William Alister Alexander
Biography
Dr William Alister Alexander was born at Wick, Caithness. The son of a doctor, he graduated in medicine at the University of Edinburgh in 1912. After junior hospital appointments in the Royal Infirmary and the Royal Hospital for Sick Children he served in the RAMC during the First World War, including almost a year in Malta and two years in the North-west Frontier. After demobilisation he became an assistant in 1920 in the Department of Pathology. When he decided to switch to clinical work he held simultaneous appointments at Leith Hospital, the Royal Infirmary of Edinburgh and the Royal Hospital for Sick Children, a combination which remained unique in Edinburgh. Later he worked solely in the Royal Infirmary, becoming assistant physician in 1927 and physician in charge of wards in 1936. He retired from his hospital post in 1955.
He served on the Royal College of Physicians of Edinburgh's Council and succeeded Sir David Henderson as President in 1951. After demitting office in 1953, he became Honorary Librarian of the college.
Details
- Date of interview: October 1973
- Archive reference: OBJ/ORA/1/45
- Interviewer: Angus Stewart
Transcription
Narrator:
The memoir of Dr William Alistair Alexander, recorded at his home in Randolph Crescent, Edinburgh in October 1973. The introduction is by Dr Angus Stewart and the recording by Dr Stewart Fletcher, both of the Pathology Department of the University of Edinburgh Medical School, then at Teviot Place.
William Alistair Alexander:
Well, Dr Alexander, this is very good of you to have us down to your house and to talk to us about early medicine in Edinburgh. As you know, this meeting is a reflection of the interest of the Edinburgh Pathological Club in medicine. And I remember that some years ago, you were once the secretary of the club, I believe in the 1920s. You graduated in medicine in Edinburgh in 1912, you were elected a Fellow of the Royal College of Physicians in 1927, you were a consultant physician in the Royal Infirmary in Edinburgh and were also a physician to the Royal Sick Children's Hospital and then later on you became President of the Royal College of Physicians in Edinburgh. Well after this very distinguished medical career which goes back for over half a century, we would very much like to hear your views and opinions about medicine in Edinburgh when you were a young man. Now, there's also another special reason why the Pathological Club is particularly interested in your contribution, and that is that you were a lecturer in the Department of Pathology in the days of [James] Lorrain Smith.
Speaker 3
I embarked on the study of medicine in 1907. That is 66 years ago. The course covered five years and it was usual, as now, to start in the autumn. But it was allowable for a student, if in a position to do so, to start in summer. This made no difference to the date of graduation, but although we were blessed with a less crowded curriculum, it had the advantage of giving an extra term which could be put to good use in the dissecting room and during the clinical years. The proportion of overseas students, especially from Australia, New Zealand, and South Africa, was high, and they were an asset to the university in both the academic and athletic fields. The South Africans, many of whom were of Boer stock, had their own union in Buccleuch Place. At a somewhat later date, there was also an Indian union. Women medicals were few in number, perhaps 15, and were taught separately so that we hardly got to know them. The ladies had their union in Lothian Street, where there is now a Franciscan friary. There was not the same supervision of the undergraduate as there is today, and there was scope for almost unlimited deferment. Often, of course, this was on account of failure to cross an academic hurdle, but it might be because of the need to take time off to replenish the kitty. And, in the case of some who could afford it, it seemed to be a matter of choice. At any rate, the admixture during the course of long-term students and chronics gave a welcome leaven, as some of them were real individualists. The bulk of the student body, whose homes were not in the locality as mine was, lived in digs, chiefly in the Marchmont district, but there were four halls of residence, patronised largely by medical, Ramsay Lodge in Ramsay Garden, Lister House in Mound Place, Blackie House in North Bank Street, backing onto Lady Stairs Close, and St. Giles House in St. Giles Street. These were independent of the university, being owned and administered by the Town and Gown Association, founded by Patrick Geddes. There were no wardens and each had its committee of management elected by the residents and accountable to the association, the secretary of which at that time was Thomas Whitson, later Lord Provost of the City. Members of staff were eligible for residence. For example, E.B. Jamieson lived in St. Giles House for many years greatly to its advantage. In certain circumstances, it was possible to obtain help with university class fees from the Carnegie Trust. I qualified for this grant, which however, I refunded at a later date. Otherwise, no subsidy was available, although a few students were in receipt of bursaries from one source or another. Many had to exercise extreme thrift and tried to get remunerative work on the vacations. There were fewer distractions in these days. Athletic standards were high, especially in rugby. There was no official gymnasium. The University Infantry Company, of which the commanding officer was Auckland Campbell Geddes, of whom more anon, attached to the Queens Edinburgh Volunteer Brigade, which I joined, and the University Battery, were strongly supported. Spring marches and summer camps took us to a variety of interesting country. Soon these detachments along with the University RAMC were to be incorporated into Lord Halden's territorial army as Senior Officers Training Corps. There was also a University Company of the 9th Royal Scots which remained outside the OTC and had the attraction for some of wearing the kilt. Debating societies had a strong hold and union debates were well attended. Dances were formal affairs with [programmed] stiff shirts and white gloves, and with the waltz, polka, [lancers] and reel, a strenuous routine. There were not so many musical occasions, though the Music Hall in George Street and the Queen's Hall, now the BBC studio, were used for this purpose. Concerts were held regularly in the Union. The Usher Hall was at the planning stage. Some celebrity concerts were held in the McEwen Hall, and I heard [Nellie] Melba there with Landon Ronald as accompanist. The theatre was popular and the Lyceum had its student nights with a sixpenny charge for the gods. The Theatre Royal in Broughton Street was noted for its pantomimes. The Empire was a variety house. It was burnt out in or about 1910 when a well-known illusionist lost his life. The Kings had recently been completed. A very