A history of Scottish medicine: themes and influences

289 Pages·2003·1.834 MB·English

by  Helen Dingwall

A HISTORY OF
SCOTTISH MEDICINE:
THEMES AND
INFLUENCES
Helen M. Dingwall
EDINBURGH UNIVERSITY PRESS
A H I S T O R Y O F
S C O T T I S H M E D I C I N E
THEMES AND INFLUENCES
Helen M. Dingwall
EDINBURGH UNIVERSITY PRESS
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For Dr W. G. Middleton
with gratitude
© Helen Dingwall, 2003
Edinburgh University Press Ltd
22 George Square, Edinburgh
Typeset in Linotype Ehrhardt
by Koinonia Ltd, Bury, and
printed and bound in Great Britain by
The Cromwell Press, Trowbridge, Wilts
A CIP record of this book is available
from the British Library
ISBN 0 7486 0865 6 (paperback)
The right of Helen Dingwall
to be identified as author of this work
has been asserted in accordance with
the Copyright, Designs and Patents Act (1988).
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CHAPTER 3
CONTENTS
Abbreviations iv
Acknowledgements v
Introduction. Two Millennia of Medicine in Scotland 1
Part I A Nation in the Making. Medicine in Scotland
from Earliest Times to c. 1500
1 Scotland and Scots in the Making 15
2 Early Medicine in Early Scotland 23
3 Medicine in Medieval Scotland 38
Part II A Nation Ascendant? Medicine in Scotland
from c. 1500 to c. 1800
4 Scots and Scotland in Britain 63
5 Medicine in Early-Modern Scotland 72
6 Medicine in Enlightenment Scotland 108
Part III A Nation Eclipsed? Medicine in Scotland
from c. 1800 to 2000
7 Scotland and Scots in Modern Scotland 153
8 Public Medicine in Public Scotland 164
9 Modern Medicine in Modern Scotland 209
Conclusion 254
Further Reading 264
Select Bibliography 272
Index 275
iii
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CHAPTER 3
ABBREVIATIONS
Bull. Hist. Med. Bulletin of the History of Medicine
Comrie, History Comrie, J. D., History of Scottish Medicine.
2 Vols (Oxford, 1932)
EUL Edinburgh University Library
Hamilton, Healers Hamilton, D., The Healers. A History of
Medicine in Scotland (Edinburgh, 1981)
Lynch, History Lynch, M., Scotland. A New History
(London, 1991)
Med. Hist. Medical History
NAS National Archive of Scotland
NLS National Library of Scotland
Porter, Greatest Benefit Porter, R., The Greatest Benefit to Mankind.
A Medical History of Humanity from
Antiquity to the Present (London, 1997)
Proc. Roy. Coll. Phys. Ed. Proceedings of the Royal College of Physicians
of Edinburgh
Soc. Hist. Med. Social History of Medicine
NOTE ON REFERENCING
In the main text, full references are given for first citation, and a
shortened version for subsequent citations. The Further Reading section
contains items not referenced within the text, and the Select Bibliography
comprises a short list of major works cited in the book.
iv
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ACKNOWLEDGEMENTS
This book has been many years in the making. It has changed out of all
recognition since the first tentative outline was submitted to Edinburgh
University Press; changed, it is to be hoped, for the better. I wish to
acknowledge the help and support of many individuals and institutions
who have made the work possible. Considerable help has been received
from the staff of a number of institutions, including the Royal College of
Surgeons of Edinburgh, the Royal College of Physicians of Edinburgh,
the National Library of Scotland, the National Archive of Scotland, the
Library of the Royal College of Surgeons of Ireland and the Libraries of
Stirling, Glasgow and Edinburgh Universities. I am grateful to Sir John
Clerk for permission to consult the Clerk of Penicuik papers.
Among the many individuals who must be acknowledged are, first and
foremost, the entire staff of the Department of History at the University
of Stirling, who have been of considerable help and support, often
through rather stormy times in recent years. Dr M. A. Penman, Dr I. G.
