The Clinical Hospital for the diseases of children opened its doors to the public for the first time in February 1856. It was housed in rented premises at No. 8, Stevenson Square, next to St. Clement’s Church, which stood at the corner of Lever Street and Stevenson Square. According to the hospital’s first annual report, there was no announcement in the public newspapers of its opening and only a small sign next to the door indicated that the building was used as a hospital for children. Nevertheless, within the first year of opening, the physicians claimed to have treated over five hundred children as well as some thirty nursing mothers “variously afflicted” [1]. Their figures appear to show a need for such an institution after it had been opened, but why did Drs Merei and Whitehead decide to open it in the first place? After all, there was already a General Dispensary for Sick Children which had been opened by two general practitioners, John Alexander and W. B. Stott in 1829 and St. Mary’s Lying-in charity had established a ward intended to accommodate forty children in 1847, although this was little used [2]. In this chapter I will briefly relate James Whitehead’s life, in particular his connections with the Clinical Hospital, and then I will describe the events leading up to the opening of the hospital and its running over the first few years, including Merei and Whitehead’s plans and justifications, and discuss whether it achieved its objectives.
James Whitehead was born in Oldham in 1811. Educated locally, he is said to have, “gained an insight into the medical properties of the vegetable kingdom,” [3]. At the age of nineteen he became a pupil of Mr. Clough, surgeon at the Manchester Lying-in Charity (later St. Mary’s Hospital and Dispensary fro the Diseases peculiar to Women and also for the Diseases of Children under six years of age [2]) , which is probably where he acquired his interest in the diseases of women and children [4]. He spent some time studying in London and then France and Germany where he “…was able to add to his English acquirements a more than superficial knowledge of the French school of medicine and surgery,” [3]. He returned to practice, specialising in the diseases of women, in rooms which were also in Stevenson Square, Manchester, in 1839. His reputation must have spread quickly for after only two years he removed his practice to the more salubrious Mosley Street where it remained until his retirement. This was probably due, at least in part, to his appointment as senior officer in ordinary (surgery) at the Lying-in Charity which also occurred at around this time. In 1845 he was among the first listed as having passed the new examination for Fellowship of the Royal College of Surgeons [5] and by 1850 had graduated M.D. from the University of St. Andrews and been appointed to lecture on the diseases of women and demonstrate anatomy at the newly founded Chatham Street School of Medicine. It was at this point that he met Merei and little more of his career outside the Clinical Hospital need be mentioned here, except to mention that his obituary says that he “…was justly regarded as the premier accoucheur of Manchester,” [3].
The history of the Clinical Hospital really goes back to 1851, when August Schoepf Merei and James Whitehead wrote ‘Suggestions for a Clinical Hospital for the Diseases of Children,’ an eight page letter which was printed and circulated among their friends [6]. This was written shortly after the decision to build a children’s hospital at Great Ormond Street in London under the patronage of Queen Victoria. It is possible that Merei was influential in the founding of that hospital through his “distinguished friend” Charles West who became chief physician at the London hospital. Certainly it will have influenced his decision to suggest that such an institution be opened in Manchester. Within their ‘Suggestions’ Merei and Whitehead described the need for a children’s hospital in Manchester and its purposes, as well as the proposed management structure. It is probable that they put prospective donors off with this letter as they expected people to donate without being part of the active management of the hospital. They proposed a scheme whereby they managed the institution without the layman’s committee which was usual in hospitals at that time because, they said, they did not want to be restricted by financial matters or committee decisions. Obviously, not many people would want to donate to an institution which they could not have a say in running but both doctors had experienced conflict with hospital committees; in Pesth we are told that the children’s hospital was “almost wrecked” by arguments between Merei and the committee [6], and Whitehead had become disillusioned with the committee at St. Mary’s as the ward which he served there was meant to accommodate forty children but was seldom open [7]. Whitehead’s dispute with the committee at St. Mary’s came to head in 1856, as the committee passed new rules forbidding appointments in other charities or in public or club practice forcing Whitehead to resign from St. Mary’s in favour of his position at the Clinical Hospital [2].
