Glasgow Pathological and Clinical Society

As the College embarks upon a refurbishment programme, we’ve been delving into the historical uses of the rooms of our St Vincent Street building. The old Faculty Hall (now named Alexandra Room) was the venue for most of the College’s business until the new College Hall extension was built in 1893. In addition to Faculty meetings, and meetings of the Medico-Chirurgical Society of Glasgow, this room hosted the meetings of the Glasgow Pathological and Clinical Society from 1876.

GP&CS Transactions book

Transactions, 1873 – 1883 (RCPSG 4/1/6)

We were keen to explore what these meetings involved, who attended them, and the history of the Society itself. We are extremely fortunate to hold the archives of the Society, from its foundation in 1873 until its merger with the Medico-Chirurgical Society of Glasgow in 1907.

There is mention of an earlier Glasgow Pathological Society (established 1850) in the 1852 Medical Directory. However, it appears to have only lasted for 2 or 3 years. The idea of forming a new Pathological Society came from four prominent Glasgow physicians and surgeons in the early 1870s – Thomas Reid, Joseph Coats, William Leishman, and William Tennant Gairdner. James Finlayson was the first secretary and describes the initial idea for “a society composed of working members“, creating an environment where “specimens could be quietly examined and discussed… in a friendly manner, without any temptation to ostentatious display or personal bitterness.”

GP&CS First meeting proposal 1873

From Transactions, 1873 – 1883 (RCPSG 4/1/6)

The first meeting was held on 25th November 1873 in the rooms of the University Lying-In Hospital and Dispensary for Women on Wellington Street. James Finlayson and Hector Cameron constituted themselves interim secretaries, while Dr Gairdner (then Professor of Medicine at the University of Glasgow) became chairman. In addition to those already mentioned, the original membership included the young surgeon William Macewen.

GP&CS first agenda 1873

From Transactions, 1873 – 1883 (RCPSG 4/1/6)

From the first meeting, the format was established. The Agenda pictured above shows the list of specimens presented by the members for discussion. In further meetings, patients would also be presented. For example, in May 1874, Dr McCall Anderson showed a patient who had been treated for syphilitic paralysis.

In 1874 the name was changed to the Glasgow Pathological and Clinical Society, and with the number of members increasing to 30, a new venue was found at the Glasgow Eye Infirmary on Berkeley Street. Then, in the fourth session, beginning in October 1876, the venue settled at the Faculty Hall, in the College’s current building on St Vincent Street. The origins and early history of the Society were usefully added to the book of Transactions (RCPSG 4/1/6) by James Finlayson in 1879 (below).

GP&CS Memorandum 1879

Memorandum by James Finlayson, 1879 (RCPSG 4/1/6)

An important part of the Society’s business was the publication of its reports, in both the Glasgow Medical Journal and the British Medical Journal. This placed the research and practice of the Society in the context of the wider medical and surgical literature, which was at this time exploring many new areas and innovations.

Notable in the records of the Society are cases concerning neurological conditions and physiology, the treatment of cranial injuries, and cranial surgery. For example, Glasgow physicians such as Alexander Robertson, who was pioneering in his approach to aphasia in the 1860s, and William James Fleming, who investigated the physiology of the ‘motions of the brain’, provide a stimulating context for the advances in brain surgery made by William Macewen in the 1870s.

GP&CS Agenda 1879

From Society Minute Book 1879 – 1891 (RCPSG 4/1/2)

An exciting discovery in the Society’s Minute Book shows that on the 11th November 1879, Macewen presented to the meeting in the Faculty Hall “two patients on whom trephining was performed, one for injury and one for disease.” One of these patients was the fourteen year old girl upon whom Macewen had performed the first removal of a tumour from the dura mater (minute book detail below).

GP&CS Minute 1879

From Society Minute Book, 1879 – 1891 (RCPSG 4/1/2)

This procedure has since been identified as a major breakthrough in the history of neurosurgery. An editorial in the British Medical Journal (11th August, 1888) acknowledges the innovation and success of Macewen’s early brain surgery: “With indisputable justice… may Dr Macewen claim the proud distinction of having been the leader in this country, and we believe in the world, of this great advance in our art.”

