History Editor of the Journal of the Royal College of Physicians of Edinburgh, Edinburgh, UK

A sceptic and an empiric in medicine: George Young (1692–1757) and the beginnings of the Scottish medical Enlightenment IMC Macintyre Retired Surgeon and History Editor of the Journal of the Royal College of Physicians of Edinburgh, Edinburgh, UK

ABSTRACT The Edinburgh surgeon-apothecary and physician George Young was an Correspondence to IMC Macintyre empiric who emphasised observation, practical experience and a sceptical approach 20 Lygon Road, to evidence in medicine. He was an early member of the Rankenian Club, a group of Edinburgh EH16 5QB, UK young intellectuals whose ideas were to be at the heart of Scottish Enlightenment e-mail thinking. Young certainly influenced his pupil Robert Whytt, who went on to make [email protected] important contributions to the understanding of nerve and muscle function. James Hill, Young’s apprentice, to whom he emphasised the importance of experience and observation, would later advance thinking and practice in the management of head injury. Young was an important, but to date relatively neglected, figure in the early years of the Edinburgh Medical School and the Scottish Enlightenment. This paper describes what is known of his life and work, aims to assess his legacy and suggests that he deserves greater recognition and appreciation.

Keywords George Young, Rankenian Club, Edinburgh surgeon and physician, philosopher, Treatise on Opium

Declaration of Interests IMC Macintyre is the History Editor of The Journal of the Royal College of Physicians of Edinburgh. This article was submitted to, and handled exclusively by, the JRCPE’s Editor and has been peer-reviewed in line with standard JRCPE procedures.

George Young was born in Edinburgh in 1692, into a Many Edinburgh surgeon-apothecaries at this time had family who were brewers on the Water of Leith, with his apothecary shops4 and a Burgess ticket was required to father and brothers Alexander, Robert and Thomas all practise. Young obtained this on 27 May 1719, becoming a involved in the family business.1 Nothing is known of his Burgess and Guild brother through his marriage to Janet schooling, but on 14 March 1711 he was apprenticed to Ross, daughter of Robert Ross, writer [to the Signet] (i.e. the Edinburgh surgeon-apothecary Alexander Simpson.2,3 solicitor) to the Incorporation of Skinners and Furriers.2 The majority of the Edinburgh surgical apprentices did George Young seemed set for a career as an Edinburgh not proceed to sit the examination of the Incorporation surgeon-apothecary, but he was to prove no ordinary of Surgeons and Barbers,4 but becoming a master or surgeon. Around this time he joined the Rankenian Club, freeman of the Incorporation conferred higher status the only surgeon known to have done so. and the possibility of a more lucrative practice. In July 1719 Young sat the Incorporation examination in four parts, each a month apart, as was customary at that The Rankenian Club time.5 The examination topics are recorded in the minutes of the Royal College of Surgeons of Edinburgh Learned clubs and societies were a feature of the (RCSEd) and a candidate’s choice of subject for his Scottish Enlightenment and the Rankenian Club was one discourse can often give a guide to his current or future of the most important.6,7 Founded around 1716–9 by a interests. In Young’s case the topics on which he was group of Edinburgh students with the aim of stimulating examined included the operation of ‘empioma’ literary and philosophical discussion, its influence was (presumably the drainage of empyema), the operation of described by the Scots Magazine of May 1771. ‘It is well bronchotoma (tracheotomy), the spleen, the fetal known that the Rankenians were highly instrumental in circulation and scarf skin (epidermis). The topic on which disseminating throughout Scotland freedom of thought, he chose to give his discourse was ‘muscular motion’ boldness of disquisition, liberality of sentiment, accuracy which, as discussed later, was to remain a subject that of reasoning, correctness of taste and accuracy of continued to fascinate him.5 Young was admitted to the composition.’ No less a figure than the philosopher history Incorporation (roll number 169), some three months Dugald Stewart confirmed this assessment in his book before his near contemporary Alexander Monro primus. on the life of William Robertson.8 The club was named

352 history 353 20 Yet he appears to have been to have he appears Yet 3 Between 1720 and 1754 he trained a total Between Robert Whytt Robert The Whytt (1714–1766). Edinburgh 3 Such was the demand for medical teaching for Such was the demand Persuaded by political lobbying and and lobbying political by Persuaded 19 18 George Young (1692–1757): a sceptic and empiric and sceptic a medicine in (1692–1757): Young George figure 1 figure subsequently and lectures Young’s who recorded physician nerveof the understanding to contributions major made CourtesyRCPE. function. muscle and attracted to a career as a physician. To practise as such in practise To as a physician. attracted to a career of the that he become a licentiate Edinburgh required which meant passing the licentiate examination. RCPE, Young continued to practise as a surgeon, as demonstrated to practise as a surgeon, continued Young Incorporationat attendance his by minutes RCSEd in training of surgical his continued meetings and also by apprentices. of twelve apprentices. of twelve encouraged by the success of this extramural teaching, teaching, this extramural of the success by encouraged medical the University Council established Town the Anatomy of Monro’s in 1726 with the transfer school the and University the Hall into Surgeons’ from chair of one medicine and of chairs four of establishment midwifery. that the extramural tradition flourished in parallel with that the extramural medical delivered Young medical school. the University in 1730–1 were those he gave in Edinburgh and lectures was himself who 1), (Figure Whytt Robert by recorded the understanding contribution to significant a make to below. discussed as the nervousof system, later joined by Adam Drummond, in 1717 by John McGill John by in 1717 Drummond, Adam by joined later primus. Monro Alexander after that by years three and and in botany classes extramural gave Alston Charles taught chemistry and 1713 James Crawford from medicine.

