Friday, 27 May 2016

Clubbed fingers, long eyelashes, and a subaverage condition: unusual markers of tuberculosis in the Royal Victoria Dispensary case notes


This week, Rebecca takes a look at the Royal Victoria Dispensary case notes, exploring the wealth of information collected from each patient before they were clinically examined.

Diagram of the Edinburgh Scheme, showing the central role of the dispensary.
(LHSA Slide Collection)
 
I’m currently working on a series of case notes from the Royal Victoria Dispensary, the outpatient clinic which acted as the first point of contact for people suspected of having tuberculosis in Edinburgh. The dispensary, based on Spittal Street with an additional clinic in Leith, saw thousands of people each year.

The former dispensary on Spittal Street, Edinburgh
(screenshot from Google Street View ©2014 Google)
Being referred to the dispensary was not a sign that someone had tuberculosis, rather it was a way for likely cases to be examined and a diagnosis of tuberculosis eliminated. Patients would be referred for a number of reasons: they may have lived with or been related to a notified case of tuberculosis; their GP or School Medical Officer may have referred them based on their symptoms; they may have been sent for a ‘large film’, a more detailed X-ray to check on any abnormalities detected during mass radiography; or they might require examination before entering certain professions. For example, all apprentices in the printing trade would be screened, as it was an industry with a high mortality rate from tuberculosis, attributed to crowded working conditions. Others requested to go in for an ‘overhaul’, usually due to nervousness that they had the condition.

When they arrived, the patient would be quizzed on a variety of factors which would give a general background to their health and lifestyle. But what exactly was it that was being looked for?

Case note, for a symptomless contact of TB, showing the standard checks performed at the RVD
(LHB41 CC/2/PR2.5695)

Firstly, a patient would be questioned on the presence of key symptoms including coughs and sputum, dyspnoea (breathlessness), and haemoptysis (coughing up blood). Temperature, pulse, and weight gain or loss would also be recorded - not for nothing was TB also known as ‘consumption’, as dramatic weight loss would often accompany the condition. Other symptoms such as night sweats or the presence of finger clubbing, associated with severe pulmonary tuberculosis, would also be recorded.

Pulmonary tuberculosis can often be present without visible symptoms, so factors such as the size of the patients’ family and any family history of tuberculosis were also recorded. Tuberculosis spreads following prolonged close proximity to sufferers, so a close relationship with a sufferer was worth investigating. The patient’s occupation would also be noted, in order to ascertain if they worked in a dusty occupation or a physically taxing position. This information was also a valuable indicator of poverty and poor living conditions, which were associated with tuberculosis and which a doctor would have borne in mind when recommending treatments.

Case note from 1949, includes a record of the smoking habits of the patient -
note that this is not pre-printed on the form.
(LHB41 CC/2/PR2.5704)

From the 1940s onwards, case notes also note how many cigarettes a patient smoked per day, which is interesting considering the relationship between smoking and lung cancer was first proposed, and not immediately accepted, around 1950. Smokers who were found to have some lung symptoms were usually told to stop or curtail their smoking, which goes against the impression that many people now have of the popular and clinical attitudes towards tobacco consumption at the time.
A final note on the patient’s general condition (‘subaverage’, ‘satisfactory’, etc.) would also be made. A few case notes refer to ‘long eyelashes’, referring to an earlier idea of two forms of tuberculous patient; the beautiful, delicate consumptive, with long eyelashes and fair complexion, and the other with “coarse, thick features” and a sallow complexion. If a patient was perceived to live in poor conditions, to be malnourished, or to have an unsatisfactory personality, this would often be recorded as well.

Note on a patient's general condition: "GC Fair only. but not bad for age"
(LHB41 CC/2/PR2.5717)
All of this information would be recorded before a patient even got so far as a clinical examination or an X-ray, and it is not clear from the case notes if this part of the examination was carried out by a doctor or not. But it was important for all of this to be recorded, and it is obvious from the case notes that this information was a useful aide in determining if a patient was suffering from pulmonary tuberculosis. As well as this, these case notes also provide a fascinating insight into the work and habits of tens of thousands of Edinburgh residents in the post-war period.


