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Birmingham Accident Hospital, formerly known as Birmingham Accident Hospital and Rehabilitation Centre, was established in April 1941 as Birmingham's response to two reports, the British Medical Association's Committee on Fractures (1935) and the Interdepartmental Committee (1939) on the Rehabilitation of Persons injured by Accidents. Both organisations recommended specialist treatment and rehabilitation facilities. The hospital, generally recognized as the world's first
trauma centre
A trauma center (or trauma centre) is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergenc ...
, used the existing buildings of Queen's Hospital, a former
Teaching Hospital
A teaching hospital is a hospital or medical centre that provides medical education and training to future and current health professionals. Teaching hospitals are almost always affiliated with one or more universities and are often co-located ...
in Bath Row,
Birmingham
Birmingham ( ) is a city and metropolitan borough in the metropolitan county of West Midlands in England. It is the second-largest city in the United Kingdom with a population of 1.145 million in the city proper, 2.92 million in the West ...
, England, in the United Kingdom. It changed its name to Birmingham Accident Hospital in 1974 and closed in 1993. A listed building it is now part of Queens Hospital Close, a student accommodation complex. A
blue plaque
A blue plaque is a permanent sign installed in a public place in the United Kingdom and elsewhere to commemorate a link between that location and a famous person, event, or former building on the site, serving as a historical marker. The term i ...
commemorates its former role.
History
The Queen's Hospital (Birmingham)
Earl Howe
Earl Howe is a title that has been created twice in British history, for members of the Howe and Curzon-Howe family respectively.
The first creation, in the Peerage of Great Britain, was in 1788 for Richard Howe, but became extinct on his ...
laid the foundation stone of the
Royal School of Medicine and Surgery in Birmingham's new teaching hospital on 18 June 1840, the building being completed the following year at a cost of
£8,746.
Henry Pepys
Henry Pepys (; 18 April 1783 – 13 November 1860) was the Church of England Bishop of Sodor and Man in 1840–1841 and of Worcester in 1841–1860. He gave generously to the Three Choirs Festival, held in Worcester every third year. His daughter ...
, the
Anglican
Anglicanism is a Western Christian tradition that has developed from the practices, liturgy, and identity of the Church of England following the English Reformation, in the context of the Protestant Reformation in Europe. It is one of th ...
Lord Bishop of Worcester, presided over the ceremony formally opening the 70-bed hospital.
The hospital's first president was
Prince Albert. Upon his death in December 1861, the post remained vacant until 1875, when
Lord Leigh was appointed to the position. This building was designed by
Bateman Bateman may refer to:
Places
*Bateman, Western Australia, a suburb of Perth, Australia
**Electoral district of Bateman, an electorate of the Western Australian Legislative Assembly, centred on the suburb
*Batemans Bay, a town and bay in New South W ...
and Drury and is a Grade II
listed building
In the United Kingdom, a listed building or listed structure is one that has been placed on one of the four statutory lists maintained by Historic England in England, Historic Environment Scotland in Scotland, in Wales, and the Northern Irel ...
.
The hospital expanded rapidly. By 1845 separate
ward
Ward may refer to:
Division or unit
* Hospital ward, a hospital division, floor, or room set aside for a particular class or group of patients, for example the psychiatric ward
* Prison ward, a division of a penal institution such as a pris ...
s were added containing 28 beds for infectious and contagious disease cases, raising hospital capacity to 98. In 1867, adjacent grounds were purchased, and in 1871, Lord Leigh laid the foundation stone for a new
outpatient
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health care ...
department, originally known as the "Workmen's Extension" as it was funded by local working people, to the strains of a hymn written for the occasion by the Rev.
Charles Kingsley
Charles Kingsley (12 June 1819 – 23 January 1875) was a broad church priest of the Church of England, a university professor, social reformer, historian, novelist and poet. He is particularly associated with Christian socialism, the working ...
and sung by 1,000 child choristers from the Birmingham Schools Choral Union.
This building was designed by
Martin & Chamberlain
John Henry Chamberlain, William Martin, and Frederick Martin were architects in Victorian Birmingham, England. Their names are attributed singly or pairs to many red brick and terracotta buildings, particularly 41 of the forty-odd Birmingham bo ...
and is also Grade II listed. It opened for patients on 7 November 1873.
