Can the period 1750-1850 be viewed as one of medical reform?

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Can the period 1750-1850 be viewed as one of medical reform?

Before looking at the events, which occurred during the period 1750-1850 and assessing, whether or not they amount to a period of medical reform it is necessary to define what constitutes reform. Reform is defined as:

‘To convert into another and better form, to amend or improve by some change or form of arrangements or composition to free from previous faults or imperfections.’1

Traditionally this time is seen as one of medical reform, uninterrupted progress stimulated by advances in medical education, professional unity and social reform and confirmed by medical legislation. Although there was progress during this period there is controversy as to the extent of change that was actually achieved and to whether the motivations behind the change mean that they can be constituted as genuine reform.


The reform, which is said to have taken place during the aforementioned hundred-year period, is attributed to the advances in medical education. By the second half of the eighteenth century medical education was in disarray. Although most physicians did have a medical degree (MD) they could be purchased through the post and those who did gain them legitimately could have received them from one of eighteen different medical corporations which offered varying forms of medical diplomas, licenses and degrees. This chaotic system led to a demand for a ‘single portal of entry’ in which one exam held simultaneously across the country awarded the certification needed to become a medical practitioner. Although this can be seen as a reforming move the motivation behind it was not to produce better doctors but to make it easier to identify the irregular practitioners and so abolish them.

According to Loudon periods of reform require two sorts of preceding events. The first being a period running up to the time of reform in which there is a general feeling of discontent and a realisation that change may be beneficial. This period is followed by a catalyst which triggers the reform.2 In the case of the so-called ‘period of medical reform’ the trigger was the rise of the dispensing druggist. These ‘irregulars’ were viewed as more dangerous than other irregular practitioners as they tricked the public into believing that they were a cheaper form of medical practitioner who was also able to practise pharmacy. The war between the general practitioners and the dispensing druggists is central to this period of reform. Following a failed presentation by the Pharmaceutical Association to the three London medical corporations, the predecessors of the general practitioners began to take an interest in protecting their living and position in the world of medicine.1 After the 1795 attempt there were no further attempts for reform for seventeen years instead three physicians: Dr Latham, Dr Harrison and Dr Barlow, began to suggest measures for reform within British medical practise. Of these Dr Harrisons proposals were the most likely. He was persuaded to undertake an investigation into the nature and extent of irregular practice and discovered that in some areas of the country regular practitioners were outnumbered 9:1.  Harrison’s aim was to expose the extent of irregular practise and to suggest measures of reform. His ideas for reform included regulation of education, examination and licensing and more controversially the proposed licensing of midwives and druggists. His proposals came up against strong opposition from the Royal College of Physicians who asked him to leave his proposals with the college who would then consider if reforms were needed. Harrison refused and in doing so gained a powerful enemy. The Colleges were aware that parliament would not introduce such legislation without their approval and eventually Harrison was forced to give up his cause. This case clearly demonstrates the attitude of the Royal Colleges had towards change and their constant blockade of reforming measures puts the idea of the hundred-year period as one of reform, under question.  

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        The foundation of medical associations during the period 1750-1850 led to a birth of professional unity. This was set in motion with the foundation of provincial medical clubs and societies which began to appear in the late eighteenth century. One of the first objectives of reform was to decrease the division between the university trained and apprentishiped practitioners. Narrowing the gap would meet the medical needs of a whole population and achieve professional unity.2 The breakdown of traditional divisions is evidence of actual reform taking place in this period. Wear believes that the most important feature of medical practise in ...

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