A Bird’s Eye View of Medical Education in 1830
The changes under way in medical training in the transatlantic world by 1830 owed much to the political and social transformations of the preceding half-century. The political revolutions of the old century, which ushered in a long period of turmoil and conflict, had been followed by a period in the early nineteenth century of reaction and consolidation, new industrial growth and the spread of cities, commercial expansion and rising prosperity, and a high degree of political turbulence in every country. No nation escaped the impact of rapid population changes, of buoyant capitalistic enterprise, of the spreading democratic tide, or of the efforts of reformers to help those most adversely affected by the urban-industrial revolution. The training of doctors was inevitably influenced by the rising power of the middle classes in Europe and America as they demanded more medical services and a higher standard of medical competence. The continued growth of industrial cities, notably in Britain, posed serious problems of public health and the medical care of the poor. By 1831, London’s population was already approaching a million and a half, and nearly half the remaining population were now living in towns of more than five thousand. The doctors most in demand in these conditions were those who joined a skill in practical medicine with a knowledge of the new practical sciences. The new studies of science, it was increasingly believed by laypeople, gave the physician a surer command of diagnosis and a better understanding of the disease process, and his practical skills assured the patient of the best possible treatment. Medicine as a practical science, in short, was seen by the public as an important advance over both the old humanistic medicine of the universities and the crude empiricism of the earlier practical schools. The triumph of the clinic and the rise of the new sciences together created a new confidence in medical education. The schools themselves were becoming more alike.