The Practice of Practical Education: Male Students and Female Apprentices in the Lying-in Hospital of Göttingen University, 1792–1815

Abstract

It is generally agreed that, in most European countries, practical education became increasingly important for future physicians and surgeons during the course of the eighteenth century. Recent studies have shown that, around 1800, clinical teaching took place in a variety of contexts: hospitals with inpatients, polyclinics or outpatient dispensaries, consultation hours for poor people, private tutoring by, or a kind of apprenticeship with, an experienced practitioner. 1 While these organizational forms have become fairly clear in several countries, much less is known about what ''practical'' training actually meant. Did it mainly consist of ''studying written case histories'', 2 or following ''clinical lectures'' in the classroom where the teacher brought in patients and explained their diseases? Did students attend the hospital rounds of professors and hospital physicians, or did they ''walk the wards'' on their own? To what extent were medical students allowed to question patients, and physically examine them? Were they given responsibility for patients under the supervision of a professor or an experienced physician? If so, how many patients did they examine or treat during their education? It is true that we know the regulations of some medical schools at specific points in time, but we have much less knowledge about how these rules were implemented. The few surviving memoirs, diaries and travel accounts make clear that there may have been a considerable gap between norms and practice. A major constraining factor was of course the number of students per patient, and per teacher. Detailed archival and printed sources from the lying-in hospital of Göttingen University allow a deeper insight into the practice of clinical teaching during the late eighteenth and early nineteenth centuries. In this period, when midwifery was being transformed into # J€ u urgen Schlumbohm 2007

Early Use of Simulation in Medical Education

“…66 In Germany in 1794, the University of Göttingen purchased an obstetric phantom made from a female pelvis covered in leather for Friedrich Osiander to use in practical obstetric teaching at the university's maternity hospital. 67 Osiander tried to make the teaching on the simulator as authentic as possible and preferred to use dead babies preserved in alcohol instead of dolls. He had a maximum group size of 4, and when he was unavailable to teach, he had a more experienced student to supervise the others.…”

“…67 Simulatorbased teaching of determining fetal position and dealing with difficult births was first scheduled by Osiander for Wednesdays and Saturdays every week, but this soon had been increased. 67 In 1831, Dr Ozenne 68 presented an improved mannequin that had been working on for 6 years to the French Royal Academy of Medicine. 67 Osiander tried to make the teaching on the simulator as authentic as possible and preferred to use dead babies preserved in alcohol instead of dolls.…”

History of Medicine: Health, Medicine and Disease in the Eighteenth Century

“…They have also been valuable in highlighting broader notions of medicalisation, linked to shifting conceptualisations of sickness and poverty, and the negotiation of hospital care by its recipients. 19 Noteworthy among recent institutional surveys covering our period is Guenter B. Risse’s extensive study of British and European hospitals, while national and regional hospital histories have also been very well served. 20 Some studies spotlight the social, epidemiological and mortality impact of medical institutions; others concentrate on access to, and boundaries of, institutional charitable relief and the economics of hospital provision.…”