C. Hutchison, Dr J. L. M. Jenkinson and Dr E. V. Macleod have all made
useful comment on sections of the book, and this is much appreciated. I
am also grateful to Dr M. Barfoot, Dr M. Dupree, Professor H. J. Cook,
Mr D. Hamilton and Professor L. Rosner for helpful advice and criticism.
Errors of fact or interpretation that remain are, of course, my own.
This book was in large part conceived and created for, and as a result
of, my special subject course on the history of medicine and society in
Scotland. The students who took this course regularly provided original
and stimulating insights and suggestions, without which the book would
have been much the poorer. Their contribution is acknowledged with
appreciation.
Holly Roberts and Nicola Carr of Edinburgh University Press remained
sanguine throughout many delays and missed deadlines, and their help
and encouragement were most welcome, as was the assistance of editors
Eddie Clark and Alison Rae.
As most authors will acknowledge, no book can be completed without
v
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vi ACKNOWLEDGEMENTS
the help and support of family and friends. I am happy to extend my
thanks to my sister Elizabeth, and to Bill, James and Andrew, Robert
and Anne, and also to Irene Drummond, Patricia Cripps and Doris
Williamson.
Finally, I am indebted, for support and, importantly, friendship and
encouragement, to Professor G. C. Peden, Dr R. B. McKean, Professor
M. Lynch and Professor C. A. Whatley; and for medical reasons to Mr
E. W. J. Cameron, Dr A. J. Jacob, Dr F. C. McRae, Dr N. R. Grubb
and, most of all, to Dr W. G. Middleton, to whom this book is dedicated
with grateful thanks. There is much that is very good about medicine in
Scotland today.
vi
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TWO MILLENNIA OF MEDICINE IN SCOTLAND 1
INTRODUCTION
TWO MILLENNIA OF
MEDICINE IN SCOTLAND
To write a global history of medicine in Scotland is virtually impossible.
How can one modestly-sized volume account with any measure of
adequacy for the evolution and increasing complexity of medicine and
medical practice in a small, but equally complex and often dispropor-
tionately important nation? It is necessary not only to chart the progress
of medical and surgical training, professionalisation, institutionalisation,
practice and the experiences of the consumers of medical care, but also
to assess these developments in terms of a number of complex, inter-
acting forces, including Scottishness, Scotland, Britain and Empire.
Medicine in the rural areas and remote highlands and islands of Scotland
was, and in some ways still is, very different from lowland urban
medicine. The distinctively Scottish influence is perhaps less now than it
was three centuries ago, though it may not be insignificant that a fair
proportion of the medical personnel who occupy the highest national
institutional posts, including the British Medical Association, are Scots.
It has been claimed that surveys have shown that doctors with Scottish
accents are trusted more than those without. This may be a statistical
quirk, or even mildly amusing, but may also be taken more seriously.
The major aim of the book is to account for the progress of Scottish
medicine in the context of the evolution and progress of the nation. The
Scottishness, it may be claimed, is a false notion. It may be argued that
medical practice in Roman-occupied Scotland was influenced by Romans.
Traditional medical care in the south-west of Scotland may have had
much in common with Irish practices. Could there have been in any
sense Scottish medicine before Scotland existed as a geographical entity?
Did the strong and well-used European contacts made by Scottish
doctors in the late-medieval and early-modern period mean that Scottish
medicine was in fact European medicine? Did the increasingly British
and, later, Imperial, context from the early nineteenth century mean that
Scots were participating in British and Imperial medicine? Does the
highly technological nature of twenty-first-century medicine, which has
1
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2 A HISTORY OF SCOTTISH MEDICINE
virtually no national barriers and is truly global, mean that historians
must write about medicine in Scotland, and not Scottish medicine?
There has been much debate among historians as to whether there was a
distinctive Scottish Enlightenment in the eighteenth century, or whether
there was merely Enlightenment in Scotland. The same dilemma is faced
by historians of medicine.
