Speaker

Professor John Harley Warner (Yale)

Title

Student Work: Collective Identity, Belonging, and the American Medical School

Event

Keynote paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly at CHOMI, UCD, October 2014

Summary

Professor John Harley Warner’s paper examines identity and identity formation among American medical students from the middle of the nineteenth century and into the 1920s. His aim is to rethink the place the medical school occupied in shaping and conferring collective identity drawing especially on the short, hand-written, highly mannered these

s that most colleges required for graduation. Continuing this focus on collective identity he turns to one site within the medical school – the dissecting room – and the genre of photographic group portraiture that students cultivated there; a depiction and production of student work that enriches and challenges our understanding of medical student culture.

The starting point for his talk is a particular problem in the historiography of American medical education. The American case was peculiar and Warner begins by mapping how the mid-nineteenth century American medical school is portrayed in the regnant historiography. By all accounts this was the profession’s low point. The American medical marketplace had become the freest and most open in the western world. Like other professions, medicine was a target for popular animosity against all groups claiming special privilege. In the face of radical democratic protest against putative monopolies, state legislatures revoked virtually all medical licensing laws. A medical degree wasn’t required to practice as a physician or to be considered as a fully fledged member of the profession.

But if you wanted a medical degree, you could easily attain one by attending three months of didactic lectures taken twice, submitting a thesis, undergoing a very brief oral examination and paying fees. The proliferation of proprietary medical schools, often of low standards, greatly increased the production of sometimes poorly trained practitioners leading to overcrowding and divisive competition in the medical marketplace. Alternative healers – homeopaths, hydopaths, botanics – attacked the pretensions and therapies of orthodox self-styled regular physicians, and competed successfully for paying patients. With good reason regular physicians believed that the power and prestige of their profession was declining and that medical schools bore a lot of the blame. This was a profession in crisis.

For more than a hundred years that’s how the story of medical education in nineteenth century America has been told. It’s a true story, yet this telling of it is also ahistorical in its distorting selectivity. Criticism of schools at the time had less to do with the education received there than with the overproduction of medical degrees.

 

 

 

Speaker

Dr Michael Brown (Roehampton University)

Title

Teaching Compassion – Surgical Education and the Inculcation of Moral Values in Early Nineteenth-Century Britain

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014

Summary

It is often generally assumed that the practice of operative surgery in the pre-anaesthetic era was dependent upon the cultivation of a dispassionate and detached attitude towards pain and suffering, what William Hunter famously described as a ‘necessary inhumanity’. By performing dissections on cadavers and witnessing painful surgical procedures, it has been suggested, surgical pupils learnt to harden their hearts and act with cool rationality in the face of profound emotional distress. However, a closer reading of the historical sources suggests that the reality was more complex than this.

In fact, contrary to this established narrative, the early nineteenth century saw the flowering of a rich language of compassion as, shaped by the cultures of sensibility, surgeons began to conceive their relationship with patients in terms of emotional intersubjectivity. As Astley Cooper put it: ‘In the performance of our duty one feeling should direct us; the case we should consider as our own and we should ask ourselves, whether, placed under similar circumstances, we should submit to the pain and danger we are about to inflict’.

Much of the evidence for this culture of surgical compassion can be found in lectures and other such pedagogic materials. This paper therefore considers the importance of the lecture theatre as a space for the shaping of a new surgical culture. It demonstrates how certain lecturers sought to promote the values of restraint and responsibility in contrast to the imagined brutality of earlier periods. Hence it also explores how this new surgical identity was linked to surgery’s self-conscious social and professional ‘improvement’ in the early decades of the nineteenth century.

Dr Michael Brown is a Senior Lecturer in History at the University of Roehampton.

 

 

Speaker

Nathalie Sage Pranchere (Paris-Sorbonne University)

Title

Midwives’ and Medical Students’ Clinical Obstetric Training in Nineteenth-Century France

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014

Summary

This paper intends to shed some light on the forms of midwives’ and medical students’ clinical obstetric training in nineteenth-century France, along with the evolution of clinical resources and the specific expectations of both professions. It will also highlight the strong imbalance between doctors and midwives, in favour of the latter, caused by the difference of availability and quality in training, and the slow constitution of a quality clinical training for physicians.

Therefore, this paper seeks to challenge the usual interpretation of the masculine preeminence in the medical field gained through the control of clinical training. In the last quarter of the eighteenth century, as the European states decided to train midwives on a large scale, the practical dimension of training became a problem. Three dimensional anatomical representations (ceramics or waxes), prepared and articulated bones or mannequins provided in this period and throughout the nineteenth century an alternative and / or a complement to clinical training. The Office des Accouchées of the Paris Hôtel-Dieu became the model for every European midwives’ school based in lying-in hospitals (such as Strasbourg, Turin or the Accouchierhaus of Göttingen).

