Tales from the Archive (3): Women and the Royal Infirmary of Edinburgh, 1870-1950

This was a period of huge change in medicine, and with the opening of the then brand new building at Lauriston Place in 1879, the Royal Infirmary of Edinburgh (RIE) was at the forefront of healthcare in Edinburgh. At this time, not one but two revolutions were underway for women associated with the Infirmary: radical changes to nursing and the challenge for women to receive medical training.

Nurses

Florence Nightingale’s Training School for Nurses at St Thomas’ Hospital in London was opened in 1860. This introduced a greater degree of professionalism to nursing, turning it into a career for educated women. There was a movement to formalise procedures and create high standards for all nurses to attain. Taking note of these changes, the managers of the RIE instituted a probationary period of training and a higher wage to attract “a better class of woman” to the profession. A Lady Superintendent of Nurses, Elizabeth Barclay, was appointed in 1872, and the RIE Nurse Training School was founded in the same year. The School gained an excellent training reputation, and RIE-trained nurses went on to take up positions all over the world.

Angelique Lucille Pringle, Lady superintendent of nurses, with a group of senior nursing staff ( Miss Ferguson; Miss Grant; Miss Reith; Miss FE Spencer; Miss Wade) at the Royal Infirmary of Edinburgh, c.1880 (P/PL1/S/257).

 

Female Medical Students

Whilst these changes in nursing were taking place, another set of women were fighting hard to overcome institutional barriers. Female medical students, led by Sophia Jex Blake, recently given permission to receive a medical education at the University of Edinburgh in 1869, were effectively prevented from completing their training when the RIE refused to allow women the clinical instruction necessary for qualification. Whilst a wider public debate raged on the issue, Peter Bell, clerk to the managers, sent a letter to all medical and surgical staff asking whether they were in favour of admitting female students on the same terms, and at the same times, as male students. Of the 19 responses we hold in the Archive, only three were in favour. William Walker’s letter typifies the response of the majority; not only did he think that examination by a mixed class of students would be “repugnant to patients” but also that “many examinations and operations are offensive in nature and could not be undertaken before a mixed class without violating the feelings of propriety and decorum”. Despite this, in December 1872, the Board passed a motion to allow female matriculated students of the University to receive clinical instruction but at a separate hour to the male students and only in certain wards. They were not permitted to view post-mortems, to see major surgical operations, nor to act as clerks and dressers.

William Walker’s letter (page 2) (LHB1/73/1/7).

 

Female Medical Graduates

This did not deter an increasing number of women from gaining medical degrees. Over time, female medical students achieved more concessions and larger numbers of women began to apply to study medicine. During the First World War, there was a sizeable increase in the numbers of women matriculating as medical students, rising from 106 (versus 962 men) in 1914-15, to 373 (versus 1,310 men) in 1918-19. Provision was made at this time to, as far as possible, allow instruction on the same basis as men. Medical and surgical staff were depleted, some on foreign service and those at home were overworked, often doing extra work in the war hospitals that had sprung up in the city. It was not until 1927, however, that female medical students were able to obtain clinical instruction on medical wards in mixed classes. And it would be a further nine years before the same was true of the surgical wards.  Differences were highlighted in not so subtle ways as the syllabus booklets below show.

 

Syllabus for the use of Male Students attending the Royal Infirmary of Edinburgh, summer term 1925 (LHB1/113/1/1).

Syllabus for the use of Female Students attending the Royal Infirmary of Edinburgh, summer term 1925 (LHB1/113/1/2).

 

Residency at the RIE

As well as being able to receive clinical instruction and graduate in medicine, women wanted the right to apply for residency at the RIE. After graduation, a medical student had to serve a practical apprenticeship. To do this, he or she had to obtain an approved appointment as a resident House Officer in a hospital. Residencies at the RIE were considered to be prestigious, although before 1948 the position was unsalaried. The usual period of service was six months, rising to 12 months in 1950, six of which were spent attached to medical wards, and six to surgical wards. Although female residents were admitted from the 1920s, they were not permitted to live in the Residency itself. In the 1940s, this led to another fight for the female residents to be allowed to live in the Residency ‘mess’ (the residents lived within the Infirmary building in the Residency, each new intake forming a separate ‘mess’). The Residency contained a sitting room and a dining room as well as bedrooms. Food was supplied from the Hospital kitchens. A letter from 1945, written by the mess secretary, shows that a proposal to allow women to live in the mess was not very popular. In fact, they viewed it “with much concern and annoyance”. Women did eventually win the right but were allowed access to only one bathroom upstairs and were not permitted to attend the two annual formal dinners!

