Download Alexander J O`D. Progress in the dermatological service in the West

1
Progress in the Dermatological Service in the West of Scotland since 1948
(Reproduced, with permission, from the website of the Scottish Dermatological
Society)
By Dr J. O'D. Alexander, Emeritus Consultant Dermatologist, Glasgow Royal
Infirmary
In this follow-up to my paper of 1971 (Brit J Dermatol. 84:470-86) I shall deal with
the general situation and its development and then with the individual skin units. My
knowledge of these springs from my having been on the staff of the Glasgow Royal
Infirmary Skin Department in various grades from 1.4.47 until 1.4.80 apart from 4
months spent as consultant dermatologist at Stobhill Hospital in 1964-65.
The introduction of the NHS on 5.7.48 heralded a new philosophy for health care in
the U.K. It was to be free to all for life. Those preferring private care retained this
privilege without reduction of their tax-paying contributions to the NHS.
Newly qualified doctors and aspiring specialists had no difficulty with the new
service. Established specialists did face a problem. Accustomed to independence, giving
their service voluntarily to local hospitals and earning their living from private consulting
practice, they now became salaried employees (called 'consultants'), only allowed private
practice if they elected to work part-time (or not at all) in the NHS.
In 1948 before the NHS started there were 6 or 7 consultants in Dermatology in the
West of Scotland, three covered the Western Infirmary, the Southern General Hospital
and Stobhill Hospital, one (possibly two) at the Royal Infirmary and two at the Victoria
Infirmary. I am doubtful of the position of Drs Harvey (Royal) and Carslaw (Victoria) at
that time. These seniors were responsible for the dermatological services for the whole
region (population about 2.75 million), for teaching of medical students and any
postgraduates there might be. They were helped at O.P. clinics by assistant
dermatologists who were for the most part either aspiring specialists or G.P.s. As far as I
know none of them were paid for their services but gave it for the experience and their
2
expectations. Each of the five Glasgow teaching hospitals had dermatological beds and
the in-patient routine was looked after by a house physician.
New Arrangements under the NHS.
The new Western Regional Hospital Board (WRHB), which changed its name from
time to time, decided on the consultant staffing to replace the old Voluntary hospital
system. The scale of appointments was empirical and largely dependent on advice from
the incumbent staff. Not unexpectedly the previous seven senior posts were confirmed
with slight adjustments. Dr. Herbert Brown retired from the Victoria Infirmary and was
replaced by Dr. RW Carslaw; Dr. AD MacLachlan retired from the Western Infirmary
but was not replaced immediately by a consultant. Dr. Ferguson Smith retired from the
Royal Infirmary but appointed to a new post covering Ayrshire. His post was taken by
Dr. George Harvey, and Dr. AC Dewar was also appointed to the Royal with sessions in
Lanarkshire. This meant that the total number of Consultants for the whole WRHB area
remained at seven and did so for the next 12 years.
Junior staff in the five Glasgow teaching hospitals was established on an ad hoc basis.
That is to say, there should be enough to cope with the clinical work load plus training
time for aspiring consultants and for experience for those intending to be G.P.s. Account
had also to be taken for study leave for trainees bearing in mind the necessity of obtaining
a higher degree in general medicine to qualify for a consultant post. The number of those
wishing to acquire some experience in skin disorders was boosted by returning ex-service
dermatologists with considerable knowledge of war-time and tropical dermatology but
with no formal training in civilian dermatology and no higher medical degrees. Many of
these men had taken up a Government offer of training in 6-monthly periods as 'Class III
post-graduates'. In the new scheme they were classed as Senior Registrars (SR) and
because of their number there was often more than one SR in an individual unit. A few
were classed as Senior Hospital Medical Officers (SHMO), which was an established
post below consultant level and presumably the equivalent of an Assistant Dermatologist
in the pre-NHS days. A teaching unit would thus consist of two consultants, possibly one
or two SHMOs, one or more SRs, one or more Registrars, a Senior House officer (SHO)
3
and a house physician, who was resident. In unusual instances there might be a Junior
Hospital Medical Officer (JHMO) who would probably be a G.P. This general
arrangement continued more or less for 12 years.
