A transformation in training: the formation of University medical faculties in Manchester, Leeds, and Liverpool, 1870-84.

INTRODUCTION There is little disagreement among historians of British medicine that between 1858, when the Medical Act reached the statute books, and 1900, the profession underwent profound changes. In contrast to the pluralistic structure of the first half of the nineteenth century, the profession greeted the new century in corporate unity. There was still considerable diversity of income among practitioners, but minimal educational standards were in force and all doctors were registered with a central body, the General Medical Council (GMC). Many aspects of this process of change have yet to be explored. In this essay I focus on the implications of the educational reforms introduced by the GMC after 1858 for professional training in the provinces. Its explicit aim was to raise the standard of medical education and so to improve the social status of the profession. In the larger provincial towns, the reforms in licensing requirements initiated a major institutional restructuring of medical education. Emphasis shifted from apprenticeship towards schools and colleges for professional training. As the curriculum of medical studies became more elaborate, provincial schools looked to the resources of newly-founded university colleges to augment their modest facilities. The development of medical training played a crucial role in the establishment of the British university system, providing links with the professions and ensuring a relatively stable market of students for fledgling colleges. The medical profession in return upgraded the status of its training system and, in so doing, created a structure that would accommodate to major curricular reforms, including the introduction of the biomedical sciences. I shall explore in detail changes in the organization of medical training in Manchester, Leeds, and Liverpool where the relocation of medical education into the local university colleges (which eventually formed the federal Victoria University) involved the setting up of several pre-clinical laboratory-based departments. Full-time chairs in physiology made clinical practice impracticable. These developments mirror events in the United States where medical schools appointed many pre-clinical specialists during a period of rapid growth and reform between 1890 and 1914. Robert Kohler has argued that these changes were integral to the professionalization of American medical practice. In Britain also, the profession sought to underline the "scientific" basis of its authority. *Stella V.F. Butler, PhD, Greater Manchester Museum of Science and Industry, Liverpool Road Station, Castlefield, Manchester M3 4JP.