Performing Medicine: Medical culture and identity in provincial England, c.1760–1850 9781526129710

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Performing medicine

Performing medicine Medical culture and identity in provincial England, c.1760–1850

M I CH AEL BROWN

Manchester University Press Manchester

Copyright © Michael Brown 2011 The right of Michael Brown to be identified as the author of this work has been asserted by him in accordance with the Copyright, Designs and Patents Act 1988. Published by Manchester University Press Altrincham Street, Manchester M1 7JA, UK www.manchesteruniversitypress.co.uk

British Library Cataloguing-in-Publication Data is available Library of Congress Cataloging-in-Publication Data is available ISBN 978 0 7190 9557 3 paperback First published by Manchester University Press in hardback 2011 This paperback edition first published 2014 The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-party internet websites referred to in this book, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.

Contents

List of figures Acknowledgements List of abbreviations Introduction 1 The Doctors Club: politeness, sociability and the culture of medico-gentility 2 Polite and ornamental knowledge: medicine and the world of letters 3 The asylum revolution: politics, reform and the demise of medico-gentility 4 The march of intellect: social progressivism and the transformation of provincial medicine 5 Guardians of health: cholera, collectivity and the care of the social body 6 True heroes and healers: expertise, authority and the making of medical dominion Epilogue: pasts, present, futures Select bibliography Index

vi vii ix 1 13 48 82 113 150 193 223 232 244

Figures

1 John Raphael Smith, ‘Alexander Hunter’, mezzotint after himself, 1805. Reproduced courtesy of the Wellcome Library Iconographic Collection, London 2 William Etty, ‘James Atkinson’, oil painting, 1832. Reproduced courtesy of the York Museums Trust (York Art Gallery) 3 William Sharpe, ‘John Hunter’, 1788, line engraving after Sir Joshua Reynolds, 1786. Reproduced courtesy of the Wellcome Library Iconographic Collection, London

62 127 128

Acknowledgements

Nearly a decade has passed since I first began research on the PhD from which this book is ultimately derived. In that time I have been a student, lecturer and research fellow in three separate academic institutions and have accrued a far greater debt of gratitude than it is possible to repay in such a form as this. If there is anyone I have neglected to thank individually then I apologise and will do my best to make amends. The research for this book would not have been possible without the generous support of the White Rose University Consortium who funded my PhD in the Department of History at the University of York. The Wellcome Trust likewise provided essential financial and professional support by awarding me a Research Fellowship which I held at the Centre for the History of Science, Technology and Medicine at the University of Manchester between 2007 and 2010. This post not only allowed me to continue work on the book but also enabled me to develop and expand my research interests within the social and cultural history of medicine. For their tireless and ever-patient assistance I would like to thank the staff of the British Library, J. B. Morrell Library at the University of York, John Rylands Library at the University of Manchester, National Archives, Oxford University Museum of Natural History, Royal Botanic Gardens, Royal Society, Templeman Library at the University of Kent and Wellcome Library. Of especial importance for my research were the various archival repositories in York which act as custodians for that city’s rich historical record. Particular thanks therefore go to the staff at the Borthwick Institute for Historical Research (most notably Katherine Webb), York Art Gallery, York City Archives, York City Library, York Minster Library and Yorkshire Philosophical Society. This book would not exist without their help. During my career to date I have benefited enormously from the advice, criticism and support of friends, colleagues and fellow-travellers. It is impossible to acknowledge everyone who falls into this category. Nevertheless I would like to acknowledge the particular debt of gratitude I owe to my PhD supervisor, Mark Jenner, whose unstinting support, critical encouragement

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and personal friendship have shaped and inspired me far beyond my doctoral studies. As a PhD student at the University of York I was also fortunate to be part of a wonderfully stimulating and collegial postgraduate community, many of whom remain dear friends. Notable among these are Neil Armstrong, Melissa Hollander, Catriona Kennedy and Helen Smith. Between 2005 and 2007 I lectured in the School of History at the University of Kent and I would like to thank all of those who made my time there a most pleasant one, especially Angela Crolla, Tim Bowman, Karen Jones, Joe Street and John Wills. While at the Centre for the History of Science, Technology and Medicine at the University of Manchester I profited from numerous conversations with members of staff including Ian Burney, John Pickstone and Michael Worboys. The Centre is particularly notable for having what must be one of the most vibrant postdoctoral communities in the country. All on the ‘West Wing’ made my time in Manchester both memorable and profitable but particular thanks go to Neil Pemberton and Vicky Long with whom I shared many a stimulating, good natured and supportive exchange of ideas. Finally I would like to thank the history staff at Roehampton University where I recently relocated for having placed their faith in me and for allowing me to continue my long-standing love affair with the study of history. Writing a book requires far more than academic support and I would therefore like to conclude by acknowledging the essential role played by my brother, Andrew, and my parents, Monika and Stephen. Words can hardly convey how much I owe them, except to say that their unstinting love and encouragement has been a constant source of inspiration, support and consolation during the trials and tribulations of an early academic career. This book is, and will always be, for them. Brief sections of Chapters 1 and 5 have already appeared in print as ‘From the Doctors Club to the Medical Society: medicine, gentility and social space in York, 1780–1840’, in Mark Hallett and Jane Rendall (eds), EighteenthCentury York: Culture, Space and Society (York: Borthwick Publications, 2003). A version of Chapter 3 was published as ‘Rethinking early nineteenthcentury asylum reform’, Historical Journal, 49:2 (2006), 425–52 and sections of Chapter 6 have appeared in ‘Medicine, quackery and the free market: the “war” against Morison’s Pills and the construction of the medical profession, c.1830–c.1850’ in Mark S. R. Jenner and Patrick Wallis (eds), Medicine and the Market in England and its Colonies, c.1450–c.1850 (Basingstoke: Palgrave Macmillan, 2007).

Abbreviations

BIHR BL DNB Kew OUM RS UCL YC YCA YChr YCL YG YH YML YPS

Borthwick Institute for Historical Reasearch, York British Library, London Oxford Dictionary of National Biography (Oxford: Oxford University Press, 2004) Royal Botanic Gardens, Kew Oxford University Museum of Natural History Royal Society, London University College London York Courant York City Archives York Chronicle York City Library Yorkshire Gazette York Herald York Minster Library Yorkshire Philosophical Society, York

Introduction

I

f you hap p ened t o b e p as s i ng through York in the winter of 1787 you may well have stayed at the York Tavern, the city’s principal coaching inn. Sheltering from the unseasonably stormy weather, you might have delayed your sightseeing for the comparative comforts of a seat by the fire and a copy of the local newspaper, the York Courant. Perusing its pages you would probably have noticed that the citizens of York were as concerned with their health and physical well being as any of their fellow countrymen. Among the many notices on the front page was an advertisement for the ‘Royal Chemical Wash Ball’, which ‘frees the skin from all manner of Deformities as . . . Pimples, Pitts, [and] Redness of the Smallpox’ and which could be purchased from ‘Mrs Ann Robinson, Perfumer, Coney-Street’. Below this was an advertisement for ‘Dr Steers’ Opodeldoc’, an ointment alleged to be ‘of the greatest service in Cramps, in Numbness and Weakness of the Joints, and in restoring a proper Circulation to the Limbs when in a paralysed state’. On the back page was yet another advertisement, this one proclaiming the ‘Extraordinary Efficacy of Dalby’s Carminative in Disorders of the Bowels of Children’ and including letters of testimony from satisfied customers. Like ‘Dr Steers’ Opodeldoc’, ‘Dalby’s Carminative’ could be purchased from a number of local chemists and druggists, as well as from the printers, Henry Sotheran and William Blanchard. Had you dipped into the main part of the paper, however, you would have seen a notice which presented a rather different vision of medical practice in the city: As the Experience of many years has proved the utility of Public Dispensaries in different parts of the Kingdom, the Gentlemen of the Faculty resident in York would not willingly be thought to possess less Humanity than those in other Places. It is upon this principle that the underwritten Gentlemen have formed the laudable Resolution of establishing a DISPENSARY in this City and they do it more readily as they are confident of receiving the Assistance of the Affluent in Support of a Plan that has for its only Object, the Relief of those who are oppressed with Poverty and Sickness.1

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Who exactly were these ‘Gentlemen of the Faculty’ and what distinguished them from the other healthcare practitioners and ‘artisans of appearances’ who graced the pages of the local newspaper?2 A clue lies in those ‘underwritten’ names. Alongside the usual civic worthies one finds ‘Dr Swainston, Dr Hunter, Dr Withers, Dr White, Dr Thomasson, Mr Atkinson, Mr Jas. Atkinson, Mr Champney, Mr Peacock . . . Mr Garencieres [and] Mr Whaley’.3 All of these men were ‘orthodox’ medical practitioners: physicians, surgeons or apothecaries who possessed formal qualifications of their knowledge and skill, normally a university degree in the case of physicians, or a seven-year apprenticeship in the case of surgeons and apothecaries. But these individuals were also distinguished by something less tangible yet just as important. Unlike the purveyors of the ‘Royal Chemical Wash Ball’ or ‘Dr Steers’ Opodeldoc’ they did not appear in the newspaper to promote their goods and services but to exhort their fellow citizens to an act of charity. Disdaining financial self-interest they announced that their ‘only Object’ was the ‘Relief’ of the city’s sick poor. In many ways, however, their notice was no less calculated than the commercial advertisements with which it shared space. In particular, the phrase ‘would not willingly be thought to possess less Humanity than those in other Places’ betrays an anxiety not simply to be charitable but to be seen to be charitable. By thus projecting themselves into the public realm, these ‘Gentlemen of the Faculty’ shaped a highly public identity, one predicated on the values of humanity, benevolence and, above all, gentility. Performing Medicine seeks to explore this vital yet comparatively neglected aspect of medical experience, to examine the ways in which medical practitioners presented themselves to the public and how they positioned themselves within the broader social, political and intellectual landscape. It is a book about late eighteenth- and early nineteenth-century English medical culture, a study of what it meant to be a doctor and how this changed over time. To some this might seem a strange endeavour. Surely, the sceptic might suggest, what it means to be a doctor is a timeless constant, relatively impervious to the vagaries of historical change. Has not medicine always been dedicated to the treatment of sickness and the alleviation of bodily suffering? Do not modern day practitioners trace their lineage back to ancient Greece and do not some medical students continue to take an oath little changed from that of the Hippocratic corpus? Of course at one level this is true. Medicine, as both art and science, has always been concerned with the preservation or restoration of health. And yet this broad continuity serves to disguise the many marked discontinuities which have characterised the meanings, interpretations and practices of medicine throughout the historical past. Even if the basic premise of medicine has remained more or less the same, then the identities of its practitioners, and their interactions with the public and with

Introduction

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each other have not. One of the key points of Performing Medicine is to show that being a doctor in the late eighteenth century was not the same as being a doctor in the mid-nineteenth. More than this, it is to demonstrate how much of what we currently assume about the role of medicine and its practitioners in society, about professional expertise and public service, for example, is rooted in a very particular historical moment and is inextricably related to broader social, cultural and political processes. By focusing on the cultures of medicine and by adopting a chronology stretching from the later eighteenth to the mid-nineteenth centuries, Performing Medicine engages with two major traditions of medical historical scholarship. The first of these, which has had a particularly significant impact on the first half of our period, is known as the ‘medical marketplace’ model. The second, which is particularly relevant to the latter half, concerns the socalled ‘professionalisation’ of medicine. Both of these approaches have exercised a vital shaping influence on understandings of healthcare and medicine in the early modern and modern periods. However, they have also established conceptual frameworks which have tended to constrain analysis and which are in need of reappraisal and revision. The marketplace model of medicine was first developed in the mid-1980s as a way of conceptualising the provision and consumption of healthcare in seventeenth- and eighteenth-century England. Although it has since been applied to a diverse range of contexts, including the ancient Hellenic world, early modern Italy and the nineteenth-century Cape, it is in the field of early modern English history that it retains its greatest analytical currency.4 Through the work of Roy Porter, Irvine Loudon and Anne Digby, medicine in this period has been characterised as an unrestricted free market in which ‘orthodox’ practitioners, such as physicians, surgeons and apothecaries, competed with a wide variety of healthcare providers for those who were increasingly aware of their status as consumers within a commercial economy.5 By shifting attention away from the traditional focus on ‘orthodox’ medicine, such works were, to quote a recent commentator, ‘in the vanguard of a wave of scholarship that . . . began to set out the characteristics of an emergent, diverse, plural and commercial pre-professional system of health care’.6 They have, among other things, made historians more wary of anachronistic assumptions about the cultural and epistemological hegemony of scholastic medicine and have revealed the importance of self-help, spiritual belief, familial relations and the role of gender in the early modern experience of illness and physical suffering. In this sense the marketplace model has been highly valuable. And yet perhaps its greatest shortcoming is a tendency to conflate the general concept of medical plurality with a specifically economic understanding of financial competition.7 As our brief glance at the pages of the York Courant suggests, early modern actors had access to a range of

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potential resources when confronting bodily infirmity. But while scholars such as Porter are right to suggest that physicians, surgeons and apothecaries were by no means the only purveyors of healthcare in this period, this emphasis on plurality has obscured what it was that made certain practitioners different from others. David Harley has already suggested that the medical marketplace model encourages historians to treat all providers of healthcare as ‘social equals, supplying an undifferentiated commodity’.8 And yet it would seem obvious that medical practitioners operated within the same structures of social differentiation and cultural distinction as other historical actors. The contrast between Mrs Ann Robinson selling the Royal Chemical Wash Ball from her perfume shop and the ‘Gentlemen of the Faculty’ soliciting donations for a new dispensary is clearly more than just a difference between two forms of economic practice: it is a contrast between two different forms of social and cultural identity. The analytical weight given to the market has tended to elide these distinctions and to foster the notion that the pursuit of financial wealth was the desideratum of eighteenth- and early nineteenth-century medical practice. It is certainly true that making a living was central to the social aspirations of many contemporary practitioners. However, such accounts tend to neglect the wider dimensions of historical experience, assuming a somewhat unproblematic relationship between financial wealth and social reputation. The actions of medical practitioners are often interpreted as little more than doctors ‘selling themselves’ and the pursuit of social respectability is relegated to a form of ‘product differentiation’. In his study of the social identity of William Hunter, for example, Roy Porter devotes considerable space to his ‘vast riches’ and extensive practice, but gives only a cursory treatment of Hunter’s public display of taste, learning and cultural sophistication.9 Yet it is clear that for an outsider from a relatively modest family background, such displays were central not only to Hunter’s success as a medical practitioner, but also to his acceptance into metropolitan society. Financial wealth, though important, did not, in and of itself, make him a gentleman and neither did it necessitate social approbation. In shaping his identity, Hunter invested in culturally resonant forms of knowledge and cultivated associations with the elite, at court and within social spaces such as the Royal Society, the Society of Antiquaries and the Royal Academy.10 As Thomas Laqueur has noted, by emphasising financial competition between medical practitioners, the marketplace has also presented us with a fundamentally individualistic model of medical practice and experience.11 Yet recent scholarship has suggested that ‘orthodox’ medical practitioners acted co-operatively as often as they did in competition.12 Not only did such relationships make basic economic sense, in that they facilitated access to a larger pool of potential patients and customers, but an integration into vocational and

Introduction

5

social networks was a key determinant of success in this period, not simply as a medical practitioner but, more generally, as a social actor. At another level, this individuating tendency leaves little room for a consideration of collective identities or shared values. Porter’s eighteenth-century medical world is by and large a world of atomised, self-motivated historical actors. By rejecting the analytical categories of Marxist scholarship as well as the reifications of Foucaldian discourse, Porter attempted to assert the historical agency of the individual in the face of abstract historical processes.13 Though in many ways a valuable approach, undermining the grand generalisations of much historical writing, it had a tendency to make his work occasionally rather static; a focus on individual agency is, after all, rarely able to account for broader patterns of historical change. Moreover, his characterisation of medical practitioners often gives little sense of wider medical cultures, of the knowledges and ideas that bound individuals together. If the medical marketplace has provided the normative framework for understanding eighteenth-century English medicine it has found less application in the nineteenth. To be sure, M. Jeanne Peterson and Anne Digby both place economic concerns at the heart of their analyses of nineteenthcentury medical practice, but the conventional historical assumption is that the medical marketplace was an early modern phenomenon which ended around the middle decades of the nineteenth century.14 The factor generally held to be responsible for its demise is the so-called ‘professionalisation’ of medicine. Until recently, this has tended to be a matter of conjecture rather than sustained historical analysis.15 This is largely because the professionalisation narrative, which predates the marketplace model, has remained largely unquestioned, or at least underinterpreted, for so long. Indeed, for almost a generation now the concept of professionalisation has been central to, or at least implicit in, most scholarship concerned with medicine in the nineteenth and twentieth centuries, particularly in relation to the Anglo-American world. The origins of professionalisation as an interpretive device lie more in sociology than in history. From the early 1970s onwards, a number of sociologists began to examine the processes by which modern medicine had attained its social, cultural and legal authority. Many of these studies drew upon the functionalist theories of Max Weber and Talcott Parsons, conceptualising the medical profession as a self-regulating, monopolistic and highly differentiated form of labour characteristic of modern industrial societies.16 A number were also motivated by a body of popular and academic opinion which sought to undermine the intellectual and social hegemony of the medical profession and question the role of state-sanctioned expertise in the ‘medicalisation’ of everyday life. Although predominantly the work of social scientists, many of these studies, including Elliot Freidson’s Profession of Medicine (1970), Jeffrey Berlant’s Profession and Monopoly (1975) and, most notably, Paul

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Starr’s Social Transformation of American Medicine (1982) adopted a historical perspective, tracing the origins and development of the modern medical profession from the nineteenth century onwards. Although this work originated in the United States, similar patterns were also evident in Britain. Indeed, during the 1970s and early 1980s, scholarship on the nineteenth-century medical profession was dominated by historical sociologists such as Ivan Waddington and Sydney Holloway.17 Though insightful, these studies were necessarily refracted by the analytical lens through which they viewed the history of nineteenth-century English medicine. In the preface to The Medical Profession in the Industrial Revolution (1984), Waddington announced that his book was an attempt to understand ‘the emergence of medicine as a modern profession’ against the background of ‘the development of England as a modern industrial society’.18 The use of terms such as ‘emergence’ and ‘development’ hints at the implicit teleology of this approach. By searching for the ‘origins’ of medical professionalisation Waddington necessarily read back from the present on to the past. Though his work provides us with an excellent account of medical politics in the early nineteenth century, such a presentist perspective underestimates the complexity and social/cultural situatedness of political action, viewing ‘occupational closure’ and autonomous self-regulation as the inevitable conclusion to an inexorable historical process. Such works are also characterised by a sociological emphasis upon structures and systems. In Waddington’s study, the ‘development’ of the medical profession is defined almost entirely in terms of legislative enactment, institutional foundation, educational qualifications and compulsory registration. The 1858 Medical Act is presented as having ‘made’ the medical profession by granting it legislative recognition and lending it a semblance of structural coherence. While there is no denying the significance of legislation, or the importance of structural change, such accounts leave little room for historical agency and for cultural or ideological considerations. And yet, as we shall see, when viewed through a more historical lens it is clear that the medical profession of the early nineteenth century was less a structural category than an imaginative concept, a point of individual and collective self-identification which was conditioned by such factors as political ideology and social/spatial location. Performing Medicine is therefore intended to address the relative absence of agency, ideology and ideation within the existing historiography. Instead of focusing on structural, institutional or economic change, it explores developments and transformations within medical culture, identity and performance. In so doing it examines areas of medical experience which have hitherto received comparatively little attention from historians. Though changes in the patient-doctor relationship or in therapeutic knowledge and practice are

Introduction

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clearly relevant to the wider story, this study focuses on the broader aspects of social and intellectual practice by which medical practitioners made themselves known to their fellow citizens. These varied practices can be grouped into two categories which constitute the analytical axis of this book: knowledge and association. Performing Medicine is concerned to explore what the intellectual activities and epistemological forms in which physicians, surgeons and apothecaries invested can tell us about the cultural values of medicine and the identity of its practitioners. Beginning in the late eighteenth century, it considers the role of liberal learning in the elaboration of a medical identity founded upon the values of gentility and politeness. Taking the story into the early nineteenth century, it then demonstrates how this culture of intellectual liberality gave way to one of increasing vocational specificity in which knowledge came to be represented as a socially instrumental form of expertise. This transformation in knowledge was mirrored by a transformation in association. Later eighteenth-century medicine was characterised by a broad social as well as intellectual engagement as its practitioners sought to embed themselves in the formal and informal networks of local society. By the early nineteenth century, however, medical association began to take on an increasingly bounded and exclusive form as practitioners grouped together in vocationally specific societies dedicated to vocationally specific goals, sublimating their individual identities as gentlemen into the collective identity of the medical profession. Needless to say, while Performing Medicine proposes to make an original contribution to historical understanding it is heavily indebted to the work of other scholars in the field, including Ian Burney, Adrian Desmond, Mary Fissell, Ludmilla Jordanova, Christopher Lawrence and John Pickstone. However, perhaps the single most important influence has come from a tradition of American medical historical scholarship epitomised by the work of John Harley Warner. Nearly twenty-five years ago now, Warner used the concept of medical identity as the basis for his Therapeutic Perspective (1986). In this book, Warner suggests that medical therapeutics, including such practices as bloodletting and drugging, were central to the social identities of nineteenth-century American practitioners and to their perception by the public at large.19 Admittedly, Warner’s conception of medical identity is rather narrower than my own and is determined by his focus on therapeutics. Nevertheless, by emphasising the importance of styles of practice and by locating medical practitioners within a broader social and cultural milieu, he was able to break away from teleological and internalist narratives of medical ‘progress’ or structural accounts of medical professionalisation.20 If Warner’s work has tended to focus on knowledge and practice at the highest levels of debate and exchange, in the major urban medical schools and among the Bostonian medical mandarins, then Steven Stowe has presented

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an intriguing glimpse into the quotidian realities of medicine at a more local level. His Doctoring the South (2004) is particularly remarkable for the ways in which it uses letters, diaries and casebooks to build up a rich picture of medical practice in the antebellum South. Like Warner’s work, his book is sensitive to styles of medical practice as he demonstrates how knowledge and skills learned in medical school were shaped and mediated by local cultures, by the expectations of patients and by the networks of social, gender and racial relations within which its practitioners operated.21 Though it is less focused on the patient-doctor relationship than Stowe’s work, Performing Medicine is similarly concerned to understand medicine as a malleable body of knowledge and practice which was shaped by both local circumstances and wider historical forces. Indeed, one of the purposes of the book is to situate the history of English medicine within a broader social, cultural and political context. As such, it does not simply engage with the medical historical literature but reaches out to embrace a much broader range of social and cultural historical scholarship on eighteenth- and nineteenth-century Britain. This includes material on such topics as civic culture, politeness, conviviality, gender, natural history, utilitarianism, political radicalism and social reform. While it proposes a much broader historical argument about the cultural transformation of English medicine, Performing Medicine is a case study of the city of York. Mining a rich archival record including minute books, newspapers, letters and memoirs, it is able to exploit an almost anthropological level of detail in demonstrating how medical culture and identity were elaborated and enacted ‘on the ground’ of everyday experience. York has its own particular advantages as a site for this kind of study. Geographically, its location roughly halfway between London and Edinburgh meant that it was at something of a juncture between the two medical, cultural and political metropolises of mainland Britain. Its relative distance from any other major urban conurbation and its position within a largely rural county also meant that it served, for much of this period, as a centre of cultural production and political power, as well as being the hub for regional medical services. Its medical community, though significant and visible, was, in relative terms at least, reasonably small, and is thus more amenable to detailed social and cultural analysis. Unlike other cities, such as Manchester, which was transformed in the period from the mid-eighteenth to the mid-nineteenth centuries, York was not affected in such a significant way by the processes of industrialisation and urbanisation, processes which posed a unique set of problems and challenges for the local populace in general and for medical practitioners in particular. Having said this, York did not exist in isolation from wider social, economic and cultural patterns. On the contrary, it was emblematic of key

Introduction

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developments. The city was a leading light in the ‘urban renaissance’ which was instrumental in structuring eighteenth-century civic culture.22 Similarly, although it may not have experienced the same level of socio-economic upheaval as major industrial towns and cities, it was nevertheless rent by the political factionalism which characterised the post-Napoleonic ‘age of reform’. Moreover, in medical and scientific terms, while it was not as significant a centre for the production of knowledge as cities such as London, it nonetheless played host to an ideology of socio-scientific progressivism which was of critical importance for the politics of knowledge and the elaboration of medical and scientific cultures in the first half of the nineteenth century. By focusing on York, then, Performing Medicine contributes to a historiography which considers the ways in which provincial cultures were shaped both by autochthonous forces and by a dialectical relationship with the metropolis.23 Performing Medicine is comprised of six chapters. The first three of these cover the period from around 1760 to about 1815 and examine the construction, elaboration and eventual demise of what I refer to as ‘medico-gentility’, a culture of medicine in which identity and social performance were structured by aspirations to gentility and were framed by the values of politeness, sociability and civic engagement. Chapter 1 opens with a brief overview of the social, economic and cultural landscape of late eighteenth-century York before considering how forms of sociability, such as the urban club, as well as more general social strategies, such as marriage and the cultivation of patronage, could allow physicians, surgeons and even seemingly lowly apothecaries to fashion themselves as genteel and upstanding local citizens. Chapter 2, meanwhile, examines the role of intellectual liberality in this process. By examining the literary activities of a number of local practitioners, it demonstrates how public displays of polite and ‘ornamental’ learning were central to the performance of medico-gentility. Chapter 3 then proceeds to explore the incipient demise of this culture. Through a close reading of a scandal which enveloped the York Lunatic Asylum between 1813 and 1815 it explores the ways in which medical identities founded upon gentility and politeness were critically undermined by the political and social factionalism of the early nineteenth century. The last three chapters cover the period from 1815 until around the middle of the nineteenth century and chart the elaboration of a new culture of medicine in which practitioners shaped identities based upon expertise, professional self-identification and a political engagement with the care of the social body. Beginning in the 1820s with the foundation of the Yorkshire Philosophical Society, Chapter 4 looks at medical involvement in the provincial scientific movement, examining how local medical men positioned themselves relative to the so-called ‘march of intellect’, the cultural and ideological alignment between science and social reform. It then explores how, during

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the debates over body-snatching and anatomical dissection which marked the late 1820s and early 1830s, medical practitioners came increasingly to claim social authority based upon utilitarian ideals about the social application of expert knowledge. Chapter 5 continues this analysis in relation to the cholera epidemic of 1832 and the subsequent elaboration of public health as a sphere of medico-political activity. In addition, it also explores the rise of vocational association, demonstrating how such new forms of sociability played a vital role in constructing medicine as a collective and collaborative endeavour. Lastly, Chapter 6 considers how the professional dominion over healthcare was forged by the dual processes of inclusion and exclusion, situating the foundation of the Medical School in 1834 against the trial, in the same year, of a local salesman for James Morison’s ‘Universal Vegetable Medicine’. Performing Medicine offers a new and distinctive account of the history of eighteenth- and early nineteenth-century English medicine, one that places culture at the heart of its analysis. It is also one that has implications for the ways in which we think about medicine today, for if, in the past, the medical profession has been contingent upon wider social, cultural and political forces, then the same is true of its modern incarnation. At a time when talk abounds of de-professionalisation and the erosion of medical authority, there has never been a more appropriate moment to look back on the history of the profession, to consider the origins of those values of expertise and public service which appear to be under threat. For this reason I hope that what follows will be of as much interest to medical practitioners as it is to historians, for medicine’s past might well help to shed light on both its present state and future course. Notes 1 YC, 11 December 1787. 2 The term ‘artisans of appearances’ is taken from M. Pelling, ‘Appearance and reality: barber-surgeons, the body and disease’, in A. L. Beier and R. Finlay (eds), London, 1500–1700: The Making of the Metropolis (London: Longman, 1986). 3 YC, 11 December 1787. 4 R. Porter, ‘The patient’s view: doing medical history from below’, Theory and Society, 14:2 (1985), 175–98; H. Cook, The Decline of the Old Medical Regime in Stuart London (Ithaca: Cornell University Press, 1986); L. Beier, Sufferers and Healers: The Experience of Illness in Seventeenth-Century England (London: Routledge, 1987). For some examples of the range of its application, see V. Nutton, ‘Healers in the medical market place: towards a history of Greco-Roman medicine’, in A. Wear (ed.), Medicine in Society: Historical Essays (Cambridge: Cambridge University Press, 1992); D. Gentilcore, ‘Apothecaries, “charlatans”, and the medical marketplace in Italy, 1400–1750’, Pharmacy in History, 45:3 (2003), 91–4; H. Deacon, ‘The Cape doctor and the broader medical market,

Introduction

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6 7 8 9 10 11 12 13 14 15 16 17

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1800–1850’, in H. Deacon, H. Phillips and E. Van Heyningen (eds), The Cape Doctor in the Nineteenth-Century (Amsterdam: Rodopi, 2004). I. Loudon, Medical Care and the General Practitioner, 1750–1850 (Oxford: Oxford University Press, 1986); W. F. Bynum and R. Porter (eds), Medical Fringe and Medical Orthodoxy, 1750–1850 (London: Croom Helm, 1987); R. Porter, Disease, Medicine and Society, 1550–1860 (Basingstoke: Macmillan, 1987); D. Porter and R. Porter, In Sickness and in Health: The English Experience, 1650–1850 (London: Fourth Estate, 1988); R. Porter, ‘Before the fringe: “quackery” and the eighteenth-century medical market’, in R. Cooter (ed.), Studies in the History of Alternative Medicine (Basingstoke: Macmillan, 1988); Porter, Health for Sale: Quackery in England, 1750–1850 (Manchester: Manchester University Press, 1989); Porter, Doctor of Society: Thomas Beddoes and the Sick Trade in Late Enlightenment England (London: Routledge, 1991); A. Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720–1911 (Cambridge: Cambridge University Press, 1994); R. Porter, Quacks: Fakes and Charlatans in English Medicine (Stroud, Gloucestershire: Tempus, 2000). M. S. R. Jenner and P. Wallis, ‘Introduction’, in M. S. R. Jenner and P. Wallis (eds), Medicine and the Market in England and its Colonies, c.1450–c.1850 (Basingstoke: Palgrave Macmillan, 2007), p. 1. Jenner and Wallis, ‘Introduction’. D. Harley, ‘ “Bred up in the study of that faculty”: licensed physicians in the northwest of England, 1660–1760’, Medical History, 38:4 (1994), p. 398. R. Porter, ‘William Hunter: a surgeon and a gentleman’, in W. F. Bynum and R. Porter (eds), William Hunter and the Eighteenth-Century Medical World (Cambridge: Cambridge University Press, 1985). Porter, ‘William Hunter’, p. 11. T. Laqueur, ‘Roy Porter, 1946–2002: a critical appreciation’, Social History, 29:1 (2004), 84–91. For example, see P. Wallis, ‘Competition and cooperation in the early modern medical economy’, in Jenner and Wallis (eds), Medicine and the Market. Laqueur, ‘Roy Porter’, pp. 85–6. M. J. Peterson, The Medical Profession in Mid-Victorian London (Berkeley: University of California Press, 1978); Digby, Making a Medical Living. For a more recent account, see M. Brown, ‘Medicine, quackery and the free market: the “war” against Morison’s Pills and the construction of the medical profession, c.1830–c.1850’, in Jenner and Wallis (eds), Medicine and the Market. M. Weber, Economy and Society (Totowa, NJ: Bedminster Press, 1968); T. Parsons, The Social System (Glencoe: Free Press, 1951); Parsons, The System of Modern Societies (Englewood Cliffs: Prentice-Hall, 1971). S. W. F. Holloway, ‘The Apothecaries’ Act, 1815: a reinterpretation’, Medical History, 10:2 (1966), 107–29, 221–36; I. Waddington, ‘The struggle to reform the Royal College of Physicians, 1767–1771: a sociological analysis, Medical History, 17:2 (1973), 107–26; Waddington,’General practitioners and consultants in early nineteenth-century England: the sociology of an intra-professional conflict’, in J. H. Woodward and D. Richards (eds), Health Care and Popular Medicine in

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21 22

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Performing medicine Nineteenth-Century England: Essays in the Social History of Medicine (London: Croom Helm, 1977); Waddington, The Medical Profession in the Industrial Revolution (Dublin: Gill and Macmillan, 1984); S. W. F. Holloway, ‘The orthodox fringe: the origins of the Pharmaceutical Society of Great Britain’, in Bynum and Porter (eds), Medical Fringe; I. Waddington, ‘The movement towards the professionalization of medicine’, British Medical Journal, 301: 6,754 (1990), 688–90; Holloway, ‘Producing experts, constructing expertise: the school of pharmacy of the Pharmaceutical Society of Great Britain, 1842–1896’, in V. Nutton and R. Porter (eds), The History of Medical Education in Britain (Amsterdam: Rodopi, 1995). Waddington, Medical Profession, pp. x, ix. J. H. Warner, The Therapeutic Perspective: Medical Knowledge, Practice, and Identity in America, 1820–1885 (Cambridge, MA: Harvard University Press, 1986). See also, J. H. Warner, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton: Princeton University Press, 1998); Warner, ‘The idea of science in English medicine: the “decline of science” and the rhetoric of reform, 1815–45’, in R. French and A. Wear (eds), British Medicine in an Age of Reform (London: Routledge, 1991). S. M. Stowe, Doctoring the South: Southern Physicians and Everyday Medicine in the Mid-Nineteenth Century (Chapel Hill: University of North Carolina Press, 2004). P. Borsay, The English Urban Renaissance: Culture and Society in the Provincial Town, 1660–1770 (Oxford: Clarendon, 1989); Borsay (ed.), The EighteenthCentury Town: A Reader in English Urban History, 1688–1820 (Harlow: Longman, 1990); Borsay, ‘Politeness and elegance: the cultural re-fashioning of eighteenthcentury York’, in M. Hallett and J. Rendall (eds), Eighteenth-Century York: Culture, Space and Society (York: Borthwick Publications, 2003). This literature is too vast to list here, but for an overview of the issues, see D. Wahrman, ‘National society, communal culture: an argument about the recent historiography of eighteenth-century Britain’, Social History, 17:1 (1992), 43–72.

1

The Doctors Club: politeness, sociability and the culture of medico-gentility

As to the general character of a physician’s manners, I see no reason why they should be different from those of a gentleman. J. Gregory, Observations on the Offices and Duties of a Physician (1770)1

I

n 1763 the p reamb le to the local Cleaning and Lighting Act announced that York was the ‘Capital City of much of the Northern Parts of England . . . a place of great Resort, and much frequented by Persons of Distinction and Fortune’.2 Though undoubtedly coloured by the rhetorical presumptions of civic pride, this statement reflected York’s age-old standing as one of England’s most important cities. Ever since Roman times York had functioned as the administrative centre for much of the north of England and from the medieval period it was also the seat of the country’s second most important prelate. The city had thrived as a trading centre during the Middle Ages and to a lesser extent under the Tudors but had experienced something of a downturn during the seventeenth century. By the eighteenth century, however, York’s fortunes were on the rise again as it exchanged faded medieval glory for a neatly paved and brightly illuminated vision of Georgian prosperity. From a purely demographic perspective late eighteenth-century York was hardly flourishing. Between 1780 and 1800 the city and its immediate environs were home to around 17,000 people.3 The population had increased by some 5,000 since the beginning of the century but this was not enough to stop it slipping down the demographic league table. In 1700 it had been the sixth biggest town in England. In 1750 it was fifteenth and by 1801 it had dropped to twenty-fourth, below Great Yarmouth and Stockport.4 This demographic stagnation was relative. The most dramatic population increases of the late eighteenth century were those of the industrialising textile towns of Lancashire and the West Riding of Yorkshire. In the mid-eighteenth century, for example, Manchester had a population of around 15,000. In 1801 it had 75,000 inhabitants and by the 1830s it had mushroomed into a veritable ‘Cottonopolis’ with a population which, when combined with Salford,

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numbered some 233,000 people.5 Similarly, Huddersfield, which had been described in the early eighteenth century as a ‘miserable village’ with less than 1,000 inhabitants had grown to over 19,000 by 1831.6 York may not have been an industrial centre but it was by no means a city in decline and its position in the fertile Vale of York meant that it functioned as a commercial hub for the sale and distribution of agricultural produce. Most importantly, eighteenth-century York had become a cultural and social centre for the local gentry and aristocracy, many of whom took up residence in the city. In the 1720s, Daniel Defoe wrote that ‘York is full of gentry and persons of distinction . . . [who] live at large, and have houses proportioned to their quality’.7 Likewise, in his Eboracum, or the History and Antiquities of the City of York (1736), the York surgeon and antiquary, Francis Drake, claimed that ‘What has been, and is, the chief support of the city . . . is the resort to and residence of several country gentlemen with their families in it’.8 Over the course of the century York increasingly had to compete with alternative venues such as Leeds, but the needs of the gentry continued to fuel the city’s economy.9 Local merchants thrived on the importation, sale and small-scale manufacture of luxury goods to clothe the wealthy, furnish their houses, stock their larders and fill their libraries. The Oldfield family, for example, had run a successful wine importation business since the middle of the seventeenth century. Joshua Oldfield took over the business in the 1760s, gaining his freedom in 1763. He soon amassed a considerable personal fortune and came to play a prominent role in city affairs, occupying the offices of Postmaster, Councillor, Alderman, and, in 1790, Lord Mayor. Others profited from the sale of tea, silk and china while even relatively modest artisans could make a decent living manufacturing items such as wigs and combs, the latter being a product for which York gained something of a reputation.10 Books were a similarly lucrative commodity. In the later eighteenth century the city was home to at least thirteen printers, a number of whom produced and edited newspapers which were read throughout the county. Printers often combined their trade with book selling. The Todd family, for example, published and sold books from their impressive warehouse on Stonegate. The presence of the gentry also fuelled the growth of one of the city’s other notable population groups, the professional classes. Medical services are a case in point, but York also abounded in lawyers, a consequence of the proximity of wealthy clients, as well as its importance as an Assize city. Finance was an important business too and by 1780 there were three banks in operation.11 Such men did not only cater to the needs of the gentry and aristocracy. As they amassed greater wealth across the century they too became voracious consumers of goods and services. Taken together, the gentry, mercantile and professional classes reshaped the city. York was a leading light in what has been termed the ‘urban renaissance’,

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the reinvigoration of provincial English urban culture.12 As the passage of the Cleaning and Lighting Act suggests, this process of improvement was most visibly manifest in the physical transformation of the urban landscape. In 1732 the city authorities began construction of the New Walk, a tree-lined avenue along the river Ouse intended to provide an attractive and salubrious arena for polite perambulation and display.13 They also made substantial changes to the city’s streets and buildings. Between 1725 and 1730, an elegant Mansion House was constructed to provide a residence for the Lord Mayor (the first of its kind in England), and in the 1780s a number of old houses were pulled down to create St Helen’s Square, a polite civic space bounded by the Mansion House and Guildhall, St Helen’s Church, and the York Tavern.14 Elsewhere they supported the paving and widening of streets, especially in the fashionable thoroughfares of Micklegate, Blake Street and Lendal. Further improvements included street lighting during the winter season, and, in 1782, the erection of street signs at intersections ‘as is done in London’.15 Culturally, too, York was transformed into an arena for polite entertainment and public sociability. The Assembly Rooms (1731–32) which had been designed by the doyen of Palladian architecture, Richard Boyle, 3rd Earl of Burlington, played host to numerous balls and social gatherings, Drake observing that the ‘politeness of the gentlemen, the richness of the dress, and remarkable beauty of the ladies’ was set off by the surroundings which ‘cannot be equalled, throughout, in any part of Europe’.16 Other important venues included the Knavesmire racecourse, where a spectacular grandstand designed by the local architect, John Carr, was opened in 1757, the Theatre Royal (established as the New Theatre in 1744) and the many respectable inns and coffee-houses.17 Of course York was not entirely populated by gentry and wealthy merchants. Socially and spatially removed from the polite and well-to-do parishes in the centre and along Micklegate, clusters of indigent poor resided in Walmgate, Gillygate, Monkgate and the Water Lanes. There are no precise figures for the late eighteenth century but in the 1720s there were about 500 paupers receiving relief and in 1736 Drake claimed that one-third of the population was poor enough to be exempt from window tax.18 Although the number of paupers remained relatively static throughout the late eighteenth century, and was modest compared with industrialising towns, they were still a significant feature of city life, either as a charitable project for the city’s wealthier citizens or as inmates for the workhouse in Marygate. Politically, York was administered by a corporation whose structures remained virtually unchanged from the twelfth century to the Municipal Corporations Act of 1835.19 Composed of the Lord Mayor, twelve Aldermen, the Sheriffs and the Common Council, the corporation was, in effect, a closed shop, a self-perpetuating oligarchy drawn from the city’s mercantile elite.

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Despite this, the corporation provided a key focus for a more popular engagement with civic culture, not least through the medium of public display.20 On occasions when a new mayor was sworn in the city’s population was invited to meet the procession at Pavement Cross, where the health of the Lord Mayor was drunk in communality.21 Such feasts and processions punctuated the rhythm of everyday city life. With all the officials, from the Lord Mayor down to the Bellman, clad in ceremonial robes, they reiterated the centrality of the corporation in the city’s self-image and rehearsed its internal hierarchies. York had been a Whig city since the early eighteenth century but from the 1750s until his death in 1782 it came under the particular influence of local Whig grandee and two-time prime minister, Charles Watson-Wentworth, 2nd Marquess of Rockingham.22 In 1753 over a hundred members of the gentry and civic elite had founded the Rockingham Club, the principal organ for promoting the Whig interest in the city. Rockingham himself also patronised many social occasions, such as assemblies and race meetings. This period was one of broad political consensus and local parliamentary elections were rarely contested. With his death, however, York’s politics took a more radical turn. One of the key figures in this movement was Christopher Wyvill, a leading member of the Yorkshire Association, a York-based organisation that petitioned for parliamentary and ‘economical’ reform.23 Another was William Wilberforce who, as a county MP from 1784, drew much support from York’s corporation, which became one of the most politically active in England.24 The corporation was not the only political authority in town, for in a city dominated by the looming Gothic edifice of the Minster, the Church also exerted a considerable degree of influence. Relations between the corporation and Dean and Chapter were historically fraught, but generally depended on the political sympathies of the incumbent Archbishop.25 Both Archbishop Drummond (1761–77), and Archbishop Markham (1777–1808) were noted Whigs, a factor which helped to sustain the broad political consensus of the late eighteenth century. However, a mere stone’s throw from the Minster was the parish of St Michael-le-Belfry, where the charismatic preaching of the Rev. William Richardson attracted many of the city’s wealthy and socially active citizens to a more evangelical form of worship.26 York also played host to a range of dissenters and non-conformists. Catholicism had retained a foothold in the city since the Reformation and one estimate, based on Drummond’s 1764 visitation, puts the number at around 260.27 Another, based upon the census of 1767, suggests 642.28 Most of these were English Catholics and suffered little harassment. They were allowed to worship in peace at the Bar Convent on Blossom Street or the chapel in Little Blake Street and many played an active role in city life. Indeed, some even functioned as parish officials and were buried in parish churchyards.29

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However, like all non-Anglicans, they were technically excluded from civic office until the late 1820s. The 1764 visitation put the number of Protestant non-conformists as roughly equal to that of Catholics. Twenty-two families and thirty-one individuals were listed as ‘Presbyterian’, of whom some sixty belonged to the Moravian or Sandemanian sects. Most notable were the Unitarians. Although numerically small, the Unitarians were an influential group, a consequence of their public activity and social respectability. The local Unitarian congregation centred on the St Saviourgate Chapel and its ministers, Newcombe Cappe (1755–1800) and Thomas Wellbeloved (1800–58). Cappe’s second wife, Catherine, was also highly influential.30 Equally small yet influential were the Quakers, who numbered some one hundred individuals in 1780.31 The Quakers had thrived in York’s mercantile community but had generally adopted a quietist position, playing little role in city affairs. This was changing in the latter decades of the eighteenth century as men such as Samuel Tuke, inspired by the public zeal of evangelical Christianity, began to involve themselves with philanthropic and socially reforming causes.32 York and the cultural politics of eighteenth-century medicine Medical culture and identity in late eighteenth-century York therefore took shape within a social landscape shaped by the values of gentility, polite sociability and civic belonging. It was also one in which interpersonal relationships were key. The medical ‘faculty’, as it was collectively known, was relatively small. At any one time it consisted of around five physicians, about the same number of surgeons and roughly twice as many apothecaries. This contrasts with a city like Bristol which had some 230 practitioners in 1780–99.33 Although there were three major medical charities in the city, the County Hospital (1740), Lunatic Asylum (1777) and Dispensary (1788), the most common experience was of private practice among the city’s gentry, mercantile and professional communities. Needless to say, the type of practitioner consulted depended in part on the wealth of the client and the nature of the infirmity. While surgeons and apothecaries might be called in to advise upon routine cases, physicians were expensive and so even the wealthiest citizens summoned them only in serious cases. The diary of Faith Gray, wife of the local solicitor William Gray, confirms this picture. The numerous births, illnesses and deaths which permeate her account of the years 1764–1810 are attended by a variety of different practitioners including the family physician and co-parishioner, Dr Alexander Hunter, as well as Dr Thomas Withers and the surgeons James Atkinson, John Belt and Alexander Mather. On 22 May 1794, for example, her one-year-old daughter, Frances, fell ill with ‘a cold’ and was attended by ‘Mr Mather who ordered her a Blister and an Emetic’. Her

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condition deteriorated, however, and so ‘Dr Hunter was called in, [and] he ordered bleeding with Leeches, which relieved her little’.34 As this case suggests, while the idealised division of medical labour dictated that physicians attended to the interior of the body, surgeons to the exterior and apothecaries to the dispensing of drugs, most practitioners in York, as elsewhere in provincial England, combined roles. This was especially true of surgeons and apothecaries, the lines between which were so blurred as to be almost meaningless. Looking back on his early career as a surgeon-apothecary in the late eighteenth century, James Atkinson recounted the demands which such practice inevitably brought with it: For in this country . . . where the surgeon is Jack of all trades, it is by no means uncommon for him to pass many sleepless nights, without three hours repose of soul or body . . . If a practitioner be obliged, as is now the usage, to combine physic, pharmacy, surgery and midwifery, besides all the lesser ornaments of the profession, such as tooth drawing, corn-cutting, and ne quid nimis . . . what, per immortales, is to become of the physical powers . . . of such a man?35

At a more profound level, however, what the diary of Faith Gray also reveals is the highly personal nature of the consultative relationship. Judgements about a practitioner’s identity were not based simply upon an ostensibly objective assessment of skill, but also upon an intensely subjective estimation of character, an estimation which was constructed both within the affective context of the family and the political context of social relations. Ultimately Hunter’s efforts to save Frances were in vain for ‘she had a relapse in the night’ and died the following morning. Faith was devastated and though she looked to God for meaning in this tragedy there is evidence to suggest that she never viewed Hunter in quite the same way again.36 Medical practice was not confined to the city. In a county town with an extensive rural hinterland, York’s practitioners roamed far and wide, attending to farming families and members of the country gentry. For example, a receipt book belonging to the Smyth family of rural Yorkshire contains a number of prescriptions from Alexander Hunter dated 1788.37 At the other end of the scale, James Atkinson’s older brother and fellow surgeonapothecary, Charles, bemoaned, in typically melodramatic style, the trials of an extensive rural practice: What bogs and quagmires, what high roads and low roads, what gravel pits, and rabbit warrens, must a drudging accoucheur ride over, and through, to gain a solitary guinea, nay, say half a one . . . In this employ did I sweat and toil, nay sometimes shivered with cold, blowing my benumbed fingers to apply the lancet, for a long space of time[. T]he idea of such pain and penalties is enough to draw tears of blood from the eyes, instead of the arm, and stagnate the whole frame, with thought of such sufferings.38

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As practices varied, so too did fortunes. Alexander Hunter complained that ‘The life of a physician is not to be envied. Other professions have their days of vacation, but he has not a moment he can call his own’.39 His exertions paid off and in his will he left several thousand pounds in cash, together with thousands of pounds worth of goods, a grand town house in Petergate and a farm in Lincolnshire.40 In an equally lengthy will, the local physician Thomas Withers left several thousand pounds in cash and goods, while another physician, Allen Swainston, left all of his considerable personal fortune to his wife, Frances, and their children.41 Others were less fortunate. William White had only been in practice as a physician for fifteen years before his death from consumption in 1790. Even without a wife or children he could only offer his sister, Martha, the sum of £300. Meanwhile, neither Robert nor Joseph Cappe, physicians, brothers and sons of the Unitarian divine, Newcome Cappe, lived for more than a few years after setting up practice in the city.42 Even for more wealthy and successful practitioners, however, financial success did not necessarily guarantee social approbation. As Roy Porter and others have suggested, medical practitioners occupied a problematic position within the Georgian imagination; caricatured as greedy and incompetent they were a frequent subject for contemporary social satire, from Dr Slop in Laurence Sterne’s Tristram Shandy (1759) and the characters in Samuel Foote’s The Devil Upon Two Sticks (1768) to the prints of Thomas Rowlandson, over a hundred of which featured medical themes.43 The anomalous social position of the medical faculty can also be gauged from an analysis of local trade directories.44 Although some directories, such as Bailey’s British Directory and Bailey’s Northern Directory, listed the residents of towns and cities alphabetically by name with an accompanying note of their trade or station, others, notably the Universal British Directory, grouped individuals into the broad categories of ‘Gentry’, ‘Clergy’, ‘Physic’, ‘Law’ and ‘Traders, etc.’ This suggests, superficially at least, that medicine, together with the other so-called ‘liberal professions’, constituted a distinct social group. Yet on further inspection it is clear that the dimensions and contours of the local medical faculty were far from rigid. While university-educated physicians such as Alexander Hunter or Thomas Withers were generally listed under the ‘Physic’ section, those at the lower end of the medical hierarchy, especially apothecaries, were rooted in a culture of shop-based retail and were therefore listed under ‘Traders, etc.’ Surgeon-apothecaries, meanwhile, often moved, from edition to edition, between the ‘trade’ category and that of ‘physic’. Moreover, while the presence of a distinct section for ‘Physic’ indicates a certain prominence and visibility within the urban landscape, it also serves as an expression of medicine’s relative liminality. These practitioners occupied both a textual and a socio-cultural space between the gentry and the

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trades. They may not have been tradesmen per se but neither were they truly gentlemen, at least not in the conventional sense. There are a variety of reasons why medical practitioners found themselves in this position. For example, aside from the physician, John Lawson, who was the grandson of a baronet, the vast majority of local practitioners were drawn from social strata below the gentry. This was especially true of surgeons and apothecaries but also of many physicians. During the 1780s one local commentator claimed that Drs Alexander Hunter and Allen Swainston were ‘the two leading practitioners . . . in this city’.45 Hunter was a Scot, whose father had been an ‘eminent druggist’ in Edinburgh, while Swainston came from Stockton.46 Neither had graduated from Oxford or Cambridge, universities whose students were more likely to be drawn from the gentry. Hunter graduated from Edinburgh while Swainston received his MD from Göttingen. Robert and Joseph Cappe followed a similar path, the former studying at Edinburgh, the latter at Leiden.47 William White, a local man, had worked for several years as an apothecary before also receiving his MD from Leiden.48 Edward Wallis, meanwhile, had never even studied at university. Another former apothecary, he became a physician by virtue of Extra Licentiate membership of the Royal College of Physicians, conferred in 1773.49 What is striking about this group is how many of them were non-Anglicans, a far higher percentage than for the city as a whole. This factor also helps to account for why so many attended universities outside England, it being impossible to matriculate at Oxford or Cambridge without subscribing to the Thirty-Nine Articles of the Church of England. Hunter, Withers and Swainston were Anglicans, although the former two had evangelical leanings and Swainston had converted from Catholicism.50 Lawson was a Catholic, White a Quaker and the Cappe brothers adherents of their father’s Unitarian faith. The same was true of the city’s surgeons. The two major surgical families of this period were the Atkinsons and the Champneys, both of whom established veritable dynasties in the period, the former under Charles Atkinson and his sons, Charles and James, the latter under William Champney and his sons, William, George and John. Both were Catholic. Such confessional allegiances could have negative consequences in a society which generally equated gentility with profession of the Anglican faith. Furthermore, if, as has been claimed, office-holding played a key role in the formation of local and civic identities, then many of York’s medical practitioners were excluded from such offices by virtue of their religion.51 As James Atkinson complained, with reference to the office of City Surgeon: [H]ow much I have to regret being deprived of the advantage of attending, as a medical man, the corporation and aldermen of York. How? By being gagged and choaked [sic], and stopped in my growth, by the act of supremacy. This, this nasty

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thing, so abhorrent to my religion alone prevented me being raised above the chamberlain’s honourable office; which . . . cost me seven pounds; nay robbed me of a sinecure medical practice . . . Since, however, everything now is ‘No popery’, to what a miserable existence are we poor Papists doomed!52

It was not simply religion, however, which served to exclude practitioners from civic office. It has been suggested that early modern medical practitioners were generally ‘isolated from the normal structures of male authority’.53 In York, as in other incorporated boroughs, none of the city’s physicians were freemen and so were ineligible to stand for corporate office. The law likewise excused them from parochial office. The city’s surgeons were in a similar position. The York Guild of Barber-Surgeons had once provided them with a space in which to shape and perform their civic identities; for example, the surgeon Francis Bacon was elected Lord Mayor in both 1767 and 1777. Yet by this time the Guild was in decline and it eventually collapsed in 1786. Indeed, many of York’s surgeons had already distanced themselves from it, presumably since the dissolution of the London Company of Barber-Surgeons in 1745. The register of membership for the late eighteenth century includes few, if any, ‘pure’ surgeons and is almost entirely composed of barbers.54 If the split of the surgeons from the barbers reflected the former’s desire to distance themselves from trade, then it was apothecaries, whose occupation was most trade-like in nature, who were most integrated into civic life and administration.55 As shopkeepers, most apothecaries had to buy or inherit their freedom in order to trade within the city walls. As such, they were eligible for civic office and a number rose to positions of authority within the corporation. Two apothecaries served as Lord Mayor in the late eighteenth century: Edward Wallis in 1771, prior to obtaining his College licence, and Theophilus Davyes Garencieres in 1796. This does not mean that some practitioners were not locally well-connected. For example, Thomas Withers was a York man by birth whose brother, William, was a lawyer and Recorder for the corporation. A number of local surgeons, including the Atkinsons and Champneys, were also at least second generation locals. Many others, however, came from outside the city, or had spent their formative years at distant universities, hospitals or anatomy schools. While most new medical practices were often continuations of established ones, attained through vocational and familial connections, prospective practitioners were often known only to the incumbent. In a small and intimate city like York, personal reputation was all important. When they initially came to York, however, many practitioners were strangers without reputation, spatially and socially dislocated. Perhaps the most important factor which served to shape medicine’s liminality, especially in the immediate context of the eighteenth century, was its

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ambiguous relationship to the values of polite society. As Lawrence Klein has commented, ‘What defined this era was its politeness . . . Politeness was central to mapping not just cultural ideology in the eighteenth century, but also the era’s characteristic forms of cultural organisation and practice’.56 Politeness can be defined as a set of cultural values which sought to regulate and ‘civilise’ societal conduct and personal manners. Contemporary commentators were critical of rigid social formalities, lauding qualities such as courteousness and affability which were seen as conducive to a free and easy interaction among social ‘equals’. Some historians have suggested that politeness was internalised as a core psychic value and even, with the culture of nervous sensibility, as a physiological property.57 For the most part, however, it was a performative category, dependant upon exterior display for its realisation. Masculine politeness was not just a ‘social but a sociable category in which gender identity was conferred, or denied, by men’s capacity for gentlemanly social performance’.58 Despite the emphasis placed upon the mitigation of social boundaries, then, the ideology of politeness was inextricably intertwined with ideas of gentility. Politeness served as a potent tool of social and cultural distinction, one whose attributes were regarded as the preserve of the social elite.59 Some practitioners stood closer to the values of politeness and gentility than others. Physicians were at a particular advantage in having attended university. Even at Edinburgh, where specifically medical forms of instruction were more common than at Oxford and Cambridge, medical students would have received a broad liberal education and would be expected to have a reasonably thorough knowledge of the liberal arts and the classics. Indeed, in her history of medical education at late eighteenth- and early nineteenth-century Edinburgh, Lisa Rosner has suggested that ‘the purpose of even classical studies was to make gentlemen, not scholars’.60 Lay understandings of medicine in this period were, among the educated at least, reasonably sophisticated.61 Nevertheless, abstruse forms of vocational knowledge were generally considered unsuitable topics for genteel conversation. Regarded as pedantic and private, they were the antithesis of polite, public discourse.62 By contrast, classical learning and the liberal arts provided a shared intellectual resource and were deemed polite and gentlemanly because ‘it did not demand technical or specialist knowledge. Rather, it was generalist in its orientation, tending to the development of the whole person and keeping the person and his social relations in view’.63 Having said this, the culture of politeness was marked by an essential ambivalence concerning the democratising potentialities of refinement, about the worth of the ‘bred’ compared to the ‘born’ gentleman and about the capacity of education to polish the superficial manners of a plebeian without instilling genuine moral virtue.64 Coming, as many did, from modest social

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backgrounds, York’s physicians could thus be characterised as rapacious social climbers, as the vulgar sons of tradesmen or ‘enthusiastic’ clergymen who merely affected the manners of a gentleman in order to make their fortunes. As late as 1825 the York Courant published an anecdote satirising the physician’s transparently frugal attempts to effect the lifestyle and manners of the gentry. Asking ‘What is a doctor?’, it claimed that as well as being ‘a sedate looking personage’ who ‘charges you a guinea for taking your pulse’, the doctor ‘keeps a chariot and one man servant; the standing-board behind, intended for a footman is fearfully beset with spikes, to prevent the little boys from riding at the doctor’s expense . . . his servant is a coachman abroad, and a footman, valet and butler at home’.65 A similar anecdote from the same paper read: [B]eing one evening in a party where the conversation turned upon the profession of medicine, [Mr Saxby] said drily [sic], ‘all I know of it is this – the ancients tried to make a science of it and failed; the moderns have tried to make a trade of it and have succeeded’.66

Mr Saxby’s bon mots reflected a wider perception, for the spectre of trade dogged medicine’s public reputation. Of course trade was not, in and of itself, a contemptible category. Nevertheless, it was widely held to be inimical to true gentility and respectability. The mentality of trade revealed itself in an obsession with money that the truly wealthy and leisured could afford to disdain. Medical practitioners were aware that the financial pressures of establishing a viable and profitable practice made them vulnerable to such associations. In the 1760s the Edinburgh University lecturer, John Gregory, warned his students that medicine could be ‘considered as an art the most important and beneficial to mankind, or as a trade by which a considerable body of men gain their subsistence’.67 Similar tensions were evident in the work of local physician, Alexander Hunter, whose collection of aphorisms, Men and Manners: or, Concentrated Wisdom (1809) claimed that ‘Physic is an honourable profession, but avarice sometimes makes it a disgraceful one’.68 Medical practitioners in York, as elsewhere, therefore faced a paradox which required careful negotiation: to earn enough money to sustain a genteel and leisured lifestyle without actually being seen to make it or to need it. If medicine’s associations with trade could militate against social respectability then so too could its epistemological and practical object, the human body. Georgian elites were, in many ways, quite open about their corporeality. Nevertheless, contemporary medical practice necessitated an exceptionally tactile engagement with the bodies of others, including those of the dead and dying. Surgeons were often characterised as butchers, rough saw-bones who performed vigorously physical operations covered in blood, bile and other bodily products.69 Likewise, male midwives’ close working relationship with

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the female genitalia and within the female bedchamber aroused suspicion in many.70 Meanwhile, despite the normative historical assumptions that physicians distanced themselves from such manual practices, their work could also involve a surprisingly sensory engagement with the human body. During his research into consumption of the lungs, for example, William White became interested in the properties of ‘laudable pus’. When confronted by a discharge in one of his dysenteric patients, he undertook an experiment: This species of matter, in its natural state, appears to be an homogeneous, smooth, yellowish fluid, resembling good cream, without smell, and rather sweetish to the taste; it swims in water, and, when burnt, smells like burnt cheese.71

While the pus-eating physician may have presented an ambiguous image to polite society, politeness, gentility and their associated cultural forms should not be thought of merely as obstacles to medical respectability and social advancement for they also provided the key cultural resources by which late eighteenth-century practitioners shaped and performed their social identities. In a characteristically sweeping statement, Roy Porter has suggested that eighteenth-century physicians were ‘attempting to doff . . . the fuddyduddiness of the cloistered and melancholic academic, and don that of the gentleman’.72 The remainder of the chapter will flesh out this observation by exploring how the construction of the medical gentleman was effected on the local stage, firstly within the arena of public sociability and secondly through a more general set of social strategies such as marriage, charitable service and the cultivation of patronage. Clubability and identity Late eighteenth-century York provided a wide range of opportunities for sociability and social performance, including church services, civic ceremonies, assemblies, the theatre and horse races. However, perhaps the most important and intimate arena for such activity was provided by the club, the defining feature of contemporary urban homosociality.73 The city played host to numerous clubs in this period and medical practitioners were conspicuous for their involvement. York’s cultures of sociability were framed to a significant degree by the dominant political influence of Whiggism and one of the most important clubs in the city was the Rockingham Club, of which a number of medical practitioners were members. These included the physicians Alexander Hunter and William White as well as a large number of apothecaries and surgeon-apothecaries such as Francis Bacon, Theophilus Garencieres, Mr Wright and Mr Ewbank.74 Even less obviously political organisations were coloured by Whig culture, combining rational sociability, improvement and liberality in ways that were

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neither explicitly partisan nor exclusionary.75 Founded in 1768, the Ancient Society of York Florists had eighty or so members at its height in the 1780s. The Society embodied many of the values of Whig natural philosophy, particularly its engagement with Georgic traditions.76 However, while this may have appealed directly to men like Hunter, who was a committed agricultural improver and active Whig, many medical practitioners seem to have been drawn to the Society more as an associative space than as a testament to practical ability or interest, for few ever displayed flowers themselves. Nevertheless, 12.5% of the society’s overall membership was composed of medical practitioners, a number of whom seem to have been instrumental in its foundation.77 However, the club which was most notable for medical involvement and which best exemplifies the importance of sociability in structuring a late eighteenth-century culture of medico-gentility was the Doctors Club which, between 1781 and the turn of the century, met every Thursday evening, except in race weeks, at the York Tavern on St Helen’s Square. In contrast to Irvine Loudon’s characterisation of contemporary medical clubs where practitioners met ‘to discuss cases, read papers and grumble about the evils of quackery’, the members of the Doctors Club met as part of a commitment not to vocational self-improvement but to dining, drinking and socialising.78 A typical entry from the minute book reads: January 24th 1793 It was recommended by gentlemen present at this meeting that a supper shall be ordered for the annual night for twenty at 2/ per head, malt liquor included, – and that all the absent members should be fined 2/6 each.79

Neither were these ‘gentlemen’ solely medical practitioners. Of the thirty-five individuals listed at the beginning of the minute book, whose names are legible and whose occupations can be identified in contemporary city directories, only seven were either physicians or surgeons (less than 20% of the club, but about 30% of the city’s medical faculty).80 These included Alexander Hunter, William Spencer, Charles Atkinson, his son James Atkinson, and William Champney. Three others, Theophilus Davyes Garencieres, John Wallis and George Smith, were originally listed as apothecaries in local trade directories, only later appearing as surgeons. There was nothing exclusive about the term ‘Doctor’ in the late eighteenth century and it might refer to anyone in the possession of a doctorate in law (LLD) or theology (DD) as well as medicine (MD). However, of the other members of the club only two clergymen and three attorneys at law might have fallen into this category. Instead, the majority of members were leading local merchants, including silk-merchants, tea-dealers, wine-merchants and ‘chinamen’. These men were the elite of civic society. At least three were city Aldermen, and one, Peter Johnson, an

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attorney, became Recorder for the corporation. Along with Henry Raper, a tea-dealer and another member of the club, Peter Johnson was a member of the gentry, an esquire who was wealthy enough to commission the local architect John Carr to design a grand house for him in the highly desirable Castlegate. Furthermore, at least seven members of the Doctors Club had been, or became, Lord Mayors of York between the 1760s and 1830s, with two, including Henry Raper, serving two terms. The Doctors Club was therefore the embodiment of a civic culture defined not by a guild-mentality of corporate exclusivity but by the polite and civil values of cosmopolitan inclusivity and congenial clubability. This fusing of the urbane and the civic was a peculiar characteristic of the eighteenthcentury urban renaissance.81 With the rise of the polite ideal, civility became entwined with the urban as there was a shift in cultural production from the countryside to the town. As Peter Borsay claims, ‘becoming urbane was what becoming civilised meant’. In York, the construction of the Mansion House in 1725 had given physical expression to this new civic culture. Adopting an elegant Georgian style ‘favoured by polite country gentlemen, who took their aesthetic lead from London’ it was built directly in front of (and thus spatially overwrote) the fifteenth-century Gothic Guildhall, the traditional heart of civic authority and a testament to the city’s near 600-year history of self-governance.82 An integral part of this commitment to inclusivity involved the sublimation of personal difference and potential animosity into genial association. The front cover of the Doctors Club minute book is inscribed with the words ‘Good Humour’, suggesting that, like the contemporary York-based ‘Laughing Club’, it was intended to promote an easy and lively atmosphere of good-natured companionship.83 Moreover, despite the dominant influence of Whiggism on the political cultures of eighteenth-century York, the club was explicitly concerned to smooth over political rivalries with the veneer of sociability, its twelfth rule stating ‘That no party disputes are to be suffered in the Club in regard to any election of members to represent this City in Parliament’.84 However, if the Doctors Club was occupationally and politically diverse then, like most such clubs, it was also sexually homogeneous, being entirely composed of men. Contemporary cultures of politeness and civility were riven by ambiguity and anxiety when it came to gender identities.85 The polite masculine ideal was shaped by the influence of female company. Such values were espoused by those doyens of eighteenth-century politeness, Joseph Addison and Richard Steele, and epitomised by the mixed-gender sociability of the Assembly Rooms. And yet ‘politeness was always in danger of collapsing into effeminacy’.86 A number of contemporary commentators, most notably John Brown in his Estimate of the Manners and Principals of the

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Times (1757), expressed concern that an undue reverence for feminine virtues would destabilise established gender boundaries and debase the nation’s manhood. The male performance of politeness was thus a delicate balancing act wherein men were expected to ‘display a capacity for refinement while maintaining their masculine identity’.87 This duality of manners and manliness found expression in a duality of social space and social performance. At the assembly or ball, masculine performance was tailored to the company of ladies and defined by ‘self-control of both body and tongue . . . an artful mastery over one’s manners and conduct’.88 On the other hand, in the homosocial atmosphere of the tavern-based club, sociability and affability could take on more overtly masculine forms. Though no less determined by strategies of social performance, conviviality and fraternity triumphed over delicacy and refinement. The fraternal and convivial nature of the Doctors Club was evident in its two principal activities, eating and drinking. Meetings usually revolved around a semi-formal dinner, starting at about eight o’clock in the evening. This meal, a potent symbol of commensality, was not only eaten together, but was paid for from communal funds, each member having an equal stake. The exception was those occasions on which members of the club got married, the protocol for which was codified in the eighth rule: ‘That any member who shall enter into the holy state of matrimony shall entertain the club with a supper and a crown bowl of punch’.89 Marriage was a desirable and necessary condition for men to occupy. It constituted a rite of passage, the assumption of a key economic and social duty.90 It also provided an arena for the legitimate expression of male sexual identity, free from the dangers and temptations of illicit or libertine sexuality.91 As the York apothecary, Oswald Allen, commented, it was a thing to be desired in every point of view; because professional men are exposed to many temptations in the course of their practice, and many in an unguarded moment have been caught in the snare and brought upon themselves considerable disgrace and future ruin.92

Marriage also served to refine men, to temper their manners through the influence of feminine sensibility and, by fusing two people into one ‘holy bond’, to promote ‘social affections in opposition to individualism’.93 Eighteenthcentury moral reformers frequently suggested that a domestic environment of humanitarian sensibility would serve to draw men away from ‘the extravagant and cruel pleasures of tavern culture’.94 The Doctors Club was not perhaps as extravagantly masculine as societies like the Edinburgh-based ‘Beggars Benison’, in which acts of public masturbation formed the (literal) climax of initiation rituals.95 Neither was it as ‘cruel’ as the aggressively masculine forms of animal baiting and abuse associated with more ‘disreputable’ spheres

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of tavern culture.96 And yet the club’s rule concerning marriage betrays a fundamental ambivalence towards matrimony, domesticity and femininity. After all, by demanding that the member who got married should buy dinner and drinks for everyone else, rather than the other way around, the resultant ceremony constituted both a celebration and a forfeit, an implicit recognition of the contrary influence that marriage would exert on an active participation in homosocial culture and a tacit acknowledgement of the debt which that member owed to his fellows. Although such gender ideologies pervaded eighteenth-century society, there is reason to believe that they were particularly prominent within the culture of medicine. After all, physicians, most of whom had been educated at university, would have spent the formative years of their adolescence in an almost exclusively homosocial culture, one whose reputation for rowdy and boisterous behaviour was well marked.97 The same might also be said of those surgeon-apothecaries who served as apprentices and/or as pupils at teaching hospitals.98 Moreover, although the age of marriage for men was increasing generally across the eighteenth century, the duration of their education and the time taken to establish a practice meant that medical practitioners tended to marry later than most.99 William White, for example, died a bachelor at the age of forty-five, while Alexander Hunter only married his first wife, Elizabeth Dealtry, in his mid-thirties, buying dinner for the members of the Doctors Club on the occasion of his second marriage in 1799.100 Many medical practitioners therefore enjoyed an extended period of bachelorhood and were particularly likely to have been inculcated into a culture of homosocial masculinity. Drinking occupied an ambivalent place within Georgian society, even within homosocial culture. Some commentators argued that the intoxication brought on by excessive drinking resulted in the individual ‘unmanning’ and humiliating himself, while others, like the artist and club-frequenter, Joshua Reynolds, maintained that moderate drinking (however that was defined) was a vital component of male sociability. This contradiction was personified in the character of James Boswell. In his diary, Boswell often noted how drink could function as ‘the cement of the company’, yet he also recorded that ‘Drink never fails to make me ill-bred’.101 Nevertheless, the consumption of alcohol continued to be a perennial feature of late eighteenth-century male sociability. Like feasting, it oiled the wheels of social intercourse and reinforced the communal atmosphere of the gatherings. Excessive drinking was rarely, if ever, condoned, but it was doubtless a common occurrence, especially within the tavern-based club. The members of the Doctors Club certainly seem to have indulged in excess. Soon after the club’s foundation, it was realised that there were insufficient funds to sustain the joint purchase of alcohol. Given the different appetites of the members, as well as their different

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capacities, it was therefore decided as early as May 1782 that ‘each member shall pay for what liquor he calls for at supper’.102 The same ambivalence surrounded the other activity for which the Doctors Club was notable: gambling. The wagering of extravagant sums of money, or a too ready submission to the vagaries of chance, could render gambling a vice. Nevertheless, the culture of betting permeated all levels of society. Even fashionable ladies might indulge in a game of cards at an assembly or ball, while gentlemen might attend gaming clubs or racecourses such as York’s Knavesmire.103 The gambling which took place within the Doctors Club was not simply a consequence of drunken male bravado; it was enshrined in the rules. Rule number eleven states that ‘the winning of all wagers layed [sic] in the club must be spent the first club night after such are determined’.104 Gambling was integral to the collective dynamic. The winner was not to keep the spoils to himself but to spend them in the convivial atmosphere of the club. Betting was thus a highly sociable activity. It was not simply a contract between two individuals. Invigilating the bet drew in the other members of the club who were called upon to decide who had won. A lot was at stake in these bets, and not simply money. In risking their reputation in competitive wagers (albeit within a relatively safe arena), the members asserted their masculine identities. The substance of these bets is also significant, and is suggestive of the peculiar class and gender ideologies of its members. They ranged from the surgeon, Charles Atkinson’s, wager with Mr Dunslay over the parish procedures for relieving pregnant women, to Mr Spooner’s bet of a bottle of wine to each of the members of the club, that they would be unable to find the word ‘mahogany’ in a shilling dictionary.105 What is significant about these, and all the bets recorded in the minute book, is that they revolved around claims to, and assertions of, knowledge. They were not the physical challenges, usually involving alcohol, or feats of strength that one might expect to find in less ‘elevated’ contemporary settings. These were men for whom knowing was more important than doing. Margaret Pelling has argued that early modern medical practitioners, particularly physicians, ‘were deeply reluctant to associate on equal terms even with those at the upper levels of the urban hierarchy, such as merchants’.106 The example of the Doctors Club suggests otherwise. Even if they did not hold formal office, late eighteenth-century medical practitioners actively invested in civic culture. Though drawing upon the cosmopolitan cultures of politeness and gentility rather than of corporate exceptionality, the intimate nature of their association allowed the members to construct themselves as civic insiders. This much is evident, again, from the bets that they made with each other, many of which revolved around the sorts of things an upstanding and well-connected citizen would be expected to know. For example, in 1790

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Alexander Hunter wagered Mr Prichard a bottle of wine that Mr Flemming, the common councilman of Bootham, had, by that point in time, been dead for four years.107 Such wagers were a test, albeit a light-hearted one, of who was better informed about city life and affairs. It is also manifest in the club’s semi-formal relationship with the corporation. When a member was elected to the post of Lord Mayor of York, he was expected to invite the other members to dine with him at the Mansion House. This was almost always honoured but in 1794 it was not. The minutes for that year exude an almost palpable sense of disappointment when they record that ‘John Hay Esq. when Lord Mayor, did not invite the Honourable Doctors club to dine with him as usual and had uniformly been the custom’.108 That the Doctors Club functioned as a more inclusive and informal extension of corporate sociability is even evident in the space in which it met. The York Tavern had been constructed in 1770 and was the city’s principal coaching inn, described as ‘a large and elegant building’.109 As one of the largest quasi-public buildings in the city it was a major site for urban association and was predominantly, though not exclusively, dominated by the Whig interest. As such it provided the venue for the Rockingham Club and for the celebrations to commemorate the centenary of the Glorious Revolution.110 Its location on the southern side of St Helen’s Square also placed it at the very heart of civic space. Its proximity to the organs of city government shaped its political character and made it highly attractive to members of the corporation who often held meetings there, instead of at the Guildhall, at least on less ceremonial occasions.111 However, while the Doctors Club was inclusive and diverse relative to the formal structure of civic sociability then it was also highly exclusive relative to its relationship with wider society. It may have met in a public house on a highly public square but it was very much a private space whose boundaries were actively and rigorously policed. As Pierre Bourdieu notes, clubs which have a high degree of symbolic capital tend to preserve their homogeneity by subjecting aspirants to very strict procedures – an act of candidature, a recommendation, sometimes a presentation (in the literal sense) by sponsors who have themselves been members for a certain number of years, election by the membership or by a special committee, payment of sometimes very high initial subscriptions . . . plus the annual subscription . . . and so on.112

So it was with the Doctors Club. Of the club’s twelve rules, half were concerned with the protocol for admitting new members.113 Membership was limited to thirty but if a vacancy did arise and an individual wished to join, he would have to have been invited by an existing member and attended the club on at least one occasion as a visitor. He could then be proposed by his sponsor. The

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next club night after this proposition was put to the members, a vote would be taken. In order for this vote to be valid, the club had to be quorate (at least five members had to be present). The ballot would take place between nine and ten o’clock in the evening and a two-thirds majority was necessary for the candidate to be elected. The new member would then have to pay his sizeable subscription fee of 10s 6d into the joint stock. Such controls did not end with election. Membership of the Doctors Club entailed a kind of enforced sociability. Those who missed club nights were fined 6d and repeat offenders were expelled.114 On 16 March 1786, for example, the minutes announced that Mr Hotham was proposed a member of this society on 22nd December last and was admitted on the 29th of the same, but not attending from the time of his admission [to] this present date, is supposed not to be friendly to the principles of this club, and therefore a vacancy in the room of Mr Hotham is unanimously declared by the members present.115

