Conclusion

Within half a century hospitals for children had become established features of the British medical landscape. By 1900, the formerly entrenched notion that sick children would not prosper away from home had given way to the other extreme. Now, it would seem, children required to be isolated in institutions entirely dedicated to their care. As Roger Cooter has indicated, there was a 'gradual disappearance towards the end of the nineteenth century of hospitals for both women and children, and the subsequent rise of special institutions for each'.' He suggests that hospitals for women embodied distinctive conceptions of femininity while those for children 'implicitly embodied social and moral notions of childhood'. If so, perceptions of childhood had appreciably changed from those extant in early Victorian times when babies had been considered inseparable from their mothers and older children, if hospitalization was inescapable, as best cared for in the women's wards. When, in spite of such misgivings, small paediatric hospitals were instituted it appeared that in the main neither parents nor children much minded being apart. Modem psychiatric theory would suggest that appearances were deceptive, and that signs of depression and separation anxiety in the patients were being ignored or misunderstood. Charles West was rather exceptional in insisting that babies did not belong on hospital wards. Most other British physicians assumed that irreversibly serious physical illness was the main cause of death among hospitalized infants and that improved knowledge, associated with earlier admission, would prove beneficial. Older children, sometimes hospitalized for months or even years, usually resigned themselves to institutional life. Under the most favourable circumstances the nurses, themselves not much older than their charges, made life as pleasant as possible for the children. As has been noted, the ratio of nurses to patients was high, almost one to two at Great Ormond Street in 1891, allowing for more leisurely relations than in the usual general hospital. However, informal entertainment by nurses, parents and friends, and lady visitors was the only occupation for the patients since, as far as can be made out, during the nineteenth century British paediatric hospitals did not employ teachers even for long stay older children. Furthermore, as the century progressed, visiting hours were steadily restricted ostensibly to reduce the risk of infection but also, one suspects, because the hospital wards ran more smoothly when unencumbered by the presence of relatives. For similar purposes in 1894 notices were placed in the outpatient department of the East London Hospital for Children to the effect that henceforth only one adult would be allowed into the hospital with each patient, whereas formerly two or more 'parents and friends' had frequently accompanied each child to its cot.2 Mixed institutions, for example the Manchester Clinical Hospital, and the East London Hospital, Shadwell, usually only 'admitted' women as dispensary patients. The Bristol Hospital for Children originated in 1866 with a similar policy but ten years later opened a small ward for women requiring surgery, and by 1888 this had expanded to two wards for