The Heart of the Matter E-Book

Peter Pugh

• Herausgeber: Icon Books
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 341

Veröffentlichungsjahr: 2015

Beschreibung

Papworth Hospital in Cambridgeshire, founded in 1916 to tackle the great killer disease of tuberculosis, is famous for carrying out the UK's first heart transplant operation in 1979. It followed this up not only with many other heart transplants but also with the UK's first heart and lung operation in 1984 and the world's first heart, lung and liver transplant in 1986. With unique access to Papworth's archives, historian Peter Pugh here tells the story of this ground-breaking hospital for the first time. Alongside the background to that first UK heart transplant – and the ethical controversies that surrounded it – Pugh explores the opposition to heart operations in general, Papworth's difficulties dealing with NHS authorities especially over funding, and the discussions for over 50 years as to whether the hospital should move alongside Addenbrooke's hospital in Cambridge. As an insight into the history of medicine and surgery in the UK, as well as a story literally of life and death, The Heart of the Matter will be compelling reading.

Leseprobe

THE HEART OF THE MATTER

How PAPWORTH HOSPITAL transformed modern heart and lung care

PETER PUGH

Published in the UK in 2015 by

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ISBN: 978-184831-942-4

Text copyright © 2015 Peter Pugh

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ABOUT THE AUTHOR

Peter Pugh was educated at Oundle and Cambridge, where he read History. He has written more than 50 official histories, including The Magic of a Name, a three-volume history of Rolls-Royce. He lives in Cambridge and Norfolk.

CONTENTS

Foreword

Introduction

Author’s acknowledgements

Monetary values

Chapter 1 Tuberculosis

Chapter 2 The Post-War World

Chapter 3 Heart Transplants

Chapter 4 Controversies

Chapter 5 Heart–Lung Transplants

Chapter 6 Mechanical Hearts

Chapter 7 Papworth’s Range of Treatments

Chapter 8 Pulmonary Hypertension

Chapter 9 Putting Patients First

Chapter 10 The Move to Cambridge

Bibliography

Index

FOREWORD

by HRH The Duchess of Gloucester

We are fortunate to live in a country where a tradition has been built over many decades, if not centuries, of encouraging our finest brains to research into all matters medical. Consequently, Great Britain features prominently in many fields and the best researchers choose to come from all over the world to join our leading teams. Luckily, the general public enjoy contributing generously to projects where they can foresee the consequence of their support; nevertheless, it is essential that government funds also back these schemes.

Papworth Hospital has been an important element in this proud story. The 100 years that we are celebrating in this book demonstrate the battle against tuberculosis – a battle largely won, and the attention subsequently turned to organ transplants, pioneered at Papworth and now practised all over the world.

I hope that when the hospital moves to the Cambridge Biomedical Campus in the near future, it will not lose its many friends and supporters, who can be proud of the fact that a small place like Papworth should have such a big reputation internationally. I have no doubt that the high standards forever expected of its dedicated team of consultants, physicians, surgeons, nursing staff and support services and many more, will continue to provide life-changing, and in some cases lifelong, care for people who would otherwise struggle with their day-to-day lives, due to debilitating cardiothoracic conditions, and that the world will continue to notice Papworth Hospital’s contribution to medical science for a long time to come.

Her Royal Highness the Duchess of Gloucester, Patron of Papworth Hospital NHS Foundation Trust, August 2015

INTRODUCTION

Papworth Hospital is a unique place.

This book documents how it has grown and adapted since its beginnings as an innovative TB sanatorium long before the majority of treatments we now take for granted were thought of.

It is now the largest heart and lung hospital in the UK and this evolution has taken place over the last 100 years on the same site.

But Papworth is not just a place, it’s all about people, the patients whom the hospital treats and the staff who care deeply how that treatment is delivered. There is an intangible atmosphere of trust and sense of security which patients perceive, as well as a loyalty among all members of staff that is engendered. This combines to give Papworth a culture and ethos that sets it apart.

As we approach the 100-year anniversary and the move to our new hospital happens in the same year, it is that culture which we have to transfer as well as the technical, medical and surgical expertise. This will ensure Papworth continues to give the best of care to all our patients.

With the development of a world-class research and education institute alongside the hospital we will maintain the world renown and reputation which Papworth has deservedly earned.

