The Royal College of Surgeons, with its dignified, sooty facade on St Stephen's Green, sometimes seems to be one of the few unchanging parts of a city that is being transmogrified almost daily. As shopping centres go up, and banks and more banks crowd each other for space in the city centre, there is something comforting about the relics of ould dacency.
But how ould, and how dacent? J.B. Lyons, in a new book, takes us behind the facade of the RCSI into a magic grotto of Dublin history, with extraordinary personalities, science both real and bogus, and enthralling slices of Dublin life. A Pride of Professors is his title for an extended look at the personalities who occupied the chair of medicine at Surgeons between 1813 and 1985. The book reminds us, as Barry O'Donnell, the RCSI president, notes in his foreword, that until 1900 patients had only a 50/50 chance of benefiting from an encounter with a doctor; and it is only since about 1950 that it could be shown, by controlled trials, that doctors were actually doing some good.
Trial and error
This, essentially, is a book about what happened before then - when doctors operated by trial and error, trying out the most extraordinary remedies with gusto, attacking their professional colleagues with verve and spite, and - just occasionally - stumbling across scientific wisdom.
What is striking about the early years is the degree to which mortality provided them with so many opportunities for experimentation. Life was cheap, or cheapish, and death came quickly and usually for reasons that were imperfectly understood. Grave-robbing was not unknown, and some medical instruction occasionally took forms that put today's ethical questions into a new perspective. Take, for instance, this contemporary description of the unusual practices of John Timothy Kirby (17811853), using anatomical specimens provided by graverobbers.
"For the purpose of demonstrating the destructive effects of firearms upon the human frame. . .the subjects being placed with military precision along the wall, the lecturer entered with his pistol in hand, and levelling the mortiferous weapon at the enemy, magnanimously discharged several rounds, each followed by repeated bursts of applause. As soon as the smoke and approbation subsided, then came the tug of war. The wounds were examined, arteries were taken up, bullets were extracted, bones were set, and every spectator fancied himself upon the field of battle, and looked upon Mr Kirby as a prodigy of genius and valour for shooting dead men."
"Erinensis", the anonymous Irish correspondent of the Lancet (surely J.B. Lyons knows who he is, but we are not told) was unimpressed by Kirby. "In every habitable clime," he informed his English readers, "from the Equator to the Pole, where the genius of Irish emigration could find a resting place, there are thousands dying of his precepts."
Common sense
This was unfair: Erinensis was ever a witness for the prosecution. As Lyons makes clear, out of all the muddle and experimentation (James Little, who died as late as 1916, suggested that vomiting could best be cured by "a morsel of stale bread washed down by a wineglassful of champagne"), some sound common sense emerged. What is most striking, perhaps, is the realisation among all the best professors of the close and inalienable links between poverty and disease, leading many of them to call for "State medicine" - i.e. community health programmes. In many cases, recovery for the poor was effected, not by the incredible range of nostrums provided (blood-letting, mercury, opium and wine being among the most common) but by bed-rest in clean surroundings, and plain, good food.
There are ancient, historical echoes of current controversies. The first professor itemised here, a Scot named John Cheyne, wrote a treatise in 1827 on "The Feigned Diseases of Soldiers". Even Cheyne, however, was mortified on occasion when he discovered that some soldiers he had suspected of malingering died of genuine, undiagnosed illnesses. A century or so later, one of Cheyne's distinguished successors, Francis Purser, did pioneering work in the case of soldiers suffering from shellshock.
It is a rich and rare gallery. There is Thomas Moorhead, who continued in practice as a consultant after he became blind, and was celebrated by Oliver St John Gogarty; Victor Synge, who recognised the symptoms of diabetes in Brendan Behan; Alan Thompson, friend of the Becketts; and - going back a bit - Sir John Moore, who, like many of his contemporaries, was a polymath with a strong interest in meteorology.
Care for the poor
Money raises its head from time to time. Synge refused preferment on one occasion on the grounds that he was not "a commercial doctor". Cheyne's income in 1816 was some £1,700 a year, which must then have been an extraordinary amount. Yet he, and many of his successors, often had a special care for the poor. As Lyons shows us, the treatment many of them received, in Surgeons or elsewhere, may not always have been well-informed, but it came from the heart.
Doctors who read this will find themselves reflecting philosophically on the origins and objectives of their profession. For the rest of us, it is a rattling good read, and a salutary reminder than not even doctors are infallible.