The first Physician
Superintendent of the Royal Edinburgh Hospital (REH), Dr William Mackinnon,
initiated a practice of keeping detailed case notes for individual patients. These case notes have been bound into large volumes, and are now known by the shelfmark LHB7/51. They provide us with a rich resource for examining how attitudes to the causes of
mental illness changed throughout the 19th century.
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| LHB7/51/1 - The first volume of casenotes kept by the REH. |
When an individual was admitted
to the hospital certification papers would be produced. This was ‘a complicated
procedure which involved with coordination of petitioners, medical men and
legal representatives'[1].
These certification papers often described why admission was considered
necessary – such as the patient posing a threat to themselves or others – and usefully
for family historians, they can also carry a bit of information about the family’s
medical history.
These papers were legal documents: the hospital was legally stating they had the resources to board, feed and care for the patient; medical professionals were legally affirming the medical need for the patient to be admitted; and someone was legal agreeing to pay the costs of care – in the case of private patients this was usually a relative, whereas pauper patients were paid for by the local authority.
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| LHB7/52/633 - This note accompanied the patient's certification papers. |
These papers were legal documents: the hospital was legally stating they had the resources to board, feed and care for the patient; medical professionals were legally affirming the medical need for the patient to be admitted; and someone was legal agreeing to pay the costs of care – in the case of private patients this was usually a relative, whereas pauper patients were paid for by the local authority.
In contrast to these structured
and regulated documents, the first casebooks of the REH were freeform, and
physicians recorded what they felt to be most necessary to understand and
describe a patient’s mental state and the cause of their illness. For example, money
matters were considered to be the cause of this woman’s melancholia:
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| LHB7/52/633 |
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| Skae's 'classifications'. Held by the University of Glasgow and accessible on the Internet Archive. |
Skae died in post in 1873 and his
although his successor, Thomas Clouston, continued the practice of keeping
detailed case notes, he did make some changes. In 1874 the case books moved
from the freeform blank pages to pro-forma printed pages, requiring the
physicians to provide pre-specified areas of information. These went into a
great deal more detail that had previously been seen – I particularly like that
information was recorded on a patient’s appearance.
This new style of case note also supplied
a place in which to record Skae’s classification. This approach was largely
ignored in the medical community and never really took hold outside of the REH,
but the inclusion of it here allows us to examine not only what ‘disease’ patients were diagnosed with,
but how the manifestations of their illness tell us something about 19th
century attitudes to the causes of mental illness. By the early 20th
century this section had begun to be left blank, and by was eventually removed
from the proforma.
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| LHB7/51/107. Skae's classification is no longer asked for, and the notes are sparse. |
As the number of patients admitted
to the REH increased, the instances of these pages being left blank or only partially
completed also increased. Faced with high demands on their time, physicians and
clerks were not able to spend as long filling in detailed notes for each
patient, and so we’re left with sometimes frustrating ‘teases’ of records such
as these – this is a good reminder that, in the archive, an absence can speak
as loudly as a presence.
[1]
[2]
