Birmingham Accident Hospital

Last updated

Birmingham Accident Hospital
Birmingham Accident Hospital R.jpg
Birmingham Accident Hospital original (east) building
West Midlands UK location map.svg
Red pog.svg
Shown in West Midlands
Geography
Location Birmingham, West Midlands, England, United Kingdom
Coordinates 52°28′23″N1°54′35″W / 52.4731°N 1.9096°W / 52.4731; -1.9096
Organisation
Care system Public NHS
Type District General
Services
Emergency department Yes Accident & Emergency
History
Opened1840;184 years ago (1840)
Closed1993
Links
Lists Hospitals in England
Birmingham Accident Hospital outpatient department (west) building Birmingham Accident Holspital L.jpg
Birmingham Accident Hospital outpatient department (west) building

Birmingham Accident Hospital, formerly known as Birmingham Accident Hospital and Rehabilitation Centre, was established in April 1941 as Birmingham's response to two reports, the British Medical Association's Committee on Fractures (1935) and the Interdepartmental Committee (1939) on the Rehabilitation of Persons injured by Accidents. Both organisations recommended specialist treatment and rehabilitation facilities. The hospital, generally recognized as the world's first trauma centre, [1] used the existing buildings of Queen's Hospital, a former Teaching Hospital in Bath Row, Birmingham, England, in the United Kingdom. It changed its name to Birmingham Accident Hospital in 1974 and closed in 1993. A listed building, it is now part of Queens Hospital Close, a student accommodation complex. [2] A blue plaque commemorates its former role.

Contents

History

The Queen's Hospital (Birmingham)

Queen's Hospital as built The Queens hospital, Birmingham. Wood engraving by A. Allen Wellcome V0012230.jpg
Queen's Hospital as built

Earl Howe laid the foundation stone of the Royal School of Medicine and Surgery in Birmingham's new teaching hospital on 18 June 1840, the building being completed the following year at a cost of £8,746. Henry Pepys, the Anglican Lord Bishop of Worcester, presided over the ceremony formally opening the 70-bed hospital. [3] The hospital's first president was Prince Albert. Upon his death in December 1861, the post remained vacant until 1875, when Lord Leigh was appointed to the position. This building was designed by Bateman and Drury and is a Grade II listed building. [4]

The hospital expanded rapidly. By 1845 separate wards were added containing 28 beds for infectious and contagious disease cases, raising hospital capacity to 98. In 1867, adjacent grounds to the west were purchased, and in 1871, Lord Leigh laid the foundation stone for a new outpatient department, originally known as the "Workmen's Extension" as it was funded by local working people, to the strains of a hymn written for the occasion by the Rev. Charles Kingsley and sung by 1,000 child choristers from the Birmingham Schools Choral Union. [5] This building was designed by Martin & Chamberlain and is also Grade II listed. [6] It opened for patients on 7 November 1873. [7]

In 1875, Queen's became a free hospital, abandoning the previous system whereby the hospital's financial supporters issued "subscriber's tickets" to authorise treatment. A one shilling admission fee was charged but could be waived. [5]

In 1877, 16,117 patients were treated at Queen's, but by 1908, the patient count had more than doubled to 39,483, composed of 2,685 inpatients and 36,708 outpatients. Average annual expenditure from 1909 to 1911 was £14,729, against average receipts £10,778 leaving an average annual deficit of £3,951, covered by endowments and donations. [5]

In 1900, William Humble Ward, 2nd Earl of Dudley, took over the presidency of the hospital. [3] A new block opened in 1908 with three stories of wards as well as a roof ward for six patients, the first of its kind in Europe. The integrated nursing home's capacity increased from 34 to 74 beds, and the hospital itself now had 60 medical and 118 surgical beds, totalling 178. [5] Bed count and services provided continued to expand until closure. [8]

Birmingham Accident Hospital and Rehabilitation Centre

Queen's remained a teaching hospital until the Queen Elizabeth Hospital, Birmingham opened. The outbreak of war however delayed the planned partial redeployment of the building as an accident hospital. In 1941, the opportunity was taken for Birmingham to address the problems of delay in treatment of serious injuries. Accidents in Birmingham had risen by 40% as inexperienced workers entered wartime factories. Birmingham Accident Hospital and Rehabilitation Centre as it became, was thus the last voluntary hospital in the country and its specified objectives included prevention of industrial accidents. Its Surgeon in Chief and clinical director was Professor William Gissane. [9] According to former consultant surgeon Keith Porter, the hospital had eight wards and there were usually around 600 staff working there at any one time. [10]

