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Home , Alexander Monro (primus), Andrew Combe, Charles Bell, James Russell (surgeon), James Syme, John Barclay (anatomist)

SOME MEDICAL MEN AT THE TIME OF THE RESURRECTIONISTS *

By H. P. TAIT, M.D., F.R.C.P.Ed., D.P.H. Senior Assistant Maternity and Child Welfare Medical Officer, Edinburgh

Some time ago I was asked to give a paper to this combined meeting on some historical subject connected with the Edinburgh Medical s School. Since you are to be guests at a performance of Bridie " " The Anatomist tomorrow evening, it was suggested to me that I might speak of some of the medical men of Edinburgh at the time of the Resurrectionists. I hope that what I have to tell you tonight of may be of some interest and may enable you to obtain some sort " background for a more complete enjoyment of the play. The " of Anatomist centres round the figure of Dr , one he our leading anatomists in the twenties of the last century, and it was who gained an unwelcome notoriety by reason of his close association with Burke and Hare, the Edinburgh West Port murderers. Before proceeding to discuss some of the leaders of Edinburgh medi- cine at the time of Knox and the Resurrectionists, may I be permitted to give a brief outline of the Resurrectionist movement in this country- Prior to 1832, when the Act was passed and the supply of anatomical material for dissection was regularised, there existed no legal means for the practical study of anatomy in Britain, save for the scanty and irregular material that was supplied by the gallows. Yet the law demanded that the surgeon possess a high degree of skill in his calling ! How, then, was he to obtain this skill without regular dissection ? The answer is that he obtained his material by illegal means, viz., rifling the graves of the newly-buried. To those individuals " who opened graves and removed the corpses, the names of Resur- " " " " rectionists," Resurrection-men or Sack-'em-up Men were given- With the rise of Edinburgh as a medical centre, in particular of its anatomical school under the two Monros, primus and secundus, and the later development of extra-mural anatomical teaching during the professorship of the incompetent Monro tertius, the Resurrectionists became busy both in and around the city and in other parts of . The Resurrectionists of Dublin also assisted the Edinburgh School and a regular traffic in corpses developed between the two cities (Ball, 1928). The first three decades of the nineteenth century mark the peak period of the resurrectionist movement. Public indignation, roused by the evidence revealed during the trial of Burke and Hare in 1828, effectively put a stop to resurrectioning in Scotland, but a Bill introduced into Parliament in 1829 and intended to free anatomists from the restrictions under which they laboured, was withdrawn. * Read at a Joint Meeting of the Association and the Tuberculosis Society of Scotland held in Edinburgh on 16th July 1947.

