Case books of Dr Robert Cleghorn (1755 – 1821)

Written by on April 24, 2020

At the beginning of 2020 we hosted four undergraduate placement students from the University of Glasgow’s Scottish Literature department. The students were completing the placements as part of the course ‘Memorialising Scottish Literature and Culture’ lead by Dr Rhona Brown, Senior Lecturer in Scottish Literature. The course encourages students to interpret a range of cultural materials and media in order to understand the construction of Scottish cultural memory.

We chose the case books of Dr Robert Cleghorn because we wanted to get the students’ perspective on the potential interpretation of the ‘voices of humanity’ within medical writing. Cleghorn’s case books were written between 1782 and 1816, a period of interest for scholars of literature and medicine, and medical humanities, as well as Scottish literature more widely. In the old catalogue entry for the collection of volumes, they are described as containing “case histories, medical speculation and gossip.”

Dr Robert Cleghorn (1755 – 1821) was one of the first managers, and one of the first physicians, of Glasgow Royal Infirmary in the 1790s. He was also the first physician to the Glasgow Asylum (Gartnaval) when it opened in 1814. He was president of the College from 1788 to 1791.

Introduction by Ailbhe Harrison

The case books of Dr Robert Cleghorn offer an intimate insight into one of the minds of medicine that worked around the turn of the 18th Century, the peak of the Scottish Enlightenment. Four Cleghorn case books are held at the Royal College of Physicians and Surgeons of Glasgow, each containing mini-studies, open-ended ponderings and a significant number of patient cases. These case books are a source of raw medical narrative, un-polished and un-edited, providing a page for the unfiltered thought. Though written more than two centuries ago, each scribbled and fleeting thought preserves the medical history of Cleghorn untarnished by the revisions of time. 

Each case book has been assigned to individual Scottish Literature students from the University of Glasgow. The following commentaries on Cleghorn’s case books reviews different aspects of Cleghorn as a doctor, scholar and a man of the 18th Century.

Dr Robert Cleghorn (1755 – 1821) by Sir Henry Raeburn

Adversaria Cleghorn volume 1 (1782) by Eilidh Beaton

Robert Cleghorn’s case book, Adversaria Cleghorn Vol I, written in 1782, contains miscellaneous anecdotes and information about a wide variety of operations, treatments and patients. Within all this vast medical knowledge, we can sometimes lose sight of the man behind the text. However, there are times when the humanity of the physician comes through and we can understand the importance of the medical community and its workers to Cleghorn. 

From the transcription below, we can begin to understand that Cleghorn draws upon others’ work (in this case, the famous physician William Cullen) in order to learn and develop his own knowledge, and this is a common occurrence throughout the whole of the case book. This case talks of ‘A young boy about 14 who had it in a very severe degree.’  Cleghorn continues, ‘A nurse attended him constantly, perform’d every part of her duty without fear & when he died went home in appearance well.’ Here we can see how the actions of the nurse are commended by Cleghorn as he identifies that she is going above and beyond her normal duties to ensure that this young boy is comfortable and well in his final days. 

Adversaria Cleghorn volume 1 (RCPSG 1/20/2/1/2)
Transcription: ‘Dr Cullen mentions a very remarkable fact with regard to angina maligna.’

The case then takes an unfortunate turn. From this tragic event, Cleghorn makes a discovery in terms of this particular disease. This shows us that even from within this tragedy, Cleghorn can find something useful. The nurse was clearly exposed to the disease, but it had no effect on her and was thus passed unknowingly onto her children. Thus, Cleghorn was able to identify who was the most at-risk group in terms of this disease, which could help stop the spread of it. Overall, this particular case gives us an insight into the medical community and the compassion they have for their patients and fellow workers. The demonstrated sharing of information gives us an understanding of the humanity of the medical profession as they rely upon one another’s findings in order to become better physicians and develop better treatments for patients. The dedication of the nurse also shows the humanity within the medical community as she is compassionate and caring towards this young boy, with no thought of her own health or safety.

Adversaria Cleghorn, volume 1 (RCPSG 1/20/2/1/2)
Transcription: “Ere long however her children were seized with the same kind of angina from contagion convey’d as would seem in their deaths. Hence it seems certain that young people are much more expos’d to this disease than the old.”

Adversaria Cleghorn volume 2 (1782 – 1792) by Ailbhe Harrison

In Adversaria Cleghorn volume 2, moments of humanity between Cleghorn and his patients seem rare. He appears to harbour a great respect for men of war, as the only significant emotional connection he forms is with ex-marine John Jop, who evoked emotive poetics in Cleghorn’s writing. Though the patient felt some relief after a surgery Cleghorn performed, he was unable to fully recover and within a few days he passed away. Cleghorn writes: 

Adversaria Cleghorn, volume 2 (RCPSG 1/20/2/1/3)
Transcription: ‘These appearances swell’d his heart with hope and he began to congratulate himself as a Man delivered from the grave after having touch’d it’s brink.’