Professor John Wallwork CBE August 2015

AUTHOR’S ACKNOWLEDGEMENTS

The history of Papworth Hospital, The Heart of the Matter, was a particularly challenging, but fascinating, story to research and write and many people were helpful in allowing me to interview them and then, in some cases, checking that what I had written was accurate.

I would like to thank especially Stephen Bridge, the Chief Executive, and Professor John Wallwork, a long-serving consultant surgeon at Papworth Hospital and currently Chairman of the Board of Directors. They gave me the list of interviewees and read and corrected my draft manuscripts.

These were the interviewees, all of whom were most helpful:

Sir Terence English, John Dunning, Simon Fynn, Peter Schofield, Charles Haworth, John Shneerson, Bill Newsom, Julia Fleming, Stephen Large, Samer Nashef, Francis Wells, Ian Hardy, Alain Vuylsteke, Chris Flower, Keith McNeil, Susan Stewart, David Stone, Bob Verney, Michael Petch, Mrs Ellen Kemp, Celia Hyde, Natalie Doughty, Donna Ward and Hazel Farren.

Sir Terence English also provided a great deal of important archive material. (As it happens, Sir Terence and I were on a parent/teachers’ committee at St John’s College Prep School at the time he carried out the first UK heart transplant.)

On the administrative side, many were very helpful, especially Barbara Gamble, Rebecca Proctor, Roger Hall, Daniel Saxton, Colin Lattimore, Hazel Crawford, Craig Mackenzie and Rachel Allen.

As always, when my books are published by Icon Books Ltd, the Editorial Director, Duncan Heath, masterminded the copy-editing, proof-reading and indexing. The cover design and organisation of the photographs were handled by Oliver Pugh of Simmons Pugh.

Peter Pugh, August 2015

MONETARY VALUES

Money and its value is always a problem when writing about a period that stretches over a number of years, particularly when parts of that period have included some years of very high inflation. Furthermore, establishing a yardstick for measuring the change in the value of money is not easy either. Do we take the external value of the £ or what it will buy in the average (whatever that may be) weekly shopping basket? Do we relate it to the average manual wage? As we know, while prices in general might rise, and have done so in Britain every year since the Second World War, the prices of certain products might fall. However, we are writing about a hospital, which, in some ways, is like a business, and money and its value crop up regularly. We therefore have to make some judgements. We can only generalise, and I think the best yardstick is probably the average working wage.

Taking this as the yardstick, here is a measure of the £ sterling relative to the £ in 2015.

Apart from wartime, prices were stable for 250 years, but prices began to rise in the run-up to the First World War.

1665–1900 multiply by 120

1900–1914 multiply by 110

1918–1939 multiply by 60

1945–1950 multiply by 35

1950–1960 multiply by 30

1960–1970 multiply by 25

1970–1974 multiply by 20

1975–1977 multiply by 15

1978–1980 multiply by 8

1980–1987 multiply by 5

1987–1991 multiply by 2.5

1991–1997 multiply by 2

1997–2010 multiply by 1.5

Since 2010, the rate of inflation, by the standards of most of the 20th century, has been very low, averaging, until very recently, less than the government’s originally stated aim of 2.5 per cent (since reduced to 2 per cent). Some things such as telephone charges and many items made in the Far East, notably China, are going down in price while others, such as houses, moved up very sharply from 1997 to 2008 before falling back in the financial crisis. In 2011 on the back of sharply rising commodity and food prices, inflation accelerated again to reach 5 per cent per annum. However, as commodity prices fell back and much of the world suffered very low growth, the rate of inflation began to subside again in 2012 and 2013. Indeed, by 2015 many of the industrialised nations were starting to worry about deflation, which can be equally damaging as runaway inflation as consumers delay purchases and businesses delay investment.

Chapter 1

TUBERCULOSIS

The killer

Varrier-Jones

Papworth Colony

Achievements of a great man

The killer

Papworth Hospital was founded in 1918 by the social pioneer, Dr (later Sir) Pendrill Varrier-Jones, who named it the Cambridgeshire Tuberculosis Colony. The colony began in the village of Bourn near Cambridge in 1917 but, in 1918, when he had raised enough funding (£6,000 or about £360,000 in today’s money) to buy Papworth Hall, Varrier-Jones moved the colony to the village of Papworth Everard. The purchase of the Hall included most of the land in the village and the colony rapidly expanded.

