Andrew George Malcolm 1818–1856
The Working Man of the Profession
From a paper by John S Logan published in the Ulster Medical Journal 1974 vol 43 p22.
Andrew George Malcolm was born in 1818, 3 years after Waterloo, 2 years after Laennec invented the stethoscope, the fourth son of Andrew George Malcolm, the minister first of Dunmurry and then of Newry. The father died when the boy was five. His mother was Eleanor Hunter of Dunmurry. His grandfather James Malcolm, the minister of Drumbo. At the end of his schooling at Inst he had been assistant to Henry Montgomery, the famous headmaster of the English department and his father's successor at Dunmurry (Crozier 1875). There at the medical school at Inst he began his medical studies (that was long before the foundation of the Queen's College) and in 1842 at the age of 24 graduated at Edinburgh. His thesis was on the pathology of continued fever and he received one of the three gold medals of the year. No copy of his thesis is known but the next year (1843) he published what may be the substance of his thesis, his work on the Proportion of Carbonic Acid formed during Respiration in Typhus. The work had been done in the fever wards of the hospital when we were in Frederick Street. That, together with a paper on carbon dioxide formation in phthisis published in 1854, makes him our earliest respiratory physiologist. In that year, 1843, he was appointed medical attendant to the Dispensary, to attend the sick at the Dispensary rooms and in their own homes—much as young physicians now are appointed to outpatients. In 1846 he was appointed to the hospital as physician (at the age of 28), and then began that remarkable period on the staff, brief and brilliant. It was to last 10 years, and end at his death at 38.
From 1846 then he was in regular attendance on the sick in the old hospital in Frederick Street. He lived nearby in York Street as medical men did in those times. In 1848 he helped to found, and the Hospital Report for 1850 says that he himself conducted, an outpatient or extern department. No doubt it was a development of his work at the Dispensary. Doctor Allison has pointed out the importance of that department for surgical treatment and medical advice. It continues to this day, now in the new outpatient centre on the Falls Road, and many physicians feel their best and most fruitful work is done in outpatients. Malcolm was a powerful and assiduous teacher. Besides his general medicine, we know he had a class in skin diseases. His views on the duties of a teaching hospital and teaching physicians and surgeons are set out in his paper of 1851 – He had a high sense of a teacher's duty and equally of the student's duty. He says in his History, as Doctor Allison has reminded us, "Clinical instruction is not to be imparted by a careless walk through the wards." "On the part of the teacher, the most patient, assiduous, vigilant, zealous and unceasing labour, and on the part of the pupil, the most rigid attendance, are absolutely necessary to develop the educational resources of a Hospital." I am satisfied that 122 years later we have not yet developed the educational resources of the hospital. He was engaged, it seems almost daily, in morbid anatomy in the postmortem room; when not with autopsies, then with surgical specimens sent in by the practitioners of the town and also by those of Antrim and Down. Those were the days when surgery was done at home. He was a main contributor of specimens to the pathological museums of the Belfast Medical Society and the Belfast Clinical and Pathological Society. Wet specimens were inconvenient in those days, and he made many plaster and wax casts and contributed many photographs and daguerreotypes. He was an enthusiast for the microscopical examination of tissues and pathological fluids, highly imperfect as it then was. There survive to us two drawings which Malcolm made of his microscopy of the rice-water stools of Asiatic cholera in Belfast. At this time, remember, (1853) Pasteur was still a chemist. Bacteriology had yet to be born. Thirty years were to elapse before Robert Koch went to Alexandria and was the first to see the cholera vibrio. No doubt with a better microscope and with a mind better prepared. At this time began a flow of Malcolm's reports to the journals of the day, mainly on clinical and pathological correlations. It is clear that Malcolm saw the importance of these correlations. He says, "If our profession is to advance much as a practical study, it can only be by elaborate, but ordinary, intelligent observation at the bedside, going hand in hand with the results of a pure scientific research."
