The origin of geriatric medicine is rightly associated with the work of Marjory Warren from the late 1930s. At the same time, a similar and hitherto unacknowledged process was emerging in Glasgow through Noah Morris, Professor of Materia Medica and Therapeutics. This is a brief account of that story.

In the first six months of 1948 (immediately before the institution of the National Health Service), four of the eight medical staff of the Department of Materia Medica and Therapeutics of Glasgow University, with its clinical unit at Stobhill Hospital, were destined to become consultants in geriatric medicine. They were also to share between them, three of the first Professorial Chairs of Geriatric Medicine in the UK, and two Presidencies of the British Geriatrics Society. They were Ferguson Anderson (Senior Lecturer), John Hebbert (Lecturer), Bernard Isaacs and John Brocklehurst (House Physicians). Many others followed. The chain of events leading to this early interest in geriatrics in Glasgow started in 1936 when Sir Hector Hetherington became Principal and Vice Chancellor of the University, and in 1937, Noah Morris was appointed Professor of Materia Medica and Therapeutics.

Hector Hetherington came to Glasgow imbued with a determination to promote academic medicine based on full time professors with scientific backgrounds and proven research orientation (1). He was concerned about the education of medical students. While pre-clinical teaching was organised and carried out by university departments of basic science (including anatomy and physiology), the clinical curricula were the responsibility of the teaching hospitals, organised and undertaken by part time professors and honorary specialists whose primary interest and source of income was private practice.Hetherington was able to further this intention by three chairs becoming vacant in the medical faculty shortly after his appointment. These were the Regius Chairs of Medicine, Materia Medica and Therapeutics and Surgery. He altered the process of appointing professors, to be done by a small committee, without necessarily advertising the post. The committee notified the University Court that a suitable candidate had been found and should be appointed (1). By this process, Noah Morris was appointed to the Regius Chair of Materia Medica in 1937, on a full time basis.

Academia meets chronic disease
The previous incumbent in the chair, Prof Ralph Stockman, had his beds in the Glasgow Western Infirmary (one of the two teaching hospitals in Glasgow at the time) but these were not made available to Noah Morris and Hetherington had to look elsewhere. He was convinced of the advantages of the university extending its influence in medical education to the large municipal hospital sector in the city, and with the ready co-operation of the Medical Officer of Health (Sir Alexander McGregor) he brought this about. Noah Morris’s beds were to be at Stobhill Hospital. The establishment of an academic department within a municipal hospital was a precedent (and a successful one) giving it the advantages of a teaching hospital, hitherto limited to voluntary hospitals. This was to be a highly significant development for the university, for the hospital and for the not yet existent specialty of geriatrics. For the first time, a university teaching department encountered a large proportion of patients who were old and chronically ill.

Stobhill Hospital (2) was officially opened in 1903 with 1,867 beds. It provided medical, surgical, obstetric, paediatric and psychiatric beds as well as infirmary wards for the “chronic sick”. Following the eipdemics of encephalitis lethargica after the first world war, special wards were provided in the 1930s for patients with post encephalitic Parkinsonism. Stobhill was established as a Poor Law hospital by Glasgow Parish Council but under the 1929 Local Government Act, the hospital was transferred to Glasgow Corporation. Acute patients were allocated by a central agency in the city (called the Bar). They included a high proportion of young people with rheumatic fever and older people with strokes. These were medium and long-term patients, unacceptable to the voluntary hospitals.

Noah Morris
Noah Morris was a physician of outstanding drive, wisdom and humanity. Jewish, with a strong Glasgow accent, he became to the students, the father figure of the medical faculty. It was Morris’s background in biochemistry that appealed to Hetherington. Much of his research at the time of his appointment to the Chair had been in acid-base balance and calcium and phosphorus metabolism. His previous appointment as University Lecturer in Pathological Biochemistry involved clinical responsiblity at the Royal Hospital for Sick Children in Glasgow, where he established an early hosptial biochemistry laboratory (3.4). In his inaugural lecture (chaired by Sir Hector Hetherington) entitled ‘Prolegomena to the Study of Therapeutics’ (5), he dealt with the “Art versus Science” situation in medical practice. He quoted Clifford Allbut on the revolution of medicine

‘from a craft of tradition and sagacity to an applied science of analysis and law’.

He stressed the emerging importance of laboratory science but maintained a balanced outlook. He emphasised his belief in what is now called holistic medicine ‘the patient is not merely a sort of heart- lung- kidney preparation, but a human being with all the desires, emotions and
fears of humanity’. Perhaps in advance of his time, he believed that social work was to become an ever more important part of therapeutics. In all of this he was demonstrating the qualities which led him to encourage the gradually emerging specialty of geriatric medicine.

