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DietitianBorn in Blackridge, West Lothian in 1925.
Overview: Elizabeth Wilson trained at the Edinburgh College of Domestic Science and then taught for six years at a school in Leith. In 1952, she heard that dietetics was `an up-and-coming profession` and embarked on an eighteen-month training course in the School of Dietetics at Edinburgh Royal Infirmary. From 1954 to 1958 she was a ‘Social Dietitian`, working in the Infirmary`s diabetic clinics in the mornings and doing home visits in the afternoons. She was the Infirmary`s Chief Dietitian from 1964 to 1979, before becoming District Dietitian, responsible for six hospitals including the Infirmary, from 1979 until she retired in 1985.
Well, I was born
in Blackridge, West Lothian, and before I was a year old, we moved down to
London, and I stayed in
Mill Hill. But I came back to
Edinburgh in 1929, and had all my schooling in
Edinburgh. I first of all went to a kindergarten in Corstorphine,
and then, at the age of seven, went to
Queen Street, which called Edinburgh
Ladies‘ College, and was there until I left school. During the war, we shared our schooling with
Daniel Stewart‘s College, and we had half-time education. We went six days a week, and we either went
Did your education
suffer as a result?
I don‘t think
so. When the war started, the school was
closed, and we got work sent to us to do at home, but I don‘t think our
education suffered at all through having part-time schooling, as you would
say. We did, in fact, go back to our own
school before the end of the war, when we came to Highers - I mean, I was in
full-time education again.
Would you say
that your family was well-to-do?
No. My mother had been a school teacher, but my
father was what these days was called a commercial traveller. We lived quite comfortably, but weren‘t
(2) Tell me about what you did when you left
When I left
school, I went to the Edinburgh College of Domestic Science, which was
and did a three year teacher training in domestic science. Again, this was war-time and rations were on,
and we didn‘t have a lot of ingredients to do a lot of the cookery that, you
know, we should have done, but we all got there. After that, I taught for six years in a
Leith, and learnt how the other half
of the world lived, after having been living in sheltered Corstorphine, all my
life. There was going to be a change in
the work that I was going to be doing, and I felt "no, I don‘t want to do
this". And my maths master at
school had said to me that dietetics was an up-and-coming profession, so I
thought, well, I would investigate, and applied for a position at the
Dietetics at the Royal Infirmary. And from there on led to a career in
What year was
In 1952 -
October 1952. The School had been going
since 1936, because there was a need for more dietitians for when more
diabetics were being diagnosed. And the
Dietetics opened at the Royal Infirmary
and continued until 1955, with a break during the war (in fact it was only closed during the war to those with a teaching
qualification), when it wasn‘t possible to... The course was open to those who had a science
degree, those who had a domestic science teaching diploma, those who had institutional
management or household science diplomas and still to nurses. All the original dietitians were nursing
sisters. The course was an eighteen
month course: a year of theory and six months practical. It was, as far as I know, the only course
that was hospital-based, and I certainly found that, you know, very good, because
I know that later on in my career, when we got students from universities and
colleges to do their six months practical with us, some of them took quite a
long time to adjust to a hospital atmosphere.
(3) You were doing the one year of theory also in
a hospital. How did that affect the training?
Well, the School
- we had a room above one of the wards that the various lecturers came and
spoke to us every day, and we just were going into hospital every day, and
never thought anything more about it. We
were a very small class - there were only nine - because there was not room for
any more in the lab, when we did lab work. And in all, I think there were about two hundred and seventy dietitians
trained at the
Dietetics at the
What did you do
in the lab?
Well, we got
chemistry lectures and biochemistry, and we used to do experiments that were
relevant to the lectures.
Tell me about
the six months practical training.
hospital was divided into… there was the outpatient department, there was the
diet kitchen, there was a dietitian who worked in the Simpson Memorial
Maternity Pavilion, and we just spent our time going so much in each of the
departments. We just worked with the
staff in the outpatients; we worked with the dietitians in the diet kitchen, mostly,
you know, making out menus and diets for the inpatients; and we spent some time
with the Sister in the Maternity Pavilion, where she was giving nutritional advice to all the pregnant mums.
