The creation and early days of the Acci – Birmingham Accident Hospital

Origins

The report from the Fracture Committee from the British Medical Association in 1935 highlighted the poor standard of trauma care.
Report of the Independent Committee on Persons Injured by Accident 1939
The report from the Medical Advisory Council of the Nuffield provincial hospitals trust 1941
All 3 reports recognised that minor fractures and soft tissue injuries were treated by inexperienced junior doctors, treatment was often delayed because casualty services were not available in the evenings, in some hospitals this also included the afternoons and there were similar problems with radiography
Patients often had to return to out-patients during the day missing work and wages and their delayed recovery also kept them off work for longer than necessary.
Follow-up treatment if offered was carried out with insufficient knowledge of industrial conditions. An example given was that of a man with an injured finger could keep a man off work for 3 months.
Cost to industry of rising tide of industrial injuries as the nation’s factories came under wartime condition
2nd March 1939 saw a conference of the Vernon Committee (designed to bring people with vested interests in Birmingham) which was attended by representatives from the Public Health Committee ,the United Hospital (Queens and General), the Public Assistance Committee, the University of Birmingham Faculty of Medicine and the Hospitals committee met to discuss the treatment of Casualties in Birmingham. It was agreed that further information about the number of casualties and emergency cases admitted to municipal and voluntary hospitals was required. Dr Matthew Burn, Deputy Chief Medical officer for Birmingham agreed to obtain the particulars and also detail of the structure and function of the Bohler Clinic in Vienna. No mention was made of the imminent closure of the Queens Hospital.
On 23^rd May 1939, a second conference took place with the same organisations in attendance to consider the information available. At the meeting a sub-committee consisting of 5 individuals was set up to produce a report with recommendations for the development of casualty Services. Of the 5 the key people appear to have been Dr Matthew Burn and Sydney Vernon who was a distinguished solicitor and subsequently Pro-Vice Chancellor of the University of Birmingham
At a third meeting, date not known Dr Burn proposed that the Queens Hospital once vacated be utilised as a Fracture-trauma Hospital. After this meeting there was a hiatus because of the outbreak of the Second World War.
On 15^th February 1940 Professor Parsons, on behalf of the United hospital, organised a conference on casualty services. A report from the meeting was presented to the General Purposes subcommittee of the United Hospital and representatives of the other interested organisations and Mr Sydney Vernon explained how keen he and the Hospital Council were to retain the Queens Hospital for hospital purposes. This view was shared by the United Hospital. It was agreed that the United Hospital should consider the terms and conditions under which the release of the Queens Hospital could be affected. It was noted the hospital was in a pleasant area in the periphery of the city which was thought to be safer in the time of war.
Meetings of the subcommittee under the auspices of the Hospitals Council and chaired by Sydney Vernon were held on 27^th April, 13^th July, and 15^th July 1940 to consider the ways and means of taking over the Queens Hospital. A Hospital council resolution on 26^th september1940 appointed an executive committee to constitute the Board of Management for the Fracture Hospital.
On 6^th October, a meeting was held with the Chief Medical Officer and it was agreed if a suitable candidate for the position of Clinical Director was serving in the armed forces he would be released. A request for a grant was made to the Ministry of Health to help with the setting up of the hospital
On 17^th December 1940 the first meeting of the Provisional Board of the Management (PMB) was held at the Queens Hospital. Subcommittees were established and it was agreed to appoint a Clinical Director.
On 28^th January 1941, the PMB received reports from the General Purposes Committee, Finance Committee, and the Equipment and Staffing Committee.
Most of the money to open and run the hospital was provided by local industry. Factory owners were persuaded that an Accident Hospital would be of benefit to them because their workers would be treated better and would therefore be able to return to the factory floor more quickly

Numbers

	Adult males	Adult females
1938	134.752	14.626
1939	146.417	17.029
1940	173.278	23.766
1941	191.343	42.857

The high percentage of males makes me think it is to do with the annual reported accidents in Birmingham.

(I have asked Anne to confirm what these figures are – she could not confirm however she agrees and thinks they are the annual reported accidents in Birmingham)

Desire to reduce the cost by providing prompt and effective treatment
Group led by Sydney Vernon – linking up to the City of Birmingham motto “forward” Vernon presided over core group of experts
UOB willing to allow century old Queens Hospital to be used as Accident Hospital at a peppercorn rent

The Acci – Early Days

01/04/1941 new hospital opens in building whose clinical contribution had gone on intermittently from 1839-1928
First report of the Management Board 9 months post-opening
Unmistakable stamp of Gissane’s intention and plans even though he did not take up post until September 1941
Recognition given to Mr H Carson (acting Clinical Director)
3 temporary assistant surgeons
FG Allan
TS Donovan
H Donovan
Board of Management of 29 members including:
Professor Seymour Barling
Professor P Cloake
Gissane however recognised that the hospital owed most to the industrial businesses – their attitude was summed up as “you tell us what you need and leave us to find the money”
Important names included:
Mr W L Barrows (Treasurer and Chartered Accountant)
Mr C V Everal (Director of Bellis & Morecomb)
Mr C G Spragg (Secretary Birmingham Trades Council)
Mr A Caster (Silversmith)
Mr S Vernon (Solicitor)

The hospital, created in 1941, was in an old building formerly housing for the Queen’s Hospital at Birmingham which had been replaced by the Queen Elizabeth Hospital on the University’s Edgbaston campus.
The bacteriology laboratory was a pre-anaesthetic operating theatre and the burns unit in two open Nightingale-type wards. It is fair to say that the working environment was less than optimal. However, in the early 1960s an enclosed office was built within the laboratory, thus creating some privacy for its occupant. Metal and glass cubicles were installed in the burn’s unit at much the same time.

