The M.D. from Brussels University (M.D.Brux).

In the late Victorian and early Edwardian times, a curious set of letters was often appended to the list of qualifications of medical doctors – the M.D. Brux. This signified that the clinician had obtained a degree, Doctor of Medicine from Brussels University. Dr Montagu Lomax  possessed an M.D.Brux 1 , although he never declared it in the medical directories. Travelling abroad to study was relatively common in the years prior to the First World War (WW1), particularly amongst those elite doctors seeking specialist experience in the great medical centres of Paris, Berlin and Vienna. However, to travel abroad in order to obtain a degree seems odd, particularly when the qualification of M.D. was available in the British Isles. Moreover, why did Lomax go to the trouble and expense of obtaining a foreign degree, and then not advertise it in the medical directories? This short essay will attempt to answer both of these questions.

In the first place it is necessary to understand a little about medical qualifications. In the early part of the 19th century, anyone could set themselves up as a medical man. Most were trained by apprenticeship to a practicing physician or surgeon, but there were charlatans who had little or no formal training. Clinicians tried for many years to weed out these ‘quacks’ and to professionalise the business of medicine. Eventually the first Medical Act of 1858 decreed that nobody could practice medicine without being placed on the Medical Register. The necessary registrable qualifications could be obtained from one of 22 British licensing bodies including the Society of Apothecaries whose registrable qualification was Licentiate of the Society of Apothecaries (LSA). Most primary medical qualifications were licences to practice or diplomas, not degrees. In 1884, the Royal colleges introduced the first conjoint diploma in surgery and medicine  MRCS/LRCP and this became the standard first qualification for generations of doctors 2.

Lomax was typical of his generation, obtaining diplomas and licences in medicine, surgery and midwifery. His application for entry to the New Zealand Medical Register read as follows:

I, Montagu Lomax-Smith, of Christchurch, Member Royal College of Surgeons England, Licentiate in Medicine and  Midwifery Royal College of Physicians Edinburgh registered 1883, Fellow Medical Society London, and Member of the British Medical Association, hereby give notice that I have, this 2nd day of April, 1890, deposited my diplomas, in evidence of the above qualifications, with the Registrar of Christchurch District, and that I shall apply to be registered under the New Zealand Medical Act on the 2nd day of May, 1890.3

The issue of a degree in medicine was debated from time to time in the medical press. The BMJ noted that ‘most medical students in London did not seek a university degree, so that a large proportion of medical men in England possess diplomas to practice but not degrees in medicine . This is a fact which they sometimes find reason to regret’ 4. Without a degree in medicine, a medical man was not strictly speaking, able to use the title of ‘doctor’ before his name, although his patients would style him ‘doctor’ 5.  The growing middle classes in late Victorian Britain were educated and discerning, so that the magic letters ‘M.D.’ became a significant indicator of professional status for the British public 6. The BMJ noted that ‘the possession of an M.D. degree gives a practitioner a decided advantage in the eyes of the public, and on this account, the desirability of obtaining one must be urged on every student’.7.

However, one cynic noted that ‘the attraction of a university degree lay too often in its marketability than its mental cultivation’ 8. Certainly, 90% of the elite physicians working in the lucrative medical businesses based around Harley Street held a higher medical degree such as M.D. compared with  only 13% of GPs 9. Even outside of Harley Street, an M.D. made a material difference to salary, attracting a bonus of £50 per annum for an ungraded medical officer 10.

