Let’s talk about…SEX

This week, Project Cataloguing Archivist Clair talks about what she's been finding in her case note collection...

As has been mentioned in previous blogs I am working as part of the wider University Collections Facility rationalisation project to continue cataloguing work on some of LHSA’s case note collections. In particular, these are sexual dysfunction case notes from the Gynaecological Out-Patient Department at the Royal Infirmary of Edinburgh (RIE) which date from 1973 – 1994. We have around 1249 individual patient case notes from this period, and I have had the opportunity to learn from this primary source about the types of medical conditions and treatments that these patients experienced. This is an important collection because it is a very different medical specialism in comparison to other case note collections that have already been catalogued at LHSA. The case notes come from a more modern period and are structured slightly differently, which is reflected in their content. The circumstances relating to sexual dysfunction were often a combination of physical and psychological conditions and required a different medical approach.

The history of sex and sexuality is an area in which I have done a little studying before, but reading through the case notes has given me another perspective of both sexuality within a medical context and the relationship between sexual activity and physical and psychological health. Gaining insight into any topic relating to sex is interesting because of its importance to the human existence, being such a natural part of the human condition, yet historically the freedom to discuss sex and sexuality has been inhibited by values and beliefs through the ages. Although the sexual dysfunction case note collection covers a relatively late period, they give us a snapshot about how discussions surrounding sex and sexual identities are constantly evolving. In reading the case notes, I have reflected on my visit to the ‘Institute of Sexology’ exhibition at the Wellcome Library in 2015, which revealed a vast and varied selection of archival material, art, film and artefacts tracing the evolution of the way in which sex is studied. The exhibition showcased the work of many key sexologists including Sigmund Freud, Marie Stopes and Alfred Kinsey and showed how they lifted sexual taboos, developed a legitimate area of study and created a place for sexual health within mainstream clinical practice. Although the exhibition is finished, here is a short film of what was a fascinating tour.

Throughout the period reflected in the case notes (1973-1994), there are a broad range of issues addressed at the sexual dysfunction clinic. Many common medical conditions (for example, dyspareunia - pain during intercourse - or erectile dysfunction) were documented, and could often be treated successfully with a course of sexual therapy, drug treatment or, frequently for women, a minor gynaecological surgical procedure. However, the case notes also demonstrate that many sexual problems faced by patients manifested within the context of sexual relationships. Common sexual issues could be directly related to stressful relationships, living conditions and occupations, as well as ignorance or fear of sexual feelings. Some of the content of the case notes was upsetting to read because some of the patients had gone through traumatic experiences. Moreover, social attitudes towards sexuality or lack of sex education was sadly a common factor for many patients that came for help, who feared that they were sexually 'deviant', or risked being stigmatised because of their ‘unconventional’ sexual feelings.

Sexual problems categorised as a ‘dysfunction’, including frigidity, sexual unresponsiveness, loss of libido and orgasm disorders, were regarded as symptoms of emotional, psychological and personality disorder and thus were often treated thorough a course of sexual/marital/couples or individual therapy. Each patient visiting the clinic presented their own set of very personal and specific problems, so it is difficult to generalise or pick out cases that are representative of many. However, below are redacted extracts from two of the case notes that provide an indication of the complexity and array of deep-rooted issues experienced by patients.

PR1.552 (1)

PR1.552(2) These extracts come from the same file and show how attitudes towards sex and sexual feelings can be established from an early age and the way it was often seen as a taboo subject. Negative connotations of sexual activity as wrong or dirty appear as problems for many patients amongst the case notes. Bad feelings about sex often inhibited patients to form loving, healthy sexual relationships.   



PR1.555 This extract reveals the difficulties that some patients faced surrounding sexuality and gender identity.

 Patients were often referred by their GP or could make a direct appointment to be seen by one of the specialist at the sexual dysfunction clinic, based within the Gynaecological Out-Patient Department at the RIE. Key figures in the Department were Dr John Bancroft, Psychiatrist, and Philip Myerscough, Consultant Gynaecologist. Although I have struggled to find out more about Myerscough and his career, it appears that after Bancroft’s time in Edinburgh he became Director of The Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University. His research and work can be found spans many titles, including Human Sexuality and its Problems (1983). From a quick skim of this book, one can see reflections of his working practice and ideology seen in the case notes. Although it is often recorded that patients were too embarrassed to attend their appointment at the clinic or came in secrecy for fear of others finding out, the progressive nature of physicians such as Bancroft and Myerscough made many patients feel at ease. In his book Bancroft describes the feelings that many patients have which contribute to their sexual problems, including anxiety, anger, insecurity, guilt and low self-esteem. This level of understanding of all factors that affecting patients and his impartial approaches are revealed in the case notes, particularly when treatment programs or courses were tailored to meet specific patient needs.

