This project is a study of the founding of a new children’s hospital in Manchester, the Clinical Hospital for the Diseases of Children (later the Manchester Northern Hospital), during the mid nineteenth century. It deals with the ambitions and achievements of the two founders, August Schoepf Merei (1804-1858) and James Whitehead (1811-1885), during a time when children’s normal growth and development and their diseases were little understood, before even the term ‘paediatrics’ had been coined [1]. Much of the information concerning the hospital was found within its annual reports, contained in the John Rylands Library, the rest is from a book written by Merei in 1855 and various obituaries and local newspaper accounts found in John Rylands or Manchester Central Library.

By the 1850’s Manchester had become notorious for the poor health of its people, its factories and its slums. It had reached the peak of its importance in both Lancashire and England, “An economic marvel in an age of great cities,”[2]. However, its economic rise had been accompanied by great cost with massive urban growth bringing problems of organisation and provision of amenities. Edwin Chadwick’s famous Report on the Sanitary Condition of the Labouring Population of Great Britain in 1842 had compared Manchester statistics to those of rural Rutland with drastic effect; Manchester’s mechanics, labourers and their families had an average age of death of seventeen compared with thirty-eight in Rutland, tradesmen lived to an average of twenty in Manchester compared with forty-one in Rutland and the professional classes and gentry lived only to an average of thirty-eight years in Manchester compared with fifty-two in Rutland [3]. Merei and Whitehead themselves reckoned that “more than fifty per cent of them [children] perish before they reach five years of age,” [4], although they give no exact figures as evidence. In an earlier report on infant mortality, Dr. John Roberton examined the burial registers for the Collegiate Church in Manchester over the period 1816-1823 and Rusholme cemetery for 1821-25. Burials of ‘still born’ children had not been entered in either register. The ‘poorest class’ buried their dead at the Collegiate Church and ‘a class somewhat above the very lowest’ at the general cemetery. Over fifty per cent of the burials from both groups were aged under five, as shown in Table 1 [5].

During the eighteenth and early nineteenth centuries many people thought of the poor only in relation to economics and class, and the children of the poor were no exception to this. Mandeville, a social commentator, said in 1723:

Few children make any progress at school but at the same time are capable of being employed in some business or other, so that every hour of those poor people spent at their books is so much time lost to Society. Going to school in comparison to working is Idleness and the longer boys continue in this easy sort of life, the more unfit they will be, when grown up, for downright labour, both as to Strength and to Inclination. Men who are to remain and end their days in a laborious, tiresome and painful station in life, the sooner they are put upon it at first, the more patiently they will submit to it for ever. [6].

The first real interest shown in the effects of living and working conditions on children came with a survey connected with the first in a series of Factory Acts which were to mitigate the conditions. The survey, contained within the Report of the Commissioners on the Employment of Children in Factories of 1833 resulted from an inquiry into “the whole subject of the labour of children, as now enforced in the various Mills and Factories or places of work throughout the country,” [7]. In each area a Medical Commissioner was appointed and, amongst other things, he was specifically required to ascertain the stature of the children to see “whether there be any difference at any age, and what age, and in either sex, between persons brought up from an early period in a Factory and persons of the same age and sex and station not brought up in a Factory,” [7]. In the Manchester area the data was collected by Samuel Stanway under the supervision of Assistant Commissioner J. W. Cowell, a veteran of the Poor Law Commission. They visited the Bennett Street and St. Augustine’s Sunday schools in Manchester and two Sunday schools in Stockport and measured heights and weights of 1,933 children, aged nine to eighteen. The average mean difference, calculated within years of age and weighted according to numbers, comes to approximately 0.25 inches (about 0.5 cm) both for girls and boys, the non-factory children being taller [8]. However, in spite of an interest in height measurement and the use of the new statistical methods which were being developed at that time, there was little interest in the health of the children. Indeed, in a later survey of factories in the Manchester-Leeds area in 1837 by Cowell’s colleague on the Factory Commission, Leonard Horner, the factory surgeons who were involved were specifically instructed to exclude those who did not appear to be in a good state of health.

