Lane and the Medical Missionary

Analysis of E. W. Lane’s article ‘Home-work for the Medical Missionary’ (1875)

 

Min Bae

 

 

E. W. Lane (1823 - 1889)’s two-part article entitled 'Home-work for the medical missionary' was published in the Medical Press and Circular; its first part appeared on 27 January 1875, and the second part followed on 3 February the same year. The article’s total length in the journal is about six pages, and it contains no images. The article appeared in the ‘Original Communications’ section, along with two or three other articles about medical knowledge and practice contributed by doctors.

Lane’s attitude, as a doctor, towards social problems and social beliefs were well articulated in the article. He was chiefly concerned with the urgent necessity of alleviating the contemporary social problems associated with the urban poor, and he argued that the ignorance of the natural laws of health among the poor was the main target to be tackled. To effectively fight this ignorance, he suggested two things: First, physiology education should be more systematically incorporated into general education so that everyone in society, whom he regarded as generally lacking in the knowledge about the laws of health and hygienic principles, should be better educated in heatlh. Second, medical missionaries might be a way to dispense such knowledge to the poor, who are more vulnerable to the degenerative results from the ignorance. In order to put the suggestions into practice, he held that, in addressing poverty, the doctor—rather than the clergyman, as was commonly thought at the time—should take initiative, as the most urgent task was a ‘material’ work for the rescue of the poor ‘from the extreme of physical degradation’[1] In a sense, he devoted the article almost entirely to urging the medical profession to turn its attention from the mere provision of medications to preventative medicine, with a particular focus on the poor.

 

Medical Press and Circular, in which this article appeared, was a weekly medical journal that, in the 1870s, was published simultaneously in London, Dublin and Edinburgh every Wednesday at a price of five pence. The journal was a result of the merger of two medical journals, the Dublin Medical Press and the Medical Circular, after the former purchased the latter in 1866. The Dublin Medical Press had been founded in Dublin in 1839 by two faculty members of the Irish College of Surgeons, Arthur Jacob and Henry Maunsell. It was a well-known journal that had played a prominent role in the Irish history of medicine. It was deeply and actively involved in Irish medical politics, and enjoyed close ties to the Irish Medical Association. It from the extreme of physical degradation’ was a leader in the campaign on behalf of the Poor Law in the 1850s.^[2]

The Medical Circular was founded by Dr James Yearsley, in 1852, and its editor was Dr George Ross[3]. Unlike the Medical Press, it took the position that it ‘would abstain from those topics the discussion of which tended to incite discord in the profession’, but the journal showed a deep interest in Irish affairs and took such a liberal stance as to include homeopaths in its bibliography.[4]

After the merger, although the control of the journal largely remained Irish, with Arthur Jacob’s son, Archibald, serving as the main editor (throughout the rest of the century), the journal became gradually less concerned with Irish issues, particularly after 1868 when a London publisher, Albert Alfred Tindall, took on its general management. However, the journal tried to maintain the balance between English and Irish contents, carrying on the editorial work simultaneously in London and Dublin for more than fifty years after the merger, which was very unique in journalism of the time.[5] The journal held a relatively tolerant and liberal stance in certain issues about medical practitioners, compared to other contemporary medical journals, such as BMJ and The Lancet, as evidenced regarding the issue of female doctors in the years prior to 1870.[6]

General practitioners comprised the main readership of the journal. R. J. Rowlette, who wrote its centennial history, noted that the journal’s constant aim had been ‘to produce a Journal of interest particularly to the general practitioner, to keep him informed on the progress of medical knowledge and to protect his interests, and to maintain the honour of the profession’.[7] The journal also, in its own reflection on 50 years of publication in 1916, proudly noted the recognition from its readers for its determination in the ‘opposition to shams and abuses within the profession, and in its assertion of the rights and privileges of its members when assailed by interested parties outside its portals’.^[8] Although the journal never neglected to fight quackery and unprofessional practices, its editors were willing to print articles by some contributors with heterodox medical views, such as Lane, so long as their interests and the goals they pursued were shared with the journal’s editorship.