Then we have his important reports on the Sanitary State of Belfast. To make you understand this achievement, I would have to take time to picture to you early and mid-19th century Belfast, the town overcrowded far beyond its resources, deficient in water, dirty, fouled with excreta, lousy, and racked with fever. The reports were the result of several years of study of the housing, the water-courses, the sewers and drains of Belfast, the water supply, and the statistics or estimates of disease and mortality, some of which he had to compile for himself. Malcolm knew that engineering alone would not be enough. "To obtain the highest triumphs of the sanitary cause is the result of combined prudence, forethought, knowledge and zeal, gradually developed and matured in an entire people." Then the well-known statistical paper on the Influence of Factory Life on the Health of the Operatives, showing the harmful effect of flax dust on the lungs of the workers, and pleading for improvements in factory hygiene. There are two other major reports, among numerous lesser papers, one on the Asiatic cholera in Belfast (there were only 84 cases and Malcolm regretted the paucity of numbers) and one on the epidemic dysentery in the North of Ireland. "Statistical medicine", said Malcolm, "appears to be calculated to unfold much as yet hidden regarding the aetiology and treatment of disease."
Outside the hospital he became a member of council of the Belfast Social Enquiry Society, and it was mainly by his efforts that the Society for the Amelioration of the Working Classes was founded in 1845 – Secretary of that Society and President of the Belfast Working Class Association, he worked successfully for the establishment of public baths and wash-houses, of incalculable value in days when there could be no washing at home. The lady who was to be his wife, not behind him in welldoing, was the founder of the Belfast Domestic Mission to the Poor. Malcolm was the founder and soul of the Belfast Clinical and Pathological Society, which, while it lasted, was more successful and active than any Belfast medical society before or since. Its transactions are a model publication, and it circulated a weekly medical news sheet to its members, besides undertaking to report on the members' specimens. He had no paid public appointment, and no private fortune.
More than all, Malcolm was the hospital's first historian. In 1851 he published his History of the General Hospital at Belfast, invaluable as a history, but also for showing us his affectionate heart, as he writes of his town, his hospital, his colleagues and his patients. He died of rheumatic valvular heart disease after a short terminal illness in 1856, at the age of 38. His brother Isaac had died at 16 of acute rheumatism. As he left the hospital for the last time a few weeks before his death, he might have used the words of that ancient servant of God, Andrew Stewart of Donegore, "I take timber and stones to witness that in my short time I have laboured to be faithful". Indeed if it be the duty of all of us to seek the truth and to communicate it, he might have gone on to say, with the dying Stewart, "according to my light, I have revealed the whole counsel of God to the people." Malcolm had married at 36, only 2 years before his death. His wife was Maria Glenny Home, a descendant of William Knox, brother of John Knox, the Reformer. Their only child, a son, died a few months after his father. They are buried in Dunmurry in the green of the ancient meeting house where his father was minister. Fifty years later his widow was buried in the place where her son and husband lay.
How did Malcolm come to be so successful? The answer lies partly in his ancestry, partly in the ethos of the community into which he was born, and partly in the spirit of the times. His father, also Andrew George Malcolm, was the distinguished minister, first of Dunmurry, and later of Newry, where he died of typhus attending his people during an epidemic. His mother was Eleanor Hunter of Dunmurry. The Hunters had originally come from the Roe Valley where they were millers. The Malcolms came from Scotland in the seventeenth century and settled in North Down. There they flourished as small landholders through the 17th and 18th centuries, never dull if never distinguished, though the family liked to recall that a Malcolm had served with Nelson at Trafalgar. We first find distinction when we come to our Andrew George's father. Romantic and historic strains came into the Malcolm family with the father's mother. She was Fanny Kennedy of Mourne. Her great-grandfather, the Reverend Gilbert Kennedy, was a son of Colonel Gilbert Kennedy of the Ayrshire clan of Kennedys. Accounts differ as to whether he was of the Kennedys of Cassillis or the Kennedys of Ardmillan. The point is not settled but there is perhaps more evidence that Colonel Gilbert Kennedy was a brother of the 6th earl of Cassillis. He had fought with Cromwell against the King at Marston Moor, and had fought at Kilsyth for the Covenant against Montrose. Gilbert Kennedy had been minister of Girvan in Ayrshire and, being persecuted and deprived on the restoration of Charles II, he came to County Down, where he was minister of Dundonald. The line in Ulster descended to our Andrew George Malcolm, gathering, in fortunate marriages, strength of intellect and character (but not wealth). Eventually the Kennedy, the Laing, the Malcolm and Hunter strains blossomed in two remarkable men—Andrew George the father, the minister, and Andrew George the son, our physician. There is an interesting family connection to remember. Catherine, a daughter of the Gilbert Kennedy from Ayr who settled in Dundonald, sister of the younger Gilbert, married William Tennent, left County Down and went with him to America. This William Tennent was the historic minister and teacher who founded the famous Log College at the Forks of the Neshaminy in Bucks County, north of Philadelphia, on the road to New York. This Log College was the seed of the College of New Jersey, now the great University of Princeton. It was said of William Tennent's sons and students that they were to be found preaching from Massachusetts to the Carolinas, now to a sophisticated congregation in Boston or New York, now bringing their message to a handful of settlers on the upper Susquehanna, or else to homesteads under the shadow of the Alleghenies in the valley of Virginia. The story of Catherine Kennedy's sons, the four Tennent brothers, belongs to American history. The story of her brother Gilbert's children belongs to ours.
