James Douglas

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Biography

• Born on March 21, 1675 in Baads, Scotland
• 1694 – Master of Arts degree, University of Edinburgh
• 1699 – M.D. degree, Reims University
• 1700 – moved to London working closely with obstetrician Paul Chamberlen (1636–1717), of the obstetric forceps family. Douglas established himself as a skilled obstetrician with a thriving medical practice including the aristocracy and members of the Royal family.
• 1706 – elected as fellow of the Royal Society of London
• 1707 – published an anatomical textbook of comparative myology “Descriptio comparata musculorum corporis humani et quadrupedis“, detailing 13 muscles as his own in priority of description, and none of which have achieved eponymic recognition.
• 1720 – honorary fellow of the Royal College of Physicians
• 1727 – appointed physician to Queen Caroline, wife of George II. The Royal Family must have held him in esteem, for when their daughter Anne, Princess of Orange, was, in 1734, thought to be pregnant, Douglas was sent over to Holland to look after her.
• 1730 – published his Description of the Peritonaeum and Of That Part Of the Membrana Cellularis Which Lies On Its Outside, where the “pouch of Douglas” was first described
• 1741 – provided lodgings and lessons in anatomy to William Hunter
• Died on April 2, 1742. On his death his practice fell to his friend and pupil Hunter.

Immortalised in iambic pentameter by poet and satirist Alexander Pope (1688-1744)

There all the learn’d shall at the labour stand, 
And Douglas* lend his soft, obstetric hand

Pope, The Dunciad. 1728
*A physician of great learning and no less taste; above all curious In what related to Horace, of whom he collected every edition, translation, and comment, to the number of several hundred volumes.

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Medical Eponyms

Pouch of Douglas (1730)

In women, the recto-uterine pouch is the deepest point of the peritoneal cavity between the rectum and the posterior wall of the uterus in the female [aka recto-uterine pouch; recto-vaginal pouch; utero-rectal pouch; Douglas’ cul-de-sac; ]

The peritoneal cavity had been first described in the Ebers papyrus, 3000 B.C., as a definitely outlined cavity in which the viscera are somehow suspended. Early anatomists added little to the understanding of the peritoneum, the organs had been considered as being contained within the peritoneal cavity and covered with duplications or splitting of the membrane.

In 1730 Douglas published his description of the “Situation and Structure of the Peritoneum, and the membrana cellularis” and remarked in his dedication to Dr. Mead, “neither of which have in my judgment been hitherto rightly described” Douglas clearly pointed out that there were no organs within the cavity and that the peritoneum was one single membrane with no duplication.

Where the peritonaeum leaves the foreside of the rectum, it makes an angle, and changes its course upwards and forwards over the Bladder: and a little above this angle, there is a remarkable transverse stricture or semioval fold of the Peritonaeum, which I have constantly observed for many years past, especially in women.

Douglas 1730: 37-38

Douglas supported all his statements by carefully dissected anatomical preparations which he preserved in his home and allowed anybody to view. Contemporary English physician, Dr John Freind (1675 – 1728), wrote at the time of these preparations:

One ought to see the curious preparations of that diligent and accurate anatomist Dr Douglas, who is the first who has given us any true idea of the peritoneum

Freind 1725; 1: 172

The pouch with which Douglas’ name is so constantly associated receives no more attention than many other portions of the anatomy which he describes, and one would suspect that he could not possibly surmise that his name would become famous in this connection.

Line of Douglas

The curved line of Douglas, semilunar line of Douglas, arcuate line of Douglas or linea semicircularis is a sharp concave line that occurs bilaterally, midway between the umbilicus and the pubic symphysis which demarcates the lower limit of the posterior layer of the rectus sheath; the point at which the inferior epigastric arteries enter the rectus sheath.

In 1720, Douglas alluded to the line indirectly and in passing when defining his method for dissection of the anterior abdominal wall.

My Method has hitherto always been to begin on the foreside of the Abdomen, where a Longitudinal Incision being made through the common Integuments and Muscles, from a little above the Cartilago Ensiformis to the Umbilicus; I divide them obliquely from thence downwards all the way to the middle or lower part of the Inguina on each side; so that this triangular Portion; in the superior Angle of which the Umbilicus is left, may be conveniently turned down to cover the Pudenda in both Sexes

This being done, we find the Peritonaeum closely connected to the Tendon of the transversalis, scarce any Vesicular Substance being perceivable by the naked Eye between them; and therefore a great deal of Nicety and Patience is required in dividing this tendon from the Peritonaeum, all the way to the fleshy Bellys on each side. I next go on to the lower part of this foreside, where the Musculi Recti come between the Tendon of the Transversalis and peritoneum; and here the Separation is easily made, because the Quantity of Cellular Substance increases considerably all the way down to the Os Pubis

Douglas 1730: 5-6

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Controversies

The Curious Case of Mary Toft

In 1726, the court of King George I heard of the alleged birth of several rabbits to one Mary Toft (1703-1763) of Godalming, near Guildford, in Surrey. The 25 year old illiterate servant had miscarried in August 1726, but a month later still appeared to be pregnant and on September 27th, she went into labour delivering various animal parts.

The Guildford obstetrician John Howard was summoned. Over the next month he recorded the delivery of a rabbit’s head, the legs of a cat, and, in a single day, nine dead baby rabbits. Howard was astonished and sent letters to some of England’s greatest doctors and scientists and the King’s secretary, informing them of the miraculous births.

On November 15th, Nathaniel St. André, Swiss surgeon-anatomist to the King and Samuel Molyneux, secretary to the Prince of Wales arrived at Howard’s home in Guildford and were greeted with the news that Mary was in labour with her fifteenth rabbit.

