Friday, 24 February 2017

Time to say goodbye to LHSA!

     Time has flown by and today is my last blog as a project cataloguing archivist at LHSA, so I thought I would write something a bit more personal about my experience here, including my favourite items and the skills I’ve gained!

     I started working as a project cataloguing archivist here exactly one year and one month ago, but I was actually already familiar with LHSA thanks to my 10-week internship in Spring 2015. This is when I started working on the Norman Dott project: I catalogued 1200 case notes from the Brain Injuries Unit in Bangour General Emergency Service Hospital in Broxburn, dating from 1943 to 1949. It was the first time I was working on records from the Second World War, and it was truly fascinating to read all the tales of war and life stories – I will always remember, for example, this Polish patient who lost all her family in the Warsaw Ghetto, was sent to the concentration camp at Dachau where she actually fell in love with a man, whom she met again and married in Paris after the liberation. It was amazing to read her story and to realise that it wasn’t a movie or a book – it was a real woman whom Norman Dott had examined and listened to 60 years ago. Which just goes to show that medical case notes are far from containing only technical documents and abstruse descriptions!

Aline working on a case note.

    The knowledge and skills I had gained during the internship made me the right person to finish cataloguing the Dott case notes as a project cataloguing archivist LHSA a few months later. I catalogued 4944 case notes in just over six months. I felt very honoured to be the person to catalogue the very last one of the 28313 case notes of the collection, as it had been such an impressive team effort that had started more than four years ago. This time the case notes I had catalogued didn’t date from the war, but were just as interesting: I particularly enjoyed finding clinical drawings and learning more about the use of the leucotomy procedure in the 50s.

Clinical drawings of an acoustic neuroma operation (PR2.21345) (all personal details have been redacted)

     I also had the opportunity to work on another LHSA case note cataloguing project, RVH v TB, alongside the other project cataloguing archivist Becky.  The case notes were a bit different; they were often shorter and covered less medical conditions, and didn’t always delve into patients’ lives so extensively. However I enjoyed cataloguing them as well – they’ve made me smile, wince, or sigh with sadness. I have also been able to participate in a number of activities related to both projects, which has been an excellent way for me to gain dissemination skills. It was also very gratifying to be able to share my enthusiasm and knowledge on something I had worked on for several months. A good example would be our day at the Scottish Records Association conference in Perth on the 4th of November 2016, on the subject ‘Public Healthcare in Scotland before the NHS’. Both LHSA project cataloguing archivists, accompanied by LHSA access officer Alice Doyle and SFF intern Samar Ziadat, attended this conference. We created dissemination material about LHSA cataloguing projects for the delegate packs, and prepared a PowerPoint presenting the projects that was shown during breaks. We also openly requested feedback and were available to answer any questions. It was a very interesting day where we learnt a lot about other medical archives projects, and got to talk about our own!

The very last box of the norman Dott case notes.

     Next Tuesday will be my last day at LHSA, but I am happy to say that I am not going very far: on Monday 6th of March I will start my new job as cataloguing archivist at the CRC, here in the Main Library of the University of Edinburgh. From CRC intern to project cataloguing archivist at LHSA, and soon cataloguing archivist, I feel like this has been a very enriching and continual progression and I am delighted to be starting this challenging new role soon! I have really enjoyed my time working at LHSA; I am certain the skills and experience I have gained will help me to do my very best and I am very grateful for all the opportunities and support I have received.  

Aline Brodin, Project Cataloguing Archivist. 

Friday, 17 February 2017

Interpretation, interpretation, interpretation!

Lately, Samar, our ‘Opening Up Scotland’s Archives’ trainee, has been thinking a lot about ‘interpretation’ within the context of the arts, cultural and heritage sectors, so she thought she would share a bit about what she’s been learning with you…

In the month of February, I’ve focused on all things interpretation: beginning a professional development course at the University of Dundee called ‘Outreach and Education: An Introduction to the Promotion of Archives’, attending a professional development workshop at the Victoria and Albert Museum in London called ‘Planning and writing your interpretation’, and next week I’ll be delivering my own outreach workshops for the Festival of Creative Learning called ‘Making History: A Feminist Craft Project’.

