Chapter II: London From the Medical Point of View (3)

Those who have travelled from London Bridge to Cannon Street by the railway, must have noticed the fine Church of St. Saviour’s, Southwark. This church marks the site of the ancient Priory of St. Mary Overy, which was the original home of St. Thomas’s Hospital. Southwark, in ancient times, was largely occupied by the clergy. Not far from the Priory of St. Mary was the Abbey of Bermondsey, and the palatial residences of the Bishops of Winchester and Rochester. In 1207 the Priory of St. Mary was burnt down, and with it the Hospital of St. Mary. At Winchester House was living at that time Peter de Rupibus, Bishop of Winchester. This prelate decided to rebuild the hospital in a better form and on a better site, and accordingly set to work to obtain funds by means of the usual Charter of Indulgences addressed to the faithful in 1228. “Behold,” says Bishop Peter, “at Southwark an ancient hospital, built of old to entertain the poor, has been entirely reduced to cinders and ashes by a lamentable fire; moreover, the place wherein the old hospital has been founded was less suitable, less appropriate for entertainment and habitation, both by reason of the straitness of the place and by reason of the lack of water and many other conveniences; according to the advice of us, and of wise men, it is transferred and transplanted to another more commodious site, where the air is more pure and calm, and the supply of water more plentiful. But whereas the building of the new hospital calls for many and manifold outlays, and cannot be crowned with its due consummation without the aid of the faithful, we request, advise, and earnestly exhort you all, and with a view to the remission of your sins enjoin you according to your abilities, from the goods bestowed on you by God, to stretch forth the hand of pity to the building of this new hospital, and out of your feelings of charity to receive the messengers of the same hospital coming to you for the needs of the poor to be therein entertained, that for these and other works of piety you shall do you may after the course of this life reap the reward of eternal felicity from him who is the recompenser of all good deeds and the loving and compassionate God. Now we, by the mercy of God, and trusting in the merits of the glorious Virgin Mary and the apostles Peter and Paul, and St. Thomas the Martyr and St. Swithin, to all the believers in Christ who shall look with the eye of piety on the gifts of their alms--that is to say, having confessed, contrite in heart and truly penitent--we remit to such twenty days of the penance enjoined on them, and grant it to them to share in the prayers and benefactions made in the church of Winchester and other churches erected by the grace of the Lord in the diocese of Winchester. Ever in the Lord. Farewell.” The Prior of St. Mary Overy assisted in the good work, and several popes confirmed the acts of their subordinates, and thus St. Thomas’s Hospital was founded on the site now occupied by part of the London Bridge Railway Station--a site which was its home from 1228 to 1862. In 1535 there were forty beds at St. Thomas’s Hospital. In 1507 the hospital was enlarged and repaired, “the void ground,” called the “Faucon,” and afterwards the “Tenys Place” and “Closshbane” (probably connected with the game of skittles), was acquired, and the following was the bill: “Paid to Mr. Scott of Kent, and Ann, his wife, for the land forty marks, and for a gown cloth of damask for the said Ann £3 16s. 8d.--in all £31 13s. 4d.” When this land, or very nearly the same, was sold to the South-Eastern Railway Company in 1862 it fetched £296,000. The total cost of land and buildings erected in 1507, with the legal expenses, was £311 6s. 1½d. About the year 1527, James Nycolson, of “St. Thomas’s Spyttell in Southwark,” had a printing press within the precincts of the hospital, and among other notable books produced the Bible known as “Nycolson’s Coverdale.”

THE ROYAL HOSPITALS.

When the religious houses were suppressed by Henry VIII., these hospitals and asylums, which were part and parcel of them, were suppressed also, and for a time the poor found themselves deprived of much assistance to which they had become accustomed. It was therefore found necessary to re-establish these institutions on a new footing. This was done by Henry VIII. and Edward VI., and when we speak of these monarchs as founders we must remember that they refounded in a better form that which Henry had previously destroyed. St. Bartholomew’s was refounded in 1548, and St. Thomas’s in 1553; and in 1557 the four Royal hospitals--St. Bartholomew’s, St. Thomas’s, Christ’s Hospital, and Bridewell--were, in a sense, incorporated together for purposes of management. Dr. Payne has kindly permitted me to inspect a little book bearing the date 1557, and entitled “The Order of the Hospitalls of K. Henry the viii.th and King Edward the vi.th--viz., St. Bartholomew’s, Christ’s, Bridewell, St. Thomas’s. By the Mayor, Cominaltie, and Citizens of London, Governours of the Possessions, Revenues and Goods of the sayd Hospitals.” From this it appears that “one Hospital, called St. Bartholomew’s the little,” was founded by King Henry VIII., and the other three by his successor. The governors were to be sixty-six at least, fourteen aldermen and fifty-two grave commoners, whereof four were to be scriveners, “to the intent that in every house may be one or more.” Two of the aldermen were “governors-general,” one to be called controller and the other surveyor, while the remaining sixty-four were divided equally among the four hospitals, three aldermen and thirteen commoners to each, whereof one was to be their treasurer. The governors were appointed at a general court held on St. Matthew’s Day (Sept. 21st), and held office for two years from Michaelmas Day (Sept. 29th). On appointment a solemn charge was read to them, in which the objects of the four hospitals are thus set forth: “Idelnes, the enemie of all vertue, is suppressed and banished; the tender youth of the nedy and idle beggars vertuously brought up; the number of sick, sore, and miserable people refreshed, harbored, and cured of their maladies; and the vile and sturdy strumpet compelled to labour and travaile in profitable exercises.” The latter paragraph refers especially to Bridewell, which was originally established as a house of correction “for the strumpet and idle person, for the rioter that consumeth all, and for the vagabond that will abide in no place.” Bridewell has been rendered immortal by Hogarth’s fourth plate of the “Harlot’s Progress,” but as an institution it disappeared in 1863. Among the officers of the Royal Hospitals were “scruteners,” who performed the duties of “collectors” of legacies and other gifts. The charge to these officers concluded as follows: “And finally, when you shall hapen to be in the company of good, vertuous, and welthy men, you shall to the best and uttermost of your wits and powers, advance, commend, and set forth the order of the said Hospital and the notable commodities that ensue to the whole realme of England, and chiefly to the citie of London, by erection of the same; and also how faithfully and truly the goods geven to their uses are by the Governours thereof ministered and bestowed.” They were also enjoined to exhort scriveners to remind testators of the hospital when making their wills, and to provide the said scriveners with prospectuses for their information. They were further enjoined to exhort the bishop and clergy, and especially the preachers at “Pawles Crosse”: “That they twise or thrise in the quarter at the leaste, do move and exhort the people to further the said work.” The officers attached to each hospital were “the clerke, the matron, the nurses and keepers of wards, the steward, the officer appointed to warne the collectors and church wardens, the cooke, the butler, the porter, the shoemaker, the chirurgian, the barbour, the bedles.” Another institution having a similar origin to the Royal Hospitals is Bethlehem Hospital, or Bedlam. This was founded by Henry VIII., on the site of the suppressed Priory of our Lady of Bethlehem. At the end of the seventeenth century it was moved to a new building in Moorfields, and finally, at the beginning of the present century, it was established where it now is, in St. George’s Fields, Southwark.

EARLY HOSPITAL PRACTICE.

