Jukes de Styrap (1815-99): medical practitioner and ethicist

I first encountered Jukes de Styrap as the author of The Young Practitioner (1890) – an advice guide for aspiring medical men – when I was researching the early struggles in practice. De Styrap has primarily gained recognition among historians of medicine as one of the major commentators on medical ethics in the nineteenth century. In this blog post, I reveal how he established himself as a spokesperson on a constellation of issues surrounding the pecuniary, social and professional aspects of medical life.

Born in 1815, de Styrap was educated at Shrewsbury School in Shropshire and later at Stourport in Worcestershire. He studied medicine at King’s College London. Like many general practitioners at the time, he was jointly licensed by the Royal College of Surgeons of England and the Society of Apothecaries. He practised in Ireland during the 1830s and 40s, later becoming a licentiate of the Royal College of Physicians of Ireland as well. He then returned to his roots, setting up practice in Shrewsbury. Here he held appointments at the Salop Infirmary and South Salop and Montgomeryshire Infirmary. He founded the Salopian Medico-Ethical Society and acted as its secretary. The Society was subsumed into the Shropshire Branch of the British Medical Association (BMA), on which de Styrap also sat, becoming its President. In 1864, he suffered a severe illness and retired from clinical practice shortly after, standing down as Consulting Physician at the Salop Infirmary.

During his retirement, de Styrap remained actively involved in professional affairs. Firstly, he published The Medico-Chirurgical Tariffs (1874), which supplied practitioners with a recommended fee scale for a range of cases, including those involving advice, medicines, and surgical procedures (from reducing fractures to excising tumours). The guide divided patients into three classes, suggesting that their fee should depend on the cost of their house rental. Thus the recommended price of an ‘ordinary visit’ might range from two shillings sixpence (for the poorest class) to ten shillings sixpence (for the richest). De Styrap advised that night visits (defined as those between 10pm and 7am) be charged at double the ordinary rate (at least).[1] Immediately popular, the Tariffs was translated into French and went into four editions by 1888. The BMJ branded it ‘absolutely reliable’ and suggested it was a valuable reference guide for both younger and more experienced practitioners.[2]

medical-fees.png

A table of medical fees from de Styrap’s Tariffs (1874).

Four years later, de Styrap published A Code of Medical Ethics (1878), which he originally prepared for the Shropshire Ethical Branch of the BMA. The book has since been identified as ‘the only important code of medical ethics to be published in Victorian England’.[3] It drew largely on the American Medical Association’s Code of Ethics (1847), which had already circulated in Britain.[4] However, de Styrap’s reworking also included original introductory material, in which he represented medicine as a ‘sacred’ calling.[5] The AMA’s code was itself based on Thomas Percival’s landmark Medical Ethics (1803), which combined precepts about good conduct with advice on medical jurisprudence.[6]

De Styrap’s hope that the Code would be officially adopted by the BMA was never realised, but – like the Tariffs – it was well-received by the medical community. The BMJ suggested the Code would be valuable for all medical men to ‘habitually refer’ to and praised its ‘stately and old-fashioned […] diction’ which it felt bolstered its authority.[7] The Code was reproduced and enlarged in 1886, 1890 and 1895.

At the age of 75 and with his reputation already well-established, de Styrap published The Young Practitioner (1890). Once again, he drew extensively on existing sources. The book is almost a direct reproduction of Daniel Webster Cathell’s popular American manual Book on the Physician Himself (1881). De Styrap conceded that his book was largely derivative, and framed it as offering ‘modified selections from’ and ‘additions to’ Cathell’s guide.[8]  De Styrap’s major innovations were to adjust the tenets to reflect the context of British general practice and to reframe the advice into a direct address to young practitioners.

Like its ur-text, The Young Practitioner offered advice to medical men seeking to establish themselves in practice. It counselled readers on everything from their dress sense to the arrangement of their consulting-room, their bedside manner to methods for securing payment from reluctant patients. For de Styrap, medical ethics encompassed not simply moral or legal imperatives but one’s manners and behaviour in both social and professional life. Like Cathell, he approached the business side of medical with candour. De Styrap had long been interested in both pecuniary matters and medical ethics, as his earlier works testify. He saw no tension between these different facets of practice; like Cathell, he contended that the business side of medicine, if conducted fairly, was compatible with a respectable and gentlemanly profession.

Once again, de Styrap’s work was praised by contemporary medical journals. It was regarded as an important contribution to medical ethics rather than a product of plagiarism. The Edinburgh Medical Journal fleetingly mentioned de Styrap’s debt to Cathell but enthusiastically praised his emphasis on gentlemanly conduct.[9] The BMJ remarked that,

[t]he standards which [de Styrap] sets up for our conduct towards the public and towards each other is perhaps almost too high; but though it may be beyond the attainment of all men at all times, yet it is well that the standard would be put high.[10]

Following the publication of The Young Practitioner, de Styrap was increasingly confined to his home in Shrewsbury due to ill-health. He died there at the age of 84 in 1899. Announcing his death, the Lancet credited him as the ‘well-known author of “A Code of Medical Ethics”’.[11] A longer obituary in the BMJ described how this guide had ‘been of great assistance to the profession’.[12] Over the years both journals had recommended the book to correspondents who asked for a reference guide on medical ethics.[13] Meanwhile, the BMA adopted a resolution expressing ‘great regret’ at de Styrap’s death and acknowledging his ‘long connection with the Association and the interest he took in raising a high standard of professional duty’.[14] De Styrap’s career demonstrates how a medical man could develop his professional identity through his writing even after stepping back from active practice.

Questions of originality and authorship perhaps trouble us more than de Styrap’s contemporary readers, who recognised him as making an important contribution to the profession. His high-minded tone and attention to detail were well-respected and his commitment to setting and elevating standards was seen as crucial to regulating professional life. As historians have identified, de Styrap borrowed the language and recycled the tenets of earlier medical ethicists. This approach, and the enthusiastic reception of his work, reveal how ideas about good medical conduct remained remarkably stable for much of the nineteenth century.

[1] Jukes de Styrap, The Medico-Chirurgical Tariffs Issued by the Shropshire Ethical Branch of the British Medical Association (Shrewsbury: William Wardle, 1874), p. 7.

[2] ‘Reviews and Notices: The Medico-Chirurgical Tariffs’, BMJ, 14 April 1888, p. 804.

[3] Peter Bartrip, ‘An Introduction to Jukes Styrap’s A Code of Medical Ethics (1878)’, in The Codification of Medical Morality: Vol. 2, ed. by Robert Baker (Dordrecht: Kluwer, 1995), pp. 145-8 (p. 145).

[4] Code of Ethics of the American Medical Association (Oxford: John Henry Parker, 1849).

[5] De Styrap, A Code of Medical Ethics (London: Churchill, 1878), p. 6.

[6] Thomas Percival, Medical Ethics (Manchester: Bickerstaff, 1803).

[7] ‘Notes on Books: A Code of Medical Ethics’, BMJ, 30 January 1886, p. 213.

[8] De Styrap, The Young Practitioner (London: H.K. Lewis, 1890), p. i.

[9] ‘Reviews: The Young Practitioner’, Edinburgh Medical Journal, March 1890, p. 854.

[10] ‘Review: The Young Practitioner’, BMJ, 13 September 1890, pp. 632-3 (p. 633).

[11] [Untitled], Lancet, 15 April 1899, p. 1047.

[12] ‘Obituary: Jukes de Styrap’, BMJ, 6 May 1899, pp. 1130-1 (p. 1131).

[13] See, for example, ‘Medico-Legal and Medico-Ethical: Work on Medical Ethics’, BMJ, 26 February 1887, p. 486.

[14] [Untitled], BMJ, 15 April 1899, p. 928.

Advertisements

Kenneth William Millican (1853-1915): medical practitioner and journalist

In an earlier blog post, I profiled the Midland Medical Miscellany, a proudly provincial medical journal which was conducted by Kenneth William Millican. As editor, he framed himself as a spokesperson for ordinary provincial practitioners. Yet he went on to have a peripatetic and cosmopolitan career, as this post reveals.

