1

MaryLindsayMBFRCPFRCPsychFRCPCH(Hon)BorninBelfastin1926,broughtupinEngland,qualifiedQueensUniversityBelfastin1951.Afterseveralhousejobs,didpaediatricsatHammersmithHospitalandwassentbyArchieNormantoworkunderDermodMacCarthyatAylesburyandAmersham.HehadbeenhavingmothersofyoungchildrencomingintoAmershamHospitalforaboutayearwhenIarrivedtherein1954attheinstigationofhiswardsisterIvyMorriswhohadbeenanannybeforequalifyingasanurseatEGAHospital.JamesRobertsonfromtheTavistockClinicfolloweduphisfilmATwoYearOldGoestoHospitalwithGoingtoHospitalWithMotheratAmersham.ItispartlyduetotheinfluenceofthosetwofilmsandtalkingtoRobertsonandMacCarthy,whoweresupportedbyWilfredSheldon,thatPlattwasabletomakearecommendationthatmotherscomeintohospitalwiththeiryoungchildren.Afterfiveyearsofpaediatrics,didthreeyearsinGeneralPractice,threeyearsinAdultPsychiatry,andoneyearinChildPsychiatry.IwasappointedConsultantChildPsychiatristin1966atAylesbury,retiringfromtherein1991.IthendidaboutfifteenyearsasanexpertwitnessintheFamilyDivisionoftheCourts.IhaverecentlyfeltIhavearesponsibilitytousemyownexperiencetoreflectonthecontactthatchildrenhavehadwiththeirparentswhentheyweresick,athomeandinhospital,whichiswhyIwrotewhatyouareabouttoread,buthavenoideawhattodowithit.IwouldliketothankSebastianKraemerforhishelpandsupportandforencouragingmetodothis.Marywouldwelcomefellows’commentsonthispaper.Pleasesendto:marylindsay@btinternet.com

SickChildrenandtheirParents

Smallchildrenadmittedtohospitalwillnotthrivewithouthavingaparentwiththem.

Thishasbeendimlyunderstoodbypaediatriciansforatleast250yearsbutonlysince

2

avigorouscampaignforparentalvisitinginthelatterpartofthe20thcenturyhas

practicechanged,againstenormousinstitutionalresistance.

Weneedtorememberthishistoryinordertomaintainprogress.Ourcollectivewish

nottore-experiencechildhoodfeelingsofabandonmentisverypowerful.

Thispaperchroniclestheeffortsofpioneeringpaediatriciansandparentsfromthe

18thcenturytothepresentday.

GEORGEARMSTRONG

Tookpaediatricsfromaconjecturalartintoabranchofscientificmedicine

“Ifyoutakeasickchildfromitsparentsornurseyoubreakitsheartimmediately”.This

wassaidin1772byGeorgeArmstrong(1719-89).

GeorgeArmstrongsetupthefirsthospital/dispensaryforsickchildrenintheworldand

wroteoneofthefirstbooksonchildren’sillnesses.Histextbookswerewidelyreadboth

intheUKandEuropewheretheyweretranslatedintoItalianandGerman.

Inthispapertheword‘hospital’isusedinfourdifferentsenses-Armstrong’s

dispensary/hospital;afoundlinghospitalsuchasthatofThomasCoram;hospitalsas

describedbySpitzwhichwere,infact,institutionsforabandonedchildren;and,of

course,theeverydayhospitalthatweknowtoday.

Asonofthemanse,hequalifiedinmedicineatEdinburghwhenhewas19andprobably

practisednearhishomeuntil1745when,inthewakeoftheJacobiteRebellion,he

joinedhisolderbrotherJohninLondon.JohnalsohadqualifiedinEdinburghandsowas

unabletopracticeintheCityofLondonandhadtakentowriting,butwasabletowork

inanArmyhospitalsetuptolookafterthewoundedfromtheBattleofPrestonpans.

Georgebecamehisassistant.

