Consulting in the dark: Robert Hamilton (1749–1830) and the importance of ‘tenderness’ towards patients

Abstract

Robert Hamilton (1749–1830) was born in Coleraine, Ireland, attended medical school in Edinburgh, Scotland, served in the British army and practised in South-East England. In order to differentiate him from his contemporary and namesake, Hamilton is identified by having worked in Ipswich, Suffolk and Colchester, Essex. This submission considers Hamilton's biography, his 1787 book on the British regimental surgeon and his ideas therein about professionalism. Central to his concept of professionalism is ‘tenderness’, a notion that broadly equates to empathy. He notes that tenderness brings improvement in clinical outcome and he has the foresight to recognise nurses as key to such care. The authors explore the concept of ‘consulting in the dark’, i.e. without access to clinical investigations. This is exemplified by doctors of the eighteenth century and earlier. Today general practitioners must still be comfortable ‘consulting in the dark’, e.g. when attending a patient's home. Hamilton's biography offers a further example of ‘consulting in the dark’: In later life, he lost his vision but continued to practise successfully. Central to his gift of consulting ‘in the dark’ was likely to be ‘tenderness’ for his patients, expressed through language and gentle touch. Hamilton's entreaty for ‘tenderness’ contrasts with modern medical education where reliance upon clinical tests, technology and pharmacology risksblinding young doctors towards patients and their lives.