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The Fourth Statistical Account of East Lothian

Healthcare

Before 1948 when the NHS came into being there were two general practices in North Berwick, one having two partners the other having three; doctors worked from home and all the telephone calls were taken by their wives. Most patients paid for their care although certain panel patients had free care. After 1948 when all care became free, some patients chose to remain private and paid for their care. In the community there was one district nurse-midwife who did nursing care at home or delivered babies at home, and one health visitor who looked after babies and older children at school. Minor casualties were dealt with in the surgery or at the Edington Cottage Hospital in North Berwick.

In the mid 1950s the two practices joined to form a group practice, moved to group premises with consulting rooms, side rooms and office space. They employed lady assistants to deal with the extra summer visitors and in 1959 their first lady partner was appointed. A secretary and receptionist were employed to deal with letters and take daytime calls, out-of-hours calls being taken by the doctor at home. Ante-natal care was carried out by the doctor for home delivery or delivery of babies born in the Vert Hospital, Haddington. Baby clinics were held by the health visitor in what is now the library in School Road, and she also helped the school doctor and dentist with their clinics held in school.

The GPs started an appointment system during the late 1960s. With the introduction of polio and other immunisations, the health visitor held baby and immunisation clinics in School Road later in the High Street and sometimes in the doctors' surgery. In the High Street there were also eye, ENT and Family Planning clinics and clinics held by visiting orthopaedic and psychiatric consultants.

In the early 1970s a nurse was employed by the practice to take blood, do immunisations, injections, and dressing, and a second nurse did blood tests and ECGs at the patients' homes. A well-woman clinic was started in the practice, fort check-ups and cervical smears. One of the doctors did hypnotherapy.

In 1983 the group practice, now consisting of six doctors, moved to a custom-built health centre in St Baldreds Road where they still practice. At the centre there were offices for district nurses and a health visitor, and facilities for physiotherapy and chiropody. Practice nurses and local authority nurses now assisted the practice, and clinics for visiting pediatricians and psychiatrists, baby clinics by the health visitor, and well-woman and well-man clinics by the doctors were all held. Alcohol counselling was also given. During this decade all the patients' records were transferred to A4 size folders and later put on computer. Repeat prescriptions were also computerised.

By 1995 many GPs in the area joined a local co-operative based in Tranent. This is manned by all the GPs taking part and deals with all out-of-hours calls. In the North Berwick Health Centre diabetic clinics run by the GP and the nurse, asthma clinics run by the doctor and health visitor are all held. The dietician also has clinics. There is now no dental clinic, and the alcohol counsellor has retired and has not been replaced. During this decade the emergence of alternative medicine in the form of acupuncture, chiropractic, and reflexology was available in the area. In the early 1990s doctors started to have patients' records on desk computers for easy reference.

All patients with serious illness such as cancer, multiple sclerosis, AIDS, VD, ME, etc. are treated in specialist hospitals in Edinburgh.

The East Fortune Hospital took patients with TB (mainly in the 1940s and 1950s) and respiratory conditions (including pneumoconiosis), had beds for post-operative care of patients operated on in Roodlands Hospital, Haddington, long-term beds for geriatric care, and beds for the physically and mentally ill.

Roodlands Hospital used to have an accident and emergency department, but now all casualties have to be treated in Edinburgh hospitals. They have beds for medical and surgical cases, and also a geriatric assessment ward. All GPs in the area have open access to their X-ray department.

Dr Jean Walinck, North Berwick GP 1958-90, comments on health in the parish

As antibiotics in the form of penicillin only became available in the early 1940s, the main illnesses that people worried about were infectious illnesses. TB was the main worry as drugs to treat this only became available in the 1950s - patients being treated in East Fortune Hospital. Before immunisations became available there was also concern about polio, diphtheria, scarlet and rheumatic fever, rubella and measles. Before joint replacement became available in 1960s many worried about arthritis. Many patients with heart disease and heart failure suffered chronic illness before drugs for failure were used in the 1950s and coronary bypass was performed.

As far as I know, mothers in East Lothian did not encourage their children to visit others with infectious illness, as measles and whooping cough could leave long-term side effects. Girls may have been encouraged to get rubella. [There] were fears about smallpox vaccine and polio injections (before oral vaccine was used). Recently there have been fears about MMR giving autism.

