History of the Scottish Dermatological Society

History of the Scottish Dermatological Society

Gordon Fraser MD FRCP(Ed), Consultant Dermatologist, Raigmore Hospital, Inverness

Foreword

The Scottish Dermatological Society, previously known as the North British Dermatological Society, has been in existence for over sixty years. During that time it has provided a forum for clinical dermatology, and, particularly in more recent times, for the presentation of material more specifically scientific or educational in nature, and the discussion of diverse matters relating to the practice of dermatology.

But almost as important as the formal proceedings, have been the informal exchanges among members. This has not only been a useful supplement from a professional standpoint, but has fostered a spirit of friendliness and encourages a sense of common purpose. The result has been a Society able to adapt in a progressive manner to the changing demands made upon it, so that today it is stronger and more active than at any time in its history. 

The Early Years

The Society was founded in December 1924 by Sir Norman Walker (Figure 1), physician-in-charge of the Skin Department at the Royal Infirmary in Edinburgh (Figure 2) and the senior Scottish dermatologist. An able administrator as well as a distinguished dermatologist, he convened a meeting in his department of dermatologists from all four Scottish centres, together with Dr Robert (later Sir Robert) Bolam from Newcastle. The group consisted of thirteen dermatologists in all: five from Glasgow, four from Edinburgh, two from Dundee and one each from Aberdeen and Newcastle.

The inclusion of Newcastle arose from the close friendship between Sir Norman Walker and Sir Robert Bolam, a friendship which had arisen from their membership of the General Medical Council. Both were active and prominent members of that body, and used to travel together to the meetings in London. Later, after the death of his friend, Sir Norman was to write: 'In the North Bolam was held in very high esteem and when we decided to have a Scottish organisation we felt we must have Bolam with us, even at the cost of calling it North British - a name not popular, in Scotland (1) While the name may not have been universally popular, the liaison itself worked well, and led to the Newcastle dermatologists having closer ties with the Scottish group than with their colleagues in England. At that first meeting in Edinburgh cases were demonstrated by the four local dermatologists, and the task of arranging the next meeting and drawing up the rules and constitution of the Society was assigned to Dr Herbert Brown of Glasgow and Dr Cranston Low of Edinburgh.

Rules and Constitution

The second meeting was held at the Western Infirmary in Glasgow (Figure 3), on Thursday 12 March 1925, with Dr Wylie Nicol, physician-in-charge of the Skin Department and the senior Glasgow dermatologist, in the chair. The rules were presented and agreed (See Appendix). The Society was to be called the North British Dermatological Society (NBDS), and was to meet three times a year - March, June and December - with one meeting in Edinburgh, one in Glasgow and the other held in rotation between Aberdeen, Dundee and Newcastle.

By tradition the Edinburgh meeting was always held in December, the Glasgow meeting in March and the meeting in the other three centres in June. Incidentally, the venue of the Glasgow meeting remained the Western Infirmary until 1930, when a rotation began with the Victoria Infirmary and the Royal Infirmary. However, all Glasgow dermatologists were involved in the presentation of cases irrespective of the venue. The Society was to have a Secretary who would be responsible for arranging the meetings, and the chairman was to be voted in at each meeting. Qualifications for membership were not stipulated, but in the ballot vote one adverse vote in five was to exclude. This check was scarcely necessary, however, for in the pre-War period only senior dermatologists were proposed for membership.

The first Secretary of the Society, appointed at the second meeting, was Dr Cranston Low (Figure 4). A popular and interesting figure, he was a gifted artist (Figure 5) as well as a dermatologist of international repute. Later, when he retired from dermatology he was to abandon his original intention of devoting his time to painting, and returned to medicine, this time to bacteriology where he achieved further distinction by editing a highly successful Atlas of Bacteriology with Mr Tom Dodds. (2)

Development of the Society

Meetings of the Society were held almost invariably on Thursday afternoons with a starting time which varied between 2 and 4 pm. The third Thursday of the month was the most popular date but the second Thursday was also popular, particularly for the Edinburgh meeting. The number of members attending was small, averaging about 10 and never more than 15 in the pre-War years. Indeed, attendance at meetings outside Edinburgh and Glasgow was always below average, and fell to only four, including the host, Dr Tom Anderson, at the Aberdeen meeting in 1936. Such was the disappointment and annoyance of those present that a notice of motion was tabled which stated that 'there should be a fine of 6d for non-attendance, this to be used to cover postage' ! Happily, at the next meeting in Edinburgh wiser counsels prevailed and a levy of 6d was placed on each member present. Unlike the fine, this was quite in order as the imposition of levies as required had been sanctioned by the constitution of 1925. Incidentally, an annual subscription was not introduced until 1971. The amended constitution of 1950 had stated: 'There shall be an annual subscription of half-a-crown to cover secretarial and other costs' but this had never been implemented.