illustrious occasion there was the Premier of Bally's Mary Rose. The cinematograph was still in its infancy. [Victorial] elections were fiercely contested and were a source of trepidation to the authorities. A residue of the 1908 election, vote for Osler, was still decipherable on the frontage of Lindsay Place till its recent demolition. Political addresses were given from time to time in the Senate Hall, and I was impressed most by the oratory of Lord Rosebery, father of the present hour, though H.H. Asquith was a close second. A.J. Balfour, who was Chancellor of the University, was not given a chance to shine when he spoke in the McEwan Hall. Reference to the Church should not be omitted, and John Calman, New North and later St. George's West, Harry Miller, New College Settlement in the Pleasance, J.R.P. Slater, New North, Sangster Anderson Barclay, Cameron Lee St. Giles, and Wallace Williamson St. Cuthbert's come to mind. John Coleman's Sunday evening services for students in the operator house where Adam House now stands were packed out. Life in general was more leisurely and less competitive. Edinburgh was more compact and in some respects more comely. Conditions favoured the pedestrian and the cyclist, although of course some of the inclines were formidable. Public transport was by cable car and suburban railway. Hansom cabs and four-wheelers plied for hire. The motor car had established itself, but was scarcely yet a feature of the landscape. All in the garden was not lovely, however. Already the city had acquired a grimy face and its slums were atrocious, with extreme poverty not far to seek, and disease life, so that nostalgia for the older days and ways has to be tempered. To get back to the university, the principal was Sir William Turner, anatomist, and the medical dean D.J. Cunningham, his successor in the chair, to be followed by Harvey Littlejohn, professor of medical jurisprudence. Extramural teaching was widespread at all stages of the curriculum. In addition to the extramural school at Surgeon's Hall, which catered primarily for the triple qualification, there were systematic courses, particularly by clinical teachers, which were recognized by the university but were usually taken as second or revision classes. Something has been lost, in my view, by the disappearance of extramural teaching, so traditional in Edinburgh and so valuable to teacher and taught. A great lack was the absence of a library and decent reading room in the medical school and in this connection the library at the Union was a boon. I started in October and my first class was chemistry. There was then only the one department of chemistry in the university and it was situated in the new quadrangle. The class was a large one and the professor was Alexander Crumb Brown who had held the chair since 1869. It was in fact his last year. He was a gentle, small, erudite man who wore a skull cap and spoke with rather a squeaky voice into his beard. He would have made a superlative mentor of an honour's group, but although he had a certain sparkle, was incapable of controlling and holding the attention of the mob who greeted him each morning with a selection from the Scottish Students' Songbook and the Church Hymnary, the latter somewhat modified in wording. A common sequence was that, after expostulating in vain, he returned to his retiring room. After an interval, he came back to the rostrum and apologized with tears in his eyes for losing his temper. His apology was graciously accepted by his tormentors, who were really very fond of Crummy, and he was allowed to finish his lecture more or less in peace. He never once shirked his morning ordeal. The practical class was taken by Leonard Dobbin, author of Salts and their Reactions, and we [ploughed] through this rather mechanically. Any reference to organic chemistry in the course was fragmentary. The lectures on physics in the science school in Drummond Street were given by Cargill Knott, who with his technical assistant Lindsay, also came in for a good deal of battle. The professor of botany was Isaac Bayley Balfour and the class was held at 8am in the summer time at the Royal Botanic Garden. This was a far cry for many and there was more than a spice of danger for the pedestrian crossing Hanover Street during the rush of cyclists, straining to reach the botanics before the door was locked at five minutes past eight. Sir Isaac was a strict disciplinarian and always took cards himself, making quite sure that a second card for an absent friend, perhaps temporally glued by saliva, was not truffled. I found the practical class when we were encouraged to illustrate our notebooks in colour enjoyable, as I did the Saturday excursions. Zoology was also taken in the summer, and this had its drawbacks, as [skates] and the like in the practical class, in the absence of refrigeration, were not enticing in a hot season. The professor, [James] Cossar Ewart, was not an inspired lecturer. He lived at Penicuik in what is now the Craigiebield Hotel, and had a considerable acreage of ground in which his striped [tuddies] were a source of interest to the neighbours, for he was interested in primitive types of horse flesh which took in the zebra. The department was in the old quadrangle and the staff included G.H. Ashworth who succeeded to the chair. A permanent demonstration in the Royal Scottish Museum was of inestimable value to the junior zoology student. We were introduced to the dissecting room at an early stage to be followed in the second year by the main lecture course. Unfortunately, in my year, the professor, Daniel J. Cunningham, an impressive figure and renowned author of textbooks in his subject, took ill and was never to return to the department. In parentheses, his family, of whom the most famous was Admiral of the Fleet, Viscount Cunningham of Heindel, gave distinguished service to the nation during the Second World War. His place was taken with acceptance by David Waterston, afterwards Professor at St Andrews, E. B. Jamieson and Auckland Geddes. The latter was subsequently elected to the chair of anatomy at McGill, but returned to the UK shortly after the outbreak of war in 1914 to become very soon a cabinet minister and eventually ambassador to the United States. His brother Eric, Lord Geddes, was also in the cabinet, and while his sister, Mrs. Chalmers Watson, was largely responsible for the recruitment of women in the war effort. E.B. Jamieson, a Shetlander and a bachelor, was perhaps the most distinctive teacher of his time in the medical school, as he was one of the most original and well-loved characters. He shared his time between the subsidiary dissecting room in Bristo Street, of which he was in charge, and the main department in the new quad where many of the mounted dissections were his work. His flair for blackboard illustration is perpetuated in his notable illustrations of regional anatomy. His pocketbook synopsis of anatomy, Wee Jimmy, remains a standby. Exact in