Staffing Unrest.
Out-patient numbers in Dermatology increased steadily with a concomitant increase
in ancillary work such as histopathology. Embryo clinics in outlying areas (e.g. in
Paisley, Irvine, Vale of Leven, Stirling, Stonehouse etc.) staffed from Glasgow, also
increased in size. Much of the resultant work fell on SRs, who were nevertheless glad of
the extra experience. However, many of those graded as SR in 1948 (in general medicine
and surgery and many other specialities apart from dermatology) were categorised as
'supernumerary SRs' because they were considered to have completed their training. In
1955 as a result of unrest and anxiety about their position, a group of 16 of these
individuals, including two dermatologists (I was one of them) all between 35 and 40
years old, married with families, qualified between 11 and 15 years and all with one or
more higher qualifications, appealed to the Secretary of State for Scotland, who happened
to be my M.P. They claimed that they had been retained in their supernumerary status
because of "their duties there essential for the efficient conduct of clinical and teaching
commitments of their respective hospitals" (Extract from the letter to the S. of S; June
1953). They felt that their duties both before and after 5.7.48 were those of consultants.
They had accepted their original grading "as there was a definite promise of wide spread
expansion of the consultant services." (This had been a reiterated complaint since the
onset of the NHS. It was always a case of jam tomorrow but never jam today). The
expansion did not materialise. Moreover, often vacancies created by death or retiral were
not filled e.g. when Dr.AD MacLachlan retired from the Western Infirmary in 1948 his
post was not filled; instead two SMHO posts were created. This appeal was considered
sympathetically by the Secretary of State but was nevertheless rejected after consultation
with the WRHB. The latter had also considered the matter and concluded after
consultation with the respective heads of departments that the appropriate staging of a
medical or surgical and by implication specialist units, was two consultants together with
a consultant of slightly junior status (cited in the S. of S. reply to the 16). It should be
4
noted that the senior consultants, whose views were sought, were all part time and
retained their pre-NHS bias (and protected their territory). Their view was paramount. It
is also noteworthy that the WRHB's idea of two consultants took no cognisance of the
number of sessions they worked. In more than one instance this was scarcely more than
the equivalent of one whole time consultant - perhaps one or two sessions more.
Incidentally all but one of the 16 became consultants later and one was elected President
of the Royal College of Physicians and Surgeons of Glasgow. Dermatology staffing
remained unchanged.
Early improvements in staffing.
In 1958-59 the Royal College commissioned the 'Platt' report on hospital medical
staffing. As a Member of the College I felt that I was entitled to give my opinion if I
wished. Although I was still a SR at that time I submitted a scheme based on Glasgow
and regional centres outwith Glasgow, envisaging 15 consultants in Dermatology. This
scheme was taken up by the 'Wright' committee on the same subject. Their
recommendations were published in 1961 and carried out over the next 4 to 5 years. In
fact by 1965 fifteen posts in Dermatology were established in the WRHB region. Over
the next 30 years this establishment has been slowly increased to 17 by 1970, 18 by 1975
and now in 1998 there are 24 consultant dermatology posts in the Region. (See Table 1.)
These posts only came about after persistent pressure firstly from the post-war generation
of dermatologists and later by the succeeding generation. Such pressure was necessary to
overcome the procrastination, parsimony and especially the short-sightedness of the
WRHB authorities. The result, however, is the establishment of a group of enthusiastic
consultants with progressive ideas, individual interests and the drive to use their talents
for the benefit not only of themselves but also of their juniors and especially of their
patients. Because of this they are in a position to offer an enviable dermatological service
to the whole of the West of Scotland. The original impetus for this came from John Milne
and Alan Lyell. Another factor which greatly helped was that the immediate post-war
group suffered from a lack of such support in their training and were determined that
their successors should not be so handicapped.
5
The Training of would-be Consultant Dermatologists.
