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A HISTORY OF SCOTTISH MEDICINE: THEMES AND INFLUENCES Helen M. Dingwall EDINBURGH UNIVERSITY PRESS A HISTORY OF SCOTTISH MEDICINE THEMES AND INFLUENCES Helen M. Dingwall EDINBURGH UNIVERSITY PRESS EUP/Dingwall/Prelims 1 10/10/02, 3:19 pm For Dr W. G. Middleton with gratitude © Helen Dingwall, 2003 Edinburgh University Press Ltd 22 George Square, Edinburgh Typeset in Linotype Ehrhardt by Koinonia Ltd, Bury, and printed and bound in Great Britain by The Cromwell Press, Trowbridge, Wilts A CIP record of this book is available from the British Library ISBN 0 7486 0865 6 (paperback) The right of Helen Dingwall to be identified as author of this work has been asserted in accordance with the Copyright, Designs and Patents Act (1988). EUP/Dingwall/Prelims 2 10/10/02, 3:19 pm CHAPTER 3 CONTENTS Abbreviations iv Acknowledgements v Introduction. Two Millennia of Medicine in Scotland 1 Part I A Nation in the Making. Medicine in Scotland from Earliest Times to c. 1500 1 Scotland and Scots in the Making 15 2 Early Medicine in Early Scotland 23 3 Medicine in Medieval Scotland 38 Part II A Nation Ascendant? Medicine in Scotland from c. 1500 to c. 1800 4 Scots and Scotland in Britain 63 5 Medicine in Early-Modern Scotland 72 6 Medicine in Enlightenment Scotland 108 Part III A Nation Eclipsed? Medicine in Scotland from c. 1800 to 2000 7 Scotland and Scots in Modern Scotland 153 8 Public Medicine in Public Scotland 164 9 Modern Medicine in Modern Scotland 209 Conclusion 254 Further Reading 264 Select Bibliography 272 Index 275 iii EUP/Dingwall/Prelims 3 10/10/02, 3:19 pm CHAPTER 3 ABBREVIATIONS Bull. Hist. Med. Bulletin of the History of Medicine Comrie, History Comrie, J. D., History of Scottish Medicine. 2 Vols (Oxford, 1932) EUL Edinburgh University Library Hamilton, Healers Hamilton, D., The Healers. A History of Medicine in Scotland (Edinburgh, 1981) Lynch, History Lynch, M., Scotland. A New History (London, 1991) Med. Hist. Medical History NAS National Archive of Scotland NLS National Library of Scotland Porter, Greatest Benefit Porter, R., The Greatest Benefit to Mankind. A Medical History of Humanity from Antiquity to the Present (London, 1997) Proc. Roy. Coll. Phys. Ed. Proceedings of the Royal College of Physicians of Edinburgh Soc. Hist. Med. Social History of Medicine NOTE ON REFERENCING In the main text, full references are given for first citation, and a shortened version for subsequent citations. The Further Reading section contains items not referenced within the text, and the Select Bibliography comprises a short list of major works cited in the book. iv EUP/Dingwall/Prelims 4 10/10/02, 3:19 pm ACKNOWLEDGEMENTS This book has been many years in the making. It has changed out of all recognition since the first tentative outline was submitted to Edinburgh University Press; changed, it is to be hoped, for the better. I wish to acknowledge the help and support of many individuals and institutions who have made the work possible. Considerable help has been received from the staff of a number of institutions, including the Royal College of Surgeons of Edinburgh, the Royal College of Physicians of Edinburgh, the National Library of Scotland, the National Archive of Scotland, the Library of the Royal College of Surgeons of Ireland and the Libraries of Stirling, Glasgow and Edinburgh Universities. I am grateful to Sir John Clerk for permission to consult the Clerk of Penicuik papers. Among the many individuals who must be acknowledged are, first and foremost, the entire staff of the Department of History at the University of Stirling, who have been of considerable help and support, often through rather stormy times in recent years. Dr M. A. Penman, Dr I. G. C. Hutchison, Dr J. L. M. Jenkinson and Dr E. V. Macleod have all made useful comment on sections of the book, and this is much appreciated. I am also grateful to Dr M. Barfoot, Dr M. Dupree, Professor H. J. Cook, Mr D. Hamilton and Professor L. Rosner for helpful advice and criticism. Errors of fact or interpretation that remain are, of course, my own. This book was in large part conceived and created for, and as a result of, my special subject course on the history of medicine and society in Scotland. The students who took this course regularly provided original and stimulating insights and suggestions, without which the book would have been much the poorer. Their contribution is acknowledged with appreciation. Holly Roberts and Nicola Carr of Edinburgh University Press remained sanguine throughout many delays and missed deadlines, and their help and encouragement were most welcome, as was the assistance of editors Eddie Clark and Alison Rae. As most authors will acknowledge, no book can be completed without v EUP/Dingwall/Prelims 5 10/10/02, 3:19 pm vi ACKNOWLEDGEMENTS the help and support of family and friends. I am happy to extend my thanks to my sister Elizabeth, and to Bill, James and Andrew, Robert and Anne, and also to Irene