3

In1755GeorgemarriedandmovedoutofLondontoHampsteadwherehepractisedas

asurgeonapothecary.Thebirthofhisdaughtersledtoaninterestintheconditionsof

children.Hereadwidelyandwrotehisfirstmonograph‘EssayontheDiseasesMost

FataltoInfantstowhichareaddedRulestobeObservedintheNursingofChildren’

whichappearedin1767.Thisbookchangedpaediatricsfromaconjecturalartintoa

branchofscientificmedicine(andprobablyledtohimgettinganMDfromStAndrews).

Twoyearslaterhesetuphisdispensary.Atthistimetherewaslittleconcernaboutthe

highmortalityrateofinfantsandchildren,especiallyofthepoor.(EvenThomasCoram’s

FoundlingHospital,openedin1737,becauseofhisconcernoverthenumberofdead

anddyingbabiesinthestreetsdidnotgetgeneralapprobation).Butprobablymore

importantwasthefactthatthemedicalestablishmentfelttherewaslittlethatcouldbe

doneforinfantsandchildrenbecausetheycouldnotsaywhatwaswrongwiththem.In

attemptingtotreatthemonecould“dothemamischief”sotheywereusuallytakento

oldwomen.ArmstrongsetuphisDispensarysupportedbycolleaguesfromScotlandand

others,aswellastheRoyalCollegeofPhysicians,whoturnedablindeyetothefactthat

hehadqualifiedinEdinburgh.

TheDispensarylastedfortwelveyears,saw35,000childrenandhadtomovefourtimes

becauseofincreasingnumbers.Armstrongkeptexcellentrecordsandthuswasableto

writeabouthiswork,suchashistreatmentofwhoopingcoughandhisclassic

descriptionofpyloricstenosisandthepathologicalfindings.Hewrotethathedidnot

confinehimselftotreatingthechild,butextendedhiscaretotheprophylacticbranch,

enquiringintothechild’sdietnotonlyduringtheillnessbutaftertherecovery.Healso

instructedonventilation,cleanlinessandkeepingthemdry,andiftheygotillagainto

takethemtothedoctor.Thedispensaryprovidedagreatnumberandvarietyofcases

andheusedtheseforeducatingdoctors,nursesandotherslookingafterchildren.His

bookswerehislegacyandhewasseenasboththefatherofpaediatricsandof

preventivepaediatrics.

4

TheDispensaryclosedonthe1stDecember,1781duetolackofmoneyandArmstrong’s

illhealth.In1783,hepublishedhislastbookanddiedinobscurityin1789.Twoyears

afterhislastedition,MichaelUnderwoodplagiarisedandthenlatercriticisedhisbooks,

andthushisworkwasforgottenuntilresurrectedbyGeorgeFredericStill(1931),

WilliamMaloney(1954)andPeterDunn(2002).

Buthedidleavebehindoneimportantcomment.In1772therewasdiscussionabout

whetherthereshouldbeahospitalattachedtotheDispensary.Armstrongwasagainst

thisatthetime,sayinghewasworriedaboutcross-infection,childrendisturbingeach

other,themothersnotbeingabletoleavetheirfamiliestolookaftertheirchildrenin

hospital,andconcernaboutwhetherthemothersandnurseswouldgeton.Thislast

commentisnowamatterunderdebate.

JOHNBUNNELLDAVIS

TheDispensarywasbetterknownontheContinentthanitwasintheUK.Thepaediatric

conceptwasexportedtoEuropewherehospitalsanddepartmentsforchildrenwere

beingdeveloped,forexample,inPariswhichin1802hadthefirstchildren’shospitalin

theworld.

Forthenext36yearsafterArmstrong’sDispensaryclosedthereseemedtobeno

facilitiesspecificallyforthecareofsickchildrenofthepoor,thoughtherewassome

concernthatchildrenundertwoshouldnotbetakenawayfromtheirmothers[where

onearthwouldtheygoaftertheageoftwo?].Knowingthatadultswouldalwaysbe

seenfirst,mothersdidnottaketheirchildrentothegeneraldispensaries.