According to Bourdieu, the very complexity of such procedures serves to mystify the grounds for admission: Because the social reality of the criteria of selection can only come from outside, that is, from an objectification of what is refused in advance as reductive and vulgar, the group is able to persuade itself that its own assembly is based on no other principle than an indefinable sense of propriety which only membership can procure.116

Like the cultures of politeness more generally, then, the Doctors Club took the values of cosmopolitan inclusivity and transformed them into an exclusive form of symbolic capital which marked its members as civic insiders. Although it is impossible to say with any degree of certainty what role medical practitioners played in vetting the membership of the Doctors Club, given that many of the other members were already drawn from the corporate elite, it was they who had most to gain from the social exclusivity of the group and the attendant symbolic capital of membership. Excluded from the formal sphere of masculine civic authority and occupying an ambivalent position within the urban social hierarchy, medical practitioners found in the Doctors Club an invaluable arena within which they could integrate themselves into the informal networks of patronage which exercised such a profound influence on contemporary social practice and through which they could shape their identities as polite and sociable civic gentlemen. Of course the Doctors Club was a viable social space only for those who were morally and socially at ease with a culture of boozy sociability. As such it tended to exclude the spiritually high-minded. Alexander Hunter was an active member but Thomas Withers, whose evangelicalism seems to have been more pronounced, was not. Also conspicuous by their absence were the Quaker physician William

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White and the Sandemanian apothecary Oswald Allen. Even for such men, however, the urban club was only one of a multitude of potential arenas in which they might shape and perform their identities as respectable gentlemen for, as the memoir of Oswald Allen demonstrates, the process of identity formation permeated almost every aspect of social practice. Oswald Allen: practice and performance Relatively few eighteenth-century practitioners have left behind significant bodies of manuscript material which allow us to reconstruct the multidimensional aspects of lived experience. This is especially true for apothecaries whose relative lack of formal, scholastic education denied them access to some of the literary and cultural resources enjoyed by their medical colleagues. It is for this reason that the writings of Oswald Allen are so valuable. Between 1833 and 1836 Allen compiled a 469-page volume of handwritten memoirs covering his early life and apprenticeship in the 1780s through to his retirement from practice some fifty-three years later. Allen’s memoirs cannot provide unmediated access into the realities of social experience. Though not intended for publication, Allen claiming that they were ‘of a private and confidential nature . . . [and] not intended for public view’, they were directed to an audience, being calculated to provide his family and friends with an account of ‘my birth, early habits and education and my progress thro’ life’.117 Moreover, like most memoirs, they served as a self-justificatory narrative, which, in Allen’s case, was coloured by his resolute faith in the operations of divine providence. And yet it is the performative and reflexive quality of such texts that makes them such a fruitful object of analysis. They are, according to one historian, ‘technologies for . . . managing the self’, a means by which the individual seeks to imbue the experience of life with narrative, meaning and significance (‘making the self visible to the self’), through which they seek to be known to others and come to know themselves.118 In this way, Allen’s memoirs provide a revealing insight into the cultures of late eighteenth-century medicine and into the mechanisms by which its practitioners shaped their social identities. Of course, Allen’s writings speak to a very particular experience, that not simply of the individual, but also of the apothecary. While apothecaries were often more assimilated into civic culture than their medical or surgical colleagues, their relative lack of a formal liberal education and their associations with shop-based trade could function as potential impediments to true gentility and social respectability. The authorial Allen was keenly aware of the limitations imposed upon him and there are moments in his memoirs where these limitations function as an object of frustration and regret. And yet his memoirs also attest to the ways in which a variety of cultural resources

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and opportunities could be marshalled in the personal imagining and social performance of a genteel and respectable self. For the aspirant gentleman he would later become, Allen’s beginnings were inauspicious. He was born in 1767 in Gayle, a small village in upper Wensleydale, which, despite the establishment of a water powered textile mill in 1776, remained resolutely remote from the centres of cultural, if not industrial, production. His father, James Allen, was a preacher who moved fluidly and acrimoniously between the various sects of primitive, antinomian Christianity. In 1755 he had helped to found an independent chapel in Gayle and in the following year was ordained by Benjamin Ingham, a preacher who had split successively from the Moravian and Methodist churches.119 In 1761, however, Allen seceded from the Inghamites to join the Sandemanians, followers of the former Scots Presbyterian minister, John Glas, and his sonin-law, Robert Sandeman. The Sandemanians rejected ecclesiastical authority and practised intimate communitarian worship, pooling their material possessions and holding love feasts on the Sabbath at which the communicants shared food and washed each other’s feet.120 Although his father would later fall out with the Sandemanians, Oswald’s life was structured by the dictates of their strict apostolic and providentialist creed. Indeed, he claimed that when young he spent more time with his father’s friends discussing ‘divine prophecy, and its fulfilments respecting the antichristian church [i.e. the Church of England]’ than with children of his own age.121 Like his rural origins Allen’s religious upbringing was hardly conducive to social inclusion. Although in later years he would occasionally attend a Methodist service, the extreme, almost incestuous, intimacy of the Sandemanians was matched by a potentially crippling social isolation as by the 1770s they had consciously severed communication with all other denominations. Allen claimed that his youthful intention had been to devote himself to the ‘preaching of the Gospel’.122 And yet, for all the Sandemanians’ rejection of material wealth it was clear to his father that being a preacher was not a secure career for his son. It was therefore ‘very early in my life determined by my Father that I should be brought up to the medical profession’ and, while Allen had no personal desire to do so, he felt that it was his duty ‘to conform to the wishes of my Parents, especially if Divine Providence should appear to mark out that line for me to pursue, as [my] family was rather numerous and my patrimonial inheritance not considerable’.123 To this end Allen was sent to school in the nearby market town of Hawes to receive a ‘liberal education . . . then thought sufficient to my intended pursuits in life, acquiring a liberal degree of knowledge of the Latin and Greek languages, with the other branches of writing and arithmetic’. Despite making ‘considerable progress’, Allen’s education was ‘checked by my being removed from school at an early age’, a circumstance which he ‘regretted through life,

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as I should have wished to have advanced considerably further in those studies so that my mind might have been deeply impressed’. Nevertheless, he sought to ‘make up this deficiency by availing myself of every opportunity of acquiring knowledge in every way’.124 Allen’s regret at his imagined deficiencies in education, together with his determination to compensate for it, is a recurrent theme throughout his memoirs. There is a suggestion that he would have liked to have become a physician and that he was aware of the relative limitations of his medical education. Thus, a number of years later as an apprentice apothecary he attended the public anatomisation of Sophie Dickinson, executed for murdering her bastard child. There he ‘witnessed the opening of the body, and regularly attended the subsequent anatomical demonstrations, and paid considerable attention to the subject, wishing to acquire all the information I could, by making memorandums when I returned home, and also reading some anatomical work afterwards, for the purpose of impressing my mind more deeply’. He also attended a series of anatomical lectures given by the local physician, Thomas Withers and, unable to afford a copy of William Cullen’s Institutions of Medicine (1772), spent his leisure hours copying it out by hand, a circumstance which, in hindsight, he dismissed as folly but which nevertheless ‘shows with what ardour I pursued my studies’.125 However, Allen’s desire for knowledge was not limited to the sphere of medical education and vocational improvement. Rather, knowledge was a powerful cultural resource, easing his assimilation into wider networks and patterns of sociability. In the autumn of 1792, for example, he embarked upon a thirteen-day trip around England, visiting London, Bath, Bristol and Gloucester, returning to York via Birmingham, Derby, Nottingham and Newark.126 Unlike many of his socially superior contemporaries, Allen had neither the opportunity nor the money to embark upon a grand tour of the Continent; it was not until a trip to Scarborough in 1793, at the age of twentyfour, that he had even seen the sea.127 Nevertheless, his more modest excursions were an equivalent undertaking. If travelling to Italy to view the wonders of classical antiquity provided a cultural, experiential and material resource for polite discourse and genteel display, then Allen’s visits to country houses, manufactories, botanic gardens and other such indigenous sites were no less calculated to enhance the performance of his imagined social identity. Indeed, his stated reason for wanting to visit London was that ‘I might be able to join in conversation with others in future, as hitherto I had seen very little of the kingdom’.128 By acquiring and displaying other forms of more general and/ or experiential knowledge, Allen was able to present himself as a gentleman of liberal interests and to partake in polite social discourse. In this regard, it is revealing that, looking back over his life, Allen’s greatest source of regret was not his deficiencies in medicine but his limited knowledge of the classics,

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something which, as with anatomy, he ‘endeavoured as far as lay in my power to make up . . . by reading and study’.129 In 1781, at the age of thirteen, Oswald Allen was apprenticed to a family relation and co-religionist, the York-based apothecary, Francis Whaley.130 As a lowly apothecary, a young outsider from the Dales and a member of an obscure, idiosyncratic and secretive religious sect, Allen found his assimilation into the medical, cultural and social spheres of York was by no means assured. The young apprentice therefore sought to secure connections and perform public offices which were conducive to both his vocational and social advancement. In 1788, for example, he began assisting his master, who had been appointed apothecary to the newly opened York Dispensary. Such a public position was highly advantageous to Allen for ‘thus I appeared to emerge from a state of comparative obscurity, and become known to most of the Medical Practitioners of York, besides several others of considerable import and influence’.131 Networks of patronage played a key role in determining the vocational success of medical practitioners. While the importance of patronage within the eighteenth-century patient-practitioner relationship has long been recognised, the nature of such client relations between practitioners is less well documented.132 Naomi Tadmor’s work has shown how eighteenth-century friendship often served as an extension of family and kinship ties.133 Thus, when shortly after gaining his freedom in 1788, Allen lost his relative and former master to illness, it was only through ties of cultivated patronage that he was able to continue in business. He was persuaded to take over Whaley’s shop in partnership with his widow and although he was concerned about his relative youth and inexperience, ‘many friends conspired in a most sanguine and disinterested manner to encourage me in this undertaking, especially many influential medical practitioners who promised every support in their powers, especially Dr Hunter, Dr Withers and Dr White, etc’.134 As well as supporting him in his private business, Allen’s medical friends ‘arranged that I should be appointed as the Apothecary to the York Dispensary’ in his former master’s stead. Taking a ‘retrospective view of the various circumstances which had arisen’, Allen convinced himself that ‘Divine Providence had made the opening for me’.135 Allen’s providential explanation necessarily glossed over the fact that his appointment had been secured by patronage. In this respect he was not alone for appointments to medical charities in this period were almost always determined by interpersonal relations. All three of York’s principal medical charities, the County Hospital, Lunatic Asylum and Dispensary, were lay-governed voluntary associations. Although nominally open to election, medical charitable posts in York were rarely contested, at least until the 1800s when confessional and political factionalism began to erode the city’s broad political and cultural consensus. Indeed, so rife

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was nepotism and patronage that in some cases it was clearly felt that a nod at least should be paid to formal procedures. In 1778, for example, when Charles Atkinson junior was appointed apothecary to the County Hospital, an institution at which his father, Charles, was ‘senior surgeon’, the governors resolved that in future ‘proper security [i.e. references] should be taken’.136 Likewise, although Allen thought his own success a result of divine favour, he was less inclined to theological explanation when in 1804 he sought preferment for his own client and former apprentice, John Wilson. Perceiving the post of apothecary at the County Hospital to be ‘a desirable situation for him . . . thro[ugh] the influence of my family connections and friends I commenced a very active canvass’. Despite competition in the form of a candidate ‘supported by Archbishop Markham and almost all the clergy’, Wilson was successfully elected, Allen congratulating himself on the influence of his friends in being able to ‘despatch such a powerful front arranged against us’.137 Appointments to medical charities were highly valued for a number of reasons. If they were secured through networks of patronage then they also held the potential to extend and deepen these relationships. Medical historians have tended to focus on the immediate pecuniary awards of appointment, such as the opportunity for hospital surgeons to take on fee-paying pupils or the consequence of a heightened public profile for the expansion of private practice.138 However, charitable appointments were also notable for the more general symbolic capital they conferred.139 As with the Doctors Club, associations with the charity’s respectable governors could aid a practitioner’s assimilation into the social and cultural milieu of the local elite. In 1753 Tobias Smollett, himself a surgeon, wrote that the best way for a medical man to cultivate a reputation was to secure ‘interest enough to erect a hospital, lock or infirmary, by the voluntary subscription of his friends; a scheme which had succeeded to a miracle, with many of the profession, who had raised themselves into notice upon the carcasses of the poor’.140 Smollett’s comments display an evident cynicism about the attitude of medical practitioners towards their poor patients and are in keeping with the satirical traditions of the period. And yet such appointments also served to counteract charges of greed and self-interest. This was especially true for physicians and surgeons who almost always provided their services for free. Though what must have been, for many, a financial sacrifice, pro bono service testified to the practitioner’s commitment to the cultural values of civil society: benevolence and social responsibility. For apothecaries, this performance of benevolent gentility was more problematic. As the practitioner responsible for most of the day-to-day medical tasks and often a young, single man at an early stage in his career, the apothecary was normally the only salaried medical officer attached to these institutions. Such wages, while they were doubtless valued on a practical economic level, did little to distance the apothecary from the

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grubby business of trade or to serve as a testament to his imagined gentility. Indeed, the associations between the apothecary and the manual business of trade were compounded by the fact that at many institutions, including the York Dispensary, the room from which he operated was habitually, perhaps derogatively, known as his ‘shop’. And yet despite, or perhaps because of this, there is evidence to suggest that men like Allen sought, wherever possible, to obviate such associations and to invest in the same benevolent and disinterested identities as their medical and surgical colleagues. Thus, in his History of the York Dispensary (1845), Allen tactfully sidelined the issue of his £60 a year salary, preferring instead to highlight his charitable and epistemological motivations: [This salary] remained without any increase, during the whole period of my continuance in the office. I never applied for any increase of salary: though such a sum was no adequate remuneration for my labours in a pecuniary point of view; yet I felt myself amply compensated, by the pleasure I experienced in my services amongst the poor, and the extensive field of practice thus afforded me for observation and the acquisition of medical knowledge.141

Like patronage, eighteenth-century marriage was both a private relationship and a highly public signifier of social identity. Allen was keenly aware of both the personal and social significance of matrimony, claiming that he ‘always viewed marriage as a most important step, even a crisis of human life, as upon that choice, his future comfort or misery in life seem to depend’.142 Having established a viable practice and having settled on the idea of taking a wife, Allen was therefore concerned to marry well. In keeping with Tadmor’s argument about the inherent affinity between family, friendship and patronage, Allen’s choice of wife was none other than Frances Withers, the sister of his benefactor, and now close friend, Thomas Withers, who, in encouraging the relationship, appeared to Allen ‘to take a peculiar interest in my future welfare’. In September 1793, shortly after Allen had, on the advice of Dr Withers, bought Mrs Whaley out of the business for £600, the two were married.143 We have already seen how Allen was concerned about the personal, social and moral dangers posed by sexual relations, dangers which he thought were particularly pronounced for medical practitioners whose work exposed them to ‘many temptations’.144 Indeed, although marriage provided a legitimate means for the expression of masculine sexuality, Allen’s marriage to Frances was constructed in explicitly de-sexualised terms. Frances was ‘elderly’ yet ‘respectable in her appearance’ and he represented her not as an object of sexual or romantic desire but as an agreeable companion, praising ‘the frankness of her disposition, and her affable and affectionate manners’.145 To a degree, Allen’s attitude to sexuality derived less from social convention than from his idiosyncratic upbringing. Frances was, he wrote, more

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Frances’s appeal did not simply lie in her qualities as a ‘helpmate’. As well as being ‘respectable in her appearance’ she had ‘connections’. The Withers were an established local family and Allen anticipated that marrying the sister of one of the city’s most prominent physicians would be highly conducive to both ‘domestic comfort, and establishment in my Profession’. ‘These anticipations were fully realised’, for his ‘medical practice gradually encreased [sic] from the accession of many families with whom I had become in some measure connected’.147 Yet despite his new found success in private practice Allen was not about to give up on his commitments to the York Dispensary. As if to confirm the importance of public medical office as a signifier of social and moral virtue, he claimed: Though I was introduced into a genteel family connection, I determined to continue my diligence and assiduity in my profession, particularly in my attendance upon the poor in which department I always experienced a peculiar pleasure and satisfaction; and above all, never to lose sight of my duty to my Creator.148

Nevertheless, by 1808, and after nearly twenty years in the post, Allen did eventually resign as apothecary to the Dispensary, although he continued to have dealings with the charity as a director. To mark the occasion of his resignation, he was presented with a silver plate inscribed with a testimony to the ‘high approbation, not only of his professional qualifications, but of his benevolent, successful and unwearied attention to the diseased poor of this City’.149 His connections with the Withers family also continued to accumulate both economic and symbolic capital, for although their Anglican faith created tensions as to the religious education of Allen’s daughter, their wealth and social standing were to prove invaluable. When Dr Withers’ brother, William, died in 1802, he left Allen and his wife the substantial sum of £1,000, which Allen took as a mark ‘of his respect and confidence in me’.150 In keeping with his social aspirations, Allen decided to invest the money in buying William’s country retreat, Mill Crooks, a farm to the north of York. Allen expended around £3,000 on the property, including improvements, and although he considered this a sound investment, the house being eminently saleable due to its ‘situation and vicinity to York’, it also provided an opportunity for the public display of his wealth and an arena for genteel, domestic performance, a place where his friends ‘took tea with us’.151

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By the 1800s, then, the modest country lad of peculiar religious persuasion had done much to establish himself as a respectable gentleman and citizen of York. Through the cultivation of patronage and his marriage into a wealthy local family, Allen saw his fortune grow with his social standing. Of course this has been only a partial account of Allen’s life. As well as recording his successes, Allen’s memoirs also recount his disappointments and grief: the loss of his wife in 1823, his unfortunate second marriage and the continued travails of his profligate brother, Matthew. Moreover, the period in which Allen lived and practised spans the chronology of this book and was, as we shall see, one of almost seismic change both within medicine and within the wider social, cultural and political spheres. Nevertheless, despite Allen’s engagement with forms of social organisation and practice which reflected the changing circumstances of the early nineteenth century, most notably his appointment as Treasurer to the newly founded Associated Body of Surgeons and Apothecaries in 1818, his social identity remained rooted in an eighteenth-century culture within which medical identity was determined less by the vocationally specific nature of knowledge and practice than by the wider values of gentility, politeness and social virtue. Indeed, perhaps the most expressive example of Allen’s overriding concern with social respectability comes at the end of his memoirs when he recounts his reaction to finding out that his nephew and namesake had enlisted as a private in the 77th Infantry. Mustering all the indignation of the landed gentleman, Allen, the preacher’s son from a large family of moderate means who had been apprenticed at the age of thirteen to a shop-based tradesman, expressed his disdain at ‘what an afflicting circumstance that a branch of my family, and an Oswald Allen, should have become a common soldier’.152 Conclusion As both the Doctors Club and the life of Oswald Allen demonstrate, late eighteenth-century medical culture and identity were fundamentally shaped by the values of politeness, gentility and sociability and were dependent upon both an active participation in civic life and the cultivation and exploitation of patronage and social networks. From the bets made in the Doctors Club to Allen’s desire for a more extensive classical education, what these examples also reveal is the centrality of knowledge within this culture. Although practitioners necessarily required a degree of vocationally specific knowledge in order to practice as physicians, surgeons or apothecaries, such practitioners displayed an equal, if not greater desire, to acquire and display forms of broader and more socially resonant learning. The next chapter examines this in more detail, demonstrating how an engagement with polite and ‘ornamental’ knowledge such as botany and natural history or with literary styles

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such as poetry and comedy served to shape the medical practitioner as both gentleman and scholar. Notes 1 Anon. [J. Gregory], Observations on the Offices and Duties of a Physician; and on the Method of Prosecuting Enquiries in Natural Philosophy (London: W. Strahan and T. Cadell, 1770), p. 50. 2 Quoted in W. Hargrove, History and Description of the Ancient City of York, 3 vols (York: W. Alexander, 1818), vol. 1, p. 351. 3 P. M. Tilliot (ed.), A History of Yorkshire: The City of York (Oxford: Oxford University Press, 1961), p. 212. 4 Sweet, The English Town, 1680–1840: Government, Society and Culture (Harlow: Longman, 1999), table 1, pp. 3–4. 5 R. Sweet, The English Town, table 1, pp. 3–4; J. V. Pickstone, Medicine and Industrial Society: A History of Hospital Development in Manchester and its Region, 1752–1946 (Manchester: Manchester University Press, 1985), pp. 10, 98. 6 H. Marland, Medicine and Society in Wakefield and Huddersfield, 1780–1870 (Cambridge: Cambridge University Press, 1987), pp. 7–16. 7 D. Defoe, Tour Through the Whole Island of Great Britain (1724–26) reprinted, 3 vols (London: Folio Society, 1983), vol. 3, p. 108. 8 F. Drake, Eboracum, or the History and Antiquities of the City of York (York: W. Bowyer, 1736), p. 240. 9 J. J. Looney, ‘Cultural life in the provinces: Leeds and York, 1720–1820’, in A. L. Beier, D. Cannadine and J. M. Rosenheim (eds), The First Modern Society: Essays in English History in Honour of Lawrence Stone (Cambridge: Cambridge University Press, 1992). 10 P. Nuttgens (ed.), The History of York from the Earliest Times to the Year 2000 (Pickering: Blackthorn Press, 2001), p. 233. 11 Tilliot (ed.), A History of Yorkshire, p. 225. 12 P. Borsay, The English Urban Renaissance: Culture and Society in the Provincial Town, 1660–1770 (Oxford: Clarendon, 1989); Borsay (ed.), The EighteenthCentury Town: A Reader in English Urban History, 1688–1820 (Harlow: Longman, 1990); J. Ellis, The Georgian Town, 1680–1840 (Houndmills, Basingstoke: Palgrave, 2001). 13 Tilliot (ed.), A History of Yorkshire, p. 207; Borsay, English Urban Renaissance, pp. 163–4; Borsay, ‘Politeness and elegance: the cultural re-fashioning of eighteenth-century York’, in M. Hallett and J. Rendall (eds), Eighteenth-Century York: Culture, Space and Society (York: Borthwick Publications, 2003), p. 5; M. Hallett, ‘Pictorial improvement: York in eighteenth-century graphic art’, in Hallett and Rendall (eds), Eighteenth-Century York, pp. 39–46. 14 Tilliot (ed.), A History of Yorkshire, pp. 208–9; YCA, Acc. 163, MSS, W. White, ‘Analecta Eborancesia, or Memorandum of Events at York’, fo. 6. 15 YCA, Acc. 163, MSS, W. White, ‘Analecta Eborancesia, or Memorandum of Events at York’, fo. 7.

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16 Drake, Eboracum, p. 241. 17 B. Wragg and G. Worsley, The Life and Works of John Carr of York (York: Oblong, 2000), pp. 15–16. 18 Tilliot (ed.), A History of Yorkshire, p. 226; Drake, Eboracum, p. 241. 19 Tilliot (ed.), A History of Yorkshire, p. 236. 20 On ritual, see P. Borsay, ‘ “All the town’s a stage”: urban ritual and ceremony’, in P. Clark (ed.), The Transformation of English Provincial Towns, 1600–1800 (London: Hutchinson, 1984). On civic culture more generally, see J. Barry, ‘Provincial town culture, 1640–1780: urbane or civic?’, in J. Pittock and A. Wear (eds), Interpretation and Cultural History (Basingstoke: Macmillan, 1991); D. Wahrman, ‘National society, communal culture: an argument about the recent historiography of eighteenth-century Britain’, Social History, 17:1 (1992), 43–72; J. Barry, ‘Bourgeois collectivism? Urban association and the middling sort’, in J. Barry and C. W. Brooks (eds), The Middling Sort of People: Culture, Society and Politics in England, 1550–1800 (Basingstoke: Macmillan, 1994); Barry, ‘Civility and civic culture in early modern England: the meanings of urban freedom’, in P. Burke, B. H. Harrison and P. Slack (eds), Civil Histories: Essays Presented to Sir Keith Thomas (Oxford: Oxford University Press, 2000). 21 Tilliot (ed.), A History of Yorkshire, p. 238. 22 R. J. S. Hoffman, The Marquis: A Study of Lord Rockingham, 1730–82 (New York: Fordham University Press, 1973); P. Langford, The First Rockingham Administration, 1765–6 (Oxford: Oxford University Press, 1973); F. O’Gorman, The Rise of Party in England: The Rockingham Whigs, 1760–82 (London: Allen and Unwin, 1975). 23 I. R. Christie, Wilkes, Wyvill and Reform: The Parliamentary Reform Movement in British Politics, 1760–85 (London: Macmillan, 1962); J. R. Dinwiddy, Christopher Wyvill and Reform, 1790–1820, Borthwick Paper, 39 (1971). 24 Tilliot (ed.), A History of Yorkshire, p. 244. 25 C. M. Cross, ‘Conflict and confrontation: the York Dean and Chapter and the corporation in the 1630s’, in D. Marcombe and C. S. Knighton (eds), Close Encounters: English Cathedrals and Society since 1540 (Nottingham: University of Nottingham Department of Adult Education, 1991). 26 Tilliot (ed.), A History of Yorkshire, p. 303. 27 Tilliot (ed.), A History of Yorkshire, p. 252. 28 J. C. H. Aveling, Catholic Recusancy in the City of York, 1558–1791, Catholic Record Society Monographs, vol. 2 (St Albans: Catholic Record Society, 1970), p. 136. 29 Aveling, Catholic Recusancy, pp. 118–19. 30 G. M. Ditchfield, ‘Cappe, Newcome (1733–1800)’, DNB; C. Cappe, Memoirs of the Late Rev. Newcome Cappe (York: T. Wilson and R. Spence, 1802); Cappe, Memoirs of the Life of the Late Mrs Catherine Cappe; Written by Herself (York: T. Wilson and Sons, 1822); H. Plant, Unitarianism, Philanthropy and Feminism in York, 1728–1821: The Career of Catherine Cappe, Borthwick Paper, 103 (2003); Plant, ‘Gender and the aristocracy of dissent: a comparative study of the beliefs, status and roles of women in Quaker and Unitarian communities, 1780–1830,

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31 32 33 34 35 36 37 38 39 40 41 42 43

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Performing medicine with particular reference to Yorkshire’ (DPhil dissertation, University of York, 2000). S. Wright, Friends in York: The Dynamics of a Quaker Revival, 1780–1860 (Keele: Keele University Press, 1995), p. 13. Wright, Friends in York, pp. 21–30. M. E. Fissell, Patients, Power and the Poor in Eighteenth-Century Bristol (Cambridge: Cambridge University Press, 1991), p. 52, fig. 3.1. YCA, Acc. 5 and 6, D1a, MSS, Diary of Faith Gray, 1764–1810, fo. 91. See also, E. Gray, Papers and Diaries of a York Family (London: The Sheldon Press, 1927), pp. 80–1. J. Atkinson, Medical Bibliography A. and B. (York: H. Bellerby, 1833), p. 360. YCA, Acc 5 and 6, D1a, MSS, Diary of Faith Gray, 1764–1810, fo. 91; Gray, Papers and Diaries, p. 81. Wellcome Library, London, MS.4645, MSS, Smyth Family Receipt Book, fos 96–9. C. Atkinson, The Life and Adventures of an Eccentric Traveller (York: M. W. Carrall, 1818), pp. 19–20. A. Hunter, Men and Manners: or Concentrated Wisdom, 4th edn (York: Wilson and Son, 1809), p. 87. BIHR, MSS, Will of A. Hunter, September 1809. BIHR, MSS, Will of T. Withers, December 1808; BIHR, MSS, Will of A. Swainston, August 1782. BIHR, MSS, Will of W. White, August 1789; BIHR, MSS, Will of R. Cappe, September 1802. R. Porter, Bodies Politic: Disease, Death and Doctors in Britain, 1650–1900 (London: Reaktion Books, 2001), pp. 15–34, 129–49. See also, P. J. Corfield, Power and the Professions in Britain, 1700–1850 (London: Routledge, 1995); C. T. Probyn, ‘Swift and the physicians: aspects of satire and status’, Medical History, 18:3 (1974), 249–61; J. Hawley, ‘The anatomy of Tristram Shandy’, in M. M. Roberts and R. Porter (eds), Literature and Medicine During the Eighteenth Century (London: Routledge, 1993); H.-P. Wagner, ‘The satire on doctors in Hogarth’s graphic works’, in Roberts and Porter (eds), Literature and Medicine; F. Haslam, From Hogarth to Rowlandson: Medicine in Art in Eighteenth-Century Britain (Liverpool: Liverpool University Press, 1996), p. 8. For a general analysis of the genesis of trade directories, see P. J. Corfield and S.  Kelly, ‘ “Giving directions to the town”: the early town directories’, Urban History Yearbook, 11 (1984), 22–35. Cappe, Memoirs of the Late Rev. Newcome Cappe, p. 49. A. Digby, ‘Hunter, Alexander (1729?–1809)’, in DNB; ‘A Memoir of the Life of Alexander Hunter, M.D.’, appended to A. Hunter (ed.), Silva: Or a Discourse of Forrest Trees and the Propagation of Timber in his Majesty’s Dominions, 4th edn, 2 vols (York: Wilson and Spence, 1812), vol. 2, pp. xi–xii; Aveling, Catholic Recusancy, pp. 139, 149. Cappe, Memoirs of the Life of the Late Mrs Catherine Cappe, pp. 247–8, 266–7.

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48 In 1775 Thomas Withers, referred to ‘Mr White, a very ingenious accurate apothecary in the city of York’. T. Withers, Observations on the Abuse of Medicine (London: J. Johnson, 1775), p. 123. 49 The Medical Register for the Year 1780 (London: Fielding and Walker, 1780), pp. 158–60. 50 Plant, Unitarianism, Philanthropy and Feminism, p. 18. 51 H. French, The Middle Sort of People in Provincial England, 1600–1750 (Oxford: Oxford University Press, 2007), pp. 90–140. See also, French, ‘Social status, localism and the “middle sort of people” in England 1620–1750’, Past and Present, 166 (2000), 66–99. 52 Atkinson, Medical Bibliography, pp. 85, 123. 53 M. Pelling, ‘Politics, medicine, and masculinity: physicians and office-bearing in early modern England’, in M. Pelling and S. Mandelbrote (eds), The Practice of Reform in Health, Medicine and Science, 1500–2000: Essays for Charles Webster (Aldershot: Ashgate, 2005), p. 85. 54 A. Tomkins, York Barber Surgeons Guild, 1730–1786, Being Part of the Barber Surgeons Guild Volume BL Eg 2572 (Keele: Keele University, 1998). 55 Pelling, ‘Politics, medicine, and masculinity’, p. 89. 56 L. E. Klein, Shaftesbury and the Culture of Politeness: Moral Discourse and Cultural Politics in Early Eighteenth-Century England (Cambridge: Cambridge University Press, 1994), p. 10. 57 J. W. Yolton, Thinking Matter: Materialism in Eighteenth-Century Britain (Oxford, Blackwell, 1983); A. C. Vila, Enlightenment and Pathology: Sensibility in the Literature and Medicine of Early Modern France (Baltimore: Johns Hopkins University Press, 1998); G. J. Barker-Benfield, The Culture of Sensibility: Sex and Society in Eighteenth-Century Britain (Chicago: Chicago University Press, 1992); G. Rousseau, ‘Nerves, spirits and fibres: toward the origins of sensibility’, in Nervous Acts: Essays on Literature, Culture and Sensibility (Basingstoke: Palgrave, 2004); H. Steinke, Irritating Experiments: Haller’s Concept and the European Controversy on Irritability and Sensibility (Amsterdam: Rodopi, 2005). 58 P. Carter, Men and the Emergence of Polite Society: Britain, 1660–1800 (London: Longman, 2001), p. 209. 59 P. Langford, ‘The uses of eighteenth-century politeness’, Transactions of the Royal Historical Society, 12 (2002), 311–31. 60 L. Rosner, Medical Education in the Age of Improvement: Edinburgh Students and Apprentices, 1760–1826 (Edinburgh: Edinburgh University Press, 1991), p. 35; T. N. Bonner, Becoming a Physician: Medical Education in Britain, France, Germany, and the United States, 1750–1945 (Oxford: Oxford University Press, 1995). 61 R. Porter, ‘Lay medical knowledge in the eighteenth century: the evidence of the “Gentleman’s Magazine” ’, Medical History, 29:2 (1985), 138–68; P. Rieder, ‘Patients and words: a lay medical culture?’, in G. S. Rousseau, M. Gill, D. B. Haycock and M. Herwig (eds), Framing and Imagining Disease in Cultural History (Basingstoke: Palgrave, 2003).

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62 S. Copley, ‘Commerce, conversation and politeness in the early eighteenthcentury periodical’, British Journal for Eighteenth-Century Studies, 18:1 (1995), 63–77; K. Gleadle, ‘Opinions, deliver’d in conversation: conversation, politics and gender in the late eighteenth century’, in J. Harris (ed.), Civil Society in British History: Ideas, Identities, Institutions (Oxford: Oxford University Press, 2003). 63 Klein, Shaftesbury, pp. 6–7. 64 Langford, ‘The uses of eighteenth-century politeness’. 65 YC, 8 March 1825. 66 YC, 23 September 1823. 67 [Gregory], Observations, p. 9. 68 Hunter, Men and Manners, p. 60. 69 C. Lawrence, ‘Divine, democratic and heroic: the history and historiography of surgery’, in C. Lawrence (ed.), Medical Theory, Surgical Practice: Studies in the History of Surgery (London: Routledge, 1992). See also, P. Stanley, For Fear of Pain: British Surgery, 1790–1850 (Amsterdam: Rodopi, 2003). On the tensions between politeness and surgical/anatomical practice, see A. Guerrini, ‘Anatomists and entrepreneurs in early eighteenth-century London’, Journal of the History of Medicine and Allied Sciences, 59:2 (2004), 219–39. 70 R. Porter, ‘A touch of danger: the man-midwife as sexual predator’, in G. S. Rousseau and R. Porter (eds), Sexual Underworlds of the Enlightenment (Manchester: Manchester University Press, 1987). See also, A. Wilson, The Making of Man-Midwifery: Childbirth in England, 1660–1770 (Cambridge, MA: Harvard University Press, 1995); L. F. Cody, Birthing the Nation: Science, Sex and the Conception of Eighteenth-Century Britons (Oxford: Oxford University Press, 2005), chapter 6. 71 W. White, Observations on the Nature and Cure of Phthisis Pulmonaris, or Consumption of the Lungs (York: Wilson, Spence and Mawnan, 1792), p. 71. 72 Porter, Bodies Politic, p. 144. For a more considered examination of genteel medical self-fashioning, see, R. Porter, ‘William Hunter: a surgeon and a gentleman’, in W. F. Bynum and R. Porter (eds), William Hunter and the Eighteenth-Century Medical World (Cambridge: Cambridge University Press, 1985); L. Jordanova, ‘Medical men 1780–1820’, in J. Woodall (ed.), Portraiture: Facing the Subject (Manchester: Manchester University Press, 1997); Jordanova, Defining Features: Scientific and Medical Portraits 1660–2000 (London: Reaktion Books, 2000). 73 Borsay, English Urban Renaissance, pp. 237–84; P. Clark, British Clubs and Societies, 1580–1800: The Origins of an Associational World (Oxford: Oxford University Press, 2000). 74 YC, 11 November 1788. 75 J. Bord, Science and Whig Manners: Science and Political Style in Britain, c. 1790–1850 (Basingstoke: Palgrave, 2009). 76 Bord, Science and Whig Manners, chapter 5. 77 YCL, MSS, Minute Books of the Ancient Society of York Florists, vol. 1; R. E. Duthie, ‘The Ancient Society of York Florists’, York Historian, 3 (1980), p. 44.

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78 I. Loudon, ‘Medical education and medical reform’, in V. Nutton and R. Porter (eds), The History of Medical Education in Britain (Amsterdam: Rodopi, 1995), p. 234. 79 YML, Additional MS 129, MSS, Doctors Club Minute Book. 80 YML, Additional MS 129, MSS, Doctors Club Minute Book. 81 Barry, ‘Provincial town culture’; Borsay, ‘Politeness and elegance’, p. 8. 82 Borsay, ‘Politeness and elegance’, p. 8. 83 An advertisement for the inaugural meeting of the ‘Laughing Club’ at the Star Inn on Stonegate was inserted in the YC, 21 August 1787. 84 YML, Additional MS 129, MSS, Doctors Club Minute Book, 29 March 1781. 85 M. Cohen, Fashioning Masculinity: National Identity and Language in the Eighteenth Century (London: Routledge, 1996); Cohen, ‘Manliness, effeminacy and the French: gender and the construction of national character in eighteenthcentury England’, in T. Hitchcock and M. Cohen (eds), English Masculinities, 1660–1800 (Harlow: Longman, 1999); Cohen, ‘ “Manners” make the man: politeness, chivalry and the construction of masculinity, 1750–1830’, Journal of British Studies, 44:2 (2005), 312–29; P. Carter, ‘Men about town: representations of foppery and masculinity in early eighteenth-century urban society’, in H. Barker and E. Chalus (eds), Gender in Eighteenth-Century England: Roles, Representations and Responsibilities (London: Longman, 1997); Carter, Men and the Emergence of Polite Society. 86 A. Vickery, The Gentleman’s Daughter: Women’s Lives in Georgian England (New Haven: Yale University Press, 1999), p. 217. 87 Carter, ‘Men about town’, p. 49. 88 Cohen, ‘ “Manners” make the man’, p. 313. 89 YML, Additional MS 129, MSS, Doctors Club Minute Book, 29 March 1781. 90 L. Stone, The Family, Sex and Marriage in England, 1500–1800 (London: Harper and Row, 1977); L. Davidoff and C. Hall, Family Fortunes: Men and Women of the English Middle Class, 1780–1850 (Chicago: University of Chicago Press, 1987), pp. 322–3. 91 P. Carter, ‘James Boswell’s manliness’, in Hitchcock and Cohen (eds), English Masculinities. 92 YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 83; Davidoff and Hall, Family Fortunes, pp. 323–4. 93 Barker-Benfield, Culture of Sensibility, pp. 215–44, 247–50. See also, Stone, Family, Sex and Marriage, pp. 221–69; Davidoff and Hall, Family Fortunes, pp. 322–9. 94 Barker-Benfield, Culture of Sensibility, pp. xxvi, 92–3. 95 Barker-Benfield, Culture of Sensibility, p. 92. 96 Borsay, English Urban Renaissance, pp. 176–8; Barker-Benfield, Culture of Sensibility, pp. 231–47. 97 Rosner, Medical Education, p. 33; Bonner, Becoming a Physician, pp. 61–89. 98 J. Lane, ‘The role of apprenticeship in eighteenth-century medical education in England’, in Bynum and Porter (eds), William Hunter; Lane, Apprenticeship in England: 1600–1914 (London: University College London Press, 1996);

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99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127

Performing medicine M.  Fissell, ‘Innocent and honourable bribes: medical manners in eighteenthcentury Britain’, in R. Baker, D. Porter and R. Porter (eds), The Codification of Medical Morality: Historical and Philosophical Studies of the Formalization of Western Medical Morality in the Eighteenth and Nineteenth Centuries. Volume One: Medical Ethics and Etiquette in the Eighteenth Century (London: Kluwer, 1993). Stone, Family, Sex and Marriage, pp. 46–54. Pelling, ‘Politics, medicine, and masculinity’, pp. 85–6. Digby, ‘Hunter, Alexander’; YML, Additional MS 129, MSS, Doctors Club Minute Book, 20 February 1799. Carter, Men and the Emergence of Polite Society, pp. 83fn. 39, 194. See also, Carter, ‘James Boswell’s manliness’. YML, Additional MS 129, MSS, Doctors Club Minute Book, 9 May 1782. G. Russell, ‘ “Faro’s daughters”: female gamesters, politics and the discourse of finance in 1790s Britain’, Eighteenth-Century Studies, 33:4 (2000), 401–584. YML, Additional MS 129, MSS, Doctors Club Minute Book, 29 March 1781. YML, Additional MS 129, MSS, Doctors Club Minute Book, 19 January 1800 and 30 August 1799. Pelling, ‘Politics, medicine, and masculinity’, p. 95. YML, Additional MS 129, MSS, Doctors Club Minute Book, 21 October 1790. YML, Additional MS 129, MSS, Doctors Club Minute Book, 27 November 1794. William Combe, History and Antiquities of the City of York, from its Origins to the Present Times in Three Volumes (York: 1785), vol. 2, p. 379. YC, 28 October 1788. This pattern was also repeated in a number of other urban communities in this period. Clark, British Clubs and Societies, p. 162. P. Bourdieu, Distinction: A Social Critique of the Judgement of Taste (Cambridge, MA: Harvard University Press, 1984), p. 162. YML, Additional MS 129, MSS, Doctors Club Minute Book, 29 March 1781. YML, Additional MS 129, MSS, Doctors Club Minute Book, 29 March 1781. YML, Additional MS 129, MSS, Doctors Club Minute Book. Bourdieu, Distinction, p. 163. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 1. P. Joyce, Democratic Subjects: The Self and the Social in Nineteenth-Century England (Cambridge: Cambridge University Press, 1994), p. 19. C. J. Podmore, ‘Ingham, Benjamin (1712–1772)’, DNB. D. B. Murray, ‘Glas, John (1695–1773)’, DNB; Murray, ‘Sandeman, Robert (1718–1771)’, DNB. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 5 YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 9. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 3. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fos 4–5. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fos 30–1. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 85. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 87.

The Doctors Club 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152

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YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 87. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 465. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fos 19, 53. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 63. N. D. Jewson, ‘Medical knowledge and the patronage system in eighteenthcentury England’, Sociology, 8:3 (1974), 369–85. N. Tadmor, Family and Friends in Eighteenth-Century England: Household, Kinship, and Patronage (Cambridge: Cambridge University Press, 2001), pp. 198–217. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 71. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 71. BIHR, YCH 1/1/2/1, MSS, Court of Governors Minute Book, 12 May 1778. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fos 220–1. For example, see A. Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720–1911 (Cambridge: Cambridge University Press, 1994), pp. 249–50. This has been acknowledged by A. Borsay, Medicine and Charity in Georgian Bath: A Social History of the General Infirmary, c. 1739–1830 (Aldershot: Ashgate, 1999), pp. 105–38. T. Smollett, The Adventures of Ferdinand Count Fathom (1753) reprinted (London: Penguin, 1990), pp. 328–9. O. Allen, History of the York Dispensary: Containing an Account of its Origins and Progress to the Present Time; Comprising a Period of Fifty-Seven Years (York: R. Pickering, 1845), p. 10. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 83. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fos 89–90. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 83. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 84 YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 84. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fos 91, 93. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 91. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 42. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fos 167–8. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 168. YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 465.

2

Polite and ornamental knowledge: medicine and the world of letters

The Doctor, being possessed of an active and liberal mind, considered himself as not only engaged to benefit those with whom he lived, but also to do something for posterity. ‘A Memoir of the Life of Alexander Hunter, M.D.’ (1812)1

I

n 1794 th e York p h y s i ci an, Thomas Withers, published A Treatise on the Errors and Defects of Medical Education. His work was heavily indebted to John Gregory’s lectures on the duties of a physician, which he had attended as a student in Edinburgh.2 Like Gregory’s lectures, Withers’ book was addressed to the aspiring practitioner and outlined the type of education and forms of behaviour he deemed necessary for the successful physician. Withers was clearly a man who valued politeness, learning and social grace. Although published in London, his Treatise was dedicated to the York solicitor and Doctors Club member, Peter Johnson: Your character in the literary world is too well known to receive any additional lustre from my pen. In private and public life, the excellency of your conduct has been equally conspicuous; as is clearly evinced by the high esteem of all who know you. Not to mention the happiness of your friendship, your distinguished learning, as a Gentleman and a Scholar, adorned with every social virtue and sound principle of religion and morality.3

If Withers admired these genteel qualities in his friends, he thought them essential to the very character of the physician. His text, a veritable exposition of medico-gentility, offered instruction on all aspects of social performance, ranging from the benefits of fencing and dancing for the cultivation of a ‘firm, easy and genteel carriage’, to the importance of mixed gender association and the potential pitfalls of ‘gaming’, one of the ‘most fashionable vices of the age’.4 However, it was knowledge which was, for Withers, the most important aspect of the physician’s identity and he dedicated the first chapter of his book to the subject of ‘preliminary and ornamental learning’. Withers regarded such knowledge as ‘ornamental’ because it was not explicitly connected with

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medicine. Nevertheless, it was essential if a physician was to partake in polite society as a gentleman: The character of a physician ought to be that of a gentleman, which cannot be maintained with dignity but by a man of literature. He is much in the world, and mixes in society with men of every description. He ought therefore to be well acquainted with men and manners. If a gentleman, engaged in the practice of physic be destitute of that degree of preliminary and ornamental learning, which is requisite to qualify him to act with dignity and propriety in his profession, he will be in danger of exposing himself, as well as his profession, to ridicule, if not to contempt. Such a one, for instance, if he do but speak on any subject, either of history or philosophy, is immediately out of his depth, his thoughts are confused, his language incoherent, and his conclusions weak and erroneous.5

Withers thought this ‘defect in medical characters’ a ‘real discredit’ to the individual and to the faculty as a whole. He therefore proposed to offer some advice as to the forms of knowledge with which the prospective practitioner might familiarise himself.6 Languages were particularly important. Latin was ‘absolutely necessary for a medical student’, not simply because many medical texts were written, and most medical dissertations submitted, in that language, but also because, without it, the practitioner would be ‘deprived of the pleasure of reading the Latin classics’. Greek was ‘both ornamental and useful’, while French was desirable because of the ‘many excellent medical publications which have originated from them’ and because the French had ‘always been esteemed a learned, and till of late, a polished people’.7 Withers also recommended that the medical student not neglect his ‘native tongue’ and that he should develop a ‘distinct and harmonious pronunciation’, a ‘great ornament in common life . . . and well worth the attention of the physician’, especially if he had an ‘expectation of practising amongst the higher ranks of society’.8 A familiarity with mathematics was likewise ‘necessary in the character of a gentleman, and consequently of a physician’. So too was a knowledge of history, logic, rhetoric, belles lettres and natural history. The latter was particularly important because it facilitated an appreciation of the beauties of Providence and because: To understand the general principles of natural philosophy is highly ornamental to the physician, for without a knowledge of these (which is by no means difficult to be attained) no man can pass through life in the character of a gentleman.9

Withers’ work suggests that a broad liberal education, embracing polite and ornamental knowledge, was central to a late eighteenth-century culture of medicine in which gentility and social inclusion were paramount concerns. He was not alone in his opinions. His mentor, John Gregory, had told his students that they should pursue ‘any genteel accomplishment, that becomes

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a gentleman’, for such ‘amusement[s]’ served as a relaxation ‘from the severer studies of his profession’ and rendered his conversation ‘more chearful [sic] and entertaining’. ‘[I]nstead of that awkward pedantry, which modern men of learning have generally chosen to distinguish themselves’ they ‘diffuse[d] a liberal, ingenious, and elegant air over his whole manner’.10 Others put such sentiments into practice. Erasmus Darwin was probably better known to the public as an author of botanical and poetical works than as a medical practitioner.11 Likewise, while Thomas Percival wrote a number of medical works, including his Essays Medical and Experimental (1772), he also published a series of ‘moral and literary dissertations’ on subjects such as a ‘taste for the fine arts’ and ‘the alliance of natural history, and philosophy, with poetry’.12 This chapter explores the place of polite and ornamental learning in the social self-fashioning of the late eighteenth-century medical gentleman. During this period a number of local practitioners produced what might be called conventional medical works. Indeed, for a city remote from the centres of corporate and epistemological power, late eighteenth-century York was a relative hive of medical publishing. In addition to his advice on medical education Thomas Withers wrote Observations on the Abuse of Medicine (1775), Observations on Chronic Weakness (1777), and his seminal Treatise on the Asthma (1786).13 During a career cut short by disease, William White likewise produced Essay on the Diseases of the Bile (1771) and the posthumous Observations on the Nature and Cure of Phthisis Pulmonaris, or Consumption of the Lungs (1792). To this list one might also add Allen Swainston’s Thoughts Physiological, Pathological and Practical (1790). And yet for all these conventional medical works there were other practitioners who effected a much broader engagement with the world of letters. It is these textual and epistemological practices which provide the focus for our analysis here. York’s medical practitioners published on a broad range of subjects, some of which had a closer affinity to medicine than others. Indeed, in an era of pre-specialist intellectual plurality, the epistemological domain of medicine reached deep into the field of natural history.14 Each of these subjects and each of these publications did different kinds of cultural work, shaping different aspects of social identity. Depending on their form, content and place of their publication, they could project their authors on to a national stage or a more local one. Others mediated between local and national realms. Their authors might be wealthy physicians and members of the Royal Society, or surgeon-apothecaries with more limited social networks. All, however, had one thing in common. As Thomas Withers claimed, ‘few gentlemen are judges of medical attainments’ and ‘recourse is therefore often had to the more general topics of polite literature, in order to convince the world of sense and abilities’.15 If medical texts introduced their authors to fellow practitioners then these publications reached out to a much broader public audience. Through the forms of

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knowledge they displayed, their authors announced that they were not locked into the narrow trammels of a trade-like consciousness but were gentlemen of liberal tastes and learning, able to participate in polite and cosmopolitan discourse. This chapter takes the form of three case studies of local practitioners whose interests and publications spanned the spectrum of polite learning from what might be called ‘natural’ forms of knowledge, including botany and agricultural improvement, though antiquarianism and chorography to the more ‘social’ forms of comedic literature. It begins with Alexander Hunter, whose botanical and agricultural publications shaped his identity as a patriotic Whig of refined sensibilities, before proceeding to consider how medicine intersected with the cultural politics of place in the work of his friend and fellow physician, William White. With White’s antiquarianism providing the link between the natural and the social, it then concludes with the work of Charles and James Atkinson, exploring how comedic writing could present medical practitioners as men of wit and literary imagination, at ease with the droll discourse of men and manners. Alexander Hunter: gentleman and scholar In 1774 Alexander Hunter was proposed a member of the Royal Society of London. Among those who signed his election certificate were Sir Thomas Frankland, attorney and future High Sheriff of Yorkshire, and the Manchester practitioners Thomas Percival and Charles White.16 The certificate read: Doctor Alexander Hunter, an eminent Physician at York, desires to offer himself a Candidate for election into the Royal Society. He is well known to the Public as the Editor of the Georgical Essays, and as the Author of some of the most valuable Papers on Agriculture and Natural History, in that Collection. His Treatise on Buxton Water has been much read and approved; and he is now engaged in preparing for the Press a very correct and splendid Edition of Mr Evelyn’s Silva; a Work which originated from the Royal Society in 1664, and is highly deserving of their present encouragement. We, whose names are subscribed, recommend Dr Hunter, from our knowledge, as a Gentleman, a Scholar, and a Philosopher, and we believe that he will be a valuable acquisition to the Royal Society, if he shall have the honour of being elected a Fellow.17

Hunter’s testimonial clearly demonstrates the importance of publication in his election to the Royal Society in 1775. It also attests to the role played by social networks in facilitating his assimilation into the intellectual elite of metropolitan and national society. His election to that august body owed less to his reputation as an ‘eminent Physician’ than it did to his identity as ‘a Gentleman, a Scholar, and a Philosopher’, an identity which was fashioned in part through an investment in natural history and agricultural improvement.

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Hunter was not necessarily typical of the medical practitioners of York. He was, after all, a highly successful physician and a prolific author. He is, however, a shining exemplar of late eighteenth-century medico-gentility as a form of social performance and self-presentation. While surgeons and apothecaries were able to shape similar identities, the physician’s university education provided him with a particularly valuable set of cultural resources for the cultivation of a polite and learned persona. Hunter’s first foray into the world of letters came in 1761, with the anonymous publication of A Treatise on the Nature and Virtues of Buxton Waters.18 In 1768, five years after arriving in York from Beverley to take up a post at the County Hospital, he published an expanded edition under his own name.19 A third edition followed in 1773.20 As with his service at the County Hospital, Hunter sought to foreground his charitable humanity and in a preface written in 1765, he claimed that he had ‘no motive for the publication of these observations, than a sincere desire to contribute to the ease and satisfaction of the infirm’.21 Such sentiments were, in themselves, a performative claim to the values of genteel benevolence. However, Hunter also had a number of other reasons for taking an interest in such matters. For one thing they appealed to his sense of the appropriate relationship between medicine and chemistry. As a student at Edinburgh he had been taught chemistry by William Cullen’s predecessor, Andrew Plummer, and he recorded how he had undertaken chemical experiments on the waters with ‘the greatest accuracy and attention’.22 And yet despite his high estimation of chemistry’s practical utility he believed that in bathing, as in all matters relating to health, chemical knowledge should be subordinated to a rigorously medical sensibility.23 The patient, Hunter maintained, ‘should always consult his Physician before he enters upon [the baths]’.24 Only physicians possessed the breadth of learning necessary to determine the effects that exercise, air, diet and bathing might have on a patient’s constitution. To neglect or ignore a doctor’s advice was to risk serious consequences for one’s health. The Treatise thus served to promote Hunter as an authority in the field of medicinal bathing and almost certainly enhanced the credibility with which he opened his ‘Medicated Baths’ in York in 1779.25 Bathing remained a lucrative, if competitive, enterprise throughout the eighteenth and early nineteenth centuries and Hunter maintained his investment until the last years of his life. In 1806, for example, he published a paper on the sulphur waters of Harrogate, taken from a public lecture delivered ‘at the Promenade’.26 However, perhaps the most important function of Hunter’s Treatise was that it introduced him to a wider public audience. In the preface he stated that his intended readership was ‘persons unacquainted with medicine’ and he had therefore ‘endeavoured to make the whole as plain and concise as possible’.27

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Clearly, this imagined audience was polite and respectable, those with enough money, time and leisure to contemplate a sojourn at the baths. It was also a national one, for the first three editions of the Treatise were published in London. Moreover, by dedicating them to William Cavendish, the 5th Duke of Devonshire, Hunter aligned himself with a wealthy and powerful aristocratic patron who had been instrumental in Buxton’s transformation into a respectable spa town and who was also an influential figure within the Whig circles in which he mixed.28 The Treatise became a best-seller. After the first three editions, Hunter renamed it The Buxton Manual and it was reprinted another three times between 1787 and 1797. Following this success, Hunter was able to consolidate a local and national reputation as a gentleman of learning. In 1770 he was instrumental in establishing an Agricultural Society at York. The society appears to have been reasonably short-lived (public notices cease after the early 1780s) and there are no surviving records.29 The York Agricultural Society was one of many such local associations conceived to promote agricultural improvement.30 Its members attended and discussed ‘philosophical’ papers and offered premiums (i.e. cash prizes) to farmers, agricultural labourers and experimenters. Like other such associations, the York Agricultural Society combined an Enlightenment concern with improvement and experiment with an attachment to the political interests of the Whig elite.31 Most Yorkshire agricultural societies had aristocratic Whig patrons, many of whom, like the Duke of Portland and the Marquess of Rockingham, were themselves committed improvers. The York society’s investment in the landed interest is evident in a cash premium which it offered in 1779. Reflecting a concern about the impact of social mobility on the ties of deference and dependence which underpinned social relationships in the countryside, payments of three and two guineas respectively were to be awarded to those male and female servants ‘who shall have lived the longest in one place on the 1st Day of March 1779’.32 Hunter’s interest in agriculture was both theoretical and practical. He possessed some small estates in Lincolnshire, the legacy of his marriage, in 1765, to his first wife, Elizabeth Dealtry, the coheiress of a wealthy local squire.33 The purchase of country estates by medical practitioners was a common practice in this period, at least by those who could afford them, or, like Hunter, had made a wise choice in marriage. We have already seen how the York apothecary, Oswald Allen, spent £3,000 purchasing and improving Mill Crooks Farm. Such patterns are also evident elsewhere. In Manchester, for example, Hunter’s friends, Thomas Percival and Charles White, both owned property outside the city.34 Hunter’s estates allowed him to conduct agricultural trials and experiments in a manner similar to William Cullen’s, that doyen of the Scottish Enlightenment who managed a farm for his brother at Parkhead near

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Glasgow and, by the late 1780s, owned one of his own outside Edinburgh.35 Both men were motivated by an Enlightenment commitment to improving agricultural production and by a faith in the applicability of chemical knowledge to that end. Farm ownership and agricultural management also performed a broader set of functions within a late eighteenth-century culture of medico-gentility. In 1789 the celebrated American physician, Benjamin Rush, published Medical Inquiries and Observations to which he appended his ‘Observations on the Duties of a Physician and the Methods of Improving Medicine’. After a cursory introduction, his first piece of advice was ‘to recommend to such of you as intend to settle in the country, to establish yourself as early as possible upon farms’.36 His reasoning was as much socio-cultural as practical and was concerned with the projection of an appropriately genteel image. Owning and working a farm, he suggested, would ‘reconcile the country people to the liberality and dignity of your profession by shewing [sic] them that you assume no superiority over them from your education’, and would keep practitioners occupied in ‘healthy seasons of the year’, discouraging them from ‘dram or grog drinking’. It would also ‘create such an independence as will enable you to practice with more dignity’. Obviating any associations between medicine and trade and reinforcing the social and moral authority of the practitioner, it would ‘change the nature of any obligations between you and them [the patients]’, for ‘While money is the only means of your subsistence, your patients will feel that they are the channels of your daily bread; but while your farm furnishes you with the necessities of life, your patients will feel more sensibly, that the obligation is on their side, for health and life’.37 Applied natural philosophical knowledge was integral to this image of genteel liberality: By living on a farm you may serve your country by promoting improvements in agriculture. Chemistry (which is now an important branch of a medical education) and agriculture are closely allied to each other. Hence some of the most useful books upon agriculture have been written by physicians. Witness the essays of Doctor Home of Edinburgh and Dr Hunter of Yorkshire in England.38

Clearly then, Hunter’s investment in agricultural improvement not only raised his profile within a local context or within the Whig circles of Rockingham and Portland; it also brought him to the attention of an international audience. Crucially, it provided entry into a network of natural philosophical correspondence, for as Lord Kames, the foremost Scottish agriculturalist, claimed in his Gentleman Farmer (1776), the ideal medium for the dissemination of chemico-agricultural knowledge was through ‘a gentlemanlike communication of factual reports’.39 Rush’s comments, together with references in published material and personal papers, suggest that Hunter’s network of correspondence was extensive and that he corresponded with a

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wide range of individuals who had practical experience of, or a philosophical interest in, agriculture and botany.40 He formed a particularly strong association with a group situated in and around Manchester, especially Charles White (who shared his interest in trees), Thomas Percival (his ‘most excellent and leaned friend’) and the magistrate, Thomas Butterworth Bayley.41 Indeed, so close was Hunter to members of the city’s philosophical coterie, that when the Manchester Literary and Philosophical Society was established in 1781 he was appointed an honorary member, along with such Enlightenment luminaries as Benjamin Franklin, Anton Lavoisier, Erasmus Darwin and Joseph Priestly.42 One of Hunter’s most notable correspondents was the agricultural improver, Arthur Young. Young had met Hunter on his tour of northern England in the late 1760s and was impressed by his philosophical abilities and genteel manners: Dr Hunter of York, whose polite and obliging conduct I cannot avoid to acknowledge, made known to me several points of husbandry with which I was before unacquainted . . . No one can understand the principles of agriculture and vegetation better than this ingenious cultivator whose ideas are philosophical and perspicuous, and whose experiments are accurate and judicious.43

Young was elected an honorary member of the York Agricultural Society in 1771 and the two men built up a correspondence which lasted until a short time before Hunter’s death in 1809.44 This correspondence conformed to the model of polite obligation and reciprocation outlined by Anne Goldgar.45 Hunter and Young supported each other’s endeavours and exchanged information in a manner becoming gentlemanly scholars. As Hunter wrote, ‘it is a duty we owe to one another’.46 Shortly after the foundation of the York Agricultural Society in 1770, Hunter ‘prevailed on the members to reduce their thoughts and observations into writing’ in order to ‘give respectability to the institution’.47 These papers first appeared in four volumes between 1770 and 1772 under the title Georgical Essays. The later volumes contained a number of communications from Hunter’s associates, including an essay on rainfall by Thomas Percival and accounts of experiments by Thomas Butterworth Bayley and Arthur Young, among others.48 At first the publication was anonymous but from the second volume onwards Hunter’s name appeared on the frontispiece and he was universally credited with being its editor, often its author. Hunter’s many contributions to the Georgical Essays testify to the cultural configuration of late eighteenth-century natural philosophical knowledge. In a later work he claimed that he had ‘contributed to the advancement of my profession by a mixture of the UTILE and DULCE’.49 This fusion of utility and pleasure structured the ways in which he presented his investment in

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natural philosophy and agriculture. For Hunter, a commitment to agricultural improvement was the expression of patriotic zeal. Thus, while it may have been predominantly Whig in its political and philosophical orientation it was inclusive in its practical application and effects.50 In an introductory essay on the ‘Rise and Progress of Agriculture’ he was keen to note the efforts of the French in the field of agricultural improvement and was wary lest Britain should fall behind: Let us imitate the virtues of that fashionable nation. As we have often vanquished them on the field of battle [despite being a Scot by birth, Hunter was addressing an English, or Anglophile, audience], let us put our hands to the plow [sic], and overcome them in the field of industry. Such pursuits have graced the public life of ancient heroes. May they be recorded in the Annals of a British King.51

When Hunter referred to ‘our hands’, he meant rural labourers rather than natural philosophers like himself or his gentlemanly readership. Nevertheless, the natural philosopher’s task was to provide the ‘guiding hand’ of knowledge: Until the Philosopher condescends to direct the plow [sic], Husbandry must remain in a torpid state. It is the peculiar happiness of this age, that men of a liberal education begin to cultivate this art with attention. We cannot say too much in praise of the respective societies lately established in this island, and in France, for the improvement of Agriculture. They have raised a noble spirit for emulation among our country gentlemen and sensible farmers. Each seems envious of contributing something towards the general stock of knowledge. Such a pleasing intercourse cannot fail of spreading the improvements of Agriculture over the most distant parts of this island.52

However, if agricultural improvement was useful, it was also pleasurable, even rapturous: The study of nature is one of the most pleasing amusements that can engage the mind of man. The entertainment that it gives is as infinite as the variety of subjects of which it is composed. When we consider the history of nature as interwoven with religion, our breast is immediately opened, and the divine goodness sinks down into the breast with energy and conviction [. . .] He considers the works of Nature as the silent but expressive language of the Deity.53

Agricultural knowledge was polite knowledge. It was not only aesthetically pleasing, but also morally improving, allowing for deep reflection on the wonders of Providence. Obscure though it may seem, agriculture had an underlying affinity with medicine. Hunter studied botany as a student and such interests are evident in his agricultural works. In the Georgical Essays, as well as in later publications, he devoted considerable space to the discussion of the Linnaean system of classification as well as to the analogies between plants and animals.54

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However, in his rhetorical self-presentation Hunter actively distinguished the agricultural from the medical. ‘[S]uch works’, he wrote in the preface to a later book ‘are with me an amusement and not a study’.55 Elsewhere he anticipated the question of why a medical man might spend his time on such matters: It may appear a matter of singularity that a person of my profession should engage in a work, which, it must be confessed, has but a small alliance with Medicine. But I wish to have it known, that during the whole time this edition was under my hands, I considered it only as affording amusement and relaxation from studies of a severer kind. To liberal minds this will be sufficient apology.56

In reality, of course, the cultural value of such literary endeavours derived from the very fact that they had, superficially at least, ‘but a small alliance with Medicine’. Such pursuits were, by their very nature, leisured. By taking an active interest in natural history and agriculture, Hunter announced that he had the time, the money and the intellectual freedom becoming a gentleman. He was free to exercise his ‘liberal mind’. An apology was scarcely necessary. However, there was a degree of slippage between this image and the everyday practicalities of his vocation. In the 1770s he may have been a reasonably successful physician, but the task of consolidating and expanding his practice continued to make demands on his time. As he admitted to Arthur Young: It gives me concern that the hurry of an extensive practice should deprive me of the pleasure of conducting a set of experiments and observations upon one of the most agreeable, as well as useful branches of natural hystory [sic].57

Whatever the difficulties Hunter experienced in pursuing his agricultural interests, the Georgical Essays were an unqualified success. The first edition of four volumes sold out, as did a second edition in 1773, and demand was sufficient to republish them in a single volume in 1777. Despite the apparent demise of the York Agricultural Society, the Georgical Essays continued to attract interest and several further parts were added so that by 1803 the project reached its final form of six octavo volumes. Their success helped to consolidate Hunter’s public profile, and in announcing the publication of his next work, that barometer of literary taste, the Gentleman’s Magazine, noted that he was ‘well known by his Improvements in Husbandry, as well as by his writings’.58 The combination of utile and dulce which structured Hunter’s literary representation of natural philosophical knowledge found its greatest expression in his magnum opus, his edited republication of John Evelyn’s Silva. Sylva, as the original was spelt, was a treatise on forest trees and the propagation of timber whose origins lay in a paper delivered to the Royal Society in 1662 prompted by ‘certain queries . . . by the Honourable the principal Officers and Commissioners of the Navy’.59 Editing a new and improved edition of

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this work was Hunter’s most significant literary undertaking. It was no mere facsimile of Evelyn’s original text. Hunter added copious footnotes and commentaries, doubling the size of the work. He probably began work on it in the early 1770s and the first edition was completed in 1776 (although a specimen copy was ready by 1774). Another four editions followed, two of which were published after his death.60 Silva combined natural history with patriotism, utility and aesthetics in a manner which made it a popular commodity. Hunter clearly intended it for a wide audience. In a letter of 1775, he wrote that as ‘Silva is intended for general reading I think the references should be as free from Latin terms as possible’.61 However, Silva’s readership was intentionally limited in one respect. Although concerned with the cultivation of trees, it was not aimed at foresters, gardeners and those engaged in the day-to-day practicalities of arboriculture. In this sense it reflected Evelyn’s original intention: Let it be remembered that I did not altogether compile this work for the sake of our ordinary rustics, mere foresters and woodmen, but for the benefit and diversion of gentlemen and persons of quality, who often refresh themselves in these agreeable toils of planting and gardening.62

Silva was aimed at a gentlemanly readership, particularly the Whig landed elites. The original work had been prompted by the concerns of the navy at the time of the Dutch wars.63 Evelyn and others, particularly Samuel Pepys who was both a Fellow of the Royal Society and Lord of the Admiralty, were concerned that England’s supply of timber was being depleted. Silva was therefore intended to encourage English landowners to cultivate forest trees so that the navy might be guaranteed a ready supply of shipbuilding materials. Anxieties about England’s timber stocks continued throughout the eighteenth century and Evelyn’s book was followed by a number of similar works on tree cultivation.64 Hunter’s republication of Silva in 1776 was particularly apposite. By the late eighteenth century Britain’s place on the political map of Europe was largely dependent on her overseas empire, an empire made possible by the Royal Navy. However, the Seven Years War (1756–63) had shown that Britain was not the only nation in the world with a powerful fleet and imperial ambitions. The French had been defeated at Quiberon Bay in 1759, but the spectre of their naval might loomed large, especially now they hovered on the fringes of the American conflict. Many commentators were worried that France might overtake Britain in the naval race unless something was done to improve its stocks of timber. Hunter was concerned that the cutting down of all kinds of wood is become so general, that unless some effectual remedy be soon applied, it is more than probable that very little full-grown timber will be left in this island for the use of the ship-builder. The simple apprehension that this nation will, at some distant period, feel this great

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calamity cannot but occasion some uneasiness in the minds of those who wish well to their country. But when the most serious and positive proofs can be produced, that, at this very moment, the royal navy is in want of that supply, how justly are our fears increased! – and with what zeal ought we to join in warding off the impending danger.65

He therefore sought to spread Evelyn’s message once more: As an inducement to raise plantations of useful timber, I shall observe, that many of the ships which gave laws to the world in the last war [the Seven Years War], were constructed from Oaks planted soon after the publication of Mr Evelyn’s Silva; and I flatter myself that the present Republication will be the means of raising the same virtuous and patriotic spirit.66

In appealing to the aristocracy and gentry to plant more trees, Hunter resorted to a patriotic imperative. ‘All Planters are Patriots’ he exclaimed. The truly patriotic gentleman ‘will set apart some good land for the generous purpose of raising timber, which will be employed in the building of ships for the advancement of our commerce and the security of our island’.67 Trees were not only practically important; they were also imbued with symbolic meaning. Thus the oak, that great symbol of English strength, liberty and longevity came in for particular praise.68 Furthermore, patriotism was not the only motivation, for in a neat alignment of Whig ideals, Hunter assured his readership that arboriculture could also be a profitable enterprise. In effect, however, Silva’s appeal, both culturally and politically, seems to have derived as much from its aesthetic as its didactic qualities. It was not a text designed to be read from cover to cover. Rather, it is best understood as a fashionable artefact, a status symbol that was to be enjoyed for its form as well as its content. It was a handsome and expensive work, coming in at around seven hundred and eighty pages in two lavishly bound volumes. For those who deigned to read it, the text was practical yet enlivened with classical, historical and literary allusions. These served both to entertain the reader and to display Hunter’s extensive knowledge and liberal education. They also encouraged religious contemplation on the wonders of nature: How beautiful are the general laws of Providence! The more we explore them, the more we have cause for wonder and astonishment! Everything is wisely disposed; nothing is fortuitous; all is order, regularity and wisdom.69

For Hunter, the consummate Whig, the study of the ‘lesser objects’ of nature was a more salubrious and polite pursuit than astronomy. Whereas contemplation of the heavens engendered a ‘simple awe and silent reverence’ which was private and bordered on the melancholic, natural history and botany were public and improving activities, ‘encouraging zeal and fervency’.70 Silva’s real aesthetic value, and its expense, lay in its thirty-five engraved

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plates, most of which had been especially commissioned by Hunter. Among the most impressive were an illustration of the Cownthorpe oak near Wetherby by Hunter’s erstwhile friend, the political polemicist William Burgh, and several views of the Greendale oak near Welbeck by Michael Angelo Rooker, after a drawing by the Swiss artist, Samuel Hieronymous Grimm. Both of these plates, illustrating particularly spectacular and ancient trees in the English countryside, were couched in a symbolic pictorial language of the pastoral, presenting an idealised rural landscape of timeless natural beauty populated by genteel sightseers and colourful travellers.71 The other plates were executed by the German-born botanical engraver John Miller (Johann Sebastian Müller).72 Each of the chapters dedicated to a particular tree, or set of trees, was accompanied by an engraving of its leaves and seeds. Although they were diagrammatic, and served a didactic function, they were also notable for their beauty. Indeed, so central were these plates to Silva’s aesthetic appeal that Hunter produced a number of specially commissioned deluxe editions in which the illustrations were hand-coloured.73 As with Hunter’s previous forays into the world of polite literature, Silva was an unqualified success, both in terms of the number of editions printed and the quality of its readership. A work of Silva’s size and expense could never have been released on to the open market and Hunter therefore set about compiling a subscription list, circulating specimen pages in 1774 and eventually procuring over seven hundred subscribers.74 The subscription list, inserted at the beginning of the first edition, served a dual function. While acknowledging the patronage of Hunter’s many subscribers, it also displayed the breadth and respectability of his readership. Among the listed names are many which would have been instantly recognisable to a late eighteenthcentury audience. They included men of letters such as James Boswell, natural philosophers like Joseph Priestly and medical men, including John Hunter, John Pringle and John Fothergill. The social status of Silva’s subscribers was particularly notable. Many of Hunter’s patrons were aristocrats with over 18% holding baronetcies and above. Among these were Whig grandees such as the Marquess of Rockingham, who bought five copies, the Duke and Duchess of Portland, who bought three, and the dukes of Argyll and Devonshire. Among the others there were over thirty earls, numerous lords and several bishops, including the Archbishop of York and the Archbishop of Armagh and Lord Primate of Ireland. Of those subscribers who were not titled, almost all were gentlemen and were recorded as esquires. A number of institutions also purchased copies for their libraries, including Edinburgh University, several Oxbridge colleges, the Beverley Agricultural Society and even the ‘Library of South Carolina’.75 The success of Silva allowed Hunter to assimilate himself into the intellectual elite of late eighteenth-century metropolitan society. John Evelyn had

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been one of the original promoters of the Royal Society and was one of its most celebrated and prolific members. Hunter’s edition of Silva therefore served as a monument to the Society’s early history and eased his entry into its ranks. Furthermore, in preparing Silva for publication, Hunter had cause to develop a relationship with one of the Society’s most influential members and one of the most prominent natural philosophers of the age, Joseph Banks. Hunter first wrote to Banks in 1774, asking for his opinions on Miller’s engravings.76 While the two men continued to correspond over Silva their relationship soon developed the reciprocal quality characteristic of a genteel and scholarly discourse.77 In 1786, for example, they discussed the possibility of commissioning a history of Lincolnshire, a county to which both had an attachment. They also exchanged information about mutual friends, including Sir Thomas Frankland.78 The fact that Banks continued to correspond with Hunter on such matters, even after he had been elected President of the Royal Society in 1778, is testament to the strength of their relationship. Their correspondence also suggests that, despite its broadly Whig orientation, agricultural improvement could, as a quintessentially polite pursuit, transcend party political boundaries for unlike the Rockinghamite Hunter Banks was a Pittite Tory.79 Through his publications, Hunter was thus able to extend his social networks and to shape his identity as a polite and learned gentleman. As Ludmilla Jordanova has demonstrated, such representations and performances of gentility could take a figurative form.80 Figure 1 is a reproduction of the only known portrait of Alexander Hunter, a mezzotint by John Raphael Smith, after his own painting, executed in 1805 when Hunter was in his mid-seventies. Smith was a prolific artist who produced many satirical prints as well as a large number of portraits.81 What is particularly notable about this image is that there is nothing in it to suggest that Hunter was a physician. This exclusion of explicitly medical references seems deliberate. Hunter is portrayed not as a working practitioner but as a refined gentleman of letters and leisure. His learning is evident in the books that adorn the shelf behind him, partly obscured by the opulent velvet drape (these books are not for show) and he is caught in the act of reading, his index finger marking the place of the book he holds in his right hand. The quill in its ink well, just visible on the table to the left, serves as a visual reference to his many publications and extensive correspondence network. With his fine clothes, powdered wig and polite learning, Hunter appears every inch the leisured gentleman, complete with gout and pronounced paunch. Nearing the end of his life, having amassed a not inconsiderable fortune, and having firmly established himself in polite society, he could afford to be portrayed in this way. This self-fashioned image of genteel liberality also seems to have reached a broader audience. Shortly after Hunter’s death in 1809 an obituary appeared in the Gentleman’s Magazine, itself an indicator of public recognition:

John Raphael Smith, ‘Alexander Hunter’, mezzotint after himself, 1805.

