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Thursday, 29 November 2012

“…To Rescue Ailing Little Children from “The Two Grim Nurses, Poverty and Sickness…” Or: The Birth of Great Ormond Street Hospital:

This year Great Ormond Street Children’s Hospital in London celebrated its 160th birthday. If you watched the opening ceremony of the Olympics you may have noticed a little section devoted to it, in which its child’s-face logo and the letters GOSH were spelled out in light, paying tribute to this great institution that has been nursing sick children for over a century-and-a-half.

Victorian cities were no places for poor children. They were crowded and dirty, and poor neighbourhoods in particular were prone to outbreaks of disease. Many families struggled to provide their little ones with basic necessities such as proper clothing or food, so illness amongst weakly children was rife.

In London this was particularly true, as Augustus Mayhew noted in his excellent novel ‘Paved with Gold’:

The streets of London make, at the best, but a stony-hearted parent, the gutter forming but a sorry cradle for foundling babes to be reared in. The “back slums” of the metropolis are poor academies for youth, and moral philosophy is hardly to be picked up under “dry arches” and in “padding kens.” 

So under-privileged children had a hard time of it in the Victorian city, but what could be done?

An eventual saviour came in the shape of London-born Charles West. Born in 1816, as a young man Charles had studied as a physician in Germany and France between 1835 and 1837, and went on to qualify as a Doctor of Medicines before returning to London and setting up his own medical practice. This venture, however, was a failure. He left London for Ireland where he spent some time at Meath Hospital in Dublin, specializing in gynecology and midwifery.

Charles West
He was made a member of the Royal College of Physicians in 1842, and so returned to London where he took a post as Chief Physician at the Waterloo Road Dispensary for Sick and Indigent Children. Two years later he began teaching midwidery at St. Bartholomew’s Hospital, and in 1847 started giving lectures on children’s diseases. By now Dr. West had made up his mind to specialize in the care of children, and attempted to turn the Waterloo Road Dispensary into a Children’s Hospital. However, all his attempts met with no success, but he was not to be deterred.

He was made a member of the Royal College of Physicians in 1842, and so returned to London where he took a post as Chief Physician at the Waterloo Road Dispensary for Sick and Indigent Children. Two years later he began teaching midwidery at St. Bartholomew’s Hospital, and in 1847 started giving lectures on children’s diseases. By now Dr. West had made up his mind to specialize in the care of children, and attempted to turn the Waterloo Road Dispensary into a Children’s Hospital. However, all his attempts met with no success, but he was not to be deterred.

This 1891 article from Strand Magazine explains what happened next, gives as insight into the history of the building, and takes us on a guided tour of the Hospital in the 1890’s:  

“We want to move Johnny to a place where there are none but children; a place set up on purpose for sick children; where the good doctors and nurses pass their lives with children, talk to none but children, touch none but children, comfort and cure none but children.”

Who does not remember that chapter in ‘Our Mutual Friend’ in which Charles Dickens described Johnny’s removal – with his Noah’s Ark and his noble wooden steed – from the care of poor old Betty to that of the Hospital for Sick Children in Great Ormond Street? Johnny is dead – he died after bequeathing all his dear possessions, the Noah’s Ark, the gallant horse, and the yellow bird, to his little sick neighbour – and his large hearted creator is dead too; but the Hospital in Great Ormond Street still exists – in a finer form than Dickens knew it – and still receives sick children to be comforted and cured by its gentle nurses and good doctors.

And this is how the very first hospital for children came to be founded. Some fifty years ago, Dr, Charles West, a physician extremely interested in children and their ailments, was walking with a companion along Great Ormond Street. He stopped opposite the stately old mansion known as No. 49, which was then “to let.” and said, “There! That is the future Children’s Hospital. It can be had cheap, I believe, and it is in the midst of a district teeming with poor.”
The house was known to the doctor as one with history. It had been the residence of a great and kindly man – the famous Dr. Richard Mead, Court Physician to Queen Anne and George the First, and it is described by a chronicler of the time as a “splendidly-fitted mansion, with spacious gardens looking out into the fields” of St. Pancras. Another notable tenant of the mansion was the rev. Zachary Macaulay, father of Lord Macaulay, and a co-worker with Clarkson and Wilberforce for the abolition of slavery.

