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Dr Robert D McIntyre
Chapter 19 - Fight Against TB


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?


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