The meetings themselves consisted of clinical and business sections. In the clinical part, patients were brought into the room where members were gathered and presented to the assembled group. This practice was modified in 1932 when the Society agreed with Sir Norman Walker's suggestion that members be allowed to examine patients before they were presented. The only addition to clinical material in the pre- War years was the introduction of discussion on selected topics. However, only one such discussion took place when infectious eczematoid dermatitis was considered at the Western Infirmary, Glasgow in March 1939. The report states that most of the members took part.

In the business section of meetings little appears to have transpired apart from election of new members, but in 1926 Sir Norman Walker did ask for statistics of lupus vulgaris, a condition in which he had a special interest. There is, however, no record of a response to this request. One other matter considered was publication of the more unusual cases seen. Before this could be implemented, rule 7 of the constitution which stated that no report of the proceedings was to be sent to the lay or medical press, had to be amended.

This was duly carried out, agreement on publication obtained from the Editor of the British journal of Dermatology and Syphilis and the first report published in May 1934. (3) Of note in this submission was a summary of the original patient of Dr John Ferguson Smith with multiple squamous carcinomata with spontaneous healing. (Figure 6) This patient had been shown at the Royal Infirmary, Glasgow in March and was more fully documented in the subsequent issue of the journal. (4)

The onset of the Second World War in 1939 brought this period in the Society's history to a close as meetings were suspended until the War was over. Only limited change had taken place in these pre-War years, and the total number of members enrolled during this period was only 25. But the Society had become firmly established and was ready for the challenge of the post-War era. Never again, however, was it to regain the informality and friendliness of these early years.

After the War

When the Society eventually reassembled in the Victoria Infirmary in Glasgow (Figure 7) on Thursday, 21 March 1946, it's leading figure, Sir Norman Walker was dead. He had died in November 1942. At that meeting the chairman Dr Herbert Brown, after referring with deep regret to Sir Norman Walker's decease, noted with pleasure the appointment of Dr George Percival to the newly established Chair of Dermatology in the University of Edinburgh - the first University Chair of Dermatology in Britain. Professor Percival was to play as prominent a role in the affairs of the Society in the post-War period as Sir Norman Walker had done in the pre-War era.

Political Awakening

Two main issues concerned the Society at this time. The first, and one in which Professor Percival played a leading role, was the future of dermatology, particularly in Scotland, in the light of the imminent establishment of the National Health Service. Two extraordinary meetings were held in Edinburgh in 1947 and 1948 respectively, at the first of which a Subcommittee was formed to collate statistics of outpatients attending the various centres. It appeared from the figures obtained that in Glasgow and Edinburgh one in twelve of the total population were seen annually as skin patients. Numbers attending other centres were somewhat lower. At the second of the extraordinary meetings Society policy, which was to be available for the Scottish Home and Health Department if requested, was formally adopted. It was agreed that:

1. 'No new major dermatological centre is at present required in Scotland.' The possibility of a major centre at Inverness had been considered, but Professor Percival moved against .
2. 'With the possible exception of Inverness, no new subsidiary dermatological centre shall be created unless there is a likelihood of an annual attendance thereat of not less than 2,000 patients. Such a centre, if set up, shall be visited weekly by a specialist in dermatology.'
3. 'There must be adequate bed accommodation in main and subsidiary centres for skin cases, the ratio being one bed per 5,000 of the population.'
4. 'Nursing staff for centres shall be in ratio of one nurse to two patients and there shall be one bath provided for five beds.'
5. 'Main units shall have at least four specialists working in it. Juniors intending to specialise will be trained in such units and there must be ready access to adequate laboratory and library facilities if teaching was to be successful.'
   One other subject discussed at these special meetings was the possibility of a Diploma in Dermatology but, although promoted by Professor Percival, it did not receive general support.

Amending the Constitution

The second major issue to which the post-War Society directed its attention was a review of the constitution. This was carried out in 1950 by a small Subcommittee formed as a result of prompting by Dr James Sommerville of Glasgow, who had sought clarification of the qualifications required for membership and the procedure to be followed in the election of members. But even before this review the Society had begun to change its practices. In December 1948, it had been agreed for the sake of standardisation that meetings be held on the second Thursday of the month. To some of the members at least this had been the date fixed by tradition even although it had been honoured more in the breach than the observance. At all events, the agreement did by and large hold firm. More significantly the Society also decided at this time to hold a second annual meeting in Glasgow in October. This was to alternate between Stobhill General Hospital and the Southern General Hospital, while the March meeting continued as before. As with the other local centres all Glasgow dermatologists were invited to contribute cases to meetings at these hospitals, a practice which continued into the late Fifties. This pattern of meetings in Glasgow was not to change until the Southern General Hospital decided to withdraw from the rotation in 1968, and combine with the Western Infirmary, with which it had a close working relationship. The venue of the other meetings throughout the Society's area did not alter, although meetings at various peripheral centres had been mooted, and the possibility of one in Ayrshire considered but rejected in 1956.

