Introduction

     Glasgow Royal Infirmary (GRI) emerged late into the 18th Century as a voluntary hospital to supply a local need for reliable medical/surgical care, the teaching of junior doctors and professional training for medical students from the University of Glasgow. An expression of philanthropic endeavour, Glasgow Royal remained a self-financing institution reliant upon the generosity of the denizens of the city and private sources of funding until the start of the National Health Service in 1948. As it grew to become the second largest voluntary hospital in the United Kingdom, the Royal overcame the many difficulties that accompany a rising city population and, over the years, has contributed both nationally and internationally in important areas of medicine, surgery, the specialities and nursing. GRI was administered by committees of lay members serving in a voluntary capacity and was staffed, particularly early on, by physicians and surgeons working in honorary and unpaid positions.

     Like all medical specialities, endocrinology developed throughout the 19th and 20th Centuries, advancing slowly at first and then at a pace that surprised most of the individuals who chose to work in that area. This blog will attempt to outline, however imperfectly, the relentless progression of hospital building and development and the progress in medicine, surgery and nursing in this Institution. It will also introduce the medical practitioners and scientists at the Royal Infirmary who were at the heart of endocrinology and its development throughout the 20th Century unfolding for the reader, a drama of endocrine proportions.

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Lister’s male surgical ward 24 with a student dresser in short white jacket[1]
Reference

[1].     Image courtesy of Andrew McAinsh and the Royal College of Physicians of Glasgow archive, 2018.

Contents

  1.  A Royal Infirmary Appears in Glasgow

Development of Voluntary Hospitals

The First Royal Infirmary of Glasgow

Early Distinguished Staff

Early Hospital Organisation

The Auld Hoose

2.  Milestones for Medicine at Glasgow Royal Infirmary

Anaesthesia from Edinburgh

Rise of Antisepsis

Aseptic Surgery Triumphs

Medical Student Training

Women in Medicine

Reform of Nurse Training

The Electrical Department

Redevelopment at Last

              — The War Years and Penicillin

Glasgow Royal in Poetry

3.  An Endocrine Prologue

A Thyroid Narrative

The History of Diabetes

Contributions from Physiology and Anatomy

A Surgical Contribution

Parathyroid, Pituitary and Adrenal

The Fog Clears

4.  Birth of an Endocrine Unit

The University Returns to Glasgow Royal

Clinical Practice and Biochemistry

Endocrinology Emerges

Early Trainees in Medicine and Endocrinology

5.  Development of Academic Medicine at the Royal

A Laboratory Focus Appears

Development of Specialist Academic Medicine

6.  General Endocrinology and Thyroid Combine

Development of Academic Endocrinology

Trainees in Medicine and Endocrinology

Temporary Transfer of Endocrinology to Diabetes

7.  Nuclear Medicine Emerges from Endocrinology

Link with Radio Iodine

Nuclear Medicine Gathers Strength

Apprentices in Nuclear Medicine

Scientists in Nuclear Medicine

8.  A Quantum Leap in Diagnosis and Therapy

Biochemistry Grows

From Chemistry to Immunoassay

Technical Advances

Endocrine Pathology

Endocrine Neurosurgery

Endocrine Surgery

Endocrine Oncology

Endocrine Imaging

9.  Endocrinologists of the Future

The Diaspora

Islets of Endocrinology and Diabetes

10.  Bone Targeted

Mineral Metabolism Develops

Mineral Metabolism for the 21st Century

11.  Bone Apprentices

The Nuclear Medicine Connection

The Rheumatology Connection

The Endocrinology and Diabetes Connection

A Caledonian Society for Endocrinology is Born

12.  Endocrinology Pushes the Boundaries of Science

Technical Advances in Biochemistry

Clinical Biochemists in Endocrinology

Clinical Genetics and Molecular Analysis

Recombinant Hormone Production

13.  Summary

14.  Acknowledgements

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A Royal Infirmary Appears in Glasgow

     In the dark ages of Scotland, prior to the Reformation of the 16th Century, care of the sick, aged, infirm and dying was undertaken charitably by the established Catholic religious orders in hostels or ‘spitals’ which appeared to be hostels with some beds for the sick. In London, St Bartholomew’s Hospital had appeared in 1123 and remained the only Institution for the sick until the early 1700s.

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Cathedral with old Western Tower in 14th Century[14]

     Following their forceable closure during the Scottish Reformation which took place from the sixteenth century, the sick, dying and infirm poor became totally reliant for care upon either secular charities or municipal provision provided by town councils who did subsidise physicians and surgeons to attend the sick poor. Institutions such as hospitals, asylums and infirmaries emerged under the Scottish Poor Law system which were supported by voluntary financial giving from local philanthropists, special collections, donations, fines and the occasional levy by Parish councils and Kirk Sessions in each area. Although there was a Poor Law in Scotland to deal with poverty and health issues, unlike England, there was no legal provision for relief of destitution. Indeed, evidence strongly suggests that the Kirk Sessions favoured education and provision of schools over poor relief. They promoted personal charitable giving for the poor without local authority involvement and the need for hypothecated taxation by Parish Councils.[1]

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Provand’s Lordship, Castle St

Only ‘Provand’s Lordship’, a residence built in 1471 for the chaplain of the nearby St Nicholas Hospital by Bishop Andrew Muirhead remains on Castle Street to remind us of that era. A garden for cultivation of ancient remedies can be seen today at its rear. Physicians were few, some training at the University of Glasgow founded in 1451, but most felt that they had to go abroad to Paris or Leiden after their degree for further training. These individuals tended to work in the cities. Barber-surgeons were more numerous and were employed for blood-letting, treatment of wounds and fractures, pulling teeth and the ‘cutting’ for bladder stones. Surgeons eventually separated from barber-surgeons in 1745 into specific trade guilds which were more regulated, required more training and apprenticeship, and permitted them to work in more difficult areas such as amputations and difficult births. One institution established by these tradesmen was a ‘Crafts Hospital’ or ‘Trades Almshouse’ sited between Rottenrow and St Nicholas Hospital. Peter Lowe was the first surgeon of this institution in 1609.

     In 1641, Hutcheson’s hospital for the elderly and school for boys was opened in Trongate and was known for the large garden used by it’s apothecary. Pharmacopoeias of the age contained medicaments of vegetable origin presented in waters, syrups, powders, lozenges, pills, ointments or tinctures. When animal substances appeared, it was usually dried goats blood, urine mixed with salt, millipedes prepared for their formic acid and dried bees. Apothecaries not only provided over-the-counter remedies as Chemists do today but also visited the sick at home and were the doctors of last resort for the poor. Surgeon apothecaries or apothecaries looked after everyone in the countryside. After an apprenticeship of 5 years to a surgeon or an apothecary which required payment, individuals could then set up in practice on their own given the lack of systematic training of the age. There was much irregularity of practice and many charlatans.

Development of Voluntary Hospitals

With the 18th Century came the Union of Parliaments, its associated  industrial developments and the resulting population growth in cities. The population of London burgeoned and five voluntary general hospitals appeared namely the Westminster (1719), Guy’s (1721), St George’s (1733), The Royal London (1740) and The Middlesex (1745). Due to Scotland’s trade with the United States,  and as a result of highland clearances, Glasgow’s population grew from 14,000 in 1712 to 83,000 in 1801 and 200,000 in 1830. Later on, it was the lingering effects of potato famines in the 1840s-50s that continued to swell the population of Glasgow. At this point, the ‘Voluntary Hospital’ movement also appeared in Scotland to help, care for and treat those in work who were unable to afford health care in the community. Medical and surgical staff in such Institutions were honorary and unsalaried. This work did, however, permit access for them to the developing middle class and professional men who could afford health care and, in particular, the really wealthy families in the community. It was this wealthy group who increasingly subscribed to the hospital’s upkeep.

     In the period from 1729 to 1782, the Crown granted Royal Charters to Edinburgh (1729), Aberdeen (1739), Dumfries and Galloway (1776), Montrose (1782) and Paisley (1786) for the development of hospitals which in Scotland were called Royal Infirmaries and not Hospitals. They were built ostensibly for the care of the working poor who were essential members of the workforce but had less access to good healthcare. For example, they could not afford private physicians who treated members of the family at home.[2]

The first civic response in Glasgow, which had more poverty, disease, beggars and destitution

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Town’s Hospital and Poorhouse

than Edinburgh, was to build Town’s Hospital and Poorhouse[3] close to the river Clyde which opened in 1733. This institution was managed and maintained by the Provost of Glasgow assisted by directors elected by the town council, the General Session representing the Church in each Parish, the Merchants’ Guild and the Incorporated Trades (Producers’ Guild) who contributed in agreed proportions.

 

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Town’s Hospital on Clyde St on map by John MacCarthur 1778[15]

It provided relief, food and education, for the destitute, infirm, widows and orphans by the use of a workhouse system but beds for the sick were added a few years later in an Infirmary Block which accommodated mentally ill in it’s basement.

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Mr Peter Lowe[9]
Medical provision was courtesy of attending physicians and surgeons from the Faculty of Physicians and Surgeons of Glasgow (FPSG). The FCSG had been founded by Royal Charter from King James the 6th of Scotland in 1599 by Mr Peter Lowe (surgeon) and Dr Robert Hamilton (physician). The charter established the Faculty in law as a regulator of medical and particularly surgical qualifications and licensing of said practitioners for work in the West of Scotland in addition to the legal power to inspect drugs where it mentioned William Spang, apothecary. The Charter also tasked the Faculty of visiting the poor on a regular basis without fee which was the first sign in Scotland of a medical interest in public health. Peter Lowe had been an Ambassador for Britain abroad and an experienced surgeon in France for many years. He had trained at the community of St-Côme in Paris and brought to Glasgow a level of surgical expertise unrivalled among his peers in the UK and his published work remains testimony to this.[4] 

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William Cullen[17]

     The addition of the infirmary beds into Town’s Hospital permitted some teaching for Glasgow University medical students and the apprentices of local surgeons of the FPSG who were more numerous. William Cullen who was Professor of Medicine from 1751 to 1756 at the University and lectured in English, not Latin, was one of the teachers found in Town’s Hospital from 1747 and it was he who advocated the training of doctors in modern scientific subjects such as chemistry.

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William Cullen’s House Hamilton[10]

He himself was an apothecary as well as a surgeon and had a huge number of ‘medicines’ at his disposal from his druggist in Hamilton where he practiced.[2]  He advocated inoculation against smallpox and this was quite effective. Later in 1796, Edward Jenner had discovered vaccination and smallpox became less of a problem in Scotland.

     One year after opening, 61 old people and 90 children were resident in Town’s Hospital. It is not clear when it closed but it is likely to have been after GRI opened in 1794. Residents were transferred to the Glasgow City Poorhouse on Parliamentary Road.

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Joseph Black

Joseph Black followed Cullen as Professor of Medicine and Chemistry at the University of Glasgow until 1766 when he left for Edinburgh. His laboratory research was extraordinarily fruitful with discoveries of the element magnesium, latent heat, specific heat and the gas, carbon dioxide.

     

William Hunter from Long Calderwood, East Kilbride, was a pupil of Cullen’s when he worked in Hamilton and, from him, learned the importance of practical demonstration to illustrate major points during teaching. After studies at the University of Glasgow and abroad, he went to London to be a pupil in midwifery with William Smellie, another Scot in London, performing groundbreaking work on the gravid uterus. By developing his own extra mural school of midwifery and anatomy in the Capital in the 1740s at Great Windmill Street, he completely changed how these subjects were taught in the United Kingdom and became the leading obstetrician in London and man-midwife to Royalty. William Hunter died in 1783 and bequeathed his museum to the University of Glasgow Medical School. This museum continues to exhibit his specimens to this day.

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John (L) and William (R) Hunter  medals in Physiology and Surgery of the University of Glasgow, 1960

     John Hunter, William’s younger brother had a basic education only and, aged 20, followed his brother to London in 1748. William trained him in anatomical dissection and in return, he helped his brother with the dissections for display in William’s anatomical school. Within a short time, John showed such skill and aptitude that he began to teach in his brother’s school. He trained in the art of surgery at the Chelsea and St Bartholomew’s Hospitals then spent 3 years as an army surgeon. During all this time, his curiosity, observation and insight helped him develop a scientific method of investigation in medicine and surgery that majored on proof by trial and experiment. John became the first to use anatomy as a corrective diagnostic tool in medicine and became a leader in the new investigative medical science. His interests extended beyond medicine with his mastery of comparative anatomy. John Hunter, an irascible Scot, died in 1793 and left an enduring legacy of achievement for one so humbly born. On his death, he gifted his extensive museum to the Royal College of Surgeons in London.

     John Anderson, was Professor of Natural Philosophy at the University from 1757 and an important academic who stayed in Scotland to influence medical training.

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Professor John Anderson

In 1796, he bequeathed money on his death to found  Anderson’s University, later a College in 1877, as an educational establishment for scientific subjects to rival the University. Anderson’s Medical College provided excellent training for aspiring physicians and surgeons in anatomy and in the science of medicine and was a training ground for aspiring lecturers and Professors at the University. There were 700 students matriculated in 1830. Medical training was first rate and as an extra mural medical school, played an important role in the training of doctors at the GRI. By 1840, Anderson’s University had twice as many medical students enrolled as the University. It’s scientific departments eventually became the Glasgow Technical College in 1886 and in the 1960s, the University of Strathclyde.[5]

The First Royal Infirmary of Glasgow

     The continued rapid growth in the population of Glasgow to feed the industrial machine and the success of the Royal Infirmary of Edinburgh, both as a teaching hospital linked to the University of Edinburgh and in providing institutional care for the working poor in Edinburgh city, soon prompted a rethink by those in most need of a healthy workforce, the factory and mill owners of Glasgow.

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Map of land around the High Church and St Nicholas Hospital by John MacCarthur, 1778[15]

There was also a political aspect to the need for advanced healthcare for the working poor. This was the time of the French Revolution and the new social and political ideology from France lent credence to worries of a French invasion. Insurrection was a constant fear for the governing and upper classes and so it was in their interest to support the ‘common weal’.

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Professor George Jardine

On 5th June, 1787, a meeting of those interested in the foundation of a hospital in Glasgow met with George Jardine, Professor of Logic and Alexander Stevenson, Professor of Medicine. Within 2 weeks, a committee had formed, including the President of the FPSG, that began laying plans for ‘the relief of indigent persons labouring under poverty and disease’. The first legacy was £300 from the will of one James Coulter who died in 1789 and this did much to encourage the team. They had to seek a Royal Charter in 1791 and began to organise for the collection of subscriptions from the working poor and the middle classes. All legal fees incurred by this were gifted to the Infirmary building. In 1792, a Royal Charter was granted by the Crown, to establish a Royal Infirmary in Glasgow providing charitable care for the working needy of the city. The choice of site was driven by cost, proximity to water, water drainage and to the nearby University Medical School which was within the ‘Old College’ on High Street.

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University Courtyard, High Street ‘Old College’ 1761[14]

The ideal site was Crown property leased to the Earl of Dundonald until 1792 and close to the Glasgow Cathedral. This was at the site of the former Archbishop’s Castle and yard established in the 13th Century. Professor Jardine persuaded the Lords of His Majesty’s Treasury and Barons of the Exchequer to grant the land for the Hospital. This site was ideal since there were two Scotch acres available suitable for the Infirmary and also a walk for patients. It was just up High Street from the University of Glasgow (College) and also in proximity to the largest cemetery in Scotland which eventually became the Glasgow Necropolis in 1835.[6]

 

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Royal Infirmary to be built on site of Archbishop’s Castle, West of the Cathedral of St Mungo, 1792[10]

The site was high above the city, well aired and could not be surrounded by buildings. There was a sufficient supply of good water from wells within the castle and grounds, and it was near the Monkland canal. There was also a public washing green at the Molindinar Burn nearby. As it happened, a water pipe required to be laid from the Monkland Canal to GRI in 1794 and the water filtered before use. Some decades later, supply was from Loch Katrine from the Glasgow Water Works.

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Robert Adam, Architect

     Robert and James Adam, Scottish architects and designers based in London, were asked to produce a 4 storey and basement building for 136 beds, eight wards with 17 beds each, within the financial means of the good people and Institutions of Glasgow. In May 1972, the foundation stone of the Royal was laid by the Lord Provost assisted by James Adams, architect, and Messrs Morrison and Burns, Contractors. A Benediction was then pronounced over the stone. “May the Grand Architect of the Universe grant a blessing on this foundation stone and may he enable us to raise a superstructure upon it which shall prove a house of refuge and consolation to the diseased poor of this city and neighbourhood”.[7]

Unfortunately, Robert Adam died before his plan was completed so it was brother James who was present at the opening of Glasgow Royal Infirmary (GRI) in 1794.  The whole building endeavour cost £9,000. Jardine, an able administrator and said to be consumed by zeal and philanthropy, chaired the Board of Management for another 20 years. Robert Cleghorn, past president of the FPSG and physician to the GRI was also on the Board as was David Dale the industrialist and philanthropist who founded New Lanark. The President of the FPSG and Professors of Medicine and Surgery of the University were on the Board ex officio.

