The Royal Infirmary of Edinburgh’s Royal Charter

On 25 August 1736, Scotland’s first hospital, in the modern sense of the word, was granted a Royal Charter by His Majesty, King George II. Founded in 1729, it was first known as the Infirmary, or Little House, or Physicians’ Hospital. The Charter conferred the more familiar title of The Royal Infirmary of Edinburgh, by which it has been known ever since. LHSA produced three posters about the Royal Infirmary of Edinburgh's Charter.

General information

King George II granted a Royal Charter in 1736, naming Edinburgh's Infirmary, which had been founded in 1729, the Royal Infirmary of Edinburgh.  The charter is in Latin and has the Great Seal of Scotland attached.

As well as extending royal patronage to the hospital, the Charter made it into a corporation. This gave it legal rights to use a common seal, to perpetual succession, to sue and be sued, to own lands and erect properties upon them, to lend money and to make bye-laws, rules and regulations, on condition they were consistent with the laws of the land, and with the institution’s charitable purpose of caring for the sick poor.

Image of the Royal Charter and The Great Seal of Scotland.

The Charter also specified how the Infirmary was to be run. Twenty named managers were nominated in it, drawn from Edinburgh Town Council, the law, the church and the medical profession. They were given the right to elect their successors annually. Charitable contributors who had given five pounds sterling or more were made into a general court, which was empowered to make and amend managers’ regulations.

Originally in English, the text was translated into Latin by the noted Scottish classicist Thomas Ruddiman (1674-1757). It was then inscribed onto parchment and The Great Seal of Scotland was attached by means of intertwined blue and pink silk threads. The wax relief shows King George in military uniform, mounted on a rearing stallion and overlooking the City of Edinburgh. An idealised but still identifiable panorama of the Castle, the church and tenement buildings of the Royal Mile and Salisbury Crags, can be seen behind the horse’s legs.

The Seal was originally kept in a metal tin (not shown) and had broken into several pieces. The subsequent repair and restoration work, carried out by the National Archives of Scotland, can be clearly seen in the illustration, which is approximately life size. The Charter consists of four sheets of parchment folded to make eight pages, four sides of which are blank. As it was kept in its original leather pouch for over 250 years, the parchment had to be relaxed and flattened prior to the Charter, restored Seal and pouch being permanently housed in a specially made box.

 

The Charter text in English

The original English text reproduced in ‘The History and Statutes of The Royal Infirmary of Edinburgh’, 1778, can be seen in the following images.

Images of the Charter and Seal

First and second pages of the Latin text, 1736

Account of expenses associated with the Charter, 1737.

Front and reverse of The Great Seal of Scotland attached to the Charter.

Further resources

Poster 1: General information about the Charter and Seal

Poster 2: The Charter text in English

Poster 3: Images of the Charter and Seal

Conservation (5): The conservation of four handmade booklets by Robert Clennell

In 2006, the National Manuscripts Conservation Trust awarded £649 (50% of the total cost) to conserve four booklets produced by Robert Clennell, an early nineteenth-century asylum patient. The booklets form part of the private papers of Medical Superintendents of the Royal Edinburgh Asylum. Such patient writings, together with artwork and photographs, were used to illustrate what was perceived as the mental pathology of the diseased brain and are now a very scarce historical source for understanding mental illness from the patients’ point of view.

 

Condition

The booklets are constructed of varying numbers of folded sheets of European wove paper almost entirely covered with written text in iron gall ink with coloured borders and initial letters in watercolour wash. Three have been sewn along the spine to hold the folded sheets in booklet format. They exhibited extensive surface dirt, tears and creasing to edges and the centre fold, damage to the original sewing and localised surface abrasions. As a result, future use of these items, without prior conservation treatment, posed significant risk of transfer of dirt and exacerbation of the physical damage noted.

Booklet titled 'The Adventure. A poem' by Robert Clennell (GD16).

Treatment

Treatment was undertaken by Helen Creasy of The Scottish Conservation Studio during March 2006 and included careful surface cleaning using a chemical sponge and tear repair using wheat starch paste and a medium weight Japanese paper. Where the original sewing had been damaged, this was not repaired as this meant that an order had to be imposed on loose sheets that could compromise the integrity of the item. The four booklets were re-housed to provide suitable long-term protection and to facilitate easy identification and access. Photographic and written documentation of the treatment was also produced.

