OBSERVATIONS, &c.

ON returning lately from a long journey, I found on my table various communications from the College of Sur⯑geons, reſpecting the Chirurgical Department of the Royal Infirmary, a ſubject highly intereſting to the College, to the Hoſpital, and to the Public, in ſo far as, whatever relates to the ſtudy and practice of Surgery in this place, will, in a con⯑ſiderable degree, be found to depend on it.

Theſe communications were accompanied with a requeſt, that any plan which I wiſhed to ſuggeſt for regulating the attendance of Surgeons on the Infirmary, might be delivered by the 27th of laſt month:—This it was not in my power to accompliſh; but I may not yet be too late in communicating my opinion; and in doing ſo in a matter which involves ſuch variety of intereſt, I judge it right to ſtate ſome of the reaſons on which it is founded.

In thus addreſſing a letter to the Members of the College of Surgeons, I have not the vanity to think, that I ſhall have much influence on their deciſions; but in a matter of ſuch im⯑portance as this undoubtedly is, I conſider it as a duty incum⯑bent on every individual of our number, to let his opinion be clearly ſtated: ſo that the ſubject may be fully conſidered, and in every variety of view, before the College, as a public body, ſhall take an important ſtep which cannot be recalled, as muſt be the caſe if it ever ſhall collectively adopt and de⯑clare, any opinion or reſolution, on a queſtion ſo nearly con⯑nected with the intereſt of the public.

In regard to the legal right of the College of Surgeons to attend the Infirmary in rotation, the conſequence of an agree⯑ment entered into, upwards of ſixty years ago, between the Members of the College at that time, and the Managers of the Infirmary; as very oppoſite opinions have been given of it by good lawyers, it would be preſumption in others, not ver⯑ſant in the law, to judge of it. But with this difference of opinion among the counſel who have been conſulted, on the only point upon which the claim of the College of Surgeons reſts; with much uncertainty, therefore, of ſucceſs, were it to become a queſtion at law; we are all entitled to judge of any meaſure that ſhall pledge the funds of the College, or rather the property of our poor, on the event of an expenſive—doubt⯑ful litigation, which might not be brought to a concluſion du⯑ring the exiſtence of any of our preſent number.

Even in this view of the buſineſs, and thinking, as I do, that the tranſaction on which the claim of the College of Surgeons reſts, was unguardedly entered into on the part of thoſe Managers of the Infirmary by whom it was conducted, who in this matter appear to have done what their charter does not warrant, I am clearly of opinion, if the Managers [5]are now reſolved on making it a queſtion, as ſeems to be their intention, that the College ought to depart from it.

But were the legal rights of the College on this point even eſtabliſhed, I would ſay, as on all occaſions I have done, that we ought freely, and of our own accord, to relieve the Mana⯑gers of the Infirmary, from the effect of a tranſaction which ought never, in my opinion, to have taken place; which I have always conſidered as prejudicial to the Infirmary, with⯑out anſwering any good purpoſe to us; whilſt it did not tend to afford ſuch advantages to the pupils who daily reſort to the Infirmary for improvement, as there is reaſon to ſuppoſe they might have reaped from the practice being conducted by a limited number of Surgeons, ſelected for the purpoſe, and pla⯑ced on a fixed eſtabliſhment; inſtead of being under the di⯑rection of any ſet of practitioners changed in rotation every two or three months, or on any ſyſtem of rotation that can be propoſed.

Thus ſituated, the College of Surgeons, have, in every re⯑ſpect, acted as well as the ſame number of practitioners, un⯑der ſimilar circumſtances, any where could have done; and I doubt not of the Managers of the Infirmary being clearly of this opinion: But I alſo believe, that the buſineſs would have been conducted with more accuracy and care, if it had been left entirely to a few: If, however, the majority of our num⯑ber are not of this opinion, the meaſure to which I allude, that of our departing voluntarily from the right which hi⯑therto we have claimed, to attend the Infirmary in rotation, will neceſſarily be rejected; which moſt ſincerely I ſhall de⯑plore, as to me it appears, that in adopting the conduct which I have propoſed, the College would act more conſiſtently with its character as a public body, and, on the whole, that more ſatisfaction would reſult from it, than is ever likely to be the caſe, from their entering on a tedious lawſuit with the Ma⯑nagers [6]of a public charity; in defence of their own rights; on a point in which the public are materially intereſted; which they will not therefore regard with indifference; and which, after many years of litigation, might probably be decided againſt us.

