ARCHIBALD PITCAIRNE

By L. JOLLEY, M.A. Librarian of the Royal College of Physicians of Edinburgh

Archibald PlTCAIRNE occupies an ambiguous position in the history of medicine. Edinburgh and Leyden hold him in honour as one of the founders of their medical traditions. The rest of the world remembers him, if they remember him at all, merely as one of the more extreme exponents of the iatro-mechanical doctrines. Many of the histories 1 of medicine omit his name. Haeser devotes more space to him than any other historian but for Hseser Pitcairne is merely an outmoded and irrational theorist with a taste for useless and disgusting remedies. It is hard to see how such a man could have won an international reputation and have been remembered with pride and affection by succeeding generations. 3^952 is the tercentenary of Pitcairne's birth and an appropriate occasion to re-examine his achievements and try to reconcile the conflicting impressions of the man. The outline of Pitcairne's life is generally familiar. Born on Christmas day 1652, the son of a prominent Edinburgh merchant, he first planned to enter the church but like his great contemporary and rival, Sir Robert Sibbald, he was repelled by the barrenness and violence of late seventeenth century presbyterianism. After con- sidering the law he decided on medicine. He graduated M.D. at Rheims in 1680 and returned to Edinburgh to practice. He rapidly became one of the leading Edinburgh physicians and when the Royal College of Physicians received its Royal Charter on St Andrew's Day 1681 he was elected a Founder Fellow and became its second secretary. In 1692 the University of Leyden invited him to become Professor of Medicine. His stay there was brief and within twelve months he had returned to Edinburgh. The causes of his return are not altogether clear but pressure from the relatives of his second wife, Elizabeth Stevenson, certainly played a part. The rest of his life was marked by no external incidents of note and he died in 1713- Despite the fact that he spent the greater part of his life remote from the medical centres of the day Pitcairne was never isolated. He remained in con- stant touch with the great continental physicians and indeed an un- " friendly critic said of him that from the depths of Scotland he 2 attempted to reign over the whole of medicine." It was from his published works that Pitcairne drew the European reputation he enjoyed in his own day and an examination of these works must come first in an effort to see him again as his contem- A Sydney Watson Smith Lecture delivered in the hall of the Royal College of Physicians of Edinburgh, 18th December 1952. 40 L. JOLLEY

poraries saw him. It must be admitted that these works contain no> distinctive original contribution to knowledge. It is true that Pitcairne, by a process of arithmetical calculations rather similar to those employed by Harvey himself, arrived at the conclusion that the circulation of the blood was completed by its passage through the minutest vessels of the body.3 His deduction of the existence of the capillaries had, however, been anticipated by Malpighi and Leeuwenhcek who worked on the sounder basis of microscopic observation. There is no reason to doubt the originality of Pitcairne's work but it cannot entitle him to even a modest place amongst those who are remembered because they made some essential addition to the understanding of the working of the human body. This is an admission which must be made but it remains true that Pitcairne clearly contributed something to the study of medicine which his contemporaries valued. His first printed work, A Solution of the Problem Concerning Inventions (1688), is a discussion of those passages in Hippocrates which were cited by Harvey's enemies to show that the circulation of the blood was no new discovery. In the seventeenth century a physician had still to be a master of Greek and Latin learning and Pitcairne, one of the most distinguished of Scots Latin poets, was not deficient in this. But the work is more than a display of classical knowledge. It is primarily a discussion of the principles of evidence and a plea for reason and demonstration against authority. Pitcairne constantly turns to the mathematicians for help in showing how conclusions should be drawn because the mathematicians have established a certain method of reasoning. The combination of well-knit argument and wide knowledge of the early medical writers proved irresistible, and by this little work Pitcairne finally disposed of the obscurantists who when no longer able to deny the circulation of the blood, maintained that the ancients knew all about it. The Solution of the Problem of Inventions first drew attention to Pitcairne. The Oration Proving the Profession of Physic Free from the Tyranny of anty Sect of Philosophers (1692), established his repu- tation with his contemporaries and the study of it still provides the best explanation of that reputation. It was delivered as the inaugural lecture in the chair of medicine at Leyden and won from the University authorities the unusual recognition of a doubling of the professor's stipend. In some histories of medicine the Oration is referred to as a manifesto of the iatro-mechanical school, but this it is not. Although the title suggests a theme completely remote from any modern interest, what Pitcairne is discussing is a subject of perennial importance? what are the problems the physician should attack and how should he go about them ? Pitcairne sets out to explain why medicine in 1692 has not made the advances which it could have been expected to make. The practical improvements which should have sprung from the great discovery of the circulation have not appeared. In the course of the century all the other sciences have made great advances, ARCHIBALD PITCAIRNE 41