The compassion he shows John is unmatched in this casebook, but humanity in his writing can be found elsewhere. Cleghorn’s unique way of understanding the systems of the body is through the personification of its parts which allows him to write creatively about certain organs and bodily processes. He writes fondly of the heart and its resistance to fatigue as if to admire the organ’s determination and of vessels as having ‘little nerves of their own.’ Cleghorn’s view of the body is not of cogs turning in a grand machine but rather a community of active beings, all tasked with different jobs, each with individual relationships to one another. This humanising of the body allows for a level of theatricality in his writing; during the study of one patient he arrives at the profound question: ‘Is this a proof of life in the blood?’

Adversaria Cleghorn, volume 2 (RCPSG 1/20/2/1/3)
Transcription: ‘Is this a proof of life in the blood?’

However, what appears most notable in the search for Cleghorn’s humanity is his lack of it when dealing with female patients. Cleghorn often omits names and ages of female patients from his records and, though humanity from Cleghorn is a rarity, he seems especially distant from women’s cases. One example of his blatant disregard for women can – in the comfort of the knowledge that today there are systems in place to prevent this type of wrongful treatment of women – be read somewhat comically:

Adversaria Cleghorn, volume 2 (RCPSG 1/20/2/1/3)
Transcription: ‘James Purdon at 6 months – very fat & healthy. Ever since birth had his breasts distended with milk…’

He is referring to the mother’s breasts, and the problem was not with the child’s inability to take the milk but rather the mother’s inability to produce it. Yet Cleghorn refers to the baby as his patient and the mother, along with her breasts, a mere faulty accessory owned by the baby.

Though his treatment of female patients is unacceptable, it is important to remember that as a man of the 1700’s this wasn’t uncommon. Thanks to the progress made by feminism, Cleghorn’s discrimination of female patients may be rare for white women to experience in present-day Britain. However, the same cannot be said for ethnic minorities, members of the LGBTQ+ community, or those who suffer from mental health issues. It is of vital importance not to leave historical discrimination in the past but instead place it in the context of the most vulnerable people in our society today, otherwise we are in danger of creating mistreatment worth writing about in the future.

Private Case Book of Dr Cleghorn (1792 – 1816) by Nina McCue

From its appearance, the private case book of Cleghorn may merely appear as a relic of the past or even as a professional diary entirely clinical in its nature. However, what we uncover when we delve deeper is an inherent humanity throughout the diary.  

Private Case Book of Dr Cleghorn, 1792 – 1816 (RCPSG 1/20/2/1/1)

Rather than being devoid of feeling, sections of Cleghorn’s writing imply the significant emotional impact felt by his work, speaking of his alarm and anxiety at the unexplained suffering of patients. For example, upon examining Mrs Lang, he writes of her anguished expression which deeply disturbs him. He is also plagued by questions arising through failing treatments or unclear diagnosis such as ‘What ought to be done?’ and ‘What was the origin of the disease?’ Evidently, Cleghorn experiences great distress upon witnessing the suffering of others and being unable to do anything.         

However, as well as expressing anxiety and fear, Cleghorn obviously takes much joy from his work, as evident in his account of the birth of Mrs Law’s first child below.

Private Case Book of Dr Cleghorn, 1792 – 1816 (RCPSG 1/20/2/1/1)
Transcription: ‘Before this was over, Dr [King?] holding the Patient firmly, Mr [Anderson?] applied the forceps very dexterously and brought forth a lively boy who with a loud
voice demanded what all this meant. Everything went on well & there was no more Epilepsy.’

The description above is joyous and one in which Cleghorn’s delight in the good outcomes of his patients is clear. This and other examples such as his celebration of the ‘good nights’ of patients such as Mrs Hutchinson in which they are free from pain, give us traces of Cleghorn’s humanity. Rather than merely an occupation, medicine appears to be a vocation in which Cleghorn has become deeply invested, both celebrating successes in treatments and patients’ improving health, and being acutely troubled by his charges’ suffering.

Cleghorn’s writing also implies his continued pursuit of professional improvement. Throughout the text we find Cleghorn constantly questioning himself in relation to diagnosis, treatment and abnormalities, frustrated with his lack of answers and the ensuing consequences for his patients. Again, this is emphasised by Cleghorn’s frequent questioning throughout the text. Furthermore, Cleghorn seeks to reflect on his own practice and the moral rights and wrongs for a doctor.

‘1st Never rejoice in the misconduct of a Rival where a fellow creature suffers by it. […] 2nd Never neglect or under-rate the feelings of a patient. How often must I repeat this to myself? Poor A. could not without shrinking bear the slightest touch on the discoloured skin; we like conceited unfeeling Idiots called it Fancy!!!’

