Medical societies in the 19th Century: How they influenced general practice

Stephen Gillam is a retired GP and public health specialist whose career embraced education, research and health policy. He is on LinkedIn.

Introduction.

The eighteenth century medical marketplace was very congested with a mixture of different health care providers competing for custom. The period from 1790 to 1860 witnessed major reforms.¹ Surgeon-apothecaries were campaigning to define training and licensing arrangements and to outlaw unqualified ‘irregulars’. The resulting Apothecaries Act of 1815 hastened the appearance of a self-confident, new breed of ‘general practitioner’. The growth of medical schools and doctor numbers heightened competition over the course of the nineteenth century. All this occurred against a background of growing medical knowledge. To help our predecessors navigate these turbulent waters, numerous new medical societies were formed.² They helped to shape our discipline. The Norwich Medico-Chirurgical Society provides an illustrative example.

Origins.

Some societies originated in salons established to discuss scientific advances. The Norwich Philosophical Society formed in 1812 included many medical members. Other societies arose from the book clubs and libraries which were the main conduit for doctors exchanging new knowledge.³ The Norwich & Norfolk United Medical Book Society dated from 1824 with elaborate rules governing the use of its subscription library.

In 1845, a museum room was opened to house an extensive collection of anatomical specimens that had been accumulated by William Dalrymple, a notable surgeon at the Norfolk and Norwich Hospital. Shortly afterwards, the Norwich Pathological Society was formed. While the main focus was clinico-pathological case discussion, the Society sought ‘to foster a high sense of professional ethics among its members.’ One member went so far as to “hope that the time is not far distant when not to be a member of this Society will be a mark of professional or moral disqualification.”⁴

In 1867 these two societies merged to form the Norwich Medico-Chirurgical Society. John Green Crosse, as the prime mover in establishing its predecessors, is generally regarded as the founder (though he had died in 1850). A celebrated lithotomist, he had trained in London, Dublin and Paris. He is buried in the cloisters of Norwich Cathedral.

The first meeting was held on 2 July 1867 in the museum of the Norfolk & Norwich Hospital. The president elect, Dr Peter Eade (later knighted after three terms as Mayor of Norwich) pronounced: “This an age of medical change. He who would not be thrown out must keep well in the race; the pace is so rapid that leeway can scarcely be recovered. In spite of being engaged in the active busy pursuits of daily practice, time must be found to learn the ever new facts of medical science.”⁵ The language may be quaint but the sentiments resonate today.

Activities.

The functions of the new Society were threefold: firstly, the ‘cultivation and promotion of physic and surgery’, e.g. library, meetings (CPD); secondly, ‘consideration of public matters affecting the profession’ (medico-political); and thirdly, ‘encouraging friendly intercourse between its members’ (social).⁶ The constitution determined its rhythms and rituals. Membership was drawn from local doctors for an annual subscription of one guinea. Most members were general practitioners in single-handed practice. Monthly meetings were held on ‘the Thursday nearest the full moon in every alternate month of the year at 2.00pm’  to allow those attending by trap or horse-back to return home safely. Annual, presidential and retrospective addresses were established.

Doctors have always had a taste for pomp and frippery. The requisite regalia were duly acquired. The presidential chain of office sports a large medallion of John Caius (1510-73). Norwich’s most famous son had been President of the Royal College of Physicians, physician to Edward VI as well as founding the eponymous Cambridge college. The chain of links bearing the names of past presidents extended over time such that one member waggishly remarked that it was “more like a sporran than a chest piece.”³ Minutes of the meetings provide an intriguing account of members’ clinical and political preoccupations.

The Society’s educational purpose was fulfilled through case-based discussion with individual members presenting in turn, e.g. on many different manifestations of diseases like tuberculosis. Over time, with the emergence of new specialties, presentations became topic-based. Outbreaks of communicable disease, e.g. diphtheria, remained a threat. War-time merited consideration of burns, bullet wounds and other trauma. The meetings might involve demonstrations, e.g. ‘of the apparatus for taking the x-rays’ (1896). They were sometimes given over to discussing ethical questions, e.g. whether or not to inform patients of their incurable cancer diagnoses.

Some minutes have an extraordinarily prescient ring. Discussing ‘the appropriate use of antibiotics’, all of today’s concerns regarding overuse and resistance are foreshadowed – in 1962. A ‘cinematograph projector’ was purchased in 1957 and, from this period, meetings begin to reflect changes in postgraduate medical education.

In the last quarter of the nineteenth century, the minutes record evident concern with economic security and how to maintain professional monopolies. Friendly Societies were employing doctors on capitation-based salaries deemed inadequate to provide open-ended care. This ‘Battle of the Clubs’ was in full spate. Medico-Chirurgical Society members were forbidden to enter discussion with medical aid societies at risk of expulsion.

