Medicine and the Industrial Revolution . A force for change in 18th and 19th century Scottish medicine.

The establishment of good medical practice in Scotland is as much part of the Industrial Revolution asMedieval doctor with nosegay mask. the ingenuity that went into developing mighty pieces of machinery. A more widespread medical treatment for the common man began its existence in the towns and cities with its development fostered by the demand from poor people in overcrowded housing, no sanitation and a lack of awareness among the populace to the cause and spread of disease. Factors such as these forced consideration of the causes and contributed to the worldwide reputation of both Glasgow and Edinburgh as centres of excellence for medical training.

Medicine and medical aid from the medieval times rested mainly with the monasteries and  the Augustinian monks who did much good service with herbal remedies. One such establishment that has recently been subject of archaeological investigation is that of Soutra Aisle, between Edinburgh and the Borders near Duns Law. Founded  ca 1160 it was run to assist  the poor, travellers, the sick, aged and as a refuge. Funded by the monastic estates  it was probably the best endowed medieval hospital in Scotland and received its charter  from Malcolm IV in 1164.The `digs` have produced a rich store of data pointing to the use of medicaments  from all over the known world, including cloves  from East Africa; mixtures of hemlock, black henbane and opium poppies apparently used as sedatives during amputations. Researchers have uncovered evidence that surgery and psychiatric services were supplied and that illegal abortions were made ( bones of very young infants, still born, have been recovered). Instruments such as scalpels point to widespread blood letting; opiates  mixed with lard; a form of disinfectant made of myrrh and honey has been found; and ointments for scabies and louse made with arsenic. A mixture of liquorice and coltsfoot plant was given for coughs , bronchitis and catarrh, There was also  signs that the diet of patients was of concern with  minerals, vitamins and sea salt brought in from further afield. The hospital declined ca 1460 when complaints were made to Rome, and the estates were confiscated  and assigned to the Trinity College Hospital in Edinburgh. Before then, in 1336 a prohibition was placed on  any friars from practicing medicine  because of some scandal ( eg abortions ?); hitherto they had been allowed to practice with a licence granted by the prior. In 1553 the Chapter General  of the  Black Friars  decreed " We ordain and most strictly prohibit every one of the friars of our Order, under the pain of the graver fault, from following the art of the doctor, physician, or surgeon, and all permits hitherto granted we absolutely annul."

There had long been the shamans and those knowledgeable in `country ` or `folk ` medicines. In the Highlands there was the strong Gaelic tradition of the Beatons and the McConachers as the traditional physicians. In the Lowlands the educated laird or minister and his wife might have had some rudimentary knowledge. The fact was that only the rich had benefit of medical advice through their employment of the few doctors that were available in Scotland at the beginning of the 18th century. Moreover it was a time when the dictum of the 16th century essayist, Francis Bacon, held true - " the weakness and credulity of men is such that they will often prefer a mountebank or witch before a learned physician."

Until the establishment of a faculty of medicine  in 1726 there was little by way of trained doctors available nor was their practice controlled. Thus the streets were available to the peripatetic quacks  and their sideshows to amuse, entertain and bemuse the gullible people of Edinburgh. The city in the early 1700s was of some 40,000 souls, closely packed together, rich and poor rubbing shoulders and sharing their diseases. The quacks were often showmen and apart from selling oils, balms, unctions, pills, potions, and liquors of dubious origin, they also staged entertainments such as tight rope walking, juggling, dances and plays. For a populace working six days a week with the seventh day bound to the kirk, relaxation was little and such shows a great entertainment; and a source for `folk medicines` that sometimes worked. But in the main they were a confidence trick and the medication sold for whatever the quack could get. In one instance a Jon Pontius sold his medicine (1663) for one pound Scots,  at a later visit the same was sold for 1.9s.0d;  but on a third visit it was only 18 pence. He apparently did a good trade with local physicians who bought his medicines for resale at a profit. In later years the Guild of Surgeons was founded and they took action where possible against the mountebanks and quacks intruding on their trade. On later years the sideshows gave way to better educated persons, perhaps with some actual medical training, who made exaggerated claims for their skills, such as curing `stammering or hesitation of speech`, and disease of the eyes ( including short sightedness). Of the latter, John Taylor MD visited Edinburgh in 1744, calling himself "Chevalier John Taylor, Opthalminator, Pontifical, Imperial, Regal" who had trained at St Thomas` Hospital, London. Part of his presentation was a lecture on "The Eye" given to persons of quality, which is described as a "tissue of bombastic nonsense, but no word  of the anatomy  or diseases of the eye which he professes to describe and treat". This charlatan was quick to turn to his advantage the attendance of any doctors or physicians to his lectures, implying that they did so to learn from his expertise. Finally the Royal College of Surgeons and the President  and Fellows of the Royal College of Physicians had an exchange of letters which helped drive him away - to Glasgow.