Lane had already contributed to the journal before ‘Home-work for the Medical Missionary’ appeared, but only sporadically. The journal ran a lengthy and favourable review of his Old Medicine and New (1873), which may have encouraged him the next year to submit an article titled, ‘What is Disease?’[9] And in 1875, just a few weeks before the ‘Medical Missionary’ article appeared, he published another, ‘What is Medicine?’[10] All of these articles appeared in the ‘Original Communications’ section. The two earlier articles largely repeated the main themes which Lane had elaborated and argued in his previous books, such as Hydropathy; Or, Hygienic Medicine, whereas the ‘Medical Missionary’ article engaged with broader social issues. Compared to Lane’s concept of “hygienic medicine”, public hygiene might seem a less controversial subject that might win more sympathy from his readers. For instance, one of the leading articles that appeared several months before Lane’s article was taken from a lecture by an American doctor, Nathan Allen, who emphasised the importance of public hygiene.[11] Allen was, like Lane, deeply interested in Andrew Combe’s medical philosophies, particularly his laws of health and hygienic concepts. Lane’s voice in the article is evangelical and persuasive in tone, but at the same time, it mirrored the formal style of the other articles in the same section of the journal. His suggestions targeted the overall medical profession, and he mentioned a wide range of groups within it, from young doctors to medical authorities.

 

At the time when he wrote this article, Lane was practising at his hydropathic establishment in Sudbrook Park, Richmond. Although we know that he had been installed there since 1860, and had published his third book, Old Medicine and New in 1873, few details about his activities from the mid-1860s until the early 1870s have survived. He was no longer actively advertising his practice or book in 1870s as he had done in the early part of his career, possibly as he established in his career, with less need for self-promotion. This article was published only a few years after his long, apparently dormant, period.

Lane’s main goal in this article was promotion of more effective ways to improve social conditions for a healthier life, ‘having regard more particularly to the condition of its majority, the working classes’.^[12] His concerns for the poor appear to be affected by deep concerns about social instability; he explicitly referred to ‘the moral nightmare’ of the Paris Commune (1871).^[13] In this article, Lane reserves his thoughts about medical philosophies and instead chooses to concentrate on the possible social roles of the medical profession in improving the lives of the poor. He briefly considered certain preventive measures for social problems, including birth control, and enhancing the material and physical conditions of the working classes, but he ultimately argued that hygienic medicine was the most cost-effective set of principles for the prevention of disease.

The Public Health Acts of 1872 and 1875 might have motivated Lane to write his article, and it would be reasonable to think that he might have expected the discourses about legislation on public health to influence the mind of the medical profession. Compared to the works he published in the 1850s, his tone in the 1870s had become more openly critical and sceptical of conventional medicine and its practitioners. In his 1873 work, his criticism of the medical profession was direct. He noted that ‘the profession of medicine has been a sort of close borough, and its practitioners, unfortunately for themselves, irresponsible, their practice, ... carried on in the dark among an unreasoning community, without challenge or inquiry from any one’.^[14] This attitude may have stemmed from his frustration with the situation of medicine, compared to science, which, he felt, had moved towards higher public recognition in the late 1860s. In his eyes, except for ‘a few valuable accidental discoveries, like that of chloroform’, the majority of medical practitioners still adhered to the ‘prescriptive tradition and antiquated routine’, and ‘the medical art had become crystallised in its original form, while surrounded by progress on every side’.^[15] Although expressing such a critical attitude possibly might reflect his own greater confidence from experience or reputation, his opinion was not groundless. Compared with France, where the chairs of hygiene had been established in the major faculties of medical schools by the early nineteenth century, it was not until 1864 that hygiene became a specialist field in any medical curriculum in the United Kingdom.^[16]  

