Friday, 13 September 2013

Dispensing hope

Following on from a number of blogs on the treatment of Tuberculosis (TB), this week we look at the formation of the Royal Victoria Dispensary and the start of preventative measures for the disease.
A scourge of Scottish Society in the 1880s, TB infected 1.9 out of every thousand persons in Edinburgh at that time. In 1882 however, German physician Robert Koch made an important breakthrough by identifying that tubercle bacillus was the cause of all of the various forms of the disease in the humans and livestock.
In the years following this, Edinburgh clinician Robert W Philip (1857-1939) was at the forefront of finding a holistic solution to the problem. Using Koch’s discovery as a starting point, Philip decided that the best way to eradicate the disease was to prevent and treat it at all points of transmission. He thought that since TB had been introduced to society through ignorance and neglect, it could equally be removed by methodical reasoned actions. In 1887, from just 3 rooms in Bank Street, Edinburgh, he set up the Royal Victoria Dispensary with the idea that TB patients must be sought out by the physician, along with their whole families for examination. This was the first dispensary of its kind in the world and these combined actions became known as the Edinburgh Scheme.
An early 20th Century slide of Bank Street with a cross marked at the door of the Royal Victoria Dispensary
Following on from the Dispensary, the Royal Victoria Hospital was founded in 1894 and Polton Farm Colony in 1910, keeping ill and recuperating TB patients away from the community. In 1914, the Dispensary, Hospital and Colony were given to the City of Edinburgh and the Royal Victoria Tuberculosis Trust was founded to manage them. 

By 1910 in Edinburgh, infection rates had reduced to 1.07 per thousand and 0.8 per thousand by 1920, vindicating Philip’s actions. Philip tirelessly lectured around the world to see his ‘Edinburgh Scheme’ put into practice around the world wherever TB was found and the results were the same – a steady decrease in infections was to be found.
Dr, later Sir, RW Philip taken from the Summer 1883 Royal Infirmary of Edinburgh Residents photograph
LHSA related records include Royal Victoria Dispensary minutes back to 1891 and case notes back to the 1920s. 
Reference: National Association for the Prevention of Tuberculosis, Sir Robert W. Philip 1857-1939: Memories of his Friends and Pupils, 1957

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