Friday, 29 August 2008

Geoff Smith comments after spotting the blog & contacting us by email

I started training as an Orthopaedic Nurse at Huddersfield Royal Infirmary, as part of that training you were seconded to MHH, cant remember how long 2 or 4 months. I think only 2 or 3 groups were seconded, and then they were sent to a hospital in Sheffield. At this time (1971) it was not beneficial for nurses from a training point of view.

The staff were very friendly, and a lovely community atmosphere. The hospital had some lovely grounds, but not used. Nothing was locked up and you could go an raid the hospital fridge if you were hungry.

Gerry (Gerald Appleyard) was one of the Charge Nurses and that's how I got to know him.The Matron was called Weddall and her brother worked nights there. He used to make the porridge for breakfast. He had it cooking all through the night. He had a Ford Zephyr car and would go into Boston Spa and get us fish and chips.

Ward 3 was for older boys and Ward 4 younger ones.

Very few Orthopaedic Patients, some babies from Meanwood Hospital who had severe mental disability and stayed in cots all day, they were fed, washed. They had repeated epileptic fits and just awaited the inevitable. Most of their parents never visited.

There was a portacabin on the grass as you went into the grounds, this was

for admin staff.

Monday, 25 August 2008

Edward Green, at MMH 09/56 to 03/57. At aged 14, he was the oldest patient!

I came across your blog re. the above hospital. I was a patient from September 1956 to March 1957. I had an orthopaedic problem with my knee. I have lots of happy memories from my stay.

Aged 9 I took a really hard bang on my knee from a roundabout in a children’s playground. In the following 5 years the knee would repeatedly lock and I was back and forwards to Leeds General Infirmary to see an orthopedic specialist.

He eventually admitted me to MH Hospital for 2 weeks observation in September 1956, so that if it locked he would have a "reliable" witness. I thought "Great, 2 weeks off school”, as my Mam and I drove down the lane leading to the hospital in an Ambulance car. I saw all the kids on the veranda doing school work, and my bubble burst! I was 14 years and 2 months old, the next oldest boy was just 12.

MH. Hospital at that time was a probationary training hospital for nurses having to do a 2 year course then going onto larger hospitals, like Leeds General Infirmarly and Pinderfields [in Wakefield]. They started at age 16 then moved on at age 18.

Up to that time I had rarely come into contact with girls and couldn’t understand why I seemed to get more attention than the other kids. There where about 20 boys on ward 2, as it was known then, and I was the only one not confined to bed. I was amazed to find out some of the kids had been in hospital for years, being treated for TB, Polio and Perthe's disease. I became scared in case I caught one of the diseases until I was assured this could not happen.

I spent most of my time picking things up off the floor that had fallen off the other kids’ beds and passing comics, toys and any other item from bed to bed. On the day the orthopaedic specialist visited I was confined to bed. All our case-notes lay at the base of the bed. I picked mine up and tried to read it but couldn’t understand it, until I turned a page, and written across the full page in large letters were the words "TRUTH DOUBTFUL". I felt my face redden and quickly threw the case-notes back on the bed. I suddenly felt so alone and afraid. When the consultant came to me Sister told him I had been very active and very helpful on the ward - in other words there’s nothing wrong with him!

Two days before I would be discharged I was bouncing on my bed when my knee "locked". Ii screamed for Sister, she and 2 nurses came dashing from the office and witnessed my knee locked with a pea sized piece of cartilage protruding from the side of my knee-cap. The outcome was I had an operation, 12 pieces of shattered cartilage were removed (along with "that" page from my case-notes). I spent the next 6 weeks in a plaster cast, groin to ankle, but was still fully mobile, doing all kinds of jobs helping the nurses hand out and collect bed-pans and bottles. One job I enjoyed was rolling up the dozens of bandages on a small mangle like machine after they had been washed - they where used to strap all the kids’ legs into their frames and splints. Thirteen years ago, aged 53, I had a total knee replacement.

