OF THE EXPEDIENCY and UTILITY OF TEACHING THE SEVERAL BRANCHES OF PHYSIC and SURGERY, BY LECTURES, AT THE LONDON HOSPITAL; And for ERECTING THEATRES for that Purpose, WITH THE RESOLUTIONS of the GENERAL COURTS relative thereto OF THE EXPEDIENCY and UTILITY, &c. ALL those advantages which distinguish civilized from barbarous and savage nations, have first arisen from, and are preserved by their possession of the arts, and a knowledge of the sciences on which they are founded: And if among civilized nations there are some which excel others, this superiority is in proportion to the degree and extent to which they have carried the arts and sciences. Amongst the various arts which contribute to the good of mankind in society, there is perhaps no one that holds a more distinguished rank than that of medicine, since, while it is capable of affording relief to some of the greatest distresses that afflict human nature, and presents the strongest proofs of the infinite wisdom and goodness of the Great Creator, it at the same time suggests the most pow- erful motives to the practice of every religious and social duty. For reasons like these, the improvement of Physic and Surgery, has, in all ages, in every civilized country, been an object of attention and encouragement with princes, public bodies, great and good men. But unless these arts be cultivated with assiduity, and proper methods of instruction employed for such as are to practice them, the advantages which mankind actually derive from them may fall far short of what they are capable of affording. If they be not promoted with industry by such as are in the practice of them, future discoveries and inventions for the benefit of mankind, must cease, and former ones be lost and forgotten. And it proper and effectual methods be not adopted in the education of young persons in these arts, then, though (4) though some few may possess them in a high degree of perfection, they may, nevertheless, with the generality of practitioners, be in a very imperfect state, and even prove pernicious and destructive, instead of useful and salutary. It were to he wished that experience had never afforded examples of the truth of this observation; but unhappily it is otherwise. In private practice, the difference between a skilful and unskilful practitioner can hardly ever, or very seldom be determined, since the persons who are witnesses of the proceed- ings, want either opportunities of making a proper comparison, or abilities to judge of the difference; but in the navy and army, judicious, attentive and humane officers, possessing tbese Qualifications, have been enabled to make a proper distinction. In the beginning of the late war, many young gentlemen obtained Sur- gical appointments in the navy and army, who, to the great distress of mind of many of our brave officers, and greatly to the injury of our valuable sailors and soldiers, proved not to have been properly instructed in the principles, and thence to have been greatly deficient in the practice of their profession. On this account the Examiners of the Surgeons’ Company, prompted by their zeal for the preservation of the lives and health of such useful members of society, published the following Declaration. “SURGEONS' THEATRE, October 21, 1779. “The Court of Examiners having been under the very disagreeable necessity “of refusing even the lowest qualification to some young Gentlemen, who “lately came before them to be examined,, on account of their total ignorance “of Anatomy and Surgery, they think it therefore incumbent on them to give “this Public Notice, That for the safety of his Majesty’s subjects, both by sea “and land, no Gentleman can be admitted at this theatre to any Qualification “whatever in Surgery, unless he understands Anatomy, and is acquainted with “the operative parts of Surgery. “And the Court think, That it's the more necessary that a sea Surgeon “should be very intelligent in his profession, as his situation deprives him o£ * Although war is at an end, the reasons for providing the means of qualifying young gentlemen for practice in the navy or army are as cogent as ever, since it would be too late to set about the work, for all the good purposes intended, when, unhappily, we may be engaged in another war. It is at the beginning that Surgical Assistants are most wanted; and the means of qualification should undoubtedly be ready, and as easily obtainable as possible. “the (5) “the advantage of Consultation, and obliges him to depend on his own judg- “ment in the most important cases, both in Physic and Surgery. It is there- “fore hoped that no person will propose himself to the Court of Examiners “who is not qualified as above, as they will necessarily be refused any Qualifi- cation."* That students of Physic or Surgery may be rendered properly qualified for the practice of their profession, an attendance upon an hospital is indispensibly necessary; for though by other means they may be taught the principles, without this they can never become expert in the practice of it. So great is the utility of hospitals in this respect, that it may reasonably admit of a question, whether more immediately, from the relief they afford to the poor afflicted with diseases, or more remotely, from the general good they produce to the world, by improving the knowledge and skill of the Medical Gentlemen em- ployed in them, and properly qualifying students for the practice of their profess- ion, they more deserve the countenance of humanity, religion, and found policy.