Wednesday, May 23, 2007

Medical doctors in the Victorian Era...

After much tasking and trouble, I have finally formalized my medical certifications. The methods and background of medical accomplishment was quite different during Victorian England, as opposed to the modern era. I have an except from my library which explains it better than I...

"... the rich got a physician, the poor got the apothecary, and one may call for a surgeon..."

Physicans had the most prestige in the 1800s. They were called physicians because they only administered drugs, or "physic". They did not deal with external injuries or perform surgeries or set bones or do physical exams, other than the patient's pulse and urine. They took detailed case histories and then wrote out a perscription to be filled by an apothecary.

"Professional practice" as George Eliot dryly observes in Middlemarch, "chiefly consisted in giving a great many drugs. Physicians made up only a tiny handfull of the doctors precticing in early ninteenth-century England, but were concentrated in London, where it was perhaps easier to to find a substantial patient population of wealth and social standing. To practice as a physician in London, you had to be licensed by the Royal College of Physicians. If, in addition, you had gone to Oxford or Cambridge, you could become a Fellow of the College (F.R.C.P.) too, which meant a good deal more status, exemption from unpleasant things like jury duty, and the right to a say in the internal governance of the college.

There was no systemof medical school training and only a handful of hospitals (in 1851 there were only some 7,500 hospitals in the United Kingdom, out of a population of 18 million). No doubt if there had been any medical schools, many of the physicians would have not been interested in them anyways, because they believed quite firmly that medicine was to be taught largely out of books, and antiques ones at that. As late as 1819, the licensining exam given by the Royal College could require the applicant to construe passages from first-century and seventeenth-century medical texts; the fellowship exam took place entirely in Latin. For to be a physician was rather to be a gentleman (their wives could be presented in court, while those of surgons could not), and anything that smacked of manual labor - for example, cutting people open or doing serious physical exams, was not gentlemanly. Tapping on the chest and the use of the stethoscope were apparently slow to be adopted in British medicine for just that reason.

Next below the physicians in the medical hierarchy were the Surgeons. They were the men who cut people open, dealt with fractures, skin diseases, V.D, eye problems - anything, in short, for which a physician could simply not give a perscription. From a social point of view, the problem with being a surgeon was that the actual work involved was like manual labor; you did, after all, use your hands to treat people and did something with them - unlike the physician - besides just write on a piece of paper.

In addition, it had not been so long - 1745 in fact - since surgeons had been formally linked with barbers, and what's more, until 1833 surgeons got the bodies on which they learned their anatomy from graveyards - sometimes by rather unscrupulous means.Perhaps because of this difference in status, the physiciann was usually addressed as "Dr.", while the surgeon made due with plain "Mr.". On the other hand, you did need a license to practice surgery, and it cost less to tran as a surgeon than a physician. The cost of the usual necessary preliminary education at Oxford and Cambridge put physic out of reach for most poor boys. Instead, surgery was learned, like other manual skills, largely by being apprenticed.

If you really wanted to find out what was going on in the surgical world, you went to Edinbrugh and Paris. However, the boundries between the physician and suregon began to blur as the century wore on. The suregons tried to make themselves more prestigious by allowing the Royal College of Surgeons in London to create Fellows like the one physicians had. At the same time, with scientific discoveries coming thick and fast, it was becoming apparent to even the physicians that you now had to study germs and bodies in the same way a surgeon did. Hence, the rise of the "General Practitioner" - the man who... "resolved to resist the irrational severance between medical and surgical knowledge", as Elliot puts it. Such a man, knowledgable in both physic and surgery, became an increasingly influential figure in the English medical world.

And then there was the apothecary - the man for whom Mrs. Reed sent to attend Jane Eyre while her own children were cared for by a physician. The apothecary was the lowest man on the medical totem pole. He was originally only supposed to make up prescriptions form the physicians, but in many areas there was no physicians, so the apothecary began giving advice, too. This was officially permitted in the eighteenth century - but with the stipulation that he could not charge for the advice, only for the drugs. Like the surgeon, he learned his trade by apprenticing himself to a man with experience. He was selling things over the counter, and hense, "in trade", which made him hoplelessly lacking in social status."

- Pool, D. (1993). "What Jane Austin at and Charles Dickens knew - from fox hunting to whist - the facts of daily life in 19th century England", pgs 249 - 250. Touchstone : New York.

This was a "small" overview of English medical practices. With perservence, and a bit of assistance from my dear uncle (to overcome some professional faux pas), I was granted my physician's license, in spite of my use of foreign medical practices, including skills I learned in the far east, to assist the ill. I now feel comfortable using my proper title, Doctor, although my patients are less concerned with my social accoutriments and more with resolving their aches and pains!

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