We get an insight into the methods of practice in the London hospitals in the sixteenth and seventeenth centuries from a series of papers in the St. Bartholomew’s Hospital Reports, written by Sir James Paget, Dr. Church, and Dr. Norman Moore. In the eighteenth volume of St. Bartholomew’s Hospital Reports Dr. Norman Moore gives some interesting facts with regard to the first medical officer, Thomas Vicary, who was appointed somewhere near the year 1550. He lived in the hospital, wore a smart livery which cost fifty-three shillings, was sergeant-surgeon to Henry VIII. and his three successors, and wrote a book on anatomy. Thomas Vicary is represented in Holbein’s picture of Henry VIII. granting a charter to the Barber-Surgeons. He appears to have served abroad with the army, and to have been a person of considerable experience, and to have had a proper sense of his duty as a professional man and a citizen. Not so much is to be said for the first physician to St. Bartholomew’s, Dr. Lopus, a Portuguese Jew, appointed in 1561, whose main object in this world appears to have been to get money. He was convicted of conspiring with the Spaniards to compass Queen Elizabeth’s death by poison, and in 1594 was hanged at Tyburn. Dr. Norman Moore gives another graphic picture of an Elizabethan surgeon in William Clowes, a man who was an army surgeon attached to the Earl of Leicester, and who in the intervals of foreign service was attached to St. Bartholomew’s. Clowes appears to have been a man of learning and experience, devoted to his art, and well able to do battle with irregular practitioners. Of these encounters he doubtless had many, and he gives a lively description of an interview with a quack vendor of a balm and plaster. “Then riseth out of his chayre, flering and gering, this myraculous surgeon, gloriously glittering like the man in the moon, with his bracelets about his armes, therein many precious jewels and stones of St. Vincent his Rockes, his fingers full of rings, a silver case with instruments hanging at his girdle, and a gilt spatula sticking in his hat, with a rose and crown fixed on the same.” Clowes was surgeon to Christ’s Hospital, and we learn the interesting fact that in his day twenty or thirty children had the scurvy at a time--a fact due to a diet largely composed of fish and other salted provisions, with a scanty allowance of vegetables and a total absence of potatoes.

Sir James Paget, in an interesting paper (written in 1846 while he was filling the offices of Warden to St. Bartholomew’s and Lecturer on Physiology) entitled “Records of Harvey,” gives us some facts regarding this very great man, which help us to understand London “hospital practice” as carried on during the reigns of James I. and Charles I. Harvey was appointed physician to the hospital in 1609, seven years after taking his degree at Padua, and seven years before he imparted his great discovery of the circulation to the College of Physicians. He was appointed during the lifetime of his predecessor, Dr. Wilkinson, and was to succeed on the death or retirement of the latter, and, like candidates for hospital appointments of the present day, he came furnished with testimonials, one from the King, and another from the President of the College of Physicians; and it is almost needless to say that his application was granted. On his appointment after the death of Dr. Wilkinson, the following “charge” was read to him:--“Physician,--You are here elected and admitted to be the physician of the poor of this hospital to perform the charge following--that is to say, one day at the least through the year, or oftener as need shall require, you shall come to this hospital and cause the hospitaller, matron, or porter to call before you in the hall of this hospital such and so many of the poor harboured in this hospital as shall need the counsel and advice of the physician. And you are here required and desired by us in God His most holy Name, that you endeavour yourself to use the best of your knowledge in the profession of physic to the poor then present or any other of the poor at any time of the week which shall be sent home unto you by the hospitaller or matron for your counsel, writing in a book appointed for that purpose such medicines with their compounds and necessaries as appertaineth to the apothecary of this house, to be provided and made ready for to be administered unto the poor, every one in particular according to his disease. You shall not for favour, lucre, or gain, appoint or write anything for the poor, but such good and wholesome things as you shall think, with your best advice, will do the poor good, without any affection or respect to be had to the apothecary. And you shall not take gift or reward of any of the poor of this house for your counsel.”

