Life and death in 1960’s Civil Service: Whitehall Study I collection now available

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Chris Olver, Cataloguing Archivist, London School of Hygiene & Tropical Medicine


The London School of Hygiene & Tropical Medicine has been at the centre of excellence for epidemiology and medical statistics for 90 years. Researchers at the school have contributed to our understanding of disease outbreaks, effectiveness of drug and vaccination treatments and effect of environmental and lifestyle choices on population health. The papers of one of the most renowned longitudinal studies on population health, Whitehall Study, is now available for consultation at the School’s Archive Service.

Infographic showing clinical procedure for health screening of the Whitehall Study volunteers. 

The Whitehall Study I, also known as the ‘Health Survey of Male Civil Servants aged 40 or over’, was a longitudinal health survey of male Civil Servants, aged 40-60, based in London, conducted from 1967-1970 by the London School of Hygiene & Tropical Medicine and Guy’s Hospital. The study involved a mass health screening of 18300 subjects selected across 38 departments conducted in a special screening centre situated in Whitehall. The initial purpose of the study was to identify early signs of cardiovascular, respiratory and metabolic diseases and refer at risk patients onto medical services. The second phase of the study involved selecting subjects for a series of controlled studies on effectiveness of intervention methods, these included weight loss trials, exercise trials and a smoking cessation study involving 1445 men. The entire study cohort were then monitored and tracked by the survey team, through the Office of Population Censuses and Surveys (OPCS), with any deaths and certain disease diagnoses recorded.

Table showing smoking habits of Grade I (Administrators). The questionnaire asked volunteers about current smoking habits, previous smoking history along with a supplementary section for pipe and cigar smokers.

 

It was through the analysis of the resulting mortality data that the most famous finding of the study was revealed. Sir Michael Marmot noticed that lower grade employees were a third more like to die from various mortality causes than those employed at higher grades. This finding showed a clear social gradient in mortality and led to a second Whitehall Study being created that focused directly on the extent and causes of the social gradient. The Stress and Health Study, or Whitehall II, followed a new cohort of 10,308 male and female subjects, aged 35-55, from 1985 to the present day.

 

The archive collection provides an invaluable resource of the data collection, monitoring work and analysis conducted on the original Whitehall Study. The majority of the papers include raw data from the health screening, primarily questionnaires but also clinical test results including electrocardiograms, X-ray and blood results. Mortality data includes photocopies of death certificates, medical coding and computer coding forms and sickness absence reports collected from across the participating departments. Other material includes follow-up studies, primarily relating to the smoking cessation trial and graphs, tables and working papers regarding data analysis. The collection also includes a rich holding of material from preceding health surveys conducted at the School including material relating to General Post Office (GPO) health trials, 1964-1993, and the survey on the effects of air pollution on rates of chronic bronchitis in the Civil Service, 1950-1958.

 

Blank questionnaire from 1966 General Post Office health survey

The Whitehall Cataloguing Project sought to preserve, catalogue and make available the Whitehall Study collection for wider access. It was undertaken by the LSHTM Library & Archives Service between January and September 2017, with funding provided by a Wellcome Trust Research Resources grant. The catalogue description is available on the London School of Hygiene and Tropical Medicine online catalogue and can also be viewed on the AIM25, Archive Hub and the National Archives Discovery catalogue.

Introduction to The King’s Fund Digital Archive

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By Ruth Nitkiewicz, Information Specialist, The King's Fund (r.nitkiewicz@kingsfund.org.uk)

 


 

Selection of documents that have been scanned and are available through the King's Fund Digital Archive

 

The King's Fund is a charity that works to improve health care in England. Established in 1897 as an initiative of the then Prince of Wales, the initial purpose of the Fund was to raise money for London's voluntary hospitals, which at the time offered the only health services available to poor people in the capital. The charity has been renamed over the years (firstly, King Edward's Hospital Fund for London and then later, The King's Fund) and our role has evolved accordingly, reflecting the significant and ongoing changes to health care in England.

