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

We need not insist on the tendency of this system to the protection of idleness and incapacity, or the injustice inseparable from it to the young gentlemen whose interests it is supposed to guard. One necessary consequence is obvious—namely, that the hospitals, instead of having to select from the general body of pupils, or from the more industrious or talented of them, is obliged to choose from a very small minority.

It is, in fact, just as if scholarships and fellowships at public schools and universities were conferred without any reference to the proofs which the candidates might have given of their talents or industry; but were distributed to those who had given a certain fee to a particular professor. Would any man in his senses doubt as to the influence of such a plan on the interests of classical literature or mathematical science? It seems to us impossible that men should really differ on that point, or hesitate to admit that, mutatis mutandis, whatever the science might be, so far as the cultivation of it could be influenced by system, the result must be alike prejudicial in all cases. We are, however, far from arriving at the end of the System by this general statement.

The public and the government, uninformed or unmindful of this "system," wish to consult authorities on professional matters. They not unnaturally look to those who hold public appointments, because these afford the prestige of extensive opportunity, which is supposed to imply, and under a fair system would ensure, skill and experience. Men are apt to look at a man's position, without stopping to inquire how it was obtained; and although position may cut both ways, and in particular instances "throw a cruel sunshine" over incapacity, still amongst gentlemen extreme cases are not to be expected; the rule is much more likely to be a respectable and protected mediocrity, which is just that tone which has rarely done anything to enlarge the boundaries of any kind of knowledge.

It happens, however, from the "system," and the position thus given to those who are supposed to profit by it, that the interests of the poor, and, in a considerable degree, those of the rich also, are, in a very large sense, confided to their care.

It thus follows that positions, in themselves highly desirable, and which enable men to exert considerable influence on the progress of a science, on the sound condition of which the physical comforts, and in no small degree the moral condition, of mankind depend, are occupied by men who have undergone none of those tests which public competition alone affords, and which the summi honores of almost every other profession either directly or indirectly imply.

So far for one mode in which the interests of the public are compromised; but there are many other channels. The government, ignoring the evils of this system, have placed the regulation of the surgical branch of the profession in the hands of a body of men whom, when we examine, we find to be no other than the apprentices we had recognized at the hospital, grown into the full bloom of a legislative body—whence again are chosen Presidents, Vice-Presidents, Examiners, &c., of the Royal College of Surgeons of London!

If, fatigued with this machinery, we walk to the Royal Medical and Chirurgical Society—a chartered body for the especial cultivation of science—we meet, as its name would imply, a number of our honoured brothers, the physicians; but here we find that, whether we observe Presidents or any other Officers, the influence exerted by the apprentice system continues; and that, in almost everything surgical, the best possible individual is an apprentice who has attained his first position without any public competition. Can any one be surprised that the published transactions of this society are not of a higher character. We hope and believe that the point of the wedge is already inserted, which will, at no distant period, rend asunder this system, which we shall not trust ourselves by attempting to characterize farther. But there are points in connection with the interests of science and of Abernethy which require yet to be noticed.

We need scarcely observe that it would be very desirable that the interests of science should be entrusted to those who had shown most assiduity or talent in the cultivation of them; that if operative surgery be really, as a whole, a series of facts exemplifying the defects of a science—that whilst every pains should be taken that what is necessary should be done thoroughly well—all factitious inducement to multiply their number should be avoided, and especially any which tended to increase emolument commensurately with their multiplication.

That as operations (with some few exceptions) merely minister to effects, their real bearings on disease can only be estimated by knowing the ultimate result; and that, in order to this effect, returns of all operations should be kept, with full accounts of the cases; the addresses of the patients should also be taken, and such means as were obvious and practicable employed to obtain the ultimate result of the case.

Another point which should be attended to in hospitals, is an accurate notation and return of all cases whatever; so that we might obtain from statistical records whatever light they might be capable of affording in aid of the prosecution of a definite science. In this return, a full history, and all the phenomena of the case, which are known to have an influence on the Body, should be accurately noted, and in tabular forms convenient for reference.