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THE
EDINBURGH SCHOOL OF SURGERY
BEFORE LISTER
PASTKUR AND AFTER
PASTEUR
(nDet)ical t>t5torie /I>anual0)
Ry STEPHEN PAGE I, F.R.C.S.
ContainiiiK 8 . aie Illu8trativ)..s
Crown 8vo.. cloth Prict Ss. tut
I'he men and matters with which it deals are prob-
ably the most interesting to be found in the field of
medicine, and to such men as Pasteur and Lister the
world owes a debt which can never be paid in full
Mr. Paget has given us a brief bio^rnphy of Pasteur
and a condensed but comprehensive revitw of his great
discoveries." — J'ht Outlcok.
" We heartily commend this fascinating volume,
which records the achievements of a great scientist
with knowledge, sympathy, and skilX" — Aberdeen
rUDI.ISHED HY
1. i; 1^- 6 SOUO SOUARE, LONDON, \V I
THK OM) ROVAI. INl-IRMARV
(Ff-om ap.tiHliHf: f'y Samitrson, in the /K>sstssioH 0/ tht MatM^ers oj tlu
Royal In/irmary 0/ EJinl^urgh.)
THE EDINBURGH
SCHOOL OF SURGERY
BEFORE LISTER
BY
ALEXANDER MILES
SURGEON TO THE ROVAL INFIRM ARY, EDlNBUkGH
WITH EIGHT PAGE ILLUSTRATIONS
A. & C. BLACK, LTD.
4, 5 & 6 SOHO SQUARE, LONDON, W. i
IQ18
BIOLOGY UBH/^Mt
BIOLOGY
LIBRARY
PREFACE
The student of surgery who confines his reading
to modern textbooks, which of necessity deal only
with matters of present-day interest, fails to see
the outlines of his subject in their true historical
perspective. The existing state of surgery as a
science and an art is duly presented to him, but
the steps by which it has reached this state he has
no means of tracing. The names of the old
masters he may meet, but they remain to him but
names attached to particular operations or instru-
ments, and he gathers little of the part they played
in the evolution of our knowledge and less of what
manner of men they were. Seeing only the per-
fected results of the surgery of to-day, he fails, on
the one hand, to realize the difficulties that had to
be overcome by the pioneers of surgery, and, on
the other, to grasp the real significance of the
revolution effected by the master mind of Joseph
Lister.
The purpose of this brief sketch is to enlist the
interest of the student in the history of his subject
by tracing the rise and development of a school of
surgery from the days when the practice of the
V
785
vi PREFACE
surgical art was in the hands of the craft of barber-
surgeons, who carried it on largely as a trade,
down to the beginning of the Listerian era, when
it had attained to the dignity of a learned and
scientific profession.
The limits I have set myself by selecting, for
obvious reasons, the Edinburgh Scliool, restrict
the scope of the historical study and exclude from
these pages many names famous in the annals of
surgery, but in other numbers of this series of
" Historical Manuals " tlie gaps I have left will
doubtless be filled up.
In the biographical sections, for the convenience
of the reader, I have inserted in italic figures the
age of the subject at important periods of his
career, believing that this is of greater interest than
the mere date. The superior figures refer to the
items in the bibliography at the end.
For facilities in providing the illustrations I
desire here to express my indebtedness to the
Managers of the Royal Infirmary, the Royal
College of Ph}sicians of Edinburgh, the Royal
College of Surgeons of Edinburgh, the Professor
of Surgery in the University, and Miss Bell, FMin-
burgh.
Al.KXANDKK MILES.
EUINUUUOH,
October, l})!?.
CONTENTS
CHArTEF PAGE
PREl-ACE - - - - - - V
[. THE PERIOD OF THE BARBER-SURGEONS - - 1
II. THE EARLY ANATOMICAL SCHOOL - - - 11
III. THE FOUNDATION OF THE FACULTY OF MEDICINE IN
THE UNIVERSITY - - - - - 21
IV. THE ROYAL INFIRMARY - - - - 27
V. THE PERIOD OF THE PRACTITIONER-SURGEONS - 38
VI. THE BEGINNING OF THE SURGICAL SCHOOL - - 47
VIL THE FOUNDATION OF THE CHAIR OF SYSTEMATIC
SURGERY - - - - - - 76
VIII. THE CHAIR OF CLINICAL SURGERY - - - 96
IX. THE CHAIR OF MILITARY SURGERY - - - 108
X. SOME SURGEONS OF THE EXIRA-MURAL SCHOOL - 121
XI. ROBERT LISTON - - - - - 146
XII. JAMES SYiME ----- 174
BIBLIOGRAPHY - . . - - 212
INDEX - - - - . - 216
LIST OF ILLUSTRATIONS
THE OLD ROYAL INFIRMARY - - - Frontitpiece
KACIHG PAi.K
rHK TOMHSTUXK Oh JAMES HORTHWK K IN GREYFRTARS
( HIRCHYARD, EDINBURGH - - - - li3
I-ORD PROVOST DRUMMOND \
ALEXANDER MONRO pi'imUS
A
BE>
JOHN THOMSON ^
23
LEXANDER WOOD 1 -^
ENJAMIN RELL |
84
WILLIAM JOHN TURNER j
SIR WILLIAM FERGUSSOK - - - -132
ROBERT LISTON - - - - -146
JAMES SYME - - - - - - 174
THE EDINBURGH SCHOOL OF
SURGERY BEFORE LISTER
CHAPTER I
THE PERIOD OF THE BARBER-SURGEONS
The Barber-Surgeons — The Seal of Cause — The Craft of
Chirurgeons — The Separation of the Surgeons and
Barbers.
The Edinburgh School of Surgery may be traced
back to the year 1505, when the " surregeanis and
barbouris," who had just been erected into a
Corporation, presented to the Town Council a
petition which included the request '* that we may
have anis in the yeir ane condampnit man after he
be deid, to make anatomea of, quairthrow we may
heif experience, ilk ane to instruct utheris, and we
sail do suffrage for the soule."^
It may be that the granting of such a petition,
even with its explicit obligation that each one
should instruct others, is not sufficient to mark the
foundation of a School, but it expresses the
willingness of the governing authorities to satisfy
1
2 THE EDINBURGH SCHOOL OF SURGERY
the aspirations of those who desire to cultivate
and impart knowledge, which is the first step
towards it.
It is to be borne in mind that this petition was
made and granted eight years before the Battle of
Flodden, when Scotland was in a state of political
anarchy, her people poor, ignorant, and cruelly
oppressed by the despotic barons, and when learn-
ing was held in small esteem. The fathers of
anatomy, Vesalius and Fallopius, were still unborn,
and it was not till many years later that the
Emperor Charles V. convened the divines at
Salamanca *' to determine if it were consistent with
conscience to dissect a human body for the purposes
of science." Thirty-five years had still to elapse
before the English Company of Barber-Surgeons
was chartered, and even the oldest of the English
Medical Corporations, the Royal College of
Physicians of London, was not founded till thirteen
years later.
Thus early do we find the surgeon-barbers of
Edinburgh arrive at the great truth, which has
governed the teaching of surgery in the school ever
since, tliat the foundation of sound surgical practice
rests upon a knowledge of anatomy, and in their
petition they represent ** that everie man that is to
be maid frieman and maister amangis us be examit
and previt in thir poyntes following — thatt is to say :
THE PERIOD OF THE BARBER-SURGEONS S
That he knaw anatomea nature and complexioun
of every member In manis bodie. And in lyke
wayes he knaw all the vaynis of the samyn thatt
he may mak flewbothomea in dew tyme. And als
thatt he knaw in quilk member the signe hes
domination for the tyme for every man aucht to
knaw the nature and substance of every thing thatt
he wirkis, or ellis he is negligent. ..." Inci-
dentally, the petition contains the germs of the
Prehminary Examination, for it was stipulated that
no master of the craft should take an apprentice
** without he can baith wryte and reid."^
It must not be omitted that under their ** Seal of
Cause" the Incorporation were granted privileges
other than the right to dissect a condemned
criminal once a year, for it was further ordained :
** That na person man nor woman within this
burgh mak nor sell ony aquavitse within the same
Except the saidis maisteris brether and frieman of
the saidis craftes under the paine of escheit of the
samyn but favouris."
It would be ungracious to canvass the question
as to which of these privileges was most highly
valued by the masters, brethren, and freemen of the
craft, but it is a matter of history that while their
prescriptive right to make and sell whisky has long
been lost, they have never relinquished any legiti-
mate claim to anatomical material. They were
4 THE EDINBURGH SCHOOL OF SURGERY
even at one time accused of favouring methods
which were not strictly legitimate, but " the scan-
dalous report, most maliciously spread about the
town, that some of their members were accessary "
to the violation of the sepulchres in the Greyfriars
Churchyard was vehemently denied in a Memorial
Act sent to the Magistrates in Council, and it was
enacted that any member found guilty of such
** unnatural and unchristian practises " should be
expelled their Society, and that any apprentice or
servant similarly convicted should be •* expelled his
master's service with disgrace."
One effect of the granting of the Seal of Cause
was to throw upon the Incorporation the onus of
providing the citizens with a sufficient number of
barbers licensed " to clip, cow, and shave," but as
the simple barbers were restricted to fulfilling these
humble offices, and were not permitted *' to use any
point of chirurgie, under pain of tinscU of their
fredome," each section of the craft performed its
proper functions, and the cosmetic needs of the
community were satisfactorily met. In course of
time, however, the conditions of admission of the
simple barber were so modified that his entering the
Incorporation was ** without prejudice to him to
crave admission to the art of chirurgie when it shall
please God that he be able to discharge his duties
therein." It must be assumed that the test of the
THE PERIOD OE THE BARBEH-SURGKONS 5
applicant's ability to perform the duties of a surgeon
was less exacting than this condition seems to
suggest, for the *'tryaH" for promotion to the
status of surgeon- barber was conducted by the
Craft itself, and was so lenient that most of the
fresh entrants passed it. Thus it came about that
the simple barbers, who in the earlier years of
the Corporation were in a majority, were soon
out-numbered by the surgeon-barbers, and the
" Barber-Craft " gradually gave place to the " Craft
of Chirurgeons," which, in 1583, was granted pre-
eminence amongst the Trade Guilds of Edinburgh,
the first Deacon being Gilbert Prymross, an
ancestor of the Earl of Rosebery. A brass mortar
and pestle bearing the name of Gilbert Prym-
ross is in the possession of the present Earl, and
the connection between the family of Primrose
and the Edinburgh College of Surgeons is still
maintained, as the present Lord Rosebery is one
of its Honorary Fellows.
The oldest minute-book of the College dates
from about this time (1581), and contains on its
first page a prayer, ascribed by well-founded tradi-
tion to John Knox, with which every meeting
of the College is opened to this day. It is as
follows :
** O eternal God, and our loving and merci-
full Father in Christ tiesus, seeing we are
6 THE EDINBURGH SCHOOL OF SURGERY
conveenit heir to treat uporui these things that
conccrnis our caUijig, we beseik thee, O Lord,
to he mercifuU to us, and giff us grace to proceid
the?'eint/ll without malice, grudge, or parti alitie ;
sua that the things we maij do Jtiaij tend to the
glorie of God, the weill of our vocation, and
confort of every member of the samcn ; throw
Jesus Christ, our only Ijord and Saviour ;
Aineny
In 1648 a further step was taken to strengthen
the surgical side of the Incorporation, for it was
then decided that '* no barber should be admitted
in time coming except he be tryed and found
qualified in Chirurgie." Tliis action brought the
surgeons into active conflict on the one hand with
the barbers, who were thus deprived of their right
to practise their calling except on the suftrance of
the surgeons, and on the other with the Town
Council, who, in order that *' the lieges may not
have sufficient ground to clamour " on account of
there being " a great scarcity of good qualified
persons within the city who have skill to trim
and barbcrize," called upon the Incorporation of
Surgeons ** to take some effectual course, that the
City might be furnished with a competent number
of persons skilled in cutting of hair and taking off
beards." A number of barbers were duly licensed,
THE PERIOD OF THE BAUBEU-SURGEONS 7
and the clamour of the Ueges ceased, but the
barbers were far from satisfied with their subor-
dinate position.
After many family quarrels, and finally a pro-
longed litigation in the Courts, the two bodies
were separated by a decree of the Lords of Session
in 1722.^ Neither party desired this decision or
was satisfied with it, but it had the advantage for
the surgeons that it freed them of a certain incubus
and enabled them to develop their own art on pro-
fessional lines untrammelled by the more purely
trade outlook of the barbers.
The Society of Barbers lingered on till 1892,
w^hen its last meeting was held. ** At that meeting
the w^hole Society — a father and son — were present.
They elected each other Preses and Box-master
respectively, reappointed their clerk, and departed
to meet no more. The Preses died, the Box-
master left the country, and has not been heard of
for years, and the clerk alone is left, with the old
oak treasure box, the minute-books, and papers in
his keeping."*
It cannot be claimed that in the period during
which the barber-surgeons dominated the medical
profession in Edinburgh the standard of surgery
was a high one, or that any striking advances were
made in surgical science. The records of the craft
that have come down to us deal largely with
8 THE EDINBURGH SCHOOL OF SURGERY
domestic affairs, and it is only incidentally that
the surgical activities of the members are men-
tioned. There is evidence that Gilbert Prymross,
Chirurgeon to King James VI. and the first Deacon
of the Incorporation, enjoyed a considerable reputa-
tion beyond the boundaries of the '* gude toune "
in which he lived, for Doctor Peter Lowe, the
founder of the Faculty of Physicians and Surgeons
of Glasgow, dedicated to him his Treatise on
Onrurgeric, an honour which he shared with
James Harvie, another member of the craft and
surgeon to the Royal Family.
An entry in the accounts of the Lord High
Treasurer refers to the payment of the sum of
fourteen shillings to an early member of the barber-
craft for " taking furth the Kingis tuth," which
shows that the barbers did not confine themselves
to trimming, shaving, and piilebotomizing. Indeed,
the King's barber not only supplied His Majesty
with " holland claith at ten shillings the elm, but
supplemented his income by selling crossbowes and
daggers."
To what extent the followinij record, dated 1 542,
refers to surgical services can only be surmised :
*' Item : gevin to Anthone Brisset, surrurgeane, for
labouris done by him to the Queenis Grace* at
* Mary of Guise, second Queen of Jftnies V.
THE PERIOD OF THE BAHBEH-SURGEONS 9
this time allenarly . . . .va^ li." There is no doubt
about the next item, which refers to the payments
made to four members of the Craft engaged on
mihtary service against '' our auld inemyes of
England " during some border raid : •' Item : gevin
to George Lecke, WiUiam Quhite, George Foth-
eringhain, and David Robertsoun, Surrurgeanis
passand to the bordouris, for curing of all personis
that hapnit to be hurt by the IngUs nienne. xii. li."
It is on record that in 1572, "James, erle of
Mourtoun, regent, lay diedlie seik of rumbussanes
[rupture], and war nocht he was cuttit he had lost
his lyff." The operator who thus prolonged the
life of the Regent, till " the maiden " claimed his
head nine years later, is believed to have been
John Chisholm, Doctor of Medicine, a member
of the Incorporaton, and Chirurgeon to King
James VI.
As late as 1627 the barber-surgeons shared in
the public appointments in the City, for we find
that provision was made by the Governors of
George Heriot's Hospital to appoint " one Chy-
rugian-Barber who shal Cut and Poll the Hair of
all the schoUars in the Hospital ; as also look to
the Cure of those within the Hospital who any
way shal stand in need of his Art."^' ^' ^
If the barber-surgeons contributed little to ad-
vance surgery as an art, they rendered an abiding
10 THE EDINBURGH SCHOOL OF SURGERY
service to the progress of the Edinburgh school by
the part they took in cultivating the study of
anatomy and preparing tlie way for the develop-
ment of the great anatomical school out of which
the Faculty of Medicine in the University subse-
quently arose.
CHAPTER II
THE EARLY ANATOxMICAL SCHOOL
The Anatomical School — James Borthwick — Examination in
Anatomy — Alexander Menteith — Tlie Beginnings of the
Surgeons' Museum — The Surgeons' Anatomical Theatre
— The First Public Dissection — Robert Eliot — The
First Professor of Anatomy in the Town's College —
Adam Drummond — John McGill.
If the history of the barber-surgeons can be said
to mark the first phase in the genesis of the
surgical school in Edinburgh, the gradual develop-
ment of the school of anatomy may be taken as
the next step in its evolution.
It will not be forgotten that from its earliest
days the Incorporation had been inspired with the
idea '' that every man ought to know the nature
and substance of everything that he works, or else
he be negligent." This fundamental principle of
all good w^orkmanship seems to have dominated
the mind of the surgeon-craft, and for two hundred
years its records show that it made persistent
efforts to obtain an increased supply of the
material necessary for acquiring a sound know-
ledge of surgery based upon the study of anatomy
11
1^ THK KDINBURGII SCHOOL OF SURGEllV
by dissection. It is true that for more than a
century the annals arc singuhirly silent regarding
the use made of the *' ane condampnit man ''
granted by the Town Council in 150.5, but it
would not be fair to assume from this that the
members of the caUing had fallen away from grace
and allowed their enthusiasm for the study of
anatomy to lapse. The social and political condi-
tions in Scotland throughout the sixteenth and the
first half of the seventeenth centuries were not
favourable to scientific research or even to the
pursuit of utilitarian study. For the majority of
the people life was one long struggle to obtain a
bare subsistence ; comfort was for the favoured
few, and luxury, as we now know it, could not be
said to exist. The members of the Incorporation
belonged to the middle classes ; as individuals their
first necessity was to obtain a decent livelihood,
and as members of a trade-guild they were more
immediately concerned to protect the corporate
rights and property of their craft than to extend
their capacities for usefulness. In view of the
meagre and precarious opportunities they had for
dissection the wonder ij that they retained the
interest that they did.
As early at least as 1()4.7 the study of practical
anatomy was part of the training of the apprentices
of members of the craft, for it is recorded in the
Till'; TOMHSTONK OK JAMKS IJORTHWICK IN' ( .RK VI k lARS
CHURCHVARD, p:DINHrR».H
(From a photc>i;;r,i(>k in the Collection o/tht Ko^al College o/ Surgeons ot Eainbur^h.)
THE EARLY ANATOMICAL SCHOOL 13
Minutes of the Incorporation of Cheirurgeons that
on his admission James Borthwick took the oath
to conform to the Seal of Cause, " especially to the
point of dissecting of anatomy for the further
instruction of apprentices and servants."
This James Borthwick was one of the most
active of the early surgeons of whom we have
any record ; he played a prominent part not only
in the affairs of the Incorporation, but in the
wider field of national politics. While he was
Deacon, in 1661, he was selected by the Town
Council as one of the two representatives of the
city in the Scottish Parliament. His portrait —
the oldest in the possession of the College — hangs
in the hall, and represents him as a somewhat
heavy-featured man, dressed in the style of Rem-
brandt's Syndics. He was buried in Greyfriars
Churchyard, and his tombstone on the gable of the
old church confirms Stevenson's fancy that " we
Scotch stand highest among nations in the matter
of grimly illustrating death. " A dancing skeleton,
holding at arm's length an open folio, is sculptured
in the centre astride the scythe of death ; the
plinth bears the familiar skull and crossbones,
representations of coffins, spades, and picks ; and
the side panels are festooned round with various
surgical instruments.
About this time rules were laid down for the
14 THE EDINBURGH SCHOOL OF SURGERY
trial of intrants to the Incorporation, which seem
to show that the early obligation of the members
that each one should instruct others in anatomy
had not been unfulfilled. Thus, it was ordained
that ** on the first day of the examination the candi-
date shall begin with the introduction to surgery . . .
and make a general discourse on the whole of
anatomy without any demonstrations." On the
second day ** he is to demonstrate by ocular inspec-
tion more particular on some parts of anatomy
which shall be appointed to him by the Deacon
and Masters . . . and show some operation in the
foresaid subjects.'' That this examination was no
mere formality is evident, for it is furtlier specified
that " if the Deacon and Masters find him qualified
or unqualified they may admit or reject him, or
otherwise continue his examination in the first
subject," and it is grimly added, ** aye, and until
they find him qualifit."
The first serious attempt to establish a regular
course of instruction in anatomy was made in 1694,
when Alexander Menteith approached the
Town Council with a view to obtaining a more
adequate and regular supply of anatomical material
than had hitherto been available. His request was
favourably received, and he was allowed to have
"those bodies that dye in the correction-house,"
and *' the bodies of fundlings that dye upon the
THE EARLY ANATOMICAL SCHOOL 15
breast, . . . for encouragement of so necessary a
work as the improving of anatomy." He was also
granted '* a convenient house for dissection and
the use of the College Kirk Yard for the burial."
In his petition Menteith had promised that " he
would not only lay himself out for the improving
of anatomy, but also would serve as chirurgeon to
the town's poor gratis, but to be paid for his drogs
at prime cost." This duty he was well qualified to
undertake, as he was acknowledged to be the lead-
ing surgeon of his day, and w^as twice elected Presi-
dent of the Incorporation of Surgeons.
It would appear that the museum of the College,
which is now one of the finest collections in the
kingdom, had already been started, for we find that
jNIenteith " added to the rarities in the College, ane
egyle," which found itself in the company of " three
scorpions and a chameleon," presented by Lord
Royston, and " an allegatory or young crocodile,"
the gift of Dr. Charles Oliphant. The minutes
of the College show that the members of that day
were interested in natural history, for it is recorded
that the treasurer was ordered " to pay the man a
crown for showing them two live tortoises "; and
they entered into a lawsuit with the magistrates of
Dundee over the carcass of " ane elephant. " A
later addition to the ** rarities " took the form of '* a
strange creature called ourang outang," which had
Ifi THE EDINBURGH SCHOOL OF SURGERY
to be accommodated in the surgeons' hospital until
a room could be prepared for it in the College.
About the same time there visited Edinburgh " ane
heigh great beast, callit ane dummodary, quilk
being keepit clos in the Canongate, none had a
sight of it, without three pence the person. . . .
It was very big, and of great height, cloven futted
like unto a kow, and on the bak ane saitt, as it
were a sadill to sit on. Thair was brocht in with
it ane lytill baboun, faced lyke unto an aip." ^
During his second period of office as President,
in 1G99, Mcnteitli was deposed by the Lords of
the Secret Council, at the instance of the magis-
trates, ostensibly as a result of a dispute about one
of the steps in his election as representative of the
Incorporation in the Civic Council, but more
probably on account of his sympathies with the
Jacobite cause, to which he was hereditarily attached
being the son of James Menteith of Auldcathie,
the representative of the Stuart line of Earls of
Menteith, wlio were staunch friends of the old
royal family of Scotland.
For some reason, probably a want of co-operation
with the corporate body of surgeons, Menteith's
anatomical venture does not seem to have prospered,
and after three years he abandoned the teaching of
anatomy and commenced a course of instruction on
chemistry.
THE EARLY ANATOMICAL SCHOOL 17
The Surgeons' Anatomical Theatre.
Meanwhile, the Incorporation has obtained for
themselves a further supply of anatomical material
— " the bodies of fundlings who dye betwixt the
tyme that they are weaned and thir being put to
schools or trades ; also the dead bodies of such as
are stiflet in the birth, which are exposed, and have
none to owne them ; as also the dead bodies of
such as are felo de se, and have none to owne them ;
likewayes the bodies of such as are put to death by
sentence of the magistrat, and have none to owne
them." This very liberal grant was made, however,
expressly upon conditions " that the petitioners
shall, befor the terme of Michallmes 1697 years,
build, repaire, and have in readiness, ane anatomicale
theatre where they shall ^once a year (a subject
offering) have ane public anatomicale dissection as
much as can be showen upon one body, and if the
failzie thir presents to be void and null."
The Incorporation proceeded to carry out this
obligation ; the surgeons' anatomical theatre was
completed within the specified time, and arrange-
ments were made for conducting the public dissec-
tions, the first of which mentioned in the surgeons'
records took place in 1703. The accounts of these
dissections that have come down to us are scanty,
but full of a weird interest, and we can imagine a
2
18 THE EDINBURGH SCHOOL OF SURGERY
scene not unlike that depicted by Rembrandt iii
his Lesson on Afiatomy. They were to take place
in the winter between the two equinoxes " allenarly "
(only) ; the right of being present was reserved to
any of the magistrates who thought fit ; any friend
who desired might require the body to be buried if
he refunded '* to the Kirk Treasurer what expenses
he hath been at upoii the said deceased persons."
Some idea may be formed of these expenses from
certain entries of disbursements found in the
accounts of the treasurer : *' To the Suttimen for
carrying the body from the gibbet to the church
17s. 6d. To the two sentineles for six days atten-
dance £4. 7s. For weights for weighing the body
9s. 6d."
To admit of the body being buried within the
specified ten days, the work of dissection and expo-
sition was divided among a number of operators,
each of whom dealt with a particular subject
allocated to him by the College. Much against
the wish of the surgeons the attendance at the
demonstrations was restricted to the regular
apprentices and pupils of the freemen, a wise pro-
vision on the part of the Town Council that they
should constitute a formal course of anatomical
instruction.^
Eight members took part in the first public
dissection— James Hamilton, John Baiilie, Alex-
THE EARLY ANATOMICAL SCHOOL 19
ander Menteith, David Fyfe, Hugh Paterson,
Robert Clerk, James Auchinleck, and Dr. Pitcairn,
and the calHng, being satisfied with the way in
which their duties had been performed, pubhcly
thanked them and ordered " that the same be
inserted in their books there to remain ad futuram
re viemoriam.'" The following year another dissec-
tion was carried out in the same way by James
Hamilton, John Mirrie, Mr. Alexander Nisbet,*
George Dundas, Robert Swintoun, Henry Hamil-
ton, Robert Eliot, John Jossy, Walter Potter, and
Dr. Archibald Pitcairn.
The following year, 1705, Robert Eliot repre-
sented to the Incorporation that, in view of certain
designs which an outsider had on the public teach-
ing of anatomy, it was desirable that they should
elect one of their number to instruct their appren-
tices and servants. For this office he offered him-
self, and was accepted. In this way the teaching
of anatomy passed into the hands of one man
selected for the purpose, and under the authority of
the Incorporation. The Town Council confirmed
this arrangement and appointed Eliot Professor in
the Town's College at an annual salary of fifteen
pounds. His duties included those of Conservator
of the Museum, for he was to ** take exact notice
* The prefix " Maister " indicates that he was a Master
of Arts.
20 THE EDINBURGH SCHOOL OF SURGERY
and inspectione of the rarities in the colledge,'' and
to make *' an exact inventar of the same.' Thus
the name of Robert EUot comes to stand at the
head of the official hst of Professors of Anatomy in
the University of Edinburgh.
In 1708, Ehot obtained permission of the Town
Council to have Adam Drummoxd conjoined with
him in the teaching of anatomy, and the Incorpora-
tion gave its approval. Drummond, who became
President of the surgeons about 1748, was a
member of the old Perthshire family, the Drum-
monds of Megginch, and his father was one of the
commissioners to inquire into the massacre of
Glencoe. He continued to collaborate with Eliot
for seven years and to enjoy half the salary of the
Chair.
On the death of Eliot in 1716, John iM'Gill, the
Deacon of the calling, was appointed to be Pro-
fessor in conjunction with Drummond, and this co-
partnership existed till 1720, when, ** as the state
of their health and business were such that they
could not attend the said professorships," they
resigned in favour of Alexander Monro, whose
advent to the Chair of Anatomy opened a new era
in the history of the Edinburgh School of Medicine.
CHAPTER III
THE FOUNDATION OF THE FACULTY OF
MEDICINE IN THE UNIVERSITY
Foundation of the Town's College, 1582 — Faculty of
Medicine, founded 1726 — Alexander Monro primus
— His Introductory Lecture — The Origina,l Faculty of
Medicine.
King James VI., the founder of the " College of
Edinburgh," or ** the Town's College," granted a
Charter of Erection in 1582, and so satisfied was
he with the early progress of the infant University
that some years later he " thoct it worthie to be
honoured with a name of his awin imposition," by
which name — the "College of King James" — it
was long called.
Nearly a century and a half elapsed, however,
before the teaching of medicine received academic
recognition by the foundation of a Faculty of
Medicine within the University, when the first of
the great dynasty of the Monros became Professor
of Anatomy. This was in 1726. It is true that
in 1685 the Town Council adopted certain *' Acts "
21
29 THE EDINBURGH SCHOOL OF SURGERY
appointing three Professors of Medicine, but as
these were neither granted salaries nor assigned
duties, the appointments appear only to have been
titular. A Physic Garden had been established
some time about the year 16G8, ''in ane inclosure
of some forty foot of measure in every way,
obtained of John Brown, Gardener of the North
Yardes of the Abby of Holyrood," and the subject
of botany was taught in the University as early as
1G76 the Professor, for a fee of one guinea, under-
taking " to attend upon the apprentices in the
garden and demonstrate the plants whensoever
they should have inclination, and to wait upon
them at a solemn public herberizing in the feilds
four severall times in every year."
Prior to the foundation of the Medical Faculty,
such systematic instruction in the various branches
of medical science as was available in Edinburgh
was given by *' private lecturers " under the auspices
of the Incorporation of Surgeons, in what is now
known as the Extra-mural School. For long the
only subject which seems to have been deemed
worthy of special study in the schools was anatomy,
and this the surgeons naturally cultivated as the
scientific basis of their special work. Their appren-
tices learned the practical or clinical part of their
business as they assisted their masters in their shops
and accompanied them on their daily rounds. A
^
^
§ 1.6
O i; «
■^1
FOUxNDATION OF FACULTY OF MEDICINE 23
course of chemistry was started by Menteith in 1697,
and later extra-mural classes on Theory of Physic,
Practice of Physic, and Midwifery were established.
To John Monro belongs the credit of having
instigated the authorities to organize a complete
system of medical education within the University.
This " far-seeing and good man," after serving with
the army of King William in Flanders, had settled
in practice in Edinburgh, and joined the surgeons
in 1703. He had for long entertained tlie idea of
" founding a Seminary of Medical Education in
his native country," and about the year 1720
formulated a plan which was favourably received
by the medical corporations of the city. In his
only son he recognized, with a paternal insight
more than usually discriminating and wholly
altruistic, the instrument by which his cherished
dream might be realized, and he lived to see the
Medical School of Edinburgh safely launched on
its great career, his son Alexander guiding its
destinies with a success worthy of his talents.
Alexander Monro Primus
(1697-1767)
For the role which his father had designed for
him Alexander Mo^^no p?'inms received a prepara-
tion which was carefully planned and thoroughly
carried out. To supplement the preliminary train-
24 THE EDINBURGH SCHOOL OF SURGERY
ing he had obtained in the Edinburgh School, he
proceeded to London, where he became a favoured
pupil of Cheselden, whose originality of mind and
dexterity of hand inaugurated a new era in British
surgery. In Paris he continued his studies in
anatomy and surgery under Bouquet and Thibault,
and at Leyden he came under the spell of the
great Boorhaavx, a man whose authority pro-
foundly influenced Monro's mind and was a potent
factor in moulding the traditions of the Edinburgh
School.
On his return to Edinburgh in 1720, at the age
of twenty-two, on the recommendation of the
College of Surgeons, Monro was elected to succeed
M'Gill, who had resigned the Chair of Anatomy.
An interesting story is told of how Monro " found
himself " as a lecturer. To lend eclat to the occa-
sion of his introductory lecture, his father, unknown
to Alexander, had invited *' the whole of the sur-
geons and apothecaries, and the members of the
Royal College of l^hysicians, with their l^-esident
at their head. It was certainly an arduous task for
a young anatomist to appear as a teacher in such
an assembly. The emotions which he felt on this
occasion tinged his cheeks with the glow of modest
diflidence, and the presence of his auditors effiiced
the words of liis intended discourse from his
memory. ' Having conunitted liis lecture to
FOUNDATION OF FACULTY OF MEDICINE 25
memory, he had left his notes at home, and "in
this dilemma ... he began to show the prepara-
tions which lay before him ; the signs of the things
signified arranged themselves in his mind, and the
utterance immediately followed. This experiment
succeeded so well that Monro ever afterwards ac-
customed himself to extemporaneous delivery." ^^
In 1725, a rumour having got abroad that the
graves in the Edinburgh churchyards were being
desecrated, an angry mob threatened to wreck the
anatomy rooms at Surgeons' Square, where Monro
conducted his classes, and in fear of having his
precious preparations destroyed, he removed them
to more secure keeping in the University, where
he lectured henceforward. Thus it came about
that the Surgeons' Theatre ceased to be the official
centre of anatomical teaching in Edinburgh, and
the link which bound the surgeons to the University
was violently broken.
Monro's great achievements as an anatomical
investigator and teacher do not concern us here.