Dr. Charles West pushed his project for turning the house into a hospital for sick children with such effect that a Provisional Committee was formed, which held its first recorded meeting on January 30, 1850, under the presidency of the philanthropic banker Joseph Hoare. As a practical outcome of these and other meetings, the mansion and grounds were bought, and the necessary alterations were made to adapt them for their purpose. A “constitution” also was drawn up – which obtains to this day – and in that it was set down that the object of the Hospital was threefold:-

(1) The Medical and Surgical treatment of poor Children;
(2) The Attainment and Diffusion of Knowledge regarding the Diseases of Children;
(3) The Training of Nurses for Children

So, in the February of 1852 – exactly nine-and-thirty years ago – the Hospital for Sick Children was opened, and visitors had displayed to them the curious sight of ailing children lying contentedly in little cots in the splendid apartments still decorated with flowing figures and scrolls of beautiful blue on the ceiling, and bright shepherds and shepherdesses in the panels of the walls – rooms where the beaux and belles of Queen Anne and King George, in wigs and buckle-shoes, in frills and furbelows, had been wont to assemble; where the kindly Dr. Mead had learnedly discussed with his brethren, and where Zachary Macaulay had presided at many an anti-slavery meeting. It was, indeed, a haunted house that the poor sick children had been carried into – haunted, however, not by hideous spirits of darkness and crime, but by gentle memories of Christian charity and loving-kindness.

For some time poor people were shy of the new hospital. In the first month only eight cots were occupied out of the ten provided, and only twenty-four out-patients were treated. The treatment of these, however, soon told upon the people, and by and by more little patients were brought to the door of the Hospital than could be received. the place steadily grew in usefulness and popularity, so that in five years 1,483 little people occupied its cots, and 39,300 passed through its out-patient department. But by 1858 the hearts of the founders and managers misgave them; for funds had fallen so low that it was feared that the doors of the hospital must be closed. No doubt the anxious and terrible events of the Crimean War and the Indian mutiny had done much to divert public attention from the claims of the little folk in 49, Great Ormond Street, but the general tendency of even kindly people to run after new things and then to neglect them had done more. It was then that Charles Dickens stood the true and practical friend of the Hospital. He was appealed to for the magic help of his pen and his voice. He wrote about the sick children, and he spoke for them at the annual dinner of 1858 in a speech so potent to move the heart and to untie the purse-strings that the Hospital managers smiled again; the number of cots was increased to 44, two additional physicians were appointed, and No. 48 was added to No. 49, Great Ormond Street.

From that date the institution prospered and grew, till, in 1869, Cromwell House, at the top of Highgate Hill (of which more anon) was opened as a Convalescent Branch of the Hospital, and in 1872 the first stone of the present building was laid by the Princess of Wales, in the spacious garden of Number Forty-Nine. The funds, however, were insufficient for the completion of the whole place, and until 1889 the Hospital stood with but one wing. Extraordinary efforts were made to collect money, with the result that last year the new wing was begun on the site of the two “stately mansions” which had been for years the home of the Hospital. With all this increase, and the temptation sometimes to borrow rather than slacken in a good work, the managers have never borrowed nor run into debt. They have steadily believed in the excellent advice which Mr. Micawber made a present of to his young friend Copperfield, “Annual income twenty pounds, annual expenditure nineteen nineteen six: result, happiness. Annual income twenty pounds, annual expenditure twenty pounds ought and six: result, misery”; and, as a consequence, they are annually dependent on the voluntary contributions of kind-hearted people who are willing to aid them to rescue ailing little children from “the two grim nurses, poverty and Sickness.” But, in order to be interested in the work of the Hospital and its little charges, there is nothing like a personal visit.

