Friday, 6 March 2015

The early days of dietetics in Edinburgh...


It was observed in early hospitals that patients tended to get better more quickly if they were well nourished. It was also noted that patients with certain illnesses sometimes needed more of particular foods while others could not tolerate some foods at all.
According to the British Dietetic Association website, the earliest dietary observations were at St Bartholomew’s Hospital in 1687 and the first recorded therapeutic diet was at Radcliffe Infirmary, Oxford in 1837. It was not until the late 19th century and early 20th century, however that the science of dietetics was developed, first in the United States of America. In 1920 a report was commissioned by the Board of Managers of the Royal Infirmary of Edinburgh (RIE) to investigate dietetic arrangements and the Dietetic Department opened in 1924, the first hospital known to have developed such a department. Sister Ruth Pybus was appointed dietician and obtained a Rockefeller Scholarship to study dietetics in American hospitals. In 1928, the Rockefeller Foundation also generously gave the hospital a grant towards the building of facilities for the Dietetic Department which included a metabolic unit, two wards, a diet kitchen and laboratory. The image shows the diet kitchen in 1950.

 
Staff working in the dietetic kitchen, ward 21 RIE, 1950 (P/PL1/S/395)
 
Much ingenuity was exercised in the creation of recipes in the early days. The ‘liver diet’ and the ‘spleen diet’ were created for patients with pernicious anaemia and great effort was made in producing bran wafers for diabetics, made from bran with the starch removed put into a jelly of agar-agar or carragheen moss. The consistency was described as being like fairy toast with the appearance of thin firelighters, but they were much in demand by patients! LHSA holds a set of tasty recipes from the Dietetic Department from the 1950s, which includes this one for chicken in jelly (LHB1/89/4/1).


Recipe for chicken in jelly, 1950s (LHB1/89/4/1)

References: The Growth and Development of the Dietetic Department: 4 The Royal Infirmary of Edinburgh by Anna Buchan, International Journal of Food and Nutrition vol. VII, no. 2, Summer 1954.

British Dietetic Association website: http://bit.ly/18WpDeb

Friday, 27 February 2015

Just mess-ing around...

In this week's blog, Archivist Louise has been looking at a hidden side of hospital life...

Perhaps unsurprisingly, the records that we hold for hospital staff are considerably less detailed than most of those that we have for patients. We can often say that someone was a nurse, doctor or a member of non-medical staff at a particular time, but can provide few other details than that. Although sometimes photographs, monographs and nurse training records can fill some gaps, it can be hard to access individual personalities behind professional roles or to reconstruct the daily lives of hospital staff from archives alone.

However, for some periods and for some institutions, we have a little more to build up a picture of life off the wards. One example that I’ve become intrigued by is the section of our Royal Infirmary of Edinburgh (RIE) collection from the Residents’ Mess. After graduating from their medical course, physicians had to complete a period of practice experience in a hospital, in whose grounds they lived as a House Officer for six months (before 1950 – although this then was amended to a full year of service). We have quite a range of records from those serving this medical apprenticeship, from the photographs of residents that appear fairly often on our website and social media, including our earliest featuring Joseph Lister…..

Our earliest photograph of RIE residents, 1854 (P/PLI/S/294)

… to lists of residents (charting the early careers of clinicians who would go on to change the course of Scottish medical history), rules, correspondence, financial records and ephemera.


Page from Rules Subscribed by Resident Physicians and Surgeons (1895-1928) from October 1921. Can you spot and famous names? (LHB1/114/1)

One set of records that stood out to me was the log books of the Residents’ Mess – what would a canteen log book be like, I wondered naively? In fact, a ‘Mess’ referred to each new intake of residents. Looking at the Residents’ Mess log book from 1914 to 1915, it is a curious document, recording the lighter side of clinical life with an entry for each day. There are in-jokes lost in the interceding years, nicknames, some decidedly savoury language and an almost daily recording of fines handed down to members of the Mess. Here is a more than typical (and relatively tame!) page:


 
Page from Log Book of Residents' Mess 1914 - 1915 (LHB1/115/4)

This loose page from an unknown volume mentions (amongst the obligatory sampling of wine for the mess dinner) a fancy dress parade, which seems to have dropped off, but was planned to be revived:


 
Page from undated Log Book of Residents' Mess, undated (LHB1/115/5)

The Mess Log from 1914 has more detail about the parade, which took place every Christmas Eve at 11pm from the Surgical Outpatients’ Department (SOPD), and lists in delightful detail the individual outfits of each member taking part, including the prize-winner, Dr W A Alexander, who cut a dash as a ‘ballet girl’. Dr Alexander was far from alone, since ‘there was a strong majority of ladies of all ages, nationalities and description from Little Red Riding Hood up to the fully developed butterflys [sic.]’.