† But an attendance upon an hospital, however necessary, is by no means, alone sufficient to qualify students in Medicine for the practice of their profession: it is further required that they be properly instructed in the principles on which only a found practice can be founded. As it is necessary that students of medicine who attend hospitals, should be instructed in the principles of their profession ; and as these are deduced from different branches of knowledge which it is,, therefore, proper they should study. * Vide an article at the end. † Since the writing of this paper, a very remarkable passage in a most excellent sermon, preached by the Right Reverend the Bishop of Litchfield and Coventry, before the Governors of the London Hospital, at their anniversary, and since published, hath been suggested to the writers. It is so expressive and cor- roborative of the principle maintained in the above paragraph, that it was judged proper to insert it. The Right Reverend Author having spoken of several advantages arising from an hospital, proceeds as follows: “Before I conclude, there is yet another light in which I shall remind you of its peculiar merit. It “is a nursery for the useful science of medicine, its advantages in this respect are not confined to the “walls of the hospital itself, but are extended over the whole race of mankind. The most eminent “practitioners in every branch of medicine attend; and the recovery of the patients is but one of the “good purposes answered by their attendance. Experience is the mother of this science, which hath “ever profited more by observation and practice, than by theory and the labor of the closet. Thus the “treasure of knowledge are increased in this instance, by the exercise of our charity. Virtue and sci- “ence go hand in hand to the advancement of the honor of God, and the welfare of mankind. At the “time that we relieve the present necessity of our patients, we transmit to posterity a more intimate “knowledge of God’s capital work, the frame and constitution of man, together with all the benefits to “be derived from a good and well conducted hospital." so (6) so the experience of learned men for ages past has evinced, that the most effectual method of conveying this knowledge is by lectures, Hence this method has been adopted in every part of Europe, and in America. In Great Britain, in particular, it is employed in the Universities, at the College of Physicians, at the Surgeons’ Theatre, &c. It follows, therefore, that students who attend an hospital for the study of medicine, should be taught the different branches of knowledge relating to it, by means of lectures. But the Lectures should be read in the hospital which they attend, for, by this mean the instruction conveyed will be more efficacious, as the teacher will have continual opportunities of exemplifying and confirming by practice the principles he teaches; it will also be much more convenient, and save a great deal of valuable time to the students; besides, if they are under the necessity of going to a distant place for necessary instruction, their due attention to their business at the hospital must be diminished, and the patients under their care be more or less neglected. And further, much of the executive part of the business of hospitals necessa- rily rests on the pupils: to fit them therefore for the proper performance of their duties, as early as possible after their admission, must be very desirable. But this end can no other way be so effectually accomplishied as by the means under consideration. From what has been already observed, the importance and expediency of instituting Lectures on the different branches of knowledge appertaining to Physic and Surgery, at the London Hospital, must be very obvious.* But we may add that the situation and circumstances of this hospital are such as render it peculiarly adapted for this purpose; for besides the advantages it possesses in common with every other hospital, it is remote from places of dissi- pation, which might draw off the attention of students from what ought to be their proper objects. And, were the different branches of knowledge be- longing to medicine properly taught in the hospital, it would be a mean of raising its credit and reputation, as the want of this, and the necessity the students are now under of going daily to other places for that instruction which is required, are well known to have had an opposite effect, that is, to lessen it in the estimation of many. * The Governors of Hospitals of the highest reputation justly consider teaching as naturally connected with curing, and of the greatest importance to the interests of mankind, and have accordingly provided the most ample, and some of them magnificent conveniences for the purpose. The (7) The friends of the Hospital would do well seriously to consider in what really does consist the reputation of an hospital; and the good or evil that must necessarily slow from the possession or want of it. It may truly be said of public institutions as of private persons, that to be a bankrupt in reputation is worse than to be so in property. Riches may follow reputation; but when this is gone, the source of riches will fail, and the finest edifices and best designs go to decay. Hospitals of the greatest celebrity, where every mean is employed, every accommodation afforded for teaching as well as practising the healing art, will inform us in what does consist the reputation of this kind of institution. The London Hospital has always experienced the bad consequences arising from the pupils attending Lectures in different parts of the town. The Rules require that certain pupils should reside constantly in the house, that in the absence of the Surgeons they may be ready to administer relief in case of accidents happening either to patients in the hospital, or to such as may be occasionally brought thither. Yet these rules have been often and un- avoidably infringed, and patients in the most dangerous conditions, requiring immediate assistance, have, in consequence of the resident pupils being at a distance, attending lectures, been perhaps for hours without the necessary means of relief. This evil has been long complained of, and frequent attempts have been made to remedy it; but no regulation has yet been found sufficient; nor can it be prevented ’till the necessary instruction which the students require be- comes obtainable within the hospital, and thereby the necessity they are under of seeking it in distant places, removed. For the last two years, however, that anatomy has been taught by lectures at the hospital, the candid visitors have acknowledged that the pupils have been much more in the house, and the evil so far lessened; but still they are obliged to go to other hospitais to be instructed in chemistry, materia me- dica, &c.