At Stobhill Hospital, Noah Morris was given charge of six medical wards and was immediately confronted with chronic disease and old age on a scale which had never before impacted on academic medicine. He established an outstanding department of clinical medicine, in which biochemistry, social medicine and recognition of the uniqueness of the ‘person’ in each patient played a part. He confronted the challenge of ageing and old age in his Honorary Presidential address to the Glasgow University Medico Chirurgical Society in 1941 entitled, ‘De Senectute’ (6). He reviewed the current state of knowledge in ageing in relation to the mammalian homeostatsis in the presence of stress and the place of homeostasis in normal ageing and disease in old age. He proposed two questions - is the prolongation of the human lifespan an important goal, and if so, how is it to be achieved?

Research into ageing
He inspired his students and staff with the importance of research including the problems of ageing. He was negotiating with the Nuffield Foundation to set up a geriatric clinic at the time of his tragic death in 1947 at the age of 52 (7). Thus was cut short potential leadership in gerontology and geriatrics in Britain. Members of his staff were to take up this challenge.

Stanley Alstead
Stanley Alstead (7) who had joined Noah Morris’s department in 1936 followed him eleven years later as Professor of Materia Medica and Therapeutics. He continued his interest in chronic disease and old age, facilitating research in those areas. He also encouraged members of the department to become involved in the infirmary of the nearby Glasgow workhouse, Barnhill (renamed Foresthall). It had 600 beds, 90% being occupied by virtually undiagnosed and totally bedfast patients, (as encountered by Marjory Warren and other pioneers of geriatrics).

‘Fergie’
Ferguson Anderson (8) became lecturer in the Department of Materia Medica and consultant physician at Stobhill Hospital in 1937, and returned after war service in 1946 as senior lecturer. He committed himself to geriatric medicine in 1952 when he was appointed Adviser in Diseases of Old Age and Chronic Sickness to the Western Regional Hospital Board of Scotland, and Consultant Physician in Geriatric Medicine in Stobhill Hospital. Characteristically, the Medical Staff Committee of the hospital had opposed the establishment of two geriatric wards, recording that ‘the introduction of geriatrics would adversely reflect on its status as a major teaching hospital’ (2). How wrong they were proved as the geriatric department became a Mecca for visitors from across the world (as did the West Middlesex Hospital under Marjory Warren and Cowley Road Hospital, Oxford under Lionel Cosin). Ferguson Anderson was appointed David Cargill Professor of Geriatric Medicine in Glasgow University in 1965, the first such chair in the UK. He was elected President of the British Medical Association in the same year - also the year in which he received his knighthood.

Taylor Brown
However, ‘Fergie; was not the first geriatrician in Scotland. That distinction belongs to Dr O Taylor Brown. After five years’ service in the Royal Air Force, Dr Taylor Brown joined Noah Morris’s department for Post Service Training at Stobhill Hospital in 1946. Noah Morris arranged for him to receive periods of training in geriatric medicine with Marjory Warren (whose work Morris admired) at the West Middlesex Hospital. He was involved in the first recorded postgraduate training event in geriatric medicine in Scotland. This was organised as a weekend seminar by Noah Morris who personally invited the 40 guests (9).In 1948, Dr Taylor Brown was appointed to a newly created post of Assistant Physician with an interest in geriatrics at the Southern General Hospital in Glasgow. In 1951, he was appointed consultant physician in geriatric medicine to the Eastern Regional Hospital Board of Scotland and senior lecturer in the Department of Medicine at the University of Dundee. By the time of his retirement in 1984, he had established a comprehensive geriatric service at Ninewells Hospital and the Victoria Hospital in Dundee and a University Department of Geriatric Medicine. In due course, a chair in Geriatric Medicine was established and Prof Marion McMurdo was appointed. It may be noted that five past presidents of the BGS have been Glasgow graduates, namely, Ferguson Anderson, John Brocklehurst, James Williamson, John Dall and Brian Williams.

Prof John Brocklehurst
Past President of the BGS

References:

1. Hull A: Hector’s House: Sir Hector Hetherington and the Academicisation of Glasgow Hospital Medicine before the NHS. Medical History, 2001, 45: 207-242

2. Watt O M: Stobhill Hospital; the First Seventy Years. Robert Maclehose, Glasgow, 1971

3. Obituary. Noah Morris. Brig Med J ; 1947 I: 866-867, II: 36

4. JWSB. Obituary. Glasgow Med J; 1947; 28: 194-196

5. Morris N. Prolegomena to the Study of Therapeutics. Glasgow Med J 1937; 10: 137-151

6. Morris N. De Senectute. Surgo, Glasgow University Med J 1942; 8, (2); 28-33

7. Thomson T J. Stanley Alstead. Munk’s Roll, Royal College of Physicians of London; 9:8-10

8. Williams B. Anderson, Sir William Ferguson. Munk’s Roll, Royal College of Physicians of London; www.rcplondon.ac.uk

9. Brown W T. Personal Communication, 2004