Gissane had three main principles by which injury treatment could be raised to a proper level. These principles were:

separate the sick from the injured
appropriate personnel and facilities for treatment and investigation should be immediately available for the injured. E.g. senior surgeons should be on the spot or short call-no waiting for x-ray or theatres
care of the patient should be in the hands of the same clinical team from arrival through to rehabilitation and discharge.

Early Medical Staff

Mr William Gissane (Clinical Director)
Mr FG Badger (Deputy Clinical Director)

Mr TW Hunnatt (Assistant Surgeon from 1941)
Dr LJ Wolfson (Senior Anaesthetist 1941)
Dr MJ Rowley (Anaesthetist)
Mr AB Weston (resident surgical officer (RSO))
Plus, x4 house surgeons

Other staff included:

Miss EM Bullivant (Matron)
Mrs E McNab (Dispenser)
Mr I MacIver (Administrator)
The Chaplains
Rev FL Craig-Kelly
Rev W Ratcliffe

Capacity

The hospital had 322 fully equipped beds (83 not used as on top floor and risk of air raids)
50 more beds kept in reserve for air raids
1941 attendance figures
Average inpatients 110
New outpatients per week 350
Inpatient average stay – 3 weeks
First nine months, 13,000 attendees, 10% admitted

Finances

First nine months total expenditure £33,279.18s 0d (£6,488 greater than income)
Salary entire:
Medical staff £950,2s 0d
Nursing staff £2,091,6s 0d
Income £40,000 from:
Birmingham Hospitals Contribution Association
City of Birmingham
Ministry of Health
Local firms, charitable institutions and individual benefactors raised £10,000 in 1941
Generous firms included:
ICI Metals
The Austin Motor Company
W&T Avery
Cadburys
Guest, Keen and Nettefold

Objectives and Plans

1941 – Gissane pushed for training nurses in industrial medicine. Also supportive of an industrial liaison officer
Gissane was responsible for setting up mobile surgical unit
1942 – New facilities:
Casualty reception with cubicles
X-ray department
Operating room in ED
Dressings unit kept separate from main casualty
Dressings unit was essentially outpatients
Conveyor belt concept – doctor, nurse and secretaries stayed put and patients came past them, had their dressings removed and treatment prescribed, then moved to have prescribed treatment delivered by nurses in the dressing’s rooms. Effective removal of dirty instruments and introduction of clean kit
Alterations complete by 1944
In 1944 in the House of Commons Sir Patrick Hannon said of the Acci …“The hospital is giving the lead in the rehabilitation and restoration of injured and wounded men to make them fit for industry, and their work should be known throughout the length and breadth of the land.
It is a particularly ambitious venture, which has received substantial support and the success of its experiment has been remarkable.
What has happened is that the Accident Hospital, under admirable control and direction, is in contrast with various works, and as the process of restoration to working capacity goes on in the Hospital the men are gradually brought back in context with the work in which they engaged in the particular factory before the injury. Even before full capacity is reached, they may be back at work and his work may go side by side with the work of restoration”
June 1994 – Injured soldiers received. 183 received during year.
Ward G – the short stay ward opened in 1944
In 1944 over 4,000 admission to 210 beds
1945 Almoner’s department established to provide for visits to homes
1945 Austin Motor Company mobile surgical unit provided
1945 Visit by His Majesty King George VI and Queen Elizabeth on 7 November
Structured attendances were sufficient for the hospital to treat 50,000-60,000 new patients a year

New patient numbers:

1951 > 50,000
1954 54,000
The Accident Service Review Committee report (Platt 1961) resulted in the creation of 5 major accident units in and around Birmingham thus reducing caseload
The Scott Review in 1972 led to the reversal of orthopaedic surgeons being in the Casualty Department gatekeepers and paved the way for the development of the Emergency Medicine specialty.

Daily Activities

Surgeons did review of previous days x-rays each morning. Dr James Brailsford (Consultant Radiologist) attended regularly
Team activity
One day in Casualty
One day in outpatients
on day in main operating theatres
Casualty Department – had clean and dirty theatres
There was 24/7 short stay ward
1944 seeing 20,000 new patients/year
1946 seeing 25,000 new patients/year
1947 workload justified formation of 3 surgical teams
Monthly MDT meeting reviewing all deaths
Regular meeting inviting guest speakers included:
John Charnley
Sterling Bunnell
As a result of Bunnell’s visit hand clinic and shoulder clinics were established

Outpatient Department

Designed to see one patient every 2 minutes

Achieved by having secretary next to the doctor and patient on each side of the table

In addition, there were 2 to 4 patients in cubicles

Some follow ups especially for interesting cases were undertaken in Casualty in the “dirty theatre”

An excellent teaching opportunity for junior doctors

Surgical Care

Operating theatres on top floor of building – distinguished by having an instrument curator. Chisels for osteotomy were always beautifully sharp!

Notes

The entire team in 1941 comprised of:

2 surgeons

1 assistant surgeon

1 registrar

1 assistant registrar

2 house surgeons

1 anaesthetist

Progress

1946 – 2 small teams

1947 – 3 teams

19478 – 1 burns team

Birmingham Accident Hospital last voluntary hospital set up in the UK.

