van Teijlingen, Edwin

English

Bournemouth University Research Online

The man and the visionSir Dugald Baird: three decades of transforming work in reproductive healthDugald Baird was born in Beath, in Ayrshire, in 1899. He studied medicine at the University of Glasgow,where he became interested in epidemiology and social inequality. Baird’s experience ‘as a medicalstudent attending home confinements of women in the Glasgow slums in the 1920s was fundamental inshaping his career’,1 and he became interested in social class differences as he observed ‘the contrastbetween childbearing in the upper social classes and in the slum dwellers ...’.2In 1936, Baird was in stiff competition for the post of Regius Chair of Midwifery at the Universityof Aberdeen with Chassar Moir, an Edinburgh graduate, who went on to discover ergometrine andbecome Nuffield Professor of Obstetrics in Oxford,3 but Baird came to work at the University ofAberdeen in 1937 and continued to work at the University until well after his retirement in 1965. Hepromoted the study of the non-medical influences on stillbirth and maternal health, such as housing,nutrition and psychological and social factors. Baird was awarded a Knighthood for this work in 1959.Dugald’s wife, May (Matilda; née Tennant), also read Medicine at Glasgow. Prominent in herown right, in 1937 she became town councillor in Aberdeen for the Labour Party and in 1947 shewas appointed as the first Chair of the North Eastern Regional Hospital Board, with which sheserved until 1960. She was also a National Governor of the BBC in Scotland for 4 years. In 1966,May and Dugald were awarded, as a couple, the Freedom of the City of Aberdeen, and an Aberdeen streetwas named in May Baird’s honour. Lady May Baird died in 1983 and Sir Dugald in 1986.Achievements in obstetrics and gynaecologyIn his practice of obstetrics and gynaecology, Sir Dugald established the classification of stillbirths andperinatal mortality in Scotland, promoted population-based cervical screening, helped establish familyplanning services, and offered abortion on social grounds long before the Abortion Act of 1967.Baird and his colleagues in Aberdeen introduced one of the first proper classifications of stillbirth andperinatal mortality in Scotland.4 The published classification was based on the meticulous checking of 14-years worth of records from Aberdeen Maternity Hospital for the period 1938–1952.5 Baird also started thefirst population-based cervical screening programme in 1960.6 It was directed at married women between25 and 60 years of age.7 In Aberdeen, Baird initiated a full screening programme, with proper call andrecall under ‘the enthusiastic supervision of Dr J. E. Macgregor.’8 The subsequent fall in the incidence ofcervical cancer in the region illustrated the success of the programme. Another of Sir Dugald’s notableachievements was his help in establishing the first free family planning clinic in Aberdeen, with supportfrom his wife at the Regional Health Board – representing a very early example of multi-agency working. Ofall the changes introduced in obstetrics and gynaecology, Sir Dugald is best known for his support for thetermination of pregnancies for socio-economic reasons. In the period 1938–1947, 233 women in northeastScotland had their pregnancies terminated in Aberdeen and were sterilised,9 and Baird started offeringabortions on the NHS in the 1950s. In his famous ‘A fifth freedom: freedom from the tyranny of excessivefertility’, Baird emphasised the need to liberate women from the burden of frequent childbearing.10 Hewould offer to terminate the unwanted pregnancies of women of high parity and then offer subsequentsterilisation. As Sir Dugald was such a strong supporter of abortion law reform, it created the impressionthat abortion was rife in Aberdeen. MacGillivray and Horobin highlight the fact that although many‘...thought the situation was one of “abortion on demand”. This was and is far from the truth.’11Reproductive health researchBaird’s enthusiasm for social reproductive health research showed in his involvement in the establishmentof a number of research units in Aberdeen (Figure 1). Baird saw Aberdeen as a unique opportunity inwhich to conduct research to establish the factors that contribute to efficient childbearing and the influenceof social conditions. The ‘population was of an appropriate size and a settled nature, which would permitfollow up of women and their families, and there was a centralised medical service’.12 The relative isolationof the northeast of Scotland, with the City of Aberdeen as the major administrative centre for a large ruralhinterland, facilitated the epidemiological study of a total population13 – true before the oil boom of the early1970s.a World War II delayed his plans, but Baird’s recognition of ‘...the value of complete accurate factualknowledge about his patients led to the establishment of the unique case records system at the MaternityHospital’.14 This case records system developed into what is now known as the