A distressed mother hits out at Great Ormond Street Hospital

engraving

Great Ormond Street Hospital, c.1858 from The Illustrated Times 

Most if us are familiar with the amazing work that Great Ormond Street hospital does today. Great Ormond Street (or GOSH) opened in 1852 with a mission to treat  sick children. At the start it only had 10 beds and treated the sick poor from the local area. It was founded by Dr Charles West, who had written and lectured extensively on the particular diseases of children and how to treat them.

GOSH was a charity, and so relied on donations to survive. Within a few years it was in trouble, unable to treat the number of patients that applied to it. In 1858 Dickens gave a performance at a charity dinner, raising enough money to buy the property next door and extend provision to 75 beds. In 1871 readers of a popular children’s magazine, Aunt Judy’s Magazine, donated £1,000 to sponsor a cot; this set a trend for future sponsorships.

So by 1872 the hospital had survived an early crisis and was now well established. it treated the children of the poor, providing a much needed service not available before. In the Victorian age children were increasingly valued and legislation was passed to protect them. The idea of ‘childhood’ (something limited largely tot the children of the wealthy) was extended to all children in the later 1800s.

GOSH was a pioneer from the start, and the hospital has seen many advances in paediatric medicine. In 1872 surgeons began to experiment with the use of electricity to treat paralysis and other ailments.  There years later GOSH’s first purpose built 100 bed hospital opened to the public and in 1878 a dedicated paediatric nursing college started training future nurses.

The extent of medical knowledge in the 1800s had improved considerably from the previous century but it was still very limited by today’s standards. In June 1872 a ‘respectable’ mechanic’s wife came to the Clerkenwell Police court to complain about the hospital to Mr Barker, the sitting magistrate.

Mrs Sarah Hornblower lived at 52 Johnson Street, Somers Town, and when one of her children fell ill she took it to the hospital. The child was an out patient at GOSH from April 1872 but on June 7th it fell dangerously ill and she took it in again.

While she waited to be seen to the poor child died in her arms, and she left it with the hospital while she went to make arrangements for its burial. When she returned later she discovered, to her horror, that a post mortem had been performed.

While this was, it was later established, standard procedure, it came as a terrible shock to Susan. When she complained to the justice she told him that:

‘the surgeons, without her authority or sanction, had cut open her child from the throat downwards’, and no one it seems had apologised or explained it to her.

Later that day Mr Barker was able to discuss the complaint with the hospital’s house surgeon, Mr Beach. He explained that Mrs Hornblower’s child had been suffering from croup or diphtheria and it was important to establish which had proved fatal. Croup (or laryngotracheobronchitis) is caused by a virus and affects the lungs. It causes a ‘barking’ cough and today it very rarely proves fatal.

Croup was not contagious but diphtheria is. Today diphtheria is rare in the UK because children are vaccinated against it, but in the 1870s it was a disease that could and did kill children in London.

So Dr Beach was being sensible he said, in checking for the cause of the child’s death so he ‘better attend to the applicant’s other children’. He was asked if there was any other way to ascertain what had killed the child, short of performing a partial autopsy. There was not he replied, and he had only done what was absolutely necessary.

Dr Beach added that Mrs Hornblower should not seen her child in that state. When she had entered the room where the body lay she had ‘in the most hasty manner pulled the sheet off the body, and thus it became exposed’. Mr Hornblower had been consulted and had agreed to the post mortem so the hospital was covered.

We can only feel sympathy for Susan Hornblower, the loss of a child is always a tragedy however it happens and she was probably shocked to see her son or daughter like that, and understandably in  distress she hit out. The magistrate told her that no one had done anything wrong and while she was upset there was nothing to support a summons.

He added that there ‘was a great deal of difference  between anatomy and making a post-mortem examination’, a possible reference to popular fears of the anatomisation of pauper bodies in the nineteenth century following the passage of Anatomy Act (1832), which allowed hospitals access to the cadavers of the dead poor.

