SOME KEY EVENTS IN THE HISTORY OF MEDICINE
IN THE 18th AND 19th CENTURIES

In approximate date order

1. Science with relevance to Medicine
2. Anatomy and Physiology
3. Diagnosis and the Study of Disease
4. Infectious Diseases
5. Surgery
6. Midwifery
7. Drug Treatments
8. The Rise of Edinburgh as the leading centre for Medicine in Britain in the 18th century
9. Hospitals, Medical Education and Professional Bodies

1. Science with Relevance to Medicine

John Mayo (1641-1679) showed in 1668 that only part of the air would support combustion or respiration. It was another hundred years before it was shown that air comprised mainly oxygen and nitrogen.

Robert Boyle (1627-1691) showed that air was a material substance that could be weighed.

Invention of thermometers by Fahrenheit (1709), Reamur (1731) and Celsius (1742) but not used in medicine at that time.

Carl von Linné (1707-1778) usually known as Linnaeus, Swedish physician and botanist, began the classification of plants and animals in which each has two names, one for the genus and one for the species, as in Homo sapiens and Papaver somniferum.  Published Systema Naturae in 1735, Materia Medica in 1749 and Genera Morborum (Types of Disease) in 1763.

Joseph Black (1728-1799) a Scottish chemist at Edinburgh University, showed in the 1750s that when substances burn they gain weight by taking up something from the air.  He came close to discovering oxygen.  Studied what he called fixed air (carbon dioxide).

Henry Cavendish (1731-1810) discovered hydrogen and showed that water was a compound made up of hydrogen and oxygen in 1785.  Daniel Rutherford, a medical student in Edinburgh, discovered nitrogen in 1772.

Joseph Priestley (1733-1804) an English Unitarian minister, isolated oxygen in 1772 but did not recognise its importance.  He communicated his findings to Lavoisier.  Karl Wilhelm Scheele (1742-1786) independently discovered oxygen in Sweden.  Priestley discovered several other gases including nitrous oxide, later known as laughing gas.

Antoine-Laurent Lavoisier (1743-1794) recognised the importance of Priestley's discovery of oxygen in combustion and in respiration.  He showed that air was made up of oxygen and nitrogen.  He was executed in the "The Terror" during the French Revolution.  One of his important contributions to chemistry was to make it more quantitative by weighing the materials used in a chemical reaction and weighing the products.

Karl Wilhelm Scheele (1742-1786) a Swedish chemist, discovered chlorine in 1774.  He published Chemical Observations and Experiments on Air and Fire in 1777.  Chlorine was shown by the English chemist, Humphry Davy, to be an element in 1810.  The French chemist, Claude Louis Berthollet (1749-1822) introduced bleaching by chlorine.  It is still the agent used to kill bacteria in drinking water.

L B Guyton de Morveau (1737-1816) disinfected Dijon cathedral in 1773 using hydrogen chloride gas. The cathedral was scarcely used because of the problems caused by bodies buried within.  Later Guyton developed the use of chlorine as a disinfectant and wrote Treatise on Disinfecting the Air in 1801.

Luigi Galvani (1737-1798) of Padua experimented with electricity on the nerves in frogs' legs.  In 1792 published On Electric Powers in the Movement of Muscles.

Alessandro Volta (1745-1827) of Pavia followed Galvani's work and wrote Letters on Animal Electricity in 1792.  He invented the first battery, known as the Voltaic pile.

Sir Humphry Davy (1778-1829) well known for his contribution to the miners' safety lamp made many chemical discoveries including sodium and potassium.  As a young man he worked with Thomas Beddoes and experimenting with nitrous oxide found it caused dizziness, relaxation and a tendency to laugh.  He recommended it for use in surgery in 1800 but it was scarcely used for 40 years.  (See under Surgery)

John Dalton (1766-1844) an English chemist and teacher working in Manchester developed the modern atomic theory in 1804.  He published his work in the journal founded by the Manchester Literary and Philosophical Society. Dalton was a Quaker.