 

Conclusion

The conservation treatment has been carried out to a high standard and has successfully brought the booklets to a condition at which they can be accessed and displayed. In addition, the remedial treatments have been sensitively undertaken to ensure that the booklets are conserved without compromising their character or historical value.

Spotlight On… (7): Photograph of Sir Michael Woodruff, Surgeon (1911-2001)

Sir Michael Woodruff performed the first successful kidney transplant in the UK at the Royal Infirmary of Edinburgh in October 1960.

Professor Sir Michael Woodruff, Surgical Unit, Wards 13-14, Royal Infirmary of Edinburgh, c.1975 (P/PLI/D/095).

Woodruff was born in London but grew up in Australia where he went to medical school, graduating in 1938. After the Second World War (where he fought and was imprisoned in Malaysia), he travelled widely and took up various teaching posts in the UK and New Zealand.  In 1957, he was appointed to the Chair of Systematic Surgery at the University of Edinburgh, a position he held until 1976. There, he established a team that achieved world renown in the fields of graft rejection, cancer immunity, and immunosuppression. In 1960, he attempted the first kidney transplant on a set of identical twins. The operation was a success, and the brothers survived.

Press cutting titled 'The Twins. One gives kidney to save the other' (LHB1/70/32).

Press cutting titled 'Day To Remember for 'Kidney Twins', 30th October 1960 (LHB1/70/32).

Woodruff went on to be elected a Fellow of the Royal Society of London, and was knighted in 1969.

Bioengineering in Edinburgh

Learn how breakthroughs in artificial limbs developed in Scotland's capital changed lives across the world. Bioengineering is a combination of engineering and medicine – it is the industry involved in designing and constructing artificial limbs and living aids for those with disabilities. Edinburgh has been a world-renowned centre for the field since the early 1960s.

Use of artificial limbs in the Lothians can be traced back to the First World War, when Edenhall Hospital, a facility specifically for soldiers who had lost limbs in battle, was moved from Kelso in the Scottish Borders to Pinkieburn near Musselburgh. In Edenhall Hospital, there was a workshop where the ex-servicemen were able to construct their own artificial limbs – they were inspired by the work that was being done at Roehampton, a limb-fitting centre at Queen Mary’s Hospital in London.

Photographs of soldier patients at Edenhall Hospital, c.1910 (LHB52/4/2).

However, apart from soldiers, there were few, if any, prostheses' services for the civilian population until after the Second World War. Bioengineering was not viewed as a legitimate medical discipline within the newly-formed National Health Service. This changed during the early 1960s, when the thalidomide tragedy occurred in Britain and other parts of Western Europe. Thalidomide was a drug that was first licensed for use in the UK in 1958 and was advertised as a mild sleeping pill for pregnant women. In 1961, it was realised that there was a link between the thalidomide drug and the increase in births of children with physical impairments. Many children were born with severe limb deficiencies or had no limbs, with the effect being often bilateral – affecting either both arms or legs. In Scotland, around 100-150 children were affected and 20-30 of these children had severe disabilities as a result.

This sparked an emotionally-charged campaign to provide treatment for these children. In May 1963, the Scottish Home and Health Department funded the creation of The Powered Prosthetics Unit, a small workshop dedicated to making artificial limbs for children affected by thalidomide located near the Edinburgh University George Square campus and the old Royal Infirmary building, now Quartermile. This space was eventually too small and it moved to the Princess Margaret Rose Hospital in 1965, opening a Self-Care Unit for the children to stay with their families when receiving long-term therapy and treatment the following year. In 1969, it was renamed The Bio-engineering Centre. Although it mysteriously dropped the hyphen in the 1980s and has changed locations multiple times over the last decade (it moved to the Eastern General after the PMR closed in 2002 and the SMART Centre at Astley Ainslie Hospital in 2007), it has kept this name.

Since the Powered Prosthetic Unit opened, Edinburgh has been a major innovator in bioengineering technology. Professor David Simpson, who helped to open the Unit and was the first Director of the Bioengineering Centre, designed pneumatic (gas) powered prostheses that used his extended physiological proprioception (EPP) theory, making the prosthesis feel more natural to the user. Simpson also made a Low Pressure Airbed that prevented patients who had long rest periods from getting bedsores. It was used both in hospitals and for home use, and was sold commercially well into the 1990s.

