Date of this Version
Beginning in the 1730s and 1740s, "market forces" tempered by professional and institutional constraints shaped the growth and organization of medical teaching in London. Gradually, after 1815, the growing protectionism of the licensing corporations undercut the private entrepreneur and, by the middle of the nineteenth century, led to the ascendancy of organized medical schools and university-granted medical degrees.
Recent work on eighteenth-century medicine has begun to focus attention on London as a dynamic center for both practical clinical experience and formal lecturing. Such current research has, however, primarily concentrated on a few significant individuals, especially William and John Hunter and their courses on anatomy and surgery, or on the testimony of a handful of students who left accounts of their London training. These limited, albeit welcomed, forays still seriously underrepresent the variety and complexity of the opportunities for medical education available in London A careful look at the courses offered, the relationships among lecturers, hospitals, and extramural teaching, and the effects of London-wide competition reveals that London developed a medical curriculum as well rounded as that of the universities in Edinburgh and in Paris after the Revolution. By the late eighteenth century, London had become not only a center for surgery, anatomy, firsthand dissection, and hospital experience, but also a training ground in medicine, chemistry, and midwifery. The evidence suggests that many London students pursued an education suitable for general practice without regard to the ostensible professional divisions embodied in the traditional London medical corporations. The very existence of a broad and popular curriculum by the turn of the nineteenth century, furthermore, challenges the common historical assumption that the Apothecaries' Act of 1815 spurred the development of specifically medical lecturing.
The men who came to London to study had a pivotal role in two unregulated markets: medical practice and medical training. The apparent demand by British patients for knowledgeable medical care stimulated many aspiring practitioners voluntarily to pay for medical courses that gave them a competitive advantage in their intended careers. The growing number of pupils coming to the metropolis in turn increased the demand for the accessible and flexible "academic" teaching provided by energetic entrepreneurs, who offered courses at reasonable prices in their homes, in private theaters, or in rooms and theaters at several of the general London hospitals.