Sources:
LHB41 CC/2/PR2

Cairns, Margaret; Stewart, Alice, ‘Pulmonary Tuberculosis Mortality in the Printing and Shoe-making Trades. Historical Survey, 1881-1931.’, Brit. J. Preventive & Social Med., 5 (2), (Apr 1951), pp. 73-82 http://www.cabdirect.org/abstracts/19512703370.html;jsessionid=53F6E61EACAA51F66F6650F988C4EE89?freeview=true

Imray, Keith, A popular cyclopedia of modern domestic medicine : comprising every recent improvement in medical knowledge : with a plain account of the medicines in common use, (1849), available at: https://archive.org/stream/63580420R.nlm.nih.gov/63580420R
Macfarlane JT, Ibrahim M, Tor-Agbidye S., ‘The importance of finger clubbing in pulmonary tuberculosis.’, Tubercle, 60 (1), (Mar 1979), pp. 45-48.

Ruddock, E. H., The diseases of infants and children and their homœopathic and general treatment, (1899), available at  https://archive.org/details/b28134825

Woodcock, H de Carle, ‘Adolescent and other forms of tubercle’, Tubercle¸5, 2, Nov 1923, pp.64-69 http://www.sciencedirect.com/science/article/pii/S0041387923800939
‘Smoking and cancer of the lung: minister’s press release and statement in House of Commons’, Tubercle, 35, 3, (Mar 1954), pp.70-72) http://www.sciencedirect.com/science/article/pii/S004138795480047X

Friday, 20 May 2016

An example of obsolete treatment in the Norman Dott Case Notes (1920-1960): lobotomy.

     The Norman Dott case notes are an invaluable source for the history of neurosurgery. They contain many examples of pioneering medical techniques, but also of treatments and diagnoses which are now obsolete. One of the most striking examples is the psychosurgical procedure on the frontal lobe better known under the name ‘lobotomy’. Nowadays, this word evokes a botched, barbaric practice that trampled the rights of patients and stripped them of their individual and humane qualities. However in the 40s and 50s, this operation was regarded as a way to relieve some patients of their sufferings when all the other treatments had failed.

     In Britain, where the term ‘leucotomy’ was used rather than the American word ‘lobotomy’, the first operations were carried out at the Burden Neurological Institute in Bristol in 1940, at the instigation of Frederick Golla, Effie Hutton and F. Wilfred Willway. The use of the procedure peaked in the late 1940s and early 1950s, with nearly 1500 operations a year. However, the poor results of the operation, the harmful consequences observed in patients, and the progressive introduction of psychiatric drugs led to a sharp decline of the practice by the end of the 1950s. The vast majority of the case notes I have been working on as the cataloguing archivist of the Norman Dott project date from this period; and indeed, out of the 2500 case notes I have catalogued so far, less than twenty mention a leucotomy. However, these cases greatly help to understand in what context it was used and on what kind of patient, and for which results.

     The vast majority of patients who underwent a leucotomy in the Norman Dott case notes at the end of the 1950s were women, aged from 24 to 73 years old. They were usually suffering from various mental illnesses described in the case notes as: ‘hebephrenic schizophrenia’, ‘catatonic schizophrenia’, ‘chronic depression’, ‘agitated depression’; or more precisely: ‘long-standing and deep seated neurotic illness in an inadequate personality’, ‘recurrent depression with maniac depressive personality’.

     Doctors were well aware that leucotomies were not a ‘miracle solution’, far from it. They knew that recovery was not guaranteed and that it could change the patient’s personality and make them less socially apt; however the alternative was judged worse and the goal was to dull the symptoms of psychiatric illness to enable the patient to lead a more peaceful life or at least to make him or her easier to nurse. This sentiment is expressed by two doctors considering a leucotomy at the Royal Infirmary for their patients: ‘I think that leucotomy would relieve his suffering and might make it possible for him to make some sort of adjustment outside hospital’; ‘[I feel] that a leucotomy would allow of a modified social recovery enabling [the patient] to lead a fairly normal life though leaving her rather ineffectual and needing guidance in her day to day activities’.

 
Excerpt from a case note relating to a female patient suffering from chronic depression, 1959. LHB1 CC24 PR2.20898.