' SOME EDINBURGH MEDICAL MEN "7

Only in 1832, after the Anatomy Act was finally passed did resur- rectioning become, for all practical purposes, extinct in Britain. These resurrectionists comprised two groups of men. The first Sroup was composed mainly of anatomists, surgeons, physicians and Medical students, who, though their activities were illegal, were largely anirnated by a desire to advance science. As members of this group ^e might cite such men as the immortal , and Sir . The second group consisted of low fellows, whom Sir Astley Cooper " " Ascribed as the lowest dregs of degradation (Ball, 1928), and ^'hose activities were pursued solely for financial gain, who stopped at nothing to achieve these ends, and whose patron was ever he with the most liberal purse. Some of the Edinburgh members of this group were well-known characters locally and rejoiced under such names as " " " " Merry Andrew," the Stupe and the Spune (Macgregor, 1884). As extra-mural teachers of anatomy and surgery quickly increased ln numbers during the first quarter of the last century, competition f?r " " subjects became acute, and the rival gangs of resurrectionists had many encounters, often bloody. The general public gradually became cognisant of the activities ?f these intruders, and began to take measures to circumvent them. Guarded graves, such as still may be seen in Greyfriars' Churchyard here, and watchers over the graves were both tried but with varying sUccess. Too often whisky, darkness and the eerie surroundings of the graveyard proved too much for the watchers who deserted their " Posts leaving the coast clear for the thieves of the night." Burke and Hare appeared on the scene in the winter of 1827, hut, having no stomach for body-snatching, they resorted to cold, calculated murder?one of the fine arts of de Quincey. The method adopted by this couple was to render their victims drunk with whisky, or to smother them then to compress their mouths and nostrils, else as they lay in their drunken sleep. By such .means, some sixteen Hare for Dr c?rpses of murdered folk were provided by Burke and Knox before that infamous pair were arrested in November 1828. The subsequent events of the trial of this couple are well known. while Hare escaped the hangman's loop by turning King's Evidence, on ^Urke paid the supreme penalty by public hanging 29th January was *829. The day following, a public lecture and demonstration in serious given on Burke's brain?an event which nearly resulted were rioting in the City. On the 31st January, the general public wrote in permitted to view Burke's body and Sir his " Journal that, all the world flock to see him." After this exhibition, for future lectures. the body was further dissected and preserved Burke's skeleton now rests in the Museum of the Anatomy Department ?f our University here. the first of the Might I remind you that during thirty years was not the world centre nineteenth century, Edinburgh only of vol. lv. no. 2 H 2 118 H. P. TAIT of medical education, but this period also marked the culmination her intellectual glory (Gillies, 1886). It was the period of the philosophy of , of the physical researches of Playfair, Leslie and of Hope, of the portraiture of Raeburn, of the immortal writings Sir Walter Scott, of the Bar resplendent in Jeffrey, Cockburn and Moncrieff. In the twenties appeared the facile pens of John Wilson (" Christopher North ") and . The Edinburgh Review exerted its all-powerful influence in literary criticism, while Maga, Blackwood''s Magazine, and the publishing house of Constable were known to all. of The leaders of Edinburgh medicine at this time were men powerful personality and forcible character and exerted their influence on medicine throughout the world. The first who falls to be briefly mentioned is Alexander Monro, tertius (1773-1859). Appointed Professor of Anatomy at the University in 1798 as colleague and successor to his father, Monro secundums, he was indifferent to his students and careless, though he lacked neither ability nor accomplishments (Christison, 1885). Garrison (1929) " refers to him as the evergreen tertius." Small wonder, then, that he soon lost command over his class, though Christison admits Monro gave a very clear and complete course of lectures on anatomy. Monro was one of the central figures in a most exciting afternoon of in the history of anatomy. In the presence of a great concourse local celebrities and students, he lectured on Burke's brain the day after the execution. Monro practised as a physician, and this, combined with his ineptitude in teaching anatomy, contributed to the steady rise of the extra-mural anatomy teachers, and to the clamant necessity f?r s instituting a Chair of Surgery within the University, since Monro a duties as Professor of Anatomy also included instruction in surgery, subject which he dealt with in a most perfunctory manner in his lectures. Such, then, was the way anatomy and surgery were taught in the University, and small wonder, therefore, that other, more striking figures appeared outside the sacred walls and began to teach these subjects. One of these extra-mural teachers of anatomy and surgery who arose during the period under review was (1758-1826)- He had an active period of teaching extending from 1797-1825- Destined for the Church, for which he qualified after a distinguished academic career, he turned his attention to medicine and graduated M.D. at Edinburgh in 1796. After spending a year in studying anatomy under Marshall, Barclay returned to Edinburgh and began to teach it privately. After a period of struggle, he gained official recognition as a teacher in 1804, and from that time his classes swelled rapidly in number, many students transferring their attendance from Monro to Barclay (Struthers, 1867). Barclay was a clear and witty lecturer, holding the attention of his audience by the frequent use of apposite anecdote. His knowledge SOME EDINBURGH MEDICAL MEN n9

