The complicated legacy of a true medical pioneer

Louise Wilkie Surgeons’ Hall Museums Curator

In April 2025, we open a one-year exhibition at Surgeons’ Hall Museums, celebrating women in surgery. This will be followed by a long-term display in the main Museum galleries, offering an in-depth look at this remarkable subject. Leading up to these events, we are pleased to share pertinent stories from our past. History often presents us with conundrums, and Robert Christison (1797-1882) is certainly that  – a man whose contribution to medicine was extraordinary in numerous fields, particularly so in toxicology and forensic medicine. However, his legacy is overshadowed by his violent opposition to women practising medicine in the late 19th century. While it is always difficult to place the behaviour of the past in the context of modern morality, it can be argued that Christison went further in his views and actions than what was considered normal by his peers. 

Pioneering figure 

Christison found his foothold in medicine through the field of medical jurisprudence, the forerunner to both forensic medicine and public health. He was appointed to the Chair of Medical Jurisprudence at the University of Edinburgh – at the extraordinarily young age of 25 – in 1822. He thrived in this role and is celebrated by historians for both establishing the role of the medical expert witness in Scottish courts and cementing the subject of jurisprudence in medicine. 

Because of his role as Chair of Medical Jurisprudence and his abilities in court, Christison was appointed crown medical witness, a role he held for more than 30 years. This would see him as a key witness at some of the country’s most famous trials, including William Burke in 1829 and Madeline Smith in 1857. Christison’s reputation as a medical witness was also built upon his integrity. Unlike some of his contemporaries, his contribution was always based entirely on medical investigation and evidence – he never speculated. Despite being key witness for the Crown, he wrote: “On several occasions I put a stop to further procedure, either by eliciting proof of innocence or by showing the inconclusiveness of evidence and the futility of proceeding to trial.”

"Christison’s contribution was always based entirely on medical investigation and evidence – he never speculated" 

While Christison covered all areas of forensic investigation it was his work on poisons that he is most remembered for; his accomplishments in this area are evident in A Treatise on Poisons, published in 1829. Katherine D Watson, a historian of forensic medicine, says Christison’s and others’ work on poisons ensured “the invisible was rendered visible through the medium of science”.

The expert witness 

The trial of Mary Smith in 1827 reveals all Christison’s abilities. Smith was accused of poisoning her farm maid, Margaret Warden, who it transpired was pregnant with Mrs Smith’s grandchild. She was seen giving Margaret a glass of white liquid, followed by Margaret’s illness and death two days later. During her illness Margaret confided in her mother that Mrs Smith had given her something to “cause this”. During a doctor’s visit Mrs Smith informed him Margaret was pregnant and asked if her illness would cause a miscarriage.  

Rumours of poison led to the body being exhumed and examined by three doctors in Dundee, with specimens removed for further chemical analysis by Christison in Edinburgh. In total there were seven chemical tests performed on the remains of the victim, each giving the result of arsenic. Here is what Christison made of these tests and the evidence he gave in court: “Singly they are not decisive of the presence of arsenic; but I must observe that taken conjuctly they form satisfactory evidence. Some of the tests mentioned are not correct tests. Any one of them singly would not afford decisive evidence. They are now less relied on than they once were, and one or two of them are still relied on by some more than they ought to be; but when they agree in their indications they supply perfectly satisfactory evidence… I consider that that the liquid tests alone gave decisive proof of the presence of arsenic; at least I do not know of any other substance in nature which could produce the same effects on them all.” 

Christison is honest to a fault, pointing out the flawed testing conducted by the less forensically aware witnesses. He also expertly explains that, while not all these liquid tests are accurate, together they make compelling evidence that arsenic was present. The defence’s case casted doubt on the medical evidence, claiming the victim died of cholera (as originally diagnosed by the visiting doctor), and therefore questioned the accuracy of the chemical testing. Concluding, the judge claimed “there could be no doubt” the victim died of arsenic poisoning, a clear indication of how medical forensics was beginning to take hold. 

The trial came down to administration of the poison and onset of symptoms. The only beverage given to Margaret by Mrs Smith, which was witnessed, was on Tuesday evening. Christison believed that the fatal dose was later, most likely Wednesday, because of the delayed onset of serious symptoms and death. He refused to agree with his fellow medical witnesses or speculate, but later wrote: “As I was not at the time acquainted with a parallel case… I hesitated to ascribe the symptoms to the draught; and consequently… the proof of administration was considered to have failed. I am not sure that I should have now felt the same difficulty.” 

In this trial the defence team used the defence of suicide, and Mrs Smith was found ‘Not Proven’. Walter Scott’s reaction indicated that this was an unpopular verdict in this case: “She is clearly guilty but as one or two witnesses said the poor wench hinted an intention to poison herself, the jury gave that bastard verdict.” 

Christison moved to the Chair in Materia Medica in 1832, holding that role for 45 years. In addition to his private practice and work as Physician to the Royal Infirmary, he became Physician-in-Ordinary to the Royal Family in Scotland and was twice elected President of the Edinburgh College of Physicians. By 1869, Christison was well established in Edinburgh, particularly the University, where he had been teaching for 47 years. The following years witnessed the biggest battle of Christison’s career; while he would go on to triumph, this would ultimately damage his legacy. 

Women in medicine 

In 1869 seven women led by Sophia Jex-Blake were admitted to study medicine at the University of Edinburgh – the first to do so. In this early stage they had some powerful supporters, including men such as James Young Simpson. They also had the public support of the media. Jex-Blake summarised how powerful and determined Christison was and the part he played in the prevention of women in medicine when she wrote: “The whole opposition to the medical education of women was, in Edinburgh, dictated by one man… whose great age and long tenure of office naturally gave him unusual weight, both in the University and among the medical men of Edinburgh.” What Jex-Blake and future historians agree on is that Christison was the strongest opposition to the ‘Edinburgh Seven’. His standing and position meant that he influenced or sat on every body that had power over the outcome of their education, including the University Court, Senatus, Council, The Royal Medical Society and, importantly, the Royal Infirmary.

