End of project update

After nearly three years of hard work we have now reached the end of this fantastic project.

During the course of the project we have achieved a huge amount and there are so many highlights, some of which I will list here, along with a summary of the project’s outcomes and some reflections.

I took on the management of the project during 2016 and formally in 2017 and before that acted as the line manager for project staff and supported the work of the Trust Archivist from the point of application and thereafter.

Project timeline:

2013 – Scoping report (funded by Wellcome Trust) produced by consultant archivist Judith Etherton and conservator Jonathan Rhys-Lewis. This was instrumental in working towards our application which was successful in October 2013.

2014 – having made a successful application in late 2013 we began the project in February 2014, but did not start in earnest until a few months later when we advertised for our project archivist. Rebecca Nielsen was appointed in October and began working on the Brompton Hospital and Frimley Sanatorium records. In particular, Brompton’s records are unique in their detail and completeness and unusual in that correspondence survives between the Lady Almoner’s department and sanatorium patients. The patient registers, case notes, follow-up record books and correspondence were all catalogued in fine detail. In addition, many photographs were digitized and attached to the catalogue record.

2015 – in January we welcomed Alexandra McGuire to the project as our conservator. We had never previously employed a conservator to work on site and so initially much was done to kit out the space we had taken over for use as a conservation studio. You can find out more about how Alex and the team achieved this in an earlier blog post. Once Alex had settled in and assessed the collections it was clear that we had underestimated the time required to complete the conservation element of the project. Therefore, we felt it necessary to request an extension to our original grant. Fortunately this was approved and Alex was able continue for another 13 months.

Rebecca departed after 9 months of excellent work on a wide range of material. Her blog posts were all well-researched and fascinating and she went on to work on another project focused on tuberculosis for Lothian Health Services Archives in Edinburgh. In late 2015 we launched our online CalmView catalogue hosted by Axiell. This opened up all collections held across our Trust (Royal London Hospital and St Bartholomew’s Hospital Archives) including much of the material we hold on the treatment of tuberculosis. This was a major step forward for us and was made possible through the grant received from Wellcome Trust for the Fight Against Tuberculosis project.

2016 – Alex made excellent progress and completed the conservation and rehousing of hundreds of records which occupy around 100 linear metres of shelving – a brilliant achievement. Notably, we digitised a 35mm film ‘A day in the life of a sanatorium’, filmed at Frimley in the 1920s as well as a set of audio reels which contained recordings of London Chest Hospital symposia on the history of tuberculosis from the 1970s. The range of material which Alex conserved included large volumes of bound case notes, loose bundles of patient records, photograph albums, glass plate negatives, scrap books, stereoscopes and film. Sadly Alex left us in August 2016 to join the Oxford Conservation Consortium and it was not until December that we brought in our last team member.

2017 – We decided to recruit a project archivist to work on some final cataloguing and re-housing leftover from Rebecca and Alex. Virginia Dawe-Woodings worked with us for 6 months mostly on our other Wellcome Trust project but was very efficient is tying up these loose ends, not always an easy task.

Conclusions

In summary, the project has encompassed records of Brompton Hospital and Sanatorium (a very large collection), London Chest Hospital, Harefield Hospital, Middlesex County Sanatorium Committee as well as the private papers of clinicians such as Dr William Wheeler, Dr Hamilton Bailey, Dr J Beal, Dr Alymer Foster-Carter and Dr Kenneth Perry. In addition, we took in quite a large number of library and museum material from the London Chest Hospital on its closure in 2015. This will be catalogued and made available in due course by our new Assistant Curator.

As a department we learned a great deal over the past three years; from techniques in digitization, to working very closely with conservators, estimating workload and balancing project management with a busy archives and museums service. All of this was immensely valuable and gave us the confidence to apply and succeed in obtaining another Wellcome funded in 2015, Sexually Transmitted Infections in 20th century London.

We expect to have an updated CalmView catalogue to include all records relevant to the project in September so please do take a closer look to discover these remarkable, unique collections which are available to researchers at The Royal London Hospital Archives.

Acknowledgements –

My thanks firstly go to Jonathan Evans, former Trust Archivist of Barts Health NHS Trust, who was the successful applicant and project managed until his retirement in mid-2016. Also to Stephen Moore, Learning Resources Manager, co-applicant who ably assisted us in liaising between Queen Mary University of London colleagues and the Joint Research Management Office.

Thanks also to Judith and Jonathan who gave us such detailed and practical scoping reports without whom our application would not have been anywhere near as strong.

Rebecca, Alex and Ginny, you were all fabulous to work with and I’m sure will go on to work on more projects and achieve great things.

Finally to those who have read this blog with interest and have used our archives to delve deeper into the history of tuberculosis hosptials their sanatoria and its treatment.

 

Richard Meunier, Archivist and Principal Investigator

The Fight Against Tuberculosis Wellcome project

 

 

Conservation of the Collection: one year in

Introduction

It has been a year since Project Archivist Rebecca’s first introductory blog and now seems an ideal time to overview what has been going on in the paper conservation studio.

