Eminent doctors: Their lives and their work; Vol. 1 of 2

by G. T. Bettany

Notwithstanding the early date of the foundation of the College of Physicians of London, and the fact that the illustrious names of Harvey and Sydenham and others adorn the rise of rational medicine in the south, the credit of first developing a famous medical school belongs to Edinburgh, where the Monros, Gregorys, Cullen, Black, and Rutherford maintained during the eighteenth century an unbroken succession of brilliant names. It cannot be allowed, however, that the Town Council of Edinburgh, in founding medical professorships, deserves as much of this credit as do the outside founders of medical teaching, whose existence and success extorted from the municipality a recognition formal and limited at first, and certainly unremunerated. It may be questioned whether the University of Edinburgh has not really been indebted almost as much to the extra-academical teachers of medicine who have continually stimulated the actual professors to their best endeavours, as to those professors themselves.

Anatomy, the necessary foundation of medicine, had a kind of beginning in Edinburgh in 1505, for the surgeons and barbers of the city had procured the insertion in their charter of a clause enabling them to obtain “once in the year a condemned man after he be dead to make anatomy of.” But little came of this, and it was reserved for a number of able physicians, educated abroad, in the latter part of the seventeenth century, to set on foot some practical teaching in medicine and the allied sciences. The names of Sir Robert Sibbald, Sir Andrew Balfour, and Sir Archibald Stevenson must be honourably mentioned in this connection. The first two of these were most influential in establishing the earliest public botanic garden in Edinburgh, a piece of ground about forty feet square, belonging to Holyrood House. They subsequently allied to themselves James Sutherland, who afterwards became a notable botanist, and obtained the appointment of keeper of a much larger garden near Trinity College Church. Many valuable collections of seeds and plants were procured; medical students were incited to collect and send home seeds and cuttings from places they might travel to; and so the garden became an important starting-point for materia medica.

Professional feuds already became prominent in Edinburgh. The surgeon-apothecaries were jealous of the physicians and doctors of medicine. Several abortive efforts were made by the latter towards the establishment of a College of Physicians. In 1621 King James gave a warrant to the Scottish Parliament for this purpose; but no action was taken. In 1630 the subject was referred to the Privy Council. In 1656 Cromwell constituted a College of Physicians for Scotland; but his death prevented its completion. Thus it was not till Sibbald and Stevenson, by the aid of Sir Charles Scarborough, Harvey’s friend, gained the ear of the Duke of York, that at last the College of Physicians of Edinburgh was founded, in 1681, notwithstanding the strong opposition of the surgeons and the townsmen.

Soon after this, in 1685, the Town Council of Edinburgh appointed three principal members of the College of Physicians to be Professors of Medicine in what they now for the first time, at any rate in existing documents, called “the university of this city.” Sir Robert Sibbald was appointed Professor of Physic, and rooms were allotted to him, but not a salary. Drs. Halket and Pitcairne were speedily added to the list of professors, and the division of duties between the professors was left to themselves. We have no record of any lectures given by these professors for a long period, but we know that Pitcairne in 1692-3 held a professorship at Leyden. On his return to Edinburgh he became enthusiastic in promoting the medical school, aiding Alexander Monteith in gaining permission from the Town Council to dissect the bodies of people who died in “Paul’s Work.” “We offer,” says Pitcairne, “to wait on these poor for nothing, and bury them after dissection at our own charges, which now the town does; yet there is great opposition by the chief surgeons, who neither eat hay nor suffer the oxen to eat it. I do propose, if this be granted, to make better improvements in anatomy than have been in Leyden these thirty years.”

Monteith obtained a grant in October 1694 of “those bodies that die in the correction-house,” and of “foundlings that die upon the breast.” He was allowed to make his dissections in “any vacant waste-room in the correction-house, or any other thereabouts belonging to the town.” Magistrates were to be admitted if they desired, and the apprentices of the surgeons might attend at half-fee. However, Monteith’s scheme did not succeed, because he had acted without concert with the other members of the Surgeons’ Corporation. These made a more successful start in the same year, having obtained a right to “the bodies of foundlings who die betwixt the time that they are weaned and their being put to schools or trades, also the dead bodies of such as are stifled in the birth, which are exposed and have none to own them; also the dead bodies of such as are felo do se and have none to own them; likewayes the bodies of such as are put to death by sentence of the magistrate and have none to own them.” A condition was annexed to this grant that by Michaelmas 1697 an anatomical theatre should be built, where public dissections should be made once a year, if opportunity offered. This was evidently intended to extend to a course of anatomy, including as much as could be taught on one body. The method, however, in which anatomy was first practised in the Surgeons’ Hall was for ten surgeons to lecture, on following days, each in succession taking a special part. The body had to be buried within ten days.