Millican was born in Leicester in relatively prosperous circumstances. His father William was an architect, a member of the Conservative Party, and a colonel in the Volunteers. The young Millican was educated at Atherstone Grammar School in Warwickshire, and later Emmanuel College, Cambridge, where he graduated with honours in the classical tripos. He then entered St Mary’s Hospital in London with a natural science scholarship. During his medical training, some of his case notes were printed in the Lancet and the BMJ; early glimmers of his interest in medical journalism.[1] In 1879 Millican took the diploma of the Royal College of Surgeons of England (RCS) and a year later he became a licentiate of Royal College of Physicians of Edinburgh.[2]

Despite his reasonably illustrious education, Millican’s medical career had humble beginnings. He worked as a ship’s surgeon for the Ocean Steamship Company. Openings such as these provided immediate paid work, but they were widely considered to be temporary situations for young men rather than a long-term career choice. In The Student’s Guide to the Medical Profession (1878), Charles Bell Keetley suggested that a sea voyage might restore the constitution of young men exhausted by their medical education, but warned that more than a year at sea would be ‘demoralising’ and might drive a man to drink.[3]

Kineton_Village_Centre

Kineton Village, where Millican practised (Credit: Arlo 715, Creative Commons).

Following his brief time at sea, Millican soon settled as a general practitioner in Kineton, a village in Warwickshire not far from where he went to school. It was common for newly qualified medical men to return to their roots, since they could use their family’s local connections and standing to attract patients.

At the outset of his practice, Millican launched the Midland Medical Miscellany, which he edited from 1881-5. The journal sought to represent ordinary provincial practitioners, implying that they were excluded from the mainstream medical press. Yet Millican was simultaneously a prolific contributor to journals such as the Lancet and the BMJ. He offered them observations from his practice, commenting on subjects as varied as fracture of the leg,[4] the relief of toothache,[5] and treatment for facial neuralgia.[6] He was also active in local medical societies. In 1882, he showed samples of bacilli from cases of diarrhoea to the Midland Medical Society.[7] Millican’s efforts to make a name for himself were rewarded. The Lancet’s overview of medical activity in 1882 namechecked Millican as having advanced the therapeutics of intestinal obstruction.[8]

One of Millican’s principal medical interests at this time was the ‘germ theory’ of disease. In 1882, he presented a paper on ‘The Etiology of the Acute Specific Diseases’ to the section on public medicine at the Annual Meeting of the British Medical Association (BMA). Drawing on his own experiences and championing the interests of the provincial practitioner, he argued that the aetiology of infectious diseases was much easier to trace in rural districts. While endorsing the germ theory of disease, Millican maintained that – from his observation – some infectious diseases (such as scarlet fever) could materialise de novo and that these ‘self-originating’ cases were more likely to present atypically.[9] A year later, he produced a book on The Evolution of Morbid Germs (1883). His obituary in the Lancet would commend the volume for its ‘remarkable foresight’ in applying ‘Darwinian doctrines’ to disease.[10]

Millican not only commented on clinical matters, but a range of issues surrounding professional life. In 1883, for example, he complained to the BMJ that his paper had been ‘crowded out’ at a sectional meeting of the BMA due to poor scheduling and overrunning presentations from more senior colleagues.[11] In 1884, he criticised the opening hours of the RCS’s library and museum in a letter to the Lancet. He suggested that early closing was ‘prohibitive’ for ‘juniors’ who spent their days engaged in study and tuition.[12] In letters such as these, Millican represented himself as industrious but overlooked. Though he succeeded in getting his name into print, he seemed to identify with the portrait of the hard-working and unappreciated general practitioner which he put forward in the Miscellany.

In the mid- to late-nineteenth century, enterprising medical men often abandoned provincial general practice to pursue specialist medicine in the metropolis and Millican’s career followed this trajectory. After his time in Warwickshire, he set himself up as a specialist in throat diseases in Wellbeck Street, London. In 1887, he was appointed as surgeon to the Margaret Street Hospital for Consumption and Diseases of the Chest and Throat, where he specialised as a laryngologist.[13] He also worked as surgeon to the West End Hospital for Paralysis and the Throat Department of the Queen’s Jubilee Hospital in Queen’s Gate, South West London.[14] Though popular with patients, some professionals regarded specialties as self-serving and akin to quackery.[15] In 1887, Millican wrote to the Lancet to reject claims he was a homeopath and to staunchly defend his status as a regular, rational practitioner. Nevertheless, he highlighted his indebtedness to certain homeopathic practitioners and the drugs they had introduced. [16]

Despite his apparently dogged determination to advance his medical career, Millican also pursued other interests. While in London, he produced two volumes of verse – ‘Smoke Clouds’ (co-written with Dr A.B. Clarke) and ‘Passion Spray’. Millican’s obituary in the Lancet remarked on his display of ‘literary capacity’, noting that he showed ‘considerable command of metre’. It also commented on his theatrical interests. In 1887, he had helped to produce a domestic drama, Fettered Freedom, at the Vaudeville, and he was also known as an amateur actor. Like his father, Millican took up voluntary military service as well, serving as Captain in the 9th Battalion of the King’s Royal Rifle Corps. His obituary remarked that he was ‘a thoroughgoing soldier in spirit’ and ‘an authority on military administration’.[17]

California Mines

Gold mining in California (Wellcome Images)

After about five years working as a specialist in London, Millican left the country in 1892. He was hired as a surgeon by the British and Foreign Steam Navigation Company, and subsequently became medical officer to mining works in Mexico. Three years later he resigned this post for an appointment with the Mountain Copper Mines in California, where he worked until 1897.

Once established in America, Millican pursued a career as a medical editor and journalist. In 1897/8 (reports vary), he became associate editor of the New York Medical Journal and in 1904 he assumed ‘editorship and entire charge’ of the St Louis Medical Review.[18] Two years later, the BMJ recorded him participating in a meeting of the American Medical Editors’ Association. He voiced his opinion that not all medical advertising should be decried, but that greater honesty was needed.[19] In 1907, the BMJ remarked that the St Louis Medical Review had become ‘one of the most readable of the American journals’ under Millican’s ‘able editorship’, but that it was shifting from weekly to monthly publication.[20] By this time, however, Millican had joined the editorial staff of the Journal of the American Medical Association. His journalistic activities were tracked in the British professional press, which avidly followed the progress of medical journalism on the other side of the Atlantic.

Obituary Millican

Millican’s obituary in the BMJ

In 1911, Millican became Assistant Editor of the Lancet, joining the journal he had once covertly attacked through the Miscellany. Millican’s first outing as an editor was not even mentioned in his obituaries. Perhaps the Miscellany (which folded in 1895) had already faded into relatively obscurity, though the Lancet subsequently printed a follow-up note to say that the Pharmaceutical Society of Great Britain’s librarian had pointed out their oversight.[21]

Millican died on 28 November 1915, the day after his 62nd birthday; his obituaries reported that he had been ill with heart trouble for some time. Married twice, he left a grown-up son and daughter from his first marriage (both had settled in the United States), and a 12-year-old daughter from his second wife, who survived him.[22]

Millican seems to have been enterprising, energetic and industrious and his working life illustrates the mobility of medical men in this period.  In its obituary of Millican, the Lancet reflected on his meandering career path. It quoted a letter from his friends, which described him as ‘a man of singularly versatile and varied talent; so versatile, indeed, that it probably operated against his obtaining a great success in any one direction’.[23] Nevertheless, his patchwork career saw him ascend the proverbial ladder and secure recognition for his medical journalism.

Millican’s visibility in the medical press allows us to put together a detailed portrait of his career. He supplied clinical communications and correspondence to the leading professional journals, conducted his own periodical, and joined the editorial teams of high-profile journals. His journalistic endeavours were recorded in ‘Literary Notes’ and finally in his obituaries. Reading across these different forms of content in the medical press enables researchers to re-construct medical careers of the past.

[1] ‘A Mirror of Hospital Practice, British and Foreign: St Mary’s Hospital’, Lancet, 19 July 1879, pp. 80-1. ‘Reports of Medical and Surgical Practice in the Hospitals and Asylums of Great Britain and Ireland’, BMJ, 19 July 1879, p. 87.

[2] ‘Obituary: Kenneth William Millican’, BMJ, 11 December 1915, p. 878.

[3] Charles Bell Keetley, The Student’s Guide to the Medical Profession (London: Macmillan, 1878), pp. 29-30.

[4] Kenneth W. Millican, ‘Surgical Memoranda: Fracture of the Leg’, BMJ, 20 May 1882, p. 738.

[5] Millican, ‘Letters, Notes, and Answers to Correspondents: The Relief of Toothache’, BMJ, 1 September 1883, p. 455.

[6] Millican, ‘Correspondence: Gelseminum in Facial Neuralgia’, BMJ, 26 March 1881, p. 490.

