Scottish Philanthropy Snippet – Andrew Duncan, Sr

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Friday 2 July 2021

Andrew Duncan, Sr (1744-1828)

Persevering with a 40 year fundraising campaign

Born in Pinkerton, Fife, in 1744 and a graduate of the University of St Andrews (MA 1762; MD 1769), Andrew Duncan, Sr was Professor of Institutes of Medicine at the University of Edinburgh and served numerous terms as President of the Royal College of Physicians of Edinburgh. He played an instrumental role in providing public medical services to the poor, founding both Edinburgh’s Dispensary for the Sick Poor and the Edinburgh Lunatic Asylum, for which he received the Freedom of Edinburgh in 1808.

In 1776 Duncan set out to establish a Public Dispensary that would meet two aims: (1) provide free medical treatment for the poor, and (2) allow him to meet his teaching requirements once the Royal College of Surgeons no longer allowed its use for seeing patients. After initially treating patients in rented rooms and within the College of Physicians, the Dispensary needed to expand to meet the growing number of patients (between 1776 and 1779, the Dispensary saw 733 patients).

Having raised sufficient funds through contributions from the public and churches, the Dispensary opened in 1785 on Richmond Street. Costs were kept low with volunteer medical staff and student labour, the latter of whom attended Duncan’s lectures and were required to pay half a guinea towards the costs of medicines supplied by the Dispensary. Even Duncan’s academic work drew on the clinical conditions he saw at the Dispensary, which he published in Medical Cases for the benefit of his colleagues, pupils and the public.

The Annual Report (1777) of the Public Dispensary provides insight into its activities, purpose and what it deemed as acceptable patients: ‘Advice and medicines are there given gratis to such people in indigent circumstances, as are deemed proper patients. Those patients, who come recommended by subscribers, are admitted to the benefits of this charity in preference to all others.’ (1) 

Bust of Andrew Duncan, Sr by Lawrence MacDonald in the Royal College of Physicians of Edinburgh
Source: https://www.rcpe.ac.uk/heritage/art/duncan-andrew-1744-1828

Noteworthy is that Duncan viewed the Edinburgh New Town Dispensary (13 North James Street), established in 1815, as a rival to his Royal Public Dispensary (per a Royal charter of 1818), given the competition for charitable funds from the same local churches. The New Town Dispensary, unlike the Royal Public Dispensary, was open every day of the week except Sundays, visited patients in their home and campaigned for child vaccinations, likely stopping the spread of smallpox in the neighbourhood. Rather than merge together, however, the two dispensaries continued to function as separate entities although they became quite similar in terms of their activities. 

By the time of Duncan’s death in 1828, the Dispensary had seen an average of 320 patients per month. The establishment of the NHS in 1948 rendered dispensaries obsolete and the Royal Public Dispensary became the University of Edinburgh’s General Practice Teaching Unit. By 1963, the Trustees of the Dispensary donated its remaining assets to the University of Edinburgh.

Duncan is also credited with founding the Edinburgh Lunatic Asylum which admitted its first patient in 1813. The story of its founding is one of a 40-year fundraising campaign driven by Duncan’s perseverance, having witnessed the demise of his former patient, the poet Robert Fergusson. Reflecting on Fergusson’s death after a mere two months in the Edinburgh Bedlam, Duncan wrote in 1818 – some 44 years later, ‘…His case, however, afforded me an opportunity of witnessing the deplorable situation of Pauper Lunatics even in the opulent, flourishing, and charitable Metropolis of Scotland.’ (2)

The Royal Edinburgh Hospital – then and now. Image credits: https://www.rcpe.ac.uk/sites/default/files/royal_lunatic_asylum_wellcome_0.jpg and https://org.nhslothian.scot/CapitalDevelopments/CurrentProjects/REHCampus/Slider/REH%20slider%202.png

A slow start to raising funds for the asylum meant that 14 years after its initiation in 1792, a paltry sum of £223 was raised from 21 subscribers, including The Royal College of Physicians and Duncan himself. After obtaining a grant from the Government of £2000 forfeited from the Jacobite estates after the rebellion, Duncan bought the site in Morningside. The Royal charter of 1807, granted by George III who himself suffered from mental illness, established a charitable institution for the maintenance and cure of lunatics in Edinburgh. Originally, the hospital proposal was for “the reception of Insane Patients from among the rich as well as the poor”, yet in the Address of 1807, free admission for the poor was no longer stated as the intent. A revised account of the admission plans set out that poor patients and the criminally insane were to be admitted at a rate of 7/- per week, supported by parishes or charitable funds. Duncan is the likely author of a series of anonymous pamphlets regarding the hospital in three volumes which featured as fundraising appeals between 1807-1812. 

This provision of care for the wealthy, rather than the poor, contravened the asylum’s charitable purpose. Eventually the surplus funds from fee-paying patients led to a new building of the Royal Edinburgh Lunatic Asylum, partly funded by Queen Victoria, opening in 1842 to accommodate 350 poor patients and thus finally realizing Duncan’s original intent. An additional £15000 was raised to cover part of the costs for this new building, including funds from members of the Duncan family. The largest single benefactor to the Asylum long after Duncan’s death was his granddaughter Elizabeth Bevan. In 1886 she left a legacy of £13,000 for patients of the educated class and the Bevan house, one of the Craighouse villas, is named in her memory.

Duncan’s philanthropic activities were deeply wedded to his medical profession, but went beyond into areas of horticulture as well, as seen in his founding of the Caledonian Horticultural Society for the ‘encouragement and improvement of the best fruit, the most choice flowers and most useful culinary vegetables’ and his efforts to create a public experimental garden‘ (3). 

Artefacts of his philanthropy include the Andrew Duncan Clinic, an acute emergency admission unit which was opened by Queen Elizabeth in 1965. His contribution to the founding of the hospital is also commemorated in a plaque on the wall of McKinnon House. Finally, on a more macabre note, plaster casts from the heads of patients of the Lunatic Asylum, collected for the study of phrenology, are housed by the Scottish National Portrait Gallery. 

Overall, Andrew Duncan Sr’s philanthropic endeavours point to the challenges of raising funds for less popular causes, especially where there is competition for the same pool of funding. Perhaps more importantly, however, his story highlights the issue of preferential treatment of certain beneficiary groups (i.e. patients recommended by subscribers), as well as the need for wealthier fee-paying users and voluntary labour to subsidise costs and eventually allow him to realise his philanthropic vision. 

References

(1) Kaufman, M.H. (2010) Edinburgh’s Royal Public Dispensary. In: Chalmers, J (ed). Andrew Duncan Senior. Physician of the Enlightenment. NMSE – Publishing Ltd, pp. 56-71.

(2) Chalmers, J. (2010). The Edinburgh Lunatic Asylum. In: Chalmers, J (ed). Andrew Duncan Senior. Physician of the Enlightenment. NMSE – Publishing Ltd, pp. 72-89.

(3) https://thecaley.org.uk/history/ 

Featured image: Gordon, John Watson; Andrew Duncan (1744-1828); University of Edinburgh; http://www.artuk.org/artworks/andrew-duncan-17441828-94133

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