It’s easy to take for granted the standards of service we have in nursing today, and the equality of opportunity for men and women to obtain medical training. This has not always been the case and we owe a debt of gratitude to those first women who paved the way and challenged societal norms.

International Women's Day 2025 #AccelerateAction

To mark International Women’s Day and Women’s History Month, we delivered a presentation for NHS Lothian’s Women’s Network to highlight the instrumental role of two pioneering women who held very different roles but whose career paths converged in the mid-1980s to tackle a major health crisis. The theme for this year's IWD is #AccelerateAction and, with this in view, Dr Helen Zealley and Dr Jacqueline Mok played an essential part in establishing a response to critical issues that affected the health and wellbeing of the people in Lothian.

Dr Helen Zealley completed her studies in Medicine at the University of Edinburgh. In the 1970s, she became involved with the emerging speciality of Community Medicine, specialising in Maternal and Child Health within the children’s service of the Edinburgh Public Health Department for 10 years. She was appointed Director of Public Health (DPH) – also known as the Chief Administrative Medical Officer (CAMO) – of Lothian Health Board, which later became NHS Lothian in 1998, and Executive Director of LHB in 1991, a post she held until her retirement. During her career, she encountered challenging periods for Lothian Health Board, such as initiatives to combat the high rate of HIV infection in Edinburgh and a financial crisis in the early 1990s.

As the Director of Public Health, Dr Zealley was involved, directly or indirectly, in all the developmental aspects of Lothian Health Board during the period. These included policies, strategic planning processes and frameworks, service provision, operational plans, efficiency savings, and auditing… all of which are evidenced in our archive.

LHB Smoking Policy, Promotional leaflet (GD25/1/1/1/2)

LHB Smoking Policy, 'Smoking Prevention, A Health Promotion Guide for the NHS' promotional booklet (GD25/1/1/1/2)

However, the hardest challenge she had to face, at least during the first years of her tenure, was the government’s white paper Working for patients published in January 1989. In short, 1990 was a year of significant change and turbulence for the NHS both nationally and locally since a new form of healthcare was established whereby health services and long-term care were to be planned and managed as a competitive market. Within this system, Health Boards were to assess the “health needs” of the population for which they are responsible and place contracts to “purchase” services to meet those needs from a range of “providers”, both locally and on a national basis, who were responsible for the day-to-day management of these services. NHS hospitals and clinics were also given the opportunity to opt out of their direct management links with Health Boards and form “self-governing trusts”.

Pamphlets like this were created as a response to the government's 1989 White Paper (GD25/1/1/1/23)

Dr Zealley was not onboard with this new form of healthcare as the right means to achieve improved service delivery and provision within the NHS. As she stated in a letter written to an external healthcare agency, ‘my problem is that I do not believe that the purchaser/provider split is a useful mechanism to achieve this – and I am deeply distressed by the signs of “competition” between our provider units amongst whom we have spent years developing a collaborative, integrated approach so that patients receive the most appropriate “package” of preventive, acute and rehabilitative care – irrespective of the provider of each component’. While she expresses a clear openness to change, she opposes the privatisation of health services. Dr Zealley was a leader, an influential woman, and a real decision-maker. Yet, although she held a prominent position within the structure of LHB, decisions dictated by the higher ups, or the Tory government in this case, escaped her control.

Excerpt from Dr Helen Zealley's letter to an external healthcare body in response to the government's White Paper (GD25/1/1/1/23)

Cartoon published in a newspaper critiquing the government's White Paper (GD25/1/1/1/23)

The reform resonated across the UK and received substantial media coverage, leading, unsurprisingly, to major disagreement and backlash from the Labour party. Their main claim was that the government’s ‘ideologically-driven view of healthcare as another commodity to be bought and sold in a marketplace, rather than a public service’ sought to benefit only a small portion of the population. While aspects such as poverty, unemployment, poor housing, and a polluted environment are essential to determine people’s health, the two-tier system established in the early 1990s resulted in that two patients with the same disease living in the same street and the same circumstances could be treated differently depending on what particular type of doctor they happened to have. This may well give an idea of the convoluted scenario in which Helen Zealley worked during the 1990s and how her role was impacted by the country’s political fabric.