(M. F. Porter – consultant surgeon)

One of the prominent landmarks in dealing with trauma was the development of Birmingham Accident Hospital in 1941.
The hospital was established to deal with the rapidly increasing road traffic and industrial accidents.
The pioneer of the project was Professor William Gissane.
The hospital looked after all sorts of injury including victims of air raids during the war.

The hospital provided continuous cover with a full-time consultant surgeon, 24-hour radiography, and blood transfusion, and a mobile operating theatre (surgical unit) that was based at the hospital.
The idea of a separate accident hospital was extremely innovative but the isolation of the unit from other acute specialties led to problems.
Professor Gissane planned to associate the hospital more closely with specialist units. These plans were shelved because of a lack of funds.
The National Health Service in July 1948 inherited a large number of casualty departments, most of them in substandard accommodation. The standard was poor, with absent support from seniors who were in nominal charge only— “absentee landlords” as called by Maurice Ellis.
As most of the departments were not planned or staffed adequately, the situation became serious and the level of care was below the expected standard.
In 1959 the British Orthopaedic Association Memorandum on Accident Services recommended that regional hospital boards, in association with teaching hospital boards, set up at least one comprehensive accident service within its area. It was hoped that such units would integrate to form a nationwide accident service.
They were in favour of having accident units that were part of a general hospital.
Orthopaedic surgeons should be in charge, as the locomotor system accounted for three quarters of all injuries.
This was the probably the beginning of the structure of the modern UK service of the “DGH A&E”.
The Nuffield Provincial Report (1960) showed that the casualty services in the studied areas were still badly housed in unplanned accommodation.
The staffing was inadequate with juniors receiving very little support from seniors.
The main duties of the consultant in charge were to plan the rota and to do pre-planned clinics.
The majority of the departments received low rating in all aspects apart from the quality of the casualty sisters.
Concerns had increased over the level of care provided for the seriously ill and injured patients.
These concerns and the desire to improve the service initiated the subcommittee report prepared by Sir Harry Platt, the ﬁrst meeting was held on 20 April 1960. They met 19 times until the production of their package of recommendations.

BAH

Planning and Formation

Three key reports informed the decision to create BAH
- Fracture committee of the British Medical Association (1935)
- Interdepartmental Committee set up by the Ministry of Health to enquire into the Rehabilitation of Person’s Injured by Accident (1939)
- Medical Advisory Council of the Nuffield Provincial Hospitals Trust (1941)
The problems to be solved:
- minor fractures and soft tissue injuries were treated by inexperienced junior doctors
- treatment was often delayed because ‘out-patient’ (I think this meant A&E in modern parlance) services were not available in the evenings and sometimes during afternoons – there was a similar problem with radiography.
- Patients often had to return to out-patients during the day, missing work and wages and their delayed recovery also kept them off work for longer than necessary.
- Follow up treatment if offered was carried out with insufficient knowledge of industrial conditions.

Example: an infected, injured finger could keep a man off work for three months.

2^nd March 1939: A Conference of the Vernon Committee
- (precise role unknown but possibly to bring together vested interests in Birmingham)
- Attended by representatives from:
  - Public Health Committee
  - United Hospital (Queens and General Hospital)
  - Public Assistance Committee
  - University of Birmingham Faculty of Medicine
  - Hospitals Council
- met to discuss the treatment of Casualties in Birmingham
- It was agreed that further information about the number casualties and emergency cases admitted to municipal and voluntary hospitals
- Dr Matthew Burn, Deputy Medical Officer of Health for Birmingham agreed to obtain particulars of the Bohler Clinic in Vienna
- No mention was made of the imminent closure of the Queens Hospital.
23^rd May 1939: Second Conference – same organisations attended to consider the information available
- A Conference Subcommittee consisting of 5 individuals was appointed to consider and report a detailed scheme for casualty services
- Of the 5, the key people appear to have been Dr Matthew Burn and Sydney Vernon who was a distinguished solicitor and subsequently Pro-Chancellor of the University of Birmingham.
Third Meeting: Dr Burn proposed that the Queen’s Hospital be utilised as a Fracture – Traumatic Hospital.
After this meeting there was a hiatus due to the outbreak of war.
15^th February 1940: Professor Parsons on behalf of the United Hospital organised a conference on casualty services
- A report about the conference was presented to the General Purposes committee of the United Hospital
- Representatives of the other interested organisations and Mr Sydney Vernon explained how desirous he and the Hospitals Council were to retain the Queens Hospital for a hospital purposes – This view was shared by the United Hospital
- It was agreed the United Hospital should consider the terms and conditions under which the release of the Queens Hospital could be affected.
- It was commented that the hospital was in a pleasant area on the perimeter of the city which was thought to be safer in time of war.
27^th April, 13^th July, and 15^th July 1940: Meetings of a subcommittee under the auspices of the Hospitals Council – chaired by Sydney Vernon
- To consider ways and means of taking over the Queen’s Hospital
26^th September 1940: A Hospital Council resolution – appointed an executive committee to constitute the provisional Board of Management for the Fracture Hospital
6^th October 1940: a meeting was held with the Chief Medical Officer
- It was agreed that if a suitable candidate for Clinical Director was serving in the armed forces, he would be released
- A request was also made for a grant from the Ministry of Health to help with the setting up of the new hospital
17th December 1940: First meeting of the Provisional Board of Management (PBM) – held at the Queens Hospital
- Subcommittees were established and it was agreed to appoint a Clinical Director
28^th January 1941: PBM received reports from:
- General Purposes Committee
- Finance Committee
- Equipment and Staffing Committee.
20^th February 1941:
- PBM agreed to appoint temporary staff and to take over the Queen’s Hospital on 31^st March 1941
- Also agreed the name would be Birmingham Accident Hospital and Rehabilitation Centre