In this first blog I aim to talk about setting up a studio and how I approached the task of conserving a large and varied collection.

Setting up the studio

In January 2015 I was fortunate to gain the post as Project Conservator and my first task was to equip the studio space. I was given the Medical Simulation Room where students previously learned how to treat patients, which was well set up as a laboratory space with a sink, units and storage. However I had no real working area so quickly starting acquiring basic items. I should point out that because the project is funded by the Wellcome Trust I needed to be mindful of the budget and purchase only what items were entirely necessary.

The Conservation Studio

Photo 1 The Conservation Studio at the Royal London Hospital Archives

I ordered large work benches from a shelving and racking company that were a fraction of the cost of specialist desks, the desks also came with large shelves and when put together could hold large papers and boards. I also purchased daylight lamps (being unfortunately based in a basement with no natural light), a guillotine, basic materials (tissues, blotter, manila, paste, gelatine, glassware), a basic range of chemicals, a microwave and a free standing fume cupboard (the most expensive but essential item). To enable the washing of larger documents and mindful of cost I also purchased a paddling pool! I provided all my own personal tools also and equipment I had gathered over the years.

Once the basics were on order I turned my attention to the project.

Project Planning

There were summaries of the various parts of the collections that make up the project divided into Hospitals – Royal Brompton Hospital, Harefield Hospital and London Chest Hospital (see Rebecca’s earlier posts for more detail) as well as some Private Papers of various medical professionals.

However there was not sufficient detail to start conservation work and nothing at item level. I therefore spent my first few weeks surveying all the material. What I discovered was that there was a lot of work considering the Wellcome Trust had funded a 9 month contract (of which I had already spent around one month setting up and surveying. There were approximately 1,050 volumes throughout the various collections, 11,000 patient files in bundles, various photographic materials, 16 boxes of letters, numerous boxes of additional paperwork as well as mixed items making up the private collections of medical professionals, including a collection of philatelic items. Most of which was either un-housed or not in suitable housing.

How therefore could this be achieved? The answer was and continues to be, to take a wide-scale, minimal conservation approach – ensuring all items are stabilised and accessible although more in-depth conservation would be carried out where necessary. The other solution was to request a time extension based on the survey from the Wellcome Trust to make the project almost 2 years, which fortunately, was granted.

In addition I needed to come up with a practical re-housing solution.

The Conservation Approach

Through the survey I gained a good idea of the condition of all the material at item level which allowed a reasonably accurate treatment time estimate. In order to meet the time estimates a first-aid conservation approach was applied to items that were not in poor condition; this meant that volume bindings were given a clean using a museum vacuum cleaner and consolidated where needed. The text block was then repaired along the handling edge and any large tears supported. In order to maximise time and efficiency re-moistenable tissue (pre-coated with gelatine (3%)) was used to support tears, enabling quicker repairs than the traditional paste and tissue technique. An example of this repair method is shown below. The 11,000 patient files were also repaired using the re-moistenable tissue technique.

 

tissue repairs grouped

tissue repairs grouped final.jpg

Photo 2 shows the re-moistening of the pre-coated tissue, photo 3 shows the positioning of the repair, photo 4 shows the repair being pressed in place, photo 5 shows the final repair.

Some items including hospital plans were repaired using the traditional paste and tissue technique and items in poor condition received individual treatment.

Re-housing

Another important and time consuming element of the project was re-housing as many of the volumes were unhoused and other items not appropriately housed.

Volumes

The majority of the volumes were stored vertically loose on the shelves, many suffering from distortion and red-rot and were at risk of further damage. After research, I concluded that purpose made phase boxing was the most effective solution. However, I quickly found this to be very time consuming to assemble and I therefore looked for an alternative. Some companies offer box making services and ready-made boxes (in standardised sizes) but this was both very costly and not necessarily made-to-measure. Thankfully I came across the box making service offered by Lancashire Archives and requested a quote. The extremely helpful Chris Gannon took on the challenge of pricing and eventually making the necessary bespoke boxes. He was also able to offer a solution for producing some extra rigid boxes for some very large volumes and constructed the boxes to save time. All the boxes were delivered in under 10 weeks and have so far have been a perfect fit.

Patient Files

The 11,000 individual patient files wrapped in tight acidic covers presented another re-housing dilemma. I started by looking for the best solution which was to house each file (which are multi-paged) in archival 4-flap folders however this would have been very expensive. I therefore considered using archival paper, cut and folded to size, but we were aiming to fit 30 files into a record box, so I was concerned the files would just slip out and possibly suffer further damage. Further, the time needed just to cut and fold the paper would work out at approximately 6 weeks; approximately 5% of my entire project time. I therefore contacted my conservation colleagues and Sue Hourigan, Senior Conservator at The Berkshire Records Office referred me to JvO Papers who sourced approximately 15,000 4-flap folders ready-folded.