Christmas was a great time, with a doctor dressed as Santa handing out presents to us kids. The Registrar was a Mr. Yeomans, the Physio was Miss Anne Berry. I can only remember one nurse who I had a school-boy crush on, Margaret Brett, and Mary the cleaning lady. I have enjoyed writing about my 6 months in M H Hospital and many other memories have come flooding back. I do hope you have enjoyed my small contribution.

Sunday, 24 August 2008

Making plaster beds – a film about how they did it

Since the blog has gone a bit quiet, I though this might be a good time to share my rather curious experience of watching this film, last year before we started the blog. I thought it might interest especially those of us with TB spines, who spent much of our time at MHMH on plaster beds. I've mentioned my memories of this a couple of times (28 April 08, and again on 9 July when I promised to come back to it in more detail). So here it is.

It all started when I went to the internet to check some facts about how spinal TB was treated, including the use of plaster beds. I googled “tuberculosis of the spine”, and came across a reference to a film held at the Wellcome Library in London, called “A demonstration by diagram and illustration of preparing anterior and posterior shells in the treatment of tuberculosis of the spine in children”. So I decided to follow it up.

Because the film is very old, you have to view it with a member of the library staff in a special viewing room. So last July I made my first visit to the library – I’ve been a few times since then, and it’s a fascinating place with lots of interesting medical history documents, objects and pictures. My appointment was with Angela Saward, Wellcome’s curator of moving images, and I went with her to view the film in a special viewing room. She made sure I was comfortable and in a position to take notes, and offered to stop the film if I needed time to write, which I did at a couple of points. In fact, I was rather glad to have her there and that the viewing was set up in this rather academic way – it kept me fairly detached from what I was watching, rather than projecting myself into it more personally, as I might have done had I seen it on my own.

It’s a black and white silent film, quite grainy and faded in places, so the only sound effects were the whirring of the projection, and my own hasty scribblings. It was made in 1936 at Abergate Sanatorium, Manchester, and donated to the Wellcome Library by the British Medical Association Film Archive. Angela thought it might have been a training film to spread best practice at a time when there was no centralized training system.

It shows the making of two plaster beds on a small boy – an “anterior shell”, for him to lie on his front – and a “posterior shell”, for lying on his back. As the film progresses, the different stages of the process are illustrated with diagrams at the bottom of the film. I’ve tried to reproduce some of these to illustrate the stages. My drawing skills are not very sophisticated, but I hope the diagrams will help make the process clear.

The posterior bed they made in the film went up over the child’s head, as though for patients who had upper spinal problems, like some of you who have contributed to the blog. For this, the boy was placed face down on a frame, with a crossbar passing roughly under the stomach, to “ensure a degree of hyperextension of the spine” it said; in other words to keep it stretched and not curving inwards. His legs were bent and the shins and feet were raised by another pair of crossbars, one over the knees and one under the ankles – so that the finished bed would keep his legs slightly bent. (See diagram 1).

Diagram 1: Patient lying face down for making of
"posterior shell"

Next he was rubbed all over with Vaseline, and his head wrapped in a cloth. Then they laid strips of bandage-cloth impregnated with wet Plaster of Paris on the child’s body in a carefully designed pattern, slightly overlapping and patted down till they all melded into a single piece (see Diagram 2 below).

Diagram 2: Patient lying face down for making of "posterior shell". The numbers show the order in which the strips were placed, and the arrows the direction of the strips

In the film, the first strip went from the bottom of the child’s torso (leaving the behind clear) right up the centre of the back and over the head, and was carefully tucked in to follow the curve of the neck (1). Next came side slabs (2). Then a curved slab was placed round each shoulder just touching onto the central one (3), and another went across all three (sorry, I omitted this from the diagram, and I don’t want to re-scan it). For the legs, a single strip was placed along the back of each leg, from the groin right down to the ankle (4). Then bandages soaked in plaster of Paris were rolled back and forth crossways to this slab, moving from thigh to ankle and creating a curved shell (5). As the different sections were applied, they were smoothed and slathered down very firmly until they form a continuous whole, with seam-lines down them which looked like those on a certain design of dress, or the taped joins of the ‘liberty bodices’ I remember wearing later on.