BAH Board of Management Annual Reports

In 1941 and 1942, reports listed all individual contributions from donors including private and industrial
In 1943, Paper Restriction Orders prohibited hospitals from publishing lists of donors although they were allowed to keep a paper record within the hospital – The paper restriction was not lifted until 1947

1^st April 1941: BAH opened
- The need for a hospital specialising in the treatment of accidents was greater during time of war than during peace
- During 1940 and 1941, the number of industrial injuries in the Birmingham area requiring treatment at hospitals increased by at least 40%, the annual total now being well over 100,000

BAH was the last voluntary hospital to be opened before the advent of the NHS

BAH had no endowments, investment, or a public subscription list. It was reliant on promises made by industry and individual donors for financial support (unlike longer established hospitals)
It was also the first hospital to offer from the outset a 24 hour service, 365 days a year with senior staff in attendance.

Buildings and equipment

1941: The Birmingham United Hospital (meaning the new QEH and the General Hospital) handed over responsibility for the Queen’s Hospital with the contents for the use of the Accident Hospital
- no charge was made for rent or the use of equipment
- Provisos were that all moneys including donations, grants and endowments received by the Queen’s be transferred to the United Hospital and also that should the BAH no longer be there, the building and land would revert to the United Hospital
- Staffing was to be sufficient for the teaching of medical students
- At the time of handover, a small midwifery department remained and use of outpatients was retained by United Hospital until alternative arrangements could be made. (It is not clear when these departments were cleared for use of BAH and no mention is made of them in the first Annual Report)

Bed Accommodation

1941:

322 fully equipped beds.
83 on the top floors could not be used during the war by direction of the Ministry of Health.
50 beds were reserved for air-raid casualties
leaving 189 for the use of other injured patients.
The Ministry of Health made available 200 beds at Hollymoor Hospital. It is unclear whether these were ever used.

1942:

189 available beds occupied by an average 118 daily number of patients.

1943:

226 available beds including 16 reserved for air raid casualties.

1944:

210 in total
113 male beds, 66 female beds, 31 children’s beds and cots.
Of the women’s beds 22 were occupied by battle casualties.
22^nd June, 16 days after D-Day the first of 11 convoys brought injured soldiers to BAH.
In total, the hospital treated 183 battle casualties some of whom remained an inpatient for over six months.

1945:

194 beds in total.

1946:

average of 166 beds available.

1947:

average of 170 beds available

Out-Patient Department

1941:

The department had been used unchanged for the past 70 years
Was deemed unsuitable for large scale casualty work and hence patient numbers were restricted.
Plans were approved for the modernisation and re-equipment of the department to be completed by 1st May 1942.

1942:

Plans for redevelopment were approved rapidly by the Ministry of Health but the unnamed authorities responsible for granting a building licence delayed its issue until June.
Work started immediately but was slower than expected because of shortage of materials and manual labour.
This department would consist of a Reception department including shock room, reception cubicles, 3 operating theatres and X-Ray units and an Out-Patient Treatment Department – consisting of a Fracture Suite consisting of consulting rooms, plaster room and X-Ray as well as soft tissue dressing and redressing stations. Each area was designed for efficiency allowing ‘the maximum number of patients to be treated by the minimum member of staff’. [modern day casualty department/ ED?]

1943:

Alterations were still ongoing, so the temporary ‘Out Patient’ department was housed in a ward, but the staff were better organised.
Patients were divided into three groups: fractures and serious injuries, injuries not involving bone but including infections and rehabilitation.
An appointment system was introduced for each group which reduced patient waiting time and was welcomed by them.
The board notes that the ongoing shortage of staff sometimes led to a breakdown of the appointments system.

1944:

New department opened in August.

1947:

The department was designed for 25000 new cases per annum but was treating 34000 with demand expected to rise further.
The Board felt obliged to put together an extension plan but recognised that permission was unlikely to be granted ‘during the present national situation’.

Finance

1941:

The accounts were presented in three parts.
- Ordinary Income and Expenditure plus separate accounts for the first six months showing the cost of setting up the hospital.
- Total income was £26791 10s 5p. Those contributing the most were Industry (£10009), City of Birmingham (£5000), Birmingham Hospitals Contributory Association (£3320) and Ministry of Health (£7249).
- Of the day to day outgoings all were ‘small’ except for coal, gas, and electricity (£1566) and nursing (£2091). Medical staff cost £950 10s 4p.

1942:

The year ended with a deficit of only £586.
But there was still a need to raise capital for building projects and funds were raised by a Capital Appeal and a broadcast appeal by the Mayor of Birmingham.
The annual report for the invited readers to pay the £1500 fee to endow a bed.
Coal gas and electricity costs rose to £6303, nurses cost £8437 and medical staff £5277.
Another ‘interesting’ cost is shown in the Surgery and Dispensary accounts where £11 was spent on wines and spirits!
Another notable entry in the extraordinary expenditure account was for £294 for Photographic Room Expenditure.