He amply fulfilled the highest hopes even of his
father, and now enjoys the title (which might
surely be shared with his devoted parent) of " the
father of the Edinburgh School."
It cannot be claimed that he left his mark on the
surgery of his day, for although his course of
instruction included the demonstration of opera-
26 THE EDINBURGH SCHOOL OF SURGERY
tions on the dead body and the use of various
bandages and appliances, and he frequently attended
at the hospital and "gave lectures on the chirur-
gical cases," he does not appear ever to have prac-
tised as an operating surgeon, and the papers he
left on surgical subjects relate chiefly to morbid
anatomy and pathology. In another direction,
however, he conferred an inestimable boon on
surgery, for with Lord Provost Drummond he was
the moving spirit in founding the Royal Infirmar}\
Monro primus held the Chair of Anatomy for
thirty-eight years, and died in 1767, at the age of
seventy.
During the five years that Monro continued to
lecture in the Surgeons' Hall after being appointed
Professor, lie gathered round him a small band of
teachers who came to form tlie nucleus of the
Medical Faculty, which was formally organized a
year after he migrated to the University class-
rooms. Dr. St. Clair lectured on tlic Theory of
Physic ; Drs. Rutherford and Inneson the Practice
of Physic ; and Dr. Plimmer on Chemistry. These
gentlemen, on being made Professors in 1726,
together with Dr. Alston, the Professor of Botany
and Materia Medica, and Dr. Joseph Gibson, who
was elected to the newly-created professorship of
Midwifery, constituted the original Faculty of
Medicine in the University.
CHAPTER IV^
THE ROYAL INFIRMARY
Georf]je Drummoiid — *'The Physicians' Hospital" — The
Royal Infirmary — The Surgeons' Hospital — Amalgama-
tion— The Building of the Old Infirmary — The New
Infirmary.
When the Medical Faculty was founded Edinburgh
was still without a public hospital where the Pro-
fessors could supplement the systematic discourses
of the class-room by practical instruction given at
the bedside of the sick. The want of such facilities
for demonstrating to the students and apprentices
the phenomena of disease and the appropriate
methods of treatment was keenly felt by the
teachers, while the students lacked that human
interest in their work which comes from being
brought into actual contact with sick people in the
wards of a hospital.
It must not be inferred that the requirements of
the necessitous poor had hitherto been neglected in
Edinburgh. From time immemorial the magistrates
had been in the habit of making provision for those
^7
28 THE EDINBURGH SCHOOL OF SURGERY
of the sick poor who were " free of the city " by
granting them small pensions and providing a
physician and surgeon to attend them at their own
homes. For those who were not " burgesses," and
therefore did not enjoy the freedom of the city,
provision was made by members of the Incorpora-
tion of Surgeons and of the College of Physicians
giving tlieir services gratis, and for many years an
arrangement existed by which two members of the
College of Physicians in turn gratuitously gave
advice and medicine to necessitous persons in the
College hall. These arrangements, however, were
insufficient to meet the requirements of those
suffering from severe forms of illness, nor did they
provide an efficient means of imparting bedside
instruction to the increasing number of students
who were being attracted to the School.
The first tentative effi^rt to provide hospital
accommodation was made in 1721, when a number
of charitably disposed persons made an attempt to
raise funds to open a small hospital in which the
most necessitous cases might be treated, but for
various reasons this movement did not meet with
success. In 172o tlie proposal was renewed under
more favourable auspices. George Dkt\mm()XD,
one of Edinburgh's most pubHc-spirited citizens,
had just been elected Lord Provost (p. 23). A man
of outstanding ability. Drunmiond had, while still a
THE ROYAL INFIRMARY 29
youth of eighteen, evinced his genius for affairs by
settling the national accounts of Scotland prepara-
tory to the legislative union of the two kingdoms ;
and in the various national and civic offices which
he subsequently held he secured the complete
confidence of his countrymen by the breadth of
mind and largeness of heart he brought to bear on
the discharge of his public duties. To him we owe
the inception of most of the improvement schemes
which have transformed ** the worn-out little
capital " of Scotland that survived the '45 into the
fair city we know to-day. Into none of his pro-
jects did Drummond throw himself more whole-
heartedly than into that of establishing a hospital
for the benefit of the sick poor. In his life-
long friend, Alexander JMonro, the Professor of
Anatomy, he found an enthusiastic coadjutor, and
to these two men belongs much of the credit of
establishing the Royal Infirmary of Edinburgh,
which was destined to become one of the most
famous medical institutions in the world. In the
entrance hall of the present infirmary stands a bust
by Nollekens, bearing the inscription : " George
Drummond, to whom this country is indebted for
all the benefit which it derives from the Royal
Infirmai^y"
With Scottish caution a modest beginning was
made, the sum of £2,000 being arrived at as " the
30 THE EDINBURGH SCHOOL OF SURGERY
least sum with which the erection of an Infirmary
can be set about." It so happened that a certain
Scottish fishing company w^as being dissolved about
this time, and tlirough the influence of the Lord
Provost a part of the capital was assigned to the
promoters of the hospital scheme. This money,
together with contributions from the College of
IMiysicians and the Incorporation of Surgeons, and
subscriptions from the general public, soon provided
the necessary funds, and the managers " took a lease
for nineteen years of a house of a small rent near
the College, which was made more agreeable and
convenient by the Professors of Medicine granting
liberty to the patients to walk in a garden adjacent."
The hospital was opened in 1729, and during the
first year of its existence the number of patients
admitted w^as thirty-five, of whom only one died.
In its early years the infant infirmary owed much
to the fostering care of the College of Physicians,
who ** nursed it as a child of their own." Their
undertaking that " ane or more of their number
shall attend the Hospital faithfully and freely,
without any prospect of reward of sallary," was
loyally carried out. In other ways they gave
generous support, and so closely did the institution
become identified with the College that it was
popularly known as " the Physicians' Hospital."
That the surgeons as art I?icorporation took a
THE ROYAL INFIRMARY 31
less active share in the management and working
of the hospital in its earliest days was due to certain
difficulties which arose regarding the method of
selectinof the surmcal members of the staff, and not
to any want of sympathy with the movement or
lack of philanthropic spirit. The Incorporation as
a body indeed offered to furnish medicines and
operative treatment gratis to the sick and wounded
in the hospital for a period of two years, but this
offer was rejected by the managers in favour ot
another made by Alexander Monro and five other
surgeons, who agreed individually to attend in
turns, each acting as " ordinary " for two months at
a time, " and dispensing out of our own shop as we
do to other patients the medicines, whether external
or internal, prescribed by the physicians for the
sick poor, and that gratis, renouncing all claim to
payment of accounts or of fee. " This plan, although
it limited the choice of surgeons and restricted the
privilege of acting on the staff to the six selected
members, seems to have worked satisfactorily, and
the hospital soon gained the confidence alike of the
sick poor and the charitable public.
In 1736, the managers presented a petition to
King George II., praying that he should grant to
the contributors a Royal Charter, erecting them
into a corporation. In this petition it was set forth
that the purpose of the hospital was for the treat-
32 THE EDINBURGH SCHOOL OF SURGERY
ment of ** poor sick properly recommended from
any part of the country, who are not absolutely
incurable," and that they should be " taken care of
by the Royal College of Physicians of Edinburgh,
and some of the most skillful surgeons." This
petition was granted, and the same year the con-
tributors were erected into a body corporate by the
name of the Royal Infirmary of Edinburgh.
Meanwhile, the Incorporation of Surgeons, who
keenly felt their exclusion from the service of the
new Infirmary, decided to establish a hospital
under their own auspices, " to alleviate tlie deplor-
able condition of the many indigent and diseased
poor who languish under various diseases, and are
ready to perish for want of that timely assistance
which they might find in a hospital erected for their
entertainment." They did not profess that they
were entirely moved by this altruistic consideration,
for they avowed that *' the benefit of their appren-
tices and students was a considerable motive to
them " in making this proposal. In this as in all
their actions the Incorporation of Surgeons con-
sistently kept the idea of teaching prominently in
mind. The Surgeons' Hospital was opened in 173G,
and it was no less successful than its older rival had
been, the demands for admission proving that there
was ample scope in Edinburgh for both institutions.
It soon became evident, however, that the dual
THE ROYAL INFIRMARY S3
arrangement was neither economical nor for the
best interests of the medical school, and in 1738
the Surgeons' Hospital threw in its lot with the
Royal Infirmary, one of the conditions of the union
being that all the members of the Incorporation
should be eligible to act on the staff, under such
regulations as the managers might make.
The demands on the infirmary soon outran the
capacities of the modest "house of small rent,"
opened in 1729, and a movement was set on foot
to erect a hospital worthy of the capital of Scotland
and of its rapidly growing medical school. Drum-
mond and Monro were again the moving spirits,
and their enthusiasm became contagious. Never
was seen in the whole history of philanthropic
effort anything more remarkable than the sympa-
thetic outburst of energy by the whole of a com-
munity. " The proprietors of many stone-quarries
made presents of stone, others of lime ; merchants
contributed timber ; carpenters and masons were
not wanting in their contributions ; the neighbour-
ing farmers agreed to carry the materials gratis ;
the journeymen masons contributed their labours
for a certain quantity of hewn stones ; and as the
undertaking was for the relief of the diseased,
maimed, and lame poor, even the day labourers
would not be exempted, but agreed to work one
day in the month gratis towards the erection of the
3
34 THE EDlNBrUGlI SCHOOL OF SURGERY
building. The ladies also assisted in their way :
they appointed an assembly for the benefit of the
work, which was well attended, and everyone
contributed bountifully."-^^ The Lord Provost
himself went to the Mercat Cross, the place where
merchants and others assembled on the Saturdays,
to solicit subscriptions for carrying on the work.^'-
He and Monro not only formed the •* building
committee," but personally supervised every detail
of the work, and actually paid oul tlie wages of the
masons with their own hands.
The foundation-stone was laid in August, 1738,
and in 1741 the building was ready for the recep-
tion of patients. Designed in the Scoto-French
style of the eighteenth century, the building con-
sisted of a central block with side wings. The
graceful facade was surmounted by a dome and
lantern dome, and in an alcove over the main
entrance stood " a full-length statue of George II.
in a Roman dress, with an inscription on either
side: *I was naked and ye clothed me.' 'I was
sick and ye visited me.' " When Dr. Samuel John-
son visited the infirmary in 1773, his attention was
attracted by a board at the main doorway bearing
the inscription " Clean your feet." He slyly
remarked to Bos well, who had just conducted him
over St. Giles : ** There is no occasion for putting
this at the door of your churches."
THE ROYAL INFIRMARY 35
In the centre of the boundary wall facing
Infirmary Street was an ornamental gateway,
evidently not intended for carriage traffic, as it was
reached by a flight of steps, and was never known
to have been opened.
Among the architectural features that arrested
attention at the time was the central staircase,
which was *' so spacious as to admit of sedan-chairs
being carried up it." In addition to '* cold and
hot baths for the patients," a marble bath was
provided for the use of the citizens, and this for
many years was the only public bath in the city.
In 1822 it was used by King George IV., after
which the " royal bath " became so popular that the
city instituted public baths outside the infirmary.
Great care was bestowed on the arrangements
made for the accommodation of the patients, and "in
the disposition of this whole building nothing has
been more anxiously studied than ventilation."^^
Accommodation was provided for 228 patients,
** each in a distinct bed," and " the apartments of the
male and female patients were entirely distinct."
Wards were provided for lying-in women ; for
" female patients undergoing salivation," a small
room for female patients requiring the same treat-
ment, " who, being sufferers not by any fault of
their own . . . had applied to be taken under cure in
the hospital "; and "cells for mad people." Later,
a ward was fitted up for the use of sick servants.
36 THE EDINBURGH SCHOOL OF SURGERY
In the central part of the building under the
dome the operating-theatre was situated. It was
capable of accommodating 200 students, and has
been described as '* steep, well-like, and sombre,"
with dark woodwork and walls and a compressed
area. In these dismal surroundings was performed
much of the brilliant surgical work of John Lizars,
William Fergusson, Robert Liston, and James
Syme.
Some years after the new building was opened,
the Lords of the Treasury gave to the infirmary a
grant of £8,000, in return for which the managers
kept sixty beds constantly in readiness for the
reception of soldiers. During the rebellion of 1745
several hundreds of wounded and sick soldiers were
treated in the hospital. For many years a military
guard was mounted at the infirmary.
Among the pious benefiictors whose generosity is
commemorated on the panels in the corridors of the
infirmary, many were famous in Scottish history,
but many more were humble citizens whose modest
contributions represented the hard-earned savings
of a lifetime.
It is recorded in the liistory of the infirmary-^ that
** in 17C8 the Royal Infirmary was furnished with
an electrical conductor. . . . This precaution
against future accidents by tlumder was taken in
consequence of the house having suffered consider-
THE ROYAL INFIRMARY 37
ably by lightning a few months before. . . . One
of the physicians, while examining a patient, was
affected as if he had been struck with a large pillow
full of soft down."
It is unnecessary to trace the structural changes
which the ever-increasing reputation of the in-
firmary called for : the absorption of the High
School buildings, the erection of the new surgical
liospital with its improved operating-theatre, de-
signed by Bryce, in 1852, the building of the Lock
Hospital, its conversion into a fever hospital, and
finally the transfer of the whole Institution to the
new site at Lauriston, where the present building
was opened in 1879, by Lord Provost Boyd, w4io
had taken a prominent part in providing for its
erection.
The closing scene in the old infirmary took place
on a cold dark evening towards the end of October,
1 879, when the residents gathered round the table in
the great operating-theatre for the last time, and in
*' a wild mysterious strain of weirdest harmony "
sang " Aulcf Lang Syne " in solemn cadence. ^^
On the architect's plans of the original building,
signed *- Gul : Adam, inv : et deling' is this legend :
" This hospital will be open to all curcable distressed
from whatever corner of the world they come with-
out restriction." Patet omnibus is the motto over
the portals of the Royal Infirmary to-day.
CHAPTER V
THE PERIOD OF THE PRACTITIONER-SURGEONS
Surgery during the Reign of 'Monro jv'nn us — Alexander Wood
— Old Edinburgh Medical Clubs — Anecdotes — John
Bennet — Medical Duels — Anecdotes.
DuRiNc; the first half of the eighteenth century,
while the medical world of Edinburgh was domi-
nated by the first Monro, surgery was relegated to
the position of the step child among the medical
sciences. The subject was taught, in so far as it
was taught at all, in a few perfunctory lectures at
the tail end of the course of anatomy ; the Pro-
fessor himself was not even a practising surgeon.
Not only so, but the University actively opposed
various efforts made by the College of Surgeons to
improve matters. It is little wonder, therefore,
that few names stand out prominently in the
surgical history of this period, and those that liave
come down to us were rather general practitioners,
who had a predilection towards surgical work, than
surgeons devoting themselves to the practice of the
art and to promoting its progress. Of these, two
38
PERIOD OF THE PRACTITIONER-SURGEONS B9
may be mentioned — Alexander Wood and John
Bennet — both belonging to what may be called
the class of practitioner-surgeons, and remembered
as much for their eccentricities and convivial
tendencies as for their surgical achievements.
Alexander Wood
(1725-1807)
" Oh, for an hour of him who knew no feud —
The octogenarian chief, the kind old Sandy Wood.""^'
While it must be admitted that the fame of
" liang Sandy Wood " rests more on his marked
individuality and amiable social qualities — and, be
it added, his genially convivial habits — than on his
eminence as a surgeon, his memory is still one of
the cherished traditions of the Edinburgh School.
If he made no memorable contribution to surgical
knowledge, he did much to sweeten the social life
of his medical brethren, and to soften the asperities
which too often marred the harmony of professional
life in his period. Himself the most clubbable of
men, he was a moving spirit in founding various of
the medico-social societies that still survive and
form one of the most pleasant and characteristic
features of medical life in Edinburgh. The
practices and manners of these coteries have
changed with the changing times, but the spirit
of Sandy Wood still pervades them. He was the
40 THE EDINBURGtH SCHOOL OF SURGERY
chief instigator of the Gymnastic Club (1786), the
members of which met annually at Leith to cele-
brate the " Ludi Appolinaris " and to compete
with each other at '' gowfing, bowling, and swim-
ming." In all these exercises Wood excelled, and
although he lived beyond his eightieth year he was
a keen *' gowfer " to the end. This club was dis-
solved in 1811, but its medals and pocula still adorn
the table of the iEsculapian Society on guest-
nights.^^
In the Poems of Andrew Duncan (1818) we find
*'a song composed on a memorable event in the
annals of the Gymnastic Club." ^^
" Here lies Sandy Wood, a good honest fellow,
V^ery wise when sober, but wiser when mellow ;
At sohsibk 7ionsc'usc* by no man excel Td,
With wit and good humour dull care he repelTd.
" But though now he's laid low, we must not complain.
For, after a sleep, he'll be with us again.
Shed no tears, my good friends, wear no garments of
sable;
Sandy Wood is not dead, but laid under the table."'
A rhyming explanation of this '* memorable event "
was subsequently forthcoming which, while admit-
ting that
" 'Tis true that ance in evil hour
Beneath the table he did cour.
Which raisVl the tale, you may be sure.
That wc had lost our Sandv,"
A free translation of the;>7/ (Tnpnt of the French.
PERIOD OF THE PRACTITIONER-SURGEONS 41
went on to offer the excuse, always considered
valid in these days, that
" It was a glass that laid him low —
A glass his friend, and not his foe."
Many tales are extant of similar adventures
which befel Lang Sandy and his cronies in these
gay times, but they must be judged in the light of
the manners and customs of the period. These
were the days when the taverns of the High Street
were the only meeting-places alike of sedate
medical societies and of such dare-devil reunions
as the " Sulphur Club," the " Hell Fire Club," and
the "Demireps." Daily at half-past eleven the
" gill-bells " rang from St. Giles to call the citizens
to their " meridian," which consisted of a gill of
brandy or a glass of ale, and by four o'clock " lords,
lawyers, and lairds " had assembled for dinner,
thereafter to enjoy their ** high jinks " well into the
early hours of the morning. ^^
Throughout his long life " he could toil all the
day, and yet laugh all the night," and the *' Sons of
iEsculapius " solemnly conferred on Mr. Wood the
diploma of " Doctor of Mirth " on April 12, 1813.
In a period when " originals " abounded in Edin-
burgh, and when it was not considered an affecta-
tion for a citizen to retain his own peculiarity of
gait or dress, or to express his individuality by any
whim of mind or action. Wood was a striking
42 THE EDINBURGH SCHOOL OF SURGERY
personality as he wended his way down the closes
and up the scale stairs of the city accompanied by
a pet sheep and a raven. 2" John Kay-'^ repre-
sents him passing along the North Bridge, in
periwig and cocked hat, with an umbrella under
his arm, *' in allusion to the circumstance of his
having been the first person in Edinburgh who
made use of that very convenient article."
It is related of Wood that when he sought of
her father the hand of Miss Veronica Chalmers,
in reply to the question how he was to support
a wife and family, he drew from his pocket his
lancet-case and said : " I have nothing but this, sir,
and a determination to use my best endeavour to
succeed in my profession."
" V^era is yours ! " rewarded this spirited reply.
The incident illustrates a pleasing sincerity and
frankness, amounting at times to bluntness, whicli
characterized him throughout. Many years later,
when by the assiduous use of his lancet and of
more ambitious implements of surgery he had
gained such a position tliat he met in consultation
on ecjual terms with the great Dr. Cullen, it is
recorded that on one occasion lie commented on
the great physician's prescription of certain pills in
these terms : *' Oh, doctor, doctor. Nature has
already done her work, and the patient is saved.
As for your pills, ye may just as weel gie him some
pease meal."
PERIOD OF THE PRACTITIONER-SURGEONS 4S
It has been said -of Wood, as it was of Boorhaave,
that " he considered the poor his best patients, and
never neglected them." His popularity with the
lower classes on one occasion stood him in good
stead. During a street riot directed against the
Lord Provost of the day, some of the mob mistook
Mr. Wood for the head of the municipality, whom
he closely resembled in figure, and, seizing him,
were about to throw him over the parapet of the
North Bridge, when he cried out, " I'm lang Sandy
Wood ; tak' me to a lamp-post, and ye'll see." His
identity having been verified, he was cordially
cheered and protected from further violence.
While Wood's fame as an operating surgeon did
not spread far beyond his native city and did not
long survive his own day, he was until within a few
years of his death universally recognized as the
leading surgeon in Edinburgh, and '' the dexterity
of his skill in operating tended much to raise the
reputation of the surgical department of the Royal
Infirmar}^"
Wood lived to the age of eighty-two, and died
on May 12, 1807. Almost without interruption his
descendants hav^e ever since worthily represented
the best traditions of the medical profession in
Edinburgh. His grand-nephew, Dr. Andrew Wood
(1817-1884), introduced the practice of hypodermic
medication and invented the hypodermic syringe.
44 THE EDINBURGH SCHOOL OF SURGERY
John Bennet
{d. 1805)
Another member of what may be called the con-
vivial school of Edinburgh surgeons flourished some
time later than Alexander Wood. John Bennet 's
professional success appears to have been due more
to his " polish and pleasant manners," and his
" occasional indulgence in those excesses and
frolics which were then deemed extremely fashion-
able," than to his purely surgical achievements.^^
Soon after he began practice one of the numerous
escapades in which he figured enabled him to *' set
up his carriage." A highly respected citizen,
while in convivial company, threatened to cut his
own throat ; one of his cronies, lifting a knife, said,
** I will save you the trouble," and " very nearly
converted jest into earnest by making a severe
incision." Mr. Bennet's treatment of the wound
was so successful that the assailant presented him
with "an elegant chariot." This same vehicle was
the indirect cause of another of Bennet's escapades.
Being in need of repair, it was sent to the coach-
yard of the firm of Crichton and Field. Mr.
Bennet and Mr. Field had some words about the
matter, which culminated in the coach-builder
challenging the doctor. Bennet refused to meet
Field on the ground that '' his rank was not that
PERIOD OF THE PRACTITIONER SURGEONS 45
of a gentleman." At this point Field's partner,
Colonel Crichton, appeared, and, taking the quarrel
upon himself, renewed the challenge. Bennet, the
former surgeon to the Sutherland Fencibles, could
not refuse the challenge of the Colonel of the
East New Town Company of Edinburgh Volun-
teers. They met ; the Colonel was wounded ;
** the ball, which entered near the left side of the
chest, passed through part of the pectoral muscle
and came out behind, near the edge of the blade-
bone. The wound was severe, but not dangerous,
and he speedily recovered."
In 1805 Bennet took part in another duel, but
not as a principal. This is the report of the affair
pubhshed at the time : '* On Wednesday morning,
July 3, a duel was fought, in the neighbourhood of
Duddingston, between Mr. Romney and Mr.
Leckie, students attending the medical classes in
the University, when the latter received a wound
in the groin, in consequence of which he died next
Saturday morning. Four shots were, we under-
stand, exchanged. Mr. Leckie received his wound
by the first fire, but did not discover it. After
shaking hands with his antagonist, he declared he
was mortally wounded, and desired Mr. Romney,
the seconds, and the surgeon who attended, to
make their escape, which they accordingly did."
For his kindness and attention to Mr. Leckie,
4(i THE EDINBURGH SCHOOL OF SURGERY
whose father was the senior magistrate of London-
derr)% Mr. Beniiet had the freedom of that city
conferred upon him.
Bennet was given to practical joking, which was
one of the fashionable frolics of the period. Having
on one occasion lost a wager, he had to entertain
a number of friends to '* dinner and drink " and a
visit to the theatre. At the hour appointed for
leaving the festive board of *' a house of good cheer
at Leith," he had provided, instead of ordinary
hackney-carriages, a number of mourning-coaches,
in which the party were driven off in slow time,
** amid the wonderment of a numerous crowd, who
were no less astonished at the mirth of the mourners
than amazed at the place where the procession
halted."
Many stories are extant of his wliims and
pleasantries, but nothing of his surgical achieve-
ments.
He met* a tragic fate. Having gone to enjoy a
day's shooting in the autumn of 1805, he was found
dead in a field near his friend's house, with his dog
and his empty gun beside him.
CHAPTER VI
THE BEGINNING OF THE SURGICAL SCHOOL
The Rise of the Edinburgh Surgical School — Benjamin Bell,
'•the Father of the Edinburgh Surgical School'' — His
Training in Surgery — Surgeon to the Royal Infirmary —
His Contributions to Surgery — His System of Surgery
— John Bell, the Originator of the School of Surgical
Anatomy — Literary and Artistic Tendencies — Exclusion
from Royal Infirmary Staff — Controversy with Dr. James
Gregory — His Surgical Writings — The Doctrine of the
Anastomosing Arteries — Principles of Surgery — Opera-
tion for Iliac Aneurysm.
The second half of the eighteenth century saw the
rise of a definite School of Surgery in Edinburgh.
This may be traced to a variety of circumstances.
The founding of the Academy of Surgery in France
had given a great impulse to surgical progress
throughout Europe, and the fame of Petit, Chopart,
and Desault attracted to Paris numbers of young
Scots, who came back full of enthusiasm and fired
with the desire to emulate these masters. In the
Royal Infirmary, which was now adequately
equipped and in full working order, those who
were eligible to act on its staff found greater
47
48 THE EDINBURGH SCHOOL OF SURGERY
opportunities of acquiring clinical and operative
experience than had hitherto been available. The
thorough training in anatomy which was then the
outstanding feature of the Edinburgh teaching
enabled them to take full advantage of these
opportunities, and the encouragement given to the
teaching of surgery by the College of Surgeons
induced a number of able young men to devote
themselves to the subject. The number of students
attracted to the school was gradually increasing,
and by their classes the rising young surgeons could
hope to maintain themselves until they secured a
share of the limited consulting and operative
practice which the city and district then provided.
The names of Benjamin Bell, "the father of the
surgical school," 2- and of John Bell, who origi-
nated the school of surgical anatomy,'^ dominate
this period, although that of James Bae, who was
the first to deliver a complete course of lectures on
surgery, must not be overlooked (p. 70).
Benjamin Bell
(1749-1 80G)
Benjamin Bell was born in Dumfries in April,
1749, the eldest son of a family of Hfteen.^s- '-^^
His forbears had held land in Dumfriesshire since
early in the fifteenth century, and on both sides
THE BEGINNING OF THE SURGICAL SCHOOL 49
had suffered the penalty of their adherence to the
Covenant. His father appears to have been a
man of parts, which, however, did not include an
aptitude for business, and for a time the fortunes of
the house were none too rosy. It is to Benjamin's
credit that he did what he could to retrieve them,
because it is recorded that early in life he disposed
of the estate of Blacket House, to which he had
been served heir by his grandfather, in order that
the younger branches of the family might be suit-
ably educated.
In the Grammar School of his native town he
received an excellent classical education, and was
thereafter apprenticed to Mr. James Hill, surgeon in
Dumfries, a man of considerable note in his day.
In 1766, at the age of seventeen, he was sent to Edin-
burgh, and came under the influence of the band
of illustrious men who at that period formed the
teaching staff in the University. The first Monro
was still a lecturer in clinical surgery and medicine
in the Royal Infirmary ; Monro secundus was
teaching anatomy ; William Cullen held the Chair
of Institutes of Medicine ; John Gregory that of
Practice of Physic ; John Hope was responsible for
the teaching of botany, and Joseph Blake had just
become the Professor of Chemistry.
The study of anatomy particularly attracted
young Bell, and he seems to have pursued it with
4
50 THE EDINBURGH SCHOOL OF SURGERY
the deliberate object of applying his knowledge to
the practice of operative surger}\ In 1770 (?i)* he
became a Fellow of the Royal College of Surgeons,
and a letter written to his father relative to a plan
he had conceived of proceeding to Paris to continue
his surgical studies indicates very fairly the position
of the Edinburgh School of Surgery at this time.
** To be sure," he says, " medicine is taught in
Edinburgh in greater perfection than in any other
part of Europe, or, indeed, of the whole world ;
but notwithstanding there are some particular
branches which are to be had in Paris, and nowhere
else, and which cannot possibly be got in Edin-
burgh, and particularly with regard to surgery,
which I have now the prospect of applying pretty
closely to, and upon which I am now altogether,
for some time at least, to depend. Had I been
now entering to the world as a physician, I should
never have thought of going farther than where I
have been ; but for a surgeon, I assure you, Edin-
burgh comes greatly short of either Paris or
London, and for that reason Dr. Monro and any
others that I have spoke to here upon the subject
approve of the scheme very much.'"-^
After much discussion of ways and means, this
project was carried into effect, and the next two
* The italic figures in brackets indicate throughout the
age of the subject at the date mentioned.
THE BEGINNING OF THE SURGICAL SCHOOL 51
years were spent in the great surgical schools of
Paris and London. In the latter city Bell made
the acquaintance of John Hunter — "the most
agreeable and at the same time the most useful
acquaintance I ever met with " — and studied
anatomy under William Hunter, whom he found
** by no means so free or so ready of access as his
brother."
On his return to Edinburgh, at the age of twenty-
three, he set up in practice. Acting with that
strict regard for business principles which marked
all his dealings, he acquired, from one who was
about to relinquish practice, his shop, " drawers,
counters, mortars, and all," and established himself
in a humble dwelling above the shop. His sister
Rebecca was installed as housekeeper, and by the
exercise of those habits of frugality with which
their upbringing had made them familiar they
managed to get along very comfortably. Regular
supplies of dairy produce came by the Hawick
carrier from Woodhouslees, and in return Ben
furnished such simple medical advice as the home
folks required : bark for his mother's headaches —
" as much as easily lies on a shilling four times a
day "; scarification of the gums of " little Eben,"
who was teething ; and baths for one sister '* freely "
and for another ''with caution." *' With regard to
the use of the cold bath," he writes, ** in a variety
52 THE EDINBURGH SCHOOI. OF SURGERY
of diseases it is a most excellent remedy, and even
people in health are not the worse for it." With-
out adventitious aid or iniiuence Bell speedily
acquired a reputation and a practice, and hefore he
had been established a year in Edinburgh he had
the singular good fortune to be elected surgeon to
the Royal Infirmary at the early age of twenty-
four, and this office he lield for twenty-nine years.
Three years later his position was so far assured
that he felt justified in assuming further responsi-
bilities, and married Miss Grizel Hamilton, the
only sister of Dr. James Hamilton, who had been
his companion during his visit to Paris. Soon after
his marriage he had the misfortune to fall from his
horse, and sustained injuries which laid him aside
for nearly two years, during which time he retired
to the farm of I^iberton on the eastern slope of the
Braid Hills, about three miles to the south of
Edinburgh. Under the kindly and skilful treat-
ment of Alexander Wood, to whom in gratitude
he dedicated the second volume of his System of
Surgery, he so far recovered as to be able to resume
his work in Edinburgh, and from this time on his
success was unbroken. During many years *' he
was more employed than any other surgeon in
Scotland," and *' at one time nobody could die con-
tented without having consulted Benjamin Bell."
Among his many distinguished patients was
THE BEGINNING OF THE SURGICAL SCHOOL 53
Admiral Duncan, the hero of Camperdown—
whereby hangs a tale. Arriving on one occasion
at an English port, Bell was no less alarmed than
astonished when a band of sailors unloosed the
horses from his post-chaise and dragged him in
triumph through the town. It turned out that
these fine fellows, many of whom had served under
Admiral Duncan, had somehow^ learnt that the
health of their idol had been restored by Bell's
surgical skill, and they took this rough and ready
method of expressing their gratitude.
The strain of a busy professional life, added to
the ill effects of the accident \vhich interrupted his
early career, and fi*om v/hich he never seemed to
have quite recovered, and accentuated by many
minor w^orries connected wdth the management of
various properties he had acquired, told upon his
health, and in 1804, he had become so feeble that a
few professional visits each day w^ere all he could
accomplish. At the comparatively early age of fifty-
seven he died at Newington House on April 5,
1806.
Contemporary evidence all goes to show that
Benjamin Bell w^as an outstanding figure in the
surgical world of his time (p. 89). In John Kay's
Edinburgh Portraits he is depicted as a short,
thick-set man, burly without being corpulent, w^ith
pleasing features, clean-shaven, and a full crop of
54^ THE EDINBURGH SCHOOL OF SURGERY
wavy hair falling over his collar. He wears the
knee-breeches, silk stockings, and silver-buckled
shoes of the period, a long, full swallow -tailed coat
with lace ruffles at the neck and wrists, and a broad-
brimmed beaver hat, and carries in his hand the
traditional gold-headed staff of the physician.
" His address was mild and engaging, his informa-
tion varied and extensive, and his powers of con-
versation such that his society was much courted."
