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THE LANCET.

London, Saturday, July 10, 1841.

IMPORTANCE OF CASE-BOOKS IN HOSPITALS.

IVIIE-4 we reflect upon the great number ofinstitutions for the treatment of disease

which exist in this country, the gratifica-tion arising from the thought of how muchsulferingmight be saved and affliction relieved

by them, is mingled with regret that so vast asource of information on the history of diseaseand the results of therapeutical treatment

should be lost to mankind. It is true that a cer-

tain proportion of this knowledge is preservedfrom the destroying swoop of time by themedical officers to whom the charge of theseinstitutions is confided, but it exists only inisolated fragments in private note-books, orin some few instances it is bestowed upon the

profession at large in the forms of desultoryvolumes, or individual cases. In every in-

stance such extensive sources of information

naturally confer, where observation and in

dustry are present, great advantages upoithose whose opportunities permit of their

drawing instruction from them. But sud

ought not to be the sole application of the riclistores of information existing in our hos-

pitals, which are intended for a higheland a nobler purpose, viz., to bestow the

invaluable results of the experience of years,in thousands of cases, upon the public. Withthis beneficent object, our forefathers werewont to collect the history and mode of treat.ment of all the diseases which were broughtinto their temples for the exercise of their

skill, and to preserve the records of such dis-eases in their case-books, that their expe..rience might descend to their successors. In

one or two of the London hospitals this admi-rable practice is still pursued, and with an

advantage which is each day increasing, andwhich will undoubtedly continue to extend.It is most sincerely to be deplored that thesame excellent custom does not exist in all.

Hospital surgeons and physicians seem tobe unaware of the important position which I

I

they occupy in relation to the education

of the medical practitioner. They are stillcontent to pursue the accustomed track of

ages, apparently unwilling to suggest any im-

provement upon the past, or to admit of anyproposition for the future, which may tend tothe general benefit of the profession. This

supineness, in too many instances, takes itsorigin in the envy and jealousy of which hos-pitals may be considered to be very hot-beds.Where is the hospital in which unanimityand cordiality of feeling exists among the

medical officers ? Echo answers, 11 Where ?"

How then can it be expected that proper regu-lations for carrying out the objects of medicalscience should be found in institutions

where no common interest unites its rulers ?

But our present intention is not so much

to direct attention to that which is alreadytoo obvious, as to point out, in the first place,the true position of our hospitals in relationto medical education ; and, secondly, to sug-gest a means by which a record of diseaseand its treatment could be preserved in each

hospital, without inconvenience to the medical

officers, and with advantage to the generalmanagement of the institution.

In relation to the profession, hospitals areintended to supply to the student a know-

ledge of disease ; they are the laboratories inwhich the various manipulations and pro.cesses necessary for the cure of physical suf-fering are conducted. Within their walls

human misery displays a thousand varied

shapes; the student is appalled at the im-

mensity of the labour that seems spread be-fore him, and no friendly hand is stretchedforth to aid him through his difficulties.

Clinical teaching has become a mere word,without signification ; and the few hasty re-marks made at the bedside are directed to

those who are already informed upon the

subject, and tend only to perplex still

more the junior student. The too frequenteffect, on the mind of the student, of the diffi-culties met with in comprehending the na-ture of disease, from its Protean manifesta-

tions, and of the absence of all assistance

or stimulus, excepting that distant and little

546

regarded one-a sound knowledge of his

profession,-is a distaste for the duties of thehospital, and, as a consequence, gradual neg-lect of their performance,-a neglect in whichthe well-disposed are as apt to take part asthe idle. In those hospitals in which a case-book is kept, the industrious student finds agreat resource in the perusal of its pages, andwith its aid is enabled to make up for the

deficiency of instruction of which all most

justly and reasonably complain.

We are perfectly confident that every medi-cal officer of an hospital must be ready toadmit that the history of all the cases treatedin the different medical institutions of London,would constitute an invaluable national re-

cord, and the most important property of the

hospital. But the question naturally arises,upon whom shall the duty devolve of keep.ing such a record ? Upon the physicians andsurgeons ? Certainly not ; for their occupa-tions necessarily preclude the possibility of iits performance. Upon the assistant-physi- Icians and surgeons ? We know of none

better; for while such employment would be asource of considerable information, the officemight be made a part of the training for the

higher rank of the physician or surgeon. Butit is a point of the first importance that who-ever is chosen, the appointment should beendowed with an income equivalent to thelabour required. If it were considered that

the duties of keeping the case-books were toolaborious for the assistant medical officers,the appointment might be awarded as one ofhonour to any one of the students of the hos-

pital who might most distinguish himself inhis practical studies.

We trust that all who have any influence

in the hospitals, will consider it to be a

duty which they owe to them and to society,to devote some portion of their time to

the consideration of the manner in which so

important a benefit to those institutions could

be obtained, as would be conferred by the

universal record of their proceedings in hos-

pital case-books.

BRITISH MEDICAL ASSOCIATION.Exeter Hall, July 6, 1841.

: Dr. WEBSTER in the chair.THE minutes of the last meeting were read

and confirmed. The following gentlemenhaving been duly proposed and seconded,were elected members of the association :-

J. Fosbroke, M.D., Ross, Herefordshire.J. Curtis, Esq., Union-terrace, Kentish.

town.J. Knaggs, Esq., Mornington-crescent,

Kentish-town.H. Oliver, Esq., sen., Stilton, Huntingdon.

shire.Reports of deputations appointed at the

last meeting to wait on Parliamentary candi.dates were given to the meeting by the fol.lowing gentlemen :-Dr. Webster, R. David.son, Esq., R. Wallace, Esq., E. Evans, Esq.,and C. H. Rogers Harrison, Esq., and or.dered to be received.A letter was read from Dr. Fosbroke, of

Ross, containing suggestions for improve-ments in medical politics.A letter was read from J. H. Nankivell,

Esq., of St. Columb.The followingresolutions were unanimously

agreed to :-ic That an address be framed in the form of

a circular, and forwarded to the individualmembers of the House of Commons, expres-sive of our views on the subject of medicalreform, and inviting their co-operation."

" That an address be issued to the medicalpractitioners throughout the United Kingdom,pointing out the progress of medical reform,and calling on them to exert themselves onthe present occasion, by explaining its objects,importance, &c., to members of Parliamentfor their neighbourhoods."" That a deputation be appointed to attend

at the ensuing annual meeting of the Provin-cial Medical Association to be held at York."The meeting then adjourned.

BETHLEM HOSPITAL.

PER CENTAGE OF CURES.

To the EditO1’ of THE LANCET.SiR:—Whilst the letter of Dr. Monro

satisfactorily exculpates him from theheavy imputation cast upon his medicalskill by the strange discrepancies betweenthe reports of himself and Lis brother phy-sician, it exhibits in the strongest light notonly the want of unity of action and designbetween the medical officers of the hospital,and the absence of an intelligent superin-tending body, but also the great impolicy ofwithholding the statistical tables annexedto the published documents. The effect ofDr. Monro’s letter, notwithstanding his en-<

deavoura to mystify that part of it which