Sir John Struthers (1823-1899), Professor of Anatomy in the University of Aberdeen (1863-1889), President of the Royal College of Surgeons of Edinburgh (1895-1897).

Between 1841 and 1845 John Struthers attended both the University of Edinburgh and some of the various Extra-mural Schools of Medicine associated with Surgeons' Hall. While a medical student he became a Member of the Hunterian Medical Society of Edinburgh and later was elected one of their Annual Presidents. He graduated with the MD Edin and obtained both the LRCS Edin and the FRCS Edin diplomas in 1845. Shortly afterwards he was invited to teach Anatomy in Dr Handyside's Extra-mural School in Edinburgh. The College of Surgeons certified him to teach Anatomy in October 1847. He had two brothers, and all three read Medicine in Edinburgh. His younger brother, Alexander, died of cholera in the Crimea in 1855 while his older brother James, who had been a bachelor all his life, practised as a Consultant Physician in Leith Hospital, Edinburgh, until his death.When associated with Dr Handyside's Extra-mural School in Edinburgh, John taught Anatomy there until he was elected to the Chair of Anatomy in Aberdeen in 1863. Much of his time was spent in Aberdeen teaching Anatomy and in upgrading the administrative facilities there. He resigned from this Chair in 1889 and subsequently was elected President of Leith Hospital from 1891 to 1897. This was in succession to his older brother, James, who had died in 1891. Later, he was elected President of the Royal College of Surgeons of Edinburgh from 1895 to 1897 and acted as its Vice-President from 1897 until his death in 1899. In 1898, Queen Victoria knighted him. His youngest son, John William Struthers, was the only one of his clinically qualified sons to survive him and subsequently was elected President of the Edinburgh College of Surgeons from 1941 to 1943.

Three Licentiates of the Royal College of Surgeons of Edinburgh who were decorated with the Victoria Cross.

Since the Victoria Cross was introduced in January 1856 by Queen Victoria to reward acts of valour in the face of the enemy, initially during the Crimean War, over 1350 medals have been awarded. Of these, three were awarded to medical officers who had previously gained the Licentiate Diploma of the Royal College of Surgeons of Edinburgh (LRCS Edin) - Valentine Munbee McMaster on 25 September 1857, Henry Thomas Sylvester on 20 November 1857 (although the acts of valour for which he was awarded his VC occurred on two occasions in September 1855) and Campbell Mellis (or Millis) Douglas on 7 May 1867.

Further observations on the removal of an enormous facial tumour by Robert Liston in 1834.

In 1834, shortly before Robert Liston (1794-1847) left Edinburgh to take up the post of senior surgeon to the North London (now University College) Hospital, he operated on Mrs Fraser, from Banchory, in north-east Scotland. Her tumour was believed to have originated as a result of trauma to the left maxillary antrum. It was immense in size when he first saw it, and produced an enormous degree of facial distortion. The tumour was associated with drooping and disfigurement of the left angle of her mouth and extended forwards from her left external ear to the left side of her nose. Its upper part eventually obstructed the vision of her left eye, while its lower part extended for some inches below the level of her mandible. The volume of the tumour was just slightly less than that of her face. Liston provided a detailed description of her appearance when he first saw her, and gave a detailed history that suggested its possible aetiology. Descriptions of her pre-operative cast were previously published in this Journal in 2000. Since then, additional casts showing her post-operative appearance and that of her tumour have been located, and these form the basis for this follow-up account.

John Barclay (1758-1826) extra-mural teacher of anatomy in Edinburgh: Honorary Fellow of the Royal College of Surgeons of Edinburgh.

John Barclay (1758-1826) was one of the most distinguished, respected and enthusiastic teachers of anatomy in Edinburgh during the first decades of the 19th century. He taught this subject in the extra-mural school from 1797 until 1825. He initially studied divinity at St Andrews University, intending entering the Church. After acting as a minister of the Church for about 10 years and tutoring for most of these years, he decided to study medicine in Edinburgh, and was particularly attracted to anatomy. After he qualified with the MD degree, he proceeded to London where he attended the anatomical classes of Dr Marshall for about a year. On his return to Edinburgh he taught anatomy to a small class for three years in High School Yards. He then acquired a property at Number 10 Surgeons' Square where he taught from 1800 until 1825, when he was forced to withdraw due to poor health. His lectures were meticulously prepared, and his illustrations clear and copious. In 1804, his class was recognised by the Royal College of Surgeons of Edinburgh as fulfilling their requirements for students who wished to take the College's examinations. During the winter sessions he taught anatomy, physiology and surgery, while in the summer sessions he taught comparative anatomy, a subject in which he was particularly interested. He was elected an Honorary Fellow of the Royal College of Surgeons of Edinburgh in 1821. His classes were taken over by his partner Robert Knox, at that time Conservator of the College's Museum.

