Montagu Lomax went to Trinity College, Cambridge to start his medical studies in 1878. He qualified in 1883, having completed his clinical training at St Bartholomew’s hospital in London. It was arguably one of the most exciting times to be a medical student with rapid innovations in medicine and surgery. Anaesthesia had been in routine use for only a decade, asepsis, pasteurisation and bacteriology was just around the corner, and X-rays were just on the horizon.
At the turn of the 19th century, British doctors were divided those who had been to university – an intellectual elite known as physicians, and those who had learned by apprenticeships – the surgeons and the apothecaries. The university-educated physicians took medical degrees, whilst the surgeons and apothecaries took licensing exams. There were no nationally organised curricula and standards were set by colleges of physicians and surgeons and the London Society of Apothecaries, with no Government input. This contrasted with the continent, where governments were predominantly concerned with having high quality doctors to service their armies. In France, some Parisian hospitals treated the poor for free simply to provide case material for doctors in training. The British Government had no control over numbers entering the profession, and consequently by the 1830s, medicine was overcrowded and medical incomes were falling. After a prolonged campaign by the doctors, the 1858 Medical Act was passed with the avowed aim of protecting the public from quacks and standardising the medical curriculum so that there was a legally enforceable guarantee of a minimum standard of competence. The General Medical Council was established to police standards. Doctors were divided by the Act into hospital-based consultants and community based GPs, although some GPs also held part time surgical posts in their local hospitals. The apothecaries were given some years to transition into the medical profession, but some split off and became chemists and druggists. Doctors could then view themselves as part of a single profession with a collective identity.
So when Montagu Lomax qualified in 1883, he became a member of a fairly new and rapidly evolving profession. His clinical studies would have taken part within small cohorts of young men, who trained and played sport within their ‘cliniques’, forming lifelong allegiances. His studies would have been conducted in English, a complete contrast from the latin and greek used at Cambridge University for the old Physicians in training. The Anatomy Act of 1832 guaranteed that the bodies need for anatomical studies were legally acquired. Knowledge was being shared widely through a plethora of local and national medical societies, and through medical journals, the first of which was the Lancet founded in 1823. Great strides were being made in surgery, facilitated by the relatively new use of anaesthetics, and asepsis.
Anaesthesia was initially used in dentistry, but had been adopted by American surgeons, and popularised in the UK by its use in childbirth by Queen Victoria in 1853. Speed was no longer of the essence so that surgeons were able to experiment with new techniques, some of which are still in use today. In 1853, Pasteur showed that wine was soured by the presence of microorganisms, confirming the germ theory of disease and decay. Pasteur’s germ theories were picked up by Lister, professor of surgery at Glasgow. He was actively seeking for a way to reduce post operative mortality rates, and thought that cleanliness might improve on the filthy hands and operating coats of his colleagues. He introduced antisepsis into his theatre using carbolic acid for hand washing and a spray for the surgical field, first described in the Lancet in 1867. His death rates fell dramatically and gangrene disappeared from his wards. This was nothing short of miraculous at the time, and the technique was disseminated widely by Lister’s students who dubbed him ‘the father of surgery’.
The technique of roentgenography (X-Rays) was discovered in 1895, and for the first time doctors could observe the bones of a living person.
The sanitary reform movement which set out to provide clean water and living conditions had already resulted in a decline in deaths from communicable diseases by 1880. The germ theory of disease established by Pasteur in 1853, and confirmed by Koch’s work with the microscope formed the basis of the new science of bacteriology. For the first time, the causes of diseases were being discovered, and very rapidly. Koch determined that consumption was caused by the tuberculosis bacillus in 1882, Mott found the syphilis spirochete in the brains of patients with General Paralysis of the Insane in the 1890s. Syphilis and TB caused much of the mortality and morbidity in society at the end of the 19th century. Work by Koch, Mott and fellow bacteriologists laid the foundations for cures which transformed society in the 20th century.
These were indeed exciting times to be a medical practitioner.