Aberdeen Maternity andNeonatal Data Bank. The Databank includes social data, is now computerised, and is still an importantresource for researchers from all over the UK.15In the late 1940s, Baird was able to take,...the unprecedented and controversial step of introducing an epidemiologist, a physiologist,psychologist and statistician, as well as dieticians and sociologists, to his department. Suchactions aroused some hostility in the more reactionary sections of the medical profession,but he was able to persuade the Medical Research Council (MRC) to support suchinterdisciplinary research within the London based Social Medicine Research Unit (SMRU)under the directorship of Professor Jerry Morris.1A letter from the MRC to Baird, dated 24 July 1948, stressed that it was ‘anxious to promote thisinquiry, for which…there are unrivalled opportunities in Aberdeen ...’.16 The University of Aberdeen wasalso sympathetic to the idea; the minutes of its Court recorded the following on the establishment of asubsidiary unit in Aberdeen:A letter of date 30th July, 1948, was submitted from Professor Baird forwarding a proposal bythe Medical Research Council that a scheme of research should be carried out in collaborationbetween the Department of Midwifery of the University and the Social Medicine ResearchUnit of the Medical Research Council and the Court warmly approved the proposal.17Jerry Morris and Richard Titmussb were involved in the initial planning and the research started later in1948.Raymond Illsley, the first director of the Aberdeen MRC Medical Sociology Unit, came toAberdeen in 1951. Illsley worked initially with Angus Thomson,c a nutritionist recruited by Baird andtrained by Boyd Orr18 and Barbara Thompson, who was what was then called a ‘Lady Almoner’. Thenumber of social scientists in the Department of Obstetrics and Gynaecology slowly grew.19 It becamerecognised that ‘many aspects in the lives of young and growing families...were being studied by theUniversity Midwifery Department.’20 After visiting Aberdeen in 1952, Sir Herald Himsworth, secretary of theMRC, commented in a memorandum that he had,...returned from this visit with a favourable opinion of the work in progress, that this is themost impressive work in obstetrics I have met in this country, and that I have seen whatappears to be a model of how the approach of social medicine can be effectively used in thestrategy of research into a clinical problem.21In 1955, the Aberdeen offshoot of the SMRU developed into an autonomous unit: ‘...the MedicalResearch Council created for Dugald Baird the Obstetric Medicine Research Unit. Together with theUniversity and the Health Board, they built a new research floor on the top of the Maternity Hospital’.22 Thenutritional and physiological parts of the Obstetric Medicine Research Unit was relocated toNewcastled when Sir Dugald retired (1965), but the Aberdeen-based sociological team formed the nucleusof a new MRC Medical Sociology Unit under Professor Raymond Illsley23 (see Figure 1). In the early days,research links were mainly with obstetrics, through Baird. Thus many of the research papers highlighted inthe MRC Unit’s first 5-year progress report (1970) were related to social aspects of obstetrics and childhealth.e When Illsley retired in 1984, the MRC Medical Sociology Unit moved to Glasgow, with SallyMacintyre as its new Director.In this very positive atmosphere of encouraging good research into the social aspects ofreproductive health, it is easy to see the DBC today as the continuation of a long-standing trend –one that is of high-quality reproductive health research that is relevant to practitioners as well asto policy makers and one that focuses on issues that matter in society. The ethos of the DBC linksback directly to Sir Dugald Baird’s vision of and achievements in nurturing quality interdisciplinaryresearch.References1           Thompson B. Foreword. In: Thompson B, Fraser C, Hewitt A, Skipper D. Having a first baby:Experiences in 1951 and 1985 compared. Aberdeen: Aberdeen University Press, 1989: v.2           Baird D. Social research and obstetric practice. Question 1969; January: 3–4.3           Levack I, Dudley H. Aberdeen Royal Infirmary: The People’s Hospital of the North-East. London:Baillière Tindall, 1992.4           Baird D, Wyper JFB. High stillbirth and neonatal mortalities. Lancet 1941; ii: 657–659.5           Baird D, Walker J, Thomson AM. The causes and prevention of stillbirths and first week deaths.Journal of Obstetrics and Gynaecology of the British Empire 1954; 61: 433–448.6           Macgregor JE, Baird D. Detection of cervical cancer in the general population. British MedicalJournal 1963; i: 1631–1636.7           Macgregor JE, Campbello MK, Mann EMF, Swanson KY. Screening for cervical intraepith elialneoplasia in north east Scotland shows fall in incidence and mortality from invasive cancer withconcomitant rise in preinvasive disease. British Medical Journal 1994; 308: 1407–1411.8           Nasseem Husain OA, Blanche Butler E. Cytopathology in the