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Robert Burns Lives!
Robert Burns – His Life, Illness and Death: 18th Century Medicine in Scotland By Thorne Winter, MD.

Edited by Frank R. Shaw, FSA Scot, Dawsonville, GA, USA

It is always an honor to introduce to our readers someone I have known for many years, especially when that person is a fellow member of the renowned Burns Club of Atlanta. More importantly, it is special when that person is loved and respected by all club members as is our writer today. Recently he spoke to members and guests at our Burns Club, and when I asked to share his talk with our readers, he graciously consented.

Dr. Thorne S. Winter, III of Atlanta, Georgia, sent to Duke University and graduated cum laude from Harvard Medical School. His post medical school training included Peter Bent Brigham Hospital in Boston, the National Cancer Institute, and Emory Medical School in Atlanta. He was in the private practice of internal medicine and cardiology for 40 years and currently serves as medical director of the internal medicine division of the Multiple Sclerosis Center of Atlanta.  Thorne is a Fellow of the American College of Physicians, the American College of Cardiology, and the Society of the Antiquaries of Scotland. He is a member of the American Osler Society and the American Society of Clinical Oncology. And, he is a past president of the Burns Club of Atlanta.

I remember how excited Thorne was a few years ago when on behalf of the club I invited Dr. David Shi, President of Furman University, to speak at one of our monthly Burns Club meetings. The Burns cottage was packed to hear Dr. Shi speak. Several members had Furman connections but Thorne’s stand out. His mother, Lanche Friend Attaway Winter, graduated from Greenville Women’s College, which officially merged with Furman University in 1937. His son, Thorne Winter, IV married a Furman classmate, Sandra McAlaster, and both are graduates of the university. Thorne’s granddaughter, Melissa Mabry, if my memory does not fail me, was a freshman the year Dr. Shi spoke, and she has since graduated as well. Dr. Shi gave a brilliant speech that night on John Witherspoon, the famous minister from Scotland who not only signed the Declaration of Independence but also the Articles of Confederation while President of the College of New Jersey which later became Princeton University. Why so much Furman University information? Well, I graduated from Furman back in the dark ages and I do not mind giving the school a plug every time I have an opportunity. Furman today is still one of the most beautiful campuses in America and the academic record there is just as impressive.

It is a joy to welcome Dr. Winter to the pages of Robert Burns Lives!. I want to thank my friend Bill Tucker, editor of the excellent monthly Burns Club of Atlanta newsletter, for his assistance in providing the speech and accompanying photo of Thorne which first appeared in the April issue. It is one I look forward to receiving each month. In addition, I do not thank my son Scott enough for the help he gives me with articles for this website. When I bump into a computer problem that I cannot solve, I usually send it to him and ask him to put it in a Word document and email it back to me - and he does it every time!. Thanks, son. You’ll never know how much your assistance means to me in this labor of love on behalf of Robert Burns and his friends. (FRS: 4.27.11)

Robert Burns – His Life, Illness and Death:
18th Century Medicine in Scotland

By Thorne Winter, MD

Thorne S. Winter, III, MD

Ladies, gentlemen, members of the Burns Club of Atlanta and their guests, my talk is divided into two parts:

  1. Robert Burns – his life, illness and death,

  2. A review of medicine in the 18th Century in Scotland with an emphasis on medicine in Edinburgh during Burns’ lifetime in the later half of the century.

Robert Burns was born in 1759 and died in 1796. He is the national bard of Scotland, the world’s most popular love poet and a major advocate of liberty and humanity. His works are largely in the Scottish dialect, but some of his works are in Standard English.

Burns was born in the rural town of Alloway in southwestern Scotland. He was educated by his father and a local teacher. He supplemented his education by reading on a wide variety of topics. Like his father, Burns was a farmer for much of his life. Initially, the writing of poetry was only for recreation.

At the age of 27, Burns published in Kilmarnock, Scotland a limited edition of 600 copies of his poems titled: Poems Chiefly in the Scottish Dialect. This was a success and it was followed the next year by the publication of a larger Edinburgh edition of 3,000 copies of his poems. He continued to write poetry throughout his life.