Theodor Schwann (1810-1882) and Matthias Jakob Schleiden (1804-1881) set out their theory on the cellular nature of living tissue, based on microscopy studies of plants. Rudolph Virchow (1812-1902) applied this theory to pathology.

Friedrich Wohler (1800-1882) was the first chemist to synthesise a substance found in animals when he made urea in 1828.  This disproved the idea that a "vital force" was at work in biology.

Michael Faraday (1791-1867) a student of Humphry Davy, was one of the most productive scientists of the century, making discoveries in the fields of chemistry, electricity, magnetism and light. He developed new forms of glass to make achromatic lenses for microscopes. These did not produce the rainbow-coloured fringes on images, which were a feature of early instruments.

Charles Darwin (1809-1882) published On the Origin of Species in 1859.

Clerk Maxwell (1831-1879) discovered the nature of electromagnetic waves in 1864 and in 1873 he published his Treatise on Electricity and Magnetism.

Gregor Johann Mendel (1822-1884), a monk in Czechoslovakia, founded the subject of genetics from his work on peas.  His reported his studies in 1865 to a local scientific group but his papers then lay undiscovered until 1900.

Wilhelm Conrad Röntgen (1845-1922) discovered X-rays in 1895.  The Curies isolated radium in 1898.

2. Anatomy and Physiology

Hermann Boerhaave (1668-1738) often regarded as the leading physician of the 18th century, developed medical education at Leyden in Holland.  He was professor of botany and medicine in 1709 and professor of chemistry from 1718.  He wrote books in all three fields.  Institutiones Medica was published in Edinburgh in 1752.  He was the first to have a hospital attached to a medical school so that students could examine patients.  Boerhaave and his pupil, Bernhald Siegfried Abinus (1697-1770), re-edited and published the books on anatomy by Vesalius (1514-1564) who had been the first person in Europe to advance anatomy since the time of the ancient Greeks and Romans.  Boerhaave taught 2000 students of whom 660 came from English speaking countries; Alexander Munroe was one of these pupils.

Albrecht von Haller (1708-1777) from Bern in Switzerland, became professor at Göttingen and was the founder of the subject of physiology. He published between 1759 and 1766 his Elements of the Physiology of the Human Body.

Giovanni Battista Morgagni (1682-1771) professor of anatomy at Padua, founded the study of morbid anatomy i.e. the differences between healthy and diseased organs, by correlating symptoms in life with findings from post mortem examinations.  He published On the Sites and Causes of Diseases in 1761.  The Scotsman, Matthew Baillie, (1761-1823) working in London, published Morbid Anatomy in 1793.

François Xavier Bichat (1771-1802) of Paris used the microscope to begin the study of cellular changes in disease.  This type of investigation was hampered by the inadequate nature of glass available for making lenses until the middle of the 19th century.  Bichat published Treatise on Membranes in 1800.

Charles Bell (1744-1842) a Scot working in London was a leading anatomist and surgeon and published his work The Nervous System of the Human Body in 1830.

An Act for Regulating School of Anatomy was introduced in 1832, in response to body snatching scandals.

Claude Bernard (1813-1878) a Frenchman, was one of the leading physiologists of the century. He made discoveries concerning digestion and developed the idea that the body maintains constant conditions in the blood and tissue fluids.  In 1865 he published Introduction to the study of Experimental Medicine.

Friedrich Gustav Jacob Henle (1809-1885) working in Zurich, Heidelberg and Göttingen exploited the improvements in microscopes for the study of tissues and published Handbook of Systematic Anatomy between 1866 and 1871.  Henle advanced the theory that infectious diseases were caused by living microscopic organisms, an idea subsequently proved by Louis Pasteu

3. Diagnosis and the Study of Disease

Reverend Stephen Hales (1677-1761) was the first person to measure blood pressure.  He did it on a horse.

Leopold Auenbrugger (1722-1809) working in Vienna invented the diagnostic technique of tapping parts of the body and listening to the noise produced.  He reported his findings in New Invention in 1761.  His discovery was neglected for almost fifty years before his book was found in 1806 by Jean Nicholas Corvisart, Napoleon's personal physician.

