History of Pathology

The foundation of the chair

On the 14th September 1831, a Royal Commission was signed by His Majesty King William IV creating, in the University of Edinburgh, the first Chair of Pathol­ogy in the United Kingdom, and appointing Dr John Thomson as its first incumbent. It was not welcomed by the Senatus Academicus who took all possible steps to block this Commission and also the one sent down at the same time for a Chair of Surgery. The Chair of General Pathology was also one of Clinical Medicine - the occupant was entitled to beds in the Royal Infirmary, an option Thomson never exercised, because of a long standing quarrel with the Managers of the Royal Infirmary.

There were several reasons for the Senate's antagonism to the new Chair of Pathology and its occupant. Firstly, the medical professors could be divided into two classes; one comprised of the seven professors, attendance at whose classes was compulsory for all candidates for the M.D., and the other consisted of the other professors, whose classes were optional. Those who taught the "imperative" classes were examiners in the final examination and members of both the Medical Faculty and the Senate; they were guaranteed an income from the class and gradua­tion fees. By contrast the professors who taught optional classes had to attract students, and their fees, by the excellence of their teaching. Dr Thomson's Commission, however, granted him the right to be an examiner and a member of the Senatus, without, as the Senatus claimed, having served his apprenticeship with a voluntary class of pathology to "prove his comparative importance in the University system of education." Secondly, the content of the classes taught by each professor was jealously guarded and each professor was specifically barred by his commission from trespassing on the fields of others.

The Senatus considered that a mandate to teach Pathology was virtually a permit to teach another course on the Practice of Poysic, already the province of Professor James Home. Thirdly, apart from the academic considerations, the Senatus had just lost a lengthy legal action in which it was judged that the Senatus of the Town's College (the Univer­sity) had no right to make regulations, statutes or laws in contradiction to the Town Council, the "Honourable Patrons of the College". The Senatus must have felt it was bad enough to be dictated to by the Town Council without the Crown also having its say. A fourth factor was the difference in political colour between the Whig Government and the Whig Thomson - who was at one time suspected of harbouring revolutionary sentiments - and the largely Tory Senatus and Town Council.

The possibility of the creation of a Chair of General Pathology had first arisen in 1824 when John Thomson had suggested the separation of the Chair of the Institutes of Medicine into a Chair of Pathology and one of Physiology. In 1826 he presented evidence to this effect to the Visitation of the Universities and Colleges of Scotland by the Royal Commissioners. The Senatus gave evidence against the foundation of a separate Chair of Pathology although most medical opinion was in favour. However, the final report of the Royal Commission in 1831 recommended the foundation of a Chair of Surgery but it did not advocate a Chair of Pathology. Thomson sent a Memorial to the Home Secretary, Lord Melbourne, claiming that although Physiology, Pathology and Therapeutics were at that time all part of the class of the Institutes, or Theory, of Medicine this was too much for one course of lectures and "the particular subjects of investigation in each of these branches, and the proper modes of prosecuting them are so different as to render it desirable for the promotion of medical knowledge that they should be separately studied and taught by separate Professors".

Having put the case for a Chair of Pathology he then made his claim to sit in it, since he had "procured from Hospitals at home and abroad, with considerable pains and difficulty and much expense, a large collection of Coloured Delineations of the Morbid Alterations of Structure which occur in the different Textures and Organs of the Human Body". Further "this mode of teaching pathology which he believes he has been the first to employ on an extensive and systematic plan in lecturing the Practice of Physic, would if applied to a distinct Course of Lectures on Pathology in the University of Edinburgh and with a reference to the specimens of diseased structure that are present in the Museums of the University and the Royal College of Surgeons, convey to students of Medicine much more correct notions of many diseases and of the morbid appearances to which they give rise than can possibly be done by verbal descriptions alone".

This Memorial, along with his not inconsiderable political influence, convinced Lord Melbourne and the Commission of 14th September 1831 was issued. The Senate's first reaction was to appoint a Committee to "consider any and what steps ought to be taken by the Senatus". A Memorial on the subject of the Chair of Pathology was sent from the Senatus to the Town Council on 4th October 1831. The burden of it was that: Dr Thomson had been appointed without the consideration of any other candidates; the chair had been wished upon them without any consultation; the topics of general and systematic pathology were already covered in existing classes and the examiners found the students "generally well informed" in pathology; the Crown, by specifying Dr Thomson as an examiner, was exceeding its authority and the Senatus would refuse to make his lectures 'imperative'; and lastly they complained that the pathology class would poach on the preserves of the other professors. On the following day, despite this Memorial, the Town Council resolved to sustain the Commissions for the Chairs of Pathology and Surgery.

