The first part of the project has been to look at records from The Hospital for Consumption and Diseases of the Chest, Brompton, in particular the hospital’s sanatorium at Frimley. Over the next few posts, I’m going to be sharing some of what these records can tell us about the treatment of tuberculosis.
The records of the Royal Brompton Hospital cover much of the history of the hospital, which was one of the first in London to admit patients with tuberculosis. Many notable physicians, including William Paton Cleland, Sir John Forbes, and Sir Richard Douglas Powell, worked there, and the hospital was responsible for treatments such as the ‘Brompton Cocktail’, and the first mass radiology survey in England in 1926. While the hospital now deals with all heart and lung conditions, for much of its early history the key focus was on tuberculosis.
The Hospital for Consumption and Diseases of the Chest, Brompton was founded in 1841 by Philip Rose (later Sir Philip Rose), a young solicitor who was disappointed to find that a clerk in his firm had been refused admission to any hospital to treat his consumption. The Hospital initially opened with a small number of beds in Manor House in Chelsea and with an out-patient department at Great Marlborough Street; demand soon outgrew the available space, and funds were raised to build a new building for the hospital, with the foundation stone laid by Prince Albert at a ceremony in 1845.
The hospital continued to expand, supported by figures such as Charles Dickens, Benjamin Disraeli, and the famous singer Jenny Lind, who performed an in concert to raise £1606 for the Building Fund (equivalent to over £90,000 in today’s money). A sizeable donation came from Cordelia Read, who left her personal estate to the hospital, including valuable paintings by John Opie, to the surprise of her family. After a long dispute, the hospital received £100,000 which was used to build a new extension in 1882. The collection of paintings was used to decorate the boardroom. (Papers relating to this bequest can be found in the archives with the reference number RLHBH/A/14/28 and RLHBH/A/14/40).
By 1879 the hospital had 368 beds, and dealt with thousands of patients (in- and out-) each year. Although primarily associated with tuberculosis, Brompton Hospital had a number of departments which dealt with other diseases of the chest. A throat department was started in 1889, and expanded in 1922, and a radiology department was instituted in 1900, and expanded in 1925. Several attempts were made at creating a sanatorium for patients who required long-term inpatient treatment; a hospital at Bournemouth was used initially, but problems with transportation made it unsuitable. In 1904, a purpose-built sanatorium was opened at Frimley; I’ll look at this more closely next time. Moving away from respiratory ailments, a cardiac department opened in 1919, and in 1934 a physiotherapy department opened, initially as a “breathing exercises” department; by 1948, the department had expanded to include 6 full-time and one part-time ‘instructresses’, due to the success of these techniques in patients with chest conditions.
In 1948 Brompton Hospital came under the control of the NHS, and merged with the London Chest Hospital to become the Hospitals for the Diseases of the Chest. Thanks to the advent of effective antibiotics, tuberculosis became less of a concern for the hospital, and the emphasis began to shift to other areas of lung and heart medicine. A number of administrative changes took place as hospitals joined and left the NHS Trust, or administrative unit, reflecting changing expertise and priorities within the organisation. In 1971 the Hospitals for Diseases of the Chest merged with the National Heart Hospital, which was closed and moved to Brompton in 1991. This merger formed the National Heart and Chest Hospitals, later known as The Royal Brompton National Heart & Lung Hospitals. In 1998 the Royal Brompton Hospital joined up with Harefield Hospital creating The Royal Brompton and Harefield NHS Trust, which is still the largest cardiothoracic centre in the UK.
The records held at the Royal London Hospital Archive for the Royal Brompton Hospital includes large numbers of patient case notes. The information recorded in these volumes includes notes on the health of the rest of the family, reflecting nineteenth-century beliefs that tuberculosis was in some way hereditary, whereas we now know that more than one incident in the same family was due to proximity. Notes on treatments given, including the growing use of artificial pneumothorax and other surgical interventions from the 1920s, also provides us with details regarding the changing treatment of tuberculosis. The careful collection of data on temperatures, pulses and weight show us how a diagnosis was reached and the progress of the disease was monitored. Diagrams of lungs are used, with problem areas indicated, which gives us hints as to how infected areas were identified before the routine use of x-rays to image patients’ chests.
The records also include papers and volumes relating to the administrative history of the hospital; a collection of deeds, financial records, and minute books, alongside correspondence, appeal files, press cuttings and photographs, which reveal how the hospital grew, adapting to the changing medical landscape.
In the pre-NHS days, the hospital was reliant on donations and subscriptions for revenue, and often ran under-capacity due to lack of funds. New equipment or facilities could only be provided through voluntary contributions. When a new X-ray department was required, appeals were made to City Companies for their help, raising several hundred pounds, a considerable sum in those days. In return for their support, subscribers and significant donors were granted the right to recommend patients; in fact, patients required recommendations in order to obtain treatment, and could be refused treatment on subsequent occasions if they failed to properly thank the subscriber who recommended them.
Fundraising appeal literature reveals some of the attitudes people had towards tuberculosis. During the First World War, the appeals took on a patriotic approach, requesting assistance for the British, French and Belgian soldiers being treated at the hospital. One such appeal described Brompton as “…the Fort or Entrenchment of those who are being attacked by the Disease. Their only hope of being saved is to keep under cover of the Institution until the attack of the Enemy has spent itself…” (RLHBH/A/20/3). Peacetime materials took a different approach, highlighting both the duty of the well to care for the ill, and the universal risk of tuberculosis. Several leaflets emphasis this with taglines like “Consumption respects neither persons nor classes” and paragraphs stating that “…at any time, you, or someone near and dear to you, may have cause to be grateful for the skill with which the doctor has effected a cure as a result of the knowledge obtained due to the work of the hospital.” These leaflets reveal a lot about the undiscriminatory nature of the disease, and the dread which people must have had of catching it; comparing it to the bombardment of trench warfare may seem extreme, but it shows us how frightening it must have been to suffer from tuberculosis at the time.