The medical profession at the beginning of the 19th century was in disarray. Most doctors were trained through apprenticeship, often within their own families which saved money in tuition fees. The medical schools, particularly in Edinburgh, and London offered lectures in a wide range of subjects as well as practical training in anatomy but attendance was by no means compulsory for aspiring doctors. The need to standardise training and exclude quacks was seen as imperative. The 1815 Apothecaries Act and The 1858 Medical Act defined curriculum content and prescribed the routes to medical qualification. The medical apprenticeship was taken away from the family setting and transplanted into the hospital system where established physicians and surgeons headed ‘firms’ of doctors in training. Examinations became the only method to obtain a license to practice. By the mid 19th century, medicine had become a true profession and its practitioners were an intelligent elite who had earned their position in society on merit not through accident of birth.
The rise of the medical profession during the Victorian era paralleled the rise of the middle classes whose new money came from the industrial revolution. Montagu Lomax was a perfect example of this new professional class whose training was paid for from profits his father’s family had made through the leather industry.
Unfortunately, by the time Lomax qualified in 1883, the profession was overcrowded. The vast majority of medical graduates followed the path of general practice at this time. It was possible with enough money to buy into an existing general practice, but most new doctors ‘set up their plates’ on their own. Some newly qualified men took on salaried appointments with local dispensaries, occupational schemes or within the poor law hospitals and asylums. This ‘club practice’ provided an income as they began to build their own lists of paying patients. However, club practice was perceived as low status work, poorly paid and with the added disadvantage that doctors were supervised by laymen (Peterson 1978).
There is no doubt that some doctors found it hard to make a decent living and were forced to look for other options. Some joined the military where they signed on for a set period and were able to accumulate funds to buy a practice at the end of their service. The pay was reasonable, there was usually travel and sport in every posting and much less drudgery than general practice at home. Astonishing numbers of young Irish graduates (around 20%) signed up for the Indian Medical Service between 1860 and 1905 (Jones 2010). This allowed retirement on half pay after 20 year’s service, and a severance honorarium which would pay for the purchase of a practice. Others went to the colonies, often to Australia where prospects were considered to be better than Britain, and society to be less hierarchical (Peterson 1978).
It is a fascinating exercise to browse through medical directories of the late 19th century – doctors are listed under ‘London’; ‘Provincial’, ‘Hospitals, Dispensaries and Lunatic Asylums’,‘Local Government Medical Services’, ‘Scotland’, ‘Ireland’, Practitioners Resident Abroad’, and ‘Services and Mercantile Marine’. Of the many practitioners registered abroad in the 1891 edition, British doctors were working all over the world including Uruguay, China and Tasmania. The majority of Irish doctors who went abroad settled for good in their adopted country, but around 40% returned to set up practice at home after ten years (Jones 2010). This was certainly the case for Dr Montagu Lomax whose six years spent as a GP in New Zealand were both lucrative and personally challenging. (see New Zealand 1890-1896).
Jones, G. (2010). “”Strike out boldly for the prizes that are available to you”: medical emigration from Ireland 1860-1905.” Med Hist 54(1): 55-74.
Peterson, M. J. (1978). the Medical Profession in Mid-Victorian London. Berkley, Los Angeles California, University of California Press.