Before the College ſhall reſolve on a point of ſuch import⯑ance, attended, as it probably would be, with conſequences which all of us might regret, they ought to conſider, that the Managers of the Infirmary, were they even ultimately to loſe the queſtion in a court of law, might ſtill defeat entirely the views of thoſe who wiſh for frequent changes in our attend⯑ance, and yet adhere to the very words of their agreement with the College of Surgeons; by allowing them to attend in rotation, but inſtead of a change at the end of every two or three months, that it ſhould only take place every twelfth or fifteenth year, as at one period they meant to have done.

From every view, therefore, that can be taken of the queſ⯑tion; the uncertainty of our prevailing in a trial at law; the important loſs which the expence of a tedious lawſuit would occaſion to our poor, who are ill able to bear it; the power which the Managers of the Infirmary poſſeſs, whatever the event of the litigation may be, of diſappointing thoſe who wiſh for frequent changes; and the ſatisfaction that we all would derive, from the Chirurgical Department of the Infir⯑mary being put under the direction of ſuch a ſmall proportion of our number, as would tend to improve all that relates to it; I am, from all theſe conſiderations, induced to hope, that the College will reſolve on reſigning voluntarily all thoſe rights in this matter, to the Managers of the Infirmary, which hi⯑therto we have claimed; inſiſting on no conditional attend⯑ance, and on no other terms but a reſtitution of that ſum which the College originally gave to the Infirmary, on the [7]agreement firſt taking place, and to which the Managers will not probably diſpute their claim.

While, by this liberal conduct, the College would be entit⯑led to the warmeſt thanks of the public, and of all who are able to judge of its importance, they will alſo derive ſatisfac⯑tion from a ready compliance with the requeſt of the Mana⯑gers of the Infirmary, in ſuggeſting that plan for their conſi⯑deration, which, in this intereſting buſineſs, ſhall to a majori⯑ty of our number, appear to be the beſt.

On a point of ſuch general intereſt, ſubmitted to the conſi⯑deration of a large Society, much variety of opinion muſt pre⯑vail, and many ſchemes be propoſed; but it will be the duty of the College to decide on that plan, which they wiſh to re⯑commend to the Managers, who will carry it into effect, ei⯑ther in the form in which they ſhall receive it, or under ſuch modifications as to them it ſhall appear to require. It may likewiſe be ſufficiently proper for the College to tranſmit to the Managers of the Infirmary all thoſe plans of attendance, whether printed or in manuſcript, which individuals of our number may incline to ſuggeſt; as I ſhall take the charge of doing with this.

Having premiſed this explanation of my opinion, and think⯑ing it probable that the Managers of the Infirmary may not yet be determined whether the Surgeons ſhould be put on a permanent appointment or not; but of which they will not probably remain long in doubt; the following articles of a plan for a limited courſe of attendance, liable to ſuch altera⯑tions as the College ſhall wiſh to propoſe, is in the mean time offered to their conſideration.

ON all the Members now on the liſt of the College of Sur⯑geons having attended in the preſent courſe of rotation, but not till then, Four ſenior and Two junior Surgeons ſhall be [8]elected by the Managers, and to their charge the whole Chi⯑rurgical Eſtabliſhment of the Infirmary ſhall be intruſted.

The two eldeſt of this nomination to attend daily when not prevented by diſeaſe, or ſome other neceſſary cauſe of abſence, for the ſpace of ſeven, eight, or ten years, as may be agreed on,—the longer, in my opinion, the better; each to have the charge of one ſide of every ward, in the ſame manner as has long been the caſe with the Phyſicians, and to perform all the operations on his own patients, which during that period ſhall occur.

In abſence of either or both of the acting Surgeons, the buſineſs to be done by one or both of the two other ſenior Surgeons; and in the event of their being alſo abſent, by the firſt junior Surgeon who can be got.

No operation of importance to be performed, but with the ſanction of a conſultation, at which all the ſix Surgeons may attend, but which neceſſarily ſhall conſiſt of three, the acting Surgeons for the time always conſtituting two; if it be not in accidents requiring immediate aſſiſtance, and when the ſenior Surgeons cannot be got.

