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  • The Invisible General Practitioner: The Careers of Scottish Medical Students in the Late Nineteenth Century
  • Anne Crowther (bio) and Marguerite Dupree (bio)

Whereas the theme of medical history in the nineteenth century was the integration of diverse skills into one medical profession, the theme of twentieth-century medical practice is a fragmentation within the profession. 1

The relationship between general practitioner and specialist, as outlined by Rosemary Stevens, is central to the history of the British medical profession in the modern period. The effects of the Medical Act of 1858 in integrating the educational patterns of practitioners, and of further legislation in 1886 requiring them to take basic qualifications in both [End Page 387] medicine and surgery together with some training in midwifery, gave the profession an appearance of unity. 2 Stevens emphasizes twentieth-century technology as the crucial element in the growth of specialties, and technological division was reinforced by a long series of conflicts between government and the profession after the National Insurance Act of 1911. 3 It is plain, however, that the growth of medical specialties continued apace during the later nineteenth century, with the incorporation of new techniques into the general hospitals, and the transformation of specialist hospitals from private entrepreneurial ventures into the mainstream of medical education. 4 In Britain, as elsewhere in Europe, specialization increasingly became a characteristic of the medical elite. 5

Nevertheless, in these formative years for the medical profession, the distinction between specialty and general practice remains blurred—largely because of the imbalance of the historical record toward the history of specialties, hospitals, and elites. For the early and mid-nineteenth century there are a number of important studies of the development of general practice; after 1880 the record is thinner, except for substantial studies of the financial status of general practitioners, and the role of medical societies in their professional life in Scotland. 6

General practitioners, apart from the occasional outstanding individual, are often invisible, or tend to be most visible when aggrieved. [End Page 388] From the mid-nineteenth century they appear in their relations with the British Medical Association (BMA), and in their attempts to acquire direct representation on the General Medical Council. 7 The medical journals record their collective struggles, particularly over the planning of the 1911 National Insurance Act and, after that, their constant negotiations with the state over fees and conditions of service. 8 The political struggle reveals the problems general practitioners encountered in their work, but as a group they are rarely as visible or articulate as the specialists. General practitioners have left behind fewer private papers than their specialist colleagues, though the surviving records—private, fictional, or autobiographical—flesh out their individual experiences. 9

The invisibility of the GP also arises from problems with some of the main historical sources. The Medical Directory, published annually since 1845, listed the educational patterns of practitioners, and the great expansion of the types of work available to them, including posts in an ever-growing number of specialist and private hospitals, schools, factories, the Post Office, insurance companies, and many other occupations. 10 But the Directory, except for the early editions so effectively consulted by Irvine Loudon, does not identify general practitioners, who are simply taken for granted. 11 [End Page 389]

One way to overcome the limitations of the Medical Directory is to build up a collective biography of physicians. For this purpose we have selected a cohort of about a thousand students from Glasgow University and a similar number from Edinburgh University, who first matriculated in the years centered on 1871. 12 Using the universities’ matriculation records as a basis, we follow the careers of as many students as possible, literally from the cradle to the grave.

This cohort represents the first generation to undertake their training at the point when, as a result of the Medical Act of 1858, general practitioners were integrated into the institutional structure of the profession. Because they studied in Scotland, where the universities required training in both medicine and surgery (with midwifery training), they anticipated the amendment of the Medical Act in 1886 that made such dual qualifications compulsory.

These two Scottish medical schools were the largest individual schools...

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