may have originated
from a contemporary
list from the Corporation of Surgeons of London. 95 Of interest to this thesis is where these medical people set up their practices in the late 18th century.
Since the fashionable areas for the beau monde were Westminster, St. James's,
Mayfair and
consequently
it
be that may
the medical
practitioners
were
drawn to these localities as a result. Table 2.1 Appendix B,
distribution the shows
of the practices of surgeons, apothecaries,
and
(London, History Bzitish MedicalAssociation, Little, 1932), p. 5. the Muirhead Ernest 91 of 92Ibid, Little maintained that the figures for the 1841 Census showed that of the 33,339 form held third, listed some of medicine one a practising only approximately as people medical qualification. 93 Wright, Index of London Surgical Practitioners, pp. 1-9. 94Ibid., According to Wright, there was one other short-lived directory, BafleyýyDirectoryof 1784, which also included the names of surgeons, and was derived from the Corporation of Surgeons' London list. This directory however is incomplete for the following year; 1785, as there are no details of surgical practitioners after the letter'p. ' 95Ibid.
67
in London, as reported in the Universal
physicians
British
Directorv
of
Trade and Commerce. 96Although the entries contained in the Directory are
however, indication do, they provide us with an as to where the arbitrary located. were majority of practices
According to Zachary Cope, "in the seventeenth and well on into the lived within the confines of the City of eighteenth century most consultants London! '. Their choice of residence, Cope argued, was dictated by their need to be close to the hospitals, their patients and the College of Physicians and Company
Cope further Surgeons. 97 of
stated
that
"in
the middle
of the
hospitals London to the and extended west many new as eighteenth century (Guy's, St. George's Middlesex Hospitals), Westminster, and a number arose took up residence in the new and pleasant
of physicians
Bloomsbury. 1198As Raymond
Crawfurd
remarked
quarters
of
in his 1931 Harveian
Oration, "it should be remembered that in 1831 the centre of medical Street, but in district in Harley the to the adjacent now not as was activity British
Museum".
99
The data in Table 2.1, Appendix B, corroborates Cope's findings and a be in location London the of made on practices can number of observations 96Source: John Wilkes, and Peter Barfoot, compilers, The Universal Bzitish Directory of Trade and Comme=4 (London, 1790), Vol. 1, pp. 444-452. This Directorywas used as the Street Directory' 'an Alphabetical 'London List included a which contained of publication the Streets, Squares, Lanes, Courts, Alleys, & C. in London, Westminster, and Borough of Southwark, pp. 641-711. The listing for the medical practitioners did not usually contain the district in which the streets, lanes or squares were located. YY2eStreet Directory was therefore a useful supplement. According to this publication, the only Surgeon registered in Harley Street was Benjamin Humpage. 97 Cope, 'Harley 98 lbid
Streef,
p. 7.
99Sir Raymond Crawfurd, 'The Place of Medical Societies in the Progress of Medicine', 'Harveian Oration'on the Occasion of the Centenary of the Harveian Society of London' 11 June, 1931, Archives of the RCP/245/2, p. 3.
68
by
the
end
concentration
of the
eighteenth
of apothecaries,
century.
Unequivocally,
the
biggest
(33 per cent) surgeons (58 per cent) and
(40 physicians per cent) was still in the City and Holborn. The vast majority (i. e., three-quarters)
of the apothecaries were concentrated in the City, East
London and Holborn. However, these areas only attracted 40% of surgeons data The 41% suggests that by the close of the century, and of physicians. Mayfair was certainly becoming a fashionable area in which to establish a both for The district physicians. surgeons and attracted 20% of the practice Therefore, 60% 11% and of surgeons. of the physicians chose the physicians
City, Holborn or Mayfair as their place of business with St. James's increasingly becoming a popular area. With the exception of the City and Mayfair,
the location of surgical
London, more evenly across was spread although practices
it should be
large had this that a significantly number of respondents with sector noted had fully Marylebone not yet established its reputation no recorded address. Bloomsbury Soho just the and men, and were medical marginally amongst more attractive
to them. It
must be emphasised
the of medical practitioners. portion a represents
that
Table 2.1 only
Some did not return
an
for hospital list for Notably, the others and a address was given. all address
the apothecaries in the sample recorded a place from where they worked, hospital. their practice or a either The Urbanisation of St. Marylebone In
1832, Peter Potter's plan of the parish of St. Marylebone, in Plate
2.5, which emulates Richard Horwood's maps of London executed in the 69
1790's, illustrates
how far the area had developed since Rocque's map of
1747.100In Horwood's map of the Marylebone area, the street names could be deciphered. The borders of individual easily
dwellings
were clearly
marked and in some cases,the houses were numbered.
100Potter's , Plan of the Marylehone Estate, the first edition of the Map was dated 1821 and by Vestry. the the See introductory notes, which accompany a order of was commissioned by Richard Bowden, Archivist, Marylebone Library for thegaint the map of reproduction Marylehone Society.
70
Image removed due to third party copyright
71
Though Potter's map is similar to Horwood's, Richard Bowden maintained that the numbering is more precise than one would find on a Horwood map. On Potter's plan, the large town houses are coloured a dark shade of grey and the 'lesser dwellings, ' such as the mews houses and workshops, are etched in a lighter shade. 101The advance in urbanisation
since John Prince's
is 1719 plan of obvious. The development, as it now exists, is no longer a simple geometric configuration.
Regent Street has replaced Bolsover Street
Street. Edward The latter has been relegated to a narrow offshoot of and Foley Place. Ogle Street has disappeared and in its stead curves Langham Place, around All Souls and through to Portland Place. Upper Harley Street is now firmly
established
as a continuation
of Harley
Street. Notably,
Harley Street is no longer situated to the northeast of Cavendish Square. On Potter's plan, the names of Chandos and Harley interchanged.
have been
Harley Street now runs through to Upper Harley Street, from
the northwest side of Cavendish Square. It comes to a halt at the New Road, is interesting Road. It Marylebone now
to ponder, if the designata of Price's
been Chandos had Street executed, whether a plan address would have held the same cachet as a Harley
Street address for the aspiring
medical
practitioner.
By the middle of the 1840s, Cavendish Square and the surrounding increasingly becoming attractive to medical men. In 1845, nine streets were had qualified medical practitioners set themselves up in Wimpole Street, Street, in both in Harley Margaret Street and Queen Anne Street six eight Aid. 101 72
Square itself. Cavendish These in four were predominately and
physicians,
the rest were GPs and surgeons.102This compares favourably with 20 medical practitioners the surrounding
in Finsbury Square in the City and an additional
12 in
held district This 103 the greatest concentration streets.
of
Street in Brook Mayfair in London time the and was a close at medical men Savile Sloane Street Street, Row Gower 19. and were near second with 13 13,11 practitioners and with contenders Establishing
respectively. 104
in Street became Harley progressively a practice
popular over the course of the nineteenth
century. The following
more factors
Street developed how Harley determine to as an urban were examined incumbent, length location the the of period of each previous medical area:
dramatic in for Street Harley in the the the and rise cohort of registration number
of medical practitioners
Great War. Finally, to the up
to what
increasing indicator be the of medical viewed as an area extent could in London? indeed, the acme of medical addresses prosperity or,
Previous Practice Address Table 2.2, Appendix B, shows that 422 medical practitioners,
approximately
in London had the prior to established practices two thirds of male cohort, half Just Street. total the Harley to cohort, were of under moving
Southey, E., H. H., Street, for Riadore, in Harley 1845, Me&Cfi]DjýMtory, and 102 example, "Obstetric Clarke, Sir C. M., "Physicians" to an as categorised was were referred as Physician", Hancock, H., as a "Surgeod, Coles,J., as a "Surgeon - Orthopedist", and Maclure, W., as a "General Practitioner" 103Sir Hermann Weber, the father of the Harley Street physician F. Parkes Weber was described as having "a fashionable practice in the 1860'sin Finsbury Square, which was then a doctors' quarter in Londoe'. Anon, T. Parkes Weber' BMJ, June 9,1962, p. 1630. 104Information on the number of registered medical practitioners and their location was Me&Ca1DireCt0r7,1845. from obtained
73
established in West and West Central London. The area north of Cavendish Square, between Portland Place and Marylebone High Street, was the most Over the group. a third of the cohort popular previous registered address of (36.83 per cent, n= 242) moved from the streets parallel and perpendicular
to Harley Street. Morell Mackenzie was one of this group who relocated from
nearby
Weymouth
Street
to Harley
Street.
encouraged him to move at the age of thirty-three
Growing
prosperity
to "one of the largest
houses in Harley Street". 105 A sizeable number (n = 54) arrived in Harley Street within two years
(64%) However, these the shared an address with a majority of of qualifying. in Street. Of had the the entire a practice already established relation who in hospitals from to a private practice in 52 posts resident moved group, Harley Street. Most were from the London general hospitals, although 32 % (n = 17) of these held resident posts at specialist hospitals such as The Royal Hospital
for the Diseases of the Chest, The Hospital
for Sick Children
(Great Ormond Street) and the Ophthalmic Hospital (Moorfields). 106 An analysis of the cohort's address prior to arriving further
in Harley Street
(n 2.28 that = 15) of practitioners per cent only revealed
Dual 107 two registration addresses. registered at
were
increased when the cohort
became established in the Street; moreover, dual registration was more
105Robert Scott Stevenson,More]] Mackenzie: TheStor:y of a Victorian aaged7, (London, 1946), p. 40. 106The number who were registered at a General Hospital prior to Harley Street are as follows: 9 St Thomas's, 7 Middlesex, 6 St Bartholomew's, 4 University College, 4 King's, and 2 at each of the following* Charing Cross, and Guy's and 1 from St George's. 107For the purpose of Table 2.2,1 have taken their first address listed in the Directoryor Register.
74
frequently recorded in the Medical Directory from the 1880s. Thus, in the 34 (n listed from 1879,6.92 9) 1845 to the = per cent of male cohort were years in the 34 years from 1880 to 1914 this two addresses, whilst as registered at had increased to 19.92 per cent (n = 105). Jane Harriet
Walker, who also
had a practice at Cannon Street, was the only member of the female cohort listed as registered at two addresses. Most of these additional practices were outside Central London and, although
they were positioned
preponderance
of any particular
throughout
the country,
there
was no
county. The location of second practices
St Wood John's in London, in from to other such as counties areas spread Englanýd such as Sussex. The majority of these practices were in the South
East, like those of the orthopaedic surgeon, Bernard Roth who held practices in London and Brighton
for 27 years, catching the train
at midday to
few located in Only 108 Midlands between the the two a were areas. commute delineated Liverpool England. the North the most northern extremity of and
in the UK. Five of the cohort had overseas addresses: such as Arthur J. M. Bentley, for example, who practised in Cairo during the winter months.
Period of Registration in Harley Street The average period for a medical practitioner to be registered in Harley Street was over 14 years; this ranged from a minimum of up to one year (10.65 per cent) to a maximum of 61 (one person only) years. The period of
in Harley Street Appendix is Table 2.3, for the cohort shown on registration (n half Just B. = 337,51.29 over
Street Harley the total per cent) of men
108Anon, Bernard Roth, Lancet, Apr. 10,1915, p. 772.
75
in Street for for Harley to ten the up years, were registered rest stayed between 11 and 61 years. However, of those that stayed up to ten years, only
Street Appendix B, Harley Area. Table 2.4, the out of a small number moved location the of the group's registered medical address after practising shows
in Harley Street. Over three quarters of the cohort, 76.41 per cent (n = 502) (n Street in Harley 319,48.44 = per cent) or moved to another either stayed Street Area. The died in in Harley the majority retired, or remained address this medical district; thus, Harley Street or the Harley Street Area can be for the the majority of the cohort. practice of private pinnacle as viewed The age on arrival in Harley Street was ascertained from obituaries
for almost half of the male cohort (48.55 per cent, n= 319) and their average in Considering be found 39.109 that to one could qualify medicine at age was the age of 21 this number was used as a basis to estimate the age for the
date first between difference the their the the of medical cohort: rest of was added to 21, which produced an
qualification
date the of arrival and
approximate
Street in Harley The 34. average age of the of age on arrival
Almost did the time-period. three over significantly change not cohort male (72.32 30 the group aged or over, which of entire were cent) per quarters
indicated that most men would have been in practice for approximately a decadebefore their arrival in Harley Street. A few of the cohort, including George Thin, practiced overseas before
becomingestablished in the Street. Following his education at Edinburgh 109The age of the rest of the cohort could not be found from the available sources. Eight of the group who were in the Medical Directory 1845 were not included, as their date of They have be in the to the may of ascertained. start arrived any up year arrival could not period, 1845.
76
University,
Thin practiced in Scotland before travelling
to Shanghai where
he continued his medical career.110It was not until he was 58 that he established
his consultancy
practice
in dermatology
later and
tropical
disease in Harley Street. Because of the length of time the cohort were in Street, for 14 the the male on which was average almost registered years for female longer Street Harley be the cohort, can cohort and slightly viewed leading up to the peak of their career. as a period of consolidation Only a minority
houses in the their occupiers cohort were sole of of
Harley Street. Whilst Reginald Pound claimed that, "multiple and the resultant
proliferation
room letting
of doctors' nameplates first began, in the
Graph Multiple data in 2.1, 1920s", the early
Occupancy, revealed that
date. determine frequency To began "' letting the earlier at a much multiple of occurrence of multiple
lettings,
the number
of medical practitioners
From Directory did 'per house' list 1905, the was calculated. not registered the house number next to the person's name in the Street List; thus, the biographical
for in Directory the was consulted each person. As can section
be seen in Graph 2.1, multiple letting was well established before the start by house fact, In War. 1900 Great the as many shared a as were sole of by the the of period multiple occupancy greatly exceeded end and occupiers, first doctors in Harley The to address share a practice single occupancy.
Street in 1853 were father and son, Edward and Henry Monro.
210W.F. Bynum and Caroline Overy, eds., The Beast in the Mosquito: tbe Correspondence (Amsterdam, 1998), p. 505. &fahiekManson, Ross ofRonald III Reginald Pound, Harleygtree4 (London, 1967), plate between pp. 78 and 79.
77
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Why Harley Street? The reasons for choosing to set up a practice in Harley Street were varied,
but it has long been associated with exclusivity. Johnston Abraham he in 1930s the this when remarked: confirmed there are names, apparently casual, which convey a world of meaning quite intrinsic in their connotation, and therefore to anything of proportion out generally due to some external association distinguishing them from all others. Such a name is "Harley Street"... To the medical student in his hospital days it represents the highest position in the calling he has chosen, in its Olympian remote exclusiveness, an altitude something almost apart. 112
In The Road to Harley Street, (1963), the physician William Byam in Harley Street in how like 1921 a practice was obtaining getting recounted
into the ...Holy of the Holies'of the medical worl&'. 113The title of William Evans' autobiography, reaching
Harley
the Joume.7 to Harle.7 Street (1968), suggests that
Street, which he did in 1947, represented
one of the
114 his career. medical of pinnacles Whilst some historians have argued that Harley Street first became because in it the nineteenth century, was close popular as a medical quarter to the railway stations on the Euston Road that brought patients from the Street's for Harley the popularity reasons country,
are considerably
more
By Paddington, 115 the the mid-1870s railway stations at complex and varied.
Euston, St Pancras and King's Cross, were already in existence and in 1899 the last terminus in London opened at Marylebone. The railway network of central
London had by then largely
assumed the shape it has today.
112J. Johnston Abraham, Ninety-Nine Wimpole Street, (London, 1937), p. 55 113William Byam, The Road to HarleyStreet, (London, 1963), p. 227. 114William Evans, Journey to Harlevgtree4 (London, 1968). I 15.1hid., and Paul Ferris, The Doctors (London, 1965), p. 24.
79
According to Irvine Loudon's article on doctors and their transPort, the train had a considerable effect on consulting practices. With doctors' travelling
times reduced, more patients could be seen.116In addition, the rail system facilitated also
Harley Street to referrals more consultants, as there were at
the time, few well-known consultants in the provinces. Abraham pondered that, "there seemsto be no particular reason why [Harley Street] should ever have originated, or why, once started, it should
by Yet, he 117 the the wealthy westward move was aware of still remairý'. from City Covent Garden, Bloomsbury to the the and aristocracy merchants
by Street Oxford The the the to then middle of nineteenth century. on and individuals likewise these to attend moved medical practitioners wishing London hospital Due the the teaching to staff of regulations, westward. hospitals were required to live within a short distance, so that they could be Undoubtedly, in 118 in case of emergency. quickly called
the use of the car,
from the late 1890s freed a few consultants from the hospital environment
however, Car larger to them was, use catchment area. access a and allowed limited:
by 1913 only one person in every 165 in Britain
owned a motor
car. 119
When Charles Heanley, consulting plastic surgeon to the London Sir Street his Harley the Hospital was writing surgeon reminiscences of
April, 2001, Transport, 'Doctors Med4calffistory, their 1750-1914', p. Loudon, Irvine 116 and 13 117Abraham, Wimpole Stree4 p. 57 I's irbid, pp. 57-58. p119Trevor May, An Econom;c and Social History ofBiitain, 1760-1990, ssex, 1996G), 318.
80
Henry Souttar in 1996, he described how Souttar and other consultants were paid a sum of 150 per annum by the London Hospital. ... to as cabbage' - money given to them for transport referred
This was from their
West End consulting rooms in Harley Street" to the hospital. 120Whilst some
hospital by the public transport: the train, tram, bus and later the arrived at tube others, such as Theodore Thompson, arrived in a Rolls Royce.121 The proximity
of the cohort's hospital posts was not the only issue in
deciding whether to establish a practice in Harley Street: an analysis of their staff posts showed that they held appointments
across a range of 526
different medical institutions both inside and outside London. When the location of these hospitals were examined, it was found that they were for London: Bart's, had dispersed the greatest example, which across widely affiliation
Smithfield, lay in West the group, of
whereas St. George's
Hospital was at Hyde Park Corner and Westminster Hospital was near Westminster hospitals
Abbey. It thus seems likely that the location of the teaching
in development the of Harley played a small role
Street as a
medical centre. Graph
1.1 Harley
Street on page 28, shows the increase in the
during There the practitioners period. was a steady of medical number increase in numbers up to 1885, and then from this point until 1914, the Had is the trajectory the growth continued same on as that exponential. rise to 1885, the total number would have been approximately 120, in fact, the 120Charles Heanley, 'Reminiscencesof Sir Henry Souttar' The London Hospital Gazette, Medical and Dental Clubs Issue', no. 21,1996, pp. 9-10. 121]hid.
81
number
This 298.122 was rise was a reflection
population population
of London
during
the period.
In
of the growth 1871, for
in the
example,
the
Greater London was 3,900,000 by 1901 it had increased to of
6,600,000.123 Concomitant
with
the increase of medical practitioners
in
Harley Street were medical practitioners throughout Greater London who in 2,027 1845, which increased to 3,947 in 1880 and swelled to numbered 6,694 in subsequent disciplines
1914.124 The rising growth
professionalisation
of specialisation,
along
with
of medicine the
new
and the academic
during this time played, no doubt, a role in the formation
of a
geographical location where professionals worked side-by-side in the same area.125 Whilst medical students pursued their qualifications in medical schools within
various
universities,
which
was followed
by
training
in hospitals, life those the medical practitioners who chose of a undertaken consultant institutional
did
not necessarily
affiliation
have the
same geographical
they had when they were at university
locus or
or training in
hospitals. For the medical consultant who had achieved prominence, partly due to their initiative in creating new specialities and because they were in in their chosen experts area, congregating one street may regarded as
122This figure included 17 women and three men who had retired from practice. 223Chris Cook, Bzitain in the Nineteenth Century, 1815-1914,(London, 1999), p. 114. 124Totals from the 1880 and 1914 Medical Directory. Own count from the 1845 Medical Directory. 125For a discussion on the development of professionalisation and the increase in demand for medical care see Ivan Waddington, The Medica]1! rofessionin the Indus&alRevolution, (Ireland, 1984),J. B. Morrell, 'Professionalisation'in R.C. Olby, G.N. Cantor, J.R.R. Christie Companion (London, Historyofgeienep, Hodge, to the M. J. 1996), pp. OSO-OSO eds., and fessional (London, Rise Societv, Perkin, Englandsince Harold the 1989). 1980, ofP". and
82
have provided community
the opportunity
that
a degree of professional
to maintain
they had experienced previously
at university
and in
hospitals. Other factors that account for this rise are detailed below. An improved communication network enhanced the referral system decreased for both time the travelling the doctor and the patient. The and invention of the telephone in 1876 allowed accessto a wider client base and for increased business Harley Street the as a result consultant. It was not
until 1901 when the telephone was widely used that it became possible for consultants
to have a practice in Harley Street a couple of days a week in
They longer had to be on site to deal to no a practice elsewhere. addition issues. All increased business for this the medical of meant or with problems profession
in
Harley
Street
and arguably
an increased
demand
for
Harley Street's The location, of convenience central consulting rooms. near
hospitals train the and stations and the use of the motorcar major of most are
but some,
not
all,
of the
reasons
for
the
Street's
popularity.
Commentators have overlooked the importance of social and professional family the and eminence of medical practitioners who relations connections, inhabitants to the area. new could attract The snob appeal of Harley Street as an address was already (1798-1834) Mr St. John Long John the medical charlatan established when began to treat society ladies there in the 1820s. He claimed to be able to
distinguish between "sound and consumption and unsound tissues" cure through the medium of a lotion that he invented. He then:
83
took a large house in Harley Street, and fitted it up for the reception of people anxious to consult him; and for some seasons every morning and (from ) 8 4 to the public way was blocked up with a. m. p. m. afternoon carriages pressing to his door. The old and the very young alike flocked to him; but nine of his patients out of every ten were ladies. 126
St. John Long had "rooms handsomely fitted up elegant waiting...
his He had highly 127 the grace and polish of patients". rooms matched a lucrative practice and his income has been estimated as 213,000 in 1829.128 Part of the reason for his success was attributed to the location of his because "a intellect good and a considerable address quantity of practice distinguished him from the vulgar herd of cheats7.129Even though the deaths of Catherine Cushin in 1830 and soon after Mrs Colin Campbell Lloyd have been attributed
to him, St. John Long retained the patronage of
his wealthy patients. many of When the physician Jukes De Styrap advised young practitioners in he 1880s, the practice urged them to
wishing
to establish a private
acquire
"a good address". 130 Harley
Street would have been one such
location, since it was viewed by then as "the Mecca of the profession" by the Cavendish Square However, 131 a address aspiring and ambitious consultant.
in Harley Street. The desirable than closer one's practice was one was more to Cavendish Square, the more prestigious
was one0s address; thus, the
lower numbers in the Street were the most sought-after. Sir Alfred Garrod (London, A Doctors, Book Jeaffreson, 1861), p. 227 Cordy J. 126 about (London, Histoiy Quackery, Natural Tbe 1961), p. 68 Jameson, Eric 127 of 128Juanita Burnby, Caricatures and Comments, (Staines, 1989), p. 5. 129Jeaffreson, Doctors, p. 225. Qualified medical practitioners derided St John Long and Wakley denouncedhis quackery in the Lancet. SeeRoy Porter, Quacks, Fakersand Charlatans in English Medicine, (Gloucestershire, 2000), p. 194. 130Jukes De Styrap, The Young Practitioner, (London, 1889), p. 21 131J. Purves - Stewart, Sands of Hme-*Recollections of a Physician in Peaceand War, (Loondon,1939), P. SO.
84
for example, who had lived at number 84 Harley Street, moved to number 10 in 1874, to be "nearer to Cavendish Square". 132 Harley Street was regularly associated with ambitious young medical practitioners
lured by the Street's eminent
men and the possibility
of
Street's Thus, James Purves-Stewart had in the when prosperity. sharing hospital junior Westminster Hospital, physician at as a a position secured like "every ambitious young medical man at the time", he set out to find consulting
in Harley rooms
Street. In 1900, he managed to secure a
bedroom house The attached. was not close to consulting room with a small Cavendish Square since it was "the far end" of the Street. Purves-Stewart gradually
built a successful consultancy practice as a neurologist and later
door from Cavendish Square". "near 133 the one away end: at rooms acquired Likewise, Sir Henry Thompson, who was also "not without some ambition" took a seven-year lease in Wimpole Street prompted by his colleague at UCH, George Harley who recommended the Harley Street Area to him. 134 George Harley's daughter who edited his account of Life as a London
Pbvskian, described her father, when he set up practice in Harley Street in 1860, as entering
the doctors' "Elysium". 135 George Harley
chose Harley
Street because "excepting Portland Place, [it was] the first really good street Street had family He the there associations and was within also going west".
132Anon, 'Sir Alfred Baring Garrod', BMJ, Jan. 4,1908, p. 58. 133Purves-Stewart, Sands of Hme, p. 97. 234His colleague at UCH was probably GeorgeHarley. W. R. Merrington, University College Hospital an d its Medical School-a History, (Lon don, 1976), pp. 71 and83. Seeal so ) (ed. GeorgeHarley F.R.S. or the Life of a London Rbysician, (London, Tweedie, Alec. Mrs 1899), P. 133. 135 Tweedle, Harley, p. 133.
85
15 minutes
walk
of University
College London,
appointed Professor of Medical Jurisprudence
where
he had been
in 1859. The prestige of the
aristocracy and of titled members of the medical profession was also an important factor, which Harley noted when he moved into the house once by occupied
Baroness Burdett-Coutts
during
her
childhood. 136 His
included Sir William Jenner, Sir John Williams, Sir Alfred neighbours Garrod and Sir Richard Quain. Edward Collett Hort, who bought a practice in Torquay in 1907, found that when he moved to Harley Street in 1909, he immediately
developed a "high-class practice" specialising in bacteriology
and, in particular,
immunology. 137
Some consultants, such as William Francis Victor Bonney wanted to in Harley larger the to premises, yet remain move
Street Area. Bonney
Street Harley 15 with three other medical practitioners, shared rooms at
including his friend, the eminent surgeon Sir Gordon Gordon-Taylor. 138 When a house became available consulting
Place in 1911, "with
floor living Bonney the ground and on quarters above", rooms
took over the lease.139Similarly, consultant
at 29 Devonshire
to Moorfields
after Gordon Holmes was appointed
Eye Hospital
Charing and
Cross Hospital,
he
in When he Harley Street 1911. 58 at practice married established a private
in 1918, however, needing larger premises for entertaining
his and
burgeoning consultancy practice, he moved to the adjoining Wimpole Street
136
Ibid. 137Anon, 'Edward Collett Hort', BMJ, Oct. 21,1922, p. 777. 138Geoffrey Chamberlain, KctorBonnety-'the GynaecologicalSurgeon of the Twentieth CenturyGndon, 2000), p. 21. 139Chamberlain, Bonney, p. 130.
86
large had "a house he five floors where over which required a permanent staff of nine servants". 140 The houses in Harley Street were in varying states of repair. Some
incumbents such as the ophthalmic surgeon, Walter Jessop, decided to refurbish their premises prior to their renewal of their lease. In 1903, Jessop's lease had terminated and in his determination to rebuild the premises, he took to scouring the neighbourhood for "Adam's mantelpieces
house be down, to a was pulled and in this he was often whenever Despite 141 successful".
the
illustriousness
of
many
of
the
Street's
inhabitants, Harley Street was not immune to such health hazards as typhoid. In 1873, an outbreak occurred in London and Mrs William
Squire,
in letter from Paris, received a one of the inhabitants who was on vacation of Portman
Square in London. The writer
described how parts of West
London were in a poor state of health: I am afraid Dr in consequence of a very large number of typhoid cases ... Squire will find many of his colleagues whose households have suffered the Harley Street, Cavendish Square fever it is about principally ... ... hereabouts drains dangerous. be 142 the that would very considered
Familial
connections often played a decisive role within
the medical
Peterson "systematic data Whilst 143 that, claimed on the social profession.
origins of medical men of all ranks are not available" and that records exist FRCSs LSAs FRCPs, for Venn's and she overlooked such sources as only 140Davis Coakley, Idsh Masters ofMedicine, (Dublin, 1992),pp. 259-260. 14,F. W. Andrews, W. McAdam Eccles,G.E. Gask, W.D. Harmer, H. Thursfield, and H.Williamson eds., Saint BartholomewýgHospital Reports, (London, 1920),Vol. Liii, 1917 and 1918, pp. 2-3. 142Quoted in Merrington, University CollegeHospital, pp. 54-55. 143Irvine Loudon, Medical Care and the General Practitioner-'l 750-1850,(Oxford, ING), pp. 34,201.
87
Alumni
Cantahrigienses and obituaries. 144 Nevertheless, there
were
problems associated with some available sources; The Oxford Calendar, for listed degrees the only students' example, and year of qualification, of the
personal
information
relating
to a student,
whilst
but none obituaries
frequently provided the name but not the occupation of the father. Peterson found that "the most common background for the Victorian family. "145 Parental that of a medical student was medical occupation was Street for Harley the a quarter of cohort and it was found that ascertained less than half of these (43.78 per cent) came from medical families. Parental
for determined the rest of the cohort showed that they came from occupation dominant backgrounds; the next group were the clergy, followed a range of
by the law, civil servants, merchants and businessmen, academics and other professions such as accountants.
A fifth of those whose social background had been established had a brother or father who was a Harley Street man. 146Some, such as the dermatologist James Harry Sequeira and William McAdam Eccles, came from a long line of doctors; five generations of Sir Buckston Browne's family had been doctors.147RobertFortescue Fox was the youngest of seven sons of the surgeon Joseph John Fox all of whom went into medicine.148Therewere many instances where a young medical practitioner shared a consulting
144John Venn and J. A. Venn, Alumni Cantabzigienses,(Cambridge, 1922-1954). 145M. Jeanne Peterson, The Medical Profession, (London, 1978),p. 41 and Table 9 p. 198. 146Parental Occupation was found for 25.72 per cent of the Harley Street cohort (n = 169). 147'Sequeira,James Harry, Munkýr Roll, 1905,Vol. IV, p. 467 and Anon, 'William McAdam Eccles, BW 15 June, 1946, p. 892. Anon, Sir Buckston Browne, BMJ, Jan. 27,1945, pp. 132-133. 148Anon, R Fortescue Fox', BMJ, June 29,1940, p. 1072.
88
in Street. 149Having the a relative who was already established room with qualified
MRCS,
Demonstrator
LRCP
in
1889, Alfred
Downing
Fripp
was
appointed
following Anatomy Guy's in Fripp the at of year. was nearly
25 when his brother-in-law Dr. Hale-White offered him a consulting room at Street. As his biographer
65 Harley
remarked,
"a Harley
Street address
[was] invaluable to a young doctor of ambition". 150When Duncan Maclure's father William
died, Duncan took over his father's practice in Harley Street
in 1852.151 Connections within
the cohort were important
and in some cases
When Frederick the practitioner's career. course of a medical changed William University,
Price
arrived
in London,
having
graduated
from
Edinburgh
he took the position of assistant medical officer at the Brompton
Hospital. But it was through his interest in cardiology, which was fostered
by his association with the eminent cardiologist, Sir James Mackenzie, that he became interested in the subject. James Mackenzie had moved from his G. P. practice in Burnley, Lancashire to Bentinck Street in 1907. Although he would have preferred a Harley Street address he was reluctant to take on in himself London. he had lease long there established until a A year later, with Price's recommendation, Mackenzie joined the staff later Hampstead Price's Hospital, Vernon took Mount the a room and at of
149Fathers and sons in Harley Street included Vaughan Harley, son of GeorgeHarley, Harry Arthur Sansom, son of Arthur Ernest Sansom,William Soltau Fenwick son of Samuel Fenwick, Henry Gervis son of Henry Gervis and John Edward Squire son of William Squire. (London, AlfredýWpp, 1932), p. 51. Roberts, Cecil 150 151Anon, 'Duncan M. Maclure', Lancet, Jan. 3,1880, p. 34.
89
house in Harley Street. Mackenzie's biographer Alex Mair remarked on the Street's "magic name", and maintained that by 1910-12 Mackenzie had built
he treated such a large number of the a celebrated practice, where aristocracy
that "his diary reads like an edition of Burke's Peerage". 152So
following Mackenzie's his Price that allure great was retirement, occupied Mackenzie's vacant room and his practice was said to have increased because of this association.153 Some moved to Harley Street because they were invited to become partners or assistants to medical practitioners
who were already established
there. Samuel Ernest Dore had worked with the skin specialist, Sir Malcolm Morris, in the skin department of St Mary's, and in 1903 he moved to Morris's
practice, number
8 Harley
Street. In the following
year, Dore
his in Wimpole Street. 154 the own nearby of a practice established
Whilst George Buckston Browne was a demonstrator of anatomy at UCH
in the late
consulting
1870s, he met Sir Henry
hospital. to the surgeon
Thompson
Thompson later
who was then
invited
Browne
to
become his assistant, and then partner, at his "fashionable practice in Wimpole Streee'. 155Browne went on to establish his own successful practice in Harley Street from 1878, specialising in diseases of the urinary tract. The
interest Herring, disease Thomas Herbert whose was also special surgeon,
(London, MD., Mackenzie, GeneralPractitioner, Sir James 1853-1925, 1973), Mair, Alex 152 pp. 238-39 153Anon, 'F. W. Price', BW March 30,1957, p. 765. 154Anon, 'Samuel Ernest Dore', Lancet, July 8,1950, p.78. 155Ibid., Sir Henry Thompson's octave dinners: "8 persons, with 8 courses, at 8 o'cloev by Royalty. famous occasionally occasions attended social were
90
of the urinary
tract, assisted Thompson in his private practice (from 1888)
before establishing a practice in Harley Street in 1891.
Many of the group had formed friendships with each other at university
or medical school, which continued throughout
their period in
Harley Street. Three King's College Hospital alumni, John Charlton Briscoe, George Lenthal Cheatle and Arthur Whitfield shared a research laboratory Williams "a link
in Harley Street. 156Herbert Ritchie Spencer met Sir Dawson at UCH and they formed "a life long friendship" which established
between the British
Hospitar'. 157 Williams
Medical
established
Journal
University and ...
College
a practice in the Street in 1896 and
Spencer followed him there three years later. Thus, when Dawson was
editor of the BMJ, Spencer contributed several articles to the Journal on history the of medicine. 158 obstetrics and The Success of a Harley Street Practice Consideration
was given to exploring whether a Harley Street address was
an indicator of achievement within the medical arena. Whilst it was not possible to ascertain
the entire
practice, a prosperous reputation
cohort's income or profit
from private
could be ascertained by adopting James
Paget and Squire Sprigge's hierarchical system of success.They regarded a indicator the most significant as practice of a consummate career, private "distinguished led to the by them their classify success" of which peers in leading in 1) position a a practice great cities, 2) a place on the obtaining: 156Anon,'John Charlton Briscoe', Lancet, Mar. 5,1960, p. 554. 157Anon,'Herbert Spencer', BW Sept. 12,194 1, p. 389 158.1hid
91
honorary
large hospital staff of a
important
public office. As Bill Bynum observed, however, achieving any of
and 3) an academic chair or 4) some
the latter three was unlikely except in conjunction with a private practice. 159
For those who could survive the half dozen or so years of relative hardship in building up a consulting practice, the financial rewards could be substantial: a man might expect to take between five and seven years to establish a viable consulting practice and these years of struggle and striving would be in relative poverty. 160 spent
During this time, paid hospital work, teaching or locum fees were important to the fledging consultant. 161A hospital post was virtually
de rigueurfor
any
had become to ambitions who medical practitioner a successful Harley Street consultant. Sir George Buckston Browne was one of the few surgeons who built
up a large and successful consultancy practice first in Harley
Street and later in Wimpole Street without having a hospital appointment. His biographers related that when Browne was sitting near an open window Street in he heard in Wimpole 1900, house his a passer-by proclaim to his at
house. has it "Buckston Browne's He done all without a hospital companion, Being 162 a member of the permanent appointment".
or visiting
staff of a
hospital was regarded at the time as essential to keep abreast of new developments in 163 and medicine. procedures operating
159W. F. Bynum, Medical Values in a Commercial Age, in T. C. Smout, (ed.) Victozian Values, (Oxford, 1992), P. 156.
1600. Connor Ward, John Langdon Down: 1828-1896.'A CazinglYoneer (London, 1998), p. 27. 161 Ihid 162Jessie Dobson and Sir Cecil Wakeley, Sir GeorgeBuckston Browne, (London, 1957), p. 127 163 Ihid.
92
Success in private practice did not always depend on family money. John Langdon Down, who was described by his biographer as "one of the
famous medical men in a golden age of London medicin&' and "a figure of life with no capital and yet eventually started society",
became "one of
London's wealthiest doctors".164 Most of the obituarists of the cohort in George Nixon these the of men private practice. success remarked on Briggs, surgeon to the Ear, Nose and Throat Hospital, had, for example, a "very busy private practice" while Sir Henry Trentham St. Bartholomew's
Hospital, "had acquired a lucrative
Butlin,
surgeon to
practic6". 165Samuel
Fenwick's "large private practice" was partly the result of having a series of
dressing rooms at his Harley Street house "in which he was able to examine by he their this the cases, means of was able notes patients after recording his burgeoning Fenwick time". to three to attend continued patients at a (and diligence 82.166The the to the perhaps avarice) of age of up practice by Horder's is Lord 61ite Street Harley remark: exemplified successful
"I
into if he 167 himself Beelzebub treat consulting-roorre'. my came would Alite: Court Physicians and Surgeons The Social Physicians and Surgeons to the Court were considered, both socially and included be these their to a number careers and at zenith of professionally, from Harley Street. These positions not only enhanced the status of these individuals amongst their peers, but elevated their status in society and
164Ward, Down, pp. xvii and 1. 165Anon, 'George Nixon Biggs', BMJ, Nov. 25.1922, p. 1049.Anon, 'Sir Henry Trentham Butlin', BMJ, Feb. 3,1912, p. 276. Others included Joseph John Perkins and Victor Bonney. 166Anon, 'Samuel Fenwick', BMJ, Dec. 27,1902, pp. 1973-74. 167Anon, 'Lord Horder of Ashford', BMJ, Aug 27,1955, p. 565.
93
thereby
increased their
significant.
Sir William
earning
power: the financial
rewards
Jenner, physician to Queen Victoria
be could
(1819-1901),
fortune amassed a of Y.375,000; Sir Oscar Claytonýs will was proved at more than
E150,000 in personal property
and Sir Richard
Quain left 2117,000.168
Many of the prominent members of the medical profession registered
in Harley Street achieved fame and celebrity in their practices; both Henry Herbert Southey and Sir Charles Mansfield Clarke were Royal Physicians. Southey, an authority
lunacy on and examiner of lunatics at the Court of to George IV (1762-1830). 169Clarke
Chancery, was Physician-in-Ordinary
(1792-1849), Queen Adelaide in to 1830, receiving physician appointed was
a baronetcy the following year. 170 Queen Victoria (1819 - 1901, reigned 1837-1901) Queen Victoria's medical attendants consisted of a hierarchical chain of from Physicians-in-Ordinary Sargeant the the and command, which ran Surgeons down to Physicians and Surgeons Extraordinary, physician
followed by a
household the to and a resident physician, finally and surgeon
there were the Apothecaries. There were two or three each of Physicians-inOrdinary
Surgeons; Sargeant, these were paid appointments whilst the and
Physicians and Surgeons Extraordinary
were honorary positions. 171FrOM
168A. M. Cooke in T12oHlsto--y of the Roval CoUege ofphysicians ofLondon , Vol. 111, (Oxford, 1972), pp. 893-894 and p. 894, fh. I and Anon, Medical News, BMJ, March 26, 1892, p. 688. 169Anon, 'Dr. Southey, BMJ, June 17,1865, p. 629. 170Anon, 'Sir Charles Mansfield Clarke', BMJ, 12 Sept. 1857, pp. 774-75 and Munks'Roll, 1835-36, p. 13 for Royal physicians and surgeons, see Rivington, Medical 171For details of remuneration profession. p. 331.
94
1864, the apothecaries usually
had the combined LSA and MRCS, thus
becoming Surgeon ApothecarieS. 172
Surgeon Apothecaries were appointed to the Queen at Osborne and for the household at Windsor. Victoria also employed a surgeon occulist, a
dentist household in dentist to the and a addition to chemists and surgeon druggists
in ordinary.
Additionally,
Royal physicians,
dentists, surgeons,
Queen in Scotland Ireland. the attended apothecaries and and occulists Physicians, surgeons, apothecaries and dentists were appointed on a lesser
Prince Princess Wales, households Duke the the the to and of of and scale Duchess of Edinburgh and the Duke and Duchess of Connaught, the Prince Christian Princess and
and Princess Beatrice and Prince Henry of
Battenberg. 173
A. M. Cooke listed the members of the Royal Medical household and found
that
Extraordinary
there
were
28 Physicians-in-Ordinary
and
Physicians
Four from between Harley 1837 1899. and were appointed
Street: Sir James McGrigor, Sir William Jenner, Sir Richard Quain and Sir Alfred Baring Garrod. In addition, George Lawson was appointed Surgeon Occulist to the Queen and Thomas Granger Stewart acted as her Physician in Ordinary whilst she was in Scotland. The naval surgeon William Lloyd, who represented the Admiralty
Harris
in various scientific congresses was
William Hickman Queen in 1894.174 honorary to the surgeon appointed
172A. M. Cooke,'Queen Victoria's Medical Household', Medical History, Vol. 26,1982, pp.310. 173Medical practitioners to the Court are listed in the Medical Directory from 1894 onwards. 174Anon, "Deaths in the Services", BMJ, April 14,1923, p. 665.
95
became Surgeon in Ordinary
to the Duke of Edinburgh
(1837) whilst
Sir
John Williams was Physician Accoucheur to Princess Beatrice (1861).
McGrigor who was Physician Extraordinary to the Queen had served as Director- General of the medical department
in the army. 175He is best
known as the "Father of the R.A. M. C." and the Duke of Wellington's Surgeon-General.176Garrod who was appointed to the Royal Household in 1890, was a consulting physician to King's College Hospital and well known for his work on the chemical pathology of goUt. 177Whilst Quain was for half a century 'Society, especially in it upper strata and physician of ... its literary and artistic circles. His patients were legion and included the most influential men of their day - men like the late Mr. Delane of the Times, Mr. Carlyle, and Iord Beaconsfield. 178
Jenner was generally recognised as one of the leading physicians in London
where
he established
a large
and very
He Physician-Extraordinary was appointed practice. gazetted Physician-in-Ordinary century
remained
successful consulting to the Queen in 1861,
the following year and "for a quarter of a
Her Majesty's
most trusted
adviser". 179Jenner looked
Royal Family, including Albert Edward, the the the medical affairs of after
Prince of Wales (1841-1910, crowned Edward VII in 1901) during his near fatal illness of typhoid in November 1871. In 1864, Jenner was elected
175Anon, 'the late Sir James McGrigor, BMJ, April 10,1858, p. 296. Yr aX 176Richard L. Blanco, W, 115ngtoný5Surgeon GenTe ap SJ mes McG gor, (D ur ham, 19 74), (ed. ) McGrigor, Mary McGrigor, Sir James Scalpel Sword. The the * the and see also (Dalkeith, [Scotland], 2000). Autohlography of the Father ofArmyMedicine, 177There was a resident physician at Balmoral and at Windsor who did not practice (ed.) Tbe Scalpel, pp. 313-19. Edmund Alexander Parkes McGrigor, privately. would have been appointed physician to the Queen, however, ill health prevented him from accepting the role. See Anon, 'Professor Parkes', Lancet, Mar. 25,1876, p. 480. Anon, 'Sir Alfred Baring Garrod', BW Jan. 4,1908, p. 58. 178Anon, 'Sir Richard Quain, Lancet Mar. 19,1898, p. 798. 179Anon, 'Sir William Jenner, BMJ, Dec. 17,1898, pp. 1849-50.
96
Fellow of the Royal Society, and later awarded a baronetcy. He also served (1881-88). Royal College Physicians President the of of as
There were no other surgeons attending Queen Victoria who had Street in Harley George Lawson. Lawson was the with exception of practices
leading Europe's injuries it to the one of authorities on regarded as eye and he Surgeon-Oculist in Jenner's that was appointed recommendation was on Ordinary to the Queen. Lawson attended the Queen's son-in-law, HRH Prince Christian
(1831-1917) when he incurred an injury to his eye whilst
John In Jenner Williams 180 1886, also recommended out shooting. Victoria
to Queen
to attend her youngest daughter Princess Beatrice of Battenberg
(1957-1944), Battenburg, Williams
who
was
expecting
her
son Alexander
he took the name Mountbatten
We
Prince
of
in 1917) in November 1886.
later became Physician Accoucheur to Queen Mary
(1867- 1953)
(1894-1972, Prince Wales Edward, in birth the 1936 the of of and attended King Edward VIII). 181Queen Victoria
also appointed honorary physicians
Street Harley the practitioners such as were naval and some surgeons, and Lloyd. 182 Harris William surgeon
Edward VII (1841-1910, reigned 1901-1910) Sir Alfred
Fripp senior surgeon to Guy's Hospital had a long association
(1864Clarence began Albert, Duke family 5th Royal that of with with the 1892), Queen Victoria's grandson in 1890. Whilst Fripp was in locum tenens
180Anon, 'George Lawson, BMJ, Oct. 17,1903, pp. 1019-1021. 18,Ruth Evans, John Williams: 1840-1926, (Cardiff, 1952), p. 45 and Anon, 'Sir John Williams', BMJ, May 29,1926, p. 922. 182Anon, 'William Harris Lloyd', BMJ, Apr. 14,1923, p. 665.
97
for Dr. Jalland at York he met the Duke, who was stationed at York barracks
Sir Jalland's Oscar Clayton Harley one of patients. of and was
Street and Extra Surgeon to Albert Edward, the Prince of Wales (Edward VII) and Surgeon in Ordinary to Alfred, the Duke of Edinburgh (1844-1900), Fripp. He Fripp 183 in "to the approved and young proceeded vet" was called
to Scotland to where the Duke was recuperating from a dislocated ankle. 184 Fripp's attendance on the Duke and subsequently on Queen Victoria and the Prince of Wales, earned him the nicknames "The Baron!' and 'My Friend the Prince" at Guy's Hospital. 185 In 1897, Fripp
was appointed
Surgeon-in-
Ordinary to the Prince of Wales and reappointed when the Prince was Surgeon later became Honorary He George VII. Edward King to crowned V. 186He was awarded the CB and CVO in 1902 and two years later was knighted and received the KCVO. Several Harley Street men held prominent positions in King Edward VII's
Horder Lord medical staff.
of Ashford
had treated
Edward
VII's
(which Sir by Edward Treves in 1901 on was operated appendiceal abscess in 1902) and became a popular Royal physician with a thriving
practice in
Harley Street, which he maintained from 1902 to 1946. Others included Sir Anderson Critchett who was Surgeon-Oculist and William Harris Lloyd who William Watson from Edward VII Surgeon 1901. to Honorary was an Cheyne, Professor of Surgery College Hospital
at King's
College and surgeon to King's
baronet in 1908 and appointed created was
183Anon, 'Sir Oscar Clayton, Lancet, Jan. 30,1892, p. 285. (London, Affi-edlWpp, 1932),p. 31 Roberts, 184Cecil 185Anon, 'Sir Alfred Fripp', BMJ, Mar. 8,1930, p. 473. 186Ibid.
98
Honorary
Surgeon in Ordinary to King Edward VII. Whilst, Sir William
MacCormac
Edward VII he to when was sergeant was Prince of Wales and was later honorary appointed sergeant-surgeon when he became King Edward VII. 187
Two years after Bertrand Edward Dawson left Harley Street, he was appointed physician-extraordinary to Edward VII in 1907. By then, Dawson had created a prosperous practice, and he remained in the Harley Street Area, taking a house in Wimpole Street. Dawson's connection with the Royal family was sustained through the appointment
of Physician-in-Ordinary
to
George V, moreover, it was Dawson who signed the bulletin in 1936, which informed
the country that "the King's life was drawing
Physician-in-Ordinary later He appointed was close".
peacefully to its
to Edward VIII
and
head George became VI Queen the to advisers of medical and subsequently Mary. 188Dawson was the first medical consultant to receive a peerage full-time in 189 being practice. engaged whilst Harley Street continued to be associated with the Royal family and their households. 190Reginald Ernest Bickerton, appointed
honorary
ophthalmic
King George V from to surgeon
surgeon, was
1927 to 1932 and
Richard Robert Cruise was Surgeon Oculist to King George V and Queen
187Anon, 'Sir William MacCormac', Lancet, Dec. 7,190 1, p. 1618. 188Anon, 'Viscount Dawson of Penn', BMJ, March 17,1945, p. 389 189Munký; Roll, Vol. 1903, p. 448 190In 1946, Sir Arnold Walmsey Stott who specialised in diseases of the chest, was HM Household, Munký; Roll, Vol. V., Some 402. Extra to physician see p. such as appointed Edward Farquhar Buzzard were physicians to the King George V following their departure from Harley Street. Buzzard was physician-in-ordinary to George V from 1932-6, Munk's Rov, Vol. IV, (London, 1906), p. 473. Others included Louis Knuthsen who had a special . interest in diseases of the skin. He was Physician- in- Ordinary to The Princess Royal from 1935 and from 1951 Extra Physician. no Was no, (London, 1987), p. 628.
99
Mary. 191Wilfred Trotter became Sargeant Surgeon to George VI, whilst Sir Morton Smart was his manipulative
surgeon.
SocialLife The social life of the group or their interests outside medicine was difficult to determine as obituaries seldom provided this information nor was it included in the Medical Directory. Autobiographies, biographies and archival material
in however, that suggest, common with Victorian
Harley Street medical practitioners society, many
entertained
When John Langdon Down moved from his rented consulting
genteel
at home. 192 rooms in
Welbeck Street to his newly leased premises in Harley Street, he and his family became involved in many social events in London and "they attended [and] Street Fitzroy Street". in Harley 193 social occasions George Harley was "a great diner-out, as well as a giver of diners",
helped him during have his the that gout plagued early which will not frequent Harley held In to evening parties, addition a regular adolescence.
Sunday morning breakfast at his home, and invited his medical neighbours Other included Quain. Sir Richard the guests renowned novelist as such Charles Dickens, the celebrated artist George Cruickshank, the Punch Cartoonist John Leech, the naturalist
Frank Buckland and Lord Lyon
191The Medical IMoýv Who, (London, 1925), p. 143. 192Examples include the ophthalmologist Walter Hamilton Jessop who invited distinguished members of the profession and in particular, ophthalmologists from around Europe to his house in Harley Street, which was once owned by Mr. Gladstone, see Anon, Walter Hamilton Jessop, LanceA Feb. 24,1917, p. 312. Others included the surgeon William Rose who was described as an "admirable dinner-giver, " and excellent host, Anon, Villiam Rose', Lancet June 11,1910, p. 1657. 193Ward, Eponymists in Medicine, P. 12 1. 100
Playfair, Vice-President of the Privy Council. 194These "cannibal breakfasts" contained
gastronomic
thousand-years-old
delicacies from
around
the globe such as one-
Chinese eggs, sea-slugs, rats,
mice, elephant
feet,
hedgehogs and Kangaroo tails. 195
Whilst a few medical practitioners had little time for activities that Guthrie Rankin "work to their as such whose profession, related were not Mervyn hobby" his and was
H. Gordon, whose "work was everything
to
hirn", many had wide-ranging interests and a number were members of London Gentlemen's clubs.196Forexample, Bryan Donkin, was "particularly fond of the Savile club". Several of the cohort, such as Walter Hamilton Hylton Jessop, collected pictures or rare books. Jessop invested in a number
been had Royal Academy. lithographs, the Whistler exhibited at which of Like
literature Jessop the music, enjoyed group, many of.
and country
horse lesser bird Fishing, to 197 extent riding and a and shooting pursuits. for the group, as was gardening activities outdoor popular were watching, and playing painting
hobbies, literature Of the cerebral music, more golf.
Enjoyment favoured. were
and
of foreign travel was also frequently
in the cohort's obituaries. mentioned The Image of the Harley Street Consultant During the Victorian and Edwardian period the sartorial appearance of the hallmark his how he himself of was a presented medical practitioner and 194Tweedie, Harley, pp. 218,309 and 335. 195Jbid, pp. 218-225. 196Anon, 'Guthrie Rankin', BMJ, Sept. 27,1919, p. 429 and Mervyn H. Gordon, BMJ, Aug. 8,1953, P. 343. 197Anon, 'Jessop',Lancet, p. 3 12. 101
success. By the middle of the nineteenth century, the new dress code for distinguished
medical practitioners
and consultants
consisted of trousers,
frock coat and waistcoat worn with a fob watch, which replaced the breeches and tailcoat
coat of the previous era. 198During
the first
decade of the
twentieth century, Harley Street's high noon, [could be regarded as] the golden age of consulting practice ... when white spats were the insignia of medical eminence where formerly it was the gold-knobbed cane with the concealed pomander of sweet-smelling herbs; when frock coats and silk hats were the 'livery of the laborious week'. 199
Illustrations
including the those in Harley Street of medical men,
from the mid-nineteenth century to the start of the Great War. In changed the 1840s, portraits were reflective as demonstrated by the illustrations of Sir James McGrigor (Plate 2.6) and Sir Charles Mansfield Clarke (Plate 2.7). 200 These were "representations
of medical men, phenotypically
and
physiognomically
rather as the profession might have wished itself to be
if pompous seen,
in its postures". 201 By 1914 cartoons,
such as those of Sir
William Jenner by Sir L. Ward (SpO, (Plate 2.8), were being published. 202 A couple of years before he arrived in Harley Street, Thomas Jeeves Horder (later Lord) was described as wearing, "a long frock-coat and curly
198Penelope J. Corfield, Power and the Professions in Bzitain: 1700-1850 (London, 1995), p. 140. 199Pound, Harley Street, p. 24. 2(* Sir James McGrigor, Mezzotint by W. Ward after J. Jackson, in R. Burgess, Portraits of Doctors &Scientists in the Wellcome Institute, 1973, no. 1845.1 and Sir Charles Mansfield Clarke, Mezzotint by T. Hodgetts, 1833, after S. Lane, 1832, in R. Burgess, Portraits of Doctors & Scientists in the Wellcome Institute, 19 73, no. 616.1. 201Roy Porter, Bodies Politic: Disease, Dea th an d Doctors in Biitain, 1650-1900, (London, 2001), p. 268. 202Sir William Jenner, Colour Lithograph by Sir L. Ward [Spy], 1973, in R. Burgess, Portrait.; ofDoctors & Scientists in the Wellcome Institute, 1973, no. 1529.4.
102
brimmed
'topper',
Remembering
which
the
dignity
of
his own career, David Ferrier,
his
position
a neurologist
imposed". 203 registered in
Cavendish Square reflected that in the 1890s, "which were supposed to be frivolous days which are now spoken of as the naughty nineties - all HPs
[house-physicians] wore frock-coats on their rounds, and so did the HSs [house-surgeons]". By the beginning of the twentieth century, resident staff duty, "always hospital, on wore, when a white washable coat generally of a
knee-length". 204 There were a few men such as the (non-Harley Tommy Annandale,
Stewart's
professor of clinical
Street) surgeon
surgery at the Royal
Edinburgh Infirmary, who clung to the "blood encrusted chocolate frock been 205 Ferrier had hitherto the norm. maintained that the coae', which crisp and clinical
introduced white coat was
after the Boer War. 206 The
Harley Street ophthalmologist George Lawson, surgeon to the Middlesex Hospital for 33 years from 1856, was one of the first surgeons to replace the blood stained frock coat with a washable overall, though according to his
little "not the this a subject of was novelty obituarist
bantee'.
207
It was not
late hansom from 1890's the the the cab and the replaced motorcar until hat by War, Harley Great that the top the worn professional silk onset of Street consultants became outmoded.
203Anon, Lord Horder of Ashford', BMJ, Aug 27,1955, p. 565. 204Phillis Cunnington & Catherine Lucas, Occupational Costumein England, From the Eleventh Century to 1914, (I-A)ndon,1967),p. 309. 205 [hid. 206The first Boer War occurred in 1880-1881but the main war lasted from October 1899 to May 1901. Quote from Anon, John Charlton Briscoe', Lancet, Mar. 5,1960, p.554. 207Anon, 'GeorgeLawson', BMJ, Oct. 17,1903, p. 1019.
103
The Harley Street urologist, Cyril Arthur
Rankin Nitch, was typical
in his for in the the the considering correct generation attire of consultant
be to a morning coat and striped trousers. 208 Reginald Pound wards discussed the "vanity" in Harley Street during the Edwardian period, when
be found in "white their attending could patients medical practitioners [and] buttonholeS". Hunter 209 Finlay carnation spats, astrakhan collars, Tod, senior aural
surgeon at the London
Hospital,
took his sartorial
described He "certainly as smartly attired was and was elegance seriously.
best dressed being 'London' the the man on considered staff. 210 pleased at Dr. Nathaniel Edward Yorke-Davies, an expert on dietetics, arrived in Harley Street in 1895. As with a small number of his fellow consultants, his patients came from all sections of society, from Royalty downwards. His slightly
unorthodox
approach to treatment
included
champagne for the
he image Plate In 2.9, the the the wears uniform on of consumptive. consultant:
the frock coat, the striped trousers, the waistcoat,
the wing
he has left behind his Though 211 this top on occasion silk spats. collar and
hat and instrument case. Sir George Lenthal Cheatle surgeon at King's College Hospital, who "Victorian described the epitome of sartorial perfection", appeared as as was
"one of the last survivors of the age of elegance": he was "always
208Anon, 'Cyril Arthur Rankin Nitch, Lancet; Sep. 27,1969, p. 702. 209Pound, Harley Street, p. 3 1. 210Anon, 'Hunter Finlay Tod, Lancet; Feb. 3,1923, p. 257. 211Spy, 'Men of the Day, No. 788, Dr. Nathaniel Edward Yorke-Davies', Vanity Fair, April, 12 1900, (London, 1900). ,
104
immaculately
dressed with top hat and morning coat". 212Even by the 1950s,
he did not use the private car, which was the then common mode of transport for the Harley Street medical practitioner. Instead, he hired a 1920s cab. Cheatle remarked that he was "maintaining Streee'.
the dignity of Harley
213 Moreover,
he carried this eleganceeven into the designing of the white coats he wore at outpatients and during his ward visits. He smoked cigarettes continually, device long holder for ridding itself of the a mechanical using a with unexpended portion of the cigarette.214
Few Harley Street medical men ignored the custom to dress smartly. The laryngologist
Charles Parker "refused to conform in such matters as
dress with the conventionalities of the age and scorned any effort to pose as the successful consultant". Although he remained in Harley Street for ten his indifference from 1901 1911, to as a consequence of perhaps years
to
dress codes, "his practice was never large". 215
Conclusion Throughout
the eighteenth
century, London medical practitioners
set up
London Holborn. By City, East in the end of the century, the and practise Mayfair
fashionable for becoming popular area a more and physicians was
By 1845, neighbouring and surgeons. surrounding
it, were increasingly
Cavendish Square and the streets
prestigious
areas in which to live and
in West End district few this that the of a matter cachet a of work; such was decades medical practitioners began to spill over into Harley Street.
212Anon, 'Sir Lenthal Cheatle', BMJ, Jan 13.195 1, p. 95. 213[bid
214Anon, 'George LenthalCheatle', Lancet, Jan. 13,1951, p. 116. 215Anon, 'Charles Parker, Lancet Feb. 5,1938, P. 351.
105
Eventually, medical
Harley Street began to be regarded as the holy grail of the
world,
attracting
finest the some of
medical
practitioners
in
Victorian London who aspired to live a life ensconced into the highest echelons of society. The next four chapters analyse all of the practicing medical men and Street between by in Harley 1845 1914 and using a women who arrived prosopographical
methodological framework;
by a very extensive use of primary
these results are interwoven
published and unpublished
historically and provide a more complete
than has hitherto been offered.
106
sources to
sensitive analysis of Harley Street
restricted access
CHAPTER 3
Medical Education The medical education of the Harley Street group was coterminous with the
restructuring of nineteenth century medical education, which resulted in the Apothecaries Act of 1815, the 1858 Medical Act and the 1886 Medical Amendment Act. The consequences of these Acts for the Harley Street cohort was reflected in the increasing accumulation of their medical qualifications
from the 1860s onwards. As the history of medical education
and the various routes to qualification from the mid-nineteenth to the early twentieth centuries has received considerable attention from historians, it in be discussed in depth this thesis. ' will not This chapter analyses the academic calibre of the Harley Street cohort by evaluating extent
the level of their qualifications
to which the group's education
and determining
was homogeneous. Indicators
the of
educational pre-eminence such as scholarships, medals and prizes awarded to the cohort during
their undergraduate
The relationship examined.
and post-graduate
years were
between the cohort's professional achievements
background was also assessed. A comparative and educational
analysis of
Harley Street with the Harley Street Area and with Greater London was determine if from Harley Street had, indeed, been those to undertaken
For a comprehensivestudy of medicaleducationand the passingof the 1858MedicalAct, The (London, Medical Rivington, Profession, Walter 1888),CharlesNewman,The see Evoiution ofmedical Educationin the Nineteenth Century,(Oxford,1957),M. Jeanne Peterson,TheMedicalProfession,(London,1978)and ThomasNeville Bonner,Becoming,a Pbysician:Medical Educationin Great Bdtain, France,Germanrand the U552ited States, 1750-1945,(Oxford,1995). ill
(MD higher level degree MS) fellowship the top a of and or awarded ranking Colleges Royal the or both. of
Some historians have argued that the division in the medical between the general practitioner profession
and the consultant
elite was
development Dorothy 19th throughout the the to of medicine century. pivotal Watkins found, for example, that these divisions were "represented through the level, type and place of qualification". 2 Before an analysis of the Harley Street group's medical qualifications
is presented, the methods by which one
in medicine in Victorian
and Edwardian
Britain
in nineteenth anyone could practice medicine
century
could qualify
will
be
discussed. The Medical Acts of 1858 and 1886 Although
practitioners
had to hold a registrable
qualification
Britain,
in medicine or surgery
licensing bodies British be included in by 22 to the the one of awarded Medical Register. Under the 1858 "Act to Regulate the Qualifications of Practitioners
in Medicine and Surgery", medical practitioners
qualification
from an approved licensing body were eligible to have their
with a single
Amendment Register. 3 The Medical Act in 1886 listed the redefined names the minimum registerable qualification as a diploma or degree in medicine, from in the a medical corporation university or midwifery and surgery
2 Dorothy E. Watkins, 'The English Revolution in Social Medicine: 1889-1911',(London University: Ph D Thesis, 1984), p. 58. Watkins quotes Ivan Waddington "General Practitioners and Consultants in Early 19thCentury England; The Sociologyof an IntraProfessional Conflict" in Woodward and Richards, (ed) Health Cam and Popular Medicine in 19thCentury England, (London, 1977) and Frank Honigsbaum, Diýision in Ezitish Medicine, (New York, 1979). 3 Rivington, Medical Profession, pp. 94-98.
112
United
Kingdom
qualifications.
recognised by the GMC, as being able to grant
As a concession, those who were permitted
to register
such before
1886 on the basis of a single qualification were still admitted to the register by degrees foreign obtained examination and
prior to 25th June 1886 were
before June Thus, 1887 who medical practitioners registered acceptable. practised according to their qualification whilst those who registered after this date were eligible to practice medicine, surgery and midwifery. 4
The basic qualification needed to practise medicine changed across the nineteenth
(1815-1858) from LSA to either the LSA or the century, (1858-1886). In 1884, the RCS and the
MRCS or another single qualification
RCP introduced examinations
the
conjoint
diploma
MRCS/LRCP
and
the
first
were held in January 1885. Thereafter, this diploma became
the standard qualification
for general practice in England. Thus, from 1886,
LRCP MRCS LSA MRCS 5 or and and were popular. as such combinations There were three routes to pursuing through the conferment of a university
medical qualifications:
degree; second, by examination
first, of a
double in by a qualification medicine and surgery or single qualification, in from 1886, triple medicine, surgery and midwifery qualification a and from the conjoint board of the Royal Colleges of Physicians and Surgeons in
England, Scotland and Ireland. The third route was by a licence from the Society of Apothecaries in England or from the Apothecaries' Hall Dublin in Ireland. By the beginning of the First World War there were 22 Medical 4 W. Oliver Hodges, 'Abstract of the Principle Laws Affecting the Medical Profession' Medical Directoz7, Vol. 1914, pp. 10-11. 5 For an analysis of this change seeWatkins, 'English Revolution in Social Medicine', pp. 56-57.
113
Schools in England and Wales offering medical courses in preparation
for
the above examinations, 12 of which were in London. Though not all instruction provided
in the full medical course of preliminary,
intermediate
final 6 clinical exams. or and The basic university medical degree was an MB (physic) or the BS or BCh. (surgery). The higher qualification for physicians was the MD and for ChM MS. The however, it the or standard, was not uniform: was surgeons for University, St. Andrews 1897 example, automatically awarded the until MD to medical practitioners until
(and it was not 40 who were over years of age
1907 that the first postgraduate qualified MD by thesis). 7 Similarly,
the MD could be bought from Aberdeen University upon the basis of written testimonials
in The 8 MS in Scotland years practice. could be and several
Scottish degree holding by those medical and on the payment of a a acquired fee. 9 There was no MB course at St Andrews until 1859, whereas the Royal University
of Ireland medical students proceeded straight to the MD.
The second route to acquiring
a registerable
qualification
was by a
licence in medicine or surgery or in both, awarded by the medical and Corporations. surgical
The Royal Colleges of Physicians and Surgeons in
England, Edinburgh, Ireland and the Faculty of Physicians of Glasgow Fellow. Fellows Royal higher the the of member and qualification of offered
6 Sir GeorgeNewman, SomeNotes on Medical Education in England, A Memorandum Addressed to the President of the Board, (London, 1918),pp. 1 and 5. 7 John S.G. Blair, History ofMedicihe in the University of St Andt-ews, (Edinburgh, 1987), pp. 155 and 171. 8 R. S. Downie and Bruce Charlton, eds., The Making of a Doctor, Medfcal Education in Theory and Practice, (Oxford, 1992),p. 11. 9 Rivington, Medical Pmfession, pp. 259-261.
114
Colleges were regarded as the elite, as they were an integral
part of the
governing body of the Colleges and had a right to vote in the elections for
the members of the Council. Fellowships were usually awarded by examination at the RCSs and by election at the RCPs.10From the time of their
foundation,
the
Colleges
were
almost
exclusively
examining
fraternities rather than teaching bodies." The third examining body was the Society of Apothecaries in England
Hall Dublin. By Apothecaries' the provisions of the Apothecaries Act the or 1815, apprentices
who had served five years and who then passed the
Licence: LSA. In the 1861, the society granted a were examination society's
introduced a compulsory examination in mathematics and the classics following recommendations by the GMC. 12A proposal to establish a conjoint board with the Royal Colleges in 1871 failed, due to the restriction
imposed
Act. Once Royal by Colleges 1815 the the the society proceeded to on establish
their
marginalized.
own conjoint
board,
the
To satisfy the requirements
Society of Apothecaries of the 1886 Amendment
was
Act the
Society applied to hold examinations in surgery, in addition to the existing
in medicine and midwifery. examinations The Society also learned that it would not be entitled to a position on the reformed GMC following the 1886 Act. As Penelope Hunting has shown
10The laws relating to the fellowshipof the RCSin Ireland werechangedin the 1880s. Fellowshad beenelectedby ballot, hereafterentry wasby examination.The FPSGlasgow by ballot by For details the two rest examination. of thesesee, candidates were admitted Rivington, MedicalProfession,pp. 238-252and 563,569. " Downieand Charlton,Makingofa Doctor,p. 11. Hunting, A History of the SocietyofApothecafies,(London,1998),pp. 206-207. 12Penelope
115
the Society struggled in the 1880s to preserve its position as an independent licensing body. It was only due to the appointment of examiners in surgery, a petition by the licentiates and the "forceful representation" Street
Society's the surgeon and representative
by the Harley
GMC, Robert the on
Brudenell Carter, that the Society maintained its position on the GMC and its application to hold examinations in surgery was successful. 13
Qualifications of the Harley Street Group An analysis of the Harley Street cohort was undertaken proportion
to establish the
degree licence awarded a or a who were and to determine the
level of their qualification
from the respective awarding body. The results
Only Appendix C. degrees have in Table been 3.1, earned are shown included in this Table. Though honorary degrees do not form part of the prosopography,
they are discussed later in this chapter, as they were an
important indicator of esteem within the profession. The data used in Table, 3.1, Appendix C, were taken from the Medical
Directory and crosscheckedwith information from the Medical Register and All 657 male medical practitioners who were obituaries. as sources such between Street included in in Harley 1845 1914 the and were registered in Street during The the the of cohort who arrived qualifications analysis. the period were examined together with those who earned their degrees during their years of practice there, which for some, extended beyond 1914.
