'Vaccination from the calf' C. J. Staniland. Illustration from The Graphic 1883

“Among the objects of the medical practitioner it is one of no secondary importance to promote the normal development of the human body during the stages of its growth, and to regulate its functions in accordance with the various natural dispositions of the individuals. This purpose, in order to be satisfactorily realised, requires enlightened views and notions on the principal agencies of life not only in the profession but in the public generally,” [1].

These words introduce the first chapter of a book published by August Schoepf Merei in 1855. They reflect a life’s work and ambitions which were interrupted by the turmoils of 19th century European politics. Although said to have “obtained the favourable notice and lasting intimacy of several men of the highest repute in the literary and scientific world”, [2], little has been written about Merei or his work with children.

Born in April 1804 at Raab, near Cormorn in Hungary, August Schoepf Merei was the son of a prosperous German merchant who was assassinated during a violent robbery. He is said to have been educated at a local seminary and started his medical career at the University of Pavia, Italy, where he first graduated. He further studied at and obtained diplomas from the Universities of Heidelburg, Vienna and Pesth and was Licentiate of the Royal College of Physicians, London. After several further years working at the general hospital in Pavia, he returned to practice in Pesth where he founded the Children’s Hospital in Pesth in 1835, taking the institutions in existence at Paris, St. Petersburg and Vienna as models. During this time he built up a practice “to a great extent among ladies of middle and higher classes” [1] and was directing physician of the children’s hospital until his expatriation in 1849. He had allied himself to Kossuth and the revolutionary party as the Hapsburg Empire showed signs of falling apart and accompanied them during the campaign of 1848-49, abandoning his position in Pesth. During the siege at Temesvar, his wife died of cholera as an epidemic swept through the starving refugees. The siege ended when the town was seized by Imperial troops under the command of Haynau, and Merei was forced to flee with his two children to the Turkish frontier town of Widden, thence to Constantinople. Capable of speaking several languages. he soon found work in Constantinople and even gained a good government salary but there was a lack of scientific and intellectual activity in Turkey at that time and he decided not to stay [3]. Merei himself then describes his first few months of exile as “ähaving spent (after the disastrous events which occurred in summer 1849, and before taking a permanent position in Manchester, where I have again had every opportunity of practical experience) about a year, partly in Paris, partly in London and other towns of Great Britain – though merely as a visitor,” [1].

At this point it appears that Merei’s involvement in politics, disastrous as it had been for him, came to an end. He did not remain with Kossuth and other Hungarian nationals, who were interned for over a year by the Turks before accepting an invitation from the American government to settle there. He also did not obviously feel able to return to Hungary although Austrian representatives soon appeared in Widden with the promise of amnesty to the lower ranks of Kossuth’s army [4].

He seems to have followed the route taken by many German refugees from the failed uprisings in that country going at first to Paris, and then to London as Paris rejected them. In fact, from letters which were written to Ferenchez Pulszky, who was coordinating funds for Hungarian refugees in London, it appears that Merei left Paris because it was too expensive for him to live there as he had found no suitable employment. He had attended lectures given by Trousseau, an eminent physician specialising in children, and had met many other experts in the field. At first he wanted help from Pulszky to publish his notes from his observations and lectures attended in Paris, but in later letters he mentions that money he had expected from Pesth had not come and asks for money from the refugee funds and letters of recommendation from Pulszky so that he could go and find work where he wanted [3]. It is possible that Merei came to England for the same reasons as other exiles – the freedoms which existed nowhere else in Europe. Engels once said of England, “England is undeniably the freest, in other words, the least unfree, country in the world,” [5].

However, it is more likely that he came seeking a refuge from the turmoils of European politics, where he could continue his work studying children’s development and diseases. It was cheaper to live in Britain than in Paris and he already knew at least one medical man, Dr. George Keith in Edinburgh, with whom he had had professional correspondence since 1839. He was reported to be “able to speak and write Latin with a facility equal to that of his native tongue, and with almost every European language he was equally familiar,” [2]. Merei’s interest in medicine and medical observations appears to outweigh any other concerns he might have had, particularly those of a political nature. His friend, Dr. Keith of Edinburgh, who knew Merei before his exodus to England wrote:

When I first knew Dr. Merei in Pesth in 1839, he was director of the Children’s Hospital, Professor of the History of Medicine in the University, and editor of the only Hungarian journal. He was then also in excellent practice, and I certainly looked upon him as the first Medical man in Pesth; though, from belonging to the popular political party, he was not, I believe, looked upon with favour at Court. I know, however, that his services were afterwards demanded by members of the Imperial family, as he attended throughout a long illness the Archduchess M., who became his warmest patroness, [2].