Despite growing skepticism, seemed convinced that her case was genuine. He believed that these were indeed supernatural births taking rabbit specimens to show the King back to London and alerting Douglas, the eminent obstetrician of the case.

Sir, I have brought the woman from Guilford to the Bagnio in Leicester-Fields. She has now a live rabbit in her, and I expect shortly a delivery; you will infinitely oblige me to deliver her yourself. Mr. Amiand is already here.

St André, November 29th 1726

Douglas smelled a rat. He went to see her himself, to put an end to the nonsense. He examined her and declared her a fraud.

I am oblig’d to Sir Richard Manningham for the Justice he has done me in his Diary lately publish’d, by owning (p20), that when he talk’d to me of the Affair of Mary Tofts, I told him in a peremptory Manner, that it must be a Cheat; and likewise (p32) that I assisted him in persuading and preparing that unhappy Woman to make a Discovery of the Truth

Douglas, 1726: 1-2

William Hogarth’s satirical print pokes fun at the incompetence of the early 1700s medical profession. All the main characters in the Toft saga are featured, the doctors being shown as ignorant and credulous fools.

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Major Publications

• Douglas J. An Account of what Dr. Douglas obliges himself to perform in a Course of Human and Comparative Anatomy. 1707 [Advertisement as private lecturer in anatomy, given 3 times a year at 31/2 guineas a head]
• Douglas J. Descriptio comparata musculorum corporis humani et quadrupedis. 1707
• Douglas J. Lilium sarniense: or, a description of the Guernsay-lilly. 1725
• Douglas J. The history of the lateral operation: or an account of the method of extracting a stone, by making a wound near the great protuberance of the os ischium. 1726
• Douglas J. Arbor Yemensis fructum cofè ferens: or, A description and history of the coffee tree. 1727
• Douglas J. An advertisement occasion’d by some passages in Sir R. Manningham’s diary lately publish’d. 1727
• Douglas J. Description of the Peritonaeum and Of That Part Of the Membrana Cellularis Which Lies On Its Outside; With An Account of the True Situation Of All the Abdominal Viscera, in Respect Of These Two Membranes. 1730 [Pouch of Douglas]
• Douglas J. An appendix to the history of the lateral operation for the stone. Containing Mr. Cheselden’s present method of performing it. 1731
• Douglas J. Myographiae comparatae specimen, or, A comparative description of all the muscles in a man, and in a quadruped; shewing their discoverer, origin, progress, insertion, use and difference; to which is added an account of the muscles peculiar to a woman ; with an etymological table, and several useful indexes. 1750 [revised 2e 1775]

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References

Biography

• Freind J. The history of physick. 1725; 1: 172
• Young J. A catalogue of the manuscripts in the Library of the Hunterian Museum in the University of Glasgow. 1908: 428-448
• Bryn Thomas K. James Douglas of the pouch, 1675-1742. Br Med J. 1960;1(5186):1649-1650
• Brock H. James Douglas of the Pouch. Med Hist. 1974;18(2):162-172.
• Persaud TVN, Loukas M, Tubbs RS. James Douglas. In: A History of Human Anatomy. 2e 2014: 266-267
• Koutsouflianiotis KN, Paraskevas GK, Kalitsa N, Iliou K, Noussios G. The Anatomist James Douglas (1675-1742): His Life and Scientific Work. Cureus. 2019;11(1):e3919.
• Baskett TF. Douglas, James (1675–1742), In: Eponyms and Names in Obstetrics and Gynaecology. 3e. 2019: 127-128
• Bibliography. Douglas, James 1675-1742. WorldCat Identities

Pouch of Douglas

• Oughterson AW. James Douglas and the Surgery of the Peritoneum. Yale J Biol Med. 1930 May;2(5):331-9.
• Sorensen T. The pouch of Douglas. Med J Aust 2015; 202 (11): 598.

Arcuate line of Douglas

• Retzius A. Some Remarks on the Proper Design of the Semilunar Lines of Douglas. With Three Illustrations. Edinb Med J. 1858 Apr;3(10):865-867.
• Rizk NN. The arcuate line of the rectus sheath–does it exist? J Anat. 1991 Apr;175:1-6. 
• Mwachaka PM, Saidi HS, Odula PO, Awori KO, Kaisha WO. Locating the arcuate line of Douglas: is it of surgical relevance? Clin Anat. 2010 Jan;23(1):84-6. 
• Montgomery A, Petersson U, Austrums E. The arcuate line hernia: operative treatment and a review of the literature. Hernia. 2013 Jun;17(3):391-6.
• Hacking C, Tromp D. Arcuate line. Radiopaedia

Mary Toft

• Saint-André N. A short narrative of an extraordinary delivery of rabbets: perform’d by Mr John Howard, Surgeon at Guilford. 1726
• Swift J. The anatomist dissected: or the man-midwife finely brought to bed. : Being an examination of the conduct of Mr. St. Andre. Touching the late pretended rabbit-bearer; as it appears from his own narrative. 1727
• Brathwaite T. Remarks on a short narrative of an extraordinary delivery of rabbets, perform’d by Mr. John Howard, surgeon at Guilford, as publish’d by Mr. St. Andre, anatomist to His Majesty. With a proper regard to his intended recantation. 1726
• Manningham R. An exact diary of what was observ’d during a close attendance upon Mary Toft, the pretended rabbet-breeder of Godalming in Surrey, from Monday Nov. 28, to Wednesday Dec. 7 following: Together with an account of her confession of the fraud. 1726
• Steevens G. A complete collection, of all the tracts, both printed and manuscript, relating to Mary Tofts, the celebrated Rabbit Woman of Godalming. 1727
• The Curious Case of Mary Toft. 2009

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