patient files

Asthma, school phobia and broken bones: other conditions at Stannington in the era of antibiotics

31/10/2016 by Northumberland Archives

Whilst the majority of the case files we hold are for patients who suffered from tuberculosis, a significant number of the latter case files we hold are not. In the middle part of the 20^th Century detection and antibiotic treatment for T.B. developed and social conditions improved. This resulted in fewer children suffering from the disease requiring hospital treatment and beds being made available to children suffering from other complaints. From just a few non tuberculosis patients admitted in the mid-1950s numbers grew and in the 1960s around 80 in every hundred patients did not suffer from tuberculosis. Here we will look at the range of other illnesses and afflictions which children admitted to Stannington suffered from during this period.

To begin with, starting in 1956, non T.B. patients were admitted by referral from the same three visiting consultants who oversaw the treatment of tuberculosis patients. These patients were children who had chronic illnesses including asthma, respiratory infections, rheumatism and orthopedic conditions. This reflected the individual specialisms of the visiting consultants who were treating T.B. patients, and the illnesses it was thought would benefit from the environment and experience of the sanatorium and its staff.

By 1959 the situation had changed to the extent that most patients did not have tuberculosis; In the extract below from a letter found in a patient file, Dr Miller, one of the consultants who oversaw the care of patients at the hospital, explains what has changed.

Until a few years ago it [the sanatorium] was used entirely for children with tuberculosis, but recently as the number of children suffering from clinical tuberculosis has decreased so remarkably and social conditions have improved, we have been able to use the hospital for non – tuberculosis chronic respiratory disease and now the children with tuberculosis are in the minority.

From this point onwards the range of conditions which patients admitted to the hospital suffered from continued to grow. The table below summarises the range of conditions patients admitted to the hospital were diagnosed with in 1966, the last year of admissions for which we have case files, and is also illustrative of the preceding years in the decade.

Diagnosis	Cases admitted in 1966	% of total
Asthma	36	23
Tuberculosis (all types)	21	14
Behaviour Problem	15	10
Bronchitis	13	8
Chronic Respiratory infection	9	6
School Phobia	7	5
Bronchiectasis	4	3
Rheumatism	4	3
Diabetes	4	3
Muscular Dystrophy	3	2
Enuresis	3	2
Epilepsy	3	2
Malnutrition	2	1
Chorea	2	1
Eczema	2	1
Bronchopneumonia	2	1
Meningocele, glomerulonephritis, leg injuries, abdominal pain for investigation, endocarditis, headaches, osteitis of pubic ramus, Coeliac disease, Marfan’s syndrome, post pneumonia, neuroblastoma, Perthe’s disease, streptococcal infection, paralysis, obesity, for observation, habit spasms, post burns, fractured leg, scoliosis, mesenteric adenitis, post road accident, fibrocystic disease, pschomatic vomiting and amystonia congenita all accounted for 1 diagnosis on admission each.		16

The largest proportion of patients admitted to the hospital suffered from respiratory conditions such as asthma, bronchitis, and respiratory infections. Orthopaedic cases, conditions and injuries affecting bones and joints are also present. Patients diagnosed with psychological complaints make up a large group of patients admitted to the hospital. In addition to these there a number of other conditions are represented in the patient files; these include diabetes, obesity, chorea and admittance for a period of recovery after suffering from burns.

Patients suffering from asthma or other bronchial conditions were often admitted for several months or years at a time with the aim of improving their condition. For these patients treatment often included antibiotics such as penicillin, breathing exercises and postural drainage. If judged well enough, patients were often allowed home for holidays with permission from doctors. This allowed the patients to visit their families and also appears to have been used to trial patients in their home environment to see if they could sustain improvements in their health outside the hospital environment.

Treatment summary card — The treatment summary card of a patient admitted to Stannington Children’s Hospital in 1959 suffering from Asthma (HOSP-STAN-07-01-01-3710-03)

In the latter years of the time for which we have files patients were admitted with a range of psychological complaints. These were varied and include depression, psychosis, anxiety and school phobia. School Phobia, or the refusal to go to school, often had an underlying cause of depression or anxiety. These patients often came from difficult home backgrounds and were often admitted in part to give them respite from the home environment and the conditions which were causing their conditions. During the 1950s the care of these patients was overseen by Dr Connell, a consultant who had originally started visiting the hospital to see patients who had been admitted with conditions which it was felt may have in part had psychosomatic causes.

Case file cover for a child suffering from School Phobia (ref: HOSP-STAN-07-01-01-4501-01)

Children with orthopaedic conditions made up another group admitted to Stannington. Some of these were congenital, for example Perthe’s disease and talipes equinovarus (club foot), and some had other causes such as accidents. These patients were often admitted for recovery in a medically supervised environment following procedures and operations carried out at the general hospitals. The Royal Victoria Infirmary and Fleming Memorial Hospital in Newcastle feature regularly as places from which cases are referred.

