Hospital Life in Enlightenment Scotland: care and teaching at the Royal Informary of Edinburgh

Cambridge University Press, 1986

This work offers the first complete account of institutional life in an eighteenth-century British hospital. Using a multitude of surviving documents, the author presents an intimate view of the experiences of the sick poor and their physicians at the Royal Infirmary of Edinburgh between 1750 and 1800. The first voluntary institution of its kind founded outside London, the Infirmary is examined within the contemporary context of the Scottish Enlightenment and the tenets of British philanthropy. From its inception, this hospital was a focal point for the convergence of charitable intentions, local civic pride, and the improvement of scientific medicine.

After briefly reviewing the Infirmary’s early developments, building projects, finances, and regulations, the story concentrates on the experiences of patients and staff. Both groups are followed from the admitting room to the various wards, from the teaching section to the operating theatre. Admission routines, history-taking, diagnoses, and treatment are all meticulously reconstructed with the help of registers, minutes of meetings, lecture notes, and nearly 100 individual clinical histories preserved in casebooks. The final chapter is devoted to clinical instruction of medical students and surgical apprentices who were flocking to the Edinburgh University for their training.

Histories of hospitals have traditionally failed to probe the nature, workings and meaning of institutional confinement. Such narratives downplay the fate of patients and their diseases while medical treatments are judged to be harmful. By contrast, Professor Risse delves deeply into the organizational aspects of the Edinburgh Infirmary and effectively demonstrates that through careful patient selection and the assistance of experienced practitioners, this eighteenth-century British hospital played an important role in the study and treatment of the sick poor who secured admission.



1. The Sick Poor and Voluntary Hospitals

“Desirous of accommodations in the house”: the road to hospital admission
The origins of the British hospital movement
The Royal Infirmary of Edinburgh

2. Hospital Staff and the Admission of Patients

Who attends the sick? Infirmary professionals and their helpers
“The patient comes into our hands”: admissions process

3. Patients and their Diseases

Entering diagnoses in the General Register
The spectrum of diseases at the Infirmary, 1770-1800
Length of hospitalization

4. Hospital Care: State of the Medical Art

Principles of eighteenth-century therapeutics
The context of hospital Care
Therapeutic effects of hospitalization
The use of drugs
Physical methods
Effects of treatment
Discharge from the hospital

5. Clinical Instruction

Organization and enrollment
Students and clinical teaching
Clinical teaching and the patients
Instructional objectives
The didactic role of autopsies
The teaching of surgery and midwifery
Edinburgh and Europe contrasted


General considerations
Medical therapeutics
Eighteenth-century hospitals: for better or worse?
The “birth” of the clinic
The final blessing

Selected clinical cases
Clinical teaching
Drug usage at the Infirmary: the example of Dr. Andrew Duncan, Sr.
(by J. Worth Estes)


This scholarly work has been awaited with interest. It does not disappoint. Earlier historians have not neglected the Royal Infirmary of Edinburgh and clinical practice in the eighteenth century, but this book must be the first thorough examination of the hospital. It is clear that new primary sources have been available and that Professor Risse has been the first to turn them over… The book deliberately opens with a human vignette which gives the introduction to the day-to-day life in the hospital and some details of ‘those desirous of entry.’…Risse’s narrative is never dull and occasionally sections can be read again simply to enjoy the author’s ability to capture a mood or use an apt phrase, or find the mot juste.
— David Hamilton, Bulletin of the History of Medicine 60 (1986): 595-96
Hospital Life is a tour de force of primary analysis, but pervading it is a subtle argument that becomes more pronounced as the book progresses: this hospital was indeed a worthwhile and beneficial health-care institution. With this argument, Risse challenges the generalization that the eighteenth-century hospital was a gateway to death or a death trap…While additional studies of other eighteenth-century hospitals will have to be undertaken to buttress Risse’s counterclaim fully, his own contribution must be considered a palpable blow to prevailing thought concerning hospital historiography.
— J. T. H. Connor, Canadian Bulletin of Medical History 5 (1988): 78-79
Histories of specific hospital institutions have far too often been no more than hagiographic accounts of local heroes, lacking appropiriate social and medico-historical contextual analysis. Recently, social historians of medicine have repaired some of these deficiencies, but in their zeal to explore their necessarily slanted hypotheses, they have ignored actual medical practice. Because he not only examines the infirmary as a product and manifestation of its economic, social and cultural environment but also gives details of the interaction of the staff and patients within its walls, Guenter Risse has written a most important book.
— Jacalyn M. Duffin, Journal of the History of Medicine 42 (Jan 1987): 97-99
Risse gives a fascinating and well-written description of the day-to day workings of an eighteenth-century hospital. His most important source, 808 case histories of individual patients, allows detailed consideration of their diseases and treatments…he has done the magnificent collection of records full justice.
— M. A Crowther, American Historical Review 92 (1987): 964