Our digital archive records nearly 2,000 digitised King's Fund publications dating from 1898. This unique resource not only records our history and our work, but also the health of people living in the capital and the development of the NHS. The collection doesn't contain any medical records, but it does provide a rare insight into the early voluntary hospital system in London. In the early 20th century, before the NHS was established, there was no central body responsible for collecting information about hospitals, such as bed numbers, costs and expenditure. However, the considerable funding provided to London hospitals gave the Fund influence to achieve reform and improvement. For example, the Fund made it a condition of awarding grants to hospitals that they produce, for the first time, standardised accounts and hospital statistics.

While our digital archive reflects the nature of our work, I should point out that it is really a digital repository for King’s Fund publications. We don’t use the system to store any archival material (our original archive collection is kept in the safe custody of London Metropolitan Archives), so effectively it is a digital library. However, we called it a ‘digital archive’ to reflect the nature of the collection within and to differentiate it from our extensive physical library collection, which includes non-King’s Fund publications. As a former archivist, I originally found the title hard to accept, but I admit that it does have a better ring to it than ‘digital repository’.

We currently use E-Prints as the underlining repository system for the digitised images, and the Universal media viewer (originally the Wellcome digital player) for rendering the images into viewable packages on our library website. At the moment, we are investigating other digital repository systems as we want to expand the collection to include new materials, such as images and born-digital documents and files. One system we’re interested in is the open-source Hydra repository, particularly because of its ability to utilise plugins that enhance collection management and curation. It’s a new area that we are excited to explore, as it will allow the library to showcase these materials in more dynamic ways.

 

Explore The King’s Fund digital archive here: http://archive.kingsfund.org.uk

The Neurosurgical Case Notes of Sir Geoffrey Jefferson

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By Karen Rushton, Wellcome Archivist/Curator, University Archive & Records Centre, The University of Manchester (Karen.rushton@manchester.ac.uk)


 

At the University of Manchester thanks to a generous Wellcome Trust grant we are currently working to catalogue the case files of 20th century neurosurgeon Sir Geoffrey Jefferson (1886-1961). Jefferson was the UK’s first Professor of Neurosurgery who spent most of his career at the Manchester Royal Infirmary (MRI).

 

The case files we hold cover Jefferson’s time working at the MRI between 1927-1940 on a wide range of neurological disorders including brain tumours, epilepsies, neuralgias, head injuries, and congenital spinal deformities. We also see references to lingering war injuries from WWI, occupational and traffic accidents, neurosyphilis, and the use of surgical and diagnostic techniques later considered to be controversial. The files themselves contain a number of record types including detailed case notes and accounts of surgery, correspondence, x-rays, and both clinical and pathological photographs.

Neurosurgery lecture, with Sir Geoffrey Jefferson on the back row second from the left & Norman Dott on the second row from the back on the left, n.d. ref: JEF/1/10/3

 

Going into the project the first major decision centred on what information we wished to record. The Lothian Health Services Archive in Edinburgh have recently completed a similar project centred on the case files of neurosurgeon Norman Dott (1897-1973) and so it was very helpful to be able to talk to staff there about their approach to the records. Most importantly we recognised that the Jefferson collection is one of a number of neurosurgery collections held across the country and it was important to recognise its part in a wider research web and so make our catalogue comparable to that of the Dott Collection.

 

When dealing with relatively modern patient records considerations surrounding data protection were paramount and procedures are in place to produce a public facing catalogue with all personal information removed and a complete catalogue for use in-house and to be accessed by approved researchers. MeSH has been employed throughout for indexing purposes and provides an invaluable tool for selecting files based on conditions and symptoms. It is here where expert advice from a neurologist based within the University has aided us in creating accurate indexing terms and updating old-fashioned terminology. However, the major barrier with MeSH has arisen regarding the potential indexing of surgical procedures. As a neurosurgeon rather than a neurologist the procedures that Jefferson performed were seen as being a very important factor in the descriptive content of the catalogue, but whether or not it was appropriate to index them or not was another matter. As a thesaurus of modern medical terminology MeSH essentially is not fit for this purpose. Whilst old-fashioned terms for conditions can be updated there is no appropriate terminology for now obsolete surgical procedures such as the frontal lobectomy.

