J R Coll Physicians Edinb 2005; 35:356–364 PAPER © 2005 Royal College of Physicians of Edinburgh The excoriation of Benjamin Bell: who was ‘Jonathan Dawplucker’? MH Kaufman School of Biomedical and Clinical Laboratory Sciences, University of Edinburgh, Edinburgh, Scotland ABSTRACT Because of a perceived lack of continuity of care of the surgical patients Correspondence to MH Kaufman, in the Edinburgh Royal Infirmary, James Gregory, one of its managers, suggested School of Biomedical and Clinical that from 1800 a total of only six surgeons should be appointed full-time to that Laboratory Sciences, Hugh Robson institution. As considerable animosity existed between Gregory and John Bell, a Building, George Square, Edinburgh, senior Edinburgh teacher and surgeon, a pamphlet that was extremely hostile to EH8 9XD his activities was posted in prominent locations throughout Edinburgh. While the tel. +44 (0)131 650 3113 author was named as ‘Jonathan Dawplucker’ it was speculated that Gregory, or one of his close associates, was its real author. The contents of a second fax. +44 (0)131 650 3711 Dawplucker pamphlet, in the same style, but probably written by John Bell, was subsequently published. This was extremely hostile to Benjamin Bell, one of e-mail [email protected] Gregory’s close surgical colleagues. While much distress was caused at that time, the real authors of these pamphlets are unlikely ever to be established. KEYWORDS Benjamin Bell, care of surgical patients, Dawplucker pamphlets, James Gregory, John Bell, Royal Infirmary of Edinburgh DECLARATION OF INTERESTS No conflict of interests declared. INTRODUCTION Towards the end of the eighteenth century, an enormous amount of bad feeling existed in the Edinburgh medical community. This was principally because of the suggestion that had been made by one of the managers of the Royal Infirmary, Professor James Gregory (1753–1821) (see Figure 1A), that the arrangements then in force for looking after the surgical patients in the House were both unsatisfactory and unacceptable. Gregory was a particularly influential figure on the Board of Managers of the Infirmary. From 1790 he had been Professor of the Practice of Physic in the University of Edinburgh, and subsequently held this post until 1821. He was also President of the Royal College of Physicians of Edinburgh from 6 December 1798 until William Wright was elected to this office on 3 December 1801, and until his death was First Physician to the King in Scotland. The managers recognised from an early stage, after the establishment of the Infirmary, that it was of critical importance that there was both continuity of patient care FIGURE 1A One of the three of the individuals who might have and an adequate standard of clinical teaching achieved in authored the first Dawplucker pamphlet. Professor James the medical wards. Accordingly, from 1751, they Gregory, portrait by Sir Henry Raeburn, by courtesy Royal appointed two Fellows of the College of Physicians who College of Physicians of Edinburgh. were to be styled Physicians-in-Ordinary to the staff of faculty agreed to give a joint series of didactic lectures the Infirmary. The College of Physicians also arranged that each year. They each lectured for five weeks, and in this some of its Fellows should visit the Infirmary on a regular way covered the subjects of Anatomy and Surgery HISTORY basis. These men acted in a purely consulting capacity, (Alexander Monro primus), Chemistry in relation to were readily available, and could always be consulted by Medicine (William Cullen), the Institutes of Medicine, or the Physicians-in-Ordinary should this be needed. From Physiology (Robert Whytt) and the Practice of Physic, or 1757, four of the professors of the University medical Medicine (John Rutherford). The managers also assigned 356 The excoriation of Benjamin Bell: who was ‘Jonathan Dawplucker’? This was a theme approved by John Thomson (see Figure 1B). He was a young and ambitious surgeon, who had previously attended the Edinburgh Medical School, and gained the fellowship diploma of the Edinburgh College of Surgeons in 1793. He had previously spent a year in London attending the Great Windmill Street School, and gained a large circle of Whig friends in the Capital. In 1800, he was the youngest of the six surgeons appointed to the Infirmary. Shortly before this time, Thomson had indicated in his pamphlet that he was distressed: ‘by the present mode of allowing indiscriminately every young member of the College of Surgeons to take his turn of public duty in the Infirmary, some of them must be supposed to have but little previous preparation for so important a trust, so very arduous an undertaking.’ He did, however, express his reservations about the selection of the most senior and experienced surgeons, FIGURE 1B One of the three of the individuals who might have stating that: authored the first Dawplucker pamphlet. Mr John Thomson, by courtesy Royal College of Surgeons of Edinburgh, artist ‘If the permanent surgeons were selected from unknown. among the older and more experienced members of the College, and who of course must be supposed to them special wards from where they could select be much occupied in private practice, they could not individual patients to illustrate their lectures.1 give that punctual, constant, and regular attendance, which is necessary in the conduct of the surgical A feeling had for some time existed amongst the department of the Infirmary.’ managers, as well as amongst many of the surgical patients, that they experienced little in the way of In this regard he was in agreement with Gregory’s more continuity of care in the Infirmary. For the previous three recent view on this topic. Thomson further indicated or more decades, all Fellows of the Edinburgh that, in his opinion, there were considerable advantages Incorporation (later Royal College) of Surgeons were to be gained by appointing permanent surgeons to the entitled to look after the surgical patients there. In order Royal Infirmary.3 In 1804, he was elected Professor of for this arrangement to function properly, the surgeons Surgery to the College of Surgeons, and in 1806, due to were required to work a rotation system. the influence of his Whig friends in London, he was appointed the first holder of the Regius Chair of ATTENDANCE OF THE SURGEONS AT THE Military Surgery in the University of Edinburgh.4 EDINBURGH ROYAL INFIRMARY BEFORE 1800 Two of the most distinguished surgeons who attended The attendance of the surgeons was on a number of the Infirmary between 1770 and 1800 were Benjamin occasions a cause for concern. In December 1793, for (1749–1806) and John Bell (1763–1820). While both example, the Board of Managers felt it necessary to set shared the same surname, they were unrelated.5 Both up a committee to enquire into the effectiveness of were skilful surgeons and impressive teachers of the the rotation system. They had noted that an increasing subject, although, as will be seen below, for the latter number of recently qualified surgeons were placing part of this period they were not on particularly their names on the register for service in the friendly terms. It is likely that one of the reasons for Infirmary, while the older and more experienced their animosity was because Benjamin Bell was a close surgeons were declining to do so. The Board was ally of Gregory, and had written a pamphlet in support forced to recommend: of the latter’s views on the staffing of the surgical wards of the Infirmary,6 while John Bell strongly ‘That no future Intrant Member of the College of opposed Gregory’s views on this topic. He also acted Surgeons shall be admitted to practise as an as the spokesman for the younger members of the HISTORY Attendant Surgeon in the Infirmary till after the lapse College of Surgeons.7 As the century drew to a close, of five years from the time of his being admitted a difficulties were encountered due to the increasingly member of the Incorporation of Surgeons.’2 irregular and less frequent attendance of the senior J R Coll Physicians Edinb 2005; 35:356–364 357 © 2005 RCPE MH Kaufman surgeons at the Infirmary. Gregory came to the another, one of the Surgeons-in-Ordinary be absent conclusion that continuity of patient care was the from the Infirmary, his, or their, posts would be filled by greatest priority, and could only be achieved if an the surgeon or surgeons next on the list. Their entirely new system of surgical cover was implemented successors in office were required to attend the in the Infirmary.8 When his views were offered to the Infirmary for one month before taking over their duties College of Surgeons they gained little sympathy from on a regular basis in order that they should become fully that and other quarters, and numerous acrimonious acquainted with all of the patients in the wards. The pamphlets were published, most of which were latter feature of his proposal was of particular directed towards the managers.9 importance in ensuring that continuity of patient care was maintained. SUGGESTIONS BY PROFESSOR JAMES GREGORY FOR THE STAFFING OF THE Despite a substantial degree of opposition from many of SURGICAL BEDS OF THE INFIRMARY the junior members of the College of Surgeons, on 23 December 1800, the managers appointed six members of It all came to a head in about 1800, when Gregory the College of Surgeons of appropriate standing to the six published his Memorial to the Managers of the Royal vacant posts. The six surgeons appointed, in the order of Infirmary.10 In this substantial pamphlet, he their seniority, were James Russell, Andrew Wardrop, recommended that a total of six full-time senior James Law,Andrew Inglis,William Brown, senior, and John surgeons should be appointed to the Infirmary by the Thomson.