In the 1980s technological advancements meant that artificial limbs could be electrically powered, and so the team at the Centre began to develop the first electrically powered hand in collaboration with REACH, a charity for children with upper limb deficiencies, and fitted it for the first time on an adult a decade later. In 1998, the Edinburgh Modular Arm System (EMAS), the world’s first ever electrically powered arm with a powered shoulder, elbow, wrist and fingers, was fitted at the Bioengineering Centre.

Photograph of Campbell Aird, the first person to be fitted with the EMAS, 1998 (Acc10/001).

In 2001, bioengineer David Gow founded the private company Touch, later TouchBionics. This company that created and launched the i-limb hand, the first artificial hand in the world to have independently powered digits, in 2007. TouchBionics is now owned by Ossur, an Icelandic prosthetics and orthotics company, and there have been several developments to the i-limb hand since, but this Edinburgh invention continues to have a monopoly over the prostheses market.

For more information about the bioengineering industry in Edinburgh, please view our online resource here.

Spotlight On... (6): The Andrew Kennedy Drawings, c. 1888

Today marks the 185th birth anniversary of Dr Thomas Clouston, Physician Superintendent of the Royal Edinburgh Asylum (1873-1908). LHSA holds Clouston's paper as part of the 'Physician Superintendents of the Royal Edinburgh Hospital, c.1850-c.1980' collection (GD16). A number of drawings were found amongst these papers, which may have been sent to Clouston as indicative examples of mental illness. They are certainly a window into patients' perspectives on mental health care of the late 1800s.

Andrew Kennedy (1825-1899) was a patient at the Glasgow Royal Asylum and other Scottish hospitals in the second half of the nineteenth century. Thirty-four of his drawings are held within the papers of Dr Thomas Clouston, who was physician superintendent to the Royal Edinburgh Hospital.

The drawings typically represent matrons or doctors, but also include birds, fish and cows.  They were all drawn on small scraps of paper, often accompanied by writing and offer a rare insight into the patient experience.  A selection of these drawings was loaned to an exhibition of British Outsider Art at the Halle Saint Pierre, Paris from March to September 2008, and again in 2010 for the Talbot Rice Gallery exhibition 'Drawing for Instruction'.

Conservation (4): Production of Surrogates and Substitutes

In LHSA, we strive to give our different service users access to our varied collections. However, there are cases when collection items are too fragile and there is a serious risk of damage and deterioration associated with their handling. In some instances, our team considers the production of high-quality physical and digital surrogates and substitutes that help us preserve irreplaceable items while ensuring collections are still accessible for research and teaching. 

Production of Surrogates

LHSA produces surrogates so that access to original items and the risk of damage associated with access may be reduced. A surrogate can also be used for display where the conditions are not suitable for the original. Wherever possible, a high-quality surrogate is produced to recognised standards since it may also serve as an additional means of long-term preservation of the informational content of the original item. Priorities for surrogacy are those items of particular historic significance or in such poor condition that the informational content is at risk.

LHSA often uses digital images in TIF format as surrogates. These are produced in-house using our digital reprographics equipment or by a commercial company as appropriate. The images and their metadata are stored in a database for access. Because LHSA is yet to establish a trusted digital repository, these images are not relied on as a means of long-term preservation of the informational content of an original item. For this purpose, a master copy preservation microfilm is produced, and a working microfilm is created to serve as the surrogate. The digital images and microfilm for surrogacy are often used in collaboration to best meet the preservation and access needs of a particular collection item.

Where a surrogate copy is produced, the work undertaken is documented, and appropriate storage for both the original and the surrogate is provided. The LHSA catalogue is also amended to indicate where a surrogate is available for consultation.

Individual examples of digital surrogacy include facsimiles created for Charters of the Royal Infirmary of Edinburgh (RIE) and the Royal Edinburgh Hospital. These have been used for open display and reproduced in poster format providing background to the hospitals' histories. More on these in the coming weeks!