One bitterly cold afternoon a little while before Christmas, we kept an appointment with the courteous Secretary, and were by him led past the uniformed porter at the great door, and up the great staircase to the little snuggery of Miss Hicks, the Lady Superintendent. On our way we had glimpses through glass doors into clean, bright wards, which gave a first impression at once cheerful and soothing, heightened by contrast with the heavy black cold that oppressed all life out of doors. By the Secretary we were transferred to the guidance of Miss Hicks, who has done more than can here be told for the prosperity of the Hospital and the completion of the building. She led us again downstairs, to begin our tour of inspection at the very beginning – at the door of the out-patients department. That is opened at half-past eight every week-day morning, and in troop crowds of poor mothers with children of all ages up to twelve – babies in arms and toddlekins led by the hand. They pass through a kind of turnstile and take their seats in the order of their arrival on rows of benches in a large waiting room, provided with a stove, a lavatory, and a drinking fountain, with an attendant nurse and a woman to sell cheap, wholesome buns baked in the Hospital; for they may have to wait all the morning before their turn arrives to go in to the doctor, who sits from nine to twelve seeing and prescribing for child after child; and, if the matter is very serious, sending the poor thing on into the Hospital to occupy one of the cosy cots. All the morning this stream of sad and ailing mothers and children trickles on out of the waiting room into the presence of the keen-eyed, kindly doctor, out to the window of the great dispensary (which stretches the whole length of the building) to take up the medicine ordered, on past a little box on the wall which requests the mothers to “please spare a penny,” and so out onto the street again.

There are two such out-patient departments – one at either end of the great building – and there pass through them in a year between eighteen and nineteen thousand cases, which leave grateful casual pennies in the little wall-box to the respectable amount of £100 a year. It does not need much arithmetic to reckon that that means no less than 24,000 pence.
Leaving that lower region (which is, of course, deserted when we view it in the afternoon) we re-ascend to look at the little in-patients. From the first ward we seek to enter we are admonished by our own senses to turn back. We have barely looked in when the faint, sweet odour of chloroform hanging in the air, the hiss of the antiseptic spray machine, and the screens placed round a cot inform us that one of the surgeons is conducting an operation. The ward is all hushed in silence, for the children are quick to learn that, when the big, kind-eyed doctor is putting a little comrade to sleep in order to do some clever thing to him to make him well, all must be as quiet as mice. There is no more touching evidence of the trust and faith of childhood than the readiness with which these children yield themselves to the influence of chloroform, and surrender themselves without a pang of fear into the careful hands of the doctor.
Sometimes, when an examination or an operation is over, there is a little flash of resentment, as in the case of the poor boy who, after having submitted patiently to having his lungs examined, exclaimed to the doctor, “I’ll tell my mother you’ve been a-squeezing me!”

We cross to the other side and enter the ward called after Queen Victoria. The ward is quiet, for it is one of those set apart for medical cases. Here the poor mites of patients are almost all lying weak and ill. On the left, not far from the door, we come upon a pretty and piteous sight. In a cot roofed and curtained with white, save on one side, lies a flaxen-haired girl – a mere baby of between two and three – named “Daisy.” Her eyes are open, but she does not move when we look at her; she only continues to cuddle to her bosom her brush and comb, from which, the nurse tells us, she resolutely refuses to be parted. She is ill of some kind of growths in the throat, and on the other side of her cot stands a bronchial kettle over a spirit lamp, thrusting its long nozzle through the white curtain of the cot to moisten and mollify the atmosphere breathed by the little patient. While our artist prepares to make a sketch, we note that the baby’s eyes are fixed on the vapours from the kettle, which are curling and writing, hovering and melting over her. What does she think of them? Do they suggest to her at all, child though she is, the dimness and evanescence of that human life which she is thus painfully beginning? Does she wonder what it all means – her illness, the curling vapour, and the people near her bed? Poor Daisy! There are scores of children like her here, and tens of thousands out of doors, who suffer thus for the sins of society and the sins of their parents. It is possible to pity her and them without reserve, for they have done nothing to bring these sufferings on themselves. Surely, then, their parents and society owe it to them that all things possible should be done to set them in the way of health.

And much is certainly one in this Hospital for Sick Children. We look round the ward – and what we say of this ward may be understood to apply to all – and note how architectural art and sanitary and medical skill have done their utmost to make this as perfect a place as can be contrived for the recovery of health. The ward is large and lofty, and contains twenty-one cots, half of which are for boys and half for girls. The walls have been built double, with an air space in the midst, for the sake of warming and ventilation. The inner face of the walls is made of glazed bricks of various colours, a pleasant shade of green being the chief. That not only has an agreeable effect, but also ensures that no infection or taint can be retained – and, to make that surety doubly sure, the walls are once a month washed down with disinfectants. Every ward has attached to it, but completely outside and isolated, a small kitchen, a clothes room, a bath-room, &c. These are against the several corners of the ward, and combine to form the towers which run up in the front and back of the building. Every ward also has a stove with double open fireplace, which serves, not only to warm the room in the ordinary way, but also to burn, so to say, and carry away the vitiated air, and, moreover, to send off warm through the iron-work surrounding it fresh air which comes through openings in the floor from ventilating shafts communicating with the outer atmosphere. That is what architectural and sanitary art has done for children.