9 9, 14 9, It is 10,11 Young’s Young’s 6,13

16 17 Later physician Later physician 12 2012; 42:352–60 2012; Before 1719 only two Edinburgh two only 1719 Before 15 oung’s career J R Coll Physicians Edinb Coll Physicians J R © 2012 RCPE surgeon-apothecaries had MD degrees, Christopher Christopher degrees, MD had surgeon-apothecaries Pitcairne (1652–1713), Archibald Irvine (1620–1693) and both of whom practised as physicians. membership of this elite club is the first indication of his His place as a philosopher has considerable intellect. entry an by been acknowledged in the Dictionary of is, account the but CenturyEighteenth British Philosophers , treatise and notes his lecture on entirely based perforce, below. considered both opium which are on members included Alexander Dick (1703–1785) Alexander Dick (1703–1785) who members included of Physicians College of the Royal of president became later Pringle (1707–1782), Edinburgh (RCPE) and John University Edinburgh at philosophy moral of professor London. Society of of the Royal president and In the tradition of the surgeon of his day, however, Young Young however, his day, of the surgeon of tradition In the in his this stage at graduate, let alone matriculate, not did medical course at was no formal Indeed there career. although the University at this time, Edinburgh University half of 1705–1726, between 21 MD degrees granted to Scots. these One of the earliest topics they discussed was the discussed they earliest topics One of the of Bishop Berkeley ‘immaterialism’ philosophy complex their intellectual stature corresponded; with whom they complimenting Berkeley a letter from was confirmed by his theories. of them on their understanding Y surgeon- a as practise to began Young 1720 From medicine had of The teaching apothecary in Edinburgh. the of years early in the in Edinburgh momentum gained had of Surgeons The Incorporation eighteenth century. Robertin 1705 appointed anatomy, Elliot as teacher of It is not clear how Young became a member of such an such of member a became Young how clear is not It been have to appear Other members illustrious group. than one account and indeed more students, university only’. graduates for ‘strictly the club was that suggests for the venue in which they met, Ranken’s Tavern on the the on Tavern Ranken’s met, which they in venue the for the High Street. off just Square, Hunter’s of side west worth noting Young’s early membership of this club as it membership early Young’s worth noting to make on go to men who were young included several instances in many and contributions academic significant the of leaders teachers and ‘literati’, to become were in the contemporaries Young’s Scottish Enlightenment. the first later Charles Mackie (1688–1770), club included John of history of Edinburgh; the University at professor of logic and later professor (1695–1775), Stevenson and theologian (1698–1748), Turnbull George rhetoric; College, Marischal at philosophy moral of professor and theologian (1697–1771), Wallace Robert Aberdeen; population William Wishart scientist; (1691–1753), Edinburgh principal of and minister church leading (1698–1746), MacLaurin Colin and University the greatest and Newton of Isaac protégé philosopher, Scottish mathematician of his day. IMC Macintyre

Young’s personality

Although described by one of his pupils as a ‘very sensible, honest, good-natured man’, other sources show a determined, perhaps even domineering side to George Young’s character.20 The most revealing insights come from papers that show his relationship to his son George. Young intended that his two sons, George, born around 1718 and Thomas, born around 1726 would follow him into medicine. In October 1738 George junior, having served as an apprentice and attended his father’s apothecary’s shop, was sent to Paris to walk the wards of the great teaching hospitals.26 In an accompanying letter his father wrote that his son ‘has been used to no degree of luxury or elegance...’, that his usual fare was ‘pottage and milk’ and that he was to be ‘kept free of company until his studies are over.’27 The recipient of the letter was Aeneas MacDonald, the Paris-based Scots banker (later one of the Seven Men of Moidart, subsequently found guilty in London of high treason for his role in handling the finances of Prince Charles Edward Stuart, but pardoned and returned to Paris figure 2 Sir John Pringle (1707–1782) was a fellow where he resumed banking.) He was authorised to make member of the Rankenian Club. He later attended Young’s payments to George junior for living expenses in Paris, lectures and was a member of the RCPE committee which and after 12 months these seemed reasonable at £10026 made Young a College licentiate. Pringle went on to a (around £8,500 in buying power in 2005).28 distinguished career as a military physician.Courtesy RCPE.

