General Practice – 1950s | General Practice in 2000 | Dentists
The people of Haddington in the first decade of this period could enjoy a fairly comprehensive medical service without having much recourse to Edinburgh. Roodlands had just ended its role as a fever hospital where the increasingly rare cases of scarlet fever, diphtheria, etc. were kept isolated from all contact including parents (who could only look through the window). It had become Roodlands General Hospital with about 66 beds offering both surgical and medical treatment, with accident and emergency services dealing with everything from playground falls to bypass crashes. Space for patients recovering from surgery at Roodlands was also given over at East Fortune Sanatorium, itself still busy with TB patients. The ambulance station was also at Roodlands. The Vert had changed from a general hospital to a GP maternity hospital, providing both ante and post-natal services to the county, and the base for a team of local midwives. Around half of births were home deliveries. As county town, Haddington was also home to the Herdmanflat hospital, referred to at that period as the County Lunatic Asylum. The more able patients looked after the extensive gardens and also provided labour to Alderston Farm.
My husband’s uncle was manager of Alderston Farm in Haddington, and my husband used to spend a great deal of his time there as a boy. The farm was owned by the Health Board. He remembers how the patients from the mental hospital were marched up in the charge of a couple of male nurses to work on the farm. They did quite a lot connected with feeding and watering the animals – there was for example a wee deaf and dumb man known in those less politically correct days as ‘the dummy’ whose responsibility was the hens – he appeared to enjoy this very much my husband says. They did a lot of work at harvest time and although nowadays the practice would be frowned upon of using ‘learning disabled’ as farm labourers, it was probably wonderful therapy both for body and mind. It went on after the war and was probably discontinued after the introduction of the Health Service.
Judith (and Robert) Stewart – ‘Therapy’ for mental health patients at Alderston Farm, late in the 1940s
Hospital treatment involved long periods of admission and much bed rest. At Roodlands a hernia operation meant three weeks’ hospitalisation. Patients with heart attacks spent the first five days of their admission prone. This was as nothing compared to the six to twelve month periods TB patients spent at East Fortune.
Nursing staff at Roodlands were almost all single women and were under the charge of their matron, Miss Mowatt, later Miss Mutch. Both ran tight ships. The nurses’ residence was at Roodlands, although later some were accommodated at Alderston House. Nurses dined communally and stood before meals until given leave to sit by the matron. Patient reports were delivered standing with hands behind the back. According to one assistant nurse from this period, Miss Mowatt’s favourite phrase was ‘I will not tolerate’.
In the 1950s Roodlands became the first hospital to launch an assistant nurse-training programme. Classes were held at Alderston House by the nurse tutor, Miss Morrison. A typical day for an assistant nurse would entail reporting for duty at 7.45am for an 8am start. She had many domestic duties as well as patient care. These included dusting beds with carbolic cloths, serving meals to patients, cleaning sinks, and ensuring a supply of clean towels for the doctors. Maids mopped the floors. The day continued to 9pm with half an hour for lunch and a two-hour break. A sister might have a month of nights followed by seven nights off. In spite of long hours and poor pay, there was a strong feeling of camaraderie, and nurses valued the fact that they could get to know patients because of the lengthy periods of admission.
Three General Practices provided primary care to the town and surrounding country, with patients as far away as Humbie. All were one or two person practices. Most GPs lived on the job: surgeries were usually a room in the family home or a simple annexe. Facilities were sometimes very basic. No practice had an appointments system; it was a case of sit and wait your turn. This situation continued until the 1970s when Dr Cranston introduced numbered cards, so that at least patients knew their place in the queue. The same practice was the first to introduce an appointments system, but only for afternoons, towards the end of that decade.
From a patient’s point of view, the old system had its advantages. You would always be seen eventually. You could be reasonably certain in an emergency of seeing your own doctor – night cover locums were rare. The elderly and chronically sick would enjoy a routine visit from time to time. One doctor, at least, welcomed the social aspects of a morning tour of the chronically ill amongst his country patients. In general, patients avoided a visit to the doctor unless they had a real complaint. Late presentation of serious illnesses was common. Emergency call-outs were just that. Most families kept a basic pharmacopeia for the treatment of minor ills – castor oil or syrup of figs, Beecham’s powders, Dr Gregory’s Mixture, milk of magnesia, medicinal brandy – and these were the first line of defence before a visit to the doctor was considered.
Almost every household had a ‘Home Doctor’ book which was used like a bible. Children were put in contact with others to contract chickenpox, measles and so on. Research was being done on the risk of rubella for girls. Advantage was taken regarding free spectacles; many were provided for people who didn’t really require them.
One illness was prevalent – cancer, known as the Wasting Disease. People worried about the prospect of cancer.
Nita Fraser – 1950s
Three dentists practised in the town. ‘Gas’ was used for painful work, and drills by this date were electric with the drive transferred by a system of pulleys.
People were registered with dentists on the National Health which much improved dental care after people not being able to afford treatment.
Nita Fraser – 1950s
Changes in medical services in the period have been profound. Control has passed from county to region, affecting hospital services in particular. The Vert closed in 1974. The building was sold for private housing after some controversy; it had been built with a donation from John Vert and matching funds raised locally. The great majority of local babies are now born in the Simpson (Edinburgh), though in the 1990s there has been some return to home delivery.
Accident and emergency services at Roodlands closed in 1989. The Lothian Health Board would not provide the necessary registrar and it was difficult to obtain the services of an anaesthetist from Edinburgh. Casualties are now directed to Edinburgh Royal Infirmary or even St John’s, Livingston. The last general surgeon retired in 1989/90.
