James Scarth Combe

James Scarth CombeFRSE,FRCSEd(1796–1883) was a British surgeon. He was the first person to give an accurate description ofpernicious anaemiaand to recognise thatatrophic gastritiswas a feature of the condition.He was elected a Fellow of theRoyal Society of Edinburghin 1850 and served as President of theRoyal College of Surgeons of Edinburghin 1851–52.

Early life and education

The grave of James Scarth Combe, Warriston Cemetery

Combe came from a family of brewers based inEdinburghand appears to have been second cousin toGeorgeandAndrew Combe,who come from the same brewing family.

He was born inLeithon 5 January 1796 to Matthew Combe, a brewer at the Yardheads. After studying medicine at theUniversity of Edinburgh,he received his doctorate (MD) in 1815 and was licensed as a surgeon (LRCSEd) in the same year. While taking the MD examination, he was being questioned byProf Andrew Duncanwhen the guns of Edinburgh Castle fired to mark the victory at Waterloo and end of theNapoleonic Wars.He was elected a fellow of theRoyal College of Surgeons of Edinburgh(FRCSEd) in 1823.

Medical career

Combe appears to have taken an early interest in diseases of the blood, presenting a case of anaemia to the Edinburgh Medico-Chirurgical Society in 1822. In 1824 he published this in detail in a paper entitledHistory of a Case of Anaemia.Combe modestly starts with the statement that the case had already been presented by "my distinguished preceptor and friendDr Kellie".He goes on to credit continental writers with earlier descriptions of the condition. Combe then describes a patient with the typical features of a severe anaemia. Despite various treatments including iron, chalybeate (iron-containing) spa water and a nourishing diet, the patient died. At the autopsy, where he was assisted by Kellie, he found the stomach was" thin, showing no vessels and transparent ", a description ofatrophic gastritis,which is a distinctive feature ofpernicious anaemia,and preceded DrThomas Addison’sadmittedly fuller account by 27 years. Although the condition bears Addison's name, Combe's was the first accurate description and the first to link it to atrophic gastritis.

In 1827 he was elected a member of theHarveian Society of Edinburgh.

In 1828 Combe published a paper in theEdinburgh Medical and Surgical Journalentitled "On the Poisonous effects of the Mussel, Mytius Edlulis", looking at the issue of accumulation of toxins in molluscs. At this time the mussel beds of theFirth of Forthwere dangerously close to the sewage outlets of the city ofEdinburgh.

Around 1829 he travelled to India to treat and studycholerain the city ofCalcutta.He returned to theUnited Kingdomaround 1832, just in time to aid in combating a wave of cholera that was sweeping across the country at that time. Back in his home town ofLeith,he worked with DrThomas Lattaon the pioneering use of intravenous infusions of saline to manage the disease. He signed Latta's death certificate when he died prematurely in 1833.In 1839 he is described as being 17 years in the practice of midwifery, delivering 100 children per year. As part of a debate on survival of premature children, he stated that there was no reason why a child of less than seven months gestation could not survive, but a child of less than five months gestation was not viable.

He moved from 27 Charlotte Street(now Queen Charlotte Street) in Leith to York Place,Edinburghin 1847, probably at the point of becoming a manager of theEdinburgh Royal Infirmarywhich would have required his closer presence. Whilst now absorbed into Edinburgh, the distance between Leith and Edinburgh, though only a few miles, would have presented a significant time problem in the mid-19th century. However he remained consultant physician toLeith Hospitaluntil his death.

In 1843 he was elected a member of theAesculapian Club.He was elected a Fellow of theRoyal Society of Edinburghin 1850, his proposer beingRobert Christison.He succeededJames Symeas President of theRoyal College of Surgeons of Edinburghin 1851 and was succeeded in 1853 by DrArchibald Inglis.

Combe died on 14 February 1883 at his home 36York Place, Edinburgh.He is buried with his wife inWarriston Cemeteryin north Edinburgh. The grave, marked by a tall slim obelisk, lies slightly south of the central vaults.

Family

In 1824 Combe married Anne Thomson (1798-1875). They had one daughter, Margaret, who married the surgeonJames Simson,who, like his father-in-law, becamePresident of the Royal College of Surgeons of Edinburgh.They had three sons Matthew, who became an army surgeon, Charlesand James (1833-1877).