The ageing population is having an impact worldwide and has created a serious challenge in Thailand's healthcare systems, whereby healthcare practitioners play a major role in promoting independent interaction of their client's abilities, as well as environmental factors. The purpose of this study was to survey features of the home and assistive technology (AT) for the home-bound elderly in the community of Chiang Mai, Thailand. Home evaluation included features inside and outside the home, and AT was based on the International Classification of Functioning, Disability, and Health (ICF) concept. Methods included observation and an interview that were used by the researcher for evaluation. The study found that every home had at least one hazardous home feature such as inappropriate width of the door, high door threshold, tall stair steps, no bedside rail, and inappropriate height of the toilet pan. AT was found in houses as general products and technology for personal use in daily living and for personal indoor and outdoor mobility as well as transportation. Therefore, home features and AT can afford the home-bound elderly independent living within the community. Perspective AT according to the ICF concept could provide a common language for ageing in place benefits. Ageing is not merely the passage of time. It is the manifestation of biological events that occur over a time span. It is important to recognize that the ageing body changes differently in different people. Some systems slow down, while others lose their “fine-tuning.” As a general rule, slight, gradual changes are common, and most of these are not a problem to people who experience them. However, more dramatic changes might indicate serious health problems, and the United Nations Principles for Older Persons has called for action by luring governments into national programs that cover many areas . The strThai society is ageing rapidly due to an increasing elderly population, but active ageing level of Thai older persons is not high . The proThe environment is perceived to play a significant role in elderly people experiencing falls . The WHOThe risk of falling relates to personal health and the environment. The elderly have a higher risk of accidents and more severe consequences than younger people, and recovery takes longer for older people after a fall. Therefore, prevention of accidents is the best solution for these people. The environment can facilitate health maintenance and management by supporting health promoting behavior and provision of healthcare services. Environmental modifications, healthcare technologies, and assistive technology (AT) can compensate for limitations in functional abilities by reducing the risk of falling and promoting independent living and well-being . ApplyinThe International Classification of Functioning, Disability, and Health (ICF), which originated from the WHO, intends to specify a useful framework for functioning and disability. The term framework of disability, as specified by the ICF, has focused more on the close connection between the limited experience of disabled people, with their environmental design and structure, and the attitude of the general public in providing a common communicative language . EnvironEnvironmental factors in ICF can have the effect of improving or obstructing the body function of an individual and their ability to execute an activity or participate in society. ICF is able to serve as an organizing framework for AT outcomes. However, Smith et al.  reportedThis study was conducted as pilot study in Chiang Mai, Thailand, between October 2015 and April 2016. This city was selected as the study site because the local administrative units play a significant role to support activities for healthy ageing and arrange home visits for community healthcare undergoing rapid urbanization. Two local communities, Namprae and Sanklang villages, were selected based on the existing structures of primary healthcare program with a significant role of the home visit for the elderly. The study was a cross-sectional survey of people aged 60 years and older. Lists of home-bound elderly people were obtained from the Health Promoting Hospital. Home-bound elderly people were contacted and visited in their homes. All those who agreed to participate in the study were inspected and assessed for home environmental factors and AT. Ethical approval was given by the Ethics Committee of the Faculty of Associated Medical Sciences, Chiang Mai University.A survey tool was divided into three parts. Part one was the sociodemographic information on age, gender and marital status, condition of health, comorbidities, and physical disability. Part two was a home assessment checklist, using an observation tool with a room assessment technique, in order to evaluate the hazardous features used for elderly and disabled adults living in the community. Finally, part three consisted of an AT checklist completed for the elderly, in order to assess the listing of classification categories from the ICF.Criteria for judging home features were determined by the 2005 ministerial decree, which specifies the facilities in buildings for the disabled/physically handicapped and elderly  as well The AT checklist was developed as a first version based on the ICF framework under environmental factor components comprising chapter “e1” and a sublevel (category 2 level and category 3 level), as shown in In the first stage to validate the checklist, an expert panel was designed to determine and analyze category variables of the AT of the home-bound elderly. Ten items from all in chapter products and technology were selected. Second stage was carried for rating of agreement by calculating indexes of Item-Objective Congruence (IOC). The value of IOC was higher than 0.5; the item was acceptable. It indicates a good quality for measuring . FinallyPersonal data were collected by face to face interviews with the elderly and/or their family members at home and by direct observation of the home environment. Many techniques were used to complete all of the assessment tools.Home-bound elderly people were investigated in the community at Namprae subdistrict. In all, 66 home-bound elderly people (87% of the target population) agreed to participate. Demographic, home evaluation data, and the AT checklist were analyzed by using descriptive statistics to calculate frequency and percentage. The results were divided into three parts: demographic profile of the home-bound elderly, home evaluation, and AT.All of the home-bound elderly people had chronic health conditions. The majority of 69.70% of them were female and 57.57% had mobility impairment. Characteristics of the participants are presented in Home evaluation was divided in two parts. The first and second one included assessment outside and inside the home, respectively. The results of home hazard evaluation in the bedroom and bathroom/toilet are shown in The survey of AT in houses of the home-bound elderly is shown in AT in homes of the elderly was analyzed in ICF categories as facilitators or barriers as shown in AT device categories listed in ICF categories are presented in In these findings, most of the home-bound elderly people were over 70 years of age and with chronic health conditions and physical disabilities. Perhaps surprisingly, most of their homes had poor features in areas indoors and outdoors, which were barriers in performing activities of daily living. Furthermore, all homes had multiple risks of hazards in rooms and areas where daily routines are performed, such as the bathroom/toilet, kitchen, bedroom, and areas around the house. A strategy for reducing the problems of physical environmental barriers needs to adapt the home environment to enable people with functional limitations to live in their homes as independently as possible. Home modifications such as handrails, stair glides, or grab bars can reduce the chances of elderly people falling , 28. IntIn this study, the AT in ICF categories on home visits was evaluated. The results showed that e140  and e145  were not found in the homes seen. However, AT devices were not covered in all category 3 levels. Although AT plays a role in facilitating independent living for elderly residents in their own homes , the maiThis study generated the solution that it is possible to develop AT devices that cover all ICF categories, thus enhancing ageing in place and quality of life. There is research evidence that applying ICF has the potential to identify underlying facilitators and barriers in its human participants , 35, 36.The study was to developing a better measure of the environmental factors of the home-bound elderly people as new approach that can evaluate as either the facilitators or barrier to functioning in the home. Thus, challenge for future research is to use this assessment as a tool at a strategic-level intervention to facilitate ageing in place.This study presented a strategy to improve understanding by identifying home hazards using the home evaluation process and evaluating AT in the home by applying ICF. AT is a service or tool that helps the home-bound elderly or disabled to perform their daily activities. Nevertheless, assistive devices can be used to meet the demands of a particular task.


