GOSH: The Children First and Always

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GOSH or, more formally, Great Ormond Street Hospital is a children’s hospital in the Bloomsbury area of London that has been in practice for over one and a half centuries. Every day, over 600 children or young people arrive at the hospital for life-changing treatment. Thanks to extraordinary charitable support, doctors have been able to achieve pioneering medical breakthroughs and thousands of children have been given a new lease of life. Now the most famous hospital in the country, GOSH has an interesting history that is worth investigating.

Opened as the Hospital for Sick Children on 14th February 1852, the first UK hospital dedicated to inpatient care for children only contained ten beds. Despite this, the hospital grew with the help of royal interest and the insistent campaigning of its founder, Doctor Charles West. Born in 1816 to a Baptist preacher and schoolmaster, West received his first education in his father’s school until he was apprenticed at the age of 15 to a general practitioner in Amersham, Buckinghamshire. Little did he know he would grow up to become what the British Medical Journal of 1898 deemed, “One of the men who have helped to make the reign of Queen Victoria a memorable period in the history of medical progress.”

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Charles West photographed by G. Jerrard.

From 1833, West spent two years as a medical student at St Bartholomew’s Hospital (Barts) in London. After his father’s theological opinions prevented him from attending Oxford University, West decided to complete his education on the continent. He first attended a university in Bonn, followed by Paris, and finally Berlin where he completed his medical degree in 1837. His first positions as a professional took place at the Rotunda Hospital and Meath Hospital in Dublin, however, by the 1840s, he had returned to Barts in London.

West was appointed as a physician to the Universal Dispensary for Children in Waterloo Road, then a lecturer in midwifery at the Middlesex Hospital in 1845 and later again at St Bartholomew’s. During this time, he became more and more involved in the treatment of children and earned fame for his book Lectures on the diseases of infancy and childhood (Longman 1848).

Despite several attempts, West failed to transform the Waterloo Dispensary for Children into a hospital, therefore, he changed tact and began a fundraising campaign to establish a London children’s hospital. Due to his medical acclaim and way with words, West successfully raised enough money to establish a tiny hospital at 49 Great Ormond Street in a house once belonging to the physician Richard Mead (1673-1754). From the very first day, the hospital began to grow and now has almost 40 times the amount of beds.

“The Hospital for Sick Children (…) was the first hospital for children ever established in this country. The poor now flock to it, sick children from all parts of London are brought to it.”
– Charles West (1854)

Doctor Charles West’s new hospital would not have become the successful establishment today without the help of dozens of notable people and medical achievements. Many of the doctors that worked at the Hospital for Sick Children, later Great Ormond Street, were at the forefront of medical science, participating in new trials and developing techniques and inventions. Sir Thomas Smith (1833-1909), for example, who was House Surgeon at the hospital in 1854, was the first surgeon to try antiseptic surgery in 1875. He also specialised in cleft palate surgery.

The Historic Hospital Admission Records Project lists Lady Superintendent Catherine Jane Wood (1841-1930) as “an unsung hero in the history of nursing at Great Ormond Street and in the field of paediatric nursing as a whole.” She began volunteering at the hospital as a teenager, reading to the patients and doing a few menial tasks that the nurses were too busy to do. Later, Wood was appointed Ward Superintendent and received tutelage from Doctor West. In 1868, she left Great Ormond Street to establish the Hospital for Hip Joint Disease (later to become the Alexandra Hospital for Children with Hip Disease), however, was coaxed back to GOSH to take up the position of Superintendent of Wards at the hospital’s convalescent home Cromwell House in Highgate.

Whilst many children benefitted from Wood’s care, she was most concerned about the wellbeing of other nurses. Many had not received proper training and were treated more as housekeepers than medical personnel. At a time when women had very little rights, nurses had little importance and many of them worked voluntarily. Determined to change things, Wood introduced a training scheme for children’s nurses that provided specialised and appropriate training. She became a founder member of the British Nurses’ Association and campaigned for the registration of nurses and improved education.

