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The Scot in England
Chapter VI - Guardians of John Bull's Health

A number of Scottish physicians and surgeons established themselves in London during the reign of James I, and the English metropolis continued to attract "herbalists" and "chirurganes" from the north until the time of Union. Beyond the Court, where they had established themselves in a favour that proved to be permanent, they laboured in obscurity; but by the time Lord Bute had appeared upon the scene they were having a good deal to say, in one way or another, about the Englishman's health. If they were not fortunate enough to be in a position to have their say at bedsides, they remained in their lodgings and wrote books and pamphlets on diseases and their treatment. It was an early illustration of the great advantage which the Scot enjoyed—and still enjoys over his English competitors—the gift of articulation.

There was no stopping such men. They prospered, and some of them, indeed, lived long enough to see their profession in England completely transformed by the medical genius which was nurtured ln Edinburgh and Glasgow. Indeed, it is not too much to say that if Scotland had made no other contribution to England's advancement than that of sending her distinguished physicians and surgeons, she could be proud of that achievement alone, for it resulted in rearing the noblest structure ever dedicated to the service of humanity.

When we search for a reason for Scotland's amazing fecundity in the production of able surgeons and physicians, medical teachers, and medical administrators, we discover it without difficulty. A virile and intelligent peasantry was flowering profusely from one end of the country to the other. There is no other explanation of the phenomenon which the medical schools of Edinburgh and Glasgow symbolized, for the distinguished men which they turned out were recruited from the middle and lower classes of the country, not in platoons, but in battalions. Every parish sent its "lads o' pairts" to Edinburgh and Glasgow to study for the higher professions, and Scotland became a cornucopia which poured its best brains across the Border. This was particularly true of the medical profession, and if England reaped the benefit, Scotland may be proud of the fact that her sons were so influential in a profession which, since the dawn of civilization, has been devoted to the amelioration of human suffering.

The first Scottish surgeon to emerge from the fogs of the north was Michael Scot, who has already been mentioned. After he passed from the scene we do not hear much about the art of healing in Scotland for a long time. When we come to the sixteenth century, however, we begin to hear about surgeons and operations, which indicates that some progress had been made, with the help of Continental schools, in the art of surgery. John Chisholm had operated on the Earl of Morton for strangulated hernia, and it must have been a case of touch and go for the hardy Douglas, for the man who wielded the knife on him tells us that "the erle of Mortoun lay deidle seik of rumburssanes and war nocht he was cuttit he haid lost the lyff".

It was probably just as well for the English that not many of these sixteenth-century Scottish surgeons and herbalists followed King James south, for their medical knowledge left something to be desired. Those were the days of truly heroic surgery, and if the knife did not make an end of the hardy churl who submitted to it, he stood an excellent chance of dying a violent death by swallowing the concoctions which passed for medicine. The hoofs of elk, the gizzards of hens, the juice of woodlice, mother-of-pearl, boars' teeth, horse dung, pigeons' blood, human urine, spiders' webs, snake-skin, crabs' claws, and frogs' flesh were popular ingredients of tonics, and eminent physicians swore by them. [The medical profession were quite reluctant to part with these potent materials. All of them were listed in the Edinburgh Pharmacopoeia of 1737. Even at a later date, the really eminent Edinburgh physician. Doctor Pitcairn, recommended and used a tincture composed of wild valerian root, white dittany, pigeons' dung, charred bark of oak, rosemary tops, and white French wine, to which was added, after straining, powder of human skulls, shavings of elks' hoof, amber, and castor. The concoction was not, as may be supposed, intended to cause convulsions and death; on the contrary, it was a prescription greatly recommended for the cure of epilepsy!]

In those days, just before the dawn of the era which made Scotland famous in the world of surgery and medicine, the physicians, and their allies the "Chyr.-apothecaries", had cure-alls that far out-do the modern American medicine-man and his rattlesnake oil. Bezoar, for instance. This was a sort of stone that was supposed to be found in the stomachs of the goats that roamed the wilds of Borneo. It was believed to be a sure cure for a number of widely differing diseases, among them being jaundice and the plague. The stuff, of course, never came from Borneo, but enterprising and unscrupulous pedlars sold it to physicians of standing for as high as four pounds an ounce. The only goats connected with it were the buyers.