And what does not medical and nursing skill do for them? And tender human kindness, which is as nourishing to the ailing little ones as mother’s milk? It is small reproach against poor parents to say seldom do their children know real childish happiness, and cleanliness, and comfort, till they are brought into one of these wards. It is in itself an invigoration to be gently waited upon and fed by sweet, comely young nurses, none of whom is allowed to enter fully upon their duties till she has proved herself fond of children and deft to manage them. And what a delight it must be to have constantly on your bed wonderful picture-books, and on the tray that slides along the top rails of your cot the whole animal creation trooping out of Noah’s Ark, armies of tin soldiers, and wonderfully woolly dogs with amazing barks concealed in their bowels, or – if you happen to be a girl – dolls, dressed and undressed, of all sorts and sizes! And, lastly, what a contrast is all this space, and light, and pure air – which is never hot and never cold – to the low ceilings and narrow walls, the stuffiness, and the impurity of the poor little homes fro which the children come. There, if they are unwell only, they cannot but toss and cry and suffer on their bed, exasperate their hard-worked mother, and drive their home-coming father forth to drown his sorrows in the flowing bowl: here they are wrapped safely in a heavenly calm, ministered to by skilful, tender hands, and spoken to by soft and kindly voices: so that they wonder, and insensibly are soothed and cease to suffer. Until he has been in a children’s hospital, no one would guess how thoughtful, and good-tempered, and contented a sick child can be amid his strange surroundings.

But we linger too long in this ward. With a glance at the chubby, convalescent boy, “Martin,” asleep in his arm-chair before the fire – whom we leave our artist companion to sketch – we pass upstairs to another medical ward, which promises to be the liveliest of all; for, as soon as we are ushered through the door, a cheery voice rings out from somewhere near the stove:-
            “Halloa, man! Ha, ha, ha!”
            We are instantly led with a laugh to the owner of the voice, who occupies a cot over against the fire. He is called “Freddy,” and he is a merry little chap, with dark hair, and bright twinkling eyes – so young and yet so active that he is tethered by the waist to one of the bars at the head of his bed lest he should fling himself out upon the floor – so young, and yet afflicted with so old a couple of ailments. He is being treated for “chronic asthma and bronchitis.” He is a child of the slums; he is by nature strong and merry, and – poor little chap! – he has been brought to this pass merely by a cold steadily and ignorantly neglected. Let us hope that “Freddy” will be cured, and that he will become a sturdy and useful citizen, and keep ever bright the memory of his childish experience of hospital care and tenderness.

Next to “Freddy” is another kind of boy altogether. He has evidently been the pet of his mother at home, and he is the pet of the nurses here. He is sitting up in his cot, playing in a serious, melancholy way with a set of tea-things. He is very pretty. He has large eyes and a mass of fair curls, and he looks up in a pensive way that makes the nurses call him “Bubbles,” after Sir John Millais’ well known picture-poster. He has a knack of saying droll things with an unconscious seriousness which makes them doubly amusing. He is shy, however, and it is difficult to engage him in conversation. We try to wake his friendliness by presenting him with a specimen of a common coin of the realm, but for some time without effect. For several seconds he will bend his powerful mind to nothing but the important matter of finding a receptacle for the coin that will be safe, and that will at the same time constantly exhibit it to his delighted eye. These conditions being at length fulfilled, he condescends to listen to our questions.
Does he like being in the Hospital?
            “Yes. But I’m goin’ ‘ome on Kismas Day. My mother’s comin’ for me.” 
            We express our pleasure at the news. He looks at us with his large, pensive eyes, and continues in the same low, slow, pensive tone:-
            “Will the doctor let me? Eh? Will he let me? I’ve nearly finished my medicine. Will I have to finish it all?”
            We reluctantly utter the opinion that very likely he will have to “finish it all” in order to get well enough to go home. And then after another remark or two we turn away to look at other little patients; but from afar we can see that the child is still deeply pondering the question. Presently, we hear his slow, pensive voice call:-
            “I say!”
            We go to him, and he enquires: “Is Kismas in the shops? Eh? Is there toys and fings?”
            We answer that the shops are simply overflowing with Christmas delights, and again we retire; but by and by the slow, pensive voice again calls;
            “I say!”
            Again we return, and he says: “Will the doctor come to me on Kismas morning and day ‘Cheer up, Tommy; you’re goin’ ‘ome to-day?’ Will he? Eh?”
            Poor little boy! Though the nurses love him, and though he loves his nurses, he longs for his mother, and the “Kismas” joys of home. And though he looks so healthy, and has only turned three years, he has insipient consumption, and his “Kismas” must be spent either here, or in the Convalescent Home on the top of Highgate Hill.

