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”.

Spotlight On… (5): Letters from the Royal Infirmary of Edinburgh

At the turn of the twentieth century, the Royal Infirmary of Edinburgh had an indisputable reputation as a leading medical institution. Medical students travelled to Edinburgh in order to undertake their studies under the supervision of pioneering practitioners. However, students will always be students regardless of the period and there was always time for mischief and gossip. These two letters are an excellent example of the student experience at the time: confetti, Saturday night fever, and guinea pigs. As a bonus track, we bring you some really stylish photographs of RIE Residents.

Letter by Eva Lyon, medical student Royal Infirmary, c.1904

Below is a letter sent by Eva Lyon to her cousin Florrie probably in 1904. Lyon studied English and Latin in 1903, going on to undertake a medical course at the Royal Infirmary the following year. She vividly describes her life as a student, particularly the hazards of weekend work in the outpatient department.

These items were gifted to the archive by the cousin's daughter (LHSA ref: GD1/132).

She writes: 'Whenever a case comes in to be dressed a bell rings and we go to do it. On a Saturday night we always get a lot of cases especially after the public houses close'.

She goes on to add that a lot of the patients were the worse for drink, but this had its advantages: 'I was most pleased with my handiwork...as the man was drunk he didn't feel any pain during the proceedings'.

These items were gifted to the archive by the cousin's daughter.

Letter to the President of the Royal Infirmary of Edinburgh Residents' Mess, March 1922

This letter was written by Willam Caw, the Deputy Superintendent of the Royal Infirmary of Edinburgh, to the President of the Residents' Mess on 27th March 1922. In it, he asks for an explanation of some rather mischievous behaviour!

LHB1 Admin Files, Box 1, 1919.

The residents of the Royal Infirmary of Edinburgh were medical graduates serving practical apprenticeships as House Officers. The residents lived within the Infirmary building at Lauriston Place in the Residency, each new intake forming a separate 'Mess'. The residents were bound by two sets of rules: one drawn up by the Board of managers; the other drawn up by themselves, and which governed the running of their Mess.

Unfortunately, we don't have a copy of the President's response!

100 Years of the Royal Infirmary of Edinburgh Residents

The residents of the Royal Infirmary of Edinburgh were medical graduates serving practical apprenticeships as House Officers. Before 1950, a resident usually served for 6 months, and up until 1948, the position was unsalaried. The residents lived within the Infirmary building at Lauriston Place in the Residency, each new intake forming a separate 'Mess'. The residents were bound by two sets of rules: one drawn up by the Board of managers; the other drawn up by themselves, and which governed the running of their Mess.

Royal Infirmary of Edinburgh Residents, Winter 1865-1866.

Royal Infirmary of Edinburgh Residents, Winter 1875-1876.

Each intake of residents were photographed as a group and LHSA holds an almost complete run of residents' group photos from the 1850s to the 1960s. The photographs are mounted on card and in most cases feature the signatures of each resident.

Royal Infirmary of Edinburgh Residents, Winter 1895-1896.

Royal Infirmary of Edinburgh Residents, Winter 1905-1906.

The photographs shown below span 100 years, starting with the Winter 1865-1866 group.  The collection as a whole is fascinating to look at, not only for finding famous individuals or ancestors; but for charting changing styles of dress and appearance, spotting the appearance of women from the 1940s onwards (although the first female resident was appointed in 1920), men in service uniform during the war years, and the odd residency pet!

Royal Infirmary of Edinburgh Residents, Winter 1935-1936.

Tom Baker visits the Royal Edinburgh Hospital for Sick Children

Stephen Willis, Archive & Library Assistant at the Centre for Research Collections, writes about Tom Baker’s visit to the Royal Edinburgh Hospital for Sick Children.

LHSA holds two photographs accessioned in 2011 showing the actor Tom Baker, who played the Doctor in the BBC science fiction series, Doctor Who, posing with nurses from the Royal Edinburgh Hospital for Sick Children when he did a publicity visit in approximately 1977. In both images, the nurses are together holding his twenty-foot long scarf, which was a trademark of Baker's costume. 

Although public hospitals in Scotland have been funded through the NHS since 1948, they have still often looked for additional funding streams to augment this and have used publicity to increase awareness and remind potential donors that they still need help, which may be why this image was taken.

Tom Baker and a group of nurses hold the actors twenty-feet-long scarf.

 

Doctor Who (1963-1989, revived in 2005) is a famous British science fiction series about a humanoid alien, known only as the Doctor, who travels through time and space in a craft which resembles a police box. The series is known for periodically changing its leading actor, where he ‘regenerates’ into a new persona if he becomes old or suffers a severe trauma. Tom Baker was the fourth actor to play the Doctor on television and starred from 1974 to 1981.