Those who held Scottish medical degrees were exempted from this (although those with degrees from continental European universities were not). The University of St Andrews was renowned for awarding such degrees without examination, and on 21 June 1736 Young was awarded the degree of MD (St Andrews) in absentia ‘on account of his communicating to the public a secret for the cure of the dysentery and on account of his good character, for his known skill in all parts of medicine and his successful practice therein’.21 The following year he successfully applied to became a licentiate of the RCPE, where those who sat to consider his application included two of the inaugural professors of medicine at Edinburgh, Drs Plummer and St Clair, and Dr (later Sir) John Pringle, (Figure 2) the latter a fellow Rankenian who had earlier attended Young’s lectures. Young’s career seems to have flourished as he lived in a prestigious area of the town, in a large flat in Paterson’s Court, Lawnmarket (now figure 3 Leiden University and physic garden where occupied by Deacon Brodie’s tavern).22,23 George Young junior was sent to study medicine. The consequences of his hedonistic lifestyle and extravagant In 1751 he and his son Thomas were able to rent spending there may well have been factors which ultimately extensive land in Harprig and Torphichen in what is now contributed to his father’s loss of influence among his West Lothian. Thomas’s will in 1755 suggests contemporaries. Courtesy Wellcome Library, London. considerable family wealth.24 Thomas Young was appointed Professor of Midwifery at Edinburgh in 1756, In October 1739 after a year in Paris, George enrolled the year before his father’s death. He went on to a at the University of Leiden (Figure 3) to study successful career in that speciality, credited with setting medicine.29 Aeneas MacDonald arranged for Messers history up, at his own expense, the first lying-in ward in Scotland Grant and Crawford, his agents in Rotterdam, to in Edinburgh Royal Infirmary.25 continue to make payments to him. By now however

35 355 Because Because 30,31 24 34 Little is known of the fate of her ex-husband, ex-husband, her of fate the of known is Little 31,32 George Young (1692–1757): a sceptic and empiric and sceptic a medicine in (1692–1757): Young George Margaretha had cohabited with another man in The in man another with cohabited had Margaretha junior was granted a Young George Hague in 1748, the Edinburgh Commissary by Court in 1750, divorce living expenses again awarded was although Margaretha costs. and Young senior offered her £70 sterling if she would would she if sterling £70 her offered senior Young then obtained power He She declined. his son. divorce of his son. the case on behalf to pursue of attorney father a as seen be could Young George stage Until this by day, of the the standards by concerned, reasonably which might impede his a marriage as what he regarded some reveals behaviour subsequent his but career, son’s church a Through character. his of aspects darker by examined be to Margaretha for arranged he treasurer of other pregnancies signs a ruse to look for a midwife, 1742, since husband her seen not had she as which, were signs such No adulteress. an as her brand would easy of woman a her as portray He tried to apparent. seduced had who prostitute a even digger, a gold virtue, collected in Holland suggested But the evidence his son. ‘true up in the been brought had she that otherwise, In that. to adhered Christian tradition’ and reformed he left unsigned which line letter, chilling three curt, one son. her eats she that her to suggests Young undated, and a was granted case, her adherence won Margaretha herself gaining maintenance for of marriage’ ‘declarator and her son and winning legal costs. George Young senior, having refused to reimburse the to reimburse refused having senior, Young George case lost his to his son, made payments for agents Admiralty in London. them at the High Courtagainst of had senior Young George that conclude can We to be when these appeared and his son ambitions for who was a determined adversary, he was threatened to ruthless, even perhaps to be devious, prepared in The affair had financial repercussions; his end. achieve ‘labouring cattle and the confiscated Young April 1746 to Dundas James (baker) baxter the of instruments’ Muirbarns, at houses and fields he leased whom and household ‘furniture He then took Kirknewton. house for pay to refused and houses the from effects’ in further litigation. which resulted actions repairs, Yet he continued to defy this judgement. In 1744 his this judgement. defy to he continued Yet been ‘...his has son argued Maitland Charles lawyer courses...and in the most idle and extravagant engaged these obliged to reimburse not feel his father does money. of advances ruinous but there is no record of his graduating from the of his graduating from is no record but there or Edinburgh and he does not of Leiden Universities His medicine. in career a on embarked have to appear estatehis leaves 1755, in will his writing Thomas, brother but and uncles, ‘failing whom’ a list of cousins to his father, George. his brother is no mention of there

23 2012; 42:352–60 2012; By pretending to pay for books and tuition books and tuition for to pay By pretending 26 J R Coll Physicians Edinb Coll Physicians J R © 2012 RCPE Over his 20 months in Leiden George had courtedhad in Leiden George months 20 his a Over parent’s her to and, Cassa Margaretha girl, local He his intention to marry announced her. consternation, a to evidence as rather, but little time studying, spent ‘...coming every time spent later courtsuggested, case house...’ [the Cassa’s] their before sauntering hour permission to wed, Claiming that he had parental to Colchester with Margaretha George junior travelled were they paid a £200 bond, having where, in Essex, later Margaretha Six weeks 1741. 19, on May married in Paris telling her parents honeymoon from wrote as her husband had to and, that she was pregnant, she was unspecified business, to Scotland on return his sudden for The reason alone to Leiden. returning his father from to be a letter to Scotland proved return but promising telling him that he was in disgrace, son Margaretha’s home. if he returned rehabilitation Her letters to her husband went was born in 1742. letter a received she 1748 in but unanswered, her to come to inviting a well-wisher) from (apparently The letter was in fact Edinburgh to join her husband. of aim the with written senior, Young George from getting her to testify to a tribunal that she had never a feisty be to however She proved son. his married an adherence legal action, individual who began her own aiming the Edinburgh Commissary Court, before case, and wife lawful Young’s was George that she to prove ‘Dr Her action alleged that that her son was legitimate. persuaded, induced, either had father the Young This his son’ to desertcompelled or threatened her. since George been justified, allegation seems to have in parents senior had written to Margaretha’s Young eldest son is disinherited and banished ‘ ...my 1742 then He had cannot comfort him.’ You forever. declaratorya imposing by situation the compounded of began to When it on his son. silence (gagging order) George might win her case, look as though Margaretha young George had acquired tastes for those luxuries luxuries those for tastes acquired had George young the largest his first year In in Edinburgh. denied him and spirits (claret, wines for were paid to him sums ‘Gentlemens’ chocolate and tea, rhenish and arrack), Magazine’. George junior’s reason for travelling to England was very travelling for reason George junior’s have which followed, the events and this, and different, Houston in some detail by been set out and analysed Heijden. der van and fees he was able to limit his spending to £100 in the the in £100 to spending his limit to able was he fees 1741 he period in May a ten-day But over first year. he to cover, a total of £252, and was paid, requested, his at where, London, to travel his and books claimed, ‘a curious operation’. was to watch he request, father’s to refused and no such request His father had made who began court proceedings the agents, reimburse their payments. to recover Youngs against the IMC Macintyre