In this respect, Lane regarded public health legislation as the chance to reform not only public hygiene, but medicine itself. He had already shown his interest in legislative reform in Old Medicine and New, in which he noted, ‘In the last session of Parliament, it will be remembered, one of the foremost measures of the Government was its Sanitary Code’.^[17] He anticipated that social issues regarding people’s health would draw increasing attention from the public and Parliament alike, thus he argued that ‘It is abundantly manifest, indeed, that in the future legislation of this country social questions, and not politics as ordinarily understood, must necessarily occupy the chief attention of statesmen’.^[18]

Rather than focusing on legislation of the new Public Health Act, he tried to persuade rank-and-file practitioners to change their perceptions of doctors’ roles. He stated, ‘I repeat, then, that the cure of diseases ought not, properly considered, to be the sole function of the doctor, but equally with this, and really much rather, their “prevention”’.^[19] The preventive and social aspects of medicine were the main focus of the article, rather than ideas ancillary to his concepts of the natural laws of health or hygienic principles, as they had been in his previous writings.

This more active engagement with social problems and public health in the 1875 article had been foreshadowed, to a certain extent, in Lane’s 1873 work, although it did not specifically focus on education or the dispensing of knowledge of physiology and hygienic principles. He had called for ‘a moment's reflection on the position which the Profession of Medicine bears, not merely towards sanitary legislation, but towards social economy generally, [as it] will suffice to show, that ...  medicine must needs challenge more and more of public attention, [and] be better understood in its essence by the laity’.^[20] In a sense, this article continued the concerns for reform that he had been expressing since 1850s. In his doctoral Thesis (1853), he had remarked upon the necessity of drawing public attention to acquire governmental support for hospitals.^[21]

However, in comparison with his works of the 1850s, which, regarding doctors’ roles, had focused more on hospital reform and medical reform based on the principles of his hygienic medicine, Lane’s view of the role of the medical profession in this 1875 article extended beyond the walls of the infirmary and his own establishment, as with his proposal of providing hygienic education in public schools and to the poor. His focus was not just on the prevention of disease, but on taking leadership in health reform, ultimately aiming to preserve social integrity against destructive political upheavals.

One of Lane’s suggestions to addressing poverty was the dispensation of hygienic knowledge: the ‘medical missionary’, his article’s title. Two years previously, in Old Medicine and New, he had complained that ‘On no one subject whatever have such gross ignorance and utter general neglect hitherto prevailed among the laity, as on physiology and medicine, or anything, in short, connected with the functions of their bodies in health or disease’.^[22] Medicine was, by contrast, ‘considered a kind of forbidden study, to be dealt with exclusively by the ministers of a dark mysterious calling’. This criticism of the gap between doctors and the lay public might have driven him to suggest the necessity of dispensing hygienic principles to the poor. He believed that knowledge of hygienic medicine could be the medium through which the medical profession could come out of its castle and move towards the lay public. He noted that such missionary projects could bring irreplaceable benefits, especially for the poor. He stated, ‘For mankind, be it observed, even in the most adverse of physical circumstances, are not always ailing, and, therefore, do not need the help of a physician as such; but the homes of the lowly are few where his daily presence in another and extended character – that of a “medical missionary” (so to speak) – would not be a boon of the highest value’. [23]

Lane’s idea of the medical missionary, in a sense, was an expanded version of his consistent ideas about the relationship between physical health and morality. In Hydropathy; Or Hygienic Medicine, he had stated that his concerns included not only ‘how to live consistently, with the now well-established laws of health’, in such a way that bodily health could be secured, but ‘along with it, the cleanliness, decency, and self-respect, the comparative morality, the absolute increase in humanity’.^[24] In Lane, this proportional relationship between physical health and morality was an important ground for social reform. one of the most influential explanatory hypotheses of the time—related to both personal and social aspects of life—was the idea of each individual having only a limited sum of energy or vital force for their mental, physical and reproductive functions. As Herbert Spencer put it, nature was ‘a strict accountant’.^[25] The moral reform movement of the late nineteenth century was closely related to training or maintaining such a self-responsible way of life. Lane most likely had similar ideas, considering that he importantly used the concept of vitality in his medical theories and held mental rest in high regard in his hygienic remedies. Lane employed his medical belief in physiology and hygiene as not a mere measure for preventative medicine, but also as a set of principles about a way of life obeying the natural laws of health. In his article, he emphasised, ‘In attempting to work in their behalf, it is necessary to begin at the very beginning, and the first great lesson to be inculcated - however laborious it may be - is how to live, “physically”’.^[26] Furthermore, unlike the continental hygienic reformers, Lane’s methodology was in line with the liberal English intellectual atmosphere and the evangelical way of reform, which preferred ‘acting through education and persuasion’.[27] For the material to distribute in the missionary framework, Lane replaced bibles and religious tracts by knowledge of hygienic principles.

