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The Anatomical Museum of the University of Edinburgh contains a substantial collection of human osteological preparations that display the effects of musket-ball and sabre injuries. Most of these formerly belonged to the Museum Collection associated with the class of Military Surgery. This collection had principally been amassed by Sir George Ballingall to illustrate his lectures when he was Regius Professor of Military Surgery in the University of Edinburgh from 1822-55. About half of the osteological preparations in his collection had been purchased from Dr Rutherford Alcock in 1843. Alcock had collected them when he was Deputy Inspector General of Hospitals to the British Auxiliary Legion in Spain during the Carlist War of 1835-37. Just under 60% of the osteological preparations purchased from Alcock still remain on display in the Anatomy Museum of the University of Edinburgh. Previously, the only information on these items was that published in Ballingall’s Catalogue of the Museum attached to the Class of Military Surgery, published in 1855. Very recently, twelve volumes of manuscript material, consisting principally of clinical case records prepared by Alcock and his medical officers have been located in the Special Collections Section of Edinburgh University Library. This has now enabled the full clinical case records of the majority of the individuals whose osteological preparations are still available in the collection to be studied. This manuscript material provides a unique record of the treatment of the sick and wounded men in this campaign. It also allows the clinical records of men wounded by musket-ball to be studied with their associated bony lesions.
Keywords: University of Edinburgh Anatomical Museum, Carlist War, George Ballingall, military surgery, osteological preparations, Rutherford Alcock, surgical history
J.R.Coll.Surg.Edinb., 46, October 2001, 279-289
BACKGROUND: CASUALTIES SUSTAINED DURING THE CARLIST WAR OF 1835-37
There was considerable British interest in the activities in Portugal and Spain during the 1830s, and various wars were fought over the disputed succession to the thrones of both of these countries during that decade. In Portugal, Dom Miguel had challenged the right of his niece Queen Maria II to take the throne, while in Spain, Isabella’s right to succeed her father King Ferdinand VII was disputed by her uncle, Don Carlos. In both cases, the two pretenders to the throne were in favour of an absolutist form of government, and believed in extreme religious traditionalism. In both of these countries, the population favoured a more liberal and constitutional regime, headed by the two young Queens.
In April 1834, the British joined the Quadruple Alliance, with France, Spain and Portugal and sought to compel the two pretenders to renounce their claims and, thus, establish liberal and constitutional regimes in the Iberian Peninsula. In Portugal, Dom Miguel renounced his claim to the throne shortly afterwards, whereas in Spain the situation worsened, and the British Government, with Palmerston as Foreign Secretary, promised to supply arms and, if necessary, a naval force to the Spanish government of Queen Isabella. Such a force was requested, as the Spanish government was in danger of falling. They wished to raise a force of 10,000 volunteers from Britain to serve against the Carlists. Although they would have preferred intervention by the British Army, the Tory opposition was against this. They considered the volunteers as mercenaries, despite the fact that most were supporters of the Constitutionalist cause. The force commander of the British Auxiliary Legion of Spain, Colonel George de Lacy Evans, who had previously served under Wellington in the Peninsular War, had also been a Whig MP, and had supported British intervention in Portugal from about 1833. The Legion was deployed in the summer of 1835, but was badly affected by an outbreak of typhus. Its principal campaigns were fought during 1836 and 1837, and most of the force returned to Britain towards the end of 1837 and during the early part of 1838. The war eventually ended in 1839, with victory for the forces of Queen Isabella. Although there were resurgences on various occasions during the 19th century, the Carlist War of 1835-37 was the only campaign that had the active support of a British military expedition.1
By the end of October 1835, about 7,800 recruits for the British Auxiliary Legion had reached Spain. As force commander, de Lacy Evans held the local rank of Lieutenant General of the National Army of Spain.2 When fully established; the force contained about 400 officers and 9,600 other ranks. To make up for inevitable losses, retirals and men invalided out of the service, additional officers and other ranks joined the British Legion throughout the campaign.3 A Medical Board had earlier been established shortly after the volunteers arrived in Spain, and was forced to reject a considerable proportion of the recruits either because they were too young or too old for service, were deformed, diseased or crippled.4 The campaign lasted about 23 months, and a detailed account of its medical history and statistics was published shortly after the cessation of fighting by Dr Rutherford Alcock, the Legion’s Deputy Inspector General of Hospitals.5 Dr Alcock, who had served in Spain and Portugal as a British volunteer during the various civil wars of the 1830s, was appointed in July 1833 a surgeon to the British Marine Brigade and saw considerable service in Portugal during the Miguelite War. He had been appointed on the recommendation of Mr George Guthrie, one of the most distinguished military surgeons from the Peninsular War, and both the founder and the senior surgeon in the Royal Westminster Ophthalmic Hospital at Charing Cross where Alcock had recently been employed as a House Surgeon.6 During the first week of May 1835, with the termination of the war in Portugal, he transferred to the newly created British Auxiliary Legion for service in the Carlist War in Spain.7 After only one year he was appointed Deputy Inspector General of Hospitals, and held this post for the last 18 months of the campaign. The Inspector General of Hospitals was a Mr Callander.8 An abbreviated history of the campaign, indicating the various types of casualties sustained with observations on their fate, has recently been published.9
