Transcript of an interview between Mr Roger Farrell and Professor Gissane, undertaken around
1960, following the publication of a book by Gissane on Trauma Services.
Mr Roger Farrell – Medical Research Officer and editor of the “Acci Magazine”

Mr. F. Why did you come to this country and when?

Prof. G. I came to this country as a ship’s surgeon on the S.S. Ataki shortly after my graduation from Sydney University, in 1925.

Mr. F. I believe you came to do a postgraduate course here

Mr. F. Had you already developed a particular interest in trauma?

Prof. G. No, but in those days the injured in all hospital, including England, were treated by the residents, the house surgeons, in rather indifferent casualty departments, and I became the resident of many hospitals in succession and always I was responsible for a large volume of the care of the injured.

Mr. F. Now, in this book here you say that the number of people in and around Birmingham, particularly those involved in industry became very interested in setting up a better method of treating the injured, particularly form industrial injuries, and I wonder how you became involved in this movement and became the director of this hospital.

Prof. G. The injured had been so badly treated by hospitals of Great Britain that in 1939 the government appointed a committee of enquiry to visit all the hospitals in England and report on the standard of treatment and what was necessary to improve those standards. That committee published that report in 1939. I was interested in that committee’s report and, indeed, gave some evidence at its inquires through my membership of the Accident Services ? ? where I occupied some minor posts of importance.

Mr. F. Were you then already a consultant surgeon?

Prof. G. By that time I was a consultant surgeon to the London County Council Hospitals
for the care of the injured, particularly in St. James’s Hospital, Belham and Lewisham Hospital.

Mr. F. Were you invited to take the post of clinical director here?

Prof. G. I was approached and asked to apply for that appointment, yes, but it was an
open appointment and there were other candidates and I was appointed in open competition

Mr. F. In the actual setting up of the Accident Hospital, who in particular in the industrial world campaigned for such a specialist hospital? To become the Accident Hospital and how did they come together to form themselves into this body?

Prof. G. The body was formed, I think, through the interest of Dr. Donald Stewart, who was an industrial medical officer, and the Association of Industrial Medical Officers. They and the University of Birmingham were actively interested in improving the facilities for the treatment of the injured and out of that interest of industrial medicine, industry and the University of Birmingham a board of governors was formed to direct and supervise the foundation of the hospital and particularly to find the money not only for its foundation but for its maintenance.

Mr. F. There is a list of people in their Annual Report who represent various bodies I notice and I notice Mr. Keats’ name there who was chairman of the Accounts committee and also linked with the League of Friends for many years after the National Health came into being.

Prof. G. Mr. who?

Mr. F. Mr. Keats, a director of Pressed Steel as it was in those days, it has become part of the British Leyland now. On the front of the report is who they represented on the board of management and I notice Mr. Keats’ name amongst those.

Prof. G. Yes, Mr. Keats was a representative of industry. Also, you will note there are a large number of representatives of the Birmingham City Council in the board of governors, which, incidentally, are one of the main employers in the city and they were there as representatives of the work people.

Mr. F. This report is the report of the year when you were able to expand the staff of the hospital, having worked with a small skeleton of staff during the war years and you were able to appoint additional staff to get the hospital staffed to the level you wanted.

Prof. G. Yes, that happened in 1947. By the time we were treating something like 40,000 people a year.

Mr. F. Yes, those figures are in there, I notice those figures with great interest, of course, because I produce the figures for the hospital now. It has been very interesting to see the comparative figures for 1947 and 1979. When you were increasing your staff did you look for any particular experience and did people who had been involved in treating war wounded have any special place in that?

Prof. G. The staff were exclusively old army surgeons who had had experience in treating war wounds. What was demanded of them was a good general surgical knowledge because the injuries can involve any part of the body. They were expected to have two specialist knowledge, orthopaedic surgery dealing with the limbs and plastic surgery dealing with injuries of the skin and, above all else they had to be young and enthusiastic because the treatment of injuries at any time of the day or night is an arduous task.