On 14 August 1944 the President of the Hospital, the Lord Mayor of Birmingham welcomed the Minister of Health Sir Henry Willink at the opening of a new reception area and Outpatients department. Willink said the Accident Hospital experiment was being closely watched and was likely to have a permanent future in hospital services. Referring to the Beveridge report and his own 1944 White paper, he said he recognised the close co-operation between the University, the city authorities and the hospital and hoped that this spirit of co-operation would pervade the future National Health Service. The Parliamentary secretary to the Minister of Labour George Tomlinson described rehabilitation as "one of the great social advances which has emerged from this war". He added that only 18,000 of the 200,000 disabled and unemployed remained so. [11]

Burns unit and Medical Research Council ('MRC') Unit

Whilst infection was known in the 19th century as a dangerous complication in severe burns, until the 1950s, its significance was regarded as secondary. It was only after treatment for shock was available that it became recognised as the main cause of death. Whilst initially a burn is likely to be sterile, it will quickly become colonised from external sources, usually other patients in the same ward. Prevention of cross infection was therefore a key objective. [12]

In 1941, Sir Ashley Miles, Professor of Bacteriology at University College Hospital Medical school and a member of the War Wounds Committee worked as part-time director of the hospital's MRC unit. [13] [14] He left in 1946, eventually becoming director of the Lister Institute of Preventive Medicine. In 1943 Leonard Colebrook, an expert on the earliest antibiotic Prontosil, active against streptococcus, moved with his burns unit from Glasgow Royal Infirmary. A joint project led to the development of MRC cream no 9, the main burns treatment at that time. [15]

Colebrook established the practice of placing the patients in a near sterile environment. [16] His political campaigning against unguarded fires and inflammable children's nightwear led to the Heating Appliances and Fireguards Act 1952. [17] [18]

In 1949, Edward Lowbury succeeded Colebrook as Head of Bacteriology. In the 1960s and 1970s, as one of the foremost researchers in hospital infection particularly in the prevention of burns infection, the problems of antibiotic resistance and skin disinfection, he lectured around the world. Clinical trials confirmed Colebrooke's work showing that specialist positively pressurised dressing rooms reduced infections. [19] With John Babb he proved that a specialised filter system could remove bacteria from an airstream and retain them either reducing infection risk or allowing an already infected patient to be treated in an open ward. [20] He documented the treatment of infections with Pseudomonas aeruginosa , noting that the development of carbenicillin resistance used a single mechanism, which conferred protection against a range of antibiotics. He further showed that overuse of a new antibiotic led to increased staphylococcus resistance, and that a subsequent reduction in use reversed the effect. [20] His work with Rod Jones contributed to the development of a pseudomonas vaccine. With Harold Lilly he developed tests for the effectiveness of hand washes before alcohol became the norm in 1974. These tests were still the basis for European standards when he died in 2007. [19] He worked on topical antibacterial compounds with surgeons Douglas Jackson and Jack Cason eventually leading to topical silver, which was still in use at his death. [20]

Dr Simon Sevitt and Pathology

In 1947, Dr Simon Sevitt set up a pathology department that covered bacteriology, haematology, biochemistry, histology, and morbid anatomy. [21]

Though his best known work was in venous thrombosis and pulmonary embolism, fat embolism, and the healing of fractures, he was to become an "outstanding pathologist, particularly in accident surgery". [21]
His controversial 1959 paper on thromboembolism after fracture of the hip in old people [22] written in conjunction with Gallagher, which found that fatal pulmonary embolism might occur 30 days or more after surgery for hip fracture [23] triggered work by other researchers and revolutionised the profession's attitude to preventing, diagnosing, and treating the condition. [21] Dr Sevitt died in September 1988. [21]

Ruscoe Clarke and the Treatment of Trauma

By 1954, before the introduction of crash helmets, UK road injuries were increasing rapidly. Motorcyclists alone accounted for over 1,000 UK deaths [24] compared to the 2008 road user total of just 2,645. [25]

"Research work at the Birmingham Accident Hospital improved the treatment of injury immeasurably." [24] Alan Ruscoe Clarke studied haemorrhagic shock for different types of injury and showed that the lethal collapse of blood volume was caused by swellings around a fracture or burn and not by blood becoming temporarily static in the capillaries. Immediate transfusion and surgery reversed or delayed the "illness of trauma" and was essential. [26]