In1816,JohnBunnellDavis(1777-1834)opened‘TheUniversalDispensaryForChildren’

inStAndrewsHill,London.HehadbeendetainedinFranceandtherestarteddreaming

ofadispensary,beingthefirstofmanyinthemetropolis,possiblyevenextending

5

acrossthecountry,withsomeofthembecominghospitals.(Hadheheardof

Armstrong’sdispensary,headmittedlateron,hemightnothavebeenquiteso

enthusiastic.Hedidlovebeingthefirst).BackinEngland,Daviscampaignedtoraise

moneybeforebeingabletoopenhisdispensary,whichwassosuccessfulthatit

outgrewitspremisesandhadtomove.Onceagainhebecamethetirelessandeffective

fundraiser,letter-writerandorganizerwithroyalsponsorshipandwasabletomovethe

dispensarytoWaterlooRoad.Therewerealsotwowardswhichwereneveropened.

Twomonthsbeforeitwasfinished,attheageof47,hesuddenlyandunexpectedlydied,

leavingdebts.Evenwhentheseweresettled,theCommitteewasunabletomove

forward.Itcontinuedasadispensary,butthehopeofadispensary-hospitalforchildren

seemedtohavediedwithDavis.

Hehadgreatcompassionforsickchildren,thoughthereisnoevidencethathe

understoodtheneedofyoungchildrenfortheirparentsornurse,butthiswasnormal.

CharlesWestwasappointedtotheDispensaryin1842anddidtrytoopenupthewards,

butwasunsuccessful.

CHARLESWEST

Whenthenursesarrived,themothersleft,becomingvisitors,orsimplyabsent

CharlesWest(1816-1898),thesonofaBaptistministerinAmersham,wasatBarts

HospitalasastudentandthenwenttoEuropequalifyingfromBerlinin1837.Returning

toEngland,hetriedgeneralpractice,thencespentayearattheRotundaHospital,

Dublin.Withthearrivalofhisowntwochildren,hebecameappalledatthehighdeath

rateandlackofmedicalinterestinthesickchildren,especiallyofthepoor.

In1840CharlesWestwasallowedtoattendtheDispensaryinWaterlooRoadandin

1842wasappointedthere.FamiliarwithhospitalsforchildrenasastudentinEurope,

hetriedtopersuadetheCommitteetoopenitswards,asDaviswouldhavedone.But,

6

aftersevenyears,hebecameexasperatedbythelackofprogress,andresignedin

September1849.Onceagain,Davis’dreamdied.

West,likeeverybodyelse,believedthatsickanddyingchildrenwouldbebetterathome

withtheirlovedonesandthatthefamilyhadaresponsibilitytolookafteritsown.But,

fromhishomevisits,hehadseenfirsthandtheconditionsinwhichthesechildrenlived

andtheburdenofthechild’sillnessonthemother.Inadditionhehadseenfromhis

experienceinEuropethathospitalsforchildrenwerenecessaryandcouldbeachieved,

butintheUKtherewasconsiderableresistancetochildren’shospitals.Westmetup

withthedistinguishedHenryBenceJonesFRS(1813-1873)who,havingalsoworkedin

Europe,understoodtheneedforthem.BenceJoneshadthesocialandfinancial

contactswhichCharlesWestlacked.AcommitteemetatBenceJones’shouse,andthe

moneywasraised.CharlesWestplayedhispartasapersuasivespeakerandwas

excellentatwritingpamphlets.HewenttoEuropeandinvestigatedthehospitalsthere.

LikeArmstrong,healsothoughtalargenumberofsickchildrengatheredtogetherin

oneplacemightstimulatemedicalinterestinchildren’scomplaints.

‘TheHospitalForSickChildren’wasopenedinGreatOrmondStreet,on14February

1852,withWestasthefirstphysician.Tobeginwith,therewereaboutsevenbedsbut

nonurses,andatfirstthemotherscameintolookaftertheirchildren.ButWestnever

atanystagebelievedthatchildrenundertwoshouldbeadmitted-theyhadtostaywith

theirmothers.Hesawthatthenursingofchildrenwasmorecomplicatedthanofadults

sohestartedatrainingschool.Thiswasthefirstinthecountryandwaswayaheadof

FlorenceNightingale.Whenthenursesarrived,themothersleftandbecamevisitors.