United Kingdom: 1854 to thepresent. Diagnostic Cytopathology 2000; 22: 203–206.9           Aitken-Swan J. Epidemiological background. In: Horobin G (ed.) Experience with Abortion: a CaseStudy of North-East Scotland. Cambridge: Cambridge University Press, 1973: 12–46.10         Baird DA. A fifth freedom. British Medical Journal 1965; ii: 1141–1148.11         MacGillivray I, Horobin G. Introduction. In: Horobin, G. (ed.) Experience with abortion: A casestudy of North-East Scotland, Cambridge: Cambridge University Press, 1973: 6.12         Thompson B. Obituary. Sir Dugald Baird. British Medical Journal 1985; 293: 1446.13           van Teijlingen E, Barbour R. The MRC Medical Sociology Unit in Aberdeen: its development andlegacy. In: Adams A, Smith D, Watson F (eds). To the Greit Support and Advancement of Helth.Papers on the History of Medicine in Aberdeen arising from a Conference held during theQuincentenary Year of Aberdeen University. Aberdeen History of Medicine Publications. Aberdeen:University of Aberdeen, 1996: 55.14           Ireland RD. University News. The Aberdeen University Review 1965; XLI: 313.15         Thompson B, Fraser C, Hewitt A, Skipper D. Having a first baby: experiences in 1951 and 1985compared. Aberdeen: Aberdeen University Press, 1989; 2–3.16         Public Record Office. FDI/290: Letter to Professor D. Baird, 24 July 1948, signed by A. L.Thomson, Assistant Secretary to the MRC. London: Public Record Office.17         University of Aberdeen. Minutes of the Aberdeen University Court, 24 August 1948, Minutes of theAberdeen University Court. Aberdeen: The University Press, 1950; XVI: 143.18         Hargreaves JD. Academic strategies of expansion. In: Hargreaves JD, Forbes A (eds.), AberdeenUniversity 1945–1981: Regional Roles and National Needs. Aberdeen: Aberdeen University Press,1989: 13.19         van Teijlingen E, Barbour R. The MRC Medical Sociology Unit in Aberdeen: its development andlegacy. In: Adams A, Smith D, Watson F (eds). To the Greit Support and Advancement of Helth.Papers on the History of Medicine in Aberdeen arising from a Conference held during theQuincentenary Year of Aberdeen University. Aberdeen History of Medicine Publications. Aberdeen:University of Aberdeen, 1996: 56.20          Rowntree G. The finances of founding a family. Scottish Journal of Political Economy 1954; 1:201.21         Public Records Office. FDI/290: Social medicine research in the Department of Obstetrics,University of Aberdeen. Note by the Secretary, H. P. Himsworth, 6 June 1952. London: PublicRecords Office.22         A. K. Obituary. Honorary Graduates: Baird, Sir Dugald, MD FRCG DSc (LLD 1966). AberdeenUniversity Review 1988; LII: 82.23         Baird D. Social research and obstetric practice. Question 1969; January: 4.Notesa The indigenous population of the region is still relatively stable compared to many other parts of the UK.b Titmuss (later Professor) studied social policy. He pointed out that times were changing for women. InEssays on the Welfare State (London, 1958, p. 91), he wrote that in the 1890s the typical working-classmother experienced ‘ten pregnancies, spent about fifteen years in a state of pregnancy and in nursing achild for the first year of its life. She was tied for this period of time, to the wheel of child-bearing’. Hecontrasted this with the typical mother of the late 1950s: ‘the time so spent would be about four years...’.c Dr Angus M. Thomson had worked on reproduction in sheep at the Rowett Institute, Aberdeen.d This became the Human Reproduction and Growth Unit under directorship of Angus Thomson.e See, for example: Kincaid JC. Social pathology of foetal and infant loss. British Medical Journal 1965; I:1057–1059. Gill DG, Illsley R, Koplik LH. Pregnancy in teenage girls. Social Science and Medicine 1970;3: 549–574. Thompson B, Baird D. Some impressions of childbearing in tropical areas. Journal ofObstetrics and Gynaecology of the British Commonwealth 1974; 3: 329–338.Edwin van TeijlingenReader in Public HealthAbout the authorEdwin van Teijlingen is a medical sociologist and co-ordinator of the MSc in Public Health & HealthService Research. He is seconded (part-time) to the DBC where he has been involved in reproductivehealth research projects in the UK and abroad. He has produced many papers and several books ondifferent aspects of maternity care. He has also written a series on papers on social science researchmethods.Figure 1 Research units established under Dugald Baird.|1948             |    |1955                       |    |1965–1984               ||Part of MRC      |    |Obstetric Medicine Research|    |MRC Medical Sociology   ||Social Medicine  |(   |Unit, Aberdeen.            |(   |Unit, Aberdeen.         ||Research Unit,   |    |Honorary Director: Dugald  |    |Director: Raymond       ||London.          |    |Baird                      |    |Illsley                 |Pic Dugald Baird MD DSc LLD DPH FRCOG, 1899–1986; Regius Professor of Midwifery, University ofAberdeen, 1937–1965. (Photograph courtesy of Dr Barbara Thompson.)

