Conference report: Medical training, student experience and the transmission of knowledge by Anne Hanley

In the first blog post of 2015, Dr Anne Hanley reports on 'Medical training, student experience and the transmission of knowledge' - a conference which took place at the Centre for the History of Medicine in Ireland in October and which was funded by the Irish Research Council and the Wellcome Trust. Podcasts of papers from the conference were recorded by Real Smart Media and may be accessed here. 

I recently attended the conference, 'Medical training, student experience and the transmission of knowledge, c.1800-2014' (or #MTSE14 if you want to look over our live tweets), at University College Dublin. Needless to say its focus, and the discussion generated from its wide-ranging collection of papers, was excellent and very much overdue.

Students dissecting

Medical education

Despite an ever-growing interest in the history of medicine, the subject of medical education and student experience continues to be overlooked (the last international symposium dedicated to this subject having taken place in the early 1990s). Yet throughout the nineteenth century medical education was being increasingly formalized, centralized, and consolidated. It became the backbone of one’s medical career. Strangely, however, it has occupied the negative space in histories of clinical practice and patient care. This omission is incredibly problematic (but I digress…).

So, when Laura Kelly emailed to ask if I would give a paper at a conference devoted to the history of medical training and knowledge production, I sent back an immediate and unequivocal ‘YES!!’. (There were so many excellent papers about which I want to talk that my own paper, ‘Venereology at the Polyclinic’, will have to take a back seat for now.)

An important focus of MTSE was the centrality of pedagogy. Traditionally, histories of medical education have been written as administrative histories of major teaching hospitals. They have concentrated on the big names, significant infrastructural changes, and major medical developments that altered practice in these hospitals. Rarely have such histories considered in the implications of the big names and significant changes for the day-to-day learning and experiences of students. Happily, however, historians of medicine are beginning to recognize the importance of pedagogically-focused histories and MTSE really demonstrated this change. It brought a whole host of issues to the fore and, as those of you who follow me on Twitter will have gathered, I was rather excited by the rich collection of papers.

Professor John Harley Warner delivering his keynote.
Image courtesy of Real Smart Media

John Harley Warner keynote address

We began with the keynote address from John Harley Warner, who introduced us to his most resent and gruesomely fascinating work on the photographic history of dissection in American medical schools. As Warner observed, nineteenth-century medicine was often a solitary occupation and so medical schools provided an important opportunity for group learning and for developing a collective professional identity. And this is particularly well-evidenced in the strange collections of photographs in which groups of students posed around tables upon which they were dissecting cadavers. One particularly interesting aspect of Warner’s keynote was the figure of the medical school porter who often appeared in these photographs and who Warner identified as playing a key role in the facilitation of medical education (but I’ll return to this shortly).

Attendees at MTSE.
Image courtesy of Real Smart Media.

Microbes to matron

Many fantastic papers followed, including Claire Jones’s presentation of her most recent research on the ‘Microbes to Matron’s’ project. Her focus on the pedagogy and practice of infection control in British nursing between 1870 and 1900 offers an important counterpoint to what have traditionally been male-focused accounts of medical education. It is very easy to forget that there were (and continue to be) other groups of trained medical professionals beyond doctors who provided care to a wide cross-section of the population. What also interested me about Jones’s paper were the types of sources she and her fellow project investigators are drawing upon. By using surgical nursing examinations, Jones demonstrated the increasingly active role of nurses in their own education, and in surgical practice more broadly.

Dollhouse diorama

Crime scenes and dollhouse dioramas

Similarly, Neil Pemberton’s paper on teaching crime scene investigation through dollhouse dioramas also prompted us to reconsider the role of women in medical and scientific training. By appropriating the traditional female practice of miniature making, women like Frances Glessner Lee created a new way of thinking about crime scene science. Nathalie Sage Pranchère also looked at the important role of women in medicine, speaking about the development of nineteenth-century French midwifery training. Importantly, she also described how obstetric teachers used models to develop the anatomical and obstetric knowledge of their midwifery students. As we saw with Pranchère’s paper, the role of material objects in medical training and practice is becoming an increasingly central focus of historical scholarship and this was reflected throughout MTSE. For example, Jenna Dittmar used the collections from Cambridge’s former Anatomical Museum to demonstrate how human remains allow biological anthropologists to examine the historical tools and techniques of dissection.

Speakers Greta Jones, Anne Hanley,
Nadav Davidovitch and Victoria Bates.
Image courtesy of Real Smart Media.

Spaces of medical education

Another important theme to emerge from MTSE was the different spaces of medical education. Warner described the dissection room as a space for developing collective professional identify. Michael Brown spoke about the dynamic space of the nineteenth century lecture theatre, in which students and their lecturers were appealing to culturally resonant sets of values. Clare Hickman presented eighteenth-century botanic gardens as important spaces for thinking about the material culture of medical teaching. Hickman’s paper, like Warner’s keynote, also demonstrated that the history of medical education is never simply about those who learned the art of medicine but also those in the background. Like the African American medical school porters who procured cadavers for students, gardeners were important (but silent and overlooked figures) in the maintenance of teaching spaces and the facilitation of teaching practices.