Cover page of The Edinburgh and Lothians Post (published on week ending Saturday, 19 October 1991) (GD25/1/1/1/23)

Page from BMA News Review (January 1990) (GD25/1/1/1/23)

A few years before this, Dr Helen Zealley joined forces with Dr Jacqueline Mok to address the HIV/AIDS crisis affecting Edinburgh from the mid-1980s. Originally from Malaysia, from where she came from to complete her Medicine studies in Edinburgh, she was a Paediatric Consultant for Community Health, Lothian Health Board, as well as a member of the Royal College of Paediatrics and Children’s Health. Her research mostly focused on HIV and AIDS in infants and children, with a particular focus on mother-to-child transmissions. She worked extensively on research for HIV therapies that are not only safe for children, but also for expectant mothers. Her research expanded beyond HIV-infected children to include HIV-affected children. That is, children whose mothers were HIV positive. Dr Mok started a clinic for HIV-infected children at the City Hospital in the mid-1980s, the first of its kind in the UK. The clinic moved from this space and was granted use of Ward 8 (Ward for Infectious Diseases) at the Royal Hospital for Sick Children.

In October 1985, she was asked by Dr Helen Zealley to look after children born to women with HIV infection. At this time, Edinburgh was the first city in the UK to recognise that HIV could affect the non-gay community and that it was drug use that resulted in heterosexual spread; a third of drug users being young women of reproductive age. The uniqueness of Edinburgh in comparison to other places was that many young heterosexual men and women were HIV positive, but not ill.

Reducing Mother to Child Transmission of HIV Infection in the United Kingdom, April 1998 (GD59/1/2/3/2)

Dr Mok travelled to New York, New Jersey, and Miami to learn about the services that had been set up in these places, which were described as paediatric AIDS by Dr Arye Rubinstein in 1983. He established that transmission of AIDS can occur in utero and published his findings in 1986. After her trip, Dr Mok acknowledged that the HIV/AIDS programme in Edinburgh could benefit from her respiratory background since many children would present with pneumocystis.

The first reports of paediatric AIDS in 1983 talked about an acute life-threatening illness with a high level of mortality. When they eventually got that link of mother-to-child transmission, it was thought to be as high as 50% to 80%. It was almost certain that if you had a mother with HIV, you were likely to be infected, and then if you were infected, you would be dead within the first 5 years of life. However, paediatric AIDS turned out to be a long-term condition and not every child was going to be infected. The transmission rate they found from mother-to-child was less than 10%. And from those children with HIV in Edinburgh, many of them were very well, even before the days of antiretroviral therapy.

On the other hand, Jacqui encountered some adversity within NHS staff. When she was asked to set up a clinic for these children, a colleague told her, “Well, I hope you don’t share their cups with them, Jacqui!”, whereas somebody else asked her to keep the clinic at City Hospital as opposed to Sick Kids, where she was based at the time. This gives an idea of the high level of anxiety experienced by everyone. It was all doom and gloom. Nothing was known about transmission, which could be relatable to those who didn’t live through this crisis, but experienced the Covid-19 pandemic.

Community Child Health Research Report (GD59/1/1/5)

At the time of establishing this clinic at City Hospital, there was only one Ward for Children and all paediatric trainees were at Sick Kids with no rotation into City Hospital. Dr Mok would be called because they had no junior doctors who could assess the children. To exemplify, if they needed an intravenous infusion, she had to go and do it herself because the trainees were adult-trained. As for her team, it consisted of Dr Mok (half time), an MRC- funded research fellow for 3 years who was then replaced by a trainee, a paediatric trainee, a full-time health visitor, and a secretary working 17.5h. They were eventually joined by an obstetrician and a specialised midwife as well.

In 1989, she attended her first HIV international conference and as a result of meeting other paediatricians and epidemiologists, they started the European Collaborative Study (ECS), for mother-to-child transmission of HIV. In its hayday, Dr Mok received referrals from Edinburgh and the Lothian, Fife, Tayside, the Borders, the Highlands and Islands, and even northern England.

The Public Health Challenge, Outline Programme (GD25/1/2/2/2)

Excerpt from The Public Health Challenge, Outline Programme (GD25/1/2/2/2)

 

In the early days of the European Collaborative Study, she was always having to justify herself every time she was asked, “You’ve only got 150 children, why are you needing so much time?”. However, each child needed follow-up at one week, three weeks, six weeks, and then six-weekly until six months, three monthly until aged 2 years, and then six to twelve monthly. The reason for this was that they were looking for signs of infection.