Shortly before this report, several establishments had been founded for the treatment of diseased children. Before the founding of these establishments, children were formally excluded from admission to hospitals as inpatients, and while not excluded from dispensaries, rarely became dispensary patients. The reason for this is unknown, some such as J. B. Davis thought that parents did not take children to dispensaries because they expected them to be neglected there [9]. Carbutt in his review of medical cases in Manchester Infirmary and Dispensary in the late 1820’s, remarked that children’s infectious diseases were very few – “for causes sufficiently obvious to practitioners,’[10]. The first such institution, an outpatient dispensary established in 1769 in Red Lion Square in London by George Armstrong, lasted only thirteen years, being forced to close in 1782 for “lack of public interest and support,”[11]. It treated outpatients only for, as Armstrong said in discussing a children’s hospital:

“But a very little Reflection will clearly convince any thinking Person that such a scheme as this can never be executed. If you take away a sick Child from its Parent or Nurse you break its Heart immediately; and if there must be a Nurse to each Child what kind of an Hospital must there be to contain any Number of them? Besides, as in this case the Wards must be crowded with grown Persons as well as Children must not the Air of the Hospital be thereby much contaminated? Would not the Mothers or the Nurses be perpetually at Variance with one another if there were such a Number of them together? Would not the Children almost constantly disturb each other with their Crying? Supposing only a few in one Ward should be taken ill of a Vomiting and Purging, to which Infants are so very subject, would not this presently infect the Air of the Ward and very probably communicate the Disorder to other children confined there? Yet this is one of the principal Diseases where an Hospital might be of Service to Infants, were it not for insuperable Objections just now mentioned. Add to all this it very seldom happens that a Mother can conveniently leave the Rest of her Family to go into an Hospital to attend her sick Infant,” [12].

This passage anticipates most of the arguments that have since been raised on the subject, about separation, cross-infection and the effect of visitors in the ward.

It was not until 1816 that any further support was found for children’s institutions, this time for John Bunnell Davis’ Universal Dispensary for Children, also in London. This had three departments across the city and was almost entirely devoted to the treatment of outpatients. Manchester was the first of the provincial towns to copy the idea of a dispensary for children. The General Dispensary for Children opened at 25, Back King Street on the 2nd of February, 1829. This followed a public meeting which was held at the Exchange in the previous November at which Drs. John Alexander and W. B. Stott were appointed physicians, with Dr. Hancock assisting. The reasons given for establishing the General Dispensary were: the multiplied incidence of diseases in infancy, the sources of epidemic disease which children constitute and the ‘fact’ that general establishments cannot give immediate enough treatment [13]. The founders’ motives were purely philanthropic, rather than as a result of any scientific interest in children, which is shown by an article in the Manchester Guardian requesting support in 1829:

“The originators of the Dispensary are sensibly aware of the blessings which flow to the poor from those noble monuments of public benevolence which already exist amongst us; but to a community which from being essentially a manufacturing [one] must, amongst its operative branches, be of necessity, an indigent one, there has still been wanting an asylum open exclusively to the cries of the helpless child, suffering from the afflictions of the varied diseases which are the common lot of early years,” [14]

The General Dispensary for Children remained a small establishment, with admissions fluctuating between 800 and 1,600 per year. By 1850 the subscriptions amounted to only £60 and the number of children seen per year was fewer than it had been in the late 1830’s [15]. Davis’ Universal Dispensary had also declined with buildings which had been new in Davis’ time which were decayed, overcrowded and still lacking sanitation [13]. The old style dispensaries, with their emphasis solely on charity rather than scientific research and no facilities for inpatients, were obviously seen to be inadequate both by those who donated and by those who were meant to use them and it needed new blood bringing Continental ideas to change child healthcare in this country.

The first children’s hospital in the world had been opened in Paris as early as 1802. This was the Hôpital des Enfants Malades at the Rue de Sèvres which quickly established itself as part of the increasingly prestigious clinical/pathological Paris School. Fundamental scientific research into children’s diseases based on the new methods began here and it became almost exclusively oriented towards the gaining of knowledge for medical science, with comparatively little concern for the care of the afflicted [16]. It was a further fifty years until the new methods of investigation into children’s diseases were to cross the Channel, as English physicians brought back experience acquired on the Continent and a flood of refugees fleeing the conflicts of the late 1840’s brought their skills with them.

The most important man in the former category was Charles West, founder of the first British Hospital for Sick Children on Great Ormond Street in London in 1852. A more complete description of his achievements can be found in the chapter on Children’s Hospitals in The Evolution of Hospitals in Britain, pp103-121 (Ed. F. N. L. Poynter) [13]. He had spent two years of his medical training in Europe, in Bonn, Paris and Berlin and before the Hospital for Sick Children opened he spent two months specifically studying the children’s hospitals in France and Germany so that the house on Great Ormond Street could be adapted to this purpose. His aims were to provide hospital care for poor sick children and to advise the mothers of those who could not be admitted; to advance medical science and to improve student teaching in connection with children; to educate “all classes but chiefly the poor,” in the management of sick children, and to train women in the special duties of children’s nursing. West’s great achievement was the provision, for the first time, of inpatient beds for children. However, only very rarely were children under the age of two admitted, possibly for reasons similar to those given by Armstrong in his discussion of children’s hospitals in the eighteenth century. Thus the section of the population with the highest mortality, the infants, were still largely uncatered for.