With the successful struggle over staffing ended in the early 1960s, the log-jam on the
training ladder caused by the number of supernumerary SRs was removed. New
postgraduate recruits of high quality, including some from overseas, began to apply for
registrar posts, of which there might be two or three in any one unit together with one SR.
A few of these recruits already had a higher medical qualification but as before most had
to obtain one whilst at the same time studying dermatology. The proportion of women
applicants steadily increased, although not all necessarily intended to practice
dermatology. The latter were not included on the training ladder but might be needed for
the necessary clinical requirements of any particular unit. It quickly became apparent that
the possession of a higher degree was now mandatory to achieve SR status and in the late
1970s was also deemed necessary for a registrar post on the training ladder. This
incidentally fulfilled the view expressed by McCall Anderson some 90 years earlier. The
intention was for trainees to concentrate all their efforts on dermatology, the academic
standard of which was steadily improving.
In the early 1960s, under the influence of Milne and Lyell and supported by most of
the consultants, schemes were evolved for training which would be more or less common
throughout the Region. They predated the present national scheme. The various teaching
units, apart from tutorial schemes within their own departments, hosted Seminars on
various subjects connected with dermatology for all the junior staff in the Region. This
made use of specialised knowledge which particular individuals (of whatever status)
might have and also occasionally involved inviting the help of specialists in subjects such
as Plastic Surgery, Radiotherapy or Immunology. John Milne ran courses in
dermatopathology on a regular basis and these were augmented by joint sessions in some
units between dermatologists and their reporting histopathologists to their mutual benefit.
The trainees were also expected to give tutorials to small groups of medical students,
which was a valuable exercise for them. They were generally supervised by a consultant.
Thus, a broad education in the clinical aspects of Dermatology was given over a
period of two to three years throughout the Region. Trainees were also encouraged to
6
prepare papers on unusual clinical cases or on subjects of their own choosing. It was the
custom at the Royal Infirmary that all such papers whether by junior or senior staff were
read before a full departmental meeting for criticism prior to its being published or read
at a meeting elsewhere. This is an invaluable exercise and educational for all concerned,
leading to clear, concise presentations with good quality illustrations and acceptable
mode of speaking to an audience.
In 1948 there was no special University department of Dermatology in Glasgow. The
consultant staff in the various hospitals were appointed as "honorary clinical lecturers' by
the Faculty of Medicine and were paid a token honorarium of between £80 and £150 per
annum. In the 1950s James Sommerville suggested that a University Department of
Dermatology be established with a base at the Western Infirmary. John Milne was
appointed as lecturer in Dermatology with a special interest in dermatopathology. He had
trained as a pathologist and had the added advantage of being MRCP. A chair in
Dermatology was endowed in 1960 and Milne was appointed the first Professor, thus
following in the footsteps of GH Percival in Edinburgh. Milne started what was to
become a celebrated course in dermatopathology for trainees and consultants, for which
there is keen competition to get a place. To complement this he wrote an excellent textbook on the subject. He also started a laboratory for basic research into subjects
connected with dermatology, with a lecturer and post-graduate researchers. He was also
responsible along with Prof. PJ Hare of Edinburgh for the foundation of the Skin Biology
Club. This is an association of dermatologists, veterinarians and scientists involved in or
interested in any way with work connected with the skin. They meet twice yearly and
read papers on subjects so diverse as the wing structure of birds, the growth of vibrissae
in mice, photobiology, ectoparasites, bullous diseases, atopic eczema, mutations in sheep,
the culture of trout not to mention the very basic research into abstruse genetic and
carcinoma research. This has proved an outstanding success and has broadened the
outlook of all participating. It has also acted as a forum for the presentation of papers for
junior staff to give them experience for larger meetings. Mixing clinicians and research
workers is an excellent idea.
7
After his sad and sudden death in 1978 Milne was succeeded by Rona Mackie. She
had been appointed a consultant dermatologist in 1973 having previously worked as a
researcher with special interest in malignant melanoma and the immunology of the skin.
