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Nottingham Children’s Hospital

LET'S BEGIN WITH THE CHILDREN



A History of Nottingham's Children's Hospital

1869 – 1978



By Lucia Crothall



"Let's Begin with the Children"


Transcribed by Paul R. Swift B.A.

 Honorary Archivist, Nottingham University Hospitals NHS Trust


Let's Begin with the Children was written by Lucia Crothall, Editorial Public Relations Officer for South Nottingham District to mark the transfer of the Children's Hospital to the University Hospital, Queen's Medical Centre, on 11th of November 1978.

_______________


Is this a holy thing to see

In a rich and fruitful land.

Babies recud’d to misery,

Fed with cold and usurous hand?


Is that trembling cry a song?

Can it be a song for joy?

And so many children poor?

It is a land of poverty!"


William Blake (1757-1827)


SOCIAL SCENE IN THE EARLY NINETEENTH CENTURY


At the same time as was Blake was writing about the poverty and hardships encountered by the children of his generation, 2,625 under the age of five died each year in Nottingham. In working-class areas, children were as likely as not to die before they reached five years of age.


Entire families had moved to what is now the centre of the city where the lace and hosiery industries consumed their labour ruthlessly. Land for building was limited and most people lived in dark, damp, overcrowded houses where fresh air and freshwater was unlikely to be encountered as wild crocuses in the city today.


The density of population in some areas was over 450 people per acre and a report in the 1830s stated that "in such quarters it is hardly possible that a family can preserve for any term of years either decency, moral or health." There was an enormous population growth in the city during the 1800s.


Local chemists mixed together enough treacle and laudanum each year to produce "many gallons" of the lethal opiate Godfrey's Cordial. The Cordial was used by working mothers to pacify their babies and its effects were often devastating in the long-term, leading to drug addiction, handicap and even death.


Other working mothers farmed out their infants to teenage baby minders whose knowledge of child care and whose finances must have been even less than their own. And working conditions in the factories were equally squalid. For the 8,000 Nottingham children – from the age of three – who worked in them, it must have been the case of "home from home".


For those who became ill, statutory bodies, self-help societies and apothecaries provided the only form of medical support available. The rest came from quacks and from within the family itself where folklore – which had been handed down from mother to child for generations – provided some ingenious remedies. Crabs eyes, eggshells, burnt harts horn and oyster shells have all at some time been employed in the search for good health.


The work of statutory bodies was particularly important in the steady awakening of an impulse towards the relief of the poor. They encouraged voluntary inoculation and vaccination in the late nineteenth century, while Nottingham's General Hospital offered hospital treatment to adult citizens of Nottingham from 1782. Children were only admitted there in cases of severe accident or illness.


So it was that poverty and ignorance helped to proliferate child exploitation, appalling housing conditions, (see illustration below) and a high rate of child illness and death; but throughout the century, social responsibility on the part of influential and religious individuals in Nottingham was quickened in an attempt to ameliorate the situation. On 22nd of June, 1869, a committee met to promote public charity and to discuss the formation of a hospital for the treatment of sick children in Nottingham.


Sussex Place



Sussex Place: was one of many yards, courts in the Broad Marsh/Narrow Marsh area with a density of population of 300 to the acre at its worst. These back-to-back houses of three or sometimes four rooms were about 10 ft.², and consisted of a ground floor living room and bedroom above and the workroom – which were originally housed in the knitting frame – at the top. At the end of the yards were the communal toilets, originally ash-pit privies, and the dust hole. By the middle of the nineteenth century most of these yards had a stand-pipe tap, supplying water which until 1880, was contaminated with sewerage. At its worst the official death rate reach 33 per 1,000, though this was probably well below the real figure. The expectation of life of a child born in the Marsh was 14 years. When these houses were demolished in the late 1920s and 30s the majority were venomous and rat infested.


NO NICE HOME TO BE ILL IN


Why establish a Children's Hospital?


1869 – The year of the formation of Nottingham's first Children's Hospital – was also the year of the Great Sanitary Commission. The coincidence of the two is significant because at last medical professionals had begun to realise the connection between bad sanitary conditions and ill health. National concern about the living conditions experienced by thousands of working families simultaneously challenged the arguments against using hospitals especially designed for children. These were separating the child from its mother and the risk of cross infection.


Dr George Armstrong, founder of the first children's dispensary in Red Lion Square, London in 1769, had warned: "If you take away a sick child from its parents or nurse you will break its heart immediately." Today the same fear has inspired a policy of unlimited visiting hours at the Children's Hospital; but even in 1977 it was shown that over 20% of children admitted to the hospital were taken in for social rather than medical reasons. The home environment can now – as in 1869 – be an overriding argument for admitting children to hospital.


In time, doctors who witnessed the suffering of children in their homes began to advocate the establishment of children's hospitals despite the risk of cross infection. By 1859, a Dr John Smith of Edinburgh admitted that: "The mixing up of sick children with sick adults is a deteriorating arrangement, yet worse is the retention of these little ones in their miserable homes. That country is strongest in riches which can boast the largest number of healthful men and women. LET US BEGIN WITH THE CHILDREN."


Edinburgh established its first hospital for the relief of sick children in 1859 – seven years after the Hospital for Sick Children in Great Ormond Street, London, and had been founded by the famous paediatrician, Dr Charles West. Between 1865 and 1875 a Children's Hospital was founded nearly every six months in England and Wales. Nottingham's was one of the many that reflected a change in attitude towards the role of children and the increase in medical knowledge that accompanied the change.


Changes in attitude and practice:


Ignorance and superstition had in the past prompted people to be indifferent towards child illness and death. They accepted the phenomena as God’s will. As late as 1874, one Whately Cooke Taylor, proclaimed: "I would far rather see even a higher rate of infant mortality prevailing and has ever been proved against a factory district or elsewhere than intrude one iota further on the sanctity of the domestic hearth and the decent seclusion of private life."


This preoccupation with the sanctity of the family indicates just how hard medical men of the time had to fight to win the public to their belief that children would fare better if treated in separate hospitals. Meanwhile children who had worked in the lace and hosiery industries continued to suffer from widespread diseases of the eye, the lungs and the stomach. At last doctors began to discover the reasons – working for long hours in candlelight, with the windows closed to prevent fresh air from entering and ruining materials and with the body pressed against the beam of the loom for hours at a time.


In its different ways, the literature of the day showed how the public reacted to the realisation that most diseases could be prevented. While Charles Dickens described in heart rendering passages the plight of individual children like Little Nell and Oliver Twist, the Nottingham newspapers dedicated their front pages to hundreds of advertisements along the lines of: –



"Just published, post free for one stamp.


WONDERFUL MEDICAL DISCOVERY


With local means of self-sure without medicine, whereby the following maladies are speedily and permanently removed, and vigorous health restored; nervous and physical disability, Spermatorrhoea, incapacity for marriage, lassitude, depression of spirits, loss of energy and appetite, pains in the back and limbs, timidity, self-distrust, dizziness, love of solitude, groundless fears, palpitation of the heart, noises in the head and ears, indecision, impaired  site and memory, indigestion and bodily prostration of the whole system."


– But unfortunately we can still suffer from some of the same symptoms on Monday mornings!


Headlines such as, "Every man his own doctor" and "Great remedies of the age" filled the advertising pages of the popular press, although many people assumed that children should bear hardships and pains without any fuss or bother. Charles Dickens and other writers of the day are now criticised for overindulging in sentimentality – but how else amongst these conflicting ideas could they get their message across?