There were many arguments for the suitability of Manchester for a children’s hospital. Firstly, Manchester had a large number of medical students but no facilities for studying the diseases of children, a subject which the two doctors considered important enough to be designated as a separate branch of medicine. They felt that Manchester, as an important, wealthy town, should be setting an example in the English Provinces. They also observed that Manchester had a large proportion of poor people and a high level of infant death. This is further emphasised in the first annual report of the hospital:
“Whether we consider the extraordinary rate of mortality of children in Manchester, where more than fifty per cent of them perish before they reach five years of age, or the preponderating proportion of its poor population, the desirability of this kind of institution becomes more striking here than in other places; and whilst this city exhibits such pressing demands, and so extensive a field for the study of the diseases of children, the presence here of a considerable number of medical students speaks the more strongly in favour of a Clinical School for this class of maladies,” [1].
They further describe the requirements for a children’s hospital. Initially they wanted to provide between six and eight beds over an experimental period of two years, which they estimated would cost £200 per year. For the hospital to be beneficial, they argued that it should be capable of admitting children of all ages, along with their mothers or nurses if necessary. They argue that admission of children’s mothers with the children is also important because childhood disease is often a result of poverty and disease of the mother and that separation of mother and child is a disadvantage for treatment of the latter. Children’s hospitals should also be separate from other medical institutions:
“Sick children were formerly admitted promiscuously with other patients into Infirmaries, Foundling Institutions, and Lying-in Hospitals, as is now done in that of St. Mary of this city; but the importance of separate establishments for this class of patient, in which suitable arrangements and undivided attention are exclusively directed to their particular requirements and the peculiarities of their ailments, is sufficiently obvious,” [1].
After circulating this letter of ‘Suggestions’ it took a further two years before they found a suitable benefactor who would help with fundraising but trust the doctors to make decisions for themselves as to the running of the hospital. This was Mr. Salis Schwabe, a German industrialist who had become a wealthy Manchester businessman. He and his wife were Unitarians and adherents of the ‘Manchester School’ of Free Traders, as well as liberal supporters of good causes. Mrs Salis Schwabe was, with Richard Cobden’s wife, a prominent member of the ‘Society of Friends of Foreigners in Distress,’ which raised money, among other things, to help patients of the German Hospital in London find employment when they were discharged [8]. Salis Schwabe would probably have done the lion’s share of the fundraising without interfering in the doctors’ work as he was already prominent and influential in Manchester and didn’t need the prestige of involvement in a hospital management committee. In 1853 there was a meeting of “a number of friends” with the two doctors with Salis Schwabe as Chairman to discuss the project. Unfortunately, Schwabe died before any progress was made with founding the hospital and the efforts were discontinued for a time as they were deprived of the scheme’s “most efficient promoter.”
No other help was forthcoming after Schwabe’s death and eventually the doctors felt that if they delayed any more it would be seen as an abandonment of the project. They refined their plans and reduced the number of beds to only two for emergencies to cut the expense of opening the hospital. They planned to expand the number of beds later if they could raise the money but their ideals had to be curtailed to suit the circumstances and the institute which opened in 1856 consisted of an out-patients department combined with a teaching institute. This was the two doctors’ private experiment and we are told in the third annual report that, “The expenses of the establishment, until lately, were almost entirely defrayed by Drs. Merei and Whitehead,” [9].
Merei and Whitehead must have soon felt that their experiment had been a success. By November 1856 twenty medical students had registered at the Clinical Hospital, some showing great enthusiasm for the new school had “…uninterruptedly devoted themselves to the study of this class of diseases, having assisted at the same time in an efficient manner in recording the histories of diseases.” [1]. As well as those for students, formal lectures and informal instruction of mothers had been given on nursing, feeding and managing children, with principles of hygiene and physical education. Although there was no publicity about the hospital’s opening, they treated over five hundred children up to the age of thirteen in the first year, summarising the results as follows:
| Of the 530, to this date (November 26th) there are ascertained as cured | 273 | |
| Have ceased attending, improved, and are probably cured | 94 | |
| Treatment prematurely interrupted, therefore uncertain | 62 | |
| Considered to be under treatment | 67 | |
| Dead | 34 | |
| Total | 530 |
The detailed annual report at the end of the first year was probably meant as much as a report on the progress of their experiment of running a hospital for children as a public account of the running of the institution. They included in-depth analyses of their patients’ backgrounds as well as a breakdown of the numbers of each type of illness encountered. The greatest number of patients were children of labourers, porters, packers and bricklayers, followed by weavers, spinners and joiners. The majority of these were English, with one seventh being Irish and only twelve foreigners. In keeping with the annual report being an experimental result, it had a large amount of detailed research data concerning such things which these days are commonly asked about as milestones in the normal development of a child. The scheme of investigation developed by Merei and Whitehead for the examination of children was unusual at that time for its detail which included: 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.
