James Steel Scott
Professor James Steel Scott did as much as any obstetrician of his generation to unravel the diseases caused by defects in the immunological relationship between mother and baby. Primarily a clinician, his method was observation of the natural experiment of pregnancy.
An enthusiast who constantly fired off ideas for his pupils to chase up, he was unusual both in that most of the ideas were good, and that he afterwards rarely claimed credit. I recall him almost bursting with excitement in 1977 when he learned of the discovery that hydatidiform moles, tumours of the fetal component of the placenta, were of entirely paternal origin. Many years earlier he had observed that pregnancies complicated by anatomically similar fluid collections in the placenta had a high risk of pre-eclamptic toxaemia, a disease of pregnancy characterised by high blood pressure, multi-organ damage and in severe cases by maternal convulsions and death. He also knew that, in the days when moles had been allowed to progress into the latter half of pregnancy, they were almost always associated with severe forms of pre-eclampsia. He immediately saw the research projects that would come from this dramatic discovery.
His immunological interest had begun in Liverpool in the 1950s when he met Cyril Clarke, and Ronald Finn whose rhesus disease prevention with anti-D immunoglobulin was to save the lives of millions of babies worldwide. It was an exciting time, and Scott, like others, hoped that many other pregnancy diseases would turn out to have similar causes and treatments. Sir Cyril Clarke, as he was by then, later wrote the forward to his seminal book, the Immunology of Human Reproduction, edited jointly with Warren Jones one of Scott’s pupils.
When he became professor of obstetrics and gynaecology in Leeds in 1961, at the early age of 37, he threw himself and his department into the new specialty of reproductive immunology. He was one of the first to recognise that transient forms of adult diseases in the newborn, previously regarded as curiosities, were often signs of the transplacental passage of harmful antibodies from the mother. The neonatal forms of thyroid overactivity, of bleeding due to lack of platelets, and of systemic lupus erythematosus are now recognised as the classic examples. His greatest personal success, achieved in collaboration with his wife Olive, a paediatric cardiologist, was his demonstration that transplacental passage of the anti-Ro antibody, named after the patient Madame Robert in whom it had been first detected, caused the rare but serious condition of fetal heart block.
The big prize for obstetric researchers, then as now, was to untangle the cause of pre-eclampsia. Scott believed that it might be caused by a harmful immune reaction between parent and fetus He and his collaborators observed that it was more common and more severe in pregnancies with a new male partner, but less severe if the mother had previously received an organ transplant, a blood transfusion, or been exposed for a long period to male antigens in the form of semen via non barrier-contracepted sexual intercourse. These clinical observations have stood the test of time, but he had less success in his efforts to test the hypothesis in the laboratory.
For years his laboratory, using the laborious techniques of immunology then available, tested the blood groups, tissue types and immune reactions of parents and babies from affected and unaffected pregnancies. He never found the secret combination, but nor did he miss it either. Even today with all the techniques of molecular biology at our disposal the cause of this terrible disease remains obscure.
He was the sort of clinician to whom colleagues referred their most difficult cases and he made good use of these opportunities. In the early 1980s he looked after a number of young pregnant women who had lost limbs, been blinded or had strokes as a result of vascular damage caused the lupus anticoagulant, a rare and particularly nasty type of anti-phospholipid antibody. He never tired in his efforts to treat them, but was always on the lookout to learn from them too. It was not long before he suggested that someone looked at another group of women with high rates of anti-phospholipid antibodies, those who had an unconfirmed positive test for syphilis on routine pregnancy screening; perhaps they would be more likely to suffer from pre-eclampsia. They did not, but they did suffer from an increased risk of miscarriage. Testing women with recurrent miscarriage for these antibodies is now routine practice, and a positive result is the basis for treatment with aspirin and other blood thinning agents.
He ended his career as Dean of Leeds University Medical School; a job he characteristically insisted was only part time, remaining head of his own department. But his colleagues will remember him best from his Saturday morning ward round, an occasion we juniors missed at our peril. After teaching the medical students at the bedside, he would see a dozen “special” patients, not staff or society women, although he treated many of those, but women with intractable genital ulceration, people with intersex conditions or ambiguous genitalia, or women who had lost 10 or 20 pregnancies in a row. He knew that many were untreatable but he never gave up on them, and they loved him for it. At the end of it all we would assemble in sister’s office for coffee to learn about twentieth century Irish literature, skiing, the Scottish Colourists and grand opera, but most importantly to hear him say; “Did you read [a recent paper]? It might be interesting to take a look at [a particular group of patients]?” Many of us made our own names doing just that.
Jim Thornton, Nottingham 3 October 2006. Reprinted from the Independent
Born in Glasgow on 18 April 1924 James Steel Scott went to school and university there before two years national service in West Africa. On his return he trained as an obstetrician and gynaecologist at Queen Charlotte’s Hospital in London and in Birmingham, before moving to Liverpool in 1954. He was professor of obstetrics and gynaecology at Leeds University from 1961-89 and Dean of Leeds University Medical School 1986 to 1989. He died on 17 September 2006 of prostate cancer.
Readers might be interested in what I left out of the Independent. In 1967 he had been one of three or four senior professors of obstetrics and gynaecology in Britain who had publicly opposed the 1967 Abortion Act. He later was rather reticent about the episode, and I think felt that he had been hijacked by the pro-lifers.
Nevertheless his department always provided a safe refuge for conscientious objectors, and when he became Dean of Leeds Medical School he introduced the reading of the Hippocratic Oath at medical student graduation ceremonies. I had always assumed that that was in an attempt to get the words “I will not procure abortion” read out. If so, it was foiled. He ended up reading a more modern version of the oath without the controversial phrase. However, others told me he had no such aim, so I omitted the story.