The golden era of medical science that put Scotland on the map

Advances in surgery and pharmacology in a Scottish context were frankly magnificent, and today I will be showing how numerous Scottish individuals were instrumental in making this nation one of the leading countries in the world in medical science. It is no small boast to say that in the 1800s Scotland was one of the countries that the world looked to for medical progress.

If only those who say Scotland’s too wee, too poor, to regain our independence could realise that we Scots played a huge part in the 19th century leap forward in so many fields and could do so again.

I do not doubt that the expansion of the British Empire had a lot to do with Scotland moving forward back in the day, but that empire has been dead for decades and “Britain” is now holding us back. That’s why I often say we need to look at our history to know our future, and medical science in the 19th century shows us what we as a nation can do.

Individual men – it was only in the final years of the 19th century that women were given the chance to show what they could do – made huge leaps forward in developing medical science to the benefit of all humanity.

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But I will say that there were so many pioneers in Scottish medical science in the 19th century that it is not possible in one column to quote them all.

And wait to you see what we Scots did in the early 20th century...

Very often, medical science is confined to surgery and pharmacology, and there is logic to that. But perhaps I have not emphasised enough the development of a particularly Scottish practice, namely the establishment of hospitals, dispensaries and asylums, which became widespread in the late 18th and early 19th centuries.

Let me quote from the History of Scottish Medicine published in 1927 by John D Comrie: “In Edinburgh, the Royal Public Dispensary was founded in the year 1776, mainly through the instrumentality of Dr Andrew Duncan. This institution served the double purpose of affording attendance to the sick poor and of giving instruction and an opportunity for practice to senior medical students. As the town grew, the necessity for another dispensary was felt, and the New Town Dispensary was instituted in 1815 in Thistle Street.”

Glasgow soon followed and in 1794 the city’s Royal Infirmary began to take in patients. Comrie recorded: “The Town Council of Aberdeen, in 1739, convened a public meeting of citizens with the proposal to erect an infirmary and a workhouse within the burgh.

“The project was approved by the citizens an in November 1739 William Christall, Convener of the Trades, was directed to go to Edinburgh and Glasgow in order to see the hospitals there and to prepare the necessary plans and estimates. These having been passed, the foundation stone of the Aberdeen Infirmary was laid on January 1, 1740, on a piece of ground at Woolmanhill, gifted by the Town Council.

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“By 1749 the infirmary had increased to a capacity of 19 beds and a few years later two wings were added, bringing the number of beds up to 80. The important step was taken in 1773 of obtaining a Royal Charter for the infirmary, which henceforth enjoyed the title of the Royal Infirmary of Aberdeen. Early in the 19th century it was decided to rebuild the institution and the new building was completed in 1840 with accommodation for 230 patients.”

It was not just the cities which had their medical institutions. The Dumfries and Galloway Infirmary was founded in 1776 and the Montrose Royal Infirmary and Dispensary in 1782. It had begun life as an asylum.

Dundee Dispensary was founded in 1782, the foundation stone of the infirmary laid in 1793 and the Royal Infirmary was finally opened for the reception of patients in 1798.

At Paisley, a dispensary was instituted in 1786, to which a house of recovery was added and in-patients admitted in 1805. It was the forerunner of today’s Royal Alexandra Hospital.

The Northern Infirmary at Inverness was founded in 1799 and opened for patients in 1804. Comrie reports: “At Greenock, a house of recovery was added to a previously existing dispensary in 1807, and opened for the reception of patients in 1809. This hospital was largely extended, and the new house was opened in 1868.

“At Perth, the County and City of Perth Royal Infirmary was founded in 1834, and opened for patients in 1838. The Royal Infirmary at Stirling was acquired and opened in 1874.”

Like the hospitals for physical disease, asylums for the humane treatment of the insane were established at an early date in Scotland. The Royal Asylum of Montrose was founded in 1779, the buildings completed in 1781, and the first patients admitted early in 1782.

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Asylums for the insane developed widely in the 19th century with probably the most important development being what Comrie calls “an institution for the feeble-minded, as distinct from the insane”. This took place in 1859, with the founding of the Royal Scottish National Institution at Larbert, which opened for patients in 1862.

So, as you can see, all across Scotland, hospitals and asylums were developed and all of them played their part as this nation became a leader in treatments of physical and mental ailments.

I have previously quoted from Charles W Thomson’s excellent piece of propaganda Scotland’s Work and Worth: An Epitome of Scotland’s Story from Early Times to the Twentieth Century, with a Survey of the Contributions of Scotsmen in Peace and in War to the Growth of the British Empire and the Progress of the World, published in two volumes in 1909.

Thomson was one of the first authors to compile for the general public a list of medical people, and indeed scientists and engineers, who had brought distinction to Scotland and there’s a hint for my next few columns as I aim to show why Scottish innovators in all science-based activities should be better known.