Smartphone apps can be a tool to facilitate independent medication management among persons with developmental disabilities. At present, multiple medication management apps exist in the market, but only 1 has been specifically designed for persons with developmental disabilities. Before initiating further app development targeting this population, input from stakeholders including persons with developmental disabilities, caregivers, and professionals regarding the most preferred features should be obtained.The aim of this study was to identify medication management app features that are suitable to promote independence in the medication management process by young adults with developmental disabilities using a Delphi consensus method.A compilation of medication management app features was performed by searching the iTunes App Store, United States, in February 2016, using the following terms: adherence, medication, medication management, medication list, and medication reminder. After identifying features within the retrieved apps, a final list of 42 features grouped into 4 modules  was included in a questionnaire for expert consensus rating. A total of 52 experts in developmental disabilities, including persons with developmental disabilities, caregivers, and professionals, were invited to participate in a 3-round Delphi technique. The purpose was to obtain consensus on features that are preferred and suitable to promote independence in the medication management process among persons with developmental disabilities. Consensus for the first, second, and third rounds was defined as ≥90%, ≥80%, and ≥75% agreement, respectively.A total of 75 responses were received over the 3 Delphi rounds—30 in the first round, 24 in the second round, and 21 in the third round. At the end of the third round, cumulative consensus was achieved for 60% (12/20) items in the medication list module, 100% (3/3) in the medication reminder module, 67% (2/3) in the medication administration record module, and 63% (10/16) in the additional features module. In addition to the medication list, medication reminder, and medication administration record features, experts selected the following top 3 most important additional features: automatic refills through pharmacies; ability to share medication information from the app with providers; and ability to share medication information from the app with family, friends, and caregivers. The top 3 least important features included a link to an official drug information source, privacy settings and password protection, and prescription refill reminders.Although several mobile apps for medication management exist, few are specifically designed to support persons with developmental disabilities in the complex medication management process. Of the 42 different features assessed, 64% (27/42) achieved consensus for inclusion in a future medication management app. This study provides information on the features of a medication management app that are most important to persons with developmental disabilities, caregivers, and professionals. Developmental disabilities (DDs) is a term encompassing a range of disorders that are usually present at birth, last throughout the life span, and negatively affect the course of development of an individual at physical, intellectual, or emotional levels . In the As a result of a high burden of diseases -9, polypPersons with DDs may live with their family (71%) or in a group home (13%) and often rely on caregivers for the performance of instrumental activities of daily living . One sucTechnology is on the rise as a tool to promote independence in many areas including mobility, hearing and vision, communication, independent living, and computer use . ExistinAt present, there are hundreds of medication management apps in the market, some designed to manage all medications  and otheWith regard to apps specifically targeting persons with a DD, Dicianno and colleagues -37 develPrevious assessments of medication management apps highlighted their low quality ,33,39 anTo identify medication management app features to be included in the Delphi questionnaire, a sample of medication management apps was reviewed. The works by Haase et al , Dinh etFeatures of the apps reviewed were identified and summarized by 2 independent researchers (AF and TMS) based on the description included in the App Store and personal experience with the app after downloading and exploring its content and features. The common features identified across the apps, and that served as the basis for the questionnaire development, included the following: medication list, medication reminder, and medication administration report (including recording of medication taking). Additional features identified across the apps included prescription refill reminders; automatic pharmacy refill mechanisms; barcode scan to enter medications; use of a drug directory to enter new medications; ability to take a picture of the pill being added; indication of missed doses; overdose warnings; link to an official drug information source providing information about the disease and the medication; ability to export a file with medication taking data; record of vital signs home monitoring ; record of side effects; record of drug allergies; drug interaction checker; scan health documents and upload them to the app; ability to share medication information through the app ; notification of caregiver if drug not taken; emergency contacts list; doctor name; doctor appointment reminder; pharmacy name; pharmacy locator; and gamification with rewards for users who adhere to their medication.After identifying the list of medication app features, the research team evaluated and weighed the inclusion of each of these features in the final questionnaire, as well as the flow, organization, and format of the questions. The final version of the questionnaire  was orgathink aloud fashion. The survey took about 15 min to complete.Before recruitment was initiated, the questionnaire was piloted with 3 individuals not directly associated with the research who provided feedback about the clarity of the wording and instructions, the answering format, and the flow of the questions in a A 3-round Delphi technique was used to gather consensus about medication management app features that would be suitable to assist young adults with DDs to independently manage their medications. The Delphi method utilizes a panel of experts in a field to establish consensus regarding a certain topic, with the ideal number of experts being between 15 and 30 . In thisExperts were invited via an email, which included a link to the anonymous questionnaire on Qualtrics. The invitation encouraged experts to participate in all 3 rounds; however, they were not excluded from participating in a round if they missed the previous round(s). Participants were also able to make comments and suggest additional features which were reviewed by the research team at the end of each round, with relevant items being included in subsequent rounds. Each Delphi round lasted 1 week and, in-between rounds, we allowed 1 week before rolling out the following round to minimize respondent fatigue. The first round occurred between July 14 to 22, 2016; the second between July 28 to Aug 4, 2016; and the third between Aug 12 to 19, 2016. E-mail reminders were sent 3 days before the closing of each round to increase response rates. The process ensured anonymity of respondents at each round, and the number of individuals responding per round was noted. This study was approved as exempt by the University of Michigan Institutional Review Board (HUM00113908).Consensus criteria were established based on a progressive filtering process, with higher consensus requirements for the first Delphi round and progressively lower consensus for subsequent rounds—≥90%, ≥80%, and ≥75% agreement for the first, second, and third rounds, respectively. Items achieving consensus in each round were removed from the following rounds and not scored again.For the screenshot ranking-type questions, consensus was calculated by assigning each screenshot a scaled score based on whether it was chosen as the first, second, third, or fourth option. Specifically, for a given screenshot option, we multiplied the number of experts by 1, 2, 3, or 4  according to how screenshots were ranked, creating a score for each screenshot. Lower scores indicated higher preference for a screenshot based on design and visual appeal.For the Likert scale-type questions, consensus was calculated based on the percentage of positive versus negative responses for each feature, with positive being the sum of the percentage of experts that selected both important and very important or essential and very essential and negative being the sum of the percentage of experts that selected both not important and less important or not essential and less essential.Descriptive statistics (percentages) were calculated to rate consensus obtained for each feature in the 3 Delphi rounds and to determine the 3 most and 3 least important additional features that should and should not, respectively, be included in a future app.A total of 75 responses were received over the 3 Delphi rounds—30 in the first, 24 in the second, and 21 in the third round. Similar proportions of persons with disabilities and caregivers participated in the study, but most respondents were either researchers or professionals with an interest in DDs. Most respondents were female, with extensive experience and knowledge regarding DDs. Additional respondent characteristics are outlined in Of the 4 screenshots presenting different designs for the medication list, option B (133 points) was the most preferred among experts, but no consensus was achieved as to the best way to present the information. The distribution of experts selecting options C (145 points), D (146 points), and A (166 points) was very similar .Of the 20 items assessed to be incorporated in the medication list feature of a medication management app, consensus was achieved for 12 (60%) throughout the 3 rounds . In the Items suggested by participants that were included in further rounds were as follows: ability to upload a medication list from pharmacy records, which achieved consensus in round 3, and a speech-to-text feature to produce a medication list that did not achieve consensus as an essential feature.The design and visual appeal of option A (25 points) reached consensus among experts as the best to display medication taking reminders . All 3 iNo consensus was obtained among experts as to the best design to present the record of medication administration, but the calendar format in option D (127 points) was preferred by most respondents, followed by options B (132 points), C (143 points), and A  of additional features assessed reached consensus for inclusion in a medication management app. In the first round, experts agreed that the following features should be part of the app: ability to record known drug allergies, ability to share medication information from the app with providers and caregivers, emergency contact list, and prescription refill reminders . In the Finally, the top 3 most important additional features elected by experts were as follows: automatic refills through pharmacies; ability to share medication information from the app with providers; and ability to share medication information from the app with family, friends, and caregivers. The top 3 least important features included a link to an official drug information source, privacy settings and password protection, and prescription refill reminders.In total, at the end of the 3 rounds, 27 of the 42 (64%) features assessed achieved consensus . For 12 The summary of items achieving consensus, and respective percent agreement, in each of the 3 rounds is presented in Overall, comments reflected the importance of apps to be simple, easy to use, customizable, and not overbearing in the amount of information they contain. There should be a balance between including options for individuals to personalize the app to their needs and including only those most important features to achieve the goal of improved adherence and greater independence for young adults with DDs. Respondents suggested that the app included different information depending on whether the user was a caregiver or a person with a DD, with more complex information being