Friday, 26 May 2017

Introducing our new intern...Emily!

My name is Emily and I am the current cataloguing intern with LHSA, welcome to my first blog post. I thought I would take this opportunity to tell you a little about myself and the collection I have been working on.
I am nearing the end of my MSc in Information Management at the University of Glasgow. Alongside the internship I am also working on my dissertation, which is due at the end of August. I will be studying the implications of digitizing psychiatric hospital records, specifically those of the former Hartwood Hospital. The records for this institution have recently been acquired by the North Lanarkshire Archives, where I volunteer. Very handy indeed!

Before entering the working world as a new professional I felt it was important to obtain as much work experience as possible. The LHSA internship was a perfect opportunity for me to expand my skill set, and to work with an archive service I had long been curious about.

One of the most exciting things about archives is the vast variety of collections there are to discover. I have never encountered a collection I did not enjoy working on. I do however, have rather a spot for healthcare records, presumably because that is where my love of archives stems from. For my undergraduate dissertation, I studied the use of moral therapy at the Crichton Royal Hospital. The Dumfries and Galloway Archives was the first repository I ever set foot in, and I was astounded by everything I was shown. I loved perusing through the registers, copies of the New Moon (newspapers produced by the patients) and the beautiful scrapbook produced by Physician Superintendent W.A.F Browne. From this point onwards, I knew I wanted to work in archives, so back to school I went.
Dr Andrew Logan (c.1965) P/PLI/D/068
For the past four weeks I have been cataloguing and conserving cardiac thoracic case notes of patients treated by surgeon, Andrew Logan (1906-2005). The collection consist of roughly 470 case notes, dating from 1951-1958. Dr Logan (smiling beautifully in his portrait) was a consultant cardiothoracic surgeon in Edinburgh. It seems he was based at the Eastern General Hospital Thoracic Unit, while also heading surgical wards 7 (male) and 8 (female) at the Royal Infirmary of Edinburgh. Patients were referred by Dr Rae Gilchrist of the RIE Cardiology Department (wards 22 and 23) to wards 7 and 8 for thoracic-cardiac surgery. Over the remaining few weeks of my internship I shall research Dr Logan further and see what I can dig up.
Example of original patient case file.
While cataloguing this collection I have really enjoyed familiarising myself with some rather tongue-twisting terminology. I think my favourites have to be ‘patent ductus arteriosus’, ‘polycythaemia’ and ‘dyspnoea’. Thank goodness the case notes are all typed!

Removed rusty paperclips
Unlike other past interns, I have been given the task of conserving and rehousing, as well as cataloguing this collection. This has involved the removal of great many rusty paperclips and straightening the edges of some very flimsy paper (all good fun). The aim of this is to try and establish an efficient method to catalogue and conserve in tandem to be used in future work at LHSA. So far so good, but I will share my conclusions on my next blog post.

Friday, 19 May 2017

How Pleasant Surroundings and Conditions affect the Health and Happiness

How do our surrounding affect our mental health? Access Officer Alice recently attended a conference organised by the Churches Conservation Trust and [Mind UK] to celebrate the opening of Quay Place, a new community mental health resource in Ipswich. Throughout the conference, there was a lot of focus on the impact our environment can have on us, and on the development of hospital architecture. Here at LHSA, we’ve been working with a number of artists and researchers involved in the redevelopment of hospital spaces across the Lothian area, and this has got us thinking about hospital architecture in a bit more depth. This week, Alice looks at Dr Thomas Clouston’s views on asylum design, and how the physical space of the Royal Edinburgh Hospital in Morningside was tied to its therapeutic outlook.

Dr TS Clouston was Physician Superintendent of the Royal Edinburgh hospital (REH) between 1873 and 1908, and during this time he also published extensively on the causes and treatments of mental illness. One of Clouston’s preoccupations seems to have been asylum design – indeed, whilst Physician Superintendent he undertook an expansive rebuilding programme, with a key part of his legacy being the opening of Craig House, a series of buildings specifically tailored for the treatment of private, paying patients of the Royal Edinburgh Hospital. As part of our Royal Edinburgh Hospital collection (LHB7), we hold two of his papers that give an insight into his thinking on asylum design: these are “An Asylum or Hospital - Home for Two Hundred Patients” (Boston, 1879), and “How Pleasant Surroundings and Conditions affect the Health and Happiness” (Edinburgh, [1887]).

