Medicine in Modern Britain 1780-1950

Deborah Brunton

• Publisher: Routledge
• Year: 2018
• ISBN:
  9780429949098
• Edition: 1
• Topic: Historia
• Subtopic: Historia del mundo

Medicine in Modern Britain 1780–1950 provides an introduction to the development of medicine – scientific and heterodox, domestic and professional – in Britain from the end of the early modern period and through modern times. Divided thematically, each chapter within this book addresses a different aspect of medicine, covering diseases, ideas, practices, institutions, practitioners and the state.

This book centres on an era of rapid and profound change in medicine and gives students all they need to establish a solid understanding of the history of medicine in Britain, by offering a clear and coherent narrative of the changes and continuities in medicine, including names, dates, events and ideas. Each aspect of medicine discussed within the book is explored and contextualised, providing an overview of the wider social and political background that surrounded them. The chapters are followed by a documents section, containing important primary sources to encourage students to engage with original material.

With a selection of images, tables, a who's who of all the key people discussed and a glossary of terms, Medicine in Modern Britain 1780–1950 is essential reading for all students of the history of medicine in Britian.

Part I
Introduction

1 Introduction

This book aims to provide an introduction to medicine in Britain between 1780 and 1950 – or, to use the historian’s terminology – from the end of the early modern period through the modern period. (Events after 1945 are usually designated as ‘contemporary history’.) This is a significant era: it saw the emergence and establishment of scientific (or Western) medical ideas, practices, and institutions in Britain, alongside other and older systems of medicine. The book assumes no prior knowledge of the subject. Each chapter addresses one basic aspect of medicine in the past – diseases, ideas, practices, institutions, practitioners and the state – and sets out to explain what happened, where and why, as well as introducing some of the central figures associated with the topic.

Even though it is not intended as a historiographical essay that analyses the scholarship on the topic, this book inevitably reflects the literature on the history of medicine in the early twenty-first century. History of medicine as an academic discipline is relatively young: it was only established in the 1970s. Since that time, researchers have moved away from a traditional concern with those great steps forward, such as the development of anaesthetics or antiseptics, which seemed to lead to modern medicine. Historians began to explore much broader fields of medical experience. They grappled with making sense of medical ideas and practices in the past that now seem irrational, showing how the use of medicines that caused patients to vomit, sweat, or urinate were a rational response to illness, when understood within the framework of humoural medicine. Instead of dismissing heterodox and unqualified practitioners as medical frauds, historians explored the reasons for their continuing popularity. In recent years, the scope of the field has continued to expand to cover topics on the borderline of medicine and other aspects of society, such as the relationship between health and beauty. Researchers now use medical issues to analyse broader historical questions: for example, the development of public health initiatives has been used as a means to analyse the shaping of nineteenth-century government administration. Research papers, once found only in specialist journals such as Medical History or Social History of Medicine are now published in a wide range of history journals. As historians’ approach to medicine has shifted, so has their focus of research and the scope of the field. The strong interest in eighteenth-century medicine and the patients’ experience of illness that dominated in the 1980s has given way to studies of nineteenth and twentieth century medicine, including explorations of the role of government in health, of the work of charities and voluntary bodies, practitioners’ experiences of working within medicine, and medicine practiced within the home.

Much research in the history of medicine is underpinned by a common approach. In the 1970s, developments in medicine were seen to be driven by the internal logic of ideas and the work of doctors. From the 1980s, historians of medicine have sought to locate change within its social, political and cultural context. In this reading, developments in medicine were not inevitable, but emerged, were taken up, dropped and shaped within a particular set of circumstances. For example, efforts to control cholera were not motivated simply by a desire to help poor victims of the disease, but rather to protect local economies which always suffered during epidemics. Similarly, the desire to exclude women from the medical profession reflected widely held ideas about their inability to study and to deal with the difficulties of medical practice, but it was also informed by a concern that the medical profession was overcrowded, with too many practitioners chasing the fees of too few patients. In such circumstances it made sense to male practitioners to marginalise a new group of rivals.

Some historians have gone beyond seeing social factors shaping medicine, and have argued that medicine is socially constructed. In this reading, diseases are not constant biological entities but products of a particular time and place. Practitioners, they argue, created illnesses by noting certain phenomena and fitting them into frameworks of theory, which explains why diseases have appeared and disappeared within the historical record. While most historians shy away from the notion that diseases have no biological reality, it is widely acknowledged that understandings of disease have changed significantly over time. ‘Heart attacks’ only appeared in medical records in the late nineteenth century, although undoubtedly people had suffered from this condition for hundreds of years. However, their symptoms were understood and labelled in different ways.