How an M.D. could be obtained:

Having established that the possession of and M.D. or equivalent university degree was a prerequisite for a financially successful medical career, the problem was how to obtain such a qualification. The different licensing bodies which included the medical schools, did not all issue M.D.s, and those that did had vastly different rules and requirements. In Scotland, St Andrews gave all its graduates an MD once they reached 40 years of age and it wasn’t until 1907 that the MD was granted on the basis of a written examination. Aberdeen University’s M.D.  required written testimonials and several years of practice 11. Durham required practitioners to be at least 40 years of age with a minimum of  fifteen years in practice. If a Durham candidate didn’t have an arts degree, he had to translate latin passages from the classic texts into English as well as sit written examinations in medical subjects in exchange for an enormous fee of 50 guineas. The London universities required three years clinical experience after matriculation,  knowledge of organic chemistry12,  and an M.D. was only granted after attending a course of prescribed study followed by written examinations. The London M.D. was recognised as being difficult with a high failure rate and consequently it was  accorded high prestige 13.

Effectively then, to gain an M.D., one had to wait until one was well into middle age for the Scottish universities, and Durham. Durham was enormously expensive and required evidence of education in the classics and the Arts, The  London M.D. was prestigious precisely because it was notoriously difficult to pass the examinations. A doctor  writing in the Lancet noted that ‘One reads in almost every issue of the medical press complaints against the English Royal Colleges and other licensing bodies that their members and licentiates are prevented from obtaining the coveted title of M.D.’ 14 .

 However, there was another option open to clinicians hoping to improve their prospects. The Brussels M.D. had been available  to British graduates since the 1870s, and a steady stream of hopeful candidates crossed the channel every year to take its examinations. Even accounting for  travel, living expenses for a week  and exam fees, the whole venture cost less than two thirds of the examination fee for the  Durham M.D. 15 . Prior to WW1, there was no requirement to have studied at the University of Brussels, no additional courses to take,  no written papers, and candidates were examined in English through an interpreter. The standard was considered to be  lower than the English Royal Colleges although the failure rate was still 50-60% 16. The Lancet felt confident that the possession of the degree would amply repay the candidate in social status and it was ‘well worth the time and trouble’ 16. The attractions of the Brussels M.D. were clear, and it became a popular option. In 1914, the BMJ reported that there were 600 Brussels graduates known to be in practice in England and the colonies 17.

Correspondents to the Lancet in 1903 noted that the exam taken by British candidates was exactly the same as that sat by Belgium doctors who were awarded a legal M.D with licence to practice. The British candidates were awarded a scientific M.D., with no automatic right to practice in Belgium. However,  if the a successful candidate decided to live in Belgium, it was thought  that he would have no difficulty in obtaining a State permit to practice without the need for further examinations 18. This was almost certainly the route  Lomax took since he worked in Brussels between 1907 and 1914.

Looking through the medical press around the turn of the century, there was a good deal of publicity about the M.D. Brux from the British side of the channel. Letters appeared frequently in the British Medical Journal and the Lancet offering to clarify the terms and conditions of the examination 19 . A small pamphlet  published in 1903 by Dr Albert Henchley, provided  hints and tips on passing the examination and even recommended the best rail route and hotels in Brussels for aspiring candidates 15. There was an active association for the alumni of the Brussels M.D. in the UK – The Brussels Medical Graduates Association. The association provided a link between  existing and aspiring British graduates and the Free University of Brussels. It also lobbied hard for the claim of its members to register their degrees as an additional medical qualification in the UK.

The main drawback of the M.D. Brux. was that it was not ‘registrable’, namely it could not be inscribed as a qualification in the British Medical Register. There was much debate in the medical press as to whether practitioners were breaking the law by putting ‘M.D. Brux’ after their names. There had been a court case but no action was taken against the offending doctor 20. The general feeling seemed to be that if doctors wished to add their degree to their name plate, they should do so 21. Many were proud to place ‘M.D.Brux’ on their list of qualifications. Helen Boyle’s entry in the 1895 Medical Directory is a typical example where the degree of M.D.Brux takes precedence over her basic qualifications of licentiate in surgery and medicine: 