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Miller Engraving of GRI from Kirkgate. Building with steeple is Trades Hospital, 1800[10]

  Surgery and medicine were in the same building and because it had always been planned that GRI would be a teaching hospital, there was an operating theatre beneath the huge dome which held 200 students and apprentices. The theatre became a chapel on Sundays for early morning services so it was no surprise that it became a permanent chapel for the Infirmary when the Lister Surgical Block opened 60 years later,

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Permanent Chapel in the dome from 1861[10]

Students would come for teaching from the University on High Street or from the FPSG. The sick-poor could receive free advice from attending physicians and surgeons in the ‘waiting room’ at GRI (forerunner of Casualty/Accident and Emergency) which was in the vestibule of the Adam building and in the first year, had seen 3,000 individuals. The more sick and therefore less fortunate would have required ‘lines of admission’ from GRI subscribers which guaranteed admission. Wards were opened incrementally when funds for equipment became available. In the first year, 276 were admitted to the wards. In 1796, a report on the finances of the Infirmary widely circulated in Glasgow reminded non-contributors that they were not exempt from the ills of life. It went on that ‘time may come when assistance and sympathy of others may be more useful and comfortable than all their current possessions’. In the annual report of that year, the Managers ‘acknowledged the faithful and useful labours of medical gentlemen who, leaving their business 2 hours each day, employ their time in the painful and fatiguing labours of the Royal Infirmary’. The most junior physicians and surgeons (clerks) were not resident initially but by 1796 it was decided that they were required to stay within the premises and were charged £30 for the privilege of full board. The Apothecary was charged with collection of student fees and the money paid by patients. Together, the Matron and the Apothecary had to check that the gates were locked each night at 10pm and that no member of the team were absent without leave. By arrangement with the FPSG, 2 attending part-time physicians, Drs Hope and Cleghorn, provided the medical expertise and were given permission to lecture in 1794. Four surgeons in rotation provided the surgical expertise and Mr John Burns began giving lectures in Surgery in 1797. Pure surgery was very primitive given the lack of anaesthesia and inevitability of post-operative infection. In 1800, for example, there were only 41 operations on 803 patients and by 1840, only 120 ops on 5185 patients.[7]

In November, 1797, two sedan chairs were purchased to convey fever patients to hospital in order to prevent public infection. This was the beginnings of an ambulance service. Initially, one of the surgeon clerks was the apothecary (dispensing pharmacist) but in 1800, John Allan was appointed to provide, prepare, dispense medicine and take care of the leeches.

The University wanted their own medical professors to provide lectures at GRI but the FPSG guarded its monopoly on lecturing resolutely and it remained a bone of contention between the organisations until 1907-11 when the Muirhead Trust intervened to make the University an equal partner with FPSG in medical/surgical undergraduate training at GRI.

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Adams Building Logo for GRI Annual Reports

As a voluntary hospital from the day that the first stone was laid, GRI had to raise its own capital and running costs but this provided fewer difficulties than one might expect because Glasgow was a generous city. There was strong financial support from the Faculty of Physicians and Surgeons of Glasgow and the University contributed a massive £500 to the construction. In 1802, the First Regiment of Glasgow Volunteers disbanded and gifted £1200 to GRI. Inevitably, however, GRI’s fortunes became closely linked to the economic health of Glasgow’s trade and industry. At the time, Glasgow was a major port. Shipbuilding had developed as had light and heavy engineering which were all labour intensive.[13]

Throughout this early time, the innovative methods used by GRI Board of Management to seek financial support were of the greatest importance. There were three broad classes of revenue. Firstly, there was conditional income where money was received for a service that the Infirmary could supply to the donor. Examples were the regular subscriptions from the middle classes and working families which provided access to the hospital when necessary, the charging of patients who could pay for their board such as the soldiers billeted locally, contributions from local merchants, factory owners and church congregations for health care access for their employees or parishioners, the money raised from the sale of student ‘tickets’ to attend the wards and theatres for teaching and practical experience and for the resident clerk’s board and lodging.  Secondly, there were the free gifts where there was no condition or restriction such as legacies from estates, donations from the wealthy middle class, gifts of small or large sums, fines, special collections after sermons relating to ministry, exhibitions and lectures by medical staff, and money raised from specific social events or publications.  This included the Charity Box which was kept in full view in the Adam’s building (The Auld Hoose). Finally there was hospital income itself derived from lands, rents from houses that the hospital had been gifted, and the interest on all capital, Bonds or accumulated stock invested in the City. The GRI was never wealthy in the final category since most funding was used to improve the premises.

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The Collection of Subscriptions

In 1810, fees paid by students for tuition in wards or in lectures amounted to over £200.  In the early days, those in the community who paid a lump sum of £10 or an annual subscription of 1 guinea (£1.10) were entitled to recommend one patient each year to be admitted to GRI for treatment. Those, such as the landed gentry, who provided a higher donation could recommend more individuals to the hospital.

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The Adam Block in 1807 with St Nicholas Hospital and Trade’s Almshouse on Kirk Street by Peter Fleming, 1807[15] 

The Board’s overall success in income generation from the general public was indicated by the addition of a further 72 beds in 1815 with the construction of a North Block in

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GRI Adam Block with North Block, 1815

sympathy with the original construction. Needless to say, however, that the stimulus

and determination to planning for a North Block was an increasing use of the Manager’s  rooms for paying patients. North block cost the sum of £4000. The beds were built at a right angle to the centre North face of the Adam building and directly into the courtyard. Interestingly, the spiral staircase providing access to the different levels of the North Block produced a deep-toned note like a great organ pipe during gales originating from the South West.

Distinguished Staff

     In the 1820s, Andrew Buchanan became surgeon to GRI after training in Glasgow, Edinburgh and Paris. He was an astute and inquisitive clinician and established the Glasgow Medical Journal in 1828 as a forum for local research.

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Andrew Buchanan

It was, however, his research instincts that he is remembered for and in particular his interest in the blood and its coagulation. He noted that there was a soluble component of blood and body fluids that coagulated in contact with serum of blood already coagulated. He called this a ‘fibrinoplastic’ substance that we now know as thrombin. That soluble component of blood he called ‘fibrinogen’. He was the first Regius Professor of the Institute of Medicine (later called Physiology) from 1839 to 1876 and in 1879, became President of FP

 

The Glasgow scene in the early 19th Century was punctuated by recurrent epidemics of cholera, typhus and enteric fevers that impacted hugely and of necessity upon the use of beds at the new hospital. Fever patients were admitted in an attempt to control the spread of the epidemic within the city. This became a real problem and in 1827, wooden huts were erected in the grounds to act as overflow for the fever cases. Since these patients were admitted as emergencies, they were non-payers and therefore during epidemics, the finances of the hospital became critical. Special appeals were made by the Board and published in the Herald at times like these to maintain solvency and the people, Trades Guilds and congregations of Glasgow rose to the challenge each time.

It was during this period that Dr Robert Perry, physician to GRI, first pioneered the distinction between typhus and typhoid which up until then were not medically recognised and, in 1836, published this work in the Edinburgh Medical Journal.[2]

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Dr Robert Perry

He also showed conclusively to the civil authorities that epidemics were related to areas where squalor and appalling poverty were the norm. He used maps to show where the fevers struck most severely and published the influential ‘Facts and Observations on the Sanitary State of Glasgow ‘ in 1844.  This was the method used years later by John Snow to show the distribution of cholera around a single water well on Broad Street in Soho, London. Perry may have been the first to use epidemiological techniques in Glasgow.[4]

Professor William Pultoney Allison, Chair of Medicine at Edinburgh, argued against the General Assembly that hypothecated taxation for the relief of the poor was a necessity in Scotland.

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Slums off High Street photographed by Thomas Annan[10]

He showed persuasively that the English system eliminated beggars and reduced destitution which was so prevalent in Scotland and successfully linked it with epidemics of infectious disease. His recommendations were accepted and the new Poor Law was passed in 1845. This taxation enabled Councils to fund the building of fever hospitals, and in 1865, Belvedere Municipal Fever Hospital was built to accommodate infectious disease in Glasgow.[8]

Fever cases in Glasgow were so numerous in 1831 that 213 out of 374 beds, which included the wards in wooden huts for 80 beds, were occupied by fever cases. GRI Managers responded by renting an unused cotton mill in town and fitted it with 135 beds to cope with the overflow of cases. Money was eventually found to build a new West-facing fever hospital at a right angle to the Adam building and this opened in 1834 providing a further 220 beds and cost £8,292.9s.3d.

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Extended Adam’s Block, new Fever Block and Glasgow University (College) in High Street by J Rapkin 1854[15]

The huts, however, became a permanent feature and when there was little infectious disease around, they were used for surgical patients. It was always thought that cases from huts recovered better because of the better ventilation.

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1832 drawing proposing a 220 bed fever hospital onto the original extended Adam’s Block[11]

Early Hospital Organisation

     In 1830, there were six main Committees of Management of GRI and senior members of staff were co-opted onto more than one committee. Committees were formed when required, such as a ‘fever committee’.

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Committees of Management for Glasgow Royal Infirmary, 1831[7]

We know from Dr Moses Steven Buchanan[7] in his history of the first 30 years of GRI, that management of the enterprise could be difficult and it was crucial to co-opt contributors and not free-loaders.

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Moses Buchanan

There were 27 Directors which included the Professors of Anatomy and Medicine of the University, President of the FPSG, Lord Provost and Dean of Guild. Eight Directors were nominated and ballotted by public bodies and 10 were also elected by ballot by the Main Subcommittee, the ‘General Court of Subscribers’. It is not clear how many were on this latter committee but it appeared to have control and the final say in any change of policy suggested by the Directors. Those who “paid the piper, did actually call the tune’.

The House Committee is likely to have been related to estate planning decisions. There was a Subscriptions Committee of 9 that dealt with all matters of income and this was arguable the most crucial of all the management groups. The Accounts Committee of 5 members were likely charged with all matters relating to yearly income and expenditure. The Weekly Committee of 5 which changed monthly, each member doing 3 months each year, dealt with matters relating to the GRI’s relationship with the outside world and in particular, complaints made by visitors, medical or surgical attendants and students. The Medical Committee of 6 probably dealt with matters medical and surgical including apothecary stock, leeches and equipment. Leeches were a substantial expenditure for the Infirmary and in 1829, they cost £89, all 22,400 of them. Castor oil on the other hand cost much less. Finally, the Provisions Committee of 13 ensured that the GRI kitchen had sufficient food, wine, victuals and fuel. The tasks of this committee was often made easier by the gifting of supplies of bread, food and fuel by suppliers in Glasgow. For example, 150 tons of coal was gifted annually for heating purposes.

     By the 1850s, the demands upon the Infirmary were increasing almost exponentially due in part to an increasing confidence in the Institution by the people of Glasgow and in part due to the rapid increase in the population within the City.

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Adam Block, Fever Hospital and new Surgical Block, 1861

It was becoming clear that medical and surgical cases should be separated and so plans were laid for a new Surgical Block designed by Clarke and Bell. The opening of this Block in 1861 completed the original Infirmary surrounding a courtyard on three sides and cost £12,206. A new operating theatre was constructed in the upper floors to accommodate 200 students. The new build brought the total bed complement to over 600. By 1886, in agreement with the Council and for the public health, infectious fevers were excluded from GRI and hospitalised in the new Glasgow Corporation Fever Hospital at Belvedere which opened in 1865.

By this time, although physicians had started to use the new monoaural ‘stethoscope’ invented by René T H Laennec in 1816, they still relied heavily upon accurate observation and skill for diagnosis.

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Glasgow Royal Infirmary: Original Fever and Surgical Blocks from Courtyard, 1880[12]
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Glasgow Royal Infirmary – The Auld Hoose (Adam) with Vicar’s Alley on the right[9]
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Glasgow Royal Infirmary: Original Adam Block from Castle St and Cathedral 1880[12]     

As part of the service to the community at large, one of the surgeons attended the ‘Waiting Room’ daily giving advice to both medical and surgical cases. It was hoped, apparently, that each patient would see the same doctor at subsequent visits and that there would be ‘recorded facts’ as to the complaint and to the means of cure. It is not clear where this waiting room was. Most likely, it would have been in one of the smaller buildings on the West side of the courtyard with the laundry and sleeping quarters by now possibly even on the site of the original Casualty Department built in 1909 and used until the 1980s when the new Accident and Emergency Department opened in the Queen Elizabeth building on Alexandra Parade. Prescriptions for attendees to the waiting room were made up by a Dispensary pupil.

The Auld Hoose (The old Royal Infirmary of Glasgow)

In the 20th Century, the GRI as an Institution played a major role in maintaining the health of the citizens of Glasgow. There was real anxiety and disquiet in Glasgow when the Board of Management made the decision to rebuild on the same site such had been the aura surrounding the building and the awe and esteem held for the work done within its walls.

John Freeland Fergus. Doctor and poet edited
John Freeland Fergus[9]

Dr John Freeland Fergus graduated MA at Glasgow in 1883, MB in 1888 and MD in 1897. He had been a resident at GRI in 1889 and reflected this mood of sadness yet one also of expectation when he penned the following poem called ‘The Auld Hoose’. He followed the ballad style first popularised by Carolina Oliphant (Lady Nairne 1766 – 1845) in her own poem ‘The Auld Hoose’ which is still sung today within the Scottish folk lexicon.

The Auld Hoose

(The old Royal Infirmary of Glasgow)[16]

Oh, the Auld Hoose, the Auld Hoose,      

That noo they’re pu’in doon,

Mair than a hunner years it’s been

The glory o’ the toon;

The memories that round it cling

Are sweet as flo’ers in May;

But the Auld Hoose, the Auld Hoose,

It’s passing fast away.

 

Oh, the Auld Hoose, the Auld Hoose,

What though the wards were wee;

Nae better wark than there was done

We couldna wish to see.

And, oh, the leal and kindly hearts,

That through the lang, lang years

Wi’ pity  tended on the sick

Or soothed the dyings’ fears.

 

Oh, the Auld Hoose, the Auld Hoose,

What names it can reca’;

But Lister’s, a’ folks maun aloo,

Maist glorious o’ them a’;

His name’s a treasured memory

That lives in every stane;

And still will live, although ere lang

The Auld Hoose will be gane.

 

Oh, the Auld Hoose, the Auld Hoose,

Beside the auld High Kirk,

Fu’ mony a cheerin’ beam it’s thrown

Ower a’ the city’s mirk;

The radiant light that frae it streams, Will aye haud on to burn;

Although the dear Auld Hoose itsel’

To dust and ashes turn.

 

Oh, the Auld Hoose, the Auld Hoose,

Sae couthy, kind and bein;

Where stately ye ha’e stood sae lang,

Ye’ll be nae langer seen;

But frae your ruins, born again,

The New Hoose springs to life;

Full armed, with death and dread disease

to wage a noble strife.

 

Oh, the New Hoose, the New Hoose,

We wish it a’ success,

That Heaven may aye upon it smile

And God its labours bless;

The New Hoose, the New Hoose,

It’s big and braw and high;

But, oh, it’s chiefest glory is

That it’s the GRI.

                                                 John Freeland Fergus (1865 – 1943 )

References

[1]           The Healers: A History of Medicine in Scotland. David Hamilton. 1981

[2].   A Medical History of Scotland. John D Comrie, 2nd edition. Published by the Wellcome Historical Medical Museum, 1932.

http://www.electricscotland.com/history/medical/scottishmedicine02.pdf

[3]          Town’s Hospital and Poorhouse

http://workhouses.org.uk/glasgow/

[4].       Physicians and Surgeons in Glasgow: The History of the Royal College of Physicians and Surgeons of Glasgow, 1599 – 1858. Johanna Geyer – Kordesch and Fiona MacDonald, The Hambledon Press, 1999.

[5]        The Shaping of the Medical Profession. The History of the Royal College of Physicians and Surgeons of Glasgow, 1858-1999.  Andrew Hull and Johanna Geyer-Kordesch, The Hambledon Press, 1999.

[6]           The Royal: The History of Glasgow Royal Infirmary 1794 – 1994. Jacqueline     Jenkinson, Michael Moss and Iain Russell. 1994

 

[7].       History of the Glasgow Royal Infirmary. Dr Moses Steven Buchanan, Glasgow, 1832. – Courtesy of Mr Alistair Tough, Archive Department, Mitchell Library, Glasgow.

https://books.google.co.uk/books?id=ppaKKNRWtPIC&pg=PA26-IA1&lpg=PA26-IA1&dq=Walter+King+Hunter+Glasgow+Royal+Infirmary&source=bl&ots=xWQr5D9u1i&sig=0UPQmtPK7mWdbAWTPxc2E765JP4&hl=en&sa=X#v=onepage&q=Walter%20King%20Hunter%20Glasgow%20Royal%20Infirmary&f=false

[8].      A Short History of Glasgow Royal Infirmary. John Patrick, 1940. Written for Colvilles magazine, Messrs Colvilles Ltd, Steel Manufacturer – Courtesy of Mr Alistair Tough, Archive Department, Mitchell Library, Glasgow.

[9].     Images courtesy of Andrew McAinsh and the Royal College of Physicians of Glasgow archive, 2018.

[10].   Images courtesy of Alistair Tough, Archive Department, Mitchell Library, Glasgow, 2018.

[11].   Image courtesy of Craig Richardson and the Glasgow Royal Infirmary archive.

[12].   Image courtesy of the Welcome Medical Library archive 

[13].    Glasgow Works: An account of the economy of the city. Michael Boulton-Jones, 2009. ISBN: 978-1-905553-35-8. Published by Dolman Scott.

[14].   Old Glasgow: The place and the people. Andrew MacGeorge, 3rd edition, 1888

[15].  Reproduced with the permission of the National Library of Scotland

http://www.maps.nls.uk/index.html

[16].      Fancies of a Physician: verses medical and otherwise, in Scots and English. John F Fergus; Brown, Son and Ferguson, Glasgow, 1938.

[17].      William Cullen engraving from Robert Chambers and Thomas Thomson, A Biographical Dictionary of Eminent Scotsmen in Four Volumes, vol 2, 1855.           

 

 

Milestones for Medicine at Glasgow Royal

     The latter half of the 19th Century was a significant era for surgery and Scotland was in the vanguard. Pioneers from Glasgow Royal Infirmary, step by step, changed the scope and safety of invasive surgery forever and radically improved the patients experience of the procedures.

Anaesthesia from Edinburgh

     It all started in Edinburgh, however, when the Professor of Medicine and Midwifery, Sir James Young Simpson began to experiment with the anaesthetic properties of chloroform after news of the trials of sulphuric ether by Dr Morton had reached him from Boston, USA in 1846.

Sir James Young Simpson Wellcome copyright copy edited
James Young Simpson

He had been sent a small supply of chloroform by Mr Waldie, chemist in Liverpool. Ether and chloroform had been used in Veterinary Medicine for 5 years but had been considered too toxic for use in humans. In 1847, Simpson was the first to show, despite opposition, how the safe use of sulphuric ether could revolutionise childbirth. In November 1847, he experimented with chloroform and discovered its superior effect and so provided a platform for its use during all surgical procedures. Despite the possible complication of epiglottal obstruction, it was rapidly and enthusiastically adopted at GRI one week after Simpson’s announcement. More certain in effect and simpler to administer, chloroform rapidly became the anaesthetic of choice in Scotland. Usually, the resident doctor administered the agent despite warnings that experience was preferable. Queen Victoria apparently was given chloroform during the birth of Prince Leopold in 1853.

