Disciplining medicine: science and the rhetoric of medical education reform in Britain, 1770-1858.

Abstract

In Britain, medical education evolved significantly between roughly 1770 and 1858. The doctrines established by medical teachers in the late eighteenth century not only revised or overturned received theories of disease, physiology, and therapeutics, but also entailed new approaches to instruction. Though this educational reform process met some resistance, by the mid-nineteenth century, the new scientific perspective had displaced the traditional humanistic paradigm in medical pedagogy. In Britain, this evolution was initiated in Scotland, where its leading medical teachers would gain considerable fame for championing a new science-based educational curriculum. A contribution to the fields of rhetoric of medicine and rhetoric of science, this study investigates the rhetorical demarcation of the medical discipline in Britain during the years of medical education reform. It draws attention to how the medical discipline evolved and transformed between these years, ultimately defining itself as a science. Focusing on documents addressed to questions of pedagogical method, curricular emphases, and doctrinal disputes, this study identifies the chief arguments, assumptions, and aspirations that motivated and justified innovations in the teaching of medicine at specific British institutions and promoted broader, sweeping reform of the whole system of British medical education. The analysis of these texts highlights the complexities of medical education reform in Britain, and the diverse perspectives that coalesced to shape medical education in new ways. Moreover, these discourses serve as historical markers for how the medical discipline was (re)shaped scientifically. Finally, this study contends that disciplines are most apparently shaped through what is taught, and to understand the rhetoric of disciplinarity in British medical education reform, one must understand the history of its teaching practices.