The influence of the free dispensaries upon medical education in Britain.

THE PART played by the Free Dispensaries in the evolution of medical education in Britain has not yet been adequately appreciated. This may initially have been due to the campaign of vilification of dispensaries carried on by Thomas Wakley in the early years of the Lancet, for such campaigns often leave a lasting impression on readers who are not informed of the other side of the question. The rapid spread of the number and popularity of the dispensaries proved their value to the community, while the Report of the Select Committee of the House of Commons on Medical Education (1834) provided unequivocal evidence of their educational importance. They filled a gap in the teaching of clinical medicine. The teaching of clinical medicine in Britain was later in beginning than the teaching of surgery. Anatomy and surgery were taught by several surgeons in the early years of the eighteenth century and William Cheselden's Anatomy of the Humane Body, based upon his lectures and practical demonstrations, was published in 1713 and was destined to undergo thirteen editions before the close of the century. Then, soon after the separation of the Barbers from the Surgeons in 1745, William Hunter opened his School of Anatomy that ultimately settled in Great Windmill Street, and soon other private anatomical-surgical schools followed. During this time the only regular teaching of medicine was by Dr. George Fordyce (1736-1802),1 who for thirty years onward from 1764 lectured on medicine, chemistry and materia medica at his house in Essex Street, Strand. At this time there was no other regular instruction given in medicine in London. On page 89 of that delightful book Mr. Guy's Hospital,2 it is stated that in 1768 'it was then agreed that students should be allowed to attend the surgical practice of both hospitals although no corresponding arrangement was made as to medical practice for the good reason that at the time teaching in medicine did not exist'. Opportunities for medical teaching were however soon to be provided in the Aldersgate Street Dispensary founded, largely owing to the enthusiasm of John Coakley Lettsom,3 in 1771. From the very first, Lettsom had it in his mind to use the clinical material at the Dispensary for teaching purposes. In his Medical Memoirs, published in 1774 he analysed the various kinds of disease afflicting patients seen at the Dispensary or visited at their own homes during the previous year, and gave clinical descriptions of many of them. The total number of cases was 1650, of whom 512 had been seen at their homes. Though there is no evidence that Lettsom actually taught at the Dispensary it is clear that he contemplated doing so, for in his pamphlet on The Improvement ofMedicine in London (1775) he discussed the use of the General Dispensary as a school of physic, and made the practical suggestion that 'young