What is of considerable interest is that 9.0% of the officers and 6.2% of the other ranks were either killed in action or died of their wounds, while the corresponding figures for deaths from sickness were 15.5% and 18.6%, respectively. Most of the wounded received their injuries during one of five major battles, with the number of wounded indicated in parentheses: these took place on 5 May 1836 (382), 6 June 1836 (65), 1 October 1836 (158), 10-16 March 1837 (491) and 16-17 May 1837 (83). Thus, total wounded in these actions was 1179, and total wounded in the campaign was 1351 men. Five per cent of officers and 4.0% of other ranks were killed in action, while 49.3% of officers were wounded in action, compared with 15.6% of other ranks. This latter difference presumably reflects the fact that regimental officers led their men into action, and suffered accordingly. Of the medical officers associated with this force, a total of 17 were lost during the campaign, of which 15 died of fever during the first winter. 10, 11
During the campaign, a total of 13,407 cases were admitted to one or other of the hospitals associated with the Legion, and of these 1,588 died. Many of the wounded sustained gunshot injuries of the soft tissues or bones. Compound fractures of the extremities were frequently encountered, while other men suffered penetrating wounds of the abdomen, cranium or thorax. While almost all of the casualties that sustained penetrating wounds died, many with compound fractures also died as a result of shock, infection or secondary haemorrhage, either shortly or occasionally some considerable time after surgical intervention had been carried out if or when this was considered advisable.
A considerable collection of osteological preparations was made by Alcock and his medical officers illustrating the effects of gunshot injuries. These were mostly obtained following amputation of the extremities, although additional osteological and occasionally soft-tissue specimens were obtained after the death of individuals, if for one reason or another the injuries sustained were considered unsuitable for surgical intervention. This was invariably the case if the wound involved an area, such as the pelvic bones, or the abdominal or thoracic cavities, that was inaccessible to the surgeons.
Ballingall’s museum collection associated with his class of military surgery
Sir George Ballingall purchased the collection of osteological preparations from Alcock when he was Regius Professor of Military Surgery in the University of Edinburgh in 1843. He also acquired a considerable collection of soft-tissue specimens from him. 12 These had been gathered together by Alcock and his team of military surgeons and supplemented Ballingall’s own collection provided principally by his expupils, or from friends who were still in military service. The receipt of Alcock’s material was first publicly acknowledged in 1843.13 Alcock was destined to take up a Chair of Military Surgery at King’s College, London, but was unable to pursue his surgical studies. He had sustained an illness, believed at that time to have been a severe form of rheumatic fever, contracted at the siege of San Sebastian, possibly during May 1836. As a consequence of the latter illness, he suffered many months of pain and misery, and even when the paralysis of his arms and hands had subsided he never recovered the use of his thumbs, and was unable to practice as a surgeon on his return to Britain. This was also said to have marred the legibility of his writing to the end of his life. 14 Alcock was also wounded on 5 May 1836, during the attack on the entrenched lines of the Carlists around San Sebastian, but the extent of his injuries are not known. 15 After he retired from the British Legion, Alcock was appointed in 1842, on the recommendation of Sir Benjamin Brodie, to the post under the Home Office of an Inspector of Anatomy (London). He drafted several reports on the unworkability of the Anatomy Act of 1832, and resigned shortly afterwards when it was obvious to him that the Government had no intention of amending the Act. 16 Alcock later embarked on a successful diplomatic career. 17
Ballingall applied for a grant of £300 from the University’s Reid Fund to establish a museum to be associated with his class of Military Surgery. 18 After a considerable delay, the Trustees awarded him half the money he originally applied for the year previously. 19 Ballingall spent a considerable proportion of the money he received from them in purchasing Alcock’s collection, while what remained was spent on models and other related items for the Museum. The Trustees noted: ‘On the motion of Dr. Christison, the Trustees resolved that the proposed purchase of specimens and models for the Chair of Military Surgery, for which £150 was granted at last meeting, be agreed to under the condition that the Seller may call them back within 5 years or repayment of the purchase money, and remitted to Sir George Ballingall, Dr. Christison and Mr. Henderson to arrange the details and conclude the transaction.’ 20, 21 The final item in the Reid Fund Minutes Book relating to the purchase of Alcock’s collection is dated 2 November 1844: ‘Read letter from Mr. Alcock cancelling the Deed of Agreement by which he retained the right to reclaim the collection of preparations for the Class of Military Surgery, and also making a present to the University, of Surgical Drawings and Manuscripts - thanks ordered to be returned by Sir George Ballingall.’ 20,21 A letter from Alcock to Ballingall dated 7 November 1843 is available in Ballingall’s File in the Special Collections Section of Edinburgh University Library. 23 This states as follows: ‘ ... Now that you have had time to examine the preparations at your leisure I should be very glad to hear how far your views coincide with mine, which I put on record in the Catalogue, and their bearing on Military Surgery. ... Governments ... are more easily moved to provide Ammunition and Engines of Destruction than a good race of Medical Men to avert some of wars worst consequences on those who bear the brunt of the battle.’
