An Uncertain Enterprise: Learning to Heal in the Enlightenment

There was no more turbulent yet creative time in the history of medical study than the latter years of the eighteenth century. During this troubled era, familiar landmarks in medicine were fast disappearing; new ideas about medical training were gaining favor; the sites of medical education were rapidly expanding; and the variety of healers was growing in every country. Student populations, too, were undergoing important changes; governments were shifting their role in medicine, especially in the continental nations; and national differences in educating doctors were becoming more pronounced. These transformations are the subject of the opening chapters of this book. These changes in medical education were a reflection of the general transformation of European society, education, and politics. By the century’s end, the whole transatlantic world was in the grip of profound social and political movement. Like other institutions, universities and medical schools were caught up in a “period of major institutional restructuring” as new expectations were placed on teachers and students. Contemporaries spoke of an apocalyptic sense of an older order falling and new institutions fighting for birth, and inevitably the practice of healing was also affected. From the middle of the century, the nations of Europe and their New World offspring had undergone a quickening transformation in their economic activity, educational ideas, and political outlook. By 1800, in the island kingdom of Great Britain, the unprecedented advance of agricultural and industrial change had pushed that nation into world leadership in manufacturing, agricultural productivity, trade, and shipping. Its population growth exceeded that of any continental state, and in addition, nearly three-fourths of all new urban growth in Europe was occurring in the British Isles. The effects on higher education were to create a demand for more practical subjects, modern languages, and increased attention to the needs of the thriving middle classes. Although Oxford and Cambridge, the only universities in England, were largely untouched by the currents of change, the Scottish universities, by contrast, were beginning to teach modern subjects, to bring practical experience into the medical curriculum, and to open their doors to a wider spectrum of students.