Polio vaccine was started in the late 1950s and during my time in North Berwick from 1958 I did not see a confirmed case. There was however quite an epidemic in 1947. As this is an agricultural area we did see occasional cases of brucellosis and orf.

Before 1948 some poorer families might not call a doctor because of the cost, and might try some home cures instead. After 1948 there was no rush of patients to be seen.

Minor bumps and scrapes were treated with iodene, Germoline and later with TCP. Splinters might be treated with a bread poultice and infected wounds with eusol or mag sulph and glycerine dressings.

The doctor, helped by the health visitor, routinely did eye tests in primary school. Adults consulted an optician. When free eye tests were introduced I think parents then had the option of taking their child to an optician of their choice.

Both adults and children had to pay for dental care but I believe they could have their children's teeth looked at by the school orthodontist who, until 2000, held clinics in the health centre. After free dental care was introduced, all who wished it could choose a dentist who offered free care.

Foot care was available privately from a chiropodist in North Berwick. An NHS chiropodist saw people in a clinic in the health centre, or visited frail elderly at home. Some people were referred to the foot clinic in Edinburgh, if they required special footwear.

Children

All children up to school age were checked regularly by the health visitor giving them advice about feeding and immunisations. She held clinics to distribute powdered milk, orange juice and vitamins and folic acid to pregnant mothers. Any problems could be referred back to the GP or the paediatrician who held clinics in the health centre. In the 1990s the GPs assisted by the health visitor held child health surveillance clinics. Contraceptive advice was given either by the GPs or at a family planning clinic for all women in the area and held in the High Street.

Maternity care

In the years before the closure of the Vert Maternity Hospital (1971), GPs did their own ante-natal care and delivered babies at home or at the Vert. In more complicated cases GPs shared care with the hospital and babies were born in the Simpson Memorial, Eastern General, Western General or Elsie Inglis Hospitals. After the closure of the Vert, all babies were born in the Edinburgh hospitals. Should a mother wish to have a baby at home, the district midwife would attend, only calling in the local GP or the Flying Squad ambulance if complications developed. GPs did not have a statutory duty to attend if they did not wish.

Dr Jean Walinck recalls

Until pregnancy testing came in (possibly early 1970s), diagnosis of pregnancy was done by the doctor examining the patient. The test usually took several days to be reported, and was superseded by a test the patient could buy from the chemist which gave instant results.

Pregnant women were given antenatal care by their own GP for delivery at home or in the Vert Hospital. Because all the doctors were trained in midwifery shared care was done with the hospital obstetricians for mothers having hospital delivery. In the 1980s the district midwife also did shared antenatal clinics.

Up until the Vert Maternity Hospital closed in 1971 a mother could choose (provided her GP agreed) to have her baby at home, in the Vert or in one of the Edinburgh maternity hospitals. After that all pregnant women had their babies in Edinburgh, but could decide to take 48-hour discharge. (With mothers who took a 24-48 hour discharge there was usually help from the husband or a close relative, especially if there were other siblings). Should a mother decide to have her baby at home she would have to find a GP willing to do that. In the North Berwick practice we decided not to do any home deliveries. She could however decide to be looked after antenatally by her own GP and have the district midwife supervise her delivery, the doctor only being called in in an emergency.

Fathers did attend the birth of their babies in the 1960s but this did not become common practice until the 1980s.

Lynne Turnbull on maternity matters in the 1990s

Babies were born in the Simpson's and the Eastern (Edinburgh) until 1994, then Simpson's or St John's Hospital in Livingston. Birthing pools were very popular. Antenatal classes - usually six (three including partners) which involved breathing exercises, watching videos of birth, breast-feeding workshops. Father's job to use his mobile phone to call friends and relatives with the good news. Helium balloon 'It's a boy' is a common present. Father usually gets drunk that evening with close friends to 'wet the baby's head'. Mother stays in hospital average three days. Breastfeeding in the 1990s - on demand not four-hourly. Commonplace myth to give formula bottle as the last feed of the day to make the baby sleep through the night.

Midwife visits mother at home daily for first ten days, then health visitor visits once a week.

