deficiency in the medical corps, which has been more and more apparent in recent wars; dwellings and churches were often crowded with wounded imploring relief, to whom no other relief came than death; hundreds died of wounds which admitted of prompt succor. We hear of surgeons, who frequently stood appalled at the magnitude of their duties, and their utter inadequacy to the task. Foreign States have in some measure supplied these deficiencies. In addition to the three regimental surgeons, they have organized corps of ambulance attendants, trained to the proper handling of the wounded, and who are made, by special instruction, sufficiently familiar with injuries to be able to succor the severely wounded on the field, as where hemorrhages are imminent. These semi-medical auxiliaries to the staff of surgeons are of great service on the field. They follow the advancing column closely; examine the fallen; if their wounds are necessarily immediately fatal, they merely place the soldier where he may die undisturbed and uninjured. If the wounds do not demand immediate surgical attendance, they are temporarily dressed and the soldier is dispatched to the permanent hospital; but if they require immediate operation, the wounded man is sent to the field hospital, where the surgeon is in waiting with assistance. Thus the surgical staff is prepared to meet every emergency, however great it may be.

XLIX.

HOSPITAL APPOINTMENTS.

T

HERE can be no doubt that a new era in medical education has begun in this country. The marked success of schools connected with hospitals proves too unmistakably that theoretical instruction is about to be supplanted by the demonstrative. It is vain to oppose the progressive change in the public mind. It is based on the self-evident truth that medicine, a science of experiment and observation, can be cultivated successfully only at the bed-side—a truth which all the logic of causistry can never unsettle. That truth underlies every branch of scientific industry, but finds in practical medicine its highest development and brightest illustration. Science and art, theory and practice, are one and indivisible. Science teaches the mind, and art instructs the hand; the former gives the sound, discriminating judgment, and the latter the cunning skill in execution. Both are alike essential to success, both are to be acquired together. We advise the student of anatomy to dissect with his chart before him; and why should we not advise the student of practice to study his book at the bedside? The simple truth is, we have

far too long taught medicine by an artificial plan. The profession has not been governed by the same good sense that men exercise in the ordinary duties of life. Let us now call attention to the organization of hospitals, when regarded as the great centres of medical education. They have hitherto been regarded as merely the receptacles of the sick. In their organization the comfort of the inmates has been the especial care of their guardians, and but secondary attention has been given to the character of the medical attendance. They have been rendered subservient to the profession as practical schools, where the physicians and surgeons might attain by experience and observation to great excellence. The large majority of the distinguished men of the profession have held positions in hospitals, and in these large fields for study and accurate investigation have acquired that skill which has given them success in practice. Nearly all of the familiar names which adorn the pages of medical history represent so many different hospitals. But a higher and nobler service is about to be rendered by these institutions. They are to be not only the resort of the sick, and schools for the training of a few physicians and surgeons, but they are to become the great fountains of medical knowledge. Within the hospital ward the student of medicine will hereafter begin and complete his education. The school and hospital will no longer be separate institu

tions, but they must be the same in location, the same in name, and the same in organization. In this view it becomes a matter of no small importance, that their medical and surgical staff be selected with great care. Hitherto the governing Boards have exercised but little discretion in the choice of candidates for vacancies. In general, that person has been chosen who has brought the largest pressure of a political, social, or pecuniary kind to bear upon the appointing power. Merit is almost universally elbowed out of the way by arrogant conceit; and places of power and influence are filled by those whom the genius of medicine would discard. For this reason, our hospitals have been, for the most part, poorly provided with medical attendance. The physicians selected are rarely the growing and advancing members of the profession. They are too often those third-rate men, who, in practical life, necessarily take an inferior rank. They are not familiar with the late discoveries in medicine, nor do they reflect its present condition; errors in diagnosis and treatment are the daily clinical lessons which they teach. The surgeons are equally unqualified for their responsible positions. They are not only frequently men of no science, but they are as frequently deficient in ordinary skill. We must go to our hospitals to witness poor surgery. Here may be seen the most palpable and deplorable errors, openly and shamelessly committed. We shrink from the

mention of the terrible lessons which incompetent surgeons impress upon those who attend much upon public practice. If the study of mal-practice is useful to the student, then do those half-educated physicians and surgeons, who may be found in every hospital, serve a beneficial purpose; their lessons are certainly most impressive. The medical attendance upon these institutions can never meet the present and prospective demands of the profession until a new system of appointment is adopted. So long as Boards of laymen may choose a physician or surgeon from among candidates, no reliance can be placed upon their choice. They may by mistake select a proper person, but the present staff of most civil hospitals proves that the contrary must be the result. If the French method of deciding by concours is not adapted to our social peculiarities, it certainly would not be difficult to devise a plan by which the unqualified could be distinguished from the qualified and the former be prevented from securing these positions. The evil is one which will not correct itself, but like many others must be fearlessly met and remedied. And the remedy must be devised and applied by the medical profession. It has but to manifest its purpose, and assign the reasons therefor, and governing boards will yield and promptly comply with its demands.