is always an honor to introduce to our readers someone I have known for many
years, especially when that person is a fellow member of the renowned Burns
Club of Atlanta. More importantly, it is special when that person is loved
and respected by all club members as is our writer today. Recently he spoke
to members and guests at our Burns Club, and when I asked to share his talk
with our readers, he graciously consented.
Dr. Thorne S. Winter, III of Atlanta, Georgia, sent to Duke University and
graduated cum laude from Harvard Medical School. His post medical school
training included Peter Bent Brigham Hospital in Boston, the National
Cancer Institute, and Emory Medical School in Atlanta. He was in the private
practice of internal medicine and cardiology for 40 years and currently
serves as medical director of the internal medicine division of the Multiple
Sclerosis Center of Atlanta. Thorne is a Fellow of the American
College of Physicians, the American College of Cardiology, and the Society
of the Antiquaries of Scotland. He is a member of the American Osler Society
and the American Society of Clinical Oncology. And, he is a past president
of the Burns Club of Atlanta.
remember how excited Thorne was a few years ago when on behalf of the club I
invited Dr. David Shi, President of Furman University, to speak at one of
our monthly Burns Club meetings. The Burns cottage was packed to hear Dr.
Shi speak. Several members had Furman connections but Thornes stand out.
His mother, Lanche Friend Attaway Winter, graduated from Greenville Womens
College, which officially merged with Furman University in 1937. His son,
Thorne Winter, IV married a Furman classmate, Sandra McAlaster, and both are
graduates of the university. Thornes granddaughter, Melissa Mabry, if my
memory does not fail me, was a freshman the year Dr. Shi spoke, and she has
since graduated as well. Dr. Shi gave a brilliant speech that night on John
Witherspoon, the famous minister from Scotland who not only signed the
Declaration of Independence but also the Articles of Confederation while
President of the College of New Jersey which later became Princeton
University. Why so much Furman University information? Well, I graduated
from Furman back in the dark ages and I do not mind giving the school a plug
every time I have an opportunity. Furman today is still one of the most
beautiful campuses in America and the academic record there is just as
is a joy to welcome Dr. Winter to the pages of Robert Burns Lives!. I
want to thank my friend Bill Tucker, editor of the excellent monthly Burns
Club of Atlanta newsletter, for his assistance in providing the speech and
accompanying photo of Thorne which first appeared in the April issue. It is
one I look forward to receiving each month. In addition, I do not thank my
son Scott enough for the help he gives me with articles for this website.
When I bump into a computer problem that I cannot solve, I usually send it
to him and ask him to put it in a Word document and email it back to me -
and he does it every time!. Thanks, son. Youll never know how much your
assistance means to me in this labor of love on behalf of Robert Burns and
his friends. (FRS: 4.27.11)
Robert Burns His
Life, Illness and Death:
18th Century Medicine in Scotland By Thorne Winter, MD
Thorne S. Winter, III, MD
Ladies, gentlemen, members of the Burns Club of Atlanta and their guests, my
talk is divided into two parts:
Robert Burns his life, illness and death,
A review of medicine in the 18th
Century in Scotland with an emphasis on medicine in Edinburgh during
Burns lifetime in the later half of the century.
Robert Burns was born in 1759 and died in 1796. He is the national bard of
Scotland, the worlds most popular love poet and a major advocate of liberty
and humanity. His works are largely in the Scottish dialect, but some of his
works are in Standard English.
Burns was born in the rural town of Alloway in southwestern Scotland. He was
educated by his father and a local teacher. He supplemented his education by
reading on a wide variety of topics. Like his father, Burns was a farmer for
much of his life. Initially, the writing of poetry was only for recreation.
the age of 27, Burns published in Kilmarnock, Scotland a limited edition of
600 copies of his poems titled: Poems Chiefly in the Scottish Dialect.
This was a success and it was followed the next year by the publication of a
larger Edinburgh edition of 3,000 copies of his poems. He continued to write
poetry throughout his life.