Burdened as it was by such absurd beliefs, the medical profession of Scotland was on a higher plane at this period than the profession in England. Men like Cullen were cutting away the fungi of superstition, and science got a chance. Things did not move so quickly on the other side of the Border, for at the middle of the century the Royal College of Physicians in London still stood with firm dignity behind such nostrums as vipers' broth, bezoar, and brick oil.

One sad result of the enlightenment which scientific knowledge brought to the profession in Edinburgh was the rupture which developed in the ancient Incorporation of Surgeons and Barbers. The surgeons were becoming a bit class-conscious. There had been friction—little contre-echanges—which indicated very clearly that the men with the lancets were beginning to look askance at the men with the razors. The barbers were to be cast out. They were not good enough. The amputation was performed quite skilfully, but without the use of an anaesthetic. The barbers found themselves brought up short for "barbourizing" on Sundays, which had suddenly become "a sin contrair to the Word of God and to all laws humane and divyne". The end came in 1727. From that year onward the barbers were degraded. All that was left to them was the right to advertise their shops with the blue-and-red-striped poles which still symbolize the arterial and venous blood they used to shed so copiously.

The day of the "Chirurgeon-apothecary" had arrived. This hyphenated customer learned his trade by apprenticing himself to an established practitioner, serving three years. At the conclusion of that training came a sketchy examination, and if the candidate satisfied the Incorporation, he got his licence and was turned loose on the unsuspecting public.

Stiffer standards were not long in coming, however. In 1705 Robert Eliot was selected by the Incorporation as "public dissector", and the Edinburgh Town Council voted him a salary of fifteen pounds a year. How the Council managed to get such an expenditure passed is a mystery, but it was probably justified by the significant fact that its recipient was the first Professor of Anatomy to be appointed in Great Britain. Another Professor of Anatomy was appointed at the University of Edinburgh in 1726, and he happened to be Alexander Munro, who displayed such brilliance as a surgeon, and as a teacher, that he drew clever students from the far corners of Scotland, England, and Ireland. Thus, under able leadership, Edinburgh's medical school took form, and it was this old school which, in the century that followed Munro's appointment, became such a hotbed of medical genius that it transformed the profession, not only in Scotland, but in England as well.

It was no longer necessary to go to Leyden, Paris, or Utrecht; the cleverest physicians and surgeons in Great Britain began to flock to the Scottish capital, and as their numbers increased the old slipshod ways of entering the profession were closed by rigid regulations. Candidates were critically examined by the Faculty. It was no longer possible for a barber to gain the coveted distinction by paying forty pounds. Brazen and ignorant quacks woke up to the realization that they could not secure degrees by clever solicitation. No longer were men admitted to the profession on sentimental and patriotic grounds, as in the case of one Andrew Brown, who got his degree by reason "of his well-known abilities and of his constant adhering to the cause of God in the midst of so many trials and temptations within the Kingdom of Ireland, and transporting of himself and his wife and family to this kingdom from thense!"

A faint echo of the grinding machinery of the new control comes down to us across the centuries. We hear of one Christopher Irving, a Scot who had taken his Doctorate of Medicine abroad, appealing to the Privy Council against the rulings of the College of Physicians, and it is worth noting that Christopher carried his point, because he was declared, in spite of the Edinburgh dictators, to be "Ane frie chirurgane"!

Irving was not the only man to kick against the hardening authority of Edinburgh. Years later, a famous London quack by the name of Graham decided that he would expand his business by opening an establishment in the Scottish capital on lines similar to his London "Temple of Health". He had spoofed the London public for years, lining his pockets in the process, so when his application was refused by the Town Council he went into action, attacking the honest burghers with a barrage of letters and pamphlets. It was no use, and Graham left Edinburgh with this Parthian shot at the immovable authorities: "I look down upon you as the meridian sun in its glory looks down upon an expiring farthing candle, and as God Almighty Himself might regard the impertinent twistings of little animals in a rotten cheese!"

