I Christopher Lawrence Incommunicable Knowledge: Science, Technology and the Clinical Art in Britain 1850-1914 By the end of the nineteenth century, medicine in Britain existed legally as a single profession. Besides its lawful status, a number of very general features also characterized this professional group: a core body of knowledge, licensing, recognized educational institutions, educational standards and other trappings, such as the running of learned societies and the publishing of periodicals. In many ways, doctors can be accom- modated into the category ‘forgotten middle class’, when considered in terms of their cultivation of respectability and intellectuality, their professional organization, their praise of meritocracy and their apparent aloofness from the struggle €or income. ’ But recent historical work has thrown light on several aspects of medical life in the Victorian and Edwardian eras. In particular, comparison of scholarship from different areas shows that, behind its legal unity, the profession was extremely variegated in its attitudes, goals and standards, and especially in its definition, evaluation and use of science. At the one extreme were those doctors, for whom perhaps T. H. Huxley was a spokesman, who sought the role of scientifically trained expert and intellectual. At the other extreme, however, were a number of physicians who seem to have courted the sort of deference more likely to be associated with landed gentility. These latter practised throughout Britain, but were most obvious in London, particularly amongst those doctors who were Fellows of the Royal College of Physicians and who had appointments at the grand voluntary hospitals. Their cultivation of this role can be linked to the running of hospitals by distinguished lay governors, and to the fact that they practised medicine in the highest social circles, in a world in which the public chose their doctors by evaluating their class attributes rather than their medical skills.2 Following from this, it is easy to see why some of the leaders of English medicine, especially those in London, Journal of Contemporary His101-y (SAGE, London, Beverly Hills and New Delhi), VOI. 20 (1985). 503-520504 Journul of Contemporary History stressed the value of a classical and general education rather than a narrow technical one, and why they praised the attainment of character more than the pursuit of expertise. Recently, S.E.D. Shortt has analysed historical accounts of the role of science in the language of the nineteenth-century profession.’ He concurs with current historians in rejecting the older, but still prevalent, model that linked the achievement of professional hegemony in the nine- teenth century to medicine’s success in harnessing science for the practical relief of sickness. Quite frankly, there is little or no evidence to support this account, which is not to deny its profound importance as an historical ideology serving to sustain the claims made on behalf of twentiethcentury medicine. Of greater interest is Shortt’s attack on the work of those he calls the ‘revisionists’. In the last decade, a number of historians have revealed the peculiarly difficult passage of continental experimental science, notably physiology, into the British medical curriculum. ‘ Anti-vivisedionist sentiments, the natural theological tradition, and a longestablished preference for anatomy over physiology, meant that many British clinicians snubbed the attempt to introduce the experimental sciences to medical students and denied the claim that these disciplines had relevance to the practice of medicine. Whilst not arguing with the findings of these historians, Shortt suggests that the revisionists mis- takenly identify experimental science with some ideal, ahistorical, ‘real’ science. Such an approach, he suggests, insidiously smuggles a new Whiggism into medical history, for, by thinking of science as meaning only experimental science, historians have been selectively deafened to .the rather more general noise made by nineteenth- and early twentieth- century physicians, whether general practitioners or specialists, allopaths OJ homeopaths - all of whom sought to establish links between science (any science) and medicine. In general, he concludes, ‘By forcing the rhetoric of science into the social vocabulary of the period, physicians secured a vehicle for their professional recognition. ’ ’ The aim of this paper is to suggest that there was an historical language of late nineteenth- and early twentieth-century clinical medicine which is captured neither by Shortt’s account of events nor by his characterization of the revisionist position. In fact, it falls somewhere between the two. Between about 1850 and the Great War, many senior British physicians, particularly those with hospital posts in London, employed a vocabulary which routinely invoked science as the foundation of medicine but which prescribed for science only a limited role in clinical practice. In Shortt’s terms, they were indeed using the rhetoric of science to bolster their professional authority, but only in one area, for, equally, they resisted ! Lawrence: Inconununicable Knowledge 505 the wholesale conversion of bedside practice into a science - any science. For them, ‘professional recognition’ depended much more on a rhetoric which brought to public notice the cultured practitioner of arcane skills. To defend the autonomy of clinical medicine, these physicians invoked an epistemology of individual experience which, by definition, defied analysis. A similar distrust of applied science, an approval of craft skills and the praise of rule-of-thumb practice, can be found in the language of many other contemporary professions, such as chemistry or engineering. But, in medicine the account of the nature of clinical skill was linked to other things. It.was used to show that only the gentleman, broadly educated, and soundly read in the classics, could be equipped for the practice of medicine. The equation almost ran: perfect gentlemen alone made great clinicians. This paper is concerned with the remarkable continuity in a rhetorical tradition in British medicine during years which saw profound changes in its organization, educational basis, and social relations. It will suggest that this clinical language was employed to demonstrate the ‘natural’ qualities of