Despairing doctors: professional stress and suicide

Newspaper reporting of inquests reveals 285 instances of medical men who killed themselves in the period 1800-1890. This chapter considers the motives and methods of medical suicides, and uses the circumstances surrounding a minority of deaths to explore the aspects of professional pressure that proved most challenging. Once again, covert medical competition was a prominent source of anxiety.

Crimes against the body: causing harm

Medical practitioners who were accused of committing violent crime against the bodies of people other than patients presented both the profession and the public with a problem. Both professional bodies and the lay public desired doctors to be social heroes, inhabiting the role of expert witness and protecting the body rather than appearing as a defendant. This study of practitioners accused of either rape or murder finds the limits of medical competition, as men accused of rape were likely to be acquitted to courtroom applause. Medical murderers, on the other hand, offered the profession viable scapegoats to reinforce the impression that the medical fraternity was willing to admit to limited instances of wrong-doing.

Thwarted ambition and disappointing careers? Narratives of the Indian Medical Service

Men recruited to the Indian Medical Service would have been justified in regarding their careers with apprehension, given the high mortality among medical men in India and the slim chances of either swift promotion or rich rewards. This chapter uses both quantitative and qualitative means to consider the dissatisfactions of Indian service including challenges to medical masculinity. It identifies the need for patronage, and the drive towards competition, as ongoing features of professional life, particularly from the diaries and letters of men serving 1810-1850.

Mad doctors: lunacy and the asylum

The stresses of professional life could become so severe as to prompt an admission to an asylum. This chapter considers the propensity of practitioners to undergo admission to either a pauper lunatic asylum or a private, licensed house, and unpacks the experiences of those men whose suffering was acute, or which exemplified the issues which arose when men were treated by their former and (for some) future colleagues. It locates causes of professional stress and fears of competitive practice.

Introduction

Medical professionalisation is well represented in the existing literature, but the impact of the process on medical masculinity is not. Similarly there has been an assumption that professionalisation rapidly overwrote the drivers of the medical marketplace when this work suggests this is anachronistic. The introduction to this work sets the standard account of medical professionalisation in a new frame, by revealing the ongoing role of market concerns, and intra-professional rivalry as giving rise to covert competition. It also outlines the impact of increasingly stringent professional criteria on medical masculinity. Finally it unfolds the value of digitised newspapers for providing new avenues to evidence for halting or truncated professional careers.

Conclusion

The conclusion surveys the extent of empirical data used in this research and summarises key findings about the persistence of the medical marketplace and the challenges to medical masculinity. It highlights the 1860s as a period of transition, and reflects on the value of studying failure as a component of medical professionalisation.

Accident or on purpose? Neglect, incompetence, and unintentional killing

Practitioners have always been liable to accusations of incompetence or neglect, but the New Poor Law exacerbated the pressures on medical men at the same time that expectations for their performance of salaried service were being heightened. Therefore this chapter examines instances of neglect which resulted in patient deaths, and accusations of manslaughter leveled by coroners’ inquests. It also evaluates practitioners’ involvement in abortion, a procedure which inherently requires a death.

Financial hardship: bankruptcy, insolvency, and medical charity

Bankruptcy and insolvency were the types of career turbulence that were most likely to interrupt medical careers. Insolvency might entail a stay in debtor’s prison. This chapter examines the experiences of men who suffered financial setback and explores their access to support systems. The Royal Medical Benevolent Fund was established in 1836 and might have offered a prop, but analysis of their records suggests that medical bankrupts and insolvents were rarely among their beneficiaries. Therefore other sources of informal support must be inferred, beyond formal medical charity.