observation and punctilious in the use of the English language, he gave valuable help in the revision of the Cunningham textbooks. His remarkable memory extended to the recognition and naming, initials included, of a generation of students. A brother held a chair of anatomy in England, but he himself had no ambition to head a department. There were no personal chairs in his day. Otherwise, the university would have done itself honour in electing him. A useful but not obligatory class of applied anatomy, preferably attended later in the curriculum, was taken by Harold Stiles. No review of the teaching of anatomy in Edinburgh during the first two decades of the century would be complete without mention of J. Ryland Whitaker, lecturer at Surgeon's Hall. He was a Lancastrian and a great entertainer. His revision courses drew large audiences, including many from the English schools during the summer vacations. Curiously enough, his deputy was also a Whittaker, but no relation. He too, Charles R. Whittaker, spelt with two Ts, ran successful, though frankly, coach, classes in applied anatomy and surgery. Incidentally, he was elected an honorary academician, Royal Scottish Academy. The eminent professor of physiology was Edward Schäfer, afterwards Sir Edward Sharpey- Schäfer. His was a very fruitful department. It was not easy to keep up with him, but he was a lucid lecturer. He lived at North Berwick and was hospitable to students. John Tate was responsible for the experimental class. He was an Orcadian and later filled the chair at McGill with distinction. Chemical physiology, which touched on organic chemistry for the first time, was under the charge of a German, William Cramer or Cramer, an earnest teacher who, however, had yet to acquire full freedom in the use of English. Histology included the embedding of tissues and cutting and staining of sections, and was supervised by Harold Pringle and W.A. Jolly. Fortunately, there was no dearth of textbooks on physiology. The favorites were Harold's and Starlings, along with Schäfer’s Essentials of Histology. W.S. Greenfield had come from London to fill the chair of pathology in 1881, and much of his best work, as on anthrax and Hodgkin's disease, had been done even before then. He held a clinical charge in the Royal Infirmary in addition, and was an accomplished physician. By reason of age and increasing deafness, combined with a liability to labyrinthine vertigo, He did not show to advantage in my time and his great gifts were not fully appreciated. Happily, an excellent textbook embodying his teaching in two volumes had just appeared. This was by two of his assistants, J.M. Beattie, by that time professor at Sheffield and about to go to Liverpool as professor of bacteriology, and W.E. Carnegie Dickson, senior lecturer in Edinburgh and Greenfield's son-in-law. Bacteriology did not [balk] largely in the course and was deputed to Carnegie Dickson, who also, along with Alexander Murray Drennan, took the practical classes. Outstanding microscopical demonstrations were laid out weekly by Richard Muir, who had started as a laboratory technician with Greenfield, and had attained eminence as a histologist and illustrator. Theodore Shannon was senior pathologist at the Royal Infirmary and was assisted in the postmortem room by James Miller and Murray Drennan. Shannon was lecturer in the extramural school and subsequently professor at Aberdeen. Miller succeeded Shannon at Surgeon’s Hall and became professor at Queen's University, Kingston, Ontario. Murray Drennan went to Dunedin, New Zealand as professor and eventually succeeded James Lorrain Smith at Edinburgh. Happily, he is still alive. Thomas R. Fraser, the professor of Materia Medica, was another legend in the school. Having been appointed to the chair in 1877, and to the clinical charge in the Royal Infirmary which went with it. A wisp of a man with a beard, he was imperious and sharp in tongue, though with a pretty wit. Amongst many other contributions, he had introduced the calabar bean, physostigmine, and strophanthus into the pharmacopoeia. For one reason or another, for example, his membership of the General Medical Council and the Council of the Pharmaceutical Society, not to mention his tendency to bronchial catarrh, he was away a good deal and much of the lecturing fell on the capable shoulders of W.C. Sillar. The practical class included the compounding of pills, ointments and potions according to the pharmacy of the day. A charming book, Edinburgh's Child, which was published a few years ago, was the work of Dr. Sillar’s widow. The Sillars lived in George Square, or George's Square as W. D. Stewart always called it. The professor of medicine was John Wyllie. It was said that William Osler had been a candidate for the chair in succession to Sir Thomas Granger Stewart, but that local influence prevailed. While he was in fact an excellent teacher, both in his systematic course and in hospital, especially for junior students, he had one assistant, J.G. Catnach, who sat in at every lecture and was occasionally called on to deputise when his chief had one of his attacks of migraine. It was a common practice to take a second extramural class and I attended that of Sir Byrom Bramwell, who by that time had been joined by his son Edwin, who recently returned to Edinburgh after some years at Queen Square and married to a daughter of DJ Cunningham. The holder of the chair of surgery was for a change, a new boy, Henry Alexis Thomson, who succeeded John [Sheen] in 1909. He was a brother of Patrick Thomson of the store on the North Bridge, and it was rumoured that he had been blackballed for the new club because his brother was a draper. There was excitement over the appointment, and we were led to believe that there had been strong lobbies for J.W.B. [Hodson], who had long conducted a very popular extramural class, and Harold Stiles. In the event, the choice in my view was the right one, for Alexis Thomson was a talented and sound teacher with a light and witty touch which made him one of the most stimulating and entertaining personalities in the medical school. His offhand sketches on the blackboard were extremely clever. The manual of surgery in which he collaborated with Alexander Miles had been widely acclaimed and had reached its third edition. He lived in Drumsheugh Gardens but had also a small estate near Gilmerton where he kept open house for students on Sunday afternoons when the sawing of logs was an optional part of the entertainment. He was one of the first members of the profession to drive a motor car and to adopt the lounge suit and bowler hat in lieu of the accepted professional garb of frock coat and top hat. He had a competent and popular deputy in James M. Graham who along with A. Perry Watson and R.C. Alexander conducted the ancillary classes on fractures, minor surgical procedures, bandaging and surgical pathology. The indispensable technical assistant was Frank Pettigrew. Operative surgery was