Glasgow Pathological and Clinical Society

As the College embarks upon a refurbishment programme, we’ve been delving into the historical uses of the rooms of our St Vincent Street building. The old Faculty Hall (now named Alexandra Room) was the venue for most of the College’s business until the new College Hall extension was built in 1893. In addition to Faculty meetings, and meetings of the Medico-Chirurgical Society of Glasgow, this room hosted the meetings of the Glasgow Pathological and Clinical Society from 1876.

GP&CS Transactions book

Transactions, 1873 – 1883 (RCPSG 4/1/6)

We were keen to explore what these meetings involved, who attended them, and the history of the Society itself. We are extremely fortunate to hold the archives of the Society, from its foundation in 1873 until its merger with the Medico-Chirurgical Society of Glasgow in 1907.

There is mention of an earlier Glasgow Pathological Society (established 1850) in the 1852 Medical Directory. However, it appears to have only lasted for 2 or 3 years. The idea of forming a new Pathological Society came from four prominent Glasgow physicians and surgeons in the early 1870s – Thomas Reid, Joseph Coats, William Leishman, and William Tennant Gairdner. James Finlayson was the first secretary and describes the initial idea for “a society composed of working members“, creating an environment where “specimens could be quietly examined and discussed… in a friendly manner, without any temptation to ostentatious display or personal bitterness.”

GP&CS First meeting proposal 1873

From Transactions, 1873 – 1883 (RCPSG 4/1/6)

The first meeting was held on 25th November 1873 in the rooms of the University Lying-In Hospital and Dispensary for Women on Wellington Street. James Finlayson and Hector Cameron constituted themselves interim secretaries, while Dr Gairdner (then Professor of Medicine at the University of Glasgow) became chairman. In addition to those already mentioned, the original membership included the young surgeon William Macewen.

GP&CS first agenda 1873

From Transactions, 1873 – 1883 (RCPSG 4/1/6)

From the first meeting, the format was established. The Agenda pictured above shows the list of specimens presented by the members for discussion. In further meetings, patients would also be presented. For example, in May 1874, Dr McCall Anderson showed a patient who had been treated for syphilitic paralysis.

In 1874 the name was changed to the Glasgow Pathological and Clinical Society, and with the number of members increasing to 30, a new venue was found at the Glasgow Eye Infirmary on Berkeley Street. Then, in the fourth session, beginning in October 1876, the venue settled at the Faculty Hall, in the College’s current building on St Vincent Street. The origins and early history of the Society were usefully added to the book of Transactions (RCPSG 4/1/6) by James Finlayson in 1879 (below).

GP&CS Memorandum 1879

Memorandum by James Finlayson, 1879 (RCPSG 4/1/6)

An important part of the Society’s business was the publication of its reports, in both the Glasgow Medical Journal and the British Medical Journal. This placed the research and practice of the Society in the context of the wider medical and surgical literature, which was at this time exploring many new areas and innovations.

Notable in the records of the Society are cases concerning neurological conditions and physiology, the treatment of cranial injuries, and cranial surgery. For example, Glasgow physicians such as Alexander Robertson, who was pioneering in his approach to aphasia in the 1860s, and William James Fleming, who investigated the physiology of the ‘motions of the brain’, provide a stimulating context for the advances in brain surgery made by William Macewen in the 1870s.

GP&CS Agenda 1879

From Society Minute Book 1879 – 1891 (RCPSG 4/1/2)

An exciting discovery in the Society’s Minute Book shows that on the 11th November 1879, Macewen presented to the meeting in the Faculty Hall “two patients on whom trephining was performed, one for injury and one for disease.” One of these patients was the fourteen year old girl upon whom Macewen had performed the first removal of a tumour from the dura mater (minute book detail below).

GP&CS Minute 1879

From Society Minute Book, 1879 – 1891 (RCPSG 4/1/2)

This procedure has since been identified as a major breakthrough in the history of neurosurgery. An editorial in the British Medical Journal (11th August, 1888) acknowledges the innovation and success of Macewen’s early brain surgery: “With indisputable justice… may Dr Macewen claim the proud distinction of having been the leader in this country, and we believe in the world, of this great advance in our art.”

These records of the Glasgow Pathological and Clinical Society not only provide us with a wonderful source of evidence of the innovative research and practice in the city in the late 19th century, but also provide us with inspirational stories to tell in our College rooms.

40 Years of the Glasgow Coma Scale

The 20th March has been designated as Head Injury Awareness Day in several countries, and the whole month of March is given over to Brain Injury Awareness Month in the USA. We decided that today would therefore be a particularly apt occasion to post about the upcoming 40th anniversary of the Glasgow Coma Scale.

The Glasgow Coma Scale (GCS) is a neurological scoring system which provides a reliable and objective way of measuring the conscious state of a patient. This allows practitioners to gauge the extent of an acute brain injury and the severity of a coma.  The scale was first published in The Lancet in 1974*, and is still taught to all new medical practitioners and frequently used in hospitals around the world. The GCS takes its name from the fact that it was developed by two researchers based at the University of Glasgow’s Institute of Neurological Sciences at Glasgow Southern General Hospital. Professor Sir Graham Teasdale and the late Professor Bryan Jennett are both hailed as world-renowned neurosurgeons. Each man also held the position of Professor of Neurosurgery at the University of Glasgow during the course of their long and  distinguished careers. Sir Graham Teasdale has a particularly close link to the Royal College of Physicians and Surgeons of Glasgow, as he served as President of the College from 2003 until 2006. His portrait can currently be seen in the College, hanging opposite the David Livingstone Room.

Portrait of Professor Sir Graham Teasdale © Anne Mackintosh

Portrait of Professor Sir Graham Teasdale
© Anne Mackintosh

The GCS can be used to assess the level of consciousness in patients who have suffered a head injury, both in emergency trauma situations, and in chronic patients in intensive care. The scale includes three tests which are used to assess the patient’s eye, verbal and motor responses. For each of these elements, the patient is assigned a score ranging from 1 to 6, and the scores for the three elements are then considered separately and together. The final score for a patient can be as low as 3 (for deep coma or death) and as high as 15 (for patients who are fully conscious and awake).

The 1974 paper from The Lancet* has, over the course of the last 40 years, become a true citation classic in neurosurgery, with a greater number of citations than any other single publication in the field. The GCS is not without its critics, and some more recent researchers have suggested alternatives to the GCS, including tests such as the Simplified Motor Score and the FOUR Score. None of these scales, however, have been successful in gaining the universal consensus of the original, and the GCS remains the default method for assessing consciousness in almost every hospital and medical school in the world. Even actors in medical dramas on TV can often be heard delivering lines such as, “the patient has a GCS of 9” (indicating a moderate to severe brain injury).

The Glasgow Coma Scale

The Glasgow Coma Scale (click to zoom)

The enduring popularity of the GCS makes its development one of Glasgow’s greatest contributions to the world of medicine. To mark the 40th anniversary of the Glasgow Coma Scale, Professor Sir Graham Teasdale will speak as part of the History of Medicine seminar at the College’s Triennial Conference in June. The conference is titled Advancing Excellence in Healthcare and will take place at Glasgow’s SECC on the 19th and 20th of June. More information about the conference, including details of the History of Medicine programme, can be found at Advancing Healthcare.

* Teasdale, G. & Jennett, B. (1974). Assessment of coma and impaired consciousness: a practical scale. The Lancet. 304 (7872), pp. 81-84. http://dx.doi.org/10.1016/S0140-6736(74)91639-0
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