Memoir of Dr Alexander, Wooler

by John Struthers

MEMOIR OF DR ALEXANDER, WOOLER.

Mr Alexander was born about the year 1795 in Dunfermline, where his father was a surgeon. Both his father and mother, whose only child he was, were above the average in talent, and he used to speak of his mother as a person of unusual cultivation. He studied medicine in Edinburgh, and among his teachers were John Gordon, Andrew Duncan, Home, Hope, Hamilton, and James Gregory. He took his surgeon's diploma in 1815, and among his examiners on the occasion appears the name of Dr Abercrombie, with whom he formed an intimacy which lasted for life. Finding that he must endeavour at once to get some position where he could maintain himself, he had to relinquish his ardent desire to fight his way in Edinburgh, and the chance of circumstances led to his being fixed for life in the remote district where he worked so long. He went to Wooler first as the partner of Mr Cupples, the partnership continuing till the death of the latter. He married very soon after he went to Wooler, and Mrs Alexander, like himself from Dunfermline, proved throughout life to him and his children the most devoted and unselfish of wives and mothers. She survived him a year. With much domestic happiness he had his domestic sorrows, in the death of three of his children, losing his eldest daughter of scarlet fever at the age of seven, his eldest son after he had commenced the study of medicine, and his youngest son, who had entered the army as a surgeon, died of cholera in India.

The district of Glendale in which Mr Alexander practised, with Wooler as its centre, is essentially a rural one. An extensive, fertile, and beautiful valley, watered by the Till and some of its tributaries, divided for the most part into large and highly cultivated farms, skirted by the Cheviots, giving a Highland aspect to the scenery, and implying many long rides to the shepherds' huts which are scattered among the glens. Practice in such a district, extending as his practice came to do some ten miles in either direction, was necessarily laborious, involving long rides, much exposure, and frequent want of sleep. He drove partly, but some of the roads were so hilly that he was more frequently in the saddle. But naturally active and energetic, he did not feel this, and took pleasure in his daily rounds, endowed as he was with a genial many-sidedness which enabled him to find sources of interest and pleasure where some men would have experienced only the dulness and fatigue of daily routine. His habit of keeping up his general as well as his professional reading no doubt contributed to this. After twenty or thirty miles in the saddle, with the breeze in one's face, it is no easy matter to find time for evening study, or wakefulness to pursue it, but Mr Alexander managed somehow to do this. Much of his reading was accomplished during his daily rounds. He read everywhere, riding, driving, or sitting by the bedside of his patients, and often in bed both in his own house and elsewhere. Many a down-come of his horse was the consequence. The danger of this became so evident that his family endeavoured latterly to prevent him taking a book with him, and his combined love of reading and amiability of character were sometimes amusingly illustrated by his innocent stratagems to conceal the book, and his laughingly yielding it up when it was found on him or secreted in some unlikely place. His habit of reading in bed on one occasion got him into an amusing predicament in a friend's house. His light having been accidentally extinguished, he ventured out into the passage to try to relight it, forgot which was his own bedroom door among several around him, and was obliged to stand in the middle of the night en robe de nuit and call loudly to the gentleman of the house to extricate him from his undesirable situation.

With such tastes and habits it need hardly be added that Mr Alexander was well acquainted with the literature of his profession, and that he kept abreast of what was new. Although familiar with the writings of the older physicians, he was far from being a man of the old school, and was sparing in his use of drugs and of the lancet. He early used the stethoscope when some men of his standing were sneering at it, and he was at all times ready and indeed eager for surgical operations, not merely those of emergency which the country practitioner might take in hand, but operations which he might have sent to the metropolitan surgeons, such as lithotomy, tying the arteries for aneurism, and the excision of tumours. Besides reading the journals and the new books, he was himself an occasional contributor of reviews and papers, chiefly in the Edinburgh Medical and Surgical Journal, the Edinburgh Medical Journal, and in the British and Foreign Medico-Chirurgical Review. It is to be regretted indeed that what he wrote was mainly in the form of reviewing, and not more in the form of communications bearing his name. Of these, however, there are several in the Edinburgh journals. In the Edinburgh Monthly Journal he published a "Case of Popliteal Aneurism, with Remarks", and his "Case of Excision of the Sub-maxillary Gland". This case furnishes at least one example in which the tumour excised really was the sub-maxillary salivary gland.