available to the previous and simpler and supportive information for self-management provided to the latter. Additionally, the app should have a system to assess the severity of side effects, provide decision support on how to manage side effects, and follow-up for evaluation.Within the medication list feature, experts emphasized the importance of pictorial representations of the medication taking times to address low health literacy and suggested that medications be sorted according to the time of the day. Several experts suggested that a picture of the pill be included for each of the medications on the list with the ability to select from all possible shapes, sizes, colors, and manufacturer name to avoid confusion. One expert voiced that the screenshots presented too much information and advocated that end users provide ultimate feedback. Using speech-to-text functionality to enter medications on the list was supported by some experts, but discouraged by others who raised concerns about problems with pronunciation and inaccuracy of the medication entered. The alternative way consisting of having the information autopopulate as the user types in the first few letters of the medication was seen as risky and prone to errors because of the variety of presentations available in the market. Finally, experts believed the app should allow ordering medications from the pharmacy.took option. Experts discouraged the use of skip as one of the options, because they believed this word seemed to give permission to be nonadherent. Rather, it was suggested that not taken or other neutral word be used. This should be followed by a text message to notify the caregiver. Several experts commented that the snooze option should be coupled with a functionality of how long to snooze the reminder for.With regard to the medication reminder feature, experts suggested that the reminder delivery mode  vary depending on whether medications were optional or mandatory and that a sketch of the pill be shown on the reminder screen. Geotagging reminders to go off when the person is at home or at work was another idea. Following the reminder, the app should provide feedback as an audio verbal and as a sound when patients tap the As per the medication administration record feature, comments that the dashboard  should depend on the number of medications taken daily  were made. A display of how the user is doing in terms of adherence compared with other peers or a gaming reward system to serve as a motivational effect to promote adherence were also proposed. The ability to email or export an adherence report within the app was deemed helpful, as was the ability to record reasons for missing doses.A compilation of all the expert remarks is presented in In this study, we reviewed existing medication management apps and identified app features that appeared particularly relevant in supporting independence of young adults who have DDs during the medication management process. Of the 42 different features assessed, almost 65% achieved consensus for inclusion in a future medication management app.The strength of our study is that the panel of experts included persons with disabilities as well as other stakeholders involved in their care. The number of experts included was within the recommended range , and we Within the medication list feature, experts considered information on how to take the medication and specific aspects such as dosage and indication essential. It was also important for experts that the app included ways to facilitate the entry of a new medication. This is especially critical for individuals with dexterity or visual impairments, as these are more prone to problems in task completion . AlthougThe medication reminder feature, which is ubiquitous among medication management apps, should have 3 reporting options in an easy-to-use screen—taken, not taken, or snooze. Previous studies assessing the experiences of app users reported their desire to keep apps as simple as possible to make processes easier , includiThe top 3 most important additional features selected by experts were the ability to perform automatic refills through pharmacies, to share medication information with providers, and to share medication information with family, friends, and caregivers. Of all the apps reviewed, only 1—Medisafe—included the feature to share medication information with caregivers, which would be of great value for young adults transitioning to independence. Previous studies demonstrated that involvement of caregivers through an app gives them a sense of better being able to monitor and control their child’s condition . This feSeveral safety-related features such as recording side effects and drug allergies, overdose warning, or checking drug interactions also achieved consensus among experts. Specifically with regard to the latter, a recent study demonstrated that most of the apps containing a drug interaction checker did not identify all possible interactions associated with a given medication and half were unable to detect drug-herbal medication interactions . TherefoAdditional features that did not achieve consensus, but that were initially thought to be important for young adults with DDs, were gamification (earning rewards or prizes for being adherent) and socialization. Mixed opinions about gamification were also found in a previous study assessing preferences of users of apps for cystic fibrosis . HoweverAs implications for future app development, participants in this and other studies emphasized the need for customization options to meet individual preferences, needs, and goals ; this maThe methodology used in this study does not provide the depth of information necessary to fully design an accessible app for medication management in this population, but it is a first step toward achieving that goal and provides useful information to adapt existing apps. Of note, as a result of the variety of levels of impairment across different disabilities, apps designed to help in the medication use process may be more applicable to persons who have mild-to-moderate impairment of cognitive or physical function, but this aspect would warrant further research.This study has limitations. First, we selected the screenshots that we thought were the most different from each other and included 4 of them in the questionnaire. Many others could have been selected, yielding different results. However, the screenshots selected allowed the extraction of key design aspects to take into account in future app development. Second, researchers and professionals with an interest in DDs comprised the largest proportion of the panel of experts, which could have affected the results. Third, we did not track individual participation in each round, and this may have prevented input on items previously removed due to consensus being achieved. Finally, 1 limitation with the Delphi method is that the opportunity for experts to elaborate on their choices and produce a dialogue around controversial topics does not exist. This may have been partly addressed by the inclusion of free text comments sections at the end of each module.Although many mobile apps for medication management exist, few are specifically designed to support persons with DDs in the complex medication management process. This study provides information on the features of a medication management app that are most important to persons with DDs and their caregivers that should be taken into account by researchers, developers, and designers who create apps specifically designed for this population. Two key findings from this study are that simplicity is key and that constant communication between the person with a DD, the caregiver, and the health care professional through the app is critical.Future research will require that a medication management app specifically designed for persons with DDs be developed or an existing app be adapted to include the features identified in this study. Further assessment of the impact of using an app on independence, medication adherence, self-management behaviors, and health outcomes is critical to guide their future use, widespread adoption, and, ultimately, financial support by payers.


This article offers a novel perspective on the evolving identities and relationships of human medicine and veterinary medicine in England during the decades that followed the 1791 foundation of the London Veterinary College. Contrary to the impressions conveyed by both medical and veterinary historians, it reveals that veterinary medicine, as initially defined, taught and studied at the college, was not a domain apart from human medicine but rather was continuous with it. It then shows how this social, cultural, and epistemological continuity fractured over the period 1815 to 1835. Under the impetus of a movement for medical reform, veterinarians began to advance an alternative vision of their field as an autonomous, independent domain. They developed their own societies and journals and a uniquely veterinary epistemology that was rooted in the experiences of veterinary practice. In this way, "one medicine" became "two," and the professions began to assume their modern forms and relations. Outlines of the Veterinary Art (1802), veterinarian Delabere Blaine committed himself to improving a "branch that has sprung from, and must grow with medicine as its parent stock."1 Claiming that until recently, the art had advanced mainly "by stealth . . . usually by the exertions of some enlightened physician or surgeon," he aimed to complement the work of the London Veterinary College (LVC) in raising its dignity and utility.2 He wrote for the three groups he thought likely to study the art: surgeons—who had already "travelled three fourths of the road towards making a good veterinarian," "persons of fortune with enlarged minds and extended educations," and "farriers . . . or persons intending to profess veterinary medicine."3 Preferably they should attend the LVC, but if this was not possible they should study general descriptions of the human body, dissect horses "at the tan yard or kennel," and read medical literature on physiology, pathology, comparative anatomy, chemistry, materia medica, and farriery. After this, the farrier lacked only "experience and practice to perfect him."4In his popular and influential book 5 He was not unusual in this regard. During the previous century, elite providers 6Written just a decade after the 1791 creation of the LVC—an event that veterinarians today regard as the foundation of their profession in Britain—Blaine's account draws attention to an important and understudied aspect of medical history: the relationships between human and veterinary domains. Whereas today these exist as separate fields involving different professions, institutions, and human/animal subjects, Blaine's