The Old Royal Infirmary – Projected in time of George I. – The First Hospital Opened – The Royal Charter – Second Hospital Built – Opened 1741 – Size and Constitution – Benefactors’ Patients – Struck by Lightning – Chaplain’s Duties – Cases in the Present Day – The Keith Fund – Notabilities of Surgeon Square – The House of Curriehill – The Hall of the Royal and Medical Society – Its Foundation – Bell’s Surgical Theatre.
THOUGH the ancient Scottish Church had been during long ages distinguished for its tenderness and charity towards the diseased poor, a dreary interval of nearly two centuries, says Chambers, intervened between the extinction of its lazar-houses and leper-houses, and the time when a merely civilised humanity suggested the establishment of a regulated means for succouring the sickness-stricken of the poor and homeless classes.
A pamphlet was issued in Edinburgh in 1721 suggesting the creation of such an institution, and there seems reason to suppose that the requirements of her rising medical schools demanded it; but the settled gloom of the “dark age” subsequent to the Union, usually stifled everything, and the matter went to sleep till 1725, when it was revived by a proposal to raise £2,000 sterling to carry it out.
In that year a fishing company was dissolved, and the partners were prevailed upon to assign part of their stock to promote this benevolent institution, which the state of the poor in Edinburgh rendered so necessary, as hitherto the members of the Royal College of Physicians had given both medicines and advice to them gratis.
A subscription for the purpose was at the same time urged, and application made to the General Assembly to recommend a subscription in all the parishes under its jurisdiction; but Arnot records, to the disgrace of the clergy of that day, that “ten out of eleven utterly disregarded it.”
Aid came in from lay purses, and at the second meeting of contributors, the managers were elected, the rules of procedure adjusted, and in 1729, on the 6th of August, the Royal Infirmary – one of the grandest and noblest institutions in the British Isles, was opened, but in a very humble fashion – in a small house hired for the sick poor, near the old University – a fact duly recorded in the Monthly Chronicle of that year, on the 18th of the month. This edifice had been formerly used by Dr. Black, Professor of Chemistry, as the place for delivering his lectures, says Kincaid, but this must have been before his succession to the chair. It was pulled down when the South Bridge was built. Six physicians and surgeons undertook to give, as before, medicines and attendance gratis; and the total number of patients received in the first year amounted to only thirty-five, of whom nineteen were dismissed as cured. The six physicians, whose names deserve to be recorded with honour, were John McGill, Francis Congalton, George Cunninghame, Robert Hope, Alexander Munro, and John Douglas. “Such was the origin of the Edinburgh Infirmary, which, small as it was at first, was designed from its very origin as a benefit to the whole kingdom, no one then dreaming that a time would come when every considerable county town would have a similar hospital.”
In the year 1736, by a royal charter granted by George II., at Kensington palace, on the 25th of August, the contributors were incorporated, and they proposed to rear a building calculated to accommodate 1,700 patients per annum, allowing six weeks’ residence for each at an average; and after a careful consideration of plans a commencement was made with the east wing of the present edifice, the foundation-stone of which was laid on the 2nd of August, 1738, by George Mackenzie, the gallant Earl of Cromarty, who was then Grand Master Mason of Scotland, and was afterwards attainted for leading 400 of his clan at the battle of Falkirk. The Royal College of Physicians attended as a body on this occasion, and voted thirty guineas towards the new Infirmary.
This portion of the building was, till lately, called the Medical House. Supplies of money were promptly rendered. The General Assembly – with a little better success – again ordered collections to be made, and the Established clergy were now probably spurred on by the zeal of the Episcopalians, who contributed to the best of their means; so did various other public bodies and associations. Noblemen and gentlemen of the highest position, merchants, artisans, farmers, carters – all subscribed substantially. Even the most humble in the ranks of the industrious, who could not otherwise aid the noble undertaking, gave their personal services at the building for several days gratuitously.