?f anatomy was profound, and he was often consulted by surgeons before they tackled some difficult or intricate operation (Struthers). His a had reason liberality was proverbial, and many medical student to be grateful for Barclay's generosity. Comparative Anatomy was Barclay's special study, and he at one tirne petitioned the Town Council of Edinburgh to be made Professor ?f that subject in the University, but his petition failed. Nevertheless, he was largely instrumental in having established the Royal (Dick) Veterinary College here. He was not a prolific writer, but his works were of a high standard, and he retained to the end an early interest in philosophy. He retired from teaching in 1825, being succeeded by Knox, his assistant, and he died in 1826, bequeathing his excellent Museum to the Royal College of Surgeons of Edinburgh. Robert Knox (1791-1862) next must be mentioned. Dux of the Royal High School of Edinburgh, he entered the University and graduated M.D. there in 1814. After a period as military surgeon, be studied in Paris, absorbing the works of Bichat, Cuvier and St Hilaire. He then returned to Edinburgh, becoming assistant and then successor to Barclay. Knox was an able and gifted teacher and investigator, gathering Ground him such men as (Sir) William Fergusson, Thomas Wharton Jones, John Goodsir and Thomas Hodgkin when students. He quickly made his mark and his anatomical lectures and demonstrations Were sometimes attended by over 500 students in a year. To achieve bis ambition to be the principal teacher of anatomy in Edinburg , t at Knox stinted neither time, labour nor expense, and to ensure his own bis dissection tables were never bare, he was reckless of Pocket, and in "one session he lost the almost incredible sumo ta es ?700 or ?800 by 'subjects' alone" (Lonsdale, 1870). His as no mo a consequence were always well furnished, and being *nan, he openly declared that he could command subjects a ways an unfortunate boast in view of later events (Roughead, 1921). s on1 is Knox's wit was caustic and egotistical, and his remar e a 1 e fellow anatomists and surgeons openly critical. Socially ne Access, though it is said that he fascinated women. Physically a ^as unattractive, having lost the use of his left eye as consequence ?f an attack of confluent smallpox in childhood. when Bur e an are Knox was at the very height of his fame Were arrested in 1828. When the facts of the nefarious activities once t e o ?f these two scoundrels became public, Knox was at jec ?f infuriated mobs an popular anger. His house was besieged by of the n o effigies of him were hung in various parts City. spite even in the all this abuse, however, Knox preserved a rigid silence, a face of vituperative attacks in the press. Finally, specia y appointe committee, after enquiring into the relations whic nox ore to Burke and Hare, largely cleared him of blame-an opinion endorsed by Henry Cockburn (1856). Other contemporaries, such as Sir Walter 120 H. P. TAIT

Scott, Christopher North and a medical colleague Sir Robert Christison, were gravely perturbed by his behaviour and passed censure on his actions in not inquiring as to the origin of his anatomical material. Generally speaking, taking Knox's position in relation to his times, he was no worse in his conduct than his fellow anatomists in Britain generally (Currie, 1933). " " Knox's students were delighted with their idol's acquittal and presented him with a gold cup?an act The Scotsman (25th March " 1829) described as injudicious." But from that time the ability of Knox as teacher and investigator declined, and he left Edinburgh in 1844, dying in London in 1862. Other anatomists of the period were Andrew Fyle (died 1824)' John Gordon (died 1818), David Craigie (died 1866), (died 1828) and (died i860). Turning now to the surgeons of the period, let us take a brief look at some of these men. (1762-1820) was the older brother of Sir Charles Bell, with whom he was associated for a time in the teaching of anatomy in Edin- burgh. John, however, forsook anatomy for surgery in 1799 (Struthers). He was a skilled draughtsman as well as an expert anatomist, and his Engravings of the Bones, Muscles and Joints, published in 1794' revealed one who had set out to help the surgeon in his figures. He to was, in fact, the Father of Surgical Anatomy. Patients came John Bell from all over Britain and even from the European Continent. Bell had a high regard for the dignity of his profession, and spared no efforts to qualify himself both professionally and culturally. His library was a storehouse of the works of the masters, both of medicine and of the arts. The warmth of his temper, unfortunately, involved him in many disputes and his notorious quarrel with James Gregory was a long and bitter one. Both partisans wrote several volumes " about it, Bell's main contribution being his Letters on Professional Conduct and Manners ; on the Education of a Surgeon, and the Duties and Qualifications of a Physician ; Addressed to James Gregory, M.D." After a long peregrination on the continent, John Bell died at Rome in 1820. Robert Liston (1794-1847), probably the original of Robert Louis Stevenson's Dr Macfarlane in The Body Snatchers (Guthrie, 1945)' was at first the assistant to Barclay before striking out on his own as a teacher of anatomy during session 1818-19. He was an active resurrectionist as a student. A man of unusual initiative and con- siderable dexterity in operations, Liston rapidly became a well-known surgeon, but his uncompromising manner, together with a certain jealousy on the part of his seniors, involved him in many quarrels. Liston's surgical publication of a series of cases of aneurysm in 1820 really set the seal to his reputation, and his further work on amputations and lithotomy added to his fame. He left Edinburgh in 1835 for London where he gained further renown by carrying out SOME EDINBURGH MEDICAL MEN 121

