Pediatric Practice at the London Foundling Hospital

P e d ia tr ic P r a c tic e a t th e ihgfedcbaZYXWVUTSRQPONMLKJIHGFEDCBA L o n d o n F o u n d lin g H o s p ita l R U T H K . M c C L U R E The title of my paper is, admittedly, anachronistic: the word p e d i­ a tr ic s did not come into use until the late nineteenth century. In eight­ eenth-century England neither the word nor the specialty itself ex­ isted. Physicians received no training in the diagnosis and treatment of children's diseases. Everyone assumed that any qualified practi­ tioner could treat all patients who came his way, whether they were young or old. But, in fact, many physicians preferred not to attend child patients if they could avoid it.1 Nevertheless, when the Foundling Hospital in London opened its doors in 1741, at least four eminent physicians and two surgeons immediately offered their services to the infant foundlings. And all through the century leading members of the medical profession re­ sponded to the needs of these children, who, sooner or later, suf­ fered all the normal illnesses of eighteenth-century children and some that the more fortunate escaped. The common run of ailments included smallpox, measles, fevers, and chincough. In addition, the physicians had to deal with venereal diseases, scabies, scald heads, scrofula, and illnesses caused by diet deficiencies. Everyone worried about smallpox. In the eighteenth century it was chiefly a disease of infants and children under three years of age. As Dr. John Coakley Lettsom remarked late in the century, "most born in London have smallpox before they are seven."2 Between 1721 and 1760 smallpox caused ten percent of all deaths in London and left 361 362 / MCCLURE many who recovered blind.3 It was no respecter of social status. But the aristocracy and persons of the middling sort could, if they chose, fend off the disease by inoculation, a technique that Lady Mary Wortley Montague had popularized upon her return to England from Constantinople in 1718. Because inoculation, unlike vaccination, in­ duced a case of smallpox in the recipient, the procedure was hazard­ ous. It required the combined services of a physician, a surgeon, and an apothecary. The preparation of the patient with purges and emet­ ics, bleeding and blisters, could take a month, and the recovery pe­ riod might last five to six weeks.4 In short, it was expensive. Yet inoculation was one of the earliest preventative measures adopted by the Governors of the Foundling Hospital. Three years after admitting the first foundlings, they asked Dr. Richard Conyers, the Hospital's physician, to inoculate some of the children. The out­ come of this experiment proved so satisfactory that the Governors decided to make it a rule to inoculate all of the children on their re­ turn to the Hospital from the country where they were nursed from admission to age three or four. By the end of April 1755, 211 children had been inoculated with only one loss of life.5 The action of the Governors in having the foundlings inoculated at such an early age was indeed forward-looking. The smallpox hospi­ tals for the poor, established in London between 1746 and 1768, did not inoculate children under seven years of age,6 and many children of well-to-do families were not inoculated earlier. Doubtless the strong approval of Dr. Richard Mead and Sir Hans Sloane influenced their fellow Governors.7 But they were less willing to embrace the new method of vaccination when Jenner published a report on his work in 1798, and the Hospital's physician was still inoculating the children in the usual way during the autumn of 1799. In spite of these efforts, some children died of smallpox contracted in the natural way, usually while at nurse in the country. But deaths from a great variety of fevers outnumbered any other category spec­ ified in the Hospital's records. This was to be expected, since fevers caused eight out of ten deaths in the eighteenth century. But of what diseases these fevers were symptomatic I cannot say. The...