Long before Graham went back to London, Scotland had quite definitely outdistanced England in medical organization, research, and teaching. The profession was attracting an ever-widening stream of exceedingly able and courageous men, and some of them became famous throughout Europe. Archibald Pitcairn, who did so much to develop the Edinburgh Medical School, was recognized as the most celebrated physician in the world. Robert Smellie, who helped to establish the Royal College of Physicians in Edinburgh, was made an honorary Fellow of the College of Physicians of London. Men like James Gregory, William Cullen, Joseph Black, and John Bell became known all over Europe for their daring and constructive work.

The tide of Scottish emigration began to carry a heavy freight of medical genius into England. Charles Bell, who took over the anatomy class at Edinburgh at the close of the eighteenth century, was called away to London, where he became a pioneer in nerve work. He was followed at Edinburgh by such brilliant figures as Lizars, Liston, Syme, and Fergusson; but the great exodus to the south continued. William Smellie, who was the first doctor in Scotland to invade the field long dominated by midwives, moved to London in 1738, to become Great Britain's foremost obstetrician. Ten years later Sir John Pringle, a Roxburghshire man, after a distinguished period of service as Physician-General to the British Forces in Flanders, began to practise in London. He became physician to the Duke of Cumberland and Physician-in-Ordinary to Queen Charlotte. In 1772 this great physician was elected President of the Royal Society, and two years later he was appointed Physician-Extraordinary to the King. His monument may be seen in Westminster Abbey, but his greatest monument was his work, and his Observations on the Diseases of the Army, an exhaustive diagnosis which was promptly recognized as a medical classic and which made its author the acknowledged founder of modern military medicine.

James Johnstone, who was born near Annan, Dumfriesshire, in 1730, was the man who discovered a cure for the Kidderminster Fever, which had puzzled the English medical authorities for years. This resourceful Scot also discovered, in 1758, an antidote for putrid febrile contagion—a primitive but highly important discovery at that time, consisting of pouring vitriolic acid on salt.

William Hunter, who was born at Kilbride, Lanarkshire, in 1718, opened a consulting-room in London in 1741. Three years later he had become the leading accoucheur of the metropolis, and had published his Essay of the Structure and Diseases of Articulating Cartilages, a work of great importance. Hunter became Physician-Extraordinary to the Queen, was elected a Fellow of the Royal Society in 1767, and in 1781 was accorded the supreme honour of being elected President of the Royal College of Physicians of London. In 1775 he published his great thesis, The Anatomy of the Human Gravid Uterus, which marked a long forward step in obstetrical surgery.

The little Scottish village of Kilbride made another important contribution to the development of medical science in England, for John Hunter, a younger brother of William, became famous in London as a physician. He was appointed Surgeon-Extraordinary to the King, but he took greater pride in the fact that he was one of the founders of the London Veterinary College.

When we enter the nineteenth century, the pre-eminence of Scottish surgeons, physicians, and medical administrators was an established fact in England. Almost every corner of that country had been invaded by soundly trained, aggressive, and skilful practitioners from the north; [A few examples of the achievements of Scottish doctors in the provinces will indicate how much England owes to the medical schools of Edinburgh and Glasgow. The Royal Institution of Liverpool and the Liverpool Mechanics Institution were founded by Thomas Stewart Traill, a native of Kirkwall, who graduated from Edinburgh in 1802. The Liverpool Medical School was developed by Sir William Mitchell Banks, a native of Edinburgh and a graduate of its medical college, while he was Professor of Anatomy at University College, Liverpool. Sir William was largely responsible for the rebuilding of the Royal Infirmary of Liverpool. Charles White, who took his degree at Edinburgh, became one of the most distinguished physicians of Manchester, and was one of the founders of the Manchester Infirmary and the Manchester Lying-in Hospital. He was followed by William Henry, another Edinburgh graduate. Henry became physician to Manchester Infirmary, and while holding that Position wrote his Experimental Chemistry, a learned work that went through eleven editions before 1829. The founder of the Birmingham Medical School was Edward Johnstone, a native of Dumfriesshire. This able Scot was the first principal of Queen's College, Birmingham. Another Scot who followed Johnstone to Birmingham was Robert Lawson Tait, who graduated from Edinburgh in 1886. He was a physician of great skill, and became Professor of Gynaecology in Queen's College. The Sheffield Royal Infirmary was founded by William Younger, a Scot.] but in London, the centre and heart of the art of English medicine, Scotsmen had swarmed to the highest heights of the profession, bringing to it, moreover, a new knowledge and energy that raised it to the status of nobility. Every phase of the art was influenced, if indeed not dominated, by the Edinburgh and Glasgow men, and while it is true that England herself produced many brilliant men of medicine at this time, they were eclipsed by their competitors from the north.