In a large number of cases other factors played a role in a child’s admission alongside their medical condition. The continued provision of education meant that children were able to continue learning whilst their health improved. This appears to have been a particularly important factor in the cases of children with bronchial complaints such as asthma who outside Stannington could be missing large chunks of education. Schooling played such a large role in hospital life that admissions, discharges and holidays were commonly scheduled to coincide with school terms.

Home and social condition also played a role in the decision to admit children to Stannington. Examples include poor or overcrowded housing, a disrupted family environment, or where it was considered care or treatment administered by parents may be unreliable.

The case files for patients not suffering from T.B. largely follow the same format as that for T.B. patients. The case files for non-tuberculosis patients often include numerous letters regarding the progress of the patient’s recovery and arrangements for check-ups and procedures at other hospitals. These could often involve Stannington, the visiting consultant overseeing the patients care, specialists at other hospitals who were involved in a patient’s treatment, the family of the patient and the family doctor. In addition there can be other documents included in the files such as weight and height charts. One example is the page below, which is a dietary guide found in the file of a patient who was admitted to Stannington after being diagnosed with diabetes.

Recommended diet for a patient with diabetes. (ref: HOSP-STAN-07-01-01-3310_19)

Writing the Century: Stannington

29/11/201603/10/2016 by Northumberland Archives

Stannington Sanatorium collection will feature in a play broadcast on BBC Radio 4 this week by Newcastle University’s senior Lecturer in Creative Writing Margaret Wilkinson. The play will be broadcast on BBC Radio 4 each day from Monday 3^rd October to Friday 7^th October at 10.45am, with a repeat at 7.45pm. Margaret often uses archival research in her plays, including working with post graduate students to tell the story of the 1649 Newcastle witch trials in The Newcastle Witches, performed at the Newcastle Guildhall in 2014. Margaret’s play Queen Bee has been performed at the Northern Stage and 8 other venues, and Blue Boy has been performed at the Durham Literary festival. She won the Northern Writer’s awards Time to Write award in 2000. We asked Margaret to tell us a little of what it was like to write the play and the sources of her inspiration for it.

Margaret Wilkinson (right) with Dame Sian Philips at the recording.

My inspiration for writing ‘Stannington’ came from the wonderful resource I found at Northumberland Archives based at Woodhorn, Ashington and the kind assistance of the

Opening up the patient files and our new Flickr collection

21/12/202006/07/2016 by Northumberland Archives

We our happy to now announce at just past our halfway point in our repackaging and digitisation project of the 1944-1966 patient files we are launching a new collection of Flickr sets of some of the files. Our hope in this is that we can showcase some of the types of documents for those wishing to study the files.

We hold the patient files covering the period 1937 to 1966. The first files are pre-printed sheets, which were sorted and bound into books after the patient’s discharge. These give the medical and family history of the patient, the tests done, temperature charts and diagrams of the front and back of the torso to record observations on the chest. Additional sheets of temperature charts and diagrams could be pasted in once the first sets were used. The project’s first phase looked a lot at these and there is much about them in previous posts. We have chosen one as an example, which you can see here. In 1943 the staff transitioned to using files, which were also filed by the date of discharge until 1946.

first page in the discharge book for HOSP/STAN/07/01/01/476 — The first page in the discharge book for patient HOSP/STAN/07/01/01/476

We don’t find the same documents within each file, but wanted to show a range of what we commonly find, and have divided these into what we have described as ‘core’ and ‘non-core’. The core documents give an overview of each case and are appended to our online catalogue, available to search here. Non-core documents include temperature charts, correspondence and less common documents; these cannot be viewed via our catalogue. Our new Flickr page will give a glimpse of how the whole files and their associated radiographs look.

However, choosing which files to use has been difficult, as the cases and the contents of the files themselves are so varied. We have chosen two files from each of the three types of disease identified by the patient files – pulmonary (in a blue file), bones and joints (in a green file) and cases of Tuberculosis where tissues were affected (in a pink file). For each type we have shown an earlier case, around 1946-1948, and another from after the introduction of streptomycin and similar antibiotics at Stannington, around 1949-1953. After 1953 we have fewer radiographs, and we wanted to ensure these were included too. Each file has been redacted to remove the names and personal details of each patient, leaving details of treatment, condition and other aspects of their stay at Stannington. We have left out long runs of temperature charts, superfluous backs of documents, and included only a few of the radiographs where they are taken repeatedly over months and years. However we can always be contacted by emailing archives@northumberland.gov.uk if you have any further questions.

Rather than taking you through each file here when they can be explored fully on Flickr, we will look instead at some of the types of documents that are included in the files. We have divided the non-core documents into those we commonly find which are present in some combination in most files, and those we find less regularly, even rarely, in some of the files.

Treatment card from file HOSP/STAN/07/01/01/2654, showing stars indicating all three antibiotics were used.