Digital surrogates have also been produced on a series level, for example, RIE and Associated Hospitals case notes held in microfilm copy only. In this instance, the digital surrogate is used for access, and an additional preservation microfilm is produced at the same time to secure the long-term preservation of the informational content of these records. This work is detailed in the case study below.

Case study: NHS hospital records microfilms

Background

During the 1960s and 1970s, NHS hospital records committees, chaired by senior doctors, frequently chose to microfilm series of case notes rather than retaining the originals, which were subsequently destroyed. A number of these microfilms have been accessioned and due to the poor film quality of the originals are at risk of deterioration.  

Treatment

Work was carried out over the period 2000-2007. After a careful search of services offered and cost comparisons, Transmedia Technology Limited (TMT), a Swansea-based company, was selected to carry out the work. Original microfilms were transferred to and from TMT by courier. The original microfilm was washed and the spool replaced. A microfilm copy was produced and the film scanned at 300dpi, with the images saved as multiple TIFs. A master and a copy version of these images were saved to CD. The images were scanned by TMT using PixEdit software. On return, the image quality and the labelling of the copies were assessed and, once deemed satisfactory, TMT was instructed to remove all copies from their systems. All work was fully documented.

Master copies of the original microfilm and the CDs are boxed and stored in The University of Edinburgh Main Library. Microfilm and CD copies have been boxed and stored off-site.

Conclusion

Through services purchased from TMT, the original microfilm series has been preserved and surrogates produced to aid future access. Treatment of the remainder of the collection of case notes in microfilm version only is ongoing, as is an appraisal of LHSA’s digital assets and provision of a trusted digital repository.

 

Production of Substitutes

Substitution is undertaken only if the item is at serious risk of deterioration. This is determined when it is past the point at which the informational content is accessible and/or the material nature of the item poses risk to health and safety or the long-term preservation of other collection items. All other options are explored first, and the decision to substitute is carefully taken with a full understanding of the implications. LHSA demands the highest quality of production of the substitute to recognised standards, and acknowledges that the format chosen for the substitute may have an impact on its longevity.

 

Extensive documentation is undertaken to record the substitution and, wherever possible, an example of the item in its original format is stored safely to act as a reference sample to accompany the substitute.

 

LHSA has used substitution to address the risks associated with cellulose nitrate and poor condition cellulose acetate x-radiographs in the collections.

 

Case study: Digitisation of the x-ray collection

Background

LHSA collections include c.20,000 x-rays originally on cellulose acetate, cellulose nitrate and polyester film base. They relate to hospitals in the Lothian region and a series of patient case notes held. Serious concerns regarding the x-rays in their original format were identified, including low potential usage due to limited available cataloguing, the inappropriate and inefficient current storage system, and the degraded – and, in the case of nitrate film, flammable – nature. The condition of the film-based x-rays also posed health and safety risks to the staff and the potential to accelerate deterioration of paper-based collections held in the same storage area.

 

Cold storage for the whole x-ray collection was not a realistic and sustainable long-term solution for the volume and condition of the x-rays held and the decision to digitise and dispose as appropriate was carefully taken. A small collection of x-rays (relating to the Dott case notes) to serve as a reference sample, and any x-rays too fragile to undergo the digitisation process have been preserved in cold storage.

 

Treatment

Liaison with Transmedia Technology Limited, who had previously digitised LHSA’s historic microfilm, determined the scanning parameters. Professor Jonathan Best, Radiologist, acted as a consultant to ensure that no medical information was lost in the digital version. The x-rays have been scanned at 300dpi, 16-bit and saved as TIFs on master and copy DVDs. Work to accompany digitisation included assigning a unique ‘X’ number to the x-rays for a given patient, packaging and labelling the x-rays for transit and scanning, compiling an Excel spreadsheet to enable future access to the collection, and a comprehensive quality control check of the substitutes produced.

 

Conclusion

The work to digitise the x-ray collection was an ambitious project, which, through successful execution, has met the preservation needs of both the x-rays and the paper-based collection items in the Archive. Investigation into means to promote use and the need for any future migration of data to ensure long-term accessibility to LHSA’s digital assets is ongoing and led by the LHSA Archivist.