13Hunting, Apotbecalies, pp. 214 - 227. See also, Anon, 'Robert Brudenell Cart&, Lancet, Nov. 2,1918, p.607.
116
Table 3.2, Appendix
C provides complete details
of medical and other
degrees held by the entire cohort.
Examinations for degrees such as the MB and MD became increasingly important
in the Victorian
"magic The letters" MD were an especially era.
indicator for British the status of professional significant
public who,
Rivington, "happily Walter ignorant to were according of the varying standards of universities
and traffic in university
degrees". 14 Findings from
the data that formed the basis of Table 3.2, Appendix C, indicated that (43.99 Harley Street half, 289 per cent) of practitioners almost
had one MD
James had MDs McGrigor had two three. 15 and whilst eight The proportion
of the cohort
whose highest
medical
MB/BMs totalled 25.72 per cent (n = 169), whilst Arthur two MBs (from the universities majority,
or almost
three
of Liverpool
quarters
Edward Giles had
and London).
of the Harley
degree was
Street
Hence, the practitioners
(69.71%, n= 458) were qualified MB or MD. It was further established that
the majority of Harley Street MI)s and MBs were earned at London University,
Scottish Universities the with
1881, the University
being the second most popular. In
of Glasgow, and soon after the Universities
of
Edinburgh and Aberdeen, made it compulsory for medical students to take MB MS the the together the with as primary up
qualifying
exam. 16 The
Street Harley did MS the group who qualified so after this majority of requirement
was introduced: 78 per cent of those who qualified MS
24Rivington, Medical I'mfession, p. 255. is Mc Grigor qualified MD from the Universities of London, Edinburgh and Aberdeen. Ja me s Coutts, A History of the University of Glasgo w, (Gla sgow, 190 9), pp. 573- 574. 141
117
Edinburgh
and 90 per cent of those who earned their MS from Glasgow
from from in Street in Results Harley 1895 1914. the the to period arrived
data base revealed that the acquisition of degrees relative to the number of medical practitioners
in Harley Street increased during the period 1845-
1914, which follows the increasing
of tertiary
popularity
education
for
in medical students the nineteenth century. In his advice to young medical practitioners
wishing to establish a
Styrap in late Jukes De 1880s, the the physician advised private practice
them to be conversant with general literature conversational
infrequently powers not
and added that, "good
impression produce a greater
of
facto by is de in the than possessed conversationalist professional ability In '. 17 question!
discussing
the
optimum
Clifford Allbutt, in Thomas 1905, profession
education
for
the
medical
who advocated a university
arts degree, remarked that: it is freely said of the abler men in our laboratories that those who enter them with minds already expanded on other kinds of study, such as language and literature, bring to the sphere of scientific studies a riper from larger immediate draw them powers and a richer and understanding, later life. for 18 endowment
Despite his support for this course of study, he argued that the attraction
of
in its lay its degree too than often marketability rather mental a university cultivation-" Few medical practitioners, apart from the 61ite, took Arts degrees.20 The majority of male medical practitioners
in the Victorian
period bypassed
17Jukes De Styrap, The Young Practitioner, (Ijondon, 1889), p. 21. Is Thomas Clifford Allbutt, On Riviessional Education with Special Reference to Medicine, (London, 1906), p. 37. 19Allbutt, Education, p. 38-46.
118
a liberal
education and attended medical school straight
after their
(21.46%, Just fifth Harley Street the secondary education. over a of n cohort
= 141), however, had a liberal education, as indicated by the 95 practitioners held held MA BA. This 46 the who a an and who was the typical educational Almost fifth for a a physician. of the cohort chose this route and were route later elected FRCP. For some universities such as London, Durham, Oxford, Cambridge and Trinity
College, Dublin, a batchelor of arts degree was a prerequisite for
Science Natural From Tripos Cambridge, 21 1860 the at study. which medical included the study of Chemistry, Physics and Biology, led to an Arts degree. Whilst the first set of tables in this chapter indicated the highest degree in Harley by those obtained
Street, Table 3.3
Appendix,
C provides a
breakdown of licences and the levels of these licences obtained from the Royal Colleges and the Societies of Apothecaries. Table 3.3 Appendix C, shows that over half (51.14 per cent, n= 336) of all medical practitioners
in Harley Street between who were registered
1845 and 1914 held the 61ite licences of fellowship of the Royal Colleges of Physicians or Surgeons of England, Scotland or Ireland during their time in (n 14.76 220f Street. these the per cent = 97) were FRCPs only, and an men, FRCP FRCS individuals held 17 two and were men whilst, six additional FRCPs; from London and either Ireland or Scotland. Of the surgeons in
20Peterson,Medical PrOfessiOn, p. 58.
21Charles Bell Keetley, edited by the author and Robert Wharry, The Students and Juniar Guide to the Medical Profession, 2ndedition (London, 1885), pp. 19,52 and 59. 22Hence, 340 individuals held 365 Fellowships.
119
Harley Street, 36.38% per cent (n = 239) were FRCSs only, a further both FRCP and FRCS, whilst two individuals,
Henry MacNaughton
17 had Jones
and Inglis Taylor held the FRCS from Edinburgh and London. Most of the (79.60%, fellows 532) cohort n= were or members of the RCP or RCS. After the 1886 Amendment
Act the majority
of general practitioners
in Britain
held the combined MRCS/LRCP as their highest qualification, whilst only a minority
(7.31%, n= 48) of Harley Street men did so.
Of the 20.85 per cent (n = 137) who held the LSA, almost all of them had additional
medical qualifications.
Five qualified LSA only, two of these
Charles Oswin Park Pittar Lattey, gained their LSA in 1824 and and men, 1840 respectively,
before the development
medicine from the middle of the nineteenth the Licence in Midwifery
of the professionalisation
of
century. 23 Of the 57 who held
(LM), they also held other medical qualifications,
from LRCP LRCS the RCP or RCS in Scotland or Ireland. the or such as Although qualification
the
1886 Medical
Amendment
Act
had
compulsory, most of those who qualified
made
the
triple
LM (n = 37) did so
before this requirement was introduced. A. M. Cooke noted that FRCPs constituted a very small section of the few as as one per cent were listed in the Medical medical profession:
Register in 1851 and this remained unchanged for nearly a century. 24He
23For a discussion of various models of professionalisation seeJ. B. Morrell, 'Professionalisation'in, R. C. 01by, G. N. Cantor, J. R. R. Christie and M. J. S. Hodge, eds., Companion to the History OfModern Science,(IA)ndon, 1996), pp. 980-989 and Paul K Underhill, 'Science,Professionalism and the Development of Medical Education in England: An Historical Sociology',(PhD, University of Edinburgh, 1987),passim. History of the Rct7a]College WP12. 24A. M. Cooke in Y71o VSiciansof London, Vol. 111, (Oxford, 1972), pp. 803-804.
120
further remarked that whilst the fellows wielded considerable power within the medical profession, the majority of the educated public would have been letters FRCP; whereas Fellows of the Royal Society or the unfamiliar with Royal physicians or surgeons would have been, for example, better known to
the educated classeS.25 While all FRCPs held a university degree, over a third (37.50%, n= 96) of the 256 Harley Street practitioners
(including FRCS the who qualified
17 who had both FRCP and FRCS) did not have a degree.26MoStwere FRCS (England)
and four
were
FRCS
(Edinburgh),
whilst
one was FRCS
(Ireland). 27 Henry Hancock, for example, who had received his medical joined Hospital Westminster Charing Cross the and staff at education at Hospital university
in 1839, gained the FRCS in 1843 without
having
acquired a
degree. Candidates were eligible for the FRCS after six years of
had be three to of which at a recognised London hospital. study, professional For those who held an Arts
degree, however, the period of study was
by one year. reduced
Qualifications: Harley Street, the Harley Street Area and Greater London in 1845. Charles Singer and S.W. F. Holloway analysed all medical practitioners
in
ýust Directory Medical 1856 the prior to the 1858 Medical Act). They
25Cooke,RQ p. 804. In 1835, the Royal College of Physicians removed the restriction of Oxbridge FRCP to the graduates only. awarding 26Until 1835, Fellows of the RCP were obliged to hold a degreefrom an English university. 27An analysis of those who held the FRCS without a university education showed that there was no preponderance in any one year or decade;the individuals were spread throughout the period.
121
classified practitioners
into eight categories and their analysis showed that
54.6 per cent qualified LSA/MRCS, 18.5 per cent were MRCS only, whilst 11.8 per cent were LSA only. 28 Singer and Holloway's study further showed MD, MB, FRCP, LRCP or Extra-LRCP.
that only 3.9 per cent qualified
Before 1815,3.4 per cent had been in practice and the balance, 7.8 per cent held foreign, Scottish or Irish diplomas.29 Digby found in her study of general practitioners
in the period 1847-1856 that her proportions
were
Holloway's: Singer her data 75 per cent of to to and according comparable
GPs had qualified LSA or MRCS or both and an additional 13 per cent qualified
MB or MD. 30 In the first
part of the nineteenth
century
few
from become those to apart practitioners wishing aspiring medical pure 31 univerSity. physicians, attended The findings in Tables 3.4 and 3.5, Appendix C, for Harley Street, the Harley Street Area and Greater London show that in 1845 (as also shown in a similar
study
MRCS/LSA practitioners qualifications
by Dorothy
Watkins),
were the standard in
London. 32 In
the MRCS,
qualifications contrast,
LSA, or combined
for the majority the
most
of medical
commonly
held
in Harley Street were Fellowship of the RCS or the RCP (50
(25 The Harley Street Area had MD per cent). comparable per cent) or
28Charles Singer and S.W.F. Holloway, 'Early Medical Education in England in Relation to the Pre-History of London University, Me&cal History, Vol. 4,1960, p. 4. 29Ibid.
30Anne Digby, The Evolution of Bzitish General Practice, 1850-1948,(Oxford, 1999), p. 5 1, the graphs on pages 52 and 218 for GPs with MI)s did not correspond with the text on page 51, therefore the figures in the text were taken as valid for the purpose of comparatives in this thesis. 31The Universities of the Nineteenth Century, Birth ofModern Bdtain Series, Michael Sanderson, (ed.), (London, 1975), p. 80. 32Watkins, 7he English Revolution in Social Medicine, p. 57.
122
results, the majority
being Fellows (63.16 per cent) and almost a quarter,
(21.05 per cent) qualified MD.
Rivington found that the majority of medical practitioners in London from Scottish the to mid-1880s graduated universities. up
London was less
popular, as in 1880 only 20 per cent of medical students in London were
for University London's MB degree. Scottish The 33 the of system registered by Edinburgh typified of medical education,
University,
offered a broader
curriculum
than at Oxbridge to satisfy the requirements
for its RCP the of
Licentiate.
The syllabus included
geared towards
surgery and midwifery
and was thus
general practice. 34 However, from the time of the 1858
Medical Act, the prominence of the Scottish universities began to decline, as there was "a hierarchy
institutions the among of respect
in and particular, medical education ...
responsible for
the major Scottish universities
were
failing to provide the highest standards of examination for prospective 35 the to profesSion". entrants Whilst over 77 per cent of the Greater London practitioners
held an
MRCS, LSA or a combination of these as their highest qualification, only 25 Street held Harley The these the cohort qualifications. of majority, per cent that is, 75 per cent of those in Harley Street and 84 per cent in the Harley
Street Area, held the elite licences of FRCP or FRCS or the MD. 33Stella V. F. Butler, 'Scienceand the Education of Doctors in the Nineteenth Century, Ph. D, University of Manchester, December 1981, p. 194. 34Underhill, 'Science,Professionalism', pp. 94-95. 35James Bradley, Anne Crowther and Marguerite Dupree, 'Mobility and Selection in Scottish University Medical Education, 1858-1886,Medical History, Vol. 40,1996, p. 1. These authors argued that Scottish universities were not selective in the medical students they accepted to their coursesand Scottish university exams were less rigorous than in English universities.
123
Qualifications Obtained by the 1880 Group As the number of medical practitioners
registered in Harley Street, the
Harley Street Area and Greater London was so small in 1845, it was necessary to explore whether the cohort in Harley Street continued to obtain
the highest level of qualification in later years. Thus, the middle of the period, the year 1880, was examined. The results from the analysis in Tables 3.6 and 3.7, Appendix
C,
(29.82 that third almost a per cent) of the Harley Street group held showed the FRCP. This represented 5.57 per cent of the total number of fellows (n = 305) at the Royal College of Physicians for the year 1880. -36Almost the same
(29.16 in FRCPs Harley Street Area as the per cent) practiced of percentage those who were in Harley Street, whilst only a small proportion
(1.52 per
in Greater London the cent) of medical practitioners were elected FRCP. Therefore, there were nearly 20 times as many FRCPs in Harley Street and
the Harley Street Area than there were in Greater London. In total, more than half (56.14 per cent) of those registered in Harley Street in 1880 held
the elite licences of FRCP or FRCS compared with a similar number for the Harley Street Area (51.67 per cent), but more than four times the (13.71 Greater London per cent). percentage of The findings also show that over half of the medical practitioners in Harley Street in 1880 had qualified MD (54.39 per cent) in contrast to the Harley Street Area, which had just over a third (38 per cent) and in Greater London less than a quarter
(22.84 per cent) qualified
36 Cooke, J?CP, p. 1131.
124
MD. Rivingtoes
(32.2 Medical for Directory 1884 the third that showed almost a analysis of
in included London, have which would per cent) of medical practitioners Harley Street, had qualified as an MB or MD. 37Thus, if the proportion were for Harley Street had 1880 1884 the then as over twice the same roughly
Greater London. than graduates of medical number A breakdown of the universities awarding the MD to the Harley Street cohort is provided in Table 3.7 Appendix
C. This analysis of MDs
from the sample in 1880 demonstrates that of those who earned an MD, (42.42 from University half the were per cent) almost
of London -
more
than any other single university, and the same number qualified MD from London as did from the Scottish universities combined. Scottish Universities (29.17% Street Area for Harley the the of those who most popular were qualified
MD).
Of the Greater
London
medical
practitioners,
the majority
(53.06%) earned their MD at a Scottish University and only a few qualified from London (12.24% of those who qualified MD).
Although London was the centre of medical education in the middle of the nineteenth century, it was not until 1834 that UCH was founded and (established London University in 1828) became later the that two years of an examining
body for University
Colleges. King's 38 The established and
St. Bartholomew's in that as resisted any such change schools medical
37Rivington, Medical Profession, p. 261. 38Singer and Holloway, 'Medical Education', p. 1 and F.G. Brooks, 'The University of London', PhD, University of London, 1958), p.22, quoted in. Butler, "Science and the Education', p. 40.
125
direction fearing potential loss of income. 39Students, therefore, were forced to obtain
a recognised qualification,
usually
LSA/MRCS.
In 1839, the
University of London awarded its first medical degrees.40 Various commentators have acknowledged the exacting standards of the University of London medical degree and the high number of failures relative to other British universitieS. 41Writing in the mid 1880s, Charles Bell Keetley argued that the University
of London's prestige was due to its
Rivington observed that for the "difficult and searching examinationS11.42 5,219 men in England holding an MB or MD in 1884, only 622 graduated
from the University of London.43 In 1880, no medical practitioner
in Harley Street or the Harley Street
Area held only the most basic medical qualifications
of the LSA or LM,
(n Greater London 12) 6.09 = of cent medical practitioners per whereas The vast majority of medical practitioners practitioners
did.
in Greater London were general
MRCS/LSA MRCS/ILRCP. 44 or qualified either
39Bonner, Becoming a Physician, P. 144. 40Cooke, RCP, p. 931
41Bradley,'MohilitA p. 21. 42Keetley,MedicalProfession,p.18. 43Rivington, MedicalProfession,pp. 262-263. 44Singerand Holloway,'MedicalEducation,p. 4 and p. 12.,statedthat generalpractitioner by familiar however, 1860s; term the becoming they arguedthat the practicebegan was Apothecaries Act LSAs following 1815, the to practicemedicine permitted which earlier, Hunting, in Apothecaries, for fh. 196-197 287 7., argued this service. pp. and p. charge and that the term was first usedby J. Bellersin An Essaytowardsthe ImprovementofEbysic (1714)and adoptedby R. M. Kerrison in An Inquir in to th e Present State of the Medical .v (1814). Hunting contendedthat from the 1830sthe term was Professionin England holding to the LSA and MRCS. a person mean understood 126
Qualifications Obtained by the 1914 Group As the number of combinations of qualifications was so extensive for 1914, has in been included Table 3.8, different the total 191 categories, containing Appendix C. The university degree of MD was tabulated in Table 3.9 Appendix C. Thirty-one (11.15 per cent) of the medical practitioners in Harley Street in 1914 were FRCP, which represented almost 9 per cent (8,80 per cent) of the 352 fellows of the Royal College of Physicians of further and a
London
percentage
two individuals
were FFPS.45 Although
the
from declined had 1880 1914, FRCPs to the proportion of
of
physicians
in Harley Street, nevertheless, accounted for almost double the
proportion
in the Royal College of Physicians in 1914 than they had in 1880.
Almost half (48-92 %, n= 138) of all the medical practitioners
registered in
Street in 1914 were Fellows of the Royal Colleges of Physicians or
Harley
The percentage
Surgeons. roughly
equivalent
considerably
in Harley Fellows of
to Harley
Street Area had been
Street in 1880, but by 1914 had fallen
(n = 68). to 17.04 per cent
The number of Fellows in Greater London was dramatically
lower
(0.06, less than to Street Harley one per cent amounting n= group, the than it Great that to the is the difference confirms up onset of significant: 7). The 61ite for Street the medical practitioners preferred address War, Harley was in
hospitals teaching London routinely London.
required the higher
for MD MRCP FRCS, the FRCP, or positions of assistantof qualifications to the a stepping-stone which was one of assistant-surgeon, or physiCian ----------RCP, Cooke, from 1132. Fellows p. 45Total number of
127
(83.45%, honorary Over four fifths appointments. n= 232) of the prestigious 1914 Harley Street group satisfied this criteria, with 21.58 per cent (n = 60)
(but Fellows further MD Royal Colleges) the not of were and a who qualified 12.23 per cent (n = 34) were MRCP. Comparable figures for the Harley
Street Area were just over three fifths (63.16%, n= 252) satisfying the above (n (n MD MRCP. 182) 0.50 2) 45.61 = = cent qualified per and with criteria, How did these figures compare to the Greater London Area? Significantly fewer; just over a quarter (25.76%, n= 85) satisfied the requirement
for a
junior post at a London teaching hospital.
Student Prizes and Awards One of the criteria employed in determining the academic calibre of the the the of prizes, awards, exhibitions accumulation was cohort
or
during 46 their training. they that medical education received or scholarships Archives of the relevant universities,
hospitals and the Royal Colleges were
Few these these to prize winners. of universities examine consulted contained straightforward
lists of prizes and prize winners in medicine, with
Oxford UniversitieS. Cambridge 47 The most useful and the exception of handbooks the listing were calendars prizes or published university sources details bursaries the together with contained of typically annually, which hospital The archives revealed similar the prize winners.
details in
46Thesewere listed in the MedicalDirectory,however,the awardinginstitution was not investigation identified, of other sourceswas necessary. and always 47SeeJ. R. Tanner, (ed.) TheHistorical Registerof the UniversitYof Camhzidge,to 1910 (Cambridge,1917),thereafter HistozicalRegisterSupplements,publishedeveryten years Historical Register, Oxford 1220-1900. the, 1990 to and
128
(for in handbooks Bart's) example, or the prospectuses or calendars or (for in for St MaWs). books 48 the period example, minute Very little attention has been paid by historians to the role of prizes few listed to the medical students; given secondary sources awards and H. Willoughby by Mngýq Lyle's, Some the year. winners prize and prizes and Mng'ýý Men, was an exception, although it did not provide details of the Indeed, Jeanne Peterson few 49 the prize. was one of monetary value of each
historians who discussed the importance of prizes or scholarships in the field of medicine in general.50Nonetheless, accounts of the benefactors and is in Penelope Hunting's the system provided award an analysis of
recent
History of the Society of Apothecaiies, and Mark Weatherall's Gentlemen, Medicine Doctors: and
Scientists histories
Cambridge, at
1880-1940, and recent
St Mary's, for individual Bart's provide useful references and of
institutions.
51
for St Andrew's, University for the Calendars The example, were according to the of 48 keeper of manuscripts Dr Norman Reid, sporadic up to 1914 and of limited content before in for Bart's 1841. Handbook first The was published 1880. c. (London, Some Mngýg Men, MngýFand 1935) and see Rivington, Lyle, 49H. Willoughby Medical Plession, pp. 710-721 for the value of scholarships and prizes by medical school in 1885-1886. 50Peterson, Medical Profession, pp. 75-85. Rivington, Me&calProfession, pp. 534-723 little but importance. their the details offers prizes commentary cash on of of some provides Histories of Hospitals and Medical Collegessuch as W. R. Merrington, University College (London, History, School-7 1976) and V. C. Medvei and J. L. Medical its Hospitaland a (London, Bartholomew, Hospital 1874) contain scant, and in Royal Tbe ofSaint Thornton7s, to the of cash prizes and system scholarships. references no cases some "Gentlemen, Mark Weatherall, Scientists 253, 248ApotbeCafi&S, Hunting, pp. and 51 Doctors: Medicine at Cambridge, 1800-1940",History of the University of Cambridge, Texts (Cambridge, 2000), pp. 248-53. Keir Waddington, Medfcal Education at St 3, andStudies (Suffolk, 2003). E. A. Heaman, St MaiyýF, the Histary Hospital, 1123-1995, bolomewý; Bart, (IA)ndon, Hospital, 2003), pp. 43 and 63. Others include Willoughby Teaching London ofa Lyle, Kingý;, Appendix X, pp. 509-540.
129
By the end of the nineteenth century, Peterson argued, "competitions
had become a major part of student
life".
52
She also suggested that together
with the expansion of medical societies and the publication of medical textbooks and journals, the prize-system in medical colleges was a forum "for the exhibition of medical and scientific achievement".53 The prize increased their the their attention of medical staff gained who winners chances of a successful application
for a position within
the hospital
or
Lancet BMJ, hospital the Journals the and reports also such as college. the the the the award winners and of monetary value of names published "like the the of one's master, recommendation medical school and prize, institution's '. 54 the endorsement of new medical man! an as prize served The amount of possible prizes for medical students from 1845 to 1914 frequency, but the requirements was extensive,
and monetary value of the
body. By 55 to the the according awarding varied end of scholarships prizes or
between the medical schools to the competition the nineteenth century, attract
had intensified medical students
and the increased value of
At indication 56 Merton College, this. this time of scholarships, were an Oxford offered 18 scholarships, whilst Balliol awarded eight and Christ Church offered one.57 The teaching hospitals such as Bart's typically
52Peterson, Me&cal Profession, p. 83. 53]hid, p. 172.
U Ihid., pp. 83-84. 5, At Durham University, for example, the University medical scholarships of 225 p. a from 5 in Pears founded for 1898 was awarded 4 the tenable 1856 were scholarship, years, for Durham University 240 three tenable p. a. years with a value of triennially and Calendar, 1930-31,pp. 571-572. Profession, Medical Rivington, pp. 710-721. 56 57Rivington, Medical Profession, pp. 589-590 and 710-722.
130
(five (five in first 1914), the the at end of awarded prizes at entrance years in 1914), at the end of the second year (five in 1914, including
the Foster,
Harvey and Wix prizes) and at the end of the third and later years (11 in 1914, including
scholarships in medicine and surgery such as the
Brackenbury). The total value of prizes at Bart's amounted to approximately 1930 per annum by 1917.58 At
the London
Hospital
in
1899-1900, seven different
types of
from Price for the awarded, ranging were scholarship entrance scholarship
Buxton 1120 to the 230 scholarships, of worth a value and with science 220.59 In addition,
21 prizes were awarded to existing
students,
which
included prizes in practical anatomy of 14 and 26 and the triennial Hutchinson Prize of Y.35 for an essay on clinical surgery. Gold medals in (in basis first 1858, the on an awarded annual were surgery, and medicine Mackenzie). Morell There hospital, in was medicine were prize-winner Duckworth Nelson the scholarships; osteological and obstetric midwifery Ounior in from 210 Letherby to and senior) ranged the value prizes and E20.60
Charles Bell Keetley maintained that prizes and scholarships had an importance that exceededtheir intrinsic value. He argued in 1885 that, "a before led income has, Y. 5 to thousand now, an of a aworth medal gold
(London, HospitalReports, Vol. LIII, 1917 1918, Eartholomewlr 1920), Saint and 68Anon., by British details the the For 55-57. of scholarships and prizes awarded of value pp. Me&calllivfession, Rivington, 722. p. see medical schools 59The Royal London Hospital Archives, Prospectus 1899-1900, pp. 27-87. There was also a Price scholarship for physiology, value L60. 60The osteological scholarship founded in 1865 was discontinued in 1871. 131
Keetley's 61 year".
figure
was enough, therefore,
to satisfy
the
BMJs
least by 1700 1901 that at was essential to maintain calculation
a
life. Prizes be 62 of and scholarships way could also of significant gentlemanly Vincent Warren in for helped Low, themselves. to example, monetary value
defray the cost of his education by winning several exhibitions whilst at Cranleigh School, and in 1885, he was awarded the science entrance School. Medical The 63 St Mary's cost of medical education at scholarship from deter the medicine, and students provision of cash prizes some could individuals the of such career path changed
as Walter
Hamilton
HYlton
Jessop. Whilst Jessop was at Cheltenham College his father died and Jessop in Befford. After his the to school modern completing was subsequently sent
in Indian Civil Service. It he the a career on was only embarked schooling, Caius College, Cambridge Tancred in he 1871 the at scholarship won when College. funds 64 to the had he study medicine at that sufficient Entrance portion
scholarships
and other prizes could cover a significant
fees. Keetley the estimated the total cost of medical student's of
be in London 1600 1885, Peterson for to student whilst a education have been between; E533 in 2581 to the and cost average estimated
1884.65
Rivington! s calculation in the late 1880s, of between 2100 to Y.140 per be Although 66 four therefore, to the for appear would, average. years annum
61Keetley, Medical PwIession, p. 28. in General Digby, Practice, p. 41. 1,1901, 513-14 Vol. EMJ, Anon, pp. quoted 62 63Zachary Cope, The History of St. Marys Hospital and Medical School, or A Cen tury of Medical Education, (London, 1954), pp. 181-82. 64Anon., 'Walter Hamilton Hylton Jessop', Lance4 Feb. 24,1917, p. 310. 65Figures quoted in, Bradley, 'Mobilit. V, p. 19. See also Peterson, Med(calPmfession, p. 74 66Rivington, Medics] PmfessioA p. 694.
132
there was the additional cost of materials and books plus living expenses of approximately
1100 p. a. for four to five years to be considered. 67 Keetley
half Oxford University the that of cost of residence about at could calculated be covered by scholarships.68Other awarding bodies such as the Society of Apothecaries, offered both a medical scholarship and a surgical scholarship In being 69 for to two 1100 addition some prizes years. a good p. a. each of
important indicator funds, they also a very were of academic source of increasingly in professionalized market: an ability as the London hospital medical schools expanded the numbers of courses both in the ability to on efficiency relied practice and students available ... to teach. Students with these abilities were singled out in their careers by 70 in and prize examinations. scholarship success
In his 'Hints to Students', William Tennant Gairdner, physician to the Royal Infirmary
of Edinburgh, condemned the self-seeking attitudes
developing amongst students, whom he felt had a duty to perform to society,
devotion: be one of self-sacrifice and which should I have seen some of the very ablest of our students display, in the mere for the all evidences of a selfish and unscrupulous prizes, college struggle nature. 71
However, this ambition
perhaps, unsurprisingly,
led many of the
William Watson Cheyne have distinguished to as such prize winners
Cheyne Edinburgh University 72 studied medicine at and medical careers. 67, lbid.
68Keetley, Medical Profession, p. 58. 69Rivington, Medical Profession, P. 534. These were later made "redundant by the See Act". Hunting, Apothecazies, Medical 249. 1886 the p. of provisions 70Weatherall, 'Medicine at Cambridge', p. 113. 71William Tennant Gairdner, 'Hints to Students, on the Prosecution of their Studies: being Extracts from the Introductory Address at Surgeon!s Hall, Session 1856-7', Edinburgh medical Journal, Vol. III, No. 4, Oct. 1957, p. 351 72There are many examples of prizewinners who developedsuccessful or distinguished (gold Medal MD from included Peter Freyer RUI). the they urologist careers and
133
graduated MB and CM in 1878. During his residence at Edinburgh, he including twelve medals, gained chemistry.
three for anatomy, physiology and
Cheyne went on to develop a distinguished
in career surgical
(1880) he Jacksonian for his dissertation the won prize science: on antiseptic (1894), (1915) Hunterian FRS Orator surgery and was elected and President (1914-1917). Cheyne is best RCS 73 known for his bacteriological the of in he confirmed and promoted Lister's theory of antisepsis. which research In 1924, he was awarded the Lister Memorial Medal by the RCS in distinguished surgical science. recognition of The majority
of the prize winners also taught at the university
or
hospital in which they were awarded a prize. 74As a student, Arnold Lawson (later Sir) was awarded the senior entrance scholarship at the Middlesex Hospital in 1886 (worth Y.100) and the Broderip scholarship in medicine, (worth He 260). Hetley Clinical to the went on pathology win and surgery (worth he in 225), later surgery and gynaecology medicine, clinical and prize became senior surgeon to the Ophthalmic Department at the Middlesex Hospital. 75
Medical schoolswere aware of the attraction of these rewards for late St George's In 1880s, the 2857 provided success. per annum academic 73Anon, 'Sir William Watson Cheyne', BMJ, 30 Aug. 1932, pp. 821-22. 74Lyle, Mngýv, pp. 393-396 and 413-414. There are many examples of this at King's College (1889), Sir Raymond Payne Crawfurd, include Warneford junior they scholar and alone (1894) (1891) King's College London later became scholar at senior and who scholar (1930) King's Emeritus Lecturer Medicine in to Medical the and on physician consulting School. For additional King's prizewinners see above. Lo ndon, 75H. Campbell Thomson, The Story of the Middlesex HospitalMedicaiSchool 1935), p. 129. Other Middlesex prize-winners included Walter Knowsley Sibley and Joseph Strickland Goodall. Goodall was a senior entrance scholar later became Sub-Dean of the Hospital.
134
for scholarships and prizes (including, Y.380 p. a. for entrance scholarships) Bart's and
(including, f. 692 awarded per annum
2310 p. a. for entrance
between Increasing 76 in the competition scholarships). medical schools the forced half the them to maintain a prize nineteenth century of second Guy's Hospital, which refused to offer entrance scholarships and system. decrease in from 1847 1859, to the number of experienced a prizes When Treasurer, Mr. Turner, reversed the to study medicine. applications this policy in 1859 and introduced a meritocratic system, the effect was that, "Prizes and numerous successesin the examination for the MB of London have combined
to produce a very large entry
1890s, the
of first-year
G. M.
students". 77 From
Humphry
pressed
for
improvements in the medical education at Cambridge University.
He
the
1840s to the
surgeon
high by list to calibre of medical students attract sending a of endeavoured Although to the there were medical scholarships press. and available prizes for medical students, entrance scholarships no specific prizes instituted to them, were open science, which were Cambridge colleges at
for natural
in a number
of the
from the 1860S. 78
Nearly a third (n = 209) of Harley Street medical practitioners were (entrance those to scholarships scholarships and prizes, open awarded from Universities during degree their exhibitions or students), existing Royal Colleges during hospitals from To their training. or medical or course determine
whether
the Harley
Street cohort received more awards than
76Rivington, Medical I'miession, pp. 710 - 722. (London, Guyýg Cameron, Mr Hospital, Charles 1954), pp. 227-28. Hector 77 78For details see Weatherall, Medfeine at Camkidge, pp. 113- 15.
135
other medical practitioners in the Harley Street Area or Greater London, the samples in Table 3.10 Appendix C, were assessedfor the years 1845, 1880 and 1914. As has been mentioned previously, the style of the MecUcal Directary changed throughout medical
practitioners
the period covered by this thesis. Thus, none of the listed their examined
The findings
Directory.
showed that
graduate and undergraduate
prizes in the 1845 Medical earned during
awards
students's
years had become increasingly important
with
The the over period. winners results also demonstrated that in more prize Street practitioners
1914 Harley
were awarded more than ten times as in other parts of London.
many of these awards as medical practitioners
Thus, another criterion for the Harley Street group as an intellectual
elite
has been fulfilled.
Medical Training By 1914, there were eleven medical schools in London, in which a medical intermediate the final take preliminary, could and subjects.79Since student 1905, Westminster Hospital and later St. George's Hospital examined only the final examination and students took their preliminary and intermediate College. King's 80 In common with the majority at
examinations practitioners pursued
in Victorian
their
apprenticeship,
Edwardian and
medical training
Britain,
at a university
a method of medical training
of medical
the Harley Street group or a hospital.
Practical
whereby a student paid a
included the LSMW. soS. Squire Sprigge, Some Considerations OfMedical Education (Undon, 1910), p. 64. 79 rMiS
136
qualified
medical practitioner
to teach him became less popular from the
1850s and it was not a common method of medical training for the Harley Street cohort. 81 Digby noted the demise of the apprenticeship
system over
the course of the nineteenth century before it was finally abolished by the GMC in
1892.82
Table 3.11 Appendix C examines the place of training for the Harley Street group. By 1914, in addition to those in London there were nine in Scotland in in Ireland. the eight provinces, and eight medical schools Hospitals or universities with less than five students from the cohort have Appendix in C, Table 3.11 included been they as were too numerous. not The figures below are also not mutually cent, n=
(49.41 half exclusive; almost per
294) of those who recorded their place of medical training
Medical Directory
trained at more than one medical school or university.
Reginald Ernest Bickerton, for example, received his medical training London Hospital Frederick
in the
and the universities
Smith trained
of Berlin
London Hospital the at
Halle, Leipzig and Oxford. Ascertaining degree was problematical; cohort's
at the
and Vienna, whilst
John
and the Universities
the medical school awarding
as many medical practitioners
of the
listed
institution. In the not simply awarding attended addition, medical schools the years in which they attended the medical school were not returned to
the Directory.
81Digby, General Practice, p. 53. 82Jbid, pp. 43-44 and 47.
137
Almost four fifths of the cohort (79.69 per cent, n= 517) received their (36 large London hospitals teaching the received their at one of
training
training at more than one of these hospitals, so they were deducted from the total of 553). Beginning in 1861, attendance at medical schools began to be Of Director7did Medical 62 in the the medical practitioners who recorded School in Medical in Directory, details 33 include their the of were not Harley Street and listed in the Directory before 1861.83Thus, it is possible that the number who received their training at the metropolitan hospitals included some of those who did not return these details to the Directory. George Busk, for example, who arrived in Harley Street in 1856, received
his medical training at St Thomas's and St Bartholomew's, but he did not Medical DirectoryU details 1856 to the these return The results in Table 3.11 Appendix
C, show that Bart's and UCH
for Waddington the the schools of medical cohort. choice most popular were found
that
Bart's were
students highest
between
number
Rivington's
1788 and 1939, an increasing men, whilst
of registered
Rivington
medical
number
found that
students
in
the
of medical
Bart's late
had the 1880s.85
analysis of the number of students registered at medical schools
in London in 1885 and 1886 showed that Thomas's had the second highest intake followed by London, Guy's, UCH, King's St Mary's, Charing Cross,
83The medical training of 61 could not be ascertained. Half of those who did not provide Street before fairly Harley in 1860, the details rest were spread evenly arrived these through out the period 1860 to 1912 (1807-1886), found in Gordon Cook, "George Busk details FRS, Busk's George were 84 Nineteenth Century Polymath: Surgeon, Parasitologist, Zoologist and Palaeontologist', (May Vol. Blogzapby, 5,2, 1997),pp. 88-101. Journal ofMed1cal Rivington, Pmfession, Medical BaTO, 219-221 Waddington, pp. and pp. 677-678. 85
138
St. George's, Westminster and finally the Middlesex. 86 By the 1890s, however, whilst Bart's retained its position as the largest London medical highest intake Guy's had followed by St. Mary's. 87Tables the second school, 3.12 and 3.13 Appendix C, show the medical schools attended by medical practitioners
Street, in Harley Harley Street Area the who were and
Greater London in 1880 and 1914 respectively. Post-Graduate Study Most medical students in the Victorian period who went abroad for postgraduate qualifications,
attended the chief medical schools of Paris, Vienna
five Rutherford British William that Berlin. calculated medical students and in in Berlin during 1864, and six studied during the session winter studied the spring term at Vienna, whilst Paris had considerably more. Thus, in the Victorian the numbers who studied at continental schools era mid early-to Rutherford, to JOW. 88According who analysed the medical schools on were the continent in the late 1860s, the best surgical school was considered to be in Paris, which remained a popular choice for the Harley Street cohort until 1914.89 In the decade from 1864 to 1874,13 of the arrivals to Harley Street
in decade leading Paris, the 1914,18 to up whereas new arrivals at studied Appendix C, Table 3.11 that 10 there. showed almost per cent of studied Street before 1914, continued their education at in Harley those registered
86Rivington, Medical Profession, pp. 677-678. 87Heaman, St Mkryýg, p. 85 88William Rutherford, 'The Chief Medical Schools of the Continene, Edinhurgh Medical journal, Vol. XL July 1865 to June 1866, p. 342. 89kid
139
the University
(56 Paris the these of and majority of per cent) were
(28 (16 GPs balance Physicians the per cent) and was per cent). surgeons, Berlin also had a good reputation for surgical teaching and was deemed the best school to study pathology. The founder of modern Virchow Rudolf pathology,
(1821-1902), established the Institute
of
Pathology in Berlin in 1856, which became the model for nineteenth century in Vienna Germany. taught the that pathology and rest of medical schools His lectures were always "singularly
interesting
instructive, and
and
given on the Continent". 90 I Consequently, medical schools in these countries became renowned for their
form[ed]
the
best
course
on pathology
teaching of the subject. One of the cohort who studied pathology under Virchow was George Harley. 91 Following his graduation from Edinburgh University Edinburgh period at the Continent. victims
Royal Infirmary,
and a short
Harley spent five years studying on
He moved to Paris to study gun shot wounds among the
d'dtat Napoleonic the coup of
number of physiological
of 1851 and went on to work in a
and chemical laboratories
including
those of the
(1817-1884). Adolph WUrtz 92In 1853, he moved to Charles French chemist, Wfirtzburg to study histology under the Swiss Physiologist and histologist (1817-1905), Albert von Ixulliker and later moved to Virchow's laboratory to Tr-
his London in It to 1855, time well spent, as on return was study pathology.
90Rutherford, 'Medical Schools',p. 346 91Keetley, Medical Profession,p. 87 and Abraham Flexner, Medical Education, A Comparative Study, (New York, 1925),p.33. (ed. ) Alec. BMJ, Vol, IL Oct. Mrs Tweedie, Harley, 31,1896, 1354 'George Anon, and p. 92 GeorgeHarley FR. S or the Life ofa London Mysician, (Ijondon, 1899), pp. 34-120.
140
lecturer appointed was
Harley
of Practical
Physiology and Histology
at
College.
University
Like his father, Harley's son Vaughan also gained his post graduate abroad, working
experience
with
the pioneer of Tropical
Medicine,
Manson (1844-1922) and then spending four years studying
Patrick
Sir in
Leipzig, Turin, Vienna, Budapest and Christiania and working in Paris for Louis
Pasteur
graduate
(1822-1895).
The knowledge
acquired
during
his
post
led Victor Horsley invite Vaughan to set up the first to years
department of pathological chemistry in England in 1893.93
A number of the Harley Street cohort who had an interest in Gordon Holmes, in Germany. Following his MB studied as neurology, such College Dublin, Holmes pursued his studies first in Berlin and
from Trinity then
at
the
Senckenberg
Institute
at
Frankfurt-an-Main
where
he
the German the research under guidance neuroanatomical of undertook neurologist
founder of comparative and
neuro-anatomy
Ludwig
Edinger
(1855-1918). 94
From the 1880s, Vienna was often the first choice for those who wished
to study the diseases of the skin and gynaecology. It was an
increasingly
for Harley Street the preferred choice group up to 1904, (based
on arrivals
to 1914) thereafter
its popularity
waned slightly,
decreasing
(of in Vienna from 22 students who studied the arrivals) in 1895-1904 to 13 (of the arrivals) in 1914. In total 8.07 per cent of the cohort gained post93Anon, 'Vaughan Harley, BMJ, June 2,1923, p. 956. 94Davis Coakley, Ilish MBsters OfMedfcine, (Dublin, 1992),pp. 255-56.
141
University Vienna the of graduate experience at and the majority of these later became surgeons. Rutherford argued that before the middle of the nineteenth
century medical students wishing to study a speciality such as
diseases of the eye were better served by the continental medical schools.95 A number of post-graduate schools were established in Britain by the The West London Hospital first the the century. nineteenth was end of general
hospital
beginning
in London
of the
twentieth
to offer post-graduate century,
newly
teaching. 96 By the
established
post-graduate
Colleges included the North East London Post-graduate College established in
1902, largely
through
the
efforts
of the
Arthur Leslie, Murray Robert practitioners William
Harley
Street
medical
John Whiting and Herbert
Carson. This soon became very popular, being recognised by the
Navy and the India Office as a suitable place for further education. 97
Towards the end of the nineteenth century, the acquisition of postgraduate increasingly
diplomas in specialist areas such as public health became important
for the cohort. Diplomas
in special branches of
in Diploma State in Medicine, Trinity the began 1870 with medicine College, Dublin, followed by Cambridge University's Diploma in Public Health (DPH) in 1875. Fifteen of the cohort obtained a DPH, beginning in 1879 with Cuthbert Chapman Gibbes, who in common with 12 of the cohort Cambridge. from One Oxford DPH, diploma his obtained an whilst gained UCL. from two were 95Rutherford,'MedicalSchools',p. 347 96Digby, GeneralPractice,p. 61. 97Anon, 'Herbert William CarsoW,Lancet,Sept.6,1930, p. 556.
142
Postgraduate Prizes The range
of postgraduate
prizes
was extensive:
the RoYal Colleges,
had a range of fellowships and awards universities and medical societies all for post graduate research or for contribution made to advances in medicine known The first by from RCS the the most and well prize granted or science. 1800 was the Jacksonian, which was awarded to the candidate with the best in A 98 he Wimpole to surgery. subject year a practical after on moved essay
Street in 1851, Henry Thompson (later Sir) became FRCS following the Urethral Stricture for his he his on essay which of was awarded publication first Jacksonian Prize. This work brought him considerable notoriety when de la Chirurgie de Paris Societe it. As the plagiarized of a result, a member
this member was expelled and Thompson was invited to Paris by the Society. Whilst there, he worked with the renowned surgeon and urologist Jean Civiale (1792-1864) who introduced him to the method of compressing bladder stones which Thompson used so effectively in 1863 on Leopold, King
Queen Victoria. Thompson his to Belgians the uncle and won second of Jacksonian
Prize in 1860 for his work on the prostate gland: after the
Leopold, his King on reputation successful operation
was established. "The
king improved so much that his recovery was referred to as a miracle and the surgeon who had cured him 'became the hero of the hour at the Belgian Court'. His fame spread on the Continent and patients came to him from all "99 parts.
(I'Ondon, History College Surgeons TbeRqval England The Cope, 1959), Zachary 98 of of of p. 32. 99Merrington, University College Hospital, pp. 71-72
143
Postgraduate
prizes
and
scholarships,
such
as
the
Syme
Bacteriological Scholarship from Edinburgh University, the QueenýsMedals from the Royal Society or the Radcliffe travelling
fellowship
by awarded
Oxford, were both a mark of distinction and could be a useful source of funds. 100Following his graduation from Edinburgh University, William Watson Cheyne used a legacy of MO to study bacteriology in Vienna and Strasbourg. When he returned to Edinburgh in 1876, he undertook a Syme bacteriological the that and won experiments scholarship of number Radcliffe for The Travelling Fellowship two him 1100 years. was a year gave including Reginald Southey in The 1860.101 the to cohort, several of awarded
fellowship was open to students of medicine, who had passed their BA degree
at
examinations
Oxford,
gained
of the
a first
university
I class
and had
degree
won
in
one
of
the
a university
Three such awards were granted annually scholarship.
public
prize
or
and held for three
The fellowship 2200. the of purpose of years with an annual value
was to
102 abroad. promote postgraduate study The most common honorary degree awarded to the cohort was the LLD: ten of the cohort, including Henry Head, were granted honorary LLDs.
(from MDs for Belfast degrees Frederick Price and honorary Other were Hildred Carlill and from Dublin for Richard Quain and William
Hale
100The Royal Society had a range of medals and most such as the Davy Medal or the Hughes Medal relate to sciencesubjects. However, the Queen's Medals awarded to George Busk (1871) and Henry Head (1908) were for contributions to the advancement of natural knowledge. Sharkey, Seymour David Forsyth and Pennell Hawkins, John Herbert included Others 101 William Henry Corfield. 102Rivington, Medical Pmfession, p. 589.
144
White). Several universities and licencing bodies conferred honorary degrees Street Sir Harley Richard distinguished Quain, for men; on example, was (TCD, (Edin., (RUI, LLD MD MD 1889), 1890), 1887) and the awarded an FRCPJ.
103
Conclusion An analysis of the three years 1845,1880 and 1914 shows that the basic qualification
registerable
from 1845 to 1880 and again in 1914. In changed
1845, the most common qualifications London
for medical practitioners
in Greater
(28.72 (11.88 MRCS LSA the per cent), per cent) or a were
combination
(36.63 two the per cent). Whilst of
the combined MRCS/LSA
(21.31 per cent) was still popular in 1880, there was a decrease in the
held LSA the who single practitioners qualifications of medical of proportion (4.06 per cent), MRCS (11.68 per cent) or LM (2.03 per cent). By 1914, this further been 5.75 held had that so only reduced per cent a single percentage licence: LSAfLMSSA only 4.24% (n = 14), MRCS or LRCS only, 1.21% (n (n 1). 0.30% LRFPS 4), = only In Harley
Street the single licence also became less popular from
1845 to 1914: in 1845,37.50 per cent held a single licence; in 1880, this had
been reduced to 7.01 per cent and by 1914, it had fallen to 1.80 per cent. This downward trend was in line with what was happening in the rest of the in London in the and was a reflection of changes medical medical profession legislation
in As Roy Porter this earlier chapter. argued, from the mentioned
the nineteenth century, of middle 103AfedjcalDiiwtory,1898,P. 320
145
London's elite physicians and surgeons had ceasedto require the creaking armour which Collegiate privileges appeared to provide, for they were establishing themselves in plush positions of professional authority and eminence. The distinction of a Harley Street practice, combined with leading London hospital, with patients referred by one's a consultancy at former pupils for whom one had found preferable practices: these features ensured that medicine continued hierarchical even after the old corporations finally had their teeth drawn. 104
Within this hierarchy, the most popular qualification for the Harley Street investigation in the remained constant: a combination of period under group the fellowship of the RCP or RCS with a medical degree. (86.00 9 10 almost out of every per cent, n= 565)
The vast majority of medical practitioners
in Harley Street were qualified
MD, MB, FRCP,
FRCS or MRCP or held a combination of a medical degrees and fellowships. A considerable number of these men in comparison to medical practitioners in England pursued postgraduate studies abroad and they received more prizes, scholarships medical practitioners
and awards during their
graduate years than other
either in the Harley Street Area or across other parts
Street Harley London. men were quite clearly among the most highly of qualified
medical
practitioners
in England,
and were at the very pinnacle
of
the medical academic 61ite in London. The next chapter examines the cohort's
hospital
and
teaching
posts
and the
emergence
of medical
the group. within specialists
104Roy Porter, Bodies Politic. *Disease, Deatb and Doctors in Etitain, 1650-1900,(London, 2001), p. 255.
146
CHAPTER 4 Establishing and Developing a Career: Hospital and Teaching posts The period from the 1850s to the First World War witnessed a surge in the foundation hospitals, hospitals, the with of specialist particularly growth of dispensaries, infirmaries, institutions as such cottage and other charitable hospitals, convalescent homes, friedenheims (for terminally patients),
lunatic orphan and
asylums. ' Moreover, the range of specialist
in various areas of medicine and surgery proliferated subjects rapidity.
ill cancer
with great
These developments were coextensive with the range of hospital
appointments
held by Harley Street men, which were across an array of
hospitals. teaching, royal, general and specialist Whilst
Harley Street men were employed part-time
institutions corporate and public these posts will
by a variety
of
such as assurance companies and schools,
in be this chapter. analysed not
Though these duties
the the time, their greater part of cohort's work was spent of occupied some in private
practice
and their
hospital
appointments.
This chapter
will,
hospitals during Victorian the the of specialist creation therefore, examine hospital held by Harley teaching to the the they and posts relate period, as Street men. The growth in specialism in medicine and surgery will the contributions vis-h -vis examined
be
that the cohort made to these emerging
Chapter In 3 on education, a comparative with common areas of expertise. (London, The MedicaMvfession, 1978),pp. 262-263 and Richard Peterson, I M. Jeanne (London, Hospitals, 1909), pp. 38-39. Special Kershaw,
147
analysis was undertaken
to establish if Harley Street men were appointed
to a higher proportion of senior hospital and teaching posts than those in
the Harley Street Area and Greater London. Bill Bynum has remarked, "hospitals have long been a popular topic for historical work, and few hospitals of much antiquity have not had their history written". 2 The history of British hospitals is disparate, varying from Many to and pictorial accounts pamphlets monographs. of enormously
the histories, such as H. Cameron's M-r GuyýgHospital, or J. Blomfield's St. GeorgeýF, H. Willoughby
Lyle's,
Mngýg and
Some Mngýg Men,
frequently hospital; by they the consequently, were commissioned
were
written
by a retired consultant from the Alma Mater. Whilst these are very useful hospitals foundation the the and administration of and students of accounts they their than teachers schools, often offer medical nothing more of an and institution. 3Recent individual the of scholarship of uncritical assessment hospitals, by such historians of medicine as Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker, and Keir Waddington's
The History ofBetblem,
Elsbeth Heaman's St Maryýg and Keir Waddington's Medical Education at St. Bartholomewýg Hospital, offer a more critical analysis of their subject.4 As the history of various hospitals and the development of specialism has
2 W. F. Bynum, Scienceand the Practice ofMedicine in the Nineteenth Century, (Cambridge, 1995), p. 231. (London, Mngý; Some Kingýg Men, 1935), Hector Charles Lyle, Willoughby H. 3 and (London, Hospital, Gqyý? 1954) and J. Blomfield, St. George 1733.9 Mr 1 33., Cameron, (London, 1933). 4 Jonathan Andrews, Asa Briggs, Roy Porter, Penny Tucker, and Keir Waddington, The History of Bethlem, (London, 1997), E. A. Heaman, St Mai7ý9, the History of a London (London, 2003) and Keir Waddington, Medfcal Education at St Hospital, Teaching Bartholomew's Hospital, 1123-1995,(Suffolk, 2003).
148
been well covered by historians, these topics will not be discussed in detail in this thesis. 5 There
hospitals, of
classification institutions
accounts that
are no published
dispensaries, infirmaries
during the Victorian
offer
a taxonomical
and other charitable
period. Whilst a variety of directories are
details include of these establishments, such as the number available, which of patients,
annual
income
accrued
and staff
appointments,
there
were,
however, too many variables to allow for a coherent taxonomical classification
of hospital
and voluntary
organisations
in relation
to their
historians Whilst the London 6 that the and medical profession accept status.
teaching hospitals are the most prestigious, because of their longevity, size, hierarchy high staff, creating a calibre of all the other patronage and have been The Royal Eye Hospital, institutions problematic. would medical St George's Circus, Southwark, for example, would have fallen into both the 'Royal' and the 'Specialist' category. If the number of beds or the income of the hospital
were used as a criteria
then The Establishment
for
5 For a general history on the development of hospitals see, Brian Abel-Smith, The Hospitals. A Sudy in SocialAdministration in England and Wales, 1800-1948,(London, 1964), Lindsay Granshaw and Roy Porter, The Hospitalin History, (London, 1990). There is individual hospitals, includes Lyle, Mngýv, on material which of scholarly amount a vast Blomfield, St. Georpeýg, Guyý;, Andrews, Cameron, and passim, passim, et al passim, Bethlem, passim, Heaman, StMarO;, passim and Waddington, Baztýv,passim. For the development of medical specialism see,for example, Rosemary Stevens, Medical practice in Modern England, the Impact ofSpecialization andState Medicine, (London, 1966), Charles Newman, The Evolution of Education in Blitain, (London, 1966), GeorgeRosen, 'Origins of (1949-51), CYba Symposia, Vol. Horatio Bryan Donkin, 'Dangers of 2, Specialism', Medical Medical Specialism', The FortnightlyReiiew, (London), July, 1885, pp. 67-78, Morell. Mackenzie, 'Specialism in Medicine', The Fortnight]7 Reidew, (London), June, 1885, pp. 772-787. Undon, Burdett, Sir Henry Hospitals Chaiiiies, 1902), Kellyý; for See, and 6 example, Lon don Medical Directory, (Lon don, 1896), Charl esR. Hewi tt, The Me&ýal Year Book, Sampson Low, (London, junior, The Malitles in (London, 1924), 1861, ofLondon 1924, 1862).
149
Gentlewomen
during Temporary
Illness, Harley
Street, with
an average
income beds have in 20 21,885 1902, annual and an of of would number Ear Hospital, higher Royal Frith Street, had than the which an ranked beds income in 9 1772 the same an annual of and number of average institutions Imposing 7 sort of classification onto some period.
that were
have the century would nineteenth over posed additional changing for first By the twentieth the of quarter century, example, many problems. infirmaries and Poor Law hospitals were remodelled as general hospitals, just the the poor. and not public general serving
Hospital Appointments held by London Medical Practitioners Historians have acknowledged the problem of classification of medical men, in Victorian boundaries the the as the type of practice undertaken Directory Frequently,
and obituaries,
medical world were fluid. 8 Determining
by the cohort from the records in Medfcal
could not always be ascertained with certainty.
too little information
was given in these records to establish the
Qualifications type of practice Pursued. indicator of the individual's
could not be used as an exact
status or type of practice. For example, 17 of the
FRCS; FRCP both the held the and other sources such as obituaries cohort had to be used to ascertain the nature of their practice. As Digby found "the distribution
be to generalists relative specialists cannot always of practising
boundary both because the was permeable and changing". plotted precisely At the beginning
of the nineteenth
century, a consultant
was defined as
7 j'hjd
(Oxford, Evolution General Practice, The 1850-1948, 1999), p. 6 Digby, ofBiftisb 8 Anne Crowther, Medical Profession in ScotlanX, pp. 223-225 Dupree and and
150
Oxbridge FRCP an who was graduate and someone or FRCS and on the large hospitals. 9 Thus, Charles Bell the the of general one physician staff of
Keetley recommended that if a student wished to become a consultant or house-surgeoncy he house-physiciancy take a or should and take specialist,
definition This did FRCS. MRCP 10 the or not remain static over the either historians have the the as and century, of medical profession course described its changing meaning over time.
A consultant in the mid- to late-nineteenth century usually indicated that
the medical
practitioner
had retired
from
hospital
Senior
work.
hospitals, in the teaching of surgeons particular, physicians and senior
were
"consulting honorary ' "consulting the position of physician! or given often from "usually between the their the permanent staff, retirement surgeon" on 65 twenty 60 to the years service, after according or and rules of the of age particular
hospital. They received no emolument and were not permanent
Sir Walter Langdon-Brown, The " in physician, staff'. remarked of members hospital "a to that 1930s a who has been relegated by anno the physician domini to what is known as the 'consulting staff, has a position of great dignity
but of no importance". 12 By the end of the nineteenth
however,
century,
the distinction between consultant and specialist had become
blurred. Andrew Morrice considered that the role of a consultant was determined by the central ethical committee of the BMA in 1909. In the 9 J. Johnston Abraham, Ninety-Nine Wimpole Street, 10Charles Bell Keetley and Robert Wharry, eds., Tbe med(cal Profession, 2ndedition, (London, 1885), p. 39 11Walter Rivington, 7he Medical Profession, (Dublin, 12W. Langdon-Brown, 'Crabbed age and youth' in Sir shirt Sleeves (London, 1939), p. I.
151
(London, 1937), p. 59. Studentsand Junior Guide to the 1888), pp. 664-665. Henry Bashford, (ed.) Doctors in their
BMA report on the ethics of medical consultation, a consultant was defined as: is called upon to give a second opinion respecting a who any practitioner [and] is the term the practitioner care of another case already under frequently used also as the designation of a special class of medical fact by distinguished that a proportion of the patients the practitioner, ... in by him the with, or under care consultation ordinarily seen are attended 13 practitioners. of other
A dichotomy in the medical profession in Britain was evident by the 1840s. Thomas Neville Bonner remarked that 80 per cent of medical practitioners
were
engaged
in
general
practice,
whilst
"the
more
the trained usually and surgeons, members of royal physicians academically colleges, were concentrating
their practices more and more in and around
further '. Bonner 14 London! hospital the centres of earned
from
emoluments
consultancy
and private
practice
acknowledged that fees together
with
teaching
"to 15 the these continue as members of men elite". allowed
According to Anne Hardy the division between general practitioner
and the
hospital consultant who also ran a private practice was evident from the 1860s, by had f 1900 the the top consultants, who the were irmly scale of at 61ite of the profession operating private the themselves as established Street Area but Harley London, in in based the of also practices, often 16 towns and cities. provincial
in Britain, interests': Work Medical the "Honour Morrice, and ethics of the Andrew and 13 (MD, Ethical Committee, University Central 1902-1939", Association's Medical of British J,ondon, 1999), pp. 146-47. Education in Great Biitain, Physlcian:. Medical Becoming Bonner, Neville a Thomas 14 (Oxford, 1995), 184. States, United 1750-1945, Germany, the p. France, and 15Ibid. (Hampshire, 200 in 1), p. 14. Medicine Bfitain Realtb 1860, Hardy, Anne and since is
152
Membership
or Fellowship of the Royal Colleges was a prerequisite
for a
The Harley Street 17 medical practitioner, career as a medical consultant. Gordon Holmes, who became a director of research in clinical neurology at Queen Square, illustrates this point. Holmes had qualified MD in 1903, but have in hospital MRCP, hold did he the the a consultancy post would not as been unlikely. A ruptured Achilles tendon forced him to give up clinical for he him MRCP, the time to the study with which research and provided he for Queen Subsequently in 1908. applied a consultancy post at passed Square and was elected on the narrow margin of one vote. During the Queen Square, Jackson, Hughlings John at physician meeting, hear deaf discussion to the too then and committee's elderly quite was who him he the to consultant next asked who should candidates, about various 'HOLMES' Jackson The on a piece of paper and wrote consultant support. deciding 18 the vote. cast
Rivington classified medical practitioners
in the late 1880s as:
physicians, surgeons, obstetricians, general consulting physicians and Physicians, or pure physicians, or consulting physicians, specialists. whether specialists or not, practise, or are supposed to practise, medicine in first After the the ordinary qualifying examinations, or, passing only. instance, they have usually become members or fellows of a college of doctors the 19 one universities. medicine of of of and physicians
Rivington's organisation of the medical profession was a useful taxonomical (38-96%) his By 256 to the for categorization the period. cohort, applying tool (FRCP, be defined "pure MD Street Harley as physicians", or men would (FRCS (37.14%) "pure 244 MRCP), surgeons" or MS) and only a quarter as (23.90%, n=
157) as general practitioners. Using Rivington's definition,
be the could viewed as pure physicians 76.10 per cent of cohort
17Rivington, Me&cal Profession,p. 666. (Dublin, Masters hish 1992),pp. 255-56. Coakley, ofMedicine, 18Davis 19Rivington, MedicalPmfesslon,P. 277.
153
or pure
Harley Street be Thus, seen as a nucleus of the medical and could surgeons. surgical elite.
The various categories of medical practitioner
were, however,
The inconsistent in the century. nineteenth nature of the mutable Victorian be in medical practitioners can of seen a number of classification the cohort who referred to themselves as general practitioners, such as Sir Morton Warrack Smart and Sir James Mackenzie, but who were, in principle,
consultant
Smart was the manipulative specialists.
surgeon to
George VI and Mackenzie was an internationally renowned heart specialist. Whether the cohort were styled physicians, surgeons, general practitioners,
indeed, depended these, a construct or, of on a consultants or specialists, factors the and as self-perception obituarist's perspective. such number of Professional status was also a question of economics; it was advantageous for medical practitioners
to develop a particular
interest
in a medical or
build Since their field they could reputation. which on surgical the public do not believe in universalism as applied to the practice of faith has "Taken but the their on specialist who up" or is pin medicine, "Good for" some particular ailment or organ. Some specialists take up three besides body. time the 20 the four the same rest of at specialists or
Historians agree that few medical practitioners were specialists by the in London. 21 Digby this 1850s and of asserted that: minority most worked [historians] have divided seen a new and professional some although defined difference between GP based clearly on a and consultant structure
20Rivington, Medical Profession, pp. 277-278. Doctor, Charlton, TheMakingof Medical Education in Bruce Downie S. eds., a R. and 21 (Oxford, 1992), p. 18 and Digby, General Practice, pp. 37 and 289. Practice, Theory and
154
before it is more accurately seen as a phenomenon 1850, occurring even confined mainly to London where a small minority practised as specialiStS. 22
Up to the end of the nineteenth century only a minority of the medical
large hospital build the to not on staff of a who were a were able profession practice. F. N. L. Poynter
successful private Victorian
hospital appointments period,
acknowledged
served as an indicator
that
in the
of success,
benefits had they since provided an opportunity to also pecuniary which A 23 Harley Street the teaching number of poStS. physicians salaried gain
Sir Richard G. Wright Quain Henry Sir the and and surgeon, such as, Charles Ryall managed to circumvent
this standard system, but this was
held Wright "minor hospital for the who only period. appointments" unusual
including being physician to the Samaritan Hospital, acquired a position in practice
"men 'out hospital in the the which of profession, and
[found] it very difficult to acquire". 24Similarly,
groove'
Quain had never been on the
but built hospital, to teaching managed staff of a
a large and profitable
his Street from Harley "upper in the of where many patients came practice
strata of
society".
25
When Ryall, senior surgeon to St Marles Hospital and
(1914-1922), Council RCS it hospital to the the Bolingbroke was elected of decision, he "unprecedented7 the teaching as was not on staff of a was an hospital and could, therefore, "not command the support ensured by such a poSitioe'.
26
22Digby, General Practice, p. 289. ) (ed. The Evolution OfMedfcal Practice in Biitain, (London, 1961), p. ill. Poynter, L. N. 23F. 24Anon, 'Henry G. Wrighe, BW Jan. 16,1869, p. 62. 25Anon, 'Sir Richard Quain', LanceA Mar. 19,1898, p. 798. 26Anon, Sir Charles Ryall, BMJ, Sept. 16,1922, p. 534.
155
Harley Street consultants worked part time in one or more of the hospitals. As resident consultants they usually had their board and lodging did in for, but If 27 general not receive a salary. a medical practitioner paid for delivering lectures; teaching the these staff, early mornings were on was
hospital by house followed and calls visits that usually took place were In lunchtime. 28 the afternoon, they typically around
received private
in their consulting rooms. patients
Table 4.1, Appendix D, shows the hospital affiliation of the Harley Street group. As the majority of the institutions posts were numerically
where the cohort held staff
small, this table includes only those hospitals in
had Posts held the of cohort a staff or more appointment. cent which one per Street departure in Harley from the their the and at year of on arrival Street
are included
in this
Table.
Hospital
the cohort, particularly of many as exclusive,
held multiple
posts were not mutually distinguished
consultants,
different in hospitals, of a variety posts which will be
discussed later in the chapter.
Hospital Appointments held by Harley Street Men The range of staff appointments held by the cohort was extensive and included posts across a variety of 526 different institutions. Henry Burdett hospitals by 300 in 1896 England there that were some cottage calculated
27Provincial Consultants could earn 280 to 4:100 in the mid 1880s according to Keetley in Charles Bell Keetley and Robert Wharry, eds., The Students and Junior Guide to the (London, 2-d 1885), p. 40. profession, Medical edition, 28Rivington, Med(calFmiession, pp. 277-278.
156
In for 29 the to their their care according means. medical paid patients where Kellyý, year same
directory
listed London of
186 special institutions
London alone (apart from cottage hospitals).
in
dealt with
These hospitals
for hospitals diseases 51 and of patients, example, or groups various five devoted homes 12 to to to children, and midwifery were convalescent Britain had In 66 30 diseases. the period, county asylums and a same skin large number of private
built asylums were
to deal with the increasing
from few inmates in ill thousand a patients, which rose number of mentally 1800 to over 100,000 in 1900.31In total, over 90 per cent of the cohort held institutions 526 these in a variety of of one or more staff posts though
these were
mainly
confined
to Greater
London.
in England, Dupree
and
Crowther, who found the range of hospital posts to be confusing, highlighted the difficulty
in summarising
hospital
posts for their
Scottish medical practitioners, of century cohort the MeaUcal Directory
early
twentieth
as many of the entries in
be found in standard could not
sources such as
Burdettý; Hospitals and CbaritieS.32 Recruitment The vast majority of students who eventually became consultants on Harley
from Alma Mater. This best hospital their their Street, gained posts was hospitals: St Londori's Thomas's four by most prestigious of exemplified
29Henry Burdett, Cottage Hospitals, General, Fever and Convalescent: their Construction, (London, 1896), p. 6. Work, Management and soKeilyýv London, 1896, pp. 376-407. (ed. ), (Cambridge, Roy Porter, Medicine, History. Illustrated Camhzidge in 31Roy Porter 1996), p. 296. in Anne A Medical Profession M. Crowther, Profile Dupree the W. of Marguerite and 32 Scotland in the Early Twentieth Century: The Medical Directary as a Historical Source', Bulletin of the History ofMeckine, Vol. 65,1991, pp. 223-24.
157
its Street boast Harley 95% had that trained at the of staff members could
hospital's own medical school,followedby Bart's with 88%,UCH with 87%, four hospitals The Guy's demonstrated 86%. teaching that the other at and Street from Harley had their staff of also trained at the medical majority (65%), in hospital later St Mary's they the to which worked: school attached (61%), (58%), (63%), (54%). George's King's Middlesex London the the and Only a quarter of the men (27.27%) who held a staff post at Westminster
Hospital, and none from the Royal Free, completed their training there. This since Westminster
was not surprising
and the Royal Free were not large
full did Only the offer medical not curriculum. students medical schools and for
preparing intermediate
This
the
final
examinations
pattern
examination
were
tutored;
preliminary
and
were taken at King's College. 33
of employment
in
the
London
teaching
hospitals
historians have the of medicine amongst who view shown that corroborates recruits
to staff positions in the London teaching hospitals were selected
from their century
Thus 34 Peterson found, body studentS. as of nineteenthown
hospitals
continued
to "favour their
OWII! '. 35
When the teaching
hospitals did not employ members from the cohort who had trained at their from largest Bart's, the medical school, graduates usually medical schools, filled their staff vacancies. As the demand for appointments at the London teaching hospitals far outstripped supply, many of the cohort had to find hospital. Thus, Edward Arthur work at another
Saunders, who had
(London, 1910), p. 64. 33S. Squire Sprigge, Some Considerations ofMedicalEducation 34See, for example, Peterson, Medical Profession, p. 161 and Heaman, St Maryýg, p. 43. 35Peterson, Medical hvfession, p. 161.
