ST. BERNARD'S.* Tue author of this book holds, apparently, a

view of the effect of knowledge the very reverse of that put into Lord Say's mouth by Shakespeare,—" Ignorance is the curse of God ; knowledge, the wing wherewith we fly to heaven." Knowledge —at any rate, the knowledge of the human body—our author evidently thinks—and brings a mass of statement to endeavour to prove—the road to a moral bell, if that road be taken through the English hospital schools of medicine. If this book represents, even approximately, what goes on in our great teaching hospitals, we have among us a monster iniquity that closely rivals the vivisecting institutions of unenviable notoriety. That St. BeAnard's is a deliberate libel, we cannot believe, for what possible motive can its author have for vilifying his pro- fessional brethren, and incurring their lasting enmity, except the hope of putting wrong right P Though writing anonymously, he can hardly hope to remain quite unknown ; so that he is risking not only his professional, but his social position, and even the respect of his personal friends. There is one probable theory on which we may reconcile the honesty of his book with our ability to retain much of our old belief in the benevolent practices of our hospitals: itis that our author has collected together a mass of facts that have come to his knowledge from many hospitals and various sources, and from a long series of years ; so that when all are woven into a tale, and connected with the brief experience of a single hero, it gives, unintentionally, a grossly exaggerated im- pression of the actual state of things in any one hospital at any given time. We suggest this view oat of respect to the great teaching hospitals. But however exaggerated, as we hope and believe, the picture is, as a representation of the hospital schools as a whole, there must be truth enough in the book, if we are any judge of style, to cause us all great anxiety. And if that be so, it is no wonder that the author should shelter himself under a nom de plume, and should describe the hospital in which he studied under the imaginary name of " St. Bernard's."

The story, if story it can be called, is very thin indeed, and is merely a chain with whioh to connect the incidents of the hos- pital and after-career of a medical student. It is very desultory, wandering from horrible hospital details to the ungentlemanly " sprees " of light-hearted and more than questionably moral " medicos ;" thence to discussions between earnest Christians and " advanced " and flippant agnostics ; to the scenery and gipaies and cholera of Spain; and finally back to London, where the hero, Elsworth, marries a strong bat right-minded and Christian lady—though not one to our taste—and starts a hospital on the principle of healing and not experimenting ; teaching thoroughly, but with only such experience as honest • St. Bernard's. By Asenlapies Scalpel. London Swan Sonnenechein, Lowrey, and Co.

healing supplies. There is, besides, a horrible episode of a physiologist who murders his wife, a story which is meant to show the effect of hospital research in hardening the heart. We shall not further discuss here either the story or the really earnest arguments for Christianity, bat confine ourselves to the question of hospital practices.

We believe the truth to be that the teaching hospitals, so far as they sin against the subscribers, sin chiefly in a somewhat extravagant expenditure. The anther says, at p.179," one-half " would suffice" for the patients' benefit alone," by which he means that the medical staff retain patients for scientific purposes far longer than is necessary to discharge them cured. This delay is not always to the injury of the patient, who is often far better fed and looked after than he could be at home, although it may well happen that his family suffers by his detention after he might, without injury to himself, be again earning wages. A. more wasteful practice is that of admitting without careful inquiry, patients whose circumstances do not at all justify them in claiming the charity of hospitals. We heartily trust that our author's more serious charges are coloured by an indignation that is not as circumspect as it should be in avoiding excursions into the region of misrepresentation. With regard to the charge that the hospital surgeons perform examinations and operations without anmsthetics, a practitioner not far removed from his hospital experiences assures the present writer that he never saw a painful operation performed without them, unless when it was not worse than the extraction of a tooth ; and then more with the object of not upsetting the stomach of a patient who had to go at once to work, than to save expense or trouble. Again, one of our author's most indignant passages is directed against the wanton indecency practised in the women-patients' receiving-room. In such rooms, we are assured, that female patients are sheltered by a screen, and only one or two of the chief medical men are present, and that neither there nor in the wards, is indecent or unnecessary publicity allowed. First-year students are said never to be admitted at all to the women's wards ; and that for an obvious reason,—namely, that midwifery and diseases of women cannot be explained, and the treatment developed, without some amount of unpleasantness to the patients. We cannot easily believe that refractory patients are plied with spirits to give them Dutch courage and induce them to undergo operations, especially on the very unprofessional ground that whether the operation benefits the patient or not, it will add to the practice and experience of the teachers and learners. It is still harder to believe that moribund patients, or apparently moribund patients, are operated on without any atom of hope that life will be saved, or prolonged, or made more endurable. At all events, our author obviously colours his picture, when he introduces, into his modern story, the Burkeing and body-snatching of old times, and tells of bodies slipped in through a hole and a five-pound note passed out, without question asked or recognition of the purveyor. It is strongly asserted, on the other hand, that in the present day the bodies of unclaimed paupers only, or of those who, at rare intervals, bequeath their remains to the hospitals, are the subjects for the dissecting-rooms. Again, in the same way, our author disgusts us with the proceedings of a Mrs. Podger, while himself telling us that the " Gamp and Harris Sisterhood" are ousted in favour of "the noble profession " of lady-nurses initiated by Miss Nightingale. More truth, we fear, exists in the charge that the vivisection of animals without licence is connived and winked at. The anecdote of the student who surrendered a favourite retriever to the scientific greed of his teacher, is at least founded on fact.