James Wardrop, speaking of Bell as he remem-
bered him in the year 1796 (47), says : " His manner
was devoid of every kind of ostentation. He was
of a kindly disposition, and in stating his opinion
made use of very plain and acciu'ate language. He
had an impressive mode of expressing himself,
giving great assurance and confidence to the sick.
In all the excitement of a surgical operation lie dis-
played the greatest composure. He was one of the
best and shrewdest observers I have ever known."
No sketch of Iknjamin Bell would be complete
which omitted reference to his interest in practical
agriculture and political economy, subjects on
which he published several essays which received
the conunendation of no less an authority than
Adam Smith. He has been referred to as *' the
sage and prophet of some of the most remarkable of
the political reforms that have occurred between
his time and our own." He was also a bold and
THE BEGINNING OF THE SURGICAL SCHOOL 55
successful speculator, and at the time of his death
he owned the greater part of the suburb of Edin-
burgh which goes by the name of Newington. This
tendency, his biographer suggests, may be traced to
his relationship to William Paterson, his great
grand-uncle, the founder of the Bank of England
and the originator and chief promoter of the
" Darien Scheme."
His descendants through several generations
continued to hold prominent positions in the Edin-
burgh Medical School, the last of the race being
Dr. Joseph Bell, who died in 1911, and who, having
served as Syme's house-surgeon, brings the race of
Bell up to the time of Lister.
While it cannot be claimed that Bell stands in
the very front rank of scientific surgeons, it must
be admitted that in his day and generation he con-
tributed materially to the progress of his art. He
brought to bear upon his work a faculty of accurate
observation, and an open, alert, and speculative
mind that enabled him to draw clear deductions,
which proved of great chnical and practical value.
Early in his career he realized that the ends the
surgeon has in view are in general attainable by
very simple means, and in his practice he made a
laudable endeavour "to divest the art of all the
useless machinery " with which it had become
encumbered, and which tends " more to evince
5() THK EDINBURGH SCHOOL OF SURGERY
the ingenuity of its authors tlian to render the
operations for which it was intended more easily
accomphshed."
His writings show that through his mind there
had passed the first glimmerings of some of the
great ideas which, when realized some three-quarters
of a century later, changed tiie wiiole aspect of
surgery. He was one of the first to emphasize the
importance of seeking for some means of preventing
or diminishing pain in surgical operations, and
althougli the methods he describes in the last
volume of his System of Surge?!/ seem crude and
ineffectual in the light of subsequent developments,
they mark a stage in the evolution of this great
advance.
In his dissertation On the Chirurgical Treatment
of InHammation (1777) {^^) he lays stress on the
danger which results from the admission of air to
the contents of large abscesses and other collections
of matter, and strongly advocates the use of the
seton, a practice which had been recommended by
James Rae, a Fellow of the College of Surgeons,
and adopted in the Royal Infirmary thirty years
before. He offers no explanation of the fact that
too frequent dressings and the admission of air eacli
time of changing '* tends to retard the cure," and
" constantly vitiates the nature of the discharge,"
but his experience satisfied him that by means of
THE BEGLNNING OF THE SURGICAL SCHOOL 57
the setoii a cure was commonly obtained in little
more than half the time usually found necessary
after a large incision had been employed.
His views on the rationale and practice of what
is now called *' massage " in the treatment of stift*
joints following inflammatory conditions were well
in advance of those of his own times, and not far
behind those of our own. He recommended the
persevering use of gentle friction thrice in the day,
for an hour each time, not over the joint merely,
but over the adjacent muscles, and considered that
the friction thus performed was more important
than the embrocation employed.
Bell's most important contribution to the scien-
tific literature of surgery was his Treatise on
Gonorrhoea Virulenta and Lues Venerea, pub-
lished in 1793 {44). In the hght of an unusually
extensive clinical experience, and from much care-
ful observation and accurate deduction, he clearly
demonstrated that the poisons of gonorrhoea and
syphihs are essentially different, and that the
diseases themselves are specifically distinct. The
credit due to Bell of closing the long-standing
controversy as to the identity of these diseases is
enhanced when we bear in mind that his opinions
ran counter to those of no less an authority than
John Hunter. Bell's views on the morbid anatomy
and treatment of gonorrhoea were singularly en-
58 THE EDINBURGH SCHOOL OF SURGERY
lightened and, save for what we owe to the science
of bacteriology, the hundred odd years that have
elapsed since his treatise was written have added
comparatively little to our knowledge of the subject.
In the province of operative surgery he is still
remembered for the share he took in improving the
methods of amputating. While still a student he
was much impressed by the unsatisfactory healing
of amputation wounds and by the interference with
the usefuhiess of the stump that so often resulted
from the "sugar-loaf" shape of its extremity.
These disadvantages he attributed to the fact that
sufficient skin was not saved to admit of the muscles
and bone being completely covered. To obviate
them he devised a method of amputation which he
put into practice the first time he had an opportunity
of removing a limb, in 1772 (.?J), and which came
to be known as '' the triple incision of Bell." This
was for long one of the approved methods of ampu-
tating, and with slight modifications may still be
advantageously employed in suitable circumstances.
In amputating through the thigh, Bell employed
a long anterior flap, thus anticipating the procedure
which many years later came to be associated with
tlie name of Teale of Leeds. '* Save skin " was
one of his surgical watchwords, and he applied the
principle in the removal of tumours and in a variety
of other ways.
THE BEGINNING OF THE SURGICAL SCHOOL 59
Bell's most ambitious literary effort was his
System of Surgery, published in six octavo volumes
between 1783 and 1788 {34-39), Modelled on
Heister's great System, published nearly half a
century earlier, it was the first attempt in English
** to bring together the art of surgery in broad and
orderly form," and was designed *' to exhibit a view
of the art of surgery as it is at present practised by
the most expert surgeons in Europe." Despite its
singular lack of systematic arrangement, which the
author avowed and defended, it furnished a com-
prehensive, if somewhat diffuse, exposition of the
subject, and contained much that was of perma-
nent value. That it went through seven editions,
was translated into French and German, and was
for long a standard authority alike with students
and teachers of surgery, disposes of the inept and
callow criticism passed on it by Benjamin Brodie,
who, when a lad of nineteen, borrowed it from a
friend and found it ** a most unreadable production,"
and doubted " whether it was ever read by anyone."
Such an immature judgment might well have been
modified when this distinguished surgeon came to
write his autobiography in more mature years. ^^
60 THE EDINBURGH SCHOOL OF SURGERY
John Belt.
(1763-1820)
The name of Hell has occupied a prominent
place in Edinburgh surgery for welinigh two
centuries. It has come down through two lines,
the older of which, founded by Eenjamin, whose
career we have just followed, has been uninter-
ruptedly represented in tlie School down almost to
our own times. The other line, if shorter, is no
less brilliant, for it gave us the brothers John and
Charles.
Born in Edinburgh, where his father, the Rev.
William Bell, was established as a clergyman of the
Episcopal Church in Scotland, John was the second
of four sons, all of whom attained to positions of
distinction in professional life ; two became Pro-
fessors of Law, and the youngest and most famous
was the great anatomist and physiologist. Sir
Charles Bell.
Endowed with considerable natural abihty and
prompted by a belief in himself and a determina-
tion to succeed, John Bell was destined to take a
high position in whatever profession he chose to
adopt. As a young man he moved in a social
circle which had been strongly influenced by the
awakening of intellectual life that took place in
Scotland about the middle of the eighteenth
THE BEGINNING OF THE SURGICAL SCHOOL 61
century. The cult of literature became the
fashion in Edinburgh, and, following his inclina-
tions no less than his interests, Bell became a
devotee. He collected what for that day was an
extensive and varied library, and, what was perhaps
less common, he read his books, annotating freely
on the margins. His well-regulated mind, aided
by a retentive memory, enabled him to make use
of the varied information he thus acquired, not only
in his professional writings, but still more perhaps
in his controversial brochures. He was a skilful
draughtsman, as the excellent illustrations in his
works on anatomy and surgery testify ; and he also
cultivated music, ** wdth more taste, however, than
execution," it is said, and the musical parties at
which he collected the elite of Edinburgh society
were among the events of the social season.
He is described as a man considerably below
middle height, but exceedingly well proportioned,
studiously elegant in his movements, and dressed
with excellent taste. He w\as polished and easy in
his manners, his eyes keen and penetrating, and
his whole expression intellectual and intelHgent in
no ordinary degree.*
Strange it seems that this dapper little man
should enter on his professional life as the pupil of
* I have failed, after careful search, to find a portrait of
John Bell.
62 THE EDINBURGH SCHOOL OF SURGERY
Mr. Alexander Wood, better known in his own
day, and even in ours, as *' Lang Sandy." There
seemed Httle in common between the kindly,
convivial, and Bohemian master and the dignified,
literary, and artistic apprentice. Yet so it came
about, and the association appears to have been
a happy one, for Bell, in acknowledgment of his
gratitude and affection for Mr. Wood, dedicated
to him the first volume of his Anatomy of the
Human Body (1703).
After completing his professional education,
Bell travelled for some time in Russia and the
north of Europe, and then settled down to practice
in Edinburgh.
In 1786 {23) he became a Fellow of the Royal
College of Surgeons, a position which at that date
entitled him to the privilege of acting in rotation as
one of the Surgeons to the Royal Infirmary. In this
capacity he early manifested his clinical ability and
manual dexterity, and was soon recognized as one
of the most skilful surgeons on the staff. In the
extra-mural school at Surgeons' Square, where he
lectured on anatomy and surgery for ten years
(1786-1796), he made a name for himself as a
forcible and inspiring teacher. In 1800 a change
was made in the mode of selecting the surgeons to
the infirmary which profoundly infiuenced Bell's
whole career. At the instigation of Dr. James
THE BEGINNING OF THE SURGICAL SCHOOL 63
Gregory, Professor of Medicine in the University,
the managers introduced a regulation under which
six members of the College were elected to act as
surgeons to the infirmary for a period of two years
at a time. This involved the exclusion of Bell,
along with the other younger Fellows, from the
staff of the hospital, a disappointment from which
he never recovered. An embittered controversy
arose which at first divided the whole of the
medical profession, but eventually resolved itself
into a battle of words between Dr. Gregory and
Mr. Bell. In pamphlets, memorials, Censorian
Letters, and Historical Memoirs of the Medical
War in Edinlmrgh Gregory attacked Bell and his
party with extraordinary acrimony, and Bell replied
in his Letters on the Education of a Surgeon and
the Duties and Qualifications of a Physician^
addressed to James Gregory^ M.D., an octavo
volume of over 650 pages of sustained vituperation.
The exclusion of such a man as John Bell from
the infirmary staff was a double misfortune : it not
only deprived the sick poor of the services of a
surgeon of genuine ability and proved skill, but
it checked the development of a career which
promised to add materially to the reputation of the
hospital and of the medical school of Edinburgh.
Fortunately, Bell's personal reputation was already
secure, and he continued for nearly twenty years
64 THE EDINBURGH SCHOOL OF SURGERY
to be looked upon as the leading consulting and
operating surgeon in Edinburgh.
No authoritative memoir of John Bell was ever
published. His brother Charles prepared notes for
a Life, but on consideration it was decided by his
family not to go farther, as " it was better to allow
his works to speak for him than to excite anew the
controversies into which his enthusiasm for his
profession had drawn him."^^ This decision,
doubtless a wise one when it was made, has with-
held from us much of the material necessary for a
just estimate of one who played an important part
in the development of surgery in Scotland.
Above the average of his contemporaries in
mental capacity and general education, by tempera-
ment inclined to be contentious, and by bitter
experience rendered even quarrelsome, John Bell
was little disposed blindly to follow traditional
teaching. His acuteness of mind was tempered
by a fund of sound common sense, and he had
at command a wealth of vigorous and incisive
language. These qualities are manifest in his
writings, which in boldness and piquancy contrast
favourably with the prosy and colourless works of
some of his predecessors.
After spending some time amongst the wounded
men of Lord Duncan's fleet after the Battle of
Camperdown, he wrote his treatise on GuTishot
THE BEGINNING OF THE SURGICAL SCHOOL 65
Wounds, which contains evidence of much careful
observation and sound deduction. We in our day
have had to relearn much that was known to John
Bell and has been since forgotten.
** There seems to be a sort of mystery in the
business of gunshot wounds," he says, " which
arises merely from the singular ideas which the
older physicians entertained regarding the nature
of shot. Gunshot wounds are made by a blunt
round body, which inflicts a deep and dangerous
wound, and so bruises the surrounding flesh, that
the wound is at first livid, soon becomes black, has
little bleeding and no pain, soon falls into actual
gangrene, and is extremely difficult to heal."
He is wisely discriminating in the use of the
probe in gunshot wounds, and condemns those
" who, with a flippant vanity, will introduce their
probes among the viscera of the chest or abdomen,
w^here they never should be, for the contemptible
desire of exalting their own little character by
pronouncing their opinion over a dying man."
Bell deserves credit for the prominent share he
took in propounding the " doctrine of the anasto-
mosing arteries," and thereby in limiting the
indiscriminate amputation of limbs for gunshot
wounds of the main arterial trunks. As an anato-
mist he had devoted special attention to the investi-
gation of the anastomosing arteries, and he was
persuaded that the collateral circulation between
5
66 THE EDINBURGH SCHOOL OF SURGERY
the vessels was sufficient to maintain the vitality
of the limb even if the main artery was ligated
" close to the point where it comes out from the
body." The application of this " doctrine of
inosculating arteries" to the problems of wound-
healing led Bell to support those who were begin-
ning vaguely to attempt to secure union of wounded
tissues without the intervention of suppuration.
" In wounds and operations there are but two
great points to be attended to ; first, the securing
the arteries, so that the patient may be in no
danger from bleeding, and then the procuring a
speedy adhesion, by which the pain, suppuration,
waste of tissue, and all the other bad consequences
of the wound are prevented."
To this end he advised the ** laying of the
wounded parts so cleanly, so neatly, and so evenly
in contact with each other that they may adhere.
The rest we leave to nature."
This *' doctrine of adhesion " was then compara-
tively new, and like all novelties in surgery gave
occasion for much animated discussion, both with
regard to its merits and to the question of priority
in discovering it. The battle raged chiefly around
the question of the flap amputation. The French
surgeons who first invented this method of amputat-
ing had claimed that by placing the fresh surfaces
of the flaps in apposition, adhesion of the flesh had
THE BEGINNING OF THE SURGICAL SCHOOL 67
often occurred, even in three days. To this claim
O'Halleran, who continued *' to dress the flap and
the face of the stump as separate sores till the
twelfth day," replied — " with a rudeness and
ignorance quite unparalleled," says Bell — '* These
tales are told with more confidence than veracity.
Healing by inosculation, by the first intention, by
immediate coalescence without suppuration, is
merely chimerical, and opposite to the rules of
nature." Gradually, however, through the advocacy
of Allanson, Hunter, Benjamin Bell, and John
Bell, the doctrine of adhesion gained ground and
gradually worked its way into the practice of
surgery ; even O'Halleran lived to see it adopted
as the basis on which both accidental wounds and
operations were treated.
The credit of initiating this advance in surgical
practice cannot be allocated to any of the numerous
claimants to the honour, but John Bell's work on
the inosculating arteries contributed to give it a
rational basis.
An early but unsuccessful experiment in what
would now be called aneurysmorrhaphy is thus
described by Bell in his Principles of Surgery, with
the comment that " our motives for repeating this
dangerous operation are very slight indeed."
" T opened the aneurysm, hooked out the clots
of blood, and then raised the artery upon my fore-
68 THE EDINBURGH SCHOOL OF SURGERY
finger ; 1 took next a very fine bleeding lancet and
scarified the two lips of tlie wound ; after having
made them raw, I passed a very delicate glover's
needle through both lips of the wounded artery,
and twisted a fine cambric thread round the needle,
so as to draw the lips of the wound close. Upon
letting go the tourniquet, the artery was seen beat-
ing in the bottom of the wound ; the pulse in the
wrist became instantly as strong as in the other
hand ; indeed, we thought this artery beat rather
more powerfully. Everything went on well till the
twelfth day, . . . when a dangerous hiemorrhagy
came on in the evening. On the fourteenth day
the bleeding returned, . . . and the artery was tied
with the two ligatures as usual."
A reasoned conservatism is chaiacteristic of Bell's
attitude towards many of the surgical problems
that in his day occupied the minds of surgeons.
Throughout his career he ** constantly endeavoured
to moderate the rage for operations, and to inspire
the young surgeons w^ith a just and rational reliance
on the provisions of nature for the cure of wounds
and diseases." " Operations," he says in the intro-
duction to his Principles of Surgery, '' usurp an
importance in surgical education which they should
not naturally have. Operations have come at last
to represent, as it were, the whole science, and the
surgeon, far from being valued according to his
sense, abilities, and general knowledge, is esteemed
excellent only in proportion as he operates with
skill."
THE BEGINNING OF THE SURGICAL SCHOOL 69
Respecting neither tradition nor authority, he pro-
tested against the prevaihng practice of trepanning
for every fracture of tlie skull, whether attended with
symptoms or not. Thus, he falls foul of Mr. Pott,
" a surgeon of unrivalled excellence, whose influence
was fairly acquired. But let those who hav^e influ-
ence with their profession use it discreetly and
wisely ; let them ponder w^ll the maxims they
announce ; for Pott fell into a system of practice
so bloody and enterprising that, in the few years
which ha^e elapsed from his death, it has fallen
into utter discredit, and he delivered his maxhns
in a style so decisive and imperative as to impose
even now upon the younger part of the profession,
while, by all w^ho judge for tliemselves, his practice
is abandoned. No wonder it is abandoned, being,
in every point, except one, repugnant to good
principles."
Of M. Quesnow, who, before the French
Academy, had advised incision ot the cortical
substance of the brain in cases of suspected abscess,
remarking that he had often observed that the brain
substance is insensitive, Bell could not trust himself
to speak : '* The paragraph is so audacious that in
place of translating it in my text, I transcribe it on
my margin ; there let it stand, like a beacon on
a foreign shore." There it stands — not the only
beacon from that same shore that has lightened the
firmament of surgery.
70 THE EDINBURGH SCHOOL OF SURGERY
This is not the only occasion on which we find Bell
falling into a fault of which he was prone to accuse
others — that of " writing surgery by conjecture
and mere guess." Sound as his surgical instincts
usually were, when blinded by professional jealousy
or personal animosity, failings of which he was by
no means free, his judgment was apt to become
warped and his language acrimonious. Benjamin
Bell, with whom he agreed in nothing save the
surname, had recommended that with a view to
securing more accurate suturing of divided bowel,
the gut might be kept ** extended by means of some
round body inserted into it." For this purpose he
suggested " a small roll of tallow ... as it will
afterwards melt and pass easily with the faeces." In
the light of our modern experience of bone bobbins
and metal buttons this simple device appears both
natural and ingenious, but in John Bell it seems to
have raised all the righteous indignation of which he
was capable. *' If there be in all surgery," he says,
*'a work of supererogation, it is this operation of
sewing up a wounded gut. . . . These observations
are unparalleled in all the books of surgery from
the invention of printing down to the present
day." ... *' It is an untried experiment as yet,
and let it be tried when it may, I shall venture to
predict that it will turn out a very sad one."
That John Bell was a man who held his surgical
THE BEGINNING OF THE SURGICAE SCHOOL 71
opinions strongly and expressed them forcibly will
be evident from the quotations we have so freely
made from his writings. Crowded together and
condensed as they necessarily are, these extracts
are liable to give a wrong impression of Bell's
literary style and to exaggerate its acerbity. We
cannot correct this better than by quoting at length
the description he gives of an operation performed
in the Royal Infirmary for aneurysm of the iliac
artery,^^ which in human interest and dramatic
intensity vies with the famous description of a
similar operation performed by Syme in the same
hospital more than sixty years later (p. 203).
" A poor man, who was by trade a leech-catcher,
fell as he was stepping out of a boat, and the long
and pointed scissars which are used in his business
being in his pocket, pierced his hip exactly over the
place of the sciatic notch, where the great Iliac
Artery comes out from the pelvis. The artery
was struck with the point of the scissars, it bled
furiously, the patient fainted ; and in so narrow
and deep a wound, the surgeon, when he came,
found little difficulty in stopping it up, and less
difficulty still in making it heal. The outward
wound was cured, the great tumor soon formed ;
and the man travelled up from the North Country,
where the accident had befallen him, and in six
weeks after arrived in our hospital here with a
prodigious tumor of the hip, his thigh rigidly
contracted, the ham bended, the whole leg shrunk,
cold, and useless, as if it had been an aneurism
7l> the EDINBURGH SCHOOL OF SURGERY
rattier of the artery on the fore part of the
thigh.
" The tumor was of a prodigious size, and by
that very circumstance of its being one of the
greatest aneurisms, it lost all the characteristics of
aneurism ; especially there was no pulsation, no
retrocession of the blood when the tumor was
pressed upon ; there was nothing peculiar except
this, that the great and sudden distension was the
cause of great pain ; and from the continual pain,
lameness, and his hopes of a cure, he was ready to
submit to anything, beseeching us to operate.
** There was little doubt of its being a great
aneurism, but there was a possibility of its being a
vast abscess ; and it was resolved, in consultation,
that he should be carried into the operation-room ;
that a small incision should be made ; that the
skin being cut, the bag itself should be just touched
with the point of a lancet ; and if found to contain
matter, should be fully opened ; but if blood, that
it was then to be considered as an aneurism of so
particular a kind, as to entitle us to call for a full
consultation.
*' 1 made an incision two inches and a half in
length ; tlie great fascia in the hip, blue, and very
strong, formed the coat of the tumor, and under
that were seen the big fibres of the great Glutaeus
Muscle. The knife was struck into it, and large
clots of very firm black blood rolled out by the
tenseness of the tumor, which began to emit the
clots in this way, the moment that it was opened at
one point. There was one thing further desirable,
before we put the patient to bed, that we should
understand the case so far as to be able to re-
port to the consultation, whether the artery was
THE BEGINNING OF THE SURGICAL SCHOOL 7ii
absolutely open, and whether it was the great
artery of the hip. I continued therefore, knowing
that the opening I had made could be covered with
the point of the thumb, to pull out a few more
clots of blood, till the warm and florid blood began
to flow ; 1 then pushed in a tent-like compress into
the small wound of the tumor {viz., of the fascia),
laid a broad compress over the outward wound, and
put the patient to bed, with one of the pupils hold-
ing his hand upon the hip.
" This was done at one o'clock ; at four the con-
sultation met, and the operation was performed.
And in my notes, I And two steps of the operation
chiefly marked : Fi?'st, That upon our opening the
tumor fully with an incision of eight inches long,
and turning out the great clots, the blood was
thrown out with a whishing noise, and with such
impetus, that the assistants were covered with it.
In a moment twenty hands were about the tumor,
and the bag was filled with sponges, and cloths of
all kinds, which had no better effect than the cloths,
which, in any accident, the friends in great confusion
wrap round a wounded arm ; for though the blood
was not thrown in a full stream, nor in jets, it was
seen rising above the edges of the incision ; it floated
by the sides of the cloths, which were pressed down
by the hands of the assistants. But we knew by a
more alarming sign that the artery was throwing
out blood ; for the man, who was at first lying not
flat, but supporting himself on his elbows, fell down,
his arms fell lifeless, and without pulse, over the
side of the table, his head hung down and his
countenance was livid, he uttered two or three
heavy groans, and we believed him dead.
** Secondly, Seeing in this critical moment that if
74 TOE EDINBURGH SCHOOL OF SURGERY
he was to be saved, it could be only by a sudden
stroke, I ran the bistoury upwards and downwards,
and at once made my incision two feet in length ;
I thrust my hand down to the bottom of the tumor,
turned out the great sponge which was over the
artery, felt the warm jet of blood, and placed the
point of my finger upon the mouth of the artery ;
then I felt distinctly its pulse, and then only was I
assured that the man was still alive. The assistants
laid aside tlie edges of this prodigious bag, and
sought out the several smaller sponges which had
been thrust in, and the bag being deliberately
cleaned, and its edges held aside, I kept the fore
finger of my left hand steady upon the artery,
passed one of the largest needles round under my
forefinger, so as to surround the artery : one of my
friends tied the ligature, and then upon lifting the
point of my finger, it was distinctly seen, that it
was the Posterior Iliac Artery, that the artery had
been cut fairly across, and had bled with open
mouth — that it was cut and tied exactly where it
turns over the bone : and although the extremities
were cold, the face of a leaden colour, and the man
had ceased to groan, and lay as dead ; though the
faint pulsation could not be felt through the skin,
in any part of the body ; we saw the artery beating
so strongly, whenever I lifted my finger, tiiat we
were assured of our patient's safety. However, he
was so low, that after laying down the sides of the
sac, and })utti ng bandages round his body to keep
all firm, wc were obliged to have a bed brouglit in,
and having given him some cordials, we left him to
sleep in tlie great operation-room, attended by the
pupils and by nurses.
*' He was cured of this great wound in less than
seven months."
THE BEGINNING OF THR SURGICAL SCHOOL 75
In a footnote lie adds : " Dr. Farquharson, who
succeeded me in the charge of the hospital, has
just informed me of this man having called upon
him, after his return from England, walking stoutly,
and in good health."
Through the medium of his writings, Bell's name
became favourably known throughout the surgical
world, and when he visited the Continent after the
peace of 1815 he was most cordially received by
members of his profession wherever he went.
He died at Rome on April 15, 1820 {57), and
there he was buried. On one side of the Celtic
cross, erected by the Royal College of Surgeons of
Edinburgh in 1891, to mark his resting-place, is the
nameless grave of John Keats, identifiable only by
his self-appointed epitaph : '* Here lies one whose
name was written in water." On the other side,
Keats's devoted friend and death-bed companion,
Joseph Severn, the artist, was buried more than half
a century later, after he had lived to see the friend
of his youth " numbered among the immortal poets
of England."
Of Bell it has been truly said that '* he was one
of those men who, without apparently achieving
great success, leave behind them an abiding impres-
sion, and stamp their character in the institutions
and thought of the age in which they live."*^
CHAPTER \ II
THE FOUNDATION OF THE CHAIR OF
SYSTEMATIC SURGEUV
The Teachiiiii^ of Systematic Surgery in Edinburt^h — James
Hae — x\lexander Monro scaindus — Prok'SSoishi|) of
Surgery of the Royal College of Surgeons — Alexander
Monro tertius — John William Turner — Sir Charles Bell
— James Miller.
It might be supposed that the estabhshment of a
Faculty of Medicine within the University in 172G
would have inevitably led ere long to the founda-
tion of a Professorship of Surgery. But many
obstacles had to be overcome before this desirable
step was taken and the teaching of surgery as an
independent subject was placed upon a satisfactory
footing. 'I'he time was ripe for such an advance,
and there were not wanting in Edinburgh surgeons
who were able and willing to make it.
The progress which had been made in anatomy
and physiology during the seventeenth century
had prepared the way for the advances in pathology
which marked the eighteenth. The Academy of
7(i
THE CHAIR OF SYSTEMATIC SURGERY 77
Surgery, which was founded in Paris in 1731,
under the guidance of such distinguished men as
Petit, Desault, and Chopart, set a very high
standard ahke in scientific and in practical surgery.
Under its influence a great impetus was given to
original investigation in surgical pathology, and
this was reflected in the improvements which
resulted in operative procedures.
A natural direction for such pioneer work to
take was that of elucidating the reparative pro-
cesses which accompany the healing of wounds
and the cure of diseases. Petit investigated
the changes in bloodvessels which bring about
the natural arrest of haemorrhage ; John Hunter
studied the process of coagulation of the blood and
the repair of wounds in general ; and Duhamel — a
French botanist and engineer, by the way — threw
much light on the formation of callus in the repair
of fractures by studying the growth of bone in
animals after mixing madder with their food.
At the hands of Petit, Desault, Gooch, and
Percivall Pott many improvements were made in
the treatment of fractures, the last-named surgeon
taking advantage of a riding accident which befel
him in 1756 to study and describe the fracture of
the ankle which is still known as " Pott's fracture,"
and his book, Some feiv Remarks upon Fractures
and Dislocations, despite its modest title, aroused
78 THE EDINBURGH SCHOOL OF SURGERY
great interest in Great Britain and France. From
his pen also came that description of caries of the
vertebnL^ whicli in point of lucidity and accuracy
left little room for subsequent emendation ; as well
as contributions on the subject of head injuries and
on rupture.
In the field of operative surgery, also, important
advances were being made. Cheselden, the friend
of Sir Isaac Newton, Alexander Pope, and Sir
Hans Sloan, first performed in 1727 his "lateral
operation for the stone," based upon that of Rau
of Leyden ; and he devised a means of improving
certain forms of blindness by making an artificial
pupil by iridectomy. John Hunter introduced his
operation of tying the femoral artery in the thigh
for popliteal aneurysm, a procedure which at the
time *' excited the greatest wonder." Gimbernat
began to operate for strangulated femoral hernia ;
Chopart and Hey of Leeds introduced their opera-
tions for partial amputation of the foot ; and
tentative attempts were made to excise diseased
joints by Charles White of INIanchester and Henry
Park of Liverpool.
The more active spirits among the Edinburgh
surgeons had not remained uninfluenced by these
progressive movements which were taking place in
the great schools in London and on tlie Continent.
To these schools the best of the Edinburgh students
THE CHAIR OF SYSTEMATIC SURGERY 79
had gone to complete their sui-gical education, and
they had brought back with them fresh ideas and a
keen desire to emuhite the masters under whom
they had studied.
The idea of devoting a complete course of
lectures to the exposition of surgery apart from
anatomy seems first to have occurred to James
Rae, who was Deacon of the Incorporation of
Surgeons in 1764. In any case he was the first to
put the idea into practice, and for some years he
conducted a course privately, with considerable
success.
Mr. Rae was descended from a family of long
standing as landed proprietors in Stirlingshire.
He resided in a house at the head of the old Flesh-
market Close, and obtained much reputation as a
dentist, being " among the first (if not the very
first) in Edinburgh to rescue that department from
the ignorant and unskilful hands in w^hich it was
then placed/' He also gave private lectures on the
diseases of the teeth.^^
In 1772 he asked the College " to recognize and
support a course of lectures on the whole art of
Surgery, with practical discourses on the cases of im-
portance as they occurred in the Royal Infirmary."
This the College, "being desireous to promote
every usefull undertaking towards the advance-
ment of the knowledge of Surgery," readily agreed
80 THE EDINBURGH SCHOOL OF SURGERY
to do, and they not only recommended their
students to attend the course, but resolved to
communicate to Mr. Rac such cases of importance
as might occur in their practices. Rae may there-
fore be looked upon as the founder of the practice
of teaching surgery clinically in Edinburgh.
The success which attended this early \enture in
the systematic and practical teaching of surgery
was so encouraging that in 1776 the College
approached the magistrates with a view to having
a Professorship of Surgery established within the
University. This proposal was vigorously opposed
by Alexander Monuo secundus, who by this time
had succeeded his father in the Chair of Anatomy,
and who represented to the magistrates that
although it was not expressed in his commission,
** the teaching of surgery has been universally
understood to belong to his office," which was con-
stituted ** on the plan of the most celebrated
University of Leyden."'^ In reply to this con-
tention the College urged that as their Charter,
granted by King WilHam and Queen Mary, gave
them the exchisive right of operation both on
living and on dead bodies, any nomination of a
Professor of Surgery should be made from their
Society, and as Monro was neither a member of the
College of Surgeons nor a practical surgeon, they
maintained tiiat it was not in the interests of their
THE CHAIR OF SYSTEiMATlC SURGERY 81
art that the teaching of the subject should be in
his hands, to be carried out as a subsidiary part of
his course of anatomy.
These pleas seemed sound both in law and in
reason, but the combined influence of the Monros
and the University prevented the petition of the
surgeons being granted, and the ultimate outcome
of a bitter controversy was that, in 1777, Monro
received a new commission appointing him Pro-
fessor of Medicine, and •' particularly of Anatomy
and Surgery."
Thus did vested interests stand in the way of
progress ; and although the name of Alexander
Monro secundus stands at the head of the official
list of Professors of Surgery in the University, it
cannot be claimed that he did anything directly to
advance the art which he professed.
He was among the leading Scottish physicians of
his own time and one of the great anatomists of all
time, and the celebrity he attained throughout the
scientific world did much to enhance the rising
reputation of the Edinburgh School, of which he
was the acknowledged head for many years.
'" Monro was a man of middle stature, vigorous and
athletic, with a large head and a countenance
expressive of intelligence, solidity, and humour.
Busy as he was, he enjoyed society, in which his
anecdotal powers shone ; he was an enthusiastic
6
82 THE EDINBURGH SCHOOL OF SURGERY
admirer of the theatre ; and he took great pleasure
in cultivating his garden and in planting and
ornamenting the estate of Craiglockhart, which
his success in his profession had enabled him to
purchase in 1779."" He held the Chair of Anatomy
for fifty-four years, and died in 1817 at the age of
eighty- four.
