Sheonagh M. K. Martin Phd Thesis

WILLIAM PULTENEY ALISON: ACTIVIST, PHILANTHROPIST AND PIONEER OF SOCIAL MEDICINE Sheonagh M. K. Martin A Thesis Submitted for the Degree of PhD at the University of St. Andrews 1997 Full metadata for this item is available in Research@StAndrews:FullText at: http://research-repository.st-andrews.ac.uk/ Please use this identifier to cite or link to this item: http://hdl.handle.net/10023/2815 This item is protected by original copyright This item is licensed under a Creative Commons License William Pulteney Alison: Activist Philanthropist and Pioneer of Social Medicine. Sheonagh M. K. Martin Ph.D 31st March 1997 Abstract The thesis looks in detail at three inter-related aspects of Alison's life. It examines, firstly, his role in the development of Edinburgh's rudimentary 'health' network, achieved through the expansion of the existing medical charity structure and the introduction of a more interventionist and coordinated approach to the city's health problems. It traces, secondly, the development of Alison's social thought - in 1820 he believed that medical and practical relief for the poor could and should be supplied through the voluntary charities and only when that proved unsatisfactory through the poor law, whereas by 1840 he argued that public health should be the responsibility of government and that the excessive increase in poverty and disease in Scotland, which he believed had occurred, was proof that the charitable and legal relief provided was inadequate. Finally, Alison's influence on the passage of Scottish poor law and public health legislation in the 1840s and 1850s is examined - the latter involving an assessment of how far he was responsible for the legislative delay. The poor law debate, 1840-1845, which reveals the forces shaping the reform and the prevailing attitudes to poverty, highlights the challenge which Alison's opinions represented and the resulting turmoil in Scottish social thinking, while his reasons for opposing health legislation, which established London control are of great importance. They reveal differences in the rationale behind, and way in which, the concept of public health was developed in Scotland and England. Unlike Chadwick and his supporters, Alison emphasised poverty amelioration and sanitary reform. Part of the explanation for the differing opinions lay in their respective miasmatic and contagionist theories for fever generation, but it also reflects, perhaps more significantly, the impact of European medical police ideas on Scottish medical opinion - Alison's view of public health closely resembled that of the French hygienists. Abbreviations A.U.L.: Aberdeen University Library E.U.: Edinburgh University Main Library EU NCL: Edinburgh University, New College Library NLS: National Library of Scotland PRO: Public Record Office SRO: Scottish Record Office SRO WRH: Scottish Record Office, West Register House DNB: Dictionary of National Biography I.D.U.B.: Imperial Dictionary of Universal Biography R.C.P.E.: Royal College of Physicians, Edinburgh R.C.S.E.: Royal College of Surgeons, Edinburgh Br. & For. Med. Rev.: British and Foreign Medical Review Br. & For. Med.-Chir. Rev.: British and Foreign Medico-Chirurgical Review Br. Med. J.: British Medical Journal Ec. Hist. Rev.: Economic History Review Ed. Med. J.: Edinburgh Medical Journal Ed. Med. & Surg. J.: Edinburgh Medical and Surgical Journal Lon. Med. Gaz.: London Medical Gazette Med. Chir. Rev.: Medico-Chirurgical Review and Journal of Practical Medicine Alison's Observations on the Management of the Poor, and its Effect on the Health of the Great Towns is referred to throughout the text simply as Observations. Page references relate to the Second Edition. Acknowledgements My thanks are due, firstly, to St. Andrews University who gave me the opportunity and the initial funding to undertake my research on Dr. Alison. Grants were later received from the Royal College of Physicians in Edinburgh and the East Lothian Educational Trust, for which I wish to record my thanks. My research took me all over the country from Aberdeen to London, in which regard I wish to thank Aberdeen University Library, St. Andrews University Library, the Bodleian Library in Oxford, the Royal Society Medical Library, the House of Lords Record Office, and the Public Record Office for giving me access to the relevant material and permission to use it in my thesis. Most of my research, however, was carried out in Edinburgh: my special thanks are due to the National Library of Scotland, the Special Collections Department of Edinburgh University, Edinburgh City Archives (Council Chambers), but most of all to the Royal College of Physicians in Edinburgh for giving me access to their Minutes and their Alison Collection. In connection with the latter I owe Joy Pitman, their Archivist, a huge thank you. When I first looked at Alison's Papers they were in four big boxes and wholy undocumented - I returned months later, thinking I faced a daunting task, to find that they had been ordered and catalogued. The idea to study Alison came from my original supervisors, Professor