Chapter 2
The Development and Role of the Veterinary and Other Professions in Relation to Companion Animals
Co-author: Andrew Gardiner BVM&S, Cert SAS, MSc, PhD, MRCVS, Senior Lecturer
Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Scotland, UK
- 2.1 Introduction
- 2.2 The Veterinary Profession
- 2.2.1 Development of veterinary treatments
- 2.2.2 Early development of companion animal veterinary practice
- 2.2.3 Development of the veterinary profession and the rise of companion animal veterinary practice
- 2.2.4 Role of the veterinary profession in setting ethical standards
- 2.2.1 Development of veterinary treatments
- 2.3 Development and Role of Other Professions in Relation to Companion Animals
2.1 Introduction
In Chapter 1 we saw how it became possible for many people in industrialised Western nations to keep cats, dogs, and other animals as companions. In this chapter, we consider how the veterinary profession evolved alongside these changes, and how these developments affected the lives of companion animals, and shaped emerging ethical concerns.
Take, for example, an issue such as the neutering of dogs. That people have their dogs neutered is to some extent driven by demand. However, this demand is enabled and encouraged by the availability of veterinary services and the activities of animal welfare organisations; across nations (e.g. United States vs. Sweden), the level of neutering of dogs is influenced by the different policies of the respective national veterinary associations (see Chapter 10).
The chapter also briefly considers two of the other most significant professions dealing with companion animals: veterinary nurses/technicians and behaviour therapists.
2.2 The Veterinary Profession
As an intellectual discipline and empirical practice, veterinary medicine arose from three factors that came together in the late eighteenth century: the idea of comparative anatomy, the pursuit of livestock improvement, and the commercial, military, and social role of horse power.
Human anatomy had been intensively studied in Europe from the fourteenth century. The similarity of humans to other animals was evident to very few people in 1600, but by 1700 ‘nearly everybody recognised it’ (Fraser, 2008: p. 33). This new, comparative way of looking at human and animal bodies generated the same degree of intense interest and speculation throughout society that, for example, gene technology does today. However, the major stimulus for building and opening most European veterinary schools in the late eighteenth and nineteenth centuries was a devastating livestock disease that regularly wreaked havoc with national economies: cattle plague (also known as rinderpest and steppe murrain). Another major influence on the emergence of veterinary education was the wish to develop an improved approach to the health and productivity of the horse, whose labour kept society, industry and armies moving.
Against the background of these intellectual and economic drivers, different political regimes also shaped the development of veterinary education. In France and many other European countries, veterinary schools were mostly public institutions, founded and funded by the state; in Britain, they were initially private enterprises; in the United States, a mix of private and university-based schools developed, the latter mainly being associated with Land Grant universities in rural areas (Jones, 2003: pp. 49, 55). Nearly all European veterinary schools started in towns or cities, where many horses and cows (in large urban dairies) were to be found. There were also a great many dogs, and archival research into the caseloads of nineteenth-century veterinary schools shows that surprising numbers of dogs were treated at a time well before the main ‘rise’ of canine medicine in the 1930s (Gardiner, 2010: pp. 83–90).
However, until relatively recently, for a vet to focus exclusively on dogs suggested an unhealthy (even unmanly) sentimentality. Even by the middle decades of the twentieth century, to call someone ‘a mere dog doctor’ was a professional insult (Anon, 1947). Cats did not fully appear on the veterinary radar as a species in their own right (rather than as ‘small dogs’) until the 1960s. What changed, then, such that the majority of time spent by practising vets in the industrialised Western nations today is directed towards ensuring the health of companion animals, in what is now regarded as a highly prestigious field within clinical veterinary medicine?
Part of the answer, as we saw in Chapter 1, has to do with demographic changes, with middle-class families moving into suburban areas, and later with changes to the traditional family structure. Companion animals moved into homes and took up a place in human families and domestic life (Fudge, 2008). As people became wealthier after World War II, they were prepared (and able) to pay for more elaborate medical interventions to maintain the health of these new additions to the family, and as a result, companion animal medicine flourished (Swabe, 1999).
