Guest Post

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.

Archives

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.

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Book now – Workshop on Wellcome’s Research Resources Grants Fund

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Boots Archive have recently received funding from the Wellcome Trust to help develop its collections through The Wellcome’s Research Resources Grants Fund. On 7th October there will be a chance to hear more about Boots Archive’s experience and the Fund in general. This is an excellent opportunity for business archives to find out more about the opportunities offered by the Wellcome Foundation for projects to increase access to material which has a link to wellbeing or health in its widest form.

The programme is as follows:

10.30 – Introduction and plan for the session  – Sophie Clapp, Boots Archive

10. 45 – Intro to Research Resources Scheme (and initial questions) – Chris Hassan, Wellcome Trust

11. 15 – Boots: why we wanted to transform our service, approach taken & learnings – Boots Archive, SC

11.45 – Boots: Rediscovering the Boots Archive -project delivery, decisions taken & learnings – Hannah Jenkinson, Boots Archive

12.15 – LUNCH

1.00 – Tour of Wellcome – Ross MacFarlane, Wellcome Library

1.30 – Dr Richard Hornsey, History Department, University of Nottingham: Providing an insight into the researcher’s experience

2.00 – Boots: Assessing the benefits and next steps – Judith Wright, Boots Archive

2.30 – Coffee

2.45 – Q&A panel session – Boots team, Dr Richard Hornsey and Chris Hassan

3.15 – Finish

The meeting will take place in the Burroughs Room at the Wellcome Collection Conference Centre. Lunch and refreshments throughout the day will be provided.

To book please contact Sophie Clapp at sophie.clapp@boots.co.uk