Page mentioning the residents' outfits from the Log Book of the Residents' Mess 1914-1915  (LHB1/115/4)

If you’d like to put some faces to some of the names mentioned, here is the class of Winter 1914, with the fancy dress prize-winner in the centre front row:



RIE Residents, Winter 1914 (LHSA photographic collection)

And to prove that the parade was not an isolated occurrence, here's an early twentieth century image of residents in their finery:



Residents taking a break from their hospital white coats, early twentieth century (P/PL1/R/008)


The residents also produced a light-hearted magazine, the Infirmary Independent, of which we have the first (and perhaps only!) edition from 1913. It serialised stories, published satirical poems, and included outlines of out-of-work activities, including theatre and sports.


 
 
  
 
 
 
 
 
 


Cover and first page of The Infirmary Independent, 1913 (LHB1/115/12)
My favourite part of the magazine is ‘The Probationer’s Guide to Knowledge’ (a probationer is defined in the piece as a trainee – or in this case ‘trying’ – nurse) – but at least these young doctors seem to know their place before the ultimate earthly hospital authority, since they acknowledge that 'above [the probationers] are the assistant nurses, above them the sisters, above them the assistant-superintendents , above them the lady superintendent, above her, we believe, the Almighty.'

What we have left from the residents' off-duty life is at times funny, sometimes (to our twenty-first century ears) bordering on the (or actually) offensive, but reveals a world lost in time. This world was undoubtedly a privileged one, since residents had the advantage of an elite education and received no salaries from the RIE before the NHS, but would come to rely for their income on private practice.

 
Residents' event invitation sent to Dr W A Alexander, the fancy dress competition winner! (LHB1/115/7)
Although this world of Latin invitations and medical graduates dressing as ballet girls may justifiably invoke ire at the social inequalities of the early twentieth century, it must be read in the context of its time - perhaps as an outlet for people at the start of their careers with heavy expectations on their shoulders. Similarly, we can see these items with some relief that we have moved towards an era in which there is a narrower social gap between doctors and many of their patients.

And if you ever wondered what the Mess actually had for their dinner every night, we can tell you that as well:


Pages from book of residents' daily menus, 1918 - 1921 (LHB1/115/8) 
If you've been equally fascinated by the world of the RIE residency, you can read more in coming weeks, as we outline a theatrical visit to the fledgling doctors in our Every Picture Tells a Story feature. And this time, it's not the residents dressing up....

 

 

Friday, 20 February 2015

Making friends and influencing people (with the Scottish Council on Archives)

AKA Ruth provides an update on a recent Scottish Council on Archives development and its impact on LHSA...

Last week I went to a Scottish Council on Archives (SCA) event in which they introduced their brand new Scottish Charitable Incorporated Organisation status (SCIO). SCA provides leadership for the archives and records management sector in Scotland in a number of important ways (more information here) and we’ve worked closely with SCA for a few years now. We’ve certainly taken advantage of all the fabulous advocacy work SCA does for our sector - our most notable success was submitting a recipe for invalid fruit tart to their awareness raising campaign, ‘Edible Archive’, which made its way onto the 2012 Great British Bake Off!

More recently we were awarded Accredited Archive Status, a process which was supported by SCA, and we’ve been pumping their Education Development Officer for information to help with our new Wellcome Trust-funded public engagement project where we’ll be producing online resources for teachers. We’re also looking forward to Paul, Edinburgh University’s Skills for the Future Trainee, spending some time with us over the summer. He’s been based in the Centre for Research Collections since October last year as part of a Heritage Lottery Fund grant managed by SCA that aims to offer experience in the archive sector to six people each year for three years.

But what does SCA’s new SCIO status mean for us? Well, we’ll be hoping to carry on working with a great organisation, but now it will be as a member of it! Becoming a member is free, and if you’d like to join us in joining them, more information is available here: http://www.scottisharchives.org.uk/membership.