These innovations were incorporated into the new Constitution by the Subcommittee along with other changes. On the question of membership the Subcommittee decided that those who held, or had held, a post above the rank of Junior House Officer in a Dermatological Unit or University Department were eligible. Later, in 1956, after a postal ballot the minimum requirement was altered to the grade of Registrar. The result of this relaxation of entry qualifications was a significant increase in membership with the average attendance at meetings in the Fifties rising to about 20. Then again the Subcommittee proposed that the chairman at each meeting would be the senior dermatologist of the host unit, rather than a member who had been voted in. All these recommendations were accepted by the Society and in addition the Subcommittee was instructed to include a further rule proposed by Dr John Kinnear of Dundee allowing Honorary Membership. No such members, however, were elected. Finally, from the Secretary's notes, it appears that the possible election of a President on an annual basis was considered.

More Business

These were not the only issues confronting the Society at this time. Many other matters were discussed leading to expansion of the business section of meetings. In 1951, the Society, seeking to publicise its active and vigorous nature, obtained the agreement of the Editor of the British Journal of Dermatology to resume publication of Society proceedings. There were, however, many difficulties in this arrangement which kept the item irritatingly under review. On the one hand there was the selection of cases to be submitted and the adequacy of the material presented, and on the other editorial reluctance to publish mere lists of cases. Then again, in 1962, Professor Percival raised the question of the propriety of advertisement for a Senior Registrar post in dermatology which asked for a higher degree but did not require experience in dermatology. As a result, representation was made to the Department of Health and the Consultants and Specialists Committee and the Society itself set up a Subcommittee to review the training of dermatologists in Scotland.

Two other issues which figured prominently were case reporting for the Ministry of National Insurance and training in dermatology for nurses. The former problem was mainly concerned with the fact that these reports undertaken in private practice commanded a fee, whereas when completed in hospital practice, often by the same consultant, no fee was payable. Representation on this issue was made to Sir Kenneth Cowan, Medical Officer of Health for Scotland and eventually a statutory fee became payable for all these reports. As to training in dermatology for nurses, the concern here was that this was being reduced and was no longer obligatory. The response of the General Nursing Council was to point out that training could not be obligatory if it was not universally available, but the assurance was given that dermatology would continue to be taught wherever facilities allowed.

Educational Content

Alongside the increased prominence of business matters in the post-War Society, was evidence of a desire for a greater educational content in meetings. In 1949, Dr James Innes, a haematologist gave a short paper at the Edinburgh meeting on The Technique and Dangers of Nitrogen Mustard Therapy in Reticuloendotheliosis and this practice was repeated from time to time. In 1953 discussion on selected topics was revived and was continued for five years despite limitations which were reflected in the minutes: 'A short discussion on the treatment of infantile eczema shed little light on the subject!' or 'A spirited but very inconclusive discussion followed on 'Is nummular eczema an entity?' The desire for presentation of more substantive information is also seen in the Society's acceptance of Dr Herbert Brown's suggestion in 1954 that each meeting should include a group of cases for discussion. These cases were to be notified to members beforehand but the procedure proved too difficult to implement. Although at the Edinburgh meeting later that year three cases of porphyria were shown, followed by a short talk on the general aspects of the condition by a physician, Dr Alastair Macgregor.

More significantly in 1958 Dr Owen Finn of Dundee (later of Stirling), stimulated by the development of postgraduate education in England and also desirous of helping younger members acquire the skill of presenting papers in a friendly atmosphere, proposed that one meeting every 18 months should be set aside for papers only. Aware of the likely opposition who would argue that such an innovation would be in competition with the British Association of Dermatology and the Royal Society of Medicine, Dr Finn deliberately set his sights low in the hope of obtaining agreement. Professor Percival for one appeared to be sympathetic, but on the suggestion that papers would last thirty to sixty minutes his riposte was: 'No paper should last longer than twenty minutes. If a person cannot say his piece in twenty minutes he either does not know his subject or his material is badly prepared!' The outcome was an agreement that at one meeting each year a paper of twenty minutes would be delivered in place of the discussion of cases. Consequently, Dr Jack Alexander of Glasgow spoke on: The Role of Hyaluronidase in Dermatitis Herpetiformis at the Edinburgh meeting in 1959. Unfortunately, the meeting also included a period of case discussion and as a result of trying to accomplish too much in a limited time the practice was not repeated.