Even after resigning from Great Ormond Street, Wood continued to help improve the wellbeing of nurses. She published many works, her most famous being two handbooks, The Handbook on Nursing (1878) and The Handbook for Nursing of Sick Children (1889). She also instituted a pension and savings scheme for nurses and maintained a close connection with the development of nurses’ welfare for the remainder of her life.

Over time, Great Ormond Street has had some unconventional doctors, including Doctor Roger Bridges (1844-1930), who is the only physician to have become Poet Laureate. He was initially educated at Eton College and Oxford University before going on to study medicine at St Bartholomew’s. Whilst he may not have been involved with any scientific breakthroughs or great changes at the hospital, Bridges was a conscientious physician and was sensitive to the suffering of the children. Rather than distance himself as some doctors are prone to do, Bridges made his patients’ wellbeing a priority.

Roger Bridges left medical practice behind at the age of 40 to concentrate on his poetry. His decision eventually paid off when he was appointed Poet Laureate from 1913 until his death in 1930. His poems typically focus on his deep Christian faith and, although his fame came late in life, some of his works have been put to music by Hubert Parry (1848-1918) and Gustav Holst (1874-1934). Bridges is also remembered for writing and translating hymns, some of which are still sung today, such as Jesu, Joy of Man’s Desiring, When morning gilds the skies and All my hope on God is founded.

A doctor of medicine who did play a part in medical developments was Sir Thomas Barlow (1845-1945). Barlow had grown up in a philanthropic family who helped to fund charities connected with the Methodist church, including Action for Children. Barlow, therefore, was no stranger to disadvantaged children when he began working at Great Ormond Street Hospital in the 1870s. By 1899, Barlow had been promoted to a consultant, however, he made his claim to fame much earlier. In 1883, Barlow proved that infantile scurvy was identical to adult scurvy and that rickets was not always a symptom of the disease. As a result, Barlow’s Disease (infantile scurvy) was named after him.

Barlow’s second claim to fame came after his time at Great Ormond Street. Appointed to Royal Physician Extraordinary and knighted as a Knight Commander of the Royal Victorian Order, Barlow was at Queen Victoria’s bedside when she passed away in 1901. He was also the physician of Edward VII and George V.

Without a doubt, the person with the biggest association with Great Ormond Street Hospital is James Matthew Barrie (1860-1937) – or, one could say, Peter Pan. In 1929, Barrie generously gifted his copyright of Peter Pan to GOSH. The hospital continues to benefit from Peter Pan’s popularity.

Born the ninth of ten children in Kirriemuir, Scotland, to a conservative Calvinist family, Barrie was schooled in the “three Rs”: reading, writing and arithmetic. When he was eight, Barrie attended Glasgow Academy where his eldest siblings, Alexander and Mary Ann, were teachers. Two years later, he switched to Forfar Academy and then, at 14, enrolled at Dumfries Academy. He loved to read and, being small (he only grew to 5 ft 3), Barrie fought for attention by storytelling and acting.

After obtaining an MA from Edinburgh University, Barrie moved to London to start his career in literature and theatre. His first accommodation was in Grenville Street, which lies behind Great Ormond Street Hospital. It is said he based the Darlings’ family home in the story of Peter Pan on this house.

Peter Pan was inspired by the Llewelyn Davies family who Barrie met and befriended in Kensington Gardens. Arthur (1863–1907) and Sylvia Llewelyn Davies (1866–1910) -daughter of the cartoonist George du Maurier – had five sons: George (1893–1915), John (Jack) (1894–1959), Peter (1897–1960), Michael (1900–1921) and Nicholas (Nico) (1903–1980). The character of Peter Pan is said to be based upon the characteristics of these five boys. Barrie also used their names in the story: Peter Pan, the children John and Michael Darling, and the father George Darling. Nico, who was only a baby at the time, was not included.

