One of the pleasures of working with a physical collection of journals is serendipity. Scholars of periodical literature frequently cite chance encounters with interesting material as the chief advantage of engaging with original, hard-copy sources. My PhD research drew extensively on a collection of journals in the Royal College of Surgeons of England’s library. It was while I was wandering around their underground stacks that I came across the Midland Medical Miscellany. I was initially attracted by its playfully alliterative title and its beautiful frontispiece. However, I soon became absorbed by its insight into provincial medical identities and its in-depth discussions of ‘problem’ patients. This was not an irreverent ‘light entertainment’ magazine but a serious periodical catering for beleaguered practitioners outside the metropolis.
A periodical for the provinces
The Miscellany was a general medical monthly which launched in 1881 as a Leicester-based publication. It was originally edited by Kenneth W. Millican, a general practitioner in the village of Kineton (Warwickshire) and later a specialist in throat diseases in London. In a future blog post I’ll be profiling Millican, showing how he presented himself as a spokesperson for provincial practitioners but ended up leading a relatively cosmopolitan career. In 1885, editorship passed to Thomas Michael Dolan, a doctor based in Halifax. The periodical was renamed the Provincial Medical Journal, a title it retained until it folded in 1895.
The inaugural issue of the Miscellany featured a long opening address, which set out the journal’s intended readership. While noting that its ‘careful selection of information’ would not ‘be uninteresting to those in what are commonly considered to be the higher ranks of the profession’, it asserted that it was designed to be of ‘especial value to the hardworking and leisureless General Practitioner’. In particular, it felt that its condensed reports of new research would be ideally suited to the ‘overworked’ medical man.[1] This editorial engaged with common tropes about the toils of provincial and country general practice.
As its later title implies, the journal proudly asserted its provincial character, while criticising the metropolitan elite. In 1882, the Miscellany reprinted comments made by its future editor. Dolan had characterised England’s major medical journals – the Lancet and the British Medical Journal (BMJ) – as essentially ‘London publication[s]’. He suggested that:
the literary activities of the provincial general practitioners were increasing each year – the London Practitioner alone could produce enough material to fill the Lancet and Medical Journal – therefore, if they desired not to be beaten out of the field, they must look for a new vehicle for the conveyance of their thoughts.
The Miscellany styled itself as this ‘new vehicle’. It modestly suggested that it did not lay claim to be ‘at present in a position adequately to represent the General Medical Practitioners of the Country’, but emphasised that it was ‘compiled in [their] interests’.[2] The journal suggested that there was an opening in the market for a new type of publication, implying that provincial GPs felt underrepresented by mainstream metropolitan journals. It positioned itself as better suited to these readers’ interests and lifestyle.
By insinuating that the BMJ privileged metropolitan practitioners, Dolan implied that it had alienated its traditional readership. The BMJ began life in 1840 as the Provincial Medical and Surgical Journal (PMSJ), the defacto periodical of the Provincial Medical and Surgical Association. Both were rebranded in the 1850s, becoming the BMJ and British Medical Association respectively. These changes were controversial; some Association members expressed fears that the interests of the metropolis were being prioritised over those of the provinces.[3]
Under Dolan’s editorship, the Miscellany was later renamed the Provincial Medical Journal. This was presumably a marketing tactic designed to increase the journal’s appeal outside the Midlands; by this time, it was also published in London, Edinburgh, and Dublin. Further, by framing itself as a journal for provincial medical practitioners, it effectively positioned itself in the space once occupied by the PMSJ. Perhaps this was a bid to claim the BMJ’s disaffected readers, though it came several decades after the controversy surrounding that journal. Scholars have discussed the diminishing popularity of the ‘provincial’ as a template for national identity.[4] However, the journal’s use of the term as late as the 1880s and 90s indicates a desire to reclaim provincialism and assert it as a broader identity. The journal addressed itself to all those who practised outside of the metropolis.
Engaging with ‘problem’ patients
Upon its launch, the Miscellany asserted that among its chief interests were ‘Ethics and Etiquette, the relations of members of the profession with the public’.[5] The journal did not adopt a romanticised perspective of the doctor-patient relationship, but rather discussed what it saw as the challenges of general practice.
In 1882, it featured a lengthy article on ‘The Question of Patients’, which focused on the difficulties encountered in ‘diagnostic interrogation’. The article demonstrated remarkable snobbery towards ‘the badly educated classes’, remarking on the ‘sheer inability […] of persons who have led unintelligent lives, to grasp the meaning and importance of questions that are put to them’.[6] The writer implied that patients were to blame for unsatisfactory medical interactions.