The lectures are a comprehensive account of contemporary medical, and some surgical practice. In the style of the day, they include some 20 case reports illustrating common conditions. Lectures are devoted to specific ailments such as smallpox, scurvy, gout, rickets, ‘King’s evil’ and madness. There are accounts of surgical conditions including wounds, ulcers, bladder stone and haemorrhoids and of various treatments, largely based on humoral medicine, including clysters (enemas) and diureticks [sic]. He also discussed chemical (e.g. mercury), herbal and natural remedies such as cooling, cold bathing and ‘regimen’ (diet and lifestyle).

Nerve function

It is in the lectures on physiology and on Boerhaave’s Institutions that Young’s sceptical approach becomes especially apparent. His lecture on nerve and muscle function, recorded by Robert Whytt, challenged conventional theories and here Young contributes to the ongoing quest for an understanding of the relationship between mind and body.

Galenic concepts of a fluid ‘animal spirit’ flowing down nerves from the brain prevailed until the human figure 4 John Boswell (1710–1780) the Edinburgh anatomical dissections of Vesalius paved the way for physician who described Young as a ‘sceptick and emperick’. alternative explanations. Isaac Newton had suggested By buying the copy of Young’s lectures transcribed by Whytt that transmission was accomplished by vibration of the he ensured that Young’s writings were available to future ‘ether’ within the nerves or by pressure. Yet the generations. Courtesy of RCPE. anatomists had shown that nerves were solid, calling these iatromechanical hypotheses into question. Young’s lectures When Young gave his lectures in 1731–2, the theories Young delivered lectures in Edinburgh in 1730–1. On about nerve function centred around the ‘animus’, the the inside cover of the copy of his lectures in the RCPE life force being transmitted along nerves by an as yet library, the Edinburgh physician John Boswell (1710– unknown mechanism. The experiments that would 1780) (Figure 4), uncle of the diarist, inscribed: ‘I bought clarify this were yet to come. What part did Young’s this book at Dr Whytt’s sale for it contains a variety of lectures play in that clarification? Young considers the things, amongst others the Dr’s [Whytt’s] own ms various theories that had been postulated. He outlines notes when a student of old Dr Young’s lectures on his the views of those who followed the Newtonian own private practice... Dr Whytt and I were iatromechanical theory like James Keill (1673–1719), the contemporary fellow students of Dr Young’s in 1730– Edinburgh physician and anatomist;36 Daniel Bernoulli 31... Dr Young was a very sensible, honest, good- (1700–1782) the Swiss mathematician and physician natured man, but a sceptick in medicine (and emperick) whose ideas on iatromechanical theory had only recently as well as in every other thing, confining himself to been published in Hydrodynamica.37 Young goes on to good, evident common sense.’20 discuss the proponents of ‘gunpowder theory’. John Mayow (1645–79), the English physician and chemist had The references to scepticism, empiricism and evident developed the gunpowder theory of physiology, believing common sense give an indication of some of the core that nitrous and sulfurous particles in the body were beliefs which characterised Young’s teaching. His ‘engaged in perpetual hostilities with each other’.38 surgical background and the influence of his Rankenian Mayow’s theory was extended by Thomas Willis (1621– friends are apparent throughout his lectures; he 75) who suggested that blood containing nitro- repeatedly emphasises the need to rely on observed sulphureous particles was pumped into muscles where rather than inferred phenomena before reaching it met with ‘animal spirits’ or a nervous fluid, to produce conclusions. His philosophy of medicine based on an ‘explosion’: the particles ‘suddenly intumified, as if history observation and experience is very much in the inkindled and exploded.’ The nerve acted as an ignition tradition of Thomas Sydenham. mechanism, controlled from the brain, producing ‘the fiery inkindling or the match… [to] blow up the Muscle’.38

