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Becoming a PhysicianMedical Education in Great Britain, France, Germany, and the United States, 1750-1945$
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Thomas Neville Bonner

Print publication date: 1996

Print ISBN-13: 9780195062984

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780195062984.001.0001

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The Clinical Impulse and the National Response, 1780-1830

The Clinical Impulse and the National Response, 1780-1830

4 (p.103) The Clinical Impulse and the National Response, 1780-1830
Becoming a Physician

Thomas Neville Bonner

Oxford University Press

As the previous chapters have suggested, striking changes in medical education had occurred by 1800 in nearly every Western country. In particular, the movement toward practical training in medical teaching had gathered momentum toward the end of the eighteenth century. Not only in Vienna, Paris, Edinburgh, and Leyden but also in scores of universities, hospitals, military schools, dispensaries, lying-in clinics, and private courses spread across Europe and North America, students were finding new opportunities to practice dissection; see patients at the bedside; take case histories; practice surgical, obstetrical, and other procedures; and even diagnose and treat patients under a teacher’s supervision. It is this sea change in attitudes toward practical training that we explore in this chapter. Spurred by Enlightenment concerns for public health and utilitarian concepts of practical training, new clinical experiences were becoming available in many places. Although in some countries, notably France and Germany, the state played a decisive role in fostering the new development, in others, especially Britain and America, students were left largely on their own to gather practical experience, choosing from a variety of lecture-demonstration courses, hospital training, apprenticeship opportunities, experience in outpatient dispensaries, and private classes. National differences in social and political development channeled the strong pressures for utilitarian education into new forms of clinical training. Differing concepts of what constituted a “teaching clinic” came to exist side by side, especially in Europe. In unsettled France, the clinical impulse, which had early centered on surgical practice in urban hospitals and was now promoted by an all-powerful revolutionary government, found its primary outlet in large hospitals. In the German states, on the other hand, politically divided and lacking large hospitals in most university towns, clinics developed largely as small appendages to university programs in medicine. British clinical training, as described in earlier chapters, was centered haphazardly in the London hospitals away from the nation’s universities and was growing also in provincial hospitals and dispensaries. In North America, the search for clinical experience was spread over a great variety of small infirmaries, dispensaries, and private courses, and apprenticeship training remained the dominant mode of getting hands-on practice.

Keywords:   Bamberg, Chatham, Dresden, Edinburgh, Greifswald, Hospital teaching, Innsbruck, Landarzte, Magdeburg

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