Towards unity and autonomy: the Belgian medical profession in the nineteenth century.

INTRODUCTION Sociological literature on the professions has focused on the fact that they are characterized by a high degree of autonomy, that is, legitimated control over their organization and terms of work.' The development of such autonomy must, therefore, be seen as central to the process of professionalization. However, the problems which beset sociologists in ascertaining whether professional autonomy has diminished in recent years are similar to those of establishing when and how the medical profession in various countries, in this particular case Belgium, became autonomous in the first place. Too often conclusions have been drawn on the basis of changes in legislation. But there is more to the concept. Different dimensions need to be distinguished: economic autonomy, the right of doctors to determine their remuneration; political autonomy, the right of doctors to make policy decisions as the legitimate experts on health matters; and clinical or technical autonomy, the right of the profession to set its own standards and control clinical performance, exercised, for example, through clinical freedom at the bedside, control over recruitment and training, and collegial control over discipline and malpractice.2 We normally use the term "medical profession" to describe all those persons who hold a formal qualification to practise medicine. With respect to this definition, two points should be made. First, in the early nineteenth century, those who made a living providing medical care not only exhibited few of the characteristics of the modem medical profession but, equally important, did not constitute a single occupational group. To apply the term "profession" in the early nineteenth century tends to mask the significance of the major changes which occurred in the structure of medical practice later in the century.3 Second, a profession is more than an aggregate of individual practitioners. It is a social entity