Friday, 3 August 2018

New devices. New data?


LHSA is a member of the Health Archives and Records Group (HARG, https://healtharchives.co.uk/), which is a forum for bringing together people who have a research interest in, or are responsible for, health records. Over the last couple of years HARG has been reinvigorated by a dynamic committee that has been providing a programme of events to explore relevant issues in the care and use of health records.

Last week, Ruth went to HARG’s most recent session, a workshop on wearable medical devices and the data generated by them. (And to prove it here’s a photo from the day taken by our colleague Clare, who organised the event, Ruth’s on the right, talking to the the woman in green!)


The day included a number of shorter presentations with a longer discussion session in the morning and afternoon. The speakers were from a wide range of backgrounds (and this diversity was evident in the attendees too): information governance professionals, developers of wearable medical devices, clinicians, researchers using data from wearables and, of course, those responsible for archive collections.  

This is a new and constantly evolving area with people regularly using wearables now, from Fitbits for fun through to clinical devices to monitor conditions. Much of the day helped those attending understand what is currently available in terms of wearable medical devices and looked at the importance of the individual knowing what data about them is being generated and how it is being used to ensure the users’ ongoing confidence. Several papers demonstrated how much benefit can be derived from appropriate use of these devices in terms of adherence to treatment/exercise regimes, and that this then translates into fewer and/or quicker appointments with clinicians, and more sustained positive outcomes for the patient. So that continued confidence in the device, and the use of the data it creates, is crucial.

But from an archival point of view, the papers that looked at the kind of data that is being collected, whether and how it can be shared and used ethically, and how to ensure the data is authentic and has the right information associated with it to be meaningful were particularly relevant. The final paper of the morning looked at these issues in detail and was the basis of the subsequent discussion session which looked at the technology, the policies, the people and the training that should be considered in this context. Does the device measure what you want it to measure? Will the data be accessible for as long as it needs to be? Does the policy generated around the use of wearable medical devices establish who is responsible for the data and for how long? In terms of the people involved, we looked at what the users of wearables need to be able to use the devices effectively and to understand what data will be collected and how it will be used, with training being a strong aspect of this.

It was a really informative day, but perhaps more importantly it was a thought-provoking one. What information on wearable medical devices should be preserved in the archive: how are we going to capture this emerging and growing facet of 21st-century healthcare?

HARG will be providing the slides from the presentations, and a report that will give an overview, on their website in due course. We will be contributing ourselves to the next HARG event, with Louise presenting on our case note catalogue and describing the methodology used.

Friday, 20 July 2018

CRC Summer School!

Last week we had the pleasure of welcoming this year’s Centre for Research Collections Summer School attendees who came to the centre to gain a sense of the different areas of work that we do here. The summer school aims to help those who are interested in a career in the heritage, museum, and libraries sectors and they were provided with a week-long schedule of activities including tours, talks, and practical exercises.

At LHSA we decided to treat them by introducing them to the world of enquiries. We receive hundreds of enquiries every year from people wishing to learn more about individuals, hospital history, local history and the history of medicine. Many of the people who contact us here at LHSA are family historians who wish to learn more about their relatives who perhaps were patients or staff in a Lothian hospital. We decided to let the group do the research for a selection of family history enquiries in order to see how much information they could find.

The Summer School group were split into four groups with each group given a set of records and an enquiry to solve.




One group was given records from the Royal Edinburgh Hospital and asked to find out as much as they could about a patient who was admitted there in 1902. From the General Register of Patients, Register of Deaths, Certification Papers and a Casebook they were able to learn about how he came to be admitted to the hospital, the nature of his illness, the cause of his death, and even details such as hair colour and weight.





Another group were asked to find information about a woman who worked as a housemaid at Rosslynlee Hospital. They were not given a specific date but were told that she stopped working there in 1908 when she married. Using the Register of Attendants Leaving and Register of Attendants Engaged and working back from 1908 they were able to find her employment record. They also read the rules and regulations for staff in order to provide the enquirer with a little background information on what it would have been like for their relative to work in the hospital.