One of the junior Surgeons to attend daily at the uſual hour of receiving patients, by which a ſufficient number for con⯑ſultation will always be at hand; and to his care all diſſec⯑tions to be intruſted. This attendance of the junior Surgeons to be regulated by their own convenience, either on changes of two, three, or ſix months.

At the end of the period to which their appointment ſhall extend, the two acting Surgeons ſhall reſign their places to the other two ſenior Surgeons, who being ſucceeded by the two junior or aſſiſtant Surgeons, two juniors muſt be elected by the Managers: And thus, with an election, every ſeven, eight, or ten years, as the Managers ſhall prefer, of Two ju⯑nior Surgeons, the whole buſineſs will be conducted: it be⯑ing [9]underſtood, that every vacancy ariſing from death or re⯑ſignation, or any other cauſe, ſhall be immediately occupied, by the Surgeon, who, in ſeniority, is next to him who previ⯑ouſly held the place; and in no inſtance, that a newly elected Surgeon ſhall be preferred.

THE advantages of this ſcheme are, that while it avoids all the inconveniences which reſult from frequent changes of practitioners, no Surgeon, after thoſe who are firſt ap⯑pointed, will ever have charge of any important part of the buſineſs, till, by attending for a conſiderable time as aſſiſtant, he has acquired experience; nor will any practitioner be allowed to occupy the appointment till he is too much ad⯑vanced in years.

It alſo would ſecure a regular conſultation daily, with lit⯑tle trouble to the practitioners,—an object of much import⯑ance in every plan that can be propoſed, and from which, much advantage would accrue to the Infirmary: for by this arrangement, every patient would receive an immediate opi⯑nion, and would not be admitted in the view of a future con⯑ſultation, as on the preſent plan of attendance is frequently found to happen, with caſes for which nothing can be done, and by which patients are often kept in the Hoſpital, with much inconvenience to themſelves, and loſs to the funds of the inſtitution.

On this plan, all the inconveniences ariſing from conſulta⯑tions being too numerous, would likewiſe be avoided. It might indeed be an improvement of this, and of every plan that can be propoſed, to have the number on conſultations limited to a very few; probably to three: for while all the advanta⯑ges of conſultation are obtained from a ſmall number, as very univerſally is allowed to be the caſe in private practice, it would in the ſureſt manner tend to obviate thoſe objections to which large conſultations are almoſt in all circumſtances [10]found to be liable; which commonly are ſo great, that few Surgeons of experience, and in full employment, would enter on any charge in which they ſhould be obliged to ſubmit to them.

The chief deficiency indeed of the plan which I thus ſuggeſt for your conſideration, and for that of the Managers of the Infirmary, is, that it does not ſecure to the Infirmary, ſo long as in various circumſtances might be deſirable, the exertion of thoſe Surgeons, who, from their abilities, expe⯑rience, and reputation, the Managers might ſtill wiſh to re⯑tain: and this I muſt acknowledge is a very important ob⯑jection to every ſcheme in which it occurs: for all mankind, and patients in Hoſpitals among others, are abundantly ſen⯑ſible of the various advantages which in every branch of the medical preſeſſion are derived from experience, when conjoined with ſufficient abilities, humanity and attention; without which indeed it ſignifies nothing.

In every ſimilar inſtitution of importance of which we have any account, whether in England or other parts, ſuch value is placed on the advantages which experience affords, that the Surgeons in almoſt the whole of them are now put on a permanent footing; and for this very obvious reaſon, that no Surgeon with a riſing reputation, ſuch as the Mana⯑gers of any public inſtitution would wiſh their practitioners to poſſeſs, would conceive it to be either for his credit or in⯑tereſt, to accept of the appointment under any other con⯑dition; and we all know how feeble thoſe exertions common⯑ly are, where the credit and intereſt of thoſe by whom they are made, do not in a conſiderable degree depend on them: and in judging from matter of fact, the progreſs which the art of ſurgery makes where theſe permanent appointments have taken place, is ſo evident and great, that we cannot doubt of their utility.

Before we attempt, therefore, to oppoſe what in a matter of this importance other large communities have done, who, with equal opportunities of judging, and the ſame capability of doing ſo, have uniformly departed from the limited appoint⯑ment of Surgeons to Hoſpitals, and put them on a fixed eſta⯑bliſhment, the moſt ſubſtantial reaſons ſhould be ſet forth for it; which, ſo far as I know, has neither been done nor at⯑tempted.