The names and achievements of these Scottish medical pioneers in London would fill a ponderous volume, and one can only pass down the long list rapidly, indicating, here and there, some of the great names and the achievements linked with them. It is appropriate that one of the first names to make us pause is that of a chemist, Thomas Graham, of Glasgow. He was appointed Professor of Chemistry at University College, London, in 1837. He occupied that position until 1855, when he became Master of the Mint—an acknowledgment of his pre-eminent ability in his chosen field. [Distinguished Scottish chemists have maintained the traditions established by Graham. Sir William Ramsay, who was born in Glasgow in 1852, and who was appointed Professor of Chemistry at University College, London, in 1887, was the discoverer of Helium, Argon, Neon, Krypton, and Xenon, and, largely as a result of his work with rare gases, was awarded the Nobel Prize for Chemistry in 1904. Sir William Dewar, who was born at Kincardine-on-Forth in 1842, and who became Professor of Chemistry in the Royal Institution, London, in 1877, was the first chemist to produce liquid air, and liquid and solid hydrogen.] It was this Scot who taught the famous Joseph Lister, who, by his discovery and promotion of antiseptic methods, cleared hospitals of the horror of gangrene and similar infections. Graham induced his brilliant pupil to go on to Edinburgh to study surgery under the great Syme, and one may say that a new era in the medical art opened when, in 1860, Queen Victoria issued a commission to Joseph Lister—then a lecturer in surgery at Edinburgh—to be Professor of Surgery at Glasgow University. There, five years after he assumed his new duties, he began to wrestle with the septic scourges that had long been so dangerous a feature of British hospitals. In those days the conditions under which surgeons operated were crude in the extreme. They wore torn and stained operating coats that would drive business away from a modern butcher's shop, and were addicted to the faunty but decidedly unsanitary habit of carrying ligatures in their buttonholes! The loose ideas with regard to cleanliness of many of the women who took up the nursing profession were another hazard that had to be faced by the unfortunate wight who was subjected to the knife—not to mention the fact that he had to go through it all with his eyes open! Encountering opposition that would have disgusted and discouraged most men, Lister began his cleansing campaign—with carbolic acid—and in a few years had shown the medical profession how to control the foul germs that had, previous to his time, risen up like demons to nullify the skill of surgeons. This great man succeeded his father-in-law, the distinguished James Syme, in the chair of clinical surgery at Edinburgh in 1869. He was not to remain there, however. His name had become famous throughout the world, and, yielding to persuasion, he proceeded to London in 1877, to be Professor of Clinical Surgery at King's College.

The alarming thought that we have been following the career of a Scottish-trained Englishman crowds in upon us, reminding us of old Wullie Tamson's considered opinion, to wit, that "a book about Scotsmen in England will maybe be a' richt—if ye can manage tae keep the damned English oo o't!" We must hurry back to Edinburgh, therefore, and pick up the trail of Scots who are doing things to elevate the profession in England.

A name leaps out of the long list at us—that o James Simpson, who, by his discovery and bold use of chloroform, conferred upon the world one of it greatest blessings. Simpson was the seventh son of a baker of Bathgate, in Linlithgowshire, where he was born on 7th June, 1811. His determination to make something of himself led him to Edinburgh, and in 1830 he was licensed by the Royal College of Surgeons. The brilliant and strong-minded young medico became surgeon in the small village of Inverkip, on the Clyde, and a period of dull and unappreciated service ensued. Inverkip, like man another small community, had no eye for genius, and—perhaps fortunately for the world—Simpson was glad to leave the place. He went back to Edinburgh, and in 1832 got his degree of Doctor of Medicine. He became assistant to Dr. John Thomson, professor of pathology at the University, receiving salary of fifty pounds a year. It sufficed. Simpson pursued his studies and banked money, for in 1835 he visited the best hospitals of England and France. In that same year he wrote a treatise entitled Diseases of the Placenta.