A lot of the feedback received from the group was that they were surprised at the amount of detail in some of the records, particularly the Royal Edinburgh Hospital casebooks. Others described the difficulty in deciphering the handwriting and talked of their relief when finding some of the records were typed. Overall it was a really enjoyable afternoon and we hope that it has inspired a few people in the room to consider a career in the archive sector!

Friday, 6 July 2018

Happy Birthday to You!

This week, we've been very busy celebrating a very special birthday. Over to Archivist Louise...

Yesterday marked 70 years of the National Health Service in the UK - a health system controlled by government, funded by taxation, free at the point of use, committed to universal care and offering comprehensive coverage. When we learnt that proposals were being taken for potential displays to fill our exhibition spaces here on the 6th floor of the Main Library, we couldn't resist suggesting an exhibition highlighting how our region and the health of its people has been transformed in those 70 years.

Our exhibition - Dawn of a New Era - opened in April, and you can see it here at the Main Library until 15th August. But for the anniversary of the NHS Appointed Day yesterday, we wanted to do something extra-special by hosting a talk on why we chose what we did for the exhibition, and to give people an opportunity to see some extra archive material that didn't quite make it into the display cases.

It was wonderful to see so many people come along to hear how our collections tell stories of changing healthcare over the years, from the treatment that was available before 1948 to cutting edge breakthroughs in bioengineering. It was particularly lovely to welcome members of NHS Lothian staff past and present, including members of the Pelican League of nurses trained at the Royal Infirmary of Edinburgh School of Nursing, some of whom came along wearing their prized Pelican badges!

The talk covered Edinburgh's pride in its high quality voluntary hospitals, funded entirely by public donations and fundraising...

Small flag badges were sold on pageant days to raise money for the voluntary hospitals that were funded entirely by public donation before the NHS (LHB1/35, c. 1930s)
and the precedents for state control of healthcare in Scotland that made both medical staff and civil servants more prepared for 5th July 1948, particularly wartime initiatives such as the Department of Health for Scotland-run Emergency Medical Service.

Ward 32, Bangour. Formally part of Bangour Village Hospital, this villa was taken over as part of the wartime Emergency Medical Service. It offered neurosurgical specialist services to troops, but also treated civilians.

We also looked at the structure of the Health Service in Scotland...

Diagram of the National Health Service in Scotland, from a booklet posted to every Scottish household (GD1/112, 1948)
and some of the innovations of its early days, such as locally-transforming campaigns for mobile x-ray screening for tuberculosis and health visiting:

Badge given to each participant in Edinburgh's 1958 mass miniature radiography campaign, screening against tuberculosis on the move.

Health visiting, organised by local authorities in the new National Health Service structure, helped promote the good general health that was seen as essential to the success of a nationalised health service (Acc16/009, 1960s)


As we looked at the different themes represented in the exhibition, some of the attendees' favourite items were the recent donations that we've received from the Edinburgh Children's Hospital Charity. In 2016, Writer in Residence Linda Cracknell and Illustrator in Residence Cate James produced a series of books designed for child patients in the Royal Edinburgh Hospital for Sick Children. With titles like Cathy the Friendly Cannula and Edward the Nervous Medical Notes, the books are designed to make the hospital experience less intimidating for children, by helping them to understand how treatment works, pictured below:




It was a pleasure to spend an afternoon looking back at the past 70 years, and how LHSA material both marks unique local breakthroughs, and fits into narratives of healthcare in Scotland and the UK as a whole. But if you couldn’t make it to meet us yesterday, there’s plenty of time to visit Dawn of a New Era before 15th August!



Me with one of our slides!










Friday, 22 June 2018

NHS Scotland Event 2018


Our 70th anniversary celebrations continued this week as we attended the 2018 NHS Scotland event in the SEC Glasgow. The event is in its thirteenth year and is the ‘premier meeting place’ for those who are committed to delivering high quality health and social care services. It brings together those working for and with the NHS in Scotland and provides them with the opportunity to consider the challenges, to share best practice, to view the latest innovative approaches and to develop tools and techniques designed to support them in their various roles.
The 70th anniversary provided the event with an excuse to reflect on what the NHS has meant for people in Scotland, to recognise and thank staff for their contributions, and to celebrate the massive achievements that have been made over the past seven decades. The event theme was ‘Delivering Now, Improving for the Future’, and this flavoured many of the discussions throughout each day as people speculated on what another 70 years of the NHS could achieve.
LHSA were situated on the NHS 70th stand where alongside freelance historian Chris Holme and NHS Greater Glasgow and Clyde Archivist Dr Alistair Tough we spoke to attendees who were passionate about the history of the NHS in Scotland. As well as sharing stories relating to our collections we listened to many people who were eager to share their personal memories and experiences too.





On day one those who visited the stand were encouraged to write down their memories of NHS Scotland and what makes them proud to work for the service. These thoughts were then taken by artists Ken Darling and Andrew Forsyth (http://www.darlingforsyth.com/) who then used them to create a large mural over the course of the day. Which was fascinated to watch develop:




Day two was focused on looking to the future and people recorded their hopes for how NHS Scotland will progress in the years to come. These thoughts were also captured in the artwork of Darling and Forsyth. The themes of funding and technology were prevalent and the idea of a robot nurse made it to the board:




The event was an excellent opportunity to engage NHS staff with the history of the health service throughout Scotland, and we found people were very excited to both learn and share stories from the past.
If you want to learn more about the past 70 years of the NHS in the Lothian area then come and visit our exhibition currently on display on the 6th floor of the Main Library, University of Edinburgh, George Square.
We also have a free event based on the exhibition on the 5th July. The event will also be held in the Main Library where as well as a chance to view our exhibition there will be a short talk alongside a display of our collections: https://www.eventbrite.co.uk/e/celebrating-the-dawn-of-a-new-era-tickets-46649093695

Friday, 8 June 2018

70 years in pictures...


This week, Access Officer Louise has been getting to know LHSA's image collections:

5th July is fast approaching, and as the National Health Service prepares to turn 70, here at Lothian Health Services Archive we have been hard at work promoting the big day.

Our exhibition, Dawn of a New Era, has been on display in the Main Library of the University of Edinburgh since April 13 and will continue until August 15 with the addition of two further display cases arriving in late June. The exhibition uses LHSA collections to chart the journey of the NHS from pre-1948 experiments with state healthcare through 70 years of innovation, challenges and breakthroughs. The exhibition showcases a diverse range of objects, and it is definitely the first exhibition I have seen featuring both a pacemaker and a board game.




NHS objects on display inside the exhibition
As well as our preparations, I have been answering enquiries from others who are collecting images to use in their own promotion of the anniversary. Image requests have been helpful in allowing me to gain an ever broadening understanding of the collections held by LHSA and I have already compiled a long list of favourites.

While searching for images that depicted nurses at work I came across this wonderful scene from 1960s which shows nurses at Christmas with geriatric patients on a ward in Bangour Village Hospital.
Patients and nurses at Christmas, Bangour Village Hospital, c. late 1960s (P/PL44/P/088)
Another image I enjoyed was a photograph showing a classroom of nurses being taught in their new teaching department at the Royal Infirmary of Edinburgh which opened in 1957.
 
Nurses' classroom, Royal Infirmary of Edinburgh, 1957 (P/PL1/S)
I also conducted a search through our extensive collection of midwifery and nursing badges from across Scotland. My favourite is from the North Edinburgh School of Midwifery which has a dolphin arching across the centre.