Cataloguing these case notes using a similar methodology to other LHSA case note cataloguing projects has been really interesting because of the trends that can be spotted over time and the impressions that can be gained about a particular topic. Dr Gayle Davis, Senior Lecturer in the History of Medicine at the University of Edinburgh, used the sexual dysfunction case notes before they were catalogued for her research into the medical response to infertility in late 20th century Scotland. Therefore, we already know that there is an interest in using this primary source material and we can aid research by creating catalogues as a better way in to the collection. We hope that the way in which the case notes are described in the catalogue will help to highlight other potential areas of interest to the research community. The case notes can be explored without revealing anything biographical or medical which could identify those who were treated - this is not only important because of the information legislation surrounding health records, but also due to their sensitive subject matter.

This catalogue will go further in making our growing collections on sexual health, gender and sexuality accessible - collections that cover women's health and activism, reproductive health, LGBTQ+ health, HIV and AIDS awareness and the treatment of venereal disease.

Objects of mystery

Archivists like lists. We like box lists, catalogues, inventories. We like knowing what we have and where it is. This isn’t always straightforward, though, and sometimes things turn up that stump us all. For example, my first ever cataloguing assignment involved working with the papers of a prominent Scottish art critic. Two days in I came across an instruction manual for a radio. Was this an integral part of this critic’s routine? Did she listen to the radio whilst writing? Did she read the manual before she sat down to an assignment? Were there some particularly striking illustrations that she enjoyed looking at to put her in the right frame of mind? Or was it that the manual had just fallen in to the box before she’d loaded up the car and driven to the archive?

Deciding what to keep from a donation or accession is a process called ‘appraisal’, which involves assessing the value of materials according to pre-agreed criteria – although what ‘value’ means is a very contentious and much debated issue! Sometimes, we have to take things in without being in a position to make informed decisions about their value. As we’re seeing more digital media come into the archive in obsolete or hard-to-access formats like floppy-disc or Betamax tape, we can’t always be sure what is on them, so sometimes we agree to take them in on the assumption they will be of value. Other times, it’s not accessing the information that’s the problem – sometimes we simply don’t know what an item is!

The LHSA objects database is a good example of this. Broadly speaking, archives tend not to collect objects - this is more the purview of museums - but LHSA does hold over 1000 objects, ranging from badges and condoms to straitjackets and clocks. The collection includes around 300 medical instruments and implements, such as these wonderful drug cabinets:

M026 & M027 - Drug cabinets

With so many objects, it’s not too uncommon to come across entries in the database with the description ‘function unknown’. Now, my archivist’s brain finds this difficult to deal with and internally I’m screaming “everything must be correctly labelled and identified!”, but although we’ve come to know a lot about the history of medicine through working at LHSA, none of our staff are medically trained, and nor are we medical historians.

M250 - previously listed as an 'unknown device' from Leith Hospital 

Earlier this week, Twitter came to my rescue when Robert Culshaw (@RobertCulshaw) helpfully clarified that these mysterious and alien-looking metal items were in fact the two parts to an amputation shield, explaining “they go around the bone to retract the muscle out of the way ready to saw through it”.

Eep.

With that in mind, we’re calling on the expertise of our followers – can you help us identify some other instruments? We’ll be sharing photos of a few 'unknown' objects on Twitter over the weekend. Get in touch if you can help solve any of these mysteries! Here are two to get you started....

M202

M214

In which intern Emily says goodbye…

Well, the last 8 weeks have flown in and here I am writing my second and final blog post. 

Photograph of resected aneurysm

I have continued to catalogue and conserve Andrew Logan’s case notes. There are 477 in total, and the majority consist of a case summary and a duplicate copy, some included reports (such as pathology and post-mortem reports) and correspondence, sometimes from other doctors and others from grateful family members. One case note also contained photographs of a re-sected aneurysm, interesting and stomach-churning in equal measure. This provided an opportunity to learn another conservation skill. To protect the photograph and the corresponding case note, I was taught how to make a protective wallet using acid free paper.

After conducting a little more research I can now provide a bit more background to Andrew Logan, as promised. In 1948, Logan was appointed to establish the unit for cardiac and thoracic surgery at the Royal Infirmary of Edinburgh. It was around this time that rheumatic fever was prevalent, resulting in progressive damage to heart valves, particularly mitral valves. Many young and middle aged patients died from unrelieved congestion of the lungs. In response to this, Logan pioneered the use of a trans-ventricular mitral valve dilator for mitral stenosis. This method proved very successful and this is reflected in the case notes. The majority of the case notes related to mitral valve stenosis patients and the vast majority seem to have survived the procedure.