Extract from the Nottingham Guardian, January 1869


In 1832, Chadwicks Poor Law Commission had concluded that disease was propagated among the labouring classes by atmospheric pollution resulting from filth, overcrowding, lack of drainage and effective water supplies. Significantly, one of Chadwicks advisers was Thomas Hawksley of Nottingham, the designer of Trent River Water Works, who condemned sanitary conditions in Nottingham long before the Sanitary Act of 1866, the Factory and Workshop Act of 1867, and the Artisan and Labourers Dwelling Act of 1868 – all of which illustrate the sudden spate of activity, coinciding with the opening of the Children's Hospital in Nottingham in 1869, that began to rectify the sordid situation. Thomas Hawksley wrote an important report about the appalling environmental conditions in Nottingham and presented it to the Royal Commission on the State of Large Towns and Populous Districts in 1845.


In 1867 an Act empowered Poor Law Boards of Guardians to enforce infant vaccinations, but reports indicate that one third of all illegitimate children died in the first year of life and that a quarter of legitimate children also died from starvation and drugging – baby farming and Godfrey's Cordial were still rife. In Charlotte Mason's story "Royal Law" (1889), the child is asked what would she do with some money. She answers "Oh build a hospital for the little sick and suffering children who are all crowded together in their homes in the street and have no nice homes to be ill in: where they can be away from the noise, have just what they ought to have to eat!"


This description of Poor, sick children and the aims of the first Children's Hospitals sums up conditions in Nottingham before the foundation of its own Children's Hospital. From 1800 to 1870, about half the children of Nottingham were vaccinated against smallpox. Indeed 1869 itself marked clinical advancements and voluntary endeavour in other ways too. It was the year when the clinical thermometer was first used in the city's hospital and the date of the Hospital Sunday Funds first collection. Nottingham's Fund was part of a national church-based campaign designed to bring forth regular Sunday donations for voluntary hospitals.


Other ailments of the day:


Pulmonary TB flourished in the conditions exhibited by industrial towns in the nineteenth century, but the number of deaths from the disease fell from an annual average nationally of 60,000 in 1838-43 to 3.6 deaths per 1000 in 1851 and 1.9 deaths in 1900. Consumption (TB) killed more people every year in nineteenth century Britain than smallpox, scarlet fever, measles, whooping cough and typhus fever put together. Towards the end of the century, a high proportion of operations were performed for TB of the glands, bones and joints, but it was not until 1925 that BCG vaccinations reduced the incidence of TB to only 79%.


This dramatic reduction in the incidence of TB was achieved by a combination of medical and scientific discoveries, social legislation and improved amenities, such was the decline in other common ailments suffered by the children of Nottingham. Of the 1,023 deaths of children under one year of age in the town in 1911, 347 were from diarrhoeal diseases. Measles, abdominal TB, phthisis and enteritis were also high on the death toll. The death rate in Nottingham that year was the highest in England and the number of children vaccinated had fallen to 44.10%. The work that began at the Children's Hospital in 1869 was undeniably required.



FOUNDATION OF THE HOSPITAL FOR

SICK CHILDREN, NOTTINGHAM


The first home


In 1868, the Rev Prebendary Miles encountered a lady who was walking through his parish. He reported that she said: "Can you do anything for me in this work I am wishing to undertake?" The work this mysterious lady referred to was the setting up of a hospital for poor ailing children, and soon she got the support of the Rev Miles. He brought forward the subject at a meeting of the General Hospital and it was not long before he had gathered together friends and other supporters for the scheme.


On 8 January 1869, the Rev J.C. Willoughby was elected Chairman of the Committee for the Hospital for Sick Children and Home of Charity and Mr Cann was nominated secretary. Miss Hine, daughter of Thomas Chambers Hine the architect, and possibly the mysterious lady who originated the idea, was a Sister of St Lucy's Home and Charity and Children's Hospital at Gloucester, and nursing sisterhood under the patronage of the Bishop of the diocese. She became Sister Millicent in Charge of the new Nottingham Children's Hospital while two local doctors from the General Hospital – Dr Ransom and Mr Wright – offered to take temporary charge of the patients.


The first job for the committee was to find a building for the Hospital. It took them three attempts to find a suitable accommodation, but the third – an offer to buy Russell House for £1500 – proved successful. Mr A. Knight who owned this property opposite the General Hospital, gave a £50 donation towards the scheme and £450 from the Hospital Funds went towards paying for the house that was bought on 26th of May, 1869. The rest came from other voluntary donations.


On 22nd of June 1 meeting of the donors and subscribers of the Hospital was held in the Exchange, and the Mayor, Mr John Barber, presided. The report of the provincial committee was received and adopted. His Grace the Duke of St Albans was elected President and the first Board of Management was formed.


At this first meeting the Chairman explained: "the nursing in this establishment would be voluntary nursing, a nursing prompted by the highest religious feeling…. That was essential to carry out the proper nursing of sick children" and Mr Willoughby illustrated the significance of mortality among the "lower classes" with the example of a woman who had given birth to 13 children, 10 of whom died and one who was in hospital for treatment. "That her children should die one after another had come to be regarded by her as a normal state of things," he concluded. "There is need for an institution to instruct the lower classes as to the effects of overcrowding, dirt, drunkenness and improper food."


Rules and aims


The rules and regulations recommended by the provincial committee were adopted at the meeting and it was agreed that the objects of the Free Hospital for Sick Children at Nottingham should be: –


1. To provide for the reception, maintenance and medical treatment of the children of the poor, from any distance, under ten years of age during sickness, and to furnish with medicine and advice those who cannot be admitted into the Hospital, as far as the means of the Institution will allow.

2. To obtain and diffuse a better acquaintance with the management of children during sickness, and

3. To assist in the training of women in the special duties of children's nurses.



It was clearly stipulated that "patients seeking admission for children, must sign a declaration of poverty, which declaration must be countersigned by the Clergyman of their Parish, or by some Minister of Religion, or a Town Missionary, testifying to the poverty of the applicant... Cases of children who are not poor can be received for treatment and nursing, special payment."


The second annual report of the Children's Hospital stated that "no Child with smallpox is received into the house. Many cases of rickets, hip-joint disease, or scrofulous disease of the spine or of the joints, are of necessity refused; either because they are quite incurable, or because they require nothing but rest for many months, or because good diet and fresh air, for months or years, are essential for improvement, and the reception of such cases would convert the Hospital into an asylum for sickly children instead of a place for the treatment and cure of the diseases of childhood; such cases, therefore, can be received only on a special medical certificate, or by special payment.


Russell House, No.3, Postern Street, the former residence of Alderman Knight and afterwards the first Nottingham Children's Hospital

Fever cases were sent to the General Hospital. In most cases the "sad fact is forced upon the committee that the greatest ignorance, not to say carelessness, on the part of their parents, has been the cause of these aggrieved forms of disease, which most probably might have been cured by an earlier application for admission to this hospital."


Opening – and teething troubles


The hospital was opened on first of July 1869 for eight inpatients who, from what we can infer from the ruthlessly restrictive rules, must have been there for a short time. They've probably suffered from those child diseases easily treated today, such as diarrhoea, scarlet fever and measles. The children were most likely to have been cured by the novelty of warmth, food and fresh water and by medical intervention.



By the end of the year 80 patients had been admitted. The Hospital was £100 in debt while expenditure amounted to £350 a year. Services in the Chapel were objected to and in February 1871, the Committee accented the resignation of the first Sister Millicent from St Lucy's who left the Hospital in the charge of two nurses and a domestic servant until the Sisterhood of St John's House, London, took over. Whether or not Sister Millicent was more concerned with the "spiritual" value of   her work then actual management of the sick is unclear, but Florence Nightingale's description of nursing in the late 19th century indicates that there was a conflict between methods of nursing employed by lady nurses/nuns and ‘professional’ nurses.


