Royal Brompton & Harefield NHS Trust boasts a colourful history that spans several hundred years. Both Royal Brompton and Harefield Hospital have evolved from an era when poverty was rife, when doctors visited those who could afford it in their own homes and only the very destitute or desperate went to hospital, and when the survival of medical institutions depended on the kindness of benefactors.
The two hospitals merged in 1998 to become Royal Brompton & Harefield NHS Trust. The boards of both trusts decided a merger would bring benefits to patients. This officially took place on 1 April 1998 and has led to many advances in treatment by successful cross-site working, such as transplantation for patients with cystic fibrosis.
Today, the two hospitals are world-renowned leaders in the research and treatment of heart and lung disease and are recognised teaching institutions.
In the beginning
In 1841, 25-year-old solicitor Philip Rose became the founder of what is today Royal Brompton Hospital.
Rose decided to build a tuberculosis hospital when his sympathy was roused for one of his clerks who had the disease and was unable to gain admission to any hospital in London.
At the time, general hospitals were reluctant to admit and treat people with tuberculosis due to the fear of the disease spreading, so the need arose for specialist hospitals.
Rose found and leased a house in Chelsea, known as the Manor House, which opened for inpatients on 13 September 1842 as the ‘Hospital for Consumption and Diseases of the Chest’.
In the 17th century Brompton was known for its ‘salubrious air,’ which was thought to be important for improving the health of consumptives.
The need soon arose to enlarge the hospital but rather than extend the Manor House, it was decided to purpose build a hospital especially suited to the needs of tuberculosis patients.
By the spring of 1844 a new hospital was being built on Fulham Road and by 1855 all the new wards were opened. The building still stands today, although it is now not part of the hospital, and the exterior Elizabethan appearance has hardly changed.
South Block was later built following a substantial donation from a local resident, opening in 1882, and Sydney Wing was opened by Queen Elizabeth II in February 1991 when the hospital was granted Royal Charter.
Research and innovation
Research, innovation and education have been constant themes in the history of the hospital and over the course of the next century physicians and administrators ensured the dynamic progression of the hospital, and of medicine as a profession.
The Brompton cocktail (an anaesthetic), the Brompton cough lozenge and the Brompton pack (a ventilator) are well-known examples of Brompton innovation.
The Brompton cough lozenge first appeared in 1886 and pirated versions were sold on stalls on the Fulham Road for a penny a box.
Hospital physicians developed the famous Brompton cocktail – a mixture of morphine, cocaine, alcohol, syrup and chloroform water - given in the distressing, terminal stages of certain conditions. The mixture was used for almost a century and had a brief resurgence in the 1970s before contemporary analgesics took its place.
The cocktail is even referred to in literature – in Michael Ondaatje’s The English Patient, one of the characters decides to use the mixture to relieve pain: “I’ll cook up a Brompton cocktail. Morphine and alcohol. They invented it at Brompton Hospital for their cancer patients.”
The Brompton pack was developed in the late 1980s as the first ventilatory support machine. Replacing the iron lungs, the Brompton pack prolonged the lives of many patients who needed help with their breathing. The pack has now evolved into a mask and a small portable machine.
Brompton researchers examined the effect of cod-liver oil on tuberculosis and published a paper in the London Journal of Medicine in 1849 finding there was some benefit. For a hundred years thereafter, children all over the country were given daily four doses of the unpleasant tasting oil. In 1852, patients consumed 569 gallons of codliver oil at a cost of some £203 while only £308 was spent on drugs!
The Madeira project
In November 1864 an optimistic venture was launched: the Madeira Project. Some 20 patients set sail on the Maria Pia - the Brompton paying their passage there and back! Madeira was chosen as a climatic resort to improve the health of people suffering from tuberculosis. The ship brought the patients back the following spring and Brompton physicians concluded that their progress was no more than would have been expected if they had stayed at home in England!
The kindness of benefactors
The hospital acquired an enormous legacy in 1841 under the will of the late Miss Cordelia Angelica Read.
Miss Read’s distant relatives contested the will on the grounds of her well-known eccentricity, hoping that a post-mortem would establish evidence of brain disease. Despite her great wealth, it was said she lived in a filthy house, existing on penny buns and biscuits and that she was an avid collector of bits of string and paper bags!
The post-mortem revealed no evidence of any mental abnormality or disease and the hospital received close to £100,000 – a large sum in those days. South Block became an extension of the hospital, opening in 1882 and doubling bed capacity.
A place of education and study
In 1894 the College of Physicians and Surgeons recognised the Brompton as a place of study - foreshadowing the important role it was to play in postgraduate education. Over the course of the next century, the hospital developed into a centre for the treatment of heart and lung disease where doctors, nurses and other health professionals from around the world came to study.
A major influence on the course of surgery
In December 1928, Tudor Edwards performed the first, one-stage lobectomy on a patient with cancer. This would not have been possible without the assistance of Royal Brompton anaesthetist Ivan Magill. Magill was a major influence on the course of British anaesthesia during the next three decades and helped to establish thoracic surgery.
