Archives and manuscripts cataloguing, June 2011

This month’s new cataloguing bulletin from the Archives and Manuscripts department releases a large tranche of material for researchers to work upon: five collections of twentieth-century papers, totalling over 230 archive boxes of material or over 1000 new database records. Our congratulations to the cataloguers! All this material is now not merely catalogued in the online database, but also enabled for online ordering so that researchers can, should they wish, browse the catalogue, click the ordering link and have the material ready to view on Monday.

Although the records’ date is similar – twentieth-century, with a bias towards the latter half - the subjects documented span a wide range, from institutional documentation to personal papers, from hard-core laboratory science to the social implications of health and welfare. The largest and smallest collections are both records of organisations concerned with public health and with communication (in both directions) between citizens and their health-providers.

The records received from the Royal Society for Public Health and its predecessor bodies (SA/RSP) total well over 100 archive boxes and span the widest date-range of any released this month, going back to the foundation of the Sanitary Institute in 1876. The organisation’s history is complex. The Sanitary Institute amalgamated with the Parkes Museum of Hygiene in 1883 (and opened a School of Hygiene), changing its name in 1955 to the Royal Society for the Promotion of Health (the shorter form Royal Society of Health was also used. The Royal Institute of Public Health was founded in 1886 (simultaneously, the same founders set up the College of State Medicine which merged in 1892 with the laboratory founded by the British Institute for Preventive Medicine and eventually became the Lister Institute: see that organisation’s records held as SA/LIS). The third major strand in the organisation’s history is that of the Institute of Hygiene, which was founded in 1903, and merged in 1937 with the Royal Institute of Public Health to form the Royal Institute of Public Health and Hygiene. In 2008 the Royal Society for the Promotion of Health merged with the Royal Institute of Public Health and Hygiene to form the Royal Society for Public Health, bringing all these bodies together. The archives document some strands in the history better than others: the main body of records of the Royal Institute of Public Health and Hygiene were held at its headquarters in the 1990s and surveyed by the Wellcome Library’s archivists then, but had gone elsewhere by the time the newly-unified society presented its historic papers to the Library in 2009. When the missing records are located, they will join the archive here. The collection is, however, already a rich source and includes minutes, examination registers relating to the various qualifications awarded by the societies, publications, financial, legal and administrative material, photograph albums and property records and was first described in an earlier blog posting a few days ago.

A far smaller collection is that of Health Concern (SA/HCN). This body was founded in the mid 1980s with the primary aims of 'campaigning for more resources, co-ordinating comment on Government plans for the NHS and exchanging information on research.' – it was a broad alliance of various member organisations who shared the aim of supporting the NHS by promoting its basic principles and mounting an educational programme on healthcare and treatment. Although non-party in its remit, it clearly operated at a time when the whole concept of socialised healthcare versus the market was a political hot issue (and indeed was founded by Lord Ennals, who had been a Labour minister under Harold Wilson) so its activities were inescapably political in their context. The papers, dating from the 1980s, document its founding and administration during these crucial years.

Turing to personal papers, the records created by Professor Tim Lang and held as PP/TLA are also of major importance regarding public health issues. Tim Lang’s work has been in the field of public understanding of the food supply chain and the issues raised by what we eat and how we get it. His archive, totalling seventy boxes, documents his extensive involvement and role in the field of food policy, nutrition, environment and public health from the late 1970s up until 2000, and also provides a significant record of the development of food policy as a topic for discussion, notably in the UK, during this period. Organisations such as the London Food Commission, Parents For Safe Food, the National Food Alliance and the Sustainable Agriculture Food and Environment (SAFE) Alliance are documented, as well as Tim Lang's wide-ranging writings on food; subject files cover some of his interests such as meat production standards, a school meals campaigns in Lancashire (early 1980s) as well as the national school meals campaigns in the 1990s, low income and food poverty, the Food Safety Act 1990, the salmonella and the listeria 'scares' in the late 1980s, and the impact of General Agreement on Tariffs and Trade (GATT) reform and the Common Agricultural Policy (CAP) on the food trade, health and safety, the environment and the developing world.