Drummond, Patricia Cripps and Doris Williamson. Finally, I am indebted, for support and, importantly, friendship and encouragement, to Professor G. C. Peden, Dr R. B. McKean, Professor M. Lynch and Professor C. A. Whatley; and for medical reasons to Mr E. W. J. Cameron, Dr A. J. Jacob, Dr F. C. McRae, Dr N. R. Grubb and, most of all, to Dr W. G. Middleton, to whom this book is dedicated with grateful thanks. There is much that is very good about medicine in Scotland today. vi EUP/Dingwall/Prelims 6 10/10/02, 3:19 pm TWO MILLENNIA OF MEDICINE IN SCOTLAND 1 INTRODUCTION TWO MILLENNIA OF MEDICINE IN SCOTLAND To write a global history of medicine in Scotland is virtually impossible. How can one modestly-sized volume account with any measure of adequacy for the evolution and increasing complexity of medicine and medical practice in a small, but equally complex and often dispropor- tionately important nation? It is necessary not only to chart the progress of medical and surgical training, professionalisation, institutionalisation, practice and the experiences of the consumers of medical care, but also to assess these developments in terms of a number of complex, inter- acting forces, including Scottishness, Scotland, Britain and Empire. Medicine in the rural areas and remote highlands and islands of Scotland was, and in some ways still is, very different from lowland urban medicine. The distinctively Scottish influence is perhaps less now than it was three centuries ago, though it may not be insignificant that a fair proportion of the medical personnel who occupy the highest national institutional posts, including the British Medical Association, are Scots. It has been claimed that surveys have shown that doctors with Scottish accents are trusted more than those without. This may be a statistical quirk, or even mildly amusing, but may also be taken more seriously. The major aim of the book is to account for the progress of Scottish medicine in the context of the evolution and progress of the nation. The Scottishness, it may be claimed, is a false notion. It may be argued that medical practice in Roman-occupied Scotland was influenced by Romans. Traditional medical care in the south-west of Scotland may have had much in common with Irish practices. Could there have been in any sense Scottish medicine before Scotland existed as a geographical entity? Did the strong and well-used European contacts made by Scottish doctors in the late-medieval and early-modern period mean that Scottish medicine was in fact European medicine? Did the increasingly British and, later, Imperial, context from the early nineteenth century mean that Scots were participating in British and Imperial medicine? Does the highly technological nature of twenty-first-century medicine, which has 1 EUP/Dingwall/Intro 1 10/10/02, 11:40 am 2 A HISTORY OF SCOTTISH MEDICINE virtually no national barriers and is truly global, mean that historians must write about medicine in Scotland, and not Scottish medicine? There has been much debate among historians as to whether there was a distinctive Scottish Enlightenment in the eighteenth century, or whether there was merely Enlightenment in Scotland. The same dilemma is faced by historians of medicine. All of these factors need to be taken into account, though it will be a major contention of this book that whereas the nature and precise manifestation of the Scottish factor changed over the course of the last two millennia, it is still possible to identify distinctive characteristics or aspects which, if not nowadays very different from British or Western medicine, have been influenced and characterised by Scots and by Scotland. At the beginning of the first millennium there were no Scots, but the various peoples who inhabited the territory which became Scotland lent their individual and group characteristics to the development of the nation and its people. Over the course of the next two thousand years the descendants of these people became Scots and inhabited a discrete territory, but also maintained contacts with England, Europe and ultimately the New World and the technological globe. The identity of the Scots is difficult to describe or assess. One view is that it was influ- enced considerably by two factors: the Christian religion and a continuous monarchy.1 This may well be true of the medieval period, but different and more complex factors shaped modern Scots, so that by the end of the second millennium AD, the average Scot may not be either Christian or monarchist. Despite this, though, some factors do seem to remain, including the importance placed on educational opportunities. These changes are complex and the influence of the Scot within and furth of Scotland is less easy to identify, but it does seem that the complexities of the past have produced, whether by coincidence or intent, something which can be labelled Scottish, although the debate on what precisely this is will go on.

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