The principles and practice of medicine : founded on the most extensive experience in public hospitals and private practice; and developed in a course of lectures delivered at University College, London / by John Elliotson ... ; with notes and illustrations by Nathaniel Rogers.

  • John Elliotson
Date:
1839
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine : founded on the most extensive experience in public hospitals and private practice; and developed in a course of lectures delivered at University College, London / by John Elliotson ... ; with notes and illustrations by Nathaniel Rogers. Source: Wellcome Collection.

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    In the other great mode of instruction in the Practice of Medi- cine and Surgery, the University fails; and our school can never deserve the name of a great medical school while the defect exists:— a hospital is imperiously necessary. It is true that we have a dis- pensary ; but a dispensary must always be a miserable substitute to the student for a hospital. No medical University would grant the degree of Doctor in Medicine, to any who had frequented merely a dispensary. At a dispensary the majority of patients are so little indisposed, as to be able to go about. When seen, they necessarily pass in rapid review before the practitioner; giving him an oppor- tunity of showing how practice may be dispatched, rather than how disease should be investigated: for, if the time demanded for the scientific and patient investigation of each case, and for demonstra- tion and explanation to the pupil, were given, the poor creatures would be compelled to lose, in attending at the charity, far more time than their condition in life or their strength would allow. There is, besides, no certainty among the patients of a dispensary, that medicine is regularly taken ;—no possibility of fixing their diet; —no certainty of their continuing to attend, so that each case may be regularly followed up to its conclusion ;—no possibility of making daily observations. When cases are severe, and the patients con- fined at home, there is not only the same uncertainty of strict at- tention to the injunctions respecting medicines and diet, but the student must lose a great deal of time in running from one house to another; and the physician or surgeon will not visit all such patients daily with his pupils; and, indeed, his pupils cannot accompany him in these visits, with any degree of regularity. In an hospital the patients are compelled to obey every injunction; and being under the same roof, they may be seen at pleasure any hour of the day, without loss of time; so that long and repeated observation of their cases is easy. When death occurs to a dispensary patient, and an examination is permitted, the student loses still more time; for he not only must go to the house of the family, but prepare the body, and afterwards reinstate it; and, in all probability, will seldom be accompanied by the physician or surgeon. At hospitals the exami- nation takes place without any loss of time; the student has no where to go; servants prepare, and sew up, and wash the body; and the physician or surgeon usually superintends the inspection. So supe- rior are the advantages of hospitals, that, as I have already remarked, certificates of attendance upon them are required at all medical Universities, previously to examination for the doctorate; and al- though certificates of attendance at dispensaries are admitted by the Apothecaries’ Company of London, and may be obtained at a cheaper rate than those of hospitals, the majority of English medical students voluntarily enter themselves to the medical practice of hospitals. The inferiority of dispensaries is, indeed, acknowledged by their medical^ officers, in the greater cheapness of their terms; and the Apothecaries’ Company declare it, in their demand of a longer at- tendance at them than at hospitals. It is, therefore, much to be
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