| Description | Mr TOM SCOTLAND interview on Wednesday 6th September, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) THOMAS ROBERT SCOTLAND, born in St Andrews on 24th April, 1948. Retired in November 2007 as Consultant Orthopaedic Surgeon. Family background, had a cousin who was a medic, but no direct family in Medicine. Brought up in Earlsferry, went to local Elie primary school, then to Waid Academy in Anstruther, decided when he was in about Fifth Year that he wanted to do Medicine, explains influence of his father for this, despite him dying when Tom was only a month old. Explains about his interests at Waid Academy. Got an unconditional acceptance for the University of Edinburgh, started studying Medicine there in 1965. Talks about what life was like for him as a Medical undergraduate, met his wife at the end of his Second Year, got married at the end of Fifth Year; worked hard, a good life. (0:05:34) Explains about studying Medicine in those days, six year course; not exposed to patients till about Fourth Year. Subject that stuck most in his mind and influenced his future career was an attachment in Fifth Year to Obstetrics; explains about significance of a very good Registrar who taught him to tie knots with his fingers; realised his future was in Surgery. Recalls one young woman patient with ovarian cancer who made a great impression on him, another patient who had terminal stages of Motor Neurone Disease. Patient who made most impression on him was dead, called Thomas McWhinnie, his first post mortem, decided that he was not going to be a Pathologist. Talks about inspirational tutors, mentions Obstetric Unit in the Western General Hospital in Edinburgh, and great influence of then [Senior] Registrar John Scrimgeour. (0:09:59) Graduated in 1971, arranged SHO (Senior House Officer) job for later at Western General, but explains his disappointment in not getting any of the House jobs he applied for in Edinburgh area, instead got a job in Falkirk, explains; very demanding, lot of clinical experience. After that six months had a job in Dunfermline, where there was a very good General Surgeon called Bill Brydon, learned a great deal from him, explains. Then went on to do the SHO job which he had previously arranged in Obstetrics at the Western General with Ron Clark and Tony Anderson. Learned a great deal, because he was enthusiastic got a lot to do, explains; decided Obstetrics was the career for him, explains in detail. Did a year as anatomy demonstrator in Edinburgh under Professor George Romanes, with prime aim to study for his Primary Fellowship for the Royal College of Surgeons of Edinburgh. Then decided to do a year’s training in General Surgery. (0:14:51) Got job in Raigmore Hospital in Inverness in 1974-75, and the Royal Northern Infirmary in Inverness; a great experience, explains in detail. Time came for him to apply for a Registrar’s job in Obstetrics, went for interview in Edinburgh, but realising he enjoyed General Surgery so much he just went back on train to Inverness, explains. Job came up in Aberdeen, arrived there in June 1975; this was the Surgical rotation, going through the different specialties. Very first specialty he was appointed to was Orthopaedics. But surgeons in Elgin were short of a Registrar, explains; so after just six weeks in Aberdeen Tom had to shift his wife and two children to Elgin for six months. Small hospital with two surgeons, John Smith and John De Beaux; then back to Aberdeen to be attached to a General surgical ward with Norman Matheson and Stanley Miller, very busy, explains in detail. Then went to do Urology with Bill Garvie and John Steyn, and Orthopaedics again with Alex Adam and Neil Hendry. Speaks about Alex Adam’s consideration with patients, he later became Tom’s mentor when Tom subsequently joined the Orthopaedic Dept as an Orthopaedic trainee. (0:20:26) Then had another General Surgical attachment with Peter Jones at Woodend (Hospital). But family life quite difficult, by then had three young children, hardly ever saw them. So applied for a job in General Practice in Grantown-on-Spey; got it, went there in 1977. Realised it was a mistake after two weeks, but stayed there for nine months. Career Registrar job in Orthopaedics came up in 1978 in Aberdeen, got the job, recalls the interview; on the interview committee was Peter "Puffy" Jones, whose Registrar job he had left to go to General Practice, thinks he was against him getting the job. But also on the committee was Bob Fraser the Neurosurgeon, who argued in his favour. At the time he got the career Registrar job there were six orthopaedic surgeons; Alex Adam, Neil Hendry, Tom Carr and Ian Mackenzie, and John Gibson and Ken Mills; and Jim McLauchlan was there as a Senior Lecturer, so really seven orthopaedic surgeons. Explains in those