All of the osteological and soft-tissue specimens purchased from Alcock, as well as Ballingall’s own osteological and other material, are briefly described in Ballingall’s Catalogue. 24 In most cases, this provides abbreviated clinical details, such as the surname of the individual concerned, his age if known, whether he survived or died, and if the latter --how long (days or months) after the wound was received or surgery performed. According to the Preface to the printed Catalogue, a manuscript version of this catalogue was prepared during the Session 1843-44 by two students for a Prize Essay. The definitive printed version was subsequently published more than 10 years later. It is dated July 24 1855, and contains additional material, some of which relates to the Crimean War. When the manuscript Catalogue was originally prepared, it is likely that the two students had access to Alcock’s notes on these specimens. Ballingall describes these in the following terms in the Preface section to his Catalogue: “The preparations made by Mr Rutherford Alcock, during the service of the ‘British Legion of Spain,’ and of which full descriptions, with valuable details of the cases, are contained in the Manuscript Catalogue and Appendix...” Unfortunately, these manuscripts have yet to be located. 25
It is relevant to note here that Alcock had previously donated three pathological preparations of lungs with evidence of the effects of musket-ball injuries sustained during the Carlist War to the Museum of the Royal College of Surgeons of England. These specimens formed the basis for the Jacksonian Prize Essay awarded in 1841.26 Ballingall had purchased a similar preparation of a lung from Alcock in 1843.27 While the Museum of the Royal College of Surgeons of Edinburgh contains a number of osteological preparations displaying the effects of musket-ball injuries to various bones, their Inventory indicates that none of these had been donated by Alcock, nor are there preparations from the Carlist War of 1835-37. The majority of the osteological preparations of musket-ball injuries in the Edinburgh College’s collection are from the Peninsular War and from the battle of Waterloo. 28
CLINICAL CASE NOTES FROM THE CARLIST WAR
Until very recently, this author had assumed that all of the ‘Manuscript’ material prepared by Alcock and his colleagues referred to in the Reid Fund Minutes Book had been lost. 29 This no longer appears to be the case, as all of the manuscript material prepared by Alcock and his medical colleagues has now been located in the Special Collections Section of Edinburgh University Library. Accordingly, it is now possible to read the full clinical case details in relation to the majority of the specimens purchased by Ballingall from Alcock. This exercise is facilitated by the fact that all of the museum preparations still possess their original labels bearing their Catalogue reference numbers, and each, therefore, may be located in the printed Catalogue. Moreover, in the majority of cases, the abbreviated notes associated with each specimen are provided with the surname and, in some instances, the age, if known, of the soldier from whom the osteological preparation had been obtained. In a number of cases, the clinical histories provided in the manuscript case notes have appended to them mostly ink drawings of the macerated osteological preparations. In only one case is the associated sketch drawn in pencil and in a number of others the sketches are highlighted by watercolours. These osteological preparations had either been obtained following surgery, in most cases following amputation, or at post-mortem examination if the patient died before surgery was undertaken, or after death if it was not considered technically possible or clinically appropriate to operate on them.
It is now clear that the ‘Manuscripts’ referred to in the Reid Fund Minutes Book were the complete collection of clinical case notes, in all consisting of 10 volumes, prepared by Alcock and his medical officers during the Carlist War, covering the period between May 1836 and December 1837. A further volume deals exclusively with clinical case notes of sick and wounded soldiers during the Miguelite War in 1832/3. A final volume entitled ‘Statistical Returns of the Sick and Wounded admitted in the General Military Hospitals of the Legion’ was undoubtedly used by Alcock as the source material for his monograph prepared shortly after the end of the Carlist War. The twelve volumes of manuscript material are now located in the Special Collections Section of Edinburgh University Library, and bear the Reference Numbers: E62/45, 596 and E62/46, 597-607.30 Excluding the final volume which contains the statistics of the campaign, these manuscripts contain about 1,500 pages of text, most of which consists of clinical case reports. In a number of cases, the clinical case notes are supplemented with detailed ink drawings of the wound sites and/or the macerated osteological specimens mostly obtained following amputations after musket-ball injuries. Many of these sketches are of particularly high quality. It is these volumes that bear directly on the osteological preparations purchased by Ballingall from Alcock in 1843. There can be little doubt that a considerable number of the pages in these manuscript volumes were used by Alcock and his colleagues on a daily basis to record their clinical case notes and were, at some unknown later date, (presumably by Alcock), bound together to produce a uniform series of volumes. In some cases, Alcock carefully transcribed the case notes from the original sources, and in these cases only his notes were subsequently bound into these volumes both for completeness and for his further reference.