These records of the Glasgow Pathological and Clinical Society not only provide us with a wonderful source of evidence of the innovative research and practice in the city in the late 19th century, but also provide us with inspirational stories to tell in our College rooms.

Macewen on wounds

We have had a lot of interest in our collection of the papers of Sir William Macewen recently, particularly the material relating to his early position as Police Surgeon in Glasgow (1871 – 1875). This relatively small part of the collection represents a short, formative and under-researched part of his distinguished career. It nevertheless contains fascinating material that provides some insight into the early work of the great surgeon. The focus of this post is on Macewen’s treatment of and research on wounds during this period.

The Private Journal (of surgical cases) covering 1872 – 1875 contains notes on a wide range of Police Office cases. Possibly the most common type of case is the treatment of wounds, usually penetrating wounds caused by assault or accident (the example above shows notes and illustration of a head wound). Macewen was interested in both the effective treatment of wounds via investigative surgery, and research into the specific causes of wounds for forensic purposes. These interests resulted in two notable articles in the Glasgow Medical Journal.

1876 saw the publication of his article ‘Wounds in relation to the instruments which produce them’ (Glasgow Medical Journal, viii, 1876). In the article title (above) he was listed as Casualty Surgeon, and also Lecturer in Medical Jurisprudence at the University. In addition to its original purpose as an aid to accurate wound diagnosis, this extraordinary article provides a detailed catalogue of the clinical results and context of (mainly) violent crime in the city at a specific period. Detail includes the range of weapons used, and the context of the wounds caused by assault and accident (many involving alcohol). The image below shows how Macewen presented this data, and the eclectic range of instruments identified as causing the wounds.

tablesIn the article’s introduction, Macewen sets the context of these cases with an intriguing commentary before beginning his rigorous analysis:

The observations in the present paper were made on the living, as accident in part, but mainly the physical expression of human passion […].”

In addition to his move into forensic medicine, this period also saw Macewen challenge the conventional wisdom of surgical textbooks (and their esteemed authors). In 1872 and 1873 he noted several cases of treatment of wounds, particularly of the lungs, for example a case involving a 12 year old boy with a life-threatening knife wound. By adopting a bold, investigative approach (which was not at the time recommended when treating damage to the lungs), Macewen was able to locate a fragment of the knife in the lung. He then removed the fragment, using the antiseptic approach developed by his ex-teacher Joseph Lister. The page from the journal below records this case.

img_0233

Private Journal of Surgical Cases (RCPSG10/9/12)

His resulting article ‘Penetrating wounds of thorax and abdomen treated antiseptically’ (Glasgow Medical Journal, vii, 1875) was explicit in its criticism of the contemporary textbook approach to the lung. In his remarks on the case, he challenges the assertion made in recent surgical literature that the surgeon “should throw aside all direct or manipulative modes of investigation.” Instead, he boldly asserts that –

If, without complicating the original injury, an investigation is enabled to be made into the nature of such wounds, and an intelligent treatment thereby adopted instead of groping in the dark, an advance in surgery has been made.”

It is worth bearing in mind that at the time of writing, Macewen was still only in his mid-20s, and employed in one of the most junior surgical positions available.

In addition, he emphasised the adherence to Lister’s antiseptic approach to treating the wounds. In return, Lister wrote Macewen a note, congratulating him on the successful removal of the fragment of pocket knife specifically. This is among a number of items of correspondence between Macewen and Lister in our collections.

Explore Your Archive campaign

The College Library is celebrating the national Explore Your Archive campaign with a special display of some of the College’s archival treasures.  Members of the public visiting the College on Monday afternoons 18th and 25th November and 2nd December from 2.00 pm until 5.00 pm will be able to view precious items such as the Crimean War diary of George Buchanan and a ward journal of the famous Glasgow surgeon, Sir William Macewen. Our President, Dr Frank Dunn, commenting on the very first Faculty minute books says:

First Faculty Minute Book

First Faculty Minute Book

“I have repeatedly in my time as President benefited from the extensive information in our College archives. In particular it is invaluable to still have the minutes of meetings  going back almost to our inception in 1599. The mission statement is essentially unchanged from that time and still guides what I do on a day to day basis.”