In April 1872, it was proposed by the Committee of the Medical Conference that the Children's Hospital be amalgamated with the General Hospital to save money. The Board of Management disagreed, reinforcing their reasons for establishing the Hospital in the first place by saying "special nursing by the Sisterhood is one of the main elements of the efficient nursing of children."


A year later it was estimated that the average cost of each child was 4s 6d a week and the cost of supporting 12 children, one Sister in Charge, two nurses and two servants for three weeks came to £16 8s in comparison with £8 0s 9d for four weeks with only nine children in 1873.


In the world outside the Children's Hospital, conditions had not improved much. Edward Seaton, the first Medical Officer of Health in 1873, decried the insanitary conditions in houses in lower parts of the town and the Meadows. A series of epidemics that hit the town during the next few years was closely connected with the insanitary conditions. Some of the Children's Hospital patients at this time could well have been victims of these epidemics. Unfortunately there is no record of their treatment or care in the Hospital, but we know that space and resources were limited, as at each of their meetings the Committee stressed the need for more of both.


As if to answer the Committee's prayers, in March 1874 a local townsman, Mr Charles Smith wrote to the Secretary saying: "I think we ought not to continue to keep thirteen or fourteen children in the space which is only calculated for eleven. I shall be happy to take up the expense of fitting up an additional ward to the value of £100." Later in the year, 10 additional beds were provided and Miss Townson, then Sister in Charge, began a system of visiting the houses of patients after they had left the hospital. For making as many as 227 such visits a year and running the Hospital, she earned £15, but in September she had at least acquired a superior title and more staff. The Sisters of St John's House withdrew and Miss Townson was elected Lady Matron of the Hospital. From 15th of November she was given £80 a year for nursing and managing the Hospital.



OBJECTIONS AND OBJECTIVES


A dispute in the local paper


Before 1876, outpatients were accepted at the Children's Hospital on only one week; after that date, two days a week work dedicated to outpatients. (This has now of course increased to cover five working days, the average number 20 clinics a week including such specialities as paediatric medicine, surgery, urology, cardiology and diabetes). The hospital was closed for a time following an outbreak of typhus that affected three staff members. Funds were again low, the demand for treatment was increasing and the Committee wrote more letters asking for help. In the same year a Ladies Committee was formed to encourage subscribers and raise money by organising annual concerts. Although donations were made – and the Board was able to construct a £2,050 new wing to the Hospital for 24 patients, in the same year – members of the committee had to make up a deficiency of accounts from their own pockets.


The changeover in staff was the probable cause of further aggravation. Both Miss Townson and Mr Beddard resigned in 1877. There are indications of disagreement and indecision among the governors in their inclination to discuss superficial details rather than to make firm decisions. The minutes of the monthly meeting held on 6th January, 1877, read like this –


"The question of the new building considered whether the plan originally proposed be carried out, or a second one as suggested by Mr Miles with dormers in the roof be adopted. Resolved that the original plan be executed and that the interior be so far modified that the buff bricks be carried up to the sill, then one course of a different colour, to be elected by Mr Evans, and above this, line a tile of lighter colour. With reference to the question of laundry, after discussing it, resolved that it stand over till next meeting."


Considering this extract it is tempting to agree with the comment of an "enquirer" in a letter to the Editor of the Nottingham Journal on 11th November, 1878… "My object in writing is… to point out to the actual or would-be subscribers (to the Hospital for Sick Children) the extravagance with which the hospital has been managed in the past – extravagance which requires so much begging and so much subscribing."


This letter was in fact written in reply to another from a subscriber who made an urgent appeal for more donations. "From what I hear", says the individual, this charitable institution "has never been in better working order or more economically managed than at the present time, and I believe the committee would listen to any reforms if fairly laid before them. It's two fine new wards were opened at beginning of this year for the accommodation of 24 or more cases...and since that date a lady (Mrs Jacoby) has generously offered a set of isolation wards (in remembrance of her daughter)."


The subscriber invited people to visit the Hospital and supported the changes in staff for which the committee had been criticised. She stated that nearly £1,000 was required for the annual maintenance of the hospital and that not much more than a quarter of this came from annual subscriptions. "There are no funds invested, and the annual subscriptions have not been increased according to the last report ten shillings since 1874… There are, I know, bad times for Nottingham, but they might be worse for our sick poor than inside the Hospital for Sick Children."


The objector replied that he would be interested to know what the £1,000 was spent on and that he/she exhibited the old attitude against hospitals for children when stating: "... If the mothers who send their offspring to the hospital, and thus rid themselves of all the cares nature intended for them, could hear their pitiful cries and dreadful screams, there would soon be no want of a hospital; for I daresay no mother, how little affectionate, would take their child there to be nursed by paid strangers."


An "eyewitness" responded even more vehemently, saying the Hospital: "had no right to be set up there, in the midst of a popular neighbourhood to the great annoyance and injury of property all around. Every step taken to alter and enlarge only makes matters worse… Nothing could be more foolish and reprehensible than to erect the large factory-looking wing upon the small bit of ground... and then to plunge headlong into a job without means to carry it out in a proper manner is wholly unpardonable" – sentiments similar to those we sometimes hear about the Children's Hospital's new home?


Help and development


So it was that lack of space, money and support thwarted development while demand for beds increased during the first 10 years of the Hospitals life. The upper age limit for the admission of patients was raised from 10 years to 12 years. This made matters even worse, the report for 1879 states that the work of the Charity Organisation Society was helpful in discriminating between deserving and undeserving cases. In order to reduce further the number of patients who "used" the Hospital, and to save money, the Board that year instituted a charge of medicine supplied to outpatients.


In 1879 the Children's Hospital was one of the first buildings in Nottingham to be equipped with a telephone. This revolutionary modern device was an invaluable method of contacting medical staff who were based largely at the General Hospital. The new outpatients department was built in 1886 at a cost of £1,000 and it was opened the following year by the Duchess of St Albans. The opening of the new Department led to an increase in outpatient attendances to 617 during the year.


Voluntary groups, organisations and individuals have always played a valuable part in contributing to the upkeep of the Hospital and the comfort of patients. This seems to have started with the establishment of the Cot Fund in 1881 when Nottingham Girls High School inspired several other schools to follow suit and help maintain beds. Furthering this spirit of voluntary endeavour, Colonel Charles Seely, the famous Nottinghamshire M.P. of the day, lent his own house and later another as convalescent homes for patients. A Samaritan Fund was introduced in the town in 1890 with the purpose of raising £1,000 capital to be invested to buy surgical appliances for ex-patients and after-care for patients who could not afford them.


In nearly 1890s, Dr Marshall and an increasing number of new medical colleagues stressed the Hospitals capacity to develop. In 1892 they were joined by the first House Surgeon to be appointed to the Hospital. Demands on the Hospital resources continued to outstrip the Management Committees ability to cope with them and they were forced to refuse admittance to a number of deserving cases. In the early years between 1877 and 1897 the number of inpatients rose fourfold and the number of outpatients, fivefold. In December 1876 there were 131 outpatients and the following inpatients:


 Send home cured 48 patients

 Relieved 19 patients

 Incurable   8 patients

 Died   3 patients

 Taken home for various causes   9 patients

 In Hospital on 31 December 1876 13 patients


By 1887 the number of new outpatients a year was 2,195, of which there were:


 Inpatients 297

 Accident and Emergency Cases 85

 Operations:

  Amputation – femur 2

  Amputation – finger 1

  Excision of hip 1

  Calculus Vesicole 2

  Impacted Calculus 1

  Osteotomy 2

  Needle in knee removal 1

  Harelip 9

  Circumcision 4

  Hypospadias 1

  Naevus treated by Electrolysis 1

                                                   ____

  Total number of operations 37


(Laryngotomy,tracheotomy,necrosis of the jaw and cleft palate were also listed).