Rise of Antisepsis

     Up to the mid-19th Century, however, anaesthesia was not the main problem because it didn’t matter who performed the operation, how skillful he was, how fast the operation was concluded or how sharp the utensils were, the dreadful scourge of surgery of any type was post-operative sepsis.[1][2]

Hospital gangrene, erysipelas, septicaemia and pyaemia were almost regarded as inevitable and were so prevalent that infection was called the ‘hospital disease’. Presumably, one had a better chance of recovery if surgery was performed at home and indeed many minor ops were performed in this environment by choice by those who could afford it.

Teaching Theatre edited
Teaching theatre in the Lister Surgical Block[10]

It was hoped and probably assumed by managers and surgeons alike that moving to the brand new hospital building in 1861 with up-to-date theatres and wards would reduce the incidence of this ghastly and potentially fatal condition. Unfortunately, they were all disappointed. Suppuration and ‘laudable’ pus with its associated stench continued to be the norm. Change came in the figure of  Joseph Lister who had trained in London then in 1854, spent time as an assistant surgeon and lecturer in Edinburgh with Professor James Syme, a pioneering Scottish surgeon. In 1861, he was appointed to the Regius Chair of Surgery of the University of Glasgow at GRI on the death of Prof James Adair Laurie and spent 15 months in teaching and research since there were no wards available in GRI at that time.[3][4]

A young Joseph Lister RCPS Edited_edited-1
Joseph Lister[14]

His teaching classroom was situated in the inner quadrangle of the Old College of the University of Glasgow on High Street and he also spent time profitably investigating the clotting of blood. When he started ward duties in 1862 as an assistant surgeon, he was given ward 24, male, with 14 beds and ward 25, female, with 21 beds. He was a popular teacher with students and his class in systematic surgery numbered 182 in his first year. Lister’s initial interest was in limb amputation and he duly reported that between 1862 and 1865, 45 to 50% of all his amputation cases died of post-operative sepsis despite all his efforts. Surgical wards at GRI had to be closed for cleaning if there were epidemics of septic infection among surgical cases. Wards generally were not well equipped with washing facilities and instruments were used over and over again. Operating coats were used indefinitely and surgical ligatures carried in button holes. Clearly, surgeons of the age had been unaware of the Treatise on Puerperal Fever[5] by Dr Alexander Gordon (1752-1799) of Aberdeen where in 1795, he recognised the contagious features of puerperal fever and its transmission by medical attendants or nurses who had been exposed to the disease.

Old College of the University of Glasgow where Lister taught copy edited
Old Glasgow College, High Street[11]

     Around this time, a new instrument appeared to assist diagnosis of infection so prevalent after surgery. Following publication of ‘A Manual of Medical Thermometry’ by the German Physician, Carl R A Wunderlich, the clinical thermometer came into general use in the mid 1870s.

     In 1865, Dr Thomas Anderson, Professor of Chemistry, drew Lister’s attention to the work of Louis Pasteur suggesting that micro-organisms, minute forms of life, were the cause of the putrefaction, and not emanations from the air. Antiseptics such as tincture of iodine and derivatives of coal tar had already been tried. Indeed Dr Jules Lemaire in Paris had written a book on the uses of carbolic acid in preventing wound infection in 1863 (antiseptic properties) but his methods never caught on outside the French Capital and he appeared to be using a much more dilute solution than Lister. Prof Lister heard almost incidentally that carbolic acid treatment of sewage at Carlyle had reduced the stench and unpleasantness of the Treatment Works. Anderson provided Lister with crude carbolic acid for his initial experiments and then when a purer form of the chemical became available, Lister trialled the application of a formula of diluted carbolic acid to his instruments, hands, wounds, bandages and experimented with antisepsis in all aspects of his surgical work but particularly in compound fractures where infection was guaranteed. He was fastidious in all attempts to exclude bacteria from the wounds and clearly had better outcomes than Lemaire.

Student lecture course card Lister 1867 2 edited
Lister’s Surgical Course Certificate[14]

Lister published initial results in 1867 justifying his reasoning and citing the falling death rate. He also tried to reduce the air bacteria by using a carbolic spray in his theatre. This spray went through several iterations and ended up a steam aerosol. A local instrument maker, Mr Andrew Brown of George Street made several types of spray for this research. Lister then reported that the overall use of antisepsis in his male accident ward, ward 24, between 1865 and 1869 had reduced his surgical mortality to 15%. Some British surgeons began to visit GRI to find out how to use dilute carbolic and his pupils would  also pass on his principles and methods.

 

Victorian surgeons use carboloc spray edited
Victorian surgeons use carbolic as spray for antisepsis around 1870

Lister experimented also with ligatures for arterial bleeding and found that carbolic-sterilised silk prevented suppuration following surgery. Irritation did result from the presence of silk as a foreign body, however, so he embarked upon experiments with sterile absorbable cat-gut. This was successful in elimination of both infection and irritation. Like Ignaz Semmelweis before him, however, his research, claims of originality and methods of antisepsis were rejected for a time by some GRI and UK surgeons though were more rapidly adopted worldwide, particularly in the USA.

Joseph Lister in Library of Congress
Professor Joseph Lister, London

Most surgeons in England apparently baulked at the rigmarrole, and the supposed waste of time, money and energy. He was promoted to Professor of Surgery in Edinburgh University in 1869 and continued his research into preventing wound infection with antisepsis. It was only really when he followed Sir William Ferguson as Professor of Clinical Surgery at King’s College, London in the late 1970s that his methods gained credence. He eventually met Pasteur in person in 1878. Lister had managed to completely change the global surgical approach to the prevention of wound sepsis. He had introduced antiseptic surgery to the world and had set the scene for his young pupil at GRI, Macewan, to bring modern aseptic surgery into the 20th Century and to remove the fear associated with ‘hospitals’.[6]

Lister is also known for his early research on the coagulation of blood and he was clearly influenced by the work of Andrew Buchanan, one of his predecessors at GRI. He probably was the first to demonstrate scientifically that there were two systems operative in blood coagulation, the intrinsic and the extrinsic. Lister did publish on chloroform anaesthesia and advocated use of the conjunctival reflex for assessment and advised fasting before surgery. Since he believed that experience was not required for the use of chloroform, surgeons at GRI controlled the teaching and administration of anaesthesia for several decades thereafter.

Lister was President of the Royal Society (1885-1900) and President of the British Association (1896). He had many honours, British and foreign and was made a Baron in 1897. He died in 1912.

 Aseptic Surgery Triumphs

     Professor Sir William Macewan, MB 1969, a pupil of Lister’s and dresser in his wards as a student, became an assistant surgeon at GRI in 1875, a surgeon 2 years later aged 29, then a lecturer in systematic surgery at GRI School of Medicine.[5]

He had also spent time as Superintendent of the new Fever Hospital at Belvedere and while there, had experimented with rubberised elastic catheters from mouth into trachea in cases of laryngeal obstruction due to diphtheria. This was the first endotracheal tube and his invention to preserve life in a severe attack of diphtheria was soon to be crucial in the new speciality of anaesthetics.

Sir William Macewen (1848-1924)
Sir William Macewan[11]

Macewan carried his mentor’s antiseptic principles further by introducing the complete aseptic theatre environment by adopting the scrubbing of hands and arms for cleaning and disinfection, by steam sterilisation of surgical instruments, by use of sterile surgical gowns, by the sterilisation of dressings and swabs and finally by fully adopting the new chloroform anaesthesia to reduce the horror of surgical induced pain. He was one of the first to ask his colleagues administering the anaesthetic to use the endotracheal anaesthesia with equipment which he had personally designed and developed. He introduced catgut hardened in chromic acid  which not only sterilised it but lengthened the time for its absorption.

Dowell, Charles R., c.1876-1935; Sir William Macewen (1848-1924), CB, DCL, FRS
Sir William Macewen by Charles R Dowell

Macewan became one of the most innovative surgeons of his era and was able to advance modern surgical technique in neurosurgery, orthopaedics, hernia repair and other invasive surgical specialities in particular, thoracic surgery. His expertise in bone grafting was important in surgery required for the treatment of rickets secondary to Vitamin D deficiency in Glasgow. He taught that wound dressing should be left for 2 weeks if there was no sign of infection, that unnecessary damage to tissue should be avoided and that there should be minimal use of antiseptics. He also emphasised the importance of absorbable sutures. Needless to say, this transformed the recovery times and significantly reduced the mortality of his patients.

Macewan introduced anaesthesia training to the student curriculum much in the way that vaccination training was compulsory.

Sir William MacEwan in theatre 1892 edited
Sir William Macewan operating in 1892 with an anaesthetist sitting and Matron, Rebecca Strong, second from the right[14]

Macewan required well trained nursing staff for his pioneering advances in surgery, particularly surgery of the brain. He favoured a systematic basic training for nurses leading to advanced training and supported Rebecca Strong in all her endeavours to make nursing a profession. He was promoted to become the Regius Professor of Surgery in 1892 on the death of Professor Sir George H B McLeod and moved to the Western Infirmary close to the University.

in 1882, concern was being raised at the number of deaths thought to relate to chloroform anaesthesia and so training eventually became formalised to make anaesthetics a post-graduate speciality. However, it was 1905 before the first anaesthetist, Dr Laurie Watson, was appointed at GRI as a specialist on a salary of £25 per annum. The second, Dr H Prescott Fairlie was 4 years later.[7]

Among many honours, Macewan was knighted in 1902 and died in 1924.

Medical Student Training

     Throughout the mid-19th Century, Glasgow Royal Infirmary remained solvent through generous personal giving from those with means, through Parish and Kirk contributions, combined with industry and commercial subscriptions as well as the donations of wealthy benefactors and philanthropists who were particularly essential for capital projects.

GRI Collection Day copy edited
GRI Collection Day 1934[14]

In 1871, a larger dispensary for outpatients was opened and 2 years later, the number of attending physicians and surgeons was increased to 5 each, and visiting changed to 9am.  In 1875, a hoist was fitted to surgical house to facilitate movement of sick patients and in 1878, baths were fitted to all wards of the Infirmary. In 1882, the telephone was introduced which permitted ward staff to talk to seniors in their homes. In the same year, the board and lodging paid by resident doctors was stopped.

At the turn of the 19th to 20th Centuries, the original GRI had managed to  maintain the building estate and provide up-to-date charitable care not only for the working poor but also the destitute and infirm of the area. The increasingly open door policy enabled the medical students to see as much of medicine and surgery as possible and attend clinical lectures delivered in the wards by physicians. In fact, GRI trained all future generations of physicians and surgeons from the University of Glasgow until the opening of the Western Infirmary (GWI) in 1874, also a voluntary hospital. Although the scourges of typhus, smallpox and typhoid had disappeared with the advances in public health and vaccination, tuberculosis remained ever present in the adult population and whooping cough and measles killed or maimed vast numbers of children.

At this point, when the University students left GRI for the new ‘University’ hospital to complete the clinical aspects of their training, the Professor of Medicine, William Tennant Gairdner, had been a physician to GRI for 12 years. He and the Professor of Surgery, George H B MacLeod, transferred their chairs from GRI to the new University hospital at GWI. Gairdner was a philosopher and well-loved teacher who directed young minds along scientific paths in medicine. If truth be told, he was delighted at the move since he was able to improve the structure of the clinical training for his students. Apparently, clinical tuition at GRI had up till then been ‘ad hoc’ and many of the academic staff felt that the training resources of the GRI were not being used wisely.  Since the GRI was now short of medical students, the Board of GRI decided to develop their own Medical School on the model of the long established London Teaching Hospitals. A supplementary Charter was obtained that gave the power to provide facilities and accommodation for teaching of medicine and surgery. Classrooms were found within the GRI estate, and lecturers appointed to develop an in-house extra-mural Royal Infirmary School of Medicine and, aligned with the larger Anderson College of Medicine down in College Street, shared lectures and facilities.[3][4]

M0006527 Glasgow Royal Infirmary, 3/4 front.
Glasgow Royal Infirmary, Robert Adam Block, 1880[17]

Glasgow Royal Infirmary School of Medicine was in the vanguard of Institutions removing restrictions on women registering for training as doctors by complying with the 1876 Act of Parliament. Others included King’s and Queen’s College of Ireland in Dublin and the Royal Free Hospital, London. GRI admitted two female students in 1884 who were permitted to attend all clinical classes, all pathological demonstrations and to become house physicians and surgeons. These women, Janet Hunter of Ayr and Sarah Gray of London, both passed the Triple Examination in 1888.

St Mungo's Medical School
St Mungo’s Medical School

     Sir William Macewan was unhappy with the compromises in space and facilities. He managed to persuade the Board to fund, by public donation, a  purpose built College situated North of the surgical block. This up-to-date facility contained a dissecting room, anatomical museum, osteology and reading room, lecture room for 150, classrooms for chemistry and physiology, a large general medical library and administrative offices. The new College building opened for student training in 1888. One year before, however, the Anderson Medical College had moved to Dumbarton Road closer to the University because of the increasing unsuitability of their cramped central premises which required more space for laboratories. Anderson’s students naturally began attending the Western Infirmary for clinical instruction because of the proximity to that hospital.

St Mungo's College Syllabus 1911 copy edited
St Mungo’s Medical Curriculum from 1911[11]

The GRI  now had inadequate numbers of medical students who had hitherto, worked as dressers in the surgical wards before qualification and had become house officers after qualification. The GRI Board appeared to have enough on their plate at the time so called time on their school and in late 1888, handed over training of medical students to the new incorporated St Mungo’s Medical College.[3][6]

 This was designed as a complete medical faculty with professors from GRI and Anderson’s College. It absorbed the classrooms, laboratories, museum and libraries necessary for a medical course from the GRI Medical School and moved into it’s well appointed premises. The Library became the meeting place for the newly formed GRI Medical Society.

 

Triple examination crest_edited-3
Triple Qualification Colleges in Glasgow

St Mungo’s College was governed by a Board of 27 men who were appointed by the Managers of GRI. From 1886, students from St Mungo’s and Anderson’s graduated in medicine and surgery by the ‘Triple Qualification‘ in medicine, surgery and midwifery as Licentiates of the Royal College of Physicians and Surgeons of Glasgow, the Royal College of Physicians of Edinburgh and the Royal College of Surgeons of Edinburgh. St Mungo’s College actually prospered because their fees were lower than the University of Glasgow.[9]

St-Mungo's-medal-for-the-web
St Mungo’s College medal

St Mungo’s followed the GRI Medical School and complied with the 1876 Act of Parliament admitting women students who were permitted to attend all clinical classes, all pathological demonstrations and become house physicians and house surgeons.

1938-Final-Year-GRI-Medical-School-for-the-web
GRI St Mungo’s Medical Class graduating 1937 – reference to staff and students[16]

Further, by accepting Jewish applicants, St Mungo’s College was a popular choice for many students who came from the USA. At that time in the US, most Jewish individuals were banned from studying medicine at home by the operation of secret quotas. These individuals obtained their own American Diploma by passing the State exam which permitted them to practice in the USA.

While St Mungo’s Medical School had many fewer student clubs than the University with

St Mungo's Football Team edited
St Mungo’s football team, 1936

its sizeable student base, St Mungo’s mostly male students were known to regularly challenge other medical schools to football. The photograph represents the St Mungo’s football team in 1936 with many individuals graduating in 1937.

 

 

Good map of GRI John Bartholomew1982 edited
Fully developed ‘old’ Royal Infirmary. College Station has replaced University of Glasgow on High St. Map by John Bartholomew, 1882[15]

Women in Medicine

     For decades, prior to the momentous graduation of 1888, women aspiring to become medical practitioners had experienced nationwide discrimination from the governing bodies in medicine.[8]

  It was not so much a ‘glass ceiling’ but ‘the complete absence of a floor’. Some pioneers like Elizabeth Garrett Anderson managed to use a loophole in the regulations of ‘The Worshipful Society of Apothecaries’ of London and with some private training thrown in, obtained registration with the General Medical Council. She was prevented from obtaining a post in hospital, however, so after a post-graduate degree at the Sorbonne in Paris in 1870, she simply set up her own successful clinic.

Sophia Jex-Blake and several others were permitted to study at the University of Edinburgh in separate ‘ladies classes’ in the mid 1870s but the establishment closed ranks after training and refused to permit their graduation. The women had to obtain their licences from Dublin which allowed them then to register with the GMC. She later founded the short-lived ‘School of Medicine for Women’ in Edinburgh in 1886.

An early attendee at the ‘School of Medicine for Women’ in Edinburgh was a twenty-two year old Elsie Maud Inglis. She, and others, including Ina and Grace Cadell, rebelled against Jex-Blake’s methods, set up a short-lived school of medicine to rival her erstwhile tutor then eventually were forced to come West to Glasgow Royal Infirmary, it’s Dispensary and the St Mungo’s School of Medicine for 18 months to complete their practical training under Sir William Macewan. Inglis passed the Triple Qualification in 1892, and in 1894, opened a maternity hospital in Edinburgh for poor women called ‘The Hospice’ which was a forerunner of the Elsie Inglis Memorial Hospital. She eventually graduated MB.ChM from Edinburgh University in 1899, the same year as it opened its medical course to women.

Elsie Inglis best copy edited
Elsie Inglis

In 1914, her plans for an all women front-line hospital unit had been rejected by the UK Government so she led a Scottish Women’s Hospital Team of doctors and nurses to Serbia for the French Government and eventually suffered emprisonment. This gave her celebrity status and her courage, skill and endeavour were universally lauded in Britain. Having been repatriated, she eventually took another all woman unit to Russia, this time with permission of the War Office.