Varrier-Jones’s aim was to rehabilitate tuberculosis, or TB, sufferers by providing treatment for them, consisting of surgery and fresh air, and also by offering employment and housing.

In his book, On the Road: The Papworth Story, published in 1977, Rowland Parker explained the history of TB very well. This is what he wrote, with some modifications and additions:

The presence of a tubercle bacillus had been suspected before 1882, and something of his nature known as early as 1865, when it was proved that Mike [Parker called TB ‘Mike’] could be transmitted from one person to another, though that also had been suspected. It was Dr Robert Koch, a German scientist, who discovered and identified him. Hats off to Dr Koch, and all due credit to the craftsmen and technicians who made his microscope, without which Mike would not have been seen to be discovered, for he is a very little fellow. Robert Koch, with Friedrich Hoffler, formulated the postulates to describe the causes of cholera and tuberculosis.

A little devil, shaped rather like a minuscule bit of vermicelli, he has no dimensions on his own. Take a box with a capacity of one cubic millimetre; fill it right up with TB, and you have a quarter of a million.

TB’s object in life, like that of so many more of God’s creations, was, so far as humans could judge, simply to be and to go on being. TB’s favourite haunt was the lung of a human being, though it could happily reside in the bones, the throat, the intestines or the blood-stream, and did not mind hanging about in the air for a few hours before finding a home. One variety of TB lived in the milk and milk-producing organs of cattle, and another, much smaller in number, in the bodies of certain birds. They all liked lungs, because it was so easy to get there. One deep breath, and there they were.

Once there, TB lost no time in getting down to the job of reproduction, feeding on the tissue of the lung and so destroying it by forming little nodules which grew, ulcerated, then collapsed in the middle, leaving a crater from which the next generation of TB emerged to go and start another nodule not far away. Several square inches of lung soon became ‘nothing but holes’. The effect was rather like that of rust on a car body, inadequately cared for. But whereas the busy or negligent car owner could see what was happening, the unfortunate host of those parasitic guests may not have been aware for several months, or even years, that they were there. Awareness began with sweating in the night, coughing and spitting; then more coughing and spitting; loss of weight and energy; then spitting of blood, denoting that the lung was suffering serious damage. Then – if nothing was done – death. Babies died before the blood-spitting stage was reached.

Here is a more cheerful note. The human body did not take this parasitic invasion lying down. It fought back. If the lungs could be filled constantly with clean fresh air; if the amount of energy expended by the body was reduced to a minimum; if the fighting-back mechanism was reinforced by good wholesome food; and if those conditions were provided early enough, before the degree of infection was too great, the body would win. TB would give up the struggle.

The disease, aptly called ‘consumption’ (the names ‘phthisis’ and ‘tuberculosis’ are relatively recent) had been known for centuries; the symptoms clearly recognised before the nineteenth century. As diagnosis became more accurate and statistical information accumulated, TB was eventually seen to be what for a long time it had been suspected of being: Killer No. 1. In the year 1837, in an area comprising Cambridgeshire, Huntingdonshire and South Lincolnshire, 3,048 people died. Of these, 585 died of ‘consumption’ bracketed with ‘decline’. That was more than double the number of deaths from any other single cause, and should almost certainly be increased by transfer from the totals registered as dying of ‘pneumonia’, ‘disease’ and ‘causes not specified’, the latter being next highest on the list, with ‘old age’ a good third. And that, be it noted, was in an area where fresh air was plentiful and malnutrition well below the average.

Fresh air in particular was early recognised as a contributory factor, if not to a cure, at least to a prolongation of life in consumptives. In the 1870s and 80s ‘sanatoria’ were established in localities where the air was considered to be wholly free from pollution – ‘wholesome’ was the word – and Switzerland headed the list, though almost any mountainous area served as well. This added a further element to the ‘consumption syndrome’, already highly charged with emotion. The rich were able to go abroad for expensive care and possible cure; the poor were obliged to stay in their crowded city slums and slowly die. Consumption became a ‘fashionable’ disease even in its real state. It was adopted by some wealthy people as an excuse for spending years in idleness, basking in sunshine and sympathy, and paying exorbitant fees for the privilege. The fatality of the disease afforded admirable scope for dramatists, novelists, librettists and writers of moral stories for the young, particularly as its incidence was very high in young females.