By late 1889 the number of operations performed had more than doubled to 72, harelip's (9) and simple abscesses (14) being the conditions for which surgery was most frequently performed. The number of operations performed in 1895 increased further to 209. That year they were 11,174 outpatient attendances, 405 inpatients and 153 Accident and Emergency cases. By 1898 overcrowding in the 32 cot Hospital had become such a problem that an emergency meeting was held to negotiate for more property.



NEW HOME FOR THE CHILDREN'S


Forest House


On 16th October, the committee received a letter from Mr Thomas Birkin. He had heard of the difficulties and offered them his own large mansion known as Forest House, and by doing so, he managed to save the day. Without hesitation the committee accepted the offer and soon afterwards the architects Evans and Son were employed to convert the house into a hospital, while preserving its original structure. Forest House had formally belonged to Edwin Patchitt, a well-respected Nottingham solicitor and registrar for the County Court. This explains the emergence of the term "Patchitt's ground" to describe the land on which the Children's Hospital was situated.


Looking upwards in Forest House, Section of the Children's Hospital –a kaleidoscope view not to be encountered at University Hospital


The Hospital Staff, 1901


Forest House as it looked shortly after openly as the Children's Hospital


The Empress Frederick Ward


The Duchess of Portland Ward

As soon as it became practicable, after the move from Postern Street, arrangements were made for the official opening of the new hospital. It had been hoped that the Empress Frederick of Germany, the eldest daughter of Queen Victoria, will perform the ceremony, but owing to a prolonged illness she was forced to cancel the engagement. One of the new wards with ten beds was named after her.


Forest House, the new Children's Hospital, was finally opened in December 1900 by the Duchess of Portland. The larger 24 bed ward was given her title and she became actively involved in plans for a Grand Bazaar to raise funds and to reduce the debt incurred by the alterations to Forest House. At the end of 1900 income amounted to £1,546 while expenditure was £1,803.


Meanwhile, Sir Charles Seely bought the old hospital and Thomas Birkin again demonstrated his generosity by presenting the newly sited hospital with £3,000 to form an Endowment Fund. The Grand Bizarre – originally scheduled to take place soon after the opening of Forest House – eventually took place on 7th, 8th and 9th November 1901 when the public was less preoccupied with the South African War.


The Grand Bazaar


It wasn't simply a good natured sale as we know them today. A profit of £4,109 doesn't just emerge from the odd stall and cup of tea. Instead, many of the greatest, richest and noblest personages of the City and some of the most well-known entertainers of the day – including "Madame Melba" – combined forces to provide dramatic entertainment, concerts and stalls with a difference. The King, no less, instructed that the Bazaar be funded by Field Marshal Earl Roberts, who "consented to receive purses containing not less than £5 each from children" – a lot of money in those days! The Field Marshal, Commander-In-Chief of the Army, also unveiled a memorial plaque commemorating Thomas Birkin's gift of Forest House and its gardens.


The commemorative plaque that once adorned the entrance hall to Forest House


DEVELOPING A POLICY


In 1907 the new building was in full swing; there were 408 inpatients, 26,410 outpatient attendances, 907 operations, 22 patients with infectious diseases and 276 patients waiting for admission. According to Thomas Birkin, money was so well spent that "the institution could compare favourably with the best London Hospitals." But his instruction that Forest House could not be changed in his lifetime restricted the hospital's ability to expand and cater for more patients.


Matters were undoubtedly improved by the 1907 Education Act which provided for the medical examination of schoolchildren. This new measure may have been responsible for the fall in the number of patients indicated by the hospital in its annual report of 1910 which nevertheless ended with a plea for more money. The Public Health Act of 1913 aimed at quelling tuberculosis and promoted home visiting. National legislation of this kind must be recognised as being responsible for many improvements in the health of children in Nottingham, although local support is still vital to the welfare of the hospital.


The Player Extension


It must have been with great relief that, following the death of Thomas Birkin in 1923, Miss M Boden, matron of the hospital received the news of Mr and Mrs John Player’s offer to pay for the building and equipping of a new wing for the hospital at a cost of £30-£40,000. Extending the old building and bringing up-to-date accommodation for all the staff, while retaining the old world character of the exterior was a tremendous challenge. The Player's were determined, nevertheless, to increase the number of beds available to twice their number – 80 in total.


The new wing of the Children's Hospital was opened by Princess Mary on 30th April, 1927. The Princess was received at the main entrance by the Duchess of Portland and, amidst a burst of applause; she was presented to Mr John Player, Chairman of the Board and provider of the wing. About 1,500 spectators watched from the hospital grounds and the guard of honour was formed by Boy Scouts, Brownies and the Boys Brigade. It must have been as colourful as site the one that greeted the arrival of our present sovereign to open the Queen's Medical Centre fifty years later.


Mr John Player explained to the Princess that – "Encouraged by the possession of this beautiful site, the gift of the late Sir Thomas Birkin some years ago, we have endeavoured to make a new building in every way suitable for nursing and comfort of little children in the most up-to-date lines, being mindful of the great advantage of fresh air and sunlight."


The Bishop of Southwell blessed the building, and the architect then presented Princess Mary with a gold key to unlock the main entrance. Princess Mary visited the wards, and open-air ward and the playgrounds in the roof and named one of the wards "Princess Mary." She concluded: "I think this is charming – I have never seen anything like it."


During her visit, the Princess was told that the number of beds could not be further increased immediately because temporary accommodation was required for the additional staff needed for work in the new wing. Forest House, now only part of the total hospital, was later to be enlarged and converted into nursing quarters. Other developments, including an extension to the outpatient department, and x-ray department, ultraviolet ray and electrical massage departments, were to follow during the next few years. In May 1936 there were 358 attendances at the Sunlight Department and 39 x-ray films were taken.


The bronze plaque commemorating the opening of the Player Wing on 30th of April, 1927


Princess Mary visits award in the Player Wing during her visit on 30th April 1927


Princess Mary is accompanied by Mr John Player at the opening of the Player

Wing on 30th April 1927


Recollections


Personal memories about the Children's Hospital contain some vital information which cannot be obtained anywhere else.


In 1903 Mrs W Sanders was admitted to the hospital to have a tubercular gland removed. She remembers – "salt and sand bags to keep my head in place – back teeth taken out without anaesthetic – nurse held me to make me swallow rice pudding – long windows right to the floor – mother and father used to come and stand outside just to look at me as they were not allowed in – on the day I was to be discharged,  mother came at 8 a.m. – can remember her walking down the ward with clothes and Sister called "We don't discharge until 10 a.m., Mrs Fincham – come again then."


Mrs Ethel Field remembers this –


"Early 1920s and only a few years old, but I still retain a vivid recollection of my stay in hospital. My bed was situated on an open verandah overlooking a lawn. We were given a real treat on fine afternoons – blankets were placed on the grass and, carried by a nurse, we had tea out of doors."


In 1921 Miss M Boden joined the Children's Hospital to run the Duchess of Portland Ward and the Outpatients department. A few weeks before her death in June 1978 she remembered how:


"The 12 hammock beds were used for overnight recovery from tonsil and adenoid operations; the surgical and orthopaedic wards were mixed; steam tents were used for patients suffering from croup; tracheostomies were sometimes performed at the bedside; the nurses supervised the cleaning, the purchase of food and the stores; resident nurses lived in rooms on Thorncliffe Road under the supervision of a Sister Tutor; the great Boardroom was magically transformed each year for the grand dance; Mr John Player became Chairman of the House Committee."


