Disabled Children

Contested Caring, 1850–1979

Anne Borsay

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317320371
• Edition: 1
• Topic: History
• Subtopic: World History
• Index: History

This volume of essays attempts to identify the shared experiences of disabled children and examine the key debates about their care and control. The essays follow a chronological progression while focusing on the practices in a number of different countries.

1 Club Feet and Charity: Children at the House of Charity, Soho, 1848–1914

Pat Starkey

DOI: 10.4324/9781315654874-1

Introduction

Charitable activity grew rapidly in Britain from the late eighteenth century and disabled people were caught up in this expansion. Blindness and deafness were popular causes because these sensory impairments denied access to the word of God and hence appealed to Christian sympathies. Support for physical disabilities was slower to arrive, gathering pace after the 1870 Education Act revealed how many ‘crippled’ children did not receive schooling. Therefore, the House of Charity for Distressed Persons, founded in Soho in 1846, was unusual in caring for physically disabled children. This was not part of its original plan. The House was largely the achievement of a group of Anglo-Catholic laymen, known as the Engagement, whose members agreed to perform regular acts of charity.¹ Their aim was twofold; to provide temporary shelter for suitably selected or recommended persons in London, and to give an opportunity for association with charitable activity to those too busy to get directly involved themselves.² Its involvement in the provision of temporary accommodation for children with disabilities came about almost by accident. Although contrary to the founders’ original intentions, it was probably a necessary response to the urgent need to keep its beds full, both to ensure a regular income from those benefactors who pledged to pay for the care of individual inmates, and to satisfy the spiritual needs of those of its supporters for whom the financial support of the House of Charity was a religious exercise, as well as a response to pressure from its supporters for a place of refuge for children receiving treatment in the capital. This chapter will suggest that this broadening of the activities of the House also intersected with a growth in charitable foundations that supported advances in paediatric medicine and surgery and the foundation of specialist hospitals in London.

Why Children?

In 1846 the founders had assumed that recipients of the care funded by their beneficence would be adults or families, fallen on hard times through no fault of their own, who needed short-term assistance until they could get back on their feet. They were the deserving, not the casual, poor. As it happened, the supply of that sort of person dried up fairly quickly, probably because the general economic situation improved during the 1850s and fewer people were in need of assistance. Driven by the need to continue to give its donors a locus for their charitable giving, the House began to diversify its activities. For example, it lowered its standards for admission and took in increasing numbers of men and women who failed to meet the original criteria. It also made arrangements with several London hospitals to provide convalescent beds and in the mid-1870s it even entered a short-lived, and not very satisfactory, arrangement with the Charity Organization Society (COS) whereby COS clients were admitted to the House.³ Between 1848 and 1914 more than 240 unaccompanied children and persons aged eighteen or younger were admitted to the House of Charity.

The staff at the House were not unfamiliar with children. From its earliest days, it had followed a policy of admitting families with children. Additionally, more than a hundred unaccompanied children were taken in as emergencies at the instigation of Catherine Gladstone during the cholera epidemic of 1866.⁴ Most of these had been orphaned by the effects of the disease which seriously affected parts of East London and they stayed for a very short time, until they could be placed with family members or sent to orphanages. The reception of those children was formally agreed at a meeting of the Council, but there is no record of any decision to admit those other children found in the House who were suffering from a variety of medical conditions, most of which could be classified as disabling or potentially disabling. As well as helping to meet the House of Charity’s need to keep its beds full, their presence in central London also allowed emerging medical specialties patients on whom to practise their new skills and reflected an increasing interest in the welfare of the handicapped child.⁵ It is also evidence of a tension between philanthropy and medical expediency: hospital governors needed to avoid their beds being occupied for long periods of time by patients who were more or less convalescent and frequently wished, therefore, to concentrate on treating acute cases, so as to maintain any income dependent on charitable giving. But many medical procedures necessitated long periods of bed-rest and supervision and patients needed somewhere to stay within easy reach of the hospital so that they could attend the outpatients department at regular intervals.⁶ By accepting children for whom this was the case, the House of Charity enabled other charitable foundations, the voluntary hospitals, to maximize their contribution. This is explicit in the sad case of Ellen Meagher, aged eight, who had congenitally dislocated hips. In April 1869, after twelve weeks in St Bartholomew’s Hospital, Rochester, she was discharged in spite of the fact that she was deemed to need six months’ further care. The reason given was that because the hospital was ‘so small and the urgent cases so numerous’ the house surgeon was unable to allow her to stay. Although the House of Charity admitted her, presumably with the intention of looking after her for six months, she did not return to Rochester because she died of scarletina, a disease that quite frequently was contracted in hospitals, three weeks later.⁷

Children Admitted to the House

If the children admitted to the House are divided into groups according to their diagnosis, by far the greatest number (thirty-six) is represented by those, like Ellen, who suffered with orthopaedic problems. Some are given very vague descriptions in the case books, for example ‘no use of legs’ or ‘lameness’ or ‘cripple’, but the conditions affecting some of the others are described more specifically. A number of children were admitted with recognized diagnoses like club feet or curvature of the spine, and a couple were reported to be suffering the after-effects of infantile paralysis (poliomyelitis). Other distinct groups were those with ophthalmic problems (twenty-two children); eleven were admitted with epilepsy or mental health problems, which tended to be grouped together; and a further group, not really a group at all, had chest diseases or dental problems. This chapter will concentrate primarily on the orthopaedic cases, although reference will also be made to children with other conditions.