Inglis was a revolutionary at heart and became the Secretary of the Scottish Federation of Woman’s Suffrage Societies . Her contribution has been belatedly honoured in 2018 by having her name etched on the plinth of the Millicent Fawcett statue in Parliament Square as a crucial supporter of universal suffrage. Inglis died in 1917.

Women in Medicine and Surgery date around 1904 West end of colonnade 2 edited_edited-1
Women staff of GRI around 1904 – reference to names[15]

In the years 1884-9, 819 (96.5%) males passed the Triple Qualification (TQ) and 30 (3.5%) females while from 1890 to 1899, 2,136 (93.3%) males and 157 (6.8%) females were successful. On average, until the Universities took over all undergraduate training in 1946, about 7% of the medical class for the TQ was female. It is estimated that about 50% of those sitting the TQ were successful. The first successful woman to pass the TQ was Alice Ker who received her diploma on 30th July, 1886.[9]

Subsequently in 1889-2, the Universities of Glasgow, Edinburgh and London opened up registration for medical courses to women though for some years, classes were separate from the men. The first ladies to graduate MB CM from Queen Margaret College at the University of Glasgow were Marion Gilchrist and Alice Louisa Cumming in 1894. The first lady resident at GRI was Marion Jamieson Ross who graduated from Queen Margaret College in 1898 and was resident in the same year.

Women doctors were still barred from Fellowship of the Faculty of Physicians and Surgeons of Glasgow up till 1912. The first lady Fellow was Yamani Sen, a Licentiate in Medicine and Surgery of the University of Calcutta.

Medical ward in the 1980s at GRI in Adams Block RCPSG
Medical Ward in Adam Block[14]

 Reform of Nurse Training

 Until the 1860s, nursing of the day attracted a largely unsuitable cohort of individuals who were  often uneducated, malnourished, and untrained in the concept of cleanliness  and hygiene.    It was open to all comers and work was hard with the day shift starting at 6 am and finishing at 10 pm. As well as looking after the patients, the nurses were effectively housekeepers with duties which included dusting, cleaning rooms and washing down the long corridors. Many effectively lived and slept in rooms attached to the wards or in a building which was built facing onto Castle Street, South of the Gatehouse. Clearly, parents of able young women of sound character would consider hospital the last place when considering a career for their offspring.

 As a young widow aged 24 with a young child to support, Rebecca Strong was the 135th entrant to the Florence Nightingale School of Nursing at St Thomas’ Hospital, London in 1867. She completed the probationer training a year later and had further experience working in the Military Hospital, Millbank, and Winchester Hospital.

Florence Nightingale GRI whole sculpture edited_edited-1
Florence Nightingale, GRI

Her experience and insights allowed her to pioneer nursing reform unthinkable in the mid 19th Century and after a spell as Matron of Dundee Royal Infirmary, she became matron of GRI in 1879, the largest voluntary hospital in Scotland.

Rebecca Strong info copy edited B & W
Rebecca Strong

Nursing at GRI prior to 1879 was at a low ebb with organised training minimal. Lectures were arranged to provide training by the physicians and surgeons of the hospital, but they were held often after a 14 hour shift in the wards. Rebecca Strong’s ambition and passion was to professionalise their craft by improving the working conditions of nurses along with their education and training. She battled against the male dominated hospital culture which saw nurses as pairs of hands only fit for the most menial of tasks. As a first stage, she persuaded the Board of GRI to buy new uniforms to provide an ‘esprit de coeur’ as well as a clean apron.

Rebecca Strong sister uniforms edited
Rebecca Strong Sister’s Uniform

In light of her increasing reputation, experienced nurses came to GRI from London, Edinburgh and from all over UK for further training. She had a redoubtable ally in William Macewan who always believed that nurses required more than basic training and education. He believed that nurses required specific training in anatomy, physiology, therapeutics, medicine and surgery to enable them to understand the progression of disease and the treatment that was provided. She was attracted to Macewan’s approach to care and provided him with the most able of her probationers. Apparently, Macewan nurses became particularly loyal to the great man and even purchased a fish-kettle to enable him to sterilise his instruments.

Strong always insisted that a nurses home was essential for nurses welfare and for success of any School of Nursing. When she resigned to make her point crystal clear, the Board in 1888 eventually built her a nurses home with 88 bedrooms and a glazed covered way, called the ‘colonnade’ and providing shelter to nurses going to the wards. When Strong was re-appointed Matron in 1891, she was able to reassure women entering nursing school that living and working conditions were improving. The Nurses Home was extended in 1926.

In 1893, the Board agreed that all probationer nurses should be required to produce evidence of educational attainment before their acceptance into the training programme.

Nurses covered walkway to nurses home edited_edited-1 B & W
Covered shelter for nurses 1890[11]
School of Nursing badge 1950 edited
GRI Training School Crest 1950

 With the support of Macewan, a ‘Preliminary Training School for Nurses’ (PTS) was established providing a systematic course of training followed by an examination. She developed the Block Apprenticeship programme where short periods of instruction in school were followed by periods of clinical practice in the wards. The Training School proper opened in 1893 with the support of the GRI Board and the practical assistance from St Mungo’s Medical College who provided two courses of instruction for the pupil nurses. Firstly, 3 months of lectures in anatomy, physiology, and hygiene followed by examination. A pass permitted the pupil nurse to start training in medicine, surgery and practical nursing, again with examination. The prospective nurse was then able to enter the hospital with this theoretical knowledge. Nurses were now receiving at GRI a more thorough and technical education that was available anywhere else in the United Kingdom.

Rebecca Strong and her nurses at GRI edited
Rebecca Strong with her team of Sister Tutors and graduating pupil nurses around 1895 in front of the South door of the Adams building

This training programme was very successful and popular with able young women who wanted to nurse and this more rigorous and theoretical nursing education approach was later adopted by other teaching hospitals and imitated in the UK and worldwide.[10]. 

John A Thomson's mother finishing as probationer 1922
Graduation photograph of the 1924 probationer nurses at GRI with Miss M S Donaldson, OSS, Matron, in front of the Templeton Block of the new building[20] 
As well as improvements in accommodation arrangements, financial considerations also changed which gave nursing a new status in the community. Nursing hours decreased from an average of 15 per day in 1870 to 11 hours in the 1890s. The nature of duties also changed with domestic chores ending to permit the nurse to concentrate her efforts exclusively on patient care. In 1895, Mrs Strong addressed the Matrons of the London Teaching Hospitals to explain the advantages of her theme of education for the advancement of nursing. She therefore played a major role in hospital reform in the UK by providing a resource of well-trained nurses upon whom the care of hospital patients depended.

Sister Tweedlie teaches at the bedside_edited-1
Sister Tweedlie teaches at bedside 1960, with staff nurse (right) wearing ‘Wings’

Mrs Strong

Nurses badge GRI eduted
Nurses Badge

supported the State Registration of nurses which enabled standards to be upheld throughout the country and this began in 1919. The Nurses (Scotland) Act established a register of qualified nurses and a General Nursing Council. By formulating rules for nurse training and arranging for State examinations in the larger training centres, the Nursing Council improved and standardised general nursing qualifications. In 1918 Strong helped found the Scottish Nurses’ Club in Glasgow and in 1921 she was in the chair at the inaugural dinner for the Glasgow Royal Infirmary Nurses’ League. Miss Jane Melrose became Matron on Rebecca Strong’s retiral in 1903.

GRI witnessed this revolution in bedside nursing care and profited by it. A new PTS was purchased in the West end of Glasgow at 4-5 Lancaster Crescent with accommodation for 53 pupil student nurses and consisted of Lecture Rooms, a Practical Demonstration Room, a Demonstration Kitchen, a Laboratory, Sitting Room and Dining Room. Following the 3 months in PTS, the probationer spent 3 months in the wards of GRI before full acceptance for a further three and a half years training, two and a half as a pupil nurse and 1 year as a fully trained staff nurse permitted to wear ‘wings’.

An old Rebecca Strong edited
Rebecca Strong O.B.E.

Not before time and aged 95, Rebecca Strong was awarded an O.B.E. in 1939 for services to nursing.

In the early post-war years, the Wood Report advised that student nurses be relieved of repetitive and non-nursing duties to enable basic training in 18 months which would permit a further 6 months of concentrated study in a speciality before registration. In the 1950s, GRI embarked upon an experiment in nurse training that would see essential theoretical and practical training completed in 2 years followed by a 3rd year of practical experience before registration. Apart from the integration of theoretical and practical instruction, the other objective was to establish the concept and practice of team working. This was a success and led to greater personal contact between patient and nurse and could be implemented by nurses in training. A further experiment in training in 1957 saw a streaming of the more educationally qualified probationers into a more academically oriented training based in teaching premises on Clevedon Road, Glasgow. These ‘Clevedon Ladies’ were, in fact, the first steps in Glasgow towards a degree course in nursing.

The University of Edinburgh had a degree course in Nursing studies from around 1960. It was the recommendation of the Briggs Report in 1972 that brought graduate training in Nursing to the fore in Glasgow. Under the guidance of Professor Edward McGirr who was Dean of the Faculty of Medicine, a joint committee of Greater Glasgow Health Board and the University agreed to set up a 4 year course for an ordinary degree combining academic study and professional training. The graduates were recognised by the General Nursing Council of Scotland for registration as a general nurse.

From the 1980s, nurses at GRI have increasingly become an integral part of the care package with autonomy of action within the medical or surgical team.

      The Electrical Department

Coincidental with advances in medicine, surgery and nursing of the mid to late 19th Century, reform of public health, sanitation, water supply, food storage and supply contributed to improvements in Glasgow’s population health at this time. The 20th Century appeared with confidence bringing with it the advances from the 19th Century in antiseptic surgery and more complex surgical treatment following upon the discovery of ether and chloroform. Anaesthesia in the UK had advanced quickly following the introduction of chloroform in Edinburgh by Sir James Young Simpson for obstetrics in 1847 and Macewan had been instrumental in embracing lessons from the new specialists  in surgical theatre, the anaesthetists, and applying them to ever more complex surgical procedures. Pre and post-operative nursing care improved too with the recruitment of able and motivated nurses, a greatly expanded training programme and improvements in their working conditions.

Diagnostic radiology also appeared in the first X-ray department in the world at GRI in March 1896 with the title ‘the Electrical Department’ under Dr John Macintyre only months after Röntgen‘s discovery of X-rays in 1895[11].

John_Macintyre
Dr John Macintyre

Macintyre, a Glasgow graduate, became the medical electrician to GRI in 1885 having originally trained as an electrical engineer and in 1886, became a demonstrator in Anatomy at the Royal Infirmary Medical School and surgeon for diseases of the throat. James Thomson Bottomley, a physicist, was alerted to Röntgen‘s discovery by Lord Kelvin of the University, and working quickly with Macintyre at GRI to demonstrate the power of X-rays, the potential to reveal hidden disease was clear for all to see. Macintyre started the GRI Electrical Department (X-ray) in 1896 as a Department of Surgical Photography and persuaded the Board of GRI to pay for electrical cables from the Department to all the hospital wards and operating theatres to avoid the need for carrying the heavy equipment around the hospital. In 1897, ‘the New Electrical Pavillion’ opened in the ground floor of the old Surgical Block at GRI in Lister’s old wards and equipment was purchased for this revolution in clinical diagnosis.

The electric Pavillion GRI 1896
The Electrical Department 1897, surgical block[10]

Apparently, the Department had its own generator in case the mains supply from Glasgow Corporation went down. He founded the Röntgen Society of London being their first President in 1900. The Department became more and more busy and by 2003, Macintyre was warning the Board of the inadequate space in which he was working. It was not till 1914 that they moved into a custom built department in the basement of the Jubilee Medical Block. The first issue of the journal ‘Archives of Clinical Skiagraphy’ had 3 papers by Macintyre. This journal was the forerunner of the British Journal of Radiology.

Redevelopment at Last

     These multiple revolutions in patient care highlighted for the Board of GRI, the unsuitability of the GRI estate, patient accommodation and theatre provision for the present let alone the future. The Lord Provost of Glasgow, Mr David Richmond, had no problems therefore in persuading the Hospital Board in 1897 to commemorate the 60th Anniversary Year of the reign of Queen Victoria by replacing the historic block built by the Adam brothers with a modern building. Planning started around 1897 for a new 6 floor modern Surgical Block designed by James Miller ARSA, FRIBA who had been the architect for the 1901 Exhibition in Kelvingrove. The new building was constructed North and behind the old surgical block which required the exhumation of around 5,000 bodies from the 1849 cholera epidemic pit situated behind Lister’s ward 24. They were re-interred at Sighthill cemetery in 1905. The Foundation Stone was eventually laid by the Prince of Wales in 1907.

James Miller's Block plan for GRI reconstruction edited
James Miller Block plan of GRI showing both original and proposed buildings[16]

The building called the Robert and James Dick block was opened to patients in 1909 in recognition of the crucial gifting of the Dick family.

Marjory Shanks Schaw memorial 2nd floor surgical edited
Plaque on 2nd floor surgical to Marjorie S Schaw

It cost £500,000 to build. Other gifting was from the Trustees of Miss Marjorie S Schaw who endowed the three second floor wards of this block as the ‘Schaw Floor’. The Casualty and Admission Block on the West of the courtyard also opened that year with underground access to the ward blocks for patients requiring admission by trolley.

A Less busy Casualty Department B & W edited_edited-1.jpg
The New Admission Block completed 1909 which became The ‘Casualty’ Department[16]

A new Pathology Department followed and then in 1912, the Special Diseases and Administration Block designed by Miller opened as the Templeton Block in recognition of the gifting from the local carpet manufacturer.

Modern GRI emblem in the Star edited
Glasgow Royal Infirmary crest in the ‘Star’

This block, the largest of the three, was built to a different specification with a rectangular turreted central entrance tower  compared with the dome of the Medical block. Inside is a central circular ‘well’ with steps to each floor at the rear. The ground floor has an arcade feel with Scottish 17th Century detailing and terrazzo marble flooring with a symmetrical multipointed star in the centre of the well with the crest of the Glasgow Royal Infirmary set within the marble. ‘Auspice Caelo‘ means ‘Favoured by Heaven’.

Insight into the conditions for residents and staff during the old hospital’s existence can be obtained from the records of the Glasgow Royal Infirmary Residents Club.[18]

demolition of Adam Block at GRI edited
Demolition of Adam Block begins 1911[15]

Finally and many years after Queen Victoria’s Jubilee (1897), Miller designed the 6 floor Jubilee Medical Block with a basement and an extra floor providing for 5 Medical Units.

Medical-wing-of-GRI-circa-1900-001-saved-for-web
The new Queen Victoria Jubilee Medical Block 1914[14]

He cleverly reproduced features from the Adam scheme including the dome and supervised it’s building.

Dummy clock erected as trial 1914 edited
Dummy clock in situ in Jubilee Block[11]

The Board decided not to replicate the clock on the South face of the building after a trial of a dummy clock in situ. This was because it occluded a window in the Matron’s accommodation under the dome. A large bronze statue of Queen Victoria by Albert H Hodge was placed over the main South entrance and was a gift of Dr John and Mr James Templeton. Opened in 1914 by King George 5th as the new Queen Victoria Jubilee medical block, the Radiology Department in the basement was called the ‘King George 5th Electrical Institute’.

The old surgical block including the Lister wards remained in situ and within the new courtyard. It was used throughout WW1 by the military for wounded soldiers and thereafter as a cloakroom for female medical students attending classes at GRI. The Lister lecture theatre was opened in October 1928 along with two Casualty wards and a waiting room.

Lister plaque on Casualty wall Wellcome copyright edited_edited-1
Plaque on Castle Street commemorating the Lister Wards[13]

There then appeared a long campaign in Glasgow and furth of Glasgow to have one of Lister’s wards preserved in honour of the man, his achievements and the hospital where surgery entered the modern era. Distinguished surgeons from many continents including Kocher from Switzerland and the Mayo brothers from the USA wrote about their support for the concept. The Board had the final say, however, and the building was eventually demolished in 1925 to be replaced by the Lister lecture theatre erected at the site of ward 24.

Demolition of Lister's surgical Unit built 1861 edited
Demolition of old surgical block (Lister and Macewan) from Castle Street[13]
Old Lister wards for demolition and Lister lecture theatre_edited-1
Demolition of old surgical block (Lister and Macewan) from The Medical Block. New Casualty and Admission Block on the left of courtyard[16]

Drawing of Surgical and Admin Blocks edited
Drawing of ‘new’ Surgical and Centre Blocks

The continued support from the working citizens of Glasgow and from those with means remained crucial throughout the early to mid 20th Century. Catherine Weaver Bequest 1st Floor surgical GRI edited

One unusual but very generous donation known as the Catherine Weaver Bequest was a Deed of Covenant providing free care at GRI for any poor Brazilian visitors or residents of Glasgow who were not subscribers. The commemoration plaque remains on first floor surgical in the old surgical (Dick) block. This bequest was arranged by John James Weaver, retired cashier and accountant of the City of Liverpool as a memorial to his late mother and was to be used for the general purposes of the Infirmary. He was formerly of Manaos Amazonas, Brazil and his reasons were the Brazilian courtesy and consideration shown during his long residence in Brazil.

In 1933, alarmed by the readmission rate from treated medical and surgical cases, The Board sectioned the appointment of the first almoner to GRI having come to the conclusion that social factors were playing an important part in the continuation and causation of disease. By 1942, there were 8 fully employed almoners to look at the environment in relation to diagnosis. The cooperated with medical staff to remove the social conditions affecting recovery.

The complete building renewal in the early 20th Century set the scene for further monumental advances in medicine and surgery with accommodation for patients and staff that was of high standard and flexible. For years, space for outpatients had been inadequate being usually linked to the Dispensary and Admissions Block.

