Last update:
08-Sep-2020

A remarkable flowering of scientific and philosophical thinking, the Scottish Enlightenment, took place in the second half of the 1700s, centred on Edinburgh. The city's new medical school benefited, developed new integrated teaching methods, exploded in size, and sent its graduates around the world. One was Richard Bright, the creator of the specialty of nephrology. Robert Christison, professor of medicine in Edinburgh, was one of those who prominently extended Bright's observations, but his lasting influence was probably limited by his opposition to women doctors. Almost at the same time, Edinburgh graduate Thomas Latta described the first use of intravenous fluids to rescue patients with terminal shock from cholera. Meanwhile in Glasgow, Thomas Graham was describing the principles of dialysis. Scotland took up dialysis and transplantation as treatments for renal failure a hundred years later. Dialysis for AKI from 1959, and the first successful transplant in the UK was performed in Edinburgh in 1960. Establishment of early units for chronic dialysis and transplantation followed, still at a time when the viability of neither was assured. Research centred on complications of dialysis, and on immunosuppression. Edinburgh suffered a devastating dialysis-associated hepatitis outbreak in 1969–1970. This was a major but temporary setback to the development of services. It was followed by a remarkable research initiative that created a landmark, early commercially successful recombinant protein product – hepatitis B vaccine.

Key words: Dialysis hepatitis, Edinburgh medical education, Scottish enlightenment, Richard Bright, Robert Christison, Thomas Graham, Thomas Latta.