Finally, two collections relating to laboratory scientists conclude this month’s round-up. The papers of Robert Race and Ruth Sanger relating to their work on blood groups (PP/SAR, complementing the organisational records held in SA/BGU) were described in a separate blog posting earlier today. Like Race and Sanger, Dr Shirley Ratcliffe (PP/SRA) was involved in work at a Medical Research Council Unit, in this case the Edinburgh Cytogenetics Unit Study of Long Term Outcomes for Children Born with Sex Chromosome Abnormalities which in 1967 embarked on a longitudinal study of children born with these abnormalities, to establish the conditions’ incidence and long-term prognosis. The study – which also looked at a control group of children without these conditions – ran until the mid-1990s, but Dr Ratcliffe’s papers on the subject continued to be generated until 2010, the very year in which they were transferred to the Library. Much of the material, clearly, is made of clinical patient data that for the moment is closed under the Data Protection Act; however, there is much material on the conditions in general that is available for consultation now, with more to come of course as the years pass.

Image: a man with Klinefelter Syndrome, in which an extra X chromosome is added to the normal male XY pairing; the work of Shirley Ratcliffe looked at children born with this type of chromosomal abnormality, among others. In this picture, taken from Wellcome Images, the subject - who has undergone testosterone replacement therapy to enable development of male secondary sexual characteristics such as development of muscle bulk - is working out to avoid the development of osteoporosis, a common problem in males with his particular Syndrome.

NHS founder dies

Fifty years ago today, Aneurin Bevan MP died of cancer at the age of 62. His legacy, of course, is very much alive: as the UK enters a round of what we are warned will be ferocious cuts in government spending, one of the few departments whose budget we are promised will be protected will be Health, and specifically the National Health Service that Bevan brought into being in 1948. For all the changes that have taken place around the margins (some of them changes that Bevan would have hated: he resigned from the cabinet in 1951, along with the young Harold Wilson, over the introduction of prescription charges for dental care and spectacles), the central concept of a National Health Service paid for by taxation and free at the point of delivery remains one of the nation’s political untouchables. British readers will rely on Bevan’s handiwork many times in the course of their lives: this is Bevan’s monument.

He was elected MP for Ebbw Vale in 1929 at the age of 31, already with considerable life-experience under his belt: he had left school at 13 to become a miner, been sacked as an agitator at 19 then reinstated following a court case, won a scholarship to the Central Labour College in London, set up the Tredegar “Query Club” as a mutual support organisation for working people, been active in the General Strike and begun his political career by winning a seat on Monmouthshire County Council.

Bevan became Minister for Health in the Labour government elected in the 1945 landslide (combining the portfolio with responsibility for housing). The National Health Service he set up owed much to his, and voters’, experiences in the inter-war years. The Beveridge Report had already done much to crystallise voters’ determination that this time the aftermath of war would see the country reshaped (there was a widespread perception that soldiers in the First World War, despite talk of “homes for heroes”, had returned to a country that repaid their sacrifices by leaving them as poor as they had been before signing up). For all the public support for the new scheme, there was resistance within the medical profession to their being effectively nationalised, and Bevan himself spoke of buying off the British Medical Association by “stuffing their mouths with gold”. (This famous phrase later became the title of a radio documentary series made in the early 1980s, on the origins of the NHS: taped interviews with various politicians, civil servants and medical personnel, which fed into the documentary, are held in the Archives and Manuscripts department as GC/98. The BMA's archives are held as SA/BMA.) The National Health Service Act of 1946 finally came into force, after much negotiation, on 5th July 1948 – sixty-two years and one day ago.

There had been vigorous debate within the Labour cabinet as to the shape this new service would take. In its final form, one could argue that it was a creature of its time: the country had just emerged from a war in which central government planning had affected life as never before, with all sorts of services that had normally been organised locally (for example, the fire brigades) brought under national control. Bevan was keen that the new health service should be universal and consistent in its nature, and the public resistance to anything that smacks of a “postcode lottery” in health provision suggests that this strikes a chord with the electorate. For this to be the case, he felt that funding had to be national, not local, as the latter might mean poorer services in poorer areas. However, this did mean the loss of some local responsiveness, with – for example – former Poor Law infirmaries previously run by local authorities falling under central control. (A browse through the hospitals documented in the joint Wellcome Library / National Archives Hospital Records Database shows how common this was.) Herbert Morrison, another towering figure in that post-war Labour cabinet, had made his career in the London County Council and argued strongly for the retention of a local element, but Bevan’s views won the day. Various local initiatives bit the dust as a result – notably, the Pioneer Health Centre in Peckham, a revolutionary interwar experiment in health promotion whose papers are held in the archives as SA/PHC, did not fit into the new structure (although the Pioneer Health Foundation is still going strong as a health promotion charity and lobbying group).