 

Files and volumes before and after conservation

Photo 6 and 7 showing the files and volumes before and after re-housing.

 

conserved files

Photo 8 Inside one of the boxes containing the files in four-flap folders

 

Conclusion to date

I am currently on target to complete the project at the end of this year (2016). I have conserved and re-housed over half of the volumes, all of the patient files and have conserved most of the photographic material ensuring it is all accessible to researchers and members of the public.

It is vital as a Conservator to consider all options, research products thoroughly, do not be afraid to ask other Conservators for their advice and to build relationships with suppliers;  they can really help you to save time and money.

I hope my future posts shall showcase some of the more unusual items and those which have required more in-depth conservation treatment.

 

Alexandra McGuire, Project Conservator

Online catalogue launch

We are delighted to announce that after many months in development there is now a platform for researchers to browse our archive and museum catalogues online. Our CalmView catalogue webpage includes the holdings of Barts Health Archives services (The Royal London Hospital and St Bartholomew’s Hospital Archives & Museums) and includes over 50,000 items as well as many accompanying images, many of which relate to the study of tuberculosis.

Please follow this link: here

Screenshot (3)

After all the hard work put in over the last year or so it is very gratifying that researchers can now see the scale of the Fight Against Tuberculosis project in the many descriptions for Brompton Hospital, Frimley Sanatorium, Harefield Hospital, The London Chest Hospital, Middlesex County Sanatoria Committee, the private papers of Hamilton Bailey, Dr Aylmer Foster-Carter, Dr John Reginald Beal and Dr Bill Wheeler.

The many highlights of these collections include the correspondence between patients and the Lady Almoner’s Department of Frimley Sanatorium, the fascinating case notes of Brompton Hospital’s physicians and surgeons, the photographs taken during the early days of Harefield Sanatorium, the tuberculosis seals collected by Dr Beal and the extensive clinical records of Dr Hamilton Bailey.

If you wish to view these records in person you may arrange to view the Archives Searchroom from Monday-Friday. Appointments must be made in advance by contacting us by email (rlharchives@bartshealth.nhs.uk) or telephone (02073777608).

In addition, we have recently digitised a film which features Frimley Sanatorium during the 1920s. This silent black and white documentary titled ‘A Day in a Sanatorium’ dates from 1926 and depicts a typical day at Frimley with patients working in the garden and enjoying recreation time. We also see inside the buildings which allows us to get a realistic sense of what tuberculosis sanatoria were really like.

A short clip of the film will hopefully be available online in the near future. If you wish to see the film this is available to view at The Royal London Hospital Museum (advance warning of this is required as it is not one of the films shown in the public display area), details for which are here

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Male patients digging as part of their exercises; a key part of the treatment at Frimley Sanatorium. RLHBH/P/2/9/3

Although the cataloguing phase of the project has largely been completed, there is still much conservation work to be done over this year, and our Project Conservator will discuss some of the techniques and expertise required to repair and rehouse these valuable records in the next posting.

 

Concluding Thoughts…

We’ve now reached the end of the cataloguing phase of the project, and I thought it would be nice to conclude with some brief final thoughts on what I have seen over the last few months.

The archives here at the Royal London Hospital contain a wealth of information on this disease, of which I have only been able to share a small amount. Over the course of the project I’ve looked at case notes, hospital minutes, photographs, letters, printed leaflets and all manner of other materials, which have revealed the extent of tuberculosis in Britain, and the desperation to find a cure. Thousands of case notes, each detailing the symptoms, diagnosis, and progression of disease in the patient, show how prevalent tuberculosis was. The list of medications given in each of these rarely amounts to anything more effective than cod liver oil and other solutions to ease symptoms, giving a sense of the futility of the battle against tuberculosis without either surgical means or antibiotics. The archives also include letters from people who claim to have found a brilliant cure (and if you pay them upfront, they might tell you what it is! – RLHBH/A/14), as well as dissertations and statistical notebooks attempting a more rigorous approach to curing the disease.

The archives also show something of the social stigma of TB, caused partly through fear of catching the disease, and partly because sufferers were seen as weak. The Frimley Sanatorium Almoner’s Letters (RLHBH/AL/3) are a great record of some of the attitudes towards tuberculosis in British society throughout the early twentieth century. This is a series of correspondence between patients and the almoner (forerunners to social workers) at the hospital, written in the years following their treatment. They reveal a lot about how the patients progressed; some patients reported perfect health for years after treatment and lived to a ripe old age, while others repeatedly fell ill to TB and other chest diseases. But some of the letters also reveal a stigma; quite a few patients sent stern requests that neither letters nor health visitors should be sent to them, while others communicated only through their mothers or other close relatives (one woman begged not to be written to directly, as she feared that her husband would divorce her if he found out she had been treated in a sanatorium!). This series contains many fascinating insights into society at the time, with patients’ writing to request charity, seeking medical advice, or simply providing a complete update on their lives since they last wrote.

