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Significant Scots
Andrew Combe

COMBE, ANDREW, M.D.—This excellent physician and physiologist was the fifteenth child, and seventh son of Mr. George Combe, brewer, at Livingston’s Yards, in the suburbs of Edinburgh, and Marion Newton, his wife, and was born on the 27th of October, 1797. After being educated in the initiatory branches at a private seminary, he was sent at the age of eight to the High School of Edinburgh, and having continued there at the study of Latin and Greek for five years, he went to the university, where, in the course of two seasons, he contrived to forget what Latin he had learned at school, and become a respectable Grecian. But with all this teaching of dead languages, his own was allowed to shift as it might, so that, although he could read Homer, he was unable to pen a tolerable ordinary epistle. Like many others under a similar process of teaching, and who have risen to distinction in the world of authorship in spite of such a perverted education, Andrew Combe, by the diligent self-cultivation of after years, acquired that mastery of the English language and excellence in composition, which his works so fully attest. After he had passed a sickly taciturn boyhood, and entered his fifteenth year, it was fitting that he should announce the future profession he meant to follow; but to every question on this head from his parents, his invariable answer was, "I’ll no be naething." They understood these two negatives in the Scottish acceptation, of course, and reckoning such a choice inexpedient in one of a family of seventeen children, his father chose for him the medical profession, into which the apathetic youth was to be inducted without further delay. Accordingly, in spite of all his struggles, Andrew was forced into a new suit of clothes, carried out of the house, and trotted along, by dint of pulling and pushing, to the dwelling of his future master, where he was bound and left—to an apprenticeship which he had no subsequent cause to regret.

After finishing his apprenticeship, during which he attended the usual medical course at the university and the public hospital, Andrew Combe, when he had entered upon his twentieth year, took the diploma of surgeon. Previous to this event his intellectual habits had received not only a fresh impulse, but also a new direction from the study of phrenology, which was introduced into Edinburgh through the arrival and lectures of Dr. Spurzheim. Of this science Mr George Combe, afterwards its distinguished advocate, became an earnest student, and his younger brother Andrew was not long in following the example. This latter, however, when he had little more than commenced his inquiries in earnest upon the subject, went to Paris in 1817 to perfect himself in his professional studies. The Continent was now opened to Britian by the general peace, and our medical students were eager to avail themselves of the opportunity by completing their education in the French capital. Among the Parisian lecturers on the various departments of science whom Andrew Combe attended for this purpose, he was so fortunate as to be a pupil of Professor Dupuytren, to whose lessons so many of our most eminent physicians have been so deeply indebted. He also frequently associated in Paris with Dr. Spurzheim, by whom he was completely converted to a belief in that science by whose rules all his future habits of investigation were more or less directed. As this was a most important event in his life, it may be proper to give his own account of it:—"My attention was first seriously turned to the examination of these doctrines during my residence at Paris, in the autumn of 1818, when Dr. Spurzheim’s ‘Observations sur la Phrenologie,’ then just published, were happily put into my hands at a time when, from there being no lectures in any of the Parisian schools, I had ample leisure to peruse that work deliberately. I had not proceeded far before I became impressed with the acuteness and profundity of many of the author’s remarks on the varied phenomena of human nature, and with the simplicity of the principles by which he explained what had previously seemed contradictory and unintelligible; and in proportion as I advanced, the scrupulousness of statement, sobriety of judgment, and moral earnestness with which he advocated his views and inculcated their importance, made me begin to apprehend that to condemn without inquiry was not the way to ascertain the truth of phrenology, or to become qualified to decide in a matter of medicine or of philosophy. I therefore resolved to pause, in order to make myself acquainted with the principles of the new physiology, and to resort, as he (Dr. Spruzheim) recommended, to observation and experience for the means of verifying or disproving their accuracy, before again hazarding an opinion on the subject." Thus prepared for examination and conviction, he examined and was convinced. After two years of such study the following conclusion was the result:--"Actuated by the natural feeling of improbability that so much should have been discovered in so short time by only two individuals, however eminent their talents and felicitious their opportunities, I still expected to meet with some important errors of detail; and, so far from being disposed to adopt implicitly all the propositions of Drs. Gall and Spurzheim, I rather looked for, and expected to find, some hasty conclusions or unsupported assumptions; and my surprise was extreme, to discover that, in the whole extent of their inquiry, they had proceeded with so much caution and accuracy as, in all their essential inferences, to have rendered themselves apparently invulnerable." At the early age of twenty-one he thus became a firm believer in phrenology, and, unlike many others of his contemporaries, he continued to believe in its principles and apply its rules to the last.