As a part of my Dundee course, I read a really interesting publication, A Closer Look (2001), which was written collaboratively between Interpret Scotland and the Scottish Museums Council (now Museums Galleries Scotland). It was written in order to support a policy statement that Scottish Museums Council had outlined at the time, called Museums and Social Justice. The publication includes practical guidelines that should be considered when museum professionals plan their interpretation. On the very first page of the publication it is explained that “the notion of social justice asserts that people have a right of access to the collections and to associated information that museums hold on their behalf”. I agree with this statement, and strongly believe that social justice is integral to every form of interpretation that we plan, from exhibitions and talks to workshops and online content. This is because, interpretation is the key way in which arts, cultural, and heritage organisations can make the most of the meeting between their collection and their visitors, and it is our responsibility to make this meeting as stimulating, rewarding and memorable as possible for every visitor that engages with us.

I attended the V&A course on interpretation this month because I wanted to learn how to write exhibition text that is interesting, engaging and accessible to a wide audience. When planning an exhibition, it is a matter of principle to me that the way in which the material is presented is engaging to any visitor who may attend. This was a daunting task to me, considering exhibition visitors can range from experts in the field to young children. The V&A course reassured me that although this is a difficult task, it is not an impossible one. I learnt that in order to cater to a wide audience, I don’t have to ‘dumb down’ the research or collection that I’m presenting, rather, I have to recognise people’s needs and interests, and use the devices of good writing to communicate my ideas. By good writing, the course instructor didn’t simply mean clarity and proper grammar, but producing a personality, life and rhythm in the text that can appeal to all.

As a heritage professional, interpretation is one of my favourite parts of my role, because it’s a chance for me to share my enthusiasm for our collections with the public. So, I’ve been very excited to get to apply this new knowledge in the planning of my own series of workshops for the University of Edinburgh’s Festival of Creative Learning. When planning my workshops, I wanted to interpret Lothian Health Services Archive’s material in a way that illustrates the role of social justice within the archive sector, as well as diversifying the general public’s understanding of history and heritage.

The materials which archives hold are the foundations from which history is written, and historically, as well as in the present day, women’s achievements and contributions to society have been omitted from archives, and therefore history. In my workshops, I wanted to counteract this damaging effect by working with the public to make sure that the stories that we hold at LHSA about Scottish medical women are written into the canon of history. During both workshops, held on Monday 20th February and Wednesday 22nd February, we will discuss the ways in which archives can be, and have been, used within activism, and then do some feminist activism ourselves by producing a crafty zine that celebrates the achievements of LHSA's medical women. After the two workshops, the zine will be converted into an online booklet which will be shared on this blog and our Facebook page, in order to highlight the significant women in our collections, not only to the participants of our workshops, but to our wider online audience. These workshops have been months in the making, and I can’t wait to get crafty with all of you, so if you’re interested in attending, we still have a few places left, so make sure to sign up soon!

Friday, 10 February 2017

Tuberculosis: Historic Developments and Modern Misconceptions


In this week’s blog Project Cataloguing Archivist, Clair looks at the latter 20th century progress in tackling tuberculosis but to what extent has this assigned TB to a disease of the past?

From the introduction of the BCG vaccination in the 1950s, Scotland began to see a dramatic decline in TB infection and death rates. The Royal Victoria Hospital (RVH) in Edinburgh began using the vaccination to protect children and young adults in close contact with others suffering from TB - read more about the development of the BCG vaccination and its introduction to Edinburgh in Rebecca’s blog. Furthermore the decline in TB rates were also affected by the successful introduction of the Mass Miniature Radiography Campaign (MMR),  a screening process which found undiagnosed cases of TB among the at risk population. MMR, a routine vaccination program and antibiotic treatment all contributed to a positive outlook in the decline of TB throughout the latter half of the twentieth century.

It is also important to highlight the work of Professor John Crofton, who was appointed chair of the Department of Respiratory Diseases at the University of Edinburgh in 1952.



Prof. John Crofton, c.1950-1970.  P/PL41/TB/049

Amid the TB epidemic, Crofton experimented in strengthening earlier developments in TB medicine. To streptomycin (which became resistant to some strains of pulmonary TB) and aminosalicylic acid he added isoniazid, and this new combination of drugs became the most powerful treatment of TB throughout the 1960s. Although this was considered a radical approach it soon became known as the ‘Edinburgh Method’ (not to be confused with the earlier ‘Edinburgh Scheme’) and this paved the way for momentum in international standards for the treatment of TB.  Early distribution of the drug combination saw the notification rates of TB fall by 54 per cent in Edinburgh between 1954 -1957. It soon became the leading treatment for TB, abandoning other methods, such as bed-rest and surgical treatment.[1] Here is a short film featuring interviews with the late John Crofton, explain his TB trials and the turning point in TB treatment and drug-trial methodology.


