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York Journal of Medicine-not more than twenty of the students actually took the Hospital ticket ; and in the lecture before us Dr. Watson grievously deplores their scanty attendance.
“ There were probably," he says, “between six and seven hundred medical students in this city (New York) during the last winter. I was on duty in the second surgical department of this hospital during the greater part of that time, and strange to say, it was a rare thing to see the face of a single student in any of my wurds during the whole of my attendance."
With what propriety, then, can the array of cases of sickness treated in that institution be adduced by any Medical College as an incentive to the medical student for preferring New York to Philadelphia, when in the latter city there are not only opportunities for clinical instruction, but these opportunities are actually embraced by numerous students. During the last official yearwespeak from authority--not fewer than one hundred and fortysix students took the ticket at the Pennsylvania Hospital; and from Jan. 1846 to Jan. 1847—the University of Pennsylvania requiring their candidates for graduation to have attended one course of hospital instruction--not fewer than two hundred and eightythree.
Dr. Watson properly urges the importance of clinical instruction, and who denies it? But it is an interesting question, whether it be to the welfare of the patient or to the advantage of the student that masses shall congregate daily in the wards, disturb the febrile and inflammatory, and examine individually, and in succession, the physical signs in thoracic and other diseases. There can be, from the philanthropist but one answer we apprehend to the question ; and hence the clinical teacher is compelled to select cases—as was long the custom at the Philadelphia Hospital and is still at the College clinics--for illustration in the amphitheatre, the student having, at the same time, ample opportunity for witnessing the surgical and general management of the hospital.
So far, then, as facilities are afforded and embraced, there would seem to be no comparison between the advantages actually derived from clinical attendance by the students of Philadelphia and of New York.
The author of the lecture gives a brief history of clinical instruction in this country and elsewhere, into which we cannot follow him. We have only space for one or two comments and rectifications. He is not quite as cosmopolitan as we could desire. Not only the hospital to which he is attached, but other institutions in the city of his residence, occupy, we think, too high a place in his thoughts. For example, he says:
“ The cause of education in our well-appointed colleges and especially in the rival schools of this city, (rivals be it ever hoped only in their ability for usefulness,) is every year becoming more and more elevated."
Quod est demonstrandum. We pause at least for the evidence.
Dr. Watson is a reformer-doubtless the advocate of a judicious reform-as we were wont to hear of the advocates of a judicious tariff. The following sentiment appertains to many as well as to himself.
“Gentlemen, the medical institution which first comes up to the reasonable demands of the profession in this respect, and, possessing the facilities, requires of its graduates practical acquirements equal to those at present enjoined upon the students of European schools, will find its interest in the measure.” p. 8.
We do not believe in this. Such an institution may be able to exclaim with Francis the first, “ tout est perdu sauf notre honneur," or it may have to submit to its benches being filled by a “select few.” We have now in mind a distinguished literary institution, in which it was determined to “raise the standard,” , and to render its highest honours difficult of attainment. This was done; and whilst the graduates of other institutions were annually numerous, this distinguished school did not confer its highest degree at any time on more than half a dozen; and in some years, we believe, not a single candidate presented hirnself. It may be said, that they who succeeded would be more respected and successful than the alumni of other institutions where graduation was more easy; but we have had no evidence of this; on the contrary we do not know a single case in which marked advantage has accrued to the graduate for the toil which he had to undergo for this more elevated collegiate distinction. Let a department of higher mathematics be established in our colleges, and even if filled by a La Place or a Gauss, it might be attended by a few pupils; whilst the benches appropriated to lower mathematics under an ordinary teacher would
be filled to overflowing. A certain, or rather uncertain, amount of knowledge is admitted by all to be requisite; but the general feeling - erroneous we grant it to be - is that high literary and scientific distinction is not necessary, and may be injurious in the transaction of the business concerns of life; hence we not unfrequently see the learned and accomplished physician dismissed, and the lowest empiric consulted in his place. It is strange, but not less true, that an individual ordinarily-and even more than ordinarily-intelligent will consent to confide in the prosessional judgment of one whose opinions on any other matter he would contemn.
On the subject of College Clinics,” Dr. Watson dwells at some length, properly urging, that “to dispensary service, when con. fined to the management of such affections as legitimately belong to it, there is no direct objection;" but college dispensaries should never be held up as sufficient to supply the place of hospitals.
The college cliniques, he remarks, were first started in a neighbouring city, where hospital privileges had been so much restricted as to be of little service to the winter students.” In this he is altogether misinformed,—if he applies the remark to Philadelphia.