The fact that he was reportedly prepared to sacrifice the ideals of those involved in the Hungarian revolution in order to treat a member of the Imperial family, suggests that politics played a lesser role in Merei’s life than an act which would have given him a certain amount of money and prestige. This income would certainly have been important if he was to carry on with his preferred occupation of collating medical observations. The importance he placed on such a task is evident in several writings, both his own and in an obituary written by his friend and colleague Dr. James Whitehead of Manchester. The first of these is contained in the preface to his 1855 book:

Having been transplanted, by an uncommon concurrence of events and circumstances, from an extensive hospital and general practice in a distant part of the Continent to professional activity in this country, I have been enabled to observe and examine the subjects here treated in a comparative point of view, [1].

This is evidence, not only of Merei’s willingness to play down the events of 1848-49, but also to take advantage of his circumstances to compare his existing knowledge to new observations, even if he was there “merely as a visitor” [1]. His delight in such observations is further apparent throughout his 1855 book as he “äendeavoured to trace the peculiar features and dispositions of temperaments from the early period of life,” comparing observations of children and adults, not only in England and Hungary, but also Germany and Italy where he had studied and worked in the past, and France where he spent his first few months of exile. Many of these comparisons must have been made without reference to notes he had collated over the years. James Whitehead wrote of Merei that, “Among his losses, what he ever seemed to most regret were his note-books, containing an abundance of facts which he had industriously accumulated on the subject of children’s diseases,” [2], further evidence that Merei regarded his medical work to be more important than his politics.

The last pieces of evidence of the importance that Merei placed on his medical observations are to be found in the two detailed annual reports written by him after the founding of the ‘Clinical Hospital for the Diseases of Children’ in Manchester in 1856 [6 & 7]. Exactly why Merei chose to settle in Manchester is unclear. He already knew medical men in both Edinburgh and London, Dr. George Keith, mentioned previously, who he later names as a trustee of his will, and Dr. Charles West, who became chief physician at Great Ormond Street Children’s Hospital in London and whom Merei describes as a “distinguished friend”. In his book, he mentions visiting several towns in Great Britain, presumably looking for work, before “taking a permanent position in Manchester.” It seems likely that this position was at the newly founded Chatham Street School of Medicine where Merei used much of the same material that he was later to use for his book for a series of lectures in 1851-52 [1].

Merei presumably met many of Manchester’s medical men through his position at the medical school as he mentions being asked to consult with several local practitioners on paediatric cases, notably Dr. Noble, physician, and Mr. Melland and Mr. Mellor, both surgeons as well as Dr. James Whitehead on numerous occasions. James Whitehead, a surgeon at Manchester’s Lying-In Charity, had been on the staff at the school since its foundation in 1849 lecturing on ‘the diseases of women’. Between them, Merei and Whitehead wrote ‘Suggestions for a Clinical Hospital for the Diseases of Children,’ an 8 page letter which was printed and circulated among their friends in 1851 [3]. This plan was “äapproved by a number of friends, who, in the year 1853, met together, with the late Salis Schwabe as Chairman, for the purpose of entertaining the project and of appointing a committee of management.” Schwabe, a wealthy German industrialist in Manchester, died unexpectedly and the plans were discontinued for a time as they were “deprived of a most efficient promoter,” [6]. However, the hospital was eventually founded, initially serving only as a dispensary with two beds for emergencies, in rented premises at 8, Stevenson Square, a poor district of Manchester.

Merei’s objectives at this time are still primarily associated with the acquisition of medical facts about children. The stated intentions of the hospital are printed in the first annual report of 1856:

“The objects of this institute are the following – it being intended not more as a charity than as a clinical school for the department of medical science to which it is devoted:- To carry on scientific investigations into the causes, nature and treatment of Diseases of Children;

To inquire into the causes and character of the principal infantile disease prevalent in Manchester, the progress of physical development in childhood, and the causes which hinder its due advancement; the different modes adopted among the poorer classes, of nursing, feeding and managing their children, with the development respectively on health and disease;

To impart instruction to mothers and nurses and to spread sound principles on the subject of nursing and managing children amongst the lower ranks;

To afford to students and young practitioners opportunities of acquiring practical knowledge in this branch of medicine, and to deliver periodically, for this purpose, Clinical lectures, illustrated with appropriate cases,” [6].

I do not think that Merei had any motives apart from these in setting up the Clinical Hospital. Many specialist hospitals in the 19th century were founded by doctors who wanted to achieve the prestige associated with a hospital post and consequent increase in private practice. However, Merei was already well-known to many of Manchester’s medical men through his lectures at the Chatham St. school and had been consulted by some on matters relating to their child patients. He also seems to have had a reasonable amount of private practice before the foundation of the hospital. In his book, which was published the year before the hospital opened, Merei refers to a “sufficiently large field of practice in this town,” [1]. During his time working at the Clinical Hospital, he was able to carry on the scheme of investigations which he had developed in Pesth. Every child seen was examined and the following observations were noted: Physical development of the child, recorded age, size, and habit of body, complexion, dimensions and shape of head and size of chest, date of eruption and number of teeth erupted, date of walking, presence of anything tending to check development, length of period of breast feeding, attention given by the mother and the kind of food given after weaning.