As to the community that Andrew George was born into, the flowing tide of European rationalism had had its full effect on eighteenth century Ulster. His people had spent that century, and were to spend the nineteenth, in the great debate between the rationalists and those who clung to the older thought, in religion, in politics, in sociology and biology. By the early nineteenth century a parting of the ways had come. The Malcolms belonged to that section which was won over to rationalism. Nevertheless, in their Ulster way, they realised that the exposure of error, rationalism's chief success, is not enough. It is, after all, loving-kindness, love and not logic, that makes the world go round. Malcolm's community therefore, rational, radical, utilitarian as they might be, preserved the ancient pieties, the ancient ethos, and a due regard for the ancient learning. I say that born as he was into this intellectual climate, free but self-disciplined, dutiful to the past, but looking to the future, young Malcolm's heredity gave him the large heart, the large mind and the early intellectual take-off, which enabled him to do so much in his short life.
As to the spirit of the times, listen to Doctor Wales speaking of practice in Belfast. "About this time men began to rouse themselves out of the old grooves of thought. Physiological, pathological and chemical research took on more activity—a spirit of enquiry and criticism spread abroad, leading not only to a disposition to break new ground, but also to test afresh the foundations of received opinion and established practices. Among the foremost to catch the spirit of the times was the late Doctor Malcolm. Like a little leaven, he leavened the whole mass with the spirit which animated himself."
Let us hear further what his contemporaries said of him. At the opening of the session in the theatre of the General Hospital in 1856, shortly after Malcolm's death, Professor Ferguson gave the address. They met then as we meet to-day, to open the session. And we have a record of his remarks. He said they should have been addressed that day by Doctor Malcolm. Medicine had lost a most zealous and indefatigable and talented cultivator. This school one of its most admired and popular teachers. The student his kind companion, and his bright example. His colleagues a friend and fellow labourer. The sick a tender physician. Society an honest man. The amount of success in his professional career that the late Dr. Malcolm had achieved sprang not from patronage, nor from fortunate accidents. To his own talents, to his active philanthropy, to the weight of his moral character, and to the resistless force of industry, was he indebted for his position. Truth might perhaps oblige us to confess that unhappily these qualifications are not the most invariable, the most certain or the most unequivocal avenues to success in medical practice. Nevertheless Doctor Malcolm spent his time and exercised his energies in the acquisition of knowledge, rather than in a hunt after practice, and, said Ferguson, "I think he may be put before you, my young friends, as a good specimen of the working man of our profession well worthy of your imitation."
Published Work of Andrew George Malcolm, M.D.
1842 – On the pathology of continued fever. M.D. thesis. University of Edinburgh. There is no copy in the library of the University of Edinburgh.
1843 – Some experiments on the Proportion of Carbonic Acid formed during respiration in typhus. London and Edinburgh Monthly Journal of Medical Science, 3, 1.
1846 – Belfast Society for the Amelioration of the Working Classes. Circular number 1. Prospectus of the Belfast Public Baths and Washhouses. 1st July. Attributed to Malcolm.
1846 – Perforation of the Stomach. Medical Times, 13, 51.
1848 – Belfast People's Magazine. Volume 1. Number 1. Editing and much of the contents attributed to Malcolm.