43 40 In 42 357 published in 1751. in published ‘I have always thought’ he writes ‘that a man man a ‘that writes he thought’ always have ‘I 27 George Young (1692–1757): a sceptic and empiric and sceptic a medicine in (1692–1757): Young George marked contrast to the scepticism of Young, Monro Monro Young, of scepticism the to contrast marked ‘fluid’ in of the traditional Galenic view presented of Keill to the views nerves and his passing reference of uncriticalan view takes Bernouilli, and theory. hydromechanical his training as a in rooted was philosophy Young’s we lectures Young’s ‘in Stott concluded that surgeon. tradition of surgeon-apothecaries see the continuing obtained other than critical of medical knowledge external sensory of evidence the perception.’ through who lays down a settled theorysettled a down to point a strain must lays who Boerhaave once laid down... has maintain what he scruple of squeezing facts into a no more makes does of theoryconsistency with his than a lawyer considers that it Young criminal...’. bringing off a [guilty] of his eloquence rather than the worth is Boerhaave’s theory his reputation, that has made hydromechanical oratoryof master great a is he thereby ‘As is he or harm.’ good much of doing capable function, muscle In seeking a valid explanation for his students to start advises with the observation Young This was muscles. that the will causes the motion of the which by ‘sensible phenomena’, by he argues, mediated, the by perceived he meant phenomena which could be argues Young these phenomena for In searching senses. by detected be can which mechanisms those only that time he Do not waste considered. the senses should be explanations looking for by hypothesising in urges, course of action Pursuing this which cannot be seen. mechanisms ad ‘pursuing invisible in might result use of make ‘the will must He concluded that infinitum.’ influence Young’s some instrument to dilate the muscle.’ Vital and Essay on the is seen in the latter’s Whytt on Animals InvoluntaryOther of Motions Here he describes experiments on muscle stimulation, stimulation, on muscle he describes experiments Here He had promoted. Young the observed phenomena that theory of animal spirits as outright Haller’s rejected contraction, about muscle the mechanism which brought nervesno tubules in allow to were there that arguing (he not cited is Young Although of such fluid. the flow Whytt’s topic), the on published not all after had, emphasis on observation repeated basis for as the teacher. echoes the doctrine of his former hypothesis Willis, including influences other had course of Whytt his Could Stuart. Alexander and Stahl Boerhaave, his other been influenced by thinking on the topic have primus ? In Alexander Monro Edinburgh teacher great little time devoted series Monro lecture his extensive function. nerveof subject the to muscle and Indeed Young is scathing about Boerhaave. In a letter to to letter a In Boerhaave. about scathing is Young Indeed 31 dated student at Leiden, a medical Sinclair, William a Boerhaave’s of view sceptical a expresses he 1737, May theories. 39 He also 40 41 2012; 42:352–60 2012; breaking the the spiritumspecula breaking animalium J R Coll Physicians Edinb Coll Physicians J R © 2012 RCPE Muscle function Muscle function muscle of in the physiology interest Young’s on the after the dissertation continued he gave clearly critical analysis with a he begins before, As topic in 1719. He rejects function. theories of muscle of the prevailing on based are the theories that on the grounds these never [sic] ‘Keil observations. on than rather reasoning saw whoever the attraction of animal spirits, saw Bernouilli’s the struggling saw ever nobody Globules of Blood... does nor in the blood... alkali’s and betwixt the acids that he seen the bloody fray to have Willis pretend in the time of every of the muscle in the belly supposes his saw himself never Boerhaave great The contraction; which he accounts by spirits Influx of the animal greater motion.’ muscular for At much the same time as Young was giving his lectures, giving his lectures, was Young time as the same At much Stephen Hales (1677– the English cleric and physiologist 1761) was making observationson experiments. based be might powers’ ‘electrical that suggested He that a frog Hales found transmitted along nerves. and been decapitated, to jump after it had continued stimulus when a withdrawn be would limbs hind its that cord. spinal intact an on depended These applied. was it in described Hales did not publish the experiment but further who performed frog Whytt, a letter to Robert activity depended on experiments to confirm that reflex integrity of the spinal cord. the segmental Yet Willis was clear that nerves were responsible for responsible nerves was clear that Willis were Yet ‘transmission is movement: and muscle sensation implant[ing] nerves... the spirits within the by performed too Boerhaave Hermann force’. elastic or contracture a this hypothesis. promoted and in recent versed well was Young It is clear that discussed the Having contemporary literature. hefunction muscular of and sensation of mechanisms of the instruments nerves‘...the are concludes that as though unconvinced but, or another’, motion some way goes he theories, iatrophysical and iatrochemical these by nerve whether question to on through was conduction another mechanism?’ is it by ‘...or liquid or vibration which he wrote It seems certain that these lectures, to think Whytt Robert inspired with such care, down further that an about the topic and influenced his view observationon based be must explanation by not and Young’s dogma. variations on Galenic or Newtonian his suggestion and mechanical explanations of rejection to applied mechanics, of those than other laws, that forward. take to was Whytt which ideas were bodies, described the reflex pupillarylight and to reflex the described response the terminology response. and of stimulus introduced written up by were experiment, Hales’s including These, in 1751. publications of series in a Whytt IMC Macintyre

