The usual story of medicine in the past couple of centuries is one of growing professionalisation, and increasing distance between patients and practitioners. But is a new era of public participation in medicine upon us? Clinicians and patients are moving towards shared decision making in many areas, whilst some medical journals now invite patients to take part in peer review. Citizen Science projects, such asCell Slider, run by Cancer Research UK, andZooniverse, have enabled the public to contribute to medical research. Such developments open up new possibilities.
One might assume that 19th-century medicine lies in stark contrast with 21st-century citizen science. After all, it's more often associated with the authoritarian doctor or the sinister “quack” preying on the helpless patient. Such tropes contain kernels of truth; the second half of the 19th century saw a legal and cultural consolidation of doctors' power that, in turn, diminished that of patients and alternative practitioners. But as part of Constructing Scientific Communities, an AHRC funded project in collaboration with the University of Leicester, we are uncovering a different narrative that complicates and challenges the well-worn story of professionalisation. As an interdisciplinary group of historians, literary scholars, and scientists, our project is exploring parallels between today's forms of citizen science and the 19th-century print revolution, when an explosion in medical and scientific journals enabled networks of knowledge exchange between the public and professionals to thrive.
Starving physicians lament their lack of work after improvements in public health; wood engraving after G Du Maurier (1875)
Working with our partner institutions, the Royal College of Surgeons of England (RCS), the Royal Society, and the Natural History Museum, project researchers have been examining an array of journals from across the scientific spectrum. Many of these titles are rich in contributions from non-professionals, and are often aimed at a general audience.The Lancet, for example, appealed to a reading public well beyond the profession; in its first editorial it claimed to be of relevance to “every individual in these realms”. Non-medics often contributed to its pages. By the 1880s, a wealth of popular medical titles likeHealthandThe Hospitalalso began to flourish. Such journals targeted lay audiences, offering not only medical advice, but also a forum for public debate.
One sphere in which the public were particularly engaged was that of public health. The sanitary movements in the Victorian era have of late been much derided; seen as officious, ill-judged attempts to control dirt and the masses. But returning to the journals of all the local and national societies, one finds a record of extraordinary public engagement across the UK, with local societies campaigning for curbs on environmental pollution, improved sanitation and water supplies, and promoting a holistic vision of the relationship between individual, public health, and the environment.
We endeavour to practise what we preach. As part of our collaboration with Zooniverse, we are supporting the development of a number of citizen science projects, inviting the public to participate in research. Two of these projects,Science GossipandOrchid Observers, have now gone live, and a further project on the Medical Officers of Health reports for 19th-century London, developed in collaboration with the Wellcome Trust, will be available in the autumn. Next year we will host a symposium at the RCS, inviting perspectives on public engagement with medicine. The growing consensus is that greater engagement between the medical profession and the public enriches health care. Looking at modes of communication used in the 19th century is not simply a historical exercise. Rather, the flourishing journal culture of that time offers potential models of knowledge exchange that might be usefully applied today.