Unsuitable cases: the debate over outpatient admissions, the medical profession and late-Victorian London Hospitals

Surviving the Lunacy Act of 1890: English Psychiatrists and Professional Development during the Early Twentieth Century

In recent decades, historians of English psychiatry have shifted their major concerns away from asylums and psychiatrists in the nineteenth century. This is also seen in the studies of twentieth-century psychiatry where historians have debated the rise of psychology, eugenics and community care. This shift in interest, however, does not indicate that English psychiatrists became passive and unimportant actors in the last century. In fact, they promoted Lunacy Law reform for a less asylum-dependent mode of psychiatry, with a strong emphasis on professional development. This paper illustrates the historical dynamics around the professional development of English psychiatry by employing Andrew Abbott's concept of professional development. Abbott redefines professional development as arising from both abstraction of professional knowledge and competition regarding professional jurisdiction. A profession, he suggests, develops through continuous re-formation of its occupational structure, mode of practice and political language in competing with other professional and non-professional forces. In early twentieth-century England, psychiatrists promoted professional development by framing political discourse, conducting a daily trade and promoting new legislation to defend their professional jurisdiction. This professional development story began with the Lunacy Act of 1890, which caused a professional crisis in psychiatry and led to inter-professional competition with non-psychiatric medical service providers. To this end, psychiatrists devised a new political rhetoric, 'early treatment of mental disorder', in their professional interests and succeeded in enacting the Mental Treatment Act of 1930, which re-instated psychiatrists as masters of English psychiatry.

Risk, responsibility and surgery in the 1890s and early 1900s

This article explores the ways in which risk and responsibility were conceptualised in the late nineteenth and early twentieth centuries by surgeons, their patients and the lay public. By this point surgery could be seen, simultaneously, as safe (due to developments in surgical science) and increasingly risky (because such progress allowed for greater experimentation). With the glorification of the heroic surgeon in the late Victorian and early Edwardian period came a corresponding, if grudging, recognition that successful surgery was supported by a team of ancillary professionals. In theory, therefore, blame for mistakes could be shared amongst the team; in practice, this was not always the case. Opening with an examination of the May Thorne negligence case of 1904, I will also, in the latter third of this piece, focus on surgical risks encountered by women surgeons, themselves still relatively new and, therefore, potentially risky individuals. A brief case study of the ways in which one female-run institution, the New Hospital for Women, dealt with debates surrounding risk and responsibility concludes this article. The origin of the risks perceived and the ways in which responsibility was taken (or not) for risky procedures will provide ways of conceptualising what ‘surgical anxiety’ meant in the 1890s and 1900s.