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The Fourth Statistical Account of East Lothian

Healthcare

There was no surgery in Pencaitland village. Pencaitland patients mostly used that in Ormiston, which itself was part of the Tranent practice.

Dr J.S. Milne recalls a little of his work from his Ormiston practice, 1945-66

The practice …extended from Haddington … to near Dalkeith … up to and into the Lammermuir hills. The surgery was in my house. My wife answered the door and the telephone and dealt with emergencies. I was able to call on the district nurse and the health visitor who were employed by the local authority. [By 1950] my partner and I took on two others, … [and] built a surgery outside my house. It had a consulting room, a waiting room and a room serving as laboratory, spare consulting room and eventually an office for a secretary.

… all colliers, whether married or not, paid sixpence a week to the doctor of their choice for medical attendance and medicine for their families. We also allowed anyone … to join a club on the same terms as miners' families. … most of our income came from capitation payments and only about an eighth … from sending out bills. [Our] dispensing ceased in 1948 … if there was a pharmacist in the village, which there was, dispensing by doctors (except in emergency) was prohibited.

… there were very few motor cars … and all patients had to be visited who could not walk or cycle to the surgery. Service buses were too infrequent to suit. We used to consult morning and evening, seeing about 15 patients each time. … no appointments …

Childhood illnesses were mainly not serious. We saw many throat, ear and chest infections. Wheezy bronchitis was common in small children. … Pregnancy showed a post-war boom … home delivery by the doctor and the district nurse was common with forceps if necessary. … by 1966 GP deliveries had nearly stopped. …

There was no geriatric service. … once an old person was on the visiting book we kept calling once a month. …the opportunity to tell us their troubles. The modern silent epidemic of dementia had not started…

In the 20 years from 1946-66, general practice changed a great deal…. demand … rose and continued to do so. In my time the demand was not unsatisfiable … in subsequent years increasing out-of-hours demand led to the creation of large rosters in which the doctor on call was up all night.

Dr Gilbert Kennedy (1966-90) continues

By 1966, due to the GPs Charter, we were able to build custom-built surgeries… to employ staff - a secretary and four part-time receptionists in Tranent and a secretary in Ormiston.

… The Ormiston end of the practice was run by two partners, and staff increased to a secretary, two receptionists, and a visiting district nurse when required…. Infectious diseases had virtually disappeared by 1966 due to immunisation clinics. Bacterial infections … with the ever widening range of antibiotics. … Childhood ailments were rarely serious but … asthmatic problems seemed to increase…. we started an Asthma Clinic run by the practice nurse. …

By the 1970s the elderly in the practice were increasing and when they became dependant, they were not as readily looked after by the family as they had been in my early days in practice. “Old Folks Homes” were built to help the situation…

… smoking in the 1960s … still socially acceptable, but by the next decade … it was gradually becoming socially unacceptable. There were already many chest problems in the mining community such as pneumoconiosis and cigarette smoking added to these problems…

And finally, Dr Andrew Davies (1990-2000)

I work in Tranent Medical practice, which is situated in Tranent (six partners) and Ormiston (two partners). … In 1990… the practice changed its area, drawing in its area considerably, hoping that with more patients being closer to the health centre, there would be easier access for patients to the centre and so reduce the need for home visits. This has happened in Tranent and also in Ormiston.

Workload has increased. Nursing homes have opened in Pencaitland and Tranent. … emergencies are handled by a co-operative of 11 practices (36 doctors) which covers west East Lothian.

Work in surgeries continues, looking after ill patients, many of whom are discharged from hospital early on many drugs and who need a lot of attention. Use of day surgery means increased vigilance and significant numbers of patients need readmitted. …

Our area has a high incidence of heart disease and stroke and diabetes (national average is 2%, ours is 10%), and cancer continues with levels of lung cancer in women approaching that of men. Infections still cause great problems, not least the upsurge in resistance to antibiotics and the onset of new lethal bacteria like E coli 157….

In general, children are very healthy but there is a new incidence of asthma and severe allergies eg to peanuts. Use of antibiotics has reduced in children. Most illnesses previously treated with antibiotics are viral and self-limiting….

Youth culture is an unknown area for many of us for the use of illegal drugs is greatly increasing. … Some patients in their late twenties have now been abusing drugs for 15 to 20 years. There is a definite incidence of long-term brain damage appearing….