In 1875, Queen's became a free hospital, abandoning the previous system whereby the hospital's financial supporters issued "subscriber's tickets" to authorise treatment. A one
shilling
The shilling is a historical coin, and the name of a unit of modern currencies formerly used in the United Kingdom, Australia, New Zealand, other British Commonwealth countries and Ireland, where they were generally equivalent to 12 pence o ...
admission fee was charged but could be waived.
[
In 1877, 16,117 patients were treated at Queen's, but by 1908, the patient count had more than doubled to 39,483, composed of 2,685 ]inpatients
A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health car ...
and 36,708 outpatients. Average annual expenditure from 1909 to 1911 was £14,729, against average receipts £10,778 leaving an average annual deficit of £3,951, covered by endowments and donations.
In 1900, William Humble Ward, 2nd Earl of Dudley
Earl of Dudley, of Dudley Castle in the County of Stafford (now the West Midlands), is a title that has been created twice in the Peerage of the United Kingdom, both times for members of the Ward family.
History
Dudley was first used for a pe ...
, took over the presidency of the hospital. A new block opened in 1908 with three stories of wards as well as a roof ward for six patients, the first of its kind in Europe. The integrated nursing home's capacity increased from 34 to 74 beds, and the hospital itself now had 60 medical and 118 surgical beds, totalling 178. Bed count and services provided continued to expand until closure.
Birmingham Accident Hospital and Rehabilitation Centre
Queen's remained a teaching hospital
A teaching hospital is a hospital or medical centre that provides medical education and training to future and current health professionals. Teaching hospitals are almost always affiliated with one or more universities and are often co-located ...
until the Queen Elizabeth Hospital, Birmingham
The Queen Elizabeth Hospital Birmingham is a major, 1,215 bed, tertiary NHS and military hospital in the Edgbaston area of Birmingham, situated very close to the University of Birmingham. The hospital, which cost £545 million to construct ...
opened. The outbreak of war however delayed the planned partial redeployment of the building as an accident hospital. In 1941, the opportunity was taken for Birmingham to address the problems of delay in treatment of serious injuries. Accidents in Birmingham had risen by 40% as inexperienced workers entered wartime factories. Birmingham Accident Hospital and Rehabilitation Centre as it became, was thus the last voluntary hospital in the country and its specified objectives included prevention of industrial accidents. Its Surgeon in Chief and clinical director was Professor William Gissane. According to former consultant surgeon Keith Porter, the hospital had eight wards and there were usually around 600 staff working there at any one time.
On 14 August 1944 the President of the Hospital, the Lord Mayor of Birmingham welcomed the Minister of Health Sir Henry Willink at the opening of a new reception area and Outpatients department. Willink said the Accident Hospital experiment was being closely watched and was likely to have a permanent future in hospital services. Referring to the Beveridge report and his own 1944 White paper, he said he recognised the close co-operation between the University, the city authorities and the hospital and hoped that this spirit of co-operation would pervade the future National Health Service
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom (UK). Since 1948, they have been funded out of general taxation. There are three systems which are referred to using the " ...
. The Parliamentary secretary to the Minister of Labour George Tomlinson
George Tomlinson (21 March 1890 – 22 September 1952) was a British Labour Party politician.
Biography
George Tomlinson was born at 55 Fielding Street in Rishton, Lancashire, the son of John Tomlinson, a cotton weaver, and his wife Alice, né ...
described rehabilitation as "one of the great social advances which has emerged from this war". He added that only 18,000 of the 200,000 disabled and unemployed remained so.
Burns unit and Medical Research Council ('MRC') Unit
Whilst infection was known in the 19th century as a dangerous complication in severe burns, until the 1950s, its significance was regarded as secondary. It was only after treatment for shock was available that it became recognised as the main cause of death. Whilst initially a burn is likely to be sterile, it will quickly become colonised from external sources, usually other patients in the same ward. Prevention of cross infection was therefore a key objective.
