Through an in-depth study of medical practitioners in York, Michael Brown seeks to show that being a doctor in the late eighteenth century was not the same as being a doctor in the mid-nineteenth. The focus is on the changing cultures and values of medicine that Brown argues resulted in Enlightenment learned gentlemen becoming Victorian expert medical men. He especially seeks to challenge and refine the notion that the medical marketplace simply gave way to the professionalization of medicine. The introduction discusses the historiography of the marketplace and professionalization models and criticizes the former for its overemphasis on economics and the latter for the influence of sociology. Brown is interested in considering the agency, ideology, and ideation that he sees as lacking in historical studies of medical practitioners. Specifically, this work is a cultural analysis of the changing intellectual endeavors and activities of physicians, surgeons, and apothecaries largely in York and how these related to the fashioning of their public images.

The first chapter provides an introduction to late eighteenth-century York and its medical practitioners. Brown notes that many of them were non-Anglican and came from social strata below the gentry. However, the key issue Brown points to as defining the medical faculty, as they were known, is their closeness or distance from the values of politeness and gentility. To get to this relationship, Brown provides a lively and interesting review of the activities and ambitions of members of the Doctors Club, which, between 1781 and circa 1800, met every Thursday evening except race weeks at the York Tavern. Fraternal, convivial, and homosocial, the Club was a space where medical practitioners could define themselves as polite and civic gentlemen. Brown mines the memoirs of an apothecary, Oswald Allen, to further this argument. The second chapter examines the intellectual activities of four medical men and their desire for and promotion of a classical and liberal education as the necessary foundation of the polite gentleman doctor. Their publications in agricultural improvement; chorography, or the study of place; and medical bibliography are analyzed for what they reveal of the values of benevolence, liberality, and sociability in late eighteenth-century medical culture.

Chapter 3 examines the social identities of medical men attached to the York Lunatic Asylum and how their reputations were affected by the cries of various reformers. In particular, Brown picks apart the scandal, which consumed the asylum from 1813 to 1815. He concludes that the social authority of the medical practitioner as gentleman was eroded by the reformers’ imposition of surveillance and regulation on the asylum. It was the beginning of the end of medico-gentility. The next chapter analyzes the beginnings of what replaced it, namely, social progressivism and utilitarianism. Brown considers the increase in the number of medical practitioners and the resultant fracturing of polite society to be at the root of the emergence of more formal and exclusive bodies than the Doctors Club. The Yorkshire Philosophical Society was founded in 1822. The heated public debates about the practice of body snatching in the late 1820s saw York’s medical practitioners project themselves as experts and public servants rather than gentlemen. Local medical associations were formed that stressed the care of the social body. The theme of chapter 5 is the cholera epidemic of 1832 and how it affected medical identity in York and to some extent elsewhere in England. That same year, physicians and surgeons in York founded the York Medical Society. Unlike the Doctors Club, it was only to be open to medical practitioners. No laymen or women were to be admitted. The business of the society was lectures and debates in medicine and the intellectual activities of Dr. Thomas Laycock in particular are examined within this context. Members discussed their experiences with the cholera epidemic and the utility of medical statistics and, Brown notes, like practitioners elsewhere, “constructed the social as a legitimate sphere of interest and activity” (182). Such activities explain why public health had become a medical domain by the 1840s. The final chapter considers the claims of increasing self-confidence in the supremacy of medical science. Brown sees this as a rhetorical device, as there was little evidence of new effective therapies and a rising cure rate. Part of this self-confidence manifested itself in the creation of medical schools in the provinces. An examination of the York Medical School founded in 1834 and closed in 1860 and Morison’s Vegetable Universal Medicine allows Brown to pit the collectivity and expertise of medical practitioners against the individuality and simplicity of Morison and his followers. By 1850 the author argues medicine had been redefined as a noble public duty and an exclusive profession made up of scientific clinicians. It was no longer the realm of civic gentlemen and liberal scholars. In the epilogue, Brown relates this to the foundation of the National Health Service in 1948 and to current debates on its future.

This is at times a densely written monologue, and the thesis is sometimes lost in jargon; however, Brown has produced a convincing and nuanced argument about the need to reexamine the shift that occurred between circa 1760 and 1850 in how some practitioners defined medicine and their role in practicing it. The sections where he focuses on York are particularly effective in demonstrating the competing projections of what the practice of medicine meant in terms of public identity for two generations or more of men. Let us hope that it leads to further studies like Brown’s of provincial medicine.