In his 1957 lecture to the St. John Ambulance Brigade Surgeons' Conference in Harrogate, [27] Ruscoe Clarke described the old theory of shock and why it failed. Despite the success of James Blundell with blood transfusions, saline solution was the standard substitute from 1868 to 1916. [28]

Surgeon Ernest Cowell, writing in The British Official History of the Great War described the results of saline solution at the Battle of the Somme as "most disappointing". Canadian surgeons recommended whole blood transfusions [29] though volumes used were small: even the largest transfusions used were only about a litre. [27]

Treatment of shock from 1919 was based on observations of Cowell and Walter Bradford Cannon. However, plasma volume measurements suggested that more blood was disappearing from the circulation than could be accounted for. Since it was in neither the veins nor the arteries, it was assumed to be temporarily immobilised throughout the capillary system. Treatment was therefore aimed at encouraging blood to return to the circulation by heating the patient, rubbing the limbs and providing hot sweet tea intended to increase circulation volume. [30]

The large transfusions made possible by the development of blood banks in the 1930s transformed many patients. In 1940, Alfred Blalock proposed that shock was caused by bleeding, a view accepted by various authorities by 1946. The war injuries study of Grant and Reeve published 1951 recommended early transfusions for large wounds and suggested existing theories were inadequate. [27]

Ruscoe Clarke further described how observations at the Birmingham Accident Hospital on peacetime accident victims confirmed Grant and Reeve's work and provided evidence to reject the old capillary theory. Their work showed that blood was missing from the circulation just as often in closed fractures as in open wounds, that the blood lost appeared proportional to the severity of the wound and that the swelling of the injury frequently corresponded to the volume of blood lost. Blood loss from open wounds similarly matched blood lost from circulation. Blood losses had been consistently underestimated in the past but the provision of large transfusions during the Korean War had saved people with injuries who would not otherwise have survived. He recommended that where significant blood loss had occurred, even over an extended period of time, the patient should be transferred to expert medical care and receive an immediate transfusion. There was no place for hot tea, heat treatment or massage, which delayed proper treatment. [31]

Road Injuries Research Group

In 1960, Professor Gissane became honorary director of the Road Injuries Research Group, which investigated and analysed accidents on the newly opened M1 motorway at a time before seat belts were mandatory. Gissane believed risks of accidents occurring were lower on motorways but the consequences were more serious. [32]

A further study of "all deaths from road accidents in certain areas and periods" suggested lorries were the main cause of car fatalities on Motorways and Link roads and that seatbelts provided little protection available for the car occupants. [33] UK lorries are now fitted with an impact absorbing rear barrier, meeting one of the recommendations. Investigation techniques included interviews with police, hospitals, survivors and coroners to study ways in which vehicle design could be changed to avoid accidents in the first place and to mitigate the injuries caused. [34] Speaking in 2002, the former director of the hospital's research unit, Dr John Bull credited the unit with calling for mandatory seatbelt installation in new vehicles and compulsory wearing of motorbike crash helmets. The AA provided some money for research. [18]

Birmingham Bombings 1974

The Birmingham Pub Bombings was the worst terrorist attack in Great Britain until the 7 July 2005 London bombings. Taxi cabs and all available ambulances ferried victims to either the Accident hospital or to Birmingham General Hospital. [35] Accident Hospital switchboards were jammed as a total of 217 victims were brought in. Speaking in 2011, Roger Farell, the head of medical records described how he set off for work immediately on seeing the TV newsflash. Injuries included wood and glass shards –which cannot be detected by x-rays and some victims were rendered unrecognisable. Drinkers at the Tavern in the Town pub which was located underground suffered very severe blast injuries. The only fortuitous aspect was the geographical location of the blast -within a mile of a hospital housing the only specialised burns unit in the country at the time. The very worst cases went into the “world-leading major injuries unit” though nine of the twelve died. [36]

Related Research Articles

<span class="mw-page-title-main">Plastic surgery</span> Medical surgical specialty

Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery covers a wide range of specialties, including craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. This category of surgery focuses on restoring a body part or improving its function. In contrast, cosmetic surgery focuses solely on improving the physical appearance of the body. A comprehensive definition of plastic surgery has never been established, because it has no distinct anatomical object and thus overlaps with practically all other surgical specialties. An essential feature of plastic surgery is that it involves the treatment of conditions that require or may require tissue relocation skills.