It is impossible, and needless, to go round all the little beds; it is a constant tale of children innocently and cheerfully bearing the punishment of the neglect, the mistakes, or the sins of their parents, or of society. Here is a mere baby suffering from tuberculosis because it has been underfed; there, and there, and there are children, boys and girls – girls more frequently – afflicted with cholera, or St. Vitus’ dance, because their weak nerves have been overwrought, either with a fright at home or in the streets, or with overwork or punishment at school; and so on, and so on, runs the sad and weary tale. But, before we leave the ward, let us note one bright and fanciful picture, crowning evidence of the kindness of the nurses to the children, and even of their womanly delight in them. Near the cheerful glow of one of the faces of the double-faced stove, in a fairy-like bassinette – a special gift to the ward – sit “Robin” and “Carrie,” two babies decked out as an extraordinary treat in gala array of white frocks and ribbons. These gala dresses, it must be chronicled, are bought by the nurses’ own money and made in the nurses’ own time for the particular and Sunday decoration of their little charges. On the other side of the stove sits Charlie, a pretty little fellow, on his sofa bed.
And so we pass on to the surgical wards; but it is much the same tale as before. Only here the children are on the whole older, livelier, and hungrier. We do not wish to harrow the feelings of our readers, so we shall not take them round the cots to point out the strange and wonderful operations the surgeons have performed. We shall but note that the great proportion of these cases are scrofulous of some order or other – caries, or strumous disease of the bones, or something similar; and, finally, we shall point out that one little fellow, helpless as a dry twig, but bold as a lion, at least if his words are to be trusted. He has caries, or decay, of the backbone. He has been operated upon, and he is compelled to lie flat on his back always without stirring. He could not have tackled a black-beetle, and yet one visitors’ day the father of his neighbour having somehow offended him he threatened to throw him “out o’ winder,” and on another occasion he made his comrades quake by declaring he would “fetch a big gun, and shoot every man-jack of ‘em!” But, for all his Bombastes vein, he is a patient and stoical little chap.

There are here altogether 110 cases in five wards (there will be 200 cots when the new wing is finished) and a few infectious fever and diphtheria cases in an isolated building in the grounds; and the cases treated and nursed in the course of the year average 1,000. but the most obstinate cases, we are told, are now sent to Highgate, to keep company with the convalescents, because of the constant urgency of receiving new patients into Great Ormond Street. To the top of Highgate Hill, therefore, to Cromwell House, we make our way the following afternoon.
            - Strand Magazine, 1891

Charles West retired in 1876 at the age of 60, and spent a lot of time in the warmer French climate – especially in winter. He died in Paris at the age of eighty-two whilst travelling back to London.

It surprises me that he is not better known and has no memorial to commemorate his contribution and dedication to improving the health, and ultimately, the lives of children, although there is a room at the hospital named after him, and after asking the Great Ormond Street Hospital charity, they told me that they are “finding out about memorials.”

Perhaps the greater surprise is that the names of Florence Nightingale and Mary Seacole have lived on, with the former being extremely well-known known and having a museum dedicated to her (rightly so) whilst a statue of Mary Seacole is due to be erected at St Thomas’ Hospital. West, however, not only opened Great Ormond Street, but also wrote a book entitled ‘How to Nurse Sick Children’ in 1854; five years before Nightingale published ‘Notes on Nursing’ suggesting that he perhaps deserves a share of Nightingale’s parent of modern nursing tag.

To this day the hospital still relies on public donations collected through its charity in order to raise the £50million that it requires annually to care for sick children. You can read more about this, or donate here and explore more history and photographs of the hospital here.