text suggests at the turn of the nineteenth century their relationships were more fluid. Then, the "veterinary art" existed as a "branch" of human medicine, grounded in knowledge of humans and partially populated by surgeons. Blaine's career trajectory reinforces this portrayal. He was originally apprenticed to a surgeon-apothecary, then enrolled as a medical student at the Borough hospitals, London, where he assisted the physiologist, Dr. Haighton, in his animal experiments. He then worked temporarily as a teacher at the LVC, before leaving to take up human civilian then military surgery. Finally he became a veterinary practitioner and author.7 medical historians have generally failed to recognize the interpenetration of human and animal health care in Britain in the decades around 1800. Despite the well-documented epistemological breadth of late eighteenth-century medicine, its inclusion of pursuits remote from medical practice,8 and the many important roles it awarded to animals—as subjects of experiment, comparative anatomy, and natural history and as sources of cowpox lymph for use in human vaccination9—histories of medicine remain largely focused on human healers and their human patients,10 while animal healers and patients are compartmentalized into the separate sphere of veterinary history.11 Authors either fail to consider the possibility that veterinary medicine lay within the boundaries of human medicine, or else reject it outright on the grounds that medical men looked down on and showed little interest in animal health and healing.12With the exception of Michael Mackay, whose doctoral thesis provides an illuminating analysis of these elite equine healers and the horse infirmaries they established in response to the growth of human infirmaries,13 While the early veterinary art did 14 This is acknowledged by veterinarians writing the history of their profession, who recognize that surgeons played important roles in the early years. However their interpretations of this phenomenon are skewed by the presentist assumption that the veterinary profession was always destined to assume its modern shape and significance. Concluding that participation of medical men was a necessary, temporary stepping stone to veterinary autonomy, they celebrate surgeons like John Hunter who helped to establish the LVC, while denigrating others who refused to withdraw from that institution at the "appropriate" time.15The latter opinion is open to challenge because it unproblematically reproduces the rhetorical claims of men like Blaine, who argued that veterinary improvement was needed because the field was degraded and beneath the dignity of a gentleman.In attempting to address these deficits in historical understanding, this article has three main goals. First, it aims to advance conceptions of what constituted human medicine in England at the turn of the nineteenth century by taking seriously its relationship with the "veterinary art." Second, by analyzing how that art was perceived and shaped by its early promoters and participants, it offers a novel perspective on the history of veterinary medicine. Third, having described the highly integrated nature of human medical and veterinary domains circa 1800, it aims to explain their subsequent separation, largely from the perspective of reforming veterinarians who worked to develop an occupational and epistemological identity distinct from that of human medicine.Veterinary Art proclaimed the "prospect of a new era in medicine, [each field] equally perhaps useful and important to the one as to the other."16 It had advanced further by the fourth edition of 1832, in which Blaine wrote the contributions of surgeon-farriers out of history, sidelined the teachings of medical doctors, and referred to veterinarians as a "brotherhood."17 In 1844, the award of a Royal Charter set a legal seal 18 Concurrently, human medicine underwent its own, well-documented transformations as new medical knowledge, cultural values, professional overcrowding, and the wider climate of social, political, and religious reform prompted the questioning and refashioning of medical institutions, identities, and epistemologies.19 This article draws heavily upon historical accounts of the latter events in order to make sense of and demonstrate their connection with changes in the veterinary field.As we will see, this separation was under way by 1826, when the third edition of Blaine's 20 Students who passed its examinations were deemed "qualified to practice the veterinary art" and assumed the title "veterinarian," or (after army commissions were introduced in 1795) "veterinary surgeon." They either joined the army, or entered a competitive market for animal healing that was already populated by farriers (who treated livestock as well as horses), horse doctors, cow leeches, blacksmiths, druggists, cunning folk, country surgeons, and animal owners.21 Along with their teachers, these men wrote the first texts on the "veterinary art," a term that was used interchangeably with "veterinary medicine" and less commonly "veterinary surgery." Unlike in human medicine, there was no distinction between the practice of physic and surgery.In this analysis, "veterinary" will be treated as an actor's category. It was first defined as an occupation and as a field of enquiry in Britain by men who created, taught and studied at the LVC.22 Mackay has argued convincingly for its overlap with the "improved farriery" pursued by elite eighteenth-century medical men. In the closing decades of the century, these men—who were mostly surgeons—established 23 Its promoters may have adopted the term "veterinary" in order to create a  distinction from farriery, and to position it alongside the French Ecoles de Veterinaire in Lyons (est. 1762) and Alfort (est. 1765). Their founder, Claude Bourgelat, had adopted the title for that very reason, and the LVC's first principal, Charles Vial de Saintbel, had trained under him at Lyons.24While veterinarian-historians have tended to regard veterinary medicine as discontinuous with the preexisting form of animal healing known as farriery,25 The focus is more on the image of English veterinary medicine than on its actual practice, which remains a subject for further investigation. However, for the purposes of this article it is important to note that while veterinarians sometimes treated farmed livestock, pets, and occasionally exotic animals, horses were the most common veterinary patient, and in military contexts and the LVC infirmary other species were seldom if ever seen. The most common condition treated by the LVC was lameness, which had multiple causes and was generally managed through surgical interventions and the use of specially designed shoes, fitted by blacksmiths under veterinary supervision. Horse patients were also treated with physic for various internal ailments, and frequently bled.26This article draws on the books, journals and correspondence of the first English men to define themselves as veterinarians in order to determine how they perceived the veterinary art and its relations to human medicine, why they participated in it, and how they contributed to its evolution over time. Scottish veterinary medicine—which grew out of the school founded in Edinburgh in 1823 by farrier William Dick—is beyond the scope of analysis, although this would make for an instructive case comparison.Through exploring the early participation of medical men in the formation and running of the LVC, the first section of this article will reveal that circa 1790 to 1810, veterinary medicine lay within the broad domain of human medicine. The second section explores how its identity was 27 He went on to exhibit Eclipse's skeleton in his home. He also announced his intention to lecture gentlemen on horse anatomy, physiology, and disease, and to accept as lodgers those "inclining to make extraordinary improvements in the veterinarian art."28 Penn helped to set these plans on a more formal setting. A London-based committee was created and raised funds by subscription for a veterinary college. It appointed a president (the Duke of Northumberland), vice presidents, 29In 1792, the LVC opened its doors to pupils. Established with the objectives of teaching the veterinary art, establishing a veterinary infirmary, and encouraging the pursuit of veterinary science, it represented the culmination of a drive to improve farriery initiated several years earlier by the Odiham Agricultural Society. This small, provincial organization had pursued this goal as part of its wider agenda for agricultural improvement, which was a popular Enlightenment ambition. The decision to found a college derived from a chance meeting between one of its members, the wealthy Quaker, scholar, and reformer Granville Penn, and the French veterinarian Charles Vial de Saintbel, who was already planning such a college. Saintbel had moved to England in 1788 following his studies at the Ecole de Veterinaire in Lyons and a post as comparative anatomy demonstrator at the Montpellier medical school. In 1789 he made a name for himself in horse-racing circles after dissecting the famous British racehorse Eclipse.30 It formed a medical experimental committee to suggest experiments to be carried out at the LVC. Populated wholly by medical men, particularly surgeons, the committee's remit was soon extended to staff appointments, student examinations, and awarding signed diplomas to successful candidates.31 Many of its members were associates and former pupils of John Hunter, and would dominate the London hospitals and the Royal Colleges of Surgeons and Physicians for decades to come. Their reasons for participating in the LVC are best understood by reference to what historian Michael Brown has termed the culture of "medico-gentility." This offered a way for medical men—and particularly surgeons, who were trying to shed their reputation as uncultivated manual workers—to differentiate themselves at a time when medicine had not yet developed into a bounded vocation characterized by compulsory licensing, specialist education, the exclusive possession of scientific expertise, and a strong professional identity. Orienting themselves toward polite society rather than the medical collective, medical gentleman sought gentility through active participation in civic life, the cultivation of social networks, and investment in various enlightened pursuits that formed part of—but were not exclusive to—the broad epistemological domain of medicine.32Medical men were enthusiastic participants in the creation of the LVC. Its vice presidents included the prominent surgeon John Hunter (who died in 1794), Sir George Baker (physician to the king), and Sir William Fordyce (a prominent London physician), as well as three earls, a lord, and a baronet. The board contained nobles, gentlemen, and