1943:

no beds having been endowed in 1942 the cost was reduced to £1250!
This led to the endowment of a bed by the Birmingham Small Arms Company.
At the dedication service, Charles Kingsley’s hymn ‘From thee all skill and science flow’ was sung. The hymn was composed for and sung at the opening of the Queens Out Patient department in 1873.
There was an excess of expenditure over income of £4092.
Most costs were similar to 1942 but due to their pay rise, nurses cost £10392.

1944:

Due to funds received from the Ministry of Health for the treatment of battle casualties, there was £653 excess of income over expenditure.
A bed was endowed by Mrs FM Farmer in memory of her father, William Parsons and the General Electric Company gave £850 intending to raise the remaining money in a few months.
Nursing Costs increased to £12882.
Fuel costs had risen to £7961.

1945:

Expenditure exceeded income by £11811 mostly because many salaries were nationally decided.
In total 58% of money was spent on salaries and wages.
In its report the Board wrote that they hoped ‘that the springs of private charity may not dry up before the tides of public benevolence begin to flow’ – reference to the new NHS, then called the Government Health Scheme, that was being proposed.
The General Electric Company bed was dedicated.

1947:

Expenditure exceeded income by £66845.
Between 1946 and 1947 salaries for medical staff increased from £8200 to £17193 and for nursing staff from £19361 to £31836.
Energy costs were £10651.
There was still a note that wines and spirits cost £13.

Statistics and Medical Records Department

1941:

A new records system was being installed. Noted that in December in-patients averaged 110 and out-patients 350 per week.
In the nine month period, 1371 ordinary inpatients admitted + 95 air raid casualties and their average length of stay was 12.9 days, 63066 out-patient attendances of which 11312 were new patients, 21898 physiotherapy attendances of which 1324 were new patients.

1942:

There were ‘extensive’ additions to the records department.
19837 new patients suffering from injuries, 91398 casualty attendances including follow up of whom 17663 were new patients, 2174 in patients admitted and 8123 operations performed including many minor operations. Average length of stay for inpatients was 19.8 days. Demand exceeded the number of medical staff available. But no more staff were allowed by the government appointed Central Medical War Committee who said that their priority was to appoint medical staff to look after the fighting services.

1943:

Short- hand typists were appointed to ease the burden on medical staff in record keeping.
20796 new patients in total, 2027 in patients, 2541 short stay patients, 99600 outpatient attendances including 16156 new patients.
Average length of stay for in patients was 19.6 days.

1944:

2109 in patients (including 213 soldiers), 2001 short stay patients, 179,981 out-patient attendances of whom 22273 were new patients.

1945:

2504 in patients with an average length of stay of 20.3 days. 1286 short stay patients. 113975 out patients of whom 22182 were new patients.

1946:

28313 new patients of whom 3130 were in patients with an average length of stay of 14.47 days. 121571 total outpatient attendances of whom 23666 were new. 1517 were treated in the short stay ward.

1947:

34258 new patients treated of whom 4065 were in patients with an average length of stay of 11.28 days. This reduction was attributed to improved staffing levels.
Total number of out-patient attendances was 129,965 of whom 32852 were new patients.
2695 patients were treated on the Short Stay Ward.

Medical Staff

1941:

Until permanent staff were appointed, Mr Hugh Carson was acting Clinical Director and was supported by Temporary Assistant Surgeons FG Allan, H Donovan, and TS Donovan.
There is no mention of a senior anaesthetist, but Miss MJ Rowley is listed amongst the permanent staff as an anaesthetist.
Surgeon in Chief and Clinical Director, William Gissane started on 1st September, FG Badger started as deputy Clinical Director on 24^th November, TW Howatt was first Assistant Surgeon from 1^st December and LJ Wolfson started as Senior Anaesthetist on 17^th November.
It was expected that brain and abdominal injuries would be treated by surgeons from the United Birmingham Hospitals.
Junior staff consisted of 1 resident surgical officer, 1 resident surgical registrar and 4 house surgeons.

1942:

A few changes occurred. Mrs WG Mills became the junior anaesthetist replacing Miss Rowley and the surgical registrar post was lost or unfilled.
Prof JFD Shrewsbury was appointed a consultant bacteriologist, JF Brailsford as consultant radiologist and J Rhaiadr Jones as rehabilitation consultant.

1943:

Colonel Leonard Colebrook was appointed to the MRC Burns Unit with J Mckessar Duncan as resident surgical officer and one house surgeon.

1944:

JT Linklater was appointed as the third anaesthetist. Two wards were converted for the use of burns patients.

1945:

In their annual report, the Board wrote at length about the difficulties caused by junior staff being called up at short notice.
In 1945, senior doctor’s Dr Wolfson and Mr Howat were called up and replaced by Dr FJR Stoneham and Mr SH Harrison, respectively.
The Board mourned the loss of the integrated team that Gissane had developed.

1946:

Dr Stoneham is the only anaesthetist listed.
JR Squire was appointed the director of the new MRC Industrial Injuries Unit supported by Betty Topley as Research Assistant.
The Board reported the dire shortage of medical staff despite increasing numbers of patients being treated and towards the end of the year were given permission to recruit more staff.