It was in 1705 that a special appointment of one man to lecture on anatomy was first made, and the first lecturer, Robert Elliot, was also made Professor of Anatomy in the University, with a small stipend. This formal appointment appears to have been directly occasioned by the offer of some unknown teacher to give public and private teaching in anatomy to the surgeons and their apprentices.

It is not till 1706 that we have any record of Sibbald’s lectures. The Edinburgh Courant was then made the medium whereby he announced, in Latin, his intention to lecture on natural history and medicine “in privatis collegiis,” or private courses of lectures. He appears to have lectured in Latin, and to have received no pupils but such as were skilled in Greek, Latin, mathematics, and philosophy.

About this time had settled in Edinburgh the progenitor of the long line of distinguished Monros, John Monro, formerly an army surgeon, who became President of the College of Surgeons in 1712. His son Alexander, afterwards so distinguished, was born in London on the 8th September, 1697. Being an only son, his father gave unusual attention to his training, and early perceiving his acuteness of mind, sent him successively to London, Paris, and Leyden to obtain the best medical education at that time accessible. The anatomical preparations which he made during his studentship gave such evidence of ability, that Drummond, who then taught anatomy at Edinburgh, offered to resign in his favour as soon as he returned home. Cheselden in London and Boerhaave in Leyden were highly impressed by the young Scotchman’s promise.

The year 1720 may be taken as witnessing the actual start of the Medical School of Edinburgh, and Alexander Monro as its real founder. Although the father did much to promote the successful start, the son becoming actually the competent teacher, must necessarily have the greater credit. At the age of twenty-two, Monro was appointed Professor of Anatomy, and having announced his first course of lectures on anatomy, to be illustrated by the preparations he had made and sent home when abroad, his father, without his knowledge, invited the President and Fellows of the College of Physicians and the whole of the city surgeons to the first lecture. The surprise caused the young lecturer to forget the discourse which he had committed to memory, and being without notes, he had presence of mind enough to commence talking about some of his preparations, and soon became collected in speaking of what he was confident he understood. Thus the surprise and temporary forgetfulness thereby caused was a foundation of his success: he found himself applauded as a ready speaker, and resolved throughout life to speak extempore, being persuaded that words expressive of his meaning would always occur in speaking on a subject which he understood. From this time the subjects of anatomy and surgery in Monro’s hands attracted large classes of students, the average of the first decade being 67; of the second, 109; of the third, 147. Even during the second session his lectures attracted students from all parts of Scotland, also from England and Ireland. Seizing the opportunity, other professors were persuaded to start courses of lectures, so that soon a respectable curriculum was provided, and Monro secured in 1722 a grant of his professorship for life. It had previously been held only at the will of the Town Council.

Monro was now face to face with the difficulty of providing sufficient material for the instruction of his large classes. Under Cheselden in London he had been accustomed to a supply of subjects, more even than he could make use of. In Edinburgh, as early as 1711, complaints were made at Surgeons’ Hall of violation of graves in Greyfriars’ Churchyard, “by some who most unchristianly have been stealing, or at least attempting to carry away, the bodies of the dead out of their graves.” But, said the surgeons, “that which affects them most, is a scandalous report, most maliciously spread about the town, that some of their number are accessory, which they cannot allow themselves to think, considering that the magistrates of Edinburgh have been always ready and willing to allow them what dead bodies fell under their gift, and thereby plentifully supplied their theatre for many years past.” They consequently beg that the magistrates will seek for and punish the offenders, and resolve to expel any of their number found accessory to the violation of graves. The populace nevertheless continued to be excitable on the subject of the violation of graves, and in 1721-2, surgeons’ apprentices were especially bound “not to raise the dead.” In March 1725 Monro was put under the stringent obligation of giving information when he procured each dead body, and guaranteeing that it was regularly obtained; but the mob were suspicious, and threatened to demolish his museum and theatre at Surgeons’ Hall. Monro consequently applied for and obtained a room in the university building, being there safer than at Surgeons’ Hall. Here his course included dissections not only of the human body, but also of animals. Diseases affecting the various organs were referred to; operations upon the dead body were performed; bandages were applied; and lastly, such physiology as was known was treated of. This course was continued for nearly forty years.