During the last nine years of his life, Burns devoted much of his time to
the collection and preservation of about 350 old Scottish songs and ballads.
Some of these works existed only in fragments. He re-worked about 250 of
these into the forms that have endured to this day. In many cases this
required the taking of Gaelic tunes of Celtic origin and fitting them with
words of Scots-English, a language of Germanic origin.
few of Burns more famous poems and songs include: To A Mouse; To a
Louse; The Cotters Saturday Night; Tam OShanter; A Mans A Man for A
That John Anderson, My Jo; Ae Fond Kiss; A red, Red Rose; an Address to a
Haggis; and the New Years Standard, Auld Lang Syne.
the age of 29, he moved to Ellisland, a farm near Dumfries where he became
an exciseman or tax collector. At the age of 32, he moved to Dumfries where
he died at the age of 37.
Burns early biographers felt that alcoholism was the cause of his death.
But after reviewing his medical history as quoted by Burns himself and his
friends, I have come to a different conclusion.
a teenager, Burns had episodes of headache, palpitations, fainting and
nocturnal shortness of breath. At age 22, he had a three months illness with
fever that was treated with ipecac, rhubarb, opium and Peruvian bark. At age
23, he suffered a relapse with fever, heart irritability and nocturnal
faintness. This was treated with cold-water baths. At the age of 30, he had
a bout of Quinsy. This is severe tonsillitis with pus. At the age of 36, he
had a severe toothache that he memorialized in the poem, Address to a
When fevers burn, or ague freezes
Rheumatics gnaw, or colic squeezes
Our neebors sympathise to ease us.
We pitying moan.
But the! Thou hell O a Diseases
They mock our Groan
Subsequently, Burns health progressively declined. He suffered from flying
gout or migratory arthritis, fever, rapid pulse, weakness, pallor, delirium
and ultimately, death. Treatment consisted of cold-water baths up to his
armpits in the Solway Firth.
feel that Burns had rheumatic fever as a primary illness. This is an
autoimmune disease that is initiated by an infection with a Beta-hemolytic
Streptococcus bacterial infection. The body reacts to this infection by
making antibodies that react against the streptococcus. Unfortunately, these
also cross react against the bodies joints, heart, skin and nervous system
causing inflammation in these tissues. Symptoms include fever, migratory
joint pain, palpitations and shortness of breath. The illness may be
Inflammation of the heart valves may lead to scarring and deformity of the
valves. If at a later time, bacteria enter the blood stream, as from an
infected tooth, the bacteria may lodge and grow on the deformed valves. This
sets up a chronic infection that ultimately leads to death. This is
variously called: Chronic Infective Endocarditis, Subacute Bacterial
Endocarditis, or Infective Endocarditis with specification of the organism
and valves involved.
Rheumatic fever itself was not fully described until the early 19th
Century. Chronic infective endocarditis was not fully described until 100
years after Burns death by Dr. William Osler. He described 10 cases similar
to Burns. Six had a history of rheumatic fever. All had remittent fever.
All had valvular heart disease. The ages ranged from 19 to 53. The duration
of the disease was 4 to 13 months. It took almost another 100 years before
effective treatment was available in the form of antibiotics and surgery.
I will now turn to a discussion of
Medicine in Scotland. In the 17th
Century, there was no knowledge of what caused disease. Some observable
features of diseases were known e.g., Gout, Rheumatism and Quinsy. Some
empirical remedies were known e.g., Peruvian Bark.
In 1638, Peruvian Bark became
the first major specific treatment of a disease. The wife of the Spanish
Vice Roy in Peru, the Countess Chencon (Chin Chon) developed a fever that
was cured by the bark of a tree. The popular name of the tree bark was
simply, Peruvian Bark. The scientific ingredient was quinine. The disease
was malaria. In Scotland, this was used to treat Ague that was a fever and
aches that was probably malaria contracted by Scottish sailors in the
By the end of the 17th
Century in Scotland, future medical practitioners had little formal
education and questionable examinations. Medicine was unscientific. During
Century, Scotland had been economically poor and politically distraught.
