Physicians, science, and status: issues in the professionalization of Anglo-American medicine in the nineteenth century

Abstract

THE professionalization of Anglo-American medicine, most scholars would agree, took place during the nineteenth century. But how this process occurred or, indeed, what the term itself signifies, encourages no such consensus. This confusion may be a reflection of the relatively little historical curiosity sparked by those individuals or institutions subsumed under the diffuse designation "middle class". The professions, a significant feature of middle-class culture, have inspired "house histories of professional bodies",' but such studies are in general "so thin and lacking in critical framework as to be of almost no use to succeeding scholars".2 Faced with the analytical vacuum in existing literature, the historian may turn to studies by sociological colleagues. To the uninitiated, the works encountered present both a taxonomic quagmire and a series of theoretical constructs quite at odds with the historian's principal concerns. Since most of the sociologist's formulations are derived from current practice, they are likely to produce what one historian has called "nonsensical results" when applied to the historical process. Lyell, Herschel, and Darwin, for example, would find themselves excluded from the ranks of professionals by a twentieth-century definition of scientist emphasizing specialized training and income derived from the sale of that expertise.3 Neither does such terminology take into account vestigial criteria. To the earnest Victorians, for example, the attainment of professional status was intimately linked to the possession of "character", a nineteenth-century cipher signifying a range of "enduring credentials" such as "mental initiative, self-reliance, and usefulness".4 Confronted by such difficulties, it