Complete history of GOSH
Great Ormond Street Hospital’s growth into an
internationally famous centre for child healthcare started from modest
beginnings in 1852, in a converted 17th Century townhouse on the corner
of Powis Place.
At the time of the hospital’s foundation, the population of London had grown hugely in the preceding decades, following the Industrial Revolution and the end of the wars with Napoleon’s France. This growth was not, however, matched by growth in hospital provision for the City, and the few long-established general hospitals, such as St. Bartholomew’s and Guy’s, struggled to cope with the increase in demand. In these circumstances, the hospital care available to the many thousands of children living in poverty in London was minimal, and a low social priority.
A survey in 1843 revealed that, of some 2,400 patients in all the London hospitals, only 26 were children under 10 years of age; of 51,000 people dying that year in the capital, 21,000 were children under 10. It was generally assumed that children were "expendable", and better off staying with their mothers even when seriously ill. What little healthcare that was available before Great Ormond Street Hospital opened was largely provided by various Dispensaries for Women and Children, in modem terms a cross between a pharmacy and a hospital outpatients’ department.
Dr. Charles West, the principal founder of Great Ormond Street Hospital, was an expert on Gynaecology and diseases of women and children. He had trained in Medicine at Paris and Bonn, in countries where provision for children’s health was already more advanced than in Britain, and where hospitals exclusively for children had been long established.
In the 1840’s, West worked at the Universal Dispensary in Waterloo Road. When he failed to persuade its management of the need to become a fully-fledged hospital for children with in-patient beds, West determined to set up the first children’s hospital in Britain. Through his own efforts, and through social contacts made by his fellow doctor, Henry Bence-Jones, a committee was formed in 1850 for this purpose, with support from eminent philanthropists and public health reformers such as Lord Shaftesbury, Baroness Burdett-Coutts and Edwin Chadwick of the Board of Health.
By February 1852, sufficient backing had been obtained to open The Hospital for Sick Children at No. 49 Great Ormond Street, a mansion with a previous medical connection; it had been the home of Queen Anne’s physician, Dr. Richard Mead, 100 years earlier, with the extension built to house Dr. Mead’s large library providing more space. Dr. West had three principal ambitions for the hospital, which remain the basis of its work today: the provision of healthcare in all fields to the children of the poor, the encouragement of clinical research in paediatrics, and the training of paediatric nurses.
The hospital opened with just two ten bed wards, one for boys and one for girls; for the first two months, the number of in-patients was so few that just one ward was in use for both sexes. Unlike today, the patients were almost all very local, from the teeming slums of nearby Clerkenwell, Holborn and St. Pancras.
Initially the hospital was regarded as a suspicious innovation by many
people, and few patients came, but soon its reputation began to spread
across the city. Charles West was fortunate in having as a friend
Britain’s leading novelist Charles Dickens, who wrote a powerful article
in his popular magazine Household Words to publicise the hospital when
it opened.
In the early years, the patients were all treated in
shared wards for a wide variety of conditions, from serious illnesses
such as bronchitis, phthisis and syphilis to relatively minor ailments
like catarrh and diarrhoea that today would be dealt with by a General
Practitioner. Being a Voluntary Hospital exclusively for the children of
the poor, the hospital was funded by subscriptions, donations and
fundraising events such as its Annual Festival Dinner, which often
attracted eminent speakers, including Charles Dickens, Oscar Wilde,
senior clergymen and members of the Royal Family as speakers. In some
years, this one event could raise almost half the hospital’s total
income. The hospital received its first legacy in 1855. Wealthy donors
and patrons could become Governors of the hospital and were entitled to
recommend a certain number of patients for admission each year,
depending on their level of contribution.
During the hospital’s first years, Dr. West, his
colleague Dr. William Jenner (also Physician to the Royal Family and an
expert on infectious diseases such a typhoid and ‘Membranous group’,
since re-named as diphtheria) and one Surgeon were the only clinical
staff. As remained the case until the establishment of the National
Health Services in 1948, the senior medical and surgical staff were not
paid; they worked at the hospital alongside their private practices in
Harley Street and elsewhere as a social duty and for its value to their
reputation and experience in dealing with a huge number of patients with
very varied conditions.
