London (Ancient and Modern) from the Sanitary and Medical Point of View

by George Vivian Poore

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.

SURGEONS’ HALL, OLD BAILEY.

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.

UNIVERSITY COLLEGE, GOWER STREET.

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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?