Friday, 17 March 2017

Edinburgh Dental Hospital and School

This coming Monday 20th March sees the dental industry celebrate World Oral Health Day. In this week’s blog, Alice looks back at the history of the Edinburgh Dental Hospital and School.

Visiting the dentist now may still be a scary prospect for some, but prior to the 1878 Dentists Act it was undoubtedly more terrifying. Dentistry had traditionally been carried out by ‘barber-surgeons’, and generally took the form of ‘drawing’ or removing teeth. As surgeons and physicians moved away from being seen as traders and became recognised as professionals (through the founding of the Royal Colleges, for example), so did dental surgeons. By the late 1870s the profession had begun to organise and regulate itself, and in 1878 the Dental Reform Committee was successful in campaigning for the titles of “dentist” and “dental surgeon” to be restricted to registered practitioners. Furthermore, registration was reserved for those who could show they had practiced dentistry for at least five years.

Given Edinburgh’s established role at the forefront of medical education, it was only a matter of time before a dental school was opened in which to train the dental surgeons of the future, and the Edinburgh Dental Dispensary was an obvious choice. The Dispensary had first opened in January 1860 at 1 Drummond Street, and by 1862 it was “agreed that the success of which had attended the experiment of opening such an institution seemed to warrant an extension to its arrangement and support” and a move was made to new premises in Cockburn Street.

LHB25/1/1 - Minute book of the Edinburgh Dental Dispensary, 14 Jan 1862

Branching further into education, the Dispensary joined forces with the Scottish Dental Education Committee and on 30th October 1878 a Dental Hospital and School was established at 30 Chambers Street (known then as Brown Square). Due to a high demand and increase in student numbers, the School moved briefly to Lauriston Lane in 1889. LilianLindsay (the first qualified female dentist in Britain and first female president of the British Dental Association) described the Lauriston Lane hospital in glowing terms as one of the best in the country: “I entered the school at the end of 1892, and had visited those in Leicester Square and Great Portland Street, London, which were greatly inferior”.

A further influx of students again required the School to find larger premises, and on 13th December 1894 the Lord Provost opened a new School at 31 Chambers Street, next to the original site.
LHB25/5 - Prospecti showing the different locations of the School

The Edinburgh Dental Students’ Society dates back to the Lauriston Lane days of the School, and produced a number of different publications. My favourite of these, White Jacket, began in 1933, and provide a colourful insight into student life. As with most student publications, they’re tongue-in-cheek and often fall on the frivolous side, and were sold just to cover the costs of publishing. On occasion, ‘charity numbers’ were produced with slightly more lavish designs, and the proceeds donated to deserving causes:


As well as providing its resident artists a chance to shine, White Jacket also provided regular sporting commentary, albeit in its own mischievous way…
LHB25/12/26 - This recurring joke appears in at least 4 issues that I've found....
…and the adverts for dental equipment, clothing and other items (such as sporting attire) really stand out as being both beautifully composed and rather of their time:
Today’s advice for World Oral Health Day couldn’t be more different – tobacco is definitely a no-no! Check out the FDI World Dental Federation’s website for more advice and guidance on how to Live Mouth Smart:

Friday, 10 March 2017

Food for thought

This week, Archivist Louise has been looking at just what was on the menu for patients in the Royal Infirmary of Edinburgh:

We’ve recently been in contact with the team behind the People’s History of the NHS resource  -  part of a Wellcome Trust-funded project based at the University of Warwick to research the cultural history of the NHS in time for its 70th anniversary in 2018. The project aims to delve into the meaning of the National Health Service in all our lives, exploring how the Service has impacted on our ideas, health and identities.

Because the team are looking into hospital food at the moment (including tea!), I couldn’t help but mention the evidence we have of how patients were fed at the Royal Infirmary of Edinburgh (RIE), a national leader in the science and practice of dietetics.

