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covered the diaphragm ; the kidneys in thesecond stage of granular degeneration, and ina state of great vascular congestion; in thechest, obstructive and slightly regurgitantdisease of the aortic valves. I was unable toexpress an opinion as to the disease in thehead, but I said that it was not improbablewe should meet with marks of old disease.And you remember how true the prognos-

tication was, and what a variety and extentof diseased action was exhibited in the bodyof this poor patient. All the organs werefound diseased, as the symptoms during lifehad led me to expect, and the brain showedmarks of an old apoplectic cyst existing inthe fissure of Sylvius.

In conclusion, let me exhort you not tocontent yourselves fsolely with making thediagnosis of the diseases you witness here,but to watch the progress of each case ; tolook out for every new symptom ; to comparethe cases one with another. It has been

truly said that " all observation is suggestedby comparison," and experience is foundedin a well-directed and extended observa-tion.A large proportion of our therapeutics

rests upon the results of experience ; andthe practical tact which each individual acquires in the application of remedies mustbe derived from the same source. You can-not, therefore, begin too soon to acquirethose habits of observation, and that experi-ence, upon which your success as practi-tioners must, in a great degree, depend.

LECTURE, CALLED CLINICAL,*DELIVERED BY

MR. GUTHRIE

AT THE

WESTMINSTER HOSPITAL,ON SATURDAY, OCTOBER 15, 1842.

* Forwarded last week to THE LANCET-Office for publication, with the title " CLI-NICAL LECTURE."

Badness of the medical arrangements of thehospital.-Liberties which the student maytake with the- lecturer.-His anxiety to

retire from office.—Medical students unableto spell.-Tlteir 11 education" in London

cheaper than a shoe-black’s.—" Reforms"in the college.—The spy system.--Custornof the medical schools to give false certifi- ,

cates.-How, under the certificate system, ,

to become a naember of the Royal College of ’Surgeons in London, without having seendisease, or known a muscle when shown it.

GENTLEMEN,—I desired last Saturday thatnotice might be posted up in the hall, of myintention to give an introductory this day tomy lectures, having refused to permit my

name to be placed in the list of clinical lec-turers for this season, because I do notchoose to promise that which I may not per-

: form. I read in THE LANCET early in thepresent year some uncivil observations onthis subject, from some one purporting to bea student; my mouth was immediatelyclosed ; not one word have you heard fromme since. I have, however, now reason tobelieve that the gentleman who wrote thoseremarks is not a student, and I do not thinkit right to punish the innocent for the guilty;I shall therefore notice some of these excel-lent cases, and bring the individual subjectsof them before you. For the first six monthsof this year, these cases brought me, almostwithout an exception, every day to the hos-pital ; and I shall be happy to think thateven one-half of you had paid them a portionof the attention they received from me. Itappears to me that some gentlemen wish todeteriorate the merit of this hospital, both asrelates to the relief the poor receive, and theinstruction which students obtain at it, byinveighing strongly against the managementwhich does and does not take place withinits walls. I regret very much that many ofthe assertions of mismanagement are, in allprobability, true, as relates to medical ar-rangements, many of which are not, in myopinion, fitting for a public hospital inLondon : they are all of them, however,good, and well adapted for a parish infir-

mary ; and as long as it may be thought rightto continue them, the hospital must remainin a depreciated state, both as a place of

refuge for the sick poor and as a school ofinstruction.When things become so bad that any

change must be for the better, we may hopefor improvement; and I care not how soonthis takes place, for I confess I shall lookforward with the hope that this hospital willthen rise from its remains, and assume thatcharacter and obtain that reputation it nevercan have under existing circumstances. Ihave done my endeavour to remove theabuses and grievances of which I am sen-sible, but I abhor all disputes and squab-bling, more particularly when they becomepersonal; and I have no wish to contendwith gentlemen whom I personally respect,although I believe them to be in error, andeven if I thought it right to do so, I have notthe time to spare which the forms of thehospital require.