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The late Dr Alexander Hunter of York, died in his 80th year. He graduated at Edinburgh in 1751 [actually 1753]; and practised near 50 years at York with the highest eminence and credit in his professional character, his knowledge of which was the result of science, skill and well-founded experience. His goodness as a man, his urbanity and gentlemanly manners, his practice of every real and social value, the manly and pleasing manner with which he gave his advice, whether as a Physician, a Friend, or a Mentor, his encouragement of the Arts, or whatever appeared to be beneficial to mankind, will ever embalm his memory . . . In the World of Letters he was highly esteemed, being author and annotator of several works of great merit; among which were his editions of Evelyn’s ‘Sylva’, 2 vols. 4to; ‘Georgical Essays’ 6 vols. 8vo, etc., etc. In his leisure hours he used to amuse himself with composing miscellaneous pieces such as ‘Essays on Cases of Insanity’, on ‘Agriculture’ etc., etc., and which were always well received by the Publick [sic].82

The author clearly positioned Hunter as a gentleman and made a connection between his social character and his intellectual and literary activities. A later commentator remembered Hunter in a similar manner, portraying him as a man of wealth and manners, a genteel Whig of enlightened liberality: His property, independent of his profession, was neither mean nor contracted. His hospitality was well known and truly liberal. Strangers of good reputation, and all men of merit, found a welcome in his house. He was the ready patron of every projected improvement in science, civilisation, or public accommodation; and not sparing in the means to promote them, whether of personal labour or pecuniary assistance.83

William White: science, history and civic identity Seventeen years before his own obituary appeared in the Gentleman’s Magazine, Alexander Hunter had written a similar eulogy to his friend and fellow physician, William White. Appended to White’s posthumously published account of the nature and cure of consumption it described him as ‘an honest, as well as a rational practitioner’ who ‘labour[ed] in the service of mankind’.84 White was perhaps a more prolific medical author than his colleague but, like Hunter, he also entertained an interest in other forms of natural philosophical knowledge. In the late 1770s, for example, he contributed an essay on the ascent of vapours to the Georgical Essays.85 However, whereas Hunter was motivated by an interest in agricultural improvement White’s contribution is indicative of his commitment to chorography, or the study of place. Chorography played a particularly important role in shaping White’s social identity. On the one hand it had direct medical applications, assimilated to a revived Hippocratic tradition of environmental medicine. On the other it was also an expansive field of study which allowed for an

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engagement with both natural forms of knowledge, such as meteorology, and more social forms, such as local history and politics. Chorography can thus be taken as emblematic of a culture of medico-gentility defined by intellectual plurality and epistemological inclusivity. However, for men like White it also performed another important social function. Unlike Hunter White was a local man, born and raised in York. And yet as a Quaker in an era of quietism he was part of a religious community which operated, for the most part, ‘under the radar’ of civic society. White’s desire for social inclusion can be read into his high level of civic participation, uncharacteristic of many of his co-religionists. It can also be read into his interest in the study of place, an interest which shaped his reputation not only as an ‘ingenious and skilful physician’, but, just as importantly, as an upstanding gentleman deeply committed to his native city.86 The multiple cultural and epistemological registers of chorographic knowledge are evident in two papers which White submitted to the Royal Society in 1778 and 1781, both of which were subsequently published in the Philosophical Transactions. The first of these was entitled ‘Experiments upon air, and the effects of different kinds of effluvia upon it; made at York’.87 White was not a member of the Royal Society and his paper was communicated to the institution by his friend and correspondent, the fellow Yorkshire-born Quaker physician, John Fothergill. Ostensibly, this paper can be read as a contribution to contemporary understandings of the relationship between environment and disease, a project which took particular shape in the latter decades of the eighteenth century through developments in pneumatic chemistry and their harnessing to continental ideas of enlightened government.88 White’s research followed on from that of Sir John Pringle and Joseph Priestly. He was of the opinion that phlogiston was the active principle of putrefaction and was ‘per se, pestilential’. He also believed it was imperceptible to the smell and could only be detected using eudiometrical apparatus.89 White therefore used his eudiometrical equipment to measure the quantity of phlogiston in the atmosphere of the city, by rivers and marshes, at different times of the day and in different weather conditions. The results of these experiments seemed to confirm the findings of Pringle, Lind and Cleghorn, that damp marshes and bogs gave off putrid exhalations and were unsuitable for human habitation. They also confirmed the widely held belief that the atmosphere by running water was purer than in other locations.90 In addition, White sought to measure the amount of phlogiston produced by animal, vegetable and faecal matter. He conducted experiments on a piece of veal, which was found to give off noxious vapours, even while apparently still fresh. To White’s surprise, fresh vegetables and flowers were also shown to corrupt the air, rendering it ‘not only useless, but fatal to animal life’. By contrast, faeces (from healthy individuals at least) had little or no effect upon the quality of the atmosphere.91

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While eudiometry and gas chemistry constituted White’s primary experimental methodology his paper can also be read in ways which reveal a different set of intellectual priorities. Although it concluded with a series of generalised observations and conclusions, White’s interests were geographically specific and he claimed that his experiments ‘were originally undertaken with the design of ascertaining the state of the common atmospheric air in and about this city’.92 All his experiments were conducted in York, and the city itself, as much as the composition of the atmosphere, was also his focus. In his introduction, for example, he provided a topographical and meteorological account of the local environment. He also provided a historical perspective, particularly on the ‘nastiness’ of the river Foss. He quoted the antiquary John Leland on this matter, and also referred to Francis Drake’s Eboracum, or the History and Antiquities of the City of York (1736) citing historical examples of the corporation’s attempts to prevent refuse being discarded into the river.93 Such commentaries served an important medical function, for they made chronology, as well as place, an axis of eudiometric and epidemiological analysis. Most significantly, however, they also testify to White’s long-standing interest in antiquarianism and local history. These interests were especially evident in the second paper which White submitted to the Royal Society in 1781. ‘Observations on the bills of mortality at York’ shared many of the same concerns with environmental medicine as its predecessor. However, its local focus was even more explicit, as were its antiquarian aims and structure. White began by noting the number of births, marriages and deaths between 1728 and 1753, including those recorded in Drake’s Eboracum. Suggesting that a comparison might be made between these figures and those of recent years, he then listed the numbers of births and burials in York between 1770 and 1776 as provided by parish records. White’s observations agreed with those of his associate, Thomas Percival, who, after undertaking studies in Manchester, found that summer was the healthiest season, followed by autumn and spring, with winter ‘being by far the most fatal’.94 He also found that the health of the population had improved somewhat since Drake’s time. He suggested that inoculation, therapeutic advances and ‘greater attention to nature in the management of infants’ (i.e. maternal breast-feeding) in some measure accounted for this. However, the principal cause he identified was that ‘York has been much improved within a past few years’. ‘The streets’, he noted, ‘have been widened in many places, by taking down a number of old houses built in such a manner as almost to meet in the upper stories, by which the sun and air were almost excluded in the streets and inferior apartments’. These streets had also been paved and, with the construction of additional drains, were ‘much drier and cleaner than formerly’. Together with the building of locks on the river, these improvements had contributed to the

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‘salubrity as well as beauty of York’, and had ‘added to the health as well as the convenience of its inhabitants’.95 White’s paper neatly illustrates the fluid relationship between natural and historical knowledge in the late eighteenth century, between the study of the environment and the study of place. As the correspondence between Banks and Hunter demonstrates, many natural philosophers were interested in local history. Antiquarianism was not the esoteric pursuit of amateurish dilettantes but a philosophically reputable branch of liberal learning.96 Indeed, membership of both the Royal Society and the Society of Antiquaries became so common that ‘F. R. S. & A.’ was an established abbreviation. White’s membership of the Society of Antiquaries was something which he proudly announced on the frontispieces of his medical works and was part of a much broader medical engagement with the discipline. In 1770 the Society established a journal, Archaeologica: Or Miscellaneous Tracts Relating to Antiquity. Most contributors were clergymen, but it also contained articles and letters from numerous medical practitioners, including Thomas Percival, William Hunter, Charles Combe and the York physician, John Burton. Such men also donated gifts to the Society. The Quaker physician, John Coakley Lettsom, was a regular benefactor who bestowed copies of his own publications as well as relevant works by other authors. Another elite metropolitan practitioner, Richard Warren, donated an urn found at Sandy in Bedfordshire. The Society of Antiquaries also received donations from medical associations. As if to stake a claim to historical posterity, the Medical Society of London and the Humane Society (both founded by Lettsom) regularly gifted copies of their transactions and memoirs. Such activities exemplify the ways in which the cultures of late eighteenthcentury medicine were shaped by the values of intellectual liberalism. When the Medical Register was republished in 1780 its editor noted that he had received a number of letters suggesting that, in addition to members of the Royal Society, the Register should also list members of the Society of Antiquaries. Although he declined this revision, claiming that the Society was ‘too remotely allied to Physic’, a number of practitioners evidently thought otherwise.97 As well as being part of a broader intellectual trend, White’s antiquarianism also performed a peculiarly local form of cultural work. As an ancient city with Roman heritage, York had been the subject of a number of historical and antiquarian studies. However, it was in the eighteenth century when the ‘urban renaissance’ encouraged a greater investment in local civic identities, and when the market for secular literary productions was burgeoning, that these works acquired real cultural value.98 York’s two most notable eighteenth-century antiquarians were the surgeon, Francis Drake, and the physician, John Burton. Rather than a mere

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curiosity or liberal quirk, their historical studies shaped their medical reputations, serving as a testament to their liberal education, especially their knowledge of classical languages and history. However, their most important purpose was as public avowal of their local civic and county identities. This was especially important for Burton and Drake, both of whom were crypto-Catholics and suspected Jacobites. As with Burton and Drake, White’s religion threatened to work against his social assimilation and he too made a public display of civic pride. However, unlike Burton and Drake, whose Jacobitism and Toryism shaped their emphasis on York’s ancient and medieval/Catholic past, White, a Quaker with a reformist Whig political outlook, emphasised the city’s present and its future improvement. Such concerns were perfectly compatible with antiquarian studies for the introduction to the first volume of Archaeologica (1770) suggested that the antiquarian should not only research the past, but also record the present for posterity.99 As Vladimir Janković has argued with reference to eighteenth-century clergymen like William Borlase and Gilbert White, William White’s antiquarian and chorographic interests enabled him to elaborate a provincial identity and at the same time participate in a cosmopolitan scholarly discourse.100 Like Janković’s clergymen, White stood at the nexus of local and national networks of cultural exchange. He was known in local society as a man of science who took an active interest in his native city, yet he also achieved wider recognition via his correspondence and publications. The intellectual endeavours of such a man are illustrative of the structures of eighteenth-century natural philosophical discourse. Like those clergymen’s accounts of extreme weather conditions, strange lights in the sky or spectacular meteors to the Philosophical Transactions, White’s observations on York’s epidemiological and atmospheric constitution were at once of both local and national interest. They may have been concerned with the particular, but combined with other reports from other towns and cities, they contributed, in a Baconian sense, to the general stock of philosophical knowledge. The manner in which White’s diverse interests were unified by his commitment to chorographic study is best illustrated by an unpublished manuscript entitled ‘Analecta Eboracensia, or Memorandum of Events at York’.101 Written in the early 1780s, ‘Analecta Eboracensia’ is a disparate collection of materials relating to late eighteenth-century York. Observations on local and national politics, often informed by White’s own Whiggish sympathies, feature prominently. These include accounts of local elections, events such as the Marquess of Rockingham’s funeral (White was particularly keen to note the role played by the Rockingham Club, of which he was a member) and meetings of the corporation at the Guildhall (having gained his freedom as an apothecary in 1771 he was allowed to attend such meetings, even if he was barred from office by virtue of his religion). Observations on the weather, one

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of White’s greatest passions, are also included. Extreme weather, such as the bitterly cold winter of 1783, is accorded the most space, a common feature of eighteenth-century chorography which valued the exceptional over the routine. However, as with many like-minded practitioners, White also kept a more systematic weather diary which he continued for upwards of twenty years.102 ‘Analecta Eboracensia’ is also notable for the manner in which it records York’s physical and topographical character. White’s observations on street widening, the demolition of dilapidated buildings and the erection of street signs are accompanied by a set of hand-drawn maps of the city.103 These maps, which represent householders, shops and public houses, as well as bridges, walls, waterways and other remarkable features, indicate White’s desire to record the layout of late eighteenth-century York for posterity. It is unclear quite what White intended for this work. Its form is that of a diary or commonplace book and yet there are suggestions throughout the text that some of it was destined for public consumption. It seems that the ‘Analecta’ represented the raw materials for a more coherent publication which never came to fruition due to White’s early death. The literary activities of William White demonstrate how intellectual pluralism lay at the very heart of late eighteenth-century medical identity and social performance. Even more so than Hunter’s interest in agricultural improvement, whose cultural value derived in part from its relative distance from the specifics of medical study, they also demonstrate how this intellectual liberality shaped the content of medical knowledge itself, fusing the natural and the social, the environmental and the historical in such a way as to embrace both cutting-edge chemical and medical research and the values of civic pride and local identity. Men and manners: the cultural register of wit and wisdom Natural philosophical knowledge was not the only epistemological resource for the elaboration and performance of medico-gentility, however. If chorography encompassed both the natural and human worlds then there were other interests that were of an even more explicitly social or anthropocentric orientation. This was particularly true of contemporary comedic literature, much of whose humour derived from an incisive yet light-hearted familiarity with the peculiarities and pretensions of men and manners. Like that of the gentleman scholar, the image of the medical practitioner as man of wit was firmly established within the eighteenth-century popular imagination through the works of men like Oliver Goldsmith and Tobias Smollett. However, these two images were not mutually exclusive. Publications such as Silva and the Georgical Essays might have presented Alexander Hunter as an august scholar and natural philosopher but other works revealed a different

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side to his character. In 1794, for example, Hunter, together with his winemerchant friend, John Croft, published a musical farce entitled No Cure No Pay: Or the Pharmacopolist, credited to Harry Rowe, who, despite having his own entry in the Oxford Dictionary of National Biography, appears to have been little more than a figment of these men’s literary imaginations.104 The targets of satire in this play were unorthodox empirics and ‘sham’ doctors who had obtained degrees from the universities of St Andrews or Aberdeen or licences from the Royal College of Physicians.105 However, Hunter was not averse to satirising more orthodox forms of practice, including well-worn targets such as medical systems, dogmas and regimens. Nor was he above laughing at himself. One of the patients in the play complains that he has the care of a ‘pot-farm belonging to a physician’ and that he is sick from having to ‘taste and smell the various stinking composts’. On being asked why he did not apply to his master for medical advice, he replies: In truth Sir, he is so much taken up with experiments in agriculture, that he has no time to think of his patients. – During the time we were nursing a sick potatoe [sic], no less than seven patients slipped through his fingers; and about a month ago, he was a whole hour in debating whether he should save a turnip-rooted cabbage, or the life of a first rate speaker in the House of Commons. He at last decided in favour of the cabbage, which soon recovered, but the gentleman died.

Needless to say, Hunter turned this joke about his agricultural interests on its head. Asked whether this event had ruined his master, the patient replied that, on the contrary, ‘His reputation encreased [sic] upon the occasion’ and his ‘medical abilities’ were spoken of ‘in terms of the highest approbation’.106 Moreover, a footnote to this passage notes that: For some years past several very ingenious medical men have engaged in the honourable pursuits of agriculture, and from their labours the public have received considerable advantages. It will therefore seem extraordinary that those gentlemen should here receive a kind of censure. But when we consider that the author of this piece was himself a physician, and probably a cultivator, we must suppose that he is only making free with himself, that he may take greater liberties with other people.107

It is not known whether No Cure No Pay was ever performed, or even if it was meant to be staged at all. What is clear, however, is that Hunter’s involvement served as a public display of his good humour. It confirmed his reputation as a man of wit, capable of laughing at his own foibles as well as satirising the failings of others. Not only was this an asset in the droll discourse of eighteenth-century sociability, but, by embracing the conventional forms of medical satire, Hunter robbed them of their potency. The play had a different cultural register from his other works. Unlike many of his agricultural productions it probably had a limited circulation and was only printed

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in York. Also it was pseudonymous and Hunter’s involvement may only have been known to friends and associates. As such, it worked within a specifically local, even intimate, context. Presumably, this was a side of Hunter’s character which was displayed within the convivial arena of the Doctors Club rather than at meetings of the Royal Society. If Hunter was known to dabble in comedic literary traditions then their two greatest exponents in York were undoubtedly the Atkinson brothers, Charles and James. Their father, Charles senior, was a noted wit and friend of Laurence Sterne. His burial notice recorded that he was ‘a man of great Genius and infinite humour’.108 His sons evidently sought to shape similar social identities. Their circumstances were different from Hunter’s and their literary productions performed different kinds of work. Both were surgeonapothecaries and both were Catholics. Moreover, unlike Hunter, whose work was of national, even international, renown, the Atkinsons were comparatively unknown outside their immediate locale and most of their publications were printed in Yorkshire. And yet these works are no less significant for this fact, for the identities they helped shape were ones which worked within a local social context. In his first publication, The Mind’s Monitor (1793), Charles Atkinson wrote that ‘Affability and Politeness besp[eak] the sentiments of the inward Man’.109 During his career Charles sought to perform these qualities through print. In addition to The Mind’s Monitor, a contemplative text in the manner of Edward Young’s The Complaint: Or Night-Thoughts on Life, Death and Immortality (1742), he published a series of literary and poetical works including The Neighbourhood of Heslington (Near York): A Rural Poem (1815). Both The Mind’s Monitor and Heslington were published by local printers in Leeds and York and their circulation was parochial. Nevertheless, The Mind’s Monitor presented Charles to a respectable audience, including members of the local gentry and aristocracy, while Heslington secured the patronage of Henry Yarburgh Esq., lord of the manor and resident of Heslington Hall.110 If these works portrayed Atkinson as a man of refined sensitivity and sensibility, they also gave public expression to his ‘affability’ and humour, for as he wrote in 1802, ‘Science and Mirth oft together blend’.111 Perhaps the greatest literary expression of this aspect of Charles’s character was his Life and Adventures of an Eccentric Traveller (1818). Less overtly localist than Heslington, it was clearly intended for a more general readership. Nevertheless, the fact that it was published by one of York’s less established printers and was illustrated with relatively crude woodcuts, suggests that its market was limited, both geographically and socially. The Eccentric Traveller combined a humorous and self-deprecating narrative of his own rather unsuccessful and peripatetic surgical career with a series of irreverent

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vignettes. By turns light-hearted and defensive, it can be seen as an attempt to negotiate and tame its author’s ambivalent social identity. Charles had served as an ensign and surgeon in the Revolutionary and Napoleonic wars and yet he was no ‘plain Englishman’.112 Not only was he, in his own words, ‘a staunch Catholic, yes a downright papist’, but he had been educated by Jesuits in French-speaking Lille.113 In the aftermath of the French wars, Charles was apparently keen to identify himself with a bellicose nationalism epitomised by the recurrent figure (both in his own work and more generally) of the ‘Jack Tar’. Looking back on his youth in Lille, for example, he recalled a time when, in attendance at a military review, ‘I happened to place myself near to a French Petit Maitre or some such like coxcomb’. On the other side of the Frenchman stood ‘an English Lieutenant of the Navy’: [When] with his accustomed civility, the French beau presented an elegant snuff box, and asked him to take a pinch of snuff, the British hero deliberately put his hand into his pocket and pull’d out a rough hairy leather pouch, filled with tobacco: Here! said he, you half starved Frog, here’s some English quids for you; and actually filled the Frenchman’s mouth so full, that he had nearly choked him.

‘I could not forbear’, he claimed, ‘laughing heartily at the contrast between French politeness, and honest English eccentricity’. Apparently this unprovoked physical assault was merely one of ‘many similar pranks’ played upon ‘those slippery gentlemen’.114 Regardless of the immediate context of the French wars, there is something rather eighteenth century about this story. Charles’s contrast between English ‘honesty’ and French affectation was part of an established trope which sought to fashion an appropriately masculine national identity within the ambivalent parameters of polite society.115 Indeed, Charles’s anti-French posturing owned as much, if not more, to the fear of being thought a ‘coxcomb’ as to any suspicions of national disloyalty. Hence, another of his vignettes to feature a ‘Tar’ positioned the English sailor’s honesty in opposition not to the French per se but rather to the social affectations and pretensions of a native ‘Butterfly Gentleman’. This ‘Beau’, this ‘supercilious macaroni’ was one of Charles’s companions on a coach from Brighton to York: He seemed to pride himself upon his powdered head and genteel address, and seemed to be blown up like a bladder with self-conceit and impudence. He sat stiff and erect, as if he had swallowed a hedge snake, and appeared as if it would have put out his Eyes, to have exchanged a glance with any one, who did not admire his tout ensemble, and as such was very sparing of casting a look, that might probably have met disappointment half way.116

The moral of this story, such as it is (the ‘Beau’ ends up in the mud, courtesy of the ‘Tar’), is that foppish affectation is always trumped by plain honest

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masculinity. Once again artificiality is made synonymous with French ‘manners’ and upon concluding his story Charles returns immediately to the issue of his continental education. In general, he claims, the Englishman crosses the Channel not ‘in remembrance of his own country, but to forget it; foibles and poverty he brings back in exchange to ridicule his native soil’.117 Charles, however, was not to be contaminated by such pompous illiberality, and it was not long before he was ‘divested of French etiquette, and dismantled of the curious habiliments, which I appeared in on my first arrival at home’.118 Charles’s work can thus be situated within a tradition of comedic literature epitomised by his fellow surgeon, Smollett, and his father’s friend, Laurence Sterne, both of whom wrote books (albeit from radically different perspectives) about men, manners and the cultures of travel.119 A similar concern with affectation and manly honesty also frames Charles’s self-representation as a medical practitioner. Although he never calls into question his abilities as a surgeon-apothecary, he readily admits, in fact revels in, the trials and tribulations of his career, making light of his failures and relative marginality. Through such self-deprecating humour he was able to cut through the charge of artificiality which so often marked the performance of gentility and whose worst aspects were personified in his character of the English ‘Beau’. In so doing he fashioned himself as an authentic gentleman, ‘eccentric’ certainly, but also of honest and open sensibility.120 In this way, what Charles’s text reveals is not only that the elaboration of medico-gentility as a form of social identity was intimately bound up with wider discourses about gender identity and national culture but also that it was a carefully calibrated performance, always sensitive to the charge of affectation and artifice. Compared to his older brother, James Atkinson had a rather greater reputation as a ‘man of science’. He was a noted anatomist with a large private collection of specimens, both human and comparative. An advertisement for surgical students in the York Courant announced that he had ‘made an useful collection of anatomical subjects and preparations’ and that those who chose to study under him would have ‘proper surgical instruments’ provided for them. It also claimed that ‘A select library of the first medical and chirurgical authors in the different languages, as well as numerous manuscripts of his own, and some of the best anatomical tables’ would be available ‘on proper terms’ for those pupils who wished to ‘employ their vacant time from the hospital in the study of their profession’.121 As we shall see, Atkinson was also instrumental in the establishment of the Yorkshire Philosophical Society in 1822. However, like his father and his brother, James cultivated a reputation as a man of genteel tastes. His passion for music and his skill with the violin were well known and he was a personal friend of Nicolo Paganini. He collected portraits of medical practitioners and was an avid bibliophile with an

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impressive library of both medical and literary texts.122 Like his brother and father he was also noted as something of a wit and in 1833, six years prior to his death, he took those qualities into print with his one and only publication, Medical Bibliography A. and B. Atkinson’s book took the form of a standard work of bibliography and contained entries for numerous medical authors from classical times up to the nineteenth century. At face value it owed much to the sixteenth-century work of Conrad Gesner and the eighteenth-century publications of Albrecht von Haller and Edward Harwood. However, Atkinson’s work was no ordinary bibliography. Although the references were full, and the work could potentially have been read as a serious record, there is nothing to suggest that he intended to complete a full survey of medical texts, adding the other twenty-four letters of the alphabet. Indeed, in the preface he claimed very little in terms of originality, stating that ‘The mere arrangement of dates, somewhat more regularly than heretofore in the medical department, is my only assumption’.123 Instead, the text served as a public display of Atkinson’s droll humour and its various entries were accompanied by jokes, puns, anecdotes and reminiscences.124 ‘[W]hat amende can I venture’, he asked, ‘for that sad lack of gravity, (no, not of decorum,) which here and there, and every where, is so apparent in the most serious pages?’125 As with his brother, Atkinson’s humour owed much to the literary style of Sterne, who was referenced throughout the book: I am not the sort of fellow, to undertake to write a sentimental journey; and therefore, wanting better amusement, and through mere incident, I stumbled upon the dry, dusty, tedious, accursed, hateful, bibliography. It may perchance, mollify duller than ordinary hours.126

Like Charles, James derived a great deal of humour from knowingly satirising himself, particularly his shortcomings as an author and the fruitlessness of his task. He repeatedly scolded himself for the banality, tedium and futility of his ‘two letter life’, claiming ‘What blockhead but myself would chose such a subject for relaxation’.127 As with Hunter he also sought to make light of medical practice itself, subverting contemporary prejudices by actively embracing them. As a surgeon-apothecary, such rhetorical strategies were a particularly important element of Atkinson’s public character. An established and relatively socially secure practitioner at the end of his career, he was confident enough to mock his vocation’s ambiguous place within the social and civic hierarchy. In reference to the fifteenth-century text Lumen Apothecariorum, for example, he wrote: We hear butchers talking of calf lights, aldermen and common council-men of city lights and gas lights, and methodist parsons of divine lights; but what are

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Performing medicine the apothecaries’ lights? – are they chemic, electric, or phosphoric? Or do they practically and mechanically apply them to their light weights; to their minims and half minims, leaving out their scruples? Or what difference is there between the calf lights of the butcher and those of an apothecary? – Come in Brother Butcher.128

This quotation makes multiple allusions, not only to the apothecary’s associations with trade but also, with the pun on the words ‘light weights’ and ‘scruples’ (a traditional unit of apothecarial measure), to his reputation for greed, deceit and sharp practice. And the choice of trade is no mere accident. The highly manual, not to say brutal, nature of contemporary surgical procedure drew repeated comparisons with butchery, reducing the human body to the level of the animal carcass. Also, Atkinson was an anatomist, a practice which occupied a particularly problematic place within the eighteenth- and early nineteenth-century popular imagination. Although public anatomical dissections, such as those which Atkinson gave, could attract large audiences and embraced a wide range of social, cultural and moral meanings, they were perhaps too bloody and gruesome to be regarded as normatively polite activities.129 Through humour, however, Atkinson glossed over these aspects of his practice and resisted his association with the eviscerated corpse. As with his brother’s work such humorous self-mockery had a particular resonance within the arena of masculine public sociability, where seriousness and self-importance were rejected in favour of affable irreverence. The Artkinsons were deeply involved in this arena and were active members of the Doctors Club, a club whose minute book, lest we forget, was inscribed with an exhortation to ‘Good Humour’.130 Conclusion Politeness, sociability, affability, benevolence, and liberality: these were the values which underpinned the late eighteenth-century culture of medicogentility. Atkinson’s Medical Bibliography was a product of this. However, by the time it was published in 1833, it was already outmoded. A tantalising annotation to a copy held at the Minster Library in York states that Atkinson’s text is ‘extremely rare’ because, after his death in 1839, ‘Nearly all the copies were destroyed at the urgent demand of his family’. Quite why they made this demand will forever remain a mystery and it may refer only to the 1833 edition, published in York, and not to the 1834 London edition. However, one possibility is that his family ordered the book’s destruction because they were concerned it might sully his reputation as a ‘serious’ medical practitioner in the mid-nineteenth-century mould. Atkinson’s career is particularly revealing because it spanned two contrasting models of medical culture and identity. By the time of his

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death, the model of the gentleman practitioner, the medical man of letters, which he had inherited from his father and brother, had itself passed away. In the next chapter our study moves into the early nineteenth century to examine the beginnings of the demise of medico-gentility as the hegemonic model of medical identity and practice by considering the controversy which engulfed the York Lunatic Asylum between 1813 and 1815. The Asylum scandal may have been a local event, but it had national ramifications and was constitutive of a much wider historical transformation, one which would have a profound impact on provincial English medical culture. Notes 1 ‘A Memoir of the Life of Alexander Hunter, M.D.’, appended to A. Hunter (ed.), Silva: Or a Discourse of Forrest Trees and the Propagation of Timber in his Majesty’s Dominions, 4th edn, 2 vols (York: Wilson and Spence, 1812), vol. 1, p. xii. 2 Anon. [J. Gregory], Observations on the Offices and Duties of a Physician; and on the Method of Prosecuting Enquiries in Natural Philosophy (London: W. Strahan and T. Cadell, 1770); J. Gregory, Lectures on the Duties and Offices of a Physician (London: W. Strahan and T. Cadell, 1772). 3 T. Withers, A Treatise on the Errors and Defects of Medical Education (London: C. Dilly and H. Murray, 1794), pp. iii–iv. 4 Withers, Errors and Defects, pp. 106–9. 5 Withers, Errors and Defects, pp. 31–2. 6 Withers, Errors and Defects, p. 33. 7 Withers, Errors and Defects, pp. 33–7. 8 Withers, Errors and Defects, pp. 37–8. 9 Withers, Errors and Defects, p. 42. 10 [Gregory], Observations, p. 87. 11 D. King-Hele, Erasmus Darwin (London: Macmillan, 1963); King-Hele, Doctor of Revolution: The Life and Genius of Erasmus Darwin (London: Faber and Faber, 1977); King-Hele, Erasmus Darwin: A Life of Unequalled Achievement (London: DLM, 1999); M. McNeil, Under the Banner of Science: Erasmus Darwin and his Age (Manchester: Manchester University Press, 1987). 12 T. Percival, Moral and Literary Dissertations (London: W. Eyres, 1784). 13 For Withers on asthma, see M. Jackson, Asthma: The Biography (Oxford: Oxford University Press, 2009), pp. 75–81. 14 For example, see L. W. B. Brockliss, Calvet’s Web: Enlightenment and the Republic of Letters in Eighteenth-Century France (Oxford: Oxford University Press, 2002). 15 Withers, Errors and Defects, pp. 45–6. 16 E. M. Brockbank, Sketches of the Lives and Works of the Honorary Medical Staff of the Manchester Infirmary from its Foundation in 1752 to 1830 (Manchester: Manchester University Press, 1904); J. V. Pickstone, ‘Thomas Percival and the

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17 18 19

20 21

22 23

24 25 26 27 28 29 30 31

32 33 34 35 36

Performing medicine production of medical ethics’, in R. Baker, D. Porter and R. Porter (eds), The Codification of Medical Morality, Vol. 1: Medical Ethics and Etiquette in the Eighteenth Century (London: Kluwer Academic Publishers, 1993), p. 165. RS, EC/1774/26, Election Certificate of Alexander Hunter (Cert. III, 203; A03677). Anon. [Alexander Hunter], A Treatise on the Nature and Virtues of Buxton Waters with a Preliminary Account of the External and Internal Use of Natural and Artificial Warm Waters Amongst the Ancients (London: D. Wilson, 1761). ‘A Memoir of the Life of Alexander Hunter, M.D.’, pp. xi–xii; Hunter, A Treatise on the Nature and Virtues of Buxton Waters with a Preliminary Account of the External and Internal Use of Natural and Artificial Warm Waters Amongst the Ancients, 2nd edn (London: 1768). A. Hunter, A Treatise on the Nature and Virtues of Buxton Waters with a Preliminary Account of the External and Internal Use of Natural and Artificial Warm Waters Amongst the Ancients, 3rd edn (London: T. Durham, 1773). A. Hunter, The Buxton Manual, Or a Treatise on the Nature and Virtues of Buxton Waters with a Preliminary Account of the External and Internal Use of Natural and Artificial Warm Waters Amongst the Antients, 6th edn (York: G. Peacock, 1797), p. 4. Hunter, Buxton Manual, p. 31. N. G. Coley, ‘Physicians and the chemical analysis of mineral waters in eighteenth-century England’, Medical History, 26:2 (1982), 123–44; C. Hamlin, ‘Chemistry, medicine and the legitimization of English spas, 1740–1840’, in R. Porter (ed.), The Medical History of Waters and Spas, Medical History Supplement, 10 (1990). Hunter, Buxton Manual, p. 62. YC, 12 January 1779. A. Hunter, A Lecture on the Sulphur Waters of Harrogate (York: Wilson and Spence, 1806). Hunter, Buxton Manual, p. 4. M. Durban, ‘Cavendish, William, fifth duke of Devonshire (1748–1811)’, DNB. For example, see YC, 9 March, 23 March and 3 August 1779, and 7 March and 28 March 1780. YC, 16 November 1778, 16 March and 23 March 1779. S. Wilmot, ‘The Business of Improvement’: Agriculture and Scientific Culture in Britain, c.1770–c.1870, Historical Geography Research Series, 24 (Bristol: Institute of British Geographers, 1990); J. Bord, Science and Whig Manners: Science and Political Style in Britain, c. 1790–1850 (Basingstoke: Palgrave, 2009). YC, 9 March 1779. ‘A Memoir of the Life of Alexander Hunter, M.D.’, pp. xi–xii; BIHR, MSS, Will of A. Hunter, September, 1809. Pickstone, ‘Thomas Percival’, pp. 165–6. J. Golinski, Science as Public Culture: Chemistry and Enlightenment in Britain, 1760–1820 (Cambridge: Cambridge University Press, 1992), p. 31. B. Rush, Medical Inquiries and Observations (London: C. Dilly, 1789), p. 243.

Polite and ornamental knowledge 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55

56 57 58 59 60 61 62 63

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Rush, Medical Inquiries, pp. 243–5. Rush, Medical Inquiries, p. 244. Golinski, Science as Public Culture, p. 32. Hunter (ed.), Silva, vol. 1, pp. 185, 286. Hunter (ed.), Silva, vol. 1, p. 267; Pickstone, ‘Thomas Percival’, p. 165. Memoirs of the Literary and Philosophical Society of Manchester, 3 vols (London: T. Cadell, 1785), vol. 1, p. xviii. A. Young, A Six Months Tour through the North of England (1771) reprinted (New York: Augustus Kelly, 1967), pp. 179, 186. BL, Additional MS 35126, MSS, Original Letters to Arthur Young, vol. 1, fos 62, 109, 132; BL, Additional MS 35129, MSS, Original Letters to Arthur Young, vol. 4, fos 71, 127. A. Goldgar, Impolite Learning: Conduct and Community in the Republic of Letters (New Haven: Yale University Press, 1995), pp. 12–53. BL, Additional MS 35126, fo. 109, MSS, Hunter to Young, 8 September 1771. ‘A Memoir of the Life of Alexander Hunter, M.D.’, p. xii. T. Percival, ‘On the different quantities of rain which fall at different heights over the same spot of ground’, in A. Hunter (ed.), Georgical Essays, 2nd edn (York: A. Ward, 1777), pp. 287–301. A. Hunter, Culina Famulatrix Medicinae; Or, Receipts in Modern Cookery (York: Wilson and Spence, 1804), p. 11. Bord, Science and Whig Manners, chapter 5. Hunter (ed.), Georgical Essays, pp. 5–6. Hunter (ed.), Georgical Essays, p. 7. Hunter (ed.), Georgical Essays, pp. 160, 163. Hunter (ed.), Georgical Essays, pp. 37–46, 56–86; Hunter (ed.), Silva, vol. 1, pp. 65, 284–5, vol. 2, pp. 127–8. A. Hunter (ed.), Terra: A Philosophical Discourse on the Earth Relating to the Culture and Improvement of it for Vegetation and the Propagation of Plants as it was Presented to the Royal Society by J. Evelyn Esq., appended to Hunter (ed.), Silva, vol. 2, p. i. ‘A Memoir of the Life of Alexander Hunter, M.D.’, p. vii. BL, Additional MS 35129, fo. 109, Hunter to Young, 8 September 1771. Emphasis added. Gentleman’s Magazine, 58:2 (1788), p. 133. Hunter (ed.), Silva, vol. 1, p. 19. The dates of publication are: first edition (York: 1776); second edition (York: 1786); third edition (York: 1801); posthumous fourth edition (York: 1812); posthumous fifth edition (London: 1825). BL, British Records Association Collection, Additional MS 52482, fo. 93, MSS, Hunter to Unknown Recipient, 31 October 1775. Hunter (ed.), Silva, vol. 1, p. 49. J. Evelyn, Sylva: Or a Discourse of Forest Trees and the Propagation of Timber in his Majesties Dominions (London: John Martyn and James Allestry, 1664); S. Schama, Landscape and Memory (London: Harper Collins, 1995), p. 162.

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64 For example, B. Langley, Sure Method of Improving Estates by Plantations of Oaks (London: Francis Clay, 1728) and J. Wheeler, The Modern Druid (London: 1743). 65 Hunter (ed.), Silva, vol. 1, p. 95 66 Hunter (ed.), Silva, vol. 1, p. 96. 67 Hunter (ed.), Silva, vol. 1, p. 84. 68 Hunter (ed.), Silva, vol. 1, pp. 332–3. 69 Hunter (ed.), Silva, vol. 1, p. 36. 70 Hunter (ed.), Silva, vol. 2, p. 348. 71 J. D. Hunt, The Figure in the Landscape: Poetry, Painting and Gardening during the Eighteenth Century (Baltimore: Johns Hopkins University Press, 1976). 72 T. Clayton, ‘Miller, John Sebastian (1715–1792)’, DNB. Hunter did not take to Miller, who had been recommended to him by Banks, via the intercession of the latter’s friend, Edward Hugh Boscawen, MP for Truro. Kew, D T C, 1.69–70, MSS, William Boscawen to Joseph Banks, 29 April 1774. In his letters to Banks, he referred to him as ‘an illiterate and irritable old man’. Kew, BC, 1.47, MSS, Alexander Hunter to Joseph Banks, 24 December 1774. 73 Schama, Landscape and Memory, p. 170, plate 17. 74 ‘A Memoir of the Life of Alexander Hunter, M.D.’, p. vii. 75 Hunter (ed.), Silva, vol. 1. 76 Kew, BC, 1.47, MSS, Alexander Hunter to Joseph Banks, 24 December 1774. 77 Kew, BC, 1.55, MSS, Alexander Hunter to Joseph Banks, 3 December 1775; Kew, BC, 1.56, MSS, Alexander Hunter to Joseph Banks, 25 December 1775. 78 Kew, BC, 1.229, MSS, Alexander Hunter to Joseph Banks, 15 April 1786; Kew, BC, 1.233, MSS, Alexander Hunter to Joseph Banks, 16 May 1786. 79 Bord, Science and Whig Manners, p. 117. 80 L. Jordanova, ‘Medical men 1780–1820’, in J. Woodall (ed.), Portraiture: Facing the Subject (Manchester: Manchester University Press, 1997); Jordanova, Defining Features: Scientific and Medical Portraits, 1660–2000 (London: Reaktion Books, 2000). 81 E. G. D’Oench, ‘Smith, John Raphael (bap. 1751, d. 1812)’, DNB. 82 Gentleman’s Magazine, 79:1 (1809), p. 578. Emphasis added. 83 Incontestable Proofs from Internal Evidence that S.W. Nicoll Esq. is not the Author of ‘A Vindication’ of Mr. Higgins from the Charges of Corrector (although Mr. Higgins attributes it to him) in a letter addressed to Earl Fitzwilliam (York: W. Story, 1815?), p. 58. 84 W. White, Observations on the Nature and Cure of the Phthisis Pulmonaris, or Consumption of the Lungs (York: Wilson, Spence and Mawman, 1792), p. v. 85 W. White, ‘On the rise and ascent of vapours’, in Hunter (ed.), Georgical Essays, pp. 95–130. 86 T. Withers, Observations on the Use and Abuse of Medicine, with a View to the Prevention and Cure of Disease (London: C. Dilly and H. Murray, 1794), p. 123. 87 W. White, ‘Experiments upon air, and the effects of different kinds of effluvia upon it; made at York’, Philosophical Transactions of the Royal Society, 68 (1778), 194–220.

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88 J. C. Riley, The Eighteenth-Century Campaign to Avoid Disease (New York: St Martin’s Press, 1987); C. M. Cipolla, Miasmas and Disease: Public Health and the Environment in the Pre-Industrial Age (New Haven: Yale University Press, 1992); A. Corbin, The Foul and the Fragrant: Odour and the French Social Imagination (Leamington Spa: Berg, 1986); S. Schaffer, ‘Measuring virtue: eudiometry, enlightenment and pneumatic medicine’, in A. Cunningham and R. French (eds), The Medical Enlightenment of the Eighteenth Century (Cambridge: Cambridge University Press, 1990); R. Porter, Doctor of Society: Thomas Beddoes, Medicine and Reform (London: Routledge, 1991); A. A. Rusnock, Vital Accounts: Quantifying Health and Population in Eighteenth-Century England and France (Cambridge: Cambridge University Press, 2002); M. Brown, ‘From foetid air to filth: the cultural transformation of British epidemiological thought, ca. 1780–1848’, Bulletin of the History of Medicine, 82:3 (2008), 515–44. White’s eudiometric activities are noted by Golinski, Science as Public Culture, pp. 119–20. 89 White, ‘Experiments upon air’, p. 219. 90 White, ‘Experiments upon air’, pp. 212–13, 219. 91 White, ‘Experiments upon air’, pp. 200–3. 92 White, ‘Experiments upon air’, p. 194. 93 White, ‘Experiments upon air’, p. 196. 94 W. White, ‘Observations on the bills of mortality at York’, Philosophical Transactions of the Royal Society, 72 (1782), p. 41. 95 White, ‘Observations on the bills of mortality, pp. 42–3. 96 R. Sweet, Antiquaries: The Discovery of the Past in Eighteenth-Century Britain (London: Hambledon and London, 2004). 97 Medical Register for the Year 1780 (London: Fielding and Walker, 1780), p. ix. 98 Sweet, Antiquaries; Sweet, The Writing of Urban Histories in Eighteenth-Century England (Oxford: Oxford University Press, 1997); Sweet, ‘History and identity in eighteenth-century York: Francis Drake’s Eboracum (1736)’, in M. Hallett and J. Rendall (eds), Eighteenth-Century York: Culture, Space and Society (York: Borthwick Publications, 2003); Sweet, ‘Provincial culture and urban histories in England and Ireland during the long eighteenth century’, in P. Borsay and L. J. Proudfoot (eds), Provincial Towns in Early Modern England and Ireland: Change, Convergence and Divergence (Oxford: Oxford University Press, 2002). See also, D. Wahrman, ‘National society, communal culture: an argument about the recent historiography of eighteenth-century Britain’, Social History, 17:1 (1992), 43–72. 99 Archaeologica, 1 (1770), p. ii. 100 V. Janković, Reading the Skies: A Cultural History of English Weather, 1650–1820 (Manchester: Manchester University Press, 2000), pp. 103–24. 101 YCA, Acc. 163, MSS, W. White, ‘Analecta Eboracensia, or Memorandum of Events at York’. On the cultures of meteorological diaries, see J. Golinski, British Weather and the Climate of Enlightenment (Chicago: Chicago University Press, 2007), chapter 1. 102 YCA, Acc. 163, MSS, White, ‘Analecta Eboracensia’, p. 19.

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103 YCA, Acc. 163, MSS, White, ‘Analecta Eboracensia’, p. 7. 104 W. R. Jones, ‘Rowe, Harry (1726–1799)’, DNB. 105 H. Rowe [Pseud.], No Cure, No Pay: Or the Pharmacopolist (York: Wilson and Spence, 1794). The exact same play appeared under the title The Sham Doctor, a Musical Farce and was appended to J. Croft, Memoirs of Harry Rowe: Constructed From Materials Found in an Old Box after his Decease (York: Wilson and Spence, 1806). 106 Rowe, No Cure, No Pay, p. 41. 107 Rowe, No Cure, No Pay, p. 61. 108 BIHR, PR. Y/HEL 1–9, 25, MSS, Parish Records of St Helen’s Stonegate, Register of Burials, 27 January 1793. 109 C. Atkinson, The Mind’s Monitor: Or a Serious Discourse on the Advantages of Self-Preservation, Society, Friendship, Love, Learning, Religion and on Death (Leeds: Thomas Gill, 1793), p. 29. 110 Atkinson, The Mind’s Monitor, p. iv, refers to an unnamed ‘worthy Baronet’ who had ‘in many instances been eager to serve me’. 111 C. Atkinson, The Mind’s Monitor: Or a Serious Discourse on the Advantages of Self-Preservation, Society, Friendship, Love, Learning, Religion and on Death, 2nd edn (York: W. Storry, 1802), p. 189. 112 C. Atkinson, The Life and Adventures of an Eccentric Traveller (York: M. W. Carrall, 1818), p. 93. 113 Atkinson, Life and Adventures, pp. 10, 6. 114 Atkinson, Life and Adventures, pp. 12–13. 115 M. Cohen, ‘Manliness, effeminacy and the French: gender and the construction of national character in eighteenth-century England’, in M. Cohen and T. Hitchcock (eds), English Masculinities, 1660–1800 (London: Addison Wesley, 1999). 116 Atkinson, Life and Adventures, pp. 33–4. 117 Atkinson, Life and Adventures, p. 51. 118 Atkinson, Life and Adventures, p. 18. 119 T. Smollett, Travels through France and Italy (London: R. Baldwin, 1766); L. Sterne, A Sentimental Journey though France and Italy (London: T. Becket, 1768). 120 Atkinson, Life and Adventures, p. 5. 121 YC, 15 August 1786. 122 T. F. Dibdin, A Bibliographical, Antiquarian and Picturesque Tour of the Northern Counties of England and in Scotland, 2 vols (London: 1838), vol. 1, pp. 211–15. 123 J. Atkinson, Medical Bibliography A. and B. (York: H. Bellerby, 1833), p. ii. 124 For a fuller, albeit largely antiquarian, discussion of Medical Bibliography, see J. Ruhräh, ‘James Atkinson and his Medical Bibliography’, Annals of Medical History, 4 (1924), 200–21. 125 Atkinson, Medical Bibliography, p. iii. 126 Atkinson, Medical Bibliography, p. 365. Emphasis added. 127 Atkinson, Medical Bibliography, pp. 365, 364.

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128 Atkinson, Medical Bibliography, p. 94. 129 A. Guerrini, ‘Anatomists and entrepreneurs in early eighteenth-century London’, Journal of the History of Medicine and Allied Sciences, 59:2 (2004), 219–39. 130 YML, Additional MS 129, MSS, Doctors Club Minute Book.

3

The asylum revolution: politics, reform and the demise of medico-gentility

[W]hat man of civilized feelings or gentlemanly habits – what man of property or of respectable rank in society – what man of learning or of character, will engage in the care or treatment of this unfortunate class of mortals? They must be left in the care of the vulgar, illiterate, and robust keeper, and the ‘Mind’ that might have been solaced and restored by the influence of manner and education, must be overthrown, debased, lost. A. Mather, A Plain Narrative of Facts relative to the Reception and Treatment of Jane Horsman at the Establishment in Clifton of which Dr Belcombe and Mr Mather are Proprietors (1819)1

I

n 1819 the York s u rgeon, Alexander Mather, was an anxious man. What had begun with the committal of a ‘certified’ lunatic to the private madhouse in Clifton (a village to the north of York), which he ran in partnership with his colleague, Dr William Belcombe, had become a public political scandal. The ‘lunatic’ was a woman by the name of Jane Horsman, and after her committal, her friends had approached the local solicitor and evangelical Anglican, Jonathan Gray, to enquire after her. They claimed that Jane’s incarceration had little or nothing to do with the state of her mind, but was part of a plot hatched by her uncle, Francis Bulmer, to secure the substantial pension which she received from her brother, a wealthy East India Company official. In response to their request, Gray enlisted the help of the Acting Magistrate, Mr Dickens. In the company of a local physician, Baldwin Wake, Dickens gained admittance to the asylum, where Dr Wake declared Miss Horsman to be sane. Shortly afterwards, Dickens returned to Clifton with a number of Jane’s friends and two constables, and demanded entry. On being refused, he ordered the constables to break down the door, which they did. Once inside, he confronted Jane and proposed that she come with them. At first she refused the offer, claiming that Mather, a personal friend, had ‘behaved to me like a gentleman’ and had promised to release her. Dickens retorted that Mather was no friend, but a ‘villain’, and that if she did not leave with him then, she would never leave at all. Upon this, she relented and left the house in the company of Dickens and the ‘ladies’.2

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Events did not end there, however. Horsman decided to take Mather and Belcombe to court. Together with the surgeon-apothecary, William Matterson, Horsman’s uncle, Francis Bulmer, cousin, William Bulmer, and servant, Helen Scott, the two practitioners were charged with false imprisonment and trespass and ordered to appear before the Assizes in August. The situation had become so tense, and Mather’s public reputation so fragile, that when Matterson accused him of acting in an ‘ungentleman-like and unprofessional-like’ manner, Mather had, by his own admission, seized a poker, exclaiming, ‘If you repeat those expressions, I’ll break your head!’3 Mather had good reason to be worried. History seemed to be repeating itself. Just over five years before, a similar scandal had enveloped the York Lunatic Asylum and had resulted in the public disgrace of its principal medical officers. Between 1813 and 1815 the York Lunatic Asylum became the target of a vocal group of men who sought to reform the conditions in which the patients were held and the treatment to which they were subjected. In 1815 this scandal exploded on to the national stage, as the York Asylum, together with Bedlam, became the subject of a parliamentary inquiry into the state of madhouses. The findings of the Select Committee were damning, and although legislative action was some time in coming, their investigation marked the beginnings of a significant transformation in the management and treatment of the insane. As such, the York Lunatic Asylum occupies a central place within the historiography of early nineteenth-century asylum reform and the events of 1813 to 1815 have been discussed at varying lengths by Kathleen Jones, Roy Porter, Andrew Scull and Anne Digby, among others.4 Much of this scholarship is distinctly triumphalist and differs little from the accounts supplied by Jonathan Gray in 1815 or Charles Gaskell in 1902.5 Such accounts tend to discuss asylum reform as if it were the ‘natural’ response to a self-evident ‘evil’. The reformers are represented as ‘humane’, ‘public-spirited’ and ‘honest’, the staff and governors of the Asylum as ‘shifty’, ‘corrupt’, or at best ‘supine’.6 Post-Foucauldian and neo-Marxist accounts have critiqued these assumptions about the humanitarian ‘imperative’, but in their place have erected an equally reductive bourgeois social control model that views asylum reform as an ideological constituent of the transition to a capitalist market economy.7 While there is much material dealing with both the specifics of the York case, and the reform of lunatic asylums in general, an important area has escaped attention. Aside from the work of Andrew Scull and Jonathan Andrews on John Monro, few historians have sought to examine the social identities of medical practitioners engaged in the care of the mad within charitable institutions.8 Even fewer have considered how the reform of such institutions affected the public reputations of those involved.9 Attendance at public charities allowed medical practitioners to accrue symbolic capital by presenting

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themselves as benevolent and genteel citizens with an investment in local civic and county identities.10 Crucially, in their capacity as medical officers, these practitioners were credited with specific and visible areas of competence and authority. Although technically subject to lay governors, the medical officers at the Asylum were allowed an almost total dominion over what I refer to as the ‘medical space’ of the institution. At Bedlam in London, where a similar scandal erupted in 1815–16, the therapeutic regime, established and administered by the physician and apothecary, became one of the key points of contention between the reformers and the existing administration. This was not the case at York, where it was the custodial care of patients and the behaviour of the keepers which elicited most concern. And yet by virtue of the authority credited to them as the heads of an institutional ‘household’, the physician, Charles Best, and his assistant, the apothecary, Charles Atkinson, were held accountable for all matters relating to the physical, moral and mental wellbeing of the patients. It is these matters, as opposed to the functional aspects of administration, which I include under the term ‘medical space’. As Mather’s comments suggest, for contemporary medical practitioners the issues of authority, public identity and social reputation were inextricably intertwined (even within the context of a private madhouse). During the ‘Asylum Revolution’, this authority was called into question, as the reformers sought to instigate a rigorous system of visitation, subjecting the medical staff to routine regulation and inspection.11 In defending their authority, medical practitioners such as Best, Atkinson and, later, Mather, repeatedly appealed to their status as gentlemen. However, lay visitation challenged the claims to humanity, benevolence and disinterestedness which underwrote such social identities. In so doing, the reform of the York Asylum, and of medical charities in general, was both a significant contributor to, and clear indictor of, the incipient demise of medico-gentility as the hegemonic model of medical performance and identity. Of course, the reform of the York Asylum and its impact upon the cultures of medical social practice can only be understood as part of a much wider transformation. Despite more recent attempts to integrate class and gender into the frameworks of analysis, scholarship on the history of asylums and asylum reform has often adopted a rather narrow focus.12 Apparently unable to escape the intellectual shadow of Foucault, it has tended to prioritise the concept of ‘custody’, with the asylum functioning as the institutional embodiment of shifting conceptualisations and understandings of the mentally ill and of their place in society. Thus, despite the best efforts of many scholars to situate changing perceptions of madness within their social and cultural contexts, these historical accounts have frequently failed to do the same for the asylum as an institution and have been largely unwilling or unable to link their reform to more general cultural currents.

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This chapter therefore demonstrates how the scandal which engulfed the York Lunatic Asylum from 1813 to 1815 constituted a clash between competing notions of social power and public authority. Indeed, despite the emphasis of recent scholarship, the immediate debates surrounding the York Asylum made curiously little reference to theories of madness. Instead, they focused on the asylum as charitable institution and on the rights, roles and responsibilities of its governors and staff. In attacking the existing administration, the reformers repeatedly invoked the languages of ‘public’ and ‘private’. Post-Habermasian scholarship has attempted to unpack the complex meanings of these terms, both for contemporaries and as tools of historical analysis. As Kathleen Wilson has suggested, the concept of the ‘public’, like that of its ideological counterpart, the ‘people’, was central to eighteenth- and early nineteenth-century political discourse, conjuring, as it did, the rhetorically appealing image of an inherently virtuous civil polity.13 Likewise, the ‘private’, while it has often been linked to domesticity and the social space of the household, had an equal, though perhaps less well understood, discursive resonance. For many Georgian commentators, the ‘private’ connoted self-interest. Of course, there was nothing inherently wrong with self-interest. A man’s business was, after all, his own affair and, as the late seventeenth- and early eighteenth-century philosopher, Bernard Mandeville, suggested, could even contribute towards the collective good.14 But when self-interest became the structuring ideology of social relations within the public sphere, it tended, in the eyes of many an observer, towards nepotism, oligarchy and corruption. Having said all this, we must be very wary in our reading of such languages. After all, the meanings of these terms were by no means fixed.15 What one chose to celebrate as ‘public’ or decry as ‘private’ was contingent upon differing political, social and religious perspectives, and was the subject of debate and dispute. Thus, although the governors of the York Asylum regarded their institution as a public one, dedicated, as it was, to essentially ‘public’ goals, the reformers of the early nineteenth century frequently criticised it as a ‘private’ institution. Yet, for all their complexity, such languages were not free-floating, but were rooted in distinctive and mutually opposed conceptions of civil society. As we shall see, the governors, most of whom were drawn from county society, operated within a culture structured by the values of gentility, patronage, and polite, informal association. As such, their conception of the ‘public’ was limited to those, like themselves, who enjoyed wealth, influence and a stake in existing social, political and economic structures. For the reformers, however, the ‘public’, like the ‘people’, had different associations. Unlike the governors these men were predominantly drawn from the ranks of urban tradesmen and professionals, particularly lawyers, and were predominantly evangelical Anglicans or adherents of ‘rational’ dissent. They were, in other words, members of an

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ideological, if not necessarily structural, ‘middle class’.16 Their conception of the ‘public’ was, hence, broader and potentially more radical than their opponents’, encompassing the politically disenfranchised and socially ‘marginal’. Moreover, in their use of the ‘private’ they challenged the informal ties of patronage and association through which such voluntary charities invariably functioned. This chapter opens with a brief account of the early years of the York Lunatic Asylum under its first physician, Alexander Hunter. In particular, it examines an incident in the late 1780s, when a small group of governors tried unsuccessfully to challenge Hunter’s authority. Though often invoked by later reformers, this affair offers an illuminating contrast to the later controversy, demonstrating how such challenges could fail when they lacked the moral, political and cultural force they were later to possess. After examining the events of 1813–15, it concludes with a brief account of similar incidents at the County Hospital and at Mather and Belcombe’s private asylum. In so doing, it situates the ‘Asylum Revolution’ within a wider context of institutional and social reform. The ‘physician’s asylum’ The York Lunatic Asylum was founded in 1772, by a predominantly Rockinghamite Whig clique. Alexander Hunter was one of the original twenty-five proponents and appears to have taken a particularly active role in promoting the institution. His ‘Memoir’ claimed that, ‘In 1772, he successfully projected a plan of a Lunatic Asylum at York’, adding that ‘In the prosecution of this scheme he took unwearied pains’.17 As well as subscribing money to the institution, Hunter, together with the Lord Mayor and fellow promoter, Charles Turner MP, was given the task of locating and purchasing an appropriate site for the Asylum.18 The institution was initially dogged by financial difficulties and it was not until 1777 that it was finally ready to receive patients.19 At a meeting in September of that year, the governors appointed Hunter sole physician to the institution. This meeting was attended by only six governors, one of whom was Hunter, suggesting that the decision was taken without widespread consultation. However, as Jonathan Gray later noted, ‘Dr Hunter’s appointment by this Committee, although never confirmed, must have been acquiesced in by the governors at large’.20 Given his active involvement in its foundation, it seems unlikely that anyone else had been considered for the post.21 Indeed, some governors seem to have had an interest in his social and vocational advancement. At least three of the original promoters (now governors) were members of the Rockingham Club.22 One, John Dealtry, himself an established local doctor, may have been a relative, and another, Sir Thomas

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Frankland, the 5th Baronet of Thirkleby, was instrumental in Hunter’s election to the Royal Society.23 Although Hunter was appointed sole physician, he was not to be the only medical officer. A special committee, which included Hunter himself, together with his colleagues Thomas Withers, Allen Swainston and Edward Wallis, proposed that an apothecary be appointed, and recommended that he should have attended either Bedlam or St Luke’s, the two principal metropolitan public asylums.24 Clearly, having had no experience whatsoever in the practical large-scale management of the insane, Hunter was keen to recruit someone who knew what he was doing. However, even if the office of apothecary was central to the day-to-day administration of the Asylum, it was Hunter who was unquestionably in charge.25 Indeed, so dominant did he become, that Anne Digby has characterised the early history of the institution as the ‘Physician’s Asylum’.26 Historians have often regarded voluntary medical charities, such as the York Asylum, as embodying that openness and inclusiveness which characterised the eighteenth-century ‘public sphere’ and differentiated it, in the opinion of many contemporaries, from the closed structures of the Georgian state.27 And yet, looking at the mechanisms of Hunter’s election and the extent of his authority, it is clear that, in many cases, such institutions operated through similar systems of patronage and obligation. In part, this can be seen as a product of circumstance; what Mary Fissell has called the ‘abdication of the governors’.28 This was a feature of many eighteenth-century medical charities and the same situation may very well have pertained at the York Asylum. More substantively, however, it seems that these informal power relations were rooted in the very ideology of civil gentility which gave rise to such intuitions in the first place. As a subscriber, a governor, and the principal medical officer, Hunter was credited with the authority to regulate the ‘medical space’ of the Asylum. Although it was still the governors’ prerogative to accept or reject petitions for assistance, they rarely, if ever, interfered with medical issues, attending instead to the more routine aspects of administration. As a later commentator noted: At the quarterly meetings, four or five Governors with difficulty collected, summed up the items of a tradesman’s bill, contracted the butcher for the ensuing three months, ordered a wall to be pulled down, or a door to be blocked up – wished each other good morning – and retired.29

Although intended as a criticism of how moribund they had become under Hunter, this account could be read as a description of the ideal of gentlemanly performance within a charitable institution. Likewise, in caricaturing their complacency in the face of the ‘abuse’ of the patients, the same author demonstrated how the Asylum functioned as the very apotheosis of contemporary social relations:

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Hunter’s conduct as physician conformed to this model. If the staff were the servants of a grand house with their own internal hierarchies, then Hunter was their benevolent, if often absent, patriarch. In his will, he not only bequeathed money to his own household servants, but left legacies to even the most menial of his underlings at the Asylum.31 One of the consequences of the decline in the governors’ attendance and the extension of Hunter’s authority was that the Asylum became, in one sense at least, less ‘public’. Announcements of meetings continued to appear periodically in the local newspapers and anyone, at least in principle, could ask for a copy of the rules and a printed account of the ‘current state’ of the Asylum. However, as time wore on, this became increasingly difficult and a later critic noted that ‘an inaccessibility to any of the rules is one of the first principles in the clandestine conduct of this institution’.32 This retreat from public scrutiny did not go unnoticed. In 1788, three Asylum governors mounted a challenge to Hunter’s authority. They were the poet and Precentor of York Minster, the Rev. William Mason, the Recorder for the York corporation, William Withers, and the political polemicist, Dr Burgh. Mason, the group’s most eloquent spokesman, objected strenuously to Hunter’s recent proposal that he should be allowed a salary of £200 per annum.33 This proposal indicates the problems facing practitioners engaged in charitable medical practice. Although such positions conferred symbolic capital, they were, in principle at least, financially unrewarding. Like those attending the poor at the County Hospital, Hunter worked for free.34 Mason was unsympathetic to this tension between public image and financial necessity, however. He wrote to the secretary of the Asylum, Michael Eastburn, asking for a copy of Hunter’s proposal.35 Soon afterwards, he published a pamphlet and sent a letter to the York Courant, in which he outlined his principal objections.36 Mason maintained that the Asylum had been established for the relief of parish paupers, not those of ‘middling rank’ as Hunter had claimed. In 1784, Hunter had pressed for the admission of a number of ‘superior’ (i.e. wealthier) patients, whose increased payments, both he and many of the governors maintained, would defray the costs of admitting paupers.37 In reality, however, he was taking fees from them.38 What was perhaps most significant about this controversy was the fact that Mason chose to go public with his accusations. While claiming that his letter to the Courant was not intended for publication, he appealed to the ‘graver

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citizens who are the constant readers of your impartial paper’ to concur with his objections.39 In response, Hunter sent his own letter to the governors and to the press.40 He began with a quotation from Joseph Addison: ‘I know no evil so destructive to society as literary incendiary’.41 This rhetoric continued throughout the letter. Hunter suggested that, in attacking the public reputations of both the Asylum and himself, Mason had broken an unwritten code of gentlemanly conduct. Claiming that he desired to be treated with ‘civility . . . decency and propriety’, he stated: I shall pass over in silence the many low and illiberal attacks made by Mr Mason upon the constitution of the Asylum and the honour of the Governors, and, in particular, upon the attending physician.42

Despite their appeals to the public, the challenge posed by Mason, Burgh and Withers was soon subsumed into the space of the committee room. They were asked to attend a meeting of the governors where their objections were to be heard. Their reception was unfavourable. The other governors made no attempt to restrain Hunter when he launched a verbal attack on Dr Burgh, stating that he had ‘long thought him a scoundrel and had never had any reason to alter his opinion’.43 They swept aside Mason’s concerns and reiterated their acquiescence to Hunter’s self-regulated dominion of the Asylum, thanking him for ‘his great attention to all the interests of this institution’. Their verdict on his opponents was damming: Resolved . . . that such Governors [Mason et al.] as profess themselves friends to the Asylum would express their good-will to it much better by attending in their places at the times of the meeting, and there giving their advice for the regulation and improvement of the Institution, than by prejudicing the minds of the public by their misrepresentations.44

There was clearly more to the governors’ actions than simple nepotism. Mason and his associates had overstepped the boundaries of gentlemanly protocol, and by appealing to the undifferentiated newspaper-reading ‘public’, rather than their social equals (or superiors), they had broken the vertical ties of deference that regulated social action within such voluntary charities. The governors of the Asylum often employed the rhetoric of the ‘public’, both in representations of the institution’s utility and in their pleas for donations. And yet, while they claimed to be open to public scrutiny, it was clear that the Asylum was also a ‘private’ space; it was regulated and controlled by its benevolent patrons and the governors could not suffer such internal disputes to enter the world of ‘public’ print.45 Mason and his associates were not entirely silenced by this censure. Despite Mason’s limited appeals to the ‘public’, their initial challenge had been articulated from within the cultural space of the Asylum. Their subsequent

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criticisms, however, entailed a subtle, but highly significant, change of emphasis. Instead of that preoccupation with the particulars of administration, which characterised their previously internal discourse, they now exhibited the concerns of disgruntled outsiders. Thus, rather than seeking to steer the course of the Asylum from within, they attacked the institution itself, and the cultural forms that had given it birth. For example, in 1791, William Wilberforce had written to Dr Burgh expressing concern over the administration of the Asylum. Burgh’s reply characterised the institution as a ‘private madhouse’ whose conduct was ‘clandestine’. ‘Criminal deviations’ had taken place, he claimed, which had ‘defrauded’ the ‘public’. Burgh also made reference to the architectural grandeur of the Asylum and its projection of civic and county pride. Like many of those who were critical of the ‘inappropriate’ magnificence of Bedlam, he contrasted the public and private aspects of the structure, claiming that the building was both ‘a magnificent edifice and [a] pompous display of human degradation’.46 Burgh’s criticisms of the Asylum were prescient, for they articulated the same concerns over the regulation and inspection of ‘private’ space that were to become a staple of later debates. Also significant was the involvement of William Wilberforce, a Yorkshire MP. Wilberforce, an evangelical philanthropist concerned with the regulation and moral reformation of the poor, was typical of the self-appointed ‘reformers’ who would later be found in the vanguard of the assault on the ancien régime of the York Lunatic Asylum. For the moment, however, the physician’s hegemony appeared secure. Not only had Hunter survived the challenge posed to his authority by Mason and the others, but he had also gained further concessions from the governors. In 1790, they allowed him to open a private asylum in Acomb, even though this was contrary to the original rules.47 In 1809, Hunter died and the post of sole physician to the public Asylum passed to his protégé and successor, the consumptive Edinburgh graduate, Dr Charles Best.48 However, while Hunter had successfully invoked the rhetoric of genteel civility in defence of his authority, Best’s attempts to do so would meet with failure. The revolution One of the more notable changes that took place in York between the Asylum controversy of 1788, and that of 1813 to 1815, was the establishment of the Retreat. The Retreat had been founded in 1792 by the Quaker tea and coffee merchant, William Tuke, in response to the suspicious death of the Leeds Quaker, Hannah Mills, in the public asylum. It was denominationally specific, catering only for the Quaker insane. Under the administration of the Tukes, and the medical attendance of the superintendent, George Jepson, and the physician, Thomas Fowler (later William Belcombe), patients at the Retreat

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were subjected to what was referred to as ‘moral therapy’.49 This treatment avoided physical restraint wherever possible and sought instead to instil an internal moral restraint in the lunatic through what Samuel Tuke called the ‘desire of esteem’.50 Ever since its foundation, the Retreat had been a thorn in the side of the public asylum. Although the 1807 Select Committee on pauper and criminal lunatics had commended the York Asylum, the widespread praise of the methods of treatment practised at the Retreat risked the drawing of unfavourable comparisons.51 Moreover, unlike the Asylum, the Retreat had gained recognition as something approaching a national institution. Because of its confessional specificity, it drew in patients from around the country. The asylum, on the other hand, largely restricted itself to Yorkshire. This fact helped raise the profile of the Retreat, and, during the late eighteenth and early nineteenth centuries, it attracted a range of visitors from doctors to foreign dignitaries.52 The Retreat was not only of interest to medical practitioners; it was grounded in a wider social and religious movement. The late eighteenth and early nineteenth centuries saw the rise of an increasingly vocal group of philanthropic men and women committed to social and moral reform. Most of these individuals were religious dissenters or were on the evangelical wing of the Church of England. This movement was particularly apparent in York. William Wilberforce, the great figurehead of philanthropic reform, was a county MP. His election campaign, combined with the growing influence of evangelical ideology, galvanised a previously disparate dissenting community into something approaching a homogeneous entity with shared interests and goals. In York, the economically significant Quaker population had traditionally played little role in public affairs. However, in his active support for Wilberforce, Samuel Tuke broke this mould and led the way for much more open Quaker activity.53 Tuke found like-minded activists in York’s Unitarian and evangelical communities. The Unitarian influence was particularly strong, as together with the Rev. Charles Wellbeloved, the Unitarian matriarch Catherine Cappe stood at the centre of an intra- and international network of dissenting and philanthropic interest.54 Also significant was evangelical Anglicanism, centred on the Rev. William Richardson and the parish of St Michael-le-Belfry. One of the most well known, and publicly visible, evangelical families were the Grays, led by the solicitor, William, his wife, Faith, and their son, Jonathan. Together, this heterogeneous group made a significant impact on the social and political landscape of early nineteenth-century York, founding such morally and socially reforming societies as the Anti-Slavery Society, the Auxiliary Bible Society, the Missionary and Religious Tract societies, and the Society for the Prevention and Discouragement of Vice and Profaneness.