We must remember that if the poor gain the benefit of the hospitals, they should not grudge some alight return,—to pay, as we may call it, in kind. They should not mind, for instance, some publicity for the advantage of students, or some short detention for the medical staff to study the effects of treatment. A prolonged detention, as we have said before, is often beneficial to the patient as well as to the student ; it is the subscriber in these cases who has the most right to complain. It is probable that if some of our author's statements and opinions are founded on personal knowledge, much is gleaned from the proverbial grumbling of those who are under obligation to the hospitals. It is human nature to feel every painful remedy, every weary waiting, every roughness of manner, keenly, and not to be so ready to recognise adequately the relief, the patience, the readiness and kindness of those who minister to us in our sufferings; and it is certain that many a patient, released from hospital, tells sad

and frequently very exaggerated stories of all the pain and indignity, and delay and inattention, which he has been made to endure, as he thinks, unnecessarily. All this is endorsed with still growing exaggeration by those who have old scores to settle with the hospital, and thus, at second and third hand, we may imagine our author to have gathered the account be gives us of the terrible things that are done in the teaching hospitals. He quotes Sir Astley Cooper, when addressing the students of Guy's :—

" ' Look, gentlemen, at one hundred patients who come into the hospital. What is the miserable treatment of these patients ? You axe aware that I scarcely ever enter these wards (the medical wards) of the hospital. I will tell you why I do not enter them. I abstain from entering them because patients are compelled to undergo so infamous a system of treatment that I cannot bear to witness it No consideration shall induce me to repress my feelings, and I do say that the present treatment of patients is infamous and disgraceful, for their health is irremediably destroyed.' On another occasion this great surgeon said 'The art of medicine is founded on conjecture and improved by murder.' " Now, we must remind our readers that Sir Astley Cooper died nearly half-a-century ago. Bat it is only fair that " 1Esoulapius Scalpel" should be allowed to speak for himself, and having said our say, we must leave him and his book to the judgment of the public. That teaching and scientific investigation is too much, and healing—quickly, humanely, and cheaply—too little the practice of our medical schools, we can scarcely doubt, even when we have deducted a large per-tentage from our author's statements, originating, as in the main we must believe they do, in his Christian humanity.