     One must keep in mind that the procedure was only used as a last resort. The patient had to be in a deeply disturbed state which would make living in these conditions unbearable. Again quoting from Norman Dott case notes, it is said that one patient ‘was inaccessible and auditorily hallucinated. There was considerable volitional retardation and she was monosyllabic’. For another patient, ‘operation was especially commended because of intractable noisy perseveration; the word “money” occurring endlessly’. Moreover, leucotomies were only performed when all other treatments had failed: in the case note PR2.20920, it is said that ‘ECT has only produced temporary improvement and tranquillizers have not been effective’, in the case note PR2.20698, the doctors who examined the patient agreed that ‘he should have a leucotomy carried out in view of the prolonged period of unsuccessful conservative treatment’. At the time, other treatments included electroconvulsive therapy (ECT), tranquilizers, and modified insulin injections, also known as insulin coma therapy (ICT).

The following extract from a case note describes a leucotomy performed in 1959 on a patient suffering from ‘agitated depression’ at Ward 20 of the Royal Infirmary of Edinburgh. Essentially, the surgeon would drill a pair of burr holes into the skull in order to insert a sharp instrument called a leucotome into the brain, that he would then sweep from side to side to separate the frontal lobes from the rest of the brain.

Operation notes describing a leucotomy, 1959. LHB1 CC24 PR2.20920

     From what we can gather, the outcomes of the leucotomies carried out in the Norman Dott case notes were very mixed. Only one patient seemed to do better: ‘in the few days after the operation and prior to her return to Bangour, [the patient] certainly appeared more relaxed, approachable and less disinclined to talk’. However most of the time the results were more disappointing: ‘little change was noted after operation’; ‘however, [in the following days], there was some suggestion of her being less accessible’; ‘in the first post-operative days [the patient] was confused and towards the end of the first week still disorientated in time; somnolent and incontinent of urine and faeces. He recognised his surroundings; knew that he had been operated on and why. There was no appreciable change in his mood’ and he ‘still appear[ed] to be grossly preoccupied and depressed’. Unfortunately, the case notes only mention the days immediately following the operation so we have no way of knowing how the situation evolved for these patients on the long term, but from other leucotomy cases, we know that it was not uncommon for patients to be crippled for life or to live in a vegetative state.

     The use of leucotomy has been criticized from the very beginning for the risks it posed for the patients and for its very limited and often unpredictable results, although it was performed in situations in which the doctors thought that the benefits would outweigh the risks. The cases we find in the Norman Dott collection, although few in number, enable us to understand the context of this operation, and what the reasoning behind its use was. The study of medical failures and outdated treatments is essential to understand the evolution of neurosurgery.

Sources:

History of psychosurgery in the United Kingdom [online]. Wikipedia. Available from: https://en.wikipedia.org/wiki/History_of_psychosurgery_in_the_United_Kingdom [Accessed 19/05/2016].

Levinson, H. (2011), The strange and curious history of lobotomy [online]. BBC News magazine. Available from: http://www.bbc.co.uk/news/magazine-15629160 [Accessed 19/05/2016].

Friday, 13 May 2016

Happy 200th Birthday to the stethoscope!

When you picture a doctor in your mind, what do they look like? Are they wearing a long white coat? Carrying a clipboard? Chances are, draped around their neck is a stethoscope. An iconic object, the stethoscope turns 200 this year. To celebrate, Alice is looking back at the history of the stethoscope in Edinburgh… 

The stethoscope was invented in 1816 by the wonderfully-named Rene Theophile Hyacinthe Laënnec (phew!). The practice of listening to the sounds of the body as a method of diagnosis is known as auscultation, but before the stethoscope came on the scene, most diagnosis was done through observation and interviews with patients, and any attempts at auscultation required the doctor to place his ear directly onto the patient. In a world before deodorants and dental hygiene, many doctors felt that this physical contact was improper and unseemly – not to mention a bit smelly. Some even felt that a ‘good’ doctor shouldn't need to touch a patient – he should be able to diagnose by observations alone. Patients weren't too keen on physical contact either - women in particular felt that the process was invasive and degrading.

