The Royal Edinburgh Hospital's Royal Charter

King George III granted a Royal Charter in 1807, establishing the Edinburgh Lunatic Asylum. The foundation stone of the original building was laid in 1809, and the first patient was admitted in 1813. The charter is in Latin and has the Great Seal of Scotland attached. LHSA created three posters capturing the Royal Charter in advance of the Hospital's bicentenary celebrations in 2009.

In 1792, Andrew Duncan initiated an appeal to establish an asylum in Edinburgh. Voluntary contributions were initially slow. However, a government grant of £2,000 in 1806 significantly increased the funds and allowed for the purchase of a villa and four acres of surrounding land in Morningside. Soon after, in the spring of 1807, a Royal charter or warrant granted by His Majesty King George the Third established the Edinburgh Lunatic Asylum (ELA) as a corporate body. The foundation stone of a building designed by architect Robert Reid was laid on 8 June 1809. ELA admitted its first patient on 19 July 1813.

Pages of the Royal Edinburgh Hospital's Royal Charter of Incorporation (LHB7/19/12/21).

As well as extending royal patronage, the warrant made ELA into a public body. This gave legal rights to use a common seal, to perpetual succession, to sue and be sued, to own lands, to lend money and to receive donations and legacies. It could also make bylaws, rules and regulations, provided they were consistent with the institution’s charitable purpose.

The warrant also specified how ELA was to be run. Twenty named extraordinary managers and twelve named ordinary managers were elected. They were drawn from the Edinburgh Town Council, the law, the University and the local medical profession. A governor and five deputy governors, along with four ordinary managers, could be chosen from among charitable contributors who had given £10 or more and who resided in or near Edinburgh.

Front and back image of the Great Seal (LHB7/19/12/21).

The warrant consists of four sheets of parchment folded to make eight pages. The text, in Latin, is inscribed onto each page except the last, which is blank. The Great Seal of Scotland is attached using intertwined silk threads. Its wax relief shows King George in military uniform, mounted on a rearing stallion and overlooking the City of Edinburgh. An idealised, but still identifiable, panorama of the Castle, the churches and tenement buildings of the Royal Mile and Salisbury Crags can just be made out behind the horse’s legs. 

In 1841, Queen Victoria allowed the prefix ‘Royal’ to be added and, ten years later, the name was officially changed to the Royal Edinburgh Asylum by a private Act of Parliament. In 1927 a new charter was obtained which changed it to the Royal Edinburgh Hospital for Mental and Nervous Disorders. Today it is simply known as the “Royal Edinburgh”. 

A new building, designed by William Burn, was added in 1842. Originally known as West House, it was later renamed after Dr William M’Kinnon, who served as the first Resident Physician from 1839 to 1846. Additional accommodation was added in 1894 when Craig House opened nearby. The original building, soon called East House, was eventually demolished. During the twentieth century, the site saw a series of outpatient and residential developments. The Royal Edinburgh Hospital was granted a Coat of Arms in 1959. 

Further resources

Poster 1: General information about the Charter and Seal

Poster 2: The Charter text in English

Poster 3: Images of the Charter and Seal

History of the NHS (2): The dawn of a new era

In 2008, a photographic exhibition by LHSA celebrated the 60^th anniversary of the National Health Service.

The National Health Service (NHS) was launched on 5th July 1948. It heralded a new era of health care for the UK. The main provision was for every man, woman and child to have access to a complete health service, regardless of who they were or where they came from. Medical care and treatment were to be free to all individuals, funded by central taxation.

Back cover of Royal Infirmary of Edinburgh League of Subscribers Annual Report, July 1948 (GD1/38/6).

Leith Day Nursery, South Fort Street, c.1950s (LHSA Photographic Collection) [Image reproduced by permission of The Scotsman Publications Ltd.]. The NHS strengthened and consolidated maternity and child welfare services, which were first established in Scotland at the turn of the century. As well as providing clinical care for expectant mums, babies and young children, it offered further assistance to mothers through ante-natal classes, health visitors, nurseries and play centres.

Sighthill Health Centre, c.1950s. Sighthill Health Centre opened in May 1953 and was the first of its kind in Scotland. Sighthill was chosen because it was a new housing area with a large population that was inadequately served by existing provision. he idea behind it was to create a facility for related health care services under one roof. The Centre housed GP consulting rooms, child welfare and school health services, an NHS dental surgery, a pharmacy and a physiotherapy department.

