Medical Care

From the viewpoint of the medical founders, although not necessarily of their non-professional colleagues, one of the main objectives of the new hospitals was to facilitate the study of diseases of childhood. Continental experience indicated that specialized institutions provided unrivalled opportunity to advance knowledge of the clinical course and pathology of illness. An honest appraisal would also have indicated that sick children had a lesser chance of recovery in hospital than when carefully nursed in their own homes (as happened with more prosperous families) and that hospital medicine, as practised in Paris during the first half of the nineteenth century, had not contributed appreciably to the discovery of better remedies or actual cures.' The founders of British paediatric hospitals hoped to avoid the spread of infection, the main cause of high mortality in the continental institutions, by not massing children together in large wards (which anyway were not available), by careful attention to hygiene, and by encouraging good nursing. Furthermore, the new hospitals would cater for poor children who had little chance of proper care at home. As to finding cures, it was assumed that improved knowledge of disease must lead to better and more specific treatment. Although much was said about the advancement of science, in the voluntary British paediatric hospitals all that was originally intended by this high sounding phrase was the observation of disease and of its morbid pathology, if and when death ensued. Given the small size of the paediatric hospitals that could be funded by voluntary contributions, it might seem that more children would have benefited from expansion of the rudimentary dispensary system already in existence, furthered by advice and assistance in improving home conditions of care, as opposed to the establishment of inpatient facilities. However, apart from the fact that at mid-century there was no efficient way of delivering home help and no trained people to so, to have provided such assistance would have conflicted with the Poor Law system. One of the deliberate consequences of the 1834 Poor Law had been to restrict medical relief to the truly destitute, with the expectation that other working-class families would pay for health care through sick clubs and self-supporting dispensaries.2 This did not happen to any great extent since the needy could use hospital outpatient departments and public dispensaries without becoming branded as paupers. The subscriber's letter of recommendation served as an acceptable guarantee that the …