a required class and there was a wide choice as almost all the assistant surgeons ran a summer course at the hour of 8 am. There seemed to be no shortage of bodies for this purpose. There was a sense of occasion at the lectures on midwifery, delivered by Sir John Halliday Croom, immaculate in dress and [portion], and equally thoroughly prepared and rehearsed. The course was combined with gynaecology, which was taken by A.H. Freeland Barbour, who did not have the panache of Sir John, but was a conscientious teacher. He was co-author with David Berry Hart of a manual of gynaecology which had an international circulation. Incidentally, he lived in the house on the north side of Charlotte Square which had been occupied by Lord Lister and to which he invited his clinic to tea on Saturdays. The assistants R.W. Johnstone and B.P. Watson greatly enhanced the value of the teaching by the tutorial classes. The latter became professor at Columbia University, New York, and returned in due course to succeed Halliday Croom. He stayed for only a few years, however, accepting an invitation to resume his duties in New York, which offered so much more in the way of facilities. R.W. Johnstone was then elected to the chair and may be said to have adorned it. In Edinburgh, early in the century, there were other obstetricians of the first rank, fertile in research, of whom Berry Hart and J.W. Ballantyne were perhaps the most outstanding. Opportunities locally for practical obstetrics were limited, and many had to do their cases elsewhere. The Rotunda and the Coombe in Dublin were the favourite resorts. I did mine in Glasgow, living in a hostel attached to the hospital in Rottenrow. Rickets was rife in Scotland at that time, especially in Glasgow, with the result that obstetrical complications due to the rickety flat pelvis were commonplace. Antenatal supervision was the exception, rather than the rule, and elective caesarean sections seemed to be seldom performed. Difficult forceps deliveries and obstructed labour entailing the use of that horrific instrument, the cranioclast, were everyday occurrences, often performed on the district by members of the junior hospital staff. This experience in the Gallowgate and other poor parts of Glasgow, aggravated by fleas, for which I was a sitting target, and lack of sleep, was something of a nightmare. The Department of Medical Jurisprudence, or Forensic Medicine, was under the charge of Harvey Littlejohn, who had succeeded his distinguished father, Sir Henry Littlejohn, in the chair in 1906. He was a polished and dramatic lecturer and the class was an attractive one, as it needed to be to hold the attention after lunch on a summer afternoon. The subject of public health had been incorporated in Sir Henry Littlejohn's course, but now there was a separate department based on the Usher Institute, the first incumbent being Charles Hunter Stewart. This was inevitably a somewhat factual class and the professor did little to embellish it. Passing now to clinical studies, these were, for me, years of surpassing interest and enjoyment, tempered, of course, by contact with the suffering arising from devastating diseases such as are seldom encountered nowadays or effectively treated. All clinical teaching was in the Royal Infirmary except for attendance at the City Hospital, the Royal Hospital for Sick Children, and the Royal Hospital for Mental Disorders. There were no municipal general hospitals then. The professors of medicine, materia medica and pathology, were also professors of clinical medicine. This group constituted something of an enclave, combining to deliver clinical lectures in the East Medical Theatre in conjunction with clinical gynaecological sessions taken by A.H. Barbour, William Fordyce, or B.P. Watson. The other units, sometimes referred to as extramural, shared the same routine in the West Medical Theatre. These were under the charge of Byron Bramwell, George Gibson, Alexander Bruce, Robert Philip, and William Russell, all together an outstanding team. Russell had a role apart in teaching the women. The gynaecologists who cooperated were N.T. Brewis, well known as a Rugby International forward in his day, and James Haig Ferguson. There was freedom of choice and I elected to sit at the feet of the university coterie, attending in sequence the clinics of John Wiley, Thomas Fraser and W.S. Greenfield. The assistant physicians, who were mature clinicians, R.A. Fleming, Harry Remy and J.J. Graham Brown were given few opportunities of teaching in the wards, their help being enlisted only in an emergency, although they officiated at the medical outpatient department. On the other hand, the clinical tutors, who were George Mathewson, Charles McNeil, and Louis Thatcher, were actively engaged, though formal tutorials being taken in the evenings at 7pm. It might be mentioned that medical radiology was not available, that the sphygmomanometer was not in common use, and that electrocardiography had yet to come. Sphygmographic tracings of the radial pulse were often recorded by the Marey or Dudgeon instrument, especially in Sir Thomas Fraser's wards, and some clinicians were testing out James Mackenzie's instrumental methods. There was, of course, no biochemistry, and such investigations as were undertaken were carried out in the [side] ward. The emphasis was on case taking, clinical observation, and physical signs. The wooden stethoscope was still commonly employed. The very [meekum] of the student and house physician was Hutchison and Rainy’s Clinical Methods. In my last year, I attended regularly the famous duck pound clinics of Sir Byrum Bramwell at 12 on Wednesdays, many of which were recorded in his Clinical Studies. An occasion which is etched on my memory occurred in 1912. Greenfield was due to deliver a clinical lecture on the day after the death of Lord Lister had been announced. He had been on the junior staff of King's College Hospital when Lister arrived there from Edinburgh in 1877 and from that time Joseph Lister was his hero. he paid a heartfelt and eloquent tribute and, deeply moved, dismissed the class. The senior surgical staff comprised F.M. Caird, who had succeeded Thomas Annandale in 1908 as Professor of Clinical Surgery Alexis Thomson, Professor of Surgery Sir Montagu Cotterill, a former rugby and cricket internationalist, C.W. Cathcart, J.W.B. Hodson, afterwards Sir James, David Wallace, afterwards Sir David, and Alexander [Myers], who took the women's clinic. It is not without interest to record that Charles Cathcart, a most lovable man, was wont to invite his students to breakfast at 8am on Saturday mornings. I did all my clinical surgery with Francis Caird and spent a great deal of time in Wards 7 and 8, acting as instrument clerk and giving anaesthetics, open chloroform on a towel and ether on a mask, during vacations and often on Saturdays, and attending ward rounds on Sunday mornings. There was no specialist anaesthetist attached to the unit, supervision