The state of medical knowledge in the 1850s meant
that many of the patients could not be properly treated but, many more
doubtless benefited from being washed, fed and kept warm properly for
probably the first time in their lives. In the first years of the
hospital, the lack of suitably qualified nurses meant that the patients’
families were allowed to help with their children’s treatment, but
soon, as with most other hospitals, the fear of infection being brought
in and the disruption caused by large numbers of family members being
present meant that visitors were excluded except for an hour and a half
on Sunday afternoons. This remained the case until the 1950s, since when
the arrangements have been progressively relaxed to encourage full
participation by parents in their children’s treatment.
In 1858 the hospital survived its first major
financial crisis, when Charles Dickens spoke at the Festival Dinner and
gave a public reading in aid of the hospital at St. Martin-in-the-Fields
church hall. This also raised enough money to enable the purchase of
the neighbouring house, No. 48 Great Ormond Street, increasing the bed
capacity from 20 to 75.
The 1860s saw a continuing
growth in the number of patients as the hospital’s reputation and the
population of London increase. In 1860, 384 in-patients and 6,833
out-patients were treated.
By 1870, the figures were 691 and
12,221. By 1870, the clinical staff had grown to seven physicians, five
surgeons, a dentist and a pharmacist. From 1868, individual beds were
sponsored by wealthy benefactors, following an example set by the
children’s magazine, Aunt Judy . This could be done either for a fixed
term or in perpetuity, depending on how much was given and remained an
important source of income until the creation of the NHS; cots were
endowed in memory of Lewis Carroll, and by many others, ranging from
members of the Royal Family to the racing motorist Parry Thomas and the
armaments magnate Sir Basil Zaharoff. In a speech at the Annual Dinner,
William Gladstone suggested the hospital open a country branch and in
1869 the hospital was able to open a convalescent home at Cromwell
House, the 17th Century mansion on (then still rural) Highgate Hill,
which was retained until 1924.
By 1870 the original two houses containing the
hospital had become grossly over-intensively used and were a danger in
themselves from poor sanitation and overcrowding on the wards. Dr. West
and the Hospital’s Board of Management committed themselves to raising
the money to pay for the construction of a new purpose-built hospital
building. In this they were successful, and the new building was
constructed from 1871-75 along Powis Place, on the site of the gardens
of the original houses.
An additional Isolation Block, with separate wards
for infectious diseases, was opened to the north in 1878. At the time of
its opening, the new building was a state of the art paediatric
hospital, designed by Edward Barry, the son of the more famous Sir
Charles Barry, the architect of the Houses of Parliament. It contained
100 beds in four new wards, a purpose-built operating theatre, a
substantial Out-Patients Department in the basement, and a sophisticated
under-floor heating system. This building also contained the hospital’s
splendid Gothic chapel, endowed by the architect’s cousin William Barry
in memory of his wife.
In 1990, when the 1875
building (by now in an advanced state of decay and having long outlived
its usefulness in its original role) was demolished to make way for the
new Variety Club Building. The chapel was preserved and moved on its
concrete foundation by hydraulic skates to its present location, where
it continues to play an important (and now more ecumenical) role in the
life of the hospital. The Foundation Stone of the 1875 building (or "The
Hospital in the garden" as it became known) was laid on July 11th 1872
by HRH The Princess of Wales, Princess Alexandra who was accompanied by
Edward, Prince of Wales. Queen Victoria had been a patron of the
hospital since its inception, but this marked the beginning of a closer
interest in the hospital being taken by the respective Princes of Wales
and other members of the Royal family as Patrons, an interest which
continues to the present day.
In the decades between the opening of the new
building and the outbreak of the First World War, the Hospital continued
to grow dramatically in both staff and patient numbers, and firmly
established its national and international status as a teaching and
research centre in paediatric illness. Thanks to the growth of both its
reputation and the public transport system, the hospital was
increasingly treating patients from beyond the London area, from the
home counties and then the rest of Britain, and also the Colonies of the
British Empire, a trend matched by the recruitment and training of
clinical staff from the Colonies.
The 1,047 in-patients and 14,522 out-patients of 1880 had risen to 1,690 in-patients by 1900, and 19,000 out-patients by 1890.