As the title suggests, “An Asylum or Hospital…” was very much concerned with how to make the buildings under his charge comfortable for its inhabitants, and foster the community ideal that he felt was crucial to the successful recovery of patients. In it, Clouston begins by pointing out how attitudes to ‘insanity’ had changed over the years:

“In planning the asylums for the insane, built 70 years ago, the dominant idea in the minds of their architects was secure custody : in the case of those built 30 years ago, the idea of curing the patients had modified in a marked degree the jail-like features of the earlier buildings. Since that time, under the new regime in this country, improvements in the character of the hospitals for the insane have been going on steadily”.

The concept of custody was indeed a key shift in the attitudes of the time. Although ‘open-door’ policies didn’t find real traction until the mid-twentieth century, Clouston saw it as important that patients didn’t feel like inmates, and effort was made to obscure any necessary security features: “all the special arrangements of rooms, window-shutting, strong-rooms, padded rooms, &c., should be as little prominent and offensive as possible ; and above all, they should not be suggestive of what they are intended to prevent”. Not only could these security features be obscured, Clouston suggested, they could also become decorative features in themselves that added to the general positive feeling of the institution. For example, he details how to installed padded leather walls in  a secure room: “the surface of the leather should be neatly stencilled, and coated with four coats of the best varnish. It is then soft, impervious to urine, strong, and makes a pleasant-looking room, just like an old library hung with stamped leather. In this way the forbidding features of an ordinary “padded room” on the patient’s mind are avoided”.

LHB7/14/5 - A block plan for 'An Asylum or Hospital Home for 200 Insane Patients'
Indeed, Clouston seems to have wanted his patients to think of themselves more as residents in a grand hotel than patients in an institution: “in the general arrangements, furnishings, &c., I took a first-class hotel as my model, and not any pre-existing asylum at all”. In defending this relaxed and accommodating attitude, Clouston argued that, even if there were accidents or escapes, and if some physicians had relaxed their attitudes too far, “their indiscretion has done good. It has had for its object the restoration to ordinary conditions of life a portion of humanity that lay in fetters and chains 100 years ago”. By avoiding the tropes of the ‘insane beast’, Clouston thought, the patients of the asylum would develop a greater sense of self-respect, take more interest in their own personal care and appearance.

In this respect, the social aspect of the hospital was an important factor. By bringing patients together to dine “in rooms … the general arrangements of which are precisely those of a table d’hote in a good Swiss hotel in the summer”, Clouston relied on the enduring social nature of people to help improve patients’ opinion of themselves and capacity for social intercourse. He stated that “since we began to use a common dining-room … several inveterately untidy patients have been cured of their slovenliness of dress [and] self-control is taught. The public opinion of the room or the table won’t tolerate noise or disturbance”. The greatest complaint of patients, he stated, tended to be around their lack of control, lack of entertainment and often, their horror at being locked up with ‘lunatics’, and he therefore tried to remedy this by providing opportunities for what he considered “pleasant conditions of life”. These included, in his view, “suitable work for the doer of it with some leisure time, some agreeable companionship, games, amusements, newspapers, books, baths, and liberty of action”.

LHB7/14/5 - the ground plan for 'An Asylum or Hospital Home'
Another key element of Clouston’s design was to avoid “uniformity of accommodation and arrangements” throughout the hospital: in an awareness of different types of mental illness, and the illogicality of treating all patients in the same manner, Clouston stressed that all patients had different needs based on a number of factors such as their bodily health, their propensity to be dangerous to themselves or to others, and their potential ‘curability’. Accordingly, “it should be a principle, never departed from, that the structures and arrangements that are necessary for the worst classes of patients should not be used for the best…”.

