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”.