In 1626 Harvey’s stipend, which had been £25 per annum, was raised to £33 6s. 8d., on condition that he relinquished his claim to one of the hospital houses. In 1630 he obtained leave of absence from his hospital duties, having been commanded by the King to travel with James Stuart, Duke of Lenox. Harvey was at this time physician extraordinary to the King, and in the year following was appointed physician in ordinary. Dr. Andrewes appears to have been appointed as Harvey’s substitute during his absence, the governors showing themselves somewhat unwilling to accept Dr. Smith, who was Harvey’s nominee. It appears that the work of the hospital increasing, and Harvey being much occupied at court, Dr. Andrewes was definitely appointed Harvey’s coadjutor, or, as we should say, “assistant physician,” with the yearly stipend of £33 6s. 8d. A set of rules was drawn up by Harvey and accepted by the governors, which are interesting in two particulars: first, as showing that Harvey was impressed with the necessity of limiting the relief afforded by the hospital, and that he foresaw the inconvenience likely to arise from a press of what we should call “out-patients;” and secondly, that in the matter of prescribing internal remedies the chirurgeons were unable to act independently of the physicians. It further appears that there were “lock” hospitals in connection with St. Bartholomew’s, established in Southwark and Kingsland, in the disused Leper Hospitals (leprosy having then disappeared from London), for the reception of venereal cases. That venereal disease had long been very rife in London appears from the statement of William Clowes in 1596, that within five years over 1,000 cases had been cured at St. Bartholomew’s, and he adds, “I speak nothing of St. Thomas Hospitall, and other houses about the city, wherein an infinite multitude are daily cured.” Harvey retired from St. Bartholomew’s in 1643. In Harvey’s time the staff consisted of two physicians, three surgeons, one of whom, John Woodhall, was the author of the “Surgeon’s Mate,” and in his twenty-four years’ service amputated “many more than 100 of legges and armes,” with a mortality of 20 per cent., one surgeon for the stone, two surgeons or “guides” for the lock hospitals, an apothecary, and “a curer of scald heads.” This latter functionary appears to have been a woman, and the salary paid to her for her services varied from £27 in 1623 to £126 in 1642, and there is evidence to show that she received three or four shillings for each scald head cured. According to Dr. Church, at St. Bartholomew’s Hospital, where the diet, owing to the munificence of Dr. Radcliffe, has, since his time at least, been exceptionally good, so late as 1767 potatoes do not seem to have been introduced into any of the diets; greens were given on certain days of the week, but no other vegetables are mentioned.

THE PHARMACOPŒIAS.

Dr. Church, in an article in St. Bartholomew’s Hospital Reports (vol. xx.), called “Our Hospital Pharmacopœia,” gives many interesting facts. The surgeons found their own drugs in 1549, and they were allowed £18 a year “because things pertaining to their faculty be very dear.” In a note appended to an old formula in the St. Bartholomew’s Pharmacopœia for a poultice, of which cow-dung was one ingredient, Dr. Church says: “Those who have not had the curiosity to look back at the old Pharmacopœias of the London Colleges of the sixteenth and seventeenth centuries, can hardly imagine the disgusting nature of the substances they contained. In the catalogue of the official simples of our own London College for the year 1689 occur--‘Homo Vivens: Capilli, ungues, saliva, cerumen, sordes, sudor, urina, stercus, sanguis, calculi, semen, lac, menses, secundinæ. Homo mortuus: Cadaver caro, cutis, pinguedo, ossa, cranium, cerebrum, cor, fel, manus.’ And this at a time when R. Morton, Edward Tyson, Hans Sloane, and Richard Blackmore were Fellows of our College and Sydenham a Licentiate.... It is not until the fifth edition of the Pharmacopœia of our London College that we get rid of the old traditions handed down from the earliest periods of medicine. The 1746 Pharmacopœia may be said to mark a perfect revolution, or rather, I should say, reformation in the annals of pharmacy.” This purging of the Pharmacopœia of disgusting things, “for the most part superstitiously and doatingly derived from oracles, dreams, and astrological fancies,” was largely due to Dr. Plumptre, who was president of the College from 1740 to 1746, and the extent of it may be gained from the fact that the “simples,” which numbered 645 in the fourth edition, had, in the fifth, dwindled to 208. Many of the formulæ previously in use had been derived from the East, and notably from a learned pharmacologist called John of Damascus, concerning the date of whom authorities agree to differ.

