David Skae .sx According to Clouston ( 1911 b ) , Dr William MacKinnon , the first Superintendent of the Royal Edinburgh Asylum , had provided elementary lectures for medical students during his period of office .sx In 1850 , the Royal College of Physicians of Edinburgh passed a motion suggesting that formal instruction in mental disease should be provided at the Morningside asylum .sx The impetus had originated from the East India Company , which required its doctors to have some knowledge of mental disease .sx The Asylum Board of Management eventually approved the scheme , and on 7 May 1853 , David Skae ( pictured in Fig. 3.5 , p. 47 ) , who had succeeded MacKinnon , gave his first lecture ( Skae , 1853) .sx Skae's 1853 course involved a clinical lecture on a Saturday and thrice-weekly tours of the asylum in the company of one of the medical officers , who would demonstrate interesting patients , encountered en passant .sx By Clouston's time , at the end of the decade , Skae was giving two lectures weekly but the asylum visit had been reduced to one each week .sx According to Laycock ( 1869 ) , Skae's class depended for its numbers upon the army and navy requirement of certificates of competence in mental disease .sx When their respective boards abolished this requirement , the numbers fell and Skae was forced to abandon the class .sx Skae taught that mental diseases were brain diseases and was interested in organic disorder , moral insanity , and medicolegal problems ( Skae , 1858 , 1860 , 1861 , 1867 ; Clouston , 1873 b) .sx As indicated above , Skae ( 1863 ) felt that his major contribution was his classification of mental diseases , a system which even his most sympathetic biographer , Fish ( 1965 ) , admits was " best forgotten " .sx It is not appropriate to give a detailed consideration of Skae's system here , but it is worth noting the clinical significance it held for Clouston ( 1895 ) , who was to write :sx " In large degree it is founded on bodily causation- 'the somato-etiological' .sx Its great merit is that it helps the practising physician in his efforts to discover the causes of the insanity and also assists him in his treatment and prognoses .sx It seizes on the bodily and constitutional relationships of the mental symptoms , and groups the latter accordingly .sx " .sx Skae's classification met with much opposition at the time ( e.g. Tuke , 1870 ; Crichton-Browne , 1875 ; Journal of Psychological Medicine and Mental Pathology , 1877) .sx Crichton-Browne had pronounced it " Philosophically unsound , scientifically inaccurate and practically useless " .sx Browne also used the opportunity to castigate the entire Edinburgh School , and seized upon a remark Clouston had made about the classification , " excluding everything mental " .sx Crichton-Browne saw this as an example of Morningside's antipathy to the mental and metaphysical aspects of man .sx He scoffed that :sx " The physician who limits himself to the outside view of humanity must remain below the level of an intelligent dog " .sx However , despite the hostility and its lack of general acceptance ( Robinson , 1988 ) , Clouston ( 1876 a ) continued to defend the classification ; as late as 1894 , he was claiming that Skae's system was " the most useful yet devised " .sx Thomas Laycock .sx The most important figure in Edinburgh psychiatry at this time was undoubtedly Thomas Laycock , Professor of the Practice of Medicine ( Fig. ) .sx Laycock had been elected to the Chair in 1855 and became the first Englishman to occupy the senior professorship in medicine at Edinburgh .sx He had previously worked in York , where he greatly influenced Hughlings Jackson , the eminent neurologist , and Danziger ( 1982 ) has lauded him as the most original of all the British mid-century psychologists .sx Laycock was among the first to argue that a science of mental life was possible- that the mind could be studied using the principles of physiology .sx In his classic book , Mind and Brain ( 1860 ) , he sought to develop a " scientific Cerebral Psychology " which would unite philosophy and physiology .sx He believed that medicine and biology , not metaphysics , represented the proper foundation for psychology ( Hearnshaw , 1964) .sx Laycock argued that the mind/body problem was resolvable in terms of a psychophysical parallelism ; that consciousness could accompany brain processes , but did not interact with them .sx An important concept in this grand synthesis was the reflex , and he was the first thinker to extend the reflex function to the brain ( Smith , 1970 , 1981 ; Jacyna , 1980 b , 1981) .sx Clouston ( 1894 c ) was later to write of him :sx " He promulgated the law of reflex action of the brain , and in my opinion anticipated Spencer and Darwin .sx He was a daring speculator and thinker .sx He was not afraid of startling conclusions , tried to include all mental phenomena , in animals and man , in health and disease , within his generalizations , and was the most suggestive writer on the subject at the time .sx " .sx Laycock did much to improve the study of insanity .sx In 1857 , he obtained a sanction from the university for putting a question on mental diseases in the MD degree , for the first time in Britain ( Clouston , 1879 a) .sx In 1861 , he instituted an examination for those studying mental diseases .sx Seven years later , he called for a formal course of lectures and examinations for doctors wishing to pursue an asylum career , in an attempt to improve both the standards and morale among asylum doctors , but , unfortunately , this came to nothing ( Journal of Mental Science , 1861 ; Laycock , 1866 , 1868 , 1869) .sx Laycock's most important contribution was the introduction of a specialised course of lectures on 'medical psychology' , the first of its kind within a British university medical school ( Smith , 1970) .sx As Laycock wrote ( 1871) :sx " The rapid development of a new school of cerebral physiology and pathology ( in which I had my share ) rendered it year by year necessary for me to introduce into practice something more intelligible than the old empiricism as to mental diseases , until at last at Edinburgh during the Winter session 1857-8 .sx .. I set apart one lecture in each week for a distinct course of Practical Psychology .sx In the Summer of 1858 , I was requested by the Senatus Academicus to give a Summer course of lectures on Medical Psychology , which I did in the following year ( 1859) .sx To this course I subsequently added the practical study of mental diseases in an