Treatise on Opium (1753) The treatise represents a valuable guide to prevailing knowledge and practice from an experienced practitioner, Opium was widely prescribed by doctors but there were with a clear warning about the risks of opium. It was the very few treatises on the topic to guide its use. Young’s largest, clearest, most balanced and most comprehensive contemporary Charles Alston, professor of botany and account to that time in English. materia medica at Edinburgh University had published a seminal paper in 1742 in which he described opium’s The work of Young and of Alston on opium had a major history and its preparation from poppies he had grown, influence on Whytt, whose later experiments concluded the first person in Britain to have done so.44 He described that opium acted on the nerve endings and the medulla, detailed chemical experiments and experiments assessing a view which took him into conflict with Monro secundus its properties using frogs and dogs. Although his was the and Haller.47 most objective, rational and scientific account to date, Alston wrote curiously little about the side-effects and nothing about addiction, previously well described. Young’s apprentice James Hill ‘Opium’ he concluded ‘does more honour to medicine than any other remedy whatever’. Young’s treatise seems Young’s legacy is also apparent in the thinking of one of to have been stimulated as a response to this, since, at the surgeons whom he trained. Of Young’s 12 known the outset he emphasises the risks ‘...that I may prevent apprentices one, James Hill (1703–1776), was to make such mischief as I can, I here give it as my sincere important contributions to the understanding and opinion... that opium is a poison by which great numbers management of head injury. Hill was apprenticed to are daily destroyed.’45 James Young in 1723 and returned to his native Dumfries where he set up in practice as a surgeon in 1732.3 Some In a thinly veiled reference to Alston, and true to his 40 years later he published Cases in Surgery which was in reputation as a sceptic, Young is fiercely critical about effect an account of the cases that he had treated over writers who have described chemical or animal a working lifetime in surgery, considered under three experiments: ‘...but how little satisfaction do we find in headings, head injury, cancers and sibbens.48 reading their accounts! How much are we disappointed when we come to compare these observations with our Cases is set out in considerable detail and with great own experience!’ Thereafter he describes his considerable clarity. In his series of 18 cases of cranial trauma Hill’s experience with the drug and makes little reference to mortality rate was only 16%, much lower than other the experience of others. contemporary published series, such as those of Le Dran (57%) and Potts (51%), although both were similar In 41 chapters over 182 pages the treatise sets out the to Hill’s in terms of severity of trauma.49 This is partly effects of the drug and its uses in a variety of conditions, explained by a much lower infection rate. Yet it is clear including his use of the drug for his own chronic cough that Hill understood concepts based on observation, a and diarrhoea. Thus he advocates its use in small doses discipline which must have been instilled into him by (20 rather than 30 drops) as a cough suppressant. He Young. Thus he appreciated the importance in skull describes its use in treating diarrhoea, urging caution as fracture of brain pulsation, of when and where to trepan in higher doses it is more likely to produce nausea and to relieve brain compression. A detailed account and vomiting in those with diarrhoeal illnesses. Other painful analysis of Hill’s series is given elsewhere.49 conditions in which he finds it effective include toothache, tenesmus, prolapsed haemorrhoids, and labour pains. Yet Hill’s influence continued to be felt long after his death. he advised against its use for ‘a small stone in the kidney His work was cited by later authorities such as John or ureters because opium will hinder nature from Bell,50 John Abernethy51 and WHA Jacobson,52 the last exerting itself in expelling it.’ This view became widely writing over 150 years after Hill’s death. This reputation accepted into medical practice for more than two was related to his management of head injuries which centuries. For decades pethidine was regarded as the showed a willingness to be guided by his own observation least likely to produce this effect, until opiates were and experience rather than the writing of others. Like superseded by non-steroidal anti-inflammatories as Young he was a sceptic, ready to criticise authorities drugs of first choice in this situation.48 when their views did not match his observations.

Young described the use of opium for ‘lowness of the Spirits’ and melancholia. He advocated its use in surgery Young’s influence and legacy as premedication: ‘Opium taken 2 or 3 hours before the operation gives courage and steadiness, both of body As a Rankenian, Young would have spent formative years history and mind.’ Yet, unlike some of his contemporaries he did with some of the most influential thinkers of his not prescribe it routinely during operations, concerned generation. David Hume is known to have met that it made the patients sleepy. Rankenians, but we can only speculate about their