The difficulty of accommodating in an afternoon session all that members expected from the Society had been fully debated before Dr Alexander's paper was delivered. Indeed, the clinical section of the meeting at the Royal Infirmary, Glasgow in March 1959 had been restricted to six cases, so that the 'The future of the Society' could be considered. The keenness of the discussion was thought to augur well for the Society, but no further change was forthcoming and indeed the previous authorisation for a yearly paper was only reaffirmed reluctantly .

Desire for Change

Society meetings in the Sixties must have been very different from the relaxed and leisurely gatherings of earlier times. The membership roll had increased markedly in the post-War years with an average attendance at meetings in the Sixties rising to over 20. Many of the new recruits were from the junior ranks and among this group in particular, expectations were high. They looked for change to accommodate new developments. Others, already carrying a heavy work load, were reluctant to set aside time for meetings. Despite the reservations of this latter group, it was agreed in 1963 to ballot members on holding whole-day meetings. Those who voted for change were still in the minority but it was now a substantial minority, and as a result it was decided to allow individual units to determine their own timetable. The next meeting after this decision, the summer meeting in Dundee in 1464 was a whole-day meeting. It was considered a real success with a high standard of hospitality, but it did not set a new pattern; although a second whole-day meeting was held in Aberdeen in June 1969. A change in practice which was established at this time was in the recording of minutes. From 1924 they had been kept in the Minute Book, the contents of which were not communicated to the membership at large, but from 1965 minutes of the business section of meetings were circulated to all members.

'Wee Red Book'

As a record of the Society's history the Minute Book or ''Wee Red Book' (Figure 8) as it was otherwise known, has proved invaluable and much of interest can be gleaned from perusal of its pages. Indeed, its very existence is a matter of interest for rule 7 in the original constitution had stated: 'The meetings shall be quite informal. No minutes shall be kept...' Not until the constitution was revised in 1950 was the keeping of minutes officially sanctioned. Despite that the Minute Book contains a careful record of Society proceedings from the beginning. But there is something of a mystery in the entry for 1929. Only one meeting is detailed for that year, the Edinburgh meeting in December. However, it would appear that in 1935 Dr John Kinnear, who had been appointed Secretary in 1932, pencilled in the dates of two further meetings in 1929 and altered the numbering of subsequent meetings by adding two (Figure 9). Were these unminuted meetings actually held in 1929 and if so, why had the Secretary, Dr Cranston Low failed to record them? The explanation may lie in the fact that after the death of Dr Wylie Nicol in 1928, Dr Goodwin-Tomkinson was appointed physician-in-charge of the Skin Department at the Western Infirmary. The March meeting of 1929 would normally have been held there, but may have been cancelled as Dr Goodwin-Tomkinson was at that time President of the British Association of Dermatology and Syphilology (BADS), and would have been preparing to host the annual meeting of that Association in Glasgow in June. Furthermore, and this too may be relevant, Dr Goodwin-Tomkinson was never a member of the NBDS. As to the June meeting, due for Dundee, study of the rotational programme indicates that this meeting was postponed for a year. This would have been consistent with the procedure adopted in 1934 and again in 1937 when the BADS also held its annual meeting in the Society's area in Newcastle and Edinburgh respectively. Oddly enough, these latter meetings of the BADS were entered in the Minute Book as joint meetings of both Societies, although reference to the minutes of the BADS does not reveal any acknowledgement of this arrangement.

All this must cast some doubt on the numbering of Society meetings from 1929 onwards, and in particular on the validity of the celebration to mark the 100th meeting in June 1960 in Aberdeen. Although it was Aberdeen's right to host the 100th meeting with a founder member of the Society in the chair, it was only allowed after a vote. Presumably some members felt the celebratory meeting should have been held in Edinburgh or Glasgow. Be that as it may, the meeting itself was a resounding success.

A large number of members, many accompanied by their wives, gathered in the Station Hotel, Aberdeen (Figure 10) on the evening of Friday 3 June, and were entertained to sherry by Dr and Mrs Tom Anderson followed by a Society dinner. The following morning, cases were presented at the Royal Infirmary and discussed at length, with Dr Ferguson Smith, a founder member, in the chair. 'There was a pleasant feeling', wrote the Secretary, Dr Robert Carslaw of Glasgow, 'that time was unlimited and there was no need to watch the clock and catch the train.' Thereafter, members passed the afternoon playing golf, fishing and sightseeing.

This was the first major social occasion in the Society's history; although dinners had been held after three of the meetings in the years 1947-48, the first at the North British Hotel, Glasgow in March 1947. The Minute Book, however, is coloured not only by its cases seen', to find Dr Carslaw writing of a meeting in the Western Infirmary in 1962:'after a rather meagre tea an interesting discussion of the cases followed.' Or again, at the very next meeting in Newcastle he wrote: 'Business concluded, a very lively discussion of the cases demonstrated took place, while Edinburgh and Newcastle battled on the field, Glasgow and Dundee stood on the sidelines.' Aberdeen appears to have stayed at home!