Attendees at MTSE.
Image courtesy of Real Smart Media.

MTSE demonstrated how the nature of medical training has changed over time and within distinct national contexts. Through an excellent collection of papers we explored the emergence of centralized and consolidated systems of medical training. We looked at the development of new tools of training and the different spaces in which these tools were employed. And we looked at how medical knowledge and codes of professional identity were being assimilated by medical and dental students, nursing probationers, midwives, and qualified practitioners seeking further education.

I came away from MTSE with a new appreciation for the diversity of student experiences and systems of knowledge dissemination, and will certainly be drawing upon these ideas in future. With any luck, events like MTSE will slowly begin to generate greater interest in the important place of medical training in wider narratives of medical history.

Dr Anne Hanley is an LHRI Research Fellow at the University of Leeds with particular expertise in the history of modern medicine, medical education, health policy and the history of science. She recently completed her PhD at the University of Cambridge on the development and dissemination of venereological knowledge among English medical professionals, 1886-1913. She writes a blog Clinical Curiosities and tweets at @annerhanley.

Workshop report: Soviet healthcare in the comparative perspective by Susan Grant

In this month's blog post, Susan Grant reports on the recent 'Soviet healthcare in the comparative perspective' workshop which took place at UCD in May 2014.

Historians of Soviet and medical history met in the UCD Humanities Institute May 29-30 to discuss Soviet healthcare in comparative perspective. Generously supported by the Wellcome Trust, UCD Seed Funding, and the Irish Research Council, this workshop represented an important international gathering of scholars from Ireland, the UK, Canada, and the United States.  The inter-disciplinary nature of the workshop meant that there was much debate and discussion among participants (the programme is available on the CHOMI website here).

Nursing in the Soviet Union

The overall aim of the workshop was to analyse the history of Soviet nursing and healthcare in comparative perspective, and to critically examine issues such as professionalization, gender, and care. The workshop mandate was to evaluate Soviet nursing relative to international nursing and healthcare, and to explore how nursing in the Soviet Union developed in relation to other medical professions. Participants were asked to consider the development of Russian healthcare and to compare the Soviet healthcare system to that of other countries.

Comparative aspects of Soviet healthcare

The workshop was a great success, particularly in facilitating cross-disciplinary discussion about the comparative aspects of Soviet healthcare. Panels focused on three key aspects of Soviet healthcare: professionalization, gender and care. The issue of care and the idea of the ‘virtue script’ (as conceptualised and explained in the work of Prof. Sioban Nelson, University of Toronto) fostered a particularly engaging dialogue about how nursing care is conceived and understood. This fed into discussions of what constitutes a ‘good’ and ‘bad’ nurse, as well as patient perceptions of ‘good’ and ‘bad’ nurses.  Nursing care, whether in the Soviet Union or elsewhere, depends on a variety of factors and an individual’s experience of nursing care. Studies of Soviet nursing are limited and probing expectations of care from an international perspective proved very productive in thinking about approaches to Soviet nursing and healthcare practices.

Panel on gender

Papers that focused on gender were particularly helpful in illuminating the difficulties and challenges of dealing with source material such as memoirs, interviews, etc. Prof. Dan Healey, Dr Laura Kelly, and Prof. Christopher Burton shared their experiences of working with memoir literature and the problems this can raise in terms of medical history. This was very informative for everyone, and especially instructive in highlighting the similar experiences of scholars who focus on different periods and countries. Indeed, scholars of medical and nursing history, and also the history of Russia, Ireland, Great Britain, etc., found that they had much in common. Participants specialising in Soviet history were surprised to learn of the liberal aspects of medicine in Ireland at the turn of the century. Cross-disciplinary dialogue here proved fruitful and underlined points of intersection and diversion between Russia and the West.

Transnational healthcare

The comparative dimensions of international healthcare were underscored in the panel featuring Prof. Susan Solomon, Prof. Paul Weindling, and Prof. Anne Marie Rafferty. Papers here focused on the transnational aspects of healthcare, dealing with Soviet cultural diplomacy in the 1920s, continental nurses in the UK  1933-1945, and nursing and decolonization during the second colonial occupation of Malaya, 1946-1955.

Round table on professionalization

The issue of professionalization was discussed in the opening and round table discussions. Scholars of Russian history, including Prof. Donald Filtzer, Prof. Benjamin Zajicek, and Dr Susan Grant presented their papers on professionalisation and practice in Soviet healthcare history.  Discussions about professionalization were elaborated on in the roundtable session, with participants Prof. Susan Solomon, Prof. Sioban Nelson, Prof. Dan Healey, and Prof. Anne Marie Rafferty contributing to a lively debate. It was questioned whether or not theories of professionalisation and histories of the professions are helpful as methods in analyzing both healthcare history and the Soviet case. Findings here were inconclusive, with some scholars acknowledging the merits of professionalisation literature in their work on the Soviet Union or healthcare, and others noting that they found this literature less useful.

The workshop proved that healthcare history continues to be a vibrant field and one that has much value when considering comparative international experiences. We look forward to more discussion of these debates in the future.