[7] ‘Midland Medical Society’, Lancet, 23 December 1882, pp. 1078-9 (p. 1078).

[8] ‘The Annus Medicus 1882’, Lancet, 30 December 1882, pp. 1119-31 (p. 1122).

[9] ‘The Etiology of the Acute Specific Diseases’, BMJ, 30 September 1882, pp. 629-31.

[10] ‘Obituary: Kenneth William Millican’, Lancet, 11 December 1915, pp. 1319-20 (p. 1319).

[11] ‘Correspondence: The Sectional Meetings: A Grievance’, BMJ, 11 August 1883, p. 299.

[12] Millican, ‘Notes, Short Comments, and Answers to Correspondents: The Library of the College of Surgeons’, Lancet, 22 November 1884, p. 941.

[13] ‘Margaret Street Infirmary’, BMJ, 9 April 1887, p. 797.

[14] ‘Medical News: Medical Appointments’, BMJ, 16 April 1887, pp. 859-60 (p. 859).

[15] See Lindsay Granshaw, ‘ “Fame and Fortune by Means of Bricks and Mortar”: The Medical Profession and Specialist Hospitals in Britain 1800-1948’, in The Hospital in History, ed. by Granshaw and Roy Porter (London: Routledge, 1989), pp. 199-220.

[16] ‘Correspondence: [Untitled]’, Lancet, 23 April 1887, p. 849.

[17] ‘Obituary’, Lancet, 11 December 1915, p. 1319.

[18] ‘Literary Notes’, BMJ, 24 September 1904, pp. 761-3 (p. 762).

[19] ‘Medical News: The American Medical Editors’ Association’, BMJ, 30 June 1906, p. 1547.

[20] ‘Literary Notes’, BMJ, 27 July 1907, pp. 213-14 (p. 213).

[21] ‘Obituary’, Lancet, 18 December 1915, p. 1372-3 (p. 1372).

[22] ‘Obituary’, Lancet, 11 December 1915, p. 1320.

[23] ‘Obituary’, Lancet, 11 December 1915, p. 1319.

 

 

Arabella Kenealy (1859-1938): Medical woman, author and eugenicist

NB: This article contains references to eugenicist ideas and descriptions of miscarriage that readers may find upsetting.

Yesterday was International Women’s Day, which we typically mark by highlighting the achievements of pioneering women in history. Last year, I appeared in a video for ConSciCom discussing the Victorian medical-woman movement, talking about how early female practitioners paved the way for later generations of women in medicine. There is immense value in highlighting the inspirational activities of our female forerunners; it improves the visibility of women’s history and helps to redress traditionally male-dominated narratives. However, in doing so, we also risk sanitising or erasing more problematic aspects of women’s history. Not all ‘pioneering’ women can or should be treated as proto-feminist icons.

The subject of this profile – Arabella Kenealy, an early medical woman and author, who was also an outspoken eugenicist – deftly illustrates this. As Angelique Richardson has shown, there was considerable interaction between the New Woman and eugenicist movements at the fin de siècle,[1]  and Kenealy was a particularly prolific and extreme spokesperson on degeneration.

Arabella Kenealy

Born in Portslade, East Sussex in 1859, Kenealy was one of eleven children from the marriage of Edward and Elizabeth Kenealy. Her father was a barrister, who earned notoriety for his eccentric conduct when he acted as counsel during the Tichborne Case. The young Kenealy was educated at home, and she later studied at the London School of Medicine for Women. In 1883, she was licensed by the King’s and Queen’s College of Physicians in Ireland, the first licensing body in the UK to admit women. She went on to practise medicine in London and Watford between 1884 and ‘94.

In 1893, her novel Dr Janet of Harley Street appeared, amid a vogue for fiction about medical women.[2] The narrative tells the story of Phyllis Eve, a young woman who runs away from her dissipated husband on her wedding day. She finds refuge with Dr Janet Doyle, a successful physician who attempts to make Phyllis her protégé.

Dr Janet is a pragmatic, confident and capable medical woman, who has a large and prosperous practice. Yet the story largely perpetuates gender stereotypes. Women doctors were often seen as androgynous or unconventional figures, and Janet fits this archetype – she is masculine in appearance and describes herself as having a ‘neuter-nature’. [3] By contrast, Phyllis is almost hyper-feminine – sensitive, innocent, and highly-strung. Whereas Janet thrives in medicine, Phyllis wilts from the pressures of study. The narrative is interested in medical education and practice, but it is largely concerned with Phyllis’s attempts to escape her reprobate husband and find love with Janet’s cousin, Paul. The story unfolds as a battle between Janet and Paul for Phyllis’s future. He insists that ‘[a] woman like that is made for love and home and children’ rather than ‘skeletons and pharmacopeias’.[4] He is proven right, and the novel implies that only some (atypical) women are suited to medical work.

In an earlier blog post, I profiled one of Kenealy’s contemporaries, Margaret Todd, the author of Mona Maclean, Medical Student (1892). This novel has aged relatively well, retaining much of its humour and charm, and its independent heroine remains sympathetic and engaging. By contrast, Dr Janet now seems distinctly unpalatable and even shocking in places, both in its more restrictive attitude towards gender roles and its scorn towards the working classes. The titular character vehemently warns of the dangers of degeneration, presenting working-class sexuality as a threat. In one scene, she attends poor patients at the hospital, asking the parents of ‘sickly or evilly-disposed children’ if they are ‘not ashamed to have brought such “human rubbish” into existence’.[5]

The novel was also considered rather outlandish at the time of publication, however. Whereas Mona Maclean is a romance in the realist mode, Dr Janet is a sensationalist and melodramatic novel, with a plotline that encompasses a faked death, bigamy, and adultery. In the closing chapters, the titular character even persuades Phyllis’s dissolute husband to commit suicide, to release his young wife from their doomed marriage. Reviewing the novel, journalist Hilda Gregg suggested that this method of dispatching the villain was ‘highly ingenious’, adding that ‘[i]n Miss Kenealy’s opinion, it is also highly moral in character, but this is a matter on which a very different view may be held’.[6]

Shortly after the novel’s publication, Kenealy contracted diphtheria and retired from active medical practice due to ill-health. She increasingly focused on writing both popular fiction and articles for magazines such as The Nineteenth Century and Eugenics Review. In Dr Janet, the eponymous character represents sexual difference as the ‘acme of development’, positing her own ‘neuter-nature’ as an aberration.[7] Kenealy’s later writing espoused similar views on evolution and sex. It implied that Nature was unconcerned with women’s physical or intellectual prowess, and more interested in procreation. Unlike many of her fellow medical women, Kenealy endorsed conventional femininity and gender roles, fearing that women’s work would detract from their most important vocation: motherhood. She presented women as passionless creatures, who needed to conserve their energies for reproduction.[8] Her book Feminism and Sex Extinction (1920), as its title suggests, concentrated on what she perceived as the harmful effects of the women’s rights movement. The British Medical Journal (BMJ) branded it ‘an interesting study in modern sociology’, and one that would confirm the views of those who saw ‘nought but harm in votes for women’.[9]

As with many eugenicists, Kenealy’s fixation with the decline of the national stock included a concern with congenital illnesses, including venereal disease. In 1895, she wrote a letter to the BMJ, which appeared under the title ‘A Question of Conscience’. This is the first known example of a woman doctor attending venereal disease in private practice.[11] The correspondence records a case where Kenealy withheld treatment from a pregnant women with syphilis, who appeared to be approaching a miscarriage. The patient had previously suffered several miscarriages and borne one child with congenital syphilis. Kenealy characterised her patient as ‘a wreck of a young woman’, dehumanising the existing child with reference to its ‘dull misshapen head’.[10] Kenealy asked the BMJ’s readers for their opinion on her handling of the case.

The letter raised questions about medical ethics and morality and Kenealy’s approach drew criticism from some of her contemporaries. The BMJ later printed a letter from A.G. Welsford, who argued that allowing or enabling miscarriages whenever there was chance of inherited disease amounted to ‘a radical method of eliminating unhealthy strains in the race’. He anticipated it would lead to ‘terrible abuses’, and contended that it was not for doctors to decide whether or not a particular life had ‘value’.[12] In a later letter, Kenealy said that she appreciated ‘the position of trust held by the physician’. She denied that she was advocating euthanasia but claimed that practitioners should ‘allow’ Nature to ‘cast off’ a foetus with congenital syphilis.[13]She continued to use graphic and dehumanising language while defending her position. The BMJ shut down further correspondence on the matter, as it often did with lengthy and inflammatory exchanges.