158
from Oxford in became FRCP MB in 1910 and completed 1894, graduated forced St Hospital, Thomas's to apply elsewhere. Even at was
his training
Saunders his that was unable realised colleagues one of to rind a footing in his own hospital-such appointments [were] few in like Hence to applicants. others he journeyed west and suitable comparison in 1899 was appointed assistant physician and pathologist to the West London Hospital. 36
The medical schools attached to the London teaching hospitals also recruited
their
teachers and lecturers from within.
The pattern
of
hospital for to that teaching was remarkably posts similar of recruitment Virtually
appointments.
also trained
all of the cohort
who taught
St Thomas's at
had
(94.74%), (88.89%), followed by Bart's their medical school at
(66.67%), (72%), (85.71%), Mary's UCH the London (66.67%), George's Guy's (63.64%), Middlesex appointed
(57.69%) and King's
Westminster at
(47.62%). Only 25% of those
from those the Royal Free had and none of
trained there. Special Hospitals Specialism Development The and of Until
the nineteenth
did not threaten the livelihood of century, specialism
did it hospitals the conflict with work nor of general medical practitioners, Indeed, hospitals dealt institutions. the the early special with or charitable kinds of diseases, such as insanity, venereal disease and smallpox, which to hospitals to admit willing and physicians were not were reluctant general treat.
37
Since the emergence of medical specialism was a gradual process,
beginning it to to an particular assign a specific problematic this makes 36Anon, 'Edward Arthur Saunders, Lance4 Sept. 27,1947, p. 494. 37Charles Newman, 'The Rise of Specialism and Postgraduate Education', in Poynter, Me&cal Education, p. 175.
159
area
of expertise. The study of the various diseases that would later become but increase in to the the not new were nineteenth century, specialties development knowledge the and of new instruments medical medical practitioners
to concentrate on a particular
enabled
organ or a particular
disease. Before the knowledge of many diseases or organs became sufficiently dealt often practitioners medical with a number of special established, included: Such ophthalmic and aural surgery, paediatrics groupings areas. and obstetrics,
bacteriology, pathology and
whilst
dermatology
was often
(venereal diseases). Table Appendix D 4.2, syphiology with shows combined the medical and surgical specialities practiced by the Harley Street group. This Table also displays the special interests of the group, defining special interest specialist
as a practice
which
largely, was
though
not exclusively
nature.
By the 1890s Harley Street, according to the historian Shorter,
of a
had become the nucleus of London's consultant
half Harley Indeed, the 38 of over practice.
Edward
and speciality
Street men were medical or
interest had in Many, a special one or or more subject. specialists surgical
by income in being the doubt, potential gained attracted were recognised no by the public as a specialist. As the Victorian physician, Jukes De Styrap in 1880s, the remarked knows, it is impossible time to practitioner worn elder, almost every as become rich by the practice of medicine, unless it be by some speciality,
(ed. ) in Roy Porter, Cambridge Mustrated HistorY. medii,, e, Shorter 38Edward (Cambridge, 1996), p. 146.
160
commanding heavy fees and many specialists did indeed acquire considerable fortunes in the period.39
Some physicians,
Hort,
such as Horace Benge Dobell and Edward Collet
in fields that were working
specialities; thus,
had not yet become established
they could only be viewed as specialists retrospectively.
Dobell, who was appointed consulting physician to the Royal Hospital for
Diseases of the Chest (1858-1892), worked almost exclusively on diseases of the chest and pulmonary
tuberculosis.
However, he was part of the "old
developed, he before be to and while specialism aspired master of one school knowledge". his he kept his 40 general up art part of Hort, who had been a general practitioner
in Torquay was nearly 40
Harley Street decided he bacteriology, to to concentrate move on when "henceforth he which
pursued with ceaseless, almost feverish, energy
devoted 1141 Whilst to research was work. moment every spare
he was not
lifetime, in his Dr J. G. Adami, Vice-Chancellor own specialist considered a University the of
in 1922, "1 am convinced that future Liverpool remarked of
Hort in bacteriology". the A 42 one of masters as establish will number years
George Buckston Browne devoted life's their the as such most of cohort, of field, they to yet were not viewed contemporaneously as chosen a work last in Browne, the the quarter of who nineteenth century was, specialists. "one of the busiest surgeons of his day, as he saw patients morning, noon holiday for his 25 took years, no made name as an expert on and night" and
39Jukes De Styrap, The YoungPractitioner, (London, 1889), p. 227. 40Anon, 'Horace Benge Dobell', Lance4 Mar. 10,1917, p. 391.
41Anon, 'Edward Collett Hort, BMJ, Oct. 21,1922,p.777. 42Dr.J. G. Adami, 'Edward Collett Ifort, BMJ, Oct. 21,1922,p. 778.
161
diseases of the genito-urinary tract. Although the bulk of his practice was in invented for he instruments a of surgical number which urology,
and many
for he few him, hence developed saw also a general patients and more were 43 the time, to, general as a surgeon. at referred was Anomalies
between were common
perception
and practice:
even
distinguished specialists such as Charles Edward Beevor and Frederick Still, who were prominent
in their field, presidents of specialist societies,
their chosen subjects, were not regarded as on orators and and writers few A in 44 those time. the of who specialised a particular specialists at
area
Percy Sargent who made cerebral
"specialists". being as classed resisted
"never he his to wished pose as a specialist claimed speciality, surgery
[which]
from him the wealth of material in his publishing prevented ...
45Whether brancli". one was classified as a specialist or generalist special be a reflection of an obituarist's may nineteenth
century
when specialism
own agenda, particularly was on the fringe
during the
of conventional
in deference Therefore, deceased, to the practice. an medical and surgical
broad interest his in Charles to subject's medicine. obituarist may refer Edward Beevor's obituarist, for example, recorded in 1908, that Beevor Victor Horsley, Beevor bent "a towards neurology". with whom showed Institution Brown the worked at
noted that Beevorýs experimental and
forwarded had "not in its only notably neurology most clinical research George Buckston listed in Sir Browne Jessie Dobson and Sir Cecil inventions are of 43The Wakeley, Sir GeorgeBuckston Browne, (London, 1957), p. 140 (1907) (1907) Croonian Lecture Lettsomian Lectures delivered the the and on the 44Beevor into by Royal Society, his the the published nervous were system, which research results of he was also President of the Neurological Society before it merged with the RSM in 1907. 45Anon, 'Sir Percy Sargent, BMJ, Jan. 28,1933, pp. 167-69.
162
practical
but has greatly contributed aspects,
to enhance the character of
this branch of applied science in Great Britain7. Yet, Beevorýs obituarist [he] he "although interested field in that the was specialised of whole noted "46 medicine. Keetley
argued
that
by
1885 there
was a movement
towards
he in large thought that there were some areas of the cities; specialism diseases those connected as such with surgery of the eye or or medicine
badly informed. He and surgeons general physicians were where obstetrics, deplored the "humbugsý' and thought it was "unfortunate gives such opportunities
that Specialism
to puffery and quackery". 47 In June of the same
laryngologist Street Harley the year,
Morell Mackenzie praised the virtues
Reýiew, his Harley Street Fortnightly in The whilst neighbour, of specialism Horatio Bryan Donkin lambasted Mackenzie for holding such views and Mackenzie believed 48 dangers that the specialism. of specialism of wamed
it in though the the profession, even medical was going on within originated Like biological the time. at same sciences many successful and physical had "declared itself Mackenzie thought the public opinion also specialists, the the that the side of specialists' on profession emphasis such with [medical] profession ha[d] been coerced into [a] sullen acquiescence in the inevitable". 49Thus, the public voice decisively approved of the existence of be that young physicians could also meant more receptive specialists, which to the idea. Donkin countered that Mackenzie did not provide a definition of 46Anon, and Sir Victor Horsley, Charles Edward Beevor, BMJ, Dec. 12,1908, pp. 1785-86. 47Keetley, MeaYca]Prufession, p. 47 48Donkin, 'Specialism', passim, Mackenzie, 'Specialism', passim. 49Mackenzie, 'Specialism', p. 772.
163
did have therefore, and, not a clear notion of what specialism specialism in To Donkin, 50 this was nothing new since he matters of medicine. meant thought that specialism in the "wide sense of devotion of special attention had existed for a long time". 51 His main argument was built on the premise
that the body was interconnected and could not be studied in a piecemeal fashion, To treat the heart with no regard to the other organs of the human body would not be medically expedient. These debates were conducted amongst various medical practitioners until
into the twentieth well
Hugh Morriston
century.
The Harley
Street chest surgeon,
Davies, for example, received a considerable amount of
his RCP UCH in from first decade the the colleagues and at criticism of the twentieth
for his he thoracic pioneering surgery, and century was recognised
in his late career. as an expert only Historians
generally
accept that by the middle of the nineteenth
century, obstetrics and ophthalmology were recognised as areas of expertise. According to Digby, [i. in 1878 that they was e. specialisms] could be an authoritative view limited to ophthalmics and obstetrics, on the grounds that these were the in lecturing, men are not capable whichordinary of areas and which only they delegate to otherS'.52
However, other subjects such as urology and laryngology were beginning to
from The 1850s. the subjects recognised specialities of emerge as specialist
50Donkin, 'Specialism, 9 p. 67. 51Jbid, p. 68.
52Digby, Genera] Pra ctice, p. 37.
164
radiology,
anaesthetics, paediatrics,
neurology and dermatology belong to
the late nineteenth century.
twentieth
of the London specialist hospitals
in the beginning
of the
from also employed specialists century other disciplines.
In the
Many
1920s, for example, Norman Harman, a specialist in ophthalmology
treated
for End Hospital Nervous West Diseases Victor diseases the at and eye Bonney was the gynaecologist at the Hospital for Epilepsy and Paralysis.
However, other hospitals, such as the Hospital for Diseases of the Throat, Fitzroy Square, had no facilities for cases other than those concerned with its specialist area. 53 There was an ongoing struggle in the legitimisation medical lamented
specialities.
The laryngologist,
Greville
Matheson
of
MacDonald,
the lack of respect for specialists, before he moved to Harley
Street in the early 1890s, when he remarked: Street in Wimpole would not give me a place among room consulting even a the really elite. The Throat Hospital, in spite of its new and irreproachable by looked a carefully censorious procession as simply not upon staff, was in distrust The this newest of speciality medicine was chiefly respectable. due to the prevalent disapproval of specialism in general; for it was for that practitioners competent qualified were all everything. 54 considered
Veiled Specialism and Special Interests
Veiled specialism was evident in a number of the cohort whose names became identified with particular
specialities, but who also saw other
interest Rivington is that remarked a special or speciality medical cases. "taken up" when,
53Hewitt, Year BOOk,Passim. (London, ReminiWences Specla&4 1931), p. 388. MacDonaldo Greville 54 Ofa
165
a practitioner writes a book, or paper, or a pamphlet, or founds or attaches himself to a special hospital, or the special department of a general hospital, and makes himself known in the branch or branches which he cultivates. 55
Few medical practitioners throughout London, even in the late nineteenth century,
confined themselves exclusively to specialist cases. For example,
Gordon Holmes and Aldren Turner saw other patients in addition to those from However, Samuel Alexander complaint. neurological a suffering Kinnear Wilson and George Frederick Still were amongst this minority during the period who restricted their practice to neurology and paediatrics respectively. The
degree of specialism
amongst
so-called
specialists
in
the
Victorian period varied according to the subject. Poynter remarked that whilst ophthalmologists their
speciality,
rectal
and otolaryngologists
rarely saw patients outside of
surgeons saw themselves
as general
surgeons
but diseases in the rectum, of equally saw patients with other specialising interests The the 56 of mid-nineteenth special complaints.
century, such as
diseases become diseases the to the of skin, and were established children's specialities
of paediatrics
dermatology and
in the late nineteenth
century.
Peterson distinguished between the early quack specialists and the later Victorian consultants and specialists in England: "the latter involved the development and elaboration of institutions
hospitals, societies, and -
journals - devoted to their subject".57As Roy Porter observed, "specialities
55Rivington, Me&cal Profession, pp. 277-278. 5oPoynter, Medical Education, p. 177. 57Peterson, Me&calPmfession, p. 260.
166
flourished when they involved a conspicuous body part or pain responsive to interventiojý'. 58 surgical
Those medical and surgical fields in which the cohort specialised or had a special interest are shown in Table 4.2, Appendix D and their main
below. There discussed far too many specialised are are areas of expertise individually, discuss them to all areas Particular during the period. changed
especially as a number of them
attention is thus given to those areas
that were growing rapidly during the period and to those where the cohort field, to the such as creating a new either made significant contributions discipline
or in establishing
new special hospitals.
Ophthalmology
is of
first interest this the one of was areas where specialisation since particular in medicine occurred. Ophthalmology Although
the study of diseases of the eye were greatly
assisted by the
(1821-1894) by Hermann Helmholtz in the invention of von ophthalmoscope 1851, the prototype for nineteenth century ophthalmic
hospitals in Britain,
Moorfields had Hospital, Ophthalmic Royal already been established by the John Cunningham Saunders in 1804. It began as the London Dispensary for Afflicted Ear Eye Diseases-159 Poor By the 1890s, Relief the with and the of
four other eye hospitals were established in London including The Royal Westminster
Ophthalmic
Hospital
(1816) and the
Central
London
58Roy Porter, The Greatest Benefit to Mankind-7A Medfcal History ofHumanityfrom Antiquity to the Present, (London, 1999),p. 388. 51)Lindsay Granshaw, "'Fame and Fortune by means of bricks and mortar, the Medical Profession and Specialists Hospitals in Britain, 1800-1948"in Granshaw and Porter, The Hospital, p. 202.
167
Ophthalmic
Hospital
(1843). Approximately
half of the senior staff at
Moorfields and the Central Hospital and a third of the staff at Royal Westminster in the 1890s were Harley Street men. At Moorfields these included consultant surgeon George Lawson, the surgeons John Tweedy,
Arthur Quarry Silcock and assistant surgeons,John Bowring Lawford and Andrew Stanford Morton. Whilst Ernest Clarke, Arthur Poulett Lethbridge Wells were surgeons to the Central, and James Thomas James and Norman Maclehose were assistant surgeons. Lawson, Tweedy, Lawford, Silcock and Morton, were all also on the staff of the Royal in the same period. 60 A number of Harley Street men were extremely influential
in the
development of modern ophthalmic surgery in the 1860s and 1870s, and began few their the careers as a general surgeons and who amongst were later
switched
Critchett,
to working
exclusively
on diseases of the eye. George
together with his Harley Street neighbour the ophthalmic surgeon
George Lawson, ophthalmology
were two
of the
most prominent
specialists
in
in the period. Other eminent men included the non-Harley
Street Sir William Bowman and Jonathan Hutchinson. 61 George Critchett was educated at a private school in Highgate and at
Scott, John London Hospital. to to the became 17 surgeon apprenticed George rose through the ranks of the London becoming assistant surgeon in in Following introduction 1861. full the 1846 and of anaesthesia, surgeon George and his colleague, Sir William
Bowman, who advised him to
6oKejjvý? 1896, pp. 381,400 and 401.
6IAnon, 'Sir AndersonCritchett', BMJ, Feb. 14,1925,p. 338.
168
concentrate
on ophthalmology,
played a pivotal
in inventing role
new
improving the eye, as well as existing practices, such surgical procedures on
for They the termed their new surgical those of cataracts. removal as "iridesis" procedure
formation the or
of artificial
iris. by tying the pupils
George was also very interested in the inflammation of the cornea and his iridectomy fundamental in 62 to establishing acute glaucoma. work was According to the ophthalmologist Maitland Ramsey, William Bowman and George Critchett did more than any other two men to raise the standards of British (sic. ) Moorfields known it the to that make and so widely ophthalmology from Mecca, be the to ophthalmic which ophthalmologists regarded as came came from all parts of the world. 63
It was, perhaps, unsurprising
that Sir George Critchett's
eldest son,
Anderson, should become an ophthalmic surgeon, as it was the desire to help his father that drew Anderson to ophthalMology. 64Educated at Harrow
he Arts degree in Cambridge Anderson took 1867, later an where at and (1872). Middlesex MRCS his the training at and qualified medical completed In 1881 he was elected, against
strong competition,
to the position
of
Mary's Hospital. It here St he that was at established ophthalmic surgeon his reputation 94,
by department into turning a small ophthalmic a specialist as
an internationally
by the beginning of the twentiethrenowned clinic"
Anderson 65 received virtually century.
every possible professional
honour
62Treacher Collins, 7he History ofMoorfields Eye Hospital. *100years of Ophthalmic (London, 1929), p. 92. Development, Discovery and Critchett, 'George FRCS', The Biitish Journal of Ophthalmology, Ramsay, Maitland A. 63 Aug. 1923, pp. 4-5. father he his Anderson successfully operated at the International Congress when 64 assisted in Paris on a German woman who was blind from a cataract, see.1bid 65Anon, Critchett, pp. 338-39 and Heaman, StMaiyýr, p. 77.
169
that could be conferred on him, including President of the OPhthalmological Society of the United Kingdom (1899-1901), first President of the Section of Ophthalmology British
(1912), first President of the new Council of RSM the at
Ophthalmologists
(1918) and Master of the Oxford Ophthalmological
Congress (1924). As surgeon-occulist to King Edward VII he received a knighthood in 1901 and was made a baronet seven years later. He was not a he his father collaborated although with writer, prolific on the sixth edition known book Critchett's Diseases George text well of tbe Eye.66Anderson's of his "doyen the established reputation surgeon as a skill as of ophthalmic leader "recognised the amongst eye men of all countrieS". 67 surgeons", and
Like Anderson Critchett, the surgeon Arnold Lawson followed his father, another Harley Street ophthalmologist,
into his speciality. Arnold,
the fourth son of George Lawson the surgeon occulist to Queen Victoria, was Taylors School before Merchant the proceeding to his medical at educated training at the Middlesex Hospital. He graduated MD, Brussels (1891), took (1891) MRCS/LRCP diplomas and in 1893 became FRCS. He worked for the John Tweedy before joining his to father time assistant a clinical as own a in 1892 at his practice at 11 Harley Street. Arnold developed his reputation there over the next 55 years to becomean "eminent ophthalmic surgeon". Lawson was just one of 55 Harley Street men who rose to prominence by concentrating on diseases of the eye. Of these men, 47 were specialists FRCS. They the academic success; majority were achieved were very who all
66Anon, 'Arnold Lawson', Lancet, Feb. 1,1947, p. 198. 67Anon, Critchett, p. 338.
170
involved in their speciality, contributing lecturing
on their
subject, establishing
Ophthalmological in the positions of eminent
to the literature
consulting
eye hospitals
on ophthalmology, holding or
senior
Society of the United ffingdom. 68The cast surgeons included
ophthalmic
Sir John Tweedy
(UCH), Robert Brudenell Carter (St. George's), Reginald Affleck Greeves (the Middlesex) and Robert Lyell (the Middlesex). Tweedy was particularly Ophthalmic he Professor Medicine Surgery known, of was and at as well UCL, President of the RCS (1903-1906) and Consulting Ophthalmic Surgeon to UCH and Moorfields. At various times he was also President of the Ophthalmological Society of the United Kingdom, of the Medical Society, the Medical defence Union and the Royal Medical Benevolent Fund. Larygology and Aural Surgery As the use of the ophthalmoscope had revolutionised ophthalmic surgery, the development of the laryngoscope transformed
the Paris
singing-master
Manuel
laryngology. Invented by
Garcia (1805-1906) in
1855, this
instrument allowed the practitioner to view inside the organ, which had not been possible previously,
and thus helped to establish an interest
in the
throat.
The emergence of laryngology as a specialist subject owes it origin to
Morell
Mackenzie,
father to the as of British referred
laryngology,
who
for Diseases Throat, first Dispensary Golden Square, the the of established in in book, England In his The Laryngoscope, kind 1863.69 its first the one of
for founded Hospital Carter, Eye in Nottingham with a the Brudenell 68Robert example Elliot Dr. Brookhouse. Robert Henry doctor, Street Harley was a prolific writer and non Anon, books 'Robert Henry Elliot, see on ophthalmology, and papers of number wrote a L,qncet,Nov. 21,1936,p. 1240. 69Anon,'Sir Morell Mackenzie'BMJ,Feb.13,1892,pp. 362-63. 171
(1880first diseases treatises the the the throat methodical on of of nose and 1881), Mackenzie traced the history of the instrument and argued that invented laryngoscope, Garcia Professor Czermak of Pesth the although (now Budapest) refined the apparatus in 1857 including the substitution
of
the more reliable artificial light for the rays of the sun. Mackenzie thus diagnostic laryngoscopes before Czermak's that tools useful were not argued time. 70
Mackenzie's desire ASSO to concentrate in a many pioneers, so with hostility area of medicine provoked
particular
amongst many generalists
for However, keen did the the specialism. need see not public were on who specialists.
As another
Harley
Street laryngologist
Greville
MacDonald
"patients too readily would run after and applaud any newly all out, pointed fashionable unorthodox
practitioner
claiming
special
knowledge'. 71 Mackenzie's
him be by his to caused practices ostracised colleagues surgical
his German Crown Prince the treatment the of of of account and publication further alienated him from the medical establishment. 72 In 1887, Queen Victoria
Berlin her Mackenzie to to to go attend son-in-law who was asked
his larynx; in from unfortunately, a growth suffering
the Prince died in June
1888, possibly due to syphilis. 73 In Mackenzie's
account of the case, he
denigrated his German colleagues, all of whom were established general had failed he felt diagnose Prince's to the correctly whom surgeons,
(London, The Laryngoscope Mackenzie, 1865), quoted in Source Book OfMedicaj Morrell 70 (New Clendening, by Logan York, 1942), pp. 664-65. History, compiled (London, Reminiscences SpeciaYst, MacDonald, 1931), p. 229. Greville 71 ofa 72Anon, 'Mackenzie, pp. 362-63. (London, HfirleyStreet, Pound, 1967), p. 3. 73Reginald
172
condition.
Mackenzie's attack was seen as a breach of confidence,
Colleges led by Royal Mackenzie's down-fall. 74 the to and condemned MacDonald too suffered trenchant opposition, as he had to "face incredibly [he] honoured from the most some of was even after stupid opposition ...
invited to join the staff at King's College Hospitar'. 75 Joseph Toynbee (non-Harley Street), who was one of the founders of in Britain, modern otology
gained professional recognition for his speciality
first St Mary's in he Hospital the to aural as surgeon appointed was when 1852.76
Though as early as the 1830s the surgeon George Pilcher was
based "a he the to successful aurist", most as on practice referred Street, George Westminster. Great Pilcher later in won the established Fothergillian Prize for his "Treatise on the Structure and Pathology on the Eae' and ten years after he was elected FRCS in 1843, he established a Street. laryngology, 77The Harley in specialities of rhinology and practice First World War become just before the to the recognised merged otology (ENT). Edward David Darelan Davis throat and nose ear, was speciality, Davis, in both the practitioners. who qualified pioneering medicine amongst Charing Cross in in to 1903 dentistry appointed as a senior was surgeon and 1912 just as ENT was emerging as a new speciality. He wrote numerous
74A.M. Cookein TbeHistory of the Royal Coflegeofpbysidans OfLondon,Vol. 111, (Oxford, 1972),pp. 904-905. 75 kid. 76PenelopeHunting, TheHistorY of the RoyalSocietyof Medicine (London,2002),p. 90 77Anon,'Death of Mr. GeorgePilcher, Lance4Nov. 10,1855,p. 452.
173
for his Lancet BMJ became the speciality and on and a respected articles
teacher of his subject at Charing Cross medical school.78 Diseases of the Skin and Dermatology Although some medical practitioners had specialised in diseases of the skin it late beginning 1870s the the the century, was nineteenth not until of at that
dermatology
Harley
When 79 the nona recognised as speciality. emerged
Street physician
Erasmus Wilson (1809-1884) was a student
he
Thomas Wakley Lancet, he to the the whether should stick of editor asked Wakley dermatology. take replied: up anatomy or but Read to about skin, write skin, speak nothing about skin, and skin. stick that as publicly and as often as you can. Get your name so closely associated Erasmus Wilson is directly in the that of name mentioned any with skin drawing room, everybody present will begin to scratch.80
Subsequently,
Wilson became a celebrated skin specialist and amassed a
fortune from his practice. In the 1890s diseases of the skin were usually dealt with by general
hospital. During Street Harley this the time a physicians or surgeons within few his Whitfield the Arthur was one of physicians who confined physician, hospital in his both his dermatology, to post and private practice. career When, the Royal Free Hospital created a dermatological department in the 1900s, Willmott H. Evans was put in charge, specialising in diseases of the Whitfield 81 he but with general work. surgical continued entered also skin, dermatology in the late nineteenth century, when knowledge of bacteriology
78Anon, E. D. D. Davis',BMJ, Mar. 27,1976,p. 76. diseases books Bateman Thomas Dr For published on of the skin in 1813,for 79 example, RSM, Hunting, 91. details p. see more soKershaw,SpecialHospitals,P. 30 81Anon, Villmott H. Evans',Lancet;Sept. 17,1938,p. 701. 174
he devoted in deal the early stages and a great of time to the was still finding his discovery of subject; consequently,
fungus in ringworm
of the
toes was considered, "epoch-making".82His endeavour proved fruitful when in he was appointed Professor of Dermatology
(1906), College King's at
became President of the Section of Dermatology at the RSM (1919-21) and (1927). Association British Dermatology President the of of was appointed Henry
Radcliffe
Crocker,
Tilbury
and
Thomas
Fox,
Henry
MacCormac, James Startin and Malcolm Morris were among the Harley Street men who became well known dermatologists. Crocker who was described as "the foremost dermatologist of Britain! ' worked with and Fox UCH in Tilbury He 1879.83 the at assiduously succeeded subsequently later in his of cases which were number published vast a recorded (1893). Skin, Diseases Although Atlas he the the of of was monograph, regarded
as a specialist,
his obituarist
claimed his expertise lay in his
from 84 dermatology the to point of view of general medicine. see ability
Obstetrics and Gynaecology Obstetrics was an enduring area of controversy in the nineteenth century deliver babies did their practitioners general as part of role as only since not the family responsibility.
doctor, but the man-midwife or accoucheur also had this Obstetric
physicians
and
surgeons
largely
confined
themselves to the practice of obstetrics, they were not specialists in the strict
dealt they also with general patients. sense, as
82Anon,'Arthur Whitfiel&, BMJ, Feb. 15,1947,p. 274. 83Dr Pernet,'Henry RadcliffeCrockerý,BMJ, Sept.11,1909,p. 732. 84Anon,'Henry RadcliffeCrocker, BMJ, Sept.11,1909,p. 729.
175
Poor standards
of
practice Harley
and inadequate Street physician,
newly formed Obstetrical
training
in midwifery
Charles Mansfield
stimulated
the eminent
Clarke, and members of the
Society (1826) to campaign for a licence in the
Apothecaries Consequently, Society demanded that students the subject. have LSA the should proven midwifery experience. However, the sitting Royal Colleges' apathetic response to exams in midwifery lay in the dual defined they the subject, which of as neither "pure physic" nor "pure nature Clarke 85 retorted surgery".
that 'Midwifery
is a branch of physic, [or] a
branch of surgery ... it is either medicine, or it is surgery, or it is both: it 861t be Medical Act 1886 the that midwifery was not until nothing". cannot became a compulsory part of the medical curriculum.
Lying-in hospitals, such as Queen Charlotte's in Marylebone (1752) from in London By 1750s. late the the 1890s, 12 mid established were hospitals had been set up for maternity cases. St George's hospital was the first of the London teaching hospitals to create a specific lying-in ward in 1831. Previously women patients had been received in the general ward and in 1842, the first
hospital for specialist women's diseases, (renamed the
Hospital for Women in 1845) was opened in Red Lion Square by Protheroe Smith. Robert Barnes, who beginning in the 1860s, sought to raise the profile improved increased training, through education and and of obstetrics staff
85See Ornella Moscucci, 7be Science of Woman, (Cambridge, 1990), for nineteenth century debates on obstetrics and gynaecology, see also Jean Donnison, Mydoives andMedical men -,A History of the Struggle for the Con trol of Childh&h, (Undon, 198 8). w Report from the Select Committee on Me6cal Education, pp. 1834, Vol. XIII, evidence of Charles Clarke, Q. 4220, cited in Moscucci, Tbe Science of Woman, p. 63.
176
appointments
and representation
on the GMC, became the first consultant
to a teaching
hospital
in
1855. He was educated
obstetric
physician
privately
in Norwich and Bruges and at the age of 15 was apprenticed to a
local medical practitioner;
he later moved with his family to London. Barnes
(1842) St George's Hospital, his MRCS training at qualifying and received before in Paris returning spent a year Mayfair
in 1843. He qualified
to London to set up practice in
MD, London (1848) and FRCP (1857). He
decided to specialise in obstetrics and was appointed Obstetric Physician to the London Hospital, then to St Thomas, before being elected Obstetric Physician at St George's in 1874. Five years later he moved to Harley Street. Perhaps because Barnes was not a Fellow of the Royal College of Surgeons, (which would be the normal requirement for a senior member of him St. George's gave the surgical staff) a side room, away from the main body of the building. The medical historians Terry Gould, and David Uttley, known "whether it this dictated that not arrangement was was commented by a sense of decency, or whether, lacking a Fellowship, he was considered Nevertheless, league". Barnes 87 for in the to major was rewarded play unfit his skill in obstetric surgery by the Royal College of Surgeons in 1883 when
he honorary FRCS: him they granted an was one of the few physicians in honour. He be this to was a celebrated teacher of obstetrics the period given London, St Thomas's George's St the taught at successively and who
97Terry Gould& David Uttley, StGeorgeýg Hospital and theOziginofits (London, 1997), p. 35.
177
Ward Names
the Robert Barnes laboratory
Hospitals;
at St George's Hospital
medical
in his honour. 88 named posthumously was school According to the Harley Street surgeon and consulting gynaecologist
to Charing Cross Hospital, Cuthbert J. J. Lockyer, "the old scissors-and-tape domain began to the the on encroach of abdominal physician obstetric by for fight to the the to right remove pelvic structures and surgeon hospitals in London The 89 teaching their response varied route". abdominal to gynaecological permitted
surgery.
At
St George's, Barnes
was, for
example,
to undertake abdominal surgery, but this was a concession only
Even 90 the the of obstetric practice physician. as standard and not part of
late as 1912, no physician-accoucheur at Bart's was a full member of staff, he permitted nor was basically
to undertake
extensive
because they were not qualified
physician,
gynaecological
surgery,
FRCS. 91 The Harley
Walter Spencer Anderson Griffith,
Street
was the first accoucheur in
did in he FRCS, 1881. When he became a full the take London to which he in do Caesarean 1912, Bart's to the was permitted staff member of 92 sections. Thirteen gynaecology
medical practitioners
(four
also practiced
in Harley
obstetrics),
Street specialised in
including
the
renowned
leading, described "a if foremost, Bonney the Victor was who as not surgeon,
88Blomfield, St Georgeý; p. 76. in 'Forewar&, HistozicalReidewofBiiash Ohstetzics and Lockyer, J. J. Cuthbert so Gynaecology,J.M. Munro Kerr, RA Johnstone and Miles H. Phillips, eds., (London, 1954), p. 355 goMoscucci, The Scienceof Woman,p. 167. 91Green-Armytage, 92Ihid
in Bjitish
Ohstetzics, p. 358.
178
first half the of the twentieth gynaecologist of
century". 93 The 21 Harley
Street men who specialised in obstetrics included the well-known, though later disgraced, physicians Isaac Baker Brown and Herbert Ritchie Spencer. Baker Brown, who was one of the founding governors and lecturers at St. Mary's Hospital, Paddington was appointed surgeon accoucheur in 1851 its first He built large hospital the patients. and successful received when Street in from in first in Harley 1867 Regent's 1870 and practice surgical
Park, but his eagerness to perform clitoridectomies on girls as young as ten to cure them of their insanity resulted in his expulsion from the Obstetrical Society. The Society was not appalled by his method - other members had but Brown had his this coerced operations patients such and performed Spencer, 94The career of obstetric physician to was considered objectionable. UCH, was also discredited when he was accused of undertaking a vaginal examination
on thirteen
year old Eliza Armstrong,
without
her father's
95 consent.
Children's Diseases and Paediatrics (a Street Davis Bunnell John non-Harley man), who earned his MD from Montpellier in 1810, was one of the first medical practitioners to set up a dispensary for sick children. 96 The Universal Dispensary opened at 5 St
Bonney, Gynaecological Victor Surgeon Chamberlain, the Geoffrey 93 of the Twentieth Century, (London, 2000), p. vii. 94Elaine Showalter, Tbe Female Malady Women,Maduess and English Culture, 18301980, (London, 1988), pp.75-77. 95Moscucci, The Scienceof Woman,footnote 66, p. 236. 96Thomas Coram, a retired sea-caption established the London Foundling Hospital, in the hospital first for in England. See Elizabeth M. R. Lomax, the children century: eighteenth Swafl andSpecial-The Development ofHospitals ror chil&. en in Victotian Bzitain (Wellcome, 1996). A dispensary for children in London openedon 24 April 1769 by George
179
Andrews' Hill, Doctor's Common in 1816, with the Dukes of Kent and Sussex as patrons. 97 The dispensary thrived until Davis died in 1824 and then languished
for 15 years until
the Harley
Street physician,
Charles
West began to work there, where he remained for 10 years. During his time
he it into dispensary, hospital to the vigorous attempts made convert a at facilities, but His however, in-patient was not successful. were efforts, with launch Hospital he for Sick Children, Great the in to on went vain, as not
Ormond Street in 1852.98This was made possible because hospitals grew larger and gained prestige during the second half the nineteenth century; consequently,
their outpatient
departments
began to absorb patients who
had previously used a dispensary. 99
idea Victorians, hospital the the of establishing a children's was For Im-
doctors because by many children were regarded as contentious and opposed difficult
describe their symptoms and often all, not, after could who patients
The hospitals in teaching intensive their varied nursing. response required London Hospital in the junior opened a children's to ward patients; whereas 1840, children were still being mixed with adult patients until 1923 at St Bartholomew's.
late as as
Opposition was also mounted because it was
hospital to that would encourage childrenýs poor parents a neglect assumed
their responsibilities.
Armstrong in Red Lion Square in Holborn, seeJules Kosky and Raymond J. Lunnon, Great Ormond Street and the History ofmedicine (London, 1991), p. 4. 97Alfred White Franklin, 'Children's Hospitals'in Poynter, Medical Education, p. 108. 98For research into Great Ormond Street see,Andrea Tanner, Great Ormond Street Hospital Registers Project, Lance4 March 9,2002, pp. 897-98. tv Irvine Loudon, 'The Origins and Growth of the Dispensary Movement in England' (198 History 55 1), pp. 322-42. the BuBetin of ofMedicine,
180
It was Edwin Chadwick's 1842 Report on the Sanitary Condition of the Lahouzing Population of Great Britain, depicting the high mortality in living districts in manufacturing towns, that children slum rates of small challenged the idea that the home was the best place for a sick child and indicated that there was a need for special hospitals for children. Following Chadwicles report, the establishment of charitable institutions
for the
deserving poor became an acceptable option and made it easier for Charles West to set up a hospital exclusively for children.
West was educated at a school run by his father and then apprenticed to a general practitioner in Amersham. He entered Bart's in 1833, but after two years went to Paris and then to Berlin where he earned his MD in 1837. He was considered to be an outstanding student at Bart's where he won the first in in Midwifery in Medicine 1834, the prize prize
and the prize in
Forensic Medicine, both in 1835.100 He practised in Dublin made midwifery Infirmary
initially
and
his speciality; on his return to London in 1839 he joined the
for Children,
Waterloo Bridge Road and
there in 1842. He qualified
was made physician
FRCP in 1848, published his Lectures on the
(which Childhood, Disease ofinfanc: y and went through seven editions), and
in Midwifery Lecturer Bart's. He held lectureship for the at was appointed 12 years, contributing to his reputation as an expert on the diseases of
(8 August 1816-19March 1898) MD, Berlin and FRCP, Munk ýFRoll West 'Charles Anon, 100 VOIIV(1848). Felix S Besser, "Notes on Dr Charles West and his grave in Chislehurst (Kent)", History ofMecUcine,Spring 1975,Vol 6, no 1, pp. 47-50.
181
full lectures He 101 gave a course of also on children's women.
diseases in
1847 at the Middlesex Hospital. In 1850 West spent a year abroad researching children's hospitals. On
his return to London, with the help of Lord Ashley (later Lord Shaftesbury), he set about raising funds for a children's hospital. After securing the his West William Jenner funding, medical colleagues, and and essential Henry Bence-Jones, established the Hospital for Sick Children in the house Anne's in Great Ormond Street, Queen Mead, Richard physician, which of St Day There few in Valentine's 1852. its door were very on patients opened
the first six weeks, and it was not until the novelist Charles Dickens first description hospital, Buds", it "Drooping the the that of published A its Queen Victoria after week publication, received some recognition. became the Patron and mothers started bringing their children to the hospital. 102 West was the hospital's senior physician for 23 years, resigned from its staff in 1875 and was subsequently
appointed
consulting
physician.
Samuel Gee, also of Harley Street, worked at Great Ormond Street whilst William Jenner resigned in 1862, one year after being appointed PhysicianExtraordinary to the Queen. Jenner stayed on as consultant physician and for Sick Victoria Hospital Children its inception his to the time on also gave
10,Anon, 'Charles West', Lancet, Apr. 2,1898, pp. 968-970. 102Kosky and Lunnon, Great Ormond Street, pp. 6-7
182
in 1866.103 By 1862, children with diseases of the bones and joints formed (10.7%) inpatients largest the of at Great Ormond Street. single groups Following the establishment
of Great Ormond Street, new paediatric
hospitals opened in London and across Britain.
Over a period of 40 years,
from the 1850s, ten children's hospitals opened in London. Various Harley Street medical practitioners were attached to all of these hospitals, such as the Victoria
Hospital
for Sick Children,
by the Harley which was set up
Street surgeon George Cowell and Edward Ellis (non-Harley Street) in Tite Street, Chelsea in 1866. Other London children's hospitals included the East (1868), Shadwell Cheyne Children's Hospital, Children, for Hospital London Chelsea (1874), the Evelina Hospital
(1869) and Paddington Green
(1883). Hospital Children's Britain did not have a chair in paediatrics until after the First World War. Whilst,
King's College appointed
George Frederick
Still,
a Harley
Street physician who specialised in paediatrics, as an honorary professor of in 1906, this was a non-stipendiary disease the of children
college position
Still than who remained a physician at professorship. a university rather Great Ormond Street for 30 years, was later considered by many to be "the father of British clinical paediatrics7. His work on juvenile rheumatoid arthritis
led being known "Still's to the condition as subsequently
it was advantageousfor somespecialiststo adhere rigidly disease".104VVhilst involve it could also to one subject,
financial great
risks.
George Still
Small and Speeb],p. 158. 103LOMaX, & Stilr, Miller-Keane, RMJ, July Encyclopaedia 12,194 1, 69 Frederick 'Sir p. and 104Anon, (Pennsylvania, Nursing & Allied Health, 1997),p. 1532. Dictionary ofMedycine, 183
realised
it was possible to make a livelihood
out of paediatrics
only in
London; his colleague in Edinburgh, Dr John Thomson, whom he regarded just living the could of all paediatricians, not greatest make out of a as treating children's diseases.105 In 1890 there were about 50 convalescent homes for children in England and by 1900, the former entrenched notion that sick children would home had been from It the thrive reversed. was then thought that away not institutions dedicated isolation within specifically to their children required treatment.
As Roger Cooter observed, there was a "gradual disappearance
toward the end of the nineteenth century of hospitals for both women and institutions the of rise specialist subsequent children, and
for each".106
Although 7.46% (n = 49) of the cohort were on the staff of a children's hospital, only a handful including West, Still and Eric Pritchard, confined diseases the to and treatment of children. 107Perhaps as their practice Lomax has suggested, medical practitioners
realised that
being financially hold did the promise of a out not paediatrics
advantageous
Elizabeth
speciality-108
Electro-therapeutics, Radiography and Neurology Although medical practitioners had used electricity as a therapeutic aid on Guy's the century, eighteenth was the first teaching their patients since
105Newman, 'Specialism', p. 172. (ed. ) in Roger Cooter 'Introduction' In the Name ofthe Cbild-* Health and Cooter, Roger 106 (London, 1992), pp. 1-18. 1880-1940 Welfare 107Pritchard was a pioneer in child hygiene and was director of the Infants' Hospital, Vincent Square, Westminster, the largest children's hospital in Britain in the 1920s and Pritchard', 'Eric BMJ, Nov. 6,1943, pp. 591-92. Anon, See, 1930s. io8 Jomax, Small and Special, p. 9
184
hospital
to publicly
"electrifýing
endorse the procedure and in 1836 designated
an
From for 109 1870s 1850s the to the this a purpose. room"
in in hospitals electro-therapeutics were established specialising number of Mayfair and the Harley Street Area. The first and largest of these in the Victorian period, the National Hospital for Paralysed and Epileptic, was
founded in Queen Square in 1859. In the 1860s the London Galvanic Hospital opened in Cavendish Square (1861) whilst the London Hospital for Epilepsy and Paralysis was established in Regent's Park in 1866 (renamed the Hospital for Diseases of the Nervous System in 1888). The fourth institution
dealing with epilepsy and nervous diseases in London, the West
End Hospital for Nervous Diseases, which opened in 1878.
All the Harley Street men who specialised in diseases of the nervous hospitals. In first these the the one of of specialist staff on system, were 14 twentieth the nine out century, senior Physicians and surgeons quarter of in the National
Hospital for Paralysed and Epileptic
including men,
the physicians,
Howard
were Harley
Street
Henry Tooth, Thomas Grainger
Stewart, Samuel Alexander Kinnear Wilson and the surgeon, Donald John for the Other 110 Armour. medical staff, example the physician, members of William Aldren Turner
Percy William George Sargent, the surgeon, and
interest in diseases. but had a special nervous not exclusive One of the principal founders of the London Hospital for Epilepsy (1855) Althaus Julius MD from the Paralysis who graduated was and Measure Man: Technologizing 'The Victorian Body', History of Morus, the Rhys Iwan of 109 Science,xxxvii, (Bucks, 1999),p. 4 110Hewitt, YearEookpassim.
185
University of Berlin and later settled in London becoming MRCP in 1860.111 Althaus first established a practice in Bryanston Street, Marylebone using in Street before diseases Harley 1884. to to treat moving nervous electricity A prolific
his Treatise Electricity his Medical on specialty, on
writer
went
(1859-1873). In Treatise he the three cautioned that through editions by be "powerful trained which should used a agent", only a electricity was Wilhelm 112 physician.
Roentgen's subsequent discovery of X-rays in
WUrtzburg in 1895 led to the establishment of X-ray departments in all the by First World War. Some Britain in the the hospitals the of earliest major including Street Warren Shenton, Edward Harley men, radiologists were described "pioneer Guy's was who as a radiologist". surgical radiographer at He made numerous original contributions to the speciality including an instrument
to detect metallic foreign bodies. His X-ray photographs brought
him universal radiologists
recognition
in the medical profession. Other as an expert
included Robert Knox, consultant
radiologist
to King's, Hugh
Walsham and Henry Lewis Jones, both consultant radiologists to Bart's. In the first
quarter
of the twentieth
century
Robert
Knox was
described as "the best-known British radiologist abroad" for his original (1892), MB/BS Edinburgh Knox LRCP/MRCS in qualified radiology. work (1893) and gained his MD Edinburgh in 1897. He began his career in Great department Northern Hospital before the the of electrical radiology at being
appointed
Director
of the
Electrical
and
Radio-Therapeutic
(June D!, Ritish MedicalJournal, M. 16,1900), p. 1508. Althaus, Julius Ht Anon., Althaus, A Treatise J. Medical MaW, 6-7. EjectHcjt: Measure 'The MOrUS, pp. on of y, 112 its Neuralgia, Treatment Practical, the * usein OfPara]Ysis, and andother yyleoretical and Diseases, (London, 1859), p. 344.
186
Department
at the Cancer Hospital, Fulham in 1912.113The following year
he became the senior radiologist at King's. In
1891, when the Harley
Street
(a Steavenson Harley Dr. non succeeded
physician
Henry
Street practitioner),
Lewis
Jones
as medical
department in the electrical at Bart's, it was a simple one charge of officer into divided a waiting roomed structure,
room for patients, a room
bath, the an operating room and a consulting room. 114By electric containing
the 1900s, the department had expanded fourfold, excluding ancillary rooms that were used for X-rays. Jones, considered the "founder of the English school of electro-therapy
influential its most and
teachei', introduced a number of innovative
in included Bart's treatment the to of paralysis, which using mains methods lighting instead from from batteries. the the He of street current electricity (chemical) method and diathermy (high frequency ionic introduced the also into Britain. Jones involved his currents) was actively with electromagnetic speciality,
writing
numerous papers and articles on medical electricity.
In
(1903President Electro-therapeutic becoming the Society to of addition 1904) and editor of its
Transactions, he was instrumental
in the
the electro-therapeutic section of the newly established of establishment RSM in 1907. The Harley Street surgeon, Chisholm Williams became the Secretary. London first section's
113Lyle, Mngiv, p. 401. 114Anon, 'Henry Lewis Jones', BMJ, April, 17,1915, pp. 700-701.
187
Until the nineteenth century the study of diseases of the nervous (later neurology) was viewed as part of internal system
It medicine. was not
half developments in the the second of nineteenth century with neurountil became that neurology physiology and anatomy a specialist subject. 115The
Harley Street physician, Samuel Alexander Kinnear Wilson, was one of the figures in international neurological medicine. 116He was most renowned MB Edinburgh 1902 BSc. later. He and qualified at and a year educated house for Royal Edinburgh time the as a physician short a at worked Infirmary before going to Paris where he worked with Pierre Marie (18531940), a pupil neurological
disciple Jean Martin of and
clinic
was
internationally
Charcot (1825-1893), whose
recognized.
In
1904, Kinnear
he house England to got a post as where physician at the National returned Hospital,
Queen Square, eight years later
physician
to Westminster
he was appointed
assistant
Hospital and became Dean of its medical school
two years later. In 1919 he moved to King's College Hospital and was made junior
neurologist
and lecturer
in neurology
to King's
College Hospital
(1919). In 1928, following the retirement
of another Harley Street physician
William Aldren Turner, Wilson was appointed senior neurologist at King's. Wilson retained his loyalty to the National Hospital for most of his career, his the ranks of resident medical officer, registrar, to an up way working appointment
in-patients to as physician
(1925). He became a long standing
(New A Sbart HistozyYork, 1982), p. 202. Ackerknecht, Erwin 15 ofModidne, 116Anon, 'S.A. Kinnear Wilson, Lance4 May 22,1937, pp. 1253-54.
188
friend and follower of one of the founders of British neurology, John Hughlings Jackson (1834-1911). Wilson
was among the Harley
Street physicians
who also had a
disease named after them. In 1912, he published his discovery of inherited journal Brain, in disease linked liver the the which cirrhosis of progressive in brain degenerative the changes with and
the body's inability
to
become known Wilson ýr disease. is He as which also well metabolise copper, known for his work on various disorders of muscle tone and hysteria. Wilson was a prolific
his included speciality which writer on such monographs as
Modern Views on Neurology (1928). He delivered the Croonian lectures at (1925) (1930) lectures Morison RCP, Edinburgh the the RCP the at and on his subject. He was described as an able teacher, whose lectures at the National Hospital were attended by "throngs of students from all over the worl&'.
117
One of the described
by
frequently
the Harley
expressed objections
Street consulting
to specialism
physician
was
to the National
Hospital, Queen Square and to Charing Cross Hospital, Sir Gordon Holmes,
Square Queen that who said of foundations hostility the to the the new exposed which was risks was one of hospitals, to the the establishment profession of special medical as at the of time several institutions had sprung up in London, sponsored by quack or irregular practitioners or devoted to special, and usually unorthodox 118 treatment. of method
117]bid
118Gordon Holmes, National Hospital Queen Square, (London, 1954), p. 12.
189
Holmes was also a Harley
Street eponymist
who gave his name to the
Holmes-Adie syndrome (which symptoms include a dilated pupil
in
leading disease). He in the one of was specialists neurological cerebellar in twentieth the early medicine
century.
Other Harley
Street men who
diseases included in Henry the the nervous system of physicians specialised Head, Frederick Stephen Palmer, Frederick Eustace Batten, James Purves Stewart and the surgeons Edwin Lancelot Ash and Donald John Armour. Pathology From the first quarter of the nineteenth century, pathology was an intrinsic
London hospitals. Whilst the teaching the at curriculum medical part of Guy's Hospital,
for example, taught
the subject from the opening of its
W. D. Foster, in to 1826, there according were no professional school medical
It in Britain time. doctors the 1840s the that was not until at pathologists in demonstrators morbid anatomy and who commonly acted who worked as in by of charge pathological specimens were appointed curators as museum hospitals. Though these were junior posts, this was London teaching the to the stone coveted consultant appointments stepping useful nevertheless a
hospital. the at Charles Alfred Ballance, an aural surgeon, was amongst the leading A his in Harley Street in the pathology. year of after practise arrival experts in 1884, Ballance was described as the driving force in the development of diagnostic bacteriology at St. Thomas's Hospital. 119Another prominent
figure in the field was Henry Trentham Butlin, who was describedas "one of 119Lomax, Swal/ and Special, p.
190
the most distinguished members of the profession!'. 120He had planned to become a general practitioner in Kent but changed his mind after acting as James Paget's house surgeon, and decided instead to remain in London to develop a consulting
practice. Butlin
was a surgeon and pathologist
and
later the first Dean of the Medical Faculty of London University. In his role Society, he Pathological delivered its President the the of address at as jubilee in 1896.121Butlin was a member of the Council of the RCS from 1895-1912 and held the office of President from 1910-1911. William
Watson Cheyne, considered a pioneer in antiseptic surgery,
Lister's Joseph was
first
House surgeon at King's
College Hospital
in
1877.122He became interested in surgical pathology to such an extent that "he nearly ruined himself as a surgeon by becoming too well known as a In 123 addition pathologist".
to his role as President
Society, Cheyne also served as President
of the Pathological
(1914-1917), RCS the the of
(1902) (1912). Medical Society London Society the Harveian and of Some Other Harley Street Specialists When Hugh Morriston Davies specialised as a thoracic surgeon in London in 1910, it was then a completely new field of surgery in Britain:
many
believed that diseases of the lungs and chest could not be surgically treated. Davies was educated at St George's Ascot, Winchester and then Trinity College, Cambridge where he qualified BS (1904). After graduating, he 120Anon, 'Sir Henry Trentham Butlin', BMJ, Feb. 3,1912, p. 277 221[hid. The Rotral College of Surgeons ofEngland Histor The Cope, Zachary v of 122 p. 313. 123Lyle, Mngý;, p. 339.
191
(London, 1959),
trained at UCH where he met Wilfred Trotter with whom he would share a house in Harley Street in 1912. Davies became FRCS in 1906 and later (1908) (1907) his Alma MD Mater. his MD, MS Following at and qualified he spent a month in Germany to learn the language and when he returned to London in 1909, he accepted the position of Assistant Surgeon at UCH. His appointment provoked strong opposition amongst the surgical staff at the hospital as Davies's surgical methods were considered unorthodox; the junior physician declared that Davies had "no right to be a surgeon at this hospital. accepted
I have done my best to oppose you. It is a disgrace that they yoll".
124
Another Harley Street medical practitioner, Arthur Edward James Barker, who introduced spinal anaesthesia into Britain, helped Davies with UCH. Davies decided his X-rays to the at study patients of a number of patients
with
diseases of the chest, but he faced continued
opposition
later UCH. Davies his recalled: at colleagues amongst but I went on to fight the surgeons and physicians in the hospitals! I knew that X-rays were going to tell us things we did not know before. But they didn! t believe me! There was a big row. My fellow physicians thought I was it 125 felt I but essential. was crazy,
In 1912, Davies performed the first thoracic operation in Britain in which he female her lungs that the patient so of a collapsed, allowing ribs removed
itself. The 126 to diseased tissue repair patient recovered well and lived the for a further 27 years.
(Wales, Hugh Morriston D,? Pioneer Surgeon, Thoracic Webb, 1879-1965, Kathleen 124 fies, 1998), p. 3. 125 Webb, Moz7iston Dafies, p. 17. 126. fbid, p. 18.
192
Described as a pioneer in mental illness, Francis Warner, physician
to the London Hospital, was one of the first to embark on clinical research into the physical and mental defects of children. 127In 1890, he published his from in 50,000 106 London, which revealed children schools on research large variations in the development of children from different locations and Street Harley in backgrounds. diseases 128 included specialists mental ethnic the physicians Thomas Claye Shaw and John Langdon Down. Shaw gained his experience at Colney Hatch Asylum before becoming Medical Director of Banstead County Asylum, Surrey. He was a recognised authority
in mental
disease and a campaigner for the creation of mental clinics in out-patients departments
of
general
hospitals. 129 Langdon
Down,
identified
the
(re-designated in 1866, Down's with mongolism associated abnormalities The Langdon Down's in 130 1961). later of results research was syndrome MentalAffections published as
(1887). 131
Urology, was established as a specialist subject in Britain through the Sir Street Henry Thompson. Wimpole Known "the the surgeon, of as work father of British urology", Thompson first delivered a paper on the prostate in The Harley RSM 1857-132 the gland at
street surgeon, Cyril
Arthur
127Anon,'Francis Warnee, BMJ, Nov. 6,1926, p. 857. 128Anon, Varner, pp. 857 and 1022.
129Lyle,Mngý?,P. 159. Davis Coakley,Iiish MastersofMedicine,(Dublin, 1992),p. 259.Other eponymists 130 included GeorgeBusk, a skilful anatomistwho discoveredlarge parasitesin the duodenal lumen of an East Indian seamanat post-mortemexamination.The organismwas buski Distoma by E. Ray Lankester. the See Cook,Gordon, named zoologist subsequently (1807-1886), NineteenthCentury Polymath:Surgeon,Parasitologist, FRS, Busk "George Zoologistand Palaeontologist',Journal ofMedicalBiography,Vol. 5,2, (may 1997),pp. 88101. 13,John LangdonDown,MentalAffectionA CLondon,1887). RSX, P. 143. 13211unting, 193
Rankin Nitch was also regarded as a pioneer in the development of urology in England. He was responsible for starting
urology as a speciality at St.
Thomas's in the 1920s by establishing an outpatient department for those diseases 133 tract the urinary of with . Orthopaedics emerged as a special branch of surgery in the nineteenth century when medical practitioners began to focus on the deformities in the their patients, particularly of skeletal system of correction
A 134 Paris, advances, such of as number quick-drying plaster of children. devised by leg Hugh Owen iron Thomas, Liverpool splints or arm of and (1834-91) greatly assisted patient recovery. It was not, however, until after the Great War that orthopaedics was generally recognised as a speciality, acquiring
academic
departments
support
as medical
introduced hospitals and
the leading orthopaedic
schools developed orthopaedic
special surgical procedures. One of
surgeons in Britain,
Sir Thomas Arthur
Harold
Fairbank, joined the staff of the Charing Cross Hospital, as an orthopaedic before he in Harley Street. in 135 Charing Cross 1904, arrived year a surgeon hospital London first to for the elect a surgeon exclusively orthopaedic was
he Great Ormond When to the Street he appointed staff of was work. It First World the War that was not surgeon. until general after a as worked Fairbank was asked to run the newly established orthopaedic department at King's College Hospital.
133Anon, 'Cyril Arthur Rankin Nitch, Lancet, Sep. 27,1969, p. 702. 134For a history of orthopedics see, Roger Cooter, Surgery and society in Peace and War, (1--ondon, 1993). 135Anon, 'Sir Thomas Fairbank, BMJ, March 11,1961, pp. 751-52.
194
Teaching Hospitals and Specialist Departments The number of special departments in London teaching hospitals rose from 23 in 1855 to 52 in 1875, which Peterson argued was as much to do with the Victorian of practitioners ambitions monetary
as with philanthropic
motives
In 136 desire however, the to the science. serve nineteenth century, or teaching hospitals remained formal institutions
with a high degree of
London hospitals, Medical St teaching staff at and surgical such as protocol. Mary's, were expected to resign if they accepted a position at a specialist hospital,
particularly
teaching
hospital's
if that hospital dealt with cases normally remit.
The Harley
Street
part of a
surgeon, Walter
Coulson
in he St Mary's 1865 his when at was offered the position position resigned Hospital for St. Peter's Stone. He the to was unsuccessful of senior surgeon be St Mary's, later he to tried re-elected at when Elsbeth
Heaman
"into the twentieth argued,
probably because as
century
St Mary's
was a
bulwark of generalism". 137Similarly, newly appointed staff at teaching hospitals
were normally
expected to relinquish
However, hospitals. approximately specialist
previous appointments
half (47.62%, n=
at
10) of those
holding hospital posts at St Mary's had other staff positions, and this became increasingly more prevalent from the time of the First World War. In the mid-nineteenth century, St Mary's relaxed its stance on in-patients in they where would not usually accept areas such as specialism,
diseases, fever the or venereal maternity or skin cases and children,
136Peterson, Medical 1ý*olession,pp. 248-249. 137Heaman,StMaes, p. 43.
195
insane. 138The paediatrician, Reginald Henry Miller, was, for example, a both St Mary's Paddington Green Children's to and paediatric physician Street in in Harley William he 1914.139Likewise, arrived when
Hospital
John Gow, Obstetric Surgeon to St Mary's, was concurrently consulting Waterloo Hospital for Children Royal Women to the and and gynaecologist Charlotte's Queen Lying-in A Hospital. to similar consulting physician St George's Hospital, during discernable the nineteenth at precedent was in diseases, had ophthalmology obstetrics, or childhood experts only century, St George's. hospital outside posts additional To counter the threat established greatly.
their
King's
from specialist hospitals,
departments. own special
College Hospital,
comprehensively
teaching hospitals
The change of pace varied
for example, did not adopt specialism
it had 1930s the when profited from the work of such until
Harley Street men as Sir George Still in paediatrics, Harold Arthur in orthopaedics and Samuel Kinnear
Fairbank
1831, Guy's was the first ophthalmic
London
teaching
Thomas
Wilson in neurology. 140In hospital
department. 141St Mary's opened an out-patient
to establish
an
clinic in 1867,
diseases. However, it in throat 1882 that and was not until skin specialising Malcolm
Morris
Harley of
Street was appointed
dermatologist. 142After Morris's medical training 1870, he returned 138Peterson, 139Heaman, 140Newman, 141Cameron,
to Yorkshire
as the hospital's
first
at St. Mary's Hospital
in
to work in general practice. Nevertheless,
MedicBLI'm'Fession, p. 104. StMauý;, P. 168. 'Specialism', p. 178. Guyýg,P. 191.
142Anon, 'Sir Malcolm Morris, BMJ, March 1.1924, pp. 407-409 and Cameron, Guyý;, p. 107.
196
his interest in skin diseases encouraged him to accept an appointment to the
Skin, Diseases Blackfriars Hospital he "lost the the of of no time and staff at in identifying himself with the speciality in which he was later to become a leader. "143He was the first surgeon to be elected to the skin department at St Mary's, and he continued his work as a surgeon at the Seamen's Hospital,
Greenwich.144 Specialisation was further advanced at St Mary's when the dean of its
Street Harley George Purdey Field, the aural surgeon, medical school, build by to the the new special wards extending governors persuaded hospital onto Praed Street. By the end of the 1880s ophthalmic, aural, dental and dermatological patients could separately be accommodated.145 Of the senior staff of St George's Hospital only 10 out of 98 (10%) four Only Humphry 146 Street these, Harley of men. were
Davy Rolleston,
Robert Barnes, Robert Brundell Carter and Harold Barr Grimsdale, became his George's. 147Rolleston St through the to worked way ranks of consultants (1898-1918) (1893-1898), finally physician and was assistant physician in December Until 1918. physician appointed consulting dealt George's St exclusively with specialists at
the 1890s,
diseases of women
(obstetrics and gynaecology) and diseases of the eye, all other conditions hospital's by Carter the dealt general surgeons and physicians. with were first hospital's in 1893 the registrar ophthalmic and was was appointed 143
1hid 144Anon, Worris', BMJ, pp. 407-409 145Heaman, StMaiyý; p. 108. 146Compiled from a list of senior and junior staff members between 1733 and 1933 in Blomfield, St Georgeý;,pp. Appendix II and III, pp. 110-113. 147 1hid
197
first St George's having to consulting surgeon elected served as ophthalmic
(1870-1893). Arthur surgeon
Gamgee (1887-1889) was elected assistant
(1889-1897) George Francis Penrose Golla Frederick whilst and physician (1920-1923) became physicians. Apart from the obstetric and ophthalmic wards, none of the cohort worked as surgeons or assistant surgeons to the hospital. Hospital Appointments
held by the 1845,1880 and 1914 Groups
The hospital appointments held by the Harley Street men and those from the Harley Street Area and a sample from Greater London were examined for the years 1845,1880 and 1914. Results are shown in Tables 4.3,4.4
and
4.5 Appendix D, respectively. Although this comparative study was based
in it found 1845 Harley that practitioners of medical was number on a small Street (12.50%, n= 1) and the Harley Street Area (52.62%, n= 10) had more consulting
from the London teaching and physicians surgeons senior and
(5.94%, London Greater hospitals than n= 6). The data also confirm that 50 Street Harley 31.58 from Harley the the cohort and per cent of cent per Street Area did not hold a staff post in 1845 (which may be due to omissions in the Medical Directory as discussed in Chapter One), whilst the majority,
did London, Greater in 78.22 per cent not have a staff position in the period. The numbers in Harley Street, however, were too small to make decisive judgements
on the professional profile of these groups, consequently
the
1914 1880 were also analysed. and years
When Peterson evaluated status in London teaching hospitals in 1878, she used the criteria of rank and suggested that senior status in a 198
hospital could be used as an index of success. From this basis she then argued that for most of the nineteenth century, the inner circle of elites numbered no five London just 180 than percent of all practitioners more over one and in England practitioners of medical and Wales.148 percent
An examination of all the medical practitioners in Harley Street and the Harley Street Area just two years later, indicates that a large proportion of Street held in Harley London the teaching senior positions at practitioners hospitals. In 1880 there were 26 men in Harley Street, in addition to the 45
from the Harley Street Area, which represents almost 40 per cent of the inner circle. In contrast to Greater London in 1880 (38.18%, n= 126) few Harley Street men (10.79%, n= 30), or those from the Harley Street Area (10.53%, n=
42) relinquished
practice. disorders
their
hospital
posts when established
in private
Edwin Lancelot Ash, a specialist
in the prevention
of nervous
to the Kensington
General Hospital
(previously
and physician
house physician at St Mary's Hospital) was one of the few Harley Street hospital their to appointments owing pressure of private resigned who, men
149 practice. (37.05 third, In 1914, over a per cent, n= 103) of those registered in
Harley Street were either consultants or held a senior posts at one of the London teaching hospitals, whilst slightly fewer (30.58 per cent, n= 122) Street Area held Harley in This these the positions. contrasts registered in Greater London; tiny the of medical practitioners proportion only with 148Peterson, Medical A%fession, P. 137. 1497yie Medical noýg no, 1913, p. 18.
199
2.12 per cent (n = 7), who held similar appointments.
Thus, Harley Street
had fifteen times as many prestigious consulting or senior physicians and
in Greater London general. as surgeons Three quarters of Harley Street men (73.74%, n=
205) held a
in hospital, in teaching a or a general post contrast consulting or senior staff
(62.66% Street Area in Harley the to two thirds ,n=
250) and (10%, n=
33) in Greater London. The majority of those in Greater London (73.94%, n hospital in held 1914, the time the 244) at a at of post sample staff no = (though 35.76%, n= 118, had held one previously) the opposite was true for Harley
Street where only 16.55 % (n = 46) did not hold a current
appointment
staff
(10.79%, n= 30 had a former hospital post) whilst 22.56% (n =
90) from the Harley Street Area, did not hold a current staff appointment
at
(10.53%, held Thus, 42 hospital times one previously). n= eight as many a of the medical practitioners
in Greater London (38.18%, n=
126) held no
hospital appointment at all by 1914 as opposed to those from Harley Street (5.76%, n= 16). Thus, it may be argued that a hospital appointment
was a
Street Harley in successful practice. creating a sine qua non Multiple
hospital appointments became increasingly common over the
the the of a reflection changing nature was of medical which period, hospitals in the of special growth and professionalisation and profession Hancock Harley Henry Street held In the 1845 was only man who medicine. (at hospital Charing Cross Royal Westminster the than post and one more
Ophthalmic Hospital). By 1880, the number with more than one hospital appointment,
had increased to 36.84 % (n = 21) in Harley 200
Street; the
held The distinguished two three either or positions. majority obstetrician Robert
Barnes,
consulting
physician
to St George's Hospital,
was an
he held hospital in 6 diseases other since posts of women and exception, (56.47%, half By Harley Street 1914, 157) than the more n= group children. had multiple posts. The majority held two posts (32%, n= 89), followed by (5.76%, (3.60%, (14.03%, four five 39), 16), three posts posts n= n= n= 10) (48.62%, (1.08%, Just half 3). in finally 194) the under n= six men n= and the Harley Street Area held multiple hospital appointments. The majority held two posts (28.32%, n= 113), followed by three posts (14.54%, n= 58), four posts (4.76%, n=
19), five (1%, n= 4). Only a minority in Greater
London held more than one hospital position (6.66%, n= 22), most of these held two posts (5.45%, n= 18), whilst two men held three posts, two held four posts and only one, G. D. Robinson an obstetric physician registered at Portman Square held six hospital appointments.
Thus, over eight times as
from Street Harley Street times Harley the and seven as many men many Area held multiple hospitals posts than those from Greater London. Teaching Appointments Half the cohort (49.77%, n= 327) lectured at some point in their careers, of these, approximately
(n fifth from 71) their teaching post before = retired a
Street. Whilst Harley in George Harley, were others, such they arrived as forced by the pressure of private practice to resign their teaching posts. The include to British physiology as a recognised subject on medical college only College in University London, 1845 though the the medical curriculum was
201
subject was at that time theoretical rather than clinical. 150A decade later George Harley was invited by UCL to lecture in Practical Physiology and first became the subsequently
Professor of Practical
Physiology in
England. 151However, his Harley Street practice flourished to such a degree that he was forced to relinquish his lectureship in 1869. A proportion of the cohort lectured at Bart's (n = 27), and the Middlesex (n = 27), the most prosperous of the London medical schools. Teaching posts at UCH (n = 26) and the London (n = 24) were the next (n (n George's St 11) Royal Free the 6) = and whilst = choices, were popular (15 Overall, demand. in the least teaching the single most common post per cent)
amongst
the cohort
was demonstrator
of anatomy
or assistant
demonstrator. Demonstratorships were junior positions brought in by the London teaching hospitals from 1840 onwards, whilst the assistant positions 152 the the towards of nineteenth century. end appeared Apart from these junior positions there was no preponderance of any particular lecturer
subject taught
in general medicine or surgery and in many specialists subjects.
The vast majority post
at
by the group; they ranged from professor or
a time,
Street Harley medical practitioners of only
three
individuals
had
multiple
held one lecture posts.
Charles
Wilberforce Daniels held the greatest number of teaching posts, as he
-rst 150Sir Edward Sharpey-Schafer, F.R.S. History o(tI2ePbvsJ6IqgicvjSOCiet y during its j:L (London, 1927), pp. 1-2. fiftyyvars-'1876-1926 (ed. ) GeorgeHarley F.R.S. or the We of a London Pbysician, Tweedie, Alec. Mrs 151 (London, 1899), pp. 120-21. Profession, MedfCal Peterson, p. 160. 152
202
lectured
on tropical
diseases concurrently
at the London Hospital,
the
LSMW and the London School of Tropical Medicine. Teaching posts held by those in Harley Street, the Harley Street Area Greater London from for 1845,1880 the were examined years sample and a
in Table Appendix 4.6, D. The 1914 these results are shown and and (n in Harley Street in had 1914, 128,46.04%) twice that = as many showed teaching
than those in the Harley
appointments
Street Area and fifteen
times more teaching appointments than practitioners
in Greater London.
