In the 1700s many of the founders of dispensaries were outsiders - outsiders for reasons of religion, nationality or social class.

At this time Edinburgh was viewed by many as the national, and even international, centre of medical learning. It was also, arguably, the centre of medical nepotism. Family names such as Monro, Gregory and Hope appear over and over amongst successive generations of professors at the University of Edinburgh.

The founder of the Edinburgh dispensary, Andrew Duncan, was definitely not part of this established elite.

Early life and career

Duncan was born in East Neuk, Fife, in 1744 to a father who was a local shipmaster. He studied medicine at the University of Edinburgh before taking up a position as ship’s surgeon with the East India Company. After travelling to a number of countries, including to China, he returned to Scotland in 1766.

Duncan, like many less-well-off medical students at the time, had not completed his medical studies while at Edinburgh. That university’s fees were exceptionally high and, as a result, Duncan and many others acquired their MDs at the University of St. Andrews instead.

Duncan then worked hard to develop his reputation. In 1773 he founded a journal titled Medical and Philosophical Commentaries which, with periodic changes to both title and format, remained in print for over a hundred years. This was the first medical review journal published regularly in Great Britain.

That same year Duncan also founded a medical society, the Aesculapian Club, whose aim was to forge better relationships between practicing physicians and surgeons. This was only the first of many clubs and societies, both medical and non-medical, which Duncan was responsible for.

Founding the dispensary

In 1773, John Gregory, Professor of the Institutions of Medicine at the University of Edinburgh, died, and the following year Andrew Duncan was nominated as his temporary replacement until a successor was found.

In 1776, when a final decision came to be made, there were two candidates for the position: Duncan and James Gregory. Gregory was the son of the previous incumbent and, although only 23 years of age, was appointed to the position.

While Duncan had been serving in this temporary position, he had been granted access to the Royal Infirmary of Edinburgh’s teaching ward, a privilege only available to medical professors at the university. After losing his professorship, therefore, he also lost access to his charitable patients and to the teaching and research opportunities which they provided.

And so, this is the moment when Duncan decided to establish his dispensary - to help the sick poor, yes, but also to enable him to advance his position and to continue the research that he had begun when he held his temporary professorship.

Duncan began advertising private medical classes and brought in non-fee-paying patients to be used for teaching purposes. In the following years this informal system developed into a more formal dispensary.

Duncan devoted most of the 1780s to his dispensary work. Researching and studying his patients there, and then continuing that study through his published journal.

Later life

The 1790s were a time of much activity for Duncan, and the period when many of his greatest achievements were put in motion. In 1790 he was finally appointed to the post he had long sought – Professor of the Institutions of Medicine. In the same year he was also elected President of the Royal College of Physicians of Edinburgh.

Duncan also played a key role in establishing the Royal Edinburgh Hospital – then known as the Edinburgh Lunatic Asylum. Duncan launched an appeal for funds to establish the hospital in the 1790s and, over 20 years later, in 1813, the asylum finally opened its doors to admit patients. In Duncan’s original vision the asylum would provide treatment to those unable to afford private care but, because insufficient funds were donated to the cause, for the first three decades of its operation the asylum only admitted fee paying patients. It was only in 1842, fifteen years after Duncan’s death, that the poorer individuals he had always envisaged as the main patients of the Edinburgh Hospital were finally admitted.

Another significant achievement of Andrew Duncan was the establishment of Britain’s first Professorship of Medical Jurisprudence in 1807. Medical jurisprudence meant something rather different then than what it does now. In essence, it was legal medicine in all its forms – combining forensics and public health. So, by establishing this post, Duncan established both the first forensics university post, and the first public health university position in Britain.