THAT Scotland has an honoured place in the history of medical science is beyond doubt. From the pioneering days of surgery in Edinburgh, Glasgow and Aberdeen in the Middle Ages to the cloning of Dolly the Sheep, this small nation has long been at the forefront of developments in medicine.

Most Scots know, or should – I suspect, however, that a great many are not aware of how we gained this reputation.

They will probably know about James Young Simpson and his development of chloroform as anaesthesia, while almost all Scots will know about Sir Alexander Fleming and his discovery of penicillin. But what most people will be unaware of is the breadth of talent which Scottish physicians and surgeons displayed, and the sheer numbers of them.

Over the next few weeks I am going to devote this column to our great medical Scots, and hopefully show how Scotland came to prominence globally for the expertise developed in this country and exported worldwide. I will show how Scots changed the world for the better with innovations that still have a legacy today.

To start with, I applaud the work of the Scottish Society of the History of Medicine, and acknowledge my debt to the excellent website for some of the information I will be publishing. Both are outstanding resources for anyone wishing to learn about Scotland’s medical history and in particular deserves huge praise for its preservation of many documents about Scottish history in general.

I am certainly not the first history writer to attempt to tell this story. The extraordinary growth in Scottish patriotic fervour in the 19th century led not only to the erection of the Wallace Monument but also such groups as the Scottish Patriotic Association, while in the early years of the 20th century with Home Rule a big issue there was considerable public demand for lectures on the themes of Scottish history.

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Several “histories” were also published, but one which stands out is Scotland’s Work and Worth: An Epitome of Scotland’s Story from Early Times to the Twentieth Century, with a Survey of the Contributions of Scotsmen in Peace and in War to the Growth of the British Empire and the Progress of the World. It was published by Charles W Thomson in two volumes in 1909.

Thomson was rector of Larkhall Academy at the time and was known for his popular public lectures on Scottish history. As far as I am aware, his book was the first attempt to show just how influential Scotland had been in the world and especially the British Empire. Those who deny Scotland’s role in the British imperial project are advised to consult Thomson’s work before making such denials.

As a propagandist for Scotland he had few equals and his chapters on Scotland’s role in medical and other sciences are particularly illuminating.

Thomson is nothing if not ambitious in his claims about Scottish medical science: “In the noblest of all sciences – that devoted to the alleviation of human suffering – Scotland has clearly done more than her share in adding to the sum of human knowledge and human skill.

“The rise of medicine and surgery to the dignity of sciences can scarcely be regarded as dating further back than the Reformation period, although in 1505 the Edinburgh College of Surgeons was established as a medical school, developing later into the Royal College of Surgeons of that city.

“From Reformation days onwards Scotland has not only furnished her own full quota of talent to this most honourable profession, but has been able to send skilled doctors to other lands.”

Prior to the 12th century, medicine had been classed almost as magic, while Christian saints had their own devotees as healers from beyond the grave – the well of St Triduana at Restalrig in Edinburgh was noted as a place of pilgrimage for those with eye problems, based on the legend that the saint had plucked out her own eyes to avert the attentions of a local heathen chieftain.

As with so much of life in medieval Scotland, the church was the controlling influence. Abbeys and monasteries with their libraries and “physic gardens” were the main source of genuine medical help from the reign of King David I onwards, while the first Scottish physician of international note was Michael “The Wizard” Scot (c1175-c1232) who was famed at various royal courts on the Continent for his treatment of gout and dropsy, as well as his mathematics and astrology. He is even mentioned in Dante’s Inferno.

There is one remarkable testament to the accomplishments of Scottish clerical medics before the establishment of a royal court by Robert the Bruce. English court records show that in 1298, King Edward I, Longshanks himself, was treated for a leg injury at Torphichen Priory, Scottish headquarters of the Knights Hospitaller of the Order of St John of Jerusalem. This ties in with the account that Longshanks was kicked by his horse at the Battle of Falkirk.

Returning from the Crusades, the Knights had brought with them practitioners of herbal medicine and they laid the foundation for several advances in Scottish medicine in the forthcoming centuries which include the development of basic hospitals.

By the 14th century, Latin and Greek medical treatises were being translated into Gaelic, and some of these volumes are in the collections of the National Library and British Museum. They show that rudimentary medicine was being practised in the Highlands at least 600 years ago.

Medical science developed in Scotland as a direct result of royal influence. Kings and queens insisted on having their own physicians, usually foreign-trained. As early as 1164, King Malcolm IV founded a hospital at Soutra, south of Edinburgh. Its ruins are close by the A68. Mary of Guelders, widow of James II, founded Trinity Hospital in Edinburgh, while Papal edicts on the care of the sick saw hospitals established in dioceses including Glasgow and Aberdeen.

