Friday, 11 September 2015

Tuberculosis and the Edinburgh Scheme

This week, Project Cataloguing Archivist Rebecca provides some further background to the ‘RVH v TB’ cataloguing project…
In my previous post I introduced this project, which will catalogue the case notes from the Royal Victoria Hospital. In this post I’m going to look at the history of tuberculosis and the development of the Royal Victoria Hospital, which will explain a bit about the context of the case notes.
Graph showing the decline in mortality death rates from pulmonary (lung) and non-pulmonary tuberculosis. (LHSA Slide Collection)
In 1881, prior to the opening of the Royal Victoria Hospital, tuberculosis was responsible for 306 in every 100,000 deaths in Scotland. By 1919 this had fallen to 130 deaths per 100,000, and by 1958 only 13 in every 100,000 deaths in Scotland were caused by tuberculosis.
Tuberculosis is spread by the sneezes, coughs or spit of an infected person. The bacteria can remain in the body for years without causing illness, a condition which is known as latent tuberculosis. The majority of active tuberculosis cases occur in the lung, which is why the common perception of tuberculosis is as a lung disease. However, once infected the bacteria can spread throughout the body causing tuberculosis of basically any organ you can think of. Case notes here include many cases of tuberculosis of the spine, abdomen, and lymph nodes, to name only a few.
The bacteria which causes tuberculosis was discovered in 1882, though this did not lead to the immediate discovery of a cure. Developments in tuberculosis treatment throughout the nineteenth century were mostly based on trying the effectiveness of different climates, from the heat of Madeira to the Alpine air of Switzerland. Within Britain, specialist hospitals for tuberculosis sufferers were established, and by the turn of the century a move towards the sanatorium model saw patients treated with total bed rest followed by a progressive increase in activity in large, airy buildings with plenty of light. Surgical treatment to collapse the infected lung rose in popularity between the wars, along with other methods of treatment with doubtful efficiency, such as injections with an extract from the tuberculosis bacteria (tuberculin). These methods were used up until the discovery of streptomycin and other antibiotics in the 1940-1950s, which led to a rapid decline in the mortality of tuberculosis.
In Edinburgh in the late 1880s celebrated physician Sir Robert Philip pioneered a scheme, known as the Edinburgh Scheme, which took a three-strand approach to tackling tuberculosis through prevention, detection, and treatment. In 1887 he opened the Royal Victoria Dispensary in Bank Street, the first of its kind in the world. The dispensary became the cornerstone of the Edinburgh Scheme. Sufferers would report there for examination of their symptoms, when full details of their case history would be taken and patients would be instructed in how to avoid spreading the disease. The patient’s contacts would be identified and examined in order to catch the disease in its earlier, more treatable stages. Health visitors and medical officers would visit the patient’s home and check on living conditions, providing information on disinfection of the home.
A nurse from the Royal Victoria Dispensary visiting "an infected house". (LHSA Slide Collection)
Several other institutions provided treatment as part of the Edinburgh Scheme. Philip opened the Royal Victoria Hospital in Craigleith in the 1890s, with 76 beds. Patients could be sent there from the Dispensary for x-rays and treatment at the direction of the tuberculosis officer for Edinburgh. The Royal Victoria Hospital Trust also managed a voluntary institution at Southfield Sanatorium in Liberton, founded in 1914, which admitted patients with all forms of tuberculosis to its 96 beds. Scottish local authorities from outwith Edinburgh could send patients there for a standard fee if they lacked treatment facilities. Patients could also be admitted on the agreement that they were responsible for their own fees, which they were charged according to their means. Polton Farm Colony provided work for recovering or cured patients in an environment which was suitable for their health. Together, these institutions could provide treatment for tuberculosis sufferers at all stages of the disease.
The success of the scheme, reflected in the declining mortality rates highlighted at the beginning of this piece, inspired the legislative drive towards the notification of tuberculosis throughout the UK. Local authorities were ‘notified’ of infectious persons in their area, in order that a Medical Officer could examine the patient and check that they were receiving the treatment to which they were legally entitled. In this way, Sir Robert Philip and the Royal Victoria Hospital can be seen to have influenced tuberculosis treatment throughout the UK in the early twentieth century.
The case notes which form the bulk of this project come from the Dispensary and Southfield Sanatorium. Not only do they show us the background, symptoms and treatment of patients, but they also provide an insight into how this influential scheme worked in practice.
Bhopal, R. & Last., J, ed., Public Health: Past, Present and Future (2004)
Jenkinson, J., Scotland’s Health, 1919-1950 (2002)
Dept of Health for Scotland, Scottish Hospital Survey: Report on the south-eastern region (1946)

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