Demographic trends, and older people over 65 years disproportionately occupying beds in psychiatric hospitals, pointed to their increasing clinical needs. Clinical work with older people often required different skills from work with younger people. ‘General psychiatrists’, nominally working with adults of all ages, usually had little interest in working with older people. By 1977, it was clear to clinical leaders in the field of psychogeriatrics that official recognition of their specialty by the government was essential to ensure service development. Official recognition would provide the means to collect data to identify gaps in services, to obtain information on the implementation of government guidance and to advocate for resources, including ensuring high quality training posts for doctors wanting to specialise in the field. Doctors have traditionally taken the lead in creating new medical specialties, and psychogeriatrics was no exception. However, support fluctuated towards the specialty from the leadership of the Royal College of Psychiatrists. Health service leaders who did not undertake work with older people, were incredulous that others wished to do so. Negotiations between the Royal College of Psychiatrists and the Department of Health and Social Security about recognising psychogeriatrics were convoluted and prolonged. Recognition was achieved in 1989, following intervention by the Royal College of Physicians of London.

This article examines the career and reform agenda of Christopher Merrett as a means of evaluating the changing conditions of medical knowledge production in late seventeenth-century London. This period was characterised by increasing competition between medical practitioners, resulting from the growing consumer demand for medical commodities and services, the reduced ability of elite physicians to control medical practice, and the appearance of alternative methods of producing medical knowledge – particularly experimental methods. This competition resulted in heated exchanges between physicians, apothecaries, and virtuosi, in which Merrett played an active part. As a prominent member of both the Royal Society and the Royal College of Physicians, Merrett sought to mediate between the two institutions by introducing professional reforms designed to alleviate competition and improve medical knowledge.These reforms entailed sweeping changes to medical regulation and education that integrated the traditional reliance on Galenic principles with knowledge derived from experiment and artisanal practices. The emphasis Merrett placed on the trades suggests the important role artisanal knowledge played in his efforts to reorganise medicine and improve knowledge of bodily processes.