Tales from the Archive (4): Treatments for Tuberculosis - The Edinburgh Scheme

Tuberculosis (TB) is a highly contagious disease, usually affecting the lungs but which can attack other parts of the body. It is spread through the air by coughing, sneezing or spitting (expectorating). The world’s first TB dispensary was opened at Bank Street, just off the Royal Mile, Edinburgh by Dr Robert Philip in 1887. It was the central point of what was to become known as the ‘Edinburgh Scheme’ for tackling the prevention, detection and treatment of TB.

Prevention and Detection

There was no known cure for TB at the start of the twentieth century and efforts were instead focused on its detection and prevention. In Philip’s address to the Edinburgh Sanitary Society in 1906, he noted that there were 400 deaths per annum attributed to TB in Edinburgh. Despite this, voluntary notification of the disease had only begun in 1903, and would only become a compulsory measure shortly after his speech. Philip advocated notification of the disease as a key measure in tackling its spread.

B/W photo of teacher and blackboard and children seated outside, Royal Victoria Hospital (P/PL41/TB/028).

B/W photo of covered shelter and female patients (P/PL41/TB/040).

The Victoria Dispensary was designed to operate as a ‘uniting point of all agencies’. Located within reach of all who might need it, it became a place of notification and the first point of contact with medical practitioners who could offer advice and treatment. A visiting nurse was sent to each affected home to provide care in situ. Whilst at the home, the nurse could identify others who might well also be infected and arrange for them to receive treatment.

Advice was given on how to prevent the spread of the disease with detailed instructions on where and where not to expectorate and rules on how to clean a consumptive’s room. Given the living conditions of the time, it is hard to imagine that affected households would have been able to adhere to these conditions.

 Rules for consumptive patients and those looking after them, Royal Victoria Hospital (P/PL41/TB/044).

Continuation of rules for tuberculosis patients, Royal Victoria Hospital (P/PL41/TB/045).

Treatment

After presenting themselves at the Dispensary, the patients were classified according to ‘The Edinburgh Scheme’ into three categories: advanced cases, early onset, and cured patients who required further rest to avoid a recurrence of the disease.  Advanced cases were sent to a hospital. In 1906, 50 beds had been made available at the City Hospital for these patients where they could be treated in a sanitary environment. Their removal to a hospital was designed to help prevent the spread of the disease to their families with whom they would often share very cramped living conditions.

Lantern slide explaining anti-tuberculosis measures used in Edinburgh from the end of the 19th century. Taken from The Public Aspects of the Prevention of Consumption by R.W. Philip 1906 (P/PL41/TB/002).

Early onset cases were sent to a sanatorium, such as the Royal Victoria Hospital (originally the Victoria Hospital for Consumption) which was opened in 1894, where they could rest and, in being exposed to lots of sunlight and fresh air, arrest the development of the disease. The three outside walls of the sanatorium consisted largely of windows for this purpose. There were shelters in the grounds where people could spend the day, or for those out-patients, who needed to work during the day, could be occupied at night.

The third part of the scheme, the colonies, were designed to provide work in an environment where recovering and cured TB patients could improve their health. Often, this was not possible in the home environment in which the patient had contracted the disease in the first place. Polton Farm Colony was opened in Midlothian 1910 and patients here could partake in work such as rearing crops and tending to farm animals.

Effects of the Scheme

The death rate from TB in Edinburgh showed a steep decline from 1899 onwards. By 1910 the rate was 1.07 per 1,000, down from 1.9 per 1,000 in 1887 when Dr Robert Philip opened the first dispensary. In 1920, when the full scheme had been in operation for 10 years, the rate had reduced to 0.8 per 1,000. Despite the success of the Scheme in reducing the number of deaths, the Medical Officer for Health, A. Maxwell Williamson, commented that without any way of curing the disease, efforts should remain focused on prevention.

 

TB Today

Today TB still exists in Britain. According to Scotland’s Department of Health, there are 400 cases per year or a prevalence rate of 7.9 per 100,000 people.  An Action Group to combat it was created in 2009. Although there are now effective antibiotics available to treat TB, the advice given by the UK Department of Health remains similar to that advocated by Dr Robert Philip over 100 years ago: “The most important part of controlling TB is identifying and treating those who already have the disease, to shorten their infection and to stop it being passed on to others”.