She trained for these in the pathology and immunology departments of the University at
the Western Infirmary. She pioneered a technique for the rapid clinical diagnosis of
pigmented skin lesions primarily to identify early malignant melanomas. The latter
became her main interest although she pursued investigations into atopic eczema and the
immunology of the skin. She is an excellent organiser and skilful procurer of funds for
research purposes. This has been so successful that the department under her has
expanded greatly. The laboratory now occupies splendid purpose-built premises in the
Robertson building of the University with a staff of two Senior Lecturers, 12 postdoctoral and graduate researchers in grant-funded posts, six technical workers and four
secretaries. A large number of publications and papers read to learned societies bear
witness to the output of the laboratory.
Prof. Mackie was President of the British
Association of Dermatologists in 1996.
Apart from the research aspect the University department now has the responsibility
for co-ordinating all the junior staff in training posts for the West of Scotland. The new
specialist registrar system involves the trainees rotating through the Western and Royal
Infirmaries, the Southern General Hospital and Monklands Hospital. This seems a
sensible scheme as the number of trainees is now in line with the likely number of
consultant vacancies. The great reduction of SRs and registrars of the old scheme, and
their final disappearance, is compensated for as regards staffing the hospitals with an
adequate personnel to cope with the clinical load by the appointment of career grades
below the rank of consultant (Shades of the old SHMO grade!). These are associate
specialists and clinical assistants and SHOs (some of the latter may be on the training
ladder).
Is the present staffing level adequate? Although there are now 24 consultant
dermatologists their functions and distribution vary considerably. For example at Stobhill
Hospital there are two consultants but between them they only spend 16 sessions whereas
in the 1970s there were 25 sessions. The number of new referrals in the intervening
8
period has gone up by 150%.For this added burden of work there are now 3 SHOs to
help. Previously there were registrars and an SR all with dermatological experience
whereas SHOs have the minimum of experience. In contrast in the Forth Valley area
there are now two consultant dermatologists whose time is entirely taken up with clinical
dermatology. They have four GP assistant sessions per week. The service here seems to
be a consultant orientated one (in the opinion of one of them the service given to the area
is better for this). Would this system of almost entirely consultant service not be very
suitable for the more remote areas such as Dumfries and Galloway, Argyllsire and
Dunbartonshire? If so, then more consultant posts still will be needed. I can envisage the
number ending up about 30.
The Contact Dermatitis Investigation Centre.
The CDI unit was the brain child of Dr. Milne and Dr. Lyell. It was started on a
shoestring budget at Belvidere Hospital and run and organised from the Royal Infirmary.
It supplied a service for the whole Region (although many individual units carried out
their own routine testing). There was a whole time nursing staff of three with a secretary
and a consultant in charge. It began about 1974 with Dr. SL Husain in charge. He had
done a 3-month tour of European centres for information and advice. After his departure
for the USA in 1977 his place was taken by Dr. Angela Forsyth, who remains in charge.
The unit moved to better premises around this time and in 1990 it transferred to the Royal
Infirmary into even better accommodation next to the Dermatology department. It offers
an advisory service to industry in the West of Scotland and is much appreciated. It has
also proved to be of great assistance in elucidating some difficult cases of
eczema/dermatitis for other units in the region apart from the Royal Infirmary.
The Influence of inflation and bed closures.
Beds for dermatological purposes were first introduced by McCall Anderson in 1874
when he moved from the Royal Infirmary to the Western Infirmary to become the
Professor of Medicine and also Dermatologist to the Infirmary. His out-patients clinic the Glasgow Skin Dispensary, founded in 1861 - remained in its original building in the
9
city centre but transferred to the Western Infirmary after his death in 1908, its funds
being used to endow beds already there. These beds are still in use. With the onset of
inflation in the mid '70s the reduction of Glasgow's population by one third and the
development of independent peripheral units in the Region, a reappraisal of beds for
dermatology became inevitable but was hastened by financial priorities.