They also had to speak to the mothers in the ante-natal period to seek their consent and explain the purpose of the study, and they all were very thankful that somebody was interested in them and their children. Our colleague, Louise Williams, who’s Archivist at LHSA, did an oral history interview with Jacquie Mok and Helen Zealley in 2018. In the interview, Dr Mok recalls that when women ‘were recognised to have HIV during labour, people would come into their rooms dressed in what they call “space-suits”, and then auxiliaries would open their door, put their meals in and then shut the door and run off’. Likewise, Dr Zealley confessed that it was ‘understandable that there was fear and there was a lot of blood and a lot of unknown’.

AIDS Guidelines for Social Work Personnel, December 1985 (GD59/3/2/2)

We often think of the role of medical staff from a clinical perspective. But, while Dr Mok was facing an unprecedented challenge, other associated challenges added pressure to her role: the human element. Jacqui ran community-based sessions. This means she didn’t wait sitting in her clinic for parents to show up. She proactively visited households to examine her patients and this involved encountering all sorts of situations. She recalls that mothers were always grateful for her visits and would comply with anything she asked from them. Many of these women were on their own, whereas, in other instances, Dr Mok would see a man in the house and assume he was the father without asking any questions. Fathers may or may not join their partners for the visit. It was rather common that they left the room during the blood-letting as they couldn’t stand seeing how the medical staff inflicted pain on the baby by putting a needle into their veins. Likewise, there were cases when they ended up shouting at her after trying to extract their baby’s blood several times.

The Sunday Times - "Born survivor", 15 February 1998 (GD59/1/2/1/2)

The Sunday Times - "Learning to live with the HIV virus", 15 February 1998. The page displays a photograph of Dr Jacqueline Mok (GD59/1/2/1/2)

Many of the mothers saw the birth of their child as an opportunity to stop using drugs, although there would still be mums who would continue to use them. At the time of the visit, Dr Mok wouldn’t know what state they would be in. They could be awake, or not, and there was no way to tell whether they would cooperate.

In those cases where women were deemed unfit to be parents due to their ongoing use of drugs, Dr Mok had to work with social workers and foster carers. For this purpose, she ran special training sessions to educate them about the needs of infected children and the risks they presented to their families. Some of these children ended up going to school and because of confidentiality, Dr Mok’s team didn’t disclose that a child was HIV-positive and, by extension, that the mother was positive too. Instead, they implemented a universal management of children who could be infected approach to every school and nursery, which was a success.

The case of Aileen Ballyntine received plenty of media attention and made Dr Mok realise that they might have more children affected by HIV rather than infected by HIV. Ten years down the line HIV-infected parents were getting ill, before antiretroviral therapy, and they would develop pneumocystis or suffer from encephalitis. Disclosing their secret to their children was a very sensitive thing for the mothers to cope with. A lot of these women, because of their drug use, didn’t have a support network and had distanced themselves from their families. They lived dysfunctional lives and were very unsupported. Others would have parents who rejected them. A ‘you brought it on yourself’ kind of situation. Some grandparents took care of the children instead of having them become fostered or adopted. In this scenario, many children born to HIV-positive mothers had behavioural problems, in particular during their adolescence, as this seemed to be the time when many of them found out their mum was going to die.

The Sunday Times - "Letting go of mum", 15 February 1998 (GD59/1/2/1/3)

The Sunday Times - "Families living on borrowed time", 15 February 1998 (GD59/1/2/1/3)

In the oral history interview, Dr Mok remembers one particular case of a child who turned out not to have HIV. The grandfather was desperately trying to do everything right for his granddaughter, feeling they had failed their daughter in the past and were trying to make amends. His wife became very ill and he brought the little girl to Dr Mok since he couldn’t take care of simple things such as giving her food because he couldn’t cook. He had relied on his wife all his life to raise their children and now felt powerless. In other cases, parents could not gather the courage to explain to their children why they were having their blood taken over the years and asked Dr Mok to speak to them. There is even a mention of a case when the father wanted to find and kill the person who gave his wife HIV after she was diagnosed with it. Dr Mok wore many hats. She was an HIV-specialist doctor, a counsellor, a social worker…

The mothers’ social spectrum remained a constant during these years. Unless children were fostered or adopted (this would be by more structured families), children would grow up within a disadvantaged and dysfunctional family system. It was in areas like Craigmillar, Niddrie, Muirhouse, Pilton, and Leith where HIV hit hard. We may think of Leith, for instance, as this trendy part of Edinburgh nowadays. A place with a lively cultural scene and full of nice cafes, bars, and restaurants. However, the reality was way different during the mid-1980s and early 1990s. Think of Trainspotting.