The complexity of some of the old formulæ was prodigious. The antidote of Matthiolus against poisons and plague contained 131 ingredients, and Venice treacle, which was largely prescribed by Sydenham and even later physicians, contained over sixty. In the sixth (1788) edition of the Pharmacopœia, sixty-three articles which appeared in the fifth edition were discontinued.

Among those who stayed at his post during the plague must be mentioned Dr. Francis Bernard, apothecary, and subsequently physician (1678) to St. Bartholomew’s Hospital. To rightly estimate his conduct we must remember that the governors of the hospital, as well as the physicians had deserted it. Dr. Church gives the following extracts from the minutes of the Court: “Held at the ‘Green Man,’ near Laieton, in the county of Essex, Sept. 28th, 1665. Forasmuch as it was now understood that the two doctors were remiss to officiate or procure their business to be done as it ought to be. It was therefore thought fit for Dr. Bernard, the apothecary, whose ability is so well approved, should prescribe at the present for the patients in the said doctors’ stead, until further orders thereon.” At the same Court the salaries of the two doctors, Dr. Micklethwaite and Dr. Tearne, were ordered not to be paid.

The treatment of the patients in the early days of the hospitals was occasionally a little severe. Thus Dr. Steele of Guy’s has kindly furnished me with a few extracts made from one of the old committee books of St. Thomas’s: “1567. Patients were ordered to be whipped at the cross for misdemeanour. 1573. A hand-mill was ordered to grind corn to keep patients from idleness. 1598. Foul patients (_i.e._, venereal), notoriously lewd livers, were ordered when cured to be punished at the cross before being discharged.” This reads like great severity, but severity was probably necessary in Southwark, which was rather a rough suburb of London. Thus an old map of Southwark given in Mr. Rendle’s paper shows that in the year 1542 there were some eighteen large inns, of which the “Tabard” or “Talbot” was one. Here also in later times was Paris Garden, bull rings, bear rings, the Globe Theatre, and lastly, the brothels or stews which were under the control of the Bishop of Winchester, the denizens being known as Winchester geese. Perhaps, therefore, it is not surprising that in this map are shown two sets of pillories and cages, and that the governors of the hospital found strong measures to be necessary to maintain discipline.

THE RISE OF THE MEDICAL SCHOOLS.

The anatomical lectures given by the Barber-Surgeons and Physicians were for a long time the only sources of practical anatomical knowledge; but the want of more opportunities for dissecting began in time to be felt by the apprentices of the surgeons employed at the hospitals. In the later days of the Barber-Surgeons’ Company difficulties were experienced in obtaining subjects for dissection, and there is evidence to show that the officials having charge of executions were bribed to let the bodies of felons pass into private hands. William Cheselden (1688-1752) was one of the chief offenders in holding “private anatomies,” which were contrary to the rules of the Company. Cheselden was renowned as an anatomist and surgeon, and did much to perfect the operation of lateral lithotomy, and must be looked upon as the real founder of the medical school of St. Thomas’s. Before his time, however (viz., in 1695), complaint was made that the surgeons of St. Thomas’s taught surgery to other than their own apprentices; and in 1702 the governors of St. Thomas’s, while recognising the right of the surgeons to take pupils, ordained that “none shall have more than three cubbs at one time, nor take any for less than a year.” “Private anatomies” began gradually to be more common, and in 1717 we come upon a record of “body-snatching,” when “the widow of William Childers made complaint that her husband’s corps, after its buryal in the burying place in Moorfields, was taken up by the gravedigger and sold to some surgeons, which corps was stopped at an inn in a hamper to be sent to Oxford” (Church). In 1726 the anatomical museum at St. Bartholomew’s was commenced by John Freke, which is strong evidence of the growth of anatomical teaching, and in 1734 mention is made in the records of “the dissecting-room belonging to this house.”