In 1941, Sir Ashley Miles, Professor of Bacteriology at University College Hospital Medical school and a member of the War Wounds Committee worked as part-time director of the hospital's MRC unit. He left in 1946, eventually becoming director of the Lister Institute of Preventive Medicine
The Lister Institute of Preventive Medicine, informally known as the Lister Institute, was established as a research institute (the British Institute of Preventive Medicine) in 1891, with bacteriologist Marc Armand Ruffer as its first director, us ...
. In 1943 Leonard Colebrook
Leonard Colebrook FRS ( – ) was an English physician and bacteriologist.
Education
Colebrook was educated at the Grammar School in Guildford (1891–96), Westbourne High School in Bournemouth (1896–99) and Christ's College Blackheath in Ke ...
, an expert on the earliest antibiotic Prontosil
Prontosil is an antibacterial drug of the sulfonamide group. It has a relatively broad effect against gram-positive cocci but not against enterobacteria. One of the earliest antimicrobial drugs, it was widely used in the mid-20th century but is ...
, active against streptococcus
''Streptococcus'' is a genus of gram-positive ' (plural ) or spherical bacteria that belongs to the family Streptococcaceae, within the order Lactobacillales (lactic acid bacteria), in the phylum Bacillota. Cell division in streptococci occurs ...
, moved with his burns unit from Glasgow Royal Infirmary
The Glasgow Royal Infirmary (GRI) is a large teaching hospital. With a capacity of around 1,000 beds, the hospital campus covers an area of around , and straddles the Townhead and Dennistoun districts on the north-eastern fringe of the city cen ...
. A joint project led to the development of MRC cream no 9, the main burns treatment at that time.
Colebrook established the practice of placing the patients in a near sterile environment.
His political campaigning against unguarded fires and inflammable children's nightwear led to the Heating Appliances and Fireguards Act 1952.[
In 1949, ]Edward Lowbury
Edward Joseph Lister Lowbury (December 12, 1913 - July 10, 2007) was a pioneering and innovative English medical bacteriologist and pathologist, and also a published poet.
Life
Edward Lowbury was born in Hampstead to the recently naturalised Benj ...
succeeded Colebrook as Head of Bacteriology. In the 1960s and 1970s, as one of the foremost researchers in hospital infection particularly in the prevention of burns infection, the problems of antibiotic resistance and skin disinfection, he lectured around the world. Clinical trials confirmed Colebrooke's work showing that specialist positively pressurised dressing rooms reduced infections. With John Babb he proved that a specialised filter system could remove bacteria from an airstream and retain them either reducing infection risk or allowing an already infected patient to be treated in an open ward. He documented treatment of infections with ''Pseudomonas aeruginosa
''Pseudomonas aeruginosa'' is a common encapsulated, gram-negative, aerobic–facultatively anaerobic, rod-shaped bacterium that can cause disease in plants and animals, including humans. A species of considerable medical importance, ''P. aerugi ...
'', noting that the development of carbenicillin
Carbenicillin is a bactericidal antibiotic belonging to the carboxypenicillin subgroup of the penicillins. It was discovered by scientists at Beecham and marketed as Pyopen. It has Gram-negative coverage which includes ''Pseudomonas aeruginosa'' ...
resistance used a single mechanism, which conferred protection against a range of antibiotics. He further showed that overuse of a new antibiotic led to increased staphylococcus resistance, and that a subsequent reduction in use reversed the effect. His work with Rod Jones contributed to the development of a pseudomonas vaccine. With Harold Lilly he developed tests for effectiveness of hand washes before alcohol became the norm in 1974. These tests were still the basis for European standards when he died in 2007. He worked on topical
A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...
antibacterial compounds with surgeons Douglas Jackson and Jack Cason eventually leading to topical silver, which was still in use at his death.
Dr Simon Sevitt and Pathology
In 1947, Dr Simon Sevitt set up a pathology department that covered bacteriology Bacteriology is the branch and specialty of biology that studies the morphology, ecology, genetics and biochemistry of bacteria as well as many other aspects related to them. This subdivision of microbiology involves the identification, classificat ...
