St. Mary's: The History of a London Teaching Hospital (review)

Famously, London buses are infrequent (less true these days), but when they come they do so in pairs or clusters. The same seems to be true of histories of major London hospitals: Until recently, historians wanting to refer to the past of these institutions and use evidence from them to bolster arguments about, say, medical education or research have had to rely on older sources. Many of these latter are valuable, but they do not ask all the questions that perplex modern scholars. In the last year two books have appeared that approach the old, great hospitals with a modern eye and have illuminated features of London medicine that throw light not just on their local history but also on wider issues. First to appear was Keir Waddington's Medical Education at St Bartholomew's Hospital (2003), which covered that hospital's history from the Middle Ages to nearly the present day. The contribution of Waddington's book to the history of medical education was prominent in its promotion, yet for the years after 1850 it is equally rich in its analysis of the relations of modern science and ward work. The advertisements for E. A. Heaman's book, by contrast, stress its value in furthering our understanding of medical research. This is equally misleading, for Heaman gives us a rich account of medical education at St Mary's, and much else besides.

Heaman begins with a survey of the geography and population of the area—Paddington, West London—in which St Mary's, the last great voluntary hospital, was founded. Such introductions are customary and often no more than ritualistic, but Heaman puts hers to work later in the book showing that the very conservative bias of the hospital, until after the Second World War, was derived to a great extent from the power of its local, wealthy, bourgeois governors. Not that Paddington was homogeneously affluent and a morally well-ordered place: prostitution abounded, and more than a little of this volume is devoted to the efforts of some of the hospital staff to provide, and others to thwart, treatment for venereal disease.

From the start, Mary's was a teaching hospital with a medical school attached to it. If I have any criticism of this excellent book (besides the fact that Charles Harington is spelled with a double r), it is that sometimes I could not figure out whether and when the hospital and school had separate departments of, say, biochemistry or bacteriology, for basic teaching and for clinical care. A rich clinical curriculum was rapidly developed, aiming students at the licensing examinations of the Royal Colleges and the Society of Apothecaries. In line with its conservative approach, the school largely kept to itself and showed little enthusiasm for integration with London University. Even when professorial units were established in the 1920s they were no great success. Like Waddington, Heaman is extremely good at historicizing the conversion of the wild medical student of 1850 into the relatively tame scholar of the 1930s. This Mary's did through establishing residential quarters, scholarships, written exams, and, above all, sport. Mary's was the most sporty of all the London hospitals, especially in the interwar years under the deanship of Charles Wilson (Lord Moran or "Corkscrew Charlie" during his NHS negotiations). Rugby was Wilson's passion and he saw in it the vehicle for creating character, manliness, and achievement. There were few good rugby players with modest academic qualifications who failed to find a place at Mary's.

Bart's, like Mary's, was a conservative medical school. Yet alongside Bart's' conservatism ran a vein of original scientific research. At Mary's, with exceptions, few of the staff raised their heads above the parapet of the ordinary into the light of scientific fame...