The cough of a Mimi or a Violetta would reach the heart no less surely than one of her purest notes. The blood-spotted handkerchief had more dramatic impact than a whole chapter of words. Meanwhile the wretched poor, and those less poor but just as wretched, continued to die in their thousands.

For it was one thing to diagnose; an altogether different thing to cure. The medical world did what it could. An injection of carbolic was tried in a few cases; the surgeon’s knife was tried (actually it had been tried two centuries earlier!). It was generally realised that the disease need not be a killer, given early diagnosis and proper care. It was known that hundreds of thousands of cases, all potential spreaders of the disease, were at large. In 1887 Sir Robert Philip of Edinburgh inaugurated specific measures for control on the principle of careful supervision and a serious effort to improve the standard of living. The machinery of State and Local government took a long time to get wound up. In 1907 the Local Government Board urged voluntary notification of the disease, but it was not until 1911 that regulations were issued making notification of all cases of pulmonary TB compulsory. (The same regulations imposed fines for spitting in certain places, and gave rise to the ‘joke’ about the two old ladies at the concert where the band played the ‘Refrain from Spitting’.)

Sanatoria were erected all over the country, some managed by private philanthropic agencies, others by local authorities, Counties or County Boroughs. The treatment once available only for the rich became the commonplace of the poor. County TB Officers were appointed. The State was in the battle against TB.

It undoubtedly slowed its march. But the casualties were still such as to render illusory whatever victory was claimed. Of those discharged from sanatoria, classified as having had the disease ‘arrested’, between one third and two thirds died within five years of leaving, most of them within two years. Nobody knew what it was costing the country in cash. (Dr H. Biggs in 1903 estimated that it was costing the USA £66,000,000. Sir A. Newsholme estimated that the eradication of TB would save Great Britain £10,000,000 [£1 billion in today’s money].)

Varrier-Jones

As Rowland Parker wrote in 1977 in his book On the Road:

That was good enough for Varrier-Jones. If it could be done, it would be done. He talked to all the right people. That was another of the assets of this man – he knew all the right people. If he did not already know them, he soon made it his business to get to know them. He already had the willing cooperation and backing of his chief, Professor Sir C. Allbutt, KCB, who was largely instrumental in forming, on Dec. 2nd 1916, the Cambs. Tuberculosis After-Care Association, the independent authority which was needed to put V-J’s scheme on an official footing. Friendly Society members (there were only fifteen of them in the county) in need of TB after-care would get ten shillings a week to begin with, less as they got stronger. Non-members would be helped from subscriptions – there would not be more than five of them at any one time, it was thought. The aim of the After-Care committee was to raise a fund of £100 a year to begin with. It was not much – but it was something. That was in January 1917.

Committee meetings take time. People have other equally important things to do; their own lives to live. There was a war on. Varrier-Jones could not wait for official progress. It would catch up with him in time, perhaps. Having started things moving in one sector, he went off on his own to get the money to start doing while the committees were still talking. Not that he was impatient with them. He was just downright damn-well-determined to get something done. He begged, bullied and cajoled £603 [about £36,000 in today’s money] out of the local worthies. (The contributions included £10 from P.C. Varrier-Jones, Esq. MD.) He begged a green-house, garden tools, a governess-cart, a harmonium; provided his own croquet-set and ‘clinkers’; formed a committee; bought a house at Bourn and established the ‘Cambridgeshire Tuberculosis Colony’ in February 1916 (eleven months before he had official backing). The Colony consisted of six patients and a nurse! Never mind, it was a start. He was off the ground. Wrong idiom for that date – he was on the ground. By August of that year the personnel numbered nineteen; fourteen patients, three nurses, Matron and V-J. There were 48 ‘Governors’.