Some of the children from Dr Mok’s cohort became mothers themselves and coped with varying levels of success. Many mothers continued to lead an equally dysfunctional life and parenthood didn’t change that. Many of them are part of a cycle, or a loop, that goes round and round as that’s how their children are raised. They know no different and follow what their mothers say and do. Just like any other kid. But, to conclude on a positive note, Dr Mok stated that those cases who managed to break the cycle of deprivation managed to do well for themselves.

Disability Livelihood and Employment (3): The one with Tyne Lodge, the National Coal Board Medical Service, and Dingleton Hospital

In this week's blog, we're exploring three distinct records reflecting on disability livelihood and employment to say goodbye to this series.

In 1955, Tyne Lodge, the first outpatient unit at Astley Ainslie Hospital, opened. New inpatient facilities included a model coal face provided by the National Coal Board to help with the rehabilitation of miners, and a model of the back of a bus so people could practice getting on and off.

Tyne Lodge General Register of Patients, 1955-1973 (LHB35/4/3/1). Sample page showing the range of disabilities and health conditions of the Outpatient Unit.

The Tyne Lodge General Register of Patients records individual patients' attendances at the Rehabilitation Unit. Given the records cover the 1955-1973 period, they are classed as confidential and the images on this blog post have been redacted due to General Data Protection Regulation. Each line references the medical diagnosis of individual patients, while their disposal shows the patient's employment status after being discharged. It is worth highlighting two very different diagnoses that give a good sense of the variety of conditions treated at the Tyne Lodge Outpatient Unit.

 

DIAGNOSIS                                     DISPOSAL

Amputation rb. Leg mid thigh.          Light work. Second admission. Had a prior 20 

                                                         attendances between [dates redacted due to GDPR]

Hemipligia                                        To light job with some employers.

 

Hemiplegia is a very recurrent diagnosis in this volume. In its more severe form, it refers to the complete paralysis of one entire side of the body. It can result from a range of medical causes such as brain damage, trauma (injuries received through a fall, car accident, etc.), stroke, cerebral palsy, brain tumour, or diseases of the nervous system or brain. While the sample page above may suggest the unit focused on physical disability solely, mental health conditions are also reflected in its pages. The following image shows an instance where psychoneurosis was mentioned as a patient’s diagnosis. The record states that the ‘treatment has failed from a physical point of view but she is now attending Dr Macrae, psychiatrist, regularly for treatment’.

Tyne Lodge General Register of Patients, 1955-1973 (LHB35/4/3/1). The Unit did not exclusively focus on physical disabilities or health conditions. This page shows an example of a patient diagnosed with psychoneurosis.

The collection of National Coal Board Medical Cards (GD46) is a valuable source that provides insight into the numerous cases in which miners got injured or became physically disabled between the 1940s and 1980s. Amongst the most recurrent injuries and disabilities, there are mentions of slipped discs, punctured thumbs and big toes, strained backs and knees, bruises on feet/hands/arms, pustules on the knees, cut forearms/fingers, abrasion to fingers/legs/shoulder blade, jerked back/lumbar area, chest pains, and burst fingers. The medical card below shows the medical history of a patient who started to work as a miner at the age of 16 during the 1950s. They were diagnosed with 60+ injuries over a span of 20 years. Their medical history reflects the challenges associated with carrying out their work for decades in order to sustain themselves and provide for their family.

National Coal Board Medical Cards, 1940s-1980s (GD46)

The Dingleton Hospital magazine, ‘Outlook’, also reflects on issues around disability employment. This publication is an example of collaborative efforts between patients and staff that was described as ‘a worthwhile therapeutic venture’ by one of its readers. Its first issue was published in September 1963 and LHSA holds copies spanning the period from its inception until 1986. The first editorial column set the hopes and objectives for the magazine in the context of several changes taking place in the hospital at the time, both physical and in the approach to patient care. The editor wrote that, ‘It is with the idea of enlarging this brighter, and pleasanter community aspect of Dingleton that this magazine has been designed….We do not intend to fill this magazine with stuffy and high-brow technicalities, or to bore the readers with long unlimited surveys on medical history, but to fill its pages with good honest humour and humanity.’

Dingleton Hospital Magazine, "Outlook", December 1963 (GD30/15/1). The image shows an article titled 'Outside employment of patients' written by J. Smith.