The baker's son was getting along. He was brilliant, and not afraid of new ideas. We hear of him recommending and demonstrating the use of metallic sutures in preference to threads of silk. There were jeers and sneers from medical circles, but Simpson was not the sort of man who wilted under the fire of adverse criticism. He had an iron will and boundless energy. When he was attacked by bitter pamphlets—and he was attacked in that manner more than once by jealous rivals—he replied to his anonymous critics by pamphlets. It was no effort at all to write them, for he revelled in controversy.

One thing, however, filled this courageous little man with dismay—the agony endured by men and women who underwent operations. The screams and unavailing struggles of these people—they were held under the knife by brute strength or by straps— preyed on his mind so much that he decided to quit the medical profession altogether. He started to look for another job, but the daughter of Eris must have plucked at his coat-tails, for he had a change of heart and remained with surgery.

Something had clicked in his active brain, however. He began to study the use of anaesthetics. He was the first physician to use ether—an American dentist had used it previously—in obstetric practice. It was a great advance in medical practice, and his continued use of it made him famous. He was appointed Physician to the Queen.

"I am far less interested in the Queen's flattery," this hard-headed and modest Scot wrote at the time, "than in having delivered a woman this week without any pain while she inhaled sulphuric ether."

He continued to experiment with anaesthetics—a hazardous form of research. A Linlithgow chemist had spoken to him about chloroform. Simpson had a bottle of it on his library table. One night he picked up the vial of mystery and suggested to his two assistants that they test its potency. The three then inhaled the fumes and promptly passed into Unconsciousness. When they regained their senses, Simpson was elated. He had found what he had been looking for. It took courage to use it, but Simpson had enormous courage. He succeeded, a few days later, in getting chloroform submitted to tests in three operations at the Royal Infirmary of Edinburgh. It proved entirely successful. Simpson began to use it in all his operations, in spite of opposition, which came from medical quarters and from the clergy, who denounced the new anodyne as "a decoy of Satan, apparently opening itself to bless women, but in the end hardening and robbing God of the deep, earnest cries that should arise to Him in time of trouble".

Simpson, however, had heard more of these "deep, earnest cries" than any of the clergy, and with characteristic pugnacity and the proverbial Scottish flair for argument he continued to promote the use of his great discovery, answering the girning priests with the argument that God Himself had anaesthetized Adam before he removed the rib that caused so much mischief in this world. ["And the Lord God caused a deep sleep to fall upon Adam, and he slept: and he took one of his ribs, and closed up the flesh instead thereof."— Genesis ii, 21.]

That routed the clerics. Simpson's great discovery swept England, spread around the world. To attempt to measure the benefit of chloroform to humanity would be futile; one can think of nothing that has brought so much relief to mankind in the past century.

The baker's son from Bathgate had become the greatest figure in the world of medicine. He was inundated with honours. In March of 1835 he was elected a Foreign Associate of the Academy of Medicine of Paris—an honour held by no other native of Great Britain. Three years later he received the laureateship and gold medal of the French Academy of Sciences, with the Monthyon Prize and two thousand francs, awarded for the most important services conferred upon mankind. In 1866 a baronetcy was conferred upon him. It would be difficult to name a man who has conferred more upon the English people than Sir James Simpson.

Meanwhile, other Scottish doctors were doing great things for England. David Pitcairn, a native of Fifeshire, with degrees from Glasgow and Edinburgh, headed down the Great North Road about the turn of the century. Another Scot, John Abernethy, took the same road about the same time. The fogs of London swallowed them up for a while, but they were destined to meet, and they left a permanent record of themselves in medical history as founders of the famous St. Bartholomew's Hospital Medical School.

John Yellowly, another Scot who graduated from Edinburgh in 1796, and who became a distinguished and much-respected physician of Norwich, was one of the founders of the Royal Society of Medicine of London.

John Richard Farre, who took his degree at Aberdeen in 1806, established a lucrative practice in London, and was co-founder of the first eye hospital established in the English metropolis—at Moor-fields.