The final thing I’ve taken away from this project, which has occurred to me time and time again as I’ve looked at these records, is how lucky and privileged we are compared to even 70 years ago. The archives here include countless photographs and case notes from patients of all ages suffering from various forms of tuberculosis; this includes clinical photographs of children suffering from scrofula, who have gaping holes in their necks following surgery (RLHPP/BAI/5), as well as the letters and case notes of older patients, who may only be in their teens or twenties, who suffered for years before dying from tuberculosis. Procedures such as Artificial Pneumothorax or Thoracoplasty are awful-sounding answers to a problem that nowadays can mostly be solved by tablets. While tuberculosis remains a serious problem elsewhere in the world, the fact that in Britain it barely even registers as a concern shows how lucky we are here, today.

 

I hope you have enjoyed reading this blog as much as I have enjoyed writing it! Although the cataloguing phase is over, the conservation of the records is continuing apace, and our project conservator will be posting here on her progress. If you have any enquiries about records at the Royal London Hospital, tuberculosis-related or otherwise, you can contact us at rlharchives@bartshealth.nhs.uk.

London Chest Hospital, Victoria Park

Olding ward, London Chest Hospital, c.1925

Olding ward, London Chest Hospital, c.1925. Photograph: Royal London Hospital Archives. RLHLC/P/2/2/7

London Chest Hospital was founded in 1848 by a group of philanthropic bankers and City merchants, many of whom were Quakers, who had witnessed the success of the Brompton Hospital and wished to provide the same service to residents of the City and the East End of London. As a general hospital, The London Hospital was unable to provide specialist care to chest patients, and the other London chest hospitals were too small or too far away to provide services to patients in the east of London.

Initially opening as a public dispensary based in Liverpool Street, it proved an immediate success and limits soon needed to be placed on the numbers of patients treated. Funds were soon raised to build a hospital, and the site next to Victoria Park was purchased as it had extensive grounds so that the hospital could start small and expand.

Postcard showing patients sitting in deckchairs on the front lawn of the hospital 1923

Postcard showing patients sitting in deck chairs on the front lawn of the hospital,  1923. Photograph: Royal London Hospital Archives. RLHLC/P/2/1/4

Amongst the proposed designs for the hospital was a ‘Crystal Sanatorium’ presented by Sir Joseph Paxton, designer of the Crystal Palace for the Great Exhibition. The Illustrated London News described the principles of the building, “in which the purity of the atmosphere should be secured by a process of artificial filtration and an equable and pure temperature… the outer air being admitted by tunnels to the centre of the building”. However, this idea was too expensive to put to use, and instead of a Crystal Sanatorium, the residents of Bethnal Green had to make do with a typical Victorian hospital. (RLHLC/X/17)

Prince Albert laid the foundation stone for the hospital in 1851, and an initial sum of £30,000 was raised to build the hospital. In 1853 the hospital opened with 12 beds, expanding to 80 by the end of the decade. It was a huge success, and by 1862 had treated 9074 out-patients and 442 in-patients. Two further wings were added in 1865 and 1871, providing 160 beds in total.

From the beginning, the mission of the hospital was to treat patients with all chest conditions, not just tuberculosis. No more than half of the beds were to go to tuberculous patients; however, this requirement was relaxed by 1864, as the majority of cases were tuberculous. As you can see from this table, this was still the case in 1924, a year after the hospital clarified with a change of name that it was “The City of London Hospital for Diseases of the Heart and Lungs”.

1924 Inpatients: (All diseases with more than 10 admissions)
315 Pulmonary tuberculosis*
43 *PT and other complication
29 observed for PT, found to have no disease
35 Fibrosis of Lung
30 Bronchitis and Emphysema
29 Mitral Disease
27 Pleurisy, Acute Serous
26 Bronchiectasis
25 Acute Lobar Pneumonia
24 Hypertrophy of Tonsils and Adenoids
19 Auricular Fibrillation
16 Asthma
15 Acute Bronchitis
14 Tuberculous Adenitis, Mediastinal
11 Acute Lobular Pneumonia
11 Acute Tonsilitis
Female patients on the balcony taking air, 1923

Female patients on the balcony taking air, 1923. Photograph: Royal London Hospital Archives. RLHLC/P/2/2/4

Nineteenth century principles of tuberculosis treatment were very different to the later methods that would develop in the sanatoria, and hot, airless wards were the order of the day. Unlike the open shapes of later sanatoria, such as Frimley or Harefield, the London Chest Hospital was built in a standard shape, lacking balconies. As the new ideals took hold, in 1900 two balconies were added. Each could take 8 patients, who remained on balconies day and night regardless of weather; beds were fitted with Mackintoshes to keep patients dry in the rain!

