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Andrew Duncan

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Andrew Duncan (17th October, 1744- 5th July 1877) was a Professor of the Theory of Medicine at Edinburgh University, and a President of the Royal College of Physicians. He is notable as a medical reformer, best known for his humane treatment of the mentally ill[1] Disgusted by the death of his patient the poet Robert Fergusson in the horrific conditions of the Bedlam Asylum, he fought for an appropriate institution to house the insane. Approval to build the Edinburgh Lunatic Asylum was eventually given in 1807. The Asylum was built in the Morningside district of Edinburgh by the architect Robert Reid and grew into the Royal Edinburgh Hospital.

Life

Andrew Duncan was born at St Andrews; his father was a merchant and shipmaster, and his mother a daughter of Professor Villant. After obtaining the degree of master of arts from St Andrews University in May, 1762, he moved to Edinburgh, where he studied medicine as first the pupil, and then the friend, of William Cullen, John Gregory, Alistair Monro the second, John Hope, and Joseph Black, when Edinburgh University was beginning to be prominent in the scientific and literary world. Duncan was elected a president of the Royal Medical Society in 1764, in the second year of his medical studies in Edinburgh. In 1768-9, after completing his studies, he went to China as a surgeon to the East India company’s ship Asia. In October 1769, he received the diploma of doctor of medicine from St Andrews, and in the following May was admitted a licentiate of the Royal College of Physicians in Edinburgh. About this time he became attached to, and married Elizabeth Knox, the daughter of a surgeon in the service of the East India company, with whom he had twelve children.

In February 1773, on the death of John Gregory, Professor of the Theory of Medicine at Edinburgh University, Duncan was chosen to supply the temporary vacancy, which he did until the 19th of June 1776 when James Gregory, the son of the late professor, was elected to the professorship. Duncan immediately began delivering an independent course of lectures on the theory and practice of physic, outside the university. "While these lectures," he said, "are more immediately intended for the instruction of students, they will be also the means of furnishing the indigent with advice and medicines gratis, when subjected to chronical diseases." He soon found that the number of sick poor who applied to him for relief was so considerable, that he began a plan to establish a dispensary to alleviate the sufferings of those whose diseases did not entitle them to admission into the Royal Infirmary. Funds were raised, and, in Richmond Street, on the south side of the city, a building was erected, and in 1818, the subscribers were incorporated by royal charter.

In 1790, Duncan was elected President of the College of Physicians in Edinburgh, and in the same year, when William Cullen resigned the Professorship of the Practice of Medicine, James Gregory was translated to that chair. Duncan was then elected successor to James Gregory as Professor of the Institutions of Medicine.

In 1792 Duncan proposed plans for a lunatic asylum, which he put before the Royal College of Physicians of Edinburgh. The idea was suggested to him by the death of the poet Robert Ferguson, who in 1774, soon after Duncan had settled in Edinburgh, died in the cells of the common charity work-house, in a state of appalling wretchedness. In due course, a petition was presented to the King, who granted a Royal Charter under which, a lunatic asylum was erected and opened at Morningside. In 1806, Parliament granted £2,000 out of the funds of the estates forfeited in the aftermath of the Jacobite Rising of 1745' the villa of Morningside was purchased with four acres of ground, and in 1809 the foundation stone was laid. The architect was Robert Reid. The Edinburgh Lunatic Asylum opened in 1813, the original building being known as East House. At first, only paying patients were accepted, but in 1842, West House, designed by William Burn, opened its doors to pauper patients, and in 1844 it received the inmates of the City's Bedlam.

In September, 1808, the magistrates and town council of Edinburgh presented Duncan with the freedom of the city, in acknowledgment of his services to the community.

East House was demolished in 1896, but the Royal Edinburgh Hospital remained, and included the Andrew Duncan Clinic, opened in 1965. The (New) Royal Edinburgh Infirmary relocated to a new site in the Little France district of Edinburgh in 2003; the old hospital site is now being redeveloped.