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There was also a more overtly political dimension to this movement. Early nineteenth-century York remained a resolutely Whig city but during the 1810s an increasingly unstable political climate, fuelled by the economic privations of the war with France, shaped a more radical strain of reformism. The immediate effects of this political upheaval were, at first, observed only at a distance. In January 1813, for example, a special Assize was held in York to try sixty-four prisoners accused of Luddite machine-wrecking in the West Riding of Yorkshire. Nineteen were subsequently hanged in front of a large public audience in Castle Yard.55 Six years later reports circulated that radicals were smuggling pikes and other weapons into Leeds in preparation for an armed uprising.56 And yet even if the real tensions were elsewhere, there were some in the city who were also articulating a radical, if less violent, critique of the political establishment. One of these men was S. W. Nicoll, attorney, Recorder for the York corporation and a leading member of the York Whig Club. He was avowedly opposed to the political power exercised by the aristocratic elites, and called for the enfranchisement of ‘the people’, broadly conceived.57 According to Nicoll, the 1810s had seen the erosion of a broad political consensus. In the eighteenth century, he claimed, the Whigs and Tories had divided the country between them, the people being called upon to decide which party ‘best consulted the national weal’. In recent years, however, ‘an entirely new system has arisen’ in which political opponents were so entrenched that ‘they can never exist together in peace or equality’.58 Nicoll was speaking about the national picture but even in York cracks were appearing in the Whig hegemony. After all, more radical reformers like Nicoll were as sceptical of the complacent aristocratic Whig elites as they were of the Tories. Moreover, with this development of a more reformist Whiggism, others were rallying to political conservatism as the only sure defence of political order. From the middle of the eighteenth century the only significant newspapers in the city had been Whig ones. Under the ownership and editorship of the radical printer, William Hargrove, the York Herald and York Courant had both nailed their colours to the mast of political reform. In 1819, however, the printer, Henry Bellerby, and his associates established the Yorkshire Gazette as the voice of opposition. Together with Hargrove and the Herald, which it described as the ‘apologist and encomiast of the Political Protestants’, the Gazette’s particular bugbears were the York Whig Club (‘this organ of discontent and radicalism’), the Fitzwilliam family, and the city’s increasingly radical corporation.59 One of the principal objects of scrutiny for both moral and political reformers alike was public institutions. Taking their lead from the pioneering activities of John Howard they developed a close interest in the management of institutions such as prisons, workhouses, hospitals and asylums, which might promote the degradation of their inmates or which subjected

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them to conditions, punishments or restraints which imposed upon their individual liberties. For some, institutional reform was a fundamentally spiritual and humanitarian issue. For many, however, it also had broader political implications in that such institutions functioned as a microcosm of ‘Old Corruption’, embodying the nepotism, oligarchy and even tyranny, of the political and social establishment.60 As one York-based reformer put it, their concern was with ‘those numerous establishments and endowments – half public and half private in their nature – by which I mean hospitals, schools, infirmaries and asylums, at once the honour and disgrace of the nation’.61 Many of the non-conformists involved in this movement were excluded from established positions within the social and political hierarchy. In opening up such spaces to their authority, they thereby sought to extend their own social and political influence. And yet they did not frame their activities as self-interested. They saw themselves not only as the representatives of an evangelical or dissenting movement, but as the guardians and enforcers of an authority vested in the ‘public’ at large. In the early 1810s, the ancien régime of the York Lunatic Asylum therefore came under attack from a group of reformers whose stated aim was to break open the ‘private’ space of the institution, self-regulated by corrupt medical practitioners and the local elites, and subject it to the regulation and surveillance of a publicly mandated authority.62 The controversy began in September 1813 when the Asylum’s physician, Charles Best, wrote an anonymous letter of complaint to the York Chronicle.63 In it, he launched an attack on Samuel Tuke and his recently published Description of the Retreat (1813). This book, a historical account of the foundation and administration of the Retreat, and panegyric to ‘moral therapy’, was, Best argued, a thinly veiled attack on his practice at the York Asylum, and by extension, his private ‘House of Retirement’. He maintained that remarks in Tuke’s work were calculated to discredit him and were thrown out against other establishments for the same purpose, the intended application of which, no one could misunderstand, and which were as strikingly illiberal as they were grossly unfounded.64

Best also took offence at a public handbill, recently circulated around York by Dr Belcombe, physician to the Retreat. This handbill announced Belcombe’s intention to establish his own private asylum, and in it, he claimed that the system he practised there would be the same as the ‘mild methods’ he practised at the Retreat. Best evidently believed that such claims posed a threat to his public reputation as a medical practitioner with expertise in the management of the insane. He argued that Belcombe’s statements ‘were intended to impose a belief upon [the handbill’s] readers that methods of treatment of an opposite direction were employed at the other Establishments for insane

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persons in York and its vicinity’. Such an ‘insinuation’, Best maintained, was both ‘perfectly unprofessional and palpably incorrect’.65 Best’s letter prompted a triangular row between Tuke, Belcombe and himself in the letter pages of York’s newspapers. Initially, this row was dominated by a familiar intra-medical dispute between Best and Belcombe over the propriety of medical advertisement. Best castigated Belcombe as a quack, and argued that he had overstepped the boundaries of gentlemanly medical conduct.66 However, for Tuke and his reformist allies, this debate offered an ideal opportunity publicly to oppose the existing Asylum administration. In October, Tuke’s friend and fellow Quaker, Samuel Wemyss, wrote to the York Herald, pointing out that the controversy appears, like too many others, to consist of charge and exculpation between the parties at variance, when it ought to assume a more important form, as having relation to the public at large.67

Wemyss’s letter was infused with a language of the ‘public’ interest, and his concern with the public regulation of private space was one that would come to dominate the reform of the York Lunatic Asylum. He portrayed the Asylum as a secretive institution, and compared it to that other great object of reforming interest, the prison. Quoting Hamlet, he called upon Best to ‘unlock the secrets of the prison-house’, and referred to the ‘benevolent zeal of Howard in exploring prisons of a different kind’. Wemyss’s letter also alluded to the political dimensions of the debate. Although it is difficult to establish class-based dichotomies with regards to reform, it is clear that Wemyss was tapping into an emergent, radical, ‘middle-class’ belief that their exclusion from the arenas of social and political power was the product of aristocratic oligarchy. Thus, he claimed, the ‘office of a Reformer’ was a ‘hopeless’ one because ‘the parties requiring Reformation are powerful and affluent and strongly entrenched behind prescriptive usages and customs’.68 For all their epistolary fury, however, it is unlikely that the York-based reformers would have engaged in any constructive social action had not a magistrate for the West Riding of Yorkshire, named Godfrey Higgins, entered the fray. Higgins had studied law at Trinity Hall, Cambridge, but did not take a degree and was never called to the bar, opting instead to take a commission in the 3rd West York militia. In 1800, on the death of his father, he inherited a considerable estate at Skellow Grange, near Doncaster. Higgins’s religious beliefs are best described as unconventional. His political ideology was similarly radical and was informed by Benthamite utilitarianism.69 As magistrate Higgins had been responsible for the committal of a man named William Vickers (or Vicars) to the York Asylum. Vickers’s wife had allegedly begged him not to send her husband there, as she feared he might be mistreated. When he returned from his stay at the Asylum, his wife again

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sought Higgins out, claiming that he had indeed been ‘ill-used’. Vickers was examined by a local surgeon, Charles Maples, who observed that he was infested with lice and that his leg was in a ‘state of mortification’.70 Armed with this case, Higgins decided to act. He did not pursue the expected course of action, however. Rather than approaching the governors of the Asylum, he resolved, almost immediately, to publish his findings and his accusations of abuse. Higgins’s decision was a political one. In ignoring the protocols of that culture of civil interaction on which the Asylum was founded, Higgins appealed to a different form of authority. This was the ‘public authority’ to which he frequently referred and it was an authority, which, in his opinion, was most effectively channelled through his magisterial office. From the outset, Higgins was perhaps the most vociferous and implacable of Best’s opponents. This may have had something to do with the fact that, as a relative outsider, he was not so sensitive to Best’s public reputation and familial connections.71 Even reformers like S. W. Nicoll expressed a concern that Higgins was out to destroy Best.72 Whatever their reservations, however, he was quickly received by the reformers and was greeted as an ally.73 Needless to say, the governors of the Asylum took great offence when Higgins published his accusations. One of them remarked that it constituted a ‘flagrant breach of good manners’, while another dismissed it as an ‘unseemly novelty’.74 Best and the Asylum’s governors attempted to blunt this challenge by inviting Higgins, and the other reformers, to attend the quarterly meeting in December 1813.75 There they would be given an opportunity to present their case. Both Best and the governors knew that their opponents would be at a crippling disadvantage on entering the ‘private’ space of the committee room. The reformers were equally aware that their arguments, ill-formed and lacking in any real proof, would hold little truck.76 It is unsurprising therefore, that when this quarterly meeting was held, the governors dismissed them, just as they had dismissed those of Mason and his associates some twenty-five years before. As with Mason, they censured Higgins for his breach of protocol in appealing to the public through the newspapers: Resolved, That whilst the Governors are at all times ready and anxious to promote an inquiry into the supposed existence of any abuse in the conduct of this institution, they cannot but regret the mode by which an ‘ex-parte’ statement of this case, which has come this day under consideration, has been circulated in several Newspapers previous to an opportunity being afforded to the Governors of a regular investigation on the grounds of complaint.77

Despite this setback, the reformers continued to push their case through an increasingly radical and politically polarised local press. In keeping with their desire to subject the Asylum to ‘public’ scrutiny, they consistently demanded

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the introduction of visitors to monitor the condition of the patients and regulate the conduct of the staff. Visitation had far-reaching consequences for medical authority, and by extension, medical identity.78 The concept was by no means new. From its opening in 1777, the governors had elected a committee to investigate the running of the Asylum. However, as with most aspects of the Asylum’s administration, it appears that visitation was subject to Hunter’s authority, and he was often appointed as one of the visitors himself.79 Moreover, it was evidently far from thorough. When asked by the parliamentary select committee whether the governors ever inspected the patients’ quarters, Best replied: ‘That I cannot say; they examined the beer and the bread; there was a repugnance on the part of the Governors to enter the rooms where the patients were confined’.80 The reformers called for a markedly different system of visitation. Significantly, they maintained that medical practitioners, especially those actually engaged at the asylum, should play no role. Such practitioners, they argued, had an ‘interest’ in the institution and could not therefore be regarded as objective witnesses. The reformers’ argument thus ran counter to a public medical identity founded on notions of gentility and disinterested benevolence. It assumed that medical practitioners were not disinterested, but were motivated by financial imperatives.81 Most importantly perhaps, this proviso challenged practitioners’ authority over the ‘medical space’ of the Asylum. Not all the reformers were agreed on the form that visitation should take. Higgins felt that, as the representatives of public authority, magistrates, like him, should investigate public asylums, just as they had the legal right to investigate private ones. Nicoll and Tuke, on the other hand, favoured the appointment of ‘responsible’ and ‘disinterested’ laymen and women, doubtless drawn from the same group of self-selecting philanthropists to which they belonged. Regardless of their differences, all were agreed that this responsibility should not fall to the governors, or their medical lackeys. Instead, Best, and the apothecary, Atkinson, were themselves to be subjected to regular and thorough surveillance, for as Nicoll claimed, ‘the keeper must himself be kept’.82 This system of visitation was also to go much further than previous forms. In a later work on the subject, Nicoll characterised earlier visitations by governors as inefficient in part because of their genteel manners. These men, he argued, in some measure converse . . . [and] out of politeness, keep together, never going on before the head person in the company; and on the whole, saunter along, half in attention, and seeing thoroughly into nothing.83

In contrast, the ideal visitor was a ‘no nonsense . . . man of business’, preferably a ‘respectable tradesmen’. Uninhibited by refined manners, this visitor

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would be able to baffle the efforts of the asylum staff to conceal abuse and neglect: [H]e must have reached the garret, whilst he was yet thought to remain in the kitchen, be in the airing-court before the keeper had locked up the cell he has scarce left.84

Not only was he to be a man of action, but he was also to possess a keen eye and a hardy constitution: He must not be a man of refined niceness; but firmly endure, both in eye, ear and nostril, what an ordinary man would shrink from with horror.85

Nicoll anticipated the antagonism that such a form of visitation would engender. He remarked that both the governors and the medical staff would resent having their ‘private’ institution invaded by ‘strangers’, especially if that stranger was ‘some tradesman from the next street’.86 Yet for Nicoll, such anxiety was a positive advantage. As in the political and social realms, it was only through the invasive surveillance of like-minded reformers that abuse and corruption could be eradicated. These men were to be the physical manifestation of what he described as the ‘voice of the public’.87 Yet for medical practitioners, such as Best and Atkinson, visitation posed a direct threat to the dominion which they exercised over the Asylum. In challenging their competence, and in subjecting them to the authority of magistrates and tradesman, these reforms turned them into little more than servants and, as such, were an affront to their self-professed identities as gentlemen. In December 1813, an incident occurred that made the prospects of reform ever more real. That month, a number of the reformers discovered a clause in the rules of the Asylum that allowed anyone subscribing more than £20 to become a governor. Forty-five individuals then took advantage of this provision and secured seats in the committee room. These ‘new’ governors, as they termed themselves, included most of the leading reformers. Among their number were Samuel Tuke and his grandfather, William, Godfrey Higgins, S. W. Nicoll, the evangelical solicitors, William and Jonathan Gray, and the Unitarian minister, Charles Wellbeloved.88 In infiltrating the Asylum, these reformers blurred the lines between the public and the private. Conversations which had previously taken place within the ‘private’ space of the committee room were now communicated to the local newspapers. Needless to say, the election of these men was greatly resented by many of the older governors. This was due in part to the fact that as outsiders, they had adopted positions which opposed the existing administration. However, this resentment also had religious and class dimensions. One of the senior governors, and one of Best’s most vocal supporters, was Edward Vernon Harcourt, the Archbishop of York, and figurehead of York’s Anglican community. Most of the other

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senior governors also came from established Anglican families. The reformers, on the other hand, were mostly dissenters or evangelicals. Thus, when the reformers later proposed that a chaplain be appointed to the asylum, one of the clerical governors reportedly commented that they might have ‘some mad Methodist perhaps’.89 Furthermore, whereas many of the old governors, like Earl Fitzwilliam, were established, wealthy members of local society, many of the reformers were socially inferior. This is not to say that they were not respectable. S. W. Nicoll, for example, was a leading member of the corporation, and the Grays were a prominent, if recently established, York family. Nevertheless, as members of a largely urban commercial class, there was an evident degree of social snobbery in their pejorative nickname of the ‘two guinea governors’.90 Indeed, Nicoll and Higgins were allegedly taunted that their donations of £20 ‘did not make them gentlemen’.91 By the end of 1813, the reformers had secured a majority of seats on the governing committee; in early 1814 they extended their authority even further. In March, Godfrey Higgins was in York for the Assizes. While in town, he paid a surprise visit to the Asylum. Acting as the very embodiment of Nicoll’s ideal visitor, he forced his way past the servants and into the medical domain of the patients’ quarters. In a language charged with associations of privacy and secrecy, he claimed in a letter to Earl Fitzwilliam that he had stumbled across a door ‘of a retired appearance . . . which was almost concealed by another opening upon it’. In a remarkable incident, Higgins ‘ordered’ that the door be opened and when the keeper refused, he threatened him with a nearby poker.92 Upon this, the key was produced and the space opened up for Higgins’s ‘investigation’. In a vivid rendering of filth and squalor, he wrote that: On entering the first cell [of four], I found it in a state dreadful beyond description: some miserable bedding was lying on straw, which was daubed wet with excrement and urine; the boarded floor was perfectly saturated with filth; the walls also besmeared with excrement; the round air hole, about eight inches in diameter, partly filled with it – this cell was about eight feet and a half square, perfectly dark when the door was shut and the stench almost intolerable.93

Higgins published his findings in both the York Herald and the Doncaster Gazette. He described the Asylum as being in a ‘shocking state’, and made frequent references to it as a ‘private’ and ‘secret’ space. He portrayed himself as a man opening this ‘private’ space to public scrutiny, claiming that ‘With unhallowed hand, I have violently torn aside the veil which concealed the secrets of this filthy temple of MOLOCH’.94 Higgins’s opponents questioned by what authority he had entered the Asylum, let alone threatened the staff. One characterised him as a ‘prying mischief-maker’ and claimed that the law did not endow magistrates with the

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power to ‘interfere’ in the affairs of the Asylum.95 Another stated that had he been present, he ‘would smack the door in his face and drive him to his legal redress’, adding ‘Tell me not of Mr H’s thoughts, let him show his authority, or he may as well be silent’.96 Higgins’s actions were most keenly felt by Best. In invading the ‘medical space’ of the Asylum, Higgins had directly challenged his authority. In a letter to the Herald, Best therefore accused him of launching an ‘attack . . . personally and particularly levelled at me’.97 In a series of meetings throughout 1814, Best’s authority and that of his assistant, Charles Atkinson, came under increasing scrutiny. As his authority was called into question, so too was his public reputation. As Nicoll observed, ‘He [Best] always considered his own character to be involved in the past state of the Asylum’.98 Best still had influential supporters among the older governors, and it is striking how frequently they appealed to gentility in defending him. Higgins accused them of blazoning forth the names of his ‘friends’ in an ‘undignified’ manner, and alleged that they sought to defend him by using ‘unmeaning phrases’ such as ‘gentlemanly man’ and ‘man of unquestionable honour’.99 However, Best’s friends were fighting a losing battle. Although the committee appointed to investigate Higgins’s ‘cells’ found that Best had had ‘no INTENTION’ of hiding them from the governors, they also passed a resolution thanking the magistrate for his exertions.100 Moreover, this committee appointed the first visitors to inspect the Asylum in twenty-seven years.101 The medical hegemony established by Hunter, and enjoyed by his successor, had been effectively destroyed. Events came to a head in August 1814 at the Annual Court of Governors. Significantly, the meeting was not held in the committee room at the Asylum, but in York’s Guildhall. While this was partly due to the large numbers attending the meeting, it also expressed the reformers’ desire to ‘open up’ the Asylum to public scrutiny. The meeting started reasonably well for Best. Higgins noted that there was ‘a strong disposition in a very powerful party, to retain in office all those persons who had so grossly abused the trust confided in them, and thereby once again to convert the charity into a private job’.102 Best’s supporters took the initiative and managed to secure him a salary of 300 guineas a year, in lieu of fees. He was also allowed to retain his private asylum in Acomb. However, a blow was dealt to his medical authority when it was resolved that the friends of patients might call any ‘regular Physician’ to attend them. From then on, things went downhill for him. Higgins reiterated his demand that all the staff of the Asylum be dismissed and their positions declared vacant. Best’s supporters claimed that this was ‘a personal attack upon the Doctor’, but he was nevertheless compelled to take the stand. Under interrogation, Best revealed that he had been taking fees from patients for many years, but claimed that this practice had been established by Hunter and was known to the governors. On this admission, Best was subjected to the withering criticism

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of Earl Fitzwilliam and his son, Lord Milton. According to Jonathan Gray, Best was ‘baited’, and ‘stood there like a culprit palliating these accusations as well as he could, but compelled to answer and confess that he had pocketed the money’.103 Without such aristocratic support Best was highly vulnerable. Lord Milton moved to support Higgins’s motion, stating that if they were to ‘pounce on the head’, then the physician must be dismissed.104 In the end, however, Best had enough supporters to ensure that he was retained. The other members of staff were not so lucky.105 All the servants, the steward, and the apothecary, were dismissed. Charles Atkinson, the apothecary, was acutely aware of the damage that had been done to his standing. As a relatively lowstatus surgeon-apothecary, and a Catholic to boot, Atkinson’s public reputation was especially fragile and dependent upon a carefully fashioned image of medico-gentility. Even some of the reformers were sympathetic to his plight. Gray noted that ‘Atkinson is to be pitied’.106 Others were critical of Higgins for ‘exulting in the sufferings of a civilised, well-meaning man’.107 Soon after his dismissal, Atkinson published a vitriolic attack on Higgins, and a spirited defence of his reputation. He claimed that he had been assaulted with ‘blackguard language’ and treated like a ‘vagabond servant’. He also cast aspersions on the social status of his reformist opponents, dismissing them as a ‘vulgar tribe’ and as ‘low-bred, foul and vulgar carcasses’. Atkinson maintained that he had been the victim of ‘party malice’ and had paid the price for being a Roman Catholic. He concluded, however, by defending his identity as a gentleman: My early life was schooled with gentlemen! I am the son of a gentleman! My education was that of a gentleman! And my profession is so.108

Even if Best had not been sacked, his was a Pyrrhic victory. The Annual Court found that ‘no criminality’ attached to him for embezzlement of the Asylum’s funds. However, this was hardly a positive vindication of his honour, integrity or gentility. Even though he was retained as physician, Best’s public reputation and his authority over the Asylum lay in tatters. Gray observed that his supporters ‘give it out that Best is completely acquitted of blame’, but maintained that their claims ‘will hardly make the public believe that an escape from Botany Bay or the hulks, which some of our great Governors seem to think he merits, is any cause for triumph’.109 Indeed, so tenuous was Best’s reputation that he later wrote a threatening letter to the editor of the York Herald, William Hargrove, stating that if ‘one syllable’ of libel against him appeared in his paper, he would take him to court.110 The reformers’ victory had been total. At a meeting in September 1814, a committee was appointed that included S. W. Nicoll, Jonathan Gray and two members of the Tuke family. The first visitors were also named, among whom were Charles Wellbeloved and William Tuke. This group of reforming philanthropists had opened up the ‘private’ space of the Asylum to their scrutiny and

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authority. From now on, the Asylum, once dominated by the county gentry, would be administered by a group of urban dissenters and political radicals and the physician’s dominion, once total, would be subjected to penetrative lay surveillance and regulation. Meanwhile, Best’s public reputation, already tarnished, was to suffer further. In 1815, those who were agitating for asylum reform managed to secure a parliamentary select committee to investigate the state of madhouses in England and Wales. Although the committee was politically heterogeneous, it was dominated by reformers, including Samuel Whitbread and George Rose as well as Lord Milton, the increasingly politically radical MP and governor of the York Asylum. Best was soon called to give evidence to the committee. Things did not go well for him, however, and his combative manner alienated even potentially sympathetic members of the panel.111 Halfway through the proceedings, Best tendered his resignation, citing ill health. A long-suffering consumptive, he left England for Nice. There he remained for eighteen months before his death in 1817. Surveillance, regulation and the challenge to medical authority The reform of the Lunatic Asylum was the most visible, and perhaps the most aggressive, example of the subjection of charitable institutions and their medical officers to a lay ‘public’ authority, but it was not an isolated incident. Events at the York Asylum were mirrored by those at Bedlam, where, in the aftermath of the 1815 select committee, the apothecary, John Haslam, was sacked and the physician, Thomas Monro, forced to resign.112 Moreover, in the 1810s, those associated with the reforming coterie that had ‘opened up’ the Asylum sought to do the same for a number of other local medical institutions. This chapter opened with a brief account of how, in 1819, Alexander Mather and William Belcombe came to be taken to court by their former charge, Jane Horsman, for false imprisonment and trespass. According to the Courant, the subsequent trial ‘excited an extraordinary degree of interest in the City of York and many parts of the county’, due in part to ‘the respectability of some of the party’. The Archbishop of York secured a seat next to the judge, while the body of the courtroom was ‘crowded beyond description – the galleries . . . ready to bend under the weight and numbers of spectators’.113 At the conclusion of the trial, the Bulmers, as well as Mather, Matterson and Belcombe, were found guilty on both counts (Helen Scott was acquitted). However, rather than the £2,000 damages, which Horsman had requested, the defendants were ordered to pay a mere £50. Yet despite the token sum, and the fact that the judge had noted that ‘no improper conduct appears to have taken place on the part of Dr Belcombe and Mr Mather’, the humiliation was keenly felt.114

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Mather was particularly offended that Jonathan Gray, with whom he had a ‘private friendship’, should have acted against him, both during the incident itself, and as a witness in court.115 Revealingly, in his attack upon Gray, he appealed to the protocols of civil gentility. He claimed that Gray had ‘transgressed the limits of civilised life’ and that, rather than acting with ‘Christianlike and gentlemanlike liberality’, he had conducted himself in a manner ‘inconsistent with true urbanity of manners’.116 He repeatedly sought to remind Gray of the irreparable damage he had inflicted on both his social and vocational reputation. Referring to Belcombe and himself as ‘medical gentlemen’, and ‘men . . . who . . . have maintained a highly respectable rank in society’, he asked ‘What reparation have you offered to British subjects – members of society as respectable as yourself and Dickens – for classing them with felons . . . [and] aiming a deadly blow at their social and professional existence?’117 In his defence, Gray, who had taken an active part in the reform of the public asylum, claimed that he had acted, in both circumstances, from a commitment to principle, rather than from personal animosity. In a letter to a colleague, he maintained that ‘the characters of Dr Belcombe and Mr Mather stand so high that it cannot be suspected that they have acted from any mercenary motives’. Rather, they acted on the ‘high, but mistaken, notion of the prerogatives of the keepers of Madhouses’. However, despite Gray’s attempts to draw a distinction between principles and persons, it is clear that for Mather, as for many contemporary practitioners, the link between ‘prerogatives’ (i.e. social authority) and public identity was an inseparable one: Was it to be supposed that Dr Belcombe, on such an application [Gray’s demand that Horsman be released], could forget his own respectability, and be so pusillanimous as to say, ‘Oh yes! Sir, since you desire it, I will set her at liberty directly. ’Tis true I have received a Certificate, and I took her into the House as a person “disturbed in her mind” etc. and I have found her so; but I will concede that I have done wrong when an Attorney calls me to account’?118

In subjecting them to the authority of a magistrate and by humiliating them in court, Gray and Dickens had critically undermined their identities as gentlemen. Nor was it just madhouses in which medical practitioners were subjected to such lay scrutiny. In 1787, the governors of the County Hospital had agreed to appoint visitors to ‘enquire into the conduct of the patients and servants’. These men (for only men were appointed) were to visit the Hospital twice a week and were to note down their observations in a book ‘kept at the Hospital for that Purpose’. This book was then delivered to the following Quarterly Court, for the consideration of the governors.119 Unlike the Asylum, where the original system of visitation had fallen into disuse, the County Hospital appears to

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have been subject to regular investigation. However, this was far from the invasive and regulatory system later imposed upon the Lunatic Asylum. The visitors’ remit was limited and did not extend to the conduct of the medical staff. Indeed, many of the visitors, like Drs Lawson and Cappe, were themselves medical practitioners, while others, such as the Lord Mayor, Joshua Oldfield, no doubt conformed to Nicoll’s stereotype of the polite but inefficient gentleman visitor. All this was to change in 1813, when there was ‘an occurrence of a very disgraceful nature’ involving the apothecary, William Husband.120 Neither the records, nor contemporary commentators, referred to Husband’s offence in any detail, but it would appear to have been some kind of sexual misconduct involving a patient. A committee was appointed to inquire into the incident and found that his conduct had been ‘highly blameable’.121 Anticipating his imminent dismissal, Husband, who had served as apothecary for almost twelve years, tendered his resignation. His transgression was apparently severe, because the governors refused his offer to remain in the post until a successor could be found (a customary practice). For the Unitarian philanthropist, Catherine Cappe, this episode of wanton immorality provided an ideal opportunity to pressure the governors into allowing women visitors to investigate and regulate the running of the Hospital, something which she secured in November of the same year. While it was not as contested as at the Asylum, this ‘quiet’ infiltration of laywomen into the ‘medical space’ of the Hospital was no less significant. For Cappe and her associates, such visitation provided philanthropic and reforming women with a comparatively rare opportunity to perform an active political role in local society. For the medical staff of the Hospital, however, it constituted an assault upon their authority. In a later publication on the subject, Cappe wrote of the role which female visitors should play in monitoring the conduct of the male medical staff.122 Considering the incident involving William Husband, it is hardly surprising that the office of apothecary came in for particular scrutiny. The apothecary was the only resident medical officer, and, being responsible for the day-to-day medical care in the Hospital, was in the most constant contact with patients of both sexes. He was also often a young unmarried man, who had only just finished his apprenticeship. For Cappe, this was a morally fraught situation, and she expressed concern that as ‘the master of a great family’, he might use his position to take advantage of the more vulnerable female patients: Is it to be expected that he will always use his authority as a check upon the conduct of others? Is it not, on the contrary, highly desirable that there should, if possible, be some powerful restraint on his own? 123

It would appear that the female visitors continued to voice concerns about the relationship between the young male apothecary and his female charges, for

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in 1817 a decision was taken to reduce the degree of physical contact between the two. The governors resolved that the ‘clothes and persons’ of the patients were to be examined before they entered the wards, but that the apothecary was to examine only the males, while the matron dealt with the women.124 It was not until 1844, however, that the rules relating to the apothecary were substantially altered. In that year the age qualification was raised so that anyone occupying the post had to be between thirty and forty-five years old.125 The apothecary was not the only young man whose presence in the Hospital was a subject of concern. In August 1786, the Court of Governors had encouraged the Hospital’s two surgeons to run lecture courses in anatomy.126 From this period onwards, the Hospital therefore played host to an increasingly large number of surgical pupils. Although Cappe recognised the importance of the Hospital as a ‘means of supplying a better medical education to young students’, she was also desirous that these young men should be ‘remarkable for decency of conduct, and propriety of conversation and behaviour’. In her opinion they should have a uniform and steady observance of the salutary rules of Christian morality, neither capable of seducing others, nor liable to be seduced themselves by licentious conversation, by the improper demeanour of a selfish, unprincipled nurse, or by the opportunities sometimes unavoidably afforded in the course of their medical attendance.127

Cappe saw female visitation as a way of subjecting a potentially corrupt and corrupting space to the moral discipline of ‘virtuous’ and respectable ladies.128 They would, she argued, encourage ‘a sense of propriety and decency in conversation and behaviour’. However, in claiming authority over the patients and servants, female visitors challenged that exercised by the physicians, surgeons and apothecary. Moreover, the conduct of the medical officers was itself to be subject to constant regulation and surveillance. In the Hospital, as in the Asylum, the keepers had themselves to be kept. Conclusion Historians of psychiatry, particularly those working within a post-Foucauldian frame, have tended to view the reform of the York Lunatic Asylum as the victory of a specific therapeutic and ideological regime, namely moral therapy, wherein the mad were freed from physical shackles of restraint but simultaneously subject to the internalised shackles of a domesticated bourgeois consciousness. However, as we have seen in this chapter, events at the Asylum can only be fully understood as constitutive of a much wider transformation in the cultures and politics of early nineteenth-century England. As Philip Harling has suggested, later eighteenth-century assaults on ‘Old Corruption’,

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such as those initiated by Christopher Wyvil and the Yorkshire Association, were primarily concerned with ‘economical reform’, with ridding the state of jobbery and financial inefficiency.129 Such concerns were clearly evident in Mason’s and his associates’ initial objection to Hunter’s proposed salary in the late 1780s. However, with the events of 1813 to 1815 we witness the emergence of a rather different, and much wider, conception of reform, one that sought nothing less than the restructuring of social and political relations. It was, after all, no coincidence that the reformers would later couch these events in terms of ‘revolution’, rather than ‘improvement’ or ‘amelioration’. Moreover, whereas the core of Wyvil’s support had come from the county gentry, those involved in the reform of the Asylum were predominantly drawn from the urban ‘middling orders’. Despite Dror Wharman’s work in nuancing an entrenched set of assumptions about the ‘rise of the middle class’, it is clear that in their stated opposition to the nepotism, corruption and abuse which they saw as the necessary consequence of the oligarchical administration of the Asylum, these men were articulating a new set of political discourses which anticipated later radical and Whig-radical assaults on the social and political hegemony of the aristocracy and which would, through the course of the 1820s and early 1830s, come to form a central component of middle-class political identity.130 In its language and ideology, the reform of the York Lunatic Asylum exemplifies a broader social, cultural and political transition which marked the beginning of the end of polite society as a peculiarly eighteenth-century construction. By demanding increased surveillance and regulation in the administration of ‘public’ institutions the reformers launched a direct attack on the cultures of informal civil association which had hitherto been central, not only to the running of ‘public’ charities, but, as we have seen, to public life more generally. This assault upon civil gentility had a particularly profound impact upon the social identities and performances of medical practitioners. At one level, the introduction of surveillance and regulation posed a direct challenge to the social authority of the medical practitioner as gentleman. In addition, the demise of civil gentility and polite association as the structuring ideological forms of social practice occluded the channels through which the culture of medico-gentility was constituted. John Pickstone has detected similar patterns in Manchester with the medico-ethical work of Thomas Percival.131 As in that case, Atkinson’s and Mather’s vigorous defence of their status as gentleman can be seen, not as a testament to the continued cultural resonance of medico-gentility but, in their articulation of what had once been unspoken, to its increasing untenability. Indeed, Higgins’s reference to ‘unmeaning phrases’, such as ‘gentlemanly man’, suggest that, by the 1810s it had become, for some at least, culturally unintelligible.132 If the period immediately following the end of the Napoleonic wars can

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be said to have constituted the beginning of the end of medico-gentility then it also witnessed the rise of an alternative set of identities and performances. The next chapter will consider how, in the socially and politically fraught climate of the 1820s, a number of medical practitioners began to articulate new visions of medical identity and practice, ones which embraced the capacity of knowledge itself to reform social relations and which laid the groundwork for socially progressive imagining of the medical practitioner as expert and public servant. Notes 1 A. Mather, A Plain Narrative of Facts relative to the Reception and Treatment of Jane Horsman at the Establishment in Clifton of which Dr Belcombe and Mr Mather are Proprietors; with some Preliminary Observations on Insanity in General and some remarks on the circumstances preceding and attending the late trial of Horsman against Bulmer and others (York: J. Wolstenholme, 1819), p. 80. 2 A Full and Impartial Report of the Case of Jane Horsman vs. Francis Bulmer the Elder, the Rev. William Bulmer, Alexander Mather, Wm. Matterson, Wm. Belcombe M.D. and Helen Scott, being an Action of Trespass and False Imprisonment Tried at the Summer Assizes for the County of York, August 4, 1819, before the Hon. Sir George Wood, Knight of one of the Barons of his Majesty’s Court of Exchequer and a Special Jury. Taken from the shorthand notes of Mr Fraser (York: T. Wilson and Sons, 1819); Mather, Plain Narrative of Facts; J. Gray, Horsmania: Mr J. Gray’s Statements and Observations Occasioned by the Publications of Mr Mather (York: J. Wolstenholme, 1819). 3 Mather, Plain Narrative of Facts, p. 52. 4 K. Jones, Lunacy, Law and Conscience, 1744–1845: The Social History of the Care of the Insane (London: Routledge, 1955), pp. 83–92; A. Scull, Museums of Madness: The Social Organization of Insanity in Nineteenth-Century England (London: Allen Lane, 1979), pp. 73–7; A. Digby, From York Lunatic Asylum to Bootham Park Hospital, Borthwick Paper, 69 (1986); Digby, ‘Changes in the asylum: the case of York, 1777–1815’, Economic History Review, new series, 36:2 (1983), 218–39; R. Porter, Mind-forg’d Manacles: A History of Madness in England from the Restoration to the Regency (Harmondsworth: Penguin, 1990), pp. 133–5, 144; L. Smith, Lunatic Hospitals in Georgian England, 1750–1830 (London: Routledge, 2007), pp. 172–91. The 1813–15 scandal has even been the subject of a television documentary, BBC Television, ‘The Asylum War’. Broadcast 24 April 1995. 5 J. Gray, History of the York Lunatic Asylum: with an Appendix containing Minutes of Evidence on the Cases of Abuse lately Inquired into by a Committee etc. addressed to William Wilberforce Esq., one of the Contributors to Lupton’s Fund (York: J. Wolstenholme, 1815); C. M. Gaskell, Passages in the History of York Lunatic Asylum, 1772–1901 (Wakefield: W. H. Milnes, 1902). 6 Porter, Mind-forg’d Manacles, pp. 135, 144.

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7 A. Scull, ‘Moral treatment reconsidered: some sociological comments on an episode in the history of British psychiatry’, in A. Scull (ed.), Madhouses, Mad-doctors and Madmen: The Social History of Psychiatry in the Victorian Era (Philadelphia: University of Pennsylvania Press, 1981); Scull, Museums of Madness, pp. 13–48. See also, M. Foucault, Madness and Civilization: A History of Insanity in the Age of Reason (London: Tavistock, 1967). 8 J. Andrews and A. Scull, Undertaker of the Mind: John Monro and Mad-Doctoring in Eighteenth-Century England (Berkeley: University of California Press, 2001); Andrews and Scull, Customers and Patrons of the Mad-Trade: The Management of Lunacy in Eighteenth-Century England (Berkeley: University of California Press, 2003). See also, A. Scull, C. MacKenzie and N. Hervey, Masters of Bedlam: The Transformation of the Mad-Doctoring Trade (Princeton: Princeton University Press, 1996). 9 Scull, Museums of Madness, pp. 125–63 is one of the few works to consider the threat to medical authority posed by asylum reform. 10 See, A. Borsay, Medicine and Charity in Georgian Bath: A Social History of the General Infirmary, c. 1739–1830 (Aldershot: Ashgate, 1999), pp. 105–38. 11 The term ‘Asylum Revolution’ is taken from a letter written by Jonathan Gray and included in Mather, Plain Narrative of Facts, p. 42. 12 J. Andrews and A. Digby (eds), Sex and Seclusion, Class and Custody: Perspectives on Gender and Class in the History of British and Irish Psychiatry (Amsterdam: Rodopi, 2004). 13 K. Wilson, The Sense of the People: Politics, Culture and Imperialism in England, 1715–1785 (Cambridge: Cambridge University Press, 1995), pp. 17–25; L. G. Mitchell, ‘The Whigs, the people and reform’, Proceedings of the British Academy, 100 (1999), 25–42; P. Harling, ‘Parliament, the state and “old corruption”: conceptualising reform, c. 1790–1832’, in A. Burns and J. Innes (eds.), Rethinking the Age of Reform: Britain, 1780–1850 (Cambridge: Cambridge University Press, 2003). 14 J. G. Schochet, ‘Vices, benefits and civil society: Mandeville, Habermas and the distinction between the public and the private’, in P. R. Backscheider and T. Dykstal (eds), The Intersections of the Public and the Private Spheres in Early Modern England (London: Routledge, 1996). 15 J. Brewer, ‘This, that and the other: public, social and private in the seventeenth and eighteenth centuries’, in D. Castiglione and L. Sharpe (eds), Shifting the Boundaries: Transformation of the Languages of Public and Private in the Eighteenth Century (Exeter: University of Exeter Press, 1995). 16 D. Wahrman, Imagining the Middle Class: The Political Representation of Class in Britain, c.1780–c.1840 (Cambridge: Cambridge University Press, 1995). 17 ‘A Memoir of the Life of Alexander Hunter, M.D.’, appended to A. Hunter (ed.), Silva: Or a Discourse of Forrest Trees and the Propagation of Timber in his Majesty’s Dominions, 4th edn, 2 vols (York: Wilson and Spence, 1812), vol. 1, p. xii. 18 Digby, From York Lunatic Asylum, p. 2; Smith, Lunatic Hospitals, pp. 30–4. 19 YC, 27 July 1773; Digby, From York Lunatic Asylum, pp. 3–4.

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20 Gray, History of the York Lunatic Asylum, p. 12. 21 As at York, John Monro also presided as sole physician at Bethlem. Andrews and Scull, Undertaker of the Mind, pp. 15–16. 22 See list of Rockingham Club members in YC, 11 November 1788. 23 ‘A Memoir of the Life of Alexander Hunter, M.D.’, p. xii. RS, EC/1774/26, Election Certificate of Alexander Hunter (Cert. III, 203; A03677). 24 Gray, History of the York Lunatic Asylum, pp. 11–12. For more on Bedlam and St Luke’s, see C. N. French, The Story of St Luke’s Hospital (London: William Heinemann, 1951); J. Andrews, A. Briggs, R. Porter, P. Tucker and K. Waddington, The History of Bethlem (London: Routledge, 1997); Smith, Lunatic Hospitals. 25 The apothecary was also responsible for quotidian medical care at Bethlem. Andrews and Scull, Undertaker of the Mind, pp. 16–17. 26 Digby, From York Lunatic Asylum, p. 9. Smith, Lunatic Hospitals, chapter 4. 27 K. Wilson, ‘Urban culture and political activism in Hanoverian England: the example of voluntary hospitals’, in E. Hellmuth (ed.), The Transformation of Political Culture: England and Germany in the Late Eighteenth Century (Oxford: Oxford University Press, 1990); Wilson, The Sense of the People, pp. 73–83. 28 M. Fissell, Patients, Power and the Poor in Eighteenth-Century Bristol (Cambridge: Cambridge University Press, 1991), pp. 110–25. 29 A New Governor, A Vindication of Mr. Higgins from the Charges of Corrector: Including a Sketch of Recent Transactions at the York Lunatic Asylum in a Letter Addressed to Earl Fitzwilliam (York: W. Hargrove, 1814), p. 7. 30 A New Governor, A Vindication of Mr. Higgins, p. 9. 31 BIHR, MSS, Will of A. Hunter, September 1809. 32 YCL, MSS, Letter from Dr Burgh to William Wilberforce, 10 November 1791. 33 YML, ‘York Lunatic Asylum’ (1791), Letter from A. Hunter to Governors of the York Lunatic Asylum, 24 August 1787. 34 Gray, History of the York Lunatic Asylum, p. 12. 35 YML, ‘York Lunatic Asylum’ (1791), Minutes of the Governors of the Lunatic Asylum, held at the York Tavern, 3 January 1788. 36 W. Mason, Animadversions on the Present State of the York Lunatic Asylum; in which the Case of Parish Paupers is Distinctly Considered in Series of Propositions (York: W. Blanchard, 1788); YC, 11 January 1788. 37 Gray, History of the York Lunatic Asylum, pp. 13–14. 38 Gray, History of the York Lunatic Asylum, p. 14. Smith, Lunatic Hospitals, pp. 124–5. 39 YC, 11 January 1788. 40 A Letter from a Subscriber to the York Lunatic Asylum to the Governors of that Charity (York: Wilson and Spence, 1788). 41 A Letter from a Subscriber, p. 1. 42 A Letter from a Subscriber, pp. 5, 18. 43 Incontestable Proofs from Internal Evidence that S.W. Nicoll Esq. is not the Author of ‘A Vindication’ of Mr. Higgins from the Charges of Corrector (although Mr. Higgins attributes it to him) in a letter addressed to Earl Fitzwilliam (York:

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44 45

46

47 48 49

50 51 52 53

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55

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W. Story, 1815?), p. 60. Dr Burgh had been an erstwhile friend of Hunter’s and had contributed an illustration of the Greendale oak to his 1776 edition of Silva. A Letter from a Subscriber, pp. 20–1. J. V. Pickstone and S. V. F. Butler, ‘The politics of medicine in the early industrial city: a study of hospital reform and medical relief in late eighteenth-century Manchester’, Medical History, 28:3 (1984), 227–49; J. V. Pickstone, ‘Thomas Percival and the production of medical ethics’, in R. Baker, D. Porter and R. Porter (eds), The Codification of Medical Morality, Vol. 1: Medical Ethics and Etiquette in the Eighteenth Century (London: Kluwer Academic Publishers, 1993), pp. 168–9. YCL, Letter from Dr Burgh to William Wilberforce, 10 November 1791. On the debates about the ‘appropriateness’ of asylum architecture, see C. Stevenson, Medicine and Magnificence: British Hospital and Asylum Architecture, 1660–1815 (New Haven: Yale University Press, 2000), pp. 14–18, 85–105. Gray, History of the York Lunatic Asylum, pp. 20–1. Gray, History of the York Lunatic Asylum, p. 23, appendix, pp. 3–4. S. Tuke, Description of the Retreat, an Institution near York for Insane Persons of the Society of Friends. Containing an Account of its Origins and Progress, the Modes of Treatment, and a Statement of Cases (York: W. Alexander, 1813), pp. x–xii, 131–87; A. Digby, Madness, Morality and Medicine: A Study of the York Retreat, 1796–1914 (Cambridge: Cambridge University Press, 1985). Tuke, Description of the Retreat, p. 157; Foucault, Madness and Civilization, pp. 248–9. Scull, Museums of Madness, pp. 59–60. Tuke, Description of the Retreat, appendix pp. 221–7. S. Tuke, Memoirs of Samuel Tuke, with some Notices of his Ancestors and Descendants, 2 vols (London: 1860) vol. 1, p. 95; S. Wright, Friends in York: The Dynamics of a Quaker Revival, 1780–1860 (Keele: Keele University Press, 1995), pp. 23, 101–2. G. M. Ditchfield, ‘English rational dissent and philanthropy, c.1760–c.1810’, in H. Cunningham and J. Innes (eds), Charity, Philanthropy and Reform: From the 1690s to 1850 (Basingstoke: Palgrave, 1998); H. Plant, Unitarianism, Philanthropy and Feminism in York, 1728–1821: The Career of Catherine Cappe, Borthwick Paper, 103 (2003); Plant, ‘Gender and the aristocracy of dissent: a comparative study of the beliefs, status and roles of women in Quaker and Unitarian communities, 1780–1830, with particular reference to Yorkshire’ (DPhil dissertation, University of York, 2000). YC, 4 January, 11 January, 18 January 1813; J. Berry, The Luddites in Yorkshire (Clapham: Dalesman, 1970); J. A. Hargreaves, ‘Methodism and Luddism in Yorkshire, 1812–13’, Northern History, 25 (1990), 160–85; Hargreaves, ‘ “A metropolis of discontent”: popular protest in Huddersfield, c. 1780–1850’, in E. A. H. Haigh (ed.), Huddersfield: A Most Handsome Town: Aspects of the History and Culture of a West Yorkshire Town (Huddersfield: Kirklees Cultural Service, 1992); A. J. Brooke and L. Kipling, Liberty or Death: Radicals, Republicans and Luddites, 1793–1823 (Honley, W. Yorkshire: Workers History, 1993);

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61 62 63 64 65 66 67 68 69

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Performing medicine A. Nuvolari, ‘The “machine breakers” and the industrial revolution’, Journal of European Economic History, 31:2 (2002), 393–426. YG, 6 November 1819; R. J. Morris, Class Sect and Party: The Making of the British Middle Class: Leeds, 1820–1850 (Manchester: Manchester University Press, 1990). S. W. Nicoll, A Letter to the Members of the York Whig Club (York: 1819); Nicoll, A Second Letter to Members of the York Whig Club (York: 1819); P. Brett, The Rise and Fall of the York Whig Club, 1818–1830, Borthwick Paper, 76 (1989). Nicoll, Letter to the Members, pp. 1, 6. YG, 31 July 1819, 9 November 1822. W. D. Rubinstein, ‘The end of “old corruption” in Britain, 1780–1860’, Past and Present, 101 (1983), 55–86; P. Harling, ‘Rethinking “old corruption” ’, Past and Present, 147 (1995), 127–58; Harling, The Waning of ‘Old Corruption’: The Politics of Economical Reform in Britain, 1779–1846 (Oxford: Oxford University Press, 1996); Harling, ‘Parliament, the state and “old corruption” ’. A New Governor, A Vindication of Mr. Higgins, p. 6. Emphasis added. On the associations between ‘philanthropy’ and surveillance, see A. J. Kidd, ‘Philanthropy and the “social history paradigm” ’, Social History, 21:2 (1996), 180–92. YChr, 25 September 1813. The letter was signed ‘Evigilator’. YChr, 25 September 1813. YChr, 25 September 1813. YChr, 25 September, 7 and 14 October 1813; YC, 11 October 1813. YH, 16 October 1813. Emphasis added. Tuke, Memoirs of Samuel Tuke, vol. 1, p. 219. YH, 16 October 1813. A. Gordon, ‘Higgins, Godfrey (1773–1833)’, rev. Myfanwy Lloyd, DNB. One biographical account claims that ‘As a politician, his opinions were extreme’. E. Hailstone (ed.), Portraits of Yorkshire Worthies Selected from the National Exhibition of Works of Art at Leeds, 1868, 2 vols (London: Cundall and Fleming, 1869), vol. 2, p. 181. G. Higgins, A Letter to the Right Honourable Earl Fitzwilliam, Lord Lieutenant of the West Riding of the County of York respecting the Investigation which has lately taken place into the Abuses at the York Lunatic Asylum; together with various Letters, Reports etc. and the New Code of Regulations for its Future Management (Doncaster: J. W. Sheardown, 1814), pp. 3–4; YH, 27 November 1813. Higgins, A Letter to Earl Fitzwilliam, p. 4. Higgins, A Letter to Earl Fitzwilliam, pp. 49–50. Tuke, Memoirs of Samuel Tuke, vol. 1, pp. 224–5. Corrector, A Few Free Remarks on Mr Godfrey Higgins’ Publications respecting the York Lunatic Asylum (York: W. Blanchard, 1814), p. 13; Incontestable Proofs, pp. 96–7. YChr, 11 November 1813. YChr, 18 November 1813. Higgins, A Letter to Earl Fitzwilliam, appendix pp. 16–17; YH, 4 December 1813.

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78 G. Mooney and J. Reinarz (eds), Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting (Amsterdam: Rodopi, 2009). 79 Gray, History of the York Lunatic Asylum, pp. 22–3. 80 Minutes of Evidence taken before the Select Committee Appointed to Consider of Provisions being made for the Better Regulation of Madhouses, in England (London: 1815), p. 144. Emphasis added. 81 For more on the relationship between gentility and credibility, see S. Shapin, A Social History of Truth: Civility and Science in Seventeenth-Century England (Chicago: University of Chicago Press, 1994). 82 S. W. Nicoll, An Enquiry into the Present State of Visitation in Asylums for the Reception of the Insane and into the Modes by which such Visitation may be Improved (London: Harvey and Darton, 1828), p. 3. 83 Nicoll, Enquiry, p. 64. 84 Nicoll, Enquiry, p. 75. 85 Nicoll, Enquiry, p. 75. Emphasis added. 86 Nicoll, Enquiry, p. 74. 87 Nicoll, Enquiry, p. 23. 88 Gray, History of the York Lunatic Asylum, pp. 33–4. 89 Gray, History of the York Lunatic Asylum, pp. 70–1. 90 See also, E. Gray, Papers and Diaries of a York Family (London: The Sheldon Press, 1927), p. 156. 91 Gray, History of the York Lunatic Asylum, p. 98. 92 Higgins, A Letter to Earl Fitzwilliam, pp. 13–14; Minutes of Evidence taken before the Select Committee, p. 1. 93 Higgins, A Letter to Earl Fitzwilliam, p. 14; Minutes of Evidence taken before the Select Committee, pp. 1, 10–11. 94 G. Higgins, A Letter to the Committee of the House of Commons Appointed to Inquire into the Abuses in Madhouses (1815), p. 58. 95 Incontestable Proofs, pp. 104, 35. 96 Corrector, Free Remarks, pp. 10–11. 97 YH, 2 April 1814. 98 Higgins, Letter to the Committee of the House of Commons, appendix, p. 1. 99 Higgins, Letter to the Committee of the House of Commons, p. 57. 100 Gray, History of the York Lunatic Asylum, pp. 62–3. 101 Gray, History of the York Lunatic Asylum, p. 64. 102 Higgins, Letter to Earl Fitzwilliam, p. 18. 103 Gray, Papers and Diaries, p. 159. 104 Gray, History of the York Lunatic Asylum, p. 85. 105 Gray, History of the York Lunatic Asylum, p. 85. 106 Gray, Papers and Diaries, p. 159. 107 Corrector, Free Remarks, p. 14. 108 C. Atkinson, Retaliation; or Hints to Some of the Governors of the York Lunatic Asylum (York: M. W. Carrall, 1817), p. 22. 109 Gray, Papers and Diaries, p. 159. 110 YH, 24 December 1814.

112 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128

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Performing medicine Digby, From York Lunatic Asylum, pp. 22–3. Scull, Museums of Madness, p. 78. YC, 9 August 1819. Full and Impartial Report of the Case of Jane Horsman, p. 135. Mather, Plain Narrative of Facts, p. 35. Mather, Plain Narrative of Facts, pp. 42, 48, 52. Mather, Plain Narrative of Facts, pp. 9, 14, 42. Emphasis added. Mather, Plain Narrative of Facts, pp. 33–4. Emphasis added. BIHR, YCH, 1/1/2/1, MSS, Court of Governors Minute Book, 8 May 1787. C. Cappe, Memoirs of the Life of the Late Mrs Catherine Cappe; Written by Herself (York: T. Wilson and Sons, 1822), p. 415. BIHR, YCH 1/1/1/1, MSS, Court of Trustees Minute Book, 16 February 1813. C. Cappe, On the Desirableness and Utility of Ladies Visiting the Female Wards of Hospitals and Lunatic Asylums (York: T. Wilson and Sons, 1817). Cappe, Desirableness and Utility of Ladies, p. 5. Emphasis added. BIHR, YCH 1/1/2/1, MSS, Court of Governors Minute Book, 12 August 1817. BIHR, YCH 1/1/2/2, MSS, Court of Governors Minute Book, 14 May 1844. BIHR, YCH 1/1/2/1, MSS, Court of Governors Minute Book, 18 August 1786. Cappe, Desirableness and Utility of Ladies, p. 5. For more on the relationships between female philanthropy, discipline and ‘surveillance’, see F. K. Prochaska, Women and Philanthropy in NineteenthCentury England (Oxford: Clarendon Press, 1980); Kidd, ‘Philanthropy’; E. Yeo, The Contest for Social Science: Relations and Representations of Gender and Class (London: Rivers and Oram Press, 1996); Cunningham and Innes (eds), Charity, Philanthropy and Reform; J. Rendall, ‘ “Ladies suspected of democratic principles”: reforming and dissenting women, philanthropy and surveillance, 1790–1820’. Unpublished conference paper, ‘Spies and Surveillance in the Eighteenth Century’, Humanities Research Centre, Australian National University, Canberra, November 2001. Harling, ‘Rethinking “Old Corruption” ’; Harling, Waning of ‘Old Corruption’; Harling, ‘Parliament, the state and “old corruption” ’. Wahrman, Imagining the Middle Class. Pickstone, ‘Thomas Percival’. Higgins, Letter to the Committee of the House of Commons, p. 57.

4

The march of intellect: social progressivism and the transformation of provincial medicine There never was an age in which they who intend to support the dignified character of graduated physicians, had better opportunities for improvement in physiology. Lectures, as well as books, in anatomy, chemistry and in every part of science and natural philosophy, never abounded more. Let the student devote himself to these with long and serious application, and depend more upon them, than on the caprice of fashion, or any singularity in his chariot and livery . . . [He] is a very important member of society, considered merely in a political point of view. The lives, limbs, and spirits of a very great part of the subjects of a kingdom, depend upon his skill and honesty. Lancet, 16 January 18301

I

n the early 1830s t h e clergyman bibliographer, Thomas Frognall Dibdin, visited the city of York; it proved to be a mixed experience. A fortuitous trip to Mr Todd’s bookshop introduced him to James Atkinson’s recently published Medical Bibliography A. and B. (1833), a book which he praised for its ‘candour, frankness . . . humour, drollery, and originality’.2 It also introduced him to its octogenarian author and the two men soon struck up ‘an acquaintance – be it rather said an intimacy – which has known no diminution’. In his fellow bibliophile, Dibdin recognised a ‘gentleman and a man of varied talent: ardent, active, and of the most overflowing goodness of heart’. 3 However, if Dibdin was enamoured by Atkinson’s gentility, liberality, hospitality and humour, he was profoundly disappointed by the degree to which such values had lost their social and cultural purchase. Attending the Assembly Rooms in the company of his friend, Dibdin heard Atkinson reminisce about how he had once taken part in amateur music concerts, ‘things now . . . of rare occurrence’. ‘Time was’, Atkinson explained, ‘when in yonder chair, I was the conductor of this little band of patriots, in their way . . . But alas! we are all now out of tune; and these walls, though of comparatively yesterday’s growth, are as desolate as those of Belclutha – described by Ossian’.4 Pausing for a minute in silent contemplation, Atkinson seized his friend by the hand and ‘rushed precipitately out of the room’ as if he could bear to be there no longer. Dibdin thought he understood the root of his friend’s distress:

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York is NOT what it WAS. In the centre of one of the finest neighbourhoods in the kingdom, an indifference has grown up of late to past forms and ceremonies and visitings; which, when large parties do assemble, produces something like mutual distrust. People do not heartily commingle. The curtsey is not so low and graceful, the bow is not so profound. Rare interchange of hands: rarer union of hearts. A. looks at B. with the trail of his eye, to recognise whether he be of Athens or Sparta; which, being interpreted, is whether he be a Whig or a Tory? Politics are said to have estranged the once warmest of friends. This is sad and foolish work.5

Atkinson’s wistful nostalgia was understandable, for during the early nineteenth century the city of his youth and young manhood had been transformed almost beyond recognition. In 1814 he had seen his own brother’s career destroyed as the ancien régime of the York Lunatic Asylum collapsed in bitter acrimony. However, the Asylum scandal merely marked the beginnings of a much more protracted period of political instability. Where once the values of politeness and sociability had mitigated political differences between ‘patriots’ and sustained a broad cultural consensus, where once informal interpersonal relationships had ensured the relatively harmonic functioning of civil society, political and confessional factionalism now held sway. Divided by such issues as the franchise and religious toleration, the citizens of York split into mutually hostile camps, casting all aspects of social practice in a partisan political hue. In the era of Peterloo, Catholic emancipation and the reform bill, there was no place for the easy conviviality of the Doctors Club or the formal grandeur of the Assembly Rooms. Now the Whigs held court at the York Tavern and the Tories at the George Inn. The demise of polite society and the transformation in social relations that it brought about had profound implications for a medical culture founded upon the values of civil gentility. Moreover, if the social and political landscape had become more fraught and complex then so too had relations between medical practitioners themselves. According to Irvine Loudon, ‘It seems incontrovertible that [in the period after 1815] the profession was overcrowded to an extent not seen before or since, and general practitioners competed desperately for patients, not only with each other, but with physicians and surgeons’.6 The end of the Napoleonic wars was a key factor in this regard.7 As one author observed: While the war raged, our Fleets and Armies required a constant and continued fund of Medical aid . . . the crowds at the schools increased three and four-fold, and Medical education was the order of the day. This state of things has now ceased [. . .] crowds have been thrown back on the quiet stream of peace and private life, at periods and with habits too advanced to turn to other sources, and with finances too slight to render them independent [. . .] the impression which the war created, has left an artificial stimulus; what seemed a temporary tide still flows; Medical speculation is still afloat.8

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The population of York increased by some 19,000 between the 1800s and the 1840s but the number of practitioners rose by an even greater percentage. In 1783 the practitioner/patient ratio had stood at 1:825; by 1843 it had fallen to 1:462. Moreover, many of the newer immigrants to the city were drawn from the poorest sections of society, especially, from the 1830s onwards, the Irish. York continued to be home to wealthy families; Pigot’s General Directory for 1828–29 noted that the local economy was supported by ‘the many genteel and opulent families in York and its respectable vicinage’ while domestic service accounted for an ‘astonishingly high’ 71% of female employment.9 But as Dibdin’s comments suggest, York’s halcyon days as a social centre were passing. The city played host to the occasional grand ball, often associated with the Yorkshire Music Festival, but these were rare exceptions in an otherwise sparsely attended social calendar. The political factionalism and economic privations of the post-war period as well as competition from alternative venues such as Leeds and Sheffield encouraged many wealthy families to abandon the city.10 At a time when the number of practitioners was increasing, the pool of private patients was therefore decreasing in relative terms. This, when combined with the challenge posed by the rise of the dispensing druggist, wholesale tradesmen who dispensed medicines at a fraction of the price charged by their more orthodox competitors, created a struggle for financial solvency that could be intense.11 The consequences of an overcrowded ‘medical marketplace’ were not simply economic. The local physician, Thomas Laycock, summed up the socially debilitating consequences of political factionalism and vocational competition: Must I follow my profession at York? No, because there are many opponents in the field, it is not a very improving place, society is cramped: at least so far as I have scarcely found a companion: – there are numerous sectarian and political parties, a vast [amount] of petty scandal, a deal of pride and not a little poverty.12

While the size of the local medical faculty had been relatively small, personal and vocational relationships had been comparatively easy to structure. With a larger number of practitioners, however, such relationships became harder to regulate. This period therefore witnessed the emergence of more formal and corporatist mechanisms for the governance of medical conduct and practice. In 1818, for example, a number of local practitioners founded the Associated Body of Surgeons and Apothecaries.13 The stated objects of this society were the ‘regulation of the professional conduct of its members, both among themselves, and in relation to the other branches of the Profession’ and the establishment of ‘a more uniform system of charges’ for medicines and attendance.14 Clearly then, the Associated Body was founded in response to the increasingly competitive nature of medical practice, especially among

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general practitioners. But its significance went far beyond this. With the fracturing of polite society, medical practitioners began to invest in more collectivist forms of association and identity. Although they continued to function as independent citizens, as members of a civic polity, the culture of the Doctors Club which had embedded practitioners in a wider social and cultural milieu was now giving way to more vocationally specific configurations. Central to this process was the practice of boundary maintenance, which sought to separate ‘orthodox’ surgeon-apothecaries from more ‘fringe’ practitioners, especially druggists. The passage of the Apothecaries Act in 1815 had lent general practice a degree of legal recognition. However, the distinction between licensed medical practice and the druggist’s trade remained vague, especially within the public imagination, and the members of the Associated Body were evidently keen to establish more formal boundaries: [A]ny Gentleman should be eligible to become a member of this Society who can give Testimonials of his being a legalized general Practitioner, except he shall keep an open shop or shall have advertised or solicited Practice by sending Cards or Circulars.15

This shift from inclusive forms of medical identity and performance to more vocationally specific ones also had its corollary in the field of knowledge. As Mary Poovey has argued, the early nineteenth century saw the culmination of a process whereby the broad cultural and epistemological field which had characterised the early modern period disaggregated into specific and specialised disciplinary domains: This transformation . . . involve[d] the drawing of boundaries and the codification of rules in such a way as to create from what once seemed to be an undifferentiated continuum of practices and ideas new and more specialized conceptual – or imaginary – entities. This transformation occur[red] both in the register of representation (what Foucault calls the ‘order of discourse’) and in the register of materiality, producing effects that can be measured or felt.16

Within an eighteenth-century culture of medico-gentility, practitioners invested in a broad range of knowledge including botany, agriculture, antiquarianism and literature. The ‘oddness’ of such an engagement is only apparent from the standpoint of the modern observer, for it was in this period that medicine, as a discrete disciplinary domain, was carved out of the cultural field. From gentlemen of letters and liberal interests, early nineteenth-century provincial English medical practitioners such as those in York increasingly shaped identities (‘representation’) and performed roles (‘materiality’) based upon the possession of specific forms of vocational competence. As Poovey recognises, this process of disaggregation and specialisation was intimately linked to a progressivist vision of governance, inspired by utilitarianism and

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political economics, which embraced the capacity of applied knowledge to rationalise social relations. In the sphere of medicine this was particularly evident from around the time of the cholera epidemic of 1832 and it is this period which shall provide the focus for our analysis in the following chapter. However, as she also recognises, this disaggregation and cultural reconfiguration was no clean break from past forms. Rather it was a gradual, contested and occasionally uneven process which preserved residual vestiges of once dominant cultural and epistemological forms.17 This chapter considers the local dynamics of that process of disaggregation during the pivotal decade of the 1820s. In York, as elsewhere, many medical practitioners involved themselves in what might be called the provincial scientific movement, witnessed by the growth of literary and philosophical societies, provincial museums and mechanics’ institutes. The chapter therefore begins by exploring the extent and significance of medical involvement in one of the city’s most important cultural institutions, the Yorkshire Philosophical Society (1822). In many ways the Society had links to earlier cultures of liberal learning. In reality, however, the Society occupied a space somewhere between the traditions of polite knowledge and those of political engagement and for many of its members the Society encapsulated something more ambitious and radical, namely an ideology of socio-scientific progressivism epitomised by that most evocative of contemporary phrases, the ‘march of intellect’. Thus while medical involvement in the Yorkshire Philosophical Society might testify to the capacity of polite and liberal forms of learning to flourish alongside, and even within, an emergent cultural politics of knowledge, it also indicates the direction that medical culture and identity would increasingly take. During the course of the decade an investment in intellectual and social inclusivity began to give way to more specific epistemological and cultural configurations as medicine broke its ties with gentlemanly science. Nowhere was this more evident than with the practice and representation of anatomy. The end of the 1820s saw heated public debates about the practice of bodysnatching and the social functions of anatomical knowledge. In contributing to these debates, practitioners in York, as elsewhere, projected a new vision of themselves which, shaped by the values of utilitarianism, presented medical practitioners as experts and public servants dedicated to the health and welfare of a newly imagined ‘social body’. As the epigraph from the Lancet suggests, the ‘character of graduated physicians’ was now being cast not in terms of gentility and ‘fashion’, but in the ‘political’ terms of social engagement and public responsibility. In this way, the culture of political and social reform, that culture which had contributed to the demise of medico-gentility, was itself being utilised as the basis for new forms of social performance and collective identity.

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Much has been made of the socio-political significance of early nineteenthcentury provincial science. From the early 1970s, social historians sought to understand this engagement with natural philosophical knowledge in relation to the social, cultural and confessional politics of the ‘Age of Reform’. According to scholars such as Ian Inkster and Arnold Thackray, science functioned as a part of the counter-cultural and reforming ideology of elements within the ‘middle class’ who, while possessed of economic capital, were aware of their relative political and social marginality, their lack, as it were, of symbolic and cultural capital. For these largely urban men, lesser industrialists, ‘professionals’ and dissenters, the rational potentialities of scientific knowledge presaged wider social, political and cultural change.18 With the growth of provincial scientific societies, such scholars have argued, the polite, gentlemanly and Anglican culture of knowledge which had characterised the eighteenth century was supplanted by the utilitarian concerns of practically minded dissenters: by ‘Quaker thee’s and thou’s [and] the discussion of steam pressures’.19 Similar arguments were made by those writing under the influence of the sociology of scientific knowledge in the late 1970s and early 1980s. Moving beyond forms of scientific association to examine their cognitive content, Roger Cooter and Steven Shapin demonstrated how the materialism of early nineteenth-century popular science could serve as a challenge to the contemporary social, cultural and political order.20 Not all were convinced of the radicalism of provincial science, however. In their very different ways Morris Berman and Michael Neve have argued that scientific enquiry, as both ideology and practice, was sanctioned by the cultural hegemony of the ruling classes, allowing its ‘middle-class’ practitioners to assimilate themselves into respectable society and to act as a conservative bulwark against the political agitation of radical unions and their Whig fellow-travellers.21 More recently, Paul Elliot has sought to navigate between these two positions. While his conception of the ‘creative class’ owes much to Inkster’s use of ‘marginality’ his identification of the continuities between eighteenth-century natural philosophy and early nineteenth-century science as forms of knowledge ‘reciprocally shaped by the assertion of provincial identities’ tends to mitigate some of the bolder claims of radicalism.22 The politics of knowledge in early nineteenth-century York does not lend itself to a simple, bipolar political narrative. To be sure, there was an association between attitudes towards science and the cultural politics of the post-war period. Throughout the course of the 1820s the York Herald, edited by the Whig-radical William Hargrove, and its sister paper, the York Courant, repeatedly used the phrase ‘march of intellect’ to describe an imagined relationship between progressive scientific knowledge and social reform.

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On Christmas Eve 1822, for example, the Courant reported on a meeting in Sheffield to discuss the formation of a Literary and Philosophical Society: Do not these useful institutions which are daily forming around us, convey a sense of reproof to the tardiness of our own City? Whilst YORK can boast her Musical Societies, and her Associations for Fashionable Amusements, she presents none of the characteristics of an enlightened and scientific people. Her mental energies are either suffered to lay entirely dormant, or only exerted in solitary and unasserted instances. – When will the literary and philosophical talent which we know are contained within the walls of Old Ebor be concentrated into some focus and shine forth its innate brilliance?23

There is a clear opposition here between the ‘Fashionable Amusements’ of polite society, which many radicals perceived to be little more than a mask for ‘Old Corruption’, and the progressive qualities of an ‘enlightened and scientific people’. However, the Courant was not the only advocate for the foundation of a scientific institution in the city. Comparable sentiments could also be found in quarters of York’s burgeoning Tory press. The Yorkshire Observer, for example, a short-lived paper whose proprietor had been editor of the archly Tory Yorkshire Gazette, was an energetic advocate of a ‘Museum and School of Arts’ and argued that knowledge should be central to York’s rejuvenation as a city: To make the city commercial is impracticable; to make it manufacturing is not desirable; to make it considerably more extensive is not necessary. What then remains to be done to restore to it a large portion of its individual character and magnificence? There remains to confer upon it the distinguished rank of a literary City, and as the centre of scientific attraction between London and Edinburgh.24

Yet despite their apparent similarities, these two statements betray rather different conceptions of scientific knowledge and its cultural significance. For the Whig Courant, science functioned as a tool of progress and improvement. For the Tory Observer, on the other hand, science was linked to literary forms and to a conservatively minded restoration of civic glory. In practice, the cultural and political profile of the Yorkshire Philosophical Society (YPS) can be located somewhere between these alternative visions of science as socially progressive or as a polite, literary activity. The origins of the Society lay in the discovery by workmen, in July 1821, of a large collection of animal bones in a cave at Kirkdale, north Yorkshire. This attracted the attention of a number of geologists, most notably the Rev. William Buckland, Reader of Geology and Mineralogy at the University of Oxford, who identified the bones as belonging to animals unknown in the British Isles and interpreted their discovery as evidence of a prediluvian animal population wiped out by the Noachian flood. Another visitor to the caves was the York resident, William Salmond. A retired army colonel with an interest in geology,

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Salmond was concerned that the cave’s treasures might be dispersed among private collections. In December 1822 he therefore met with the solicitor, Anthony Thorpe, and surgeon, James Atkinson, at the latter’s house in York, to found a society to act as custodian of the bones and to provide library facilities for its members.25 According to one historian, A. Derek Orange, those who promoted the Society were men ‘who, although they did not admit as much, were clearly carried some way by the tide of progressive opinion’.26 He also suggests that such early nineteenth-century philosophical societies ‘drew their main support not from the aristocracy but from the rising middle class’.27 Such claims are reasonably well founded. Anthony Thorpe, for example, was a solicitor and land agent in partnership with William and Jonathan Gray. Like them he was an evangelical Anglican and sometime Vice-President of the Auxiliary Bible Society. He was also associated with the Unitarian minister, Charles Wellbeloved, and both men helped to establish the York Subscription Library in 1794. This was a bold undertaking, for in the 1790s such institutions were often denounced as seminaries of Jacobinism.28 Further evidence for Thorpe’s political sympathies comes from his friendship with William Hargrove. Like Hargrove, Thorpe was a keen antiquarian and the two men collaborated on the History and Description of the Ancient City of York (1818). Another early member of the YPS was William Venables Vernon (later William Vernon Harcourt). The fourth son of Edward Vernon Harcourt, Archbishop of York (1808–47), he had served in the Royal Navy for five years before matriculating at Christ Church, Oxford in 1807. By 1822 he was chaplain to his father and vicar of Bishopsthorpe (his father’s residence).29 Vernon is best described as a reforming Whig.30 During his time with the navy in the West Indies he wrote home expressing his hatred of slavery and in York he was a regular speaker at anti-slavery meetings.31 Vernon extended his associations with York’s evangelical and dissenting philanthropic clique through his involvement with charities such as the Castle Howard Reformatory, the Yorkshire School for the Blind, the Auxiliary Bible Society and the Society for the Propagation of the Gospel in Foreign Parts.32 He was also a proponent of Catholic Emancipation and when the clergy of Yorkshire met at Thirsk in 1823 to discuss the issue, he ‘expressed himself friendly to the admission of Roman Catholics into Parliament’.33 The YPS was also attractive to the Asylum ‘revolutionaries’ of 1813–15 who continued to agitate for political and social reform throughout the 1820s. Jonathan Gray was elected in December 1822 and served as the Society’s first Treasurer until his death in 1837.34 The Quakers, Samuel Tuke, Daniel Tuke, Thomas Backhouse, James Backhouse and F. J. Copsie, were all early members, as was the Unitarian Charles Wellbeloved.35 In addition to these men, the YPS included Lord Milton and Sir George Cayley, both

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leading reformers. Milton, who succeeded Vernon as President of the YPS in 1831, was Whig MP for the city of York from 1806 to 1831, and was a regular fixture at meetings of the York Whig Club’s Reform Committee. Cayley, a dissenter and political radical, was President of the York Whig Club from 1819 until 1827. However, although the YPS did indeed contain a large number of individuals with reformist sympathies it was not an entirely partisan association, for it also included conservatives, such as William Cockburn, Dean of York.36 Neither was it viewed as an overtly political body by contemporaries. Indeed, it was embraced by the Tory press, even if the Gazette continued to attack individual members (such as Lord Milton and George Cayley) and constituent groups (such as the Unitarians) for their activity in more overtly political realms. Moreover, despite the large proportion of Quakers, there was little, if any, ‘discussion of steam pressures’. In contrast to the utilitarian or industrial forms of knowledge identified by some scholars, the YPS was predominantly concerned to ‘celebrate and study the geology and antiquities of Yorkshire’.37 Antiquarianism had an established pedigree as a polite pursuit which attested to it as an investment in local civic and county identities.38 This is not to say that it could not be pursued by radicals and reformers. After all, its most active proponents in the YPS were William Hargrove and Charles Wellbeloved. Nevertheless, its potential for the expression of socio-political radicalism was limited. Similarly, although contemporary geology could act as a focal point for intense politico-religious conflict, the form practised within the YPS, under the direction of the devoutly Anglican John Phillips, was of a distinctly conservative and Bucklandian variety.39 Science was not a crude tool of political interest. The YPS was no hotbed of radical agitation and continued to embody many of the values of polite knowledge and civic sociability. Nevertheless, for many of its members an active participation in the ‘march of intellect’ and in the ‘advancement’ and dissemination of scientific knowledge did indeed form part of a wider commitment to social progress and political renewal. As Thackray has argued: The adoption of science as a mode of cultural self-expression . . . depends on a particular affinity between progressivist, rationalist images of scientific knowledge and the alternative value system espoused by groups peripheral to English society.40

A rationalist and progressivist figuring of scientific knowledge could function as the epistemological expression of a counter-cultural ideology. The rhetoric of science therefore carried over into political discourse. In 1820, for example, the Gazette referred to the York Whig Club, many of whose members would later join the YPS, as ‘those Gentlemen who announce themselves as a Club of Philosophers, and as the regenerators of the human race’.41 In this

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respect they were akin to Stephen Jacyna’s ‘Philosophic Whigs’, men who located themselves within an ideological matrix comprised of freighted moral polarities: ‘reason/prejudice’, ‘science/ignorance’ and progress/reaction.42 It may not have been a stable party-political platform but it did constitute a broad social agenda: one that embraced the primacy of knowledge and the desirability of progressive reform. After politeness: medicine and natural knowledge The participation of medical practitioners in the provincial scientific movement of the early nineteenth century was proportionally high, second only to that of clergymen. In York, for example, six of the city’s eight physicians and five of its seventeen surgeons (44% of the medical faculty) were members of the YPS during the first ten years of its existence (1822–32).43 Traditionally, little serious attempt has been made to account for this level of commitment. In his account of the scientific life of Bristol, for example, Neve states that ‘Although they played an important role, they were not dominant intellectually’.44 Likewise, another commentator notes the large number of medical practitioners in the YPS, but claims that they ‘took only an insignificant part in the [Society’s] scientific activities’.45 More suggestive, perhaps, are the lines taken by Inkster and, more recently, Elliot. In his work on late eighteenth- and early nineteenth-century Sheffield, Inkster claims that many of those practitioners who took a leading role in local voluntary associations, including scientific and educational institutions, were political radicals and religious dissenters. Through association with likeminded individuals, he argues, such men shaped and projected a ‘distinct and positive image’. Inkster is unspecific about exactly what this ‘image’ entailed, save to say that it functioned as a counterweight to ‘social marginality’.46 In contrast to Inkster’s radical interpretation, Elliot is more concerned to emphasise the continuities between eighteenth- and early nineteenth-century scientific culture. In his analysis, provincial philosophical societies and scientific institutions provided a space wherein medical practitioners might reinforce ‘their gentlemanly professionalism’ and differentiate themselves ‘from the numerous quacks and nostrum-mongers who plied their trade in provincial Georgian towns’.47 Elliot is, to a degree, right to stress such continuities. And yet while the phrase ‘gentlemanly professionalism’ is no oxymoron, it perhaps conflates two rather distinct modes of self-representation. Later eighteenth-century medical culture was fundamentally geared towards social and cultural inclusion. However, early nineteenth-century York, like early nineteenth-century England more generally, was not the same place it was in the 1780s. The political factionalism and antagonism of the 1820s not only contributed to the decline of medico-gentility but also provided a new set

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of cultural resources with which medical practitioners might shape alternative and, perhaps, more self-consciously progressivist identities. Though not perhaps so pronounced as Inkster implies for the case of Sheffield, medical participation in the YPS was nonetheless characterised by a relatively high proportion of political reformers and non-Anglicans. The two earliest and most active medical members were the surgeon, James Atkinson, and the physician, George Goldie. Significantly, both were Catholics at a time when their political status was a bitterly contested issue and as members of the YPS they associated with many, such as Charles Wellbeloved and William Vernon, who were active proponents of Catholic Emancipation. Atkinson was certainly a supporter of political reform and voted for both Whig candidates in the city election of 1832.48 However, as we saw at the beginning of this chapter, he was no radical but rather nostalgic for the days of political and social consensus and by 1835 he had turned Tory.49 By contrast, Goldie was a significantly younger man and a more active political figure. Born and educated in Edinburgh he was closely associated with the radical and utilitarian London University and entertained hopes of securing a chair in medicine there.50 His personal correspondence likewise expressed a desire for political reform and he regularly attended meetings of the York Whig Club and its Reform Committee.51 Goldie was not alone in his sympathies. George Champney, for example, surgeon, Catholic, Lord Mayor (1829) and member of the YPS from 1824, consistently voted for the Whigs in city elections.52 Similar observations might be made of Baldwin Wake who was elected to the YPS in 1823.53 He was the reformers’ choice to replace Dr Best as physician to the Lunatic Asylum and was a close friend of Charles Wellbeloved.54 He was also associated with reforming and philanthropic societies such as the York Subscription Library, the National Society for the Education of the Poor and the Auxiliary Bible Society.55 To this group one might also add Oswald Allen, who was elected to the YPS in 1823 and who was a political liberal, though by no means a radical.56 Having said this, not all the medical members of the YPS were liberals. Some, like the surgeon, George Brown, and the physicians, Stephen Beckwith, Henry Stephens Belcombe and Thomas Simpson, appear to have been politically conservative, though not necessarily reactionary.57 One of the more problematic interpretive aspects of the medical engagement with the provincial scientific movement is reconciling a high level of membership with a relatively low level of active participation. In York, medical members of the YPS generally took little direct part in the Society’s intellectual proceedings; they did not publish on geological or antiquarian subjects, nor did they perform lectures or demonstrations. And yet they remained a visible presence, playing a key role in the Society’s management and administration. George Goldie served as the Society’s secretary from

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1823 until 1830. Some served as Vice-President, others sat on the governing council, or on the various ad hoc committees, and few meetings took place without the presence of at least two or three medical men.58 Moreover, even if they did not play that active a role in the ‘advancement of knowledge more directly’ they were enthusiastic contributors to the ‘materials of knowledge’.59 Indeed, donations were perhaps the most significant way in which medical practitioners aligned themselves with the Society’s intellectual endeavours. Books were a particularly popular choice. Between 1822 and 1832, for example, Goldie donated over thirty scientific books and journals to the library. Others gifted artefacts including apparatus, such as telescopes and microscopes, as well as ancient coins, a Javanese dagger, a pair of Indian sandals, minerals and fossils, and all manner of zoological specimens and preparations, including the skull of a polar bear, a stuffed pheasant, and even the preserved carcass of an alligator from Guiana. Such acts of donation were not limited to the individual and his immediate resources but embraced a wider matrix of friends, associates and family members. Thus, James Atkinson’s daughter and son-in-law, Lieutenant Colonel Chatterton, sent fossils from the Isle of Wight while William Belcombe’s daughter donated jasper from the Yorkshire coast. Neither were they limited to the British Isles. Rather, as with Baldwin Wake’s relative, Ensign Wake of the 34th Native Infantry, and his donation of a large collection of birds from the East Indies, they embedded both donor and recipient in an international network of imperial exchange.60 Such eclectic collection practices clearly had parallels with the dilettantism of polite science. Yet unlike the cabinets of curiosity so beloved of the eighteenth-century gentleman, the YPS couched its collections in the language of ‘utility’ and the ‘advancement’ of scientific knowledge rather than that of ‘curiosity’, ‘entertainment’ or ‘diversion’.61 Moreover, whereas most eighteenth-century collections had been private, intended for the delectation of the individual and their friends, those of the YPS were, in principle at least, of a more public nature. By contributing books and other artefacts, these medical practitioners aligned themselves with a public institution professing avowedly public objectives and thereby displayed their commitment to a collective scientific endeavour. This commitment was also enacted through public ritual. In 1827, for example, a ceremony was held to mark the laying of the foundation stone of the new museum on the Manor Shore. The procession began at Dr Wake’s house on Blake Street and was led by James Atkinson.62 An involvement in the YPS may have marked out its medical members as men of learning, as socially progressive participants in the ‘march of intellect’, but it did not mark them out as medical men per se. After all, although the level of medical participation was high, it was not a collective act. Medical

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practitioners did not join such organisations in their capacity as medical practitioners but rather as individual members of the civic polity. Moreover, although the epistemological profile of the YPS was scientific in the broadest sense, it did not include medical knowledge and its practitioners do not seem to have pursued any kind of explicit medical agenda within it. It is true that some practitioners donated medical books to the library. Atkinson, for example, donated an edition of the Tabulae Medicae (1605) while Goldie gifted copies of Johann Blumenbach’s early nineteenth-century text on comparative anatomy and Martin Lister’s De Fontibus Medicatis Angliae (1682). Such acts were relatively uncommon, however, and the appeal of Lister’s De Fontibus and the Tabulae Medicae derived as much from their antiquity as from their contemporary relevance. Nevertheless, Goldie’s donation of Blumenbach’s work does hint at one of the ways in which medical knowledge, broadly conceived, was assimilated into the YPS. Comparative anatomy, though largely the preserve of the medical practitioner, also appealed to the palaeontological interests of the YPS’s founders. During the course of his career, James Atkinson had built up a large personal collection of human and comparative anatomical specimens, both of which provided an important didactic resource for his surgical pupils. However, in 1824 Atkinson decided to donate the comparative section of his collection to the YPS: The President stated, on behalf of the Council, that Mr Atkinson had made an offer, which had been accepted by the Council, to deposit in the Society’s Rooms his valuable collection of Comparative Anatomy. The President remarked that this collection would be of peculiar interest to the Society as affording illustrations of the specimens of Fossil Osteology, which so peculiarly distinguish the Museum.63

Atkinson’s donation was an act of conspicuous generosity. His collection contained a vast array of animal skeletons, as well as tusks, teeth and a number of preparations, both wet and dry.64 However, what is perhaps most notable about Atkinson’s bestowal was that it did not include his collection of human anatomical specimens. No doubt the YPS would have balked at the idea of displaying human remains, even if he had offered them. Unlike his comparative collections they did not fit so easily within the Society’s natural historical remit and they might well have offended the sensibilities of some of its members. Their absence at the YPS demonstrates both the limitations of the Society as a space for the performance and display of medical knowledge and the particular configuration of Atkinson’s own public persona. The donation of his comparative anatomy collection and his associated role as curator of the Society’s zoological department allowed him to present himself as man of science, an authority on zoology and natural history. What they did not do was

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present him as a surgeon and anatomist, a dissector of dead human beings. For the time being at least, his collection of human anatomy remained in the ‘private’ space of his house. That James Atkinson’s public identity was determined more by intellectual liberality than by surgical or anatomical knowledge is forcibly evident in his pictorial representation. Figure 2 is a portrait of Atkinson by the local artist, William Etty. Here Atkinson is portrayed as Dibdin’s ‘gentleman . . . of varied talent’ rather than as a medical practitioner per se.65 As with the earlier portrait of Alexander Hunter (figure 1) it is notable for the lack of any reference whatsoever to his vocation or even to his investment in scientific or natural historical knowledge. Indeed, despite his activities as both a surgeon and an anatomist, his portrait contrasts markedly with the famous 1786 image of John Hunter by Joshua Reynolds, with its multiple motifs of anatomical knowledge (figure 3). Clearly then, the provincial scientific movement of the 1820s did not, in and of itself, constitute the disaggregation of a broad cultural and epistemological field into separate spheres of specialised vocational knowledge. As Atkinson’s portrait implies, many of those practitioners who involved themselves with organisations such as the YPS did so as part of a much wider engagement with varied cultural and epistemological forms. And yet if this engagement with natural philosophical knowledge did not represent a ‘clean break’ from an established culture of intellectual and social plurality then it did signal the beginnings of a process whereby scientific and medical expertise would come to supersede gentility and intellectual liberality as the determining logic of medical performance, representation and social practice. In this regard, what was perhaps most significant about the provincial scientific movement was its links to a broader ideology of social progressivism, a belief that improved knowledge about the natural world could contribute to, and was commensurate with, the advancement and improvement of society as a whole. In the later 1820s, this association between medicine and the ‘march of intellect’ was brought to the fore, for while James Atkinson’s collection of human anatomical specimens continued to reside in the privacy of his house, the manner in which such specimens were procured would enter the public arena in nothing short of a scandal. The furore surrounding the practices of body-snatching and anatomical dissection which marked the turn of the decade would, in many ways, be deeply damaging for medical practitioners, especially in their relationships with the poor, but it would also give rise to a new discourse of medicine, one which emphasised the value and necessity of medical and anatomical knowledge for the advancement and well-being of the social body.