What was generally considered to have been the first major operation Ur*der ether anaesthesia in this country, at University College Hospital In 1846. Recent research seems to point to the first operation under ether anaesthesia in Britain having been performed at the Dumfries and Galloway Infirmary at an even earlier date (Underwood, 194-6)- Liston, in spite of his bluntness of manner, obtained his world-wide reputation by a high character and professional ability. He was sud- denly cut off in his prime in 1847 when he died from an aortic aneurysm. (1799-1870), the "Napoleon of Surgery" (Miles, X9I8), and the father-in-law of Lord Lister, was one of the younger and abler surgeons of the period under review. As a youth of eighteen, he narrowly missed fame as a chemist by the discovery of the process " " waterproofing cloth. As a pupil of Barclay and colleague of Liston, Syme early acquired a thorough knowledge of anatomy, but ever regarded anatomy as a means to fitting himself for surgery. His early interest in bone and joint surgery established his reputation, but: being unsuccessful in his application for the post of surgeon to *he Royal Infirmary here in 1829, he set up his own hospital in which he " taught clinical surgery, and which has been immortalised in Rab " and his Friends (Brown, 1897). Syme in his later years looked back on these early days with pride, as he accomplished much during the life of that little hospital. Syme was appointed Professor of Clinical Surgery in Edinburgh *n 1833, and, save for a short period in London (1848), he held this chair till 1868, when he resigned following an apoplectic seizure. It His Principles of Surgery is a masterpiece of clear exposition. " Was said of Syme that he never wastes a drop of blood or of ink, " " and as a surgeon in all supreme, complete in every part (Brown). the Other surgeons of the period were (i755-I^3^)? first Professor of Clinical Surgery in the University (1803) a s?mnolent lecturer, . . . yawning while he spoke, and continuing " t? speak while he yawned (Christison, 1885), (1765- *846), first Professor of Military Surgery in the University (1806) ; J- W. Turner (1790-1836) and Sir Charles Ballingall (1780-1855). An extraordinary character of the times was James Hamilton He (died 1839), the Professor of Midwifery from 1800 till his death. Was the acknowledged head of obstetrics in Scotland, and gave clinical maintained at his instruction to his students in a lying-in hospital made a ?Wn expense. After long efforts attempting to get midwifery c?mpulsory subject in the medical curriculum, he finally succeeded in doing so in 1833 (Comrie, 1932). students and Though generous and kindly both to his patients, and Hamilton was a trenchant critic of his colleagues always regarded actions himself as in the right (Christison). His legal against Hope created interest and Gregory are well known to you all, and great among the citizens of Edinburgh at the time. Mention of Gregory brings me to the physicians, and who deserving 122 H. P. TAIT of mention first more than James Gregory himself? The successor of the great William Cullen, he was quite the most imposing figure, mentally and physically, among the medical brethren of the Edinburgh of his day. Rapidly achieving an extensive practice and wide popularity, and basing his therapeutic armamentarium on blood- letting, cold affusions, brisk purging and vomits of tartar emetic, he was, nevertheless, in advance of his time in many respects. Thus he taught how frequently rheumatism led to heart disease, and he urged a light diet in the early stages of pulmonary tuberculosis and a more liberal one during the chronic stages, and, of course, he achieved immortal fame by the invention of his celebrated powder. Gregory's Conspectus Medicince Theoretics was a model completeness and of classical elegance. It obtained instant and wide success, being adopted as a standard textbook at some German Universities (Christison). Gregory always lectured to his students wearing his three-cornered hat, while, when walking about the City he carried his stick military fashion over his shoulder. Forceful in action, he was fearless in speech, and his disputes with John Bell, the surgeon-anatomist, and James Hamilton have already been noticed. Suffering much from attacks of pulmonary inflammation in his declining years, Gregory died from hydrothorax in 1821. Our next physician is Andrew Duncan, senior (1744-1828)?" The " Old Club-Maker so-called from his activity and enthusiasm as a promotor of medical and social clubs. Professor of the Institutes of Medicine, he was an amiable old gentleman, behind the times in his lectures, from which his students learned little (Christison). He is deserving of notice for he advocated in 1798 in a Memorial presented to the Patrons of the University, the teaching of Medical Jurisprudence. This term comprehended both Medical Police or what we might now call Preventive Medicine, and Juridical Medicine which Duncan " asserted was the aggregate of all the information afforded by the different branches of medicine which is necessary for elucidating doubtful questions in courts of law." Duncan also exerted himself greatly in obtaining Royal Charters for no fewer than four institutions, including the Royal Edinburgh.Asylum for the Insane. John Abercrombie (1780-1844) was a most successful physician in the City though he held no academic position. He gathered around him a group of apprentices, conducting what was in effect a private medical school. He divided the City into five districts and assigned patients in each of these to a certain number of his senior students. At the Royal Public Dispensary, of which he was physician, he organised a form of Polyclinic. He was an ardent pathologist and contributed much of value to the medical journals. Abercrombie was honoured by Oxford University and by Marischal College, Aberdeen, being appointed Lord Rector there. As a philosopher, Abercrombie's writings received favourable notice from contemporary reviewers. Sudden rupture of the heart caused his death in 1844. SOME EDINBURGH MEDICAL MEN 123