In 1804 the College of Surgeons, having failed
in their endeavours to persuade the Town Council
to establish a separate Chair of Surgery in the
University, decided to institute under their own
tegis a Lectureship on the Principles and Practice
of Surgery. It was stipulated that the course
should be given annually, that it should be of the
same duration as the courses of the Professors of
Medicine in the University, and that officers of the
medical staff of the army, and surgeons and
surgeons' mates in the navy, should be admitted to
the lectures gratis. John Thomson was appointed
the first lecturer, with the title of " Professor of
Surgery of the Jloyal College of Surgeons." The
University, through the Town Council, opposed
the establishment of a Professorship outside its own
walls, on the ground that it would interfere with
one of the classes taught within the University, but
they did not push their objection, and Thomson
was duly installed in his office. Thus it came
about that a Professorship devoted entirely to
THE CHAIR OF SYSTEMATIC SURGERY 83
surgery was founded in the Extra-mural School
twenty-seven years before the teaching of surgery
was separated from that of anatomy within the
University. ^2
Two years later Thomson was appointed by the
Crown Professor of Military Surgery in the Univer-
sity, but he continued, by permission of the College,
to perform the duties of the Professor of Surgery.
In 1821, Thomson resigned his College appoint-
ment, and was succeeded by Mr. J. W. Turner
(p. 84), who had for two years been recognized by
the College as his assistant. When he resigned in
1831, on becoming Professor of Surgery in the
University, he was succeeded by John Lizars
(p. 127), who held the post for eight years. On^,
receiving his resignation, the College decided to{
discontinue the Professorship, in view of the fact
that their long-cherished desire that a Chair of
Surgery should be established within the University
had now become an accomplished fact.
Alexander Monro tertius succeeded his father
in the anatomical Chair in 1798, and while he
engaged in practice as a physician, he continued to
deliver the few lectures that constituted the
official course of surgical instruction given in the
University.
Although he '* lacked neither ability nor accom-
plishments," Monro was by universal consent " far
84 THE EDINBURGH SCHOOL OF SURGERY
from being a popular lecturer.' ** In all he did
and said his manner betrayed an unimpassioned
indifference, as if it were all the same to him
whether his teaching was acceptable or not."^^
** He w^as so insufferably careless and lazy that it is
said he absolutely forgot the elements of the subject
he professed to teach. . . . He used to read his
grandfathers lectures written about a century
before "; and even the shower of peas with which
the expectant students greeted his annual reference
— *'when 1 was a student in Leyden in 1719"
failed to induce him to alter the dates. ^^
Under such conditions it is little wonder that
the students filled the class-rooms of the extra-
mural teachers, and the need for a complete course
of surgery within the University was more clamantly
felt than ever.
It was not until 1831, however, after the Monros
had monopolized the University teaching of surgery
for 110 years, that the Crown, on the recommenda-
tion of the Town Council, established a separate
Chair of Systematic Surgery and appointed John
William Turner the first incumbent.
John William Ti rner
(1790-183G)
The action of the Crown in erecting the system-
atic Chair seems to have come upon the surgical
^s
O u
in '^ M >
." %i ^
THE CHAIR OF SYSTEMATIC SURGERY 85
world of Edinburgh as something of a surprise, for
even the College of Surgeons, who had fought for
it so long, first learned that their object had been
attained when their own Professor of Surgery, Mr.
J. W. Turner, intimated to them that he had been
offered the University Chair, and had accepted it.
Born in England, Turner received his medical
education in Edinburgh, and after making a voyage
to India as surgeon to an Indiaman served for some
time as assistant-surgeon of militia and as medical
officer of artillery at Leith Fort.
He then became assistant to Dr. John Thomson,
with w^hom he formed a life-long friendship. Along
wdth Thomson, he took an active share in founding
the New^ Town Dispensary, and in 1821 he succeeded
his master as Professor of Surgery of the Royal
College of Surgeons. He did a great deal to
develop the museum of the College while he
acted as conservator, and was chiefly responsible
for the compilation of the first printed catalogue of
the collection.
His work was frequently interrupted by illness,
and for the benefit of his health he w^ent to Paris
as private medical attendant to Lord Holland, and
in a similar capacity spent a summer in the High-
lands of Scotland with the Duke of Bedford.
In 1829 (39), his health restored, he w^as appointed
one of the surgeons to the Royal Infirmary, and
86 THE EDINBURGH SCHOOL OF SURGERY
two years later he entered upon the duties of the
newly-created Professorship. His tenure of the Chair
was short, for in 183G (46) he died after an acute
illness contracted in the course of his infirmary
duties, as a result of exposure on a wet night.
He was buried at Xewbattle, where he had spent
his early years.
Mr. Turner " was a most uninteresting lecturer ;
a timid, shy man, who could not look his class in
the face, and seemed fitted by nature for anything
rather than the duties and responsibilities of an
operating surgeon. "^^
He left little save a few papers in the medical
journals from which we may judge his position as
a surgical writer. As a man he was highly
esteemed, and ** his conduct towards his professional
brethren was marked by the most delicate attention
to their feelings."
Sir Charles Bell
(1774-1842)
The Edinburgli School can only lay claim to a
modest share of the glory reflected from the great
name of Charles Bell. His epoch-making investi-
gations on the structure and functions of the ner-
vous system were made while he lived in I^ondon,
and it is on his discoveries in physiology rather than
on his contributions to surgery that his fame rests.
THE CHAIR OF SYSTEMATIC SURGERY 87
It was in the Extra-mural School in Edinburgh,
however, that his attention was first directed to the
study of the nerves, and " even before he left
Edinburgh a suspicion had grown upon his mind
that the prevalent opinion regarding the functions
of the periplieral nerves was erroneous." At that
time he was acting as assistant in the anatomical
rooms of his elder brother, John (p. 60), who was
then engaged on his Anatomy of the Human Body,
Charles's passion for drawing (inherited from his
mother) found ample scope in the preparation of
the illustrations for this work, particularly of the
volume devoted to the nervous system and special
senses. He had already, while still a student in 1798
{24), published a Syste?n of Dissections, illusti^ated
by his own drawings, and the artistic excellence of
these works had brought him under the favourable
notice of the profession both at home and abroad.
His election to the Fellowship of the Royal College
of Surgeons of Edinburgh, in 1799 {25), entitled him
to act as one of the attendant surgeons to the Royal
Infirmary, and the prospect of a successful career
in surgery seemed to open out before him. The
following year, however, new rules for regulating
the attendance of the surgeons at the infirmary
came into force, and along with others — including
his brother John — he was excluded from the privi-
lege of acting on the surgical staff. There seems
88 THE EDLNBURGH SCHOOL OF SURGERY
little doubt that this restriction of his opportunities
for acquiring clinical experience, and his natural
repugnance to engage in the heated controversies
which arose from the change, influenced his decision
to try his fortunes in London. Thither he went in
1804 (30), and, not without a struggle, made for
himself a reputation in the world of science which
*'put him beside Harvey."
In 1836 {6£) he returned to Edinburgh as Pro-
fessor of Surgery, an office to which he was invested
" witli the unanimous assent and acclamation " of
the electing body — the Town Council. ** And
surely," wrote his brother George, '' never was an
offer more honourable to an individual, for I do
assure you it has the approbation of all ranks and
classes of men, and of none more than the Professors
of the University and the whole medical profession."
In spite of the great scientific reputation he had
earned by his genius, and tlie high social position
to which he had attained, Bell does not seem ever
to have been quite at home in London, and such
reward as comes in the form of an extensive con-
sulting practice had not been his. Yet he left the
scenes of liis life-work with genuine regret, and
with a sense of ** pain of resigning all here which
has hitherto been my pride."
The professional considerations which led to his
acceptance of the Chair of Surgery appear in his
THE CHAIR OF SYSTEMATIC SUKGERY 89
correspondence with his brother George : " It has
ever been my pride to join the pursuits of science
(and lecturing is of all conditions the most con-
ducive to scientific pursuits) and practice. In
surgery they cannot safely be separated. ... I
could imagine many happy circumstances in a life
devoted to the University. . . . The place of a
Professor who fills his place is the most respectable
in life. My hands are better for operation than any
I have seen at work ; but an operating surgeon*s
life has no equivalent reward in this world, and
some from coarseness, want of feeling, and stupidity,
deserve in the next . . . ! I must be the teacher
and consulting surgeon to be happy."
In a letter to John Richardson he says : " I had
hoped ... to accomplish a great work on anatomy,
a design which was innermost at my heart when
coming here."
Less definitely avowed but perhaps not less
potent motives appear to have been a vague sense
of failing health, " the hope of an easy professorial
life, love for George,* and ready access to the
beautiful country around Edinburgh."
The high expectations with which he entered on
his new sphere of activity do not seem to have been
^ His brother, the author of Bell's Covimentaries of the
Laws of Scotland, still one of the standard textbooks on
Scots law,
90 THE EDINBURGH SCHOOL OF SURGERY
fully realized. Nor was it likely in a man of Bell's
temperament, torn at the age of sixty-two from an
environment in which he had lived and worked for
thirty-two years, that he would take root kindly in
new surroundings. When he had made the choice
he himself said, '* I have been dislocated, and 1
feel it."
He was most kindly received in Edinburgh, and
acquired a not inconsiderable practice among the
nobility of Scotland — an association which for Bell
had the added advantage that it *' let him have free
access to their streams," and so enabled him to
indulge to the full his passion for fishing and his
love of the country.
Some years before his return to Edinburgh (1825)
the museum he had collected at the Windmill
Street School of Anatomy was secured by the
Royal College of Surgeons of Edinburgh, and is
now incorporated in their collection, together with
a series of water-colour drawings of gunshot wounds
made at Brussels after the Battle of Waterloo,
when he was engaged as a surgeon with the Britisli
troops.
Of his surgical work in Edinburgh there is not
much to be said. He performed tlie routine duties
of the Chair with such meticulous care that before
the examination for degrees— which then included
an examination in Latin -we find him every morn-
THE CHAIR OF SYSTEMATIC SURGERY 91
ing reading diligently at his old school-books — " an
imanibitioiis, dreamy use of time tlmt gives perfect
rest." George Wilson records that he found him
'' a most gentlemanly, kind examinator," who gave
him " a i'ew questions regarding the diseases for
which legs are cut ofF."^^
In 1838 (64) he published his Institutes of
Surgery, and in 1841 [67) a volume of Practical
Essays, but these works do not contain any contri-
butions to surgical knowledge which add to the
reputation he had already made by his works on
the nerv^ous system.
** His dexterity and coolness as an operator were
remarkable ; yet he went to operations wdth the
reluctance of one who has to face an unavoidable
evil, in this respect resembling Hunter and many
other first-rate surgeons. Like Cheselden, who is
said always to have turned pale when about to cut
for the stone, Bell's cheek was often seen to blanch
on proceeding to operations performed with the
utmost self-possession and skill." ''^
His letters written after he settled in Edinburgh
contain frequent references to the unsatisfactory
state of his health, and within a year of his return
he was " full of forebodings."
During the spring vacation of 1842 {68), he set
out on a visit to London, and on April 27 had got as
far as Hallow Park, near Worcester. That evening
92 THE EDINBURGH SCHOOL OF SURGERY
he walked in the churchyard, and while sketching
an old yew-tree remarked to his wife : " This is a
sweet spot ; here I fain would rest till they come to
take me away." During the night he was seized
witli an attack of angina pectoris, and died. '* They
laid him to rest in the peaceful churchyard, not far
from the yew-tree."
James Miller
(1812-1864)
The next professor of systematic surgery, and
the last of the pre-I^isterian period, was James
Miller. Like so many of his Scottish compeers.
Miller was a son of the manse. His father, the
Rev. James Miller, was minister of the parish of
Eassie in Forfarshire, where his third and name-
son was born on April 2, 1812.
Before commencing his purely medical studies in
Edinburgh, Miller spent three years at the Uni-
versity of St. Andrews, where he came under the
influence of Dr. Thomas Chalmers, the great
Scottish divine, whose lead he followed in 1843
w^hen the Free Church parted with the Established
Church at tlie Disruption.
Early in his student career Miller became a pupil
of Robert Liston, and one of his most enthusiastic
admirers. By nature the two men would not
appear to have had many affinities, yet they formed
THE CHAIR OF SYSTEMATIC SURGERY 9S
a strong and lasting friendship. For the last ^vq
years List on was in Edinburgh Miller acted as his
private assistant, sharing not only in his operative
work, but also, it is said, in his literary labours,
particularly in the preparation of his Elements of
Surgery. When Liston went to London in 1834,
he was anxious that Miller should accompany him,
but the prospect of obtaining the vacant assistant-
surgeonship in the Royal Infirmary, as well as
other considerations, determined him to try his
fortune in Edinburgh. His hopes regarding the
infirmary post were realized, and he succeeded to
the greater part of Liston 's private practice.
In 1842 Miller became a candidate for the Pro-
fessorship of Surgery, rendered vacant by the death
of Sir Charles Bell, and after a keen contest with
Dr. Argyll Robertson and John Lizars was elected
at the early age of thirty. As events proved, the
selection of the Town Council, who were then the
patrons of the Chair, was abundantly justified, for
it was as a teacher and lecturer that Miller was at
his best. Handsome in person, with an extra-
ordinary fluency of diction, punctuated by appro-
priate gesture, he ranked amongst the orators of his
day, and secured the interested attention of his
students even when the subject-matter was least
attractive. His lectures were aptly illustrated by
telling anecdotes, and illumined by flashes of wit
94 THE EDINBURGH SCHOOL OF SURGERY
Although as an operator he was bold and
dexterous, excelhng particularly in the performance
of lithotomy (then the crucial test of manipulative
skill) and in other operations on the urinary organs
and on the rectum, he was singularly conservative
in the use of the knife. In tuberculous affections,
for example, he relied much more than the majority
of his contemporaries on treatment by constitutional
measures, and in some directions he anticipated the
practice of our own day.
His most important contribution to surgical
literature was his Principles and Practice of Surgery,
in two volumes, which went through four editions,
and was recast in a fifth as a System of Surgery
shortly before his death. He contributed the
article *' Surgery " in the then current issue of
the Encyclopa:^dia Britannica, and published many
papers on professional and social subjects. His
literary style was fluent, if somewhat diffuse, and
showed a distinct partiality for '*apt alliteration's
artful aid."
Professor Miller took a prominent part in social
and Church work in Edinburgh, and was an enthu-
siastic supporter of the temperance movement. For
many years he acted as Professor of Pictorial
Anatomy to the Royal Academy, and at the time
of his death he was Surgeon to the Queen in
Scotland.
THE CHAIR OF SYSTEM A TIC SURGERY 95
While still at the height of his power as a teacher,
and enjoying an extensive practice, which was not
confined to surgery, his health rapidly gave way,
and he died at Pinkhill near Edinburgh on June 17,
1864, at the age of fifty-two, having held the Chair
of Surgery for twenty -two years.
CHAPTER VIII
THE CHAIR OF CLINICAL SURGERY
The Chair of Clinical Surgery — Foundation of the Chair —
First Professor, James Russell — Position in the Royal
Infirmary — Friendship with Sir Walter Scott — His
Surgical Writings.
The premier surgical Chair in Edinburgh is that of
CHnical Surgery. It was erected in 1803 by King
George III., wlio endowed it with a stipend of fifty
pounds a year. It thus ante-dates the foundation
of a separate Chair of Systematic Surgery by
twenty-eight years. Bedside instruction had been
given in the Hoyal Infirmary ever since its founda-
tion, and the practical teaching in the hands of tlie
acting surgeons had reached a high standard of
efliciency. For some reason which it is difhcult
to exphiin, when the subject of chnical surgery
received academic recognition, the Professor who
was selected to Hll the chair — James Russell —
ceased to be an acting surgeon, and only enjoyed
the doubtful privilege of lecturing on the patients
under the care of otliers. Nor were the students
96
THE CHAIR OF CLINICAL SURGERY 97
required to attend the class. This unsatisfactory
state of affairs was remedied when Syme succeeded
Russell ; the managers allocated a number of
beds to the clinical Professor, and the Senatus
made attendance on the lectures compulsory for
graduation.
James Russell
(1755-1836)
The first incumbent of the clinical Chair was
James Russell, a leading member of the Incorpora-
tion of Surgeons, w^ho had for a number of years
before he was appointed Professor taught clinical
surgery to large classes in the Extra-mural School.
Through several generations his family had been
associated with the surgeons : his grandfather was
elected a member of the surgeon-barbers in 1721,
the year before the crafts were separated ; his
father was president of the surgeon-apothecaries in
1752. but relinquished his lancets and pestles to
take up the mantle of Adam Fergusson as Professor
of Natural Philosophy in Edinburgh University in
1764. James Russell joined the Incorporation in
1777 {22), and became President in 1796 {41).
Russell was one of the six surgeons selected by
the managers of the Royal Infirmary in 1800, when
the agreement of 1738, that all the members of the
Incorporation of Surgeons should be privileged to
7
98 THE EDINBURGH SCHOOL OF SURGERY
act on the staff, was abrogated. Much against his
will, for he is reputed to have been a man '* singu-
larly free from the jealousies and painful rivalries of
liis contemporaries," he was thus dragged into the
bitter controversy which arose between the managers
and the Incorporation at this time. It does not
appear that any serious objection was raised, either
on personal or professional grounds, to Russell, or
indeed to any of the selected six, but the Incorpora-
tion looked upon the action of the managers as a
breach of a solemn engagement which could only
be terminated by agreement betw^een the parties.
The personal factor in the dispute arose from the
fact that some of the most brilHant of the younger
surgeons, includhig the brothers John and Charles
Bell, w ere excluded from serving on the infirmary
staff, and surgical careers of exceptional promise
were thus summarily nipped in the bud.
The advent of Mr. Russell to his surgical charge
was the occasion of a stormy scene. At the
appointed hour he arrived to take over the patients
from his predecessor, Mr. Flanagan, but the latter
was not present. After waiting for half an hour
Mr. Russell commenced his duties, but no sooner
had he done so than Mr. Flanagan, accompanied
by John and Charles Bell and a number of other
surgeons and students, came in and angrily
upbraided him before the students and nurses for
THE CHAIR OF CLINICAL SURGERY 99
what he considered an act of discourtesy in not
awaiting his arrival. So animated did the discus-
sion become that the managers found it necessary
to send a peremptory message requesting the
visitors to withdraw and leave the consulting- room
** to the acting surgeons, for whom it is intended ";
and they further resolved that " if any member of
the College of Surgeons should hereafter be guilty
of such unwarrantable conduct he should be deprived
of the privilege of access to the hospital. "'^2' ^^ It
must be said that in no sense was Mr. Russell the
aggressor on this occasion, and that throughout he
behaved with calmness and dignity. The incident
is scarcely worth recalling except to illustrate the
feeling which the action of the managers aroused
amongst the surgeons at the time.
Mr. Russell's popularity with his fellows was in
no degree diminished, and when he was selected by
the Crown to fill the newly created Chair of Clinical
Surgery in the University, his appointment on
personal grounds met with their cordial approval.
The establishment of a Surgical Chair, and the
selection of one of their number to fill it, were
objects for which the College had long struggled,
and now their hopes had been fulfilled. But the
College had not been consulted in the matter, and
the action of the Crown appeared to them to
infringe what they considered their immemorial
100 THE EDINBURGH SCHOOL OF SURGERY
privilege of teaching as well as practising surgery
within the city. A protest was therefore framed
to safeguard their rights, but it does not seem to
have gone farther than a pigeon-hole in the office
of the Lord Chief Baron, to whom it was sent, " not
as an official paper, but merely to show the view^s of
the College."
By an arrangement which was singularly incon-
ducive to his success as a teacher, when he was
appointed Professor, Russell ceased to be an acting
surgeon to the infirmary. " He received, however,
the appointment of permanent consulting surgeon,
in which capacity he regularly accompanied the
attending surgeons in their visits, was cognizant,
therefore, of everything going on in their wards,
and, moreover, was in some measure answerable for
all acts of surgical interference which required to
be authorized by a consultation. Having thus no
hospital cases of his own, Russell nevertheless
undertook, and by the acting surgeons was allowed,
to discharge the delicate duty of lecturing on the
cases of others. In such a method, criticism, of
course, is impossible. Mistakes cannot be acknow-
ledged. Better methods cannot be suggested.
Even commentary must otlen tread on tender
ground, imless it consist entirely of approval, or at
least of assent. Thus the student will be led to
suppose that surgery is a sure and easy-going art,
THE CHAIR OF CLINICAL SUUGEUV 101
which either always attains its object, or, if not,
fails through no fault of its own or of the sur-
geon. Russell, however, piloted his way skilfully
among these quicksands, and gave much useful
information to well-attended classes."^' It is hard
to conceive of such a plan working smoothly, even
w^ith the exercise of the most consummate tact on
the part of the Professor, and we are not astonished
when a contemporary writer tells us that while
Russell *• lectured at large on the cases of the
ordinary surgeons, making remarks on their treat-
ment, they, especially Mr. Liston, made remarks
on him."
" The Professor was a tall thin gentleman of the
old school, who Wore a red wig, was always dressed
in black, with a white neck -cloth — not a tie, but a
choker of the ' Beau Brummell ' style (perhaps
that exquisite might have condemned it as * a
failure '). He indulged in a broad frill on his shirt-
breast. The tailed coat was then the ordinary
morning coat, so that was nothing conspicuous ;
but he considered it essential to maintain the style
of knee-breeches, silk stockings, and shoes, though
the muscular development of his lower limbs at
that time hardly warranted its continuance. He
lectured at 4 p.m. in a small room opening into
the consulting-room, from a sort of pulpit, the
benches immediately surrounding which were
102 THi: EDINBURGH SCHOOL OF SLUGERV
seldom crowded, owing to the retiring character of
the students of tliat period ; and, although he was
most poUte in pointing out the vacant spaces to
those he saw standing near the door, the same
unfortunate modesty prevented them availing
themselves of the kindly meant invitation. With
all his peculiarities, we ratlier venerate the memory
of the old gentleman, for such he emphatically
was."^^ This recollection of an old pupil may be
supplemented by another : '* But I must say he
was a somnolent lecturer, a quality whicli was
fomented by an evening class-hour, and betrayed
by an inveterate habit the Professor had of yawning
while he spoke, and continuing to speak while he
yaw^ned.""^
Among his ultimate friends Russell counted Sir
\Valter Scott, in whose Jour?ial ^'* are to be found
the following entries : Dec. 5, 1825 : " Supped at
Dr. Russell's usual party, which shall serve for
one wliile." Dec. 8, 1827 : *' We supped at Dr.
RusselFs, where the conversation was as gay as
usual." Mmrh 3, 1828: *' At Royal Society.
Also went after the Society to Dr. Russell's
symposium.'
A footnote to one of these entries explains that
" of the many Edinburgli suppers of this period
commemorated by Lord Cockburn, not the least
pleasant were the friendly gatherings in 30, Aber-
THE CHAIR OF CLINICAL SURGERY 103
cromby Place, the town house of Dr. James
Russell, Professor of Clinical Surgery. They were
given fortnightly after the meetings of the Royal
Society during the session."
After acting as Professor for thirty years, and
" by his own exertions securing for the teaching of
clinical surgery its rightful place in the curriculum
of surgical study," Russell relinquished the Chair
in 1833. Although he had reached the age of
eighty-one and suffered from many of the frailties
which accompany such advanced years —including,
doubtless, the old man's sense of being indispen-
sable— Russell made it a condition of his resigning
that his successor should pay him the sum of £300
a year for the period of his lifetime. James Syme
was elected his successor, subject to this condition
(p. 191).
Syme's strongest opponent for the Chair was
Robert Lis ton, who " positively, and in rather coarse
terms,' ^•' refused to agree to pay this retiring
allowance. The circumstances of the transfer gave
rise to an acrimonious discussion in the medical
Press, and afforded Robert Knox, the anatomist,
an opportunity of exhibiting that caustic rhetoric
of which he was such a master. In a pamphlet^^
he attacked what he called '' the most complete of
all jobs " — the " selling " of the Chair of Chnical
Surgery, and its '* purchase " by "a person who^
104 THE EDINBURGH SCHOOL OF SURGERY
tliough possessing \ cry respectable talents as a
surgeon and merit as a lecturer, ought to have
been allowed to grow a little older before being
placed in so responsible a situation." The matter
in itself was not so serious as Knox would have us
believe, and the transaction was in every respect
open, fair, and honourable. In its consequences it
certainly belied all his predictions, for the advent
and career of James Syme added to the reputation
of the P2dinburgh School of Surgery a lustre that
will never fade.
Russell died three years after his retirement, at
the age of eighty-foiu'.
His contributions to the hterature of surgery
were of no outstanding merit, but his published
works show that he was a painstaking and accurate
observer, although not a profound thinker.
At the Royal Society of Edinburgh in 1803 (48)
he contributed a paper on ** A new and hitherto un-
described X'ariety of Hernia " — what is now known
as the '' direct " form of inguinal hernia. It is
interesting to note that he inclined to the modern
opinion that this is to be looked upon as a form of
ventral rather than of inguinal hernia. '^^
His Practical Essay on a CotaDi Disease of the
Bones termed Xecrosis (Edinburgh, 1704) {oli) con-
stitutes one of the first attempts to give a complete
and detailed description of what nmst have been a
THE CHAIR OF CLIMCxAL SURGERY 105
common surgical affection. It lias the merit of
being original, and is evidently based upon a con-
siderable experience of the disease at the bedside
and an exhaustive study of the available patho-
logical material. He brings out the interesting
fact that although the condition w^as known to
Albucasis, who flourished in Arabia towards the
close of the eleventh century, it was not till 600
years later that Scultetus described a typical case
of it, and that e\ en such comparatively modern
surgeons as Cheselden, Gooch of Norwich, and
William Hunter were but imperfectly acquainted
with the nature and course of the disease. Ilussell's
own study is of value chiefly for the full and
systematic description he gives of the clinical course
of the disease both in its acute and chronic phases.
What he has to say on the causation of necrosis is
summed up in four short sentences, the gist of
which is that it seems ** to be connected with that
'state of the constitution which depends upon the
age of the patient, . . . and it more readily attacks
those who have a scrophulous taint in their consti-
tution." On the perennial question of the role of
the periosteum in forming new bone, Russell held
a definite opinion. '* To me it seems proved," he
says, " almost to a demonstration, that the original
periosteum has no share whatever in the formation
of the new bone." It must be confessed that his
106 THE EDINBURGH SCHOOL OF SURGERY
proof is far from convincing, and he has no more
satisfactory explanation of the formation of the
new case to offer tlnn that '* the pulpy mass which
extends from one portion of the bone to the other,
and is itself at last converted into bone, is entirely
a new creation, and has no dependence upon tlie
original bone or its periosteum." Almost inevitably
he invokes the intervention of that blessed thing
called '' inflammation," and unconsciously gropes
towards the modern doctrine of artificial hyperemia
when he says : " It w^ould doubtless be most con-
venient to possess the means of calling for so useful
an effort of nature, . . . but as yet this is an
expectation which we cannot indulge with confi-
dence." Yet the first line of treatment he suggests
in the early stages is the application of " emollient
poultices and warm fomentations." How^ often do
we write prose without knowing it !
Further evidence of Russell's powers as a clinical
observer is to be found in his Treatise on the Morbid
Affections of the Knee Joint (1802) {47), which
contains a remarkably clear and comprehensive
account of the clinical aspects of *' white swelling,"
in striking contrast to the involved and inconclusive
discussion of the treatment of the condition in which
it is diflicult to trace any guiding principle. The
symptomatology of *' moveable bodies " in the joint
is also well described, and the treatment logically
THE CHAIR OF CLINICAL SURGERY 107
criticized. He doubted the prudence of attempting
to remove them, especially when pedunculated, by
excision. ** Indeed, every case in which I have
known the experiment tried has terminated un-
favourably ; I can, therefore, with more confidence
condemn the practice as rash and injudicious." A
special chapter is devoted to the description of an
" uncommon disease " of the knee, of which Russell
had seen four or five cases, which in the light of our
modern knowledge appears to have been myeloma of
the head of the tibia.
The last of his published works. Observations on
the Testicles, is also the best. It was issued the
year he resigned the Clinical Chair (1838), and was
dedicated to the President and Fellows of the
Royal College of Surgeons, in acknowledgment of
his obligation to the College "for .the patronage
afforded to the Class of Clinical Surgery, and for
the facilities and support granted me to promote the
success of the undertaking." It differs from his
previous works in that he freely quotes the experi-
ences and opinions of other surgeons, and culls
many quaint and curious records from remote
sources. In style it is vastly superior to its pre-
cursors, and is a work which may still be read with
profit as well as pleasure.
CHAPTER IX
thp: chair of military surgery
Foundation — John Thomson, the P'irst Professor — Surgeon
to Royal Infirmary — Professor of Surgery of the Roval
College of Surgeons — His Surgical Writings — Professor
of Pathology — Sir George Ballingall, the Second Pro-
fessor— Contributions to Military Surgery — Abolition of
the Chair.
King George III., who founded the Clinical Chair
in 180.S, three years later extended his patronage by
erecting a Chair of Military Surgery, and endowing
it with a salary of one hundred pounds a year.
The need for such an institution was first pointed
out by John Bell, whose experiences amongst the
wounded sailors after the Battle of Camperdown
moved him to address a memoir*'^ to Earl Spencer,
then First Lord of the Admiralty, pleading for the
establishment of *' one great school of Military
Surgery," and sketching a plan on which it might
be organized. Of this memoir, which admittedly
paved the way for the I'oundation of the Chair, Sir
George Ballingall has said : '' With some cntlmsiasm
in the language, perhaps I may say some extrava-
lOS
THE CHAIR OF MHJTARY SURGERY 109
gance of expression, it breathes throughout a spirit
of patriotism and a feehng of sympathy with the
wounded seamen worthy of all admiration. "^^
Had action been taken promptly, the choice of the
Crown would doubtless have fallen on Bell, but
after the lapse of several years Dr. John Thomson
w^as nominated as the first incumbent of the Chair.
John Thomson
(1765-1846)
John Thomson was born at Paisley in 1765, and at
the age of eleven was bound apprentice to his father
as a silk-weaver for seven years (p. 84). In such
spare time as he could find he educated himself in
the hope that circumstances might some day enable
him to enter the profession of medicine, on which
he had set his heart. By the time his " seven long
years were out " he had acquired a considerable
knowledge of botany, natural history, and chemistry,
and with the aid of a friendly teacher had mastered
something more than the elements of the Latin
language. The doubts of his father having at
length been removed, he abandoned the weaver craft
and was apprenticed to Dr. White of Paisley, who,
recognizing the talents of the lad, took great pains
in directing his studies. In 1788 Thomson entered
the University of Glasgow, and a year later
migrated to Edinburgh, where he completed his
no THE EDINBURGH SCHOOL OF SURGERY
course. Thereafter he visited other schools and
spent some time in London.
As a pupil of Sir Everard Home, the disciple as
well as the brother-in-law of John Hunter, Thomson
early came under the spell of the Hunters, and
this connection did much to influence in more ways
than one the lines on whicli his career was subse-
quently developed. To it may be traced his solid
grounding in the principles of pathology which
formed the basis of his surgical teaching, and ulti-
mately landed him in the Chair of Pathology. He
has been bracketed with John xVbernethy and
Astley Cooper as among the chief expounders of
the Hunterian doctrines ; ** it is probably not
going too far to say that to the veneration in which
these three distinguished men held the opinions and
example of John Hunter, and to tlieir constant
references to him in their lectures, the propagation
of liis doctrines and their influence on English
surgery has been mainly owing. "^^
On his joining the College of Surgeons in 1703
(28), Thomson became eligible to act on the surgical
staff of the Royal Infirmary, and as he was one of
the six surgeons selected by the managers in 1800,
his clinical opportunities as an operator and teacher
were not interrupted, as were those of so many of
his contemporaries, by the new regime.
When the Professorship of Surgery of the Royal
THE CHAIR OF MILITARY SURGERY 111
College of Surgeons was founded in 1804, Thomson
was selected as the first Professor {39).
In 1806, when the Whigs came into office with
the Grenville party, the Chair of Military Surgery
was founded in the University, and Thomson, who
was '' a combative prominent Whig, and at one
time somewhat more than a Whig,"^'' was appointed
the first Professor {41). He continued, however, to
act as the Professor of the College of Surgeons till
1819, when, on the ground that the stress of work
involved in the dual Professorship was interfering
with his health, he requested the College to
recognize Mr. J. W. Turner as his assistant in
conducting the operative part of his course. This
request was granted, but two years later he
resigned the College Professorship, after having
held it for seventeen years, and Mr. Turner was
elected in his place. Thomson's success as a
lecturer may be judged by the fact that in 1815-
1816 as many as 250 to 280 pupils attended the
course.