Percival Potts described the association between chimney sweeps and scrotal cancer in 1775.

Rene Laënnec the French physician invented the stethoscope in 1817.  He used initially a roll of paper to listen to the chest of a female patient.

James Parkinson (1755-1858), working in London, described the disease of the nervous system that now bears his name in 1817 in his essay On the Shaking Palsy.

Richard Bright (1789-1858) was born in Gloucestershire and graduated in medicine in Edinburgh.  After working on the continent he settled in London and became assistant physician at Guy's Hospital London.  He described the kidney condition now known as Bright's disease in 1828.

Thomas Hodgkin (1798-1866) was born in Tottenham and educated at the University of Edinburgh.  Hodgkin was an associate of the eminent physicians Richard Bright and Thomas Addison at Guy's Hospital, London.  He described the condition of the lymph glands now known as Hodgkin's disease in 1832.

Thomas Addison (1793-1860) was born in Northumberland.  In 1837 he became a full physician at Guy's Hospital in London and a joint lecturer with Richard Bright.  They collaborated on Elements of the Practice of Medicine (1839).  Addison described the adrenal gland condition now known as Addison's disease in his publication On the Constitutional and Local Effects of Disease of the Supra-Renal Capsules in 1855.  Together with John Morgan, he wrote An Essay on the Operation of Poisonous Agents upon the Living Body (1829), the first English book on the subject.

Hermann Ludwig von Helmholtz (1821-1894) invented the opthalmascope and wrote of it in Physiological Optics in 1856-67.

4. Infectious Diseases

Lady Mary Wortley Montague (1689-1762), wife of the British ambassador to Turkey, witnessed smallpox inoculation in Turkey and had it performed on her son in 1718.  On her return to London she campaigned to have the technique used in England.  It was tested initially on 6 prisoners at Newgate and 11 children at a charity school. Innoculation involved the use of matter from smallpox pustules and could lead to full blown cases of the disease.  Later it was discovered that innoculation did not reduce the overall death rate from the disease; those innoculated, while suffering even from a mild case of smallpox were infectious and could transmit the disease to others.

Edward Jenner (1749-1823) a student of William Hunter in London became a practitioner in Gloucestershire and introduced vaccination against smallpox using cowpox. He had vaccinated an eight year old boy, James Phipps, with matter from a cowpox lesion on Sarah Nelmes.  Similar trials had been performed by the farmer, Benjamin Jesty, on his family in the 1770s and 1780s.  Jenner published An Inquiry into the Causes and Effects of the Variolae Vaccine in 1798.  By 1801 all the sailors in the British Navy were being vaccinated.  In 1802, Jenner was awarded £10,000 by Parliament, later doubled, for his services to the nation and a Jennerian Institution was set up in London to promote vaccination.  This was replaced in 1808 by the National Vaccine Establishment.

John Snow (1813-1885), an English Physician, was the first to realise that cholera was transmitted by water polluted by sewage during the epidemic in London in 1854.  He identified the Broad Street Pump as the source of a local outbreak of disease and the only remedy was to ask the curate to remove the handle from the pump.  Snow was also the physician who first administered chloroform to Queen Victoria as mentioned below.

Louis Pasteur (1822-1895) Professor of Chemistry at Lille, made the most significant breakthrough in medical research of the 19th century by demonstrating in the 1860s and 1870s that micro-organisms were responsible for fermentation of wine and beer, the spoilage of wine, beer and milk, and infectious diseases in animals and man.  He developed pasteurisation of milk and produced vaccines for anthrax (1876), tuberculosis (1882), cholera (1883) and rabies (1885).  This was the most significant piece of medical research in the 19th century, a period in which about half of all deaths were caused by infectious diseases.