<span class="mw-page-title-main">Surgery</span> Medical procedures that involve incisive or invasive instruments into body cavities

Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions, to alter bodily functions, to reconstruct or improve aesthetics and appearance, or to remove unwanted tissues or foreign bodies. The subject receiving the surgery is typically a person, but can also be a non-human animal.

<span class="mw-page-title-main">Blood transfusion</span> Intravenous transference of blood products

Blood transfusion is the process of transferring blood products into a person's circulation intravenously. Transfusions are used for various medical conditions to replace lost components of the blood. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, plasma, platelets, and other clotting factors. White blood cells are transfused only in very rare circumstances, since granulocyte transfusion has limited applications. Whole blood has come back into use in the setting of trauma.

Bloodless surgery is a non-invasive surgical method developed by orthopedic surgeon Adolf Lorenz, who was known as "the bloodless surgeon of Vienna". His medical practice was a consequence of his severe allergy to carbolic acid routinely used in operating rooms of the era. His condition forced him to become a "dry surgeon". Contemporary usage of the term refers to both invasive and noninvasive medical techniques and protocols. The expression does not mean surgery that makes no use of blood or blood transfusion. Rather, it refers to surgery performed without transfusion of allogeneic blood. Champions of bloodless surgery do, however, transfuse products made from allogeneic blood and they also make use of pre-donated blood for autologous transfusion. Interest in bloodless surgery has arisen for several reasons. Jehovah's Witnesses reject blood transfusions on religious grounds; others may be concerned about bloodborne diseases, such as hepatitis and AIDS.

A trauma center, or trauma centre, is a hospital equipped and staffed to provide care for patients suffering from major traumatic injuries such as falls, motor vehicle collisions, or gunshot wounds. A trauma center may also refer to an emergency department without the presence of specialized services to care for victims of major trauma.

<span class="mw-page-title-main">Blood-borne disease</span> Medical condition

A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious agents such as viruses. Three blood-borne pathogens in particular, all viruses, are cited as of primary concern to health workers by the CDC-NIOSH: HIV, hepatitis B (HVB), & hepatitis C (HVC).

<span class="mw-page-title-main">Orthopedic surgery</span> Branch of surgery concerned with the musculoskeletal system

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

<span class="mw-page-title-main">Injury in humans</span> Physiological wound caused by an external source

An injury is any physiological damage to living tissue caused by immediate physical stress. Injuries to humans can occur intentionally or unintentionally and may be caused by blunt trauma, penetrating trauma, burning, toxic exposure, asphyxiation, or overexertion. Injuries can occur in any part of the body, and different symptoms are associated with different injuries.

<span class="mw-page-title-main">Internal bleeding</span> Leakage of blood within the body

Internal bleeding is a loss of blood from a blood vessel that collects inside the body, and is not usually visible from the outside. It can be a serious medical emergency but the extent of severity depends on bleeding rate and location of the bleeding. Severe internal bleeding into the chest, abdomen, pelvis, or thighs can cause hemorrhagic shock or death if proper medical treatment is not received quickly. Internal bleeding is a medical emergency and should be treated immediately by medical professionals.

<span class="mw-page-title-main">Spinal cord injury</span> Injury to the main nerve bundle in the back of humans

A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. It is a destructive neurological and pathological state that causes major motor, sensory and autonomic dysfunctions.

<span class="mw-page-title-main">Hip fracture</span> Broken bone in hip joint region

A hip fracture is a break that occurs in the upper part of the femur, at the femoral neck or (rarely) the femoral head. Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk.

<span class="mw-page-title-main">Spinal fusion</span> Immobilization or ankylosis of two or more vertebrae by fusion of the vertebral bodies

Spinal fusion, also called spondylodesis or spondylosyndesis, is a surgery performed by orthopaedic surgeons or neurosurgeons that joins two or more vertebrae. This procedure can be performed at any level in the spine and prevents any movement between the fused vertebrae. There are many types of spinal fusion and each technique involves using bone grafting—either from the patient (autograft), donor (allograft), or artificial bone substitutes—to help the bones heal together. Additional hardware is often used to hold the bones in place while the graft fuses the two vertebrae together. The placement of hardware can be guided by fluoroscopy, navigation systems, or robotics.