Thomson held the Military Chair for sixteen
years, but it cannot be said that his success was
commensurate with his talents and opportunities.
The fact is, he was not bred a military surgeon, and
he did not know at first hand the conditions of work
in the field in time of war or even in barracks in time
of peace. According to Ballingall, his successor in
112 THE EDINBURGH SCHOOL OF SURGERY
the Chair, who had it on " the best of all authority "
— namely, from Dr. Thomson^s own lips — *' a main
object which he had in view in connecting the
Professorship of Military Surgery with his other
oflice, was the more complete and effective teach-
ing of surgery within the University. . . . By this
arrangement the course of military surgery was
conducted during the whole of the Peninsular War
in conjunction with, or as an appendage to, a more
extended course of lectures."
The only record we find of his experience in
actual warfare is contained in a Report of Observa-
tions made in the British Military Hospitals in
Be^i^ium after the Battle of Waterloo, which he
made to His Royal Highness the Duke of York,
Commander-in-Chief, in 1816 {51).
" Upon hearing of the result of tlie Battle of
Waterloo," he says, *' 1 immediately resolved to
proceed to Belgium, that I might have an oppor-
tunity of observing the medical and surgical con-
dition of the men who had been wounded in that
battle." He left [.ondon, accompanied by Dr.
Somerville, Principal Medical Officer in Scotland,
on the 4th, and arrived in Brussels on the 8th of
July, and was afforded every facility for observing
the wounded in the hospitals at Brussels, Antwerp,
a!id Termondc. In addition to studying the treat-
ment and progress of the wounded, he made a
THE CHAIR OF MH.ITAHY SdRGERV 118
series of sketches, which he subsequently presented
to his successor in the chair.
In 1822 (J7) he resigned the Professorship of
Military Surgery, and after failing to secure the
Chair of Medicine, rendered vacant by the death of
Gregory, he applied himself to the study of patho-
logical anatomy.
In 1831 {66) the Crown instituted a Chair of
Pathology in the University, and issued a com-
mission nominating Thomson the first Professor.
This was the third Professorship in Edinburgh
that Thomson had been the first to fill, which led
Robert Knox to refer to him as " the old chair-
maker."''^ This tendency to fill Scottish Chairs, if
not to make them, he appears to have transmitted
to his sons, for William became Professor of the
Practice of Physic in the University of Glasgow,
and Allen successively held the Chairs of Anatomy,
at Aberdeen, Institutes of Medicine, at Edinburgh,
and Anatomy, at Glasgow.
It was while he was Professor of Pathology that
Thomson made one of his most valuable discoveries.
Among the graduation theses submitted to him in
1832 was one on "Death from Inflammation,"'
bearing the name James Young Simpson, and so
impressed was he by its merits that he invited the
writer to become his assistant at a salary of £50
a year, '-and hence," says Simpson, ** I came to
Hi THE EDIxNBURGH SCHOOL OF SI RGERY
settle down — a citizen of Edinburgh." Simpson
took up obstetrics as his speciahty on the recom-
mendation of Thomson, and in after years spoke of
him as one *' to whose advice and guidance I owed
a boundless debt of gratitude. "^^
Thomson held the Chair of Pathology till 1842,
and died in 1846 (81).
The best known of Thomson's surgical writings
is his Lectures on Infhnnmatioii, Exhibiting a
Viexv of the General Doctrines, Pathological and
Practical, of Medical Surgery (Edinburgh, 1813)
{48). As if to justify the term *' medical surgery "
on his title-page, he begins with an essay on
the reciprocal relationship between medicine and
surgery, with the object of combating the growing
tendency of his day onc*e more to separate the two
arts in practice as well as in education. His
historical sketch of the evolution of the healing art
shows wide research, and is of permanent value.
For the rest, the work is an exposition of John
Hunter's views on inflammation and inflammatory
diseases, and manifests a wide acquaintance with the
literature of the subject rather than an extensive
practical experience. It has a merit which Hunter's
own writings sadly lacked of being clear, consecu-
tive, and comprehensible.
His Report of Observations made in the Bintish
Mi lit aril Hospitals in Belgium after the Battle of
THE CHAIR OF MHJTARY SURGERY 115
Waterloo (Edinburgh, 1816) (51) is chiefly of value
for the Appendix, *' Some Remarks upon Ampu-
tation," whicli contains a complete history of the
operation from the earhest times, the result of
extensive literary research. Thomson's writings on
Vainoloid and Small Pace, on which his reputation
as a clinical observer chiefly rests, and his Biogi^aphy
of William Cullen,^'^ do not concern us here.
Sir George Ballixgaix
(1786-1855)
When Dr. Tiiomson resigned the Chair of
Military Surgery, three candidates were nominated
to the Secretary of State as his successor. Two
were put forward by the College of Surgeons : Dr.
David Maclagan, " an active and eloquent citizen
who made himself useful in many public positions
in Edinburgh,!' and who had seen much active
service as a physician to the forces in the Peninsular
War. Not the least of his public utilities was the
family of gifted sons he left to adorn high positions
in the medical profession and in the Church. One
became Archbishop of York, another was the
beloved Sir Douglas, the Professor of Medical
Jurisprudence in Edinburgh till 1897, and others
served the State in the army and in civil practice.
Dr. Maclagan had the distinction, which was shared
IIG THE EDINBURGH SCHOOL OF SURGERY
by his son, Sir Douglas, of being elected President
of both the Royal Colleges in Edinburgh.
The other member of the surgeons proposed was
George Ballingall, who began his career in the army
as surgeon to the 38rd Regiment of Foot, after-
wards the 1st Royals, and subsequently was in the
Duke of Kent's regiment. He saw service in India
and in other parts of the East, and was present with
the army in Paris in 1815.
The third candidate. Dr. Borthwick, was not a
member of the College, and received his nomination
by family influence through the Town Council.
The choice of the Crown fell upon Ballingall, and
he was installed in the Chair in 1822 (.^6').
The task before him was not an easy one. His
predecessor had never taken the subject of MiHtary
Surgery quite seriously, and his conduct of the
Chair had rather encouraged the idea that the course
should consist merely of a series of lectures on the
subject of gunshot wounds. No lecture room or
museum had been assigned to the class within the
University. Moreover, the times were times of
peace, and the country, heartily tired of war, was
turning its attention to tlie reconstructions and
economies which a long and expensive campaign
liad rendered necessary.
His experience in India, at I'rince of Wales
Island, at Java, and with the army in France, had
THE CHAIR OF MILITARY SURGERY 117
convinced Ballingall of the need for a complete
course of instruction, not only on the injuries
incident to warfare, but also on the diseases to
which European troops are specially liable abroad,
and on the general hygiene of camps. He had
found the gentlemen educating for the East India
Company's service and those serving with Her
Majesty's regiments in India in special need of
such instruction, and it was uphill work to persuade
those in authority of the importance of reform,
xifter many disappointments, he received the aid
and encouragement of the East India Company to
the extent that they required candidates for their
service to attend a course of military surgery. In
1829 the Royal College of Surgeons of Edinburgh
revised their regulations so as to permit of candi-
dates for their diploma taking a course of military
surgery in lieu of one of the two courses of surgery
prescribed. This action of the College was speedily
followed by a corresponding movement on the part
of the heads of the medical departments of the
Navy, the Army, and the Ordnance giving the
same option to candidates for their respective
brandies of the service. In response to the perse-
vering efforts of Ballingall, strongly supported by
the Lancet, the Secretary of War included in
the armv estimates for 1854 a vote of £400 for the
118 THE EDINBURGH SCHOOL OF SURGERY
endowment of additional Professorships of Military
Surgery in London and in Dublin.
Into the work of his own Chair he threw him-
self with equal ardour, and for over thirty years he
maintained a high standard of efficiency in teaching
his subject. His Outlines of Military Surgery,
which ran through four editions, contained the
substance of his lectures, ttnd, in addition to much
historical matter, furnished a lucid exposition of
the principles and practice of military surgeiy based
on a sound knowledge of the general surgery of his
day. As surgeon to the Royal Infirmary he was
kept in touch with clinical work, and a selection of
the lectures he delivered in association with the
Professor of Clinical Surgery shows him to have
been a shrewd observer and a graphic teacher. He
was the first to suggest the administration of
chloroform as an aid to the detection of feigned and
fictitious diseases.
His Practical Observations on the Diseases of the
Europeaji Troops in India (Edinburgh, 1823) (37)
was highly esteemed in its day. Another result of
his activities in India may still be seen, in the
museum of the College of Surgeons, in the form
of tlie skeleton of an elephant, whicli he prepared
and presented to his former master. Dr. Barclay,
the anatomist, oi' whom he wrote a short biography
prefixed to his Introductory Lectures (1827).
THE CHAIK OF MILITARY SURGERY 119
Ballingall received the honour of knighthood on
the occasion of the accession of King WiUiam IV.
in 1830 {Jt4), He has been described by a contempo-
rary as a man of " bright face, well-set figure, and
miUtary bearing," who was "unselfish and ready to
help younger men," and who " bad the esteem of
all his professional brethren, and was generally
popular."
He died suddenly at Altamont near Blairgowrie
in December, 1855, at the age of sixty-nine.
Before a successor was appointed, Mr. Syme
addressed a letter to Lord Panmure, then Secretary
of State for War, pointing out that the circum-
stances under which the Chair of Military Surgery
was founded in 1806 had entirely altered — notably
by the establishment of the Chair of Systematic
Surgery in the University, which provided for the
teaching of the purely surgical aspects of the army
doctor's work. He submitted that the proper duty
of a Military Professor should be to explain " the
arrangement of hospitals, the position of camps,
the effects of diet and exposure, the admission of
recruits, the invaliding of soldiers, the management
of wounded men, the keeping of records, the
diseases of climates and seasons, with their preven-
tion and remedy, and all the other peculiarities of
a military and naval life, in health as well as in
sickness," and that these duties could only be
120 THE EDINBURGH SCHOOL OF SURGERY
efficiently performed in a large military hospital by
actual demonstration. He advised the abolition of
the Chair as *' a useless incumbrance." His sugges-
tion was acted upon, and the Chair of Military
Surgery was abolished in 1856.^*^
CHAPTER X
SOxME SURGEONS OF THE EXTRA-MURAL
SCHOOL
The Extra-mural School : Its Origin, Growth, and Influence
— Clinical Teaching — Extra-mural Surgeons — John
Lizars — William Fergusson — Richard John Mackenzie.
In tracing the growth of the Edmburgh Medical
School it has been shown that not only did it take
its origin in the ancient craft of barber-surgeons,
but that for nearly two centuries and a quarter it
was carried on under the aegis of the Incorporation
of Surgeons and the College of Physicians by
teachers who had no official connection with the
University. It was not until 1726 that the Faculty
of iMedicine had what the historian of the Univer-
sity, Principal Sir Alexander Grant,^-^ called ''its
quasi-fortuitous beginning" by incorporating as
Professors a number of the *' private lecturers."
Those who were not thus drawn within the walls
of the University continued to conduct their classes
as extra-academical or extra-mural lecturers in a
x'ivalry more or less friendly to the Professors,
121
12J2 THE EDINBURGH SCHOOL OF SURGERV
This dual grouping of teachers has ev er since been
one of the characteristic features of the Scliool.
" One of its greatest advantages," says Grant, '* has
been that the University has continued to be
surrounded by extra-mural rivals, who have kept
its Professors up to the mark, and sometimes
eclipsed them, and who have always been in train-
ing to HU up the ranks of the University whenever
vacancies occurred."
In another direction the extra-mural teachers
have played an important part in guiding the des-
tinies of the medical school. Free from tlie bonds
of statutes and ordinances, tliey have always been
able to lead the way in developing instruction in
special branches of knowledge, and many of the
specialities that are now represented within the
University originated in the Extra-nun*al School.
Special courses of instruction were given by extra-
mural lecturers in Mental Diseases, Neurology,
Diseases of the Ear, Throat, and Nose, Dermatology,
Diseases of Children, Applied Anatomy, Operative
Surgery, and Tropical Diseases for many years
before lectureships in these subjects were founded
in tlie University.
At first the teaching was carried on in private
premises or within the precincts of the College, but
as the number of students increased, and more
teachers entered the lists, the lecturers banded
SURGEONS OF THE EXTRA-MURAL SCHOOL 123
themselves together in groups and conducted
a number of classes in co-operation, each group
occupying a separate building. Thus there arose
a number of rival schools within the School —
** Surgeons' Square," *' Argyll Square," ** Brown
Square," " Minto House," and in more recent days
** Park Place " and " The New School " — each with
its band of lecturers and its loyal following of
students.
When the Royal Infirmary was founded the
managers " resolved to spare no pains in cherishing
the medical school, as far as the hospital could serve
that purpose ; and, foreseeing that its interest
would soon be interwoven with that of the Univer-
sity, they resolved to adopt every measure that
could tend to facilitate medical education and to
render it complete. They therefore permitted all
students, upon paying a small gratuity, to attend
the hospital that they might have all the benefit
that could be derived from the practice of the
physicians and surgeons." ^^
The clinical teaching as conducted in the
infirmary by the Professors and certain other
members of the honorary staff outside the Univer-
sity is described by Arnot^^ as '' in some measure
peculiar to itself." In wards set apart for the
purpose, under Professors in the University, or
other physicians and surgeons sufficiently quahfied
124 THE EDINBURGH SCHOOL OF SURGERY
for the office, " the most minute attention is paid
to every circumstance of the disease, . . . and
every industrious student keeps a journal for him-
self of the reports taken daily from the mouth of
the physician, in wliich are accurately related all
the effects resulting from the use of medicine . . . :
they have, further, the advantage of hearing the
grounds of this practice afterwards fully illustrated
and explained in lectures." In the surgical wards
certain of the '* dressers " were told off for the
purpose of bleeding patients, and to assist the
** visiting cupper of the hospital." These wore blue
checked aprons " with a pocket and sleeves," in
contrast to the white linen aprons worn by the
surgeons. Among the duties of the surgeons was
'' to attend to the instruction of the dressers ; to
improve them as far as possible in accurate, neat,
and even elegant dressing ; to examine their reports
from time to time, and to subscribe in the register
their approbation or dislike of the reports every
week."-^ For long only the senior acting surgeon
had the right, along with the Professor, of delivering
clinical lectures, but gradually the privilege was
extended until all the surgeons enjoyed it.
The importance of the Extra-mural School as a
factor in medical education was recognized by the
Town Council, who, as the patrons of the Univer-
sity, in 1842 issued statutes allowing University
SURGEONS OF THE EXTRA-MURAL SCHOOL 125
students to take a certain number of their classes
with the extra-mural teachers. To this proposal
the Senatus demurred, and appealed to the Courts
for support, but the point was finally settled against
them by the House of Lords in 1847. This con-
cession had the effect of increasing the number of
extra-mural teachers, and among those who were
thus stimulated to take to lecturing was Mr. Lister,
described in the medical Press of the day as " a
former clerk of Mr. Syme's and said to be a protege
of that distinguished surgeon. "^•'^ In 1895 the
Extra-mural School was reorganized and consoli-
dated as *' The School of Medicine of the Royal
Colleges." The privilege of attending the extra-
mural teachers has gradually been extended, until
iiow^ one-half of the classes required for University
graduation may be taken in the School.
The fears of the Senatus that the opening up
of the extra-mural classes to University students
would militate against the interests of the Univer-
sity proved gioundless. On the contrary, both
sections of the medical school received benefit.
The most distinguished periods in the history of the
Medical Faculty have alw^ays coincided with the
periods during which the teaching power of the
Extra-mural School was at its highest. It would
be idle to speculate as to which body has set the
standard, but to each the efforts of the other acted
126 THE EDINBURGH SCHOOL OF SURGERY
as a stimulus to maintain a standard which neither
alone would have reached. Where one has been
weak, the other has supplied the defect, and the
healthy riv^alry between the two has invariably been
beneficial to both. The Extra-mural School has
ever remembered that its success depends on the
prosperity of the University ; the University has
sometimes forgotten how much of its reputation
it owes to the Extra-mural School. From its ranks
the Professoriate has been largely recruited, and
many of the names that have made the I ^niversity
of Edinburgh famous were transferred from the
lists of extra-mural teachers. In surgery these
include the first Monro, J. ^V. Turner, John
Thomson, Sir George Ballingall, Sir Charles Bell,
James Miller, James Kussell, James Syme, and
Joseph Lister, and the other departments of medi-
cine have been no less worthily represented.
The fame of the Edinburgh Medical School was
never higher than in the fifty years preceding the
opening of the Listerian era, and to the surgeons
of the Extra-mural School of that period — Robert
Liston, John Lizars, \\'^illiam Fergusson, Kichard
J. Mackenzie, and James Syme — it owed no small
share of its reputation.
SURGEONS OF THE EXTRA-MURAL SCHOOL 127
John Lizars
(1794-1860)
Although the name of John Lizars-^ is less familiar
now than that of most of his contemporaries, in his
own day he attained to considerable prominence,
as much perhaps from his friendly association with
such great men as John Bell, William Fergusson,
and Robert Liston — and, be it said, from his life-
long antagonism to an even greater, James Syme
— than from his own surgical achievements, notable
as these were.
Following the Edinburgh tradition, Lizars
entered surgery through the portals of anatomy.
These were the halcyon days of the "private
lecturers '* on anatomy in Edinburgh. The teach-
ing of the subject within the University under the
third Monro left much to be desired, and the
students, who were numerous, were driven to seek
instruction elsewhere. In the Extra-mural School
they had ample choice of accomphshed teachers :
William Cullen (grand-nephew of the great Dr.
Cullen), elegant, painstaking, and abreast of the
times — *'he gave some special lectures on the
stethoscope, then new in Edinburgh 'V John Aitken,
who combined the teaching of physiology with
anatomy and surgery ; and, greatest of all, that
tragic personality, Robert Knox, whose profound
128 THE EDINBURGH SCHOOL OF SURGERY
knowledge of morphology '* invested the subject of
human anatomy with a new interest," and whose
*' wonderful command of the most powerful and
felicitous language," combined with wealth of caustic
rhetoric, rendered his lectures most attractive.
Lizars was not wanting in confidence when lie
entered into competition with such rivals, but his
courage was justified, for his class-roll showed an
average attendance of about 1 50 students.
\Mien in 1826 the practice of dissection was
made compulsory on all candidates for degrees,
the difficulty of obtaining sufficient anatomical
material to meet the demands of something
approaching a thousand students threw a serious
responsibility on the teachers. The straits to
which they were driven need not be dwelt upon
here. The story of the evil traffic which led to
the desecration of the local churchyards, and worse,
forms the most sordid episode in the annals of the
Edinburgh Medical School, but it only touches
indirectly on the history of the surgical school, and
on that plea may be passed from.
Tlie scarcity of subjects for dissection forced
certain teachers to tall back upon the use of
pictures to illustrate their lectures and demonstra-
tions. In so far as they rehed upon tlie admirable
series of engravings which had been produced under
the guidance of the Monros, the Bells, Fyfe,
SURGEONS OF THE EXTRA-MURAL SCHOOL U^
Gordon, Barclay, and Knox, this practice was all to
the good, but it was otherwise when they covered
the walls of their class-rooms with crudely drawn
and brightly coloured diagrams, " a kind of mural
art, neither natural nor aesthetic . . . huge mis
representations of nature," as Knox disdainfully
called them.'"^
Lizars was one of the worst offenders in this
respect, and he has been described as a draughts-
man-anatomist, who favoured alphabetic mnemonics
and puerilities of learning, and dealt uncommonly
in gaudy colours and big pictures "^^ — a type of
teacher unfortunately not yet extinct.
His aim, however, was to become an operating
surgeon, and he gave up the teaching of anatomy
and began to lecture on surgery alone. When
Mr. Turner resigned the Professorship in the
College of Surgeons in 1831, Lizars contested the
vacancy against Syme, and, thanks to the influence
of Liston and Fergusson. was elected, but only by
the narrow majority of one vote. Syme could
afford to lose the appointment, his position as a
surgeon and a teacher being already well assured,
but to be beaten by Lizars was a sore blow to his
pride. Between the two there arose a bitter
animosity, which cropped up repeatedly in after
years. Lizars has been described as **a Nimrod
famous for * going at anything,' but frequently
130 THE EDINBURGH SCHOOL OF SURGERY
coming ofFhis horse involuntarily." This was usually
his fate when he engaged in his favourite sport of
" going at " Syme. On one occasion he had to pay
costs and damages awarded by a jury ''for false
and calumnious statements " relative to Syme's
practice. Later he had to withdraw his work on
Practical Surgerij in order to expunge a similar
statement. In the protracted controversy regarding
the merits of Syme's operation of external urethro-
tomy time has given the verdict against Lizars.
The breach between the two was never healed,
but by a curious stroke of irony it was Syme who
left on record the highest testimony we have to
the surgical foresight and acumen of Lizars. Speak-
ing, in 1865, on the operation of ovariotomy, Syme
disclaimed for Edinburgh such '' honour of priority "
as attached to its having first been performed there,
and to emphasize his derision of the originator of
the operation he added : "It was brought forward
by the same person wlio had proposed to remedy
hypertrophy of the heart by blowing air into the
pericardium, to puncture the brain in acute hydro-
cephalus, and to treat enlargement of the prostate
by cutting out the entire gland." This person was
John Lizars.
He resigned his appointment of Professor of
Surgery to the College in 1839, and the opportunity
was taken to abolish the Chair.
SURGEONS OF THE EXTRA-MURAL SCHOOL 131
Lizars is said to have been " bold and fearless,
almost reckless, as an operator," but " his know-
ledge of after-treatment was scarcely equal to his
operative dexterity." His most famous operation
was the ligation of the innominate artery for
aneurysm, which he carried out for the first time
in Scotland, with the assistance of Fergusson, in
1837 {4Sy^
He w^as the first in this country to perform ovari-
otomy, and a reviewer of his Obsei^vations on
Ecvtraction of Diseased Ovaria'^ considers his
record of two successful cases out of four very
satisfactory.
In 1826 he pubhshed"^ a report of the first
operation of removal of the maxilla for sarcoma
performed in Scotland. In addition to a series
of Anatomical Plates he published a System of
Practical Sv/rgery, which was highly thought of
in its day, and as appendices descriptions of the
Operatio?i for the Cure of Squinting, and Opera-
tion for the Cure of Club-foot. His Practical
Observations on the Treatment of Stricture of the
Urethra and Fistula in Perineo (Edinburgh, 1851)
{57) is an elaborate attack on Mr. Syme's operation
of external urethrotomy, and is only interesting as
an example of the surgical polemics of the times.
Lizars died of cerebral haemorrhage on May 21,
1860, at the age of seventy-four.
132 THE EDINBURGH SCHOOL OF SURGERY
SiK AVn.TTAM Fergt'sson, Bart.
(1808-1877)
** I ha\ e great pride in considering myself of the
Edinburgh School." This was said by Sir William
Fergusson when, after more than a quarter of a
century of strenuous work in London, he stood at
the head of his profession in the metropolis, un-
rivalled as an operator and revered as a man.
Edinburgh reciprocated the compliment, for she
had always felt a peculiar pride in Fergusson's
brilliant career. His enduring contributions to the
progress of surgery were mostly made while he was
in London, but they shed on the Edinburgh School
a glory that was not entirely reflected, for their
inception could usually be traced to the dissecting-
rooms of Knox at Surgeons' Hall, or to the
operating-theatre of Liston, Lizars, and Syme in
the old Royal Infirmary.
A native of Prestonpans, East Lothian, educated
at the High School of P^dinburgh, Fergusson
entered the University originally with the object
of following tlie law, but life in a lawyer's office
did not prove congenial, and he soon fell in with
his father's desire that he should study medicine.
At the age of seventeen he became a pupil of
Robert Knox, then at the height of his fame as a
teacher of anatomy. Knox was not long in recog-
SIR WJLIJAM FERCU'SSON, I^ART.
{From a tnczzolint by F. Joubcrt (.1874), after R. Leh/iiann, in the Author s Collection.')
SUllGEONS OF I'HE EXTHA-MUKAL J5CliOOL 1^5
nizing the capacities of his young pupil, and, in-
spired and encouraged by his master, Fergusson
soon developed a genuine enthusiasm for anatomy.
His days, and often his nights, were spent in' the
dissecting-rooms, and before he was twenty he
was acting as Knox's demonstrator. ** Tall, lithe,
handsome, with an animated, cheery countenance,
a bright eye, and manly bearing," he shared in the
remarkable popuhirity of his chief as a teacher.
Unfortunately, he could not escape sharing also in
the opprobrium which at that time attached to
Knox, and indeed to all who were responsible for
providing the material fbr dissection. In this
matter, how^ever, Fergusson's record is clear, for,
while he did not lack zeal in maintaining the supply
of subjects, there is nothing to show that he even
suspected the awful sources from which some of them
came. If lie profited by his association with Knox,
he also suffered, but he never winced, and when
dark days came to his master he proved his faithful
friend and generous helper.
In the infirmary lie was fascinated by the manual
dexterity of Listen, Lizars, and Syme, and he
deliberately set himself to emulate their manipula-
tive skill. He cultivated his natural aptitude for
mechanics by making such instruments and appli-
ances as he required, and he greatly pleased Knox
by presenting him with a complete dissecting-case
1,34- THE EDLNBURGH SCHOOL OF SURGERY
made and furnished by his own hands. To train
himself in the use of his scalpel he laboriously made
those wonderful dissections of the bloodvessels of
the hand, foot, and head which are still amongst
the most treasured preparations in the museum of
the Royal College of Surgeons of Edinburgh. It
is said that he even practised the violin, less to
gratify his love of music than to gain the delicacy
and accuracy of touch demanded by that instru-
ment.
A new departure in the teaching of anatomy was
initiated in Knox's rooms in 1829, w^hen Fergusson
began his course of demonstrations on '* Surgical
Anatomy," an aspect of anatomical study which
specially appealed to him, and which he was in
the habit of tracing to the introduction of the
llunterian operation for aneurysm. He made
special dissections of the different surgical regions
of the body to illustrate the operations most
frequently performed in those days, and these he
demonstrated to small sections of the class seated
round a table. It is difKcult to imagine a more
perfect means of arousing in the student an intelli-
gent interest in practical anatomy and of concen-
trating his attention on essentials.
In 1829 (21) Fergusson was admitted a Fellow
of the Royal College of Surgeons of Edinburgh,
and two years later he became surgeon to the
SURGEONS OF THE EX rRA-MUHAL SCHOOL 155
Royal Dispensary. Here he found opportunities of
practising his art, and amongst other operations of
importance he tied the subclavian artery, an opera-
tion that had then been done only twice before in
Scotland, once by Wishart and once by Liston.
Gradually his increasing practice and hospital
duties compelled him to abandon to a great extent
his work in the dissecting-rooms.
In 1839 [31) he w^as appointed surgeon to the
Royal Infirmary in succession to Liston, and there
he obtained a wider scope for operative work. In
1840 a vacancy occurred in the Chair of Surgery at
King's College, London, and, on the advice of Sir
Astley Cooper, Fergusson w^as invited to till it.
The main consideration that induced him to
migrate from Edinburgh was undoubtedly the
fact that the Chair carried with it the surgeoncy to
the hospital, and as the tenure of his appointment
in the Royal Infirmary was only for five years, with
a possible extension of two years more, he foresaw
that he w^ould have to relinquish his hospital work
just when he was becoming most useful. His
departure from Edinburgh w^as a cause of sincere
regret, for it was universally recognized that the
School was losing one of its most distinguished
members.
Fergusson could not expect to escape the tradi-
tional period of struggle that awaits the young
VH) THE EUINBUUGH SCHOOL OF SURGERY
Scot who seeks professional fortune in London, but
circumstances conspired to lighten it for him.
Within a few years of his arrival, Astley Cooper,
Callaway, Aston Key, and Robert Liston passed
from the scene, and other surgeons of note retired
from practice. A fair field was thus opened for
him, and his professional skill, no less than his
personal (jualities, enabled him to take full advan-
tage of his opportunities. He was elected an
Honorary Fellow of the Royal College of Surgeons
in 1844- (.>6'). It is told that his appointment to the
post of Surgeon-in-Ordinary to H.R.H. the Prince
Consort, in 1849, came about in this way. Sir
.James Clark was consulted with reference to the
claims of several surgeons of distinction whose
qualifications were under discussion, when the
Prince clinched the matter by saying, *' Well,
Clark, the question is— Supposing I had to have my
leg amputated, who is the best man to do it ?"
" Why, Fergusson, by all means," said Sir James.
** Then," replied the Prince, ** he shall be my
surgeon." In 1855 {47) he was appointed Surgeon-
Extraordinary, and, in 18()7 (^•'^), Sergeant-Surgeon
to the Queen. The previous year a baronetcy had
been conferred on him ** in consideration of distin-
guished merit and eminence as a surgeon."
His appearance at his prime — " connnandingand
dignified in person and bearing, with handsome
SURGEONS OF THE EXTRA-MURAL SCHOOL VM
features and a large dark eye, soft and benevolent
in its expression" — is preserved for us in the portrait
painted by Rudolph Lehmann, and reproduced in
mezzotint by F. Joubert. He died from Bright's
disease on February 10, 1877 (6\9), in London, and
was buried at West Linton, near his beloved
Scottish home at Spittlehaugh.
No small part of Fergusson's reputation rests on
his remarkable dexterity as an operator. Deliberate
yet rapid, concentrated on his object, and avoiding
all display in accomplishing it, every step in proper
order and carried out in silence, the impression left
on the mind of the spectators was that even the
most ditiicult and complicated operation w^as per-
fectly simple and easy of execution. All contem-
porary evidence goes to show that, after the death
of Liston, he was unrivalled as an operator in
London. It is sufficient testimony that Sir James
Paget, in his famous Hunterian oration delivered
the day before Fergusson was carried from I^ondon
to be laid at rest in his native Scotland, spoke of
him as " the great master of the ;irt, the greatest
practical surgeon of our time." In his operations
he employed few instruments, and these were of
the simplest Some, devised by himself, are still
in everyday use, and have made his name familiar
to succeeding generations of students. Fergusson's
lion forceps, his angled bone pliers, his mouth gag,
\m THE EDINBLKGH SCHOOL OF SURGERY
and his clefl-palate knives and needles are amongst
tlie most purpose-like implements in the surgical
armamentarium. Others, like his lithotrite and
certain kinds of specula, formed the models on
which the modern patterns that have superseded
them were designed.
As a teacher he impressed his pupils more by
his example than by his precepts. Reticent and
wanting in fluency, it has been said that he
failed to impart the results of his vast experience
and knowledge.'"
Fergusson's contributions to the advance of
surgery were many and varied, if not strikingly
original or revolutionary. To priority of invention
he seldom laid claim — indeed, he was singularly
generous in acknowledging what he owed to his pre-
decessors as well as to his contemporaries — but he
is entitled to the credit of introducing many im-
provements in operative technicpie that have stood
the test of time. His attention was early directed
to the congenital deformities of the mouth, his first
formal operation, performed while he was still a
demonstrator with Knox, being for hare-lip. About
the same time he had an opportunity of studying
by dissection the muscular apparatus in a case of
cleft palate, which led him to improve upon the
classical operation of Roux by dividing the levator-
palati and palato-pharyngeus muscles before bring-
SURGEONS OF THE EXTRA-MURAL SCHOOL 139
iiig together the edges of the soft palate. The
improvement in the results which followed this
procedure at once led to its general adoption, and
Fergusson himself was able to claim 129 successes
out of 184 cases operated upon. For this particular
operation he did not use an anaesthetic, as he con-
sidered it '' absolutely requisite to have the patient
conscious, so that he may facilitate the steps in a
variety of ways." Although he excelled in the
performance of lithotomy — the crucial test of
surgical dexterity in those days — he was a strong
advocate of the crushhig operation, and the in-
genious form of lithotrite he devised did much to
simplify this operation and to make it popular.
" Thanks to the skill, labour, judgment, and
forcible example of the Professor of Clinical Surgery
in the University of Edinburgh, excision of the
elbow-joint has now become ' a great fact ' in
surgery," said Fergusson in 1867, and the revival of
excision of joints for disease, initiated by Syme,
had no more enthusiastic supporter than Fergusson.
His advocacy of " conservative surgery " — it was he
who coined the term — did much to impress upon
his surgical contemporaries the possibilities of saving-
useful limbs by excision, and so avoiding the
"opprobrium of surgery" which lay in ampu-
tation.
