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THE LANCET.

LONDON: SATURDAY, OCTOBER 6, 1860.

THE OPENING OF THE MEDICAL SESSION.

THE first day of October is the red-letter day in the medicalcalendar. Inasmuch as the pleasures of Hope are commonlymore exciting than the pleasures of Memory, so do teachersand students feel more elation on the opening than on theclosing day of the medical session. No doubt the busy teacherand practitioner enjoy their scant holiday as heartily as do themembers of other professions-perhaps more so; for their escapefrom the haunts of men brings them to the presence of otherscenes of Nature’s works, which their scientific acquirementsand skilled observation peculiarly fit them to appreciate.Yet they are always found to return to hospital duty andteaching with an interest only whetted by relaxation. There

is, perhaps, no one who so thoroughly loves his work as

the physician or surgeon. He is rewarded not by fees alone,but by the gratification which the pursuit of natural studies issure to bring. Added to this, is the consciousness that hisstudies are also labours having an immediate application to thepurposes of benevolence. Over and above all these sources of

interest, there is for many the pleasure of teaching. We do

not observe that amongst the introductory addresses, which wepublish elsewhere more or less in detail, one of them has

touched upon this latter subject in the terms which it deserves.The teaching of physical and biological science must needstranscend in interest and fascination that of any other depart-ment of human knowledge. The teaching of literature, of

law, of theology, of mathematics, may no doubt possess at-tractions where the professor is earnest and able and the pupilunusually intelligent. But we fear there is a sad tendency inall these branches to entice the teacher into the complacentpaths of dogmatism, or to entangle him in the fetters of

routine. There is something too finite, and at the same time tooabstract, in them to keep alive any great amount of enthusiasm.On the other hand, there is in Medicine, and in all its ancillarysciences, still so much to be discovered, and the way to disco-

very-the study of Nature by experiment and observation-isso open to all, that dogmatism is rebuked and routine repetitionbecomes impracticable or absurd. Teacher and pupil stand in theposition of fellow-workers; the more experienced labourer rather

instructing his companion in the modes of investigation thanprofessing to impart the doctrines of determinate science. This

is a charm that hardly exists in equal strength out of theschools of Medicine. It is seen in its highest perfection inclinical teaching. Here the physician or surgeon associates

with himself more or less intimately a body of young men, allanimated with the desire of improvement, in the pursuit of acommon object, not yet fully revealed even to the teacher. A

patient is admitted into the hospital. The teacher first, in the

presence of the pupils, explores the case, explains its actualcondition, and ventures to foreshadow its course. Day by day,and hour by hour, he or some members of his class watch thevarying phases of the disease, none knowing certainly theresult, but each aiding the other to a fuller comprehension,eliciting anrl imparting knowledge hv turns Then there 1H

õhe advantage of conference upon the points of interest, andnstruction when the history is complete. And all, with thisFund of information, are armed with fresh means for new

inquiries.Thus we may understand the zest with which the teacher

returns to his labours. And who shall set bounds to the

exultant hopes, the joyous sense of emancipation, that attendthe transition of the student from the rule of pedagogy to thefields of free inquiry into the wonders of creation !Some have doubted the utility of the practice of inaugurating

the medical session by public discourses. We do not see anyvalid objection to the custom, and there are certain advantagesthat ought not to be foregone. These occasions are amongstthe few we possess for informing the general public upon therelations held by the profession of Medicine to society. n isboth right and useful that we should avail ourselves of everyfair opportunity of asserting the dignity and interest of a pro-fession whose pursuits and attributes are from their naturemore difficult of popular apprehension than are those of theLawor the Church. But probably even those who have hitherto questioned the use of these annual addresses, will be less dis-

posed to insist upon their objections after reading the collec-tion which this year has produced. They are, for the most

part, compositions of unusual merit; and may, without dis-credit to our calling, be compared with the similar efforts inwhich the members of other professions are wont to indulge,on various pretexts, at this season.As might be expected, these opportunities are further seized

for the purpose of reviewing the several questions of internaland external polity which have during the preceding yearengaged the attention of the profession. Thus we have from

Dr. WILKS, at Guy’s, an emphatic condemnation of the systemof specialism in Medicine, and of the conduct and motives of-those who get up special hospitals.The educational and moral advantages of the study of Medi-

cine were forcibly illustrated and proved in the addresses deli-vered at St. Bartholomew’s, the London, and at St. Thomas’s

Hospitals.Mr. SAVORY ably elaborated the argument in favour of in-

dustry, displaying by numerous instances the near relationship’of this quality to genius, and how indispensable it is to success.