In June 1917 the After-Care committee caught up with him; it and the Colony joined forces. The latter was approved by the Local Government Board as an ‘Institution for the Treatment of early cases of Pulmonary and Surgical Tuberculosis’. (I wonder what would have happened if they had disapproved!) The staff lived in the house, the patients in open-air shelters which they had made. A word about these ‘shelters’, since they were to become a sort of jocular legend, and are still in fact. They were really just wooden boxes about seven feet square, with a pyramidal roof, three sides being fitted with canvas screens which could be raised or lowered as required; so that the occupant was virtually indoors and out of doors at the same time; in all weathers – a waterproof sheet being provided to keep the worst of the rain and snow off his bed. Bath-room, lavatories, dining and recreation room were arranged. ‘Continuous temperature records were registered’ – I take that to refer to the temperature of the patients, not the air, which in that first January was perhaps best left unrecorded. The charge per patient was thirty shillings a week. The patients did all the work which had to be done to get the Colony ship-shape – cutting down trees, making paths, draining, cultivating the garden. They designed and planned everything, and ‘showed the keenest interest in the work’. Listen to one of them, writing anonymously in the ‘Papworth Annual’ of 1942:

‘It was the second year of the Great War. Some of my colleagues were soldiers of recent experience, and what experiences they recounted, and how they appreciated the luxury of beds and wooden huts! – F.S. and his home-made barometer – the Scot who very much resented the ice in his toilet water-bottle – the nightly sing-songs after lights-out at 8 p.m. The little house, the Sister, the Cook – and what a kind soul she was to all the lads – and last but not least Dr Varrier-Jones, his morning and evening rounds; how we looked forward to them – his readiness to answer questions, and not always medical questions at that – his astonishment at much of the truth we told him regarding the working-man’s wage, and how it was spent! – F.S. was the first to be put on work, one hour in the morning and one hour in the afternoon – the first obvious piece of constructive work was to drain the pond – F.S. dug a trench in the course of a few days, and so well was his work carried out that without due warning the village of Bourn was well-nigh flooded out! The second patient for work wished to look after the chicken-farm – I doubt if any twenty hens were ever so well cared-for before or since. What a happy party we were, more like a family, each with a self-appointed duty for the patients confined to their beds.’

If any of my readers suppose that Varrier-Jones rested on his laurels and preened himself on having done a good job, then I have made a bad job of depicting his character so far. He was already planning the next move before the first move was anything like complete. I spoke earlier of the ‘path of destiny’. It will be noticed that Bourn is only about five miles from Papworth. Fate did not arrange that. But Fate, surely, arranged that Papworth Hall should still be empty, and for sale, just when Varrier-Jones was looking for somewhere to go next. If Buckingham Palace had been empty, and for sale, and a bit nearer, he would doubtless have gone for that. (As a matter of fact he did, in a different sense, a bit later.) He was not a man; he was a dynamo; a dynamo with a head, a heart and a voice.

He used all three to good effect. The Rt. Hon. Sir Ernest Cassel came up with a cheque for £5,000 [£300,000 in today’s money]; others, most of them ‘Governors’, added £1,338; the Institutional Committee of the Government granted £3,000; and an anonymous donor, with the purchase of the 23 acres of woodland in mind, raised the sum to just over £9,600. Which, by an odd coincidence, was the very sum the committee needed to purchase the Hall (£6,000), lay on a water-supply, make the necessary structural alterations, buy furniture (of a slightly different pattern from that of Cheere or Hooley [see below] and leave a bit over for a working balance and incidentals. Who but a Varrier-Jones would have had the courage to leap at such an opportunity, bristling as it was with problems and difficulties? It was not that he did not see the problems. What he saw most clearly was the opportunity. The fences beyond the next would be jumped when he got there.

At this point, lest it be forgotten in the whirl of events to come, I must pay due tribute to those people – and they were many, too many to be named individually – who supported this dynamic man, not only with money, but with faith. He could not have achieved what he did without them. They perhaps would not have done what they did without him. The greatest asset of all those which Pendrill Varrier-Jones possessed was perhaps this – his ability to inspire in others the faith which he had in himself.

The Bourn colony was established not just by the doctor and nurses but by the patients. Varrier-Jones sought the opinions and the expectations of his patients, the foundations of a self-governing community were being laid.

So the Colony moved from Bourn to Papworth Hall. Let my anonymous informant tell it his way:

‘Shall I ever forget that cold bright sunny morning in February, 1918, when we moved, seventeen patients and four staff? How excited we were to pack our luggage, beds and shelters; and the discussion as to how we were to travel! Laddie, the pony in the Jingle, took three patients. Others travelled by car. One youthful member, H.L., had the loan of Dr Varrier-Jones’s bicycle, and so arrived earlier than the majority. (The beds and shelters went on farm-carts borrowed for the occasion.) How we admired the Hall, the lake and the gardens, and how busy we were, or thought we were, helping to erect our shelters for the night.’