The College Baillie, George Aitchison was delegated to induct the two new professors at the meeting of the Senatus on 11th October and Dr Andrew Duncan junior, the Secretary to the Senate, was informed by letter of this decision. There was another important reason for having a Senatus meeting on Friday 11th October. The Committee which had drawn up the Memorial on the Chair of Pathology had drawn up another on the Chair of Surgery and this had to be considered by the Senatus before it was presented to the meeting of the Town Council on 12th October. The Convener of the Committee, Dr Christison, forgot to make any arrangements for this meeting of the Senatus until, on the 10th October, he realised he had not received a billet for the meeting. He dispatched a University servitor to summon the other members of the Senate but only seven attended the meeting.

The Senatus was astounded when the College Baillie arrived to induct the two new professors and protested that they knew nothing about the proposed induction. It was then they discovered that Dr Duncan, the Secretary, had failed to pass on the information to the Senatus - he had gone off to the country for a few days. The Senatus responded predictably by forming a committee of three to persuade the College Baillie to go away and take his two professors with him since the Senatus had not yet decided on their policy on the two new chairs. The College Baillie was adamant that he had his instructions from the Town Council and he was going to abide by them. Eventually, however, he was prevailed upon to return to the College Committee of the Town Council, which was meeting at the same time, and inform them that the Senatus was unwilling to receive the professors.

After the College Baillie had left, the Senatus decided that their best course of action was to adjourn before he could return. They justified this, to themselves, on the grounds that the meeting had not been summoned by letter and was thus unconstitutional and that seven members were not enough to make the major decision whether to accept these professors. (A spurious argument as many equally important decisions had been taken by smaller numbers.) Just as they were about to close the meeting, the Baillie returned with the message that he had to carry on with the induction. He was not impressed with the argument that the meeting was not legal and the Senatus was forced to capitulate and admit the two new professors. However the Senate were not yet willing to accept defeat and they complained to the Home Secretary reiterating their objections to the appointments. 

Mean while the Town Council had formally agreed to accept the chairs and requested that the patronage be vested in them. Lord Melbourne agreed to this proposal but his reply to the Senatus was much less cordial. After accusing them of impertinence in questioning the Crown's right to do what it had done he pointed out that the Senate's arguments "appear to them (the Government) to be so palpably irrelevant to the actual state of the case and so incapable of any present practicable application that they are at a loss to conjecture for what purpose they are pressed upon the attention of the Government". There was to be no question of rescinding the Commissions.

The first class in Pathology was held in the winter of 1832. John Thomson's first assistant was J.Y. Simpson of chloroform fame. Thomson, as an acknowledged expert, had been asked to examine Simpson's graduation thesis on inflammation and had been so impressed by it that he had offered Simpson the post. This enabled the impecunious Simpson to stay in Edinburgh, rather than be forced to take a job as a country general practitioner or a ship's surgeon, and thus allowed him to prosecute his studies in midwifery.

Thomson was 66 when he took up his chair and a life-long sufferer from rheumatism and asthma. His health soon broke down, and in 1837 he was obliged to offer to resign. This opportunity was seized by the Medical Faculty who offered, if Thomson resigned, to give a series of lectures in Pathology, to allow the Chair to be suppressed. Numerous pamphlets were issued advocating the abolition of the chair, including one by James Syme, the Professor of Surgery, who argued that general pathology was not a practical subject and a Professor of General Pathology "need not be a practical man. He may be merely a man of respectable talents and application, well supplied with modern French books, and coloured delineations of morbid appearances, with the assistance of which he may not only appear to others but even persuade himself that he is truly acquainted with the subjects of his study". There was an equal number of pamphlets produced on the other side, with John Thomson defending his Chair and his son William supporting him and putting himself forward as a prospective candidate.

One of the other candidates was Robert Knox, the erstwhile employer of Burke and Hare, who was trying to live down his association with the 'resurrection men'. The Town Council, now apparently doubtful about the value of the Chair sent a Memorial to the Home Secretary, Lord John Russell, asking for the Chair to be abolished on the grounds that it was costing Edinburgh £10,000 per annum as the necessity of studying pathology in the medical course was dissuading students from coming to Edinburgh. However John Thomson convincingly showed their sums were wrong and the Council were told in no uncertain terms by the Home Secretary that the Chair was there to stay.

The upshot of this episode was that Thomson withdrew his offer to retire and his lectures were given by his deputies, Drs Simpson and William Thomson. However, when William Thomson became Professor of the Practice of Physic in Glasgow and Dr Simpson became Professor of Midwifery, John Thomson decided to retire.

Written by Dr Edward Duvall and Sir Alastair Currie for the 150th Anniversary of the Founding of the Chair of Pathology, 17th Sept 1981.