Badge from the RIE School of Dietetics, c. 1930s (LHSA object collection, O225)
The first Dietetic Department in the whole of the United Kingdom opened in the RIE in 1924. Thanks to the Department, by the dawn of the NHS in 1948, patient diets in the hospital had moved on considerably since its foundation in the eighteenth century, when principle foodstuffs were oatmeal, barley, milk and baps. In 1920, the RIE Board of Management appointed a special committee to consider diet in the hospital, recommending the appointment of a dietician with general responsibility for patient diets. As a result, Sister Ruth Pybus became the Senior Dietician in the new department. Dietetics was a growing strand of science around the world, and this infant department reflected this new interest in the chemistry of patients’ food. It also roughly co-incided with the first use of insulin to treat diabetes (in Canada in 1922), which was prescribed along with special diets in an attempt to keep the disease in check.
A diet leaflet for diabetics produced by Lothian Health Board, 1980s (LHB1/89/5/5)
In 1925, Pybus won a Rockefeller Foundation grant to observe kitchens in the United States – the Rockefeller Foundation also funded the building of the Infirmary’s metabolic unit with a diet kitchen.

RIE diet kitchen, c. 1950s (P/PL1/S/395)
Some of the diets prescribed by the kitchen would turn modern stomachs – the ‘spleen diet’ for example, involved serving pulp scraped from the fibrous part of the spleen, tossed in oatmeal and fried! Great care was taken with meal plans for diabetics, with fats and carbohydrates strictly calculated. This kitchen soon reached beyond the specialist wards attached to it, supplying food across the hospital – and continued to do so until a larger kitchen was eventually opened in 1966.
Nurses in the RIE diet kitchen, 1960s (LHB1/89/6/1)
In 1934, the first School of Dietetics was opened in the Infirmary, offering specialist training in clinical diets for the first time in the United Kingdom. The School offered a Diploma, open to State Registered Nurses, students with domestic science qualifications or with a BSc. in Household and Social Science. From our syllabuses and prospectuses, we know that the course consisted of lectures and practical elements, covering cookery, biochemistry and chemistry, ward work, anatomy, patient observation, medicine, physiology, dietetics and bacteriology. Students were also tested on social and environmental aspects of nutrition, including the impact of poverty on health. The School operated until the 1950s – perhaps a victim of its own success, since dietetics was by then routinely included in nurse training.

Prospectuses from the School of Dietetics, 1930s (LHB1/89/3/2)
Some of the most popular material that our archive users ask for from the Dietetic Department is undoubtedly evidence of special diets. We have a quite a number of recipes from the 1950s for savoury dishes:

Selection of diet sheets, 1950s (LHB1/89/4/1)
And some for sweet:

Diet sheets for sweet foods, c. 1950s (LHB1/89/4/1)
Even the making of drinks had strict rules attached:

The first rule of beef tea club is.... (LHB1/89/4/1)
The kitchens also shared their expertise beyond their own dietetic wards. There were diets formulated for expectant and new mothers in the Infirmary’s maternity section, for example:

Diet formulated for use in the Simpson Memorial Maternity Pavilion (LHB1/89/4/2)
Some of the sources in the collection reflect attitudes to food education at home, including this 1946 leaflet used in the Department, produced by the Ministry of Food:

Ministry of Food public information leaflet, 1946 (LHB1/89/5/5)
An American influence (probably since dieticians from the Infirmary were awarded scholarships to research in the States) is also represented in the information collected by the Department. A particular “favourite” (please note inverted commas) of mine is this small booklet on weight control for women:
An 'introduction to slenderness' from across the Atlantic, 1950s (LHB1/89/5/1)
But my highlights from the Dietetic Department archive tell us about recommended food for older members of the community, shared outside hospital walls for the benefit of everyone. This 1956 edition of Old People’s Welfare Scottish Bulletin reprints a diet table for the elderly from the Infirmary:

Royal Infirmary of Edinburgh diet table for the elderly, and cover of Old People's Welfare Scottish Bulletin, 1956 (LHB1/89/7/6)
Whilst the People’s Journal in the same year published Infirmary diets given to the Edinburgh and Leith Old People’s Welfare Council, with recommendations for those with or without an oven… and with or without teeth!