being given by the clinical tutor and house surgeons. Caird was a pioneer in abdominal surgery and was prepared to do emergencies at any hour, giving his assistant surgeon A.A. Scott Skirving comparatively little responsibility. He revelled in teaching and hospital work and was a talented artist on the blackboard and illustrator of operations for inclusion in the case notes. His unit benefited greatly from the services of DPD Wilkie as clinical tutor. He was also Caird's private assistant. The constant companion of the undergraduate and house surgeon was Caird and Cathcart's surgical handbook, which went through many editions. Visits of members of the American Surgical Touring Club stand out vividly in my memory, including Halstead, Murphy, the Mayo Brothers, [Crile] and Cushing, amongst others. They went also to Chalmers Hospital and the Royal Hospital for Sick Children at both of which Harold Stiles was the draw. He was not on the staff of the Royal Infirmary till he succeeded Caird as Professor of Clinical Surgery in 1919. The Senior Assistant Surgeon, J.W. Dowden in my time, was in charge of the lock wards, where the more acute manifestations of venereal disease were seen. The later manifestations, which were manifold, came under the province of the general wards. Logan Turner, assisted by J.S. Fraser, was senior surgeon to the Ear, Nose and Throat Department. He was the son of Sir William Turner and was already established as a general surgeon when an injudicious dressing of a septic prick to his right index finger, with a 1 in 20 carbolic covered by oiled silk, resulted in gangrene and the loss of the distal and part of the middle phalanges. He switched to ear, nose and throat surgery and became a power in the land and his specialty. He was a bachelor and was a generous benefactor to the University and the Royal College of Surgeons. He was a prolific writer and was the author of compendious histories of the University and Royal Infirmary. He was an excellent teacher. Senior in the eye department was George Mackay and W.G. [Simm] who were strongly supported by Arthur Sinclair and H.M. [Traquair]. George Mackay and his team were my mentors and this was also a valuable class. Boards 1 and 2 adjacent to the surgical outpatient department housed the skin department under Norman Walker, later Sir Norman, one of the leading dermatologists in this country and author of a notable textbook which went into many editions. His lecture demonstrations on Saturday mornings in the West Medical Theatre were memorable. His assistant, Robert Cranston Low, became a worthy successor and mention should also be made of Miss Rae who contributed so largely to the efficiency of the department. Sir Norman took an active part in medical affairs and succeeded Sir Donald McAlister as Chairman of the General Medical Council. Rather surprisingly, attendance at the Royal Hospital for Sick Children was not compulsory. I became a resident house officer there and shall refer to it later. Dispensary practice was required and could be very valuable if conscientiously performed. I recall five dispensaries, in Marshall Street, Richmond Street, Regal Street at Toll Cross, property recently demolished, Thistle Street, New Town Dispensary and the Cowgate. The latter, Livingstone Dispensary, was associated with the Edinburgh Medical Missionary Society and was residential. They were charitable foundations and served a very useful purpose, [no] charge being made for attendance or medicines. Staffs consisted of young doctors in practice, many of whom became hospital physicians. For example, John Thomson may be said to have started his paediatric practice in a special clinic he established at Thistle Street. The student registered with one of the dispensaries, attended clinical sessions and was on call for district visits. If in difficulty, he called in his tutor. It gave an indelible insight into the miserable, indeed appalling conditions in which many of Edinburgh's poorer citizens, some of them respectable people, had to live. My own district was mainly Dumbiedykes and the High Street, and in the latter it was not unusual after finding the address in the warren of a tenement, to step into a well-proportioned room with fine plaster ceiling and cornice, a residue of the heyday of the Old Town, though furnished now with the barest necessities. It was at these dispensaries that a short course in vaccination was undertaken for which a separate certificate was demanded. The infectious fevers [built] largely in medical practice at the time of which I speak and the opening of the new city hospital at Carrington by King Edward VII in 1903 had made for a great advance in the care of these patients, being well sited and planned and under the resident superintendence of a distinguished clinician and author Claude Buchanan Ker, spelt with one R and often for some reason pronounced car. It could be a very busy place and the student had to be in good training to keep up with Dr Ker as he sprinted from one pavilion to another to take advantage of available clinical material. Typhoid fever was by no means a rarity. And I would like to diverge for a moment to mention an occasion in Ward 23, Royal Infirmary, when WS Greenfield, seeing the new patients on the morning after a waiting day, made a provisional diagnosis of enteric fever from feeling the pulse and noting its relatively slow rate in the presence of fever and its dicrotic character before carrying out his general examination, which confirmed his conjecture. Enteric fever could be a source of the greatest anxiety because of the dangers of haemorrhage and perforation, not to mention other possible complications. It used to be said that a knowledge of the disease and its complications and sequelae covered a large slice of medicine. An even more urgent and anxious problem was posed by laryngeal diphtheria. The treatment of diphtheria had been revolutionized by the use of antidiphtheritic serum, perhaps the first example of therapy based on a planned scientific experiment, the next being the introduction of Salvarsan 606 by Ehrlich in 1909. Cases of late diphtheria were still being admitted, however, and everything needed for emergency tracheotomy was laid out in the ward, though intubation in expert hands was taking its place. Here I may be allowed to describe a personal experience. In 1916 I was in Peshawar on the northwest frontier of India and developed a sore throat. A swab was taken and sent to the divisional lab which had been evacuated to its hill station a considerable distance away, it being the hot season. The report was negative. I suspect there had been no growth of any kind from the dried swab. I was due for leave and went to a hill resort in Kashmir, Gulmarg, some 8,000 feet up. Here I did not feel at all well and was very breathless. On the second day after my arrival, I went to the crowded lounge of the hotel for a cup of tea and was much embarrassed when the first mouthful came down my