The latter category, the refugees, included three men who were, or were to become, important in paediatrics. The most internationally renowned of these I will mention only fleetingly as he did not stay long in Britain. This was Abraham Jacobi, a young German, who came to Manchester in 1853 but was unable to attract a practice, seeing only one paying patient in two months. Later that year he gained employment as ship’s physician and hence free passage to America, where he was to become the so-called “father” of American paediatrics, being the first in the world to hold a chair in the Diseases of Children, the first to use the term paediatrics in English and the founder of the American Paediatric Society [1].

The other German to arrive in Manchester in the early 1850’s was Louis Borchardt, who had helped organize the fight against typhus in Silesia in 1845. He was imprisoned for anti-government agitation in Prussia in 1848 and after release in 1850 was prevented by systematic persecution from regaining his medical practice and so was forced to emigrate. He was quickly appointed physician to the General Dispensary for Children on his arrival in Manchester and it was about this time that the need for inpatient beds is first mentioned. Dr. Borchardt was the catalyst needed to change the failing Dispensary into a popular children’s hospital, undoubtedly using those on the Continent, especially in Germany, as models. By 1855 Borchardt had opened a six-bed hospital in St. Mary’s Parade, by 1860 there were twenty-five beds in new premises in Bridge Street and they were seeing 2,600 outpatients per year. The further history of what became the Royal Manchester Children’s Hospital is recounted elsewhere [13,15] and need not be repeated here, suffice it to say that the turnaround in the institute’s fortunes was brought about by the energies and new ideas of Louis Borchardt.

In spite of Borchardt’s effects on the running of the General Dispensary for Children, little has been written about any research that he might have done there. It is probable, as was common at that time, that few of his patients were under two years old. Again Armstrong’s arguments may well reflect the reason for this but also it seems that there was still little interest on the part of the medical profession in the health of infants. This can be seen in an article in the Journal of Public Health in March 1856 reporting on a lecture given by a Dr. Barker:

“‘It may seem,’ Dr. Barker remarked, ‘to an undisciplined mind, something beneath the dignity of the profession to give advice on the preparation of food for a babe,’ but he went on to point out that medical students rarely encountered infants during their course, unless they were surgical cases, and that medical teachers passed over the treatment of infants ‘lightly and briefly’,” [17].

Most authors agree that it was not until towards the end of the nineteenth century that doctors and the general public became interested in infant welfare as distinct from child healthcare and in everyday effects of nutrition on growth and development. In a recent collection of essays, In the Name of the Child, Harry Hendrick says in his contribution, “Šit was only when social reform achieved its new status after the Boer war that the condition of children (& adolescents) came to be popularly regarded by politicians as in any way necessary for national health and welfare,” [18].

By this time it had become an issue which concerned the Public Health authorities. In Medicine and Industrial Society, John Pickstone documents the change in attitude towards sick children by the end of the century. He points out that “General sanitary measures were no longer enough: the remaining problems required special remedies. The reduction of infant mortality, like the suppression of tuberculosis, required doctors and health visitors to visit the homes of the vulnerable, to educate and perhaps to subsidise,” [15]. In his thesis on Catherine Chisholm and the founding of the Manchester Babies’ Hospital, Peter Mohr also documents this change in attitude and says that by the start of the twentieth century, “The various strands of the child welfare movement were united by the idea of ‘education’ as a tool of social reform. Health education was seen as the key to improving the living conditions of the working-class.” Thus by stressing social and medical factors, many common childhood illnesses came to be seen in terms of environment (inadequate feeding, poor housing and ignorance about hygiene matters) rather than as a result of genetic or inherited degeneration, about little could be done [19].