What are your
memories of those three areas?
Well, we spent,
probably, about eight weeks in outpatients. Most of the patients were diabetic patients, although we did have a selection
of obese patients, people with gastric problems - that was very common at this
time - people with allergies. The
patients were referred from medical outpatients, often, because that was their
first port of call, or else we saw ward patients who were ready for discharge
and we arranged for their diets for home.
What are your
memories of the outpatient clinics, in 1954?
outpatient clinic was very, very busy. There was no appointment system then, and patients just really turned up,
and sometimes it was standing room only, and other times it could be quite
quiet. There were clinics every day of
the week, Monday to Saturday, and there was a clinic, also, on a Tuesday
evening, so that people who were at work, didn‘t need to get off work to come. At that time, there were many employers
reluctant to employ diabetics, because some of them had got a bad name, because
of poor control, that they were switched from being hypoglycaemic to being the
opposite, and having too much sugar. And
there were a lot of professions that weren‘t open to diabetics. One of my friends, who wanted to be a PE
teacher, wasn‘t allowed to be a PE teacher because of that. And she ended up by doing dietetics, so she
was able to appreciate the patients‘ feelings from both side of the fence.
(4) Can you remember how the dietitian in post
related to the clinic, and to other staff in the clinic?
Well, the person
in charge of the department was a sister dietitian. And there were two other dietitians, and one
of them was a social dietitian, which I became, eventually, when she left. It was always a very friendly place; everyone
got on very well together, and patients liked to see a familiar face. And even after I worked there for thirty one
years, a lot of the patients came in and said "oh, I‘m glad there‘s
someone here I know", because staff change so much, over the years.
Tell me more
about the staff at the clinic in 1954.
Well, there was
a staff nurse, along with two dietitians and the sister in charge. The patients were weighed on each visit. They brought a sample of urine with them,
which was tested. And we had a great
mixture of containers that the urine was brought in, and there was one chap,
who came to the clinic, and said his sample had been pinched on the way to the
clinic. And as it had been in a miniature
whisky bottle, the mind boggled as to what the culprit felt when he took a swig
of it! They then had a review, usually
by the dietitian, and then they saw the doctor. And if there were any changes required, they were referred back to us.
And tell me
about the doctors.
Well, we had a
different doctor every clinic. They were
usually doctors that were registrars in the professor‘s ward, and the professor,
himself, took a clinic on a Wednesday afternoon, and then afterwards was entertained
to a cup of tea and cucumber sandwiches! The professor was Derrick Dunlop, who was very well-known in the Royal,
and was the professor of therapeutics, at the time, and had always been very
interested in diabetes.
And would you
have had tea and cucumber sandwiches with him, or not?
Well, the tea
and cucumber sandwiches was with the sister dietitian in charge. We lesser mortals weren‘t included. We sometimes were asked to go and speak to Women‘s
Institutes or the Rural about some aspects of diet, and we were usually
accompanied by one of the dietitians - often in the afternoon, sometimes in the
evening - but it was all good experience for us.
(5) And what are your memories of the patients,
during your training, in 1954?
Well, we had
many very interesting patients. They
came from all over the country, because diabetic clinics, in these days, were
few and far between. We had a lady who
came down twice yearly from Thurso, because she had family in
Edinburgh, and she combined her visit to the
clinic with a visit to the family. We
had a lady that came up from Berwick-on-Tweed, and was always most annoyed if
it happened to be a public holiday and all the shops were shut. Otherwise, we had a wide spectrum of patients;
wide age group. We had no children - the
children went to the Sick Children‘s Hospital, which was just across the
meadows from our hospital. And when they
were ready to come to an adult clinic, there was a liaison between one of our
staff and the Sick Kids. There were exceptions
to all rules, and we had a lad that was only fourteen, but as he was six feet
tall, they really didn‘t have the heart to send him to a children‘s hospital,
so he was, in fact, admitted to the Infirmary.