Robert Koch (1843-1910) a German physician, trained with Friedrich Gustav Jacob Henle (see Anatomy and Physiology) and followed Pasteur as a great experimentalist with many discoveries of his own.  He showed that bacteria and other micro-organisms could be seen more easily under the microscope if they were stained with dyes.  He discovered the tubercle bacillus (1882) and the cholera bacillus (1883).  By 1900 he had discovered the organisms responsible for 21 diseases and he received a Nobel Prize in 1905.  Other scientists added to the list such as Friederick Gustav Johann Löffler (1852-1915), diphtheria; Albert Neisser (1855-1916) gonorrhoea; and Howard Taylor Ricketts (1871-1910), typhus.

Emil Baring discovered how to use anti-toxin made in horse blood for treatment of diphtheria and its first use was in December 1891.

Alphonse Laveran (1845-1922) a French army surgeon, was the first person to describe the parasite causing malaria in 1880.  In 1897-8, the British physician Sir Ronald Ross (1857-1932) proved that malaria is transmitted by mosquitoes.

Sir Almroth Wright (1861-1947), a British bacteriologist, produced the first typhoid vaccine in 1897.  It was tested intially in India but when the Boer War broke out it was made available to soldiers who wanted it.  However, many chose not to be vaccinated and more men died from typhoid than from the fighting.

5. Surgery

William Cheselden (1688-1752), surgeon at St. Thomas's Hospital developed a method for removing bladder stones in 90 seconds.  Published Osteographia in 1733.

John Hunter (1728-1793) moved to London in 1748 to join his brother William (see Midwifery) and worked with him for ten years developing the skills of dissection.  He became the leading surgeon of the day and built a large house in Earl's Court which had dissecting rooms, and he also collected a menagerie of unusual animals which were dissected when they died.  He moved to Jerym Street to the property of his brother William when the latter moved to Great Windmill Street and at these premises took apprentices for 5 years at a fee of 500 guineas.  Among his pupils were his brother-in-law, Everard Holme, Edward Jenner, Astley Paston Cooper (born 1768), Anthony Carlisle, John Abernethy and William Clift.  In 1783 John started to build a new museum and lecture room near Leicester Square.  Eventually Hunter's collection of anatomical samples became the basis of the Hunterian Museum of the Royal College of Surgeons but was damaged in the blitz on 10 May 1941.  John Hunter became surgeon to the King in 1776.  He published The Natural History of Human Teeth in 1771, On Venereal Disease, in 1786, Observations on Certain parts of the Animal Economy, in 1786, and Treatise on the Blood, Inflammation and Gunshot Wounds in 1794.  (Following John Hunter's death, Sir Everard Holme, published under his own name, work from Hunter's manuscripts, which had been deposited in the College of Surgeons.  He then destroyed the original manuscipts, setting fire to his house in the process.  This must rank as one of the most disgraceful episodes in the history of medicine.)

Ephraim McDowell (1771-1830) working in Kentucky, performed the first operation for an ovarian tumour in 1809.

Thomas William Morton (1819-1868) working in Boston, used ether as an anaesthetic in Massachusetts General Hospital in 1846.  He tried to keep the substance secret but news soon reached London and in the same year Robert Liston (1794-1847) performed an amputation at University College Hospital using ether as an anaesthetic.  This was witnessed by Joseph Lister (see below).

James Young Simpson (1811-1870) gained his MD at Edinburgh in 1832.  He became an obstetrician in Edinburgh and experimented with various volatile liquids as possible anaesthetics.  He hit on chloroform in 1847.  John Snow (1813-1885) administered chloroform to Queen Victoria during childbirth in 1853 and 1857.  He wrote On Chloroform and other Anaesthetics in 1858.

Joseph Lister (1827-1912), the Professor of Surgery at Glasgow and later at King's College in London, realising the importance of Pasteur's work, was the first to use an antiseptic (carbolic acid) during surgical operations, in 1865.  It was very damaging to the hands of surgeons and nurses and led to the introduction of rubber gloves.

6. Midwifery

Edmund Chapman published his Essay on Midwifery in 1733 and in a later edition of 1735 described in detail the obstetric forceps, whose design had been kept secret by the Chamberlen family for 150 years.