Another
new building with three large wards (the surviving red-brick frontage
building, today’s Paul O’Gorman Building), was opened in 1893, partly
funded by money collected by children nation-wide as a "Jubilee Tribute"
to commemorate Queen Victoria’s Golden Jubilee in 1887. This building
finally replaced the original houses of the 1850’s hospital. The
strengths of the clinical staff continued to deepen, with by 1914 three
Consulting Physicians, five Out-Patient Physicians, seven Surgeons and
new clinical specialisms being reflected in the appointments of an
Ophthalmic Surgeon (1881), an Anaesthetist (1894), a Pathologist and
Bacteriologist (1901) and a Radiographer (1904).
An X-Ray Department (then called the "Electrical
Department" and also performing then-fashionable sun-ray treatments) was
set up in the Hospital basement, with new laboratory buildings for the
pathologist being attached to the side of the 1875 building. Doctors had
been admitted to the hospital for training since it opened and courses
were run over many years but in 1909 the HSC Medical School opened under
the First Dean, Dr. Penrose.
Dr. Charles West had resigned from the hospital in
1877, following personal and policy differences with the Board of
Management, but continued to take a close interest in both the hospital
and paediatric medicine in general until his death in 1898. Many of his
colleagues and successors on the clinical staff were, or became, leaders
in their profession, men such as Dr. W H Dickinson (an expert on kidney
diseases), Dr. Samuel Gee (Coeliac disease) Dr. W B Cheadle and Sir
Thomas Barlow (Scurvy and rickets). Barlow, later Queen Victoria’s
Physician, remained on the honorary staff until his death aged 99 in
1945, establishing a record 70 years’ service to the hospital.
The next generation, in Edwardian times, produced:
Dr. G F Still, an expert on child rheumatism who was appointed the first
Professor of Paediatrics at London University, and was arguably the
first full-time paediatrician (the other clinical staff had all been
generalists); Dr. A E Garrod, the pioneering microbiologist who laid
down guidelines for metabolic disorders and became Regius Professor of
Medicine at Oxford University; Dr. F J Poynton, another expert on
Rheumatism and its infectious causes, who served the hospital for 40
years; and Dr. F E Batten, inventor of pioneering orthopaedic
treatments. In surgery, men such as Sir Thomas Smith and Sir William
Arbuthnot Lane pioneered cleft palate and mastoid surgery, abdominal
surgery for conditions such as pyloric stenosis and first used fracture
plates.
Nurse training had always been important to Dr.
West, who had written a handbook on the subject, ‘How to nurse sick
children’, published in 1854’. Formal nurse training with examinations
was introduced in the 1890’s, evolving into the Charles West School of
Nursing, which remained on site as a national centre for paediatric
nurse training until its transfer to South Bank University, reflecting
changing national trends in nurse training, in 1995.
From 1898 to 1948, the
hospital also trained private nurses to work in the community and for
the children of wealthier parents and maintained its own staff of
"Supply" nurses for hire by private patients.
The private
nurses may have been the first to wear the famous pink uniforms that
subsequently became the standard hospital uniform for many decades.
Catherine Wood, the hospital’s Matron (then called
"Lady-Superintendent") from 1878-88, wrote pioneering textbooks on the
theory of nursing and nursing management.
By the turn of the Century, the hospital’s
Out-Patient Department in the basement of the 1875 building was becoming
insufferably overcrowded, with more than 20,000 patients each year
making over 70,000 individual visits. The hospital was once again
fortunate in obtaining funding from William Waldorf Astor (later Lord
Astor), the American newspaper proprietor, to pay for a new
free-standing Out-Patient building on Great Ormond Street. This was
opened in 1908 on the site adjacent to the Hospital formerly occupied by
the Working Men’s College and the Hospital and Convent of St. John
& St. Elizabeth; the latter’s grim accommodation block for the nuns
was retained by the Hospital as a nurses’ home until the present nurses’
home on Guilford Street was built in the 1930s.
The World War of 1914-18 brought about considerable
disruption to the hospital’s patient intake and finances. The hospital
also suffered near misses from German bombing raids, with bombs landing
in the garden and on neighbouring Queen’s Square. With most of the
regular medical staff on military service, women doctors were employed
at Great Ormond Street hospital for the first time.
The wartime financial situation compelled a change
in the established policy of treatment at the hospital being free to the
children of the poor. This was changed to a means-tested "pay what you
can afford" system which continued until 1948, with the hospital
appointing an Almoner to assess parental needs and ability to pay. The
hospital’s traditional benefactors from the aristocracy and gentry had
been hard-hit by the War and the declining agricultural value of their
estates and more and more of the hospital’s income now came from
subscriptions from middle-income families, aided by grants from
organisations such as the King’s Fund.
