Background to medical education in Exeter
Exeter has for centuries been the administrative
centre for much of the South-West peninsula of England for government,
the church and law. Much of its history, including medicine, has been
well documented. Ancient foundations existed in the South-West to care
for leprosy, in Exeter it was the Magdalen Hospital which we know from a
charter of Bishop Bartholomew (1161-1184) was funded from the
cathedral’s secular income with specific regulations for its conduct
established by the Third Lateran Council in 1179, later confirmed by the
Pope in 1193. Before the Reformation the church provided medical care
for other medical conditions in later years receiving secular patronage
from the city mayor and corporation. There is also evidence of a faculty
of surgeons existing in Exeter but seemingly no actual documents have
survived to the present day.
Over the ensuing centuries we know of hospital
provision by the city corporation from 17th century and by
other institutions pressed into service to deal with battle injuries
following William of Orange’s arrival in Torbay in
1688 to cope with epidemics such as cholera. No doubt there would have
been some basic medical care provided by the institutions for the poor.
We know of individual physicians, surgeons and apothecaries who
practised either in the city or its neighbourhood who would have
provided some domiciliary care. But, it is not until the 18th
century that pattern of medical care becomes clearly established and
well-documented.
Dr Alured Clarke DD founded a hospital in
Winchester when he was a prebendary of Winchester Cathedral. When later
he was appointed Dean of Exeter Cathedral he energetically canvassed for
funds so that within a short time it was possible to lay the foundation
stone followed by the hospital opening on 1st January 1742 -
note that this is the equivalent of 1743 because
there had been a statutory revision of the calendar the previous year.
Although there was no formal medical school, we know from the hospital’s
statute book that students attended the clinical practice of the
physicians, surgeons and apothecary by paying a fee for the privilege.
This was not too surprising because there were several notable people on
the hospital staff who had national reputations as clinicians,
researchers and teachers. Medical education in the 18th
century was very different with students attaching themselves to
individual practitioners in hospital or in general practice: the term
‘general practice’ was already emerging at that time. Often they would
gain additional experience by moving elsewhere either to one of the
metropolitan or regional centres. In those days universities played a
much less important part in training of most doctors. Some aspiring
students would attend lectures at a university in the UK or in
continental Europe before seeking practical clinical training. The
apothecaries, who provided medical care for the less wealthy, received
their training by becoming indentured as apprentices and likewise the
surgeons. The Universities of Oxford and Cambridge conferred degrees in
medicine but the practical training had to be acquired elsewhere, some
students went overseas to graduate at one of the European medical
schools. Their practice was mainly amongst the wealthy who could afford
their fees although there were some who practised in rural areas notably
at times of religious tumult when they had moved away from larger
cities.
Outside of hospital it was apothecaries who
provided much medical care with the London-based Society of Apothecaries
licensing those who had received appropriate training. The Royal College
of Physicians of London licensed those who had received a degree from
Oxford or Cambridge or from one of the Continental universities but
these formed a very small number of the total number of medical
practitioners; they primarily cared for the wealthy. In 1815 the
Apothecaries Act was the first national legislation regulating medical
practice. At its inception roughly three-quarters of medical
practitioners were registered and by many this Act is thought to be the
basis for general practice as we know it today. Surgeons were less well
regulated with apprenticeship as the avenue of training but following
foundation of the Royal College of Surgeons their training became more
formalised.
We know from the hospital’s Minute Books formal
undergraduate medical school was fully established by the 19th
century with the physicians, surgeons and apothecary playing their part
in teaching with additional contributions coming from the by now
established Exeter Dispensary. A Library and teaching accommodation and
facilities for anatomical dissection were provided by the Governors. The
teaching appears to have been of a high standard as shown by Exeter by
1823 being probably the second provincial medical school after
Manchester to introduce the teaching of chemistry, quite a novelty in
medical education in those days. However, concerns were beginning to
arise nationally about the quality of medical education resulting in a
Parliamentary Committee on Medical Education in 1834. A review of
Exeter, along with other provincial medical schools, recommended its
closure - a proposal that was opposed by 27 students and 38 local
medical practitioners, this spirited defence suggesting it was not
lacking in numbers compared with the other provincial medical schools.
Nothing happened, though, until the Medical Act was passed eventually in
1858: the history of its passage is a fascinating social commentary of
the times and relationships within the medical community. Once it was
passed the fate of the medical school was sealed and it closed. Medical
education came under the control of the General Medical Council which
limited the right to award degrees or diplomas permitting medical
practice to universities, Royal Colleges and the Society of
Apothecaries. Thoughts of re-establishing medical education did not die
with closure of this first medical school – they re-emerged in the
latter part of the 20th century.
Further Reading
Russell, PMG. A History of the Exeter Hospitals
1170 to 1948. Exeter, 1976
Delpratt Harris, J. The Royal Devon and Exeter
Hospital. Eland, Exeter, 1922.
Knox A, Gardner-Thorpe C. The Royal Devon and
Exeter Hospital 1741-2006 Exeter, 2008
Newman, C. The Evolution of Medical Education in
the Nineteenth Century. Oxford: Oxford University Press, 1957
Poynter, FNL ed., The Evolution of Medical
Education in Britain London: Pitman Medical Publishing, 1966