All of these observations are documented in the detailed scientific report included with the annual reports for 1856 and 1857. Most hospital annual reports contain little more than a few paragraphs written by the chairman or secretary of the managing committee and, indeed, this was the format assumed after Merei’s death, with a short report added by Whitehead on the types of disease encountered in the preceding year. Merei may have had several reasons for printing such detailed reports. He obviously felt that his observations were important because, “äthe excessive mortality of children is, to a great extent, owing to the obscurity of their diseases, and consequent difficulties experienced in their treatment.” It may have been an attempt to make people take notice of the enormous lack of information about children’s development and diseases available at that time. As well as the hospital’s subscribers, the reports were probably sent to Merei’s medical friends and acquaintances. Indeed, Dr. Routh, physician to the Samaritan Free Hospital for Women and Children in London refers to the reports in a paper presented to the Medical Society on ‘The Causes of Mortality in Foundling Hospitals’:

“On the last occasion I had to allude to the little advantage usually derived from hospital experience to the profession. I have now to allude to one of the exceptions, viz., the first and second reports of the Clinical Hospital for the Diseases of Children in Stevenson Square, Manchester, prepared by Drs. Merei and Whitehead, and kindly sent to me by the former gentleman. These are most able and philosophical documents, not a fact being asserted which is not substantiated by accurate statistical researches – documents like those which might be yearly produced by every hospital and confer endless good to thousands,” [8].

It is also very likely, though, that such detailed reports were produced because Merei deeply regretted having lost all of the data he had collected over many years in his hospital and private practices in Pesth and publishing such reports would mean that his new observations annually would be less likely to be lost before they could be compiled into a book.

It cannot be known whether Merei ever intended returning to his homeland, as many of the Hungarian revolutionaries did over the decades following 1849. He died after a short illness at his home on Oxford Street, Manchester on 12th March 1858, before the second report of the Clinical Hospital had been published and before an amnesty offered by the Hungarian government to those who had taken part in the revolution. His post mortem indicated that he had suffered from cancer of the liver. Although he was described as “the first Medical man in Pesth” by his friend, Dr. Keith, and founded the first children’s hospital in Hungary, which was only the fourth of its kind in the world, August Schoepf Merei died in relative obscurity in a city which he had once described as, “äthe most unpleasant, smoky, foggy and rainy place in the kingdom,” [1]. He left little behind, apart from his observations, as most of his valuables and property had been lost or confiscated when he left Pesth. His two children inherited such personal possessions as they chose from his house and after his debts and funeral expenses had been paid, any remaining money was to be invested, with half of the annual interest to be paid to each child. As an indication as to how little this was, Merei further states that his son could choose to have quarter of his share paid directly to him if he wished, this to be made up to £50 if the quarter did not reach that sum [9].

If he had lived longer, August Schoepf Merei may have been able to continue his researches much further and perhaps even recover some of his lost note-books full of the observations upon which he placed so much value. However, as a result of his affiliation with Kossuth and the revolutionary party in Hungary, his reputation and prospects were destroyed. His name disappeared from Hungarian medical history, only to be mentioned in the military police files [3]. Although he appears to have abandoned his political persuasions in favour of continuing his work on the development and diseases of children, which he believed to be so important, he died too soon to be able to gain a wider respect for his deep knowledge of children’s development and diseases in a country which was very foreign to him.

References

1. Merei, A. S. On the Disorders of Infantile Development and Rickets; Preceded by Observations on the Nature, Peculiar Influence and Modifying Agencies of Temperaments. Churchill, London, 1855.
2. Whitehead, J. “The Late Dr. Schoepf Merei,” Medical Times & Gazette, 3 April 1858: 359-361.
3. Osváth Zsuzsa, “Schoepf Merei Ágost Angliában,” 1970. Orvostört. Közl., 54: 99-121. Thanks to Irma Scantlebury for her help in translation of this article.
4. Deak, I. The Lawful Revolution: Louis Kossuth and the Hungarians, 1848-1849, Chapter 8 & Epilogue, pp311-351. Columbia University Press, New York, 1979.
5. Engels, F. Essay on ‘English liberties’, 1844. From R. Ashton, Little Germany – Exile and Asylum in Victorian England. Oxford University Press, 1986.
6. Merei, A. S. and J. Whitehead. First Report of the Clinical Hospital for Diseases of Children, Stevenson Square, Manchester,1856.
7. Merei, A. S. and J. Whitehead. Second Report of the Clinical Hospital for Diseases of Children, Stevenson Square, Manchester,1857.
8. Included as an appendix to the Second Report of the Clinical Hospital for Diseases of Children, Stevenson Square, Manchester,1857.
9. Merei, A. S. Last Will And Testament. Copy contained within Osváth Zsuzsa, “Schoepf Merei Ágost Angliában,” 1970.  Orvostört. Közl., 54: 99-121.