Becoming a Physician: Medical Education in Britain, France, Germany, and the United States, 1750-1945 (review)

The title gives an accurate statement of the ambitious nature of this work. Thomas Bonner attempts to provide an account of the development of medical education over a (very eventful) period of almost two hundred years in the major centers of medical learning in western and central Europe as well as in the United States; for good measure, he adds occasional asides about events in Canada and in other European schools. This enterprise involves the assimilation and synthesis of a mass of monographs and articles in several languages. Bonner has also, moreover, undertaken an impressive amount of original research in both published and archival sources.

Bonner insists on the need to place changes in medical education in the context of “the social, industrial, political, and educational transformations of Europe and North America that took place between the Enlightenment and World War II” (p. 4). While experimental science may insist upon its isolation from “external” infuences, the training of physicians has always been an unequivocally public and social undertaking subject to the values and mores of the society that these embryonic practitioners are ultimately to serve. For example, around the turn of the nineteenth century, at a time of prolonged warfare, the demands of the military for serviceable physicians was a powerful force for change in the reordering of medical schools.

Another recurrent theme throughout this book is the persistence, during the whole of the period covered, of national differences in the way that medical education has been organized. These peculiarities survived even the growing power of the rhetoric of scientific and medical internationalism that was such a feature of the decades before 1914. While British medical students may have traveled to France in the 1820s, and Americans to German schools toward the end of the nineteenth century, when they came home the ideas and techniques that they had learned abroad were transformed by the exigencies of their native cultures.

A work of this kind inevitably invites quibbles about particular judgments or emphases from specialists in the numerous areas that Bonner encompasses. It must be said, however, that overall he offers an admirably balanced and judicious treatment of the complex issues with which he deals. But his frequent assertions that certain establishments provided a “good” level of training does somewhat beg the question of what, in a given epoch, qualified as adequate or excellent medical education.

Bonner’s assertion that by ca. 1830 the “new studies of science, it was increasingly believed by laypeople, gave the physician a surer command of diagnosis and a better understanding of the disease process” (p. 158) also gives pause. He provides no evidence for this very strong, and far from uncontroversial, claim. Many scholars would argue that for most of the nineteenth century scientific medicine failed to command such widespread popular authority—hence the difficulties that the orthodox medical profession experienced in seeking to distinguish itself from its various competitors.

Nonetheless, this is an extremely valuable study, which makes the results of several decades of scholarship readily available to the reader. It can be warmly commended to all with an interest in the history of medical education.