- Garrison Lecture: How the Concept of Profession Evolved in the Work of Historians of Medicine
Most medical historians working with primary sources have run across references to the profession of medicine. The word profession is found, with varying frequency, in the literature of medicine from medieval times to the present. Nor would it be easy to miss: all of the European languages have equivalent expressions for “profession.” 1 [End Page 1]
From ancient times, medical writers occasionally referred to the expertise of physicians as a profession. 2 In addition to this idea of profession as special knowledge, however, a second meaning developed: a collectivity of those who defined themselves, and were defined by society, as practitioners who followed the vocation of medicine. Moreover, the identity of “professional” took on historical and social meanings. It is those meanings, so important in very modern discussions, and the accompanying spirit of professionalism, that I propose to track in the writings of medical historians.
Over many generations, such scholars in fact viewed allusions to profession in a collective social sense as a distraction to be ignored. Eventually, late in the twentieth century, a few historians of medicine did take note of the idea, and by the mid-1990s, writers were using the modern concept of profession routinely. 3 Indeed, the prominence of scholarship dealing with professions in recent years has led one scholar to observe ironically that investigators have found “the structural form of professions . . . more interesting than the work they do.” 4
Earlier historians of medicine therefore employed the term profession much less frequently than did those of the late twentieth century. Moreover, for earlier scholars, especially before World War II, the concept had different connotations than it had later. Such changes in usage of course indicated changes in society in general, and among physicians in particular. The whole idea of “the profession” in fact became urgent only as the Eurocentric countries became industrialized and organized or bureaucratized and (after some delay) thinkers began to believe that the professions were central to civilization and progress.
But my enquiry focused more narrowly on the ways in which medical historians who dealt with the idea of profession over the centuries approached their subject. Implicit is another question: the extent to which medical historians resisted or advocated following particular thinkers, both in the history of medicine and outside of the field—notably the [End Page 2] sociologists and more general historians who in the twentieth century, for their own reasons, took a special interest in the concept. At some point, then, historians of medicine, in whose hands lay the remembered past of what was becoming the model profession, had to decide how the sense of profession, which Bernice Hamilton identified in 1951, would fit into medical history. 5
What I found was that many medical historians never did recognize professional forces as historical determinants. Furthermore, other scholars chose to view any idea of profession as incidental to a developing social history of medicine. Still other medical historians, however, especially after the mid-1960s, made professional phenomena a special field of inquiry and borrowed conceptualizations from the sociologists. Finally, another era began in the late 1970s, when new sociological thinking about professions ceased to serve as a major inspiration to historical investigators.
Founders of the History of Medicine
Later writers have depicted the work of Daniel Le Clerc, first published in 1696, as the model that established the traditional format of the history of medicine. 6 Le Clerc himself spelled out what he was doing. Unlike some predecessors, he wrote, he was not just compiling a chronology of physicians and writings; instead, he was going “to set forth the opinions of the Physicians, their Systems, and Methods and to trace step by step all their discoveries.” 7 Even though Le Clerc’s narrative did not go past the ancient Greeks, in his day the medical ideas that he described still had a direct bearing on medical practice. History therefore served to filter out the practical knowledge base of medicine.
Not that Le Clerc failed to mention the profession. He did use the term: he noted that some ancients made physick “their...