nose, an indication of course that I had diphtheritic paralysis of the soft palate. At the same time I was unable to pronounce the letter B as in the taste phrase Billy Button bought a buttered biscuit. I had also quite a severe tachycardia for several months from the associated toxic myocarditis. Fortunately there was a colleague with me and he kindly accompanied me to a lower level in the Vale of Kashmir, where we finished our holiday in a houseboat on the Dal Lake and River Jhelum at Srinagar. Measles and whooping cough took a heavy toll from bronchopneumonia in debilitated babies till Claude Ker took the bold step of nursing them in the open air on the ward balconies with a resultant significant improvement in the prognosis. Acute otitis and mastoiditis was a common complication as it was also in scarlet fever. The latter was common and often severe but was not so prone to attack infants. All sufferers were kept in bed for three weeks to cover the delayed complication of acute nephritis. Arthritis was another possible effect and with this there was a danger of endocarditis. Erysipelas was another not uncommon cause of admission to the city hospital. There were pavilions for tuberculosis which were under the charge of the medical officer of health for the city with Dr Alexander James as consultant. Those for advanced pulmonary tuberculosis of which I had experience while doing a locum in 1914, were quite the most depressing and horrible I have ever known. The smell was indescribable and massive hemoptices were the order of the day. Few left these wards alive. On a lighter note, I had charge during that same locum of a hut for men suffering from chronic chest disorder, suspected of being tuberculous. When more was declared on the 4th of August 1914, a number of these patients who were old soldiers simply disappeared. They had gone to their recruiting offices and been accepted as instructors and an attempt to trace them came to nothing. Passing now to psychiatry, a word not then in vogue, a lectureship in mental diseases had long been in existence and in 1910 Sir Thomas Clouston had been succeeded by G.M. Robertson. He was an energetic and ebullient physician, popularly known as Rosy Robertson, and his clinical lectures at West House were arresting and histrionic. The student had to complete a trial form of certification on a patient. And when I went to Craig House, the private section of the Royal Edinburgh Hospital, for this purpose, I was quite overcome by the magnificence of the entrance hall in which the interview took place. A chair was endowed in 1919 and George Robertson was the first incumbent. An eminent alienist at that time in Edinburgh and a prominent figure in the medical world, was Sir John Batty Tuke, but he was getting old in my student days. It is of interest to note that there was a class on the history of medicine taken by J.D. Comrie and one on physical medicine, including hydrotherapy and spas, by Harry Rainy. Both well illustrated by lantern slides, which weren't then in common use in teaching. These were voluntary classes. Great credit is due to John Comrie for his monumental work on the history of Scottish medicine which, however, had not then been published. Any picture of medical undergraduate life in Edinburgh would be incomplete without reference to the Royal Medical Society, essentially a student society and almost [inaudible] with the medical school. It celebrated its bicentenary in 1928. Its membership roll in the 18th and 19th centuries was one of great distinction. The old building in Melbourne Place, architect David Bryce, not I may say its first home, with its fine debating hall has gone the way of so much of Edinburgh's architectural heritage. But the society's unbroken existence is not in jeopardy, and there will soon be new premises in the university complex. The bulk of its valuable library was sold at Sotheby's a few years ago, I think wisely, as many of the books were uncared for, and this has put the society in good financial trim. I speak feelingly because I was honorary treasurer for 30 years when the situation was very different. I joined the society in 1909. I would like now to amplify briefly references in my talk to the very wonderful, indeed unbelievable change that has taken place in the incidence and pattern of disease since I was an undergraduate and house officer. Incidentally, I would say that clinical teaching was easier then than it is at present, as there was a superabundance of dramatic illustration. The most devastating of all ills in Scotland at the time was undoubtedly tuberculosis, from which no tissue or organ was exempt. Although the enlightened Robert Philip was slowly getting some order out of chaos, not without opposition, and Harold Stiles, with the help of John Fraser and Philip Mitchell, was proving his point that involvement of lymphatic glands in neck and abdomen and much of bone and joint disease was bovine in origin. The large amount of control which has now been obtained over tuberculosis is my own deepest cause for thankfulness in the medical field. The [protein] late manifestations of syphilis were to be seen in every general ward, especially perhaps its effects on the cardiovascular system in the shape of aortitis leading to aortic aneurysm and severe incompetence of the aortic valve. So-called parasyphilitic diseases, locomotor ataxia and general paralysis of the insane were relatively common. While on the subject of venereal disease it is well to record, each surgical ward had its regular urethral stricture sessions and its large armamentarium of bougies and catheters. Pyogenic osteomyelitis often proved fatal in the acute stage from pyaemia, but was also responsible for much chronic sepsis culminating in waxy disease. Lobar pneumococcal pneumonia, that most fascinating of diseases, was to be seen in every medical ward. Nothing could be done about it except careful nursing. The mortality was high, especially in alcoholics who were toppled into delirium tremens and had to be transferred to Ward 3. In a favourable case, the body resources to speak loosely rallied to produce enough antitoxin to counteract the infection and the transformation at the moment of crisis, which happened usually on the sixth day, was one of the most dramatic occurrences in medicine. Even then there was a danger of empyema developing afterwards. In an unfavourable case, the peripheral circulation gradually failed as a result of [toxic] shock, which was irreversible. Diabetes mellitus in a young person was a heartbreak, as were a host of other conditions such as pernicious anaemia and acute thyroid toxicosis. Severe iron deficiency anaemia was often seen and indeed one form was regarded as an entity. I refer to chlorosis occurring in young females, often in domestic service. Rheumatic fever frequently presented in a form with pronounced constitutional features and this tended to obscure the insidious nature of the bulk of juvenile rheumatism. Rheumatic