Horace Walpole (1717-1797) wrote of Taylor:

Why Taylor the quack, calls himself Chevalier,
Tis not easy a reason  to render,
Unless he would own what his practice makes clear,
That at best he is but a Pretender.

Sir Robert Sibbald (1641 - 1722 ) was instrumental in the founding of the Edinburgh Botanical Gardens and by growing medicinal herbs there he produced his "Pharmacopoeia " in 1699.  He was Professor of Medicine at Edinburgh University in 1685  and also wrote a pamphlet proposing solutions  for poverty. The pamphlet "Provision for the Poor in Time of Dearth and Scarcity""  listed Scottish herbs and wild plants that were edible and even advocated eating cat flesh as a means of sustaining life. He also stands tall in Scottish medical history for the founding of the Royal College of Physicians where he was one of the earliest Fellows. He and others saw there was a need to train the medical man, the physician and the surgeon; and separate them from the quack and the apothecary. So it was that with the aid of surgeon, John Monro and the Lord Provost George Drummond, the Edinburgh medical faculty was founded in 1726

The first professor was Alexander Munro (1697 - 1767 ) - who founded the Edinburgh Royal Infirmary ; followed by his able son Alexander (1733 -1817) and a grandson, the third Alexander Munro (1773 - 1859).

Anatomy can never be far from the mind in Edinburgh for here were the infamous Burke and Hare, the body snatchers who eventually murdered in order to keep up their supply of bodies for anatomical examination by the likes of Dr Robert Knox (1791 - 1862). A final irony for William Burke, who was hanged on 28 January 1829, was that he was convicted on the testimony of his accomplice, Hare, and his body was also used for anatomical study. One of the products created to stop body snatching was the Kingskettle Collar, an iron hoop around the neck and bolted to the coffin ; another was the ` mort safe` - a heavy metal cover that dropped over the coffin, which would be kept there for six weeks or so after which the body was of no use for dissection in anatomy lessons.

The proper study of the human body by observation had begun in Italy and brought to Scotland by Peter Lowe of Glasgow, who was the driving force in creating the Faculty of Physicians and Surgeons of Glasgow in 1599. The Hunter brothers , William ( 1718 -1783) and John (1728-1793 ) were anatomists born in East Kilbride, who made their names in London. John Hunter worked at St. George's Hospital in London at a time when very little was known about the workings of the human body. His own work in dissection, examining dead bodies to understand how they function, made him the founder of pathological anatomy. William was a pioneer in obstetrics. Both were collectors of sample parts of the human body and were the founders of the Hunterian Collection at the University of Glasgow. As early as 1678 the surgeons in Edinburgh were pressing for the provision of bodies, having an agreement that they would receive  a malefactors body once a year. At this time it was common practice in Paris and Leyden  to provide bodies of those who died in hospital, for disection.

Inherent in the teaching of anatomy was the development of surgical skills with eminent surgeons such as Robert Liston (1794 - 1847 ) from Ecclesmachan, West Lothian, whose speed in the operating theatre was legendary. Liston was responsible for publicising the early use of ether as an anesthetic when he removed the right leg of a Frederick Churchill, a Harley Street butler, on 21 December 1846. This was widely publicised although the first doctor to use ether in EuropeDr William Scott was in fact Dr William Scott (photo right), a surgeon at the Dumfries and Galloway Royal Infirmary two days earlier on 19 December 1846. To the operating theatre also came London born Joseph Lister (1827 - 1912) who became surgeon at Glasgow Royal Infirmary in 1860 and introduced the use of antiseptic carbolic acid sprays to control infection to wounds. While William MacEwan (1848 - 1924 ) developed aseptic surgery which involved sterilizing equipment and bandages and ` scrubbing up` of the staff involved in the operation.

Experience of anatomy before the creation of proper schools usually came from the battlefield and the often crude amputations that it called for. Military service abroad also played a part in the use of quinine for treatment of malaria which was at one time rife in Scotland, as discovered by Army surgeon George Cleghorn (1716 - 1794). In later years Sir Patrick Manson ( 1844 - 1922 ) was to make the link of malaria and the mosquito. While James Lind ( 1716 - 1794) a Naval physician, identified that a diet of fresh vegetables or including citrus fruits was a cure for scurvy.

IJoseph Black M.D.n Glasgow Joseph Black ( 1728 - 1799 ) was professor of anatomy from 1756 and then of chemistry in Edinburgh from 1766. He discovered carbon dioxide and the concepts of latent and specific heat. In doing this he used the thermometer developed by George Martine ( 1702 - 1741) and Alexander Wilson ( 1714 - 1786 ) both of St Andrews. Most important of Joseph Black`s work was that he brought the concept of scientific measurement to medicine and the use of the fine chemical weighing scales and the thermometer.

