SMJ 2002: 47(5): 115-117
Hugh Conway
The
holders of these regius chairs taught in the
Old College and Royal Infirmary mainly by lecture and demonstration. In 1851, students made representation to the Senate in
favour of originating Chairs of Clinical Medicine and Clinical Surgery to
encourage bed-side instruction. Four
years later, J.A. Lawrie, Regius Professor of Surgery, approached the Ferguson
Fund for support and tried to secure wards in the Royal Infirmary to accommodate
the proposed new professors in
their clinical practice and teaching.
This came to nothing. By
1861, the University was averse to the founding of the chairs nor was finance
and space forthcoming.1
In
1872, when the Western Infirmary was nearing completion, interest in the
proposal was renewed and a capital fund of £2500 was available for each of the
twin chairs. Deeds of
Foundation were drawn up and both chairs were assigned to the patronage of the
Court in 1874. Later that
year, the Western Infirmary opened beside the new University and became the
centre for university clinical teaching.
The Regius Professors of Medicine and Surgery transferred from the Royal
and the two clinical professors were given wards in the new institution.
The Royal Infirmary was then deprived of its historic and central role as
the sole teaching hospital in the city.
The
Regius Professor of Medicine (W.Tennant Gairdner) was joined in the Western by
T. McCall Anderson, the first Professor of Clinical Medicine.
George Buchanan, a longstanding colleague of Lister in the Royal became
the Professor of Clinical Surgery. The
other surgical wards in the new institution belonged to the Regius Professor of
Surgery (G.H.B. McLeod). So
the first four units in the Western Infirmary were headed by University
placements. Thereafter, the
Board of Management controlled appointments and soon, as other wards were
opened, two visiting chiefs, James Finlayson, physician, and Alexander
Patterson, surgeon were added to the staff.
McCall
Anderson was the grand-nephew of John Anderson, Professor of Natural Philosophy
in the University from 1757 to 1796 and founder by an article in his Will of
Anderson’s “University”, progenitor of the University of Strathclyde.2
The family connection was renewed when the young physician (MD
1859) became lecturer in medicine in Anderson’s College in 1866. Appointed a physician in the Royal Infirmary in 1870,
the young William Macewen was one of his house physicians.
Buchanan’s
chair was endowed by his family relatives in memory of his father Moses, the
anatomist and surgeon.3 The
main mover was William Leechman Buchanan, brother of George and an accountant in
the city. Another was a
cousin, John Grieve (MD 1850) whose generosity extended also to the foundation
of the Grieve Lectureship in Physiological Chemistry in the University.4
The other involved cousin, George Stevenson Buchanan, an industrialist,
was treasurer of the Buchanan Society for fifty years.
So George Buchanan was elected to a chair founded by his family,
including a personal contribution.
The
University provided no further remuneration beyond the income of the capital
funds but the two salaries were supplemented by the fees paid by the clinical
students. These chairs had
the lowest emoluments of any in the University but the holders had large private
practices.
After
the foundation of the clinical chairs, questions arose regarding the province
and standing of the new professors in relation to those of the regius professors
of medicine and surgery. The
case for surgery was taken up by Professor McLeod.
In 1878, he appealed to the Court against a decision of the Senate,
and the Court found that he was equally entitled with Buchanan to have the lists
of his clinical students printed in the class catalogues of the University and
opined that the regius professor was “by virtue of his inherent rights as such
a professor and without any other or further recognition on a par with the
professor of clinical surgery as regards clinical teaching”.5
The same edict applied to medicine.
The
decree went further. Apart from denying a monopoly of clinical teaching for the new
against the regius professors, it was resolved that no restriction would be
placed on the non-professorial staff of physicians and surgeons, in the same
regard. The significant
upshot was the system of teaching units in the Western Infirmary under chiefs
with honorary university rank and eventually the honorary clinical lectureships
of today.
The
strength of the four part-time professors lay in teaching rather than clinical
research. When McLeod died in 1892
and Macewen succeeded to the regius chair with charge of beds in the Western
Infirmary, albeit proffered reluctantly by the management, a new era opened in
that establishment.
The
Chair of Clinical Medicine lapsed in 1908 and Clinical Surgery in 1910 and a
subsequent decision made in the reign of Principal Sir Donald MacAlister had a
profound effect on the future of medical education in the University. An arrangement between the University, the Royal
Infirmary management, the Carnegie Trust, St Mungo’s College (the Medical
School of the Royal Infirmary) and the trustees of Henry Muirhead founded four
chairs at the Royal Infirmary viz the Muirhead Chair of Medicine, the St Mungo
Chair of Surgery, the Muirhead Chair of Obstetrics and Gynaecology and the St
Mungo-Notman Chair of Pathology.
In
1911, an ordinance established these chairs and suppressed those of Clinical
Medicine and Clinical Surgery. The
result greatly strengthened the faculty.
The creation of four new chairs, with only two lost, and the rebirth of
academic teaching in the Royal expanded the faculty into two co-operating
clinical schools each of which was to grow in the future by the addition of
specialised chairs.
After
1870, student numbers exploded. In
1860 the total number of medical students was 311; from 1867-1871 the annual
average was 330; from 1872-1876, 381; from 1877-1881, 551; from 1882-1886, 692
and from 1887-1891, 802. The
highest number in the period under review was 829 in 1891.
Classes became so big (100-200 in surgery alone) that bedside instruction
was still not used to any great extent.