For obvious reasons, the granting of the Brussels  M.D. was suspended during WW1, and was formerly discontinued after the armistice. In 1921 the university announced that the examinations would no longer be open to British doctors and nor would the M.D.Brux be granted to foreign medical practitioners ad eundem 22.The Secretary of the Brussels Medical Graduates Association prepared a petition to the University of Brussels 23. The petition had little effect and letter to the BMJ from the Secretary of Brussels University explained that university regulations meant that it was no longer possible to grant an M.D. without at least one year’s attendance in Brussels on  relevant courses 22. Furthermore, the exams had to be taken in French with no interpreter available 24. It was claimed that the change in university regulations was brought about in order to standardise degrees with other foreign universities so that British medical graduates should no longer be granted special status. However, the Lancet noted that the special reciprocity between Belgium and British doctors set up after the armistice whereby there was a free movement of medics between the two countries, was formerly ended by the British government  in December 1920 25. Perhaps some tit-for-tat was at play, but whatever the reason,  the new regulations  effectively saw the end of the M.D. Brux for British graduates. However, the degree was already becoming an irrelevance as the drive for post graduate education grew stronger in  1920s  Britain. 

(References available on request)

Shell Shock And Lunacy Reform

Wilfred Owen (1883-1918), Treated for shell shock Craiglockhart hospital.

By the time Dr Montagu  Lomax wrote The Experiences of An Asylum Doctor (1) in 1921, the campaign for lunacy reform had been ongoing for over half a century. There had been some successes such as the 1890 Lunacy Act, designed to reduce the number of unregulated madhouses.  However, little had been achieved to improve living conditions for pauper lunatics in the asylums. This was partly because the campaigners were often ex-patients as in the Alleged Lunatics Friend Society, so had little status, and partly because  psychiatrists were resistant to change. Dr Lionel Weatherly published his ‘Plea for The Insane’ in 1918. This book was aimed at the medical profession and was largely ignored. Lomax’s book was written for the public. His writing style was clear, and direct, perhaps with an overtone of sensationalism. However, it could be understood by any lay person and more importantly, by members of the Press. The book set in motion a wave of public outrage. 

Cleverly, Lomax keyed into public concern over the treatment of shell shocked soldiers. He wrote about the plight of these young men who had been sent back from the trenches with shattered minds only to find themselves incarcerated within the lunatic asylums. Lomax allied himself with the Ex-Services Welfare Society (ESWS), and was a guest speaker at a number of the Society’s public meetings. The aim of the ESWS was to raise public awareness and funds to help these veterans, some 5000 of whom were still in the asylums five years after the end of the war. Lomax was a good public orator and the national press reported his speeches. The wave of public outrage became a tsunami.

It is worth considering what a diagnosis of ‘shell shock’ meant. On 12 December 1914, the British Medical Journal published an article on functional paralysis following shell explosions (2). The author noted that although there was no obvious physical injury, the proximity to explosions was seen as a causative factor and from the winter of 1914/15 ‘Shell Shock’ became a valid medical diagnosis (2). 

There was a running debate between the top psychiatrists of the day as to whether the diverse collection of signs and symptoms which contributed to the diagnosis of shell shock were functional (psychological) or had an organic (physical) origin. The psychiatrist, Dr Frederick Mott noted the presence of microscopic brain hemorrhages in post mortems of men with shell shock, and hypothesised that the condition was due to blast trauma. This lead him to believe that shell shock had an organic cause (3). The Maudsley psychiatrists believed that shell shock was due to a breakdown of psychological mechanisms. Doctors could find no identifiable organic pathology in 38% of admissions for shell shock (2). This dichotomy between psychodynamic and physiological explanations for shell shock was never resolved (3). There was however a military classification which attempted to distinguish between men who were physically damaged, categorised as ‘Shell Shock (Wounded)’ and a second category of ‘Shell Shock (Sick)’ (4). The Shell shock (W) cases were entitled to a wound stripe and a pension. If a soldier’s neurosis did not follow a shell explosion, he was to be labelled Shell shock (S) and was not entitled to a wound strip or pension. Many of the 306 British soldiers shot for cowardice would probably have fallen into this latter category, now recognised as Post Traumatic Stress Disorder (PTSD).