Robert Ferguson, who graduated from Edinburgh in 1823, was the first Professor of Midwifery appointed at King's College, London, and before that recognition of his ability came his way he had founded the Medical Gazette.

Another Scot of the same name, Sir William Fergusson, filled the chair of surgery at King's College at that time. He was recognized as one of the most daring and delicate surgeons of his day.

Neil Arnott, an Arbroath man, introduced the waterbed to London medical practice about the middle of the century, and added to his fame by becoming one of the founders of London University. Neil Arnott was often confused with James Moncrieff Arnott, another graduate from Edinburgh, who left his name in the hall of medical fame by becoming one of the founders of Middlesex Hospital Medical School.

Sir John Scott Burdon Sanderson, who was born in 1828, and whose remarkable career extended into the twentieth century, was a Scot, graduating from Edinburgh in 1851. He became physician to Middlesex Hospital, lectured at University College, and in 1895 was appointed Regius Professor of Medicine at the University of Oxford. Sir John's most enduring achievement was the establishment of the modern medical school at Oxford—an achievement of worldwide significance.

Sir James Crichton-Browne, who graduated from Edinburgh in 1862, and who, in his ninety-third year, disposed of the seven-course dinner at the 1933 meeting of the Royal Society and enjoyed himself thoroughly at this feast of wisdom, has made a vast contribution to the art of medicine in England. A pioneer in neurology, and a wise and fearless innovator, the school of neurology at West Riding Asylum—the first of its kind—was founded by this grand old man of British medicine.

The extraordinary record of Scots in the field of medical science in England is reflected from yet another angle—that of the medical organization of the Army and Navy. In both fields, from the very beginnings of any systematic attempts to take care of the health of our fighting forces, Scots appear at the head of the organizations. How they managed it we do not know, but they seemed to crowd the poor Sassenach completely out of the picture, and they kept on using their shoulders so effectively that it is no easy matter to find the name of an Englishman in the long list of Directors-General of the medical services of our land and sea forces. It really ought to be looked into.

The man who may be called the pioneer of our Army medical organization was Robert Jackson, who was born at Stonebyres, in Lanarkshire, in the year 1750. He was a graduate of Leyden, served in the American War of Independence, and at the conclusion of that campaign became head of the Army hospital at Chatham. Soon afterwards he was promoted physician to the British Army on the Continent, but the promotion was made by the Commander-in-chief—probably a Scot!—without proper reference to the Army Medical Board at home. It does not do to ignore a medical board of any kind, for they take themselves very seriously. Jackson's appointment was ignored by the bureaucrats in London. The Scot, however, did not take the treatment lying down. Snubbed by the Surgeon-General in the street one day—those were the days when enemies glared at each other instead of smiling excessively—he thrashed the exalted official with his cane. It must have been a good thrashing, for Jackson was arrested and sentenced to six months' imprisonment in the King's Bench Prison.

The man from Stonebyres had still a few shots in his locker, however. He waded into the powerful but moribund Army Medical Board with reckless gusto, and when the public learned that the stubborn stupidity of the Medical Board had a good deal to do with the Walcheren fiasco of 1809—in which 7000 soldiers died of disease and more than twice that number were made permanent invalids—Jackson's critical attitude was more than vindicated. The Board was abolished—not too soon to suit the men who were fighting Britain's battles—and the Scot who had brought about its sudden demise became the medical dictator of the Army. He was aggressive, energetic, and able, and brought about great reforms in the Army medical organization. For many years his book, A Systematic View of the Formation, Discipline, and Economy of Armies, was regraded as a military classic.

Following the militant Jackson came another Scottish dictator of Army medical methods, the renowned Sir James McGrigor. He was born at Crandale, Inverness-shire, took his degrees at Edinburgh and Aberdeen, and joined the Army in 1804. After service on the Continent, in the West Indies, India, and Egypt, McGrigor joined Wellington's Army in the Peninsular in 1812, as chief medical officer. In that dreary campaign he displayed his mettle as an organizer by actually keeping the Army intact during that desperate year in which no reinforcements came from England. Three years later this resourceful Scot was appointed Director-General of the Army Medical Department. At the end of the war with Napoleon he was described by the Duke of Wellington as "one of the most industrious, able and successful public servants I have ever met with". Sir James originated the system of medical reports and returns from all military stations, and these exhaustive returns formed the basis of his celebrated book, Statistical Reports of the Health of the Army.