During the last nine years of his life, Burns devoted much of his time to the collection and preservation of about 350 old Scottish songs and ballads. Some of these works existed only in fragments. He re-worked about 250 of these into the forms that have endured to this day. In many cases this required the taking of Gaelic tunes of Celtic origin and fitting them with words of Scots-English, a language of Germanic origin.

A few of Burns’ more famous poems and songs include: To A Mouse; To a Louse; The Cotter’s Saturday Night; Tam O’Shanter; A Man’s A Man for A’ That’ John Anderson, My Jo; Ae Fond Kiss; A red, Red Rose; an Address to a Haggis; and the New Year’s Standard, Auld Lang Syne.

At the age of 29, he moved to Ellisland, a farm near Dumfries where he became an exciseman or tax collector. At the age of 32, he moved to Dumfries where he died at the age of 37.

Burns’ early biographers felt that alcoholism was the cause of his death. But after reviewing his medical history as quoted by Burns himself and his friends, I have come to a different conclusion.

As a teenager, Burns had episodes of headache, palpitations, fainting and nocturnal shortness of breath. At age 22, he had a three months illness with fever that was treated with ipecac, rhubarb, opium and Peruvian bark. At age 23, he suffered a relapse with fever, heart irritability and nocturnal faintness. This was treated with cold-water baths. At the age of 30, he had a bout of Quinsy. This is severe tonsillitis with pus. At the age of 36, he had a severe toothache that he memorialized in the poem, Address to a Toothache:

When fevers burn, or ague freezes
Rheumatics gnaw, or colic squeezes
Our neebors sympathise to ease us.
We pitying moan.
But the! Thou hell O a’ Diseases
They mock our Groan

Subsequently, Burns’ health progressively declined. He suffered from “flying gout” or migratory arthritis, fever, rapid pulse, weakness, pallor, delirium and ultimately, death. Treatment consisted of cold-water baths up to his armpits in the Solway Firth.

I feel that Burns had rheumatic fever as a primary illness. This is an autoimmune disease that is initiated by an infection with a Beta-hemolytic Streptococcus bacterial infection. The body reacts to this infection by making antibodies that react against the streptococcus. Unfortunately, these also cross react against the bodies’ joints, heart, skin and nervous system causing inflammation in these tissues. Symptoms include fever, migratory joint pain, palpitations and shortness of breath. The illness may be recurrent.

Inflammation of the heart valves may lead to scarring and deformity of the valves. If at a later time, bacteria enter the blood stream, as from an infected tooth, the bacteria may lodge and grow on the deformed valves. This sets up a chronic infection that ultimately leads to death. This is variously called: Chronic Infective Endocarditis, Subacute Bacterial Endocarditis, or Infective Endocarditis with specification of the organism and valves involved.

Rheumatic fever itself was not fully described until the early 19th Century. Chronic infective endocarditis was not fully described until 100 years after Burns’ death by Dr. William Osler. He described 10 cases similar to Burns’. Six had a history of rheumatic fever. All had remittent fever. All had valvular heart disease. The ages ranged from 19 to 53. The duration of the disease was 4 to 13 months. It took almost another 100 years before effective treatment was available in the form of antibiotics and surgery.

I will now turn to a discussion of Medicine in Scotland. In the 17th Century, there was no knowledge of what caused disease. Some observable features of diseases were known e.g., Gout, Rheumatism and Quinsy. Some empirical remedies were known e.g., Peruvian Bark.

In 1638, Peruvian Bark became the first major specific treatment of a disease. The wife of the Spanish Vice Roy in Peru, the Countess Chencon (Chin Chon) developed a fever that was cured by the bark of a tree. The popular name of the tree bark was simply, Peruvian Bark. The scientific ingredient was quinine. The disease was malaria. In Scotland, this was used to treat Ague that was a fever and aches that was probably malaria contracted by Scottish sailors in the tropics.