Thomson’s list of 19th century innovators and developers begins within two brothers who were reckoned supreme in their fields.

Edinburgh-born Sir Charles Bell (1774-1842) was one of Scotland’s most distinguished surgeons while his brother George (1770-1843) was a notable Professor of Law who penned the seminal work Principles of Scots Law, which is still quoted in courts to this day. Thomson notes the Bells had a relative, a Dr Joseph Bell on whom Sir Arthur Conan Doyle based Sherlock Holmes.

It is Sir Charles we must concentrate on, however, and, like so many medical Scots, he had to move south to build a career, in his case after he and his brother fell out with the authorities at Edinburgh University and the Royal Infirmary.

Thomson reports: “After much hard work and many discouragements he became surgeon to the Middlesex Hospital in 1814, holding this post till 1836. In the Napoleonic Wars he gained, as an army surgeon, much experience which served to make him one of the leading authorities on anatomy and surgery.”

We know that to be the case for he kept a famous diary recording his experiences at the Battle of Waterloo in 1815, during which he attended to mainly French casualties for three days and nights. Many of them, perhaps as many as 90%, died of their wounds or infection and he was somewhat unfairly criticised for the fatality rate, field hospitals being notoriously under-equipped and without nursing staff.

In his youth, Bell had trained in art and his drawings were a vital part of his greatest works. Thomson records: “He created a revolution in medical knowledge in by clearly establishing the distinction between the sensory and motor nerves.”

In effect, he laid the basis for the study of clinical neurology even before he was appointed to the senior Chair of Anatomy and Surgery in the London College of Surgeons and helped found the medical school of the University of London.

His reputation grew apace and he was knighted in 1830. Six years later he returned to Scotland as Professor of Surgery at Edinburgh – obviously no grudges were held.

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Thomson misses out on one of Sir Charles’s greatest achievements – his classic description of a type of facial paralysis which is named after him. That’s because Thomson was writing before the name Bell’s Palsy became accepted.

The son of an Episcopalian cleric, Bell also wrote works on theology and philosophy – in short he was a real Scottish lad o’pairts.

Interestingly, it was two Aberdonians who took Bell’s work forward in different fields. Sir David Ferrier (1843-1928) and Alexander Bain (1818-1903) knew each other well, the former becoming the scientific assistant to the latter as Bain developed the scientific approach to psychology for which he is most renowned with Bell’s ideas on neurology greatly influencing Bain and his colleagues.

Ferrier outstripped his mentor in terms of fame, however, especially after he moved to London in 1870, having graduated in medicine at Edinburgh University.

He began his greatest work at an asylum in Yorkshire where he conducted experiments on the brains and nerves of small animals and proved conclusively his theories about electrical stimulation of the cortex, work that brought him international fame but also criminal prosecution by anti-vivisectionists. Just a few years later, another great Scot, Bute-born Sir William Macewen (1848-1924), used Ferrier’s theories and experimental findings as he studied the difficult, indeed well-nigh impossible, practice of brain surgery, at Glasgow University where he became Regius Professor.

Starting at the Glasgow Royal Infirmary and latterly at the city’s Western Infirmary, Macewen was the first surgeon to show that brain tumours could be detected and safely removed, and Thomson recorded while Macewen was still operating: “By his contribution to surgical science he has acquired such a reputation that his clinic is a Mecca to which pilgrims are drawn from all parts of the world.”

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All these medical heroes were not just surgeons or professors. A simple country doctor, James Currie (1756-1805) gained fame for being the first to use a thermometer to keep records of patients’ temperatures, standard practice now across the globe. He also happened to be doctor and biographer of Robert Burns – another lad o’pairts for us to celebrate.

I will leave it to Charles Thomson to state his choice of other famous medical Scots of the 19th century: “Sir John Forbes (1787-1861), a native of Banffshire, one of Queen Victoria’s physicians, and one of the founders of the British Medical Association, is now chiefly remembered as having popularised the use of the stethoscope, thus adding greatly to the efficiency of diagnosis in chest affections.

“Another of the queen’s physicians was Sir Robert Christison (1797-1882), a native of Edinburgh, who became Professor of Medical Jurisprudence and later of Materia Medica in that city. His Treatise on Poisons (1829) is still regarded as a standard work on that subject.

“One of the most noted of Edinburgh’s many great surgeons was Robert Liston (1794-1847), a native of Linlithgowshire. His Principles of Surgery (1833), together with his skill and rapidity as an operator, made his name a household word in medical circles throughout the world. Sir William Fergusson, born at Prestonpans (1808-77), became Professor of Surgery in King’s College, London, and president of the Royal College of Surgeons in that city. Many surgical instruments owe their invention or improvement to him.”

The best is yet to come. Next week, I’ll name my Super Six medical figures who helped make Scotland’s reputation as a world leader in the science of medicine.