The NHS brought together a number of existing services which had begun many years before. It provided a uniform national structure that had previously involved voluntary, provident, private and government provision at the hospital and community levels. The main features were: regional hospital boards to co-ordinate hospital services; local health authorities to run community-based services and executive councils to administer GP, dental, chemist and eye services. The complete service offered by the NHS aimed to encompass all aspects of health care from the cradle to the grave. It also promoted good health and welfare in general.

National Health Service (Scotland) Act, 1947. The text reads, 'Chapter 27. An Act to provide for the establishment of a comprehensive health service in Scotland, and for purposes connected therewith. [21st May 1947.]'

Newspaper cartoon, c.1946 (LHSA Pamphlet Collection). This cartoon shows an elderly patient worrying about the potential effects of the new National Health Service. The British Medical Association agreed with the creation of the NHS in principle, but felt it was not properly consulted when the legislation was being developed.

People playing cards and dominos at Sighthill Health Centre, c.1950s [Image reproduced by permission of The Scotsman Publications Ltd.].

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.

Royal Edinburgh Maternity Hospital (Simpsons) Case Note, 1935 (LHB3 CC1/ 1935/1010). This image is taken from a patient case note and shows a husband and wife's pre-NHS insurance provision. The National Health Insurance Scheme was introduced as part of the National Insurance Act of 1911. It entitled the working man (and in some cases his family) to medical treatment, his wife to maternity care and offered him sickness benefit during periods of his incapacity for work. By the mid-1930s, all manual labourers earning no more than £250 a year were made compulsory members of the Scheme.

Nurse and patient in ambulance, 1942. Before 1948, the ambulance service in Scotland was supplied jointly by the St. Andrew's Ambulance Association and the British Red Cross Society, and funded by voluntary contributions. This joint service continued post-1948, the only change being that the costs were now met by the State.

School Dental Service, c.1950s. Dental check-ups and treatments were free under the early NHS, as were visits to a GP, eye tests and spectacles, hearing tests and hearing aids.

The first part of the exhibition focuses on aspects of pre-1948 health care and selected features of the NHS Scotland Act. The second part provides photographic snapshots of the many components of the service provided by the NHS in Edinburgh.

Royal Edinburgh Hospital Admission Register, 1920 (LHB7/35/12). These volumes recorded several patient details, including an individual's status as 'private' or 'pauper'. If private, the patient or their family would be charged an appropriate board rate. If a pauper, the state would pay the minimum for their care under the provisions of the Scottish Poor Law. Private patients in this psychiatric hospital were housed separately from paupers in finer surroundings and had access to many other privileges which paupers were excluded from.

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.

School Medical Service, diphtheria immunisation, 1953. In Scotland, the School Medical Service was established in 1908. For the next 40 years, it was administered and financed at a local level, often with very limited resources. With the coming of the NHS, medical services for school children became the responsibility of the State nationally. It soon began to offer vaccinations and immunisations to all children.

Royal Edinburgh Hospital Case Book, 1916 (LHB7/51/100). This image shows the higher annual board rate paid by this private patient. Despite staff working hard to improve the mental health of all patients, fundamental inequalities remained.

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 60 years ago in Scotland and is unfortunately not so in many countries of the world today.

Hospital ward, East Fortune Hospital, 1953. East Fortune Hospital was a tuberculosis sanatorium which opened in 1922. It was converted for this purpose from a World War One naval airship station in Drem, East Lothian. From 1956, the hospital also began to care for children and adults with learning disabilities.

Audience receiving question cards at a health education meeting, New Victoria Cinema, 1947. Health education was not just for mothers and children. Public meetings held in cinemas were organised by the Edinburgh Public Health Department, now a fully integrated part of the NHS. Films were shown followed by question-and-answer sessions on a range of topics. For example, tuberculosis, venereal disease, hygiene and exercise. Anybody could attend without charge.

The 'Audience of 2000' leaving the New Victoria Cinema after a health education meeting focusing on tuberculosis, 13 March 1949 [Image reproduced by permission of The Scotsman Publications Ltd.].

Central Leith Health Campaign, 1955 [Image reproduced by permission of The Scotsman Publications Ltd.]. In the 1950s, Edinburgh worked hard to promote the fight against tuberculosis. The Central Leith Health Campaign of 1955 encouraged people to have their chest x-rayed to detect any signs of the disease. This was followed in 1958 by the Mass Radiography Campaign, which invited all citizens of Edinburgh over the age of 15 to have their chests x-rayed. A staggering 77% of the population took part.