Lane urged the participation of young doctors in these hygienic education efforts. He regarded labouring ‘in the missionary spirit among the poor’ as ‘one of the prime functions and most solemn duties of the young practitioner’.[28] More practically, he argued, such preventive medicine would be a promising field, ‘of which it is impossible to overrate either the extent or the moral glory to be achieved’.[29] He also argued that these ideas should be ‘taken up by the leaders of the profession’.[30]

 

However, Lane’s position in the medical profession was not one that would enable him to influence medical opinions. Although he continued to run advertisements for his books and hydropathic establishments in general newspapers, and in his earlier monographs he referred to the medical profession as his works’ main readership, few among the well-known general medical journals apart from the Medical Press and Circular took notice on his thoughts.

Although this and a few of Lane’s other articles managed to appear in the Medical Press and Circular, it is ambiguous how much support or attention the article attracted. For, his suggestions were based on his heterodox medical views, which were characterised by his objection to drug-based medications and the promotion of the concept of the natural laws of health. It was also Lane himself who, in Old Medicine and New, expressed frustration with British medicine which ‘have failed so notoriously to advance’, even though he had continuously tried to make his thoughts known and understood among his medical brethren.[31]

Lane’s arguments also presented more or less contradictory points, compared with other arguments in his own books. In Old Medicine and New, he noted that the medical profession itself was divided into, and competing among, different factions, and he did not negatively view the situation, indicating that ‘it is not made up at present of precisely a happy family, … but like the Church, has long had its dissenting bodies’.[32] Such a hopeful ‘transitional phase’, however, might have contradicted his argument in this article that the medical profession was the most qualified group to lead the plans that he suggested. Or, he might be seen to imply that he saw as his real target audience the limited number of doctors who, like Nathan Allen, agreed with and supported the notions of nature cures, or the hygienic approach, to disease. 

Lane did not develop the specific ideas that he suggested any further. The ideas in the article are, more or less, abstract and lacking in specificity. For instance, he did not give any concrete notion about the plans of physiology education and medical missionary, such as of types of contents to be taught or distributed, or levels of the students or boundaries of the groups to be targeted. Thus, it is not easy to estimate historically and to reconstruct the picture that he might have in mind about public education in hygiene.

 

 

 

 

 

Reference)

 

Allen, Nathan. "Medical Problems of the Day." The Medical Press and Circular 68 (1 July 1874): 1-3.

Berge, A.E.F.L. Mission and Method: The Early Nineteenth-Century French Public Health Movement. Cambridge University Press, 1992.

Cassell, R.D., and Royal Historical Society. Medical Charities, Medical Politics: The Irish Dispensary System and the Poor Law, 1836-1872. Royal Historical Society, 1997.

"The Jubilee of Amalgamation." The medical press and circular 152, no. 1 (1916): 4.

Lane, E. W. "Home-Work for the Medical Missionary." the Medical Press and Circular 70 (1875): 71-73, 92-94.

———. Hydropathy: Or, Hygienic Medicine. Churchill, 1859.

———. Thesis: Notes on Medical Subjects, Comprising Remarks on the Constitutions and Management of British Hospitals.  Edinburgh: James Hogg, 1853.

———. "What Is Disease?". the Medical Press and Circular 68 (23 December 1874): 543 - 44.

———. "What Is Medicine?". the Medical Press and Circular 70 (6 January 1875): 6 - 7.

Lane, E.W. Old Medicine and New. J. & A. Churchill, 1873.