As this institution became the School of the Hospice de la Maternité of Paris in 1802, it strengthened the choice of clinical primacy and inspired the chapter dealing with midwifery matters of the law of 10 march 1803 reforming medical education. Training midwives had to take place from then on in lying-in hospitals. The time dedicated to clinical training in the global course of midwives’ education became one of the most important evaluation criteria and this evolution reveals both the progressive definition of educational methods based on gesture’s repetition and quantified observation, and the increasing demands of qualification. Meanwhile, during the main part of the nineteenth century, medical students had access only to theoretical lessons in obstetrics and weren’t allowed for clinical training in lying-in hospitals. Those were exclusively reserved to midwives-to-be. The exclusion was based on moral criteria but resulted more of the political preference given to the training of midwives, more likely to fulfill the political expectations of a wide supervision of birth.

A first evolution occurred in 1834 with the opening in Paris of the Hôpital des cliniques. This hospital was part of the medical faculty and became quickly fully dedicated to clinical obstetric training. Nevertheless, it wasn’t until the 1860s that the physician’s clinical obstetric training really improved on a national scale. In the meantime, medical students had to rely on midwives’ goodwill who allowed them to observe the deliveries they performed in return for payment. This paper will use the archives of several midwifery schools, those of the Hôpital des cliniques and Baudelocque hospital, as well as those of the chair of obstetric clinic of the Faculty of medicine of Paris.

 

Speaker

Dr Claire Jones (King’s College London)

Title

Hygiene, Antiseptic and Aseptic Pedagogy and Practice in British Nursing, c. 1870 – 1900

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014

Summary

The introduction of sanitary standards, antisepsis and asepsis into British hospitals following Florence Nightingale’s and Joseph Lister’s celebrated innovations has been long discussed by historians in terms of the changes they brought about in operative and post-operative surgical practice. Rather less attention, however, has been paid to the consequences of this introduction for nurse training and practice. Indeed, the history of nurses’ everyday practice is only beginning to be uncovered. This paper aims to readdress the imbalance by exploring the extent to which sanitary standards, antisepsis and asepsis within the late nineteenth century nursing curricula at two London hospitals associated with Nightingale and Lister – King’s College Hospital and St Thomas’ Hospital – can be identified and tracked archivally and by assessing how the ideas of Nightingale and Lister penetrated hospital practice and daily ward routines in these institutions. It draws on the extensive archival sources of these hospitals, including lectures to nursing staff, case notes and students’ ward diaries, in order to demonstrate that nursing staff played a more significant role in late nineteenth century hospital infection prevention and control than has hitherto been discussed.

Speaker

Professor Jonathan Reinarz (University of Birmingham)

Title

Portrait of the medical student as a young man – caricatures, realism and airbrushed history, c.1825-1939

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014

Summary

The focus of historians of education has in recent years shifted from ‘top down’ to ‘bottom up’, concentrating on pupils rather than professors. As a result, historians of medical education now more regularly place the medical student at the centre of their studies, charting, for example, women’s entrance into medical schools, changes in students’ backgrounds and, most notably, their behaviour. Keir Waddington has specifically charted these changing perceptions of the medical student in Victorian London and suggests that these young scholars were being reinvented as part of doctors’ efforts in the nineteenth century to improve the status of their profession. As such, the image of the medical student slowly transformed from rowdy youths into professional medical gentlemen.

This paper seeks to augment this portrait of the medical student by exploring the culture of medical education in the English provincial schools from the Victorian period and into the twentieth century. While it has been suggested that rowdy young medics were gradually tamed during their years of medical instruction, this paper will consider the roles of protest, privilege and professionalization in fashioning particular images of medical students. Rather than suggest that provincial students were gradually professionalized in the late nineteenth and early twentieth centuries, this paper will argue that their image was carefully crafted, embellished and even repainted depending very much on the values and outlook of those who taught them.

Jonathan Reinarz

Professor Jonathan Reinarz is the Director of The History of Medicine Unit, University of Birmingham. He has published extensively on the history of hospitals and medical education, including a history of the Birmingham teaching hospitals (Boydell, 2009) and, with Graham Mooney (Johns Hopkins) a history of hospital and asylum visiting (2009). He has recently completed a history of smell (University of Illinois Press, 2014), and an edited collection on medical scandals (with Rebecca Wynter), entitled Complaints, Controversies and Grievances in Medicine (Routledge, 2015). He has also edited volumes on the history of workhouses (Rochester University Press, 2013), hospitals and communities (Peter Lang, 2013) and the medical history of skin (Pickering & Chatto, 2013). Jonathan is writing a history of medical education in provincial England and editing a volume in the Bloomsbury ‘Cultural History of Medicine’ series. His numerous book reviews have appeared in Social History of Medicine, Medical History, Isis, American Historical Review, Social and Cultural History, Women’s History Review, History, Twentieth Century British History, French History, Journal of British Studies, London Journal, Centaurus, Senses and Society, Museum & Society, Midland History, Journal for the Society of Army Historical Research, Canadian Journal of History and Social History of Alcohol Review. Since 2001, he has presented academic papers at more than 100 seminars and conferences nationally and internationally. Most of these have subsequently been developed into publications.