From Private Case Book of Dr Cleghorn, 1792 – 1816 (RCPSG 1/20/2/1/1)

Listening to the feelings of patients is emphasised throughout the case book, with Cleghorn placing great emphasis on the need to respect, sympathise and empathise with those he treats. Indeed, in addition to being a space in which to record various cases, this case book acts as a space in which Cleghorn reflects on his own practice. However, rather than due to vanity, pride or solely professional reasons, this appears to be motivated by a desire to better serve the people of Glasgow.                                

Consequently, this case book gives us real insight into the motivations underlying Cleghorn’s work. In a profession where the clinical is sometimes believed to overtake the personal or the humane, these private notes present a doctor deeply concerned with his patients and his continued development as a servant to these people. Indeed, instead of a mere relic of the past, the case book will undoubtedly resonate with today’s medics.

Case Notes of Patients from Glasgow Asylum for Lunatics (1814-) by Jennifer Finn

This notebook is particularly interesting because it contains the writings of another doctor as well as Cleghorn – John Balmanno, who added a number of anecdotes about experiences at the Asylum, taking note of not only patients’ interactions with him but also with each other. This will be an exploration of humanity and compassion present in the Asylum notebook.

Case notes of patients from Glasgow Asylum for Lunatics in the hand of Robert Cleghorn with further notes by Dr John Balmanno, 1814- (RCPSG 1/20/2/2)

Cleghorn presents his notes in a professional and clinical manner, giving an interesting insight into medical views of mental health in the early nineteenth-century. It is clear from Cleghorn’s notes that when observing and caring for patients in the Asylum there is a greater focus on the patient’s physical health, rather than mental health – something which might suggest belief of a correlation between a person’s physical and mental wellbeing. Cleghorn has a particularly odd focus throughout his notes – bowel movements. One might describe this focus as obsessive – in a number of cases, he prioritises this above other elements of their health care. Although this could be Cleghorn’s humanity in making his patients more comfortable, he doesn’t spend much time on other elements of their healthcare, instead, associating mental unwellness with the inability to pass stool and the physical health concerns that this might cause.

In the case of his patient Boyle, who suffers great difficulty with his bowel movements, Cleghorn’s treatment for his ailment is the use of laxatives, purgatives and ‘glysters’.[1] Cleghorn seems satisfied with his treatment and results of a ‘softer’ stomach as this appears to indicate improvement in the patient. However, Boyle rapidly deteriorates and days later passes away in the night:

Every effort was made to support him by jelly which he swallowed more readily than any thing else _ He ceased to void any urine or blood, or faeces, continued sensible but more & more weak till about 5 o’Clock this morning when he quietly expired.

Case notes of patients in the Glasgow Asylum for Lunatics, 1814- (RCPSG 1/20/2/2)

[1] Clysters (or glysters) are cleaning medicines injected into the rectum through clyster pipes or syringes.

It is obvious that Cleghorn and physicians at the Asylum had put in all they could to help this patient, but death had been inevitable. Cleghorn’s description of his passing, though saddening, is serene and profound, the peacefulness that this man seemed to encounter in his final hours is somewhat encouraging and satisfying. It is interesting to note, throughout Cleghorn’s observation and treatment of Boyle in the Asylum, he focuses on his bowels and physical ailing, rather than his mental health.

In the reverse of the notebook, Dr John Balmanno adds a series of anecdotes from his experience in the Asylum – where he succeeded Cleghorn as physician in 1821. Balmanno’s input is a far cry from that of Cleghorn in that his style of writing here is significantly more informal and relaxed, but instead focusing on the patients as people and how their personalities continue to be shown despite their present circumstance. These anecdotes are successful in presenting a more human side to Balmanno as a physician, but also in displaying the human elements of these patients who, all too often, cease to be considered as people and instead as a case. One of these is the occasion on which a Ms Broom tried to ask a question and was met with incredulity from a fellow patient:

Case notes of patients in the Glasgow Asylum for Lunatics, 1814 – (RCPSG 1/20/2/2)
Transcription: One of the females M Broom having earnestly asked me why a fire was not allowed the patients as the weather was cold. Miss Malone who was in a state of high excitement and quite insane turned quickly around to Broom before I could reply and exclaimed “You great fool, what would we do with a fire but fall into it and burn ourselves? Don’t you know that we are a’ daft?”

This anecdote identifies a self-awareness and sense of humility in the patient Miss Malone, where, in being able to proclaim this ‘daft’-ness, she presents the notion that despite being locked in an Asylum and dubbed ‘Insane’, she is aware of what is happening. She owns her mental illness and embraces it, rather than suppressing her individuality. This is a pure show of innocent humanity and perseverance despite the difficulties and restrictions that life presents.

Doctors Cleghorn and Balmanno, in this notebook, present their experiences at the Glasgow Asylum in writing in different ways. Cleghorn conforms to clinical, medical roots, whereas Balmanno embraces the more humanity-bearing informality of comedy, and real experience. There is no claim that either doctor is more or less compassionate or capable at their job than the other, however for the purpose of finding evidence of humanity in the notebook, the stark differences between these two have been instrumental to the exploration of this concept.

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