With respect to you as students, I havenot recommended one to come here, I havenot invited you in any way, you have comebecause it suited your own views, and beinghere I am at all times happy to give youevery information in my power. My days ofattendance are Tuesdays and Saturdays, ac-cording to the rules of the hospital ; but youwill see it posted in the hall that I alsoattend on Thursdays, believing that everyphysician and surgeon should see every par-

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ticular case three days a-week, and when I They spared the present ones, very muchhave any one in danger I visit them every against my wishes; and have perpetuatedday. You need never expect me before a an evil for some twenty, or, perhaps, thirtyquarter past one, and never wait for me after years, which I hope myself and my col-a quarter past two, before which time the leagues will have the virtue to remove.assistant surgeon will go round with you if I When I had the honour of being elected ashould be absent; and whenever he does the member of the council of the College of Sur-duty of one of the surgeons, he ought to geons, I found regulations existing whichreceive a regulated proportion of the money had been made many years, requiring anwhich the seniors derive from the fees you apprenticeship, or studentship, for six years,pay for permission to attend, one only of which was required to be spent

I am never so contented as when you make in studying surgery in a London hospital,yourselves constantly known to me, by obey- for which year the same sum was paid asing my injunctions, so frequently repeated, of you pay now, the age for examination beingwalking up to me and repeating your names twenty-two. This I considered with othersin my face ; I do not desire one word more. a great error, and we applied ourselves soWhen you wish anything from me, you have steadily for its removal, that we have suc-

only to ask it; when you desire to have a ceeded in reducing the term of study to fourclinical lecture on any subject, you have years; the age, to twenty-one. If the youngonly to show to me that you have yourselves candidate for the medical profession remainsattended to it, by presenting your own notes at school until he is seventeen, he will in allof the case or cases on which you wish to probability have profited considerably by itshave my opinion, and your request will ordinary instruction, and have gained suffi-always be granted : you have simply to con- cient preliminary information to qualify himduct yourselves with order, regularity, and to pass through life without remark, if notstrict attention to what I say to you, and with much credit ; and I hope the forth-there is nothing I can do that I will not do coming Act of Parliament will enable us toto serve you; but as to obtaining anything secure such preliminary education to all, forfrom me by any other line of conduct, it is I regret to say that among those studentsnot to be done. I have never perceived the who entered the profession some years back,slightest mark of personal disrespect to my- and are only now presenting themselves forself on any occasion, and I believe it is the examination under the regulations of 1835,last thing any one of you would think of there are many who cannot spell very com-offering; and as to what idle persons may mon words in their native language. If thewrite in your name, we will not in future first years of professional education of a stu-give it any consideration. I shall judge of dent were passed in the apothecary’s shopyou by what you say and do here; and shall of an hospital, or that of a practitioner,think the better of any young man who comes visiting the sick wards occasionally, he wouldup to me boldly, but respectfully, to state acquire a sufficient knowledge of the makinghis wishes or his grievance, even if the com- up of medicines, and of the articles them-plaint should be against myself. selves, and something of other things thatWith respect to the office I hold here, I would smooth his path, and remove many

value it very little as to the money it brings. difficulties which he would otherwise expe-There are two or three of the influential rience by going at once to lectures in an hos-governors who know it is at their service pital. When we augmented the course ofwhenever they please to ask it, and, in fact, surgical study from one year to three, weI only keep it because I hope the day is not took care you should pay no more than wasvery distant when I may be able to make my expected from you thirty years ago, and theresignation more useful to the profession, whole amount of fees for hospital attendance,and to the public, than it would be at the including the practice of the physicians, aspresent time. I think it exceedingly unfair well as of the surgeon, and all the lecturesto the younger men who are hanging on you are required to attend, does not exceedabout an hospital, that they should have no at this hospital JE70, and is very little,hope of the opportunity of distinguishing if anything, higher at any other. You

themselves, except by the death of, perhaps, could scarcely learn to black shoes in a

their best friend. The governors of the fashionable manner, certainly not to make

Ophthalmic Hospital at once assented to my them, for less money. We did more; we

proposition, that every surgeon should retire considered that if we caused your parents towhen sixty years old; and I must retire keep you at school until you were seventeen,when I shall have attained that age, although, instead of sending you into a shop to openperhaps, the hospital is indebted to my con- the door, and perform other menial offices, atstaut care and superintendence for its exist- fourteen or fifteen, and thereby incur an ad-ence. I proposed to the governors of this ditional expense in your education, we

hospital that every physician and surgeon might with propriety save them the expenseshould retire at sixty-five years of age, and they would incur in your support the lastthey were pleased to make it a law for all year, to twenty-two, and we made the periodsuch persons who may in future be elected. of examination twenty-one instead of twenty-

