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INJURIOUS TENDENCIES OF THE HOSPITAL & DISPENSARY SYSTEM.
375
The opinions of their se- inflammation always is, ot rather ought to authors are entitled to our respect, excepting in the peritoof them almost to our adoption ; but neal variety, preferring veuesection to the indiscriminate application to every application ol leeches, a practice which both :. aamed or taisoamed puerperal fever, experience and theory amply justify. Where t’ too strongly reprobated. To apply the mental excitement and collapse of the be i- fnerol remarks to our present consi- system in this complaint are great, the exthe treatment of this complaint: A ternal application of turpentine, and the free is tracked with genuine puerperal use of warm wine, are loudly called for; but and is seen by an exclusive disciple it is in these cases that we have an opporschool. Believing, asitunity of appreciating the value of opium, a taughtto believe, that this fell inroaddrug which should not be measured by the - ease can only be successfully opposedstrength or number of its doses, but by its In conclusion, allow me to exprebs re large abstracvion of blood, he plunges; effacts. the hope, that should the above trespass cet iuto the veins of his unfortunate t, prolongs the copious stream, andupon your pages fail to convince, it may poss ior her a certain passage into an-sibly excite the attention of the more expeworld. Another female, by dint off rienced in the profession, to a disease so constitional powers, or the mild type’ choice in its victims, so formidable in its we complaint, has survived this disorder,, character, and, too often, so fatal in its termiattacked by successive inflammation.. nation. may happen tn be seen hv a diseinlp. nf f Manchester, November, 1829. Brnian school, who, under the imon that her complaint is puerperal tM. slias debility, that bugbear of medibecause, forsooth, she is a puerperal INJURIOUS TENDENCIES ferer), pours in his cordials to support a OF THE which he thus unconsciously destroys. ad this latter female been seen by the & DISPENSARY SYSTEM. mer practitioner, her life would probably re been saved, not because his views of eomplaint are more correct than those of MANY are the complaints made by the huer, but because, although exclusive, governors of hospitals, and other charitable ey would have been more immediately ap- institutions, of the negligent manner in plicable to the case. Again, a woman is which the medical officers, attached to those ed with a mild degree of puerperal institutions, perform their duties, while the er, and is seen by a disciple of incompetence of the majority of these officers n has turpentine given her, and the at- is as notorious to the profession at large as is removed. Exposing herself to cold the sun at noon-day. Such is the inevittwo or three days afterwards, she is seized, able result of the system at present pursued *’ will of physicians and surpresume, with enteritis ; well, her in the al attendant sees her again, and again geons to these institutions. However deeply cribes her turpentine. To detail its this is to be regretted, the governors and ’!’[!< would be superfluous-they will be supporters of these establishments have no tired. To instance one more operation, right to complain of it, as the evil originates and consists in the accept not an example of the exclusive doc- with es, a female is attacked with genuine anceof thegratuitous services, as they are. peral fever; her attendant not knowing called, of physicians and surgeons. That what to do, equally fearing to stienulate or man must know bnt little of human nature, plete, orders a little castor oil, and a who supposes that the members of the medraught at night; the disease pro- dical profession are more disinterested than —the medical man is distressed-the the rest of mankind ; for, notwithstanding all ies. their professions, unless they directly or measures adopted upon visiting a indirectly serve themselves, there would be eral female, sbould invariably be re- as much difficulty in finding men to devote ed by the symptoms.I have, in se- their time and talents to hospitals and inwell-marked cases of puerperal fever, firmaries, as in finding lawyers to do the successful recourse to hot bean poultices, duties of Lord Chancellor, or clergymen, ce, and castor oil, during the day, those of Lord Archbishop, if those offices by very powerful diaphoretic were divested of power, emolument, and at right; allowing at the same time patronage. That medical appointments are of weak warm negus as a beverage. regarded as stepping-stones for their own there has succeeded to, or been com- private interests by physicians and surgeons, with the complaint, any visceral the avidity with which they are sought, and, tion, I have treated it as abdominalthe expensive contests which are sometimes
than good.