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Statue of Peter Pan outside the hospital

The much-loved Peter first appeared in 1902 in a chapter of The Little White Bird titled Peter Pan in Kensington Gardens. From here, Barrie continued the story in the stage play of Peter Pan, which opened at the Duke of York’s Theatre in London in 1904. Due to its phenomenal success, Barrie novelised the story and published it as Peter and Wendy in 1911.

Throughout his time in London, Barrie regularly supported GOSH and in 1929 he was asked to sit on a committee to help buy land in order to build a new wing for the hospital. Whilst he declined, he generously donated all his rights for Peter Pan, which meant the hospital received and continues to receive all the profits. The hospital has benefitted greatly from this gift, particularly after Peter Pan was made into a silent film in 1924 and a Disney animated film in 1953.

J.M. Barrie is not the only well-known children’s author connected with GOSH. British author Roald Dahl (1916-90), who is famous for stories including Charlie and the Chocolate Factory, Matilda, and James and the Giant Peach, assisted with ground-breaking work at the hospital.

Dahl and his wife Patricia (1926-2010) had five children: Olivia, Chantal, Theo, Ophelia and Lucy, whom they loved very much. So, when Theo was severely injured after his baby carriage was struck by a taxi, Dahl was determined to do everything he could to help his son. As a result of the accident, Theo suffered from hydrocephalus, which causes pressure inside the skull. Dahl, along with hydraulic engineer Stanley Wade and paediatric neurosurgeon Kenneth Till, worked diligently to develop a cerebral shunt to alleviate the condition. The valve, “Wade-Dahl-Till” (or WDT), successfully drained excess fluid from Theo’s skull and has since been used to treat almost 3,000 children around the world.

Australian surgeon Sir Denis Browne (1892–1967) is another notable name in GOSH’s history. Considered to be the forefather of modern paediatric surgery in England, Browne was the first full-time children’s surgeon and president of the British Association of Paediatric Surgeons. Throughout his time at the hospital, Browne invented several surgical instruments, including a method of administrating anaesthesia to children.

For over 160 years, Great Ormond Street has seen the results of hundreds of experiments, inventions and medical developments that have helped to save the lives of thousands of children. In 1962, GOSH pioneered the first heart and lung bypass machine for children. Since then, over 500 heart and/or lung transplants have been conducted at the hospital. Today, GOSH is one of the largest centres for heart transplantation in the world.

In 1967, GOSH held the first clinical trials in the UK for the rubella vaccine. Within one year, 110 children had been vaccinated against the contagious viral infection. GOSH was also the first place to conduct a bone marrow transplant. In 1979, Professor Roland Levinsky (1943-2007) successfully cured several children with severe combined immunodeficiency by transplanting cells from a healthy donor into the bone marrow.

Continuing to research into immunodeficiencies, in 2000 the hospital launched the world’s first gene therapy trials for children born without functioning immune systems. Within a year, 14 children whose conditions had been diagnosed as fatal, had been cured.

The latest breakthrough at GOSH took place in 2001 with the introduction of heart valve replacements. Rather than subject young children to open-heart surgery, the valve can be inserted via a blood vessel.

As well as medical inventions, workers at GOSH are constantly researching to improve treatments, find cures, and ultimately achieve a greater understanding of the illnesses their patients present. Professor Roger Hardisty (1922–1997) was the first professor of paediatric haematology in Britain. He also opened the country’s first leukaemia research unit at the hospital in 1961, which made remarkable steps, changing a 100% death rate into a 70% survival rate.

GOSH do not only concentrate on physical illnesses but tackle mental disorders too. Mildred Creak (1898–1993) was both the first female consultant at the hospital and the founder of child psychiatry in Britain. Best known for her work on autism and organic mental disorders, Creak opened the first department for psychological medicine in the hospital. During the 1960s, autism was generally considered to be a result of inadequate parenting, however, Creak proposed that autism, or “schizophrenic syndrome of childhood” as it was then known, was primarily caused by genetic factors.

