The Edinburgh System

Dr. Sutherland’s work refers to the “Edinburgh System” for the control and eradication of tuberculosis. This post answers the question: “What was the ‘Edinburgh System’?”

Dr. (later Sir) Robert Philip was a pupil of Dr. Robert Koch, the German physician who proved that tuberculosis was caused by the bacillus tuberculosis. Philip realised that anti-tuberculosis dispensaries alone would not address the problem. The patient at the dispensary was part of a family and had been infected by, or had infected, his or her parents and siblings. The home might be in a slum in conditions that were ideal for the spread of the disease and, if a breadwinner was incapacitated the whole family might face a spell at the poor house. For these reasons, Philip created the “Edinburgh System” to systematise the measures required to prevent tuberculosis in the places in which it was found, and to provide care that was appropriate for sufferers at different stages of the disease. As a pupil of Dr. Philip, Dr. Sutherland implemented many of his schemes.

In essence the System comprised:

1. Anti-Tuberculosis Dispensary (the “clearing house” at the centre of the system);
2. Sanatorium for Indigent Curable Cases;
3. Hospital for Advanced Cases; and the
4. Farm Colony for Convalescents.

In addition there were administrative measures, such as notification of the disease, as well as assistance to impoverished workers and their families. So for example, if a family member was found to be suffering from Consumption, a visit was made to the home of the patient. A “march past” – the examination of all members of the household – would be carried out by a doctor attached to the Dispensary and, if required, family members removed to institutions where they could be properly looked after. In addition, a nurse from the dispensary would advise how to improve living conditions, such as airing the room, placing sick beds closer to open windows, removing dusty curtains, table cloths, flock wallpaper and carpets.

Dr. Halliday Sutherland Suggested Plan for a Popular Lecture on Consumption, published in 1917, touched on all aspects of the System:

Note the “great need for these industrial centres to treat these patients apart from the Poor Law.” If breadwinners came down with the disease, the Poor House was sometimes the only place available to shelter and feed a destitute family.

For more information about the Edinburgh System:

• The Story of John M’Neil, a 1911 film produced by Dr. Halliday Sutherland, which depicts the Edinburgh System;
• The Control and Eradication of Tuberculosis Dr. Halliday Sutherland (editor);
• The Annual Report of the St Marylebone Dispensary for the Prevention of Consumption 1911 and 1914.