Across her career, Kenealy was recognised as both a woman doctor and an author. Like Todd, her literary and medical identities intersected, though sometimes in less affirmative ways. In 1896, the BMJ printed a critique of her short story, ‘A Human Vivisection’, in which a Professor vivisects a drunk man. An anonymous reviewer lambasted the plotline, suggesting that if a writer who appeared on the Medical Register believed a practitioner capable of such acts, she should ‘publicly […] disassociate’ herself from the profession. If not, she should do other than ‘slander’ her peers.[14] In a rejoinder, Kenealy emphasised her pride in the profession and pointed out that other authors (such as Robert Louis Stevenson and Arthur Conan Doyle) were not attacked for their dubious portraits of medical men. The BMJ inserted an editorial apology, saying it regretted any ‘misrepresentation’ as to Kenealy’s intentions.[15] Kenealy remained active in medical, cultural and public spheres. She campaigned against vivisection, giving evidence to the 1912 Royal Commission, and she also became interested in occultism. She died in Marylebone, London in November 1938.

Kenealy is not the type of woman to be reclaimed as a proto-feminist icon. Her views on eugenics and sexual politics make for distinctly troubling reading. While they partly reflect contemporary ideologies, they were also regarded as controversial and even abhorrent by her peers. Nevertheless, it is important to engage with problematic female ‘pioneers’ such as Kenealy. As identified at the outset, simply reifying individuals as inspirational heroines risks oversimplifying and sanitising women’s history. Recently, historian Fern Riddell has highlighted the role violence played in the suffragette movement, discussing how such militancy has been erased in the cultural imagination. Of course, Kenealy in many ways went against this grain, using her platform to decry women’s rights, but she is another figure who proves difficult to accommodate or integrate into our popular narratives of women’s history. To understand fully women’s varied contributions to history, however, we need to engage with a range of attitudes, opinions and behaviours that shaped public and private life.

[1] Angelique Richardson, Love and Eugenics in the Late Nineteenth-Century: Rational Reproduction and the New Woman (Oxford: Oxford University Press, 2003), p. 9.

[2] Kristine Swenson, Medical Women and Victorian Fiction (Columbia: University of Missouri Press, 2005).

[3] Arabella Kenealy, Dr Janet of Harley Street (New York: Appleton, 1894), p. 124.

[4] Kenealy, Dr Janet, p. 143.

[5] Kenealy, Dr Janet, p. 195.

[6] Hilda Gregg, ‘The Medical Woman in Fiction’, Blackwood’s Edinburgh Magazine, 164 (July 1898), 94-109 (p. 108).

[7] Kenealy, Dr Janet, p. 124.

[8] Patricia Fara, A Lab of One’s Own: Science and Suffrage in the First World War (Oxford: Oxford University Press, 2018), p. 40.

[9] ‘Notes on Books’, BMJ, 15 May 1920, p. 676.

[10] Kenealy, ‘Correspondence: A Question of Conscience’, BMJ, 14 September 1895, p. 682.

[11] Anne Hanley, Medicine, Knowledge and Venereal Diseases in England, 1886-1916 (London: Palgrave, 2017), p. 154.

[12] A.G. Welsford, ‘Correspondence: “A Question of Conscience”’, BMJ, 28 September 1895, p. 807.

[13] Kenealy, ‘Correspondence: “A Question of Conscience”’, BMJ, 12 October 1895, p. 934.

[14] ‘Letters, Notes, and Answers to Correspondents: “A Human Vivisection”’, BMJ, 20 June 1896, p. 1544.

[15] ‘Letters, Notes, and Answers to Correspondents: “A Human Vivisection”’, BMJ, 27 June 1896, p. 1588.

Midland Medical Miscellany (1881-95)

MMM

One of the pleasures of working with a physical collection of journals is serendipity. Scholars of periodical literature frequently cite chance encounters with interesting material as the chief advantage of engaging with original, hard-copy sources. My PhD research drew extensively on a collection of journals in the Royal College of Surgeons of England’s library. It was while I was wandering around their underground stacks that I came across the Midland Medical Miscellany. I was initially attracted by its playfully alliterative title and its beautiful frontispiece. However, I soon became absorbed by its insight into provincial medical identities and its in-depth discussions of ‘problem’ patients. This was not an irreverent ‘light entertainment’ magazine but a serious periodical catering for beleaguered practitioners outside the metropolis.

Medical Miscellany

A periodical for the provinces

The Miscellany was a general medical monthly which launched in 1881 as a Leicester-based publication. It was originally edited by Kenneth W. Millican, a general practitioner in the village of Kineton (Warwickshire) and later a specialist in throat diseases in London. In a future blog post I’ll be profiling Millican, showing how he presented himself as a spokesperson for provincial practitioners but ended up leading a relatively cosmopolitan career. In 1885, editorship passed to Thomas Michael Dolan, a doctor based in Halifax. The periodical was renamed the Provincial Medical Journal, a title it retained until it folded in 1895.

The inaugural issue of the Miscellany featured a long opening address, which set out the journal’s intended readership. While noting that its ‘careful selection of information’ would not ‘be uninteresting to those in what are commonly considered to be the higher ranks of the profession’, it asserted that it was designed to be of ‘especial value to the hardworking and leisureless General Practitioner’. In particular, it felt that its condensed reports of new research would be ideally suited to the ‘overworked’ medical man.[1] This editorial engaged with common tropes about the toils of provincial and country general practice.

As its later title implies, the journal proudly asserted its provincial character, while criticising the metropolitan elite. In 1882, the Miscellany reprinted comments made by its future editor. Dolan had characterised England’s major medical journals – the Lancet and the British Medical Journal (BMJ) – as essentially ‘London publication[s]’. He suggested that:

the literary activities of the provincial general practitioners were increasing each year – the London Practitioner alone could produce enough material to fill the Lancet and Medical Journal – therefore, if they desired not to be beaten out of the field, they must look for a new vehicle for the conveyance of their thoughts.

The Miscellany styled itself as this ‘new vehicle’. It modestly suggested that it did not lay claim to be ‘at present in a position adequately to represent the General Medical Practitioners of the Country’, but emphasised that it was ‘compiled in [their] interests’.[2]  The journal suggested that there was an opening in the market for a new type of publication, implying that provincial GPs felt underrepresented by mainstream metropolitan journals. It positioned itself as better suited to these readers’ interests and lifestyle.

By insinuating that the BMJ privileged metropolitan practitioners, Dolan implied that it had alienated its traditional readership. The BMJ began life in 1840 as the Provincial Medical and Surgical Journal (PMSJ), the defacto periodical of the Provincial Medical and Surgical Association. Both were rebranded in the 1850s, becoming the BMJ and British Medical Association respectively. These changes were controversial; some Association members expressed fears that the interests of the metropolis were being prioritised over those of the provinces.[3]

Under Dolan’s editorship, the Miscellany was later renamed the Provincial Medical Journal. This was presumably a marketing tactic designed to increase the journal’s appeal outside the Midlands; by this time, it was also published in London, Edinburgh, and Dublin. Further, by framing itself as a journal for provincial medical practitioners, it effectively positioned itself in the space once occupied by the PMSJ. Perhaps this was a bid to claim the BMJ’s disaffected readers, though it came several decades after the controversy surrounding that journal. Scholars have discussed the diminishing popularity of the ‘provincial’ as a template for national identity.[4] However, the journal’s use of the term as late as the 1880s and 90s indicates a desire to reclaim provincialism and assert it as a broader identity. The journal addressed itself to all those who practised outside of the metropolis.

pmj.jpg

Engaging with ‘problem’ patients

Upon its launch, the Miscellany asserted that among its chief interests were ‘Ethics and Etiquette, the relations of members of the profession with the public’.[5] The journal did not adopt a romanticised perspective of the doctor-patient relationship, but rather discussed what it saw as the challenges of general practice.

In 1882, it featured a lengthy article on ‘The Question of Patients’, which focused on the difficulties encountered in ‘diagnostic interrogation’. The article demonstrated remarkable snobbery towards ‘the badly educated classes’, remarking on the ‘sheer inability […] of persons who have led unintelligent lives, to grasp the meaning and importance of questions that are put to them’.[6] The writer implied that patients were to blame for unsatisfactory medical interactions.