days there was not a great deal of specialisation, as there is now; Alex Adam really did most of the hip replacements; explains, mentions John Charnley, who did the first low-friction arthroplasty in 1964, he thinks; Alex had been sent to see him, and did most of the hip replacements. Explains how Jim McLauchlan started doing research into hip replacements. Neil Hendry specialised in Spines. Ian Mackenzie did Children’s Orthopaedics, as did Alex Adam, explains. John Gibson did Rheumatoid Disease, and Ken Mills General Orthopaedic surgeon. (0:25:36) On reputation of the department in those days, describes it as a Cinderella specialty, explains in detail, including Aberdeen’s role in the development of Orthopaedics. Recalls history. In early 20th Century there was a surgeon in Aberdeen called Henry Gray, acquired very good reputation. Mentions general surgeon in Leeds called Sir Berkeley Moynihan, later Lord Moynihan. Invited Henry Gray and others to join the Moynihan Chirurgical Club, from which London surgeons were excluded, explains. One of the members was a Welsh surgeon called Robert Jones, who was working in Liverpool; Jones and Moynihan and Henry Gray would play a very big part in Orthopaedics during the First World War. Explains about this in detail; problem of badly treated fractures. Jones appointed to open a 500-bed unit at Alder Hey Hospital in Liverpool in 1915. In 1916 he became Director of Military Orthopaedics; opened orthopaedic centres around the UK, including at Old Mill Hospital in Aberdeen, what is now Woodend Hospital. Had surgical facilities and what were called Restorative Workshops, where patients with wounds were treated and had adequate rehabilitation. On Western Front problem of how to address fractures; Robert Jones introduced a splint in 1915 called the Thomas Splint, used for immobilising fractures of the Femur. (0:30:15) Up to that time they had been treated using a Rifle Splint; explains deficiencies of this method. Henry Gray in opening months of the war had noted there was a dreadful problem with these musculoskeletal wounds arriving at his base hospital in Rouen; ghastly infections, explains why in detail. Surgery had to be performed earlier. Surgery was wound excision, explains. Henry Gray was one of the first to describe this. Other surgeon to describe this was an Australian called Edward Milligan. Explains significance of the Thomas Splint in condition of casualties arriving for treatment; mortality of the compound gunshot fracture of the femur fell from about 80% to less than 20%. Gray became recognised as an expert in the treatment of fractures. Made a great contribution to Orthopaedics on the Western Front, just as Robert Jones made a great contribution to Orthopaedics in the UK, with even Aberdeen as a centre of excellence. But opposition from the general surgical establishment in London, explains about this in detail; move to get Orthopaedics back into the hands of General Surgeons, consequences of this. Henry Gray came back to Aberdeen after the war, he knew how effective the Thomas Splint was. Tom convinced General Surgeons at the time continued to use the Thomas Splint. (0:35:29) As late as 1948 there was a view that there was not going to be enough work for an Orthopaedic Surgeon in Aberdeen. It was 1953 before Orthopaedic surgeons started to look after fractures in Aberdeen. First Orthopaedic surgeon, about whom Tom knows little, was called Mitchell, known as Crippled Mitchell because he had a disability. All the other surgeons whom Tom worked for when he started were post-Second World War appointees; [Later added: I should have mentioned Professor Alec Rennie, who took over orthopaedic department from Mitchell in 1947. Rennie served in RAMC during the war where he gained much orthopaedic experience. I knew him briefly after my appointment to surgical rotation. Then I had to go to Elgin after a few weeks and by the time I came back, Alec Rennie had retired], Alex Adam, Neil Hendry, John Gibson, and Ken Mills who was later; none of them had any particular expertise in fractures. So when Tom joined the Orthopaedic Dept in 1975, fractures treated pretty much the same way as they had been in 1953; in plaster, conservatively; some fractures treated operatively, but not many. Surgeon who did most to change this was Buchan Chesney, who is still alive; interested in the internal fixation of fractures; first person to do an Intramedullary Nail, on a femoral fracture, in Aberdeen; explains in detail the Heath Robinson nature of the equipment he had to use. Eventually got funding for better equipment and material, but there was never a dedicated Trauma Theatre for the treatment of orthopaedic injuries till relatively recently. Talks about having to compete with General Surgeons for theatre access; explains about