This week, Rebecca
takes a look at the Royal Victoria Dispensary case notes, exploring the wealth
of information collected from each patient before they were clinically examined.
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| Diagram of the Edinburgh Scheme, showing the central role of the dispensary. (LHSA Slide Collection) |
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| The former dispensary on Spittal Street, Edinburgh (screenshot from Google Street View ©2014 Google) |
Being referred to the dispensary was not a sign that someone
had tuberculosis, rather it was a way for likely cases to be examined and a
diagnosis of tuberculosis eliminated. Patients would be referred for a number
of reasons: they may have lived with or been related to a notified case of
tuberculosis; their GP or School Medical Officer may have referred them based
on their symptoms; they may have been sent for a ‘large film’, a more detailed
X-ray to check on any abnormalities detected during mass radiography; or they
might require examination before entering certain professions. For example, all
apprentices in the printing trade would be screened, as it was an industry with
a high mortality rate from tuberculosis, attributed to crowded working conditions.
Others requested to go in for an ‘overhaul’, usually due to nervousness that
they had the condition.
When they arrived, the patient would be quizzed on a variety
of factors which would give a general background to their health and lifestyle.
But what exactly was it that was being looked for?
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| Case note, for a symptomless contact of TB, showing the standard checks performed at the RVD (LHB41 CC/2/PR2.5695) |
Firstly, a patient would be questioned on the presence of key
symptoms including coughs and sputum, dyspnoea (breathlessness), and
haemoptysis (coughing up blood). Temperature, pulse, and weight gain or loss
would also be recorded - not for nothing was TB also known as ‘consumption’, as
dramatic weight loss would often accompany the condition. Other symptoms such as
night sweats or the presence of finger clubbing, associated with severe
pulmonary tuberculosis, would also be recorded.
Pulmonary tuberculosis can often be present without visible
symptoms, so factors such as the size of the patients’ family and any family
history of tuberculosis were also recorded. Tuberculosis spreads following
prolonged close proximity to sufferers, so a close relationship with a sufferer
was worth investigating. The patient’s occupation would also be noted, in order
to ascertain if they worked in a dusty occupation or a physically taxing
position. This information was also a valuable indicator of poverty and poor
living conditions, which were associated with tuberculosis and which a doctor
would have borne in mind when recommending treatments.
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| Case note from 1949, includes a record of the smoking habits of the patient - note that this is not pre-printed on the form. (LHB41 CC/2/PR2.5704) |
From the 1940s onwards, case notes also note how many
cigarettes a patient smoked per day, which is interesting considering the relationship
between smoking and lung cancer was first proposed, and not immediately
accepted, around 1950. Smokers who were found to have some lung symptoms were
usually told to stop or curtail their smoking, which goes against the impression
that many people now have of the popular and clinical attitudes towards tobacco
consumption at the time.
A final note on the patient’s general condition
(‘subaverage’, ‘satisfactory’, etc.) would also be made. A few case notes refer
to ‘long eyelashes’, referring to an earlier idea of two forms of tuberculous
patient; the beautiful, delicate consumptive, with long eyelashes and fair
complexion, and the other with “coarse, thick features” and a sallow complexion.
If a patient was perceived to live in poor conditions, to be malnourished, or
to have an unsatisfactory personality, this would often be recorded as well.
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| Note on a patient's general condition: "GC Fair only. but not bad for age" (LHB41 CC/2/PR2.5717) |
All of this information would be recorded before a patient
even got so far as a clinical examination or an X-ray, and it is not clear from
the case notes if this part of the examination was carried out by a doctor or
not. But it was important for all of this to be recorded, and it is obvious
from the case notes that this information was a useful aide in determining if a
patient was suffering from pulmonary tuberculosis. As well as this, these case
notes also provide a fascinating insight into the work and habits of tens of
thousands of Edinburgh residents in the post-war period.
Sources:
LHB41 CC/2/PR2 Cairns, Margaret; Stewart, Alice, ‘Pulmonary Tuberculosis Mortality in the Printing and Shoe-making Trades. Historical Survey, 1881-1931.’, Brit. J. Preventive & Social Med., 5 (2), (Apr 1951), pp. 73-82 http://www.cabdirect.org/abstracts/19512703370.html;jsessionid=53F6E61EACAA51F66F6650F988C4EE89?freeview=true
Imray, Keith, A popular cyclopedia of modern domestic medicine : comprising every recent improvement in medical knowledge : with a plain account of the medicines in common use, (1849), available at: https://archive.org/stream/63580420R.nlm.nih.gov/63580420R
Macfarlane JT, Ibrahim M, Tor-Agbidye S., ‘The importance of finger clubbing in pulmonary tuberculosis.’, Tubercle, 60 (1), (Mar 1979), pp. 45-48.
Ruddock, E. H., The diseases of infants and children and their homœopathic and general treatment, (1899), available at https://archive.org/details/b28134825
Woodcock, H de Carle, ‘Adolescent and other forms of
tubercle’, Tubercle¸5, 2, Nov 1923,
pp.64-69 http://www.sciencedirect.com/science/article/pii/S0041387923800939
‘Smoking and cancer of the lung: minister’s press
release and statement in House of Commons’, Tubercle,
35, 3, (Mar 1954), pp.70-72) http://www.sciencedirect.com/science/article/pii/S004138795480047X
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