Laennec's stethoscope, c 1820.
By Science Museum London / Science and Society Picture Library -  CC BY-SA 2.0, 

Dr Laënnec's solution was simple but very, very effective. He had found himself struggling to diagnose a patient because her weight prevented him from being able to hear her heart, and immediate auscultation – the ear-to-skin approach – was out of the question because of her sex. Laënnec improvised, possibly inspired by his other life as a flautist. He rolled up a piece of paper “into a kind of cylinder and applied one end of it to the region of the heart and the other to [his] ear, and was not a little surprised… to find that [he] could thereby perceive the action of the heart in a manner much more clear”. 

While the idea of stethoscopy was well received in Britain, it took a while for the stethoscope to become the ubiquitous tool of the physicians' diagnostic arsenal that it is today. While many were keen on the instrument in theory, they didn't know how to use it in practice. The scientific art of auscultation involves a lot more than simply listening: it requires an educated ear to correctly interpret what is heard. In 1822 Dr Andrew Duncan, one of Edinburgh's early enthusiasts, tried to employ the methods he had read about, but found that "it requires attention and some adroitness to apply [the stethoscope] properly at one end to the chest of the patient, and at the other to the ear of the observer", and in the end conceded that he "had not acquired skill enough" to use it effectively.  

Dr William Cullen seems to have reached the same conclusion. In the same year as Duncan was experimenting, Cullen submitted a thesis to the Royal College of Surgeons of Edinburgh which detailed the "usefulness of the stethoscope...in a manner which suggests he had had some experience of the use of the instrument” (Nicholson, 1993:144). In order to improve his skills, Cullen travelled to Paris to study under the masterful Laënnec himself, and by 1824 Cullen was back in Edinburgh and holding his own classes on stethoscopy.

With an educated teacher to instruct them, the Edinburgh medical community embraced the stethoscope: it became a feature of their medical textbooks from 1828, and in the same year Dr N. P. Comins (a physician at the Royal Infirmary of Edinburgh) remarked proudly that the new, more flexible stethoscope that he had designed was now being used in every one of the Infirmary's thoracic cases.

A stethoscope from LHSA's Objects collection
The stethoscope had well and truly arrived, and now this humble instrument is 200 years old. In light of ever-improving non-invasive diagnostic techniques, some medical commentators have questioned whether it still has a place in modern practice, but a study published earlier this year by the European Society of Cardiology argued that “the time-honoured stethoscope, in spite of its limitations, still has potential as a patient-friendly, effective, and economical instrument in medical practice”. Whatever the future for this iconic instrument, we are pleased to celebrate 200 years of stethoscopy. Thank you, Rene Laënnec!

If you'd like to see a stethoscope like Laënnec's up close, the National Museum of Scotland will have one on display in their new Enquire Galleries later this year, so 'keep an ear out'...!
______

Sources

Nicolson, M. (1993). The introduction of percussion and stethoscopy to early nineteenth-century Edinburgh. In: W. Bynum and R. Porter, ed., Medicine and the Five Senses, Cambridge: Cambridge University Ppess, pp.134-153.

Friday, 6 May 2016

Conservation and cake!

Earlier this week Ruth attended what is now an annual get together for Scottish conservators to share ideas and news. Employing a pecha kucha approach, 18 speakers had five minutes each to talk to a room packed full of conservators representing the major nationals for library, museum, art and archive collections, as well as universities, councils and those in private practice. There were also a few aspiring conservators, with students and volunteers there too.


The Centre for Research Collections hosted the event, following in the footsteps of 2015’s host, the National Library of Scotland (NLS), and it was great to be able to welcome so many professionals with shared goals and backgrounds to talk about recent developments in our field. I spoke at last year’s event, presenting a whistle-stop tour of our internship programme for archivists and conservators, but this year I confined myself to loading up all the PowerPoints, enjoying the presentations, and tweeting using #PaperConservators.