A fifth freedom.

Aberdeen Royal Infirmary: The People’s Hospital of the North-East. London: Baillière Tindall,

Academic strategies of expansion. In:

Cytopathology in the United Kingdom: 1854 to the present. Diagnostic Cytopathology

Detection of cervical cancer in the general population.

Epidemiological background. In: Horobin G (ed.) Experience with Abortion: a Case Study of North-East Scotland. Cambridge:

Experience with abortion: A case study of North-East Scotland, Cambridge:

Having a first baby:

Having a first baby: experiences in 1951 and

High stillbirth and neonatal mortalities. Lancet

Honorary Graduates: Baird, Sir Dugald,

Office. FDI/290: Letter to Professor

Office. FDI/290: Social medicine research in the Department of Obstetrics,

Screening for cervical intraepith elial neoplasia in north east Scotland shows fall in incidence and mortality from invasive cancer with concomitant rise in preinvasive disease.

Social research and obstetric practice. Question

The causes and prevention of stillbirths and first week deaths.

The finances of founding a family.

The MRC Medical Sociology Unit in Aberdeen: its development and legacy. In: Adams

The man and the vision. Sir Dugald Baird: three decades of transforming work in reproductive health,

The man and the vision. Sir Dugald Baird: three decades of transforming work in reproductive health,

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