However, before any school of ideas becomes part of popular thinking, there is usually a period where one or two individuals have been forward thinking and researched a topic which was primarily of interest to themselves rather than the general public. I would argue that the third emigré to arrive in Manchester in the 1850’s, August Schoepf Merei, was one of these individuals. His interest in growth and development of children began while still in Pesth, possibly as a result of ideas of equality, individual rights and democracy, which were spreading across Europe from post-revolutionary France. Some governments, especially in France and Germany started to view the health and fitness of their child population as important for the wealth and security of their nations. However, little has been written about the attitude of the Austro-Hungarian empire towards its children and it is possible that Merei’s interest in children stems from the intellectual climate of the Continental universities and their encouragement of individual research. Of England he says, “There is in this country little excitement for the mind, imagination, and senses, in comparison with the Continent ŠScientific professions in Britain receive comparatively little support or encouragement, and seldom reward from the state; and their public position is altogether not nearly so attractive as in Germany and France. To this general rule the medical profession, in spite of its practical importance to humanity, forms no exception,” [20]. He was obviously affected by lack of encouragement for his ideas in this country.

In spite of this, Merei continued his researches into infant nutrition and child growth and development, topics which were unusual in this country at that time – the little interest which did exist in children’s diseases tended to be in those which could be surgically treated. In this thesis I will describe Merei’s work in Manchester and his part in the founding and running of the Manchester Clinical Hospital for the Diseases of Children (Manchester Northern Hospital) against a background of little public interest in his researches or objectives.

References

1. Viner, R. “The Pediatrics of Abraham Jacobi: Socialism, Materialism and American Destiny.” Unpublished. Submitted to Bull. Hist. Med. Thanks to R. Cooter for supplying a copy of this paper.
2. Kidd, A. Manchester. p36. Ryburn Publishing, 1993.
3. Chadwick, E. Report on the Sanitary Condition of the Labouring Population of Great Britain. 1842. Quoted in A. Briggs, Victorian Cities, pp88-138. Penguin, 1968.
4. Merei, A. S. and J. Whitehead. First Report of the Clinical Hospital for Diseases of Children, Stevenson Square, Manchester,1856.
5. Roberton, J. 21 Feb. 1835. Medical Gazette: p733.
6. Mandeville, B. de. An Essay on Charity and Charity Schools. 1723. Tonson, London.
7. Report of the Commissioners on the Employment of Children in Factories. 1833. Parliamentary Papers, 1833, English Historical Documents, 1956-, vol. 12 (1962), p79 & pp934-949.
8. Tanner, J. M. A History of the Study of Human Growth. pp142-169. Cambridge University Press, 1981.
9. Loudon, I. S. L. 1979. John Bunnell Davis and the Universal Dispensary for Children. British Medical Journal,1: 1191-4.
10. Carbutt, E. 1831. Observations on Disease. North of England Medical and Surgical Journal, 1: 27.
11. Maloney, W. J. George and John Armstrong of Castleton: Two Eighteenth Century Medical Pioneers. Edinburgh, 1954.
12. Still, G. F. The History of Paediatrics: The Progress of the Study of the Diseases of Children up to the End of the XVIIIth Century. p422. Dawson, London, 1965.
13. Franklin, A. W. Children’s Hospitals. Chapter 6 in The Evolution of Hospitals in Britain. pp103-121. (Ed. F. N. L. Poynter.) Pitman, London, 1964.
14. Manchester Guardian, 3 January 1829.
15. Pickstone, J. V. Medicine and Industrial Society: A History of Hospital Development in Manchester and its Region, 1752-1946. pp53-54, 115-22 & 235-241. Manchester University Press, 1985.
16. Seidler, E. An Historical Survey of Children’s Hospitals. Chapter 7 in The Hospital in History. pp181-197. (Ed. L. Granshaw & R. Porter.) Routledge, London, 1989.
17. Journal of Public Health, II. March 1856. pp57-8. Repeated in Lancet, 18th October 1879, p584. Quoted in F. B. Smith, The People’s Health 1830-1910. p87. Croom Helm, London, 1979.
18. Hendrick, H. Child Labour, Medical Capital and the School Medical Service c. 1890-1918. In In the Name of the Child – Health and Welfare 1880-1940. p55. (Ed. R. Cooter.) Routledge, London, 1992.
19. Mohr, P. D. “Women-run Hospitals in Britain: A Historical Survey Focusing on Dr. Catherine Chisholm (1878-1952) and The Manchester Babies’ Hospital (Duchess of York Hospital).” PhD. Thesis, Manchester University, 1995.
20. Merei, A. S. On the Disorders of Infantile Development and Rickets; Preceded by Observations on the Nature, Peculiar Influence and Modifying Agencies of Temperaments. pp92-93. Churchill, London, 1855.