Inventors A number of the earliest specialists in the Victorian
period, such as the
Edward James Barker, Edward Canny Ryall,
Harley
Street's Arthur
Morrell
Mackenzie, James Coles, Henry Hancock, Hugh Morriston
George Buckston Browne and Victor Bonney designed instruments
Davies, to assist
them in their practice. Baker, who was one of the original authorities on invented instruments for his number a of surgical abdominal surgery, speciality,
"surgical the was one such appliance
sewing machine", which
his designed be to to the needle and was re-thread need used on eliminated be but body. 153 the used on equally other parts could of the abdomen, Ryall, who was described as a "pioneer in genito-urinary
worle',
developed his speciality in the 1920s at the All Saints Hospital, Buxton Road, London. Among the many instruments developed by Ryall in the 1920s, his prototypical
cystoscopes and endoscopes were still in general use
Coles James invented the orthopaedic sofa for the later. decades two James Edward Baker, LanceA Apr. 22,1916, p.883 'Arthur Anon, 153
203
treatment
of spinal afflictions,
and Henry Hancock created "an apparatus
for the treatment of fracture of the clavicle". 154Although Sir Morell Mackenzie
devised
many
instruments
for
his
laryngological
practice,
down he his his he felt "it to played obituarist achievement as was according it for think to who would men worth while claim credit only second rate ingenuity of that mechanical
kind.
"155
Conclusion The rapid proliferation of special hospitals at the end of the nineteenth century exemplified
the changing nature of medicine in Victorian
London.
Such Harley Street men as Charles West, George Cowell, James Startin, Morrell Mackenzie, Julius Althaus and Robert Brudenell Carter were at the forefront of establishing special hospitals for children, dermatology, throat diseases, electro-therapeutics these hospitals
and ophthalmology
respectively.
in response to the development were set up
Many
of
of technical
for the that creation of sub-disciplines such as the allowed apparatus X-rays laryngoscope techniques and and new such as the ophthalmoscope, George Critchett, Morell Mackenzie, Hugh of work surgical pioneering Morriston Davies and James Mackenzie, which advanced specialist areas. In such a highly competitive job market for medical practitioners
during the
for late-nineteenth those century, when work was scarce even who mid-to it be that the highly may seen establishment of new qualified, were led branches to the of medicine not only professionalisation of specialised
is4Medical Directory, 1852, p. 23 and Medical Directory, 1845, p.71 Mackenzie', BMJ, Morell Feb. 13,1892, p. 363. 'Sir Anon, 155
204
these fields of study, but this also meant that many Harley Street men had,
ipso facto, created jobs for themselves. Yet specialists could not claim unanimous support from the medical in Scathing Lancet the appeared attacks profession. and to a lesser extent
the BMJ, ascribing egocentric motives to doctors in founding special hospitals. In an editorial in the BMJin 1860, the decline in contributions to institutions in to the attributed was rise subscriptions to special charitable hospitals, particularly those established by: an energetic surgeon who makes up his mind to step to fame and fortune by means of bricks and mortar, thinks up a striking speciality, such as a 'Dispensary for the Treatment of Inverted Eyelashes', takes a house in a side street, persuades a goodly sprinkle of the aristocracy, in an incredibly short time, to pledge support, produces accounts audited by dilettanti and help the of careful got up statistics expands the Dispensary into a with hospital, converts the old woman who used to sweep the Dispensary into a in back into hall table a small a porter and room a board room. 156 proud
Despite scientific advances in pathology, bacteriology and physiology, and the crucial nineteenth
developments century,
their
in surgery of anaesthesia therapeutic
effectiveness
and asepsis in the did
not
have
an
immediate effect on the lives of their patients. Nonetheless, it was often the
in advances such science, medicine and surgery, public who embraced doubt, the specialities, medical which, new no enhanced the especially Their likely helped the to profession. medical attitude of quite reputation demand for increased the new specialities that were emerging an produce in Britain from the 1850s onwards. With over half of all Harley Street men claiming an interest or different they areas of medicine or surgery, in not only played a expertise
1" Anon, 'Special Hospitals', BMJ, 1860, p. 458, cited in Newman, 'Specialism', p. 174.
205
role in the creation of new areas of expertise, but their efforts to
pivotal
establish
hospitals
professionalisation
for societies and
these
specialities
facilitated
the
of medicine during this time. In the 1930s, Rolleston
Street lure Harley be "by the that the may popularity of explained remarked Street Specialist"' he "during 'the Harley that the and surmised phrase of the last century ... one of the most important the complete recognition George
Frederick
Edmund Alexander
Still
of legitimate (paediatrics),
[in been has events medicine]
specialisin! '. 157 Such men as Sir Morell
Mackenzie
Parkes (rare diseases), Frederick
(laryngology),
Parkes Weber (rare
(diseases Dobell Benge Horace diseases), of the chest), Edward Collet Hort (bacteriology), George and Anderson Critchett, (ophthalmology) George and Lawson
Arnold Willmott
(ophthalmology), Sir
John
Tweedy (ophthalmology),
H. Evans (dermatology), Charles Mansfield Clarke (obstetrics),
(obstetrics), (gynaecology), Barnes Robert Henry Lewis Jones Bonney, Victor (radiology), Robert Knox (radiology), Samuel Alexander Kinnear Wilson (neurology), John Langdon Down (mental diseases) and William Watson Cheyne (antiseptic surgery) who pioneered new areas of medicine and foremost improved other areas of expertise, were amongst those medical practitioners who made specialisation of medicine and surgery a possibility. The comparative
Harley Street, the Harley Street Area of analysis
Street lesser Harley degree London that to the Greater and proves a and Harley
Street Area were unequivocally
the nucleus
of consulting
and
Advance in Medicine in Medical Profession 'The Rolleston, the Humphry changes and 157 during the Last 50 Years', BMJ, 23 July, 1932, pp. 129-130.
206
before the First World War. The next Chapter discusses practice specialist
the cohort's professional development vis-A-ýis their contribution membership of medical societies.
207
and
CHAPTER 5 Professional Advancement and the Transmission of Medical Knowledge - Public Lectures and Society Memberships The dissemination of knowledge via lectures, societies' meetings and through publications is a hallmark of virtually all areas of medicine; such activities
in the late nineteenth and early twentieth
signalled the growth of professionalisation Orations
lectures and
ranged from
centuries often
and specialisation
the very
prestigious
of medicine. to the more
illustrious Harveian Oration, The the was most which adopted mundane. in ideas the Victorian that used were creation of traditions through many combining the adoption of older, established practices along with the Such ' Harveian Oration the the that prestige was of rituals. creation of new Lancet, BMJ, Daily Umes, Telegraph the the editors of and the Press Association were invited to this event.2 Despite the role that orations and lectures played amongst medical historians London, Victorian have in little of medicine paid professionals lectures. full There has been these the to of range no critical attention based large lectures during the of orations number medically and analysis of Moreover, time. whilst there was an extensive range of medical this
1 For a discussion of the creation of tradition in the Victorian period see, Eric Hobsbawm (eds.), The Invention of Tradition, (Cambridge, 1983). Ranger Terence and [for the Harveian Oration]" 1902, Letters and to 2 "List of those whom cards were sent RCP, 1024/17. Library the in the of papers
208
during the latter many of which were created societies, century,
part of the 19th
these too have not been subject to any systematic
analysis by
historians of medicine. Hence, the first part of this chapter will discuss Harley Street orators and these will be placed in the broader context of the Victorian reinvention of traditions. The range of the medical societies to belonged Street Harley to and the aims of these societies the group which in It further be be the this part of second chapter. assessed will will established
which
high-ranking
positions
Harley
various
Street
held within these medical societies. practitioners
Rituals and Public Lectures The nineteenth century was a period of rapid transformations through the developments many monarch,
political
in technology and science that affected society, the institutions
and the rising
professional
classes. At a
fundamental due faster level the to changes were most modes of social transportation
forms of communication and quicker
than had previously
been feasible. Steam power made steamboats and steam trains possible and
began in 1830: later first the service railway the seven years commercial telegraph was first used on English railroads. By 1876, the telephone had faster methods of communication whilst opened up
the typewriter,
X-rays lighting irrevocably radio waves, and gas microphone, phonograph, The Victorians, invention British society. who regarded as a way of changed solving
problems,
responded
to
these
dramatic
and
disorientating
developments by inventing new traditions and creating rituals for various
209
As David Cannadine observed, these new social and political reasons. traditions
impression in gave an of stability periods of domestic change and
in international times tension and decline.3 Eric and comfort of of continuity Hobsbawm regarded the idea of inventing traditions
as a process of
formalisation and ritualisation, characterised by reference to the past, if In 4 baroque by the tradition, a renaissance repetitions. imposing of only best in together, the came which often was exemplified state and church Harveian Oration and Sermon. Compelling
rituals
grew up around various
events and occasions,
in lectures formed where orations and societies and clubs a part of especially
the organisation.
For some events, this involved the attendance of
dinners, festivals, Oration itself, toasts the and officials, which government Ideas borrowed this process. complex were of often part were all medieval
times such as the wearing of gowns to attend an oration.
from For
Penn President Dawson RCP Lord the wore a of robe as of on the example, Oration in Harveian 1936, his by the modelled after gown worn occasion of
William Harvey (1578 - 1657) when he received his medical degree from the University
Upholding in Padua 1602.5 this new tradition, of
the RCP
Fellows Oration in 1827 the that of should wear robes and a mandated (Though for fixed by 1923 12 the non-compliance. was wearing of of penalty
"the belief it discontinued that the under mistaken was causeof was robes 3 David Cannadine, 'The Context, Performance and Meaning of Ritual: The British Monarchy and the 'Invention of Tradition', c. 1820-1977-in Eric Hobsbawm and Terence Ranger (eds.), The Invention of Tra&tlon, (Cambridge, 1983), pp. 101-164. 4 Eric Hobsbawm, 'Introduction: Inventing Traditions' in Hobsbawn and Ranger, Invention 4. d(tion, Era p. Of 5 Hunting, RSX, plate 34.
210
non-attendance
of younger
Fellows". 6) Decorations
were
worn
at the
Harveian dinner when any one of the following attended: a member of the Royal Family, a Knight of the Garter or the Lord Mayor of London.7 Whilst the first Harveian Oration in 1657 was delivered in Latin, by
1865 it could be delivered in English. Perhaps this decision reflected an attempt to appeal to a greater audience. The Oration was to be followed by a
"General
FeaStII.
8
The Sermon was usually delivered by a distinguished
St. Mary-le-Bow, its Endowment the of church at and preacher was the joint William Croone the of will of 1684 and of his widow, later Lady product of Sadleir, in 1706. In the early years of the twentieth century, attendance in five it 1923 and persons, was suggested that the Sermon never exceeded be relinquished. 9
In 1854, the RCP resolved to have a dinner in the College each year Oration distinguished Harveian that the and guests should be invited. after Over the course of the next 34 years, the dinner was held on June 25th until 1888, when the date was changed to St Luke's Day, 18 October. Toasts became an integral feature of the evening, such that by 1861 twelve toasts dinner including before Her Majesty The Queen to started made were and the rest of the Royal Family, in addition to the House of Lords, the Medical Institutions of the country, and the President of the Medical Council. 10
6 Lord Dawson, 'Harveian Celebration Committee", 1936, Library of the RCP: 1024/203. 7 George Newman, Letter to Mr Barlow (9 August 1923), Library of the RCP: 1024/154. 8According to the terms of the will of the physician William Harvey (1578-1657) who discovered the circulation of the blood. 9 Dawson, "Harveian Celebration Committee7. lo "List of Toasts at the Harveian Diner,", 15 June 1861, Library of the RCP: 1024/179.
211
Public lectures and orations provided medical practitioners
for increased visibility opportunity
with an
within the medical profession. They
knowledge, display to those of and elected who were afforded a prominent the thus, profession; within orations and memorial renowned were speak lectures can be seen as a symbol of success. With the exception of the Goulstonian lecture (occasionally spelt Gulstonian) and the Erasmus Wilson lecture, which were given by young medical practitioners, the Harley Street Society lectures RCP, RCS Medical the delivered the at or public men who (60 in the their the careers: majority per cent) of established were well lectures between 50 70. these were aged and public gave cohort who
Ten per cent (n = 68) of medical practitioners, who arrived in Harley Street before 1914 delivered a named lecture: 16 of the cohort gave the Goulstonian Lectures, 13 the Lumleian lectures, 12 the Harveian Oration Leading Lectures. Croonian the medical practitioners and six
lecture: than to one speak at more asked
usually were
Herbert Ritchie Spencer who
Lettsomian Lectures the in gave and obstetrics, gynaecology specialised (1920), the Harveian Oration (1921) and the Fitzpatrick Lectures (1927)." The significance of being selected the speaker in any given year lay in being 61ite large from throughout group of physicians and surgeons a chosen
11Herbert R. Spencer, "The Lettsomian Lectures on Tumours Complicating Pregnancy, Labour, and the Puerperium", BMJ, Feb. 7 1920, pp. 179-184, Feb. 21 pp. 246-249, Mar. 6, The History of Bzitish Midwiferyfroml650-1800. 'theRtzpattick 320-324.1dem, pp. (London, College delivered before Royal the for 1927 offhysicians ofLondon, Lectures Gynaecologist: being Obstetric Harvey, Physician the Rarvaian William Idem, and 1927). (London, Royal College October I&h, the 1921, 1921). delivered oration at of1hysicians,
212
England,
in Fellows 303 Royal College 1886 the of consisted of of which
Physicians and 1,124 Fellows of Royal College of Surgeons.12 Eponymous Lectures at the Royal College of Physicians in London The Royal College of Physicians held various eponymous lectures that were basis. The but 13 lectures these cachet of varied, usually given on an annual
the most well known up to 1914 were: the Harveian Oration and Lectures, (a Croonian Lectures Croonian lecture was Lumleian, Goulstonian, the and Other Society). Royal the memorial also given at
lectures given by the
(a lecture, Bradshaw lecture Bradshaw included the was also given cohort Fitzpatrick RCS), the the at
lectureship on the History of Medicine,
Sanitary lectureship State in 1901, a and on medicine and established in Milroy lecture 1886 to the hygiene and also referred as established public Milroy. Gavin 14 Dr. benefactor its after The Harveian Oration was a luminary
occasion during which one of
Weber Parkes Moxton, the the and the Bisset-Hawkins, were three medals, presented
at various
times to physicians
for their
contribution
to the
President The 15 RCP the the of nominated medicine. of advancement
College The RoTal A History Clark, George ofRbysicians ofLondon, Vol. 11, of 12Sir (Oxford, 1966) p. 739, A. M. Cooke,A History of The Royal College ofPbLvsiciansof London, Vol. III, (Oxford, 1972) p. 1133, and Walter Rivington, Me Medical Pmfessjon, (Dublin, 1888), p. 549. 13Clarke, History of the RQ p. 621. For some such as the Fitzpatrick Lectures (established 1901) or the Oliver-Sharpey Lecture or prize (established in 1904) speakers Censors by President College the the the to and of give one or more annually elected were lectures under the terms of the endowment. 14 The Fitzpatrick Lectures were published in book form. The origin of the Bradshaw Lecture is summarised in Lancet, Dec. 13,1902. 15Anon, "The Moxton Medal Regulations, 1893-1898",RCP: 1002/31.Also see"List of Medals from the Royal College of Physicians7,Administration Notebook. (Unpublished: no date), the Library of the RCP, and Gordon Wollenscroft, "Medals Mostly Medicar,
213
body from fellows declined the the those of senior of college and speaker who the invitation were fined by the RCP; the penalty in 1864 was 110.16 By 1860, speakers were selected for their contribution to the advancement of during 17 the previous year. science medical
The Harveian banquet, which was a lavish and expensive affair was in fellows FRCPs in to general, most newly and, elected all attended open their first year but fewer thereafter. 18One reason for the fall in attendance Banquet, Lord Oration Dawson Penn, to the according and of was at because "a few were attracted by the prospect of a good speech, while others [were] by dull kept Nevertheless, the 19 the apprehension of away ones". are
Oration was published and reprinted in the main medical journals and the Guests banquet thus the a wide reaching audience. at newspapers, national included public and learned figures from the upper echelons of government, medicine, science and universities.
A list of attendees at the 1874 Banquet
included the Baron of the Exchequer Sir Anthony Pleasby, the Master of Christ's
College,
Cambridge
and
Professor
Thomas
Henry
Huxley. 20
Members of Royalty or heads of government were occasionally present; in
(Unpublished April-September Exhibition, 1986, Catalogue of an manuscript: Library of the RCP), Anon, "Weber of Parkes Prize Committee, 1895: the Library of the RCP: 1003/20". 26Anon, 'Leading Articles, BMJ, Oct. 8,1864, p. 419. The subject of the oration was College its the to to tribute of and patrons aim was engender mutual respect a originally College, Anon, BHJ, May 12,1866, 4 95. the the see of p. members amongst 17Anon, Leading Articles', p. 360-361 and Rivington, Medfca]Pmfession, op, cit., (12), p. 502. is Anon, Minutes of the Committee meeting of the Royal College of Physicians of London, RCP, November 27th, 1936, p. 4. 19Ibid. 20Anon, BHJ, March 31,1866, p. 338 and see"Harveian Banquet: Entertainment Committee Minutes 1874", RCP: 1024/180-183.
214
1865, for example, attendees included the Prince of Wales and the Prime
Minister, Mr William Gladstone.21 The three lectures, the Lumleian,
Goulstonian and Croonian,
delivered at the RCP were all in English. The annual Goulstonian lecture (established under the will of Dr. Goulston in 1632) was originally to be read by "one of the four youngest doctors [of the College] on some dead body" ... that was to be dissected, according to the President and Elects of the College. 22 During practitioner
every decade from the 1850s to 1914, a Harley
delivered at least one Goulstonian
Street
Lecture. Several speakers
known in distinguished their area of practitioners and well medical were expertise.
WiRiam Jenner, who was described at the peak of his successas, "the undisputed
leader of the profession" was the first Harley Street practitioner
to be appointed
Goulstonian
lecturer
in
1853.23 In
1850, Jenner
had
his London Fever Hospital the the research at of results on published he feverS. 24From had 1847 1848, to taken case notes of typhus typhoid and from fever. Thanks to the work of Drs 1,000 patients suffering continued Lombard in Geneva and of Gerhard and Pennock in Philadelphia, there was highly fever, typhus that the contagious more commonly growing evidence
21Anon, 'Harveian Society, Lance4 July 1,1865, p. 12 22 4non, 'Leading Articles, p. 355. 23Francis Bisset Hawkins delivered the Goulstonian Lecture in 1828 and the Lumleian lecture in 1835; however, he had retired from practice before arriving in Harley Street in 1856. Jenner delivered the Goulstonian lecture in 1853 just prior to establishing a practice in Harley Street between 1854 -1855. He moved to Brook St, Grosvenor Sq. London, in 1869. 24William Jenner, On the Identity of Typhold or Non -Identity of TYphoid and 7ýph us Fevers, (London, 1850).
215
known as gaol fever in Britain,
was distinct from typhoid fever. This view,
however, did not receive general acceptanceuntil the publication of Jenner's Goulstonian lecture His based the on subject was on this specialist paper. knowledge "with which his name has ever since been identified". 25 Other Harley Street practitioners who delivered the Goulstonian lectures included Humphry Davy Rolleston, who was instrumental in founding a society for British radiology and later became President of the British Institute of Radiology. The subject of his 1895 lecture was Addison's disease (caused by the insufficient hormonal production from the adrenal gland). 26 Following an endowment from Lady Sadlier, two lectureships were Croone: "one be Dr before in these to the the of of read yearly name gifted College of Physicians, following the sermon and the other on the nature and laws of muscular motion, to be delivered annually before the Royal Society". 27 Lady Sadlier later arranged for four-fifths
of the endowment to
be donated to the RCP and one-fifth to the Royal Society. Lectures were to be on some aspect of anatomy, physiology or pathology and their relation to the prevention
diseases. 28 The Croonian lectures were the Royal or cure of
Society's most prestigious lectures in the biological sciences and those asked to
speak
were
amongst
the
most
prominent
scientists
and
medical
25Anon, 'Sir William Jenner, BMJ, Dec. 17,1898, p. 1849 and G.H. Brown, Lives of the FeBows, (London, 1955), p. 68. William Munk et al, The Boll of the Royal College of Physicians, (London, 1955), pp. 352-354. (1862-1944): Sir Humphry Davy Rolleston K Banerjee, Arpan 26 a Physician's Contribution Radiology, Journal British Development of ofMedica1BYograpAV,Number 3, Aug. the to 1994, pp. 177-178. 27Munk, RCP, p. 359. It appears from a review of the obituaries that most of the Croonian Lecturers were also fellows of the Royal Society, however, I have not been able to find a (192 Both Henry Head that this Arthur 1) was a requirement. stated and which source, Gamgee (1902) delivered the Croonian Lecture at the Royal Society. (12), Profession, Medical Rivington, op, cit., p. 603 28
216
practitioners
in the world. Harley Street lecturers joined the ranks of such
(1858), (1893) H. T. Huxley Rudolph Virchow speakers as and Ivan Petrovitch Pavlov (1928).29 The first Harley Street physician to deliver the Croonian Lecture in
1871 was Professor Edmund Alexander Parkes who had been a fellow William student with
Jenner at University
College London. 30 Jenner held
Parkes in such high regard that he acknowledged, "the desire to possesshis has been from has that encouraged which me my earliest student esteem days". 31 Parkes's had a distinguished
record, his Goulstonian
Lecture on
(fever) in been Medical had YYmes Gazette in 1855 published and pyrexia (two Proceedings in Rotval Societv in in the the 1867 and three of papers and described diet Parkes the in 1871). effects of and exercise on the one independently the which confirmed nitrogen, of work of the elimination (1829-1901) and the chemist Johannes Wislicenus Fick Adolph physiologist
(1835-1902).32 Parkes' Croonian lecture on Nitrogeneous Elimination, published in based in 1871, Lancet on the study of the liver as the main organ in was the the formation of urea. This challenged contemporary views on the subject, by German developed Baron Justus Liebig the those chemist von such as
thology among Biological Studies, Huxley, "On the theory of 29Virchow, 'The Position oAr"Pe the vertebra te SkuYand Pavlov, 'Certain Problems in the PhYsio]0,97of the Cerebral Hemispheres' 30Charles West had delivered the Croonian lecture in 1854; however, he did not set up his Street 1886. in the until practice 31Anon, 'Edmund Alexander Parkes', LanceA Mar. 25,1876, p. 480. 32E. A. Parkes, 'The Gulstonian Lectures, on Pyrexia, Medical Y)mesand Gazette, Lecture I, March 17,1855, pp. 253-255, March 24,1855, pp. 279-280, Lecture II, April 7,1855, pp. 331-335, Lecture III, June 2,1855, pp. 535-537, June 9,1855, pp. 561-563.
217
(1803-1873) who claimed that muscular
implied work
the destruction
of
Parkes dependent that the proved elimination of urea oxidation. was not on the amount of muscular exercise, but on the consumption of nitrogenous food, and on the transforming
action of the gland-cells, especially those of
the liver; he further proved that muscular tissue does not consume itself as Thus, 33 during fuel the the cohort often used public orations to work. a findings debated their and were research sometimes at such present original lectures as the Croonian. Lord Lumley had established an endowment for the Lumleian Lectures in 1581, which provided for a lectureship in surgery. From 1825 to 1862, the Lumleian
lecturer was appointed for a two-year term; thereafter,
done basis. Alfred Baring Garrod's on an annual were appointments Lumleian Lectures on uric acid were considered by his contemporaries to be Lectures Watson Cheyne these, such as as remarked, groundbreaking. "criticising for have forum been the that advances made, of provided a (sic) doubtful these advances are good of and what are of value, seeing what furnishing thus of and
a basis for further work7.34 Cheyne had been
Bradshaw lecturer (1908) and Hunterian Orator (1915) and gave the first Lister Memorial Lecture in 1925. Those of the cohort who were elected Lumleian lecturer were all distinguished men and included Richard Quain, Charles West, Reginald Southey, Thomas Jeeves Horder and Frederick Eustace,Batten. 33Anon, 'Edmund Alexander Parkes, Lancet, Apr. 8,1876, p. 547. 34A. B. Garrod, 'Lumleian Lectures, Lancet, Mar. 24,1883, p. 487 and W.W. Cheyne, Lettsomian Lectures, onThe Objects and limits of Operations for Cancer%BMJ, Feb. 15, 1896, p. 385.
218
Experts or specialists in a particular typically
area of medicine or surgery
Colleges. Of lectures Royal Street Harley the the at gave men who
including Thomas Philip Horder, Jeeves to speak, several were elected Henry Pye-Smith, Richard Quain and Charles West, delivered numerous lectures in the course of their career. One such physician, James Mackenzie, in diseases founded St. heart, leading the the the of consultants one of Andrews Institute for Clinical Research and became honorary consulting Physician to King Edward VII whilst he was in Scotland.35 In 1911, Mackenzie delivered both the Oliver-Sharpey Lectures at the RCP on heart failure and the Schorstein Lectures at the London Hospital on auricular fibrillation.
He was later selected to be the first George Alexander Gibson
Memorial Lecturer at the Royal College of Physicians, Edinburgh in 1914.36
A number of Harley Street benefactors established lectureships, In in Horace Dobell 1903, Research funds the their own name. prizes and
College in honour of Horace Benge Dobell. the Lectures were established at The subject of the lectures was to be based on research into "the ultimate life-history bacilli the of and other pathogenic microorigin, evolution, and in honour lectures Harley Other 37 established of an eminent organismS"'. (1936), Ryall Bequest included: the the Charles West Street practitioner
35Anon, 'Sir James Mackenzie', BMJ, Jan. 31,1925, pp. 242-245. Others who gave more Butlin, Armour, HenrY Trentham James David Andrew John include lecture and than one Mitchell Bruce. 36 Ihid.
(London, See Anon, Benge 'Horace 625. Fellows, 1955), Lives Brown, G. H. also 37 p. ofthe Dobell', Lance4 Mar. 10,1917, p. 391.
219
Lectures
(1937), the Humphry
Davy Rolleston Lectures
(1944) and the
Gordon-Watson lectures (1952).38 Eponymous Lectures at the Royal College of Surgeons
The RCS was also a beneficiary of endowments for memorial lectures. The (annually Oration Hunterian important from 1813 to 1853, the was most (1728-1793). John Hunter bi-annually) It was a to thereafter commemorate Royalty delivered by attended occasionally which event, and was prestigious
Orators from 39 Harley Street, included Sir John distinguished surgeon. a Tweedy, Sir Henry Butlin, Sir Anthony Bowlby and Sir William Watson Cheyne all of whom were eminent surgeons Stephen Jacyna, who examined the historiographical construction of John Hunter's image made by various medical practitioners in the 19th Hunterian Orators had Hunter's the that early created century, argued image by the 1820s. Through
their
alignment
with
Hunter,
who was
"the has described this greatest man whom as, country produced variously in medical science" and "the Shakespeare of medicine the orators were,
38Aid Donated by the wife of Sir Charles Ryall, in his memory, the endowment provides for a Ryall scholar or a paid assistant in the College's museum or Library. The Charles West Lectures are triennial lectures on childhood diseasesin honour of West. An annual lecture, usually on diseasesof the liver or physiology in honour of Humphry D. Rolleston (1862 -1944). The Gordon-Watson lectures, to be delivered every fifth year were provided for by an endowment from Col. M. Gordon-Watson in honour of his father Sir Charles Gordon-Watson. See also the Anon, LancetApril 9,1921, p.777, Dr Murray Leslie also founded a medal at Edinburgh University in honour of his mother who had three sons who University. AnonRobert Leslie, M. D', BMJApr9,1921. the of were graduates Hunterian Sir delivered Oration William MacCormac in 1899 the the For 39 when example, Prince of Wales was in attendance, see Sir William MacCormac, Tbe Hunterian Oration: delivered on Tuesday, Fehruary 14,1899 at the Royal College ofSurgeons of England in Fresence ofAis Royal Highness the Pýince of Wales,(London, 1899).
220
"actively
involved in efforts to advance the social standing of surgeonS". 40
These orators strived to elevate their status in the medical profession by associating themselves with
by Hunter. science as embodied
They
represented: the tiny elite of London surgeons, whose interest was to achieve a formal leading the their parity with physicians of the capital. social of recognition These two groups together constituted the nucleus of the consultants who Royal Colleges in future dominate the the to of government years. 41 were
Other lectures at the RCS included the Arris and Gale lectures, the Bradshaw lecture and the Thomas Vicary lecture. 42 The Arris and Gale lecturers were funded by legacies from Edward Arris in 1646 and John Gale in 1655, which were later combined to provide an annual demonstration or lecture
As 43 with on anatoMy.
the lectures
mentioned
above, they also
innovative Henry forum to practice and satisfy criticism. validate a provided Hancock, for example, took the opportunity defend his improvement
in his Arris and Gale lectures to
Moreau's excision of the ankle-joint, of
credit for
deprive him! had '. 44 to "certain endeavoured writers which
The importance of the Bradshaw lecture (established 1880) was Member Council RCS that the in the the senior a of of stipulation reflected it the the that deliver subject should advance and medical profession. should (n fifth 1945, = 31,18 percent) of the cohort almost a Between 1845 and
40L. S. Jacyna, 'Images of John Hunter in the Nineteenth Century, Histozy afScience, Vol. 21,1983, pp. 88,92 and 96. 41Jacyna, 'Hunter, pp. 104-105. (established lecture Morton in 1887) on cancer. include, the Others 42 43Brown, 'FeBows'v p. 8, Footnote 1. 44Anon, 'Henry Hancock', Lance4 Jan. 17,1880, p. 111.
221
Council. Charles Alfred Ballance, a 45 time this one members of were at Council from 1910 to 1919, described as a pioneer in the member of delivered Bradshaw the on arteries and nerves, surgery experimental lecture
heart in 1919.46 the the on surgery of
The Thomas Vicary Lecture, which covered a particular topic from the history of anatomy or surgery, was instituted at the RCS in 1919. Sir John Tweedy of Harley Street, later professor of ophthalmic
medicine and
RCS in President UCL first the 1903, the of and was person to surgery at history Tweedy from lecture. 47 Egypt traced the this of surgery and present
Greece and through to the Latin, Arabic and French texts. 48 In addition to annual lectures or series of lectures, the RCS was also lectureships for funds Erasmus Wilson Lecture. the such as with endowed This
lectureship
(originally
a professorship)
was
on the
subject
of
dermatology, but in 1880 was changed to pathology. 49The exalted status of
by Sir Henry Trentham Butlin, who was on the the speakers was epitomised Council of the RCS (1895-1912) and later President (1910-1911) and who became the first Erasmus lecturer in pathology at the RCS. He was an brilliant was regarded as a and expert on cancer
lecturer
by his
his lectures Sarcoma Butlin Carcinoma: published on contemporaries. -and their
Pathology,
Diagnosis,
and
Treatment
(1885)
and
his
textbook,
Members Council Zachary Cope, History Rqyal College list the the the For see, 45 of of of a (London, 1959), pp. 342-345. Surgeons ofEngland, 'the Bradshaw Lecture on the Surgery of the Heart: Delivered Ballance, Charles Sir 46 before the Royal College of Surgeons, December 11th,1919', (London, 1920). 47Cope, RCS, p. 338. The announcement was in Lancet, Oct. 25,1919, p. 755. 48Quoted in Anon, 'Sir John Tweedy, BMJ, Jan 12,1924, p. 88. (12), Profession, Medical Rivington, op, cit., p. 549. 49
222
Diseases of the Tongue, was considered a classic. 60 In the 1907 Erasmus
Wilson lecture, the surgeon Willmott H. Evans challenged the accepted view (a leucoderma in that the pigmentation change specialists skin amongst
of
the skin) was a disease relating to the nervous system; he proposed that it
from due by local fact, in the toxin to alimentary a canal assisted a was, injury.
51
As with the RCP, the RCS established a number of lectureships, honours
and trusts
that
were named after various
Harley
Street
benefactors.52 When Sir Berkeley Moynihan was President of the College (1926-1931), he called for donations to advance surgical research: a few distinguished
Sir George Buckston Browne as such surgeons responded. 53
Browne purchased Darwin's home, Down House in Kent, in 1927 and for He into it centre science. also established an annual a research converted dinner, open to the members and fellows of the college plus invited guests
(up to half of the audience was invited to the dinner in memory of his son Lt. -Col. Buckston Browne). Three years later, he endowed the College with building for the 1100,000 and maintaining purposes of
a centre for surgical
biological research. and
Lectures at Medical Societies The Harveian Society established the Harveian Society Lectures in 1875, initially
there were a series of two or three lectures delivered annually, but
50The lectures were published in 1885. Cope,RCS, p. 312 and Anon, 'Sir Henry Trentham Butlin', BMJ, Feb. 3,1912, p. 276. 51Anon, Villmott H. Evans', LanceA Sept. 17,1938, p. 701. 62For a list of these, see Cope,ROS, pp. 333 - 338. 53Cope, RCS, pp. 190-191,202,334.
223
by 1903 the number of lectures had been reduced to one. A decision was made at this time that distinguished members of the profession who were foreign the of society, such members as not medical practitioners,
be could
to give a lecture. 54 George Buckston Browne was 51 when he was
invited
deliver Harveian Lectures in the to 1901. The result was that his asked lectures, which were based on "Twenty-five years of experience in Urinary Surgery in England
had an immense effect on whatever success he had ...
in his profession as a private surgical practitioner met with
in 11, ondon7'.55
The Medical Society of London's most prestigious lecture, the Lettsomian, was named after their founder and benefactor John Coakley Lettsom
(1744-1815). 56 This annual lecture, which comprised a series of
three speeches, was the only one endowed in the society at the end of the Harley Street The 57 surgeon Edward William century.
nineteenth
Professor of Midwifery
Lettsomian
Murphy,
at UCL, was one of the first to deliver the course of
lectures at the Medical Society. During March 1853, he
delivered three lectures on the first, second and third stages of labour, including
the associated problems; his third lecture was on the necessity of
54Anon, The Harveian Society ofLondon: 1831-1981.(London, no date possibly 1982), p. first page (no page numbers, p. secondpage). 55Buckston Browne was paid 15 guineas a lecture, seeAnon, 'Sir Buckston Browne', BMJ, Jan. 27,1945, p. 132. 56Other societies which held memorial lectures included the West London MedicoChirurgical Society whose Cavendish lectures were on the application of pathology to in BMJ, for Anon, These the BMJ, June 1900, pp. published were see example, surgery. 1577-82. 57The Fothergill Medal was triennially from 1920, the Lloyd Roberts Lectures were delivered, in turn, at the Royal College of Physicians, The Medical Society of London and the Royal Society of London. This lecture was given by the Harley Street Herbert Spencer, in 1924
224
obtaining
in his Many 58 the practice of midwifery. of a scientific education
lectures and publications were on the subjects of midwifery and chloroform; he was one of the first surgeons in London to use chloroform in midwifery Other 59 practice.
members of the cohort
such as the physician,
John
Langdon Down, also used the Lettsomian Lectures to disseminate the Down's Langdon 30 60 his the mentally year on study research. results of handicapped was presented to the Medical Society and subsequently BMJ 61 in the published These orations and lectures were not only symbols of professional recognition
for many of these medical practitioners,
but they provided the
Harveian to the the embellish such activities as opportunity cohort with Oration, by incorporating
rituals and using newly created tradition,
thereby
The lectures to the occasion. also provided a adding considerable prestige dissemination for the venue
facilitated
of their
professional
medical expertise
and
lectures interaction those amongst who attended and social
in be the As next section, professional societies afforded shown will orations. even greater opportunities
for professional advancement and especially for
the professionalisation of medicine that was occurring at the end of the nineteenth century. for Association Lectures Medical Lettsomian Journal, no. 1853, Murphy, William Edward 58 Society March Delivered 2499,16 23, the 15,1853. 25-April March at on and pp. 12-15, 254,289-293 and 323-329. its Safety CUOrOll'orm; ProPerties in Cbildbirtb, W. Murphy, Edward For and 59 example, (London, 1855) and Lectures on Na tural and DiAl"cult Partuzition, (London, 1845). See also, Anon, 'Edward William Murphy", BMJ, Jan 27,1877, p. 122. had Fox, Tilbury included Others who written extensively on various aspects of 60 in For his list Eczema lectures 1869-70. Lettsomian he the a of on dermatology, gave Fox', 'Tilbury BMJ, June 916. Anon, 14,1879, p. publications, see Affections Mental Lectures the 'Abstracts Lettsomian the Langdon-Down, on some of 61J. of Youth, BMJ, 1887, pp. 49-50,148-151,256-259. Childhood and of
225
Medical Societies Membership
of clubs and societies had been a prerogative
of British
least the seventeenth century, though it was not until gentlemen since at the middle of the eighteenth century that professional medical societies Some 62 of the earliest medical societies of the Georgian were established. in houses houses these gentlemen's and coffee met clubs: period coffee served primarily a political
role,
a social function. In contrast, licensing bodies represented protecting
their
members'
intereStS. 63 As
Roy
Porter
for intellectual interests that the century clubs eighteenth catered observed, and supported professional ambitions were meeting places; in addition
to
being a place to socialise, they were also a venue for medical men to 64Few ideas in Georgian the contacts. medical and make societies exchange period explicitly promoted medical advancement. The nineteenth
century medical societies, which were also meeting
from different the majority were places,
of their predecessors because they
for forum knowledge promoting sharing, and advancing a medical provided within
the medical profession at large. The aims and profiles of the medical
in had links 1850s the to those of the Royal that arose closer societies Society (established in 1662), the Medical Society of London (1773) and to Medical Philosophical the Society as medical societies and at such student Bart's (renamed the Abernethian Society in 1832) that sprang up in the late (ed. ) Bzidsh Medical Societies, (IA)ndon, 1939), P. vii., Roy Porter, Power, DArcy Sir 62 London a Social History (Undon, 1996), see also Peter Clark, Bzitish Cluhs and Societies, 15go-18oo.,tbe Oz*ins of an Associated World, (Oxford, 2000). 63Porter, London, p. 170. e4jbid, pp. 178-179. 226
century, than to the coffee houses and gentlemen's clubs. r-5The
eighteenth
Royal Society, in particular, scientific
played a critical
role in the dissemination
of
and medical knowledge and became a template for many of the
medical societies, which were established by the middle of the nineteenth century.
W. H. McMenemey drew a distinction between the medical societies developed that towards the end of the eighteenth associations medical and first the quarter of the nineteenth centuries. Medical societies, he and in scientific and social contrast to the emerging medical argued, were "medico-political combinations ... the majority associations, which were foster legislation for improving to the professional education were convened Most 66 doctorS". of
to curb unqualified
regulations of their
of these
associations practitioners
The 67 most prominent members.
Surgeon and
Apothecaries
Associated
General Medical
regulation,
recognition
were
formed
interested
in
and in protecting
was the Association
the interests of Apothecaries
in 1812 (in 1826 it changed
and Surgical
Practitioners)
supporting
its name to
whose focus was the
and reform of the surgeon apothecary. 68
65Penelope Hunting, The History of tbeR0Ya1S0ciet:VofMedicine (London, 2002), pp. l- 3 Medical Societies, two There 5. other early were one established in Edinburgh in and p. 1731: the Medical Society and another in London in 1752 called the Medical Society, this later Medical Society founded in London to the 1773. connected was not 66W.H. McMenemey, 'The Influence of Medical Societies on Development of Medical Practice in Nineteenth- Century Britain'in F.N. L. Poynter, (ed.), The Evolution 0M edyCaI practice in Bzitain, (London, 1961), pp. 67-68. 67For details of these medico-political associations established up to the late 1880s see, Rivington, Medical Pmfession, pp. 465-486. 68Irvine Loudon, Medical Care and the General Practitioner. * 1750-1850,(Oxford, 1986), Chapter 7 and p. 279
227
The first half of the nineteenth
century witnessed a burgeoning
of
for the professional middle-classes such as lawyers and scientists, clubs included a proliferation which
for of societies medical practitioners. 69
Penelope Corfield argued that membership of these organisations, which during feeling identity to this the contributed period, group of emerged
and
As 70 the numbers of medical assistance. combined conviviality with mutual Victorian the throughout period, many medical students practitioners rose found employment increasingly difficult to procure, thus they had to look for
Medical their alma mater. societies provided a venue staff positions outside for students to meet influential members of other medical schools, thereby increasing their chance of gaining a staff position. By the 1850s, medical increasingly conduit of general as a and served societies
specialist
knowledge. 71 New medical societies emanated from existing groups such as medical
book clubs and social clubs; however, the organisations that arose in the 1850s began to promote the dissemination of medical knowledge and the 72 In his the standard within of a professional medical arena. establishment Societies Medical in Progress Place Medicine", "The Sir the of of on paper Raymund Crawfurd maintained that whilst the diffusion of knowledge was
69]bid, and Peter Clark, Bzitish Clubs and Societies 1580-1800-'the Origins ofan Associated World, (Oxford, 2000), p. 114. 70Penelope J. Corfield, Powerand the Professions in B"itain: 1700-1850,Q'Ondon,1995), p. 159. 71Anne Digby, The Evolution ofBzitish General Practice, 1850-1948,(Oxford, 1999), p. 62. 72The Manchester Medical Society formed in 1834 arose out of a medical book-circulating 'A brief Swann, Position Role Medical Philip Societies in See the summary of and of club. the early Nineteenth Century Medical Profession! Ile Journal ofLocal Studies, Vol. 1, Summer, 1980, pp. 43-46.
228
the principal
function of medical societies, the acquisition
and creation of
importance. becoming Crawfurd, To knowledge 73 of paramount was new role in fostering conviviality,
important an medical societies played he saw as essential for productive
professional
which
cooperation. Membership
thus appealed to the London medical elite because it served "as a place for introductions and professional connections amongst consultantSP.74 Membership of Medical Societies A collection of papers printed in the Medical Press and Circular between 1936-38
compiled
by Sir
DArcy
British history of comprehensive
Power
in
1939, remains
the
most
medical societies in the nineteenth
[were] Power DArcy "they Though that 75 realised even not a century. history of all the British Medical Societies, for that would be a very difficult histories Individual 76 to of general medical societies, such tasle' undertake. Bartrip's, Peter as
Themselves writ Large: the Bzitish Medical Association,
histories together of specialist societies such as the History 1832-1966, with Physiological the of
Society by Edward
Sharpey-Schafer
are a valuable
in lieu history in historian, for the of a general of medical societies reference The 71 twentieth centuries. more prestigious societies the nineteenth and have, however, Society Royal the received considerable attention such as
in Medical Societies Place 'rhe Crawfurd, the Progress of Medicine', Raymond Sir of 73 Harveian Oration on the Occasionof the Centenary of the Harveian Society of London: 11 June, 1931, Archives of the RCP/ 245/2, pp. 3 and 14. (London, Medical Profession, The 1978), p. 18. Peterson, Jeanne M. 74 75For the period before 1800, see Peter Clark, Biitish Cluhs and Societies,passim. 76Power, Medical Societies,p. viii. 77Peter Bartrip, Themselves wit Large: the Bzitish Medical Association, 1832-1966, (London, 1996), see also Ernest Muirhead Little, History of the British MedicalAssociation, (London, 1932). Sir Edward Sharpey-Schafer, P.R.S. History of the Physiological Society during its firstfiflyvears: 1876 -1926 (London, 1927).
229
from
historians
of science and a number of these studies include
commentaries on other societieS.78 The recent History of the Royal Society of Medicine by Penelope Hunting and the earlier book published by the RSM, The Roval Society of Medicine by Maurice Davidson are particularly
useful, as they incorporate
the histories of the societies that merged in the early 1900s to form the
RSM.79Their work providesa valuable framework for the history of medical institutions.
Further research remains to be done and as Irvine Loudon
history "a has be to of comprehensive medical out, societies yet pointed writterý'.
80
By 1913, it was estimated that there were "at least 132 Medical Societies in this country, England claiming 104 (28 in London and 76 in the Provinces)", which excluded students' associations or benevolent societies.81 Thus, one of the difficulties
in analysing
the medical societies that had
is Street Harley diversity. from their It be quantity and will shown members that Harley Street practitioners proliferation
of medical
participated
societies from
in this rapid development and
1845 to 1914. The number
of
by in listed Medical Directory increased the the cohort male memberships dramatically
in this period, but this was partly
because the style and
78See, for example, David Philip Miller, The Royal Society of London 1880-1835:A study in (Ph. D. dissertation, University of organisation', the cultural politics of scientific Pennsylvania, 1981) where he discussesthe Linnean Society and the Astronomical Society, Sir Lyons, S. Society-'1660-1940-*A Henry F. R. The Royal History and ofits others amongst Administration under its Charters (Cambridge, 1944) and Sir Harold Hartley, F.R.S. (ed.) The Royal Society.' Its Ozigins and Founders, (London, 1960). 79Hunting, RSX, passim and Maurice Davidson, The Royal Society ofMedicine, (London, 1955). Care, Medical Loudon, p. 281. so 81Jamieson B. Hurry, Tbe Ideals and Organisation of a Medical Society, (TAndon, 1913), p. 9.
230
Directory In decade from the 1845 to the the altered of over period. content
1855, it was less common to include membership of medical societies in the Medical Directory. This did not, of course, necessarily imply that these practitioners
were not members of organisations,
rather that they may not
have reported it. By 1914, listing membership of professional associations or
increased became the variety and of common memberships societies was be increase This diverse. could attributed to the rise of specialist markedly during last the the of overseas expansion memberships and organisations quarter of the nineteenth century. The
total
number
of societies that
the
cohort joined
was
included in UK 300, The the societies and which abroad. approximately (n had from Harley Street before 239) these only one = member majority of however,
1914 arid
are, therefore,
significance
lies in the spread of the cohort's memberships. 82 Many of the
numerically
unimportant;
their
in field, those in their the who were eminent particularly group, such men Langdon John as
number
Down and George Harley,
learned of
were members of a large
societies and were occasionally invited
to be
institutions. Harley 83 of overseas academies and members corresponding Street practitioners, such as Edward Farquhar Buzzard who belonged to at least a dozen medical organizations, were assiduous attendees and orators 8246 societies had two members or fellows from Harley Street, 13 had 3,5 had 4,3 had 5 had 6. 7 and 83Langdon-Down's memberships included the Anthropological, Medico-Psychological, Neurological, Pathological, New Sydenham, the Medical Societies and the BMA. Harley Giessen, Society Microscopical Medical Society the the of member of of was a corresponding Halle, the Badish Society of Medical Jurists, the Royal Academy of Medicine of Madrid, and (ed. ) George Alec. Harlet., Sciences Bavaria. Mrs Tweedie, FRS Academy or the the of v of (London, Ebysician, London 1899), pp. 170 -17 1. Life of a
231
Since 84 in these of medical meetings. meetings were reported at a variety
the medical press, Buzzard's biographer argued that such attentiveness was
judicious.85 Table 5.1 Appendix E displays the main London society memberships
(i. from Harley Street, the or more seven members or over e. cohort, of Societies in Medical Harley Street than cent). which men one per greater discussed below. a significant contribution or made are were prominent Digby's analysis of 961 GPs revealed that between 40 to 50 per cent were figure for 86 The Harley Street however, societieS. was, members of medical
(n 84 Harley higher: 545) the Comprised which = majority, per cent of much Street practitioners
least members of at one medical society by the were
time of their arrival in the Street. Of those who were not members, that is, 112 (16 per cent), 38 of these listed their membership of a medical society in left Harley Street. before Directory Thus, almost 90 per they Medical the (n during 583,88.74 members cent) were of per a medical society = cent On Harley Street. Street twice in the time average, as many their men were Digby's findings compared with society medical a members of practitioners
on general
in Britain. It is not surprising that the figure for Harley Street
in London the higher, the was centre of medical societies as period and was Harley Street. the within organisations were easy reach of main many of
84For a list of the medical societies, seeA. M. Cooke, Sir E. Farquhar Buzzard, Bt. (Oxford, C. P. An APPreciation, F. R. M., 1975), p. 11. D. VO., C. K. 85Ald 86Digby, General Practice, pp. 6 and 62.
232
As was mentioned in Chapter 2, the City and the Finsbury
Square
in in the were particular, most popular places area, which to establish a From 1840s. the the middle of the century, the slow westward to practice up migration
had begun and practices in St James, Savile Row, Mayfair
and
Marylebone were the preferred choice. This westward relocation had an Medical Chirurgical the the such societies as medical and effect on some of Society. Members who were dissatisfied with the "inconvenient location!' of the Medical and Chirurgical Society at Lincoln's Inn Fields petitioned for the society's removal to the West End. Agents were also dispatched to assess the possibility of Wimpole Street, although suitable accommodation could leased house in found Berners the be there eventually society and a not Street near the MidcUesex Hospital
in 1834.87
The Medical and Chirurgical Society moved closer to Harley Street in 1889 when they relocated to Hanover Square where they remained for 21
Cavendish Square in to By 1910. temporary the then, the move until years, RSM, Wimpole Street 1 to the two which moved of part years was society
later. Other societies who wanted a West End location included the Pathological
Society,
the
Clinical
Society,
the
Zoological
Society
and
Harveian Society all of which were invited by the Royal Medical and Chiurgical
Society to take rooms at Berners Street. 88 The Medical Society,
Society Ophthalmological Gynaecological Society were the British and the
87Hunting, RSM, pp. 61-2. ssjbid, pp. 73-74.
233
Street, being in Chandos Harley Street, Cavendish 11 to also convenient Square.
London medical societies ranked differently in terms of prestige; BMA, the were egalitarian as such some,
and open to all medical
Medico-Chirurgical Society, the the as such others, whilst. practitioners Hunterian Society and the Medical Society of London were more exclusive Peterson fewer had maintained that these selective societies members. and "seem to have been the preserve of the London elite, serving as a place for introductions
89 connections amongst consultants". and professional
Scientific Societies The most prestigious of all scientific societies led George Harley to remark that,
"everyone knows by reputation
the Royal Society, which allows its
Fellows to use the magic letters F. R. S. after their name". 90 Established in 1662, the Royal Society remained unique until the middle of the eighteenth
century. particular Linnean
From that period onwards, specialist societies interested in began form, the to natural sciences of such as the aspects Society (1788), the
Horticultural
Society (1804) and the
(1820). Increasing interest in scientific knowledge and Society Astronomical its relevance to industry in the late nineteenth century led to demands for Society its fellows Royal the amongst a number of scientific restructuring known as the reformers. 91In his book, The Royal Society in the Nineteenth Century, A. B. Granville criticised the way in which the society was run (no ]ý*Ofession, footnote 18, Medical Peterson, P. number). 89 90Tweedie, Harley, p. 333. 9ijbid., p. 242.
234
during
this period. 92 He disapproved of the society's selection procedure,
because they accepted members who were genuinely not interested in had into felt he "an 93 that the society changed ordinary club". and science By the beginning of the First Word War, however, the Royal Society increasingly becoming was
more scientifically
based. Twenty-four
(4 per
Street Harley FRS, the were cohort elected which was a cent) of from Fellows 1845 1914 to 1,318 there were of considerable number as (11 had from Those Harley 94 151 medical qualifications. cent) per whom Street included distinguished medical practitioners such as Sir George Buchanan (1882), Sir William Watson Cheyne (1894), Sir Charles Mansfield Clark (1825), Sir Thomas Spencer Cobbold (1864), Sir Henry Head (1899) (1933). An analysis of the FRSs from Holmes Morgan Gordon Sir and Harley Street indicated that they were not concentrated in any particular decade; they were spread throughout the period.
George Busk was elected FRS in 1850 and later appointed VicePresident of the Royal Society on four occasions. Busk was also the first (1860-1869). Society A distinguished he Zoological the scientist, of secretary In palaeontology craniometry, and marine on zoology. was an authority 1846, he formulated
the first
(Polyzoa), a type of primitive
scientific
arrangement
of the
Bryozoa
mollusc. He was the editor of a number of
QuarterIv Journal, Microscopic Journal Microscopic journals: of scientific
(London, in Nineteen Century, Rcyalsociety The the th, Granville, 1836). B. A. 92 (London, Society History Tbe Royal A Blief 1960), p. 11. Andrade, C. Da N. of 93E. Archives Society. Royal Some Harley Fellows', Street the the the 'List of of cohort, Such 94 of (1933) FRS Holmes departure from Sir Gordon their after were elected the neurologist as (Dublin, Coakley, IHsh Davis Masters 1992), p. 261. Street, ofMedlcine, see the
235
Science, Natural
History Review and Journal of Ethnological
Society. With
Thomas Henry Huxley (1825-1895), he translated and edited Albert von K61liker's (1817-1905) Manual of Human Histology (1853) and was later (1815-1891) Carl Wedl's Rudiments ofPathological translator of editor and His tology (18 5 5).
An increased interest and knowledge of minerals, plants and animals in the early 1700s, led to the establishment of the Botanical Society (1721), followed in 1745 by the Aurelian
Society (to study of insects) and in 1780,
the short-lived Society for Entomologists of London. 95The Linnean Society, one of the most popular of the new natural societies with the cohort, is discussed below. The Linnean
Society was established in 1784 to commemorate Carl
Linnaeus (1707-1778), the Swedish botanist and physician who founded the modern taxonomical
system of the classification
of plants
and animals.
George Busk later became under-Zoological Secretary and J. J. Bennett, a non-Harley
Street botanist
was appointed
as secretary
of the Linnean
Society.96 Busk succeeded to the position of sole secretary in May 1860, being the society's first zoological secretary and he held this position until 1869. There was a slight increase in the popularity
of the Linnean Society
in Harley Street during Busk's Henry tenure arrivals when amongst
95Andrew Thomas Gage,A History of the Linnean SocietYOfLondon, (London, 1938), p. 1. The Society for Promoting Natural History formed in 1782 was active until 1800, but the its Linnean Society lost to in the 1788. of members established newly many society 96Gage, Linnean, p. 55.
236
William Haden-Haden, Thomas Spencer Cobbold, John Thompson Dickson joined W. Podmore-Jones H. the society. and As a classifier and investigator, Busk's work provided corroborative his Charles lived ideas Lyell the neighbour, and of who also evidence of Charles Street, Owen. Darwin Harley Richard in as as well and worked Busk was member of the X Club (a dining club united in defence against the evolutionary
naturalism
by Sir evangelical along promoted scientists) with
Joseph Hooker, Huxley, John Lubbock, Herbert Spencer and John Tyndall be independent Busk theology. that should science of was who advocated President of a number of scientific societies including the Ethnological Society and the Microscopical Society of which he was a founder member. General Medical Societies in London In the report from the meeting at the Royal Medical and Chirurgical in April
1905, the Chairman, Sir William
Society
Church, defined general medical
[were] "embrace[d] the that that those all medicine and subjects societies as allied
to it" and included:
Chirurgical
the Medical
Society, the Hunterian
Society, the Royal Medical
and
Society and the Harveian Society. 97
Following the exclusion of the eighteenth century physician, John Coakley Lettsom from the fellowship of the RCP, because he was neither an Oxbridge graduate nor a member of the Church of England, he conceived of in bringing together idea physicians, surgeons and apothecaries one the of democratic first in Britain, the the He medical society established society.
(1, Society Royal The Anon, ofMedicine, ondon, 1914),p. 86. 97
237
Medical Society of London in 1773.98Lettsom modelled the Society after the
RCP, but also provided a forum for the three branches of medical men and the advancement of medical knowledge. 99 From its inception, the
facilitated
found keen ideas. Irvine Loudon and research new on promoting society was
that by the late nineteenth century, the Medical Society of London had become "the most prestigious of all London medical societies".100As Sir Christopher Booth observed, this society was "the first medical organisation, Society, by for Royal from to the encourage research awarding medals apart
Between 101 1848 1941, and almost a quarter of contributionsý'. outstanding the Presidents of the Medical Society of London were Harley Street men, (21 (1927), included Herbert William Carson Presidents): 93 the which of out of Arthur
Ernest Sansom (1897) and Vincent Warren Low
(1919).
102
Carson
East North London founders Post-Graduate College. A the the of was one of frequent
speaker
at medical
Sansom 103 surgery. fermentation published the Medical
was
responsible
to the Medical in The Antiseptic
societies,
his main for
interest
bringing
was in abdominal
Pasteur's
Society in a series of papers, which
research
on
were later
System (1871). 104Low was elected President
of
Society in 1919 and later became one of its trustees. 105
98Crawfurd, 'Medical Societies', p. 11. in Society Medical The arranged was a similar hierarchical structure as the RCP 991hid, treasurer, registrar and council. president, a with 100Loudon, Nedical Care, P. 201. in Science Booth, Doctors C. Christopher and Society. ' Essays ofa Clinical Scientist, 10, (Cambridge, 1987), p. 9. just before in Presidents Harley Street four their Three arrival and 102 were appointed were President following their departure from the Street. William Carson, Lancet, Sept. 6,1930, p. 556. 'Herbert Anon, 103 104Anon, Arthur Ernest Sansom, BMJ, Mar. 23,1907, p. 722. Low, BMJ, Sept. Warren 'V. 19,1942, p. 354. Anon, 105
238
The drawn out tenure and inflexibility of the President of the Medical Society, Dr. James Sims, led a number of influential Medico-Chirurgical
members to set up the
Society, as a separate organisation
in 1805, which
became in its 1834 the Royal Medical and Chirurgical and charter received Society (RMCS). Entry to membership was by ballot. The society's name was
development following the the of modern scientific surgery a reflection of Hunter, "the John which represented emancipation of surgery practices of from the mortmain of medicine".106The largest of the London medical in Berners it Street, Oxford Street conveniently situated was and societies, (18.49%) fellows 109 from Harley the the as cohort were with popular Street. Though the RMCS was accessible for those in the West End, many felt there was a need for a medical society within easy accessof the City and the eastern district
Consequently, London. of
the Hunterian
Society was
(1728Cooke in in William 1819, by John Hunter memory of established 1793). At the time "many practitioners lived within the boundaries of the Old City of London, in and around Finsbury Square, which was then the 'Harley Street! area."107The Harley Street surgeon Robert Fortescue Fox Secretary the time the Honorary at of proposed affiliation was
with the RSM
Sir William Blizzard, Hunter his who was an ex-pupil of who neighbour, and
John Hunter believedthat theorieshad to be testedscientifically certainty couldonly be 106 'the Crawfurd, Place Medical Societies', through research and observation. of p. established 12. 107A.E. Mortimer Woolf,'The Hunterian Society,in Power,Medical Societies,p. 78,fh., 18. 239
its first became President. Several 108 the society's name, other proposed
Harley Street men held senior positions within
the society and they
included the surgeon Herbert William Carson who was President during the early twentieth
century. 109
Whilst the Hunterian Society catered for the medical profession in the East End, the West London Medico-Chirurgical Society served those in the Hammersmith and Fulham areas and the Harveian Society catered for in Established September 1831, the Harveian West End. in the those Society was originally
called the Western London Medical Society because of
in for the Western General Dispensary, the the venue society's meetings
Lisson Grove, London. It became the Harveian Society later in the month as its to to the "token adhere strictly course of observation and resolution of a induction
by illustrious the pursued so successfully
discoverer of the
The blood". 110 the the the aims of society were advancement of of circulation in debate discuss to to through addition meetings unusual medical science held From Medical 1851, the the society's meetings were at medical cases. Society of London and two years later, it opened its doors to corresponding
members. The Council decided that a general practitioner should be elected Harley Street triennially. the the produced society a number of of president from least decade 1830s the 1900s, to the one at per and society's presidents, Society: if Hunterian Hstary 'The 1869-1969', Med Y, ýine, Autumn 1970, p. Stewart, F. E. 108 , 8o William Carson, Lance4 Sept. 6,1930, p. 556. Herbert Anon, 109 (London, Society Marveian 1831-1981. Tbe Anon, no date possibly 1982) p. 110 ofLondon! first page (no page numbers). Women were not admitted as full members until 1964.
240
included, these of some
William
Macintyre
(1838-39 and 1845-46), Sir
Richard Quain (1853), Thomas Carr Jackson (1877), William Hickman (1882), Sir Malcolm Morris (1893) and Sir William Watson Cheyne (1902). All were distinguished and established medical practitioners who had also been presidents of other medical associations."' The Right Honourable Lord Horder, consulting physician to Bart's (1936) who was described as "as the day", President his in elected was greatest physician of
1931.112
(BMA) Association Medical British The British
Medical Association was the most popular organisation
Street Harley practitioners cohort and many
were prominent
for the
members. As
Peter Bartrip has shown, the BMA was never designed by unanimous fulfil duty. by Its to any one exclusive statue essence changed agreement or
It being 113 the time adapted. was goals principal medical society with over for members of the medical profession throughout
the British
Empire and
had 12,000 members in 1886.114Peterson noted that by the 1890s, more than half of all registered medical practitioners were members of the BMA. 115At least 30% of the new arrivals in Harley Street listed their BMA Association Medical Directory. The had in the an extensive membership branch least branches the throughout country and each elected at of system
HI For a list of Harveian Presidents, seeAnon, Rkrveifin Socie,t,-Y,pp. 6-9, (no page numbers). 112Jbid, p. Appendix Biographies of some of the Presidents'. (London, Mit Large, BAM, Tbemselves 1822,1936, the 1996). Bartrip, Peter 113 (12), Profession, Medical Rivington, op, cit., pp. 452 and 478. For a comprehensive 114 history of the BMA, see Bartrip, BAM, passim. I's Peterson, Medical Profession, p. 231.
241
one representative
annuaRy. 116The main objective of the Association was to
improve medical science and enhance the status of the medical profession.117 Thus, by the 1950s, Paul Vaughan remarked that long held time, a generally ago, opinion was that the so very and not at one BMA was run by 'diehard old fossils', 'a small body of politically-poisoned 118 Street Harley guineas grabbers. people,
Though a number of people regarded the BMA with some disdain becauseof from Harley Street, it involvement the was, nevertheless, a of so many men democratic Association which represented the views of the majority of active in Britain medical practitioners "lobbying
and thus exercised a high degree of
119 potentiaY'.
It was common for the cohort to join the BMA early in their career
increasingly through trajectory their senior posts: a way and some worked The 120 their advancement. career ophthalmologist which also reflected Nathaniel
Bishop Harman who joined the BMA just after qualifying,
worked
Marylebone Division Honorary Secretary the to from his way up secretary of
he Division, Branch in President Branch the Treasurer and served as of and he Treasurer he later, BMA, the Two appointed was of which 1922-23. years
held until 1939 -
becoming the longest holding member to date of that
Gold for Medal his Society he the to the In 1931, service awarded was office. in in his the for ophthalmology, especially work prevention pioneering and blindness. of 116Branches with more than 200 members elected an additional representative who also had a position on the council. Rivington, Medical Profession, p. 479. 117Little, BAM, pp. p. 296. 1Is Paul Vaughan, Doctors'Commons, a Short History of the Biitish MedicalAssociation, (London, 1959), P. xiv. 119Aid William Sibley, March BMJ, 25,1893, p. 671. 'Septimus Anon, 120
242
Other Harley Street practitioners
BMA
included Septimus William
who were actively involved in the
Sibley who was President of the
Metropolitan Counties Branch of the BMA 1878 and later Treasurer. He Council from 1881 Cocker Henry Radcliffe the 1891. to of was a member became honorary secretary of the association's Counties Branch in 1889, two he later was elected a representative of the Branch on the Central years Council, and finally in 1907, he was elected Treasurer. 121In general, those who were members of a number of societies were also members of the BMA. Charles Oliver Hawthorne who was described as a "good committee man!' "at one time or another ... a member of thirty was
committees or
Association7.122 In he became 1924, the of a member of the subcommittees Council and was Chairman of the Representative Body from 1928 to 1931. Appointment humbling
to the position of President of a section was for some a
experience and a role they took seriously. When Tilbury
Fox was
Subsection Dermatological in President Section the the of as of elected Medicine at the BMA, he remarked in a letter to his friend, and Harley Street colleague, Professor Macnaughton Jones: how much he appreciated the honour conferred upon him and in accepting the presidency, which he did, "with considerable diffidence", he pledged to make the meeting a dermatology is far 123 "as concerne&'. as success
Radcliffe Crockee, BMJ, Sept. 11,1909, p. 730. 'Henry Anon, 121 122Anon, 'Charles Oliver Hawthorne, BMJ, Oct. 29,1949, pp. 986-87. 123Anon, -filbury Fox, BMJ, June 14,1879, p. 916.
243
Hospital Medical Societies and University Clubs Most of the Medical Schools had students' societies. The oldest of these was the Edinburgh Royal Medical Student Society established in 1735, followed by Guy's Physical in London in 1775 and the Medical and Philosophical Society in 1795. The aims of these societies were twofold: they provided a forum for the reading of papers on medical and surgical subjects, and facilitated the exhibition of specimens and the discussion of patient case histories. Many of the cohort maintained strong links with their university hospital, particularly or
if they were appointed to its staff. They also
institutions, for led these to the work which sometimes voluntary undertook establishment of student societies. From 1908 to 1926, the Presidents of King's College Hospital Medical Society were the Harley Street surgeons Frederic Burghard and Lionel Vernon Cargill
who were ex-students of Kings. 124Cargill,
who graduated
from King's, had a life long bond with his medical school. He excelled academically,
winning
scholarships and prizes, which included the Carter
"Todd for in 1888, the for prize clinical and medicine and prizes gold medal
forensic 125From 1902-1903, anatomy and meclicin&". pathological obstetrics, he was President of the College's Medical Society at the hospital and was later appointed president of the Clubs and Societies Union. 126Cargill was hospital later became lecturer in to the and surgeon a appointed consulting
Street Other Harley King's included George Belben men ophthalmology.
124 Anon,
'L. V. Cargfll, BMJ, Dec. 24,1955, pp. 1568-69.
125
Jhid. 126 Aid.
244
Flux who qualified
in 1888, and was appointed Assistant
Anaesthetist
in
1902; he was largely responsible for establishing the King's College Hospital
Societies Union in This incorporated 1908.127 the Listerian union and Society together with sporting societies and other leisure pursuits.
The surgeon, John Abernethy (1764-1831) is regarded by historians founder St. Bartholomew's Hospital. the the medical school of at principal as He established his series of anatomical lectures in 1788, at the hospital and he in later, Medical 1795, the created and Philosophical Society seven years for the teachers and students and alumni of the hospital. 128This was Society in Abernethian in honour 1832, its founder. the 129 of renamed Papers on medical
science and practice
were presented
at the weekly
during the winter session and results of clinical cases were meetings displayed.
However,
information
concerning
the formative
"no is since especially authoritative sparse, society
years of the
record of the Society is
known to exist" between 1815 and 1832-130Keir Waddington noted that the high point for the society was in the 1870s and 1880s, when with papers that encompassedthe relatively new subjects of pathology and bacteriology it became more scientific. 131Attendance began to decline in the twentieth
(London, MnglrandSomeMngý; Lyle, Men, 1935) p. 427 Willoughby 127H. ) (eds. John L. Medvei Thornton, 7he Rqyal Hospital ofSaint Cornelius Victor 128 and (London, 1974), p. 47 1123-1973, ' Bartholomew. 129Medvei, Bartýv, P. 55. i3o 'A brief sketch of the 'Abernethiansome time known as the 'Medical and Philosophical' (eds. Rowland H. Coombs in Dr. Andre ), Mr Bartholomew's, St. Callender, and -Society of Saint Bartholomewýv HOSPitfilReports, Vol. IV, 1868, Clondon, 1868), p. 269. 131Keir Waddington, Medical Education at St Bartholome wýgHospital, 1,123-1995, (Suffolk, 2003), pp. 247-258.
245
century when students were taught these new subjects in the class-room lost its focus. the research society and In the 1834-35 session, the Harley Street physician, submitted
a number
of papers to the Abernethian
Charles West,
Society, including
"Structure and Functions of the Placenta" and "On the diffilculties in the diagnosis and treatment of Head affections in Children! '. 132As was noted by West's fellow growing reputation member, a
as an expert in obstetrics could
"have been marked out by his papers at the Abernethiaif'. 133He later (1854), lectures Croonian the Lumleian Lectures (1871) and delivered the (1874). The election of Mitchell Oration Harveian the
Henry to the
for brief financial 1847-48 the session coincided with a period of presidency Society. By Abernethian for however, 1856, the the society was prosperity forced to discontinue the practice of publishing its transactions due to lack funds. of The record of members of the Abernethian Society just after the Great War showed that more members were from Harley Street and the Harley Street Area than from any other region. 134 They included
the surgeon
William McAdam Eccles who graduated MB in 1890, BS in 1891 and MS in 1894 from UCL. He later became a lecturer in surgery and took a keen interest
in education and opportunities for recent medical graduates.
