Professor James Scott
Tuesday 03 October 2006
James Steel Scott, obstetrician: born Glasgow 18 April 1924; Obstetric Tutor, Liverpool University 1954-58, Lecturer 1958-60, Senior Lecturer 1960-61; Professor of Obstetrics and Gynaecology, Leeds University 1961-89 (Emeritus), Dean of Faculty of Medicine 1986-89; married 1958 Olive Sharpe (two sons); died Harrogate, North Yorkshire 17 September 2006.
James 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. He was primarily a clinician, and 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 foetal 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.
Scott was born in Glasgow in 1924, and after Glasgow Academy and Glasgow University did 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 then in Birmingham, before moving to Liverpool in 1954.
His immunological interest began at Liverpool 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 foreword to Scott's seminal book Immunology of Human Reproduction (1976), edited jointly with Warren Jones, one of Scott's pupils.
When Scott became Professor of Obstetrics and Gynaecology at Leeds University in 1961, at the early age of 37, he threw himself and his department into the new speciality 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 foetal 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 foetus. 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, or 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 Scott's 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.
James Scott 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 by 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.
Scott ended his career as Dean of Leeds University Medical School, from 1986 to 1989; 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 20th-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.
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