Infirmary diet tables reprinted in People's Journal, 1956 (LHB1/89/7/11)
If you’d like to know more about diet in the Royal Infirmary, you can search our collections (for LHB1/89) online here or here

Friday, 3 March 2017

From LA to the UCF

Though the blog title may suggest that we’ve been off to the west coast of America, the content of this blog will be a little closer to home – this week, Ruth will be concentrating on developments in one of our stores…

The Library Annexe (formerly abbreviated to LA) is getting a lot of good attention at the moment, and is transforming itself into the University Collections Facility (UCF). Material held there is being reviewed to make sure that it is in good condition, stored well and accessible for use now and in the future: a collections spring clean if you will!

While a lot of the work will concentrate on the University’s fine art, musical instruments, rare books and archives, here at LHSA we wanted to make sure that we’re in on the action too. We’re very pleased to have Clair (who you will know from blogging on our Dott and TB projects) stay on a little longer with us to take part in some of this rationalisation work in the UCF. We’re boxing clever and making sure we use Clair’s expertise to best effect – she’ll be continuing her case note cataloguing work on another series that has previously received Wellcome Trust funding to conserve it. We also hope to look at some of our other collections in the UCF and make improvements to storage to help preserve the collections for the long term and make best use of available shelf space. We’ll be working with Helen (the UCF Rationalisation Project conservator) to do some rehousing and re-organisation. So keep an eye out for future blogs from Clair (on these page) and Helen where you will see more of this rationalisation work in action.

Friday, 24 February 2017

Time to say goodbye to LHSA!

     Time has flown by and today is my last blog as a project cataloguing archivist at LHSA, so I thought I would write something a bit more personal about my experience here, including my favourite items and the skills I’ve gained!

     I started working as a project cataloguing archivist here exactly one year and one month ago, but I was actually already familiar with LHSA thanks to my 10-week internship in Spring 2015. This is when I started working on the Norman Dott project: I catalogued 1200 case notes from the Brain Injuries Unit in Bangour General Emergency Service Hospital in Broxburn, dating from 1943 to 1949. It was the first time I was working on records from the Second World War, and it was truly fascinating to read all the tales of war and life stories – I will always remember, for example, this Polish patient who lost all her family in the Warsaw Ghetto, was sent to the concentration camp at Dachau where she actually fell in love with a man, whom she met again and married in Paris after the liberation. It was amazing to read her story and to realise that it wasn’t a movie or a book – it was a real woman whom Norman Dott had examined and listened to 60 years ago. Which just goes to show that medical case notes are far from containing only technical documents and abstruse descriptions!

Aline working on a case note.

    The knowledge and skills I had gained during the internship made me the right person to finish cataloguing the Dott case notes as a project cataloguing archivist LHSA a few months later. I catalogued 4944 case notes in just over six months. I felt very honoured to be the person to catalogue the very last one of the 28313 case notes of the collection, as it had been such an impressive team effort that had started more than four years ago. This time the case notes I had catalogued didn’t date from the war, but were just as interesting: I particularly enjoyed finding clinical drawings and learning more about the use of the leucotomy procedure in the 50s.

Clinical drawings of an acoustic neuroma operation (PR2.21345) (all personal details have been redacted)

     I also had the opportunity to work on another LHSA case note cataloguing project, RVH v TB, alongside the other project cataloguing archivist Becky.  The case notes were a bit different; they were often shorter and covered less medical conditions, and didn’t always delve into patients’ lives so extensively. However I enjoyed cataloguing them as well – they’ve made me smile, wince, or sigh with sadness. I have also been able to participate in a number of activities related to both projects, which has been an excellent way for me to gain dissemination skills. It was also very gratifying to be able to share my enthusiasm and knowledge on something I had worked on for several months. A good example would be our day at the Scottish Records Association conference in Perth on the 4th of November 2016, on the subject ‘Public Healthcare in Scotland before the NHS’. Both LHSA project cataloguing archivists, accompanied by LHSA access officer Alice Doyle and SFF intern Samar Ziadat, attended this conference. We created dissemination material about LHSA cataloguing projects for the delegate packs, and prepared a PowerPoint presenting the projects that was shown during breaks. We also openly requested feedback and were available to answer any questions. It was a very interesting day where we learnt a lot about other medical archives projects, and got to talk about our own!

