Henry George Ferguson
Dr Andrew George Malcolm (1818 - 1856):
Andrew George Malcolm, physician; innovative medical teacher, progressive public health reformer and local medical historian was the most significant figure in the promotion and delivery of the progressive socio-medical agenda of early Victorian Belfast.
He was born in Newry, County Down on 17 December 1818, sixth child (and fourth of the five sons) of Rev Andrew George Malcom (so spelled), minister of the first Presbyterian congregation, and Eleanor Hunter, second daughter of William Hunter of Dunmurry, near Belfast. He was educated locally, probably at the Lancasterian School in Newry established by his father in 1814. On the family’s move to Belfast on his father’s death, he enrolled (in 1829) at the Belfast Academical Institution (‘Royal’ from 1831) and became an assistant teacher in its “English School” before progressing to its collegiate section where he studied logic and rhetoric (1834-5) and moral philosophy (1835-6) before taking classes in the newly-formed Faculty of Medicine. After further study in medical subjects in Glasgow and Edinburgh, on 1 April 1842 he graduated Doctor of Medicine (MD, with Gold Medal) in the University of Edinburgh, his thesis subject being “On the pathology of continued fever”, and on 25 July that year he also became a Licentiate of the Royal College of Surgeons of Edinburgh. Deciding on a hospital-based medical career he returned to his mother’s house in Belfast (29 York Street) to take the familiar appropriate career path of a district medical attendant to the General Dispensary (in his case to No.1 district of Belfast) while starting also in practice from home. On 15 April 1845 aged 26 and qualified less than three years, he was elected an attending physician to the Belfast Fever Hospital while still retaining his position with the General Dispensary, a most unusual arrangement at the time but one which allowed him to develop his teaching programmes using both in-patients (in the hospital) and out-patients (at the dispensary). His stellar career had begun.
It is convenient to record Malcolm’s activities under discrete headings, e.g. teaching and practice methods; health of factory workers; public health initiatives, and so on. Many, however, would fall under more than one heading: this should be borne in mind when considering the whole spectrum of his achievements.
Clinical care and teaching
As one of the four attending physicians at the Fever Hospital, Malcolm was required “to deliver clinical lectures and generally attend to the instruction and behaviour of the students”, requirements which he fulfilled assiduously; but in addition the partial rationalisation of the Belfast dispensary system allowed him to develop out-patient teaching for the hospital students thereby bringing the clinical teaching spectrum more into line with the best “Polycliniques” of the Continent, Edinburgh and London. He also extended the range to include teaching students at other centres, such as ophthalmic disorders at the Ophthalmic Institution in Mill (now Castle) Street, and children’s diseases at the Belfast Lying-in Hospital in Clifton Street where he later (1853) became secretary and registrar. When (from 1849-50) the Faculty of Medicine at the Royal Belfast Academical Institution was superseded by that of the Queen’s College, Belfast, the teaching syllabus became more formalised affording Malcolm an opportunity, which he seized, to develop his “hands-on” regime for student training and instruction along the lines of the reformed “Dublin system” which was driven mainly by Robert Graves at the Meath Hospital, Dublin, with emphasis on bedside teaching, full student involvement, comprehensive courses of clinical lectures, autopsy demonstrations, microscopy, and opportunities for student involvement, under supervision, in emergency admissions and out-patient attendances. He wrote a textbook for clinical students, the first of a planned four (An Introduction to Clinical Study, etc.: Belfast: Henry Greer, 1856), which was published posthumously. His other clinical and pathological innovations have been frequently described by his medical commentators.
The health of the factory worker
Malcolm was concerned at the socio-medical implications of rapid industrialisation, such as in Belfast, and wrote two reports (1848 and 1852) and many papers on “the sanitary state of Belfast” as well as articles associated with the cholera (1843) and other epidemics. One, however, stands supreme for originality and contemporary statistical rigour, namely his study of the health of factory workers. The rapid industrialisation of Belfast, the replacement of cotton by flax and the move of its spinning and weaving from rural cottage to urban factory and mill, combined to focus attention on the health of the operatives. In 1849 Malcolm had unsuccessfully sought the post of “certifying factory surgeon” for Belfast, but this went to the brother of the recently retired incumbent! However, he was successful in 1854 when the post again fell vacant. At the time there were some 25 spinning mills in Belfast with over 11,000 operatives, and in a landmark study read before the Statistical Section of the British Association for the Advancement of Science, in Glasgow in 1855, he drew attention to the health hazards faced by the operatives including “pulmonary affections” mainly in the dust-laden carding and hackling processes, which would later be shown to be the equivalent of “Lancashire” cotton byssinosis. This study for thoroughness, technique and importance of sequelae prompted Malcolm’s biographer to write “If Malcolm had left behind nothing more than this paper, it would be sufficient to single him out as a devoted and potent social reformer” (Calwell, 1977, p.51).
