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

by G. T. Bettany

A great hospital was lacking, and the whole force of the medical faculty, with the powerful aid of the far-seeing provost, George Drummond, was engaged to secure the building of the infirmary. Monro and Drummond were constituted a Building Committee, and Monro planned in particular the operation-room. Dr. Moore in his Travels through Scotland records that “the proprietors of many stone-quarries made presents of stone, others of lime; merchants contributed timber; carpenters and masons were not wanting in their contributions; the neighbouring farmers agreed to carry the materials gratis; the journeymen masons contributed their labours for a certain quantity of hewn stones; and as this undertaking is for the relief of the diseased, lame, and maimed poor, even the day-labourers could not be exempted, but agreed to work a day in the month gratis toward the erection. The ladies contributed in their way to it; for they appointed an assembly for the benefit of the work, which was well attended, and every one contributed bountifully.”

The completion of the hospital gave Monro the opportunity of delivering clinical lectures on surgery, while Rutherford from 1748 gave clinical lectures on medical cases. Monro himself was present at every post mortem examination, and dictated to the students an accurate report of the case. It was said of him “it is hardly possible to conceive a physician more attentive to practice, or a preceptor more anxious to communicate instruction.”

His first and perhaps best known work was his Osteology, published in 1726, and translated into several foreign languages. A French edition appeared in folio with excellent engravings by M. Sue, demonstrator to the Royal Academy of Paris. A treatise on the Nerves followed; and later, a series of Medical Essays and Observations, many by Monro, was issued by him, as the result of meetings of the principal medical men in Edinburgh, which flourished for some years. Another interesting work of Monro’s was his treatise on Comparative Anatomy, in which he proposed to illustrate the human economy by the anatomy of such vertebrate animals as he knew. But the contrast is astonishing between Monro’s knowledge and that of the present day. He divides quadrupeds into carnivorous and herbivorous; fowls into those that feed on grain and those that feed on flesh; fishes into those that have lungs and those that have not. He remarks that the fishes that have lungs differ very inconsiderably from an ox or any other quadruped, and are not easily procured; consequently he omits all account of them. Moreover, he says, “as the structure of insects and worms is so very minute, and lends us but little assistance for the ends proposed, we purposely omit them.” He has a strangely unpenetrating view of the relation between an oyster and a sensitive plant. “What difference is there betwixt an oyster, one of the most inorganised of the animal tribe, and the sensitive plant, the most exalted of the vegetable kingdom? They both remain fixed to one spot, where they receive their nourishment, having no proper motion of their own, save the shrinking from the approach of external injuries.” Dr. Monro’s writings generally are not inviting to quote from, being written in a plain and rather bald style, with very little attempt at illustration.

In private life Monro, primus, was humane, liberal in sentiment, a sincere friend, and an agreeable companion, an affectionate husband and a kind father, having the art of making his children his companions and friends. In 1745, after Prestonpans, he went down at once to the battlefield to assist the sick and wounded, dressed their wounds, and busied himself in securing them provisions and conveyance to town. Nor did he confine his attentions to the loyal, but aided the rebels also. He took an important share in the education of his children, of whom Donald became a successful physician, and wrote his life prefixed to the quarto edition of his works, 1781, to which all subsequent biographies are much indebted.

Monro was a man of a strong muscular make, of middle height. Yet his constitution was considerably weakened in early life owing to his being too frequently bled. He was liable to attacks of chest affections throughout life, but died finally of a painful ulcer of the rectum and bladder, on July 10th, 1767. He had resigned his chair of anatomy to his son Alexander in 1759, but continued to practise and to attend the infirmary till the last. He bore his painful illness with fortitude and Christian resignation, and talked of his approaching death with the same calmness as if he were going to sleep.

“He was,” says Professor Struthers, “an able and active, and at the same time a calm and placid man. He had family and friends influential and plenty, but the work he had to do was of a kind at which friends could only stand and look on. He had to do a new thing in Edinburgh; to teach anatomy and to provide for the study of it, in a town of then only thirty thousand inhabitants, and in a half-civilised and politically-disturbed country; he had to gather in students, to persuade others to join with him in teaching, and to get an infirmary built. All this he did, and at the same time established his fame not only as a teacher but as a man of science, and gave a name to the Edinburgh School which benefited still more the generation which followed him.”

Although we must depart from strict chronological order to do so, it will be more convenient to give here an account of the second Monro, who was born May 20th, 1733, and was early attracted to the study of anatomy, showing great perseverance and possessing a good memory. He soon became a very useful assistant to his father in the dissecting-room, and when the students grew too numerous for one lecture, his father deputed his son, at the early age of twenty, to repeat his course in an evening lecture to those who had failed to obtain admission in the morning. His father, seeing how successful his son was, petitioned the Town Council to have him appointed as his colleague and eventual successor, promising, if this were granted, to send his son to the best medical schools in Europe, and in every way to fit him for the post. This plan being carried out, young Monro took his M.D. degree at Edinburgh in 1755, and set out for a round of medical schools, London, Leyden, Paris, and Berlin; in London he attended William Hunter; in Berlin he had the still greater advantage of living in the house of, and sharing the intimate instruction of, the great anatomist, Meckel—a truly good start for a promising career. On his son’s return to Edinburgh in 1758, his father resigned his chair to him, and the son commenced by teaching quite novel views on the blood, controverting his father’s teaching. “The novelty of his matter, combined with the clearness of his style, is described by one who was present as having acted like an electric shock on the audience. It was at once seen that he was master of the subject, and of the art of communicating knowledge to others; his style was lively, argumentative, and modern, compared with that of his more venerable colleagues; and from the beginning onwards, for half a century, his career was one of easy and triumphant success” (Struthers). As a lecturer he was clear, earnest, and impressive, eloquent without display, and at the same time grave and dignified. No wonder that his classes increased in size, until they even reached four hundred.

At the same time Monro entered into practice as a physician, and became one of the leading practitioners in Edinburgh, so much so that Dr. James Gregory described him as being far more than half a century at the head of the medical school, and for a great part of that time at the head of the profession as a practising physician. He was also frequently called into consultation on surgical cases, though he did not operate. His chief fame is, however, as a successful anatomist and teacher of anatomy. In 1777 he successfully resisted the appointment of a separate Professor of Surgery, claiming that his office included surgery.

Monro secundus claimed, and not without good grounds, to have made important original discoveries in regard to the lymphatic system; but his merits as a discoverer in this department do not interfere with the greater lustre of William Hunter and Hewson. His observations on the structure and functions of the nervous system enjoy the distinction of having called Sir Charles Bell’s attention to the ganglion of the fifth pair of cranial nerves, and to important particulars of the origin of the spinal nerves, which led in no insignificant degree to his own great discoveries.

In 1758 Monro published at Berlin his first essay on the Lymphatics, and Professor Black testified to having read this essay in manuscript in 1755. It contained an account of the lymphatics as a distinct system of vessels, having no immediate connection with the arteries and veins, but arising in small branches from all cavities and cells of the body into which fluids are thrown, and stating that their use was to absorb the whole or the thinner parts of these fluids, and to restore them to the general circulation. He showed further by medical observation that in cases where acrid matter was applied to the pores of the skin, or gained access to the cellular membranes, the glands between the parts affected and the centre of the body became swollen and painful, manifestly from being absorbed by the lymphatics.