Other establishments enjoyed royal patronage and there was an increasing professionalisation of the trade of physician with educational exchanges taking place with several countries on the Continent.

One king above all transformed medicine in Scotland. James IV is remembered chiefly for his fatal charge at Flodden Field in 1513, but before that he took particular interest in medical science.

Before his reign many barbers had practised as surgeons but James IV was an amateur surgeon himself – there are records of his failed operations and successful dentistry – and he may have instigated and certainly authorised the aforementioned establishment of the College of Surgeons in Edinburgh in 1505, the first such medical craft body in the country, and based on the Barber-Surgeons guild in Dublin.

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The town council granted a “Seal of Cause” to the craft and also authorised the use of a cadaver for dissection – a huge privilege in those days; this had really only happened in Italy prior to then.

The development of the profession of surgeon-apothecaries during the 16th century can be charted in the records of Edinburgh Council, with the most important decree being one that forbade anyone from practising the trade without suitable training.

Mary, Queen of Scots, also took a personal interest in medical people during her short reign. In May 1567, she issued an edict exempting surgeons and doctors of medicine from bearing armour in wartime, although Scotland had it own corps of military surgeons in that era. Interestingly, her son James VI took his own Scottish physicians with him when he went to England to become their King James I in 1603.

BY then the Reformation had occurred and Catholic hospitals and monastic pharmacies soon disappeared, to be replaced by institutions run by local parishes and presbyteries. John Knox and his colleagues had also begun their drive for “a school in every parish” and the improvement in the nation’s literacy rates arguably did more for medical studies than any other development.

Frequent outbreaks of bubonic plague affected most of Scotland from the 14th century onwards and arguably the first “medical officers” were the “foule clengers” employed by councils to inspect possible house of plague victims and ensure that they were cleaned and bodies disposed of.

We would probably now call them environmental health officers but back in 1585 they were seen as a branch of the medical profession, regulated in Edinburgh by the town council.

During an outbreak of 1585-6, the most famous of the foule clengers were Alexander French and John Speir. French was originally from Fife and had no formal training in medicine,but somehow he worked out that the plague spread from human to human though infection from the pus-filled buboes that gave the disease its name. By applying strict quarantine and thoroughly cleaning every open sore, they enabled hundreds if not thousands of victims to survive, including French himself.

In the late Middle Ages, the most important development for every science was the establishment of the four ancient universities of Scotland. At Aberdeen, Edinburgh, Glasgow and St Andrews there were no formal medical schools at first and it wasn’t until the early 1600s that formal teaching of medical science began, based mostly on the pioneering educational work at Leiden University in what is now the Netherlands, and at universities in France.

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The first university in Britain to create a medical degree course was Aberdeen, then split into Kings and Marischal colleges, with the first “mediciner” or teacher being James Cumyne, the city’s medical officer. The first degree “doctus in medicina” was awarded in 1630, and where Aberdeen led, the other universities eventually followed.

No-one can say exactly when Scotland turned into an international powerhouse of medical science, but national expertise in medical science was recognised by the end of the 17th century, with Edinburgh being the main centre for progress with the professions of barbers, surgeons and apothecaries becoming independently established, the latter having their own premises for the sale of herbal and other distillations.

There had been long and frequent disagreements between the various branches in the capital but the establishment of the Royal College of Physicians of Edinburgh (RCPE) by Royal Charter in 1681 ended much of the impasse, with apothecaries joining this college and the surgeons maintaining theirs.

Sir Robert Sibbald (1641-1722) was the main instigator of the RCPE, and his career is a good example of how doctors progressed at that time. He was educated at the Royal High School of his native Edinburgh and then studied at three universities on the Continent before returning home to practise as a physician in Edinburgh, where he also played a major role in developing the Botanical Garden for the growth of medicinal herbs in 1677.

He was elected president of the RCPE in 1684 and the following year he was appointed the first Professor of Medicine at Edinburgh University. He also became physician to the king – and in a curious footnote to his personal history, the blue whale species was first named Sibbaldus after him, as he was the first to provide a written description of the world’s largest animal.

Surgeons and physicians rivalled each other in becoming the most important profession and a vital step in the progress of Scottish surgery was made by Sir Andrew Balfour (1630-94) of Fife, who studied at Leiden and was greatly impressed by that university’s science-based approach to teaching.

Thomson wrote: “He was the first to introduce the study of human anatomy into his native country, and he instituted in the Scottish capital a hospital which, by the public spirit of Provost George Drummond, was incorporated as the Royal Infirmary in 1738.”

The seeds of greatness were sown and next week we’ll meet several individuals who hugely enhanced Scotland’s reputation for medical science in the 18th and 19th centuries.