The war years
During the Second World War, the Brompton was designated as one of the principle casualty-clearing stations in the area for seriously wounded cases. During the Blitz, the hospital was only twice seriously affected – on one occasion the roof and upper floor of North Block (the original hospital built by Rose) were damaged by fire when bombs fell nearby, and then in 1942 the nurses’ home and south wing were badly damaged by a blast from a landmine.
After the war
When the war ended and the NHS was formed, there was no doubt that the hospital would be recognised as a teaching hospital. Drugs to treat tuberculosis were introduced around this time so the workload and focus of the hospital gave way to other interests – including the study of other chest conditions. In recent years the study of allergy and immunology has become well-developed areas of medical study and treatment.
A place of ‘firsts’
The year 1947 hailed a major development in surgery as the first cardiac surgery operation took place and Brompton surgeons were instrumental in the development of advanced surgical techniques.
Royal Brompton established Europe’s first adult Cystic Fibrosis (CF) clinic in 1965 and the hospital has grown into the largest treatment centre for the condition in Europe. The CF team has been a leading force in developing better physiotherapy treatment and specialised nursing care for patients, and has pioneered CF treatment internationally. Working collaboratively with Imperial College, London and other medical centres over the past decade, important breakthroughs have been made in gene therapy, anticipated by many as the next big breakthrough in this field.
There are many other ‘firsts’ – too numerous to all be mentioned here. They include pioneering the peripheral clinic system - running joint clinics at local district general hospitals to take specialist knowledge and expertise into the community. Today, the peripheral clinic system is an integral part of the service at all major centres and has expanded to cover foetal cardiology and adult congenital heart disease.
Our cardiologists were the first to use ‘closure devices’ - pioneered throughout the early 1990s as an alternative to surgery for children born with a hole in the heart. The study and treatment of adult congenital heart disease was established at the National Heart Hospital, which merged with Royal Brompton in 1971 and transferred all its services to Sydney Street in 1989.
The hospital has become a national and international leader in the treatment of heart failure, with large research trials (such as EUROPA and COMET) leading to significant developments in the area. We have successfully implanted some of the first ‘artificial hearts’ in Europe.
Our cardiac surgeons have pioneered several new techniques; they performed, for example, the first robotic assisted endoscopic coronary artery bypass surgery in the NHS in 2000. Our lung cancer surgery outcomes have surpassed national benchmarks for many years and our experts have developed innovative palliative techniques. The hospital’s paediatric surgeons undertake some of the most complex cardiac work in the country and we have an international reputation in anaesthesia and critical care.
With 160 years’ experience in respiratory disease, our physicians have one of the largest patient populations, and are recognised throughout the world, for their contribution to research.
Investment in imaging technology has been pivotal in the treatment of heart and lung disease. Royal Brompton invested in the first dedicated cardiac MRI scanner in the UK in 1984 and undertook the first clinical MR heart scan.
In 1990, the hospital invested in the Imatron - then the world’s fastest computerised tomography (CT) scanner and the only one of its kind in the UK. Today more nuclear cardiology is undertaken at the Trust than anywhere else in the country.
In the beginning: family home to war hospital
Harefield Hospital has evolved from a war hospital to a tuberculosis hospital and then to a centre of excellence for transplants and the treatment of heart and lung disease. The hospital began life in 1915 as series of wooden shacks intended as a temporary convalescent centre during World War I. The land was owned by an Australian family, the Billyard-Leakes, who offered it to the Australian government during the First World War, for the treatment of injured Australians and New Zealanders.
As the war continued and the ‘Australian Hospital’ expanded, taking over more of the estate, some 50,000 were treated there.
Word of the hospital spread and such was its success that King George V and Queen Mary visited on 16 August 1915, speaking to every bed-bound patient and later donating playing cards and reading stands.
Right through to the present day, an ANZAC day service has been held at St. Mary’s Church - home to the ANZAC graveyard - which hospital staff, community members and representatives of the Australian and New Zealand High Commissions attend every year.
After the war… a sanatorium for tuberculosis
When the war finished, the Billyard-Leakes felt they were unable to move back to their home, because of all that had happened there during the war years. The family estate was sold to Middlesex County Council which had been searching for a suitable venue for a sanatorium for the treatment of tuberculosis – a condition which was claiming up to 60,000 lives a year in the early 1900s.
Harefield was chosen because, as one of the highest points in Middlesex 290 feet above sea level, the site had abundant fresh air and sunlight – and so lent itself to the then popular ‘open-air’ method of treatment for tuberculosis. Harefield Sanatorium quickly gained a reputation in the treatment of the disease.
Second World War
In the Second World War, Harefield dealt with casualties north of the River Thames and, along with St. Mary’s Hospital, enlarged its scope to deal with general and thoracic surgical war casualties.
