Wartime realities...

This week, our Project Archivist, Louise, talks about how Norman Dott’s case notes reflect the harsh conditions of the Second World War for those on the home front…

 

At present, I am cataloguing case notes created by neurosurgeon Norman Dott during the Second World War. During this period, Dott split his time between the Royal Infirmary of Edinburgh and Bangour General (Emergency Medical Service) Hospital in West Lothian. Dott had two surgical teams working to assess and treat military cases in Bangour whilst still working at the Royal Infirmary with civilian cases. Civilians would be assessed at the Infirmary and then transferred to Bangour for operation if one was needed.

 

The Royal Infirmary civilian cases might seem to be less gripping than the casualties of war treated by Dott at Bangour, but nothing could be further from the truth. Rather, they chronicle life on the home front and the unintended results of wartime necessity – they represent a different kind of wartime casualty.

For example, Dott commonly faced injuries sustained during the blackout, when a lack of street lighting could make a step off a tram hazardous and crossing the road after dark into a real undertaking. Inexperienced military drivers also created accidents and injuries. In this period, Dott treated a great many patients from reserved occupations, such as miners who suffered head and back injuries through accidents in the course of their dangerous work.

 

The war also had a clinical effect since even previously common medicines suffered from wartime shortages, and hospital staff members were stretched to the limit. In one 1944 case, a woman was described as “an indirect victim of the Second Front invasion” when her operation to reduce the pressure in her brain caused by hydrocephalus went disastrously wrong.  The Second Front invasion began on 6 June 1944, when Allied troops launched their invasion of occupied France in Normandy (the D-Day landings). The hydrocephalus operation also took place on this date. Half of Dott’s staff had left to meet expected military casualties on the previous day, and so the operation was left under-resourced. The patient died from pentothal poisoning, which had been administered as an anaesthetic for too long a period since the operation had been delayed by hours due to inexperienced theatre staff not making correct preparations for the procedure.

 

In these wartime case notes, the ways in which conflict touched people’s lives are ever-present, from mothers contacting Dott to urge him to write letters exempting their children from being called-up to accounts of evacuations, bombings and wartime home service. These details demonstrate the value of Dott’s case notes as records of strained social and economic realities – which could not help but effect clinical ones.

Image: GB237 Coll-32/A14 Dott (left) and Manchester neurosurgeon Sir Jeffrey Jefferson (centre) meet a Canadian medical officer at a meeting of the Society of British Neurosurgeons, 1944.

It's all about the WGH: accessions update

This week our accessions have all come from former staff of the Western General Hospital. They chronicle important developments at the Hospital which rather than being a general hospital in the traditional sense, has built up a number of specialist units such as the coronary and gastrointestinal units, and regional units for radiotherapy and neurosurgery. 

Regular readers will be familiar with the Norman Dott cataloguing project currently underway and we imagine that Project Archivist Louise will be delighted to return from annual leave to find 1950s Norman Dott letters and plans relating to the building of the DCN (Division of Clinical Neurosciences) Building which he designed! Papers and photos of physiotherapy training, and newscuttings relating to the professionalisation of physiotherapy make up this great accession.

 

Front cover of The Western Revue '66

On a light-hearted note, there is also an LP of The Western Revue ‘66, a musical show performed by staff for the small sum of £14 3s. 11 ½d, 3,268 cigarettes and 124 bottles of whisky.* One can only imagine the delights of the second act entitled ‘Urea’…and spare a thought for patients of the labour ward having to endure the ‘Labour Ward Lament’…

*apparently

Snapshot of reverse

Bangour Hospitals

During the late 19^th century, the problem of mental illness became more acute in Edinburgh and as the Royal Edinburgh Hospital (REH) became very overcrowded, so a new psychiatric hospital was proposed in woodland on the Bangour estate, near Uphall and Bathgate, some 14 miles from Edinburgh. The first patients were transferred from the REH in 1904 and Bangour Village Hospital officially opened in 1906; at this time most of the buildings were only of temporary construction. An array of various residential buildings, a shop and church were constructed on the site over a number of years.

The distinctive Bangour Village Hospital site, 1970s

From 1915-1922 and 1939-1945, the Hospital was taken over by the War Office for use by military patients. During this period, it is common in the records to see asylum patients being moved in groups from the Hospital to other asylums, and then returned after the wars. During the Second World War, an annexe of huts was built to house more military patients, which remained open to civilians after 1945, as Bangour General Hospital. Norman Dott carried out some of his pioneering neurosurgery work from here and his case note records are now being catalogued at LHSA, as reported in previous blogs. Other areas of specialist treatment developed at the General Hospital included tuberculosis, plastic and facio-maxillary surgery and thoracic surgery.