After a course of diligent study at Paris continued for nearly two years, and a tour through Switzerland, he returned to Edinburgh at the close of 1819. He was now ready, as far as professional knowledge and the encouragement of friends went, for the commencement of business as a medical practitioner, but, unfortunately, he needed for himself the aid which he should have imparted to others. In his rambles in Switzerland he had over-tasked his strength, and on returning to Edinburgh, a cold room and damp bed confirmed the evil. A voyage to Italy was judged necessary for his recovery, and he embarked at Greenock for Leghorn at the end of the following year. The cure was effectual, for he returned to Edinburgh in May, 1822, and soon after commenced practice as a surgeon, while his extensive family connection, and the reputation he had already acquired, soon procured him an extensive circle of occupation. At this time, also, he first appeared before the world as an author, in an essay "On the Effects of Injuries of the Brain upon the Manifestations of the Mind," which was first read before the Phrenological Society, and afterwards published in its "Transactions." In this way, he brought his beloved science into full play at the commencement of his public life, not only in a literary but also a professional capacity, notwithstanding the obloquy and derision with which it was generally treated at this period. And this integrity was not without its reward. "My advocacy of phrenology," he stated, in a lecture before the Andersonian Institution of Glasgow, "did not prove any impediment in my professional career; on the contrary, it in many respects extended my field of usefulness, and greatly contributed to my happiness, by giving a more definite and consistent direction to the faculties which I possess. No doubt, some who might otherwise have employed me, were at first deterred by their prejudices from doing so; but their place was more than supplied by others, who, in their turn, would not have sought my advice except for phrenology; and ere long many even of the prejudiced ventured to return, and ultimately took place among my warmest friends. . . . .In the private relations of life, also, I have derived the utmost advantage from the lights of phrenology, and have gained a firmer hold on the confidence of my patients, by pointing out to them its great practical value in conducting the intellectual and moral training of the young, in promoting mutual forbearance and general kindness of intercourse, and thereby adding to their general means of happiness." In 1823, while the phrenological controversy was at its height, Mr. Combe again entered the field in its defence, by an essay entitled, "Observations on Dr. Barclay’s Objections to Phrenology," which was also published in the "Transactions" of the Society. In the same year he, in conjunction with four others, established the "Phrenological Journal," to which he was an active contributor till his death. In 1836, he collected the most important of these articles, and published them in a separate volume. Eager to extend the knowledge of a science to which he was so devoted, and justify its claims to universal attention, he also hazarded their introduction into a quarter where they were little likely to appear without a severe examination. This was in the Royal Medical Society of Edinburgh, of which he was a member, and before which he was obliged in his turn to write a dissertation upon a subject selected by a committee of the society. The question proposed in 1823 was, "Does Phrenology afford a satisfactory explanation of the Moral and Intellectual Faculties of Man?" and Mr. Combe was appropriately selected to write the dissertation. He set to work upon the question con amore, and produced a digest of all he had learned, thought, and observed, to bear upon the affirmative, while the discussions that followed upon the subject occupied two nights of earnest debate before crowded audiences. This able article, which was first published in the "Phrenological Journal," was also included in the volume of selections to which we have already alluded. In 1825, he graduated as Doctor of Medicine, and on that occasion chose for the subject of his thesis, "The Seat and Nature of Hypochondriasis," which was also published in an enlarged form in the "Phrenological Journal," and the "Selections."