T. C. Smout and the late Dr. Alan Robertson whose guidance and help were invaluable. My thanks go to them both, but especially to Dr. Robertson who encouraged me in my undergraduate years, first suggested the idea of a Ph.D, and took over sole supervision following Professor Smout's retiral. He may have wondered if I would ever complete the writing up - that I have I owe partly to the sound advice and help from Dr. Barry Doyle and Dr. Bill Knox, who saw potential in the early drafts and encouraged me, through the subsequent re-drafts, to "keep at it" until it was finished. My thanks to them. The thesis would not have been completed without the support and help of many friends and family. May I thank particularly those friends with whom I stayed while researching - Rosalind Murrell in Oxford, but especially Heather and Adrian Broad for their hospitality while I was researching in London. I owe my greatest thanks to my family - to my brother Richard and his wife Elaine without whom the thesis could not have been printed, to my brother Jamie for transport, to Aunt Maie for her kindness, thoughtfulness and concern, but especially to Mum, without whose understanding, and practical and moral support the thesis could not have been completed. I would like, finally, to dedicate the thesis to my Mum, Margaret Martin, and to the memory of David Martin, my Dad. "We trust ... that in due time the world may possess a life of this great and good man, which may serve to set forth an example to those who are to succeed him worthy of their imitation. The life and conversation of the virtuous should not be let die. Edinburgh Evening Courant, 24 September 1859. Introduction Tributes following William Pulteney Alison's death, on 22 September 1859, described him variously as "one of the most distinguished ornaments of our [medical] Profession, ... one of the most excellent of men", as a man who "combined in his person the eminent physician, the earnest philosopher, the unwearied philanthropist, and the sincere Christian", and as "one of the noblest of [Edinburgh's] sons".' ) Closer associates, like W.T. Gairdner and Dean Ramsay, spoke of Alison as a man whose quiet and unassuming nature disguised a tremendous force of character - a force which they believed originated in his humane and disinterested devotion to the plight of the poor. His belief that considerations of ambition, wealth, time and self-interest should be secondary to his Christian duty and responsibility to aid the destitute and improve their condition, was to them the source of his greatness.(2) Thus although Gairdner, Ramsay, and other friends and colleagues, notably Robert Christison and A. Halliday Douglas, expressed misgivings about Alison being subject to importunity because of the liberality with which he gave money, time and medicines to the poor, they admired rather than censured him for it.(3) The obituary testimonies may be the glowing tributes of close friends but their essential truth is suggested by the unanimity which emerges from them and, more significantly, by a similar assessment of Alison which was made in 1828. Predating the most active period of his life's work for the poor - the campaigns for poor law and sanitary reform in the 1840s and 1850s - the sketch highlighted the same qualities later identified by Gairdner and Ramsay. The writer warned readers not to be deceived by Alison's appearance into mistaking him "for an overgrown schoolboy". Time spent following his daily movements soon revealed "new charms in his person", with the observer being: unable to determine whether his skill as a physician, his excellence as a teacher, or his humanity as a philanthropist [shone] the brightest in the splendid aggregation of his moral and intellectual attributes.(4) Alison's continued work for the poor, which so impressed his contemporaries, has also ensured his lasting fame. His regard for the poor's health, and the poverty which often resulted from ill- health, was evident from the outset of his career in his work with Edinburgh's medical charities. Experience with these institutions, however, convinced him that poverty also caused disease, a perception which led him to found the House of Refuge for the Destitute, a voluntary charity which aimed to tackle destitution per se. Ultimately, he felt compelled by his concern over disease, and the factors causing its increase - although he placed most emphasis on poverty he also stressed insanitary conditions - to enter the public arena, where he headed the campaigns for Scottish poor law and public health reform. He was thus, according to Olive Checkland's definition, an "activist philanthropist", that is, a man who forced "people to consider the needs of society", a precipitator "who persisted until the necessary action was taken".( 5 ) Other observers, notably Una Maclean and Brotherston, have focussed on Alison's pioneering of Scottish public health reform and, more significantly, on the fact that he did so because of his concern to remove or ameliorate the social causes of disease.

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