At the start of the Great War, the military hospitals absorbed psychologically damaged men, who could be treated by specialist doctors without the stigma of certification. As the war progressed, casualty number rose and young soldiers with shell shock were increasingly shunted into the County Asylums (4). Estimates vary, but one study found 63% of shell shock cases in 1916 were placed within the asylum system (3). These men were officially classified as private patients, so that their fees were paid by the government, but their private status was effectively meaningless in times of war and carried no special privileges  for the soldiers. The asylums were understaffed, and overcrowded with patient food reported as ‘starvation rations’ (5). The asylum medical staff were overworked, and had no facilities or specialist skills to treat broken soldiers. For those young men who weren’t insane, there was a significant risk that they would be made insane by their surroundings.

For relatives, there was a very real stigma to having a soldier son in a County Asylum. The asylums were viewed as the domain of the pauper lunatic. Admission was by ‘certification’ under the 1890 Lunacy Act, and a certified pauper lunatic in the family carried with it great shame. This was partly because poverty was a frightening spectre for the working class, but also because of the  strongly hereditarian discourse of mental health which dominated through the 1920s (4). 

Towards the end of the war, the British public were growing increasingly uneasy that ex-soldiers were being treated as ‘ordinary lunatics’ (4). The Ex-Services Welfare Society (ESWS) was founded in 1919 to support the ex-servicemen who were effectively trapped within the County Asylum system. The aim of the Society was to set up residential homes for traumatised veterans so that they could be released from the totally unsuitable environs of the lunatic asylums. It was an ambitious project which required enormous financial input. Fundraising and a prominent public profile was therefore crucial to the success of the ESWS. The Society appointed Captain Charles Loseby, to speak on its behalf. He was a lawyer by training and had a distinguished military service record. As an MP between 1918 to 1922, he concentrated on veteran welfare, eventually taking a keen interest in the plight of shell shocked veterans detained within the lunatic asylums. He took the ESWS under his wing, organising and speaking at a number of public meetings on their behalf. Dr Montagu Lomax used the ESWS public platforms as an opportunity to drive forward his case for lunacy reform. Unfortunately, the ESWS’s association with the  campaign for lunacy reform was subsequently viewed as controversial, and after a series of financial scandals, the Society’s supporters quietly distanced themselves. By the mid 1920s, the British Legion had assumed responsibility for much of the practical support required by veterans including liaison with the Ministry of Pensions, and the ESWS was sidelined. 

It is heartbreaking to read Lomax’s account of the shell shocked soldiers in his book The Experiences of An Asylum Doctor. Men such as these were usually ‘other ranks’, whilst the officer class with shell shock were sent to exclusive military hospitals such as Craiglockhart. For the interested reader, Pat Barker’s Regeneration trilogy portrays shell shock amongst the officer class at Craiglockhart.

Bibliography

1. Lomax M. The experiences of an asylum doctor : with suggestions for asylum and lunacy law reform. [S.l.]: Allen and Unwin; 1921.

2. Linden SC, Jones E. ‘Shell shock’ revisited: an examination of the case records of the National Hospital in London. Med Hist. 2014;58(4):519-45.

3. Jones E. Shell shock at Maghull and the Maudsley: models of psychological medicine in the UK. J Hist Med Allied Sci. 2010;65(3):368-95.