The accompanying Table 2 sets out the skin bed state in the West of Scotland over the
years and is self-explanatory. The precipitation of events after 1980 was due to pressure
to close hospital beds in general and to an (undeserved) tendency of the WRHB and its
successors to regard Dermatology as not requiring beds, whilst dramatic conditions such
as cardiac surgery and organ transplant with their relative tiny numbers of patients as
having priority over the 95% of the rest of the population. Skin beds therefore became an
easy prey to pressure from all sides. The Royal wards, a vital part of a renowned teaching
unit, were closed in 1990 after a valiant rearguard action for 10 years by Dr. John
Thomson. The in-patient needs of the Royal were to be supplied by Stobhill Hospital,
which had its original large complement of beds reduced in 1994 to 16 and in 1996 to nil.
Thus the admissions for the Royal, for Stobhill, the Argyll peninsula and for Forth valley
were to be to the Western Infirmary, which also had to cope with its own inpatients as
well as those from Dunbartonshire and North Argyll. To do this, its bed complement was
increased from 20 to 22 beds. Sick children's bed state remained at 12 (now reduced to 4)
but this had to take the children formerly admitted to Stobhill. The bed state in the
periphery was greatly improved as shown in the Table. The most serious loss was in the
Royal Infirmary, where Dermatology had started as a specialty in its own right in 1861.
This unit had a great tradition in the training of consultants and the likelihood of this
continuing was enormously diminished by the closure of the in-patient department. It is a
mistake that will be regretted for years to come and the authorities may ultimately be
forced to reverse the situation. The merger of the Southern General Hospital and the
Victoria Infirmary is also serious as both are teaching hospitals. The Southern General,
however, has better facilities and may well compensate for the diminution of the role of
the Victoria in the end. There is also the possibility that centres like Lanarkshire and
Crosshouse in Ayrshire may be able to train post-graduates in the future (see previous
10
discussion). This is especially applicable to Lanarkshire which has a team of five
consultants.
The influence of incomers on Dermatology in the West of Scotland.
In 1948 all the senior dermatologists in the Region were Glasgow graduates. There
was undoubtedly a parochial atmosphere, well recognised by me since I was a graduate
of another centre of medical parochialism - Birmingham. Aspiring dermatologists after
1948 did not all hail from Glasgow. Several European refugees desired to practise here.
They included Dr. Tad Pasieczny an ex-Polish Army Dermatologist, and three women Dr. Lominska also from Poland, Dr.F.Cohn from Breslau and Dr. Maria Ratzer from
Prague. Later Kalman Keczkes from Hungary who escaped in 1956 whilst a medical
student. He quickly learnt English, completed his degree at Glasgow and within 16
months had acquired the MRCP. He is now a consultant in Hull. Dr. Pasieczny deserves
special mention. A highly decorated colonel in the Polish Army he escaped from the
Gestapo in 1939, crossed Europe on foot and skis and ended up in Scotland. There he
spent the remainder of the War apart from a distinguished episode as second in command
of the Polish expedition to Narvik. Apart from his medical qualifications he had a degree
in physical education, was Polish Universities' Fencing and Skiing champion and an
International referee for Association Football. He was highly experienced in both
Dermatology and Venereology. He was appointed JHMO, the lowest established rank in
the NHS at the Royal Infirmary in 1948. Apart from his invaluable whole-time daily
work in Dermatology he spent several evenings weekly in the city venereology clinics at
the specific request of the WRHB and for nearly 20 years he was the mainstay of the
service. It is fair to say that without his authority and experience that service would have
been second rate. Yet the WRHB did not pay him a penny for this service and he only got
promotion to SHMO after 10 years, and ultimately and belatedly in 1965 was made a
consultant. He was extremely popular with everyone who worked at the Royal Infirmary,
from consultants to clerks, joiners, plumbers etc. to whom he was affectionately known
as 'The wee Polish Doctor' .
11
Apart from these Europeans I was the first and only non-Glaswegian graduate to
work as a dermatologist in the West of Scotland for the next 14 years. First impressions
were of a closely knit group but there were amazing rivalries, usually concealed. There
was almost no communication between the various hospital staffs except at meetings of
the North British Dermatological Society (now the SDS) but with many juniors from all
areas now attending the atmosphere soon thawed and we began to know not only the
seniors in Glasgow but throughout Scotland. The increased friendliness, however, did not
extend to an increase in the consultant establishment.