relative regard in which Orthopaedics and General Surgery were held, using anecdote from his own experience operating in Emergency Theatre in Ward 10, mentions encounter with General Surgeon Alan Davidson; and having to do operations during the night which should’ve been done during the day, but no theatre to do it. Had one designated Orthopaedic Theatre in Foresterhill, but only worked during the day; most cases done in the Emergency Theatre as and when they came in, frequently operating during the night. (0:40:59) Reference to the book on War Surgery 1914-18 which Tom edited with Steven Heys, and how Aberdeen became a centre of excellence in orthopaedics during the war. Tom goes on to explain more about how the resistance of general surgeons resulted in one of the missed opportunities from the First World War, not just in Aberdeen but elsewhere. But feels Henry Gray must have had some influence; left Aberdeen in 1923 to go to Canada, where his career ended in complete disaster. Tom explains that the general surgeons believed they should be doing Trauma. Explains origin of term Orthopaedics, was originally straightening crippled children; went back to that after the First World War, did not properly use the expertise that had been gained during the conflict to properly manage fractures. Paper published by the British Medical Journal as late as 1935 looking at the few centres in the UK where Orthopaedics had become established, especially Manchester where Sir Harry Platt had a unit; this report showed results of fractures were very much better where there were Orthopaedic surgeons than the results obtained by General surgeons. Nothing was really done about it. By the time the Second World War came along, nothing had really changed, Orthopaedic centres opened up again, but by then Orthopaedics was rather a Cinderella specialty, explains. Only after the war did Orthopaedic surgeons begin to have more impact. (0:45:24) Defines Orthopaedic Surgery nowadays; covers all aspects of musculoskeletal conditions and trauma. Tom ’s own interest was children’s orthopaedics; and knee surgery, when he became consultant in 1983 established a specialist knee clinic; and also tumour surgery, explains. Talks about relations between Orthopaedics and other medical departments while he was working in Aberdeen; was initially regarded as down at the bottom somewhere. Gradually improved as new consultants were appointed. Figure most associated with the transformation of Orthopaedics was Prof Jimmy Hutchison, explains why. Regarding what is important about the history of Orthopaedic surgery in Aberdeen, Tom feels people in future should understand the importance of the First World War in its origins; the development of sub-specialties as time has gone on; during his time in the Orthopaedic Dept it became much more specialised, explains. Talks about how the work was divided up between the orthopaedic surgeons. Alex Adam was his mentor, so when he retired, Tom took on his clinical role of Club Feet; Alex had an interest in knee surgery, encouraged Tom to do a Knee Fellowship, which he did in Toronto in 1981-82; came back full of enthusiasm to do a Knee Clinic. Tumour Surgery a different matter; talks in detail about treating a young man who was sent to his Knee Clinic, had an osteosarcoma of his distal femur. Decided to treat this patient with the help of his Oncology colleague Derek King, to give the chemotherapy, while Tom contacted Hugh Kemp who ran the Bone Tumour service at Stanmore Hospital in London, for advice. (0:51:35) Ordered an endoprosthesis from bio-engineering unit at Stanmore, Derek King did the chemotherapy cycles, Tom did the operation, Derek gave more chemo afterwards, patient alive and well about thirty years later. Refers to issue of Clinical Governance, and how it would now be very difficult to suddenly decide to do that operation, explains. Tom subsequently dealt with tumours in Aberdeen. Helped in this because we have a managed Clinical Network in Scotland on bone and soft tissue sarcomas, explains. Had meeting four times a year in Western Infirmary in Glasgow, run by Pathologist called Robin Reid; started to have a clinical meeting with interested surgeons, Tom from Aberdeen, James Robb and Daniel Porter from Edinburgh, and Glasgow people (unspecified). Led to establishment of first national cancer Clinical Network in Scotland, explains how this worked. Explains in detail how the sub-specialisations developed in Aberdeen during his time there; now 26 orthopaedic surgeons in Aberdeen since his time. Doug Wardlaw did a fellowship in Toronto with Ian MacNab, who had expertise in spinal surgery. Buchan Chesney took forward the management of trauma. Explains how treatment of femoral fractures when he first arrived was being put in a Thomas Splint for twelve