These detailed investigations are justified when the doctors go on to report the types of diseases encountered. They state that they found nearly eight hundred different ailments in the 530 children treated, indicating the poor health of their patients. There were 274 males and 256 females and the majority of the children were under six years old, which was documented as follows:
 |
With the exception of whooping cough, which was generally not fatal, there was no infantile epidemic prevalent in 1856, unlike other European cities (Vienna, Munich, Frankfurt and St. Petersburg) where typhus and gastric fevers were constantly present. In contrast to these cities, there was a high proportion of cases of ‘mucous inflammation’ of the bronchi and intestines. Diseases “originating in chronic dyscrasy of the blood,” for example, scrofulous, tuberculosis and syphilis also compared favourably in Manchester to other European cities. On the other hand, developmental disorders, rachitism, disorders of “digestive and assimilative functions,” including dyspeptic diarrhoea, atrophy and mesenteric disease formed a much higher proportion of the childhood illnesses in Manchester. These illnesses greatly occupy Merei and Whitehead’s investigations, for they say,
“the frequency of this class of diseases demands the more urgently careful consideration, inasmuch as, to the greatest extent, they arise from ignorance, prejudice and errors, on the part of the parents, in nursing and managing children, and consequently from causes which are within the possibility of control,” [1].
The second annual report goes further into the detailed information they had collected on their patients. By the end of the second year they had treated 1548 children and 53 nursing mothers, all as outpatients with many home visits. There are descriptions of homes and streets which have been visited in the course of the doctors’ work and a survey of the districts where most of the patients live, with lists showing the proportion in each district. For example:
| Patients from Ancoats district is about | 27 per cent |
| Patients from Oldham Road is about | 22 per cent |
| Patients from Rochdale Road is about | 18.5 per cent |
| Patients from London Road is about | 13 per cent |
| Patients from Picadilly and neighbourhood | 8 per cent |
| Other districts collectively | 11 per cent |
The research documented during the second year compares the value of mothers breast feeding their babies with feeding substitutes such as cows milk or mixtures of bread and water. The findings are presented in tables comparing growth and development of the children examined with their diet as infants and are illustrated with case histories reflecting maternal ignorance on the subject. One such history, which they say is typical of the local population is as follows:
“A woman, 39 years of age, solicited advice for an infant, 15 months old, utterly emaciated and exhausted, affected with vomiting and diarrhoea of many months duration. The woman, near to the last stage of her pregnancy, was still giving her infant, twenty to thirty times a day, the watery secretion of an exhausted breast. Not many days after the visit, she was delivered of her twenty-second child; the above-mentioned, being the twentieth who had perished under the circumstances,” [10].
Also within the second report is a detailed investigation into the qualities of cow’s milk. They mention that they had strong reasons for suspecting the extensive fraudulent practice of watering and skimming the milk on the part of retailers, and set out to establish a scale representing the natural qualities of cow’s milk in the neighbourhood. Data was obtained, showing that in the largest proportion of retail places, especially those of where poor families purchased their supplies, “Šthe milk was of a quality almost unfit for the use of children.” [10]. They advised mothers to obtain their supplies from trustworthy places, but stated that the matter was of sufficient importance for the attention of proper authorities. Further tables of data from the first two annual reports are presented in the Appendix, starting p65.