North Edinburgh School of Midwifery badge, late 1970s (O467)
As well as midwifery and nursing, badges held by LHSA cover Edinburgh’s hospitals from the early twentieth century through to HIV awareness campaigns of the late 1980s and ‘90s.
For more images of our historic badges, visit: https://www.flickr.com/photos/49439570@N08/sets/72157625849589925

Friday, 25 May 2018

'To have a Blue pill & Black draught in the morning'

This week, archivist Louise has been looking into the story of a nineteenth century Edinburgh writer...

LHSA's rich history of psychiatry collections are understandably popular with researchers: with collections from the Royal Edinburgh Hospital, Midlothian and Peebles District Asylum, Haddington District Asylum, Bangour Village Hospital, and Roxburgh, Berwick and Selkirk District Asylum, we have built up a rich picture of Scottish psychiatric hospitals, their patients and their medical staff, particularly in the late nineteenth to early twentieth centuries.

Of these collections, our material from the Royal Edinburgh Hospital is undoubtedly the most consulted. Of particular interest to many researchers are letters written by patients, which we originally found inserted into the pages of the hospital case books. These letters have been the subject of academic scholarship in recent years, and are also popular with history of psychiatry students (who persevere despite the fact that they can be notoriously difficult to decipher!). Letters were written to patients' relatives, friends, and some to the medical staff of the hospital. So why were they never sent?

One possible reason for their retention by the hospital staff may have been that they did not want to distress potential recipients with some of the contents of the letters, or that doctors were worried that letters may not have painted the hospital in a very positive light. The 1866 Scottish Lunacy Act allowed physicians to suspend letters they felt to be unsuitable (excepting complaints sent to the General Board of Control, the body that policed asylums in Scotland). However, a couple of years ago, I found a reference to the confiscation of patient letters in a Royal Edinburgh Hospital annual report of 1863, in which the Physician Superintendent, David Skae, defended the practice by stating..'it has long been observed that the letters of patients in many instances betray their insanity and morbid impulses much more frequently than their conversation'. Skae went on to state that he had been given authority to confiscate letters by the hospital Board of Directors (an earlier internal regulation than the 1866 Lunacy Act), but that many letters did in fact get sent out and received by patients, and that any inspection or retention of letters was always communicated to the writer.

In researching our letters for one of the many enquiries we receive about them, I came across this resource on Grace Webster, a nineteenth century Edinburgh writer (most famous for her books Ingliston and The Edinburgh Literary Album). A large bundle of her letters had been found bricked into the chimney by builders when restoring a house (presumably where she lived in St Patrick Square), and have been catalogued and transcribed by an academic. One of the letters was written by Grace from the Royal Edinburgh Hospital, and this made me keen to look up her medical case....

'Ms Webster' was admitted five times to the Royal Edinburgh Hospital between 1845 and 1873 for 'acute mania', an illness which (from her case notes) seemed to consist of erratic behaviour being interspersed with periods of relative mental well-being and calm. For example, on her first admittance,she was described as 'a native of Edinburgh and unmarried but received a good education. Is an Episcopalian and has edited & written several books.... is quiet and industrious & is fond of sorority... is generally considered a person of considerable talent' (LHB7/51/2). Her illness was attributed to 'over do of a romantic state of mind.'

First page of Grace Webster's case (LHB7/51/2)

Grace's quietness and industriousness were not to last long, however, since throughout her admissions, her illness manifested itself in 'abhorrent language' and also more physical acts: tearing her clothes, refusing to be moved, and in breaking windows. This erratic behaviour seems to have earned her a reputation with the doctors and nurses, who moved her between several galleries (wards) of the hospital (including confinement alone) during her time there. Grace seemed to have had little time for her medical attendants, who stated that 'she constantly tries to bring charges against the officers and attendants of cruelty and neglect not so much to herself as to the other patients'. Moreover, Grace is often described as 'obstinate' in her case notes, and her actions can be read as both affects of her illness, and as acts of resistance and defiance against the depersonalising regimes of the hospital (it is mentioned that 'her head was shaved', for example). Her decline is clear to trace, however, for by 1873 she is described as more and more feeble and habouring 'delusions of conspiracies against her'. She was apparently 'still very argumentative and cantankerous', though (which just makes me like her more!).