Many joiners gave sashes to the windows. A Newcastle glass-making company glazed the whole house gratis; and by personal correspondence money was obtained, not only from England and Ireland, but from other parts of Europe, and even from America, as Maitland records; but this would be, of course, from Scottish colonists or exiles.
So the work of progression went steadily on, until the present great quadrangular edifice on the south side of Infirmary Street was complete. It consists of a body and two projecting wings, all four storeys in height. The body is 210 feet long, and in its central part is thirty-six feet wide; in the end portions, twenty-four. Each wing is seventy feet long, and twenty-four wide. The central portion of the edifice is ornate in its architecture, having a range of Ionic columns surmounted by a Palladian cornice, bearing aloft a coved roof and cupola. Between the columns are two tablets having the inscriptions, “I was naked and ye clothed me;” “I was sick and ye visited me;” and between these, in a recess, is, curiously enough, a statue of George II. in a Roman costume, carved in London.
The access to the different floors is by a large staircase in the centre of the building, so spacious as to admit the transit of sedan chairs, and by two smaller staircases at each end. The floors are portioned out into wards fitted up with beds for the patients, and there are smaller rooms for nurses and medical attendants, with others for the manager, for consultations, and students waiting.
Two of the wards devoted to patients whose cases are deemed either remarkable or instructive, are set apart for clinical lectures attended by students of medicine, and delivered by the professors of clinical surgery in the adjacent University. Within the attic in the centre of the building is a spacious theatre, capable of holding above 200 students to witness surgical operations. The Infirmary has separate wards for male and female patients, and a ward which is used as a Lock hospital; but even in ordinary periods the building had become utterly incompetent for the service of Edinburgh, and during the prevalence of an epi- demic afforded but a mere fraction of the required accommodation, and hence the erection of its magnificent successor, to which we shall refer elsewhere.
The Earl of Hopetoun, in 1742, and for the last twenty-five years of his life, generously contributed £400 per annum to the institution when it was young and struggling. In 1750 Dr. Archibald Kerr of Jamaica bequeathed to it an estate worth £218 11s. 5d. yearly; and five years afterwards the Treasury made it a gift of £8,000; yet it has never met with the support from Government that it ought to have done, and which similar institutions in London receive.
But the institution owed most of its brilliant success to Lord Provost Drummond. Among his associates in this good work he had the honoured members of the Colleges of Physicians and Surgeons in Edinburgh, ever first in all works of goodness and charity; and the first Dr. Munro, Professor of Anatomy, was singularly sanguine of the complete success of the undertaking.
That portion of the house which was founded by the Earl of Cromarty was opened for the reception of patients in December, 1741. The theatre described was made to serve the purposes also of a chapel, and twelve cells on the ground floor, for cases of delirium tremens, being found unnecessary, were converted into kitchens and larders, &c. The grounds around the house, consisting of two acres, and long bounded on the south by the city wall, were laid out into grass walks for the convalescents, and ultimately the house was amply supplied with water from the city reservoir.
In the years 1743-4 the sick soldiers of the regiments quartered in the Castle were accommodated in the Infirmary; and in the stormy period of the ‘45 it was of necessity converted into a great military hospital for the sick and wounded troops of both armies engaged at Prestonpans and elsewhere; and in 1748 the surgeon-apothecaries, who since 1729 had given all manner of medical aid gratis, were feed for the first time. Wounded from our armies in Flanders have been sent there for treatment.
In 1748, after paying for the site, building, furniture, &c, the stock of the institution amounted to £5,000; and sick patients not wishing to be resident were invited to apply for advice on Mondays and Fridays, and were in cases of necessity admitted as supernumeraries at the rate of 6d. per day. About this time there was handed over an Invalid Grant made by Government to the city, on consideration of sixty beds being retained for the use of all soldiers who paid 4d. per diem for accommodation. This sum, £8,270, was fully made over to the managers, who, for some time after, found themselves called upon to entertain so many military patients, that a guard had to be mounted on the house to enforce order; and liberty was obtained to deposit all dead patients in Lady Yester’s churchyard, on the opposite side of the street.