At various times, the Legion may have had a number of military hospitals. However, the General Military Hospital at St Telmo, San Sebastian, would appear to have been their principal hospital. This is where all the sick and wounded men were transported for treatment, and where all surgical operations were performed other than those that had to be carried out on or near to the battlefield. It is now clear from the analysis of these recently located detailed clinical case notes that facilities were also available in the General Military Hospital at St Telmo to prepare by maceration the osteological specimens of gun-shot injuries. These must have been prepared within a very short time after their receipt from the surgeons, as detailed descriptions of the bony lesions were invariably located in the post-mortem reports that were included in all of the clinical case notes so far studied of those that died. In those cases where the individuals survived surgery and were subsequently invalided out of the service, detailed descriptions of the osteological preparations were also included in their appropriate case summaries.
Shortly after the cessation of the Carlist War on 10 June 1837, these manuscript volumes were used by Alcock (particularly Volume 607) as the basis for his account of the campaign. 31 It is believed that access to Alcock’s osteological preparations still in Ballingall’s collection, and the full clinical case notes that refer to them, provides an important insight into the management of a selection of the typical type of injuries and clinical conditions encountered by military surgeons during the 1830s. These would, in fact, also be almost identical to the injuries and clinical conditions encountered during the Peninsular War that took place only 20-30 years earlier, as both campaigns were fought in the Iberian Peninsula. Furthermore, the injuries were induced by similar weapons --musket balls, grape shot, cannon balls and as a consequence of sabre or bayonet injuries. Some of the individuals sustained both musket-ball and sabre injuries.
Osteological preparations from Alcock still in Ballingall’s museum collection
Of the 35 osteological preparations that were purchased from Alcock that still remain in the collection, six are only very briefly described in the Catalogue, and do not have the name of the individual associated with them, or any other information that would allow them to be identified. Furthermore, four of these preparations have only a minimal amount of clinical information associated with them. A fifth preparation is described as being an example of an oblique fracture at the middle of the shaft of the femur from ‘A Carlist prisoner,’ while the sixth is a specimen of a comminuted fracture at the lower third of the right femur from ‘Capt. -----.’ Of the 29 remaining preparations, it has now been possible to unequivocally establish the full clinical histories from an analysis of the various manuscript volumes in 26 cases. While a considerable number of these cases have sketches associated with them indicating the appearance of the entrance and, where present, the exit wounds, others have associated with them drawings of the macerated osteological preparations. Attention will be drawn to five of the latter examples in order to emphasise the high quality and accuracy of the draughtsmanship involved. In all but one of these examples (A.62, see below), the drawing(s) associated with the clinical case notes will be compared with photographs of the osteological preparations displayed in a similar orientation. The reference numbers and text are from Ballingall’s Catalogue, although the Christian names of the individuals have been inserted here, having been obtained from a perusal of the manuscript case notes.
(A.19). 32 Os innominatum and upper part of the femur, 72 days after the reception of a gunshot injury. The ball would seem to have struck the dorsum ilii, coursed between its plates, passing obliquely out near the sacro-ischiatic notch, injuring the superior portion of the acetabulum. The dorsum and venter ilii, the whole of the acetabulum, along with the head of the femur, present marked appearances of absorption. Died seventy-second day. John Quin. MS. Catalogue, page 44. Appendix, page 37(Figure 1).
1a 1b
Figure 1: (a) Sketch of the macerated osteological preparation of the innominate bone and upper part of the femur of John Quin, who died 72 days after receiving a gun-shot injury to the dorsum ilii. A photograph of this preparation is shown in Figure 1b
(A.34). 33 Elbow-joint of a man, in which the ball passed obliquely through the external condyle, not perceptibly fissuring the bone, but leading to extensive caries and a complete bony anchylosis. Callus has been abundantly thrown out, and absorption has been active at the same time. The epiphyses of the humerus have been evidently detaching, and a thin external plate of bone, up to the point of amputation, has in places scaled off. The limb was amputated on the 136th day. Corporal Daniel Williams aet 23. MS. Catalogue, page 78. Appendix, page 64 (Figure 2).
2a 2b
Figure 2: (a) Sketch of antero-lateral view of the macerated osteological preparation of the elbow joint of Daniel Williams after a musketball had passed obliquely through the joint. The forelimb was amputated on the 136th day with complete healing. He was subsequently discharged from the service. For a photograph showing a similar view of this preparation to that shown in Figure 2a, see Figure 2b
(A.66). 34 Fracture of the femur at its upper third. The preparation shows that absorption has been active, and that all the old and dead bone has been removed with a slight exception. Callus has been thrown out everywhere around the edges of the bone, and has united slightly a very complicated fracture; consisting of three fragments and two shafts. The union is by no means firm, but all the different parts of the fracture are put together in a direct line and in a desirable position. Amputation was performed on the 76th day. John Steevens, aet 19. MS Catalogue, pages 116, 126. Appendix, page 101. According to the clinical notes, this patient died the day after the amputation was performed (Figure 3).