E.M. Cox, R.S.C.N. recollects some of the important happenings at the Children's Hospital between the 1920s and the 1940s: –


"My mother remembers going to the hospital by pony and trap to have a Tonsillectomy when patients were nursed in what had been the Boardroom/Ballroom of Forest House – this would have been in the last decade of the 1900s. I myself had a Tonsillectomy about 1929. Patients with this operation were admitted one day, had the operation the following morning, and the morning after were dressed and sat on red blankets in a small room adjoining the restroom in the Outpatients Department until collected by parents. It is still quite vivid in my memory how wretched I felt on the 12 mile journey home by bus... I recall my mother taking in a whole basket of fruit for children on the wards of the newly built hospital.


On September 1st 1939, I commenced my training at the hospital and recall how on Sunday morning while bed bathing patients on Margaret Jenny Player Ward, Sir Neville Chamberlain announced England was at war with Germany. That evening the sirens were sounded (a false alarm) and Miss Boden, the Matron ordered as many patients as possible to be moved into the nurses sitting room. Following this episode, it was decided to move all patients if possible into the basement where we lay them on mattresses, and the babies into clothes baskets. Obviously patients on traction or receiving an infusion were wheeled in their beds into the corridors between the wards.


Following one serious air-raid on Nottingham – May 8th 1941, I believe – when part of the Outpatients and main theatre suffered some damage – it was decided by the consultants and committee to evacuate the patients with tuberculosis of the hip or spine who were nursed on frames in shelter, now Wilkie Scott Ward, out to a hospital at Grindley-on-the-Hill. I travelled with Teddy, Terry and Brenda by ambulance and will never forget the excitement of those children when they caught a glimpse of buses through the windows, having never seen any. It was heartbreaking having to leave them as they anticipated the other nurse and myself would be staying, even though we had explained that we had to return to Nottingham."


Sisters’rules O.K.?


"Parents of patients were not allowed to visit their children, unless critically ill and the Sister from each Ward sat at a table in the Outpatients Department Hall each Saturday afternoon to interview parents and to inform them of their child's progress and collect food, books, etc. When long-stay patients were discharged, mainly toddlers, they would cling to the nurses, having forgotten their parents. I often wonder if these children were affected emotionally, due to being separated from their parents, especially when one thinks of free visiting these days.


Even though the discipline and rules were very strict, they were happy, memorable days and we had tremendous respect for our Matron, Sisters and Seniors – and, of course, the Consultants and Doctors. Our parents had to provide all our uniform, enough to last practically our three years of training. Our salary in old currency was –


1st year – £2 10s a month

2nd year – £2 18s 4d a month

3rd year – £3 6s 8d a month


The hours of duty were long and unless one had an evening or day off, we were not allowed out after duty, and on day or evening off we had to be in by 9:30 p.m. and late leave once a month until 11 p.m. and everyone had to live in, including Sisters."


"Mr Player and his male secretary visited the hospital each week, going round the wards with Miss Boden. He was such a gentleman, with a good morning for any member of staff.


I remember all the Consultants – Dr Wilkie Scott and Dr Proctor, Mr Davies, later to become Surgeon Emeritus and Lord Mayor of Nottingham, Miss Glen Bott, Mr Swan, Mr Crookes and Mr Birkett (Orthopaedic surgeons) Mr Marshall (E.N.T. Surgeon) and Dr Bywater (Dermatologist). There was only one House Physician, one House Surgeon and a Casualty Officer, so you will appreciate they were often on duty 20 hours of 24. I remember the first Sulphonamide drug M&B 693 being used and the wonderful response to the drug…


I am pleased to have nursed through two errors, the one before the days of antibiotics and the many wonderful cytotoxic drugs and wonderful equipment now in use. I still keep in touch with nurses I trained with in 1939 and they, like me, feel rather sad and nostalgic when we think of the Children's closing. However, I'd take this opportunity in wishing all the Consultants and entire staff, every success when they move to the new University Teaching Hospital.


Extract from 1978 patients information booklet:


Visiting


It is very important that parents visit often. At first, your child may cry to be taken home because no matter how kind the nurses are, he would much rather be at home with you. Show that you understand how he feels, so that although he cannot leave hospital just yet, you will be ready to take him home as soon as the doctor says he is well enough. Even though he cries when you leave, your visits will make him feel more secure, so do visit as often as you can.


What to bring


Ask him what favourite toy he would like to take into hospital with him. It does not matter how old it is, as it will remind him of home and if he, like many young children, usually goes to bed holding something special (such as a soft hanky or a piece of blanket) let him have that too and draw Sisters attention to it.


Enquiries


You can ring the hospital at any time, but to avoid ward staff answering unnecessary enquiries, we ask that only parents make telephone calls, and during the following times:


  9.00 a.m. – 12.00 noon

  2.00 p.m. –  4.00 p.m.

  6.30 p.m. –  8.30 p.m.

 10.00 p.m. – 11.00 p.m.


NURSING BEFORE THE WAR


By 1929 the hospital had 100 beds and was therefore big enough to establish a preliminary nurse training school. An application was made to the General Nursing Council for recognition to raise the status of the hospital, and each floor was staffed by one Sister and two fully trained Staff Nurses. Medical staff recommended that the Board consider arranging for the admission of a limited number of paying patients.


In 1937 a spread of intestinal infection in the hospital prompted the recommendation of increased vigilance in the sterilisation of bedpans, napkins and other objects. The following instruction was issued – "After handling bedpans or soiled linen, nurses should always wash their hands thoroughly in running water. They should also wash their hands before handling food or feeding babies."


Another extract from the Medical Committee minutes for that year reads – "It was pointed out that on the Top Storey children are washed, etc. in the laundry, which the honorary staff consider it very undesirable." Hospital hygiene evidently left a great deal to be desired – should children and soiled linen have been washed together!


Mrs Eva Scott, who formerly nursed at the Children's Hospital and Sister Joyce Jepsom who still works there, recall some even more surprising happenings that occurred around this time. Sister Dorothy Sykes – still in charge of the outpatients department – knitted clothes for children on the wards as part of the job. A gentleman named Mr Sturk apparently had the ability to extract the correct record card as soon as an accident patient arrived. He must have known many children from the poorer quarters of Nottingham, whose parents couldn't afford to pay a General Practitioner.


Mothers would arrive at the outpatient departments carrying children wrapped in blankets, together with carrier bags and thermos flasks ready for the long wait. Sister Doris Snape's first move would be to walk up and down the rows of bundles examining each to see if the swaddled babies were dead or alive. It was more than likely that one of her next duties would be to use an early form of anaesthetic while reducing simple fractures by the "rag and bottle" method – gauze and chloroform.


W. H. Maslen remembers the same procedure in his descriptions of a visit to the Outpatient department in 1911 and an operation at the Children's: –


"There always seem to be hundreds of mothers and children, so many that it left only a narrow space for nurses etc., to walk along between the people… I remember my first operation, a removal of adenoids very clearly. I was first for the operating table, placed on my back, my arms and legs held by theatre staff, whilst what appeared to be in inverted tea strainer was held over my nose, chloroform was dropped in spots upon it, this gas, heavier than air, came down as I breathed in, I fought and struggled for dear life, then it seemed I went into the tunnel of darkness and fell off into space."


Further recollections from the 1930s included varied duties of staff, one of whom even cleaned the Physiotherapy Department in the mornings and did post-mortems in the afternoon, swapping a green apron for a white one. Another washed dried and ironed napkins each working day at the Hospital. Chesty children were nursed on outside terraces. Coal fires roared away in each of the wards. In 1938 the Medical Committee reported that the House Physician had mistakenly used chloroform instead of ether in the operating theatre, and the surgeon had operated on a child for the wrong complaint because of improper identification. Horrifying though such incidents may seem, it is only comparatively recently that rigorous efforts to avoid such accidents have been built into nursing and medical practice. Similar events – when they occasionally happen today – invariably receive the "shock horror" treatment they deserve.