Of the few objections which have been made to Surgeous of large Hoſpitals being permanently fixed, the foſlowing only ſeem to require notice: That they muſt be apt to become indolent, to neglect their duty, and, on the approach of old age, to do harm to the eſtabliſhment of which they have the charge, by continuing to operate after being unfit for it; and as theſe opinions have made an impreſſion on ſome part of our number, and perhaps alſo on the Managers of the Inſir⯑mary, who may not therefore as yet be induced either to alter the mode of our attendance ſo completely as to render it permanent, or to reduce the number of Surgeons ſo much as in my opinion ought to be done; in offering the foregoing plan for their conſideration, I have endeavoured to make it retain in a conſiderable degree the chief advantages of a permanent appointment, with a moderate number of practi⯑tioners, without ſtretching the principles on which it is found⯑ed too far.

I am not, however, of opinion, that this, or any other li⯑mited attendance of Surgeons, will ever prove ſo uſeful to the Infirmary, or the City of Edinburgh, as permanent ap⯑pointments in other places have done; chiefly for this rea⯑ſon, that no practitioners can be ſuppoſed to enter with much zeal on this or any other appointment, which they know will terminate in a few years, and from which, after having ſpent thoſe years, often the moſt valuable of their lives, in the charge of, they muſt be turned off, never to be connected [12]with it again: and if the zeal of thoſe to whom the care of any department is committed be not fully excited and encouraged, thoſe who are beſt acquainted with human na⯑ture will admit, that every branch of it will be in the riſk of being carried on with languor, and of ſuffering from want of exertion.

This opinion of the permanent appointment of Surgeons to large Hoſpitals, being apt to leſſen their aſſiduity, and in other circumſtances alſo to do harm, in a great degree ap⯑pears to be ſpeculative, and not ſupported by experience of the effects of it: for wherever appointments of this kind have taken place, the ſtate of ſurgery has been greatly im⯑proved, while in thoſe Hoſpitals which long ago have car⯑ried the meaſure into effect, we are not accuſtomed to per⯑ceive that any part of the buſineſs is more liable to fall into neglect than it is in others; or, in ours, where the ſyſtem of attending in rotation has been at its height, and of long du⯑ration, that it has met with more attention than that which Surgeons on permanent appointments commonly give to it: both plans may occaſionally be ill conducted, and every mode of attendance that can be propoſed may be produc⯑tive of much harm if any important duties are omitted, which thoſe in the charge of them ſhould perform; but without full evidence of the fact, we are not entitled to ſay, that the plans of attendance which other Hoſpitals have adopted, and continue to prefer, are worſe, and liable to great⯑er difficulties, than our own.

Thoſe who have been induced to ſupport a different opi⯑nion, ſhould recollect, that the bad effects which they ſeem to dread from permanent appointments in Hoſpitals, are powerfully counteracted by many cauſes: the credit of the practitioners with the public; their real intereſt; and that laudable pride which we are bound to believe that every man muſt feel in the honeſt diſcharge of his duty, whom the Ma⯑nagers of a public charity could be ſuppoſed to elect; are all [13]ſtrong pledges for its being done: beſides which, the conduct of practitioners in this ſituation, being at all times under the direct obſervation of the Managers by whom they were e⯑lected, and by whom they can be turned off; before we ven⯑ture to aſſert that improprieties from this cauſe take place in other Hoſpitals, or that they are either likely to happen, or to be long permitted to exiſt in ours, we muſt ſuppoſe, what we are not entitled to do, that the Managers of our public charities act their parts with groſs miſconduct indeed; as would ſurely be the caſe, were they, for any length of time, to allow the buſineſs of any department, whether that of the Surgeons, or any other under their charge, to be either ne⯑glected or improperly performed.

The inconveniences which ſome have ſuppoſed muſt reſult from Surgeons with fixed appointments in Hoſpitals, being apt to continue in the diſcharge of their duty till too late a period, muſt be equally liable to happen on every plan of at⯑tendance in which no reſtriction from age has taken place, as hitherto has been the caſe in ours: but in almoſt every Hoſpi⯑tal in which fixed appointments have occurred, theſe incon⯑veniences are guarded againſt, by a young practitioner be⯑ing elected as aſſiſtant to every ſenior Surgeon, who takes charge of all ſuch parts of the duty as the other may not be able to perform, and who, from being long trained to the bu⯑ſineſs, is commonly fit for every part of it when it devolves on him at laſt.