In the Edinburgh Medical Journal he published in 1857 a "Case of Suppurating Tumour in the Groin, resembling Hernia", and a "Case of Dislocation of the Humerus Backwards;" in 1858 a "Case of Cancerous Tumour treated by Chloride of Zinc"; in 1859 "Cases of Suppression of Urine," and on "Surgical Statistics"; and in 1862, "Case of Strangulated Hernia, accompanied with Chronic Abscess in the neighbourhood of Poupart's Ligament," in which he takes occasion to inculcate early recourse to the operation in strangulated hernia. These communications contain useful practical remarks besides the record of interesting cases. The most remarkable of them is the one entitled "Surgical Statistics," in which he gives a tabular view of 126 operations which he had performed, although the district, being purely agricultural, is one in which accidents comparatively seldom occur. There are 12 larger amputations, 2 of ligature of the femoral artery for popliteal aneurism, 2 of lithotomy, 11 cases of operation for strangulated hernia, a case of excision of the eye- ball; of excision of the mamma for cancer, 8 cases; of excision of the lip for cancer, 34 cases; of other tumours, 6; and 42 of minor operations. Of the cases of excision of the mamma for cancer, the operation appeared to have afforded permanent relief in only 2, while in the cases of cancer of the lip the disease returned in only 7 of the 34. His object in giving these statistics and remarks was to make his small contribution illustrate the effect of country air and home influences on recovery after surgical operations as compared with the opposite conditions. The result is certainly remarkable enough, for, with the exception of 1 of the 11 cases of strangulated hernia, and 2 cases of fistula in ano in which the patients died of phthisis, the whole of the cases did well as far as the operations were concerned.

Mr Alexander was strongly impressed with the idea that important contributions to the statistics of practice could be made from the experience of practitioners in the country; that the statistics commonly founded on are from town practice, and even there from the practice of hospitals and dispensaries, in which many of the patients are below the average in constitution and condition. He was fully aware of the difficulties attending the obtaining of such statistics, as distinguished from mere opinions, but thought that much might be done if an organisation could be formed, or some machinery put in motion by the medical journals or by the colleges or influential societies of the profession. He took an active interest, along with his respected friend Dr Charles Wilson, then of Kelso, in the Border Medical Society. In the Transactions published by the society in 1841 occurs an interesting paper by Mr Alexander, containing, besides a tabular view of cases, 1,705 in number, treated by him in the Glendale Dispensary, some useful reflections on the prevalence of fever and the means by which it is spread in the country, and on the difficulties of the country practitioner.

Notwithstanding the difficulties there feelingly expressed, he managed to keep up his reading in literature and philosophy. He was especially familiar with Shakespeare and Milton, with Scott and Burns, and could quote them readily on occasion, and with much fervour and point. In philosophy he was familiar with the writings of Hume, Reid, Dugald Stewart, and Hamilton, and with those of Locke and Butler, and he engaged eagerly in philosophical discussion. He wrote in the Reviews occasionally, and his later writings I find were reviews of such works as Buckle's "History of Civilisation," the "Essays and Reviews," Sir Wm. Hamilton's "Lectures on Metaphysics." The review of Dr John Brown's "Horæ Subsecivæ" in the Edinburgh Medical Journal of February 1859, which I know to be from his pen, is a good specimen of his style. He took an active part in organising courses of lectures, and among his papers are manuscript lectures on Burns, Byron, on the philosophy of history, &c.