Dr Andrew Logan (c.1965) PLI/D/068

As an interesting side note, although he smiles sweetly in his portrait, the manner in which he ran his surgical was supposedly rather different. Apparently he preferred an autocratic and dictatorial style of managing. There are a couple of anecdotes to support this, however, my favourite has to be:

During surgery, when a registrar apologised for inadvertently removing a clamp from the aorta during a coarctation repair, Logan replied, ‘I should be the one apologising, I am the one who employed you’.
Perhaps his portrait smile is reserved for his bed-side manner.

As time passed, case notes became easier to navigate, in the sense that I was able to predict where I would find specific details of conditions or treatments for the catalogue. For the purposes of this project I was encouraged to use the Medical Subject Headings Browser (MeSH) produced by the U.S. National Library of Medicine to locate appropriate index terms for the catalogue. As well as this the Centre for Research Collections (CRC) have developed a collections management system that links an index term with an authority number. As LHSA have already catalogued a significant amount of clinical case notes, a great many index terms had already been established. I was taught how to search for and add new index terms to the collections management system if needed.

The conservation guidelines provided during training were very useful in getting started as I found the idea of rehousing a little daunting in the beginning. A major fear being that while trying to remove a paper clip I would inadvertently rip something in half. (Luckily no such crisis occurred.) I began the process quite slowly, as advised, following the guidelines and removing paperclips and flattening creases as carefully as I could. As my confidence grew, I made small changes to the process that would ultimately quicken the outcome. 

One of the aims of this project was to try and develop a method to enable future projects to catalogue and conserve at the same time. Because of the way it worked out with scheduling, by the time I got round to conservation training in my second week I had a considerable head start with cataloguing. I was about 100 case notes ahead by that time. I thought that rather than trying to catch up with myself, I would try and consistently split my time between conserving and cataloguing, so I was never more than 100 case notes ahead in cataloguing.

Before conservation and rehousing.

One reason I found this easier was that cataloguing before conserving allowed me to familiarise myself with the case notes and take note of any features that may pose a challenge.

After conservation and rehousing.

On reflection I would say that the project was successful. I was able to catalogue and conserve the case notes well within the allotted time. As you can see, in the ‘before’ image, case notes took up an entire shelf and their original state on the shelf was not ideal for long term preservation. In their rehoused state they are safe and secure, and they take up far less shelf space. This is a positive result for the University Collections Facility Rationalisation Project, whose aim is to make sure that collections held outside the main library are stored appropriately and accessible for the future. Also, learning conservation skills was very worthwhile as it now forces me to consider the needs of the physical document rather than focusing purely on the content.

I have not been glued to my desk for the entire internship. Other things I have been lucky enough to do over the last eight weeks include a tour of the anatomy school, a print making class, a visit to the National Records of Scotland, a tour of St Cecilia’s and much more. In my last week I have also been helping Clair catalogue Sexual Dysfunction case notes. This has allowed me to familiarise myself with a different kind of case note, and of course, another load of terminology to wrap my head around.

Working with LHSA has been everything I wanted it to be and more. I have learned invaluable skills working with an extremely interesting collection, and I have met many lovely people from variety of working backgrounds, all of whom have been extremely generous with their time. Conserving as well as cataloguing has significantly altered my perspective. When I look at records now, I will not only focus on their informational value, I shall also consider what measures I can take to ensure their physical preservation, and use my skills where possible to achieve that.

I think all that remains is to say thank you very much to LHSA for having me, it has been a pleasure and a privilege.

Found in translation...

This week's blog comes from LHSA's new intern, Kimyana Scherer. Kimyana's with us as part of the Employ.ed On Campus scheme, which offers paid internships to students throughout the University during their summer break. Kimyana's working on an exciting collection of personal papers - which have already become a lot more accessible through her German-language expertise! As you'll read below, she's made some fascinating discoveries:

Hello, readers of the LHSA blog!

My name is Kimyana and I am the new intern working at LHSA through the University of Edinburgh’s Employ.Ed on Campus scheme. I study English Literature and History at the University of Edinburgh and am going into my final year after the summer. I was drawn to this internship and working with the LHSA as I had taken a module in Modern Jewish History which ignited my interest in Jewish history, which I plan to make the topic of my dissertation. My bilingual upbringing by German parents is already proving an advantage in reading the old German documentation and script in the collection I'm working with. I've had little formal experience with archives, and think that many students are unaware that this fascinating discipline is a potential career path! The Centre for Research Collections and all its staff have been exceptionally welcoming in giving talks and tours of their departments and stores, including Rare Books and Art Collections – I find the interdisciplinary, varied nature of these jobs incredible!  

