Thomas Grainger Stewart

“ An old friend once told me that he met a hospital physician who had been working hard in town all autumn, and who, in answer to an inquiry what the work bad been, innocently replied that he had been writing his clinical lectures for next winter. I do not know whether the clinical lectures proved useful or not, but I believe that the Edinburgh students of the present day would not relish such productions. Good clinical lectures must be the fruits of accurate and thoughtful study of the individual cases to which they relate. ”

“ Not unfrequently it is possible for us to bring patients into the lecture-room, and there demonstrate the features of their maladies, and even when this cannot be done, I know of no method more profitable than clinical lecturing, for the comparison of an individual case with the type, or of a group of cases with the type and with one another. ”

“ In this we have an instance of a great rule which one may constantly observe in operation in different spheres of life—that the great step in advance of to-day becomes a matter of course to-morrow, and at last is displaced by some new suggestion. ”

“ Every effort is made to enable you to perceive the facts involved in the cases, to teach you to discriminate between different conditions under observation, to reason soundly upon the facts observed, to determine the line of treatment, and to watch its result. ”

“ Besides the regular clinical teaching in the wards, there has been introduced of late years another course of instruction—the clinical tutorial class. This class is intended to initiate the student into the methods of examination of patients, and, in particular, the physical examination of the heart and lungs. It is manifest that such training cannot be given by the Clinical Professors, and the tutor is entrusted, under their superintendence, with the work of training and drilling in those respects. ”

“ The first essential in hospital construction is abundance of air and light. The evils of overcrowded wards are well recognised in surgical practice, but although less obvious in medical cases, they are not less real. And this is true, not only of fever wards, but of general medical wards; overcrowding, or the presence of some peculiarly unhealthy case, lowering the vitality, and otherwise exerting an injurious influence upon the patients. In our new wards, air and light are abundant. ”

“ In 1681, the physicians of Edinburgh, who had long been aiming at incorporation, received from Charles the Second a charter constituting them the Royal College.
We know, unfortunately, very little as to how the practitioners of these early days received their education. The surgeons learned their work by the system of apprenticeship. Those who wished to join the craft being apprenticed to a member of the guild, whose practice he watched, and with whom, like other apprentices, he lived in family. But their class education must have been very deficient. ”

“ The Wightman Prize in clinical medicine is awarded annually to the student "who shall write the best dissertation on any subject presented by the Medical Faculty, or who shall make the best report and commentary on cases which have, during the previous winter and summer sessions, been treated in the University clinical wards of the Royal Infirmary." ”

“ An arrangement was made whereby the apprentices of the surgeons and the students of physic should have the opportunity of observing the practice at the bedside; and when the Infirmary to which we are now bidding farewell was opened, careful arrangements were made to regulate the clinical work. The earliest developments of clinical study must certainly be regarded as very crude. A clerk received a salary for copying into a ledger records of the cases treated in the wards, and he was further entrusted with the duty of reading aloud in the hearing of the students the records that he had made. ”

“ The demands made by an infirmary upon the public drainage system, although formidable enough, are not so great as those of an ordinary town district of similar extent, for the population inhabiting the eleven acres of infirmary ground will be much less than that of adjoining spaces occupied by dwelling-houses. But the liability to infectious excreta makes the hospital drainage of special importance, even in an infirmary like ours, where infectious cases are not received. ”

“ The aim of the course of systematic lectures is to give in bold outline a description of the features of the various types of morbid action, and of these types as they manifest themselves in the different parts and organs of the body, also to describe the treatment which each condition demands. ”

“ Longer attendance in the wards is also desirable, and if the number of students goes on increasing, a further development of the tutorial system may be required. After a time the tutorial class may have to be conducted, not by one tutor, but by a group of tutors, each training and drilling a small party of students with individual attention, one or more taking up the subject of the physical examination by means of percussion and auscultation ”

“ To any one acquainted with the subject, it must be apparent that it is impossible to do this work adequately within the limits of a single winter session; but as the present regulations for graduation require attendance during only one session, and as many students, however anxious they may be for a more extended course, are prevented by pressure of other work from attending more than once, an effort is made to render the course in each session as complete as possible. In different years, however, more time is devoted to one group of diseases and less to another ”

“ Third, that each should aim at obtaining a clinical clerkship, so as to be entrusted with the duty of keeping the official records of cases. But this should not, as a rule, be attempted before you have had some experience at the bedside, some tutorial instruction, and, if possible, a course of systematic lectures. Fourth, that you should prepare, during the time that you are clerks, or, at all events, during the later period of your ward attendance, what we call "Studies of Cases." ”

“ The opportunities afforded by this class have been largely taken advantage of by the students, and I consider that any one who fails to avail himself of it, is neglecting an important means of self-improvement. ”

“ For the supply of fresh air we are to depend to a large extent upon the windows, all of which are made to open at three places. At the top, fourteen feet from the ground, there is an arrangement for swing opening, which may be kept closed or opened to a very small extent, or to several feet. ”