Central Leith Health Campaign, 1955 [Image reproduced by permission of The Scotsman Publications Ltd.].

Window display at Woolwoths, Princes Street promoting 'Health Week', 1952 [Image reproduced by permission of The Scotsman Publications Ltd.]. Edinburgh's 'Health Week' ran from 10th to 18th May 1952 and employed the slogan 'Your Health is Edinburgh's Wealth'.

History of the NHS (1): A history of the NHS

As a result of the National Health Service (NHS) (Scotland) Act 1947, the NHS came into being on 5 July 1948. It aimed to meet all health needs free of direct charge to the citizen.

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.

Before the NHS, Scottish healthcare combined elements of voluntary, municipal, provident, private, and government provision at both hospital and community levels. Subsequently, over four hundred hospitals, accommodating 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 (RHBS) were established to oversee Scottish hospitals on a regional basis. This was achieved through eighty-five local Hospital Boards of Management (HBM). RHBs coordinated various aspects of hospital services, including specialists and diagnostic laboratories, as well as medical research. They also played a similar role in relation to ambulance services for hospitalised patients and blood transfusions, although both continued to be run on a voluntary basis. Hospitals in the Lothian region were managed by the South Eastern Regional Hospitals Board.

Pamphlet, Your Health Service: How it Will Work in Scotland, HMSO 1948 (GD1/112/1).

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.

 

The NHS in England and Wales

The administrative structure of the NHS in Scotland differed from that in England and Wales with respect to some of its arrangements:

• Teaching hospitals remained under the control of RHBs via Medical Education Committees (MEC). In England they were managed by Boards of Governors directly responsible to the Minister for Health.
• Boards of Governors of hospitals also controlled pre-NHS endowments, whereas in Scotland they were vested in RHBs and the Scottish Hospitals Endowments Research Trust (SHERT).
• As well as communicating with HBMs via RHBs only, the SSS was also responsible for the provision of HCs, whereas in England and Wales, this came under LHAs.
• The SSS also had equivalent responsibilities for the ambulance service, blood transfusion, and laboratory services, whereas in England and Wales it was LHAs, RHBs and the Ministry of Health (MH) respectively.
• HBMs were called Hospital Management Committees south of the border and had a different appointment mechanism.

Your Health Service leaflet, Pictorial plan of the new health service (GD1/112/1).

NHS re-organisation in Scotland

Since the inception of the NHS in 1948, a number of organisational changes in the structure of the service have taken place. The first of these administrative changes was introduced following the publication of the NHS (Scotland) Act 1972. It was decided that, in order to provide a more integrated health service, the 3-tiered system of administration should be abolished. This led to the Regional Hospital Boards (planning and development of hospitals services) and the Executive Councils (pharmaceutical and general medical, dental and ophthalmic services) being disbanded and responsibility for Community Health Services (welfare, preventative medicine and public health) removed from Local Authorities. Boards of Management, which had been responsible for the day-to-day management of hospitals, were also abolished under the new system.  Instead, 15 health boards acting on behalf of the Secretary of State for Scotland were established. Lothian Health Board (LHB) was made responsible for Midlothian, East Lothian and West Lothian. Within LHB, three Health Districts operated from 1975-1984: North Lothian District, South Lothian District and West Lothian District. The Common Services Agency managed ancillary services such as the ambulance service, blood transfusion service and health education programmes.

Further reforms followed the publication of the Griffiths Report in 1983 which recommended a move away from consensus management where responsibility was shared between doctors, nurses and administrators. This approach was seen to delay decisions and instead general managers were appointed with overall responsibility for the service. The district level of management of the NHS was eliminated in April 1984 in order to devolve responsibility for services to hospital groups of management. General managers were subsequently employed at unit level to further speed up the administrative process. Clinicians were more closely involved in the management process and units were now responsible for their own budgets.

The publication of the white paper "Working for Patients", January 1989 led to further changes in the health service. In order to provide a more efficient service, as much responsibility as possible was devolved to local level with hospitals now having the opportunity to apply for self-governing status as NHS Hospital Trusts. The role of the Health Boards was to set performance criteria, monitor the performance of the Health Service and evaluate its effectiveness. Lothian Health was responsible for assessing the needs of the local population and purchasing services from health care providers. The NHS hospitals were concerned with the day-to-day management of medical services. From 1992, the units of management were re-structured with the introduction of service units. Hospitals could now "opt out" and become self-governing hospital trusts.