In the same vein, Clouston believed that this lack of uniformity should extend to the d├ęcor: “variety in the shape, size, and aspect of buildings and rooms, tends to interest, rouse, and cheer the patients, when they pass from one into the other”. He acknowledged that architects and painters were often unwilling to expend their talents on an asylum, whether their efforts might not be as well received as they would be elsewhere in society, but stressed that variation and a lack of monotony in surroundings had a greatly beneficial impact on the mental health of patients.

Overall, Clouston was a strong believer that health and happiness were improved by pleasant surroundings. Furthermore, he saw the benefits of this for the professionals involved in the care of patients, asserting that “the management of an asylum is necessarily much affected by its construction … a cheerful, broken-up asylum is far more apt to be managed on principles that are pleasant to its patients”.

Friday, 12 May 2017

'A most peculiar bird...'

This week, Archivist Louise celebrates International Nurses Day with a spotlight on a resource that charts the history of nurse education from the first half of the twentieth century right up to the present day…

Happy International Nurses’ Day 2017! Since 1974, the International Council of Nurses has celebrated the amazing achievements of the nursing profession throughout the world. 12 May was chosen since it’s also the birthday of Florence Nightingale – whom I’m sure needs no introduction, but you can read more about our Florence Nightingale letters here. Around each International Nurses’ Day in the UK, there’s a service at Westminster Abbey in London, in which a symbolic lamp is passed, and more local celebrations in hospitals and health organisations. There are also annual events across the world (including these impressive displays in China).

We’ve no shortage of nurse-related records at LHSA – in fact, we have much more about nurses than we have for doctors! We’ve nursing ephemera, badges (like the ones featured on our new postcards – shameless plug!):

One of our new colour postcards!

… staff registers, photographs (although not always with named nurses), wage books and training records up to the early 1960s (when nurse training began to be re-organised from individual hospitals to wider local institutions – the Lothian Colleges). In fact, there’s a handy source list if you’re wanting to look into nursing records here.

One nursing history resource that I’d love to highlight, though, is The Pelican, the magazine of what is now The Pelican Nurses’ League, an organisation made up of nurses trained in the Royal Infirmary of Edinburgh. But why a Pelican?:

Royal Infirmary of Edinburgh nurses with an extraordinary patient! (LHSA photograph collection)
The Pelican had long been a symbol of the Royal Infirmary of Edinburgh, appearing on its crest. Shown as a female plucking its breast to nourish its young with its blood, it became synonymous with nurture and self-sacrifice, a fitting emblem for the work of the Infirmary as a charitable institution, and as a symbol of the RIE Nurse Training School (founded in 1872), appearing on its badge from 1917.
Pelican badge, Registered Nurse (LHSA object collection, O254)
Nursing badges were worn with pride, a very visual reminder of years of (often extremely challenging) training to meet rigorous professional standards. Back in 2011, we carried out the Unsung Heroes project with jewellery and silversmith students from Edinburgh College of Art to create new badges from our original archival holdings, taking inspiration from oral histories from retired nurses, recorded by the students themselves. You can hear some of the recordings online, here.

The first issue of The Pelican appeared in 1927, and was founded by the Student Nurses’ Association. The foreword of the first edition (written by the Lady Superintendent – the ‘Head’ -  of Nurses, Annie Warren Gill), welcomed the magazine, ‘which aims at reflecting and bringing together the many sides of a nurse’s life, and which will keep the old in touch with the new.’

Cover and first foreword from The Pelican,  1927-1928 (LHB1/190A/1)
Throughout its life, The Pelican has focused on nurse training rather than life as a qualified nurse. The PTS (Preliminary Training School) is often mentioned, where new recruits were educated before learning on the wards, along with ‘pros’ (not ‘professionals’, but ‘probationers’, who might be called student nurses now). The first magazine was a mixture of official news and events, along with anecdotes and humour:

Humour from the pages of the first edition of The Pelican, 1927-1928 (LHB1/109A/1)
'The Perfect Nurse' strikes a typical tone in early issues of The Pelican – of squinting up at an ideal, angelic nurse, but never quite reaching. It's a reminder that the (then) women who washed the bedpans, changed bandages and (as their training went on) administered treatments and aided operations were flesh and blood human beings doing their best against often unrealistic expectations that they carried with them as new starters.