However, there are also other drivers behind this development; we will consider two of these here. First, technological developments allowed vets to do things to dogs and cats that were previously unheard of. We will consider two examples, one surgical (limb prostheses for dogs) and the other medical (the treatment of diabetes mellitus with insulin). Second, there were important developments in animal welfare and protection: various charities that cared about those in poverty and their companion animals adopted practices with much broader ramifications for companion animal veterinary care. We will illustrate this by discussing the pivotal role played by the British charity, the People’s Dispensary for Sick Animals (PDSA).
2.2.1 Development of veterinary treatments
Although currently considered ‘cutting edge’, and the subject of some ethical debate (see Chapter 12), the fitting of limb prostheses to dogs has a long medical history. The procedure was originally described in a textbook first published in 1900 (Hobday, 1900a). As general anaesthesia (with chloroform) was being used more often and was proving safe and practicable (Hobday, 1900b), dogs with crippling leg problems could have their damaged limbs removed. Fitting a prosthesis after limb amputation was a straightforward example of translational medicine – treating canine orthopaedic patients like human ones. And, just as in people, the quality and cosmetic appearance of the prosthesis depended on the socioeconomic status of the animal’s owner (Hobday, 1906: pp. 343–347).
However, the fashion for canine prosthetic limbs declined as vets realised that dogs appeared to cope well without one, and occasionally even two, legs. Recently, interest in canine limb prostheses has re-emerged, and advanced prosthetics (intra-osseous transcutaneous amputation prostheses, or ITAPs) are being developed for both dogs and cats, and human beings (see Chapter 12 for an ethical discussion of ‘novel’ treatments and ‘overtreatment’).
The development of limb prostheses for dogs may sound like a fairly straightforward example of a development or discovery (safer anaesthesia in this case) making a new form of treatment possible (the ability to amputate a dog’s damaged leg and subsequently fit a prosthesis). However, the process by which clinical signs become recognized as a ‘disease’ that should be ‘treated’ is actually rather complex, involving social, economic, political and cultural factors. Diseases such as rabies in dogs and foot-and-mouth disease in cattle are interpreted through political, economic and cultural lenses that make them much more than simply physical signs of illness and pathologies (Pemberton and Worboys, 2007; Woods, 2004). Seen from this perspective, diseases are not simply ‘discovered’ but are the results of a social process – a kind of ‘framing’ of a group of clinical signs as a disease that can and should be treated in particular ways.
One of the important consequences of calling something a ‘disease’ is that it may imply a prospect for treatment or intervention where none existed before, potentially generating new ethical issues. Either withholding a treatment, or administering one that is experimental or has unpleasant side effects, may raise ethical questions. For example, does the ability to fit complex limb prostheses to dogs and cats mean that it is right to do so? Given the availability of a preventive vaccine for parvovirus, should an owner be castigated for electing not to have their dog immunised?
The transfer of technology and procedures from human to veterinary medicine is an important and recurring theme in the development of the profession. But the direction of transfer from human to animal often turns out to be more complex than it first appears. This is illustrated in the second brief case study.
Diabetes mellitus, caused by lack of the pancreatic hormone insulin, was first treated in 1922, when a seriously ill 14-year-old boy, Leonard Thompson, was injected with a crude substance derived from bovine pancreases (Bliss, 1984). A few days previously, a small crossbreed dog called Marjorie had received the same treatment for her own diabetes (although Marjorie’s diabetes had been created experimentally by removing part of her pancreas). Leonard initially received a ‘dog dose’ of the extract based on comparison of his and Marjorie’s weights. In this sense, Leonard was treated ‘like a dog’ and the translation of medical treatment was the opposite of that seen with limb prostheses, that is, dog → human (insulin), rather than human → dog (prosthetic limb). The discovery of insulin became one of the iconic discoveries of modern medicine, and Marjorie became a ‘canine heroine’, featuring on stamps and other memorabilia across the world (Gardiner, 2006a,b).
In the development of insulin, the dogs (Marjorie was just one of many) were models and research tools rather than patients in their own right. However, the distinction was sometimes blurred: Marjorie became a companion animal to the lead researcher Frederick Banting, who was reportedly deeply upset when she had to be euthanased. The first dog to receive insulin as a patient (rather than an experimental subject) was probably treated in Ithaca in 1923, around 14 months after insulin’s discovery: she survived for 5 months, before being euthanased because of complications (Milks, 1932).