Century was different. The politics in Scotland was volatile, being a
mixture of religion, patriotism and patronage. By 1750, the population was
75% literate (one of the highest rates in Europe). In the last half of the
century, Edinburgh became the center of learning in almost every human
insight and activity. This was called the Scottish Enlightenment.
Participants included: Adam Smith (philosopher and political economist,
and author of The Wealth
of Nations), David Hume (philosopher), William Cullen (physician) and
James Hutton (geologist).
will now turn to medicine in Edinburgh in the 18th Century. Since
1505, there had existed in Edinburgh Incorporation of Surgeons and Barbers
with the surgeons ultimately separating from the barbers in 1727. The
Incorporation was a craft guild under charter from the City of Edinburgh.
Surgeons as Cirugeon-Apothecaries acted as general practitioners. They
compounded and sold drugs and performed surgical procedures using crude
instruments made by blacksmiths. Education was by apprenticeship for three
years to surgeons of variable competency. Upon completion of apprenticeship,
the apprentice was questioned by the Incorporation on the theory and
practice of his profession. He then dissected a part of the body, compounded
a prescription and produced a thesis. If he passed, he could be admitted to
1776, the Incorporation partially separated from the town council of
Edinburgh and received a Royal Charter as the Royal College of Surgeons of
Edinburgh. This became a degree granting institution, granting a diploma but
an M.D. degree. The Royal College of Physicians of Edinburgh was founded in
Physicians were those medical practitioners who practiced Physic. Physic was
the treatment of internal diseases by medical means. Physicians could
prescribe medicine, but they could not dispense medications. They could not
do any form of surgery. Diagnosis was by history, observation of the patient
and his urine in combination with a check of his pulse. There was no
physical examination. The Physicians possessed a university degree; but
prior to 1727, there was no place in Scotland where they could study
medicine. They had to go to Europe instead.
In 1726, the town council of
Edinburgh established a medical school of Physic, and four physicians of
prominence were installed as professors of surgery, physic, botany and
material medica. In subsequent years, professorships were added chemistry,
medical practice, medical theory, mid-wifery, clinical medicine and clinical
surgery. The many eminent teachers who filled the medical and surgical
chairs in successive generations effected a major change in the methods of
teaching and practicing medicine. Regular scheduled lectures were
established and courses could be attended by students as they chose.
Graduation requirements for an
M.D. were specific:
The student must have
completed all the courses that were offered. This was usually done in
He must pass a private oral
He must write and publicly
defend a thesis on a topic of his choice.
He must write commentaries
a. A general medical question
b. Two case histories
c. Aphorisms of Hippocrates
[Aphorisms are concise statements containing a subjective truth or
observation cleverly or pithily written. Hippocrates wrote the first
book of aphorisms. An example is: Persons who are naturally of a full
habit (i.e., fat) die suddenly, more frequently than those who are
slender. This is the first written observation that fat people have more
frequent heart attacks.]
Except for the courses taken, all of the examinations were in Latin. If
successful, the student was awarded the degree, Doctor of Medicine.
Only a small portion of the students at Edinburgh Medical School received an
M.D. degree. For varying reasons, many students attended only a few courses
for varying periods of time. They might be apprentices or fellow of the
Royal College of Surgeons. They might be auditors from general practice.
From 1760 to 1826, 17,000 students from many parts of the world attended. It
became the most influential European school for the development of medicine
in America. In the second half of the 18th Century, 117 Americans
gained their medical degrees from Edinburgh, and a much larger number
attended courses there. Sons of Presbyterian Scottish emigrants and sons of
Pennsylvania Quakers attended because they could not attend Oxford or
Cambridge that were only open to Anglicans.