Speaker

Alain Caubet (University of Rennes)

Title

The French med student ‘carabin’ is no longer what he used to be

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’ hosted by CHOMI, UCD, October 2014

Summary

The resounding folklore surrounding the French study of medicine was established after the Second Empire and before the Great War. Overly bountiful, it is represented by a chimera of the med student “carabin” and the intern. These two archetypes rival each other in incarnating the freedom from morals, indiscreet salaciousness, and a lack of concern for their suffering patients, who were considered as inferior human material and victims of endless cruel anecdotes. The “Medical Student’s Breviary” is a collection of Gallic songs, bawdy, scatological, indelicate, loaded with extravagant illustrations; for over a hundred years, its verses and choruses have represented the ultimate abomination to mothers who entrusted their innocent daughters to us in order to begin their studies to be a female doctor! These rituals (ragging, rag weeks and forfeits) and these songs had something of the nature of an initiation process, an integration, a clan recognition; in a time stifled by the corset of prudishness, they gave substance to the fantasy of the body and its sexuality without any mystery for those who trod the soil of dissection room.

From then on, no more shame or restraint: the doctor had to hear everything, see everything, smell everything and palpate ad nauseam, as in staff waiting room songs. Few writers have left us autobiographies on their student life in medicine (Dr. Louis Véron (1798 – 1867), Léon Daudet (1867-1942), …). The former educational program plunged teenagers, often from privileged family backgrounds into the cloistered microcosm of common wards where the chronically ill languished. The encounter with the body and the hopeless was deeply moving. The initiation was violent for these boys, lacking armor or support; especially when the most significant and most praised doctors were often eccentric, excessive, and abusive. Today, the hospital is still a place of medical discovery but the shocking aspects have been reduced or conjured away for them. In charge of the PACES (Common first year for health studies) in Rennes, we know by observation and by several surveys of our students that they come up against the inevitable much later, through the prism of technical reasoning that is their bulwark. Often coming from sheltered environments, a good half of our promotions stays away from the excesses of folklore that is usually associated to them (The Breviary!), and many others pretend to be someone else during a year or two, far from the limitless emotional liberation that used to take place.

Speaker

John Borgonovo (University College Cork)

Title

Students at the Cork University Dental School and Hospital, 1913-1990.

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014

Summary

While medical education has attracted the attention of historians, less work been done on dental education. This paper will draw on the recent monograph, Prevention is Better Than Cure: History of the Cork University Dental School and Hospital, 1913-2013, completed for the school‟s centenary celebration last year. It will survey the dental school student experience at University College Cork during the school’s first seven decades. The dental school‟s general evolution as a learning institution will be summarized. Special note will be taken of the experience of women students, political activism by the student body, and some aspects of dental student social life.

Speaker

Jackie Uí Chionna (NUI Galway)

Title

The G.I. Bill and American Medical Students at University College Galway, 1946–1966

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014

Summary

Acknowledged as one of the most significant pieces of legislation ever produced by the U.S. federal government, the Servicemen’s Readjustment Act of 1944 – commonly known as the G.I. Bill of Rights – was designed to provide recently de-mobbed members of the American armed forces with the opportunity to avail of a wide range of educational opportunities, with the fees for such courses, and associated living and subsistence costs, paid for by a grateful U.S. government. It was a radical piece of legislation, and marked an equally radical departure in U.S. social policy. The response to the Bill was immediate, and, from the point of view of the U.S. education system, overwhelming. With the American colleges literally bursting at the seams – and with medical schools in particular receiving forty applications for each available college place – the Veterans Association which administered the scheme sought out universities in other English-speaking countries (specifically Canada, the United Kingdom and Ireland) which would be prepared to offer places to veterans who were eligible for G.I. Bill funding.

This paper will examine the experiences of the American students who came to study Medicine at the only Irish college to be approved as an accredited school for G.I. Bill medical students in Ireland – University College Galway . It will examine the impact of the arrival of the American students on a small medical school in the West of Ireland, the manner in which they responded to, and in turn influenced, the type of medical training received under the Irish system, and will assess their impact on the university as a whole, and on the city which was to be their home for five years.