Rapidly improving techniques for dealing with common orthopaedic conditions meant that increasing numbers of children and young people were treated at general hospitals in London. For example, among those admitted to the House of Charity was Hannah Larter, a thirteen-year-old from Suffolk with a spinal curvature. She was an outpatient at Guy’s Hospital where her spinal support was fitted and maintained. Her stay in the House of Charity lasted from January to May 1878, because, as the case book records, ‘her parents were too poor to pay for the journey back and forward to London and too ignorant to understand the necessity for her attending hospital, even if money were available’. Encased in her spinal support, she went ‘to Guys from time to time when a new splint was required’.⁸ Another child at the House of Charity who was treated at a general hospital was Mary Fuzzle, who was twelve years old and a patient at St George’s Hospital in May 1889 with ‘contraction of the muscles in the leg’.⁹ Mary had been admitted to his own ward at the hospital as a personal favour by one Dr Ewart, but sadly nothing could be done for Mary ‘but to leave well alone’. She was discharged home after three weeks in the House. In Mary’s case, ‘home’ was almost certainly the Anglican convent of St John Baptist in Clewer, near Windsor. Close links were maintained with that institution, whose sisters managed the housekeeping services in the House as well as running a home for ‘fallen women’ nearby.¹⁰ In the extensive grounds of their mother house at Clewer, in addition to a House of Mercy for penitent women, were both an orphanage and a convalescent hospital, which meant that both homeless children and those with complaints necessitating care and nursing over a long period could be sent there.¹¹ Children in the care of the Clewer sisters were sent to stay at the House while they received treatment in London, and the journey in reverse was taken by children needing convalescence or longer-term care. One such was nine-year-old David Hall whose lower body was paralysed and who was admitted to the House of Charity in October 1872 while his mother gave birth. After a few days he had to be sent to Clewer because he needed more care than the staff at the House of Charity could provide.¹²

Children Suffering from Orthopaedic Conditions: Club Foot

Although general hospitals continued to provide orthopaedic treatment for patients like Hannah and Mary, increasingly such children were to be found in those specialist institutions that had their origins in the first half of the nineteenth century. The Infirmary for the Correction of Club Foot and Other Contractions, for example, was founded in Bloomsbury in 1838. It quickly changed its name to the Orthopaedic Institution, and by 1855 it had seen 6,000 patients including 1,600 who had deformities resulting from rickets. The Orthopaedic Institution had also treated 500 patients with foot deformities and 450 for spinal problems. It became known as the Royal Orthopaedic Hospital in 1845.¹³ Some sufferers would have been admitted as inpatients, while others would have attended outpatients clinics. Many, perhaps most, would have had the initial stage of their treatment performed while they were resident in the hospital and then have attended for aftercare as outpatients. Not all of them would have been children, of course, but it must be assumed that because childish deformities were deemed to be more susceptible to treatment than those afflicting adults, the average age in such hospitals would have been quite low. In fact, as Roger Cooter has argued, because orthopaedic hospitals catered very largely for children they became quasi-children’s hospitals,¹⁴ and their services were increasingly in demand. The growing numbers of patients presenting for treatment at the Royal Orthopaedic Hospital prompted its governors to consider the need to extend their building as well as to make plans for a completely new orthopaedic hospital.¹⁵ Its waiting list of more than 300 ‘crippled poor’ at the Royal led to the foundation of the City Orthopaedic Hospital in Hatton Garden for ‘the gratuitous surgical treatment of poor persons of every nation afflicted with club foot, contractions or distortions of the limbs, curvature of the spine or other bodily deformities’ in 1851.¹⁶ A third institution, the National Orthopaedic Hospital was founded in 1864.¹⁷ These figures are very remarkable: in little more than a generation a medical specialty whose origins, though long and honourable, lay more with the mechanics of bone-setting and therefore with trauma than with responses to deformity, whether congenital, pathologically acquired or idiopathic, now found itself expressed in specialist hospitals in the capital as well as with practice in general ones.¹⁸