Charles Madryll Cheere had built Papworth Hall to impress the county. Ernest Terah Hooley had bought and used the Hall to impress the country. For example, he hosted large, ebullient parties giving rise to the name ‘Hoolies’. Pendrill Varrier-Jones was not out to ‘impress’ anybody. Yet in the space of less than twenty years the name of Papworth was to be known throughout the world.

The Colony was no sooner planted than it started to grow at an astonishing speed. Varrier-Jones’s knack of knowing the right people, and skill at getting them on his side, brought him into contact with Sir Frederick Milner (‘the Soldier’s Friend’) and through him the support of the Royal Family was secured. On Oct. 9th 1918 Her Majesty Queen Mary, accompanied by HRH The Princess Royal, paid what was to be the first of many royal visits to Papworth. ‘What a gala day for everybody! And how it rained! And the mud! Did ever royal visitors give more pleasure and encouragement to the sick and to those struggling back to health?’

The Colony at that time consisted of 25 shelters, 60 beds in the Hall, eight cottages and five ‘industries’; these latter being carpentry and cabinet shops, boot-repair shop, poultry-farm, fruit-farm and piggery. Not bad for eight months’ effort!

In 1921 there were 200 men, mostly ex-soldiers, under treatment; 140, along with 25 convalescents living in the settlement, were undergoing a course of training. A new Village Store had been opened; St John’s Hospital opened; St Peter’s House became a Nurses’ Home; a new drainage-system was completed, and 28 cottages were erected by the County Council. There was no marking time on any sector of the front. The ‘Sims Woodhead’ Research Building opened in 1923, and ‘Homeleigh’ (once Home Farm) developed as a hostel for women. A grant from the Government enabled the construction of 25 new cottages which were formally opened on July 23rd as ‘York Cottages’ by Their Royal Highnesses the Duke and Duchess of York. Never before had so many people visited Papworth, for it was Flower Show Day.

Encouraged by success, undeterred by failure, Papworth had to go on. There were more cottages, new hostels, new workshops, recreation-rooms, etc. In 1930 there were 200 men and 80 women patients; 294 on average were in daily employment; the Industries had an annual turnover of £68,000. Royal visits became a commonplace, but none the less appreciated for that: Duke and Duchess of York in 1927, 1929 and 1932; The Duke of Windsor (then Prince of Wales) in 1928; HM Queen Mary in 1929, 1933, 1939 and again in 1945; on July 26th, 1934, HRH The Duke of Gloucester opened the Bernhard Baron Memorial Hospital and laid the foundation-stone of the new Surgical Unit. ‘What a good speech he made. Another sunny happy day.’

On 28 October 1932 The Times reported:

Grant From Bernhard Baron Trust

The growing needs in the fight against tuberculosis of the Papworth Village Settlement have been further met by a grant from the Bernhard Baron Trustees for the building of a hospital and today the foundation stone was laid by Lady Baron.

The new hospital which will be erected so far as possible by skilled workers in the colony and which has been designed by Mr McMahon, manager of the building department and Mr Copse, both of whom have been patients at the Settlement, will accommodate about 84 patients and will also contain an out-patients department for the use of the whole village.

And on 4 July 1932, The Times reported:

The Queen signified her intent to being present at [the play] The French Picture in aid of Papworth Village Settlement.

Followed by, on 9 July 1932:

ROYAL VISIT TO CAMBRIDGE

New Wing Opened at Addenbrooke’s

The Duke and Duchess of York visited Cambridge and the Papworth Village Settlement today. The occasion was the opening of a new women’s hospital at Papworth and an important addition at Addenbrooke’s.

Arriving at Papworth the royal visitors were met by Sir Humphrey Rolleston and the Medical Director, Sir Pendrill Varrier-Jones. They proceeded to the new building where the Duchess unveiled a tablet and declared the hospital open. The design, construction and furnishing have been done by Papworth Industries and the designers who are ex-patients at the colony, have embodied in the hospital novel features whose value was impressed upon them by their experience as patients. Instead of big wards there are bedrooms for one or two patients, each of which has an outlet on to a veranda where all the sunshine available is obtained. Bright furnishings provide a most agreeable effect.

