Sir Dugald Baird, Professor of Obstetrics and Gynecology in Aberdeen, introduced reforms which were to have a profound influence in Scotland and beyond. In 1961 he wrote that he “wanted to help to free women from the tyranny of unwanted pregnancies and also make them more independent and able to choose freely how they will use their training and skills”. His reforms resulted in more liberal attitudes to contraceptive advice, and easier access to termination of pregnancy. These reforms were influential in leading to David Steel’s 1967 Abortion Act. His policies were - and still are - controversial, yet undoubtedly helped shape a climate where virtually all women who wish to return to work while raising a family are able to do so.

The Glasgow Coma Scale (GCS) was devised in 1974 to give an accurate, objective assessment of changing levels of consciousness. It is a remarkable reflection of its worldwide popularity that viewers of Holby City and E.R. seem to be aware of the serious significance of a fall in GCS. It is based on a numerical scoring system so that in the case of head injury a falling score can alert to the need for medical intervention. When introduced by Graham (now Sir Graham) Teasdale and Prof Bryan Jennet it was designed for assessing patients with head injuries but has come to be used routinely in monitoring patients with any form of brain insult.

The first successful kidney transplant in the UK was performed in Edinburgh by Sir Michael Woodruff and his team in 1960. The patient had an identical twin brother, who was healthy, and was willing to donate a kidney. Because their tissues were genetically identical it was not necessary to suppress the recipient’s immune system and he lived for 6 years, dying from an unrelated disease.

In general the earlier a disease is detected, the better the chance of a cure. In 1986 when Sir Patrick Forrest, Professor of Surgery in Edinburgh, produced proposals for a national screening programme, breast cancer caused more deaths in women than any other (except lung cancer). The NHS Breast Screening Programme was the first of its kind in the world. Women were invited for screening from 1988 and UK coverage was achieved by 1995. As a result death rates have fallen by a third and breast screening is now saving 1,400 lives every year in England alone. Scotland’s bowel (colorectal) cancer screening pilot began in April 2000 under the leadership of Professor Bob Steele of Dundee and will cover all of Scotland by 2009.

Sir Alfred Cuschieri, Professor of Surgery in Dundee made major contributions in advancing laparoscopic surgery (keyhole surgery of the abdomen). Removing the gall-bladder in this way needed new instruments and new techniques and Cuschieri’s team developed both, starting with animal models and progressing to the UK’s first cholecystectomy (gall-bladder removal) in 1989. Minimal access surgery is now used in every surgical specialty and has great benefits for patients, including less pain, shorter hospital stay, earlier return to work and minimal scarring.

Iain Macintyre
Retired Surgeon

Keyhole surgery at Western General Hospital, Edinburgh, 1990. 
Credit: SCRAN

Have standards of surgical care improved since the advent of the NHS in 1948? Is the expected outcome for the patient better? Scotland has been at the forefront of surgical audit, a system designed to answer those questions.

From 1946 at weekly surgical audit meetings in Edinburgh each surgical death was discussed in detail and recommendations made about improving outcome in future similar instances. In the 1970’s this evolved into Lothian Surgical Audit, a system which collected written information about all surgical operations in Lothian and their outcomes. The discussions and recommendations for change which followed were published each year. In 1994 this developed into the Scottish Audit of Surgical Mortality.

This can help patients by showing for example:

  • which techniques and operations get the best results;
  • that emergency operations should be done by senior surgeons; and
  • that results can be improved by providing critical care beds.