500 years of the College of Surgeons and 300 years of the Chair of Anatomy in Edinburgh.

2005 represents the 500th anniversary of the award of the first Charter to the Guild of Surgeons and Barbers at Edinburgh, and the 300th anniversary of the establishment of the Chair of Anatomy in the University of Edinburgh, the first Chair in this discipline in Britain. The first Charter of the Incorporation, in 1505, specified that they should dissect the body of one dead condemned criminal each year. Candidates who wished to join the Incorporation were required to be familiar with all of the gross structures of the human body. In Cambridge and Oxford, those pursuing the medical courses in these Universities during the 16th and 17th centuries were expected to have both seen and undertaken a number of anatomical dissections during their undergraduate careers. Difficulties were often encountered, however, in obtaining adequate numbers of bodies for this purpose. In Edinburgh, from 1505, for more than a century, surgical apprentices were instructed in Human Anatomy. As a result of the efforts of certain surgeons during the 17th century, Pharmacy was also taught in addition to Surgery and Anatomy. During the mid-17th century, difficulties were encountered because the earlier examiners had not entered into the Incorporation's Minutes how their examinations should be undertaken. A new Act was prepared that described in detail how these should be conducted, and this emphasised the importance of a detailed knowledge of Anatomy. In 1694, Alexander Monteith, probably on the initiative of Archibald Pitcairne, requested unclaimed bodies from the Town Council to undertake dissections. Later in 1694, the Incorporation made a similar request to the Town Council, and both requests were granted. It is believed that for political reasons Monteith probably did not pursue his claim further. The Council stipulated that the Surgeons should build an Anatomical Theatre by the end of 1697 where public dissections could be carried out. This was achieved, and these were carried out in 1702 and 1704. On 1 February 1705, the Surgeons appointed Robert Elliot as their "public dissector of anatomie." He had volunteered to undertake all of the annual public dissections in Edinburgh, and the Members of the Incorporation of Surgeons unanimously accepted his offer. On 29 August 1705, at the request of the Surgeons, the Edinburgh Town Council appointed him their first Professor of Anatomy, and instructed the University's Treasurers to pay him 15 pounds Sterling per annum as his salary. As a result of the activities of the Incorporation of Surgeons and the Town Council, the first Chair of Anatomy was established in Britain, in the University of Edinburgh.

The military career of Mr (later Sir) Rutherford Alcock (1809-97).

Rutherford Alcock obtained the MRCS diploma in 1831. During the following year he volunteered for service as a medical officer in the British Marine Brigade, which fought during the Miguelite War in Portugal from 1832 to 1834. After that campaign, he transferred to the British Auxiliary Legion of Spain in May 1835 for service in what later was called the First Carlist War (1835-37). After serving for one year as a surgeon he was promoted to the rank of Deputy Inspector General of Hospitals. He had hoped to return to King's College Hospital, London, to the Chair of Military Surgery, with an associated assistant surgeonship at the Westminster Hospital but, because of a severe bout of what is now believed to have been rheumatic fever, he lost the use of his thumbs and decided he could not continue as a surgeon. Accordingly, he decided not to take up the Chair of Military Surgery at King's on his return to Britain. In 1839 he was appointed to a lectureship in surgery at Sydenham College and, for a brief period in 1842, he was the Home Office Inspector of Anatomy. He then decided to explore other career opportunities and initially was British consul to China, at Fuchow in 1844, at Shanghai in 1846 and at Canton in 1854. In 1858 he transferred to the Diplomatic Service. He retired in 1871 after a successful and distinguished career.

John Bell (1763-1820), the 'father' of surgical anatomy.

John was one of four very talented sons of the Reverend William Bell. Two qualified as advocates and both became professors. John and his younger brother Charles (later Sir Charles) entered medicine. John qualified with the Edinburgh MD degree in 1779, then obtained the FRCS Edin diploma in 1786. As a student, initially he studied anatomy under Professor Alexander Monro secundus, and it was soon evident to him that his teacher did not have any first-hand knowledge of the problems encountered by surgeons. He then decided to teach anatomy, while practising as a surgeon, and was among the first to emphasize the relevance of anatomy to surgical practice. During this period he lectured and wrote on anatomy and surgical anatomy. After 1800 he, like many of his surgical colleagues, was excluded from the Edinburgh Royal Infirmary as a consequence of the activities of Professor James Gregory, one of the most influential of the managers of that institution. When he stopped lecturing, he continued practising as a surgeon and wrote several influential textbooks but he never forgave Gregory for exclusion from the Infirmary. He was soon recognized as one of the foremost surgeons in Scotland. He spent the last few years of his life on the Continent attending to the surgical needs of the numerous expatriate Britons who lived there.

