ITALIAN AND ENGLISH SYSTEMS OF MEDICAL INSTRUCTION.

63

ENGLISH SYSTEMS OF MEDICAL

ITALIAN AND

INSTRUCTION.

though they derive their practical knowledge of disease from observations of each particular case, they are nevertheless sufficiently disposed to generalize of their both as to the nature

Letter of Dr. Clark, M. D. the University of Edinburgh, to

Professor Tommasini,

his

spect at

on

Observations with reto the Clinical School

Edinburgh

(Effemeride

letterarie di Roma t. 6. p. 85.) Letter of Professor Tommasini, in reply to the Letter of Dr. Clark (Effemeridi letterarie di Roma, t. 7. p. 1.)

(From

Omadei’s Annali Universali di Medicina.)

IF the system of Medico-Clinical Instruction in Italy be not the most perfect of all, it is certainly not inferior to any at present adopted in the most cultivated nations of Europe. We were confirmed in this opinion by a discourse pronounced a short time since, in the Clinical School of the University of Bologna, by Professor Tommasini, and by the answer of this distinguished professor to Dr. Clark, of the University of

Edinburgh.

from which it appears, that al-

Professor Tommasini sent to Dr. Clark his Discourse on the Medical Establishments of Great Britain, requesting him to give a candid opinion on that production. Dr. Clark, in his reply declares that the opinion of Professor Tommasini, as to the system of Clinical Instruction in Edinburgh, is incorrect, and that he would have thought differently ,of the present state of Medical Science in England, if he had been acquainted with the writingsof many medical men,

ideas,

and the methods which should be adopted for their cure. Dr. Clark maintains that the Medical Professors of Edinburgh do not confine themselves to the mere indication of symptoms, and medicinal formulæ, but that they endeavour to ascertain the nature of diseases by a strict examination of symptoms, to form a correct prognosis, and to point out such remedies as are calculated to restore the health of the patient. Dr. Clark admits that the Students do not receive instruction by the bed-side of the patient; but he contends that this system of instruction is injurious to the sick, and inconvenient to the Student himself; in which latter opinion he observes, that he is confirmed by Professor Frank, of. Wilna. The method of Clinical Instruction adopted at Edinburgh, is, according to Dr.- Clark, less subject than any other to superficial and dangerous imitation, since it obliges the Student to hear the instructions of many professors, to follow them to the bed-side of the patients, and learn the method of treating each case. The Students are obliged to write down, in the presence of their colleagues, the history of every disease to which they are called; these histories may be consulted, and examined by the other Students ; and the professors make appropriate oblervations every three months upon of diseases

64

in the the advancement of the science: Hospitals. By such observations and in proof of this he refers to Dr. Clarke imagines he has many which appear to have proved by these observations, escaped the notice of Dr. Clark. that the plan pursued in the ’, But accurate researches, and new Medical School of Edinburgh is maxims in pathology, and thenot only not superficial or de- rapeutics, as deduced from corfective, but superior to any other rect observations, have no influ-

.the eases which

occur

adopted, in Europe.

The professor of Bologna, in his reply to Dr. Clark’s letter, contends that the system of medical instruction adopted in * England is not, generally speak-ing, preferable to the Italian system, and that the reasons on which his opinion is founded are .distinctly stated in his Latin .Discourse, presented to the Medico-Chirurgical Society of London. In the first place Professor Tommasini insists upon the necessity of distinguishing what. may be essentially different in two cases of disease, though the symptoms may be apparently the same, and what in different cases may be similar and identical. For example, theEnglish in treat-

the state of

general knowledge in Great Britain, nor

ence

on

indeed is much value set upon them. The doctrines of Brown and Cullèn refuted

nor

are

neither adopted,

by English physicigreatly in this

ans, who differ

respect from their Italian brethren, whose great object it is to explode erroneous systems by proving their fallacy, to es-

pathological principles by accurate investigation, and to apply these principles to therapeutics, as far as possible, in all cases of difficulty which tablish true

may arise. Professor Tommasini

practical works of Frank,

compares

the

Borsieri,

and Professor

with the commentaries of He-

berden, de morborum historia et

ing colic, convulsions, asthma, curatione, and with the practical attend only to the work of Thomas. In the latter the disease, and the the medical Student finds no symptoms of remedies indicated by those directions in doubtful cases, no symptoms, without considering reasons for preferring one mode

tetanus, &c.