 

Sources of reference

Committee of Enquiry into the Cost of the National Health Service: the National Health Service in Scotland: Memorandum by the Department of Health for Scotland DE22532/1/944 100 6/52R. DHS. June 1953

Committee of Enquiry into the Cost of the National Health Service: the National Health Service in Scotland: The main differences between the Service in Scotland and the Service in England DE 23172/1/351 35 8/53R. DHS. August 1953

Leathard, Audrey. Health care provision: past, present & future London: Chapman & Hall, 1990

Lothian Health Board circular: General Management in Lothian, May 1987

Main differences between the health services in Scotland and in England and Wales DHS. December 1956

The National Health Service in Scotland: notes for speakers DE 2175/1/284 25 2/53R. DHS. January 1953

Scottish Home & Health Department Circular no. 1983 (Gen)27 (LHB1/81/218: Reorganisation of NHS Jan 1980-83)

Williamson, Peter J. General management in the Scottish Health Service University of Aberdeen, 1990

Your National Health Service: how it will work in Scotland Edinburgh: HMSO, 1948

Spotlight On… (10): Project to re-order LHSA’s twentieth-century case notes

LHSA holds the second-largest collection of medical case notes in the UK, comprising one million folder-based patient records that date back to the 1900s. These consist of over 100 discrete collections from some of the great general and specialist practitioners in the Lothian area, including Harold Stiles, John Fraser, and Norman Dott.

Inside ear and throat department box.

During a move of the case note collections, a shelving collapse occurred in November 2006. Although the overall damage was minimal, this incident resulted in the disorganisation of 71 of the collections. The time-consuming task of restoring order was carried out by LHSA Archive Assistant Stephen Willis. Taking more than a year and a half to complete, he re-ordered over 208,000 case notes. At the same time, additional information was extracted, for example, regarding medical specialty, date range, and mentioned wards.

Re-ordering of the case note collections.

Occasionally, miscellaneous items were found among the case notes. Some of the more unusual items have included a hair comb, a pair of nail scissors, and the colour supplement from a 1959 edition of Woman magazine!  

This project not only improved access for enquirers, but also made the case notes ready for potential future conservation or digitisation work.  

Since the project's completion, attention shifted to the rest of the case notes, as many of these had not been reviewed before. They were being systematically checked, and similar information was recorded.

Conservation (7): Conservation of twentieth-century folder-based clinical case notes

Background

LHSA has a large and important collection of twentieth-century folder-based case notes, with around thirty specialities and over fifty physicians and surgeons represented. They are a scarce local and UK resource with potential international significance.

LHSA was fortunate to be awarded five separate project grants from the Wellcome Trust’s Research Resources in Medical History programme to conserve and re-house this material:

• Preserving twentieth-century hospital case notes of University of Edinburgh clinical professors: Edwin Bramwell and Norman Dott ran from June 2002 to June 2003.
• Preserving twentieth-century hospital case notes of University of Edinburgh clinical professors: James Learmonth and Derrick Dunlop ran from April 2004 to April 2005.
• Preserving twentieth-century case notes of the Royal Edinburgh Hospital ran from July 2005 to January 2007.
• Preserving Edinburgh’s twentieth-century reproductive and sexual health case notes ran from February 2007 to April 2009.
• Preserving Edinburgh's twentieth-century case notes: treating tuberculosis and World War II injuries is a 6-month project that began in May 2009.

The case notes treated in these projects were prioritised because they meet a range of intellectual, conservation and access criteria.

Condition

Heavy usage and inappropriate storage prior to accession meant that the majority of the folder-based case notes were in poor condition and couldn’t be accessed without causing further damage. Surface dirt, folding and tearing were frequently noted. Metal paperclips and staples caused extensive rust damage, and the inferior quality of the folders posed a risk of physical and chemical damage to their contents.

Treatment

A Project Conservator and a Conservation Assistant were employed to treat and re-house the case notes. Because of the large number, remedial treatment is restricted to surface cleaning with a chemical sponge, re-aligning folding and creasing to the paper, and the removal of any paper clips and staples. Black and white photographic prints found within the case notes were given individual folders of photographic storage paper and retained within the original format. Parts of the original folders with informational content were retained and samples of each style of folder were kept for reference. Each case note was placed in a single-creased paper folder constructed of good quality material within an equally high specification drop spine box. The new storage system was labelled appropriately, and handling guidelines were produced to ensure that future access is safe and easy.

X-ray of feet, Royal Infirmary of Edinburgh,1962 (LHSA X-ray Collection).