Mr. GRAINGER’s discourse was characterized by a lofty toneof religion, and was the more impressive, from the circumstancethat his pupils were listening for the last time to the instruc-tion of one who has filled so honourable a place amongst theteachers of Anatomy of this metropolis. With characteristic

enthusiasm for the subject he had taught so long and so well,he could not let his farewell interview with his pupils passaway without impressing upon them the results of his researchesand reflections upon Life and Matter. The views he unfolded

in his admirable address he had, indeed, illustrated many yearsago in his Hunterian Oration before the College of Surgeons.But they will bear repetition, development, and re-inforcement.

Dr. CHOwNE, at Charing-cross Hospital, enlarged minutelyupon Medical Jurisprudence and the Coroner’s Court-topicsthat well deserve to be brought in a connected manner beforethe public.

Dr. JOHNSON’S address at King’s College was essentially oflocal interest, and might be defined as an eulogy of Dr. TODD.The opportunity was devoted formally to bestow upon thelamented deceased the honours of apotheosis.

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THE MELBOURNE HOSPITAL.

Dr. PiTMAN, at St. George’s Hospital, more particularly "several other inszruments which were hardly ever touched.addressed himself to the task of pointing out to the student Up to April, 1858, the institution accommodated 200 in-

the method of observation and the conduct he ought to pursue, patients, who were attended by two physicians and two sur-Dr. POWER, at the Westminster Hospital, and Dr. CooTE, geons. At this period a new wing was opened, which it was

at the Middlesex, pursued a similar argument. calculated might afterwards admit of the number of inmatesAt St. Mary’s, Dr. TYLER SMITH, and at the Grosvenor- being increased to 350. The Hospital administration imme-

place School, Dr. BLOXAM, dwelt very effectively upon the diately determined to increase the full acting officers to fourservices of the medical press, and enlarged upon the scien- physicians and four surgeons. But this increase did not satisfytific and social aspects of Medicine. The remarks of Dr. Dr. MACKENNA and his party. They affirmed that, with per-BLOXAM upon the qualifications of medical students, and upon haps 400 beds, together with an " extern clientelle enormouslyclinical teaching as the result of long and keen observation, increasing year by year," the number of medical officers shouldare especially valuable. be doubled, or twelve should be appointed. The hospitalThe address given by Dr. BARNES at the London Hospital duties had hitherto been very inefficiently performed, because

was designed to exhibit the general relations of Medicine to the physicians and surgeons had too much to do; and thissociety, with a view to guide the student in his endeavour to would continue to be the case unless a much larger staff wasfollow out the career he had chosen in a broad and generous established. A petition to this effect was laid before the Com-

spirit. mittee of Management of the Melbourne Hospital, and it is

Surely in all these topics may be found extent and variety of fully shown by Dr. MACKENNA that he was the animatingthemes enough worthy to engage the thoughts of those to whom spirit of the whole agitation. The direct result was the increasethe profession and the public look for a representation of the of the staff by two physicians and two surgeons. Failing instate, prospects, and claims of Medicine. We repeat, then, his efforts to effect a greater increase, Dr. MA.CKENNA-himselfour opinion that the custom of opening the Medical Schools being a candidate for one of the offices in futuro-continuedwith discourses, addressed partly to the public and partly to the agitation by insisting upon showing the impossibility of thethe student, is one that we should cherish and uphold. In existing staff being able to devote sufficient time to their duties.justification of this opinion, we invite the attention of our And how did he seek to prove his case ? Why, by the some-readers to the epitome of the metropolitan addresses we have what unprofessional expedient-to call it by no other name-collected. We hope in our next number to present a similar of bringing charges of neglect against certain members of theview of the addresses delivered in the Provincial Schools. staff! His own words are: " I was driven to the necessity,

.. ’’ by impeachments of my veracity, to bring before the public" the case I had alluded to, and another of which I was per-