The very last box of the norman Dott case notes.

Next Tuesday will be my last day at LHSA, but I am happy to say that I am not going very far: on Monday 6th of March I will start my new job as cataloguing archivist at the CRC, here in the Main Library of the University of Edinburgh. From CRC intern to project cataloguing archivist at LHSA, and soon cataloguing archivist, I feel like this has been a very enriching and continual progression and I am delighted to be starting this challenging new role soon! I have really enjoyed my time working at LHSA; I am certain the skills and experience I have gained will help me to do my very best in my new role, and I am very grateful for all the opportunities and support I have received.  

Aline Brodin, Project Cataloguing Archivist. 

Friday, 17 February 2017

Interpretation, interpretation, interpretation!

Lately, Samar, our ‘Opening Up Scotland’s Archives’ trainee, has been thinking a lot about ‘interpretation’ within the context of the arts, cultural and heritage sectors, so she thought she would share a bit about what she’s been learning with you…

In the month of February, I’ve focused on all things interpretation: beginning a professional development course at the University of Dundee called ‘Outreach and Education: An Introduction to the Promotion of Archives’, attending a professional development workshop at the Victoria and Albert Museum in London called ‘Planning and writing your interpretation’, and next week I’ll be delivering my own outreach workshops for the Festival of Creative Learning called ‘Making History: A Feminist Craft Project’.

As a part of my Dundee course, I read a really interesting publication, A Closer Look (2001), which was written collaboratively between Interpret Scotland and the Scottish Museums Council (now Museums Galleries Scotland). It was written in order to support a policy statement that Scottish Museums Council had outlined at the time, called Museums and Social Justice. The publication includes practical guidelines that should be considered when museum professionals plan their interpretation. On the very first page of the publication it is explained that “the notion of social justice asserts that people have a right of access to the collections and to associated information that museums hold on their behalf”. I agree with this statement, and strongly believe that social justice is integral to every form of interpretation that we plan, from exhibitions and talks to workshops and online content. This is because, interpretation is the key way in which arts, cultural, and heritage organisations can make the most of the meeting between their collection and their visitors, and it is our responsibility to make this meeting as stimulating, rewarding and memorable as possible for every visitor that engages with us.

I attended the V&A course on interpretation this month because I wanted to learn how to write exhibition text that is interesting, engaging and accessible to a wide audience. When planning an exhibition, it is a matter of principle to me that the way in which the material is presented is engaging to any visitor who may attend. This was a daunting task to me, considering exhibition visitors can range from experts in the field to young children. The V&A course reassured me that although this is a difficult task, it is not an impossible one. I learnt that in order to cater to a wide audience, I don’t have to ‘dumb down’ the research or collection that I’m presenting, rather, I have to recognise people’s needs and interests, and use the devices of good writing to communicate my ideas. By good writing, the course instructor didn’t simply mean clarity and proper grammar, but producing a personality, life and rhythm in the text that can appeal to all.

As a heritage professional, interpretation is one of my favourite parts of my role, because it’s a chance for me to share my enthusiasm for our collections with the public. So, I’ve been very excited to get to apply this new knowledge in the planning of my own series of workshops for the University of Edinburgh’s Festival of Creative Learning. When planning my workshops, I wanted to interpret Lothian Health Services Archive’s material in a way that illustrates the role of social justice within the archive sector, as well as diversifying the general public’s understanding of history and heritage.

The materials which archives hold are the foundations from which history is written, and historically, as well as in the present day, women’s achievements and contributions to society have been omitted from archives, and therefore history. In my workshops, I wanted to counteract this damaging effect by working with the public to make sure that the stories that we hold at LHSA about Scottish medical women are written into the canon of history. During both workshops, held on Monday 20th February and Wednesday 22nd February, we will discuss the ways in which archives can be, and have been, used within activism, and then do some feminist activism ourselves by producing a crafty zine that celebrates the achievements of LHSA's medical women. After the two workshops, the zine will be converted into an online booklet which will be shared on this blog and our Facebook page, in order to highlight the significant women in our collections, not only to the participants of our workshops, but to our wider online audience. These workshops have been months in the making, and I can’t wait to get crafty with all of you, so if you’re interested in attending, we still have a few places left, so make sure to sign up soon!