Creak was also responsible for increasing visiting hours at the hospital because she believed children would benefit mentally from seeing their parents. She had a better appreciation of a child’s emotional needs than previous consultants and also endeavoured to assist parents with their distress.

All of these people mentioned and more have helped to create the best hospital in the world for children. GOSH prioritises providing the safest, most effective and efficient care and promises to improve children’s lives through research and innovation.

The hospital has relied on charitable support since it first opened and receives the majority of its money through the Great Ormond Street Hospital Children’s Charity. The NHS helps with the day-to-day running of the hospital but the fundraising income allows Great Ormond Street Hospital to remain at the forefront of child healthcare. The charity aims to raise over £50 million every year for research, rebuilding, life-saving equipment, and support for families. More information can be found on their website.

Great Ormond Street Hospital Children’s Charity (charity number 1160024)

The Order of St John

St John’s Gate, Clerkenwell has been a London landmark for many centuries. From medieval priory to Georgian coffee house and Victorian pub, the building is now a museum exploring the history of a military order of ancient origins from its beginnings in Jerusalem to its present day role with the St John Ambulance Service. Combining historic weapons, medals, hospital equipment, art and a cannon given by Henry VIII, the Museum of the Order of St John spans 900 years of history and a fascinating story.

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The St John Ambulance logo of a white eight-pointed cross on a black background is recognised around the world where it appears on the sides of ambulances and on the uniforms of its volunteers. Although the charity has only been around since 1877, the symbol dates back almost 1000 years. The Brother Knights in the ancient hospital in Jerusalem were also recognised by the symbol on their robes.

 

The History of the Order of St John began shortly before Pope Urban II (d.1099) declared a crusade to recapture Jerusalem and the Holy Land from the Muslim Arabs who had been in control since AD 638. In 1080, a hospital was established in the city by a group of monks under the instructions of Brother Gerard (c.1040-1120) who would shortly become the founder of Order of St John of Jerusalem (Knights Hospitaller), which was officially recognised by the Church in 1113.

The purpose of the hospital was to care for the many pilgrims who had become ill on their travels to the Holy Land. The Hospitallers, as they were then recognised, took in people of all faiths and race, treating everyone equally. It was only after the fighting in the Crusades that the hospital workers became known as the Knights of the Order of St John of Jerusalem.

From the description of the hospital provided by the museum, the Hospitallers/Knights were ahead of their time in terms of care and treatments. Brother Gerard combined traditional Muslim practices with those used in the western world in order to improve medical care. He was also concerned with healthy eating, emphasising the importance of fresh fruit as an aid to recovery.

During the 11th and 12th century, only rich people could afford to sleep in a bed, however, Brother Gerard insisted each patient should have a bed “as long and as broad as is convenient and each should have a coverlet and its own sheet.” The wards were also well-aired and clean and workers, both male and female, were encouraged to pray for the speedy recovery of the sick.

In some ways, the hospital was a combination of a hostel and a hospice with clothing, shoes and money provided to those who needed it as well as beds. The Hospitallers also looked after orphaned children and provided an ambulance service for the injured. Typically, the hospital could house 1000 people but at times of need could find space for double the number.

 

Unfortunately, the antagonism between Christians and Muslims, in general, meant the hospital in Jerusalem could not last forever, especially after Emperor Saladin (1138-93) led a Muslim military campaign against the Crusader states in the Levant. Jerusalem was captured in 1187 and the Knight Templars moved their Order and hospital to Acre in the north of Israel. Yet, by 1291, Muslim forces had succeeded in recapturing the entire Holy Land, forcing the Order of St John to seek refuge in Europe.

