Memoirs of John Abernethy / With a View of His Lectures, His Writings, and Character; with Additional Extracts from Original Documents, Now First Published

by George Macilwain

He very naturally sets to work to do the best he can; and from this first budding, we very soon arrive at the full blossom of the System; one effect of which is, that, in hospitals, which have so large a care of public health—institutions which, whether correctly or incorrectly, give so much of the tone to the medical opinions of the day, which exert, either directly or indirectly, an influence on the claims of hundreds to public confidence—that in these hospitals there is not one single surgeoncy that is fairly and bonâ fide open to scientific competition.

Let us now examine a little into the machinery by which these results are brought out.

The experience afforded by the hospitals necessarily supplies abundant means for instructing students in surgery. They are accordingly admitted on paying certain fees to the surgeon; and this at once supplies a large revenue. This revenue is of course regulated by the number of pupils; and as there are in London many hospitals, so it follows that there is an active competition. Thus, some time before the season commences, the advertisements of the medical schools occupy a considerable space in the public journals, and circulars are also liberally distributed.

Well, the points here, as in all other cases, are the advantages offered, and the price paid—the maximum and minimum respectively. Here we arrive at the elements of numerous evils.

Students are not always—and before they try, hardly ever—judges of a school. The general reputation of a man (as he is never subjected to open competition) is no test whatever of his comparative power in teaching students; but they are accustomed to ascribe great importance to operations; and, cæteris paribus, they incline to prefer that hospital where the greatest number are supposed to be performed.

This arises from various causes; in some of which the public play no unimportant part. The student has perhaps seen, in the country, a good deal of medical and surgical practice; but very few operations. His stay in London is comparatively short, averaging, perhaps, not more than the better part of two years. Unnecessary length of time is generally inconvenient, always expensive, and the student is naturally anxious to see most of that which he will have least opportunity of observing elsewhere. Moreover, he knows that when he returns to the country he may save twenty limbs, before he obtains the same amount of reputation that he may possibly get by one amputation—the ignorance of the public, here, not appreciating results which very probably involved the exercise of the highest talent, whilst they are ready to confer a very profitable distinction on that which does not necessarily involve any talent at all.

We have no wish whatever, and certainly there is no necessity, for straining any point in reference to this very serious matter; but these two facts are indisputable—that the surgeons obtain their remuneration from the hospitals by the fees they obtain from the pupils; and, cæteris paribus, the pupils will flock the thickest where they expect to see most operations.

The next thing that we would submit, is that the prestige in favour of operations is both directly and indirectly opposed to the progress of scientific surgery. Almost all operations, commonly so termed, are examples of defective science. To practical common sense, therefore, it would appear a very infelicitous mode of obtaining the maximum of a man's genius in aid of the diminution of operations, to open to him a prospect of enriching himself by the multiplication of them. We desire to consider the subject with reference to its scientific bearings only, and would avoid entirely, were that possible, any appeal merely to the feelings. Such impulses, however right, are apt to be paroxysmal and uncertain, unless supported by the intellect. But, on such a subject, the feelings must necessarily become more or less interested. Wherever a system takes a wrong direction, a great many minor evils insensibly grow out of it.

The erection of a theatre for the purpose of operating, though founded on a feasible pretext, is a very questionable measure; and, unless of clear advantage to the profession or the public, is surely not without some character of repulsion. As regards art and science, it is certain that not more than twenty or thirty can be near enough in the theatre to see anything that can be really instructive in the performance of operations. In the absence of actual advantage, therefore, an exhibition of this kind is more calculated to give publicity to the surgeon operating, than it is to raise the tone or chasten the feelings of men about to enter a profession which almost daily establishes requisitions for our highest faculties. Operations without opportunities of real instruction, are merely unprofitable expenditure of valuable time. That which is viewed as a sort of exhibition to-day, may be with difficulty regarded in the light of a serious duty to-morrow. Were the object to tax the sensibility of a student, and blind him to any higher association with pain and suffering than that afforded by custom and chloroform, and to substitute for a dignified self-possession and sympathy with suffering, which each kept the other in due control, an indifference to everything save adroitness of manipulation and mechanical display,—no machinery could be better calculated to effect such objects; but science and humanity require very different qualifications, and experience has shown that they are neither incompatible nor beyond our power.