Bevan occurs as an individual in various archive holdings here: as was mentioned last week, the papers of the Nobel Laureate Sir Ernst Chain include correspondence with him both in and out of office, including a 1954 letter from Chain which could fairly be described as fan-mail. In more general terms, the Library is rich in materials for researchers looking to investigate the impact of the NHS, or to write the alternative history of how different assumptions might have led to a different structure. What is beyond debate is the enormous impact on several generations of UK citizens of the National Health Service set up by the man who died fifty years ago. When so many other structures set up by the 1945 government have been dismantled – British Railways, British Steel, the National Coal Board – the NHS remains. It is a measure of Bevan’s achievement in changing the landscape that to the UK electorate anything else would seem unthinkable.

Images, from top:
1/ Aneurin Bevan MP, from Wikimedia Commons.
2/ Pioneer Health Centre, Peckham: image copyright belongs to the Pioneer Health Foundation.

Patients Association Archive Available in the Wellcome Library

Readers may have observed recent media publicity following publication of the Patients Association's report 'Patients... not numbers, People... not statistics' in August 2009. In this report the healthcare charity focused on poor standards of nursing and domiciliary care for the elderly, highlighting the difficulties that patients and their relatives have encountered in access to information, communication with health authorities, and the complaints investigation process. These and many other aspects of patient care are issues examined and discussed in detail in the archive of the Patients Association which has recently been catalogued and is now available to historians and researchers.

The Patients Association, a registered charity, was founded in 1963 by Dame Elizabeth Ackroyd (1910-1987), civil servant and consumer rights campaigner. It was set up as an independent national voluntary body to protect and develop the interests, rights and well-being of users and potential users of health services in the UK. The Association was probably the first to address this angle of health, being set up before Community Health Councils and many other self-help organisations. Its activities focused on patient frustration with the National Health Service, particularly hospitals, doctors and bureaucracy; the paucity of information on how to make a complaint; educating the public on their rights and responsibilities as patients.

Over the years the Association has monitored trends in patient satisfaction and opinion; promoted the voice of the patient in NHS and private healthcare; represented the patient's viewpoint to official bodies such as the Department of Health, medical and nursing colleges and professional organisations such as the British Medical Association and General Medical Council; provided an advisory service for patients and their relatives; offered patients the opportunity to share their experiences of the whole range of healthcare services; campaigned on issues such as hospital conditions, waiting lists and visiting hours, standards of care, patient consent, codes of practice regarding use of patients in teaching, subject access to medical records, and confidentiality.

Elizabeth Ackroyd virtually ran the Association from its early days until her death in 1987. She was president from 1971-1978 and from 1978 chairman. She was considered to be the heart and soul of the Association in terms of representation on committees and working parties, engagement with the media, attending events, and (with a small industrious staff) the day-to-day business and running of the organisation. A source of formidable energy and enthusiasm, as well as running the Association Dame Elizabeth held prominent roles in the Consumer Council established in 1963, the Consumers’ Association and numerous other voluntary organizations.

The Archive has been allocated collection reference SA/PAT and comprises 112 boxes. It is divided into ten sub-sections and covers the history of the organisation from its establishment in 1963 up to about 1996. It contains material relating to the organisation and administration of the Association, correspondence with numerous voluntary, professional and other health related bodies, files on a wide range of health subjects, publications, press cuttings and patient correspondence (the latter is however closed for a specified period in order to protect the confidentiality of individual members of the public).

The catalogue can be viewed by entering ‘SA/PAT’ in the reference field of the search interface of the Archives and Manuscripts online catalogue. To navigate around the catalogue click on the light blue numbers on the left side of the results page and the ‘See this in context’ links.

The papers are available subject to the usual conditions of access to Archives and Manuscripts material, after the completion of a Reader's Undertaking. Please note that parts of this collection are subject to specified restrictions or closure periods for the purposes of data protection.

It is hoped that the Patients Association archive will provide valuable evidence of the concerns of patients from the 1960s through to the mid-1990s and thereby also a basis upon which comparisons can be made with issues affecting today’s health service consumers.

Author: Amanda Engineer