The Scottish Society Of the History of Medicine (Founded April, 1948) REPORT OF PROCEEDINGS SESSION 2012-2013 and 2013-2014 1 The Scottish Society of the History of Medicine OFFICE BEARERS (2012-2013) (2013-2014) President DR DAVID BOYD DR AR BUTLER Vice-President DR AR BUTLER DR M MCCRAE Past President MR R MILLER DR DAVID BOYD Hon Secretary MRS CAROL PARRY MRS CAROL PARRY Hon Treasurer MR IAIN MACINTYRE MR IAIN MACINTYRE Hon Auditor DR RUFUS ROSS DR RUFUS ROSS Hon Editor DR DJ WRIGHT DR DJ WRIGHT Council DR FIONA BROWN DR N FINLAYSON DR N FINLAYSON DR GEORGE GORDON DR GEORGE GORDON DR G HOOPER DR LVH MARTIN DR GORDON LOWE PROF A RAEBURN DR M KINNEAR DR J RICHARDSON PROF A RAEBURN MISS CHRISTINE SHORT DR J RICHARDSON MISS CHRISTINE SHORT 2 The Scottish Society of the History of Medicine (Founded April, 1948) Report of Proceedings CONTENTS Papers Page a) All Changed : Changed Utterly - The Disciplinary Process 4 of the GMC, 1858-2012 Roz Sullivan b) Adaptations for the Empire: Roman Medicine 9 753 BC to AD 235 Jessica Dalzell c) The Locational History of Lunatic Asylums in mid- 18 19th Century Scotland Kim Ross d) The Early History of Drugs for the Treatment of Angina 23 Anthony Butler e) From Harvey to Heart Attacks: what Stoppeth the Circulation? 27 Gordon Lowe f) Casualties sustained by the BEF, France and Flanders, 34 1914-1918 Tom Scotland g) The Beaton Medical Kindred in the Highlands and Islands 37 Alasdair Munro h) The Hospitals of the Highlands: an Overview of their Origins 41 Stephen Leslie and Jim Leslie i) The Hand Clinic at Leith Hospital in the Second World War 61 Geoffrey Hooper j) Footprints on the Sands of Time, Scotland’s Contributions 65 to Obstetric Progress Andrew Calder k) A Short History of Peptic Ulcer Disease 75 Alexander Pollock l) Poverty, Philanthropy & Paediatric Care, the Founding of 83 Glasgow’s RHSC Iain Hutchison m) The Tuberculous Golfers of the Late Nineteenth Century 98 David Hamilton SESSION 2012-2013 and 2013-2014 3 The Scottish Society of the History of Medicine _________________ REPORT OF PROCEEDINGS SESSION 2012-2013 ________________ THE SIXTY FOURTH ANNUAL GENERAL MEETING The Sixty Fourth Annual General Meeting was held at the Edinburgh Academy on 27 October 2012. The President, Dr David Boyd, was in the chair. The Secretary, Dr Nigel Malcolm-Smith, presented his report and the Treasurer, Mr Iain Macintyre, presented the Treasurer’s report, which was accepted. Mrs Carol Parry was elected as Secretary in place of Dr Nigel Malcolm-Smith who was thanked for his contributions. Professor Tony Wildsmith retired from Council and was thanked for his contributions and three new members were elected to Council, Professor Sandy Raeburn, Dr Joyce Richardson and Miss Christine Short. THE ONE HUNDRED AND NINETY FOURTH ORDINARY MEETING The One Hundred and Ninety Fourth Ordinary Meeting of the Society was held at the Edinburgh Academy on 27 October 2012, directly following the Sixty Fourth Annual General Meeting. There were four speakers, Poppy Edwards, from Dundee, talked on “Better than Bedlam – the Rise and Fall of the Mental Asylum”, Roz Sullivan from Glasgow, talked on “The General Medical Council and the Changes in its Disciplinary Procedures 1858-2010” Jessica Dalzell, from Dundee talked on “Adaptations for the Empire: Roman Medicine 753BC to AD235” and Kim Ross, from Glasgow, talked on “The Locational History of Lunatic Asylums in 19th Century Scotland” ALL CHANGED: CHANGED UTTERLY THE DISCIPLINARY PROCESS OF THE GMC 1858-2012 This title is the refrain from a poem by William Butler Yeats, 'Easter 1916 ', and was used as the title of an article written by the then editor of the British Medical Journal, Dr Richard Smith, at the end of the GMC's disciplinary action against the doctors involved in the Bristol Case. Smith suggested that this case would result in total change for the medical profession: change in the 4 NHS organisation, change in society's attitude towards doctors' organisations and - most importantly - change in the trust patients place in individual doctors. This changing relationship between the public and the medical profession was relatively new. Until the 1990s there had been few changes in the processes for dealing with the self-regulation of medical practitioners. The Medical Act entitled 'An Act to Regulate the Qualification of Practitioners in Medicine and Surgery' (1858) established the General Council for Medical Education and Regulation, (abbreviated to the General Medical Council - GMC - in 1951). The GMC was the first body to be given statutory powers to regulate a profession. Their powers enabled them to control the standards of medical education for the profession, entry to it and discipline within it. The Council were mandated by Parliament to maintain a formal Medical Register of all duly qualified practitioners. Maintaining the Register is the basis of the