By the end of the 17th Century in Scotland, future medical practitioners had little formal education and questionable examinations. Medicine was unscientific. During the 17th Century, Scotland had been economically poor and politically distraught.

The 18th Century was different. The politics in Scotland was volatile, being a mixture of religion, patriotism and patronage. By 1750, the population was 75% literate (one of the highest rates in Europe). In the last half of the century, Edinburgh became the center of learning in almost every human insight and activity. This was called the Scottish Enlightenment. Participants included: Adam Smith (philosopher and political economist, and author of The Wealth of Nations), David Hume (philosopher), William Cullen (physician) and James Hutton (geologist).

I will now turn to medicine in Edinburgh in the 18th Century. Since 1505, there had existed in Edinburgh Incorporation of Surgeons and Barbers with the surgeons ultimately separating from the barbers in 1727. The Incorporation was a craft guild under charter from the City of Edinburgh. Surgeons as Cirugeon-Apothecaries acted as general practitioners. They compounded and sold drugs and performed surgical procedures using crude instruments made by blacksmiths. Education was by apprenticeship for three years to surgeons of variable competency. Upon completion of apprenticeship, the apprentice was questioned by the Incorporation on the theory and practice of his profession. He then dissected a part of the body, compounded a prescription and produced a thesis. If he passed, he could be admitted to the guild.

In 1776, the Incorporation partially separated from the town council of Edinburgh and received a Royal Charter as the Royal College of Surgeons of Edinburgh. This became a degree granting institution, granting a diploma but an M.D. degree. The Royal College of Physicians of Edinburgh was founded in 1861.

Physicians were those medical practitioners who practiced Physic. Physic was the treatment of internal diseases by medical means. Physicians could prescribe medicine, but they could not dispense medications. They could not do any form of surgery. Diagnosis was by history, observation of the patient and his urine in combination with a check of his pulse. There was no physical examination. The Physicians possessed a university degree; but prior to 1727, there was no place in Scotland where they could study medicine. They had to go to Europe instead.

In 1726, the town council of Edinburgh established a medical school of Physic, and four physicians of prominence were installed as professors of surgery, physic, botany and material medica. In subsequent years, professorships were added chemistry, medical practice, medical theory, mid-wifery, clinical medicine and clinical surgery. The many eminent teachers who filled the medical and surgical chairs in successive generations effected a major change in the methods of teaching and practicing medicine. Regular scheduled lectures were established and courses could be attended by students as they chose.

Graduation requirements for an M.D. were specific:

  1. The student must have completed all the courses that were offered. This was usually done in three years.

  2. He must pass a private oral examination.

  3. He must write and publicly defend a thesis on a topic of his choice.

  4. He must write commentaries on:
    a. A general medical question
    b. Two case histories
    c. Aphorisms of Hippocrates
    [Aphorisms are concise statements containing a subjective truth or observation cleverly or pithily written. Hippocrates wrote the first book of aphorisms. An example is: Persons who are naturally of a full habit (i.e., fat) die suddenly, more frequently than those who are slender. This is the first written observation that fat people have more frequent heart attacks.]

Except for the courses taken, all of the examinations were in Latin. If successful, the student was awarded the degree, Doctor of Medicine.

Only a small portion of the students at Edinburgh Medical School received an M.D. degree. For varying reasons, many students attended only a few courses for varying periods of time. They might be apprentices or fellow of the Royal College of Surgeons. They might be auditors from general practice.

From 1760 to 1826, 17,000 students from many parts of the world attended. It became the most influential European school for the development of medicine in America. In the second half of the 18th Century, 117 Americans gained their medical degrees from Edinburgh, and a much larger number attended courses there. Sons of Presbyterian Scottish emigrants and sons of Pennsylvania Quakers attended because they could not attend Oxford or Cambridge that were only open to Anglicans.

The Medical School of the College of Philadelphia was founded in 1765. This was the first medical school in North America and all of its founding members were trained in Edinburgh.