Dingleton Hospital Magazine, "Outlook", August 1969 (GD30/15/1). The image shows an article titled 'Something About My Army Life' written by William Whitehead.

The December 1963 issue showcases the patient rehabilitation service delivered by the hospital. The author discusses the benefits of the professional scheme the hospital ran in partnership with Currie & Mills Ltd. Patients joining the scheme were exposed to a new environment and ideas while readjusting to a regular working pattern. The article points out that patients settled down quickly into the working routine with the scheme showing positive results for all parties involved.

Likewise, the August 1969 issue reminisces the challenges faced by WW2 soldiers through William Whitehead’s account. A war veteran at the time of publication, he discusses his partial deafness as a result of being shocked by an explosion in Algeria. Interestingly, Mr Whitehead continued to serve the army in the years to come by assisting with light duties in the cookhouse across different countries such as Italy and Austria.

Conservation (2): Condition Surveys and Re-Housing

Last month, we started a new series that explores the conservation work that cares for LHSA collections. LHSA has spent years establishing a conservation profile and now has an active programme of preservation and conservation work funded by the annual budget. Condition surveys are a pivotal aspect of this work and help us assess and prioritise items in need of interventive treatment and/or re-housing. In this blog, we look at why condition surveys are needed and sneak behind the scenes to enjoy some truly satisfactory before/after photographs of some of our re-housed collections.

Condition Surveys

A full understanding of the condition of the LHSA collections is necessary to inform priorities for preventive and interventive conservation treatment. To date, LHSA has carried out two National Preservation Office (now National Advisory Centre, NAC) Preservation Assessment Surveys; the first in 1999-2000 of the collection as a whole and the second in 2001 of the photographic material only. These surveys have helped establish and develop LHSA’s preservation and conservation programme and have provided supporting evidence for external funding applications.

Once priorities have been identified by the NAC Survey, more in-depth surveys of specific parts of the collections are carried out to determine which particular items need interventive treatment and/or re-housing, and to provide estimates for associated cost and time required. These surveys are not based on a formal model like the NPO Survey. Instead, the criteria for assessment and format for recording the data collated varies according to the type of material and proposed end use for the findings. Examples of this include a survey the Scottish Museums Council were commissioned to undertake in order to determine the condition of the object collection, and an in-house assessment to ascertain how far the repository met the specifications of BS5454:2000: Recommendations for the storage and exhibition of archival documents.

The survey data and written reports based on it are retained for comparison with future condition surveying in order to assess progress. The image below shows a bar chart from the 1999-2000 NAC Survey showing the anticipated impact of improved physical conditions for the collections: most items would be (2) low preservation need.

Re-housing LHSA collections

Many of the collections are accessioned with little, no or unsuitable housing, putting the items at risk of accelerated deterioration and/or accidental damage. LHSA has implemented a boxing policy to ensure that the collections will be provided with appropriate long-term housing. This will ensure that incident light damage and dust accumulation are reduced, ameliorate against any fluctuations in the ambient environment, improve handling and aid access. Boxing may also help ensure the most efficient use of available storage space.

Before and after: Correspondence from Jordanburn Nerve Hospital.

A range of standard size boxes and folders have been developed to meet the housing needs of the majority of the collections, particularly paper-based items in sheet format. Customised storage solutions for outsize items or those that have specific requirements, for example photographic material, are also provided. Wherever possible, re-housing is coupled with any interventive treatment required by the collection items.

Before and after: Object collection.

Original storage systems are kept where they pose no risk of damage to the collections contained. When replaced, written and photographic documentation of the original system is produced to record any additional information that would otherwise be lost.

Before and after: Patient index cards.

Before and after: Glass plate negatives.

Collections to be re-housed are prioritised according to physical vulnerability, demand for access and historical importance. The highest specification materials within the available budget are used and principles of best practice are adhered to. On entry, all new accessions are assessed and re-housed as necessary, and work continues to provide all collections with suitable secondary protection.

Tales from the Archive (2): Miners and the Royal Infirmary of Edinburgh, 1900-1950

Patients and Funding at the Royal Infirmary of Edinburgh

The issue of how the Hospital would pay its ever-increasing costs was always pressing. The annual reports built a picture of the pressures it faced. During the period 1900-1950, ordinary expenditure always exceeded ordinary income. In 1900, ordinary income amounted to £30,009, whilst ordinary expenditure was £47,868. The report cites the cost of coal, lights, cleaning materials, ordinary repairs, wages, and the rising price of meat as reasons for the increase in expenditure.

