Friday, 10 July 2015

Neurosurgery after the days of Dott

In this week’s blog Project Cataloguing Archivist, Clair looks at the foundations laid by Norman Dott for the future of Neurosurgery…

The process of cataloguing Professor Norman Dott’s Neurosurgical case notes (1920-1960) has made me think about the wider history of Neurosurgery from its foundations, to the way in which it is practiced now. Sticking to the Edinburgh context, I decided to find out a bit about how Neurosurgery developed after the days of Dott and how his legacy paved the way for the future of the medical science.

Photograph of Professor Norman Dott. LHB1 CC24-PR1.1536
Around ninety years ago Dott began working with the great Harvey Cushing, motivating Dott’s enthusiasm for neurosurgery and his approach in specialising in this area of medicine. From there the foundations of neurosurgery in Edinburgh had been made, with Dott opening up the first dedicated neurosurgical ward in Scotland, in 1938, at the Royal Infirmary of Edinburgh (RIE). Now with the facilities to practice this medical specialism, Dott made an incredible impact on the development of surgical neurology. He undertook major work in intracranial operations, pioneering surgeries throughout the 1920s and 1930s, and was one of the founders and presidents of the Society of British Neurological Surgeons.  In his later years this prestigious career continued when Dott developed a new Department of Surgical Neurology at the Western General Hospital (WGH) in the early 1960s (more information about this development can be found in a past blog post here). Although he retired in 1963 this unit was a lasting testimony from Dott to the future of Neurosurgery.
Photograph from a promotional brochure for the Department of Surgical Neurology (WHG) showing the operating theatre. LHB11/7/2
The development of the neurosurgical unit at the WGH meant that the second half of the twentieth century saw neuroradiology, neuroanesthesia, neuropathology, clinical neurophysiology and neuropsychology all being practiced in one purpose built site. When Dott retired he was replaced by Professor John Gillingham, who had worked as a consultant neurosurgeon under Dott’s directorship. Gillingham’s career, undoubtedly influenced by Dott, saw him make international contributions to the neurosurgical treatment of movement diseases such as Parkinsonism, and in his work with spinal and head injury patients, he became a campaigner for legislating the use of seatbelts in cars. Two other neurosurgeons, who trained under Dott, include Phillip Harris and John Shaw. Harris also went on to specialise in spinal trauma, whilst Shaw played an important role in the recognition of paediatric neurosurgery as a separate medical specialism.
By the 1980s many of the neurosurgeons appointed by Dott were beginning to retire, including Gillingham, Shaw and Harris and also Kate Herman and Sneddon Watson. The face of surgical neurology in Edinburgh was also beginning to change and by the late 1980s the Surgical Neurology Department at the WGH merged with the University of Edinburgh department of Medical Neurology in 1986 forming a new Department of Clinical Neurosciences, with a physical merge at the WGH in 1989. Combining surgical practice and medical research made way for advances in neuroscience technology, particularly in imaging services, facilitating the use of MIR (magnetic resonance imaging) scanning technology in the department. 
Moving into the 1990s saw major changes for NHS administration and financial difficulties for Lothian Health Board (LHB). However, the Department of Clinical Neurosciences continued to develop, building an intensive care unit so that all severe head injury patients could be admitted to the Department at the WGH. Today the Department of Clinical Neurosciences still operates in the WHG, with ten Consultant Neurosurgeons, 48 beds throughout 3 wards, serving a population of 800,000 across Lothian, Fife and Southern Scotland.
From the days of Dott it has been interesting to chart the developments in neurosurgery and the strong links that his remarkable career has had to the future of the medical science and treatment of neurological conditions. From the pioneering work that came from those influenced by Dott’s work and training, to the neurosurgical departments and facilities that he established, neurosurgery continues to develop in Edinburgh today.
Miller, J.D. & Steers, A.J.  (July 1996). Surgical Neurology and Clinical Neurosciences in Edinburgh, Scotland. Neurosurgery. 39 (1), 151-159.
Managed Service Network Neurosurgery. 2015. Managed Service Network Neurosurgery. [ONLINE] Available at: [Accessed 08 July 15].

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