Christison’s conduct 

With Young Simpson’s death in 1870, Christison’s influence began to take hold. He refused not only to teach the women in his classes, but to allow anyone else to do so on his behalf – influencing others to act accordingly. At a meeting of the University Court in October 1870 Christison, as Queen’s Physician in Scotland, quoted her majesty’s disapproval of women in medicine. He argued that there was no demand for female medics, even from within the female community. 

"He used his privilege and position to not only roadblock the advancement of women in medicine but to influence and often bully others into following his lead" 

He was heavily slated for both speaking on her majesty’s behalf and for his conduct and language in his fiery speeches. The Times remarked in a leading article: “We cannot sufficiently express the indignation with which we read such language, and we must say that the strongest argument against the admission of young ladies to the Edinburgh medical classes is that they would attend the lectures of Professors capable of talking in this strain.”

Christison’s arguments on “the lack of demand for female medics” seems misplaced, as in 1871 a petition in favour of the Edinburgh Seven was presented, signed by 956 women of Edinburgh. In addition, a General Committee for Securing a Complete Medical Education for Women had been formed with more than 300 members, including significant names such as Charles Darwin.

Surgeons’ Hall riot 

In an atmosphere of increasing hostility towards the Edinburgh Seven, the Surgeons’ Hall Riot took place on 18 November 1870. The women were attacked outside the RCSEd by a crowd of angry students, who did their best to disrupt the women sitting an anatomy exam. One of the ringleaders was Christison’s Class Assistant, Edward Craig. Jex-Blake would later announce his involvement and conduct during the riot. 

While Christison may not have condoned this type of behaviour, he certainly encouraged protest towards the woman and whipped up objection from the student population. Jex-Blake pointed out that while Christison may not have been directly involved in the riot, she highly doubted his assistant would have taken part if he in any way thought his mentor would object: “I do not say that Dr Christison knew of or sanctioned his presence, but I do say that I think he would not have been there had he thought the Doctor would have strongly objected to his presence.” She was sued for libel over her comments, but Craig was only awarded one farthing in damages, a clear indication of the futility of the case. 

Influence and effect 

Perhaps the biggest battle for the education of women was admittance to the Royal Infirmary for crucial clinical experience. Outspoken supporters of women in medicine Dr Watson and Dr Handyside had urged the Board to allow women to be admitted and had obtained promises from three medical officers of the Infirmary to give the women instruction. However, the decision was delayed. In which time, the male student body submitted a petition signed by 500 students, objecting to the seven’s inclusion. Before the vote, a new act was formed, demanding all Royal Infirmary managers vacate their seats unless re-elected. In Jex-Blake’s words: “I can give no more significant proof of the immense amount of pressure brought to bear by the medical clique than by stating that, of the three medical men who had voted for us six weeks before, it was found when the day of election came that two had turned their coats, while the one, Dr John Moir, who refused to do so, was unseated by the medical body that he had represented.” 

"He refused not only to teach the women in his classes, but to allow anyone else to do so on his behalf"

Through outward pressure, a new board of managers was appointed and with support from George W Balfour and Heron Watson (who agreed to teach the women separately on a Sunday), the women were finally granted clinical instruction in January 1873. But this victory was short lived; the Court of Session ruled in July 1873 that the women should never have been admitted to the University and that they were to be denied degrees. 

Many of the seven would find qualifications elsewhere, including Switzerland, and gained access to the Medical Registrar by obtaining a Licentiateship of the College of Physicians of Ireland (the first to offer qualifications to women). Jex-Blake returned to Edinburgh and opened a medical school for women and a hospital run by female medics, indicating Christison was mistaken about demand. 

Complicated legacy

“The next formidable assault on the University was the attempt, first to induce and afterwards to compel it, to undertake the medical education and graduation of women. This, if not so prolonged a contest as the previous ones, was quite as fierce, and was embittered by the fact that a portion of the garrison took part with the enemy” – this is an excerpt from Christison’s autobiography, which was completed by his sons after his death.

Many argue that those in the past cannot be judged by the standards of today. Some would argue that Christison was just one of many male members of the medical community of Edinburgh who was opposed to women in medicine and describe him as a man of his time. However, while there was substantial opposition to women studying medicine from the male medical community, there was also significantly prominent medical men championing the cause of the Edinburgh Seven, as indicated by Christison’s himself – “a portion of the garrison took part with the enemy”. Aside from eminent medical men such as Simpson, Handyside and Watson, one only has to look at the advancements of women in medicine in Europe, America and Ireland to see Christison and his followers were behind the times. 

While Christison’s beliefs were shared by others, his conduct sets him aside and significantly damages his legacy. He used his privilege and position to not only roadblock the advancement of women in medicine but to influence and often bully others into following his lead. His behaviour during this time is at odds with a man known for his fairness and advanced understanding, but perhaps his time as a medical witness had prepared him to win this case. This extract from a speech by the Lord Advocate, at a dinner celebrating Christison’s 50th year of teaching, might give the insight into to his stubborn, precise and sustained attack on the Edinburgh Seven: “He formed his opinions after much and careful deliberation, and, when they were once formed, they were not to be shaken. The consequence was that cross-examination with him was comparatively useless. He had nothing to conceal, and, if it came to a mere conflict of intellects between the professor and the examining counsel, the odds were the professor would have the best of it.”