William Smellie (1697-1763) a Scotsman, was the first man to teach obstetrics and midwifery on a scientific basis.  After working for 20 years in Scotland he set up a midwifery school in London in the 1740s and taught the correct use of forceps.  He published A Treatise of the Theory and Practice of Midwifery in three volumes between 1752 and 1764.  William Hunter (see surgery) studied with Smellie.

Dublin Lying-in Hospital was founded in 1745.  The British Lying-in Hospital at Convent Garden began in 1749, the City of London Lying-in Hospital in 1750.  The General Lying-in Hospital which later became Queen Charlotte's was founded in 1752 and Westminster Lying-in Hospital in 1765.  Manchester Lying-in Hospital, which became St. Mary's, was founded in 1790.

William Hunter (1718-1783) born in Lanarkshire, trained first with William Cullen then moved to Edinburgh to study for a winter before moving to London to work as an assistant to James Douglas, a Scottish physician.  William Hunter made a European tour in 1848 visiting Leyden.  On his return, William was joined by his brother John, who helped with dissections and over the next ten years became a very skilled anatomist.  William became a celebrated surgeon in London and then concentrated on obstetrics.  William Hunter produced his The Anatomy of the Gravid Uterus (i.e. pregnant womb) in 1774.  Other works include The Structure and Diseases of Articulating Cartilages, a paper presented to the Royal Society in 1843.  (See also medical education.)

Charles White (1728-1813) was apprenticed as a surgeon to his father, Thomas White, in Manchester.  Later he trained in London with William Hunter and in Edinburgh before returning to Manchester.  He published in 1773 his Treatise on the Management of Pregnant and Lying-in Women, which advocated cleanliness in the delivery of babies.  He described the condition of 'white leg' caused by thrombosis following childbirth.  White was one of the founders of Manchester Infirmary in 1752 and the Manchester Lying-in Hospital, later St. Mary's, in 1790.

Oliver Wendell Holmes, working in Boston in the USA, insisted on high standards of cleanliness for obstetricians and employed bleaching powder as an antiseptic for hand cleaning.  He read a paper On the Contagiousness of Puerperal Fever to a medical society in 1848 but other doctors took his views as a personal attack. Holmes' view on the drugs available at the time was that "If the entire materia medica was sunk in the ocean it would be so much the better for mankind and so much the worse for the fishes."

Ignaz Philipp Semmelweis (1818-1865) working in Vienna, showed that child bed fever was much more common in mothers attended by doctors and students who had undertaken or attended post-mortem examinations on women dying from the disease.  He suggested that the disease was carried by the doctors and was widely reviled in the profession.  Semmelweis published The Cause, Concept and Prophylaxis of Puerperal Fever in 1861.

7. Drug Treatments

The 1st Edition of the London Pharmacopoeia was produced in 1618 by the Royal College of Physicians and had worms, dried vipers, foxes lungs, powdered precious stones, and oil of ants.  The 1650 edition included moss from the skull of a victim of violent death.  Later in the 17th century the pharmacopoeia included human perspiration, saliva of a fasting man, urine and excrement of all kinds, and jaw bones from the skulls of executed criminals.  By the late 18th century these exotic and occult items had been dropped in favour of a compendium of drugs producing vomiting, purging, sweating, blistering, and urine flow.  Pharmacopoeias were produced at intervals in London, Edinburgh and Dublin.  The fourth edition of the Manchester Hospital Pharmacopoeia was produced in 1827.  All were superseded from 1858 by the British Pharmacopoeia.

James Lind (1716-1794) a naval surgeon who had trained in Scotland, showed that scurvy among sailors on long voyages could be avoided by eating limes and published A Treatise on Scurvy in 1753.  Scurvy is now known to be caused by vitamin C deficiency.