3a 3b
3c 3d
Figure 3: Figures 3a and 3b. Sketches showing anterior and posterior views, respectively, of the macerated osteological preparation of the middle third of the femur of John Steevens with a complicated fracture induced by a musket-ball. The limb was amputated on the 76th day, but the patient died of exhaustion on the following day. The two sketches are signed ‘RA ft.’ and ‘RA fect.’ (i.e. ‘RA fecit’). For photographs showing similar views to those shown in Figures 3a and 3b, see Figures 3c and 3d
(A.75). 35 Upper part of the humerus fractured just below its neck, with two fragments of considerable size. Little callus has been thrown out and little absorption has taken place. Died on the thirty-fifth day. Robert Fountain aet 30. MS. Catalogue, page 132. Appendix, page 113 (Figure 4).
4a 4b 4c
Figure 4: (a) Sketch showing two views of the macerated osteological preparation of the upper part of the humerus of Robert Fountain, who died on the 35th day after receiving the injury. A musket-ball struck the region just below the neck of the bone causing extensive local damage including two large fragments of the shaft. Minimal evidence of callus is seen. Photographs showing similar views of this preparation to those shown in Figure 4a, see Figures 4b and 4c
The sketches illustrated in Figures 1a, 2a, 3a, 3b and 4a are all drawn in black ink, and there appears to be little evidence that these were superimposed on top of preliminary pencil drawings. Some of the other sketches in these manuscript volumes are equally skilfully drawn, and have areas highlighted in what appears to be watercolour paint. A typical example of the latter style is illustrated in Figure 5 (Catalogue Reference Number A.62), although this preparation is no longer in the collection, so that it is not possible to compare it with the actual osteological preparation. A relatively small number of additional sketches, for example that of the partially macerated osteological preparation of the secondary amputation specimen from Francis Hoffman illustrated on page 63 in Volume 599, are highlighted using watercolour paints of various colours to give them a more ‘natural’ appearance.
(A.62). 36 Acetabulum (not shown in the sketch) and upper third of the femur of a man in whom a ball had passed through the bone at the junction of the neck with the shaft, opening the capsular ligament. In the preparation, the absorbent process is seen to have been the most active, little callus being thrown out. Some may, however, be traced within the insertion of the capsular ligament. Died on the 47th day. William Evans aet 23. MS. Catalogue, page 123. Appendix, page 91 (Figure 5).
Figure 5: Sketch of the macerated osteological preparation of the upper third of the femur of William Evans, who died on the forty-seventh day. The musket-ball struck the bone at the junction between the neck and the shaft opening the capsular ligament. This sketch is skilfully drawn, and appears to be highlighted with white watercolour paint. It is signed ‘RA’
Several of the sketches bear the signature ‘RA fecit’ or ‘RA’. Only three of those illustrated here (Figures 3a, 3b and 5) are signed, and bear one or other signature, and were clearly drawn by Rutherford Alcock. Of the signed sketches, all appear in the manuscript volumes from the period between May and December 1836, and most of these are located in Volume 599. It is noticeable that only the more sophisticated sketches are signed. None of the very simple sketches that display entrance and exit wounds and post-operative views of amputation stumps are signed. The majority of the sketches, however, though bearing certain stylistic similarities, are unsigned and it is unclear whether they are also the work of Alcock or of other individuals. In a few cases, for example only one of the three sketches provided to illustrate the case of Michael Black is signed ‘RA fecit’, the other two being unsigned although all three appear to have been sketched by the same individual. 37
While the volumes that contain case histories of individuals admitted during the January-December 1837 period contain an approximately similar number of cases to those included in the January-December 1836 period, the volumes from the later period are only rarely illustrated. Most of the case histories in these volumes also appear to be in the hand of Alcock, with only a few insertions in the hand of others. It appears likely that Alcock transcribed these for his future reference, possibly because the original notes were particularly difficult to read, or were soiled or damaged, although the detailed case notes of some of his colleagues were bound into these manuscript volumes.
It is relevant to note here that, when only a youth, Alcock already had a passion for art, and paid frequent trips to the sculptor Chantry’s studio to learn the art of modelling. 38 At the age of 16 years, when a medical student at the Westminster Hospital and Royal Westminster Ophthalmic Hospital, he visited Paris for about a year. This was ostensibly to learn medicine and surgery, but while there he took regular lessons and mastered the art of modelling in wax and in plaster. He was even able to maintain himself while in Paris by the sale of his anatomical models each of which sold for between 35 and 50 guineas. 39 At the age of 16, he was awarded the “Gold Isis Medal” of the Royal Society of Arts, and one year later was awarded their “large gold medal” for a model in coloured wax. Three of Alcock’s anatomical models from this period, including those for which he was awarded the Gold Medal of the Royal Society of Arts in 1826, were formerly preserved in the museum of the Royal College of Surgeons. The government bought others from him for the use of the Indian medical schools. Between 1828-32, he continued modelling and took pupils in that art. These wax models were initially offered to the Royal College of Surgeons in London 1829 for 50 guineas, but the offer was declined at that time. Alcock later, in 1844, when Inspector of Anatomy, donated them to the London College. As these models are no longer on the Inventory of the museum of the Royal College of Surgeons, it is believed that they were probably lost when part of the museum was destroyed by enemy action in 1941.40 With the tuition he received from Chantry in particular, it should not be altogether surprising that Alcock was also a very competent artist.