The College’s Chief Operating Officer, John Cooper, has taken inspiration from the Crimean diary of surgeon George Buchanan:

Map of the siege of Sebastopol from the Crimean diary of George Buchanan.

Map of the siege of Sebastopol from the Crimean diary of George Buchanan.

“The Crimean War was a turning point in the provision of medical care in war.  George  Buchanan’s diary highlights the struggles and achievements of the then medical organisation. His legacy is seen today in the UK medical facilities in Afghanistan, which continue to be manned by Fellows and Members of this College.”

For the College’s Honorary Librarian, Mr Roy Miller, inspiration comes from the work of Glasgow’s greatest surgeon, Sir William Macewen (1848-1924).  Commenting on a portrait of the young Macewen, Mr Miller states:

William Macewen as a young man

William Macewen as a young man

“The world was not to know that this image of a young surgeon was to be that of a world famous and innovative man in his profession.  Our extensive archive shows some of the cases he dealt with and the records he wrote.”

It has been a group of women and their determination to achieve recognition for their professional work who have particularly inspired Dr Elaine Morrison FRCP(Glasg) to research their story:

Girton and Newnham Unit of the Scottish Women's Hospitals about to embark on board ship at Liverpool, October 1915.

Girton and Newnham Unit of the Scottish Women’s Hospitals about to embark on board ship at Liverpool, October 1915.

” It’s 1915 and the members of the Girton and Newnham unit of the Scottish Women’s Hospitals are about to set off for Serbia. Their story is at once compelling and inspirational. On discovering this image, I simply had to find out more.”

If you wish find out more about the treasures in the College’s archives then visit the College website or email: library@rcpsg.ac.uk

Rebecca Strong – remarkable nursing pioneer

Rebecca Thorogood was born on the 23 August 1843 in London.  She married and had a daughter before the age of 20.  Very little is known about her husband apart from his surname, Strong, and the fact that he died within a couple of years of marriage and was buried in Liverpool.

Widowed at a very young age, Rebecca Strong decided to go into nursing and was accepted as a probationer at the Nightingale Training School which had started in 1860 at St Thomas’ Hospital in London.  In 1868, following her training, she gained nursing experience at Winchester and at the British Army hospital at Netley, being appointed matron of the Dundee Royal Infirmary, in 1874.  At Dundee, Rebecca Strong was able to introduce new nursing practices (see the Dundee Women’s trail for further information about her time in Dundee).

In 1879 Mrs Strong was appointed matron at Glasgow Royal Infirmary, the largest voluntary hospital in Scotland.  Attracted by the challenge, when she arrived in Glasgow she was shocked to find how backward the Infirmary appeared in relation to its nurses.  She devoted her energies to improving nurse education and training and working conditions.

An example of the letters from Mrs Strong to Sir William Macewen in the College archive (RCPSG 10/1A/128/49)

An example of the letters from Mrs Strong to Sir William Macewen in the College archive (RCPSG 10/1A/128/49)

Letters from Rebecca Strong can be found in the papers of Sir William Macewen in the College archives.  The relationship between the two could at times be stormy but they greatly respected one another.

In January 1891, Macewen gave an address at Glasgow Royal Infirmary on the subject of “Nurses and Nursing”.  A copy of the address is in the College archive (RCPSG 10/1A/129/11).  In the lecture he said “Cannot nursing be raised to a distinct profession, with its entrance examination, its minimum requirements, theoretical and practical, its teachers, its examiners and its diploma?”  He also felt that  nursing was specially suited for women: “Nursing is, beyond all cavil, a sphere for women’s work; indeed man can scarcely enter there . . . one can scarcely expect a man to be a nurse, as his instincts and training do not suit him for it . . .  A woman possesses such a magnificent compass of susceptibilities, is so full of human sympathies and soft compassions, if her life is not to be a barren wilderness she requires opportunities to enable these to expand”.