Some case notes have x-rays and glass plate negatives accompanying the paper-based case note. Cellulose acetate x-rays in good condition were re-housed in cold storage. Cellulose acetate x-rays in very poor condition and cellulose nitrate x-rays were reformatted and subsequently destroyed. Extensive documentation and cross-referencing was undertaken to ensure that the informational content of the case notes was not compromised in any way. Glass plate negatives were housed vertically in good quality four-flap enclosures and boxes with plates of the same size wherever possible.

Extensive photographic and written documentation was produced and a final report submitted to the Wellcome Trust.

Conclusion

To date, c. 300,000 case notes have been treated. This represents c. 30% of LHSA’s total holdings of material of this nature. These projects succeeded in securing the long-term preservation of, and improved access to, these medically and historically important case notes. In addition, a methodology for the preservation of folder-based clinical case notes was developed, which includes the treatment of photographic material (print and glass plate) and x-rays, as well as paper-based notes. This is sufficiently robust to be transferable to other historically significant folder-based collections of papers held by archives, record offices, libraries and other repositories.

Additional information

The projects were supervised by the LHSA Paper Conservator and managed by the LHSA Archivist. The experience gained and methodology developed was disseminated wherever possible via publications, presentations and tours. To get further information or ask advice on producing preservation proposals of this kind, please contact us.

Acknowledgements

LHSA gratefully acknowledges the support of the Wellcome Trust and thanks past project staff: Rosy Marshall, Kate Kidd, Louisa Coles, Toby Gough, Sue Turnbull, Simona Cenci and Katrina Redman.

The Leith Roll of Honour

The Leith Roll of Honour, created by a resolution of the Leith Town Council in 1920, lists the 2,206 officers and men who were killed in the Great War of 1914-1918, as well as the 350 who earned special honours. The first volume contains details on the background of the War and a summary of its events, including the part played by the town and people of Leith. The list of deceased provides the name, age, address, army division and number, and the cause and date of death.

The first volume of the Roll also provides the background to its inclusion as part of a war memorial at Leith Hospital. It had been decided to erect a new wing at the hospital as a memorial to the people of Leith who lost their lives serving in World War I. Contributions were made by people from all walks of life, and the wing was officially opened on 29th January 1927. A managers’ minute of 12th May 1927 tells us that a design for the case to display the Leith Roll of Honour was unanimously approved. The new wing and its contents, including the Roll of Honour, were formally handed to the managers of the hospital on 15th December 1927 by ex-Provost Lindsay on behalf of the War Memorial Committee.

Two pages of the Leith Roll of Honour (LHB6/38).

Leith Hospital became part of the NHS in 1948, and its records were later transferred to LHSA after the hospital closed.  The Roll of Honour is permanently preserved in appropriate archival and environmental conditions.

Spotlight On… (9): Recipes from the Royal Infirmary of Edinburgh Department of Dietetics

The relevance of nutrition in the care of patients was recognised by the Royal Infirmary as far back as 1742 when managers of the hospital were given guidelines in the form of a ‘Bill of Fare for the Infirmary Patients’. By 1843, there was a selection of diets available for patients with particular conditions, such as a low-fat diet, a rice diet and a steak diet with bread.

Diet sheets and recipes, Royal Infirmary of Edinburgh, 1930s-1950s (LHB1/89/4/1).

Continuing this ground-breaking role, the Royal Infirmary became the first hospital in Britain to appoint a dietician in 1924. Miss Pybus, a nursing sister, was given the post with the title Sister-Dietician although she had no formal training in the field. As a reflection of the growing importance of nutrition, in 1928, science graduates were appointed as dietitians. The kitchen work was undertaken by student trainees on a 6-month placement as part of their courses.

Eventually, greater formalisation was required, and in 1936, the British Dietetic Association was founded to help maintain professional standards and develop a code of conduct. Then, in 1944, state registration was introduced.

Baked custard recipe (LHB1/89/4/1).

Fish custard recipe (LHB1/89/4/1).

LHSA holds records relating to the Department of Dietetics. These include student applications and assessments, prospectuses, nutrition leaflets, and photographs. Amongst them are a number of recipes that the department prepared for patients in the hospital's care. They are not dated, but are probably from the 1940s or 1950s. Some of these are very basic – how to make tea and coffee, for example – and some would not be particularly appetising now, such as tripe! But some are also quite tempting. An inviting lunch menu could have consisted of fish soufflé followed by baked custard. The two recipes are pictured above.