During the War special arrangements had to be made. Sister Jepsom prepared an emergency theatre in the hospital basement where she spent many nights with patients. Some children had to be evacuated in case of severe damage to the hospital. There were temporary appointments for Honorary Assistant Surgeons. The post-war staff consisted of two General Surgeons, one Ear Nose and Throat Surgeon, one orthopaedic surgeon, one assistant surgeon, to physicians and one assistant physician. Nursing staff, though, were in short supply, and in 1946 the situation threatened the closure of a medical ward. It was at this time that the appointment of a paediatrician was first discussed.



NEW CONCEPTS IN CARE


About 200 years ago the main causes of death in children were the common diseases which can now be cured. Today "accidents" account for the principal causes of death in children aged 1 to 15 years. Even so, about a quarter of the accident and emergency admissions to the hospital are derived from the same causes that were prevalent but virtually untreatable in 1869. Problems and limitations in the home still account for just under a quarter of admissions, and a recent survey published in the British Medical Journal showed that about 30% of child admissions came from each of social classes V, IV and III in Nottingham, while only 0.5% and 7.0% came from social classes I and II.


As many as one in four children from some parts of the city are still admitted to the hospital in the first year of their life, and it is these same areas that are judged to be badly off with respect to income, employment, housing, education, socio-cultural background and crime. In deprived areas the rates of infant death and child mortality are also above the city average.


But great advances have taken place as a result of changes in the treatment of children and attitudes towards them. In 1977, Professor Donald Court, Chairman of the Committee on Child Health Services, said at Queens Medical Centre:


"I think there has been a tremendous improvement in the health of children in this century, particularly in the last 30 years since the beginning of the Health Service."


Impact of the National Health Service


What improvements have taken placed at the Children's Hospital since the nationalisation of the Health Service on 5th July, 1948? The National Health Service was introduced by an Act of 1946 which stipulated that hospital services should be planned as regional bodies, each region having a teaching hospital and general supervision over hospital services. With the introduction of the NHS the Children's Hospital became a free hospital not only for the poor but also for the rich.


By 1946, financial support for voluntary hospitals was dwindling when most in demand. Medical progress had reached the point where, without finances, it could not develop. The introduction of the National Health Service meant just what the doctor ordered – more financial support and medical intervention. So it was that the Children's Hospital became administered by the Sheffield Regional Hospital Board and the Nottingham No. 2  Management Committee, which describes itself as "primarily concerned with the enlightened pursuit of economy as far as is consistent with the requirements of the sick."


The old House Committee continued despite the introduction of a new management committee. And although Mr John Player resigned from his position of Chairman, never to visit the hospital again after his former daily dedication to it, other members of the house committee continued to make recommendations to the management committee and to use the remnants of their former power. Mr Frank Pragnall became chairman of the committee and the hospitals endowments were transferred to an Endowment Fund to be used outside the official budget.


Medical work was entrusted to a number of part-time Honoraries, each of whom was responsible for a number of beds. Improvements were made to the X-Ray Department, theatres and wards. New X-Ray equipment and anaesthetic apparatus, especially designed for children, were introduced.


Nursing outside in 1927

On 27th April, 1949, members of the Hospital’s Comforts Fund had their first meeting and they have since gone on to raise money, giving many comforts and gifts not only to the children but to the staff of the hospital as well.


Accident and Emergency cases were now taken into the hands of specialists, though the general surgeons were to treat young patients alongside their adult practice for years to come. One orthopaedic surgeon established a tradition of himself treating burns cases among children on-site. In 1977 this unusual practice was abandoned because children's with burns were then admitted to the plastic surgery unit at the City Hospital.


In 1950, John Player died, having been a member of the Board for 49 years, Chairman for 28 years and having donated £180,000 of his own money to rebuild the hospital. He died when medical staff at the Children's Hospital were true specialists in the care of sick children rather than physicians with an interest in children. For the first time in history of medicine, children were surviving from conditions which, in John Player's prime, would have led to an untimely death.


It was not until the late 1950s however, that the control of infection came to the fore. Concepts of antiseptics and hospital hygiene as we know it today were in their infancy. Indeed, one surgeon who operated with the theatre windows opened and a mask on, and another who preferred to have the windows shut and to be unmasked. Both had a high success rate!



THE SPECIALIST APPROACH



The yearly maintenance costs for 1948 was £30,638, as compared with about one and a half million pounds today (1978). Both the waiting list figures (374 in 1977) and outpatient attendances have decreased significantly over the years. In 1950 there were 79,773 outpatient attendances, whereas in 1975 there were 24,765. In 1950 there were 1,030 children waiting to be admitted. In 1975 the figure was a mere 318.


Undoubtedly the most dramatic change shown in the statistics is the average length of stay. Not surprisingly, the number of children going through the hospital has increased from 3,675 in 1948 to 5,223 in 1975 and the length of stay has been reduced from an average of 11 days in 1948 to an average five days – little more than half the length of time – in 1975. The average length of stay for inpatients in 1977 was 5.1 days for General Medicine, three days for General Surgery, 3.5 days for Ear, Nose and Throat and 8.3 days for Trauma and Orthopaedic Surgery.


The Operating Theatre in 1927


When Fred Carrier joined the hospital as its first porter in January 1949, he found that every Monday afternoon he had charge of the 20 patients who were admitted to Bell Tawes Ward to have their tonsils or adenoids removed. They were discharged on Thursday mornings, while on Thursday afternoon another 20 arrived and the same pattern was repeated. On Wednesday afternoon at the fracture clinic, Fred had what he described as a "slack afternoon" if he removed 20 plasters. He was electrician, technician, Gardner, clerk and "Uncle Fred" all "rolled into one" as occasion demanded.


But over the years, Fred's duties, like those of the doctors and nurses, became more specific, and several other new groups of professionals joined the hospital team, each with a skill unique to themselves.


Visiting – New approaches


Contact between parents and nurses were rare during Fred's first years at the Children's Hospital. A quick word with the Sister on a Saturday was all lucky parents could expect. The reasons behind such restrictions were mainly fear of cross-infection, and a sincere belief that children would adapt more easily to hospital life and make a quick recovery if they didn't see their parents too often.


The importance of childhood experience had first been recognised by Sigmund Freud in his theoretical work on mental health. More recently, Dr John Bowlby’s studies on the effects of maternal deprivation in early childhood have presented evidence that such deprivation could lead to short and sometimes long-term effects on the child's personality, intellect and future mental health.


In 1961 a group of young parents formed the National Association for the Welfare of Children in Hospital to bring pressure to bear on hospital authorities and staff to adopt the recommendations of the Platt Report on the Welfare of Children in Hospital. The acceptance and adoption of these new concepts in childcare have called for a change in the attitudes and duties of the paediatric nurse. A major aspect of her new role is supporting, teaching and counselling parents – a function that is expected to increase at the University Hospital.


This new approach to the relationship between child and parent at times of illness has been so revolutionary that planning for the transfer of the Children's Hospital to the University Hospital has included as a matter of course the provision of parent accommodation. No purpose-built accommodation for resident parents could have been envisaged by earlier generations of childcare specialists.


In 1959, the Platt Report on the Welfare of Children in Hospital reported that a new approach to the care of sick children had dawned, thanks largely to medical and surgical advances. The committee considered that children in hospital need not necessarily be confined to bed, that special amenities for recreation and education should be available and that visiting should be unrestricted. One of the main philosophies behind this report was that the child "should be subjected to the least possible disturbance of the routines to which he is accustomed." Twenty years later the acceptance of these findings and their gradual implementation at the Children's Hospital has amply vindicated the views of the Platt Committee.


