People's History of the NHS

Over at the Lothian Health Services Archive, Louise has been looking at just what was on the menu for patients in the Royal Infirmary of Edinburgh over time … :

The archive has much evidence of how patients were fed at the Royal Infirmary of Edinburgh (RIE), a national leader in the science and practice of dietetics.

Badge from the RIE School of Dietetics, c. 1930s (LHSA object collection, O225)

The first Dietetic Department in the whole of the United Kingdom opened in the RIE in 1924. Thanks to the Department, by the dawn of the NHS in 1948, patient diets in the hospital had moved on considerably since its foundation in the eighteenth century, when principle foodstuffs were oatmeal, barley, milk and baps. In 1920, the RIE Board of Management appointed a special committee to consider diet in the hospital, recommending the appointment of a dietician with general responsibility for patient diets. As a result, Sister Ruth Pybus became the Senior Dietician in the new department. Dietetics was a growing strand of science around the world, and this infant department reflected this new interest in the chemistry of patients’ food. It also roughly co-incided with the first use of insulin to treat diabetes (in Canada in 1922), which was prescribed along with special diets in an attempt to keep the disease in check.

A diet leaflet for diabetics produced by Lothian Health Board, 1980s (LHB1/89/5/5)

In 1925, Pybus won a Rockefeller Foundation grant to observe kitchens in the United States – the Rockefeller Foundation also funded the building of the Infirmary’s metabolic unit with a diet kitchen.

RIE diet kitchen, c. 1950s (P/PL1/S/395)

Some of the diets prescribed by the kitchen would turn modern stomachs – the ‘spleen diet’ for example, involved serving pulp scraped from the fibrous part of the spleen, tossed in oatmeal and fried! Great care was taken with meal plans for diabetics, with fats and carbohydrates strictly calculated. This kitchen soon reached beyond the specialist wards attached to it, supplying food across the hospital – and continued to do so until a larger kitchen was eventually opened in 1966.

Nurses in the RIE diet kitchen, 1960s (LHB1/89/6/1)

In 1934, the first School of Dietetics was opened in the Infirmary, offering specialist training in clinical diets for the first time in the United Kingdom. The School offered a Diploma, open to State Registered Nurses, students with domestic science qualifications or with a BSc. in Household and Social Science. From our syllabuses and prospectuses, we know that the course consisted of lectures and practical elements, covering cookery, biochemistry and chemistry, ward work, anatomy, patient observation, medicine, physiology, dietetics and bacteriology. Students were also tested on social and environmental aspects of nutrition, including the impact of poverty on health. The School operated until the 1950s – perhaps a victim of its own success, since dietetics was by then routinely included in nurse training.

Prospectuses from the School of Dietetics, 1930s (LHB1/89/3/2)

Some of the most popular material that our archive users ask for from the Dietetic Department is undoubtedly evidence of special diets. We have a quite a number of recipes from the 1950s for savoury dishes:

A diet sheet, 1950s (LHB1/89/4/1)

Even the making of drinks had strict rules attached:

The first rule of beef tea club is…. (LHB1/89/4/1)

The kitchens also shared their expertise beyond their own dietetic wards. There were diets formulated for expectant and new mothers in the Infirmary’s maternity section, for example:

Diet formulated for use in the Simpson Memorial Maternity Pavilion (LHB1/89/4/2)

Some of the sources in the collection reflect attitudes to food education at home, including A 1946 leaflet used in the Department, produced by the Ministry of Food.  An American influence (probably since dieticians from the Infirmary were awarded scholarships to research in the States) is also represented in the information collected by the Department. A particular “favourite” (please note inverted commas) of mine is this small booklet on weight control for women:

An ‘introduction to slenderness’ from across the Atlantic, 1950s (LHB1/89/5/1)

But my highlights from the Dietetic Department archive tell us about recommended food for older members of the community, shared outside hospital walls for the benefit of everyone. This 1956 edition of Old People’s Welfare Scottish Bulletin reprints a diet table for the elderly from the Infirmary:

Royal Infirmary of Edinburgh diet table for the elderly, and cover of Old People’s Welfare Scottish Bulletin, 1956 (LHB1/89/7/6)

Whilst the People’s Journal in the same year published Infirmary diets given to the Edinburgh and Leith Old People’s Welfare Council, with recommendations for those with or without an oven… and with or without teeth!

Infirmary diet tables reprinted in People’s Journal, 1956 (LHB1/89/7/11)

If you’d like to know more about diet in the Royal Infirmary, you can search our collections (for LHB1/89) online here or here.

The People’s History of the NHS team have also been taking a look at hospital food recently – including the cultural significance of tea!  Our team are co-organising an event with Warwick’s Prison Health team, about Diet and Nutrition in Institutions of Care, on 21st April.  If you’d like to know more, or to apply for a space, please email J.Crane.1@warwick.ac.uk and M.Charleroy@warwick.ac.uk)

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