William Etty, ‘James Atkinson’, oil painting, 1832.

William Sharpe, ‘John Hunter’, 1788, line engraving after Sir Joshua Reynolds, 1786.

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Anatomy and the origins of medical progressivism The unofficial procurement of human bodies for anatomical dissection had a history that stretched back to at least the mid-eighteenth century. In 1540 the newly founded Company of Barber-Surgeons had been granted the right to dissect four hanged felons annually, extended to six during the reign of Charles II. In 1752 Parliament then passed an Act ‘for Better Preventing the Horrid Crime of Murder’ which gave judges the discretionary power to order the dissection of hanged felons in place of gibbeting.66 Despite this, however, the supply of bodies never adequately met demand. The later eighteenth century witnessed the proliferation of private anatomy schools, particularly in London. Some 300 students were said to have attended anatomical courses in the capital in 1798, rising to some 1,000 by 1823.67 Whereas traditional anatomical instruction had involved the lecturer reading over a single corpse, tutors such as William Hunter promoted their courses by guaranteeing each student ‘hands on’ access to their own cadaver.68 Anatomical subjects therefore had to be procured by a variety of unorthodox means. These included the impersonation of relatives in the claiming of bodies, the stealing of bodies before burial and the removal from the gallows of hanged felons who had not been sentenced to dissection. However, by far the most common, and certainly the most notorious, practice involved the disinterment of bodies from recently dug graves, either by anatomists themselves or, more commonly, by individuals known euphemistically as ‘resurrection men’.69 While the number of private anatomy schools and university courses was particularly high in the educational and corporate medical centres of London and Edinburgh, provincial towns and cities also experienced an expansion in anatomical education and a consequent demand for human subjects. In York both the Champneys and the Atkinsons were active in the teaching of anatomy. In 1787, for example, William Champney had advertised a series of lectures on anatomy, surgery and midwifery, proclaiming that his students would enjoy ‘opportunities of practice equal, at least, to any in London’.70 James Atkinson was at a particular advantage in that, as acting medical officer to the County Gaol (a position he had inherited from his father), he was guaranteed a legal, if somewhat irregular, supply of bodies. His advertisement for a course of anatomy in 1786 thus concluded with the reassuring note that ‘Criminals sentenced by law will have lectures read over them at the Hospital for the general good of the pupils’.71 Having said this, there is reason to suspect that Atkinson may well have resorted to other, less official, means of procurement. His father, Charles, had taught anatomy to fee-paying students in the 1740s, one of whom was the future painter, George Stubbs. One biographer claimed that, as a student, Stubbs’s ‘anatomical concerns’ earned him a ‘vile reputation’ and that he had ‘an hundred times, run into such adventures

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as might subject anyone with less honourable motives to the great severity of the law’.72 Clearly then, body-snatching, or similar such practices, had an established history in the city. Established though it may well have been, it was not until the mid- to late 1820s that the practice of body-snatching truly entered the popular consciousness. A rise in disinterment resulted in increased vigilance on the part of relatives, sextons and other ‘petty officers’ which led, in turn, to a shortage of anatomical subjects.73 In 1828 the MP Henry Warburton therefore established a parliamentary Select Committee ‘to inquire into the manner of obtaining Subjects for Dissection in the Schools of Anatomy and into the State of the Law affecting Persons employed in obtaining or dissecting Bodies’.74 However, if the publication of the Select Committee’s report in July 1828 served further to arouse public concern, it was as nothing compared to the fear and outrage engendered by the discovery, later that year, of the murderous activities of William Burke and William Hare in Edinburgh. The Burke and Hare case is too well known to require further explication here; suffice it to say that the sixteen murders for which Burke was executed (Hare having turned King’s evidence and been granted immunity) not only constituted a horrendous, if perversely logical, development in the free-trade in corpses, but, through the role of Robert Knox, the surgeon-anatomist to whom they sold the bodies of their victims, demonstrated the deep complicity of medical practitioners in the trade.75 In York, as elsewhere, it was the Burke and Hare murders which excited the public imagination. In January 1829 the Yorkshire Gazette published a report of Burke’s trial, ‘calculated to make the breast thrill with horror’.76 Meanwhile, reports of body-snatchings and attempted ‘burkings’ proliferated.77 In November 1828 the York Courant reported that the body of one Martha Jewitt of Clifton had been taken from a churchyard in Osbaldwick, the lid of the coffin having been sawn in half.78 Public concern about the activities of ‘resurrection men’ was so rife, that in January 1829 the same paper maintained that ‘scarcely a funeral takes place in our city or its vicinity, but watchers are set over the graves’.79 The York Chronicle even recommended that sulphuric acid be poured into the coffin before internment, rendering the body ‘unfit for the purposes of dissection’.80 Fear and consternation inevitably led to mistakes and misapprehensions. In December 1828, for example, an open grave was discovered in St Denis’s churchyard and word spread that both body and coffin had been stolen. However, on further investigation it turned out that the sexton had merely forsaken the digging of a plot for the comparative comforts of the tavern.81 Similarly, in January 1829, it was reported that two men had attempted to abduct a ten-year-old boy in Walmgate, but had been chased off.82 And yet for every false alarm, apparently genuine cases of body-snatching, and even

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murder, were discovered. In the same month, a crate on board a northbound coach from York was opened in Newcastle and found to contain the body of a three- or four-year-old child, ‘quite fresh and almost healthy looking’. Suspicions were aroused that the child, thought to be from Wetherby, had died a violent death, marks on the body suggesting that it had been both strangled and stabbed.83 None of York’s medical practitioners were directly implicated in such activities. Indeed, one historian has suggested that most of the bodies taken from churchyards or discovered in transit in and around the city were destined for Edinburgh rather than for the local market.84 Nevertheless, the distrust and anger that such cases aroused necessarily reflected back on to the city’s medical citizens. In 1829, for example, the Gazette reported a story, which, though humorous in tone, linked local medical men with the purchase of illegally acquired corpses. Allegedly, two men had taken a sack ‘which appeared to contain a body, to the house of a professional gentleman, not far from York, for which they demanded the usual fee’. When the sack was opened it was found that the man inside was not dead, but merely ‘dead drunk’ and had been ‘carried to the gentleman as a spice, by the worthy companions of the drunkard’.85 More seriously, perhaps, James Atkinson wrote of how the practice of anatomy could expose surgeons to acts of public violence. Lamenting popular credulity, he claimed that: In our day, the surgeons (to please John Bull) must affix over their doors – ‘never dissected a body!’ – not ‘the sign of a “dissected” body’ – or woe, woe be to his windows – The March of Intellect! 86

Although it was the poor who were most vulnerable to the practice of bodysnatching and who were most likely to express their anger towards medical practitioners, such sentiments also found expression in more elevated social spheres. In 1829 a correspondent to the Gazette, signing himself ‘No Quack’, asked: Are these things to be tolerated in a Christian country . . . boasting, as is the fashion, of the March of Intellect! Shame on their besotted impudence. I would again ask, how long is this brutality to be patronized by the medical men of the 19th century?87

Clearly, then, the furore surrounding the acquisition of bodies for anatomical dissection posed a very real threat to the public perception of medicine and to the reputation of its practitioners. It is therefore of little surprise that many sought to meet this challenge. What it remarkable about the medical response to body-snatching, however, is the form which this took. As we have seen with James Atkinson, and as scholars such as Ludmilla Jordanova and Susan Lawrence have suggested elsewhere, late eighteenth- and early

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nineteenth-century anatomists had tended to overcome the culturally problematic nature of their vocational activities through a form of strategic distancing. Even if they performed public dissections and were well known, among the cognoscenti at least, as anatomists, their public identities sought to obviate such associations, presenting them as genteel members of polite society, ‘details unspecified’.88 As Simon Chaplin’s work on John Hunter’s house has shown, this dualism of identity could also take on spatial and architectural form. Hunter’s house in London was essentially divided into two halves. The western end, facing on to the respectable Leicester Square, constituted the ‘main social space of the house’ and was the location of the drawing room, a polite venue for entertaining guests and holding salons. Meanwhile, the eastern end, on Castle Street (now Charing Cross Road), provided the back entrance and housed the dissection room. Here it was that bodies, most often illegally acquired, were brought ‘under the cover of darkness’ and also where his anatomical students lived. As Chaplin argues, the drawing room and the dissecting rooms ‘represent[ed] the poles of an “axis of propriety” along which physical, temporal and social strategies combined to isolate the private business of dissection from the public life of Hunter and his family’. Halfway along this ‘axis of propriety’, and occupying a ‘transitional space’ in the middle of the property, was the museum. As with Atkinson’s donation to the YPS, this largely consisted of Hunter’s comparative anatomical and zoological collections, providing a space within which ‘the notorious labours of the dissecting room were rendered presentable to the polite audience of the salon’.89 In contrast to this genteel model, many of those medical practitioners who responded to the public outcry over body-snatching and anatomical dissection in the late 1820s did not seek to distance themselves from such practices. On the contrary, despite knowing that they would be published, the majority of the surgeons and anatomists who provided testimony to the 1828 Select Committee were candid about their activities, even readily admitting to employing the services of ‘resurrection men’.90 However, these men did not frame their practices in terms of personal intellectual curiosity or vocational advancement. Rather, in arguing that dissection was fundamentally necessary for ensuring the ‘progress’ of surgical science and the competence of its practitioners, they presented medicine and surgery as socially instrumental forms of knowledge and practice, as being, in the words of one petition presented to the Committee, ‘of utmost value to mankind’.91 Moreover, despite the fact that fee-paying private practice was the dominant mode of medical and surgical practice and that it was the poor who were most vulnerable to disinterment, many were keen to stress that such knowledge and skill would not only benefit the wealthy but be of advantage to society as a whole. Asked by the Committee whether or not it was the ‘middle and poorer classes’ who would gain from liberalising the practice of anatomical dissection, Dr Thomas

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Southwood Smith responded ‘Certainly; because the rich can always procure the best assistance’.92 In January 1829 a letter appeared in the Whig-radical York Courant which echoed Smith’s sentiments.93 Although its author is unknown, only identifying himself as ‘N. Y.’, it seems highly likely that he was a local medical practitioner, and one who had clearly been paying close attention to the findings of the Select Committee. However, while his proposals were similar to those which became law in 1832, they were, in some ways, even more radical than the Committee’s, for rather than simply claiming the bodies of those who had died in workhouses or hospitals, he recommended that all those who had ‘received parish relief, within a year before death [should] . . . be subject to dissection’. Neither did he allow any period after death during which the bodies might be claimed. Rather, all such individuals would be dissected, and, after seven days, returned by the surgeon to the parish officers ‘to be interred by them according to the rules of the Church of England, or of such religious community as the deceased shall have belonged to’.94 N. Y.’s proposals were also notable for the ways in which they placed the demands of surgical and anatomical knowledge above the concerns of disinterment and the trade in corpses. Whereas the 1829 bill was entitled ‘A Bill for Preventing the Unlawful Disinterment of Human Bodies and for Regulating the Schools of Anatomy’, his proposed legislation went under the heading of ‘An Act for more Effectually Punishing the Offence of Stealing Bodies from Burial Grounds, and for Aiding the Study of Anatomy, by Affording Facilities for Dissection’.95 Of similar importance was the author’s conflation of the interests of medicine with those of the state, claiming as he did that ‘those who throw themselves upon the state for subsistence while they are living, ought to do the state some service at their deaths’.96 In his preamble, N. Y. thus portrayed surgical knowledge as essential to the well-being of the public, claiming that ‘A foolish prejudice against the dissection of dead bodies, has . . . impeded those surgical researches, which are for the benefit of the living’.97 N. Y.’s letter attests to the ways in which the local context of practice was being shaped by events at a national and international level. The political climate of the post-war period had served to radicalise large numbers of medical practitioners, particularly among the overcrowded lower ranks. As with the disenfranchised in the parliamentary political realm, many general practitioners felt themselves excluded from the medical body politic, lacking representation within the metropolitan medical and surgical colleges and excluded from the best practices and institutional appointments by wealthier and better-connected practitioners.98 Perhaps the greatest exponent of this radical and reformist tendency was the Lancet, a weekly medical journal founded in 1823 by the general practitioner turned journalist, Thomas Wakley. In the hands of Wakley and his supporters scientific and medical knowledge

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was made into a powerful ideological tool, a claim to authority not simply in opposition to medical ‘Old Corruption’ but also within the broader social and political spheres.99 In both their vision of a reformed medical polity and their valorisation of medical ‘science’, many radicals and reformers were inspired by the politically contentious model of France.100 In the wake of the revolution, French medicine had been reformed so as to unite the practices of physic and surgery. Operating under this new regime, practitioners such as Xavier Bichat and R. T. H. Laennec had developed new ideas about disease and the body which signalled a move away from an idiosyncratic and fluid humoralism towards a universalist understanding of pathology as located in the solid structures of human tissue.101 The example of French medicine exerted a particularly forceful influence over debates about body-snatching and anatomical dissection in Britain, for, as many British observers were concerned, it was only through the routinisation of post-mortem dissection and the free availability of cadavers that Parisian practitioners had been able to make such a contribution to the ‘advancement’ of medical and surgical science. Moreover, during the revolutionary period, the Parisian hospitals had been brought under the control of the state and their medical staff granted salaries and titles in accordance with their role as state officials. Within a revolutionary ideological frame, health was envisioned not simply as a privilege of wealth but as a fundamental right of citizenship.102 Unlike in Britain, then, where fee-paying private practice constituted the sole route for social and vocational advancement and where service at medical institutions was structured by the charitable imperatives of genteel benevolence, French medicine had effectively been made a tool of state governance.103 This Francophile vision of medicine as a socially instrumental form of governance converged with a native English utilitarianism. The debate about anatomical dissection formed a crucible for Benthamite ideas about the social utility of knowledge.104 Thomas Southwood Smith was particularly active in this regard, being the first to suggest, in an 1824 article for the utilitarian Westminster Review, that in order to guarantee a legal supply of cadavers the bodies of all those who died under the care of the state, in institutions such as hospitals, workhouses and prisons, should, if unclaimed by relatives, be appropriated for the purposes of dissection.105 Bentham himself also took an active interest in ‘rationalising’ the perception and regulation of anatomy, corresponding with Peel on the matter, and arranging for his own body to be dissected and preserved by Smith on the occasion of his death.106 This combination of Francophile radicalism and utilitarian progressivism was most appealing to the young, notably to students in metropolitan medical schools and provincial hospitals. Indeed, while the Lancet was read by practitioners at all stages of their careers, it was particularly aimed at students.

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Through the dissemination of medical and surgical lectures and editorial exhortation, Wakley repeatedly encouraged his juvenile readers to improve their knowledge and to seek to play an active and progressive role in the social and political spheres. In York, therefore, some of the most vocal supporters of the anatomy bill and of the political and social relations it encoded were aspiring practitioners for whom the practice of dissection formed an increasingly central component of their claims to social and epistemological authority. In October 1832, for example, the York Herald carried a letter from ‘A Medical Pupil’.107 Written just over two months after the passage of the Anatomy Act, it urged the foundation of an anatomical school in York. In a language of scientific progressivism the author asserted that the present era was one ‘when knowledge is attainable through so many sources, and when the spring-tide of science is fast carrying away superstition’. The subject of anatomical dissection, he granted, was not ‘proper for the consideration of the delicate parts of mankind, but is a subject which has long and imperatively called on the patrons of science to support’. Appealing to the Herald’s liberal political sympathies he trusted that, as the organ of an ‘enlightened city’, it would ‘at once acknowledge the justice and propriety and the indispensability of legalising that, which alone forms the foundation of medical knowledge’. Those who opposed the Act, he somewhat condescendingly alleged, were ‘tender-hearted people’ who were unaware of the ‘scenes of horror and disgrace’, which the Act would ‘for ever, do away with’.108 Needless to say, the popular reception of such claims about the ‘necessity’ of anatomical dissection and about the duty of the poor to provide its subjects was less straightforward than ‘A Medical Pupil’ would have had his readers believe. Some commentators, even those in the liberal press who were otherwise sympathetic to the epistemological progressivism of the ‘march of intellect’, were caught off guard by the stark, unflinching rationalism of these utilitarian medical visions. For those who claimed to speak for ‘the people’ it was difficult to justify access to the dead bodies of the poor, especially when medical claims to do so were as unsympathetically phrased as by Dr James Jeffray, Professor of Anatomy at the University of Glasgow, who, in submitting his testimony to the 1828 Select Committee, stated that ‘they who pay so little attention to their relatives when they are alive, as to allow them to die in an hospital or poor’s house [sic] . . . have very little reason, or indeed right to make any noise about them, or claim any interest in them, when they are dead’.109 Thus, in response to N. Y.’s letter, the editor of the Courant claimed that while they were ‘desirous to open our columns to any suggestion which may have a tendency to serve the progress of surgical knowledge, and remove the apprehensions which at present exist’, he could not bring himself to agree with its proposals. ‘[I]ngenious’ though the proposed legislation was, the editor maintained that to subject the poor ‘to a revolting operation, merely

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because they are POOR, and their poverty has rendered them DEPENDANT, would be looked upon as an effort still further to degrade and depress them, and would inevitably call forth the strongest feelings of popular indignation’. He even confessed to ‘a strong persuasion’, that ‘the present DEMAND for subjects is much more than the due requirements of science need’.110 Opinion among the poorer members of society was even less equivocal. As the editor of the Courant predicted, the passage of the Anatomy Act in 1832 did little to allay popular fear and hatred of dissection. In fact it compounded them. York may not have witnessed the level of anti-medical unrest experienced by cities like Sheffield, where the Medical School was destroyed during a ‘burking’ riot in 1835, but revulsion at anatomical dissection continued to structure popular attitudes towards medical practitioners, particularly, as we shall see, during the 1832 cholera epidemic.111 Coming, as it did, less than two months after the passage of the Reform Act, it also exacerbated political disaffection with the Whig government among the lower orders. Having been left unenfranchised by parliamentary reform, many plebeian radicals viewed the Anatomy Act as a further betrayal by their erstwhile allies. As John Doherty’s Poor Man’s Advocate observed, ‘the “anatomy bill” has passed the legislature and is now the law of the land. Not content with the people’s toil while living, the rich insist upon having their bodies cut up and mangled when dead, for their instruction or amusement’.112 In York such discourses coalesced around the parliamentary election of November 1833. Contested elections were traditionally rare in York, the city being an undisputed Whig stronghold. Nevertheless, by the early 1830s, and under the leadership of John Henry Lowther, the Tories were making a concerted effort to break the Whig political monopoly and sought to exploit popular anger to their advantage. They circulated a handbill accusing the Whig candidate, Thomas Dundas, of ‘wishing every feeling of decency to be outraged’ and called upon the populace to proceed ‘as one man to the Guildhall to-morrow morning, at an early hour, and assert our rights, by holding up our hands for JOHN HENRY LOWTHER, Esq.’ The following day a ‘band of music, with Tory banners’ paraded the streets of the city, gathering a crowd who descended upon the Guildhall as Thomas Dundas was due to be proposed as a candidate for election. Alderman Spencer took the stand, claiming that Dundas was ‘a Reformer’ and urging the crowd that if they were ‘sincere Reformers’ then they would approve of him. But Spencer’s introduction was constantly interrupted by the crowd with cries of ‘No resurrectionists’, ‘No burking’, ‘Who voted for the poor to go to the doctors?’ and ‘No dissection’. When Dundas himself appeared on the podium and attempted to speak, he too was shouted down with cries of ‘Take him away to the doctors’.113 In effect, however, the sentiments of the poor, who had no official political voice, mattered comparatively little and Dundas successfully saw off

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Lowther’s challenge by 491 votes.114 The same held true for medical practitioners who were generally untroubled by expressions of popular antagonism except, perhaps, when personally encountered. As in the political realm the opinions of the manufacturing classes or indigent poor counted for much less than those of that newly enfranchised middle class of which they were themselves a part. Indeed, even if the Reform Act did not signal the end of a radical popular politics, it brought about an irreparable split in the radical-reforming coalition which had characterised the later 1810s and 1820s. Despite the initial concerns expressed in some quarters of the liberal press, middle-class public opinion generally fell behind the Anatomy Act, or forgot about it altogether. Meanwhile, while many medical practitioners continued to talk of ‘reform’, they did so increasingly within a broad liberal consensus. In this sense, then, the Reform Act can be said to have at least partially depoliticised medical rhetoric in provincial England. Invoking the image of French medicine may have been a radical gesture still in the 1830s but it was not as radical as it was in the 1820s, now that the possibility of a native English revolution seemed, for the moment at least, to have passed. In pressing their case, therefore, medical practitioners rarely appealed directly to any sectional political interest. Rather, they presented their interests as being inherently congruent with those of the ‘people’, a people who, as in the political realm, were now to be written about rather than spoken for.115 There were exceptions of course. Despite his enthusiasm for surgical education Thomas Wakley’s broader political radicalism led him to voice serious concerns over the precise stipulations of the Anatomy Act, which he worried would further degrade the poor by objectifying their bodies as the property of the state. Wakley would continue this radical political agenda as MP for Finsbury, a position to which he was elected in 1835 and which would see him voice public support for the Chartist movement among other progressive causes. But in general, by the mid-1830s, medical reform became increasingly distinct from its political cousin as radical populism gave way to liberal paternalism. The emergence of professional culture After the turbulence and conflict of the later Regency period, the 1820s were a decade characterised by a new earnestness among the middling orders of society, by a commitment to social, moral and intellectual improvement. While Lord Byron, who mourned the passing of bawdy libertinism, might have dismissed it as the age of ‘cant’, there were others for whom the ‘march of intellect’ constituted a welcome form of social renewal, an abandonment of prejudice and superstition in favour of reason and science.116 For some of its adherents, the ‘march of intellect’ embodied an implicit political agenda, a reformist assault against the bastions of reaction and ‘Old Corruption’. For

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others it was merely the ‘spirit of the times’. For the cultures of provincial English medicine, however, it was pivotal. Beginning in the early part of the decade with a multivalent investment in liberal knowledge, the movement in the latter years saw the rise of ever more instrumentalist visions of medicine. Particularly for a new generation of practitioners and students, medical identity came to be defined less by intellectual plurality and social inclusivity than by the possession of specific bodies of specialised knowledge which had direct social application. Benthamite and Francophile radicalism directed against the medical establishment may have provided the ideological driving force behind these new configurations but they were generally framed in ways which elided their political and sectional origins. As the debates over the practice of anatomy demonstrate, medicine’s utility was presented as manifest, requiring little if any explanation or justification beyond the health of the nation; as N. Y. suggested, by giving up their bodies for dissection, the poor did not merely gratify the curiosity of the medical student or assist the vocational advancement of the general practitioner, they did ‘the state some service’. With this in mind it would be little exaggeration to suggest that the 1820s marked the origins of modern English medicine as a discrete, culturally bounded body of knowledge and practice. If this suggestion seems to mirror Mary Poovey’s observation about the disaggregation of the epistemological field into discrete and specialised disciplinary domains, then it also demonstrates how this disaggregation entailed a relative disengagement from wider social and cultural forms.117 While it would be foolish to suggest that medical practitioners withdrew from society into some vocationally cloistered existence, what is clear is that this refashioning of medicine served irrevocably to transform the relations between medicine and the wider social sphere. This transformation can best be understood in terms of the interplay between public and private, between the accessible and the inaccessible, the knowable and the unknowable. In an ironic twist, just as the public identities of medical practitioners were being framed in terms of expertise, just as these men would come to claim social authority and perform public roles based upon their possession of specific forms of knowledge, the meanings of this knowledge and the mechanisms of its construction were rendered increasingly inaccessible to the uninitiated. The language of the consultation coupled with the disappearance of the ‘patient’s narrative’ is but one example of this.118 Another is the growth of specialist journals and the decline of a literary interaction between lay and ‘professional’ medicine.119 However, this process of mystification, this development of what, to quote Poovey, might be termed the ‘esoterica of specialization’, is perhaps most clearly exemplified by the altered practices, meanings and representations of human anatomy.120 When James Atkinson had performed anatomical demonstrations in the

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1780s he had done so in front of a public audience. However, these performances were not essentially medical ones. Rather, they constituted what Anita Guerrini has termed a ‘moral theatre’ in which the cadaver was imbued with a variety of aesthetic, social and spiritual meanings.121 Charles Atkinson hinted at these wider meanings when, in a poem composed on the occasion of one of his brother’s anatomical demonstrations, he wrote ‘No longer Physics’ power is hid in Night, / It cheers the Scene and brings Mankind to Light’.122 Neither were such performances calculated to frame their protagonists in explicitly medical terms. Atkinson and his ilk may have presented themselves as men of science, men of letters and learning, but they were, as we have seen, first and foremost, gentlemen. By contrast, if eighteenth-century anatomy had been a largely public activity with only private medical meaning (when interacting with students in the dissection room, for example) then by the early 1830s it had become a predominantly private activity whose public meanings were configured, by its practitioners if not by the poor, in starkly medical terms. After all, in their defence of anatomy to the newspaper-reading public of York, neither ‘N.Y.’ nor ‘A Medical Pupil’ spoke of God, beauty or providence; they merely referred their readers to the necessity of improving medical knowledge and practice. This transformation, this reversal of the public and the private meanings of corporeal knowledge, took spatial as well as discursive form. The early nineteenth century witnessed the decline of the public anatomical demonstrations, and the configuration of anatomical dissection as a bounded medical activity beyond the comprehension of the ‘delicate parts of mankind’. In 1795, for example, a dissection room was built at the York County Hospital, which, from 1806, no one except ‘medical men’ was allowed to enter without express written permission.123 Then, in 1834, two years after the passage of the Anatomy Act, medical practitioners were given permission by the Hospital’s governors to erect a wall across the women’s airing grounds, allowing bodies to be taken to and from the dissection room out of sight of the patients.124 Moreover, while anatomical dissection had played an important role in medical education for some time it was during the early nineteenth century that it would come to occupy a pre-eminent place in medical ritual and culture. As many personal accounts of the period suggest, dissection was perhaps the most challenging aspect of medical education. The sights, the smells and the irreverence with which the body was treated elicited profound reactions in the uninitiated student. Looking back on his time as a student at Edinburgh University in the early 1820s, for example, James Phillips Kay-Shuttleworth recalled: I remember the first time I entered upon a dissecting-room . . . I was fresh from a pure home. There was a corpse on the table covered by a sheet. I had an awe of death, and of the cold and livid ruin which it had made. I sat down in silence. I

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waited perhaps an hour. What thoughts passed through my mind! Then suddenly entered a group of initiated students. They stripped the sheet from the subject. It was a female form. The conversation jarred upon my ears – wrung my heart. It was jesting, ribald, even profane. Even the Professor . . . said nothing to rebuke this tone. My blood was almost curdled in my veins. At that moment I could not conceive it possible that I should spend every livelong day of many months in rooms crowded by such bodies, over which would swarm the votaries of a great but degraded science. 125

Like so many others, however, Kay would learn to harden his eyes and ears, if not his heart and soul, to the necessities of anatomical dissection. Meanwhile others developed a more enthusiastic taste for the ‘indecencies’ of the dissection room. In the early years of the century, Hampton Weekes, a student at St Thomas’s Hospital, wrote to his father, a surgeon-apothecary in rural Surrey, to inform him of a recent preparation which he had made and intended to send home, a ‘Poenis [sic] (pretty large) . . . [of] a black man’.126 His father, objecting to the idea, suggested that ‘you had better sell the Penis that you have injected as it is an indecent preparation & cannot be exposed at least it is not proper it should’.127 And yet Weekes’s act was no mere jape but a profound expression of social and vocational identity. As Michael Sappol has observed of the United States, it was exactly the private and profane nature of anatomical dissection which constituted its ‘charm’. During the nineteenth century it became the key rite of passage for medical students, a moral and sensorial confrontation which, if overcome, immunised the medical initiate and marked him as distinct from his peers.128 Hence, even as he chastised him, Weekes’s father noted with pride that ‘You write on Anatomical subjects and express yourself like a Veteran’.129 No longer a memento mori, a signifier of a universal humanity, the anatomised body had become a marker of social and professional difference. The process of disengagement, this development of a ‘privatised’ culture orientated towards a public audience, also had implications for the provincial scientific movement with which we began. During the course of the 1830s and 1840s a number of local medical practitioners delivered lectures to the York Mechanics’ Institute, founded in 1827 for the ‘improvement of the middling and lower orders of society’.130 James P. Needham spoke on ‘The Constitution of Man’ while Edward Allen talked about ‘The Circulation of the Blood’ and ‘The Eye and Ear’. William Dalla Husband was particularly active, lecturing on a variety of subjects including ‘Physiology’, ‘Dreams’, ‘Hygiene’ and, most popularly of all, ‘Phrenology’.131 However, while such institutions may have provided a space for the display of medical knowledge they were not the locus of its production. By this period, medical practitioners had largely abandoned such broad intellectual arenas for more specialist associational spaces. Nowhere was this gradual withdrawal more apparent than with medical

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involvement in the British Association for the Advancement of Science (BAAS). The BAAS originated from the suggestion of David Brewster, scientific author, evangelical Anglican and political Whig. In a review of Charles Babbage’s Reflections on the Decline of Science in England (1830) for the Quarterly Review he concurred with the author’s observations that British science was in a ‘wretched state of depression’, a depression which he attributed to the ‘ignorance and supineness of the government’ and the ‘injudicious organisation of our scientific boards’.132 Inspired by the example of Germany, where various societies had been established combining natural philosophers and medical men, he suggested that a similar society might be established in Britain to provide a communal arena for the dissemination of scientific knowledge and to put pressure on the government to fund scientific research.133 By 1831 plans were already underway for the formation of a national society and Brewster wrote to John Phillips, then keeper of the Yorkshire Museum and secretary to the YPS, to tell him that York had been selected as the location for the inaugural meeting.134 Involvement of medical practitioners in the early years of the BAAS was high. As with the YPS they were exceeded only by clergymen.135 However, medical knowledge itself occupied an anomalous position within the Association and no medical papers were presented at the York meeting.136 The status of medical knowledge was raised at the second meeting at Oxford in 1832 when the General Committee proposed the formation of a medical ‘committee of science’. Nothing was done. The absence of a relevant section at the Oxford meeting prompted some of the Association’s medical members to voice their dissatisfaction. Letters appeared in the London Medical Gazette concerning medicine’s notable absence in an Association purportedly dedicated to ‘universal science’.137 The Manchester physician, William Charles Henry, proposed that the Association establish a committee which would concern itself with medical sciences such as physiology, anatomy and pathology, claiming that it had been a source of ‘regret’ to the medical practitioners at the Oxford meeting that they had no ‘common centre of union’.138 Indeed, the dissatisfaction was so great that several medical members of the BAAS even suggested founding a separate Medical Association, which, like the ostracised Phrenological Association, would shadow the BAAS around the country.139 This concern was noted by the Association’s ruling oligarchy. In July 1832 Buckland wrote to Harcourt asking ‘Had we not better next year meet the objections stated in the Medical Gazette?’ His proposed solution demonstrated the ruling clique’s desire to resist the inclusion of medical knowledge, or at least to sideline it. As Buckland saw it, an increased medical influence would lead to the Association becoming ‘a receptacle of papers that ought to go at once to the medical journals’. He therefore suggested that the BAAS’s fourth subcommittee, which already

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included anatomy and physiology along with zoology and botany, should be split to form a new subcommittee dedicated to physiology and anatomy alone. He was keen that the BAAS should ‘omit altogether the word medicine’ and thus ‘by implication exclude the practice of medicine’.140 His proposals were accepted and, at the 1833 meeting in Cambridge, a new section was founded, devoted to ‘Anatomy and Medicine’. This section remained unchanged until it was renamed ‘Medical Science’ in 1836. However, the institutional establishment of medical knowledge belied deeper underlying problems, for many of the BAAS’s medical members felt constrained by the remit allowed them. Moreover, medicine’s position as the fifth of five sections indicated the grudging nature of its admission into the pantheon of the physical sciences and its lowly status among the BAAS’s hierarchy of intellectual priorities. In 1838, the medical section received a coup de grâce when its request for additional funds was declined, and by the time the Association met at York for the second time, in 1844, medicine had been excluded altogether.141 Conclusion The disappearance of medicine from the BAAS was not so much an indication of the marginality of medical knowledge as it was the final marker in a process of intellectual disaggregation. It was, in many ways, the logical conclusion to the splitting of the Association’s fourth subcommittee, the splitting of medicine from more broadly natural philosophical forms of knowledge. The period between the foundation of the BAAS and the liquidation of the medical section in 1844 saw the proliferation of specialist medical societies, both local and national. Limited to medical practitioners and concerned solely with the production and dissemination of medical knowledge, they both shaped and gave expression to new forms of collective identity which emphasised the particular status of medicine and its practitioners. Moreover, this period also saw medical practitioners performing a variety of social roles, most notably in the sphere of ‘public health’. In York, as elsewhere, these two key developments in the forging of the medical profession as a collective and socially active body converged in the year 1832, with the foundation of the York Medical Society and the worse outbreak of epidemic disease in Britain since the plague. It is to these that we now turn. Notes 1 Lancet, 13:333, 16 January 1830, p. 534. 2 T. F. Dibdin, A Bibliographical, Antiquarian and Picturesque Tour of the Northern Counties of England and in Scotland, 2 vols (London: 1838), vol. 1, p. 212.

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3 Dibdin, Bibliographical, Antiquarian and Picturesque Tour, vol. 1, p. 213. 4 Ossian was the supposed author of a cycle of poems allegedly translated from the original Gaelic by the Scottish poet, James Macpherson, and published in 1765. Their authenticity was a matter of great controversy. 5 Dibdin, Bibliographical, Antiquarian and Picturesque Tour, vol. 1, pp. 216–17. 6 I. Loudon, Medical Care and the General Practitioner, 1750–1850 (Oxford: Oxford University Press, 1986), pp. 7–8. 7 I. Loudon, ‘Medical practitioners, 1750–1850 and the period of medical reform in Britain’, in A. Wear (ed.), Medicine in Society: Historical Essays (Cambridge: Cambridge University Press, 1992), pp. 240–1; M. Ackroyd, L. W. B. Brockliss, M. Moss, K. Retford and J. Stevenson, Advancing with the Army: Medicine, the Professions, and Social Mobility in the British Isles 1790–1850 (Oxford: Oxford University Press, 2006), pp. 217–54. 8 T. C. Speer, Thoughts on the Present Character and Constitution of the Medical Profession (Cambridge: J. Smith, 1823), pp. 37–9. See also, G. Darling, An Essay on Medical Economy, Comprising a Sketch of the State of the Profession in England and the Outlines of a Plan Calculated to give the Medical Body in General an Increase of Usefulness and Respectability (London: Thomas Underwood, 1814). 9 Pigot’s General Directory, 1828–9 (Manchester: Pigot and Slater, 1828), p. 132; A. Armstrong, Stability and Change in an English County Town: A Social Study of York, 1801–1851 (Cambridge: Cambridge University Press, 1974), p. 30. 10 J. J. Looney, ‘Cultural life in the provinces: Leeds and York, 1720–1820’, in A. L. Beier, D. Cannadine and J. M. Rosenheim (eds), The First Modern Society: Essays in English History in Honour of Lawrence Stone (Cambridge: Cambridge University Press, 1992). 11 Loudon, Medical Care and the General Practitioner, pp. 129–51; Loudon, ‘Medical practitioners, 1750–1850’, pp. 230–2; H. Marland, ‘ “The doctor’s shop”: the rise of the chemist and druggist in nineteenth-century manufacturing districts’, in L. H. Curth (ed.), From Physick to Pharmacology: Five Hundred Years of British Drug Retailing (Aldershot: Ashgate, 2006). 12 Quoted in F. E. James, ‘The life and works of Thomas Laycock, 1812–1876’ (PhD dissertation, University of London, 1995), p. 37. 13 BIHR, YMS 2/1/1, MSS, Minutes of the York Association of General Practitioners. 14 BIHR, YMS 2/1/1, MSS, Minutes of the York Association of General Practitioners, Report for 1856. 15 BIHR, YMS 2/1/1, MSS, Minutes of the York Association of General Practitioners, 12 February 1842. Although codified in 1842, the rules of the York Association of General Practitioners appear to date back to the earlier foundation of the Associated Body of Surgeons and Apothecaries. 16 M. Poovey, Making a Social Body: British Cultural Formation, 1830–1864 (Chicago: Chicago University Press, 1995), p. 5. 17 Poovey, Making a Social Body, pp. 15–17. See also, R. Williams, The Long Revolution (London: Chatto and Windus, 1961). 18 I. Inkster, ‘The development of a scientific community in Sheffield, 1790–1850: a network of people and interests’, Transactions of the Hunter Archaeological

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Performing medicine Society, 10 (1973), 99–131; Inkster, ‘Science and the mechanics’ institutes, 1820–1850: the case of Sheffield’, Annals of Science, 32:5 (1975), 451–74; A. Thackray, ‘The industrial revolution and the image of science’, in A. Thackray and E. Mendelson (eds), Science and Values: Patterns of Tradition and Change (New York: Humanities Press, 1974); Thackray, ‘Natural knowledge in cultural context: the Manchester model’, American Historical Review, 79:3 (1974), 672–709; D. Porter, ‘Charles Babbage and George Birkbeck: science, reform and radicalism’, in R. Bivins and J. V. Pickstone (eds), Medicine, Madness and Social History (Houndmills, Basingstoke: Palgrave, 2007). Thackray, ‘The industrial revolution’, p. 9. R. Cooter, The Cultural Meaning of Popular Science: Phrenology and the Organization of Consent in Nineteenth-Century Britain (Cambridge: Cambridge University Press, 1984); Cooter, ‘The politics of brain: phrenology in Birmingham’, Bulletin, 32 (1983), 34–6; S. Shapin, ‘Phrenological knowledge and the social structure of nineteenth-century Edinburgh’, Annals of Science, 32:3 (1975), 219–43; Shapin, ‘The politics of observation: cerebral anatomy and social interests in Edinburgh phrenology disputes’, in R. Wallis (ed.), On the Margins of Science: The Social Construction of Rejected Knowledge, Sociological Review Monographs, 27 (1979); Shapin, ‘Homo phrenologicus: anthropological perspectives on an historical problem’, in B. Barnes and S. Shapin (eds), Natural Order: Historical Studies of Scientific Culture (London: Sage, 1979); Shapin, ‘ “Nibbling at the teats of science”: Edinburgh and the diffusion of science in the 1830s’, in I. Inkster and J. Morrell (eds), Metropolis and Province: Science in British Culture, 1780–1850 (London: Hutchinson, 1983). M. Berman, ‘The early years of the Royal Institution, 1799–1810: a re-evaluation’, Science Studies, 2:3 (1972), 205–40; Berman, Social Change and Scientific Organization: The Royal Institution, 1799–1844 (London: Heinemann, 1978); M. Neve, ‘Science in a commercial city: Bristol, 1820–60’, in Inkster and Morrell (eds), Metropolis and Province. P. Elliott, ‘Towards a geography of English scientific culture: provincial identity and literary and philosophical culture in the English county town, 1750–1850’, Urban History, 32:3 (2005), p. 411. See also, Elliott, ‘The origins of the “creative class”: provincial urban society, scientific culture and socio-political marginality in Britain in the eighteenth and nineteenth centuries’, Social History, 28:3 (2003), 361–87. YC, 24 December 1822. Yorkshire Observer, 22 February 1823. YPS, MSS, General Meeting Minute Book, 1822–39, 14 December 1822; A. D. Orange, Philosophers and Provincials: The Yorkshire Philosophical Society from 1822 to 1844 (York: Yorkshire Philosophical Society, 1974), pp. 10–12; Orange, ‘Science in early nineteenth-century York: the Yorkshire Philosophical Society and the British Association’, in C. H. Feinstein (ed.), York, 1831–1981: 150 Years of Scientific Endeavour and Social Change (York: Ebor Press, 1981), pp. 6–9; B. J. Pyrah, The History of the Yorkshire Museum and its Geological Collections (York: Ebor Press, 1988), pp. 14–16.

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26 Orange, ‘Science in early nineteenth-century York’, p. 6. 27 Orange, Philosophers and Provincials, p. 9. 28 P. Keen, The Crisis of Literature in the 1790s: Print Culture and the Public Sphere (Cambridge: Cambridge University Press, 1999). 29 J. Morrell, ‘Harcourt, William Venables Vernon (1789–1871)’, DNB; Orange, Philosophers and Provincials, p. 13; Pyrah, History of the Yorkshire Museum, pp. 18–22. 30 J. Morrell and A. Thackray, Gentlemen of Science: Early Years of the British Association for the Advancement of Science (Oxford: Oxford University Press, 1981), p. 25. 31 Pyrah, History of the Yorkshire Museum, p. 20; YC, 27 December 1825. 32 Morrell, ‘Harcourt, William Venables Vernon’; YG, 17 February 1827. 33 YG, 29 March and 5 April 1823. 34 YPS, MSS, General Meeting Minute Book, 1822–39, 28 December 1822 and 13 January 1824. 35 YPS, MSS, General Meeting Minute Book, 1822–39, 1 and 21 January 1823; Orange, Philosophers and Provincials, p. 24. 36 YPS, MSS, General Meeting Minute Book, 1822–39, 10 June 1823. 37 Elliot, ‘Towards a geography of English scientific culture’, p. 402. 38 V. Janković, Reading the Skies: A Cultural History of English Weather, 1650– 1820 (Manchester: Manchester University Press, 2000), pp. 103–24; Janković,  ‘The  place of nature and the nature of place: the chorographic challenge  to the history of British provincial science’, History of Science, 38:1 (2000), 79–113. 39 R. Porter, The Making of English Geology (Cambridge: Cambridge University Press, 1977); A. Desmond, The Politics of Evolution: Morphology, Medicine, and Reform in Radical London (Chicago: Chicago University Press, 1989). 40 Thackray, ‘Natural knowledge’, p. 678. 41 YG, 7 October 1820. Emphasis added. 42 L. S. Jacyna, Philosophic Whigs: Medicine, Science and Citizenship in Edinburgh, 1789–1848 (London: Routledge, 1994), p. 48. 43 Figures for the number of practitioners in the city are taken from Pigot’s General Directory. 44 Neve, ‘Science in a commercial city’, p. 187. 45 Orange, Philosophers and Provincials, p. 25. 46 I. Inkster, ‘Marginal men: aspects of the social role of the medical community in Sheffield, 1790–1850’, in J. H. Woodward and D. Richards (eds), Health Care and Popular Medicine in Nineteenth-Century England: Essays in the Social History of Medicine (London: Croom Helm, 1977), pp. 150 and 129. 47 Elliot, ‘The origins of the “creative class” ’, p. 379. 48 The Poll for Members of Parliament to Represent the City of York . . . 1832 (York: H. Bellerby, 1833). 49 The Poll for Members of Parliament to Represent the City of York . . . 1835 (York: H. Bellerby, 1835). 50 OUM, 1831/1, MSS, George Goldie to John Phillips, 31 January 1831.

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51 OUM, 1831/5, MSS, George Goldie to John Phillips, 1 May 1831; YC, 2 October 1820. 52 YPS, MSS, General Meeting Minute Book, 1822–39, 10 February 1824; The Poll for Members of Parliament to Represent the City of York . . . 1830 (York: H. Bellerby, 1830); The Poll . . . 1832; The Poll . . . 1835. 53 YPS, MSS, General Meeting Minute Book, 1822–39, 7 May 1823. 54 YC, 7 February 1829. 55 YChr, 18 April 1811; YChr, 2 April 1812; YC, 14 October 1823. Wake split his vote in 1832 and, like Atkinson, was associating with Tories by 1835. The Poll . . . 1832; The Poll . . . 1835; YH, 24 January 1835. 56 YPS, MSS, General Meeting Minute Book, 1822–39, 5 March 1823; YCL, Y920, MSS, O. Allen, ‘Autobiography and Memoirs’, fo. 243. 57 This is based on voting records and, in Simpson’s case, an obituary which stated that he was ‘from conviction Conservative and Protestant, yet tolerant of those who differed from him’. YG, 7 March 1863. 58 YPS, MSS, General Meeting Minute Book, 1822–39. 59 YPS, MSS, General Meeting Minute Book, 1822–39, 5 March 1823. 60 YPS, MSS, General Meeting Minute Book, 1822–39, 8 February 1825 and 4 December 1832; YPS, Annual Reports, 1823–32. 61 A. Walters, ‘Conversation pieces: science and politeness in eighteenth-century England’, History of Science, 35:1 (1997), 121–54. 62 YG, 27 October 1827. 63 YPS, MSS, General Meeting Minute Book, 1822–39, 11 October 1824. 64 YPS, Annual Report for 1824, pp. 19–20. 65 Dibdin, Bibliographical, Antiquarian and Picturesque Tour, vol. 1, p. 213. 66 R. Richardson, Death, Dissection and the Destitute (London: Routledge, 1987), pp. 32–7. 67 Report from the Select Committee on Anatomy (London: 1828), p. 4. 68 S. Lawrence, ‘Entrepreneurs and private enterprise: the development of medical lecturing in London, 1775–1820’, Bulletin of the History of Medicine, 62:2 (1988), 171–92. 69 Select Committee on Anatomy, p. 5; Richardson, Death, Dissection and the Destitute, pp. 53–72; B. Bailey, Resurrection Men: A History of the Trade in Corpses (London: Macdonald, 1991). 70 YC, 6 November 1787. 71 YC, 15 August 1786. 72 W. Gilbey, Life of George Stubbs (London: Royal Academy, 1898), p. 7. 73 Select Committee on Anatomy, p. 124; Richardson, Death, Dissection and the Destitute, p. 101. 74 Select Committee on Anatomy, p. 3. 75 L. Rosner, The Anatomy Murders: Being the True and Spectacular History of Edinburgh’s Notorious Burke and Hare and the Man of Science who Abetted them in their most Heinous Crimes (Philadelphia: University of Pennsylvania Press, 2009); B. Bailey, Burke and Hare: The Year of the Ghouls (London: Mainstream, 2002); Richardson, Death, Dissection and the Destitute, chapter 6.

The march of intellect 76 77 78 79 80 81 82 83 84 85 86 87 88

89 90 91 92 93 94 95 96 97 98

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YG, 3 January 1829. A. J. Peacock, ‘York and the resurrection men’, York Historian, 1 (1974), pp. 3–5. YC, 11 November 1828. YC, 6 January 1829. YChr, 8 January 1829. YC, 30 December 1828. YC, 6 January 1829. YC, 6 January 1829. Peacock, ‘York and the resurrection men’, p. 3. YG, 9 January 1829. J. Atkinson, Medical Bibliography A. and B. (York: H. Bellerby, 1833), p. 342. YG, 3 January 1829. L. Jordanova, Defining Features: Scientific and Medical Portraits, 1660–2000 (London: Reaktion Books, 2003), p. 161; S. Lawrence, ‘Anatomy and address: creating medical gentlemen in eighteenth-century London’, in V. Nutton and R. Porter (eds), The History of Medical Education in Britain (Amsterdam; Rodopi, 1995); L. Jordanova, ‘Medical men, 1780–1820’, in J. Woodall (ed.), Portraiture: Facing the Subject (Manchester: Manchester University Press, 1997). S. Chaplin, ‘John Hunter and the anatomy of the museum’, History Today, 55:2 (2005), 19–25. For example, see Astley Cooper’s testimony to the Select Committee on Anatomy, pp. 18–19. Select Committee on Anatomy, p. 109. Select Committee on Anatomy, p. 86. YC, 6 January 1829. YC, 6 January 1829. YC, 6 January 1829. Emphasis added. YC, 6 January 1829. YC, 6 January 1829. Emphasis added. I. Waddington, ‘General practitioners and consultants in early nineteenthcentury England: the sociology of an intra-professional conflict’ in Woodward and Richards (eds), Health Care and Popular Medicine; Waddington, The Medical Profession in the Industrial Revolution (Dublin: Gill and Macmillan, 1984); Loudon, Medical Care and the General Practitioner; Loudon, ‘Medical practitioners, 1750–1850’; M. Brown, ‘Medicine, reform and the “end” of charity in early nineteenth-century England’, English Historical Review, 124:511 (2009), 1,353–388. Desmond, Politics of Evolution, pp. 101–51; J. H. Warner, ‘The idea of science in English medicine: the “decline of science” and the rhetoric of reform, 1815–45’, in R. French and A. Wear (eds), British Medicine in an Age of Reform (London: Routledge, 1991); Warner, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton: Princeton University Press, 1998); I. Burney, ‘Medicine in the age of reform’, in A. Burns and J. Innes (eds), Rethinking the Age of Reform: Britain, 1780–1850 (Cambridge: Cambridge University Press, 2003).

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100 Warner, ‘The idea of science’; Warner, Against the Spirit of System, pp. 190–202; Burney, ‘Medicine in the age of reform’; Brown, ‘Medicine, reform and the “end” of charity’, pp. 1,372–3. 101 E. Ackerknecht, Medicine at the Paris Hospital, 1794–1848 (Baltimore: Johns Hopkins University Press, 1967); M. Foucault, The Birth of the Clinic: An Archaeology of Medical Perception (London: Tavistock, 1973); J. V. Pickstone, ‘Bureaucracy, liberalism and the body in post-Revolutionary Paris: Bichat’s physiology and the Paris School of medicine’, History of Science, 19:2 (1981), 117–42; A. La Berge and C. Hannaway (eds), Constructing Paris Medicine (Amsterdam: Rodopi, 1998). 102 D. B. Weiner, The Citizen-Patient in Revolutionary and Imperial Paris (Baltimore: Johns Hopkins University Press, 1993). 103 Brown, ‘Medicine, reform and the “end” of charity’, pp. 1,372–4. 104 Richardson, Death, Dissection and the Destitute, p. 109. 105 T. S. Smith, ‘The uses of the dead to the living’, Westminster Review, 2 (1824), 59–97. 106 National Archives, PROB 11/1801, Will of J. Bentham, 21 June 1832; T. S. Smith, A Lecture delivered over the Body of Jeremy Bentham, Esq. in the Webb Street School of Anatomy and Medicine, on the 9th of June, 1832 by Southwood Smith, M. D., Physician to the London Fever Hospital, and Teacher of Physiology and Forensic Medicine, etc., etc., etc. (London: E. Wilson, 1832); C. F. A. Marmoy, ‘The “auto icon” of Jeremy Bentham at University College, London’, Medical History, 2:2 (1958), 77–86; Richardson, Death, Dissection and the Destitute, pp. 109–14, 159–60. 107 YH, 20 October 1832. 108 YH, 20 October 1832. 109 Select Committee on Anatomy, p. 129. 110 YC, 6 January 1829. 111 YH, 31 January 1835. See also, S. Burrell and G. Gill, ‘The Liverpool cholera epidemic of 1832 and anatomical dissection: medical mistrust and civil unrest’, Journal and the History of Medicine and Allied Sciences, 60:4 (2005), 478–98. 112 A Penny Paper by a Poor Man’s Advocate, 15 September 1832, p. 3. 113 YG, 9 November 1833; YH, 9 November 1833; Peacock, ‘York and the resurrection men’, p. 7. 114 YG, 16 November 1833; YH, 16 November 1833. 115 J. Vernon, Politics and the People: A Study in English Political Culture, c.1815–1867 (Cambridge: Cambridge University Press, 1993), chapter 3. 116 V. Gatrell, The City of Laughter: Sex and Satire in Eighteenth-Century London (London: Atlantic Books, 2006), pp. 435–82. 117 Poovey, Making a Social Body. 118 N. D. Jewson, ‘The disappearance of the sick man from medical cosmology, 1770–1870’, Sociology, 10:2 (1976), 225–44; M. E. Fissell, ‘The disappearance of the patient’s narrative and the invention of hospital medicine’, in French and Wear (eds), British Medicine in an Age of Reform; D. Harley, ‘Rhetoric and the social construction of sickness and healing’, Social History of Medicine, 12:3 (1999), 407–35.

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119 For the earlier context, see R. Porter, ‘Lay medical knowledge in the eighteenth century: the evidence of the “Gentleman’s Magazine” ’, Medical History, 29:2 (1985), 138–68, R. Porter (ed.), The Popularization of Medicine, 1650–1850 (London: Routledge, 1992); W. F. Bynum, S. Lock and R. Porter (eds), Medical Journals and Medical Knowledge: Historical Essays (London: Routledge, 1992). 120 Poovey, Making a Social Body, p. 4. 121 A. Guerrini, ‘Alexander Monro primus and the moral theatre of anatomy’, The Eighteenth Century, 47:1 (2006), 1–18. 122 C. Atkinson, The Mind’s Monitor: Or a Serious Discourse on the Advantages of Self-Preservation, Society, Friendship, Love, Learning, Religion and on Death, 2nd edn (York: W. Storry, 1802), p. 184. 123 BIHR, YCH, 1/1/2/1, MSS, Court of Governors Minute Book, 12 May 1795 and 13 May 1806. 124 BIHR, YCH 1/1/3/1, MSS, House Committee Minute Book, 8 July 1834. 125 R. J. W. Selleck, James Kay-Shuttleworth: Journey of an Outsider (Newbury Park: Woburn Press, 1994), p. 26. 126 J. M. T. Ford, A Medical Student at St Thomas’s Hospital, 1801–1802: The Weekes Family Letters, Medical History Supplement, 10 (1987), p. 138. 127 Ford, A Medical Student at St Thomas’s, p. 140. 128 M. Sappol, A Traffic of Dead Bodies: Anatomy and Embodied Social Identity in Nineteenth-Century America (Princeton: Princeton University Press, 2002), chapter 3; Sappol, ‘The odd case of Charles Knowlton: anatomical performance, medical narrative, and identity in Antebellum America’, Bulletin of the History of Medicine, 83:3 (2009), 460–98. See also, L. Payne, With Words and Knives: Learning Medical Dispassion in Early Modern England (Aldershot: Ashgate, 2007); J. H. Warner and J. M. Edmonson, Dissection: Photographs of a Rite of Passage in American Medicine: 1880–1930 (New York: Blast Books, 2009). 129 Ford, A Medical Student at St Thomas’s, p. 140. 130 YC, 26 June 1827. 131 YCA, TC 49/1:15, MSS, York Mechanics’ Institute Lecture Book, 1827–51: 1835–36, 1837–8, 1839–40, 1844–45, 1846–47, 1848–49, 1849–50. 132 D. Brewster, ‘Charles Babbage, reflections on the decline of science in England’, Quarterly Review, 43:86 (1830), p. 341. 133 Morrell and Thackray, Gentlemen of Science, p. 342. 134 Orange, ‘Science in early nineteenth-century York’, p. 18. 135 Morrell and Thackray, Gentlemen of Science, pp. 110, figure 6, 287. 136 YG, 1 October 1831. 137 Quoted in Morrell and Thackray, Gentlemen of Science, p. 287. 138 Morrell and Thackray, Gentlemen of Science, p. 287. 139 Morrell and Thackray, Gentlemen of Science, pp. 287, 279–80. 140 Buckland to Harcourt, 10 July 1832, in J. Morrell and A. Thackray (eds), Gentlemen of Science: Early Correspondence of the British Association for the Advancement of Science (London: Royal Historical Society, 1984), p. 148. 141 Morrell and Thackray, Gentlemen of Science, p. 290.

5

Guardians of health: cholera, collectivity and the care of the social body

This establishment [the York Medical Society] alone reflects honour to the faculty in York – this alone is a light so luminous that its vivifying influence is already felt among the members of the profession at large. ‘A Medical Pupil’, York Herald, 20 October 1832

I

[T]he scientific physician enlarges the sphere of his enquiries, the good of men is his great object – the end of all his labours being to prevent moral and corporeal disease, to alleviate pain, to restore health. They feel, it is true, that they have the melancholy privilege of studying man dissected by infirmity and anguish; but also that they are thus enabled to better perform their duty, to aid him in the time of his distress. And what can be less melancholy, less mean, more pleasurable, nay, more godlike, than this? T. Laycock, A Treatise on the Nervous Diseases of Women (1840)1

n J une 1832 t h e ci t y of York was preparing to celebrate the passing of the Reform Act, an event which just a month before had seemed almost unimaginable. With the House of Lords resolutely opposed to any extension of the franchise, the only solution for Lord Grey’s administration was for the King to appoint a large number of sympathetic peers to guarantee the passage of a heavily compromised third bill. William IV was hesitant, however, and Lord Grey’s government teetered on the brink of collapse. In York, as in many other towns and cities, the prospect of a third rejection and the reinstating of Wellington’s Tory administration met with popular indignation. A proreform crowd, which had been attending a meeting at the Guildhall, gathered outside the George Inn, where a petition was being signed in support of the King’s refusal to appoint the new peers. Several individuals burst into the inn to ‘commit violence’ and, when the petitioners attempted to flee, the crowd outside ‘showed their respect for freedom of opinion by assaulting every individual who came out’. There followed several nights of rioting, which, according to the Tory Yorkshire Gazette, ‘disgraced our city’. An effigy of the Archbishop of York, who had voted against the bill, was burnt outside his palace at Bishopsthorpe and a number of his windows were broken. Several other houses, principally those of prominent Tories, were also attacked and

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rumours circulated that armed revolutionaries were on their way from Leeds. The situation even appeared serious enough to mobilise the local garrison of the 8th Hussars.2 In the end, however, Wellington was incapable of forming a government and the King was able to pressure the Lords without creating new peers. The third reform bill became law, receiving royal assent on 7 June. To celebrate the momentous occasion, York’s Whig-radical corporation arranged a grand illumination of the city so that, in the words of the Courant, ‘this great epoch in our history will be commemorated in a manner worthy of itself – fitting the exultation which should animate Britons on being put in possession of their long-withheld rights’.3 Yet less than two days later it was announced that the planned celebrations had been cancelled. The Gazette, for one, was relieved. Public illuminations, it claimed, ‘were not a very rational means of rejoicing at any time’, especially concerning an issue ‘over which so much contrariety of opinion prevails’. It then added, almost as an afterthought: At this present period too, when a malignant disorder is raging in the city, anything which tends to draw together crowds of persons should be avoided and on this ground, the Board of Health have joined the magistrates in discontinuing an illumination.4

The unfolding drama of the Reform Act played out against the spectral backdrop of cholera, which had finally arrived in Britain, after increasingly anxious anticipation, in October 1831. On the pages of the city’s newspapers political speculation and diatribe shared equal space with exhortations to prayer, proclamations from the Board of Health and fears about the contaminating influence of ‘vagrants and tramps’.5 The political, the moral and the physical intertwined in a complex discourse of order and disorder as the pestilence exacerbated deep fissures in the social and political body. Cholera was at once a divine judgement on a sinful nation, a scourge of poverty and intemperance and a political conspiracy to defeat the cause of reform. No single voice could claim absolute legitimacy in determining the meanings of cholera but, during the course of the epidemic, one would become increasingly prominent: the medical. The later 1820s had witnessed the increasing disaggregation of medicine from the broad cultural and epistemological field as its practitioners drew upon the ideologies of social progressivism and utilitarianism to represent themselves and their work as having a distinct character and a particular relationship to the public and the state. It was the cholera epidemic of 1831–32, however, which played the pivotal role in galvanising these ideologies and in exacerbating the processes by which the medical was constructed as a distinct sphere of socio-political activity. This chapter does not attempt to provide an exhaustive history of the 1832

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epidemic, either locally or nationally. Such accounts have already been written.6 Neither does it attempt to show how medical understandings of cholera came to dominate or displace alternative discourses. Rather, it demonstrates how in York, as in other parts of the country, the cholera epidemic provided a focus around which new forms of medical identity and activity coalesced, and how practitioners came to frame their vocational identities in terms of expert knowledge and an active engagement with the care of the social body. This was by no means as ‘natural’ a thing as it might appear. As historians have observed, seventeenth-century medical practitioners, particularly physicians, felt little compulsion to treat the victims of plague. As private citizens they had the right, indeed the duty, to flee affected areas.7 Likewise, although a number of eighteenth-century practitioners, especially those influenced by continental physiocracy, had taken an interest in the occurrence, spread, and potential mitigation of epidemic disease, they were under no obligation to play an active ‘public’ role. 8 Indeed, in the absence of any co-ordinated state response to epidemic disease there were few institutional structures through which such activity might have been channelled. This was to change with the outbreak of cholera when for the first time medical practitioners sat in an official capacity on legally constituted bodies dedicated to the management of disease.9 The historical literature has tended to underestimate the significance of this development, characterising the medical response to cholera as conflicted and ineffective.10 While there is a degree of truth to this it is clear that such narrowly functionalist readings do not address the wider cultural and ideological impact of the 1831–32 epidemic. Medical action may well have been unco-ordinated, tempered by limited political authority and popular resistance, but it nonetheless constituted a significant expansion of the intellectual and practical sphere of medicine from a private, patient-centred individualism towards a much more public and political investment in the health and welfare of the population at large. The cholera epidemic did not guarantee a uniform or consistent involvement by medical practitioners in the field of public health. And yet on both the local and the national stage the activities of a number of key practitioners, combined with the development of new political structures and forms of knowledge, did facilitate a more collective engagement in the field. As is evident from the writings of the York physician, Thomas Laycock, some practitioners entertained elaborate visions of the relationship between themselves and the state, interposing medicine as a key intermediary between government and the people. Although these visions often ran counter to prevailing social ideologies and were rarely, if ever, realised, they nonetheless marked a significant development in the imagining of medicine as a form of social governance.

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To a great extent, these visions of medical service were channelled through new forms of social organisation and formulated within new ideological frameworks, for the medicalisation of the social body was matched by a commensurate process: the socialisation of the medical body. The previous chapter concluded with the medical withdrawal from associations such as the British Association for the Advancement of Science and this one begins by considering new forms of medical organisation and association. In March 1832 a number of local practitioners founded the York Medical Society. Where late eighteenth-century medical culture had been underwritten by inclusive forms of social activity and a pluralism of knowledge the medical practitioners of the 1830s were increasingly associating within exclusive social spaces dedicated to the specifics of medical knowledge and practice. What is more, and as the epigraph at the beginning of this chapter suggests, these new forms of social organisation were seen by many contemporaries as the defining characteristic of the medical profession ‘at large’. The York Medical Society was critical to the shaping of medical culture and identity at the local level but it should be made clear at the outset that such developments were by no means peculiar to York. Indeed, the late 1820s and 1830s saw a proliferation of similar organisations including the Huddersfield Medico-Chirurgical Society (1825), Nottingham Medico-Chirurgical Society (1828), Bury and Suffolk Medical Society (1830), Liverpool Medical Society (1833), Manchester Medical Society (1834) and the Medical and Surgical Society of Newcastle upon Tyne (1834). Given such parallel developments it is perhaps surprising that provincial medical and surgical associations have been subject to so little historical analysis. Save for the odd institutional history, or broad-sweep survey, virtually nothing has been written on them.11 And yet these societies constituted perhaps the greatest expression of a reformist spirit within provincial English medicine. They were central to the figuring of medicine as a collective endeavour, bringing physicians and surgeons together in an institutional setting, in many cases for the first time. They also provided a space within which practitioners remote from the centres of corporate power and education might ‘improve’ themselves, embracing knowledge as a democratising tool of progress and reform. They were thus of critical importance in the transformation of medicine into a discrete disciplinary field, a private culture orientated towards public engagement. However, this process was not without its discontents, for as with the medicalisation of anatomy, where the dissected body was removed from public view and divested of popular meaning, the withdrawal of medicine into private and exclusive social spaces placed it in an ambivalent relationship to the public at large.

