Consulting in the dark: Robert Hamilton (1749-1830) and the importance of 'tenderness' towards patients.

Robert Hamilton (1749-1830) was born in Coleraine, Ireland, attended medical school in Edinburgh, Scotland, served in the British army and practised in South-East England. In order to differentiate him from his contemporary and namesake, Hamilton is identified by having worked in Ipswich, Suffolk and Colchester, Essex. This submission considers Hamilton's biography, his 1787 book on the British regimental surgeon and his ideas therein about professionalism. Central to his concept of professionalism is 'tenderness', a notion that broadly equates to empathy. He notes that tenderness brings improvement in clinical outcome and he has the foresight to recognise nurses as key to such care. The authors explore the concept of 'consulting in the dark', i.e. without access to clinical investigations. This is exemplified by doctors of the eighteenth century and earlier. Today general practitioners must still be comfortable 'consulting in the dark', e.g. when attending a patient's home. Hamilton's biography offers a further example of 'consulting in the dark': In later life, he lost his vision but continued to practise successfully. Central to his gift of consulting 'in the dark' was likely to be 'tenderness' for his patients, expressed through language and gentle touch. Hamilton's entreaty for 'tenderness' contrasts with modern medical education where reliance upon clinical tests, technology and pharmacology risksblinding young doctors towards patients and their lives.

William Taylor, Peninsular War surgeon and deputy inspector of hospitals at Waterloo.

William Taylor was a British army surgeon remembered for his role as deputy inspector of hospitals (DIH) at Waterloo serving under Sir James Grant MD (1778-1852). No biography of Taylor exists beyond his entry in Drew's records of commissioned officers in the medical services of the British Army. Taylor appears to have been a Scotsman and is first noted as a hospital mate in 1795. He joined the 10th Royal Dragoons (Hussars from 1806) as an assistant surgeon in 1797. He is recorded at Guildford (1800) and Brighton (1803). He was made surgeon in August 1803. A further reference to Taylor, deduced from the title of "regimental surgeon," is documented at Lewes, Sussex, in 1808. Taylor served with the 10th Hussars in the Peninsular and Challis' roll call records his service at the Battles of Sahagún (21 December 1808) and Benavente (29 December 1808). Taylor was transferred to the staff on 20 June 1811 and made DIH on 25 July 1811. He was put on half-pay before being reinstated for Waterloo. Taylor retired on half-pay in February 1816 and died at Turnham Green on 9 January 1820. His Waterloo medal was sold in 2006.

'Disciples of Aesclepius': Glimpses into lives of the 'Gentlemen of the Faculty' of medicine in Brighton, England 1800-1809.

Here we present newspaper accounts from the Sussex Advertiser to consider hitherto largely unknown Brighton doctors active between 1800 and 1809. This body of physicians, surgeons and apothecaries comprised Brighton's 'Gentlemen of the [medical] Faculty', whom the newspaper also dubbed the 'Disciples of Aesclepius'. Members are considered under three broad categories. First, are Brighton-based clinicians (Mr Barratt, Mr Bond, Charles Bankhead, Thomas Guy, John Hall, John Newton, Benjamin Scutt and Sir Matthew Tierney). Second are London clinicians, probably in attendance to the Prince of Wales (John Hunter and Thomas Keate), More widely, two dentists (Dr Durlacher and Mr Bew) and two Royal Navy surgeons (Robert Chambers and Thomas Thong) also recorded at Brighton are considered. Other aspects of medical life are described: recruiting an apprentice, anatomy training at Joshua Brooke's London museum, midwifery, a description of a surgeon's bag and the last reference to the Royal Sussex Jennerian Society (which disappears from the newspaper record in 1807). Clinical cases described include: resuscitation from near-drowning, post-mortem examinations, death from the 'gravel and stone' and accounts of suicide. The primary sources presented in this paper offer rare glimpses into medical life in Brighton at the very start of the nineteenth century.

Robert Henderson: Scottish doctor who was appointed Physician to the Forces (1795) and practised at Brighton, England.