Consequently, he became one of the founders of the University of London Coombs,Ahernethlan, p. 277. 133 Aid 134F.W. Andrews, W. McAdam Eccles, G.E. Gask, W.D. Harmer, H. Thursfield, and H. Williamson eds., Saint BartholomewývHospitalReports Vol. Liii, 1917 and 1918, (Ixndon, 1920), pp. xi-xxiii. 132
246
Medical Graduates
Club.
Medico-Chirurgical
Society. 136
135
Eccles was also President of the West London
Medical Clubs Informal
associations for physicians and surgeons in London such as dining
be bridge during 137Many to the created continued clubs period. and clubs hospital, United Guy's Hospitals Club'for formed the as such around a were institutions Royal Colleges Surgeons Thomas's the such as other of or or and Physicians.
Some were fairly
exclusive and consisted of fellows or senior
Council had Club for RCS the a members of the council members of stafir, for Club "inner College had "very the RCP the a ring" which was select and [with]
(only 22) members". 138Another
club founded to cater for an elite
Samuel Wilks Fifteen Club, the surgeons was and group of physicians (1824-1911), Wilks Samuel Guy's honour Hospital in to physician of named founding fathers 139The the of one of clinical as science. club and regarded Westminster Hospital, its to two at physicians one of whom was origin owed the Harley Street resident Horatio Bryan Donkin, the club's secretary. 140 Donkin, who was on the Committee of the Savile Club, moved freely in described "progressive in thinker", and was as circles a socialist radical and 135Anon,Villiam McAdamEccles,BMJ, 15June, 1946,pp. 892-93. June, Eccles', Lance4 McAdam 8,1946, p. 873. 'William Anon, 136 137Sir Humphry Rolleston,'MedicalFriendships,Clubsand Societies',Annals ofMedical Histo.ry, Vol. II, May, 1930,Number3, p. 253. 138 Ibid. Anian M Banerjee,'Sir SamuelWilks: a FoundingFather of Clinical Science',Journal of 139 the Royal SocietyofMedicine,Jan. 1991,vol. 84, p.44. A Samuel Wilkes Fificen Cluh: Recordh-omits Foundationin The Donkin, Sir Bryan 140 Fehruary 1885,to May27,1926, (London,1926),p. 1. The club'seponymSir SamuelWilks, (1823-1910) leading Guy's Hospital on morbid and a authority anatomy senior physicianat President. "begged" by When Donkin be to the to reluctant accept a position, appeared first his "modesty forbade later Wilkes's Wilkes that that adding at assent" refused stated for the to accept office morethan a year. 247
in he Men Women's Club, because the and was a member of established part (1857by Victorian Karl Pearson late 1880s, the the eminent statistician, 1936) and his Cambridge friend, the barrister Robert Parker, for the open discussion of relations and problems between the sexes.141 The object of the Wilks club was to "bring together from time to time during the collegiate year a few congenial men especially interested in the informal It 142 medical education". was an club scientific side of medicine and "talks as might on occasion spring spontaneously except with no speeches from members' brains". 143During the life of the association, at least eleven Street. in Harley Many founding the its of club's members practised of Bart's, Andrew, Phillip Henry James to physician and members, such as Pye-Smith, Vice-Chancellor of the London University
and physician to
Guy's, were also Harley Street men. Although the club did not take on a knowledge, it in medical was, nevertheless, an advancing significant role Harley Street from London distinguished group of men various example of a Hospitals fraternising with their colleagues from the Street. There is no Street but informal Harley like the medical club, clubs specific a of record Samuel Wilks Fifteen Club show evidence of conviviality
and social
interaction between the Street's medical practitioners.
Female Malady. Women, The Madness and English Culture, 1830* Showalter, Elaine 141 1980, (London, 1988), p. 131. See also, Eileen Magnello, Victofian Values: The Ozigin of [Cambridge, 20041. Statistics, modern 142Donkin, Wilkes, P. 1. 143Donkin, Wilkes, p. 4.
248
Prominence within Medical Societies Of the cohort who listed their high-ranking positions in medical societies in the Meefical Directory, 65 were Presidents and a further 20 were Vice Presidents during their time in Harley Street. Others were appointed to departure from following Street. A their the number of the senior positions in the establishment of these general medical also active cohort were McGrigor, founders Aberdeen Sir James the the was one of of societies: Medical
Society (1789)144; Sir
Horatio
Bryan
Donkin,
physician
to
Westminster Hospital, was a founder member of the Society for Venereal Diseases.145;George Allan Heron, physician to the city of London Hospital for diseases of the chest, became a principal founder of the London and Counties Medical Protection Society in 1892 and held the position of Treasurer until he was elected President of the Society in
1913.146
(RSNO Medicine Society The Royal of
One of the most comprehensive London medical societies during the early twentieth
Society Royal Medicine the was of century
following created
the amalgamation
(RSM), which was
of the RMCS with
other specialist
hospitals With in London, from the 1907. the growth of specialist in societies
late-nineteenth in there the the century, was a concomitant rise mid-to including Pathological Society the societies medical specialist number of (1846), the Epidemiological Society of London (1850), the Odontological (1858) (1856), Obstetrical Society the Society and the Clinical Society 144Sir James McGrigor, The A utobiography and SeT;ices of Sir James McGligor Bart. Late Directm-Generalof the Arm7Me6caj Departmen4 (London, 1861), p. 6. 145Anon, 'Sir Bryan Donkin', BMJ, Aug. 6,1927, p. 240. 146Anon, 'GeorgeMan Heron', BMJ, Dec. 25,1915, p. 946.
249
(1867): many of these societies were absorbed into the RSM once it was
in At for 147 time the the of proposed scheme amalgamation established. 1905,22
had been 26 that the societies approached ostensibly out of a "membership
represented
of 7000
...
[however]
an
and
analysis
lists that this the show membership was made up of various of comparison
4750 persons". 148Two years later, 26 London medical societies were invited to
participate
in
the
emerging
comprehensive
organization:
fifteen
form Society "Royal they to the amalgamated were responded positively and of Medicine".
119
With the increasing number of specialist societies emerging at the location their the unification at century, one geographical nineteenth end of for convenient more medical practitioners meant attendance was
who
developments in informed to about various areas of specialist stay wished Area following Street Harley The was chosen medicine. [which] by Street began at Harley the medical profession the colonization of the south end of the street as an overflow from Mayfair and Cavendish Square. Royal appointees made the area fashionable and attracted lesser had 20th Mayfair by the the century area replaced early as the mortals ... base for the medical coterie of London: it was therefore an ideal location for the Royal Society of Medicine. 150
As Hunting further pointed out, the union contained several societies interests "the landmark in the to and merger was a that appealed specialist gradual
Additional 151 acceptance of specialization".
joining societies
in
Society for Study included Diseases in Children the of and subsequent years
Hunting, RSX, P. 102. 148Anon, RSM, for a list of the 22 societies see p. cxlii. 149Maurice Davidson, RSM, pp. 14-22. 150Hunting, RSX, Pp. 179-180. is, Ibid., p. xix. 147
250
the Society of Anaesthetics
in 1908. This successful amalgamation
of the
RSM was co-ordinated by the Harley Street consulting physician to Bart's, Sir William Selby Church. 152 In 1905, Church, who had ceased to be President of the Royal
College of Physicians (1899-1905), became the chairman of the organising Osler, Sir William He RSM. for the was an able negotiator and committee he first RSM's President, ChurcYs the remarked election, as who seconded Other business 153 in bird the "that mae'. profession, a good rare was, Street include Sir William Harley from RSM the the physician presidents of (President (1922-23) Vincent Low Warren the Hale-White of surgeon and RCS ViceVice-President 1928-1939 the in 1932-34, RSM of and the President of St. MaWs Hospital).
154
Six of the cohort, including Sir Humphry
Rolleston and Sir Henry
RSM left Presidency Harley the they the to of after Tidy, were elected Street. 155Rolleston was elected President of the History of Medicine Section (1918-20) and in 1930-31 served as President of the RSM. 156He was also President
Medical the of
Society of London
(1927), the Association
of
(1932). Vice-President BMA Tidy (1925 the 1929) of and was Physicians and
"several before". Anon, 'Sir been had times tried, unsuccessfully, This 152 amalgamation William Church, BT`, BMJ, May 5,1928, pp. 778 - 780. 153 ]bid. Appendix V. Warren RSX, Anon, 481Hunting, 482 Church, Selby William pp. and Sir 154 354. 19,1942, Sept. BMJ, p. Low', Sept Tidy Bt. BMJ, 30,1944, 452 454. Rolleston, Humphry 'Sir pp. Anon, was 155 in in See RSM 1942 to the senior offices of other addition medical societies. President of four 1896-97. The F. BMJ, June MB. 18,1960, Tidy, Henry 'Sir pp. other were Anon, (1938 (1928-1930), Ball Sir Henry Girling Sir William Penn Dawson of Viscount -40), (1944 (1942-44) Gordon Sir Gordon 46). Tidy Letheby and -Taylor 156Hunting, RSM, p. 199.
251
appointed Physician-in-Ordinary
to the Duke of York (later King George
VI) in 1936 and in 1952 became Extra-Physician
to The Queen. In 1942 he
President RSM the elected of was and also chaired International Conferences at the Society. 157
The Pathological Society of London158 The societies, which joined the RSM and attracted the greatest number of from the cohort were the pathological and clinical societies. members in
Beginning specialist
the
interests
1850s, collaboration
amongst
desire to inform, and a
those with
particular
educate and disseminate
the
knowledge, gave rise to a number of specialist expanding specialist
rapidly
Pathological the societies such as
Society of London (1846). In the last
Presidential address of the Society before it was absorbed by the RSM in 1907, Philip
Henry Pye-Smith the Harley
Street consulting
physician
to
Guy's Hospital, remarked: founded Society was pathology was still the hand-maid of our when Medicine and Surgery as is shewn by the names I have cited. The science has now a far more independent position, and is the foundation or in Sit tute disease treatment prevention and scientific all of must rest. 159 on which
The practice of pathology as a branch of medicine dates back to William
Harvey (1578-1657) whose own "anatomical lectures contain[ed]
in his to 160 By observations the midown morbid anatomy". allusions many
(London, Society Royal Presidents the Moll, H. 1996), p. 300. Other M. J. of OfMedýcine' 157 (1938-1940), Street Sir in Harley Girling Ball were Presidents who were 158There was also another pathological society established in 1906, which met bi-annually Society of Great Britain and Ireland. This society's mouthpiece Pathological the called was been Bacteriology, had founded in 1893. Journal and which the ofTathology A History Dible, Henry Pathological J. the Societ in Quoted of 159 y of Great Blitain and [reland (Edinburgh, 1957), pp. 3-4. . W. D. Foster, PatbO109Y PrO-fessiOn in Gmat Britain and the EarlyHjstory of the as a i6o (London, Pathologists, date Coll, no probably circa 1970s),p. 1. William Harvey J?07al -ge of
252
1820s, the study of pathology had become an essential part of the medical curriculum
began British by 1831, to employ professors medical schools and
Pathological The 161 of pathology.
Society was established in 1846 for the
"cultivation and promotion of Pathology, by the exhibition and description of Specimens, Drawings, Microscopic Preparations, casts, or Models, of Morbid Parts". 162Its aim was to promote an interest, initially in morbid anatomy (though later other branches of pathology were added) and to encourage a had hitherto, to to studies, which medical according approach more concrete the
been too abstract. society,
Sspeculative
argumentation
The Society's rules "specifically
banned
or discussion' at meetings". 163Papers presented
in Transactions Pathological the of periodically at the society were recorded Society ofLondon. Two of the twenty members of Council, who managed the affairs of
George Busk, from Harley Street. Quain 164 Richard Society, were and the in Harley Street 1846 but few the were members men, Only a original of increasing from lists the Street. 165Apart number an show later membership Pathological Society RSM, had the the the greatest BMA from the and 107 from fellows the cohort: male members and eight number of members
blood, to this time Galenic the up physicians accepted the of discovered circulation blood did for heart the the in around not pump system, an explanation of which physiology Greatest Benefit Mankind. A The Porter, Medical History to Roy See, of Harvey's theory, (first published 1997, this edition London, 1999), Present, the Antiquity to Humanityfivm p. 211-216. 2-4. patbology, pp. Foster, i6l (London, Society London, Pathological the 1848), 15. li-ansactions of of p. Anon, j-, 162 163Xd
7 PathologicalSOCie(y, p. ia4Anon, listed McIntyre in William Harley 7-14, was as practicing member, one only i65.1hid., pp. Alfred Garrod, William Jenner Edmund Alexander and members but three other St., Street. later the to move Parkes would
253
Street Harley practitioners were
and a number of these played a prominent
in development the the of pathology as a subject. society and role within The Clinical Society of London The Clinical Society, founded in October 1867 in Queen Anne Street, was late in that the the appeared nineteenth wave of specialist societies part of
belief insufficient in the that It attention was paid was established century. to the discussion and exhibition of living cases.166Thus, the purpose of the "cultivation for the society was
and promotion
of practical
medicine and
interest, bear by the cases of of especially of such collection as upon surgery, undetermined
in Pathology Therapeutics". or questions
Invitations
to join
London hospitals to of staff of recognised the society were sent members and 167 medical schools. The society planned to support physicians and surgeons who believed
in the actual observation and treatment of patients, who endorsed practical investigational The theoretical methods. or clinicians were so medicine over discussions topics that they to on general academic allotted opposed strongly discussions. Instead, for they concentrated their such just ten minutes histories. together their 168Reports with case patients efforts on presenting however, this the was abandoned published; when these occasionally were of in Members RSM Clinical 1907. Society the the of with society amalgamated distinguished Morell Mackenzie, included Street Harley men such as from
Societies', 14. Wedical p. Crawfurd, 166 (L40ndon, CEnical Society the 1, 1868). Transactions OfLondon, vol. of Anon, 167 106. RSM, Hunting, P. 168
254
Vincent Warren Low, William Hale-White, Dawson Williams and Charles Alfred Ballance. Societies founded by Harley Street men which merged with the RSM Peterson found that the first specialist medical society emerged in the 1820s. Whilst a number were established after the middle of the nineteenth "great the era" of specialist societies was the 1880s when, according century, to Peterson, six new societies were formed. 169In the last quarter of the Harley Street the of men a number on century, staff of specialist nineteenth hospitals were instrumental in the foundation of new medical societies. Alfred Herbert Tubby's work on diseasesin children at the Evelina Hospital for Sick Children prompted him, together with Stephen Stephenson, to Study Disease for in Children Society in the 1900, the of which establish had 102 original members. The focus for the society was for "the more exact in disease 170 By 1904, childhood". of study society membership and scientific had risen to 304. When the society was amalgamated with the RSM in 1907, Tubby was appointed President of the Section for a term. 171
Advancements in Dermatology in the late nineteenth century were due largely to a number of Harley Street men who were also prominent in the
Dermatological
Dermatological
Society of London established in
Society of Great Britain
1882 and the
and Ireland founded in 1894.
dermatologist Abraham Simon to the West London consultant a Phineas Hospital
Hospital the to and
for Diseases of the Skin, Blackfriars,
Profession, Medical p. 266. Peterson, 169 310. Medical p. Peterson, 170 -Profession, March BMJ, 1930, Herbert Tubby, 1, 419. 'Alfred p. 171Anon,
255
was
(a Harley Street Wilson Erasmus together with non practitioner)
founders of the Dermatological Society of Great Britain was also instrumental
Abraham
one of the
and Ireland.
in establishing the Royal Academy of
Medicine of Ireland. 172At the 1910 London meeting of the BMA, Abraham Dermatology had been President President the of and section of was elected Society in 173 The Medico-Chirurgical London the West the previous year. of Society included specialists and GPs who were interested in dermatology.
Following the foundation of the RSM, these two dermatological Section Dermatology. form the to of societies merged
and
the
Section's first
three
Its founder members
Presidents were the
Harley
Street
dermatologists, Henry Radcliffe Crocker, Malcolm Alexander Morris and Thomas Calcott Fox. Crocker was elected in 1907 with Dr Arthur Whitfield Street the Crocker two Harley acted as one of who man, secretaries. another Dermatological Society founder the been of member had also and much of a been has Section's attributed early success the
to his enthusiasm and
Calcott Fox succeededCrocker as President on his death 174Thomas energy. in Sir Malcolm Morris was 1911 until when office in 1909 and remained nominated. Morris was also a prolific writer and was active in developing the joUrnal
DerMatojogyM of
His position as medical editor of Cassell and
being in board in 1906 to the 1880s, in the a addition member of Company
172 Anon,
Thineas Simon Abraham', BMJ, March 12,1921, p. 406.
173 ]bid,
Sept. 729 Council BMJ, 11,1909, Minutes Crocker' the Radcliffe p. and 'Henry of 174A, non, May in Hunting, 31 1910, RSM, 258. Dermatology quoted p. Section of BMJ, March Morris', 1,1924, 407. Malcolm 'Sir p. Anon, 175
256
from 1895 to 1902, meant his contacts
Practitioner journal the and editor of
that included
Book he Health In 176 1883, the edited of were extensive. from a number of his Harley
contributions
Street colleagues, including
James Cantlie. Morris, who was also co-editor of the International
Section of the
of the Dermatological
Science and President
Medical of
Journal
Congress, London 1913, was both socially and professionally
International
a
leading figure in the world of medicine and was awarded the KCVO in 1908, King Edward VII. his to professional services of
in recognition
Herbert
Alfred
Tubby,
orthopaedic
surgeon
to the Westminster
Orthopaedic Hospital, instrumental National Royal the was and
Hospital
the foundation
for Study in Disease Children Society the the of of Orthopaedic
the British
in large establishing part a played
in and
Society. This
in by British 1918 few the lasted was superseded and years only a society Orthopaedic
Association. 177One of this Association's founders, Sir Thomas
Harold Fairbank an eminent orthopaedic surgeon, was later elected
Arthur as the
proponent
Association's
President
(1926-27). 178 Fairbank
of orthopaedic surgery as a speciality,
was
an active
and helped to raise its
he became President Orthopaedic the in when of the arena medical profile RSM. the section of Increasing nineteenth advances
century
interest
in
neurology
and
neurosurgery
gave rise to the establishment
in the field. The Neurological
in
of a society
the
late
to discuss
Society of London was set up in 1886
276Ibid.
177 Anon, Tubby', BMJ, p. 419. 178 Did.
257
to cater for this medical speciality. The name of the society was changed in
1903 to the Neurological Society of the United Kingdom to reflect the from London. The Harley Street physician, attendees outside number of Charles Edward Beevor was the last President of the society prior to its in Beevor, RSM 1907. the who specialised in neurology, merger with his the extensive clinical and experimental research of results published Victor Horsley Sir on muscular movements and their place in the with led him becoming This "one to publication system. of the recognised nervous neurological
in
authorities
the
country". 179 He further
enhanced
his
his 1908 the brain, to the paper on arterial supply with reputation which had been described in first this 180 that time the print. was Another Harley Street neurologist, Henry Head who had been instrumental with
in directing the merger negotiations of the society (1905-1907)
the RSM, was appointed
President
of the Neurological
Section in
Street Harley A physicians such as Alexander 1918.181 number of Bennett, Alexander
Gordon Morgan
Edward
Farquhar
Buzzard,
Samuel
Kinnear Wilson and Wilfred Trotter were active members of the
society and contributed 182 ain. ,B
Holmes,
Hughes
regularly
to the society's associated publication
Leslie J. Paton was President of the Neurological Section of the
RSM in 1931 and was also President of the Ophthalmological Society of the
Dec. Beevor', Lance4 Edward 19,1908, 'Charles Anon, P.1854 179 in Philosophical Transactions the Paper published The was of the Royal Society of 180 London, and later published as a book. Ibid., and Anon, 'Charles Edward Beevor, BMJ, 12 Dec, 1908, p. 1785. 181Hunting, RSM, p. 265. diseases an article on of the nervous system to almost every volume 182Bennett contributed Anon, 'Alexander Hughes Bennett, EMJ, Nov. 9,1901, p. 1444. in 1880s, the Ergin of
258
United Mngdom. In 1934, he was President of the Section of Ophthalmology
had been Treasurer BMA International Ophthalmological the the and of at Council. 183 Three of the 15 founder members of the British
Proctology Society,
Street Harley Charles in Ryall 1912, two, were men and and established Frederick Swinford Edwards, went on to become Presidents following the Society's
amalgamation
with
the RSM in the following
year. Edwards
became the section's first President (1913-1919 and in 1924-1925). 184 A short-lived Augustus system
Granville
Obstetrical
Society (cl825-1830)
was set up by Dr
to canvass the medical corporations
of regulation
number of unqualified
for midwifery,
to introduce
a
which was essential because of the
medical practitioners. 185To provide a meeting place
for the discussion of subjects relating to obstetrics, a new Obstetrical Society in 1858, under the chairmanship
of Dr Edward
Rigby.
Before he arrived in Harley Street in 1879, the eminent obstetrician
Robert
was established
Barnes was also one of the society's principal founders. Twenty-six
December later, 27 Barnes 1884, on years called for a
Society be founded Gynaecological "that be to the now a called resolution, British
Gynaecological
Society". 186 The resolution
was passed and the
"to the & the aim promote with established science art of society was
June BMJ, 741. 12,1943, J. Paton, 'Leslie Anon, p. 183 369-370. SM, I? Hunting, pp. 184 A History Mldppives Donnison, Jean See of the Stmffffle for the andMedicalMen: 185 (London, 1988). Cbildhirth, Control of May BW 18,1907, Barnes', 1221-22. 'Robert pp. Anon, iso
259
Obstetric Gynaecological The 187 Societies functioned the and gynaecology". until
1907 when they were absorbed into the Obstetric and Gynaccological
Section of the RSM. 188The Harley Street obstetric physician to the London
Hospital, George Ernest Herman was an active fellow of the Obstetrical Society of London and was President from 1893-95. Of the 27 original London members of the Laryngological Society of London
founded in 1893, seven were Harley
Street practitioners
and a
further 12 practised in the surrounding streets such as Wimpole Street and
Queen Anne Street.189Others such as Atwood Thorne held high-ranking positions
Rhinological the the merged with society when
and Otological
Societies. Thorne was Vice-President of the Association and later secretary Laryngological the of members
Section of the RSM. Whilst
Harley in based the were
development
Street
most of the original
and were involved
Sir Henry Trentham the as such speciality of
President of the Laryngological
in the
Butlin, who was
Society (1897-98).
Street Harley RSM the men Sections of and A number of the cohort held high-ranking Positions in the sections of the be discussed below. The Balneological and these will RSM and some of Climatological Section of the RSM was established in 1909; its forerunner
477. 1899, p. MedlefilDireCtOrY. 187 106. BSX, Hunting, P. 188 Anon, from Proceedings the tbe provinces. There members some of 189 also were (London, Vol. 1,1893-94 SOciet: 1895) pp. v-vi. There were also r ofLondon, Laryngological (1852-1906), William founding Stewart Other as such Country members 13 members. London Throat Hospital had previously practised in Harley Street. SeeAnon, to surgeon Stewart, BMJ, Apr. Henry 1906, 7,1906, p.837. Robert 'William
260
had been created in 1895 and by 1905 had a membership Balneology,
the medical study of bathing
and climatology
of 380.190
the scientific
interest to the Victorian conditions, was of of considerable climatic study Leonard Edwardian 191 Williams who had been medical profession. and Climatology Journal Balneology the of and editor of and Vice-President of the British Balneological and Climatological Society, was appointed as the first
President of this section of the RSM. His fluency in French and
German was useful in building up a considerable knowledge of Continental included Sir Charlton Other Presidents Briscoe 192 physician to King's spas. College Hospital
interest in main was whose respiratory
disease. He was
President of the Section of Medicine from 1935 to 1937.193 Raymond Crawfurd played an active role along with (the non-Harley Street) Sir William
Osler in establishing the History of Medicine Section of
Oslerýs Following in 1912. RSM retirement the
in 1916, Crawfurd, who had
books including, historical The Mngýg Evil Echoes of number a and written Art, became the section's second president in Literature pestilence and of 1918.194 held this until position and
Caroline Murphy discusses 316-17. RSM, the role of balneology in cancer Hunting, pp. 190 in'Cancer in Britain: 1850-1950, (PhD thesis, during the radiotherapy and period patients UMIST, 1986). interested Street Harley in the subject include Other Aid, practitioners who were 191 Robert Fortescue Fox, who for many years edited the Medical Directorys section on health 'Robert Fortescue Fox, Lance4 June 22,1940, p. 114 1. Anon, resorts. Aug. BMJ, 26,1939, Williams', 472. 'Leonard Anon, p. 192 Briscoe', EMJ, March 5,1960, 733. Charlton 'Sir Anon, p. 193 Mar. Crawfurd, Lance4 19,1938, 697 Hunting, Raymond RSM, p. 330. 'Sir Anon, p. and 194 his Crawfurd's supplemented extensive contributions to medical literature by Sir Raymond Last DfiJvs (1909) Cbarles Crawfurd's the 11, historical Of of account his work. reviewed the in King's the death and concluded that the practitioners attendance at medical of reports by Gout. death caused probably of convulsions his was a result
261
In addition to being President of the Orthopaedic Section, Sir Thomas Fairbank
was also President of the Paediatric Section.195Hugh Lloyd
Williams was President of the Odontological Section from 1911-12 and was Vice-President of the RSM in the following year. Others included elected Malcolm Langton Hepburn who was Vice-President (1912-1933) and later President of the Ophthalmological Section (1938-1940). In 1920, Sir Peter Freyer, surgeon to St. Peter's Hospital for Stone formed President Section the of newly was elected of Urology. Freyer had
books of on urological surgery and received the Arnott a number published Memorial
medal for his original research in his speciality in 1904. He built a
large consulting practice in Harley Street and several of his articles in drew journals the from his practice such as experience on garnered medical "1000 Cases of Total
Enucleation of Prostate for Radical Cure of
Enlargement of that OrgaW'.196Sir Thomas Horder was elected one of the in October Vice-Presidents delivered two the first paper 'On and section's the treatment of subacute nephritis by kidney decapsulation'. Other Harley Street medical practitioners such as the urologist Cyril Nitch and the Bonney Victor first the were also present at session. 197 gynaecologist Herbert
James Marriage,
aural surgeon at St. Thomas's Hospital,
Otological Section in the 1915 had President been of and was secretary of Otology at the annual meeting of the BMA in London in the section of
195Anon, 'Sir Thomas Fairbank', BMJ, March 11,196 1, pp. 751 - 52.
Freyer, Johnston Lance4 Peter Sept. 24,192 1, pp. 677-678. 'Sir Anon, 196 RSU, 351. Hunting, P. 197
262
1910.198 Edward
David Darlean
Davis, a specialist
in ENT surgery
at
Charing
Cross Hospital, was President of the Otological and Laryngological
sections
of the RSM. 199
Not all societies were keen to be engulfed by the RSM, some preferred to retain
Walter
Hamilton
Hylton
Jessop, senior
Bart's Harley Street to a and surgeon practitioner,
ophthalmic the
independence.
their
opponents
chief
to
the
for
proposal
the
was one of
amalgamation
of the
Society of the United Kingdom with the RSM in 1907.
Ophthalmological
Jessop's role in maintaining
the individuality
of the society was rewarded in
1915 when he was elected President, "an honour which he valued more than hiM". been have 20OAn independent that conferred upon could section of any Ophthalmology
later RSM in 1912 with the Harley the established at was
Street practitioner,
Sir George Anderson Critchett, the knowledge of British
Jessop's desire to further
International the he of attended most meant
as its first President. ophthalmology
abroad
Congresses on ophthalmology
Spanish Belgian, American the Ophthalmological and of member and was a societies.
He also worked
assiduously
in Britain
to establish
an all-
encompassing
Journal of Ophthmology, which absorbed the Royal London
opht, balmic
Hospital
Reports,
the
Ophthalmic
Revdew and
ophthalmoscope. 201
Marriage', BMJ, Jan. James 26,1946, 148-149. 'Herbert Anon, pp. 198 BMJ, March, 1976, 776. 27 Davis', D. D. 'E. Anon, p. 199 Bartý;, 2. P. Andrews, al., et 200 Hylton Jessop', Lancet, Hamilton Feb. 24,1917, 'Walter Anon, P. 3 10. 201
263
the
Other Specialist Societies and Harley Street men When Patrick Manson (1844-1922) invited the Harley Street surgeon, James to Hong Kong in 1887 Cantlie gained his knowledge of tropical
Canthe
diseases in his surgical practice during the plague epidemic in Canton in 1894.202On his return to London, he resolved to establish a school of tropical journal diseases tropical to on publish a and called for a section on medicine, tropical diseases at the BMA. In 1898, the council of the BMA concurred and the section was formed with
Sir Patrick
Manson as its first
President.
(later founder Society Royal) of Tropical the member of was a
Canthe
Medicine and Hygiene (1907). 203
Carnegie Brown, another Harley Street physician who
William specialised
in
tropical
Mitchell J. secretaries.
Hospital,
an important
of the society and was appointed
formation
Harley
disease also played
Street
part
in the
one of society's first
two
Bruce, a boyhood friend of Cantlie. Bruce, a fellow
practitioner
and consulting
physician
to Charing
Cross
"essentially Cantlie inventor, to as, an certainly a pioneer referred
in things great and small" and Cantlie was described in his obituary as "an outstanding connections
figure with
in the medical field". 204 Cantlie
retained
China that when one of his ex-students
such close
Sun Yat-Sen
leading fellow Scot, in Britain Manson and a surgeon expert a 202 a was on tropical diseases, in particular malaria. He was the driving force in the establishment of the London School of Tropical Medicine and was also the first President of the Society of Tropical Medicine. See Father Manson: 'Patrick Manson-Bahr, of tropical medicine', in Bijtish Men of Philip ), (ed. (London, de Beer, Gavin 1962). Sir Selies, Science Hardy, Anne Prevention Cure: The London School of H5Wene & Wilkinson Lise and and 203 for GIohaIPuhKc Century Quest Health, (London, 200 1), pp. 19, A 20d Tr0pjC,qlNecYcine: Stewart, The QualitY Cantlie Jean Lives See the ofMercy-* also of Sir James and 334-5. (London, Anon, 'William See Carnegie Brown', Lancet; Oct. 11. 1983). Cantlie, L,,qdy also, 1913, P. 1090. BMJ, Cantlie', June James 5,1926, pp. 971-972. 'Sir Anon, 204
264
(1866-1925) came to London, he stayed with him in Harley Street. Yat-Sen
Ching defeat dynasty in in China later figure key the the of and was a became the first President of the Republic of China. In 1896 while Yat-Sen kidnapped Ching him Street, Harley in sympathisers and sparked a was diplomatic crisis. Cantlie secured his release with the help of the Foreign Office.
205
Conclusion The constellation professionals, their enhance
interchanges professional and social of
amongst medical
lectures, through orations and societies, could made possible reputations
within
the profession, especially something
as
Oration, in Harveian BMJ, the the the was which reported as prestigious Lancet
and national
Given 206 the tumultuous newspapers.
Britain Victorian during changes Victorian occurred,
technological
and the rapid speed at which they
for looked ways to ease the tension and society
instability
the transformations by their of of culture consequence a as
inventing
"new," traditions
and creating rituals
in their orations and
be it the professional medical societies, which offered to Yet, lectures. was As Sir Humphry Rolleston social cohesion. practitioners these medical remarked, legitimate intra, a means offer[ed] of professional medical societies living, however, young men, so enable[d] and mainly on advertisement, hope, to make themselves known to their older, better established, but not brethren. 207 better equipped, necessarily
'The Sir Chen, James Cantlie', Journal SY Peter Chen of accomplishments and 205Thomas Vol. 7, Number 4, Nov, 1999, p. 198. ofNedicalBiography, Bt KCV0., D. M., F. R. Buzzard, c. p An Appreci,, E Farquhar don Sir Cooke, M. 206A. (London, 1975), p-11 Friendships', 263. 'Medical P. Rolleston, 207
265
A sense of community location
of Harley
spirit
was greatly facilitated
by the geographical
Street, which was in close proximity
to many of the
in London. Meeting and interacting with medical and scientific societies some of their medical neighbours, as well as other medical practitioners, created
an
essential
physical
space
for
the
development
of
the
professionalisation and specialisation of medicine at the end of the 19th century.
266
CHAPTER 6 Professional Advancement and the 95ransmissionof Medical Knowledge - Medical Publications This chapter will examine the dissemination of medical knowledge via journals Harley Street The to the of number which medical publications. practitioners contributed was extensive -
as was the wide range of their
I Thus, in that these argue men were more prodigious society memberships. their
publications
throughout Harley authority
than
other medical practitioners
in
London and
Great Britain during the same time-period. As will be seen,
Street
practitioners
wielded considerable collective
editorial
in their role as editors of a wide range of medical journals,
dictionaries hospital reports, manuals and such as Clifford Allbutt
and
Humphry Rolleston's A System of Medicine and Richard Quain's Dictionary Harley Street men, William Moreover, three Medicine. of generations of Williams, Dawson Hart Ernest Markham, and were editors of the British input Journal spanned nearly seven continuous Medical whose editorial Medical Press In the influence. addition, decades of and Circular was in editorial
Street Harley for times men at various of nearly six control
(6 least 38 per cent) other members of the decades. Finally, there were at journals hospital or medical scientific of or editors reports, cohort, who were founded. they some of which The percentage of the cohort who had a) published at least one article b) hospital in BMJ journal the or report, published in a scientific or the
267
Lancet or c) who published an article or a book was assessed. The handbooks, lecture textbooks, guides and student manuals, publication of The ' to then by the results were compared considered. also was group notes had in Britain practitioners who also published the proportion of medical
2 material. Concomitant with the rise of medical societies in nineteenth century Britain was an increase in the number of medical publications. Although the Society had
Royal
published
medical papers in
its
Philosopbical
Transactions since 1662, it was not until the eighteenth century, with the development of medical clubs and societies, that other associated journals The Victorian for the market. medical period witnessed specifically catered journals; these scientific and some were published medical of a proliferation in association with medical societies whilst others were run on a commercial the these Prior to various methods of publishing one's publications, basis. books, by through findings pamphlets, correspondence, or were research 3 lecture. giving a
lecturers by from the main London the textbooks, Medical written hospital the hospitals publication of with reports, reflected along teaching locus in hospital the the of medical education the as nineteenth the rise of century.
Some of the earliest medical reports to appear were from Guy's
list in the of a complete cohorts' publications provide and not NedjCalDizwtorydid I The Whenever their altogether. possible publications other sources such as omitted cases some DirectorX. the to biographies supplement used were and obituaries in, The Evolution General Anne Digby's to analysis ofBzitish 2 The results were compared including (Oxford, 6 217218, 218. 1999), and graph on page pp. 1950-1948, practice, Clubs Societies, Annals 'Medical Friendships, Rolleston, and ofMedical 3 Sir Humphry Number 3, 257-58. May, 1930, 2, pp. Vol. History,
268
and St Thomas's Hospital in 1836. Other teaching hospitals, such
Hospital
followed St Bartholomew's as with publications of their own from 1865. The hospitals the specialist such as the London Ophthalmic, beginning in rise of
the middle of the nineteenth century, continued this sponsorship of in-house As discussed in Chapter 4 Three, the granting of prizes for reports.
hospital
essays on medical matters and the creation of new ones such as the Prize encouraged ambitious students to have their
Carmichael
work
5 published. Such publications
displayed medical knowledge and also attention
from the senior members of the hospitals -
an important
in
consideration
As Peterson remarked, "reputation, development the of a medical career. built on visibility burgeoning
as well as sound achievement, could be found in the
industry
of professional
Harley
Street oto-laryngologist
1920s,
that
argued
medicine".
journals
publication! '.6 R. Scott Stevenson, a
who was also sub-editor of the BMJin were
"indispensable
to the
the
progress
of
He referred to the medical advances such as those made by
Lister and Mackenzie that had been brought to the attention of the medical
in journals. 7 through medical accounts profession Various historians have endeavoured to determine the total number British of
in the nineteenth published periodicals scientific
century.
4 M. Jeanne Peterson, 'Medicine'in J. Don Vann and Rosemary T. Van Arsdel, (eds.), (Toronto, Victotian Society 1994), p. 28. pelio&cals and Victozian Royal by Council The College in 1887 the First of 5 of Surgeons in Ireland. awarded (London, Medical The Profession, Peterson, 1978), p. 172. Jeanne a M. 7 Lister's accounts of his surgical case studies were published in the BMJand Mackenzie's heart the in BMJand Lancet See R. Scott the were and published pulse on work (London, Street Mirror Barley In 195 1), p. 6. Stevenson, a
269
Between 1824 and 1900, these were listed in The Waterloo Directozy of Victmian Perjo(ffefilS.8 William Brock found there were 535 periodicals and Jeanne
Peterson
that
calculated
there
were 458 medical
9 periodicals.
Excluding periodicals founded before the nineteenth century, Bill Bynum Wilson Janice computed the number of new medical publications and In 479.10 from 1899 1800 to the transactions to addition as of the established Royal Society Linnean Society, the the as and which scientific societies such ideas, by in 1840s the interested there were also medical certain were transactions of medical societies, including the Royal Medical Society of Edinburgh
Provincial the and
Provincial the was
organ
Medical
and Surgical
Surgical and
Journal
Association
Apart
from
whose journals
journals independent Lancet the to medical such as societies, were affiliated for debate for forum and published profit. set up as a Many of the Victorian
periodicals were of such an ephemeral nature
found Loudon Irvine that 168 the Jean of periodicals established that and between
1800 and 1849 only 12 survived
to 1900-11 Bynum
and Wilson
Victorian but that periodicals were medical not standardized, varied showed in their layout, frequency of publication and the focus for their intended
Deering, The Dorothy Waterloo North Directory of Victolian S. John Wolff, and Michael 8 (Waterloo, Ont., I, Phase 1976). 1824-1900, peziodicals: Press'in W. F. Victorian Bynum, Stephen the 'Medicine Lock Brock H. and W. and Roy 9 Knowledge, Medical Histozical (London, Journals Essays, 1992), p. 7 1. me&cal and porter, Peterson, Medicine', p. 29. C. Wilson Medicine Janice Victorian Press'in the Bynum et al, Bynum F. and W. and 10 Afedical Journals, p. 30. Loudon Irvine 'Medicine, Politics Medical Periodical the 1800-50' Loudon and and Jean 11 Journals, Medical 49. p. Bynum in et al,
270
included Lancet, The Prmincial Weekly 12 the publications subscribers. 13The frequency of Medical and Surgical Journal and the Medical YYmes. issue from The Medical Press the times weekly of and varied publication Circular to an annual report for the Medico-Cbirurgical Transactions. To into Bynum Wilson disparate them the and classified publications, analyse these five broad groups: general periodicals, specialist periodicals, scientific journals, journals on health and related topics for the general public and first "were The journals. two categories: general periodicals unorthodox ' "specialist the the the and profession! medical periodicals of whole at aimed principal
have been would some group within the readership of which
in interest The 14 this thesis. second group profession" are of particular included publications that were specifically aimed at general practitioners. Anne Digby found from her sample of 961 British GPs between 1850"active in in investigation 1850s, they the beginning were clinical that 1948, disseminating in and
their findings" and that up until the 1900s, more than
date but declined this the just had to after number published, 40 per cent Loudon by Irvine 15 publications examined physicians only. over 20 per cent. He calculated 2000
the number who had published material
physicians
randomly
from selected
the
London
from a sample of and ProTincia]
Journals Medical in Knowledge: Editors 'Periodical their Wilson, and 12Bynum and Med(caliournals, Bynum Britainin al, et pp. 29-48. Nineteenth'Century (established in 1827) Gazette Medical Medical the London merged with 23In 1852, the Medical YYmes Gazette. Peterson, in 1839) (established renamed and was and Tymes . footnote. 24, 'Medicine', p. Knowledge', 32. 'Periodical Wilson, p. 14Bynum and 217218, 218. 6 Practice, General and graph on p. pp. and 15Digby,
271
Directories
for the year 1847 and found that approximately
50 per cent had
16 work. published Whilst Digby and Loudon showed that up to 50 per cent of GPs and physicians prolific,
published
material,
Street
Harley
practitioners
were more
(n 558) 17 least 85 these their = of published work. per cent since at
They contributed
journals, hospital to or scientific prepared medical articles
during before books their or arrival reports or published Additionally,
in Harley Street.
(68.34 the the majority of group per cent, n= 449) contributed
journals. Thus, in to to medical or scientific of contrast range wide a articles Digby's sample of general practitioners
Loudon's or sample of physicians,
highly in disseminating Street the Harley active medical practitioners were results
of their
clinical
investigations
and circulating
their
medical
knowledge within the medical and scientific community. As a contributor to leading "many to men are content BMJremarked, put after their names: the ' journals, the of younger members give specific many to scontrib. med. (or Almost 18 70 the per cent of entire cohort details of their contributions". 80 per cent of those who published) contributed specifically to various indication hospital that they journals reports, which was an and medical leading in men. this of category were
in Bu Ifh Men letin ýxiet Medical 1847', Soci, I 'Two thousand 0teS, Loudon, o : Vft r8 16Irvine Anne Makinga in Digby, MedicalLiving. Quoted Doctors 7. 1983, p. History ofMedicine, in the English Market forMedicine, 1720-1911,(Cambridge, 1994), p. 192. andPatients be higher is likely to in Medical the the given omissions published who 17This number Directory mentioned in Chapter 1. in W. Aug., Vol. Marguerite BMJ, 1902, 2, 426, 9 Direct0e, Medical p. quoted ig "The Medical Profession in Scotland in A Profile the Early Crowther, the Anne M. of Dupree and Directory History Medical Historical Source', Bulletin The the Century: as a of of Twentieth 214. 65,1991, Vol. p. Med(cine,
272
In contrast to Digby's figures, the number of publications for the Harley Street group did not decrease over time. Indeed, those who did not (n in Harley during Street before their time 99,15 = or per cent) publish Publication in eminent medical men-19 general, were not,
intrinsically was
linked to eminence within the Harley Street group. Digby also noted that dissertations: MI)s held the their the those on subject wrote of who most of between her that there showed was analysis a relationship results of degree. 20 That is, higher held MD those the medical who an and publication likely more were qualification
to publish
than those with
Approximately MB. such as an
MI)s published
a lower educational
a third of her cohort who held
between 1820-1939.21 The percentage of Harley something
Street practitioners
who had received their MD before or during their time
in Harley Street and who had published was more than three times greater Street Harley had the MDs, 93 per cent Digby's in group of who study: than
their work. of aspect some published There are a number of reasons for the productivity of the Harley been has As already mentioned, publication Street group.
in the popular
BMJ, Lancet Prfictitioner the the the journals or as such medical the attention market,
could gain
hospital in the competitive the staff, and senior of
this was a useful adjunct to one's medical qualifications
medical in lieu of
fact, did, in Chambers his James though publish who not until The was 19 exception Chambers Street Harley from was an assistant editor of the Journal ofMentýftj departure BMJ, Chambers' June Anon, 'James 18,1938, p. 1,342. Of 1900-1905, from see, Sej,ance had in Lancet BMJ, Francis Bisset the had none an obituary or published, not those who Fitton was the only FRCP the others were mainly general practitioners. 216-218. Practice, General pp. 20Digby, 21.fbid, p. 218.
273
the Royal Colleges' veto on advertising. Another reason was that many of the cohort were interested
in promoting
a particular
or special area of
William For this. their of example, most publications reflected medicine and Henry
Corfield's
sanitation
extensive
publications
were concerned with
hygiene,
Consequently, 22 Corfield health. was appointed and public
Professor of Hygiene at UCL - the first chair of its kind in London. Only a Frederick William Forbes Ross the the surgeon as such cohort, minority of Forbes Ross' topics. contributions ranged of medical wrote on a wide variety from researches into tuberculosis, cancer and diseases of the nose, mouth, 23 larynx. throat and Digby found that there was an increase in the number of GPs who
BMJ Lancet from the the to least 1850s the or article one at submitted that further She contributions were marginally established more onwards. Lancet. 24 It was difficult to determine the BMJ the than in the common Street Harley to practitioners who contributed either of number maximum in Mechcal Directo BMJ, the the the of many records as Lancet y or the "various journals7. Further investigation in to were entered as contributions biographies that these revealed and some of obituaries such sources as Lancet, but it BMJ be difficult the the to to or would were contributions from Publications 25 in those who specifically each case. determine this however, Lancet This analysis BMJ the were, the analysed. or mentioned Anon, Villiam Henry Corfiel(r, BMJ, Sept. 12, his see details publications, For many 22 of 1903, p. 627. 834. Sept. 27,1913, BMJ, Ross', Forbes W. p. T. 23Anon, 217. Practice, General p. 24DigbY, for One, 52 % the Chapter in only were available of obituaries cohort. )U 26 stated
274
GPs, in Digby's Harley Street the to that contrast practitioners revealed
(n in least frequently Lancet in BMJ 254) the than the = at more published (n = at least 194). Given the Victorian convention for publishing anonymously or using a initials, or pseudonym
the total figure for those in the group who published
if it been identify have to these greater were possible would undoubtedly to the individuals. 26Many of the physician Henry G. Wrighescontributions Lancet, which were frequently
fell
under
instructive
or sardonic, were unsigned and
the heading of "annotations". 27 Another
physician, John
Thompson Dickson, a lecturer in mental diseases at Guy's Hospital he journals; to also wrote a series of controversial a variety of contributed "A Social Blot". BMJ, titled Though his for the were which articles his had they anonymously, obituarist published stated were comments erroneously
been attributed
to a number of other authors. 28 The names of
for to the BMJin write articles or reviews those who were commissioned Victorian
the
leading Edwardian the were not revealed period and articles in or
As Bynum Wilson 29 discerned, Lancet and even the were unsigned. the board the 30 those editorial on was the often obscure. or editor name of
Sbort History Biftish MeXcalAssociation, Doctors'Commons, the Vaughan, a of 26Paul (IA)ndon, 1959), p. 137. Vaughan stated that many of the articles in the BMJwere anonymous. 62. BMJ, Jan. 16,1869, Wright, G. p. 'Henry Anon, 27 in his Carriage', Jan. BMJ, Anon, 'John 10,1874, Physician 52 'Death p. a and of 28Anon, 94. Jan. 17,1874, RMJ, Dickson! p. Thompson (Oxford, BMJ MbTor the 1840-199o, 75 ' 1990), Bartrip, J. ofMedicine. W. p. 29P. Knowledge', 'Periodical 42. Wilson, p. Bynum and 30
275
Articles in Medical Societies'Transactions Publications provided the cohort with a forum for challenging accepted for communicating new theories or the results of practices, medical experimental
work and for submitting
these to their
audience for
Garrod's Sir Alfred Baring pioneering work on the discovery of evaluation. from blood for in the patients suffering of gout was, example, first uric acid before Royal Medical in Chirurgical. the Society paper read a and presented
in 1848.31This was later published as a Treatise on Gout and Rheumatic Gout in 1859 and a third edition was produced in 1876. Garrod's treatise,
into French German, his European translated and established was which reputation
in leading the pathology of goUt.32 expert as a
When a paper challenged accepted medical opinion, it could lead to a heated discussion: John William's "On the natural
history
of dysmenorrhoea",
"men of much reputation, which [Henry] Galabin
Gervis [Editor
[Treasurer of the
paper on painful
menstruation,
provoked a lively
entitled debate in
[Robert] Barnes, Graily such as
of the Obstetrics Obstetrical
Society] and Wfred
JournaA,,
MacCormac's paper on the application of Listerism
Hewitt, Lewis]
participated. 33 William in military
surgery was
The 34 Metropolitan to the Counties was presented paper also challenged. Branch of the BMA in 1879 and caused a "spirited debate". MacCormac's (later by Professor Lord) Lister, may the attended discussion on subject was
before in the 1848. Anon, 'Sir Alfred Baring Williams the CJB society Dr paper read 31 Garrod, Lancet, Jan. 4,1908, p. 65. BMJ, Jan 11,1908, 58-59 'Garrod' AMon, p. 121. and pp. 32 BMJ, Williams', May 29,1926, Johý 'Sir Anon, pp. 922-23 33 34Based on Joseph Lister's method of using of carbolic acid as an antiseptic during surgery.
276
his "among been, debates have the obituarist, commented most useful well that has ever taken place in the history of surgery" because Listerism in Britain in its early stages still
and not universally
was
accepted, particularly
by the old school of surgeons.35 Sir Richard Quain!s original research into heart disease was also Chirurgical Society in Quain! Medical Royal 1850. the to and s presented blockage included 83 the cases of of coronary arteries, was paper, which
breaking be fellows by to the ground and was: considered listened to throughout with the greatest attention; at its close the fellows, large its their by formed expressed meeting, opinion of merits very a who the unusual compliment of warm applause. Many felt that the meeting have been have to advantage, with so as prolonged afforded the might important for discussing 36 this new and subject. opportunity
Thus, presenting
a paper at one of the medical societies was an essential
dissemination in the process
of one's clinical findings to other members of
the medical profession. During
the Victorian
period, self-experimentation
also played a role
in scientific research for some medical men.37 The neurologist Henry Head left his in arm cut and subsequently stitched them back so had the nerves he could observe the sensory changes and regeneration of his nervous his in in 1908 The self-experimentation were published of results system. day, journal Brain, he the of leading which edited, thus neurological the Dec. Lance4 7,1901, For 1618. discussion MacCormac', William p. 'Sir a Anon, on 35 Science Practice F. Bynum, W. the in the and ofMedicine see surgery, antiseptic (Cambridge, 132-137. 1995), Century, pp. Nineteenth in 367-68, Penelope Hunting, Mar. 23,1850, The History Lancet, quoted pp. Amon, of the 36 (Undon, 103. 2002), Society p. j?oval ofMedicihe, (which later became involved Davies thoracic to Morriston a who surgeon surgery Hugh 37 "the Trotter the Wilfred by themselves" effects of nerve section studied on the chest) and Anon, 'H. in Morriston BMJ, Feb. Davies', 27,1965, their arms. nerves p. various cutting 593.
277
Head's He later 38 became the journal's editor, a reputation. establishing from George he held Harley's scientific research and 1910 1925.39 to position clinical observations were also published in the medical press; they included (and for days later for fourteen days) three surviving on a diet of asparagus in order to "stimulate diabeteS".40On another occasion, he swallowed pure him temporary that caused paralysis. nitro-glycerine Harley Street Editors Permanent salaried positions on the editorial board of journals such as the Lancet, the BMJ or the Medical Press and Circujar, were unusual during this time. The Harley Street practitioners who edited journals largely did so Bynum Though basis. Wilson found that editorship and on a part-time in four-to-ten a medical practitioner's early career with occurred a usually Street Harley the the did term norm, medical as practitioners year not For fit this some, editorship occurred when they were profile. always establishing
their career during their late twenties or early thirties:
Leonard A. Bidwell was typical of this type.41Bidwell, who was a surgeon to Hospital London West and a member of the West London Medicothe Chiururgical
Society, was 26 in 1891 when he edited the society's
by When they the Joumal the superseded were publication of proceedings.
The later 265. RSU, experiment was Hunting, p. reprinted in Studies ofNeurologD, 38 Oct. BMJ, 19,1940, p. 540. Head', Henry 'Sir Anon, 39 (London, Street. Harley 1967), pp. 17-18 and Anon, 'George Harley', Pound, 40Reginald BMJ, Oct. 31,1896, p. 1354. Money, Angel Richard 27, Wolfenden, aged 33 and Norman included aged Others 41 Maclehose, aged 32.
278
Societg became its Bidwell Medico-Chirurgical London West the editorial of 42 secretary.
The majority of the Harley Street editors were, however, over 40 found It 43 their that the they positionS. also was assumed when years of age journals the the were on staff of medical who group period of employment of being One 10 30 the from to three over norm years. with years ranged model may be that
from Bynum/Wilson deviated the the that group reason
journals and editorship came most of them established or edited specialist in built had as experts a particular they a reputation after
speciality. Whilst
different journals, three the of medical a range of edited group members of the principal
journals for the period, the BMJ, the Lancet and the Medical
in detail discussed be to assess the cohort's Circular, more press and will in these publications. prominence
Journal Me&cal Bzitish the Street Harley and founded Journal, Surgical in 1840, and the Provincial the and In 1853, in 1853, form Medicine, to Journal established merged of a new London journal
entitled
the Association Medical Journal
which became the
Surgical Association. Provincial This 44 the the and was of mouthpiece forerunner
Journal, Medical in following British 1857 the renamed of
Association. 45 Medical British the formation of
Sept. BMJ, 14,1912, 667-67. A. Bidwefl', 'Leonard pp. 42Amon, Malcolm Morris, 54, Williams, Morell 46, Leonard included aged aged This 43 group Henry Rayner, 53. 50 aged and Mackenzie, aged 13. Mirmr p. Bartrip, ofMedlcine, 44 Scientist, in Science Society: Essay Clinical Doctors Booth, C. and of a 45 Christopher ,s (Cambridge, BMJ, 1987), Pp. 211-12.
279
For nearly seven decades, from 1860 to 1928, Harley Street medical
BMJ The between dominated the the of editorship connection practitioners the Journal and Harley Street began with William Orlando Markham, who from 1861 until was editor
1866 when he resigned to become a poor-law
inspector. He was replaced by the BMJs most progressive nineteenth held for Hart Abraham Ernest the three who position century editor, decades until his death in January 1898 when Dawson Williams was Journalfrom had to Williams the 46 contributed appointed.
1881 and became
in Following his 1886. the appointment editorial staff a member of
as editor
in 1898, he retained this position until January 1928, a month before his death, aged
74.47
Markham graduated MD from the University of Edinburgh in 1840 Paris Heidelberg. He his trained at and education medical at and continued later Hospital Cross accrued additional professional experience Charing and Lying-in-Hospital Road York at the New
Road. When St Mary's
Markham
and the Western General Dispensary,
Hospital
at Paddington
was appointed physician to out-patients.
opened in
1851,
Three years later, he
from in he lecturer 1857, and pathology also lectured in held the position of Markham, 48 physiology.
Gulstonian a
lecturer
at the RCP in 1865, was
trenchant "fluent a writer and on speaker occasion, especially a as regarded when
he wished to unmask
anything
like quackery
humbug or
in the
(29), In Jonathan 63. 1869, Hutchinson Minvr p. op cit, replaced Bartrip, OfMe&cine, 46 in later 1870. Hart the a year role resumed Hart as editor. Bynum Wilson, Medical Retrospect'in Journ BMJ: 'Tbe 140and Bartrip, spp. a] a Peter 47 41. Markham', EMJ, Feb 7 1891, 323. Orlando 'William p. Anon, 48
280
His 49 profeSSioll". extended critic
acerbic
to specialism
in the BMJof
language
and true
specialists
Prior to Markham's
was
not
confined
to type, Markham
to quackery,
but
became an outspoken
in medicine. 50
appointment
as editor of the BMJ, the members
bulk BMA the the of their subscriptions saw who of
go into keeping the
that it represented poor value for money. 51 This
Journal
afloat thought
tension
between the association and the Journal
had forced Markham's
Wynter, With Andrew Markham, to the resign. arrival of an predecessor, between the two truce organisations, as the members of made was unspoken BMJs began the to BMA see usefulness and acknowledged the gradually the high standard of its articles. Despite an increase in the expense of during for BMA Markham's Journal the tenure, the the members running began the to number of new and members supportive rise. remained Markham's period of office marked the beginning of mutual respect between Bartrip "never the Journal as remarked, association, the and again was the BMXs existence seriously questioned".52 Markham's successor,Ernest Abraham Hart, was the son of a Sloane his City He the dentist. studies at Street of London School where pursued his academic achievements were noteworthy. One of his obituarists "the that the story apocryphal number of prizes obtained possibly reiterated he had to charter a cab to remove them that Hart by young was so great 49Anon, 'Markham', p. 324. Markham's E. A. Heaman, StMary's, the discussion of specialism views see, of For 50 a (14ndon, Hospital, 2003), pp. 43 and 62. Teaching London History of a Retmspect' 42. BMJ: The I a p. Bartrip, 51 P dMedidne, Mkmr p. 35. Bartrip, 52
281
after
each
distributiorý'. 53 Academic
success achieved
at
school was
St. his George's during Hospital it medical education at where sustained "210 during he his He 54 that training there. prizes" was awarded was said in in City. MRCS 1856 then to This the to too and private practice proceeded was an unqualified
his first during five his years earnings allegedly success:
22,000 per annum averaged
at a time when the earnings of a successful
London physician ranged from between P-800to 23,000.55 A growing interest in ophthalmic
him to accept the position of ophthalmic surgery encouraged
in St Mary's 1863. to surgeon Following his appointment
to St Mary's, Hart established a practice
in Wimpole Street, which his obituarist remarked "was then by no means it is However, 56 in his to-day". Valhalla that eulogy of Hart, the the medical 'TAr. Hart for that, time the was a short erroneously only stated author doctor in the street". 571n 1864, there were, in fact, an additional 17 medical in
Wimpole
Street,
including
practitioners
registered
distinguished
Charles West Henry Thompson. In 1871, as and such men
a
number
of
in Harley Street his and in the same year joined Hart established practice
Hospital Middlesex the under the esteemed recommendation of the staff of did "not from think testimony Jenner, any William me can give weight who distinguished highly to one so
in the profession as you are I hold you to be ...
Jewish Chronicle, Appreciation' January Hart: 14,1898,p. 11. 'Ernest an WAnon, 541hid. for "top" this Digby not a was physician.This figure abovewas for the notes Although, as 55 (1857), Choice 169,quotedin Digby, Makinga Thompson, B. H. p. ofProfession, 1857. year in market English Doctors the jorMe cne Liping' andIatients Medical (Cambridge,1994),p. 192.1720-1911, Appreciation', 11. Hart: 'Ernest p. an Anon, 56 57 lbid. 282
to the highest degree for the post of assistant
qualified
surgeon to the
Hospitar'. 58 Hart remained in Harley Street until 1873 when he
Middlesex
Street. Anne Queen to moved
Hart gained his editorial experience at the Lancet, where he was sub(d. Hart's departure BMJto Wakley 1886): Goodchild to the James to editor [the] "sparked '30 years' war between in 1866, take up the position of editor the two journals. "59Bynum who has referred to Hart's "crusading activities" "the Victorian British Hart the that greatest editor of was also argued Medical Journal'. 60 In 1910, Hart was described by Sir Henry Trentham Butlin, a Harley Street medical practitioner and President of the BMA, as "a features Jew, little sallow-faced and piercing eyes, active in with clean-cut Hart keen his into body men are made". as poured as energy and mind and the Journal
At the start of his editorship,
the BMA had approximately
Journal, by the his to death the in time subscribed of 2,000 members who to his influence,
1898, as a testimony
this
had increased
to 17,000
his tenure, Hart claimed that the superior quality of his During 61 members. journal
directly was
Indeed,
the circulation
membership
for increase in BMA the responsible of the Journal
was almost
membership.
double that
of the
Such in Hart's BMA 1871.62 he the that was prominence of
became known nationally
"voice the of the B. M. A. ". Moreover, many of as
in such as sanitation, believed, he that the causes
cholera and vaccination
Wellcome, Archives 1841-96, Manuscripts, letters 5423/1. Hart, received and ref Ernest 58
Lancet, Oct. 23,1998, Lancef, 1141 "175 Kandela, p. at Peter years 59 in journals, Medical 4. 'Introduction', p. 6o]3ynum et al, 131. DoctorsCommons, P. Vaughan, 61 See Vaughan, BMJwas 7,000. the the 4,403 had and circulation of members 62 The BMA
131-132. Commons, I pp. Doctors 283
in Journal As BMJhe the the the pages of championed editor were of also from distinguished many medical practitioners, commissioned contributions including Sir Joseph Lister, Sir Patrick Manson and Lawson Tait, thereby international Jouma]ýF 63 the national and profile. enhancing When Dawson Williams succeeded to the editorship of the BMJ, it his the way through the ranks of the culmination of years of working was Journal. 64His connection with the BMJbegan clinical
with the writing
of reports of
lectures at hospitals and on the proceedings of medical societies, in his earnings during
order to supplement
the early years of consultancy
in born 1854, He the 65 son of a clergyman was practice.
and part-time
Cambridge. College He John's St. follow his to was expected at scholar father into the church, but decided against it in favour of a career in (1879) (1881) MB/BS MD Dawson from the and graduated medicine. University
of London
and was awarded
a gold medal following
both
in FRCP he became 1895 He himself in and when established examinations. Harley
Street a year later; he was an assistant editor of the BMJ, and in
In 1902, the council of the BMA insisted that became the he editor. 1898 Williams
relinquish
his hospital appointment
at the Children's
Hospital in
Shadwell because he was to be employed as the JOUTnalýqfirst full-time 66 editor.
134 136-137. DoCtOrs'COmmOns, and PP. Vaughan, 63
in Journalin 1881 he 1884 hospital to the began and was appointed contributor 64He as in 1886 and assistant editor in 1895. See Bartrip, Mirmr then sub-editor principal reporter, 181. p. OfMedicine,
Street Mirmr, Harle. 6. Stevenson, ýT p. Scott 6s Mizmr 18 1. Bartrip, ofMedfcine, p. Ihid, 66 and
284
When he took up this position, Williams introducing
expanded the Journal by
the weekly Supplement, which covered medico-political
issues
Association. According to the to his Harley Street and other matters relating Chairman Representative Body BMA Acting the the of and of and neighbour
Chairman of the Council, Charles Oliver Hawthorne, the Journal was for Williams, "post-graduation training brought to the practitioner's door".67 Williams worked hard for the reform of medical education and the creation His in schools. period office coincided with of post-graduate medical turbulent
times both inside and outside the medical profession, which
included the introduction of the 1911 Insurance Bill and the onset of the First World War. During the War "he gave unflinching and effective support Medical Indian Army Naval, services, and forwarded with all and to the best interests in In their his his war". recognition command at of means he was made CBE in 1919 and received a knighthood RAMC, for the efforts in 1921. By the end of the War, Williams's
health began to suffer, which
his editorship were not as illustrious as the final his ten of that years meant his lasting Nevertheless, legacy was the increase decades. first two part of
Journal, the and its ability to influence in the circulation and revenue of the from through acceptance of scientific or medical papers opinion medical
John Sir Bland-Sutton, President of the Royal distinguished men such as CMO George Newman, Sir Surgeons, to the Ministry College of
of Health,
Sir Patrick Manson the pioneer of tropical medicine, and the distinguished 'Sir Dawson March Williams', BMJ, 10,1928, p. 422. Hawthorne, 0. C. Dr. 67
285
bacteriologist, Sir Almroth Wright. These qualities established the BMJ during the Edwardian period as "probablY at the peak of its standing as a journar'.
scientific
68
Harley Street and the Lancet Up to the mid-nineteenth century, the Lancet was the yardstick by which be judged. journals Despite its irascible Thomas could editor, other medical Wakley
(1795-1862), and his habit of criticising
certain
sections of the
its institutions, the and standard of articles on medicine profession medical Unfortunately, high. 69 and medical science was
although Harley Street
Journal few to the and a undertook editorial work, contributed practitioners it
is
difficult
to determine the full
extent
of their
involvement.
Historiographical accounts on the Lancet mainly concentrate on the life and times of its founder, Thomas Wakley and historians have not investigated detail. in The journal's any staff problem for the researcher editorial the because Lancetýg the for to much of the material, source archive relates has War World First the their to survived not and extant archives up period from 1926.70 of writers anonymous of articles records only contain James Goodchild Wakley succeededhis father Thomas as editor in in he he Although medicine, qualified never practised and "made no 1862. knowledge " He frequently thorough to of medicine or a science. pretension Street Harley Sir John Tweedy. the Wakley the surgeon, of advice sought 14 1. BMX, 140'Tbe pp. BartriP, 68 'Medicine, Politics Loudon Irvine Loudon Jean and the Medical Periodical 1800-50, and 69 Journals, Medical p. 62. in Bynum et al, Boys] Coflege Histary Tbe in the Cooke M. ofRbysicians ofLondon, Vol. 111, A. of 70 (oxford, 1972), P. 1135. The most comprehensive history of the Lancet and its founder was by Squire Sprigge, The Lilb and Hmes of Thomas Wakley, (London, 1899).
286
remarked
in a paper published posthumously
in 1886, that he had been,
Dr. by Mr. John Tweedy, J. A. Marston, aided
"materially
G. Dr. J. and
[and had] great reliance in the soundness and fairness of their ...
Glover
judgement,
their
literary scientific and
ability,
and the integrity
of their
Tweedy few Even 71 though wrote only a clinical papers and no character". textbook, this seemed no impediment to his election to a permanent post on the staff of the Lancet to the journal
presumably, his earlier anonymous contributions
Tweedy his later position. was offered the editorship secured
forced decline he his but to the journal, the on grounds was of professional of commitments.
Others from Harley Street editorially associated with the Lancet included William Henry Battle, consulting surgeon to St Thomas's Hospital for 20 than the years and who contributed articles on more staff who was on Sir John Tweedy He as succeeded general surgical adviser subjects. surgical journal 'A the the Mirror involved section of editing entitled with of and was Surgical Pra6tice'. 72Arthur H. N. Lewers obstetric physician to the London Hospital was a regular contributor to the Lancet and was on its staff for 15 Proceedings to the the 73He editorial contributor a regular also was of years. Society Medical The Society ofLondon. Lewers's textbook on ohstetrical and diseases of women ran to seven editions and remained popular with medical students
for
74 Tilbury 20 years. some
Fox, whose medical career
dermatology "study for the of as a speciality", was many concentrated on Jan Tweedy, BMJ, 12,1924, John 87-88. 'Sir Anon, in pp. Quoted 71 Feb. Lance4 Battle', 15,1936, 396-397. Henry Villiam pp. Anon, 72 Feb. N. Lewers', Lance4 24,1934, 430. H. 'Arthur p. 73Anon, 74 jhid.
287
years connected editorially
had written
with the Laneet. 75 In 1883, Angel Money, who
diseases textbook on a popular of children, also joined the
journal's staff. 76The consultant obstetrician to St George's Hospital, Robert Barnes, made a living by writing
on medical matters during the early days
for long his time a on the staff of the and was career, medical of
LanC49t. 77
Willmott Henderson Evans, later consulting surgeon to the Royal Free, was long "over 78 the perio&'. a staff also on
The ophthalmic surgeon to St George's Hospital, Robert Blundell Carter first joined the editorial staff of the Lancet in 1868 and contributed a journal. He first leading to the the was article allegedly member of weekly the Lancet editorial staff to use a typewriter
and was renowned for "wearing
late From his 1870s, the two pairs of spectacleS11.79 work as a member of the GMC occupied much of his time and his connection with the journal waned. On his retirement
from the Council in 1899, he resumed his writing
less frequently Lancet. to the he contributed although rm
.1"e
Metyca]. Press and Circular
(1839) Press, Medical Duhlin and the London medical Circular In 1865 the (1852) merged to form the weekly Dublin Medical Press and Circular-80Two from its title, even though the "Dublin" in 1867, later removed was years Irish to on medical matters through its "Irish Journal continued comment
June 915-116. BMJ, 14,1879, Fox', 'Tilbury pp. Anon, 75 Oct. Lance4 29,1904, Money, 1256. 'Angel p. Amon, 76 May 25,1907, Lance4 1465. Barnes, 'Robert p. Amon, 77 Sept, Lance4 H. Evans', 17,1938, p. 70 1. 'Willmott Amon, 78 Society (London, A History the Hunting, 1998), p. 289. ofApothecazies, of 79Penelope Medical Press Circulaet The Hun dr, 1839-1939, Ye, Rowlette, in J. the and Robert ed qrs so ,a Undon, 1939), pp. 65-66. I, we ofa Medical Jou=4
288
which
supplement"
largely
reflected
the
views
of the
Irish
Medical
Association. 81 In common with the BMJand
members of staff on The Medical Press and Circular and they
prominent
exerted their Threhorn
the Lancet, Harley Street men were
influence at various times between 1861 and 1918. Arthur
Norton, surgeon to St. Mary's Hospital had a share in the Medical
Press and Circular and was the journal's first English Editor. Though the his involvement date of exact
is unknown, it is believed to date from the
he that show served as editor for the journal for some 30 records merger and years, until
about 1891 and continued his proprietary
death in 1912.82 During this period, Norton contributed articles
interest
until
his
a large number of
in addition to giving the Circular "a faithful subjects on surgical
dramatic the many record of
advances in medical science which passed
From the 1870s, the tone of the Circular and its before his eyeS11.83 subject matter was restrained;
"the acerbity of the two parent journals had largely
disappeared7'. 84 On a few occasions, however, the Circular adopted a liberal into the admission of women on as medicine. Its editor, Norton, stance, such for the d4an of movement supporter admitting ardent was
women to medical
The Circular championed the right of women to enter medicine degrees. 1185 liberty the grounds of on founders
London the of
justice and and Norton later became one of the School of Medicine
for Women, when it was
81Rowlette, Me&cfilPress, p. 88. 82]hid, pp. 104-05. s3.1hid, p. 105. s4 ]bid, pp. 89-90. 85Anon, 'Arthur Threhern Norton', Lancet, Aug. 17,1912, p. 491.