The Order briefly moved to Cyprus before settling on Rhodes, the largest of the Dodecanese islands of Greece, in 1309. Another hospital was set up and the Knights remained here for 213 years until the Turkish Sultan, Suleiman the Magnificent (1494-1566), conquered the island. The Museum owns a copy of the Rhodes Missal, an illuminated manuscript printed in 1504 that contains the services for a Roman Catholic Mass. In another display case, the Museum shows two handwritten letters from brothers Rostand and Claude de Merles to their father whilst on their journey to Rhodes to join the Knights.

 

Forced out of Rhodes in 1532, the Knights were, temporarily, without a home. Fortunately, the Holy Roman Emperor, Charles V (1500-58) offered to rent them the island of Malta, which they eventually settled on in 1530. Again, they quickly set up a hospital for “pilgrims and to all the sick that happened to come to Malta from all parts of the world.” Once fully established, the knights began to build a fortified city, now the capital of Malta, Valetta.

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Jean Parisot de la Valette

The capital city was named after the military commander Jean Parisot de la Valette (1494-1568). Born into a noble family in south-west France, Valette joined the Order of St John at the age of 20, thus being present at the Great Seige of Rhodes. Later in his career, he became the Master of the Galleys then, in 1557, the Grand Master.

During his time as a knight, Valette was captured by Muslim pirates and forced to be a galley slave for a year. Although slaves were required to row for 12 hours a day on very little provisions, Valette beat the odds by living three times as long as most slaves before his rescue.

The city named after the military commander was where many of the knights were housed on the island. It was also the location of the Order’s religious centre, the Church of St John the Baptist.

The Order of St John remained on the island of Malta until the 18th century, when, as fate would have it, their home was once again invaded. On this occasion, it was General Napoleon Bonaparte who ousted the knights from their location, thus ending their rule over the Mediterranean.

 

Although patients of all faiths were treated at the hospital, the Hospitallers like to treat each individual as though he or she were Christ, the Son of God. Only the best possible supplies were used including silver plates and decorated medicine containers, which can be seen on display in the museum. Many other items belonging to the Knights are also preserved in glass cases to offer insight into their lives.

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The Cardsharps – Caravaggio

As well as objects, there are a few paintings, such as panoramas of Jerusalem, however, one artwork initially appears out of place. This is The Cardsharps by the Italian artist Michelangelo Merisi da Caravaggio (1571-1610). Whilst the painting does not add any further insight into the lives of the Knights Templar, Caravaggio was a Knight of the Order. Accused of murder in 1606, Caravaggio fled to Malta where he was made a Knight; unfortunately, he later upset another member of the Order causing him to flee back to Italy.

 

Down the road from the museum is the remainder of the Order of St John’s English priory. In 1144, the Order was gifted 10 acres in Clerkenwell to establish its religious community. The English Knights of the Order of St John remained at St John’s Gate until 1540, when Henry VIII abolished all monastic orders. Since then, the church has changed many times, particularly after extensive damage by an incendiary bomb during the Second World War. Although the church was rebuilt in 1958, the majority of the original architecture has been lost. Nonetheless, the Order of St John Museum offers guided tours of the church and crypt on Tuesdays, Fridays and Saturdays. When not open for tours, a small gallery and garden are available to the public.

 

The Knights of the Order of St John of Jerusalem lives on in the St John Ambulance Association set up in 1877. The founders wanted to reflect the Order’s ethos of caring for the sick and revolutionising health care. First Aid classes were given to the public, which encouraged a large number of “ordinary” people to sign up to become part of a trained St John Ambulance Brigade. By training volunteers, more people were on hand to help the injured and the sick, thus saving more lives that could have perished whilst waiting for a doctor.