He relished society keenly, and shone in it, for his conversational powers were high, and he abounded in anecdote and quotation. Although the district was a rural one, there were not wanting in it men of education who met round his table, and I have there heard discussions and conversations which could not be easily surpassed. He took pains himself to assist in the education of his children, getting up early in the mornings for this purpose, and as they grew up the evenings were spent with them as often as possible in family readings. In matters of religion, while it may be said to have pervaded his whole life and character, he had a strong dislike not only to cant but to the too common use of religious phraseology or the unwise obtrusion of sacred things. With earnest convictions of his own he combined a wise and tolerant charity for those who differed from him, and there was nothing ascetic in his view of religion. Ecclesiatically he adhered to the Scotch form in which he had been educated, but he attached no importance to such distinctions. In politics he took an intelligent interest and was an active Liberal, and that in the days when Liberalism did not pay. I understand that he rather suffered for this in his early years at the hands of those who came afterwards to trust him as their physician and friend.

One intention of his life remained unaccomplished. He had been urged by friends who knew his literary ability, and the large store of experience of human nature which he possessed, to write a book of recollections, embracing his experiences of life as a country surgeon. There can be no doubt that that would have proved a work full of interest alike to the professional and to the general reader. He had accepted the idea, and thought over the plans, but the end came before it had been even begun.

He had always said that he would die in harness, and so the event proved. He had paid a visit to Edinburgh during the meeting of the Social Science Association early in October 1863, and though to outward appearance the same as ever, full of interest in what was going on, he felt some breathlessness, and complained sometimes of violent pain across the chest. He was carefully examined by his friend Dr W. T. Gairdner, who could detect no disease beyond a more than usually atheromatous state of the arteries, and warned him against violent exercise of any kind. The night before the apopleptic seizure which carried him off, he experienced severely the pain across the chest, but was so well in the morning that he preferred riding to driving. An hour after he left home he was found lying on the roadside insensible. On being removed to a neighbouring cottage, where a stimulant was administered, he recovered consciousness so far as to be able to relate that he had dismounted to pick up his whip, which he had dropped, and had been knocked over by the horse; that being his impression of what had evidently been the result of the apoplectic seizure. He was conveyed home, unconsciousness deepened into coma, and on the evening of the fourth day, the 23rd of November 1863, he passed away. He had reached his sixty-seventh year. A tombstone in the Wooler Churchyard marks his resting-place.

It is almost needless to say that a man of this stamp held a high position in a locality in which he practised for more than forty years. His practice was extensive, all that the district admitted of, and he was on terms of intimacy and personal esteem with all classes of the community. One is apt to feel that a man of such capacity and attainments was in a measure lost in such a position. That he would have taken a high position had his lot been cast in the metropolis or in connection with the medical school, there can be little doubt. At the same time we must not underestimate the value and influence of such a life. The great majority of the profession are and must be country practitioners; the hardest work of the profession is done by them; in the winter nights, when the world is asleep, they have many a long and weary drive; they are far from libraries, from hospitals and museums, and from societies; and thus in their comparative isolation want that stimulus and guidance which tend to keep the city practitioner up to the mark. It depends more upon himself what the country practitioner shall be, whether he shall succumb to the influences around him, or resolve on a plan of life and work up to to. It has been truly said that if the country practitioner is a man of observation and reading, he is in the best position to develop the whole medical man, for unlike the town man, he has not the consultants and specialists at his elbow, and must rely on himself in every branch and corner of his profession; his intimacy, too, with his patients, closer than the town practitioner can have, gives him greater influence among them, and perhaps a deeper insight into human nature. The subject of this notice was essentially such a man, and we must not therefore underrate the influence and usefulness of such a life wherever it may have been spent. The presence of such a man in the community must have been beneficial to a degree which it is not easy to calculate. As he moved about his district from day to day, not merely alleviating suffering and saving life, but as a man of genial and sunny spirit, and a good man, he must have used his influence often consciously, but much more have diffused it by his unconscious example. Such a life for forty long years, during which he must have seen generations of human beings come and go, could not fail to have a wide effect, felt not only during his lifetime, but now after he has passed away. Let us therefore honour his memory. We do so not merely as a just tribute to the memory of the man, but because such lives are an honour to the profession in which we belong, and deserve to be held up as an example to the younger numbers and as an encouragement to those who are now engaged in the daily work of their profession, that their lives are not being spent in vain.