4. Reid F. Broken Men: Shell Shock, Treatment And Recovery In Britain 1914-30: Bloomsbury Publishing; 2011.

5. Crammer JL. Extraordinary deaths of asylum inpatients during the 1914-1918 war. Med Hist. 1992;36(4):430-41.

Hospital Scandal

JH Murray-Aynsley

In the spring of 1895 The Christchurch Hospital was in trouble. A series of complaints about the standards of care at the hospital had resulted in an inquiry which dragged on for several long months. It was covered in excruciating detail in the local press, and syndicated across New Zealand. Amongst the many complaints from the citizens of Christchurch was the callous attitude and rudeness of the house surgeon, a certain Dr J.H. Murray-Aynsley. It was alleged that he had often arrived on the wards drunk, sometimes in his slippers and dressing gown if he was called at night. He  smoked during his ward rounds. He was accused of insisting that  the prettiest probationer nurses assist him in theatre and was prone to peculiar behaviour such as placing patients on a bread and water diet, and squirting water in the face of an injured  child to stop it screaming. The inquiry drew to a close  in August 1895, and for lack of convincing evidence, Dr Murray-Aynsley was cleared of all charges.

However, that was not the end of the story.

John Henry Murray-Aynsley was born in Lyttleton, New Zealand but studied at Christ’s College Cambridge , and St Georges Hospital, London before returning to Christchurch, to work as the house surgeon at the hospital. His job was to look after patients who had been operated on by the honorary  surgeons including those of Dr Montagu Lomax-Smith (later Montagu Lomax).

The two doctors shared the same year of birth – 1860 – but they had little else in common. Lomax-Smith came from three generations of tanners, Murray-Aynsley  had an English aristocratic background, his great, great grandfather was the third duke of Athol. Lomax-Smith’s father was a Church of England Vicar. Murray-Aynsley’s father was a wealthy business man who kept a string of race horses and was a member of the New Zealand Parliament. Lomax-Smith was raised to service and duty, Murray-Aynsley had little sense of the professionalism that his role required. It is not difficult to imagine that Murray-Aynsley would have rubbed Lomax-Smith up the wrong way.

Lomax-Smith must have been appalled that Murray-Aynsley was vindicated by the hospital Inquiry in August 1895. Less than two months later, Lomax-Smith brought further charges against Murray-Aynsley, alleging that he was drunk on duty and neglected the care of his patients. The Hospital Board was reluctant to get involved in another inquiry. Lomax-Smith resigned as honorary surgeon, claiming that Murray-Aynsley had systematically neglected his surgical cases. A series of vicious letters were published in the local and national press with both sides making claims about the other which would be considered libellous today. Lomax-Smith was accused of unethical behaviour for complaining about a brother doctor. Two doctors resigned in support of Murray-Aynsley. Eventually, the Hospital Board agreed to another investigation.

In April 1896, The Hospital Board found Murray-Aynsley guilty as charged and asked for his resignation. Lomax-Smith subsequently withdrew his own resignation. 

The outcome of this poisonous dispute was poor for both men. Murray-Aynsley left Christchurch for a small bush town where he worked for a short time as a GP. He tried to work in the UK, but never really established himself and returned  to New Zealand where he died aged 57. Lomax-Smith left New Zealand in the summer of 1896 to return to the UK. He left behind a prosperous, comfortable existence, and never really recovered the standard of life he had had in New Zealand. However, Lomax-Smith did learn about the personal difficulties faced by whistle-blowers.  He learned that attacking a person rather than ‘the system’ which allowed an incompetent to work within it, was  was personally devastating. Finally, he learned how to harness the power of the Press. These tribulations were  to stand him in good stead some thirty years later when he wrote his book: The Experiences of an Asylum Doctor, with suggestions for asylum and lunacy law reform in 1921.

More at: 

  1. https://en.wikipedia.org/wiki/The_Experiences_of_an_Asylum_Doctor
  2. The New Zealand years.
  3. Montagu Lomax – montagulomax.org 

Why Montagu Lomax matters.

Montagu Lomax (1860-1833) was a British general practitioner  who wrote The Experiences of an Asylum Doctor, with suggestions for asylum and lunacy law reform in 1921[1]. The book was an exposé of conditions within two English lunatic asylums based on Lomax’s experiences as an asylum medical officer between 1917 and 1919. 