1947:

The complement of staff expanded dramatically with several well-known individuals appearing.
Surgeon in Chief and Clinical Director: William Gissane
Surgeon and Clinical Director: FG Badger
Surgeons: A Ruscoe-Clarke, E Mervyn Evans, SH Harrison
Assistant Surgeons: P Essex-Lopresti, JS Horn, CC Jeffrey, AC Kanaar
3 resident surgical registrars, 6 house surgeons
Senior anaesthetist: LJ Wolfson
Anaesthetists: DL Carter, JR Rook
1 resident anaesthetist

These appointments allowed the creation of three trauma teams responsible for their patients from admission to discharge after rehabilitation.
Pathologist: Simon Sevitt
Consultant bacteriologist: JFD Shrewsbury
Consultant radiologist: JE Brailsford
Consultant in rehabilitation: J Rhaiadr Jones
Consultant in statistics: Lancelot Hogben
MRC Industrial Medicine Research Unit: Director JR Squire
Research workers: Elizabeth Topley, JP Bull, CND Cruikshank, CR Ricketts, JE Lennard-Jones
MRC Burns Unit: Director: Leonard Colebrook
Senior Resident Surgical Officer: WP Dallas-Ross
1 junior resident surgical officer and 1 house surgeon

Nursing Staff

1941:

The Queens Hospital Matron, Miss E Bullivant agreed to stay on with a small nucleus of sisters.
All the other nurses moved to the new QEH. So, the nursing staff were either trained nurses interested in specialist nursing or auxiliary members of the Civil Nursing Reserve. Nurses in training were also used.

1942:

Situation although still difficult improved by the employment of student nurses after two months basic training.
Members of the Friends Ambulance Unit acted as auxiliaries and helped with civil defence duties during air raids.
Many auxiliary members of the Civil Nursing Reserve also increased the complement of nurses.

1943:

Miss Bullivant was replaced by Miss Bonthron as Matron.
Of 16 candidates entered, 12 passed their Preliminary State Examination.
Residential accommodation for nurses was in short supply so St Thomas’ Church House in Bath Row was leased by the Board ‘for a period of years’.
The Board also adopted the Rushcliffe Report’s recommendations on nursing pay.

1944:

13 of 17 passed PS exam at the first attempt and 2 of 3 were successful at the second attempt.
A prize was introduced for the best student nurse of the year and was awarded to Nurse Violet Colgan.

1944 – 1946:

similar numbers took the exam and the pass rate remained similar.
At the end of 1946, Miss FM Harris was appointed as Matron but resigned after a year.

1947:

Although not mentioned in the annual report, it appears that the Board acquired a leasehold property at 44 Carpenter Road which was presumably to provide nursing accommodation – certainly, that was its function in the 1980s.

1945:

Towards the end of the year, the hospital was finally allowed to recruit newly qualified SRNs.
BAH was only allowed to take students for the first 2 years of their training and they had to complete it elsewhere.
Two of these nurses qualified in 1945.
The dire shortages of nursing staff led to the closure of two wards.

1946:

Nursing numbers were even worse mostly because many got married and moved away to be with their new husbands and Ministry of Labour restrictions were removed.

1947:

The number of nursing staff rose to a heartening 136 including male orderlies appointed for the first time. Miss PM Smith was appointed as Matron. Badges were struck for nurses qualifying in 1947 and also for nurses who qualified before this time.

Industrial Nursing

1941:

The Board in collaboration with the Royal College of Nursing, prepared a training course and it was expected that Birmingham University would recognise it and grant a certificate in Industrial Nursing.
A six month experimental course was run and appreciated by the students.

1942:

12 month course approved and run with certificate awarded by Birmingham University – the first of its kind in the UK.

1943:

31 candidates were examined and 23 passed. These nurses were an important part of the nursing workforce.

1944:

Courses continued but were less well subscribed due to Ministry of Labour war time restrictions on where nurses might work.

1945 and 1946:

Courses continued.

1947:

Courses were popular and the pass rate improved to 25 out of 26.

Industrial Medical Officers

1941:

Gissane encouraged large factories to have a Medical Officer, facilitated their training and encouraged close links with BAH by appointing an Industrial Liaison Officer.
He also allowed the Industrial Medical Officer’s Association to meet at BAH.

Mobile Surgical Unit

1941:

The Austin Motor Company promised the MSU as a gift.

1942:

Reported to be near completion.

1943:

When commenting on the demanding staffing requirements for the Short Stay ward and staffing difficulties in general due to war restrictions, the MSU although built and fully equipped could not be used due to the general lack of medical and nursing staff caused by war conditions.

1947:

The MSU was finally presented and used for the first time. (see MSU chapter).
Garaging and maintenance were paid for by the Birmingham Hospitals Contributory Association.
It was driven by two men appointed for the purpose who worked 8 hour shifts

Plans for Development outlined by William Gissane

1941:

Primarily serve the accidents of industry and we will develop close links with Industrial Medical Officers working in factories. The Board will appoint an Industrial Liaison Officer to facilitate this.
Collect records of value affecting treatment, rehabilitation and accident prevention which will be shared with Industrial Medical Officers.
The Hospital will be developed as a training school for industrial nurses and ambulance staff.
Admit and treat patients with non-industrial accidents because they too might be wage earners and their treatment and rehabilitation are important to industry.
Will be a teaching hospital for undergraduate and postgraduate students working closely with Birmingham University and United Birmingham Hospitals.
Rehabilitation is an integral part of treatment and the title Birmingham Accident Hospital and Rehabilitation Centre signifies our intention to carry on the treatment of our patients until such time as they are fit to return to work.
Gissane promised that Rehabilitation would consist of repeated physical exercise but noted that these could be boring so targeted Occupational Therapy would provide mental stimulus and Recreational Therapy would be considered. (I am uncertain whether the dates fit, but suspect that Gissane had heard about the work of a refugee Jewish doctor at Stoke Mandeville whose name escapes me but who achieved remarkable results with paraplegic patients who played team games and participated in the first ever para Olympic games).
These were to be combined with traditional physio and electrotherapy.
Gissane predicted that the Accident Hospital model proposed would be adopted by other similar hospitals throughout the UK. It was the Americans who followed our lead (however, in the US and elsewhere, none of their Trauma Centres seemed to have considered rehabilitation as a major part of their role)

Fund raising

1941:

A public fundraising campaign was considered but rejected because the medical staff were concerned it would attract too many patients who they could not cope with.

