Harley Street has long been synonymous with the top echelon of the medical profession, a Harley Street consultant the apogee of the profession. This reputation was forged in the second half of the nineteenth century, and although it dimmed a little in the years after the Second World War, it enjoyed a resurgence in the late twentieth century with the growth of private health care.
The street itself has preserved its residential appearance, despite the fact that for the most part residence is now confined to upper-floor flats. It was first conceived in the early eighteenth century, but largely laid out and built up between the 1750s and 1780s. Although much Georgian fabric remains, there has been considerable rebuilding, particularly in the southern stretches of the street.
From the beginning Harley Street was one of the more fashionable addresses hereabouts, with aristocracy, gentry, politicians, high-ranking clergymen, military and naval officers resident for the London season. Here too were the portraitist Allan Ramsay, and J. M. W. Turner before he decamped round the corner to Queen Anne Street. Increasingly in the early nineteenth century wealthy merchants took up residence. Many owed their wealth to slavery, from sugar plantations in the colonies and later from the huge sums paid out in compensation to plantation owners following the abolition of the slave trade. Others had grown rich through the East India Company, so many that Harley Street became as notable for its ‘nabobs’ as it became for its doctors. As late as 1841 Blackwood’s Edinburgh Magazine reckoned that ‘the claret is poor stuff, but Harley Street Madeira has passed into proverb, and nowhere are curries and mulligatawny given in equal style’.
During the earlier decades of Victoria’s reign members of parliament and lawyers were prominent in Harley Street. The street so epitomised dull respectability that it was chosen by Charles Dickens as the home of Mr Merdle in Little Dorrit, first published in 1855–7. Disraeli too, in Tancred published in 1847, derided ‘your Gloucester Places, and Baker Streets, and Harley Streets, and Wimpole Streets, and all those flat, dull, spiritless streets, resembling each other like a large family of plain children’. Disraeli’s great political opponent Gladstone occupied 73 Harley Street from 1876–82. His arrival coincided with his campaign on the Eastern Question, arising from the massacre of Orthodox Christians in the Balkans. On a Sunday evening in 1878 a ‘jingo mob’ gathered outside his house, hurling stones and verbal abuse at his windows.
By this time Marylebone had long been associated with medicine. Indeed, medicine arrived at the same time as the housing boom of the 1750s onwards. Most of the early evidence relates to institutions for treating the poor. Hospitals, like housing, gravitated to healthy suburban locations close to open fields and fresh air. When the Middlesex Hospital was built on Mortimer street in 1757 it was at the very edge of the expanding city, as was the parish workhouse in Paddington Street.
Today, Marylebone generally, and Harley Street in particular, is most closely linked with front-rank medicine and private consultants. From the mid eighteenth century, proximity to London’s teaching hospitals became important for top medical men who held prestigious posts in them. Closeness to aristocratic patients was another major consideration. By the 1840s there were sufficient eminent physicians and surgeons in Cavendish Square and Queen Anne Street to act as a magnet for others. However, around this time those at the top of their profession were as likely to reside south of Oxford Street as north. The medical directory for 1854 shows an even distribution between Marylebone, Mayfair and Bloomsbury.
Harley Street’s subsequent primacy is probably accounted for by its immediate proximity to Cavendish Square – the acme of fashionable Marylebone. Even by 1874, when Harley Street’s significance was already established, being close to the square still mattered. In that year Sir Alfred Baring Garrod, physician and gout specialist, moved from 84 Harley Street further south to No. 10 simply to be nearer to Cavendish Square. Twelve years later the surgeon Sir John Tweedy’s move in the opposite direction, from No. 24 to No. 100, was regarded by colleagues as committing professional suicide.
As fashionable society ebbed away from Marylebone in the late nineteenth and early twentieth centuries, a similar shift of smart medical practice might have been expected, but that never happened. By then many patients of all classes were travelling to see doctors rather than the reverse. But the main reason seems to have been that once a distinct medical community had been established it was found to be enormously beneficial to those within it. This professional interaction is recalled in many memoirs of consultants, who placed great value on the ability to call on the advice or second opinion of a neighbour. In the twentieth century there was also an active policy on the part of the Howard de Walden Estate to preserve the Marylebone grid as a medical enclave.
The image of the Harley Street doctor relies much on the traditional kind of premises he inhabited. The standard London town house needed little alteration to turn it into a doctor’s house. Ground-floor front rooms became waiting rooms instead of dining rooms, with a consulting room either immediately behind or in the closet wing.
Originally, the doctor’s dependants occupied the remainder of the house above, but after families moved to the suburbs, houses might be converted or rebuilt as suites of consulting rooms for multiple medical occupation.
In the later twentieth century many consultants gave up their private rooms for the better-equipped universities and hospitals. In their place came alternative practitioners and aesthetic therapists for whom the individual consulting rooms in elegant domestic settings provided a soothing backdrop. In the latest conversions encouraged by the Howard de Walden Estate there has been a policy of reconstruction to create purpose-built consulting suites over reinforced basements, allowing the latest diagnostic equipment to be installed behind retained facades, which preserve the historic character of the district.