heart disease was rife and emphasis in teaching was on valves and murmurs, with the myocardium apt to be neglected. Although delirium cordis, that admirable old term for atrial fibrillation, had long been recognized as a sequel to mitral stenosis. Infarction of the heart wall was described in pathology books but ischemic heart disease during life or even at autopsy was not well documented. It was, of course, much less common. Though again, a good old descriptive term, status anginosus, was in clinical use to describe the sustained pain which in retrospect was the result of coronary occlusion. Hypertrophy of the left ventricle in the absence of aortic stenosis was thought to be due mostly to chronic renal disease. A rise in blood pressure was recognised from examination of the pulse, but a better understanding of hypertension had to await the common use of the sphygmomanometer. Digestive and elementary disorders were likewise imperfectly assessed and defined, though the clinical picture of duodenal alpha had been described by Moynihan and Alison. I have already referred to the high incidence of rickets with all its unfortunate effects on the skeleton in Glasgow and Edinburgh. Spinal deformities were one result, but most severe kyphosis was due to tuberculosis, Pott's disease, and infantile paralysis, that is poliomyelitis. The latter, with its extraordinary epidemiology suggesting a high basal immunity in the community, was all too common. These are but a few illustrations which make me realise afresh how privileged I have been to have lived through this period of unparalleled medical discovery and advance. On graduation, a number of my fellow students went straight into general practice. One indeed, after having been capped in the forenoon and registered in the afternoon, joined as a practice's assistant before the day was out. I marvelled at their self-confidence. But the fact was that they were starting an apprenticeship under experienced principles and undergoing training which met the demands of their life's work. What was inequitable was that so many could not afford to enjoy the experience of further hospital training, no salaries or honoraria being payable in the voluntary hospitals. I was fortunate to be able to do so and spent a year in Sir Thomas Fraser's Wards, 25 and 26, six months non-resident and six months resident. During the latter part, Sir Thomas fell on his doorstep in Drumsheugh Gardens and fractured the neck of his femur, so that my only contact was a periodic visit to take a pulse tracing on a Marey sphygmograph to check on an arrhythmia, which I expect was due to [exocytosis]. This was quite a daunting task and Sir Thomas was not the most patient or tolerant of men. During his absence Harry Rainy and Edwin Bramwell had charge of the wards and this was a very happy arrangement. I would like to mention that Miss McPherson, who was sister in Ward 25 in 1913, is still alive and reasonably well. The charge included supervision of Ward 3, where there could be pandemonium with DTs and suicides. The fashion in the latter was corrosive poisoning, as with Lysol and cutthroat, and the outcome only too predictable in most cases. I greatly enjoyed the fellowship of the residency mess in that summer of 1913 and took advantage of an arrangement whereby it was possible to sleep in the open in a weatherproof bed on the roof of the MOPD, finding this conducive to shorter and more refreshing sleep. I went on to [inaudible] Hospital for Sick Children where my chief was Harry Melville Dunlop, father of Sir Derek. He was an accomplished physician and a popular teacher. This was also a broken residency in as much as Dr Dunlop retired in the course of it. I have the pleasantest memories of his association as I have of that with the young physician who succeeded him J.W. Simpson, whose promising career was cut short in the influenza pandemic at the end of the war. The other physicians were John Thomson, J.S. Fowler, Dingwall Fordyce, and Charles McNeil, with Harold Stiles and John Fraser on the surgical side. The hospital was small enough to enable one to learn of anything of special interest, and the post was a valuable one. There was much more serious illness in the shape of pneumonia and elementary disorder then than there is today and the high death rate was distressing. Subsequently I spent three months at Derby City Asylum under Rutherford Macphail who was a brother-in-law of John Thomson. When war broke out in August 1914, I was deferred because of a varicosity on which incidentally the surgeon I consulted refused to operate. It caused no difficulty eight months later. Meantime, I became House Surgeon to FM Caird in Wards 7 and 8. And this was quite the busiest time of my life. F.E. Jordan had succeeded David Wilkie as clinical tutor. Caird was performing gastroenterostomy freely for duodenal ulcer diagnosed on clinical grounds. He did not carry it out unless there was unequivocal evidence of scarring. But that it was not always a lasting success was made clear to me three years later when one of my old patients was admitted to hospital again under my charge, under my care in Peshawar, India. Caird was however a superlative abdominal surgeon and an excellent teacher. After the war, in which I served for four and a half years, mainly in the Mediterranean and the Northwest Front of India, I returned to Edinburgh and at the instance of D.M. Lyon, then senior assistant in the department, I applied to Lorrain Smith for a post. This was [already] in 1920. After a short interval I was taken on for the staff of the university and infirmary departments. James Lorrain Smith had succeeded Greenfield in 1912. He was a Galloway man and an Edinburgh graduate in arts and medicine. He had worked for some years with J.S. Haldane at Oxford and was a fellow of the Royal Society. He had occupied the chairs of pathology at Belfast and Manchester. He was of a philosophical bent and his approach to pathology was wide and imaginative, perhaps too much so for many of his students who would have preferred more didactic teaching. He became Dean of the Faculty and heavily involved in university administration. This slowed down a fundamental research on lipids with his friend Theodore Rettie, a chemist. A useful collaborative effort had been their introduction early in the war of Eusol, Edinburgh University solution that is as an antiseptic comparatively gentle on the tissues. In the course of time I became responsible for the class of morbid anatomy which took the form under Lorrain Smith of a review of six cases illustrating different types of disease. The student was given an abstract of the clinical notes and a set of six slides. Mounted specimens were set out. Several members of staff were available to help at all sessions. There was no lack of autopsy material. Cases might be an acute infection like pneumonia, tuberculosis, malignant disease, cardiovascular disease, cirrhosis of the liver, pernicious anaemia and so