Friday, 18 March 2016

Case notes: A window into the sanatorium

This week, Project Cataloguing Archivist Rebecca shares some of the insights she's had into tuberculosis treatment whilst cataloguing the case notes of Southfield Sanatorium...

It’s been a while since I wrote about the TB project for the blog, but work is progressing well (I’ve catalogued over 4000 case notes!), and a lot of fascinating stories have been uncovered. The first series of case notes from Southfield Sanatorium has been catalogued in full, and I wanted to take this opportunity to share some of what the case notes have taught me about this institution.

Southfield Sanatorium was an inpatient facility which took patients for a minimum stay of six months. Patients were selected based on the likelihood of recovery, so that only patients who were likely to improve were allowed entry to the institution.

Form completed by patients requesting admission to the sanatorium, committing to at least six months treatment if required. (LHB41 PR1.969)

The sanatorium was oversubscribed, and much of the correspondence included with the case notes refers to the length of the waiting list, and the prioritising of patients on it. The pressure on beds and the nature of the treatment meant that discipline was strict, and patients were removed for breaking the rules. Several patients also left early, against medical advice, due to homesickness or the unpalatability of the regime.

Letter informing of the dismissal of a patient due to "consistent impudence to the nursing staff". (LHB41 PR1.467)

In the days before the NHS, treatment at Southfield had to be paid for, at a rate of around £2 10/- a week (equivalent to around £90 today – and for at least six months!).  Local authorities were obliged to provide sanatorium treatment, so patients from other parts of Scotland would be sent to Southfield for treatment. Other organisations could also pay - usually for their subscribers, for people who worked in certain professions, or for charitable cases.

Letters from the Margaret de Sousa Deiro Fund and the Post Office Sanatorium Society, promising to pay treatment fees for patients. (LHB41 PR1.1050 and LHB41 PR1.969)

Some patients attended Southfield privately, paying up to £3 3/- a week (over £100 in today’s money) according to their means, but the medical directors and Almoners would often arrange to reduce fees for those who were unable to afford it. Even with these support mechanisms in place, TB could prove a costly diagnosis.

Request from a patient for a reduction in fees, with a letter granting the reduction. A later letter in this case file refuses to reduce the fees further. (LHB41 PR1.521)

The treatment provided was in line with that provided elsewhere; chiefly bed rest and gradual exercise, with the occasional surgery for patients for whom it was deemed suitable. Southfield itself didn’t have a large provision of surgical services, so anything more complicated than a simple artificial pneumothorax (the surgical collapse of a lung) would be performed at one of Edinburgh’s other hospitals. Southfield also provided non-surgical treatment such as old tuberculin and sanocrysin; controversial treatments even at the time due to the lack of evidence in their favour.
This may not sound like an impressive treatment regime now, but in the days before effective antibiotics it was the best that could be done, and most patients did recover – though it should be remembered that their good prognosis was why they were sent to Southfield in the first place.
A front view of Southfield Sanatorium (P/PL41/TB/022)

The information in this post has been taken almost entirely from the case notes themselves.  Seeing the case notes as a unit like this gives one a unique insight into the routine of sanatorium administration and treatment, a real sense of the hard work which went into obtaining treatment for people with such a delicate and difficult diagnosis, and a renewed appreciation for both antibiotics and the NHS!

This is just a very small amount of the information which the case notes contain – there are many more stories which I’ve uncovered, and many many more case notes to catalogue!

LHB41 PR.1 – Southfield Sanatorium Case Notes

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