, haematology
Hematology ( always spelled haematology in British English) is the branch of medicine concerned with the study of the cause, prognosis, treatment, and prevention of diseases related to blood. It involves treating diseases that affect the produc ...
, biochemistry
Biochemistry or biological chemistry is the study of chemical processes within and relating to living organisms. A sub-discipline of both chemistry and biology, biochemistry may be divided into three fields: structural biology, enzymology and ...
, histology
Histology,
also known as microscopic anatomy or microanatomy, is the branch of biology which studies the microscopic anatomy of biological tissues. Histology is the microscopic counterpart to gross anatomy, which looks at larger structures vis ...
,
and morbid anatomy.
Though his best known work was in venous thrombosis
Venous thrombosis is blockage of a vein caused by a thrombus (blood clot). A common form of venous thrombosis is deep vein thrombosis (DVT), when a blood clot forms in the deep veins. If a thrombus breaks off (embolizes) and flows to the lungs to ...
and pulmonary embolism
Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain p ...
, fat embolism
Fat embolism syndrome occurs when fat enters the blood stream (fat embolism) and results in symptoms. Symptoms generally begin within a day. This may include a petechial rash, decreased level of consciousness, and shortness of breath. Other sympto ...
, and the healing of fractures, he was to become an "outstanding pathologist, particularly in accident surgery".
His controversial 1959 paper on thromboembolism after fracture of the hip in old people written in conjunction with Gallagher, which found that
fatal pulmonary embolism
Pulmonary embolism (PE) is a blockage of an pulmonary artery, artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include dyspnea, shortness of breath, chest pain p ...
might occur 30 days or more after surgery for hip fracture
triggered work by other researchers and revolutionised the profession's attitude to preventing, diagnosing, and
treating the condition. Dr Sevitt died in September 1988.
Ruscoe Clarke and the Treatment of Trauma
By 1954, before the introduction of crash helmets, UK road injuries were increasing rapidly. Motorcyclists alone accounted for over 1,000 UK deaths
compared to the 2008 road user total of just 2,645.
"Research work at the Birmingham Accident Hospital improved the treatment of injury immeasurably." Alan Ruscoe Clarke studied haemorrhagic shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emergen ...
for different types of injury and showed that the lethal collapse of blood volume was caused by swellings around a fracture or burn and not by blood becoming temporarily static in the capillaries. Immediate transfusion and surgery reversed or delayed the "illness of trauma" and was essential.
In his 1957 lecture to the St. John Ambulance Brigade Surgeons' Conference in Harrogate
Harrogate ( ) is a spa town and the administrative centre of the Borough of Harrogate in North Yorkshire, England. Historic counties of England, Historically in the West Riding of Yorkshire, the town is a tourist destination and its visitor at ...
, Ruscoe Clarke described the old theory of shock and why it failed. Despite the success of James Blundell with blood transfusions, saline solution was the standard substitute from 1868 to 1916.
Surgeon Ernest Cowell, writing in The British Official History of the Great War described the results of saline solution at the Battle of the Somme as "most disappointing". Canadian surgeons recommended whole blood transfusions though volumes used were small: even the largest transfusions used were only about a litre.
Treatment of shock from 1919 was based on observations of Cowell and Walter Bradford Cannon
Walter Bradford Cannon (October 19, 1871 – October 1, 1945) was an American physiologist, professor and chairman of the Department of Physiology at Harvard Medical School. He coined the term "fight or flight response", and developed the theory ...
. However, plasma volume measurements suggested that more blood was disappearing from the circulation than could be accounted for. Since it was in neither the veins nor the arteries, it was assumed to be temporarily immobilised throughout the capillary system. Treatment was therefore aimed at encouraging blood to return to the circulation by heating the patient, rubbing the limbs and providing hot sweet tea intended to increase circulation volume.
The large transfusions made possible by the development of blood banks in the 1930s transformed many patients. In 1940, Alfred Blalock
Alfred Blalock (April 5, 1899 – September 15, 1964) was an American surgeon most noted for his work on the medical condition of shock as well as Tetralogy of Fallot— commonly known as Blue baby syndrome. He created, with assistance from hi ...
proposed that shock was caused by bleeding, a view accepted by various authorities by 1946. The war injuries study of Grant and Reeve published 1951 recommended early transfusions for large wounds and suggested existing theories were inadequate.