Hitherto the physicians had, with exemplary fidelity, attended the patients in rotation; but in January, 1751, the managers on being empowered by the general court of contributors, selected Dr. David Clerk and Dr. Colin Drummond, physicians in ordinary, paying them the small honorarium of £30 annually.
The University made offer to continue its services, together with those of the ordinary physicians, which offer was gladly accepted; and though the practice fell into disuse, they were long continued in monthly rotation. To the option of the two ordinary physicians was left the visiting of the patients conjointly, or by each taking his own department. “It was their duty to sign the tickets of admission and dismission. In case of any unforeseen occurrences or dangerous distemper, the matron or clerks were permitted to use this authority; the physicians on their arrival, however, were expected to append their signatures to the tickets. The good and economy of the house from the first, induced the managers to appoint two of their number to visit the institution once every month, who were enjoined to inquire how far the patients were contented with their treatment, and to note what they found inconsistent with the ordinary regulations: their remarks to be entered in a book of reports, to come under review at the first meeting of managers.” (“Journal of Antiq.,” Vol. II.)
In 1754 some abuses prevailed in the mode of dispensing medicines to the out-door patients, detrimental to the finances; an order was given for a more judicious and sparing distribution. In the following year application was made to the Town Council, as well as to the Presbytery of the Church, to raise money at their several churches to provide a ward for sick servants – which had been found one of the most useful in the house. From its first institution the ministers of the city had, in monthly rotation, conducted the religious services; but in the middle of 1756 the managers appointed a regular chaplain, whose duty it was to preach every Monday in the theatre for surgical operations. He had, moreover, to say prayers twice weekly, and be ever ready to attend the dying when summoned by them.
In 1763 a number of Scottish soldiers disbanded on the great reduction of the army in that year, sick, lame, and destitute, applied for admission to the hospital. On this, an extraordinary meeting of the managers was summoned, and their application was granted, though the former did not consider themselves bound in any way to do so; and in that year, in pursuance of an order he received from the Commander-in-chief, Dr. Adam Austin commenced a regular visitation of the military wards, on the state of which he was bound to report to the Adjutant-General in Scotland. The Doctor was a Fellow of the Royal College of Surgeons. He married Anne, daughter of Hugh Lord Semple, and left a daughter who died so lately as March, 1864, aged 100 years and more. (Scotsman, 7th March, 1864.)
In 1768 the whole edifice narrowly escaped destruction, apparently not being provided with a lightning conductor. On the 30th of July the south wing was struck furiously by lightning; many of the windows were destroyed and the building much damaged; several of the patients felt the shock. Three were struck down; two recovered, but one became delirious. (Scot. Mag. Vol. XXX.)
The Colleges of Physicians and Surgeons had been in the habit of giving medical attendance in monthly rotation; but the managers, finding this to prove inconvenient, selected two regular physicians and four expert surgeons, to whom various departments were committed. The four latter were named substitutes, and divided the year equally, so that each had his own quarter.
The other surgeons, or ordinaries of the Incorporation, attended by monthly rotation. The four substitutes, besides their quarterly attendance, had their monthly tour of duty with the rest; “and when the month of any of the four fell in with his quarter, then, either the next substitute in order was to become his assistant, or he was to apply for the assistance of another for that month, that the attendance of two might at no time be wanting in the Infirmary.”
Such was the organised system of attendance; besides all this, the managers enjoined these substitutes to be present at all consultations, to take charge of all dresses and dressings, of the record of surgical cases kept by the surgeons’ clerks, and of the instruments for the use of the wards; and to each of these four surgeons, after 1766, was assigned a salary in proportion to what the funds of the institution admitted.
Distinct as these regulations were, they did not work well, and a committee was appointed to confer with the managers in 1769 to adjust certain matters that were in dispute, and new arrangements were made. Under these “one of the substitutes was to be changed annually, and his place supplied by a brother duly elected by the Incorporation of Surgeons according to seniority – at least in the order in which they could find any disposed to accept of the trust: all this was to be done under the authority of the managers, and to continue in force until they saw cause to alter it.”