" but After so great improvements in Botany and Anatomy and the appearance of a new Face of Things in so many other Arts we still find the old Standard of Physic prevail everywhere." There are two reasons for this. Physicians have asked the wrong questions and have not understood the scientific evaluation of evidence. A physician must confine himself to what will have practical consequences in curing diseases. Medicine has been entangled with metaphysics and the art " of physic is over-burdened with conjectures. Such Enquiries after Physical Causes as are generally proposed by the Philosophers are entirely useless and unnecessary to Physicians. For these are points which the Heads and Patrons of Sects have wrkngled about from the beginning of the World to our days and all to no purpose." A "Physical " " Cause which the philosophers seek after is that unknown something " in things from which they derive all its properties. The business of a physician is "to weigh and consider the Powers of Medicine and Diseases as far as they are discoverable by their Operations and to reduce them to Laws," not to seek after Physical Causes. He must " compare the observations that have been made by others, and continue to be made everywhere, upon Diseases and their Remedies, and without Regard to Opinions, which are nothing in Comparison to the certain Convictions of our Senses, to collect from what usually happens, what will, and what we are to do in that case." The physician must limit his objectives. He must also distinguish carefully between what he knows and what he conjectures. "It is unfair to assert anything for Truth either in the Theory or Practice of Physic which stands in such a degree of uncertainty as no man would willingly have the security of his Property to stand." The methods of the mathematicians and astronomers must be the methods of the " " physician. These do not trouble about a Romantick Hypothesis concerning the structure of the world but depend upon observations and deduce their laws from them. Astronomers are not worried by " " " Frivolous Disputes" whether or not Substantial Forms or " " Subtile Matter exist, but helped by a few Postulata work out the motions of the stars. Physicians must imitate them. They are not to assume things as certain which are doubtful. They are not to revive the old meaningless terms of the ancients in a new form but to cultivate " physic not under the disguise of such fictions but upon the trials of experience." Iatro-mechanical theories do peep through in many parts of the Oration but they are not its main theme and do not account for its reception. What Pitcairne presented to his audience was the prospect of a new and more rational approach to medicine which would be certain to produce startling results. The advances of the mechanical and mathe- matical sciences had already begun to transform the environment in which men lived. If medicine were only to discard the impertinent discussion of useless speculations and adopt the methods of the mathe- matical sciences then it in its turn would make a great leap forward. 42 L. JOLLEY

It is easy to understand the enthusiasm of Pitcairne's audience. To them as to the writer of the introduction to the English translation of " his works He was one of the first who leaving the old conjectural Method of Physical Writers struck into a new and more solid way of Reasoning grounded upon observations and upon Mathematical " Principles," and who took it as his task to lay more certain and infallible Fundamentals of the most comprehensive Art the Mind of Man is capable of attaining." Medicine is the slowest and most disappointing of the sciences and certainty and infallibility still elude it. To seek for these qualities in the seventeenth century was to court disaster and it is the illusion of having found an infallible method which betrays the cautious argument and solid scepticism of the Oration. Infallibility and simplification have at times destroyed a number of systems of medicine and the later works of Pitcairne do not bear out the hopes of the Oration. But if the Oration held out too much promise the points made were good and needed making. Medicine was too much entangled with metaphysics and even in the following century the writings of Haller, Whytt and Cullen, to name only a few, are often too much occupied with the discussions of problems which, whatever their ultimate value, were outwith the scope of the knowledge of the time. Unfortunately, Pitcairne could not keep in mind his own cautions and an account of the rest of his work is little more than a catalogue of the absurdities into which a brilliant mind can fall. Even his demon- stration of the existence of the capillaries is followed by a triumphant " corollary From the Principles here laid down it follows that the inspired Air is not mixed with the Blood in the lungs for the Service of Respiration." 