The Medical School of the College of Philadelphia was founded in 1765. This
was the first medical school in North America and all of its founding
members were trained in Edinburgh.
Dr. William Cullen is an example of a leading Scottish Physician. From 1736
through 1744, he was a general practitioner/surgeon in Hamilton, Scotland.
He later trained in chemistry. At Edinburgh Medical School, he became an
excellent teacher, teaching chemistry and the theory and practice of
medicine. He made clinical rounds at the Royal Infirmary of Edinburgh and he
carried on an active consultative practice. He wrote a student textbook in
English titled: First Lines of the Practice of Medicine. This was translated
into French, German, Italian and Latin. It was the leading textbook on the
practice of medicine for over 50 years. He wrote a Synopsis and Nosology
of Diseases, which was a classification of
diseases similar to the biologic classification of Linnaeus. He also
spearheaded the improvement in the Edinburgh Pharmacopoeia, a detailed
listing of medications.
The first Edinburgh
Pharmacopoeia in 1699 had 450 vegetable preparations that were so
complicated as to suggest that ignorance of treatment could be masked by
complexity in preparation. Animal preparations were repugnant as to suggest
that the more revolting and unpalpable the remedy, the more probable the
cure. Examples included: cobwebs, vipers, toads, worms, snails, wood lice,
powder of human skull, powder of mummy, goose fat and excrement of dog. The
Pharmacopoeia of 1737 continued to have a large number of bizarre
ingredients. Under the leadership of Dr. Cullen, most of the bizarre items
were eliminated in the 1776 Materia Medica Catalogue.
William Hunter was Dr. William
Cullens Surgeon/Apothecary Apprentice from 1737 to 1741. Dr. Hunter then
went to London where he became a famous anatomist and obstetrician. His
younger brother John Hunter joined him in London and became the first
scientific surgeon. He also founded the Hunterian Museum of Medicine and
Natural History. The Hunter medical gene lives on in our own Dr. Richard
Dr. John Brown was a physician
who disagreed with Dr. Cullen and developed his own theory of medicine. His
theory, the Brunonian Theory, was that all disease was the result of either
under-stimulation or over-stimulation of the body. As under simulation was
usually the major problem, he advised the use of stimulants such as alcohol
or opium. As he frequently imbibed both of these during his lectures, many
of his lectures wandered into fantasy. His ideas partially live on today. In
the current issue of Practical Pain Management the lead article is
titled, The Simultaneous Use of Stimulants (Amphetamines) and Opioids (morphine) in
James Curries was a physician who trained in Edinburgh, but who practiced in
Liverpool, England where he worked with the poor and the insane. He used
cold-water treatments in the successful treatment of a case of contagious
fever. He published a pamphlet titled, Medical Reports of the Effects of
Water, Cold and Warm as a remedy in fevers and other diseases. It
contained the first systematic record in English of clinical observations
with the thermometer. Relative to my story is the fact that he was
influenced by Dr. John Brown and his stimulant theory. Dr. Currie was one of
Burns first biographers. This may explain Curries emphasis in his Life
of Burns that excessive use of alcohol was a major factor in Burns
death. Unfortunately, this emphasis persisted for many years.
will close this talk with observations by Dr. William Heberden in his 1802
book, History and Cure of Disease. His basic considerations were:
Does the disease require any evacuations,
e.g., bleeding with leach, cup or lancet, laxatives or emetics
Does the disease have a specific or certain
known remedy e.g., Peruvian Bark or Cinchona for Malaria (Ague); Quick
Silver (mercury) for venereal diseases; Sulfur for the itch; and opium
for spasms, pain or diarrhea; drinking medicinal water for stomach
Fore severe, protracted disease with no
successful remedy, consider shocking the body e.g., cold-water baths,
mercury, hemlock, antimony or electrification.
When nothing else works, use supportive care
e.g., diet, sleep, aromatics and chamomile.
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