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Victorian Science & Medicine

The years of Livingstone's life, 1813-1873, saw some of the most profound changes medicine had ever undergone. These were part of the massive restructuring of British society that followed the industrial revolution of the late eighteenth and early nineteenth century. David Livingstone's grandfather's life embodied these changes. A tenant farmer from Ulva, an island off the west coast of Mull, Scotland, he was evicted in 1792, and came to work in a newly established cotton mill at Blantyre, near Glasgow. The move from country to town and from agriculture to industry and commerce continued unabated in the nineteenth century. Although in Africa for much of his adult life, Livingstone's letters bear testimony to these transformations, notably in so far as they affected London. When Livingstone first visited London in 1838 it was already a massive metropolis; not an industrial city but a thriving port, the centre of a rapidly expanding empire, in whose growth and administration Livingstone was to play a part. But in 1838 London must have seemed an anarchic, terrifying place (although perhaps not to someone who had studied in Glasgow). Full of overcrowded, unpoliced, disease-ridden slums, the "Great Wen", as it was known, was the seat of frightening, often violent political agitation. Indeed many missionary societies considered work at home, reclaiming the "savage" inhabitants of these slums for Christianity, as important as converting the "savages" of Africa or India.

By the time of Livingstone's second return from Africa in 1864 the city had begun to change. The heyday of Victorian stability and prosperity had arrived. The Great Exhibition of 1851, as had been hoped, inaugurated a new era. Wealth began to flow to the middle classes and also to many working-class families (the very poor and paupers were a different matter). Relative stability reigned; the threat of rioting, revolution even, had diminished. Government had become more centralized and was passing bills on health, working hours and education. A modern civil service was being created. A network of railways was unifying the nation. The great public works era -- notably in the provision of fresh water and the removal of sewage -- had begun. The first transatlantic cable had been laid in 1858. British science and technology were seen by many as the sources of these transformations. Michael Faraday's work on electromagnetism and Isambard Kingdom Brunel's engineering feats confirmed these views. In the West End of London, fashionable and prestigious scientific and medical societies flourished. Most important for Livingstone was the Royal Geographical Society (RGS). Founded in 1830, the early years of this institution were undistinguished but by mid century it had become an important centre for promoting exploration and imperial science. It is not surprising then that Livingstone looked to it for patronage and approval, and the RGS, in turn, sought its share of credit for Livingstone's work. It is not hard to imagine that Livingstone saw in the transformation of London some of the possibilities that science, technology, trade and good British governance might bring to Africa.

Medicine too would have looked considerably different to Livingstone between 1838 and 1864. Bedside medicine -- treating the sick person -- changed profoundly in these years. When Livingstone was a young doctor, the patient's history was the key to diagnosis and management, as it had been for two millennia in the West. By the time he was a mature practitioner, physical examination aided by instruments was expected of every medical man. In 1840 some still thought of the stethoscope, invented in 1816, as a toy. By 1865 its use was mandatory. A whole host of other instruments were also at the physician's disposal: for ears and eyes, the auroscope and ophthalmoscope could be used; the laryngoscope for the throat and, although modesty still surrounded its use, the vaginal speculum was deemed necessary for examination in women's diseases. The most modern practitioner might also have a microscope to examine the blood and urine. Drug therapy, though, changed little. Surgery, however, had been transformed. While Livingstone was in Africa, ether and chloroform anaesthesia had been introduced, in 1846 and 1847 respectively. Surgical intervention, although largely confined to bones and soft tissues, had become amazingly ambitious and intricate by the mid 1860s. Exceptionally, the abdomen was now being opened for the removal of ovarian tumours. Surgical deaths in the great hospitals, however, had increased considerably but Livingstone would have been well aware of the claims made by surgeons that science would solve this problem. Shortly after he returned to Africa in 1865, controversy would break out over Joseph Lister's antiseptic treatment based, he said, on Louis Pasteur's germ theory. Modern germ theory was not established until after Livingstone's death. In Livingstone's lifetime, science at the bedside, in the laboratory and in the community was increasingly seen as a potent force in medicine. In retrospect, any claim made at the time that science helped the patient is a shaky one. What matters here are two consequences of the importance that the Victorians ascribed to science in medicine. First, the Victorians saw medicine, using science, as a tool for transforming people's lives and having the capacity to do so not only in Britain but also in the colonies --- just as science and technology in general could. Second, this image of science in medicine raised the status of the medical profession. What was once an elite vocation for the few was becoming a respectable middle-class occupation for the many. If Britain and the Empire were to thrive, doctors proclaimed, they could be its backbone (engineers and chemists said much the same thing). And, indeed, doctors and other professionals were eventually churned out in their thousands to serve in the colonies.

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