Bangour General Hospital, 1970s

In 1948 under the organisation of the NHS, the Bangour hospitals came under the West Lothian Hospitals Board of Management and from the 1950s, the Village Hospital took in patients from the West Lothian area as well as from Edinburgh.

In 1989, St John’s Hospital opened in Livingston and services began to be transferred there from Bangour General Hospital, with the latter closing in the early 1990s. The practice of institutionalising psychiatric patients declined rapidly in the late 20^th century and Bangour Village Hospital finally closed in 2000. The site is still yet to be redeveloped and many of the buildings remain, albeit in a dilapidated condition. LHSA contains many records and photographs of staff and patients at the hospitals, catalogued under LHB40 and LHB44, preserving their memory.

Our collections help celebrate a birthday

Next week is an important one for the Royal Edinburgh Hospital. On Friday the 19th, it will be 200 years to the day that the very first patient was admitted. LHSA have been helping the Hospital, its patients, staff and local community, celebrate the bicentenary, and two key events have been focused on this time of year.

In June we took the Royal Charter to the City Chambers for a Civic Reception, and it was an opportunity to talk to the invited guests about the history of the Hospital. We were able to use the Charter as a window into that history - it’s a beautifully produced artefact from 1807 and it got a great response. Here the Charter is photographed against the backdrop of the City Chambers' list of Lord Provosts of Edinburgh, which records the Lord Provost named in the Charter itself, Donald Smith. For more information about the Charter please see our online posters.

Next Friday we’re delighted to be involved in a one-day event, ‘The History Room’, in the Hospital itself. Heritage objects held by the Hospital and key documents from LHSA will be on display for those who would like to find out more about the last 200 years of this Edinburgh institution. It will also be a chance for you to share your stories and memories of the Royal Edinburgh Hospital and we hope to see you there. It’s a free event, available to all, and more details can be found here. 

For those of you who can’t make the 19^th, we hope to repeat the display for the Hospital’s annual fete which will be in September, so watch this space!

From the cradle to the grave

Today is the 65^th anniversary of the NHS which, in Scotland, was set up as a result of the National Health Service (Scotland) Act, 1947. This was distinctive from the 1946 Act which established the service in England and Wales. In the years immediately prior to its creation, Scotland had pioneered new forms of organised health care, such as the Highlands and Islands Medical Service (HIMS) (1913), and the Clyde Basin Experiment in Preventative Medicine (1941) which anticipated some of its provisions. Such factors combined with other features of Scottish society to create a national health service which was in many ways as distinctive as the Scottish medical culture which preceded it.

Back cover of the Royal Infirmary of Edinburgh League of Subscribers final annual report, 1948

Prior to the NHS, Scottish health care combined elements of voluntary, municipal, provident, private and government provision at both the hospital and community levels. Afterwards, over four hundred hospitals, with accommodation for around sixty-thousand patients, became Crown property and were formally vested in the Secretary of State for Scotland (SSS) operating through the Department of Health for Scotland (DHS). Five Regional Hospital Boards (RHB) were created to administer Scottish hospitals on a regional basis. This was accomplished through eighty-five local Hospital Boards of Management (HBM). RHBs co-ordinated various aspects of hospital services, including specialists and diagnostic laboratory facilities as well as medical research. They played a similar role in relation to ambulance services for hospitalised patients and also blood transfusion, but both services continued to be run on a voluntary basis. Hospitals in the Lothian area were administered by the South Eastern Regional Hospitals Board.

Nurses at the Royal Infirmary of Edinburgh's Florence Nightingale Home take a break,
c.1950

The DHS also assumed overall responsibility for twenty-five Local Health Authorities (LHA) which co-ordinated a variety of community based services, including maternity and child welfare, midwifery, immunisation, vaccination and other aspects of preventative medicine, health visiting, home nursing and mental deficiency. General practitioners (GP), dentists, chemists and opticians remained self-employed. However, the DHS set up Executive Councils (EC) to arrange payment for services for NHS patients. In addition, a Scottish Medical Practices Committee (SMPC) was set up to help co-ordinate the distribution of GPs nationally. Locally, doctors' views were also represented via Medical Committees (MC). The DHS placed great emphasis upon the future co-ordination of doctors' activities through Health Centres (HC) which would be concerned with health education as well as direct patient care. 