It was not till 1750 that leave was obtained for the regular making of post-mortem examinations at St. Bartholomew’s. In 1767 an operating theatre was erected; and finally, in 1822, an anatomical theatre was built for John Abernethy, who was really the founder of the Medical School of St. Bartholomew’s.

HOSPITALS BUILT BY PUBLIC BENEVOLENCE.

It was in the eighteenth century that the Royal Hospitals were found to be insufficient for the wants of the population, and private benevolence began to supply the deficiencies of Royal foundations. The Westminster Hospital is said to have been the first hospital established by subscription--viz., in 1719, the present building dating from 1732. I can do little more than mention these hospitals; but in doing so, with their dates, I would call attention to the fact that most of them were originally built in what were then the outskirts of the town, just as St. Bartholomew’s was outside the walls, and St. Thomas’s in the unimportant suburb of Southwark. Guy’s was founded in 1722 by Thomas Guy, a bookseller, and, according to recent information, a publisher. He is said to have made his money partly by selling Bibles, partly by buying up sailors’ prize tickets, and partly by successful speculations at the time of the South Sea Bubble. Be that as it may, he spent over £18,000 on the building of his hospital, and endowed it with another £220,000. St. George’s was founded in 1733; the London Hospital in 1740; the Lock Hospital in 1746; Queen Charlotte’s Lying-in Hospital in 1752; the Small-pox Hospital (originally at King’s Cross) in 1746; the Middlesex Hospital in 1745; St. Luke’s Hospital for Lunaticks in 1751; the Ophthalmic Hospital, Moorfields, in 1804; Charing-cross Hospital (originating from a dispensary existing in 1818) in 1831; the Royal Free Hospital in 1828; University College Hospital in 1833; King’s College Hospital in 1839; Brompton Consumption Hospital in 1844; and St. Mary’s Hospital in 1851. The above list includes only some of the chief hospitals of London, and it is impossible to over-estimate the service they have done to humanity, not only by relieving distress, but in disseminating a knowledge of medicine and surgery.

In bringing this part of my address to a close, I have only to mention that in 1745 the surgeons finally separated from the barbers. They obtained a new charter and removed to Surgeons’ Hall in the Old Bailey, where they remained till 1800, when they again removed to the present house in Lincoln’s Inn Fields, and became the Royal College of Surgeons of England.

In treating of a subject like that which I have chosen, it becomes necessary to adopt some plan of limitation, otherwise one would talk interminably. On this account I have resolved to give no details concerning the great London physicians and surgeons who flourished in the eighteenth and the beginning of the nineteenth centuries. If, therefore, I say nothing of Arbuthnot, Akenside, Mead, Pringle, Smellie, Baker, William and John Hunter, Cline, Sharpe, Percival Pott, Abernethy, Sir Charles Bell, Liston, Brodie, Astley Cooper, John Abernethy, William Lawrence, and many others, it is not from want of appreciation of their merits, but merely because to do so would take me too far. I purpose, therefore, to skip over the eighteenth and the beginning of the nineteenth century, and conclude my paper with a few remarks on the teaching of medicine in modern London.

Fifty years ago medical schools were very different from what they are now. The teaching was far less thorough, the examinations far less complete. For example, according to Sir James Paget (“St. Bartholomew’s Hospital Fifty Years Ago”), it was the universal custom for students to be apprenticed in the country, and to spend eighteen months in London before going up for the College and Hall. The examination at the College of Surgeons was conducted by ten examiners, who sat at a semicircular table, was entirely _vivâ voce_, and lasted twenty minutes. The teaching for these examinations was entirely by lectures, and it was no uncommon thing for one man to lecture on more than one subject. Thus, at St. Bartholomew’s, Stanley, who was surgeon to the hospital, lectured on anatomy and physiology, and the senior physician on medicine and chemistry, while of clinical instruction there was practically none. The operating was swift and dexterous, the mortality after it great, “for there was scarcely a thought about blood infections ... none would hesitate to go straight from a dissection of a dead body to an operation on a living one, and at the first dressing of an amputation or any large wound the stench of the decomposing bloody fluid running from it was enough to infect the whole ward.” The nursing at that time was of a rough order. The nurses were often intemperate, and almost always women who morally and intellectually might fairly be classed among the lower orders.