Changes for staff since 1948


Dr Patrick Page joined the hospital as its first specialist paediatrician on 7th of July 1948. From this time until his retirement in 1977, he saw the introduction of unrestricted visiting, special facilities for children and the shift from local to general anaesthetics. Although Dr Page had been associated with treatment of 900 patients using local anaesthetics without witnessing a single death, of his first four cases of pyloric-stenosis, three died due to cross infection. This disaster led to the division into the cubicles on the Duchess of Portland Ward in 1949.


Until 1948, tuberculosis meningitis have been fatal, but with the development of new drugs such as sulphonamides, penicillin and streptomycin, this and other diseases including rheumatic fever, diphtheria etc., have almost vanished, and developments in anaesthetics have revolutionised surgery in operating theatres. The Frederick Crookes Operating Theatre – from which, rumour has it, Mr Crookes once threw the old theatre table out of the window in his endeavour to obtain a new one forbidden him by the management committee – was the scene of 1,852 operations in 1948. In 1977 the number of operations was 2,219.


Again in 1948, Miss "Goldie" Chambers became superintendent radiographer, having qualified in radiography as a staff nurse at the Children's Hospital. In those days she had quite literally to work "in the dark" and handle wet films in the then long and complicated process of producing x-ray films. At present about 14,000 X-Rays are taken each year with a 90 second automatic developer, image intensifiers, video-tape cine recordings and a large staff including a children's radiologist to provide the service.


When Miss M. Boden was Matron in Charge of the Hospital, medical staff did their rounds twice a day and it was ensured that no toys were insight. The patients were neatly tucked up in their beds.


What a different state of affairs is encountered by the medical staff now! For those children who can move, the Ward bed is simply for sleeping in at rest and bedtimes. The day can be spent more-or-less normally and toys, schoolteachers, activities, play leaders and relatives are always in evidence.


Dr Brandy, well-known and well-loved consultant at the Children's Hospital since 1950, recalls these and other enlightened transformations with glee, despite his current illness. A couple of years ago he wrote down some of his experiences at the Children's Hospital over 25 years: –


"When I was first appointed, the senior physician was part-time and there was only one other full-time physician who was very good to me. He found that there was too much work. The surgeons were excellent at their work but they did not understand anything about children. The children have therefore to be transferred to them in the best possible condition to undergo surgery. One of the greatest advancements I have seen is the provision of anaesthetics. We now have two paediatric surgeons… and two anaesthetists who work entirely in Nottingham. Another new innovation is that of numbering the notes and these are now done according to the date of birth so that the same number is used when he or she is treated throughout the British Isles. This saves staff a lot of time in looking for notes. Another new innovation is the high dependency nursing area. We were very lucky to get it. The unit – described in detail later – was one of the last major developments in care at the Children's Hospital."


At work in an Operating Theatre, August 1978

Parental involvement is accepted and welcome in the day-to-day routine of the Hospital. Here mum and dad help the radiographer position their child for an X-Ray.


New devices


In 1948 a new ward, the Wilkie Scott was opened, although finding the medical and nursing staff to run it proved difficult. On 21st of November 1951, the Medical Committee discussed the allocation of Senior Registrars and Registrars in the Region and it was said that "although paediatrics generally has not fared specially badly in Regional Hospital Board Hospitals, certain specialities having a close bearing on the welfare of children – viz, orthopaedic and anaesthetics – health fared very badly."


Medical representatives supported by Miss Boden's enlightened view that trainee male nurses should be accepted in view of the shortage of nursing staff, but the House Committee, who could override decisions by other Committees, firmly rejected the idea.


1953 saw the introduction of dictaphones to the Children's Hospital, about which the Medical Committee warned: "in all such mechanical devices there are, at times, technical hitches" – a view happily not extended to their newly introduced medical devices. Indeed, it was manpower rather than devices that concerned them most of the time. In June 1954 the north wing of Margaret Jenny Player Ward was close owing to a shortage of nursing staff, although the principle was accepted that no suitable case should ever be turned away from the hospital.


Problems of overcrowding in the orthopaedic ward became so acute by 1959 that the medical staff discussed the possibility of using "Brantwood" – a house situated adjacent to the hospital, as an annex for orthopaedic patients. Other suggestions for the use of this house included a convalescent hospital, accommodation for nurses on night duty, an alternative site for a nurses training school, flatlets for senior nurses, or a training school for physiotherapists. But numerous discussions about the relative merits of using the building for these purposes where to no avail, because shortly afterwards, on 5th of November, a firework shot up under the eaves of the roof. The house was accidentally burnt down in the area became what is now the hospital's car park.


Plan of the Children’s Hospital and Brantwood House

1966 saw the introduction of paediatric biochemistry at the Children's Hospital. Also a sitting room previously used by the Sisters became an interview room and overnight room for parents. The possibility of having a play room where children could continue to enjoy as nearly normal a life as possible was also discussed at the Children's Hospital in 1968. In this year, also nurse’s paediatric experience, formerly given at the General Hospital, was provided for the first time at the Children's Hospital. Eventually more special services – cardiac and orthopaedic clinics, ECG and neurology sessions – began at the Children's Hospital, and outpatients’ facilities were extended.


THE MOVE TO UNIVERSITY HOSPITAL


Ten years before the move of the Children's Hospital to University Hospital, members of the Medical Committee were discussing the implications for paediatric services in Nottingham. In 1969 a National Committee examined the functions of the district general hospital and reported they were: "To provide services which cannot be provided in the home or at Health Centres/Group practice in the community." They said that this function "can more efficiently and effectively be performed by a comprehensive District General Hospital than by a number of separate hospitals each with limited functions."


This 1969 report of the Central Health Services Committee was one of the first to determine the future of the Children's Hospital in that it spelt out, in no uncertain terms, the trend towards the interdependence of various medical disciplines and the need for a wide range of facilities for diagnosis and treatment under one roof.


Under the Single District General Hospital, argued the Committee, supporting services could be more economically provided at one control site and a patient suffering from a combination of different conditions could be treated for all at the same hospital. "We therefore do not favour any further development of separate children's, women's, accident, orthopaedic or others single speciality hospitals." Instead they recommended that services like those provided at the Children's should be transferred to comprehensive departments within District General Hospitals.


But the realisation that a transfer was to take place did not prevent improvements to the Children's Hospital itself. The Medical Committee resolved that Bell Tawse Ward would be open 24 hours a day for fracture cases, minor orthopaedic cases, head injuries and accidental poisoning, to alleviate the overcrowding on John Dane Player Ward.


In April 1970, the management of the Children's Hospital became the responsibility of the No.1 Hospital Management Committee (now the South Nottingham District) instead of the No. 2 Management Committee (North Nottingham District). This made a close link between those hospitals sharing medical staff and the same geographical catchment area.


By Christmas 1971 – three years after the original plans – a playroom on Princess Mary Ward opened with help from local bodies including the Comforts Fund and the National Association for the Welfare of Children in Hospital. Changes took place in the Accident and Emergency Department to allow more room for Medical Records, outpatients and emergency patients. Overnight accommodation in the form of 2 beds (which increased to 12) was made available for parents and a high dependency care unit was opened in 1973 to provide intensive care for the critically ill. Playroom staff were employed and toys were bought for the wards.


By the end of this year, the hospital encountered its first undergraduates in paediatrics on the wards. This influx of new faces followed the establishment of an academic department in child health based at the new Medical School and the appointment of new consultant staff to supervise clinical training. At N.H.S. reorganisation in May 1974, the first meeting of the Division of Child Health to consider future developments in both South and North Nottingham Districts, took place. Both these events, and others, such as the establishment of a Child Healthcare Planning Team covering the whole of Nottingham signifying a striking step forward in paediatric care for Nottingham in the 1970’s.