In conclusion, we might mention James Home (1758-1842), Professor of Materia Medica (1798), and later of the Practice of Physic (1821) ; Andrew Combe (1797-1847), a pioneer in health education and s?mewhat addicted to phrenology; James Scarth Combe a (1796-1883), general practitioner of Leith, who gave the first description of a including post-mortem appearances, of pernicious anaemia; ^ase>lr Robert Christison (1792-1882), Professor of Medical Jurisprudence (1822) and later of Materia Medica (1832). A medical jurist of great fiient, Christison made his early reputation by his work on toxicology and on bruising of the living body, the latter work carried out in c?nnection with the Burke and Hare murder trial. His Autobiography Published in 1885 is a rich source of information of the Edinburgh Medical School and its members during the period of his student arid later life. For much of what I have told you this evening I am lridebted to his reminiscences. Finally, William Pulteney Alison (* 790-1859), who was the beloved teacher of William Stokes. Alison's ^ork on infectious diseases and the influence of poverty and social c?nditions on the spread of disease contributed much to the framing ?f the Poor Law (Scotland) Act, 1845. I am afraid that my sketch has been very scrappy and incomplete. There were so many worthies to choose from that I found difficulty selecting those for special mention and those for passing over. However, I hope that I have been able to convey something of the spirit and endeavour of these men to whom we in Edinburgh owe so much. To those of you who are especially interested in the history of Medicine, you will find in Edinburgh a rich ground of tradition, while the museums, relics and graves of many notable medical men exist various parts of the City.

REFERENCES

Ball, J. M. (1928), The Sack- em-up Men, 49, 122 (Oliver and Boyd, Edinburgh). Brown, John (1897), Horce Subseciva, 1, 364, 2, 363 (Black, London). Christison, Sir R. (1885), The Life of, I (Blackwood, Edinburgh). Cockburn, H. (1856), Memorials of His Time, 475 (Black, Edinburgh). Comrie, J. D. (1932), History of Scottish Medicine, 2, 485 (Bailliere, Tindall & Cox, London). Currie, A. S. (1933), Proc. Roy. Soc. Med. (Sect. Hist. Med.), 26, 39. Garrison, F. H. (1929), An Introduction to the History of Medicine, 4th ed., 767 (Saunders, Philadelphia). Gillies, J. B. (1886), Edinburgh Past and Present, 91 (Oliphant, Anderson and Ferrier, Edinburgh). Guthrie, D. (1945), A History of Medicine, 308 (Nelson, Edinburgh). Lonsdale, H. (1870), A Sketch of the Life and Writings of Robert Knox, 92 (Macmillan, London). Macgregor, G. (1884), The History of Burke and Hare, 39 (Morison, Glasgow). ?Miles, A. (1918), The Edinburgh School of Surgery before Lister, 174 (Black, London). Roughead.W. (1921), Burke and Hare, Famous Trials Series, 80 (Hodge, Edinburgh). Struthers, J. (1867), Historical Sketch of the Edinburgh Anatomical School, 41, 56 (Maclachlan and Stewart, Edinburgh). Underwood, E. A. (1946), Brit. Med. Journ., 2, 530.