Aqua-natal exercise classes at local swimming pool both before and after the birth.

Tradition - ladies put a 50p or £1 coin in the pram of a newborn for luck.

In the 1940s, children requiring removal of tonsils were taken by ambulance to Belhaven Hospital, Dunbar, and admitted there for three days. In the 1940s and early 1950s some children had tonsils removed at the Edington by an ENT consultant. Most children were looked after by the Hospital for Sick Children in Edinburgh, any with infectious illness going to the City Hospital, Edinburgh.

There was very little care for either the mentally or the physically handicapped child, these children being looked after at home or occasionally being admitted to East Fortune Hospital if over twelve, and even then were only in a geriatric ward.

All patients with mental health problems could be seen by the consultant either in the Health Centre or as an out-patient in Herdmanflat Hospital, Haddington. Any requiring hospital admission would be admitted to Herdmanflat or one of the psychiatric hospitals in Edinburgh.

Disability

Up till the early 1970s there was very little provision for either children or adults with physical disability, and most of them were looked after at home. Most parents felt they got very little support. Some disabled children over the age of twelve were admitted to adult wards in East Fortune Hospital. Deaf children were taught in Donaldson's Hospital and blind children in the Royal Blind School after the age of five.

Up till the 1970s mental illness was regarded as something to be ashamed of and was often not fully understood or discussed. Although tranquillisers were used in the 1950s drugs for the more serious psychotic illnesses had not been discovered. With the coming of TV and more recently the Internet, mental illness is more discussed and understood. Also more chronic mental illness is treatable provided you can persuade the patients to take their medicine. This can sometimes be a problem with psychotics who have no insight into their illness.

People with Downs Syndrome, learning difficulties or mild brain damage could often be kept at home but older children (say with incontinence) would be too much for parents to cope with and could be admitted to East Fortune Hospital. Some older children might be admitted to Herdmanflat Hospital, Haddington.

Adults with mental health problems who needed hospital admission (either going in voluntarily or under certificate) were admitted to Herdmanflat Hospital or one of the Edinburgh psychiatric hospitals.

In the 1970s because there were no facilities for children with special needs some mothers with handicapped children started a handicapped play scheme in North Berwick Community Centre and organised a toy library, initially based in Tranent. A swimming class for disabled children and adults was started in Haddington swimming pool and took anyone living in East Lothian. All these activities were mainly run by volunteers with support with transport from the Round Table and scouts and guides raising funds. By the 1980s much more support for these disabled people was given as they were more accepted into the community. In the 1990s parents get help with speech therapy, occupational therapy, music therapy either at home or at school; there is now also a special needs class in North Berwick school.

Jean Walinck

Care of the elderly

Of the various homes available for the elderly:

Older people with one or more heathcare needs

Over the years 1945-60 fewer married women worked and were able to look after older members of their family, either by giving them support in their own homes or by having them to live with them. With more mothers now working, they are unable to give this support. Some families however do cope with older family members by having a Granny flat attached to their house, and Grannies (if fit) have always and still do play a great part in looking after their grandchildren. However with families now living in different parts of the country this is not always possible. More families - with no near family and mothers now working - are having to rely on other forms of childcare.

With early discharge from hospital, fewer beds for chronic illness, more elderly people are looked after at home helped by home care assistants, meals provided at home and help from the getting up and putting to bed carers. In general now more young people do not always feel they should be responsible for their elderly, often frail, relatives.

[Even with the inherent problems], there are still a proportion of families who will try to look after elderly members of their family in their own homes. If they do this, respite care for an elderly ill relative is very necessary. Respite care in North Berwick can be arranged in the Edington Hospital, although this is now only for a limited period. Three generations living in one house can cause quite a strain on the family, but provided the older person is still mentally active he/she can be an asset. Increasingly, with the split up of family units, more young people feel that the care of the elderly should rest with the government.

With the increase of home helps, care of the elderly in day care centres, and other care services for elderly, more people are continuing to manage to look after themselves at home. Only when either severe physical disability or deteriorating mental ability is present do they need long-term nursing home or hospital care. With the closure of many Part 4 homes and the decrease in hospital geriatric beds this is becoming more difficult.

Jean Walinck

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