Finally, presumably when the plaster had dried enough to keep its shape, you saw the whole shell being removed, and placed on a wooden frame. The final frames show the child lying on his back in the plaster bed on the frame.

The process for the anterior bed – made on the front of the body for lying in face down – was pretty similar, except that the child’s legs were straight, and there weren’t any crossbars to maintain the correct position of the spine. In this one, the leg slabs went to just above the knee, with no further bandaging to and fro.

As to how it all relates to what I remember, this is quite a difficult question. Angela asked me if we had been as compliant as this child, who kept so still I thought they must have used a doll – which Angela doubted – or that he was anaesthetized. Both processes, but particularly the one for the ‘posterior bed’, looked extremely uncomfortable, so perhaps anaesthetization was used. Yet I don’t remember any such discomfort, and I was certainly conscious throughout. What I do remember vividly was the feel of the plaster slabs, warm, wet, sticky and smelly, and the slapping and smoothing involved in their application. I imagine the Vaseline-ing must have been a strange sensation, too, though I don’t remember that either. I wonder how they cleaned it off us afterwards – we must have had to have some sort of bed bath, I suppose.

I mentioned this film to Cynthia Coultas when we had a long talk on the phone not long ago. It seems that by the time Cynthia was involved in this process at Thorpe Arch, they used single sheets, rather than strips, laying them over the whole back, or front. Apparently, each patient had an anterior and a posterior bed made, because we had to be turned frequently to prevent bed sores. Funnily enough, I have no memory of being turned, yet from what Cynthia says it must have been quite a frequent process.

So watching the film jogged my memory, but also left me with a whole series of questions. For instance, I wonder what happened to our muscles over so many years of lying flat, and what kind of preparatory physiotherapy we were given before the magic moment when we actually stood up to walk. Without any at all our legs would surely have crumpled under us!

I wonder, too, why I didn’t ask more questions about this all once I’d come out. I suppose at that age children take an awful lot for granted, and don’t question something which, though it appears peculiar with hindsight, was our ‘normality’. Then, coming home, it must have all faded into the background as I moved forward into a new ‘normal life’. I did tend to explain my inability to perform certain physical activities in terms of my having been in hospital – for instance, I always found it very difficult to sit on the ground cross-legged, but really without analysing it too much at all.

Does any of this jog memories for anyone else? Does it contradict your memories, or help fill them in? Or does it jog other memories altogether? Perhaps Cynthia will have a look at this, too, and fill in details from the nursing point of view. Please comment and add details, questions, differences of view, and so on.

Friday, 8 August 2008

Cynthia Coultas gives a nurse’s perspective on visiting limitations, and other aspects of nursing children in the

Rowland’s memories certainly back up the importance of parental input and the reason for modern day thinking and the changes to the care of children in hospital. Hence the development of programmes such as those at Great Ormond Street and others.
Like all the other things involved with caring for the sick, visiting is a multifaceted problem. There were unexpected problems when unlimited visiting was instituted, which it took time to sort out. By the time this happened I had moved on to the general hospital, but the principles are the same. On the first day we were all prepared for welcoming extra people to occupy the patients. Brilliant, we would have more time to get on with individual treatments.

As the doors opened, a flood of people surged forward to the bedsides of their loved ones. With them arrived shopping bags, wheelers and arms full of gifts. By 10 am. coffees and teas were being drunk from flasks, and by lunch time sandwiches were being enjoyed by patients and visitors alike regardless of diets! A dangerous situation for diabetics, etc. and nurses had no idea whether patients were eating or just hiding problems behind the aura of fruitfulness provided by their families. This trend continued until the last buses were due to depart and those with cars dawdled even longer.

After a few weeks of this type of scenario, patients, staff and visitors were all complaining of fatigue. Patients were exhausted and suffering from constipation and other associated digestive upsets, staff were unable to perform personal care without embarrassing the patients as they explained what they wanted the patients to do to cooperate, and visitors were finding financial implications on a long term basis.