GMC's power and is their method of controlling the profession. By registering medical practitioners, it makes them eligible to practise medicine in the United Kingdom. No medical practitioner who is not on the Register can hold any public positions. The 1858 Act contained fifty-five Sections concerning the Council's remit, but only one mention of dealing with disciplining members. Under Section XXXIX the Council had jurisdiction to erase names from the Register of those doctors deemed to be guilty of infamous conduct: If any registered Medical Practitioner shall be convicted in England or Ireland of any Felony or Misdemeanor, or in Scotland of any Crime of Offence, or shall after due inquiry be judged by the General Council to have been guilty of infamous conduct in any professional respect, the General Council, may, if they see fit, direct the Register to erase the name of such Medical Practitioner from the Register. There doesn't appear to have been much discussion in Parliament over this clause other than a reference by the then Prime Minister, Mr Walpole, during the second reading of the Act to the effect that 'if they were to have a register of duly qualified practitioners, they must have some authority to supervise and control'. Who would have thought that, based on these few lines, the GMC would be primarily known among the public as a body concerned with professional ethics and discipline? The first Medical Register contained 15,000 names and one hundred and fifty years later the number of registered doctors was over 240,000. There were very few changes made to the processes and procedures of the Council for almost one hundred years. Then in 1950 a new Medical Act was enacted making significant changes. The 1950 Act established a statutory Medical Disciplinary Committee, which would consist of the President and 18 other 5 members of the Council - at least six of whom should be lay members. Apparently this was not welcomed by the Council because until that time the entire Council sat on disciplinary cases. The Act not only dictated the constitution of the Committee, it also established the legal right for practitioners to appeal to the Privy Council; it permitted the administration of oaths of witnesses and very significantly it permitted the suspension for a set period of time. It also allowed for the restoration of names previously erased if there was suitable evidence of changed behaviour and references. Until that time the only sanction was erasure from the Register. Almost all of the cases heard by the Council were breaches of the five 'As', Abortion, Advertising, Adultery, Alcohol and Association. However, societal changes ended most of these. The introduction of the National Health Service in 1948 just about brought the end of 'Association' i.e. employing a non-registered person to assist you in your practice. Within the NHS there was no need for doctors to advertise as patients had ready access to General Practitioners, testing technology and hospitals. By the late 1990s the GMC had also withdrawn restrictions on private practitioners advertising, providing that they did not make unverifiable claims. Performing an abortion was illegal until the 1967 Act which decriminalised this practice. Adultery remains a disciplinary offence, only today it is more likely to be a charge of abusing trust with a vulnerable patient. The 'offence' of 'alcohol' was dealt with by the 1978 Medical Act. This Act established health procedures within the GMC which meant that doctors whose professional misconduct related to issues concerning alcohol, drug taking or mental health would now have to be heard by the Health Committee rather than the Professional Conduct Committee and could not be erased from the Register. Usually they were suspended and given time to receive treatment. If they recovered, they were permitted to return to work. Until the 1980s, complaints to the GMC about doctors were relatively rare and only a very small number of doctors on the Medical Register were ever disciplined, but the years since then have seen patient disquiet with the medical profession. Probably because of the highlighting of GMC cases - usually sensational sexual cases - the public has become more aware of the disciplining of the medical profession and public trust in doctors has diminished. Concerns about GPs were expressed both within the medical profession and by the Government and the public. Working parties were set up to discover what could and could not be done. The result was the Professional (Medical Performance) Act which was passed under the then President, Sir (now Lord) Robert Kilpatrick. This Act is seen as being very significant in the regulation of doctors because it opened the door for the 6 GMC to look at clinical practice. Doctors with serious deficiencies in their performances could now be investigated by the regulatory body.