Were most of the
people insulin dependent?
Well, all the
younger age group were insulin dependent. There really was only diet alone or diet plus insulin, and the only
insulins that were available, at that time, were soluble and protamine
zinc. Those that were requiring insulin
were usually admitted; the rest were treated as outpatients.
How long were
they admitted for?
Probably about a
week. It depended on how long they took
to settle down, and how readily they understood what diabetes really meant, and
how they were able to control it themselves.
(6) Can you remember what was taught to them,
during that week of being admitted, about diet?
Well, the diet,
initially, for those who were admitted, was the remit of those in charge of the
inpatients, and they would go… a dietitian would go and discuss their eating
pattern, and make the necessary adjustments. They were taught how to test their urine, and how - don‘t even think in
these days - they were taught about adjusting doses. But just generally given a talk of how to
look after themselves, and to try and keep to their normal routine as much as
Did they have to
change very much from their normal diet?
Yes, the diets,
at that stage, were all weighed diets, and were pretty strict. A lot of people… we used to advocate having
brown bread instead of white bread, but very few people in Scotland ate brown
bread. And we were never very fond of
fruit and vegetables, and even to this day, there‘s a problem with getting
Scottish people to eat fruit and vegetables; it was always fries and
chips. So, some of the patients really
had to make quite a change to their normal way of eating. Some of the patients felt that they had to
have a different diet to anyone else in the family. And it was when I worked as a social
dietitian, and visited people in their own homes, was able to reassure them
that they could eat the same as the rest of the family, with minor
adjustments. Brown bread was definitely not
eaten much, and I remember a lot of our patients saying that when they were in the
bakers buying brown bread, there was friend of theirs or a neighbour of their
was a brown bread as well, and they discovered that they had a diabetic in the
(7) Tell me a bit more about the weighing of
Well, when we
had a new patient was diagnosed that was requiring insulin, they were given a
little set of scales, so that they could weigh all their food. Everything was weighed: meat, as well as
carbohydrate foods. And they had an
allowance of milk, and butter was weighed. And it really was - when I think back on it - probably, quite a fiddle,
and, you know, quite a task for the family at home, particularly if they were a
big family. But I expect, like
everything else, they got used to, you know, the size of a slice of bread. They roughly knew how much it weighed, and
just probably became less strict. Mind
you, there were a whole lot of them, probably, didn‘t bother at all; just
pretended that they did.
And tell me a
bit more about the diet kitchen on the ward, and the menus.
The diet kitchen
was situated in ward 21, and an area off this was where the dietitians did
their paperwork. They made out the
amounts of foods that each of the patients was to have, per day, and the food
was cooked in the diet kitchen. Also, in
ward 21, there were a lot of patients who were diabetic, or who had some
metabolic disorder that was being looked into. The diet kitchen was very small, and the dietetic students had to work
in the diet kitchen during their training. They did have cooks, but this was part of our training, to work in the
diet kitchen. And we went to visit the
patients in the wards, and then, actually, we also went round with the porter,
who delivered the diets at lunchtime, and we handed the food in for the
patient. And they often had the plates
in the oven, warming. And I always
remember one of the ward sisters that said to me, as I was passing, "the
plate’s in the oven keeping warm", so I said "well, it‘s unfortunate,
it‘s salad today".
No, not at
all. There was no choice of menu for any
patient in the hospital. We had, what
they called, ‘bulk meals‘. The meals
were cooked in the kitchen, and brought up to the wards in trolleys. The ward sister was responsible for dishing out
the food to the patients. And this was,
probably, a much better system than the present day system, where you have
prepared meals; because, if Mrs Smith wasn‘t feeling very well that day, sister
said "I think we‘ll just have some soup and pudding for Mrs Smith",
and... or could give them a smaller portion, if their appetite wasn‘t
good. Whereas nowadays, things come up
in a tray, and it‘s all presented to you. And sometimes the food, let‘s face it, is not very attractive. There‘ve been a lot of problems with hospital
foods, I think.