We aren’t told in this report whether the child died of croup or diphtheria. Hopefully the Hornblowers’ other children survived and none were affected as badly as their sibling. We do know that GOSH remains at the forefront of paediatric care nearly 150 years later.

[from The Illustrated Police News etc, Saturday, June 22, 1872]

Smallpox brings death and difficult decisions to the Westminster Police Court

140227smallpox-handrobert-carswellwellcome-library

Watercolour of a hand with smallpox by Robert Carswell in 1831 (Wellcome Library, London)

Mr Selfe had only just taken his seat at Westminster Police Court on the morning of the 12 April 1863 when the officer of health for the parish of St George’s, Hanover Square approached him. As a magistrate Selfe had to deal with all sorts of problems and issues of everyday life, but few were as sensitive as this.

The health officer, Dr Aldis of Chester Place, explained to the magistrate that a three year-old child had died of smallpox, a disease that remained widespread in poorer communities in the nineteenth century despite Edward Jenner’s best efforts to promote vaccination against it.

The unnamed child was lying in his cot so people could pay their respects, as tradition dictated, at a room in a house in Pimlico and Dr Aldis was worried about the public health consequences of this. The ‘small back room’ was home to the ‘boy’s father and mother and three other children’ and no fewer than 26 other persons lived in the property. Moreover, the doctor insisted, this was a crowded locality ‘in which the smallpox is very prevalent’.

He wanted to have the child buried quickly to avoid contagion but the mother was resistant. She wanted to grieve for her son and to do so in the customary way. The family were part of London’s large immigrant Irish community and they fully supported the bereaved mother.

Mr. Badderly, the overseer of the poor for the parish, had attempted arrange the funeral and had sent a man named Osborne to the house to try and remove the dead boy. He brought a small coffin and with the father’s permission placed the child within it. When the mother found it however, she removed her son and placed him back in his cradle. When Osborn objected a group of local Irish gathered and ‘intimidated him with their threats [so that] he felt compelled to retire’.

Here then was a clash between the parish and its obligations towards the health of the community and the very personal wishes of one grieving mother and her friends and family. Since the child’s father either agreed with the health officer or simply felt much less strongly that his wife, the court was bound to side with the parish. Mr. Selfe agreed that the child needed to be buried immediately, for the sake of public health, and since the father had no objection the mother’s wishes were of no consequence. The magistrate said that in his opinion ‘there could be impropriety in the police accompanying the parish officers to see that there was no breach of the peace from the removal of the child’.

It is a desperately sad story which reveals both the reality of infant mortality in the Victorian period and the poverty and overcrowding that condemned so many to a premature death. It also demonstrates the difficult decisions that some magistrates had to make when faced with evidence that ran counter to the wishes of individuals who had not done anything wrong or in any way ‘criminal’.

The mother’s desire to mourn for dead boy in her own way is completely understandable, but when this was countered by what was (at the time) understood to be a risk to the health of very many others, the justice’s decision is also easily understood. This week we have had the heart-rending story of the struggle of Connie Yates and Chris Gard who have lost the latest stage of their battle to keep their son, Charlie, alive in Great Ormond Street Hospital.

Mr. Justice Francis, who made the decision knew, as everyone in the court did, that when he told doctors ‘at Great Ormond Street that they could withdraw all but palliative care, was to all intents and purposes delivering a death sentence’.* He acted in what he considered to be the best interest of the child and against the interests of the parents. Time alone will tell whether he was right to do so.

At Westminster court in 1863 Mr. Selfe may have done the right thing, and saved many other lives. Given what we now know about smallpox it is unlikely that anyone would have caught it unless they had physical contact with the child whilst his exposed scabs still covered him, but the magistrate was not necessarily aware of that and so his actions were perhaps the best thing he could do in the circumstances.

[from The Morning Post, Monday, April 13, 1863]

*www.guardian.com [accessed 13/4/17]