Medical Lives in the Age of Surgical Revolution (review)

Medical Lives in the Age of Surgical Revolution is a collective biography of the students of Joseph Lister (1827–1912), Professor of Surgery at the University of Glasgow from 1861 to 1869 and of Clinical Surgery at the University of Edinburgh until 1877. The study cohort, comprised of nearly 2,000 students who matriculated in medical education at the two Scottish universities in the late 1860s and 1870s, ranged in age from 14 to 70, hailed locally and from the farthest reaches of the British Empire, and included the first significant number of women. Medical Lives follows the students' careers from their university days through to death and retirement, shedding light along the way on the development of medical education and on the various career paths open to practitioners following the Medical Act of 1858. The book also traces the spread of "Listerism," describing how Lister's former students disseminated his ideas as they experimented with antiseptic surgical techniques.

Edinburgh and Glasgow were two of the most important medical schools in the United Kingdom in the 19th century, and there were no barriers to attendance except the ability to pay the fees. In theory, the total fees for education leading to medical qualification at Edinburgh would amount to just over £100—but that assumed students would take each required course of lectures only once, which was unlikely. Comparable fees for medical courses at London's prestigious St. Bartholomew's and St. Thomas's hospitals ran upwards of £125. The cost of living for medical students in Scotland was also somewhat less than that of London, averaging about £300 for fees and maintenance, rather than £400 and up. While some students in the cohort did abandon their studies for financial reasons—and at least one lamented his inability to pay the two guinea membership fee to join Edinburgh's Royal Medical Society, the medical students' debating club—most who dropped out did so because they failed one of the three required "professional" examinations.

The course of medical study in the late 19th century included both formal coursework (a minimum of four years) and practical experience. Students were required to attend lectures in the main subjects—anatomy, chemistry, materia medica, physiology, practice of medicine, surgery, midwifery, general pathology, practical anatomy, clinical medicine, and clinical surgery—as well as in botany, natural history, and medical jurisprudence. Extra requirements included hospital, dispensary, and midwifery attendance, as well as experience in vaccination. Lecture attendance was compulsory and was documented by "class tickets" signed by the instructors, but students didn't necessarily have to attend lectures offered by the universities: many elected to complete some of their coursework at one of the "extra-mural" medical schools in the area, where the lecturers could be quite as distinguished as those on the university faculties. The first professional examination was normally taken after the second year of study, which meant students were generally reviewing for exams in the previous year's coursework while simultaneously trying to keep up with their current courses. Perhaps as a result, the failure rate for the first round of examinations was particularly high: as many as 52% of Glasgow students and 30% of Edinburgh students failed (the failure rate at the University of London was comparable at 44%). Students who survived the first two exams generally pulled through on the third: failure rates for the final examination ranged only from about 12–15%. In addition to their coursework, students also gained clinical experience. Some were employed part-time by general practitioners; others signed on to sea voyages; still others worked for medical missions and dispensaries, sometimes paying a fee to gain access to patients. By the time they had completed their educations, the students were considered to be equipped for both hospital and domestic medical practice.

While contemporary medical graduates are now required to secure a junior hospital appointment, only about a third of the cohort began their medical careers in hospitals. More...