358 J R Coll Physicians Edinb 2012; 42:352–60 © 2012 RCPE history 359 Edinburgh: Edinburgh: 28 July 1742. 1742. 28 July 1985; 40:327–45. 40:327–45. 1985; . Edinburgh: Birlinn; Birlinn; Edinburgh: . . Farnham: Ashgate; Ashgate; . Farnham: . East Linton: Tuckwell Press; 1995. Press; Tuckwell Linton: East . Eighteenth century medics: subscriptions, subscriptions, centuryEighteenth medics: 1997; 15:215–42. 15:215–42. Law and History1997; Review Memoirs and writings of the life of the . Edinburgh: Birlinn; 2001. Birlinn; Edinburgh: . Essays on David Hume, medical men and the Scottish men and the medical Essays on David Hume, . Edinburgh: Edinburgh: . an anthology Enlightenment: Scottish The The Scottish Enlightenment: the historical of the age The Scottish Enlightenment: . Edinburgh; Edmonston & Douglas; 1862. & Douglas; Edmonston Edinburgh; . Scotland’s age of improvement: a survey a of eighteenth- of improvement: age Scotland’s DD. McElroy State Washington Pullman: centuryliterary clubs and societies. 1969. Press; University DD, William Robertson, and writings Account of the life of Stewart D. 1801. Cadell & Davies; FRSE. London: of David Hume a life infidel: The great Graham R. 2004. a century in Scotland. of Enlightenment The Scotch metaphysics: GE. Davie http://dx.doi.org/10.4324/9780203471159 2001. Routledge; London: A Hermathena: Club. the Rankenian and Berkeley Stewart MA. 139:24–45. 1985; Dublin Review College Trinity A. Broadie 1997. Canongate; AFT. Woodhouselee William printed for HenryHonourable Home of Kames. Edinburgh: 1807. Davies; W. Cadell and T. and Creech Clarendon Oxford: 2nd ed. of David Hume. The life EC. Mossner 1980. Press; RL. Emerson and humanity knowledge industry, Enlightenment: 2009. of Surgeons College Royal lives: Surgeons’ I. MacLaren IMC, Macintyre years. 500 over fellows of college an anthology of Edinburgh: 2005. Edinburgh; of Surgeons College of Royal The dictionary of eighteenth-century Stephens JN. JV, Price JW, Yolton 1999. Thoemmes; Britishphilosophers. Bristol: J Hist medical school. of the Edinburgh The founding Emerson RL. http://dx.doi.org/10.1093/jhmas/ 59:183–218. Med Allied Sci 2004; jrh066 History its University of the of Edinburgh from Innes C. A, Dalzel foundation College of Royal Edinburgh: on . medicine Lectures G. Young 1730–1. Edinburgh; of Physicians Andrews; Muniments.St of University Andrews. St of University UV452/4/211. 1751. Archives; City Edinburgh Annuity Tax. the the water: across Hands Heijden M. van der R, Houston the in Scots and Dutch between marriage of breaking and making mid-eighteenth century. http://dx.doi.org/10.2307/827651 8 and others. Young to Dr George Young Thomas Disposition of Mr of Scotland, Archives National Edinburgh: October 1755. 1755. GD98/27/11; obstetrical (1726?-1783) and M.D. Young, Thomas Hoolihan C. Allied Sci J Hist Med Edinburgh. at education http://dx.doi.org/10.1093/jhmas/40.3.327 and Crawford and Messers at Paris Grant Aeneas Macdonald factor in Edinburgh and George Young v Mr George factors at Rotterdam Expenses of education in surgery abroad. son. his Young 1742. GD/50/216/45; Scotland, of Archives National Edinburgh: student of medicine Leiden William Sinclair, to Letter G. Young GD of Scotland, Archives National Edinburgh, concerning his studies. 1737. 136/376; [Internet].[cited 2012 Oct converter currency National archives http://www.nationalarchives.gov.uk/currency/ from: Available 31]. Disposition by Mr Thomas Young to Dr George Young and others. and others. Young to Dr George Young Thomas Mr Disposition by 1755. GD/98/27/11; Scotland, of Archives National Edinburgh: City of the of apprentices The register M. Wood CBB, Watson Grant FJ, 1906. Society; Record Scottish Edinburgh: 1583–1666. of Edinburgh, Whittet T. Wallis Wallis R, PJ, 1985. Newcastle; of University Newcastle: . apprenticeships licenses, medicine in and apothecaries: surgeons Physicians, Dingwall HM. seventeenth-century Edinburgh . Edinburgh: Royal Royal Edinburgh: August 1719. 27 21 July; 14 July; Minutes 20 May; Edinburgh. of Surgeons College of A. Broadie historical nation

George Young (1692–1757): a sceptic and empiric and sceptic a medicine in (1692–1757): Young George

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ces Referen 1 2 3 4 5 6

54 At 53 and in the and 17 10 DictionaryLiteraryof 2012; 42:352–60 2012; attests to his status as a philosopher but his philosopher a as status his to attests The Rankenians discussed ideas later elaborated ideas discussed The Rankenians

55 was planned before he before was planned of Human Nature Treatise 55 J R Coll Physicians Edinb Coll Physicians J R © 2012 RCPE the heart of Hume’s philosophy was the emphasis on emphasis was the philosophy the heart of Hume’s theme in a recurring observation and experience, of science the ‘as write to was Hume teaching. Young’s the other sciences, for solid foundation man is the only to this science can give we solid foundation only the so observation’.be laid on experience and itself must by Hume, and Davie considered that they were one of were that they considered Davie and Hume, by the determining influences in his ideas. British philosophers section of the of section British philosophers Biography Why did such an important figure not merit a biography merit a biography not an important did such figure Why possible is pupils? It or contemporaries from tributes or around events from resulting that because of the scandal Dundas, his legal battles with James and divorce his son’s despite Yet and influence. respect lost friends, he had in importantan as emerges figure Young George that, his of tenet central The teaching. medical Edinburgh knowledge valuable only the that was philosophy medical the by provided experience i.e. from was that derived to become a core in later years, and this was, senses entry in the Dictionary Young’s belief of the Enlightenment. of Eighteenth Century British Philosophers conclusion Young’s emphasis on observation and scepticism and his Young’s of nerve and muscle critical and questioning analysis his pupil Robert inspired have surely function would that principle, sentient the of development his in Whytt sensory along the sensation nerves which conveyed force refusal on emphasis That muscles. in initiated motion and unless supported wisdom to accept established by experience and observation in the writings and is evident tradition. Young trained in the of James Hill, the results influence during his years at Edinburgh University from from at Edinburgh University influence during his years club member. a was Young when years 1725, 1721 to Hume’s was 21 years old and composed before he was 25. he was before composed and old years 21 was Young, recognised by Whytt (and presumably by other by presumably (and Whytt by recognised Young, have well may empiric, sceptic and a as contemporaries) thoughts on the doctrine of influenced the early scepticism of that and Hume by empiricism developed the out, pointed has Fosl As associated. is with which he and what became lectures Young’s similarities between and practice are probability, of causation, analysis Hume’s striking. influence deserves greater recognition and appreciation. and recognition influence deservesgreater Acknowledgements articlethe suggesting for Ganz Jeremy to grateful am I Helen Dingwall for to and manuscript the reading and Iain Milne and to thanks My helpful suggestions. many Estela Dukan at the RCPE Library and Marianne Smith at the RCSEd Library help. invaluable for Kerr and Steve IMC Macintyre

