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In the preface to their first volume of Medical Observations and Inquiries (1757), a “Society of Physicians in London” praised the publications of the Royal Society and the Parisian Academy of Sciences, yet noted that their scope “does not allow them to insert several things … calculated only for the improvement of physick.” Furthermore, the anonymous editor(s) continued, some important cases … cannot decently be read in mixed company, and there are others, of the merits of which, physicians only can be adequate judges, and which would appear neither entertaining nor instructive to philosophers or mathematicians. “Mixed company,” a phrase that evokes audiences of men and women, suggests that these physicians had extraordinary delicacy about presenting medical details to nonmedical men, unless prim ladies indeed visited the Royal Society meetings. Note how the physicians claimed to be the only “adequate judges” of their experiences. They could share the “entertaining” or “instructive” case with educated folk, but they were the appropriate interpreters of such matters of fact. Asserting their unique expertise had, of course, always marked medical practitioners, however much they negotiated their authority with patients and peers. So the editor(s) went on to explain the particular grounds for their valuable work: The persons who formed this Society, were either such as had the care of hospitals, or were otherwise in some degree of repute in their profession; and consequently had frequent opportunities of making observations themselves, and of verifying, in the course of their practice, the discoveries of others. […] [ABSTRACT FROM AUTHOR]

In 1776, Joseph Hooper, a London surgeon and man-midwife, published a short case history in Medical Observations and Inquiries. A female midwife had called him to see a woman who was a few months pregnant. The midwife was disturbed, Hooper wrote, because she was unable to “feel the mouth of the womb.” He proceeded to examine the patient per vaginum. At that moment, Hooper reported, “I immediately recollected what Dr. Hunter had said in his public lecture upon the subject of the inverted uterus.” While making the inspection, Hooper continued, “the woman, with expressions of much joy, said she could make water.” Hooper helped her to relieve her distended bladder and, following what he learned from William Hunter's course, manipulated the uterus back into its proper position. Hooper decided to tell this story – and it was his story, for no doubt the midwife and the patient had their own versions – to medical readers. He depicted himself, of course, as a clever and competent practitioner, certainly more knowledgeable than the midwife. Yet he also chose to ascribe his knowledge to William Hunter's lectures. Here he not only revealed his regular education, but also borrowed Hunter's authority and expertise. Hooper's flash of memory and insight (even if contrived) illustrates just how ordinary practitioners both accepted and established lecturers' influence and reputations. Throughout my work, I have argued that stories like Hooper's reveal a great deal about the construction of medical authority in eighteenth-century London. [ABSTRACT FROM AUTHOR]

“[L]ast night a nasty little dog was in the dissecting room shut up there for some experiment or other & made free with the Os Cuboides & the falanges of the little Toe, for wh. I have substituted part of an other foot,” wrote Hampton Weekes, a resident apothecary's pupil at St. Thomas's, to his father on 10 November 1801. Busy making anatomical preparations to send home, Hampton evinced complete disinterest in what that “experiment or other” might have been about, much less concern for the fate of the dog. Hampton later warned his family: “These things I suppose you will not circulate for what I tell you on this head I conceive goes no farther.” Hampton, happily participating in the clinical and anatomical rituals at St. Thomas's and Guy's, was quite blasé about the notion of animal experiments, yet clearly aware others might not have such enlightened views. Hampton, in short, even as a pupil on the fringes of hospital men's investigations, identified with the culture of “men of science.” He acquired those tidbits of theory that extended his repertoire not only into talk of constitutions and ultimate causes for disease, but also into experiments and science. He savored those delicious moments of knowing more about nature than others did: “I tell Dick ye source of animal heat is acertained ask him if he knows it,” he wrote to his sister, Mary Ann, “This is a chemical operation–.” [ABSTRACT FROM AUTHOR]

No degree of discipline, nor any kind of examination, can ensure the public against having a certain number of persons who are indifferently qualified included in the list of well-qualified practitioners. Young men may be compelled to have opportunities of study, but they cannot be compelled to learn. The history of medical education in London seen through official records, from the minute books of the Surgeons' Company to Acts of Parliament, is a patchwork of regulations and traditions that hides as much as it reveals about medical organization and practice. From the bureaucratic perspective that such documents offer, London medical men were separated into the familiar tripartite division of physicians, surgeons, and apothecaries, each with its own corporate body, public voice, and standards of appropriate medical training. Entry into the Royal College of Physicians, the Surgeons' Company, or the Worshipful Society of Apothecaries certainly marked professional status and acceptance into the mainstream of metropolitan practice. Yet, as much recent work has shown, defining the medical profession(s) according to these corporations' claims flies in the face of contemporary understanding of who could and should practice medicine. The lines between “quacks” and “regulars,” so bitterly drawn by medical men threatened for their livelihoods and so frequently ignored by their potential patients, are more realistically cast as the shades of gray between regular and irregular practitioners. Community acceptance and length of experience could matter as much as – or more than – formal licensing, university degrees, or corporate membership in establishing a full-time medical career in much of eighteenth-century Britain. [ABSTRACT FROM AUTHOR]

In 1796, William Blizard, surgeon to the London Hospital and earnest Anglican, introduced one of his pamphlets with a revealing text. He chose a passage by William Blackstone, the eminent legal commentator, Member of Parliament, and judge. The General Duties of all Bodies politic, considered in their corporate Capacity, may like those of Natural Bodies, be reduced to the single one, that of acting up to the End or Design, what ever it be, for which they were created by their Founder. Blizard went on to discuss the topic at hand – the importance of assistant surgeons in hospitals – as an application of this teleological principle. His essay resonated with the analogies he evoked with Blackstone's statement: hospitals were like “all Bodies politic,” like “Natural Bodies,” like God's creation. Inspired founders had shared God's vital spark, infusing their work with an all-encompassing Design. Blizard implicitly played out the rest of the analogy. Just as humans had to figure out God's Design to understand nature, hospital governors needed to grasp the founders' Design to carry out their “General Duties.” Unfortunately, like corrupted churchmen, governors tended to forget “all the great objects they comprehend” and to fail to “appreciate their own true, high relation to the public.” Blizard hastened to remind them that they were responsible “for their conduct to science, to humanity, to all mankind.” This was rather heavy-handed rhetoric for introducing an argument that the surgeons of the London Hospital needed help with their charitable duties, but Blizard was not one to resist a high moral tone when he held a pen. [ABSTRACT FROM AUTHOR]

Were I to guess at the most probable future improvements in physic, I should say, that they would arise from a more general, and more accurate examination of diseases after death. And were I to place a man of proper talents on the most direct road for becoming truly great in his profession, I would choose a good, practical Anatomist, and put him into a large hospital to attend the sick, and dissect the dead. So wrote William Hunter, surgeon turned physician, in an introductory lecture for his London anatomy class in the early 1780s. Hunter made a nicely prescient guess about the direction of progress in medicine. Read with the benefit of hindsight, his comment evokes the juncture of three paths into the “direct road” to medical modernity. First, Hunter pointed to an empirical methodology for “improvements in physic” that detached the investigation of disease from patients' experiences of illness and from direct concern for treating it. A newly conceptualized medicine started at death, when the bedside-practitioner gave up and the scientist-practitioner took over – and these were the same person. Second, Hunter placed his man in a hospital where he had equal power “to attend the sick” and to “dissect the dead.” Casting the hospital as an institution where practitioners deployed new methods to produce new knowledge transformed an expression of charitable care and social concern into a foundation for professional medical authority. [ABSTRACT FROM AUTHOR]