Friday, 17 November 2017

TB through the Lens

Throughout our on-going TBv.RVH cataloguing project here at LHSA, we have been blogging about various aspects of the history of the disease particular in the context of our TB patient case notes. Find out more about diagnosing and treating TB, the Edinburgh Scheme, the Royal Victoria Dispensary and Hospital (RVD and RVH) the BCG vaccination, Mass Miniature Radiography, TB case notes and even more at our blog site. TB was a major public health threat but throughout the twentieth century there were lots of interesting developments in preventing the spread of the disease. This is conveyed in case notes that I am cataloguing from the late 1950s but we are also lucky to have a fantastic collection of slides and photographs relating to TB. They provide another insight into the history of the disease and can take us even further back in time ...

Image 1 c.1902

Image 2 c.1908
These first two images show the block plan for the extension of the Royal Victoria Hospital in Edinburgh and a view of the building. The RVH was founded in 1894 and formed part of the foundation for Robert William Philip's 'Edinburgh Scheme' to combat TB through prevention, detection and treatment. The hospital started with 76 beds and patients were sent here for x-rays and treatment. This scheme was an early success in the fight against TB, reflected in a decline in mortality rates, and paved the way for a legislative drive to notify those with the infectious disease.

Image 3 c.1923

Image 4 c.1900
Images 3, 4 and 5 demonstrate TB patients in what was the only method of treatment prior to the antibiotic treatment of the 1940s and 50s. Fresh air and bed rest was recommended as we can see from these pictures, that come from Edinburgh hospitals and Southfield Santorum. Establishments were well set up to provide exposure to the open air for patients, with outdoor beds and shelters. As a patient's condition gradually improved, exercise and occupational therapy was introduced, or as we see in image 5 children received lessons on the roof garden. 

Image 5 c.1930

Image 7 c.1952

Image 6 1952

Work began to develop a vaccination against TB in the early 1900s but it was not used on a wider scale in Scotland until the early 1950s, known as the BCG vaccination. It worked by injecting the body with a weakened form of the disease so the immune system could recognise and defend against it. BCG vaccinations were given to children and young adults in close contact to TB sufferers, providing they themselves had not been infected with the disease. Mass campaigns were brought to communities to educate people on protecting their families with the vaccination, an example of which, in image 7, shows a BCG exhibition. Amongst the TB patient case notes that I am cataloguing I have come across many pregnant women notified as having active or inactive TB. Many comments are made by the doctors on the birth of healthy babies but it was clear that vaccinating them against TB was a priority as early as possible, shown in image 6.

Image 7 c.1920

Most commonly we associate TB as an infectious disease that most often affects the lungs and respiratory system. However, amongst the case notes we have found many instances of TB infection in other parts of the body. Thankfully we use a very helpful resource called MeSH (Medical Subject Headings), a controlled vocabulary thesaurus for medical terminology. We not only use this for indexing but it is also useful to inform the 'non-medical archivist' about complex medical conditions and treatments. It has been particularly useful to differentiate unfamiliar types of TB. So far we have uncovered 18 differed types of TB throughout the case notes, such as: tuberculosis of the skin, called cutaneous TB; laryngeal TB, involving the larynx which can produce ulcers on the vocal cords; ocular TB, an infection of tuberculosis in the eye; and genital TB which can affect both the male and female reproductive tract. In image 7 we see a patient suffering form long term spinal TB. This usually occurred because of a complication of lung TB moving through in to the vertebrae.       

These are just a few snapshots that I have picked out form our collections that allow us to focus on different events and developments, specifically in Edinburgh’s fight against TB. Even more LHSA TB images can be accessed through online platform SCRAN. Here you can also search through various Scottish perspectives in the history of TB from many other contributors.

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