In commencing the medical art, first as surgeon and afterwards as doctor, Combe was made aware of two faults which, in his course of practice, he carefully laboured to avoid. The first was the practice of never interposing until the crisis of danger had arrived. No rules were prescribed, either to avoid a disease or escape the repetition of an attack after the first had been conquered. As long as the patient was upon his legs he might use what diet or exercise he pleased: upon all this the man of healing was silent; he thought it enough to come in at the moment of danger, and treat the sufferer secundum artem until the danger was over, without troubling himself about the morrow; and if fresh excesses produced a deadlier renewal of the malady, he was ready to double the dose, and proportion the penance to the evil. The homely proverb, that "prevention is better than cure," was too vulgar a rule for scientific notice; and it was only when the disease fairly showed face that a doctor girded himself for the onset. This was anything but satisfactory to Dr. Combe; and, in his treatment of every malady, he was more solicitous to prevent its occurrence than to show his professional prowess by overcoming it at its height; and if the constitution of the patient made the disease a natural tendency, his medical skill was exerted in showing how the coming of the evil might be retarded, or its inflictions softened. Hence his carefulness in inculcating the rules of diet and exercise, of ablution and ventilation, which, homely and common-place as they are, and therefore deemed unsuited to a learned physician, are yet the true essentials of the healing art. Another fault which he was also careful to avoid, was that of dictating to the patient the medical regulations that were to be strictly followed, without assigning a cause, or enlisting his reason in their behalf. A blind, implicit faith was exclusively demanded by too many of our medical practitioners, and the remedy was to be used without question or scruple. Dr. Combe saw that, however this pope-like assumption of infallibility might gratify the vanity of the physician, it was little likely to benefit the patient, more especially if his faith was of that unruly kind that requires argument and proof. He therefore tried to enlist the reason of the patient in behalf of the rules prescribed for his cure, and showed so much of the nature, origin, and tendencies of the disease as would enable him to co-operate in its removal. "The consequences of this mode of proceeding," says his biographer, "were equally beneficial to his patients and to himself. They became convinced that was nature that was dealing with them, and that, although they might ‘cheat the doctor,’ they could not arrest the progress of her evolutions, or escape from aggravated evils, if they obstructed the course of her sanative action. Under these convictions, they obeyed his injunctions with earnestness and attention. By being premonished of approaching symptoms, which were frequently steps in the progress of the cure, but which, if not explained, might have been regarded as aggravations of the malady, they were saved from much alarm, and he from many unnecessary calls and attendances. His present biographer had ample opportunities of remarking how few messages, even during the busiest seasons of his practice, came to him from patients under treatment, and how very rarely he was called upon to visit them during the night. He ascribed this comparative immunity from nocturnal calls to the explanations and pre-arrangements now adverted to."

It was not till 1831 that Dr. Combe appeared as the author of a separate work, as his productions had hitherto been articles and essays, which were afterwards published in the form of pamphlets. Among the subjects he had studied in connection with phrenology, was that of insanity; and from its importance, as well as the general interest which several cases of mental disease had lately excited, he resolved to give at full length the fruits of his study on this painful malady, with a view to its prevention, amelioration, and cure. The title of the work he published was, "Observations on Mental Derangement; being an application of the Principles of Phrenology to the elucidation of the Causes, Symptoms, Nature, and Treatment of Insanity." After this his close application to professional duties, in which he embarked with his whole heart, and the physiological studies that occupied every moment of his leisure time, so exhausted his delicate constitution, that intermission and change of climate were again found necessary; and accordingly he spent the winter of 1831-32 in Italy, and the following year in Edinburgh, London, and Paris. In 1834, though his health was still infirm, he published in Edinburgh "The Principles of Physiology applied to the Preservation of Health, and to the Improvement of Physical and Mental Education." This work was so favourably received, and continued to be so highly valued, that at the period of his death 28,000 copies of it had been sold, exclusive of the numerous editions that had been published in the United States of North America. So highly was Dr. Combe’s professional reputation now established, that in 1836 he was honoured with the appointment of Physician to the King of the Belgians. This occasioned two visits to Brussels during the same year. At the same time he published his "Physiology of Digestion, considered with relation to the Principles of Dietetics," which went through nine editions. In 1838 Dr. Combe was appointed one of the Physicians Extraordinary to the Queen in Scotland, an office of professional honour merely, as no salary is attached to it. In 1840 he published "A Treatise on the Physiological and Moral Management of Infancy; being a practical exposition of the Principles of Infant Training, for the use of Parents." This work, which was highly esteemed, and obtained an extensive circulation, he continued to improve till his death. His last effort in authorship was an article on phrenology, which was published in the "British and Foreign Medical Review" for January, 1840.

