In the first half of the 19th century medical training for aspiring doctors was a period of apprenticeship supplemented by lectures at a medical school. Few would have been graduates of a university; most of these would have been educated at Scottish universities, particularly Edinburgh.
Until the mid-Victorian period, the medical profession remained a segregated and stratified profession, with physicians, surgeons and apothecaries (general practitioners) having different rights and responsibilities in treating patients. In the early nineteenth century, the medical elite in England had been dominated by the Royal Colleges of Physicians and Surgeons in London. Many of those practising medicine had no medical education or qualifications at all. Between these two groups were the apothecaries and surgeon-apothecaries, who undertook much of the basic medical work for the general population. They were concerned about a lack of professional status and the restrictions imposed on the work they did.
In 1815, following agitation by the Society of Apothecaries, the Apothecaries' Act was passed, which introduced tighter regulation of the profession. Those practising as apothecaries now had to be licensed by the Society of Apothecaries. Aspirant apothecaries had to prove they had undertaken a period of apprenticeship of five years, and provide certificates proving they had attended medical lectures.
Few opportunities existed for medical education in towns like Manchester before the Act. In the late 18th century, the Manchester Literary and Philosophical Society, a leading force in the provincial Enlightenment, had offered lectures in anatomy, physiology and chemistry, but nothing amounting to a medical education. With the passing of the Apothecaries' Act demand for such an education found a response in the establishment of several proprietary medical schools in the town.
The first of these was established by Joseph Jordan in 1814 in Bridge Street in central Manchester. This was the first medical school in the English provinces. Jordan was an enthusiastic teacher of anatomy who had studied under Charles Bell and Alexander Munro in Edinburgh. Jordan enjoyed some notoriety in Manchester because of accusations of involvement in body-snatching to provide his school with the necessary corpses for dissection. In 1816 his certificates for instruction were recognised by the Society of Apothecaries.
By the 1820s Jordan faced competition from other medical practitioners. Teaching medicine was increasingly recognised as a way of gaining professional status and respect, even if the fees paid by students were not substantial. In 1824 Thomas Turner (1793-1873) opened the Manchester School of Medicine and Surgery, known from 1836 as the Manchester Royal School of Medicine (MRSM), but more commonly referred to as the Pine Street School of Medicine. Pine St. was the largest and longest lived of the Manchester schools; in 1873 it amalgamated with Owens College to form the medical school of Owens College, later the University of Manchester. A further school was established at Marsden Street in 1829, which closed in 1839. Jordan later moved his school to Mount Street but he was forced to close this in 1834. In 1850 a school was opened at Chatham Street, which apparently enjoyed very good facilities and this merged with the Royal School in 1856 (from 1856-61 the Royal School was based at the Chatham St. premises not at Pine St.).
The Manchester schools would have been small, with relatively few candidates entered each year for the Licentiate of the Society of Apothecaries (LSA). It is obvious that competition for relatively few students led to financial difficulties, and it proved difficult to raise capital for investment in laboratories, museums and libraries. They did have an impact on the local medical population: for example, over half of the practitioners educated between 1810-60 who joined MRI honorary staff were educated locally. These individuals usually supplemented their education in London or Edinburgh or abroad.
As very few records survive for the proprietary schools, we know relatively little about the content of the curriculum and the methods of education. However, it is clear that an increasing number of subjects were studied by the 1830s and 1840s, not only anatomy and physiology, but also surgery, obstetrics, pathology, materia medica, chemistry, botany and medical jurisprudence. Students of the schools would have taken the LSA, and usually the MRCS (membership of the Royal College of Surgeons) as well to allow them to practise surgery. The MRCS was usually taken a year after the LSA because it required a year's clinical experience.
By the 1850s with the numbers of medical students increasing and the professional status of general practitioners being recognised, medical reformers campaigned for a reform to the system of medical qualification to assure more uniformity in quality. In 1858 Medical Reform Act was passed creating the General Medical Council which oversaw a single register of medical practitioners and the licensing bodies which awarded medical qualifications. Its education committee was very active over the next two decades in restructuring medical education. In addition to these professional developments, intellectual developments were pointing towards a greater role for science in standard medical education. In particular there was a growing recognition of the need for training in laboratory techniques for medical students, as was happening successfully in German universities. In 1870 the Royal College of Surgeons had stipulated that candidates for its diploma would have to have attended laboratory classes in physiology.
Laboratories suitable for a sophisticated teaching and research were expensive. Increasingly, these could only be provided by universities or in some cases by the largest hospitals. The amalgamation of MRSM with Owens College came to be seen as the best way of providing up-to-date medical education in Manchester. Although the two institutions had discussed a merger in the mid-1850s, academics at Owens were fearful that incorporating a medical school would give too much power to the medical faculty (some academics also feared the bumptious reputation of the medical students). By the late 1860s, Owens was a more self-confident institution, planning its move to Oxford Road, and aspiring to achieve university status. It was felt that the case for a University of Manchester would be immeasurably strengthened if Owens had a medical school. Medical students made up a very significant proportion of the total in Scottish universities and at London University.