Child welfare: nursery nurses and children, c.1950

Before the NHS, citizens had to pay for medical advice and treatment. Many simply could not afford this. So calling out a doctor, or going to a hospital, often became a last resort, with the result that illnesses or injuries often went untreated altogether, or became more serious than they might have been. The NHS meant that people of all classes no longer had to worry about how they would pay. Care and treatment became a right, not a privilege.

The NHS has adapted and developed continuously since 1948. Almost immediately it became apparent that the need for health care in Scotland (and the UK) was enormous and that the cost of meeting it was going to be far higher than previously estimated.
Many people today are quick to associate the NHS with waiting lists, prescription charges and so-called ‘postcode lotteries’. But we should never forget that the fundamental values behind the NHS still remain the same. Anyone who is sick or injured can go to a hospital or a doctor’s surgery and get the help that they need. This was not the case 65 years ago in Scotland and is unfortunately not so in many countries of the world today.

An outpatient receives treatment, c.1950

One surgeon and his dog

A small exhibition, Animal, is currently being displayed in the Binks Trust Exhibition Wall in front of the main Centre for Research Collections reception on the sixth floor of the main library. The exhibition celebrates the relationship between man and animals reflected in the varied archival collections that we hold across the University.

We were asked to contribute something to Animal by our colleague Rachel, Edinburgh College of Art Archivist. The exhibition contains fascinating items from the Royal Dick Vet collections and the Towards Dolly project on animal genetics in Edinburgh, but would we really have anything to contribute as an archive dealing very much with human health?

Luckily, it turns out that neurosurgeon Norman Dott, whose case notes Louise is cataloguing, was a great lover of animals. From his youth in a large house in Colinton, he was surrounded by family pets, from cats and dogs to a pony and even a pet bat which clung to the curtains in the Dott family living room!

Part of the Animal exhibition wall on the sixth floor of the main library

The item that we chose to exhibit reflected a case note relating to one of Dott’s two beloved Samoyed dogs, Kasyan Dott. The case note is from spring 1947. Since Kasyan suffered from a mysterious paralysing spinal condition, it was decided to put him to sleep, but not before Dott had himself tried to investigate whether his beloved pet could be saved. He even carried out lumbar puncture on Kasyan – a diagnostic technique he used on many of his human patients.

Since no cause could be found for Kasyan’s partial paralysis while he lived, a veterinary post-mortem was carried out – and when this proved fruitless, Dott asked his experienced neuropathology colleagues at the Royal Infirmary of Edinburgh to step in and have a look at the findings. Further investigations found that Kasyan’s condition was incurable, which helped Dott ‘and [his] family very much to feel that [they] had not neglected a possible cure’.

The case note is full of evidence of Dott’s strong relationship with his canine companion. Not only did Dott keep the case note with those of his human charges, but referred to Kasyan as ‘a canine member of my family’. And when hospital neuropathology came back with an undated and less than thorough initial report, Dott was not slow to demand a new investigation!

Oh.. and don’t worry, because this case note is not about a human, we can show it to you without redaction….

Some of the oldest case notes at LHSA

An exciting discovery was recently made in a box file at Edinburgh University Library Annexe – the oldest loose case notes known to exist at LHSA. Some of them date back to 1892! There are older case records in the Archive but only inside bound volumes. These patient case records hail from the Eye Department of the Royal Infirmary of Edinburgh and consist of hand-written notes and specially printed perimeter charts detailing the patients’ field of view. The box file containing these very old records was located alongside two other files relating to the Eye Department from the 1940s and 1950s. In the 1890s the Eye Department was based within wards of the Royal Infirmary. A special eye pavilion was built at the Infirmary in 1903 and the Princess Alexandra Eye Pavilion was opened on Chalmers Street in 1969 and continues its work to this day.

The records give a glimpse of people’s lives amongst the medical diagnoses. One of the examples shown is of a police constable in 1895 who ‘thought the evening became very dark…’ as he read the newspaper, ‘…& in a few minutes he could not see to read’. Another patient’s record from 1893 mentions in brackets that the vision testing has been carried out in gaslight. The Royal Infirmary was not equipped with electric lighting until 1897.

The chart from 1906 shows the obscured field of view of a patient’s left eye. The perimeter charts were produced as pairs with perforations separating charts for the left and right eyes, and these perforations can be seen on the right hand side of the chart. As a result, the text at the bottom appears to have been truncated. Some charts include the varying fields of view of the patient for different colours.

(Reference: Turner, A Logan, ‘The Story of A Great Hospital: The Royal Infirmary of Edinburgh 1729-1929’, Oliver and Boyd, 1929, pp287-289.)