All the presentations were well-rehearsed and interesting, but stand-out ones for me touched on some of the issues that we deal with when working to preserve the LHSA collections. Isobel Griffin from NLS talked about prioritising collections for treatment, and being clear and transparent when describing the processes conservators use and the decision-making that lies behind those objects that aren't treated as well as those that are. Mary Garner spoke about preparing collections for mass digitisation, and while we're not doing that with LHSA collections, it is an area that we need to keep up-to-date on to inform our smaller scale digitisation work. Gloria Conti from the National Records of Scotland presented a case study which captured perfectly the relationship a conservator can establish with those represented in the records we preserve - and the responsibility we have to treat the data in the records and, by extension the individuals themselves, sensitively.
A question and answer session with some of speakers


There were also a couple of papers on treating wallpaper in situ: Helen Creasy looked to the historic pinned and tacked repairs on the wallpaper she was tasked with conserving and used toned stainless steel staples to reattach flaking pieces of the paper that couldn't be held in place with conventional adhesive methods. Again, wallpaper is not something we have to deal with here, but Helen inspired me to think creatively when addressing damage to collection items to find the best solution for each case (though I don't think I'll be replicating any of the historic repairs I see on the LHSA collections - Elastoplast doesn't meet any of a conservator’s basic requirements for an appropriate and ethical repair!).


(As a little side note, it was a great to see Ryan Gibson’s presentation showcasing some recent films made by the conservation department at NLS - he very kindly credited our handling video as inspiration for their efforts! https://www.youtube.com/watch?v=56SE_5J-E50&feature=youtu.be.)

Conservation and cake don't often mix but, as there were no collection items around, some delicious home-baking kept us going through the afternoon - it turns out some of the clever conservators that attended the event are brilliant bakers too!

Friday, 29 April 2016

Medicalising Motherhood: a peek inside LHSA’s birth records

This week, Archivist Louise has been introducing LHSA’s maternity records to new audiences:

As Archivist, I’m sometimes asked to talk to organisations about the records that we have and what we do, and last week the Scottish Genealogical Society asked me to go along to give an evening lecture on birth records.

Maternity records are often confused with birth certificates, but whereas the latter are statutory records, the registers and accounts of births that we hold are very much medical ones. Our earliest records of birth date from 1825, from the Edinburgh Lying-In Institution, and we have some maternity register entries that go right up to the early 1990s. As opposed to birth certificates which give biographical detail on parent(s) and child, the records that we hold are created in the course of a mother’s treatment and care and give relatively scant biographical detail and (unless a particular factor affects pregnancy or postnatal care) do not record what happened to mothers prior to admission or to mothers and children after they left the hospital (although a forwarding address is sometimes given). This is not to say that these records hold back, though, as this detailed description of a birth attended by nurses from Elsie Inglis’ Canongate Hospice shows!
Excerpt from Records of Confinement, The Hospice, 1907 ( LHB8A/12/1).
Nevertheless, birth records have much to offer genealogical researchers, in that they can reveal certain details that the ‘official’ record leaves out – one of our enquirers found out the name and address of a child’s father from one of our 1860s’ birth registers, for example, which was not recorded elsewhere. Genealogists usually contact us following the discovery that an ancestor was born in one of our region’s hospitals after looking at statutory records, usually via ScotlandsPeople. Until the mid-1920s, that hospital is invariably the Edinburgh Royal Maternity Hospital (ERMH), later the Simpson Memorial Maternity Pavilion (SMMP). For this institution, I’d normally find a birth recorded in a Register of Births (LHB3/14), which would tell me more about the parents of the child and their background, including their native place, the age of the mother, where the parents had originally come from and where they were going to after the birth. You’ll notice that, in the image below, there’s a column for the occupation of the mother if illegitimate, and the occupation of the father if the child was legitimate.
Page from ERMH Register of Births, 1885 (LHB3/14/4)
This emphasis on legitimacy gives us a clue about the purpose of the hospital: the ERMH was originally founded in 1844 as a place where poor women could give birth in a medicalised environment. It started off in Nicolson Street, but by 1879 settled in a new building in Lauriston Place, becoming Edinburgh’s first purpose-built maternity hospital. The original rationale for the hospital meant that it treated women with few other places to go. The ‘Mother’s occupation’ column in these registers in and after this period is peppered with shop assistants, farm workers and domestic servants, for example – (usually) young working women with no option to give birth at home, as most other women did until the mid-1920s when hospital births grew in popularity in the city. The relatively high number of illegitimate births in the ERMH could also be explained by the close proximity of the Lauriston Home (later the Haig Ferguson Home), a home for unmarried women undergoing their first pregnancy, founded by Dr James Haig Ferguson in 1899.

