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Milne I, Chalmers I. Hamilton's report of a controlled trial of bloodletting, 1816

Commentary on: Hamilton AL (1816). Dissertatio Medica Inauguralis De Synocho Castrensi (Inaugural medical dissertation on camp fever). Edinburgh: J Ballantyne, 1816

Cite as: Milne I, Chalmers I (2002). Hamilton's report of a controlled trial of bloodletting, 1816. The James Lind Library (www.jameslindlibrary.org). Accessed
© Iain Milne, 2002.

Author contact details: Iain Milne, Librarian, Royal College of Physicians, 9 Queen Street, Edinburgh EH3 1JQ, UK. E-mail: i.milne@rcpe.ac.uk

In 1816, a military surgeon with an Edinburgh background - Alexander Lesassier Hamilton - used his Edinburgh University MD thesis on fever to describe an experiment that used rotation to assess the effects of bloodletting. Lessasier Hamilton had Edinburgh dynastic connections. Alexander was the son of Pierre Lessasier (a French doctor) and Christina Hamilton (eldest daughter of the Edinburgh University Midwifery Professor, Alexander Hamilton). Lessasier Hamilton's uncle was Alexander Hamilton's son (and successor as Edinburgh University Midwifery Professor), James Hamilton, who was President of the Royal College of Physicians of Edinburgh between 1792 and 1794.

The experiment that Alexander Lesassier Hamilton reports in his MD thesis (Hamilton 1816; unpublished (a)) took place in 1809, in Portugal, during the Peninsular War, at the hospital at Elvas, and it involved 366 sick soldiers. In the experiment Lessasier Hamilton and two other army surgeons used rotation to generate comparable groups. The crucial paragraph (which can be found at the end of the thesis) reads:

"It had been so arranged, that this number was admitted, alternately, in such a manner that each of us had one third of the whole. The sick were indiscriminately received, and were attended as nearly as possible with the same care and accommodated with the same comforts. One third of the whole were soldiers of the 61st Regiment, the remainder of my own (the 42nd) Regiment. Neither Mr Anderson nor I ever once employed the lancet. He lost two, I four cases; whilst out of the other third [treated with bloodletting by the third surgeon] thirty five patients died."

How is it that this evidence has only recently come to light? Sometime in the 1830s, in a hiatus between two court actions, an Edinburgh solicitor, John Gibson, lodged a trunk containing Lesassier Hamilton's difficult-to-decipher diary and papers in the College (Hamilton unpublished (b)). There the trunk remained, undisturbed, but stored safely and listed in the Manuscript Catalogue until 1987, when the then College Archivist, Joy Pitman, catalogued it in detail and wrote about it in the College Journal (Pitman 1987). Ms Pitman uncovered a fascinating story that was so intriguing that an American historian, Lisa Rosner, has written a book based on the papers (Rosner 1999).

Among the manuscripts are papers about Lesassier Hamilton's Edinburgh medical studies, Army Medical Department service in the Peninsular War, graduation from Edinburgh, midwifery practice, and his writing as a novelist! But that is not all there is in the archive. The court action was a divorce and it is easy to see why the solicitor representing Lesassier Hamilton's wife wanted to use the material: the papers contain an extraordinary record of his numerous extra-marital adventures. And as his numerous female partners, creditors and professional colleagues discovered, Dr Lesassier Hamilton was not always entirely reliable. Lesassier Hamilton's comprehensive diaries do not include any mention of a bloodletting trial in Elvas.

Did the trial take place? The evidence of Lesassier Hamilton's MD thesis must be weighed against the evidence of Lesassier Hamilton's diaries. Corroborative evidence also can be considered ­ there is evidence that Lesassier Hamilton's colleague, Mr Anderson, was at Elvas in 1809 (Anderson 1976), but against that is the fact that pamphlets recommending bloodletting were still being written by serving officers in 1813. Then again, the diaries show that Hamilton liked record keeping and that his work was appreciated by the director of medical services during the Peninsular War - the administrative reformer James McGrigor. Even if the account of the bloodletting trial was fabricated, however, it is still remarkable that Hamilton chose to describe the experiment in the terms that he did, particularly if he judged that his description of alternation and standard conditions would impress his examiners and other readers.

References:

Hamilton AL (1816). Dissertatio Medica Inauguralis De Synocho Castrensi. Edinburgh: J Ballantyne.

Hamilton AL (unpublished (a)). Dissertatio Medica Inauguralis De Synocho Castrensi manuscript translation. Royal College of Physicians of Edinburgh. Alexander Hamilton Collection [11/70]

Hamilton A (unpublished (b). Manuscript journals. Royal College of Physicians of Edinburgh. Alexander Hamilton Collection [11/72]

Pitman J (1987). Alexander (Lessasier) Hamilton: an eventful life. Proceedings of the Royal College of Physicians of Edinburgh 17:286-290.

Rosner L (1999). The most beautiful man in existence: the scandalous life of Alexander Lesassier. Philadelphia: University of Pennsylvania Press.

Anderson A (1976). My dear Cath …the story of an army doctor's wife. Peebles.

Milne I, Chalmers I (2001). Tackling bias in assessing the effects of health care interventions: early contributions from James Lind, Alexander Lesassier Hamilton and T. Graham Balfour. Proc Roy Soc Coll Phys Edin 31 Suppl 9:46-48.

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