weeks, Doug Wardlaw and Jim McLauchlan changed that in the late 1970s and early 1980s with introduction of Cast Bracing, explains. Buchan Chesney spearheaded the internal fixation of fractures, explains how this revolutionised things for patients, home in days. Buchan Chesney also did most of the Hand repairs, in conjunction with the Plastic surgeons, explains. Most people did joint replacements, Tom particularly did knees and revision knee replacements. Talks about how Scotland had very good setup, had an Arthroplasty Register, explains how this worked. (0:57:50) Tom speaks in detail about things that stood out in his career. Patients that affected him most were his tumour patients, explains. Gives detailed and moving account about one young female patient from Peterhead who did not survive; mentions colleagues Dr Bissett, chemotherapy, and plastic surgeon John Holmes, both involved with this case. Got call about a year later from his secretary to say Sarah (patient’s first name) had died and she wanted Tom to go to her funeral, which he could not do. Explains how he later swapped four bottles of champagne for a photo of Sarah, which remained on his desk till he retired. (1:03:37) Explains she was a lost cause from the start, because she did not respond to the Chemotherapy. Tom says successes are fine, it’s the failures he remembers. Recalls a young boy who didn’t do well; blamed himself when things did not go right, explains this involved him going in during holidays to do operations. Explains that when he was a Registrar most young people with osteosarcomas died, now most survive, and without an amputation. Talks about an absolutely delightful patient, with whom he keeps in touch, who got a malignant bone tumour at university, had a year out, and went back to get a First Class degree, married and had a family. Also speaks about being invited to the wedding of two of his patients, recalls how many of the people present at that wedding had been treated for tumours, and how when he was a Registrar none of them would have been present; also recounts how he dealt with a problem with the bridesmaid’s dress! [Later corrected this to bride’s dress] (1:10:27) Talks about relationships with hospital managers; not particularly good, explains in detail. System now not working in best interest of staff and patients, explains. Talks about the last three years before he retired, being lead clinician for the Scottish Sarcoma Managed Clinical Network, explains. Recalls his colleague Derek King showing him an article in the Press and Journal newspaper that Susan Deacon, the then Health Secretary (for the Scottish government), had decided that all malignant bone tumours would be dealt with in Glasgow. Tom’s reaction; had been treating tumours in Aberdeen for several years, as had his friend James Robb in Edinburgh; at that time Glasgow did not have a tumour surgeon; Prof David Hamblen had stepped into the breach to provide one, but the surgeon they had in mind had taken a job in Newcastle. Tom had a big row with the National Services Division in Edinburgh, explained why it was important that Aberdeen retained its tumour service, otherwise it would reduce Aberdeen to the status of peripheral general hospital. Explains about consequential meeting of interested parties including himself and James Robb. Tom’s friend and colleague Steve Cannon, who runs the bone tumour service at Stanmore in London, also at the meeting, very helpful; decided there would be a virtual centre for bone tumours. Strengthened their position by establishing managed clinical network, which they had already been doing informally; explains how this worked. Recalls how the Dept of Orthopaedics was working pretty well when he retired; 12 or 15 surgeons, waiting time for joint replacement three months. Now there are 26 surgeons and the waiting time for a joint replacement is three years; six operating theatres at Woodend, but only three actually functioning; can’t get nursing, can’t get staff; the roof leaks; waiting time for an out-patient appointment is years. Can’t understand why it takes so long, more and more people being driven to have operations privately, explains. Not impressed with current state of NHS. When he retired was working closely with his colleague David Boddie, who now runs the tumour service in Aberdeen with Louise McCullough; but explains that the bio-engineering unit at Stanmore Hospital, from which he could get an endoprosthesis in three weeks, has now been privatised and it now takes months. Talks about what he misses and does not miss about being an Orthopaedic surgeon; mentions getting on well with his colleague Bill Ledingham who operated in an adjacent theatre; pays tribute to the nursing staff he worked with. (ENDS 1:23:46)
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