289
in 1874. Other controversial perspectives taken by the Circular
established
in the 1880s, encompassed the abolition of the death penalty or its use only
for severe crimes. Norton was periodically aided by other Harley Street men, Bulkeley Llewelyn Leonard who was editor of the Circular from such as 1874 to 1882. The Harley Street physician David Walsh was editor of Medical Press Walsh from 1915. from Circular 1903 MS/MD to Edinburgh graduated and University
in 1896 and later became Lister's dresser at the Edinburgh Royal
Infirmary.
Following the discovery of the radioactive elements of polonium by Pierre and Marie Curie in 1898, a huge interest in X-Rays
and radium
A in Britain. developed X-Ray, Walsh the pioneer of arranged and radiology his Medical the Press and medical men at office at scientists of a meeting interests, to their Circular in to 1897 a society promote establish and and born Walsh Honorary Society Secretary. Walsh is Rbntgen with was as the introduced Circular having the the X-Rays in to readers of as and credited in Rdntgen Ray MeoYcal The Work, "the f Ir st book in the he 1897, published world on the
subjece,.
In addition contributed
s6
to his editorials on X-Ray and radiology, Walsh
diseases and of the skin. During his tenure articles on quackery
in promoting research in the interest of Circular the Editor, active was as scientific advancement, particularly
during the anti-vivisection
debates
Circular in for the the received several articles support of need where
109. MedicalPress, P. nowlette, sa
290
experimentation
in science and medicine from Sir Victor Horsley. 87 From
1906 to 1909, Walsh received considerable help from Harley Street's Hubert Elwyn Jones Biss, physician to Mr. Gladstone. Leonard Williams, physician to the Metropolitan
Hospital who had a
dietetics Walsh in interest treatments, spa succeeded and as the particular (1915-1918). Circular His Press Medical the and association with editor of the Circular continued for many years. He contributed
a weekly article "on
"Sinapis". 88 Williams the topics" pseudonym using general character tight
"over-eating who raged against
over-drinking, ...
was a dogmatic over-clothing,
heating, heels, high tobacco, cane sugar, and the central neck-wear,
cult of athleticism
in girls schooIS".89 Several Harley Street men contributed
including Circular, such respected members of the medical profession the to MacNaughton-Jones. Henry Professor as
Other Medical Journals There was a wide range of other medical publications, which the cohort established
diverse their of which reflected many experience and or edited
listed below: these are knowledge, some of 1. The distinguished scientist and surgeon, George Busk, an authority on craniometry,
palaeontology
and marine
zoology, was the editor
of.
Journal Quarterly Microscopic Science, Nqturql Journal, of Microscopic Society. Ethnological Journal of HistoryReview and
pp. 110'111. Aug. BMJ, WiRiams', 26,1939, 472. 'Leonard p. Amon, 88 89Aid 87 lbid,
291
2. Theo. N. Kelynack, consulting physician to Mount Vernon Hospital was editor Journal
British of
Journal
oflnebrietyfrom
nberculosis, of
(1907-1934), the British
1903 and of The Child, (1910-1927). 90
3. Walter Goldie Howarth, who has been the longest serving editor to date of the Journal of Lar yngology and Otology, held the position for 31 . from 1960. 1929 to years
4. Richard Lake was the sub-editor of Joumal of Laryngology from 1897 -1898, and joint editor from 1899-1902. 5. Norman Macmillan Maclehose was an editor of Ophthalmic Re;,jew from 1891-1899, before he arrived in Harley Street in 1904. 6. Charles Devereux Marshall, editor
Ophthalmoscope. the of
staff surgeon, Royal Navy was sub-
91
7. Leslie J. Paton, later consulting ophthalmic
surgeon to St. Mary's
Hospital, was the chairman and managing director of the British Journal of 0
p
htbajMOjOgy92
Director
Walter Hamilton
Journalfrom this of
Hylton Jessop was also Managing
1916, until his death six months later. 93
8. Henry Rayner, a specialist in psychological medicine and physician
St Thomas's Hospital diseases for mental at was co-editor of the Joumal of
A no ýv Companion no, COntainingtheBiographiesof "o, to 1941-1950, ' Was no go (London, 1980), Decade 1941-1950, Vol. Duzingthe 4, Died those wbo p. 739.
Lancet, Marshall', Oct. 12,1918, p. 502. Devereux 'Charles Anon, 91 BMJ, June Paton, 12,1943, 741. J. Leslie p. Anon, 92 Hylton Jessop', F. W. Andrews, Hamilton W. McAdam Eccles, G.E. Gask, Walter Anon, 93 H. Thursfield, Williamson eds., Saint Bartholomewý; Hospital H. Harmer, and D. W. Reports (London, 1920) Vol. Lifi, 1917 and 1918, p. 2.
292
Mental
Science from 1895 to 1911 and President of the Medico-Psychological
Society.
94
9. John Mitchell Bruce was on the staff of the Medical YYmesand Gazette and later co-editor of the Practitioner from 1919-1921. 10. Edmund Alexander Parkes was the editor of the quarterly Bzitish from Medico-Chirurgical Reýiew Foreign 1852; however, his editorship and terminated in 1855 when the Government sent him to Renkioi, Turkey during
the Crimean War to establish a new hospital. 95 The review ceased in 1877.96
publication
Other men such as Alfred Ernest Jones and James Harry Sequeira
founded or edited journals after they left Harley Street. 97 Hospital Reports and Hospital Journals Publications
were
one route
for
medical
practitioners
to
establish
themselves and gain visibility within the profession. Those who worked in further develop their own area of expertise by hospitals could writing special textbooks
interest their special and articles on
or specialism, which was,
Granshaw, an effective means to becoming leaders in Lindsay to according their
domain-98 Moreover, it enabled these medical men to define their
BMJ, Feb. 20,1926, p. 351. Rayner, 'Henry Anon, 94 gisMunký; 1854, pp. 76-77. Lancet, Mar. 25,1876, Parkes', 'Professor Anon, p. 481. 06 British Psycho-Analytical founded Society the in 1919 also established the Jones 97 who in Psycho-Analysis 1920. For further details, see The Medical Journal International of H. J. Sequeira becamethe editor of the British Journal of 337. 1925, "o, p. "Oýg BMJ, Dec. Sequeira', J. H. 11,1948, p. 1040. Anon, Dermatology, discusses the in Granshaw role of publications Lindsay special hospitals in greater detail 98 by Bricks Fortune Mortar: the Medical Profession and means of and '"Fame in and
293
medical
emerging hospital
fields. Taking
publications
up editorial
posts for various
be seen as another may also
London
way to establish
a
in hospitals to posts secure efforts were so competitive. when
reputation,
Unable to advertise directly, publications,
especially in the capacity of an
increased in have the the medical with cohort visibility provided editor, may profession.
At least 18 per cent (n = 118) of the cohort contributed to hospital (later Nester Tirard Sir) Professor John as and such some and reports Phillips (later Sir) were on the editorial staff. In 1893, Phillips published his Outline ofDiseases of Women and was made co-editor and treasurer of the K yngýgCollege Hospital Reports -a
he held until 1901. Tirard who position
Mngý3 COIlege HOsPital Reports, the later for time of editor some was became emeritus
to King's
physician revision
of the
preparation, senior
I'Ung's College medicine at of professor and consulting
editor
Pharmacopeia
College Hospital.
British
Pharmacopeia,
Tirard
made his name with
a treatise
on drugs
the
and their
for the 1898 and 1914 editions; subsequently, he was appointed in
1914. Tirard
Committee
also held the role of secretary
General Medical the of
to the
Council from 1895 to
1915.99
Greville Matheson Macdonald, Tirard's close friend from his student founded Mngýy College Hospital, College the Magazine. Like Xing's days at Tirard,
Macdonald was a professor at King's College and consulting
Granshaw in Lindsay Roy Porter, Tbe Hospitals in 1948" 1800Britain, in and Hospitals 199-200. 1989), (London, pp. Histoz7, BMJ, Nov. Tirard', 917. 17,1928, Nestor 'Sir p. 99Anon,
294
to King's College Hospital. As a student, Macdonald acted as one
physician
developed but later Lister's in laryngology, Lord a clerks, speciality of which led to a large and successful practice in Harley Street. He owed his first appointment
in his chosen field to Sir Morell Mackenzie, who proposed him
for the position of house surgeon at the Hospital for Diseases of the Throat, Golden Square in 1886. Whilst Mackenzie was overseas attending the Emperor Frederick at San Remo and Charlottenburg, Macdonald ran his for him. Street Macdonald had been in Harley 100 brought up private practice in a literary
environment,
to writing
addition
as his father George was a poet and novelist. In
on medical
matters,
Macdonald
published
several
human 10, of personality. studies and essays philosophical William Church was editor of the St Bartholomewýg Hospital Reports he As 1893.102 to was a general physician with no special interest, from 1877 his contributions which
from to the 700 of cholera effects an analysis of cases of ranged
rheumatic several Hospital private
to the reports covered a wide spectrum of medical topics,
fever. 103Not all the editors had such a long tenure as Church, for including
Harold
who edited
the St. Bartbojojnewý5
Journal for a couple of years, increasing demands of hospital and forced to them relinquish practice
did editorial the cohort student
Pritchard
their editorial work. 104Several of
during days. While he was a their student work
in neurology, was one of the founder May, Otto UCH a specialist at
% BMJ, Nov. M. D. 18,1944, 676-77. Macdonald, pp. 'Greville ioOAnon, Nov. 25,1944, Lance4 Macdonald, 708. Matheson 'Greville P. Amon, 10, BMJ, May BT', 5,1928, 778. Church, William p. 'Sir im Anon, 103Jbid, p. 780. BMJ, Dec. 1233. 10,1938, Pritchard', P. 'Harold io4Anon,
295
University the members of
College Hospital Magazine and became its first
105 editor.
Publications by Harley Street Men If the sheer number of Victorian medical periodicals is, according to Jeanne Peterson, "nearly overwhelming" then the task of researching the range and Street is Harley To by 106 take men equally arduous. publications of number Frederick Parkes Weber, "the the when examples: prodigious most one of greatest authority
in his lifetime on rare disease", celebrated his 80th
birthday in 1943, his friends presented him with a number of articles, which journals. This 107 in into had collection when he amassed various published Yet 1,000 to this separate publications. almost amounted seven volumes, he have Weber's to total as output, continued articles printed was not even had he "long BMJ, reached the age of 90".108Weber, though after in the prolific,
book is isolated devoted to a a whole example: an was not
Sir James Mackenzie. Although 109 the of papers published bibliography of from the they cohort, examples are, nevertheless, unique they are not exceptional cases. Other Harley Street men who were amongst the most prolific writers Charles Edward Ryall Rolleston, Davy the Humphry and physician include
(London, Vol V, Fellows, 1955), 274. Lives the p. Brown, of H. '0 G. 29. Medicine, p. 106Peterson, diseases, four including Rendu-Osler-Weber disease, is with associated 107Weber's name Brown, Fellows, P. 438 disease. Weber-Dimitri disease, Weber's BMJ, June 9,1962, p. 1630. Weber', Parkes T. ios Anon, T. Anon, Parkes Weber* BMJJune diseases 9,1962, 1630 these p. see, details and of log For Jan. 31,1925, 242. BMJ, Mackenzie', p. James Anon, 'Sir
296
Charles Many Elam. 110 and anti-evolutionist of the cohort were described as "frequent
writer[s]
of articles", including Bryan Donkin who wrote a large
disease disease for of articles on criminology, mental and venereal number 111 the medical press and the YYmes. from public or hospital appointments
Retirement
did not necessarily
individuals from in there the the of writing; were many cessation result group who continued to contribute their retirement
articles to the medical press well past
David Nunes Nabarro, In 1954 who was then 80 years age.
Great Ormond Street been Hospital, had to pathologist consulting and old Congenital his SjTýhilis, significant works, most of one which was produced be in by to 112 Edward the medical profession a classic. many considered David Darlean Davis, an ENT specialist, continued to contribute articles to his into 70s and attended meetings at medical societies into journals learned
his
90S. 113
In contrast, Henry
This
there was a minority
of medical practitioners
Thompson, physician to Middlesex Hospital,
such as
who were not prolific.
little because their were publications of was not
value, rather
his lectures, which were published on retirement from Thompson's clinical
included 'Operative Cystoscopy, an atlas of work whose writer i io Ryall was a prolific illustrations. Anon'Edward Canny Ryall', Lancet, Feb. 24,1934, p. 431. 670 containing he 'voluminous' denounced described the theory of vociferously as Ejamýq writing was Darwin, Huxley, he Spencer teachings the in of challenged and particular and evolution Elam', BMJ, 20 July, 1889, p. 161. There were a number of other Charles Anon, Tyndall. to as a voluminous writers see Anon, 'Julius Althaus Julius referred also was such as 1508. 16,1900, June BMJ, p. Althaus', Aug. 6,1927, BMJ, 240. Donkin', Bryan 'Sir p. ,, I Anon, Anon, in he had been 'D. N. Street Harley 1938; 1914. left there had since 112Nabarro 919. Oct. 11,1958, BW p. Nabarro', BMJ, March, 27 Davis'. 776. 1976, D. D. 'E. p. Anon, n3
297
the Middlesex Hospital were described as "an extremely able and valuable James Andrew Sir 114 Charles Ryall also published few and productioe'. Although Andrew 115 did articles. not publish many books, his medical Lumleian lectures of 1884 and his Harveian Oration of 1890 at the RCP in Ryall the medical press. published who was senior surgeon to the St were Markýs Hospital for Cancer, Fistula and other diseases of the Rectum, had life that claimed most of his attention. and social professional an active Nevertheless, "what he did write" according to his obituarist, "stood the test It 116 little, that those time". among clear was who wrote of many valued substance
over quality. Samuel Jones Gee, physician to St. Bartholomew's
Hospital exemplifies this type: "Dr. Gee" according to his obituarist, "was than solidity rather ephemeral attraction was his writer; prolific a not by his Gee, Reynold's 117 to System contributing name articles made aim". of Afedfcine and like many others, wrote early in his career. An appointment St. Bartholomew's Hospital followed to soon after. 118 as assistant physician The view that publication was also a form of publicity in the Victorian Edwardian and
is further period
supported by the fact that writing
was
form in by the of unseemly self-promotion as an some medical eschewed A the 119 that number of cohort their small were concerned place. market July BMJ, 31,1897, 320. Thompson', 'Henry p. Anon, 114 he but Anon, little, 'James Andrew', "wrote RMJ, May 8, good", wrote was what Andrew i is 1897, P. 1196Council included the RCS, interests the President membership of of Ryall's of the section its fishing, Anon, 'Sir Charles Ryall', RSM, the and mountaineering. golfing proctology at of BAfj, Sept. 16,1922, p. 534. Aug. 19,1911, 554. Gee', Lancet, Jones 'Samuel p. Anon, 117 Gee', BMJ, Sept. Jones 16,1911, 411. 'Samuel p. Anon, i is Anon, Obituary, 'Herbert Sherwell this, CIogg', Lance4 Dec. 31, see For of example iig an lf)32, p. 1460.
298
writing
be Whilst Thomas Colcott Fox, categorised as erudite. should
for diseases Westminster Hospital, contributed a the of at skin physician large number of articles to journals on dermatology, his obituarist remarked that
Fox was "too conscientious to condescend to the preparation of
Hunter Finlay 'pot-boilers"'. Tod, 120 senior aural surgeon at the professional London Hospital, wrote only a modest amount but what he wrote was well Tod's Lambert According Lack, Tod's to the colleague quality of received. important his "writings than the quantity more and never contributions was savoured of advertisement".
121
Recognised authorities in a specialist area tended to publish the by innovative Contributions the their practitioners, such work. as of results Arthur surgeon in
abdominal
Edward James Baker, who was one of the countr3es pioneers surgery,
"numerous. "122 Frederic pathologist,
contributed
frequently were
the
Clinical
as "important"
Samuel Eve, who was prominent at least 60 articles
Medical Society. bological practitioners pat, their writing confine
described
as a surgeon-
to the Transactions
of the
such as Eve did not necessarily
to specialist journals; Eve also contributed
Societyýg Transactions,
and
the Medical
articles to
Societ:v and the JRSM,
knowledge". "wide his Most based those pathological on of who were which had a special interest or who were specialists, published a number of papers or
books.
Anderson
There
were
Critchett,
some exceptions
and the
of this
minority.
was
part
ophthalmologist, He
Lancet, May, Foie, 13,1916, Colcott 10 17. -rhomas p. i2oAnon, Lancet Feb.3,1923,p. 257. Tod', Finlay 'Hunter 121Anon, Lancet, Baker, James Apr. 883. Edward 22,1916, 'Arthur p. 122Anon, 299
was
Sir
renowned
internationally
as a "leader amongst eye men of all countries" and a great
he but Though 123 the output of the Harley a was not prolific writer. surgeon,
Street medical practitioners varied, the majority of those who published, (n in book form. is, 124 % 418) 75 that = published These publications were examined to determine their contribution to the advancement of medical knowledge. Most of the eminent medical practitioners specialist
in Harley Street, particularly
those who were on the staff of
hospitals or who specialised in a particular
area of medicine or
hospitals, the teaching their 125 the published results of research. at surgery Those who would later become distinguished
physicians, such as Bertrand
Edw Iard Dawson (later Viscount Dawson of Penn), whose special interest disorders was medical
of the alimentary
journals,
hospital
tract, typically reports
and
contributed Published
to numerous textbooks
or
Isaac Baker Brown's reputation as a fashionable accoucheur 126 monographs. by the publication created was
of one of his early works, the Surgical
(1854), "established his Women which, celebrity as an operator Diseases of
BMJFeb. 339. Critchett, 14,1925, Anderson p. 'Sir 123Amon, book to a such as an edited volume. includes articles or contributions 224This include Camac Wilkinson in the which who specialised examples, There many 125 are before First Word the War. a number of clinics tuberculosis established and treatment of books letters, included and on consumption and tuberculosis. articles His publications March. Phineas EMJ, 2,1946, 335. Simon Abraham Wilkinson, Camac p. 'W. wrote Anon, leprosy he journal the dermatological and the particularly subjects edited of on extensively Simon Anon, 'Phineas Abraham', Committee. BW March 12,192 1, Investigation Leprosy Mayou Stephen widely on ophthalmology and pathology, his wrote Marmaduke 406. p. in Conjunctiva" 'Inflammation the Anon, Lectures were on also published. Hunterian 185. R. E. Bickerton, July 28,1934, BMJ, Mayou', Stephen p. made a Warmaduke his literature 'Anon, 'R. E. Bickerton', BMJ, to the of ophthalmology. contribution significant Oct 1,1949, p. 761. Penn, BMJ, March Dawson 17,1945, Dawson 389. 'Viscount of p. contributed a 126Anon, Allchin's, Manual subjects, such as medical of a variety ofMedicine, on articles of number (London, V. Fellows, Vol. 1955), 1903, Lives 448 Brown, p. H. ofthe G. see
300
bold, ingenious, and successful, and of itself will ensure his at once 127 memo&'. Many of the Harley Street group were enthusiastic
self-advertisers
demonstrated how Mackenzie Sir Morrell medical practitioners were and He Ernest Hart their the to to of research. results promote wrote at anxious the BMJ, from his address at 19 Harley Street, in June 1887 to say: I should be very much obliged if you would allow my work on Hay-fever and be in Biitish Medical Journal if the to noticed sneezing possible paroxysmal the week after next. As the Hay-fever portion originally appeared as a lecture in the BMJ, it has never really been thoroughly received; it has now into a volume of some considerable size. 128 swelled see as you will
Mackenzie,
had published who
popular
works in his specialist
area of
laryngology, such as his Manual of Diseases of the Throat and Nose, was in 129 the establishing a reputation. of print value aware of
Lecture Notes Publication the of Textbooks and Harley Street practitioners, particularly those who lectured at one of the had handbooks, those hospitals a who specialist subject, or wrote teaching for students and guides for general practitioners. 130In textbooks manuals, the their those published specialists were results who of clinical general, investigations.
In addition to published lectures, textbooks and manuals
Jan. Lancet, Brown, 25,1873, 15 Baker 1. Isaac Mr. ! p. Anon, 127 Wellcome, Archives 1871-96, Manuscripts, letters Hart, and received ref 5424/16. 128Ernest Throa Nose: Including A Manual the t the Mackenzie, of and of&seases Morrell 129 (London, Ca Nasal Neck, Oesophagus, First Trachea, Larynx, whes and published phar ý=, . in 1880,2nd edition 1884). Arthur Whitfield included, Handbook is list who wrote and ofSkin The extensive 130 Anon, Arthur Whitfield', BMJ, 71-eatment Feb. 15,1947, George 274, their p. Diseases and .Ernest Herman's StudentIr Handbook of Gynaecology.Anon, 'George Ernest Herman', John Mitchell Bruce's Materia Medfica 690. Therapeutics, 21,1914, p. March and BMJ, Anon, 'John Mitchell Bruce', textbook became students. amongst (1884) which a popular George Ernest Herman's book 77, First Lines text 13,1929, p. July ofMidwifery was BAfi, later. Anon, twenty in 1891 'George Ernest over still popular years was and first published 857. March 21,1914, Lancet; p. Herinan',
301
were often the result of a record of the case notes within the medical practitioner's practice. Textbooks by skin specialists such as Henry Radcliffe Crocker, were commonly published during this time. Crocker reproduced the results of his case studies in Atlas of the Diseases of the Skin (1896) and it became one of the standard reference books at the time. Like many medical textbooks
of the period, Crocker's Atlas
was directed not only to
dermatologists, but also to practitioners of general medicine.131 Producing popular medical textbooks not only enhanced the cohort's reputation
and experience, but was also an important knowledge. Arthur
medical
display
of their
Lewers, who was 'tan expert in dealing with
cancer of the cerviie', wrote a textbook on diseases of women that was for 20 over students years, and went through seven editions. with
popular
Lewers's recognition contact
amongst the medical profession was due to the direct
in his medical practice. and experience
He was an obstetrician
in demand had taken careful case notes from and were who whose services his patients. 132 of the extensive range
Other classic textbooks included Edmund Alexander Parkes', Manual 0fpractjcaIH5Wene Military
(1864). From 1863, Parkes worked at the Royal Victoria
Hospital at Netley, Hampshire: this was an impressive structure of
incorporating 138 wards instruction
1,000 beds. Netley also offered postgraduate
to almost 3,000 students annually who wished to gain clinical
in hygiene. Parkes developed a reputation as a good teacher and experience Crocker, BMJ, Sept. Radcliffe 11,1909, p. 729. 'Henry Anon, 131 his Lewers In 1902, published clinical monograph on the cancer of the uterus. Anon, 132 'Mhur H. N. Lewers, Laneet, Feb. 24,1934, p. 430.
302
in 1864, he published the first edition of The Manual of Practical Hygiene. This was the first textbook on hygiene by an English author and "became
the model text-book upon which many other English authors based their The book 133 for was written specifically publications". students studying own various
disease in of prevention preparation methods
for military
or civil
in four Parkes' life; It through editions an eighth was published went posts.
in 1891 and the book was subsequently translated into several European languages. Parkes published Netley
several dozen papers and submitted
once a year on matters relating
developments
reports
to hygiene and in particular
in bacteriology. From the groundbreaking
to to
work he undertook,
Parkes became known as the founder of the science of modern hygiene and his for work on military acknowledged especially was by become civilian practitioners used had so widely
hygiene. Parkes' book that in 1873 he decided
Officers Medical Health Civil for it of and added a new chapter on to adapt
disinfection. Not all the textbooks published by the cohort were on specialist Garrod's Alfred Baring Essent ja, IS f 71 Med Many, ter as 0M such Ca topics. ,q. 'a Eberapeutics and
(1855), derived from teaching experience and catered for
the standard requirements
of the medical students' curriculum.
Garrod was
Therapeutics Medica King's College Materia Hospital in and at Professor of
English Revolution in Social Medicine: The (London, Watkins, 1889-1911', E. Dorothy 133 359. 338 and 1984), pp.
303
1851 and many of his lectures were condensedin this book.134Some,such as William Hale-White owed their fame to the publication of their textbooks; Hale-White's
popular
Medica,
Materia
Pharmacy,
Pharmacology
and
Therapeutics, (commonly referred to as "Hale-White"), ran to twenty-six journalism in He 135 medical was active editions.
Gqyý; Hospital and edited
Reports (1886-193), and was later one of the founders and first editor of the (1907-1929). Journal Quarterly journal, 136 British ofMe(Ecine respected Up to the start of the First World War, medical textbooks were typically
the work of one author. Frederick William
importance specialised practitioner. field
of the specialist
that
beyond limits knowledge the went medical Price Raised with practitioners
to produce
contributions
and acknowledged
Price recognised the
a textbook
were published
that
the expansion
of the individual
who were authorities
would reflect
modern medicine:
ýF Textbook Price later re-titled ofMedicine. Afedicine, which was consulting medical
cardiologist conditions;
in their their
in the 1922, Textbook of the Practice
and prolific
writer
on heart
of
of
Price was a
disease and other
his book was popular and it ran to eight editions 137
"one during his that the opus when night magnum Price was so proud of 'blitz'
destroyed he found Street in Harley in home was was his walking ...
first love, his hugging the manuscript his in pyjamas, the street
of a new
his the textbook by the the deemed standard as obituarist on subject until end This was 134 Anon, Sir Alfred it times Baring many republished was and century, the nineteenth of Anon, 'Sir Alfred Baring Garrod, Lance4 Jan. 4 58 4,1926, April and p. BW, Garrod',. 1908, p. 66. 329 1888, Fe-HOWS, p. 13513rown, (Undon, Society Royal the 1996), 273-74. Prv-sidentq Moll, a(Medicine, H. pp. of M. 136J. Brown, Follows, March 30,1957, BW 765 338-38. Price, W. P. and pp. 'F. 137Anon,
304
famous Textbook Practice the the of of edition of Meddnd'. 138William Johnson Walsharn also achieved eminence because of his textbook Surgery., As Theory and Practice, which at the time of his death in 1887 was in its eighth
Samuel Fenwick's The Studentýg Gidde to meaycal 139 edition.
Diagnosis, first published in 1869, went to nine editions, and his OutKnes of MeaYcal Treatment (first published in 1879), resulted in four editions within a
few
Cuthbert 140 years.
Lockyer,
described
as one of the
leading
in London, Mr. T. Watts Eden to produce collaborated with gynaecologists Gynaecolo,U, a Texthook for Students and P raCtitionerS.141He went on to . publish
the large tome Kbroids andAllied
Tumours', unfortunately,
because
his research had taken so long to complete, much of the information was out his book by inaccurate time the 142 date was published. and of The cohort's career development was also assisted by the translation international of recognised was
a useful
tool for a small
When 143 advancement. establishing
medical texts. Knowledge of a foreign language
Arthur
number
of men in their
Gamgee was
his career, he translated
138 ]hid
in
the
early
professional stages
Hermannýg Physiology in 1875. As
Oct. BMJ, Walsham's 10,1903, Johnson 945. VWiam p. Anon, 139 December BW 27,1902, 1973. Fenwick, 'Samuel p. Anon, 140 Sept. BMJ, 7,1957, 693-94. Lockyer', 'Cuthbert pp. Anon, 141 included Edward by Reginald Morton, Essentials of the cohort textbooks Other written 142 (London, dfology, Arthur Ra 19 10), Whitfield, A Han dbook of Skin Electricity and Afedfcaj (London, Paul Roth's, 1907), Orthopaedfcs Treatment for Practitioners their Diseases and J. Barker E. Heinrich translated Frey's Arthur HistoloAy and Histo 1920), (London, E. J. Barker', Anon, Arthur BMJ, April, 22.1916, p. 607. German. from Chemistry ofNan development for their Herbert Morley career of part others Translations were such as 143 Metbod Kalilden's C. Histologyfrom translated ofPathological the van Fletcher, who in 1894.Anon, 'Herbert Morley Fletcher'. BMJ, Sept. 16,1950, p. 683. German original Velpeau's RegionalAnatomy later became known for translated Hancock and Henry foot. Anon, 'Henry Hancock', Lancet Jan. the 17,1880, p. 110. on operations particular
305
of
there was "a dearth of textbooks on physiology" in the period, his accurate became a standard textbook and was republished in 1878.144He
translation
later became Professor of physiology at Owens College, Manchester. William Watson Cheyne's translation
Infective Diseases (1880) was an important
Traumatic Koch,
of Robert KocYs Investigation
bacteriology, founders the of modern one
English
speaking medical practitioners.
Jacksonian results
into Etiology of
work, which brought
to the attention
of the
In the same year, Cheyne won the
dissertation history, for his the on principles, practice and prize
of antiseptic
surgery, which was eventually published as Antiseptic
SUrge. ry 145
Collaboration Several of the cohort collaborated with other medical practitioners
in
books. 146Many the textbooks, of men or who co-authored articles publishing books fellow their reference medical worked other or with monographs Cheyne 147 Street published Tuharculous Disease of Harley practitioners. Francois Frederic Burghard, Joints with a fellow Harley Street Bonesand William surgeon. Hospital
Henry Battle a consulting surgeon at St. Thomas's
and author of a number of popular works on acute abdominal
forces with another Harley Street surgeon, Edred Corner, joined conditions Journal, April Medical Efidsh 10,1909, Gamgee', 933-934. Gamgee 'Arthur pp. Amon, 144 Text-hook Pbysiological his the Cbemistry of the his path-breaking with of name made Anon, Arthur Gamgee', Lancet, in Apr. 1880. 17,1909, p. 1142. AnimalBody, published Aug. Cheyne', BMJ, 30 1932, Watson 821-22. William 'Sir pp. Anon, 145 Nabarro N. Dr D. Leonard Hill include who contributed an article to the with They 146 Oct. 919. BMJ, 11,1958, Nabarro', N. 'D. Anon, p. Lancet. Morison Purves-Stewart Purves Nerve James Injuries include, who wrote and They 147 James Anon, Purves Morison Evans. Arthur Pu La Treatment rves-Stewart, with beir nce4 t, . Grainger Thomas Stewart 1122 textbook and who co-authored p. a of 25,1949, June Aldren Anon, 'Thomas William Turner, Grainger Stewart', Lancet, Diseases with Nervous 693-94. Mar. 30,1957, pp.
306
Surgery on
of the Diseases of the Appendir in
published
1904. It
was popular
Vermiformis,
and considered
which
a useful
was
clinical
handbook. 148Harold William Wilson co-authored Tbe Moveahle Mdne,7.-.Its Symptoms, and Treatment
Pathology,
Howell. 149 Other Harley included
with Dr. Conrad Meredyth
Street practitioners
Hinds
who co-authored books
Edward Woakes, a specialist in diseases of the throat, who
On fourth Deafness, his Giddiness, edition of and Noises in the published He,adwith his son Claude Woakes, also a Harley Street practitioner. 150 Members of the cohort also teamed up with non-Harley Street practitioners.
Wilson's name is particularly associated with the textbook
Surgery, published in 1920, which he edited with Professor George E. Gask. The book contained the work of various authors and was considered an important published
contribution
to medical knowledge.
George Lenthal
Cheatle
the results of his research into breast cancer in collaboration with
Max Cutler in Tumours ofthe Breast, and Philip Henry Pye-Smith was joint author Practice
with
Dr. Fagge of the popular
of Medicine,
Collaboration
which
reached
Texthook of tbe PrinciPles its
fourth
edition
in
and
1901.151
less for the group. In addition to his common was on articles
many contributions
to medical journals the surgeon, Stanley Boyd was one
he "Cancer of the Mouth few an article when wrote co-authored the who of
Amon, 'Battle', p. 341. BMJ, Nov. 'H. W. Wilson', 28,1959, Anon, in 1908, Published p. 1184. 149 Oct. Lancet, Woakes, 12,1912, 1047. 'Edward p. Anon, 160 Jan. Lance4 Cheatle', 13,1951, Anon, Lenthal 115. 'Philip Henry Pýye'George p. Anon, i5l Others 1578. included Ernest May 30,1914, Rock Carling p. Lancv4 who was joint SrnitW, Paterson Rosson Biitish Surgical Practice. Anon, 'Sir Ernest Rock James Sir editor with 313. July 23,1960, BMJ, p. Carling', i4a
307
Face", W. H. Unwin, with and which was published in the Practitioner in 1903.152 A large number of the cohort contributed to general dictionaries of medicine and manuals and some of the editors were Harley Street men. The (first Quainýg Dictionary Medicine, of most popular were: edition 1882), A System of Meakine (first edition, 1896) foRowed by Fowlerýg
Allbutt's Dictionary .
ABchin's Medicine, Manual of of Medicine, the Practitioners,
Encvclopaedia
of Mei*cine
Surger and v, the Dictionary .
of Practical
Surgez: CbQyceýgSvstem of V153 and
Me&cme
Sir Richard Quain, Royal Physician and assistant physician to the for
Hospital contributing
enlisted
Consumptive articles
on heart
Diseases,
spent
seven
disease to his Dictionary
the support of a significant
years
editing,
and
of Medic. 10e.154 He
number of his colleagues from Harley in the preparation
Street,
most of them prominent
articles
for the book. In total, 20 per cent of the contributions
Harley
Street men, including
medical writers,
of
were from
Quain's assistant editors Frederick
Thomas
Brompton UCH Hospital the to to and Roberts, physician and John Mitchell
he did treatise books Boyd a on surgery, publish regularly not Although edited on a 152 Dr H. T. Green's Pathology seventh edition as of such subjects and variety of medical Newton Stanley Boyd', Lancet, 'James Feb. 12,1916, p. 376. ffforbjdAnatomyAnon, (ed. Clifford ), Wziters, Thomas byMany Allbutt, Vols., 1896-1905 System A ofMeXcine, 153 1906-1911,Thomas Clifford Allbutt and Humphry Davy Rolleston eds., VOls. from and (London, 1896-1911). R.HA. Whitelocke was regarded as a specialist on sports injuries and the Practitioners'Enqyclopaedfa ofMedicine andSurgery. Anon, 'R.H.A. to contributed Contributors Dictionary 1009. Nov. 26,1927, to BMJ, p. of Practical Medicine Whitelocke', (1923). Gay John French Anon, 'John Gay Frencle, Lance4 Apr. ENT the surgeon, included Chqyceýv to Ernest An Rock Carling, 969. was of a contributor example a 28,1951, p. in radiology. specialist in 30,000 followed 1882 in 1894 by first copies sold and was The publication a second 154 Fellows, 1851, p. 64. Brown, edition.
308
Bruce, physician to Charing Cross Hospital. 155The significance of articles in these
medical
authorities
compilations
was that
they
were
written
by
leading
in their fields, including Edmund Parkes, Reginald Langdon
Down and Arthur Ernest Sansom. Sansom, for example, was regarded as heart disease like in leading foremost the and many authorities one of in both Quain ýF in their and subject published authorities
Allhuttýg.
156
Like so many aspirant consultants, Humphry Rolleston gave lectures. In his capacity as demonstrator Cambridge,
of pathology, physiology, and anatomy in
he became acquainted with Sir Clifford Allbutt
(1836-1925), the
had been Cambridge Professor who a friend of his father, the Regius at (1829-1881). Oxford, George Rolleston Physiology Professor at Linacre of Allbutt
SyStem Rolleston Medicine Humphry to the on work of and asked
in its he role preparation: contributed a Rolleston played a considerable from diseases to the alcoholism ranged which of spleen articles, number of he A 157 was made co-editor. by considerable volume the number second and to various editions of Allbutt and Street contributed Harley practitioners of (1906-1911). Each devoted System A to volume was ofMedfcine Rolleston's from Harley the of contributors percentage conditions: specific medical (for in insect 1907 from 15 articles on cent and animal per Street ranged Raymond Crawfurd, Henry Sir Radcliffe Squire, Crocker, William included is5Others Reginald Langdon-Down Boyd, Stanley Herbert Thomas James Samson, and Ernest Arthur Quaies, from 57 284 third to the the of edition out of of were the contributors Herring. ýF Quain Dictionary H. list third for ofMedicine, see edition, Street, contributors of a Harley (London, W. Cecil Bosanquet, Harold John ix-xviii 1902), Murray, and eds., pp. Montague Mar. 23,1907, Others 842. included Lancet; Sansom% the Ernest p. 'Arthur Anon, im (later Sir President RCS). Tweedy the John and of surgeon ophthalmic in Scott 1898-9. Stevenson, Harjey the appeared work first eight-volume 157The editionof in Rolleston's the 22-23. name appeared revisededitionalongwith Street,iflyz-or,p. BMJ, Sept. Humphry Rolleston', 'Sir 30,1944, Anon, Rolleston 452. 1906-11. in p. Allbutt's liver diseases the the as of and such endocrine glands. on subjects monographs later wrote 309
diseases) for 62 to tropical the cent per and volume concerned with parasites Diseases of the Skin (1911). The latter featured a large number of articles from Thomas Colcott Fox plus articles from other Harley Street medical practitioners
Simon Abraham, Sir Phineas Malcolm Morris, John such as
MacLeod Hendry MacLeod, Arthur Whitfield and James Hauy Sequeira.158 Harley Street and the rise of Specialist Journals London was the most fertile area for specialist societies in Britain and so too for breeding it the two the specialist publications, as ground were often was linked. 159 In addition to contributing
articles based on their
special
interests, a number of Harley Street men such as Robert Knox and Richard Norris
Wolfenden
particularly
were
instrumental
in
launching
new
journals,
journals, became increasingly which common from specialist
British Knox JOUTnal Radiology 160 was editor Of 1870s Of and onwards. the British Association President the Radiology of of and co-founder and physiotherapy
(1920-1924).161He was well known internationally
for his
due his largely it International to that the proposals was and speciality held in in London 1925.162 Congress of radiology was Wolfenden, a physician with a special interest in laryngology, Rhinology Laryngology in 1887 Journal together with and the of founded
Head diseases Henry included the Arthur who wrote on of nerves, Other contributors 15a heart Harold Batty Shaw diseases the of and Sansom who contributed on wrote who Ernest food poisoning and osteo-arthropathy. on articles Professional Rivalries in Victorian Journals
'Specialist Peterson, and Jeanne M. 159 Reýiew, Vol. 12, Number 1, Spring 1979, p. 29. Fefiodfcals Victozian Medicine', knowledge', Medical in Journals W. dedical F. Bynum, ? Stephen Wilson, and Bynum and 160 (London, Histolical Essays, 1992), P. 33. Porter, Roy eds., I, ock and Archives & Electro-Therapr. the The other the ofRadfology of editor He also was i6l Reid. Archibald Sir founder was Sept. 29,1928, p. 681. Lancet, Knox, 'Robert 162Anon,
310
Mackenzie. 163With the growing interest in the study of nervous
Morell
diseases
during
psychopathology
the
First
World
War
and
the
development
Samuel Alexander Kinnier as a new science,
of
Wilson
journal, for the the which new could need a represent views of recognised these specialists. 164Since the publication of The Reýiew of Neurology and psychiatry had ceased during the war he founded the Journal of Neurology became its in 165Wilson 1920 in Psychopathology and editor. remained and the post when the Journal was taken over by the BMA in 1926 where he in his death Other Harley Street 1937.166 until editors of editor continued as specialist
journals
included the expert in nervous diseases, Maurice Nicoll,
Journal Neurology PsYchopathology the from of and of co-editor who was 1922 to 1932.
Sir Gordon Holmes's original research into neural disorders was widely
published
in the Lancet, BMJ and Brain. Like many of his Harley
Street contemporaries,
Holmes presented the Goulstonian and the Croonian
for his research he number of awards and a medals lectures and received including
Royal College the Conway of the of Physicians. 167He was prize
from RSM the Hughlings the and was appointed medal gold awarded in became (1922Holmes RSM 1955. Brain the lecturer editor Of at Jackson
dournalofLar Rhinolohy the Otology in Journal 1921. yngvlogy, as and The continued 163 . Lance4 Nov. Wolfenden, 13,1926, Norris 1036. 'Richard Anon, p. See also, BMJ, May Wilson' 22,1937, p. 1095. Kinnier A. S. Anon, 164 Journal Psychiatr the Journal as continued OfAeurohor and the 165In 1937, . .v College f Roval kv ( Boll The fL0 the Lo Munk oP of sician s o al, William et ndon, ndon, i so Vilson', 1095. Anon, p. 540 and 1914), P. ), (ed. Gordon SelectedPapers Holmest (London, 1956), Walshe, ofSir M. R. p. v. F. ioi Montgomery Lectures on Ophthalmology in Trinity College the delivered Holmes also him "established figure in See Davis 1919, June as a major in neurology". which Dublin (Dublin, 258. 1992), Masters ldsb p. ofMedicine, Coakley,
311
1937) and collaborated in the writing of papers with other Harley Street interest in had neurology such as Henry Head and a special who
physicians
Frederick Eustace Batten. Batten's work as a specialist in neurology at the National Hospital, Queen Square, was honoured when the hospital named
the Batten Unit after
him.
168
In 1911,Holmesand Head wrote 'Sensorydisturbancesfrom Cerebral Lesions' which was the result of five years research into the function of the described in to the cerebral cortex and was as the "first thalamus relation Holmes 169 Batten the subject. and on also collaborated account"
systematic
RSM in 'on to the 1908, they the presented which nervous on a paper, Savill Dixon in Thomas dermatology dog. who specialised system of a addition nervous editions,
to neurology
wrote a book on neurasthenia
in
(a disease of the
insomnia), depression four to and caused which which ran system Clinical Medicine System his of and
contribution
was considered an original
to the subject. 170
- After returning
from his post as Dean of the Hong Kong College of
Cantlie founded James in 1897, Transactions Chinese the for Medicine of H5, Metficine Tropical Medkine Tropical Society and giene RO of Me and tyal Journal later the He TýJ-Opjcal its monthly established of became editor. in Tropics, to the devoted gynaecological and surgical work and Afedicine, first joint Journals the editors. became one of
Holmes ix: 265. Thomas SM, also j? collaborated with and pp. i6s flunting, A Study Forty Tumours: Cases". Cerebellar of of aSymptomatology on 256. Masters p. ofMedicine, jr.9 Coakley, Jan. BMJ, Savill', 22,19 10, p. 238. Dixon 'Thomas i7o Anon,
312
Grainger
Stewart
Not all of those practicing a particular
speciality wanted to be wholly
identified
it. The physician James Purves Morison Purves-Stewart, with
practiced
at Westminster Hospital where he later became consulting
President He the elected of neurological section of the RSM was physician. including he the popular Diagnosis of wrote extensively on neurology and Nervous Diseases. Despite the fact that he had "little interest outside be liked he for his to seen as generalist, a obituarist stated that neurology", -his all-round
for him the role of general physician, and indeed ability suited
he was at some pains to assert that as senior physician to a teaching hospital he should be so regarded". 171 Once paediatrics had become a recognised, speciality at the end of the nineteenth
including Horatio Bryan Donkin of Physicians number a century,
172Donkin, the to East the textbooks subject. who was on a physician wrote Children, for Diseases Hospital published London of Childhood in 1893. he in interest his paediatrics, wrote on a range of subjects including Despite mental
disease, psychology and crime; moreover, his interest in the
disease him to deal to encouraged establish venereal a of society prevention the subject. with Two years before his arrival in Harley Street in 1901, George Frederic Still
(later
Sir) was appointed
physician
for diseases at King's
College
hospital first department teaching to the this open was a special Hospital:
Lancet, Purves-Stewart', Morison June Purves 25,1949, 1122. 'James Anon, p. 171 details see Elizabeth M. R. IA)max, 'Small and Special: The Development of further 172For Britain', in Victorian Medical Histo Supplement (Lo Children No. for 16, rY Hospitals ndon, , 1996), p. 170.
313
for children's diseases. Much of the material in his well-known textbook Common Diseases in Children (1909) was based on the lectures he gave at King's. 173Since "important contributions to the understanding of children's disease [were] presented at the meetings of the RMCS", Still presented his juvenile rheumatoid arthritis to the society and published in the papers on (1897 Transactions In 1903). 174 and addition, Garrod and Batten's society's Diseases of Cbildren, included contributors with a special interest in paediatrics
Arthur as such
Francis Voelcker, who was a physician
at the
Hospital for Sick Children, Great Ormond Street. 175 Conclusion The publication
innovative ideas of exerted tremendous influence on
For the the those who expected to of of several group. success establishing build a consultancy practice, it was a necessary adjunct to their professional Mackenzie Harley Street James to from his GP moved practice experience. in Burnley following the publication of The Study of the -Pulse (1902) and (1908). These Heart the monographs established his career as a Diseases of . cardiologist practice brought
from and
in Harley
1912 he built
Street. 176 Whilst
a large and successful consulting Mackenzie's
first
him 2114 in fees, by his second year, following
year in London the publication
he Heart, 11,000. Mackenzie the earned over Diseases of attributed .
BMJ, Stilr, July 12,194 1, p. 69. Frederick -sir Anon, 173 309-310. RSM, Hunting, pp. 174 Voelcker, BMJ, June Francis 22,1946, 969. 'Arthur p. Amon, i7s BMJ, Jan. Mackenzie', 31,1925, 242-245. James 'Sir pp. Anon, 170
314
of this
exceptional
177 fortune "to my boole'. Similarly, change of
publication
was
in fundamental establishing the career of Robert Brundell Carter who, also "up
the age of 40" had been "a conspicuously unsuccessful general -to
practitioner
in the country". 178In 1854, he had served as a surgeon in the
Crimean War and the letters that were published during his military future influence his "had it brought him to a great on career", as experiences the attention of the editorial staff of the Rmes and the Lancet. In 1869, at the age of 41, Carter came to London to join the staff of the Rmes where he later became one of its leading writers. Besides his work for the 7ymes, he . in Lancet. following The in the Carter 1870, columns year regular wrote became an ophthalmic surgeon to St. Georges' Hospital and on his becameconsulting ophthalmic surgeon. he in 1893, retirement For those who wanted recognition as specialists abroad, publishing his On the James Mackenzie's of strength Publications, was essential. reputation
beyond UK. the 179 James Purves-Stewart well extended
"serious for the the of matter" writing articles on medical press remarked He it that home claimed was on the basis of these both at and overseas. his Diagnosis text-book Nervous the of popular publication of articles and into foreign languages, translated that he built various Diseases, which was both from England practice with patients consulting and an extensive "European, His medical a wide audience reached and publications abroad.
177R. MacnairWflson,
The Beloved Fhysician:, gh- James Mackenzie, (London, 1926), p.
197. Carter, Lance4 Nov. 2,1918, Brundell 607. 'Robert p. i7s,Anon, Sands 7yme: RecoBections Physician Purves-Stewart, in Peace of James of a See, and 179 104. 1939), (London, p w ar .
315
transatlantic
and antipodean neurologists gave it a warm welcome".
Consequently,
he received the chair of neurology at a medical college in San
Francisco in 1905 and was elected as an honorary member to various foreign 180 societies. medical
As mentioned earlier, William Jenner's clinical study of fever at the London
Fever Hospital identified typhoid and non-typhus fevers. His
reputation
by the he this publication of established work and was was
Pathological Professor Anatomy University the of of position at offered College London. He contributed regularly to such medical journals as Blitish
Reýiew Medico-Cbirurgical Medical Foreign lymes and the and and
Gazette, and was for a time editor of the latter. However, he did not retain this
because demands long for the large of partly of a very position
he "relinquished because he did find work which and not practice consulting he did Therefore, deal in his later not write a great congenial". altogether his lectures181 the of exception with years, There were a small number of Harley Street practitioners, who did to 182 The themselves on medical or writing scientific subjects. not confine publications
that displayed varied interests included Percival Macleod
incorporated fairy tales diverse which writings, and the role of Yearsley's
its book in His 1937. 99,102,222. reached eighth edition iso Ibid, pp. fevers Dipthezia CEnical Essavs Lecturesand Lectures and on and and 181 His lectures: Abdominal Tumours and other Subjects were published in nberculosis, Rickets, essays On. Street. Harley Anon, left 'Sir William Jenner', BMJ, he 1895, in 1893 after and two volumes 1849-1853. 17,1898, pp. Dec. from Sir his William following Hale-White practice, retirement For wrote example, 182 (London, Centuzy John Keats Nineteenth 1935) Doctor the and as Doctors and of Great. (etc), 1938).Anon, 'Sir William Hale-White', BMJ, Mar. 5,1949, p. 415. York (New Fatient,
316
doctors in Elizabethan drama and those from the physician Raymond Crawfurd on the history of medicine.183 In general, there was no financial reward for publishing articles in the BMJ or the Lancet. Only those who were commissioned to write the leading article were paid, as were the assessors who evaluated particular contributions
financial
to the journals. 184Thus, professional advancement rather than
the of main reasons the cohort published, one was reward
their the the careers, as publication of gained start attention at particularly Sir Humphry Rolleston fits he hospital this the staff. model; senior of Anatomy following Morhid his Practical A Manual of post as published house-physician and demonstrator of anatomy at Bart's, while he was hospital. As full-time the that for the on staff of position cohort a waiting in proceeded
their
life, professional
publication
was a method of
in their to the turn, of research colleagues, results which, communicating leading figures in fields led their to their as reputation and established increasingly successful consultancy practices. As Bynum and Wilson remarked, occupational pluralism was the for the practitioner medical norm
in Victorian
Britain. 185This was certainly
Street typified Harley and was elite the true of
by Donald Armour
who
he Not did have large in only a private practice, neuro-surgery. specialised held in senior he or a role every medical society but was appointed president
L-ance4 May 19,1951, Yearsley, Anon, 1130 'Sir Macleod 'Percival p. Anon, and 183 697. Mar. Lancet, 19,1938, Crawfurd', p. Raymond (Undon, Doctors 1965), 68. The Ferris, p. 184Paul Medical Bynum 'Periodical Knowledge'in Wilson, Journals, 41. et al, p. Bynum and iss
317
to which he belonged; moreover, he was a prolific writer and contributed a large number of articles to the medical press, delivered the Lettsomian Lectures, and was appointed Arris and Gale lecturer. 186A number of the Armour: held had to many profile senior positions or were a similar cohort the in their the majority published and most work societies, medical active distinguished
delivered one or more of the physicians or surgeons
In lectures. addition, medical practitioners who eponymous or memorial develop incomes, draw to and who wished a consulting on private could not frequently practice were appointments
part-time
forced to spread their activities in teaching,
writing
across a range of
and research, as full
time
demands busy The however, 187 left of a practice, common. positions were not little the cohort of
a small
minority
medical
Not publishing societies-188
professional
time for writing one's work
or attendance
or not participating
at in
impede did development, necessarily not professional societies
Perkins, John St. Joseph Thomas's Hospital to physician but those such as became a well-known who
expert on pulmonary
Street practice, despite publishing Harley extensive
disease and built little
an
and not being a
189 were an exception. member of professional societies,
Section Neurological RSM, West London Medicothe President the the of of Armour was led Society London, Medical Association the Society, the of of of British Chirurgical Section Neurology BMA President the Surgeons of of and Psychological Neurological and Nov. BMJ, Armour, 4,1933, 84 7. 'Donald Anon, p. Medicine. Anon, Horder, lord Horder Jeeves Ashford Aug Thomas BMJ, this of An was 187 example of 27,1955, p. 565. in had later built large their they true careers when up a practice, This iss was particularly Ryall, BAfJ, Sept. 16,1922, p. 534 and Anon, 'Sir Charles Sir Anon, for example, see Dec. 1849-1853. BW 17,1898, Jenner', pp. William Sept. BAfJ, 'Joseph Perkins!, 22,1928, John Anon, p. 550. Italics 189 mine.
318
Regardless of Jeanne Peterson!s claim that there was "no formal rule in HO, 'publish the the majority of nineteenth-century medical or perish' of Harley Street medical practitioners
implicitly. 190It may this upheld maxim
thus be argued that the group's publications and collective editorial power discipline the to them of medicine and more professionalise enabled the that many areas of specialised medicine, which so many of specificaUy, these men created during significantly
their
time in Harley
Street, contributed
to the advancement of medicine in Britain
in the late
It twentieth that they centuries. seems unlikely early would and nineteenth have achieved their professional eminence if they had not followed the tacit (admittedly
American) dictum of "publish or perish7.
Journals Professional 'Specialist Rivalries Peterson, in Victorian Jeanne M. and i9o Number Vol. Spring Peziodfcals Reýiew, 1, 12, 1979, p. 30. Victozian Medicine',
319
CHAPTER 7 Women Medical Practitioners of Harley Street Introduction - The Role of Womenin Victorian Britain In mid-nineteenth underpinned
century Britain,
by legal, political
the idea of a womans place was
and social practices that subordinated
feminity Victorian ' was structured around perpetually middle class women. diseased and weak bodies, based upon the assumed dominance of an female reproductive unstable
Katharina apparatus.
Rowold has argued that
the so-called women!s question, intensely debated by many physicians and in Victorian the the century, was centred nineteenth on concept of scientists "nature" unrelenting
that emphasised gender differenceS.2 Victorian from obstacles
the medical
profession
women faced
in their
attempt
to
Nineteenth Century in medicine. career Physicians upheld a:n establish a ideology that conferred on women such traits as being passive, Pious, pure
believed that intellectually domestic women were physically and and and inferior. Henry Maudsley (1835-1918) argued in 1874 that women could never hope to match masculine achievements because physiology acted as a handicap: their body and mind were for "one quarter each month more or
Under common law, married women did not have an identity outside that of their husband's. see,Trevor May, An Economic and Social Ifistoly OMitain, 1760-1990,(Essex, 1996), p. 284. (ed. ), Gender Science, late Rowold, Arineteenth -Century Debates on the Katharina and 2 (Bristol, Body, 1996), pp. ix-xxxv. Mindand Female
320
less sick and unfit for hard work7.3 Women doctors fought back, disputing the notion that higher education was injurious to the female mind and body. 4 Elizabeth Garrett Anderson rebuked Maudsley for claiming that for "to women were of education endeavouring advocates assimilate the
female to the male mind".5 In the face of such trenchant opposition, Maudsley had, by 1878, altered his view of higher education for women, as he felt that the "womees movement must sooner or later have its day". 6 Consequently, he proposed an amendment to the RCP charter that would licence from to College, the obtain students a medical women allow provided
they met the required academic standards. The impetus for higher education began in the 1860s, when women Supporters to began to medicine. study want also their that caring and nurturing argued
of women's education
aspects combined with the desire of
be by female to seen a medical practitioner, some women patients women
for It 7 this role. was not until well suited
made
the late nineteenth
the the that professional, of meritocratic rise middle with class, century, thus posts and undertakc work normally salaried accept women could (bureaucratic, to clerical or medical). men attributed
in Mind Education, The FOrtnighttvRetiew, 1874, Vol. 15, pp. 'Sex Maudsley, Henry and 3 466-83. Female Women, Malady. The Aladness ' Showalter, and English Cultuve, .1830-.1980., 4Elaine (Undon, first edition 1985, this edition 1988), pp. 124-126.
Anderson, 'Sex in Mind Education: Garrett and Elizabeth a Reply', TheFortnightty a Also Vol. 506-517. 16, 1874, seeRowold,Cender,pp. 54-77. pp. J?eview, Hls&ry Royal College (0 in T12e don, Vol th 111, Cooke M. of e ofphysicians eAý ofLon xfo rd, 1972),p. 834. 7Rowold,Gender,P. xiii 321
Hitchin
College (later Girton) and Merton Hall, (later Newham
College) were founded for women in Cambridge in
1869 and 1871
lectures, but attend could and women until 1922 they only respectively, degrees7 letters Women "certificates their with no of after name. received full Oxford to membership at until were not admitted
1920 and at
Cambridge until 1947.8 By 1914 an English woman could operate in a far done have though than could a century she earlier; yet, she wider sphere in her Five to she was still own right, not equal men. years was a person Sex Disqualification a passed
later, Parliament
(Removal) Act, which
declared that no one should be disqualified from holding office or civil or judicial
9 by their sex. posts Women's education was inevitably
Middle
and upper
governess, until
class girls
linked to their position in society.
were typically
they were approximately
educated
at home by a
10 years old. After
this, they
Between Schools boarding 10 1864-1868, Inquiry day the schools. or attended
(Taunton Commission) examined the status of education in Commission Commission found The that there schools. was proprietary endowed and little difference between men and women's mental abilities; moreover, it for in 13 there that the only were secondary schools girls also reported few schools had opened for girls in London in the late Although 11 a country. focused 1850s, on academic achievement, progress moved which 1840s and
degrees in Edinburgh, Glasgow, St Andrews Aberdeen in to Women admitted and 8 were 1892. (London, Women, 1993),p. 243. Victozian 9 Joan Perkins, Women, Victotian P. 32. Perkins, 10 in Ibid HC 1867-8 File xxviii, quoted PRO, 11
322
free there was no state-sponsored system of at a rather slow pace and 1870.12 until schools The First Generation of Women Medical Practitioners The women who eventually set up practice in Harley Street owed much to As is known, Elizabeth female well the earliest medical practitioners. Blackwell (1821-1910) who qualified as a MD from Geneva College, New York in 1849, was the first woman to be listed in the English Medical fuelled Nevertheless, this in 1859. J?egister move much opposition as the GMC refused, thereafter, to admit medical practitioners
foreign with
degrees to the Medical Register. In practice, this meant all women, as they England. in could not qualify (1836-1917), included be Elizabeth Garrett to The second woman was began her She in in 1860 and 1866. Anderson, Garrett medical studies later diploma from English licensing hold body. Since to first an a woman was the female hospitals to closed teaching were students, she was London in London her St for tuition to and pursued Studies at private pay compelled Medical Act The 1858 13 Edinburgh. stipulated that those Andrews and had diploma, degree Register to their Medical in receive the or a listed Examining Boards. Only Society 19 the the from prescribed of licence one of Garrett LSA in Elizabeth the 1865, who was granted Apothecaries accepted in for Women Harley College Street Queen's Women, 253. Victoilan was p. 12Perkins, North London in Collegiate College 1849 School founded Befford and 1848, in was founded in 1850. Women ýg Parasols. Entry Charge ' Medical pý! to The the Blake, otthe rofgj? ssjon Catriona 13 (London, 1990), pp. 61 and 216. Elizabeth Garrett was given permission by the lecturers lessons from the take Society to of recognised medical private Apothecaries Mary Scharlieb'Women in the Medical Profession: An address' (Undon, 1898), See schools. P. 9.
323
thus, entitling her name to appear on the Medical Register a year later. However, in an effort to preclude more women from taking its diploma, the Society of Apothecaries introduced a ban on private education and from had list to the that graduate of one of approved students stipulated Although to closed women. women could, medical schools, all of which were did, their a recognised without qualification, exclusion practise and some from the Register was deemed iniquitous by a group of astute women led by (1840-1912). 14 After Jex-Blake found that no British Jex-Blake Sophia degrees her to medical women she resolved grant set up university would institution own Although
in Wimpole Street in 1874. an office up opened and
Garrett Anderson and Blackwell were initially
reluctant
to
individual, her. they outspoken eventually an supported such associate with Various
eminent male medical practitioners
and scientists lent their
Hart, Thomas Henry Huxley (1825-1895) and John Ernest including support Burdon-Sanderson
(1829-1905). Eventually,
Jex-Blake
found suitable
Street, Brunswick Square and opened the London Henrietta in premises (LSMW) October Women for 12 1874, with 14 Medicine on School of students. The only examining body that would admit women was the King's in Ireland, Physicians College to Queen's which allowed women of sit and (LKQPI) in (LM). Licentiate Midwifery the Six Licentiate and women their including Jex-Blake, Isabel Thorne Edith first and the examination, sat
Atkins, Louisa Edith Blake Pechey that 20, Eliza Walker parasols, argued and p. Blake, 14 degrees. foreign based their on built UP successful practices
324
Pechey and three who were proteges of Garrett Anderson. However, they instruction hospital the to until clinical and obtain practice unable were LSMW formed an alliance with the Royal Free Hospital, which meant they Register. It in MeaYcal December listed 1877 be that the was not until could the Convocation of London University agreed to change the University Charter and voted for the admission of women to all degree examinations. Women could finally take their medical degrees in England and set up UYL the throughout practices
By the end of the nineteenth century, the majority of London based female medical practitioners established their practices in West London, as did their male counterparts, while south-west and south-east London were Table Appendix 7.1 F. In 1899, only three see areas, popular the next most had consulting women Street Area, including
in Harley rooms
Street; nonetheless, the Harley
Wimpole Street, Queen Anne Street and Welbeck
in West End for women to establish the the Street, was most popular region Upper 15 a practice. satellite
Berkeley
Street in Mayfair
also attracted
a small
because Elizabeth Garrett Anderson's of perhaps group of women,
four later there, two the though would women practising of move presence, five in Nottingham Likewise, 16 the Street. Harley of who practised to
Place,
Street. Harley 17 to least move one would at
Yem-Book Institution, Wstinglor Eng&hwomanýg to the The H., all andDirectory M. 9, L. 15 (London, first 1888, Children, this edition 1899),pp. 100-102 Women edition penefft of and Street, Harley did Anderson Agnes Garrett F. Blackadder to Louisa as moved In igo5, 16 (later SavilOin 1908. in Thorne 1905. May This 17 was 325
Mary Ann Elston found that much of the historiography on women and medicine in the Victorian period was shaped by the belief that the This 18 almost was exclusively profession male. outlook perpetuated medical the claim, made by some historians, that female medical practitioners were before Great War, despite fact the the the that start of virtually non-existent by 1911, there were 610 women who worked in the medical profession and by
1914,24
distinguished
medical women practised
in
Harley
Street. 19 Elston
between the first generation of women on the Medfcal
J?egister, as those who qualified before the 1886 Medical Act and the second This distinction 1886.20 is those after qualified who as adopted generation, here in comparing Harley Street women with
other female medical
practitioners. Elston found that women accounted for only approximately one per to the the up practitioners end of medical nineteenth century, active of cent had five 21 Despite by 1921 their the numbers reached that percent. and dearth of women medical practitioners up to 1914, the primary published and archival
for distinguished the available sources
female medical
Even "the though and extensive. rich subject of women's were practitioners entry
to the medical profession has received considerable historical
James Stuart Garner the as years", remarked recently, most over attention in the on women medicine emphasises the obstacles scholarship of Services: Sociological in Doctors Health Study 'Women Elston, the Ann Mary a of their is (Ph. D. thesis, University of Leeds, 1986), pp. 1 and 63. opportunities' Careers and (London, in Me&ca]Profassion, 1978), p. 2, stated that "few women Peterson, ig M. Jeanne Victorian during the the era". to profession enter managed Doctors,
20 Elston, 'Women 21]bid.
p. 165.
326
by first Medical RegiSter.22Historians have the the women on encountered demand for doctors in Colonial India the women examined and the also First War World that the offered to opportunities
theM.
23
Although there exists a substantial body of scholarship on female in her Britain Empire, the role of women medical and medical practitioners practitioners
in Harley Street has been completely neglected. This chapter
imbalance. Since Harley Street the that to cohort was a very redress seeks Mary Scharlieb, Jane Walker Charlotte three of whom, and group, small IA)uisa Ellaby, were of the first generation, it was possible to undertake a it for their than their thorough education of and careers analysis was more Street Harley (24 The in this in women examined chapter male colleagues. Appendix F. in Table 7.2 listed all) are
Harley Street and Women Medical Practitioners Elizabeth Garrett Anderson's decision to pursue a career in medicine was in by Harley Street. When hostility Garrett the Anderson men with greeted
22James Stuart Garner, 'The Great Experiment: The Admission of Women Students to St Mary's Hospital Medical School, 1916-1925'sMedical History , Vol. 42, Number 1, Jan. 1998, Baker, Mrst Rebecca The Woman Doctor, Story for Elizabeth See, the 68-88. example, of pp. Blackwell, M. D. (London, 1946), Louisa Garrett Anderson, Elizabeth Garrett Anderson, (London, Jo Manton, Elizabeth Garrett, (London, M. D., 1959), 1960). For a 1836-1917, for E. Moberly Bell, Storming the history struggle, medical women's see example, of general (London, Woman Doctor Blake, Rise Parasols, passim, Edythe 1953), The the Citadel, ' of the (London, in Medicine Place Gain 1969). Elston, 'Women Doctors', Women a Lutzker, first Queen Margaret College, Glasgow the For medical graduates of of analysis an passim. (Glasgow, Alexander, K"t Wendy Ladies 1987), Jex-Blake, ofMedicine see see also and (Edinburgh, Komena Thesis History Medical 1886), M. Todd, The Jex-Blake, and a Sophia Undon, 1918) and Shirley Roberts, Sophia dex-Blake: A Woman Jex-Blake, Sophia Life of (London, CenturyMedical Reform, Nineteenth 1993). 1yoneerin Mary Scharlieb, Balfour, Young Ruth Work The Margaret India and ofNedical 23On see (Oxford, 1929) and D.C. Wilson Palace ofHealing. ' The Story ofDr Clara 1ndia in. Women (London, Me Hospital MissionaryDoctor Founded Woman 1968). For First and 8be Swain, during Mora Murray, the Army Women history see medical war, work women's as of a surycons, being the History of the WomenigHospital Corps in Pazis: Wimereux & Endell (London, October 19141920). 1919 September Street,
327
her father, Newson Garrett, in Harley Street in June 1860 to with arrived into from "the leading the medical profession on entry medical seek advice discouraged. According her daughter, to actively was she consultants", Louisa, "no one offered help or believed in her high aspiration. Some laughed, some were rude". One consultant suggested that she pursue the Louisa's instead. Despite her did 24 claim, mother receive nursing profession
Street Harley George Harley helped from practitioners. several support Anderson with her studies, he "used to repeat his lecture to her privately, as listener be his to a at she was not allowed Buchanan,
class".
25
Others, such as George
the chief medical officer and a Harley Street physician,
supported women's medical education and campaigned strenuously degrees University the to at admission of women
for the
of London. 26
As mentioned in Chapter Six, the Harley Street surgeon Arthur Trehorn Norton became a fervent advocate of women's right to enter For other practitioners, medicine.
such as John Langdon Down, support for
Langdon Down believed however, in ambivalent. womenvs women waso contribution
to society and he supported female suffrage; moreover, the
Suffrage for Women's in his house in Society Harley National convened 1872 Street.
27
However, when Elizabeth Garrett Anderson petitioned the London
be to in to 1876 admitted to their medical classes, women Hospital allow because mixing they were refused
the sexes was deemed inappropriate.
Anderson, 50 Anderson, Garrett p. Louisa 24 (ed. ),
HarI67 FR. S. or the Life of a London physician, George Tweedie, Alec. Mrs 25 (London, 1899), p. 166. BW May 1066. Buchanan, 11,1895, 'George p. 26 Anon, Langdon Down, CkringNoneer John 1828-1896-'a (IýOndon, Ward, 1998), pp. Connor 0 27 163-64.
328
Subsequently, a request was made to hold separate classes for both sexes: Langdon Down, who was by then a physician in the London Hospital, he had: though this even application opposed no grave objection to women entering the Church, Law or Medicine, still I am clearly of opinion that the scheme propounded is not a practical one ... if detrimental, be highly not ruinous to the school of the London and would Hospital. 28 Harley
Other West,
Charles
daughter dear one
her go through
physicians
Bell remarked
as Sir
such
in their
implacable were
E. Moberly
medicine.
