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-
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-
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-
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: 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-
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.
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.”
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-
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-
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-
In nearly 1890’s, 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.
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.