As the twentieth century progressed, the hospital added as dispensary, providing outpatient care to patients in Bethnal Green and Hackney. The hospital maintained a sanatorium, initially in Saunderton, Bucks, then in Camberley, and later in Arlesey. The 1920s brought a new X-ray department, creating about 1000 plates a year in 1925. The surgical ward was out-of-date and unable to meet demands by 1913 – the intervening war delayed improvement, but a new surgical wing was opened in the 1930s as a result of a public appeal. A clinic for breathing exercises was established in 1939, and a physiotherapist specialising in thoracic work was appointed in 1944 .

X-ray Examination Room, C20th

X-ray Examination Room at the London Chest Hospital, C20th. Photograph: Royal London Hospital Archives. RLHLC/P/2/5/1

The hospital was funded by the typical subscription model; unusually, however, local workmen started to club together, contributing a penny each from their weekly wages. These societies frequently donated over £1000 per year, a considerable sum which enabled them to recommend patients. This shows the strength of support the hospital enjoyed from the local community, but also suggests that the patients’ realised that the expense would be too much to bear individually. Appeals were another key feature of the hospital’s fundraising efforts, with adverts appearing on buses and in the press, as well as spoken appeals on the BBC.

Continued growth saw more than 40,000 outpatients treated per year by 1939. During World War II, The London Chest Hospital became an EMS hospital, with a minimum of 75 beds reserved for air raid casualties.

Bomb damage to the exterior front facade of the Hospital, 1941

Bomb damage to the exterior front facade of the Hospital, 1941. Photograph: Royal London Hospital Archives. RLHLC/P/2/8/1

Nurses cheering in the rubble, 1941

Nurses cheering in the rubble, 1941. Photograph: Royal London Hospital Archives. RLHLC/P/2/8/15

 

Medical staff wheeling objects salvaged from the rubble across the bombsite, 1941

Medical staff wheeling objects salvaged from the rubble across the bomb site, 1941. Photograph: Royal London Hospital Archives. RLHLC/P/2/8/16

Bomb damage in a ward in the North wing, 1941

Bomb damage in a ward in the North wing, 1941. Photograph: Royal London Hospital Archives. RLHLC/P/2/8/27

The minutes of the Committee of Management tell the next part of the hospital’s story:

28 March 1941: The Secretary reported that on the night of March 19th the Hospital buildings suffered severe damage through enemy action, the Pathological Laboratory and Chapel being completely demolished, one section of the Nurses’ Home destroyed, the North Wing of the hospital so severely damaged that it will have to be taken down as a dangerous structure, and the roof of the South Wing completely gutted by fire from incendiary bombs.

There were in the Hospital at the time 85 patients and approximately 60 staff.

There were no deaths and the staff in spite of injuries from broken glass etc. in a very short time removed the patients to safety in the Parmiters School nearby. Five nurses were buried in the debris of the Nurses’ Home and were rescued, having sustained only minor injuries.

The Vice-Chairman reported that members of the House Committee and Medical Staff attended the hospital the following morning and at an Emergency Meeting instructed the Secretary to endeavour to re-establish as soon as possible in some portion of the Hospital the Out-Patient Department, First Aid Post and Special Clinics.

The quest to re-establish the hospital suffered a setback in May, as the hospital was bombed again and all the repair work was destroyed. However, the Outpatient Department, and clinics such as the Tuberculosis Dispensary, were back at work soon after the bombing, and other patients were sent to the county branch at Camberley while re-building took place. By October patients were back at the hospital, where some rearrangement had taken place; wards now occupied the ground and first-floors, and first-floor patients were moved into the basement each evening. Surgery was slower to re-establish, although minor surgery was allowed by 1943.

The minutes also reveal some of the measures taken to prevent the spread of tuberculosis within the hospital. They were not always successful, as in 1946 some nurses were found to have contracted the disease, but there was no systemic reason found to explain why this occurred. Tuberculosis patients were kept to their own wards, with no shared corridors with other patients. Medical staff were x-rayed on arrival at the hospital, and routinely re-scanned every 1-6 months depending on their Mantoux status (which would indicate if they had been exposed to tuberculin). Nurses, particularly from rural Ireland or Wales, who were shown not to have been exposed to tuberculosis were also not allowed to work on the tuberculosis wards.

In 1948, as part of the creation of the NHS and the abolition of Voluntary Hospitals, London Chest Hospital amalgamated with Brompton Hospital for the purposes of being designated a Teaching Hospital. As the century progressed, and the need for tuberculosis treatment lessened, the hospital expanded its focus on other diseases of the chest, such as cardiology. Brompton and The London Chest Hospital worked together until the 1990s, when the London Chest Hospital was aligned instead with the Royal London Hospital, located in nearby Whitechapel. In April 2015, services from the London Chest Hospital moved to St Bartholomew’s Hospital (Barts), within the same administration group, and the building was sold.