Two months later, the journal published a feature on ‘A Practitioner’s Grievances’, many of which related specifically to country practice, particularly the demands made on ‘the Doctor’s time’. It complained that, ‘in country districts, especially, it is almost impossible to induce patients to send their messages to the doctor in decent time’. It described the practitioner arriving home after a long day, ‘weary and hungry’, only to ‘find a message awaiting him’ to return to a village he had visited earlier that day. This frustration is compounded by the fact he ‘finds that the patient has been ill for a week, and that to-morrow morning would have done just as well’.[7] Complaints about patients requesting attendance at inconvenient times were not unusual, though together these articles seem particularly critical of patients.

The journal was also concerned about medical men’s interactions with women. In these instances it was the practitioner (rather than the patient) who was supposed to alter his behaviour. An article on ‘The Relation of Medical Men to their Patients’ (1885) counselled ‘[y]oung medical practitioners [to] bear in mind a few general truths in their dealings especially with female patients’. It recommended that ‘[c]onfidential relations with ladies of a household’ were to be ‘absolutely declined’ and that ‘examinations of female patients should always be made in presence of a third person’.[8] Such warnings were common in medical writing. Jukes de Styrap’s The Young Practitioner (1890) – an advice guide for aspiring medical men – counselled its readers to be ‘extremely cautious […] in having married women or young females to consult you secretly’.[9] Practitioners were taught that their encounters with female patients should be conducted with propriety.

Medical men in rural or small-town practices were thought to be particularly susceptible to rumour, innuendo and scandal. In 1883, the Miscellany reprinted a poem entitled ‘The Doctor’s Dream’, which originally appeared in Punch.[10] The poem’s speaker is a village practitioner, who reminisces about his life and career. One of the challenges he recalls is having ‘[t]o face and brave the gossip and stuff that travels about through a country town;/ To be thrown in the way of hysterical girls, and live all terrible scandal down’. Though humorous in tone, the Miscellany suggested that the poem was ‘worthy of preservation in medical literature’ and likely to ‘strike a chord in every medical man’s heart’.[11]  The Miscellany’s later incarnation, the PMJ, featured an article on ‘Doctors and Lady Patients’ (1887) which warned of the dangers surrounding long visits to women. It noted that, ‘[i]n London possibly they might escape, for a time, from the eye of Mrs Grundy […] In provincial towns medical men who are too attentive, very soon fall under her ken and then – Nemesis!’[12] These pieces show how communities might police the practitioner’s professional conduct.

The Miscellany/PMJ framed itself as a riposte to the dominance of the London periodical press and capitalised on the provincial medical man’s perceived resentment towards his metropolitan counterparts. It grappled with the supposed challenges of general practice and proudly asserted its provincialism. While it enjoyed almost fifteen years in circulation, the fact it eventually folded perhaps indicates that its approach was not particular popular with medical readers. The journals that it attacked – the Lancet and BMJ –  remained the most widely read titles.

[1] ‘Introduction’, Midland Medical Miscellany, January 1881, pp. 1-2 (p. 1).

[2] ‘A Journal for the General Practitioner’, Midland Medical Miscellany, April 1882, p. 55.

[3] For an overview, see Peter W.J. Bartrip, Mirror of Medicine: The BMJ, 1840-1990 (Oxford: Oxford University Press, 1990)

[4] Robin Gilmour, ‘Regional and Provincial in Victorian Literature’, in The Literature of Region and Nation, ed. by R.P. Draper (Basingstoke: Macmillan, 1989), pp. 51-60 (p. 52).

[5] ‘Introduction’, pp. 1-2.

[6] ‘The Question of Patients’, Midland Medical Miscellany, February 1882, pp. 21-4 (p. 22).

[7] ‘A Practitioner’s Grievances’, Midland Medical Miscellany, April 1882, pp. 51-2 (p. 51).

[8] ‘The Relation of Medical Men to their Patients’, Midland Medical Miscellany, 1 January 1885, p. 23.

[9] Jukes de Styrap, The Young Practitioner (London: H.K. Lewis, 1890), p. 110. This book was based on Daniel Webster Cathell’s popular US manual, Book on the Physician Himself (1881), which exercised similar caution.

[10] ‘The Doctor’s Dream’, Punch, 20 January 1883, p. 35.

[11] ‘The Doctor’s Dream’, Midland Medical Miscellany, February 1883, pp. 63-4 (p. 63).

[12] ‘Annotations: Doctors and Lady Patients’, Provincial Medical Journal, 1 January 1887, p. 35.

Margaret Todd (1859-1918): Medical woman and author

Margaret Todd

Margaret Todd (Wikipedia/ Public Domain)

In 1893, the popular periodical The Nineteenth Century featured an article on ‘Medical Women in Fiction’, written by Sophia Jex-Blake, who was well-known as a pioneer in the movement for women in medicine. Her article reviewed a selection of British and American novels published between the 1870s and early 1890s, all of which represented aspiring female practitioners. Jex-Blake examined the way in which they approached what she termed ‘a great social question’. She conceded that portraits of medical women need not be ‘drawn by friendly hands’ but maintained they ‘should be in some sense taken from life’.[1]

She singled out for mention the three-volume novel Mona Maclean, Medical Student (1892), which she considered to be ‘manifestly written from the inside’.[2] The story depicts the medical and romantic adventures of its eponymous young heroine, a student at the London School of Medicine for Women. After she fails her Intermediate Examinations, Mona takes an extended break from her studies, visiting rural Scotland to stay with a distant cousin, who requests that she conceal her identity as a medical student. This ruse proves difficult to sustain when Mona falls for an aspiring medical man, Ralph Dudley. The novel is a female Bildungsroman which sees its heroine undergo various trials before she passes her exams and settles in practice with her new husband, Dudley.[3] In praising the novel, Jex-Blake suggested that its protagonist resembled a ‘genuine medical woman’.[4]

The authenticity was unsurprising. For while the novel was published under the pseudonym Graham Travers, it was written by a female medical student, Margaret Todd. Born in Fife in 1859 to James Cameron Todd (a canon and schoolmaster) and his wife Jeannie McBain, Todd briefly worked as a schoolteacher. She then became one of the first pupils at the Edinburgh School of Medicine for Women, which Jex-Blake founded in 1886. Although Jex-Blake claimed to be ignorant about the authorship of Mona Maclean – she suggested she did not know whether it was written by a man or a woman – this was disingenuous. By the time the novel was published, the pair had been living together for four years. Jex-Blake is widely considered to have inspired the book, particularly the characterisation of the formidable Dr Alice Bateson. Further, she helped to secure the novel’s publication with Blackwood’s.[5]

Mona Maclean was immensely popular upon its release, reaching 15 editions by 1900. It received largely positive reviews. The Academy endorsed it as ‘one of the freshest and brightest novels of the time’,[6] while The Speaker praised the heroine as a ‘natural lady’ and the book as ‘good and artistic work’.[7] The Athenaeum’s reviewer dwelled on the novel’s ‘obvious blemishes.’ Like other critics, he recognised it as the product of first-time authorship. He also bemoaned that it was ‘a novel with a purpose, and suffers from the drawbacks inherent in works of the proselytizing stamp’. Despite this, he suggested that it showed ‘decided promise, and was in parts exceedingly enjoyable’.[8]

 

Mona Maclean

Todd’s novel was also well-received by the medical press. This is surprising, given that many journals had been highly critical of the medical-woman movement, as I explore in this blog post. Upon its publication, the Lancet judged it ‘a capital book’ and a ‘well-written, and effectively-told tale’,[9] while the Edinburgh Medical Journal designated it ‘eminently readable’.[10] The Medical Press and Circular was slightly less enthusiastic, suggesting that the plot was rather ‘feeble,’ but it conceded that the book held a certain ‘charm’.[11] The journals commended the book to their readers, the vast majority of whom would have been medical men. None of them suggested it would make a suitable gift for a wife or daughter, though the fact it was reviewed around Christmas may have suggested this to some readers. When the Lancet reviewed the book’s fifteenth edition in 1900, it praised the publishers for bringing out a ‘cheap edition’, thus putting the story ‘within the reach of everyone’.[12]

Long overlooked by literary scholars, Mona Maclean has attracted critical interest in recent decades. Critics working on New Woman or New Girl fiction have considered its treatment of female education, friendship, and sexuality,[13] while those interested in the Victorian medical-woman movement have examined its depiction of medical education and practice.[14] Thus far, scholars have not interrogated its reception by the medical press, as I consider in my thesis.