Forthenexthundredyears,visitinghourswerefromtwotofiveonSundays-therewas

noGeorgeArmstrongtodisputethis.

Thehospitalquicklybecameacentreofexcellencefortheprovisionofhealthcareto

childrenofthepoor,fortheencouragementofclinicalresearchinpaediatrics,andfor

7

theeducationofdoctorsandnurses.Westarrangedforalibraryandmuseumtobe

builtwithinthehospital.Aswellasin-patients,therewasathrivingoutpatient

departmentwhichprovidednotonlydiagnosisandtreatmentbutalsoeducationof

mothers,ratherliketheolddispensaries.

Therewasatthetimenounderstandingoftheemotionaldistressandpsychological

damagetochildrenfromthelackofcontacttheyhadwiththeirfamilies.Forthe

children,itmusthavebeenbleakanddepressing.Occasionally,somewerekeptineven

longerbecausetheywere‘interestingcases’.Themothersknewtheirchildrenwouldbe

‘changed’whentheycameoutofhospital,buttheywerepoorandsaidnothing.

AfterthehospitalinGreatOrmondStreetwasopened,furtherchildren’shospitalswere

builtinthebigcities,usuallybyindividualdonors,suchasJennyLindinNorwich.Fever

hospitalsandsanitoriawerealsobeingbuiltbythegovernmentoutinthecountry(like

thementalhospitals)wheretherewasusuallynovisitingatall.

Hospitalsfacedrepeatedmedicaldemandstocutbackonvisitinghours(theofficial

reasonbeingthattheparentsbroughtininfectionsthoughprobablytherealreasonwas

thatthewardwaseasiertorunwithoutthem);consultantswerebeingdiscouraged

fromvisitingtheirpatientsathome;and,inaddition,childrenwerenotgoinghome,

theyweregoingtoconvalescenthomes,oftenattachedtothehospitals.Thusthe

hospitalswerebecomingdistantfromthecommunity.

Wealthierparentswereseeingthattheirchildrenneededmoreeducationthanwas

possibleathome,andsotheywerebeingsentawaytopreparatoryschoolsinorderto

preparethemforpublicschools.Itseemedasifparents,andparenting,werebecoming

lessimportant.

Intheenthusiasmformedicalimprovementinphysiologicalcareandasthehospital

movementflourishedacrossEngland,theemotionalneedsofchildrenforbeinglooked

8

afterbytheirmothersandnurseshadbeenforgotten.Inthenewhospitalstheir

medicalcareimproved,butthechildrenhadlittleornocontactwiththeirfamilies.This

wasadevastatingexperience,especiallyfortheyoungestwhobecamepsychologically

damaged.TherewasnonewGeorgeArmstrongtoremindthem.However,therewerea

fewexceptions.

HUGHOWENTHOMAS

AneccentricgeniuswithacruciallinktoSirHarryPlatt

HughOwenThomas(1834–1891)ofLiverpoolwasdescendedfromalonglineof

bonesettersHewasthefatheroforthopaedicsintheUKandaneccentricgenius.

Althoughthereisnoindicationthathewasgreatlyconcernedabouttherelationship

betweenmotherandchild,hewaspassionateaboutthetreatmentofchildrenwithTB

ofthehip,kneeandankle.AsamedicalstudentinEdinburgh,andpossiblyasa

postgraduatestudentinParisandLondon,hehadseenthemutilationthatfollowed

surgicaltreatment,whereashethoughtthetreatmentshouldbeenforced,

uninterruptedandprolongedrestusinghissplints.Thiscouldbedoneathomewith

regularvisitsfromhim,andifneededforemergencies,buttheparentshadtofollowhis

instructionsmeticulously.Healsobelievedinsunshineandfreshair,ifnecessaryona

bedchainedtotherailingsinthestreet.Hissplintsaremiraculousandarestillbeing

usedtoday.Heoccasionallygavelecturesandwroteanumberofbookswellintothe

night,havingstartedworkat5o’clockinthemorning.