Female patients taking the air on the cleared site of the ground floor of the North Wing, London Chest Hospital, c. 1948. Caption "But for an air raid these patients at the London chest Hospital might have been three storeys up. As it is they are taking the air on the ground floor on the cleared site of the North Wing that was destroyed in 1941. " New York Times Photos, 2, Salisbury Sq., Fleet Street.

Female patients taking the air on the cleared site of the ground floor of the North Wing, London Chest Hospital, c. 1948. Caption “But for an air raid these patients at the London Chest Hospital might have been three storeys up. As it is they are taking the air on the ground floor on the cleared site of the North Wing that was destroyed in 1941. ” New York Times Photos, 2, Salisbury Sq., Fleet Street. Photograph: Royal London Hospital Archives. RLHLC/P/2/2/12

Sources:

RLHLC/X – Miscellaneous Records

RLHLC/A/2 – Minutes of the Committee of Management

Harefield Hospital

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Harefield Sanatorium at night (RLHHF/P/1/1/30). The large, curved balconies allowed patients exposure to light and air.

Harefield Hospital, which celebrates its centenary this year, is renowned around the world as a cardiac centre, pioneering heart and lung transplants in the 1980s. Its proud history as a hospital for the heart and lungs includes its establishment as the county sanatorium for Middlesex.

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Australian patients celebrate Christmas in the Number 1 Australian Auxiliary Hospital, Harefield Park (RLHHF/P/1/2/9). The wards were in wooden pavilions, clustered around the old house. Photograph by Printing-Craft. Ltd, London and Mansfield

Before a hospital stood on the site, Harefield Park was home to a succession of wealthy families. Upon the outbreak of the First World War, the owners provided use of the manor to Australian forces, and the No. 1 Australian Auxiliary Hospital was therefore established in 1915, marking the beginnings of Harefield Hospital, in a very different form. The manor house was converted into doctors’ accommodation and wooden pavilions were constructed in the grounds to house the wounded soldiers.

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“A Block” at Harefield Sanatorium. (RLHHF/P/1/3/28). The wooden pavilions of the military hospital were repurposed into wards for the sanatorium, imaginatively named A, B, C, D, E, and F Block. Note the verandas, which allowed patients to enjoy outdoor treatment.

After the war, Middlesex County Council purchased the estate for use as a County Sanatorium.  Each county was required to provide sanatorium treatment for tuberculosis sufferers, but the onset of WWI had delayed this provision within Middlesex. The site was in poor condition, and the huts used for the Australian patients were carefully taken down and rebuilt to provide six pavilions for the patients of the sanatorium, with south-facing verandas in order to provide sunlight and fresh air.

The hospital provided 250 beds for tuberculosis patients, and fulfilled the requirements for rest, open air, exercise and good food. Male and female patients were segregated, with the men’s pavilions located half a mile from the site entrance to ensure that no mixing took place! There was also accommodation for children, which included a school to minimise the disruption to their education caused by their illness.

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The new hospital buildings under construction. (RLHHF/P/1/3/33). You can see the curved wings beginning to take shape.

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An aerial view of the completed hospital, showing the ‘crossbow’ design of the wings. (RLHHF/P/2/1/1). This  structure remains today, though there have been many additions since 1937. Photograph by Photoflight Limited, Elstree, Herts.

Although the wooden pavilions provided a quick solution to the need for a county sanatorium, the need for a permanent building was soon recognised, and building work commenced in 1935. The new building opened in 1937, and is the same building (with some additions) that stands today.

A ‘crossbow’ design with three large, south-facing, balcony-lined curves, the building was designed on sanatorium principles that allowed for open air and maximum sunlight. Large open spaces were part of the design, and the hospital was built with the latest treatment methods in mind, providing a modern surgical theatre and an X-ray department for the administration and monitoring of artificial pneumothorax and similar procedures. The farm, a feature since the days of the Australian hospital, remained; it allowed the hospital an element of self-sufficiency through the production of eggs, poultry and produce, and remained an important part of the sanatorium until 1960.

The sanatorium regime followed similar principles to those seen at other sanatoria, such as Frimley. Patients were segregated, and followed strict rules. They were allowed out of bed for progressively longer periods to walk in the grounds and assist on the hospital farm and orchards, and some were able to go shopping on behalf of their fellow patients. The male patients were particularly good at breaking the rules; in the days of the pavilions, they would often sneak away to the local pub, and they remained adept at getting away even after the permanent buildings were constructed.

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A surgeon performs an artificial pneumothorax procedure at Harefield Hospital. (RLHHF/P/2/6/2). A British Official Photograph distributed by the Ministry of Information.

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A physiotherapy class for male patients with pulmonary tuberculosis. (RLHHF/P/1/5/5). These stretches were designed to help patients recover strength in their lungs following the illness and treatment.

Harefield led the way in other methods of tuberculosis treatment; it is thought to be one of the first places in Britain to administer artificial pneumothorax, and soon gained a positive reputation for a high rate of success in tuberculosis treatment. Occupational therapy was provided from 1938, with printing, leather working and book-binding facilities provided. During WWII, physiotherapists at the hospital introduced popular postural techniques to assist recovery following surgery, minimising the deformities caused by some of the more extreme interventions such as thoracoplasty, which involved removing parts of the ribs.