asylum .sx " .sx Laycock had intended to use the Morningside asylum for teaching , but its superintendent , Skae , refused him access ; no doubt Skae was defending his territory , and resented the intrusion of another lecturer .sx For his part , Laycock could often be difficult and quarrelsome ; rebuffed by Skae , he took his class to Millholm Private Asylum in Musselburgh .sx Clouston recounts that there were about 40 students , and practice was given in signing lunacy certificates .sx However , within a month of the death of Skae in April 1873 , Laycock was once again requesting permission to use the Morningside asylum , and this time , it was agreed that he could teach during the summer term .sx When Clouston arrived in August of that year , Laycock approached him about teaching , and Clouston ( 1879 a ) recalled that he " made very flattering and earnest overtures to me " .sx The new superintendent readily accepted , and the minutes of the University Senate recorded that Dr Clouston was " to receive Dr. Laycock and his class at the Asylum and to give also Clinical Instruction at visits twice a week during the Summer session .sx Dr. Clouston will also give demonstrations from time to time to Dr. Laycock's class in the Pathological Anatomy of Insanity and Cognate diseases of the Nervous System .sx " It was also recorded that as a result of this new university connection , Clouston was to withdraw from the Extra-Academical School , his place being filled later by Dr Batty Tuke ( Guthrie , 1965) .sx Clouston ( 1879 a ) greatly valued his contact with Laycock , and in his later writings , frequently referred to him and employed many of his fundamental ideas .sx " My association with him " , he reminisced , " was a source of the utmost pleasure and much instruction to me " .sx Clouston as lecturer in mental diseases .sx The 19th century witnessed great changes in the Scottish university system ( Anderson , 1983 ) , which Davie ( 1961 ) has seen as a process of the steady 'anglification' of traditional Scottish values .sx Of the many Scottish University Commissions which deliberated in that century , the one of 1877 recommended the creation of lectureships .sx In 1879 the University Senate instituted a Lectureship in Mental Diseases , the first lectureship at Edinburgh , and Thomas Clouston was appointed to the post .sx It is clear that he was a success in his new position , and contemporaries were unanimous in their praise of him as a gifted speaker .sx Robertson ( 1928 ) wrote that he was " one of the most brilliant lecturers we have had at the University " .sx Phrases such as " dazzling" , " freshness of outlook " , and " novelty of phraseology " were employed to describe Clouston in action ( Robertson , 1915 ; Lancet , 1915 ; British Medical Journal , 1915 ; Journal of Mental Science , 1915) .sx As his son , Storer Clouston , recalled :sx " It was really his personality .sx .. that left the deepest impression .sx His animation , his slight frame , quivering with energy , the extraordinarily bright and piercing eyes " .sx An impression of Clouston's lecturing style can also be gained from his textbook , Clinical Lectures on Mental Diseases , which was based on his talks to students .sx On one occasion , he proclaimed to them :sx " I am able to present to you , some of the most remarkable personages that have ever lived .sx Here is Jesus Christ , and here are the Prophet Elias , the Emperor of the Universe , the Universal Empress , the Empress of Turkey , the only daughter of God Almighty , Queen Elizabeth , four Kings of England , one King of Scotland , the Duke of Kilmarnock , the inventor of perpetual motion , a man who has discovered the new elixir of life .sx .. and a lady who daily and nightly has delightful conversations with the Prince of Wales .sx " ( Clouston , 1896 a ) .sx He was evidently something of a showman , on occasions resembling a ring master in a circus of performing lunatics .sx In one lecture , he promised to produce " a one legged dressmaker of 40 .sx .. with no personal charms " , and in another , fretted that he had no really good specimens of 'microcephalics' to show his audience .sx Clouston has left a very clear account of his teaching methods in The Teaching of Psychiatric Medicine , originally delivered to the International Medical Congress in 1881 .sx He wrote :sx " My course is a Summer course of 3 months , and by far the majority of students are in their fourth year .sx .. I give 12 systematic lectures in the University , one a week ; the students come out to the asylum twice a week for clinical instruction and towards the end of the course I give four systematic demonstrations from specimens and diagrams , two being macroscopic and two microscopic , on the pathology of insanity " ( Clouston , 1881 c) .sx He maintained that illustrative clinical cases would " rouse the attention of every student , in the sultriest day when it was flagging " .sx The most important part of the course was the clinical demonstration , which he described as " the backbone of " .sx Clouston had found the Skae method of wandering around the asylum , in search of interesting patients , too haphazard and unsystematic .sx Instead , he preferred to bring patients into the lecture room and interview them in front of the students , explaining that " I try to direct and concentrate their attention on the one point to be illustrated by each case .sx My object is to create in each student's mind a vivid sense of the direct connection of brain derangement with .sx .. mind " .sx Discussion of the case usually occurred after the patient had left the room .sx Students were also expected to see patients on their own , make a diagnosis , and sign a medical certificate of lunacy .sx Clouston's lecture course was popular with the students and it was well subscribed .sx An article in the Edinburgh Student magazine of 1907 gives a mockingly affectionate tribute to Clouston the lecturer , depicting him in his frock coat and striped trousers .sx " Here is Clouston as you see , .sx Warbling of Insanity, .sx .. Thomas , garrulous and kind , .sx Gives them Hygiene of the Mind .sx " .sx During his tenure , Clouston also fought to make the study of mental diseases part of the medical curriculum , and in 1890 he put this to the Scottish Universities Commission .sx In 1893 , psychiatry was made a compulsory subject for all medical students by the General Medical Council , which Clouston ( 1911 b ) greeted as the " charter for our real and full incorporation into general " .sx