Other, better known, discoveries followed in the 1800s with James Braid ( 1795 - 1860 ) discovering hypnosis. Sir James Young Simpson (1811 - 1870) (image right) discovered chloroform as an anaesthetic and although subject of some criticism by the clergy he championed its use. Acceptance by all was given a great boost when Queen Victoria used chloroform during child birth. Alexander Wood (1725 - 1800) discovered the hypodermic syringe and, of course, there was Alexander Fleming`s (1881-1955) discovery of penicillin. Less well known but important was the work of John Hughes Bennett ( 1812 - 1875 ) who was a pioneer pathologist and discovered Leukaemia. Other Scottish doctors of note include, Robert Philip (1857-1939), tuberculosis expert, and John James Rickard Macleod, who was born in 1876, a leader in the field of diabetes research, heading the group that discovered insulin.

Scotland was also to the fore in providing treatment for mental disabilities. The Crichton Institution for Lunatics was funded by the bequest of James Crichton of Friars Carse, Dumfries. In the following year it became the Crichton Royal Hospital by Act of Parliament. The advertisement for the hospital`s opening in June 1839 includes this statement, indicating policies that were far ahead of their time:

" The great principles upon which this Institution will be conducted are justice, benevolence, and occupation; and by the application of these the Patients, in so far as is consistent with their condition, will be induced to regard the Asylum as a home, and those to whose care they are confided as friends and companions. "

Its innovative treatment under Dr William Browne included patients taking part in amateur dramatics and producing their own magazine that was widely circulated. - all the therapy now promoted 150 years later. And in 1854, Dr Browne initiated a course of thirty nursing lectures - six years before Florence Nightingale grabbed the headlines. The hospital thrived and expanded to take in some 1000 acres of land with farm buildings, electricity generators, a church, and houses to accommodate various categories of patients.

The hospital became a showpiece and a leading establishment for treatment of mental illness in all Europe. In the post war years the Easterbrook Hall., Crichton Royal Hospital,Dumfries hospital was to the fore with physical treatments such as Electric Convulsive Therapy (ECT), Insulin Coma Therapy and pre frontal Leucotomy. With new drugs from about 1950 the hospital achieved recovery rates that hitherto were unimaginable and was regarded internationally as a training and treatment centre. Easterbrook House is now the location for a medical museum.

Among the early leaders in health education was Dr William Buchan ( 1729 - 1805) who practiced medicine in Edinburgh for 12 years and produced many papers on health education. His book " Domestic Medicine " was the first book to give simple, pragmatic advice on health issues - particularly personal hygiene, based on ` modern ` medicine. An annex to his work included a pharmacopoeia and advice on treatment of some common diseases. In this work of educating and helping the common man there was the indefatigable Andrew Duncan ( 1744 - 1828 ) who set up the Edinburgh Public Dispensary in 1776.

The need to tackle the environmental problems, the overcrowding ; lack of clean water, negligible sanitation crystallised in Glasgow which by the end of the 19th century was at the centre of the most heavily industrialised area in the world. Into this arena came James Russell (1837 - 1904 ) as Medical Officer of Health. He worked with other specialists and got to know the problems of the workers - those in jute and flax manufacture suffered from dust inhalation as did miners and quarry workers; ironworkers suffered from excessive heat; and lead was poisonous. He took an interest in food, its storage and preparation and brought in meat inspectors. A major improvement was brought about by the employment of Isambard Kingdom Brunel and Robert Stephenson to report on the means of delivering fresh water to the city. This was finally achieved in 1859 by bringing 50,000 gallons of water a day the 34 miles from the Trossachs. In 1878 the first `wash house` was established that allowed washing of clothes and linen, followed by public bath houses and a swimming pool.

In Edinburgh too, the need for fresh water had been addressed as early as 1675 by supply from springs in the Pentland Hills and using the force of gravity to deliver it from a reservoir atop the Castle Hill to water cisterns around the city. This supply was little enough and over time some 13 reservoirs were created to fill the city`s needs. Sir Henry Duncan Littlejohn ( 1826 - 1914.) was another enlightened Medical Officer of Health who oversaw these changes to water supply and sanitation. He also brought in the requirement to notify infectious diseases so as to prevent epidemics, such as typhus, ripping through the overcrowded tenements.

Through the Industrial Revolution and into the 20th century, many thousands of Scots died from diseases such as smallpox, typhus, cholera and even malaria. Many men women and children were crippled in the course of their often dangerous work and required life saving surgery, or suffered from disease that thrived in the appalling living conditions of their day. The contribution made by the doctors and surgeons undoubtedly made their life longer but also brought increasing pressure to bear on the private landlords who owned the slums, and thereby contributed to the social engineering and improvements for the common good.

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