Friday, 13 February 2015

The growth of the Department of Surgical Neurology


In 1960 a new Department of Surgical Neurology was opened at the Western General Hospital, Edinburgh (WGH) under Professor Norman Dott. This new department brought together the facilities for the diagnosis, treatment and rehabilitation of surgical neurology patients that Dott had been working towards throughout his career. 
Image showing the new Department at Surgical Neurology at WGH (LHB11/7/2)
When he started out in the 1920s there were no dedicated facilities for surgical neurology patients and Dott worked in private practice, treating patients in rooms in a private nursing home and moving his surgical equipment across Edinburgh in a taxi. In 1931, Dott was appointed Associate Neurological Surgeon at the Royal Infirmary of Edinburgh (RIE) and was and given access to four post-operative beds for his patients in Wards 13 and 14 and use of the operating theatre. This was the beginning of the Department of Surgical Neurology at RIE, which was the first of its kind in Scotland.  This move was followed in 1936 with the allocation of Ward 20, which was located in the clock tower at RIE, to Dott to set up his own department. However it wasn’t until 1938 that the new department received its first patients, as the Ward had to be extended and made fit for purpose, this included adding an operating theatre (with a special steel elliptical lighting dome imported from Paris and a sound-proof viewing room which featured one-way glass for students to view operations), twenty beds, an ophthalmic room, staff-room and out-patient facilities. Further accommodation was made available to Dott and his team in 1939 at Bangour General Emergency Service Hospital at Broxburn in West Lothian, where he established the Brain Injuries Unit providing treatment to military and civilian cases. The Department of Surgical Neurology, now firmly established as a specialist unit, operated over two sites providing different services at each location throughout the 1940s and 1950s. Although the department was extended in the 1950s, the growing number of patients (in 1959/1960 Ward 20 dealt with 1,100 patients, performed 900 operations and saw 6,000 out-patients – still with only twenty beds) and the demands on the expertise of Dott and his team meant that more space was needed. A major contributing factor to the growth in patient numbers was the increase in head injuries sustained in road accidents due to the rise in car use.

Roof of operating theatre at Ward 20, RIE (P/PL1/B/l/080)

So, to the Western General were a six- storey block was built, at a cost of £500,000, to accommodate the expanded Department of Surgical Neurology.  The new building housed twin operating theatres; sixty beds; physiotherapy, hydrotherapy and occupational therapy rooms; and staff accommodation.  The theatres, which were specially designed by Norman Dott and described by fellow surgeons as ‘Utopian’, were an ovid shape designed to limit infection and had domed roofs which featured shadowless lamps.
Plan of operating theatre, WGH (LHB13/11/5)
 
Ward 20 at RIE became a specialist unit for head and spinal injuries and for out-patient services, while the new department at WGH was mainly for elective surgery, with patients transferring between the two sites. The sites were even more equipped to work together when, in 1962 a television link was set up. Norman Dott retired in 1963, but the department that he established continued to grow and lead the way in research and treatment, finally merging in 1986 with the Department of Medical Neurology to form the Department of Clinical Neurosciences.


Television link between Department of Surgical Neurology at WGH and Ward 20 at RIE (P/PL1/l/006)

More images relating to Norman Dott can now be viewed on the Scottish Cultural Resources Access Network (SCRAN) by following this link:

 References

The Royal Infirmary of Edinburgh (1929-1979), Catford, E F
A History of the Western General Hospital Edinburgh, Eastwood, M and Jenkinson, A

With Sharp Compassion: Norman Dott Freeman Surgeon of Edinburgh, Rush, Christopher and Shaw, John F

 

Friday, 6 February 2015

HIV/AIDS Project: After a short break...it's back


After I had such a fantastic time as Archive Intern with LHSA towards the end of last year, I was delighted to make a return this time as Project Cataloguing Archivist, working to finish cataloguing the HIV/AIDS collection. From my time as an intern and reading Emily and Karyn’s blog posts about the project I had a fair idea about this great opportunity to work with such a modern collection. To recap, the HIV/AIDS collections at LHSA were inscribed to the UNESCO UK Memory of the World Register in 2011 because of their importance in the context, of the study of the history of medicine.  The collections are rich in their documentation of a significant period for Edinburgh and Lothian, 1983 -2010, in the fight against HIV/AIDS. This was one of the most serious threats to public health towards the end of the twentieth century, not only in Scotland but throughout the UK.

