Doctors or Professors?: Late Victorian Physicians and the Culture(s) of Professionalism

Canadian Review of American Studies Volume 23, Number 3, Spring 1993, pp. 125-148 Doctors or Professors? Late Victorian Physicians and the Culture(s) of Professionalism Ellen S. More 125 Numerous histories of American medicine describe the efforts of lateVictorian physicians to incorporate the epistemologies, goals, and methods of laboratory science into their teaching and practice of medicine. Especially during the last third of the century, many travelled to European laboratories and clinics for postgraduate training (Ludmerer 1985, Warner 1986 and 1991). Summarizing this trend, James Cassedy writes, "Following their European studies, these [medical practitioners] came back to positions in colleges, universities, medical schools, and public health agencies. They rapidly built up teaching programs in their respective scientific specialties and undertook their own research" (1991, 78). This straightforward summary , however, belies a more complex reality. After all, as John Harley Warner has shown, many different meanings were imputed to the term "medical science," varying as greatly as the professional settings and subcultures in which a physician might choose to work (1994, 21, 24; see also Ludmerer 1985, 118). The multiple meanings of medical science thus reflected the varied purposes for which it was imported into the thought, practices and culture of American doctors (Warner 1991, 454).1 Some physicians, for example, understood "science" as a kind of knowledge; some sawit as a guarantor of professional legitimacy, authority, and power. And, a small number committed themselves not to "medical science," but to "the sciences": a fledgling academic community to which membership was regulated through the 126 Canadian Review of American Studies disciplinary standards of the college and university, not the hospital or bedside . The latter will be the subject of the following discussion, the experiences of one turn-of-the-century physician who attempted exchanging the values, norms, and institutions of medicine for those of academic science.2 Attempting such an exchange was no simple transaction. Differing professional values, reinforced by distinctive interpretations of the meaning of "science," distinguished not only medicine and the sciences, but also subcategories within each. For the practice-based clinician, laboratory findings were ancillaryto clinicaljudgment and professional custom; to the researchminded physician, "science" signified a set of procedural rules which might outweigh therapeutic norms and professional custom: an icon of individual judgment signalling liberation from outmoded professional custom. Academic scientists, too, held varying conceptions of the meaning of "science." To the professor of undergraduate biology, for example, the biological sciences might represent just one aspect of a well-rounded education; to the scientist within a graduate science department, on the other hand, scientific methods and standards were constitutive of the collegial norms regulating this new profession. Therefore, what Warner calls the "implications of experimental science for ... behaviour, responsibility, and identity," varied not only between medicine and the biological sciences, but among groups within each profession as well (1991,469;Kohler 1990). The following discussion will consider the implicationsof these multiple professional discourses for physicians who attempted to become part of the scientific professoriate in the new research universities. If the obstacles encountered by one such physician, Charles Sumner Dolley, MD (a biologist at the University of Pennsylvania from 1885 to 1892), are a fair indication, doctors were better advised to import science-in whatever sense-into medicine than to export themselves into the sciences. Such tensions were magnified when a researcher schooled in the individualistic style of Victorian medicine ventured into the new thought collectives of the scientificdisciplines.3 In the years before possession of the PhD became virtually mandatory for university scientists, some members of science faculties were physicians who had managed to acquire some postdoctoral training in the biological sciences. Indeed, the professional ten- Ellen S. More I 127 sions experienced by physician-professors can be understood as a contest between two different standards of personal success: the individualistic, entrepreneurial model of traditional professionalism and a new corporatecollegial model which measured individual performance against the qualitative and quantitative norms set by administrators and academic peers. Late nineteenth-century physician-academics like Dolley thus faced a complicated set of challenges: to reconcile collegiate undergraduate culture with the professionalising culture of academic science, to teach and to do research (Kohler 1990; Hawkins 1979). Moreover, conflicting institutional...