<span class="mw-page-title-main">Fat embolism syndrome</span> Entry of fat into the bloodstream

Fat embolism syndrome occurs when fat enters the blood stream and results in symptoms. Symptoms generally begin within a day. This may include a petechial rash, decreased level of consciousness, and shortness of breath. Other symptoms may include fever and decreased urine output. The risk of death is about 10%.

<span class="mw-page-title-main">Tourniquet</span> Medical device

A tourniquet is a device that is used to apply pressure to a limb or extremity in order to create ischemia or stopping the flow of blood. It may be used in emergencies, in surgery, or in post-operative rehabilitation.

<span class="mw-page-title-main">Middlemore Hospital</span> Hospital in Auckland, New Zealand

Middlemore Hospital is a major public hospital in the suburb of Ōtāhuhu, Auckland, New Zealand. The hospital has approximately 800 beds. There are 24 operating theatres across two sites.

Edward Joseph Lister Lowbury was a pioneering and innovative English medical bacteriologist and pathologist, and also a published poet.

<span class="mw-page-title-main">Leonard Colebrook</span> English physician and bacteriologist

Leonard Colebrook FRS was an English physician and bacteriologist.

<span class="mw-page-title-main">Facial trauma</span> Medical condition

Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures.

<span class="mw-page-title-main">Sir Robert Jones, 1st Baronet</span> Welsh orthopaedic surgeon

Sir Robert Jones, 1st Baronet, was a Welsh orthopaedic surgeon who helped to establish the modern specialty of orthopaedic surgery in Britain.

<span class="mw-page-title-main">Femoral fracture</span> Broken femur, at shaft or distally

A femoral fracture is a bone fracture that involves the femur. They are typically sustained in high-impact trauma, such as car crashes, due to the large amount of force needed to break the bone. Fractures of the diaphysis, or middle of the femur, are managed differently from those at the head, neck, and trochanter; those are conventionally called hip fractures. Thus, mentions of femoral fracture in medicine usually refer implicitly to femoral fractures at the shaft or distally.