the morbid diathesis upon which of treatment to another; in the the mode of cure chie3y depends; former, the essential differences Bo that in one case stimulating of diseases, in cases apparently medicines, and in another blood- similar, are accurately dis-

letting, and debilitating romedies may be required ; and the theories upon which such dis’ ’tinctions are founded, arethe necessary results of numerous and well-observed facts. Professor Tommasini proceeds to observe, that he is not unacquainted with the works of English medical writers, which have

essentially

confributed to

tinguished, and different modes upon just and sound reasoning, are proposed and recommended according to the nature of the case. Though many English medical works are extremely valuable and useful to advanced practitioners, they cannot be so to those who are just entering upon the study of medicine. To prove oftreatment, founded

65

the truth of this remark, Tommasini enumerates many modern among others, Raven’s Observations on the use of Tincture of Colchicum in Hypochondriasis, and Hysteria; Gaitskell, on the use of Nux Vomica in Paralysis, and Apoplexy ; Jutliffe, on Opium, in the cure of In none of the Tetanus, &c. above-mentioned works are the essential conditions of these diseases noticed; the circumstances are not stated in which the proposed remedies may prove injurious ; or if any cases are found not to agree with their general observations, no attempt is made to ascertain the reason of these differences.. It appears, therefore, that as the Italian pathology has already derived more benefit than the English from the great works of celebrated English medical writers, such as

works ;

Svderiham, Cullen, Brown, Gregory, Hunter; so it is likely to -reap

more

profit than the

ation of medical doctrines, and the systems of nosology. Doctor de Salle observes, that mercury is much abused in England, and that many medicines of opposite characters are indiscriminately employed in the same disease. M. Roche laments that the physicians of Great Britain, relying- entirely on active medicines, -publish confused and of

imperfect observations;- give

no

for facts, and make no distinction between the essential conditions of diseases, and the essential effect of medicines, so that their readers or pupils can derive no benefit from their reasons

works.

Not

foreign opinion, but physicians many enlightened English practitioners censure the empirical mode of practising physic in their only

are

of this

country,

and agree that the effects of medicines can only be correctly ascertained by following the principles adopted in many parts of Italy.

Professor Tommasini considers the method of clinical in. struction adopted in Italy superior to that of the English. The which pathology, may be prac- Student in Italy is obliged to, useful to the younger attend daily in the Hospitals, tically where a certain number of beds members of the profession. Professor Tommasini proceeds is assigned to him, and he is to shew, that. his opinion coin- thus enabled to observe the cides with that of many cele- symptomatic and nosological brated medical men who have diagnosis of the disease, to form. from modern English discoveries, and inductions, as far as regards the formation of a system of medical science, and

English

visited England. Signor Flajani a correct prognosis of the,result, us that he found the to point out a suitable method of practice-of medicine in England treatment, to note the different in a completely empirical state ; changes which may take place assures

that no system was observed, in the state of the patient, wheand that no reliance was placed ther favourable or unfavourable, on any thing but observation and and to report the results. The M. has Broussais experience. patient, when the severity of the given the same opinion ,of case may require It, is visited

English medicine in

his examin-

frequently in the hours between

66

the regular morning’’s

and eventhat the ing’svisit, progress of be the disease may -minutely watched. Every observation is noted down in books appropriated to this purpose, which may be examined, and copied by all the Students ; and by this means copious materials are formed for the history of the disease, which may be preserved in the records of the Hospital.. , This method does not in any .way disturb the patient on the contrary, he appreciates the assiduous care which is taken of him, and feels that it is best calculated to effect his cure. Besides, it is only at the bed-side of the patient that the Student can obtain an accurate knowledge of the character, and features of disease, and ascertain ’, the symptoms which indicate the danger of the patient, and the probable result of his case; it is for this reason that the school has obtained the name of clinical. But if a .long examination is likely to annoy the patient, the Professor and Student retire to discuss the case, and consider the nature and effect of any changes which may have taken place. The examinations at the bed-side of the patient are made without noise; and as the prognostic is discussed in the Latin language, which is seldom understood by the patient, his mind is not likely to be affected. The number of

patients cured by

visit the wards of clinical sur· gery, attend lectures on the ap’

plication of pathology to practice, and the Medico-chirurgical In. stitutions. They are not therefore restricted to hearing the doctrines of a single master, ve.