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On 16 February 1832 the physicians, Dr Wake and Dr Belcombe, and the surgeons, James P. Needham, Henry Russell and Caleb Williams, joined Dr Goldie at his house in Castlegate. At the ensuing meeting they ‘judged [it] expedient to form a Medical Society’, and agreed that a resolution of intent, together with an outline of the rules, should ‘be sent to the Physicians, and members of the Association of Surgeon-Apothecaries, resident in York’.12 On 3 March 1832, another meeting was held, this time at the Dispensary, and with Dr Wake in the chair it was unanimously resolved that the four physicians and eight surgeons present, along with the surgeon George Champney (who had signalled his intention to join but had failed to attend the meeting) ‘do form themselves into a Society which shall be called The York Medical Society’.13 As a forum for medical sociability and association, the York Medical Society could not have been further removed from the Doctors Club of the late eighteenth century.14 As its second rule declared: The Society shall consist only of Medical Practitioners.15

Whereas the Doctors Club was symptomatic of a culture of medicine defined by social inclusion and a deep investment in local civic society, the Medical Society embodied a new vision of medical social relations defined by exclusivity and specificity. The very ethos of the Doctors Club had been to facilitate sociability between medical practitioners and the laity. The Medical Society, by contrast, was restricted to ‘Medical Practitioners’. Laymen and women were not admitted, not even as visitors. ‘Medical Practitioners’ was, however, a somewhat ambiguous term of categorisation. In the absence of any formal legal definition, deciding what constituted a ‘medical practitioner’ was no straightforward task. This is not to say that the Society was infiltrated by those whose vocational status was uncertain, for its members exercised a strict control over entry. Nevertheless, the very foundation of the Society constituted the delineation of medicine as a discrete vocational constituency, a conscious compartmentalisation of social practice which included some and excluded others. In this regard the exclusion of druggists and chemists is of particular note. The proliferation of dispensing druggists in the first half of the nineteenth century threatened to devalue the economic and cultural capital of ‘regular’ practice.16 Not only were their services cheaper, but the fact that they offered medical advice without any formal education or training was an affront to a culture of medicine increasingly defined by the possession of specific intellectual and praxial competencies. Whereas late eighteenth-century provincial English physicians and surgeons had been willing to associate with shop-based apothecaries, the members of the Medical Society were concerned to distance themselves

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from such practices. Unlike even the Associated Body of Surgeons and Apothecaries, which had been founded in 1818 to regulate medical practice, the Medical Society was less concerned with the ‘business’ of medicine than with its intellectual aspects. If druggists were excluded then who was included? Again, unlike the Associated Body of Surgeons and Apothecaries which, as its name suggested, was composed of surgeon-apothecaries/general practitioners, the Medical Society embraced all medical and surgical ‘regulars’. It is impossible to overstate quite how significant a development this was. The imaginative and institutional formulation of physic and surgery as a singular endeavour was in direct opposition to the fractured nature of metropolitan medical governance, whose structures neither reflected nor represented the realities of contemporary medical experience. Although London played host to some of the period’s most prominent medical reformers, there was something peculiarly provincial about this phenomenon. The exclusionary, elitist and metro-centric culture of the Royal Colleges, their apparent unwillingness to act on behalf of provincial practitioners and their failure to acknowledge the congruity of medical and surgical practice as established by developments in Scottish and French medical education, encouraged provincial physicians and surgeons to constitute themselves into singular local bodies. Just as the membership of the Medical Society marked it out from its antecedents, so too did its spatial politics. The Doctors Club had held its meetings in the York Tavern, a civic institution embodying a culture of inclusive sociability. By contrast the Medical Society, together with the Associated Body of Surgeons and Apothecaries, held its meetings in the newly constructed premises of the York Dispensary on New Street.17 This is not to say that the Dispensary was not also a civic institution. After all, while medical practitioners had played a leading role in its foundation in 1788 they had been joined in this endeavour by a large number of local citizens and the charity was administered, for the most part, by lay governors.18 Moreover, such institutions had been animated by a culture of public benevolence which testified to the ‘humanity’ of the local citizenry as much as by any explicitly medical imperative. However, by the early 1830s, the meanings of such spaces were being challenged and reconfigured. As part of a general political reaction against the networks of patronage and informal interpersonal relations which had underpinned the cultures of polite civic association, medical reformers like Thomas Wakley attacked charitable institutions such as hospitals and dispensaries as nepotistic ‘puff-shops’ which were directed towards the ‘individual aggrandisement’ of their medical officers and lay subscribers rather than the ‘public good’ or the benefit of medicine as a whole.19 Inspired by utilitarian ideas about the social application of expertise and by the example of revolutionary France, radical practitioners throughout the country were questioning

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the charitable imperatives of hospitals and dispensaries, constituting them as sites for collective medical identification, improvement and activity rather than as testaments to civic virtue.20 Needless to say, such developments could lead to tension between lay governors and medical men. Although York experienced less open dissention than some other towns and cities, the role of the Dispensary in playing host to meetings of the Medical Society suggests that it was part of a general trend towards the medicalisation of such institutional spaces. It was this commitment to improvement as a collective act, this belief that medical knowledge and clinical experience should provide a shared intellectual resource, which underwrote the Society’s founding ethos, embodied in its first rule that ‘The object of the Society shall be the Promotion and Diffusion of Medical Knowledge’. 21 During the sixteenth and seventeenth centuries, ‘medicine’, in the form of physic, surgery and materia medica, had been framed by the cultural values of the guild, with their emphasis upon mystery, secrecy and initiation.22 This was especially true of surgeons and apothecaries, who were trained by apprenticeship, but it was also the case for physicians who, in a culture of corporate privilege and commercial individualism, were inclined to guard their learning closely.23 Even during the eighteenth century as medical practitioners embraced the cultures of gentility and politeness, vocational knowledge remained a source of commercial advantage. During the 1820s and early 1830s, however, the role of knowledge in medical culture was transformed by the ideologies of reform, the ‘march of intellect’ being allied to a ‘democratic’ assault upon corporate corruption, tyranny and self-interest. In his editorials for the Lancet, Wakley characterised the metropolitan corporations as monopolistic ‘companies’, more concerned with protecting their ancient privileges than with improving the discipline: The fact that the colleges have never . . . added to the stores of our knowledge, have never contributed, by any well-known act of their own, to advance the interests of science, to enlarge the privileges of their brethren, or to extend the boundaries of human research must, with all liberal minds, decide their character, and point at once to the motives by which their whole conduct has been animated.24

Just as bad as the ‘spies, traitors, [and] villains’ of the Royal Colleges were metropolitan medical grandees such as Astley Cooper who restricted their knowledge, skill and experience to those who could afford personal pupilages. By publishing their lectures without permission, the Lancet proclaimed that education and improvement should neither be a source of personal financial gain nor an individual privilege of wealth and social connection but rather the right and responsibility of all practitioners.25 This collective and reciprocal obligation was enshrined in the third rule of the Medical Society which stated that ‘Every member shall be required

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to contribute an Essay or propose a subject for discussion, at the Society’s Meetings’. To ensure that every member contributed equally to the ‘diffusion’ of knowledge, a rota was formulated ‘by Ballot’, with each member having to deliver a paper or propose a discussion as his turn arose.26 Thus in marked contrast to the semi-formal sociability of the Doctors Club, with its bacchanalian atmosphere of drinking, feasting and gambling, the Medical Society was a highly disciplined space with strict rules, formal offices and scrupulously kept minutes. Its meetings were held on alternate Saturday evenings from October to the end of April and began, according to the rules, ‘at 8 o’clock precisely’ at which point ‘members proposed shall be balloted, and other business transacted’.27 After the register was taken, a paper was delivered and at ‘10 o’clock precisely’, the meeting was adjourned. This structure was rigorously enforced and meetings were often adjourned part-way through a discussion, the debate being resumed at the next possible opportunity.28 Through the medium of these meetings, with their formal papers and ordered debate, the members of the Medical Society elaborated a fantasy of epistemological leadership that was at odds with their relative distance from the centres of corporate and epistemological power. Almost all of the papers delivered at the Society between 1832 and 1850 were concerned with new therapeutic and diagnostic techniques or with new understandings of the body and of disease. Frequent reference was made to established medical authorities, as well as to more recent authors. However, the vast majority of the papers took the form of case studies, derived from personal experience and observation.29 In this way, the members of the Medical Society imagined themselves not only as recipients of new ideas but as active contributors to the intellectual basis of their discipline. This progressivist and collaborative vision of medicine was perhaps most eloquently expressed in the Society’s annual Presidential address. In May 1832 it was resolved that each President should deliver a speech at the first meeting of the new session (or from May 1833 the last meeting of the concluding session) which should have ‘especial reference to the advanced state of Medical and Surgical Sciences’.30 Closing the 1834–35 session, for example, Dr Rawdon gave an able and eloquent address on the present state and future prospects of medical and surgical science. He commenced by defining the objects of medicine, both as an art and as a science; took an review of the new remedies and new instruments, both foreign and domestic, which have been recently proposed; stated the results obtained by the French commission appointed to report on the merits of Homeopathy; and paid tribute to the memory of the late surgeon Dupuytren. After making some observations on vaccination, he concluded by denouncing the mischiefs of quackery, and by stating his own views of what ought to be done in restraining them by the government of the country.31

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Perhaps the most important way in which the members of the York Medical Society were able to sustain this engagement with developments in medical culture, knowledge and practice was through the medium of print. In 1810 a medical library had been established at the County Hospital and membership was open to all local medical practitioners.32 Eleven of the thirteen original members of the York Medical Society were annual subscribers in 1830.33 In 1836 the members of the Medical Society also decided to establish a separate ‘book club’.34 Textual forms played a central role in promoting and sustaining early nineteenth-century cultures of medical association. A number of contemporary medical societies, including those of Leicester, Liverpool, Manchester, Newcastle and Sheffield, had been established as medical libraries. Not only did they help to defray the cost of purchasing medical books but they also embodied a commitment to mutual improvement: a sublimation of the individual to a collective endeavour. Whereas older practitioners, such as James Atkinson, had amassed personal collections of medical books which they held in the private space of the house and directed to their own personal ends, their successors were increasingly figuring texts as communal property and their premises as a point of collective medical identification. At a practical level, one of the reasons why an engagement with textual forms was becoming a matter of collective, rather than individual, responsibility was that, by the 1830s, periodical publications constituted perhaps the most important medium for the communication and dissemination of medical and surgical knowledge.35 Whereas eighteenth-century medical journals had been relatively few in number, often short-lived and published on a biennial or annual basis, the early nineteenth century witnessed a proliferation of titles, many of which were printed weekly.36 These included the London-based Lancet (1823), London Medical Gazette (1827), London Medical and Surgical Journal (1828) and British and Foreign Medical Review (1836) as well as a welter of provincial publications, some of which lasted longer than others.37 The frequency of their publication, together with developments in the field of print-production and distribution, gave rise to an unprecedented circulation of medical information, allowing practitioners throughout the country to keep abreast of the latest developments. In a characteristically self-congratulatory tone, Thomas Wakley noted in the Lancet that: We have received the French journals published in Paris up to the 23rd instant, some extracts of which are published in another part of this journal. Thus not a week has elapsed between the promulgation of French additions to medical science and their circulation through the remotest counties of England. On the 30th day, this day, the medical news will, for instance, be in York. Nothing like this celerity has before ever been heard of in the annals of medical literature, save in previous similar accomplishments of THE LANCET.38

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However, the increasing breadth, depth and scope of medical periodical publication also made it difficult for individual practitioners to cover the entire field. Titles such as the Lancet and the London Medical and Surgical Journal were designed for a mass market and were relatively cheap, but some, especially the quarterlies, could cost up to 6s a number. Multiple subscriptions could prove prohibitively expensive and many practitioners therefore preferred to pool their collective resources into local medical libraries. But the significance of periodical publication went far beyond a mere access to medical knowledge, for journals such as the Lancet were not simply a passive medium for the transmission of information. Both in the ways they functioned as texts and in the ways they were used by their readers they were productive of an intertextuality, or rather an intermodality, of discourse which was fundamental to the imaginative construction of medicine as a spatially extensive community. In his celebrated work, Imagined Communities (1983), Benedict Anderson argued that the nineteenth-century nation could be understood less as a structural category than as an imaginative process whereby members of a bounded political community came to regard themselves as existing in ‘deep, horizontal comradeship’ with others of whose existence they were subjectively unaware.39 Anderson’s ideas provide a suggestive theoretical frame through which to rethink the history of the medical profession. In his analysis, Anderson highlights the role of print-capitalism, including the newspaper, in shaping the ‘national imagination’.40 Newspapers, he suggests, embody a concept of temporal simultaneity within what Walter Benjamin called ‘homogeneous, empty time’. In other words, the variety of narratives, accounts and information encompassed within a single edition of a newspaper are connected by two key factors: spatiality (these things all happened within politically bounded spaces, usually the nation or a discrete locality within that nation) and temporality (they all happened within roughly the same period of time). In this way the readers of a newspaper imagine themselves as being part of a temporally and spatially co-extensive community, the members of which remain largely anonymous, but whose reality is objectively self-evident.41 Periodical literature can be said to have played an analogous role in the construction of medicine as reified community. The Lancet in particular was akin to a newspaper with a circulation of over four thousand. Indeed, one correspondent referred to it as ‘the Times of the medical profession’.42 As well as editorials, lectures, book reviews and reports, it included letters from medical practitioners throughout the country and the empire. Its readers were thus able to follow developments and encounter experiences of which they would previously have been unaware, making hitherto unimaginable connections between themselves and their medical ‘brethren’. Only by reading a range of similar experiences and grievances to his own, for example, could a

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correspondent have claimed that ‘there are, at this moment, hundreds of [my] brethren . . . in the depths of want and misery’.43 What is more, journals such as the Lancet also interacted with that other ‘technology of imagination’, the medical society. In York, as elsewhere, journals were brought into the space of the Medical Society, where their contents formed the basis for discussion and debate. In November 1833, for example, the surgeon William Anderson initiated a discussion on cholera by reading an account of ‘Dr Tytler’s sentiments as delivered in some of the Medical Societies in London’ together with ‘Some letters on the same subject in the Lancet’.44 Having provoked debate, the proceedings of these societies were in turn recounted in the pages of medical journals. In this way, these two ‘technologies of imagination’ intertwined in a recursive, referential and intermodal discourse which transformed readers into audiences and journals into arenas. In this way, too, a multiplicity of individual voices were configured as a collective experiential and imaginative resource. Before we get too carried away, however, it should be noted that medical societies (and medical journals for that matter) were not abstract discursive forms: they did not drop from the skies to provide fodder for sociological formulising. They were fundamentally human endeavours, products of human activity, and were consequently riddled with ambiguity, conflict and contradiction. This does not detract from their significance but does suggest the need for qualification which takes into account the idiosyncrasies of local experience. For a start, while the York Medical Society may have presented itself as a representative local body, or was at least integral to the process by which that representation could be imagined, it is clear that it was not an exhaustively inclusive organisation. By the late 1820s York played host to around eight physicians and seventeen surgeons.45 Of these, only four physicians and eight surgeons founded the Society and even as late as 1843 only three out of ten physicians and eighteen out of thirty-nine surgeons were members.46 Rather than a truly ‘democratic’ or comprehensive body, the Medical Society was mostly composed from the local medical elite: long-serving and well-established practitioners who held, or had held, offices at the city’s principal medical charities. More importantly, perhaps, if the foundation of the Medical Society constituted a significant marker in the elaboration of medicine as a discrete body of knowledge and practice, then this process of cultural disaggregation could also place the Society in an ambiguous relationship with the wider public sphere of discourse. Although some members continued their involvement with more socially inclusive and visible bodies such as the Yorkshire Philosophical Society, their identities and activities qua medical practitioners were increasingly being formulated within private, bounded space. It is hard to tell how far removed the Medical Society was from the public consciousness. However, the fact that its early meetings were rarely, if ever, recorded

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in the local press suggests that it was hardly a prominent feature of the local landscape.47 As with the practice of anatomy, then, the configuration of medicine as a socially instrumental body of knowledge also involved the withdrawal of that knowledge from public view or comprehension. This ambiguity could lead to profound disagreement over the meanings and significance of the Medical Society. While the ‘Medical Pupil’, who wrote to the York Herald in October 1832 about the importance of pathological anatomy, claimed that the Medical Society ‘reflect[ed] honour to the faculty in York’ and exercised a ‘vivifying influence . . . amongst the members of the profession at large’, his respondent, ‘R’, who challenged his assertions about the primacy of anatomical knowledge, also questioned his reading of the Medical Society: Are the Society’s transactions being made public? Are their meetings beneficial to any but themselves? No. Its proceedings and the benefits yielding from them are confined within the walls of this Society’s rooms. Perhaps these benefits, like the comet, are coming; perhaps this Society may be preparing themselves for future achievements, and by . . . studies in silence, they will be enabled to burst forth with a springtide of knowledge, which shall quickly dispel the clouds of involuntary ignorance.48

Such tensions were evident elsewhere. In 1834, the Manchester Medical Society ‘strongly disapprove[d] of the introduction of any reporter of the public papers to any Meeting of the Society’ while the members of the Medical Society of Sheffield drafted a rule allowing for the expulsion of anyone ‘who shall insert or sanction the insertion of a report of any proceedings of this Society in any but a Medical Journal’.49 However, as R’s comments suggest, the Medical Society was in an ambiguous position not only vis-à-vis the general public but also with the wider medical community. If the Medical Society facilitated a vision of medicine as a collective endeavour and of ‘improvement’ as a mutually beneficial exercise, then different members entertained rather different ideas as to how far that mutuality extended. These tensions crystallised in a controversy which engulfed the Society in 1840. In October of that year the Secretary, William Dalla Husband, noted that a report of the Society’s previous meeting had been published in the Dublin Medical Press. In response, Caleb Williams and Dr Thomas Simpson proposed that ‘the proceedings of this Society should not be published, and no communication of them shall in anywise be made, without its authority and sanction’.50 Dr Thomas Laycock, who had already contributed a number of letters to the journal, confessed that he had sent the report. A ‘very smart discussion’ ensued and the meeting broke up an hour early.51 The details of the following meeting are difficult to reconstruct, but it is clear that the row over the publication of the Society’s transactions reached such a

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pitch that Laycock, Simpson and Husband traded personal insults. All three tendered their resignations, prompting an emergency meeting. Simpson later claimed that ‘I consider myself to have been treated by one of the Members [Laycock], with marked personal disrespect, not to use a harsher term, and that allegations were made against me altogether unfounded’.52 Laycock’s defence, as contained in his resignation letter, is worth quoting at length: I need scarcely repeat that I reported and published the proceedings of the First Meeting of the Society with confident expectation that such publication was in accordance with the object for which the Society was instituted, as laid down in the first Rule, viz: the promotion and diffusion of medical knowledge and also not doubting that it would be useful and creditable to the Society and gratifying to the individual Members. This explanation the Society has already pronounced to be satisfactory – But I wish also to remark that, having never had the slightest intention of [illegible] or insulting any of my professional brethren, I apologise with the greatest pleasure for anything I may have said or written, if it be thought I have such tendency – At the same time I cannot omit stating that the great and good object of the Society has been lost sight of in frivolous disputes, that an unnecessary importance has been given to trifles and that I have been attacked with an [illegible] and Bitterness altogether disproportionate to my offence, granting (which I do not) that my publication of the proceedings was a censurable act.53

What this dispute demonstrates is that, even among medical reformers, there could be little consensus as to the meanings and ideologies of collective association. If Husband and Simpson thought of the Society as a bounded space whose proceedings should remain private and whose intellectual benefits were a privilege of membership then Laycock entertained a more extensive and idealised vision of medical relations. In the end, however, it was Laycock’s vision which would predominate for most medical societies would eventually publish their proceedings and some would even establish their own journals. The proliferation of medical societies and medical journals in the 1820s and 1830s thus played a crucial role in the construction of medicine as a discrete disciplinary domain. Banding together in inaccessible social spaces and communicating through the medium of a specialist press, medical practitioners shaped their identities outside, or rather beyond, the public sphere of discourse. And yet at the same time, the social was itself being configured as a domain for unparalleled forms of medical activity and performance. In York, as elsewhere, the crucible for this active social engagement was provided by the arrival of cholera in the summer of 1832. Cholera, 1832 At the first full meeting of the York Medical Society in March 1832 its President, Dr Baldwin Wake, introduced a general discussion of cholera and

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its members responded by debating its genesis, causes and symptoms.54 By this time the disease had been present in Britain for nearly five months, having first arrived in Sunderland in October 1831. Although it was yet to affect York, it had already established itself in the Tyne-Tees region and had spread to Haddington near Edinburgh and to the London docklands.55 Cholera and its treatment continued to dominate the Society’s proceedings up until the end of its first session in April 1832.56 Indeed, one of the motivating factors behind the foundation of the Society may well have been to provide a space in which medical opinion on the disease could be negotiated and a response co-ordinated. The elaboration of medicine both as a body of specialised knowledge and as a form of social practice were therefore simultaneous, for at the same time as they were discussing cholera behind the closed doors of the Dispensary, its members were already taking an active role in directing local measures to prevent its spread and mitigate its effects. On 12 November 1831 the Yorkshire Gazette recorded that: At the request of Lord Dundas, our worthy chief magistrate, a general meeting of the medical gentlemen in this city was held yesterday evening, at the house of James Atkinson, Esq. the senior surgeon, to take into consideration the proper steps to be adopted with regard to the Cholera. After much deliberation, a deputation was appointed who waited on the Lord Mayor, recommending that a Board of Health be forthwith instituted, consisting of the magistrates, clergy, medical gentlemen and principal inhabitants of this city.57

This meeting had taken place in response to the Privy Council’s recommendation of 31 October that local Boards of Health should be established.58 As Durey and others have observed, the Privy Council’s recommendations adhered to ‘Traditionalist and localist orthodoxies concerning the role of the State’ and placed authority squarely in the hands of the traditional local elites.59 Therefore, while the Privy Council suggested that each Board should contain ‘two or more Physicians or Medical Practitioners’, it also recommended that it should contain ‘three or more of the Principal Inhabitants’.60 York followed this pattern. At a meeting in the Guildhall on 14 November a Central Committee was established, comprising the Archbishop of York, the Lord Mayor, the Canons Residentiary, John Wood MP, four Aldermen and twenty-one prominent local citizens. Also included were ‘The PHYSICIANS and Six Senior SURGEONS resident in and near York’.61 The Board of Health may not have been a predominantly medical body but medical practitioners appear to have exercised a considerable degree of authority within it. After all, Lord Dundas’s first step as chief magistrate and Lord Mayor had been to convene a meeting of the ‘medical gentlemen’ of the city and ask for their advice. Dr Goldie was appointed Secretary and the eventual inclusion of fourteen surgeons on the Central Committee, as opposed to

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the six initially proposed, suggests that some felt a greater degree of medical representation was necessary.62 In addition to the Central Committee the Board of Health also requested that ‘the members of the medical profession of the City of York and its Neighbourhood’ should ‘constitute themselves into a General Medical Board to correspond with and aid the Central Committee and District Board’.63 Moreover, while they were there to ‘aid’ and advise the Board rather than to issue orders, its medical members were credited with specific areas of competence and expertise. A number of practitioners were sent on fact-finding missions to areas of the country already affected. For example, at some point between December 1831 and January 1832 the physician, Thomas Simpson, and surgeon, Richard Hey, were despatched to Newcastle to investigate and identify the disease that prevailed there. Their report to the York Board of Health must have made for uncomfortable reading for it claimed that ‘[we] are perfectly satisfied that we have witnessed a new disease, of a character so formidable, as in a large proportion of cases, to bid defiance to all human aid’.64 Similarly, when cases of cholera were reported at Goole and Selby to the south of the city in April 1832, Dr Goldie was sent on an official mission to ‘ascertain the fact’.65 The city’s medical practitioners were granted another key area of authority when a specialist cholera hospital was established in early 1832. This had been one of the recommendations made by Simpson and Hey on their return from Newcastle. The Subscription Committee (established in November 1831) granted the Board of Health £200 for this purpose and, after the initial plan to extend the fever ward at the County Hospital was rejected as being too expensive, an isolated house near Fishergate Postern was rented instead.66 The Board appointed Dr Goldie as its consulting physician, Richard Hey as its consulting surgeon, and William Anderson as its house surgeon.67 As Durey has noted, local Boards of Health established in the autumn and winter of 1831 soon found that they lacked legal authority, as the Privy Council’s announcement that they had the power to cleanse streets and remove public nuisances was found to apply only to areas in which cholera was already present.68 Many of the Board’s initiatives therefore took the traditional forms of voluntary charity. In December 1831, for example, a subscription fund was established to provide blankets and shoes to the poor.69 Likewise, on numerous occasions between November 1831 and January 1832, the Board discussed the possibility of founding a soup kitchen, an established feature of winter charity in the city.70 More than simply an expedient device, these initiatives suggest that understandings of cholera were formulated within the political and imaginative parameters of social amelioration and public order. Rather than a unique pathogenic problem, the threat of cholera was broadly consistent with the

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wider problems of poverty and social dislocation. Attempts to quarantine the city were particularly concerned to limit the movements of the itinerant poor, for as the Gazette suggested, ‘This disease is more likely to be propagated by vagrants and tramps than by any other means, and the utmost caution should be used to prevent them coming into contact with the healthy part of the community’.71 As some have suggested, the removal of nuisances also had an established history and was a customary means of policing social order and neighbourly relations in town and village.72 The surgeon, James P. Needham, later wrote that: [E]verything had been removed that was considered likely, or even possible, to generate the disease; and everybody felt confident, that supposing it to be contagious, and to extend itself by that means alone, it would nevertheless be met by so much cleanliness, comfort and temperance, that it could hardly obtain an extensive prevalence among us.73

As Needham’s comments suggest, concerns about moral intemperance were particularly central to visions of cholera. In November 1831 the Chronicle published an anonymous letter in which the author adopted the narrative voice of cholera itself. Claiming to be the son of ‘a well-known serpent’ (i.e. the devil), the author contrasted the vices of gluttony, drunkenness and social discord with the virtues of industriousness, neighbourliness and cleanliness: I am particularly attached to everything my parent has a hand in, consorting always . . . with the promoters of any kind of evil and iniquity. The profligate, the drunkard, the glutton, the lazy, the dirty, the quarrelsome, may be sure I will find out their abode . . . But this I must observe, that if a man be industrious, sober, and temperate, I shall have nothing to say to him. If he rise early, open wide his windows, wash himself from head to foot, whitewash often his house, take his meals with his family, and keep himself always in good humour with his neighbours; such a one I cannot abide. He may live in health, and die in good old age, for all I can do to the contrary.74

Such moralistic visions also structured official understandings. On their return from Newcastle, Dr Simpson and Richard Hey observed that those who lived in well-ventilated houses, were personally clean, and temperate in their behaviour tended to be spared by the disease.75 Similarly, one of the Board of Heath’s earliest public pronouncements was that the ‘labouring classes’ should adopt ‘precautions’ such as ‘personal and domestic cleanliness’ and ‘should avoid Drams and Hard Drinking, as they would avoid poison’.76 Both Morris and Durey have suggested that such advice testifies to the ‘poverty’ of ‘medical’ explanations of the disease.77 Certainly, medical practitioners held no explanatory monopoly, for even if most people accepted that cholera was propagated by potentially identifiable physical mechanisms,

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religious understandings possessed a broad appeal, especially with respect to cholera’s place in the wider cosmology. Pamela Gilbert has examined the tensions between these two discourses.78 However, like Morris and Durey, she posits too sharp a distinction between sin and science as explanatory frameworks. As is clear from such works as James Phillips Kay’s Moral and Physical Condition of the Working Classes (1832), moral explanations were compatible with, and in many cases functioned as, medical ones.79 From the mid-eighteenth century, those concerned with the health of institutionalised populations had established a link between disease and discipline.80 Such readings informed understandings of epidemic disease and for many practitioners who witnessed the cholera outbreak of 1831–32, factors such as intemperance, personal cleanliness and even fear itself functioned as ‘predisposing causes’.81 When the York Board of Health recommended moral observance and fortitude, they were therefore acting in accordance with medical advice.82 The arrival of cholera in June signalled an even greater role for medical practitioners. Prevention was manifestly better than cure for as a correspondent to the Gazette claimed, ‘All medical men agree that curative means have hitherto proved lamentably defective and inadequate’.83 However, once the local citizenry started to die, the lay members of the Board, though they did not relinquish their authority, generally deferred to their medical colleagues. In the same month that cholera first appeared, the Board passed a resolution that all medical practitioners, whether they were members of the Committee or not, should attend its meetings.84 On 25 June the scope of medical activity was extended even further as the Board requested that all of the city’s physicians and surgeons, not only those engaged at the Dispensary and the cholera hospital, should attend the ‘destitute poor’ in their own houses, without charge.85 Durey argues that while cholera may have allowed individual practitioners to ‘promot[e] their own social status . . . the medical profession per se did not emerge from the epidemic with increased prestige’ and was incapable of ‘convincing the laity of its scientific or moral authority’.86 Likewise, Morris alleges that they ‘failed to make any impression on the disease’ and that ‘the dominant impression the doctors left on the public mind was of squabbling, self-interest and failure’.87 We shall come on to question the accuracy of these generalisations shortly, but before we do it is necessary to acknowledge two key factors which did indeed threaten to undermine the medical response to cholera. The first of these concerns medicine’s epistemological coherence, or rather lack of it. As numerous historians have noted, by the early 1830s medical theories respecting the propagation and spread of diseases, such as plague, typhus and cholera, were varied and complex.88 It has proved convenient, for contemporaries and historians alike, to divide those practitioners who

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engaged with such matters into two opposed camps, namely contagionists (those who believed such diseases to be infectious, spread by person to person contact or through contact with infected articles) and anticontagionists (those who held such diseases to be epidemic and to derive from either a general or a local miasmatic corruption of the atmosphere). Space prevents a detailed exploration of these issues, but it is clear that, even with the inclusion of Pelling’s ‘contingent-contagionist’ category, such labels fail to do justice to the diversity and complexity of early nineteenth-century epidemiology.89 It is equally clear that they were a source of real dissension between practitioners in this period. The degree of division within contemporary medical opinion was forcefully demonstrated at a meeting of the Westminster Medical Society in early 1832. At the end of a heated discussion a vote was taken on the contagiousness of cholera. Victory went to the anticontagionists, but only by twenty-four votes to twenty-two.90 That the York Courant recorded this vote is significant, for the public nature of such aetiological disagreements made it difficult to portray medical practitioners as an epistemologically unified body acting collectively.91 The preventative measures enacted by the Board of Health were often based on a deliberate (con)fusion of contagionist and miasmatic ideas, and a similar tactic was employed by certain medical practitioners who were keen to sublimate theoretical dissension into collective action. In November 1831, for example, ‘Chirurgicus’ claimed that: It is of little real importance, in the present instance, whether the disease be the true Indian Cholera . . . Neither is it absolutely necessary, in order to provide against its attack, to know with certainty, the manner of its propagation. Whether it is originated by malaria . . . or by contagion . . . Because, as it is impossible for us to pronounce that a disease arising from malaria in the first instance, may not afterwards be propagated by contagion . . . we ought most certainly to assume that this really is the case, and endeavour as much as possible to limit the intercourse between the diseased and the healthy. For this purpose it is highly desirable that a general medical board be established in every town, consisting of all the physicians and surgeons.92

Yet despite such recommendations, disagreements concerning the aetiology of cholera continued to be openly expressed and reported in the local press. While many practitioners, such as James P. Needham, were committed to its contagiousness (even if he believed it to be ‘choleric fever’, rather than cholera per se),93 the Gazette noted that William Anderson, ‘the intelligent and active surgeon at our cholera hospital is strongly inclined to believe it is not infectious’.94 Just as importantly, such disputes created tensions within the Board of Health. In June 1832, for example, the Rev. William Bulmer expressed the determination of his parish, St Mary Bishophill Junior, ‘not to pay anything towards the expenses’ of the Board. Bulmer’s reason was that ‘a medical

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gentleman connected with the Board had declared that no such disease as the Indian Cholera ever existed in York’. At this Bulmer was met with cries of ‘Name the person’, and while he ‘declined to mention any name’, ‘Mr Hope, the surgeon, acknowledged that he was the person who entertained that opinion’. Hope then ‘argued at some length in support of it’, before ‘Dr Wake very ably replied in defence of the general opinion’.95 That Hope was not a member of the Medical Society whereas Dr Wake was its President perhaps suggests that its discussions in March and April had done much to determine the ‘general opinion’. Nevertheless, the differences between practitioners remained so deeply entrenched that it proved impossible to reach a consensus. When the Board of Health issued posters, informing the public of its measures, it was forced to admit that the identity and aetiology of the disease had been ‘warmly discussed’ and that there ‘still remains a difference of opinion’ on the matter.96 Needless to say, such admissions did little to convey the medical profession’s unity of purpose. The second key factor concerned the poor’s resistance to, and resentment of, medical intervention, fuelled by the coterminous passage of the Anatomy Act. Outrage at the proposed legislation and fears over the medical appropriation of bodies structured popular attitudes towards practitioners involved in the treatment of cholera. On Dr Simpson’s return from Newcastle in January 1832 a member of the York Board of Health asked him whether ‘the poor had any fear in case of going to the hospitals, of post-mortem examinations’. Simpson replied that ‘in order to prevent any alarm of post-mortem examinations, they had been interdicted by the authorities’.97 Despite such concessions to popular feeling, however, relations between medical practitioners and the ‘lower orders’ remained fraught. In York there were no large-scale anti-medical riots, as there were in Manchester, Liverpool and Paisley, but rumours of corrupt, even murderous, practices abounded.98 In June 1832, for example, word spread that Abraham Peck, a resident of Hagworm’s Nest in Skeldergate, and one of the first to fall ill, had been poisoned by his medical attendants. The Board of Health’s investigation of the allegations found them to be groundless and ‘created considerable conversation, as to the best means of communicating their contents to the lower order, among whom the most absurd reports were in circulation, respecting Mr W. Coates and the other medical gentlemen who attended him’.99 Peck (who was very much alive), whether of his own volition or at the request of the Board of Health, submitted a letter to the Gazette in which he refuted the ‘most malicious and unfounded reports’ that the ‘Medical Gentlemen who had attended me’ had attempted to administer him drugs against his wishes, claiming that he was ‘grateful’ for their ‘attention’ and ‘kindness’.100 Later that month, the Gazette recorded that medical practitioners had been ‘accused of all sorts of practices’ and ‘have heard it openly asserted that they

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are paid £10 a week by the parishes; and of course that whilst they continue to be so paid, there will always be cholera in York’.101 Such accusations were clearly damaging to the popular perception of medical men and at a meeting of the Board of Health, Dr Goldie decried the ‘preposterous notion that the public held [that] there was no cholera in York, and that it was only a job got up by the doctors’.102 Doubtless there were some, even among the higher social orders, who entertained a similarly cynical estimation of medical practitioners. The widespread production and circulation of satirical prints suggests as much.103 In York, however, the vast majority of ‘respectable’ opinion rallied behind them. Of particular significance was the support of the city’s newspapers. In reference to accusations of profiteering, for example, the Gazette claimed that ‘this is an assertion so unfounded, that we are anxious to remove it’ and went on to ‘beg, therefore, to assure our readers, that the medical gentlemen attend gratis, all cases of cholera which occur in poor families’.104 The Gazette also later claimed that its ‘editorial observations’ had done much ‘to remove that unpopularity under which the Board and the medical gentlemen originally laboured’.105 Such sentiments run counter to conventional historical observations about the role of cholera in shaping public attitudes towards medicine and suggest that its practitioners emerged from the epidemic with greater cultural and symbolic capital than has generally been recognised. In July 1832, for example, the Gazette carried a letter from ‘Senex’, which praised the ‘medical gentlemen’ as a collective for ‘their constant care and unwearied attention’, claiming that, in their exertions, ‘they have erected for themselves a lasting monument of honour, and insured the gratitude of all classes of the community’. ‘I trust’, the author concluded, ‘that the time is not far distant, when a public expression of thanks will be voted to them by every man, woman and child in the city of York’.106 This approbation may not have been quite so universal, but it was both official and effusive. At a meeting of the Board of Health in August 1832, the Dean of York proposed a vote of thanks to the ‘medical gentlemen of York’ which was unanimously carried and published in the newspapers.107 In his speech the Dean represented their behaviour as self-sacrificing to the point of heroic: When they looked back, and considered the zeal and activity with which they had come forward to stay the progress of the disease; that they had exposed themselves and their families to the most imminent danger of contagion; that they had passed sleepless nights, in affording assistance to their fellow creatures; and that they had stood up between the dead and the living, and stopped the plague; he was sure no words could express the feelings of thankfulness, which he, in common with the rest of his fellow-citizens, owed to the medical gentlemen of York.108

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This image of heroism retained its currency for some time after cholera finally petered out in the autumn of 1832. In 1834 the Gazette claimed that the ‘medical profession in York’ was one of the ‘most respectable bodies of men . . . to whom the citizens look with respect and esteem, not only for their uniform high character, but for the laudable manner, in which they braved that terrific disease which raged in our city a few years ago’ and ‘hazarded their own lives for the welfare of their poor brethren’.109 Similarly, the obituary of James P. Needham which appeared in the York Herald on the occasion of his untimely death in 1839 recalled ‘his intrepid and indefatigable exertions in his profession’ and that ‘Unscathed by the frightful wastes of death, he mingled in the thickest of the scene’. ‘Alas!’ it concluded, ‘even the guardians of health must themselves die’.110 And yet these effusive expressions of popular sentiment belied a fundamental disjuncture between lay and medical conceptions of public service. For the former, medical attendance upon the victims of cholera constituted a natural, if exceptional, extension of their work with the sick poor in charitable institutions such as the Dispensary and County Hospital. It served as a testament to their gentility, benevolence and ‘high character’, a selfless act of civic virtue rendered freely and without expectation of material reward. For many medical practitioners, however, it represented something rather different. In line with a broader critique of medical charity and the values it embodied, many asked that they be paid for their services.111 During the epidemic they had given up their time and risked their lives not as an act of gratuitous benevolence but as experts performing a state service. As state servants they were entitled to payment and in the very same month that the Dean publicly praised their selflessness, the York Board of Health was already discussing the issue of financial reimbursement. Somewhat ironically, given the tone of his later obituary, it was James P. Needham who was particularly outspoken on this subject: The Clergyman will not resign his fees, nor the tradesman his profits; but the medical men are too often considered as having no claim to the former, and no just interest in the latter. They are made the servants of the public, and in return do not receive even the gratitude of that selfish tribunal. Votes of thanks are indeed profusely lavished, for they cost nothing; but the just and reasonable claims of the profession are met with nothing but outcries of illiberality and selfishness.112

Despite these tensions, and despite the claims of a number of historians, the cholera epidemic of 1832 can nevertheless be said to have enhanced the cultural and symbolic capital of medicine within the broader social field. At the same time, however, it also served as a catalyst for the further elaboration of medicine as a discrete and specialised discipline, a body of knowledge which, though of general social utility, was beyond the capacities of popular

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comprehension. In the immediate aftermath of the epidemic a large number of medical practitioners used their experiences of the disease to locate themselves within a pan-national discourse of cholera and to contribute to debates about its nature, management and treatment. Although some of these, such as Kay’s Moral and Physical Condition, were orientated towards a general readership and sought to situate the disease within a wider social context, most were addressed to a narrow, if spatially extensive, medical audience. For example, William Anderson, house surgeon to the York cholera hospital, submitted two letters to the Lancet in which he detailed his treatments, and provided evidence of its non-contagious nature, the first time that a named local practitioner had contributed to the journal.113 Even more important was James P. Needham’s Facts and Observations Relative to the Disease commonly called Cholera (1833). As its title implied, Needham’s book did not seek to understand cholera as ‘commonly’ experienced or perceived but as constructed medically through its nosology, aetiology, symptomology and pathology. In this sense it demonstrates how much the cultures of early nineteenth-century medicine had been transformed. Needham’s Facts and Observations was published in the same year as James Atkinson’s Medical Bibliography A. and B., and together they constituted the first major publications by York practitioners since the poetical works of James’s brother, Charles, in the 1810s. And yet they could not have been more different. Indeed, they constitute the apotheoses of two essentially contrasting cultures of medical identity and performance. Atkinson’s book, written by an elderly, retired surgeon, epitomised the values of medico-gentility. Irreverently humorous in tone and literary in style it was intended for the amusement of the general reader and was the product of a man whose social identity was structured by an investment in polite forms of knowledge and in the extra-vocational sociability of associations such as the Doctors Club. Needham, on the other hand, was rooted in the vocationally specific cultures of the Medical Society, which he had helped to found, and was committed to the primacy of medical knowledge and expertise. His book had no literary pretensions. On the contrary, it opened with an explicit disclaimer of literary ability, the author presenting himself merely as a conduit for the transmission of ‘an authentic account of the Cholera’.114 Written in a dry, detached tone, it was an assemblage of facts, derived from first-hand observation, and was addressed to ‘his professional brethren’ rather than to the ‘public’ as a whole.115 As his obituary claimed: Those who see have a right to testify and acting on this principle, Mr Needham laid the result of his observations, made during his cholera practice, before the public. His volume on the subject, though somewhat too technical for the general reader, is a monument of the acuteness and constancy with which he marked the steps and resisted the progress of that most formidable minister of death.116

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This transformation in social identities also had its epistemological corollary. James Atkinson’s was a fundamentally anthropocentric work, underwritten by an interest in individuals and their social relations. Individually too, he was noted for his affability, sociability and personal charm. By contrast, Needham’s book epitomised the objectifying qualities of an abstract medical gaze.117 For him it was cholera in its universal theoretical configuration, rather than in its individual manifestation, that was of interest. As with Atkinson, such qualities also carried over into his more routine social performances, for as his obituary tellingly remarked, he ‘was one of the few men, ever more ready to converse about things than about persons’.118 The medicalisation of the social body When the York Medical Society reconvened for its second session in October 1832 its members brought with them an enthusiasm engendered by immediate experience. At its first meeting the President, Dr Wake, ‘directed the attention of the society to the subject of Cholera’ and to ‘the changes which have taken place in the Pathology and treatment of the disease’. Wake’s suggestion was taken up with alacrity and ‘furnished discussion for the rest of the evening’.119 During the course of the next two years cholera, together with other fevers such as typhus, also provided the focus for numerous papers.120 Yet such apparent enthusiasm should not be taken as evidence of a universal engagement with public health and preventative medicine. As far as it is possible to tell, none of these speakers called for a co-ordinated medical response to the problems of epidemic disease. On the contrary, whenever such action was suggested the response was generally underwhelming. In February 1834, for example, Caleb Williams proposed to occupy the evening by some considerations of the importance of determining what were the diseases peculiar to the locality of York – or the grouping of diseases which had lately been observed and on the desirableness of registering the diseases as they occur.

Unfortunately for Williams, ‘These subjects excited but little interest and called forth a languid discussion by the few who remained to take part in it’.121 Even in the immediate aftermath of cholera, then, interest in public health and epidemic disease remained personal and idiosyncratic. During the course of the 1830s, however, a number of factors converged which served to promote a more widespread interest in the care of the social body and which allowed certain practitioners to elaborate visions of medicine as a form of social and political governance. One of the most important of these factors was the passage of the Poor Law Amendment Act in 1834. The history of the Act is well known and need not be

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repeated here.122 The culmination of decades of debate over the relationships between poverty, dependency and economic productivity, the Act was largely framed by Edwin Chadwick and was a significant legislative achievement for Benthamite utilitarianism. Essentially concerned to eliminate the economic ‘waste’ of pauperism via the principle of ‘less eligibility’, it abolished out-relief for the able bodied and established the workhouse as a deterrent institution with a harsh disciplinary regime. It also had profound implications for the relationships between medical practitioners and the sick poor. It abolished the old parish-based structures of relief and replaced them with geographically larger Unions. In turn, each Union employed several District Medical Officers to attend to the poor in their own homes. In York the first elections to appoint District Medical Officers were held in August 1837.123 As historians have suggested, the post was a vexed one, being ‘both despised and sought after’.124 Although it provided employment at a time of great competition, the tendering system, by which practitioners competed with each other in offering lower rates for their services, generally meant that the pay was poor.125 District Medical Officers complained incessantly about inadequate remuneration, authority and independence and many shirked their responsibilities whenever possible.126 And yet the cumulative effect of the Act was to help shape a new kind of practitioner. The legacy of cholera and the burgeoning interest in the social conditions produced by urban industrial modernity helped to sustain a much greater and more consistent engagement with the bodies of the poor than had hitherto been the case. Likewise, unlike the parochial structure of old, the Union system encouraged the District Medical Officer to think of himself less as a local contractor or parish official than as a salaried state servant with an interest in the broader dimensions of social medicine. Whatever its discontents, then, the post of District Medical Officer played a profoundly important role in reshaping the values and meanings of medical practice. By formalising and deepening the kinds of relationships initiated by the cholera epidemic it can be said to have constituted ‘the principal means by which medicine was harnessed into the running of nineteenth-century society’.127 Closely related, and equally important, were the passage of the Civil Registration Act in 1836 and the consequent establishment of the General Register Office. The Act was originally conceived as a means of addressing the grievances of dissenters by providing a civil, rather than ecclesiastical, register of births, marriages and deaths.128 However, from an early stage, the bill attracted the interest of a number of medical practitioners who saw it as an opportunity to collate statistics on the number, causes and geographical distribution of deaths, especially among the urban poor. J. M. Eyler has characterised these men, notably James Phillips Kay and William Farr, as adherents of ‘socio-medical liberalism’, combining a commitment to utilitarian

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and progressivist liberal politics and a belief in the environmental causes of disease with an unswerving faith in the ability of statistical analysis to facilitate the construction of epidemiological laws.129 One might also add that Kay and Farr both occupied a liminal vocational space somewhere between medical practice and the civil service. For this reason they were perhaps inclined to carve out the socio-medical as a sphere of both personal and political intervention.130 It was through the activities of such men and pressure from medical societies that Chadwick eventually convinced Lord Ellenborough, the bill’s principal architect, to include the cause of death on the Register. It was also through Chadwick’s influence that William Farr was appointed Compiler of Abstracts at the General Register Office (GRO), a position which made him RegistrarGeneral in all but name.131 Under Farr’s direction the GRO significantly expanded its remit, essentially becoming a body for the collation of medical statistical information. It also served to galvanise sanitary activity in the provinces.132 It has been suggested that it was not until the establishment of permanent municipal Medical Officers of Health in 1872 that any consistent use was made of the information gathered, but medical and surgical societies played a crucial, if generally neglected, role in facilitating an inchoate engagement with public health.133 A year after the establishment of the GRO, Caleb Williams delivered a Presidential address to the members of the York Medical Society in which he directed their attention to ‘medical statistics and topography’.134 In 1840 he spurred them to action again when he spoke of the ‘advantages which would be obtained from a periodical publication of the number of deaths, with their causes, which occur in this City’.135 Compared to his earlier suggestion the response on this occasion was markedly more enthusiastic and a committee was duly appointed to investigate the idea. They returned with the following conclusion: [The Committee], convinced of advantages, which accrue to medical science from the publication of medical statistics, and desirous of availing themselves of the facilities afforded by the Registration of the ‘Cause of Death’ under the authority of the General Registration Act, resolve, that it is highly desirable to obtain a weekly report of the number of deaths with the causes thereof, which take place in the District of the York Poor Law Union.136

These weekly reports were ‘posted up in the Reading Room of the Hospital Library, and the Council Room of the Yorkshire Museum’.137 In 1841 the Medical Society further ordered that this information be collated, bound and ‘deposited in the reading-room of the Medical Library, where they are preserved for reference’.138 Not only was this data preserved; it was used. The Medical Society in

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particular, provided an arena whereby such information could be assimilated into theoretical understandings of epidemiology and public health. In 1846, for example, Edward Allen delivered one of many similar papers to occupy the Society’s attention. Allen was concerned by the local prevalence of continuous fever and influenza, and ‘from the statistical information which [he] . . . brought forward’, these diseases ‘were shown to have been most fatal in the crowded and unhealthy parts of the city’.139 As the work of Mary Poovey and John Pickstone has suggested, the development of new statistical techniques for envisioning the social body transformed the conceptual terrain of medical study.140 As with Needham’s earlier work on cholera, the effects of a universalising medical gaze were to construct the poor as an abstract, aggregate entity. Where once they had been objects of personalised medical charity, now they were the subjects of an inherently impersonal disciplinary field.141 But of course an interest in medical statistics did not in itself constitute a consensus of opinion as to the role of medicine in tackling the problems of disease and social deprivation. Many practitioners had no desire to establish formal structures through which medical expertise might function as social and political power. Indeed, the very idea of state-organised healthcare was anathema to many in an era in which liberal self-governance was a veritable shibboleth of English national identity. The establishment of medicine as a tool of state-governmental authority seemed far too Prussian for most tastes. And yet there were others for whom Prussia served as a model rather than a spectre. Flourishing in the imaginative space between continental state-centralism and a native civic voluntarism, a number of English medical practitioners elaborated far-reaching visions of the potential relationship between medical expertise and social governance. One of these men was Thomas Laycock. We have already encountered Thomas Laycock earlier in this chapter but in actual fact he did not arrive in York until after the cholera epidemic of 1832. He was born in 1812 at Wetherby, a small market town to the west of the city. The son of a Wesleyan minister he was educated at the Woodhouse Grove Methodist school near Leeds before being apprenticed to the surgeons John and William Spence of Bedale in the far north of the county. In 1833, at the age of twenty-one, he travelled south to study medicine at London University. There he was introduced to a radical materialist medicine by tutors such as Anthony Thomson, John Elliotson and Robert Grant.142 After a year in the metropolis Laycock relocated to Paris to attend the Medical School but was back in London by 1835 to be examined for his Membership of the Royal College of Surgeons (MRCS). A year later he returned to Yorkshire and was elected apothecary to the York County Hospital in February 1836.143 In 1837 he graduated MD from the University of Göttingen with a thesis that he later expanded and published as A Treatise on the Nervous Diseases of Women (1840).144

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Laycock was no more representative of the average York practitioner of the mid-nineteenth century than Alexander Hunter was of the late eighteenth. Indeed he was something of an outsider, operating for the most part on the fringes of the local medical faculty. And yet, like Hunter, he can perhaps be seen as the apotheosis of a more pervasive culture of medical identity and performance, one framed by the values of expertise and social engagement. Although no firebrand radical he embraced a progressive agenda and was an active campaigner for political, medical and social reform. He also combined a devout piety with a rigorously materialist medical philosophy, a complex fusion that was evident in his ‘mortalist’ understanding of the human soul and in his general receptivity towards the doctrines of phrenology.145 Now perhaps most closely associated with his contributions to mental science, particularly his work on the reflex function, Laycock was also deeply invested in the study and practice of public health and, like Farr, who had been a year ahead of him in London, was convinced of the capacity of statistical knowledge to facilitate the scientific management of the social body.146 Laycock’s first major involvement with public health came in 1840, when he was asked by the York Medical Society to publish the statistics of the York Registration District in the Dublin Medical Press.147 A year later he submitted a series of letters to the same journal on the subject of ‘Political Medicine’. Taken together these letters outlined a remarkably ambitious vision of medical authority as a form of state governance.148 Opening with a quotation from Hippocrates that ‘[the] truly philosophic physician is God-like’, Laycock claimed that with the ‘very great changes’ taking place in medicine ‘its practitioners are destined to take a much higher and more important role in the body politic than they have hitherto’.149 Laycock was inspired by a Germanic tradition of socio-political medical thought. The writings of Johann Peter Frank were particularly influential.150 Frank’s vision of a comprehensive system of state medical management found much support throughout the German Confederation, particularly with the work of the celebrated Prussian pathologist, Rudolf Virchow.151 It also experienced a brief early flourishing in Scotland where in 1807 Andrew Duncan was instituted the Chair of Medical Jurisprudence and Police at the University of Edinburgh and where John Roberton published his Treatise on Medical Police two years later.152 Laycock’s particular vision of medical police went beyond the mere ‘prevention of disease’ to advocate a much deeper social engagement, namely ‘the application of medical science to the moral advancement of mankind’.153 Hence, at the basic level medical practitioners should be empowered to direct the ‘removal or prevention of all agencies which may injuriously affect the health of the community . . . to maintain our cities, towns and villages in a sanitary condition – and to avert or ameliorate the attacks of endemic,

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epidemic, or epizootic diseases’.154 At the political level, however, Laycock’s concern was to harness medical expertise to the elimination of poverty and social deprivation. ‘Health’, he argued, ‘constitutes the real capital of the labouring man’, and ‘to diminish sickness amongst the labouring classes is to multiply his days of capability for labour, and by so much to increase his capital’.155 Laycock’s work bears the clear stamp of political economic thought but he was generally more inclined towards Benthamite interventionism than laissez-faire Malthusianism. Unlike some of his contemporaries and associates he was not averse to legislative regulation. Indeed, he was critical of those who ‘take Malthus as their guide’ and ‘deprecate any such interference with the laws of Providence as I recommend’.156 Similarly, where many political economists, notably Chadwick, were solely concerned to return the poor to productive labour, Laycock, in common with such medical contemporaries as James Phillips Kay and Thomas Southwood Smith, took a more holistic and moralistic view of social relations.157 For Laycock the vicious circle of poverty and disease inevitably led to ‘moral degradation and vice’, which destroyed the ‘humanizing feelings of domestic life’, as well as the ability to ‘perform the holy duties of religion’. These, he maintained, would be remedied by a comprehensive system of medical police, which would ‘enhance [the labourer’s] comforts and . . . improve his morals’.158 Medical expertise might also ensure social and political stability and mitigate revolutionary radicalism. Through the application of metrology and medical topography the practitioner would be able to predict poor harvests and outbreaks of disease and initiate ameliorative measures. In so doing, Laycock suggested, it might be possible to eliminate the ‘political discontent which accompan[ies] periods of scarcity . . . The typhus and the rags of poverty, the commercial pressure, the socialism and the Chartism’.159 What was perhaps most remarkable about Laycock’s vision was not so much the scope of medical authority but rather its imagined form. While Kay had perceived similar links between health and the moral economy, his proposed solution, influenced by the work of the Scottish divine, Thomas Chalmers, adhered to a model of personal and charismatic pastorship. In its emphasis upon the intersubjective qualities of social relations it was in keeping with established traditions of clerical ministerialism, charitable voluntarism and liberal self-governance.160 Laycock’s model, by contrast, was resolutely statist and technocratic. In his opinion ‘political medicine’ should become ‘a distinct branch of administration and a distinct science’ which would ‘have its professors, its literature, and its practitioners’.161 Permanent Boards of Health should be established which would act ‘by authority of the state’ and would ‘constitute medical observatories’.162 In keeping with contemporary critiques of medical charity he was also wedded to a vision of the public health practitioner as autonomous expert, free from the polluting influence of patronage

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and interest. He therefore denounced established forms of gratuitous charitable service as a ‘fruitful source of evil’, maintaining that medical practitioners should be made salaried state officials.163 Laycock was also engaged in the practical application of medical science to social distress. Along with the like-minded Quakers, Samuel Tuke and Joseph Rowntree, he undertook a sanitary investigation of the parish of St Denis in the notoriously deprived area of Walmgate.164 Together with his writings, these activities brought him to the attention of Edwin Chadwick, whose Report on the Sanitary Condition of the Labouring Population of Great Britain had been published in 1842. Chadwick visited York in November 1843 and met with local magistrates and medical practitioners to discuss the foundation of a ‘Sanatory [sic] Committee’. Tory Councilman and former Lord Mayor, George Hudson, recommended that Laycock act as Secretary for the Committee and Laycock and Chadwick soon established a close corresponding relationship.165 When the Royal Commission on the Health of Towns was established in 1843, one of its first measures was to send out questionnaires to practitioners in towns with above average levels of mortality, of which York was one. Laycock diligently prepared a report under the aegis of the ‘York Sanatory Sub-Committee’. The composition of this committee was significant, for it demonstrates how, in contrast to Laycock’s rhetorical imaginings, such bodies continued to embody established models of liberal governance and local orthodoxies of social and political power. As Secretary, Laycock was one of five medical members.166 The chairman was William Vernon Harcourt and the other members included the Lord Mayor, the Recorder, George Hudson and Samuel Tuke.167 If the composition of the Committee was decidedly civic, then so too was the information it produced. Vernon Harcourt, for example, contributed a substantial introductory section on the geology and topography of York while the architect, J. B. Atkinson, supplied an account of the city’s drainage system.168 Nevertheless, the overall thrust of the report was that the city should be ‘subjected to the regulations of a sanatory police’, for ‘It is manifest that immediate, energetic and systematic measures are more requisite than inquiry’.169 Laycock’s report was thorough, didactic and conformed to Chadwickian orthodoxies concerning the causal agency of filth. In May 1844 Chadwick wrote to Laycock expressing his admiration: I have had this morning an opportunity of reading your report on the sanitary conditions of York. I have no hesitation in saying that I think it is the most able report I have seen under this or any preceding enquiry into the sanitary conditions of any town. Other reports have very high degrees of merit on particular points, but none so complete as an exposition for non-professional persons or so complete as a whole.170

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During the mid 1840s Laycock continued to deliver lectures and publish articles on the subject of epidemic disease and sanitary reform. In 1847–48 he was also involved in political agitation to secure the passage of Chadwick and Lord Morpeth’s public health bill.171 This bill, far more than the later compromised Act, accorded with his vision of a centrally administered system of medical police mandated by Parliament to monitor and eradicate sanitary nuisances on the local level. However, in this endeavour he encountered fierce resistance from George Hudson, who had been elected as the Tory candidate for Sunderland in 1846. As with many like-minded MPs, Hudson objected to the bill on the grounds that it constituted a gross interference by the state in local affairs. Laycock responded to this charge by means of a prepared statement, read out in the House of Commons by his associate, Thomas Wakley, now radical MP for Finsbury, in which he alleged that ‘Mr Hudson had no knowledge of the sanitary conditions of the city’ and had ‘probably never visited a sick person in his life’.172 Chadwick later observed that Laycock’s comments had earned him the ‘enmity of Hudson’ whose irregular financial practices had rendered him politically vulnerable. Laycock even received a threat of libel action, though he dismissed it as a hoax.173 The conflict between Hudson and Laycock owed much to personal animosity, for Laycock was a supporter of Hudson’s political nemesis, the Liberal Congregationalist lawyer and sometime Lord Mayor, George Leeman.174 More than this, however, it was the product of a deep disagreement concerning the role of the state in mid-nineteenth-century England. Even though Chadwick had consciously downplayed the centralised administrative dimensions of sanitary reform, the creation of a General Board of Health, the levying of taxes to pay for improvements and the power of the General Board to directly intervene in areas where the mortality rate exceeded twenty-three in a thousand nonetheless offended local sensibilities. In March 1848, at a meeting of the York City Council, the Lord Mayor, James Richardson, maintained that many of his colleagues were of the opinion that the bill’s proposed measures were of ‘so despotic a character that they, as Englishmen, would not be inclined to support them’. Drawing upon an established language of common law traditions and civic rights, he claimed that it was tantamount to a ‘Political Inclosure [sic] Bill’, designed to suppress the ‘common fields’ of ‘our Saxon constitution’. Although it was the city’s Tories who were most openly opposed to the bill, a commitment to localist modes of governance and to the political functions of the civic polity was so deeply embedded that it transcended party lines. Hence while Leeman approved of the bill in principle, he was concerned that it would impinge upon the political autonomy of the Council and proposed that a petition be sent to London to ameliorate some of its more centralising tendencies.175

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Even more significantly, there was little consensus of opinion even among medical practitioners. Where Laycock was enthusiastic William Dalla Husband was sceptical. Speaking at the Council meeting, he claimed that he had ‘for many years been a strenuous supporter of sanatory [sic] measures’ and ‘the conditions of the poorer classes of society strongly demand that such measures should be carried out’. Nevertheless, he ‘felt great disappointment and indignation that the government should trifle with public opinion, and nullify their exertions to obtain [them]’.176 The debates surrounding the passage and implementation of the public health bill thereby reveal the manifest limitations of Laycock’s technocratic vision of ‘Political Medicine’. Although objections to the Act were mostly framed by the vexed relationship between the regional and the national, concerns about the involvement of the state in the traditional structures of ‘popular’ governance also intersected with a discursive negotiation of the role of experts and expertise in the regulation and management of the social body.177 Critics of the bill often made a connection between the values of Benthamite governmentalism and the interests of professionalism. In an inversion of reforming assaults upon ‘Old Corruption’ in the 1810s and 1820s, the Tory Gazette declared that such forms of scientific social management were little more than ‘Whig patronage’, stating that ‘They [the Whig government] have provided their legal friends with Recorderships, Commissionerships etc., by the hundred; and they now seek to provide for their medical friends as “Officers of Health” and so forth’.178 Dismissing the grandiose claims of Laycock and others, the Gazette saw nothing but self-interest, jobbery and a hint of political radicalism: For a period of ten years, a large number of the working classes of this country have placed themselves under the guidance of needy but ambitious men. Barristers without briefs, and doctors without patients, better skilled at fabricating grievances than either in law or physic.179

Despite such antagonistic rhetoric, the Gazette revised its opinion of the bill when, in August 1848, it was announced that Lord Morpeth had listened to the grievances of local authorities and had acted accordingly. The spectre of a second cholera epidemic also galvanised the bill’s erstwhile opponents.180 ‘We are glad’, the Gazette claimed, ‘that there is no doubt the measure will speedily become law’.181 The bill gained royal assent in September 1848 and was approved by York’s corporation in March 1850.182 Even as implemented, however, the Public Health Act fell way short of Laycock’s elaborate system of medical police. A permanent Board of Health was established in York, but it was institutionally indistinguishable from the corporation and contained no medically qualified members.183 Furthermore, although the Act had stipulated that ‘Local Board[s] of

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Health may, from Time to Time, if they shall think fit, appoint a fit and proper person, being a legally qualified Medical Practitioner or a Member of the Medical Profession, to be called the Officer of Health’, the York Board chose to appoint no such officer.184 Despite his courting of men like Laycock, Chadwick was ambivalent about the capacity of medicine to tackle sanitary problems and the provisions of the Act, such as the construction and maintenance of sewers and water systems, were a matter for engineers rather than doctors. In York, as in many other towns and cities, the only salaried official appointed by the Board was the surveyor, a post taken by the architect, J. B. Atkinson.185 In the absence of formal institutional authority, then, medical involvement in public health and sanitary reform was channelled through the informal structures of civic society. Although an entirely lay body, the Board of Health was in almost constant communication with the York Health of Towns Association, which counted Laycock, Husband and Anderson among its members. Thus, while the 1848 Act established public health as a civic, rather than an explicitly medical, responsibility, it did facilitate a closer relationship between medical expertise and the bureaucratic structures of local and national governance. Indeed, despite the evident political and cultural constraints on Laycock’s vision, medicine nevertheless became a form of social governance. The York Health of Towns Association and other bodies like it may not have adhered to his Prussian fantasy of salaried officials in ‘medical observatories’, ensuring political stability through the prediction and mitigation of pestilence, but they did not need to. Harnessed to a model of liberal governmentality they constructed a particular vision of the social body through the ostensibly neutral and objective science of statistics and provided ways through which that body might be managed in the form of sewers, drains and water supplies.186 Likewise, by providing information and advice to the public on personal conduct, cleanliness and disease prevention they promoted a culture of sanitary self-mastery which sought to mitigate the popular anger, consternation and violence associated with the cholera epidemic of 1832. The return of the disease in 1848–49 may not have been entirely without incident but, given that it took place against the background of severe agricultural distress, Chartist agitation and European-wide revolution and given that the death rate in England was far higher than before, it was remarkably free of the riots and inflammatory rhetoric of its predecessor.187 Hence, in a revealing comparison of the 1848–49 epidemic with that of 1832, the York Health of Towns Association declared that ‘The more accurate and definite knowledge now acquired as to the pre-disposing and exciting causes of the epidemic, and as to the means applicable to its prevention, has enabled the public authorities to act with greater confidence, and has tended to calm and tranquille [sic] the timid’.188

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In his work on the nineteenth-century liberal state, Patrick Joyce has claimed that the ‘new notion of “public health” emerged out of deep conflicts within contemporary medicine, so that governmentality can be read not as drawing upon already firmly established bodies of knowledge, but as located in the formative processes creating these bodies’.189 This chapter has explored these formative processes on the local level and has demonstrated how, through co-ordinated activity, through the experience of the cholera epidemic and through the elaboration of statistics, the medical practitioners of York, in common with those elsewhere, constructed the social as a legitimate sphere of interest and activity. However, Joyce’s statement, like so much of the starkly totalising literature on nineteenth-century modernity tends to admit of conflict while simultaneously dismissing it. It would be wrong to presume that a resistance to public health, or indeed an indifference to it, was simply the product of outdated rationalities, or, to quote Poovey, the ‘undigestible bits of bone, in the craw of modernity’.190 Thomas Laycock’s vision of public health was by no means universally shared and, though instructive, it is important to recognise that alternative visions had equal social and intellectual force. Nor would it be correct to assume that the move towards public health had a single, impelling ideological rationale. If Laycock, like many of his colleagues, was inspired by Benthamite utilitarianism and by continental models of state management, then others, such as William Dalla Husband could be similarly animated by Tory paternalism. And yet having said this, what it perhaps most remarkable about the social and cultural construction of public health as a medical domain is less the scope of its numbers, the coherence of its ideological agenda or the extent of its realisation, than the depth of its engagement and the relative swiftness of its elaboration. By no means all medical practitioners were public health activists by mid-century, but few denied its importance. Even more remarkably, perhaps, by the late 1840s most politicians recognised the necessity for sanitary reform, even if some objected to its structural implementation.191 The significance of Laycock’s proposed system thus lies not in its relative distance from legislative actualisation but in the fact that, a mere decade after cholera first arrived on the shores of Britain, such a system could be imagined as both possible and desirable. In this way, Laycock’s writings testify to the extent of medicine’s cultural transformation, its reconfiguration in terms of knowledge, expertise and public service. In the next and final chapter we shall conclude our analysis of this process by considering the ways in which practitioners, in York as elsewhere, sought to establish and assert the moral and epistemological authority

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of medicine, as well as the extent to which such efforts were resisted by sections of the public for whom medical authority and monopolisation were anathemas to the values of free trade and popular liberty. Notes 1 T. Laycock, A Treatise on the Nervous Diseases of Women: Comprising an Inquiry into the Nature, Causes and Treatment of Spinal and Hysterical Disorders (London: Longmans, 1840), p. viii. 2 YG, 19 May 1832. 3 YC, 5 June 1832. 4 YG, 9 June 1832. 5 YG, 21 January 1832. 6 R. J. Morris, Cholera 1832 (London: Croom Helm, 1976); M. C. Barnett, ‘The 1832 cholera epidemic in York’, Medical History, 16:1 (1972), 27–39; M. Durey, The First Spasmodic Cholera Epidemic in York, 1832, Borthwick Paper, 46 (1974); Durey, The Return of the Plague: British Society and the Cholera, 1831–2 (Dublin: Gill and Macmillan, 1979). 7 O. P. Grell, ‘Conflicting duties: plague and the obligations of early modern physicians towards patients and commonwealth in England and the Netherlands’, in A. Wear, J. Geyer-Kordesch and R. K. French (eds), Doctors and Ethics: The Earlier Historical Setting of Professional Ethics (Amsterdam: Rodopi, 1993); P. Wallis, ‘Plagues, morality and the place of medicine in early modern England’, English Historical Review, 121:490 (2006), 1–24. 8 J. C. Riley, The Eighteenth-Century Campaign to Avoid Disease (New York: St Martin’s Press, 1987); C. M. Cipolla, Miasmas and Disease: Public Health and the Environment in the Pre-Industrial Age (New Haven: Yale University Press, 1992); A. Corbin, The Foul and the Fragrant: Odour and the French Social Imagination (Leamington Spa: Berg, 1986); S. Schaffer, ‘Measuring virtue: eudiometry, enlightenment and pneumatic medicine’, in A. Cunningham and R. French (eds), The Medical Enlightenment of the Eighteenth Century (Cambridge: Cambridge University Press, 1990); R. Porter, Doctor of Society: Thomas Beddoes, Medicine and Reform (London: Routledge, 1991). 9 C. Lawrence, Medicine in the Making of Modern Britain, 1700–1920 (London: Routledge, 1994), p. 41. 10 M. Durey, ‘Medical elites, the general practitioner and patient power in Britain during the cholera epidemic of 1831–2’, in I. Inkster and J. Morrell (eds), Metropolis and Province: Science in British Culture, 1780–1850 (London: Hutchinson, 1983), p. 274; Morris, Cholera 1832, p. 162. 11 D. Power, British Medical Societies (London: The Medical Press and Circular, 1939); F. N .L. Poynter, ‘British medical societies, 1868–1968’, Practitioner, 201 (1964), 238–45; H. Marland, ‘Early nineteenth-century medical society activity: the Huddersfield case’, Journal of Regional and Local Studies, 6:2 (1985), 37–48; J. Jenkinson, ‘The role of medical societies in the rise of the Scottish medical profession, 1730–1939’, Social History of Medicine, 4:2 (1991), 253–75; Jenkinson,

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17

18 19 20

21 22

23

24 25 26

Performing medicine Scottish Medical Societies: Their History and Records (Edinburgh: Edinburgh University Press, 1993). BIHR, YMS, 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844. BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844. M. Brown, ‘From the Doctors Club to the Medical Society: medicine, gentility and social space in York, 1780–1840’, in M. Hallett and J. Rendall (eds), EighteenthCentury York: Culture, Space and Society (York: Borthwick Publications, 2003). BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 3 March 1832. I. Loudon, Medical Care and the General Practitioner, 1750–1850 (Oxford: Oxford University Press, 1986), pp. 129–51; Loudon, ‘Medical practitioners, 1750–1850 and the period of medical reform in Britain’, in A. Wear (ed.), Medicine in Society: Historical Essays (Cambridge: Cambridge University Press, 1992), pp. 230–2; H. Marland, ‘ “The doctor’s shop”: the rise of the chemist and druggist in nineteenth-century manufacturing districts’, in L. H. Curth (ed.), From Physick to Pharmacology: Five Hundred Years of British Drug Retailing (Aldershot: Ashgate, 2006). The New Street building had been started in 1827 and was completed in 1829. O. Allen, History of the York Dispensary: Containing an Account of its Origins and Progress to the Present Time; Comprising a Period of Fifty-Seven Years (York: R. Pickering, 1845), pp. 69–79, 80. K. A. Webb, ‘One of the Most Useful Charities in the City’: York Dispensary, 1788–1988, Borthwick Paper, 74 (1988), p. 6. Lancet, 12:304, 27 June 1829, pp. 401–2; Lancet, 21:536, 7 December 1833, p. 414. For a fuller account of this transformation, see Brown, ‘Medicine, reform and the “end” of charity in early nineteenth-century England’, English Historical Review, 124:511 (2009), 1,353–88. See also, R. D. Cassell, Medical Charities, Medical Politics: The Irish Dispensary System and the Poor Law, 1836–1872 (London: Royal Historical Society, 1997). BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 3 March 1832. P. Griffiths, ‘Secrecy and authority in late sixteenth- and seventeenth-century London’, Historical Journal, 40:4 (1997), 925–51; C. Chamberland, ‘Honor, brotherhood, and the corporate ethos of the London Barber-Surgeon’s Company, 1570–1640’, Journal of the History of Medicine and Allied Sciences, 64:3 (2009), 300–32. M. Pelling, Medical Conflicts in Early Modern London: Patronage, Physicians and Irregular Practitioners, 1550–1640 (Oxford: Oxford University Press, 2003); P. Wallis, ‘Competition and cooperation in the early modern medical economy’, in M. S. R. Jenner and P. Wallis (eds), Medicine and the Market in England and its Colonies, c.1450–c.1850 (Basingstoke: Palgrave Macmillan, 2007). Lancet, 15:387, 22 January 1831, p. 565. For example, see Lancet, 5:108, 1 October 1825, pp. 1–3. BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 3 March 1832.

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27 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 3 March 1832. 28 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844. 29 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 1 February 1834, 2 March 1838. 30 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 5 May 1832. 31 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 10 March 1835. 32 BIHR, YCH 1/1/1/1, MSS, Court of Trustees Minute Book, 13 May 1803; BIHR, YMS, MSS, York County Hospital Medical Library Minute Book, 1810–16; Rules and Catalogue of the Medical Library at the York County Hospital, 1830; with an Appendix to October 1837 (York: R. Sunter, 1837). 33 Rules and Catalogue of the Medical Library, p. 2, appendix, p. 4. 34 BIHR, YMS 1/1/1/1, Minute Book of the York Medical Society, 1832–1844, 16 April 1836. 35 W. F. Bynum, S. Lock and R. Porter (eds), Medical Journals and Medical Knowledge: Historical Essays (London: Routledge, 1992). 36 R. Porter, ‘The rise of medical journalism in Britain to 1800’ and J. Loudon and I. Loudon, ‘Medicine, politics and the medical periodical, 1800–1850’, in Bynum, Lock and Porter (eds), Medical Journals; W. R. LeFanu, ‘British periodicals of medicine: a chronological list, 1684–1899’, Bulletin of the Institute for the History of Medicine, 5 (1937), 735–60. 37 LeFanu, ‘British periodicals of medicine’. 38 Lancet, 20:500, 30 March 1833, p. 23. 39 B. Anderson, Imagined Communities: Reflections on the Origin and Spread of Nationalism, 2nd edn (London: Verso, 1991), p. 7. 40 Anderson, Imagined Communities, p. 30. 41 Anderson, Imagined Communities, pp. 22–36. 42 Lancet, 21:526, 28 September 1833, pp. 31–2. 43 Lancet, 12:303, 20 June 1829, p. 358. 44 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 2 November 1833. 45 Pigot’s General Directory, 1828–9 (Manchester: Pigot and Slater, 1828). 46 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844; City of York Directory (Hull: W. H. Smith, 1843). 47 The only public reference is a notice in the YG, 26 May 1832, recording the end of the Society’s first session. 48 YH, 27 October 1832. 49 Manchester Medical Society Archives, John Rylands University Library, Manchester University, MMS 1/4/1/1, MSS, Minutes of Ordinary and Special Meetings, 1834–1874, 29 October 1834; Sheffield Medico-Chirurgical Society Records, Sheffield University Library, MS 310/1, MSS, Minutes of the Medical Society of Sheffield, 10 October 1847.

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50 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 31 October 1840. 51 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 31 October 1840. 52 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 2 January 1841. 53 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 29 November 1840. 54 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 17 March 1832. 55 Durey, First Spasmodic Cholera Epidemic, p. 2; Morris, Cholera 1832, pp. 24, 41–2. 56 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844. 57 YG, 12 November 1831. 58 Morris, Cholera 1832, p. 33; Durey, Return of the Plague, p. 77. 59 Durey, Return of the Plague, pp. 77–8; Lawrence, Medicine in the Making of Modern Britain, p. 41. 60 Morris, Cholera 1832, p. 33. 61 YC, 15 November 1831. 62 YG, 26 November 1831. 63 YC, 15 November 1831. 64 YC, 10 January 1832. 65 YG, 7 April 1832; YC, 10 April 1832. 66 Durey, First Spasmodic Cholera Epidemic, p. 6. 67 Lancet, 19:476, 13 October 1832, p. 72. 68 Durey, First Spasmodic Cholera Epidemic, p. 5; Durey, Return of the Plague, p. 79. 69 YChr, 1 and 8 December 1831; YG, 13 December 1831; M. Durey, Return of the Plague, p. 85. 70 YC, 28 November 1831; YG, 21 January 1832. 71 YG, 21 January 1832; YC, 10 January 1832. 72 G. Kearns, ‘Cholera, nuisances and environmental management in Islington, 1830–35’, in W. F. Bynum and R. Porter (eds), Living and Dying in London, Medical History Supplement, 11 (1991); C. Hamlin, ‘Public sphere to public health: the transformation of “nuisance” ’, in S. Sturdy (ed.) Medicine, Health and the Public Sphere, 1600–2000 (London: Routledge, 2002). 73 J. P. Needham, Facts and Observations Relative to the Disease commonly called Cholera as it has recently prevailed in the City of York (London: R. Needham, 1833), pp. 63–4. 74 YChr, 24 November 1831. 75 YC, 10 January 1832. 76 YG, 26 November 1831. 77 Morris, Cholera 1832, pp. 129–58, 198, 202–4, 213–14; Durey, First Spasmodic Cholera Epidemic, p. 18. 78 P. Gilbert, Cholera and Nation: Doctoring the Social Body in Victorian England (Albany: State University of New York Press, 2008).

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79 J. V. Pickstone, ‘Ferriar’s fever to Kay’s cholera: disease and social structure in cottonopolis’, History of Science, 22:4 (1984), 401–19; M. Poovey, Making a Social Body: British Cultural Formation, 1830–1864 (Chicago: Chicago University Press, 1995), pp. 55–72. 80 C. Lawrence, ‘Disciplining disease: scurvy, the navy and imperial expansion, 1750–1825’, in D. P. Miller and P. H. Reill (eds), Visions of Empire: Voyages, Botany and Representations of Nature (Cambridge: Cambridge University Press, 1996). 81 C. Hamlin, ‘Predisposing causes and public health in early nineteenth-century medical thought’, Social History of Medicine, 5:1 (1992), 43–70. 82 YC, 10 July 1832. 83 YG, 12 November 1831. 84 YG, 19 June 1832. 85 YC, 26 June 1832. 86 Durey, ‘Medical elites’, p. 274. 87 Morris, Cholera 1832, p. 162. 88 E. Ackerknecht, ‘Anticontagionism between 1821 and 1867’, Bulletin of the History of Medicine, 22 (1948), 562–93; G. P. Parsons, ‘The British medical profession and contagion theory: puerperal fever as a case study, 1830–1860’, Medical History, 22:2 (1978), 138–50; M. Pelling, Cholera, Fever and English Medicine, 1825–1865 (Oxford: Oxford University Press, 1978), pp. 1–35; Durey, Return of the Plague, pp. 105–20; R. Cooter, ‘Anticontagionism and history’s medical record’, in P. Wright and A. Treacher (eds), The Problem of Medical Knowledge: Examining the Social Construction of Medicine (Edinburgh: Edinburgh University Press, 1982); J. V. Pickstone, ‘Dearth, death and fever epidemics: rewriting the history of British “public health”, 1750–1850’, in T. Ranger and P. Slack (eds), Epidemics and Ideas: Essays on the Historical Perception of Pestilence (Cambridge: Cambridge University Press, 1992); Hamlin, ‘Predisposing Causes’; P. Baldwin, Contagion and the State in Europe, 1830–1930 (Cambridge: Cambridge University Press, 1999); M. Brown, ‘From foetid air to filth: the cultural transformation of British epidemiological thought, ca. 1780–1848’, Bulletin of the History of Medicine, 82:3 (2008), 515–44. 89 Pelling, Cholera, Fever and English Medicine, pp. 1–35 90 Ackerknecht, ‘Anticontagionism’, pp. 576–7; Durey, Return of the Plague, p. 118. 91 YC, 28 February 1832. 92 YG, 12 November 1831. 93 G. S. Rousseau and D. B. Haycock, ‘Coleridge’s choleras: cholera morbus, asiatic cholera and dysentery in early nineteenth-century England’, Bulletin of the History of Medicine, 77:2 (2003), 298–331. 94 Needham, Facts and Observations, pp. xiv, 17–20; YG, 21 July 1832. 95 YC, 12 June 1832. 96 Address to the Public from the York Board of Health (York: W. Hargrove, 1832). 97 YG, 14 January 1832. 98 Durey, First Spasmodic Cholera Epidemic, pp. 24–5; Durey, Return of the Plague, pp. 162–84; S. Burrell and G. Gill, ‘The Liverpool cholera epidemic of 1832 and

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111 112 113 114 115 116 117 118 119 120 121 122

123

Performing medicine anatomical dissection: medical mistrust and civil unrest’, Journal and the History of Medicine and Allied Sciences, 60:4 (2005), 478–98. YG, 16 June 1832. YG, 9 June 1832. YG, 16 June 1832. YC, 19 June 1832. For example, H. Heath, A sketch from the Central Board of Health or the real ass-i-antic cholera (London: S. W. Forbes, 1832). YG, 16 June 1832. YG, 18 August 1832. YG, 7 July 1832. YC, 7 August 1832; YG, 11 August 1832. YG, 11 August 1832. YG, 8 November 1834. YH, 2 February 1839. For a more in-depth analysis of the rhetoric of medical heroism and self-sacrifice, see M. Brown, ‘ “Like a devoted army”: medicine, heroic masculinity and the military paradigm in Victorian Britain’, Journal of British Studies, 49:3 (2010), 592–622. Brown, ‘Medicine, reform and the “end” of charity’. Needham, Facts and Observations, pp. xv–xvi. Emphasis added. Lancet, 19:476, 13 October 1832, pp. 72–4 and 20:503, 20 April 1833, p. 111. Needham, Facts and Observations, p. xi. Needham, Facts and Observations, p. xii. YH, 2 February 1839. Emphasis added. M. Foucault, The Birth of the Clinic: An Archaeology of Medical Perception (London: Tavistock, 1973). YH, 2 February 1839. Emphasis added. BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 6 October 1832. BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 20 October, 3 November 1832, 2 and 30 November 1833. BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 15 February 1834. There are numerous local and specialist studies of the Poor Law Amendment Act, but for a more general account, see A. Brundage, The Making of the New Poor Law: The Politics of Inquiry, Enactment and Implementation, 1832–39 (New Jersey: Rutgers University Press, 1978); Brundage, England’s ‘Prussian Minister’: Edwin Chadwick and the Politics of Government Growth, 1832–54 (Pennsylvania: Pennsylvania State University Press, 1988);G. Himmelfarb, The Idea of Poverty: England in the Industrial Age (London: Faber, 1984); D. Englander, Poverty and Poor Law Reform in Britain: From Chadwick to Booth, 1834 –1914 (London: Longman, 1998); C. Hamlin, Public Health and Social Justice in the Age of Chadwick: Britain, 1800–1854 (Cambridge: Cambridge University Press, 1998). YH, 19 August 1837.