Friday, 10 February 2017

Tuberculosis: Historic Developments and Modern Misconceptions

In this week’s blog Project Cataloguing Archivist, Clair looks at the latter 20th century progress in tackling tuberculosis but to what extent has this assigned TB to a disease of the past?

From the introduction of the BCG vaccination in the 1950s, Scotland began to see a dramatic decline in TB infection and death rates. The Royal Victoria Hospital (RVH) in Edinburgh began using the vaccination to protect children and young adults in close contact with others suffering from TB - read more about the development of the BCG vaccination and its introduction to Edinburgh in Rebecca’s blog. Furthermore the decline in TB rates were also affected by the successful introduction of the Mass Miniature Radiography Campaign (MMR),  a screening process which found undiagnosed cases of TB among the at risk population. MMR, a routine vaccination program and antibiotic treatment all contributed to a positive outlook in the decline of TB throughout the latter half of the twentieth century.

It is also important to highlight the work of Professor John Crofton, who was appointed chair of the Department of Respiratory Diseases at the University of Edinburgh in 1952.

Prof. John Crofton, c.1950-1970.  P/PL41/TB/049

Amid the TB epidemic, Crofton experimented in strengthening earlier developments in TB medicine. To streptomycin (which became resistant to some strains of pulmonary TB) and aminosalicylic acid he added isoniazid, and this new combination of drugs became the most powerful treatment of TB throughout the 1960s. Although this was considered a radical approach it soon became known as the ‘Edinburgh Method’ (not to be confused with the earlier ‘Edinburgh Scheme’) and this paved the way for momentum in international standards for the treatment of TB.  Early distribution of the drug combination saw the notification rates of TB fall by 54 per cent in Edinburgh between 1954 -1957. It soon became the leading treatment for TB, abandoning other methods, such as bed-rest and surgical treatment.[1] Here is a short film featuring interviews with the late John Crofton, explain his TB trials and the turning point in TB treatment and drug-trial methodology.

At LHSA we are nearing the end of cataloguing our TB case notes and I was also interested to find out how the disease materialised after the dates of which our TB collection covers. We hold some records that can give us a picture of the TB situation in Scotland but only until the late 1980s. For example RVH annual reports demonstrate that beyond this time there was a positive outlook on what becomes thought of as a historical public health crisis.  There was marked acceleration in the decline of TB in Scotland and today low TB rates are reported at round 8-9 cases per 100 000 of the population. However, since 2005 TB rates have increased slightly and this also reflects the overall situation thought the rest of the UK, particularly in London. Key reasons for this increase seem to stem from factors including:

  • An increase in travel and migration, as most cases are found amongst those not born within the UK.
  • Drug resistant strains of the infection.
  • Health inequality and social risk factors e.g. substance misuse, homelessness and deprivation contributing to poor health, in turn and affecting immune systems.

It is well documented that relatively high rates of TB still exist throughout many other parts of the world, including India, south-east Asia and Africa. Countries such as these are still struggling to control the spread of the disease and TB continues to be one of the top 10 causes of death worldwide. The most recent statistics that can be found on World Health Organisation (WHO) website tell us that in 2015 10.4 million people fell ill with TB and 1.8 million died in that year. But in contrast to this gloomy picture, WHO also states that 49 million lives have been saved in the last 15 years through TB diagnosis and treatment, with a future health target to end the TB epidemic by 2030.

Despite the progression throughout the twentieth century in tackling the spread of TB and future advancement suggesting an optimistic outlook in controlling TB, unfortunately it is not a disease that we can yet consider eradicated.

[1] McFarlane, N, TB in Scotland, 1870-1960, Sep 1990.