A real threat in 1990 that Roodlands itself would close was lifted after local protest, and services have expanded in recent years. Currently, Roodlands has 70 beds and offers a wide range of day clinics including medical, surgical, ear nose and throat, dermatology and diabetes. Ophthalmology may be added in the near future. There is a GP minor surgery unit, and X-ray and ECG facilities are available, along with the services of a physiotherapist and dietician. Ambulance services are now controlled from Edinburgh and, although garaged in Haddington, the ambulances are posted round the county to ensure the quickest call-out time to any emergency.
The shift nationwide from institutional to community care has led to the setting up of a number of small-scale residences in Haddington for long-term patients from Herdmanflat. This has been done under the auspices of East Lothian Care and Accommodation Project (ELCAP). Patients are housed in four residences in groups of four or five with carers. The Hopetoun Unit, opened in the grounds of Herdmanflat in 1983 to provide residential care for 72 patients with learning disabilities, closed in 1993. Herdmanflat still provides psychogeriatric care and serves as a day hospital for those with mental health problems, alcoholism, and so on, but it will shortly be replaced by a new building at Roodlands. The old institution will be sold off. Its original name, along with terms such as mental defective, has long fallen out of use – a reflection of changing public attitudes towards mental health problems.
There are no single GP practices in the town. There are three group practices that share the Newton Port Surgery, purpose-built in 1985, incorporating a building that had been cavalry stables during the Napoleonic Wars. Computers were introduced in 1987 and now each consulting room has its own PC. The surgery was further extended in 1997. It has 15 consulting rooms and three treatment rooms equipped with ECGs, defibrillators and resuscitation equipment. Each practice has its own practice manager, health visitors and district nurses. Two have practice nurses. There are three waiting areas for patients. Although the practices share this facility, they are not (yet) part of an out-of-hours co-operative, unlike most practices in the county. All practices are involved in health promotion and also offer clinics for chronic disease management such as the heartscore & lipid clinic and the asthma clinic. In the field of preventative medicine, the practices are well above government targets for immunisation and cervical screening.
Changes in lifestyle are reflected in that treatments previously considered ‘alternative’ are available. For example, several local GPs offer homeopathic treatment. The increase in demand for long-distance holidays to more exotic locations has led to the creation of a travel clinic providing inoculations for the traveller. Run as a charity, Lothian’s first Cardiac Rehabilitation Group meets in the Aubigny Sports Centre providing a twelve-week period of rehabilitation for patients recovering from heart attacks.
Because patients are discharged from hospital in a very short time, hernia patients within 36 hours for example, a team of six district nurses provides a great deal of home care, where previously this would have been provided in hospital. Carers employed by the social work department also provide support.
There is evidence of gender shift in the medical profession throughout the period. Today, working from Haddington there are twelve GPs, full and part-time, with three registrars. Of them, six of the GPs and two of the registrars are female, compared with one female GP in the opening decade of this period. Male nurses were admitted to the Royal College of Nurses from 1960. Roodlands did not have a male nurse until the late 1960s.
While it is difficult to find hard evidence for attitudinal shifts, from the medical profession’s point of view it would seem that patients now have higher and sometimes unrealistic expectations regarding the services they should expect, and the efficacy of the treatment provided. The former can be measured by the growth in demand for out-of-hours treatment, much of which is now met by locums. To allow more effective use of doctors’ time, where possible, GPs will treat patients out-of-hours at Roodlands rather than on a home visit. Websites dedicated to particular health problems mean that some patients are better informed about their condition before seeking treatment. Complaints, if still rare, are now an expected feature of professional life.
While treatment has improved beyond measure throughout this period, new problems have emerged. There are now about 20 individuals registered drug dependent with local practices. They represent only the tip of the iceberg of the local drug problem. The Lothian Community Drug Problem Service has an outreach clinic at Roodlands to address this.
Like the rest of Scotland, Haddington has an increasing number of elderly. Social work carers make it possible for the elderly to remain longer in their own homes. Local practices provide annual checks for the over 75s and around 95% take advantage of this service. The 1980s and 1990s saw the growth of housing purpose-built by the private sector to allow the elderly to continue to lead independent lives: for example, Knox Court, John Brown Court and Auction Mart There is also Carlyle Court, off the High Street, and the Butts sheltered housing to the south; and Abbeyfield opened in the 1980s for those who would benefit from the presence of a warden. Nursing homes at Templedean (c1981) and Hilton Lodge (c 1983), both private sector, and Flora Bank, provide accommodation for those requiring care.
Finally there is evidence of physicians curing themselves. The expenses of the East Lothian Medical Society dinner of 1950, included the sum of £l-9s-6d for cigarettes for the 25 members and their guests. Amongst the twelve local GPs today, not one smokes.
Births – c1950-74
Births took place at the Vert hospital. There were some at home. The GP visited his patients in hospital and at the birth. There were no clinics. In 1953, you were kept in bed for seven days. By 1955, you were up the second day, given castor oil and told where the toilet was! Baby was kept with mother except at night, and mother and baby were allowed home after 10 days. Fathers visited every night, others during the afternoon. The father’s other role was to register the birth, and to ‘wet’ the baby’s head with his mates. The birth was announced in the local paper and the Scotsman. When anyone met a mother with a new baby they gave the child a silver coin.
The GP visited to provide aftercare, and then the mother and baby went to the clinic for check-ups.
Pat Moncrieff, Alice Nisbet, Margaret Pringle – Haddington Remembered Group