Tom Baker was born in 1934 in Liverpool to an Irish Catholic family. He joined a monastic order between the ages of 15 and 21, but soon after he decided to become an actor. He appeared on stage and screen in a number of roles in the 1960s and 1970s, most notably an acclaimed performance as Rasputin in the 1971 film, Nicholas and Alexandra. However, his acting work had dried up and he was working on a building site to earn money in 1974 when he was offered the lead part in Doctor Who. His performance, which mixed offbeat eccentricity and humour with deadly seriousness, is often cited as one of the best of those actors to have played the role. During the 1970s, the series gained high levels of popularity with children and adults and was regularly seen by audiences of 11 to 12 million viewers in Britain. Therefore, at the time of the Sick Kids Hospital visit, Tom Baker was a celebrity who attracted a huge amount of media interest.

Tom Baker is known to have visited many places and events during the period he played the Doctor, such as Derry Christmas illuminations in 1978, both as a means of publicising the event and giving publicity to Doctor Who for the BBC. The character of the Doctor was immensely popular with children, so a visit to children in hospital would have been very exciting for the patients and provided a welcome distraction.

Tom Baker and a group of nurses pose at the Royal Edinburgh Hospital for Sick Children.

 

According to a 2002 interview between Scottish actor, Russell Hunter and the Edinburgh and Lothians Doctor Who Group, Edinburgh Evening News had asked Russell if he could think of any stars who might visit a hospital to raise its profile and he suggested Tom Baker. To their surprise, he did it. Hunter appeared in Doctor Who: The Robots of Death with Tom Baker, broadcast in January and February 1977, so the photographs are assumed to have been taken shortly after this. LHSA also has photographs of Russell Hunter planting a tree at Liberton Hospital.

In a 2014 interview with the Radio Times, the then star of Doctor Who, Peter Capaldi, cited a photograph of Tom Baker ‘…larking about with nurses during a visit to the Royal Edinburgh Hospital for Sick Children…’ as one of the images which reminded him of his responsibility in the role, presumably referring to one of these LHSA photographs.

These photographs are amongst a number in LHSA’s collections which feature well-known figures visiting Edinburgh hospitals. One of the earliest photographs of a celebrity we hold is that of Sir Harry Lauder, the music hall comedian visiting Bangour General Hospital in 1942.

Conservation (3): Bound Volumes and Architectural Plans

LHSA collections encompass a wide array of items that require specialised conditioning and conservation treatment: volumes of all sorts, loose leaf material, and objects... not to mention all our multimedia collections. In this blog, we shed light on the treatment of bounded volumes and architectural plans, with a focus on the conservation of David Bryce's plans detailing the rebuilding of the Royal Infirmary of Edinburgh in 1729.

Examples of bound volumes in LHSA collections range from published books to annual reports, patient registers and ward journals. The 1999-2000 National Preservation Office Preservation Assessment Survey indicated that the bound volumes were in particularly poor condition. The damage sustained included degradation of and/or abrasion to the leather cover, warping or detaching of the boards and spine, mould damage and/or disintegration of the textblock (the pages). Damage may affect one or two volumes or all of a given series. Even where deterioration is relatively limited, for example, partial degradation of a leather binding, access can be problematic without causing further damage or transfer of dirt. In extreme cases, the damage may restrict access to the informational content of the volume.

Volumes have been prioritised for treatment according to condition, importance, and current and anticipated usage. Although work is largely undertaken by a commercial company specialising in the re-binding of books, extensive preparation and subsequent quality checking on completion is required in-house. All work is documented and carried out to the highest standards demanded by the LHSA Preservation and Conservation Policy. 

Wherever the condition of the item and the available funding allow, treatment ensures that damage to the textblock is addressed and as much of the original binding is repaired and retained as possible. For example, tears to the textblock were repaired, the spine was re-attached and the damaged corners consolidated for Volume 1 of the Physician’s Record dating from 1849-50.

Royal Edinburgh Hospital Physicians Record, Vol 1: before and after re-binding (LHB7/50/1).

Where the quantity of volumes to be treated is coupled with limited funds, treatment concentrates on repair to the textblock and replacement of the original case (i.e. front and back boards and spine). As much of the original binding is retained as possible by transferring endpapers, original labels and title pieces to the new binding. The composition of the new case is carefully selected to reflect something of the character of the original, or to visually replicate the appearance of volumes in similar or related series within LHSA collections. A sample of the original case is retained for reference. Examples of this treatment approach include the General Registers of Patients of the Royal infirmary of Edinburgh and the Royal Edinburgh Hospital (REH), and the Royal Maternity Hospital Register of Births.