While the Gentlemen Cadets at Sandhurst at that time received instruction in Military Draftsmanship, it is evident from the examples presented here that some military surgeons were also extremely gifted draftsmen. Some doctors were clearly naturally gifted artists, such as John and Charles Bell, and were able to illustrate most of their own published work themselves; others received training from drawing masters. 41,42 In Edinburgh, there was a long tradition of artists attending anatomical classes both in the University and in the extramural schools. 43 Robert Knox, like Charles Bell before him, had published books on anatomy for the use of artists. 44 The possibility exists, therefore, that some at least of the medical officers associated with the British Legion of Spain had some form of training in anatomical drawing. 45 This is clearly an area that justifies further exploration.
The author is indebted to Dr Michael Barfoot of the Special Collections Section of Edinburgh University Library for drawing his attention to the volumes of manuscript notes relating to the Carlist War discussed in this paper. Thanks are also due to Allan Carswell for helpful advice and discussion, Ms Jane Hughes, Audience Development Officer Royal College of Surgeons of England, and Mrs Sheena Jones, Museum Secretary, Royal College of Surgeons of Edinburgh, for information on items in their respective collections, and Mr I. Goddard and Dr Joe Rock for expert photographic assistance.
1. Kaufman MH, Purdue BN, Carswell AL. Old wounds and distant battles; the
Alcock-Ballingall collection of military surgery at the University of Edinburgh. J R
Coll Surg Edin 1996; 41: 339-50
2. Speirs EM. Radical General, Sir George de Lacy Evans 1787-1870. Manchester:
University Press, 1983
3. In his (possibly incomplete) roll of officers who served at one time or another during
the Carlist War, Somerville lists a total of 840 officers, of whom 98 were medical
officers. See: Somerville A. History of the British Legion, and War in Spain,
1835-1837. London: James Pattie, 1839: 676-715
4. Alcock R. Notes on the Medical History and Statistics of the British Legion of
Spain; Comprising the Results of Gun-Shot Wounds in Relation to Important Questions in
Surgery. London: J. Churchill, 1838: 5-6
5. Alcock, British Legion of Spain [101 pp.]. He also published an essay on wounds of
joints, which was first published in Volume 23 of Medico-Chirurgical Transactions. See:
Alcock R. Observations on injuries of joints, and their treatment. London: Richard
Kinder, 1840: 82
6. Michie A. The Englishman in China during the Victorian Era: as illustrated in the
career of Sir Rutherford Alcock, K.C.B., D.C.L. Many years consul and Minister in China
and Japan. In two volumes. Edinburgh & London: William Blackwood & Sons, 1900:
2-4. Guthrie had been elected an assistant surgeon to the Westminster Hospital in 1823 and
a full surgeon in 1827. See: Kaufman MH. Surgeons at War: medical arrangements for the
treatment of the sick and wounded in the British army during the late 18th and 19th
centuries. Westport C.T.: Greenwood Publishing Group Inc., 2001: 15
7. The Miguelite and Carlist Wars were fought over the disputed succession to the thrones
of Portugal and Spain. For an abbreviated overview of the various contestants in these
disputes, see: Holt E. The Carlist Wars in Spain. London: Putnam, 1967; Kaufman et
al, Old wounds and distant battles, 340-41. According to Somerville, Rutherford Alcock
was appointed a Staff-Surgeon on 4 July 1835, and later promoted Deputy Inspector General
of Hospitals. See: Somerville, British Legion, 676
8. This is likely to have been John Callander, who had served as a Staff Surgeon in
Portugal under Lieutenant General Sir W. Carr Beresford during the Peninsular War. See:
Peterkin A, & Johnston W. Commissioned Officers in the Medical Services of the
British Army 1660-1960. Two volumes. London: Wellcome Historical Medical Library,
1968, Volume 1, Reference Number 2730, 181
9. Kaufman et al, Old wounds and distant battles
10. According to a Table in Volume 607 entitled: ‘Casualties amongst medical
officers.’ Of the 98 medical officers listed by Somerville, the names of 11 are given
who were stated to have died during the War, 10 of whom died of fever. In the case of a
number of others, no information was available to that author to establish whether they
had served until the disbandment of the Legion in June 1837 or otherwise. Just under 70%
(i.e. 57/84) of the medical officers where their date of joining the Legion was provided
by Somerville, volunteered for service between July and September 1835. See: Somerville, British
Legion, 676-715
11. ‘In Vitoria [sic, often incorrectly spelled Vittoria, see, for example, Alcock, Injuries
of joints, 62], during the first winter, ... for many of our number were carried from
the hospitals to their quarters to rave, in the sharp access of their delirium, or
blackened feet rotting from the living flesh, of the screams of the dying still struggling
among the dead, until they themselves were added to the list. Eleven medical officers died
in 4 months, at Vitoria, and during the same period only six escaped from attacks of
fever, so severe, as to leave them long in a shattered state. ...’ See: Alcock, British
Legion of Spain, 2
12. Specimens of dura and brain (5); injuries of brain and nerves (3); injuries of
thoracic and abdominal viscera (5); injuries of blood vessels (5); worm (1). Information
from Ballingall’s Catalogue. See: Ballingall G. Catalogue of the Museum attached
to the Class of Military Surgery in the University of Edinburgh. Edinburgh: R&R
Clark, 1855: 1-2, 27, 28, 29-30, 30
13. Ballingall G. Instruction for medical officers of the army and navy. Lancet 1843;
I: 268-70
14. Michie, Englishman in China, Volume 1, 27
15. Somerville, British Legion, 676
16. Michie, Englishman in China, Volume 1, 25-26; Anon. A Collection of the Public
general Statutes, passed in the Second and Third Year of the Reign of His Majesty King
William the Fourth: Being the Second Session of the Tenth Parliament of the United Kingdom
of Great Britain and Ireland. Cap. LXXV. An Act for Regulating Schools of Anatomy. 1st
August 1832. London: George Eyre and Andrew Spottiswoode, 1832: 713-18
17. Michie, Englishman in China
18. Reid Fund Minutes Book, 85 [EUL Manuscript Reference No. Da 46.1, covering period
1838-53] ‘Item 5. [dated 29 January 1842] The Professor of Military Surgery applies
for one grant of £300 - in order to found a Museum in his department. But, if the claim
be only recognized at present, he is willing to let it lie in abeyance until Sir Joseph
Stratton’s Bequest become available.’