Physical disability is less problematic and more is organised for disabled people, for example wheelchair access to public buildings and access to adapted taxis. Children often born with a disability are encouraged to stay in mainstream education with support but there are special schools. Disability through injury like paraplegia needs a lot of support and care. Sometimes respite care is provided but there is a shortage of places for respite for young, chronically disabled.

Older people are living longer and often alone…. There are lunch clubs and day centres in each village with added outings and activities. For frail and ill old people, day hospitals allow them to be assessed and investigated without being admitted to hospital. Social work now provides packages of care to enable frail elderly people to remain in their homes. Families do try to maintain their old folk in their homes but cannot leave their jobs and the need for care plans is great.

Alcohol problems continue, with much evidence of over-indulgence. … Doctors and nurses spend much time dealing with alcohol effects on individuals and families. There is now an appointed community psychiatric nurse to deal solely with alcohol problems and counselling is available.

Tobacco use is still very strong. …

In summary, medical practice in the 1990s is expanding and is becoming more team-orientated to promote good health.

And from a member of the public

[Babies were born at] Haddington hospital or home. … There are more single mothers now than in the 1940s and 1950s, [with] partners rather than spouses.

In the 1940s, whooping cough and pneumonia [were] much feared. [There were the] odd case of diphtheria, scarlet fever and tuberculosis. When the health service came in, [we] called doctor more. Paid a nurse a regular sum before this.

First aid was practised at home; [you went to an] old neighbour for old-fashioned remedies before trying the doctor. Another [neighbour] helped with childbirth and laid out the dead. Cascara [was given] to “clear you out”. Treacle and sulphur (a teaspoon) for chests, once a year. A dental nurse came to school. Chiropodist came in later.

Pregnancy - advice from family and neighbours before going to doctor. No pre-natal classes or special care. Maternity hospital in Haddington. Own doctor, district nurse, tinned milk and orange juice.

Janet Bassett

Within the village, the WRVS (1945-date) did sterling work in delivering meals on wheels.

By the very end of the period, there were two nursing homes for the elderly in Pencaitland - that based in a new building (called Tyneholm Stables, because that was the original core of the building), and Tyneholm House, which closed during 2000.

From 1945-c1985, the 19th century Tyneholm House was used by the Dr Barnardo's organisation as a home for boys; there were about 30 residents. The house then became a nursing home for the elderly for about ten years; in 2000 it is for sale. (By 2001 Tyneholm had been sold, possibly for use as a private house).

A day centre is open once a week in the Trevelyan Hall.

The elderly used to be cared for at home; [in the past they were] considered old at 60, now have to be 80. [It is] expected that social services will look after them, not the family. Now want them put in home, partly because children move away.

I can't remember many [people with a disability] in the village. The family took care of those there were. In the 1940s, handicapped children [were] taken away to Gogarburn. [They and their families were] largely just pitied and ignored. [Mentally handicapped people were] again tolerated but ignored; [their] family coped, otherwise despised'

Janet Bassett

Pencaitland is one of several communities that fall under the Tranent Social Inclusion Partnership, a thematic SIP which is focussed on 'Youth with Community'. This partnership 'seeks to make a difference by breaking the cycle of inclusion which exists for many children and young people growing up in this ex-coal mining area.

… to involve and empower young people along with the wider community to take decisions and help deliver the kind of community and services they need' (Sipped Up News, summer 2001)

Based at Ross High School, this SIP is targeted at 16-25 year olds. Backed by government funding, the SIP was set up at the end of the 1990s.

Social issues

Child molesters were known, so children were kept away from them, but [it was] not spoken about. Homosexuals - not spoken of or known - now probably prejudice exists, but as there are no obvious ones in village, not expressed.

Illegitimacy - war changed attitudes, but this was still a stigma. How would they manage financially? Now helped with money and a house and some have babies deliberately to get away from home…. Since the pill, mores have greatly changed. Promiscuity used to be despised. Increase in materialism - 'materials come before morals.

Alcohol - drunks were scorned. [There was] no understanding of alcoholism but ordinary drunkenness was tolerated. Now the church has a visiting group. [In the] 1940s and 1950s neighbours and friends helped them.

Smoking - [socially] acceptable in 1940s and 1950s, then when cancer proved, gradually became unacceptable. Drugs - not [in evidence] at all until recently; now school children meet behind pavilion. Some get hooked when in the army.

Janet Bassett

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