Friday, 28 October 2016

The 'Lady Students', Impropriety and the Mess Stallion

The University of Edinburgh has just welcomed its latest intake of medical students, a new wave of young faces eager to begin their medical careers. Around 60% of these new students are female, but when Sophia Jex-Blake applied to study medicine in 1869 she was denied - it was not considered practicable to make alternative arrangements for one lone woman. Undeterred, she advertised for more women to join her, and eventually gathered a group who would become known as the ‘Edinburgh Seven’. These seven began their medical education on 2nd November 1869.

All seven performed well in their first exams, with Edith Pechey topping the class and qualifying for a prestigious scholarship, but the staff had noticed a growing sense of unhappiness amongst the male students, and awarded it instead to one of them in an effort to quell this. As the events of 1870 would show, this was not particularly effective…

Then, as now, the time spent on wards was crucial for producing well-rounded doctors - as any medical practitioner will know, there is a big difference between learning the theories of diagnosis and treatment, and the reality of dealing with disease ‘in the flesh’. The female students wanted to be able to experience the wards alongside their male counterparts, and requested that they be allowed to join the clinical classes that were taught on the wards. To many of the male students, however, the idea of a female element in their midst was nothing less than horrifying, and a petition was presented to the Board of Management of the Royal Infirmary of Edinburgh (RIE) in protest. In total, five hundred and four students had signed the petition, with the petitioners being keen to point out that four hundred and ninety of those had been gathered in the first seven hours…

The issues hinged on the question of propriety. Was it proper for a lady to be present on a ward, where medical examinations were taking place? Would the men be able to comfortably discuss medical concerns in the presence of women? The petitions didn’t think so:

"many subjects of the gravest medical importance will be imperfectly treated, or omitted altogether" [LHB1/1/25]

The Board of Management was divided. It was decided that the opinions of the Physicians and Surgeons of the RIE should first be sought. In the meantime, Jex-Blake wrote to the Board. In a letter that sounds both begging and defiant, she suggests that only those physicians and surgeons who want to teach the ‘Lady Students’ would have to – “both as a matter of courtesy and because we shall already be provided with sufficient means of instruction”:

The infamous Surgeons Hall Riotoccurred two days later.

The matter remained unsettled for some time. Under pressure from some influential contributors, the Board were convinced that the female students should be allowed access, but the question remained of how to implement this without resorting to objectionable and improper mixed classes. This question continued for a number of months – in October 1872 opinions were sought from the medical and surgical staff, asking whether they were in favour of admitting the women at all, and if so, how they proposed this medical instruction could take place. The responses varied; while some were encouraging, many could not see their way clear to the women being present and involved in medical examinations:

"I am not prepared to give clinical instruction to mixed classes, on account of my own feeling of its impropriety and fear of evil results following" - letter to the Managers of the RIE from J Matthews Duncan, 31 Oct 1872

We’ll be sharing more of these letters over on our Twitter page over the course of the next week.

Eventually, the board agreed to allow women to attend classes on the wards, but these were held at different hours to the men’s’; they were only allowed to visit certain wards; they were permitted no access to post -mortems, surgical operations; and they were not allowed to work as clerks or dressers as this could lead to “inextricable confusion”:


A further example of women’s fight to be accepted by the medical society of Edinburgh can be seen in the minute book of the Medico-Chirurgical Society of Edinburgh (GD3). In 1892, Grace Cadell wrote to the Society requesting a form for membership. This appears to have prompted something of an urgent discussion amongst the members, and Grace soon received a letter informing her that “the Society has passed a law asserting that its membership shall be confined to Medical Practitioners of the male sex”.
 Although the number of women studying medicine had been growing steadily over the next thirty years, it was the outbreak of WWI in July 1914 that brought about a dramatic increase in the number of female students. Even with 373 female students studying in 1918/9, there was still no provision for the full instruction of women – mixed classes on medical wards began in 1927, but it wasn’t until 1933 that they were allowed access on surgical wards.