The Provincial Medical and Surgical Society metamorphosed into the British Medical Association in 1855. Thereafter, as the new organisation began to develop regional tentacles, the Norwich Society’s medico-political activities subsided. Indeed in 1858, ‘the conduct of affairs affecting the profession’ was removed from its constitution to distance members from the grubby dealings of their trade union. Extraordinarily, there is no recorded reference to the establishment of either National Health Insurance in 1911 or the NHS. Most GPs, then as now, took little part in medical politics.

Regular meetings and ceremonial dinners provided valuable networking opportunities. Sadly, hidden agendas, e.g. job or business-related, do not feature in the minutes. The records are convivial and only one major quarrel is described but it came close to dissolving the Society. In June 1899 two surgeons fell out over the enucleation of an infected eye. One described the other’s management as “scandalous”.  This caused much ill feeling but the offending protagonist finally agreed to resign.

The Norfolk Benevolent Medical Society had been established in 1786. The Medico-Chirurgical Society cooperated in providing, ‘relief of the widows and orphans of medical men.’ Latterly, the Society’s bequests have allowed for the provision of student grants – for travel, research or hardship.

Legacy.

The penetration and impact of these various activities are, of course, hard to quantify. The Society’s social function was arguably its most important. My great great grandfather, John Truscott Skrimshire, attended meetings from his practice in Holt for nearly 40 years (including a term as president for 1886/7). For isolated, rural practitioners like him, in an era devoid of other post-graduate opportunities, the Society provided an invaluable means of maintaining educational contacts. When his son-in-law died aged 42 from a pneumonia after attending a sick patient, the Society came forward with condolences and offers of support for his widow.

Frameworks for considering the professionalization of medicine commonly emphasize the accumulation of medical knowledge, systematic medical education, autonomy and self-regulation, rising incomes and status.⁷ As important perhaps was the collective self-confidence that the proliferation of nineteenth century medical societies helped to provide at a local level. They undoubtedly contributed to the horizontal transmission of new ideas and practices between colleagues.⁸ With their journals, they provided social spaces which reinforced doctors’ growing claims to expert status.⁹ Their significance has arguably been overlooked.

Comparisons.

What of the wider historical literature? Defining societies as ‘an association of persons united by a common aim for the advancement of medical knowledge’, Batty Shaw identified 33 societies founded prior to 1850, and still in existence, beginning with the Royal Society in 1660.¹⁰ They included national (e.g. the Royal Society of Medicine) and local societies (e.g. the Fleece Society famously associated with Edward Jenner). They had often evolved from medical book clubs. Impetus for their formation was given by the foundation of provincial infirmaries and medical schools. Of these 33 societies, only a third are still in existence today though others have since been established.

Research in this area has tended to focus on individual societies or individuals. Taking a broader perspective, Jenkinson examined 160 Scottish societies founded between 1731 and 1939 – by specialism, location, membership, constitution, and transactions.¹¹ Her emphasis was on their wider context: formation, roles and relationships. She illustrated their contribution to the development of the medical profession, e.g. through publications and the encouragement of specialization. Some societies yielded public health benefits, e.g. providing services such as vaccination, education of nursing staff or campaigning on behalf of hospitals.

No complete list of past and present medical societies exists but, for predictable reasons, their numbers have been in long-term decline. Doctors seek continuing professional development elsewhere. Medicine is generally less collegial; fewer folk want meetings after hours. Many societies have struggled to find the funds and human resources to sustain them. They have needed to adapt to survive, e.g. by fostering local interest in the history of medicine.

Perhaps the most significant determinant of decline, ironically, was the establishment of our own Royal College with its local faculties. Many of these societies may be historical relics, but their contribution to the development of general practice in the nineteenth century should not be forgotten.

References

1. Loudon I. Medical Care and the General Practitioner, 1750-1850. Oxford: Clarendon Press, 1986.
2. Porter R. The Greatest Benefit to Mankind: A Medical History Humanity from Antiquity to the Present. London: Fontana, 1999.
3. Bishop J. Medical Book Societies in the 18^th and 19^th centuries, Bulletin Medical Librarian Associations, 1957; 45: 337-50.
4. Batty Shaw A, The Norwich Medico-Chirurgical Society, Norwich, Soman-Wherry Press, 1967.
5. Eade P, Presidential Address, Norwich Records Office, July 1867.
6. Norwich Medico-Chirurgical Society Constitution, Norwich Records Office.
7. Friedson E. Profession of Medicine: A Study of the Applied Sociology of Knowledge. University of Chicago Press: Chicago, 1988.
8. Digby A. The Evolution of British General Practice, 1850-1948. Oxford: Oxford University Press, 1999.
9. Locke C. GPs, Politics and Medical Professional Protest in Britain, 1880-1948, London: Routledge, 2025.
10. Batty Shaw A. The Oldest Medical Societies in Great Britain, Medical History, 1967: 12; 232-244.
11. Jenkinson J. Scottish Medical Societies, 1731 – 1939. Their History and Records. Edinburgh: Edinburgh University Press, 1993.