In 1872 agreement was reached on amalgamating MRSM and Owens College. The merger was facilitated by the gift of £10,000 from Alice Brackenbury, half of which was used to build the new school at Oxford Road, and half to endow a chair in physiology. In addition, two physiology scholarships were endowed by Robert Platt.
Teachers from MRSM joined the College medical faculty and Arthur Gamgee was appointed full-time professor of physiology, with a brief to develop medical research at the College. The number of students at the new school increased rapidly. In 1871, the School had 112 students, by 1880 Owens College Medical School had 220 students. Medical students registered at Owens/Manchester fluctuated between 20-40% of the total student population between 1872/3-1913/4 with a decline in numbers in Edwardian period (as a result of other courses expanding). On 5 October 1873 the new medical school was opened by the naturalist Thomas Huxley. The building, located in Coupland St., was designed by Alfred Waterhouse (1830-1905) in the English Gothic style; it was to serve as the medical school for over a hundred years. A major extension was added in 1894. The School had four major lecture theatres, including a physiology theatre which could seat over four hundred, and an anatomy theatre, which has the shape of an elongated horse-shoe [see the photos in MMC/5/7/4/18].
The flourishing medical school encouraged Owens College to bid for university status. They were partly successful in this; in 1880 the federal Victoria University was created with Owens as its sole constituent college. However, opposition from medical schools in Liverpool and Leeds had denied the new University the right to award medical degrees. This was overturned in 1883 following recommendations of a Royal Commission. Manchester teachers could now award the degrees of bachelor of medicine and bachelor of surgery (M.B. Ch.B.), and were entitled to representation on the G.M.C. This gave the Medical School greater control over its syllabus; in 1880 Gamgee, Henry Roscoe (professor of chemistry) and William Roberts (professor of medicine) devised a new medical syllabus - a preliminary exam in an arts subject, followed by an intermediate examination in scientific subjects, chemistry, natural philosophy and biology, then the first M.B. in anatomy, physiology and pharmacology, and finally examinations in medicine, surgery, midwifery, public health, pathology and forensic medicine for the M.B. Ch.B. In 1903 the federal university broke up and an independent University of Manchester was formed, with the right to award its own degrees
The period between 1890-1914 saw Manchester Medical School establish a national reputation. Julius Dreschfeld developed a school of pathology, Sheridan Delépine built up a department of public health and bacteriology, and taught for the diploma in public health. Grafton Elliot Smith became professor of anatomy in 1909, and brought the University the benefit of an international reputation. Despite these advances, problems remained in the developing proper schools of medical research. Relations between the University and the teaching hospitals could be difficult; clinical professors held part-time appointments, and in many cases saw their loyalties and interests more with the hospitals where they held honorary appointments than to the University. For example, the professor of clinical medicine at the University was always a distinguished local clinician who rarely saw the need to undertake 'academic' research. However, the situation with clinical teaching improved as the MRI followed in 1908 the Royal Eye Hospital, the Christie Cancer Hospital and St. Mary's Hospital to a site close to the University.
The inter-war period saw medical research becoming a more significant part of the work of UK medical schools. Bodies like the Universities Grants Commission, the Medical Research Fund and the Rockefeller Foundation were providing money for dedicated medical research facilities. To some extent, Manchester suffered as funds and personnel gravitated to new medical research facilities in London. Although Manchester could recruit talented and ambitious medical teachers and researchers, it had difficulty in holding on to them. The absence of full-time professorial posts in most subjects also discouraged recruitment. By the mid-1930s, it was becoming apparent that future developments in the health services as a whole would require greater co-ordination between teaching hospitals and the universities, and there would be the need for full-time medical teachers, capable of building up research units and of teaching a greater number of medical students in an increasing number of subjects. Professionalisation was recognised by the appointment of the first full-time medical professors in the 1940s; Robert Platt, a distinguished nephrologist, became professor of medicine in 1945, and was to build up a nationally important research school in renal medicine. Platt also introduced changes to the medical curriculum, with the aim of integrating preclinical and clinical teaching. Following the recommendations of the Goodenough Committee on medical education in 1948, the University began to introduce professorial units which gave a firmer position to academic teaching and research in the teaching hospitals.
By the 1950s it was apparent that the existing Medical School buildings were inadequate to its purposes; in the early 1960s the Royal Commission on medical education chaired by Lord Todd recommended an expansion in the number of medical students at UK universities, and the University took the decision to build a new medical school. Planning the new School took several years, and a site was chosen on the opposite side of Oxford Road, closer to the teaching hospitals. Harry Fairhurst, the architect of the new building, consulted widely with medical faculty staff about the design of the building. The new School, known as the Stopford Building, was opened in 1973 by Lord Todd and was at the time the largest medical school building in Europe.