In this manner, and with no expence being incurred by it, for ſalaries are ſeldom given to aſſiſtants, all the benefit is re⯑tained which the experience and obſervation of ſenior prac⯑titioners afford; while, from their being permitted to attend as long as they incline, every appearance of that ſeverity is removed, to which all men muſt feel that they are expoſed, on being forced to retire from a department of which they have for a conſiderable time had the ſole charge, and which they are ſtill both able and willing to continue; a degree of [14]ſeverity, I may ſafely venture to aſſert, to which no ſet of men, intruſted with buſineſs of this importance, will in any other ſituation be found to be liable.

But while, in the management of other Hoſpitals, it has been an object from which they never wiſh to depart, to re⯑tain the Surgeons whom they employ as long as they incline to continue, and thus to obtain the advantages which long experience gives; in ſaying to the Managers of the Royal In⯑firmary, as many at this time have done, that they ſhould li⯑mit the attendance of their practitioners to a few months, or at moſt to a few years, we deſire them to do the very reverſe, and only to permit the Surgeons to attend till in ſome degree they ſhall have acquired experience; then to be diſmiſſed for ever, and their places to be ſupplied by young men: thus tending to produce and to perpetuate a worſe ſyſtem, by a great deal, than that which they wiſh to be removed; for while many inconveniences reſult from attendance in rota⯑tion, it does not prevent any of our number from attending, and giving their aſſiſtance.

Before adopting this opinion, the Managers of the Infir⯑mary will do well to advert to this and other bad conſequen⯑ces that may reſult from the Surgeons being placed on ſhort appointments; and if they are not yet convinced of the propriety of putting them on a permanent footing, they will not readily doubt of protracting their attendance to a pe⯑riod of many years.

Were this even to be done, the Managers will not proba⯑bly come under any agreement for the ſame plan being con⯑tinued; for, however favourably ſome part of their number may at preſent think of a limited attendance for the Sur⯑geons, there is much reaſon to believe, that, in the courſe of a ſhort time, they will wiſh to place them on permanent appointments. They will alſo, in the conſideration of this [15]point, advert to the difficulty of changing any plan when it has been once acted upon; that half meaſures ſeldom anſwer the purpoſe for which they are meant; and while they never completely ſatisfy any of the parties concerned in them, they are commonly more difficult to carry into effect, than others that would more fully anſwer the purpoſe from the firſt, and which of neceſſity are commonly adopted at laſt.

In the diſcuſſion of this queſtion, it has been alleged, that a frequent ſucceſſion of Surgeons, whether for two months at once, as hitherto has been the caſe in the Infir⯑mary, or for ſix months; or, as ſome have propoſed, for two or three years; would be productive of much advantage to the public, which never could ariſe from their being put on a permanent footing; by affording, as they conceive that li⯑mited appointments would do, to a conſiderable number of Surgeons, opportunities for acquiring experience, and thus rendering them more able to diſcharge their duty in private practice than otherwiſe could be the caſe.

But it ought to be noticed, that the whole import of this argument implies, that we are to acquire experience, by means which the Managers of the Infirmary are not likely to admit, and ſhould not therefore be ſtated as a motive for the Surgeons being put on ſhort appointments; for the mean⯑ing of it certainly is, that from the period of our becoming Members of the College of Surgeons, we ſhould all be entitled to attend on frequent changes, and to acquire knowledge and dexterity in operations, by practiſing on the patients of the Infirmary. But while it may be greatly for the intereſt of the patients that a few Surgeons ſhould be allowed to derive this advantage from their attendance, with the view of their be⯑ing retained on permanent appointments, the Managers will not readily be induced to think, that the ſame privilege ſhould be given to others, or to more than the ſurgical department [16]of the Hoſpital requires; and if this conſideration ſhall be allowed to have weight, it will be equally obvious, that the utility of any plan of attendance which they may adopt, muſt in a conſiderable degree depend on the period to which it is made to extend; ſo that, inſtead of appointments of this kind being made of ſhort duration, few will doubt of the propriety of their being protracted to a great length.