a number of other medical men.33These pursuits included a number of animal-related areas of enquiry that connected to veterinary medicine. As already noted, elite equine farriery had begun to attract converts from medicine in the early eighteenth century. Amid growing interest in large-scale horse racing, selective horse breeding, hunting on horseback, and the performance of cavalry horses—which generated a market demand for elite horse healers and fueled aristocratic interest in the LVC—physicians like Henry Bracken and surgeons such as William Gibson and William Osmer worked to 34 Livestock were important to this agenda, but their improvement was threatened by repeated epidemics of the highly contagious and fatal disease known as cattle plague or rinderpest. Medical men made considerable efforts to elucidate, prevent, and control this disease. Its ravages gave impetus to the LVC by inspiring the Odiham Society—whose members included several medical men—to pursue the improvement of farriery.35Agricultural improvement was another area of medical interest. Working alongside the landed gentlemen whose estates were being transformed through enclosure, certain eighteenth-century medical men sought to uncover and communicate the principles of improvement through agricultural and horticultural societies, texts, and pamphlets, and the conduct of trials and experiments.36 The surgeon John Hunter, whose work was widely credited with raising the scientific status of surgery, was a particular enthusiast. He inspired pupils and colleagues to follow suit, and join him in supporting the LVC. His enormous collection of human and animal specimens attracted the attention of nobles and gentlemen. 37 Some of its members pledged support for the LVC.38There was also a long-standing medical tradition of studying animal bodies through observation, dissection, collection, and experiment. These activities overlapped with the polite gentlemanly art of natural history. Medical men, particularly surgeons, worked to identify the similarities and differences between humans and animals; to understand how bodies functioned in health and disease; to test out surgical and therapeutic interventions; to construct hierarchical classificatory systems that demonstrated human-animal relationships; and to convey this information to students and interested onlookers.39 Their participation also enabled them to forge social connections with elite supporters , and to display the relevance of their expertise to the LVC's advertised objective: "to amend, and bring into a regular system, that important branch of medicine which regards the treatment of diseases incident to horses and other cattle, and which has hitherto been neglected, and much abused in this country."40Medical and gentlemanly participants in the above activities valued them not only for their contributions to knowledge and practice, but also because of their moral worth in enhancing understandings of God's plan, nurturing improvement, advancing science, ordering society, and preventing animal suffering. The foundation of the LVC provided an opportunity for them to integrate and advance these various agendas, and thereby elaborate their identities as enlightened, benevolent gentlemen. Its medical supporters were not particularly concerned with practicing veterinary medicine themselves. Rather, as in their concurrent efforts to improve human surgery, they aimed to establish and propagate a set of enlightened principles to guide its practice by others, and through which they could establish their own gentlemanly status.41 By then, he had fallen out with and caused the departure of Blaine, who had earlier accepted an invitation to teach at the LVC because he was "enthusiastically attached to animals . . . as well as to natural history and comparative anatomy."42 Following a lengthy search, the medical committee selected two new principals, both surgeons. William Moorcroft had trained also as a veterinary surgeon at Lyons on the advice of John Hunter, and ran a veterinary practice in Oxford Street. After just six weeks in post he resigned citing ill health, leaving the LVC in the sole charge of Edward Coleman until his death in 1839.43Surgeons also exerted considerable influence over the staffing and running of the LVC. Although Saintbel, the first principal, was not a surgeon, he was in post for only two years. In 1793 he died suddenly, probably from the horse disease glanders.44 The medical committee declared him to possess "great knowledge in the veterinary art."45 He had no practical experience of it—indeed Astley Cooper claimed he would "burn his fingers if he tried to burn on a horseshoe"—but his talents "were of a higher and more refined kind."46 As a qualified surgeon and "man of science," he grasped the learned principles of the art, and was therefore considered able to teach and improve it.47Coleman had studied under Henry Cline, surgeon to St Thomas's Hospital and a member of the LVC's medical committee. With fellow pupil Astley Cooper , he had attended John Hunter's lectures and performed animal experiments, most notably to investigate the suspicion that death by hanging and drowning was caused solely by mechanical blockage of the windpipe. He had also enquired into the comparative anatomy of the eye.48 Most veterinary students also undertook apprenticeships. They came to London to add knowledge of principles to their experience of practice. They paid Coleman twenty guineas to attend his lectures on the veterinary art, training in (horse) dissection, and clinical teaching in the LVC infirmary on horse patients belonging to wealthy college subscribers. Coleman also encouraged pupils to attend external lectures for medical students on human anatomy, comparative anatomy, physiology and surgery, materia medica, chemistry, and the practice of physic. These were provided by members of the LVC's medical committee and their associates, who had followed John Hunter's lead in inviting veterinary students to attend free of charge in the wake of Saintbel's death. This provision reduced the need for lecturing at the LVC.49 Members of its medical committee were also responsible for examining veterinary students and signing the diplomas of those who passed. Their national reputation was intended 50 It also reinforced the idea of veterinary medicine as a branch of human medicine.The education offered by Coleman focused almost exclusively on the horse. It resembled and overlapped with that of medical students, who were increasingly supplementing their traditional apprenticeships with a period spent walking the hospital wards and attending lectures offered by hospital doctors and other entrepreneurial medical men.51 Students reluctant to take the whole course could attend fourteen lectures on the veterinary art delivered by Coleman at Guys Hospital from 1801, probably with the support of his friend Astley Cooper.52 Various reasons were put forward for why such men should study the veterinary art: their surgical knowledge was highly relevant to it; they would learn how to advance the "study of disease by analogy," to care for their own horses, to treat other people's where no skilled farrier was available, and to enter veterinary practice.53 Another compelling reason arose in the context of the French revolutionary wars. In 1795, recognizing the military significance of healthy horses, and in desperate need of money due to Saintbel's mismanagement of LVC finances, governors petitioned Parliament for funds. In return, they promised that Coleman, "a man of science . . . and liberal education," would train one pupil from each regiment in the veterinary art.54 Parliament approved the grant. Made annually until 1813, it netted the college over twenty-five thousand pounds in total and reinforced the curricular focus on the horse. In addition the Board of General Officers appointed Coleman chief veterinary surgeon to the cavalry and the Board of Ordnance, and announced its intention to commission veterinarians as officers to each regiment.55This idea was consolidated through the enrolment of surgeons and surgical trainees as LVC students. Governors actively encouraged this, in the belief that their participation would elevate the veterinary art.56 The 57 Evidence suggests that in the first ten years of the LVC's existence, the majority of the 101 students who qualified were surgeons. Nearly half of the total entered the army, thereby achieving status and a respectable wage.58 This situation provided Coleman with an opportunity to publicly display his enlightened credentials. He announced that the commissioning of veterinary officers had raised the veterinary art "from contempt to respectability" by inducing "medical students of liberal education, to devote their services to its improvement."59Veterinarians thereby gained a new military role, ranked higher than that of regimental farrier and on par with the human surgeon. It was in this context that the term "veterinary surgeon" was adopted.60 They highlighted the analogies between human and equine bodies, and human and veterinary medicine, while pointing out the greater difficulty of veterinary medicine on account of the dumb, irrational nature of the horse. Locating themselves within a genealogy of eighteenth-century medical improvers of farriery, whose achievements they documented and evaluated, they presented human 61 One author went so far as to claim that "the art never made any progress until it attracted the attention of those who had made special study of human economy. . . . Almost the only rational improvements . . . were either suggested or carried into effect by medical men; and nothing will contribute so much to its perfection as the interest which the profession has lately shewed to it."62A close reading of veterinary texts written circa 1798 to 1810 reveals that early veterinarians—many of them surgeons who took up army commissions—adhered to the same cultural values and epistemological outlooks as the LVC's medically trained promoters and teachers. These authors situated veterinary medicine firmly within the domain of human medicine, and sought, through its improvement, to advance their own identities as gentlemanly members of polite society.63 Authors pointed the way to a more enlightened approach, in which owner, horse, and nation would benefit from "the full establishment of rational practice, in which humanity and tenderness are blended with judgement, directed by experience."64 In this way, they presented themselves to their publics as learned, benevolent, improving gentlemen.Authors opened their volumes with florid dedications to royalty, aristocracy, members of the LVC committee, and Professor Coleman, and directed them at audiences of gentlemen, the nobility, medical men, veterinarians, and farriers. They included lengthy, erudite