Royal Asylum for the Blind - part of GRI site since 8198 edited_edited-1
The Blind Asylum, 1901

In 1934, the GRI Hospital Board acquired the ground and buildings of the contiguous Blind Asylum in Castle Street just North of the St Mungo Medical School and new Outpatient Dispensary. A new well-appointed out-patient Department in the converted and upgraded Asylum buildings within the quadrangle was opened in 1940 by RH John Colville MP of Colville’s Ltd which also contributed to the cost. The new facilities included a surgical department on ground floor, medical department on first floor, gynaecological department on second floor and was completed by an outpatient X-ray department on third floor. The five sided clock in the iconic hexagonal steeple is all that remains to this day with the sculpture of ‘Christ healing a blind boy’ by Charles Grassby. It also reveals the gateway, lower right, to wards 40 – 43. This outpatient configuration continued until 1983 when it moved to the new Queen Elizabeth building on Wishart Street. In the 1960s, cardiac surgery was eventually placed on second floor within the existing asylum building on Castle Street. In 1935, GRI also agreed to take over the work of the Glasgow Central Dispensary which had been situated in the old Anderson’s College Dispensary in Richmond Street but it was not until 1940 that the transfer occurred.

 

The sketch below shows the new outpatient department within the recently purchased Blind Asylum and the gateway to wards 40 – 43.

Miller plan for GRI 1939 edited
James Miller Sketch of GRI Estate, 1939[16]
The War Years and Penicillin

Help from the citizens of Glasgow had always been required but never more so than during the war years when volunteer support was necessary to protect the building from shrapnel and incendiary bombs. Like all general hospitals in Glasgow, GRI was under the control of the Department of Health for Scotland who provided a contribution to running costs in lieu of air raid and service casualties. In fact, accidents related to the black-out were more numerous than those due to air raids.

Sandbags at GRI in 1940 edited
Volunteers place sandbags  around GRI in 1939

An Emergency Medical Service (EMS) was developed nationwide to receive and treat casualties and beds were reserved for that purpose at the Royal. Existing patients were transferred to GRI’s associated hospitals at Schaw Home and Canniesburn to leave beds free for casualties. Other war-time innovations at GRI included the Burns Unit led by Tom Gibson, Neurosurgery led by Sloan Robertson and an enhanced blood bank under the National Blood Transfusion Scheme organised by Alice Marshall. Wartime required an unprecedented control by Government over decisions by GRI and this in turn provided Government with a rudimentary blueprint for a unified health service in the UK.

The Royal Infirmary was one of the national hospitals specially tasked in the early 1940s with trials of the new antibiotic penicillin which would arrive in vials of purple coloured liquid to be refrigerated on the wards prior to use. The first administration of penicillin at GRI was by Mr William (Willie) Beattie to a young man with meningococcal meningitis. Against all known odds, the young man was cured and the GRI, which had led the world in antisepsis and then asepsis, entered the early antibiotic era with a drug that was, at last,effective against Gram positive bacteria. The urine of all patients so treated would be collected for several days thereafter to permit recycling and reusing of the excreted penicillin. When commercial supplies of penicillin became available for clinical use 3 days after D-day on the 9th June 1944, the Royal became the distribution and advisory centre for the large supplies of the antibiotic in the West of Scotland.

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National Health Service inauguration 5th July 1948

After the General Election of 5th July, 1945 had resulted in a Labour Government, the network of voluntary hospitals  which stretched nationwide suddenly appeared redundant to the local  needs  as the Westminster plans were laid for a National and Comprehensive Health Service. The Board of GRI found it increasing difficult to raise the finance necessary for such a large hospital in light of the  increasing reluctance to fund GRI as before. It was really only the development of the National Health Service in 1948 with the Government funding which accompanied it that brought relief to an intractable and existential problem. So ended GRI’s role as a voluntary hospital reliant on the generosity of the citizens of Glasgow and those with means. Walter Henderson, who was on management at that time, wrote in the last Annual Report of 1947/48 that ‘contributers (financial) could be proud of the inheritance they were handing over to the State – the result of voluntary effort’. He continued that ‘GRI was a lasting memorial to the warmheartedness of the citizens of Glasgow and was a gift worthy of this “no mean city”.

The explosion of medical, surgical, nursing and technical advances in the mid-to-late 20th Century would require further upgrading and rebuilding 60 years later but that would require scarce National Health Service (NHS) resources and is quite another story.

Glasgow Royal in Poetry

Glasgow Royal Infirmary was an important lifeline for the citizens of Glasgow from 1794. Although a voluntary hospital reliant upon fees for admission, it’s policy was to admit emergencies without a requirement for payment. This engendered universal admiration, honour and esteem for GRI as an organisation among the surrounding populace. It is unsurprising that this would happen among  predominately poor social groupings since upon admission to a warm, clean bed and being provided with 3 meals each day, many would feel they had been sent to heaven. The population admired and supported the work done in ways that are almost unthinkable in our present day NHS where, more commonly, one finds a culture of entitlement. John F Fergus who wrote ‘The Auld Hoose’, a ballad about the first Glasgow Royal, also penned his deeper thoughts on the Institution called the GRI using Biblical allegory. He used his experience of its many patients and staff to capture the love and almost veneration for the Institution which, for some, represented the nearest place to ‘Holy Ground’.

The Auld Hoose (The Spirit of the GRI)[19]

More than a hundred years have rolled

Since near God’s House it raised it’s head

A house of hope, of life, of love

Beside the dwelling of the dead.

There stand the twain – the Almighty’s fane

Where lie the dead in hallowed ground?

This shrine of suffering – and in both

The Spirit of the Lord is found.

 

For not in temples made with hands

Doth God alone delight to dwell;

The humble, reverent, searching heart

The world’s great Master pleaseth well.

The Hymn of human thankfulness,

That rises hence throughout the years,

Strikes sweeter far than incensed praise

Upon the Almighty’s listening ears.

 

The higher that the temple stands

The deeper is the quarry riven;

From pain’s dark depths were hewen the stones

That raise this temple nearer heaven.

And who the builders? Look around

If you their multitude would see –

The sick, the halt, the lame, the blind,

Poor brethren of adversity.

 

Each bringing to the destined place

The polished stones of thankful praise,

That, slowly garnered through the years,

At length the perfect fabric raise

Which stands unblemished in its strength,

And still shall stand while ages roll,

Firm – braced against the shocks of time

By stanchions of the human soul.

 

What of the ministrants who wait

Within the temples sacred walls,

To whom, to serve its holy courts

The Spirit of the Master calls?

“Unto the least, unto the least”,

Although perchance their service be,

Yet rings the verdict from on high,

“Yea verily,  ‘tis unto Me”.

 

A splendid heritage is theirs

Descended thru untarnished years

Of tiredness, toil, of scorned delights,

Laborious days of hopes and fears;

A heritage of lustrous names,

Of honoured worth, of high desire,

And theirs the treasured privilege,

To tend with care the sacred fire.

 

Which ever burns with steady flame

Amid the whirlwind rush of life,

Unflickering ‘mid the clang of toil,

Unwav’ring ‘mid the market’s strife;

Serene and calm it sheds its light

O’er spots of darkness, like the star

That long ago in Eastern skies

The shepherds worshipped from a far.

 

And still the self-same message comes

As with the primal portend then,

Of peace on earth, of joy in heaven,

Glory to God, goodwill to men;

And still celestial shapes appear

For all the wondering earth to see,

The angel forms of steadfast Faith,

Of Hope and Blessed Charity.

 

Heaven knows how many feet have trod

The dark Gethsemane of pain,

And who shall say what weary ones

Must pace its pathways yet again;

But from this temple’s open door

There stretches forth a radiant light,

Cheering their path, and leading on

These suffering pilgrims of the night.

 

If to a Calvary – their cross

Seems lightened by the wondrous rays;

Or, if with, stronger step they pass

Back to men’s busy haunts and ways,

They bear with them across the years

Where’er Life’s toilsome path they trace,

Some shining radiance, faint or bright

Of the Shekinah of this place.

                                                      John Freeland Fergus (1865 – 1943)

References

[1].           The Healers: A History of Medicine in Scotland. David Hamilton. 1981

[2].        A Medical History of Scotland. John D Comrie, 2nd edition. Published by the Wellcome Historical Medical Museum, 1932.

http://www.electricscotland.com/history/medical/scottishmedicine02.pdf

[3].           The Royal: The History of Glasgow Royal Infirmary 1794 – 1994. Jacqueline     Jenkinson, Michael Moss and Iain Russell. 1994

[4].      A Short History of Glasgow Royal Infirmary. John Patrick, 1940. Written for Colvilles magazine, Messrs Colvilles Ltd, Steel Manufacturer – Courtesy of Mr Alistair Tough, Archive Department, Mitchell Library, Glasgow.

[5].    Dr Alexander Gordon (1752-1799) and Contagious Puerperal Fever. Peter M Dunn. 1795.

http://fn.bmj.com/content/78/3/F232

[6].        The Shaping of the Medical Profession. The History of the Royal College of Physicians and Surgeons of Glasgow, 1858-1999.  Andrew Hull and Johanna Geyer-Kordesch, The Hambledon Press, 1999.

[7].      Early Glasgow Anaesthesia. Dr Betty Bradford. Proceedings of the History of Anaesthesia Society, June 1995, Glasgow.

http://www.histansoc.org.uk/uploads/9/5/5/2/9552670/volume_17.pdf

[8].   Women and the Medical Professions. Lesley A. Hall

https://www.lesleyahall.net/wmdrs.htm

[9].    The Triple Qualification examination of the Scottish medical and surgical colleges, 1884-1993. Dingwall HM, J R Coll Physicians Edinb 2010; 40:269-276.

[10].     Booklet: Education in Nursing. An address given in London by Mrs Strong in 1895. Royal College of Physicians and Surgeons of Glasgow Archives 29/11.

[11]        The History of Radiology in Scotland, 1896-2000. Calder J F, Edinburgh, UK: Dunedin Academic Press, 2001.

[12].        Bottom row from left to right: Prof James Battersby, Prof Ian Murray, Prof Carstairs C Douglas (Dean, Anderson College of Medicine), Prof Andrew Allison (Dean, St Mungo’s College of Medicine), Prof John Henderson, Prof John Graham.

Second row from left to right: Prof D MacKay Hart, Prof John A C Macewan, Prof A A Fitzgerald Peel, Prof A Muir Crawford, Prof William Rankin, Prof J R C Gordon, Prof Eric Oastler, Prof David Fyfe Anderson.

Third row, third from right – Dr Henry Withers Gray, father of the Blog author.

Fourth row, third from left – Dr Robert McPherson Cross, uncle of the Blog author.

[13].     Image courtesy of Alistair Tough, Mitchell Library Archives.

Sitting left to right: Margaret E Bryson, Agnes B Sloan, Jessica S MacEwan, Janet T Miller, Janet G Waddell.

Standing left to right:Gertrude D Bostock, Mary J Pirret, Unknown male, Ethel McLelland, Alice Moorhouse.

[14].     Images courtesy of Andrew McAinsh and the Royal College of Physicians of Glasgow archive, 2018.

[15].   Images courtesy of Alistair Tough, Archive Department, Mitchell Library, Glasgow, 2018.

[16].   Image courtesy of Craig Richardson and the Glasgow Royal Infirmary archive.

[17].   Image courtesy of the Welcome Medical Library archive

[18].    The Glasgow Royal Infirmary Club: List of Members, 1912. Last accessed 20th June, 2018.

https://archive.org/stream/b21463542#page/n187/search/John+F+Fergus

[19].      Fancies of a Physician: verses medical and otherwise, in Scots and English. John F Fergus; Brown, Son and Ferguson, Glasgow, 1938.

[20].    Graduation of probationer nurses in 1924 including the mother of Dr John A Thomson, author of this Blog, 7th from left, second back row, Miss Margaret Provan.

 

 

 

An Endocrine Prologue

     The interest in ‘endocrine’ glands began in antiquity when the most obvious organs accessible to the knife, the testes, were sometimes removed either to make the harem safe, or to extend the duration of the male soprano voice into adulthood. On a culinary note, testicular removal made a rooster into a capon which was much more palatable. The other common presentation of endocrine disease was thirst, copious production of urine and weight loss. Descriptions of this condition can be seen in medical literature from Egyptian papyri, and from Indian, Chinese, Greek and Arab sources. In the second Century AD, Aretaeous of Cappadocia[1] coined the name ‘diabetes’ though it was not till the 17th Century that the English anatomist and physician, Thomas Willis added ‘mellitus’ to diabetes in view of the sweet nature of the urine produced.

It was, however, the emergence of anatomy and physiology as scientific disciplines that concentrated minds upon those tissues of the body which looked like glands or organs and had a rich blood supply yet had no ducts (blood-glands). [2]   

A Thyroid Narrative

     The other gland relatively accessible to the knife, particularly if enlarged, was the thyroid. The Chinese used burnt sponge and seaweed to treat goitre over many millennia. In 150 AD, Hippocrates and Plato recognised this treatment and thought that the thyroid gland lubricated the larynx. Thomas Wharton, anatomist in 1656, wrote

Greek Shield - thyroid edited
A Greek Shield

about the anatomy of the gland that he thought it was there to heat the larynx. He named it ‘thyroid’ after the ancient Greek shield with a similar pronunciation. In German, the thyroid is ‘die Schilddrüse’, the shield gland. Two other anatomists, from Holland Frederik Ruysch in the 17th, from Switzerland Albrecht Von Haller in the 18th Century and Thomas Wilkinson King who was

Gargoyle-goitre-in-Berne-1971-ETA-for-web
Swiss gargoyle with nodular goitre[8]

a physiologist in the early 19th Century Britain, each wondered whether the thyroid elaborated a secretion which was carried away by the veins.

Goitrous-cretin-painting-saved-for-web
Painting of a goitrous cretin from the Swiss Alps[8]

Thyroid history in the 19th Century, however, was a tale of three streams which converged as knowledge of its function emerged. These streams were Iodine, Goitre and Cretinism/hypothyroidism.

In 1811, the French chemist Bernard Courtois was extracting soda from burnt seaweed because of a shortage of the usual woodash. He tried to clear the deposit on the bottom of his copper extraction vessels with sulphuric acid and immediately noticed an intense violet vapour which condensed in the form of crystals. By circuitous routes, the crystals eventually reached both the French chemist Joseph Louis Gay-Lussac and, with the permission of Napoleon, Sir Humphrey Davy. 

Sir-Humphrey-Davy-edited-for-the-web
Sir Humphrey Davy

Each chemist separately identified a new chemical element which they agreed to call  “iode”, or iodine, from the Greek word for violet.

It is not clear why iodine then became the focus for the treatment of thyroid enlargement. Initially suggested by Dr William Prout in London, 1816[3], it was John Elliotson from St Thomas’ Hospital who used it for goitre in 1819. In 1820, the Swiss physician Jean Francois Coindet used a tincture of iodine more widely with initial success. His treatment was questioned and fell into disrepute when some individuals developed hyperthyroidism (Jod-Basedow syndrome). In 1825, David Scott used iodine to treat goitre in Assam, India and in 1831, the French chemist Jean-Baptiste Boussingault used iodised salt in present day Columbia for the same condition. In 1835, Caleb H Parry followed by Robert James Graves from Ireland described hyperthyroidism with

Robert Graves edited
Robert Graves

goitre and noted an ophthalmopathy. The German physician Karl Adolph von Basedow independently reported similar cases in 1840 and firmly linked hyperthyroidism with the associated ophthalmopathy. In 1851, the French physician Caspar-Adolphe Chatin discovered that certain goitrous areas of Europe were associated with a low environmental iodine. While the national scientific community in France remained sceptical about Chatin’s evidence, iodine prophylaxis for goitre began in earnest.

The History of Diabetes

    In 1815, the French chemist Michel Eugene Chevreul in Paris showed that the sweet tasting substance in the urine of patients with diabetes was glucose. In 1848, Hermann Von Fehling, a German chemist, developed a qualitative test for glucose in urine but it was not until 1889 that the pancreas became implicated in diabetes. Oscar Minskowski and Joseph von Mering, both German and working at the University of Strasbourgh, showed that dogs in whom the pancreas was removed developed diabetes mellitus. In 1893, The Frenchman Edouard Hedon showed that grafting pancreatic tissue back into the animal prevented diabetes from occurring. Something being secreted by pancreatic tissue was important for the prevention of diabetes. In the same year, the French scientist Gustave-Edouard Laguesse wondered whether the islands of tissue left after pancreatic duct ligation that had been described in 1869 by the German pathologist Paul Langerhans, might just be the source of the substance that controlled glucose levels. The concept of internal secretion by that time was close.

Contributions from Physiology and Anatomy

     In 1849, the German Physiologist Arnold Adolph Berthold performed a classic ‘endocrine’ experiment while studying maleness in chickens.

Arnold Berthold edited
Arnold Berthold

He took 6 male chickens,castrated 4 and left 2 to develop rooster characteristics such as combs and wattles. Two castrati became chicken eunuchs or capons with soft flesh. In the final two, he transplanted the testes back into the abdominal cavity and found they developed normally as roosters. He concluded erroneously that the testes conditioned the blood to result in normal development. It was not until 1935 that pure testosterone was isolated.

In 1850, Thomas Blizzard Curling correlated the absence of thyroid tissue at autopsy in two children with cretinism. Come 1855, when physiological conundrums attracted the brightest of minds, the French physiologist Claude Bernard hypothesised that the liver might somehow secrete  glucose into the blood while in the same year, Thomas Addison, an Edinburgh graduate working in Guy’s Hospital proved, by autopsy, that suprarenal

Thomas Addison edited
Thomas Addison

gland destruction was present in 11 cases with weakness, vomiting and skin pigmentation which he understood to indicate chronic adrenal insufficiency but he was not believed at the time. In 1871, Charles Hilton Fagge presented a paper describing four children with sporadic cretinism and wondered whether the thyroid had ‘wasted’. Two years later in 1873, William Gull of Guys Hospital described hypothyroidism in adult life as creating a cretinoid appearance with a thick tongue. In 1877, William Ord described ‘mucous oedema’ and proposed the term ‘myxoedema’ for the adult condition. He also described the ‘practical annihilation’ of the thyroid gland at autopsy in these patients.

A Surgical Contribution

Theodore-Kocher-surgeon-for-the-web
Emil Kocher

     In 1882, Jaques-Louis Reverdin from Geneva and in 1883, Emil Theodor Kocher from Berne, both Swiss surgeons, noted that after total thyroidectomy, myxoedema was common. Because of this, they each experimented  by conserving part of the gland during thyroidectomy, and no further cases of myxoedema occurred. [4] Although they did not understand what was happening, these surgeons had provided the medical community with the key to understanding the importance of the thyroid gland. Kocher went on to be awarded the NOBEL prize for medicine in 1909 for work relating to the surgical and medical treatment of thyroid disease.