 

Having worked on other medical case note projects in the past, namely the Stannington Project at Northumberland Archives dealing with children’s TB files, I was well prepared for the kinds of challenges we might encounter. Nonetheless there is an inevitable variation in the content of the records and in turn the approach to outreach activities and potential researchers. As all the Stannington files related exclusively to children many of the former patients were still alive meaning we were fortunate enough to be able to interact directly with subjects of the records. Equally the subject of TB feeds very well into existing narratives on public health and has many links to social history. Neurosurgery on the other hand is much less overtly approachable to those with a non-scientific or medical background and it is here where interpretative events and blogs have been essential in drawing out less obvious themes and material such as the possibility of the use of visual material in the files by artists working in the medical humanities.

 

Illustration of a brain aneurysm by Dorothy Davison, c.1940s, ref: uncatalogued

 

The cataloguing process is nearing completion but conservation and outreach work will be on-going as the project continues. As part of the Wellcome funding we will also be tackling several other medical collections including the work of 20th century medical illustrator Dorothy Davison, medical artwork from the teaching collections of 19th century obstetrician Thomas Radford, and papers relating to the pioneer of the artificial hip Sir John Charnley.

New NHS Code of Practice on Records Management

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Laura Hynds, records manager working within the NHS, January 2017


During 2015/2016 Daniel Scott-Davies and I, on behalf of the Archives and Records Association (ARA) were involved in the revision of the NHS Code of Practice on Records Management, last revised in 2009. The revised Code of Practice was written by the Information Governance Alliance (IGA) and can be found at the following link: https://www.gov.uk/government/publications/records-management-code-of-practice-for-health-and-social-care. The previous Code of Practice and associated retention schedule have now been withdrawn.

 

The NHS Code of Practice on Records Management is the key guidance document for those working at all levels in the health sector regarding records retention periods and records management. It is used as the basis for organisational policies on the subject and provides guidance to organisations on the transfer of Public Records to a Place of Deposit – these are records identified with continuing value which should be in the care of professional archivists.

 

Whilst the archives community has had significant involvement in the major revision of the 2006 Code, the first draft that was viewed by the ARA of the new code was far from best professional practice – in particular the retention schedule. Along with my colleagues, I had serious concerns about the number of categories with retention actions of ‘destroy’, the lack of consideration for records which should be reviewed for long term archival retention and inconsistencies with legislation. Following this initial review of the document, Daniel and I decided that the ARA needed to be more involved in the process.

 

It took a formal letter from the CEO of the ARA addressed to the chair of the IGA, copied to several senior stakeholders including Dame Caldicott and MPs, for our concerns to be taken seriously and for us to be added to the working group for the revised code. Once we were more formally involved, a good working relationship between the ARA and the IGA developed which will be useful to draw upon in the future. Working together, we negotiated many changes to the document which at times was challenging. Many of the changes that were made were linked to the input of archivists for the 2006 Code.

 

Whilst the published version of the code is not perfect, the document was at a stage where it could be endorsed by the ARA and is a much stronger document than it was back in the summer of 2015. The first part of the published code provides up to date guidance on a range of record keeping issues from records storage to digital continuity and there is a new, useful section on dealing with specific types of records. These range from prison health records to records created by social media and websites.

 

The area where the ARA has had the most input has been the records retention schedule. This now includes right at the start a message regarding recordkeeping and the Independent Inquiry into Child Abuse. Retention periods for clinical research trial records have changed in line with European Regulations. The disposal actions of several record categories have also been updated. If you work within the health sector or acquire records from the health sector into an archive, it is definitely worth reviewing your own policies in line with the new guidance – something we are doing at present.

 

The retention schedule is shorter than the previous one and we have concerns in particular over the length of the section on pharmacy records as this is an area that produces large amounts of significant records within many NHS organisations, particularly hospitals. The schedule at least now links to somewhere where additional guidance can be found. We also continue to be concerned over the guidance on maintaining electronic patient records held in systems. Both of these issues will hopefully be considered with the first annual review of the code in July 2017.