Also needing addressing was where all these people were to sit. Inevitably the beds seemed the obvious place. Plenty of room for two or three. As bed clothes were pulled tight, wounds groaned under the pressure and wound healing was being delayed. Added to all this of course was the added risk of infections carried in unknowingly by the visitors. I will mention MRSA and then say no more.

Again my point is that there is no easy answer to any one problem and sometimes the tug on the heart strings is the lesser of many evils.
In general, I suppose we can’t overlook what things were like at the time. 1950 was a very early post- war situation, and it is always difficult to put oneself in the mind set of an earlier period and what was happening generally to children. Money was short for everyone so food as well as clothing and everything else had to be completly eaten or worn out before it was thrown away or even still passed down to 'little Johnny'. I remember my father saying that if I didn't eat what was before me it would be returned at the next meal. That was no idle threat! 'Make do and mend', was the quote of the day for making clothing last longer, etc.

Drugs then were very minimal and basic (no broad spectrum antibiotics for example) hence lots of fresh air and rest! TB itself was also something that doctors were learning about, and without the appropriate drugs to help in the treatment they were fighting a very difficult battle.

The point Fred made about the staff being young and inexperienced is also valid. Again this doesn't or shouldn't happen today because the training separates the nurses from the wards until they have gained some knowledge. On the other side of the coin nursing is a very practical work and full knowledge can only be gained at the bedside in order that the intangible can become intuitive. We were taught about diseases and what to look for in a patient who were unwell.

Today nurses are taught about health and have some idea if a patient admitted for a cataract operation is at the time of admission developing a further problem. Not to take over the Dr's position but to know when to call for his attention.

Monday, 4 August 2008

...and Jane responds again

This added bit about your later visit to the hospital is also very interesting - it always struck me as curious that such a little place as Thorpe Arch incorporated a children's hospital, a munitions factory, then a prison and the British Library (which I think is still there). I wonder how much of that was due to re-using buildings that already exist.

I was surprised to hear that you had to be quite so assertive about staying with your son when he had his operation - I thought by then it was almost commonplace for parents to be allowed to be with their children, but obviously it all took longer than I thought, or at least did so in some places. I've read quite a lot of stuff on how Great Ormond Street hospital led the change, but of course that was up 'at the sharp end' of medical practice.

I would have liked to be able to 'walk the place' as an adult, as you did, not only lay ghosts – more to conjure up a few, especially as I have such vague memories of the actual physical aspect of the hospital. So I was sorry it wasn't there any more when we finally got around to going (in about 2005, I think). At the same time, I can understand your feelings about obliterating it. A similar hospital at Craig-y-Nos (I've mentioned their blogspot a number of times, since it inspired ours) was housed in a castle, which is now a luxury hotel, and rumoured to have at least one ghost of a child. Presumably new-build houses won’t have any at all.

Sunday, 3 August 2008

Rowland replies – with his experience of the hospital as a patient’s parent in the late 1960s

It may be of interest to know that between Sept 1969 and January 1973 I served as a young prison officer at the Thorpe Arch prison directly opposite MHH. My middle son David who was born in Malta in 1968 with Telepes (club Foot) was actually operated on at MHH to correct the deformity. The Paediatric surgeon that carried out the operation, Professor Silk, an American on secondment to Leeds Infirmary, opened up the MHH obsolete operating theatre solely for that one operation.

I have to say at that time it was a totally different hospital from what I remembered but even so the visiting arrangements were by today's standards still harsh and unfeeling towards both the patient and the parents. After my experiences of MHH both my wife and myself made it quite clear that one of us would be staying with our child throughout and one of us did for almost a week until he was finally discharged.