In 1763 Rev. Edmund Stone published An account of the success of the bark of the willow in the cure of agues.  The bark contains salicylic acid, a forerunner of aspirin.  Stone's work was communicated to the Royal Society but ignored.  Aspirin is acetyl salicylic acid, which is less irritant to the stomach than salicylic acid itself (it has additional properties too as it is a mild acylating agent and interferes with prostaglandin synthesis)

William Withering (1741-1799) studied in Edinburgh, worked in Birmingham and developed the use of fox-glove in the treatment of dropsy.  Published Botanical Arrangement of the all the Vegetables in 1776 and Accounts of the Fox-glove in 1785.

Benjamin Franklin (1696-1790) invented bifocal spectacles in 1784.

Friedrich Wilhelm Sertürner, a German chemist, isolated morphine from opium in 1806.

Pierre Joseph Pelletier (1788-1842) a French chemist, isolated colchicine, used in gout, from Autumn Crocus (Colchicum Autumnale) in 1820.  Pelletier was also responsible for the isolation of emetine (1817) the emetic principle of the South American plant ipecacuanha; strychine (1818) from Strychnos Nux Vomica; quinine (1820) from Cinchona bark; and caffeine (1821).  He is regarded as the founder of the chemistry of plant products.  He died when he experimented with breathing chlorine gas.

Bayer, a German chemical company, introduced aspirin (acetyl salicylic acid) in 1899.

Paul Ehrlich (1854-1915) was the first "medicinal chemist" engaged on a programme of drug research.  He prepared 606 arsenic compounds before discovering salvarsan in 1905, which provided a safer and more effective treatment for syphilis than the mercury compounds used up until that time.  Ehrlich shared the Nobel Prize for Medicine with Mechnikov in 1908.

8. The Rise of the Edinburgh as the leading centre for Medicine in Britain in the 18th Century

Perusal of these articles will demonstrate how many of the important advances of the 18th and early 19th century were made by those trained in Scotland.

Sibbald, a Scotsman, studied at Leyden, and founded the Royal College of Physicians of Edinburgh in 1681.  Archibald Pitcairne (1652-1713) became a professor of medicine, appointed by the town of Edinburgh in 1685 and spent 1692 as professor in Leyden.  This was the start of the medical tradition in Edinburgh that grew during the next century.  The physicians established a Botanic Garden for the study of medicinal plants.  (See also Hermann Boerhaave under Anatomy and Physiology.)

John Monroe (died in 1737) was a surgeon attached to the army of William III (William of Orange)..  He visited Leyden and studied there.  He was a student of Archibald Pitcairne (see above) and a founder of the Edinburgh medical school.  His son, Alexander Monroe 1st (1697-1767) became professor of anatomy in Edinburgh in 1719 at the age of 22 having returned from studies in Paris and Leyden under Boerhaave.  He in turn was succeeded by his son Alexander 2nd (1733-1817) and then by his grandson, Alexander 3rd (1773-1859) who held the post until 1836.

A medical faculty was established at Edinburgh in 1726 by the town council, which appointed four professors.  They were joined by the anatomy teacher of the Incorporation of Apothecary Surgeons, Alexander Monroe.  All five had studied under Boerhaave in Leyden.  Edinburgh was also noted for its chemists in the 18th century (see Joseph Black in Science section.)

The Medical Society was formed in Edinburgh in 1737 and became the Royal Medical Society in 1777.

William Cullen (1712-1790), a pupil of the first Alexander Monroe was a professor of medicine and of chemistry and helped found the Glasgow medical school in 1744.  He lectured in English rather than Latin, a novelty at the time.  One of Cullen's pupils before he moved to Glasgow was William Hunter.

William Woodville (1752-1805) trained in Edinburgh with Cullen and in 1790 published Medical Botany in London.

In 1764, a 200 seat Anatomy Theatre was built in Edinburgh.

The Royal College of Surgeons of Edinburgh was founded in 1778.

Among the many Scottish medical men who made significant contributions in the 18th century were William Smellie and William Hunter (see midwifery), and John Hunter (see surgery). In the 19th century important medical contributions were made by the surgeons Robert Liston, Joseph Lister, James Young Simpson and James Syme.