The “working man” and the promotion of health.
Malcolm knew well that improving the general health of the working man (and woman) was not simply to be achieved through protection from exposure to health hazards and sanitary and other environmental improvements, but by what Malcolm was to call “mental cultivation generally….and otherwise advance their character and condition”, and this he hoped to achieve in cooperation with enlightened philanthropists and employers through the creation in 1846 of The Belfast Working Classes Association for the Promotion of General Improvement, with its mouthpiece The Belfast People’s Magazine, which he founded and edited, following less than a year later. Optimism was the Association’s mainspring, justifiably so in its early progress, and ‘improvement’ (including self-improvement) its objective to be ensured by the preponderance of its management committee being themselves ‘working men’. A Peoples News-Room was opened on 22 June 1846 which was soon to have nearly 100 newspapers and periodicals, and by end-1848 it had 2,405 subscribers paying one or two shillings per quarter, 13,000 visitors paying one penny per visit, and open daily from 8.00 a.m. until 10.00 p.m., and with two branch news-rooms in Belfast, and even a Peoples Circulatory Library (from July 1847) boasting over 700 books which had increased to some 3,000 eight years later. Public lectures were given covering a wide range of topics of practical as well as cultural and scientific interest, Malcolm giving one of the lectures entitled “Food – its varieties and uses”. The organ of the Association, The Belfast People’s Magazine, which Malcolm edited, was non-political and non-sectarian and included some poetry and reviews to dilute its main concentration on the themes of improvement of living standards and in the working and recreational environments, with frequent contributions from Malcolm on, amongst other topics, these very issues (he was to be foundation secretary of the Belfast Sanitary Committee from 1848) and drawing attention to the appalling and unrelieved living conditions of the urban poor. These led to his involvement (in 1845) with the newly-formed The Society for the Amelioration of the Condition of the Working Classes whose objectives were Malcolm’s own, with Malcolm its stipendiary secretary with £50 p.a. and with the supply of public baths and wash-houses heading the agenda. The tortuous and salutary but instructive tale of the baths and wash-houses and Malcolm’s reluctant resignation from the secretaryship are detailed by Calwell (1977, chapter 12). Malcolm continued to be involved as a committee member but was now also a council member of the Belfast Social Inquiry Society, while in his profession he had to face the medico-social problems of the famine and its accompanying epidemics of “fever” and, in 1849, a second epidemic of cholera which lasted for 50 weeks with nearly 3,000 deaths and which stimulated even further reports from Malcolm including a paper read before the British Association for the Advancement of Science meeting in Belfast in 1852 berating the town Council (again!) for failing to deal adequately with the sanitary conditions of the town..
The Belfast Clinical and Pathological Society
Malcolm was interested also in improving the resources and amenities of the Belfast Medical Society, the only local professional medical body. Founded in 1806 but due to internal discord dissolved in 1814, then reconstituted in 1822, by the eighteen-forties it had again become subject to declining interest. Malcolm joined in 1842 and at once tried to inject some new thinking and new life, and became one (of two) Vice-Presidents in 1851. In 1853 he thought a new, more flexible Society would be desirable and was prominent in forming The Belfast Clinical and Pathological Society, which he considered would have wider appeal to both town and country members and be altogether more virile and up-to-date. At the start of its first year it had 49 members; at the end of it there were 96, and Malcolm became its President for 1855-6 He broadened the base of honorary members to include some Dublin notables including William Stokes; formed ‘”microscopical”, “chemical” and “museum” committees; attracted the interest of country doctors by sending lithographed abstracts of the week’s Proceedings; kept a general ‘Note-Book’ of unusual cases for members to consult; held weekly meetings on Saturday afternoons which were well-attended; and in every way was more active and up-to-date than its rival Society. In 1863 the two Societies amalgamated as the Ulster Medical Society, as it remains to this day. There is no doubt that Malcolm with his infectious enthusiasm, high intelligence, standing in the profession, inherent energy and sheer commitment, was the driving force.
