Thoracic Surgery
Thoracic Surgery in the West of Scotland
Although there had been many previous attempts to operate on the intrathoracic organs, Thoracic Surgery did not develop in Europe and the USA as a specialty till the 1940s and 50s, along with major developments in Cardiac Surgery and Anaesthesia for cardio-thoracic operations. Many of these early thoracic procedures were performed for the treatment of tuberculosis, with streptomycin not on the scene until the early 1950s.
In the West of Scotland, as in most UK medical centres, there was no overall plan for the development of Thoracic Surgery, but several centres proceeded to develop the specialty.
Mearnskirk Hospital to the south of Glasgow and Hairmyres Hospital in Lanarkshire had been selected years previously as more rural centres for the management of patients with pulmonary tuberculosis. Some of these patients required thoracic surgical intervention and it was considered appropriate at the time to establish chest surgery facilities in both these hospitals.
Accordingly Mr Bruce Mackenzie Dick, who was working in a war time Emergency Service Hospital at Gleneagles, was asked to set up the first thoracic surgery unit in Scotland at Hairmyres Hospital in the early 1940s.
As the need for surgical treatment of pulmonary tuberculosis diminished, thoracic surgery changed gradually and began to expand its interests particularly into the surgical treatment of bronchial carcinoma, but also into surgery for the management of conditions such as pneumothorax, empyema, chest wall deformities and mediastinal disease, including, in some centres, surgery for hiatus hernia and oesophageal carcinoma.
Over this period, Mr Barclay at Mearnskirk Hospital developed techniques in pulmonary resection which gained wide recognition, and Mr McCluskie at Hairmyres was an early advocate of pre-operative chemotherapy in some oesophageal carcinoma patients, and in addition practised other innovative techniques in lung resection.
Centres of Thoracic Surgery
In the early 1970s, there were four centres in the West of Scotland undertaking thoracic surgery. Three of these were within Greater Glasgow Health Board, and were centres which developed cardiac as well as thoracic surgery, and one was within the Lanarkshire Health Board.
- Mearnskirk Hospital was originally a TB sanatorium; part of it was developed in the 1960s and 1970s into a Cardio-thoracic Surgical Centre for both adults and children with a team led by Mr B. Barclay.
- Hairmyres Hospital, a District General Hospital in Lanarkshire, developed a Thoracic Surgery Unit under the guidance of Mr R. McCluskie for patients from Lanarkshire and Ayrshire.
- Glasgow Western Infirmary developed Thoracic Surgery with Mr M.A. Turner (Cardiac and Thoracic Surgery) and Mr K. Fraser (Cardiothoracic and General Surgery).
- Glasgow Royal Infirmary, Mr J. Hutchison developed Thoracic and General Surgery.
Respiratory medicine was developing rapidly in the 1970s with fibreoptic bronchoscopy and lung function laboratories in both Glasgow Royal Infirmary and the Western Infirmary. Anaesthesia was also changing and cardiothoracic anaesthesia gradually became a separate sub-specialty, with a major input into the post-operative care of cardiac and to some extent thoracic surgical patients. Many other services also had to change to accommodate the new specialties, e.g. nursing skills were enhanced in the wards, the theatres and intensive care units. More pressure was put on ancillary services such as radiology, physiotherapy and laboratories. Thoracic Surgeons became involved in the management of chest trauma, including the treatment of chest stab wounds, of which there were many in Glasgow at that time!
Cardiac and Thoracic Surgical Services
In the 1980s, it became clear that the West of Scotland required to rationalise the Cardiac and Thoracic Surgical Services, and in particular it was widely accepted by management, the University of Glasgow and the clinicians concerned that the presence of multiple small units with one or two surgeons and limited numbers of patients was not tenable from various perspectives. Research activities and training were difficult. The Royal Colleges of Surgeons were starting to inspect units with a view to granting approval for surgical training. If this were not forthcoming, it made recruitment of competent junior surgical staff very difficult and the reputation of the unit suffered. Outcomes of both cardiac and thoracic surgery were becoming a major topic, and suggested that a higher volume of activity could be a positive factor in some areas. New consultant contracts were being introduced and hours of work coming under scrutiny.
The reorganisation of cardiac and thoracic surgical services inevitably took many years, but resulted in a much more appropriate situation for patients from the West of Scotland. 
The cardiothoracic surgery unit at Mearnskirk Hospital closed, not long after Mr Barclay retired. In the 1980s and 1990s, adult thoracic surgery was undertaken in both the Western Infirmary (Mr MA Turner) and the Royal Infirmary (Mr KG Davidson), later joined by Mr A Faichney, Mr K Macarthur, Mr A Kirk and Mr I Colquhoun, all of whom also undertook cardiac surgery.
Hairmyres Hospital continued to provide thoracic surgery for patients from Lanarkshire; two thoracic surgeons, Mr Prakash and Mr Al-Jilawi, were appointed after the retiral of Mr McCluskie. Paediatric cardiothoracic surgery was undertaken entirely at Yorkhill Hospital.
This arrangement of cardiothoracic surgical services continued over most of the 1980s and 1990s, but the acquisition of the Golden Jubilee Hospital in Clydebank by the NHS in 2002 presented another opportunity. The advantages of amalgamating all West of Scotland adult cardiothoracic surgery in a large, recently built and well-equipped hospital were all too obvious. The disadvantages included its relative isolation, and the resulting separation from respiratory physicians, laboratories and University Departments.
In 2004, the decision was made to concentrate all adult cardiothoracic surgery at the Golden Jubilee Hospital, and over the next few years the cardiothoracic units, including the thoracic surgery unit from Lanarkshire, were amalgamated there, making it one of the largest centres in the UK for both cardiac and thoracic surgery. The consolidated Thoracic Surgery Unit for the West of Scotland employs several thoracic surgeons and, with a lead role from Alan Kirk, now offers a full range of services, including minimally invasive surgery. Close links have been established both with respiratory physicians and oncologists, generating excellent opportunities for training and research.
Mr Kenneth G Davidson