Core documents:

The file – gives the patient’s name, address, date of birth, sex, age, local authority, religion, admission and discharge dates, whether notification was given before or after admission, when immunised for diphtheria, if permission was given for dental treatment and anaesthetic, diagnosis and result of treatment. On the inside of the file was recorded the patient’s family history, results of tests, sputum reports, other pathological reports and X-ray reports (which were later recorded on the X-ray card).
Patient history – a short summary of the patient’s family history and general condition on arrival, followed by details of their progress at Stannington, often quite similar to the treatment card.
Treatment card – written up by the doctors with changes in condition and treatment. Like the above image, later examples are often quite colourful, with streptomycin and other drugs written in red and a different coloured star given to show which drug a patient was given, as shown in the above example. Red stars were for streptomycin, blue for para-aminosalicylic acid (PAS) and green for isonicotinic acid hydrazide (INH). The three were often used together, forming an effective combination treatment.
Discharge report – written summary of the patient’s progress while at Stannington, and their condition on discharge. A copy would often be sent to their local doctor, clinic or the hospital that referred the patient to Stannington.
X-ray card – listing dates, serial numbers, locations and settings of X-rays.

Bacteriological report from file HOSP/STAN/07/01/012654, showing the results of a sputum test.

Commonly occurring Non-core documents:

Medical report to institution (from local authority or other source) – a short report of a patient’s condition before coming to Stannington. Pre-NHS (and for a short while afterwards) local authorities would ‘sponsor’ a bed for a patient from their area, and the appearance of the form differs depending on the area.
Permissions and medical history form – this appears in the late 1940s and alters very little over the years. It asks parents and guardians to give details of childhood illnesses, immunisations and permission for dental treatment and anaesthetic. We also find permissions slips for specific operations, vaguely for ‘an operation’, and other instances, such as day trips.
Bacteriological reports – reports from a bacteriological laboratory showing the results of tests from samples, for example samples of pus being checked for tubercle bacilli. These change through time and are found in two types, a small sheet that would be stuck to the file, document or separate sheet of paper, or a longer thin sheet. In earliest files these may be pathologist’s reports.
Dental card – showing condition of teeth and any treatment during the patient’s time at Stannington. Also sometimes optical or dermatological cards and check-ups.
Correspondence with other hospitals and doctors – from before admission, during their stay and after the patient’s discharge from the Sanatorium. Communication from before a child entered Stannington usually arranged their admission. During their stay correspondence may have arranged a transfer for procedures at another hospital. Any correspondence after a child left Stannington was often with local authorities or the doctor or clinic providing follow up care.
Temperature charts – most patients had their temperature taken twice a day throughout their stay and recorded on a chart, and bowel movements noted. On occasions a 4 hourly chart was used when a child was suffering from a high temperature.
Correspondence with parents and family – includes letters arranging visits and interviews with doctors about the patient’s condition, and the child’s discharge home. These letters sometimes give an insight into home and family conditions.
Out patients review reports – after discharge some patients, usually orthopaedic cases, might be reviewed to monitor progress, often on a three monthly or six monthly basis until the disease was quiescent.

Permissions slip for 'any operation necessary' from file HOSP/STAN/07/01/01/2558. — Permissions slip for ‘any operation necessary’ from file HOSP/STAN/07/01/01/2558.

Some of the other non-core documents that we sometimes find:

Transfer documentation, notes and charts from other hospitals – often enclosed in the file that was used at the other hospital.
Things written or drawn by the children – very occasionally the patients seem to have got a hold of their file and written or drawn on them. On other occasions little drawings or letters have ended up in the file. As can be seen in the Flickr set, the patient in file HOSP/STAN/07/01/01/2697 was an amateur fortune teller!
Newspaper cuttings – of stories about patients may later be put in the files, such as when patients later married etc.
Permissions forms – in addition to the general Permissions and medical form given on arrival we also find permissions slips for specific operations, vaguely for ‘an operation’ like the example above, and other instances, such as day trips.
Removal without medical consent slip – signed by a parent on removing their child from the sanatorium, either pre-typed or handwritten.
Sputum charts – recorded the amount and colour of sputum produced on each day, and found in the latter end of the period our files cover. These long thin coloured graphs could almost be works of art.
Artificial pneumothorax card – like an X-ray card, showing when an artificial pneumothorax was performed. This procedure collapses a lung, allowing it to rest and heal.
Drug charts – occasionally we see charts detailing the time and date drugs like streptomycin and PAS were given.
Diabetic charts – though these are a drug chart in that they record insulin intake, they also record sugar and keytones present in urine.
Diet menus and instructions – for some patients with specific requirements we might find a typewritten sheet giving instructions of what the patient should and shouldn’t eat, or menus for a diet.

We are hoping that making some of the patient files accessible will give an idea of the contents of the collection as a whole. The collection has great potential for academic study of the radiographs and treatments that were used during a time of great development in treating tuberculosis, but also gives a valuable insight into the life of a sanatorium and its patients, and the perception of tuberculosis in wider society. You can view the whole Flickr collection here, and search the online catalogue here through our website. We hope you find the files as interesting as we do, and that they give a little insight into life at the sanatorium.

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