Asmallman,apatchoveroneeye,abeard,ablackcoatthathealwayswore,neverhad

acigaretteoutofhismouth,OwenThomasfrequentlyquarrelledwitheverybody,

althoughclinicallyhewasquickandgentle.Heworkedforthepoor,lookedafterthe

dockersandtheirinjuries,andwhenhediedattheageof57thewholeofLiverpool

mournedhim.

9

Whenhewas17hiswife’snephew,RobertJones(1857-1933laterSirRobert)lived

withthemasamedicalstudent.Afterqualifyingin1878Jonesworkedwithhisuncleat

11NelsonStreet.At31hewasputinchargeofthe20,000workersontheManchester

ShipCanal,whichtooksevenyearstobuild.HemetupwithAgnesHunt,firstasa

patientandthenasacolleague,andbecametheorthopaedicsurgeontoherhospitalin

Bathchurch.HeendedtheFirstWorldWarasaMajorGeneralinchargeof

orthopaedics.Heintroducedhisuncle’ssplint,theThomasSplint,in1915which

reducedthedeathrateofcomplicatedfracturesofthefemurfrom80%to8%.

Inaround1893JonessawHarryPlatt(1886-1986)who,attheageoffive,had

developedatuberculousknee(Plattgivesavividdescriptionofthisconsultationat

NelsonStreet).Harry’seducationwasathome,wherehetaughthimselfFrenchand

German.HebecameveryattachedtoJones,whocontinuedtolookafterhimand,

althoughmusicwasapassion,hedidnotgetahopedforscholarshiptoLondonandso

aftersomeindecisiondecidedtofollowJonesintomedicine.Hequalifiedwithbrilliant

resultsandthenwentintoorthopaedics.HarryPlattwaslatertobemadethechairman

ofacommitteeonthewelfareofchildreninhospital.

JAMESHNICHOLL

“smallchildrendobestintheirmother’sarms”

ThoughnotrecognisedbytheBritishAssociationforDaySurgeryJamesHNicholl(1864-

1921)isconsideredthefatherofdaysurgeryforchildren.

Anothersonofthemanse,NichollqualifiedinGlasgowandwenttoLondonand

probablyEuropeforhispostgraduateeducationunderProfessorFrederickTreves.In

1894,believingthatchildrenundertwoshouldnotbeawayfromtheirmothers,he

startedadaysurgeryunitinthedispensaryoftheHospitalforSickChildreninGlasgow,

treating,amongstmanyotherconditions,hernias,pyloricstenosis,cleftpalateandhare

lip.Afteranoperation,withoutamotherintheward,achildwas‘alloverthebed…if

splintedhiscryingandstrugglingputfreshstrainonhissutures’andheconcludedthat

10

thesmallchildrenwould‘dobestintheirmother’sarms,andnesttheremorequietlyon

thewhole,thananywhereelse’.Hebelievedthathospitalizationwasneitherneeded

norbeneficialforchildrenundertwo,andwassupportedbyateamofnurseswhomade

dailyvisitstochildrenintheirhomes.Nichollfeltthat‘withamotherofaverage

intelligence,assistedbyadvicefromthehospitalsister,thechildfaresbetterathome’.

Hehadahouseavailablehardbyforthemothersandchildrenwhodidnotlivelocally,

withoutwhichhethoughtnochildren’shospitalwouldbecomplete.

Nicholldescribedhisworkinapaper,‘TheSurgeryofInfancy’givenatthe1909BMA

meeting,whereinthediscussionthatfolloweditemergedthatothersurgeonsfrom

Glasgow,Edinburgh,Belfast,andLiverpoolweredoingsimilarwork.Hisdiscussionends

withadescriptionofachildgoingbackaftertheoperation,withanappropriate

dressing,totheparents’bedalongwiththeotherchildren.Hisdispensarylasteduntil

1914whenthehospitalwasrequisitionedbythearmy.

JamesNichollwasatrulyoutstandingpersonandverypopular.AftergoingtoFrance,in

1917hegotdysenteryandneverreallyrecovered,dyingin1921alongwithdaysurgery

forchildren-casualtiesoftheFirstWorldWar,bothlargelyforgotten.

