Peter Freeman joined the Warneford Hospital as a junior doctor in 1962 before joining a local GP practice two years later. In these extracts he explains how he became aware of the treatments offered at the Pump Rooms, how he was kept informed of the progress of his patients while they were being treated there, and how patients benefited from their treatments.

Did you know anything about the medical treatments offered at the Pump Room when you came to Leamington?

No, basically no. I mean medical training in those days in the fifties and sixties really, I think it accepted physiotherapy in the sense that they felt it was a necessary part of recovery and treatment, but I think as far as teaching the rudiments, the theory of physiotherapy in its widest concept was concerned, I had none. So I came here as a GP having done basic hospital experience in several specialties, with you know, a fair amount of hands-on work, but physiotherapy was something that people went to when they had an accident to recover from fractures or if they’d got arthritis or some locomotor problem. But how it worked and why it worked and what was the best bit of that sort of treatment for any particular condition was really beyond me, so I knew very little about it.

So how did you get to know about what was offered down there?

Well because I think, (a) because physiotherapy in those days was commonly used, I mean I suppose it still is, but a lot of people expected to have physiotherapy after say, a broken wrist or whatever, and particularly those who had illnesses such as rheumatoid arthritis or any sort of arthritis. I mean drug treatment at that time, forty years ago, was fairly rudimentary and aspirin was probably as good as any drug that we were using at the time. And there’s no doubt that physiotherapy helped a lot of these people and aided their recovery. So because it was done and commonly practised, one carried on in the same practice. The problem really as far as the Pump Room was concerned was that people had to pay for it, by and large. You could be referred from the hospital, which of course had its own physiotherapy department, at Warwick Hospital. And at Warneford, I think there was one at that time. Although they had their own physiotherapy, they were relatively small and they couldn’t cope with the volume of work which was required and used to send patients, refer patients to the Pump Rooms, which had a good reputation and some very skilled physiotherapists, staff, not employed by the NHS, but employed by the Local Authority, by the District Council or whatever it was, Local Authority in those days. And they would, I suppose they’d purchase, I’m not quite sure how it worked, but the hospital could refer patients to the Pump Rooms. But GPs couldn’t, at least you couldn’t under the NHS. So if I wanted to send somebody to the Pump Rooms because they had rheumatoid arthritis, from a financial point of view the best way to do it was for me to get in touch with the hospital who had perhaps seen them, seen a consultant physician, they’d perhaps seen a consultant physician for their arthritis or an orthopaedic specialist, find out what their hospital number was and persuade the hospital or persuade the Pump Rooms to see them on the basis of their hospital history. D’you see? If they hadn’t had a hospital referral and therefore didn’t have a hospital number, the only way I could expect to be able to get physiotherapy at the Pump Rooms would be by them having to pay for it. They were very happy to do it and lots of patients did, but it was a bit difficult really, specially with those who were less affluent.

So they wouldn’t contact you while the treatment was going on?

Not, probably not unless there was a problem. You know, either somebody didn’t turn up or the treatment may have perhaps made things worse or there was some sort of problem, they would. But normally during a course of treatment, unless I was seeing the patient for any other reason, they wouldn’t normally, I wouldn’t normally be contacted I think until it was finished. But eventually we were given these referral cards, pink referral cards, which we would write on the nature of the problem and what we think the cause was and what we would like the physiotherapist to be able to do. Not – which goes back to your point about what I knew or didn’t know about the treatments – they didn’t ask us to specify what treatment should be given, they would ask us to specify what we thought the problem was and what our expectations were. In other words, you know, this chap’s got a long-standing, or short-standing, short-lived lower back problem, but he happens to be a dustman and he has to lift dustbins and we need to get him back to work as soon as poss. That’s the problem. Expectations: relief of pain and improvement in mobility to enable him to work. And then the physiotherapist would decide what course of treatment he or she felt would be appropriate. And it was largely symptomatic relief. And of course we made the disastrous mistakes very often – I mean in retrospect – that people for example with low back pain were told to rest. Well, nowadays the thought is that the last thing you ought to do with low back pain is rest, you need to keep going, keep it mobile. So [laughs] sometimes our prescriptions were – but that’s typical of medicine isn’t it, it’s very fashionable, is medicine. [laughs] One day you’re told to eat this and the next day you’re told to avoid the same thing. You know, over a course of many years you realise that some of the things that we did were not the best and I’m sure that’s true of physiotherapy like other medicine.

Were the treatments – this is a generalisation I’m asking you to make – but were the treatments patients were given then at the Pump Room, were they generally successful?

I would say on the whole yes, in the sense that it wasn’t a matter of cure so much as a relief of a particular relapse or symptom. I mean I guess, looking at it objectively, the people who did go there probably would have got better anyway or not got better anyway, but it would have taken them longer to get there and a much more uncomfortable time. I mean I think patient – the answer is yes, it was good in the sense that patients felt they’d benefited from it, from symptom relief and possibly an acceleration of recovery. But whether anyone was actually cured and wouldn’t have been if they hadn’t gone there is perhaps a bit far-fetched.

So it was a mixture of financial considerations and the decline in sort of medical confidence in physiotherapy?

Oh I think it was almost certainly financial. I think even though perhaps conventional medicine has, the attraction of conventional medicine to physiotherapy may have waned a bit, I don’t think that was a significant factor because I think we all recognise how much symptomatic and psychological relief – and also the hands-on, the concept in physiotherapy of the hands-on therapy has a huge, huge psychological effect on patients and their problems, almost whatever they are, but the fact that the physiotherapist is laying on hands and offering massage or manipulation or… is hugely beneficial. And of course they had time too. One of the notable features I think about the staff there was that by and large they gave people time and offered them comfort and they were very approachable and friendly and they were smart, they were you know, dressed in their whites and looked the part, so I think people had confidence in them because of that and as I say, this laying on of hands, hugely, hugely important. So most of the people I know who went to the Pump Rooms were very pleased with what happened. So it wasn’t because people didn’t think it worked, it was because I’m sure financial difficulties. They’d needed, it got run down, it got, the premises needed a lot of work and as you know, I mean since it stopped it’s been revamped and almost rebuilt. So I mean there was a swimming bath – you don’t know that did you, or you weren’t aware. Were you aware there was a big…

Do you think hydrotherapy was a useful technique?

Yes I do. Again, not in the sense that I can explain how it worked, other than I think it’s very, it is very helpful with knees and hips and feet for therapy to be done when someone’s not weight bearing. So when you’re in water you’re not weight bearing and you can move joints and flex and extend joints that are not bearing weight rather more readily and I think the physiotherapist offering manipulative techniques in a bath of water was more helpful, yes. I think there was a place for it. And I think lots of patients felt benefit from it.