The book became a cause célèbre [2]. The national press was outraged by Lomax’s revelations, with The Times publishing an article entitled “Asylum Horrors – A Doctors Indictment’ [3]. Within ten days of the book’s publication, questions were being asked in Parliament [4]. Whilst many attempts at asylum reform had been made previously, it was Lomax’s book and the associated newspaper articles that alerted public opinion on a wide scale [2]. The Ministry of Health decided to use Lomax’s book to start the process of lunacy reform, and to subsume the mental health services, previously managed by the Board of Control [2]. The Lomax affair was a significant prelude to the 1926 Royal Commission on Lunacy and Mental Disorder [5]. The recommendations of the Royal Commission were incorporated into the Mental Treatment Act of 1930 which opened the way to many developments in mental health services over the next thirty years [2].

Lomax had a successful publication which ensured him a place in the tradition of British social reportage [5]. It was an important book because it directed public attention to the defects of the asylum system which had hitherto been taken on trust [2]. Lomax’s vivid descriptions of patients’ behaviour and mental state in asylums and of the institutional process produced insights which were to be rediscovered 30 years later by researchers who themselves went on to influence mental health care from 1959 onwards [2]. However, Lomax did more than contribute to a process of mental health reform. His willingness to write frankly and to criticise provide an example to all mental health professionals who find themselves in settings where abuses occur [2].

More information at montagulomax.org

Bibliography

1. Lomax, M., The experiences of an asylum doctor : with suggestions for asylum and lunacy law reform. 1921, [S.l.]: Allen and Unwin.

2. Harding, T.W., “Not worth powder and shot”. A reappraisal of Montagu Lomax’s contribution to mental health reform. The British Journal of Psychiatry, 1990. 156(2): p. 180-187.

3. Asylum Horrors, in The Times. July 23rd, 1921.

4. Soanes, S., REFORMING ASYLUMS, REFORMING PUBLIC ATTITUDES: J. R. LORD AND MONTAGU LOMAX’S REPRESENTATIONS OF MENTAL HOSPITALS AND THE COMMUNITY, 1921-1931. Family & Community History, 2009. 12(2): p. 117-129.

5. Towers, B.A., The management and politics of a public expose: the Prestwich Inquiry 1922. J Soc Policy, 1984. 13(1): p. 41-61.

The Tyranny of Corsets

In 1894, Montagu Lomax spoke to four hundred women of Christchurch, NZ about their corsets. It was a brave thing to do, and it resulted in a furore.

The lecture was part of a series of twelve given at the Christchurch Art Gallery with the aim of ‘helping women to put to the best use their newly acquired political rights’ [1]. They covered ‘Woman in all her chief relations of life: physiological, educational, domestic, social, economic, sexual, emotional, moral, political, intellectual, national and religious’.  Lomax published his contribution to the lecture series in a short book the following year because he had been told that his talks deserved to reach a wider audience and their content was ‘more or less inaccessible to the ordinary public’ [1].

As a doctor and a married man, Lomax considered that he was expert enough to explain the evils of corsetry and tight lacing. Lomax commented that the ideal corset should push the bust up without constricting the waist and that, like a man’s vest, it should cover the whole chest. He thought that the fashion for constricting the lower ribs to reduce the waist circumference was injurious to a woman’s ability to breath, and certainly ‘tight stays’ made athletic activity next to impossible. Lomax said that the average, uncorsetted waist of a woman under 25 years was 20-25 inches*. He believed that the hour-glass waists which were then in fashion were the ‘quintessence of deformity and ugliness’.

Lomax went on to rail against the use of feathers and fur in women’s fashion, and reminded women that they were made for a different purpose than men. He suggested that whilst some exercise was good, the sight of a woman with a gun or a fishing rod  was abhorrent to men, and women who played football have ‘lost all sense of decency and decorum’ [1].