Historians’ focus on the factors shaping medical practice has helped to highlight variations in experience across different populations – between rich and poor, urban and rural, and between different geographical areas. It also meant that ideas of progress lost their central position: medicine was no longer a succession of great improvements, usually attributed to the work of great men. Historians of medicine continue to have a slightly uneasy relationship to the concept of progress. Few academics would frame their work as tracing a shift from bad to better knowledge and practice, but notions of progress and improvement cannot be written out of history. While medicine continues to have a 100% failure rate – we all die – there has been a huge improvement in life expectancy, in the chances of surviving illness, and reductions in the levels of discomfort that patients suffered between the early modern period and the present day.

A shared approach which emphasises social factors does not, of course, mean that historians always agree on the interpretation of the past: the history of medicine has its fair share of historiographical debates. Researchers have disagreed over many topics, including the usefulness of the concept of professionalisation when analysing changes to medical occupations, the impact of public health measures in reducing incidence of infectious disease, to what extent there was a decline in infectious disease, and the relationship between clinical and laboratory medicine.

Historians of medicine have devised a number of schemas to characterise change over time. One of the most widely used is that of Nicholas Jewson, who divided medicine from the eighteenth to the twentieth century into three phases. Bedside medicine dominated in the eighteenth century, with patients and practitioners collaborating and negotiating over diagnosis and therapy. Practitioners took control of the medical encounter in the nineteenth century with the emergence of hospital medicine, with its new theories of disease and new methods of diagnosis. Their authority was further consolidated in laboratory medicine, as they possessed increasingly technical information on patients’ physiology and pathology. Jewson’s overview emphasises the relationship between knowledge and the division of power between patients and practitioners. John Pickstone’s schema of twentieth-century medicine emphasises the role of the state and political interests. Productionist medicine, associated with the expansion of welfare in the early twentieth century sought to improve the health and strength of the workforce. Mid-century medicine was communitarian in character and featured collective action, most notably the founding of the NHS (the National Health Service). The late twentieth century (which falls outside the scope of this study) Pickstone characterised as ‘consumerist’ medicine, where patients were increasingly free to choose from a range of public and private medical services.

While each chapter of this book explores a different aspect of medicine, all address a common theme of change and continuity. Between 1780 and 1950 there were significant developments in all areas of medicine, but the rate of change varied significantly: compared to the rapid adoption of new theories there was much greater continuity in the use of therapeutics. Each chapter also attempts to give some sense of the variations in medical practice and patients’ experience of illness across class, age and gender, and in different geographical areas within Britain. Comparisons of medicine within the different nations provide a useful tool to tease out the working of social and cultural factors on medicine, although they are limited by the available literature. The bulk of British history of medicine deals with England: medicine in Wales remains under-researched, although there is a growing body of material on both Scotland and Ireland. For much of the period from 1780 to 1950, the whole of the island of Ireland was part of the United Kingdom, and for the sake of continuity, material on both parts of Ireland after partition in 1921 is included where appropriate. Only lack of space has prevented the inclusion of material on medicine in the Empire.

Part II
Narrative

2 Disease in modern Britain

The landscape of disease forms the context for any history of medicine: the prevailing diseases at any time defined the experiences of patients and how long they lived, and shaped the work of practitioners, institutions and the state. However, mapping disease over time is a complex process. Different generations of doctors understood illness in different ways. Late eighteenth century practitioners identified diseases by their pattern of symptoms but by the mid-twentieth century, practitioners defined illnesses by their causative agent such as a specific bacteria or virus or a malfunctioning organ or tissue. Thus diseases changed their identity over time. Complaints labelled ‘fever’ in the eighteenth century had, by the twentieth century, been re-categorised as typhus, typhoid fever and other infections that caused a high temperature.

Nevertheless, it is possible to draw a general picture of illness in Britain between 1780 and 1950. Records of mortality – of causes of death – show that from the late eighteenth until the early twentieth century, most people died from infectious diseases such as tuberculosis, fevers, pneumonia, smallpox, and measles. Vast numbers of infants died from diarrhoea, convulsions and ‘teething’, all of which were linked to dirty living conditions. In the middle of the twentieth century the pattern of deaths shifted to one similar to the present day, with more people dying in later life from heart disease, strokes and cancer. Figures on disease taken from mortality records inevitably give only a partial picture – they tell us what diseases people died from but not the much greater numbers of illnesses that they survived. Records of morbidity – of all forms of illness – are available from the nineteenth century and present a more stable and familiar picture of diseases, dominated by cases of colds, stomach upsets and bad backs.