The barriers to the education of women weren’t always as regulatory, though. Women were granted the right to apply for residency placements (working as an appointed House Officer in a hospital) in the 1920s, but were not permitted to live in the Residency itself until the late 1940s. As the residency rules show, this was an environment very much geared towards its male inhabitants. I wonder how easily a woman would have fitted in with this bunch…
Rules of the Residency [LHB1/114/2]
The fight to be fully accepted in the medical community continued well into the 1950s. Both the Bruntsfield Hospital and the Elsie Inglis Memorial Maternity Hospital (EIMH) were closely associated with the idea of providing practical medical experience to young female doctors. Indeed, Bruntsfield Hospital took its name from Bruntsfield Lodge, Sophia Jex-Blake’s former home. In 1957, the resignation of a consultant physician at Deaconess and Longmore Hospital prompted the Regional Health Board to reconsider staffing arrangements across the Lothian area. A suggestion was put forward that a locum physician could work between EIMH, Bruntsfield Hospital & Deaconess Hospital – which could result in a male doctor working in the two women’s hospitals. This proposal was met with some anger. As Gertrude Herzfeld pointed out at a Board meeting on 9th November, “if a woman was not appointed, there would be no woman consultant physician in the Edinburgh Area to whom woman patients could be referred and there was a definite demand for the services of a woman consultant physician in the area”.
Others argued that allowing a man to take over such a role would “contravene, certainly the spirit, n and probably the terms of the trusts upon which these great hospitals were founded”, and Arthur Woodburn, MP for East Stirlingshire, suggested that “part of this trouble lies in the resistance of the male members of the medical profession to the entrance of female consultants into the higher grades of the profession”.

Instrumental in the campaign against this appointment was Helen Miller Lowe. Lowe was one of the first female chartered accountants in Scotland, and had a lifelong interest in the medical profession, acting as treasurer of both EIMH and Bruntsfield Hospital when they were transferred to the NHS. The GD34 collection contains correspondence, campaign papers, press cuttings and reports relating to the campaign she spearheaded. This garnered support from those both near to home and further afield (with some encouragement coming from a familiar name!)
The campaign was a successful one, with the RHB capitulating in Feb 1958 and agreeing that all of the vacant posts at the Brunts & EIMH be retained for women only.
 When considered in light of the history of the medical education, it seems no small feat that 60% of the current medical student intake are female. The collections that LHSA hold illuminate a small part of the fight for women’s place in medicine, and we’re pleased to be able to show them to a wider audience.

For more information, check out the Wikipedia pages on Women in Medicine

Friday, 21 October 2016

Let's get social: Using case notes to explore Edinburgh's social history

This week, Project Cataloguing Archivist Rebecca looks beyond the medical information provided in the RVH v TB case notes, to explore what they can teach us about Edinburgh's social history.
The case notes we’ve been looking at in the RVH v TB project reveal more than just medical history. The bulk of the Royal Victoria Hospital case notes cover the 1920s-1950s, a period of great social upheaval in Britain, and by recording each patient’s name, age, gender, and occupation they provide evidence for many of the changes that were happening. This was by no means the intention of the hospital and dispensary staff, who were recording this information for medical purposes, but it is a great example of how well-maintained information can be reused.

It is important to remember that most of the patients who were seen in these case notes did not have tuberculosis, or in most cases any diseases – the possibility was just being ruled out. These case notes therefore represent a very broad cross-section of society, including those in perfect health.
A clinic held in the Royal Victoria Dispensary, Spittal Street. The case notes from this dispensary provide the basis of much of this blog post. c.1950.

Living conditions:
Each case note provides the address a patient gave at their first examination, which we are recording in the catalogue as being in one of 5 areas within the city. What surprised me about this is how little the geography of the city has changed within the past century – the vast majority of addresses given in the case notes can still be found today, with a few significant exceptions. In the immediate post-war period, patients were referred who lived in the camps established to provide temporary accommodation to those left homeless due to a housing shortage after the war. There are also a number of patients who lived in now-demolished slum tenements in the Dumbiedykes area, even throughout the 1950s, which highlights just how recently the slum clearances took place. Speaking of which, the case notes often record how many adults and children lived in a household, and if they were sharing rooms. Typical of urban living, they also reveal a large community of lodgers, either in private homes or boarding houses.

Photograph from an album by David Kay, showing The Vennel, West Port, Edinburgh. This housing is typical of that found in the Old Town. c.1900.