Robert Henderson was a Scottish physician who qualified Doctor of Medicine at Aberdeen in 1786. By 1792, Henderson was working in Brighton on the south coast of England. He was admitted Licentiate of the College of Physicians of London in 1793. At Brighton he probably worked as a parish doctor. In 1795 Henderson was appointed Physician to the Forces and probably served as a garrison doctor. In Brighton, he is noted as an advocate of chalybeate water therapy (i.e. mineral spring water containing iron salts). Henderson undertook basic experiments into the chemistry of mineral water and a few, very brief, clinical observations may be his. In Henderson's time, the chalybeate in question was part of the 'Wick estate' to the North West of Brighton. Today the site of the spring is located within St Ann's Well Gardens, Hove and this article briefly considers its history. Circumstances link Henderson to Sir Lucas Pepys MD (1742-1830), physician-general to the army and closely associated with both the College of Physicians and the town of Brighton. Henderson died in Brighton on the 3rd April 1808. Henderson's daughter Sophia Janet married Captain William John Thompson Hood who served at Trafalgar aged eleven.

The undergraduate 'corridor of uncertainty': teaching core concepts for managing clinical uncertainty as the 'special technique' of general practice.

McWhinney's first principle of family medicine states that GPs 'are committed to the person rather than to a particular body of knowledge, group of diseases, or special technique'. While indeed committed to the person, we propose that the 'special technique' of general practice exists in the form of core clinical concepts for managing uncertainty (e.g. time as a tool, therapeutic examination, safety netting and doctor as drug). Managing clinical uncertainty calls for GPs (and trainees) to operate in a 'corridor of uncertainty', a cricketing analogy where the batter is unsure whether to play a defensive or attacking shot. For students to recognise and value these concepts requires longitudinal learning and simulation. Here we describe a GP module at Brighton medical school where core concepts are 'drip fed' through small group sessions across year 4. Formative simulated surgeries constitute a 'corridor of uncertainty' where simulated patients drive students into using concepts in practice (e.g. through shared management plans). Although recognised in postgraduate training, these concepts should be taught formally within the undergraduate curriculum. Doing so helps students distinguish general practice from hospital generalism and prepares them for clinical placements in general practice. These concepts are inherently 'soft' and founded upon the GP paradigm of understanding medicine. In the eyes of the specialist, they risk being unacknowledged, misinterpreted as ignoring guidelines or, worse still, as bad medicine. Soft core concepts constitute the tools to prepare students for managing clinical uncertainty and serve to inscribe the art of medicine within the undergraduate curriculum.

Matrix-Induced Autologous Chondrycte Implantation for a Glenoid Chondral Defect: A Case Report.

CASE: We describe the case of a 33-year-old man who had a 1.5 × 2 cm chondral defect of the right glenoid that that was discovered on arthroscopy and was successfully treated with matrix-induced autologous chondrocyte implantation (MACI). At 2 years postoperatively, the patient's Constant score and American Shoulder and Elbow Surgeons (ASES) shoulder score improved by 44 and 51.6 points, respectively. CONCLUSION: Chondral lesions of the glenoid are rare and are a challenge to manage. This case represents a successful outcome with MACI, thus providing surgeons with an option for treating these difficult problems.

Electronic software significantly improves quality of handover in a London teaching hospital.

The study compared paper-based and electronic-based medical handover with respect to quality of information transfer during hospital out-of-hours shifts, and analysed the caseload burden of the hospital night team. The participants were 1645 hospital patients transferred from the day team to the out-of-hours team over four months in 2006. Quality of information transfer was determined by clinical data handed over within pre-set fields, and caseload burden by the frequency of tasks required at handover. Handover information fields comprised patient's demographics and location, primary diagnosis, current problem, plan of action and primary care team details. Electronic handover achieved a significantly higher number of completed fields than paper-based handover. Blood collection, checking blood and X-ray results, and adjusting fluid balance and intravenous cannulation account for most of the workload during the nightshift. Electronic handover provides better continuity of care than paper-based handover, and redistribution of tasks during working hours would benefit night staff.