Street
opposition
that Jenner
he would rather and
William to women's
"testified
follow her
that
Jenner
and
entry
into
he had but
to the grave than allow ...
such a course of study". 29 When the Fellows of the Royal
College of Physicians were asked to vote on women's admission to medicine (a Burrows George Sir in 1878, non-Harley of the motion,
rejection
which
Street practitioner)
Proposed a
was seconded by West. In
1894, West
to the of a second motion admit women on the grounds rejection proposed that
allowing
modifying
women's entrance
to medicine
the mental and moral characteristics
would
result
of women and the relation
in thus to many respects other, revolutionising the each sexes of Even as late as 1913, when women were qualifying the Harley Bart's,
Street physician
and lecturer
in "gravely
society". 30
as medical practitioners,
on psychological
medicine
at
Thomas Claye Shaw, "warned the modern woman that her new
(London, 1887), quoted in Ward, Down, p. 164. MentalAffections, Down, 28J. Langdon Citadel, 103. the Storming P. Bell, 29 Lancet; West, Apr. See 2,1898, 968 970. Charles West, 'Charles pp. Anon, also, 30 (London, Statement Azgumen4 Women :A 1878),passim. and an Medical
329
in independence in life sport and would mar the beauty of her face, activities her 31 alienate nature, and male sympathy". change When women arrived
in Harley
Street in 1888, all male-governed
English medical schools and hospitals were closed to women. The only two in Ireland Britain degree that them and would grant a medical universities University the were
of London and the Royal University
of Ireland. 32 In
1888 there were also only three medical schools open to women: the London School of Medicine for Women (72 students in that year), the Edinburgh School of Medicine (17) and the Royal College of Surgeons, Dublin (12).33 Since the male-dominated having
a significant
opposition,
in the profession, they were excluded from the role
Medical
International
Mary
achievements.
medical profession did not recognise women as
Congress
Scharlieb
in
London
had a career path
in
1881.34 Despite marked
this
by noteworthy
Greta Jones has described Scharlieb, as "one of the most
her generation". 35 She was one of the two first distinguished women of (MB University London, the BS) in of of graduating and graduates medical first the woman to win the gold medal and exhibition in 1882, and was " obstetrics.
Jan. Shaw'BMJ, 22,1927, Claye 169. 'Thomas p. Anon, 31 188. Year-Book, H., M. p. L. 32 197. 192 and 33.1bid,pp. Ends Ir Search in To Earth, Women for Education Bonner, Neville the the of a4Thomas (London, 61. 1992), p. Afe&cine 35Greta iones, 'Womenand Eugenicsin Britain: the Caseof Mary Scharlieb,Sloan Chesser,and Stella Browne',Annals ofScience,Vol., 61,1995,p. 486. in Miss Edith Shove (MB 1882 female London1882). was medical graduate " The other 195-196. Year-Book, H., pp. M. L.
330
Five years later, in 1887 and after working as a doctor in Madras, Scharlieb returned to Britain to study for a higher degree in medicine. She from MD the the University of London and the MS in 1897 being received the first woman in Britain to secure these degrees.37In 1892, Scharlieb was Royal Free Hospital and thus became the to the gynaecologist appointed first
female
noted,
member
of staff of any general
hospital
because, as The lymes
"she was a great surgeon7.38 When she died in November
newspapers
eulogised
her role as the 'Tamous! ' and "pioneering"
1930, the woman
doctor-39
Like Scharlieb, Charlotte
Ellaby gained much of her experience in
of Bombay appointed her as second physician
India.
The government
Edith
Pechey in 1886 at the Cama Hospital for Women, where she later
to
department". Another "the 40 first eye special generation Harley established Street woman practitioner,
Jane Harriett
Walker, has been described as one
the treatment She tuberculosis. the open-air of of pioneers was also one of of the founder
Medical Womeifs the of members
Federation
established
in
1917.41 The creation of her sanatorium "while she was still in Harley Street fellow by her frowned consultants, upon was
but she ignored critiCiSm". 42
Eugenics', Vomen Jones, pp. 481- 502. and 37 June Rmvs, 1,1932, RFHSM PC, Book 7, part 2. The. Anon, 38 39'Jane Harriett Walker, in the DaVyMail, Dec. 22,1930, The 7Ymes, Dec. 22,1930, Dailv Telegraph, Nov. 22,1930, MorningPos4 Dec. 26,1930, RFHSM PC, Book 7, part 2., are just sample of the many tributes to her. ' BMJ, Ellaby, May 29,1909, 'Charlotte Anon, P. 1335. 40 41Anon, 'Jane Harriett Walker, The 7Ymes,Nov. 18,1938, RFHSM PC, Book 8, part 1, and Anon, Vane Harriett Walkee, Lancet, Nov. 1938, p. 1259. 'Jane Dawkins, Harriet F. Walker Ch, MD, LLD'Wellcome, archives of the Veronica 42 MWF, C. 132, P. I
331
Walker, who "could be quite formidable", had an indomitable spirit and she be intimidated by her to colleagues' censure. 43 refused Of the second generation, Dr. Florence Stoney has, like Scharlieb and Walker, been described by a number of her colleagues as a pioneer and "ahead of her time", particularly in relation to her expertise in radiology and One Stoney's 44 of colleagues remarked that, "pioneers electro-therapeuticS. hers TWO 45 was outstanding". and courage, other need
Harley
consulting
described were who as pioneers were Maud surgeons
Chadburn
and Eleanor Davies-Colley,
Street Mary
both of whom founded the South
London Hospital for Women in 1916.46 Chadburn also established the Marie Curie
Hospital
in Hampstead
in 1928.47 Davies-Colley
became the first
in fellowship FRCS 1911 the Royal the College the to when earn of woman Other to Surgeons women. noteworthy practitioners opened was of
included
Mary Louisa Gordon, who was the first woman to be appointed inspector of inspector inebriate 48 of reformatorieS. assistant and prisons The Cachet of a Harley Street Practice Mary Ann Scharlieb became the first registered female medical practitioner Street in Harley in in house 1888, initially a shared practice to set up
with
431bld
Stoney, 7Ymes, The 'Florence Oct 8,1932, and'FlorenceStoney,by Dr. Lee, R. J. Dr. Watson Smith for the BMA, BMJ, Oct 22,1932,'SomeExtracts from Various Obituary Noticesof FlorenceA. Stoney,RFHSM. YYMes, Oct Sheppard', The RFHSM 8,1932, PC, Amy Book7, part 2. Stoney 'Dr Anon, 45 for her during OBE She first doctors the the the work war. was one of women was awarded She became by head the to invited war be office. of radiologyin the Fulham work to Military Hospital in 1915. RFHSM PC,Book 8, part 2. May 4,1957, BNJ, Anon, 46 Mary 'Maud Chadburn, Lancet, May Anon, 4,1957, p. 939. lbid, 47 and Journal, Ir Medical May 18,1908, Woman pp. 106-108. Anon, 48
332
Professor (later Sir) Edward Sharpey-Shafer (1850-1935).49Scharlieb joined the ranks of distinguished male consultants in Harley Street such as the throat specialist, Sir Morell Mackenzie at number 19, Sir Richard Quain, Queen, in 1890, to the at number 67, and the expert extraordinary physician Morris Sir Malcolm Arthur diseases, Trehern Norton, 8. at number on skin had moved to Harley Street in 1887 -a
year before Scharlieb established
her practice there. However, Scharlieb's address at number 149, which was Street, Harley her the reflected position as someone who was extremity of at on the outskirts
fraternity. the medical of
Although Scharlieb's practice was
Marylebone Road, the to the the street, close of end north she at situated fact "the house bore herself that the the with magic name and consoled thoroughfare". into the professional great opened
50
By 1888, the number of qualified medical women on the Medical J?egister totalled 57 and of these, 23 were based in London. Of the London group,
in private most were engaged
practice;
only a couple of these
practitioners
involved medical officers or with a philanthropic were school
organisation.
The rest were widely dispersed: over a third
were resident
in India. these the of were medical missionaries majority abroad, and Approximately
80 per cent of the female cohort were in practice
before arriving in Harley Street: most of these were based in West or West
University College lecturer professor of physiology at Sharpey-Shafer assistant and on 49 deal help, for instance, Scharlieb he LSMW the offered a great of practical physiology at Scharlieb's children when she returned to Madras. See Jane looked his after wife and Walker, 'Dame Mary Scharlieb'BMJ, Nov. 29,1930, P. 937, Anon, 'Dame Mary Scharliebt, Scharlieb, (London, Mary Reminiscences, 1211-1212 29,1930, 1925), Nov. pp. and Lancet, p. 131. so Scharlieb, Reminiscences, P. 131.
333
London, only two were recent graduates. The average age of the
Central
38.5; in thus, they they their was arrived were well established when cohort Harley Street from The 51 to move another practice address medical careers. the the upward career progression, usual as was seen with male represented medical practitioners.
The majority of women stayed an average of 19 years
Street, during which time they built up their private practices,
in Harley
(n 9) these 38% either retired = of and further A address. Harley
hospital
later
Street
30% (n = 7) were at least 60 years old when they left
the war encouraged
trajectory years,
Since their
of a medical
I am arguing
in private success the early twentieth referring
cohort.
several to leave private
Street
Harley 53 CorpS.
of this
majority career
Harley
Street and may well have retired. 52 Of the younger female medical
practitioners, the
or died at their
practice century
that
was the last medical
practitioner, Harley
reflected
practice
careers
followed
represented
"women the these to many of women as
for the
the normal increased
in
the pinnacle
of
newspapers
in
women. Various
the prestige
and join
address
whose prosperity
Street
for these medical
practice
of practising
in this area,
doctors of Harley
Street
fame 9P54 .
Of for details F, Appendix their the two recent graduates one, 7.2, of ages. Table See 51 into her Scharlieb Sim mother's practice address on graduation. Ethel moved Mary does indicate Djý-ectory is Ne&eq] not always whether a person 71e T, professionally 52 .
inactive. join left Street in Harley May Anderson the Thorne to 1914. did Garrett war effort Louisa 53 following in Street Harley Ada Stoney the her Lilian to practice war. private and not return left Harley Street. they shortly after Chesney also participated LSMW in jubilee the 1920 the honour the of made at when was This guest of 54 comment Harley doctors Street fame. "women " Present at the Louise with of seated was Princess "100 100 women entertain[ing) clever clever men7,which included luncheon were from a variety of occupations, and at least 7 of the cohort, RFHSM PC, representatives Book 5, PP. 183-185.
334
Since the first women to establish practices in this 61ite male environment
were few in number, the development of a professional
for determine if to this they experienced examined group was community the professional isolation, which the early twentieth Louisa Martindale,
century surgeon,
claimed was prevalent for female practitioners
in
English Edwardian provincial practice. 55She argued that: isolation, however, is a great and her chief disability-professional depending an overwhelming one, again on the tone and sometimes almost the spirit of the women of the provincial town in which she lives. 56
Jane Walker acknowledged such isolation in her 1922 address to GPs led LSMW "solitary that the she pointed out when women a students at life" in towns, where their male colleagues would outnumber them by a ratio depicted uneasy social relations
1.57Martindale 20: of
in in towns, the and particular ranks
professional
Thus, she found an "insurmountable
wall of-is
between differing
with male colleagues.
it jealousy or sex rivalry
or,
barrier believe, due inclined to to influence the I a unconscious as am more of
She 18 wiveS".
doctors'
distinguished
would certainly
"everyone
remarked
and eminent women consultants
time". 59 Martindale
knows
the
in London at the present
have included
women such as Mary
in her Walker Jane evaluation. and
Women in an area such as
Street would have had more frequent
social contact than their
Scharlieb Harley
further
provincial
counterparts.
The referral
system
would
have undoubtedly
(London, her Future, Doctor Woman The 1922), p. 85 Martindale, and 5r,IA)uisa 56]hid Book Oct. 7, 2,1929, RFHSM PC, JYmes, yyle part 1, p. 165. 67Anon, Doctor, Woman 85-86. pp. Martindale, Iss 591bid
335
As Martindale "are to this. these also remarked women sought contributed Thus, Harley Street into 60 female consultation". medical after and called have isolation to the that experienced not appear professional practitioners Louisa Martindale claimed medical women encountered in the provinces. Motivation of the First Generation From 1888 to 1914, the first and second-generation women practitioners in Street pursued a career in medicine for different
Harley
Mary Ann Elston stated that philanthropy, independence generation,
the main
constituted
personal
motivations
for the first
ability through the pursuit of medicine
into be taken consideration, also
significant
missionary work and financial
I argue that this represents a partial explanation only and that
intellectual their desire to satisfy the must
reasons. Whilst
as this probably
played a more
Street 61 Harley for these women. role
The desire to nurture personal intellectual self-education
became an important
needs was so strong that
for academically
pursuit
ambitious
(later Scharlieb) acquisition of knowledge was typical of Bird's Mary women. doctors. female 62 Her had her taught aunt, who the early group of aspiring basic French and Latin, lectures virtually
frequently would also
her So keen thirst was on science.
accompany her to public
for knowledge that Scharlieb
Guide Science Brewer's Chfldýg to Guide the to and memorised
63 She later attended Mrs. Tyndall's 'gn-OWIedge.
60ibid. Doctom', 173. 'Women p. Elston, 61
school in St John's Wood
from "6 daily 8 " to See, Thorne, for May m. p. a. Thorne m. studied example, 62 Isabel LSMW and the Royal Free. Archives 5. the 1834-191a Diary, of p. Thorn's 63 ScharEeb,
Reminiscences,
p. 4.
336
Granny
felt "compelled hard" German found to there the work once at and and her "admirable". 64Following lectures secondary education, she took science her her to the younger governess siblings of whilst continuing own role on intellectual pursuits with lectures, museum trips and private tuition. Even her husband, in Madras barrister, with a who was she when she arrived In addition to "did [her] best to keep up languages and mathematicS11.65 helped Scharlieb her husband his legal household, the with work, running her in When he her, in his career role choice. asked a pivotal which played Sir Joseph Fayrer's to review article on medical capacity as editor, [her] found Jurist, "aroused Madras interest for this the she jurisprudence in medicine" and in 1871, she began to study midwifery. 66 Fayrer's article was concerned with the plight of the Mahommedan
in Hindu childbirth, who would particularly not permit a male women, and As due the female to there them of rules purdah. strict were no to attend medical practitioners
in India at the time, these women were frequently
left
they This or suffered midwives alone. situation to the mercy of untrained Scharlieb impression indelible that she discovered her on left such an Because desire in help the to these of medicine. women, interest academic Scharlieb's
wish to study medicine was given a socially acceptable outlet.
knowledge" into "theoretical her to practice with the aim of She vowed put India. Since the to women of bringing medical education missionary work Scharlieb's for faced less of women generation, she was viewed as acceptable
64Ihid., c,5 jrbid, 6ojbid,
P. 8. p. 2 4. p. 29.
337
from have the than medical profession would otherwise been the opposition in favour Victoria Queen doctors, Though, was not of women she was, case. however, supportive of Scharlieb's efforts in India. 67 Scharlieb began training as a nurse at the Madras Lying-in Hospital Cockerill. She later surgeon-major under persuaded and studied midwifery her husband's professional contacts to lend their support for the right of women patients
influential
to have medical practitioners
of their own sex. Two very
Governor Hobart, Madras, Lord the of and Dr Balfour, the men,
Surgeon General, backed her cause, which was also facilitated by the Indian Government's
childbirth.
sympathy
for the seemingly avoidable plight
of women in
Their efforts led to the establishment of the Madras Medical
College. 68Scharlieb later recalled that impressed day deeply by the the loss of life and Government was of the for high by the the of medical aid absence caste and gosha misery caused being intention they their to admit recorded memorialized on and women, 69 the to medical college. at classes existing women
In 1878, Scharlieb returned to England because the Indian climate further because her, to she wished did not suit and indication
determination, diligence her and of
her studies. An
common in the first
displayed her journey home on was women, when, with generation medical in the for tow, the only revised not she requisite subjects three children but "studied University exam, she also matriculation mathematics London
in Victoria Queen 1883, Queen the Scharlieb told to senda with 67During an audience [is] Queen "the them, to that her sympathizes with and say glad... to patients ... message help in to then have their Scharlieb, " See, time medical women of need. they should that BW P. 935A Medical Scharlieb* life Ann from Dacomb Harley Tdary Madras to Collinson, S. R. 68 Vol. Feb. Biomphy, 7, 1, 1999, Journal no. pp. 25-31. ofMedical Street, Profession', 13. 'Medical p. Scharlieb, 69 338
70Scharlieb the the of ship". of engineers arrived in England with with one introduction of
letters
to Florence Nightingale
and Elizabeth Garrett
Anderson, who was, by then, Dean of the newly founded London Medical School for Women, where Scharlieb enrolled to further pursue her medical in her final Scharlieb's MB assiduousness academic was rewarded studies. in and scholarship a gold medal obstetrics. exam when she won Jane Walker, who shared Scharlieb's academic leanings, was born in Drewsbury, Yorkshire on 24 October 1859, the eldest of the eight children of John Walker, a blanket manufacturer and Mayor of Drewsbury. 71 Her father influenced and encouraged her choice of a career in medicine. 72 Following qualified
secondary education
at Southport,
she attended
the LSMW,
from in Dublin LM 1884 LRCS Edinburgh LRCPI and and as
in
doctorate in Since the a of obtaining medicine in the UK possibility 1889. forced the time, to to to she was at go overseas women complete closed was her post-graduate from
Brussels
strongly
She travelled education.
University
to Brussels and qualified
in 1890. One of the early suffragists,
believed in the educational abilities
MD
Walker
of women and was an
influential role model for the next generation. Charlotte Louisa Ellaby's entry into medicine was achieved through "the most indomitable pluck and perseverance".73 Following the advice of
Ellaby her Anderson, Garrett gained work experiencein India Elizabeth
749-751. DNB, Scharlieb", 1922-1930, "Mary pp. Anon, 70 937. 'Scharlieb, p. Walker, 71 Walker, 108 Jane 'Dr. p. Anon, 72 BMJ, 1335. 'Ellaby, p. Anon, 73 339
in She later in "it the that oPhthalmology. remarked not was and specialised be but it did in to to the a genius or make a mark world, power of every one Jean Paul Richter 'as to make, as one said, much of ourselves each rest with
be as could madeout of
theStUff".
74When
Ellaby addressedthe students at
the LSMW in 1895, she advised them in their acquisition of knowledge "to be bold, be bold, and everywhere be bold". 75Harley Street women such as Mary Scharlieb, Jane Walker, May Thorne and Florence Boyd were keen supporters
in Scharlieb for the profession. of women called promoters and
the dissemination
information of
so women could be given the opportunity
to
in her Walker, London 76 to the the address students at profession. enter (Royal Free Hospital) School of Medicine for Women, urged women to "be loyal to one anotheel. 77 This pursuit of medicine by the first generation Harley Street women testifies
that
their
motivation
to
enter
medicine
cannot
be simply
"sympathy for human "purely zear, or missionary suffering". as categorised With
increasing
woman's provider's
prosperity
amongst
the middle
classes by the
increased leisure time was seen as a reflection
of their
1870s, male
his An 78 consumption. conspicuous analysis success: a symbol of
the that philanthropic showed careers these women's of
aspect of medicine
higher but itself, in to this just a group not a means end: end an was not
PC, Book RFHSM 3, 59. Oct. 2,1895, Post, p. Morning 74Anon, PC, Book 3, 59. RFHSM Oct. 2 1895, YYMes, The p. 75Anon, Book 3, 34. PC, RFHSM Dec. 15 1888, Queen, p. Tbe 76Anon, 7, 1, 165, Oct. RFHSM PC, Book 1929, ffmes, 2. p. Tbe part 77Anon, in the the the of women discussion nineteenth and oppression century emergence of For a 78 (Iondon, Hidden from History, Rowbotham, Sheila 1977), feminist see, response of a passim.
340
intellectual gained only
but they broke from the restrictions satisfaction,
of
the role of "passive female" ascribed to middle class women in Victorian Britain. 79According to the Lancet, women who pursued a career in medicine from '"drawn is, be the that the same rank as male physicians', could only first Victorian The challenged generation middle clasS11.80 capacity sensibility
that
middle
class woman
should
not
work,
female notions of because "their
it. "81 delicacy not permit would and
Connections and Relationships Entry to Harley Street was easier for the second generation, as they all knew at least one other female medical practitioner in practice in Harley (54%) Thirteen before they arrived. Street shared a practice with a female (29%) into further incumbent and a seven moved practices in Harley Street brother. Eleanor 82 Davies-ColleY husband had their or already with either her father, John Neville her Davies-Colley, with childhood of an spent much in Harley Street. lived 83 May Thorne who set up practice eminent surgeon Thorne's Harley 148 Street, Isabel her address, number and mother at Ann into Piercy 121 Hamilton number with moved Dyddgu and Willmott (9%) two met as students at the LSMW in women Evans. 84The remaining
Chapter in discussion Nineteenth for Blitain, roles see on'Women of gender May, a 79 Century', pp. 284-305. 8o.lbid, p. 300 s' Aid into Davies-Colley Eleanor in the 1912, by Mary moved practice For established 82 example in Steiger, Stoney De Taylor into 1907 in 1899 and and moved a practice Chadburn Ellaby in the previous year. by established from in Harley Street 1877 1901. Davies-Colley to He Neville was was also a 83John in Garrett Anderson. 1897 LSMW the with student at but her Evans willmott Evans in to Piercy up medicine on marriage gave Ann qualified 84 1895.
341
1891.85 Other acquaintances arose through membership of such medical Medical Women BMA. Association Registered the the of and societies as Many women also established relations with the other Harley Street women in their working environment. 86
The majority of these women would have been able to call on the Street in have had the and would contact with support of other practitioners in their membership of professional societies. their them through work and There
was a considerable
amount
of professional
admiration
amongst
found Maud Chadburn the male cohort. amongst also colleagues, which was Davies-Colley Miss "as that, was very observant, of clear a surgeon, thought logical mind, of keen intelligence, skilful, experienced". 87Chadburn found in Emily
Flemming,
scientific
of medicine,
a
Agnes honeStyll. Savill, fellow 88 Harley Street a absolute and mind
medical practitioner, therapeutics reliable,
"had knowledge a wide someone who
Stoney's Florence pioneering work in electropraised
her "helpful, She described X-ray. as a generous colleague, and
in all she undertoole'. 89 Scharlieb thorough, persevering, accurate
"many New Boyd's the work good as Florence a years' surgeon at held
late in Boyd friend LSMW 1880's. the the Boyd was also a close at of studied 85Gordon and LSMW. Scharlieb, they 1880 the were students they when at Scharlieb; around met Mary Garrett Anderson Louisa Ethel Vaughan-Sawyer 140 and were j?eMij2jSC, ences,pp. -141. from 1891. LSMW the fellow students at also Stanley Mrs Boyd, Jane Walker Ethel Scharlieb Mary with and worked 86For example, for Davies-Colley Hospital Chadburn New The Sawyer women. and set up the at Vaughan for together. Hospital women London South Archives MWF, Davies-Colley, the Wellcome, SA/MWF/B. 'Eleanor 8of Chadbum, Maud 87 11. MWF, Wellcome, Archives Flemming, 'Emily SA/MWF, Box the Chadburn, of saMaud Oct 1940. Jan 1939 2/10. 13/B. Stoney, Archives Royal Free. 'Florence the Savill, obituary notices, of 89Agnes
342
in esteem and regarded Jane Walker as "a highly valued
Hospitar',
[who] hard 90 much and valuable accomplished work". colleague
Motivation of the SecondGeneration The motives for forging a career in medicine were different for the second for first Whilst 91 the they than were generation. generation of women important, medicine was seen as a more personal experienceswere still for it for than these their women was predecessors. option career acceptable Some were encouraged to pursue medicine as a career by a parent, from background. Elizabeth Garrett those a medical came who particularly for leave France during the First World Louisa, daughter, her Anderson saw first the become the of War to women's unit there. Shortly chief surgeon left, Elizabeth remarked that if the unit succeeded "they daughter her after expedite
would
encouraged relatively
the
women's
by her mother
by thirty cause
Isabel Thorne,
went
yearS". 92 May into
medicine
Thorne, at the
because help her 30 to she wanted of age mother at the mature
LSMW- 13
her father's Walker, Jane Like encouragement to pursue who received Ada Stoney's father G. J. Stoney, ScD, FRS, Secretary of Florence medicine, her Belfast, Stoney, in University supported choice Queen's of of study. the from first the the generation, women of possessed a many with common 141. Reminiscences, PgoScharlieb, for detailed different for the Doctors', the 'Women study a of motives Elston, passim, See 91 first and second generation. April RFHSM PC, Book The YYmes, 29 1939, Work, 8, 1, 122. -Women part p. at Anon, 92 Nov. in her 3 1951, BMJ, 1094, the Thorne', p. reason not given 'May was obituary 93Anon, her help Although LSMW. May Thorne to the mother at wished she though presumably did it from followed She 1905, to the Street return not she after Harley war. practice had a became LSMW. the footsteps of and secretary her mother's
343
described She "blessed intellect. as someone was with exceptional sharp high "aimed An for 94 intellect" and who and excellence". strove ability and described Vote her in The "iron will and undaunted notice
obituary
Mackay in her Stoney 95 the top prize year as student received courage".
honour School Medicine "class London the of and won prizes or group at in every subject certificates Street
Harley
include
taken".
Ethel
96
Other distinguished scholars from
Vaughan-Sawyer,
Emily
Flemming
Florence Boyd, all of whom won academic prizes. Although Street medical women were exceptional students, the majority
and
not all Harley (58 per cent)
by in Street. MD the time their 97 had the of arrival the qualified cohort of half first of those in the second generation The entire generation and Harley
Street were MI)s by the time they left the Street. Whilst,
calculated
of
Elston
that 35 out of her sample of 55 of the first generation had MD
four Harley Street the The 98 of advancement of degrees. educational women did MDs have been impeded not obtain who may generation of the second War. 99 World First the due to the onset of
'Obituary Notices', Stoney, 'Florence Royal Free. the Chambers, archives of Helen Dr 94 from in'Some Extracts Various Obituary Notices', Oct. 28 1932, Vote, The archives 95Anon, Free. Royal the of (Royal Free Hospital School London W the Magazine The OfMedicine of oen), 96Anon, Nov. 1932. Walker, Anderson, Chadburn, Thorne, Ellaby, De Steiger, Stoney, Boyd, Scharlieb, 97Mary Mecredy. Davies-Colley, Flemming, Savill, Vaughan-Sawyer, 181. Doctors', 'Women p. gsElston, (13%) in Harley Street World in first War One. the This arrived year of Three women 99 for Katherine Harman their to been studies. have not ceased continuing reason a may the of war. outset at practice
344
Background and Medical Education As was typical of the Victorian medical profession, two thirds of the cohort had middle class parents. 100 Five of their fathers were in the legal businessmen, three three two ministers, church were were were profession, tea the one was profession, a merchant and one was an medical of members Sim Scharlieb, Ethel Mary Louisa Garret Anderson In addition, architect. had been first Thorne's the May part of mothers generation of medical and been it has Whilst to trace the possible not secondary education graduates. of the
entire
cohort,
approximately
a third
their
attended
local high
(n 3) In their 101 = received a minority, part of education at addition, school. home, all of whom were daughters of a medical practitioner. 102 The majority
female this cohort received their of
training
at the
LSMW and proceeded to take a MB or BS degrees at London University. 103 Although
the Royal College of Surgeons in Ireland
was the first
Royal
its Fellowship in 1896, RCS to in England the did to College women admit both fellowship the the to membership and not admit women in the take administration part not could and women
until
or running
1911, of the
Quarter&Refiew, ýFFederation Jan, Women Oct 19391940, pp. 40TheMetEcal Anon, loo from no ýq no. obituaries and 4 1, information also obtained Egbaston High School; A. G. Harman Savill K Dundee attended For attended 10, example, Street High School Baker Davies-Colley E. and E. Mecredy attended attended School. High Leeds High School. 'privately'. Mary Scharlieb Stoney her A. F. received educated Thorne were M. and 102 home St Leonard's School. Application then to forms, and went on at education preliminary Royal Free archives. Charing Westminster, Mary's, Cross St London, had the George's, and which 103St later Dyhouse, during See Carol 'Driving the them. excluded war, admitted women in Pursuit Education, Medical 1890-1939', ý; Women ffistoryRe; jew, Women of Ambitions: 332. 32 1. 3,1998, No. p. p. 7, Vol.
345
College. 104Though the RCP admitted women as licentiates and members in 1909, women were still ineligible for the fellowship or the government and management
College. Following by Dr John Fawcett and the a motion of
Street Dr Edward Harley Farquhar Buzzard, by the physician, a seconded College by-law was amended in order to allow women entry to the fellowship in 1925, but it was not until 1934 that the first woman fellow was elected. Unlike
Harley Street the male of practitioners a number
who
Savill Agnes Forbes Arts degree MA, BA acquired an only when or qualified Andrews in from St She her MA her 1895. gained medical she received (or (1898) Glasgow University degree in Arts ChB MB, degree at where a a preliminary
105 Before a prerequisite. was a student could examination)
London University Irish University, degree the at course or an a embark on Of be 16 the traced, most to women who could matriculate. they needed Queees College, Harley Street. for their at matriculation prepared As shown in Table 7.3 Appendix F, the LSMW provided the medical
Harley Street The LSMW was the the for the of women. majority education in London where women were able to gain pre-clinical School Medical only by As 1909.106 designed 133 had It a short-term students measure teaching. War, World First London the seven the medical schools exigency of to meet
Cooke, RCP, p. 976. Wharry, Robert The Students by Junior Keetley, the Bell author and and edited 105Charles (London, 1885,2ndedition), 118-119. MeXca]Professlon, pp. the to ,Guide has First World Doctors', 175, War to the inWomen out, pointed up p. Elston As most of 106 female LSMW. the all medical attended schools students such as the women medical 104
346
for first by their to 107However, the time. clinical courses women admitted 1928, all these had closed their doors to new female students. Hospital Training and Practice Until 1914, medical appointments for women were scarce. Before this time the only positions available were clinical assistant, house surgeon or assistant
in hospitals by in officer run women, small specialist medical
hospitals like St John's Skin Hospital or hospitals for women or children Shadwell Hospital, Clapham Children's Maternity the or such as
Hospital.
It was not until the Great War that London general hospitals opened their doors to women. Women benefited from the burgeoning of special hospitals that began in the mid-nineteenth
century, which included hospitals for the diseases of
hospitals. hospitals 108 The the and skin eye majority children, of and women cohort
of the second generation
received their
training
from
the New
Hospital for Women and The Royal Free Hospital. Special hospitals such as
Square, hospitals Golden St John's Hospital, the Throat skin of the and Blackfriars
Camberwell important infirmaries in such as remained and
establishing women's careers. In July 1866, Elizabeth Garrett Anderson established St Mary's St Marylebone, Place, Seymour in with the aim of providing a Dispensary
Charing Cross, St George's, Westminster, St Mary's, London King's These and were 107 Hospital Medical School Mary's first St the to admit women 1916, In was one of College. Garner, 'Great Experiment, 71 see, p. medical students, 'Fame Fortune by Means Dricks Mortar: Granshaw, Medical the and of and Lindsay 108 in Hospitals Britain, Specialist Lindsay 1800-1948'in Granshaw and Roy Profession and (London, 1990), p. 206. in History Hospital The porter, eds.,
347
place where women could obtain medical and surgical treatment from female medical practitioners.
The dispensary proved very popular and in
1872 when extra beds were added to accommodate the increase in patients, (NHW). its The New Hospital for Women dispensary to the name changed Two years later the hospital moved to larger premises on Marylebone Road, further hospital in 1917, the expanded and was re-established on the and Euston Road. 109Four of the cohort in the second generation took positions as
hospital. A further five the clinical assistants at medical and/or surgical held positions at the RFH and four held junior positions at both hospitals. Thus, it may be seen that a practice in Harley Street enhanced the opportunities
thirds
for hospital
positions
for these women. For the majority,
in Harley Street time their the represented cohort), of
(two
increasing
There 110 however, in their were, profession. a couple of women advancement Lilian such as
Chesney and Charlotte
Ellaby, who were well advanced in
Street. Despite "' before to the Mary Ann they Elston's moved their careers
first "minute the that of numbeF a generation of women only argument medical
practitioners
in Britain
managed to procure appointments
as a
Harley the the medical officer, majority or resident of clinical assistant do to female So.112Several, such as Scharlieb, Street cohort managed
Anderson, 250. Anderson, 241Garrett pp. Louisa 109 RFH became the physician at Scharlieb and consultant surgeon at the a consultant 110 for Boyd became NHW, Women. Flemming Hospital the London a senior surgeon at South Vaughan-Sawyer NHW became a consultant the physician at and became a consultant the RFH. at gynaecologist Chesney NHW ophthalmic surgeon, a consultant assistant medical and ill Ellaby was Walker's sanatorium. at superintendent Doctors, 2 10 232-233. 'Women pp. and Elston, 112
348
Vaughan-Sawyer, Stoney, Ellaby, Davies-Colley, Chadburn, Thorne and Flemming were consultants at the NHW or the RFH. A number of Harley Street women played key roles in significantly
for by hospitals. the the women creation of new opportunities advancing Maud Mary Chadburn and Eleanor Davies-Colley established the South London Hospital for Women in 1912, which was staffed entirely by women
One beds. had 260 their to of chief aims was provide women eventually and with an opportunity
to hold a senior position in a large hospital. Chadburn
became the hospital's senior surgeon and Davies-Colley held the position of hospital When the surgeon. George's Hospital, [who]
"pioneer prominent Hospital
in 1985, after being absorbed by St closed
a ward was named after Chadburn, because she was a
during
her professional
career,
was one of the
most
Chadburn When 113 in Marie the Curie set up medicine". women in Hampstead for women suffering from cancer, it "was the only
kind"when its one of
it opened with 17 women members of staff. 114In 1901,
Walker
the East Anglian
established
Sanatorium
for the treatment
Anderson, Garrett Louisa By together 1912, with tuberculosis. Murray
(not a Harley Street practitioner),
of
Flora
had founded the Women's
These institutions in Harrow Road. Children the for were a crucial Hospital for time at a of restricted options. women training ground
Oliginofits Ward Hoqpitaland Names Uttley, StGeorgeý; the David Gould& n3 Terry (London, 1997), p. 54. by Dai&Dispatch, Women% Manchester, Feb. 5. Hospital 1930, RFHSM A run Anon, 114 183. 1, 7, p. Book part pC,
349
Type of Practice by Harley Street Women Though it was rare for the first throughout
Britain
generation of women practitioners
to become specialists, all of the first generation Harley
Street women specialised in a particular
area. 115Jane Walker, an expert in
first introduced diseases for the treatment tuberculosis, open-air pulmonary became the first female clinical assistant to the East London Hospital for Children in 1886 and six years after her appointment, she set up a small in Norfolk. for TB 116Following its treatment centre success,she established a sanatorium
Suffolk in Nayland, 1901 and became its medical at
superintendent.
Walker opened a sanatorium for poor patients in 1904 and
a children's
in Patients 1912. added usually consulted her sanatorium was
before being admitted to the sanatoriuM. 117By Street Harley her practice at 1917, approximately
300 patients, including men, women and children, were
Another her first 118 for being cared sanatoria. at generation Harley Street Ellaby, specialised in ophthalmology. Charlotte woman,
When Florence Stanley Boyd was asked by a reporter from the New in in 1890, Herald York private practice specialised in whether women in because England, this obstetrics and gynaecology
was generally
States, in United Boyd the "no". She 119 practice replied standard considered "lies their that to work although naturally among women and say on went (Suffolk, Smith Jane Walker Dr Hospital, Michael Anna andher and no date, but 115See Century), 201h p. postscript. probably ), (ed. (London, Medical Innovations in Historical Perspective, 1992), pp. Pickstone, , 16John Century, Nineteenth the the During consumption was main cause of mortality in 53. 48Britain. 11Walker, P. Smith, 117 n8.1hid., p. postscript.
Harley Street in following i. the to 1891. Boyd Mrs year, moved e. 119
350
children",
they also took general medical cases. Nevertheless, Mary
Scharlieb recalled in her Reminiscencesthat: we pioneer medical women were never able to be what is called pure physicians or pure surgeons. We had of necessity in those early days to be willing to give advice to women as to their health, whether from the medical, surgical or obstetric point of view. 120
Though Scharlieb managed to gain surgical experience in obstetrics in Madras, this was not standard practice working and gynaecology whilst because this path was unavailable to her female contemporaries practising in
Britain.
consultancy
Her
valuable
experience
in Madras
opened the
doors to
when she was appointed gynaecological surgeon at the Royal
Free in 1902, and thus became the first woman to hold a position of this kind in Britain.
Her role was crucial to the next generation of women
it "brought development in the surgical workP about a major as surgeons, NHW'. 121 the at surgery, gynaecological especially Approximately
half of the second-generation of Harley Street women
decided to concentrate their medical career in one area. The most popular by four in and gynaecology, this practised obstetrics were women specialities for "had large Chadburn, Maud in example, a and successful practice group. "women time at a gynaecology" when and surgeons usually general surgery did not separate these two specialities". 122Others such as Agnes Savill, Kate Addison, Mary Gordon and Adele De Steiger practised in the fields of
Reminiscences, 141. P. Scharlieb, 120 Doctors, 218. 'Women Elston, p. 121
May RFHSM 4,1957, PC, Book Lancet, 8, part 2, p. 247. 122Anon,
351
electro-therapeutics, respectively.
dermatology, inebriety
and the treatment
insanity of
123
Teachers and Demonstrators Most female Harley Street practitioners attended the LSMW, which "had dominated the early output of female graduates in Britain", provided them with an opportunity time
when
few positions
and had
to gain valuable teaching experience at a
were open to women in medicine. 124 Emily
Elizabeth Flemming became the school's first demonstrator of anatomy in 1892. Eight more of the cohort held lectureships at the medical school: four demonstrators were jurisprudence
lectured two on gynaecology, one in medical of anatomy,
last in the ophthalmic and
Mary Mecredy and Jane Hawthorne London Scharlieb
surgery. 125 In addition,
Emily
lecturers were and examiners for the
County Council. 126Given her previous teaching experience, Mary importance for the teaching of gaining experience stressed one's
LSMW: development the addressed new she students when at career in February 1888 1 was definitely appointed Clinical Assistant to Mrs. Garrett Anderson at the New Hospital, so now I was Lecturer to my School
New Hospital for Women the at Chadburn obstetrician senior and consultant at a 123 was for Women. Davies-Colley Hospital London South was consultant obstetrician at the the In Vaughan-Sawyer Hospital. 1908, Anderson took over from Scharlieb as Garret Elizabeth RFH. Mecredy the at obstetrician and was a consultant gynaecologist consultant Stoney in The RFH. Savill in the areas were: specialist other radiology, at gynaecologist diseases,Addison in dermatology, Gordon in the treatment of skin and electro-therapeutics State inspector Certified (she the became Inebriate of and assistant inebriates (at insanity in Essex Steiger Co. Asylum). De Adele the treatment Ellaby of Reformatories), information NHW. No the for the at was available ophthalmologist six of consultant was cohort. General Practice, (Oxford, Evolution The Z850-1948, Digby, 1999), p. Anne ofRdtlsh 124 158. Sketch Foundat; Thorne, fMeXc1nef0. the School Isabel and oltb-LOndOn on Mrs 0. r 125 Women (1,ondon, 1915), p. 37. in 1912. Mecredy appointed was 126
352
Officer Hospital, the two objects of ambition with every junior at an and practitioner. 127
Scharlieb became the first woman to lecture in medical jurisprudence build impressive demonstrator LSMW to the an on went and career as a at In lecturer in 1889, in 128 lecturer the she was appointed as gynaecology. and
diseases of women and soon after took up the chair of Midwifery. Ethel Vaughan succeeded Scharlieb in the chair of gynaecology in 1910 and later lectured in gynaecology at the University
London. 129 of
Professional Advancement: Membership of Medical Societies The majority
Street Harley women attended one or all of the following of
(hereafter Registered Medical Women Association the of referred societies: its The Medical Women's Federation Association) successor, the and to as (MWF), Medicine.
the British
Medical Association
(BMA) and the Royal Society of
The Association and the MWF had the greatest affiliation
MWF hitherto The female consolidated a cohort. the
from
loosely related set of
Medical Women's Association was the of which local medical associations, in began 1879 the Elizabeth first This under supervision of association one. Blackwell
Anderson. Garrett The Elizabeth association aimed to protect and
female medical practitioners. interests the of and promote
Meetings were
Medical Institute, Tuesday the first every month at of the held on Hospital
New
for Women on the Euston Road, "for the shewing of cases and
146. Reminiscences, P. Scharlieb, 227 demonstrator Scharlieb 147-167, appointed of practical gynaecologyto the was 128jbid, pp. Queenýs Jubilee lecturer in By the 1888. in to 1888, nurses on physiology Hospital New for Civil Service. to the candidates women examiner 1902, she was an in Royal been had Free Hospital the from tutor 1902gynaecology at a Vaughan-Sawyer 129 08.
353
discussion the the of reading papers, of medical subjects, and of specimens, interests '. See touching the 130 that may arise, of women! matters other Tables 7.5 and 7.6, Appendix F.
Elizabeth Garrett Anderson was the first medical woman to be Counties Metropolitan Branch BMA in the the of elected as a member of 1873, a year beforethe associationwas incorporated.Sincethe BMA had not in their to the membership articles, was open anyone on women excluded Medical Register. The majority of male practitioners, however, opposedthe Garrett Anderson When became first the woman addition of women. President of the BNWs East Anglian branch in 1897,counselwas consulted legally become Though 131 determine could a member. she to whether eligible for membership after the society was incorporated in 1874, a resolution was This decision by Bath the that women. was supported exclude would passed it in 1878 the and branch of was not until 1892 that the Nottingham society branch removed this barrier and women were then free to join the BMA. By 1914, the list of members of the Association of Registered Medical
being 225, the catchment area predominately London. By Women exceeded Membership 1,200.132 had to list of the organisation was expanded 1929, the United Kingdom. the medical practitioners women of to all registered open in for 1917 to form The Medical independent merged women Ten societies founded by Harley two Street women, Jane Federation, was Women's which
Wellcome, MWF/ C. MWF the 7L. the at of 'Constitution' archives 130 Federatiore, 91-94. WomeWs Wedical pp. Hall, 13, Association 'List Members the the Registered Medical 'Constitution' of and of of 132Anon, MWF/ Of C. Wellcome, 7L. in the total, the 1913-14,14 were listed the at Women', archives Harley Street. in as practising
354
Walker and Eleanor Davies-Colley. Walker was also its first President (1917-1920) and later she held the posts of honorary treasurer and honorary "it in large due Dr. Lancet The 133 that to was measure reported secretary.
Walker that the Federation emerged, and has expanded on such sound lines". 134In 1919, this organisation became affiliated with The American Medical
Women's Association, established in 1916, to form the first Women's Medical Association. The aim of the society was "to
International
between [a] to all medical women, promote communication of means provide further friendship interest to and understanding and their general
between
the medical women of the world". 135 The amalgamation of these separate national medical societies gave it some political
Sturge D. Dr Mary affirmed power.
that the Federation
by justice" for lever "a promoting obtaining as operated
equal pay in the
Medical Women's Federation The the 136 to: of aim was sector. public (1) safeguard and promote the professional interests of medical women. (2) To enable them to speak as a body and so to exert a greater influence on health in in those to such as matters, administration, regard public policy 137 directly they concerned. are which
The Federation's focus was predominately,
on the rights
and
They issues the addressed women. medical representation of on professional Act, Insurance The dealt Ministry the that with of Health, BMA committees Maternity
and
Child
Welfare,
and
they
participated
in
various
Anon, Nov. 26,1938, 1120 BW BMJ, Oct. 22,1932. Walker, 'Jane p. and 133Anon, Nov. 26,1938, 1259-61. Lancet, Walker, 'Jane pp. 134Anon, International Association', Women! Medical Journal oft ,be M-WF, 'The Aitken, s 136janet jubilee, 1917-1967,p. 79. Federation-its Womerýs Work Aims', The Medical MWP, Sturge, D. Mary and 136Dr. Dec. 17-25. 1921, pp. Quart,orlyNews-Letter, Vol. 1925, 412. Directory, p. IVMedical. 355
Parliamentary sub-Committees.138The Federation discussed various topics including nutrition, venereal disease, penal reform and lunacy. By the time Walker died on 17th November 1938, the Federation had campaigned female GMC. for 139 to the representative a successfully Following the formation of the Royal Society of Medicine, London in 1907, women were admitted as members of the sections of the society only, but not as Fellows. Although Mary Scharlieb was a member of the Council Gynaecological Section from Obstetrics 1907, the and she was not of permitted
to participate
in the election of officers or in the running
of the
Society Anaesthetists, the Other as of societies, such encouraged society. female
to they the proposed amalgamation only agree would members:
if Fellows. RSM 140 Five later, the admitted women were as years of scheme
to the the rules relating exclusion of women as the of abrogation with Fellows, Jane Walker was elected as the first female Fellow at the RSM. 141 Council first to the the sit on She was also woman of the RSM, a Position
Nine women in Harley Street who subscribed to from 1917-1929.142 held she Although Medfca]Directo-rY Fellows. the became 48% RSM records only the (n = 11) of the group being members of the RSM, at least 58% (n = 14), of the
Committee Insurance the Sickness approved appointment of women to their The 138 See Wellcome, letter from in BMA, 1912. Feb. the 3.1912, MWF early advisory committee (1), C. 77. IV archives, section GMC: for 'Women the the Scott, M. Jean struggle representation, Journal ofthe and 139See No. Mar. Lesley Vol. 1988, A. 1, 164 Hall, '80 81, societ pp. and ofMedicine, J70 a] -166 .y .V, MeaYeal Woman, Vol. 16, no. 2, Summer 1997, Women7s Federation, Medical the years of pp. 6-9. (London, Society 19 14), 144. Royal The ofMedicihe, p. i4o Anon, (Iondon, Society Roval The 1955), & Davidson, 41 M. 56. ofMe&cihe, See pp. 141 48. Walker, p. Smith, 142
356
details Medical their to to the of membership return not women chose Directory.
The majority of Harley Street women, including Walker, Boyd, Stoney, Chadburn SocietieS.
143
Savill, were active participators and
in
medical
Boyd and Thorne were both Presidents of the Association
of
Registered Women and three of the cohort were Vice-Presidents. Stoney was branch Wessex British Institute President the the founder of of of and a Radiology. Thus, the majority of Harley Street women held a senior position
thus the medical associations, confirming and well-known respected within the cohort's prominence within the profession.
Professional Advancement: Publications Publication
important was an
form of self-promotion
within
the medical
for it Just their female the was as male counterparts. cohort, over career of had in their female work published a scientific journal or half of the cohort (n Several book. these 8) in of women = published medical reference Journal British Inehriety, the Journal journals, of as such of specialist Mental
Science or Journal of Physiology. Others, including Scharlieb,
Association lectures the Registered papers read scientific at and of Scharlieb gave 143 often Obstetric Society the of Women; member active an and the Royal Medical she was also Nov. Stoney 29,1930, 1212. Lancet, in Anon, Medicine, p. read a paper on goitre Society of President founder Wessex Branch the She BMA. and of a also of the was 1912 at the Stoney, Obituary 'Ada Archives Radiology. Royal Free. the notices, Institute of of British Association Registered Treasurer the Women Vice-President of of and and Boyd was Anon, See The Daily Telegraph, Medicine. Oct, Society 28 1910, Royal the of Secretary of President MWF Chadburn the Anon, 27. BMJ, 4 May 1926-7. Book 4, of PC, was p. RFHSM Vice-President Savill 247. 2, Book 8, the PC, p. was of electro. part RFHSM 1957, Medicine. Dr Violet Society Kelynack Royal in the of of who resided therapeutic section British the Medical for Federation 20 did but of was secretary Street not practice Harley Medical Womaný;Journal, 47, Nov. 1040, pp. 341-342. The cohort also Anon, years, Society, Fellow from Pathological the Association of Surgeons Fellow the one of included a Britain. Great of
357
Garrett Anderson, Boyd, Thorne, Stoney and Savill contributed articles to the BMJor the Lancet. The most prolific of the group, Mary Scharlieb, was issues arising out of nineteenth century debates on racial concerned with degeneration and social purity. She also sat on the Royal Commission on Venereal Diseases (1913-16). An advocate of state support for women who books healthy published she several children, and pamphlets on produced importance in improving the the the next of mother's role and eugenics, generation;
this material was specifically aimed at women. In The Welfare
Scharlieb heredity Mother, that Expectant stressed the and environment of human determine destiny: factors, two the which were the father's share in the endowment of his child must not be minimised nor hopeful field but for both individual the most probably and overlooked; is the the and care cultivation of expectant mother. 144 endeavour national
Most of her published work dealt with similar issues.145Apart from Scharlieb, other women including Walker, Gordon and Savill, published interests 146Walker's were wide ranging and this was books. professional from her in tuberculosis, writings; apart and speeches she was also reflected
diseases the and children, of women education of mothers, concerned with infant
mortality,
improvement
the
housing
problem,
nutrition,
and
the
general
in the country. 147Savill also conditions end economic of social
from to in the eczema subjects medical of use of electricity wrote on an array
(London, Expectant Mother, Welfare The the 1919), 1-2. Scharlieb, of Mary pp. 144 in Appendix listed E. She are also contributed articles to Scharlieb's publications other 145 Queen magazine. Lancet and the had been in Appendix She E. Inspector are an Gordon's publications of Prisons for 146 thirteen years. Lancet, Walker, 1259-61. Jane pp. Anon, 147
358
14" For some women, such as Mary the treatment of women's diseases. Chadburn, publication was not necessarily considered a prerequisite to distinction her Despite success.
as a surgeon, "she was not a public figure,
did not publish reports of and she
herWorle'.
149
Social Life and Interests Consideration Evidence majority
female to the cohort's membership of social clubs. was given
of membership
was not always easy to ascertain
because the
list Few did 150 their the club membership. of women not of women
had entries in the DNB or noýg Wbo where social interests might have for be this: the most There a number of been obtained. reasons may important
it for Victorian that was uncommon a was perhaps
woman to
According to the economic and social club. become a member of a social
historian, Peter Clark: female activity, though increasing by the 1780s, was always marginal; indeed, as we have argued, the absence of women was one of the essential, features of British clubs and societies in their formative defining almost Victorian era, despite their growing role in fundinto Even the period. had a secondary for associations, women subscription public raising 1151 position.
For the cohort, membership of medical societies was the more usual female In Victorian England, their interaction peers. early with method of from conventionally were excluded women class social upper and middle
in Appendix E. are 148Savill's publications May 4,1957, 939. Lance4 Chadburn, p. 'Mary 149Anon, Savill listed her Agnes Forbes membership of 150There were a couple of exceptions: No. Stoney Noý in Lyceum. Some the was member a of clubs 'Sesamcý under social Garrett Louisa Anderson became groups or parties. of political their membership recorded Vice-President becoming United Suffragists in the of movement, in the suffrage active Labour Mary Chadburn the Walker party and an member of active a was 1914. Jane Franchise. Women's International the member of Societies Ozýins Cluhs 1580-1800. 'tbe Associated Blitish World Clark, ofan and Peter 151 (oxford, 2000), p. 483.
359
did First World War. 152 this the change not until after situation clubs and However, these women found acceptable forms of social interaction through 153 services. community charity and
Harley Street women were able to entertain at home since their houses were large and the reception rooms lent themselves to the necessary art of entertaining.
Indeed having guests for drinks or dinner was regarded
integral for both important "an the part of consulting and practice" as, female and male cohort.154The women who enjoyed this form of social intercourse included Dr Jane Walker, a committed Labour supporter whose Street legendary in in Harley London intellectual house her was salon at society.
Her guests included
1929), the Labour family
Prime
Walker's Dr. were
the suffragette,
Minister, patients,
of Canterbury
Fawcett
(1847-
(1866-1937),
whose
Dame Millicent
Ramsey MacDonald and William
Temple
(1881-1944)
in 1942.155 Those who knew
became
Archbishop
referred
Her Jane". "Lady her educated to as
pastimes
encompassed
who
her well a keen
interest in literature, classical music and the collection of works of art. 156 In common with many of the upper class, Mary Scharlieb's interest
She travel. foreign in also admitted to two social aspirations: "to be Jay
Clark R. Houston, P. 'Culture Leisure'in 198-201. Peter 130-131 and and and 1521hid, pp. (Cambridge, Vol HistOTY Urhan 11,1540-1840, Cambridge ), (ed. The Of171*8in, Clark, 2000),P. 588Work Communityfor Women-* Single Women, Independent 1850Vicinus, and 153Martha 192o,(London,1985). (London, is4R. Street, 1954), Goodbye Harley to Stevenson, p. 3. 9cott Prime Ramsay Macdonald Minister from Walker, Jan-Nov 1924 poscript, p. was Smith, ir.5 1929-1935. between and again Lancet, Nov. Walker, 26,1938, 1259-1260. 'Jane pp. Anon, i5s
360
diamond "157 Court her When to a possess necklace. and wishes at presented Scharlieb that acknowledged realised, were
she now had her "two
Louisa Garrett Anderson Davies-Colley Eleanor 158 and also vanities". for foreign travel and gardening, which was also a popular pastime enjoyed Vaughan-Sawyer Ethel the in the was very antithesis perhaps group. others Street for described Harley the consultant she was as quintessential of "'unfashionably dressed". Nor did she fit the stereotype of the middle class Victorian
her by her of stories was considered range some of woman, as
"often been have to unsuited guests
to a drawing-room".
159
Many members of the group such as May Thorne were described as good conversationalists
or good speakers. 160Thorne, who was described as
develop her broadcasting to on skills on the radio "devoid of arrogance" went Nightingale's Florence knowledge her of based on Nightingale's
life and work. Thorne was
doctor during her last few years and typical
of the group
for genteel hobbies. She worked tirelessly to little her time left whose work for the Patients funds raise
and Friends League, which she founded in
Thorne's interests As were with other medical middle-class women, 1902.161 practical
rather
than the more genteel pursuits
of "walking,
sewing and
1211-1212. Lance4 'Scharlieb', pp. 157Anon, 1581bid Book PC, RFHSM 5, 183-185. Vaughan-Sawyer, 'Ethel pp. 259Anon, did Walker, Dr Jane ]bid., Vaughan-Sawyer, Ethel a considerableamount 160For example, Federation Women's BMA. Thorne the the and at and especially speaking public of Thorne May Thorne, 'Then Now', The described and see as good speakers, Scharliebwere Dec. Vol. X111, 128-129 Dame Scharlieb, No. 34, 1951, Mary The and pp. AfBgazine H. F. j?. (London, date), 45-46. Woman no pp. bejor andherProhlems Bac, funds for Free Hospital hospital. Royal to the the raise League up at set was 16,The
361
knitting". 162In general, the interests and pastimes of these women could be in that interest had little they would activities regarded as unpretentious; have supported Victorian ideals of femirdne'refinement.
These women, some
of whom were formidable, focused on their professional interests as medical practitioners, Marriage
and they were not confined by Victorian conventions.
Bachelor Girl Motherhood or and
In 1870, the BMJ claimed that women's entry into medicine would lead to in celibacy for both sexes. They reasoned that the increase an competition from
female practitioners
would result
in fewer patients
for their
male
Men would, therefore, earn less and could not afford to marry; colleagues. consequently,
there would be more single women who would need financial
derisorily BMJalso somewhat The that: claimed support. it, unless she be take is therefore, as we lady-doctor the consequently an She betrays her to traitress their sex. a celibacy, of real interests advocate for longing the will-o'-the-wisp her to own eccentric Pleasures of independence. 163
in Medical Woman The ýg JOU-Mal 1936, late article an Even as as suggested
"superior" intellect had a should pursue a career in that only women who husband have family. to The study of if they a and wished also medicine, "average" intelligence for of with a maternal woman a yearning, medicine Hulda Therlander maintained, would be pointless as, "she will marry and hobby". it 164 family, as a have a and either give up medicine entirely or use The first generation of qualified women medical practitioners who also
lives of interests For social 645. the ý no, and MeScal no 1925, The Thorne, p. 162'May WOMOP, KctoliBn Joan Perkins, Pfissimmiddle-class women see, 163Anon, 'lady doctor, BMJ, April 2,1870, pp. 338-339. V01. Journal, Ir I" Hulda E. Therlander, Vomen for Internships', The Medical Woman XLIII, Dec, 1936, Number 12, pp. 324-326.
362
embraced motherhood, such as Elizabeth Garrett Anderson, Isobel Thorne, Scharlieb, Mary and were not only highly intelligent, but they also managed juggle to their domestic and professional duties. successfully In her book, Straight Talks to Women, Mary Scharlieb extolled the She offered an alternative to those who could not or virtues of motherhood. did not wish to become a biological mother; she suggested that they could instincts deeds. Thus, through to their charitable mothering opt nurture Scharlieb believed that: motherhood is the very crown and perfection of a woman's nature and until the motherly instinct is awakened, whether by the fact of natural influences, her by character and faculties fall short spiritual motherhood or 165 ideal their possible perfection. and of She later
could
a woman
which
in
profession Furthermore, atrophying associated
which
of the
Thorne
Isabel as
career
in medicine During
of these
their
became
practice
women
mothers.
instincts,
risk
of
of a woman's
and procreation,
which
167 For
and
and
Scharlieb
Elizabeth
in Harley
Garrett
compatible. Street,
In addition,
a fitting
"well-suite&'
the
parts
was
motherly
were
that
were perfectly time
of medicine
her
satisfy
unused
marriage
with
the
thought
she
intellectualization".
"over
such
that
argued
Mary
mind could several
Anderson,
it
and
was
also
"Successful".
and
remaining
single body
and
was
lead to a tendency of the other motherhood
a 166 an
normally to
women, and
168
nine
of the cohort
Chadburn,
married
although
and six
unmarried,
(Undon, Straight Women 1923), p. 3 Talks Scharlieb, to Mary 165 i66.1bid, pp. 34-35. 167Scharlieb, Bacbelor Woman, pp. 45-46. 1869-1874, she 168When Isabel Thorne studied medicine in the University of Edinburgh brought her four children aged from 14 months to 10 years of age with her. See May Now', The R. F. H. Magazine No. 34, Dec. 195 1, Vol. XIII, pp. 128 'Then and Thorne, -130.
363
in
occupation
a
in 169Two the Harley Street three the of women children. second adopted May Anderson Thorne, Garrett As Louisa and remained single. generation, May Thorne reflected when discussing her mother's family of four children, 64manywomen might have thought this family [was] a considerable handicap to
beginning
Not an arduous education.
brave so my mothee'. 170
Nevertheless, some of these women relinquished their practices when they Ann Piercy Evans Kelynack in Harley Violet and gave up practice married. Street when they married. Katherine Street practitioner,
Chamberlain
who married the Harley
Nathaniel Bishop Harman, discontinued her practice at
the start of the war. Victorian society expected married women to cease working
fulfil their obligations as wife and eventually and
who continued
their careers after marriage
were unusual.
mother; women Those women
forced in from to the their were sector, public resign worked post on who marriage
in Walker Y01*S-ýiJe Evening to the Post in argue caused which
1938 that: "many women will prefer to give up their posts on marriage: but
be freedom they land in this should allowed to make this decision of
themselves".171 The Great War The onslaught of the war engendered new opportunities for women medical Walker that the for war represented realised a unique chance practitioners. demand increased for doctors the Two to on capitalise and surgeons. women War Office began, the female the called war on medical years after Chadburn', Lancet, 'Mary p. 939. Anon, 169 Now, 130. 'Then Thorne, p. and 170 PC, Evening Nov. RFHSM News, Book 17,1938, Yorkshire 8, Anon, part 1, p. 108. 171
364
practitioners
to join the medical corps. They did not, however, enjoy the
same privileges
as their male colleagues and were not entitled to the same
basic pay, they did not receive the billeting or the ration allowance, nor did they receive the reduced rate of income tax given to the men. Unlike their female did medical practitioners not travel as "officers", male counterparts, but as "soldiers wives". The Women's Federation was inundated with from women on this iniquity. 172 Whilst
complaints unsuccessful powerful
in changing the situation
the Federation
was
for medical women, they were a
lobby group and managed to have their grievances brought to the
table in the House of Commons.173 The Harley Street women who participated leading territory;
Lilian roles:
in the war effort took on
Chesney ran a hospital at Dobrudja,
Agnes Savill became chief of the electro-therapeutic
in the Serbian department
in
Hospital Royaumont, Women's France Scottish at the and Louisa Garrett Anderson was not only appointed chief surgeon at the Military Endell Street, London, but she and Flora Murray run a military
Hospital in
were the first women to
hospital in Britain. 174Lord Knutsford later remarked, "these
had impossible": done they the have themselves established on the women had in been that 175 to terms previously an area men as closed women. same Murray Anderson 1912, In established the Harrow Road Hospital for and
in Army, Women The Hmes, July 4,1918, RFHSM PC, Book Medical the Walker, Jane 172 5, p. 121. Federation', 'Women's Sturge, pp. 17-25. 173 (IA)ndon, Surgeons, Army Women 1920), pp. vii-viii. Stoney was head Murray, Flora as 174 hospital by British doctors in and radiologist run staff at a military the women medical of 'Stoney', Lee, 1914. in Antwerp Wellcome, 41, Archives RMFQuarter/yRmiew, B. M. L. p. 275 of the MWF, SA/MWF/B. 2/ 12-13, Box 14.
365
Stoney, Florence who was also involved in the war women and children. female her from 1914 the the along with awarded corps, star was effort, Admiralty for their work in their military hospital in Antwerp. 176 Conclusion The first women to arrive in Harley Street were a distinguished group of medical practitioners. in medicine
in Britain
doctors" attending
They were exceptional amongst women who qualified during
the period. 177At a meeting of 200 lady Congress of Medicine in 1913, Walker
the International
"a Harley-street in described the press as was
physician who is one of the
best-known of British lady doctors".178Scharlieb, Chadburn and DaviesColley were similarly
in known the profession and all of the cohort well to break into the elite male enclave
determination the necessary possessed Harley of intellectually
Street
at a time
when
women
were
generally
considered
inferior to men and were marginalized by society. 179
The majority of the cohort succeeded in building a large and lucrative
for Chadburn, concentrated who on example, general surgery and practice. large nursing homes for her private practice". 180In "ran two gynaecology,
in Profession Medical 1905, M. Foster Reaney realised the his exposition on
that: (Royfil London Magazine The Free the Hospital) &. bool Stoney, of ofMedicine 176'Florence for Women,November 1932. Doctors Patients in English L4ing, Market Medfcal for the Making and Digby, a 177 (Cambridge, In 1994), 294. 1720-1911, p. an examination of the first posts held by Med(cine, Digby in 6% 1902-04 that female calculated only graduates, were private Edinburgh practice.
PC, Book RFHSM 4. Aug. 111913, DaffySketcb, Anon, 178 (ed. June ), Purvis, 'Women Education'In Womený?History-'Biiiain, McDermid, and Jane 179 (London, 1995), 107-130. pp. 1850-1945 Lancet; 939. 'Chadburn, p. Anon, iso 366
it is only the few [women] who enter private practice; and these as far as one can see, obtain[ed] a fair share of success.Here, again, they have to be proof against the prejudices of the public, not always expressed silently; and unless they be enthusiasts they will soon return to easier paths. 181
Digby argued that women "needed considerable determination to female GP. 182Theprerequisites enter general practice single-handedly as a to putting
in Street involved Harley brass also a considerable plate up one's
fortitude. As Sunday degree Chronicle the of a and money pointed amount of had in Anderson "fashionable Garrett Louisa the in 1908, set up practice out (Italics Harley Street" doctor-dom London 183 of mine). expensive and Scharlieb gave the matter serious consideration before putting up her brass
be "the but Street, in the the relatively enormous, expense would as plate to 184 The outweigh economical considerations". seemed gain professional income from Scharlieb's first six months of practice amounted to 1200, had just become particularly as amount, she only considerable a was which established. practitioner
Digby's estimate, that
the gross income for a medical
in the first year of practice was 2150 - 2400 per annum, places
On 185 the the recommendation of the Scharlieb at scale. upper end of Elizabeth Garrett Anderson, Scharlieb charged her patients a guinea for few years. By 1902, she had established a large her first during consultation it flourished, fee the to two as and she practice raised successful and Pra(ession: TheCarmiabaellwze The Medical Essay for 1904, Reaney, Foster i8iM. (Dublin, 1905), p. 104. 182DigbY, General Prac&O, P. 166RFHSM PC, Book ChrOnicle, 20. 1908, 4, Sunday Anon, p. 183 No data 129. Reminiscences, Scharlieb, was available for the lease or premium paid P. 194 Harley Street Walker When Jane four years later she paid in to 1888. Scharlieb moved by The lease. for the premium was an additional 2300. In 1914, the rent was g8o p. a. increased to 9,100 p. a. and the premium to 9400. 'The book of terms', archives of the Estate. Rent Walden de and premiums varied considerably depending on the terms 11oward lease. the of LAing, Medica! Digby, p. 143. 185
367
fee by her in the charged standard was male colleagues guineas, which Harley Street. 186 There are various measures of eminence, and the conferral of an Three Harley Street indicator. is honour women were one award or during Great for honours the their and courage medical skill rewarded with War: Thorne and Stoney received OBEs and Garrett Anderson the CBE. 187 Scharlieb received an honorary LLD from the University of Edinburgh and Dame British in CBE 1917 the created and was a of was appointed
Empire
in 1926. Six years earlier she had been appointed one of the first female Juvenile the of
magistrates
Court. 188Walker
Companion the given was
of
Honour in 1931 in recognition of her "pioneer work! ' on tuberculosis and the University
her honorary LLD. Leeds 189Chadburn was with an presented of
appointed advancement
CBE
in
1934 for
her
indefatigable
for Not Harley women. all of medicine
commitment
to
the
Street women were
Gordon, Ellaby, Davies-Colley, Flemming and but as such decorated, others Vaughan-Sawyer
high reputation achieved a
amongst their peers in the
Geyer-Kordesch Johanna that: argued medical profession. degrees, domestic ideology was handful their first won the women of when dented beyond repair. This ideological impact, rather than their small historical 190 them significance. undeniable gives number,
185-186. 144-165 and is6.1bid, pp. CBE in May the 1917. Anderson Thorne Garrett awarded was Louisa was sent to Malta 187 OBE following Stoney RAMC the the the and awarded war. was awarded with surgeon a as OBE, Cambridge her DMRE Honoris for Cousa the Star the also conferred on 1914 and the her work. 206. Reminiscences, p. Scharlieb, 188 6. Valker', p. Dawkins, 189 Medicine', Women Vomen Geyer-Kordesch, in W. F. Medicine, and and Johanna 190 (eds.) Companion Enc:rclopedia of the History Porter, Roy Bynum and ofMedlclne, Vol. 2, (London, 1977), p. 895.
368
Whilst distinguished,
some
Harley
predominantly
Street
women
were
not
particularly
those who arrived in the Street around 1914,
Alstrom, Hedda Addison Kate and such as
the majority
(including
Mary
Florence Boyd, Jane Walker, Maud Chadburn, Ethel Vaughan-
Scharlieb,
Sawyer, Eleanor Davies-Colley, Charlotte Ellaby, Ada Stoney, May Thorne, Louisa
Garrett
advancement
Anderson)
made
a
of women's opportunities
significant
contribution
to
the
in medicine. Some such as Davies-
Colley, Chadburn, Louisa Garrett Anderson and Walker founded and ran hospitals and created new positions in medicine for other women medical had Thorne Thorne Chadburn them; wards named after and practitioners. for Royal Free Chadburn the fund her for and and support raising at St George's Hospital because of her surgical work. 191Through their personal including the cohort successes, several of
Scharlieb,
Ellaby
and Gordon,
future for generations of women medical practitioners they way paved hitherto had to which being elected Posts,
by
been the preserve of their male
down breaking by in the male prejudices existing and medical colleagues, profession.
Moreover, many of their medical colleagues described Stoney,
Chadburn,
Scharlieb, Walker and Davies-Colley as "pioneers" in their areas
of expertise. Others in the group, for example, Vaughan-Sawyer,
Flemming,
Boyd
high Scharlieb through of academic their standard excellence, a set and and distinguished
careers and their academic accolades they were an asset to
BMJ, Nov. RFHSM PC, 3,1951, Thorne', Book %lay Uttley, S. 8, Gould C. 1. D. part 191 and St George's, p. 54.