A woman’s place:
For those thinking of the stereotypical representation of the 1950s housewife whose place was “in the kitchen”, it could come as a surprise to see how many of the women of Edinburgh were in employment. In the Second World War, huge numbers of women worked in the factories, to free up men for the armed forces. But even after the war women stayed in the workplace in a variety of roles, from housemaids to shop assistants to nurses to civil servants. This was often true for young women, or those who were not yet married, as one might expect, but what’s really interesting is that some women were still working after they got married. This was usually in what we might think of as ‘working class’ roles such as cleaners, suggesting that this was women in poorer families working to keep the family above the poverty line, but it still reinforces the fact that social ideals are usually just that, an ideal rather than the reality for many people.


This final point is one that can be difficult to pin down when using archival records. Until fairly recently, the ethnic or national background of patients wasn’t recorded, which means that many people of colour or people from non-British backgrounds are ‘hidden’ in the archives. However, by looking at names we can see evidence of (mostly European) immigration into Edinburgh during this period – from the longer-standing Italian Scots families to the newer groups of Polish and German immigrants who arrived during and after the war. This includes men who served in the Polish Air Forces during World War II, young German women who were being examined on behalf of the Ministry of Labour, and even Polish families who settled here in the post-war period.  There is also evidence of emigration to countries such as Canada, the USA, South Africa, and Australia, as potential emigrants were required to provide proof that they were not infectious before being allowed to move to their new countries.  

The waiting room in the Polish or Paderewski Hospital, created in 1941 after the President of the Polish Republic issued a decree officially instituting the Polish School of Medicine, and the University of Edinburgh signed an agreement with the Polish exiled government. 120 beds were made available for soldiers and civilians, while clinical medicine was also taught.

 The RVH case notes, therefore, don’t just teach us about tuberculosis and chest diseases. They contain a wealth of information about a variety of social factors, which one might not expect to see in a medical archive.


Lothian Health Services Archive, LHB41 CC/2/PR2 – photographs and recollections of Edinburgh

Friday, 14 October 2016

Revealing Rontgen records...

It’s been a busy time for donations to the archive. In this week’s blog, Louise highlights some of the best – and celebrates an important anniversary!

I’ve been out and about quite a bit over the last couple of weeks, collecting new material to add to collections. Our holdings come from two main sources: Lothian NHS hospitals (those on our catalogues with the prefix ‘LHB’) and healthcare-related material from other local organisations and individuals (represented by the prefix ‘GD’).  In the past few days, we’ve had some very interesting new material from the LHB variety!

On Wednesday, I paid a visit to radiology at the Royal Infirmary of Edinburgh (RIE). We’d been contacted about some older books that had been kept in their library. After checking out the progress of the new Sick Kids’ building…
New developments for the RIE
 … I was delighted with what waited for me – a visitors book dating from the 1920s, plans for the ‘new’ radiology department that opened in the RIE site on Lauriston Place in 1926 and a ‘Record of Observations by means of Röntgen Rays’ from Edinburgh’s first radiology facilities (then the ‘Medical Electrical Department’):
Record of Observations by means of Röntgen Rays, 1898 - 1909 (Acc16/018)
‘Röntgen Rays’ are what we now think of as x-rays, discovered at the end of 1895 by William Conrad Röntgen. In Glasgow, Dr Macintyre opened Scotland's first radiology department in 1896. The RIE’s Medical Electrical Department followed fast on its heels (established by 1898), and the daybook of x-rays that we have just acquired records the examinations performed on its first patients. As you can see, the first entry was written exactly 118 years ago, on 14 October 1898! Conditions examined included everything from a needle in the foot to a bullet in the shoulder:
First page of volume, 1898 (Acc16/018)
The unnamed first patient was exposed to radiation for five minutes, highlighting how far we have come in medical imaging, and also how dangerous these early procedures had the potential to be. If you want to know more about the early history of radiology in the RIE (and the interesting outfits donned by its technicians), you can read about it here. By the 1920s, however, the Medical Electric Department was becoming unsuitable for the increasing demands placed on it, and the Infirmary’s managers planned for a new building, with unrivaled facilities for the time. 