About 1769 the ordinary patients, exclusive of soldiers and servants, averaged about sixty; but the funds having grown apace, eighty were accommodated. “If the physicians, on a due consideration of certain cases thought otherwise, no more were to be admitted, and those taken in, so long as they remained supernumeraries, were expected to pay sixpence per day.”
Dr. John Stedman, on the 2nd of August, 1773, was elected in place of Dr. Drummond, who had emigrated to Bristol; but his health was so infirm, that in 1775 Dr. Black was chosen in his place, and afterwards Dr. James Hamilton senior, long one of the ornaments of the city; and after obtaining also the office of physician to George Heriot’s, the Trades Maiden, and Merchant Maiden Hospitals, he superintended these benevolent institutions for upwards of fifty years.
As an estimate of the good accomplished it may be mentioned that between 1770 and 1775 the numbers admitted yearly at an average amounted to 1,567⅙, and the number of deaths 63⅙, and, omitting fractional parts, the deaths were to the numbers admitted as 1 to 25.
In 1778 the total number of patients with their attendants made up a family of 230, but so rapid has been the increase of the population, that between October 1846 and October 1847 no fewer than 7,576 patients sought refuge within its walls. Of these 1,059 died – “a large number no doubt,” says a report, “still, but for such a house of refuge, how many more would have breathed out their last amidst the noxious abodes of our city, spreading wider and wider the pestilential calamity which has swept away its thousands of victims in all parts of the country.”
In the year 1848 the chaplain was required by new regulations to read a portion of the Scriptures, and engage in devotional exercises in every ward in the house – a duty which generally occupied about five hours; he had to meet the convalescent patients in chapel for religious duty every evening; to be ready to attend the dying, and he had to preach twice on Sunday to the nurses, servants, and all patients who could attend.
In the old house over 5,000 patients were admitted annually, of whom about 2,300 were surgical cases. The average number of out-door patients yearly was about 12,000, obtaining the benefit of the highest professional skill of the medical and surgical officers, and receiving all the necessary dressings, appliances, and comforts at the expense of the house, which has an admirable staff of nurses under a lady-superintendent.
We may close our notice of the Old Royal Infirmary by a reference to the Keith Fund, established by the late Mrs. Janet Murray Keith and her sister Ann for the relief of incurable patients who have been in the house. These generous ladies by trust-deed left a sum of money, the interest of which was to be applied for the behoof of all who were discharged therefrom as incurable by the loss of their limbs, or so forth. The fund, which consists of Bank of Scotland stock, is held for this purpose by trustees, who are annually appointed by the managers of the Royal Infirmary, the annual dividend to which amounts to £250. In 1877 there were on the list of recipients 101 patients receiving allowances varying from £1 to £4; and in their deed of settlement the donors express a hope that the small beginning thus made for the relief of such sufferers, if well managed, may encourage richer persons to follow their example. Although this trust is appointed to be kept separate for ever from the affairs of the Royal Infirmary, the trustees are directed to publish annually, with the report of the managers, an abstract of the fund, with such other information as they may deem desirable.
In the account of the west side of the Pleasance we have briefly adverted to the ancient hall of the Royal College of Surgeons,1 which, bounded by the eastern flank of the city wall, was built by that body when they abandoned their previous place of meeting, which they rented in Dickson’s Close for £40 yearly, and acquired Curriehill House and grounds, the spot within the angle of the wall referred to. This had anciently belonged to the Black Friars, but was secularised, and passed successively into the hands of Sir John and Sir James Skene, judges of the Court of Session, both under the title of Lord Curriehill. Sir James Skene “succeeded Thomas, Earl of Melrose, as President on the 14th Feb., 1626, in which office he continued till his death, which took place on the 15th October, 1633, in his own lodging beside the Grammar School of Edinburgh.”
