Toward a University Standard of Medical Education, 1890-1920

In the waning years of the nineteenth century, despite (or perhaps because of) the inroads of laboratory science, uncertainty still hung heavy over the future shape of the medical curriculum. Although currents of change now flowed freely through the medical schools and conditions of study were shifting in every country, agreement was far from universal on such primary questions as the place of science and the laboratory in medical study, how clinical medicine should best be taught, the best way to prepare for medical study, the order of studies, minimal requirements for practice, and the importance of postgraduate study. “Perturbations and violent readjustments,” an American professor told his audience in 1897, marked the life of every medical school in this “remarkable epoch in the history of medicine.” Similar to the era of change a century before, students were again confronted with bewildering choices. Old questions long thought settled rose in new form. Did the practical study of medicine belong in a university at all? Was bedside instruction still needed by every student in training, or was the superbly conducted clinical demonstration not as good or even better? Should students perform experiments themselves in laboratories so as to understand the real meaning of science and its promise for medicine, or was it a waste of valuable time for the vast majority? And what about the university—now the home of advanced science, original research work, and the scientific laboratory—was it to be the only site to learn the medicine of the future? What about the still numerous hospital and independent schools, the mainstay of teaching in Anglo- America in 1890—did they still have a place in the teaching of medicine? Amidst the often clamorous debates on these and other questions, the teaching enterprise was still shaped by strong national cultural differences. In the final years of the century, the Western world was experiencing a new sense of national identity and pride that ran through developments in science and medicine as well as politics. The strident nationalism and industrial-scientific strength of a united Germany, evident to physicians studying there, thoroughly frightened many in the rest of Europe.