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two. We also removed the great grievance much to say, but I have only time to pointof which so much was made, of confining out to you and to exhort you to avoid theinstruction to the London schools ; and en- error of learning anatomy in one place, andabled a student, who might livein a provincial physic and surgery in another. Nothingtown, which had an hospital and school com- can be more absurd than the peripateticpetentfor the purpose of instruction, to pur mode, so frequently adopted, of walking fromsne his studies at home, and therefore at one end of this great town to the other tolittle or no expense. I always have thought study anatomy, and back again to learn phy-that we, who succeeded in effecting these sic. They should both be taught at the samethings, had done the profession some good place, so that all the teachers may act toge-service ; and I have been surprised lately to ther for the good of the student and the pub-see myself accused of doing exactly the re- lic ; and where this is not done as it ought toverse : it is true I have not thought it neces- be, I would recommend you not to attend.sary to enter into explanations on these I have heard it said that it is beneath thepoints. I have, I fear, in fact, hid my light dignity of an hospital surgeon, or teacher, tounder a bushel. I have now ventured to state ascertain whether his students are presentthe fact, and I trust that those who have pre- or not, and that it is equally derogatory toviously been misinformed, will not feel of- the character of a student to have a watchfended at my correcting their accidental mis- set upon his attendance. To which I haverepresentation ; I will even beg of them to always replied, that the regius professors oftry me in future by a different rule, and divinity, and others of equal rank in thewhenever anything is done in which I may Universities of Oxford and Cambridge, dobe supposed to have had a part, in which not think it unbecoming in them to ascertainpublic justice, or the best interests of the that their students attend regularly, and thatpublic, do not appear to be sufficiently con- hospital surgeons and teachers may do withsulted, to believe that the transaction has not great propriety what such men as these havehad my support. I am aware that in done ; whilst the sons of the greatest men incausing you to attend an hospital, and to this country are regularly marked ofl’everystudy anatomy for three years, the objection morning as they go to chapel in their col-is made, that a horse may be brought to the leges, and the defaulters noted, medical stu-water, but that he cannot be made to drink, dents of the same age may and ought to sub-which I do not dispute. I have, however, mit to the same ordeal, which is purely furseen some thousands of horses taken to their advantage.water, and have always seen them drink, un- The inattention shown by many professorsless they had lately drunk before ; and I am with respect to the attendance of their stu-of opinion that if a young man attends an dents, renders another functionary necessary,hospital regularly, he is much more likely to who is called a grinder. As the time ap-learn than if he should not attend at all. The proaches for the final examination of the stu-proof of such attendance is desired from the dent at the College of Surgeons for the di-

reports and certificates of the teachers ; and ploma, he becomes then sensible of the follyif the regulations on these subjects had been of his conduct in not attending to his studies,duly complied with, that proof would have and he seeks a gentleman who shall stuff asbeen complete. The surgeons and teachers much information into him in a few weeks asof the large hospitals declined to comply, may answer his momentary purpose. Thusand the college gave way. I need not tell crammed, as the term is, he fixes his day toyou the regret 1 felt on the occasion, and I go off, perfectly satisfied that he would for-may add, that there is no abuse so great in get all he had learned from his grinder in athe profession as the manner in which gentle- month, if the grinding were not daily sus-men grantcertiticates ; sometimes even of an tained. Under these circumstances young ’-attendance which, has never taken place, and men have frequently assured me they couldfor persons not actually in the country, all, I describe a part or a disease they had notam willing to hope, out of pure negligence, seen just as well as one they had; I havebut the subject is too painful to comment myself heard a student describe very well theupon ; and my only consolation on this point biceps flexor cubiti muscle, and not know itis derived from the belief, that those irregu- when shown to him. Anatomy is only to belarities will, in the course of the ensuing learned by dissection, disease by attendanceyear, be effectually corrected. at the bedside of the sick in an hospital.With regard to the lectures you are or- There is then to be acquired that confidence

dered to attend, I am of opinion that every in your own knowledge which wilt enablestudent should be a perpetual pupil to all, you to manage and subdue a complaint with-but I would not advise a regular attendance out assistance from your teacher, and whichon more than one course of each, in order confidence is only to be acquired by expe-that the student may learn the history of the rience and observation ; your whole life, inart and scieuce he is afterwards to acquire fact, mnst be one of continued study, anda knowledge of, by his own labours, under you will at last die having much to learn.the observation and with the assistance of his

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teachers. On the study of anatomy I have -