Ruscoe Clarke further described how observations at the Birmingham Accident Hospital on peacetime accident victims confirmed Grant and Reeve's work and provided evidence to reject the old capillary theory. Their work showed that blood was missing from the circulation just as often in closed fractures as in open wounds, that the blood lost appeared proportional to the severity of the wound and that the swelling of the injury frequently corresponded to the volume of blood lost. Blood loss from open wounds similarly matched blood lost from circulation. Blood losses had been consistently underestimated in the past but the provision of large transfusions during the Korean War had saved people with injuries who would not otherwise have survived. He recommended that where significant blood loss had occurred, even over an extended period of time, the patient should be transferred to expert medical care and receive an immediate transfusion. There was no place for hot tea, heat treatment or massage, which delayed proper treatment.
Road Injuries Research Group
In 1960, Professor Gissane became honorary director of the Road Injuries Research Group, which investigated and analysed accidents on the newly opened M1 motorway
The M1 motorway connects London to Leeds, where it joins the A1(M) near Aberford, to connect to Newcastle. It was the first inter-urban motorway to be completed in the UK; the first motorway in the country was the Preston By-pass, which lat ...
at a time before seat belts
A seat belt (also known as a safety belt, or spelled seatbelt) is a vehicle safety device designed to secure the driver or a passenger of a vehicle against harmful movement that may result during a collision or a sudden stop. A seat belt reduc ...
were mandatory. Gissane believed risks of accidents occurring were lower on motorways but the consequences were more serious.
A further study of "all deaths from road accidents in certain areas and periods" suggested lorries were the main cause of car fatalities on Motorways and Link roads and that seatbelts provided little protection available for the car occupants.
UK lorries are now fitted with an impact absorbing rear barrier, meeting one of the recommendations. Investigation techniques included interviews with police, hospitals, survivors and coroners to study ways in which vehicle design could be changed to avoid accidents in the first place and to mitigate the injuries caused. Speaking in 2002, the former director of the hospital's research unit, Dr John Bull credited the unit with calling for mandatory seatbelt installation in new vehicles and compulsory wearing of motorbike crash helmets. The AA provided some money for research.
Birmingham Bombings 1974
The Birmingham Pub Bombings
The Birmingham pub bombings were carried out on 21 November 1974, when bombs exploded in two public houses in Birmingham, England, killing 21 people and injuring 182 others.
The Provisional Irish Republican Army never officially admitted respo ...
was the worst terrorist attack in Great Britain until the 7 July 2005 London bombings
The 7 July 2005 London bombings, often referred to as 7/7, were a series of four coordinated suicide attacks carried out by Islamic terrorists in London that targeted commuters travelling on the city's public transport system during the mo ...
. Taxi cabs and all available ambulances ferried victims to either the Accident hospital or to Birmingham General Hospital
Birmingham General Hospital was a teaching hospital in Birmingham, England, founded in 1779 and closed in the mid-1990s.
History Summer Lane
In 1765, a committee for a proposed hospital, formed by John Ash and supported by Sir Lister Ho ...
. Accident Hospital switchboards were jammed as a total of 217 victims were brought in. Speaking in 2011, Roger Farell, the head of medical records described how he set off for work immediately on seeing the TV newsflash. Injuries included wood and glass shards –which cannot be detected by x-rays and some victims were rendered unrecognisable. Drinkers at the Tavern in the Town pub which was located underground suffered very severe blast injuries. The only fortuitous aspect was the geographical location of the blast -within a mile of a hospital housing the only specialised burns unit in the country at the time. The very worst cases went into the “world-leading major injuries unit” though nine of the twelve died.
References
External links
William Gissane 1898-1981
Dr Ruscoe Clarke
Archaeological assessment of the buildings
2007
{{Authority control
Hospitals in Birmingham, West Midlands
Hospital buildings completed in 1840
Hospital buildings completed in 1845
Grade II listed buildings in Birmingham
History of medicine in the United Kingdom
Voluntary hospitals
Defunct hospitals in England