Speaker

Florent Palluault (Poitiers City Library)

Title

Mutual Instruction Among Morbid Anatomy Students – The First Société Anatomique de Paris (1803-1809)

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014

Summary

On 12 Frimaire Year XII of the French Republican calendar (4 December 1803), twenty-eight medical students and a young surgeon gathered in the small teaching hospital adjoining the Paris medical school and founded the Société anatomique de Paris. The professed goal of the Société was mutual education in anatomy and physiology, and more specifically pathological anatomy. The society members, among whom several of the most talented students, saw it as their duty to pursue the work started by Xavier Bichat through his private teaching and his publications until his death the previous year.

The Société anatomique therefore dedicated most of its research to morbid anatomy, and the great majority of its meetings was spent observing diseases, carrying out post-mortems or examining pathological specimens, at a time where the Paris medical school did not provide any theoretical teaching in this discipline. After a year’s existence, the Société anatomique’s membership had risen to more than a hundred members, under the double guidance of Guillaume Dupuytren and René Laennec.

Despite a short life (1803-1809), the first Société anatomique provides insights about the rise of morbid anatomy as a distinct medical discipline and about the hesitant beginnings of a new system of medical education in post-Revolutionary France. The fate of the Société reveals the struggles of the newly-established Paris École de Santé to organise instruction in accordance with its prescribed missions, and the efforts of students to assert their place at a time of professional and political turmoil. It also confirms how much mutual education and learned societies are dependent upon the personality and commitment of a handful of members. Although the Société anatomique comprised the elite of medical students and benefited from the collaboration of very talented professionals, it eventually succumbed to the rivalry between two of the most brilliant medical men of the time: Dupuytren and Laennec. After meeting regularly for four and a half years, the society disappeared in April 1809.

In 1826, Jean Cruveilhier, recently appointed professor of anatomy, successfully revived the Société anatomique, which then developed and prospered under his presidency (1826-1873), mainly thanks to the quality of its debates and monthly publications. The Société anatomique has survived the significant evolution of medical knowledge and science sincethe late nineteenth century and is still active today.

Speaker

Jenna M. Dittmar (University of Cambridge)

Title

The creation and evolution of the educational role of the Cambridge Anatomical Museum.

Event

Paper given at the symposium, ‘Medical training, student experience and the transmission of knowledge, c.1800-2014’, organised by Laura Kelly, at CHOMI, UCD, October 2014

Summary

Anatomical  museums  were  integral  to  medical education from  the mid  1700s  to  the  early 1900s,  with  their  primary  function  as  a  teaching  resource.  Contemporary  anatomists

believed  that  ‘Anatomy  cannot  be  taught  without  a  museum,  and  the  more  extensive  the better…’ However, due to the changing attitude toward medical education favouring clinical and  laboratory  medicine  in  the  1900s,  the  use  of  these  collections  for  teaching  became scarce.  This  paper  aims  to  explore  the  influencing  factors  behind  the  assemblage  of anatomical preparations for teaching purposes at the University of Cambridge and how the collection and its‟ role in education changed over time.

Since its origin in the mid-1700s, the collection at the University of Cambridge was heavily influenced  by  the  individual  research  interests  of  the  Professors  of  Anatomy;  Sir  Busick Harwood,  William  Clark  and  Sir  George  Murray  Humphry.  With  their  common  goal  of providing better teaching facilities, these men compiled an extensive and varied collection through  great  personal  effort  and  funds.  During  the  mid  1800s  several  collections  were purchased to fill the „gaps‟ in the collection. This included the collection of James Macartney from  Trinity  College  Dublin  and  part  of  the  Joshua  Brooke‟s  Museum.  Anatomical preparations  for  the  museum  were  also  created  in  house  by  retaining  elements  from dissections  carried  out  by  both  skilled  anatomists  and  students.  As  the  educational environment  changed  in  the  late  1890s,  curators  Alexander  Macalister  and  Wynfrid Laurence Henry Duckworth, both embraced anthropological research.

After a gradual decline in its use the Anatomical Museum was dissolved and the osteological portions  were  given  to  the  Department  of  Physical  Anthropology  in  1968,  where  this collection  remains  a  valuable  teaching  resource.  Today,  research  on  the  collection  is underway which examines the cut marks on the osteological material providing information on human dissection practices.

This  presentation  shows  how  the  content  of  the  Anatomical  Museum  at  the  University  of Cambridge evolved from human anatomy, to human-animal comparative anatomy, and then to human material. Specifically this presentation focuses on the anthropological comparative anatomy of different human races and archaeological material, and that although anatomical museums  are  no  longer  considered  essential  to  medical  education,  that  these  historic collections can still be used for educational purposes.