 

On the NHS Digital website, it is now possible to provide feedback on the Code of Practice prior to the annual review. The link to provide feedback can be found here: https://nhs-digital.citizenspace.com/information-governance-alliance/records-management-code-of-practice-2016-feedback/. One of our concerns with the initial revision of the code was the lack of representation from the Royal Colleges. Due to the regular review cycle the document will continue to be worked upon and developed so please feedback any concerns you may have from a recordkeeping point of view. Daniel and I are also happy to raise concerns and advocate for those within the profession regarding the code of practice as well as other issues regarding recordkeeping within the NHS.

‘A Corporate Humanity’ – Cataloguing the Records of the Glasgow Public Health Department

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Alison Scott, Project Archivist, Glasgow City Archives


The Wellcome Trust is funding a project to catalogue the records of the Glasgow Public Health Department and its predecessor authorities.

Glasgow paid a heavy price for being the ‘second city of the empire’. Rapid industrialisation led to over-crowding and dangerous levels of pollution. The resulting effects on the health of the people were profound. In 1895 the Public Health Department was formed, as the city attempted to address these effects. Under its succession of dedicated Medical Officers of Health it slowly created a better city.

 

[View over Glasgow tenements, 1897 ref: D-HE/4/1/8/10]
The Department’s work lent itself to statistical analysis and the ultimate expression of this was the annual report of the Medical Officer of Health. The Department used the report both to quantify the issues and illustrate their progress. They date from 1863, when the first Medical Officer of Health was appointed, and the amount of information in them increases over time with a typical report from 1913 having 58 tables as appendices as well as further statistics in sections on population; maternity and child welfare; infectious diseases; respiratory diseases and tuberculosis; venereal disease; the work of the Port Local Authority; housing; Bacteriological Laboratory; food; air purification; and the work of the hospitals.

[Children receiving light treatment, 1926 refL D-HE/7/2/1/6]
The annual reports are supported by files of raw data used to compile them, along with weekly and fortnightly returns of mortality statistics (1844-1973); and reports on specific events such as the typhoid outbreak in 1880 and the influenza epidemic in 1957. Although not all the administrative files of the Department have survived, those that there are in the collection also help to add meat to the bones of the ‘official version’.

 

The collection also contains the Department’s working records such as reports on housing conditions and insanitary tenements (1920); returns of infectious diseases (1920-1973); prosecutions for smoke pollution (1899-1960); and files on the wartime inspection of shipping.

 

Apart from the core records other resources include 137 newspaper cuttings files on a wide variety of health and social subjects (1907-1939); publications by the Department (1897-1974); and a large number of glass negatives and lantern slides.

 

Work is already finished on the departmental records themselves and an item-level list of this important collection is available for the first time.

 

[Cover of a Public Health Department publication, c 1944 ref: D-HE/6/1/24]
The project has not stopped with the records of the Department, however. Acknowledging the complicated history of health functions in Glasgow, the current work of the project is to re-catalogue the Police records. In the 19th century policing the city was seen as much more than a crime-fighting operation. Records of the Board of Police and its committees date from 1800 and cover such subjects as health, hospitals, cleansing, and sewage disposal.

 

The project is similarly extended to the records of the burghs absorbed into the city through boundary extensions as they also had public health functions. Their records will be re-catalogued, including a substantial amount of previously unavailable material.

 

The quotation in the title come from the sermon given at the funeral in 1904 of James Burn Russell, Glasgow and Scotland’s first full time Medical Officer of Health. The minister presiding looked to a future where there would be ‘a corporate humanity, a public virtue, a body-politic with its laws, duties and responsibilities’. He saw Russell as having fought against both ignorance and selfishness to create a model of his work in sanitation for the rest of the world to follow.

 

An online article in celebration of James Burn Russell, Glasgow’s first full time Medical Officer of Health, can be found at: http://bit.ly/2dxyiZl

 

For further information contact Alison Scott, Project Archivist: alisone.scott@glasgowlife.org.uk.