References

  1. ↑ "1941 First Trauma Centre Birmingham Accident Hospital and Rehabilitation Centre, Birmingham, UK". Trauma.org. Archived from the original on 26 August 2009. Retrieved 22 July 2009.
  2. ↑ "Birmingham Accident Hospital". The National Archives Hospital Database. Retrieved 22 July 2009.
  3. 1 2 Kelly's Directory. England. 1900. Archived from the original on 30 April 2009. Retrieved 22 July 2009.{{cite book}}: CS1 maint: location missing publisher (link)
  4. ↑ Historic England. "Birmingham Accident Hospital east building (Grade II) (1219917)". National Heritage List for England . Retrieved 8 February 2013.
  5. 1 2 3 4 Lloyd, John Henry (1911). The Queens Hospital. England: Cornish Brothers Ltd. Archived from the original on 30 April 2009. Retrieved 22 July 2009.
  6. ↑ Historic England. "Birmingham Accident Hospital west building (Grade II) (1075749)". National Heritage List for England . Retrieved 8 February 2013.
  7. ↑ Showell's Dictionary of Birmingham. Cornish Brothers. 1885. p. 101.
  8. ↑ Rossbret (6 August 2007). "The Queen's Hospital". Rossbret Institutions Website. Archived from the original on 30 April 2009. Retrieved 22 July 2009.
  9. ↑ Professor William Gissane (December 1963). The stages of development and the organisation of Birmingham Accident Hospital. Post Graduate Medical Journal. Archived from the original on 18 January 2013. Retrieved 22 July 2009.
  10. ↑ Alison Dayani (15 June 2010). "ACCIDENT HOSPITAL STAFF REUNION JOY". Birmingham Mail. Archived from the original on 24 September 2014. Retrieved 22 September 2014.
  11. ↑ Birmingham Accident Hospital. British Medical Journal. 2 September 1944. p. 318. Retrieved 22 July 2009.
  12. ↑ E.J.L.Lowbury (1972). "Infections associated with burns". Postgraduate Medical Journal. 48 (560): 338–341. doi:10.1136/pgmj.48.560.338. PMC   2495235 . PMID   5049253. Archived from the original on 23 January 2016.
  13. ↑ "Obituary:Arnold Ashley Miles 10 March 1904-11 February 1988" (PDF). J.Med.Microbiol-Vol 27(1988) Pathological Society of Great Britain and Ireland.[ permanent dead link ]
  14. ↑ Graham A. Ayliffe & Mary P. English (2003). Hospital Infection:from Miasmas to MRSA. Cambridge University Press. p. 137. ISBN   978-0-521-53178-8 . Retrieved 5 August 2009.
  15. ↑ "GLASGOW UNIVERSITY" . Retrieved 5 August 2009.
  16. ↑ "AIM25 Colebrook, Leonard (1883–1967)Identity Statement". Archived from the original on 6 June 2011. Retrieved 5 August 2009.
  17. ↑ Michael N Tempest (15 June 1956). "Burns and Scalds". British Medical Journal. Retrieved 7 August 2009.
  18. 1 2 "Pioneering hospital under the spotlight. (News)". Birmingham Post. 29 January 2002. Archived from the original on 22 March 2015. Retrieved 22 September 2014.
  19. 1 2 "Edward Lowbury:Prolific poet and leading researcher into hospital infection". The Independent. London. 18 July 2007. Retrieved 5 August 2009.[ dead link ]
  20. 1 2 3 "OBITUARY Professor Edward Joseph Lister Lowbury" (PDF). Journal of Hospital Infection: 299. Archived from the original (PDF) on 21 July 2011. Retrieved 5 August 2009.
  21. 1 2 3 4 Bull J.P. (5 November 1988). "Obituary". British Medical Journal. 297 (6657): 1190–1191. doi:10.1136/bmj.297.6657.1190. PMC   1834973 .
  22. ↑ Sevitt S, Gallagher NG (1959). Prevention of venous thrombosis and pulmonary embolism in injured patients. A trial of anticoagulant prophylaxis with phenindione in middle-aged and elderly patients with fractured necks of femurii: 2:981–89. Lancet.
  23. ↑ Giancarlo Agnelli (1988). "Postdischarge prophylaxis for venous thromboembolism among high-risk surgery patients" (PDF). Sage. Retrieved 2 April 2010.
  24. 1 2 Geoffrey Rivett. "National Health Service History Chapter 1 1948–1957 – Establishing the National Health Service:Orthopaedics and trauma" . Retrieved 23 July 2009.
  25. ↑ Bird, Steve (22 July 2009). "Recession brings sharp fall in UK road deaths". The Times. London. Archived from the original on 4 June 2011. Retrieved 23 July 2009.
  26. ↑ Gissane W (November 1959). "Alan Ruscoe Clarke 1908–1959". Journal of Bone and Joint Surgery. Retrieved 23 July 2009.[ permanent dead link ]
  27. 1 2 3 A. Ruscoe Clarke; Balla, JI; Swanson, I; Foster, JB (28 September 1957). "Recent Advances in Haemorrhage and Shock". British Medical Journal. 40 (468): 610–3. doi:10.1136/pgmj.40.468.610. PMC   2482632 . PMID   14220409 . Retrieved 26 July 2009.
  28. ↑ "Andrew Fullerton (1868–1934)" (PDF). Ulster Medical Society. p. 13. Retrieved 6 December 2018.
  29. ↑ Kim Pelis PhD. "BLOOD STANDARDS AND FAILED FLUIDS: CLINIC, LAB, AND TRANSFUSION SOLUTIONS IN LONDON, 1868–1916" (PDF). p. 16. Archived from the original (PDF) on 2 July 2007. Retrieved 26 July 2009.
  30. ↑ "First Aid Journal 1943 - 1944". Ambulance and Nursing Services. 1 January 1944. p. 74. Retrieved 6 December 2018.
  31. ↑ Drummond, Lieutenant-General Sir Alexander (25 April 1960). "Care for the Injured" (PDF). Royal Army Medical Corps. Retrieved 6 December 2018.
  32. ↑ Gissane W, Bull J.P. "M1 Fatalities" . Retrieved 23 July 2009.
  33. ↑ "Fatal Car Occupant Injuries after Car Lorry Collisions". 13 January 1973. Retrieved 23 July 2009.
  34. ↑ Jackson D.J. (April 1978). "A Birthday Tribute To Professor William Gissane". The Journal of Bone and Joint Surgery. Archived from the original on 5 December 2008. Retrieved 23 July 2009.
  35. ↑ Alan Stuart Hill, FIFireE. (21 November 1974). "Birmingham Pub Bombings". Archived from the original on 15 May 2008. Retrieved 3 August 2009.
  36. ↑ BRETT GIBBONS (24 November 2011). "There were some terrible injuries... It was the most harrowing experience of my life". Birmingham Mail. Archived from the original on 23 January 2016. Retrieved 23 September 2014.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.