Makars and Mediciners: a Study of the Link Between Scottish Literature, Medicine and Health
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Calman, Kenneth Charles (2012) Makars and mediciners: A study of the link between Scottish literature, medicine and health. MLitt(R) thesis. http://theses.gla.ac.uk/3967/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Glasgow Theses Service http://theses.gla.ac.uk/ [email protected] MAKARS AND MEDICINERS A STUDY OF THE LINK BETWEEN SCOTTISH LITERATURE, MEDICINE AND HEALTH KENNETH CHARLES CALMAN, MD PhD FRCS FRSE SUBMITTED FOR THE DEGREE OF MASTER OF LETTERS SCOTTISH LITERATURE SCHOOL OF CRITICAL STUDIES COLLEGE OF ARTS UNIVERSITY OF GLASGOW JULY 2012 PREFACE Makars and Mediciners began as a personal commonplace book, an anthology, of novels, poems and short stories, which linked Scottish literature and medicine. This, in itself, grew out of a short course on literature and medicine for medical students as part of the course on medical ethics at the University of Glasgow (1984-89); the importance of literature and the arts in general, in professional education and in improving health and well-being, was emphasized. These interests expanded in the University of Durham with the establishment of a Centre for the arts and humanities in health and medicine. In this Centre, the impact of the arts and humanities on health are being explored in the growing field of Medical Humanities. This thesis is not based on a critical study of the literature in formal terms, but is both an examination and a reflection on how thematically the literature of Scotland can illuminate issues of health and medicine. Through literature, it records the medical, cultural, historical and social changes over the time period of the thesis. The period of research begins in the 18th century as a series of chapters detailing the relevant work of specific authors. By the 19th century, as the literature expands, and medical advances grow, the writings are covered through a series of themes, which represent some of the major issues in the works themselves. Its purpose, returning to its genesis, is to provide an educational resource for those interested in improving health and in changing clinical practice: for debate, discussion, disagreement and learning, and to stimulate a broader interest in the role the arts can play. Ultimately its purpose is to show some of the ways in which a study of literature can be used to fuel debate about the improvement of health and health care. It is hoped that some of the readings, by demonstrating experience of issues of the past, and of the present, will be of sufficient power to change thinking and practice. It is my pleasure to record my thanks to Dr. Gerard Carruthers and Dr. Kirsteen McCue who jointly supervised this project. Their help has been invaluable. I should also like to particularly mention the role of Professor Robin Downie in the genesis of this Thesis. He was a special mentor when I needed it most and a good friend. I should also like to thank colleagues from the School of Critical Studies at the University for their input into the project. I would particularly like to thank Dr. Linden Bicket for her help in formatting and referencing the Thesis. I wish her every success in the future. Other members of staff across the University have been very supportive and helpful and encouraged me to finish the work. Hugh Cheape from Sabhal Mòr Ostaig on Skye was always helpful. Libraries have been at the heart of this research and I am particularly grateful to the University of Glasgow Library and its Archives, the Mitchell Library in Glasgow, The National Library of Scotland, the British Library, the Library of the Royal Society of Medicine and the British Medical Association Library in London. I am also grateful to my wife and family for allowing me to do this and for their encouragement and positive criticism. Finally I should like to thank my dog Mungo who started me on this project and my new puppy Ailsa who has continued to give me time to think as we had our walks. 1 CONTENTS 1. Preface and acknowledgement 1 2. Introduction 3 3. Background to Eighteenth-Century Scotland 32 4. Robert Fergusson 36 5. Robert Burns 55 6. Tobias Smollett 89 7. John Armstrong 101 8. Further Writing from the Eighteenth Century 113 9. Background to the Nineteenth Century 124 10. Doctors and Medical Students 131 11. Health, Illness and Remedies 155 12. Social Conditions and Lifestyle 175 13. Learning Opportunities 195 14. Summary and Conclusions 221 15. Appendix 1 227 16. Bibliography 229 2 CHAPTER 1 INTRODUCTION Life is short, and the Art long; the occasion fleeting, experience fallacious and judgement difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and the externals co-operate.1 INTRODUCTION The quotation above from Hippocrates, some 2500 years ago, is as true today as it was when it was written. The points he makes include the fact that it takes time and experience to learn medicine, and that it involves judgement. There is an “art” to medicine. It emphasises the need to consider doing the right thing, the ethical dimension, and to involve the patient, and others, in the decision making process. This aphorism also highlights the two aspects of being a doctor which have been developed and written about in various ways and contexts over the centuries; the need for knowledge and experience, and an understanding of feelings, emotions and ethical issues; the science and the art. This is a very modern view of medical practice and it is at the heart of this thesis. The problem, then, is how to ensure that doctors learn the things they need, put them into practice, and ensure full involvement of the patient. One way of exploring this contemporary issue is to use the inspiration of the written word in the form of poems, novels, plays and fictional stories to illuminate the current roles and responsibilities of the doctor and other health professions. Indeed the source of this thesis was a short course on ethics for medical students, during which the use of literature was developed as a way of increasing the understanding of ethical and moral issues.2 More broadly since then the subject has expanded more rapidly in increasingly formal ways in the UK into the arts and humanities and, as an example, 2010 celebrated the 10th anniversary of the Journal of Medical Humanities.3 The purpose of this thesis, therefore, is to explore the possibility that a study of the literature of Scotland can contribute to a better understanding of the changing role of the doctor, the values of the medical profession and how the health of the population might be 1Hippocrates, ‘Aphorism 1’, in The Genuine Works of Hippocrates, trans. by Francis Adams (Baltimore: William and Wilkins, 1939), p. 292. 2K.C. Calman, R.S. Downie, M. Duthie, B. Sweeney, Medical Education, 23 (1988), 265-69. 3H.M. Evans and D.A. Greaves, ‘Ten Years of Medical Humanities’, Journal of Medical Ethics, 36 (2010), 66-68. 3 improved. It covers the period from the 18th century to the beginning of the 20th century. This introductory chapter sets the scene and describes some of the criteria and definitions against which to evaluate the creative literature and provide a standard for what determines health and quality of life. It includes a brief section on the history of Scotland over this period, together with a review of the changes in medicine, and a discussion on living and dying. It also includes a short overview of the literature of Scotland which will be expanded later in the thesis together with a summary of the critical approach selected. This background chapter, and the aims which are set out, will be re-appraised at the end of the study, as part of the conclusions. This thesis is therefore approached from a particular perspective and clinical tradition, that of understanding complexity, contradictions, realism, evidence and imagination. It began with an interest in ethics, and has continued with a broader involvement in storytelling, imagination, feeling and sentiment in further defining the evidence base, and in clarifying the process of learning of doctors over the centuries.4 It is also concerned about the future of medical and health care practice, and what can be learned from the arts. This, in turn, also raises a more fundamental issue, that of the purpose of the arts. Murray Pittock makes the point clearly and the ways in which this thesis will engage: What then are the arts for? Pursued as they should be, they serve to provide the context to evaluate claims of novelty, to frame policy and prevent us from doing the same thing twice; to understand persuasion, propaganda and the language of the situation and negotiate it, to console and heal; to empower and provide the space in which we can be, and communicate that on every level.5 THE WIDER BACKGROUND The two cornerstones of medical practice, science and ethics, have been raised already and are at the heart of the professional role of the doctor.