A MASS of papers and reports, even to a cutting from the "sonally cognisant, to prove, not the want of skill, but theMelbourne Punch, now upon our table, testifies, we are sorry want of time on the part of the honorary staff to attend toto say, to the very disunited state into which the members of their patients, by taking on themselves a burden of duty itour profession have of late fallen in an important part of the was, I alleged, simply impossible to perform."Australian colony. Melbourne and its Hospital have certainly Such, then, is a brief outline of the case submitted to thebecome famous in the annals of social medical warfare, and it judgment of the good people of Melbourne. Public meetingswill be some time, we fear, before matters attain to a steady were convened to discuss it, newspapers made it the subject ofequilibrium. We have both sides of the question before us, so leading articles, and even the Melbourne P2cnclz libelled withfar at least as a distance of many thousand miles will permit. had jokes and equally bad woodcuts the Melbourne Hospital.This remoteness from the scene of strife necessarily deprives us The latter could resist no longer. A sub-committee of inquiryof that personal knowledge of the matter which is as salt to was appointed, consisting of the Chief Justice, the Hon. Sirthe meat we endeavour to digest. The nature of the quarrel JAMES PALMER, and others. It is gratifying to find that

will be best explained by reference to the statements made by the hospital and the staff enjoyed in Sir JAMES PALMER theDr. MACKENNA at a meeting convened at the Mechanics’ In- unusual advantage of medical knowledge and temperate coun-stitute of Melbourne by some of the subscribers to the Hospital. sels. As a result of this inquiry, we have an official reportAccording to the Melbourne Examiner and News, this gentle- of fifty pages of very Parliamentary -looking" Minutesman stated that, very shortly after his arrival in the colony, of Evidence," as taken down by an authorized short-handhe, having had an opportunity of witnessing the treatment of writer. Any analysis of the evidence here detailed it is quitepatients in the Hospital, was struck by the deficiency in its out of our power, as well as unnecessary, to give. We shall

management. He learnt, too, that the general feeling of the simply refer to the report submitted by the Court of Inquiry,members of the profession unconnected with the Hospital was after the performance of their painful but necessary duty, tosuch as fully to corroborate his suspicions; for " there was not the General Board of Management. Three cases of neglect and"one who had not a complaint to make that the patients had ill-treatment-i. e., malapraxis-are dwelt upon. The first

"been badly treated. It was not a want of sufficient attend- (HUGH M’CAULEY) was one in which a dislocation of the thigh"ance, but a general rottenness of the system, which had was said to have been mismanaged. The supposed dislocation"induced him to come forward." In the next place, Dr. MAC- was reduced; matters did not, however, progress very favour-KENNA found that " the mortality in the Hospital was mon- ably, as at the end of five weeks the injured limb was foundstrous" (fifteen per cent.); that the Committee appointed men to be much shorter than the other. The patient was now toldwho were too young to the office of assistant-surgeon; and that that "the acetabulum was fractured." The limb was then

there was at the Hospital " a beautiful microscope, which had kept in splints for sixteen weeks, at the end of which time" cost about sixty guineas, but which had never been used, also M ’CAULEY was discharged, permanently lamed. The judg-

342

ment upon this case, after some exoneration of Dr. BARKER, isas follows: -

" But your Committee are not prepared wholly to acquit thehonorary surgeon of inattention in the management of the case;for when his suspicions were awakened as to the nature of theinjury, which he must have known would require great care-fulness in the management, he ought to have employed morecircumspection in the details. If the least reliance is to be

placed on the evidence, it appears that the bandages were oftenout of order, and the bed was of a most unfit construction forthe treatment of the case. It appears, also, that a laxity ofsystem prevails amongst the resident staff as to the treatmentand discharge of patients, and the application and removal ofbandages without the sanction of the honorary surgeons, whichis highly to be condemned. The system, perhaps, is more de-serving of reprehension than the individuals, but still we areof opinion that Dr. Barker, Dr. Howitt, Dr. Fitzgerald, andMr. Curtis are not to be entirely exonerated from blame in thecase now under consideration, although the issue of it wouldprobably not have been very different from what it is under

any treatment that could have been adopted."The second case is that of LUKE ALLEN, admitted with

fracture of the patella, which was followed by mortification- of the foot, amputation of the limb, and death." It would

appear from the evidence that the patient and his friends attri-buted the mortification of the foot to the tightness of the band-ages and other surgical improprieties, whilst Dr. YOUL, theCoroner, associated it with hospital gangrene. Dr. BARKER,the attending surgeon, ascribed it to " a rupture of the prin-- oipal artery of the limb." Upon this charge the Court of

