French coast. He would later serve in the RAMC in Egypt and Palestine,
all the while gaining invaluable experience in treating complex orthopedic
injuries.
Once the war was over, Mr. Charnley (surgeons in England proudly
retain the title of “Mr.”) returned to Manchester, working part time at the
Royal Infirmary. Needing additional hospital work, Charnley accepted a
position at the Wrightington Hospital, twenty-five miles north of
Manchester. Why would the young surgeon accept a post at a remote
hospital in the countryside? And why was the hospital built there to begin
with?
Tuberculosis sanitarium facilities had been built around the world in the
19th and 20th centuries, following a typical pattern of rural, purpose-built,
single-story hospitals (as recommended by Florence Nightingale), where
open walkways, large windows, and fresh country air was thought to help
patients combat TB. After Robert Koch had identified Mycobacterium
tuberculosis in 1882, scientists could only dream of a magic drug to kill
the bacteria. Until that breakthrough, the contradiction of prepossessing
hospitals in pastoral settings, housing diseased, coughing victims dying
slow-motion deaths would persist. The Lancashire County Council
purchased Wrightington Hall from a financially distressed titled family in
1920, converting it into a nurses’ home with single-story hospital
pavilions built to accommodate 226 chronic TB sufferers. Independent for
decades, the hospital’s authority was transferred to the National Health
Service in 1948, about the same time that Charnley began making monthly
visits to the bucolic outpost.
Most of the patients at Wrightington were suffering from bone and joint
infections, rotting from the inside, with only palliative solutions to
consider. Interestingly, the incidence of TB began to decline just as
Charnley began to consult at Wrightington. As sanitation standards
improved (including milk pasteurization) and living conditions advanced,
fewer children were contracting TB, and with the introduction of
streptomycin and para-amino-salicylic acid in the 1940s, a TB cure was
possible. “Sanatoria and orthopedic hospitals all over the country were
faced with the same predicament—how to use effectively that large
number of beds which had been available for tubercular patients, and
which were now no longer needed.”^5 Patients could rightly expect not to
die from tuberculosis, but the ravages of the disease had not disappeared: