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Not only was Dr McIntyre
keeping the SNP alive in the 1950’s and seeking to obtain local
authority positions but, most importantly, he was keeping folk alive as
a medical practitioner in the newly formed National Health Service. How
did he manage these tasks?
Part of the mystery
surrounding Dr McIntyre is solved by understanding his ability to
organise his time to optimum advantage. Of course, it helps if, like
him, you have an incredibly good mind and can be very patient in getting
to the nub of a problem.
But the problems in his
area of the Health Service in the period post -1945 were considerable.
As a Consultant Chest Physician dealing with tuberculosis and other
diseases of the chest, he had to campaign for additional facilities to
be provided to meet the needs of a large population and, not only did
this involve the organisation of beds, but the organisation of mass
radiography campaigns and, post - 1949 when BCG was finally made
available in Scotland, the provision of vaccination against
tuberculosis.
In the area covered by
his responsibilities, there were a number of chest clinics, including
those at Stirling, Falkirk, Kildean and Bannockburn. These required his
direct attention and, on occasions, because patients had difficulties in
getting to the hospitals, domiciliary visits had to be arranged.
A key member of Dr
McIntyre’s staff at that time was Mrs Betty Park who became his
secretary in 1952 and who worked in that capacity for 27 years. Her
assessment of his approach to his responsibilities is fair and frank and
worthy of note, especially to those who only have knowledge of the
"political" man. Her first impression of Robert was of a shy
man, yet one who made it very plain what he expected from those who were
responsible to him. Robert, as the medical man, went about his work in a
quiet, efficient manner. Not once in twenty-seven years did Mrs Park see
him lose his temper, although he could be sharp with patients who did
not take his advice. Patients, once in his charge, wanted to remain
under his attention, and there is little doubt that many "thought
the world of him". But he did not let his political views intrude
on his professional work. Mrs Park’s distinct opinion is that, in
terms of priorities, there was no doubt that his medical work came
first.
When pressed about
whether there was any noticeable slackening of his attention to his
medical practice when politics, both local and national were claiming
more of his time, particularly after the late 1950’s, Mrs Park refutes
the suggestion. She claims there was no diminution of activity in
medical terms and that Robert’s politics never intervened in his
medical work.
Whilst Dr McIntyre could
not and did not desire to hide his politics, these were kept apart from
his NHS responsibilities, and this approach gave people great confidence
in him.
Some indication of the
nature of the challenge which he and his colleagues in Stirling and
throughout Scotland faced in this period can be gauged by the reports of
the Medical Officer of Health for the area.
In Stirling County, this
post was held by Dr Edward Neil Reid. He had been in the forefront of
the fight against tuberculosis and had been instrumental in bringing
Robert to Stirling in 1945.
That he was not entirely
enamoured by the new relationship with the NHS is shown in his 1950
Report where he stated: "The tuberculosis service is now
increasingly recruited from hospital staff with no public health
training and divorced from the preventive services." As can be
gleaned from Dr Reid’s final Report as Medical Officer of Health in
1963, he believed in a total approach to the fight against tuberculosis.
DR EDWARD NEIL REID,
MEDICAL OFFICER OF HEALTH, STIRLING - REPORT 1093
Tuberculosis
In 1937 tuberculosis was
a major cause of death and disability. Through its chronic nature and,
in adults, protracted course, it was a common cause of poverty. The
greatest mortality occurred in teenagers. American doctors came to this
country to see the lesions of bovine tuberculosis, the disfiguring
cervical glands and disease located in the abdomen, hip-joint and spine
conditions rarely found there, as pasteurisation of milk supplies
developed early.
The public attitude
towards the disease at that time is well illustrated by the following
abstract from my annual report for 1938. ‘The belief that tuberculosis
is hereditary is still well rooted in the minds of a large number of
people, and to admit its presence in the family is like admitting some
criminal tendency. The patient, or the patient’s friends, feel that a
stigma has been placed upon, not only the effected individual, but the
whole family, and for the patient to go to a sanatorium is to confirm
this stigma’.