9. Hospitals, Medical Education and Professional Bodies.

London's early hospitals were St. Thomas's founded in 1106, re-founded in 1553, the Bethlem founded 1377, The Royal Hospital Chelsea in 1682 and the Greenwich Naval Hospital of 1694.  Hospitals founded in London in the 18th century were as follows: Westminster Public Infirmary in James Street, was founded in 1720 and when larger premises were required there was a split of support leading to the Westminster Hospital in Castle Lane and St. George's at Lanesborough House at Hyde Park Corner, which opened in 1733.  Guy's on the south side of St. Thomas's Street, Southwark, was founded in 1721 and endowed in 1724 by Thomas Guy MP a bookseller and governor of St. Thomas's Hospital.  The Middlesex was founded in 1745 and the London Hospital in Whitechapel had the foundation stone laid in 1752, being completed in 1759.

The Little Hospital which became the Edinburgh Royal Infirmary, was founded in 1729, followed by Bristol (1735), Winchester (1736), York (1740), Exeter (1741), Bath (1742), Northampton (1743).  Among those founded in the North West were Liverpool (1745), Manchester Infirmary (1752) and Staffordshire General Infirmary (1765).

In 1765, William Hunter built a house in Great Windmill Street with dissecting rooms, a lecture theatre and galleries to house is collection of anatomical specimens.  This became a medical school.  (see also William Hunter under Midwifery)

In 1783, Charles White gave the first public lectures on medicine in Manchester and extended his teaching to midwives in 1794.  (see also midwifery)

The London Medical College became England and Wales' first medical school in 1785. However, it was 1829 before London had a university.  In 1836 this was renamed University College under a new University of London that also included King's College.

Thomas Percival (1740-1804) studied at Warrington Academy and in Edinburgh and Leiden.  He settled in Manchester in 1767 and the Manchester Literary and Philosophical Society was founded in his house in 1781.  Percival was president until 1804. In 1790, when a number of medical staff at the Infirmary resigned, he was asked to draw up new rules of conduct. His book Medical Jurisprudence, published in 1794 was very influential in determining the relations between doctors and patients.

James Abernethy (born in London in 1764) was the son of an Irish merchant of Scottish extraction.  At the age of 15 he was apprenticed to a surgeon at St. Bartholomew's and after 8 years gained the post of Assistant Surgeon which he kept for 25 years.  He was a successful lecturer and the hospital authorities built a lecture theatre for him which was the start of the School of Medicine at St. Bartholomew's.  Abernethy's subject matter was gained in part by attending John Hunter's lectures.  Later in life, Abernethy developed the idea that most human diseases were caused by the digestive system and could be treated by diet, mercuric sulphide, calomel (mercurous chloride, a diuretic and cathartic), and other purgatives.

Astley Paston Cooper (born 1768) was apprenticed to Henry Cline, Surgeon at St. Thomas's Hospital, who encouraged him to go to John Hunter's lectures and in 1791 appointed him to be Joint Lecturer in Anatomy and Surgery.  In 1800 he was appointed Surgeon at Guy's Hospital.  In 1820 he was made a baronet for an operation on the King.  In 1825, when his nephew was not allowed to succeed him as lecturer at St. Thomas's, he persuaded the Treasurer at Guy's Hospital to found a separate medical school so that Bransby Cooper could be lecturer there.

The Royal College of Physicians (London) had been founded by Henry VIII in 1518 to organise and control teaching in London.  In 1523 an Act of Parliament extended the college's powers to licence practitioners from London to the whole of England.  To counter competition from Scottish doctors, associates were restricted to those graduating from Oxford or Cambridge, thereby excluding all Nonconformists.  There were only 50 associates and 50 licentiates, a lower grade, in 1800.  At that time neither Oxford nor Cambridge had a public hospital or infirmary.  The policy of exclusion made a few London physicians very rich.  As late as 1858, the the works of the ancient writers Galen and Hippocrates, and the 17th century English physician, Thomas Sydenham, (1624-1689) were an important part of the curriculum for the Royal College of Physicians.  The conservatism and exclusivity of the College in the 18th and early 19th centuries meant that many of the developments came from other branches of the profession and particularly from doctors trained in Scotland.