Royal Infirmary of Edinburgh General Register of Patients: before and after re-binding.

Treated volumes are provided with boxes wherever possible, for example, the REH press cuttings books. The press cuttings themselves were repaired and re-bound and a cloth-covered solander box produced for storage.

Royal Edinburgh Hospital Press Cuttings Volumes: before and after re-binding, and boxed.

A significant amount of re-binding and repair work has been carried out on important bound LHSA collections. This work has meant that these items continue to be accessible for research and have been stabilised in order to secure their long-term preservation. A considerable number of volumes in the collection continue to require treatment however, and a comprehensive list has been compiled of all damaged bound volumes held in order to direct further re-binding work.

Similarly, LHSA has a large collection of architectural plans, many of which are in poor condition and improperly housed. Conservation work is ongoing and plans from LHB7, LHB44 and GD16 have been treated to date. In addition, an important series of LHB1 plans from the office of David Bryce, which date from 1872 to 1877 and detail the re-building of the Royal Infirmary of Edinburgh (RIE) in 1729, have undergone conservation treatment. These serve as a case study to illustrate the type of conservation work carried out on architectural plans in the collections.

Case study: Background

The Bryce plans were originally housed in the RIE Architect's Office. Some of the drawings were dispersed during a period of planned re-building of the Lauriston Place site during the 1960s, finding their way eventually to the National Monuments Record (Scotland). In 2001, they were reunited with others that had been transferred from the RIE to LHSA. Despite the impressive number of plans that have survived (72), it is also clear that others still remain unaccounted for. Given their cultural value, the plans held by LHSA were made a high conservation priority.

Case study: Condition

The plans are on good quality drawing paper and have been executed with black ink and coloured wash. Pencil annotations can be found, as well as various signatures and other ink inscriptions. Drawn overlaps are occasionally found attached.  Previous inappropriate handling and storage had resulted in heavy surface dirt and extensive physical damage such as creases, tears and losses, and clumsy local repairs were often present. Although the cloth backing to many of the plans had provided protection, the fact that they had been stored tightly rolled meant that accessing the plans without causing further damage was extremely difficult.

Tears and Creasing: before and after treatment.

Case study: Treatment

Treatment was undertaken by the LHSA Paper Conservator in 2000-2001 and included surface cleaning using a chemical sponge and eraser, and removal of previous repairs. This was done mechanically where possible, and steam or acetone applied only when necessary. Tears/losses were repaired/infilled using wheat starch paste and Japanese paper. The plans were then humidified and pressed and stored in custom-made Melinex® (inert polyester) sleeves. Photographic and written documentation of the treatment was also produced. Good quality plan chests were purchased to safely store the treated plans.

Humidification and Pressing: before and after treatment.

36 of the plans were then digitised as part of The Drawn Evidence project, funded by the Research Support Libraries Programme and led by Dundee University Archive Service. Its aim was to provide a representative sample of Scottish architectural plans, drawings and associated material accessible in digital format via the project website.

Conclusion

The level of conservation treatment undertaken on architectural plans is kept to the minimum necessary in order to enable the plans to be stored and accessed safely and effectively, and is carefully executed in line with guidelines on professional best practice. Work now continues with the other plans in the collections.

Spotlight On… (4): Dr Elizabeth Robertson, Consultant Physician, Royal Edinburgh Hospital

The Royal Edinburgh Hospital (REH) celebrated the 200th anniversary of its first patient intake in 2013. In readiness for this, LHSA staff were busy working on the remaining uncatalogued records it holds relating to this famous hospital. Amongst these are the correspondence and personal papers of Dr Elizabeth Robertson, who was appointed Assistant Physician in 1947.

Dr Robertson had a particular interest in Pick’s Disease, a disease with similar symptoms to Alzheimer’s which at the time could only be accurately diagnosed post mortem.  Her papers include a number of case studies of patients with the disease at the REH and drafts of articles she wrote on the subject.

Her personal correspondence gives more insight into her personality. She subscribed to the Edinburgh University Tea Club, for example. She also made an appointment at Antoine’s, a hairdressers in London, on the recommendation of a local Conservative Party candidate!

A letter to confirm Dr Robertson's lectures on psychiatry to student nurses, 1955 (LHB7/56/2).

A signed article by Dr Robertson that she wrote with Dr Karagulla, 1955 (LHB7/56/2).

She retired in 1970 and died in 1985, leaving a substantial bequest to the University of Edinburgh. This was to be used for additional library purchases in neurology and psychiatry and was in memory of her late father, Donald Robertson.