In 1937, the care of the
tuberculosis patient, formerly shared amongst all the assistants, was
given to a specialist medical officer. Patients suffering from major
non-pulmonary lesions, such as tuberculosis of the spine and hip-joints,
were treated in a general hospital and then sent home, either in plaster
or in surgical frames. The results were extremely unsatisfactory
Arrangements were made,
therefore, for all cases requiring hospital treatment to be admitted to
a new cubicle ward recently opened in Bannockburn Hospital. A local
surgeon, after a course in orthopaedic tuberculosis at Carshalton
Hospital, was appointed Consultant in Charge, with a specialist sister.
Provision was made for plaster work and the fitting of remedial
appliances, and x-ray control was carried out by removing the patient by
ambulance to Stirling or Falkirk Infirmary. In-patient treatment was
also provided at St Andrew’s Home, Millport and the Princess Margaret
Rose Hospital, Edinburgh. A portable x-ray was provided for patients who
could not be moved and for patients in remote areas.
Hospital treatment was
also provided for severe cases of abdominal and glandular tuberculosis.
A full-time teacher was
appointed by the Education Committee to continue the education of
children in their homes.
Later, two orthopaedic
sisters were appointed to share in the after-care of patients requiring
prolonged supervision and orthopaedic appliances. While much of their
time was spent on poliomyelitis cases, following the severe epidemic in
1947, their services improved very greatly the ultimate results obtained
from long-term treatment of orthopaedic tuberculosis.
As the figures in the
report show, the number of non-pulmonary cases fell with the improved
condition of the milk supply and the increased use of pasteurised milk.
With the completion of the eradication of tuberculosis in cattle in
1954, non-pulmonary tuberculosis, which was largely of bovine origin,
was virtually eliminated. Pulmonary Tuberculosis.
With the appointment of a
full-time Medical Officer for Tuberculosis, investigation of suspects
and contacts of cases by tuberculin testing and x-ray was instituted.
Later, the appointment of
further health visitors and the full-time concentration of special
health visitors on contact tracing and supervision, and maintaining
liaison with the hospitals proved of great value.
Improved facilities at
Ochil Hills Sanatorium and Robroyston, Glasgow, enabled modem treatment
to be made available for all cases. A chest surgeon was also appointed
to Ochil Hills Sanatorium.
During the war mass
radiography was introduced. While the frequency of surveys was unduly
limited by shortage of units, the surveys detected many cases at a
pre-symptomatic stage and served to educate the commumity and the
medical profession on the importance of early diagnosis. In 1955, BCG
immunisation of 13 year old children was started. The response to this
has been excellent.
The Three Factors which
have Revolutionised the Outlook in Tuberculosis
1. The eradication of
tuberculosis in cattle and the provision of a safe milk supply - an
obvious preventive measure delayed for no good reason for a quarter of
a century.
2. The discovery of
streptomycm, the first antibiotic drug fully effective against the
tubercle bacillus.
3. Alter prolonged
deliberation, the systematic immunisation of 13 year old children
against tuberculosis was authorised in 1954.
Tuberculosis has been
reduced to relatively negligible proportions. There are still highly
infective undetected carriers in the community. Many early cases are
still being diagnosed and while the death rate is small, continual
vigilance is still required. Eradication of tuberculosis in the human
community is not yet in sight.
A striking feature of the
present trend is the shift in incidence and mortality from the teenager,
particularly the adolescent girl, to men over middle age, possible due
to the reactivation of earlier infections though stress in later life.
More frequent mass
radiography sweeps should be carried out in order to detect unknown
ineffective sources remaining in the community. There is no doubt,
however, that all patients with a cough are now being referred early for
x-ray examination and the greatest number of cases are to be found in
this group.
In 1956, systematic
arrangements were made to x-ray all those whose work brought them into
close contact with children, e.g. doctors, dentists, teachers, nurses
and, while the number of cases found in these categories was small, they
all had the opportunity of spreading serious infection amongst a highly
vulnerable group.
The number of deaths from
tuberculosis in 1937 was 54 and in 1963, with an increased population,
10. Sanatoria now house aged, long-term illness or convalescents. This
major disease, at one time called "The Captain of the Men of
Death" is controlled by a combination of preventive measures some
tragically belated, and efficient treatment. Given the nature of the
challenge facing him in his medical work, as evidenced above, how did
Robert cope with the demands of leadership of the Scottish National
Party, and the increasing role he played in local politics in Scotland? |
