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Practising medicine

Nurse's kit, Europe, 1930-1970

Nurse's kit, Europe, 1930-1970

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We all ‘practise’ medicine when we decide whether or not to take a tablet, or give advice on how to avoid catching a cold. Medicine as an occupation has a different story. In most parts of the world there has been a similar pattern. Until recent years, an educated medical elite - normally men - served the wealthy parts of the population. Everyone else made do with advice from family, friends or a local practitioner. Only since the early 1900s have welfare states and insurance schemes made possible widespread routine access to professional medicine and hospital care, for the majority of the population.

How did one become a doctor?

Ancient Greece produced the first split between educated doctors and illiterate healers. Galen reformed Greek medicine and set new educational standards. Within Islamic medicine students could study at a hospital, which provided practical and theoretical training, or be apprenticed to a local doctor. By 1076, China had established an imperial college where students were taught medicine, surgery and acupuncture. In all of these systems training and education meant a specialist body of knowledge could be developed and passed on.

The experts who were not doctors

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In Europe there was always a medical marketplace in which different practitioners competed for the custom of patients. Until the 1900s only the wealthy could afford a university-educated doctor. The vast majority of the population relied on themselves, their families and neighbours and local practitioners for help.Barber-surgeons, apothecaries, occulists (eye doctors), herbalists, piss-prophets and midwives all offered their services. Most of these practitioners would not be licensed. They may have served an apprenticeship, learned from a family member or trained themselves in their trade. Both men and women operated from their houses, shops or bath-houses, or in some cases travelled from town to town.

A medieval doctor’s legal rights

During the medieval period doctors slowly built up their legal rights. A steady supply of male doctors, surgeons and apothecaries began to graduate from the medieval universities, and a licensed guild and apprenticeship system, which excluded all priests and self-taught healers (including midwives), gave them legal protection. They joined together in medical guilds, usually in the towns where competition was fierce. Guilds were organisations of craftsmen in a particular trade. They were established to ensure standards of practice and to protect the rights of guild members. Requiring practitioners to have licences and join guilds may have benefited skilled craftsmen and their apprentices, but it also meant that only middle-class and wealthy people who could afford a university education could practise medicine.

New medical professions helped by the king

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Forming guilds, companies and colleges was part of the process of creating a professional identity. For instance, in 1540, Henry VIII brought together the Fellowship of Surgeons and the Company of Barbers to form the Company of Barber-Surgeons. By the 1700s surgeons were establishing themselves as an independent profession, and pushed for their own Company of Surgeons, which was formed in 1745. Branches of medicine developed into male-graduate specialities, such as man-midwives or asylum doctors dealing with mental illness. But while surgeons and physicians successfully established themselves as professionals, others found themselves excluded.

The exclusion of women from formal medicine

One of the results of the new emphasis on university training was the gradual exclusion of women from formal medical practice. In the 1700s women were not admitted to university courses except in very rare cases, such as those offered by the University of Bologna. In a domestic setting, women continued to provide medical care, as did nuns in hospitals or monasteries.

Nursing and female doctors

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Nursing as a profession gained recognition through the work of people such as Florence Nightingale during the Crimean War (1853-56). Nursing was seen as a female occupation, providing care and nurturing. There was huge resistance to women entering the male-dominated medical profession. Doctors argued that women were not suited to the formal study of medicine. Pioneers such as Elizabeth Blackwell in the USA and Elizabeth Garrett Anderson in the UK were the first women to graduate from medical school. It was only in the mid-1900s that women were admitted to all medical schools.

Bibliography

W F Bynum & R Porter (eds), Companion Encyclopedia of the History of Medicine  (London: Routledge, 1993)

A Digby, Making a Medical Living: Doctors and Patients in the English Market for Medicine, 1720-1911 (Cambridge: Cambridge University Press, 1994)

B Inglis, Natural Medicine (London: William Collins, 1979)

M Pelling, Unofficial and Unorthodox Medicine in Western Medicine: An Illustrated History (London/Irvine: Oxford University Press, 1997)

R Porter, The Greatest Benefit to Mankind. A Medical History of Humanity from Antiquity to the Present (London: Harper Collins, 1997)

Glossary:

Apprenticeship

An agreement where a person learns a trade from a skilled worker over a fixed period of time.