Dr. William Cullen is an example of a leading Scottish Physician. From 1736 through 1744, he was a general practitioner/surgeon in Hamilton, Scotland. He later trained in chemistry. At Edinburgh Medical School, he became an excellent teacher, teaching chemistry and the theory and practice of medicine. He made clinical rounds at the Royal Infirmary of Edinburgh and he carried on an active consultative practice. He wrote a student textbook in English titled: First Lines of the Practice of Medicine. This was translated into French, German, Italian and Latin. It was the leading textbook on the practice of medicine for over 50 years. He wrote a Synopsis and Nosology of Diseases, which was a classification of diseases similar to the biologic classification of Linnaeus. He also spearheaded the improvement in the Edinburgh Pharmacopoeia, a detailed listing of medications.

The first Edinburgh Pharmacopoeia in 1699 had 450 vegetable preparations that were so complicated as to suggest that ignorance of treatment could be masked by complexity in preparation. Animal preparations were repugnant as to suggest that the more revolting and unpalpable the remedy, the more probable the cure. Examples included: cobwebs, vipers, toads, worms, snails, wood lice, powder of human skull, powder of mummy, goose fat and excrement of dog. The Pharmacopoeia of 1737 continued to have a large number of bizarre ingredients. Under the leadership of Dr. Cullen, most of the bizarre items were eliminated in the 1776 Materia Medica Catalogue.

William Hunter was Dr. William Cullen’s Surgeon/Apothecary Apprentice from 1737 to 1741. Dr. Hunter then went to London where he became a famous anatomist and obstetrician. His younger brother John Hunter joined him in London and became the first scientific surgeon. He also founded the Hunterian Museum of Medicine and Natural History. The Hunter medical gene lives on in our own Dr. Richard Hunter!

Dr. John Brown was a physician who disagreed with Dr. Cullen and developed his own theory of medicine. His theory, the Brunonian Theory, was that all disease was the result of either under-stimulation or over-stimulation of the body. As under simulation was usually the major problem, he advised the use of stimulants such as alcohol or opium. As he frequently imbibed both of these during his lectures, many of his lectures wandered into fantasy. His ideas partially live on today. In the current issue of Practical Pain Management the lead article is titled, The Simultaneous Use of Stimulants (Amphetamines) and Opioids (morphine) in Chronic Management.

James Curries was a physician who trained in Edinburgh, but who practiced in Liverpool, England where he worked with the poor and the insane. He used cold-water treatments in the successful treatment of a case of contagious fever. He published a pamphlet titled, Medical Reports of the Effects of Water, Cold and Warm as a remedy in fevers and other diseases. It contained the first systematic record in English of clinical observations with the thermometer. Relative to my story is the fact that he was influenced by Dr. John Brown and his stimulant theory. Dr. Currie was one of Burns’ first biographers. This may explain Currie’s emphasis in his Life of Burns that excessive use of alcohol was a major factor in Burns’ death. Unfortunately, this emphasis persisted for many years.

I will close this talk with observations by Dr. William Heberden in his 1802 book, History and Cure of Disease. His basic considerations were:

  1. Does the disease require any evacuations, e.g., bleeding with leach, cup or lancet, laxatives or emetics (vomiting)?

  2. Does the disease have a specific or certain known remedy e.g., Peruvian Bark or Cinchona for Malaria (Ague); Quick Silver (mercury) for venereal diseases; Sulfur for the itch; and opium for spasms, pain or diarrhea; drinking medicinal water for stomach disorders?

  3. Fore severe, protracted disease with no successful remedy, consider shocking the body e.g., cold-water baths, mercury, hemlock, antimony or electrification.

  4. When nothing else works, use supportive care e.g., diet, sleep, aromatics and chamomile.

Thank you. Are there any questions?

Editor’s Note:

For another article on this subject, I refer you to Chapter 114 of this site entitled Remember Tam o’ Shanter’s Mare, A Study of Burns and Health by Sir Kenneth Calman who, like Dr. Winter, is a medical doctor and currently serves as Chancellor of the University of Glasgow. Simply click on tree/frank/burns-lives114.htm

See also Medical Schools of Scotland

(FRS: 4.27.11)

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