Constitution of the Lauriston Home, 1913 (GD1/7/1)

 Although we have some administrative records from this home, no records of the pregnant women confined there have survived. The ERMH Registers of Births will tell you if a mother came from the home though, giving a clue as to her circumstances. If you’d like to read about one LHSA researcher’s discovery of the Lauriston Home’s role in her own ancestor’s past, you can read an excellent account here

The next thing that I’d look for is an account of the birth itself – which focuses on medical facts, about mother and child. In this record, an Indoor Casebook from the ERMH, you can see the names and ages of mothers, but also stages in the processes of pregnancy:


Entries from ERMH Indoor Casebook, c. 1870s (LHB3/16/1)
With a bit of research into acronyms, you can see how the child was born and the health of mother and child after the birth. An interesting point for genealogists is that previous numbers of pregnancies were recorded – hinting whether there might be further ancestors to explore. The way in which this information was written varies through the years, but the type of detail remains very similar – even now, some people who have never known facts about their birth like to look at their own register entry to see how heavy and how long they were as a newborn, for example!

Of course, as medical science progressed and years went on, the style in which births were recorded changed. In my talk, I found that this table from the front page of a 1971 admissions book for the SMMP (descendant of the ERMH at the Royal Infirmary of Edinburgh) was a sharp illustration of this:

Front page from SMMP Admissions (LHB3/12A/21).
Key information about the length of pregnancy is symbolised by letters, and medical information about mother and child codified in a key with 82 possible numbers – used in SMMP recording of births from 1955. As I progress through to our more recent records of births, they become far more ‘medicalised’ and less obviously biographical and researchers might need some extra information or help to decipher them.

Birth records differ from other patient records that we hold in their slightly more complicated access conditions. Since entries in birth registers hold information for at least two people (the mother and the child[ren], and sometimes a father), each separate individual represented there has information rights, either under the Data Protection Act (1998) if living or through NHS Scotland guidance on the health records of deceased patients. Because our closure periods on adults and children differ, researchers looking at birth records after 1915 would need to talk to me about how they can access information from them – and it may be that they can see certain details in a birth register, but not others.

As well as registers from ERMH/SMMP and the Hospice, we also hold accounts of births from the Elsie Inglis Memorial Maternity Hospital, Bruntsfield Hospital, Deaconess Hospital, the Western General Hospital and the Eastern General Hospital – although the records that we hold may not cover everyone. If an ancestor was not born at home (as most people weren’t before hospital births became the norm in the 1950s), we also might be able to help. If a midwife from an institution attended a home birth, we also have some records of these visits, such as these Outdoor Casebook entries from ERMH from the 1840s:
ERMH Outdoor Casebook (LHB3/18/1)
We also have birth notification registers, giving skeleton information on all births in the City of Edinburgh – although there are a few gaps, we have these registers covering dates from 1916 until 1962. After the Notification of Births (Extension) Act 1915, local authorities were required to record all registered births as part of a duty to care for pregnant women, mothers and children under five. These registers also can tell us about other institutions that provided care for pregnant women (such as private nursing homes), but because of the lack of affiliation of most of these homes to what was to become the NHS in 1948 (meaning that they won’t be represented in our archive holdings), we cannot usually trace any further surviving records.


I always enjoy talking to groups about LHSA. We do offer a remote enquiries service, too, though – so if you think you can use the birth records that we hold, please don’t hesitate to get in touch.

Friday, 22 April 2016

What does that mean? The challenges of case note cataloguing


This week, Rebecca looks at one of the main challenges she faces in the RVH v TB project:
Cataloguing case notes can be quite a challenging task when you don’t have a medical background. Although we are interpreting the records, and not diagnosing patients, it is still important for us to understand what we are reading so that we can record the important information in our catalogues.
Firstly, doctors’ handwriting is notoriously difficult to read! Additionally, unfamiliar terms and abbreviations are often used (e.g. ‘syncope’ instead of ‘fainting’), medical terms for body parts are not always recognisable (my new knowledge from this project has won me many a point in a pub quiz), and some of the terms used are no longer in use.
Fortunately, there are web resources that can help. A combination of palaeography skills and Google usually helps to make sense of tricky handwriting. Google is also great for finding out what unfamiliar terms mean, as well as unexpectedly showing gruesome pictures of some medical conditions; my search history paints a worrying picture. We also use MeSH (Medical Subject Headings), a hierarchically organised index of medical terminology, to provide standardised terms – MeSH usually incorporates alternative and previous terms into its definitions, which is really useful.
These tools are great for standard medical terms and abbreviations, which makes up much of the case notes that we look at. However, in the RVH v TB case notes, some non-standard symbols are used which has required some detective work from me:
Samples from case notes showing different ways of expressing 'Tuberculosis' (see below) (LHB41 CC/1 and CC/2)
 