chapters on history, comparative anatomy, and the principles of horse management in health and disease. Their tone was moralizing and improving. They spoke of the horse as a noble and useful animal, of first importance to the nation and next to the human in dignity. Left in the hands of empirical blacksmiths, grooms, and stable boys, who were ignorant, cruel, prejudiced, and corrupt, its health had been sadly neglected. Such men had disparaged learning, had manipulated their employers, and, for reasons of personal gain, had discouraged the sending of horses to the LVC.65 Historians have explored this shift within human medicine. They reveal how a group of middle-class general practitioners—in which religious dissenters were well represented—turned away from civic society to develop a new collective identity as scientific experts who served the public through the development of useful knowledge. Their challenge to the older culture of medico-gentility and its polite forms of knowledge was lengthy and contentious. Fueled by economic competition between a rapidly expanding body of general practitioners and the burgeoning ranks of druggists and "irregular" healers, it underpinned what historians have labeled "the age of medical reform."66Subsequent decades saw dramatic shifts in the epistemology of human medicine and the culture that had encouraged aspiring medical men to situate veterinary medicine within it. This was part of a wider shift in knowledge and social organization brought about by the disaggregation of broad eighteenth-century modes of thinking and operating into more 67 Through the medium of journals like the Lancet (est. 1823)68 and vocationally specific groupings such as the Provincial Medical and Surgical Association , general practitioners sought to reform medical institutions, structures, and values. As in the wider political arena, they condemned as corrupt the traditional ways of working that relied on patronage and interpersonal connections, and charged their upholders with financial self-interest and the failure to advance society. They called for more democratic, meritocratic, technocratic forms of governance that would promote and reward the development of useful scientific knowledge, and erect barriers between regular and irregular healers. Their particular targets were the leaders of the Royal Colleges of Physicians and Surgeons, and the staff of the London hospitals, whom they charged with nepotism, self-interest, and the failure to value, pursue, and disseminate useful scientific knowledge.69Efforts to refashion medical knowledge and culture were constitutive with a wider reformist agenda, manifesting particularly in the 1820s and 1830s, in bids to outlaw slavery, remove trade monopolies, and bring about electoral reform, the democratization of town councils, and the dismantling of legal restrictions on nonconformists.70 Consequently, the LVC was subjected to criticisms that were almost identical in language and content to those that reformers directed at the London hospitals and the Royal Colleges of Physicians and Surgeons, and via one of the same vehicles: Thomas Wakley's radical weekly, the Lancet. Its attack commenced in 1826, when Wakley opened correspondence columns to (largely anonymous) complaints about "abuses" at the Veterinary College, and lent his editorial support to them.71Since veterinary medicine was widely perceived to be part of human medicine, it was not immune to these developments. In fact it experienced its own campaign for reform, directed against the LVC. By the 1820s, the governors of this institution were largely inactive. Meeting in small numbers once a year, they seemed content to leave the college in the hands of Coleman and the medical examining committee. Members of that committee composed the same elite circle of doctors who were targeted by the campaign for medical reform.72 They followed Wakley's example, and founded two of their own periodicals in 1828. The short-lived Farrier and Naturalist (1828–31) was created by Bracy Clark, a Quaker, surgeon, member of the Linnean Society, and one of the first students to enter the LVC. His language and sentiments directly replicated those of Wakley. The Veterinarian was a more moderate publication founded by William Youatt, a former Unitarian minister who had attended the LVC (without taking its diploma) and worked with Blaine for twelve years before taking over his practice.73 Both journals published editorial commentaries, correspondence, and scientific and clinical material, whose content reflected their editors' particular interests in the scientific shoeing of horses (Clark), and comparative anatomy and pathology (Youatt).Practicing veterinarians, many of them religious dissenters, were highly active in the campaign for LVC reform. They met in London taverns to voice their complaints and develop plans of action.Lancet editorial, "For the prosecution of physiological enquiry, for the cultivation of comparative anatomy, and for an acquaintance with the diseases of domestic animals . . . no institutions are so well adapted as those termed veterinary colleges."74 However, this potential had not been realized, for the LVC had published no lectures, case reports, or scientific findings. "Where are the fruits of 30 years in comparative anatomy and medicine?" asked Bracy Clark's Farrier and Naturalist. "Not a single fact has been added by this pompously announced [medical examining] committee to the common stock of zoological knowledge."75 Its failure meant that as in human medicine,76 veterinary medicine in Britain lagged far behind the continent.The sentiments expressed by LVC reformers  indicate their departure from the earlier culture of medico-gentility, and adoption of a new utilitarian and technocratic outlook that privileged scientific knowledge as a route to social progress. Rejecting the earlier notion that medical participation in veterinary medicine would automatically lead to its improvement, they demanded concrete evidence of medical contributions and found it lacking. Not only had the LVC failed to look beyond the horse, but even here it had failed to advance knowledge and practice. According to a 77 ruling over "one of the most rotten public establishments in England,"78 which operated more as "a private school, than as a free and public College."79 The substantial public subsidy that Parliament awarded the school had been turned into private profit. Medical examiners pocketed fees from students who they were incapable of examining properly on account of their lack of practical veterinary knowledge, while Coleman's avarice in pursuing private practice as well as his army posts detracted from the delivery of veterinary education.80 The LVC's low standards had "deluged the country with pretenders" who knew nothing of the veterinary art and "are laughed 81 The Lancet concluded, "With its patronage, funds and means it possesses of promoting the science of zootomy it is disgusting to reflect that it has served only as a mass of corruption to fatten some of the idlest and most unworthy drones."82Critics attributed this state of affairs to the LVC's nepotistic culture that rewarded privilege rather than merit. They described Coleman and the medical examiners as a "self-selected" "tyrannical few"83 of mobilizing particular social, political, and religious agendas.While the overlap between veterinary and medical campaigns for reform can be explained by reference to their shared targets, the London medical elites, evidence suggests that this was not the only reason. Veterinary reform attracted the attention of medical reformers because they—like the very men they were criticizing—still perceived it to be part of the wider medical domain. Although the earlier diversity of medical knowledge was giving way to more specific forms of vocational expertise, animals and their health and healing still held considerable interest to medical men, but for different reasons than in earlier years. This interest was no longer a marker of polite gentlemanly identity, but a means of advancing knowledge and practice, and 84 medical men sought to elucidate diseases like rabies and glanders that seemed to transmit between them;85 to elaborate species similarities and differences through comparative anatomy;86 to advance physiological understandings through animal experiment;87 and to treat sick horses belonging to themselves, their patients, and other people.88 Their interests were reflected in Wakley's Lancet, which regularly published lectures, meeting reports, articles, book reviews, and correspondence on matters concerning animal diseases and veterinary medicine. This continued even after the creation of dedicated veterinary journals. 89On the grounds that humans and animals were bound by the same fundamental biological laws,Lancet's criticisms of the LVC, and shared the values of medical reformers , they did not see themselves as participants in a broader effort to reform medicine. Rather, their ambition was to establish veterinary medicine as an independent sphere, a "sister" profession rather than a child of the medical parent. As the remainder of this article will reveal, this aspiration reflected their growing perception of themselves as a distinctive body of men holding a specific body of expertise, which could be taught, examined, and advanced only by practicing veterinarians.By contrast, veterinary reformers, including those who had trained also as surgeons, were beginning to develop a quite different vision of their domain. Although they welcomed the 90 To animal owners, the veterinarian's superiority was not self-evident, either socially—because the ranks of LVC students were swelled by the sons of tradesmen and farriers—or practically—because its training focused mainly on principles pertaining to the horse, and could last as little as three months.91 This situation led practicing veterinarians to develop a somewhat paradoxical relationship with the LVC. As shown above, they became highly critical of its failure to effect improvements in the veterinary art. At the same time, they identified increasingly with it, as the source of a collective identity that distinguished them from other animal healers.With the end of the Napoleonic Wars in 1815, veterinary opportunities for army commissions diminished. Consequently, more veterinarians sought work in private practice, where they had no monopoly on posts, or position within a predetermined hierarchy. They entered a competitive marketplace populated by many different healers, and in which horses were not the only patients.92 Whereas in 1802 Blaine (who did not hold an LVC diploma) claimed that anyone prepared to study the veterinary art could call themselves a veterinarian,93 holders of the LVC's diploma subsequently became more jealous of their title.94 They even queried