As the prices rose, so too did the number of patients. In 1900, 8,914 new patients were admitted to the Hospital; the average number of patients in the Hospital on a given day was 701.

The annual report for 1939 specifically mentions the start of World War Two as contributing towards the large rise in the number of patients. It also cites the increase in the number of motor car accidents as a significant factor. By 1946, ordinary income had risen to £264,965 but expenditure was £350,108.

By the 1930s, the Royal Infirmary of Edinburgh was the largest voluntary hospital in Britain. Its policy of being ‘the Ever Open Door’ with medical need as the only criteria for entry, enabled it to appeal for voluntary contributions on the broadest possible basis. In fact, as early as 1900 the annual report noted that the Hospital was dependent to a large extent on annual income derived from contributions. Each parish in Edinburgh was listed individually and within this, each church, individual and firm which contributed £1 or more. Many wealthy benefactors left money to the Hospital in their wills and bed plaques were often commissioned to record this, or wards were sometimes named after particularly generous individuals.

To maintain this level of contribution, the Hospital had to have an organised system of raising money. As a result, in 1917 the League of Subscribers was instituted. At the same time, the area for collection was greatly extended with subscriptions from individual donors and parishes received from all over Scotland as well as England and Ireland.

The Miners

During the period from 9 May to 8 June 1928, 77 miners were admitted to the Hospital. Their admissions can be traced through the General Register of Patients. 21% were admitted due to accidents that had occurred in the mines; nearly two-thirds were diagnosed with chronic conditions. There were some admissions which cannot be categorised as either, such as typhoid.

Of those who were admitted with injuries, the most common were fractures and breakages of the tibia and fibula bones in the leg. This was followed by penetrating injuries to the eye and fractures of bones in the arm. There were also several injuries to the head, spine and ribs noted.

There was also a definite pattern in the types of chronic illness that the miners presented with.

These conditions are all associated with the bacterium H. Pylori; presumably contained in the dirt that they were inhaling.

If 77 miners were admitted to the hospital during one month, it is likely that up to 1,000 were admitted in one year. Given that the average cost per hospital bed per annum in 1928 was £149 18s 3d, the cost of the miners’ healthcare was not inconsiderable.

Royal Infirmary of Edinburgh, General Register of Patients, May 1928-Mar 1929 (LHB1/126/72).

The Hospital’s annual reports show that the miners were very generous in giving money to it. This was perhaps in recognition of the fact that many of them would require hospital treatment at some point in their lives. This generosity didn’t go unnoticed by the Hospital managers; in each annual report, they were singled out for praise. In the managers’ 1946 annual report, shortly before the Hospital was handed over to the NHS, the following comment appeared: “Many groups of employee contributors outside the membership of the League of Subscribers, including particularly the workers in the mines and the oilworks who have been so consistently loyal and generous in their support of the Royal Infirmary have again contributed in substantial measure”.

The money contributed by the miners was in addition to health insurance which the majority of miners had by the 1930s as a result of the 1911 Health Insurance Act. This covered the costs of their medical care. With one or two exceptions, the 77 miners admitted to the hospital in May-June 1928 were all members of an insurance scheme.

The connection with the miners continued beyond the establishment of the NHS in 1948. In the 1950s, miners were sent from the Royal Infirmary of Edinburgh to the Astley Ainslie Hospital, a rehabilitation hospital. It provided for those requiring longer care and supervision to fit them for a normal life.

The Astley Ainslie created a miniature mine within its grounds to rehabilitate miners. At this time, it was thought that as many as 1 in 4 miners were suffering from industrial injuries. The miniature mine enabled miners to regain their confidence and physical stamina and reacclimatise so they could return to work in the pits.  

After the introduction of the NHS, it was felt that the contributions from the miners should be commemorated with a plaque. It is slightly larger than the usual size, perhaps in recognition of the size of the contributions that the miners made from their own wages. Between the years of 1918 and 1948 (when the NHS started), the coal and shale workers had contributed over £408,000 to the Royal Infirmary of Edinburgh. In today’s money, that is approximately £11 million.

Photograph of the 'Narratives' opening (LHSA photographic collection).

This plaque is the centrepiece of the 'Narratives' installation at the Royal Infirmary of Edinburgh, on the first floor, north corridor between Wards 104 and 101. Links with the past are considered important at the hospital and although there is no direct link with the miners today, it was felt important to continue commemorating them and their efforts. 