The Second World War saw Harefield transformed into an Emergency Medical Service Hospital, taking on some of the patients evacuated from St. Mary’s Hospital. It also became the site of a National Thoracic Unit, performing surgery of the chest. Four wards in the main block were allocated to sanatorium patients, but others were turned over to military personnel, patients with chest injuries, and non-tuberculous patients in need of thoracic surgery. Over the course of the war, the Thoracic Unit had 1804 admissions, and 501 major non-tuberculous thoracic operations were carried out. This diversification led to heated debates over the future of the hospital once the war was over; was it to return to its functions as a (still much in demand) sanatorium, should it retain the highly regarded Thoracic Unit for non-tuberculous patients, or should it become a general hospital, better suited for training nurses. Ultimately, tuberculosis remained a high priority for the hospital, but it also became the site of a Regional Thoracic Surgical Unit.

In 1947, Harefield took part in clinical trials of Streptomycin, the first antibiotic effective against tuberculosis. In the early days it took months for the medicine to work, giving bacteria time to become resistant, so sanatorium treatment and surgical intervention were often still required. Other drugs which were developed in the 1950s overcame these problems, and finally fewer patients were being treated for less time. The need for tuberculosis beds declined and the Thoracic Unit grew in importance, adding cardiovascular care to its specialties and pioneering heart and lung transplants within the UK.

 

blog RLHHF-P-1-1-151A

Patients on the balconies of Harefield Sanatorium (RLHHF/P/1/1/151A). Fresh air was an important element of tuberculosis treatment before antibiotics were found to treat the disease. The balconies were later walled off and incorporated into the wards of the present day hospital.

Harefield’s time as a sanatorium was relatively brief; however, the records still have important lessons to teach us about tuberculosis treatment. Sadly, the case notes of this institution are not included in the archive, but the archives contain information about the building itself, including plans and maintenance records. As a purpose-built sanatorium, the design and equipment chosen reveal attitudes towards the most effective means of treatment in the 1930s, with the emphasis on open air and surgical procedures. Tuberculosis may be only a small part of the overall story of Harefield Hospital, but its influence is evident in both the design and the thoracic specialties of the present day hospital.

Sources:

Royal London Hospital Archives, RLHHF, ‘Records of Harefield Hospital’

Mary P. Shepherd, Heart of Harefield: The Story of the Hospital (1990).

A Sanatorium in focus: Brompton Hospital Sanatorium, Frimley

“…idleness, the ennui, and the economic waste which are too often the reproach of Sanatorium treatment have no place at Frimley.” (RLHBH/A/20/5)

An aerial view of Frimley Sanatorium. (Photographer unknown).

An aerial view of Frimley Sanatorium. Note the ‘X’ shape of the hospital, and the surrounding fields which were cultivated by patients. (Photographer unknown). RLHBH/P/2/7/2

 

Frimley Sanatorium was part of what was then called the Hospital for Consumption and Diseases of the Chest, Brompton, and opened in 1905 to provide a rest cure and treatment to tuberculosis sufferers in a rural setting. The objectives of the sanatorium were threefold; to submit early cases to treatment in “a dry and balancing climate for several months, with a view to arresting the disease”; to educate patients in hygienic principles; and to provide a convalescent home for other patients treated at Brompton Hospital (RLHBH/X/11). The sanatorium itself was built according to the best principles of the day, with four wings in an X shape so that all wards were south-facing, with plenty of large windows and balconies in order to support open air treatment, and open grounds which could be worked on by patients as part of their treatment.

Patients working on the construction of a reservoir at Frimley Sanatorium. RLHBH/P/2/9/6. Click to see the completed work (RLHBH/P/1/2/10).

Frimley took the most promising cases from Brompton, although it soon allowed some direct admissions from paying patients. Patients came from all walks of life, and included policemen, military men, teachers, labourers, nurses and physicians, singers, and even a dancer at the Moulin Rouge! The sanatorium was open to male and female patients, although the preference was for male patients. Treatment took several months to complete, and it was felt that women were more likely to leave early to attend to their families. Male patients were also preferred as they would be the main breadwinner in their family; poverty was a major cause of disease due to poor food and living conditions, so a healthy man to lead the household was seen as a good way to ensure that the whole family did not succumb to illness.

