OBSERVATIONS ON THE MODE OF ATTENDANCE OF THE SURGEONS OF EDINBURGH ON THE ROYAL INFIRMARY; IN A LETTER ADDRESSED TO THE ROYAL COLLEGE OF SURGEONS; BY BENJAMIN BELL.
EDINBURGH: PRINTED BY ADAM NEILL AND COMPANY.
1800.
OBSERVATIONS, &c.
ON returning lately from a long journey, I found on my table various communications from the College of Surgeons, 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 considerable 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 importance as this undoubtedly is, I consider it as a duty incumbent 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 declare, any opinion or resolution, on a question so nearly connected 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 agreement 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 versant 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—doubtful litigation, which might not be brought to a conclusion during 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 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 Managers 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, without 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 placed on a fixed establishment; instead of being under the direction 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 respect, acted as well as the same number of practitioners, under 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 number are not of this opinion, the measure to which I allude, that of our departing voluntarily from the right which hitherto we have claimed, to attend the Infirmary in rotation, will necessarily be rejected; which most sincerely I shall deplore, 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 Managers 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 importance, 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 attendance, 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 question; 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 Infirmary 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 hitherto we have claimed; insisting on no conditional attendance, and on no other terms but a restitution of that sum which the College originally gave to the Infirmary, on the agreement first taking place, and to which the Managers will not probably dispute their claim.
While, by this liberal conduct, the College would be entitled to the warmest thanks of the public, and of all who are able to judge of its importance, they will also derive satisfaction from a ready compliance with the request of the Managers of the Infirmary, in suggesting that plan for their consideration, which, in this interesting business, shall to a majority of our number, appear to be the best.
On a point of such general interest, submitted to the consideration of a large Society, much variety of opinion must prevail, and many schemes be proposed; but it will be the duty of the College to decide on that plan, which they wish to recommend to the Managers, who will carry it into effect, either 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 thinking 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 alterations 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 Surgeons having attended in the present course of rotation, but not till then, Four senior and Two junior Surgeons shall be elected by the Managers, and to their charge the whole Chirurgical 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 consultation will always be at hand; and to his care all dissections 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 junior Surgeons, the whole business will be conducted: it being understood, that every vacancy arising from death or resignation, or any other cause, shall be immediately occupied, by the Surgeon, who, in seniority, is next to him who previously 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 appointed, 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 advanced in years.
It also would secure a regular consultation daily, with little trouble to the practitioners,—an object of much importance 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 opinion, and would not be admitted in the view of a future consultation, 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 consultations 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 advantages 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 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, experience, and reputation, the Managers might still wish to retain: and this I must acknowledge is a very important objection to every scheme in which it occurs: for all mankind, and patients in Hospitals among others, are abundantly sensible 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 Managers of any public institution would wish their practitioners to possess, would conceive it to be either for his credit or interest, to accept of the appointment under any other condition; and we all know how feeble those exertions commonly 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 appointment of Surgeons to Hospitals, and put them on a fixed establishment, the most substantial reasons should be set forth for it; which, so far as I know, has neither been done nor attempted.
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 Insirmary, 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 practitioners, without stretching the principles on which it is founded too far.
I am not, however, of opinion, that this, or any other limited attendance of Surgeons, will ever prove so useful to the Infirmary, or the City of Edinburgh, as permanent appointments in other places have done; chiefly for this reason, 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 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 nature 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 appears 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 improved, while in those Hospitals which long ago have carried the measure into effect, we are not accustomed to perceive 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 duration, 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 productive 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 greater difficulties, than our own.
Those who have been induced to support a different opinion, 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 Managers of a public charity could be supposed to elect; are all 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 elected, and by whom they can be turned off; before we venture 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 neglected 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 attendance in which no restriction from age has taken place, as hitherto has been the case in ours: but in almost every Hospital in which fixed appointments have occurred, these inconveniences are guarded against, by a young practitioner being 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 business, 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 retained which the experience and observation of senior practitioners 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 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 retain 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 Infirmary, as many at this time have done, that they should limit 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 rotation, it does not prevent any of our number from attending, and giving their assistance.
Before adopting this opinion, the Managers of the Infirmary will do well to advert to this and other bad consequences 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 period of many years.
Were this even to be done, the Managers will not probably come under any agreement for the same plan being continued; for, however favourably some part of their number may at present think of a limited attendance for the Surgeons, 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 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 Infirmary, 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 limited 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 meaning 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 being 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 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 Surgeon 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 early 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 retained, than to have the business again put under the charge of a younger class of practitioners.—The objections indeed 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 Gentlemen by whom they were proposed; for they amount precisely, 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 retire, never to appear in it again, at the very best and most useful 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 Surgeons.
By the whole chirurgical department of the Infirmary being given on a permanent appointment to two acting Surgeons, 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 number to whom it is given shall be large; and while the practice which they would thus possess in operations might be sufficient 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 practitioners, 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 essential 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 Infirmary, would prove highly useful to the City of Edinburgh, which in this manner would be supplied with a sufficient number of Surgeons, in the frequent practice of operations, 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 Infirmary 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 Surgeons in the Royal Infirmary might be supposed to have, and as some have alleged that it necessarily must have in this matter, still a large proportion of all chirurgical operations performed 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 public are able to judge between right and wrong, which in all that relates to their own safety and advantage they are abundantly 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 believe, 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 number of Surgeons shall be put in possession of this department, 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 result 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 duration; 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 measure; 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 wished were the case, which, at no distant period, it will probably 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 almost 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 surgery 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 taken 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 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 imagined on the business to which it relates: but, while some complain of the length to which it extends, and of the asperity 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 arriving 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 circumstance, 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 attempting it, the Managers appear now to consider it as their duty, freely and fully, to state the whole to the public, probably as a prelude to that question of right which they suppose the College of Surgeons may still endeavour to maintain, but of which, for the reasons that I have given, I would gladly 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, endeavoured 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 itself, 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 predict, that few by whom this shall be done, will require further 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 public, 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 appears 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 Managers 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 information 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 sufficient. In judging of such an important measure, the most interesting, 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 information, 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 therefore, that in fixing on a plan for this important object of their attention, they will have the aid of experience to depend on, instead of trusting, as otherwise they must have done, to discordant opinions and vague speculations.
With the Managers of the Infirmary, therefore, the business now must rest, who, having the public interest only at heart, will do in this matter, without regard to any other consideration, 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 receive, as on all occasions they have done, the most ample proofs of public support and approbation.
NICOLSON'S STREET,
16th October 1800.
FINIS