After them it became the property of Samuel Johnstoun of the Sciennes; and after him of the patrons of the university, who made it the house of their professor of divinity, and he sold it to the surgeons for 3,000 merks Scots in 1656.
This house, which should have been described in its place, is shown by Rothiemay’s plan (see p. 241) in 1647 to have been a large half-quadrangular four-storeyed house, with dormer windows, a circular turnpike stair with a conical roof on its north front, and surrounded by a spacious garden, enclosed on the south and east by the battlemented wall of the city, and having a doorway in the boundary wall of the High School yard on the north. On the site of this edifice there was raised the future Royal College of Surgeons, giving still its name to the adjacent Square.
On the west side of that square stood the hall of the Royal Medical Society, which, Arnot says, was coeval with the institution of a regular school of medicine in the University “by the establishment of professors in the different branches of that science. Dr. Cullen, Dr. Fothergill, and others of the most eminent physicians in Britain, were among the first of its members. None of its records, however, of an earlier date than A.D. 1737, have been preserved.”
Since that year the greater number of the students of medicine at the University, who have been distinguished in after years by their eminence, diligence, and skill, have been members of this Society, to which none are admitted until they have made some progress in the study of physic.
In May, 1775, the foundation stone of their new hall in Surgeon Square was laid by Dr. Cullen in the presence of the other medical professors, the presidents of the learned societies, and a large audience.
This Society was erected into a body corporate by a royal charter granted on the 14th of December, 1778, and “is intended,” says Arnot, writing of it in his own time, “as a branch of medical education, and a source of further discoveries and improvements in that science, and those branches of philosophy intimately connected with it. The members at their weekly meetings read in rotation discourses on medical subjects, which, at least six months previous to their delivery, had been assigned to them by the Society, either at their own request or by lot. And before any discourse be publicly read it is communicated in writing to every member, three of whom are particularly appointed to impugn, if necessary, its doctrines. From these circumstances the author of every discourse is induced to bestow the utmost pains in rendering it as complete as possible; and the other members have an opportunity of coming prepared to point out every other view in which the subject can be rendered. Thus, emulation and industry are excited, genius is called forth, and the judgment exercised and improved. By these means much information is obtained respecting facts and doctrines already published; new opinions are often suggested, and further inquiries pointed out. And it is acknowledged by all who are acquainted with the University of Edinburgh that the Medical Society has contributed much to the prosperity and reputation of this school of physic.”
Such are still the objects of the Royal Medical Society, which has now, however, quitted its old hall and chambers for newer premises in 7 Melbourne Place. Its staff consists of four presidents, two honorary secretaries, curators of the library and museum, with a treasurer and sub-librarian.
Many old citizens of good position had residences in and near the High School yards and Surgeon Square. Among these was Mr. George Sinclair of Ulbster, who married Janet daughter of Lord Strathmore, and who had a house of seven rooms in the yard, which was advertised in the Courant of 1761. His son was the eminent agriculturist, and first baronet of the family.
In 1790 a theatre for dissections and an anatomical museum were erected in Surgeon Square by Dr. John Bell, the eminent anatomist, who was born in the city on the 12th May, 1763, and who most successfully applied the science of anatomy to practical surgery – a profession to which, curiously enough, he had from his birth been devoted by his father. The latter, about a month before the child’s birth, had – when in his 59th year – undergone with success a painful surgical operation, and his gratitude led him to vow he would rear his son John to the cause of medicine for the relief of mankind; and after leaving the High School the boy was duly apprenticed to Mr. Alexander Wood, surgeon, and soon distinguished himself in chemistry, midwifery, and surgery, and then anatomy, which had been somewhat overlooked by Munro.
In the third year after his anatomical theatre had been opened in the now obscure little square, he published his “Anatomy of the Human Body,” consisting of a description of the action and play of the bones, muscles, and joints. In 1797 appeared the second volume, treating of the heart and arteries. During a brilliant career, he devoted himself with zeal to his profession, till in 1816 he was thrown from his horse, receiving a shock from which his constitution never recovered.
1 Vol. I., pp. 382-3.