The appointment of Alan Lyell to succeed George Harvey as head of the Royal
Infirmary Skin department marked a turning point. Trained in London and Cambridge he
came via Edinburgh and Aberdeen and was full of new ideas. Moreover, he now had the
power to put them into practice. From being an active but hum-drum teaching unit the
Royal department soon became a hive of activity and attracted post-graduates to registrar
posts in numbers and they were of good quality. During the 18 years (1962-80) when he
was in charge no fewer than 12 of these registrars obtained consultant posts either in
Scotland or elsewhere and many others continued to practice dermatology at a lesser
level. Several of these consultants were from overseas. The influence of Alan Lyell
cannot be overstated. The presence of someone with ideas emanating from outside
Glasgow was very beneficial to Dermatology in that city and thankfully has been
realised, even if subconsciously, because the recent upsurge in the total number of
consultant posts in Dermatology in the West of Scotland has included no fewer than eight
who qualified elsewhere apart from new Glasgow qualified consultants. Long may this
mix continue.
ADDITIONAL NOTE: Day Treatment Centres
Dermatology beds originated because management of skin diseases in general
medical wards was regarded by dermatologists as highly unsatisfactory for a variety of
reasons. The drastic reduction in such beds has meant the re-introduction of Day
12
Treatment Centres (DTC's).This note concerns their activities and whether they are
adequate replacement for beds.
DTC's provide a dressing service for eczema/dermatitis, psoriasis and leg ulcers
(varying from daily to weekly dressing) and routine PUVA and narrow band UYB
treatment, as well as routine patch testing, biopsies, minor dermatologic surgery and laser
therapy. They also undertake regular monitoring of patients on methotrexate,
immunosuppressive and corticosteroid therapy.
The nursing staff varies from unit to unit dependent on the size and distribution of the
local population and the presence of any designated skin beds. In an area of scattered
population, such as Dumfries and Galloway, a DTC is impractical and service is provided
by arrangement on an ad hoc basis. Where the population is somewhat more concentrated
a DTC is desirable but not always available (e.g. Vale of Leven). All the other areas in
the West of Scotland have one or more DTC's. Some (e.g. Ayrshire, Lanarkshire) are
highly organised with a full staff (Sister, 2 to 4 staff nurses, plus auxiliaries) and may
offer out of hours opening (e.g. 8am to 8pm on weekdays and Saturday opening). This is
very popular and overcomes the reluctance of employers to release workers for treatment.
Other departments only open during office hours because either management have vetoed
the expense of out of hours opening or the Nursing staff are reluctant to undertake the
extra duties. In Renfrewshire this has meant out of hours dermatology has to be
undertaken by the general physician on call, which is most unsatisfactory. PUVA and
UVB treatment is usually carried out by specially trained nurses (sometimes by the
dermatologist). The same applies to routine patch testing.
In at least one department there is a set protocol of progression of topical dressings
for eczema and psoriasis, which allows the nursing staff considerable freedom of action.
However, there is always a dermatologist (consultant or assistant) available to give
advice and change treatment where necessary.
The annual attendances at these DTC's is considerable, from 5,000 to 7,000 plus. The
duration of treatment on the whole is rather longer than would be the case were more
13
beds available. It is estimated in Lanarkshire that the availability of a DTC can reduce the
length of stay in their ward by an average of 4 days.
The general impression given by the consultant dermatologists in the Region is that
DTC's work well. Many of the younger dermatologists think that in-patient treatment is
seldom necessary but some of the older generation with experience of their own inpatient
units regret their departure, whilst acknowledging that new drugs and modern techniques
have made them less necessary. One consultant misses the weekly ward round of the
whole departmental staff and the subsequent valuable general discussion afterwards. This
is an educational opportunity that trainees in the future may be denied.