On 1 July 1934 The Times wrote:

PAPWORTH VILLAGE SETTLEMENT

The New Hospital

The report of the Medical Director, Sir Pendrill Varrier-Jones, states that progress is being made in many directions even more rapidly than financial considerations permit. ‘To proceed further along the lines of thoracic surgery seems essential and we are providing a special 22-bed surgical block. When this is completed we shall have at Papworth what we believe to be the most complete scheme for the treatment of tuberculosis that exists anywhere.’

On 23 July 1936 The Times wrote:

NEW SURGICAL HOSPITAL AT PAPWORTH

Opening by The Earl of Athlone

The tuberculosis colony at Papworth Hall was again honoured by royal visitors today when Princess Alice, Countess of Athlone, and the Earl of Athlone showed their keen interest in the work. The Earl declared the new surgical hospital open.

Sir Pendrill Varrier-Jones said that Papworth had created a record for that was the 15th visit from members of the Royal House of Windsor.

All this development was costing money, far more money than the Industries could make. In 1932 the Rt. Hon. Stanley Baldwin, MP and a Vice President of Papworth, made an appeal over the radio. Of Varrier-Jones he said: ‘For years he has struggled on, entirely without endowments, harassed by the conflicting claims of finance and humanity. His humanity has won, but his overdraft is enormous.’

A high-spot in publicity was reached in December 1935 when the world premiere of the film The Ghost Goes West was given at the Leicester Square Theatre, attended by HM Queen Mary. Seats at prices ranging from half a guinea to ten guineas [£65 to £650 in today’s money] were sold out, and the proceeds devoted to the provision of a nurses’ home at Papworth. At the same performance a showing was made of the film The Story of Papworth.

Two years later, on 20 April 1937, Jack Payne and his band played for over 500 guests at a Festival Dinner at Grosvenor House, presided over by HRH The Duke of Kent, then President of Papworth, in the company of His Grace The Archbishop of Canterbury, The Duke of AthoIl, The Marquess and Marchioness of Willingdon, Sir Patrick Hastings, KC and many other distinguished people. There cannot have been many ‘right’ people by this time who did not know or were not known by Sir Pendrill Varrier-Jones. His work had received recognition in the form of a knighthood in 1931.

On 21 February 1937, there was a simple celebration at Papworth to mark the 21st anniversary of the opening of the Bourn colony. As Rowland Parker noted in 1977:

For Sir Pendrill Varrier-Jones it was the proudest and most touching experience of his life. Twelve of the early patients at Bourn returned to give thanks for the part he had played in their restoration to health. And what a bevy of fit men they looked – fathers and grandfathers! – Sir Pendrill responded to the toast, but with great difficulty. It was, I presume, one of those occasions when to feel most is to say least.

The voice that had won converts to his faith throughout Europe and America; the voice that had charmed royalty and nobility; had gracefully acknowledged honours conferred upon him by the Royal College of Physicians; that voice failed him when those simple ordinary men came back to say ‘thank you for saving our lives’.

He died suddenly on Jan. 30th, 1941. Sir Pendrill had lived only 57 years, but he had managed to pack into them about a hundred years’ worth of distance run. To hear the old ones talk at Papworth today, you might think he was still there. In a way, I think he is.

Parker concluded:

His life was gentle and the elements

So mixed in him that Nature might stand up

And say to all the world, ‘This was a man’!

Papworth Colony

This is what Varrier-Jones wrote himself on a visit to the USA in 1926:

THE WORK OF PAPWORTH COLONY

by P.C. Varrier-Jones, MA, MRCS, LRCP

I deem it a great honour to be asked to address this Conference on the work of the Papworth colony. My task is made the lighter because during my stay in America I find many friends who not only know where Papworth is, but are fully conversant with its work, its aims, its aspirations. I no longer have to answer the question: Where is Papworth? Indeed, it is almost superfluous for me to answer the question: What is Papworth?

Papworth is a Village Settlement for the Tuberculous, a community of consumptives who have learned to live with the limitations imposed upon the life of a consumptive, and even to enjoy that life.

A tuberculosis colony is a community of consumptives in which the hygienic and economic factors have been readjusted to suit the abnormal physical and mental state of its members.