Such voluntary hospitals employed various means to fund their work. Beds at the Royal Orthopaedic Hospital were allocated according to the incomes of the patients. Some were expected to pay, but others could benefit from the hospital’s charitable income, very largely derived from gift s from generous benefactors; its designation as ‘Royal’ witnesses to one such benefaction by the Prince Consort who became a patron in 1842, with a gift of twenty-five guineas. In 1846 the Queen also became a patron and contributed £50; and in 1850 she gave 250 guineas in order to obtain for the Prince of Wales (then aged ten) the right always to have one patient under treatment.¹⁹ In addition to such benefactions, which gave the donor rights of nomination to beds, governors of the institution were permitted to recommend one inpatient and two outpatients annually. This privilege cost one guinea for one year, five guineas for ten years and ten guineas for life. Would-be patients were interviewed by a committee whose responsibility it was to enquire into their finances and decide whether they could be treated by the charity, or whether they were deemed to be able to pay, or have paid for them, the sum of £10. The City Orthopaedic Hospital, whose first president was Lord Shaftesbury, operated a scheme that purported to dispense with interviews and letters of recommendation and to provide free treatment with no strings attached. It raised funds, though not always with notable success, at annual festival dinners, at special sermons by eminent ecclesiastics in smart churches, and by encouraging subscriptions. In 1852, at its first festival dinner, it was reported that there were 799 patients on its books.²⁰

We do not know which hospital treated eleven-year-old Emily Cooper, who was admitted to the House of Charity in October 1855, and neither do we know whether she was one whose family finances had been assessed sympathetically by a committee or whether a governor had exercised his right to nominate her, but we do know that a ‘ticket for the orthopaedic hospital’ had been procured for her. We also know that she had been admitted to the House ‘because she has not the means of remaining in London to attend the hospital’.²¹ Her stay in the House of Charity would also have been paid for by some sort of benefaction: a supporter or associate of the House would have had to recommend her as a worthy recipient of their hospitality and to have paid for her keep there. It would not be surprising if the person who paid for her stay in the hospital also paid for her stay in the House. The council and associates of the House tended to be upper-middle-class and aristocratic men who supported numerous charities. The ability to utilize the services of those with complementary functions would have been an efficient and elegant way to reassure the benefactor that his money was being carefully spent. In addition, it is clear that local parish clergy throughout the country exploited the links between members of the national Anglo-Catholic network in order to access beds for their parishioners. Those from outside the capital, and possibly those from its outskirts, would have needed temporary accommodation to recuperate after medical or surgical intervention and more easily attend outpatient clinics. One such was ten-year-old Sophia Meech, from Puddletown in Dorset. She spent four nights in the House of Charity before being admitted to what is described as the ‘Spinal Hospital’ in August 1861.²² Another was Claud Brown, aged nine, from Southsea, whose spinal curvature required a support and who spent two months at the House between November 1890 and January 1891.²³ It must be assumed that parents or more likely someone else in their home area made arrangements for the children to stay in the House before they made the journey to London, although case notes rarely mention such details.

If we consider the conditions for which treatment was considered feasible, amongst those admitted to the House of Charity club feet and curvature of the spine feature largely. Surgical treatment for club foot had originated in France and Germany, with varying degrees of success, in the last decades of the eighteenth century. In England it dates from the early 1830s. Until then, it had been considered untreatable, left to the mercies of the bonesetters or treated by various forms of splinting.²⁴ In 1834, a London doctor, William John Little, himself afflicted with an acquired form of the deformity, went to Berlin to learn the surgical technique from a successful German practitioner, Johannes Muller, and two years later Louis Stromeyer of Hamburg performed an operation to realign Little’s foot.²⁵ According to his own account, Little’s surgery was performed while he sat on a comfortable sofa and, of course, without anaesthetic. So successful was it, that Little introduced the operation, which involved dividing the Achilles tendon, to this country and within the next ...

Table of contents

• Cover Page
• Half Title Page
• Series Page
• Title Page
• Copyright Page
• Table of Contents
• Acknowledgements
• Notes on Contributors
• Introduction: Disabled Children – Contested Caring – Anne Borsay and Pamela Dale
• 1 Club Feet and Charity: Children at the House of Charity, Soho, 1848–1914 – Pat Starkey
• 2 Insanity, Family and Community in Late-Victorian Britain – Amy Rebok Rosenthal
• 3 The Mixed Economy of Welfare and the Care of Sick and Disabled Children in the South Wales Coalfield, c. 1850–1950 – Steven Thompson
• 4 The Question of Oralism and the Experiences of Deaf Children, 1880–1914 – Mike Mantin
• 5 Exploring Patient Experience in an Australian Institution for Children with Learning Disabilities, 1887–1933 – Lee-Ann Monk and Corinne Manning
• 6 From Representation to Experience: Disability in the British Advice Literature for Parents, 1890–1980 – Anne Borsay
• 7 Treating Children with Non-Pulmonary Tuberculosis in Sweden: Apelviken, c. 1900–30 – Staffan Förhammar and Marie C. Nelson
• 8 Health Visiting and Disability Issues in England before 1948 – Pamela Dale
• 9 Spanish Health Services and Polio Epidemics in the Twentieth Century: The ‘Discovery’ of a New Group of Disabled People, 1920–70 – José Martínez-Pérez, María Isabel Porras, María José Báguena and Rosa Ballester
• 10 Cured by Kindness? Child Guidance Services during the Second World War – Sue Wheatcroft
• 11 Education, Training and Social Competence: Special Education in Glasgow since 1945 – Angela Turner
• 12 Hyperactivity and American History, 1957–Present: Challenges to and Opportunities for Understanding – Matthew Smith
• Notes
• Index