The Brigade also provided medical resources during the wars of the 20th century, the first being the South African War (1899-1902). Over 2000 members of St John enlisted, with the army’s medical staff, the medical orderlies making up approximately 25% of the volunteers. Later, during the First World War (1914-18) St John, along with the British Red Cross organised Voluntary Aid Detachments (VADs), which provided nurses, ambulances and hospital supplies for wounded soldiers. A similar feat occurred during the Second World War (1939-45) in which they also provided food parcels, clothing and provisions for prisoners-of-war, particularly those stranded on the Channel Islands.

 

The museum has a number of resources, photographs and medals belonging to past members of St John Ambulance. These include examples of old medical objects, such as a triangular bandage, tourniquet and first aid kits. Interestingly, the majority of the photographs are of women of whom 100,000 had served in VADs by the time the Armistice was called in 1918. One of these volunteers was Veronica Nisbet who joined the John Ambulance Brigade in 1915 when she was 28-years-old.

As part of a project funded by the Heritage Lottery Fund, Veronica Nisbet’s scrapbook from the years 1916-19 can be viewed by the public. The museum details a little of her life but her incredible story is best viewed through the photographs in the online version of her scrapbook. As a VAD Nurse, Veronica was taught the basics of first aid, nursing and hygiene in order to volunteer during the First World War. After enlisting to work abroad, Veronica was sent to the St John Ambulance Brigade Hospital in Étaples, northern France, the largest of the British voluntary hospitals. Veronica’s scrapbook shows pictures of the insides of the hospital, which could contain 750 patients at a time, and the nurses’ accommodation. There are also photographs of other St John Ambulance Brigade members and the activities provided to entertain the injured soldiers.

Throughout WWI, the Hospital Étaples cared for over 35,000 patients and was run by 241 members of the St John Ambulance Brigade. Despite the expert care, the building was constructed from several wooden huts, which was not the best conditions for patients recovering from serious injuries. Nonetheless, many soldiers survived due to the medical aid they received from the volunteers. Unfortunately, in 1918, the hospital was struck by a bomb on two occasions, the first killing five members of staff and the second a further eleven. The building was too damaged for the hospital to continue, however, the staff moved what they could to the coastal town of Trouville where they operated for the remainder of the war.

 

St John Ambulance is still going strong today and has members of all ages and backgrounds. The association has spread throughout the world with divisions being formed in other countries. Its primary aim is to be the difference between a life lost and a life saved and has been a valuable service to the modern world.

Since the association’s conception, branches have been formed to include younger people with the leading First Aid training provider. St John Ambulance First Aiders support local communities and emergency services and is determined to work with schools and develop youth programmes. As early as 1922, the St John Cadets was founded for teenagers to attend and get involved with all their great work. This also provided training for the future, either within St John or in other medical professions. Eventually, in 1987, a group for younger children was formed. The St John Badgers cater for 6 to 10-year-olds, providing them with basic first aid knowledge and the chance to earn badges to sew onto their uniforms. Finally, in 1989, LINKS units were opened at universities to provide opportunities for students to be part of a unique team of lifesavers. In total, over half of St John members are under the age of 25.

St John Ambulance relies mostly on volunteers and donations in order to keep running its expert service. To help with funding, the St John Fellowship was formed on St John’s Day 1983, which raises a generous amount of money every year. Supporters help to set up and run exhibitions, displays, concerts and competitions as well as assist at many national events.

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The Museum of the Order of St John is an excellent place to visit in London for those wishing to learn more about the original Knights of St John and the St John Ambulance. A concise timeline helps to make sense of the mass of objects displayed within the gatehouse that date back several centuries and the information about St John Ambulance is very fitting with the anniversary of the end of the First World War. It is also reassuring to know there are so many kind and caring people in the world, despite the many conflicts.

For children, some of the details may be beyond their comprehension, however, the museum provides a fun sticker trail with simple questions to keep youngsters entertained. There are also colouring sheets and simple, child-friendly first aid tips to take away.

The museum is free to enter, however, a donation of £5 is recommended for the tour of the church and priory. The museum receives no government funding, and needs continued financial help to maintain the historically important buildings and collections.