369
the women's movement and an inspiration
to the next generation of women
In common with their male counterparts, the Harley medical students. Street women were part of the elite and their role in the history of medicine lives Without their their and careers. of a study recognition of validates Street be incomplete. Harley history would of presence, any
370
restricted access
CHAPTER 8 Conclusion Throughout the course of the twentieth century, there has been a pervasive formed 61ite Street Harley that practitioners an corps among medical view long Despite Great Britain. in has this there established view, practitioners been no attempt systematically to examine this belief. Even though its importance as a medical locality has long been recognised, historians of little development have to the Harley consideration very given of medicine Street as a medical area. This thesis has, therefore, attempted to correct Comparisons literature. historical in the lacuna were made with two this individuals qualified other groups of medically
in London, those who
Area and those in Greater London for the Street Harley in the practiced 1845,1880 years
further 1914, to and
corroborate the professional
Street. in Harley those accomplishments of For historians, a prosopographical analysis is most suitable for an data is historical likely be for 'elites, to this more as available of examination less for In those socially or were professionally than who prominent. group have historical to for about an such entity any generalisations order information veracity,
must relate to the majority of individuals
being
data were available only for 10 or 15 per cent of the cohort, this If studied. biased thus unrepresentative of the become sample and random a would Hence, in form that only sources are complete regular and group as a whole. be Other the large group can used. material can, for a proportion of
373
however, be used to complement and enhance the findings from the data analysis. The results of the prosopographical
investigation
of all registered
medical practitioners who arrived in Harley Street between 1845 and 1914 overwhelming historical
provided
not only achieved unparalleled
practitioners community, group's
collective editorial authority
main
their
many
academic
in their role as editors of a wide
hospital reports, manuals and dictionaries,
that many in Harley Street greatly contributed
medical
pre-eminence in the medical
by was assessed examining
journals, medical range of
at the end of the nineteenth
specialities,
these
it found that they not only wielded achievements; and was
qualifications
medicine
evidence that
but also were unsurpassed in their professional standing. The
reputation
considerable
and empirical
to the professionalisation
century by creating
medical
journals
renowned public lectures, publishing
and generally
disseminating
their
of
new medical
establishing new specialist hospitals, taking prominent
delivering societies,
but
roles in in the
new found
knowledge and technical skills. Indeed, over half of these men were medical had interest in a or special one or more subject. Thus, or surgical specialists
by the first quarter of the twentieth century, Harley Street was regarded as for medical specialism. a centre This thesis has demonstrated that the Harley Street group followed a The trajectory. majority of these men pursued the well-defined career highest qualifications attainable,
thereafter
started their career path by
in the more eminent and well established teaching training their taking up 374
hospitals. Most were also keen to further their careers by publishing a body of work, taking on the role of editor of wellsubstantial collective established
journals,
notably
the
BMJ,
creating
dictionaries
or
journals. Many were and establishing of medicine new encyclopaedias in hospitals in securing coveted posts whilst setting up their own successful private practices. By the time they arrived qualified kudos
in Harley
Street, they were eminently
men who possessed a wealth of experience and the indispensable that
established
inhabit to them enabled they used this opportunity
such a privileged
address. Once
to create new specialists hospitals
disciplines. Whilst there were other exceptional medical and new specialised medical practitioners
in other areas of London who followed similar career
indisputably, Street Harley the were, group paths,
an identifiable
body of
by the not only recognised medical profession but also by excellence, medical for flocked to them medical advice and treatment. the public who
This thesis has also shown that Harley Street became a progressively for fashionable medical practitioners wishing to establish a choice more By Harley Street 1860s, London. in the holy the was regarded as practice grail
of the medical world, attracting
some of the finest
medical
London Victorian live in life to in who aspired the a ensconced practitioners highest echelons of society. Such was the cachet of a Harley Street address in Harley Street Area the having a practice was not good enough: that even from the these of moved than cohort one-third one of perpendicular more
375
Harley Street itself. This to streets address represented the and parallel for trajectory their virtually the entire cohort. career pinnacle of Whilst to some critics, Harley Street medical practitioners were "distinguished having inhabiting "grand addressý', a arrived at a as regarded destination! ' and offering talismanic medical cures to their patients, to other opponents
they incurred
moral opprobrium
for their
insensitivities alleged with greed and vanities along patients.
ostensible
avarice,
to the needs of their
In spite of these often misguided perceptions, Harley Street was
by the medical profession as a centre of professional and patients recognised demonstrated has thesis this amply excellence:
that such excellence was
warranted. From the extant information
on social background, it was found that
from backgrounds these came middle class men and many whilst many of families, they, from their nevertheless, earned medical qualifications came had For those who already their relatives practising on the own merits. on Street, which gave some of the cohort an advantage in setting up their did from them this Street not preclude Harley gaining the requisite practice, hard-earned accomplishments and merits before arriving on the Street. In Critchett Anderson became fact, some sons, such as more prominent than their fathers. The vast majority, almost 9 out of every 10 Harley Street medical FRCP, MD, MB, FRCS MRCP or held a qualified were or practitioners, fellowships; degrees thus, they and medical a of were amongst combination
376
the most highly qualified medical practitioners in England. Additionally, 24 Street Harley the cohort were elected FRS, which was a considerable of number
because only 151 FRSs from
1845 to
1914 had medical
in Harley Moreover, Street 1914, qualifications. men received ten times during their graduate years than more prizes, scholarships and awards in Harley Street the Area or in Greater either practitioners medical other London. By using
Rivington's
definition
of "pure
physicians"
and "pure
surgeons",
39 per cent of Harley Street men would be defined as "pure
physicians"
"pure 37 cent as surgeons". To this end, Harley Street per and
the 61ite. be Almost half of all medical of a nucleus and as surgical seen may the medical practitioners
registered in Harley Street in 1914 were Fellows
Physicians Surgeons Colleges Royal or the of whilst of
the percentage of
Fellows in the Harley Street Area was 17 per cent. However, the number of Fellows in Greater London in 1914 was dramatically less than one per cent. The difference is significant:
lower; amounting
to
it confirms that up to
Harley Street Great War, the was the preferred address for elite the onset of medical practitioners
in London. Their academic success was reflected in
their hospital appointments consulting
as three quarters of Harley Street men held a
in a teaching or a general hospital and more or senior staff post
had half multiple posts, whereas two thirds in the Harley Street Area than in Greater London held ten such posts. per cent and only
Though Digby's analysis of GPs across Britain revealed that up to 5o 90 members medical societies, of almost were per cent of Harley cent per 377
Street men were members of at least one medical society. Harley Street had London hub the since was advantage, of medical a clear geographical Street its Harley Whilst Digby in the was at centre. and and period societies Loudon showed that up to 50 per cent of GPs and physicians published least 85 Street Harley were more prolific since at per practitioners material, Harley Street The their percentage of practitioners work. cent published during before in Harley Street MD their time their had or and received who in Digby's than three times than had greater more was published who had MDs, 93 per cent published some Street Harley Of the group who study. aspect of their work. This thesis has also demonstrated that women in Harley Street not but to their had they male neighbours, aspirations also only shared similar similar Harley
be to the the wanted no more at women north end of concerns: Street
professionally
than
the
men
and socially
did.
These
ambitious,
determined
coveted highly
women
desirable
built large for lucrative their work, and posts, sought recognition and removed
a number
of professional
barriers.
Many
medical practices
were active in
in held Posts a number senior of prominent and societies medical associations.
were
Moreover, these women regarded entertaining
medical
at home as
did their the as male to consultant, counterparts. a of role essential
by being the male medical community Concerns about marginalized first the Walker, Jane of generation a member of women when surfaced it the case that some women medical often was doctors, acknowledged lived solitary lives in the provinces, as they were outnumbered practitioners 378
by a ratio of 20 to 1. However, since Harley
Street had a
geographical
London, had in being the of women centre greater opportunities advantage, for socialising
and professional
interaction
their
with
did Not they receive more referrals only colleagues. medical practitioners
women
in the provinces,
to other doctors than
but they also had more
to attend meetings at organisations
opportunities
female male and
and clubs, which were
female to members. open Approximately before arriving
80 per cent of the female cohort were in practice
in Harley Street. The move to Harley Street from another
the upward career usual progression, as was represented address practice the practitioners. medical male with seen
The majority of women stayed an
Street, during in Harley built time they 19 their which years up of average these 38 of retired cent per and practices,
private address.
For
represented
thirds
two
of the
clinical
their
time
in
Harley
Street
increasing advancement in their profession. Mary Ann Elston
"minute that only a showed medical
cohort,
at their Harley Street
practitioners assistant
number"
in Britain
or resident
of the first
generation
of women
managed to procure appointments
medical officer, the majority
as a
of the Harley
Street female cohort managed to take up such appointments.
A number of Harley Street women played key roles in significantly for through the women the creation opportunities of new advancing for first female it the Though generation rare of was medical hospitals. become first Britain the to specialists, all of generation across practitioners in Approximately half Street a particular area. women specialised Harley of 379
Street Harley decided the to concentrate of women of second-generation their medical career in one area and the majority of these women were in Just half female the societies. medical over of participants cohort active had their work published in a scientific journal or medical reference books. Several of these women published in specialist journals. Thus it may be seen that the first women to arrive in Harley Street were a distinguished group of medical practitioners. If the task of the historian is to humanise history by providing details of the lives of the many people who played a pivotal role in shaping historical
events,
prosopographical
without
analysis
historical and
empirical
thesis
this
has
shown
enables the historian
unequivocally to speak with
that
a
greater
confidence about a group of medical practitioners
making unsubstantiated
and overly simplistic
generalisations.
By
it follow lives database, to the 657 24 possible was of all a men and creating Street in considerable detail, thereby eliminating Harley in women distortions
and misinterpretations
inherent
potential
in a smaller subset of such a
group.
The database could provide future historians with material to explore (e. specialised groups of medicine g., neurology, connections amongst various ophthalmology
dermatology), as well and
as to undertake
a more
inner-workings the the of that of various analysis activities comprehensive Further followed investigations be these separatelygroups could each of determine the interconnections of the cohort, in relation to their to pursued hospital training by and subsequent and posts, examining place of education 380
their academic and professional relationships. Finally, the database may also be used as a model for those who wish to examine Harley Street after the First World War.
381
APPENDEKA Table 1.1 Population and Sample sizes across Time Regions in London Year
Harley St.
Harley St. Area
Greater London
1845 1880 1914 TOTAL
8 57 278 343
19 120 339 478
101 197 303 601
Total Registered in the Directory for London 2027 3.947 6,064 12,038
Sample of Harley Street Cohort
From the London and Provinci&lMe&calDhwtory 1845 Existing
Clarke. Charles Mansfield. Number? Coles. James. Number 25 Hancock. Hy.. Number 59 Macintyi: e. Wm.. Number 84
Maclure.
-William,
Number
Monro. Edw. Thos.. Number 87 Ria [ore. Evans. Number 73 South. H. H.. (should be Southey) Number 1 1846
Ngww ners_Qom Lattey. P.P.. Number 29 McGrigor, Sir James. Number 3 Number Charles., 72 oswiin,. L- _
382
Tuson. Edward William, Number 15 1847
New Comers:Fraser, Number Upper Harley Street
Fitton. Number 50
1848
New Comers:Garrod. A. B. Number 63 Quain. Rich.. Number 23 1849
New Comers:Chambers. Richard. Number 65 Downing. Charles T...Number 24 Elmore. J. R. Number 27
383
APPENDIX B Table 2.1 Registered Location of London Practices in 1790. District
Surgeons
Apothecaries
Physicians
North London
8%
0%
0%
South London
5%
1%
5%
South East London: Southwark
2%
1%
0%
South West London: Chelsea
1%
0%
0%
South West London: Fulham
1%
0%
0%
South West London: Westminster
3%
0%
3%
South West London: St. James's
2%
5%
7%
East London
7%
17%
1%
West London: Bloomsbury and Soho
4%
1%
8%
West London: Mayfair
6%
1%
20%
West London: Marybone
2%
0%
2%
West London: Oxford Street
3%
0%
0%
West London: Poland Street
2%
0%
0%
West London: Other
4%
3%
8%
city
25%
35%
24%
London EC: Holborn
8%
23%
16%
Hospital Address
0%
13%
1%
British Library
0%
0%
1%
Address uncommunicated
16%
0%
4%
0%
0%
District Not Known2 Total recorded in London
1% I
100% (n = 42T) 100% (n =
110)3
1
100% (n
106)
I See also Peter J., Atkins, The Directories ofLondon, 1677-1977,(London, 1932), P. 46. 2 This refers to streets whose names were duplicated in a number of different areas in these the medical practitioners practiced could not be located which street therefore accurately. 3 included in this number were 10 partnerships of 2 Peopleand one of 3 people. I have individuals. the counted The Universal Directory, Bzitlsh Barfoot, & Wilkes A contained addressesoutside London Durham Cambridge, Liverpool, these and were excluded for the purposes of the as such data set above.
384
41
Table 2.2 Registered address prior to arrival in Harley Street between 1845-1914 Area/Country
Number
London -N and NW London - SE and SW London - EC London -W and WC London -W (Harley St Area) England (excluding London) Ireland, Scotland and Isle of Wight Overseas, Navy Hospital - Resident Posts Newly Qualified Social Club Unknown5 Total
Percentage
41 43 24 72 242 64 14
6.24% 6.54% 3.65% 10.96% 36.83% 9.74% 2.13%
16 52 54 7 28 657
2.44% 7.91% 8.22% 1.07% 4.26% 99.99%
Table 2.3 Period of Registration in Harley Street Number of years in Harley Street
Number of practitioners 70
Percentage of practitioners 10.65%
2 to 10 years
267
40.64%
11 to 20 years
129
19.63%
21 to 30 years
97
14.76%
31 to 40 years
66
10.05
41 to 50 years
20
3.04%
51 to 60 years
7
1.07
61 years
1
0.15%
657
100.00%
Up to one year
Total
17 includes whose registered address was not in n' Medical DireetorY and were Figure 5 first M-'&Cal Begister, 2 others had previous date the the 1859, of address as "address pre in The Medical Dizvotory uncommunicated"
385
Table 2.4 Registered address following departure from Harley Street Area/Country
Number
London -N and NW London - SE and SW London - EC London -W and WC London -W (Harley St Area) En and (excluding London) Ireland, Wales Overseas Hospital - Resident Posts _None Social Clubs, Travelling and Army Total
'21 8 59 183
Percentage 00 3.65% 3.20% 1.22% 8.97% 27.85%
15 2 2 8 319 16
2.28% 0.30% 0.30% 1.22% 48.55% 2.44%
657
99.98%
24
386
APPENDIX C Table 3.1 Medical Degrees and Licences, Harley Street, 1845-1914
Highest Qualifications JBI-yr PERCENTAGE
QUALIFICATIONS FRFPS/FRCP/MD/MS FRCP/FRCP(i)/MD/LSA FRCP/FRCP(i)/MD )/MD FRCP/FRCP(Edin. )/MD/LRCSALM FRCP/FRCP(Edin. FRCP/FRCS/MD/MS FRCP/FRCS/MD/BS FRCP/FRCS/MD/LSA FRCP/FRCS/MD FRCP/FRCS/MB/LSA FRCP/FRCS/MB FRCP/FRCS/LSA FRCP/MD/MS FRCP/MD/BS FRCP/MD/BS/MRCS/LSA FRCP/MD/BS/MRCS FRCP/MD/MRCS/LSA FRCP/MD/MRCS FRCP/MD FRCPIMD/LSA FRCP/MB/MRCS FRCP/MB/MS/MRCS/LSA FRCF/MB/BS/MRCSILSA FRCPlMB/BS1M-Mi -FR- CP/MB/BS FRCP/MB/MRCS ýU-CPIMBALSA FRCP/MB FRCPIMS FRCP/BS/MRCS PTCP/MRCS FPS/MD/MS FRFPS/LRCP/LSA )/MD/MS/LRCP/LM F CS/FRCS(Edin. ! FR-ýCS/FRCS(Edin. )/MB/MS ýjFCSIA ýD/MRCP/MRCS/LSA FRCS/MD/MRCP/LSA CS D/MRCPor LRCP FRCS/MD/MS/MRCP -.mmý
0.15% 0.15% 0.30% 0.30% 0.15% 0.46% 0.15% 0.61% 0.61% 0.15% 0.15% 0.30% 0.91% 0.61% 0.15% 1.22% 1.52% 3.35% 2.44% 0.46% 0.76% 0.15% 0.15% 0.30% 0.30% 0.15% 0.15% 1.37% 0.15% 0.15% 0.15% 0.30% 0.15% 0.15% 0.15% 0.15% 0.15% 0.46% 0.30%
387
NUMBER
_
1 1 2 2 1 3 1 4 4 1 1 2 6 4 1 8 10 22 16 3 5 1 1 2 2 1 1 9 1 1 1 2 1 1 1 1 1 3 2
QUALIFICATIONS FRCS/MD/MS/LRCP/LM FRCS/MD/MS/LRCP FRCS/MD/MS/MAO FRCS/MD/MS FRCS/MD/BS/MRCP or LRCP FRCS/MD/BS/MRCS FRCS/MD/BS/BAO FRCS/MD/BS/LM FRCS/MD/BS/LSA FRCS/MD/MD/BS FRCS/MD1MRCP FRCS/MD/LRCP/LM FRCS/MD/LRCP FRCS/MD/LSA FRCS/MD FRCS/MB FRCS/MB/MS/LRCP FRCS/MB/MS/LSA FRCS/MB/MS FRCS/MB/BS/MRCP FRCS/MB/BS/LRCP M FRCS/MB/BSAL, FRCS/MB/BS FRCS/MB/MRCP or LRCP FRCS/MB/LSA FRCS/MSfLRCP FRCS/BS/LRCP FRCS/MRCP/LSA PiTCS/MRCP FRCS/LRCP/LSA and/or LM IýR--CS/LRCP PiTCS/LSA,and/or LM FRCS only KFD--/MS/MRCP MD/MS/MRCP/MAO MD/MS/LRCP/LRCS/LM -R-D/MS/LRCP/LRCS WD--/MS/LRCP RD-/MSTISA/LM KTDý-/MS/MRCP/MRCS KTD--/MS/MRCS/LRCP 1ZD--/MS/ACRCS iý-D-ý/MS/LSA MDIMSALM D/MS S/MRCP/MRCS/LSA MD/BS/MRCP/MRCS MD/BS/MRCP/LM MDfBSIMRCP MD/BS/MRCS/LRCP
388
PERCENTAGE
NUMBER
0.15% 1.22% 0.15% 0.91% 1.67% 0.30% 0.15% 0.15% 0.15% 0.91% 0.15% 0.15% 0.30% 0.46% 0.76% 0.76% 1.37% 0.76% 1.22% 0.15% 3.81% 0.15% 2.13% 1.37% 0.15% 0.61% 0.30% 0.15% 0.15% 2.44% 5.48% 3.35% 2.59% 1.07% 0.15% 0.46% 0.30% 0.30% 0.15% 0.30% 0.15% 0.46% 0.15% 0.15% 0.15% 0.76% 0.15% 1.22% 0.15% 0.46% 0.46%
1 8 1 6 11 2 1 1 1 6 1 1 2 3 5 5 9 5 8 1 25 1 14 9 1 4 2 1 1 16 36 22 17 7 1 3 2 2 1 2 1 3 1 1 1 5 1 8 1 3 3
QUALIFICATIONS
PERCENTAGE
MD/BS/MRCS/LSA MD/BS/LM MD/BS MD/130 MD/MRCP/MRCS/LSA MDlMRCP/MRCS MD/MRCP/LSA/LM MD/MRCP/LSA MD/MRCP MD/MRCS/LRCP MDIMRCS/LSA and/or LM MD/MRCS MD/LRCP/LRCS/LSA and/or LM MD/LRCP and/ or LRCS MD/LRCSILM MD only MBALRCP MB/MS MB/BS MB/MSIMRCP MB/MS/LRCP/LRCS MB/MS/LRCP/MRCS MB/BS/MRCP/MRCS MB/BS/MRCS/LRCP MB/BS/MRCS or LRCS MB/BS/LSA or LM MB/MRCP/MRCSILSA MB/MRCP/MRCS or LRCS M vIRCP/LRCSdM MB/MRCP ; FR CS/LRCP/LSA M MB/MRCS/LRCP/BAO --/MRCS/LRCP -ýTB MB/MRCS/LSA FiRR A fMR (7S MB only . MRCP/MRCS MRCP only LRCP/LRCS/LM ERCP/LRCS KR-C-P/LSAor LM LRCP only_ M and/or LSA MRCS/LRCPAL, ]WR--CMRCP ýiKRC - SILS-A LRCS/LM RCS only L
0.30% 0.15% 1.67% 0.15% 0.76% 1.83% 0.15% 0.15% 1.37% 1.52% 2.28% 0.61% 0.30% 0.76% 0.15% 1.52% 0.15% 1.52% 1.52% 0.46% 0.15% 0.15% 0.61% 1.37% 0.76% 0.30% 0.15% 0.46% 0.15% 1.07% 0.15% 0.15% 0.30% 0.30% 0.46% 0.30% 0.46% 0.15% 0.30% 0.61% 0.30% 0.15% 1.37% 5.94% 1.82% 0.15% 2.29% 0.15% 0.76% 100%
Total
389
NUMBER 2 1 11 1 5 12 1 1 9 10 15 4 2 5 1 10 1 10 10 3 1 1 4 9 5 2 1 3 1 7 1 1 2 2 3 2 3 1 2 4 2 1 9 39 12 1 15 1 5 657
Table 3.2 Medical Degrees held by Medical Men registered in Harley Street, 1845-1914.
Highest By Qualification ly University and degree earned MD, 60 with MS or BS London Scotland Oxbridge others-Europe' Durham Ireland2 Others England Canada Total
Percentage- at date of arrival in Harley St.
Number - at date of arrival in Harley St.
15.37% 13.70% 5.48% 4.47% 2.59% 2.59% 0.61% 0.46%
85 90 30 30 18 17 2
Percentage of additional degreesat date of departure
1.22% 1.07% 1.22% 0.15%
Number of additional degreesat date of departure
8 7 8 1
13 n=275
n=24
9.44% 8.07% 5.63% 1.37% 1.07%
62 53 37 9 7 n= 168
1
10.20% 3.20% 1.22% 0.60% 0.46%
67 21 8 4 3 n= 103
9.44%
62
MB, 117 with MS or BS London Oxbridge Scotland Durham OtherS3 Total_ Ms , 91 with MD or MB Scotland London Oxbridge Canada OtherS4 Total 13S,122 with MD or MB roxbridge
1 n=2 0.15% 0.15% 0.15%
1 1 1
0.15%
1 n=4
from following the This each one of of I universities: - Basle, Erlangen, was comprised Freiburg, Giessen, Parma, Pavia, Vienna, Strasburg and Wurtzburg and 4 from Paris, 2 from Berlin and 15 from Brussels. (in University Queen's from 1882 the name was changed to the Royal 2 Ten were University) and seven from University College Dublin. s This was comprised of one from each of the following universities: - Adelaide, Ontario and Liverpool. Dublin and Toronto, following St the Andrews, Durham and Bishops Montreal. from universities* One of each 4 (formerly departure from MS Royal QueeWs)University Ireland. at was The additional
390
University and degree earned London Scotland OtherS5 Durham Total
Percentage- at date of arrival in Harley St. 6.85% 2.44% 0.30% 1.07%
Number - at date of arrival in Harley St. 45 16 12 7 n= 142
Percentage of additional degrees at date of departure 0.30%
Number of additional degrees at date of departure 2
0.15%
1 n=3
following Adelaide Ontario from the 6 from universities: of and One and 4 from each and 5 Liverpool.
391
-i
Table 3.3 Licences held by Medical Men registered in Harley St., 1845-1914.By Highest Qualification. Licensing Bodies
FELLOWS,
Percentage at date of arrival in Harley St.
Number at date of arrival in Harley St.
Percentage of additional licences at date of delDarture
Number of additional licences at date of devarture
0.76% 0.30%
72 5 2
6.09% 0.46% 0.15%
40 3
PHYSIC: All
with medical or surgical degrees I.A)ndon/England(FRCP) 6 Edinburgh (FRCP, Edin. ) King's and Queen's College Ireland Physicians, of (FKQCPI) Total FELLOWS, SURGERY: 162 with medical or surgical L degrees de Er England (FRCS) , ) (FRCS Edin. Ed Edinburgh r I reland (FRCSI) Ir Gla s ow 7 (FRFPS) Total MEMBERS, PHYSIC: All with medical or surgical degrees. 40 with MRCS London/England (MRCP) E inbur h (MRCP, Edin. ) Total MEMBERS, SURGERY: 62 with medical or surgical degrees. PHYSIC: 6 LICENTIATE, LRCS with (LRCP) land ndon/En
n=75
n=45
3.50% 1.52%
196 23 10
3.50% 0.30%
23 2
0.46%
3
0.16%
1
n=232
0.61%
82 4
42.16%
n=90 131
26
0.61%
4
0.30%
n=4 2
9
LL LicentiaLte U-9 ._Edinburgh _4urgery: (LRCS, Edin. ) 'Licentiate, Apothecaries LSA only
2 5
6 When the RCP introduced its charter in 1843, the licence changed from RCP London to RCP England. 7 Despite its name as the Royal Collegeof Physicians and Surgeona,this was a college of Rivington, Medical Imfession, (London, 1888), pp. 241,259-261. See surgeons.
392
Table 3.4 Medical QuaHfications, 1845
Highest Qualifications 11ý-- JDY Harley Harley Street Street Percentage Number
Qualification
Harley Street Area Number Population n= 19
Greater Greater London London Percentage Number
26.32% 5.26% 31.58% , 15.79%
5 1 -6 3
5.26% 5.26%
1 1
0.99% 0.99% 5.94% 2.97% 5.94% 2.97% 0.99% 0.99% 28.72% 36.63% 12.87% 100%
Population n=8
Population/Sample
FRCP/MD FRCP FRCS MD/MRCP MD M dRCS MB/MRCS MRCP/MRCS MRCS only MRCS/LSA LSA Tota19
Harley Street Area Percentage
37.50%
3
12.50% 12.50% 12.50%
1 1 1
- -12.50% 12.50%
1 1
10.53%
2
100%
8
100%
19
Population' + 2,027(50/o) n= 1018 1 1 6 3 6 3 1 1 29 37 13 101
Table 3.5
Place of MD, 1845 University
London
Rest of Eur2pe Ko-t recorded in Directory To)_tal
Harley Street Percentage
Harley Street Number
12.50% 12.50% 25.00% 12.50%
1 1 2 1
Harley Street Area Percentage
10.53 42.11
Harley Street Area Number
Greater Iondon Percentage
Greater London Number
1.98% 0.99% 6.93% 0.99%
2 1 7 1
1.98%
2
2 8
-- T-(n= 10)
(n=5)
(n = 13)
27 late, includes whose returns lation were received pp. ix-xii, MedicalDirectary, POp ui0t in there total M the Yca]Directorx. was Populat no Mý as nc ow on ied 1845, due to roun I)ifference 9
393
Table 3.6
Medical Qualifications, 1880 By Highest Qualifications Qualification
Harley Harley Street Street Percentage Number
Population/Sample
3.51% FRCPIFRCS/MD FRCP/FRCS/MB 12.28% FRCP/MD/MRCS 12.28% FRCP/MD FRCP/MB 1.75% FRCP/MRCS 3.51% FRCS/MD 5.26% FRCS/MB 5.26% FRCS/LRCP PR-C-S/LSA 3.51% 8.77% FRCS D/MRCP/MRCS 8.77% 3.51% MD/MRCP -(MCh) MD/ý-M 5.26% MD/MRCS D/LRCS 1.75% MD/LSA 3.51% MD R-B-IMRCP/MRCS 1.75% 1.75% MB/MRCPXRCS 3.51% WB/MRCP . ý M BOMRCS/LRCP 1.75% MB/MRCS B/LRCS MB -VIMRýS MR ý, MRCP/LSA LRCP/MR S LRCP/LRC LRCP/LSA UPS ýR C§7TSA 5.26% 5.26% MRCS 1.75% LRCS LSA only I LM only % Total.
Harley Street Area Percentage
Population n=57 2
1.67% 1.67% 9.67% 14.17% 2.50%
7 7 1 2 3 3 2 5 5 2 3 1 2 1 1 2 1
Harley Street Area Number Population n= 120 2 2 11 17 3
7.50% 0.83% 3.33% 10.83% 3.33% 2.50% 0.83% 3.33% 0.83%
9 1 4 13 _4 3 1 4 1
4.17%
5
0.83% 1.67% 0.83% 1.67%
-12 1 2
3.33%
4
5.83%
7
3 3 1
0.83% 8.33% 9.17% 0.83%
1 10 11 1
57
100.48%
120
394
Greater Greater London London Percentage Number Population 3,947+20 (5%) n= 197
0.51% 1.01%
1 2
2.03% 2.54%
4 5
5.08% 2.54%
10 5
2.03% 2.03% 7.61% % 1.52% 7.11%
4 4 15 4 3 14
1.01% 1.01% 1.01%
2 2 2
0.51% 13.20% 4.57% 2.03%
1 -26 9 4
21.32% 11.68% 1.52% 4.06% 2.03% 99.99%
42 23 3 18 4 197
Table 3.7 University of MD, 1880 University
Harley Street Percentage
London Scotland Oxbridge Ireland Rest of Europe U. S. Total
24.56% 24.56% 5.26% 1.75% 1.75%
Harley Street Number 14 . 14 31 1 1
Harley Street Area Percentage 11.67% 15.53% 5.00% 10.83% 583%
10.83% (n = 33)" 1 -
Harley Street Area Number 14 19 6 1 7 I 1 I (n = 48)12
Greater London Percentage
Greater London Number
3.05% 13.20% 3.05% 1.02% 3.05%
6 26 6 2 610
i 1 1.52%
1
I
3 (n = 49
Giessen, Pisa, Paris, Brussels Durham, Breslam. following: the from and 10One A. Garrod B. MD: MD double from had London Street Harley from qualified a ii Two men MD from Durham St Andrew's. Therefore, Fenwick S. total and qualified Oxford and and MD 31. was those with number of QF M Churchill Roth) had Street two two Harley practitioners area, medical and 12in the from Pavia St. Andrews Vienna Thus, the Pavia and and from respectively. and MDs: MD 46. those an was with number of
395
Table 3.8
Medical Qualifications, 1914 By Highest Qualifications Qualification
Harley Street %
Population/Sample
FRCP/FRCS/MD or MB FRCP/FRCS FRCP/MD or MB F'RCP only FFPSIFRCS/MD FFPS/MD/MS FRCS/MD or MB FRCS/MS or BS FRCS/MRCP or LRCP FRCS/LSA FRCS MD/MRCP or LRCP MD/MS or BS MD MD/MRCS/LSA or LM MD/MRCS MDfMRCS/LRCP MD/LRCP and/ or LRCS MD/LSA B/MRCP or ARCS LRC MB/MRCS/LSA -ý ýB/MRýCS or LRCS ý SWMRCS 4 x4 _MB/MS
,
or BS
MB Ms 1RCP or B LRCP/MRCS ,Rq/1,RCP -MRCP/MRCS and/or LRCP LRCS, or LRFPS LRC [,RCS/LFFPS/LSA LRC LRCP/LRCS/LFFPS LRCP/LSA or LM LRFPS LRECT ýF 4-7 L or ýý_6 MRCS MRCS/LRCPJAnSA MRCS/LRUF Mi. CS or LR CS LMSSA
Total
or LSA
1.44% 0.36% 8.99% 0.36% 0.36% 0.36% 27.34% 2.16% 5.76% 1.44% 1.08% 3.60% 13.31%
Harley Street Number n= 278
4 1 25 1 1 1 76 6 16 4 3 i -O 37
Harley St. Area
Harley St. Area Number
Greater London
n=399
n=330
0.50%
2
T2-5%
0.61%
2
0.25%
5 1
3.26%
13
0.30%
1
9.28% 1.00% 1.50% 1.75% 6.27% 34.59%
37 4 6 7 25 138
1.21%
4
3.94%
13
6 6
19.4 5-1 Vo 0.30% 1.82%
51 1 6 1 3 4
9
1.80% 0.72% 1.44% 0.36%
5 2 4 1
-1.50% 1.50%
1.80%
5
0.25%
1
0.30% 0.91% 1.21%
0.36% 0.36% 0.36% 10.43% 0.36%
1 1 1 29 1
-5--75'Yo
3'
-2.73%
19.5 5% 0.25% 0.25%
78 1 1
0.72%
2
0.36% 0.72%
1 2
0.25%
1
0.25% 0.36% 0.72% 0-36% 1.08% 0.36% 9.35% 1.08% 0.36% 100.43%
Greater London Number 6,604+ 20(5%)
21.52% 3.03% 0.30%
71
1
10.61%
3F
6
0.75%
3
1.82% 0.30% 5.15%
12.53 2.51%
50 10
23.03% 1.21% 4.24%
76 4 14 300
1 2 1 3 1 26 3 1 278
-9 - 9.9 - 4Vo
-1
396
399
17
Table 3.9 MD, 1914 of
University
Medical Practitioners University
Harley Harley Street Street Percentage Number
London Oxbridge Durham Manchester Scotland 113 Irelan Rest of Europe U. S. / Canada Not recorded in Directory Total
14.39% 6.16% 2.88% 0.15% 11.87% 2.52% 3.60%
40 17 8 1 33 7 10
1.44%
4
Harley Street Area Percentage
Greater London Percentage
Greater London Number
19.05% 10.78% 2.76%
Harley Street Area Number 76 43 11
3.33% 3.03 2.12%
11 10 7
8.27% 0.50% 6.52%
33 2 26
6.36% 0.61% 4.55%
21 2 15
0.50%
2
0.30%
1
0.50%
2
3.64%
12
(n = 195)
(n = 120)
(n
79)
Table 3.10
Prizes, Scholarships and Medals Awarded During Student Years Year
1845 1880 1914
Harley Street Percentage None 28.07% 35.61%
Harley Street Number 16 99
Harley St. Area Percentage None 5.00% 15.54%
Harley St. Area Number 6 .1 62
Greater IA)ndon Percentage None 6.09% 3.03%
Greater London Number 12 10
RUL For Harley UCD St. 3 Area St.: Harley St., UCD Harley 1, and and For -4 outside 13 RUL 1.
397
Table 3.11 Medical Training, Harley St. Medical Men 1845-1914 Medical Schools
Percentage at date of arrival in Harley St.
Count - at date of arrival in Harley St.
16.44% 15.37% 10.05% 9.59% 6.85% 6.54% 6.09% 5.02% 3.96% 2.74% 1.52%
108 101 66 63 45 43 40 33 26 18 10
10.35% 2.74% 2.59%
68 18 17 6 5
LONDON St. Bartholomew's UCH The London St. Thomas's Guy's The Middlesex King's St. Mary's George's _St. Charing Cross Westminster PROVINCL41 MEDICAL SCHOOLS Cambridge Medical School/Addenbrook'sHospital Oxford Medical School/RadcliffeInfirmary Durham College of Medicine/Newcastle Infirmary'_4 Owens' College Manchester/Royal Infirmary15 General Queen's Hospitals Birmingham/ and Scotland/Ireland University of Edinburgh/Royal Infirmary Trinity /Sir Patrick Dun's Hospital16 University College Dublin/ St Vincent's Hospitals University of GlasgowfWestern Infirmary and Royal Infirmary) University of Aberdeen/Royal Infirmary Queen's College Cork /bouth Infirmary and Cork General Hospital EUROPE - UNIVERSITY Paris Vienna Berlin Leipzig Strasbourg Brussels Freiburg OTHERS Dental Hospital London Not Listed in the Medical Directory
-0.91% 0.76% 11.57% 1.67% 1.98% 3.04%
76 11 13 20
2.74% 0.76%
18 5
9.28% 8.07% 5.18% 2.13% 1.37% 1.07% 0.76%
61 53 34 14 9 7 5 14 62
14Students could also study in a range of other institutions, for a complete list see (1888), Profession, Medical ]Rivington, pp. 652-655 15Ibid. College from Trinity University College Dublin. 13 from and 11 is
398
Table 3.12 Medical Training 1880 Medical Schools
LONDON . University College Hospital St. Bartholomew's King's College Hos2ital Guy's The Middlesex St. Thomas's St. Mary's St. George's The London Charing Cross Westminster REST OF ENGLAND Oxbridge Durham College Bristol Medical School Liverpool Manchester University Med. College.(Owens) Royal School Manchester Norfolk + Norwich hospital Northampton Leeds Birmingham SC"OTLAND/IRET-AND Edinburgh Aberdeen Glasgow Ireland EUROPE UNIVERSITY Germany France Austria Amsterdam Brussels OTHERS NOTLISTEDINTHE DIRECTORY-19
Harley Street %
Harley St. Number n=57 22.81% 13
Harley St. Area % 26.67
Harley St. Area Number n= 120 32
Greater London % 9.14%
Greater London Number n= 197 18
10.53% 8.77% 7.02% 7.02% 5.26% 5.26% 5.26% 1.75%
6 5 4 4 3 3 3 1
11.67 9.17 5.00 1.67 3.33 3.33 2.5 5.00
14 11 6 2 4 4 3 6
9.14% 8.12% 14.21% 2.03% 4.57% 3.55% 8.63% 5.58% 6.60% 1.52%
18 16 28 4 9 7 17 11 13 3
8.77% 3.51%
5 2
3.33
4
3.04%
6
0.83
1
1.01% 0.51%
0.83
2 1
1 0.51%
1
0.51% 0.51% 0.51%
1 1 1
1.75%
1
0.83
8.77%
5
1 _1.75% 5.26% 3
5.26% 3 15.79% 9 3.51% 2
' 19 79% 9 .
1
7.50 0.83 1.67 2.50
9 1 2 3
9.64% 3.55% 3.55% 9.64%
19 7 7 19
6.67 12.50 5.00 0.83 0.83 0.83 8.33
8 15 6 1 1
1-01-'Y'O 3.55% 1.01%
2 7 2
117
1.01% 11.68%
218 23
10
St. Area Harley from the One attended the University of Pennsylvania. 17 is 13ombayand Philadelphia. by attended school medical practitioners is recorded in the Medical Directory The medical 19 following in their qualifications, however, some elect italics and parentheses not to return details. these
399
Table 3.13 Medical Training
1914
Medical Schools
Harley Street %
LONDON
Population n=278 19.06% 53 13.31% 37 11.15% 31 9.71% 27 8.27% 23 5.76% 16 5.76% 16 4.68% 13 4.68% 13 2.16% 6 1.80% 5
18.30% 14.54% 11.53% 9.27% 10.03% 6.01% 7.52% 7.52% 4.01% 3.01 4.51%
16.55% 46 1.44% 4
2 1.Y0_Yo 1.25%
85
10% _ _33 0.90% 3
1.08% 0.72%
3 2
1.50% 0.50%
6 2
2.12% 0.30%
71
0.72% 0.72% 0.36% 0.36%
2 2 1 1
1.00%1.25% -
4 5
0.61% 1.82%
2 6
0.25% 0.50%
3 1 2
St. Bartholomew's UCH The London_ St. Thomas's Guy's The Middlesex King's College Hospital St. Mary's Charing Cross Westminster St. George's REST OF ENGLAND Oxbridge Manchester University Med. College (Owens) Durham College Birmingham University (Queen's) Yorkshire College Bristol Medical School Liverpool Royal Manchester Infirmaj: X Newcastle on Tyne Sheffield Leeds SCOTLAND/IRELAND Edinburgh lasaow Aberdeen Ireland Wales ROPEUNIVERSITIES Germany Switzerland France L Bel 'um Ital AIustria
15.83% 5.76% 3.24% 5.04%
Harley St. Number
44 16 9 14
16.19% 45 10.07% 28 8.99% 25 4 1.08% 3 0.361/-
400
Harley St. Area %
Harley St. Greater Area London Number % Population n=399 73 12.72% 58 8.18% 46 9.70% 37 7.58% 40 6.66% 24 3.63% 30 4.84% 30 5.15% 16 3.33% T2_ 1.82%4.24%
9.77% 1.25% 2.01% 2.76% 0.25%
39 5 8
10.7iý% 1.00% 8.27% 1.25% 1.00%
43 4 33 A
Greater London Number Sample n=330 42 27 32 25 22 12 16 17 11 6 14
0.61% 2 0.61% 2 2 3 -. --90YO 13-33% 44 3.94% 13 4.54% 15 9.09% 30 0.90% 3
3.03%
10
2.72% 1.52%
9 5
2.42%
8
Medical Schools
OTHERS20 Outside Europe Canada and USA Australia and New Zealand India2l NOT LISTED INY THE DIRECTOR
Harley Street % 0.75%
Harley St. Number 3
Harley St. Area % 0.25%
Harley St. Area Number 1
Greater London % 0.61%
Greater London Number 2
1.75% 0.75%
7 3
1.75% 0.50%
7 2
0.61% 0.61%
2 2
1
1.52% 3.0"
5 0
1.75%
1 71
0.25% I
for Madrid Harley Street. Prague One from Prague, Cracow Copenhagen, from One and 20 for the Harley Street Area. One from Prague and Bucharest for Greater Sweden and London. Calcutta Madras, from for Greater Bombay, London. from one and Three 21
401
APPENDIX D Table 4.1 Hospital Posts Harley St. Medical Men 1845-1914 Hospital
No hospital attachments TeachingHospitals St. Bartholomew's Middlesex The London UCH St. Mary's King' 3 College St. Thomas's Charing Cross Guy's St. George's Westminster Royal Free Other Hospitals Royal LondonOphthalmic,Moorfields Gt. OrmondSt. (for Sick Children) Seamen'sHospital, Greenwich Great Northern Central, Hollowayrd. National Hospital (Paralysis),Queen'sSq. West LondonHospital, Hammersmithrd. Mount Vernon Hospital,Middlesex Brompton (Consumption),Fulham rd. ýChildren's Hospital, Southwark 'a in-: ! Ev Metropolitan, Ear Noseand Throat Hospital DisTasesof the Throat & Chest,GoldenSq. Vic ria (for Sick Children),Chelsea Inn Ear, Gray's & for Throat rd. Hospital Hospital Children's Green Padýington Western OphthalmicHospital,Marylebone WomenY (for Children and London East Square Soho Ear, Royal St. Judd Ophthalmic, London Central Ear Nose Throat, London and Central (Diseases Chest), the Lqndon of CiFyof
% on arrival in Harley St. 31.05%
Number Number %at departure at at from departure arrival Harley St. 204 9.89% 65
4.72% 3.50% 3.50% 2.59% 2.74% 2.44% 2.44% 2.28% 1.52% 1.52% 1.99% 1.83%
31 23 23 17 18 16 16 15 10 10 13 12
6.54% 5.63% 4.67% 3.96% 3.65% 3.50% 3.35% 3.04% 2.13% 1.83% 1.67% 0.91%
43 37 1 30 26 24 23 22 20 14 12 11 6
4.26% 2.89% 2.28% 1.99% 1.22% 3.04%
28 19 15 13 8 20
1.07% 1.37% 1.22% 2.28% 1.83% 0.91% 1.22%
7 9 8 15 12 6_ 8
1.37% 0.91% 1.37% 1.07% 0.91%
9 6 9 71 61
13.65% 3.35% 2.89% 2.73% 2.73% 12.59% 2.43% 1.98% 1.67% 1.67% 1.52% 1.62% 1.37% .1.22% 1.22% 1.07% 1.07% 0.91% 0-91% 0.91%
24 22 19 18 18 17 16 13 11 11 10 10 9 8 8 7 7 .6
for dispensary there for Hospital children and was a The was women. I
402
6 6
% on 'Number arrival at in Harley arrival St.
Hospital
Royal Westminster Ophthalmic, King St. Prince of Wales General, Tottenham St. Johes Hospital, Lewisham Bromley Cottage Hospital London Hospital for Diseasesof the Skin2 National Orthopedic HospitaJ3 National Hospital for Diseasesof the Heart4 West End (Nervous diseases),Cavendish Sq. New Hospital for Women, Euston rd5 Queees Hospital for Children, Hackney rd6 St. Peter's, Stone & Other Urinary Disease7
1.07%
7
1.37% 1.22%
9 18
0.91%
0.91%
%at departure Number from at Harley St. departure
0.91% 0.91% 0.91% 0.91% 0.91% 0.91% 0.91%
6 6 6 6 6 6 6
J =
161
SE Road, 1. 2BIackfriars 3Great Portland Street. W1. Street, 4Westmorland 5This supersededSt Mary's Dispensaryfor Womenestablishedby Elizabeth Garrett Andersonin 1866. Hospital for North-Eastern children. Late 6 Covent Garden Street, Henrietta 7 403
.I
1
Table 4.2 Special Areas of Medicine or Surgery Practiced by Harley Street Men Area of Expertise
Diseases of the eye, Ophthalmology '5ental Surgery Obstetrics Diseases of the skin, Dermatology Ear, Nose and Throat (ENT) Diseases of the nervous system, Neurology Aural Surgery Laryngology Mental Diseases, Lunacy Gynecology Orthopaedics Radiography Anaesthetics Pathology Diseases of children, Paediatrics Electro-therapeutics Obstetrics and Gynaecology Disease of urinary tract, Urology Hygiene and Public Health Bacteriology Diseases of the Heart, Cardiology Diseases of the Chest Physiology Respiratory Diseases Path )Jogy and Bacteriology Rare Diseases Tropical Diseases Manipulative Surgery Obstetrics and Paediatrics Other Combined Interests8 Other Interests9 ITotal
Specialists Percentage 7.31% 3.50% 3.20% 2.89% 2.28% 2.13% 1.98% 1.52% 1.37% 1.22% 1.22% 1.22% 0.91% 0.76% 0.61% 0.61% 0.61% 0.46% 0.46% 0.30% 0.30% 0.30% 0.30% 0.30% 0.15% 0.15% 0.15% 0.15%
13111111
Specialists Number 48 23 21 19 15 14 13 10 9 9 8 8 6 5 4 4 4 3 3 2 2 2 2 1 1 1 1
-238
Special Interest Percentage 1.22%
Special Interest Number 8
0.30% 0.91% 0.76%
2 6 5
0.46% 1.37% 0.76%
3 9 5
0.46% 0.15% 0.46% 1.22% 1.37% 0.15%
3 1 3 8 9 1
0.46% 0.15% 0.15% 1.52% 1.06%
3 1 1 10 7
1.22% 0.15% 0.15% 0.15%
8 1 1 1
0.15% 1.98% 10.91% 118.25%
1 13 16 1116
included balneology interests Combined and climatology, pharmacology and therapeutics, 8 dermatology histology, neurology, and and pathology and paediatrics and physiology dermatology and tropical diseases. diseases digestive the included of system, hydrology, rectal surgery and venereal These 9 diseases.
404
Table 4.3 Hospital Posts, 1845 Medical Staff
TEACHING HOSPITALS Consulting surgeon Physician Surgeon Assistant physician Assistant surgeon OTHER HOSPITALS Consulting physician Consulting surgeon Physician Surgeon Assistant physician Assistant surgeon Former Staff Post No Staff Post Total
Harley Street %
12.50%
25.00% 12.50%
50.00%
Harley Street Number Population
Harley St. Area %-
n=8 1
2 1
4 8
Harley Street Area Number Population
5.26% 36.84% 5.26%
n=19 1 7 1
5.26%
1
5.26%
1
5.26% 5.26%
1
31-58%
6 19
405
Greater London %
Greater London Number Sample n= 101
1.98% 1.98% 1.98%
2 2 2
0.99% 3.96% 8.91% 0.99% 0.99%
1 4 9 1 1
78.22%
79 101
_
Table 4.4 Hospital Posts, 1880 Medical Staff
Harley Street %
TEACHING HOSPITALS RETIRED Consulting physician Consulting surgeon SENIOR MEDICAL STAFF . Physician Surgeon Assistant physician Assistant surgeon JUNIOR MEDICAL STAFF House physician "Uubu r3uIr, VIA SPECIAL DEPARTMENTS
Harley Street Number
Harley St. Area %
Harley Street Area Number Population n= 120
Greater London %
7 4
1.02%
2
6.67ý/-o- 8 -5- - 0/6 - i .33 6.67% 6.67% _8 8
2.54% 2.03% 1.02% 0.51%
5 4 2 11 I
Population n=57 10.53% 5.26%
6 3
5.83% 3.33%
15.79% 9 8.77% 5 1.75% T -1 3.51% 1 2
A..oulo I I_ 1.75% 11
Obstetrician - physician Chloroformist 0 hthalmic surgeon
0.83%) 10.83% 1 1 1.67% 12 10.83% 11
Throat/Ear/Nose
Sample n= 197
I 1 2 03% . 12.03%
1
' Greate-r London Number
14 4
1 0.51%
surgeon Dental surgeon Assistant - special wards -6 T -- HER HOSPITALS RETIRED Physician Consulting Surgeon Consulting
0.83%
10.53% 1.75%
6 1
8.77%
5 6
1
0.83%
-1
11.6 % 7.50% 4.17% 3.33%
14 9 5 -4
1-ý-7%
2
1.52'Yo 1.02%
2 2
1.02% 0.51%
2 1
0.51% 2.03%
1 4
1.02%
2
0.51% 1.02%
1 2
SENIOR MEDICAL STAFF Physician Surgeon Assistant Assistant
JUNIOR STAFF
10.53% 1.75%
Physician Surgeon
1
MEDICAL
Medical officer Assistant medical
officer
Assistant - special wards SPECIAL DEPARTMENTS
rn-,.
1 0.83%
ital, surgeons
406
Medical Staff
Harley Street %
Harley Street Number
Harley St. Area %
Harley Street Area Number
NURSING HOMES/ CO`ITAGE HOSPITALS Consulting surgeon Physician Surgeon -3 redical oFf-icer Ve--dicalassistant Former Staff Post NO STAFF POST Total
1.75%
1
0.83%
8.77% 5 7.02% 4 - 9Y. - 57 1
1
14.17% 17 17.50% 21 100% 120 1
-T10
407
Greater London %
Greater London Number
0.51%
1
1.02% 2 3.55% 7 6.60% 13 1.02% 2 22.84% 45 44.16% 87 197 100% 1 1
Table 4.5 Hospital Posts, 1914 Medical Staff
TEACHING
Harley Street %
Harley Street Number
HOSPITALS
RETIRED Consulting Dhvsician Consulting surgeon SENIOR MEDICAL STAFF Physician Surgeon Assistant physician Assistant surgeon JUNIOR MEDICAL STAFF House physician House surgeon Physician out-patients Surgeon out-patients Registrar SPECIAL DEPARTMENTS Surgeon or physician accoucher/ obstetrician/gynaecologist Anaesthetist surgeons _Dental Skin surgeons, physicians Ophthalmic surgeon Electroiographer therapists/ra Neurology/ nervous diseases Orthopaedic surgeon Genito-urinary surgeon Throat/Ear/Nose surgeon Pathologist/Bacterologist Children/paediatrics, Assistant in special wards OTHER HOSPITALS RETIRED Consulting Physician Co ýulqng
Harley St. Area %
T
Population
a-r1ey Street Area Number Population
n=278
n=399
IIIIIi 15.04% 1 14 8.27%
23
5.04% 5.04% 1.08% 2.52%
11 no/. InII:: is
Greater London %
Greater London Number Sample n=330
1.50%
6
0.61%
2
14 14 13 17
5.51% 2.76% 2.26% 2.50%
22 11 9 10
0.61%
2
0.72% 1.44% 0.36% 0.36% 1.08%
2 4 1 1 3
2.26% 1.50% 1.50% 1.00% 1.50%
9 6 6 4 6
1.52% -F61%
5 2
0.61%
2
0.36%
4
3.26%
13
0.36% 1.44% 0.36%
1 4 1
2.51% 10 1.25% 5 1.25% - 5-
0.61% 0.30%
2 1
1.44% 1.44%
4 . 4
2.26% 1.25%
9 5
0.36%
1
0.25%
1
0.75% 0.25% 0.25% 0.50% 0.25% 0.50% 2.76%
2 1 2 11-
1.21%
4-
1.52% 0.61%
5
0.72%
2
1.44% 1.08%
4 3
3.24%
9
4.67% 13 10.79% 1 30
3.26% 13 3.51%o T 14
408
q
Medical Staff
Harley Street %
SENIOR MEDICAL STAFF Physician 6.83% Surgeon 7.19% Assistant physician 0.72% Assistant surgeon 0.72% JUNIOR MEDICAL STAFF House pbysician 0.72% House surgeon 0.36% Medical officer Assistant medical officer Physician out-patients Surgeon out-patients 0.36% Registrar SPECIAL DEPARTMENTS Anaesthetist 0.72% Dental surgeons 0.36% Electro-therapists/ radiographer Obstetrics/gynaecology 0.36% Orthopaedic surgeon Skin surgeons, physicians 0.36% 0.36% Throat/Ear/Nose surgeon 1.44% ophthalmic Surgeon 1.08% Pathologýst/Bacterologist Assistant in special wards 1.08% SING HOMES/DISPENSARIES COTTAGE. HOSPITALS 0.36% Consulting physician 0.36% Consulting surgeon 0.36% Surgeon 10.79% Former Staff Post 5.76% Post Staff o 1 100% Total
Harley Street Number
Harley St. Area %
19 20 2 2
270,, o 11.78% 1.00% 3.00%
47 4 12
2
0*25% 1.25%
1 5
1.00% 0.50%
4 2
1.00%
4-
0.25%
1
0.50% 1.50% 0.75%
2 6 3
0.30%
1
0.30%
1
0.50%
2
1.21% 0.61%
4 2
10.53% 3'4 /"' i Y. 12.03%
42 48
1 35.76% 38.18%
118 126
100%
330
11
Harley Street Area Number
Greater London %
Greater London Number
1.82% 2.42%
6 8
0.30% 2.42% 5.15% 2.12%
1 8 17 7
1
721%
4
2 1
1 1 1 4 3
1 1 1 30 16 - 278
---
409
1 100%/ .
IACIQ
--L
Table 4.6 Teaching Posts Harley Street Percentage 37.50% 1845 Formerly 1 12-50% 50.00% No Post 36 84% 1880 . Formerly 19.30% 43.86% No Post 46.04% 1914 1 Formerlv 1 16-19% ý 761/o 4ý6ý. Post No Year
Harley Street Number 3 1 4 21 11 25 128 45 1130
Harley St. Area Percentage 42.11% 5.26% 52.63% 20% 22.50% 57.50% 27.57% 7.27% 65.16%
410
Harley St. Greater Area London Number Percentage . 5.94% 8 1 0% 10 94.06% 24 3.55% 27 6.09% 69 90.36% 110 3.03% 29 1.82% 260 95.15%
Greater London Number 6 0 95 7 12 178 10 6 314
APPENDIX E Table 5.1 Summary of medical and learned society memberships held by Harley Street men - at date of arrival. 1 SOCIETIES WITH 7 OR MORE FELLOWSIMEMBERS FROM HARLEYSTREET , Medical Society D)ndon (1773-extant) Royal Society of London (1662 - extant) Hunterian Society (1819-extant) Linnaean Society (1788-extant) Zoological Society-of IA)ndon (1826-extant) British Medical Association (1832-extant) Ophthalmological Society of the UK (1880-extant)2 West London Medico-Chirurgical Society (1892-1936) Harveian Society (1831-extant) Anatomical Society (1887- extant) Physiological Society (1876-extant) Abernethian Society (1832 -extant) Societies which amalgamated with RSM3 Royal Society of Medicine (1907-extant) Royal Medical and Chirurgical Society (1805-1907) Pathological Society (1846-1907) Obstetrical Society London (1859 -1907) British GynaecologicalSociety (1884-1907) linical Society (1868-1907,after RSM) Neurological Society U 886-1907,after RSM) _Society for Study of Diseasesin Children (1900 1908) Laryngological Socie!j of London (1893-1907) Dermatological Society of London (1882-1907)
FELLOWS 1MEMBERS 99 24 14 12 7 205 47 48 40 17 11 9
128 9 25 9
108
85 17 12 10
I The only include societiesbased in London or with a London branch. A few of the cohort London Medical the Society of Edinburgh, which societies outside of such as members were had in 7 from 1737 Harley Street. The neurologist, Samuel members and established was Kinnear Wilson was the society's President from 1902-03before he moved to Harley Street in 1914. For the aims and organisation of the society see,Jacqueline Jenkinson, Scottish Medical Societies: 1731-1939,their History and Records, (Edinburgh, 1933). 2 The Ophthalmological Society of the United Ydngdombecame the Royal College of OphthalmOlOgist-9in 1988. Hunting, History of the RSM, pp. 333-4. a For a list of the societies that merged, seeDavidson, The Realisa tion ofan ideal, pp. 36-7. Five new associations had merged with the RSM by 1914, see Hunting, History ofthe RSM, 301. 171,213 and pp.
411
APPENDEKF Table 7.1 The number of women medical practitioners in the UK, London and the percentage in Harley Street Year
1889 1894 . 1899 1904 1909 1914
Total number of registered medical women
Number in London and the Suburbs.
70 166 387 6481 842
25 41 85 124 184 2433
1,0002
-
Number of registered women in Harley Street. 1 2 3 7 13
Percentage of registered women in Harley Street. 4% 5% 4% 6% 7%
Source: - The EngEsh woman ý; Year-Book and the Database
I In 1899,29 women were'not placed' and these have been included in the above data, the therefore be lower as some of these women may have retired from practice total may exact figure for 1904 includes those whose addresses were not known to the The died. or editor of be'placed. 'In 1909, the addresses of'more those Year-Book, H., also could not who L. M. found, be have I for 20 to not the 20 the purposes of women'could added medical count than be the total therefore higher than I have number may slightly consistency numerical calculated. Ambitions: 'Driving Women in Dybouse, Pursuit Carol from Figure 2 of a Medical HistorY Reýiew Women Ir No. Vol. 3,1998, p. 32 1. 7, 1890-1939' Education, Churchill, J&A London The from and Prmincyal Medical Directory for England 3 own count Undon), Vol. 1914. Wales, and
412
Table 7.2 Women Medical Practitioners registered in Harley Street, 1888 - 1914. Generation
Surname
Maiden Name
First Names
Date of arrival
1st
Scharlieb
Bird
Mary Ann Dacomb Florence Nightingale Maud Mary Lilian Mary Janet Harriet Janie Lorimer Mary Ethel Sim Louisa Garrett May
1888
Total Age on Year years arrival of death if in Harley St 19244 37 43
1891
1910
20
36
1910
1899 1902
1946 1907
48 6
31 33
1902
1938
37
39
1938
1904
1945
41
31
1945
1904
1926
23
34
1926
1905
1913
9
32
1905
19145 10
44
1906
1909
52
1906 1907
19146 9 1909 3
1907
1910
4
35 Not known I 37
1907 1908
1907 1912
11 5
30 I 46
1908
1915
8
1909
19497 41
41
1911
1928
18
48
99
AK
2nd
Boyd
Toms
2nd 2nd
Chadburn Chesney
N/A N/A
Ist
Walker
NIA
2nd
Hawthorne
N/A
2nd
Scharlieb
N/A
2nd
Anderson
NIA
2nd
Thorne
N/A
Ist
Ellaby
N/A
2nd 2nd
r Harman fStei " li De ger
Chamberlain N/A
2nd
Stoney
N/A
2nd 2nd
Taylor Gordon
N/A N/A
2nd
Savill
Blackadder
2nd 2nd
EFlemming VaughanSawyerr Iig
Vaughan
Charlotte Louisa Katherine Adele Isabella Florence Ada Mary Flint Mary Louisa Agnes Forbes Ethel May
Wood
Last year
I
4
1909
33
in demolished Street 1924, Harley in in her then house she was moved with Scharlieb's 4 'Dame Mary Scharlieb'BMJ, Nov. 29,1930, p. 937. Walker, Jane Park. Regent's in son Thorne 1094, 1, from Nov. 3,195 BMJ, in Thorne', 1914, Way p. retired practice Anon, 5 dates her Directory 1921. Medical The retirement as however her Harley Street 1941, but Harman at address until was registered ceasedto Katherine 6 She Nathaniel in Bishop 1914. Harman, to the was the of married war start a at practice Harley Street consulting ophthalmic surgeon. in her from 1949 Harley Street at practice retired address. 7Vaughan-Sawyer
413
Generation
Surname
Maiden Name
First Names
Date of arrival
Last year
Total years
Age on arrival
2nd
N/A
Eleanor
1912
1934
22
38
2nd
DaviesColley Mecredy
N/A
1912
1938
27
33
2nd 2nd 2nd
Addison Alstrom Briscoe
Brown N/A Stagg
Emily Mary Spencer Kate Hedda Grace
1914 1914 1914
1938 1925 1936
25 12 23
40 52 33
Yearof death if in Harley St 1934
Notes in bold. The for first Table 7.2, the The generation are sources were as of 1. surnames follows: The Medical Directory, vols. 1888-1914, Medical Register, vols. 1888-1914, noý; no, 1888-1914, application forms from the archives of the Royal Free Hospital, General Council Register Glasgow University, General Council Register University of Edinburgh, is in The Medical Directory from 1908 Kelynack, McLaren Violet Clara n6e and obituaries. however, did Street, following her in Harley she not practice medicine to 1909 as practicing N. Kelynack in 1904. See Medical Woman ý;Journal, 47, Nov. 1940, pp. Theo. to marriage however, from She did the Kelynack completely withdraw medical not, arena. was 341-342. for for 20 years was the secretary to the women and a profession as medicine of a supporter Medical Women's Federation. See Medical Woman ýRJournal, 47, Nov. 1940, pp. 341-342. As details in Harley Street the cohorts database of who'practised' medicine contains only the did not, she has been excluded from this data. This is also the case Kelynack Violet and as Francis Evans n6e Piercy, who also did not practice Anne with Street is date in Harley in Street the the date of registration The according to 2. of arrival be There Directory. Medical may some cases where the medical practitioner arrived The during the course of the previous year, though not registered at their Harley Street address have kept I date To be the the beginning that consistent, new year. of arrival of as the until by The Medical Directory. For example, see Anna and Michael Smith Dr Jane maintained (Suffolk, HosPitfil, no date, but probably 20th Century), p. 55. According to Walker andher Street in Harley Tbe MedicalDirectory 1901, Walker to though Dr moved the authors, 1902. there her after as arrival records
414
Table 7.3 Medical Schools attended by female medical practitioners in Harley Street Medical School (primary medical qualification, MB, BS or LSA)8 Medical College for Women Edinburgh9 London Medical School for Women (L. M. S.W.) Glasgow School of Medicine for Women (Queen Margaret College)10 .-University of Paris Grand Total
PERIOD - FROM DATE OF ARRIVAL IN HARLEY STREET Year Women 18881895Grand 19051894 1904 Total 1914 admitted 1889 1 1 1874
2
3
15
20
1890
I 1
1
2
186711
1, 51
1. 17
1 24
2
Source: Medical Directory, Scharlieb, Appendix 'Women in the Medical Profession' and Obituaries.
8 M. Scharlieb did part of her training at Madras Medical School and received a diploma, however she attended the LSMW in 1878 and took the MB and BS (London University) in University the She attended of Vienna. Jane Walker also attended the 1882. also University of Vienna and Hedda Alstom attended the University of Durham. 9 The school amalgamated with the mens extra-mural college in 1909. 10Queen Margaret College, Glasgow was founded in 1889 its medical school opened in 1890. Through a deed of incorporation in 1895, the College changed its name to the womelfs department of the University of Glasgow. Alexander, First Lad; es ofMed; cjnO, pp. 6- 6. ý; Marge Wom Parasols: Th the BI of 11 ake, e en En try to the Medical Profess! 64 p. 207.
415
Table 7.4 Hospital and other medical posts held by Female Medical Practitioners in Harley Street HOSPITAL Belgrave Hospital for Children (Incorporated) Blackfriars Skin Hospital East London Children's Hospital Shadwell . East Anglian Sanatorium for Consumption Essex County Asylum, Brentwood Evelina Hospital for Sick Children Mission Hospital for Women and Children, Canning Town12 Hospital for Women, Euston rd. ._New Royal Free Hospital St. John's Hospital for Diseases of the Skin (Incorp. ) No current hospital attachments on date of arrival I --. bource. - varaDase
1888-1894
1895-1904
1905-1914 1
Total 1
1
1 1
1 1
1
1
2 1
6 5 2
8 6 2
1
3
7
11
12The Mission Hospital for Women and Children in Canning (1900) arose out of the Canning Town Women's Settlement Dispensary, the of expansion which had been set up in Stormingthe Citadel, p. 147. Bell, 1891,
416
Table 7.5 Membership of Medical Societies SOCIETY MEMBERSHIP.
YEAR OF FOUNDATION. 13
Association of Registered 1879 Medical Women 1832 British Medical Association 1841 Medico-Psychological Association 1858 Obstetrical Society of London 1897 R15ntgenSociety 15 Royal Society of Medicine 1907 1884 Society for Study of 16 Inebriety 1893 Society of Anesthetists 1902 Therapeutical Society No Society Memberships I N/A Listed17
YEAR WOMEN FIRST ADMITTED. 1879
NUMBER YROM HARLEY STREET. 8
33.3%
1873/414
6
25.00%
1888
1
4.16%
1902
2
8.30%
1897 1907 1884
1 1 1
4.16% 4.16% 4.16%
1894 1902 N/A
1 1 8
4.16% 4.16% 33.3%
HARLEY STREET. %
13The participants were all members and there was one fellow of the Royal Society of fellow Medicine and one of the Obstetrical Society of London. 14Garrett Anderson was the only woman member of the BMA until the exclusion clause Louisa Garrett in 1892. Anderson, Elizabeth Gartwu Anderson, removed p. 262. was in honour Wilhelm Conrad R6ntgen (1845-1923) who Society The named was of 15 discovered the first xTay in 1895. 16The Society, which, was based in 133 Harley Street, studied the cause and effects of alcoholism. did Directory Nedfcal The not reflect the true total of society memberships, for example 17 Mrs Addison, Dr Alstram and Miss Mecredy were all members of the Association of Registered Medical Women in 1913-1914;they did not, however, return these memberships Directory. See, Wellcome, 'List of Members' 1913 1914 archives of the Me&cal Tbe to Association of Registered Medical Women, MWF/C. 74
417
Table 7.6 Additional Society Memberships Acquired at Date of Departure from Harley Street SOCIETY MEMBERSHIP Royal Society of Medicine British Medical Association Medical WomeWs Federation Association of Registered Medical Women Physiological Society Pathological Society of Great Britain and Ireland's Obstetric & Gynecological Society London Association of Surgeons Great Britain
YEAR OF FOUNDATION.
1907
YEAR WOMEN FIRST ADMITTED. 1907
NUMBER FROM HARLEY STREET. 10
41.67
1832
1873/4
5
20.83
1917
1917
4
16.7
1879
1879
3
12.5
1876 1906
1915 1906
1 1
4.16 4.16
1929
1929
1
4.16
1920
1920
PERCENTAGE %
4.16
is This society, which was established in the University of Manchester, is not the same as (1846 Society in London 1907). Pathological the -
418
Some Publications by Harley Street Women Mary Scharlieb,
ffIat
it Means to MazTy, * or, Young Women and Marriage
(London, 1914). (London, Children, EnAgh HO 1918). ten to Our w -Straight -
Talks to Women(London, 1923).
The Batchelor Womanandher Problems (London, 1919).
Mary Scharlieb and A. Sibly, Youth and Sex: Dangers and Safeguards for Girls and Botvs(London, 1913). Mary L. Gordon, Penal Discipline [as Applied to Women], (London, 1922). Jane Walker, The Modern Nursing of Consumption (London, 1904). -
Handhook for Mothers: heing Simple Hints
to Women on the
M, qnagement of their Health during Pregnancy and Confinement, (London, 18 -3).
Agnes Forbes Savill wrote a number of books in her own right including (London, Character 1927) and The Hair and Scalp: a Health Music, and (London, She 1935). Study, was co-author with her husband Clinical Clinical MetHeine, She 1910-1942. SaýiMr also wrote a book and Thomas of EneyelopaeeffaBritannica on Alexander the Great. for articles
419
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In Memoriam
Ernest Hart, M. R. CS., D. CL. for over thirty years editor of
the British Me&cal Journal andfor
Twenty-five years Mairman
of the
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