Mr. F. Now in your booklet the Stages of development of the organisation of the hospital and in your report there you comment on the time lapse between the injury and the person receiving treatment, and in 1947 you recorded that you had got your mobile unit which could do to the site of an accident and treat the person on the spot, that unit, I believe ceased functioning in 1958. Was that a result of an improvement in the ambulance service, because you seemed to think, from what you said earlier, that the ambulance service did not provide the sort of service that you thought was necessary.

Prof. G. I think that is wrong. The ambulance service of this country has always been good. There have been no delays in picking up the injured. What has been wrong in this country is hospital service, this is where the delay is in commencing treatment of the injured has occurred. The mobile accident unit was a gift from the Austin Motor Co. and it looked attracted in that it had the facilities for treating injuries if the staff at the hospital could arrange to go with the ambulance. The unit failed mainly because it was not called and when it was called the ambulance service very frequently got to the patient before the mobile
unit. So I at least came to realize the main problem in presenting delays had to be organized from within the hospital itself, where you could arrange to have around you all the facilities necessary for treatment. What was completely essential was that you should have in the hospital surgeons capable of taking the
full responsibility for the immediate care and diagnosis of any type of injury to any part of the body and this is a difficult challenge to meet but the experience of the Accident Hospital shows that if you put that responsibility on the young and enthusiastic surgeons of these day it can be met. This, I think; is the main lesson of the Birmingham Accident Hospital; the avoidance of delays in commencing treatment.

Mr. F. And yet this never seems to have been recognised because trauma itself has never been recognised as a speciality as far as medicine is concerned. When it comes to hospital practice.

Prof. G. No, and I think that outlook is wrong and unless it is accepted that the type of surgeons that we have in this hospital are essential to the avoidance of delays to the treatment of injured people then I believe that the standard of the treatment of the injured will revert to the pre-1939 standards when it was so heavily criticised by the ? departmental committee.

Mr. F. Why do you think similar units to the hospital have never been set up? Around the country, which is one of the things you did recommend and you say it in here that in areas of high population and urban conurbations there should be specialised units for treatment of the injured set up to deal with the problem as it is dealt with here, and yet this has never been done The only specialised units that have been set up are regional burns units.

Prof. G. Regional burns units have been set up because no hospital really welcomes a burn and the responsibility a burn gives. Accidents on the other hand, every surgeon – orthopaedic, plastic, considers himself capable of dealing with the injured. Those specialities have been against the development of the specialised traumatic accident surgeon and as a result the example of the Birmingham Accident Hospital has not been followed. The Birmingham Accident Hospital, incidentally, was established by a number o gratuitous circumstances, one of which was that a hospital was available and at that same time you had an increase in the number of injured people – the unskilled being employed in industry and you had the bombing injuries and you had the feeling of the people to do the best they could for all types of injuries. In other words the atmosphere for the foundation of the Birmingham Accident Hospital was right. But now you have got to argue very very subtly indeed and probably unsuccessfully to get another hospital allocated purely for the car of the injured.

Mr. F. Are there any comments you would like to add that you feel should be recorded in the written history of the hospital, and the whole concept of the hospital of this sort?

Prof. G. Unless it is accepted that the surgery of injuries is a speciality in its own right then the essential unity of control over the injured patient from the time of entry to the time of recovery will never be established, and as I see it the hospital organization for the care of the injured will revert to the pre-1939 level. It is considered probable that the Birmingham Accident Hospital will be transferred to another general hospital, that, I believe is the plan for the future, but what is not clear is whether it will be transferred as an interracial unit as the Birmingham Accident Hospital but rather its staff will be transferred and the team spirit of the various departments of this hospital which is essential will be
lost and this, I think, would be a sad thing.

Mr. F. Those who are involved in the planning of the new hospital and putting together information for the new hospital which is being planned for the Selly Oak site are conscious of these remarks and are doing everything within their power to get the authorities concerned to appreciate that this is a hospital, which, if it is to succeed, must kept as an identifiable entity and we are doing our best to try and ensure that this does happen.

Prof. G. This is good news, because it was accepted that we would transfer as the Birmingham Accident Hospital to the Queen Elizabeth site undisturbed, that is essential for our future development.