Even on the plan which I have propoſed, were the acting Surgeons to continue in employment only for ſeven years, as the aſſiſtants would always be young men, almoſt every Sur⯑geon would be ſet aſide by the age of forty-five; often ſome years ſooner: whilſt, by every other plan which the College has received at this time, all of which limit the attendance of the acting Surgeons to three years, their connection with the Hoſpital would very commonly end at more ear⯑ly periods, ſomewhere from the thirtieth to their thirty-fifth year; an age, at which it would undoubtedly be more for the intereſt of the Hoſpital that they ſhould be retain⯑ed, than to have the buſineſs again put under the charge of a younger claſs of practitioners.—The objections in⯑deed to which all of theſe plans are on this conſideration liable, appear to me ſo very important, that I am induced to believe that they have not been in the view of thoſe Gentle⯑men by whom they were propoſed; for they amount preciſe⯑ly, as I have already obſerved, to this, that the whole buſineſs of Surgery in the Infirmary ſhould at all times be in the hands of young men, and every practitioner be obliged to re⯑tire, never to appear in it again, at the very beſt and moſt uſe⯑ful period of his life; conſequences, which they could not poſſibly mean to reſult from them, and to which it is not probable that the Managers will ever oblige the patients of the Infirmary to ſubmit.

But whatever the views of the Managers on this important part of the queſtion ſhall be, it may eaſily I think be ſhown, that while much harm would reſult to the Public from the Surgeons of the Infirmary being put on ſhort appointments, that no benefit could ariſe from it to the College of Sur⯑geons.

By the whole chirurgical department of the Infirmary be⯑ing given on a permanent appointment to two acting Sur⯑geons, with two junior Surgeons as their aſſiſtants, a number perfectly ſufficient for every part of it, there is ſurely much reaſon to believe that the buſineſs would be done with more accuracy and attention than it is ever likely to be if the num⯑ber to whom it is given ſhall be large; and while the prac⯑tice which they would thus poſſeſs in operations might be ſuf⯑ficient for adding greatly to the inſtruction of this limited number, and might thus render them expert Surgeons, yet all who advert to the ſmall number of operations which Hoſpitals not larger than the Royal Infirmary can afford, will admit, that if theſe operations were divided among many practition⯑ers, liable to frequent changes, their effects would be in a great meaſure, if not entirely, loſt; and, therefore, that the Public, as well as the Infirmary, would ſuffer in a very eſſen⯑tial manner, were this ever to happen; while no benefit could accrue from it to us.

At all times, it has been my opinion, that, in this view, the permanent appointment of a few Surgeons to the In⯑firmary, would prove highly uſeful to the City of Edin⯑burgh, which in this manner would be ſupplied with a ſuffi⯑cient number of Surgeons, in the frequent practice of opera⯑tions, by which alone due perfection in the art of performing them can either be acquired or preſerved; a poſition which none will doubt who are able to judge of it.

Of the very important advantages which Surgeons derive from frequent employment in operations, the public indeed are ſufficiently aware; and, ſo far as it has been in their power, they have long done preciſely what the Managers of the In⯑firmary ought long ago to have done, by employing a few practitioners only as Surgeons: for all of us know, and the public knows well, that in ſpite of the influence which the frequent attendance of every member of the College of Sur⯑geons in the Royal Infirmary might be ſuppoſed to have, and as ſome have alleged that it neceſſarily muſt have in this mat⯑ter, ſtill a large proportion of all chirurgical operations per⯑formed in Edinburgh, are done by a very ſmall part of our number.

Nor is this ſtate of our ſurgery peculiar to the preſent times; for it always has been the caſe, and as long as the pu⯑blic are able to judge between right and wrong, which in all that relates to their own ſafety and advantage they are abun⯑dantly capable of doing, it will ſtill continue to be ſo: that is, till the Managers of the Infirmary ſhall reſolve on doing what their predeceſſors ought to have done, and ſhall appoint a few Surgeons to the permanent charge of the ſurgery of the Infirmary, to the number perhaps of four, the public will give a large ſhare of their employment in operations, even to a leſs number than this, by chiefly reſorting, as hitherto they have commonly done, to one or two.