The Modern Era

New Constitution

Distribution of the minutes to members was in itself an important step forward in facilitating the business of the Society, but those pressing for change looked for more radical reform. In 1968, a questionnaire was circulated to seek views on the preferred format of future meetings and on the formation of an Executive Committee to conduct the business of the Society. The proposal for an Executive Committee was accepted almost unanimously, but there was also majority support for whole-day meetings and the inclusion of peripheral centres in the rota. As a result, an Executive Committee was formed, comprising one member from each of the six regions in the Society's area and was asked first to redraft the constitution to accommodate the agreed changes. However, the Committee was divided between those who saw in the review an opportunity for radical reform, and those who interpreted the remit more literally, some of whom, it must be said, were opposed to any reform. Indeed, one Committee member striving to retain the informality of the past adopted the slogan: 'Down with formal meetings'

In the event, amendments to the constitution were made but not such as would have been likely to alter significantly the conduct of the Society: a rule was introduced on the structure and function of an Executive Committee (already in existence) and on the holding of whole-day and half-day meetings (an option accepted by the Society in 1964). Other changes were even less radical, and many were disappointed with the outcome of the review. Despite that, it is likely that the draft constitution would have been accepted but for the intervention of Professor John Milne and Dr Alan Lyell of Glasgow. In a joint letter to the Secretary, they proposed that a Subcommittee be formed to consider again the future activities of the Society. This Subcommittee was to be more broadly based with representation not only on a regional basis but also on a proportional basis and containing members of the training grades. Such was the authority of these two senior members that their proposal was carried by a large majority. Following the vote a Subcommittee of 12 members was duly elected and met in Dundee on Saturday, 18 April 1970. Dr William Frain-Bell of Dundee was appointed chairman, and a comprehensive review was set in motion which was to lead to the most radical constitutional changes since 1925.

All aspects of the Society were reviewed but appropriately the first item to be considered was the Society's name. Some felt that for the Society to represent Scottish dermatological opinion at national level the name should be changed to Scottish Dermatological Society (SDS). Others were reluctant to support the alteration without ascertaining the views of all members in the Newcastle and Carlisle areas. Later, when these views were obtained there was no dissenting voice, although one Newcastle member rather mischievously suggested that the Society be renamed the Scottish and Newcastle Dermatological Society and thereby enable tapping a similarly named, and even better known, organisation for funds! The change of name was subsequently ratified by the whole Society and thereafter, the desire of the Society to formulate national policy relating to the practice of dermatology in Scotland was incorporated into the new constitution. Other radical changes recommended by the Subcommittee involved membership, office bearers and the organisation of meetings. The constitution in operation at that time had restricted membership to dermatologists of at least Registrar status, but the Subcommittee recommended that membership should be open to those with 'an interest in dermatology', and should encompass scientifically qualified as well as medically qualified persons. The ethical problem of attendance of non-medical members at the clinical section of meetings was referred to the Medical and Dental Defence Union of Scotland and the Central Ethical Committee of the British Medical Association, but these bodies ruled that the practice was acceptable provided patients were informed that such persons would be present.

As to the office bearers of the Society, there was to be a President elected for a period of three years and an Honorary Secretary/Treasurer and Assistant Secretary whose term of office was also set initially at three years but subsequently reduced to two years. The role of the Assistant Secretary was to attend to publication of Society proceedings and it was envisaged that normally this person would succeed the Secretary. An Executive Committee was to be formed and elected on a regional basis, with some deference to proportional representation by having two members from the Western region as opposed to one from each of the other five regions. Members were to serve for a period of two years. Separate representation of junior grades was not accepted, but an agreement was reached that such a member be co-opted, if not already on the Committee, when matters affecting the careers, training or work load of these grades were being considered.

The other major constitutional reform recommended by the Subcommittee concerned the organisation of meetings. The rota for meetings was to be determined by the Executive Committee and was to include both teaching and peripheral centres. Only three meetings were to be held annually, one of which would be the Annual General Meeting (AGM). Whole-day meetings would not be mandatory but were to be encouraged, and would comprise clinical, scientific and business sections. Even the traditional Thursday came under review, and it was agreed that at least some meetings be held on Fridays. In practice, meetings were to continue on the second Thursday of the month in March and October (the March date was altered to February in 1973 to allow better spacing), but the AGM which began in Dundee in June 1971 with a two-day meeting on a Friday and Saturday, and a Society dinner on the Friday evening, was to continue on this pattern after the second successful two-day trial AGM in Aberdeen in 1972.