A less well-known Pelican badge, that of the State Enrolled Nurse (LHSA object collection, O258). 
In 1935, the magazine recorded the suggestion of starting an ‘Edinburgh Royal Infirmary League of Nurses’, and that The Pelican be its official magazine, linking those who wore the Pelican badge. E F Bladon was elected the first President of The League at its first meeting in June 1935, and in 1936, The Pelican changed its cover to reflect its new allegiance:

Covers of The Pelican showing its name-change, and the first page of the new League edition (LHB1/109A/11, 12)
The Pelican changed its contents as the nature of nursing changed – in the 1940s, it appeared as a ‘News Sheet’ to reflect both wartime shortages and shifting priorities:

The Pelican in the Second World War, and news of nurses serving in wartime (LHB1/109A/16)
Teaching was changing too, as this 1957 feature on the new Teaching Unit shows:

Feature om the new teaching facilities for probationers (LHB1/109A/33)
In 1972, the Royal Infirmary of Edinburgh School of Nursing celebrated its centenary, marked with a special issue of The Pelican:

Special edition of The Pelican, 1972 (LHB1/109A/49)
I was heartened to see a feature by the Infirmary Archivist, answering queries about the Pelican crest in ‘most correct and proper’ terms (how else???!!):

Article by Pam Eaves-Walton, RIE Archivist (LHB1/109A/49)
 The Pelican continues to publish to this day, and the 2017 edition has just been sent to LHSA for the archive. As well as administrative matters (for example, member news, notices and meeting minutes), there are also historical features based on the editor's research in LHSA and recollections from nurses in particular specialist wards, such as Norman Dott’s Department of Surgical Neurology and the Renal Unit, where the first kidney transplant from a live donor in the UK was performed in 1960.

Appropriately for International Nurses' Day, modern editions of The Pelican also feature news on the Pelican Award, funds awarded to students on Adult Nursing Programmes in selected Lothian universities in support of electives (placements to supply experience of nursing outside their own region, but anywhere in the world) and to Registered Nurses towards funding research projects or professional development. In 2016, seventeen student electives were funded, from Birmingham to China, Sri Lanka, Australia, Tanzania and The Philippines – a truly international story for International Nurses Day 2017!

If you were the proud owner of a Pelican badge (according to the League records that we hold, Pelican badges were being issued up until at least summer 1988) and would like to join the Pelican League, new members are always welcome – you can find more details on the League’s website.

A probationer's life has always been a hard one...

Friday, 5 May 2017

Midwifery in Edinburgh

This is a big week for the history of obstetrics, gynaecology and midwifery in Edinburgh… May 1st saw the 120th anniversary of the opening of the Edinburgh Royal Maternity and Simpson Memorial Hospital; May 2nd marked 83 years since the death of Dr James Haig Ferguson, founder of the first hospital outpatient antenatal clinic in Britain As today is also the International Day of the Midwife, we’re taking the opportunity to look back at the history of this discipline in Edinburgh…
LHB3A/15/1 - Certificate awarded to Margaret Reid, Midwife by Thomas Young, 1768.
Midwifery in Edinburgh as a ‘medical’ (as opposed to community) practice dates back to 1726, when Joseph Gibson was appointed Professor of Midwifery by the Town Council. It wasn’t until the 1740s that Midwifery was taught to students of the University of Edinburgh by practising surgeon Thomas Young. Young believed that practical clinical instruction was crucial for a full understanding of midwifery, and in 1781 he tried to rally support for the building of a general Lying-in Hospital in the city that would allow his students this close-up experience. Young died in 1783 before his vision could be realised, and his successor Dr Alexander Hamilton took up the mantle after him.

GD1/1/1 - Midwifery lecture notes, n.d.