Following the publication of Mona Maclean, medical journals continued to associate Todd with her debut novel. In 1894, the British Medical Journal reported that three women – including the ‘authoress of Mona Maclean’ – had passed the Conjoint examinations in Scotland.[15] In 1895, the journal summarised Todd’s response to controversial correspondence from Arabella Kenealy (another early medical woman and a eugenicist) about whether doctors should intervene to prevent miscarriages of syphilitic children. It referred to Todd as ‘[t]he Author of Mona Maclean’.[16]

It is fitting that her authorial and medical identities were entwined, for she maintained her interests in both literature and medicine. After taking her MD in Brussels in 1894, she worked as Assistant Medical Officer at the Edinburgh Hospital and Dispensary for Women and Children, and also penned further novels and short stories. She has also gained recognition among the scientific community for having proposed the word ‘isotope’ to the chemist Frederick Soddy, a family friend (though sources also suggest earlier antecedents). A correspondent from the Royal Institute of Chemistry related the incident to the Lancet in 1957, referring to Todd as ‘a medical woman’ and ‘a novelist’, again asserting her dual identities.[17]

Following Jex-Blake’s retirement at the century’s close, she and Todd moved to a small farm, Windydene, in Rotherfield, where the older woman died in 1912. Six years later, Todd published a biography of her, The Life of Dr Sophia Jex-Blake (1918). It is a painstakingly detailed and hagiographic account of the subject’s life as a pioneer for women’s medical education and practice.[18] The Lancet described the biography as ‘admirable’ and ‘as absorbing as a good novel’ in its review,[19] while the BMJ suggested it was a ‘well-written memorial’ but noted the author had ‘suppress[ed] […] any reference to her share in Miss Jex-Blake’s life, on which it would have been interesting to have some light’.[20]

Three months after the biography appeared, Todd herself died. Newspapers reported that she passed away at a nursing home in London, though some have inferred that she committed suicide.[21] When the Lancet and the BMJ announced her decease, they noted her medical career, but both suggested that she was better known as an author.[22] Following her death, the London School of Medicine for Women created a scholarship in her name, thus ensuring her legacy among future generations of medical women.

[1] Sophia Jex-Blake, ‘Medical Women in Fiction’, The Nineteenth Century, 33 (February 1893), 261–72 (pp. 261-2).

[2] Jex-Blake, p. 268.

[3] Margaret Georgina Todd, Mona Maclean, Medical Student, 3 vols (Edinburgh: Blackwood, 1892)

[4] Jex-Blake, p. 278.

[5] Kristine Swenson, Medical Women and Victorian Fiction (Columbia: University of Missouri Press, 2005), p. 131.

[6] William Wallace, ‘New Novels’, Academy, 3 December 1892, pp. 504-5 (p. 504).

[7] ‘Fiction’, Speaker, 12 November 1892, pp. 598-9 (p. 599).

[8] ‘Novels of the Week’, Athenaeum, 3 December 1892, pp. 773-5 (p. 774).

[9] ‘Reviews and Notices of Books: Other Seasonable Productions’, Lancet, 17 December 1892, p. 1394.

[10] ‘Review: Mona Maclean’, EMJ, December 1892, pp. 569-70 (p. 570).

[11] ‘Literature: Mona Maclean, Medical Student’, MPC, 19 April 1893, p. 424.

[12] ‘Library Table: Mona Maclean’, Lancet, 9 June 1900, p. 1663.

[13] Ann Heilmann, New Woman Fiction: Women Writing First-Wave Feminism (Basingstoke: Palgrave, 2000), p. 29. Charles Ferrall and Anna Jackson, Juvenile Literature and British Society: The Age of Adolescence (New York: Routledge, 2010), pp. 72-6.

[14] Rachel Carr, ‘The “Girton Girl” and the “Lady Doctor”: Women, Higher Education and Medicine in Popular Victorian Fiction by Women’ (unpublished doctoral thesis: King’s College London, 1998). Swenson, Medical Women and Victorian Fiction.

[15] ‘Medical News’, BMJ, 11 August 1894, p. 346.

[16] ‘Correspondence: A Question of Conscience’, BMJ, 5 October 1895, pp. 870-1.

[17] Hugh Nicol, ‘The Word “Isotope”’, Lancet, 29 June 1957, pp. 1358-9.

[18] Todd, The Life of Sophia Jex-Blake (London: Macmillan, 1918).

[19] ‘Reviews and Notices of Books: The Life of Sophia Jex-Blake’, Lancet, 10 August 1918, p. 174.

[20] ‘Reviews: Life of Miss Sophia Jex-Blake’, BMJ, 10 August 1918, pp. 133-4 (p. 133).

[21] Elizabeth L. Ewan and others (eds.), The Biographical Dictionary of Scottish Women (Edinburgh: Edinburgh University Press, 2006), p. 184.

[22] [Untitled], Lancet, 7 September 1918, p. 333. ‘The Late Dr Margaret Todd’, BMJ¸ 14 September 1918, p. 299.

Victorian Scientists and Periodicals

In a new series of blog posts, ConSciCom researchers will share the little-known periodicals and personalities they’ve uncovered in the course of their research.

Medical Mirror (1864-70)

Alison Moulds

Medical Mirror 1

An advertisement for the Medical Mirror, which appeared in the BMJ (1866).

The Medical Mirror was a general medical monthly, published in London. It was originally edited by metropolitan physician William Abbotts Smith. In July 1866, editorship passed to his colleague Alexander Thorburn Macgowan, who had served as Staff-Surgeon in the 52nd Oxfordshire Light Infantry. Three years later, Macgowan retired and sold the copyright of the journal.[1] The Mirror’s last editor – who oversaw production between September 1869 and December 1870 – was anonymous and has not been identified.

In his 1864 opening address, Abbotts Smith announced that his aim was ‘the production of a cheap and useful serial’. He suggested that, while the Mirror would be ‘essentially a Review’, it would also contain ‘information on current topics of professional interest’. Essentially, he pitched it as occupying an ‘intermediate position’ between news-oriented medical weeklies such as the Lancet and the British Medical Journal and the more voluminous quarterly reviews.[2]

Medical Mirror 2

The journal’s opening address following its 1869 rebranding.

In May 1869, the Mirror rebranded itself, moving to a format which more closely resembled that of a magazine. Macgowan suggested that he had been advised to bring out the periodical ‘in a form more consistent with the progressive times we live in, and at a price more consistent with the modest earnings of the general practitioner’.[3] The cover price dropped to 4s per annum (it was previously priced at 12s).

Throughout its run, the journal proudly proclaimed its independence and commitment to representing the interests of rank-and-file medical practitioners. Its first address emphasised that it was ‘unfettered by the influence of any clique or individuals’ and ‘blinded by no feelings of animosity towards any other Medical Journal’. It affirmed: ‘we start upon neutral, and […] thoroughly independent grounds’.[4] It sought to differentiate itself from journals known for their bitter rivalries, such as the radical Lancet and conservative London Medical Gazette. In 1869, the rebranded Mirror reassured its readers that it remained progressive in outlook, that it had ‘always adopted a cosmopolitan platform – free from bigotry, cliquism, and intolerance’ and that it ‘advocated the rights of the many, and the principles of free-trade’. However, it acknowledged that its calls for medical reform had now become widely accepted among the profession and the public. The journal represented itself as an ‘organ of independent thought and progress, bound only by the happy rules of unsectarian Christianity’.[5]

The Mirror printed a range of articles relevant to the experiences of general practitioners. It enthusiastically promoted the cottage hospital movement, which it saw as a means of elevating the status of country doctors. In 1859, surgeon Albert Napper converted a cottage into a hospital in Surrey. This spearheaded a movement, which saw houses adapted into small, rural hospitals and dispensaries altered to include inpatient facilities. These cottage hospitals were modelled on provincial general hospitals but staffed by general practitioners.[6] The Mirror featured various articles on the movement, including a report by Napper which emphasised that the hospitals played a crucial role in ‘the alleviation of the sufferings of the poor’ and in raising the profile of the country practitioner. Recognising that a hospital appointment was ‘always considered a sufficient guarantee of high professional attainments’ among affluent private patients, Napper suggested that ‘in the absence of any such means of affording proof of his ability, the country surgeon is too frequently regarded with distrust’.[7] The Mirror valorised the role of rural and provincial general practitioners. In one article on ‘The Country Doctor and His Work’, it affirmed that, ‘[t]here should be no better friend to the public than the man who, at all times, in all seasons, is ready to risk his own life in trying to save theirs’.[8]