29 Smith RWI. English-speaking students of medicine at the University of 43 Stott R. The Incorporation of surgeons and medical education and Leyden. Edinburgh: Oliver and Boyd; 1932. practice in Edinburgh 1696–1755 [PhD thesis]. Edinburgh: University 30 Declarator of marriage: Margaret Cassa v George Young. Edinburgh: of Edinburgh; 1984. National Archive of Scotland, CC/8/6/330; 1749. 44 Alston C. A dissertation on opium. Medical Essays and Observations 31 Grant FJ, ed. The Commissariot of Edinburgh. Consistorial processes and 1742; 5:110-77. decreets 1658–1800. Edinburgh: Scottish Record Society; 1909. 45 Young G. A treatise on opium, founded upon practical observations. 32 Process of divorce: George Young v Margaret Cassa. Edinburgh: London: printed for A Millar; 1753. National Archives of Scotland, CC/8/6/333; 1750. 46 O’Connor A, Schug SA, Cardwell H. A comparison of the efficacy 33 Information for Aeneas Macdonald, factor at Paris and Messers Grant and safety of morphine and pethidine as analgesia for suspected and Crawford, factors at Rotterdam v Dr George Young physician and renal colic in the emergency setting. J Accid Emerg Med 2000; his son George Young 20 Dec 1743. Edinburgh: National Archives of 17:261–4. http://dx.doi.org/10.1136/emj.17.4.261 Scotland, GD 50/216/45; 1743. 47 Whytt R, Whyte-Melville J. The works of Robert Whytt. Edinburgh: 34 Information for George Young Physician at Edinburgh against Aeneas Balfour, Auld, and Smellie; 1768. Macdonald, Factor at Paris. Edinburgh: National Archives of Scotland, 48 Hill J. Cases in surgery, particularly of cancers, and disorders of the head GD 50/216/45; 1744. from external violence. With observations. To which is added an account 35 James Dundas baxter, burgher, Edinburgh vs George Young, physician of the sibbens. Edinburgh: John Balfour; 1772. Edinburgh. Edinburgh: National Archives of Scotland, CS181/7484; 49 Granz J, Macintyre IMC. Traumatic brain injury in the 18th century; a 1746. journey towards clarity. Forthcoming 2013. 36 Keill J. An Account of animal secretion, the quantity of blood in the 50 Bell J. The principles of surgery, in two volumes. Edinburgh, London: humane body, and muscular motion. London: George Strahan; 1708. Printed for T. Cadell, jun. & W. Davies, in the Strand, T.N. Longman 37 Bernoulli D. Hydrodynamica, sive de viribus et motibus fluidorum & O. Rees, Paternoster-Row and W. Creech, P. Hill, and Manners commentarii, etc. Argentorati: sumptibus Johannis Reinholdi and Miller; 1801. Dulseckeri; 1738. 51 Abernethy J. Surgical observations on injuries of the head; and on 38 Mayow J. Medico-physical works; being a translation of Tractatus miscellaneous subjects. London; Longman: Hurst, Rees, Orme and quinque medico-physici (1674). Edinburgh: Albemic Club; 1907. Brown; 1810. http://dx.doi.org/10.5962/bhl.title.28895 52 Jacobson WHA. The operations of surgery. 5th ed. London; J & A 39 Wright JP. Metaphysics and physiology. In: Stewart MA, ed. Studies Churchill; 1907. in the philosophy of the Scottish Enlightenment. Oxford: Clarendon; 53 Hume D. Essays, moral, political, and literary. Edinburgh; 1741. 1990. 54 Hume D. A treatise of human nature: being an attempt to introduce 40 Whytt R. An essay on the vital and other involuntary motions of the experimental method of reasoning into moral subjects. London: animals. Edinburgh: Hamilton, Balfour and Neill; 1751. http://dx.doi. Printed for John Noon, at the White-Hart, near Mercer’s-Chapel, org/10.1037/11796-000 in Cheapside; 1739. 41 French RK. Robert Whytt, the soul, and medicine. London: Wellcome 55 Fosl PS. British philosophers, 1500–1799. In: Dematteis PB, Fosl PS, Institute of the History of Medicine; 1969. eds. Dictionary of literary biography. Detroit: Gale Group; 2002. pp. 42 Monro A. Lectures. Edinburgh: Royal College of Surgeons of 195–223. Edinburgh; 1731. history