Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions?

An arch in the UK

Arches, streamers, polar lights, merry dancers… just a few of many names used to describe the aurora borealis in historical documents in the UK. We have compiled a new catalogue of 20591 independent reports of auroral sightings from the British Isles and Ireland for 1700–1975 using observatory yearbooks, the diaries of amateur observers, newspaper reports and the scientific literature. Our aim is to provide an independent data series that can aid understanding of longterm solar variability, alongside cosmogenic isotope data and historic records of geomagnetic activity and sunspots.

Pippi Longstocking, juvenile delinquent? Hachette, self-censorship and the moral reconstruction of postwar France

This paper looks at the blockages to the publication of children’s literature caused by the intellectual climate of the postwar era, through a case study of the editorial policy of Hachette, the largest publisher for children at this time. This period witnessed heightened tensions surrounding the social and humanitarian responsibilities of literature. Writers were blamed for having created a culture of defeatism, and collaborationist authors were punished harshly in the purges. In the case of children’s literature, the discourse on responsibility was made more urgent by the assumption that children were easily influenced by their reading material, and by the centrality of the young to the discourse on the moral reconstruction of France. As the politician and education reformer Gustave Monod put it: “penser l’avenir, c’est penser le sort des enfants et de la jeunesse.” These concerns led to the expansion of associations and publications dedicated to protecting children and promoting “good” reading matter for them, and, famously, to the 1949 law regulating publications for children, which banned the depiction of crime, debauchery and violence that might demoralise young readers. Using the testimonials of former employees, along with readers’ reports and editorial correspondence preserved in the Hachette archives, this paper will examine how individual editorial decisions and self-censorship strategies were shaped by the 1949 law with its attendant discourse of moral panic on children’s reading, and how national concerns for future citizens were balanced with commercial imperatives.

Work and the adolescent in medieval England (AD 900-1550). The osteological evidence

What was it like to be a teenager in medieval England? Despite the fact that medieval society often singled young apprentices and workers out for comment, their study has been largely neglected in medieval archaeology. The skeletal remains of 4940 adolescents (6.6-25 years) from 151 sites in medieval England was compiled from a combination of primary data collection and secondary data from published and unpublished skeletal reports and on-line databases. The aim was to explore whether apprentices could be identified in the archaeological record and if so, at what age they started work and what impact occupation had on their health. The data were divided into urban and rural groups, dating from before and after the Black Death of AD 1348-9, and before the Industrial Revolution. A shift in the demographic pattern of urban and rural adolescents was identified after the Black Death, with a greater number of young females residing in the urban contexts after 14 years. The average age of males increased from 12 years to 14 years after the plague years, contrary to what we might expect from the documentary sources. There were higher rates of spinal and joint disease in the urban adolescents and their injuries were more widespread than their rural counterparts. Domestic service was the potential cause of the greater strain on the knees and backs of the urban females, with interpersonal violence evident in the young urban males. Overall, it was the urban females that carried the burden of respiratory and infectious diseases suggesting they may have been the most vulnerable group. This study has demonstrated the value of adolescent skeletal remains in revealing information about their health and working life, before and after the Black Death.