The complete recommendations of the Subcommittee were set before the Society in June 1970, and duly approved with only minor alterations. Thereafter, the procedure for the election of office bearers was set in motion and Dr Frain-Bell (Figure 11) whose firm yet tactful chairmanship of the Subcommittee had been a critical element in reaching a successful conclusion, was appointed the first President of the Society. The Executive Committee was also elected and set about the task of formally drawing up the constitution. This was finally completed in 1972, and accepted by the Society at the AGM at Aberdeen in June. Further alterations were made in 1974 to allow the election of Honorary Foreign Members, and again in 1975 to secure charity exemption.

Guidance on the requirements for charity exemption was obtained from the constitution of the British Association of Dermatologists (BAD). Thus, the aims of the Society were amended to emphasise that Society activities were for the public benefit, and clauses were inserted to safeguard the charitable status of the Society in the event of future changes to the constitution and to provide for the disposal of Society funds in the event of its dissolution. These amendments were sufficient to satisfy the Inland Revenue who, incidentally had previously in 1973 allowed tax relief on subscriptions.

A Political Voice

A consequence of these latter constitutional changes was exclusion of the clause indicating the Society's wish to represent the interests of dermatology in Scotland at national level. This did not, however, prevent the pursuance of this aim. Indeed, dissatisfaction with new administrative structures, which channelled dermatological opinion through medical divisions and other committees to area health boards, added further impetus to this aspiration. Consequently, in 1975 Professor John Milne (President) and Dr John Saving of Edinburgh (Secretary) met Sir John Brotherston, Chief Medical Officer of the Scottish Home and Health Department at St Andrew's House (Figure 12) in Edinburgh, to clarify the relationship between the specialty and the Department. The advice received was that while representation on matters relating to dermatology was to be offered at local level through the available machinery, and at national level through the National Medical Consultative Committee, it could be made, if required, by direct contact with the office of the Chief Medical Officer. Following that, the opportunity for direct contact was regularly utilised mainly to discuss the Consultant and Senior Registrar establishment. Also, the National Medical Consultative Committee was approached in 1977 with a view to the establishment of a Subcommittee for dermatology. While that was refused, the Subcommittee for Medicine later agreed, in 1980, to accept a member nominated by the Society. Meanwhile, in 1978, the BAD had indicated their willingness to nominate the President of the SDS as the Scottish representative on its Executive Committee, and stated that the member would also be likely to serve as one of the BAD representatives on the Dermatologists' Subcommittee of the Central Committee for Hospital Medical Services. Thus, the desire for an effective political voice for the Society was fully realised.

Business Old and New

The success of the Society in projecting itself on to the national medico-political scene was reflective of the increased activity to be seen at the business section of meetings. Many issues were discussed including several which had been considered previously. One such subject was education in dermatology. Undergraduate teaching was felt to be the responsibility of individual departments, but training of dermatologists was deemed the legitimate concern of the Society. Hence, publication of the range of facilities present in the Society's area was undertaken to allow individual units to take advantage of the opportunities available. Later, in 1985, the question of a Diploma in Dermatology, first mooted by Professor Percival in 1947, was raised again, but as before little support for this qualification was forthcoming.

Another matter which had previously concerned the Society was the structure and staffing of dermatological units. Further consideration again stressed the importance of separate units with appropriate facilities, and expert nursing care. A bed complement of ten beds per 200,000 of the population, the guideline figure produced by the Medical Manpower Subcommittee of the BAD was accepted. In relation to medical staffing, the Consultant and Senior Registrar establishment was kept under continuous review by the Society, as noted above, and a ratio of one Consultant Dermatologist for 150,000-200,000 of the population was regarded as appropriate for most areas (the average figure for Scotland was quoted as 1 in 180,000). But other grades were also reviewed, including the Clinical Assistant grade where concern was expressed over training and career structure.

Reappraisal of old problems, however, formed only part of the upsurge of business debate during this period. After an unsuccessful attempt to inaugurate a Mycosis Fungoides Register in 1967, the project was revived by Professor Rona MacKie of Glasgow in 1974. Also, a number of therapeutic issues were brought forward for discussion. In 1967, Dr Peter Grant of Inverness alerted the Society to the inclusion by the Standing Joint Committee on the Classification of Proprietary Preparations (5) of certain antihistamine and local anaesthetic creams in Category A (acceptable preparations) in Proplist. Complaint was made to the Committee on the grounds of the sensitising potential of these creams and they were reclassified in Category B (unacceptable preparations). However, a request to the Scottish Home and Health Department to ban the use of local antihistamine creams was unsuccessful.