The improvements he effected in operations on
liO TilE KinNliUHGH SCHOOL OF SURGERY
the jaws, particularly for malignant disease, have
become the standard procedures of to-day.
In the last of the lectures he delivered before the
Royal College of Surgeons of England in 18G.5,^*
Fergusson lifted the veil and revealed to us some
of the secret sources whicli made him the surgeon
that he was. It is too full of good things to stand
condensing, and might serve as the articles of faith
of all aspiring surgeons.
Richard James Mackenzie
(1821-1854)
Although he died at the early age of thirty-three,
a variety of circumstances combined to secure for
the name of Richard James Mackenzie a place all
its own in the annals of the Edinburgh School of
Surgery.'"'^ His singularly attractive personality, his
accomplished w^ork as a surgeon and the promise
it warranted of still greater attainments, and the
tragic circumstances of his death in the service of
his country, called forth the aflection and admiration
of his contemporaries, and have passed into a tradi-
tion among his successors.
From his boyhood he had set his heart upon being
a doctor, and when he left the Edinburgh Academy
at the age of seventeen, his father bound him
apprentice to Dr. Adam Hunter, under whose
tutelage he derived all the benefits inherent to the
SURGEONS OF THE EXTRA-MURAL SCHOOL 141
apprenticeship system of medical education. His
natural leaning towards surgery was confirmed and
the direction of his future career determined when
he became resident-clerk in the Royal Infirmary
under Professor Syme.
Early in the forties he obtained his diploma as a
surgeon, and graduated in medicine, his niaugural
thesis being entitled Practical Observations on
Injuries of the Head. Two years were then spent
in visiting the medical schools in London and on
the Continent. He studied in the surgical chnics
at Hamburg, Berlin, and Vienna, but the work of
Velpeau, Malgaigne, and Roux in Paris appears to
have attracted him most.
On his return to Edinburgh in 1844 (^3) he be-
came a Fellow of the Royal College of Surgeons, and
after being for four years in practice, he w^as elected
an assistant surgeon to the Royal Infirmary. The
following winter he began to lecture on systematic
surgery in the Extra-mural School at Surgeons'
Hall, and a year later had the good fortune to be
promoted acting-surgeon to the Infirmary at the
early age of twenty-nine. He made the best
possible use of his exceptional opportunities, and
by dint of hard work in the course of less than five
years made for himself a position in the School and
a reputation among the public such as had seldom
been attained by one of his years.
142 THE EDINBURGH SCHOOL OF SURGERY
It was a fortunate circumstance that Mackenzie
entered upon his surgical career as a pupil of James
Syme, for the bent of his mind rendered him
peculiarly susceptible to the influence of such a
master. He was essentially ** practical " in his
outlook on surgery, and " he had a clear head, and
abounded in that common sense which seems to
form so large and necessary an element in the
character of a surgeon." Although capable of
thinking for himself, and not wanting in originality,
his published writings show to what an extent his
interests and his practice were influenced by his
association with Syme. His surgical career was
not a long one, but, as Liston has said, *' years are
not the measure of experience," and the record of
surgical work which Mackenzie left behind him
makes up in quality for what it may lack in volume.
It reflects the current views on various questions
which at the time bulked largely in the surgical
mind.
His first published paper was the report of a
successful operation for ligation of the subclavian
artery for lutmorrhage from the axillary, and he
made various other contributions on the surgery
of the bloodvessels. The great controversy with
regard to the merits of Syme's operation of external
urethrotomy was raging in Mackenzie's day, and
he took part in it on the side of Syme. The first
SURGEONS OF THE EXTRA MURAL SCHOOL 143
patient on whom he performed the operation died
of pyasmia, but this had no effect in shaking his
confidence in the merits of the operation, which
he repeatedly performed with satisfactory results.
Like his master, whose methods he followed, he
was remarkably successful in plastic operations for
the restoration of the lips, nose, and cheeks, as the
illustrations which accompany his papers abund-
antly demonstrate.
In 1853 (5^) he published an important paper on
excision of the knee-joint, an operation which had
long fallen into disuse, but was then being revived.
Mackenzie was deeply interested in this subject,
and went so far as to travel to the island of Jersey
to see some of the series of fifteen cases operated
upon by JNlr. Jones there, with success in fourteen
— a remarkable record in these days. Early in the
sixties a London surgeon, Mr. Price, assistant to
Sir William Fergusson, collected the records of
250 cases, which showed the same mortahty as in
amputation of the thigh, and it was seriously
debated which operation was likely to have the
higher mortality, the majority inclining to the
belief that excision would prove the more fatal.
His most important contribution to surgical
practice, however, was the modification of Syme's
amputation at the ankle by an internal flap, which
came to be known as '' Mackenzie's amputation,"
144 THE EDINBURGH SCHOOL OF SURGERY
It consists in cutting a flap from tlie inner aspect
of the foot, and he did not propose it as a substi-
tute for Synie's operation, " in the majority of cases
the preferable proceeding/' but as one which is
available to avoid amputation in the leg, wlien the
condition of the soft parts precludes the possibihty
of forming a heel-ttap.
The crisis of Mackenzie's life came in J 854.
News came through that surgeons with liospital
experience were wanted by our army in the Crimea,
and he offered liis services. His friends realized the
risks he was taking, but he himself was eitlicr blind
or oblivious to them, and in the best of health and
spirits set out on May 13 for Turkey, where he
arrived on June G. The Earl of Aberdeen, th^n
Prime Minister, brought him under the notice of
Lord Uaglan, who posted him to the Cameron
Highlanders (the old TDtli), where he found a
number of his Edinburgh friends. The next three
months proved a wearisome period of inaction for
the regiment, but the medical officers, unfortunately,
were not left idle, for while they were stationed at
Gervehler a serious epidemic of cholera broke out
and taxed their energies to thq utmost. Mackenzie
had not gone to the East to treat cliolera, l)ut when
the call came to liim he tlnew liiiuself into the
work with sucli whole-hearted de\otion as to "gain
golden opinions of everyone."
SURGEONS OF THE EXTRA-MURAL SCHOOL 145
On September 3 orders at last came for the
regiment to embark for the Crimea, and on the
20th they took part in the Battle of tlie Alma.
Mackenzie was present throughout the action, and
was amongst the first on the field to render assist-
ance. His letters reveal the profound impression
the sufferings of the wounded made upon his
sensitive nature. " What a sight !" he writes ;
** . . . this morning it floored me when I went over
the field, the ground strewed with the ghastly dead
and wounded. I could not stand it, and went
off to the rendezvous where the wounded were
brought." There he worked from morning till
night until he was " exhausted with sheer hard
work/'
The regiment had a trying march as they moved
on towards Sebastopol, and on September 24 they
encamped at Bornoo. That night Mackenzie was
seized with Asiatic cholera, and the next morning
he died. Within an hour after his burial "the
mighty host moved on," leaving behind them one
who was described by a brother-officer as the
'* best -hearted, least selfish man I ever met — as a
Christian, as near perfection as possible."
10
CHAPTER XI
THE PERIOD OF LISTON AND SVME
Robert Liston — Lecturer on Anatoni}- — Exclusion tVoni the
Royal Infirmary — Famous Operations — Suri^eon to Royal
Infirmary — Contributions to Surgery — (Quarrel with
Svme — Reconciliation — Removal to London — First
Operation under Ether Anaesthesia in England.
TowAKDS the close of the pre-Listeriaii era the
Surgical School of Edinburgh reached the zenith of
its fame. In a band of able and accomplished
surgeons two figures stood out pre eminent :
Robert Liston. the great operator, and James
Syme, the surgeon par cdcel/ence.
H()bp:rt Liston
(1794-1847)
*' A tall man, powerl'ul in form, dressed in dark
bottle-green coat with velvet collar, double-breasted
shawl vest, grey trousers, and W^ellington boots,
the thumb of one hand stuck in the armhole of his
vest, comes along in an easy-going way, chewing
an orange-wood tooth-pick."^^ This was Robert
14G
ROBERT I^rSTON'
'zzotint by J. C. Broinlcy, after F. Grant, in the
Author's Collection.)
THE PERIOD OF LISTON AND SYME 147
Listen, the boldest and most dexterous operator of
his day : the ** Great Northern Anatomist " of the
Xoctes Ambrosimuv. A son of the manse, he was
born at F.cclesmachen in LinUthgowshire on
October 28, 1794. His father, the llev. Henry
Liston. minister of the parish and a leader in the
Courts of the Church of Scotland, acquired a
certain celebrity in his day as a writer on music,
and exercised a natural bent for mechanics by
inventing, in addition to an enharmonic church
organ that gave the diatonic scale in perfect tune,
an improved form of plough, which proved more
useful to his parishioners. 2^' ''^' ^"
In 1810 {10) Robert Liston entered upon the
study of medicine in Edinburgh by becoming a pupil
of John Barclay, an anatomist of exceptional culture,
'* distinguished not only for his Greek, mathematics,
and Hebrew, but also for his candour, good humour,
and kindliness." After spending ten years as a
preacher in the Church of Scotland, Barclay took
to medicine, and at the end of a highly successful
undergrjiduate career boxed the compass by dedi-
cating his graduation thesis to r3r. James Gregory
and Mr. John Bell (p. 63).
Liston's ambition was to become an operating
surgeon, and to this end, under the guidance of
Barclay, he devoted himself whole-heartedly to the
study of anatomy. His surgical studies were
148 THE EDINBURGH SCHOOL OF SURGEKV
pursued in the Edinburgh Royal Infirmary, at the
London Hospital under Blizard, and at St. Bar-
tholomew's under Abernethy. In 1818 (;,'4) he
obtained the membership of the Royal College of
Surgeons of Edinburgh, and about the same time
he became a member of the London College.
For a time he was one of the band of brilliant
demonstrators whom Barclay had gathered round
him, and in this capacity he acquired a high repu-
tation amongst the students both as a teacher of
anatomy and as a surgeon. In consequence, it is
said, of a misunderstanding with his master, he
decided to become a lecturer on anatomy and
surgery on his own account. A class-room was
secured and the venture was laimched in the winter
session 1818-1819, with a class of sixty students
and with James Syme as his demonstrator and
assistant. To obtain material for dissection was
his chief difhculty. The meagre supply available
in Edinburgh was already controlled by the experi-
enced *' agents '' of Monro and Barclay, witli whom
it was not easy to enter into competition. "It
was no uncommon occurrence," Christison tells us,
** for one party to iiave a lookout man sitting on
the churchyard wall in the dangerous dusk, ready
to drop down on the first appearance of the rival
party and appropriate the gni\e by striding across
it."^" Another grim method of staking out a claim
THE PERIOD OF LISTON AND SYME 149
was to drive a digger into the sod of the coveted
grave. It would appear, however, tliat the rights
thus estabhshed were not always respected, and
curious tales, many of them doubtless apocryphal,
are told of the part played by Liston and his friends
in some of these nocturnal escapades. On one
occasion, it is said, the emissaries of Barclay
successfully contested with him the rights to a
claim with the aid of pistols.
By fair means or by foul, however, the needs of
the students were sufficiently met, and for five
years Liston and Syme between them carried on
the class with ever- increasing success. But the
teaching of anatomy was not the career that these
two ambitious youths had planned for themselves,
and in course of time the claims of the dissecting-
room had to take second place to the calls of the
hospital. While he acted as surgeon's clerk under
Mr. George Bell and Dr. Gillespie in the Royal
Infirmary, Liston seized every opportunity of
acquiring clinical and operative experience, and
after his period of office had expired he continued
to follow the surgical practice of the hospital, not
only during the visits of the staff, but also in the
evenings, which he spent with his friend Syme
when he in turn became surgeon's clerk under Mr.
William Newbigging.
It can well be imagined that these evening
150 THE EDINBURGH i^CHOOL OF SURGERY
meetings in the residents' room afforded two such
enthusiastic young men, each endowed with a
natural genius for surgery and fired with the
ambition to excel in it, ample opportunity not
only of discussing the various clinical problems
raised by the cases in the wards, but also of
criticizing the efforts of their seniors to de.il with
them. It nuist be confessed that the standard of
surgery in the infirmary at this particular period
was not high, and the practice of some at least of
the visiting staff left room for criticism. Liston
and Syme would not have been house-surgeons if
they had not detected the joints in the armour of
their chiefs ; neither would they have been them-
selves if they had not pierced them with truer
thrusts than are at the command of the majority of
their kind.
The reputation that Liston Imd made as a
teacher of surgery at Surgeons' S(]uare followed
iiim'to the hospital. From the first he manifested
that boldness of initiative and dexterity in execu-
tion for which he later became famous. His
ability as an operator was quickly recognized, and
in tlic absence of serious opposition from the
senior members of the staff he soon accjuired a
very considerable practice as an operating surgeon.
Flis success in cases in which others had failed to
give relief, or had even refused to make the
THE PERIOD OF LISTON AND SYME 151
attempt, spread his reputation throughout the
district, and his services were eagerly sought by
the most seriously afflicted of the sick poor. As
he liad no official connection with the infirmary he
had to operate in the homes of the patients or in
lodgings which he provided for them, and to rely
upon the friends of the patients for such nursing as
they were capable of. Under these unfavourable
conditions, with the assistance of Syme, Liston
performed many operations that have since become
historical, and that laid the foundation of advances
in operative surgery of far-reaching import.
Liston's seniors could not but view with some
misgivings the rise of such a serious rival, and in
some at least his growing reputation aroused a
feeling which can with justice be called by no
softer word than jealousy. Sinister rumours
began to circulate that Liston was abusing his
privileges as he '' walked the hospital," and that
the patients who formed his clientele were induced
to forsake the infirmary by undue influence. He
was accused also, and not without reason, of openly
criticizing the surgical practice of the hospital in
such a way as to diminish its reputation in the
eyes of the public. The matter culminated in tlie
managers of the Infirmary passing the following
resolution : -^
152 THE EDINBURGH SCHOOL OF SURGERY
" Edinburgh,
"14M March, 1822.
" The Managers have made such inquiries as
satisfy them, that Mr. Listen has frequently heen
guilty of interfering improperly in the surgical
department of the House, and with the patients.
They therefore consider it to be their bounden duty
to take such measures as may prevent Mr. Liston,
and deter others, from pursuing similar conduct in
future ; and therefore Resolve, that Mr. Liston be
prohibited and discharged from entering the wards
or operation-room of the Royal Infirmary, at any
time, and on any pretence whatever : and he is
hereby prohibited and discharged accordingly.
And they direct their clerk forthwith to transmit
a copy of this resohition to Mr. Liston, and the
Treasurer to notify the substance of it to the
Physicians, Surgeons, Apothecary, Matron, Clerks,
and Porter."
This drastic step was taken without any formal
charge being made against Mr. Liston, and with-
out his being given any opportunity of meeting
the innuendo contained in the resolution. The
action of the managers was confirmed by the
Court of Contributors under the itiHuence of a
powerful indictment made against Liston by the
then Lord President of the Court of Session, and
the leading advocate of the day, Francis .Jefl'rey.
The learned judge and counsel spoke from a brief
which was notoriously one-sided as to the facts
and singularly biassed by personal animosity, but
THE PERIOD OF LISTON AND SYME 153
against such a weight of forensic skill and ingenuity
Liston was helpless, and the resolution of the
managers became operative.
Liston appealed to the College of Surgeons for
support on the ground that the action of the
managers in excluding from the infirmary one of
their members without their concurrence was an
infringement of one of the ancient rights of the
College. His petition, however, met with a cold
reception, the President (one of the surgeons to
the infirmary) curtly replying that " under all the
circumstances of the case the Royal College of
Surgeons do not consider it expedient or necessary
to take any steps in consequence of the communica-
tion from the managers of the Royal Infirmary."
Liston's public defence took the form of an open
letter ^^ to the Lord Provost, as chairman of the
Court of Contributors, in which the unprejudiced
reader will find a complete vindication of his pro-
fessional conduct and character.
This episode was doubly unfortunate : it checked
the surgical career of Liston for a period of five
years, and during that time deprived the infirmary
of the services of one of the most brilliant surgeons
of his day. It was not until 1827 (3S), "his im-
prudence and presumption forgotten," that Liston
was appointed one of the surgeons to the infirmary.
These anxious and weary years of waiting were
154 THE EDINBURGH SCHOOL OF SURGERY
not spent in idleness. With grim determination
he overcame the handicap of being witlioiit a
hospital appointment, and circumvented the open
antagonism of his surgical contemporaries. The
trend of his mind was towards tlie practical rather
than the scientific side of surgery, and he made the
most of his opportunities of acquiring clinical and
operative experience. iNIany of his most famous
operations belong to the period when he was
waiting for a hospital surgeoncy. In the medical
press he found the publicity otherwise denied him,
and the short pithy papers he published during
tliese years spread his fame far beyond the bounds
of his own school. It is liardly necessary to read
between the lines of these contributions to detect
the adroit thrusts he makes at the opinions and
practices of his sin-gical opponents.
One of his earliest contributions to surgery was
his *' Dissertation," read before the Royal Medical
Society in 1820 (^6'), on Fracture of the Xcck of the
Femur.-'' He condemned the prevaihng practice
of neglecting to replace the fragments and to secure
immobiHzation in these fractures, and disputed the
view of Sir Astley Cooper that excess of synovia
prevents union. lie proved from his own experi-
ence ** that there is no reason why a fracture of the
neck of the femur should not unite as well as any
other, when put in circumstances favourable to
THE PERIOD OF LISTON AND SYME 155
such an occurrence." The apparatus he favoured
for securing extension was the perineal band with
Desault's sphnt — the spHnt which to this day is
known as Liston's long splint, although lie laid no
claim to its invention.
The same year he published'^^ a remarkable series
of cases of aneurysm, five in number, which had
occurred in his practice " within the last five or
six weeks." The first — a case of ossified aneu-
rysmal tumour of the subscapular artery — is inter-
esting as being one of the cases which gave rise to
all the trouble with the managers of the infirmary,
and was in Liston's ow^n opinion^^ ** the very opera-
tion which first attracted the notice of patients to
me, and which was, indeed, the beginning of any
reputation I may have as an operator, beyond the
circle of this city, in our own country, or abroad."
It is also the first record we have of the successful
removal of the scapula by the knife of the surgeon
in Britain.
The patient was Robert McNair, aged sixteen,
whose case had been the subject of a full consulta-
tion of all the surgeons of the lloyal Infirmary.
*' It was deemed by them imprudent and not ad-
visable to attempt any operation. He was, after
the application of leeches, dismissed as incurable."
When Liston was consulted he took a different
view, and next day he " proceeded to the operation
in a small, badly lighted room.
156 THE EDINBURGH SCHOOL OF SURGERY
" I began by making an incision of a foot long
at least, from the axilla to the lower and posterior
part of the tumour. 'J'he latissimus dorsi was
then cut across at about two inches from its inser-
tion, so as to expose the inner edge of the swelling,
with a view to tie the subscapular in the first
instance. In this I was foiled, owing to its depth,
as it passed under the lower edge of the tumour,
out of the reach of my fingers. 1 then proceeded,
as is my custom in tlie extirpation of tumours, to
dissect where I expected vessels to enter from the
suprascapular. With this view% in detaching it
from the spine of the scapula, I felt my finger
and knife dip into the body of the tumour. This
was attended with a profuse gush of coagula and
florid blood. I immediately thrust my sponge
into the cavity, so as nearly to command the
hfcmorrhagy. One of my assistants, at the same
time, tried to compress tlie subclavian, but to no
purpose, as the shoulder and arm were much raised
to facilitate the dissection in the axilla, which
circumstance increased the difficulty of command-
ing the vessel on the left side. The patient, who
liad borne the operation well, exliausted by this,
and the loss of blood from the very large vessels
supplying the tumour, divided in the former
incisions, after some efforts to vomit, now dropped
his head off the pillow, pale, cold, and almost life-
less. I then only became aware of the nature of
the case, and saw that nothing but a bold stroke of
the knife could save the boy from immediate death.
Pulling out the sponge, therefore, with one rapid
incision I completely separated the upper ed^re of
the tumour, so as to expose its cavity ; and, directed
by the warm gush of blood, immediately secured
THE PERIOD OF LISTON AND SVME 157
with my finger a large vessel at the upper corner,
which, with open mouth, was pouring its contents
into tlie sac. With my right hand I then cleared
away the coagula, and, dissecting under my finger,
separated the great subscapular artery, so that one
of my assistants could pass an aneurysm needle
under it at its origin from the axillary, and about
an inch from the sac. After tying this, and two
other large vessels (fully the size of the ulnar) which
supplied the sac, 1 dissected off the tumour from
the ribs without further h^emorrhagy, cutting with
my knife the carious scapula and under part of the
sac. After removing the tumour, I found it neces-
sary to saw off the ragged and spongy part of the
scapula, so as to leave only about a fourth part of
that bone, containing the glenoid cavity, processes,
and half of the spine. In this way, ten muscles
were either wholly or partially divided. The edges
of the wound were then brought together, and the
patient cautiously lifted into bed. At this time he
was pale, almost insensible, and without any per-
ceptible pulsation in the greater arteries through
the integuments, though the ends of the vessels in
the wound beat very forcibly. By the exhibition of
stimuli, externally and internally, his pulse could
by-and-by be felt, though, on account of its
quickness, it could not be counted. In the evening,
however, it was at ninety, and soft."
The wound granulated well, and the boy re-
turned in three weeks to his home in Kinross,
where, however, he died of recurrence four months
later.
In the same journal a few months later^^ he re-
corded the first successful case in Britain of ligation
158 THE EDINBl'RGH SCHOOL OF SURGERY
of the subclavian artery. It was performed for
aneurysm of the axillary. " The patient bore the
operation with the greatest courage ; with all the
preparations, removal and replacement in bed, it
occupied about half an hour." In this operation,
for the first time he used as retractors the flexible
copper spatulas introduced by Colles, and so highly
did he appreciate this primitive implement that he
says : ** I consider them as the greatest addition
made to our surgical instruments for many years."
A more important addition to the surgeon's
armamentarium was shortly to be made by Liston
himself in the form of his bone pliers."'^ This instru-
ment, made for him by •' Mr. Young, a most
ingenious cutler in College Street," was originally
designed to iacilitate the resection of long bones,
particularly the metacarpals and metatarsals, but
was soon found to have a much wider field of useful-
ness, and is to this day an indispensable implement
in bone- surgery.
In 1828 (?/^) Liston performed another operation
which caused a great sensation at tlie time. It was
for the ''removal of an enormous tumour of the
scrotum " (of the nature of elephantiasis) measuring
forty-two inches in circumference and extending
lower than the patient's knees. '* The flow of
blood was compared by those present to the dis-
charge of water from a shower-bath ; . . . before
THE PERIOD OF LISTON AND SYME 159
half the vessels could be tied the patient sunk off
the table, without pulse, and with relaxed muscles
voluntary and involuntary. ... A cordial (good
strong whisky) was poured into his stomach, . . .
and before much sign of recovery could be observed
he had taken one pint of it." After removal the
tumour weighed forty-four and a half pounds. In
three weeks the patient was able to walk out. In
this operation Liston adds : " I had the valuable
assistance of my friend, Mr. Syme, without which
the result might have been less favourable. "^^'
Liston's Observations on Amputation^^ reflect
the importance attached in these days to rapidity
of operating, as well as the haunting fear of pyaemia,
and, incidentally, the reliance he placed in his own
muscular strength and his pride in it. "As to the
tourniquet," he said, " it is in my opinion of no use,
and in many cases it is worse than useless ..."
** I have repeatedly, when no proper assistance was
at hand, compressed both the femoral and the
humeral arteries with the fingers of one hand,
whilst with the other I removed the limb, and
with the loss of much less blood than if I had
followed the ordinary mode."
The suggestion " of that late excellent surgeon,
Mr. Hey of Leeds," to apply a ligature to the
femoral vein he characterized as a *' dangerous
expedient," with the comment ; '* The bad effect of
160 THE EDINBURGH SCHOOL OF SURGERY
tying a single vein, even under favourable circum-
stances, has only to be hinted at to show the
impropriety and danger of this practice."
The circular method of amputating was con-
demned as " complicated, and requiring a consider-
able space of time for its performance," as well as
for other reasons, and he advocated the formation
of flaps by transfixion ; " but a few seconds will
suffice for its performance, in most instances not
above ten or twelve."
In his Remarks on the Operafio/i of Lit/iotomy^'^
he advocated the use of the stiff lithotomy drainage-
tube as a means of preventing extravasation ot
urine into the cellular tissue about the neck of the
bladder, then one of the most common and serious
complications of the lateral operation. Here as
elsewhere he laid stress on the advantage of opera-
ting rapidly : " There can be no apology for the
patient being longer than a very few minutes under
the operation. Should there be but one or two
stones of a moderate size (under the size of a hen's
egg), the incisions and extraction should not occupy
more than two or three minutes at most."
In 182G {JJ) he published a short ilhistrated paper
on Exostosis of the Last Phalanges of the Toes, " a
disease of which 1 have met with a good many
instances, and whicli, so far as 1 know, has not been
adverted to in any surgical work." The treatment
THE PERIOD OF LISTON AND SYME 161
recommended was " amputation at the joint betwixt
the first and second phalanx ; an operation quite
effectual, and more neatly, quickly, and easily done
than the division of the bone."®-^
During the period of his exclusion from the
infirmary another cloud arose to mar Liston's
happiness. In their earlier years Liston and Syme
had been as David and Jonathan. They were
fourth cousins — a mysterious Scots relationship
difficult to trace ; it was through the influence and
advice of Liston that Syme took to medicine as a
profession ; they worked together as demonstrators
ih Barclay's dissecting-rooms ; and together they
passed to conduct an independent class of anatomy
and surgery. When stress of circumstances in-
clined Syme to abandon the teaching of anatomy,
Liston encouraged him to persevere, and in course
of time Syme took over the class which Liston had
started. It was to Liston that Syme dedicated his
inaugural dissertation for the Fellowship of the
Royal College of Surgeons. For a number of
years Syme assisted Liston at all his operations, and
Liston assisted Syme at his.
Till the year 1823 their friendship was unabated,
and their loyal co-operation was mutually stimu-
lating and helpful. It was perhaps inevitable, how-
ever, that the constant association of two such
brilliantly original exponents of a developing art
11
]6'2 THE EDINBURGH SCHOOL OF SURGERY
should lead to emulation, and that the relationship
of allies should in time pass into that of rivals. In
any case, it came about that their bearing towards
one another gradually became less cordial ; ** a
certain coldness arose between them," and this
finally ended in an open rupture. In the case of
Liston and Syme this could be no lovers' quarrel.
Each was by nature contentious, and the struggle
for existence, which both found hard, underlay the
discord. Despite a '* lingering fondness " w^hich
Syme retained for Liston, their differences Avere
apparently incurable, and were carried into every
sphere of professional and private life. Their co-
partnersliip in teaching was dissolved ; the harmo-
nious co-operation of former years gave place to
acrimonious wrangles, and their relations in public
w^ere so embittered that when Syme applied for the
surgeonship of the Royal Infirmary, the managers
*' declined to appoint him in the meantime," fearing
that the feud between him and Liston might lead
to disturbing scenes in the presence of the students
Factions were formed on either side : the opposi-
tion of the Liston party prevented Syme being
appointed Professor of Surgery to the Royal
College of Surgeons, and secured the election of
his hfc-long rival, Lizars. The crowning conflict
came in 188;3, when Syme defeated Liston after a
bitter contest for the CSiair of Clinical Surgery in
the University (p. 101).
THE PERIOD OF LISTON AND SYME 163
Apart from its effects in marring the happiness
of the chief parties to it, and in wasting on polemics
intellectual faculties that belonged to surgery, this
unfortunate disagreement had far-reaching influence
on the development of the Edinburgh School.
Syme's exclusion from the lloyal Infirmary in 1829
led to the foundation of the Surgical Hospital at
Minto House (p. 187) and all that that involved.
It also influenced Liston in accepting the offer of the
Chair of Surgery at University College, London,
and so deprived the Surgical School of Edinburgh
of one of its brightest ornaments.
It is pleasant to be able to conclude the story of
this episode on a more agreeable note. Five years
after he left Edinburgh, Ijiston, '* anxious to erase
from his memory any ill-feeling, and to recognize
the prestige of the great Scottish surgeon, "^^ wrote
to Syme that he *' could not resist the temptation
of saying a few words, with the view of bringing
about a reconciliation. ... I have no angry
feelings towards you, and you ought not to have
any hostile feelings towards me. . . . Write and
tell me that you wish to have our grievances and
sores, not plastered up, but firmly cicatrized. ..."
Syme eagerly grasped the hand thus handsomely
held out to him ; the old friendship was renewed ;
a cordial correspondence was carried on ; and some
years later, when Liston visited Edinburgh, he
164 THE EDINBURGH SCHOOL OF SURGERY
spent much of his time under Syme's hospitable
roof-tree at Millbank. The happiness of reconciha-
tion was mutual, but it was short-lived, for Liston
died suddenly a few months after returning to
London, and by none was he mourned more
sincerely than by Syme.
Disappointed in his hopes of obtitining a Vvo-
fessoTship in Edinburgh, Liston accepted the offer
of the Chair of CHnical Surgery at University College
and the surgeonship at the North London Hospital
which unexpectedly came to him in 1835 {41).
By his colleagues in London, as well as by the
students, he was cordially received ; his fame as an
operator attracted to the hospital a large clientele,
and his eminence as a teacher added to the reputa-
tion of the University. His professional duties
and the calls of an extensive private practice did
not leave much time for literary work, and beyond
his Practical Surgery, published in 1837 ( ^>^), he
wrote little of importance after leaving Edinburgh.
His clinical lectures, published week by week in
the Lancet,''^ were highly valued at the time, but
add little to his reputation.
The first major operation performed under ether
anaesthesia in England was carried out by Liston at
University College Hospital in 184-6 {5.J). The
patient was one Frederick Churchill, a butler, aged
thirty-six, the operation amputation through the
THE PERIOD OF LISTON AiND SYxME 165
thigh. A primitive inhaler had been devised at
short notice by Peter Squire, the famous chemist
of Oxford Street, and tested by his nephew, Dr.
WilHam Squire, who employed it next day at
Liston's operation. Dr. F. William Cock's descrip-
tion of the scene may be quoted :^^
" The well of the theatre is now almost full ; it
is 2.15 p.m. A firm footstep is heard, and Robert
Liston enters — that magnificent figure of a man,
six feet two inches in height, with a most com-
manding expression of countenance. He nods
quietly to Squire, and, turning round to the packed
crowd of onlookers, students, colleagues, old
students, and many of the neighbouring prac-
titioners, says dryly : * We are going to try a
Yankee dodge to-day, gentlemen, for making men
insensible.'
" He then takes from a long, narrow case one of
the straight amputating knives of his own invention.
It is evidently a favourite instrument, for on the
handle are little notches showing the number of
times he had used it before. His house-surgeon,
llansome, puts the saw, two or three tenacula, and
the artery forceps, named after the operator, on to
the chair close by, and covers them with a towel,
then threads a wisp of well-v/axed hemp ligatures
through his own button-hole. ' Ready, Mr. Ran-
some ?' ' Yes, sir.' ' Then have him brought
in.' . . .
" The patient is carried in on the stretcher and
laid on the table. The tube is put into his mouth,
Wilham Squire holds it and the patient's nostrils.
A couple of dressers stand by to hold the patient if
l(i(i riih EDlNBLUCrli SCHOOL OF .SLUGEliV
necessary, but he never inovei«, and blows and
gurgles away quite quietly. Listou stands by,
trying the edge of his knife against his thumb-nail,
and the tension increases ; the patient's breathing
gets deeper, more ether is dropped on the sponge.
William Squire looks at Liston and says : ' I think
he'll do, sir.' The tube is removed and a handker-
chief laid over the patient's face. * Take the artery,
Mr. Cadge,' cries Liston. Ransome, the house-
surgeon, holds the limb. ' Now, gentlemen, time
me,' says Liston to the students. A score of
watches are pulled out in reply. The huge left
hand grasps the thigh, a thrust of the long, straight
knife, two or three rapid sawing movements, and
the upper flap is made ; under go his fingers and
the flap is held back ; another thrust, and the knife
comes out in tlie angle of the upper flap ; two or
three more lightning-like movements, and the lower
flap is cut ; under goes the great thumb and holds
it back also ; a touch or two of the point, and the
dresser, holding the saw by its end, yields it to the
surgeon and takes the knife in return ; half a dozen
strokes, and Kansome places the limb in the
sawdust. * Twenty-eight seconds,' says William
Squire. ' Twenty-seven,' says Buckell, a student,
still living. ' Twenty-six,' echoes yellow-haired
Russell Reynolds. * Twenty-five seconds, sir,' says
proud Edward l^ilmer, the dresser, to his surgeon,
who smiles in reply. The femoral artery is taken
u|) on a tenaculum and tied with two stout ligatures,
and fi\e or six more vessels witii the bow forceps
and single thread, a strip of wet lint put between
the flaps, and tlie stump raised. Then the hand-
kerchief is removed from the patient's face, and,
trying to raise himself, he says : * When are you
THE in:UIOD OF LISTON AND SYME 167
going to begin ? Take me back ; 1 can't have it
done.' He is shown the elevated stump, drops
back, and weeps a Httle ; then the porters come in,
and he is taken back to bed. Five minutes have
elapsed since he left it. As he goes out, Liston
turns again to his audience, so excited that he
almost stammers and hesitates, and exclaims :
' This Yankee dodge, gentlemen, beats mesmerism
hollow.'"