One thing becomes increasingly clear to anybody who takes the time to read the history of medical services in the Army, and that is that the Scots at the head of things justified their appointments by their work. It was particularly true of Thomas Alexander, who was appointed Director-General in 1858. His achievements are a tradition in the Army, and he ranks, on his record of concrete achievements, as the greatest Director-General this country has seen in action. It was this native of East Lothian who swept away the old vicious system of promotions in the medical service, in which money and political wirepulling played important parts, replacing it with a set of regulations that did away with bribery and wire-pulling, and competitive examinations that did away with incompetent and unqualified officers. In addition to bringing about these badly-needed reforms, in the teeth of stubborn and dangerous opposition from the Old Guard, Alexander founded the Army Medical School at Fort Pitt, the Royal Victoria Hospital at Netley, and the Herbert Hospital at Woolwich.

By the time Thomas Alexander had retired, the powers that be had apparently come to the conclusion that Scots were the only men properly qualified to fill the high office of Director-General of Army Medical Services, for the list of Alexander's successors, right down to the present day, is so Scotch that it fairly shouts "Scots Wha H'aeI" [After Thomas Alexander came Sir Thomas Galbraith Logan, Sir William Mure Muir, Sir Thomas Crawford, Sir William Alexander MacKinnon, James Jameson, Sir William Taylor, and Sir William Boag Leishman (whose insistence on the use of anti-typhoid vaccine during the Great War undoubtedly prevented serious outbreaks of typhus among the troops). Work of untold value to the country has been accomplished by Scottish officers of the Army Medical Services who did not attain the supreme rank of Director-General. Peter Shepherd (1841-1879) was the author of the first handbook on first-aid. Sir William Grant Macpherson, who joined the Service in 1883, was the author of The Medical History of the Great War. Sir David Bruce, the great authority on tropical diseases, discovered the cause of Malta fever, sleeping sickness, and the tsetse fly disease.] By some special process known only to medical science and marine engineers from the Clyde, these guardians of the health of Tommy Atkins keep their profession on a strictly Scottish basis. It is very mysterious, and if it were not for the fact that they serve the country with so much distinction, the whole thing might be worth looking into—preferably by a Royal Commission composed of Scotsmen!

Scotland's most curious achievement in connection with medical work in the British Army, however, was the record of James Miranda Stuart Barry, who was graduated M.D. at Edinburgh in 1812. We first heard of this strange Scottish character in the ancient city of Quebec, when Colonel William Wood pointed out a building at one time occupied by Barry. The amazing story of the medical officer followed.

James Miranda Stuart Barry joined the Army Medical Service as a hospital mate in 1813, and saw stern service at the Cape of Good Hope, Jamaica, St. Helena, the West Indies, and the Crimea. In South Africa Barry fought a duel, killing a fellow officer. Later on, this high-tempered but capable Scot was appointed Inspector-General of Military Hospitals in Canada. For forty-six years Barry was active in the service, retiring on half-pay in 1859.

Six years later this not undistinguished military veteran died in London, and the doctor who was called in made the astounding discovery that John Miranda Stuart Barry was a woman! There was evidence that she had given birth to a child. After her death it was disclosed that Sir Thomas Longmore, the celebrated Surgeon-General, had discovered her true sex while attending her in a medical capacity at Trinidad in 1844. He had been sworn to secrecy, and remained true to his word. Indeed, the ferocious temper and cold courage of this woman was so well known in Army medical circles that he would have been a hardy man who dared to break faith with her.

We were told that she was the illegitimate daughter of a Scotsman whose exalted station and family connections render the mention of his name indiscreet, even at this late date. So far as we are concerned, James Miranda Stuart Barry may rest in peace. She was a good medical officer and a good fellow, and in addition to bestowing upon Scotland the honour of producing the first woman medical graduate in Great Britain, was a striking illustration of the fact that even a Scotswoman could compete successfully in a man's field in England!