4 By means of mathematics and the circulation of the blood, Pitcairne can explain everything from the non-contagious nature of venereal diseases 5 to the physiology of menstruation.6 Often he seems to leave reality far behind as when he gravely discusses the amount of perspira- tion which will have the same power of curing a fever as iooo stools in a day.7 There is no use attempting a precis of all Pitcairne's work. An admirable summary of his distinctive opinions can be found in a letter written by Dr John Drummond, a brother of the famous Lord Provost of Edinburgh, and a President of the Royal College of Physicians from 1722-27, on the occasion of Pitcairne's death.8

" He was the most learned Physician that this Kingdom ever bred. He was professor of Medicine at Edinburgh and Leyden, and he graced and adorned these chairs with uncommon learning and knowledge. His excellent disserta- tions are lasting monuments of his noble genius and of what advantage and light he has thrown into the darkest part of Medicine. In them he proved the continuity of the veins and arteries without which the circulation of the blood was imperfect. He has demonstrated the necessity of obstructions happening in the arteries rather than in the nerves, and in the nerves rather than in the veins and that from their make and figure. He both explained respiration and ARCHIBALD PITCAIRNE 43

the structure of the lungs and has proved that the air does not penetrate through the coats of the vessels to mix with the blood in them contrary to the opinion of the great Borelli. He has told us how digestion is performed, viz., by the strong muscles of the stomach, and the muscles of the diaphragm and abdomen and all this in a due mathematical way. He has destroyed ferments in the stomach and other parts of the body for correcting of which so many unnecessary drugs were given by physicians. He has established the circular figure of pores and defeated the contrary opinion and has given sufficient hints by which secretion and nutrition may be explained. He has banished materiae subtiles. occult qualities, and such other gibberish and has shown that acids and alkalies, as such, cure no diseases. He has demonstrated the evacuations proper in fevers by exact calculation. He has explained vision and demonstrated the nature and diseases of the eye and their causes. To be short, he has joined the Physician and Mathematician so happily together that he has given us in a manner, an ceconomia animalis, at least he has explained and demonstrated the most difficult and most considerable things in ceconomia animalis that his dissertations are so far the only solid institutions of Medicine we now have."

That Pitcairne who began by stressing the necessity of never asserting as true what was in any degree uncertain should end by so completely disregarding his own precepts is not in itself hard to explain. His personal qualities and the age in which he was born conspired against him. Pitcairne had an acute and forceful, even brilliant, mind, but he was not a sufficiently profound thinker and above all he lacked the to discern the truths which beneath , patience lay the confused and often contradictory terminology of the first physiological chemists. Mathematics was the first, probably because it was the most abstract, science to be free to develop in Scotland and mathematics remained the standard by which Pitcairne judged all reasoning. Two men fascinated Pitcairne and their names constantly recur in his writings?Sanctorius because he reduced the functions of the human body to weights and measures, and Huygens because he showed that even the games of chance were subject to mathematical laws. Harvey was the greatest influence of all. The publication of the De motu cordis had been followed by a number of works of therapeutics and " diagnosis according to the circulation of the blood." Their novel qualities extended no further than the title page but Pitcairne really tried to erect a system on the twin pillars of the circulation of the blood and mathematical reasoning. Pitcairne was not restricted to this inadequate foundation because he was a mere theorist. He was a distinguished anatomist, and, as will be shown later, constantly tried to check his conclusions by experiment. He was obsessed with the discovery of the circulation partly because it had been arrived at by the two methods of arithmetical reasoning and experiment. It happened that the first of these methods was not well adapted to the discoveries still to be made. Nor was