1 - Mediating Nation and Empire in the Political Landscape of British Medicine in the World, 1858–86

Summary

Introduction

Nation and empire defined the boundaries of medicine in the United Kingdom. But these boundaries did not encompass a unified or British jurisdiction until 1858. Instead, there were informal and formal jurisdictions. University medical degrees as well as diplomas and certificates awarded by professional colleges in England, Scotland, and Ireland controlled access to medical markets in the archipelago and state-mandated medical services in the empire. The Medical Act of 1858 altered this landscape. It provided for a unified jurisdiction and a single market through the establishment of a medical register. The register, which comprised a list of practitioners who were deemed “legally qualified,” operated as a common portal of entry into the medical profession for English, Irish, and Scottish medical graduates. This was only possible because university and nonuniversity licensing bodies modified their relationship with each other and the British imperial nationstate. Instead of serving their own narrow interests, they now functioned as equivalent routes to a national register. The rights enjoyed by graduates were one and the same. Their qualifications guaranteed admission to the register and, most importantly, the unrestricted right to practice medicine in the United Kingdom and the territorial empire. Of course, integration did not happen overnight. But the act created a framework for it to develop. Doctors retained their national affiliation with England, Wales, Scotland, or Ireland while adding an imperial or British identity. The combination of a common portal and a demarcated jurisdiction for the practice of medicine created the basis for a liberal imperial profession at midcentury. The scope of the authority of the British medical qualification in the world was based not necessarily on the superiority of domestic medical education per se, but rather on Britain's position as an imperial power. Any registered doctor could practice medicine wherever the Union Jack flew. The national and imperial reach of the newly formed field of British medicine therefore implicated all medical graduates and bodies in the defense and expansion of this jurisdiction.

As I will discuss in this chapter, admission to the register reinforced the social character of the profession as a space for white men.