Was the food
attractive in your day?
Well, we tried
to make it as attractive as possible, but it depended on how it was presented
at the ward level. It left our... the
kitchen all right, but then at the ward level, it was different. There was a lot of different theories. People, who had cataract operations, for
example, in these days, had to lie flat on their back, and they couldn‘t have
anything hard - not even a tea biscuit - in case it upset their eye. But nowadays, they come in for a cataract
operation as an outpatient, more or less: come in in the morning and go home at
How did you mean
about the food being differently presented to the patient, from how it was when
you prepared it?
Well, the thing
is, when it left the diet kitchen, it was all in containers, and it was up to
the nursing staff in the ward to then plate it. People - what we called ‘ward orderlies‘ (auxiliaries) - were the ones that were mostly responsible for
dealing with the food, and also helping patients who weren‘t able to eat,
themselves - they would feed them. Where
again, nowadays, people are often given a plate of food, and if they don‘t eat
it, too bad.
(9) Tell me about your first job, after your
Well, I was very
lucky, after I qualified, to be offered the job of social dietitian at the
Royal Infirmary. This entailed working
at the diabetic clinics in the mornings, and going out to visit patients, in
their own homes, in the afternoon. One,
of course, couldn‘t go to visit every new patient, and some of them, in fact,
lived out of town. And one had to really
timetable your work. Sometimes it was
possible to visit two people in the afternoon, if they lived reasonably near
each other, but otherwise, you know, it was just one person. This was very interesting work. The homes were all very different. Some of them had very little furniture or
carpets, or rugs on the floor, but most of them had very large television sets,
‘cause this was a must-have in the fifties. The patients, often, at the first visit to the clinic, were given so
much information, that they really got quite confused about what they were
supposed to do, and really appreciated having a visit from a dietitian, who
could sit down with them, in their own home, and sort out a lot of their
problems. Well, quite often the patients
felt that they had to do special cooking, for the diabetics. But this... I assured them that this was not
necessary, and they could quite easily incorporate food for the diabetic
patient into the ordinary menu. For
example, if they were making a milk pudding, they could just make it in the
normal way, without sugar, lift out a portion for the diabetic, and add sugar
for the rest of the family. Quite a lot
of the patients worked on shifts, and this always caused a bit of a
problem. But then, if you sat down and
worked it out with them, they knew exactly what they were to have on their day
shift and their ‘back shift‘, as they talked about, which was a three to ten
shift. And then, some of them even
worked night shifts. But there wasn‘t a
problem; one could always solve it.
Well, it was
usually three days a week, because, well, we had an evening clinic on a Tuesday
evening, and on a Thursday afternoon, the doctor and the dietitian went to a
peripheral clinic, which we held once a month, in Kirkcaldy, Haddington, Dunfermline
and Galashiels. The two in Fife entailed
going across on the ferry, from South Queensferry to
Queensferry. The one in the
borders – Galashiels - sometimes, in the wintertime, had to be cancelled,
because of the snow. We were at our Kirkcaldy
clinic the day before the
was opened, and when we got down to the ferry, the queue in
Queensferry was way through the village. So, we had to go up to the boat, and say to
the captain we had a clinic in Kirkcaldy, and we were let on. Then, after that, it was plain sailing,
because the bridge was open. Although,
sometimes, in the summertime, the queue for coming back to Edinburgh was so
long that we went round by the Kincardine bridge, which added quite a time to
Where were these
clinics located - in GPs‘ surgeries?
No. The clinics were all in hospitals, and we got
referred new patients there, as well, from the local GPs, as well as those who
had been in hospital and came to our clinics. In latter days, there were diabetologists in all of the main hospitals,
whereas, in the fifties, diabetic clinics were few and far between. On the east coast, there was probably only
Edinburgh, Dundee and
For how long
were you a social dietitian?