Rules for patients at Frimley Sanatorium (1920/30s)

Rulebook for patients at Frimley Sanatorium, showing the strict daily routine (1920/30s). Click to enlarge. (RLHBH/A/1/17/2)

Rules were strict; a letter welcoming new patients (RLHBH/AL/4/3/1) acknowledged that they “may seem tiresome at first”, but stated that these were the rules which were to be the basis of the patient’s future life and health. Male and female patients were segregated unless at rare ‘mixing’ events, outside visits were strictly regulated, and the provided timetables were to be strictly adhered to. These rules were firmly enforced, and patients were discharged from treatment for disobedience. However, patients found ways around this discipline, as the following extract from a patient magazine suggests:

 

 

A Two Minute Puzzle

You’re on Grade Four. After a terrific mental struggle you make all arrangements to say good-bye to your ‘mixer’ one evening at 9.30 on Chobham Ridges. The glad moment arrives. You clasp the dear, unreluctant, tenebrous, magic form in your arms. You say, “Darling! At last we are together.” And then you discover it is Sister —.

What would you do?

What would she do?

(RLHBH/X/14)

Rulebook for patients at Frimley Sanatorium, showing the graded exercise regime. Click to enlarge. RLHBH/A/1/17/3

Rulebook for patients at Frimley Sanatorium, showing the graded exercise regime. Click to enlarge.
RLHBH/A/1/17/3

Treatment at Frimley Sanatorium was based on a principle developed by its first Medical Superintendent, Dr Marcus Patterson, based on ‘auto-inoculation’, the inaccurate theory that through regulated exercise, a patient could develop a resistance to the bacterial products which tuberculosis released into their bloodstream. This belief, coupled with fears that too much bed rest might lead to idleness in the working class patients for whom Frimley cared, lead to the creation of a system of ‘graded exercise’ practised at Frimley Sanatorium.

Male patients digging as part of their exercises; a key part of the treatment at Frimley Sanatorium. RLHBH/P/2/9/3

Male patients planting pillars as part of their exercises; a key part of the treatment at Frimley Sanatorium.
RLHBH/P/2/9/3

Female patients at work as part of their treatment at Frimley Sanatorium. RLHBH/P/2/9/4

Female patients at work as part of their treatment at Frimley Sanatorium.
RLHBH/P/2/9/4

Patients would remain on absolute bed rest until they showed suitable improvement; they would then begin to walk in the grounds, building up their miles until they were sufficiently fit to work. At this point, they would begin to perform manual tasks which supported the upkeep of the sanatorium, building up in intensity until they were at the top grade, and ready to leave. Male and female patients would work on outdoor maintenance tasks, carrying buckets of soil, wheeling barrows, mowing lawns, caring for the garden, and maintaining a kitchen garden which was to provide the sanatorium with a supply of fresh vegetables. There was even a pig farm, and serious consideration of taking on chickens during World War II. One of the earliest tasks completed by the patients of the hospital was the construction of a reservoir; a remarkable task which featured in a series of postcards, expressing delight at the surprising work done by the consumptives.

Fresh air was another component of treatment provided at Frimley, with patients advised that “You will never beat T.B. if you can’t stand a draught.” (RLHBH/AL/4/3/1). Large windows and balconies meant that patients were constantly subjected to the open air, in common with the belief derived from the Swiss sanatoria that cool fresh air was the cure for tuberculosis. This was probably more helpful than the earlier belief that patients should be kept in stuffy, closed rooms, which meant that the bacteria could thrive. Letters written to the Almoner of the hospital by patients reported that some never slept with a closed window, even decades after they received treatment, which shows how well this advice was drilled into them!

 

From the 1920s, in line with advances in tuberculosis treatment, the new Medical Superintendent Dr Wingfield encouraged the use of surgical treatments such as artificial pneumothorax in certain cases; the patient magazine referred to earlier frequently mentions the refills that patients would have required to keep the cavity full of gas.

The sanatorium regime didn’t stop once a patient had left Frimley; an advice booklet was given to leaving patients, advising on the best kinds of employment (outdoors), housing (an uncrowded area with a southerly aspect was to be preferred), and home décor (no heavy curtains or ornaments). Smoking was permitted only after meals, so as not to disrupt appetite. (RLHBH/A/14/74).

When the sanatorium opened, it was confidently declared that “this and similar Institutions will still fulfil an essential purpose even should the advance of medical science lead to the discovery of some agent more directly affecting the activity of the organism of the disease”. (RLHBH/A/14/69) This was not to be, and due to effective antibiotics, the need for a sanatorium had diminished by the 1960s; under the leadership of Dr Aylmer Foster-Carter, Frimley transitioned into a convalescent hospital, looking after post-operative cardiac and respiratory patients from Brompton Hospital, London Chest, and National Heart Hospital, and other London Teaching hospitals, until its eventual closure in the 1980s.

An exterior view of Frimley Sanatorium, showing the garden which patients planted and maintained. Note also the beds visible on the balconies, which provided fresh air for patients on bed rest. RLHBH/P/1/2/9

An exterior view of Frimley Sanatorium, showing the garden which patients planted and maintained. Note also the beds visible on the balconies, which provided fresh air for patients on bed rest. (Photographers: The Qualis Photo Co. Ltd., for Brompton Hospital, c.1920s)
RLHBH/P/1/2/9