Inquiry thus expresses itself :-"In forming a judgment on such cases as the present, it

must be clearly borne in mind how impossible it often must befor the most accomplished practitioner, after the most careful examination, to pronounce decisively as to the nature or the ’,precise extent of the injury, which will be disclosed only bythe progress of the case; while, on the other hand, it is neitheruncommon nor unnatural, after the occurrence of new and

unexpected complications, for anxious and loving friends toimpute blame to the medical attendant. These considerations’should lead the candid mind to acquit Dr. Barker of want ofskill, or any want of attention in the management of the case,especially as it would seem absolutely incredible that in a greatpublic hospital a bandage should have been applied, and al-lowed to remain on several days, so tight as to occasion morti-fication of the limb, and yet no representation be made, eitherby the patient or any of his friends, to any of the numerousofficers or servants of the establishment that such was thecase. "

The third example is that of Mr. GEORGE BLACK, who was ad-mitted into the hospital on the 19th of May, 1858, with reten-tion of urine, and died from the effects of extravasation of

urine upon the 31st day of the same month. Dr. MACKENNA

charged Mr. GILBEE, the honorary surgeon, with want of at-tention and want of skill. The judgment here given is that,

" Upon a full consideration of all the circumstances, we are- of opinion that Mr. Gilbee is entitled to a full acquittal on bothcharges, and that these charges ought not to have been pre.ferred at so late a period, unless they could have been sup-ported by more substantial proof. Your Committee, however,disapprove of the system which allows the delegation to infe-rior officers of important operations like the present, requiringin some cases great judgment and skill in their execution; andare of opinion that the honorary surgeons should charge them-selves with these duties."

With regard to the great mortality which was stated to

occur in the Melbourne Hospital, we would urge that thismuch may at least partly account for it. In the colony, manypersons are taken to the institution in question in the agoniesof death-strangers in the country-people who have neitherfriends nor homes; some broken down by disease, some deeplyaffected by losses or by gains, and others the victims of im-morality encouraged by the sudden prosperity of the colony.Persons under such circumstances apply to be received intothe hospital that they may not die in the streets. Moreover,as there is but one hospital in Melbourne, all the worst acci-dents sooner or later arrive there.

With respect to the allegations about the microscope andother instruments, we consider Mr. GILBEE to have negativedtheir truthfulness.

After a close scrutiny of the mass of papers and evidencebefore us, we have ourselves arrived at the conclusion that the

administration of the Melbourne Hospital certainly neededreformation. We speak generally; the system was bad, andnot the conduct of any one or two officers in particular. If

the latter have been in fault, it has been rather in their en-deavours to keep their institution a "close borough." Theyshould have recollected

"Tempora mutantur et nos mutamur in illis."

Had they been a little more liberal, all this disgracefulsquabbling need not have occurred. All shortcomings in thehospital economics might have been rectified without it.With regard to the actual method adopted by the agitators

to gain their ends, it merits at the hands of the profession thestrongest disapproval. The personal animus in the agitationis plain throughout; and the traps set, the reckless statementsmade, and the energy and ingenuity exhausted in getting uponly three cases-for no more could be managed, and theseextremely defective as regards evidence,-make together buta sorry reason for the slur endeavoured to be cast upon a publichospital and some of its most respected honorary officers.

DEFICIENCIES IN THE SCHOOLS.

IN all the orations which have been delivered to the medicalstudents of London this week, two essential points have beenurged upon them with emphasis and without exception. Theyhave been told that anatomy is the basis of all their knowledge,and clinical study indispensable to its application. Dissect

diligently, and study disease in the wards. This is the burdenof every speech; no orator forgets to remind his hearers ofthese their chief duties. But these are precisely the injunctionswhich the student finds it impossible duly to observe, as thingsare at this day. The end is most desirable, but the means arewanting. In the simplest appreciation of medical education,these are the two elements of instruction which are of themost cardinal importance. But, in a candid review of themedical teaching in London, it must be admitted that theseare departments in which the greatest inefficiency reigns.Anatomical study is universally obstructed in the metropolitanschools by one prime difficulty-the scantiness and cost of ana-tomical subjects. It is impossible that the majority of medicalstudents in England should dissect as do continental students’;it is impossible that they should acquire that full, practicalacquaintance with the topography and manipulation of thehuman organs which is agreed on all hands to be the basis of

sound medicine and surgery, without a tenfold more numeroussupply of subjects than is accorded by the present legislativerestrictions. The present Inspector of Anatomy has shown