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124 Lawrence, Medicine in the Making of Modern Britain, p. 43. See also, A. Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720–1911 (Cambridge: Cambridge University Press, 1994), p. 50. 125 Digby, Making a Medical Living, p. 50; Lawrence, Medicine in the Making of Modern Britain, p. 43. 126 M. W. Flinn, ‘Medical Services under the New Poor Law’, in D. Fraser (ed.), The New Poor Law in the Nineteenth Century (London: Macmillan, 1976), pp. 54–5; Digby, Making a Medical Living, p. 244. 127 Lawrence, Medicine in the Making of Modern Britain, p. 43. 128 M. J. Cullen, ‘The making of the Civil Registration Act of 1836’, Journal of Ecclesiastical History, 25 (1974), p. 39. 129 J. M. Eyler, Victorian Social Medicine: The Ideas and Methods of William Farr (Baltimore: Johns Hopkins, 1979); L. Goldman, Science Reform and Politics in Victorian Britain: The Social Science Association, 1857–1886 (Cambridge: Cambridge University Press, 2002); Goldman, ‘Statistics and the science of society in early Victorian Britain: an intellectual context for the General Register Office’, Social History of Medicine, 4:3 (1991), 415–34. See also, Pelling, Cholera, Fever and English Medicine, pp. 81–112. 130 Such readings have proved suggestive in P. Joshi, ‘Edwin Chadwick’s selffashioning: professionalism, masculinity and the Victorian poor’, Victorian Literature and Culture, 32:2 (2004), 353–70. 131 Cullen, ‘The making of the Civil Registration Act’, pp. 56–9. 132 S. Szreter, ‘The GRO and the public health movement in Britain, 1837–1914’, Social History of Medicine, 4:3 (1991), 435–63; E. Higgs, ‘Disease, febrile poisons, and statistics: the census as a medical survey, 1841–1911’, Social History of Medicine, 4:3 (1991), 465–78. 133 F. Lewes, ‘The GRO and the provinces’, Social History of Medicine, 4:3 (1991), 479–96. 134 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 6 October 1838. 135 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 1 February 1840. 136 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 5 February 1840. 137 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 12 February 1840. 138 BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 20 February 1841. 139 BIHR, YMS 1/1/1/2, MSS, Minute Book of the York Medical Society, 1844–1870, 17 October 1846. 140 Pickstone, ‘Ferriar’s fever to Kay’s cholera’; Poovey, Making a Social Body, pp. 25–72. 141 However, for the continued resonance of personalised pastorship in nineteenthcentury social thought, see L. M. E. Goodlad, Victorian Literature and the Victorian State: Character and Governance in a Liberal Society (Baltimore: Johns

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149 150 151

152 153 154 155 156 157

Performing medicine Hopkins University Press, 2003), especially chapter 2; Goodlad, “Making the working man like me”: charity, pastorship, and middle-class identity in nineteenth-century Britain. Thomas Chalmers and Dr. James Phillips Kay’, Victorian Studies, 43:4 (2001), 591–617. M. Barfoot, ‘Laycock, Thomas (1812–1876)’, DNB; Desmond, Politics of Evolution, p. 84n; F. E. James, ‘The life and works of Thomas Laycock, 1812–1876’ (PhD dissertation, University of London, 1995), pp. 14–23. James, ‘The life and works of Thomas Laycock’, pp. 33–6; BIHR,YCH 1/1/1/1, MSS, Court of Trustees Minute Book, 16 February 1836; BIHR, YCH 1/1/2/1, MSS, Court of Governors Minute Book, 16 February 1836. James, ‘The life and works of Thomas Laycock’, p. 44. L. S. Jacyna, ‘The physiology of mind, the unity of nature, and the moral order in late Victorian thought’, British Journal for the History of Science, 14:2 (1981), 109–32; James, ‘The life and works of Thomas Laycock’, p. 104. Laycock later became secretary to the Statistical Section of the British Association for the Advancement of Science and developed associations with the Statistical Society of London. James, ‘The life and works of Thomas Laycock’, pp. 141–2. BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 12 February 1840; Dublin Medical Press, 4 (1840), pp. 165–6. The term ‘Political Medicine’ had first been used by the London Medical Repository in 1824 as a general term for matters relating to medical jurisprudence. C. Crawford, ‘A scientific profession: medical reform and forensic medicine in British periodicals of the early nineteenth century’, in R. French and A. Wear (eds), British Medicine in an Age of Reform (London: Routledge, 1991), p. 204. Dublin Medical Press, 5 (1841), pp. 167–8. G. Rosen, From Medical Police to Social Medicine: Essays on the History of Health Care (New York: Science History Publications, 1974); P. E. Carroll, ‘Medical police and the history of public health’, Medical History, 46:4 (2002), 461–94. E. Ackerknecht, Rudolf Virchow: Doctor, Statesman, Anthropologist (Madison: University of Wisconsin Press, 1953); D. Pridan, ‘Rudolf Virchow and social medicine in historical perspective’, Medical History, 8:3 (1964), 274–8; B. Boyd, Rudolf Virchow: The Scientist as Citizen (New York: Garland, 1991); I. McNeely, ‘Medicine on a Grand Scale’: Rudolf Virchow, Liberalism, and Public Health (London: The Wellcome Trust, 2002). G. Rosen, ‘The fate of the concept of medical police, 1780–1890’, in From Medical Police to Social Medicine; B. M. White, ‘Medical police. Politics and police: the fate of John Roberton’, Medical History, 27:4 (1983), 407–22. Dublin Medical Press, 5 (1841), p. 168. Dublin Medical Press, 5 (1841), p. 235. Dublin Medical Press, 5 (1841), p. 236. See Hamlin, Public Health and Social Justice, pp. 16–52. Dublin Medical Press, 5 (1841), p. 236. Goodlad, Victorian Literature, chapter 3; Goodlad, ‘Is there a pastor in the “House”? Sanitary reform, professionalism and philanthropy in Dickens’

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175 176 177

178 179 180

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mid-century fiction’, Victorian Literature and Culture, 31:2 (2003), 525–53; Brown, ‘From foetid air to filth’. Dublin Medical Press, 5 (1841), p. 236. Dublin Medical Press, 5 (1841), pp. 315–16. See Hamlin, Public Health and Social Justice, pp. 52–84. S. Gunn, ‘The ministry, the middle class and the “civilising mission” in Manchester, 1850–1880’, Social History, 21:1 (1996), 22–36; Goodlad, Victorian Literature, chapter 2; Goodlad, ‘ “Making the working man like me” ’. Dublin Medical Press, 5 (1841), p. 315. Dublin Medical Press, 5 (1841), p. 314. Dublin Medical Press, 5 (1841), p. 369; Brown, ‘Medicine, reform and the “end” of charity’. James, ‘The life and works of Thomas Laycock’, p. 136. James, ‘The life and works of Thomas Laycock’, p. 137. T. Laycock, Report on the State of York, in Reply to the Questions Circulated by the Health of Towns Commission (York: 1844), p. 1. Laycock, Report on the State of York, p. 1. Laycock, Report on the State of York, pp. 1–3. Laycock, Report on the State of York, p. 3. UCL, Chadwick Manuscripts, MSS, 2181/3135; James, ‘The life and works of Thomas Laycock’, p. 137. London Medical Gazette, 3 (1845), pp. 227–65 and 5 (1847), pp. 1,050–7; YG, 22 August 1845. James, ‘The life and works of Thomas Laycock’, p. 143. UCL, Chadwick Manuscripts, MSS, 1197/9–10 and 1197/11–12; James, ‘The life and works of Thomas Laycock’, p. 143. A. J. Peacock, ‘George Leeman and York politics, 1833–1880’, in C. H. Feinstein (ed.), York, 1831–1981: 150 Years of Scientific Endeavour and Social Change (York: Ebor Press, 1981); Peacock, George Hudson, 1800–1871: The Railway King, 2 vols (York: A. J. Peacock, 1988–89); B. J. Bailey, George Hudson: The Rise and Fall of the Railway King (Stroud: Alan Sutton, 1995); R. Beaumont, The Railway King: A Biography of George Hudson (London: Review, 2002). YG, 26 March 1848. YG, 26 March 1848. I. Burney, ‘Making room at the public bar: coroners’ inquests, medical knowledge and the politics of the constitution in early-nineteenth-century England’, in J. Vernon (ed.), Re-reading the Constitution: New Narratives in the Political History of England’s Long Nineteenth Century (Cambridge: Cambridge University Press, 1996); Burney, Bodies of Evidence: Medicine and the Politics of the English Inquest, 1830–1926 (Baltimore: Johns Hopkins University Press, 2000). YG, 18 May 1848. YG, 20 May 1848. M. W. Flinn, ‘Introduction’, in M. W. Flinn (ed.), Report on the Sanitary Condition of the Labouring Population of Great Britain by Edwin Chadwick

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Performing medicine (Edinburgh: Edinburgh University Press, 1965), pp. 70–1; Hamlin, Public Health and Social Justice, pp. 245–74. YG, 2 August 1848. YCA, York Corporation Minute Book, Acc. B. B. 3, MSS, 6 March 1850. YCA, York Corporation Minute Book, Acc. B. B. 4, MSS, 29 July 1850. 11th and 12th Victoria, cap. 63, section 40. YCA, York Corporation Minute Book, Acc. B. B. 4, MSS, 12 August 1850. P. Joyce, The Rule of Freedom: Liberalism and the Modern City (London: Verso, 2003). Gilbert, Cholera and Nation, pp. 60–3. YG, 9 March 1850. Joyce, Rule of Freedom, p. 66. Poovey, Making a Social Body, p. 53; I. Burney, ‘Bone in the craw of modernity’, Journal of Victorian Culture, 4 (1999), 104–16. Hamlin, Public Health and Social Justice, chapter 8.

6

True heroes and healers: expertise, authority and the making of medical dominion Not any universal Morrison’s Pill shall we then, either as swallowers or venders [sic], ask after at all; but a far different sort of remedies [sic]: Quacks shall no more have dominion over us, but true Heroes and Healers! T. Carlyle, Past and Present (1845)1

I

n 1848 the York p h y s i ci an, Thomas Laycock, contributed an essay on the subject of medical ethics to the British and Foreign MedicoChirurgical Review.2 As a graduate of Göttingen, Laycock was well-versed in German literature and, like his contemporary, Thomas Carlyle, was inspired by the doctrines of idealist philosophy, particularly the work of Johann Gottlieb Fichte. Building upon the intellectual traditions of Immanuel Kant’s ‘critical philosophy’, which sought to move beyond human perception to uncover the ontology of existence, Fichte elaborated a theory of the ‘divine idea’, the spiritual essence which underwrote subjective reality. For Fichte, the task of the scholar was to reveal this essence and to shape human relations in such a way that society might realise its ideal state. Fichte’s philosophy accorded with Laycock’s theological materialism and social activism and in his essay Laycock sought to apply these ideals to the practice of medicine. According to Laycock, the breadth of their responsibilities and their ‘intimate relation to mental philosophy’ meant that medical practitioners embodied many of the elements of ‘that learned culture which leads men “to the attainable portion of the Divine Idea”‘.3 ‘No class of men’, he alleged, ‘not even the clerical order – has exerted itself more disinterestedly and benevolently for the welfare of mankind’.4 As it was the ‘duty’ of the medical practitioner to ‘exert himself for the improvement of his species’, he must be ‘a social reformer in the highest sense of the word’.5 Citing the example of ‘public hygiene’, he presented medicine as a pre-eminent tool for social progress. ‘There can be no doubt’, he claimed, ‘that medical science is to be a mighty moral agent for centuries to come, and that its application to the social and political economy promises the most brilliant results’.6 There was a problem, however. In order to fulfil this important social

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and moral duty, medical practitioners needed to act collectively. ‘Whatever the individual is required to do in accordance with the sound principles of ethics, so much is incumbent on the whole profession, as a part of the body politic’, he claimed.7 And yet when Laycock surveyed the political landscape of medicine what he saw was ‘little better than a chaos’, in which the ‘whole mass is upheaving [and] decomposition and recomposition are going on’. With such turmoil, ‘It is quite impossible that the intelligent lay public will notice the professional desire for organisation and legislation; so long as the impelling motives are nothing more dignified than sectional interests, grade prejudices, or interested clamours in a pecuniary sense’.8 What was needed was unity: of purpose, practice, knowledge and identity. Medical practitioners needed to abandon their concern with customary forms of social ‘respectability’ (‘a phrase of bilious mediocrity . . . a mere pandering to dullness’) and embrace their higher calling.9 They needed to abolish the distinctions of rank and practice which divided them, establish their moral and epistemological authority over the ‘boasting sectarians’ of ‘quackery’ and establish a unified body of knowledge. Laycock was ‘more than doubtful’ that such unity was practicable ‘amidst the jar of contending interests and the clash of prejudices’. Yet there was hope. It came not from ‘influential metropolitan practitioners’, nor from the Colleges. With their metropolitan self-interestedness and ‘club exclusiveness’, they were simply concerned to ‘maintain the status quo’ and ‘establish their differences where there is scarcely any distinction’. Instead, the spirit (and for Laycock it was a spirit) of medical unity was to be found in the provinces, and in particular, within local medical and surgical societies. ‘It is indeed remarkable’, Laycock claimed, that in ‘the numerous medical societies in the provinces of the United Kingdom, all grades combine and act in harmony, without complaining, and without selfishness or pride’.10 This was the model to be emulated and, as Laycock prophesied, it was in the provinces that the medical profession would be forged. ‘We cannot doubt’, he concluded, ‘that the enlightened practitioners in the provinces will ultimately address themselves to the question [of professional unity] [and] place the organisation of the profession on its proper basis’.11 Laycock’s vision of the medical profession was, in some senses, a fantasy, a product of the discrepancy between what was, and what might be, between the manifest realities of a ‘chaos of conflicting elements’ and the potential for a unified medical body in which the ‘selfish interests’ of the individual were ‘disciplined’ to the collective will. Histories of the nineteenth-century English medical profession have traditionally set little store by such visions. Instead they have been concerned to trace the legislative actualisation of the profession, the structural regulation and division of medical labour, epitomised by the 1858 Medical Act.12 Within this interpretive frame the writings of men like Laycock are rendered as little more than failed projections, rejected architectural plans

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that never made it beyond the drawing board. Indeed if one were to take the 1858 Medical Act as the absolute definition of medical professional identity it is easy to see why Laycock’s ideas might appear absurdly optimistic. And yet while they might not reflect the structural realities of medico-political compromise, they nonetheless capture the essence of an emergent and powerful ideology of medical professionalism which was to advance itself with increasing vigour throughout the 1830s and 1840s. Exploiting the new forms of social engagement and symbolic capital engendered by the experience of cholera, many practitioners began to assert the moral, political and epistemological superiority of medicine, to claim that they stood in a unique position relative to the public and the state, and that this position should be realised through legislative enactments which restricted the care of the social body to those with recognised qualifications, talents and abilities. Needless to say, such visions were not universally shared among medical practitioners. Indeed, as Laycock’s writings suggest, they were constructed in direct opposition to the political self-interestedness of the metropolitan medical elites. This is not to say that every provincial practitioner was committed to the ideals of public service and scientific expertise, for many remained wedded to the notion that medicine was a fundamentally individualistic and patient-centred art. Neither is it to suggest that such radical and progressive ideas were unknown in London, for many of their most ardent champions, such as Thomas Wakley, were metropolitan, indeed metro-centric, practitioners.13 Nevertheless, the culture of provincial English medicine made it especially receptive to such ideas. As with the rise of the medical society the fantasy of unity, equality and authority elaborated by reformers and radicals was in many ways a product of self-conscious marginality, both geographic and political. One of the factors which underwrote such claims to authority and expertise was an increasing self-confidence in the supremacy of medical science. In reality of course, little had changed in terms of medicine’s capacity to heal from the late eighteenth century through to the 1830s. The anatomo-clinical developments of turn-of-the century Paris had yet to yield any real therapeutic benefit while physiology and cellular biology remained in their infancy. There had been no chemical revolution to speak of and germ theory still lay some thirty years in the future. Claims about the supremacy of medical science were, then, fundamentally rhetorical, designed to impress upon the public mind the moral authority of orthodox medicine.14 Perhaps the most visible manifestation of this self-confidence was the proliferation of medical schools in towns and cities throughout provincial England. Late eighteenth-century surgeons had often taken apprentices or taught pupils, but from the mid-1820s onwards there was a move towards amalgamating such practices into structured and institutionalised forms. Manchester’s

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medical school was established in 1824, Birmingham’s in 1825, a pattern which was repeated throughout the English provinces in the succeeding two decades. Such developments have hardly gone unnoticed; almost every single English provincial medical school has some kind of published history, official or otherwise.15 But such accounts are often naively celebratory, framed by a teleological conception of medical progress which divests them of meaning. Indeed, despite the recent growth of academic interest in the subject, historical understandings of the explosion of provincial medical education in the early to mid-nineteenth century remain underdeveloped.16 Historians have pointed to the increasing civic self-consciousness of the industrial towns, the convenience of educational conglomeration or economic expediency in accounting for the ‘emergence’ and ‘spread’ of institutionalised forms of medical education. And yet when situated alongside the coterminous proliferation of medical societies and when read against the rhetorical pronouncements of men like Thomas Laycock it clear that such developments were the function of a political agency, the expression of a profound ideological shift which permeated medicine as a nationwide imagined community. This chapter opens by exploring the material manifestation of this shift on a local level. The York Medical School was founded in 1834, a mere two years after the Medical Society. It did not last long and so has rarely figured in historical scholarship. A change to the rules concerning the number of hospital beds required of such an institution seems to have forced its closure at some point in the early 1860s.17 Nevertheless, the discourses surrounding its initial foundation and early operation provide a telling insight into the ways in which such a school functioned as a concrete expression and public projection of an inchoate medical identity founded upon the values of collectivity and scientific expertise, as well as the ways in which the practices of pedagogy promised to perpetuate this identity and the forms of cultural and symbolic capital which attended it. If the foundation of the Medical School was a fundamentally prescriptive act, an attempt to trace and fix, by means of instantiation, the contours of epistemological orthodoxy, then the process by which early nineteenth-century medical practitioners sought to establish the authority of their nascent profession also had a more proscriptive dimension. Laycock was not alone in perceiving the future of medicine to depend upon two related campaigns, one to establish the unity and cohesion of the profession, the other to defeat the ‘boasting sectarians’ of quackery. Of course quackery had animated medical practitioners for generations but it was only during the early nineteenth century that fringe or heterodox practices were framed as an illegitimate affront to the rightful authority of the medical profession and that their elimination became a matter of collective responsibility. The second part of this chapter considers the political, cultural and economic dynamics of this process by

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means of an incident which took place in the very same year as the foundation of the Medical School, an event with which it was both politically and rhetorically linked. In July 1834 Joseph Webb stood trial at the York Assizes for the manslaughter of Richard Richardson, a local linen-draper’s apprentice. Webb was an agent for the sale of James Morison’s Universal Vegetable Medicine and his prosecution was part of a much broader campaign by medical reformers to eliminate this most successful of commercial rivals. However, as the circumstances surrounding this trial reveal, the ‘war’ between Morison and his medical opponents was more than a matter of economic competition. Morison was targeted not so much because of his financial success but because he positioned his business in direct opposition to the authority of orthodox medicine, a stance which won him many supporters among the general public. What Webb’s trial most forcibly demonstrates, then, is that the establishment of medical professional dominion in nineteenth-century England was no natural or inevitable occurrence but was in fact a highly contested process, framed by a much wider conflict between the utilitarian values of statist expertise and the liberal virtues of free-trade and self-governance. York Medical School: the politics of pedagogy The precise origins of the York Medical School are somewhat obscure, but the idea of establishing such an institution was first publicly mooted by the pseudonymous ‘Medical Pupil’ in a series of letters to the York Herald in 1832. That this correspondent was presumably already enrolled in a course of study might suggest that personal convenience was a key motivating factor. Indeed one of his principal complaints was that without a formal ‘school of Anatomy’ the ‘medical pupils of York’ had no opportunity to ‘dissect legally’. This was because, according to the stipulations of the recent Anatomy Act, such practices had to be performed ‘under the direction of an inspector, a fellow of the College of Physicians or Surgeons’, something which could not happen until ‘some spirited practitioner’ took the ‘necessary steps towards obtaining a license’. But the Medical Pupil’s letter also suggests a broader understanding of the issue. For one thing, the very need for such a school was premised on the conception of medicine as a socially instrumental force with the science of anatomy at its heart. A thorough anatomical education, he declared, was of ‘high importance and indispensible necessity’, the only means by which medical practitioners could be made ‘useful to their fellow-citizens’ and that ‘which alone makes the grand distinction between the quack and the scientific practitioner’.18 What is more, he was keenly aware of the implications of such an establishment for shaping and projecting the collective identity of the city’s medical men. Noting the existence of similar schools in Leeds, Birmingham and Hull, he called upon them to emulate their ‘brother practitioners’:

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Shall the faculty of York in general be considered inferior in point of talent, to the faculty of other provincial towns? – have they no luminous body which reflects honour to them as a body of scientific men?19

While chastising local medical practitioners for their tardiness, the Medical Pupil recognised that the recent foundation of the Medical Society was a positive step in the right direction. This ‘primary movement has effected much’, he claimed, ‘and shall hereafter effect much more – this stirring among the doctors shall work powerfully’. The making of the medical professional body was a continuous and active process and as such the ‘the establishment of the York Medical Society [must] be looked upon as the first step towards the formation of a York Medical School’.20 The Medical Pupil had his critics, one of whom claimed that such a school was simply not practicable. ‘He would place Hull, Leeds, and Birmingham, before the eyes of the practitioners of York, in order as it were to shame them’, he suggested, without considering that ‘the dense population of those places . . . would repay the time and trouble of the lecturer’, something which ‘would not be the case at York’.21 The Medical Pupil dismissed such practical objections out of hand, however, suggesting that his respondent was motivated less by reason than by a ‘natural tendency to oppose’.22 Certainly the tide was in the Medical Pupil’s favour for by January 1833 ‘The necessity of establishing a School of Anatomy in this city, ha[d] been generally acknowledged by the medical practitioners’, and he was able to note, with great pleasure, that a recent meeting had obtained an ‘almost general sanction’ for the establishment of such an institution.23 In ‘all great undertakings’, the Medical Pupil suggested, ‘there must be some individual who will come forward and advocate the duty – the necessity – and the unhesitating call to make a beginning’.24 At first it was the experienced medical pedagogue, James Atkinson, who fulfilled that role. He apparently ‘took a warm interest in the school’ and ‘when it was finally resolved that the profession collectively should manifest their wishes and that they should elect teachers’, it was he who chaired the meetings.25 Yet while the retired octogenarian was happy to preside over discussions he was hardly the man to rally his younger colleagues to action and in the absence of a prime mover the plan soon faltered. As Dr Simpson explained, ‘what was everybody’s business was nobody’s business and consequently nothing was done’.26 In effect, however, this impasse allowed the members of the Medical Society to seize the imitative. James P. Needham, one of the founders of the Society, arranged a meeting at his house for ‘those whom he knew to be favourable to the establishment of a school’. Subsequently, a ‘general meeting of the profession’ was arranged, presided over by another of the Society’s founders, Dr Wake, where ‘each individual was requested to state whether he was disposed to become a

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teacher and what department he would take’.27 The influence of the Society is clear from the fact that seven of the ten appointed lecturers were members. Of the other three, only the surgeon, Mr Crummack, was a medical practitioner, the other two being the Unitarian minister and Manchester College lecturer, William Hincks, who was in charge of botanical instruction, and the chemistry lecturer, Thomas Tate. When a prize-giving ceremony was held in 1838, other Medical Society luminaries, including Dr Goldie, also played a conspicuous role.28 Like the Medical Society itself, then, the Medical School was a body which, while it sought to embody the values of unity and collectivity was, in actual fact, the domain of a relatively small number of practitioners. Unlike the Society, however, which operated largely in private, the Medical School was a far more public initiative, if not with regard to its day-to-day operation then at least in terms of its representation. The opening of the School in November 1834 was carried in almost all the city’s newspapers and its inaugural lectures received considerable coverage. The Yorkshire Gazette, for one, was moved to ‘congratulate the profession upon the establishment of an institution in this city, which is calculated so materially to advance the cause of medical science and to generally benefit the pupils’.29 Such progressivist figurings of medical science and practice were a prominent feature of the lectures themselves. Dr Simpson opened the School’s first session with an introduction to the Principles and Practice of Medicine which took place in the theatre of the Yorkshire Museum before a ‘numerous and respectable [audience], consisting not only of members of the medical profession, but of friends to science generally’.30 The highly public nature of the occasion provided an invaluable opportunity to shape and project a very particular vision of medicine and its practitioners. Simpson claimed that the main reason for establishing the School was ‘a desire to exalt still higher the character of the medical profession in this city’.31 He was also keen to place the York Medical School in a historical perspective. Medicine may have had a long history but the specific configurations of knowledge and practice which characterised this venture were, he suggested, the particular preserve of the present: It was remarked that the age in which we live has been strikingly fertile in its inventions, and remarkable for the brilliancy and importance of its discoveries; also for the general diffusion of knowledge; and the ardour and enthusiasm manifested by those persons who are engaged in its pursuit. The medical profession had not been backward to profit by these accessions to scientific knowledge, which the last thirty years had produced, and had led to an inevitable result – the successful cultivation of medicine requiring a general acquaintance, and in many instances, an accurate knowledge, of a greater number of the sciences, than any other profession whatsoever.32

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Other lecturers adopted a similarly teleological framework. In his introduction to the study of Materia Medica, for example, J. P. Needham ‘proceeded to trace the history of the science, from the earliest period at which any traces of medical skill existed, down to the days in which it presented itself to us, adorned and dignified by the brilliant discoveries of the last three centuries’.33 In a later lecture he went even further, suggesting that ‘it is to very modern times that we must look for every thing almost of value in this department of physic’.34 As with Simpson’s lecture, Needham’s rhetoric harnessed history to contemporary claims about the rightful authority of medical science. In detailing the ‘superstition and credulity’ of the past, he therefore collapsed historical time so as to address an issue which was of deep contemporary concern: The absurd trust reposed in medicines of little or of hurtful efficacy, especially in quack medicine, was mentioned as a proof of the credulity which still existed, and which was such as to justify the sarcasm of the foreigner that ‘England is the paradise of quackery’.35

Through their use of history the lecturers of the York Medical School sought not so much to assert the timelessness of medicine as to identify the early decades of the nineteenth century as a fundamentally transformative period, to represent their generation as the one which had seen medicine develop into a truly ‘scientific’ discipline. The narrative here was one of fruition, of realisation, a narrative which was also enacted through pedagogic practice. By providing a single focus for medical education, the Medical School formalised and institutionalised hitherto diffuse and inchoate expressions of knowledge and expertise. Hence the Medical Library, founded in 1810, was subsumed into the School while in December 1834 the Gazette carried the following notice: We understand that James Atkinson Esq., has, with great kindness, lent his anatomical museum to the school of medicine just opened in our city. Such an extensive museum as Mr Atkinson’s, which contains preparations illustrative of anatomy and surgery, is invaluable to the lecturers of the school, and we feel assured that they duly appreciate his great liberality.36

When Atkinson’s comparative anatomical collection had been moved to the Yorkshire Philosophical Society in 1824 his human collections had remained in his house. Their transfer from a private residence to the County Hospital (where the Medical School was based) was thus constitutive of a more general shift from individualistic expressions of medical knowledge to more public and collective representations of expertise. Furthermore, in 1841, two years after Atkinson’s death, the founders of the Medical School entered into a contract with the executors of his estate to purchase ‘the whole of his Museum and Collection consisting of Preparations in Human and Comparative Anatomy together with specimens in Natural History’ for the sum of £170.37 Not only did the Medical School thereby retain Atkinson’s human specimens, they also

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secured his comparative anatomical and natural historical preparations from the Yorkshire Philosophical Society. If the original separation of Atkinson’s collection had marked the splitting of the natural philosophical from the medical, then its re-assimilation within the political and intellectual space of the Medical School was a bold statement about the supremacy of medicine as the meta-discipline of life, a discipline which, within Simpson’s configuration, subsumed ‘a greater number of the sciences’ of which it was composed. However, such representations of the Medical School as the ultimate realisation of medicine’s development into a scientific discipline served to belie the vital role it played in determining that discipline’s epistemological form. After all, the parameters of what constituted ‘medical science’ in the early to midnineteenth century were by no means clear. This period was one of remarkable intellectual fluidity. New fields of study, such as physiology, pathology and microscopy were in their infancy while opinion remained bitterly divided on the subject of phrenology, mesmerism and, to a lesser extent, homeopathy. The records of the York Medical Society indicate that it acted as the primary determinant of medical orthodoxy at the local level. Throughout the 1830s, for example, phrenology was subject to heated debate and in 1843 the Society established a committee to evaluate the reality of mesmeric phenomena.38 Both of these received a general sanction from the Society, not least because in Thomas Simpson and William Dalla Husband they had influential advocates. Homeopathy and hydropathy, by contrast, were roundly rejected, even if they had piqued an initial curiosity. The final testament of epistemological orthodoxy, however, was inclusion in the Medical School curriculum. Alongside well-established subjects such as ‘Anatomy’ and ‘Materia Medica’, the York Medical School found room for developing specialities such as ‘Pathology’, ‘Physiology’, the ‘Diseases of Women and Children’ and ‘Medical Jurisprudence’. As is clear from the proceedings of the Medical Society, the negotiation of medical science took place both at the macro-level of national debate and at the micro-level of interpersonal relations, and reflected the interests and preoccupations of local practitioners. The curricula of such schools could therefore be somewhat idiosyncratic. A case in point is York’s course on ‘Psychological Medicine’, established during the 1850s. This subject was virtually unknown in any equivalent institution of the time and clearly owed its existence to the influence of its convenor, Daniel Hack Tuke, who was assistant medical officer to the York Retreat and the great-grandson of its founder.39 However, while the dynamic nature of contemporary medical knowledge and its local negotiation placed the Medical School in a position to embrace cutting-edge study, these processes were not without their discontents. The fragmentation of medicine into distinct specialisms sat awkwardly with the reforming ethos of unity and universality, as well as having established associations with quackery and

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fringe practices.40 What was cutting edge one day could be anathema the next as specialisms fell victim to a continued process of intellectual realignment. Such would appear to have been the fate of Mr Downing’s lectures on the ‘Diseases of the Teeth’, which were discontinued after a short run, no doubt because his colleagues were keen to distance themselves from the increasingly distinct practice of dentistry.41 If the negotiation of medical epistemological orthodoxy was, in part, a local process then it was also one with profound political implications. As a number of historians have observed, the discourse of scientific medicine functioned as a potent tool of democratic reform.42 The ‘improvement’ of educational standards was seen by many of its advocates as an essential first step to raising the social and political status of those at the lower end of the medical hierarchy. Thomas Laycock, appointed Lecturer in Clinical Medicine to the York Medical School in 1846, believed that the ‘education of medical practitioners is the most important branch of political medicine’, while William Dalla Husband told the members of the Medical Society that the ‘great desideratum of medicine is a better education of its practitioners. Until this is accomplished, no reform can avail’.43 What was especially notable about the establishment of medical schools such as York’s was that they were self-consciously provincial, conceived if not necessarily in direct opposition, then certainly in dialectic tension with the metropolis. The shadow of London loomed large over the initial foundation of the School, critics suggesting that aspiring practitioners would do well to study there rather than agitate for a school in their own city.44 Meanwhile, proponents of the School denied that ‘a better anatomical knowledge might be obtained in London than in York . . . [for] in York we have medical men of the first talent and highest order of attainment in their profession’.45 But it was more than mere civic pride which motivated provincial practitioners to establish rival centres of education. When Thomas Laycock attacked the ‘Cockneyism’ and ‘arrogance’ of metropolitan practitioners he did so not out of a personal dislike of the capital (where he had himself been a student) but rather because London functioned as a metonym for the iniquitous governance of the corporate elites and for a system of education which perpetuated a fallacious and outmoded distinction between the practices of medicine and surgery.46 By contrast with the metropolis, provincial schools such as York rejected such distinctions. Instead, like the unified faculties of post-revolutionary France, to which so many reformers looked for inspiration, they collapsed these two disciplines into one. Their goal was to produce not particularistic physicians and surgeons but general practitioners versed in the universal science of medicine. In this way, provincial medical education was part of a broader reformist agenda in that it sought not merely to instantiate, but through every student who graduated, to replicate and perpetuate the ideals of a unified medical profession. For men like Laycock, the Medical

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School was the very embodiment of the principle that ‘medicine and surgery are indivisible both in theory and practice’, a principle that ‘will amalgamate the old medical corporations, or if they resist, will overturn them’.47 However, if the foundation of the York Medical School was an act of medico-political agency, the material manifestation of a reformist opposition between metropolitan corruption and provincial meritocracy, then the School’s public image was markedly less contentious. When the Medical School held a prize-giving ceremony in 1837 they chose the George Inn, a Tory stronghold, to host the proceedings and asked George Hudson, Lord Mayor and figurehead of York’s Tory faction, to bestow the honours. Thus, while the movement for medical reform had originally been crafted from the ideological and rhetorical resources of Whig-radicalism and while a number of the School’s lecturers would have been personally opposed to Hudson and everything he represented, the elaboration of medical identity and authority was increasingly dependent on a nominally bipartisan public performance. Indeed, in order to maintain as broad and inclusive a front as possible even that radical firebrand, Thomas Wakley, was moved to assert that those who were ‘staunch Conservatives in politics’ could be ‘thorough reformers with regard to medicine’.48 Hudson responded in kind to the invitation extended him, claiming that it was ‘a great gratification to him, and to those around him, to see gentlemen at the head of their profession, and of such high standing in the city of York, meet together on this day, to state the high success of a school they had long laboured to establish’.49 Explicitly partisan it may not have been, but the elaboration of medical professional identity was nonetheless deeply political in the sense that it proposed an unequal power relationship between practitioners and the public. In 1835 the York Herald noted that Dr Simpson, Mr Hopps and Mr Needham had been recognised by the College of Surgeons and the Society of Apothecaries. The York Medical School was ‘now . . . placed upon the same stand as the other Metropolitan and Provincial Schools of Medicine’ and its staff and students could practice in accordance with the terms of the Anatomy Act.50 In this way, the York Medical School made manifest the idea that medicine was a public service in which the unclaimed bodies of the poor might be enlisted. Such institutionalised and legally mandated expressions of medical authority left little room for the expressions of popular resistance which had characterised the cholera epidemic a mere three years earlier. Indeed, in the very same year that it was granted formal recognition, the body of a drowned man who had been fished from the river Ouse was taken to the Medical School where ‘under the provision of the anatomy act’ it was dissected ‘before the students’. When news of the event spread through the impoverished neighbourhoods of the Straith and the Water Lanes, ‘where the man was well known’, it was ‘feared . . . that those who had been the agents in transferring the body to the

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Hospital would [suffer] from popular fury’. However, rather than assaulting these individuals or even marching on the School itself, the crowd did nothing ‘and all at length became peaceable’.51 Morison’s pills: quackery, liberalism and the ambiguities of medical dominion The foundation of the York Medical School marked a key development in the elaboration of medical identity and authority on the local stage. And yet despite this transformation in self-representation, medicine’s dominion was far from hegemonic. Medical practitioners were, as ever, only a relatively small part of a broad spectrum of healthcare which included an increasingly commercialised and competitive market for drugs.52 During the 1830s and 1840s, however, the long-standing antagonism between orthodox and heterodox practitioners was simultaneously intensified and reconfigured by the ideologies of medical reform.53 For their part, regular practitioners figured quackery and other forms of heterodox practice as the antithesis of medical professionalism: superstitious as opposed to scientific, ignorant rather than highly skilled and self-interested as opposed to utilitarian.54 With increasing self-confidence they demanded that non-professional forms of practice be outlawed by penal enactment. Dr Whytehead of Easingwold in the Vale of York spoke for many when he argued that ‘for the safety of the public, and in justice to the members of the medical profession, who by a long and expensive course of study have qualified themselves for discharging their important and responsible duties . . . protection [must] be afforded them from the encroachments of illegal practitioners’.55 Thomas Laycock likewise claimed that ‘quackery’ not only posed a financial threat to practitioners ‘in the legitimate exercise of their profession’ but also inflicted ‘mischief . . . on society’.56 However, if this period saw the rise of an increasingly co-ordinated campaign against medical heterodoxy then quackery was, for its own part, no mere passive target for professional aggression. To be sure, many established patent remedies, such as Daffy’s Elixir, continued to operate within a largely unreflexive culture of commercial retail. But for others, medical heterodoxy could function as a powerful tool of political opposition. Even if they did not tend to burn down medical schools, the public might resist professional authority by embracing remedies and regimens which were conceived in ideological, intellectual and praxial contradistinction to the regular medicine.57 This was the case for two major contemporary health movements, homeopathy and hydropathy, both of which established rival structures of training and practice. But it was perhaps even more pronounced for those systems of treatment which dispensed entirely with the mediatory functions of expertise. Combining the values of popular democracy, domestic self-help

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and economic liberalism these movements asserted the political agency of the individual in the face of professional dominion, making ‘every man his own physician’.58 Tapping into many of the prevailing ideologies of the age these movements gained considerable currency in late Georgian and early Victorian Britain and included such practices as the medical botany of Samuel Thomson and Albert Isaiah Coffin, introduced into Britain from the United States in the later 1840s. First to lead the charge against medical dominion, however, was the so-called Hygeian system of James Morison. James Morison was born in 1770 at Bognie, near Aberdeen, into a family which had ‘long been known as one of great affluence and respectability’. He entered Marischall College aged thirteen, but soon relocated to Hanau, Germany, later residing at Riga in the Russian Empire. Morison subsequently moved to the West Indies, where one of his brothers had property and his brother-in-law had business interests. He appears to have thrived there and ‘acquired considerable West India property’.59 However, while he prospered financially he was racked by infirmity, claiming to have endured ‘inexpressible suffering . . . of body and mind’ for most of his adult life.60 Finding the West Indian climate aggravated these infirmities, he moved to Bordeaux in ‘about 1814’, where he resided for some time.61 Morison allegedly sought the advice of numerous eminent surgeons and physicians, including John Hunter, Everard Home and John Abernethy. He even underwent an operation to remove ‘cartilage’ from his stomach. But when he turned fifty, the failure of his medical advisers convinced him of their error concerning the theory of disease. He reasoned that the root of his illness lay ‘in my bad humours, which, from my stomach and bowels are diffused all over my body’. He therefore experimented with pills composed of vegetable-based purgatives and, after much self-dosing, passed a ‘substance of a skinny, glutinous nature, four or five inches long, moulded like a gut’. Morison identified this as the cause of his suffering, and, in language resonant with the rhetoric of evangelical Christianity, ‘saw the light – the light that guided me to health’.62 Morison claimed that he did not initially intend to market his perfected medicine, but simply to ‘give it to the world’. Having moved to London by the mid-1820s he therefore set about lecturing and writing copious tracts ‘to make his views publicly known’. He even ‘took up sick persons from the open streets and cured them of their ailments’. However, as one of his later supporters noted: He enthusiastically used every effort to get his system adopted, for the mere sake of doing good – but his efforts were unminded. What was he to do? To conceal his own light under a bushel, and deprive mankind of the benefits of his experience? That would have been unchristian, unfeeling and dishonourable to himself. He chose the better course – to act the man and the philanthropist.63

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In 1825 Morison established a factory in Claremont Place, off Judd Street, London, where he manufactured two types of pill, the ‘No. 1’ and ‘No. 2’, denominated the ‘Vegetable Universal Medicine’.64 Their composition soon became a matter of medical interest and debate (Morison never revealed his ‘secret’), but they appear to have contained a mixture of aloes, gamboge, jalap, cream of tartar and colocynth, all of which had emetic or purgative effects when ingested.65 Initially, Morison was the sole proprietor, but by 1830 he had entered into partnership with Thomas Moat, a Devonshire businessman and a convert to his ‘system’.66 The product, popularly known as ‘Morison’s pills’, became enormously successful and, sold through a network of local agents, made the two men rich. By 1833 they had sold 80,000,000 pills and in that year alone they paid some £10,000 in stamp duty.67 Morison was not simply a businessman, he was also an ideologue. Unlike many quacks of the earlier period who ‘clung to the . . . coat tails’ of orthodox medicine, Morison ‘had designs on men’s minds’ as much as on their pockets.68 His system of medicine, which he called ‘Hygeiaism’ or ‘Hygeism’ after the Greek goddess of health, was consciously and ontologically opposed to contemporary medical orthodoxy. For Morison, blood was the primum mobile of life and the seat of all disease. Illness was produced by ‘obnoxious matter’ impeding the blood’s circulation and cured by purging it from the body. Morison saw this as a resurrection, and partial revision, of humoral pathology, which he situated against contemporary ‘organic’ medicine. ‘Organic’ medicine, he claimed, ignored the fundamental simplicity and unity of the body and treated the human frame and its ailments as a ‘patchwork’, a system that resulted in ‘a labyrinth of tales, ideas, system and conjecture’.69 In his rhetoric Morison sought nothing less than the complete overthrow of orthodox medicine. From the mid-1820s onwards, the Hygeists (as his supporters were known) engaged in a propaganda war against the medical profession on a variety of fronts. They not only regarded medical theory as fundamentally wrong, but also denounced established therapeutic techniques (particularly blood-letting and mineral-based medicines) as ‘murder’ and characterised pathological anatomy as a ‘bastard science . . . invented partly to amuse, and partly to torture mankind’. Medical practitioners were, in short, ignorant, incompetent, vicious and greedy, seeking at every turn to extend their ‘guinea trade’.70 While Morison attacked doctors and surgeons, he also mimicked their institutional structures and discursive practices. In 1828, he moved his business into imposing new premises in Hamilton Place off the ‘New Road’ (now Euston Road) which he called the ‘British College of Health’.71 In accordance with this corporate image, he titled himself ‘President’, his partner, Thomas Moat, ‘Vice-President’ and his agents ‘Honorary Members’.72 The Hygeists published numerous books, including the Origin of Life and Cause of Disease,

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Clearly Explained (1828) and The Hygeian Treatment of the Diseases of India (1836) and, from 1842, a journal called The Hygeist, which ran editorials, letters and essays opposing the medical profession and promoting the Hygeian system. They even established a Dispensary in Exeter, where the poor were treated gratis in accordance with their principles.73 Like contemporary medical and surgical societies, they also held public lectures and meetings wherein they discussed individual case studies.74 However, while they may have emulated its structural forms, at least at the highest levels, the Hygeists did not seek to replicate the ideologies or aspirations of medical orthodoxy. Quite the contrary in fact, for despite their superficial performance of professionalism the Hygeists were opposed to the very concept of expertise upon which contemporary claims to medical authority were founded. Health was not a complex phenomenon requiring expert training and intervention. It was a simple, even divine truth, accessible to all. Morison was, then, a mere conduit: That desired knowledge, and that light, which are the offering of heaven to universal man, without regard to school, class, corporation, colour, country, and clime, shone into one mind – and that was the mind of JAMES MORISON.75

In this way Morison and his followers advanced a radically democratic epistemology in which health became a matter of individual responsibility (albeit mediated through a network of commercial exchange). Possessed of a copy of his book, Morisoniana (1829), and provided with access to his pills the public could dispense entirely with what the Hygeists derided as a Puseyite ‘medical priesthood’.76 Cynical and self-interested though such claims might appear they were framed by, and resonated with, a well-established tradition of popular radicalism. Many Owenites, Chartists and other radicals embraced alternative therapies precisely because they positioned health as a universal right analogous to political subjectivity. Operating outside the inchoate structures of medical professional authority, the Hygeian system allowed for a domestic model of self-help which paralleled grass-roots models of political organisation. Hygeiaism was not intellectually sophisticated or theoretically credible enough to garner the support of middle-class radicals in the way that homeopathy and vegetarianism were to do during the mid-century decades. But the very intuitive simplicity of the system combined with its low cost nonetheless made it extremely popular among the working classes.77 Had Morison simply sold his pills as a counterpart to orthodox medicine he might well have escaped the attention of the profession. However, by invoking the language and ideology of radical reform Morison exposed the tensions and ambiguities inherent in medicine’s own self-image. After all, while medical reformers were increasingly presenting themselves as politically bipartisan the movement had drawn heavily from the cultures of political radicalism.

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And yet for many political radicals the apparently monopolistic claims of medical men, that they alone should be the legally recognised purveyors of healthcare, were an anathema to the true cause of reform, namely the political liberty of the democratic subject. By couching their movement within the language of a progressive ‘march of intellect’ and by identifying medicine as a symptom of ‘Old Corruption’ the Hygeists threatened to pull the political rug from underneath medicine’s feet, positioning themselves as the only true champions of liberty and freedom:78 The same observation will serve to evince the hypocrisy of Doctors when affecting to join in the political movement by echoing the cry of reform. Their system is literally based on corruption; corruption is indispensably necessary to its very existence; it must therefore either remain as it is, or be entirely annihilated.79

It is therefore hardly surprising that Morison was so despised by many medical reformers. Neither is it any coincidence that, during the 1830s, they engaged in a concerted attempt to discredit, and ultimately destroy, the Hygeian movement. Inspired by the case of St John Long, who had been charged and eventually convicted of manslaughter in 1830, these men sought to harness the spaces of the coroner’s inquest and criminal court to their ends.80 In their semi-public and political dimensions, both of these routes provided that mixture of judicial coercion and public ‘instruction’ which would define the medical anti-quackery movement of the mid-nineteenth century. And it was in York, with the trial of Joseph Webb, that the campaign was to begin. Joseph Webb was the owner of York’s ‘London Coffee House’ and the local agent for the sale of Morison’s pills.81 In June 1834 he was asked by Thomas Sowray, a local linen-draper, to attend his twenty-year-old apprentice, Richard Richardson. Richardson had complained of a rash on his chest which he feared was a sign of smallpox. Webb administered Morison’s pills, usually twenty a day, ten in the morning and ten at night. When Richardson’s condition failed to improve, Webb asked him if he wished to see a doctor. According to Webb’s lawyers, Richardson replied in the negative, confessing himself ‘quite satisfied with Mr Webb’.82 On the morning of 27 June, however, Richardson complained that he felt much worse, and, under pressure from Richardson’s mother, Webb allowed the family surgeon, James Allen, to call on him. When Allen arrived he pronounced Richardson to be in the advanced stages of smallpox, ordered that the room be well ventilated and applied some ‘cordial medicines’.83 In spite of Allen’s efforts Richardson died a few hours later. Following Richardson’s death an anonymous woman (most probably his mother) sent a letter demanding an inquest to the city coroner, and, after some deliberation, one was arranged.84 The post-mortem examination was carried out by Drs Wake and Belcombe, together with Messrs Allen and

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Matterson. All four were in agreement that the application of Morison’s pills had, at the very least, accelerated Richardson’s death. This opinion was communicated to the jury, all but one of whom passed a verdict of manslaughter.85 Webb was therefore ordered to appear before the Summer Assizes. The coroner’s verdict excited much interest and was reported in all the local newspapers. When the trial eventually took place the York Courant noted that: An intense anxiety has prevailed since the commencement of the Assizes respecting the issue of this trial, partly on account of the public feeling on the efficacy of this popular patent medicine, partly too by the interest taken in the question by members of the medical profession.86

In his brief, Webb’s counsel claimed that public opinion regarding Morison’s pills was split between those who had benefited from their use and those who vehemently opposed them. The latter group was ‘still the most numerous’ and included ‘nearly the whole body of medical practitioners’. ‘In York’, he added, ‘it is believed the influence of the medical men prevails, and a good deal of prejudice still exists on the subject’.87 Although Webb was on trial, it was the much wider question of medical authority that was at issue. The prosecution’s evidence consisted almost entirely of expert testimony and their case questioned the very right of laypersons to treat illness. The trial took place at a time when local practitioners were setting about the foundation of the Medical School and for the prosecution such pedagogic institutions served as a powerful justification for medicine’s dominion over the field of healthcare: Gentlemen, one cannot but lament that in a country like this, where there are so many colleges and medical schools in every town for the education of professional persons, where honours and degrees are confirmed, and where there are so many men of skill and science; one cannot, I say, but lament that there should be people, who, possessing no skill, whatsoever, should be applied to in time of sickness to administer some medicine or other which they pretend is applicable to every species of disease.88

By contrast, the defence sought to uphold lay rights and to resist the unbridled extension of medical authority, claiming that to find against Webb would be ‘to gratify and flatter doctors . . . and licentiates in physic’. Their evidence consisted of numerous ‘respectable’ members of the public who testified to the successful use of Morison’s pills. They did produce one medical practitioner, the York surgeon, James Overton, but even he considered Morison’s pills to represent an ‘extreme’ and ‘violent purgation’ and dismissed them as a ‘quack medicine’. In his summing-up speech, the judge, Lord Lyndhurst, deferred to medical authority, pointing out that Overton was the ‘only medical gentlemen of any consequence called on the part of the prisoner’, and noting that even he

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recognised the potentially deleterious effects of Morison’s pills. The jury were similarly convinced. After only ten minutes’ deliberation, they found Webb guilty of manslaughter, albeit with the recommendation of clemency. He was sentenced to six months in prison.89 Webb’s trial generated intense interest in the medical press. The Lancet welcomed the verdict, while expressing disappointment that Morison had not himself been charged. ‘If the sale of secret medicines be not suppressed by law’, it claimed, ‘the work of medical reform will not be rendered complete in this country’.90 Even the more conservative London Medical Gazette was enthused, claiming it was the ‘duty’ of medical practitioners to bring similar cases ‘to the cognisance of the public through the medium of legislative investigation’. If they could not secure criminal proceedings, by publishing their ‘findings’, they might subject such practitioners ‘to shame and ignominy at the bar of public justice’.91 Webb’s trial did indeed act as the catalyst for a more widespread campaign against Hygeiaism. Between 1834 and 1850 there were nine coroner’s inquests at which, on the basis of medical testimony, it was deemed that death had been directly caused, or at least accelerated, by an inflammation of the bowels and intestines occasioned by the ‘immoderate’ use of Morison’s pills. In two further cases, Morison’s agents were charged with manslaughter. One of these cases involved Robert Salmon, Morison’s principal agent in London, and ended with his being charged with the manslaughter of Captain John Mackenzie, of Limehouse, the master of a West Indian merchantman. Salmon was shown clemency and only fined £200. However, when Thomas La Mott, Morison’s agent in Hull, appeared before the York Assizes in March 1837 for the manslaughter of Rebecca Russell, the wife of an East Yorkshire mariner, he received no such leniency. The judge, Lord Lyndhurst, noted that the lessons of the Webb trial (at which he had also presided) had not been learnt and so he sentenced La Mott to nine months in prison.92 As with the Webb case, both of these trials functioned as an arena for the negotiation of medico-political authority. The Times noted that the Mackenzie inquest ‘engaged the marked attention of the faculty, and several eminent physicians and surgeons, who have daily attended’. Ranged against them were ‘agents for the sale of Morison’s hygeist pills and other vendors of patent medicines who have also taken great interest in the investigation’.93 In both trials, the prosecution’s case asserted the legal and moral supremacy of orthodox medicine over fringe practice and, ultimately, self-medication.94 Their evidence consisted almost entirely of medical men, who provided anatomo-pathological and physiochemical testimony as to the potentially fatal effects of the Universal Medicine. Meanwhile, with the exception of the occasional medical practitioner, notably Robert Lynch, a physician turned Hygeian lecturer, the defence witnesses were overwhelmingly drawn from a

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modest but ‘respectable’ section of the lay public.95 Called upon to demonstrate the efficacy of Morison’s pills they recounted how they had been ‘failed’ by orthodox medicine and ‘cured’ by the pills. Several of these witnesses appeared in more than two of the trials and many were probably ‘encouraged’ by Morison to provide testimony. Nevertheless, they represented a powerful voice for ‘patient power’, or rather ‘consumer power’, in the face of medical authority. Such evidence could backfire, however, in a court whose predominantly middle-class audience was generally receptive to the claims of orthodox medicine and dismissive of the bodily cosmologies of the working classes. In La Mott’s trial for instance, the audience frequently burst into laughter when defence witnesses recounted their ‘cures’. One particularly protracted outburst accompanied the testimony of Joseph Lees of Manchester who claimed that ‘The pupil of one of his children’s eyes had, from a fright his wife received previous to her confinement, been turned nearly into the inside of the socket’, but that, after treatment with Morison’s pills, it ‘was now in its proper place’.96 The relative authority of medical knowledge within the courtroom was a prominent contemporary issue, for it was at this time that medical reformers like Wakley were campaigning for the medicalisation of the coroner’s inquest.97 Hence, in relation to the Mackenzie case, the Lancet argued it was ‘absolutely necessary that the power and ascendancy of the science of medicine should be instantly acknowledged by the non-medical officers who preside in those courts’.98 And yet it is clear that in the 1830s this was not always the case. At the Mackenzie inquest, for example, the coroner repeatedly directed the jury to the ‘strong evidence in favour of the pills’, while the judge in the Salmon trial maintained that whether or not the defendant claimed to be a medical practitioner was irrelevant to the case because all medical men, regular or not, were equal in the eyes of the law.99 These three trials undoubtedly constituted a key victory for the medical profession against their Hygeian opponents, not least in the fact that they strengthened the legal precedent, established some years before by the King vs. Simpson, that, regardless of whether or not he charged for his services, ‘no man is at liberty, by the law of the land, to take upon himself to prescribe medicine, unless he is a competent medical scholar’.100 And yet they singularly failed to destroy Hygeiaism, heterodox practice or the proprietary medicine trade. They probably encouraged Morison to leave London for Paris in 1839 (where he died in 1840) but his pills continued to sell in large numbers.101 One reason for this lay with the limitations of the precedent. In the absence of statute or a formal system of licensing, what constituted a ‘competent medical scholar’ remained a subjective matter. Likewise, the precedent was targeted at prescription, not retail. It may have discouraged quacks from acting in the manner of orthodox practitioners but it could not, and was not intended to,

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prevent them from selling their product. Most importantly of all, however, the war between the medical profession and Hygeiaism reflected a much broader conflict in early Victorian society which was to prove crucial in determining the boundaries of medical professional authority. When Webb was released from prison in on 12 January 1835, he was met by Morison and Moat, and escorted to the Merchant’s Hall in York, where a crowd of fellow Hygeists were gathered. There, he was presented with an elaborate silver epergne, inscribed to the ‘First Hygeian Martyr’ from ‘upwards of 48,000 advocates of . . . Medical Liberty . . . and ENEMIES OF PERSECUTION’.102 Though the rhetoric was hyperbolic there could be little doubt that there was a concerted medical campaign to destroy Hygeiaism. As one activist claimed: Nothing can be more clear, than that this victimising of Mr Webb, personally, was not the sole aim of the junta of Doctors at York, but a mean subterfuge of the Faculty to disparage the efficacy of a new mode of treating human sufferings, which they found was alleviating and curing all complaints at so easy and cheap a rate.103

Even those who were not active Hygeists had their suspicions. In November 1834, for example, a local ‘Rate Payer’ wrote to the York Herald complaining of the ‘injustice of paying for the expenses of the prosecution of Mr Webb, out of the county rates’ because ‘the prosecution was not for the public good, but solely at the instance of the doctors, to promote their private interest’.104 By demanding that the state recognise and guarantee their unique legitimacy in the field of healthcare medical reformers ran up against a central tenet of the increasingly prevalent doctrine of economic liberalism. Drawing upon the political economic theories of Adam Smith and David Ricardo, early to mid-century liberals maintained that the public interest could only be guaranteed by an open market characterised by free and fair competition and divested of monopolies and protective restrictions. Rather than legislating in favour of medicine, Webb thought that the government should be legislating in favour of the free market: I hope to live to see an enactment made, that every person, when ill, may send to a Doctor, if they like, or to a Hygeian agent . . . where most are cured, the money will go; for in this enlightened age, people like to go with their money to the best market. Why not a competition in medicine as well as in everything else? Are Doctors heaven-born, or do they cure all they go to? If there is a benefit, let the public have it. We have now competition in every trade, and are obliged to submit.105

Also, whereas political economics proposed a model of consumer rationality based upon an individualised assessment of skill and ability, the form of

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authority demanded by medical reformers was of a more abstract and collective kind. A medical practitioner, they maintained, should be recognised as competent solely by his possession of the requisite qualifications rather than by any subjective definition of merit.106 For many contemporary observers this was unconscionable.107 As the Hygeist put it, ‘all monopolies, or exclusive privileges of any sort are injurious to the public and repugnant to common sense . . . Because a profession which cannot support itself by its own merits, should not be forced by enactment on the public – more especially that of medicine’.108 What is more, by championing the ‘Medical Liberty of the Subject’, the Hygeists harnessed a liberal shibboleth whose significance went far beyond the realm of economics. In their attempt to establish a monopoly over healthcare, medical reformers did not simply contravene the doctrines of laissez-faire capitalism, they undermined the very freedom of the individual: [A]ll exclusive privileges granted to any party, must of necessity give them power, either directly to encroach upon the liberties of society, or else to prevent others from doing what they have a just right to do . . . Of this description is the medical monopoly.109

According to the Hygeists the realm of healthcare was especially sacrosanct and inviolable. After all, they suggested, short of salvation there was nothing so dear to man as his physical well-being. The enforcement of a medical monopoly would not only be a restriction on freedom of action; it would be an affront to freedom of conscience, tantamount to the abolition of religious self-determination.110 Medical reformers therefore faced an extremely difficult task in squaring their vision of a state-sanctioned professional dominion with the dictates of political and economic liberalism. Problematic enough in the mid-1830s it became even more challenging as the decade wore on and into the 1840s when the ever more vigorous campaign to repeal the Corn Laws pushed the issue of economic protectionism to the forefront of the national political consciousness. Indeed, so contrary to the prevailing political mood did such ambitions appear that more moderate reformers either wavered or revised their opinion entirely. In an article for the Quarterly Review, for example, Sir Benjamin Brodie, argued that while most ‘quack’ remedies and treatments were useless, and even potentially dangerous, to outlaw unlicensed practice was both impractical and improper. ‘[I]f the art of healing had attained perfection’, and ‘physicians and surgeons could cure all those who apply to them’, that would be one thing. However, as things stood, ‘would not such a proceeding be a very tyrannical interference with the right of private judgement?’111 The London Medical Gazette, which had originally supported the prosecution of

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unlicensed practitioners, likewise abandoned its earlier position, arguing that ‘each individual in society has a right to consult whom he pleases’.112 In language which meshed libertarianism with a conservative rhetoric of the ‘freeborn Briton’, it claimed that legislation might indeed eliminate ‘quackery’, as it had supposedly done in Prussia, but that the ‘price’ of this ‘iron hand of authority’ would be ‘the abrogation of liberty, in speech, writing or action, and the consequent conversion of men into infants six feet high’. The medical profession, it concluded, ‘must be content with the mingled yarn of liberty and take the evil with the good’.113 By contrast, more radical reformers continued to press their case. In so doing, however, they were careful to distance themselves from any potential charge of economic self-interest. As one correspondent wrote to the Lancet in 1842: So far as these principles go they are unexceptionable, but their advocacy implies no great stretch of philanthropy. Class selfishness, or the esprit du corps, would naturally suggest to the great majority of the profession the expediency of suppressing quackery, or of re-establishing civil equality amongst the members, and more particularly of enforcing uniformity of qualification, to be tested by a sufficient examination. But these narrow professional views extend no further than the formation of an enlarged monopoly.

In order to avoid this charge, medical practitioners had to aspire to a higher purpose: The communality of the medical profession desire in the alterations in the law which they advocate, that their particular interests should be consulted so far, and only so far, as they may be proved to be identical with the interests of the public. They ask nothing for themselves exclusively; they demand the establishment of a universal good.114

Once more, then, the philosophy of utilitarianism provided the foremost ideological justification for the exercise of medical professional dominion. Medical practitioners were not self-interested tradesmen; they were fundamentally disinterested public servants who sought nothing less than the health and welfare of the social body. If the popularity of patent medicines and unlicensed practitioners proved anything, it was that the consumer was no adequate judge of merit or skill. The public therefore needed protecting from itself by preventing anyone without appropriate qualifications from attending to the sick. Thomas Wakley, like many of his radical associates, was no supporter of the arch Malthusianism of much political-economic thought, but he was generally sympathetic to the ‘doctrine of free trade and non-interference’, which he regarded as ‘sound in principle’. However, when it came to medicine, ‘its friends expose[d] it to the discredit of absurd and mischievous applications’.115 As he argued:

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We are no friends to monopoly. We are aware of the advantages of competition, and have no desire to infringe upon the rights of every man to exercise any profession to which he may devote himself . . . We do not ask for anything so contemptible as ‘protection’ for, thank GOD, we are able to protect ourselves . . . What, then, can be more advantageous to the public than to say that all who will establish their competency shall be at liberty to practice medicine; but that unqualified persons shall not attend as medical advisers, nor be permitted to tamper with the lives of Englishmen? This restraint on the ‘freedom of trade’ would be of precisely the same character as legal restraints on murder and suicide: would it be less wise and reasonable?116

Medical professionalism and its discontents were thus framed by a much broader tension in early Victorian liberal thought between the utilitarian values of state management and scientific expertise and a more libertarian and political-economic conception of social relations in which freedom of trade, action and conscience were paramount.117 Neither vision achieved absolute supremacy. After all, while the 1840s saw the repeal of the Corn Laws and the apparent triumph of free trade, the mid-century period also saw the rise of a more interventionist and Benthamite approach to social policy in which health and medicine were deeply implicated. The Public Health Act of 1848, the Compulsory Vaccination Act of 1853 and the numerous Factory Acts of the period all hinged upon the idea that in order to protect the health and welfare of the public, there were aspects of social and economic life in which market forces and individual liberties had necessarily to be curtailed.118 Needless to say, this appeal to statist utilitarianism had its critics, even from within the medical profession itself. The Westminster Review had been established in 1824 as an organ of Benthamite philosophy, but in 1856, its editor, the physician John Chapman, published an article entitled ‘Medical Despotism’ in which he refuted recent proposals to grant legal recognition to the medical profession and protect it from unlicensed competition. Chapman was frustrated by the fact that, while the repeal of the Corn Laws had apparently signalled a move ‘in the direction of free trade’, the government had repeatedly passed legislation ‘in diametrical opposition to the principles which it proclaims’. Pointing to the France of Louis Napoleon, he asserted that any move towards the creation of a ‘State medicine’ with a governing Medical Council would ‘pave the way for the insidious advance of centralized tyranny’.119 Under a centralised and interventionist regime, he argued, ‘the citizens, deprived of the discipline of self-help and abandoned by the spirit of liberty, lose their manliness, independence and vigour’ and ‘will need an increasing amount of State protection and intervention in proportion as the habit of self-reliance diminishes’.120 Rejecting the claim that the ‘medical body’ was ‘of so exceptional a nature, and that it stands in so peculiar and

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responsible a relation to the public’ that it required ‘legislative protection’, he concluded that the public good, and medicine’s own development, could only be guaranteed by severing its connections with the state.121 Others held to the alternative position, however. In the very same year that Chapman’s article appeared in the Westminster Review the Cheltenham physician Henry Wyldbore Rumsey published his Essays on State Medicine. Like Laycock and unlike Chapman he was inspired by continental developments and in his book he outlined a novel and comprehensive ‘STATE AGENDA, for promoting the physical welfare of the people at large’.122 Regarding the current system of healthcare provision and medical governance as irrational and inefficient he proposed a more centralised system in which a state-run Council of Health would regulate medical practice through the medium of evenly sized district authorities. This council would not only provide systematic healthcare relief for the poor, replacing the existing provisions of the poor law and voluntary charities, but would also determine the form and content of medical education and regulate the number of medical practitioners in any given area.123 The ‘fallacy’ had long prevailed, he claimed ‘that “medical relief”, as we call it, is a commodity . . . that it is an article to be procured, like food or clothing, for a specific necessity – and, therefore, that it may be provided, like any other comfort of convenience of life, by ordinary traffic, as between buyer and seller’.124 Health was not a commodity, he maintained, it was a fundamental right of citizenship, an integral part of the state’s duty of care.125 For Rumsey, as for many other medical reformers, this fact transformed the relationship between the medical profession, the public and the state and served to justify the legislative elimination of all non-professional forms of practice. As one provincial opponent of quackery put it in a letter to the Lancet in 1846, the truly professional medical practitioner perceived his work ‘in a higher or better light than that of a trade’. He ‘feels a pride in believing it to be part of his high vocation . . . to do all that in him lies for the protection of the public health. He knows that no department of human knowledge furnishes its votaries with such a powerful means of benefiting their fellow men as the science of medicine’: It is thus that a high-minded member of the profession feels that his calling is one entitled to public respect and gratitude; and it is from realizing this lofty idea of his profession, that he comes also to entertain a sentiment of true and chivalrous loyalty to it, so as to resent, as a personal injury, the unworthy conduct of any of its members, through which stain and discredit may attach to it. And need I ask if it be possible for our profession to maintain in public esteem the high and honourable character with which it is invested by all who love it, when [there still exists] a pestilential knavery, which . . . battens on the credulity of those whose sanguine hopes make them a too easy prey for the cupidity and wickedness of the quack.126

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Conclusion Mid-nineteenth-century English medicine was not determined by ideologues like Chapman or Rumsey but was shaped, through compromise and contention, by the dialectical intellectual and political forces of technocratic statism and liberal individualism. Nevertheless, what is remarkable is the degree to which, by 1850, the cultures of provincial medical practice had been transformed. In York, the forms of identity initiated by the foundation of the Medical Society and Medical School were to find their highest expression when, in 1842, a number of local practitioners established the ‘York District [later Yorkshire] Branch’ of the Provincial Medical and Surgical Association (PMSA). The PMSA had itself been founded, by Sir Charles Hastings, in 1832 and in 1856 would change its name to the British Medical Association, the body which, to this day, represents the interests of the medical profession. The members of the Yorkshire branch dedicated themselves both to the improvement of medical knowledge and to the political realisation of medicine’s social role. Like the anonymous correspondent to the Lancet they defined themselves as men of unique scientific skill whose calling in life was to deliver the public from disease and physical infirmity and who were members of an abstract, pan-national professional body which commanded loyalty, devotion, even love. Medicine, they contended, was not an individualistic pursuit, it was a noble public duty and collective responsibility. Addressing those who had yet to join their body, they therefore asked them to consider that every station has its duties, and that they would do well to reflect whether it is not their bounden duty to endeavour by their own exertions to raise the character of their Profession, and to hand down its exercise to their Successors ennobled and dignified by their own disregard of self, and by their anxious zeal to add to its respectability, extend its usefulness and assist in the cultivation of that Science, which is so interwoven with the comfort and wellbeing of their fellow-creatures, and your Council would confidently appeal to their unbiased judgements whether such an Institution as this does not offer a most eligible field for the exercise of their zeal and talent, for it cannot be denied that the many combined will often effect what would be wholly out of the reach of the solitary efforts of each.127

What is more, while heterodox forms of practice continued to attract converts and customers and while there were many who remained sceptical of medicine’s capacity to heal and wary of its political pretensions, such visions of the medical profession appear to have been gaining increasing currency within the public imagination. This chapter opened with a quotation from Thomas Carlyle’s celebrated collection of essays, Past and Present (1843), the fifth chapter of which is entitled ‘Morrison’s [sic] Pills’. In reality this essay is not concerned with medical authority or the challenge of quackery. Instead,

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Carlyle uses the Universal Medicine as a metaphor for denouncing the idea that the social ills of the nation might be remedied by some political panacea. Nevertheless, for metaphors to function they must resonate. Hence, while Carlyle’s diseased body was of the political rather than corporeal kind, for an increasingly large number of people in Victorian Britain when it came to physical health it was not quacks but rather the medical profession who were the ‘true Heroes and Healers’.128 Notes 1 T. Carlyle, Past and Present, 2nd edn (London: Chapman and Hall, 1845), p. 34. 2 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, 1–30. 3 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 25. 4 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 2. 5 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, pp. 14, 16–17. 6 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 16. 7 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 29. 8 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 29. 9 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 21. 10 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 29. 11 British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 30. 12 For example, see I. Waddington, The Medical Profession in the Industrial Revolution (Dublin: Gill and Macmillan, 1984); I. Loudon, Medical Care and the General Practitioner, 1750–1850 (Oxford: Oxford University Press, 1986). 13 For example, see Lancet, 27:686, 22 October 1836, p. 173. 14 J. H. Warner, ‘The idea of science in English medicine: the “decline of science” and the rhetoric of reform, 1815–45’, in R. French and A. Wear (eds), British Medicine in an Age of Reform (London: Routledge, 1991) 15 H. A. Ormerod, The Early History of the Liverpool Medical School from 1834 to 1877 (Liverpool: Liverpool University Press, 1953); J. H. Wetherill, ‘The York Medical School’, Medical History, 5:3 (1961), 253–69; S. T. Anning, ‘Provincial medical schools in the nineteenth century’, in F. N. L. Poynter (ed.), The Evolution of Medical Education in Britain (London: Pitman Medical, 1966); W. Brockbank, ‘The early history of the Manchester Medical School’, Manchester Medical Gazette, 47 (1968), 43–7; S. T. Anning and W. K. J. Wallis, A History of the Leeds School of Medicine: One and a Half Centuries, 1831–1981 (Leeds: Leeds University Press, 1981); H. Vallier, ‘The history of the Manchester medical school’ (PhD dissertation, University of Manchester, 2002). 16 J. Reinarz, ‘The transformation of medical education in eighteenth-century England: international developments and the West Midlands’,  History of Education, 37:4 (2008), 549–66; Reinarz, ‘Unearthing and dissecting the records of English provincial medical education, c.1825–1948’, Social History of Medicine, 21:2 (2008), 381–92.

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YH, 6 June 1903 (supplement); Wetherill, ‘York Medical School’, pp. 267–8. YH, 20 October 1832; 3 November 1832. YH, 20 October 1832. YH, 20 October 1832. YH, 27 October 1832. YH, 3 November 1832. YH, 26 January 1833. YH, 20 October 1832. YG, 8 May 1838. YG, 8 May 1838. YG, 8 May 1838. YG, 8 May 1838. YG, 13 September 1834. YH, 1 November 1834. YG, 1 November 1834 YH, 1 November 1834. YH, 8 November 1834. YH, 6 October 1838. YH, 8 November 1834. YG, 13 December 1834. The original contract is reproduced in A. Stacpoole (ed.), The Noble City of York (York: Cerialis Press, 1979), pp. 904–5. BIHR, YMS 1/1/1/1, MSS, Minute Book of the York Medical Society, 1832–1844, 21 January 1843. Wetherill, ‘York Medical School’, pp. 266–7. G. Weisz, Divide and Conquer: A Comparative History of Medical Specialization (Oxford: Oxford University Press, 2006), chapter 2. Wetherill, ‘York Medical School’, pp. 259–60. A. Desmond, The Politics of Evolution: Morphology, Medicine, and Reform in Radical London (Chicago: Chicago University Press, 1989), pp. 101–51; Warner, ‘The idea of science’; Warner, Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton: Princeton University Press, 1998); I. Burney, ‘Medicine in the age of reform’, in A. Burns and J. Innes (eds), Rethinking the Age of Reform: Britain, 1780–1850 (Cambridge: Cambridge University Press, 2003). Dublin Medical Press, 6 (1841), p. 23; BIHR, YMS 1/1/1/2, MSS, Minute Book of the York Medical Society, 1844–1870, 3 October 1846. YH, 27 October 1832. YH, 3 November 1832. British and Foreign Medico-Chirurgical Review, 2:3, July 1848, p. 22. Dublin Medical Press, 6 (1841), p. 43. Lancet, 41:1,070, 2 March 1844, p. 762. YG, 8 May 1838. YH, 18 July 1835. YH, 25 April 1835.

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52 Loudon, Medical Care and the General Practitioner, pp. 129–51; D. Porter and R. Porter, ‘Rise of the English drugs industry: the role of Thomas Corbyn’, Medical History, 33:3 (1989), 277–95; E. M. Tansey, ‘Pills, profits and propriety: the early pharmaceutical industry in Britain’, Pharmaceutical Historian, 25:4 (1995), 3–9. 53 R. Porter, Health for Sale: Quackery in England, 1750–1850 (Manchester: Manchester University Press, 1989); P. S. Brown, ‘Social context and medical theory in the demarcation of nineteenth-century boundaries’, in W. F. Bynum and R. Porter (eds), Medical Fringe and Medical Orthodoxy, 1750–1850 (London: Croom Helm, 1987). 54 M. W. Weatherall, ‘Making medicine scientific: empiricism, rationality and quackery in mid-Victorian Britain’, Social History of Medicine, 9:2 (1996), 175–94. 55 BIHR, YMS 3/1/1, MSS, Minute Book of the Yorkshire Branch of the PMSA, 29 October 1844. 56 Dublin Medical Press, 5 (1841), p. 266. 57 L. Barrow, ‘Why were most medical heretics at their most confident around the 1840s? (The other side of mid-Victorian medicine)’, in French and Wear (eds), British Medicine in an Age of Reform. 58 J. F. C. Harrison, ‘Early Victorian radicals and the medical fringe’, in Bynum and Porter (eds), Medical Fringe; K. Gleadle, ‘ “The age of physiological reformers”: rethinking gender and domesticity in the age of reform’, in Burns and Innes (eds), Rethinking the Age of Reform. 59 A Biographical Sketch of James Morison, the Hygeist (1840), p. 3; J. M. Bulloch, Centenary of James Morison, the ‘Hygeist’ (Aberdeen: Aberdeen University Press, 1925), p. 2. 60 A Biographical Sketch, p. 3; Bulloch, Centenary, p. 2; J. Morison, Morisoniana: Or Family Adviser of the British College of Health, 4th edn (London: British College of Health, 1833), p. 98. 61 A Biographical Sketch, p. 3; Bulloch, Centenary, p. 4; Morison, Morisoniana, p. 230. 62 Morison, Morisoniana, pp. 98–100, 102, 363; Bulloch, Centenary, p. 4; W. H. Helfand, ‘James Morison and his pills’, Transactions of the British Society for the History of Pharmacy, 1:3 (1970), p. 108. 63 J. Fraser, Public Lecture on the Medical Liberty of the Subject and on the Hygeian System of Disease and Medicine, containing also Strictures on the Attacks of Hydropathists on this System (London: 1855), p. 2. 64 Bulloch, Centenary, p. 5; Helfand, ‘James Morison’, p. 114. 65 Helfand, ‘James Morison’, pp. 101–7. 66 Morison, Morisoniana, pp. 46–7, 375–92, 411–14; Bulloch, Centenary, p. 10. 67 Trial of Joseph Webb for Manslaughter at the York Summer Assizes, 1834 (London: G. Taylor, 1834), p. 4; Bulloch, Centenary, p. 8. 68 Porter, Health for Sale, pp. 232–4. 69 Morison, Morisoniana, pp. 5–13, 15–129, 165–6. 70 Morison, Morisoniana, pp. 76–7, 232, 244. 71 Bulloch, Centenary, p. 1; Helfand, ‘James Morison’, pp. 114–15.

True heroes and healers 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92

93 94 95 96 97

98 99 100 101

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Trial of Joseph Webb, p. 4. The Hygeist, 1 August 1842, p. 1. YH, 8 August 1835. Fraser, Public Lecture, p. 6. The Hygeist and Medical Reformer, and Defender of Liberty of Conscience and Private Judgement, new series, 25 August 1855, p. 58. Harrison, ‘Early Victorian radicals’, Gleadle, ‘ “The age of physiological reformers”‘. Morison, Morisoniana, pp. v, ix, 385. Hygeian Proceedings at York, Consequent on the Liberation of Mr Webb, and Presentation of the National Subscription Plate (London: W. Houstoun, 1835), p. 67. Lancet, 11:290, 21 March 1829, p. 783; 15:375, 6 November 1830, pp. 200–7; 15:377, 20 November 1830, pp. 265–8, 286; 16:406, 11 June 1831, pp. 333–5. Trial of Joseph Webb, p. 3; Hygeian Proceedings, pp. 6–9. Trial of Joseph Webb, p. 5. Trial of Joseph Webb, pp. 5, 11–13, 60–1. Trial of Joseph Webb, p. 5; Hygeian Proceedings, pp. 12–15. YG, 5 July 1834. YC, 24 July 1834. Trial of Joseph Webb, p. 5. Trial of Joseph Webb, pp. 40–1. Trial of Joseph Webb, pp. 73, 93–5, 107. Lancet, 22:569, 26 July 1834, p. 629. London Medical Gazette, 14 (1834), pp. 610–16. For more on these cases, see M. Brown, ‘Medicine, quackery and the free market: the “war” against Morison’s Pills and the construction of the medical profession, c.1830–c.1850’, in M. S. R. Jenner and P. Wallis (eds), Medicine and the Market in England and its Colonies, c.1450–c.1850 (Basingstoke: Palgrave Macmillan, 2007), pp. 246–7. The Times, 19 February 1836. The Times, 19 February 1836; Hull Advertiser, 17 March 1837. The Times, 19 February 1836; Hull Advertiser, 17 March 1837. Hull Advertiser, 17 March 1837. I. Burney, ‘Making room at the public bar: coroners’ inquests, medical knowledge and the politics of the constitution in early nineteenth-century England’, in J. Vernon (ed.), Re-reading the Constitution: New Narratives in the Political History of England’s Long Nineteenth Century (Cambridge: Cambridge University Press, 1996); Burney, Bodies of Evidence: Medicine and the Politics of the English Inquest, 1830–1926 (Baltimore: Johns Hopkins University Press, 2000). Lancet, 25:653, 5 March 1836, p. 916. Lancet, 26:658, 9 April 1836, p. 93; The Times, 7 April 1836. Hull Advertiser, 27 and 17 March 1837; Trial of Joseph Webb, pp. 24–6, 40, 72–7. Helfand, ‘James Morison’, p. 118; The Times, 11 May 1840; Lancet, 34:872, 16 May 1840, p. 288.

222 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128

Performing medicine Hygeian Proceedings, p. 3; Fraser, Public Lecture, pp. 16–17. Trial of Joseph Webb, p. 107. YH, 1 November 1834. Hygeian Proceedings, p. 59. Dublin Medical Press, 5 (1841), pp. 266–7. G. Searle, Morality and the Market in Victorian Britain (Oxford: Oxford University Press, 1998), pp. 117–19, fn 61. The Hygeist, 4 December 1842, p. 33. Emphasis added. The Hygeist, 1 October 1843, p. 104. ‘Report of the British College of Health, New Road, London, for 1854’, appended to Fraser, Public Lecture; Harrison, ‘Early Victorian radicals’, pp. 201–2; Searle, Morality and the Market, p. 119. Quarterly Review, 71:141 (1842), pp. 105–6. London Medical Gazette, 27 (11840–41), p. 554. London Medical Gazette, 27 (1840–41), p. 413; 21 (1838), pp. 1,032–3. Lancet, 38:992, 3 September 1842, pp. 744–5. Lancet, 35:914, 6 March 1841, p. 827. Lancet, 38:986, 23 July 1842, p. 585. Searle, Morality and the Market, pp. 27–32. Searle, Morality and the Market, pp. 91–7, 145–6. J. Chapman, ‘Medical Despotism’, Westminster Review, new series, 9 (1856), p. 540. Chapman, ‘Medical Despotism’, p. 537. Chapman, ‘Medical Despotism’. p. 540. H. W. Rumsey, Essays on State Medicine (London: John Churchill, 1856), p. 5; D. Brunton, ‘Rumsey, Henry Wyldbore (1809–1876)’, DNB. Brunton, ‘Rumsey, Henry Wyldbore’. Rumsey, Essays on State Medicine, p. 292. See, M. Brown, ‘Medicine, reform and the “end” of charity in early nineteenthcentury England’, English Historical Review, 124:511 (2009), 1,353–88. Lancet, 47:1187, 30 May 1846, p. 613. BIHR, YMS 3/1/1, MSS, Minute Book of the Yorkshire Branch of the PMSA, 27 June 1844. For more on the rhetoric and popular appeal of medical heroism, see M. Brown, ‘ “Like a devoted army”: medicine, heroic masculinity and the military paradigm in Victorian Britain’, Journal of British Studies, 49:3 (2010), 592–622.