The ever-increasing volume of work was also placing a
growing strain on the Consultants, who had to combine the work with
their paid private practice, a situation which helped to set in motion
schemes for a nationally-funded healthcare system which ultimately
resulted in the NHS. Provision of treatment for infectious conditions
such as tuberculosis and venereal disease was enforced by public health
regulations introduced by the new local government authorities
established in 1848, contributing to the hospital’s role in community
medicine. An ambitious attempt in 1921 to raise money for a huge country
hospital for children, "The Children’s Hospital City", met with
failure, but in 1927 the hospital was able to replace its Highgate
convalescent home with Tadworth Court, a substantial country house on
the Surrey Downs, which was used until 1982 as a long-stay convalescent
home and a centre for the treatment of orthopaedic and rheumatic
conditions.
By the time of the opening of
the Tadworth branch, the hospital had recovered and surpassed its
pre-War volume of patients, and the familiar situation of first-class
treatments and research in inadequate buildings was once again present.
A
new campaign for a complete rebuilding of the Hospital was initiated in
1929, unfortunately coinciding with the Great Depression. A scheme to
purchase the Foundling Hospital grounds to the north of Lamb’s Conduit
Street (which would have provided a spacious site for a more low-line
open-plan hospital) failed, and all subsequent Hospital Redevelopments
have had to be built on the increasingly congested island site between
Great Ormond Street, Lamb’s Conduit Street and Guilford Street.
A new "high-rise" scheme was then commissioned,
which was never fully implemented due to the difficult financial
situation and then the outbreak of the Second World War in 1939. The
present Nurses’ Home on Guilford Street had been opened in 1934 and a
new 10 storey clinical block in 1938 (today’s Southwood Building).
Funding for this new era of redevelopment and for
the hospital as a whole ever since, was greatly aided when Sir J M
Barrie gave the copyright income from the play and novel versions of
Peter Pan to the hospital in 1929. Barrie had taken an interest in the
hospital for many years, and was a friend of its Chairman at this time,
Lord Wemyss; the copyright of Peter Pan first expired in 1987
(subsequently being extended to 2007) but a special amendment proposed
by Lord Callaghan to the Copyright, Designs & Patents Act of 1988
granted the hospital a right to royalties in perpetuity, so it will
continue to benefit from JM Barrie's most generous gift. For more information, visit
www.gosh.org/peterpan.
The new Southwood Building replaced the long open
wards of the Victorian Hospital with multiple smaller units, felt to be
more patient friendly and reducing the risks of cross-infection. The new
building, which also featured dramatically improved support facilities
such as the diet kitchen and milk room, increased the hospital’s
capacity to 326 beds, including a 36-bed unit for private patients for
the first time. The block was named the Southwood Building in 1946 as a
tribute to Lord Southwood of Fernhurst, the hospital’s Chairman from
1937-46.
Southwood (who as Julius Elias had had a mercurial
career, rising from an impoverished childhood in the Birmingham Jewish
community to become Chairman of the Odhams publishing empire), was one
of the hospital’s most dynamic Chairmen, raising large sums of money in
its cause and devoting great energy to keeping the hospital functioning
during the Second World War.
Changes in the hospital premises continued to be
matched by increases in the staff and the range of treatments on offer.
By 1935, there were nine Consulting Physicians, five Surgeons and 15
specialist clinical staff, now including a physiotherapist (1920);
Dermatologist (1921); specialist in Venereal Diseases (1922); Biochemist
(1924); Asthma Research Fellow (1929) and Aural Surgeon (1935). The
hospital’s nursing was changed by the official Registration of nurse
training from 1919, a move not universally popular with the Consultants
-The debate about how far nurses should perform routine clinical duties
was already an issue at this time. Changes in treatments in the
inter-war years saw the development of kidney surgery, the use of "iron
lung" respirators, successful blood transfusions, insulin treatment for
diabetes and the growing sophistication of anaesthetics and infection
control drugs.
A new generation of
internationally eminent clinicians maintained the hospital’s reputation
for research and medical innovation.