Pitcairne's general outlook. He had learned from Bacon to restrict inquiry to questions which can profitably be asked but this conception had been vitiated by that rather shallow rationalisation, that distrust for anything confused, uncertain and half 44 L. JOLLEY apprehended which dominates the first years of the eighteenth century. Pitcairne was a great admirer of Arbuthnott and is thus linked to the world of Pope and Swift. The self-imposed limitations which provided great literature in these writers had overwhelming disadvantages when applied to a science in which the unknown far exceeded the known. The figure who immediately suggests himself for comparison with Pitcairne is John Brown, the author of the Brunonian theory. Both put forward a simplified physiological explanation of disease. Both had their views uncritically and wholeheartedly accepted by a large following. Both were distinguished classical scholars and found their mastery of Latin a ready aid to the ear of Europe. But in one very important respect the comparison breaks down. Within a few years after Brown's death his views were rejected and his name sunk into neglect from which it has never since been revived except by pro- fessional students of the history of Medicine. The history of Pitcairne's reputation is quite different. During the whole eighteenth century he retained his renown. Speaking at a Harveian oration in 1781, sixty- nine years after Pitcairne's death, Charles Webster has no doubt that Pitcairne's physiological views have been completely discarded but this has not destroyed his regard for Pitcairne as a physician as well as a man.9 The difference in the posthumous reputation of these two men, so alike in some ways, is striking. If we can explain it we are probably coming near to a true judgment of Pitcairne's place in the history of medicine. One possibility which suggests itself at once is that it was Pitcairne's status as a practising physician which secured his good name amongst his immediate successors. Webster himself makes the very interesting point that Pitcairne's actual practice in handling diseases was very little different from the practice generally prevalent in 1781. Dr John Drummond in the letter already quoted goes on, after relating Pitcairne's " " discoveries in physiology," to add Neither were these idle specu- lations and vain amusements, for he founded on them a rational practice, which he had so universally here (i.e. in Edinburgh) for many years and performed with so great judgment and success, that even these Physicians who had no goodwill at him were forced to acknowledge his inventions and follow his methods in curing diseases, which is the best known in any part of the world being short and proper and free from the idle pomp and unnecessary farrago of too many drugs." This is in striking contrast to Haeser who, and he is echoed by Major Greenwood,10 dismisses Pitcairne as an extreme speculator who in practice fell back upon disgusting and superstitious remedies. Before going on to consider Pitcairne's therapeutics it may be well to call attention to one aspect of his medical theory which has been generally overlooked. In his time Pitcairne was reputed to have played a great part in simplifying the art of prescribing.11 He left no published treatise on materia medica but references to his influence in reducing the number and complexity of the drugs in general use are wide- ARCHIBALD PITCAIRNE 45 spread. It is well known that the Pharmacopeia of the Royal College of Edinburgh represented a great advance in simplification and Pitcairne's part in producing the Pharmacopeia may have been considerable. Sibbald complained of the factious delays to the publica- tion of the Pharmacopeia. It is possible that there were in reality efforts on the part of Pitcairne and his friends to delete even more of the meaningless complexities of remedies but no documents survive to support or oppose this conjecture. Fortunately, it is relatively easy to form some estimate of Pitcairne's methods as a physician. His published works include one or two therapeutic treatises and in addition he left behind two most valuable volumes of manuscripts. One of these is in the Library of the Royal College of Physicians and is in two parts entitled : Praxis medica Pitcarniana, and : Collegium medicince practicum secundum methodum Riverianum ordinatum per Archibald Pitcairne, M.D. This work is a fairly systematic presentation of Pitcairne's practice. The other MS. volume is in the Library of the University of Edinburgh and bears the title Praxeos Pitcarniance. I am told by Dr Sharp, the University Librarian, that it most probably reached the University from the family of Dr David Gregory, Savilian Professor of Astronomy at Oxford. It contains five most interesting letters written by Pitcairne to Gregory as well as a certain amount of material not connected with Pitcairne. For the most part, however, it consists of letters sent to Pitcairne by other physicians and surgeons and occasionally by patients. Like all compilations of this kind it makes melancholy