Reviewed by Elizabeth Todd (Department of History, University of Sydney)
Published on H-Albion (May, 2009)
Commissioned by Mark Hampton
The Life and Times of a Medical Cohort
Medical Lives in the Age of Surgical Revolution represents a unique approach from historians M. Anne Crowther and Marguerite W. Dupree to the much-studied fields of medical education and Listerism in late nineteenth-century Britain. In a gargantuan project, these historians have charted the education and subsequent careers of an entire medical cohort, in excess of one thousand students, from the beginning of their student days (the specific cohort was limited to those commencing study between 1866 and 1874) to their deaths at the end of long (or tragically short) careers. Drawing their cohort from the universities of Edinburgh and Glasgow, the two largest medical schools in Britain, Crowther and Dupree provide a window into the lives of students at two of the premier medical schools of the day. This cohort study is used as a vehicle to examine two of the key medical issues of the late nineteenth century during the "surgical revolution": the introduction of women into formal medical education; and the introduction, adoption, and spread of Joseph Lister’s theories of antisepsis.
In the first section of the book, Crowther and Dupree follow the students’ careers in a chronological narrative, emphasizing the bonds and networks formed in the early years of the cohort’s medical careers. Chapter 5 then continues this theme in the case of medical women, of whom Sophia Jex-Blake was an important leading figure and a particularly colorful character. The central section of this book focuses on the major career paths pursued by the students, in addition to the application of Listerism in their practices and the networks of Listerian practices outside Britain. The final section returns to the chronological narrative, examining the twilight years of our cohort against a backdrop of the persistence of the Listerian ideal and the exposure of its weaknesses.
This book is groundbreaking in its scope. No other study in the field of the history of medicine has attempted to trace the spread of a medical theory through a cohort of particular individuals as they traveled across the globe. While there is an abundance of scholarship on Lister’s theories and insights, and those of the medical men and women who came after him and practiced and promoted first antisepsis and then asepsis, this book is a unique exploration in tracing the spread of antiseptic practice via the emigration and medical networks of the students taught by Lister. These medical networks are the focus of this study, as Crowther and Dupree set out to “explore the paradoxical nature of a profession of competitive entrepreneurs who also shared remarkably strong communal loyalties” (p. 2). With the high volume of scholarship on Lister and antisepsis/asepsis, from hagiographic studies of Lister to more recent inquiries focusing on the notion of “contagion” that his ideas fostered, one might be forgiven for thinking there was little left to say on the subject. Here, however, is a fresh approach that will no doubt foster many new lines of inquiry.
In addition to Lister’s ideas, the other great advent in medicine that the selected cohort witnessed was the introduction of women to formal medical training. Crowther and Dupree follow the entry of Jex-Blake and her female peers into medical school, not focusing simply on the opposition that they faced, which has been well documented, but particularly emphasizing the networks that these women established at medical school. The authors illustrate the value of their university connections to these pioneering women and explore the way Jex-Blake and others continued to foster and depend on these connections during their subsequent careers. This section is largely overshadowed by the advent of Listerism and antisepsis, which permeates the rest of the book. While women did face unique difficulties and experiences as medical students, confining this analysis to a discrete chapter divorces the networks formed by the female students from the wider analysis of medical networks and their role in spreading antisepsis. There are several missed opportunities of integrating the experiences of the female students, particularly in the later chapters that focus on networks outside Britain.
Though Crowther and Dupree use the term “cohort” to describe their group of doctors, this is not the story of a faceless group, but a story of many faces. The authors follow the lives and careers of each individual of the cohort as long as historical records will allow. Their findings challenge assumptions about the stability of a medical career in this period. In this age of high imperialism in the last quarter of the nineteenth century, doctors were agents of empire, and a variety of careers were open to them in colonial settlements and imperial administrations, from general practice to the military, mission work, and colonial service. However, by following the doctors throughout their professional careers, Crowther and Dupree show that in the case of many doctors, they do not simply select one career option upon leaving medical school, but practice in several or all of the above capacities at some point in their professional career. The networks fostered at medical school between fellow students and between students and their teachers often facilitated these changes in medical postings.
This book draws on both quantitative and qualitative sources ranging from enrollment records, medical registers, and directories to obituaries, medical journals, and personal papers. Crowther and Dupree acknowledge that some of their statistics are based on data that was not easily quantifiable and required interpretation from the authors. The nature and process of such interpretations are included in a detailed appendix for those interested in pushing the conclusions of the data further. This is a dense book that is crammed with references, citations, and sources that will no doubt foster many new lines of inquiry. There is a wealth of information and detailed research here, as well as an excellent statistical base for scholars to build on.
Medical Lives in the Age of Surgical Revolution raises the important issues of patronage, medical networks, and the causes and outcomes of medical emigration from Britain in the last quarter of the nineteenth century. The work provides much of interest, both for those interested in medical education and professionalization, women in medicine, and Listerian practices, and those interested in the spread of new medical ideas and technology across an empire.
If there is additional discussion of this review, you may access it through the network, at: https://networks.h-net.org/h-albion.
Elizabeth Todd. Review of Crowther, M. Anne; Dupree, Marguerite W., Medical Lives in the Age of Surgical Revolution.
H-Albion, H-Net Reviews.
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