At LHSA we are nearing the end of cataloguing our TB case notes and I was also interested to find out how the disease materialised after the dates of which our TB collection covers. We hold some records that can give us a picture of the TB situation in Scotland but only until the late 1980s. For example RVH annual reports demonstrate that beyond this time there was a positive outlook on what becomes thought of as a historical public health crisis.  There was marked acceleration in the decline of TB in Scotland and today low TB rates are reported at round 8-9 cases per 100 000 of the population. However, since 2005 TB rates have increased slightly and this also reflects the overall situation thought the rest of the UK, particularly in London. Key reasons for this increase seem to stem from factors including:

  • An increase in travel and migration, as most cases are found amongst those not born within the UK.
  • Drug resistant strains of the infection.
  • Health inequality and social risk factors e.g. substance misuse, homelessness and deprivation contributing to poor health, in turn and affecting immune systems.

It is well documented that relatively high rates of TB still exist throughout many other parts of the world, including India, south-east Asia and Africa. Countries such as these are still struggling to control the spread of the disease and TB continues to be one of the top 10 causes of death worldwide. The most recent statistics that can be found on World Health Organisation (WHO) website tell us that in 2015 10.4 million people fell ill with TB and 1.8 million died in that year. But in contrast to this gloomy picture, WHO also states that 49 million lives have been saved in the last 15 years through TB diagnosis and treatment, with a future health target to end the TB epidemic by 2030.

Despite the progression throughout the twentieth century in tackling the spread of TB and future advancement suggesting an optimistic outlook in controlling TB, unfortunately it is not a disease that we can yet consider eradicated.



[1] McFarlane, N, TB in Scotland, 1870-1960, Sep 1990.

Friday, 3 February 2017

The REH and causes of insanity

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.

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.
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:

LHB7/52/633
In 1846, the post of Physician Superintendent was taken up by David Skae (1814-1873). In the spirit of the Victorian passion for taxonomies, Skae was concerned throughout his career with the classification of insanity, approaching the subject from a physiological perspective rooted in a belief in the ‘physical basis of all insanity’[2]. Over the course of seventeen years, Skae developed a theory of classification that grouped the ‘varieties of Insanity…in accordance with the natural history of each’.


Skae's 'classifications'. Held by the University of Glasgow and accessible on the Internet Archive.
Some of these classifications strike us immediately as being firmly rooted in Victorian attitudes to morality, sexuality and gender roles. For example, in his address to the Royal College of Physicians of London in 1863, Skae described ‘Masturbatory Insanity’ as a condition in which “that vice produces a group of symptoms which are quite characteristic and easily recognised, and give to the cases a special natural history; the peculiar imbecility and shy habits of the very youthful victim; the suspicion, and fear, and dread, and suicidal impulses, and palpitations, and scared look, and feeble body of the older offenders, passing gradually into Dementia or Fatuity”; ‘post-connubial Mania’, was “occasionally met with, both in the male and female sex, but more frequently, I think, in the latter, developed immediately after marriage and, without doubt, connected with the effect produced upon the nervous system by sexual intercourse”; and of ‘Satyriasis and Nymphomania’ no description was offered.

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.
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] Barfoot, Michael, and A. W. Beveridge. "Madness at the crossroads: John Home's letters from the Royal Edinburgh Asylum, 1886–87." Psychological medicine 20, no. 02 (1990): 265.
[2] Fish, Frank. "David Skae, MD, FRCS: founder of the Edinburgh School of Psychiatry." Medical history 9, no. 01 (1965): 42.

Friday, 27 January 2017

Cervical Cancer Prevention Week

It’s Cervical Cancer Prevention Week, so Louise has been looking again at Edinburgh’s history of advocacy and care reflected in our collections:

By their very nature, many archives tend to represent an ‘institutional’ view of the past, since it’s the history and accountability of organisations (such as the National Health Service) that these archives are set up to represent in the first place. For example, we have many, many records about patients in the form of various registers, ledgers and case histories, but these reflect hospitals’ aims in treating people and sending them out well again – case histories are taken down by a doctor or clerk (not always verbatim), clinical opinions are given on care and progress and the patient’s outcome assessed. First-hand patient experiences, reactions and feelings are almost always filtered through the clinical needs of the record and the voice of the physician – at least in our older holdings. Luckily, we have a number of more modern collections that reset this balance, conveying the direct experiences of those being cared for – one of these being our Cervical Smear and Women’s Health collection (GD31).  