SIRJAMESSPENCE

Thefirsttoactuallyhavemotherscomingintohospitalwiththeirchildren,butwasmore

concernedwiththeneedsofmothersthanwiththebabies’

In1926,JamesSpence(1892-1954)wasappointedtotheBabiesHospitalinNewcastle

(forchildrenunderthree).AsafollowerofTrubyKingSpenceadmittedmothersinitially

todealwithbreastfeedingproblems,thenformothertocareforthebaby.Hewas

unableorunwillingtoadmitallmothersbutreckonedthathecoulddecidewhoshould

beadmitted,notforsentimentalreasonsbutfromlongandwiseexperienceofthetype

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ofmotherwhowouldbenefit(Spence,in‘TheBabiesHospitalNewcastleUponTyne’,

UrsulaRidley,1956p.15).Inhislecture‘ThePurposeoftheFamily’in1946hedescribes

twogroupsofmothers.Onewholefttheirbabyinthehospital,worriedathome,and

thencollecteditfromsomebodywhohadmadeitbetter.Thesemothersalwayshada

senseoffailureandlackedconfidenceinmanagingafterwards.Theothergroup,who

wereadmittedtohospitalwiththeirbaby,lookedafterit,hadasenseofachievement

andthereafterhadgreaterconfidence.Spencecouldhavedonemoretopromote

maternalconfidence.Perhapshewastoopaternalistictoseehowtodothis.

InhisCharlesWestLecturehegivesafullerdescriptionofthesituation.Hepointsout

thatnearlyallthenursingofsickchildrenisdonebymothersathome,andthatbringing

mothersintohospitalwiththeirchildrenisjustanextensionofthis.Theyhavetheirown

roomneartheward,andsohavemedicalandnursingsupportwhentheyneedit.The

nurseslearnfromseeingthemotherandchildtogetherasdothestudentsiftheyare

there,andwiththemotherlookingafterthechildthenurseisfreetospendmoretime

ontheward.

Although,Spencehadgreatunderstandingofmothersandtheirneeds,hehadless

understandingofthebabiesneeds.Whilethelecturedescribesthelonelinessofasmall

childinhospitalwithoutmothertoreadhimthebedtimestoryhewasmoreconcerned

thatmothersneededtobewiththeirsickchildren.Asamanofhistime(liketherestof

us)hehadlittleknowledgeofachild’semotionaldevelopmentandofthechild’sneed

formother.

Spencedescribesthedistressofolderchildreninlongtermhospitals.Havingtalkedto

themasadults,hewasawareofhowtheyhadfeltasadolescentslivinginlongstay

hospitalsandwasveryunderstandingoftheirdistress.

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Hedeploredthearrangementsinmaternityhospitalswherebythebabieswerekeptin

thenurserywhilethemotherswereawayfromtheminthelying-inward.Thebabies

werebroughttothemotherseveryfourhoursforwhathescathinglycalled“milking

time”.Aftercarryingtheirbabyforninemonths,mostmotherswantitbesidethem.

Nowadays,ofcourse,thisdoesnotpertain.

Manyyearslater,KlausandKenneldemonstratedthegreatimportanceofearlyskinto

skincontactinbondformationfornewmothersandtheirbabies(ParenttoInfant

Attachment,1976).