LHSA Sources for Further Study

Royal Infirmary of Edinburgh (LHB1)

Astley Ainslie Hospital (LHB35)

Public Health Department of the City of Edinburgh (LHB16)

 

 

Spotlight On… (3): Class ticket signed by Joseph Lister, 1876

Below is a class ticket issued to Mr Thomas Preston Lewis and signed by Joseph Lister.

Class ticket signed by Joseph Lister, 1876 (GD1/3/4).

Joseph Lister (1827-1912) had become Professor of Clinical Surgery at the University of Edinburgh in 1869. He was given fifty beds to supervise at the Royal Infirmary which at that time was still at its site at the bottom of Infirmary Street. His research into the use of carbolic acid to prevent infection during surgery had already gained him a considerable reputation and he continued his pioneering work while in post. 

It is testimony to Lister’s popularity with his students that, on being offered a post at King’s College London, 700 of them signed a petition to encourage him to stay in Edinburgh. He chose to take up the new post, however, and the winter session 1876-1877, for which this class ticket was issued, was his last in Edinburgh.

Disability Livelihood and Employment (2): The Register of the Outdoor Blind

Content Warning: This blog post contains derogatory terminology that wouldn't be used in present-day records and can be distressing.

In his book Hearing Our History, Iain Hutchinson frames the concept of the ‘outdoor blind’ as the ‘people with sight loss who lived in the wider community rather than in institutions such as Edinburgh’s blind asylum’ (2015, p.1). These Registers listed blind men and women living in local communities, gave basic information about their work circumstances, and granted aid. Many people listed in the register were elderly and frail, whereas others were employed in some way.

Hutchinson explains that ‘the Society for the Outdoor Blind focussed on teaching people with sight loss to read raised type and this was primarily so that they might access religious works. The system of raised type that was promoted was the Moon system, although by the Edwardian period the society had also embraced braille and therefore offered instruction and library facilities in both methods of tactile print’ (2015, p.2). The image below shows a female register recording information concerning their age when sight was lost, the cause of the blindness, and their previous and present (at the time!) employment. While the Register shows numerous gaps, it still provides a sense of the wide range of occupations women held before and after they lost sight.

The Register of the Outdoor Blind, 1903-1910 (GD52/9).

Some of the occupations mentioned in the volume before women lost sight were servant, Bible woman, sewer, nurse, mission worker, dressmaker, charwoman (a dated term for a female cleaner), chemical worker, kept house, book sewer, poor house matron, school pupil, and mill worker; whereas the terminology or jobs listed after losing sight offer an apparent contrast in most instances: unable, knitting, unemployed, infirm, keeps house, none, labourer, small shop, bedridden, helps in house, mangle turner, on street. There is also a mention of a woman who worked as a music teacher.

Occupations performed by men covered the whole spectrum of trades and traditional jobs. Before losing sight, some of their professions were hawker (a door-to-door seller), collector, clerk, carpenter, plumber, mechanic, baker, jeweller, shoemaker, labourer, tailor… It very much covers the whole spectrum of traditional trades. While the job or terms listed after they lost sight are radically different and include hawker, on street, selling tea, not able, unable, nothing, street reader, mattress maker, bakers shop, infirm, sells fish, musician, pedlar (a dated term for a travelling salesperson), sells tea, piano tuner, street music, unemployed.

Instructions for filling out the Register of the Outdoor Blind, from the Royal National Institute of Blind People collection (GD52/9).

Interestingly, tea sellers and mangle turners were approved in Edwardian Edinburgh, whilst street musicians were not. People who earned a living ‘on the street’ were considered to not be engaging in a respectable form of ‘self-help’. Neither were musicians or oratory readers of raised type. Musicians would perform on the street, in public houses or music halls, all of which were places that didn’t present the image of blind people that the missionaries to the outdoor blind sought. On the other hand, music teachers, piano tuners, and organists were highly regarded. The first two could end up working in the homes of respectable middle-class families, whereas the latter would perform in places of worship. Some people underwent drastic career changes. Knitting was the main employment for women, whereas a high number of men worked as hawkers with different levels of success. Selling tea was the most remunerative option. For instance, there is evidence of a tea seller who was a miner prior to losing his sight. While he was widely respected for his ability to develop his business, he earned considerably less than he had earned as a coal miner.

You can learn more about the Register of the Outdoor Blind here.