"A Place for More than the Healing of Bodily Sickness": Charles Dickens, the Social Mission of Nineteenth-Century Pediatrics, and the Great Ormond Street Hospital for Sick Children

Twenty years after the publication of Oliver Twist (1837-39)—the novel that established Dickens's reputation as the nineteenth-century author of childhood—Dickens published a Christmas number of Household Words in which he revisited and rewrote the major plot elements of that earlier novel. Titled A House to Let (1858), the Christmas story was, like many other Christmas volumes of Household Words, a collaborative work. Sections of the composite tale were penned by Elizabeth Gaskell, Wilkie Collins, Adelaide Anne Procter, and Dickens, who also oversaw and edited all parts of the narrative. The tale hinges on a permanently vacant house in London with an illustrious past and a dark secret, a house that is turned into a children's hospital at the end of the narrative. As regards the melodramatic plot and dramatis personae, A House to Let unmistakably echoes Dickens's Oliver Twist. In both stories, we have an unfortunate marriage, an orphaned child, villainous family relations, drunken doctors, mysterious wills, and an inheritance at the heart of the mystery. There is, however, a crucial difference between the endings of the two narratives. While the conclusion of Oliver's pilgrimage installs him safely in Brownlow's middle-class home, the last view of the nameless little orphan of A House to Let is of the boy waving happily from a window of the formerly vacant house, now a busy children's hospital. As the narrator points out, the child is neither sick nor without protection, yet the image of the public space of the hospital displaces the private middle-class parlour as the ideal home for the neglected child.

In what follows, I locate this shift in Dickens's depiction of the vulnerable child and the agencies of his rescue within a wider social context: that of the medicalization of the children of the poor in the mid-nineteenth century. For this purpose, I will explore some of the narratives, myths, and fictions that circulated around the historical London institution on which the children's hospital in A House to Let is modelled: the Great Ormond Street Hospital for Sick Children, the first hospital for diseased and disabled children in the United Kingdom. Founded in 1852 by Charles West, one of the most eminent British pediatricians of the nineteenth century, the hospital was established both to provide medical care for the children of the poor and to enhance medical knowledge about diseases and disabilities peculiar to childhood. Professional medical provision for children was scarce before the foundation of Great Ormond Street. Hospitals admitted children on a very limited scale because they lacked personnel and resources to supervise and cater to their needs (Lomax, Development of Hospitals 4-6). Although a few children's infirmaries and dispensaries operated throughout the country, notably the Waterloo Dispensary in London, they had no facilities to accommodate in-patients and thus accepted children as outpatients only. This situation constricted both research opportunities and the number of diseases and disabilities that could be attended to (Kosky and Lunnon 1). For these reasons, the foundation of the children's hospital is today considered one of the milestones of British pediatrics (Lomax, Development of Hospitals 1; Davis 31; Colón and Colón 190, 203). Despite Dickens's well-documented support for the children's hospital in the 1850s and 1860s (Kosky 143-204), critics have not yet investigated the ways in which the notions of childhood and some of the sick and disabled characters in Dickens's writings came to be inextricably linked with the new hospital in the public imagination of that period. Dickens's personal involvement in and fictional depiction of Great Ormond Street have sometimes been blotted out by the famous twentieth-century literary patron of the hospital, J.M. Barrie, who bequeathed the copyright of Peter Pan to the institution in 1929. Despite his generous financial support, Barrie never wrote about the hospital. It was Dickens who integrated the children's hospital into A House to...