Corpus curricula: Medical education and the voluntary hospital movement

Abstract

The centrality of hospitals to medical education is a relatively recent phenomenon in the history of medicine. Like many subjects in the history of medicine, connections can be traced to the eighteenth century, if not earlier. In order to understand significant changes in medical education, and especially in the field of anatomical instruction, one must look back even further, at least to the sixteenth century. The history of hospitals also has many turning points, including the fifteenth century, when such institutions began to proliferate, many more becoming principally dedicated to the sick. However, when these two subjects are considered jointly, the eighteenth century is not just significant, but central to the development of both institutions, especially in Western Europe. According to existing historiography, it was in this period that medical education and voluntary hospitals, at least in the United Kingdom, literally came together. The hospital was not only rapidly becoming the principal site for healing, but also one of learning about the sick and training prospective practitioners. As historians have been quick to note, however, every history has its pre-history. For that reason, this chapter commences by considering some of the numerous false starts and birth pangs of hospitalbased, or clinical, education in early modern Europe. It then considers eighteenth-century developments through the work of Hermann Boerhaave, among other less familiar staff at the University of Leiden medical school, who both embraced and popularised the clinical method of medical instruction, especially in the eighteenth century. Though not entirely an eighteenth-century figure, Boerhaave's academic career is especially appropriate to the chronological parameters of this volume, having been appointed a lecturer in 1701. From Leiden, many medical men took the lessons of Boerhaave and his colleagues to Paris, Vienna and across the channel and into the charitably funded, voluntary hospitals, the proliferation of which has repeatedly been identified as an eighteenth-century phenomenon, at least in England and Scotland (Porter, 1989, pp. 149-152). Rather than trace Leiden's influence on the development of medical education throughout Europe, the final section of this chapter will examine its impact on Britain. In particular it examines the way in which clinical training quickly developed in Edinburgh and, in successive decades, inspired London practitioners to attach schools to the hospitals to which they were affiliated. Though a new generation of provincial medical schools sought to retain local boys who might otherwise have travelled to hospital schools in Edinburgh and London, or even further afield, few instructors desired to change the way in which pupils were being educated. In less than a century, hospital-based instruction had become the tried and tested method of educating physicians.