Another issue satisfactorily resolved was the request to the Society by Dr Robert Main of Aberdeen in 1973 for the provision of guidelines on the management of warts, in view of the increasing number of patients seeking treatment. A memorandum on this subject was prepared by Dr Mary Bunney of Edinburgh setting out available treatments and discussing the role of the general practitioner and dermatologist. The Society had hoped that this document might be circulated to all general practitioners, but the Scottish Home and Health Department ruled that it would be 'construed as advice on clinical matters' and thus unacceptable. They did, however, suggest publication and accordingly an article by Dr Bunney entitled A Rational Approach to the Management of Warts was published in the Prescribers' Journal in December 1974. (6) A circular from the Scottish Home and Health Department in 1979 setting out reservations on the use of PUVA treatment, (7) was carefully considered, and the value of this form of therapy defended provided it was used with proper safeguards. At the same time, the Society expressed concern over the lack of a standardised commercially available preparation of 8-methoxypsoralen.

Other therapeutic matters considered included the inappropriate advertising of potent topical steroids for the treatment of dandruff and psoriasis, and the inability to prescribe special footwear for adults with contact dermatitis of the feet.

On a rather different note, there were during this period, two submissions of a more symbolic than practical significance, reflecting the increased vigour and self-esteem of the Society. Dr Main at the end of his Presidency in 1982, presented a gavel and base (Figure 13) on which were to be inscribed the names of each of the Society's Presidents. Then, in 1986, the Society accepted a motif (Figure 14) designed by the Medical Illustration Department at Raigmore Hospital, Inverness, at the suggestion of Dr Gordon Fraser, recording its inception in 1924 and symbolising its origins, with the thistle to represent Scotland and three castles to represent Newcastle. With some modification to the design, the motif obtained the approval of the Lord Lyon King of Arms.

Papers, Lectures and Symposia

Even more striking than the success achieved in the business section of meetings, was the advancement of the scientific section. Short papers of up to 15 minutes each, usually of an investigative or therapeutic nature, but occasionally reporting or reviewing clinical material or commenting on a historical aspect of dermatology, were delivered. The pattern set was for three or four papers to be delivered in the morning of Ordinary Meetings, and seven or eight throughout the Friday of the AGM. These papers proved successful and in 1973 at the suggestion of Dr Main, a Society Prize was instituted for the most outstanding paper of the year. Funded by Imperial Chemical Industries pie, the Prize ran for five years before the predetermined review decided to discontinue it on the grounds that adjudication was too difficult in a small Society. More successful was the resolution passed in 1971 to publish extracts of papers read to the Society in the Scottish Medical Journal. The cost of this was defrayed by financial support from E R Squibb and Sons Ltd, whose Medical director, Dr Derek Chalmers, formerly Senior Registrar in Dermatology in Edinburgh, was a member of the Society. Furthermore, in 1984, another drug company, Glare Laboratories Ltd, agreed to sponsor the circulation of abstracts of papers prior to meetings.

Other innovations which added to the Society's provision for the intellectual and educational welfare of its members, were the introduction of an annual guest lecture and occasional one-day symposia and the setting up of an informal Contact Dermatitis Group by Dr Paul Burton of Kirkcaldy in 1984. The guest lecture, incorporated into the AGM, was started in 1974 when Professor Hermann Pinkus (Figure 15) of Detroit spoke in Newcastle on Clinical Manifestations of Elastic Fibre Disturbances. At the same meeting, Professor Pinkus was elected the first Honorary Foreign Member of the Society. The guest lecture was continued annually, and an agreement on financial sponsorship reached with Roche Products Ltd in 1986.

Not So Different

Amidst all this change the clinical section of meetings remained much as it always had been, although the Seventies and Eighties saw a trend towards the demonstration of larger numbers of patients - about 25 on average. This had the advantage of allowing a more satisfactory dispersal of those attending, by then regularly over 60 in number, but it did once again put pressure on the time available for discussion. Suggestions were made to limit the number of patients shown, to divide them into those shown for teaching purposes and those shown for discussion, and to notify members beforehand of the cases to be demonstrated. Apart from the latter suggestion which was considered too difficult to implement, the others were accepted. In practice, however, little change occurred. Publication of selected cases in the British Journal of Dermatology continued sporadically as before, until the practice petered out in the early Seventies. In addition, from 1967-70, case reports were also published in the Scottish Medical Journal. This had been arranged on a payment per page basis, with E R Squibb & Sons Ltd (through Dr Chalmers) agreeing to meet the cost.