reading. For obvious reasons it deals for the most part with chronic diseases and although many of these doubtless arose from organic causes which were hidden from the eighteenth century physician, and can hardly be uncovered at this time, it is clear that an appreciable proportion reflect the idleness and vacancy which is the obverse side of the spacious days of the eighteenth century. Ill-health as a social diversion or as an escape from emotional and intellectual difficulties flourished far more in earlier centuries than it can to-day, and its chronicles are dreary reading. But many of the letters present a vivid picture of Pitcairne as a physician. The study of the Prdxeos Pitcarniance disposes quite clearly of the allegation that Pitcairne was particularly addicted to scatological and similar remedies. The powdered human brain which is prescribed in the printed directions for the treatment of the smallpox is not repeated in the Praxeos. It is unfortunate that this cure for the smallpox achieved the popularity it did. It is not a fair representation of Pit- cairne's practice. It is perhaps because of its fanciful and unpleasant character that it was reprinted in Moncrieff of Tippermalloch's Poor Man's Physician, a work which contains so much which is nauseous and useless. It would be untrue to make out that such remedies are never repeated in the Praxeos. A Scots noblewoman suffering from a " menstrual irregularity is prescribed asses and mares milk, millipedes 46 L. JOLLEY and an infusion of horse-dung." Another noblewoman with cholick " is prescribed the Horse Dung Possett." My Lady Ross who suffered from melancholia and "weeps intolerablie and wishes to be in " England receives millipedes. A case has, of course, been made out for millipedes if not for horse dung and sheep's purles. But these remedies are very rarely prescribed. A list of standard remedies in- " cluded in the Praxeos gives a very small place to Animali partes," and all these were drugs in general employ. It has been stated that patients in the north of England refuse medicines which lack a disagree- able taste and perhaps Pitcairne's use of unpleasant remedies is based on a not unrelated principle. But the overwhelming bulk of Pitcairne's drugs are drugs which remained in general favour down to at least the beginning of the present century. The drug in whose powers Pitcairne had the greatest faith is the preparation of mercury known as mercurius " dulcis. In one letter to Gregory he refers to this as the panacea." Apart from drugs, milk, of mares, asses and women, is frequently prescribed, and so is the goat whey which is popularly associated with Cullen. Setons are recommended for such different conditions as whooping-cough and epilepsy. The cold bath is employed and Pitcairne must be numbered amongst the hitherto unrecorded pioneers of sea " bathing, for he writes, Sir, the best Cold Bath is the Sea Water." At times Pitcairne is scornful of accepted remedies. Writing to Colin Campbell he says of David Gregory, whose work on optics is expected, " Mean tyme, my dear doctor, is in my opinion and in his owne dying of a palpitation and polypus cordis. He's advised to go to Bath for it? 12 a ridiculous advice." He occasionally sweeps aside his own remedies. My Lady Grant is given a large list of drugs which can be used even " asses milk in either case when she is with child but will supply many drugs and mitigate most symptoms." Dr Robert Thin13 remarked that Pitcairne never attempts a " diagnosis. This is not quite the case. Of one patient he writes, The gentlewoman above has the trouble that Dr Sydenham calls Chorea Sancti Viti though he is mistaken and gives wrong cure," and then proceeds to discuss the nature and cure of the condition. But most frequently Pitcairne is content to note down the symptoms and the proposed remedies. A long rambling letter from a doctor or patient is often followed by a brief note by Pitcairne noting the essential points. of Pitcairne was very aware of the personality his patients. For some nobleman who is prescribed jalap but who has been set against jalap by an earlier physician he lays down that the jalap is to be called " simply the purging draught." Little pictures of the life of the time and to emerge from this dreary record of mental physical suffering which the best skill of the day offered no relief. Lady Anne Hay, eldest daughter of the Marquess of Tweeddale, is thin and delicate the " colds of last winter and late supping in the time of the Parlia- by " ment at Edinburgh." Or on a darker note My Lady Strathmore sleeps ill and considers too much that her mother and sister died of a ARCHIBALD PITCAIRNE 47 consumption." Pitcairne could be intolerant and scornful but his patients did not find him so. To them, as to one hypochondriac writing from the north who had tried the Inverness doctor and found no relief, " he was an asylum in all distempers." It must not be thought that Pitcairne showed any great advances on contemporary therapeutics. Like the great Harvey himself he was not above using secret remedies. There