The excellent ladies of Christchurch were outraged. There was mayhem in the Art Gallery. The correspondence columns of the Christchurch newspapers were filled with suggestions that the good doctor should keep his nose out of women’s business, especially their undergarments. Indeed, when the audience was asked at the subsequent lecture whether they were in favour of corsets, almost all of the four hundred women present held up their hands [2].

To be fair, Lomax had a point. The practice of lacing corsets tightly to produce the famous hour-glass waist of around 18-20 inches did seriously restrict a woman’s ability to move freely and to breath. Fainting was common amongst Victorian women, and such swooning was not because they were the weaker sex. Even before his ill-fated lecture, women themselves had started to explore the possibility of comfortable clothing. Dress reformers had been campaigning since the mid 19th century for less restrictive clothing, particularly foundation garments which would allow women to take part in sport. Wikipedia has a couple of fascinating articles on Victorian dress reform and Corset controversy which are  well worth reading. However, the trussing of women into whalebone corsets continued into the early 1900s until the corset firm of Symingtons released the ‘liberty bodice’ in 1908. This was  designed to flatten the bust and release the waist, and was considerably more comfortable than corsets. The liberty bodice soon became near universal wear amongst the women of Europe, and America where it was known as an emancipation waist.

Bibliography

1. Lomax-Smith, M., WOMAN in relation to physiology, sex ,emotion and intellect. 1895, Christchurch, New Zealand: Russell and Willis. 91.

2. Lectures to Women, in Lyttelton Times. 1895.

*   In 2019, young American women had an average waist size of 37 inches.

Ouida 1839-1908

Ouida – Marie Louise Rame

Ouida was the pen name of Maria Louise Rame, a Victorian writer who published more than forty novels and many short stories. She was enormously popular, outspoken, opinionated and considered rather racy in her day. Writing for a wide audience, her topics included observations of contemporary society and contemporary romance. Many of her novels were thinly veiled protests against social evils and a rebellion against moral ideals displayed in contemporary fiction [1]. She was an anti-vivisectionist, standing up for animal rights in a time when vivisection was considered perfectly acceptable to push the boundaries of medical knowledge. Ouida believed, that the line between experimentation on animals and experimenting on humans was easily crossed. She wrote a journal article entitled ‘The Scientific Torture of Lunatics. A Protest’ in 1897, expressing concerns that pauper lunatics were used as subjects for medical experimentation [2]. 

Ouida held a low opinion of the medical profession, perhaps because of their role in vivisection. Her 1892 essay proclaimed that doctors were only ‘intelligent artisans’, a parvenu profession, on a rank with ‘the merchant , the shipowner, the engineer and the banker all distinguished by their grasping dishonestly and insincerity’ [3]. She noted that physicians were not ‘gentlemen’. She claimed that doctors came from socially rising families who hid their modest origins behind the veneer of public school and university education purchased by their father’s success. Although this last comment was intended as an insult, it was certainly true for Dr Montagu Lomax.

Lomax was a great admirer of Ouida’s writings on female modesty, and referenced her several times in his lectures “Woman in relation to physiology, sex, emotions and intellect’[4]. 

Ouida may have written to shock, or perhaps to promote discussion. Her novels sold well making her a fortune which she squandered on a lavish life style and entertaining. She attracted some of the greatest literary minds to her soirees, including Oscar Wilde, Wilkie Collins and Robert Browning. She never married. The latter part of her life was spent in Florence, Italy where she died in penury in 1908

Bibliography

1. Shaw, B., Bernard Shaw’s Book Reviews: 1884-1950, ed. B. Tyson. 1991: Penn State Press.

2. Ouida, The Scientific Torture of Lunatics. A Protest. Humanity, 1897. 2: p. 82-4.

3. Ouida, The Medical Profession and its Morality, in The Modern Review. 1892, Snow & Farnham.

4. Lomax-Smith, M., WOMAN in relation to physiology, sex ,emotion and intellect. 1895, Christchurch, New Zealand: Russell and Willis. 91.