* But * No one can doubt that the hospital must acquire many friends, and a diffusion of interest from the greater number of pupils educated within its walls. The predilection for a place, which has afforded us the principles of learning, is well known to be always strong, and leads to every mean of promoting its interest and credit; and, indeed, many instances might be adduced in proof of advantages having slowed from this source to the London Hospital. If it should be possible for any to judge in so extraordinary a manner; as to suppose the Physicians and Surgeons concerned, capable of regarding their own interest or honour abstractedly, not adverting to the hospital; such would do well to consider, that, agreeably to their own notions, this cannot be the case, for, in reality, the Physicians and Surgeons, as to reputation or other benefits, must always rise (8) But whilst the teaching of the several branches of knowledge appertain- ing to Medicine, at the London Hospital, is of such unquestionable impor- tance and expediency, the proper conveniences for this purpose are wanted; and the sanction of the Governors to a measure for supplying this defect was the request of the Medical Gentlemen of the Hospital. They could not doubt but in so large a body, there would be found good sense and liberality enough to justify and encourage them in the undertaking. The following account will prove that their confidence was well founded; and they trust that while their endeavours are so directed as, at least, to have a ten- dency to raise the reputation, and not to affect a farthing of the property of the Hospital, they shall be still spiritedly supported. AT an Extraordinary and very numerous General Court, held the 5th day of February last, for the consideration of the following and other matters, the Physicians and Surgeons represented. “That, in their opinion, the teaching of the several branches of Physic and Surgery by Lectures at the Hospital, would promote the credit and ipterest of the Institution; that the present accommodations are inadequate to such an undertaking; they therefore requested leave to erect a new building.” After the Petition had been maturely considered, the following question was put, and carried in the affirmative, viz. “Whether it be the pleasure of this General Court to give the Medical Gen- tlemen leave to build, or cause to be built, a Theatre at the East end of the rise or sink with the charity, and, therefore, to support that in a manner the most acceptable to the public, must always redound to their same and advantage. If benefits should arise to the Lecturers in return for their labour, this cannot surely with any reason or justice be brought in argument against the propriety of the measure; nor, from this will candid men suppose that they are less actuated by the truest zeal for the interest and credit of the institution. The generous part of the Governors will undoubtedly be happy to find, that the gentlemen who devote the greatest part of their time to the service of the charity, can, through their industry, derive from it any share of emolument and reputation. As to that kind of opposition, and those measures, if such there should be, which flow from envy, from pride, self-interest, malevolence, or prejudice, they cannot be combated in a paper designed only to explain in the most simple and candid manner some striking and interesting facts, on the suppositinn of a candid and generous attention.-Persons actuated by such mean passions and motives, must be left to the correction of divines and moralists, and the lashes of conscience. Hospital, (9) Hospital*, according to the prayer of their petition, provided no addition expence be brought upon this Hospital, as already established by Charter; and without any claim from any subscriber to the requested Theatre to become a Governor, or to vote in any General Court or Committee, in consequence of such subscription?”† At a Quarterly General Court, held the 5th of March, the above resolution was unanimously confirmed, and a committee appointed for conducting the un- dertaking. The said committee having held several meetings have finally agreed on a plan, and the Physicians and Surgeons, concerned in giving Lectures, are now at liberty to execute the same. The following gentlemen have liberally agreed to receive Subscriptions, viz. James Rondeau, Esq. Chairman, Savage Gardens, Nathaniel Alien, Esq. King Edward’s Stairs, Thomas Blunt, Esq, Cornhill, Thomas Conway, Esq. Morton Park, near Epsom, John Harris, Esq. Cooper’s-row, Crutched-friars, Busick Harwood, Esq, Christ College, Cambridge, Alexander Higginson, Esq. Bedford-square, Samuel Davey Liptrap, Esq. Mile End, Coverdale Richardson, Esq. Mile End, and George Woolse, Esq. Wellclose-sqnare. As every mark of respect is due to the promoters of science and undertak- ings of public Utility, it is intended that some lasting memorial of the generosity of the eneouragers of this design shail be executed. The executive part of this undertaking, as far as relates to the building, has fallen to the lot of two of the parties engaged, and these gentlemen are deter- mined to exert themselves in it to the utmost of their power. Fully convinced of the truth and rectitude of the principles on which the concern has been, and will continue to be conducted, they have not the least doubt of experiencing. * The building, according to the plan adopted, will be perfectly detached from the Hospital. † To obviate the possibility of any misconstruction of this Resolution, it may be proper to remark, that not any part of the expence of the undertaking is to be paid for out of the property of the hospital. hereafter, (10) hereafter, the most perfect and general approbation of the friends of the institu- tion: but whether they should be so happy to meet this or not, they will still unremittingly endeavour to merit their good opinion. May 29, 1783. JAMES MADDOCKS, M. D. WILLIAM BLIZARD, Surgeon. N. B. As fully as possible to answer the important intention of qualify- ing young gentlemen for the service of his Majesty’s navy; and that con- tracted circumstances may not be a barrier against the pretensions of genius, merit, and industry; it is proposed, as a principle, in the future prosecution of the courses of anatomy, physiology, and Surgery, constantly to allow a certain number of students to attend gratis. They shall be bona fide either in, or in- tended for, the service of the navy.-The manner of the recommendation of such gentlemen, so as to avoid incurring any distinction, shall be settled before ibe commencement of the next courfe in October, and due notice given. -It is intended to request the advice of the Navy Board and Navy Agents on this subject.