Sir Robert Philip (1857–1939): The Edinburgh Doctor Who Took Tuberculosis to the Community

established claims rest on the records of the Royal Victoria Dispensary, Hospital and Tuberculosis Trust in the Lothian Health Services Archive, the Royal College of Physicians of Edinburgh and published statistics. shared claims involve interpretation, especially about why tuberculosis declined. traditional claims are repeated but not documented.

The weak points are these. "World first" claims for the dispensary rest on the institutions' own histories and have not been checked against every European clinic of the 1880s. Death rates from tuberculosis were already falling in Britain before 1887, so the scheme's effect is hard to separate from other causes. Sources disagree on his year of death; most give 1939.

From Koch's discovery to a Bank Street clinic

established Philip qualified in 1882, the year Robert Koch announced that tuberculosis was caused by a bacterium. After further study on the Continent, where he saw Koch's work at first hand, he became convinced that consumption was an infectious disease that could be traced and prevented, not just a hereditary misfortune. In 1887 he opened the Victoria Dispensary in Bank Street, on the edge of the Old Town. Its doorway still carries the words "The destitute sick". Patients came for diagnosis and advice, and staff visited their homes to examine relatives and teach hygiene.

The Edinburgh scheme

established Philip's idea was co-ordination. The dispensary found and assessed cases and traced contacts. The Victoria Hospital at Craigleith, opened in 1894, treated early cases with rest and fresh air. The Polton Farm Colony, opened in 1910, gave recovering patients graded outdoor work so that they could return to employment. Notification of cases let public-health officials map the disease. This combination, rather than any single institution, became known as the Edinburgh scheme.

shared The historian Helen Dingwall sees the scheme as typically Scottish: local action ahead of legislation, driven by a determined individual and backed by a mix of local authority, voluntary groups and benefactors. She reports that it was adopted across Scotland from 1908 and that the National Insurance Act of 1911 then made statutory provision for patients and their dependants. Across Scotland, deaths from tuberculosis fell from about 308 per 100,000 people in 1887 to 162 per 100,000 in 1914, according to figures she cites.

Professor and campaigner

established Philip was knighted in 1913 and in 1917 became the first holder of a chair of tuberculosis anywhere in the world, at the University of Edinburgh. He campaigned internationally for dispensaries and helped found professional bodies. The Tuberculosis Society of Scotland, founded in 1921, became the Scottish Thoracic Society.

How much did it work?

shared In Edinburgh the tuberculosis death rate fell from about 1.9 per thousand in 1887 to about 0.8 per thousand by 1920. Historians caution that rates were falling across Britain for other reasons too, including better housing, nutrition and wages, and that sanatorium treatment was neither particularly effective nor cost-effective. Real control came only after Philip's death, with streptomycin and other antibiotics from the late 1940s, BCG vaccination and mass X-ray campaigns. Philip's lasting contribution was the model of finding cases in the community, tracing contacts and following patients home, which public-health services still use.

The other route: tuberculosis in milk

established Philip's scheme was built around finding infectious people. A second route of infection ran through the dairy. The geographer P. J. Atkins, in a 1997 paper published in Order and Disorder (2000), describes how bovine tuberculosis, carried in raw cows' milk, caused mainly non-pulmonary disease, of the glands, bones, joints and abdomen, and struck young children hardest because they drank the most milk. He estimates that at least half a million, and possibly 800,000, deaths in Britain between 1850 and 1950 were directly attributable to bovine tuberculosis. Testing of city milk samples showed how common it was: in Aberdeen, 5.7 per cent of 1,561 samples taken in 1920–30 were tuberculous.

shared Atkins notes that Scotland's death rate from non-respiratory tuberculosis was consistently higher than England's, with the highest county figures in the northern half of the country. Curiously, this was the reverse of the map of total tuberculosis deaths. One explanation offered is that regular small doses of the bovine bacillus gave some protection against the lung disease, but this remains a hypothesis.

established Scotland moved early in law but slowly in practice. Atkins records that Glasgow, under its Police (Amendment) Act of 1890, was the first city to take powers to inspect any cowshed supplying it and to stop the sale of milk dangerous to health. The Milk and Dairies (Scotland) Act 1914 was delayed by the war and came into effect only in 1925, setting up a system of regular veterinary inspection that differed from England's. The decisive step came only after Philip's death: a national policy of eradicating tuberculosis from cattle from 1950, with the whole country declared "attested", its herds having passed tuberculin testing, in 1960.

• The doorway of Philip's dispensary at 13 Bank Street still carries the inscription "The destitute sick".
• Philip qualified as a doctor in 1882, the same year Koch identified the tuberculosis bacterium.
• Recovering patients at Polton Farm Colony did graded farm work to rebuild their strength before returning to their jobs.
• Edinburgh's chair of tuberculosis, created for Philip in 1917, was the first in the world.
• Between 1920 and 1930, about one in eighteen milk samples tested in Aberdeen contained tuberculosis bacilli.
• In 1890 Glasgow became the first city to take powers to inspect any cowshed that supplied its milk.

• Myth: Philip cured tuberculosis, or his scheme alone caused the fall in deaths. There was no cure until antibiotics arrived in the late 1940s. Death rates were already falling across Britain for other reasons, including better housing, nutrition and wages, and sanatorium treatment was neither particularly effective nor cost-effective. Philip's lasting contribution was the model of finding cases in the community and tracing contacts.
• Disputed: Philip's dispensary and chair were the world's first. The Royal College of Physicians of Edinburgh and the Lothian Health Services Archive, among others, describe them so. These claims rest on the institutions' own histories and have not been checked against every European clinic of the 1880s.
• Myth: Tuberculosis spread only from person to person. Bovine tuberculosis from raw cows' milk was a major separate cause, mainly of disease of the glands, bones, joints and abdomen, and it struck young children hardest.
• Disputed: when Philip died. Some sources give 1938. The Royal College of Physicians of Edinburgh records 25 January 1939, and most sources agree.