19. Reid Fund Minutes Book, 121 [EUL Manuscript Reference No. Da 46.1, covering period
1838-53] [Item dated 28 January 1843] ‘Moved by Dr. Christison, seconded by -------
that a sum of £150 be assigned from the accumulated interest of the Reid Fund for the
purchase of specimens and models for the Chair of Military Surgery. This motion was agreed
to - Sir W. Hamilton dissented.’
20. Approximately £6400 at present rates: information from Bank of England
21. Reid Fund Minutes Book, p. 122 [EUL Manuscript Reference No. Da 46.1, covering period
1838-53]
22. Reid Fund Minutes Book, p. 183 [EUL Manuscript Reference No. Da 46.1, covering period
1838-53].
23. Letter from Alcock to Ballingall. See: Special Collctions Section reference Number:
3082.2.5-6. An analysis of the handwriting in this letter allows the notes written in the
manuscript volumes to be determined
24. Ballingall, Catalogue
25. These are clearly the items referred to in the figure legends associated with the
examples of osteological preparations discussed in this paper. Reference to
Ballingall’s printed Catalogue suggests that these items probably each contained at
least 170 pages of manuscript text
26. These preparations bear the following Royal College of Surgeons’ of England
Museum Reference Numbers: 3332, 3333 and 3334. See: Paget J, Goodhart JF & Doran AHG. Descriptive
Catalogue of the Pathological Specimens contained in the Museum of the Royal College of
Surgeons of England, 2nd edn. London: J & A Churchill, 1884: Volume 3, 481-2
27. According to the information provided in Ballingall’s Catalogue: This specimen
‘shows the thickening of the pleura pulmonalis, which resulted from the inflammatory
action set up in a man who died on the 10th day, after receiving a penetrating gunshot
wound of the chest. --West, aet 29.’ See: Ballingall, Catalogue, 28, Reference
Number A.98
28. Information supplied by Mrs Sheena Jones, Museum Secretary, Royal College of Surgeons
of Edinburgh.
29. This is quite different from the more abbreviated summary of the clinical cases
associated with the osteological preparations referred to by Ballingall in the Preface
section of his printed Catalogue. See: Ballingall, Catalogue, iii.
30. These volumes were transferred to the University Library from the Department of
Anatomy [Ballingall Collection] in 1962. The full titles on the covers of these volumes
and their Special Collections Section Reference Numbers are indicated here. E62/45
Gen.596. Untitled - Index - mostly clinical case histories that occurred during 1832/3
(143 pp.) E62/46 Gen.597. Gun-shot wounds. Compound fractures of the bones of the head and
face. May-Dec 1836. General Military Hospital of San Telmo. San Sebastian. (72 pp.) E62/46
Gen.598. Gun-shot wounds of Abdomen and Chest, also penetrating wounds into joints.
May-Dec 1836. General Military Hospital of San Telmo. San Sebastian. No. 2 (140 pp.)
E62/46 Gen.599. Gun-shot wounds. Compound fractures of the femur. May-Dec 1836. General
Military Hospital of San Telmo. San Sebastian. No. 3 (151 pp.) E62/46 Gen.600. Gun-shot
wounds. Compound fractures of the extremities exclusive of the femur. May-Dec 1836.
General Military Hospital of San Telmo. San Sebastian. (117 pp.) E62/46 Gen.601.
Amputations. Primary and Secondary. May-Dec 1836. General Military Hospital of San Telmo.
San Sebastian. (168 pp.) E62/46 Gen.602. No. 6, Part I. Gun-shot wounds. Compound
fractures of the Spine and Ilium. (65 pp.) Part II. Series of flesh wounds with
contraction, also Some anomalous cases of bone, muscle, testicle & abdomen, and a case
of spontaneous salivation. May-Dec 1836 (36 pp.). General Military Hospital of San Telmo.