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MODERN MEDICAL SCHOOLS AND EXAMINATIONS.

Things are very different now, and it is only fair to state that this College and the University of London were undoubtedly the pioneers in that great improvement in medical education and medical examinations which has taken place during the reign of Her Majesty. University College was established in 1828, and within ten years of that date we find an illustrious staff of professors, nearly every one of whom has had an important share in increasing our knowledge of natural science in its widest sense. Turner and Thomas Graham, the latter certainly the greatest chemist of his time, were teaching chemistry; Lindley and Grant, each of them pre-eminent in his own department of knowledge, held the chairs of botany and comparative anatomy; while Dionysius Lardner, a man of great learning, in whom the power of expounding and lecturing was developed to an extraordinary degree, was professor of natural philosophy. Quain and Sharpey were teaching anatomy and physiology, and writing the world-famous text-book still known as “Quain and Sharpey.” Carswell was professor of morbid anatomy, and producing the series of marvellous water-colour drawings illustrative of his subject which are, and ever must be, reckoned among the greatest treasures of our museum. Samuel Cooper and Liston were teaching surgery; Anthony Todd Thompson, materia medica; Davis, midwifery; Gordon-Smith, medical jurisprudence; while Elliotson and C. J. B. Williams, who but lately was the sole survivor of his then colleagues, were setting an example in the teaching of medicine the effect of which is doubtless felt amongst us still. Here, then, more than fifty years ago, was a medical school complete in the modern sense. Our teaching has been altered in its details, and has tended to become more and more practical, but in principle it is the same now as it was then. Each branch of knowledge which is necessary for a medical man is provided for and controlled by a separate professor; and it is a remarkable fact, and redounds greatly to the foresight and wisdom of our founders, that the number of professorial chairs remains the same, the only addition being the all-important one of Public Health and Hygiene, in the establishment of which we were again the pioneers among medical schools. If imitation be the sincerest form of flattery, we ought to feel proud, for every school in London is now formed more or less perfectly on the model established here in 1828. Fifty years ago, as Sir James Paget reminds us, medical examinations were conducted in practically the same manner as that which is immortalised by Smollett in the pages of “Roderick Random.” But fifty years ago was founded the University of London, an institution which lives and progresses in spite of torrents of abuse, and which has had a greater effect for good upon medical education in this country than all the other universities and medical corporations put together. The great merit of the University of London consists, not in the severity of its examinations (in which particular it is fully equalled by the corporations), but in the _training_ which it obliges each of its graduates to undergo, and when the General Medical Council some few years since reported on the final professional examinations, without reference to the two earlier examinations, it showed a want of appreciation of the principles which have guided this University. The University of London from the first decided that no one should become even an undergraduate who had not mastered his A B C, not merely the A B C of mathematics and certain selected languages, but the A B C of science also. There are many who still cavil at the breadth of the matriculation, and seem to forget that it comprises no subject that a decently educated man can in the present day ignore. It is argued that this wide smattering of knowledge which the matriculation involves is wrong, and that the best training for the mind is to master one subject thoroughly, a thing which nobody in this world ever did, and schoolboys of sixteen least of all. The correlation of knowledge is so complete that no one can attempt to master any one branch without some knowledge of many other branches; and in this fact is found the justification for the first examination which a medical student has to undergo. Which of the subjects of the matriculation is unnecessary for a decently educated doctor?