In 1809, Duncan founded a new horticultural society, which was soon also incorporated by royal charter. "The latest public object undertaken by Dr Duncan," says his friend Richard Huie (1795-1867), "was connected with this society, in the success of which he ever took the warmest interest. This was the establishment of a public experimental garden, for the purpose of putting to the test various modes of horticulture, and also for collecting specimens and improving the method of cultivating every vegetable production, from every quarter of the globe, which could either be agreeable to the palate, or pleasing to the eye. By means of private subscriptions, assisted by a loan from government, this object was at last attained; and the venerable promoter of the scheme had the satisfaction, before his death, of seeing his views on the subject in a fair way of being realized."

On the death of James Gregory in 1821, Dr Duncan was appointed first physician to the King for Scotland.

Duncan also established the Esculapian and Gymnastic clubs, two social clubs for medical men. In 1782 he founded the Harveian Society, to which, for 47 years, he was secretary. This society proposed annually a question, or the subject for an essay; and a reward, consisting of a gold medal and a copy of the works of William Harvey.

Duncan was a close friend of the family of Erasmus Darwin. As recounted by Charles Darwin the grandson of Erasmus, the eldest son of Erasmus, who was also called Charles (1758-1778), was buried in Andrew Duncan's family vault. Duncan cut a lock of hair from the corpse, and took it to a jeweller, whose apprentice one Henry Raebirn, set it in a locket for a memorial. [2] Duncan was the subject of one of Raeburn's early portraits.

In the winter of 1827, Duncan visited the medical hall for the last time, at 83 years of age to see a full length portrait of him by Watson Gordon, commissioned by the members of the society; this now is displayed in the foyer of the Chancellor's Building of Edinburgh's New Royal Infirmary.

Every May-day morning for many years Duncan had walked to the summit of Arthur’s Seat; but in May, 1828, he fell ill and could not make his walk; he died on the 5th of July. He is buried in the kirkyard of the former Buccleuch Parish Church. To the royal college of physicians he bequeathed seventy volumes of notes from the lectures of the founders of the Edinburgh school of medicine, Drs Munro primus, Rutherford, Alston, St Clair, and Plummer, together with 100 volumes of practical observations in his own handwriting, which he had used as notes for his clinical lectures.

Publishing Activities

"No one, who wishes to practise medicine, either with safety to others, or credit to himself, will incline to

remain ignorant of any discovery which time or attention has brought to light. But it is well known that the greatest part of those who are engaged in the actual prosecution of this art, have neither leisure nor opportunity

for very extensive reading." From Duncan’s introduction to the first issue of 'Medical and Philosophical Commentaries'

Andrew Duncan saw the need for clinical research to meet high methodological standards. His major contribution to promoting this was to begin the systematic publication of critical appraisal of reports of clinical research rather than publication of individual case reports.

In 1773, Duncan also began publishing "Medical and Philosophical Commentaries," which contained an account of the best new books in medicine, and the collateral branches of philosophy; medical cases and observations; the most recent medical intelligence: it appeared quarterly until 1795, then as "Annals of Medicine" until 1804, after which, Dr Duncan ceased to be editor, and it became the "Edinburgh Medical and Surgical Journal." [3]

Honours

Duncan was elected a corresponding member of the medical society of Denmark in 1776, and of the Royal Medical Society of Paris in 1778; he was chosen a member of the American Philosophical Society of Philadelphia in 1786, and of the medical society of London in 1787; he was appointed an honorary member of the Cesarian University of Moscow in 1805, and first president of the Medico-Chirurgical society of Edinburgh at its institution in 1821.

References

  1. McCrae M (2003)Andrew Duncan and the health of nations J R Coll Physicians Edinb 33(suppl12):2–11
  2. Charles Darwin, [http://assets.cambridge.org/97805218/15260/sample/9780521815260ws.pdf The Life of Erasmus Darwin}
  3. Clalmers I, Trohler U (2000)[http://www.annals.org/cgi/reprint/133/3/238.pdf Helping Physicians To Keep Abreast of the Medical Literature: Medical and Philosophical Commentaries, 1773–1795.] Annals of Internal Medicine 133:238-43