Some years ago, when I was engaged in doing the work of a County Tuberculosis Officer, I was confronted with the problem of what to do with those patients who, having had a period of sanatorium treatment, were unable, on account of the extent of the disease or its only partial arrest, to pursue their previous employment. At first I followed the line of least resistance and gave plausible advice. I had been taught, and the text books were full of it, that a consumptive should obtain a light job in the open air. I reiterated this advice; I even went so far as to prescribe the requisite hours during which the patient should work. I reminded him that even during these short hours he should take great care not to over-exert himself; in short, I preached a ca’canny policy. I had been taught that a nourishing diet was absolutely essential for combating the disease; that fats preferably in the form of cream, should be liberally served, and that altogether a generous diet should most certainly be prescribed. I went further than this; I advised long periods of rest, and I particularly advised that the resting hours should be spent in a well-ventilated room, preferably facing south, the windows to be kept open and the room properly heated in inclement weather. I advised all this, and yet little success attended my efforts. The patients returned again and again for further examination and advice. They lost weight, very soon their general condition was worse than before they were sent to the sanatorium. Why did this state of affairs exist? I put the question squarely to myself, and in time I got the answer.

‘How can I buy good food in abundance on 7/6d a week?’ said one.

‘How can I find a part-time job, when healthy men are unemployed?’ said another.

‘How can I rest with a young family clamouring for food?’ said a third.

And I woke up to the fact that the advice I had been giving, however suitable for the well-to-do, was utterly unsuited to those with whom I had to deal – with the mass of working men and women who cannot afford to be consumptive.

Nowadays, this important aspect of the problem of tuberculosis is summed up in the term ‘after-care,’ but how many of us realise that after-care means much more than a dole of money and food, and the above-quoted advice, which can never be followed? How many of us recognise that we are dealing with a complex situation, in which medicine, economics, sociology and psychology are interwoven, as for various reasons they are in no other branch of our medical work. To send a man to a sanatorium, while his wife and family live on bare necessities at home, is only touching the fringe of the problem. When he returns, improved in health no doubt, but still unemployed and probably unemployable, it means that there is one more to be fed and, what is worse, that a source of infection is let loose amongst badly nourished, badly housed individuals, whose resistance to disease is already low and daily becomes lower. The ‘massive’ dose necessary to infect these children need, indeed, be far less massive owing to their decreased power of resistance. Is there any means of cutting this vicious circle? Is there any means of making the ‘family’ the unit to be dealt with? Is there any means of finding an environment wherein the sub-standard man may work, may help to support his family, and in which the danger of infection will be reduced, if not altogether removed? That is the problem Papworth is out to solve. That is the situation with which it has continuously grappled during the last ten years. By trial and error, through storm and sunshine, we have built up the Hospital, Sanatorium and Village Settlement, all working together towards the solution to the problem.

These various units are combined under one administrative head, and it is my firm conviction that a colony for the tuberculous must contain all these units, if success is to be attained.

It may be objected that a ‘hospital unit’ is not essential for a colony where only ‘arrested’ cases are admitted for treatment and training, and subsequent settlement. But, as I have pointed out elsewhere, there are very few arrested cases of pulmonary tuberculosis, and, as has been stated by the late Dr Hermann Biggs and others, if all our sanatoria admitted only incipient or early cases of pulmonary tuberculosis, not a third of the beds would be occupied. Most important of all, it must be remembered that tuberculosis is a fluctuating disease, a disease in which periods of so-called arrest alternate with periods of exacerbation.

If the disease after sanatorium treatment is indeed permanently arrested (and he would be a bold physician who would make such a statement), then there is no need for after-care or a special environment and a sheltered existence. It is because permanent arrest is so seldom attained amongst the working classes, that the special environment of a village settlement becomes necessary. It is because our sanatoria are filled with cases in which no permanent arrest of the disease can be expected, because the damaged organ can function in a special environment only, that village settlements are called for. They are necessary for those very cases who find it impossible to obtain employment in the outside world, and who daily crowd into the dispensaries in our large cities, looking for a cure which never comes.

We must open our doors wide, for treatment and prevention go hand in hand. It is seldom recognised that it is possible at one and the same time to treat the disease and prevent its spread. A six months’ stay in a sanatorium followed by a period of temporary arrest when the patient is able to return home and work may be one form of this combination. But when the disease re-asserts itself and the patient again becomes infectious, it is imperative that further treatment and other preventive measures should be adopted. What should these measures be? What form should they take? Should they be a further effort at temporary repair only to be broken down again, or should they be permanent treatment involving segregation?