Death and disease

Data on causes of death in Britain for the late eighteenth century is patchy. There is a comprehensive set of records available for London, where, from the sixteenth century, parish officials compiled and published bills of mortality to alert residents to the presence of plague and other diseases. Outside the capital, some (although by no means all) parish registers reported the cause of death of those buried in their churchyards. In addition, a number of medical practitioners collected and analysed data on causes of death for their local town (Rusnock, 2002). Table 2.1 gives figures on the causes of death in Carlisle, collected by John Heysham, a local practitioner. In many ways these are typical of the eighteenth-century mortality data, and reveal the difficulties of understanding what diseases were prevalent in the past. Many of the causes of death listed here appear very strange to modern eyes. In medicine in the twenty-first century, each disease has a specific biological basis – they are caused by infection with a micro-organism, a malfunction in an organ or tissue, or some genetic mutation. In the eighteenth century, diseases were categorised by their pattern of symptoms and the sensations experienced by patients. For example, fever is now a symptom, defined by a raised body temperature; in the eighteenth century it was a disease diagnosed by the experience of feeling hot or cold, excessive sweating, flushed skin and delirium (Hamlin, 2014). Fever was divided into different types: ‘putrid’ fever, for example, produced blotches on the skin and was associated with groups living in crowded conditions such as prisoners, sailors and soldiers [Document 1, p. 123]. Putrid fevers probably included cases of what would now be diagnosed as typhus, but we should not assume that every case of putrid fever was in fact typhus. Similarly, consumption – a disease associated with wasting of the body – is often equated with modern tuberculosis, but deaths from consumption could well have resulted from other diseases such as cancers.

Table 2.1 Selected causes of death in Carlisle, 1779 and 1781–1787

	Number of deaths	% of deaths
Smallpox	238	14.7
Decay of age	226	13.9
Consumption	214	13.2
Weaknesses of infancy	204	12.6
Thrush	65	0.4
Nervous fever	59	0.4
Dropsy	49	0.3
Putrid fever	43	0.3
Scarlet fever	39	0.2
Apoplexy	32	0.2
Measles	31	0.2
Asthma	27	0.2
Worm fever	27	0.2
Cancer	5	0.03

Source: Taken from H. Lonsdale (ed.) (1870) The Life of John Heysham, M.D., pp. 53-54. The data for 1780 was omitted in the original table.

Despite the problems of understanding many disease categories, mortality data combined with contemporary accounts of disease allow historians to construct a picture of death and disease in the late eighteenth century. Deaths were predominantly caused by illnesses that we would categorise as infections – fever, smallpox, measles, whooping cough, scarlet fever and consumption. Smallpox was a particularly deadly disease at this time. Almost everyone caught smallpox, usually during childhood. It was highly dangerous: around one in ten victims died, while survivors were often left scarred by the rash or ‘pocks’ but were left immune to further attacks (Mercer, 2014).

Some groups within the population suffered particularly high levels of mortality. Large numbers of infants died from convulsions and ‘teething’. Neither of these condition are now believed to be dangerous, but in the late eighteenth century, the period when infants cut their first teeth was seen as a perilous transition from helpless infancy to more independent childhood. Historians have suggested that many of these deaths were caused by weaning and the shift to eating solid food, often contaminated by microorganisms, which caused diarrhoea, and, in severe cases, dehydration and convulsions. The elderly also suffered from high mortality: their deaths were often recorded under vague categories such as ‘decay’ or simply ‘aged’.

The Carlisle data gives a picture of mortality in a substantial town, with a population of around 8,600 people at the end of the eighteenth century. Townspeople experienced a rather different pattern of disease to those living in rural areas. They were exposed to frequent outbreaks or epidemics of infectious diseases. For example, in Carlisle, smallpox was present in most years, but the numbers of deaths varied widely, from the 90 victims of a major outbreak in 1779 to just one in 1786 (Mercer, 1990, pp. 59–67). More extreme patterns were observed in isolated communities: when smallpox arrived on the remote island of Foula in Shetland in 1720, the population was all but wiped out. By contrast, in major centres of population such as London, which had a population of around 700,000 in the middle of the century, infectious diseases were endemic: they were present at all times and caused roughly similar numbers of deaths each year (see Table 2.2).

Compared to the snapshots of mortality in specific locations available in the eighteenth century, there is a vast and comprehensive amount of data on cause of death from the middle of the nineteenth century, when the government began to collect records of births, marriages and deaths as part of a wider movement to accumulate data on social issues. T...

Table of contents

• Cover
• Title
• Copyright
• Contents
• List of figures and tables
• Chronology
• Who's who
• PART I Introduction
• Part II Narrative
• PART III Assessment
• PART IV Documents
• References
• Glossary
• Further reading
• Index