Liston's exacting professional duties as one of the
leaders in the surgical world of London did not
prevent him enjoying the companionship of the
many musical and artistic friends he had made.
Almost to the end, also, he followed the outdoor
sports— shooting, yachting, and hunting — to which
he had been devoted all his life. Within three
months of his death he rode to hounds, and
•' crossed the country like Nimrod." On December
7, 1 847, at the age of fifty-three, he died suddenly
from the effects of an aneurysm of the aorta,
attributed to a blow from the boom of his yacht. ^^
He was buried in the cemeter)^ adjoining Plighgate
Hill Church.
It has been said that Liston " was a teacher more
by what he did than by what he said, " and
contemporary evidence seems to indicate that he
was not a fluent speaker. Except to his patients,
his manner was rough, even rude ; "his temper was
not quite angelic and rather uncertain," and if any
168 THE EDINBURGH SCHOOL OF SURGERY
case was going wrong ** the less you came in his
way the better."^''
As a writer he was terse rather than lucid,
vigorous rather than impressi\ e ; he took little care
in selecting his words, and had no distinctive style.
His similes were often crude and sometimes even
coarse ; his attempts at humour too laboured to be
effective. He had, however, a considerable gift of
satire and a fondness for using it. The merit of his
writing lay in its sincerity ; he was more concerned
with what he had to say tlian with how he said it.
But Liston's great reputation does not rest on what
he wrote. His principal works, the Elements of
Snrgerjj and Praetical Surgerij. we lay down M'ith
a feeling that they reveal the real Liston even less
than his contributions to the medical Press. It is
as an operator that his name lives. For boldness,
dexterity, and rapidity he has probably never been
equalled. He did not hesitate to lead what seemed
to his colle igues a forlorn hope in the combat with
disease, but his boldness was far removed from
rashness, as the success that attended his most
daring operations amply proved. His skill in hand-
ling the knife is proverbial ; ** the bystander," said
Erichsen, " was lost in admiration at the wonderful
dexterity of the operator."^^ He was at his best
in operations that lay out of the beaten track, as
there his remarkable coolness and resourcefulness
THE PERIOD OF LISTON AND SYME 169
in the face of unfamiliar emergencies found fullest
scope.
He was not unconscious of his prowess, nor did
he take pains to conceal his pride in it : witness
the assistants who stand stop-watch in hand while
he amputates the thigh single-handed, or removes
the stone by the lateral operation. *' His absurd
vanity of passing the catheter with one hand,"
according to Lizars, brought to naught the boast
he made shortly before leaving Edinburgh that he
had never failed in passing a catheter. One of his
surgical mistakes is historical ; it may be cited as
illustrating his coolness and decision in the face of
a trying emergency. A patient presented a soft
swelling in the neck, into which Liston plunged a
knife in the belief that it v/as an abscess. There
was a gush of blood. " Give me a hare-lip pin," said
he calmly ; after passing it through and fixing it,
he added, "To-morrow we will tie the carotid."
He did so, but the patient ultimately died, the case
being one of scrofulous glands with suppuration
opening into the vessel. ^^
A bust of Liston by Thomas Campbell stands in
the Board Room of the Royal Infirmary, and a
portrait is in the hall of the Royal College of
Surgeons, Edinburgh. Several engravings are
extant, one by J. C. Bromley ; and a tinted litho-
graph was done by Count D'Orsay six months
before his death.
170 THE EDINBURGH SCHOOL OF Sl'UGEUV
The Introduction of An^csthesta
To this period belongs the introduction of anaes-
thesia, one of the greatest contributions ever made
to the progress of surgery. The aboUtion of pain
during operations had been the dream of surgeons
for generations,^'^ but it was not until 1840 that it
became an accomplished fact. Wells at Hartford,
acting on a suggestion made by Sir Humphrey
Davy^'i half a century before, proved in his own
person that a tooth might be extracted without
pain while he deeply inhaled nitrous oxide gas.
His pupil, Morton of Boston, by administering
the vapour of sulphuric ether, obtained a state
of ana\sthesia sufficiently prolonged to permit not
only of dental but also of surgical operations
being carried through without suffering. Later hi
the same year Robert Liston (p. 164) performed
the first painless operation in England — amputa-
tion through the thigh — under ether aniusthesia,
and his success stimulated James Young Simpson
to employ the same means to abolish the pains of
parturition. For the latter purpose ether did not
prove an ideal anjesthetic, and Simpson set himself
to discover a better. The story of the discovery
of the anaesthetic properties of chloroform has often
been told, but Professor Miller'^ version of it will
bear repetition here.*-'
THE PERIOD OF LISTON AND SVME 171
*' Most of these experiments were performed after
the long day's toil was over, at late night or early
morn, and when the greater part of mankind were
soundly anaesthetized in the arms of common sleep.
Late one evening — it was the 4th of November,
1847 — on returning home after a weary day's
labour, Dr. Simpson, with his two friends and
assistants, Drs. Keith and J. Matthews Duncan,
sat down to their somewhat hazardous work in Dr.
Simpson's dining-room. Having inhaled several
substances, but without much effect, it occurred to
Dr. Simpson to try a ponderous material, which
he had formerly set aside on a lumber-table, and
which, on account of its great weight, he had
hitherto regarded as of no likelihood whatever.
That happened to be a small bottle of chloroform.
It was searched for, and recovered from beneath
a heap of waste-paper. And, with each tumbler
newly charged, the inhalers resumed their vocation.
Immediately an unwonted hilarity seized the party ;
they became bright-eyed, very happy, and very
loquacious, expatiating on the delicious aroma of
the new fluid. The conversation was of unusual
intelligence, and quite charmed the listeners — some
ladies of the family and a naval officer, brother-in-
law of Dr. Simpson. But suddenly there was a
talk of sounds being heard like those of a cotton-
mill, louder and louder ; a moment more, then all
was quiet, and then — a crash. On awakening. Dr.
Simpson's first perception was mental : ' This is far
stronger and better than ether,' said he to himself.
His second was, to note that he was prostrate on
the floor, and that among the friends about him
there was both confusion and alarm. Hearing a
noise, he turned round and saw Dr. Duncan
CHAPTER XII
JAMES SYME
(1799-1870)
James Synie — Chemical Studies — Anatomical Studies —
Surgeon's Clerk in Royal Infirmary — Royal Medical
Society Dissertation on Caries — Studied in Paris — First
Amputation at Hip in Scotland — Teaching — Early
Surgical Writings — Minto House — Eurtlier Writings —
Professor of Clinical Surgery — The London i\pisode —
Return to Edinburgh — Later Writings — Classical Opera-
tions— Controversies — Death — Lister's Estimate of Syme.
James Syme — the Napoleon of Surgery — was born
at No. 56, Princes Street, opposite where the Scott
Monument now stands, on November 7, 1700.^^
From his father, John Syme, a Writer to the
Signet in Edinburgh and a landed proprietor in the
counties of Kinross and Fife, he inherited those
qualities of acuteness, sagacity, obstinacy, and per-
severance that characterized him throughout life.
Shy and reserved, as a boy he made few bosom
friends among his High School companions, and he
shared little in their outdoor sports. With a few
selected friends of kindred spirit he spent much of
174
jAMfiS SYME
Professor of Clinical Surgery.
{From a photograph in the Authors ColiatioH,)
JAMES SYME 175
his spare time in the fields " considering the liHes,"
and acquiring a knowledge of plant life from which
sprang a love of flowers that was one of his most
abiding pleasures to the end of his days. His
favourite youthful pastime, however, was chemistry,
on which he spent all his pocket-money and more of
his time than his teachers thought proper. In his
father's house at Pitreavie he fitted up a laboratory,
where he acquired remarkable skill in manipulating
chemical apparatus, and when he became a member
of Dr. Hope's class in the University, he, along w^ith
Robert Christison and a dozen other students,
founded a Chemical Society, which met once a week
to repeat the Professor's experimental demonstra-
tions— the first attempt at practical study of this
subject made in Edinburgh.
As a result of his private investigations on the
distillation of coal-tar Syme discovered a solvent for
caoutchouc, and he found that by brushing a solu-
tion of indiarubber in a fluid state on a silk cloak
he rendered it waterproof. This discovery he
submitted to the editor of the Annals of Philosophy,
but publication was delayed, and before Syme's
paper had appeared a Mr. Macintosh, a manufac-
turer in Glasgow, had taken out a patent for the
process, and thereby laid the foundation of a fortune
and secured an adventitious immortality for his
name.
17f) THE EDINBURGH SCHOOL OF SURGERY
Syme's choice of medicine as a profession was
made in 1817, after he had spent two years at the
University in the study of Latin, philosophy, and
natural science. He began his medical studies in
the anatomy rooms at Surgeons' Square, attracted
thither by the fame of Dr. John Barchiy as an
anatomist and teacher, and by the presence of his
friend Robert Liston, who was tlie principal demon-
strator. Inspired by Barclay and directed by
Ijiston, Syme quickly mastered the elements of the
subject, and ere long he was sufficiently proficient
to act as a demonstrator. His ealtly association
with Liston in anatomy and surgery has already
been referred to (p. IGl), and the story of their
harmonies and discords need not be gone over
again. Suffice it to recall that when Liston left
Barclay's rooms in 1818 to commence a course of
lectures on anatomy on his own account, Syme
accompanied him as demonstrator and assistant,
and that five years later he took over the class
when Liston relinquished anatomical teaching.
To Syme the study of anatomy was but a means
to an end, and closely as he pursued it, it was ever
with the object of fitting himself for the practice
of surgery. The work of the hospital was more
congenial to him than that of the dissecting-room,
and even the exacting claims of a large anatomical
class did not prevent his devoting much of his time
JAMES SYME 177
and attention to clinical work. He acted for- a time
as medical superintendent of the fever hospital,
and then became surgeon's clerk in the Royal
Infirmary under Mr. William Newbigging. Much
of the clerk's time was occupied in performing
phlebotomy, and it is told that on one occasion
Syme incurred the displeasure of his chief, whose
faith in the efficacy of bleeding he did not share,
by giving beef-steak and porter to a youth enfeebled
by long-continued suppuration, from whom he had
been ordered to withdraw fourteen ounces of blood.
The surgeon's instructions were repeated and
carried out, but '* forty-eight hours saw the last of
the poor sufferer."
The Royal Medical Society afforded Syme, as it
has done to so many others, his earliest opportunity
of submitting his opinions to the criticism of his
contemporaries. In his dissertation On Caries of
the Bones, ^"^ read before the Society in 1821, when
he was twenty- two years of age, we find that firm
grasp of essential principles and that terse, incisive,
even disputatious literary style which was so con-
spicuous in all his later work. His essay begins :
" Mr. President, the truly deplorable ignorance of
many surgical practitioners regarding the diseases
of bones is most astonishing, especially when we con-
sider the frequency and importance of these affec-
tions. I am convinced that the trepans and rugines
of our fathers in surgery, though often misapplied,
12
178 THE KDINBLIKGH SCHOOL OF SURGERY
did, on the whole, much less mischief and infinitely
more good than the poultices of our brethren of the
present day." ... *' Caries, to many surgeons,
conveys no precise meaning of the particular morbid
action to which it is applied in correct lan-
guage." ... ''I wish, therefore, to characterize it
so clearly that the merest surgical tradesman may
never mistake it for a healthy action. While
making distinctions, it will not be amiss to observe
that surgeons may be divided into those who
practise their trade merely, and those who also
study their profession. To the former, already
established in practice, I certainly have not the
presumption to expect 1 shall be of any use, for
men who do not think, and will not be convinced
by what they see, are truly in a hopeless state.
But to those gentlemen Avho constitute the latter
division, and to the rising generation of tlie former,
the following observations may not be altogether
useless." He pointed out that much of the confusion
that existed regarding the disease called caries was
due to a failure to discriminate between the repara-
tive and destructive processes that occur in bone.
AMien this is done the relation of the carious
process to different bone diseases becomes clear.
This paper contains one of Syme's earliest obser-
> ations in surgical pathology :
'' When an ulcer happens over a vascular bone,
I have observed (and to tlie best of my knowledge
the observation is new) that the bone, instead of
exfoliating and getting carious, may simply iiave
its vessels stimulated to an increased action, so
that instead of displaying a loss of substance, it is
JAMES SYiME 179
much increased in surface, and seems everywhere as
if shooting out into stalactites."
The rational treatment of caries, he pointed out,
consists in following the example of Nature :
" Whenever she succeeds in obtaining a cure it is
by putting to death the ill-disposed bone." The
red-hot iron he preferred to caustics, and the simple
gouges and bone pliers devised by Liston to the
intricate appliances then in favour. His rooted
aversion to complicated instruments finds vent in
the folio v/ing passage : ** The chain saw, I am in-
clined to thiiik, both from the testimony of others
and my own experience, never succeeded in cutting
through a bona ever since it made its entrance
into this inventive world. And as to the saw of
Machel, I am ready to allow that it is a very pretty
mechanical contrivance, but how it should enter the
head of any man that such an apparatus could be
of any use in surgery excites my astonishment in
no small degree."
In 1822 {£S), along with his life -long friend
Sharpey, he attended the clinics of Dupuytren at
the Hotel Dieu in Paris, and went through a course
of operative surgery under Lisfranc. It was during
this visit that Syme presented Dupuytren with a
pair of Liston's bone-cutting forceps, and had the
satisfaction of seeing them used by the great
surgeon, who expressed himself much pleased with
the instrument.
180 THE EDINBURGH SCHOOL OF SURGERY
In 1823 (24), the year in which he became a
Fellow of the Royal College of Surgeons of Edin-
burgh, Synic establislied his position as an operating
surgeon by carrying through successfully the first
amputation at the hip-joint performed in Scotland.
The patient was a lad, William Fraser, aged nine-
teen, " tormented for nearly three years with
necrosis of the thigh." Assisted by his " much
esteemed friend and instructor, Mr. Liston," Syme
proceeded to remove the limb by the method he
had been taught by Lisfranc, and he thus describes
the operation :^^
** Having, with some difficulty, placed the patient
upon a table, so that the affected limb was perfectly
free, and ascertained that Mr. Liston was ready to
make pressure when and where required, I intro-
duced a narrow knife about a foot long in the blade,
which was sharp on one edge only, at the proper
place for transfixing the limb. But being prevented
by the bent position, in wliich, owing to long habit,
the patient obstinately retained it, from passing
onward in the direction of the tuberosity of the
ischium, by the neck of the femur, I lost no time
in the repetition of fruitless attempts, but instantly
changed my plan. Witliout removing tiie point of
the knife, I brought down its edge obliquely, and,
by a sawing motion, quickly cut back in a semi-
circular direction to the tuberosity of the ischium,
up along the femur, and round the trochanter
major, so as to form very speedily identically the
same flap which would ha^ e resulted from the plan
JAMES SYME 181
1 meant to have followed. While Mr. Liston
covered the numerous cut arteries with his left
hand, and compressed the femoral in the groin by
means of his right, I gathered together all the
mass of undivided parts on the inner side of the
thigh with my left hand, and then insulated the
neck of the bone by passing the knife close past
its lower surface. I now cut close down along the
bone for some way below the trochanter minor, and
lastly made my way outwards obliquely, so as to
form a good internal flap.
" Mr. Liston holding aside the flaps, I made a
single cut with my long knife upon the head of the
bone, which started, with a loud report, from its
socket, as soon as abduction was performed ; finally,
I passed the knife round the head of the bone, cut
the triangular and remaining portion of the capsular
ligament, and thus completed the operation, w^hich
certainly did not occupy at the most more than a
minute. I then proceeded to take up the arteries.
As soon as the femoral was secured, Mr. Liston
relaxed his hands, in order that we might form some
estimate as to the size and number of bleeding
vessels ; and then, had it not been for thorough
seasoning in scenes of dreadful haemorrhage, I cer-
tainly should have been startled, prepared as I was
to expect unusual vascularity, owing to the exten-
sive action so long carried on in the limb.
"It seemed indeed, at first sight, as if the vessels
which supplied so many large and crossing jets of
arterial blood could never all be closed. It may be
imagined that we did not spend much time in
admiring this alarming spectacle ; a single instant
was sufficient to convince us that the patient's
safety required all our expedition, and in the course
182 THE EDINBURGH SCHOOL OF SURGERY
of a few minutes haBmorrhage was effectually
restrained by the application of ten or twelve liga-
tures. About a month after the operation the
wound was nearly healed, and the prospect of the
patient's return to health and strength was bright ;
but symptoms of ascites from diseased liver soon
after showed themselves, and, increasing, cut him
off in the eighth week after the operation. I am
no advocate for operations whose only interest
is their danger, and assuredly regard the knife at
all times as a great though too often necessary evil ;
yet I feel no hesitation in recommending to the
serious attention of operating surgeons amputation
at the hip-joint, although it be the greatest and
bloodiest operation in surgery ; for I am sure that
there is sometimes no other mode of prolonging
existence."
For the next five years {24- -^^O) Syme's chief
occupation was with teaching : first of anatomy and
surgery in association with Liston ; later of surgery
and anatomy after he had broken with his friend ;
and finally of surgery pure and simple, w4ien he could
no longer endure the endless wrangling with the
odious "purveyors" of anatomical material. His
classes did not, however, absorb his whole attention.
The success of his amputation at the hip and his
almost intuitive powers of diagnosis soon brought
him repute, and he rapidly acquired a fair sliare of
consultative and operative work. Tlic use he made of
liis opportunities is best seen from the papers he
published during this period, whieli reficct his
JAMES SYME 183
penetrating insight into the science of surgery
and his firm grasp of the principles governing its
practice.
Ill his licmarks on Amputaiion^^ he made a
telHng attack on the *' circular" method: "Of all
the operations ever adopted for amputation, I
certainly look upon this one as the worst, inasmuch
as it is tedious, painful, and little calculated for
leaving the sound parts in a good state either for
healing or forming a proper covering for the bone."
** How ... it should still meet with such general
patronage I am at a loss to explain, unless, indeed,
the equality which it establishes, as far as amputa-
tion is concerned, among all operators good and
bad, be its redeeming virtue."
This youth of twenty-iive did not hesitate to
differ even from *' the celebrated Baron Dupuytren
of Paris," whom he regarded " as unquestionably
the best anatomist , profoundest pathologist, and
ablest surgeon of the age we live in." Syme's
advocacy of the flap method, which he frankly
admits he had learned to appreciate from observing
Liston's work, did much to make it popular in
Scotland.
His clinica^ti)bservation, as well as a painful
personal experience, led him to question some of
the methods then employed to secure that '* union
by the first intention " which all surgeons aimed at
184 THE EDINBURGH SCHOOL OF SURGERY
but so few obtained. ** Many students have assured
nie," he says in his Remarhs on the Treatment of
Incised JFounds;^'' *' that in the wliole course of
their hospital attendance they never saw an instance
of union by the first intention, except in cases of
cancer or hare-Hp and venesection." This himent-
able state of affairs he attributed to the prevaihng
practice of completely closing incised wounds,
covering them with imbricated layers of that *' in-
fallible preventive of adhesion, adhesive plaster,"
and leaving them undisturbed in *' a long bandage
tightly and curiously turned " for '' a statutory
period " of four days. This ritual he traced to the
days when wounds were healed by balsams and
incantations, which ** could work successfully only
in secret," and he vigorously attacked those who
adhered to methods so incompatible with the
natural processes concerned hi repair. ** The sealing
up of wounds is the most certain means of keeping
them open," he said, and his advocacy of free
drainage led to a most important change in the
surgical practice of his day.
Syme's earliest experiment in a field to which he
subsequently contributed so much- the excision of
joints — belongs to this period. In IS'iO'^'^ he excised
the head of the humerus for canons disease that
had existed for seven years, thus reviving " the bold
but prudent and successful innovation of White of
JAMES SYME 185
Manchester," which British surgeons had neglected
for nearly sixty years.
Two years later he published his famous case of
excision of the lower jaw for osteo-sarcoma.*^ The
tumour was the largest that had ever been removed
by operation ; '* the mouth was placed diagonally
across the face, and had suffered such monstrous
distortion as to measure fifteen inches in circum-
ference." The portraits of the patient which
accompany the description of the operation **give
some notion of what mere words are altogether
inadequate to express," and fill us with amazement
at the audacity of Syme in undertaking to remove
it — a task which had prudently been declined by
several operating surgeons. The result, however,
justified him. With the patient seated on an
ordinary chair to prevent suffocation from ha-mor-
rhage, the enormous mass was removed in twenty-
four minutes, *' a little respite being frequently
allowed to prevent exhaustion from continued
suffering." The patient, who '* possessed un-
common fortitude," bore it well, and did not lose
more than seven or eight ounces of blood. Five
weeks later he was ** quite w^ell, and thinking of
resuming his occupation."
It is to be borne in mind that these and many
other difficult and dangerous operations were per-
formed in the humble homes of poor patients,
186 THE EDINBURGH SCHOOL OF SURGERY
where the surroundings were uniavourable, the
appliances had to be extemporized from household
chattels, the nursing facihties were primitive, and
the nursing itself unskilled. They were attended
with a degree of success that would have been
notable even in a fully equipped hospital. Syme,
however, had not as yet the advantage of holding
a hospital appointment. His hopes in this direction
seemed about to be realized in 1829, when a vacancy
occurred in the Royal Infirmary, but under circum-
stances that have already been related (p. 10*2) they
were doomed to disappointment.
Syme had now reached a critical stage in his
career. What patient industry, deep reflection, and
the exercise of the talents nature had given him
could do to fit him for the vocation of his choice
had been done. He had made for himself a position
and a name such as few of his years had ever
attained. But without a place on the staff of a
public hospital he could not go much farther. The
door of the infirmary had been cl( scd upon him,
and the signs were not favourable t-o an early
reopening.
James Syme was not the man to stand, cap in
hand, waiting for favours. He was liumbly con-
scious of his own powers, proudly confident of his
ability to succeed, and fearless in the face of difli-
cultics. If there was no place for him among his
JAMES SYME 187
compeers he must make a place for himself, and
wear the spurs he had already won on a field of
his own choice.
His own plan was nothing less than to establish
a surgical hospital for himself. On the north side
of what is now Chambers Street stood Minto House,
once the town house of the Elliots of Minto, ;ind
this being available, Syme promptly secured it on
a long lease. A square, well-appointed house of
fifteen rooms, surrounded by adequate pleasure-
grounds, situated in convenient proximity to the
University and the infirmary, as well as to the
densely populated part of the old town, JMinto
House was admirably adapted to its new purpose.
The principal room was converted into an operating-
theatre and lecture-room ; provision was made for
twenty-four beds ; and accommodation was provided
for the resident staff. While tlie alterations were
being carried out a prospectus for the information
of the public was circulated, and the College of
Surgeons granted Syme's request that his lectures
should qualify for their diploma. In response to
an advertisement for two house-surgeons, each
to pay £100 for board, ten apph cations were
received. A number of apprentices became inden-
tured to Syme — the apprentice system was still in
vogue— and part of their fees went towards the
financing of the venture. Students applied for
188 THE EDINBURGH SCHOOL OF SURGERY
admission in large numbers, but only forty were
accepted, their fees yielding a sum of £250.
The response of the public was encouraging, and a
number of influential citizens agreed to act as a
Board of Directors.
The " Surgical Hospital ' was opened on May 8,
1829 (so). During the first three months 380 patients
applied for relief, 70 were admitted into the house,
and 30 operations were performed, with two deaths,
both following upon severe accidents. The first
patient admitted to the hospital was still alive in
1870, when Syme died.
Stimulated by the formidable rivalry of Liston
and Lizars in the Royal Infirmary, and Fergusson
outside, as well as by his obligations to students,
apprentices, and contributors, and loyally supported
by his devoted henchmen, Alexander Peddie and
John Brown, Syme threw his whole energy into
the venture, with what success the Quarterlif
Rcpoiis show. Quarter by quarter the number of
patients seeking admission increased ; operations
became more numerous and more important ; the
building had to be extended to provide additional
beds, and the reputation of the hospital came to
rival even that of the Royal Infirmary.
It would not be too much to say that during the
five crowded yci«rs he spent in Minto House, Syme
was making, as well as practising and teaching,
JAMES SYME J 89
surgery. To these years we trace his method of
treating indolent ulcers by blistering ; the proof of
the value of the actual cautery in diseases of bones
and joints ; the demonstration of the mechanism by
which haemorrhage is arrested in lacerated arteries ;
the first case of division of the sterno-mastoid for
wry neck in this country ; his earliest excisions of
the elbow and knee joints ; and the first of the
wonderful series of operations for aneurysm which
brought the ** old operation " back to its own. In
all the " great operations of surgery " of the time
— amputations, excisions of tumours, lithotomy,
hernia, trephining, excisions of joints, and rectal
operations — he gained a wide experience and pre-
pared the way for many of tlie improvements he
subsequently introduced in almost every depart-
ment of surgical work.
Many of the reports of Syme's operations are
famous : one is a classic. John Brown was the
clerk who posted the notice on the stair of Minto
House : " A7i operation to-day,'' and wrote the
record of that operation. It was for the removal
of a cancerous breast ; the brave and gentle Ailie
was the patient, and the immortal Rab, *' his soul
working within him," the most intent spectator.
In that idylhc clinical record the fame of old Minto
House is enshrined. ^2
Another valuable contribution to practical sur-
190 THE EDINBURGH SCHOOL OF SURGERY
gery was made by Syme when, in 1831, he published
his Treatise on the E.rcision of Diseased Joints.
It is true that as far back as 1770, in England,
White, Bent, and Orred had made tentative efforts
to avoid the necessity of amputating by removing
the articular ends of diseased bones, and twenty
years later, Moreau, father and son, in France, had
done the same ; but in the interval the operation
had fallen into disrepute and had been abandoned.
Syme revived it, and to the success of his practice
and the perseverance with which he advocated it in
the face of much opposition we owe the establish-
ment of excision of joints as one of the most brilliant
achievements of conservative surgery. He lived to
see the principle universally accepted, and surgeons
vying with one another in devising " modifications '
and " improvements " in the methods of putting it
into practice. Syme's impressive plea for excision
as an alternative to amputation was a lasting con-
tribution to conservative surgery. Of his work in
this direction it has been said : ** If he had done
nothing else, he would have been one of the greatest
benefactors of the liuman race."^^'
The first edition of his Principles of Surgerii
appeared in 1831 {3.2), This remarkable book, true
to its title, enunciated a few broad and safe general
principles and applied them to the whole range of
practical surgery. With a consistency characteristic
JAMES SYME 191
of Syme's mode of thought, his " principles " became
simpler and clearer the more they were applied, and
the fifth edition, published in 1863 {64), was more
elemental than the first.
The success of the surgical hospital venture was
now complete. Syme had raised himself to the
front rank of British surgeons, and had only one
serious rival in Edinburgh — Robert Liston. In
1833 the veteran Professor of Clinical Surgery
resigned, and Liston and Syme were once more
brought into active conflict as candidates for the
Chair Professor Russell, now aged eighty-one, had
made his resignation contingent on his successor
paying him a retiring allowance of £300 a year for
the remainder of his life. Liston refused to consider
this condition, but Syme, after open and honourable
negotiation, agreed to it, and was appointed. The
managers of the infirmary could no longer afford to
exclude him from the staff, and he was allotted
three wards containing thirty beds. At the same
time the Senatus Academicus added Clinical Sur-
gery to the list of classes imperative on candidates
for graduation.
Syme's battle was won. He had forced the
doors of the infirmary, established himself in the
premier Surgical Chair, and secured academic
recognition for his special subject.
The need for Minto House as a surgical hospital
19^^ THE KDINBURGH SCH(30L OF SURGERY
having passed, it was converted into a maison de
sant^ and dispensary, and for fifteen years, under
tlie charge of Dr. Alexander Peddie, Dr. John
Brown, and Dr. Cornwall, filled a useful place
amongst the medical charities of Edinburgh.
Later it was transformed into a branch of the
Extra-mural School.
The teaching of clinical surgery in Edinburgh
received a new impetus on Syme's accession to the
Chair. In place of the systematized dissertation
on some allied group of diseases, illustrated by the
records of selected cases under treatment in the hos-
pital, that had previously done service as a clinical
lecture, he introduced to the infirmary the method
he had so successfully practised at Minto House.
It is best described in liis own words :"'-
'* . . . To bring the cases one by one into a
room, where the students are comfortably seated,
and if the patients have not been seen by the
surgeon beforehand, so much the better ; then
ascertaining tlie seat and nature of their complaints,
he points out their distinctive characters.
" Having done this so that everyone present
knows the case under consideration, the teaclier,
either in presence or absence of the patient,
according to circumstances, proceeds to explain the
principles of treatment, with his reasons for choosing
the method preferred ; and, lastly, does what is
requisite in the presence of the pupils.
*' The great advantage of tliis system is that it
JAMES SYME 193
makes an impression at the same time on the eye
and ear, which is known by experience to be more
indeHble than any other, and thus conveys instruc-
tion of the most lasting character."
The students were questioned as to the diagnosis
and treatment, and were given opportunities of
personally examining the patients. They were in
addition taken round the wards to enable them to
follow the progress of the indoor patients. With
certain modifications the system introduced by
Syme is still followed in Edinburgh, and indeed in
most medical schools.
As a teacher Syme at once took the leading
place in Edinburgh, but for two years Liston
rivalled him as an operator and contested with him
the consulting practice of Scotland. In 1835, how-
ever, when Liston removed to London (p. 164),
Syme was left in undisputed possession of the whole
field, which he maintained till the time of his death
thirty- five years later.
Syme's tenure of the Edinburgh Chair was inter-
rupted by a strange episode. On the unexpected
death of I^iston in 184<7, he was offered, and
accepted, the Professorship of Clinical Surgery at
University College. He went to London on
February 13, 1848 (49), was cordially received by
the heads of the medical profession as well as by
the students, with whom he became very popular,
13
194 THE EDINliUllGH SCHOOL OF SURGERY
and who "invariably paid him great respect'
Certain undercurrents of feehng, liowever, were at
work which made liim uncom.ortable, and when the
Council of the College sought to impose upon him
the duties of the Systematic Professor in addition
to those of his own CHnical Chair, he found an
opportunity of withdrawing from an uncongenial
position. He recognized that '* ambition had made
him sacrifice happiness," and on July 3, with no
feelings of regret, he bade adieu to London and
returned " home. '
His Chair still being vacant, he was reinstated in
it, as well as in his office as surgeon to the Royal
Infirmary.
The high- water mark of pre-Listerian surgery in
Edinburgh was readied during the period when
Syme filled the Chnical Chair, and for forty odd
years his name not only shed a lustre on his
own school, but brought distinction to British
surgery. Adequately to estimate the share he took
in the advancement of his art would necessitate a
review of the progress of surgery during that
period, but this is beyond our present purpose.
This double task he performed for us in his own
terse and lucid way when he addressed the British
Medical Association at Leamington, ^^ and here we
need only refer to some of his most important
coDlributions.
JAMES SYME 195
The amputation at the ankle-joint that goes by
his name stands pre-eminent. It was first per-
formed in 1842 {4o), and is still accepted as the
best operation of its kind. When it is borne in
mind that it was introduced as a substitute for
amputation below the knee, then the operation of
choice for disease of the ankle, and that it not only
preserves the leg, but leaves a stump on which the
w^hole weight can be borne, this operation may
wdth justice be ranked among the triumphs of
conservative surgery. It has been said that " on
this achievement alone Mr. Syme might have based
his reputation as one of the greatest surgeons that
ever lived. *'^*'
Parenthetically, the story of this operation vividly
recalls to us the pre- anaesthetic era of surgery, for
Professor George AVilson, the second patient on
w^hom Syme performed it, has left on record his
emotions during the ordeal. ^^- '* During the opera-
tion," Wilson says in a letter to Simpson, '' in
spite of the pain it occasioned, my senses were
preternaturally acute. I watched all that the
surgeons did with a fascinated intensity. Of the
agony it occasioned I will say nothing. Suffering
so great as I underwent cannot be expressed in
words, and thus fortunately cannot be recalled.