The two most interesting aspects of her case, however, were the descriptions of her medical treatment and the writing that she did whilst a patient. The enquiries we tend to get about patients at the Royal Edinburgh Hospital usually cover the late nineteenth century: since Grace's case started in the second earliest volume of the case books that we have, I found a rare excuse to look at descriptions of earlier psychiatric treatment. For example, Grace was prescribed 'a Blue pill & Black draught in the morning'.

All this sounded very strange to me, and I wondered whether I had misread the (quite difficult) handwriting. After some research, though, I found that there was indeed such a thing as a blue pill - coming from schools of thought that advocated purging as a remedy for illness, it was a mercury-based medicine with a laxative effect, with what would now be seen as dangerous levels of mercury. A 'black draught' was another laxative medicine, made of senna with magnesia and licquorice. Grace was also prescribed another form of purging: blood-letting. On her first 1845 admission, she was treated by 'four leeches applied to the temple.' You can read about nineteenth century purging medicines and their context (albeit through United States history) here.

The other factor of interest in Grace's case is mentions of her writing. In her first admission, it is reported that she 'walks about daily and has written a note to her friend'. However, when she next appears in hospital in 1856, she has written a book, which 'was penned shortly after leaving the asylum and in it she exhibited the greatest ingratitude to parties who had treated her with the most uncalled for generosity and benevolence.' Grace Webster's writing seems to be relatively little known, and it is not easy to find out which novel this was.

Grace's letter writing is often referred to in her notes, but no letters from her were inserted in the case books, which does imply that most were sent, as Dr Skae insisted that many letters were in the 1863 annual report mentioned above. Grace certainly wrote to people a lot: doctors reported that she was constantly writing to friends and medical staff saying that she wanted to leave, and this was 'almost daily'. One example of this has been retained: an 1856 'petition' she wrote 'Unto the medical gentlemen and Matrons'.
Petition 'Unto the medical gentlemen and Matrons' (LHB7/51/11)
Insisting that she has been 'greatly insulted and imposed upon by being brought into a place of this kind under false pretenses' (an 'airing for health' in a carriage), Grace goes on to describe the losses she believes that she has incurred as a result of her time in the asylum and its 'bad air': of health, of time and of goods. One thing that I particularly like about this document is the small doodle of a face on the last page: a practice that links people writing freehand across time (but also undermines the tone of officialdom she seemed to want to add to the petition).

Doodle of a face on the 1856 petition
Sadly, Grace died soon after her 1873 discharge from the hospital, but perhaps the letters found in her chimney will inspire a new interest in a much-forgotten life.







Friday, 11 May 2018

A day early...

Tomorrow is Nurses' Day (also Florence Nightingale’s birthday) and an opportunity to celebrate all the amazing work nurses do around the world!

A little closer to home and our blog this week throws a quick spotlight on the collections we hold that relate to nurses and nursing history, and that serve to record the valuable contributions of nurses to healthcare in the Lothians.

Our source list at http://www.lhsa.lib.ed.ac.uk/source/nursing_index.htm gives lots of information about the types of nursing-related material we have, from records that show individual nurses’ experiences, to papers that describe the wider nursing training programmes and their working lives. We have some wonderful photographs of nurses too and you can see a wide selection of these online via Scran: click here to see one of my favourites!

We’re also celebrating nursing as part of our current exhibition, ‘Dawn of a New Era’, to commemorate the NHS's 70th birthday. The exhibition opened in April and will run until 15 August in the Centre for Research Collections, Edinburgh University Main Library – from 22 June we’ll have an additional display case dedicated solely to nursing. 


You can follow all the nursing stories that will be told for Nurses Day on Twitter - look out for hashtags #ThisNurse #NursesDay and #HistNursing.