I would say I
was a social dietitian for about three or four years. Then, I think, really, because the clinics
got so busy, and I was needed more at the hospital level, that it just tailed
off. Although, on occasions, even after
that, I was sometimes sent to visit a patient.
(11) And what changes were there during the 1950s?
Well, first of
all, there was a new insulin - Lente insulin - which had an effect in the
latter part of the day and overnight. And some of the patients were changed onto this, which meant that they
were only having one injection per day, as many of the others, with soluble and
protamine zinc, had a booster dose of soluble in the evening. And then, the next big change was the
introduction of oral treatment. First of
all, in 1955, with Chlorpropamide. And a
lot of our patients, who were thought suitable, were admitted to the ward for the
changeover. They weren‘t in bed, or
anything; they were allowed to more or less go about as they wished. And a lot of the patients were absolutely
delighted that they didn‘t have to have injections any more. But, sadly, there were some who the oral
treatment did not suit, and had to revert to insulin. Then, in 1959, there were the biguanides, and
these were suitable for those that were not controlled on diet alone - mostly
because they didn‘t keep to their diets, of course - but this helped to get
them under control better. At this time,
there was a marked change in the diets, too. They weren‘t nearly so strict. And we had a diet that we affectionately called a TSN, which was
"thou shalt not eat:" sugar, and those foods with a high sugar
content; to take in moderation starchy foods; and to eat freely, proteins and
low calorie foods. This was amended, of
course, for the obese patients, who were given a certain number of starch
portions, and their fats were restricted.
patients, who were not obese, allowed to eat any amount of fat?
Well, we more or
less freely let them eat as much protein and fat as they wanted. But, again, if they were putting on far too
much weight, then we would make the necessary adjustments. A lot of the patients had great difficulty in
keeping to their diets. There were those
- the older age group - who were absolutely meticulous, and not having a morsel
over what they were supposed to eat. And
the others, who thought "oh well, what does it matter?", I think, by
and large, most of them did avoid sweet things. But, a lot of the, particularly fats - as Scottish people,
unfortunately, were fond of their fries - and they did really eat that in
excess. And, as I said previously,
vegetables, apart from potatoes, didn‘t feature high in Scottish diets.
To what extent
were you part of a team?
Well, I think we
very much were part of a team. The
doctors, there was a nurse, and the dietitians all got on extremely well
together. By this time, Leslie Duncan
was in charge of the department. We had
a lot of doctors who came from abroad, even, to learn about diabetes. A doctor from
). We were quite a united nations, in the
What are your
memories of Leslie Duncan?
Oh, Leslie Duncan
was quite a character. He was very
unconventional, so different from the Professor. But he revolutionised, I think, the diabetic
department; but all to the good, looking back on it.
Well, in 1964, I
was appointed chief dietitian, and I was the first dietitian at the Infirmary
who wasn‘t a nurse. My job didn‘t really
change, all that much, except I was responsible for the students that were sent
to us from hospitals... from colleges and universities, for their six months
practical training. And you had to
arrange their programme to see that they got as much experience in all the
different departments. And also, the
smaller hospitals, who only had, perhaps, one dietitian, they went to the Sick Children‘s
Hospital, to see how they were run differently from an adult hospital.
years that you were chief dietitian, 1964 to 1979, would you say there were
many changes in the treatment of people with diabetes?
I think, during
that time, there wasn‘t much change in the treatment of diabetes. But, I think the main thing was that the
patients were educated in looking after their own diabetes, in that being
responsible for changing their insulin doses, dependent on their urine
tests. And at this time, patients, as
well as having a urine test when they came to the clinics, also had a blood
test. And we had our own lab technician,
in the department, who was able to have the result of the blood test by the
time the patient saw the doctor. At this
stage, we also had a chiropody department, and those requiring chiropody were
referred to them. Patients routinely had
an eye check, which nowadays, I believe, they don‘t have in the diabetic clinic
- that they have to go to the eye hospital to have their eye checks.