"Old Medicine and New (a)." the Medical Press and Circular 67 (30 July 1873): 103 -04.

Rowlette, Robert James. The Medical Press and Circular, 1839-1939: A Hundred Years in the Life of a Medical Journal. Medical Press and circular, 1939.

Sigerist, H.E. Civilization and Disease. Cornell university press, 1943.

Smith, Virginia. "Physical Puritanism and Sanitary Science: Material and Immaterial Beliefs in Popular Physiology, 1650-1840." In Medical Fringe & Medical Orthodoxy, edited by Roy Porter William F. Bynum, 174-97: Croom Helm, 1987.

Spencer, H. Education: Intellectual, Moral, and Physical. Williams and Norgate, 1861.

 

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[1] E. W. Lane, "Home-Work for the Medical Missionary," the Medical Press and Circular 70 (1875): 72.

[2] R.D. Cassell and Royal Historical Society, Medical Charities, Medical Politics: The Irish Dispensary System and the Poor Law, 1836-1872 (Royal Historical Society, 1997), 52, 53, 98.

[3] Yearsley was born in Cheltenham, Gloucestershire, in 1805, and earned MD at St Andrews University in 1862. He practised as an aural surgeon in London, and participated in the making the first Medical Directory in 1845. Ross was born at Stonehouse, Devon, in 1815, and began his medical apprenticeship in 1832. He was active in medical politics in London before he took the editorship of the Medical Circular.

From Robert James Rowlette, The Medical Press and Circular, 1839-1939: A Hundred Years in the Life of a Medical Journal (Medical Press and circular, 1939), 66, 67.

[4] Ibid., 71, 72.

[5] "The Jubilee of Amalgamation," The medical press and circular 152, no. 1 (1916).

[6] The Medical Press and Circular, 1839-1939: A Hundred Years in the Life of a Medical Journal, 89.

[7] Ibid., 126.

[8] "The Jubilee of Amalgamation."

[9] "Old Medicine and New (a)," the Medical Press and Circular 67 (1873).

E. W. Lane, "What Is Disease?," ibid.68 (1874).

[10] "What Is Medicine?," the Medical Press and Circular 70 (1875).

[11] Nathan Allen, "Medical Problems of the Day," The Medical Press and Circular 68 (1874).

[12] Lane, "Home-Work for the Medical Missionary," 71.

[13] Ibid., 72.

[14] E.W. Lane, Old Medicine and New (J. & A. Churchill, 1873), 36.

[15] Ibid., 36-38.

[16] A.E.F.L. Berge, Mission and Method: The Early Nineteenth-Century French Public Health Movement (Cambridge University Press, 1992), 46.

Virginia Smith, "Physical Puritanism and Sanitary Science: Material and Immaterial Beliefs in Popular Physiology, 1650-1840," in Medical Fringe & Medical Orthodoxy, ed. Roy Porter William F. Bynum (Croom Helm, 1987), 191.

[17] Lane, Old Medicine and New, 2.

[18] Ibid.

[19] Lane, "Home-Work for the Medical Missionary," 93.

[20] Lane, Old Medicine and New, 3.

[21] E. W. Lane, Thesis: Notes on Medical Subjects, Comprising Remarks on the Constitutions and Management of British Hospitals (Edinburgh: James Hogg, 1853), 15-17.

[22] Lane, Old Medicine and New, 35, 36.

[23] Lane, "Home-Work for the Medical Missionary," 93.

[24] Hydropathy: Or, Hygienic Medicine (Churchill, 1859), 28.

[25] H. Spencer, Education: Intellectual, Moral, and Physical (Williams and Norgate, 1861), 179.

[26] Lane, "Home-Work for the Medical Missionary," 72.

[27] H.E. Sigerist, Civilization and Disease (Cornell university press, 1943), 92.

[28] Lane, "Home-Work for the Medical Missionary," 93.

[29] Ibid.

[30] Ibid.

[31] Lane, Old Medicine and New, 37, 38.

[32] Ibid., 4.