1942:

Capital Appeal was launched, and a broadcast appeal was made by the Mayor of Birmingham.

1943:

Contributions from industry had increased but more needed to be raised from private donors.
From each factory, a donation of 2 shillings per worker per annum was suggested.

1944:

The Capital Appeal reached its preliminary target of £20000 and a second target to raise another £30000 was launched.

1947:

The Lord Mayor of Birmingham broadcast an appeal on behalf of all hospitals and BAH received £533.

Medical Research Council Wound Infection Unit

1942:

A unit led by Professor Ashley Miles was established to investigate the causes of infection in industrial wounds.
His staff included resident pathologist, REO Williams and research assistant Miss RB Clayton-Cooper. Another temporary MRC appointee was Dr Ethel Florey who investigated the use of penicillin for curing infections.
Within one year of its foundation the Birmingham Accident Hospital attracted the interest of the Medical Research Council under the direction of Sir Ashley Miles.

1943:

Dr Florey completed her work on penicillin to prevent infection in industrial wounds reporting that 1000 manpower days were saved by giving penicillin to 35 patients.
Unfortunately, there was insufficient penicillin for ongoing use during the war.

1945:

New laboratories for research and routine hospital work were needed and work began on them utilising two wards and one of the three operating theatres.

1946:

The unit investigating wound infection expanded its remit to include dermatitis and other industry induced skin diseases and was renamed the MRC Industrial Research Unit.

1947:

The new laboratories and a medical library were opened early in 1947.
10 beds were made available for research purposes.
Research confirmed that industrial skin disease was significant and between 2 and 5 workers per 1000 had time off work with skin problems.

Rehabilitation services

1942:

2064 new patients passed through the rehabilitation causing 31,011 new attendances.
The high roof of the Queens out-patient department was sufficient to create another floor where it was planned to build a large gymnasium and additional rehabilitation, occupational and physiotherapy services.

1943:

The gymnasium of the new rehabilitation department and allied services had been completed.
Annual attendances were 46326 including 2929 new patients.
The Board allude to the fact that each patient’s rehabilitation needs are individual and are delivered by a variety of staff under the supervision of their surgeon.
At the suggestion of Gissane, the Austin Motor Company set up a workshop under the supervision of a works engineer.
Medical supervision was provided by the Works Medical Officer and Gissane.
All the men working in it were disabled temporarily or permanently and a soon as possible during their rehabilitation their recovery continued using production machines.
During their time spent in this workshop, they were paid.
In its first 10 months of use, the workshop returned 150 men back to their original job or else to a job they had been retrained for.

1945:

88089 attendances of whom 5380 were new.
Building alterations were completed making new homes for physiotherapy and occupational therapy.

1946:

Early in the year, these departments moved to their new homes adjacent to the gymnasium.
94682 total attendances of whom 4757 were new.
The rehab workshop started at the Austin Motor Company in 1943, had returned over 800 employees to full time employment by the end of 1946.

1947:

Department reorganised so physiotherapy, occupational therapy and remedial gymnastics were more closely co-ordinated, and patients could be given a choice of appointment times.
The Ministry of Health invited the department to assess a new electrotherapy unit for the treatment of peripheral nerve lesions.
Physiotherapy and occupational therapy students from three hospitals were accepted for clinical training as well as physical education students from Bedford Physical Training College who attended for short periods to learn remedial exercises.
The rehabilitation department had 100606 attendances of who 5514 were new patients.

Head Injuries Rehabilitation Centre

Increasing skill and knowledge facilitated the acceptance that about 10 head injured patients each year survived with severe problems including inability to work, changed personality, frustration at the inability to communicate and physical as well as mental impairment.
These patients were described as problem people and BAH staff thought it unfair to send them home to be a burden on their families.
Occupational and Industrial therapy was of limited benefit.
What was needed was a community which included a place of steady work and a chance to develop friendships with similarly afflicted patients.
In 1967, with the generous help of the Nuffield Provincial Hospitals Trust, a former eye hospital was converted into a workshop.
About 30 men attended each day and did industrial work which was constructive and interesting.
The patient was encouraged to develop their personality and abilities.
Primarily the workshop was intended to provide these men with somewhere they could do useful work under expert supervision.
It was not expected that they would ever be able to earn their own living independently.
The paper this information comes form is unsigned and undated. It notes that ‘…. Already, the workshop has produced good results with 61 patients to date being returned to industry to earn their living independent of support.” Reader are not told how many years it took to achieve this number nor how many attended the workshop in total over the same period.

Short stay ward

1943:

The number of inpatients reduced by around 200.
The Board explained this by citing the use of a ward for outpatients during structural alterations and an extension of short stay facilities.
This is the first mention of a short stay ward in the Board reports but now they say it exists (implying it was created before 1943) for patients who need a bed for less than 24 hours to recover after anaesthesia and a minor operation.
2541 patients were nursed in this ward in 1943.
The Board noted that ‘one of the peculiarities of an accident hospital [is] that the short stay ward is the busiest and most expensive – in staff requirements and actual cost of any in the hospital’.

