‘ Enlightenment and Medical Education’ Lecture 2 Medicine, Disease and Society in Britain,

Keywords Medical education Apprenticeship Enlightenment Universities Birth of the clinic

Lecture Outline 1. The importance of education for a modern profession and definitions 2. Medical education in the tripartite structure - Apprenticeship - University education 3. Enlightenment and new approaches - Disease classification – nosology - Public health – smallpox inoculation - Medical education - University of Edinburgh - hospitals-based training - European comparisons and the ‘birth of the clinic’ 4. Consolidation of medical education?

Characteristics of a Profession 1.The possession of a body of highly specialised knowledge: we expect our doctors to have a deep knowledge of medicine, acquired through a long training in medical school. A doctor’s qualifications prove that he or she has completed this training to the standards required of the profession. 2.Professional unity and a strong ethos of public service: we do not expect doctors to compete with one another for patients by advertising their services or by offering cut-price practice. We do expect practitioners to cooperate when caring for patients, and to always work for patients’ best interests. 3.A monopoly of practice: only members of the medical profession can call themselves doctors. We distinguish between orthodox medical practitioners and those who offer alternative forms of medical treatment by calling them practitioners of ‘complementary’ or ‘alternative’ medicine. 4.Professional autonomy: medical practice is based on highly specialist knowledge, which is not shared with the general public. Therefore, only doctors can judge whether other doctors are trained to a suitable standard and are competent to practice. 5.High social status: doctors earn relatively high salaries and also enjoy a special social respect.

3-Tier Hierarchy of Practitioners: (orthodox, regular) Physicians Surgeons Apothecaries Physicians - University trained Surgeons and Apothecaries- Apprenticeship

Formal legal contract Guardians or parents of apprentice paid a sum of money to the master Apprentice bound to the master rather like a servant Many apprenticeships arranged through personal contacts and word of mouth

Apprenticeship Indenture, 1705 (Warwickshire County Record Office, CR 556/364) This Indenture witnesseth that John Beale of Woolscot in the county of Warwick puts himself apprentice to William Edwards, surgeon of Kenilworth to learn his art and with him after the manner of an apprentice to serve for 4 years from this date. During the term the apprentice shall faithfully serve his master, his secrets keep, his lawful commands gladly obey; the apprentice neither to do damage to his master nor see it done; the apprentice not to waste his master’s good nor lend them unlawfully. The apprentice not to commit fornication nor contract matrimony during the term; the apprentice not to play at cards or dice or any unlawful game that may cause his master loss. The apprentice not to haunt taverns nor ale-houses nor be absent unlawfully day or night from his master’s service but in all things behave as a good and faithful apprentice towards his master. William Edwards, in consideration of the sum of £53 16s, shall teach the apprentice all the art he uses by the best means he can. Wiliam Edwards shall find the apprentice in meat, drink, washing and lodging during the term. 1 May Signatures of William Edwards, John Beale and 2 witnesses (Lane, English patient, p. 3)

John Taylor, Bolton, Lancs. C (Lane, English patient, p. 4) I studied hard, learned the Latin Linnean names and doses of drugs; attended seven surgical operations, worked from 9 to 9 daily, Sundays included; made mercury ointment in the old style by turning a pestle in a mortar for 3 days in succession, to amalgamate the quicksilver with the pig’s grease; made up what the doctor called his ‘Cathartic acid bitter mixture’, as a sort of fill- up for every purgative bottle, and almost every disease that ‘flesh is heir to’; made up a bolus of a teaspoonful of preserve and half-a- grain of opium, as a sedative; drew a tooth for 6d; and took 4d if the sufferer had no more; and did many things during that 6 months which gave me a distaste for the practice of medicine, and made me desirous of another employment. John Taylor (b. 1811) left medicine to enter the law. ‘ Autobiography of a Lancashire Lawyer, ed. J. Clegg ( Bolton, 1883).

William Hunter ( ), was a Scot who settled in London and became the leading anatomy school proprietor and obstetrician of the day.