A very few Surgeons I believe to be perfectly ſufficient for all the real practice in ſurgery that Edinburgh is ever likely to afford; and for the reaſons that I have given, I alſo be⯑lieve, that a very conſiderable part of it will continue to be done by one or two, till the event to which I allude ſhall take place,—the appointment of the number that I have mentioned to the ſurgical department of the Infirmary. If this num⯑ber of Surgeons ſhall be put in poſſeſſion of this department, [19]all of them would be heard of as operators, and each would receive that ſhare of employment from the public, to which, from the general eſtimation in which he might be held, he ſhould be entitled.

But if many Surgeons ſhould be appointed to this charge in the Infirmary, while no benefit would reſult from it to the inſtitution, the public, for the reaſons I have endeavoured to enforce, would ſtill continue to give nearly the whole of their employment to a very few.

Hence, if the views which I have given in this queſtion are well founded, and they chiefly reſt on facts which few will readily diſpute, while very important advantages would re⯑ſult to the Infirmary and to the public from their being carried into effect, by putting the ſurgery of that inſtitution under the charge of a few, on appointments of long dura⯑tion; it does not appear, that any detriment would reſult from it to the reſt of our number, who ſtill would continue in the very ſame employment, which they would otherwiſe poſſeſs; which would neither be leſſened or extended by this mea⯑ſure; and without performing one operation more or leſs than they do at preſent, or of incurring the riſk, either of their emoluments, or importance in ſociety, being diminiſhed.

Nay, the arrangement to which I allude would ſoon in a high degree prove ſatisfactory to the whole of our number; for being frequently obliged by our patients, and we ourſelves, in various inſtances, alſo wiſhing, to apply for the aſſiſtance and advice of thoſe who are more in the habit of performing operations, it would very commonly be agreeable, and often uſeful, rather to have three or four to make choice of, than be under the neceſſity, as hitherto has very commonly been the caſe, of reſorting to one or two.

But there is ſtill another very important benefit that would reſult from this arrangement, which I have always earneſtly [20]wiſhed were the caſe, which, at no diſtant period, it will pro⯑bably be, and which the Managers of the Infirmary have at this moment greatly in their power to promote, I mean the total ſeparation in this place, as already has happened in al⯑moſt every large city but our own, of the operative part of ſurgery from other branches of the profeſſion. Whenever this ſhall be done, and not till then, ſurgery will be put on that foundation on which alone it ſhould reſt. Other parts of the practice will then be conducted by one part of our number; and thoſe by whom the nice and important operations of ſur⯑gery are performed, being relieved from the practice of every other branch of medicine, would, with more certainty be enabled to diſcharge their duty properly, and to ſtudy with due accuracy and attention, thoſe improvements which their profeſſion might require, than otherwiſe can be in their power.

Whatever the reſolution of the Managers of the Infirmary on this important point may be, no difference will ariſe from it to the ſenior part of our Members, all of whom will continue to poſſeſs the ſame practice which hitherto they have done, without being affected by any change that can be made in the chirurgical department of the Infirmary: but this would not be the caſe with the younger part of our number; for ſuch of them as may reſolve on confining their views to ſurgery, would advance more ſpeedily into employment and notice, than commonly happens where every individual is attempting to act in every branch of the profeſſion, each of which, from its importance, is ſufficient for any one of us: Nor does this opinion reſt on ſpeculation, for wherever the meaſure has ta⯑ken place, of ſeparating as much as it can be done, the practice of ſurgery from that of other branches of the profeſſion, thoſe who have confined their attention to chirurgical purſuits, have arrived much more early in life at the height of their [21]practice and reputation than otherwiſe could probably have been the caſe.

In the diſcuſſion of this queſtion, much additional argument might have been adduced on every part of it, if all that relates to it had not already been clearly ſtated, and ably conſidered, in the Memorial which Dr GREGORY has lately taken the trouble to write on it, and which the whole of our number muſt probably have read.

This Memorial indeed ſets forth in ſtrong colours, and in much variety of view, every argument that can well be ima⯑gined on the buſineſs to which it relates: but, while ſome complain of the length to which it extends, and of the aſpe⯑rity of manner with which it is written, we ſhould recollect, that a very conſiderable part of it is employed in reply to thoſe arguments which our predeceſſors appear to have brought forth in ſupport of a diſputed right; that on the queſtion arri⯑ving at the ſtate in which it now is, and aſſuming a form which muſt bring it to a deciſion, theſe arguments came in the firſt place, and of neceſſity, to be refuted; that this is neither the firſt nor the ſecond attempt which the Managers of the Infirmary have made for the purpoſe of being relieved from their agreement with the College of Surgeons,—a cir⯑cumſtance, of which many who complain of the length of this Memorial have not probably been informed; that having, on all former occaſions failed with means of a different nature, and deſpairing of greater ſucceſs from any other mode of at⯑tempting it, the Managers appear now to conſider it as their duty, freely and fully, to ſtate the whole to the public, pro⯑bably as a prelude to that queſtion of right which they ſup⯑poſe the College of Surgeons may ſtill endeavour to maintain, but of which, for the reaſons that I have given, I would glad⯑ly hope, that a majority of our number will not approve.

