Friday, 25 August 2017

Tuberculosis and the Health Visitor

Project Cataloguing Archivist Clair looks at the role of the health visitor in the fight against TB.
August sees the return of LHSA’s RVH vs. TB, Wellcome Trust funded cataloguing project.  The project which began in August 2015, sets out to catalogue c.25, 000 case notes from the Royal Victoria Tuberculosis Trust and associated hospitals. Covering the period of c.1920 – 2000 the records provide a detailed account of the fight against pulmonary TB at a time when the disease posed a serious threat to public health. The collection contains four series of which two have already been catalogued and I will completing the cataloguing project by the end of April 2018.

I have now worked with a few different case note collections belonging to different medical specialisms. Although we have been implementing the same methodology in order to catalogue these collections, there is always going to be some variation in the types of documents found in the case notes. The fourth series of the TB case notes holds c.2000 individual patient case files from the Royal Victoria dispensary for Diseases of the Chest. Within the case notes I have found a few different types of documents that I have not come across in other collections, in particular health visitor reports and contact sheets. Being an infectious disease, tuberculosis was deemed a matter of public health and public authorities had to take action to stop the spread of the disease. This included keeping track of all the persons who had been in contact with an infected patient, mainly their family but also their landlord and neighbours when applicable. If a person was deemed at risk they were recorded in the patients file, normally on a contact sheet or in the health visitors report.

TB Health Visitor Report 1958.  PR4.1686
The health visitor report itself provided an interesting insight into the patient’s lifestyle and social circumstances, containing data such as:

  • Demographic information  
  • Previous TB investigations
  • Milk intake (including no. of pints drunk per day)
  • Home reports (including type of housing, condition and occupancy)
  • Family history of TB
  • Work or school information
  • Leisure activities
  • Hairdresser information
  • Regular public transport used

 At the end of the report there a section which suggests the action that must be taken, in consideration of the information gathered from the report, depending on how severe the risk of infection was. Interestingly this could stem from simple hygiene changes, for example, disinfecting the home or ‘laundry disposal’, to extreme measures, including, applying for rehousing or removing children from the home.  The health visitor reports are really interesting because they reflect on the medical state of a patient in relation to the environment they and their family lived in. Moreover they lend themselves to potential social research because of their in depth analysis of standard of living and lifestyle.

TB health visitor visiting elderly lady 1952.         

Audience at TB public health campaign, New Victoria Cinema, Edinburgh 1947.
Throughout the TB project, myself and former colleagues have touched on different methods employed by public authorities to help in the fight against TB, such as, the Edinburgh scheme, Mass Miniature Radiography, BGC vaccination schemes and public health campaigns but the role of the health visitor was important too. The health visitor crossed the boundary of the medical and social worker, and therefore, their main role was to provide advice and encouragement (not judgment), to help families do the best that they possible could to prevent the spread of the disease. This could include a programme of health education and recommendations in disease prevention, such as, milk, extra nourishment and improved sleeping arrangements.  If the patient was uncooperative with the health visitor’s advice and had a chronic tuberculosis infection they were a source of danger to their families as well as the wider public. Even in extremely impoverished conditions with overcrowded homes and poorly maintained housing, the health visitor’s role to help families reach achievable habits of healthy living should be recognised in the public fight against TB. As one tuberculosis health visitor remarked:

TB health visitor visiting elderly lady 1952.  

“The chief responsibility for controlling tuberculosis lies within the community. This is a social disease.”[1]

[1] Buchanan, S. The Health Visitor and Tuberculosis (1955), p.21.

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