Science, professionalism and the development of medical education in England : a historical sociology.
Underhill, Paul K.
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Education lies at the very epicentre of professional formation, professional behaviour, and professional values. Far-reaching institutional and curricular changes occurred in the education of doctors in the nineteenth century. These changes were related, I argue, to two long-term historical processes - the 'professionalisation' and the 'scientification' of medicine. England is the main geographical focus, but the thesis also encompasses a brief comparative historical sociology of the emergence of 'hospital' and 'laboratory' medical education in France and Germany respectively. Doctors were the first occupational community to claim that their 'professional' status rested on the sure foundation of 'scientific' knowledge and expertise; but the thesis adopts an attitude of anthropological scepticism towards both the alleged cognitive supremacy of 'scientific' medicine and its assumed role in conferring 'professional' privileges. Nevertheless, the rhetorical appeal of scientific culture proved strategically useful to doctors in their collective pursuit of upward social mobility in three particular contexts: the efforts of rank-and-file practitioners to usurp the professional privileges of elite consultants; regular doctors' attempts to eliminate professionally damaging competition from a variety of alternative and irregular healers conventionally labelled as Oquacks'; and the emergent relationship being forged between the medical profession and the modern state. A finely-textured analysis of intra-professional conflict is necessary to account for the politics of medical reform and for prolonged disputation over the future direction of medical education. There were two principal axes of internal conflict between medical interest-groups: the first between general practitioners and consultants; the second between traditional clinicians, many of whom actively opposed the introduction of experimental procedures into medical education, and those who vigorously promoted progressive scientific reform. The latter conflict, which has often been underestimated, is characterised in terms of a structural opposition between the scientific 'word' and the clinical I ward'. Such an explanatory framework offers the historian a more valuable resource than the simple antithesis between 'empiricism' and 'rationalism'. At the end of the Victorian period, apprenticeship had been eliminated and all aspiring doctors were educated in a university. It was through education that doctors were imbued with a set of professional value-orientations, and forged feelings of common identity and solidarity. The instance of Victorian doctors suggests that the historic role of the professions in English society is far less marginal and peripheral than has often been supposed.