Construction was complete by 1926. The 1925 plans that we have just acquired show the extent of the services on offer in colourful detail. This is the plan for the lecture theatre, complete with a large light box and individual viewing boxes:

Radiology Department plans, Watson & Sons, 1925 (Acc16/0018)
The new department attracted physicians from around the world, as demonstrated in the visitors’ book, documenting 60 years of professional associations:
Radiology Department Visitors' Book, 1925 - 1985 (Acc16/018)
Another significant recent donation came to us from the Western General Hospital’s Health Records Team. We received 35 registers from midwifery and accident and emergency services. They date from the 1960s to the 1990s:
Edinburgh Corporation Domiciliary Midwifery Service casebook, c. 1960s (Acc16/016)
The midwifery records provide detailed descriptions of cases from the 1960s, and accident and emergency procedure registers shed light on hospital admissions in our more recent history. These volumes will be closed to general public access for quite a few years, but – with special permission from NHS Lothian – they can help current academic researchers and individuals represented in the records fill gaps in collective and private histories. More recent records like this are not what everyone pictures when they think of an archive, but we need to keep our eyes firmly on the future as well as the past in this job, and we’re laying the foundations of research in years to come.

Hospitals need to develop all the time. Changing services, technical advances and the evolving needs of patients means that facilities never stand still and sometimes buildings need to change or relocate. An example of this was my visit to the closed Royal Victoria Hospital buildings on Craigleith Road. If you’re a regular reader of the blog, you’ll associate the Royal Victoria Hospital with Edinburgh’s fight against tuberculosis. The plaques relocated to the reception area hark back to that time, after the hospital was opened in 1894 as part of the ‘Edinburgh Scheme’ of diagnosis, notification, isolation and treatment of tuberculosis patients:

Plaques built into the wall of the Royal Victoria Hospital reception area
The majority of the original hospital buildings (converted from a private house) had been found not fit for purpose by 1960 and were demolished in favour of more modern facilities. As cases of tuberculosis declined after the late 1950s, the site was also gradually re-purposed for geriatric medicine to meet a new acute need. This emphasis on geriatric services continued until the main hospital’s closure in the August 2012. 

I visited last week before the hospital is to be cleared completely later this year - but I'll be back. Even though I was there for some time, I only managed to cover half the wards! In this visit, I uncovered interesting material on NHS Lothian’s policies and procedures on care of the elderly, along with a collection of minutes.

Items from the Royal Victoria Hospital to be added to the archive, reflecting its role caring for the vulnerable elderly.
These ‘new’ (for us!) additions the archive coincide with our work with colleagues in NHS Lothian to ensure compliance with the Public Records (Scotland) Act 2011, a piece of legislation that requires public authorities to follow robust record-keeping practices – including an obligation to transfer historically significant records to the archive. In the coming months, we’ll be bringing you news of how LHSA and NHS Lothian are working together to ensure that researchers in hundreds of years’ time will not forget Edinburgh’s twenty-first century healthcare.

Monday, 10 October 2016

Women and Mental Health

Last week I explored LHSA’s holding of women’s health materials, and was particularly struck by the Cervical Smear Campaign and Women’s Health collection (GD31). As it’s World Mental Health Day, I thought it would be apt to share what I found in the collection.

The material I was most interested in was to do with an Edinburgh-based organisation called ‘Head On’. It was founded in the 1980s by feminist women who were interested in tackling issues surrounding women and mental health. The holding we have for Head On consists of documents such as meeting minutes, correspondence between the women, planning notes and lists, newspaper clippings, copies of medical articles and journals, and leaflets and booklets made by the women in the organisation.

Head On committee members as pictured in a clipping from the Edinburgh Evening News, May 25th 1983
Head On’s constitution, which was drafted in 1984, states that the organisation’s objectives were to “set up projects and programmes designed to help women become more aware of their own mental health”, “to educate and inform the public, social services, the media and others with respect to women and mental health”, “to act as a liaison between, and support of, those working in the field of women and mental health” and “to cooperate in appropriate research”. The constitution also highlighted that membership is “open to all persons who are sympathetic to the association’s objectives”. A line found in Head On’s meeting minutes from June 2nd 1983 expresses that Head On “can mean different things for us all but at the heart it stands for our individual shared experience which enables us to reach out across differences to others and to feel better about ourselves”.