InspiteofSpence’sstature,hisarrangementofhavingmothersintohospitalwiththeir

sickchildrenwaswidelyknownbutnotemulatedatthetimebuthedidhavean

antipathytopsychiatryandpsychology,evenmorethanmostpeopleatthetime,in

particulartoJohnBowlby’scollaboratorJamesRobertson’sevidenceoftheeffectsof

parentalseparationonchildreninhospital.In1951attheBritishPaediatricAssociation

annualmeetingSpencewasextraordinarilyscathingofRobertson’sdescriptionofthe

emotionaldistressthatsmallchildrenfeelwhentheyfirstcomeintohospital-“What’s

wrongwithemotionaldistress?”RobertsonhadbeenaguestattheBPAmeetinganda

fewmonthslatercalledintoseeSpence.Hewasgreatlyimpressedbythemothersin

theBabiesHospitalwiththeiryoungchildrenandSpence’srelationshipwiththembut

healsosawinanordinarychildren’swardthesamedistressedtoddlersthathehad

seenelsewhere.HeaskedSpenceaboutthisandSpenceputhishandonRobertson’s

kneeandsaid,“Robertson,Iknowhowmuchthesechildrenneed.Twiceaweekis

enough”(SeparationandtheVeryYoung,Robertson&Robertson,1989,p.20).As

Robertsonsays,Spence’sunderstandingofthemother’sneedsmeantthechildrengot

thelookedafterbyherasa‘spin-off’WhenSpencesawRobertson’sfilm,‘ATwoYear

OldGoestoHospital’,hewasas“causticallynegativeasbefore”(Brandon,S.‘Children

andParentsinHospital’SpeakingatNAWCH,Unpublishedpaper,1986p.13)

13

Spencehadgreatantipathytopsychologyandpsychiatrymayhavearisenfromhis

experienceatthefront.Hejoinedupin1914attheageof22,havingjustqualifiedasa

doctor.HegottheMCandBarforgallantryforlookingafterwoundedsoldiersunder

fire.It’spossiblethathehadsomedegreeofposttraumaticstressdisorder.Smokingat

thefrontwasencouragedtohelppeoplecopewiththeboredomandtheterror.

Spence’sheavysmokingcontinuedfortherestofhislife.Therewasneveranypublic

indicationthathesufferedfromPTSDandonemustadmirethis,butIwonderifthe

casualtywashisantipathytopsychiatristspossiblybecausehethoughttheymay

discoverit.Hisdeathin1954maywellhavebeenduetosmoking.Thus,anotherFirst

WorldWarcasualtylikeNicholl.

AFTERWORLDWARONE

Stillnoincreaseinvisitingtimeforchildreninhospital.

ExceptforJamesNichollnooneduringthefirstpartofthetwentiethcenturyseemsto

havebeenconcernedaboutbabiesundertwobeingawayfromtheirmother

BeforetheFirstWorldWartherehadbeenaworryingfallinthebirthrateandno

decreaseinthenumberofchildrenthatdiedfromdiarrhoea,leadingtoconcernabout

whowastorunthecountryandtheEmpire.Thiswasfurtherheightenedbythe

slaughteroftheWar.Motherswereinitiallyblamedforthediarrhoeaeventhoughit

wasclearthevastmajorityofcasescamefrompoorareas,butitwascheapertoblame

mothersthanimprovethetenementsandhaveuncontaminatedmilk.

PerhapsbecausealmosteverybodyhadlostsomeonetherewasaftertheFirstWorld

Waranincreasinginterestinchildren.TherewerenowenoughphysiciansintheUK

interestedinchildren’sconditionstopromoteaprofessionalorganisationinwhichto

meet.ThiswastheBritishPaediatricAssociation,foundedin1928undertheleadership

ofGeorgeFredericStill.

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Atfirst,thisincreasedinterestrevolvedaroundhabitformation,assuggestedbythe

AmericanbehaviouristJ.B.Watsonwhohadlittletimeforsentimentortenderness.And

TrubyKing,althoughhepromotedbreastfeeding,atthesametimestipulatedregular

fourhourfeedingswithnofeedingatnight(thusnegatingitsuseasacontraceptive).

Hisinsistenceonregularityincludedallaspectsofchildcare.Ifthemothercouldnot

copewithherbabycryingbeforehisfeedwasdue,sheshouldputthebabyinapramat

theendofthegarden.(Maybetheworkingclassbabieswithnopramandnogardendid

better,asdescribedbytheRobertsons.Herethebabieswerepickedupwhentheycried

andfedondemand).

Gradually,Watson’sviewswerereplacedby,amongothersthepsychoanalystand

educatorSusanIsaacs.InherbookTheNurseryYears(1929)andinheradvicecolumnin

themagazineNurseryWorld(1929-36)sheadvisedparentstohaveamoretolerant

view;totakeaninterestinwhattheirchildrenweresaying,thinkinganddoing,andto

attempttounderstandtheiranxietiesandfears.In1935JohnRickmanpublished‘On

theUpbringingofChildren’,aseriesoflecturesbychildanalysts.MargaretLowenfeld,

directoroftheClinicforNervousandDifficultChildren,alsogavelectures.Theswing

againstWatson’sbehaviourismwasfurtherincreasedwiththepublicationof‘Babiesare

HumanBeings’byAldrichandAldrich(1938).