We ought alſo to conſider, that nothing but the beſt and pureſt motives could actuate Dr GREGORY in this matter: having no private intereſt to ſerve, nothing but the public good could have induced him to appear in it. As a Manager of a public Charity, labouring under an agreement which the Managers for the time being, have for theſe fifty years paſt conſidered as hurtful, and have often, with much anxiety, en⯑deavoured to remove, he, with an unuſual degree of public ſpirit, has publiſhed one of the moſt convincing papers which at any period perhaps has appeared, and has placed the matter in diſpute in ſuch a light, as muſt of neceſſity accompliſh the end which he had in view from it: and if he has done this, without meaning to give offence to individuals, or to degrade either our College as a public body, or the profeſſion in which we are engaged, which I firmly believe to have been the caſe, inſtead of ſpeaking of his attempt in the manner which ſome, I am informed, have done, we ought to applaud the views which made him engage in it, as well as the abilities with which it has been conducted.

This intereſting paper being ſufficiently able to ſupport it⯑ſelf, I have no other motive for ſpeaking of it, but that of wiſhing it to be read with that attention which it deſerves, particularly by all who wiſh for information on the queſtion to which it immediately relates; and I can venture to pre⯑dict, that few by whom this ſhall be done, will require fur⯑ther evidence of the neceſſity of ſome plan for regulating the connection of the College of Surgeons with the Royal Infirmary, being ſpeedily carried into effect.

With no other views than thoſe which I have ſtated, that the practice in which I am engaged, the art of ſurgery, ſhould be conducted on a plan, which I have reaſon to think would ſecure to the Royal Infirmary, to the pu⯑blic, [23]and to the College of Surgeons, all thoſe advantages which could not fail to reſult from this important branch of our profeſſion being improved; I have freely ſet forth thoſe ſentiments which I have long entertained of it, leaving it to the Managers of the Infirmary finally to reſolve on what ap⯑pears to be moſt for the intereſt of the charge with which they are intruſted.

In a matter which involves ſuch various intereſts, many of our number may incline to ſtate their opinions to the Ma⯑nagers of the Infirmary, whatever the views may be which the College, as a public body, may adopt; and if this ſhall be generally done, and with the ſame freedom of obſervation as my ſentiments have thus been given, much important infor⯑mation would be obtained by the Managers, which otherwiſe they may never poſſeſs: I mean the views of thoſe, who, from ſeriouſly conſidering the ſubject, and being intimately acquainted with every part of it, ought to be beſt able to judge of it: But, while much benefit might accrue from this information, the Managers will not probably reckon it ſuffi⯑cient. In judging of ſuch an important meaſure, the moſt in⯑tereſting, perhaps, which has ever occurred to them, they will ſcarcely reſt ſatisfied with the opinions which individuals of this place may form of it: and if they ſhall apply for infor⯑mation, as they probably will do, from London and other places, in which the ſurgery of Hoſpitals is confined to a ſmall number, and the whole chirurgical practice of the place conducted by a few, they will not fail to diſcover, that great advantages have been derived from it; and there⯑fore, that in fixing on a plan for this important object of their attention, they will have the aid of experience to de⯑pend on, inſtead of truſting, as otherwiſe they muſt have done, to diſcordant opinions and vague ſpeculations.

With the Managers of the Infirmary, therefore, the buſi⯑neſs now muſt reſt, who, having the public intereſt only at heart, will do in this matter, without regard to any other con⯑ſideration, what is moſt for the intereſt of the Charity of which they have the charge; and acting on this ſtrong ground, as undoubtedly they will do, they will not fail to re⯑ceive, as on all occaſions they have done, the moſt ample proofs of public ſupport and approbation.

NICOLSON'S STREET, 16th October 1800.