Here are two of his illustrations of the treatment of moribund patients. A nurse calls a house-surgeon

Sister says she thinks he is dying fast, and are you going to operate ?'—' Going to operate ? Rather think I was. Don't you know, Nurse, this is my first capital operation ? Do you think I am going to lose the chance 1'—"Phen, sir, Sii.ter told me to ask you if I had better let the chaplain know ?'—`Chaplain be banged !' he cried. 'Certainly not ! It would only depress the poor devil. No! no ! Plenty of brandy ! Keep him up ! Cheer him all you can; tell him it is only a trifling, every-day sort of affair, and he will be well in a jiffy. You may send for his wife.'—' Oh, sir, she has been waiting abont the hospital all day.'—' All right, then ! Now, gentlemen, to business. You shall see me do something pretty.'—The bell rang for the operation, to assemble the students, some of whom said ' it was a beastly shame to torture a poor wretch who hadn't a °Lance of getting over it.'—' At, you won't talk like that when yen are house.surgeon' (H.S. they always termed it) yourself. You will be glad to operate on your own father if yea can't get anybody else. Besides, what are hospitals for, if not to qualify us for our work ? If people don't want us to learn all we can from them, why don't they stay at home and die ? The pariah doctor won't disturb their latter moments with operations.' "

And again :— " Here is a middle-aged woman, evidently having but a short time to live, yet this afternoon Dr. Wilson says his chief proposes to per. form upon her a capital operation. He has not the least hope it can save her life, but the chance of performing such an operation arises but seldom ; and it is but just and kind to the house-surgeon, who wants all the practical work he can get, to let him assist. So the woman sod her friends are duly pressed to oonsent that this= the only means of saving her life'—shall forthwith be done. To this end all the nurses are instructed to urge her. At last she submit,. She will be carried to the operating theatre, and this chance of instruction will fall to Dr. Wilson's hands; for as soon as the chloroform has effected its work, he will take the place of the chief, and do his first strangulated hernia.' "

Amongst the cases of heartless experimenting, we have the follo wing

"' Would you like to do a gastrotomy ? You ought to do one or two before you leave; it's a very pretty operation. I never knew a case survive more than a week ; but there's nothing like trying, and if you pick out a case that mast die any way, you are welcome to use any of my cases that we can get to consent ; and with Sister Agnes help

— Sister is capital at getting consent to anything, aren't you, Sister ?

— it can generally be managed.' ' I wish to investigate,' said one of his dressers, ' the presence of lithio acid in the blood of rheumatic patients. May I blister one or two of your patients, Mr. Crowe ?'—' Oh, certainly,' said the obliging physiologist ; ' only you must take precautions to let the patient imagine you are doing it for hie benefit, and be careful the nurses don't ass what you are about— nurses are getting so 'cute nowadays. With these provisos, you are free to roam at large, my friend, over the bodies of any of my clinics.' "

Almost inconceivable cases of carelessness and recklessness are charged against the operators :-

"Visions of similar oases crowded in upon the good Sister's recollec- tion—of eviscerated creatures in whom no tumour was discovered to remove ; of eases where, on the post-mortem table, sponges, and even instruments, had been discovered carelessly sewn ap in the patients after operation, and bad caused their deaths One day an old pavior smashed his hand. The surgeons at St. Bernard's wanted to remove three fingers. Not before he had been to see Sister Agnes, be thought. Sister Agnes went in for conservative surgery, and told him to refuse

his consent. How often had she known a nipple method of dressing save the digits in each a case ! In three months the man had the complete use of his hand as before the accident, bat that didn't con- sole the house-cargoes, whose fingers had itched ' to make a neat little job of it.' "

Our last extract shall be one of many hints that vivisection of animals is practised without a licence :-

"' Was that the rough little terrier which followed Dr. Arnold into the laboratory when he was starving ? I have heard him laugh at the misplaced confidence of the brute,' said Elsworth.—' The very animal,' replied the story.teller.—' But, I say, you had no licence, you know !'

'Licence be hanged ! Do you think we care for the fanatics who impede our work ? Let them show themselves at St. Bernard's ! Crowe has one, because it looks well to the public; bat don't you peach, Wilke, or you'll do for yourself. Go on.'“

Even if the general effect of St. Bernard's be, as we hope, greatly exaggerated, we cannot but believe that a great deal of lawless, as well as careless and unscrupulous practice, does take place in many of our hospitals ; and we conceive that this general belief will go at least as far towards acconnting for the recent falling-off in public subscriptions to hospitals as the hard times themselves. We should wish all hospital authorities to read St. Bernard's, and to take the utmost pains to discover and put down any of the bad practices therein described which they may find in existence.