Enough has been said in the foregoing narrative to show that Dr. Combe, although so able a physician, was himself often in need of the benefits of the healing art. Originally of a delicate and consumptive constitution, through which the activity and application of his early youth had been frequently checked, his maladies had increased from year to year, so that in 1834 he was obliged to renounce the more active part of his profession, and confine himself to consulting practice. His constitution rallied in consequence of this relief, and from 1837 to 1841 he enjoyed a better state of health than he had hitherto experienced. At a later period, however, his ailments returned, and with so permanent a hold, as convinced him that, however lingering his last illness might be, it had now commenced in good earnest. Still, however, his wonted tranquillity, and even cheerfulness, were unabated; and to the last he continued to correspond with his friends upon those important subjects which had formed the great study of his life. At length, by the recommendation of his medical advisers, he tried the effect of the climate of Madeira, to which island he repaired in November 1842. After having dwelt a few months there and returned home, he was obliged to make a second visit to Madeira, where he wintered during 1843-44. As voyaging was found beneficial in protracting at least the inevitable termination of his disease, he tried the effect of a trip to New York in the spring of 1847. But this, the last, was the most unfortunate of all his voyages, for the vessel in which he sailed carried 360 steerage passengers, chiefly Irish emigrants; and as the steerage extended from stem to stern of the vessel, the cabin overhead was pervaded during the whole passage with a sickening atmosphere, the effect of which accelerated his dissolution. Having made a three weeks’ sojourn in New York, he returned to Scotland; and only six weeks subsequently he died, after a short illness, on the 9th of August, 1847. He had thus only reached the age of fifty, but the chief subject of wonder is, that he had lived so long and done so much. He could never have held out so well but for his close and conscientious attention to those rules of health which he recommended to others; and thus, although he might be considered a dying man at the age of confirmed manhood, he was permitted to enjoy that which, above every other earthly blessing, he most valued—a life of thorough and benevolent usefulness. Even to the last he was thus occupied; and when the pen dropped from his fingers, it was in the act of writing to a friend for information about the regulations of emigrant vessels, as he was at that time employed, during the brief intervals of his last illness, in preparing a communication upon the ship-fever, which in that year was so fatal in the statistics of British emigration. "Dr. Combe belonged," as is well observed by one who intimately knew and deeply loved him, "to that rare class of physicians who present professional knowledge in connection with the powers of a philosophical intellect; and yet, in practical matters, appear constantly under the guidance of a rich natural sagacity. All his works are marked by a peculiar earnestness, lucidity, and simplicity, characteristic of the author; they present hygienic principles, with a clearness for which we know no parallel in medical literature. To this must be ascribed much of the extraordinary success they have met with; and on this quality, undoubtedly rests no small portion of their universally acknowledged utility. . . . The personal character and private life of Dr. Combe formed a beautiful and harmonious commentary upon his writings. In the bosom of his family, and the limited social circle to which his weakly health confined him, he was the same benignant and gentle being whom the world finds addressing it in these compositions. . . . .Kindly and cordial to all, he did not seem to feel as if he could have an enemy; and therefore, we believe, he never had one. It might almost have been said that he was too gentle and unobtrusive; and so his friends, perhaps, would have thought him, had it not, on the other hand, appeared as the most befitting character of one who, they all knew, was not to be long spared to them, and on whom the hues of a brighter and more angelic being seemed already to be shed."

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