Hamilton outlined a General Lying-in Hospital as constituting “a proper building, erected in an airy healthy situation, capable of containing twenty-five patients”, but advised that it “should be constructed in such a manner, that it may be enlarged when the funds can afford it”. [5/6] His appeal was successful. The General Lying-In Hospital, opened in 1793 at the site of what is now Teviot Row House, aimed to provide “women in low life” with the “management during child-bearing that opulence can produce”.

Hamilton’s hopes for the Hospital to be extended were less successful, however, and it wasn’t until 1879 that a purpose-built maternity hospital was opened. Named after one of Edinburgh’s most famous medical sons, the Simpson Memorial Hospital honoured Sir James Young Simpson’s many contributions to midwifery. He had succeeded Hamilton in the Chair in 1840, and in 1847 his infamous private experiments into the anaesthetic effects of chloroform led to it being used to relieve pain during labour.

In 1905, John Halliday Croom was appointed to the Chair, but being a specialist in obstetric alone, additional expertise had to be sought and Alex Hugh Freeland Barbour was appointed as lecturer in Gynaecology. This dualism reflected a general attitude towards the care of pregnant women at the time - as R.W. Johnstone puts it “any special care deliberately devoted to the object of preserving the health of the expectant mother [or of] forestalling dangers likely to arise in her labour … was virtually unknown”.
Portrait of James Haig Ferguson, from the collection
of the Royal Medical Society
The concept of antenatal care was introduced into Edinburgh by Dr James Haig Ferguson. Haig Ferguson had served as Assistant Gynaecologist at the Royal Infirmary of Edinburgh since 1896, and in 1899 had founded a home for unmarried women expecting their first baby. Encouraged by the impact that routine antenatal supervision had on the health of the women treated there, he successfully petitioned the managers of the Edinburgh Royal Maternity Hospital to allow him to open an out-patient clinic for married women, so as to offer them the same levels of supervision. Due to the fact that most married women gave birth at home at the time, the Hospital had somewhat of a reputation: Johnstone recounts how “to protect these respectable women from embarrassment, entrance to the clinic was arranged from an unfrequented side street, and I well remember the great consideration that had to be given to their modesty in putting up an unobtrusive and discreetly worded direction-board.”
LHB3/7/71 - Annual report, 1915

And so, Britain’s first ante-natal clinic opened its doors in 1915. This coincided with the Midwives (Scotland) Act of 1915, which made training, examination and registration for midwives compulsory. Prior to this, many women working as midwives had become ‘certified’ - that is, obtained a certificate confirming their training in a hospital - but most were still without formal training.

The Midwives (Scotland) Act also saw the introduction of the Central Midwives Board in Scotland (CMBS), which recognised three categories of midwife at first: those who had taken and passed the CMBS examination; the ‘certified’ midwives who had previously obtained a certificate; and the ‘bona fides’, women who were enrolled “by virtue of bona fide practice”. This last category covered women of good character who had been in practice as uncertified midwives or howdies for at least a year. Although they could be enrolled without examination, one third of those taking the first CMBS exam were already on the roll as bona fides. As Dr Lindsay Reid explains in her book Midwifery in Scotland: A History, midwifery before 1915 was “alegal”, with no qualifications to meet, and no regulations or licensing requirements. The passing of the Midwives (Scotland) Act of 1915 gave new status to this group of women, some who had been formally trained, some of whom had been working with the benefit of knowledge passed down through generations.

The theme for this year’s International Day of the Midwife is ‘Midwives, Mothers And Families: Partners For Life’. By moving the focus away from the act of labour itself and onto the general health of the mother leading up to birth, Dr Haig Ferguson put in place the approach to maternity care that has led to this partnership; similarly, the decision by the CMBS to acknowledge the role that uncertified, locally-respected howdies occupied in the community ensured that those who might otherwise be reluctant to seek formal medical care were still being seen by an ‘approved’ practitioner. These partnership have now extended beyond the moment of birth, and in the words of the ICM, “midwives everywhere understand that by working in partnership with women and their families they can support them to make better decisions about what they need to have a safe and fulfilling birth”.