As a result of publicised (and avoidable) deaths from cervical cancer in the early 1980s, Lothian Health Board’s existing cervical screening services were in extremely high demand – particularly since women were not invited to attend regular screenings. In 1985, laboratory facilities had a backlog of 10,000 un-read slides and froze the screening programme to catch up. In response to public concern about this, Edinburgh District Local Health Council and Edinburgh District Council Women’s Committee organised a public meeting, and the ‘Cervical Smear Campaign’ was formed.

The campaign petitioned Lothian Health Board to lift all screening restrictions and to demand a fully comprehensive service in Lothian and Scotland, including regular tests with organised call-backs and treatment for abnormal smears. Public support for the petition was massive in Lothian, Fife and the Borders, with nearly 18,000 signatures. In May 1988, Lothian Health Board introduced three-yearly screening for women aged 20 and over, a computerised recall system, and automatic notification of all test results to women themselves in addition to their doctors.

Cervical Smear Campaign video, 1987 (GD31/4/3)

The campaign became national as the decade went on. In November 1987, a second petition was launched, demanding a full screening service across Scotland. Campaign members also gave talks to hundreds of women across the region and produced information leaflets and a video in the absence of any other health education material, raising awareness and changing attitudes towards cervical cancer within the general public, the NHS and the media.

My favourite items in the Cervical Smear Campaign part of the collection are undoubtedly these publicity materials – they show a real grass-roots approach, giving straightforward and non-intimidating information about women’s health:
Cervical Smears and Women's Health leaflet, Cervical Smear Campaign, 1986 (GD31/3/1/1)
Importantly, this key information was made accessible for those whose first language was not English:
The same leaflet in Chinese (left) and Bengali (right) - GD31/3/1/2
As well as information generated by the Cervical Smear Campaign, there’s also local and national information and discussion on testing and attitudes to cervical cancer - for example, this Lothian Health Board 1988 leaflet, which echoes the imagery used in the earlier Cervical Smear Campaign:
Lothian Health Board leaflet, 1988 (GD31/3/7/1)
Debates around women’s health and morality, still very much on the agenda today, are also reflected in this collected literature. On the back page of a 1985 publication from the London-based Women’s Health Information Centre (GD31/6/1), the moral assumptions involved in abnormal smear results and cervical cancer diagnoses are explored. Since the virus that leads to cervical cancer is spread through sexual contact, the article reported women ‘already distressed by a diagnosis of cancer… additionally humiliated by insensitive questions about the number of sexual partners they have had.’ The author describes women being ascribed responsibility for the sexual promiscuity of any potential partners and being urged to keep themselves morally and physically pure to remain cancer-free. In contrast, despite the increasing incidence in young women in the 1980s, the article points out that cervical cancer ‘remains predominantly a disease of poverty and old age’ – since working class women without a bathroom at home and wives of men working in ‘dusty’ occupations (like mining, working with machine tools and with certain chemicals) were especially vulnerable. Regular testing, social change, health education and better environmental working and living conditions – rather than cementing stigma and fear – were then, as now, seen as the most effective health promotion.

If you’d like to know more about our collections around women’s health in Edinburgh and the Lothians, get in touch


Friday, 20 January 2017

Smaller stories and the bigger picture


In her final blog post for LHSA, our project cataloguing archivist Rebecca looks back on her time with us and shares some stories from the case notes.

Well, I can’t believe it’s been eighteen months since I started work on the RVH v TB project, it’s just flown by! If you’ve been following the blog during that time you’ll see I’ve learnt a lot from cataloguing the case notes about the detection,  prevention, and treatment of pulmonary and non-pulmonary tuberculosis,  about Robert Philip and the Edinburgh Scheme, and about the city and people of Edinburgh.

It’s been a great privilege, though not one without challenges, to get such a detailed look at the case notes, as these sorts of records are not usually catalogued individually. It means that as well as seeing broader trends in TB care, including the development of BCG vaccine and antibiotic treatments, and getting a sense of how the hospitals functioned (in the case of Southfield Sanatorium, apparently not very well!), I’ve been able to see the stories of individual patients.