be, treated—boldly;
antiphologistic
HOSPITAL
Brenan ;
appointment
themselves,
-
-
376
entered into to- obtain them, are tolerably conclusive evidence ; but if governors have any doubts upon the subject, and will resolve to regulate their appointments upon the principles of trade, they will find plenty of benevolent gentlemen willing to give five hundred, or a thousand pounds to be elected officers to their charities. To the question, how it can possibly an. swer the purpose ofindividuais to give their time and money to these a ready answer can be given : The facilities they afford for extracting enormous fees from apprentices, the opportunities they present for delivering lectures, and the publicity and eclat which attend these situations, are temptations of no trifling nature. It is a very common thing to find a hospital p iysician or surgeon preferred to a private practitioner, upon the ground, that having a wider field of practice, he must necessarily have greater experience, and be more capable of performing operations ; and thus do these disinterested gentlemen often establish a most prof table monopoly of both public I and private practice. It is another ques. tion, how far appointments, conducted upon such principles, are conducive to the welt’are of the objects of such charities, and the public at large. It will be no difficult matter to prove, that the gain to the individual is obtained at the expense of many lives and much suffering, and that the public are losers bythe system. Of what materials are these hospital surgeons and physicians, for the most part, constituted1 They are young men, perhaps very W(.lI, or, it may be, very indifferently educated ; but whether well or indifferently educated, they are still young men, destitute of experience, and therefore unqualitied for the situation. It will be said, that in hospitals they will gain experience and qualify themselves; but what right have they to gain this experience at the expense of the objects of charity? Before govtrnors and subscribers to hospitals can deserve the meed of pure benevolence, they must provide, no matter at what expense, men tho roughly qualified and experienced at the time of ettering upon their offices; not youngmen who ntust qualify themselves at the expense of the lives and sufferings of the objects of their benevolence. The governors have but little right to do evil that good may come of it, more especially when, by purchasing the services of menn of suffic:ent experience, they might avoid the evil
establishments,
altogether. It is said, that " charity covereth a mul. timde of ins ;" and certain it is, that our public charities, at least, till the establishment of TnE LANCET, were wont to cover " a multitude" of errors, both of omission and of commission. But let us sup-
pose the young physician or surgeon, after having committed a fair proportion of these errors (homicides), by dint of assiduity to have gained that degree of experience which qualifies him for either public or private practice, to which will his time and talents be devoted after he has done so? Nine times out of ten to private practice. It was to gain experience, and " to get him a name," that he became the gratuitous, obsequious officer of a public charity, and it is too much to expect that lie will forego the advantage. He will no longer be seen in daily, and almost hourly, attendance at the hospital, but his visits will be barely extended to the hours enjoined by the rules of the charity. By and by his engagements are far too numerous even for this ; he will then request his jitnior brother officer to officiate for him ; or, when this is inconve. nient, the physician will transfer the treatment of his patients into the hands of the apothecary, and the-- surgeon into those of his pupils, operations alone excepted; these, by the laws of most of these infirmaries, he is prohibited from delegating to another; besides, these it is his interest still to per. form; they increase and keep alive his re. putation ; but every one, who knows any thing of surgery, knows full well, that operations constitute the least difficult part of the duties of the surgeon ; it is in the after treatment that his skill and acquirements are most imperatively demanded. But upon this, the hospital surgeon in full private practice has no time to bestow, and the
patient is, therefore, consigned to the mis. management of his pupils. Alas! the pic.
exaggerated ; it is but too Having been connected with pub.
ture is not correct.
lic charities for many years, the writer has known physicians absent from their hospitals for weeks and months together; and surgeons, not having the fear of Blizard before their eyes, " with hats on," gallop through the wards, and are no more seen till
the next day for operations ; and then, when
notorious neglect has brought on them the animadversions of their masters, with what effrontery have they boasted their 11 gratuitous services ;" and, when the hollowness and hypocrisy of this plea have been unmasked, with what humiiity and servility have they bowed and averted the threatened
ejection! It has been advanced by the supporters of these charitable institutions, that they not only supply the poor with good pliysicians and surgeons, but the public also. This is but selfish charity; the right is not theirs to make the sufferings of the poor subservient to their own ease and safety. But there is ancther point of view in whioh those who are so zealous to supply the public with good practitioners, ought to regard
377
the subject;that while they are qualifying the few, they are disqualifying the many; that the experience which would be advantage-
ously divided amongst the mass, is wasted upon the select; meiit and talent come to weigh but as a feather in the scale against interest and connexion ; liowever perfect, and however expensive, a man’s medical education may have been rendered by eight
THE
LANCET.
London, Saturday, December 12, 1829. P ROFESSroNS and trades are alike so at this prosperous period, coui-
flourishing
unless he can gct appointed all his previous knowledgemerce of every description is so brisk and will avail him nothing ; he has no chance of the taxes are so light, the rates
royal collebes, to a hospital,
f profitable,
or of ever being " bad called upon to exercise his higher attain-: a;e so few, money is so plentiful, and the .nients; hospital surgeon monopolizes debts " so rare, that men of all classes all. From the rich he extorts enomous and callings are in a fair way of losing sums for the performance of his operations, the seek the and relief which lieboth reason and prudence from excess of poor " scatters gratuitously." To be wealthy is to be vicious, Having thus shown that governors of, joy. the sages; adversity is the best school the ser-
improving or continuing it,
say
hospitals, by accepting gratuitous vicesofmedical men, are only enabling such of morality; and so think his Majesty’s men to establish a monopoly of private of Stamps. General pracpractice at the expense of the public and the and that of titioners, apothecaries, and druggists, physic the profession, acquirements these men, although purchased by the community, ease the people of their agony of others, will but little avail those and not unfrequently of objects of supposed benevolence ; let it peccant humours, be earnestly recommended to lords, ladies, their imaginary sins. The depletory system and gentlemen," to secure for the objects of is sometimes carried too far, may be, for their humanity, the undivided service of’ Holberg says, that long-cherished men of tried and distinguished talent, by liberal salaries. In the army, in the navy, religious feelings will now and then disand in the walks of private life, men inwith the other effects of a drastic finitely superior in natural abilities to the appear generality of hospital surgeons are to be purgp." In return for the pharmaceutical lbund, who, for an adequate remuneration, labours of the faculty upon the people, the would gladly relinquish the to:ls and hazards of public service, and the unceitainties and Commissioners of Stamps have benevolently vexations of private practice, to devote resolved to physic the physickers. Whetheir whole time to the objects entrusted to ther the medicines prescribed have, in any their care. The profession at large must also do sometliing for itself; its members instance, produced such irreligious effects
Commissioners the
"
Baron
"
use their united, as well as separate, as are attributed to the drastic purges meninfluence with the pubhc and with their it is tioned Baron not in our Holberg, by friends, to expose the system of chicanery and monopoly, by which they have so long Ipower to communicate ; but the pills which heen suffrrers, both in fame aud property. have been so industriously prepared and Thank God ! they have also a free press on administered, by our old forensic their side, by the judicious use of which, bountifully " be more than his they may conquerors." opponent, Majesty’s Attorney General, X. X. X. and his Majesty’s Solicitor of Stamps, have Dec. 1829. certainly discliarged from the bowels of the entire medical fraternity all kindly feeling towards the doctors, by whom they were
must
ordered. The half boiling and whole boiling and half stewSCIENCE has just experienced a great loss of live cats, the half roasting of live kids, the disembowelling of by the death of the celebrated chemist, M. ing live and doves, practised by the early I pullets Vauquelin, who expired at Paris on the sons of Esculapius, were acts of refinement 14th of November, after a longand painful and humanity in comparison with the maillness. MR. VAUQUELIN.
-
The opinions of their se- inflammation always is, ot rather ought to authors are entitled to our respect, excepting in the peritoof them almost to our adoption ; but neal variety, preferring veuesection to the indiscriminate application to every application ol leeches, a practice which both :. aamed or taisoamed puerperal fever, experience and theory amply justify. Where t’ too strongly reprobated. To apply the mental excitement and collapse of the be i- fnerol remarks to our present consi- system in this complaint are great, the exthe treatment of this complaint: A ternal application of turpentine, and the free is tracked with genuine puerperal use of warm wine, are loudly called for; but and is seen by an exclusive disciple it is in these cases that we have an opporschool. Believing, asitunity of appreciating the value of opium, a taughtto believe, that this fell inroaddrug which should not be measured by the - ease can only be successfully opposedstrength or number of its doses, but by its In conclusion, allow me to exprebs re large abstracvion of blood, he plunges; effacts. the hope, that should the above trespass cet iuto the veins of his unfortunate t, prolongs the copious stream, andupon your pages fail to convince, it may poss ior her a certain passage into an-sibly excite the attention of the more expeworld. Another female, by dint off rienced in the profession, to a disease so constitional powers, or the mild type’ choice in its victims, so formidable in its we complaint, has survived this disorder,, character, and, too often, so fatal in its termiattacked by successive inflammation.. nation. may happen tn be seen hv a diseinlp. nf f Manchester, November, 1829. Brnian school, who, under the imon that her complaint is puerperal tM. slias debility, that bugbear of medibecause, forsooth, she is a puerperal INJURIOUS TENDENCIES ferer), pours in his cordials to support a OF THE which he thus unconsciously destroys. ad this latter female been seen by the & DISPENSARY SYSTEM. mer practitioner, her life would probably re been saved, not because his views of eomplaint are more correct than those of MANY are the complaints made by the huer, but because, although exclusive, governors of hospitals, and other charitable ey would have been more immediately ap- institutions, of the negligent manner in plicable to the case. Again, a woman is which the medical officers, attached to those ed with a mild degree of puerperal institutions, perform their duties, while the er, and is seen by a disciple of incompetence of the majority of these officers n has turpentine given her, and the at- is as notorious to the profession at large as is removed. Exposing herself to cold the sun at noon-day. Such is the inevittwo or three days afterwards, she is seized, able result of the system at present pursued *’ will of physicians and surpresume, with enteritis ; well, her in the al attendant sees her again, and again geons to these institutions. However deeply cribes her turpentine. To detail its this is to be regretted, the governors and ’!’[!< would be superfluous-they will be supporters of these establishments have no tired. To instance one more operation, right to complain of it, as the evil originates and consists in the accept not an example of the exclusive doc- with es, a female is attacked with genuine anceof thegratuitous services, as they are. peral fever; her attendant not knowing called, of physicians and surgeons. That what to do, equally fearing to stienulate or man must know bnt little of human nature, plete, orders a little castor oil, and a who supposes that the members of the medraught at night; the disease pro- dical profession are more disinterested than —the medical man is distressed-the the rest of mankind ; for, notwithstanding all ies. their professions, unless they directly or measures adopted upon visiting a indirectly serve themselves, there would be eral female, sbould invariably be re- as much difficulty in finding men to devote ed by the symptoms.I have, in se- their time and talents to hospitals and inwell-marked cases of puerperal fever, firmaries, as in finding lawyers to do the successful recourse to hot bean poultices, duties of Lord Chancellor, or clergymen, ce, and castor oil, during the day, those of Lord Archbishop, if those offices by very powerful diaphoretic were divested of power, emolument, and at right; allowing at the same time patronage. That medical appointments are of weak warm negus as a beverage. regarded as stepping-stones for their own there has succeeded to, or been com- private interests by physicians and surgeons, with the complaint, any visceral the avidity with which they are sought, and, tion, I have treated it as abdominalthe expensive contests which are sometimes
than good.
be, treated—boldly;
antiphologistic
HOSPITAL
Brenan ;
appointment
themselves,
-
-
376
entered into to- obtain them, are tolerably conclusive evidence ; but if governors have any doubts upon the subject, and will resolve to regulate their appointments upon the principles of trade, they will find plenty of benevolent gentlemen willing to give five hundred, or a thousand pounds to be elected officers to their charities. To the question, how it can possibly an. swer the purpose ofindividuais to give their time and money to these a ready answer can be given : The facilities they afford for extracting enormous fees from apprentices, the opportunities they present for delivering lectures, and the publicity and eclat which attend these situations, are temptations of no trifling nature. It is a very common thing to find a hospital p iysician or surgeon preferred to a private practitioner, upon the ground, that having a wider field of practice, he must necessarily have greater experience, and be more capable of performing operations ; and thus do these disinterested gentlemen often establish a most prof table monopoly of both public I and private practice. It is another ques. tion, how far appointments, conducted upon such principles, are conducive to the welt’are of the objects of such charities, and the public at large. It will be no difficult matter to prove, that the gain to the individual is obtained at the expense of many lives and much suffering, and that the public are losers bythe system. Of what materials are these hospital surgeons and physicians, for the most part, constituted1 They are young men, perhaps very W(.lI, or, it may be, very indifferently educated ; but whether well or indifferently educated, they are still young men, destitute of experience, and therefore unqualitied for the situation. It will be said, that in hospitals they will gain experience and qualify themselves; but what right have they to gain this experience at the expense of the objects of charity? Before govtrnors and subscribers to hospitals can deserve the meed of pure benevolence, they must provide, no matter at what expense, men tho roughly qualified and experienced at the time of ettering upon their offices; not youngmen who ntust qualify themselves at the expense of the lives and sufferings of the objects of their benevolence. The governors have but little right to do evil that good may come of it, more especially when, by purchasing the services of menn of suffic:ent experience, they might avoid the evil
establishments,
altogether. It is said, that " charity covereth a mul. timde of ins ;" and certain it is, that our public charities, at least, till the establishment of TnE LANCET, were wont to cover " a multitude" of errors, both of omission and of commission. But let us sup-
pose the young physician or surgeon, after having committed a fair proportion of these errors (homicides), by dint of assiduity to have gained that degree of experience which qualifies him for either public or private practice, to which will his time and talents be devoted after he has done so? Nine times out of ten to private practice. It was to gain experience, and " to get him a name," that he became the gratuitous, obsequious officer of a public charity, and it is too much to expect that lie will forego the advantage. He will no longer be seen in daily, and almost hourly, attendance at the hospital, but his visits will be barely extended to the hours enjoined by the rules of the charity. By and by his engagements are far too numerous even for this ; he will then request his jitnior brother officer to officiate for him ; or, when this is inconve. nient, the physician will transfer the treatment of his patients into the hands of the apothecary, and the-- surgeon into those of his pupils, operations alone excepted; these, by the laws of most of these infirmaries, he is prohibited from delegating to another; besides, these it is his interest still to per. form; they increase and keep alive his re. putation ; but every one, who knows any thing of surgery, knows full well, that operations constitute the least difficult part of the duties of the surgeon ; it is in the after treatment that his skill and acquirements are most imperatively demanded. But upon this, the hospital surgeon in full private practice has no time to bestow, and the
patient is, therefore, consigned to the mis. management of his pupils. Alas! the pic.
exaggerated ; it is but too Having been connected with pub.
ture is not correct.
lic charities for many years, the writer has known physicians absent from their hospitals for weeks and months together; and surgeons, not having the fear of Blizard before their eyes, " with hats on," gallop through the wards, and are no more seen till
the next day for operations ; and then, when
notorious neglect has brought on them the animadversions of their masters, with what effrontery have they boasted their 11 gratuitous services ;" and, when the hollowness and hypocrisy of this plea have been unmasked, with what humiiity and servility have they bowed and averted the threatened
ejection! It has been advanced by the supporters of these charitable institutions, that they not only supply the poor with good pliysicians and surgeons, but the public also. This is but selfish charity; the right is not theirs to make the sufferings of the poor subservient to their own ease and safety. But there is ancther point of view in whioh those who are so zealous to supply the public with good practitioners, ought to regard
377
the subject;that while they are qualifying the few, they are disqualifying the many; that the experience which would be advantage-
ously divided amongst the mass, is wasted upon the select; meiit and talent come to weigh but as a feather in the scale against interest and connexion ; liowever perfect, and however expensive, a man’s medical education may have been rendered by eight
THE
LANCET.
London, Saturday, December 12, 1829. P ROFESSroNS and trades are alike so at this prosperous period, coui-
flourishing
unless he can gct appointed all his previous knowledgemerce of every description is so brisk and will avail him nothing ; he has no chance of the taxes are so light, the rates
royal collebes, to a hospital,
f profitable,
or of ever being " bad called upon to exercise his higher attain-: a;e so few, money is so plentiful, and the .nients; hospital surgeon monopolizes debts " so rare, that men of all classes all. From the rich he extorts enomous and callings are in a fair way of losing sums for the performance of his operations, the seek the and relief which lieboth reason and prudence from excess of poor " scatters gratuitously." To be wealthy is to be vicious, Having thus shown that governors of, joy. the sages; adversity is the best school the ser-
improving or continuing it,
say
hospitals, by accepting gratuitous vicesofmedical men, are only enabling such of morality; and so think his Majesty’s men to establish a monopoly of private of Stamps. General pracpractice at the expense of the public and the and that of titioners, apothecaries, and druggists, physic the profession, acquirements these men, although purchased by the community, ease the people of their agony of others, will but little avail those and not unfrequently of objects of supposed benevolence ; let it peccant humours, be earnestly recommended to lords, ladies, their imaginary sins. The depletory system and gentlemen," to secure for the objects of is sometimes carried too far, may be, for their humanity, the undivided service of’ Holberg says, that long-cherished men of tried and distinguished talent, by liberal salaries. In the army, in the navy, religious feelings will now and then disand in the walks of private life, men inwith the other effects of a drastic finitely superior in natural abilities to the appear generality of hospital surgeons are to be purgp." In return for the pharmaceutical lbund, who, for an adequate remuneration, labours of the faculty upon the people, the would gladly relinquish the to:ls and hazards of public service, and the unceitainties and Commissioners of Stamps have benevolently vexations of private practice, to devote resolved to physic the physickers. Whetheir whole time to the objects entrusted to ther the medicines prescribed have, in any their care. The profession at large must also do sometliing for itself; its members instance, produced such irreligious effects
Commissioners the
"
Baron
"
use their united, as well as separate, as are attributed to the drastic purges meninfluence with the pubhc and with their it is tioned Baron not in our Holberg, by friends, to expose the system of chicanery and monopoly, by which they have so long Ipower to communicate ; but the pills which heen suffrrers, both in fame aud property. have been so industriously prepared and Thank God ! they have also a free press on administered, by our old forensic their side, by the judicious use of which, bountifully " be more than his they may conquerors." opponent, Majesty’s Attorney General, X. X. X. and his Majesty’s Solicitor of Stamps, have Dec. 1829. certainly discliarged from the bowels of the entire medical fraternity all kindly feeling towards the doctors, by whom they were
must
ordered. The half boiling and whole boiling and half stewSCIENCE has just experienced a great loss of live cats, the half roasting of live kids, the disembowelling of by the death of the celebrated chemist, M. ing live and doves, practised by the early I pullets Vauquelin, who expired at Paris on the sons of Esculapius, were acts of refinement 14th of November, after a longand painful and humanity in comparison with the maillness. MR. VAUQUELIN.
-