With the support of Macewen, Rebecca Strong initiated the ‘block apprenticeship’ training programme, later adopted world-wide.  Short periods of instruction in the hospital school was followed by periods of practice on the wards.  This was a great improvement on previous nurse instruction whereby nurses were expected to attend lectures and study while still working long hours on the wards.  The pioneer Preliminary Training School was opened in January 1893 under an arrangement between Glasgow Royal Infirmary and St Mungo’s Medical College.

Mrs Strong Medal in Medical Nursing

Mrs Strong Medal in Medical Nursing

In 1942 the Macewen medal in surgical nursing and the Mrs Strong medal in medical nursing were established at Glasgow Royal Infirmary to commemorate the pioneer work of Macewen and Strong in elevating nursing to the status of a profession.

Rebecca Strong was a strong supporter of State Registration for nurses which eventually happened in 1919.  She also worked for the improvement of the social life of nurses and was the moving spirit, along with Sir William Macewen, in the opening of a club for them in Glasgow in 1918.  In 1939, at the age of 95, she was awarded the O.B.E.  and celebrated her 100th Birthday on 23 August 1943.  She died almost exactly a year later, on 24 April 1944.

Further biographical details about Rebecca Strong can be found on the Royal College of Nursing website

For those wishing to find out more about the early years of nursing, digitised copies of the The Nursing Record/British Journal of Nursing can also be found on the Royal College of Nursing website.

The College Library holds books on the history of Glasgow Royal Infirmary and also has some archive material relating to the hospital.  The administrative records of Glasgow Royal Infirmary (including registers of nurses) are in the NHS Greater Glasgow and Clyde Archives.

Sir William Macewen, one of Glasgow’s greatest innovative surgeons

June 22nd is a celebratory day for Glasgow medical history; William Macewen was born in 1848 on this day on the Isle of Bute.  Macewen gained his medical degree from the University of Glasgow and ultimately became Regius Professor of Surgery at the University with wards at the Western Infirmary, Glasgow.  It was, however, whilst at the Glasgow Royal Infirmary,  that he made many of his great strides forward in both brain and bone surgery.  The College archive holds Macewen’s casebooks while he was a surgeon at Glasgow Royal Infirmary as well as other papers (RCPSG 10).  On the 29th June 1926 at the Commemoration of Benefactors at the University of Glasgow, Professor Archibald Young, then Regius Professor of Surgery, delivered an Oration on the work of  Macewen.  In researching his lecture, he wrote to many who had been associated with Macewen and these letters on Macewen’s work and character can be found in the Young Papers in the College Archive (RCPSG 39). Further Macewen archive material can be found at Glasgow University Archives.

Macewen became a Fellow of the Faculty (now Royal College) of Physicians and Surgeons of Glasgow in 1874 and was awarded an Honorary Fellowship in 1913.  Apart from his papers, the College also has an operating table that he designed and a set of osteotomes (used for bone operations). Macewen’s portrait hangs in College Hall and is one of over ninety College oil paintings depicted on the BBC Your Paintings website.

Apart from his surgical work, Macewen worked very closely with the Matron of Glasgow Royal Infirmary, Mrs Rebecca Strong, in devising a training programme for nurses – one which would be copied throughout the world.

Sir William Macewen operating at the Western Infirmary, Glasgow

Sir William Macewen operating at the Western Infirmary, Glasgow

Scientists have recently announced the first 3D digital brain based on slicing 7,400 brain sections.  Macewen, had published in 1893, a work entitled Atlas of Head Sections, which consisted of fifty-three engraved copperplates of frozen sections of the head.  Every head section was cut by Macewen himself.  At that time, the work was at the forefront of scientific achievement and the New York Medical Herald stated that it surpassed “all others in perfection of its execution and in the completeness of the work”.

Illustration from Macewen's Atlas of Head Sections, 1893.

Illustration from Macewen’s Atlas of Head Sections, 1893.

The Atlas of Head Sections and other works by Macewen can be consulted in the College Library (see the library catalogue for details).  The standard biography of Macewen is The Life and Teaching of Sir William Macewen by A.K. Bowman, 1942.  This work, too, is available in the College Library.