In order to complete the cataloguing project, to provide maximum access to the HIV/AIDS collections for future research, I have been tasked with the following:

·         Completing cataloguing of GD25: Papers of Helen Zealley, Director of Public Health/Chief Administrative Medical Officer (CAMO).

·         Completing cataloguing of GD22: “Take Care” Campaign.

·         Cross-referencing photographs and objects from LHB45: Lothian Health Board AIDS Papers, into the photograph and objects database.

But! One of the first jobs I had was to finish preparing a collection of digitised images and posters, from various HIV/AIDS campaigns, for access via the Scottish Cultural Resources Access Network [SCRAN]. Most of this work was already done but I was the lucky one who got to finish attaching metadata to the images and then hand delivering them to the SCRAN office based at Royal Commission on the Ancient and Historical Monuments of Scotland [RCAHMS]. It was great to get a behind the scenes look at how SCRAN actually delivers such an important educational resource. Working relationships between archives and online platforms, such as SCRAN, are so important to opening up unique and important parts of our history. The HIV/AIDS campaign images are now part of this online service providing access to thousands of images from archives, museums and galleries, representing Scotland’s past for mass leaning. Within a couple of days the images were up on the SCRAN website. Here is a taster of some of the images you can see just by following this link: http://www.scran.ac.uk/database/results.php?id_proj=1104


‘The one you love’ Take Care Campaign – GD22/PD1.4/115


‘Lovely Latex’ Take Care Campaign – GD22/PD1.4/58



‘World AIDS Day-Earth’ – GD22/PD1.4/81


Since then however, I have been cataloguing the Papers of Dr. Helen Zealley, Director of Public Health for NHS Lothian (previously Lothian Health Board(LHB)). The papers mainly consist of business/administrative papers including, reports/official documentation, correspondence, meeting minutes, and promotional material, relating to the running of LHB spanning an extensive period of time, c1975 – c2000. It has been really interesting to gain some perspective into the running of a major organisation from top level management. Taking responsibility for health services at this level is clearly going to be a challenging task. It is extraordinary to see how day-to-day issues, longer-term strategic planning, and also unforeseen threats to public health, are dealt with simultaneously.

One of the issues I have personally been tackling, in dealing with such a modern collection, is ensuring that appropriate Data Protection is placed on sensitive or confidential records. Opening up access to public records must be balanced by a legal requirement to protect sensitive, personal and confidential information under the Data Protection Act. Although this means that some of the records will be closed to public access, once all cataloguing and conservation work is complete there will still be an abundance of papers ready for further research and posterity. As well as a unique insight into the way in which LHB developed strategy and campaigns to tackle the spread of HIV/AIDS in Lothian, the papers of Helen Zealley will expand exploration into other areas of public health that LHB was responsible for. This includes papers relating to the developments of health promotion in education and medical specialisms, such as sexual health, non-smoking policy and environmental health.  The collection also provides us with an overview of strategic planning and policy making at LHB, particularly at a time of financial crisis in the early 1990s and the implementation of cost-cutting measures.

I look forward to completing cataloguing GD25 and keeping you up-to-date with the rest of the project! 

 

Friday, 30 January 2015

Consolidate and Repair: The Conservation of Books


Since the beginning of January, I have started to work on the main collections at LHSA. Although the Wellcome Trust project to conserve the HIV/AIDS collections is almost complete, my contract has been extended until June, so you will be hearing more of tales from the conservation studio over the next few months! During this time, I will be carrying out a range of conservation treatments such as consolidation and repair of bound volumes, surface cleaning and tear repair of flat sheet material, cold storage of x-rays, as well as supervising volunteers and interns working on architectural plans. I am really looking forward to the challenges that working with such a wide range of materials will bring.