The work that Head On carried out in the 80s is still relevant and urgent today. According to AuditScotland, more than twice as many women are consulting GPs for depression and anxiety as compared to men, with those living in the most deprived areas having lower overall mental well-being and more GP consultations for depression and anxiety than those living in the least deprived areas. This echoes the sentiments expressed by the women at Head On, who asserted that “if you are a woman you are more likely to experience depression, have tranquilisers prescribed, or be admitted to a psychiatric hospital than if you are a man”.

Head On booklet which was distributed at their health fairs (GD31/14/2)
The organisation’s earliest projects consisted of two health events, one being a ‘Women and Health Day’ which was held at Edinburgh’s still-existing Workers’ Education Association in 1982, and a ‘Women’s Health Fair’ at St. Cuthbert’s Hall which took place in 1983. These events were primarily targeted at women, but attracted and welcomed people of all genders, including their children. Talks and workshops on women’s mental health were held at these events, and literature written by the group was distributed.

In order to raise funds for their events, Head On organised parties such as the ‘GLITTER GALS DISCO’, which took place at Edinburgh nightclub Buster Brown’s, and charged a £1 entrance fee. Head On’s health fairs and fundraisers were planned through monthly meetings which were open to the public. A mailing list was also created which distributed information, meeting summaries and newsletters to members. During their meetings, the women of Head On delegated tasks to one another, discussed venue hire, drafted applications for funding, presented educational literature and illustrations which they had created to be sold at their events, distributed copies of medical reports and journals concerning women’s health, and most importantly, shared their personal experiences with one another.

Women sharing experiences at a Head On workshop in 1988
Below are some examples of the experiences that women shared at Head On’s meetings:

“We felt we were constantly under pressure to be good at everything, women must be the carers and the experts… there are expectations and assumptions that women will care. We are now seen as a resource by the state. Daughters take over the care of elderly parents, very seldom sons. Society expects women’s natures to be soft, nurturing, emotional, and mothering… Women give emotion but how do they receive it back?” - November 9th 1982

“It is considered a virtue to keep the home spotless. The pressure and the expectations are there all the time. Women should do this and is considered failing if she cannot. Here enters conflict. Her identity depends on doing the job well. She feels she should be at home, but would often rather be doing something else. Many times she feels unfulfilled. She feels unrecognised and underpaid.” - November 18th 1982

The meeting notes which I found most poignant were from January 6th 1983. When the committee asked the women at the meeting what wanted out of life they replied with, “I want peace to be myself”, “I want total economic freedom”, “I want strength to be me”, and “I want to have personal confidence”. When exploring solutions to these wants and desires, some women expressed that “I need enough physical and mental strength to be independent” and “I need to assert myself”. My favourite solution came from a woman who suggested listening to Diana Ross’ “I want muscles” or Joan Armatrading’s “I am a woman”.

Head On meeting notes January 6th 1983 (GD31/10/2/1)

The success of Head On’s health fairs lead to a request from the BBC asking to distribute some of Head On’s booklets for free. The booklets were originally written for the Scottish Health Education Group, and with this new request, the booklets were to tie in with a BBC radio and television series, Well Woman, which was about women’s health. However, due to government censorship, the BBC asked Head On to re-write the content of their booklets 36 hours before they were to be printed. Government officials felt that the booklets, which explained how the female body works and dealt with topics such as menstruation and contraception, were “overly concerned with sexuality”. This caused national outrage, landing Head On media coverage from outlets such as The Scotsman and the Guardian. Public opinion in favour of the uncensored booklets guaranteed that the uncensored version of the booklets were to be made available during the rerun of the BBC show the following year.