Friday, 3 February 2017

The REH and causes of insanity

The first Physician Superintendent of the Royal Edinburgh Hospital (REH), Dr William Mackinnon, initiated a practice of keeping detailed case notes for individual patients. These case notes have been bound into large volumes, and are now known by the shelfmark LHB7/51. They provide us with a rich resource for examining how attitudes to the causes of mental illness changed throughout the 19th century.

LHB7/51/1 - The first volume of casenotes kept by the REH.

When an individual was admitted to the hospital certification papers would be produced. This was ‘a complicated procedure which involved with coordination of petitioners, medical men and legal representatives'[1]. These certification papers often described why admission was considered necessary – such as the patient posing a threat to themselves or others – and usefully for family historians, they can also carry a bit of information about the family’s medical history.
LHB7/52/633 - This note accompanied the patient's certification papers.

These papers were legal documents: the hospital was legally stating they had the resources to board, feed and care for the patient; medical professionals were legally affirming the medical need for the patient to be admitted; and someone was legal agreeing to pay the costs of care – in the case of private patients this was usually a relative, whereas pauper patients were paid for by the local authority.

In contrast to these structured and regulated documents, the first casebooks of the REH were freeform, and physicians recorded what they felt to be most necessary to understand and describe a patient’s mental state and the cause of their illness. For example, money matters were considered to be the cause of this woman’s melancholia:

In 1846, the post of Physician Superintendent was taken up by David Skae (1814-1873). In the spirit of the Victorian passion for taxonomies, Skae was concerned throughout his career with the classification of insanity, approaching the subject from a physiological perspective rooted in a belief in the ‘physical basis of all insanity’[2]. Over the course of seventeen years, Skae developed a theory of classification that grouped the ‘varieties of Insanity…in accordance with the natural history of each’.

Skae's 'classifications'. Held by the University of Glasgow and accessible on the Internet Archive.
Some of these classifications strike us immediately as being firmly rooted in Victorian attitudes to morality, sexuality and gender roles. For example, in his address to the Royal College of Physicians of London in 1863, Skae described ‘Masturbatory Insanity’ as a condition in which “that vice produces a group of symptoms which are quite characteristic and easily recognised, and give to the cases a special natural history; the peculiar imbecility and shy habits of the very youthful victim; the suspicion, and fear, and dread, and suicidal impulses, and palpitations, and scared look, and feeble body of the older offenders, passing gradually into Dementia or Fatuity”; ‘post-connubial Mania’, was “occasionally met with, both in the male and female sex, but more frequently, I think, in the latter, developed immediately after marriage and, without doubt, connected with the effect produced upon the nervous system by sexual intercourse”; and of ‘Satyriasis and Nymphomania’ no description was offered.

Skae died in post in 1873 and his although his successor, Thomas Clouston, continued the practice of keeping detailed case notes, he did make some changes. In 1874 the case books moved from the freeform blank pages to pro-forma printed pages, requiring the physicians to provide pre-specified areas of information. These went into a great deal more detail that had previously been seen – I particularly like that information was recorded on a patient’s appearance.

This new style of case note also supplied a place in which to record Skae’s classification. This approach was largely ignored in the medical community and never really took hold outside of the REH, but the inclusion of it here allows us to examine not only what ‘disease’ patients were diagnosed with, but how the manifestations of their illness tell us something about 19th century attitudes to the causes of mental illness. By the early 20th century this section had begun to be left blank, and by was eventually removed from the proforma.
LHB7/51/107. Skae's classification is no longer asked for,
and the notes are sparse. 
As the number of patients admitted to the REH increased, the instances of these pages being left blank or only partially completed also increased. Faced with high demands on their time, physicians and clerks were not able to spend as long filling in detailed notes for each patient, and so we’re left with sometimes frustrating ‘teases’ of records such as these – this is a good reminder that, in the archive, an absence can speak as loudly as a presence.

[1] Barfoot, Michael, and A. W. Beveridge. "Madness at the crossroads: John Home's letters from the Royal Edinburgh Asylum, 1886–87." Psychological medicine 20, no. 02 (1990): 265.
[2] Fish, Frank. "David Skae, MD, FRCS: founder of the Edinburgh School of Psychiatry." Medical history 9, no. 01 (1965): 42.