as Dr. Clark fears, as oracle of the art. ’ in the in. tervals of their attendance on the sick assigned to them, they may observe cases ’asssigried to their fellow-Students, and this they do with much anxiety, as they are liable to be called to a consultation, and must then give their opinions upon the disease, and on the proper mode of treatment. Twice a week the Professor gives a clinical lecture to the assembled Students, in which he directs their attention to the most difficult cases which -have occurred in the Hospital, analysing the disease in every case, whether it is still in progress o.r has terminated favourably or fatally. In the latter case the dissection of the body either confirms the prognosis which was formed, or serves to correct the practitioner’s idea of the nature and seat of the disease; and by this means the Students acquire experience, and are enabled to treat diseases with suc-

nerated, an

cess

themselves.

-

For these reasons Professor Tommasini contends, that the English system of medical instruction is not preferable to that practised in Italy, the former being especially defective with

pupils is not very small, as Dr. Clark suspects, each pupil hav- respect to therapeutic directions ing cured nine or more in the at the bed-side of the sick. To last year. Besides this, the Stu- prove that the method of clinical dents may attend patients, and instruction in Edinburgh is less compile cases in other wards beneticial to the Student than directed by able practitioners, that adopted in many Universi-

67

ties of Germany and Italy, Tommasini further cites the authority of J. Frank, R. Humton, M. D.

will be

chiefly

loway

and Mr.

between Mr. Cal-

Morgan.

We are conyelleil this week to omit some interesting cases. Clark, of

of London, Professor Cambridge, Professor Stevat,

Doctor Brabant, and Professor MIDDLESEX HOSPITAL. Heberski, of Wilna. He concludes his letter to Dr. Clark by Case of Cancer of the Mammatranscribing’ a. passage from Dr. Mary Bacon, aetat 47.-Blue Morgan’s remarks on the state dark brown bair, and fair eyes, of medicine in Italy, in which, This woman came complexion. to the honour of the Italian on ths 31st ult. to the hospital Clinical schools it is stated, that the ascertain opinion of the the method observed in the an affection on of the school at Bologna forms a more surgeons, and to submit right mamma, complete system of medical in- herself to an operation, in case struction than he had seen pracmeasnre should be that thought tised in any country, and was examination, requisite. Upon to that adopted the nipple was found greatly superior slightly in the .Hospitals of England. puckered and retracted, the areola of a livid hue, but without HOSPITAL REPORTS. any observable discolouration of the surrounding skin. She be,5t. Thomas’s Hospital, Jan. 10. gan to conceive at the early age —The accidents that have been of sixteen, and has been the admitted here this week, are a mother of nineteen children born fracture of the 4th dorsal vertebra. alive, all of whom she has suckled for a longer or shorter a burn, dislocation of the sliolilder, with fracture of the glenoid period. At present she has nine cavity, an injury to the scuip, and children living, the youngest one or two bruises. being- six vears old. The catahas always No operations have Leen pet- menial been regular, and ceased about formed here. A patient of this hospital, who six months ago, since which had his thigh ampatated some time her general health has time ago. was prevented leaving been tolerably good. From all the house, on account of one of we could learn, it does not apthe ligaturesnot separating; it pear that any predisposition or did not come away tiii 10 weeks diathesis either to scrophula or cancer has been derived from after the her parents. She attributes the of the disease to a blow Fewacciorigin Guy’s Hospital. dents have been admitted here received on the breast twelve this week, and no operation per- months ago, followed by inflammation and swelling*, which formed. Mr. Lucas has resigned his si- were in some degree relieved by tuation as surgeon ; there are four leeches, cold applications, and other remedies, which tor the or five candidates, hut the contest

to

discharge

operation.

.

-