The controversial booklets created by Head On titled ‘Women and Depression, ‘Women and Anxiety’, ‘Women and Food’, ‘Women and Pills’, ‘Women and Sexuality’ and ‘Women and Smoking’ (GD31/14/1)

The attention that Head On garnered as a result of the booklet controversy allowed them to open a fully funded women’s centre.  The centre, which they named The Women’s Health Shop, functioned as an information service on issues that affect women’s mental health. The shop put on displays, held talks and workshops, produced feminist literature of women’s health, and became a meeting place for women to talk to women about women’s issues. Some of the talks and workshops held at the Shop had to do with the ways that menopause, benefits cuts, breast and cervical cancer, pregnancy and motherhood, and nutrition and stress affect women’s mental health. The shop also facilitated for self-help groups to meet, providing a space to share experiences of depression and anxiety with other women over coffee. Additionally, women were invited to view the Shop’s monthly displays, which advised how to eat healthy on a low budget, how to make their needs known to their doctors, and how to conduct self-examinations for breast cancer. A female nurse was also available to lend a sympathetic ear for any health worries or anxieties that the women wanted to discuss – this was especially important because many women didn’t feel that their mental health issues were important enough to discuss with their doctors who were largely male. A range of books and resources on women’s health were also made available for loan at the shop.

Although Head On and their Shop are no longer in action, there are plenty of resources on mental health available online at The Health Foundation, Mind, Timeto Change and Rethink. If you or someone close to you is struggling with mental health issues, please get in contact with your GP.

Samar Ziadat

Friday, 7 October 2016

Diagnosing and treating tuberculosis at the Royal Victoria Dispensary in the late 50s.

     One of the most interesting aspects of being an archivist is developing one’s knowledge on a new subject by diving into the primary source material. Cataloguing the case notes from the Royal Victoria Dispensary has enabled me to learn a lot about tuberculosis, its symptoms, the diagnosis techniques, and the treatment methods in the 50s, and I’d like to share this knowledge today. 
Tuberculosis and its different sites

     Tuberculosis (TB) is a disease caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. It is spread from person to person through the air and is very contagious, that’s why many people were sent to the Royal Victoria Dispensary because a family member, a friend or a neighbour had been notified. The most common symptoms described in the case notes are: a cough with or without sputum, dyspnoea (difficulty to breath), haemoptysis (coughing up blood), ‘lassitude’ (fatigue), chest pain, and weight loss.  

     Perhaps a less well-known fact is that TB can also affect other parts of the body, in this case we talk of extra-pulmonary tuberculosis. The case notes from the Royal Victoria Dispensary focus on detecting and treating pulmonary tuberculosis, but I have come across different kinds of tuberculosis: meningeal TB, a form of bacterial meningitis caused by the bacteria mycobacterium tuberculosis and which leads to headaches, seizures, cranial neuropathies, somnolence and coma; military TB, an acute form of tuberculosis in which the minute tubercles are formed in a number of organs of the body due to dissemination of the bacilli through the blood stream; osteoarticular TB, or tuberculosis of the joints and bones, including the spine – learn more in this blog post –; urogenital TB, which affects the urogenital system and may cause a persistent cystitis, dysuria, and ulcer; gastrointestinal TB, which involves any region of the gastrointestinal tract and causes abdominal pain and fever; and finally lymph nodes TB, which infects the lymph nodes[1].

Diagnosis methods

     The people sent to the dispensary would come for different reasons: many of them had been in contact with a person known to have contracted tuberculosis, some of them were sent by their doctors because they presented some symptoms, and some were there to get a ‘check-up’ before immigrating to another country. However, tuberculosis can be latent, or its symptoms can be caused by many other diseases, so it is not easy to diagnose it straightaway. By the late 50s, several tests were used to determine if a patient had tuberculosis. One of the most straightforward ways to identify a disease of the chest was X-ray, and this technique was systematically used on the patients who came to the dispensary. If a person had had TB bacteria which had caused inflammation in the lungs, an abnormal shadow was visible on the chest X-ray. 

Excerpt from the case note LHB41 CC2 PR2.13695 showing the interpretation of an X-ray. The patient suffered from pulmonary tuberculosis and died less than a year later. The text says: ‘Extensive fibrocaseous disease both upper lung zones, more marked on L[eft] than right with system of cavities in 1st, 2nd ant[erior] interspaces. Large cavity at inner end of 1st right ant[erior] interspace.’

     Another test very often carried out was the ‘sputum test’, that is to say the examination of the sputum under microscope to detect the bacteria responsible for tuberculosis. Up to the 1950s, bacteriologic diagnosis was mainly by bright field examination of direct smears stained by the Ziehl-Neelsen method.  When a patient wasn’t able to produce sputum by coughing, a ‘gastric lavage’ was performed so that doctors could check the gastric contents for the bacteria that cause tuberculosis.