Significantly, the journal also became interested in women’s rights under the auspices of its final editor, whose identity unfortunately remains unknown. When Macgowan was at the helm, the Mirror had commented on women’s education in the US. It expressed concern that in Boston, where ‘the rights of women have been for some time fully recognised’, the birth rate was steadily diminishing. It cautioned that women should not ‘neglect a department of usefulness for which Nature has peculiarly fitted them’, a reference to childrearing.[9] Under the next editor, the journal adopted a more liberal agenda and became an early supporter of the medical woman movement in Britain. An editorial on ‘Female Physicians’ maintained that ‘women have a perfect right to every facility for the study of medicine now enjoyed by men’. This article positioned the Mirror as more progressive than its contemporaries. It derided the BMJ for its ‘medieval notions concerning women’ and the Medical Times and Gazette for its ‘pseudo-scientific dogmas’ about women’s ‘physical and mental capacity’.[10]

This interjection was part of a broader sympathy for women’s rights which emerged in the journal. Another piece scathingly suggested that a BMJ journalist read ‘J.S. Mill’s judicious, enlightened, and enlightening work on the “The Subjection of Women”’, and the journal stridently opposed the ‘degrading and demoralizing influence’ of the Contagious Diseases Acts.[11] Since the Mirror ceased publication in 1870, we cannot know whether this positive coverage of the woman question would have been sustained. Perhaps the journal’s increasingly bold and liberal stance rendered it unpopular with medical readers and ultimately contributed to its demise.

[1] [Untitled], Medical Mirror, 1 September 1869, p. 113.

[2] ‘Address’, Medical Mirror, January 1864, pp. 1-3.

[3] ‘Address to the Readers of the Medical Mirror’, Medical Mirror, 1 May 1869, p. 3.

[4] ‘Address’, p. 3.

[5] ‘Address to the Readers’, p. 3.

[6] For a history of the cottage hospital movement see Steven Cherry, ‘Change and Continuity in the Cottage Hospitals c. 1859-1948: The Experience in East Anglia’, Medical History, 36 (July 1992), 271-89.

[7] Albert Napper, ‘On the Advantages Desirable to the Medical Profession and to the Public from the Establishment of Village Hospitals’, Medical Mirror, January 1864, pp. 20-4 (p. 22).

[8] ‘The Country Doctor and his Work’, Medical Mirror, 1 November 1870, p. 195.

[9] ‘The Rights of Women’, Medical Mirror, August 1866, p. 506.

[10] ‘Notes and Comments: Female Physicians’, Medical Mirror, 1 December 1869, p. 173.

[11] ‘Notes and Comments: Syphilography for Ladies’, Medical Mirror, 1 November 1869, p. 154. ‘Prostitution: The Contagious Diseases Acts’, Medical Mirror, 1 November 1869, pp.  155-7 (p. 157).

Christmas and the Victorian Medical Press

The release of The Man Who Invented Christmas (2017) – a film which tells the story of how Charles Dickens penned A Christmas Carol in 1843 – has reignited the popular myth that the Victorians ‘created’ the festive season. Historians and literary critics have long emphasised the earlier antecedents to our yuletide traditions, while recognising the close relationship between print culture and Christmas. They have shown how books, cards, periodicals, and advertisements variously shaped ideas about the holiday season. With this in mind, I began to consider how medical journals – the subject of my own research – represented Christmas. Like other contemporary periodicals, they printed festive-themed content, which reflected broader socio-cultural ideas about the season and influenced how Christmas was imagined and observed.

Trawling through digital editions of the Lancet (1823-) and British Medical Journal (1840-), it seems there was an upsurge of Christmas coverage in the second half of the nineteenth century, when the journals began publishing similar seasonal content on an annual basis.

In the run-up to Christmas, both journals reviewed popular fiction and periodicals. While the medical press engaged with non-medical and literary texts at other times of the year as well, in December the journals specifically reviewed books that might make suitable Christmas presents. The Lancet observed that it was well-known Christmas was ‘the most popular publishing season’ and highlighted the wealth of children’s literature produced.[1] The BMJ noted with pleasure that children were more willing to ‘receive with enthusiasm the gift of a book at this than at any other time of the year’.[2] In 1885, it suggested that H. Rider Haggard’s King Solomon’s Mines was ‘a brisk story of adventure’ sure to ‘stir the hearts of boys’,[3] while in 1894 the Lancet congratulated Mary Elizabeth Braddon on having abandoned ‘the realms of imperfectly understood pathology’ (which it felt characterised her sensation fiction) in favour of ‘a clear, sensible children’s story’ in the form of ‘Christmas Hirelings’.[4]

Christmas Card

 A Christmas card advertising Dr F. Onnen, Pharmacist (c. 1890-99). Wellcome Collection (Creative Commons).

The medical journals received review copies of new books from publishers, as well as cards, calendars and diaries. These items were also reviewed for medical readers. In 1882, the Lancet praised the ‘amount of time, ingenuity, and artistic skill’ that went into producing Christmas cards.[5] Although typically festive in tone, such reviews were not uniformly positive. In 1888, the BMJ complained that ‘Christmas cards are this year, perhaps, less novel and interesting than usual’.[6] Nevertheless, elsewhere the journal enthusiastically supported the tradition. Five years previously it actively encouraged the officers of medical institutions to exchange cards with their patients, which it felt ‘would largely aid the joyous and kindly influences of the season’.[7]

In the final decades of the century, both the Lancet and BMJ reported on the festivities that took place among major hospitals, in London and elsewhere in the UK. In the late 1860s, the BMJ drew attention to the plight of patients hospitalised over Christmas and welcomed the way in which some London hospitals had gradually begun to mark the season. In 1869 it enthusiastically declared that ‘Christmas-Day dawned more brightly in the wards of the hospitals of the metropolis than, we believe, it has ever previously done’.[8] A year later, the journal reassured readers that ‘even in hospital Christmas can be remembered, and efforts made to render it cheerful and pleasant to the sick and suffering’.[9]

The journals’ reports provide a fascinating insight into how Christmas was celebrated in hospital. The festivities variously included decorations, carol singing, dinners of roast beef and plum pudding, entertainment in the form of music and readings, and the exchange of presents among staff and patients. At King’s College Hospital and Guy’s Hospital, male patients were even allowed to smoke on the wards on Christmas Day, while the Consumption Hospital in Brompton marked the season with an impressive fifteen-foot high tree in 1870.[10] While twenty-first-century consumer culture typically foregrounds the importance of advent, these celebrations usually took place in the final week of December and first week of January.

Guy's Hospital Southwark

‘A Christmas Entertainment at Guy’s Hospital’, H. Johnson (1888). Wellcome Collection (Creative Commons).

The journals actively encouraged hospitals to mark the season. Festivities were thought to have a practical benefit by discouraging sick patients from leaving hospital over Christmas. They were also considered a way to de-stigmatise hospital attendance among the poor and to inspire charity among the middle- and upper-classes.[11] Historian Barry Doyle has produced a wonderful blog post on Christmas in the inter-war hospital, which shows that many of these practices continued into the twentieth century, with celebrations becoming more elaborate and institutionalised.

Christmas Pudding

 A Christmas pudding from Mrs Beeton’s Book of Household Management (1861). Wellcome Collection (Creative Commons).

Medical journals also broached the holiday season from a clinical perspective. Festive foodies will be delighted to hear that medical commentators were sometimes positive about the benefits of gastronomic indulgence. In 1897, the BMJ welcomed the fact that Christmas took place during ‘the darkest and dreariest period in northern climes’ since ‘more food is naturally required by the body in cold weather’. It emphasised the value of consuming fats and carbs.[12] Ten years later, the Lancet noted that food was the ‘principal item’ of festive entertainment. However, while praising the Christmas pudding as the ‘embodiment of good things’ and roast beef as ‘a satisfying invigorating food’, it warned against ‘a bout of gluttony carried, as it often is, to swinish extent’.[13]

The journals regularly printed sober reflections on the season as well, warning that overindulgence could pose a risk to public health and safety. In 1893, the Lancet reported on an incident at the Surrey County Hospital where a game of snap-dragon had burnt several people and resulted in the death of a choir boy. It highlighted that accidents could be caused by Christmas decorations (particularly lights on the tree) and states of intoxication.[14]