Tales from the Archive (3): Women and the Royal Infirmary of Edinburgh, 1870-1950

This was a period of huge change in medicine, and with the opening of the then brand new building at Lauriston Place in 1879, the Royal Infirmary of Edinburgh (RIE) was at the forefront of healthcare in Edinburgh. At this time, not one but two revolutions were underway for women associated with the Infirmary: radical changes to nursing and the challenge for women to receive medical training.

Nurses

Florence Nightingale’s Training School for Nurses at St Thomas’ Hospital in London was opened in 1860. This introduced a greater degree of professionalism to nursing, turning it into a career for educated women. There was a movement to formalise procedures and create high standards for all nurses to attain. Taking note of these changes, the managers of the RIE instituted a probationary period of training and a higher wage to attract “a better class of woman” to the profession. A Lady Superintendent of Nurses, Elizabeth Barclay, was appointed in 1872, and the RIE Nurse Training School was founded in the same year. The School gained an excellent training reputation, and RIE-trained nurses went on to take up positions all over the world.

Angelique Lucille Pringle, Lady superintendent of nurses, with a group of senior nursing staff ( Miss Ferguson; Miss Grant; Miss Reith; Miss FE Spencer; Miss Wade) at the Royal Infirmary of Edinburgh, c.1880 (P/PL1/S/257).

 

Female Medical Students

Whilst these changes in nursing were taking place, another set of women were fighting hard to overcome institutional barriers. Female medical students, led by Sophia Jex Blake, recently given permission to receive a medical education at the University of Edinburgh in 1869, were effectively prevented from completing their training when the RIE refused to allow women the clinical instruction necessary for qualification. Whilst a wider public debate raged on the issue, Peter Bell, clerk to the managers, sent a letter to all medical and surgical staff asking whether they were in favour of admitting female students on the same terms, and at the same times, as male students. Of the 19 responses we hold in the Archive, only three were in favour. William Walker’s letter typifies the response of the majority; not only did he think that examination by a mixed class of students would be “repugnant to patients” but also that “many examinations and operations are offensive in nature and could not be undertaken before a mixed class without violating the feelings of propriety and decorum”. Despite this, in December 1872, the Board passed a motion to allow female matriculated students of the University to receive clinical instruction but at a separate hour to the male students and only in certain wards. They were not permitted to view post-mortems, to see major surgical operations, nor to act as clerks and dressers.

William Walker’s letter (page 2) (LHB1/73/1/7).

 

Female Medical Graduates

This did not deter an increasing number of women from gaining medical degrees. Over time, female medical students achieved more concessions and larger numbers of women began to apply to study medicine. During the First World War, there was a sizeable increase in the numbers of women matriculating as medical students, rising from 106 (versus 962 men) in 1914-15, to 373 (versus 1,310 men) in 1918-19. Provision was made at this time to, as far as possible, allow instruction on the same basis as men. Medical and surgical staff were depleted, some on foreign service and those at home were overworked, often doing extra work in the war hospitals that had sprung up in the city. It was not until 1927, however, that female medical students were able to obtain clinical instruction on medical wards in mixed classes. And it would be a further nine years before the same was true of the surgical wards.  Differences were highlighted in not so subtle ways as the syllabus booklets below show.

 

Syllabus for the use of Male Students attending the Royal Infirmary of Edinburgh, summer term 1925 (LHB1/113/1/1).

Syllabus for the use of Female Students attending the Royal Infirmary of Edinburgh, summer term 1925 (LHB1/113/1/2).

 

Residency at the RIE

As well as being able to receive clinical instruction and graduate in medicine, women wanted the right to apply for residency at the RIE. After graduation, a medical student had to serve a practical apprenticeship. To do this, he or she had to obtain an approved appointment as a resident House Officer in a hospital. Residencies at the RIE were considered to be prestigious, although before 1948 the position was unsalaried. The usual period of service was six months, rising to 12 months in 1950, six of which were spent attached to medical wards, and six to surgical wards. Although female residents were admitted from the 1920s, they were not permitted to live in the Residency itself. In the 1940s, this led to another fight for the female residents to be allowed to live in the Residency ‘mess’ (the residents lived within the Infirmary building in the Residency, each new intake forming a separate ‘mess’). The Residency contained a sitting room and a dining room as well as bedrooms. Food was supplied from the Hospital kitchens. A letter from 1945, written by the mess secretary, shows that a proposal to allow women to live in the mess was not very popular. In fact, they viewed it “with much concern and annoyance”. Women did eventually win the right but were allowed access to only one bathroom upstairs and were not permitted to attend the two annual formal dinners!

It’s easy to take for granted the standards of service we have in nursing today, and the equality of opportunity for men and women to obtain medical training. This has not always been the case and we owe a debt of gratitude to those first women who paved the way and challenged societal norms.