1848 – Report of the Belfast Sanitary Committee (a committee of the inhabitants) on the Sanitary State of Belfast. Read, adopted and ordered to be printed at the town meeting held on the 2nd March, 1848. Belfast. Printed by J. Henderson.
1849 – A brief practical view of the Asiatic cholera. London. Whitfeld. [An appendix to a sermon, the Fast and the Cholera, by his brother, the Reverend James Malcolm, at that time Minister of Boston, Lincolnshire.]
1849 – A review of the symptoms, pathology and treatment of the Asiatic cholera. Dublin Medical Press, 21, 129.
1849 – Case of apoplexy. Dublin Medical Press, 21, 386.
1849 – Case of phthisis pulmonalis and extensive scrofulous disease. Dublin Medical Press, 21, 387.
1849 – Case of Bright's disease. Dublin Medical Press, 21, 387.
1849 – The Asiatic cholera. Dublin Medical Press, 22, 225.
1851 – Belfast General Hospital Annual Report, 1850-51. Medical Report.
1851 – The History of the General Hospital Belfast, and the other Medical Institutions of the town. Belfast. W. and G. Agnew.
1851 – Method of clinical study. Clinical observation in the wards of the Belfast General Hospital. Dublin Medical Press, 25, 321.
1851 – Report on the Pathological Museum of the Belfast Medical Society. Dublin Quarterly Journal of Medical Science, 11, 207.
1851 – Report on the Pathological Museum of the Belfast Medical Society. Dublin Quarterly Journal of Medical Science, 11, 47.
1851 – On Difficulties in Diagnosis with illustrative cases. Dublin Quarterly Journal of Medical Science, 12, 30.
1851 – Report on the Pathological Museum of the Belfast Medical Society. Dublin Quarterly Journal of Medical Science, 12, 47.
1852 – Report on the Pathological Museum of the Belfast Medical Society. Dublin Quarterly Journal of Medical Science, 13, 472.
1852 – The Sanitary State of Belfast with suggestions for its improvement. A Paper read before the Statistical Section of the British Association at Belfast [Pamphlet, pp. 31, with seven Maps and Plans]. Published for the Belfast Social Enquiry Society (No. 4) by Henry Greer, High Street. Printed at the Banner of Ulster Office.
1853 – On Difficulties in Diagnosis with illustrative cases. Dublin Quarterly Journal of Medical Science, 15, 77.
1853 – Report on the Epidemic Dysentery prevalent in the North of Ireland in 1852; based on returns collected under the direction of a Committee of Medical Practitioners of Belfast, and drawn up by A. G. Malcolm, M.D., Physician to the General Hospital, Belfast. Dublin Quarterly Journal of Medical Science, 16, 81.
1854 – Some experiments on the proportion of carbonic acid exhaled in phthisis pulmonalis. Dublin Quarterly Journal of Medical Science, 18, 320.
1854 – Belfast General Hospital Annual Report, 1853-54. Medical Report.
1855 – Report of the first meeting of the Belfast Clinical and Pathological Society with an abstract of an address by Doctor Malcolm. Dublin Medical Press, 34, 317.
1856 – The Influence of Factory Life on the Health of the Operative, as founded upon the Medical Statistics of this Class at Belfast. Journal of the Statistical Society of London, 19, 170.
1856 – Address delivered on the Termination of the Third Session of the Belfast Clinical and Pathological Society. Belfast. Printed at the Belfast Daily Mercury Office.
1856 – Introduction to Clinical Study, or an Interpretation of symptoms and signs. A Manual applied to the use of the hospital student. Belfast. Greer. [The Preface, written by his friends J C Ferguson and J M Pirrie, says: "The following pages had well-nigh passed through the press, when the unexpected and lamented death of their author occurred." It was suggested that this was the first of four parts.]
Numerous clinical and pathological reports in the Transactions of the Belfast Clinical and Pathological Society. There are 18 in the Transactions for 1853-54.
Mems of Public Matters
There is in the Public Record Office of Northern Ireland, a small crudely-bound booklet containing photocopies of a document bearing the above title written by Malcolm likely within a month or so of his death. It records his achievements from 1842 to 1856 – The contents have been transcribed and are available in PDF format.