A further regrettable change in medical education is the proposed removal of
dermatology from the students’ curriculum. This will undoubtedly affect general practice
and may indirectly aggravate the loss of dermatology beds.
Whether the economies of bed closure are justified remains to be seen. Can patients
be investigated adequately as out-patients? Will a central token bed complement be
sufficient or convenient for this purpose? The present writer's view, although perhaps out
of date, is that the authorities who have wrought these changes have gone rather too far
and may well have to review their hasty bed reductions for dermatology.
Table 1:
Consultant numbers in the West of Scotland 1948-98
Hospital
Glasgow
Royal
Infirmary*
Western
Infirmary(+)
1948 1950s 1960s 1970s 1980s 1990s 1998
2
2
3
4
3
2
3
2
1
3
4
4
4
4
14
Southern
General
Hospital (++)
Sick
Children's
Hospital
Stobhill
Hospital (o)
Victoria
Infirmary
(+++)
Ayrshire (oo)
0
1
1
1
2
3
3
0
0
2
2
2
2
2
0
1
2
2
2
2
2
2
2
3
3
2
2
2
1
1
1
1
2
2
2
0
1
1
2
3
5
5
0
0
1
1
2
2
2
Heathfield
Hospital, Ayr
Ayrshire
Central, Irvine
Crosshouse
Hospital
Lanarkshire
(**)
Stonehouse
Hospital
Monklands
Hospital
Hairmyres
and Law
Hospitals
Renfrewshire
(***)
Royal
Alexandra,
Paisley
Inverclyde
hospital,
greenock
15
Dunbartonshire
Vale of Leven
Hospital
0
0
1
1
1
1
1
0
0
0
0
0
1
1
0
0
1
1
1
2
2
Campbelltown
Dumfriesshire/
Galloway
Stranraer
Dumfries
Stirlingshire
Stirling R.I.
Falkirk I.
* Since 1974 includes Cons. i/c CDIU. Now shares one Cons.
with Stobhill
** Staffed from Royal Infirmary up to 1965
***Staffed from Victoria Infirmary until 1965
+ Staffed SGH, Sick Children's and Vale of Leven up to 1960.
Shares Conswith Sick Childrens since 1961 and with Vale of
Leven Since 1978
++Autonomous since 1970. Merged with Victoria in 1990
+++Merged with SGH 1990. Staffed Dumfries until 1990
o Autonomous since 1948. Staffed Stirlingshire until l982
oo Staffed Stranraer until 1990
The total number of Dermatological consultants is now 24.
Some have sessions in more than one hospital which is why
there may seem to be more than 24.
16
Table 2:
Changes in the Dermatological Bed State 1948-1998
Hospital
1948 1950s 1960s 1970s 1980s 1990s 1998
Glasgow
Royal Infirmary
20
20
20
20
20
0
0*
Stobhill Hospital
120 106
106
40
40
16
0*
Western Infirmary
20
20
20
20
20
20
22
Southern General
Hospital
47
47
47
47
41
21
16
Sick Children's
Hospital
0
0
12
12
12
12
4
Victoria Infirmary
21
21
21
17
17
0
0**
Heathfield Hospital,
Ayr
0
20
20
20
0
0
0***
Crosshouse Hospital
0
0
0
0
27
16
16
Stonehouse Hospital
0
0
20
20
20
20
20
Monklands Hospital
0
0
0
2
24
24
24
0
0
0
0
8
8
8
0
0
0
8
8
8
8
0
0
0
0
0
0
0*
Lanarkshire
Renfrewshire
Royal Alexandra,
Paisley
Inverclyde Hospital,
Greenock
Dunbartonshire
Vale of Leven
Hospital, Dumbarton
17
Dumfriesshire/
Galloway
Dumfries Royal
Infirmary
0
0
0
0
0
0
0**
0
0
0
0
0
0
0*
Stirlingshire
Stirling R.I.
* Now admit patients to the Western Infirmary
** Now admit patients to the Southern General Hospital
***Now admit patients to the Crosshouse Hospital