“ As an expedient for supplying this deficiency, they were unquestionably acceptable on the same principle that half a loaf is better than no bread. They were at first called by their true name; but this attracting Ititle notice was soon altered.
The example thus set, and the title thus assumed, were copied by the schools of other places."
Dr. Watson does not here do justice to the city of his choice. We believe, that much of the credit that attaches to the college clinics helongs to it, and that the very name was applied to the "clinical service at the University of New York before it was adopted here.
“ The clinique epidemic of the colleges, as my friend Dr. Bell has happily expressed it,” (we do not see wherein the happiness lies,] "was last winter at its height. The students, one and all, were affected by it, and the hospitals were forsaken.”
Certainly not in Philadelphia. The observation may and doubtless does apply to New York, but not to this city.
The lecturer adds"It is to be presumed, ere this, the disease has materially
abated. Such I am told, is the fact in Philadelphia, where it first broke out. The University of Pennsylvania, and some of the other schools there have already abandoned their dispensaries, and are now supplying their second course students with hospital tickets at their own expense.”
Some one has evidently been gulling the worthy author. There is not a word of real history in this quotation. There has been no abandoninent of their clinics by other schools, and consequent supplying of tickets to the hospitals gratuitously. The clinic of the Jefferson Medical College was never in so flourishing a state, and so extensively useful. One other clinic has been added to the list—that of the Franklin College. The Pennsylvania College has never had a regular clinic, and gives--as it did last yearto second class students tickets to the Pennsylvania Hospital; but no such thing has been done by the University of Pennsylvania, which-if it has abandoned the name of college clinics, professes to teach-mutato nomine demonstralive medicine" on one day of the week, and "demonstrative surgery" on another! It would be difficult to find any where a sentence in which so much error-doubtless unintentional-is contained in so sinall a compass.
Our 'opinion of hospital attendance for masses has already been expressed, and as masses must be supplied in the best mode that is practicable, we do not hesitate to affirm, as our conviction, that the introduction of “ College Clinics"-we use the term generally appropriated to them, and see no valid objection to it is the most important single addition to medical educational resources that has been proposed in recent periods.
“Gentlemen," says Dr. Watson, “if I know my own mind, I have no disposition to draw invidious comparisons, or to speak of the relative advantages of rival cities or of rival institutions."
Why then does he exclaim, after having made the erroneous statements referred to above :-and if hospital attendance there (meaning in Philadelphia,] is beyond measure superior to their misnamed cliniques, (he had before shown that both were desirable, and had not instituted an “invidious comparison,”'] what are we to think of the facilities for practical instruction enjoyed by students within the walls of the New York Hospital?”
We do not see the sequitur. If the hospital attendance in Philadelphia be better than the college clinics, what are the facilities for practical instruction enjoyed by students within the walls of The New York Hospital? Such appears to be the proposition, which we are not Cocker enough to solve.
We have no doubt of the value of the New York Hospital, and of the entire honesty of purpose of the auihor of the lecture before us; yet it must be admitted by the best friends of the Institution, that the picture of it given by him savours of hyperbole.
“ You may," he observes, “in other countries tind larger hospitals, but none presenting a greater variety of acute and important diseases; you may find in other hospitals abler teachers, but none so [?] willing as we have been to give you our time and services for nothing. You may find in some few other institutions greater opportunities for autopsic [a vile word] examinations ; you may find in the cabinets of foreign societies, more valuable pathological collections; you may, in other cities, even find larger libraries than ours; but look for all these together in any other hospital either at honie or abroad, and you will look for them in vain [?] I say it without fear of contradiction,
will not find a single hospital to compare with this,-not one that contains within itself so many advantages for both theoretical and practical study as the New York Hospital.” p. 19. Shame, then, on the profession of New York !-Shame, on the Professors of the two “rival schools,” the course of education in which “is becoming every year more and more elevated!" Shame on the six or seven hundred medical students in the city during the last winter--that in the second surgical department, during the greater part of the winter, "it was a rare thing to see the face of a single student."
The peroration of the lecturer is judicious and wholly unob. jectionable. It is well worthy of being retained in the recollection of the clinical student.
“During the coming winter, it will be well for every medical student here, but more particularly for such as are not prepared to remain in town after the close of the college session, to visit the hospital daily. Let nothing prevent you from attending at the hour set apart for the purpose.
Come not merely with your ears open, as students often do.