Any changes in
The diet: there
were no weighed diets in this era; they were all portions: slices of bread,
helpings of potatoes, this sort of thing. Although, some of our older patients, who had been coming since the year
dot, would sometimes come in and say "I‘ve broken my scales", and you
thought "gracious me, are you still using them?" But habit is a great thing. I mean, they were in the habit of weighing
their food, so weighing their food they will.
(13) And tell me about your next job, after being
Well, I was
appointed district dietitian in 1979, and this entailed being responsible for
six hospitals in the district. Some of
them had dietitians, some of them didn‘t, but there was always a dietitian
covering those hospitals who didn‘t have a dietitian of their own.
What were the
was really, originally, an infectious diseases hospital, but the chest
complaints, tropical medicine were out there. The Princess Margaret Rose was an orthopaedic hospital. The
was a general hospital; a small general hospital. Liberton was a small hospital, who mostly had
people with strokes and some elderly incapacitated people there, but again,
they didn‘t have their own dietitian, but they were covered by a dietitian from
one of the other hospitals. The Sick Children‘s
Hospital also came under my jurisdiction. They had their own dietetic department. Of course, the Royal Infirmary was still under my control, and I still
worked there, because diabetes was really my main interest in dietetics.
there were people with diabetes in the other hospitals - people who happened to
Yes, there were
a few patients in the other hospitals, who happened to be diabetics as
well. And sometimes our doctors were
called out to deal with any problems that the other hospitals had, that they
weren‘t able to cope with, themselves.
(14) By 1985, when you retired, would you say
there had been many changes in approaches to diet?
Yes. In my lifetime, as a dietitian, there had
been many changes, really, in the diets: going from the strict, when I first
started, to being more flexible, when I finished. There was less strict regime, and many of the
diabetics managed their lives extremely well, eating sensibly, within their
In what ways
were they more flexible, towards the end?
Well, I think,
generally, the way of life had changed, over the years. When I first started, it wasn‘t all that long
after the war, and people still had rationing, and these sort of things, at the
back of their minds, and perhaps ate less lavishly than they did
previously. And lifestyle had changed,
by the time I retired. And the patients
were able to adapt their diets into their social occasions; holidays all over
the world; and, on the other hand, were able to adapt their diets if they were
ill, and not feeling like eating ordinary food. But, it all went down to education, I think; to educating the new
patients in looking after their own diabetes, monitoring their blood sugars,
doing their urine tests, adapting their insulins, adapting their diets,
depending on what they were doing. And
we had... working out the diets, for some of the patients, was really quite
tricky. We had one chap who was a
professional footballer, and we had to work out a regime for his training, for if
it was an afternoon match, if it was an evening match, and for his rest
days. So, there was always a challenge
in working out something that would fit in to the patient‘s lifestyle.
(15) What educational materials did you have to
give to the patients, over the years?
Well, I think as
far as diet was concerned, with educational material, it was really purely the
diet sheet and a list of exchanges. We
also sometimes gave cookery demonstrations, where patients could come and learn
how to make the diet more interesting for the patients.
Can you explain
what you mean by lists of exchanges?
Well, lists of
exchanges just really consisted of carbohydrate foods, that they were allowed
so many portions per day. And then there
was a list of proteins that they could eat freely, and a list of low calorie
foods - vegetables, clear soups, vegetable soups, this sort of thing - that
they could eat freely.
And can you say
what you think the status of a dietitian was, during your career?
Well, I think
the dietitians always had their place, and we certainly got on very well with
the medical staff and the nursing staff. We really all worked as a team. We were consulted on what we felt was best for a particular patient, and
we were always a very friendly department, everyone getting on very well with
each other. Things have changed a lot
from the early days, when we were responsible to the matron. And before we went on holiday, you had to go
to her office, and when you came back, report that you were back. And it was the same if you had been off
sick. We even wore nurse‘s uniform -
similar to a staff nurse, only our dresses were green, and we wore the aprons,
stiff belts, and collars and cuffs, a cap, and black shoes and stockings. This, probably, was a legacy from the days in
which all dietitians were nurses.