Dangerous dissections: the hazard from bodies supplied to Edinburgh anatomists, winter session, 1848-9.

After the 1832 Anatomy Act, all bodies that were to be used by medical students for dissection were supplied to Schools of Anatomy based on their needs. During the Winter Session of 1848-9, a high proportion of the bodies supplied to the University of Edinburgh, and the majority of those supplied to the Argyle Square School had died of an infectious disease. Most had died from cholera, while others had died from typhus, tuberculosis or other infectious diseases. These bodies were not embalmed before dissection. Therefore, both medical students and their teachers in the Departments of Anatomy, in addition to those in the hospitals in which they had died, would have been at risk of becoming infected or even dying as a consequence of exposure to these infected individuals.

The excoriation of Benjamin Bell: who was 'Jonathan Dawplucker'?

Because of a perceived lack of continuity of care of the surgical patients in Edinburgh Royal Infirmary, James Gregory, one of its managers, suggested that from 1800 a total of only six surgeons should be appointed full-time to that institution. As considerable animosity existed between Gregory and John Bell, a senior Edinburgh teacher and surgeon, a pamphlet that was extremely hostile to his activities was posted in prominent locations throughout Edinburgh. While the author was named 'Jonathan Dawplucker' it was speculated that Gregory, or one of his close associates, was its real author. The contents of a second Dawplucker pamphlet, in the same style, but probably written by John Bell, was subsequently published. This was extremely hostile to Benjamin Bell, one of Gregory's close surgical colleagues. While much distress was caused at the time, the real authors of these pamphlets are unlikely ever to be established.

3D reconstruction of the vessels that enter the right atrium of the mouse heart at Theiler Stage 20.

Computer-generated 3D reconstructions of a serially sectioned mouse embryo at Theiler Stage (TS) 20 (E 12-12.5 d.p.c.) were studied. This study investigated the vessels that enter the right atrium of the heart and the drainage of the ductus venosus. It was principally undertaken to allow a comparison to be made between the situation in the mouse and at a comparable stage of human development. Later stages of prenatal development were also studied in the mouse by the analysis of serially sectioned embryos at TS 21-26. As no left brachiocephalic vein forms in the mouse, unlike the situation in the human, the left (cranial) superior vena cava drains via the left common cardinal vein, later to become the coronary sinus, into the floor of the right atrium. It was also noted that unlike the situation in the human, at no stage during the prenatal period does the ductus venosus enter the right atrium. Even shortly before birth, it enters the intra-hepatic part of the inferior vena cava at a considerable distance caudal to the right atrium. This study indicates that the haemodynamics of the prenatal cardiac circulation in the mouse differs significantly from that in the human.

The embryology of conjoined twins.

INTRODUCTION: Attention is drawn to the spontaneous incidence of twinning, both dizygotic and monozygotic in different mammalian species. Conjoined twinning, however, only arises when the twinning event occurs at about the primitive streak stage of development, at about 13-14 days after fertilisation in the human, and is exclusively associated with the monoamniotic monochorionic type of placentation. It is believed that the highest incidence of conjoined twinning is encountered in the human. While monozygotic twinning may be induced experimentally following exposure to a variety of agents, the mechanism of induction of spontaneous twinning in the human remains unknown. All agents that are capable of acting as a twinning stimulus are teratogenic, and probably act by interfering with the spindle apparatus. DISCUSSION: The incidence of the various types of conjoined twinning is discussed. Information from the largest study to date indicates that the spontaneous incidence is about 10.25 per million births. The most common varieties encountered were thoraco-omphalopagus (28%), thoracopagus (18.5%), omphalopagus (10%), parasitic twins (10%) and craniopagus (6%). Of these, about 40% were stillborn, and 60% liveborn, although only about 25% of those that survived to birth lived long enough to be candidates for surgery. Conjoined twinning occurs by the incomplete splitting of the embryonic axis and, with the exception of parasitic conjoined twins, all are symmetrical and "the same parts are always united to the same parts". Fusion of monozygotic twins is no longer believed to be the basis of conjoined twinning. Accounts are provided of the anatomical features of each of the commonly encountered varieties.