Finally, while the advent of the new constitution brought to an end the fixed rotation of meetings begun in 1925, the Executive Committee, ably guided by Dr Peter Grant, continued to rotate meetings equitably between the main teaching hospitals. However, the declared aim of involving peripheral centres was not realised untiI Dr Adrian Ive hosted a meeting at Dryburn Hospital (Figure 16), Durham in February 1977. Other centres involved later were Inverness, Carlisle and Airdrie. Indeed, the Inverness meeting became part of the seven year rotation of AGM's through the six regions of the Society (two of these meetings were allocated to the Western region). Another development in this area, although the practice had been recorded in the Thirties, was the holding of joint meetings with other societies: the Society met with the Dowling Club in Edinburgh in 1977 and 1987, and with the Scottish Pharmaceutical Sciences Group in Dundee in 1979.

Conclusion

In reviewing over 60 years of history, it is evident that the Society of modern times is in many respects very different from that of the early years: it is much larger, more formal and structured and perhaps more ambitious. But the change has been evolutionary rather than revolutionary: the development of old ideas rather than the introduction of new ones . Thus, although discussion of business matters did not feature prominently in the pre-War years and medico-political debate was conspicuous by its absence, it was largely the same Society which, in the immediate post-war period, responded promptly to the challenge of the National Health Service by setting out a comprehensive summary of its views on the practice of dermatology in Scotland. These views were formulated to allow the Society to advise the Scottish Home and Health Department - but only if requested, and there is no evidence that such consultations ever occurred. It was primarily this uncertainty over the representation of Scottish dermatological opinion, both in Scotland and the United Kingdom as a whole, which prompted the Society in the Seventies to seek and obtain the right to submit such opinion nationally. It was a bold initiative and the achievements were new and exciting, but thirty years before the Society had at least made a start along the same road. Similarly, the papers, guest lectures and symposia of the modern Society might seem a far cry from the clinical orientation of the early years. But even the need for more of an educational content in meetings had been recognised, and while the opposition in the Sixties to the introduction of a scientific section was real enough, papers by guests and members had by then been delivered on a number of occasions over many years.

It can be said, therefore that the Society has responded to the needs of the moment by drawing on the ideas of the past, and no doubt a similarly enlightened attitude will guide its affairs in the future. In the beginning a small group of dermatologists came together to view and discuss patients with interesting and unusual diseases of the skin, and as long as this remains the central element in the proceedings of the Society, then surely tradition will be upheld and the Society will remain essentially the same.

References

1. British Journal of Dermatology and Syphilis (1939). Obituary: Sir Robert Bolam, 51,326

2. Low R C and Dodds T C, Atlas of Bacteriology (1947), Livingstone, Edinburgh

3. British Journal of Dermatology and Syphilis (1934), North British Dermatological Society, 46, 243

4. Ferguson Smith), British Journal of Dermatology and Syphilis (1934), 46, 267

5. Ministry of Health: Scottish Home and Health Department (1965). Classification of Proprietary Preparations, Report of the Standing Joint Committee, HMSO, London

6. Bunney M H, Prescribers' Journal (1974), 14, 118

7. Scott G A, PUVA treatment: psoralens, Scottish Home and Health Department, (1979), Reference SHHD/CAMO (79) 5.

Acknowledgements

I would like to thank the Scottish Dermatological Society for affording me access to the minutes and other documents of the Society, thus enabling this history to be written. I am grateful too for the assistance of many individual members, including Dr G A Grant Peterkin of Edinburgh and Dr R Mason Bolam, formerly of Newcastle, both of whom joined the Society in the early Thirties, and were, therefore, able to provide information from the pre-War period.

I am indebted to Mr John G D McGhie and the Department of Medical Illustration, Raigmore Hospital, Inverness for preparation of the photographic material and the design of the cover.

Finally, I would express my thanks to Mrs Dorothy McGinley, Assistant Librarian, Highland Health Sciences Library, Raigmore Hospital for searching for references containing background information; and to Miss Isabel Gordon for the secretarial assistance required in the preparation and completion of the manuscript.

Appendix

Constitution of 1925

1. The Society shall be called the North British Dermatological Society.

2. Meetings shall be held in March, June and December of each year.

3. The meetings shall be held in rotation at Edinburgh and Glasgow each once a year and at Aberdeen, Dundee and Newcastle each every third year.

4. There shall be no fixed Chairman for the year. Any member may be voted into the chair at any meeting.

5. A Secretary shall be appointed to arrange and convene the meetings.

6. The Secretary shall send out notices of meetings at least one fortnight before such meeting.

7. The meetings shall be quite informal. No minutes shall be kept and no report of the proceedings sent to the lay or medical press.

8. There shall be no subscription but the Secretary shall, from time to time, if necessary, ask leave at any meeting to make a levy.

9. Any member of the Society may, by letter to the Secretary, not later than two weeks before any meeting, submit the name of a candidate for membership. The candidate's name shall be placed on the billet calling the meeting and candidates shall be voted on by ballot at the meeting. One adverse vote in five shall exclude.