Merei died before the second report could be published and without drawing more detailed conclusions from the data, which had been promised in the reports. The experiment, as originally proposed, was meant to last two years in the first instance so this is a good point at which to ask whether it had successfully achieved its objectives. If we take the stated objectives of the hospital (see p32 of Chapter One) as the result that Drs. Merei and Whitehead were trying to achieve through their experiment then they can be said to have been successful. They had established a clinical school where they could research childhood development and diseases in Manchester, which had attracted a number of students who wished to gain experience in the subject. They had also reached a considerable number of poor mothers in the area with their principles of childcare, if the number of patients seen and the number which had to be turned away each day can be taken as proof of this. (They report seeing thirty-five to fifty patients on each consultation day and having to turn away between eight and fifteen on admission days).
However, using their original definitions from ‘Suggestions for a Clinical Hospital for the Diseases of Children,’ they have had to make several compromises to make their experimental hospital work. The hospital had still not acquired any inpatient accommodation which, they said had been “…greatly delayed by adverse circumstances and difficulties against which the institution has had to contend,” [10]. This was in spite of the fact that in their definition of a children’s hospital they wanted to be able to admit children of all ages with their mothers or nurses. Also, we see by the end of the second annual report that the hospital has gained a management committee, although the first rule that was passed embodied the doctors’ objectives:
“Rule One: The Clinical Hospital and Dispensary for Children is founded for the purpose of the scientific investigation, and the charitable relief in Manchester and the neighbourhood, of the disorders which affect infants and young children of the poor, and for the diffusion of accurate information as to the conditions of the healthy nutrition and management of the children of the operative classes during their earlier years, [10].”
It is probable that they found that they could not raise the funds to support inpatient or the rapidly expanding outpatient requirements by themselves (a third doctor, Eduard Gumpert, was persuaded to give his services as assistant physician during the summer of 1857). Among the first members of the committee also on the list of benefactors and subscribers were the Rev. William Gaskell, with his wife Elizabeth Gaskell author of Mary Barton, Cranford and North and South who was a member of the Ladies’ Committee.
After Merei’s death, James Whitehead was appointed Chief Medical Officer for the Clinical Hospital. The annual reports became no more than those of other medical establishments, containing a summary of Committee achievements, descriptions of the number of patients and their illnesses and a plea for funds. This leads to the suggestion that it was Merei who provided the energy and ideas for the hospital’s research and achievement of its founding objectives and Whitehead followed him.
The Clinical Hospital was to go on to make two moves to bigger premises. The first in 1867 to Park Place, was to provide the inpatient wards which had been part of the original definition of a children’s hospital in “Suggestions”. After further extensions the Whitehead ward was added in 1881 to provide accommodation for adult females. In 1902 the institution’s name was changed to the Manchester Northern Hospital for Women and Children and it moved again to a new site at Alms Hill, Cheetham Hill Road in 1934 where it remained until its closure in 1994. The years following Merei’s death saw many more changes in his Clinical Hospital for the Diseases of Children and many individual achievements. However, I would argue that none were so great as those of the first few years, when a foreigner and his colleague set up a new children’s hospital in Manchester and ran it according to their own principles without outside financial support.
References
- Merei, A. S. and J. Whitehead. First Report of the Clinical Hospital for Diseases of Children, Stevenson Square, Manchester,1856.
- Pickstone, J. V. Medicine and Industrial Society: A History of Hospital Development in Manchester and its Region, 1752-1946. pp53-54 & 115-22. Manchester University Press, 1985.
- Sutton, C.W. Obituary of James Whitehead, 1885. In Lancashire Authors, Volume II. Manchester Central Library.
- Bride, J. W. History of St. Mary’s Hospitals, 1790-1922. pp87-88. Sherratt & Hughes, Manchester, 1922.
- Jordan, F. W. Life of Joseph Jordan. p128. Sherratt & Hughes, Manchester, 1904.
- Osváth Zsuzsa. “Schoepf Merei Ágost Angliában,” 1970. Orvostört. Közl., 54: 99-121. Thanks to Irma Scantlebury for her help in translation of this article.
- Jones, E. W. The History of the Manchester Northern Hospital for Women and Children. Manchester, 1933.
- Ashton, R. Little Germany – Exile and Asylum in Victorian England. p207. Oxford University Press, 1986.
- McKerrow, Third Report of the Clinical Hospital for Diseases of Children, Stevenson Square, Manchester,1858.
- Merei, A. S. and J. Whitehead. Second Report of the Clinical Hospital for Diseases of Children, Stevenson Square, Manchester,1857.