is one reference to the application " of my water." He recommends another patient to bathe the afflicted part in Moffatt-well water. On 6th July I7C>3> J- Ramsay wrote to Pitcairne from Haliburton describing the critical condition of a noble patient. On the back of the letter Pitcairne has scribbled some drugs " and underneath apply live pigeons to her feet if she is not better than she was yesterday morning. Edinburgh 7th July at 7 in the morning." The letter and its reply retain in some not altogether explicable way the tenseness of this crisis so long ago, but it is not only that which startles the reader. It is rather the stumbling upon the man who claims to apply to medicine the strictest principles of science and mathematics falling back in fact upon pure magic. The use of live pigeons applied to the feet is of course an old remedy. It is one of the remedies described by Donne as applied to himself in his sickness.14 Pitcairne employs many remedies which are to-day regarded as either inert or harmful, but there is surely a distinction between the use of physical remedies which might have an effect and the application of live pigeons to the feet and this regression into magic throws its own light on the problems of the seventeenth century physician. The stress endured by the physician who had to contend with quite inadequate weapons against diseases which were usually too strong for him is something which is usually ignored. The popular picture of the early physician is too influenced by Moliere and other literary satirists. There is a letter written by Pitcairne to David Gregory in great haste because he is vexed by the chincough which one of Gregory's children is suffering from. Pitcairne hastens to bring forward all the remedies he has. They do not amount to much?a seton, rowan tea, a steel pill, bleeding?but the haste with which they are brought forward shows Pitcairne's deep concern. So too in a different and more startling way do the live pigeons. That Pitcairne's practice should not differ greatly from that of his " contemporaries is not surprising. He had written it is plain that there is no such thing as an Art or Method of Curing but only the Practice of it as Virgil says and that Remedies were found out by chance and not Design (except Bloodletting after the Circulation was known) and will still be so.15 But this in itself would not entitle him to the reverence of posterity. It is not the doctrine he held or the practice he followed but what he himself was that built up Pitcairne's reputation both to those who knew him and to those who followed him. And Pitcairne was above all else a great student and a great teacher. His period as a Professor at Leyden lasted little more than a year. The opinions he held provoked considerable opposition but despite his brief tenure of the office he 48 L. JOLLEY made a deep and lasting impression on the development of Leyden as a medical school. At Edinburgh Pitcairne held the titular position of Professor of Medicine. There is no evidence that he ever gave University lectures but that he taught medicine in Edinburgh is certain. Comrie has summarised the evidence brought forward by Bower, Struthers and Gairdner.16 This makes clear the part Pitcairne played in initiating the regular study of anatomy in Edinburgh. In addition the frequently quoted record of a dissection at the Surgeons' Hall shows that Pitcairne at times took part in the teaching of the surgeon apprentices. But there is also evidence which suggests that Pitcairne did more teaching than this and that Comrie's tentative attribution to him of the title of founder of the extra-mural school can be made more substantial. The two manuscripts preserved in the University and the Royal College of Physicians both contain indications of having been assembled for purposes of instruction. It was common to pre- serve and even to copy the letter of eminent physicians but the University volume has an index and some of the entries towards the end of the volume are not letters but notes of cases such as could be made by or for a student. The first part of the Royal College of Physicians' manuscript is certainly in the form of a lecture with the author speaking in the first person. The second is a systematic arrangement of diseases with notes on symptoms, treatment and prognosis. The title certainly suggests a formal instruction. Collegium appears to be a Latinisation " " of the Scots term Colleges meaning a course of lectures. This and the stress on Riverius whom we know to have been highly regarded in Edinburgh might link the volume to Pitcairne's Edinburgh rather than to his Leyden days. Pitcairne did not establish anything in the nature of a formal school, but he gathered round him a group of young men who absorbed and carried on his teachings. Most of these had already obtained medical qualifications in France or Holland but not all. George Cheyne, who is stated to have been led to take up the practice of physic by Pitcairne, attended no University. He received an M.D. from Aberdeen in recognition of his pamphlet defending