Sample of correspondence in Kimyana's internship collection (Acc15/001)

My work is on the collection of Dr. Ernst Levin (Acc15/001), a Jewish-German neurologist who emigrated from Munich to Edinburgh with his wife Anicuta and their daughter Annakathrin before the Second World War. LHSA received a donation of twenty large boxes of personal archive material including very old photographs (some of which predate the turn of the twentieth century), hundreds of letters, some medical case notes and personal items. My task is to gain an insight into the lives of Ernst and Anicuta through the closer study of their correspondence with family and friends across Europe in the years of the Weimar Republic and beyond. 

An early picture of Ernst from his transport pass, when living in Berlin (Acc15/001)

The young Anicuta

Anicuta, who spent her early life in Bucharest as daughter of the wealthy Belau family, ran in bohemian and artistic circles and had an interest in fashion and drawing, as evidenced by photographs of the group in costume dress and sketchbooks. 

Studio photograph of Anicuta, c. 1910s (Acc15/001)

Anicuta's sketch book showing her interest in costume and fashion (c. 1930s)

Through the eventual creation of an outreach resource, I hope to share this glimpse into a colourful and fascinating past with the public and demonstrate the value of personal archives and the documentation of personal histories. Archives are often necessarily filled with the documents and artefacts of the elite, a symptom of ‘great men’ history, yet the tracing of an ‘ordinary’ life across war-torn Europe provides an invaluable window into the context of history.

Sketches found in the collection so far (Acc15/001)

There have been challenges in working with such a large, mixed collection: not least of which is the difficulty in reading the heavily italicised script of individuals writing in the early 1900s. There are, however, ways to overcome these obstacles, such as by trying to date correspondence between individuals using stamps and addresses. Photographs, too, can be put in context by analysing the photographic paper on which it is printed or notes on the reverse.

Another interesting find.. Anicuta's school report, 1900s (Acc15/001)

Of particular interest were the passports of Ernst and his wife Anicuta, who travelled between Britain and Germany several times. Visas and stamps for landing permission in England are renewed several times over the course of 1936 and 1937. The rise in the Nazi regime’s prominence can be seen in the difference between the ‘nationality’ qualification in the 1929 passport and the 1939 one. In 1929, Ernst is qualified as a ‘Bavarian’ citizen; by 1939, he is a citizen of the ‘Deutsches Reich’, with a list of responsibilities of German nationals abroad glued to the inside cover of the passport.

We'll hear more from Kimyana as her internship goes on and she makes more fascinating finds...

T-360 days…and counting!

It was T-minus 360 days on Tuesday, so we’re a few days closer to the point at which we must comply with the new General Data Protection Regulation (GDPR). This is a piece of European Union legislation that was passed in 2016, and that will be enforced from the 25^th of May next year. (And it looks like Brexit won’t impact on whether we, in the UK, need to be compliant – if the UK wants to continue to share data with EU countries then we’ll need to meet the requirements of this new legislation.) The GDPR is designed to provide increased protection to personal data (anything from your name to your IP address) and give more rights to the individual over where their personal data is held and what it can be used for. For anyone who wants to find out more about GDPR there are handy intros on Wikipedia (https://en.wikipedia.org/wiki/General_Data_Protection_Regulation) and the Information Commissioner's Office website (https://ico.org.uk/for-organisations/data-protection-reform/overview-of-the-gdpr/introduction/).

And with this countdown in mind, and to learn more about how GDPR might impact on the archive, Tuesday was spent at a training day to prepare for GDPR and, what the conference organisers termed, ‘the regulation revolution’. It was no small challenge to attend, with a trek across the Greater Manchester area on a number 67 bus and a quick sprint down the side of a dual carriageway to get to the venue! But once there, there were lots of opportunities to learn about some of the detail in the GDPR and get some guidance on the next steps to prepare for May 2018. One of the most helpful talks gave three main pointers: 1. examine where you store data and where it goes; 2. determine the legal basis for holding any personal data and if you don’t have a legal basis, or the consent of the individual, then you can no longer hold the information; and 3. maintain a record of the decisions you make that support your compliance.

One of the key messages of the day was that if an organisation is already compliant with the Data Protection Act (which we are!) then they are already well on the way to being compliant with the GDPR. So all-in-all a useful day: educational and reassuring, oh and there were chips for lunch!