In 1973 it was decided that "any child up to the age of three who makes three or more visits to the Emergency Department is notified to the Medical Officer of Health irrespective of the reasons for the attendances, but only to see if the social circumstances of the family are satisfactory."


Children's Playroom, Children's Hospital, July 1978

The main hospital entrance of University Hospital, off Derby Road in 1978


Preventative measures


It has taken over 200 years for hospitals to begin the adaption of their functions so that not only can they help those with temporary illness, but also attack the age-old causes of ill health.


No better opportunity exists for the expanding preventative aspects of Child Health than the move of the Children's Hospital to University Hospital in November 1978. David Hull, the first professor of Child Health at Nottingham's Medical School, sees the move to University Hospital as offering more space, opportunities, time and facilities to advise parents about their child's illness and to prevent it – and other illnesses – from occurring in the future. There will be fewer beds in Phase 1 of the University Hospital, but more space around them with personal areas for each child, and additional auxiliary facilities. An anticipated continuation of the fall in birth rate perhaps predicts less demand for beds in the future. Of the 123 beds officially available at the Children's Hospital in 1978, 34 are surgical, 18 E.N.T. (Ear, Nose and Throat), 4 High Dependency, 44 medical and 23 orthopaedic. At the University Hospital this situation will be as follows – 24 surgical, 12 E.N.T., 6 Intensive care, 24 professorial medical, 24 medical and 24 orthopaedic beds.


The future of Child health in Nottingham certainly looks encouraging. As special services improve and University hospitals offers more staff and better facilities, Nottingham children will be able to receive treatment for such illnesses as diabetes, leukaemia, respiratory problems and neurosurgical conditions in their own hospital rather than having to travel to specialist hospitals elsewhere in the country. It is hoped that as well as developing these new specialist services, the University Hospital will also provide temporary relief for the parents of handicapped children by offering care to a section of the child population which has, until now, been sadly neglected.


The results of work such as the Consumer Protection Department's recent Accident Surveillance Survey at the Children's Hospital and the birth scoring system to determine where health visitors are most needed will also help to improve child health and welfare outside as well as inside the hospital setting.


Patients frequently find themselves face-to-face with famous visitors


The High Dependency Nursing Area opened the Children's Hospital in 1973

Fit for the future


From 1948 – 1973 the infant mortality rate fell from 34 to 17 per 1,000 nationally and mortality within the 1 – 14 year age group bracket fell by more than a half. The majority of children are now taller and heavier on leaving school than any generation of predecessors. Reductions in overcrowding, better nutrition, smaller families, and greater immunisation have improved childcare. But birth and the first few months of life are still hazardous, and the home is even more dangerous than the road in causing accidents to very young children.


From 1948 – 1972 children services were never identified separately in financial or planning departments of the N.H.S. With reorganisation in 1974, there came an opportunity for improvement and the changing attitude towards the child's needs that was reflected in an upsurge of political concern similar in scale to that evidenced in the voluntary movement when the Children's Hospital was first founded. Health problems affecting the child today are not so often episodic illnesses – apart from respiratory diseases which account for 28% of GP consultations – but malformations, chronic illness, handicap, psychiatric disorder, accidents and illnesses aggravated by family stress.


The Court Report "Fit for the Future” recommends that the child health service should be a child and family centred service. Over the past five years, staff at the Children's Hospital have been anticipating its transfer to the University Hospital. The new hospital will offer them a base from which child health services – both hospital and community – will operate.


Miss Anne Phillips, present Senior Nursing Officer recalls how some of the improvements mentioned in other reports have already been made at the Children's Hospital.


Included in the many recommendations in the Salmon Report (Senior Staff Structure) was a change of title for the Matron and Assistant Matron and a change of duties e.g. the employment and supervision of domestic and catering staff, dealing with time cards and ordering and dispensing of haberdashery, were still included in Nursing Officers ‘jobs early in 1973. These were some of the alterations which have taken place in the last six years... The milk kitchen was on the top floor of the Hospital and was staffed by Sister and her staff from the E.N.T. ward. In those days all feeds were made up daily and stored in a very antiquated refrigerator until required. We now have prepared feeds for the majority of babies and a feed kitchen and store room attached to the baby ward.


The High Dependency Nursing Area, a unit of 4 beds, was opened early in 1973 after some difficulty in recruiting staff. This area had been altered many times from its original function as an orthopaedic store. Today, together with our superbly stocked resuscitation room in Accident and Emergency, it offers a marvellous service from highly skilled staff – in very restricted space. The staff anticipate removal to a much larger area with six beds which will enable a better service still to be offered.


Much thought and money went into the upgrading of what is now a divided Accident and Emergency and outpatient service. The main hall, although still a vast area, has a paediatric air about it which includes the play corner, many runabout toys/bikes/prams and a popular fish tank. The Women's Royal Voluntary Service canteen, which at one time was hidden in the basement, now does a roaring trade in the main Outpatients Department.


A vestige of the old hospital goes to the new - Dr. Philip Small, Consultant Radiologist at the Children’s Hospital, holds his own lead conversion of the face that adorns many drainpipes outside the hospital. The lead cast is presented to the Children’s Department at the University Hospital.

The importance of play was and is fully realised – we were fortunate in being one of the first hospitals to be sponsored for 2 play areas by Save the Children Fund. Establishment allows for 5 full-time Nursery Nurses and the Education Authority allows for 2 full-time teachers. However play is not much fun without toys – it is difficult to know where to begin to thank all those so generously given to the hospital over the years. They include our own Comforts Fund, the National Association for the Welfare of Children in Hospital, Fireman, Ambulancemen who have adopted wards, guides, the Royal Antediluvian Order of Buffaloes, Public Houses, local firms, organisation and individuals including a pensioner who gave his Christmas bonus £10 to the children who were less fortunate than himself and an ex-patient age 9 who charged her friends 10p to listen to her record player in her bedroom and bought in £1.65 to be spent on a toy for use in the surgical wards."


The Court Reports ‘warning that "children still die in our lifetime for 19th-century reasons" is a reminder not only of the remarkable aims and efforts of the founders of the Children's Hospital from 1869, but also of the functions of a Children's Department today.


The move of the Children's Hospital to University Hospital on 11th November can be seen as one of many significant moves in the history of Nottingham's Children's Hospital. Princess Mary, the Duchess of Portland, Margaret Jenny Player, John Dane Player and Wilkie Scott will be names that linger in the memories of many Nottingham children long after the Children's Hospital becomes the headquarters of Nottinghamshire Area Health Authority and the wards themselves have disappeared. In the meantime as children from the Hospital will be the first in patients to transfer to the University Hospital, it is once again a case of "Let us begin with the children."


A ward with no toys or visitors in the 1920’s

Inside a ward in July 1978

At least £8,234 was needed to make structural alterations and additions to Forest House. The building of an isolation block and operating theatre and ward pavilions was postponed by the board because there were insufficient funds to undertake the work, and the main entrance and massive drawing room were left unaltered. The library was converted into private quarters for the use of the Lady Superintendent, a dozen cots were installed in a south-facing room which had never been used before, and a dark, airless inner room was brightened up by the introduction of windows and ventilators. The morning room was made into the staff sitting room. The wall of the lobby garden entrance was pierced by an archway to give access to the former ballroom which was converted into one of the two main wards of the hospital. The other became a pavilion-style ward, which consisted of a new 80-foot wing constructed on the southern side of the building. The old dining room was transformed into a staff refractory, and other projects were planned to take place as and when sufficient funds became available. The amount spent on the improvements was £8,000.