Incommunicable Knowledge: Science, Technology and the Clinical Art in Britain 1850-1914

By the end of the nineteenth century, medicine in Britain existed legally as a single profession. Besides its lawful status, a number of very general features also characterized this professional group: a core body of knowledge, licensing, recognized educational institutions, educational standards and other trappings, such as the running of learned societies and the publishing of periodicals. In many ways, doctors can be accommodated into the category 'forgotten middle class', when considered in terms of their cultivation of respectability and intellectuality, their professional organization, their praise of meritocracy and their apparent aloofness from the struggle for income. But recent historical work has thrown light on several aspects of medical life in the Victorian and Edwardian eras. In particular, comparison of scholarship from different areas shows that, behind its legal unity, the profession was extremely variegated in its attitudes, goals and standards, and especially in its definition, evaluation and use of science. At the one extreme were those doctors, for whom perhaps T. H. Huxley was a spokesman, who sought the role of scientifically trained expert and intellectual. At the other extreme, however, were a number of physicians who seem to have courted the sort of deference more likely to be associated with landed gentility. These latter practised throughout Britain, but were most obvious in London, particularly amongst those doctors who were Fellows of the Royal College of Physicians and who had appointments at the grand voluntary hospitals. Their cultivation of this role can be linked to the running of hospitals by distinguished lay governors, and to the fact that they practised medicine in the highest social circles, in a world in which the public chose their doctors by evaluating their class attributes rather than their medical skills.2 Following from this, it is easy to see why some of the leaders of English medicine, especially those in London,