Correspondence from the Southfield Sanatorium series, bemoaning the poor state of the hospital prior to 1946.
(LHB41 CC/1 PR1.610)


Some of these stories have been very sad, such as the cat with TB, the child who was kept in school (despite the usual recommendation for bed rest) so as not to be “made a drudge at home”, or the husband who forced his sick wife out of the house she had been allocated to as a result of her illness. Others have been happier, including the many cases of patients making a recovery.
Correspondence relating to some of the sadder stories revealed by the case notes
(LBH41 CC/2 PR2.1042, 3322, 4179  - click to enlarge)
 
One thing that comes clear is the stigma surrounding tuberculosis, such as the patient from England who went to Southfield in order to avoid it being known in their locality that they had TB. I’ve even seen a patient threatening to sue the hospital for giving them such an outrageous diagnosis!
Correspondence revealing some of the stigma surrounding TB
(LHB41 CC/2 PR.2 17565, LBH41 CC/1 PR1.356)
 
Some records tell us about the eagerness of the patients and their families to get cured of the disease, and the anxiety faced by those who wished to avoid it, while others show signs of refusal to comply with treatment. Over the past eighteen months I’ve been able to see literally thousands of these stories, and they are still throwing up surprises!
Case notes and correspondence from cases where patients demonstrated anxiety regarding TB
(LHB41 CC/2 PR2.1863, 2631)
Extracts from case notes of patients who refused treatment or who wished to try other means of treatment
(LHB41 CC/2 PR2.1997, 2595, 6298)
 
As well as the catalogue, hopefully another great tool will come out of the work we’ve done on this project, which will reveal the larger stories which the case notes can tell. Last year, I made a successful bid for someone to work on creating a data visualisation tool using data which can be extracted from our case note catalogues. We’ve been tagging and indexing information such as the patient’s gender, age, occupation, medical conditions and treatments throughout the project, and the plan is that this will be put to use to create fancy interactive graphs and charts which can tell the story of the case notes in a visual form. Work on this project hasn’t started yet, but I’m really excited to see what will come out of it!

Some generic examples of data visualisations, from https://github.com/d3/d3/wiki/gallery

While my work here has mostly been focused on the case notes, I’ve also been lucky enough to learn more about some of the other records and objects held by LHSA. It’s also been a  great privilege to take part in other LHSA activities, including assisting Louise at outreach events, attending conferences, delivering a presentation to students on my old course, and even getting crafty and making some ‘zines last month! I’ve really enjoyed working with such a wonderful team over the last 18 months, and I’ll definitely be reading the blog to keep up with what they are getting up to!

2017 here we come!


As is LHSA tradition, we start off the new year’s blogging with a quick look at the exciting things we have on the horizon…and then it’s back to normal service with contributions from the LHSA team talking about the collections and their work with them.

This month we’re starting off as we mean to go on by getting involved in a couple of activities that will help make us a better archive – first off by taking part in a workshop to revise the NHS Records Management Code of Practice and secondly, by coming up with a plan of attack to help inform NHS colleagues of the kinds of records we want to take. Both of which will mean that the quality, quantity and regularity of transfers of records to us is improved.

Our two Wellcome Trust-funded case note projects will finish this year and we’ll be in a position to launch online catalogues, redacted as appropriate of course! Aline finished cataloguing the Dott case notes a couple of days ago - so we’ve already hit a significant milestone for the project - and Becky and Clair are well on the way to finishing the TB case notes.

We’re also looking forward to making more of the records that we hold more accessible, with digital images going onto the University’s online image platform in the not too distant future (http://images.is.ed.ac.uk/) and by continuing the work required to put our catalogues into ArchivesSpace – the University’s online catalogue for archive collections (http://archives.collections.ed.ac.uk/).

There are exciting opportunities coming up with the team as we continue to offer internships and volunteer placements, so others will be able to join our Skills for the Future trainee, Samar, in working with us to gain skills and experience in the archive sector. We’re particularly pleased to have secured an Employ.ed internship for the summer which will look at our Levin Collection (to find out more about this important material see Louise’s blog at http://jewishmigrationtoscotland.is.ed.ac.uk/index.php/2016/12/20/the-personal-papers-of-ernst-levin-1887-1975-neurologist-university-of-edinburgh/).

2017 is a big year for the Centre for Research Collections with a major new project to rationalise, preserve and make more accessible the collections in the University Collections Facility, which includes our material held there. So we’re looking forward to getting involved and seeing the benefit to our collections and the people that want to use them.

And as well as all that, we'll be providing our usual services - Alice and Louise will be answering your enquiries through 2017...it’s going to be a busy year so watch this space!