Epilogue: pasts, present, futures

Lydgate did not mean to be one of those failures, and there was the better hope of him because his scientific interest took the form of a professional enthusiasm: he had a youthful belief in his bread-winning work . . . and he carried to his studies in London, Edinburgh, and Paris, the conviction that the medical profession as it might be was the finest in the world; presenting the most perfect interchange between science and art; offering the most direct alliance between intellectual conquest and the social good. G. Eliot, Middlemarch: A Study of Provincial Life (1874)1

I

n G eorge E li ot ’ s celeb rat ed novel, Middlemarch, the young and idealistic doctor, Tertius Lydgate, enters upon his career as a provincial general practitioner with hope, expectation and not a little pride. Schooled in the avant-garde anatomo-clinical methods of Edinburgh and Paris, he intends to make a great contribution to medical science, to move beyond the pioneering work of the French anatomist, Xavier Bichat, and discover the essential ‘primitive tissue’ from which the structures of the human body are composed. But Lydgate is no mere egotist, seeking glory only for himself. He is a member of the medical profession, the ‘grandest profession in the world’. In one particularly revealing passage, Eliot employs the language of statistics, that most social of sciences, to describe Lydgate’s reformist worldview. ‘He meant to be a unit’, she writes, ‘who would make a certain amount of difference towards that spreading change which would one day tell appreciably upon the averages’.2 In this way, Lydgate endeavours, as part of a collective, to realise, against the opposition of those ‘ignorant or canting doctors’, medicine’s capacity not only as a domain of ‘intellectual conquest’ but also as a force for ‘social good’.3 Unlike his older colleagues, who are deficient in ‘knowledge and skill’, if ‘not in social status’, Lydgate’s identity is framed by his medical expertise, rather than by his social connections or adherence to convention.4 He secures the confidence of his patients by being ‘wonderfully clever in fevers’ rather than by catering to their whims and subjectivities.5 He even refuses to dispense medicines, claiming that for medical men to profit from the sale of drugs is ‘to be almost as mischievous as quacks’.6 Moreover,

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in his work at the local voluntary hospital and his advocacy of a new fever hospital he demonstrates his concern for the social and physical condition of the poor, a commitment to the care of the social body which transcends the limitations of private practice. He even dreams of establishing ‘the nucleus of a medical school’ in Middlemarch, for ‘when once we get our medical reforms’ he asks ‘what would do more for medical education than the spread of such schools over the country?’ Lydgate does not perceive his provincial situation to be an impediment to ‘scientific pursuits’ and ‘the general advance’: far from it. London is a world of ‘intrigues, jealousies, and social truckling’ where ‘very ignorant young gentlemen’ might thrive as long as they had powerful patrons. By contrast, he claims, ‘Any valid professional aims may often find a freer, if not a richer field, in the provinces’. 7 The character of Tertius Lydgate might well serve as a literary motif for those forms of medical identity and performance whose elaboration we have charted throughout the latter half of this book. It is all there: the centrality of knowledge and expertise, the sublimation of the individual to the collective, the belief in medicine’s capacity for social amelioration, the rejection of patronage in favour of meritocracy, even the tension between metropolis and province. Moreover, through its setting in the late 1820s and early 1830s, Middlemarch evokes the congruity between medical and political reform. Even if Lydgate’s own political tendency, like many of those whom we have encountered, was ‘not towards extreme opinions’, he being ‘no radical in relation to anything but medical reform’, the associations between medical and socio-political visions of progress are powerfully, if subtextually, present.8 As Lydgate’s wife, Rosamond Vincy, tellingly remarks in rebuking her husband, ‘Politics and medicine are sufficiently disagreeable to quarrel upon’.9 The character of Lydgate owes much to Eliot’s personal interest in the interface between literary and scientific realism.10 However, the figure of the reforming and socially committed doctor was by no means unique to Middlemarch. On the contrary, through the work of authors such as Charles Dickens and Charles Kingsley, it became a veritable staple of mid-century fiction. Whereas doctors in eighteenth-century literature had generally been portrayed as greedy and incompetent fools, characters such as Allan Woodcourt in Bleak House (1852–53) and Tom Thurnall in Two Years Ago (1857) serve as heroic exemplars of social activism, men whose moral and physical courage places medicine at the heart of public debates about the ‘Condition of England’.11 In such texts we see not simply the images and identities which medical reformers were shaping for themselves, but also the extent to which these images achieved a broader social resonance. Having said this, one thing that distinguishes Middlemarch from such midcentury works is that it is a historical novel; though set in a fictional provincial English town of the 1820s and 1830s, it was written in the later 1860s and

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published in the early 1870s. It therefore captures a very particular historical moment and, with the benefit of hindsight, speaks as much to the vexations of professionalism as to its realisation. After all, Lydgate’s personal ambitions are never fulfilled. Whereas Woodcourt’s and Thurnall’s marriages to Esther Summerson and Grace Harvey respectively constitute the perfect synthesis of science and sentiment, Lydgate’s betrothal to the fickle and materialistic daughter of a local banker leads to disaster, as his mounting debts and immersion in the interpersonal politics of provincial life force him into ignominious exile. Neither, perhaps, are his hopes for his profession realised. In our analysis of medicine’s configuration in terms of a unified body of experts dedicated to the social good, we have been concerned with visions and imagination, fantasies of how things might be rather than how they were. These visions were rooted in particular social and political ideologies and were far from hegemonic. Indeed, they were, as we have seen, the product of factionalism and internecine conflict. What is more, there was no one single vision but rather as many projections as there were practitioners. It is hardly surprising, therefore, that the movement for medical reform was characterised by complexity and compromise. The 1858 Medical Act was, perhaps, the signal achievement of medical reform. And yet even this proved to be a grave disappointment to many general and provincial practitioners, who continued to lack the representation and political authority they desired. Moreover, as the early Victorian ‘Age of Reform’ moved into the mid-Victorian ‘Age of Equipoise’, the Benthamite fantasies of meritocratic and technocratic medical governance outlined by men like Thomas Laycock lost much of their force in the face of a broad liberal constitutional consensus.12 Medicine was not placed in the hands of radical utilitarians and neither did it become a salaried branch of state service, though some continued to suggest that it should. Instead, power continued to reside with the metropolitan corporations. Private practice, rather than public health and ‘state medicine’, continued to be the principal concern and source of income for most practitioners and ‘quacks’ continued to operate more or less unchecked by legislative interference. Even at the level of imagination and representation, the profession proved an unstable category. Despite the totalising rhetoric of radicals and reformers it is clear that far from all practitioners felt bound to one another by the invisible bonds of professional identity. A poor-law surgeon or general practitioner in York may have embraced others of his ilk as brethren but it seems unlikely that the high-ranking members of the Royal College of Physicians felt quite the same degree of collective identification. Moreover, with the advent of female doctors and the increased technical and intellectual specialisation of the later nineteenth century, the profession became ever more fractured and complex, constantly defining itself in relation to a proliferation of new and ancillary practitioners. Christopher Lawrence has suggested that in the late Victorian

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and Edwardian hospital, antagonisms arose between clinicians and technical specialists, the former believing that reliance upon instruments such as the sphygmomanometer undermined their clinical and diagnostic authority. In asserting their superiority, he argues, these men fell back on the social distinctions of gentlemanliness, claiming that a well-rounded education, good character and accumulated clinical experience were preferable to narrow technical proficiency.13 And yet all these caveats, important though they are, do not detract from the broader significance of what we have explored here. Conflict and complexity there certainly was, but by the mid-nineteenth century, English medicine and its associated cultural forms had been undoubtedly and irrevocably transformed. From civic gentleman and liberal scholars, medical men had come to think of themselves as scientific professionals. The Medical Act may have been a political compromise, but it nevertheless marked a clear recognition by the sate of a circumscribed and unitary profession, one which was granted a significant degree of self-governing authority with the creation of the General Medical Council (GMC). Likewise, while Lawrence’s elite hospital consultants may have deprecated narrowly technical forms of knowledge, their own social performances and rhetorical strategies were nonetheless predicated on specifically medical forms of knowledge and competence. There is a considerable difference between late nineteenth- and early twentieth-century medical invocations of gentlemanliness and an eighteenth-century culture of medicogentility. These men owed their reputations to their abilities as clinicians. They felt pulses and listened to heartbeats. They did not generally write books about trees. Indeed, if anything the later nineteenth century saw an ever greater investment in scientific rationality and expert knowledge in the social and cultural configuration of medical identity and authority. The invention of anaesthesia and antisepsis, as well as technologies such as the X-ray and electrocardiogram, significantly expanded the scope of medical diagnosis and surgical intervention, while the rise of the laboratory, the ‘discovery’ of germs and the pharmaceutical revolution of the early twentieth century promised a brave new world of disease prevention, treatment and cure. Likewise, the ethos of public service and social engagement which was developed during the first half of the century became ever more significant as, with widespread concerns about the physical capacities of the British population in the wake of the South African War, and with the concomitant emergence of New Liberalism, medicine and health came to be deeply implicated in ideas about citizenship and the state’s duty of care. With the passage of the 1911 National Insurance Act, for example, medical practitioners became responsible for the health of a much broader section of the public than ever before. Meanwhile, if medicine was doing more for the state then the state was also doing more for medicine.

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The nineteenth century had seen unbridled competition from heterodox practitioners and patent medicine producers, but in the early twentieth century the government effectively put an end to such competition, handing exclusive control over the prescription of drugs to the profession by means of the Dangerous Drugs Act (1920) and Rolleston Report (1926). In the 1909 preface to his play, Doctor’s Dilemma (1906), George Bernard Shaw launched a scathing attack on the ‘monstrous absurdity’ of a medical system in which the surgeon had ‘a pecuniary interest in cutting off your leg’.14 For Shaw, professional authority was not matched by an equivalent social responsibility. While private practice reigned, he suggested, doctors could never be truly disinterested. Looking to the example of the Medical Officer of Health and inspired by the doctrines of socialism, he therefore called for the foundation of national ‘Public Health Service’ in which medicine might realise its potential for genuine social utility. ‘Until the medical profession becomes a body of men trained and paid by the country to keep the country in health’, he claimed, ‘it will remain what it is at present: a conspiracy to exploit popular credulity and human suffering’.15 Astonishing though the idea may have appeared to many at the time, some forty years later, and within the span of Shaw’s own lifetime, the British government did precisely that. It is almost impossible to address the history of medical professionalism in England without at least an eye to the foundation of the National Health Service (NHS) in 1948. After all, the NHS represented much of what many early nineteenthcentury medical reformers had hoped for: an autonomous, self-regulating body of practitioners allied to the state. It seemed to constitute the apotheosis of what Harold Perkin has described as the ‘professional society’.16 Like most such developments it was, of course, characterised by conflict, compromise and ambiguity. It was, for example, vigorously opposed by the BMA, who thought (wrongly as it turned out) that it would lessen the income of general practitioners, while it received the enthusiastic support of the hospital medical school elites.17 Moreover, ‘professional society’ did not constitute ‘a utopia based entirely on merit, social efficiency and social justice’ as many of the Benthamite radicals of the previous century might have imagined. ‘No society’, Perkin observes, ‘has ever lived up to its ideal’. Nevertheless, it still embodied the ‘principle that ability and expertise were the only reasonable justification for recruitment to positions of authority and responsibility’.18 History, however, can prove deceptive. The medical profession is not a model, an ideal system, as some twentieth-century sociologists might have us believe. It is, as we have seen, a historically contingent creation, the product of social, cultural, political and economic forces. Just as it was made, so too can it be unmade. Never has this been more evident than today. As Perkin, writing under the long shadow of Thatcherism, clearly recognised, the postwar period was not simply another step on the ever-upward trajectory of

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professional expertise. It was, instead, the ‘plateau of professional society’, the short-lived triumph of technocracy.19 As statism and welfarism gave way to a reinvigorated economism, to an unswerving faith in the operations of the free market, the medical profession found its political authority and clinical autonomy challenged on almost every front. The desire to ‘roll back the state’, combined with the increasing complexity and expense of healthcare provision, fuelled a commercialisation of British medicine, the importation not only of private sector money but also of its values: targets, profitability, ‘innovation’ and cost-cutting. Conversely, however, this process of ‘liberalisation’ did not signal a ‘downsizing’ of bureaucracy and administration, quite the contrary. Doctors found themselves increasingly subject to regulations and appraisals, their clinical freedom constrained by the dictates of ‘evidencebased medicine’ and by the authority of hospital administrators and NHS Trust managers. Most of these developments originated with the Conservative governments of Margaret Thatcher and John Major. But anyone who imagined that Labour’s victory in the general election of 1997 would reverse the trend soon found themselves disappointed. If anything, the challenge to medical professionalism has become even more intense. The marked expansion of the Private Finance Initiative (PFI) has seen business assume an even greater role in the administration of the NHS, while the putting out to tender of general practice to commercial healthcare companies appears to presage a wider process of privatisation and deregulation. At the same time, the scandal surrounding the serial killer and general practitioner, Harold Shipman, has eroded medical autonomy even further, leading to a report by the Chief Medical Officer which suggested that doctors and the GMC could no longer be trusted to regulate their own affairs.20 Likewise, while the British public may, in general, remain attached to the concept of the NHS, the stability of medical-professional expertise has also been undermined by changes in popular attitudes. The public no longer expresses the kind of deference or respect for the medical profession that they once did, and rarely do they take diagnosis at face value. A more consumerist approach to bodily and mental health and a vibrant market for alternative and holistic medicine mean that patients often scour the internet for alternative sources of advice and treatment. Meanwhile, a spate of scandals, both real (Alder Hey, Shipman, etc.) and imagined (MMR and autism) have eroded public confidence, something which the rise in iatrogenic infections (MRSA and Clostridium Difficile) has done little to counter. British medicine therefore finds itself in a deeply troubling position, facing the very real prospect of de-professionalisation. One might simply look upon these trends as examples of how medical identities continue to be shaped by broader social, cultural-political and economic forces. However, for medical

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practitioners themselves, and for those who hold the values of professionalism to be important and worthwhile, there has never been a more appropriate time to look to history, not as a mere antiquarian diversion, but as a critical political resource. History provides no easy answers, nor even direct parallels. After all, the circumstances of medical professionalism’s initial configuration are a world apart from those of its prospective demise. And yet it can shed a great deal of light on current debates. In 2005, for example, the Royal College of Physicians published a working party report entitled Doctors in Society: Medical Professionalism in a Changing World. Although its stated aim was to ‘define the nature and role of medical professionalism in modern society’, it betrayed a woeful lack of historical context.21 At one point, for example, it claimed that ‘In the UK, professionalism has provided the framework of values that has shaped the patient-doctor relationship for close to five hundred years. It was an appreciation of the importance of professionalism in medicine that was one of the founding forces behind the creation of the Company of Physicians in London (the forerunner of the Royal College of Physicians) in 1518’.22 A degree of institutional pride may perhaps explain this analytical lapse, but to conflate the values and cultures of the early modern guild with those of the modern medical profession is hardly to assist a deeper understanding of the issues. Such ahistoricism tends towards woolly definitions and even woollier thinking. While the report identified a range of associated values, many of which accord with those whose origins we have explored in this book, it displayed a striking insensitivity to the relative importance of these values in sustaining the cultures of medicine over the last one and threequarter centuries. Nowhere is this more apparent than with the concept of the ‘public good’. As we have seen, the idea that medicine was a mission, be that moral or political, to alleviate human suffering and ameliorate social distress was central to the discourse and ideologies of incipient nineteenth-century professionalism. The continued resonance of such discourses is evident in the working party’s stated aim of initiating a ‘national dialogue about the future of medical professionalism as a public good’.23 And yet the report itself made the startling assertion that ‘the idea of professionalism as a public good has no practical value to either the patient or the doctor at the bedside or in the clinic’.24 Maybe so, if by ‘practical value’ they speak in terms of specific contractual obligations. But in the broader contexts of professional culture and the political relations between medicine, the public and the state, such values have been, and remain, pivotal. Such a lack of historical understanding is all the more puzzling for the fact that the report’s principal author is Richard Horton, current editor-in-chief of the Lancet, a journal which has always been conscious of its historical origins. Indeed, with his inflammatory rhetoric and political activism, Horton seems to have taken his inspiration from the journal’s founder, Thomas Wakley. His

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commitment to disinterestedness, public service and social engagement also has obvious parallels with early nineteenth-century medical reform. Horton has vigorously championed the values of professionalism, not only in the face of government policy but also in opposition to poor internal leadership. In 2008, for example, he criticised the BMA for putting financial self-interest before ‘the health of the nation’, characterising them as ‘greedy, selfish, petulant, arrogant, pompous, elitist and out of touch’.25 ‘Professionalism’, he maintains, ‘is medicine’s most precious commodity’.26 The values it represents ‘are not redundant. They reflect the purpose and identity of doctors, and they translate directly to the quality and continuous improvement of healthcare’.27 This is not to say that modern day medical practitioners must retain all the ideas and values espoused by nineteenth-century reformers. Times change and adaptation is both possible and necessary. As Horton recognises, such concepts as ‘bounded knowledge’ are not necessarily helpful at a time when public understanding and support are essential.28 And yet at this present moment, when the certainties of economic liberalism have been called so dramatically into question, circumstances are surely conducive to the defence of professionalism as a public good against the creeping forces of privatisation and marketisation. Horton has claimed that ‘An understanding of medical professionalism sits at the centre of today’s conflicts over the future of Britain’s health system’ and that ‘research into professionalism is essential for augmenting a concept that is tied inextricably to better patient experiences and improved health outcomes’.29 Quite so, and it is imperative that a historical sensibility should be central to that endeavour, for it is vital to understand where these ideas have come from and how they have been shaped by historical circumstance. After all, if the past is uncertain then the future is more so. Notes 1 G. Eliot, Middlemarch: a Study of Provincial Life (London: William Blackwood and Sons, 1874), p. 106. 2 Eliot, Middlemarch, p. 107. Emphasis added. 3 Eliot, Middlemarch, pp. 107, 106. 4 Eliot, Middlemarch, pp. 107, 106. 5 Eliot, Middlemarch, p. 194. 6 Eliot, Middlemarch, p. 329. 7 Eliot, Middlemarch, p. 90. 8 Eliot, Middlemarch, p. 258. 9 Eliot, Middlemarch, p. 346. 10 L. Rothfield, Vital Signs: Medical Realism in Nineteenth-Century Fiction (Princeton: Princeton University Press, 1992), chapter 4; P. M. Logan, ‘Conceiving the body: realism and medicine in “Middlemarch” ’, History of the Human Sciences, 4:2 (1991), 197–222.

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11 L. M. E. Goodlad, “Is there a pastor in the “House”? Sanitary reform, professionalism and philanthropy in Dickens’ mid-century Fiction,” Victorian Literature and Culture, 31:2 (2003), 525–53; M. Brown, ‘ “Like a devoted army”: medicine, heroic masculinity and the military paradigm in Victorian Britain’, Journal of British Studies, 49:3 (2010), 592–622. 12 L. M. E. Goodlad, Victorian Literature and the Victorian State: Character and Governance in a Liberal Society (Baltimore: Johns Hopkins University Press, 2003), chapter 4. 13 C. Lawrence, ‘Incommunicable knowledge: science, technology and the clinical art in Britain, 1850–1914, Journal of Contemporary History, 20:4 (1985), 502–20; Lawrence, ‘Moderns and ancients: the “new cardiology” in Britain, 1880–1930’, in W. F. Bynum, C. Lawrence and V. Nutton (eds), The Emergence of Modern Cardiology, Medical History Supplement, 5 (1995); Lawrence, ‘A tale of two sciences: bedside and bench in twentieth-century Britain’, Medical History, 43:4 (1999), 421–49. 14 G. B. Shaw, The Doctor’s Dilemma: A Tragedy (Harmondsworth: Penguin, 1987), p. 10. 15 Shaw, Doctor’s Dilemma, p. 76. 16 H. J. Perkin, The Rise of Professional Society: England since 1880, 2nd edn (London: Routledge, 2002). 17 C. Webster, The National Health Service: A Political History (Oxford: Oxford University Press, 1998), chapter 1. 18 Perkin, Professional Society, p. 405. 19 Perkin, Professional Society, chapter 9. 20 Department of Health, Good Doctors, Safer Patients: Proposals to Strengthen the System to Assure and Improve the Performance of Doctors and to Protect the Safety of Patients (London: Department of Health, 2005). 21 Royal College of Physicians, Doctors in Society: Medical Professionalism in a Changing World (London: Royal College of Physicians, 2005), p. ix. 22 Doctors in Society, p. 8. 23 Doctors in Society, p. 10. 24 Doctors in Society, p. 18. 25 R. Horton, ‘Luckily, GPs are wiser than their leaders’, Sunday Telegraph, 17 February 2008. 26 R. Horton, ‘Medicine: the prosperity of virtue’, Lancet, 366:9502, 10 December 2005, p. 1, 985. 27 R. Horton, I. Gilmore, N. Dickson, S. Dewer, S. Shepherd, ‘Do doctors have a future?’, Lancet, 369:9, 571, 28 April 2007, p. 1,406. 28 Horton, ‘Medicine: the prosperity of virtue’, p. 1,985. 29 Horton, ‘Medicine: the prosperity of virtue’, pp. 1,986–7.

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Primary sources Archival collections Borthwick Institute for Historical Research, York (BIHR) Parish Records (PR) Wills and Probate Records York County Hospital Records (YCH) York Medical Society Records (YMS) British Library, London (BL) Original Letters to Arthur Young John Rylands Library, Manchester University Manchester Medical Society Archives (MMS) Oxford University Museum of Natural History (OUM) Correspondence of John Phillips Royal Botanic Gardens, Kew (Kew) Banks Collection (BC) Royal Society, London (RS) Election Certificates (EC) University College London (UCL) Chadwick Manuscripts York City Archives (YCA) Diary of Faith Gray W. White, ‘Analecta Eborancesia, or Memorandum of Events at York’ York Mechanics’ Institute Records York City Library (YCL) O. Allen, ‘Autobiography and Memoirs’ York Minster Library (YML) Doctors Club Minute Book Yorkshire Philosophical Society (YPS) Annual Reports General Meeting Minute Book

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Published primary sources Allen, Oswald, History of the York Dispensary: Containing an Account of its Origins and Progress to the Present Time; Comprising a Period of Fifty-Seven Years (York: R. Pickering, 1845). Anon., A Full and Impartial Report of the Case of Jane Horsman vs. Francis Bulmer the Elder, the Rev. William Bulmer, Alexander Mather, Wm. Matterson, Wm. Belcombe M.D. and Helen Scott, being an Action of Trespass and False Imprisonment Tried at the Summer Assizes for the County of York, August 4, 1819, before the Hon. Sir George Wood, Knight of one of the Barons of his Majesty’s Court of Exchequer and a Special Jury. Taken from the shorthand notes of Mr Fraser (York: T. Wilson and Sons, 1819). —, Trial of Joseph Webb for Manslaughter at the York Summer Assizes, 1834 (London: G. Taylor, 1834). —, Hygeian Proceedings at York, Consequent on the Liberation of Mr Webb, and Presentation of the National Subscription Plate (London: W. Houstoun, 1835). —, Rules and Catalogue of the Medical Library at the York County Hospital, 1830; with an Appendix to October 1837 (York: R. Sunter, 1837). —, A Biographical Sketch of James Morison, the Hygeist (1840). Atkinson, Charles, The Mind’s Monitor: Or a Serious Discourse on the Advantages of Self-Preservation, Society, Friendship, Love, Learning, Religion and on Death (Leeds: Thomas Gill, 1793). —, The Mind’s Monitor: Or a Serious Discourse on the Advantages of Self-Preservation, Society, Friendship, Love, Learning, Religion and on Death, 2nd edn (York: W. Storry, 1802). —, Retaliation; or Hints to Some of the Governors of the York Lunatic Asylum (York: M. W. Carrall, 1817). —, The Life and Adventures of an Eccentric Traveller (York: M. W. Carrall, 1818). Atkinson, James, Medical Bibliography A. and B. (York: H. Bellerby, 1833). Cappe, Catherine, Memoirs of the Late Rev. Newcome Cappe (York: T. Wilson and R. Spence, 1802). —, On the Desirableness and Utility of Ladies Visiting the Female Wards of Hospitals and Lunatic Asylums (York: T. Wilson and Sons, 1817). —, Memoirs of the Life of the Late Mrs Catherine Cappe; Written by Herself (York: T. Wilson and Sons, 1822). Dibdin, Thomas Frognall, A Bibliographical, Antiquarian and Picturesque Tour of the Northern Counties of England and in Scotland, 2 vols (London: 1838). Drake, Francis, Eboracum, or the History and Antiquities of the City of York (York: W. Bowyer, 1736). Gray, Edwin, Papers and Diaries of a York Family (London: The Sheldon Press, 1927). Gray, Jonathan, History of the York Lunatic Asylum: with an Appendix containing Minutes of Evidence on the Cases of Abuse lately Inquired into by a Committee etc. addressed to William Wilberforce Esq., one of the Contributors to Lupton’s Fund (York: J. Wolstenholme, 1815). —, Horsmania: Mr J. Gray’s Statements and Observations Occasioned by the Publications of Mr Mather (York: J. Wolstenholme, 1819).

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Gregory, John, Lectures on the Duties and Offices of a Physician (London: W. Strahan and T. Cadell, 1772). Hargrove, William, History and Description of the Ancient City of York, 3 vols (York: W. Alexander, 1818). Higgins, Godfrey, A Letter to the Right Honourable Earl Fitzwilliam, Lord Lieutenant of the West Riding of the County of York respecting the Investigation which has lately taken place into the Abuses at the York Lunatic Asylum; together with various Letters, Reports etc. and the New Code of Regulations for its Future Management (Doncaster: W. Sheardown, 1814). —, A Letter to the Committee of the House of Commons Appointed to Inquire into the Abuses in Madhouses (1815). Anon. [Hunter, Alexander], A Treatise on the Nature and Virtues of Buxton Waters with a Preliminary Account of the External and Internal Use of Natural and Artificial Warm Waters Amongst the Ancients (London: D. Wilson, 1761). Hunter, Alexander, A Treatise on the Nature and Virtues of Buxton Waters with a Preliminary Account of the External and Internal Use of Natural and Artificial Warm Waters Amongst the Ancients, 2nd edn (London: 1768). —, A Treatise on the Nature and Virtues of Buxton Waters with a Preliminary Account of the External and Internal Use of Natural and Artificial Warm Waters Amongst the Ancients, 3rd edn (London: T. Durham, 1773). —, The Buxton Manual, Or a Treatise on the Nature and Virtues of Buxton Waters with a Preliminary Account of the External and Internal Use of Natural and Artificial Warm Waters Amongst the Antients, 6th edn (York: G. Peacock, 1797). —, Culina Famulatrix Medicinae; Or, Receipts in Modern Cookery (York: Wilson and Spence, 1804). —, A Lecture on the Sulphur Waters of Harrogate (York: Wilson and Spence, 1806). —, Men and Manners: or Concentrated Wisdom, 4th edn (York: Wilson and Son, 1809). —, (ed.), Georgical Essays, 2nd edn (York: A. Ward, 1777). —, (ed.), Silva: Or a Discourse of Forrest Trees and the Propagation of Timber in his Majesty’s Dominions, 4th edn, 2 vols (York: Wilson and Spence, 1812). Laycock, Thomas, A Treatise on the Nervous Diseases of Women: Comprising an Inquiry into the Nature, Causes and Treatment of Spinal and Hysterical Disorders (London: Longmans, 1840). —, Report on the State of York, in Reply to the Questions Circulated by the Health of Towns Commission (York: 1844). Mather, Alexander, A Plain Narrative of Facts relative to the Reception and Treatment of Jane Horsman at the Establishment in Clifton of which Dr Belcombe and Mr Mather are Proprietors; with some Preliminary Observations on Insanity in General and some remarks on the circumstances preceding and attending the late trial of Horsman against Bulmer and others (York: J. Wolstenholme, 1819). Morison, James, Morisoniana: Or Family Adviser of the British College of Health, 4th edn (London: British College of Health, 1833). Needham, James P., Facts and Observations Relative to the Disease commonly called Cholera as it has recently prevailed in the City of York (London: R. Needham, 1833).

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Nicoll, S. W., A Letter to the Members of the York Whig Club (York: 1819). —, A Second Letter to Members of the York Whig Club (York: 1819). —, An Enquiry into the Present State of Visitation in Asylums for the Reception of the Insane and into the Modes by which such Visitation may be Improved (London: Harvey and Darton, 1828). Rowe, Harry [Pseud.], No Cure, No Pay: Or the Pharamacopolist (York: Wilson and Spence, 1794). Rumsey, Henry Wyldbore, Essays on State Medicine (London: John Churchill, 1856). Rush, Benjamin, Medical Inquiries and Observations (London: C. Dilly, 1789). Tuke, Samuel, Description of the Retreat, an Institution near York for Insane Persons of the Society of Friends. Containing an Account of its Origins and Progress, the Modes of Treatment, and a Statement of Cases (York: 1813). —, Memoirs of Samuel Tuke, with some Notices of his Ancestors and Descendants, 2 vols (London: 1860). White, William, ‘Experiments upon air, and the effects of different kinds of effluvia upon it; made at York’, Philosophical Transactions of the Royal Society, 68 (1778), 194–220. —, ‘Observations on the bills of mortality at York’, Philosophical Transactions of the Royal Society, 72 (1782), 35–43. —, Observations on the Nature and Cure of Phthisis Pulmonaris, or Consumption of the Lungs (York: Wilson, Spence and Mawnan, 1792). Withers, Thomas, Observations on the Abuse of Medicine (London: J. Johnson, 1775). —, A Treatise on the Errors and Defects of Medical Education (London: C. Dilly and H. Murray, 1794). —, Observations on the Use and Abuse of Medicine, with a View to the Prevention and Cure of Disease (London: C. Dilly and H. Murray, 1794). Young, Arthur, A Six Months Tour through the North of England (1771) reprinted (New York: Augustus Kelly, 1967). Newspapers and journals British and Foreign Medico-Chirurgical Review Dublin Medical Press Gentleman’s Magazine The Hygeist Lancet London Medical Gazette The Times York Chronicle (YChr) York Courant (YC) York Herald (YH) Yorkshire Gazette (YG)

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—, ‘Towards a geography of English scientific culture: provincial identity and literary and philosophical culture in the English county town, 1750–1850’, Urban History, 32:3 (2005), 391–412. Eyler, John M., Victorian Social Medicine: The Ideas and Methods of William Farr (Baltimore: Johns Hopkins, 1979). Fissell, Mary E., Patients, Power and the Poor in Eighteenth-Century Bristol (Cambridge: Cambridge University Press, 1991). —, ‘The disappearance of the patient’s narrative and the invention of hospital medicine’, in Roger French and Andrew Wear (eds), British Medicine in an Age of Reform (London: Routledge, 1991). —, ‘Innocent and honourable bribes: medical manners in eighteenth-century Britain’, in Robert Baker, Dorothy Porter and Roy Porter (eds), The Codification of Medical Morality: Historical and Philosophical Studies of the Formalization of Western Medical Morality in the Eighteenth and Nineteenth Centuries. Volume One: Medical Ethics and Etiquette in the Eighteenth Century (London: Kluwer, 1993). Foucault, Michel, Madness and Civilization: A History of Insanity in the Age of Reason (London: Tavistock, 1967). —, The Birth of the Clinic: An Archaeology of Medical Perception (London: Tavistock, 1973). French, Henry, Social status, localism and the “middle sort of people” in England 1620–1750’, Past and Present, 166 (2000), 66–99. —, The Middle Sort of People in Provincial England, 1600–1750 (Oxford: Oxford University Press, 2007). French, Roger and Wear, Andrew (eds), British Medicine in an Age of Reform (London: Routledge, 1991). Gilbert, Pamela, Cholera and Nation: Doctoring the Social Body in Victorian England (Albany: State University of New York Press, 2008). Gleadle, Katherine, ‘ “The age of physiological reformers”: rethinking gender and domesticity in the age of reform’, in Arthur Burns and Joanna Innes (eds), Rethinking the Age of Reform: Britain, 1780–1850 (Cambridge: Cambridge University Press, 2003). Goldgar, Anne, Impolite Learning: Conduct and Community in the Republic of Letters (New Haven: Yale University Press, 1995). Goldman, Lawrence, Science Reform and Politics in Victorian Britain: The Social Science Association, 1857–1886 (Cambridge: Cambridge University Press, 2002). Golinski, Jan, Science as Public Culture: Chemistry and Enlightenment in Britain, 1760–1820 (Cambridge: Cambridge University Press, 1992). —, British Weather and the Climate of Enlightenment (Chicago: Chicago University Press, 2007). Goodlad, Lauren M. E., Victorian Literature and the Victorian State: Character and Governance in a Liberal Society (Baltimore: Johns Hopkins University Press, 2003). Hallet, Mark and Rendall, Jane (eds), Eighteenth-Century York: Culture, Space and Society (York: Borthwick Publications, 2003). Hamlin, Christopher, Public Health and Social Justice in the Age of Chadwick: Britain, 1800–1854 (Cambridge: Cambridge University Press, 1998).

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Harrison, John Fletcher Clews, ‘Early Victorian radicals and the medical fringe’, in William F. Bynum and Roy Porter (eds), Medical Fringe and Medical Orthodoxy, 1750–1850 (London: Croom Helm, 1987). Haslam, Fiona, From Hogarth to Rowlandson: Medicine in Art in Eighteenth-Century Britain (Liverpool: Liverpool University Press, 1996). Hilton, Boyd, A Mad, Bad and Dangerous People? England, 1783–1846 (Oxford: Oxford University Press, 2008). Holloway, Sydney W. F., ‘The Apothecaries’ Act, 1815: a reinterpretation’, Medical History, 10:2 (1966), 107–29, 221–36. —, ‘The orthodox fringe: the origins of the Pharmaceutical Society of Great Britain’, in William F. Bynum and Roy Porter (eds), Medical Fringe and Medical Orthodoxy, 1750–1850 (London: Croom Helm, 1987). —, Producing experts, constructing expertise: the school of pharmacy of the Pharmaceutical Society of Great Britain, 1842–1896’, in Vivian Nutton and Roy Porter (eds), The History of Medical Education in Britain (Amsterdam: Rodopi, 1995). Hunt, John Dixon, The Figure in the Landscape: Poetry, Painting and Gardening during the Eighteenth Century (Baltimore: Johns Hopkins University Press, 1976). Inkster, Ian, ‘The development of a scientific community in Sheffield, 1790–1850: a network of people and interests’, Transactions of the Hunter Archaeological Society, 10 (1973), 99–131. —, ‘Science and the mechanics’ institutes, 1820–1850: the case of Sheffield’, Annals of Science, 32:5 (1975), 451–74. —, Marginal men: aspects of the social role of the medical community in Sheffield, 1790–1850’, in John Hugh Woodward and David Richards (eds), Health Care and Popular Medicine in Nineteenth-Century England: Essays in the Social History of Medicine (London: Croom Helm, 1977). Jacyna, L. Stephen, Philosophic Whigs: Medicine, Science and Citizenship in Edinburgh, 1789–1848 (London: Routledge, 1994). Janković, Vladimir, Reading the Skies: A Cultural History of English Weather, 1650– 1820 (Manchester: Manchester University Press, 2000). Jenkinson, Jacqueline, ‘The role of medical societies in the rise of the Scottish medical profession, 1730–1939’, Social History of Medicine, 4:2 (1991), 253–75. —, Scottish Medical Societies: Their History and Records (Edinburgh: Edinburgh University Press, 1993). Jenner, Mark S. R. and Wallis, Patrick (eds), Medicine and the Market in England and its Colonies, c.1450–c.1850 (Basingstoke: Palgrave Macmillan, 2007). Jewson, Nicholas D., ‘Medical knowledge and the patronage system in eighteenthcentury England’, Sociology, 8:3 (1974), 369–85. —, ‘The disappearance of the sick man from medical cosmology, 1770–1870’, Sociology, 10:2 (1976), 225–44. Jordanova, Ludmilla, ‘Medical men 1780–1820’, in Joanna Woodall (ed.), Portraiture: Facing the Subject (Manchester: Manchester University Press, 1997). —, Defining Features: Scientific and Medical Portraits 1660–2000 (London: Reaktion Books, 2000).

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Joyce, Patrick, Democratic Subjects: The Self and the Social in Nineteenth-Century England (Cambridge: Cambridge University Press, 1994). —, The Rule of Freedom: Liberalism and the Modern City (London: Verso, 2003). Klein, Lawrence E., Shaftesbury and the Culture of Politeness: Moral Discourse and Cultural Politics in Early Eighteenth-Century England (Cambridge: Cambridge University Press, 1994). La Berge, Ann and Hannaway, Caroline (eds), Constructing Paris Medicine (Amsterdam: Rodopi, 1998). Langford, Paul, A Polite and Commercial People: England 1727–1783 (Oxford: Oxford University Press, 1989). Lawrence, Christopher, Medicine in the Making of Modern Britain, 1700–1920 (London: Routledge, 1994). Looney, J. Jefferson, ‘Cultural life in the provinces: Leeds and York, 1720–1820’, in A. L. Beier, David Cannadine and James M. Rosenheim (eds), The First Modern Society: Essays in English History in Honour of Lawrence Stone (Cambridge: Cambridge University Press, 1992). Loudon, Irvine, Medical Care and the General Practitioner, 1750–1850 (Oxford: Oxford University Press, 1986). —, ‘Medical practitioners, 1750–1850 and the period of medical reform in Britain’, in Andrew Wear (ed.), Medicine in Society: Historical Essays (Cambridge: Cambridge University Press, 1992). —, ‘Medical education and medical reform’, in Vivian Nutton and Roy Porter (eds), The History of Medical Education in Britain (Amsterdam: Rodopi, 1995). Marland, Hillary, Medicine and Society in Wakefield and Huddersfield, 1780–1870 (Cambridge: Cambridge University Press, 1987). Mooney, Graham and Reinarz, Jonathan (eds), Permeable Walls: Historical Perspectives on Hospital and Asylum Visiting (Amsterdam: Rodopi, 2009). Morrell, Jack and Thackray, Arnold, Gentlemen of Science: Early Years of the British Association for the Advancement of Science (Oxford: Oxford University Press, 1981). —, (eds), Gentlemen of Science: Early Correspondence of the British Association for the Advancement of Science (London: Royal Historical Society, 1984). Morris, Robert John, Cholera 1832 (London: Croom Helm, 1976). Nuttgens, Patrick (ed.), The History of York from the Earliest Times to the Year 2000 (Pickering: Blackthorn Press, 2001). Nutton, Vivian and Porter, Roy (eds), The History of Medical Education in Britain (Amsterdam: Rodopi, 1995). Orange, A. Derek, Philosophers and Provincials: The Yorkshire Philosophical Society from 1822 to 1844 (York: Yorkshire Philosophical Society, 1974). —, ‘Science in early nineteenth-century York: the Yorkshire Philosophical Society and the British Association’, in Charles H. Feinstein (ed.), York, 1831–1981: 150 Years of Scientific Endeavour and Social Change (York: Ebor Press, 1981). Payne, Lynda, With Words and Knives: Learning Medical Dispassion in Early Modern England (Aldershot: Ashgate, 2007). Pelling, Margaret, Cholera, Fever and English Medicine, 1825–1865 (Oxford: Oxford University Press, 1978).

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—, ‘Appearance and reality: barber-surgeons, the body and disease’, in A. L. Beier and Roger A. P. Finlay (eds), London, 1500–1700: The Making of the Metropolis (London: Longman, 1986). —, Medical Conflicts in Early Modern London: Patronage, Physicians and Irregular Practitioners, 1550–1640 (Oxford: Oxford University Press, 2003). —, ‘Politics, medicine, and masculinity: physicians and office-bearing in early modern England’, in Margaret Pelling and Scott Mandelbrote (eds), The Practice of Reform in Health, Medicine and Science, 1500–2000: Essays for Charles Webster (Aldershot: Ashgate, 2005). Perkin, Harold J., The Rise of Professional Society: England since 1880, 2nd edn (London: Routledge, 2002). Peterson, M. Jeanne, The Medical Profession in Mid-Victorian London (Berkeley: University of California Press, 1978). Pickstone, John V., ‘Ferriar’s fever to Kay’s cholera: disease and social structure in cottonopolis’, History of Science, 22:4 (1984), 401–19. —, Medicine and Industrial Society: A History of Hospital Development in Manchester and its Region, 1752–1946 (Manchester: Manchester University Press, 1985). —, ‘Dearth, death and fever epidemics: rewriting the history of British “public health”, 1750–1850’, in Terrence Ranger and Paul Slack (eds), Epidemics and Ideas: Essays on the Historical Perception of Pestilence (Cambridge: Cambridge University Press, 1992). —, ‘Thomas Percival and the production of medical ethics’, in Robert Baker, Dorothy Porter and Roy Porter (eds), The Codification of Medical Morality, Vol. 1: Medical Ethics and Etiquette in the Eighteenth Century (London: Kluwer Academic Publishers, 1993). Plant, Helen, Unitarianism, Philanthropy and Feminism in York, 1728–1821: The Career of Catherine Cappe, Borthwick Paper, 103 (2003). Poovey, Mary, Making a Social Body: British Cultural Formation, 1830–1864 (Chicago: Chicago University Press, 1995). Porter, Dorothy and Porter, Roy, In Sickness and in Health: The English Experience, 1650–1850 (London: Fourth Estate, 1988). Porter, Roy, ‘William Hunter: a surgeon and a gentleman’, in William F. Bynum and Roy Porter (eds), William Hunter and the Eighteenth-Century Medical World (Cambridge: Cambridge University Press, 1985). —, Disease, Medicine and Society, 1550–1860 (Basingstoke: Macmillan, 1987). —, ‘Before the fringe: “quackery” and the eighteenth-century medical market’, in Roger Cooter (ed.), Studies in the History of Alternative Medicine (Basingstoke: Macmillan, 1988). —, Health for Sale: Quackery in England, 1750–1850 (Manchester: Manchester University Press, 1989). —, Mind-forg’d Manacles: A History of Madness in England from the Restoration to the Regency (Harmondsworth: Penguin, 1990). —, Quacks: Fakes and Charlatans in English Medicine (Stroud, Gloucestershire: Tempus, 2000).

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Index

Note: numbers in italics refer to an image on that page. Aberdeen 205 university of 69 Abernethy, John 205 Addison, Joseph 26, 89 agricultural improvement 25, 51, 53–7, 61, 63, 68, 69, 116 see also farms; York, Agricultural Society alcohol, consumption of 28–9 Allen, Edward 140, 175 Allen, James 208 Allen, James, father of Oswald Allen, 33 Allen, Matthew 39 Allen, Oswald 27, 32–9, 53, 123 anatomy 10, 117, 129–42 passim, 153, 161, 206 comparative 72, 125, 132 dissection 10, 126, 129, 131–6, 139–40 education 21, 35, 72, 104, 120, 129, 133, 135, 139–40, 197–8, 200–1, 202 pathological 134, 161, 195, 206, 210, 223 public demonstration of 34, 74, 138–9, 140 Anatomy Act (1832) 135–7, 139, 197, 203 popular opposition to 136–7, 168 Ancient Society of York Florists 25 Anderson, Benedict 159 Anderson, William 160, 164, 167, 171, 181 Anglicans see Church of England antiquarianism 4, 14, 51, 65–7, 116, 120, 121, 123, 229 apothecaries 2, 4, 7, 17, 18, 20, 24, 25, 27,

32–9 passim, 52, 53, 84, 87, 88, 96, 100, 101, 103–4, 175 associations with trade 19, 21, 32, 36–7, 73–4, 154 civic identity of 9, 21, 32, 67 education of 2, 32, 34, 156 Apothecaries Act (1815) 116 aristocracy 14, 53, 59, 60, 70, 92, 94, 100, 105, 120 Associated Body of Surgeons and Apothecaries 39, 111–16, 155 association 4, 7, 10, 24–32 passim, 35–6, 49, 53, 85–6, 105, 116, 118, 121, 122, 140–2, 153, 154–62 passim, 171, 217 see also clubs; conviviality; sociability Atkinson, Charles junior 18, 20, 36, 51, 70–2, 73, 84, 96, 97, 99, 100, 105, 139 Atkinson, Charles senior 2, 20, 25, 29, 36, 70, 129 Atkinson, J. B. 178, 181 Atkinson, James 2, 17, 18, 20, 25, 51, 70–5, 113–14, 120, 123, 124, 125–6, 127, 129, 131, 132, 138–9, 158, 163, 171–2, 198, 200–1 Auxiliary Bible Society 91, 120, 123 Bacon, Francis 21, 24 Banks, Joseph 61, 66 Bayley, Thomas Butterworth 55 Beckwith, Stephen 123 Bedlam, lunatic asylum 83, 84, 87, 90, 101

Index ‘Beggars Benison’ 27 Belcombe, Henry Stephens 123, 154, 208 Belcombe, William 82, 83, 86, 90, 93, 94, 101, 102, 124 benevolence, cultural value of 2, 36, 52, 74, 84, 96, 134, 155, 170 Benjamin, Walter 159 Bentham, Jeremy 94, 134, 138, 173, 177, 180, 182, 215, 225, 227 see also utilitarianism Best, Charles 84, 90, 93–101 passim, 123 Beverley 52 Agricultural Society 60 Bichat, Xavier 134, 223 Birmingham 34 medical school 196, 197, 198 Bishopsthorpe, near York 120, 150 Bleak House (1852–3) 224 bloodletting 7, 18 see also therapeutics Blumenbach, Johann 125 Board of Health, General 179 see also York, Board of Health body-snatching 10, 126, 129–36 passim Boswell, James 28, 60 botany 39, 51, 55, 56, 59, 116, 142, 205 Bourdieu, Pierre 30–1 Brewster, David 141 Bristol 17, 34, 122 British and Foreign Medical (MedicoChirurgical) Review 158, 193 British Association for the Advancement of Science (BAAS) 141–2, 153 ‘British College of Health’ 206 British Medical Association (BMA) 217, 227, 230 see also Provincial Medical and Surgical Association (PMSA) Brown, George 123 Buckland, William 83, 119, 121, 141 Bulmer, Francis 82, 83 Bulmer, William 167–8 Burgh, William 60, 88, 89, 90 Burke, William 130 see also Hare, William Burton, John 66, 67 Bury and Suffolk Medical Society 153

245

Cambridge 142 university of 20, 22, 94 capital cultural/symbolic 30, 31, 36, 38, 83, 88, 118, 154, 169, 170, 195, 196 economic 38, 118, 154, 177 capitalism 83, 213 print- 159 Cappe, Catherine 17, 91, 103–4 Cappe, Joseph 19, 20 Cappe, Newcombe 17, 19 Cappe, Robert 19, 20 Carlyle, Thomas 193, 217–18 Carr, John 15, 26 Cavendish, William, 5th Duke of Devonshire 53, 60 Cavendish-Bentinck, William Henry, 3rd Duke of Portland 53, 54, 60 Cayley, Sir George 120–1 Chadwick, Edwin 173, 174, 177–9, 181 Champney, George 20, 123, 154 Champney, John 20 Champney, William junior 20 Champney, William senior 2, 20, 25, 129 Chaplin, Simon 132 Chapman, John 215–16, 217 charity 15, 86, 105, 120, 164, 177 medical 1–2, 17, 35–6, 38, 83–4, 85, 87–8, 89, 99, 101, 160, 175 attack on 134, 155–6, 170, 177–8, 216 importance of 2, 36–7, 24, 36–7, 52, 83–4, 88 satire of 36 Chartism 137, 177, 181, 207 chemistry 52, 54, 113, 199 pneumatic 64–5 see also eudiometry cholera 160, 162–3, 171, 172, 175, 180, 181 epidemic of (1831–2) 10, 117, 136, 151–2, 162–72 passim, 173, 175, 181, 182, 195, 203 chorography 51, 63–4, 68 Church of England 16, 20, 33, 38, 91, 97–8, 118, 121, 133 evangelical wing of 16, 17, 20, 31, 82, 85, 90, 91, 93, 97, 98, 120, 141, 205

246

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civic culture and society 2, 8, 9, 13, 15–17, 20–1, 24–32 passim, 39, 63–8 passim, 73, 84, 90, 116, 119, 121, 125, 154, 155, 156, 170, 175, 178, 179, 181, 196, 202, 226 Civil Registration Act (1836) 173 see also General Register Office classical knowledge 22, 34, 39, 49, 59, 67 see also liberal knowledge; polite knowledge clergy 19, 23, 25, 36, 66, 67, 114, 120, 122, 141, 163, 170 see also individual denominations clubs 9, 24–32 passim, 121, 158, 194 see also association; conviviality; sociability comedic literature 40, 51, 68, 70, 72 Company of Barber-Surgeons of London 21, 129 conviviality 8, 27, 29, 70, 114 see also association; clubs; sociability Cooper, Sir Astley Paston 156 Copley, John Singleton, Lord Lyndhurst 209, 210 Corn Laws, repeal of 213, 215 coroner’s inquest 208–11 Cullen, William 34, 52, 53 Daffy’s Elixir 204 Darwin, Erasmus 50, 55 de-professionalisation 10, 228 see also professionalisation Dealtry, Elizabeth 28, 53 Dealtry, John 86 Defoe, Daniel 14 dentistry 202 Derby 34 Dickens, Charles 224 Dibdin, Thomas Frognall 113–14, 115, 126 Digby, Anne 3, 5, 83, 87 dispensaries 1, 155, 207 see also York Dispensary dissenters 16–17, 85, 91, 93, 98, 101, 118, 120, 121, 122, 173 see also individual denominations

District Medical Officer, post of 173 see also Medical Officer of Health, post of Doctor’s Dilemma (1906) 227 Doctoring the South (2004) 8 Doctors Club, the culture of 25–32, 36, 39, 70, 114, 116, 154, 155, 157, 171 see also alcohol, consumption of; gambling election procedures of 30–1 membership of 25–6, 29–31, 49, 74 Doherty, John 136 Doncaster Gazette 98 Drake, Francis 14, 15, 65–7 druggists 1, 20, 115–16, 154, 155 drugs dispensing of 18, 204, 224 prescribing of 7, 168, 227 see also therapeutics Drummond, Robert Hay, Archbishop of York 16 Dublin Medical Press 161, 176 Duncan, Andrew 176 Dundas, Thomas 136, 163 Durey, Michael 163–6 passim Edinburgh 8, 20, 27, 54, 63, 119, 129, 130, 131, 163 university of 22, 23, 48, 52, 60, 90, 123, 139, 176, 223 Eliot, George (Marian Evans) 223–4 Elliot, Paul 118, 122 Enlightenment, the 53–4, 55, 63, 64, 119, 135, 194, 212 Essays on State Medicine (1856) 216 Etty, William 126, 127 eudiometry 64–5 see also chemistry, pneumatic Evelyn, John 51, 57–61 passim, 63 Eyler, John M. 173–4 expertise, medical 3, 5, 7, 9, 10, 93, 126, 138, 155, 164, 171, 175, 176, 177, 180, 181, 182, 193–218 passim, 223, 224, 227, 228 factionalism, political and social 9, 35, 114, 115, 122, 203, 225

Index Facts and Observations relative to the Disease commonly called Cholera (1833) 171 farming 18, 19, 38, 53–4, 69 see also agricultural improvement Farr, William 173–4, 176 Fichte, Johann Gottlieb 193 Fissell, Mary 7, 87 Fitzwilliam, William Wentworth, 2nd Earl Fitzwilliam 98, 100 Fitzwilliam, Charles William Wentworth, Viscount Milton and 3rd Earl Fitzwilliam 100, 101, 120, 121 Fothergill, John 60, 64 Foucault, Michel 83, 84, 104, 116 France 56, 58, 92, 215 culture and language 49, 71–2 medicine 134, 137, 138, 155, 157, 158, 202, 223 Frank, Johann Peter 176 Frankland, Sir Thomas, 5th Baronet of Thirkleby 51, 61, 86–7 free market 3, 130, 183, 197, 212–16 passim, 228 French Revolution 71, 134, 155, 202 friendship 32–8 passim, 48, 51, 53, 55, 60, 61, 63, 64, 69, 70, 72, 82, 94, 99, 102, 113–14, 120, 123, 124, 180 see also patronage gambling 29, 30, 157 Garencieres, Theophilus Davyes 2, 21, 24, 25 Gayle, Yorkshire 33 gender 3, 8, 22, 26–8, 29, 48, 71–2, 84 see also masculinity General Medical Council (GMC) 226 general practitioners 114, 116, 133, 138, 155, 202, 223, 225, 227, 228 see also surgeon-apothecaries General Register Office (GRO) 173–4 see also Civil Registration Act (1834) gentility (and medico-) 2, 4, 7, 9, 13–40 passim, 48–75 passim, 82–106 passim, 113, 114, 116, 117, 118, 122, 126, 132, 134, 139, 156, 170, 171, 226

247

Gentleman’s Magazine 57, 61, 63 gentry 14–15, 16, 17, 18, 19, 20, 23, 26, 59, 70, 101, 105 geology 119, 121, 178 Georgical Essays (1770–1803) 51, 55–7, 63, 68 Germany (German Confederation) 60, 141, 176, 193, 205 Gilbert, Pamela 166 Glasgow, university of 135 Glorious Revolution, the 30 Goldgar, Anne 55 Goldie, George 123, 124, 125, 154, 163, 164, 169, 199 Göttingen, university of 20, 175, 198 Gray, Faith 17–18, 91 Gray, Frances 17–18 Gray, Jonathan 82, 83, 86, 91, 97, 100, 102, 120 Gray, William 17, 91, 97, 120 Greek language 33, 49 Gregory, John 13, 23, 48, 49 Grimm, Samuel Hieronymous 60 Guerrini, Anita 139 Harcourt, Edward Vernon, Archbishop of York 97, 120, 150 Harcourt, William Vernon 120, 141, 178, Hare, William 130 see also Burke, William Hargrove, William 92, 100, 118, 120, 121 Harley, David 4 Harling, Phillip 104–5 Hastings, Sir Charles 217 Hawes, Yorkshire 33 Health of Towns Association 178, 181 heroism, medical 169–70 Hey, Richard 164, 165 Higgins, Godfrey 94–100 passim, 105 Home, Henry, Lord Kames 54 homeopathy 157, 201, 204, 207 Horsman, Jane 82–3, 101, 102 Horton, Richard 229–30 hospitals 21, 28, 36, 92, 93, 133, 134, 135, 140, 155–6, 166, 167, 168, 171, 196, 224, 226, 227, 228 see also York County Hospital

248

Index

House of Commons/House of Lords see Parliament Howard, George William Frederick, Viscount Morpeth 179, 180 Howard, John 92, 94 Huddersfield 14 Medico-Chirurgical Society 153 Hudson, George 178, 179, 203 Hull 197, 198, 210 humoral medicine 134, 206 Hunter, Alexander 2, 17, 18, 19, 20, 23, 24, 25, 28, 30, 31, 48, 51–63 passim, 62, 64, 66, 68, 69–70, 73, 86–90 passim, 96, 99, 105, 126, 176 Hunter, John 60, 126, 128, 132, 205 Hunter, William 4, 66, 129 Husband, William 103 Husband, William Dalla 140, 161–2, 180, 181, 182, 201, 202 hydropathy 201, 204 Hygeiaism 205–13 passim see also Morison’s pills Imagined Communities (1983) 159 industrialisation 5, 6, 8, 9, 13–14, 15, 33, 118, 121, 173, 196 Inkster, Ian 118, 122–3 Jacyna, L. Stephen 122 Janković, Vladimir 67 Jeffray, James 135 Johnson, Peter 25–6, 48 Jordanova, Ludmilla 61, 131–2 Joyce, Patrick 182 Kant, Immanuel 193 Kay(-Shuttleworth), James Phillips 139–40, 166, 171, 173–4, 177 Kingsley, Charles 224 Kirkdale, north Yorkshire 119 Klein, Lawrence 22 Knox, Robert 130 La Mott, Thomas 210–11 Laennec, René-Théophile-Hyacinthe 134 Lancet, the 113, 117, 133, 134–5, 156,

158–60, 171, 210, 211, 214, 216, 217, 229 Laqueur, Thomas 4 Latin, language 33, 49, 58 Lawrence, Christopher 7, 225–6 Lawrence, Susan 131–2 Lawson, John 20, 103 lawyers 14, 19, 21, 25, 85, 179, 208–9 Laycock, Thomas 115, 150, 152, 161–2, 175–82 passim, 193–6, 202, 204, 216, 225 Leeds 14, 70, 90, 92, 115, 151, 175, 197, 198 Leeman, George 179 Leiden, university of 20 Lettsom, John Coakley 66 liberal knowledge 7, 9, 22, 24, 32, 33, 148–68 passim, 72, 74, 113, 116, 117, 126, 138, 226 see also classical knowledge; polite knowledge liberalism 123, 135, 137, 173–83 passim, 197, 204, 205, 212–17 passim, 225, 226, 228, 230 Life and Adventures of an Eccentric Traveller (1818) 70–2 Lincolnshire 19, 53, 61 Liverpool 168 Medical Society 153, 158 London 8, 9, 15, 26, 34, 48, 53, 66, 74, 84, 119, 129, 132, 133, 155, 156, 158, 160, 163, 175, 176, 179, 194, 195, 202–3, 205, 206, 210, 211, 223, 224, 225, 229 see also Company of Barber-Surgeons of; Medical Society of; Royal College of Physicians of; Royal College of Surgeons of; Royal Society of London Medical and Surgical Journal 158, 159 London Medical Gazette 141, 158, 210, 213–14 London University 123, 175, 176 Loudon, Irvine 3, 25, 114 Lowther, John Henry 136–7 Luddites 92 Lydgate, Tertius 223–5 Lynch, Robert 210

Index Mackenzie, John 210–11 Malthus, Thomas Robert 177, 214 Manchester 8, 13, 51, 53, 55, 65, 105, 141, 168, 211 Literary and Philosophical Society 55 medical school 195–6 Medical Society 153, 158, 161 Mandeville, Bernard 85 ‘march of intellect’ 9, 117, 118, 121, 124, 126, 131, 135, 137, 156, 208 see also progressivism marginality, concept of 72, 86, 118, 122, 142, 195 Markham, William, Archbishop of York 16, 36 marriage 9, 24, 27–8, 37–8, 39, 53, 65, 173, 225 masculinity 22, 26–9, 31, 37, 71–2, 74 Mason, William 88–90, 95, 105 Mather, Alexander 17, 82–3, 84, 86, 101–2, 105 Matterson, William 83, 101, 209 Medical Act (1858) 6, 194–5, 225, 226 Medical Bibliography A. and B. (1833) 73–4, 113, 171–2 medical botany 205 medical education 6, 22, 28, 32, 34, 48–50, 52, 54, 104, 114, 129–30, 132–40 passim, 153, 154, 155, 156, 195–204 passim, 209, 216, 224, 226 medical ethics 105, 193–4 medical faculty 1–2, 4, 17, 19, 25, 49, 115, 122, 150, 161, 176, 198, 210, 212 Medical Inquiries and Observations (1789) 54 medical marketplace 3–5, 115 Medical Officer of Health, post of 174, 181, 228 see also District Medical Officer, post of medical police 176–80 passim medical profession 3, 5–6, 7, 9, 19, 23, 33, 36, 38, 114, 115, 122, 137–42 passim, 153, 166, 168, 170, 194, 197, 198, 199, 203, 204–18 passim as ‘imagined community’, 159–60, 194–5, 202–3 see also Anderson, Benedict

249

Medical Profession in the Industrial Revolution, The (1984) 6 Medical Register, the (1780) 66 Men and Manners: or, Concentrated Wisdom (1809) 23 mesmerism 201 meteorology 64, 65 Methodists 33, 73, 98, 175 middle class 86, 94, 105, 118, 120, 132, 137, 207, 211 Middlemarch (1874) 223–4 midwifery 18, 23–4, 129 Miller, John (Johann Sebastian Müller) 60, 61 Mind’s Monitor, The (1793) 70 Missionary Society 91 Moat, Thomas 206, 212 Monro, John 83 Monro, Thomas 101 Moral and Physical Condition of the Working Classes (1832) 166, 171 moral therapy 91, 93, 104 Moravians 17, 33 Morison’s pills 10, 193, 197, 204–11 passim, 217–18 Morison, James 10, 197, 205–7, 210, 211, 212 Morris, Robert John 165–6 National Health Service 227 National Insurance Act (1911) 226 natural history 8, 39, 49, 50, 51, 57–9 passim, 200 see also zoology Navy, Royal 57, 58–9, 71, 120 Needham, James P. 140, 154, 165, 167, 170, 171–2, 175, 198, 200, 203 Neighbourhood of Heslington (Near York): A Rural Poem, The (1815) 70 Neve, Michael 118, 122 New Poor Law see Poor Law Amendment Act (1834) Newcastle upon Tyne 131, 164, 165, 168 Medical and Surgical Society of 153, 158 newspapers 1, 2, 8, 14, 88, 89, 92–7 passim, 139, 151, 159, 169, 199, 209 Nicoll, S. W. 92, 95, 96–7, 98, 99, 100, 103

250

Index

No Cure No Pay: Or the Pharmacopolist (1794) 69–70 non-conformists see dissenters Nottingham Medico-Chirurgical Society 153 ‘Old Corruption’ 93, 104, 119, 134, 137, 180, 208 see also reform Oldfield, Joshua 14, 103 Orange, Derek A. 120 ‘ornamental’ learning 9, 39, 48–51 see also polite knowledge Ouse, river 15, 203 Overton, James 209 Oxford 141 university of 20, 22, 119, 120 Paris 134, 158, 175, 195, 211, 223 see also France; French, medicine Parliament 16, 26, 69, 83, 96, 101, 120, 129, 130, 133, 136, 150, 179 Parsons, Talcott 5 Past and Present (1843) 193, 217–18 patent medicines 204, 209, 210, 214, 227 see also quackery patient-doctor relationship 6, 8, 35, 36, 52, 54, 69, 114, 115, 138, 152, 195, 211, 223, 228, 229 patronage 9, 24, 31, 35–7, 39, 60, 70, 85, 86, 87, 155, 177–8, 180, 225 Peck, Abraham 168 Pelling, Margaret 29, 167 Percival, Thomas 50, 51, 53, 55, 65, 66, 105 Perkin, Harold 227–8 Phillips, John 121, 141 Philosophical Transactions of the Royal Society 64, 67 see also Royal Society of London phrenology 140, 141, 176, 201 physicians 2, 3–4, 7, 17–18, 19, 25, 28, 34, 51, 66, 82, 86–7, 90, 93, 99, 101, 104, 114, 115, 122, 123, 141, 152–6 passim, 160, 163–7 passim, 176, 193, 202, 205, 210, 213, 215, 216

civic and social identity of 2, 9, 13, 21, 24, 29, 36, 39, 48–50, 51–2, 54, 61, 63–4, 83–4, 88, 117, 123, 150, 154–5 education of 2, 20, 21, 28, 48, 52 negative image of 19, 22–4, 36 social position of 19–20, 21 physiology 22, 50, 113, 140, 141–2, 195, 201 Pickstone, John 7, 105, 175 plague 142, 152, 166, 169 poetry 40, 50, 70, 88, 171 polite knowledge 9, 22, 34, 48–75 passim, 117, 118, 119, 121, 124, 171 see also classical knowledge; liberal knowledge politeness 7, 8, 9, 15, 17, 22, 24, 26, 29, 31, 39, 49, 51, 52, 53, 55, 61, 70, 74, 85, 103, 105, 114, 116, 119, 132, 155, 156 ambiguity and ambivalence of 22–3, 24, 26–7, 71 political economics 117, 177, 193, 212, 214–15 Poor Law Amendment Act (1834) 172, 174, 216, 225 Poor Man’s Advocate 136 Poovey, Mary 116, 138, 175, 182 Porter, Roy 3, 4–5, 19, 24, 83 Presbyterians 17, 33 Priestly, Joseph 55, 60, 64 Pringle, John 60, 64 private practice, medicine 17–18, 36, 38, 82, 84, 86, 90, 93, 99, 115, 132, 134, 152, 224, 225, 227 Privy Council 163, 164 professionalisation/professionalism 3, 5–6, 7, 122, 180, 195, 204, 207, 215, 225, 227, 228, 229–30 see also de-professionalisation progressivism 9, 117, 126, 134, 135, 151 providence, religious concept of 32, 33, 35, 49, 56, 59, 139, 177 Provincial Medical and Surgical Association (PMSA) 217 Prussia 175, 176, 181, 214 see also Germany

Index public health 10, 142, 152, 172–82 passim, 215, 225, 227 bill 179, 180 Public Health Act (1848) 180, 215 public service, concept of 3, 10, 106, 117, 138, 153, 170, 182, 195, 203, 214, 225, 226, 230 public sphere, concept of 85, 87, 160, 162 quackery 25, 94, 122, 131, 157, 193, 194, 196, 197, 200, 201, 204–18 passim, 223, 225 Quakers 17, 20, 31, 64, 66, 67, 90, 91, 94, 118, 120, 121, 178 Quarterly Review 141, 213 radicalism medical 133, 134, 137, 138, 155–6, 175, 176, 195, 203, 207–8, 214, 224, 225 political 8, 16, 86, 92, 94, 95, 101, 105, 117, 118, 119, 121, 122, 123, 133, 136, 137, 151, 177, 179, 180, 203, 207–8, 224, 227 reform ‘Age of’ 9, 118, 225 bill 114, 150–1 institutional 82–106 passim medical 133–4, 137, 153, 155, 156, 162, 176, 179, 181, 182, 195, 197, 201, 202–3, 204, 207–8, 210, 211, 212, 213–14, 216, 223–4, 225, 227, 230 moral 27, 91 political and social 8, 9, 16, 17, 67, 85–6, 91, 92, 97, 103, 105, 106, 117, 118, 120–2, 123, 136–7, 150–1, 176, 180, 193, 203, 207–8, 224 Reform Act (1832) 136, 137, 150–1 Reynolds, Joshua 28, 126, 128 Richardson, Richard 197, 208–9 Richardson, William 16, 91 Rockingham Club 16, 24, 30, 67, 86 see also Watson-Wentworth, Charles, 2nd Marquess of Rockingham Roman Catholics 16–17, 20, 67, 70, 71, 100, 123 emancipation of 114, 120, 123 Rowe, Harry 69

251

Royal College of Physicians of London 20, 69, 155, 156, 225, 229 Royal College of Surgeons of London 155, 156, 175 Royal Society of London 4, 50, 51, 57, 58, 61, 64, 65, 66, 70, 87 see also Philosophical Transactions of the Royal Society Rumsey, Henry Wyldbore 216–17 Rush, Benjamin 54 St Andrews, university of 69 Salmon, Robert 210, 211 Sandemanians 17, 32, 33 sanitary medicine see public health Sappol, Michael 140 satire, medical 19, 36, 69 Scotland 20, 33, 53, 54, 56, 155, 176, 177 see also Edinburgh Select Committees, Parliamentary on anatomy (1832) 130, 132–3, 135 on madhouses in England (1815) 83, 96, 101 on pauper and criminal lunatics (1807) 91 Sharpe, William 128 Shaw, George Bernard 227 Sheffield 115, 119, 122–3 Medical School 136 Medical Society of 158, 161 Silva: Or a Discourse of Forrest Trees and the Propagation of Timber in his Majesty’s Dominions (1776) 51, 57–61, 68 Simpson, Thomas 123, 161–2, 164, 165, 168, 198, 199, 200, 201, 203, 211 Smith, John Raphael 61, 62 Smith, Thomas Southwood 132–3, 134, 177 Smollett, Tobias 36, 68, 72 sociability 9, 10, 15, 17, 22, 24–31 passim, 34, 39, 69, 74, 114, 121, 154, 155, 157, 171, 172 see also association; clubs; conviviality social body, the 9, 117, 126, 152, 153, 172, 175, 176, 180, 181, 195, 214, 224 see also Poovey, Mary

252

Index

Society of Antiquaries 4, 66 Sunderland 163, 179 surgeons 2, 3, 4, 7, 14, 17, 18, 25, 36, 39, 52, 66, 71, 82, 95, 104, 114, 120, 122, 123, 131–3 passim, 153, 154, 160–8 passim, 171, 175, 199, 205–10 passim, 213, 225 civic and social identity of 2, 9, 20, 21, 29, 70–4 passim, 125–6, 154–5 education of 2, 104, 139–40, 156, 195, 202 negative image of 23 social position of 19–20, 21 surgeon-apothecaries 18, 19, 24, 28, 39, 50, 70, 72, 73, 83, 100, 115–16, 140, 154, 155 see also general practitioners statistics 173–6 passim, 181, 182, 223 Sterne, Laurence 19, 70, 72, 73 Stowe, Steven 7–8 Swainston, Allen 2, 19, 20, 50, 87 Swainston, Frances 19 Tadmoor, Naomi 35, 37 technocracy 177, 180, 217, 225, 228 Thackray, Arnold 118, 121 Therapeutic Perspective (1986) 7 therapeutics 6, 7, 65, 84, 91, 104, 157, 195, 206, 207 Thorpe, Anthony 120 Tories 61, 92, 123, 150, 179, 182 in York 114, 119, 121, 136–7, 150, 178, 179, 180 trade, negative connotations of 23, 32, 36–7, 51, 54, 74, 214 trade directories 19–20, 25 Treatise on the Errors and Defects of Medical Education, A (1794) 48–9 Treatise on the Nature and Virtues of Buxton Water, A (1761) 52–3 Treatise on the Nervous Diseases of Women, A (1840) 150, 175 Tuke, Samuel 17, 91, 93, 94, 96, 97, 120, 178 Tuke, William 90, 97, 100 Two Years Ago (1857) 224 typhus 166, 172, 177

Unitarians 17, 19, 20, 91, 97, 103, 120, 121, 199 Universal Vegetable Medicine see Morison’s pills ‘urban renaissance’, concept of 9, 14–15, 26, 66 utilitarianism 8, 10, 94, 116, 117, 123, 134, 135, 151, 155, 173–4, 182, 197, 204, 214, 215, 225 vagrants 151, 165 visitation of medical charities 84, 96–7, 102–3, 104 Waddington, Ivan 6 Wake, Baldwin 82, 123, 124, 154, 162, 168, 172, 198, 208 Wakley, Thomas 133, 135, 137, 155, 156, 158, 179, 195, 203, 211, 214, 229 Wallis, Edward 20, 21, 87 Warburton, Henry 130 Warner, John Harley 7–8 wars Dutch 58 French (Revolutionary and Napoleonic) 9, 71, 105, 114 Seven Years 58, 59 South African 226 Watson-Wentworth, Charles, 2nd Marquess of Rockingham 16, 53, 54, 60, 61, 67, 86 Webb, Joseph 197, 208–10, 212 Weber, Max 5 Weekes, Hampton 140 Wellbeloved, Charles 17, 91, 97, 100, 120, 121, 123 Wellesley, Arthur, 1st Duke of Wellington 150–1 West Indies, the 120, 205 Westminster Medical Society 167 Westminster Review 134, 215, 216 Wetherby, west Yorkshire 60, 131, 175 Whaley, Francis 2, 35 Wharman, Dror 105 Whigs 24, 25, 51, 53, 54, 56, 58, 59, 60, 61, 63, 67, 86, 105, 118, 122, 136, 141, 180, 203

Index in York 16, 24, 26, 30, 67, 92, 114, 118, 119, 120, 121, 123, 133, 136, 151, 203 see also Rockingham Club; WatsonWentworth, Charles, 2nd Marquess of Rockingham; York, politics of; York Whig Club White, Charles 51, 53, 55 White, William 2, 19, 20, 24, 28, 31–2, 35, 50, 51, 63–8 passim Wilberforce, William 16, 90, 91 Williams, Caleb 154, 161, 172, 174 Wilson, Kathleen 85 Withers, Frances 37–8 Withers, Thomas 2, 17, 19, 20, 21, 31, 34, 35, 37, 38, 48–9, 50, 87 Withers, William 21, 38, 88, 89 working classes 136–7, 166, 168–9, 180, 181, 203–4, 207, 211 Wyvil, Christopher 16, 105 York Agricultural Society 53, 55, 57 Aldermen 14, 15, 20, 25, 73, 136, 163 ancient history of 13, 66, 67, 120 Archbishop of 16, 36, 60, 97, 101, 120, 150, 163 Assembly Rooms 15, 26, 113, 114 Assizes 83, 98, 197, 209, 210 Board of Health 151, 163–4, 166, 167, 168, 169, 170, 180–1 City Council 179 City Surgeon, office of 20 Cleaning and Lighting Act (1763) 13, 15 Common Council 15, 30, 73 corporation of 15, 16, 20, 21, 26, 30, 65, 67, 88, 92, 98, 151, 180 County Gaol 129 demography of 13–14, 115 economy of 8–9, 14, 115 George Inn 114, 150, 203 Guild of Barber-Surgeons 21 Guildhall 15, 26, 30, 67, 99, 136, 150, 163 Health of Towns Association 181 improvement of 15, 65–6, 67 Knavesmire 15, 29 Lord Mayor of 14, 15, 16, 21, 26, 30, 86,

253

103, 123, 163, 178, 179, 203 Mansion House 15, 26, 30 medieval history of 13, 16 Merchant’s Hall 212 politics of see Whigs, in York; Tories, in York Recorder of 21, 26, 88, 92, 178 St Helen’s Church 15 St Helen’s Square 15, 25, 30 St Michael-le-Belfry, parish of 16, 91 St Saviourgate Chapel 17 Theatre Royal (New Theatre) 15 workhouse 15 York Chronicle 93, 130, 165 York County Hospital 17, 35, 36, 52, 86, 88, 102–4 passim, 129, 139, 158, 164, 170, 174, 175, 200, 203–4 Court of Governors of 36, 102, 103, 104, 139 York Courant 1, 3, 23, 72, 88, 92, 101, 118, 119, 130, 133, 135, 136, 151, 167, 209 York Dispensary, 1–2, 4, 17, 35, 37, 38, 154, 155, 156, 163, 166, 170 York Dispensary, History of the (1845) 37 York Herald 92, 94, 98, 100, 118, 135, 150, 161, 170, 197, 203, 212 York Lunatic Asylum 17, 35, 123 reform of 9, 75, 82–106 passim, 114, 120 York Mechanics’ Institute 140 York Medical Library 158, 174, 200 York Medical School 10, 196, 197–204 passim, 209, 217 York Medical Society 142, 168, 171, 172, 174, 176, 196, 198, 199, 201, 202, 217 ethos 153, 155–60 passim, 160–2 membership 154–5, 160 York Minster 16, 88 Library 74 York Retreat 90–1, 93, 201 Yorkshire, West Riding of 13, 92, 94 Yorkshire Association 16, 105 Yorkshire Gazette 92, 98, 119, 121, 130, 131, 141, 150, 151, 163, 165–70 passim, 180, 199, 200

254

Index

Yorkshire Museum 124, 125, 141, 174, 199 Yorkshire Philosophical Society (YPS) 9, 72, 117, 118–26 passim, 132, 141, 160, 200–1 York Tavern 1, 15, 25, 30, 114, 155

York Whig Club 92, 121, 123 Young, Arthur 55, 57 zoology 124, 125, 132, 142 see also natural history