All of these symbols mean ‘Tuberculosis’. Here’s how I know that:
1.       This classification was used at Southfield Sanatorium. In his “Address in Medicine Delivered at the Seventy-Seventh Annual Meeting of the British Medical Association” in 1909, Sir Robert William Philip advocates a system of classification of tuberculosis which uses the symbol ‘L’ to represent the lung or local lesion, with three stages of severity. The symbol ‘S’, in upper or lower case, represents the extent of systemic involvement.
2.       The next two symbols (actually the same symbol written in two ways), usually appear in place of the word “tuberculosis” in the sentences “No family history of tuberculosis” or “No PS [physical signs] of tuberculosis”, and is sometimes used to represent a diagnosis.
3.       This classification was used at the Royal Victoria Dispensary, and has been a little trickier to work out. Based on what else is happening in the case notes in which it appears, where a patient has been subsequently hospitalised or a later letter refers to them as being diagnosed with tuberculosis, it definitely means tuberculosis, and it appears to have a similar grading scale as Philip’s classification above.
4.       This is another version of the same classification scale, also used at RVD, and seems to show a diagnosis of a quiescent or less active case of tuberculosis.
5.       This is the classification used at the Royal Victoria Hospital, which is helpfully explained on the back of the discharge summary (see below).
Reverse of a discharge summary from the Royal Victoria Hospital, explaining the classification scheme (LHB41/PR2.4347)
 
Those were all relatively straightforward to work out, but these things are never too simple. The case notes from the Royal Victoria Dispensary also feature the symbols shown as a diagnosis in the examples below, which I have so far been unable to ascertain the meaning of.
Extracts from case notes, showing X-ray reports and the diagnosis given. (LHB41 CC/2)
The case notes in which they appear lack the context which has helped in other cases, and there doesn’t seem to be much consistency across the case notes which would allow me to say with confidence that this means, for example, bronchitis, though it is almost definitely a lung thing. As the image shows, it sometimes appears alongside a TB diagnosis, so it probably isn’t tuberculosis.  If you have any ideas what it might mean, I’d be really grateful to hear them!
As you can see, a medical background is not necessary in order to catalogue the case notes, though some medical knowledge can really help when it comes to understanding them, particularly when they start using obscure terminology or symbols. Fortunately, we have the resources to deal with these challenges, which means that we can create useful catalogues to help unlock these fascinating records.
Sources:
LHB41 CC/1 and CC/2
R. W. Philip, ‘Address in Medicine Delivered at the Seventy-Seventh Annual Meeting of the British Medical Association’, British Medical Journal, 2, 2535, (31 July 1909), pp. 256-263

Friday, 15 April 2016

A man of principle: a look into the life of Eric F. Dott.

Today, I would like to expand on the life of Eric F. Dott, a conscientious objector during the First World War and a children’s physician at the Royal Hospital for Sick Children in Edinburgh. Under the project ‘Cataloguing Norman Dott’s neurosurgical case notes (1920-1960)’, much has been written about his brother Norman, the pioneering neurosurgeon from Edinburgh, but Eric was a no less remarkable man. Simultaneously a Christian, a pacifist and a socialist, this well-loved paediatrician stood up for his principles all his life.