1944:

New Short Stay Ward opened containing 16 male and 10 female beds. 2001 patients were admitted.

Social Service Department

1943:

Established in June 1943.
From the board report, “As will be realised from the forgoing…this hospital does not treat accidents but the people suffering from accidents. When the family wage earner breaks a limb, the problem goes far beyond the setting of a broken bone and the strengthening of the muscles for the accident has also caused a dislocation of the social, domestic and employment background of this citizen. The Social Service Department is that part of the Hospital treatment team which deals this with this side of the accident problem.”
1552 in patients were helped and the service was extended to outpatients with the unfulfilled plea for another member of staff.

1947:

The number of patients requiring assistance remained relatively stable over the years but in 1947 12 student almoners attended for training.

War time difficulties and afterwards

1943:

The Board made special mention of staff shortages in all departments including clerical, maintenance, and catering.
‘The Board desires to express sympathy with senior officials who have to meet day-to-day problems without any stability of staff and indeed hardly daring to plan a day ahead.’

1944:

The Department of Physiology of Birmingham University was invited to study the quality of the diet fed to patients and nurses. It was described as very satisfactory considering the prevailing conditions.

1947:

Medical Society records for 3^rd March 1947 record two comments from Mr Badger.
The infection rates might reduce if a changing room was provided “so that surgeons do not walk into theatre in ordinary clothes and outdoor shoes.”
“a reliable supply of cold water permitting scrubbing up without scalding of the hands in the process would do much to maintain the even temper of surgeons.”

Burns Unit

1943:

A new MRC Burns Unit was established led by Colonel Leonard Colebrook supported by K Mckessar Duncan as resident surgical officer and one house surgeon.

1944:

New Burns Unit opened consisting of four wards of 8 beds each, a Shock Room, Medical Investigation room, Treatment room with plenum ventilation to provide bacteriologically ‘clean’ air for wound dressings and a saline bath annexe.

1945:

The trustees of the Bernhard Baron Charities fund gave the sum of £5000 for the development and maintenance of the Unit which was renamed the Bernhard Baron Unit for the Treatment of Burns.
The Unit admitted 205 patients of whom 78 were children under 5.
The 1945 report contains detailed warnings about the risk of children’s nightgowns catching fire. They made recommendations that fireguards should be better designed, and that children’s clothes should not be made of flammable materials.

1946:

207 patients treated including 63 children under 5.
Unlike the previous year when clothes catching fire was the commonest cause of injury, in 1946, scalds equalled the number of clothes fires.
The female and children’s wards were made into cubicles thus using space more effectively and creating a second shock room.
Due to the success of the ventilation system in preventing cross infection during change of dressings, a second ventilation system was installed in the Saline Bath Room.
Unspecified anaesthetic advances allowed more patients to be anaesthetised when their dressings were changed.

1947:

321 patients were admitted. This was made possible by the conversion to cubicles and also by excision and grafting of deep burns on the day of admission which speeded up recovery times.
The Board continued to express concern about the poor design of electric and gas fires with inadequate guards.

A stall illustrating the work of the Burns unit was displayed at the Home Safety exhibition organised under the auspices of the Birmingham Accident Council.

1948:

Colebrook retired and handed over to Dr Williams who subsequently handed over to Dr J R Squire.

1952:

Dr John P Bull became director.

Photography Department

1942:

equipment purchased.

1944:

Two experienced photographers appointed.
Their main job was to reduce x-ray films to ¼ plate photographs to circumvent the increasing storage problems being experienced until then.

1946:

All historical x-rays had been photographed so the photographers took images recording recovery from various injuries and also began a project to photograph certain bacteriological specimens as slides making then easier to interpret.
They also started documenting skin lesions for the MRC industrial injuries research unit.

1947:

Between 1945 and 1947, the number of negatives made increased from 1119 to 4958 and the number of prints from 4506 to 10652. 2500 feet of cine film were exposed in 1947.

Other staff

1947:

The names of a pharmacist, rehabilitation officer and medical records officer appear for the first time in the Board report. It is notable that from 1941 onwards, the hospital always had two chaplains.

Maintenance Department

During the war years, maintenance was kept to a minimum due to a shortage of skilled staff.
By 1947 they had been given more working space with carpenter’s and engineers workshops. New machinery and equipment were installed in the kitchen and laundry.
New mains and switch gear were installed in preparation for the rewiring of East Block.
Modifications in the boiler house were made to ensure the boiler plant and steam system would be as economical as possible.

Road Injuries Research Group

Founded by Gissane and john Bull in 1960 at the suggestion of Dr Donald Stewart, chief medical officer of the Austin Motor Company and member of the governing body of the AA.
BAH provided a room and the AA paid for a secretary for the first 10 years after which the MRC took over.
The secretary was Miss Barbara Roberts, and she did all the donkey work from 1960 – 1985. First of all, she collated the details of all the fatal road accidents around Birmingham in 1960.
Her information led to recommendations for design improvements to cars and lorries. The group also recommended combining the diagonal seat belt (favoured by the Swedes but risking strangulation if there was a side impact accident) and lap belt (favoured by the Americans) to produce the seat belts still in use today. They also looked at fatalities on the new M1 motorway. This work led to the introduction of collapsible, telescopic steering columns.