2 - Medical Revolutions

Summary

The Edinburgh Medical School was founded in 1726 and the RIE in 1729.Two hundred years later medicine could be said to have undergone one revolution and to be undergoing another.These revolutions are best described in terms of ideal types, for the spectrum of theories, assumptions, practices, and institutions that they embraced varied widely. The first revolution, often called hospital medicine, occurred in the early nineteenth century and involved the gradual transformation of a medicine based largely on the patient's narrative to one based on physical examination and the use instruments, famously the stethoscope. Clinicians, on hospital wards and in the post-mortem room, largely created this new medicine. By 1900 the method of examining patients employed within this “clinico-pathological” approach had been thoroughly systematized. Indeed an Edinburgh physician, Harry Rainy, practising at the RIE in the early 1920s was co-author of what was possibly the standard British manual of physical examination.

Of course this change in medical knowledge and practice did not come alone.There were changes in institutions, organization, social relations, and attitudes that were integral to it. First, hospital practice expanded enormously. Almost invariably hospitals were institutions dedicated to the treatment of the poor although this began to change in the early twentieth century as members of the middle classes began to be admitted to them. By the end of the nineteenth century, the hospital was regarded as the necessary site for the student, under the eye of a senior physician, to learn the ritual of clinical examination. Second, morbid anatomy was held to be the science that underpinned the new medicine. It was institutionalized academically in pathology departments in university medical schools and practically in hospital departments where the pathologist reported on specimens and performed post-mortems. Morbid anatomy, both gross and histological, became an integral part of the medical curriculum. In hospitals, ambitious young hospital doctors would seek assistantships in pathology departments and carry out hours of post-mortem work (often unpaid) that would ensure, they hoped, that they had impeccable credentials for promotion to more senior positions and thus the kudos to attract private patients outside of the hospital.