The Clinical Training of Doctors: An Essay of 1793

Philippe Pinel submitted this essay to the French Society of Medicine in 1793 as part of their annual prize essay competition. It did not win the prize then (no winner was named that year), and it probably would not win any prizes now. However, in light of the contributions to medicine that Pinel went on to make and the pivotal period in French history in which he wrote the essay, it is fortunate that Dora Weiner has rescued the manuscript from its obscurity. The topic set by the Society of Medicine in 1793 was "To Determine the Best Method to Teach Practical Medicine in a Hospital." Pinel deals with the task in three parts. In the first he discusses factors outside the hospital, such as the prevailing climate and the diseases endemic to the area, which must be considered in choosing the location for a teaching facility. In the second he develops ideas for the organization and administration of the clinical teaching wards; in this section Pinel also includes brief accounts of the major European teaching hospitals of the period. In the third he outlines the curriculum to be used for clinical training. Weiner presents Pinel's French text in its entirety, followed by her own translation of the text into English. Her translation flows freely and preserves the conversational and emotional aspects of the original essay. In a superb introductory essay, Weiner places Pinel's work in the context of the period and in the context of his own intellectual development. Historians of medicine will find Pinel's essay interesting for his ideas about dealing with the spread of disease within a hospital, his adherence to the tenets of the French Ideologues in molding an educational system that required knowledge of the basic sciences and emphasized clinical experiences over lectures, and for the insights provided into Pinel's thoughts at the time, which he would develop more fully in his better known Treatise on Insanity (1801) and Clinical Medicine (1802). Clinicians and students will recognize that we are still grappling with many of the issues Pinel raised, as we continue to seek the best method of clinical training.