Teaching depended mainly on demonstrations with the serious flaw that
day-to-day progress of a case was seldom followed.
The
Commissions under the Universities (Scotland) Act of 1858 prescribed under
Ordinance No. 15 a curriculum of four years for the MB degree which could be
taken by itself or in combination with the CM.
Most students chose the latter option but the surgical qualification
could no longer be granted separately, as it had been since 1817. Three professional examinations were specified,
increased to four in 1877. In
1881, it became compulsory to take the MB and CM at the same time. The degree of
CM was replaced by the ChB in 1892; two bachelor degrees supplanted the
incongruous twinning of bachelor and master.
In
the years 1882-1886 the annual average of students taking the double
qualification was 89 rising from 79 in 1882 to 105 in 1886.
An
Ordnance of the Commissioners under the Universities (Scotland) Act of 1889
extended the undergraduate curriculum to five years and minimum hospital
attendance was raised from two to three years.
After
1889, new minor specialties made their first appearance in the teaching
calendar, apart from diseases of the eye which
had been taught for many years. Attendance
at classes on mental diseases, fevers, ophthalmology and post-mortem
examinations was compulsory. Students
were recommended to enroll, on a voluntary basis, in classes on diseases of
children, ear nose and throat and dermatology, and most complied.
During
the eighteen-nineties, undergraduate teaching became more practical and the
introduction of the minor specialties prompted a wider distribution of students
over the city hospitals. However
for the major subjects, most attended the Western Infirmary lured by the famous
holders of the university chairs. The
few female students matriculating from 1890 onwards drifted towards the Royal
for clinical tuition. “The
Western Infirmary cannot claim to have pioneered the interests of women
doctors”.6
The
removal of the Old College from the High Street to its new site on Gilmorehill
in 1870, and the development of the adjacent Western Infirmary, gave a chance to
include a children’s hospital in close proximity to the University and Medical
School as part of the scheme. It
was not to be and bitter feelings aroused during the negotiations did not die
for many years. The lost
opportunity and dashed hopes opened wide wounds in the profession.
The
hospital did not open until 1882 in two converted houses in Garnethill at a
capital cost of £12,500. By
1887, the new hospital was under such pressure that an extension was needed and
£1500 was paid for an adjacent property.
Originally known as the Glasgow Hospital for Sick Children the
appellation Royal replaced Glasgow in 1899.
Now
there was a hospital but no specialist doctors.
The terms “paediatrics” and “paediatrician” did not come into
common use until after the turn of the century; in this field Britain was a late
developer, behind Germany and the USA.8
The two teaching hospitals provided the staff.
The outstanding honorary physician was James Finalyson who, alone among
Glasgow doctors, had some experience in the subject;
he had been a house surgeon at the Clinical Hospital and Dispensary for
Children in Manchester. His
work at Garnethill earned him recognition by his peers as an expert in
children’s diseases, but this interest was always secondary to his duties at
the Western Infirmary. There
is no evidence that much surgery was performed in the early years.
In
1888, an out-patient dispensary was opened in West Graham Street and from that
year students were given practical instruction in the hospital and dispensary as
an optional arrangement and most attended, at least part of the time.
The
Garnethill Hospital closed in 1914 when the Royal Hospital at Yorkhill opened.
Paediatrics then became a compulsory
subject which was strengthened in 1919 with the establishment of two
lectureships – the Leonard Gow on the Medical Diseases of Infancy and
Childhood and the Barclay in Surgery and Orthopaedics in Relation to Infancy and
Childhood.
Throughout
the nineteenth century notable improvements took place in the care of the
mentally ill in Glasgow. Eventually,
in 1843 the Royal Lunatic Asylum at Gartnavel was opened with its extensive
grounds.
The
University had no interest in teaching until 1875 when, with the permission of
the Senate, Dr David Yellowlees, the Superintendent at Gartnavel, started to
give occasional lectures on insanity.
In 1880 he was appointed Lecturer on Insanity.
At first his classes were voluntary but, after the 1889 Act, attendance
was compulsory from the beginning of the 1892 academic year.
Yellowlees was only the second official lecturer in the faculty;
the first was William MacKenzie in 1828 as Waltonian Lecturer in
Structure and Diseases of the Eye.
Throughout
the period under review, Glasgow citizens suffered greatly from a wide range of
serious acute infectious diseases. Such
patients, and especially if pneumonia is included, out-numbered the admissions
to the general medical wards of the Royal and Western Infirmaries, but the
University showed no particular interest.
There is no reference to the clinical teaching of “fevers” in the
Minutes of the medical faculty at that time.
The
first of the specialised fever hospitals was opened in Kennedy Street in 1865,
followed by Belvidere in 1870 and Ruchill in 1900.
Belvidere relieved the Royal of its responsibility to admit “fevers”
and , in the confines of the teaching hospitals, clinical experience was lacking
a\fter that time but Professor Gairdner included “fevers”, a huge topic, in
his systematic course of lectures to the class of the practice of medicine.
This enlightened man combined for a time his prime post of Regius
Professor of the Practice of Medicine with that of Medical Officer of Health –
the first in the city.9
Despite
the major role of the acute infectious diseases in the over-all sickness rates,
clinical teaching was only loosely organised.
Although attendance at a class became compulsory students were left to
make their own arrangements; the
only stricture was approval of the hospital by the University.
The fever physicians, even unpaid and lacking University recognition,
gave their time willingly. It
was considered an honour to have an undergraduate class, even on a Saturday
morning.