The Preliminary Scientific Examination is the most abused of all, but in making a knowledge of natural philosophy, chemistry, and biology precede the study of anatomy and physiology the University of London is undoubtedly right, and there are signs that the other examining bodies are coming round to the same opinion. Of the final examination I need say nothing. There are those who say (even eminent persons, and notably one Aberdeen graduate) that the effect of the University of London has not been good, and that the medical graduates are not “practical” men. This assertion is too ridiculous to require an answer, for it is notorious that the London medical graduates have had more than their fair share in all the practical advances made by medicine in the last half century; and in medicine, surgery, midwifery, and public health they have more than held their own. It is very possible that a scientific training makes it rather difficult for a conscientious man to be dogmatic, and until the public is more highly educated than at present, the dogmatic practitioner is sure to have a large _clientèle_ and will pass for a practical man. Scientific medicine has made enormous advances; but for a knowledge of the little arts, not always honest arts, which tend to increase our gains, John of Arderne was quite equal to any practitioner of the present day. He was, in one sense, pre-eminently a practical man, but whether we should do well to imitate him is more than doubtful.

LONDON AS A PLACE OF STUDY.

There can be no doubt that, as a place to study medicine, London is, because of its enormous population, unrivalled.

In the year 1887, according to _The Hospital_, there were treated at the London hospitals and dispensaries 79,261 in-patients and 1,180,251 out-patients, or a total of over one million and a quarter, exclusive of those who received relief at the workhouse infirmaries, sick asylums, and lunatic asylums. It is true that a considerable portion of these patients are not so readily available for the student as they might be. The following are the numbers of patients (according to _The Hospital_) treated at the hospitals attached to medical schools in 1887:--

In-patients. Out-patients. Total.
St. Bartholomew’s 6,000 150,000 156,000
London 8,260 95,760 104,020
University College 2,964 44,382 47,346
Guy’s 5,204 38,004 43,208
Middlesex 2,413 27,714 30,127
St. Mary’s 3,315 26,637 29,952
St. Thomas’s 4,643 25,000 29,643
Westminster 2,580 20,912 23,492
Charing Cross 1,686 20,306 21,992
King’s College 1,811 17,248 19,059
------ ------- -------
Total 38,876 465,963 504,839

This gives a total of 1,386 different patients for every day throughout the year. It is certain that no city in the world offers a field for medical study in any way equal to that of London. I think it is much to be regretted that, for qualified men, a composition ticket admitting freely to the practice of all the hospitals in London is not arranged for. If such a ticket were issued, and qualified men anxious to prolong their studies might, in return for a payment, feel themselves free to visit any or all of the great London hospitals, there can be no doubt that we should have a great afflux of students. I very much doubt the wisdom of the policy of trying to attract numbers of students by lowering the examination tests for a degree. This is an educational age, and we must not forget that some of the boys at the Board Schools have possibly a juster notion of physiology than had many of our professional ancestors. Science is being taught to all more and more every day. The druggist is now a highly-educated man, and nurses are being drawn more and more from the educated classes. If the medical profession is to hold its own and to grow in popular esteem, it must be chary about lowering its educational standards at a time when the education of all classes is advancing.

PRINTED BY CASSELL & COMPANY, LIMITED, LA BELLE SAUVAGE, LONDON, E.C.

Transcriber’s Notes

Punctuation, hyphenation, and spelling were made consistent when a predominant preference was found in this book; otherwise they were not changed. Archaic spellings were not changed.

Simple typographical errors were corrected; occasional unbalanced quotation marks retained.

Ambiguous hyphens at the ends of lines were retained.

Index not checked for proper alphabetization or correct page references.

Page 36: “propriâ motu” appears to be a misprint for “proprio motu”.

Page 66: Transcriber added “from” in the phrase “was expelled from the”.

Page 107: “by that which” was misprinted as “by the which”; changed here.

Page 121: “with another £220,000” was misprinted as “with other £220,000”; changed here.