Dr Robert D McIntyre
Chapter 6 - Scotland’s Health

Those who entered the medical profession in the Scotland of the inter-war years did so against a background of considerable change and competing claims.

Related to the pride in the achievements of Scottish education were the plaudits offered to the supremacy of Scottish medical practitioners and their education and training.

History, to some extent, bears this out.

The medical faculty attended by Robert McIntyre in Edinburgh had a record of achievement going back to 1726 and, in the 18th century, it played an important part in Scottish supremacy in medical education.

Other nations, including England, were to catch up in the 19th century and, in the early years of this century, there was clear evidence of Edinburgh and other Scottish medical schools falling behind.

The catching up process was to be expedited as nations like the US and Germany came through their industrial revolutions and their wealth and productivity increased.

Notwithstanding these events, statistics show that, in the mid- 1930’s, Scotland accounted for 35 per cent of the UK’s medical graduates and was still able to attract a substantial portion from overseas.

Part of the relative success was related to living on past reputations but there can be little doubt that a school such as Edinburgh had begun to put its house in order.

Views as to the relative merits of the medical and surgical aspects of the training of future doctors differ, but it seems that, in a rather macabre manner, the surgical side gained in expertise due to the influx of lecturers and practitioners who had served in the 1914-18 War, and who had ample practice in real life situations and were able to pass on their skills.

In December 1938, Robert McIntyre graduated in Medicine from Edinburgh University and the looming international crisis found him journeying to England to join a general practice in Warwick as an assistant.

After brief spells in practices in Musselburgh and Polmont, the early months of the Second World War found Robert installed as a house surgeon in Stirling Royal Infirmary. During this period, he made contact with Dr Edward Neil Reid, and this meeting, by accident, began a long and mutually beneficial association.

During this time of study at Glasgow University occurred another of the chance incidents which marked changes in Robert McIntyre’s life.

This harmony of interest brought Robert well and truly into the sphere of public health, which was to engage his future professional interest.

Ruchhill Hospital was itself a creation of the increased concern and knowledge about public health in Scotland at the turn of the century. It first opened its doors in 1900 and, in its time, with 408 beds, was one of the largest and most advanced medical institutions in Europe dealing with infectious diseases.

The improvements had a considerable legislative basis which brought new responsibilities to local authorities for the provision of new hospitals and produced a decline in the relative importance of the voluntary sector maintained by bequests, fees and public subscriptions. By the 1930’s, two thirds of hospital beds in Scotland were provided on a statutory basis.

Pivotal to these advances was the role of the Medical Officer of Health. From the middle of the 19th century onwards most progressive local authorities were appointing Medical Officers of Health. These endeavours were given additional incentive by various statutes which were passed giving local authorities responsibilities for the isolation, treatment and obtaining the important power of compulsory notification of infectious diseases.

Poor housing, inadequate sanitation and dirt, as well as inferior quality of water and air, played their parts in producing the miseries of the poor health of the Scottish people. Important steps were taken to counteract some of these problems by, for example, improvements in water supply exemplified by Glasgow’s Loch Katrine scheme, which went ahead despite objections, including those from the Royal Navy who argued that the taking of water from the Loch would lead to the silting up of the Forth and endanger, "The British Navy’s only anchorage north of the Humber".

These improvements were matched by the increasing political awareness of the need to improve the low earnings of the poor, particularly when exacerbated by old age, unemployment and ill health. The dramatic advances brought about by the Liberal Governments at the turn of the century are well recorded, in terms of pensions and unemployment and sickness provisions.

What is often forgotten is the fact that Lloyd George’s 9d for 4d Scheme, included the provision of sanatorium benefit for tuberculosis patients and, while the development of the concept was slow, under the spur of the Astor Committee in 1912 steps were taken to invite local authorities to submit schemes to control tuberculosis.

Ruchhill Hospital had been established initially as a fever hospital but had expanded to deal with tuberculosis, and its staff were amongst the pioneers in their efforts to introduce new techniques in the control of the disease.

However, almost immediately, Dr McIntyre found himself thrown into the battle to combat the dreadful infection of diphtheria - not in Glasgow but in neighbouring Paisley at the Burgh’s Hawkhead Hospital.

The early years of the War witnessed a dramatic increase in the confirmed cases of diphtheria in Scotland, rising from just under 10,000 in 1939 to over 15,000 in 1940.

Robert McIntyre, who was virtually in charge of the Hawkhead Hospital in Paisley in the early 1940’s has vivid recollections of the ravages of the infection. He was Senior Resident at the Hospital and played a leading part in the immunisation campaign directed at Paisley’s schoolchildren -visiting every school in the area to persuade the children and their parents to have anti-toxin administered against the lethal disease.

His gratification came in the success of the campaign which exceeded all expectations. He recalls: "When we immunised the children in a particular area, we could immediately see the results in that ambulances ceased to bring in the patients."

Overall Scottish statistics show that the Paisley pattern was part of an intensive national effort. By June 1941, 440,000 children in Scotland had been immunised, 40 per cent of the age group, and, by 1942, the figure had risen to 792,000, 69 per cent of the group.