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.
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.
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.
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.
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.
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.
Royal London Hospital Archives, RLHHF, ‘Records of Harefield Hospital’
Mary P. Shepherd, Heart of Harefield: The Story of the Hospital (1990).