Charles Lucas (1713-1771) by Harriet Wheelock

This week marks the 300^th anniversary of the birth of Charles Lucas, a politician, physician and writer.

Charles Lucas was born on 16^th September 1713. Left penniless on the death of his father, Lucas was apprenticed to a Dublin apothecary. Apothecaries, at that time, were the least respectable branch of the rapidly expanding medical profession, but the only one a man in Lucas’ position could hope to access. The apothecaries’ trade was notorious at the time for fraud, malpractice, adulteration of medicines and the use of poison. Lucas actively campaigned for legislation to control the profession, and was partly responsible for the 1735 act which gave this College the power to regulate the Apothecaries trade.

Rising in his profession, in 1741 Lucas was chosen by the barber-surgeons’ guild to represent them on Dublin Corporation. Lucas campaigned against the usurpation of the rights of the common citizens by the Lord Mayor and Alderman, and was instrumental in getting the matter examined by committee. However, his outspoken views created enemies and in 1744 he lost his seat on the Corporation.

Lucas’ appetite for politics had been whetted and in 1749 he decided to contest the vacant parliamentary seat for Dublin. He expanded the arguments he had used on the Corporation, to argue against the deliberate erosion of the citizens’ rights of the entire population of Ireland. His denial of the right of the English parliament to make laws for Ireland raised some eyebrows, but he really overstepped the mark when he stated that there was ‘no general rebellion in Ireland since the first British invasion, that was not raised or fomented by the oppression, instigation, evil influence or connivance of the English’.  Parliament condemned Lucas’ ‘rebellious doctrines’ and ordered his arrest, forcing Lucas to flee to the Isle of Man.

Lucas used his 11 years of exile to great advantage; he studied medicine in Paris and Lieden, before establishing a practice in London and publishing many political and medical works. In 1760, after the accession of George III, Lucas was pardoned and allowed to return to Ireland. On his return he immediately and successfully contested the Dublin parliamentary seat, and was active in pressing for parliamentary and medical reform. For the medical profession his most lasting legacy was Lucas’ Act, passed in 1761. This greatly extended the powers of the College of Physicians, re-establishing their right of inspection over Apothecaries, and giving them the right to compile a Pharmacopoeia, cataloguing and detailing the mixture of all drugs which could be prescribed. Lucas died on 4^th November 1771, at the age of 58.

To mark the tercentenary of Lucas’ birth, the Royal Academy of Medicine in Ireland will be holding an evening symposium of Lucas on 23^rd September in Dublin City Hall, starting at 5pm. The programme is as follows:

Professor James Kelly, St Patrick’s College/DCU; The Life and Significance of Charles Lucas: An Overview

Professor Jacqueline Hill, NUI Maynooth; Dublin and Irish Politics in the Age of Charles Lucas

Dr Eoin Magennis, President of the Eighteenth Century Ireland Society; Charles Lucas and Patriot Politics in mid-18th Century Ireland

Professor Marian Lyons, NUI Maynooth; The Professionalisation of Medical Practice in Dublin during the Early-17th Century: the Case of Thomas Arthur, M.D.

Dr Susan Mullaney, RAMI/UCC; Charles Lucas and Medical Regulation in 18th Century Ireland

Sean J. Murphy, M.A., Genealogy Teacher, UCD Adult Education; The ‘Essay on Waters’ and other Medical Writings of Charles Lucas

How the poor lived: Tenements, public health and medicine in 1913

In April this year, RCPI and the Dublin City Library and Archives held a joint seminar looking at medicine and public health in 1913, as part of the Dublin One City, One Book festival. Webcasts of the two papers give at the seminar are now available on the RCPI Player.

Sir Charles Cameron: Medical Officer of Health for a Strumpet City by Dr Lydia Carroll

Dr Lydia Carroll holds a PhD from the School of History and Humanities at Trinity College Dublin. She recently published In the Fever King's Preserves. Sir Charles Cameron and the Dublin Slums, the first major biography of Sir Charles Cameron. She has also contributed to Leaders of the City. Dublin's First Citizens 1500-1950, edited by Ruth McManus and Lisa-Marie Griffith. She is a seventh-generation Dubliner, whose family have lived and worked in the heart of Dublin for more than two centuries. Her paper looks at the work of Sir Charles Cameron, Medical Officer of Health for Dublin, and his work in improving the sanitary and living conditions in the city at the end of the 19^th and beginning of the 20^th centuries.

A grave crisis?: The impact of the National Insurance Act on health care and the medical profession in Dublin by David Durnin

David Durnin is an Irish Research Council for the Humanities and Social Sciences Doctoral Scholar at the Centre for the History of Medicine in Ireland, University College Dublin. He holds an MA in the Social and Cultural History of Medicine from the Centre. His current research project, entitled 'The War away from Home': Irish Medical Migration during the Great War Era, 1912-1922 explores the role and experiences of Irish medical personnel during the First World War. His paper looks at the conditions facing the medical profession in 1913, and especially the impact of the newly introduced National Insurance Act.