The Guild of Barber Surgeons was founded in 1540 but in 1745, the surgeons broke away to form a separate Company of Surgeons with its own hall close to the Old Bailey and Newgate Prison.  In 1797, the surgeons moved away from the City to property purchased in Lincoln's Inn Fields.  This coincided with the government placing into the care of the College the writings and specimen collection of John Hunter (1728-1793).  In 1800, the Company of Surgeons was granted a Royal Charter to become The Royal College of Surgeons of London, later of England.  At this time surgeons qualified by serving an apprenticeship.

Apothecaries had been recognised by Henry VIII as able to treat minor conditions.  They provided most of the medical service outside London especially for the middle and lower classes.  They formed an Apothecaries Company.  Qualification was originally by apprenticeship.  The Apothecaries' Act of 1815 empowered the Society to examine and to grant licences to successful candidates to enter practice as an Apothecary in England and Wales.  It also gave the Society the duty of regulating such practice. The title of the original qualification was Licentiate of the Society of Apothecaries (LSA).  Following the establishment of the General Medical Council in 1858 the LSA became a registerable qualification.  The apothecary was, in effect, the forerunner of the modern general practitioner. It was the chemists and druggists who were the forerunners of the modern profession of pharmacy.

Prior to 1826, the only universities in England were Oxford and Cambridge, entry to which was restricted to Anglicans until the 1850s.  The University of London was founded on 11th February 1826.  A fundamental principle was that not only would students of all beliefs be allowed entry, but that no religious subjects would be taught.  This led to the nickname "the Godless of Gower Street".  The established interests of Oxbridge and the Church prevented the University of London receiving a royal charter, so it was set up as a joint stock company.  King's College was established as a rival in 1829, supported by the Church and establishment, and received a Royal Charter.  The University of London finally received its Royal Charter in 1836 and became University College, and on the same day a new 'University of London' was established with the power to award degrees in Medicine, Arts and Laws to students from both University College and King's College.

In 1834 the North London Hospital was opened opposite the University of London and in 1837 it became University College Hospital.

Owen's College was founded in 1851 and became Manchester University in 1880.

The Medical Act of 1858 set up the General Council of Medical Education and Registration to regulate entry into the medical profession.  The Act reduced the fierce rivalry between physicians, surgeons and apothecaries by uniting them against the unqualified quacks.  The London and Provincial Medical Directory of 1858 was the only recognised register of medical practitioners at the time.  It shows that in the provinces most practitioners were surgeons and/or apothecaries.  Surgeons were mainly MRCS with a few FRCS.  Apothecaries were mainly Licentiates of the Society of Apothecaries and in a few cases had the higher qualification of Member.  Many practitioners had dual qualification as MRCS, LSA.  There were very few physicians outside London.  Those medical practitioners outside London with university qualifications usually had an MD from a Scottish university.

The Medical Act of 1858 also set up a single list of approved drugs for the whole country knows as the British Pharmacopoeia, which superseded the separate pharmacopoeias formerly produced in London, Dublin and Edinburgh.

Bibliography

An Outline History of Medicine by Philip Rhodes, 1985.
The Story of Medicine
by Vernon Coleman, 1985
The Age of Miracles, Medicine and Surgery in the 19th Century, by Guy Williams, 1981
Sixty Centuries of Health and Physick, by S. G. Blaxland Stubbs & E. W. Bligh, London, 1931.
The Greatest Benefit to Mankind, by Roy Porter, Fontana, 1997
Disease Medicine and Society in England, 1550-1860, by Roy Porter, Cambridge University Press, 1993
Encyclopaedia Britannica, 1998 edition on CD ROM
Web sites of universities and learned institutions
Wellcome Medical History Gallery, Science Museum, South Kensington.
Exhibition of Medical Books at the John Rylands Library in Deansgate, Manchester, March 2001.

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History of Medicine
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