Blaine's status, leading him to complain in 1831 of his exclusion from "the brotherhood," and to present his entire biography in an attempt to establish himself as a "legitimate" veterinarian.95 Likewise, Youatt felt it necessary to remark in 1828 that without a diploma he might be called "a bastard of the profession" but was nevertheless anxious for its improvement.96This identification can be seen in the way that veterinary reformers rewrote history during the 1820s and 1830s to minimize the contributions 97 Like its many medical counterparts—which were equally important to the development of a collective identity98—it met weekly and provided a key forum in which students, practitioners, and teachers presented papers, exchanged views, and forged a shared occupational bond.The creation of veterinary medical societies encouraged veterinarians to identify more with each other and their alma mater. The first was established in London in 1812 by Thomas Mayer, an LVC student who had already completed apprenticeships with a farrier (his father) and a surgeon. As a supplement to Coleman's teaching, he chose to attend lectures at the Windmill Street School, which led to his membership of the Westminster Medical Society associated with it. Having witnessed its benefits to medical students, he was inspired to create a similar society for veterinarians, which was subsequently brought under the LVC.99 Bracy Clark believed they should have been excluded altogether.100 A third society formed in 1836.101 Meanwhile, as already noted, Youatt and Clark founded their veterinary journals. Modeled upon the Lancet, the Veterinarian and the Farrier and Naturalist published scientific articles, editorial comment, and correspondence that served to educate readers, sharpen their political awareness, and build a sense of community. Blaine saw their creation as the most important event in veterinary medicine since the foundation of the LVC.102In 1828, Youatt and the practitioner William Goodwin founded a second London Veterinary Society. Its rules recognized "all persons engaged in the study or practice of Veterinary medicine" as eligible to become ordinary members. Medical men, including medical lecturers to veterinary students and "physicians or surgeons of eminence, who have 103 Other, more relevant forms of education had emerged. From 1829, Youatt—who emerged as the most vocal and long-standing critic of Coleman's almost exclusive focus on the horse—offered a course of lectures on the anatomy, physiology, and diseases of domestic animals with the assistance of William Percivall. These were provided at the invitation of London University, a new, nondenominational, utilitarian institution directed toward professional improvement. Offered to both veterinary and medical students, the lectures were acclaimed by and published in the Lancet.104 Shortly afterward, Charles Spooner (Youatt's former assistant) and William Morton (the LVC's dispenser) followed the example of many medical lecturers and established private classes in veterinary anatomy and pharmacy outside the walls of the LVC.105 Youatt also recommended veterinary students to attend the London University course on comparative anatomy given by Robert Grant, who was appointed in 1828 to England's first full-time chair in the subject. A number of other medical men began to offer comparative anatomy courses at around the same time.106107 the new veterinary epistemology was inherently political. It was a utilitarian body of knowledge that advertised the merits of practice over theory, and actual experience of animals over analogical reasoning about them. Developed by veterinary reformers, it aimed to set distance between what they considered to be veterinary medicine, and the domain as envisaged by both older medical elites and medical reformers. It was most evident within equine farriery and comparative anatomy. This was no coincidence because, as shown above, medical interest in both fields predated the LVC's creation and continued to develop alongside it, lending support to the idea of veterinary medicine as a branch of human medicine. By creating their own versions of them, veterinary reformers sought to challenge and overturn this perception.At the same time, veterinary student attendance at human medical lectures diminished. Having earlier trumpeted their value, by 1831 Blaine was claiming that they were merely "a secondary consideration" that students should consider only after completing their veterinary lectures.108 Coleman followed in this tradition. He disseminated his views on shoeing and the horse's feet via student lectures,109 and in his only publications, which appeared soon after his appointment to the LVC.110 As army veterinary surgeon, he oversaw the application of the shoes he designed to the cavalry, and encouraged their adoption by the general public through establishing forges around London that were run by former students.111 Farriers were quick to ridicule 112 Veterinarians appeared to accept them initially, but as the culture of medico-gentility fractured and reforming sentiment took hold, they subjected them to public scrutiny and criticism, while proposing rival principles and shoe designs.113Fundamental to farriery was the correct mode of shoeing a horse, which was performed to protect horses' feet and to prevent or manage lameness, one of the key health problems of the day. Eighteenth-century efforts to improve farriery had involved the development of new principles of shoeing and designs for horse shoes.114 It proved impossible to reach consensus on the correct way to shoe a horse. This was partly because some of the key protagonists  were business rivals, running practices and forges within a small part of London's West End, where they competed with each other and with farriers. It was also because views on shoeing were informed by political and religious sentiments. In the age of reform, opinions on the ideal relationship between hoof and shoe reflected protagonists' diverse beliefs about the ideal relationship between state and citizens, and between God and his subjects.During the 1810s and 1820s, fierce debates on the relative merits of these systems played out within the medical, veterinary, sporting, and popular press.115 By contrast, the Quaker Bracy Clark, who ran a long-established practice in London's East End, claimed that shoeing was fundamentally problematic because it used nails that constrained the natural movement of the foot and caused injury. In reflection of his radical liberal politics, he advocated that shoes be abandoned, or 116 Blaine, also a dissenter, represented the pragmatic, utilitarian middle ground. He believed that while shoeing was necessary to protect the hoof, no single shoe fitted all horses, therefore a selection should be made according to the type and use of horse, with as "little departure from nature as circumstances can justify."117 Other veterinarians arranged themselves along this political and religious spectrum.As a conservative member of the establishment, Coleman had looked to tradition for inspiration on shoeing. Taking up the shoe invented by La Fosse, a farrier to the French king, he made adjustments to ensure that it would not oppress the hoof's natural functions—in the manner that absolute rule had oppressed the French populace—but rather support and protect them, just as British citizens were supported and protected by the rule of constitutional law. The emphasis he placed on the need to prepare the hoof to accept the shoe resonated politically with resistance to the concept of popular sovereignty.118Although they failed to agree with each other, veterinary reformers united in opposition to Coleman. They claimed that his methods had harmed horses and profession alike, and were pursued purely for reasons of personal financial gain. They believed his approach to shoeing to be entirely flawed because he had no practical skill in shoeing horses. Instead, he worked on the basis of "false theory," constructed on the basis of anatomical analogies with the human body. By contrast, their methods had been developed through long experience and experiment with horses within military settings and veterinary practice, and were designed solely for the benefit of the public. For Clark, Coleman's refusal to acknowledge his failings revealed all that was wrong with "protected incorporations of men, who have interests at variance with the science they profess, and who view invidiously any knowledge or discovery not originating with themselves."Veterinarian and in lectures to London University, Youatt and Percivall advanced a distinctively veterinary concept of comparative anatomy, which deviated from that held by medical elites and medical reformers. As Desmond has shown, comparative anatomy was a key battle ground in the campaign for medical reform. In correlating structure with function, medical elites drew on Cuvier and Paley's natural theology to argue that nature—and by extension, society—was perfectly designed and sanctioned by God. By contrast, in perceiving animals to be formed on the same basic plan, but to vary in how they developed from it, reformers drew on the ideas of Lamarck, Geoffroy Saint-Hilaire, and Romantic naturphilosophie to propose that nature and society were progressive and changing.119Meanwhile, in the 120 incorporated 121 and utilized Cuverian classification in his books on the dog, horse, and cow.122 However, he differed from both groups in one crucial respect. Whether they adhered to the radical notion of self-organizing matter, or to the Paleyite belief in God as the divine architect, medical comparative anatomists were primarily concerned with discovering the universal principles common to all living things. Their search for these principles—which formed part of their wider efforts to raise the status of surgery by making it scientific—often began with very simple animals, on the basis that human complexity tended to obscure general laws, and that there was sufficient analogy between human bodies and those of lower animals to permit inference from one to the other.123In some ways, Youatt's views were closer to those of medical elites than those of medical reformers. He preached upon Paley in 1803,124 These facts derived largely from domesticated animals, and in collecting them, veterinarians aimed to uncover the differences between species rather than the similarities sought by medical men. This search for difference had obvious political connotations. In subsuming the differences between species, medical men had subsumed veterinary within human medicine. Through elevating species difference, veterinary reformers sought to create a distinctive and independent identity for their field.By contrast, as their views on both farriery and comparative anatomy reveal, veterinary reformers were extremely