In medicine, Dr. (later
Sir) Alan Moncrieff specialised in respiratory conditions, Dr. R S Frew
in Asthma, Dr. E A Cockayne in endocrinology and genetic abnormalities,
and Dr. J H Thursfield in meningitis. In surgery, Sir Dennis Browne
reputedly the first full time paediatric surgeon, developed treatments
in neonatal care and for orthopaedic abnormalities, Thomas Twistington
Higgins in genito-urinary surgery and George Waugh in ear, nose &
throat surgery.
The outbreak of war in 1939 brought more drastic
changes to the hospital than the First World War had done. During 1940,
the hospital’s remaining patients were evacuated to Tadworth Court and
other temporary accommodation outside London, and the hospital was used
as a Casualty Clearing station for the still sizable local population
during the Blitz. The newly completed Southwood Building was seriously
damaged by bombing on the night of 4 September 1940, and was narrowly
saved from complete destruction when veteran stoker William Pendle was
able to turn off the hospital’s flooded and damaged boilers before they
exploded. His brave actions were recognised with the award of the George
Medal.
The hospital entered a new phase of rebuilding
post-1945, and a new era of management as part of the National Health
Service in 1948. As part of the NHS, the hospital was able to remain an
independently managed postgraduate Teaching Hospital with its own Board
of Governors. From 1968, it was jointly managed with the Queen Elizabeth
Hospital for Children in Hackney, as The Hospitals for Sick Children
Special Health Authority. This provided a clinical and nurse training
link with a busy local children’s hospital to complement the more
specialised work increasingly performed at Great Ormond Street.
In 1994, management of the Queen Elizabeth Hospital
was transferred to the Royal London Hospital, and Great Ormond Street
Hospital for Children became an independent NHS Trust. The role of the
hospital as an international research centre in paediatrics was
confirmed and enhanced by the creation of London University’s Institute
of Child Health as its adjacent postgraduate teaching and research arm
in 1945.
The shrinkage of the population in central London in
the post-War years meant a reduction in the hospital’s role as a
provider of routine treatments to the local child population, and led
naturally to the consolidation and development of its specialist
strengths, taking patients with complex or multiple conditions as
"tertiary referrals" from other hospitals all over the country.
The Astor outpatient building had been demolished in
1938, and was replaced after the war by a more modern open-plan
Out-Patient Department building on the same site, which continued in use
until the redevelopment in 1994. This building was extended to the
north when the Barrie Wing was opened in 1963, providing accommodation
for the Pharmacy, Radiography, Cardiac and Dental departments.
Purpose-built buildings were added for the Institute of Child Health in
1965 and for the Charles West School of Nursing in 1960, with a separate
Cardiac block opening, after many delays, in 1987.
The on-going process of
rebuilding culminated in the replacement of the now near derelict 1875
building by the new Variety Club Building, opened in 1994.
This,
paid for by the nationally successful "Wishing Well Appeal" , has
provided sophisticated 4-storey accommodation for the Intensive Care,
Host Defence and specialist surgical units, designed to be as "patient
friendly" as possible in all aspects. The Camelia Botnar Building,
providing greatly improved laboratory accommodation for the hospital,
was opened on Lamb’s Conduit Street in 1996.
Clinical developments since 1945 have far outpaced
anything seen during the first hundred years of the hospital’s history
in treatments, drugs and technology, a process accompanied by dramatic
increases in staffing and costs.
In the immediate post-War years, tuberculosis was
successfully treated with the drug Streptomycin, a Psychology Department
together with the Mildred Creak Unit, (named after its first
Consultant) was established and new surgical specialisms in plastic
surgery and neurosurgery were pioneered for children. Cardiac surgery
made rapid advances, notably under Mr. David Waterston and Cardiologist,
Dr. Richard Bonham-Carter, later leading to open-heart surgery,
non-invasive angioplasty surgery and heart and lung transplants in
collaboration with Papworth Hospital. Radical new drug treatment evolved
for the treatment of leukaemia and other child cancers, for cystic
fibrosis, eating disorders and other complex genetic disorders.
Into the 21st century, the hospital’s ongoing
redevelopment continued with the opening of a new clinical block, the
Botnar Wing, on the former school of nursing site, and Weston House,
containing staff training facilities, transitional accommodation for
patients and additional accommodation for patients’ families.
A
multi-phase redevelopment
replacing the hospital’s 1930’s buildings is underway. With its
completion, Great Ormond Street Hospital for Children will be
well-placed to continue its tradition of providing a national and
international centre of excellence in child health, maintaining its
motto of serving “the child first and always”.