on. Descriptions of the morbid anatomy and histology had to be written and preferably illustrated in one book and a discussion and commentary in another. The books were read by a member of the staff, the professor taking his share, and handed back with comments and an assessment to the student. Some of their work was quite first class and I wish that I had retrieved some of the notebooks. This class, it seemed to me, was of the essence of good undergraduate teaching and deserves to be remembered. Others on the staff were F.E. Reynolds, B.J. [Rowley], G. Marshall Findlay, R.D. Mackenzie, T.R. Sprunt, Agnes MacGregor and James Davidson. Reynolds had been a member of the Plague Commission and was in Siberia at the outbreak of war. He was appointed professor of pathology at Cairo at the end of the war, but did not stay long. He was a perfectionist in many directions and was not easy to work with. He gave up academic pathology and devoted himself to public health bacteriology in Glasgow. I have already mentioned Richard Muir, but would like to emphasize his talents as a medical illustrator and morbid histologist. He was one of the two people whose help I sought when faced with a difficult [supporting] problem at the Royal. The other was James Dawson at the RCP lab. Richard Muir's daughter, Netta I think her name was, was also a valuable member of the technical staff. One of those who started his training in my time was Tom Dodds, who attained such great expertise in colour photography. Sir James MacKenzie, then settled in St Andrews, was a friend of Lorrain Smith, and I remember listening in to several conversations and arguments between them. Lorrain Smith was largely responsible for bringing Jonathan [Meekins] to Edinburgh as Professor of Clinical Medicine. [Meekins'] tenure of the chair was short but distinguished and he attracted a number of young men of ability like C.R. Harrington and J.B.S. Haldane and Whitridge Davies to work in his laboratory. Lorrain Smith died in 1931 at the age of 69. He was a lovable man and of fine presence. The laboratory of the Royal College of Physicians in Forrest Road had been inaugurated by Sir John Batty Tuke in 1887. He remained its curator until 1912. I quote from an introduction I wrote for John Ritchie’s History of the Lab in 1953. The laboratory of the Royal College of Physicians of Edinburgh was a pioneer venture of which there is every reason to be proud. During the 60 years of its existence, it made noteworthy contributions to research and provided a laboratory service which gained a reputation far beyond the confines of Scotland. Its story is well worthy of record. No history of its activities would be complete without an acknowledgement of the generous help of the Carnegie Trust nor should the support of the Royal College of Surgeons of Edinburgh and of the university be forgotten. It was hoped that the laboratory would be incorporated in the Lister Memorial scheme to the funds of which the college was a liberal contributor, but circumstances prevented the accomplishment of the original plan and meantime the introduction of the National Health Act, as well as other influences, made it impossible for the college to continue to maintain the laboratory. It is not invidious to pick out for special mention from many distinguished workers, James Walker Dawson, whose work and reports on histological material brought widespread credit to the lab and whose character was such as to make an indelible impression on colleagues and students. His main knife work was carried out in and for the laboratory and if this small book were to carry a dedication it might well be to him. It is fortunate that in Dr. John Ritchie there is available a chronicler who is admirably qualified to undertake the task of compiling a record of the laboratory. He was the last of a notable line of superintendents and his interest in medical history is well known. Previous superintendents had included Sims Woodhead, Noel Paton and James Ritchie, afterwards Professor of Bacteriology. A. G. McKendrick succeeded Ritchie in 1920 and was later joined by two other distinguished members of the Indian Medical Service, W. Glenn Liston and W. F. Harvey. who took over from J.W. Dawson when he turned ill. A chemistry department had been incorporated and W.O. Kermack was in charge of it. He was blinded as a result of an explosion in the lab but returned and eventually became professor of chemistry at Aberdeen. He was a very remarkable man. I was curator at the time of its closure in 1950. For some years I was secretary of the Edinburgh Pathological Club which had originated amongst those working in the lab and had been joined by kindred spirits from outside. It met in the premises in Forrest Road. and I regret to say that I remember very little about it. It was interdisciplinary and I do not think that membership was restricted.
Narrator:
An appendix follows. Recording sessions have to stop from time to time to refresh and relax the speaker. The microphones are always swung aside but in the conversations which follow unexpected items of interest sometimes crop up. Attempts to resume the recording are often imperfect and require heavy editing. Two items of medical historical significance retrieved in this way are included. The first concerns the father of Sir Derek Dunlop.
Interviewer:
G.H. Mellville Dunlop, the father of Derek…
William Alister Alexander:
He was well enough, he was fit enough men to go into the army medical service and he died in France. I'm not sure what year.
Interviewer:
His name is up on the memoriam of the big wooden paddle in New Club.
Narrator:
The second recalls the life and work of the pathologist Dr James W Dawson and of his wife Dr Kate Dawson who survived him for many years and made notable contributions to breast pathology in Edinburgh.
Switches between interviewer and Alexander, not clear what is said by which:
JW, James Dawson. Suffered from tuberculosis all his life and died out and at an early stage in his life he was sent I think to New Zealand to live an open air life and he became a shepherd and he's a very religious man in the best sense of the word to he was a very delightful man um James Dawson and his wife Kate, Kate Dawson. She worked in the lab, RCP lab for a while with WF Harvey. He's still working in the RCS museum.
Interviewer:
Most remarkable woman. I suppose you know that address that JW Dawson gave to the Women's Medical Society? It's a most excellent thing, I think it was published in the Edinburgh Medical Journal, The Spirit of Work and the Spirit of Leisure.
William Alister Alexander:
He did help Lorrain Smith for teaching during the morning. He was an excellent teacher, but of course it took an awful lot out of him.
Narrator:
The text of James Dawson's address, The Spirit of Leisure and the Spirit of Work, was published in January 1924 in the Edinburgh Medical Journal, Volume 31, Number 1, pages 1 to 21. That ends the 1973 memoir of Dr William Alistair Alexander.