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The Health of Young Children and the Foundation of British View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by CLoK The health of young children and the foundation of British children’s hospitals, c.1830 –1860 by Andrew James Kennedy A thesis submitted in partial fulfilment for the requirements for the degree of Doctor of Philosophy at the University of Central Lancashire Student Declaration Concurrent registration for two or more academic awards I declare that while registered as a candidate for the research degree, I have not been a registered candidate or enrolled student for another award of the University or other academic or professional institution __________________________________________________________________________ Material submitted for another award I declare that no material contained in the thesis has been used in any other submission for an academic award and is solely my own work ____________________________________________________________________________ Collaboration Where a candidate’s research programme is part of a collaborative project, the thesis must indicate in addition clearly the candidate’s individual contribution and the extent of the collaboration. Please state below: n/a Signature of Candidate ______________________________________________________ Type of Award __PhD_________________________________________________ School Education and Social Science ______ 2 Abstract Between the years 1852 and 1860 six voluntary hospitals were opened in Great Britain to provide medical care for children who would previously have been considered too young to be admitted to hospital. This thesis argues that the process was shaped by the public health movement which was ascendant at that time. The literature review shows that while historians of nineteenth-century childhood have been aware that child health was a problem, especially for working-class children, they have tended to view this through the prism of industrial and urban history, and there is little work available relating specifically to the provision of health care for younger children. Chapters two and three demonstrate the emergence of a new understanding of the nature of childhood which came about as a result of the great inquiries into child labour, the health of towns, and the condition of the labouring classes, and the impact of the emerging science of statistics. At a time of crisis in traditional British medicine, the new approaches combined with French clinical and German laboratory techniques to open British physicians to the possibility of working with young children as a serious proposition for the first time. Chapters four to six follow the various ways in which six children’s hospitals were opened in London, Norwich, Liverpool, Manchester, and Edinburgh. Influences which are analysed include the desire to rectify the acknowledged ignorance among physicians concerning children’s diseases, the recognition of environmental management as a fruitful means for improving children’s health, and a new willingness to emulate Continental practices. This thesis departs from the existing historiography in challenging the underlying assumption as to the operating model of a hospital. Histories of children’s hospitals are written in terms of the extent to which they succeeded in applying the allopathic model of health, with the administration of medicines and surgical procedures at the centre, 3 however ineffectually. What actually distinguished the new institutions was their emphasis on promoting healing not by manipulating children’s bodies but, drawing on the insights of the public health movement, by providing a therapeutic environment. 4 Table of Contents Student declaration 2 Abstract 3 Table of contents 5 List of tables 8 Acknowledgements 9 List of abbreviations and note on translation 10 Introduction 11 Chapter 1 Literature Review 24 1.1 Introduction 24 1.2 The Invention of Childhood 25 1.3 The Transformation of Childhood in the Nineteenth Century 31 1.4 The Problem of Child Health 42 1.5 Hospital Histories 48 1.6 Conclusion 53 Chapter 2 The Discovery of the Sick Child 55 2.1 Introduction 55 2.2 The Manchester Investigations 56 2.3 Social Inquiries 66 2.4 William Farr and the General Register Office 84 5 2.5 Conclusions 92 Chapter 3 Intellectual Changes Affecting Medical Theory and Practice 96 3.1 Introduction 96 3.2 Source material – the medical literature 98 3.3 Problems with Traditional Medical Practices 100 3.4 From Anecdote to Evidence 113 3.5 Continental Influences: diagnostic techniques and the use of 118 physical evidence 3.6 The Problem of Therapeutics 133 3.7 Conclusions 138 Chapter 4 Making the Case for Children’s Hospitals 141 4.1 Introduction 141 4.2 Changing attitudes towards the admission of children to hospital 143 4.3 Charles West 154 4.4 Founding a Hospital 164 4.5 The Jenny Lind Hospital, Norwich 177 4.6 Conclusions 181 Chapter 5 Foreign Inspiration: The Manchester Hospital and Dispensary for 183 Sick Children and the Cheetham Hill Road Clinical Hospital and Dispensary for Children, Manchester 5.1 Introduction 183 5.2 The Manchester Context: St. Mary’s Hospital 184 5.3 Hügel’s survey of European children’s hospitals 188 6 5.4 Whitehead, Schoepf Merei, and the Cheetham Hill Road Clinical 194 Hospital and Dispensary 5.5 Louis Borchardt and the Manchester Hospital and Dispensary for 202 Sick Children 5.6 Conclusions 205 Chapter 6 Public health at the forefront: Liverpool and Edinburgh 207 6.1 Introduction 207 6.2 Public Health Concerns: The Liverpool Infirmary for Children 208 6.3 The Scottish Context: public health, the Scottish Poor Law, and 213 medical education 6.4 Making a case for a children’s hospital 219 6.5 The hospital in action: 1861 Annual General Meeting 228 6.6 Conclusions 235 Conclusion 238 List of references 246 7 List of Tables Table 1: Deaths of boys aged 0-5 years, registered 1845 90 Table 2: Deaths of girls aged 0-5 years, registered 1845 90 Table 3: Comparison of mortality rates in percentage terms for infants and 91 young children in Manchester, Liverpool, and Surrey, 1845 Table 4: Comparison of the number of patients treated in GOSH and 229 Edinburgh in their first years of activity 8 Acknowledgements After six and a half years my first thanks must go to Sheila, James, and Nicol, to whom I have so often been an absent husband and father, whether shut away at home or visiting the many marvellous libraries and archives I’ve discovered in the course of this project. On the subject of libraries and archives it is difficult to pick out favourites, but the National Library of Scotland has always proved to be the old reliable when I’ve been tracking down elusive sources; Nick Baldwin at the Great Ormond Street Archives has not only put me on to some rare and useful material, but is one of a handful of people who would talk to me about this topic without gazing over my shoulder looking for an escape route; and the Liverpool Medical Institution has provided a haven of calm and unsolicited offers of tea, which can mean a lot. I have been well supported by my employers, Liverpool John Moores University, and especially by Professor Phil Vickerman, who very sportingly signed the cheques as well as allowing me the time to spend three months at the Leuphana University in Lüneburg as a research student with the Erasmus programme. Finally, of course, there are my supervisors, Dr. Steve Cunningham and Dr. Keith Vernon. Keith in particular has seen me through some arid patches, and has proved to be understanding when work commitments have meant that I have been both elusive and non-productive. Well, Keith, here it is at last. 9 List of Abbreviations DQJMS = Dublin Quarterly Journal of Medical Science GOSH = the Hospital for Sick Children at Great Ormond Street, London GRO = the General Register Office, London JLI = Jenny Lind Infirmary (Norwich) Translations Unless otherwise indicated, all translations from the German are by the author of this thesis. 10 Introduction “The development of the children’s hospital has received systematic appraisal from neither historians of pediatrics nor historians of medicine and medical institutions. In particular, we lack any in-depth studies on the motives which have spurred both medicine and wider society to establish this distinctive institution.”1 Seidler wrote these words in 1989, and since then there has been just one major contribution to the field, that of Lomax.2 Seidler concluded that the new hospitals had been introduced both for the protection of children and also for their exploitation by the medical profession ‘in the service of its new scientific orientation’, and that their creation reflected the growing interest of society in its children as social resources.3 The purpose of this investigation is not only to study the motives which ‘spurred both medicine and wider society to establish this distinctive institution’, but to offer a fresh explanation not only as to why such hospitals were created, but why they were opened at just the time they were. A brief study of the British voluntary hospital movement in the early- to mid-nineteenth century will show, firstly, that children younger than the age of six or seven years were not generally welcome as patients in these institutions,4 and that, secondly, there was a series of hospitals opened especially for young children in the decade between 1850 and 1860. Six institutions have been chosen for this study, representing the pioneering phase in the establishment of children’s hospitals in Great Britain. The selection has been made to demonstrate the way in which early childhood was coming to be seen as a distinct developmental phase in its own right. Hospitals such as St. Mary’s in 1 Seidler, E. “An historical survey of children’s hospitals.” in Granshaw, L. & Porter, R. (eds) The Hospital in History.
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