In 1883,  Felix Semon, a trainee laryngologist, later Sir Felix, suggested, to much ridicule from medical colleagues, that myxoedema and cretinism were one and the same condition, namely the effects of hypothyroidism. What he managed to do was to encourage his surgical colleagues to  survey the experience of thyroid surgeons Europewide. Reporting in 1888 and using experimental work on thyroidectomised

Sir Victor Horsely edited
Sir Victor Horsely

monkeys by Sir Victor Horsley [5], the renowned scientist/surgeon who followed on in neurosurgery from Sir William Macewan, the report vindicated Semon and concluded that myxoedema was almost certainly due to loss of thyroid function and could lead to cretinoid features. Horsley went on to advocate surgical grafting of sheep thyroid into patients with myxoedema and in 1890, Bettencourt and Serrano of Lisbon had success with resolution of some clinical features in a case grafted under the breast. They then tried hypodermic injections of thyroid juice in 1891 and reported these beneficial too. The function of thyroid was now clear though the mechanism remained a mystery.

In 1891, Horsely and Professor George Redmay Murray also continued along these therapeutic lines and

George Redmayne Murray
George Redmayne Murray

and used hypodermic injections of sheep thyroid extract into a patient with myxoedema and described a dramatic improvement. Murray provided details of his method of preparation and administration of the extract. Later that year, after publications from H W MacKenzie and E L Fox who had separately treated hypothyroid patients with thyroid extract by mouth, he changed to oral administration of pooled sheep thyroid extract with similar effect and so oral replacement therapy for glandular hypofunction was born.

 

 Parathyroids, Pituitary and Adrenal 

     Ivar Sandstrőm, Uppsala medical student in 1887, confirmed the existence of the parathyroid glands in 50 autopsies and in 1901, the French physiologist Eugene Gley linked the absence of parathyroids after thyroid surgery to tetany which was often a sequel. [6]

Although the pituitary gland had been recognised in previous years at autopsy, for instance in studies of the two Irish Giants, its clinical role was more difficult to define because of its position in the centre of the skull. Clinical interest in the pituitary gland mainly arose from the studies and description of Acromegaly by Drs Pierre Marie, French neurologist, and José Dantas de Souza-Leites from Brazil in 1886 [7].

In 1893, George Oliver was interested in extract of adrenal gland to treat low blood pressure. He listed the help of Edward Shafer, Professor of Physiology at University College, London and found that his extract greatly raised the blood pressure in dogs. They both went on to discover that the effect was due to extract of medulla and not cortex.

Clearly, the important parts of the ‘endocrine’ or blood-gland jigsaw were gradually being assembled and one-by-one, the glandular origins of clinical deficiency syndromes were becoming clearer. The work on insulin, in particular, clearly pointed to a pancreatic source for a secretion of some sort preventing diabetes.

The Fog Clears

     In 1905, the British physiologists Ernest Starling and his brother-in-law William Bayliss discovered something in the blood that caused the pancreas to secrete digestive juices.

Ernest Starling edited
Professor Ernest Starling[2]

Their experiment was in two parts. Firstly, they had used a completely denervated loop of duodenum, activated it by food, and found it stimulated pancreatic juice flow. Thinking that it must be something in duodenum, they liquified duodenal mucosa, injected it into the denervated animal model and found again that pancreatic juice flowed. Starling and Bayliss realised that a substance, which they called ‘secretin’, passed from the stimulated duodenum to the pancreas to stimulate it by virtue of the circulation of blood and not by the nervous system. They confirmed this hypothesis on the second experiment. Starling proposed after consultation with a classics trained colleague that such substances were called ‘hormones’ after the Greek ‘ormao’ – to excite, and at this precise point in history, a new speciality called  ‘endocrinology‘ emerged. It studied substances produced by one tissue and then transported by the circulation of blood to another tissue, called the target.

Ernest Starling first use of Hormone 1905 edited_edited-1
First use of the word ‘hormone’ in 1905[2]

The final part of the jigsaw, the concept of circulating hormones, had fallen into place in the early 20th century. The work by Frederick Grant Banting, Charles Best, John J R MacLeod and James Collip in extracting an insulin soup from atrophied pancreatic glands, purifying it, and by 1921,  using the purified material in clinical practice was a monumental moment in the history of endocrinology. They had learned the lessons of the past and even had a name for the substance because in 1909, the Belgian physician Jean de Mayer had named the putative substance produced by the Islets of Langerhans, “insulin”. Although physiologists and the new ‘endocrinologists’ were unable to directly quantitate the actual hormones at this time, indirect ways were devised by them and physiologists to measure the ‘exciting’ effects of hormones on other tissues. It would be another 40 years before clinical measurement of insulin in blood would be possible but at least in 1921, there was a rational treatment for diabetes and myxoedema.

 References

[1].    Milestones in the history of diabetes mellitus: The main contributors. World Journal of Diabetes, 2016, Jan 10; 7 (1): 1-7.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707300/

[2]      Starling Review: Ernest Starling and ‘Hormones’: An historical commentary, by John Henderson. Journal of Endocrinology, Volume 184, Issue 1, 2005, pages 5-10. 

http://ressources.unisciel.fr/biocell/chap11/res/03_hormone_starling_henderson.pdf

[3]       A History of Iodine Deficiency Disorder Eradication Efforts, by J Woody Sistrunk and Frits van der Haar, in ‘Iodine Deficiency Disorders and Their Elimination’, Editor Elizabeth N Pearce, Associate Professor of Medicine, Boston University School of Medicine, Boston, MA,  Springer 2017. Accessed on 12 February, 2018.

http://books.google.co.uk/books?id=Fo4JDgAAQBAJ&pg=PA5&lpg=PA5&dq=Chatin+endemic+goitre&source=bl&ots=KoK32iNVAi&sig=kK57jlxisqy2PsafOxFeVZFypcc&hl=en&sa=X&ved=0ahUKEwiVtITzpZ7ZAhUsC8AKHRK8BoEQ6AEIRzAG#v=onepage&q=Chatin%20endemic%20goitre&f=false

[4]       Hypothyroidism and Thyroid Substitution: Historical Aspects by J Lindholm and P Laurberg, 2011. Journal of Thyroid Research, Volume 2011, Article ID809341. Accessed 12th February, 2018.

http://hindawi.com/journals/jtr/2011/809341/

[5]     The Discovery of Thyroid Replacement Therapy.  JLL Bulletin: Commentaries on the   History of Treatment Evaluation. Stephan D Slater, 2010. Accessed 20 November 2017.

jameslindlibrary.org/articles/the-discovery-of-thyroid-replacement-therapy/

 

[6]      The History of Parathyroids. Accessed 20th November, 2017.

http://endocrinesurgeon.co.uk/index.php/the-history-of-the-parathyroids

[7]     In the land of Giants: the legacy of Jose Dantas de Souza Leite. Accessed 20 November, 2017.

http://scielo.br/pdf/anp/v73n7/0004-282X-anp-73-7-0630.pdf

[8]     By courtesy of the European Thyroid Association and from the 4th Annual Meeting in Berne, 1971, President Prof H. Studer.

 

H W Gray

J A Thomson

 

 

 

 

An Endocrine Unit Is Born

     Glasgow Royal Infirmary (GRI) entered the 20th Century with real pressures on the Board of Management to improve the surgical block to permit surgical specialisation and anaesthetic advances. Wisely, they chose to rebuild though this required agreement with GRI donors for the legal transference of running expense to the capital account. There was pressure too on the St Mungo’s College Governors who ran the medical school from 1888 without the University of Glasgow medical students who had followed their teachers to the Western Infirmary. While a University education was preferable, most individuals of modest means had chosen St Mungo’s and GRI because of cost. However, in 1901, Carnegie Trust grants to pay class fees became available for less well-off medical students and so a University degree became possible for this group. At the same time, the supply of medical students from England, Ireland and Wales began to dry up with the opening of new Medical Schools in the provincial cities of England. It was an existential problem for St Mungo’s College, a staffing issue for GRI which required young doctors for locum and house-officer posts and a waste of superb teaching facilities.

The University Returns to Glasgow Royal Infirmary

     The solution to the lack of medical students came in 1907 thanks to the Trust of the late Dr Thomas Muirhead and the insight of Sir Donald MacAlister, University Principal of the time which led to a rapprochement between University and GRI. The Muirhead Trust not only agreed to endow St Mungo’s College with a University Chair in Medicine and one in Obstetrics, but as a serendipidous caveat, insisted that the College and the University work together again for training medical students. The College agreed to endow two new University chairs themselves and also to continue their policy that medical teaching was open to women on equal terms with men, another key stipulation of the Trust. In 1911, after tying up loose ends, the Muirhead Chairs of Medicine and Obstetrics and Gynaecology were filled at GRI as were the St Mungo Chair of Surgery and the St Mungo-Notman Chair of Pathology. The clinicians at GRI were now training both the College students and those on the MB course in clinical medicine and surgery although evidence suggests that the University Professors only taught the MB course. After 37 years on its own, GRI had returned to its role as a major teaching hospital in Glasgow.

The first Muirhead Professor of Medicine at GRI was Walter King Hunter in 1911. He graduated with a BSc in 1888 and MB 2 years later. After postgraduate study in neurology in London and Paris, his MD in 1897 entitled ‘The Aetiology of Beri-beri’ received commendation.

Walter King Hunter 1911 to 1934 edited
Walter King Hunter

He went on to receive a DSc from the University in 1901. While passionate about neurology, Hunter also published on haematology while he was on the junior visiting staff of the Royal Hospital for Sick Children. He quickly became assistant physician at GRI and used his knowledge of the histopathology of the nervous system to study the effects, on the CNS, of venoms of 5 different Indian snakes in collaboration with Captain George Lamb of the Indian Medical Service. This work was published in the Lancet in 6 instalments between 1904 and 1906. By 1906, he had become physician to GRI and Lecturer in Practice of Medicine to Queen Margaret College of the University. At this time, he was also consultant physician to the Glasgow Royal Mental Hospital and visiting physician to Bellefield Sanatarium in Lanark. Experience here permitted him to contribute a chapter on ‘Treatment’ in Maylard’s Abdominal Tuberculosis in 1908.

After his appointment to the Muirhead Chair, he was recognised as an inspirational bedside teacher of clinical medicine in the mould of Sir William T Gairdner and was known by the nickname ‘Uncle Walter’ by his housemen and and generations of students.

He died in 1947[1] as one of the most distinguished physicians of his generation in Scotland.

The second Muirhead Professor of Medicine was Archibald Wilson Harrington, a

Archibald Wilson Harrington edited-2 best
Archibald Wilson Harrington

graduate of Glasgow in 1900 and MD in 1903. Elected to the junior staff at GRI in 1906, he  gained the Fellowship of the Royal Faculty of Physicians and Surgeons of Glasgow (FRFPS ) in 1912, becoming assistant physician at GRI in 1913. Harrington served in the RAMC in the Balkan theatre with health consequences which continued throughout his professional life. Returning to consultant practice at GRI at the end of the war, Harrington was appointed lecturer in clinical medicine in the University in 1925. In 1927, he contributed an excellent teaching chapter ‘Examining the Heart’ to Finlayson’s Clinical Medicine, 1927 edition and with a keen perception of character, appointed Joseph Houston Wright to be his personal assistant. Joe Wright went on to be an outstanding clinician and cardiologist at GRI, President at RFCPS, Glasgow and member of the University  Court.

Harrington was a shy man who was, nevertheless, worth getting to know in light of his wide knowledge and experience. He always taught by example and his junior staff and students learned quickly. Harrington had an inquisitive mind but, in keeping with the post-war era, did not publish as much as his predecessor.

Harrington left office in 1945 and died 1953[2].

Clinical Practice and Biochemistry in the Early 20th Century

      At GRI in the early 20th century, most senior staff were part-time generalists called visiting physicians and surgeons and made half of their living in private practice in consulting rooms down town. Many were Professors in the St Mungo’s Medical School with associated teaching and lecturing responsibilities. From 1911 to 1945, the University Muirhead Professors were also part-time with private practice. From 1884, the junior Dispensary Physicians were re-named Assistant Physicians and 4 years later, the just qualified residents were re-named house physicians.

Picture-066-Thyroid-extract-tablets-black-and-white_edited-1-without-namefor-web
Dry thyroid tabs

All the physicians would use the new preparation of dry thyroid or thyroid extract, from porcine or bovine sources, as replacement therapy for their patients with myxoedema and for those following thyroidectomy if required.

From 1923, they would also have used parenteral insulin for ketoacidotic crises of type 1 diabetes assisted by the new Department of Biochemistry established in 1926 under the then Dr David Paton Cuthbertson[3], Lecturer in Pathological Biochemistry but based at GRI. However, blood sugar measurement would only be performed during working hours in the laboratory. In the evening and during the night, the-out-of hours assay of of blood sugar had still to be done by the house officers themselves using the Folin-Wu method and this situation continued until 1966 when a rudimentary out-of-hours service was introduced.

David Cuthbertson in lab at GRI edited
David Cuthbertson in the first Biochemistry laboratory at GRI[8]

Cuthbertson gained a BSc from Glasgow in 1921 then MB in 1926. He was at GRI for 8 years during which time he actively published his research into the effects of injury, infection, bed rest or impaired mobility on metabolism.

Sir David Cuthbertson from BJN copy
Sir David Cuthbertson

This was a tour de force at this time and provided a much needed insight into the body reaction to stress from wherever it came.

During this early period of his career, Cuthbertson provided the foundation for modern nutritional therapy for seriously ill or injured patients. What he showed was trauma stimulated catabolism and that the source of the loss of nitrogen in urine was skeletal muscle. he became Director of the Rowatt Research Institute, Aberdeen between 1945 and 1965. He was later knighted, and received a CBE and DSc from Glasgow University. Cuthbertson remained a senior research fellow at GRI until his death in 1989.

Endocrinology Emerges 

     Eric Gordon Oastler, a Glasgow graduate and clinician, sowed the seeds of Endocrinology as a distinct speciality at GRI from his experiences in the physiology laboratories of Oxford where he distinguished himself with a First Class Honours BA in 1928 and an MA in 1934.

Prof Eric Oastler 1_edited-1 trial
Eric Oastler

His first appointment to GRI was as an extra physician to the out patient department in 1931. Successive promotions quickly found him as assistant physician in 1934. Endocrinology in Glasgow germinated with his appointment as Professor of Physiology at St Mungo’s College Medical School, GRI in 1932 where he lectured to the medical students.

He was awarded a Rockefeller travelling medical fellowship and spent the academic year of 1934/35 working with Professor James Howard Means of Massachusetts General Hospital, Boston as resident fellow in medicine at Harvard Medical School. Professor Means had developed the Basal Metabolic Rate as an important indirect test for thyroid dysfunction and had explored treatment for thyrotoxicosis with external X-ray therapy. This research was a forerunner of radioactive iodine therapy. Oastler worked with Dr Saul Hertz in the laboratories at Harvard, and using an experimental hypophysectomised rat model, were the first to demonstrate thyroid stimulating hormone (TSH) in the urine and blood of hypothyroid patients but not in normal or thyrotoxic patients. These findings were important because they suggested strongly, for the first time using rats, that thyrotoxicosis was a primary thyroid disorder and not related to increased secretion of TSH. This work was reported in the Journal called ‘Endocrinology’ which was also known at the time as ‘The Bulletin of the Association for the Study of Internal Secretions’.

Oastler returned to the Royal Infirmary as the St Mungo Professor of Physiology in 1935 and pursued his increasing interest in clinical endocrinology but particularly in female disorders and adrenal disease.

Following active service in the war, he spent several years as senior physician at the Southern General Hospital, Glasgow, preparing that Institution to take medical students in 1950. In 1953, and during this time as a general endocrinologist at the Southern General, Oastler wrote an incisive review of Endocrine Exophthalmos for the Ophthalmological Society which was published in their Transactions Volume 73. He returned to the GRI in 1956 as physician in charge of second floor medicine becoming an honorary lecturer in clinical medicine and endocrinology at the University of Glasgow as well as consulting physician and head of endocrinology at the GRI and Royal Samaritan Hospital for Women. In accordance with the prevailing academic influence in the Infirmary which was low key in the late 1940s and early 1950s, he published rarely but mainly in gynaecological endocrinology. Despite his experience in thyroid disease and thyroid ophthalmopathy, Oastler agreed that in view of the UDM laboratory involvement, isotope support services and major clinical research interests, Edward McGirr and the University Department of Medicine on first floor would look after the clinical thyroid work at GRI.

Other activities included membership of the board of management for Glasgow Northern Hospitals and membership of the Western Regional Hospital Board, 1955-61, and vice-chairman, 1959-60.

Oastler will be remembered for his work on adrenal pathology and the later fruitful cooperation with Dr James (Jim) K Grant, Senior Lecturer in Steroid Biochemistry, who developed the highly respected regional Steroid Laboratory at GRI.[4] 

Oastler, noted for his booming English accent, retired in 1967 and has been described by an individual who worked with him as the consummate Clinical Endocrinologist in the classical era prior to immunoassays and sophisticated imaging techniques. He is also remembered affectionately as an astute and knowledgeable clinician, a respected teacher, an able administrator, and for his sartorial elegance.

Dr Oastler died in 1990. [5]

Early Trainees in Medicine and Endocrinology

     William Gifford (Giff) Whyte, a Glasgow graduate, was a senior registrar with Dr Oastler for many

Giffen Whyte_edited-1
Giff Whyte

years on second floor. He was a highly regarded clinician and general endocrinologist who published mainly as supporting author in work concerning measurement of adrenocortical and gonadal function, obesity, hypertension and Addison’s disease. Working with Professor Robert B Goudie, he demonstrated autoantibodies to adrenocortical antigen in idiopathic Addison’s Disease. Whyte moved to South Lanarkshire in 1968 as a consultant with Robert Walker[6] where he was part of the team who first recognised and published on Phenformin induced lactic acidosis in 1972.Dr Whyte retired in 1986 and died in 2007.