My return to MHH was with mixed feelings hoping to make some sense of what happened to me there. Of course in 1973 it had changed considerably from what I remembered in 1950 and to be perfectly truthful it didn't hold the terrors that I thought it might. I was allowed to wander the grounds and hospital and as I did so I laid to rest some of the fears that I had. Personally speaking I am glad that the hospital was eventually pulled down and some better use made of the grounds. That may sound ungrateful especially of all the good things that came out of MHH and of the hundreds of children myself and my son included that benefited so greatly from its existence but I don't mean it to. It's just the way I feel.

Saturday, 2 August 2008

Jane responds to Rowland and Fred

Thanks for sharing these memories - it must have been quite difficult getting them down on paper in order, and you're the first one to have done it so frankly! Like Fred, I find they remind me of some negative memories, too, especially of being left at the hospital by my parents. I'd been transferred from a hospital in Wales, and had spent about a month at home, encased in a plaster cast. I remember lying on a sofa in the front room downstairs. Looking back, I can't imagine how my mother coped; she told me that in the first days when I got home, I regressed to a sort of baby-ish state when I wouldn't let her out of my sight for fear she'd disappear, I suppose. She even had to negotiate to go to the loo. So I felt desperately homesick when I got to Thorpe Arch, and I remember being told off because I wouldn't stop crying.

I don't get the nightmares you write about, but I was a very fearful child for quite a long time. do remember a lot of harsh treatment from some of the nurses. I still remember how one night a nurse took away the rag doll I slept with to punish me for being naughty - don't remember what I'd done - and gave it to the girl in the next bed. This doll was made for me by my Granny, and I think it was like a safety blanket to a smaller child. I cried and cried till in the end this girl got fed up and gave it back to me for a bit of peace. The nurse came to see whether I'd fallen asleep crying, I suppose, saw me with the doll, and took it away again... That kind of thing seemed like pure malice to me.

However, Fred had these second thoughts after responding to your email, which fit well with what I want to say here: "Maybe it's too easy to judge the MHH nurses by today's standards. Some of their actions would probably have been considered far less shocking fifty years ago, and were probably based on their own childhood experiences. Fred remembers his parents threatening to serve up uneaten food at the next meal time. My own parents' reaction to my pickiness was to take the plate away from me when they'd finished eating: "Oh!, so you don't want any more", till I got so hungry I ate pretty well everything that was put in front of me, with a few exceptions, like slimy mushrooms and tapioca (as I think I've said before). As their contributions to the blog show, many of the nurses were trainees and probably only in their teens with little knowledge of how to deal with awkward, stressed children in an alien environment.

I think the once a fortnight limit on visiting was the rule, actually - as you'll see from the other messages. What really used to bug us, though, was that the visit day would sometimes be postponed a week if it coincided with some apparently arbitrary date, like the 1st Saturday of the month. Then we had to wait three weeks.

I've done a bit of research into the way the rules on visiting changed, as child psychologists became aware of the damage early, sudden separation from parents could do to children. In 1956, under the Labour government of the time, the Ministry of Health set up a committee which took evidence from a huge range of people - doctors and nurses, of course, but also parents of children like us and child psychiatrists. They issued a report in 1959, called the Platt report, discussing the whole thing, and recommending more frequent visiting - though they recommended that it should be carefully managed in long-stay hospitals, where it was also important to create some semblance of a normal life for children, including school and independent play time.

Some of the evidence they considered came from letters in reaction to a series of BBC programmes. Only the scripts are left, and I've been able to see some of them in the BBC's Written Archives. They were broadcast by Woman's Hour, and some were outside broadcasts to village halls, to conduct a sort of panel discussion with local people, a bit like Any Questions nowadays, I suppose. Many ordinary people, but especially doctors and nursing sisters, were against more visiting, which they thought would disturb the ward routine and upset the children when the parents left. But the research showed that children settled better if they saw their parents more - couldn't we just have told them that!

After that, they began to bring in new policies and nowadays, of course, we have daily visiting and parents allowed to stay with their kids. I'm sure these would have created other problems for our parents - my home was in Pontefract, so the journey for my Mum was a long one, too, as she had no car, though I remember kind friends giving her lifts in their cars.