All of these factors need to be taken into account, though it will be a
major contention of this book that whereas the nature and precise
manifestation of the Scottish factor changed over the course of the last
two millennia, it is still possible to identify distinctive characteristics or
aspects which, if not nowadays very different from British or Western
medicine, have been influenced and characterised by Scots and by
Scotland. At the beginning of the first millennium there were no Scots,
but the various peoples who inhabited the territory which became Scotland
lent their individual and group characteristics to the development of the
nation and its people. Over the course of the next two thousand years the
descendants of these people became Scots and inhabited a discrete
territory, but also maintained contacts with England, Europe and
ultimately the New World and the technological globe. The identity of
the Scots is difficult to describe or assess. One view is that it was influ-
enced considerably by two factors: the Christian religion and a continuous
monarchy.1 This may well be true of the medieval period, but different
and more complex factors shaped modern Scots, so that by the end of
the second millennium AD, the average Scot may not be either Christian
or monarchist. Despite this, though, some factors do seem to remain,
including the importance placed on educational opportunities. These
changes are complex and the influence of the Scot within and furth of
Scotland is less easy to identify, but it does seem that the complexities of
the past have produced, whether by coincidence or intent, something
which can be labelled Scottish, although the debate on what precisely
this is will go on. In order to give some sort of interpretation it is
necessary to contextualise both in the Scottish and the international sense.
Chapters One, Three and Seven offer brief general historical surveys of
the periods covered in each of the three main sections of the book. The
‘Further Reading’ and ‘Select Bibliography’ sections include reference to
works on Scottish and British political, social and economic history, as
well as to books and articles on medicine.
Chapter Two is a brief account of medicine as practised in the
territories which would become Scotland and which would be peopled
eventually by inhabitants called Scots. The modern Scot is a distant
descendant of early ancestors who themselves had regional rather than
national identities. A recently published book on Scottish identity
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TWO MILLENNIA OF MEDICINE IN SCOTLAND 3
highlights the difficulties of defining Scotland, particularly before the
period when the territory became circumscribed and stabilised: ‘Before
the thirteenth century, Scotland meant different things to different
people, and different areas to different people, and any idea of Scots as a
distinct nation or people was not fully formed before the period of the
wars of independence’.2 However, even when the nation eventually
became bio-geographically delineated, the identity, culture and ideologies
of its inhabitants still depended to a great extent on their local identities,
and not on an image or identity which has been constructed by historians
and others at a distance of many centuries.
Chapter Three deals with medicine in medieval Scotland which was,
as was most of the European continent, dominated by the overwhelming
influence of the Roman Catholic church. The church dominated all
aspects of society, and so the medical discourse was also largely the
discourse of the church. Anatomists experienced difficulties in extrapolat-
ing from animal dissection to the human condition (human dissection
being frowned upon), and the attitudes of fatalistic acceptance inculcated
into the population affected the givers as well as the seekers of medical
help. If a disease or injury were considered to be just desserts for sin,
then individuals did not seek medical care from ‘professionals’, but
rather treated themselves or used common cures, charms, spells and
other superstition-based remedies, as well as the ministrations of the
church, both sacred and secular. The medieval period in Scotland was,
in the wider context, a time of consolidation of the nation under a more
stable dynastic progression. The period was not without conflict; disputes
among the nobility were settled by bloodfeud rather than litigation, and
monarchs ruled by the sword as much as by the council or parliament.
The medicine that was practised reflected this – Scottish surgeons were
becoming highly skilled in the art of the quick – though certainly not
painless – amputation; they gained repute not only in Scotland or in the
courts of Scottish kings, but also in the armies and on the continent of
Europe. Peter Lowe (c. 1550–1610), who wrote a student textbook on
surgery3 and was one of the founders of the Faculty of Physicians and
Surgeons of Glasgow, had, before settling in Glasgow, served both the
French army and the French royal house for a lengthy period.
Connections of a more peaceful, trading, educational and cultural nature,
were made with Europe, especially with France and the Low Countries,
and these ties would continue and become very important for the
progress of Scottish medicine in the early-modern period.
The medieval period was also significant in terms of the secularisation
of medical training and practice. Although any grand idea of a sudden
flowering of medical knowledge and progress is not appropriate, as
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