William Hunter ( ) Attends Glasgow University but leaves without graduating 1737 Studies surgery in Hamilton with William Cullen; attends Alexander Monro's anatomy lectures in Edinburgh 1740 Moves to London and studies midwifery with William Smellie 1743 Starts lucrative practice as physician and accoucheur in London 1747 First anatomical lectures; elected member of Corporation of Surgeon 1748 Travels to Leiden and Paris 1749 Opens anatomy school in Covent Garden, London 1751 First lectures on anatomy at St. Martin's Lane Academy 1762 Appointed Physician in Extraordinary to Queen Charlotte 1767 Builds house with school and museum in Great Windmill St. Fellow of Royal Society 1768 The Royal Academy of Arts is founded; appointed Professor of Anatomy, and made Fellow of Society of Antiquaries Dies in London, 30th March. Anatomy school continues under nephew, Matthew Baillie.

William Hunter Lecturing at his School of anatomy in London.

Enlightenment Optimism concerning the role and benefits of medicine, faith in science and experimentation and made education key to advancement. Science could overcome superstition – medicine should be rational. Greater emphasis on health of populations and environmental factors.

Edinburgh Medical School 1884 & Anatomy Lecture Theatre 1950s.

Medical classes at Edinburgh University in the late eighteenth century.

Paris Surgical college established in separate school of practical dissection Paris recognised as the birthplace of hospital medicine Emphasis on clinical experience and detailed case notes

Alexander Lesassier’s day- Edinburgh 1806 ‘I rise in the morning at 8, finish breakfast, and get seated in Dr. Gregor’s class room [in Medical Practice] by 9- from hear Dr Hope on Chemistry. From 11 to 12 Dr Barclay on Anatomy- then from 12 till 1 I attend the Infirmary. From 1-2 the famous Dr Monro [on Anatomy] – from 2 to 3 I go home and take a basin of soup- from 3- 4…lectures on Midwifery- then from 4 to 5 Diner from 5 till ½ past 6 Studying and reviewing what I’ve heard during the day- Tea over by a little past 7 and I go to the Infirmary…quarter past 9- Supper and to bed by ½ past 10.

Sources of Medical Qualifications - C18th England: Universities of Oxford and Cambridge Royal College of Physicians of London Company of Surgeons Society of Apothecaries of London Scotland: Universities of Edinburgh, Glasgow and St Andrews, 2 at Aberdeen Royal College of Surgeons Edinburgh, Faculty of Physicians and Surgeons of Glasgow Ireland: University of Dublin, College of Physicians of Ireland Royal College of Surgeons of Ireland Apothecaries Hall, Ireland Lying-in Hospital Dublin

Peter Eade Apprenticed to his father, a surgeon in Norwich for three years. In his final year he observed practice at the Norfolk and Norwich Hospital Moved to London and attended King’s College Medical School. Took classes in anatomy, chemistry and materia medica. In the summer of 1846 attended a course on medical botany. Observed medical and surgical practice at the hospital. Passed first examination for MB at the University of London 1847 Acquired the dual qualification of Licence of the Society of Apothecaries (LSA) and Membership of the Royal College of Surgeons (MRCS). Later that year passed the second exam for MB. Returned to Norfolk and set up in practice. Appointed honorary physicain to the Norwich Public Dispensary and medical visitor to the Catton Grove Lunatic Asylum 1850 Acquired Doctorate of Medicine degree (MB) 1858 Appointed honorary physician to the Norfolk and Norwich Hospital

Conclusion Was medical education ‘reformed’? Yes Role of Enlightenment Disease classification Public intervention Extended teaching of better quality Learning was by observation, theory and practical experience - rise of the hospital BUT – Still, no uniform or standard education by early c19th = complicated picture. Medical Act 1858 introduced single portal of entry but not ‘uniform’ education Question to think about : Was the Enlightenment an unqualified ‘good thing’? Why not? What are the attributes of a profession and did medical practitioners in the 18 th and 19 th centuries acquire these?