Pitcairne's theory of fevers. Whatever systematic training he received he must have had from Pitcairne. The preface to the second edition of his A New Theory of Acute and Slow Continued Fevers, London, 1701, is a paraphrase of Pitcairne's views on the development of medicine. In the preface to Cheyne's Essay on Health and Long Life, twenty-three years later, Cheyne acknowledges himself to be Pitcairne's pupil and gives an interesting picture of the working of Pitcairne's group of followers. " The first time I adventured into Print was on Account of my great Master and generous Friend, Dr Pitcairne. He thought himself ill-used by some of his Brethren of the Profession who then were at intestine War on the Subject of Fevers, and fancied the handsomest Way to bring them down was to exhibit a more specious Account of this Disease, than any of them had shown. His business then in the ARCHIBALD PITCAIRNE 49

Practice of Physic was so great, as not to allow him sufficient Time for such Work. Two others therefore, with myself, were joined to manage the Affair. In which he was to cut and carve, and to add the practical Part." 17 Another tribute from an unexpected source to Pitcairne's reputa- tion as a teacher comes from Fontenelle's funeral oration on the French anatomist, Du Verney. In this Fontenelle illustrates the renown of Du Verney by a reference to the fact that even Pitcairne, who was so fully qualified himself to instruct in anatomy, sent his fellow Scots to study under Du Verney.18 There is nothing to indicate that Pitcairne gave a complete and systematic course of instruction. The references to the great demands of his practice make this improbable. But there is every reason to believe that he was the first of the distinguished line of extra-mural teachers who were to do so much to increase the reputation of Edin- burgh medicine. If Pitcairne was a great teacher it was because he remained to the end a great student. Although he had embraced an erroneous and too comprehensive theory of medicine, Pitcairne constantly attempted to check his opinion by experience. In the published works there is a " " reference to Chymical Experiments on opium carried out by Alex- ander Monteith at Pitcairne's request. The attention given to the obtaining of bodies for anatomical dissection has tended to obscure the fact that clinical post-mortems were not uncommon in the early eighteenth century. In the Praxeos Pitcairne describes two of these, " My Lord Register Philiphaugh died lately of a neglected jaundice which ended in a lethargy eight days before he died." He was opened up although permission was not given to open his head. Pitcairne " describes the condition of the viscera and continues, I can make a theory from this and some other observations." He then refers to the Dissertatio de salibus, Leyden, 1707, of Gulielminus and contrasts what he has seen with the alleged intestine motion of the water that not only dissolves but raises and suspends salts. There was another " post-mortem on Lord Kinnaird, by next post," writes Pitcairne, " I'll tell you his story," but the letter is not preserved. The Praxeos shows a wide range of scientific reading. A reference to the Philo- sophical Transactions for dog bite and another reference to the same work and to Ray's History of Plant for the plant Jews' Ear. Pitcairne was a man of wide and vigorous curiosity in all things connected with his profession. It must not be forgotten that it was he who persuaded Martin to give an account of the medicine of the Western Islands. It is well known that in 1701 Pitcairne became a member of the Incorporation of Surgeons but the significance of this action has been very much overlooked. It is not merely that even in Scotland where the position of the surgeon was much higher than in the rest of Europe, the surgeon was distinctly the social inferior of the physician. At this period there was bitter controversy between the physicians and the VOL. LX. no. 1 D So L. JOLLEY surgeons in Edinburgh and the Promissory Engagement signed by the new Fellow of the College of Physicians contained a pledge of his loyalty to the Physician, in the struggle between the two bodies. Much later Monro Primus had to give up his membership of the Incor- poration of Surgeons upon becoming a Fellow of the Physicians. It is not sufficient to attribute Pitcairne's action to personal resentment against his fellow physicians. He continued as an honoured and active member of the College of Physicians for at least five years after his admission to the ranks of the surgeons. Pitcairne's personal and professional status was so high that even his enemies could not welcome his withdrawal from the College. There were other and more sub- stantial reasons which led Pitcairne to associate with the surgeons. Alexander Monteith, a leading surgeon and twice President of the Incorporation, was bound to Pitcairne by close professional, personal and political ties. He shared Pitcairne's Jacobite politics and dispensed his prescriptions. More important than Monteith's friendship are two other considerations. The