San Sebastian. E62/46 Gen.603. Second Series No. 1. Gun-shot wounds. Compound fractures of
the bones of the head and face. Jan-Dec 1837. General Military Hospital of San Telmo. San
Sebastian. (71 pp.) E62/46 Gen.604. Second Series No. 2. Gun-shot wounds of Abdomen and
Chest, from Jan-Dec 1837, and a series of cases of Tetanus, also lesions of nerves.
General Military Hospital of San Telmo. San Sebastian (94 pp.). E62/46 Gen.605. Second
Series No. 3. Amputations. Primary and Secondary. Jan-Dec 1837. General Military Hospital
of San Telmo. San Sebastian. (135 pp.) E62/46 Gen.606. Second Series No. 4. Compound
fractures and injuries of the extremities. Jan-Dec 1837. In the General Military Hospital
of San Telmo. San Sebastian. (308 pp.) E62/47 Gen.607. Statistical Returns of the Sick and
Wounded admitted in the General Military Hospitals of the Legion [Said by Alcock to have
been principally the work of Staff Surgeon Johnson, Surgeon Sholl and Assistant Staff
Surgeon Dolce. See: Alcock, British Legion of Spain, 3]. All of these volumes bear
the coat of arms of this force on the upper left side of one or more of the inside pages.
This consists of a shield with the Spanish coat of arms and the insignia ‘Legion
Britanica’ [sic] on either side of it.
31. According to Somerville. See: Somerville, British Legion, 676
32. For full clinical details, see Volume 602, 25-26
33. For full clinical details, see Volume 602, 11-17
34. For full clinical details, see Volume 599, 18-23
35. For full clinical details, see Volume 606, 38-40
36. For full clinical details, see Volume 599, 12
37. See: Volume 599. The signed sketch appears on the obverse side of page 116, while the
two unsigned sketches appear on pages 117 and 118.
38. Anon. Chantrey, Sir Francis Legatt (1781-1841). Dictionary of National Biography 4.
London: Oxford University Press, 1963-64, 44-7
39. £1,150-1600, in modern money. Information from Bank of England
40. According to the College’s Donation Book, one of the wax models displayed the
upper and lower surfaces of the brain, the second was a model of a dissected arm, while
the third was said to have been a fine example of the intestines displaying diseased
mesenteric glands. Information on the Inventory supplied by Ms Jane Hughes, Audience
Development Officer, Royal College of Surgeons of England. See also: Michie, Englishman
in China, Volume 1, 2-8 41. On the teaching staff of Sandhurst in 1821 there was one
Senior Military Draftsman assisted by five Masters of Military Drawing, and a Master of
Landscape Drawing, out of a total of 26 members of the Civil teaching staff. See:
Parliamentary Papers. Estimates and Accounts, Volume 1, Army; Navy; Ordnance; Chelsea
Hospital; Ophthalmia, Commissariat; etc. Session 23 January to 11 July 1821. Volume XV (London:
Ordered to be Printed by the House of Commons, 1821), 30-31
42. See, for example: Bell J. Engravings, explaining the Anatomy of the Bones, Muscles,
and Joints. Edinburgh: Bell & Bradfute, and T. Duncan; and J. Johnson; London:
G.G.G. & J. Robinsons, 1794; Bell C. The Anatomy of the Human Body. Volume 4.
Containing the Anatomy of the Viscera of the Abdomen, the Parts in the Male and Female
Pelvis, and the Lymphatic System. In 4 Parts, with an Appendix. London: T.N. Longman
& O. Rees, and T. Cadell, 1804
43. ‘The benches of Knox’s class-room were occupied by a scholarly, earnest, and
appreciative class; ... Scottish advocates and divines, scions of the nobility, artists,
and men of letters. ... Military and naval surgeons ... oft mingled with the crowd.’
Lonsdale H. A Sketch of the Life and Writings of Robert Knox the Anatomist. By His
Pupil and Colleague. London: Macmillan & Co., 1870: 131
44. See, for example: Bell C. Essays on the anatomy of expression in painting. London:
Longman, Hurst, Rees & Orme, 1806; Knox R. A Manual of Artistic Anatomy, for the
use of Sculptors, Painters, and Amateurs. London: Henry Renshaw, 1852
45. Most anatomists, unlike John Lizars, did not have the benefit of a brother who was an
artist, engraver and a publisher. See: Lizars J. A System of Anatomical Plates of the
Human Body, Accompanied with Descriptions, and Physiological, Pathological, and Surgical
Observations. Edinburgh: W.H. Lizars; London: S.Highley; Dublin: W. Curry Jun. &
Co., undated
Copyright date: 14th August 2001
Correspondence: M.H. Kaufman, Division of Biomedical and Clinical Laboratory Sciences, University of Edinburgh, Hugh Robson Building, George Square, Edinburgh EH8 9XD, UK E-mail: M.Kaufman@ed.ac.uk