The particular pangs are now forgotten, but the
black whirlwind of emotion, the horror of great
19G THE EDINBURGH SCHOOL OF SURGERY
darkness, and the sense of desertion by God and
man, bordering close on despair, which swept
through my mind and overwhehned my heart, I
can never forget, however ghidly I would do so."
Syme's experimental investigation On the Power
of the Periosteum to Foinn New Boiie, communi-
cated to the Royal Society of Edinburgh in 1837
[SS), anticipated the work of OlHer by twenty years,
and was an important contribution to a chapter in
surgical pathology which is not yet closed.
Jt is doubtful if any single operative procedure
ever gave rise to more acrimonious discussion
than did Syme's operation of perineal section for
obstinate stricture of the urethra. First performed
in 1840 (4i), its introduction to the profession four
years later was met by a perfect tornado of abuse,
in whicii .John Lizars played the leading part.
Supported by a coterie of surgeons whose names
are now for the most part forgotten, he attacked the
operation in magazine articles, letters to editors,
pamphlets, and booklets with extraordinary rancour.
The merits of the operation were soon lost sight of
as the controversy degenerated into an unedifying
personal quarrel between the protagonists, and
eventually led them into the law courts. By the
end of 1841) Syme had performed the operation
108 times, with only two fatal results, and these
were due to pyaMuia. Despite its detractors, the
JAMES SVME 197
operation established itself as one of the standard
procedures of surgery.
The treatment of aneurysm bulked more largely
in surgical practice in Syme's day than it does in
ours. The brilliant results of the Hunterian opera-
tion in popliteal aneurysm had led to the principle
of proximal ligation being applied to aneurysms
in other situations where the conditions for success
were less favourable, and the " old operation " of
laying open the sac and securing the ends of the
vessel fell into disuse. Syme's chief contribution
to this branch of surgery was the revival of the
" old operation " of Anel. Towards the Hunterian
operation he avowedly had '* no prejudice or hostile
feeling " — he performed it v/ith success in thirty-
four out of thirty-five cases of popliteal aneurysm
as well as in other forms of aneurysm — but he soon
recognized that its sphere of usefulness was limited,
especially when the axillary, carotid, iliac, and
gluteal arteries were involved. Experience had
shown, for example, that the earlier operations for
axillary aneurysm on the Hunterian principle were
literally *' mortifying failures," fully fifty per cent,
ending fatally *' from the effects of hemorrhage,
inflammation, or deep seated suppuration." The
risk from bleeding, which deterred some of his
contemporaries from performing the old operation,
had no terrors for Syme, nor did he mistrust the
19H THE EDINBURGH SCHOOL OF SURGERY
security of the ligature applied close to the dilated
part of the vessel. The records of some of his
operations in this field are amongst the surgical
classics, and one or two may be cited.
The first is a case of axillary aneurysm, which
for the first time brings us into touch with *' Mr.
Lister."
** D. L., a^t. forty-seven, applied for admission into
the hospital on January 2G, 1800, on account of a
large tumour, which completely filled the left axilla,
and greatly distended the muscles, before as well as
behind the shoulder. The skin was tense, but not
at all discoloured, and an obscure fluctuation could
be perceived throughout the whole extent of the
swelling, which the patient positively stated had
not existed more than a week, althougii for nearly
two months he had felt pain in his slioulder, and
observed that there was no pulse at the wrist.
There was a distinct aneurismal bruit, but no pulsa-
tion tlijit could be felt in the tumour, except at its
upper part, which projected above the clavicle. . . .
'* In the course of a few days after admission the
tumour enlarged consider:! hly, and assumed a dark
colour at some parts of its surface ; while a slough
formed over the scapula, where the pressure was
most severe. At the same time the patient began
to wander in his ideas, and his pulse rose to 130.
it was therefore manifest that unless some decided
steps were taken without delay to afford relief, the
result nuist very soon prove fatal. Ligature of the
subclavian was quite out of the question, from the
tumour extending above the clavicle ; and amputa-
tion at the shoulder-joint at first seemed to be the
JAMES SYME 199
only alternative. But before proceeding to this
desperate remedy, 1 felt desirous of ascertaining
the state of matters in the axilla, and therefore
proceeded in the following manner :
** On February 1, chloroform having been ad-
ministered, I made an incision along the outer
edge of the sterno- mastoid muscle, through the
platysma myoides and fascia of the neck, so as to
allow a finger to be pushed down to the situation
where the subclavian artery issues from under the
scalenus anticus and lies upon the first rib. I then
opened the tumour, when a tremendous gush of
blood showed that the artery w^as not effectually
compressed ; but while 1 plugged the aperture with
my hand, Mr. Lister, who assisted me, by a slight
movement of his finger, which had been thrust
deeply under the upper edge of the tumour and
through the clots contained in it, at length suc-
ceeded in getting command of the vessel. 1 then
laid the cavity freely open, and with both hands
scooped out nearly seven pounds of coagulated
blood, as was ascertained by measurement. The
axillary artery appeared to have been torn across,
and as the lower orifice still bled freely, I tied H in
the first instance. I next cut through the lesser
pectoral muscle, close up to the clavicle, and,
holding the upper end of the vessel between my
finger and thumb, passed an aneurism needle, so as
to apply a ligature about half an inch above the
orifice. The extreme elevation of the clavicle,
which rend-ered the artery so inaccessible from
above, of course facilitated this procedure from
below. Everything went on favourably afterwards.
The edges of the wound, which had been brought
together by stitches of the silver suture, united
200 THE EDINBl^RGH SCHOOL OF SURGERY
chiefly by the first intention. The hgature was
found loose on the thirteenth day, the pulse
gradually decreased in frequency as the patient
regained liis strength, and the discharge, which was
at first profuse and mixed with clots of blood,
progressively diminished. He was dismissed on
March 14, six weeks after the operation, and before
long resumed his employment, in possession of
perfect health."
In the next case the aneurysm involved the
conuTion carotid artery, and was due to a stab wound
sustained in a brawl.
'* The patient, a young man cvt, twenty, was
admitted into the hospital on June 10. The
aneurism, which was about the size of an orange,
extended in a transverse direction from the trachea
to the outer edge of the sterno-mastoid, and down-
wards close to, or rather under, the clavicle,
throbbing throughout with great force. Nearly at
the centre there was a cicatrix, showing where the
wound had been. In the course of a few days,
notwithstanding confinement to the horizontal
])osture and low diet, there was a distinct enlarge-
ment of the tumour, so that it seemed necessary to
decide without delay upon the course to be
pursued.
" The case was obviously one of great responsi-
bility, involving, as it did, not only the patient's life,
but also that of his assailant. There could be no
doubt that if the aneurism were allowed to proceed
it would before long prove fatal, by interfering with
rcsj)iration, or opening inwardly, if it did not do so
upon the external surface. On the other hand, it
JAMES SYME 201
was evidently impossible to tie the artery below
the tumour, while an aperture could not be made
into it without subjecting the patient to instant and
extreme hazard. The wound of the artery might
be opposite the cicatrix, but it might also be
situated at a lower point if the knife, as was not
improbable, had a downward direction, in which
case it would hardly be possible to apply a ligature ;
and, wherever situated, it could afford little assist-
ance in discovering the vessel, since the pressure
which had been in operation for nearly two months
must have so consolidated the textures as to render
their recognition and separation equally difficult.
There thus seemed to be not only a great risk of
the haemorrhage proving incontrollable, but also a
hardly less formidable danger of injuring the internal
jugular vein. Having carefully balanced these
different considerations, I arrived at the conclusion
that it was my duty to give the patient his only
chance of escape, and proceeded to perform the
operation on June 17.
" Chloroform having been fully administered,
and the patient being placed upon his back, with
his shoulders slightly elevated, I pushed a knife
through the cicatrix and followed the blade with
the forefinger of my left hand so closely as to
prevent any effusion of blood. 1 then searched
through the clots and fluid contents of the sac for
the wound of the artery, and found that pressure
at one part made the pulsation cease. Keeping
my finger steadily applied to this point, 1 laid the
cavity freely open both upwards and downwards,
turned out the clots, and spunged away the fluid
blood so as to get a view of the bottom,
which presented the smooth shining aspect of a
2(){ii THE EDINBURGH SCHOOL OF SURGERY
serous membrane, without the slightest indication
of either the artery or vein that could be seen or
felt. In order to make the requisite dissection, 1
next attempted to close the orifice by means of
forceps, but found that it had the form of a slit
which could not be thus commanded. It was also
so near the clavicle that pressure could not be
employed below it, and, to my still greater concern,
lay on the hnier, or tracheal side of tlie vessel, so
that the compression required for its closure, instead
of being backwards upon the vertebra*, was out-
wards upon the vein. In these circumstances it
seemed proper, so far as possible, to lessen the
opposing difficulties, and I therefore ran a bistoury
through the skin and the sternal portion of the
sterno-mastoid, so as to divide this part of the
muscle together with the superjacent integument.
I then seized the edge of the slit in the artery, as it
lay under my finger, with catch forceps, and desired
them to be held so as to draw the vessel towards
the trachea, while still subjected to compression ;
then carefully scratched with the point of a knife
until the arterial coat was brought into view at its
external edge, a little above the aperture, where a
ligature was passed by the needle and tied. I
repeated the same procedure below the wound, and,
when it was completed, had the satisfaction of
finding that my finger could be withdrawn without
the slightest appearance of bleeding, instead of the
tremendous gush which had previously attended
its sliglitest displacement. The ligatures separated
on the tenth day, and the patient, who had suffered
no inconvenience since the operation, was dis-
miss^.'d on July 17.
*' I have thus particularly related the steps of this
JAxMES SYME 203
operation because it was by far the most arduous
that has ever occurred in the course of my surgical
experience. Indeed, even now I cannot, without
a shudder, reflect on my position when the slightest
displacement of one hand must have instantaneously
caused a fatal haemorrhage from the carotid artery,
and a wrong direction of the needle by the other,
to the smallest possible extent, would have given
issue to an irrepressible stream from the jugular
vein."
The last — a case of gluteal aneurysm — is quoted
as a companion to the famous case of John Bell
(p. 71).
*' J. C.» cet. forty-four, from Carlisle, was admitted
on June 9 last, suffering from a very formidable
aneurism of the left buttock. He stated that
seven years ago, having been employed in cutting
willows for basket-making, he placed in his coat-
pocket the knife employed for this purpose, which
had a long, narrow, and sharp blade, with a large,
thick wooden handle, and then threw the bundle
of osiers which he had collected over his shoulder.
In doing this he struck the knife with such force as
to drive it deeply into the hip, and caused the blood
to flow with great profusion. Soon afterwards he
was found lying in a very exhausted state by some
children, who had him conveyed to tiie Carlisle
Infirmary, where, bleeding having ceased, the
wound was dressed superficially, and healed, with
the result of a pulsating tumour, the size of an
orange, being formed at the part. This had occa-
sioned little inconvenience, and rather been a subject
of amusement to himself and friends, until lately,
204 THE EDINBURGH bCHOOL OF SURGERY
when it suddenly enlarged and became the source
of pain, which was constantly severe, but occasion-
ally increased to a degree that was almost intoler-
able. He had on this account again applied to the
Carlisle Infirmary, and resided there for two or
three weeks, during which an embrocation had been
employed and a plaster prescribed. He then left
the hospital, and was recommended to my care by
Dr. Elliot.
" On examination 1 found an enormous tumour,
measuring more than thirteen inches across, in both
of its directions, extremely tense, and pulsating
strongly, while the pain had become still more
intolerable through the I'atigue of travelling. It
was evident that there should be no delay in
resorting to some effectual means of relief, and of
these I could not hesitate in preferring the old
operation, since, although the case was more favour-
able for ligature of tlie internal iliac than the one in
which I had recently operated, from tlie greater
thinness and laxity of the muscular coverings, the
large size of the tumour was opposed to the process
of coagulation and absorption, while the patient's
history clearly showed tliat the vessel must be
within reach at the seat of injury. I therefore
resolved to follow this course, and proceeded to do
so on the 14th.
*' The patient Inning been rendered unconscious,
and phiccd on his right side, 1 thrust a bistoury into
the tumour, over tlie situation of the gluteal artery,
and introduced my finger so as to prevent the blood
from flowing, except by occasional gushes, wiiich
showed what would have been the efl'ect of neglect-
ing this precaution, while I searched for the vessel.
Finding it impossible to accomplish the object in
• JAMES SYME 205
this way, I enlarged the wound by degrees suffi-
ciently for the introduction of my fingers in
succession, until tlie wliole hand was admitted into
the cavity, of which the orihce was still so small as
to embrace the wrist with a tightness that prevented
any continuous haemorrhage. Being now able to
explore the state of matters satisfactorily, I found
that there was a large mass of dense fibrinous
coagulum firmly impacted into the sciatic notch and
— not without using considerable force — succeeded
in disengaging the w hole of this obstacle to reaching
the artery, which would have proved very serious if
it had been allowed to exist after the sac was laid
open. The compact mass, which was afterwards
found to be not less than a pound in weight, having
been thus detached, so that it moved freely in the
fluid contents of the sac, and the gentlemen who
assisted me being prepared for the next step of the
process, I ran my knife rapidly through the whole
extent of the tumour, quickly turned out all that
was within it, and had the bleeding orifice instantly
under subjection by the pressure of a finger.
Nothing then remained but to pass a double thread
under the vessel and tie it on both sides of the
aperture.
** The patient did perfectly well after this opera-
tion, with exception of complaining that he felt pain
at the upper part of the thigh, for which I could not
satisfactorily account until about three weeks after-
wards, when I discovered a deep-seated abscess lying
over the sciatic nerve. The matter having been
evacuated by a free incision, there was immediate
and complete relief, so that the patient was dismissed
on July 29 perfectly free from complaint, and was
soon afterwards able to resume his occupation."
S!06 THE EDINBURGH SCHOOL OF SURGERY
Among the operations that Syme was the first
to perlbrin in this country were subcutaneous teno-
tomy of the sterno-mastoid for wry ne^k (18;32) ;
disarticulation of the clavicle for sarcoma (1841 ) ;
and removal of the entire scapula without sacrificing
the arm — an entirely original procedure ( 1 85G). He
also introduced improved methods of excising the
tongue for cancer ; of restoring the nose by Haps
taken from the cheeks ; of reconstructing the lower
lip by flaps taken from the neck ; and of remodelling
the nose in cases of lipoma nasi and '* morbid
expansion." In his operative work he always aimed
at attaining his object by the most direct method
and with the least complicated instrument. This
led him to modify many of the operations commonly
performed in his day with excessive elaboration and
needlessly complicated appliances. As an operator
Syme could not compete with his brilliant con-
temporaries, Liston and Fergusson. One of his
assistants. Dr. Joseph Bell, whose own prowess
with the knife gave him the right to criticize even
his master, thus expresses the special character of
Syme's method of operating :""
" Not naturally very dexterous, not even very
powerful, . . . his operating was entirely devoid
of flourish and dash. ... Me was not rapid, not
very elegant. But on the other hand, he was
absolutely free from fuss and hurry ; all idea of self,
JAxMES SYME 207
his own dexterity, his own appearance, liis own
comfort, was evidently banished when he took the
knife in his hand. He thought of nothing but the
patient, and the best — not the most rapid, not the
showiest, nor the easiest — but the best waj' of
relieving him. Having taken up his position by
the table, he rarely moved from it, standing quietly,
with very little movement even of back and
shoulders, w^orking almost exclusively with wrist
and elbow. ... His imperturbable coolness w^as
contagious, and thus he was generally well assisted
without noise, w^ith hardly a w^ord said on either
side. . . . Probably no surgeon ever was so simple
in his tastes and requirements as to instruments."
It is impossible to pass over without mention
Syme's controversial tendencies, which in a curious
way seem to reflect the defects of his qualities.
Enjoying a clearness of mental vision that enabled
him to see at once to the root of things, he
had no patience with shallow minds or superficial
thinking, and his remarkable gift of incisive
language and caustic retort, when brought to bear
on those with whom he differed, too often left
a sting that rankled. xV mere difference of opinion
on a surgical matter was apt to develop into a bitter
personal quarrel, in which the merits of tlie point
at issue were lost sight of in a paper war of re-
crimination. To his obstinacy as much as to his
208 THE EDINBURGH SCHOOL OF SURGERY
ingrained sense of right and justice may be traced
some of the quarrels which had eventually to be
settled at great cost to himself in the law courts. In
one case, not content to abide by the decision of the
jury, Syme carried on with the Lord Justice Clerk,
who presided at the trial, an animated discussion
on the laws of evidence in which, to the non-judicial
mind, he seems to have had the best of it. It must
be confessed that on more than one occasion his
excessive solicitude for the honour and dignity of
his profession led him to take action which in the
eyes of the laity seriously compromised both.
Syme's pre-eminence in the surgical world, as
well as his official position in the University of
Edinburgh, entitled him to act as the mentor on
matters relating to his own particular subject, but
scarcely justified the jealousy with which he viewed
the intrusion of specialists from other departments
into his domain. His adoption of anaesthesia was
delayed more because the discovery emanated from
the obstetrical department than because he tailed to
appreciate its advantages ; and the uncompromising
opposition he offered to Simpson's acupressure
method of controlling haemorrhage had avowedly
the same origin. It may have been that in the
practised hands of such a master of liis art as Syme,
ligation and torsion met all his needs, but in its day
it was recognized by many surgeons of distinction
JAMES SYME 209
that acupressure had merits. We cannot avoid the
feehng that Syme's dramatic rejection of it by
pubHcly destroying Simpson's pamphlet on the
subject was based on personal spleen rather than on
surgical principles. It has been said that '* Syme
was always right in the matter, but often wrong in
the manner, of his quarrels,'' but this claim only
contains sufficient truth to justify the making of
an epigram.
For well over a quarter of a century Syme held
a dominating place in the surgical commonwealth
of Europe, and was acknowledged to be *' one of its
chief architects." There were *'-few advances in
surgery that had not received some impulse from
his indefatigable and vigorous mind. " The last and
the greatest advance to receive his imprimatur was
that initiated by his distinguished son-in-law% Joseph
Lister. In what proved to be the last chnical
lecture he ever delivered, Syme spoke of the anti-
septic system as the most important subject that
had occupied the attention of the class, and as one
'' which, if it has not already done so, is certainly
destined in no small degree to revolutionize the
practice of surgery."
This was in 1868. In the spring of the following
year he had an apoplectic seizure, which necessi-
tated his resignation of the Chair. The few re-
maining months of his life were passed at his
14
210 THE EDINBURGH SCHOOL OF SURGERY
suburban home at Millbank, where for thirty-six
years he had found relaxation from the cares of his
work in cultivating the rarest fruits and flowers,
and entertaining his friends with simple Scottish
hospitality.
On June 26, 1870, he died at the age of seventy-
one, and his passing marked the close of the pre-
Listerian era of surgery.
Let his successor in the Clinical Chair and the
great apostle of the new era sum up his qualities :^^
" Mr. Syme may be said to have been a surgeon ' in
all supreme, complete in every part.' In clear
perception and luminous exposition of surgical
principles, both pathological and practical, he stood
unrivalled ; yet he was equally conspicuous for the
correctness of his diagnosis, his originality and
ingenuity in device, and his admirable excellence
in execution. His success was due not merely to
his great intellectual gifts and manual dexterity,
but full as mucli to his genial, sympathizing love
alike for patient and student, his transparent
truthfuhiess, and his exalted sense of honour.
These noble qualities made him keen in the pursuit
oi' his science, single-minded and earnest in the
discharge of surgical duty, and influential for good
in an immeasurable degree with those wlio came
within the range of his personal teaching."
Tlie passing of Syme marked the close of a
JAMES SVME 211
brilliant period in the history of surgery : the advent
of Joseph Lister opened one still more splendid.
In the radiant after-glow of Syme's fame the torch
that Lister had lighted before he was called to fill
the Chair of Clinical Surgery glimmered but feebly,
yet ere long its lambent flame illumined the whole
surgical firmament. That the light of Lister's
genius shone at its brightest in her midst is the
lasting pride of the Edinburgh School, but *' many
brave men lived before Agamemnon," and although
we " are without a divine poet to chronicle their
deeds," we would not willingly forget them.
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212
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^^ The Edinburgh Royal Infirmary Act, 1870. 33 and 34
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^^ " Report of the Proceedings at the Opening of the New
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214 THE EDINBURGH SCHOOL OF SURGERY
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6* Med. Times and Gas., January, 1880.
«5 Ibid., August, 1855.
«6 Ihid., 1880, vol. i.
«7 Ibid., January, 1880.
88 Ibid., April 12, 1856.
«» Laticet, 1837.
70 /62W., 1877.
'1 /6irf., 1834 onwards.
■^2 Ibid., October 1, 1864.
''S Edin. Med. and Surg. Joum., 1805.
74 /6^W., 1825.
75 Ibid., 1826.
76 /6?fi., 1855.
77 /6zrf., 1820, vol. xvi., p. QQ.
78 /6iV/., 1820, July, p. 120.
79 Ibid., 1821, January, p. 155.
80 iiji^^ 1823, October, p. 5QQ.
81 Ibid., 1824, January, p. 42.
82 Ibid., 1825, January, p. 26.
83 Ibid., 1826, July, p. 27.
8* Ibid., 1848, p. 267.
8^ Ibid., June, 1911.
^' Ibid., January, 1824.
87 Ibid., July, 1825, p. 52.
88 Ibid., July, 1826, p. 49.
89 Ibid., July, 1828, p. 286.
»o /6zJ., August, 1870.
»i 7&2U, 1868.
»2 Blackwood's MagnrJne, 1868. " Childe Harold, 5th canto.
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INDEX
Abernethy, John, 110, 148
Acupressure, 208
iEsculapian Society, 40
Aitken, John, anatomist, 127
Allanson, on doctrine of adhesion,
67
Alston, Dr., Professor of Botany
and Materia Medica, 26
Amputation, circular, 160, 183
flap, development of, 66
at hip-joint, Syme, 180
history of operation, 115, 159
Mackenzie's, 143
Syme's, 144, 196
triple incision of Beniamin
Bell, 58
Ana^^sthesia, introduction of, 170
Anatomical theatre, surgeons', 17
Anatomy, lirst professor of, 19
School of, 11
Aneurysmorrhaphy performed bv
John BeU, 67
Antiseptic system of surgery, 209
Ar^^^ll Square School, 128
Arnot, Hugo, historian of Edin-
burgh, 123
Auchinleck. James, 19
B.
Bailhe, John, 18
Ballingall, Sir George, 108. Ill
115,126
Barber craft, 5
Barber-surgeons of Edinburgh, 1 •
of England, 2
Barbers and surgeons, separation
of, 7
Barbers, Society of, 7
Barclay, John, the anatomist,
118, 129, 147, 176
Bell, Benjamin. 48, 67, 70
John, 48, 60, 87, US, 108, 127,
128, 147
George, of " Commentaries,"
H8, 89
surgeon, 149
Joseph, 55, 206
Sir Charles, 60, 64, 86, 98,
126, 128
Bennet, John, surgeon, 39, 44
Bent, on excision of joints, 190
Bibliography, 212
Blake, Joseph, Professor of
Chemistry, 49
Blizzard, of Loudon, 148
Brodie, Benjamin, 59
Brown, Dr. John. 188, 189, 192
Brown Square School, 123
Borthwick, James, 13
Dr., 116
Boorhaave, 24, 43
l^ouquet, of Paris, 24
Boyd, Lord Provost, 87
Brisset, Authone, surgeon to Mary
of Guise, 8
Bucknell, 166
C.
* Cadge, Mr., 166
; Callaway, of London, 136
! Chair of Clinical Surgery, 96
216
INDEX
217
Chair of Military Surgery, 108
of Systematic Surgery, 76, 80
of Pathology, 113
Cheruical Society, 176
Cheselden, WilHam, 24, 78, 91,
105
Chisholm, John, 9
Chloroform, Simpson's first ex-
periment with, 171
Chopart, 78
Christison, Sir Robert, 148, 175
Clark, Sir James, 136
Cleft palate, Fergusson's opera
tion for, 138
Clerk, Eobert, 19
Clinical Surgery, foundation of
Chair of, 96
teachingof, 123, 191,192
Clubs, old Edinburgh, 40, 41
Cock, Dr. F. William, 165
College of King James, 21
Colles's copper retractors, 158
Conservative surgery, 139, 195
Cooper, Sir Astley, 110, 135, 136,
154
Cornwall, Dr., 192
Craft of chirurgeons, 5
CuUen, William, the anatomist,
127
Dr. WiUiam, 42, 49, 115
Cupper to the hospital, 124
D.
Davy, Sir Humphrey. 170
Dental surgery, 79
Desault, 77
Doctrine of adhesion, 66
of anastomosing arteries. 65
Drainage of wounds, 184
Dressers, duties of, 124
Drummond, Adam, 20
Lord Provost, 26, 28
Duels, medical, 45
Duncan, Dr. Andrew, 40
J. Matthews, 171
Dundas, George, 19
Duhamel, 77
Dupuytren, Baron, of Paris, 179,
183
Edinburgh School of Surgery,
origin of, 1
E.
EHot, Robert. 19
Erichsen, Eric, 108
Excision of joints, revival of, 139,
143, 184, 190
Exostosis of toes, Listen's descrip-
tion of, 160
External urethrotomy, contro-
versy regarding Syme's opera-
tion of, 130, 131, 142, 196
Extra-mural School, 22, 83, 87,
192
lectureships founded in, 122
surgeons of, 121
F.
Faculty of Medicine, foundation
of, 21, 121
original members of, 26
Famous operations, 67, 71, 131,
138, 142, 143, 155, 157. 158, 160,
165, 169, 180, 185, 189, 198, 206
Fergusson, Sir Yvilliam, 36, 126,
127, 129, 131, 132, 143, 188, 206
Flanagan, Mr., surgeon, 98
Flap amputation, development of,
66
Fotheringhain, George, 9
Fyfe, the anatomist, 19, 128
Gibson, Dr. Joseph, Professor of
Midwifery, 26
Gillespie, Dr., surgeon, 149
Gimbernat, 78
Gluteal aneurysm, Syme's opera-
tion for, 205
Gooeh, of Norwich, 77, 105
Gordon, John, the anatomist, 129
Grant, Principal Sir Alexander,
121, 122
" Great Northern Anatomist," the,
147
Gregory, James, 63, 147
John, 49
Gymnastic Club, 40
U\H THE KDINBlRGIl SCHOOL OF SURGERY
H.
Hamilton, Heury, 19
James. 18, 19
Hare-lip, Fergusson's operation
for, 188
Harvie, James, 8
Hey, of Leeds, 78, 159
Hill, Dr. James, of Dumfries, 49
Home, Sir Everard, 110
Hope, John, 49, 175
Hospital, Minto House, 187
The Physicians', 30
The Surgeons', 32
Hunter, Dr. Adam, 140
John, 51, 57, 67, 77, 78, 91,
110
William, 51, 105
Hypodermic syringe, introduction
of, 43
1.
Iliac artery, ligation of, by John
Bell, 71
Innes, Dr., Professor of Practice
of Physic, 26
J.
JelTrey, Francis, advocate, 152
Johnson, Dr. Samuel, 34
Jones, of Jersey, on excision of
knee, 143
Jossy, John, 19
K.
Keith, Dr., 171
Key, Aston, 136
Knox, John, College Prayer com-
posed by, 5
Robert, the anatomist. 103.
113, 127, 129. 132
L.
Lancet advocates Chairs of Mili-
tary Surgery, 117
Lecke, George, 9
Ligation of arteries, oarlv opera-
tions for, 131, 135, 142, 158, 19S
Lisfranc, of Paris, 179
Lister. 125, 126. 198, 209
Liston, Rev. Henrv, 147
Robert, 36. 92, 101, 103,
126, 127, 129, 132, 133, 135,
136, 142, 146, 170, 176, 180,
182, 183, 188, 191, 193, 206
Lizars, John, 36, 83, 93, 126, 127,
132, 133, 162, 169, 188, 196
Lowe, Dr. Peter, 8
Ludi Appolinaris, 40
M.
McGill, John, 20, 24
" Mackintosh," invented by Svme,
175
Mackenzie, Richard James, 126,
140
Maclagan, Dr. David, 115
Sir Douglas, 115-116
Malgaigne, 141
Maxilla, resection of, early opera-
tion, 131
Menteith, Alexander, 14, 19
Military Surgery, Chair of, 83,
108
Millbank, 164, 210
Miller, Professor James, 92. 126,
170
Rev. James, 92
Minto House, 123, 163, 187, 191,
192
Mirrie, John, 19
Monro, Alexander, />ri/yn/«, 20, 23,
29, 31, 49, 126, 128
sccundus. 49, 80, 128
tertius, 83, 127
John. 23
Moreau, on excision of joints,
190
Morton, of Boston, 170
Mourtoun, Erie of, 9
Museum of College of Surgeons.
15, 19, 85, 90, 118, 134
Newbigging, William, 149, 17
New School, the, 123
New Town Dispensary, 85
Nisbet, Mr. Alexander, 19
Noctes Ambrosia ncF, 147
INDEX
219
0.
O'Halleran, Mr., surgeon, 67
Operations, famous. See Famous
operations
Orred, ou excision of joints, 190
Ovariotomy, 131
Palmer, Edward, 166
Paget, Sir James, 137
Park, Henrv, 78
Park Place School, 123
Paterson, Hugh, 19
William, founder of Bank of
England, 55
Peddie, Dr. Alexander, 188, 192
Petit, 77
Physic garden, 22
Physicians' Hospital, 30
Pitcairn, Dr. Archibald, 19
Plimmer, Dr., Professor of Chem-
istry, 26
Pott, Percivall, 69, 77
Potter, Walter, 19
Practitioner-surgeons, the, 88
Prayer of Eoyal College of Sur-
geons, 5
Pre anaesthetic surgery, 195
Price, on excision of knee, 143
Prince Consort, the, 136
Private lecturers, 22, 121, 127
Professorship of Clinical Surgery,
96
of Militarv burgery, 103
of Pathology, 113
of Surgery of Royal College
of Surgeons, 82, 162
in University, 76, 80
E'rymross, Gilbert, 5, 8
Public dissections, 17
^uesnow, M., 69
^uhite, William, 2
R.
Rab and his friends, 189
Rae, James. 48, 56, 79
Ransome, 165
{ Rau, th« lithotomist, 78
Resurrectionists, the, 4, 25, 128,
133, 148, 182
Reynolds, Russell, 166
Robertson, Dr. Argyll, 93
Robertsoun, David, 9
Rosebery, Earl of, Hon. F.R.C.S.
(Edin.), 5
Roux, of Paris, 138, 141
Royal Bath, the, 35
Dispensary, 135
Infirmary, charter of, 31
foundation of, 27
teaching in, 123
Medical Society, 154, 177
Russell, Professor James, 96, 97,
126, 191
Rutherford, Dr., Professor of Prac-
tice of Physic, 26
S.
St. Clair, Dr., Professor of Theory
of Physic, 26
Scapula, removal of, early opera-
tion for, 155
School of Medicine of the Royal
Colleges, incorporated, 125
Scott, Sir Walter, 102
Seal of Cause of Incorporation of
Barber-Surgeons, 3, 4
Sharpey, 179
Simpson, James Young, 113, 170,
195, 208
Somerville, Dr., P.M.O. Scotland.
112
Squire, Peter, inventor of ether
inhaler, 165
Dr. William, 165
Surgeons' anatomical theatre, 17
and barbers, separation of, 7
Hospital, 82
Square School, 123
Surgical anatomy, early teaching
of, 134
hospital, Minto House, 188
school, beginning of, 47
Swintoun, Robert, 19
Systematic Surgery, foundation
of Chair of, 76
2^0 THE EDINBURGH SCHOOL OF SURGERY
Syme. James, 36, 97, 103, 119,
125, 126, 127, 129, 132, 133,
139,141,142, 146,148,151,
159, 161, 174
John, W. S., 174
T.
Teale, of Leeds, 58
Thibault, of Paris, 24
Thomson, Allen. 113
John, 82. 83, 85, 109, 126
William, 113
Tourniquet, Liston on use of, 159
Town's College. 21
Turner, John WilHam, 83, 84,
HI, 126, 129
r.
Urethrotomy, external. See Ex-
ternal urethrotomy
V.
Velpeau, of Paris, 141
Venereal diseases, Benjamin
Bell's work on, 57
W.
Wardrop, James, 54
Wells, of Hartford, 170
White, Charles, of Manchester,
78, 185, 190
Dr., of Paisley, 109
Wishart, early ligation of sub-
clavian, 135
Wood, Alexander, " Lang Sandy,"
39, 52, 02
l)r. Andrew, 43
Y.
Young. Mr. Cutler, 158
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