Pathologist Sir Alexander Flemming spent time at Harefield during the war, studying the effects of penicillin on a wide variety of infections including tuberculosis.
From general hospital to cardiac specialist
When drugs were introduced to treat tuberculosis in the mid 1940s and the National Health Service formed, Harefield became a general hospital.
It later developed an expertise in the treatment of chest disease and became famous around the world for pioneering surgical techniques, treating diseases of the oesophagus and lung and, with the advent of heart surgery in 1947, a specialisation in cardiac work.
On 4 December 1947, Sir Thomas Holmes Sellors - the first thoracic surgeon at Harefield - carried out the world’s first direct pulmonary valvotomy (surgical incision of a valve of the heart) on a young man with Fallot’s Tetraology – a congenital heart condition. Sellors was considered by his medical peers as the ‘uncrowned king’ of cardiac surgery, cases were referred to him from all over the country and junior doctors from far and wide wanted to come to Harefield to learn from him.
In more recent times, the work of Professor Sir Magdi Yacoub and his team established Harefield as an international centre of excellence. Professor Yacoub became renowned for his innovative procedures and for his ability to master complicated techniques. In the face of a relatively new and pioneering science, he pushed beyond the medical boundaries and explored the unknown. The paediatric cardiac service at Harefield began with his appointment as a cardiothoracic surgeon in 1969.
Professor Yacoub and his team, including Dr Rosemary Radley-Smith who is now a senior clinician at Harefield, captured the attention of the international medical community when they used human heart valves in the late 1960s with amazing success. Previously, artificial valves had been used, but these were found to cause multiple problems.
The number of cardiac operations at Harefield trebled, and the Hospital quickly became the second largest centre in the country. On 8 September 1973, the team carried out its first heart transplant – an operation for which the Hospital was later to become famous. Over the next few decades, the Heart and Lung Transplant Service grew rapidly becoming internationally renowned.
In the early 1970s, Harefield continued to investigate and operate on more thoracic patients and almost as many cardiac patients as any other centre in the region. Recognised as the regional cardiothoracic centre, the Hospital provided care to a third of those in need of it in the London area.
In 1976 a two-stage operation for anatomical correction for children of a complex condition known as ‘transposition of the great vessels’ - in which the aorta and pulmonary artery leave the wrong side of the heart - was pioneered at Harefield. Harefield surgeons started doing the operation in the first few weeks of the child’s life and were probably the first in the world to perform one successfully. In 1982 the first successful single-stage correction was performed on a neonate.
The world’s first heart/lung transplant
In 1983, Professor Yacoub carried out the first heart/lung transplant worldwide and the following year he performed a heart transplant on a baby less than a month old.
In May 1987, the first ‘Domino Procedure’ was performed. It was believed that transplanting both the heart and lungs together was more successful than transplanting lungs alone. But in cystic fibrosis patients whose lungs needed transplanting but whose hearts were healthy, this meant a healthy heart was removed - making it available for transplant. The Domino Procedure is the process whereby a patient in need of a heart transplant was lined up to receive this healthy heart.
The pioneering work of Sir Magdi continues today at Harefield under the leadership of Mr Asghar Khagani.
Other areas of expertise
Less well known is that since 1940 Harefield has also treated disease and injury to the lungs and oesophagus. The oesophageal cancer service, which started in the late 1940s, is now nationally recognised for its ground-breaking work. The use of positron emission tomography (PET) scanning has seen a 17 per cent decrease in the number of patients with ‘inoperable’ disease over recent years.
Leadership and technology
The cardiology department at Harefield has developed a national reputation for its innovative work. The department regularly takes part in international live telecasts, has developed a high volume angioplasty service and pioneered mobile cathetorisation services to local hospitals. Most recently a primary angioplasty service was launched for patients with acute myocardial infarction (heart attack)
In 1995, Harefield and the National Heart and Lung Institute of Imperial College London, pioneered the development of artificial left ventricular assist devices (devices that assist the heart to pump). Initially the devices were used as a bridge to transplant, for people with severe heart failure. In recent years ‘implantable LVADs’ have been used to as a treatment for life, rather than as a temporary measure. In some cases they can also be used while a patient’s heart recovers naturally (‘bridge to recovery’).
Harefield Research Foundation
The Harefield Research Foundation was formed in 2000 to carry on the work of Professor Yacoub and his team of clinicians and scientists. This work had previously been performed by the Harefield Hospital Fund and the Harefield Hospital Transplant Trust. Located in the Heart Science Centre, the Foundation 13 became known as the Magdi Yacoub Institute in February 2004.
The ANZAC centre
In 2003, the ANZAC centre was opened, accommodating outpatients, phlebotomy and respiratory physiology (lung function), the transplant clinic, echocardiology and nuclear medicine. Taking over three years to plan and build and costing £4 million, the centre replaced some of the oldest accommodation at Harefield. It has been joined by much-needed new pathology facilities and two new cardiac theatres.