Royal College of Physicians was precluded by its Charter from teaching and, great as were its early services to medicine, its first Fellows?apart from Pitcairne and his followers? were essentially conservative in their outlook. Sir Robert Sibbald, Pitcairne's great enemy, was a naturalist and a great, if rather too credulous, antiquary, but he showed no concern over advances in medicine. Other leading Fellows, like Sir Thomas Burnet, the author of Hippocrates Contractus, had their eyes fixed even more firmly on the past. It is reasonable to deduce that what drew Pitcairne to the com- pany of the surgeons was the possibility of pursuing the study of anatomy and practical experiment?the surgeons were also the phar- macists?and the possibility of developing the teaching of medicine in Edinburgh. It is to Pitcairne's credit that he rejected that separa- tion of physicians and surgeons which so long delayed the development of medicine. It is also another indication of his contribution to the development of medical teaching in Edinburgh. Pitcairne's other activities cannot be considered here. Only as a Latin poet does he seem to have achieved anything substantial. His plays and his satire have little importance in themselves though his survives. memory as a wit survived and still One point must, however, be made. Peel Ritchie has suggested that Pitcairne, having ample private means, neglected the practice of medicine.19 All the evidence is quite contrary to this and shows that Pitcairne had one of the busiest practices of the time. The energies Pitcairne put into writing and even into politics were what were left over from medicine and although Babel and The Assembly are poor enough in themselves they are not unimportant in the intellectual development of Scotland. A comparison has been suggested between Pitcairne and Brown and an attempt has been made to show where the comparison breaks down. Another very different figure also offers himself as a parallel to Pitcairne, and that is William Cullen. It is true that hardly any two ARCHIBALD PITCAIRNE 51

men could be less alike. But they have one thing in common and that is the nature of their influence on medicine in Edinburgh and indeed the whole western world. It has been said of Cullen, with no more exaggeration than is always required for a striking statement, that he made no original observation in medicine. This may be admitted and yet it remains hardly possible to exaggerate the influence on the development of medicine of his patient, humble, cautious and sceptical mind. It is what he was and not what he discovered which mattered. So too with Pitcairne. His eager, impetuous and impatient desire for truth, his contempt for involved phrases which only concealed ignorance, led him into many errors but at the same time kindled a flame in his successors which led to more substantial results. It is not only the Edinburgh Medical School which finds in Pitcairne one of its chief creators. Through Bcerhaave and Mead, Leyden and London acknowledge his creative impulse. And his following can be traced yet further afield. Van Swieten's commentaries on Boerhaave refer frequently to his name and so even the medical school of Vienna finds one of its inspirations in Pitcairne. I have to thank the President and Council of the Royal College of Surgeons for permission to search their records for references to Archibald Pitcairne and Dr L. Sharp, the Librarian of the University of Edinburgh, for permission to consult the Pitcairne manuscripts in the University Library, and to quote from them.

REFERENCES 1 H^SER, Heinrich (1881), Lehrbuch der Geschichte der Medizin, 3rd ed. Jena, Bd. II, p. 341. 2 Eloy, N. F. J. (1778), Dictionnaire historigue de la medecine, Mons, T. II, p. 577. 3 " A dissertation upon the circulation of the blood through the minutest vessels of the body," in The Works of Dr Archibald Pitcairne, London, 1715, p. 29. 4 Works, p. 61. 5 Works, p. 238. 6 Works, p. 221. 7 Works, p. 201. 8 Babel, a satirical poem. Edited by G. R. Kinloch, Edinburgh (1830), p. v. 9 An account of the life and work of Archibald Pitcairne, Edinburgh, 1781. 10 British Medical Journal, 1949, 2, 648. 11 See amongst others William Burton, Account of the life and writings of Herman Boerhaave. 2nd ed., 1746, p. 106. 12 Five letters from Pitcairne to Colin Campbell are preserved in Edinburgh Uni- versity Library. 13 Edinburgh Medical Journal, 1928, pp. 368-382. 14 Donne, John, Devotions upon emergent occasion (1624), Section XII. Readers of Wuthering Heights will remember that Catherine Linton was unable to die because she had pigeons' feathers in her pillow. See also W. G. Black, Folk medicine, London (1883), p. 163, for other references to the use of pigeons as a last remedy. 15 Works, p. 264. 16 Comrie, J. D. (1932), History of Scottish Medicine, 2nd ed., London, Vol, I, p. 254. 17 Essay of Health and Long Life, London, 1724, p. ii. 18 Histoire de VAcademie Roy ale des Sciences ; Ann., I73?> Paris, 1732. 19 Ritchie, Robert Peel (1899), The early days of the Royal Colledge of Phisitians, Edinburgh, p. 159.