     Stuart G McAlpine, a Glasgow graduate, was registrar in the University Medical Unit with Professor Davis on first floor medicine and was tasked with explaining the number of cases with hepatosplenomegaly at the medical clinics.

Stuart-McAlpine-better-photo-for-the-web
Stuart McAlpine

While initially interested in liver disease, for which he was awarded an MD with commendation, McAlpine also published studies on hypothyroidism, dysthyroid eye disease and nerve palsy in diabetes. He moved to Dumfries and Galloway Royal Infirmary in 1957 and 2 years later, to cardiology on 3rd floor under Dr Joseph (Joe) Wright. McAlpine became consultant physician with an interest in Cardiology with Dr Hugh Conway at the Royal Alexandra Infirmary, Paisley in 1963 and retired in 1988.

 

 

     Ivor MD Jackson, a Glasgow graduate, was registrar with Eric Oastler on second floor medicine from 1963 and published widely in general endocrinology, thyroid disease, obesity and diabetes.

Ivor-Jackson-edited-for-the-web
Ivor M D Jackson

He left GRI in 1969 to work with Professor Reginald Hall of the University of Newcastle-upon-Tyne. Jackson was awarded a US post-doctoral Research Fellowship with Professor Seymour Reichlin initially at the University of Connecticut and later at Tufts University in Boston, Massachusetts where Reichlin succeeded Edwin Astwood as Head of the Endocrinology Unit. Twelve years later, he moved to Brown University Hospital, Providence, Rhode Island becoming Professor of Endocrinology, Diabetes and Metabolism and Head of

Ivor Jackson
Ivor Jackson

Department. Jackson published broadly across endocrinology but had specific interests in experimental and clinical neuroendocrinology, neuropeptide regulation and studied the role of Gamma Knife Radiosurgery in pituitary tumours. This dedicated stereotactic machine is a recognised alternative to microsurgery. With others, he contributed to the identification and characterisation of the gene for the TRH precursor.

Professor Jackson retired in 2012.

     Tarek H A Hassan, a Cairo graduate, was senior house officer with Eric Oastler on second floor medicine from 1963 and published with Jackson on pituitary function testing and with the thyroid team on simple goitre and toxic diffuse goitre. Hassan has many academic and cultural distinctions, awards and decorations.

      Matthew G Dunnigan, a Glasgow graduate, was not an endocrinologist in training but in 1961, while working at GRI, surveyed the Asian population in Glasgow and discovered late rickets and osteomalacia.

Matt Dunnigan edited
Matthew Dunnigan

He successfully treated this issue of public health with 25-OH Vit D supplementation of the flour that families used to make chapattis. Metabolic bone disease such as rickets was soon to migrate from nutritionists to be ensconced in endocrinology in the late 1960s with the discovery that the kidney, as an endocrine organ, metabolises the 25-OH VitD to 1,25-OH VitD, which is the active hormone. In his further research at Stobhill General Hospital in 1974, he noted members of a family with partial lipodystrophy featuring, in addition, insulin resistance, diabetes mellitus, dyslipidaemia and liver steatosis. Dunnigan linked his cases with a German family reported with a similar inheritance in 1975 by J Köbberling of the University of Göttingen. The condition became known as the Köbberling-Dunnigan syndrome [7].

 References

[1].      Obituary. Walter King Hunter. The Lancet Nov 22, 1947. Accessed 11th May 2018.

https://ac.els-cdn.com/S0140673647908003/1-s2.0-S0140673647908003-main.pdf?_tid=8dff450d-7153-4f32-b42b-14c7c6986aa4&acdnat=1526029794_21699e005de5c0e9b7a36105fecba73f

[2].      Obituary. Archibald Wilson Harrington. British Medical Journal, July 18, 1953. Accessed 11th May, 2018.

https://www.bmj.com/content/2/4828/152.5

[3]       “Sir David Cuthbertson,” History of Pathological Biochemistry at Glasgow Royal, accessed Nov 20, 2017,

[4]       “James K Grant,” History of Steroid Biochemistry at Glasgow Royal, accessed Nov 20, 2017,

http://www.elliottsimpson.com/history/glasgowendocrine.html

 [5]       “Eric Gordon Oastler,” Lives of the Fellows of the Royal College of Physicians, accessed November 20, 2017,

http://munksroll.rcplondon.ac.uk/Biography/Details/3354

[6].        “Robert Sibbald Walker: Obituary,” accessed 11th December, 2017 

http://www.heraldscotland.com/news/12435748.Robert_Sibbald_Walker/

[7]       “Dunnigan-Koberling syndrome: an autosomal dominant form of partial lipodystrophy,” QJM: An International Journal of Medicine, Vol 90, Issue 1 (01 January 1997): 27-36, accessed November 20, 2017,

https://academic.oup.com/qjmed/article/90/1/27/1549447

 

[8].   Image courtesy of Craig Richardson and the Glasgow Royal Infirmary archive.

H W Gray

J A Thomson

 

 

 

 

Development of Specialist Academic Medicine

A Laboratory Focus Appears in Royal Infirmary Medicine

     Leslie John Davis initially trained as a research medical scientist at the Wellcome

Professor L J Davis edited
Leslie J Davis

Bureau of Scientific Research. Thereafter he was appointed to the staff of the Wellcome Tropical Research Laboratories in Khartoum and practiced laboratory and clinical medicine there from 1927 to 1930.  Davis then became Professor of Pathology at Hong Kong University from 1931 to 1939 but left before the outbreak of hostilities. After a short spell as director of medical laboratories in Bulawayo in Southern Rhodesia, he returned to Edinburgh during the Second World War as an assistant and then lecturer in the Department of Medicine to work in medicine and haematology with Stanley Davidson (later Sir Stanley).

University tower_edited-2 zoomed out
University of Glasgow Tower

In 1945, Davis was appointed the third Muirhead Professor of Medicine in the newly formed University of Glasgow, Department of Medicine (UDM) at the Royal Infirmary (GRI). It is likely that the Principal Sir Hector Hetherington and the Medical Dean George Wishart saw in Davis, an opportunity to modernise East Glasgow hospital medicine and bring into the hospital, a research programme based on sound scientific and academic principles introducing laboratory methods into clinical medicine as well as maintaining the reputation of the UDM at Glasgow Royal Infirmary for first class clinical practice and teaching.  The closure of the Saint Mungo’s College building provided Davis with all the accommodation required to set up a laboratory based Department of Medicine adjacent to the Infirmary. The St Mungo College building had been the base for the St Mungo’s Medical School  which had opened in 1888 and only closed in 1945 along with Anderson College on Dumbarton Road following a report from the Goodenough Committee which recommended closure of all extra mural medical Colleges. Davis was therefore able to attract young medical graduates to his Unit who had the desire to apply science to clinical practice. Around nuclei of clinical research programs, young researchers were attracted by the buzz and the energy of the Unit and their involvement in clinical teaching. Funding for these young researchers at GRI was usually found from Hall Fellowship, McIntyre or Ure Research Scholarships and were keenly contested.

As the first full-time University of Glasgow Professor of Medicine at GRI, Davis began transforming his new department into a teaching and clinical research facility by appointing his senior lecturers strategically.

_Willie-Watson-for-the-web
Willie Watson

His senior appointments were Alex Brown his deputy, Edward McGirr, Stuart Douglas, Jim Ferguson and Alex McFadzean. Tom McEwan provided the NHS focus. His juniors included Arthur Kennedy, Stuart McAlpine, Albert Baikie, Robert Pirie, Robert Hume, Jock Adams, William (Willie) C Watson and George McNicol.

Professor-L-J-Davis-with-pipe-for-the-web
Prof Leslie J Davis

Despite a lack of broad clinical experience, Davis forged a  centre of excellence in academic medicine at the Royal Infirmary. His strong background in Pathology meant that his own specialty interests lay mainly in Haematology which was the predominant activity of the UDM during his tenure of the Chair of Medicine. He published work and co-authored a book on megaloblastic anaemias with Alex Brown and worked on nitrogen mustard therapy for lymphoma. Davis regularly published on haemopoietic drugs and treatments and surveyed both the ESR in clinical practice but also the educational value of the classical medical history. He quickly became recognised as a first class clinical haematologist and by his careful choice of appointments, established a reputation of his University clinical unit for excellence in clinical practice and teaching. Davis’  laboratory-based department of medicine in the Saint Mungo College allowed him to use his experience to mentor his staff on the application of scientific skills to clinical practice and research. He gradually transformed a mainly clinical hospital into one favourable to laboratory-based research, clinical innovation and sub-specialisation.

LJ, as he was known, retired in 1961 aged 60, moved to Yarmouth and, being keen on sailing, signed on with the Royal National Lifeboat Institution to help crew the local lifeboat.

Professor Davis died in 1980.[1][2]

Development of Specialist Academic Medicine

     Edward McCombie McGirr. CBE, D.Sc., a Glasgow graduate with B.Sc in 1937 and MB (Hons) 1940, joined the Royal Army Medical Corps and served in India with rank of major until demobilisation in 1947.

E M McGirr
Edward M McGirr

He obtained his MRCP in India while on active service on the advice of Max (later Sir Max, then Lord) Rosenheim and also spent time in Thailand. Professor Davis appointed him on the recommendation of Professor  John (later Sir John) McNee (Department of Medicine, Glasgow Western Infirmary) initially as a Clinical Assistant in Medicine within the fledgling UDM in 1947 and a few months later, as registrar at the same time as Dr Alex McFadzean (Brunton prize winner of his year) who later became Professor of Medicine in Hong Kong in 1950.

McGirr shared the lecturing and teaching of medical students, took responsibility for the dental student lectures, and shared the general medical responsibilities on wards 2 and 3 on first floor medicine at GRI and in ward A3 at Eastern District Hospital, Duke Street. The Eastern District Hospital had been built in 1904 as an acute hospital and was the first in Scotland to have a psychiatric assessment unit attached. At this time, the hospital medical wards were really pre-discharge wards though the psychiatric unit had enlarged and represented the mental health beds for GRI.

McGirr almost certainly would have been aware of the groundbreaking work reported in 1938 by Saul Hertz,  Arthur Roberts and R D Evans[6] where the first ever biokinetic study of radioactive iodine-128 was performed in rabbits and the Hertz and Roberts reports on the first use of cyclotron produced radioactive iodine (90% Iodine-130 and 10% Iodine 131) in the treatment and investigation of patients with thyrotoxicosis in 1946. The confirmatory study by E M Chapman and R D Evans in similar cases and the work of S M Seidlin,  L D Marinelli and E Oshry when the first therapy doses of radioactive iodine were given to patients with thyroid carcinoma confirmed that thyroid investigation and therapy had changed irrevocably. Observing these medical publications from the United States supporting the use of new cyclotron and later on, reactor- acquired radioisotopes of iodine when their production was de-classified in 1947, McGirr quickly realised that Medicine, and especially thyroid disease, could be transformed by the application of these exciting, scientific, technological and pharmacological advances to the study, investigation and treatment of disease.

Funded by the GRI, he immediately started training in the biology of radioactivity at one of the early courses at the Royal Postgraduate Medical School in Hammersmith, London and with this, began a lifelong passion for the use of radioisotopes to facilitate medical diagnosis, treatment and research.

Following a year’s sabbatical with Prof J B Stanbury at Harvard University, Boston in 1950, he returned to Glasgow and was able eventually to perform innovative and classic laboratory work on the aetiology of familial goitrous cretinism in a family of tinker patients of Dr JH Hutchison, later Professor of Child Health and with Dr Elspeth Clement, biochemist in the UDM who was responsible for much of the technical work. The pedigree of the tinker (gypsy) family extended over 160 years and revealed ten goitrous cretins. McGirr showed conclusively, in work that is still quoted and which took 6 years to complete, that enzymatic defects that caused dyshormonogenetic goitre were present in West of Scotland families. When a piece of thyroid tissue from one of them became available surgically, the biochemical defect was defined as deficiency of the enzyme iodotyrosine dehalogenase and revealed that it was transmitted as an incompletely recessive characteristic carried by an autosomal gene. This led to the award of MD with honours and The University of Glasgow Bellahouston Medal. It is interesting to note that Oastler and McGirr had both spent their sabbaticals at Harvard and each would have been been influenced by Saul Hertz, Oastler writing the important paper on the aetiology of hyperthyroidism with him in 1936 and McGirr being inspired by the many uses of radioactive iodine in thyroid disease in the early 1950s.

On return, McGirr was grateful for the sound guidance and support of his friend Sam Curran, nuclear physicist, later Sir Sam Curran, who had been a member of the Manhattan Project during the war and who had joined the Department of Natural Philosophy at Glasgow University in 1946. He later became Principal and Vice-Chancellor of the University of Strathclyde.

Sir Sam Curran 001 (3)
Sir Sam Curran

Curran provided McGirr with a supply of radioactive sodium-24 which has β- decay with a half-life of 14.9 hours. He also provided him with his first Geiger-Müller counter to detect the beta particles externally. One of McGirr’s first publications in 1952 was on the clearance of this Na24 from ischaemic skeletal muscle and another on the effects of intermittent venous occlusion on this clearance. Although the technique appeared to have few clinical applications, it confirmed to McGirr that radioactivity was a safe tool which was going to change the face of medicine. He also attempted to investigate the vascularisation of skin grafts for Tom Gibson but again radioactive Sodium was unable to provide meaningful data.

bottle-of-131I-for-oral-use-for-web
I131 in use from 1954

Reactor acquired radioactive iodine -131 (131I) had remained classified after the war and it only became commercially available in the UK around the 1953-4. By that time, McGirr had acquired scintillation counters which enabled him to accurately measure the amount of the isotope in tissue and blood samples. The scintillation counter had been invented by Sam Curran in 1944 while he had been at the Radiation laboratory, Berkeley, California.

Concurrently, McGirr was developing a screening and diagnostic service for thyroid disease and polycythaemia and was helped  initially by the GRI physicist, Walter Jackson. Later, the Regional Physics Department directed by Dr

131-ISTUDIES radioisotope report form without signature
Early Radio-Isotope Unit Report form

JMA Lenihan, provided advice and assistance, supplied the radioisotopes and monitored staff exposure to radiation.

Using test doses of 131I, a 24-hour uptake of thyroidal 131I and a 48-hour protein-bound iodine (PB131I) were routinely performed on all patients. He also developed a procedure for labelling red cells with radiochromium to estimate blood volumes in polycythaemia and administered intravenous radiochromium for its treatment.

Early scan of thyroglossal cyst with GM and Scintilation counter
Early scan of neck with G-M counter after 131-I showing a lingual thyroid only

It was from this Department that McGirr published on the first ever patient where there was accumulation of radio iodine in the ectopic thyroid tissue in the tongue with an absence of uptake in the usual site (see Fig). In the early 1950s, McGirr also developed the GRI as a treatment centre for hyperthyroidism using the thionamide drugs developed by Professor Edwin B Astwood in Boston. He organised a thyroid outpatient clinic within the University Medical Unit (UMU) in the lecture room of ward 3, supported by the Radioisotope Department, to investigate the clinical value and effectiveness of these drugs. In addition, from 1954, he supervised and trained others in the early use of 131I for treatment of hyperthyroidism. This was to be the forerunner of the nascent speciality of Nuclear Medicine. With Drs Provan Murray and John A Thomson’s support, McGirr published one of the first series of 900 cases of hyperthyroidism treated with 131I in the UK in 1964.

On Prof Davis retiral in 1961, McGirr was appointed the fourth Muirhead Professor of Medicine. His department became one of the pioneers for establishing new specialities in Glasgow and for attempting new techniques. He himself was one of the few clinicians in the UK in the early 60s to see the potential for the rapidly developing field in which radionuclides were used to diagnose and treat human disease. He chaired a groundbreaking report on Isotope Services for the Scottish Home and Health Department in 1968 and chaired the First and Second Reports of the Intercollegiate Committee on Nuclear Medicine in 1971 and 1975. He became an influential supporter of Nuclear Medicine, as it was soon known, and was the British Nuclear Medicine Society’s Second President in 1969/70.

From 1961, when appointed to the Muirhead Chair, Edward McGirr gathered round him

A senior George MacDonald edited
George McDonald

individuals who were keen to expand the academic credentials of his Unit. As technologies improved, he fostered leaders and potential leaders in the medical specialities of Endocrinology  (Drs Provan Murray and John A Thomson), Respiratory Disease (Dr F Moran), Nuclear Medicine (Dr W R Greig), Medical Computing (Tommy Taylor), Rheumatology (Dr W W Buchanan), and Clinical Haematology (Dr George MacDonald).

 

Those in Haemostasis and Coagulation (Dr Stuart Douglas), Gastroenterology (Dr W C Watson) and Renal Disease (Dr Arthur Kennedy) had already been appointed by L J Davis.

_Arthur-Kennedy-best-for-web
Arthur Kennedy

He managed to coordinate the efforts of these leaders of academic medicine yet held the reins loosely to avoid stifling what he recognised was the inevitable specialisation of hospital medicine. If LJ Davis were to be described as the father of academic medicine at the Royal Infirmary, then Edward McGirr could well be described as the father of specialist academic medicine since it prospered and developed quickly under his guidance.

Over subsequent years, McGirr gathered around him many young men and women with a similar passion for endocrinology and thyroid disease who each went on to contribute in areas of Endocrinology, Nuclear Medicine or both, either in the UK or abroad. He fostered them in practical ways and encouraged them to spend time in the USA to train further or learn new research techniques.

May-and-Harry-at-Dpt-Ball-in-late-60s-for-the-web
The Grays at the UDM Ball

McGirr was a firm believer in the proverb ‘all work and no play makes Jack a dull boy’. He was aware that a happy Unit worked better than an unhappy one and was keen to reduce the load on juniors by trying new ways of working. Encouraged by his wife Diane who had trained as a physiotherapist, he would organise a Unit Ball once a year where medical staff and their wives, nursing sisters, ward nurses and technical staff could put on their glad rags and celebrate the passing of another year with one another in a relaxed social environment. This event was not to be missed and was usually a glamorous affair.