Two months later, the journal published a feature on ‘A Practitioner’s Grievances’, many of which related specifically to country practice, particularly the demands made on ‘the Doctor’s time’. It complained that, ‘in country districts, especially, it is almost impossible to induce patients to send their messages to the doctor in decent time’. It described the practitioner arriving home after a long day, ‘weary and hungry’, only to ‘find a message awaiting him’ to return to a village he had visited earlier that day. This frustration is compounded by the fact he ‘finds that the patient has been ill for a week, and that to-morrow morning would have done just as well’.[7] Complaints about patients requesting attendance at inconvenient times were not unusual, though together these articles seem particularly critical of patients.
The journal was also concerned about medical men’s interactions with women. In these instances it was the practitioner (rather than the patient) who was supposed to alter his behaviour. An article on ‘The Relation of Medical Men to their Patients’ (1885) counselled ‘[y]oung medical practitioners [to] bear in mind a few general truths in their dealings especially with female patients’. It recommended that ‘[c]onfidential relations with ladies of a household’ were to be ‘absolutely declined’ and that ‘examinations of female patients should always be made in presence of a third person’.[8] Such warnings were common in medical writing. Jukes de Styrap’s The Young Practitioner (1890) – an advice guide for aspiring medical men – counselled its readers to be ‘extremely cautious […] in having married women or young females to consult you secretly’.[9] Practitioners were taught that their encounters with female patients should be conducted with propriety.
Medical men in rural or small-town practices were thought to be particularly susceptible to rumour, innuendo and scandal. In 1883, the Miscellany reprinted a poem entitled ‘The Doctor’s Dream’, which originally appeared in Punch.[10] The poem’s speaker is a village practitioner, who reminisces about his life and career. One of the challenges he recalls is having ‘[t]o face and brave the gossip and stuff that travels about through a country town;/ To be thrown in the way of hysterical girls, and live all terrible scandal down’. Though humorous in tone, the Miscellany suggested that the poem was ‘worthy of preservation in medical literature’ and likely to ‘strike a chord in every medical man’s heart’.[11] The Miscellany’s later incarnation, the PMJ, featured an article on ‘Doctors and Lady Patients’ (1887) which warned of the dangers surrounding long visits to women. It noted that, ‘[i]n London possibly they might escape, for a time, from the eye of Mrs Grundy […] In provincial towns medical men who are too attentive, very soon fall under her ken and then – Nemesis!’[12] These pieces show how communities might police the practitioner’s professional conduct.
The Miscellany/PMJ framed itself as a riposte to the dominance of the London periodical press and capitalised on the provincial medical man’s perceived resentment towards his metropolitan counterparts. It grappled with the supposed challenges of general practice and proudly asserted its provincialism. While it enjoyed almost fifteen years in circulation, the fact it eventually folded perhaps indicates that its approach was not particular popular with medical readers. The journals that it attacked – the Lancet and BMJ – remained the most widely read titles.
[1] ‘Introduction’, Midland Medical Miscellany, January 1881, pp. 1-2 (p. 1).
[2] ‘A Journal for the General Practitioner’, Midland Medical Miscellany, April 1882, p. 55.
[3] For an overview, see Peter W.J. Bartrip, Mirror of Medicine: The BMJ, 1840-1990 (Oxford: Oxford University Press, 1990)
[4] Robin Gilmour, ‘Regional and Provincial in Victorian Literature’, in The Literature of Region and Nation, ed. by R.P. Draper (Basingstoke: Macmillan, 1989), pp. 51-60 (p. 52).
[5] ‘Introduction’, pp. 1-2.
[6] ‘The Question of Patients’, Midland Medical Miscellany, February 1882, pp. 21-4 (p. 22).
[7] ‘A Practitioner’s Grievances’, Midland Medical Miscellany, April 1882, pp. 51-2 (p. 51).
[8] ‘The Relation of Medical Men to their Patients’, Midland Medical Miscellany, 1 January 1885, p. 23.
[9] Jukes de Styrap, The Young Practitioner (London: H.K. Lewis, 1890), p. 110. This book was based on Daniel Webster Cathell’s popular US manual, Book on the Physician Himself (1881), which exercised similar caution.
[10] ‘The Doctor’s Dream’, Punch, 20 January 1883, p. 35.
[11] ‘The Doctor’s Dream’, Midland Medical Miscellany, February 1883, pp. 63-4 (p. 63).
[12] ‘Annotations: Doctors and Lady Patients’, Provincial Medical Journal, 1 January 1887, p. 35.