hostile to analogical reasoning. According to Youatt, "reasoning from analogy is here dangerous and inadmissible. We appeal to facts, and to facts alone we bow."125 Second, because what is "different in a state of health will be different in a state of disease,"126 comparative anatomy had practical utility. For Youatt, veterinary medicine was "comparative anatomy made to bear 127 It followed that "to practice the veterinary art in all its branches, the veterinary surgeon must be a comparative anatomist."128 In support of these points, veterinarians frequently cited the comparative anatomy lecture delivered to the Royal College of Surgeons in 1818 by William Lawrence,129 a surgeon, reformer, and cofounder of the Lancet: "Comparative anatomy bears the same relation to the veterinary art that human anatomy and physiology do to medicine. . . . The peculiarities in organic structure and functions of particular genera or species lead to corresponding peculiarities in their disorders or derangements. Hence, a rational treatment of the disorders incidental to animals, presupposes a knowledge of the generic and specific characters of internal organization."130There were several ways in which a comparative anatomy focused on species difference advanced the veterinary political agenda. First, it lent a scientific character to the veterinary art and its practitioners, which helped to set it apart from empirical farriery and on a par with human medicine.131 They enabled veterinarians to uncover "the most unexpected and inexplicable difference in the diseases to which the same organs were exposed, and the effect of certain medicines."132 Through publishing select reports on his cases in the Veterinarian under the heading "comparative pathology,"133 Youatt sought to illustrate "the different character of disease in animals of different structure, food and habits."134 He expressed hopes that such contributions to "knowledge of comparative pathology, that inexhaustible mine of medical improvement" would vindicate veterinary claims to be "distinctly separate yet closely allied" to medicine.135Third, practicing veterinarians saw themselves as uniquely capable of advancing this form of comparative anatomy and the associated domain of comparative pathology through their experiences of sick animals. These experiences were extremely extensive: in 1833 alone, Youatt's practice recorded 1,748 cases, including 426 horses, 1,066 dogs, and 144 zoo animals.136 They also argued that while medical examiners claimed expertise in comparative anatomy, their failure to understand the particular differences between species made them incapable of pronouncing on veterinary students' competence to practice. Without direct experience of sick animals, these examiners, like the medical men who dabbled in veterinary practice, could only draw deductions through analogical reasoning, which was dangerously misleading. It was therefore essential that they cede such roles to practicing veterinarians.137 In this way, veterinarians constructed an epistemological basis for their political campaign to win independence from human medicine.Finally, comparative anatomy provided veterinary reformers with a weapon to attack medical men who claimed expertise in what they considered to be their domain. They attempted to undermine Coleman's In exploring the evolving relations between human medicine and early veterinary medicine in Britain, this article offers a significantly new interpretation of both of their histories. In the first place, it shows that veterinary medicine, as initially defined, taught and studied at Britain's first veterinary school, was not a domain apart from human medicine, but rather was continuous with it. This continuity was social, cultural, educational, and epistemological. Medical men, including some of London's most prominent surgeons, molded the early development of veterinary medicine through assuming roles as LVC vice presidents, board members, teachers, and examiners. As LVC students and future army veterinary surgeons, they followed a curriculum that was modeled on and overlapped with that of human medicine. In their embrace of veterinary medicine, these men were neither the heroes nor the villains described by veterinarian-historians. They were motivated partly by the way that veterinary medicine integrated their preexisting interests in animals, as expressed in the study of equine farriery, agricultural improvement, comparative anatomy and animal experiment. In addition, within the prevailing culture of medico-gentility, the promotion and pursuit of veterinary medicine offered opportunities for them to establish themselves as polite, benevolent, and improving gentlemen. They transmitted these values to the first generation of veterinary students, along with the conviction that veterinary improvement depended upon the participation of medical gentlemen capable of identifying its scientific principles.Therefore, in many ways, human and veterinary medicines in Britain at the turn of the nineteenth century were essentially "one medicine." This finding raises a new historical problem. If the foundation of the LVC resulted not—as veterinarian-historians claim—in the establishment of a distinctive veterinary professional domain, but in "one medicine," then how, when, and why did that evolve into the two separate medicines that exist today? This article locates the answer to the problem within early nineteenth-century efforts to reform the knowledge, politics, values, and institutions of (veterinary) medicine. It suggests that veterinarians were the key protagonists, for although medical reformers were engaged in attacking the very people and cultures that had encouraged the late eighteenth-century integration of human and veterinary medicine, they did not abandon their interest in animal bodies and diseases. Indeed, that interest continued to evolve under the impetus of their newly utilitarian, scientifically focused agendas. It meant that when medical men like Thomas Wakley campaigned for LVC reform, they did so in the belief that human medicine and veterinary medicine were "one," whereas veterinarians who embarked on the same objective pursued the ultimate goal of separating veterinary from human medicine and establishing it as an autonomous professional domain.The ambitions of veterinary reformers like Clark and Youatt grew out a new, collective veterinary identity that developed in the two decades following the Napoleonic Wars. Forged in the context of a competitive marketplace that demanded expertise in the health of various animal species, it grew out of shared experiences of LVC education and veterinary practice, and was fostered by new societies and journals. It involved the construction of a new veterinary epistemology that derived from and contributed to the improvement of veterinary practice. In privileging experience over reason, and species differences over commonalities, this epistemology took farriery and comparative anatomy in directions quite distinct from those pursued by medical men. It also encouraged veterinarians to see themselves as a breed apart: as scientific practitioners who were more educated than farriers, and more practically competent than medical men. These developments meant that although veterinary medicine did not achieve political independence from human medicine until the 1844 award of a Royal Charter, which established its own governing body, by the mid-1830s it had largely assumed its modern identity and characteristics as a field allied to yet distinctly different from human medicine.138 Its practitioners remained alert to medical encroachments on what they perceived to be their turf, and they continued to assert the distinctive nature of their expertise as derived from experiential knowledge of specific animals, as opposed to the general medical understandings generated through extrapolations across species.139 The period 1815 to 1835 was therefore crucial in establishing the somewhat conflicted and paradoxical relationship with human medicine that came to characterize the modern veterinary profession.Paradoxically, this article reveals that although the ambition to create an autonomous veterinary domain originated among veterinarians, it was human medicine that provided them with the tools for achieving it. In 140 Instead, he emphasizes the cultural process whereby medical men came to imagine themselves as a collective, possessing shared goals, values, and knowledge that were distinct from those of civil society.141 This article shows that this process of imagining was not unique to human medicine. In revealing that developments within it inspired vets with overlapping histories to envision themselves likewise as an independent profession, it suggests a possible explanation for how the norms of medical professionalization came to characterize the health professions in general.These findings have two broad implications. First, they enhance general historical understandings of the professionalization process. In his account of human medicine in this period, Brown critiques the traditional, teleological readings that equate professionalization with the achievement of certain structural and institutional landmarks.142 The historical record offers some encouragement to their efforts by revealing that animals and their diseases have long interested both doctors and veterinarians.143 At the same time, in highlighting the considerable efforts that went into constructing social, educational, epistemological, and political boundaries between human and veterinary medicine, this article reveals why One Health today is proving difficult to implement, for such boundaries cannot be transcended simply through the logic of a shared health problem. Rather, if modern veterinary and medical professionals are to work effectively together, it is necessary for them to understand their shared histories, and the factors that drove the original "one medicine" to divide in two.Second, in revealing that the allocation of human and animal health to two discrete professions was not a self-evident development rooted in the biological differences of their patients, but a social historical construct, this article offers insights of relevance to current health initiatives directed at breaking down the boundaries between these domains. Known initially as "One Medicine" and more recently as "One Health," these initiatives are inspired by the shared threats to human and animal health posed by climate change, food insecurity, antimicrobial resistance, and zoonotic diseases. In contrast to the historical "One Medicine" described in this article, its present-day advocates (who are primarily veterinarians) have no intention of merging human and veterinary medicine. Instead they aim to develop collaborative approaches to shared health problems.