The introduction of insulin therapy into clinical veterinary medicine was, therefore, more complicated than the simple unidirectional movement of the new technology of prosthetics. It followed a pattern of: animal model in human medicine → clinical treatment established in human medicine → clinical treatment moves across to veterinary medicine. Transfer back into clinical veterinary medicine presupposes the demand for advanced medical treatment of animals; this demand was generated through the development of companion animal veterinary practice as a major branch of veterinary medicine, to which we shall now turn.
2.2.2 Early development of companion animal veterinary practice
It is often assumed that the rapid expansion of companion animal practice in Britain and in other Western countries was a post-war activity, associated with economic recovery and urbanisation. The formation of the British Small Animal Veterinary Association (BSAVA) in 1957 fits with this chronology. However, in another important sense, there was a great deal of companion animal practice taking place in the United Kingdom earlier, in the 1920s and 1930s. This activity is largely ignored in ‘official’ histories of the British profession (e.g. BSAVA, 2007) because it happened outside the veterinary profession itself, in charity animal clinics staffed by unqualified practitioners, that is, individuals who were not members of the Royal College of Veterinary Surgeons (RCVS). Nevertheless, the emergence of this activity, and the profession’s response to it, was central in defining what companion animal practice would later become.
Clinical activity by individuals who were not veterinary surgeons was possible because, until the second Veterinary Surgeons Act of 1948 in Britain, the veterinary profession did not have a legal monopoly on the treatment of animal disease, only on the use of the specific title ‘veterinary surgeon’. In fact, many individuals without veterinary qualifications were successfully treating animal disease. They were free from prosecution as long as they were careful in how they described their animal-curing activities (a similar situation had existed in other health professions, e.g. dentistry). Some of these individuals were undoubtedly very skilled. In 1926, Captain R. Cornish-Bowden MRCVS, reporting to a committee of the RCVS, described an unqualified practitioner he had seen working at premises at Commercial Street, London, belonging to the People’s Dispensary for Sick Animals (PDSA). On the day of his visit, more than 100 people and their animals were waiting to be seen:
The gentleman I saw alleviating the suffering of these animals was a ‘quack’, but he had a better means of studying the sickness of animals than was ever accorded to me at the Royal Veterinary College. He had 30 years’ experience attending small animals; the work he was doing was excellent; he handled his animals with a great deal more care and skill than many veterinary surgeons I have seen.
(Cornish-Bowden, 1926)
Some animal charities had a policy of employing vets, but the largest organisation that focused on treatment of companion animals, the PDSA, established in 1917, initially had a policy of not employing them. This arose from the very poor relations between the charity’s founder, Maria Dickin, and the British veterinary establishment. Dickin was frequently outspoken in the press and never held back from criticising what she saw as the veterinary profession’s poor response to the treatment of animals whose owners could not afford to pay. She felt there was a need for a large-scale social programme to treat the animals of the poor. In 1931, she criticised both the RSPCA and the veterinary profession for failing to respond to this need and, instead, attacking her own organisation:
If you are so concerned about the proper treatment of Sick Animals of the Poor, open your own dispensaries; open them everywhere for there are vast factory, mining, manufacturing and dockland areas where nothing at all exists to help the Sick Animal. […] Live among it as we do. […] Do the same work we are doing. Instead of spending your energy and time in hindering us, spend it in dealing with this mass of misery.
(Dickin, 1931)
Maria Dickin’s uncompromising stance towards employing non-vets undermined veterinary professional expertise and authority. When the charity was very small, this was not very significant, but the situation became more problematical for the veterinary profession in the light of the charity’s hugely successful fundraising efforts and increased exposure within society throughout the 1920s and 1930s, when it became affectionately known as the ‘Poor Doggers Salvation Army’ and was supported by many prominent figures in politics, the aristocracy and the British royal family (Figure 2.1).
Figure 2.1 Pet owners awaiting treatment from the PDSA Caravan in the 1940s.
(PDSA. Reproduced with permission from the PDSA.)
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