Malcolm the historian
Malcolm shows a clear awareness of and interest in the historical dimension in the subjects of his writings and it is no surprise that he decided to write a history of the Belfast General Hospital and other medical institutions in Belfast, especially the General Hospital’s fore-runners: the puzzle is, where did he find the time? His decision was made in February 1851 when he hoped that funds raised from the Victoria fête in 1850, which celebrated the Queen’s visit in 1849, would be available. It was not to be; the fête committee in July pleaded lack of funds for the enterprise, and Malcolm and “a few of the Hospital’s warm friends” accepted the financial risks and the book was published in August being presumably already in final draft. As regards the structure of the book itself, after short introductory chapters on germane developments in Belfast “incorporating a chronological record of interesting events as illustrative of the progress and growing prosperity of Belfast from the earliest times”, it covers the period from 1792 (“Origin of the Belfast Dispensary”) to December 1850. The style is clinical; facts predominate; prominent individuals as well as events are mentioned; opinions on past colleagues are given (invariably favourable; if presumably unfavourable no comment is made!); chronology is strictly preserved; and 32 pages of useful Appendices cover comprehensively all hospital activities with headings such as Regulation and Duties for Nurses, Table of Bequests, Subscriptions and Proceeds of Charity Sermons, various statistical tables, to List of Medical Attendants (past and present). The whole is a mine of factual information of value to the local historian of Belfast but essential to the medical one.
After publication of his book Malcolm’s pace never slowed: indeed, two of his most important publications (‘The sanitary state of Belfast, etc’: Paper read to the British Association meeting in Belfast in 1852; and ‘The influence of factory life on the health of the operative as founded upon the medical statistics of this class in Belfast; Journal of the Statistical Society of London, vol.19, pp.170 et seq, 1856 (as well as the draft of his teaching textbook Introduction to Clinical Study, etc (1856), which was published posthumously) date from his later years. Despite his comparative youth he was honoured by his home profession when, aged only 33, he was invited to give the Winter Oration at the Belfast General Hospital in 1852, and also by colleague organisations in Ireland and England with honorary membership of the County and City of Cork Medical and Surgical Society and election as a corresponding member of the Manchester Medico-Ethical Society, both in 1855. He married in 1854 in First Belfast (Non-Subscribing) Presbyterian Church, Maria Glenny Home, only daughter of Captain William Home of the 86th Regiment who was a descendent of John Knox, although like the Malcolms the Glenny family were Non-Subscribing (or “New Light”) Presbyterians. Malcolm’s wife shared his philanthropic spirit in that she was the virtual founder, in 1853, of the Domestic Mission to the Poor in Belfast which survived for a century and which conducted a free school which taught inter alia needlework for girls and provided industrial training for boys. Their only child, Andrew George, was born in Dublin on 31 August 1856 when his parents were staying in its suburb of Rathmines. Malcolm himself was seemingly in failing health and died there on 19 September of heart failure. Andrew George died of meningitis when five months old; Maria survived until 1906. Malcolm’s funeral was on 22 September from his house in Belfast (81 York Street) and was traditional and formal, was well-attended by medical colleagues and many from philanthropic bodies and working men’s organisations. Many wore crepe as was then a fashionable mark of respect. He was buried in the churchyard of the Non-Subscribing Presbyterian Church in Dunmurry where his remains were later joined by those of his son and wife. In commemoration a Malcolm Exhibition was created for competitive examination among senior clinical students at the General Hospital, and is still competed for; and a Memorial Tablet was to be raised in the hospital to record his services there, but whether and when this intention was ever realised is a source of mystery.
|Born:||17 December 1818|
|Died:||19 September 1856|
Calwell, HG: Andrew Malcolm of Belfast, 1818-1856: Physician and Historian (Belfast: Brough, Cox & Dunn, 1977); Malcolm, AG: History of The General Hospital, Belfast and the other Medical Institutions of the Town, etc. (Belfast, W & G Agnew, 1851); Dictionary of Irish Biography, 2009: vol. 6, pp.316-318; Clarke, RSJ: A Directory of Ulster Doctors (who qualified before 1901) (Belfast: Ulster Historical Foundation, 2013, vol, II, p.762); Logan, JS, ‘The working man of the profession’, Ulster Medical Journal, 43, 22-32 (1974).
Bibliographical note: Malcolm’s book of 1851 is now rare and largely confined to specialist collections. Calwell’s book of 1977 (referenced above) is bound with a facsimile of it, and they are published together and with appropriate acknowledgements and an accompanying “Index and Explanatory Notes to the Facsimile” prepared by the author of the Memoir (H.G.Calwell). Calwell’s book and Logan’s article (referenced above) both contain a complete list of Malcolm’s professional publications.
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