Precepts and practice: Charles Hastings's vision and reality.

Charles Hastings created the Association at a time when the country was in a state of flux, both political and social. The year 1832 saw the passage of the Great Reform Bill and the Anatomy Act, the foundation of the first provincial university in Durham, and the operation of the first passenger railways. Medical practice was still not fully recognised as a profession and doctors tended to join together in numerous groups, some centred on the colleges in London, Edinburgh, or Glasgow and others joining together in the large provincial towns and cities. There was, however, no overall organisation or control of the profession and most of those practising medicine held no qualification. Poor patients were treated under the provisions of the Poor Law by the efforts of the Board of Guardians. Medical knowledge itself was obviously limited, and the recording and exchange of knowledge between doctors were primitive. Nevertheless, the Lancet had been founded in 1823, and all over Europe small local journals were beginning to record the development of medicine. One such journal was the Midland Medical and Surgical Reporter or, to give it its full title, the Midland Medical and Surgical Reporter and Topographical and Statistical Journal, which first appeared-with Hastings as its editor-in August 1828. Sixteen issues only were produced, and because of the financial problems of the publishers the last appeared in May 1832. By then, however, Hastings had clearly recognised the need for better organisation of the emerging profession, and having carried out fairly extensive discussions with many colleagues throughout the provinces he published in the last copy of the Reporter the prospectus for a new medical association. He wrote: