ADDRESS FROM THE SURGEONS OF THE BRISTOL HOSPITAL

248 but in a school-room near the church. Nor does the surgeon visit the children ADDRESS FROM THE SURGEONS OF THE afterwards at their homes, but they are BRISTOL HOSPITAL again, when in a state of disease, brought for his inspection through the most popu- To the Cliairniaiz and Members of the llledilous part of a parish (consisting of up- ’ cal House Committee the of of Commons. wards of 1600 inhabitants) to this schoolroom, where children daily meet; and

that, in one instance, they GENTLEMEN,—In addition to the ankept congregated some hours be- sivers to the questions contained in your yond the appointed time for inspection. circular, we beg leave to subjoin the folThus the contagion is carried and spread lowing statement, to which we respecthere I know were

in every direction.

call !i with fully the

your attention, as connected subject which must form no innovel proceeding for considerable portion of your inquiries,-

It appears to be a medical practitioner to contract for viz. medical education. inoculation at three shillings per head, In the year 1735 Bristol projected, and, after he had himself introduced the dis1736, carried into effect, the scheme of If this an hospital, supported entirely by volunease which renders it necessary. be regular practice, we can never hope contributions. Its foundation is bethat small-pox will be eradicated from the lieved to be nearly coeval with, if not to country. preceded, that of some of the hospiin London, and of similar institutions The question I would wish to ask of you Scotland and Ireland endowed, is, whether a medical man may with im- and chartered foundations(royal, This excepted). punity thus introduce, and thus conduct, now contains from 200 to 220 the management of this dreadful malady. from 5000 to 6000 out-paIf so, the discovery of Dr. Jenner seems and the average number of casual. tients, to have been made iu vain, and the annual ties amount to about 1200 annually. parliamentary grant of thousands of pounds i The whole range of building ib uniform for the encouragement of vaccination, uiiand extensive (having been rc-erectcd of benefit. productive general within these few years), furnished with 1 am, Sir, baths, warm air, and other motlern conYour very obedient servant, and has attached to it a spaveniences, M. M. cious garden as a promenade for comaApril 21, 1834. lescents ; in a word, no expense has been spared which could contribute to the com* In the present state of the law a fort and recovery of the inmates. surgeon may exercise his discretion, and This institution is also enriched with refuse to inoculate where there has not a valuable and daily-increasing museum, a library, a lecturing theatre, and excellent been previous vaccination. He may also for examinations and disexhibit his indiscretion, and inoculate in sections ; in the latter of which our stu. are almost daily engaged under the cases where the protective measure has of the lioiise-stirsuperintendence not been resorted to. The parish authoa

! in

tary

have

tals in institution

in-patients,

accommodation

) dents able geon.

The ordinary disbursements are annurities ought not to have employed the from :i0001. to 6000/.; and there has man who caused the mischief. This subbeen lately expended, in providing acject will not be overlooked by the Medical commodation for the out-patients, ahont Committee of Parliament, and, with a 30001. in a supplementary building. It may not be amiss here to reconnt the view to inquiry, our correspondent should advantages which the city of Bristol posfor a great medical establishment. transmit a full statement of the particulars a population equal to that of most of With to Mr. WARBURTOx, the chairman. If a and

ally

I

sesses

the capitals of Europe—with large of the medical practitioner be well-regulated hospital, and also a medical student here may learn not given, he may himself be called as a school-the the principles and practice of xnedionly witness before the Committee, when he cine and surgery, but also witness, on a may have an opportunity afforded him of great scale, the nature of most of the diseases and accidents which afflict mankind. entering on a defence of his conduct. With the above statement before you, Gentlemen, it will perhaps be a matter of the

name

surprise that there could have

existed any

249 doubt of the propriety of conceding to us: are of opinion that the above regulation of the ability to any students for the Royal College of Surgeons,—which yet the fact is, that it is requires an attendance of six months, as a of November, 1831, that only since the 25th pupil, at one of the hospitals in " we have been recognised" by the College London, in addition to an attendance of Surgeons; and even then partially, as during one or more years at a recognised our dressing apprentices of five years provincial hospital, as a necessary constanding are at present under a peremp- dition for obtaining the diploma of the tory obligation of walking, as it is termed, College,—is highly objectionablc; and, for some one or other of the London hospitals the following reasons :for a period of six months. On this 1st. Because it is unnecessary. A stuject, is remarkable that the regulation of dent iiiav spend the prescribed time quite the College should only require a profitably in attendance at a recogattendance of twe,lve months in nised provincial hospital, as upon those in hospital, from young men who never the exception of before may have beer. within the walls of four or five of the metropolitan hospitals, while our apprentices any the recognised provincial hospitals are witnessed the of the not only practice those of the Bristol Infirmary, but have been con- upon a l2rger " stantiv employed as dressing" pupils, and in the charge of casualties, for a period of 2nd. Because it is injurious to the morals of students. It is a notorious five vears. This representation, we presume, en- fact that students, after a residence of titles the Bristol Infirmary to be justly only a few months in the capital, frequently considered an hospital of the first class. fall into practices of dissipation and imEven in the metropolis there are not above morality foreign to their previous habits, four or a vc that exceed it, either in size or and ruinous to their future usefulness, importance, as a school for scientificand respectability, and happiness. 3rd. Because it has a tendency to practical surgery; and none surpass it as established its thcregulations by governorsrencler provincial education less efficient for the education of the students. Itmay be than it would otherwise be. It has often asserted, that no hospital in the kingclom ;been observed that students neglect to affords greater opportunities for the ac- ! make a proper use of the advantages to them in their attendance at a quirement of medical and surgical Provincial Hospital, from a On this the are recognised ledge. subject surgeons that the full prosecution of their desirous of the fullest investigation; as some proof, they beg to refer to every maybe delayed until their residence one of their students who have attended in in London, where, they imagine, the London, who will confirm the fact from’ opportunities of acquiring professional their own experience and observation;!knowledge will be more worthy of their besides, it is well known that students who attention; and, in consequence, they have received their medical education crowdinto that brief period a far greater number of pursuits than their time, or this infirmary have acquitted their previously-formed habits and inwith marked ability as candidates for diplomas, when under examination at the! clinations, will enable them to follow with any prospect of advantage. College of Surgeons and ’ 4tli. Because it occasions a very conHall. For these and many other reasons, the siderable increase in the pecuniary exsurgeons of the Bristol Infirmary have penditure of the student, without aelrlnever considered the following tages in any degree correspondent with the of the Council of the Royal College of Sur- extent of the outlay. geons as oppressive and unjust; but, they Lastlv. Because it implies an invidious are willing to believe, founded on an ei-- distinction between the surgeons of the roneoas view of the opportunities the recognised Provincial Hospitals and those Bristol Infirmary affords of cultivating of the Metropolitan Institutions, a dismedical science :-Pupils and apprentices, tinction which cannot be supported by a when candidates for the diploma, must. fair comparative estimate of then-respective bring proof "of hariny attended during attainments and capabilities. twelve months the surgical practice of a reIn addition, we beg to draw yonr cognised hospital in London, Dublin, E(li2z- attention to the circumstance that, not Lurgh, Glasgow, or Aberdeen, or for ci,r’ only has the time prescribed for profesmonths in any one 4f such hospitals, and; sional study been of late considerably lrrelre months in any recognised with a corresponding augrnentation of expense, but the number hospital." The surgeons of the Bristol of branches of science which must be

examination ;

qualify

walking

it

hospital;

sub-

walking as

a London London. In fact, with have scale than metropolis.

to

know-afforded and,notion studies

at themselves their; Apothecaries’ regulation

provincial lengthened,

Infirman’

250 attended to has also been greatly increased. Gentlemen, we will take up your time no longer than to submit to you that we require redress; and to repeat that the Bristol Infirmary has a fair claim, in every point of view, for admittance into the first class of hospitals in the United Kingdom. We have the honour to be, gentlemen, your most obedient servants, WILLIAM HETLING, RICHARD SMITH, RICHARD LOWE, HENRY DANIEL, NATHANIEL SMITH, The Surgeons

Bristol

to the Bristol

the case except at the periods of the menstrual secretion, when these sympHer general toms were less violent. health was deranged; she had a pale sallow cachectic appearance, and no appetite. In a clinical lecture on this case, Mr. BRODIE made the following observations:This, Gentlemen, is a case of stricture or contraction of the rectum, a disease of which you will obtain but a very confused notion from books, for in them you will gcnerally find the affections of contraction,

always

scirrhus, malignant disease, and scirrho.

Infirmary. cancer, all mingled into

Infirmary Consultation-room,

when the

one.

Sometimes

gut is contracted, it may be from

malignant disease, which may eventually destroy life. Sometimes this disease To Henry Warburton, esq., M.P. &c. &c. be kept at bay, and sometimes the may of the Committee on Chairman patient may be quite restored. Malignant Medical Education, House of Comdisease, such as scirrhus and fungus hæLondon. mons, a

matodes,

of the rectum, have been

con.

[The foregoing document has been for- founded with non-mnlignant diseases. With respect to the pathology of stricwarded to us by request of the surgeons of ture there is yet much left the Bristol Infirmary as a "corrected copy of us to of the rectum, for no one has yet efinvestigate ; their memorial. The original was sent to stated it. In the works written fectivelv the Parliamentary Committee last wcek, by Mr. COPELAND and Mr. MAYO, there and a printed copy has been placed in the are many very useful practical observahands of each member of the Committee. tions, but those gentlemen havenot stuthe pathology of the disease in a sysCopies have also been sent, or will be died tematic manner. Stricture of the rectum

the surgeons of all the different will not life for many years, and in the when destroy you have an opportunity of examining a patient after death from this affec. tion, you of course find the disease so advanced, that you cannot study its pathology, to investigate which in a proper ST. GEORGE’S HOSPITAL. manner you must have accidental opportunities of seeing the disease in its early STRICTURE OF THE RECTUM.—CLINICAL stages, and of knowing the first morbid REMARKS BY MR. BRODJK. appearances which the disease puts on. I SARAH WILSON was admitted into Burton shall not pretend to describe these to you ward under the care of Mr. BRODIE, for now very minutely, but will do so as On examina- as I can. an affcction of the rectum. tion there was found a contraction cf the When you examine the rectum in a pagut, about two inches above the anus. tient affected with stricture, you find the The mucous membrane was thickened, gut contracted to a greater or less degree, and the finger could not pass the con- and sometimes the fingerwill not reach the tracted portion, which was felt to have a contraction. In the early stage the musharp edge. The inner margin was nar- cous membrane is thickened. I believe row, with its broad base outwards, to- the disease accrues in this membrane, wards the gut. Below the stricture, the not by spasmodic contraction, but by mucous membrane of the gut was felt to chronic inflammation, throwing out lymph, be rough and irregular; there was no part and thus becoming thickened, and welted, of it ulcerated; there were hemorrhoids and attached to the muscular tunic of the about the verge of the anus, and ulcers of bowel. If the disease proceeds, it extends the legs. beyond this, so that in the advanced stages The account which we could gather of you cannot tell where it has begun. Where her previous history was, that five years the inflammation commences in the celsince she was attacked with menorrhagia, lular texture of the gut, abscesses may after which she felt a difficulty in voiding form and burst into the bladder, the her feces, which continued to increase up urethra, or the vagina, uniting the two in to the time of her admission, when the one. Ulceration may then begin in the pain and straining at every evacuation stricture, and extend to the neighbouring would last for half an hour, which was parts above and below it. The situation

sent,

to

‘

recognised’ provincial hospitals kingdom."]

nearly