For this blog post, I thought I would focus on what I have been working on for the past few weeks; the conservation of bound volumes. A common problem for books in the LHSA collections is the occurrence of red rot. For those of you who don’t work in a library, red rot is a degradation process found on leather bound books. It is characterised by a powdery layer on the surface of the book which, as archivists know, gets absolutely everywhere.  It is also associated with the weakening of the material, so along with red rot, you often find torn leather and abraded edges.
Example of red rot found on books
Damage caused by red rot is irreversible. However, the spread of red rot can be retarded by treating the leather with a consolidant such as Klucel G in Industrial Methylated Spirit (IMS). First a museum vac with a low suction is used to remove the loose powdery material from the book. Then, a 2% solution is brushed on to areas affected by red rot and left to dry. Although this consolidates the powdery material, it doesn’t cure the leather of red rot, it will just prolong its life for longer. A slight darkening of the leather is sometimes caused by application of Klucel G, so often test areas are carried out prior to full application. Although discolouration of the leather is not ideal, it is sometimes better than doing nothing at all and allowing further damage to be caused to the book due to red rot.

Using a Museum Vac to remove powdery material
Using a brush to apply a 2% solution of Klucel G in IMS

In some full leather bound books, red rot can cover the whole surface. In these cases, I decided not to consolidate the volume as it is difficult to get an even coverage over the whole book without causing streaking. Instead, with the help of volunteers Collette and Alice, I made book covers to protect these books. We made these from 650gsm boxboard tied with cotton tape. This allows for covers to be made without the use of adhesives, which speeds up the construction of the covers and ensures that the book is not affected by any potential off-gassing from the adhesive. These covers not only contain all the red rot and stop it spreading, but also protect the books whilst they are on the shelf. Often damage is caused on the shelf as adjacent books can be scraped by the corners of the volumes being removed and replaced, resulting in tearing of the leather.
A full leather book rehoused in a book cover

Example of book with torn and delaminated leather

Another common problem in the LHSA collection is the detachment of boards and spines from bound volumes. This is usually found in books that are consulted frequently as the opening and closing actions causes these areas to weaken. To fix this, I used a couple of repair techniques taught to me by private book conservator, Caroline Scharfenberg, who also works at Edinburgh University. To secure loose and detached boards, I used a strip of fairly thick Japanese paper adhered to the inner spine joint with wheat starch paste. Although further work can be done, this provides a surprisingly strong repair and is suitable for the needs of the collection. If a spine has become detached, a new hollow can be made from archival paper to reattach it. A hollow is essentially a piece of paper that has been folded twice and glued together to create a tube. This is then affixed to the spine and the original cover material is glued to the hollow. When the book is opened, the hollow also opens allowing the spine to move naturally. These basic repair techniques will extend the life of the bound volumes significantly and prevent further damage occurring.
Book, before treatment with a detached spine

Book, after treatment with spine reattached using a hollow

The conservation of books is very different to the conservation of flat archival material that I am used to working with.  Although techniques are similar, the composite and 3D nature of the book provides new challenges to me as a paper conservator. I hope to learn more book repair techniques in the future.

Friday, 23 January 2015

East Fortune Magazine


This week’s blog features two examples of Fortune magazine (LHB39/8/11-12) from the 1950s, an occasional publication by East Fortune Hospital in Drem, East Lothian.  The hospital was founded on the site of a former World War One naval airship station in 1922 and was used as a tuberculosis sanatorium and then later to look after children and adults with learning difficulties as the numbers of tuberculosis patients declined in the late 1950s. It finally closed in 1997.

The magazines claim to be for patients and the local community and each contains a substantial collection of articles, poetry and letters by staff and patients. Patients being treated for tuberculosis would often spend long periods resting in bed in reasonable health and would be grateful of something interesting to read. Typical article subjects include trips abroad and war stories. The 1955 issue includes a double-page spread of caricatures of the hospital staff!


 
Hospital staff from the 1955 edition (LHB39/8/11)

Both magazines feature striking screen printed colour covers. The one from 1955 is of the Bass Rock, a well-known landmark and bird sanctuary which can be seen along the coastline of East Lothian and Fife and is by Jemima Rennie.
 
Cover of the 1955 edition (LHB39/8/11)
The 1957 cover by George Millar features a glum looking individual with a walking stick and hunched posture entering what probably represents one of the huts which made up East Fortune Hospital in the upper picture.
 
Cover of the 1957 edition (LHB39/8/12)
In the lower section, the same man is seen striding out of the hospital relieved of his infirmities. Although tuberculosis is often thought of as a lung disease it can also affect the bones and in particular the spine. The picture shows the level of confidence the hospital staff had that some of their patients could be fully restored and become productive members of society again. As the Countess of Haddington wishes readers in the 1955 foreword, ‘good fortune and health in the years to come’.