Winter mortality was also presented as one of the dangers of the holiday season. In a piece on ‘White Christmas’, the BMJ warned of ‘the fatality of what is called seasonable weather’ and highlighted that mortality was particularly pronounced among the poor and the elderly. It soberly reflected that ‘a white Christmas will doubtlessly long maintain its popularity, although it is very desirable that no misconception should exist as to its cost in disease and death among the poorer of the working classes’.[15] In pieces such as this, the journals urged readers to consult their social conscience. In 1900, in an item entitled ‘Christmas Shopping and Public Health’, the Lancet highlighted that shop assistants worked long hours over the Christmas period, at risk to their health. It encouraged readers who were able to do so to shop ‘earlier in the day’ or ‘sooner in the season’ rather than leaving it to the last minute.[16]

If the journals were circumspect about the dangers of Christmas, they nevertheless recognised that the holiday season generally had a positive impact on public life. In 1893, the Lancet emphasised that yuletide celebrations helped relieve the pressures of modernity. It suggested that, ‘the more we as a people become over-worked and over-strung the more do such interludes of idleness and irresponsibility play an important part in our social economy’.[17] In 1909, the journal even likened Christmas to a doctor’s ‘prescription’, suggesting it had ‘a good tonic effect upon the people’. It reasoned that most people behaved sensibly enough.[18]

Rather than adopting an overly sentimental or saccharine view of Christmas, the journals generally seem to have represented it as a time of merriment for both the profession and the public. It was portrayed as a period of escapism but not one in which people should abandon their social obligations. While recognising the novelty of some celebrations (such as hospital festivities and the increasing popularity of Christmas cards), the journals contained many thoughtful observations about the festive season (including its consumerism and overindulgence) that will be familiar to modern-day readers.

Exploring the representation of Christmas demonstrates the broad scope of the Victorian medical press. It elucidates how medical commentators applied their expertise to a range of socio-cultural issues pertinent to public life and shows the importance of non-clinical content to medical journalism.

Today, medical journals continue to print a range of festive-themed content, from articles on charitable giving to popular literature. In 1982 the BMJ published its first-ever dedicated Christmas issue. Its website notes that it ‘welcome[s] light-hearted fare and satire’ but cautions that it will not ‘publish spoofs, hoaxes, or fabricated studies’. Setting the ‘tone’ for the Christmas issue appears to be a paramount consideration. As in the Victorian period, festive content might be fun but it should not be entirely frivolous. Then and now, Christmas is portrayed as a time in which medical professionals and their patients should enjoy themselves, but it is also represented as a serious subject upon which medical authority and expertise can shed new light.

[1] ‘Christmas Books’, Lancet, 15 December 1894, pp. 1443-4 (p. 1443).

[2] ‘Notes on Books: Christmas Books’, BMJ, 3 December 1898, pp. 1694-6 (p. 1694).

[3] ‘Christmas Books’, BMJ, 12 December 1885, pp. 1118-9.

[4] ‘Christmas Books’, Lancet, p. 1444.

[5] ‘Reviews and Notices of Books: Christmas Cards’, Lancet, 9 December 1892, p. 989.

[6] ‘Notes on Books: Christmas Cards’, BMJ, 8 December 1888, pp. 1295.

[7] ‘Notes on Books’, BMJ, 8 December 1883, pp. 1135-36 (p. 1136).

[8] ‘Christmas-Day in the London Hospitals’, BMJ, 2 January 1869, p. 14.

[9] ‘Christmas in Hospital’, BMJ, 31 December 1870, pp. 709-10 (p. 709).

[10] ‘Christmas in Hospital’, pp. 709-10.

[11] ‘Christmas in Hospitals’, Lancet, 10 January 1874, p. 71.

[12] ‘Christmas Fare and the Sense of Taste’, BMJ, 2 January 1897, pp. 35-6 (p. 35).

[13] ‘Christmas Dietetics’, Lancet, 21 December 1907, pp. 1773-4.

[14] ‘The Sad Sequelae of Christmas’, Lancet, 30 December 1893, p. 1645.

[15] ‘A White Christmas’, BMJ, 28 December 1878, pp. 965-6.

[16] ‘Christmas Shopping and Public Health’, Lancet, 15 December 1900, p. 1751.

[17] ‘The Sad Sequelae of Christmas’, p. 1645.

[18] ‘A Prescription for Christmas’, Lancet, 25 December 1909, p. 1933.

Symposium Report: ‘Doctor, doctor: Global and historical perspectives on the doctor-patient relationship’

ConSciCom team member Alison Moulds discusses the medical humanities symposium she co-organised earlier this year.

Symposium PosterOn 24 March 2017, a one-day symposium – ‘Doctor, doctor: Global and historical perspectives on the doctor-patient relationship’ – was held at St Anne’s College, University of Oxford. It was organised by myself and Sarah Jones, a DPhil Candidate in French. The event was funded by a Medical Humanities programme grant from The Oxford Research Centre in the Humanities (TORCH), the Constructing Scientific Communities project, and St Anne’s College.

The symposium explored practitioner-patient interactions across different cultural contexts and throughout history. From the outset, our aim was to encourage interdisciplinary and international perspectives on medical humanities. We were particularly keen to attract researchers working in languages other than English and on non-Anglophone cultures. Sarah and I were delighted with the response to our call for papers, which far exceeded our expectations.

Our final line-up for the event featured more than 30 speakers, working across a range of disciplines (from Classics to Anthropology, Literature to Sociology) and based in a range of countries (from Italy to Russia, Spain to the United States). There were humanities scholars and clinicians, as well as individuals who bridged the divide or worked in other areas, such as on creative projects. Various career stages were represented in the programme – from Masters and PhD candidates to senior academics working in the medical humanities. The event attracted more than 70 attendees also drawn from diverse backgrounds, from general practice to fine art.

Poster presentations

Poster presentations during lunch: Douglas Morgan (KCL)

The symposium opened with a keynote presentation from Dr Anna Elsner, Senior Researcher at the Center for Medical Humanities at the University of Zurich. Elsner’s paper examined the representation of clinical encounters in twentieth-century French literature alongside medical and bioethical research on the physician-patient relationship. The rest of the day was divided into parallel panels on themes ranging from medicine and material culture to institutional experiences of healthcare, and from classical to early modern medicine. Individual papers touched on issues such as medical case reports, cancer narratives, patient photography, and transgender healthcare. During lunch we had two poster presentations from Douglas Morgan and Farah Chowdhury, MSc Medical Humanities students at King’s College London.

Throughout the day there were opportunities for networking and it was wonderful to see colleagues from different disciplines and institutions sharing their interests and establishing connections.

The broad range of papers enabled participants to consider how representations and experiences of illness have changed over time and across different contexts and how patients’ expectations about their healthcare interventions have shifted. It was fascinating to see the different types of sources researchers drew upon in their work; medical textbooks, musical theatre, oral interviews, and archival documents such as court records were all scrutinised for the insights they offered into the medical encounter. Among the major themes arising from the symposium was how the doctor-patient relationship is rarely a 1:1 exchange; instead it takes place against a backdrop of other interactions. Patients also come into contact with nurses and other healthcare practitioners, while doctors interact with the patient’s friends and family. Attendees discussed how both doctors and patients bring personal experiences and attitudes to the specific medical encounter.

After the symposium, we circulated a follow-up survey among attendees to evaluate the event. We received 18 responses, which represented around 25% of attendees. Respondents were asked to rate aspects of the symposium on a scale of 1-6 (from low-high); the event programme received an average score of 5.6. We asked attendees what they enjoyed most about the event, giving them the opportunity of a free-text response. Delegates cited various aspects including the ‘varied programme’, the ‘vibrant and enthusiastic atmosphere’, and the ‘range of disciplines and voices represented’. The multi-disciplinary nature of the event was seen as particularly profitable: when asked whether the event had changed their views, one participant suggested that it was useful to hear from clinicians as they offered insights different from the ‘theoretical’ approach of medical humanities. The paper by Riana Betzler (postdoctoral fellow at the Konrad Lorenz Institute for the Advanced Study of Natural Complex Systems in Austria) was praised by a number of attendees as having challenged their preconceptions about the role of empathy in doctor-patient interactions.

It was a packed day (especially for a Friday!) and one of our key conclusions is that we would have loved to expand the symposium into a longer event. Several delegates suggested they would have enjoyed further opportunities for networking and exchange, while others wished they could have attended more sessions rather than choosing between parallel panels!

Closing remarks

Symposium organisers Sarah Jones and Alison Moulds

The purpose of the symposium was to create a diverse network of scholars working in the medical humanities and we intend to build on the success of the event. Further details regarding the symposium’s legacy will be announced on the website in due course: https://doctorpatient2017.wordpress.com/.