When we turn to the naval medical services, we find Scots at the top. The greatest name in the whole history of medical organization in the Navy is that of Sir Gilbert Blane, who was born in Ayrshire in 1749 and took his medical degree at Glasgow in 1778. He was at the siege of Gibraltar, as private physician to Sir George Rodney, and soon afterwards was appointed physician to the Fleet.

In those days the men who served in our fighting ships were not treated with anything like the consideration that is shown towards convicts to-day. Samuel Pepys, writing in his diary in the preceding century, left quaintly-worded evidence of the crude conditions imposed upon the poor devils. We learn from him that the Navy was to a large extent controlled by boodling politicians, that many a ship was officered by incompetent drunkards, and that the men who actually did the fighting had to put up with food and accommodation that would deeply offend a modern felon. There was no medical service worthy of that term. Pepys tells us about a sailor who came off a man-of-war with a wad of oakum in the socket of one of his eyes. Conditions were not quite so bad as that when Blane came into the picture, but they were bad enough to fill him with the determination to clean things up a bit below-decks.

His achievements brought about great changes in the conditions of the ordinary sailor. He studied their peculiar diseases systematically, and as a result of the knowledge gained succeeded in getting the Admiralty to issue an order enjoining the use of lemon-juice in fighting ships. By this reform the scourge of scurvy was banished from British men-of-war. He followed this up with a campaign on behalf of improved sanitation below-decks, introducing cleanliness and ventilation in places where they had not been thought necessary. Until he came along, sailors had to buy their own soap, or do without it. Most of them did without it! Blane forced the Admiralty to supply the men with a free issue of soap. When he had done these things for the ordinary sailor he went back to the Admiralty Office and made a nuisance of himself until he got the assurance that there would be a gratuitous issue of every kind of medicine to naval surgeons. When this able and energetic man retired the Navy was on an entirely new basis with regard to sanitation and the treatment of diseases and wounds, and a succession of Scots carried on the good work. [The first Medical Director-General of the Royal Navy was Sir William Burnett, of Montrose (1779-1861). It was he who established the great naval hospital at Chatham.] It is quite possible, to-day, for an Englishman to advance in the Service, but the higher up he goes the more he is crowded by men with Edinburgh and Glasgow accents.

One would think that these aggressive Scottish medicos would have been checked long ago by the General Medical Council, that austere and greatly dreaded body that sits in judgment on the British medical profession. We find, however, that when that august tribunal was formed, in 1858, one of the first six members appointed to it was Sir James Clark, Bart., M.D., F.R.S., a farmer's son of Banff. Sir James was one of the moving spirits in the Council, and with the help of Sir John Forbes, who was certainly not an Italian, he established the Medico-Chirurgical Review. Sir James Clark was Physician-in-Ordinary to Queen Victoria for twenty-six years, and his position in the medical world was supreme. All the honours and appointments made by the Crown in the medical profession were suggested by him, and if he seemed to favour Scots now and then, it was doubtless because he thought they were particularly well qualified for the posts they filled.

In any case, we can hold out no hope for the Englishman. For the past twenty-seven years the Council was dominated by Sir Donald MacAlister, who died recently at the ripe age of eighty years. Sir Donald was one of the most brilliant presidents the Council ever had, for he could speak fourteen languages, and had a good working knowledge of as many more. He could lecture an erring Highland doctor in Gaelic, and then mutter to himself in Romany. When he laid down the law to unpenitent and recreant members of the profession, his language was memorable. [Sir Donald MacAlister was succeeded as President of the Medical Council by Sir Norman Walker, M.D., who is a native of Dysart, Fife-shire, where he was born on 2nd August, 1862.]

Great names have been mentioned, but the story of the proud achievements of Scotsmen in the medical profession in England would be incomplete without a reference to the obscure men who have been true to the exalted standards of their noble calling in little places. Thousands of such men have laboured throughout England, far from Harley Street, not finding fame or wealth, but doing their duty cheerfully. Here, after all, is the essence of service and the strength of the medical profession, and thinking of these nameless ones, Kipling's lines come into our mind :

Let us now praise famous men,
Men of little showing—
For their work continueth,
Broad and deep continueth,
Greater than their knowing!

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