Sir Stuart Threipland (1716-1805), physician-in-chief to Prince Charles Edward Stuart during the Jacobite uprising of 1745.

Stuart Threipland (1716-1805), the son of Sir David Threipland, second baronet of Fingask Castle, was an ardent Jacobite. He obtained the Edinburgh MD degree in 1742, was admitted a fellow of the Edinburgh College of Physicians in 1744 and was elected its President in 1766. He accompanied "Bonnie" Prince Charles Edward Stuart during the Jacobite uprising of 1745 and went into exile shortly after the battle of Culloden in April 1746. He returned to Edinburgh under an Act of Indemnity in 1747. While he succeeded to the baronetcy after the death of his father in 1746, he was not technically allowed to use this title during his lifetime because his father's title and ancestral estates had been confiscated after the Battle of Sheriffmuir in 1715. He practised in Edinburgh for the rest of his life and outlived all of the other great Jacobite figures involved in the 1745 uprising.

Amputation through the hip joint during the pre-anaesthetic era.

Even to the present day, hip disarticulation is one of the most radical orthopaedic operations. First carried out on the Continent in 1774 and in Britain in 1779, this procedure was only deemed necessary in circumstances where death was otherwise inevitable. George James Guthrie claimed to have undertaken the first amputation through the hip joint in which the patient survived. We describe some of these cases from the pre-anaesthetic surgical literature in which amputation through the hip joint was undertaken, and we comment on the surgical techniques used. This information is complemented by the views of certain authorities on this procedure. Many surgeons during the first half of the 19th century, including Guthrie, sought alternative surgical operations to hip joint disarticulation. The removal of the head and neck of the femur was far less traumatic than disarticulation through the hip joint, and proved an extremely effective alternative procedure for lesions involving the proximal part of the femur where there was any possibility that the limb could be saved.

Clinical case histories and sketches of gun-shot injuries from the Carlist War.

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.

Primary defects in the lens underlie complex anterior segment abnormalities of the Pax6 heterozygous eye.

We describe lens defects in heterozygous small eye mice, and autonomous deficiencies of Pax6(+/-) cells in the developing lens of Pax6(+/+) <--> Pax6(+/-) chimeras. Two separate defects of the lens were identified by analyzing the distribution of heterozygous cells in chimeras: Pax6(+/-) cells are less readily incorporated into the lens placode than wild type, and those that are incorporated into the lens are not maintained efficiently in the proliferating lens epithelium. The lens of chimeric eyes is, therefore, predominantly wild type from embryonic day 16.5 onwards, whereas heterozygous cells contribute normally to all other eye tissues. Eye size and defects of the iris and cornea are corrected in fetal and adult chimeras with up to 80% mutant cells. Therefore, these aspects of the phenotype may be secondary consequences of primary defects in the lens, which has clinical relevance for the human aniridia (PAX6(+/-)) phenotype.

Frederick Knox, younger brother and assistant of Dr Robert Knox: his contribution to "Knox's Catalogues".

Analysis of the material written in the two manuscript volumes known as the "Old" and "New" Knox Catalogues has revealed that most of their contents are in the hand of Frederick Knox, younger brother of Dr Robert Knox. Frederick was employed by Dr Knox as his research assistant, and prepared detailed lists of the items in his brother's museum collection. He also dissected and prepared human and non-human specimens, many of which were described by Dr Knox in his numerous publications. As relatively little is known about Frederick Knox, this seemed a timely opportunity to evaluate his contribution to Knox's anatomy class in the extra-mural school. When in due course Dr Knox's success as a teacher of anatomy gradually declined, he decided to leave Edinburgh to pursue his career in London. It was at about this time that his brother Frederick also decided to leave Edinburgh to establish a new career for himself in the Antipodes. The present whereabouts of the majority of Knox's enormous teaching collection of anatomical preparations and his comparative anatomy collection are unknown, and suggestions are made as to their possible whereabouts.

Excision of a remarkable tumour of the upper jaw in 1834 by Robert Liston.

A series of pre-operative casts of the head, one of plaster of Paris and the other of wax, have recently been discovered in the Department of Anatomy, Edinburgh, of a patient with an immense tumour of the left maxillary antrum which produced an enormous degree of facial distortion. These casts complement a series of engravings published in the contemporary literature. This lady's tumour was successfully excised by Robert Liston in 1834 in the Royal Infirmary of Edinburgh, only a month before he left Edinburgh for London. The tumour was believed to be benign, and was removed without the benefit of anaesthesia. The patient returned the following summer to have a gold palate fitted, and while her voice was initially indistinct, it subsequently recovered.