     However, these techniques were only useful to detect pulmonary tuberculosis, and because the vast majority of people who have TB germs in their bodies do not have an active case of the disease[2] and thus show no symptoms, skin tests were also used to detect if someone had been infected with TB germs.  They were done on people in contact with someone known to have had TB; people with TB symptoms, or people who presented an abnormal chest X-ray. The case notes I have been cataloguing show examples of two of these techniques: the Mantoux test and the Heaf test. Both tests consist in injecting tuberculin purified protein derivative (PPD) into the forearm, with a syringe in the Mantoux test, and with a Heaf gun (a spring-loaded instrument with six needles arranged in a circular formation) in the Heaf test. The reaction was read several days later by measuring the diameter of induration across the forearm in millimetres: depending on the test and on the patient’s medical risk factors, an induration of over 5mm, 10mm, or 15mm would be considered positive, and would mean the person had been infected with TB. The Mantoux test is still widely used around the world, and the Heaf test was used in the UK up to 2005 to determine if the BCG vaccine was needed. Patients who exhibited a negative reaction to the test were considered for BCG vaccination, which was also offered at the Royal Victoria Dispensary, as you can read here.


     Once it was determined that a patient was suffering from active tuberculosis, treatment was started. Before the introduction of antibiotics in the 40s and 50s, doctors recommended bed rest in large, well-lit airy buildings. When the sick person started to feel better, gradual exercise was introduced. Patients were sometimes sent to Switzerland to breathe some fresh air, although this was a costly option, and therefore they were more often sent to local sanatoriums. The Southfield Sanatorium case notes, also a part of the RVD v TB project, are a great way to look into the functioning and daily life of these establishments [click here to learn more]. 

Open air treatment at Southfield Sanatorium Colony, Liberton, Edinburgh. 

     More ‘aggressive’ procedures were also performed, such as the artificial pneumothorax, a surgical treatment to collapse the lung by inserting air or nitrogen into the pleural space. This served two purposes: first to allow cavities created in the lungs to close and heal, and second to decrease the amount of extracellular bacteria expelled by an infected person’s coughing and breathing. Even though no such procedures were performed at the Royal Victoria Dispensary, I have come across cases of patients who came to the dispensary for supervision after having undergone them.   

     The discovery of antibiotics led to a rapid decline in the mortality of tuberculosis. The case notes I have been cataloguing date from the late fifties, when antibiotics were widely used. I have come across mainly three: PAS, or para-aminosalicylic acid, streptomycin, and isoniazid. Streptomycin was isolated in 1943 and was the first antibiotic found to be effective against tuberculosis, whereas isoniazid was first made in 1952. Both these antibiotics are still part of the five first-line drugs in treating tuberculosis today. PAS was introduced to clinical use in 1944, and is more expensive and less potent than streptomycin and isoniazid, although it’s still useful nowadays in the treatment of multi-drug resistant tuberculosis.

     Nowadays in the UK, tuberculosis is not perceived as a serious threat by the general public anymore. It is seen as a disease of the past, associated with poverty and terrible living conditions. However, while it is true that the progress of medicine has drastically reduced the number of tuberculosis cases, the disease has far from disappeared: HIV/AIDS patients are particularly vulnerable to it, and the emergence of multi-drugs resistant strains means it will become more and more difficult to cure.


Lothian Health Services Archive, LHB41 CC/2/PR2

Medical Subject Headings thesaurus of the US National Library of Medicine, available from: [Accessed 07/10/2016] 

Mitchison D., 'The Diagnosis and Therapy of Tuberculosis During the Past 100 Years', American Journal of Respiratory and Critical Care Medicine, Vol. 171, No. 7 (2005), pp. 699-706.

Niemi R. (4 November 2014), Tuberculosis Treatments Past and Present [online]. Intellectual ventures Lab. Available from: [Accessed 06/10/2016].

[1] Interestingly, this disease is also called the King’s Evil because French and English kings were said to have the power to cure it just by touching it.
[2] According to the Centre for Disease Control and Prevention, 'without treatment, about 5 to 10% of infected persons will develop TB disease at some time in their lives'.