McGirr was admired by his junior staff, mentoring his young lecturers and Fellows formally when advice was sought and informally at coffee time in the staff room after the ward round. He was known to help individuals  access the materials they required for their research. While McGirr could be a tough opponent to those who had their sights on the real estate of the UDM, he had a warm personality and when illness struck members of staff, he would enquire regularly on their health and for their recovery. If problems arose for his staff over which he had the power to influence, he usually made the attempt. One former member of staff recalls the UMU with McGirr at the helm as an ‘academic Camelot’.

McGirr was not afraid to venture into the arena of national politics and would contribute to ‘Standpoint’, an open forum for discussion of the local paper, The Glasgow Herald of the day. The issue of underfunding of the National Health Service and the effects of this upon medical staffing and the quality of the hospital environment for staff and patients appeared close to his heart. His most notable quotation was that ‘Life saving must take precedence over face saving’, a reference to the use of ‘Health’ as a political football. His most simple suggestion to the politicians – ‘a moratorium on change’.

He was an able ‘safe-pair-of-hands’ and this was quickly recognised within and beyond the University precincts.

Edward McGirr gets DSc
Prof Edward McGirr graduates DSc, 1994

McGirr was elected President of the Royal College of Physicians and Surgeons of Glasgow 1970-1972, and during this time, steered the College into the mainstream of national postgraduate teaching and examining by membership of the Joint Committee of Higher Medical Training 1970, Faculty of Community Medicine 1972 and the Common Final Part 2 of the MRCP UK in 1972. He became Dean of the Faculty of Medicine of the University of Glasgow in 1974 , Administrative Dean in 1978 and chaired many national bodies influencing health care and standards. He was latterly awarded both a CBE in 1978 for services to Medicine and an honorary DSc (Glasgow) 1994.

After retirement, McGirr kept contributing and published regularly in the Scottish Medical Journal  becoming a philosopher, observer, historian and commentator on the politics of the Health Service and the history of Medicine.

Edward McGirr is remembered fondly as an accomplished and kindly physician, an intellectual and academic with a national and international influence, and a man with a friendly twinkle in his eye.

Professor McGirr died in 2003[3][4]

 

References

 [1]     ” Leslie J Davis: Obituary,” British Medical Journal, Volume 281, 29      November, 1980. Accessed November 20, 2017

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1714820/pdf/brmedj00049-0064.pdf

 [2]     “Leslie John Davis”: Lives of the Fellows of the Royal College of Physicians, accessed February 23, 2018.

http://munksroll.rcplondon.ac.uk/Biography/Details/1189

[3].      Saul Hertz, and the birth of radionuclide therapy

https://dash.harvard.edu/handle/1/33029717

 [4].     “Professor Edward McCombie McGirr: Obituary,” accessed November 20, 2017.

http://www.heraldscotland.com/news/11991531.Professor_Edward_McCombie_McGirr_His_energy_and_intelligence_developed_academic_medicine/

[5].     “Professor Edward McCombie McGirr”: Lives of the Fellows of the Royal College of Physicians, accessed February 23, 2018.

http://munksroll.rcplondon.ac.uk/Biography/Details/5343

 

 

H W Gray

J A Thomson

 

 

 

General Endocrinology and Thyroid Combine

     Two strands of general endocrinology gradually developed at Glasgow Royal Infirmary (GRI) in 1968 under Edward McGirr’s direction with J A Thomson leading general endocrinology and thyroid disease on Oastler’s retiral and IT Boyle leading the second comprising calcium metabolism and metabolic bone disease in all its forms. Diabetes care continued to be run by Dr Alex Imrie, Chief of 4th floor Medicine.

 Development of Academic Endocrinology

     Dr John A Thomson, a Glasgow graduate, obtained a McIntyre Research Fellowship in thyroid disease under Edward McGirr in the University Medical Unit (UMU) of GRI in 1960 after his National Service. The first part of his training was a 2-week course on radioisotopes run by Dr John M A Lenihan, physicist to the Western Regional Hospital Board and Dr Bill Mulligan of Glasgow University Veterinary School. In the Radioisotope Department, Thomson was taught the techniques of thyroid investigation including the 24-hour thyroid uptake of 131I, the 48-hour PB131I and early thyroid scanning with a Geiger-Müller counter. Thomson’s other duties included labelling of red cells with radiochromium to estimate blood volumes in polycythaemic cases. He also learned to assess the dose of 131I therapy for hyperthyroidism and the dose of intravenous radiochromium for polycythaemia.

JAT from Sports
John A Thomson

In the early 1960s, Murray and he worked and published on an experimental 9-tube Anger type gamma camera with a 5 inch crystal produced by EKCO Electronics Limited and also set up renography in the renal unit. McGirr decided that Thomson should spend a year with Oastler in wards 4 and 5 that allowed him to explore other aspects of general endocrinology. To complete his academic training and credentials in endocrinology, Thomson and family then spent a year’s sabbatical at Harvard University in Boston on a US Public Health Service Fellowship with Professor Irving Goldberg studying the biochemistry of thyroglobulin. Thomson returned to Glasgow in 1967 just before Oastler retired.

In 1968, he was appointed Senior Lecturer in the UMU with special responsibility for endocrinology at GRI and the Royal Samaritan Hospital for Women, Glasgow and in 1981 became Reader.

Throughout this time of great change in endocrine diagnosis and technology, he retained a special interest in, and published widely on, topics related to clinical and laboratory thyroid diagnosis, pituitary disease with particular reference to prolactin secreting microadenomata and neuroendocrine treatment by either drugs or the increasingly sophisticated neurosurgical techniques of transsphenoidal microsurgery with Graham Teasdale, later Sir Graham. Thomson’s team followed up the infertile women who had selective removal of microadenomas and showed that fertility could be restored. He also published on both adrenal and gonadal disorders. Surprisingly for a clinician ‘par excellance’, he liked the challenges of the laboratory and worked closely with successive biochemists in the UDM. Elma M McDonald was experienced in plasma iodide measurements, de-iodination defects and protein bound iodine-127 while Joyce M Bissett complemented Thomson in the area of thyroglobulin biochemistry. Sheila G Baird also specialised on thyroglobulin biochemistry and compared techniques for free thyroxine measurement.

RCPSG-1-12-10-12-Aerial-view-of-Infirmary-from-M8-for-web
The New and Old GRI Campus

Dr John A Fyffe worked on the accuracy of measurements of free thyroxine and tri-iodotyrosine and Dr Rhoda Wilson specialised on the immunological parameters of thyroid disease, antioxidant systems and their role in disease processes and the immune effects or side effects of various antithyroid drugs. This latter work was in co-operation with Professor Ewan Smith of the Department of Pure and Applied Chemistry at The University of Strathclyde.

During his period running endocrinology training, Thomson was a challenging mentor and teacher for the junior staff not only in endocrinology but also internal medicine where he was a knowledgeable and insightful clinician. He encouraged general physician trainees to remember ‘hormones’, to question the status quo from the beginning of any clinical problem, and to remember Occam’s Razor.

Thomson retired in 1998 having overseen monumental advances in the diagnosis and treatment for endocrinology patients over his professional lifetime. The large number of junior staff who passed through the UMU during their medical or endocrinology training will remember him as a highly regarded physician, for his excellent teaching in medicine and endocrinology and his mentoring of those who wanted to start original work.

     J Anthony (Tony) Boyle, a Glasgow graduate, was persuaded by Professor McGirr to join the UDM in 1962 to work with Murray and Thomson in thyroid disease.

Tony-Boyle-edited-for-the-web
Tony Boyle

He first published with them on the assessment of a gamma camera for thyroid imaging in 1964 then continued on endocrine themes in 1965 and 66. He worked on many projects with W R Greig including work on the diagnosis and treatment of goitre including genetic factors gleaned from a study of twins, work on iodine deficiency factors from a study of a goitrous area of Scotland and Sudan, and he was part of the group who looked at the effect of X-ray irradiation on thyroid as part of the Iodine -125 hypothesis espoused by Greig.

From 1967, as senior lecturer in Medicine, his endocrine publications diminished in number as he embarked on rheumatological studies but also cooperating with others in the creation of the Centre for Rheumatic Diseases, Baird Street which opened in 1965 with head of Rheumatology, Dr W W Buchanan. He also became Editor of the Scot Med J around this time.

In 1970, he began a new career working in the drug industry and eventually moved to the United States of America.

Boyle died of post surgical complications in 2008. [1]

Trainees in Medicine and Endocrinology

      Dr John F B Smith – a graduate of St Andrews/Dundee, joined the UMU in 1966 as registrar in medicine and

Dr John FB Smith edited
John Smith

worked with Greig on the radiobiological consequences of radioactive iodine-131, iodine-125 and X – irradiation on thyroid cells in the laboratory and in thyroid clinical practice . He moved to the Western Infirmary as Senior Registrar in Medicine with Dr Olaf Kerr  in 1970 and to Falkirk Royal Infirmary as consultant physician in 1973. Smith became consultant physician at Stirling Royal Infirmary in 1976 and developed a successful private practice. He retired in 2014.

 

 

     Alan A Glynne – a graduate of Edinburgh, joined the UMU as registrar in 1968 and

Alan Glynne on graduation edited
Alan Glynne

worked on immunoglobulin levels in thyroid disease and the treatment of acromegaly by cryosurgery. After further training in Manchester, he became a consultant physician for the Cromwell, Wellington and Parkside Hospitals, London with an office in Harley Street.

 

 

     Mary A Wright, a graduate of Glasgow, joined the UMU as Junior then Senior House

DSC01670 Mary Wright edited
Mary Watson

Officer followed by her appointment as Hall Fellow.

She helped compare the adrenocorticotrophic effects of two synthetic polypeptides and also published on an appraisal of student performance with Ann Ferguson and George P McNicol.

As Mary A Watson, she returned to the UMU with Charles D Forbes (2) and developed an interest in computer assisted learning.

Charlie-Forbes-edited-for-the-web-better
Charles Forbes

Subsequently, Watson worked at the Western Infirmary, Glasgow with J Douglas Briggs in the renal transplant unit and studied cell-mediated immunity before and after renal allografts, drug effects on immunity and hepatitis vaccination studies. She retired in 2004.

 

     W F Bremner – a Glasgow graduate with MA in 1964, BSc in 1968 and MB 1971, worked

_Fraser-Bremneredited-for-the-web
Fraser Bremner

in the UMU in medicine/endocrinology for a short time in the mid 1970s and worked up anterior pituitary function during cardiopulmonary bypass for open heart surgery. He also studied the treatment of thyrotoxicosis with radioiodine-125 with WR Greig and colleagues. Training in cardiology thereafter, he emigrated to Loyola University Medical Center, Chicago, USA in 1978 and embarked upon cardiological practice.

Bremner died in 2002. [3]

 

 

      Susan Fraser – a Glasgow graduate, followed training in endocrinology as a registrar at

Susan-Fraser-edited-for-the-web
Susan Fraser

the Western Infirmary Glasgow by her appointment as registrar in medicine/endocrinology to the UMU in 1972 and senior registrar in 1973. Following maternity leave, she became consultant in Care of the Elderly at GRI in 1976 and the Southern General Hospital in 1979. Fraser retired in 2003.

 

 

 

 

There were also many young doctors from abroad keen to spend time with Thomson to learn general endocrinology.

     Edgar (P L) So – a graduate of Hong Kong, came to the University Department of Medicine in 1968 from

Edgar So 2013 edited
Edgar So

Professor A J S McFadzean’s[5] Department in Queen Mary Hospital, Hong Kong on a Hong Kong Government Scholarship for postgraduate training in clinical endocrinology. Working with John A Thomson, So gained experience in general endocrinology and, in particular, thyroid disease which included the Nuclear Medicine aspects of thyroid imaging and therapy. He returned to Hong Kong in 1970 and worked for two years in the University Department of Medicine with Professor Sir David Todd[6]  on cortisol metabolism in glucose-6-phosphate dehydrogenase deficiency. So became consultant in Medicine to the Queen Elizabeth and Princess Margaret Hospitals and Saint Paul’s Hospital. In 1978, he took up private specialist practice in internal medicine and endocrinology in the Causeway Bay Region.

     Irene Gavras, a Greek graduate, trained in endocrinology in the UMU in the early 1970s. She published on thyrotoxicosis complicating autoimmune thyroiditis.

     Abdul M Nurein – a Sudanese doctor worked with Thomson and Boyle before leaving for Saudi Arabia.

     Abdul Fattah Lakhdar –

Abdul Lakhdar 3
Abdul F Lakhdar

a Benghazi graduate, came in 1977 to the UMU for general training and in endocrinology. After further training at the Royal Alexandra Infirmary, Paisley and Stobhill General Hospital, he returned to Libya as associate Professor in Medicine. Since 2004, he has been consultant endocrinologist at Whipps Cross University Hospital, London.

 

 

 

     Prof Jemal Abdulkadir –a graduate of McGill University, came to the UMU and to Dr Thomson in 1979 to complete his endocrinology training.

Jemal-Abdulkadir-for-web
Jemal AbdulKadir

In 1980, he returned to Ethiopia as the first endocrinologist and played a key pioneering roll in the organisation of diabetes management in that country and in the African continent. Prof Abdulkadir was one of the first few Ethiopian physicians to introduce modern Western medicine to Ethiopia. He not only established one of the first dedicated diabetes clinics in the country but also played a key role in establishing the Ethiopian Diabetes Association. Abdulkadir died in 2013. [4]

 

 

     Athena Kolyannis from Greece and Kirtida Acharya from Kenya both trained in endocrinology with Thomson in the UMU in the early 1990s. Acharya gained experience in diabetes and nuclear medicine at GRI, returned to Kenya in 2000 becoming lecturer in medicine and Honorary physician/endocrinologist to the Kenyatta National Hospital in Nairobi. As part of her research profile, she has worked with the Kenya Camel Association on the role of camel milk in glycemic control.

     Mohammed Lamki, graduate of Egypt, and originally from Oman, joined Thomson and Boyle in the early 1990s to train in medicine and endocrinology. He returned to Oman in the mid 1990s as consultant endocrinologist in Muscat.

     Malik Mumtaz, graduate of Universities Sains Malaysia (USM), joined the UMU in the early 1990s training in

Malik Mumtaz in national dress edited
Malik Mumtaz in national dress

medicine, endocrinology, mineral metabolism  and nuclear medicine under the auspices of the Royal College of Physicians overseas training programme. He returned to Kota Bharu and joined the USM medical school there in the mid 1990s first as lecturer then as senior lecturer and Associate Professor. He left to take up the post of visiting consultant physician in full time private practice at Island Hospital in Penang in 2008 where he practises medicine, endocrinology and administers radioactive iodine. Research areas include diabetes, osteoporosis and endocrinology. He is a member of the Malaysian Clinical Practice Guidelines Committee for osteoporosis and diabetes.

     MSc Candidates. From 1980, the following individuals obtained an MSc thesis in endocrinology working with Thomson in the UMU at GRI. Omar Hijleh, Khalid Al Sammar, M Zamah Shaikh and Fatheya Fardullah Alawadi.

Temporary Transfer of Endocrinology to Diabetes

     Kenneth (Ken) R Paterson and Miles Fisher, both Glasgow graduates and established

physicians in Medicine, Diabetes and Endocrinology, took over the management of referrals for pituitary and adrenal diseases from 1998 until 2004 when Colin Perry was appointed physician in Medicine, Endocrinology and Diabetes at GRI.

Paterson became consultant Physician in Medicine and Diabetes in 1986 becoming heavily involved in the local diabetic services advisory group and in SIGN.

Ken-Patersonedited-for-the-web
Ken Paterson

He was also involved in Diabetes UK. His interests included diabetic epidemiology and population screening as they related to improvement in diabetes care. Paterson’s  parallel interest was in clinical pharmacology and therapeutics which led to his chairmanship of the New Drugs Committee of the Scottish Medicines Consortium (SMC) which was a lifeline for patients with rare conditions and expensive therapies.  This was followed by chairmanship of the SMC itself.

Paterson retired fully in 2017.

 

 

Miles Fisher became consultant in Medicine and Diabetes in 1990 and became interested

_Miles-Fisheredited-for-the-web
Miles Fisher

in the premature atherosclerotic disease associated with Diabetes. In particular, he concentrated upon the possibility of preventing or delaying the onset of the Diabetes itself. Fisher looked first at cardiovascular drugs such as those acting upon the renin-angiotensin system and beta-blockers and explored their anti-diabetic properties. He also looked at the thiazolidinediones and was particularly focussed upon the reduction of inflammatory mediators associated with atherosclerosis or cerebrovascular (CV) disease which might provide a benefit for populations with type 2 diabetes. Finally, his team explored the use of glucagon-like peptide 1 receptor agonists as a class of injectable therapies for their benefit in preventing CV events.

Fisher retired partially in 2018.

References

[1]      “Tony Boyle: Obituary,” Legacyia, accessed 20 November 2017.

legacy-ia.com/obituary/boyle-tony/569863?s_source=nqgl_her

[2]       “Charles D Forbes: Obituary,” from the British Medical Journal, Volume 358, Page 280, ref J3595, 19-26 August, 2017.

http://www.bmj.com/bmj/section-pdf/949835?path=/bmj/358/8118/Comment.full.pdf

 [23]      “W Fraser Bremner: Obituary,” from the Chicago Tribune on September 18, 2002 and accessed November 20, 2017.

http://articles.chicagotribune.com/2002-09-18/news/0209180180_1_cardiology-clinic-preventive-cardiology-group

[4]       “Jemal Abdulkadir: Obituary,” accessed November 20, 2017.

http://www.ethiosports.com/2013/11/27/in-memoriam-professor-jemal-abdulkadir/

[5].      Alexander James S McFadzean obituary, accessed 2nd July, 2018

http://www.europepmc.org/backend/ptpmcrender.fcgi?accid=PMC1612825&blobtype

[6].     Sir David Todd obituary, accessed 3rd July, 2018

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32600-4/fulltext

H W Gray

J A Thomson