Eric Dott was born on the 3rd of December 1898 in the Dott’s family house in Colinton, at that time a small village five miles out of Edinburgh. He was a bright young man who discovered his Christian faith at an early age: when he was 11 year-old he was deeply moved by an organist practising in the church near his house, and from this moment he pushed his whole family to go to Church, thing that the Dotts weren't doing before. He stayed consistent with his Christian beliefs during one of the darkest and most proving times of the 20th century: the First World War. In 1917, when he was eighteen, he was called up to active service and sent to a place near Kinghorn, in Fife. However, at the first opportunity he disobeyed a direct order on moral grounds and thus was sent to the guardroom under arrest – he had become a conscientious objector. He was sent to Wormwood Scrubs camp, where he endured solitary reclusion and severe restrictions. After a bit less than four months, he was transferred to Dartmoor Prison to do some work of ‘national importance’: it mainly entailed digging holes or breaking stones, activities that Eric called ‘a farce’. However the living and working conditions in Dartmoor Prison weren't as gruelling as in Wormwood Scrubs, and prisoners had more liberty. Eric Dott spent a lot of time debating with other men of similar principles about religion, philosophy, and politics. At first he had opposed the war because of his Christian principles, and then he had become increasingly interested in the political aspect of the conflict, influenced by his father’s ideas about socialism. This ideology stayed important for him: when his father Peter McOmish Dott died in 1934, Eric was left to administer the considerable sum of money he had left in his will for the benefit of the Labour Movement and Socialism generally. Eric founded the Peter McOmish Dott Memorial Library, where books were purchased with a bearing on socialist education.


A young Eric Dott soon after he joined the staff of Royal Hospital for Sick Children.


After his liberation, Eric enrolled at Edinburgh University to study medicine, and soon set up in practice as a doctor: by 1929 he had started up a small practice in Eltringham Gardens, off Rob’s Loan, in the west of Edinburgh, and by the mid-1930s he was working at the Royal Hospital for Sick Children. Records about him are somewhat lacking, however a few documents show what kind of doctor he was. His competence was recognised: in 1935 Eric Dott was appointed Honorary Assistant Physician to the hospital for five years, and in 1939 he was appointed ad interim as Physician of the Forteviot House. Eric also demonstrated his dedication and eagerness to help during the Second World War. Indeed, in a letter dating from 1939 addressed to Mr. Henry, the Honorary Secretary to the Hospital, he confirmed that he was absolutely ready to put his car and himself at the hospital’s disposal if the children needed to be evacuated. In another letter to Mr. Henry dating from December 1941, it is explained that Eric Dott had had to work both as a Ward Physician and as an Assistant Physician during one year because of a shortage of personnel: he gave a lot of himself during this difficult period.


Photograph of the Royal Hospital for Sick Children, where Eric F. Dott worked as a paediatrician.

I had the pleasure to have a chat with Professor Arnold Myers, who knew Eric Dott personally, to give a little personal touch to the portrait. Mr. Myers describes him as ‘a small man with nice features, very bright, alert and courteous’. He was a very keen chess player, and was very fond of his cat like his brother Norman was very fond of his dogs. Eric Dott spent his retirement in his quiet home of Canaan Lane, where he lived with his three sons, and died on the 8th of July 1999 in Edinburgh, aged 100.


Sources

Rush, C., and Shaw, J. (1990) With Sharp Compassion, Aberdeen: Aberdeen University Press. 

Goodall, F. (2010) We Will Not Go to War: Conscientious Objection During the World Wars, Stroud: History Press.

Conscientious objectors at Dartmoor Prison in England, c. 1917 [online]. Scottish Cultural Resources Access Network. Available from:  http://www.scran.ac.uk/database/record.php?usi=000-000-463-616-C [Accessed 14/04/2016]. Photograph of conscientious objectors at Dartmoor in 1917. Eric Dott can be seen on the front row, fifth from the left, wearing glasses.

Conscientious objection in Britain during the First World War [online]. Learn Space. Available from: http://www.ppu.org.uk/learn/infodocs/cos/st_co_wwone4.html [Accessed 14/04/2016].

Clements, K., Podcast 37: Conscientious Objection [online]. Imperial War Museums. Available from: http://www.iwm.org.uk/history/podcasts/voices-of-the-first-world-war/podcast-37-conscientious-objection [Accessed 14/04/2016].

Lothian health Services Archives, LHB5/36, Royal Edinburgh Hospital for Sick Children, 1859-1992.

Interview with Professor Arnold Myers who was a personal friend of Eric Dott, and whom we would like to thank for his time and contribution. [date of interview: 12/04/2016 at Edinburgh University Main Library]