Charles Hanley was a consultant general physician who came to Leamington in 1964. In these extracts he discusses his relationship with the Pump Rooms' medical department and gives his views on the value of spa treatments.
Did you know much about the treatments offered at the Pump Rooms when you arrived in Leamington?
I knew virtually nothing. In fact I’m not even sure that I knew there was a Pump Rooms, but I was introduced to it by one of my predecessors who was a consultant in what was called physical medicine in those days and his responsibility included supervision of the physiotherapy department at the Warneford Hospital, I think also at Warwick General Hospital and he had a close connection with the Leamington Pump Rooms.
Did your colleague encourage you to refer patients there?
Encouragement yes, I think that understates the case. He was obviously very much attached to it and he gave me to understand that he would much appreciate my continuing in the same way. I knew right at the start that this was not going to be possible.
How did you know that?
Because the discipline in which he had grown up in medicine was totally different from that in which I had grown up. I’d grown up at the, well I won’t say the beginning of, but well into the development of rheumatology as a science based discipline within general medicine and physiotherapy had grown up as an empirical practice which had its roots in the field of rehabilitation and going back even further, in the field of spa therapy dating from the eighteenth and nineteenth centuries. It was a very different scenario.
So you almost knew immediately that referring patients to the Pump Room wouldn’t be for you?
No, it wasn’t as clear-cut as that because I knew that they had certain facilities which couldn’t be replicated within the NHS, notably pool therapy, which is valuable. It’s essentially non-weight bearing therapy and it provides extra physical attributes, namely warmth, exercise is much easier in a pool for some patients than it is on dry land, so there were some advantages, added to which I thought and was later convinced that the staff were extremely supportive, both of their patients and of the referring doctors. I had a high opinion of the staff. That of course came later once I got to know them.
So would the treatment at the Pump Rooms be offering more of a relief than a cure or not?
In regard to the patients that I was seeing, predominantly relief. I was dealing with the more medically oriented branch of rheumatology; notably inflammatory joint disease and the biggest component of that is rheumatoid arthritis which is chronic, usually over many, many months or years, and it’s progressive and it’s destructive. In other words, it destroys joints, can destroy other structures as well, muscles, tendons and so on. For those people it was a question of getting either a remission, which is a cessation of the active phase of the disease, or palliation, which is to relieve the symptoms which could be acute or chronic. Then there were other patients that I would see, predominantly in the field of degenerative joint disease, of which osteoarthritis or osteoarthrosis as it’s now called in some quarters, was the chief component, but it wasn’t restricted to patients with osteoarthritis of the peripheral joints. Often the big weight bearing joints like the knee, the hip and so on. I saw many patients with spinal osteoarthritis, disc disease, cervical spondylosis, which can be very damaging and whose effects may be seen in damage to the nervous system and that is much more in the field of general medicine with perhaps a slant towards neurology. They could be very, very interesting, in the sense that what one was presented with was the complications of the underlying disorder.
Was it a popular choice amongst the local GPs to send patients there, do you remember?
Well, I think this was a matter of generations. The older GPs very often felt that it was beneficial, not purely on the grounds of physical benefit to the patient – physical benefit to the patient – but initially when I first arrived, there was a social and psychological element involved in a referral to the Pump Rooms because one needs to remember Leamington Spa was a particular sort of environment, particularly before the Second World War, it was a place which had a population comprising a certain number of elderly retired middle class and upper middle class people, some of whom enjoyed the benefits of physiotherapy in the Pump Rooms. And if you want to know more about that scenario I suggest you make an enquiry into the modus operandi of the French and German spa towns, whose economies are very much defended by the powers that be in those cities and towns. It is part of the local economy and Leamington had its share of that, very small share. It was a field of medicine that I viewed with the most extreme suspicion.
Because of that commercial aspect as well?
No, because it’s a form of mumbo-jumbo. The application of mud packs and things like that.
So the whole thing to do with the beneficial agents of spa water and as you say, the mud packs, you’re completely sceptical about?
Let’s say I was sceptical, I could see certain areas in which my patients might be helped. I was particularly conscious of the fact that the staff in Leamington Pump Rooms, the physiotherapy staff, the professional staff, were generally of a high standard and therefore I had no hesitation about placing my patients in their care. But as to the scientific basis for hydrotherapy and physiotherapy as a whole, this is a very grey area, it still is a grey area, but there were parts of it that were extremely useful.
Rheumatology has undergone a massive transformation. It wasn’t even a respectable subject at one time. It is now a highly respected subject, a very important part of medicine and is based on the science of immunology which grew up in the 1950s and sixties. So we’re in a totally different scene. And you have to contrast that, or set it up alongside the concept of institutions founded in the nineteenth century, a source of civic pride whose survival was important to the civic fathers.
Right. So you see the spas of Bath, Leamington, Harrogate as survivals from a nineteenth century form of medicine?Yes, and a nineteenth century form of civic architecture as well. These are valuable components of the civic scene. You walk down the parade at Leamington Spa, you see the Pump Rooms, it’s an ornament. Now of course it’s been transformed and it is a most attractive part of the town and these are very valuable assets in a civic community. One must not denigrate these things, they’re very important, but medicine should be based on science, fundamentally and there comes a time where people have to make a choice between the pursuit of a scientific understanding of what it is they’re doing and an empirical understanding of what it is they are doing and the two sometimes diverge. And this is a classic example of where they did diverge.
So do you see the Pump Rooms and other spas as possibly having a place as leisure facilities?
No, I don’t because I think that they are a relic of the nineteenth century and the ageing population in the UK now is not derived from the social environment in which patients who used the Pump Room facilities had grown up. Now what are we looking at? We’re looking at baby boomers who are reaching retirement. What do they know about the Pump Rooms? Nothing. What is their taste in recreational activities? Mud packs? [laughs] Well maybe some of the elderly gentlemen would like to float in a pool with an attractive physiotherapist massaging them, but I don’t think that that’s a great number. No, I don’t think it’s a starter really. Swimming pools, yes, that’s another matter. But that’s an athletic story, nothing to do with medicine.