Inspiteofthisgrowthinunderstandingtherewasstillnoincreaseinvisitingtimefor

childreninhospital.Thesewerelargelythechildrenofthepoor.Themiddleclasseshad

theirchildrenlookedafterathomeorinnursinghomes.

Itwasthechildguidanceclinics,importedfromAmericaandpaidforbythe

CommonwealthFundofNewYork,thatmadeamajorcontributiontothechangein

attitudes.Theseclinicsweresetupfrom1926,thefirstonebyEmmanuelMillerinthe

EastEndHospitalfundedbytheJewishBoardofGuardians,andwiththesupportofthe

15

NewYorkCommonwealthFundfurtherclinicsinGlasgow,BirminghamandLondon

wereopened,40inall.Thoseworkingintheseclinicswereanalyticallyorientatedchild

psychiatrists,psychologistsandsocialworkers.Theclinicsprovidedaplaceforparents

tovisittodiscussandoccasionallygetadviceabouttheirdisturbedchildren,and

sometimesthechildrengottreatment.Theyalsoprovidedanopportunityforresearch

includingthatdonebyHarryEdelstonandJohnBowlby.

HARRYEDELSTON

Amaverickchildpsychiatristwhosaw,butwithoutthebenefitofattachmenttheory,

thatsmallchildreninhospitalsufferedgreatly

Apartfromtheparentsofthechildreninhospitalnoonewasawareofthechildren’s

emotionaldistressafteradmission.From1936to1939thechildpsychiatristHarry

Edelston(1902-1994)followedup42childrenwhohadbeenreferredtoachild

guidanceclinicbecausetheyhadbeendisturbedanddistressedbyahospitaladmission.

Hedoesnotseemtohavemadeanyspecificcommentsaboutthesignificanceofthe

ageofthechildnorthedurationofhospitalstay.Neverthelesshedidshowthattimein

hospitalcanbeatraumaticandemotionallydamagingexperienceforchildren.His

paperwaspublishedin1943inanAmericanpublication,GeneticPsychology

Monographs(EdelstonH,Separationanxietyinyoungchildren:astudyofhospitalcases

Geneticpsychologymonographsv.281943,no.1)sadly,nopaediatricianwouldhave

heardofthisjournal,andsonobodyreadit.Thepaperwascriticizedbyhiscolleagues.

EdelstonhimselfwouldcontinuetowritetotheBMJandLancetafterthewar.

ANNAFREUD

In1938,AnnaFreud(1895-1982)cametoEnglandfromViennawithherfatherto

escapetheNazis.InViennashehadbecomeoneoftheleadingfiguresinchildanalysis.

16

In1937shehadstarteduptheJacksonNurseryforchildrenundertwowithaviewto

tryingtoobservetheactualexperiencesofthefirstyearsoflife.Thefollowingyearshe

cametoLondonwithherfather,bringingwithherasetofspeciallydesignedMontessori

toysfromthenurseryinherluggage.WiththebombingofLondon,shewasawarethat

manychildrenwouldbehomelessandwithoutparents.DuringtheBlitz,therewere

somechildrenandtheirparentswhocametostayinashelternearMissFreud,butit

wasnotuntilthespringof1941thattheHampsteadWarNurserieswereproperly

organizedwithmoneyfromtheAmericanFosterParents’Plan.Withherlongtime

friendMrsDorothyBurlinghamsheopenedupnurseriesforchildrenorphanedor

homelessfromtheblitz,andencouragedtheirmotherstovisitthemasmuchasthey

could.Tobeginwithchildrenwereputtogetherwithothersofthesameagebutlater

thearrangementwaschangedsothatthereweretwoorthreestafftoagroupof

childrenofdifferentagesinafamily-likestructure.Thiswasavastimprovementandthe

childrenbecameveryattachedtotheadultinchargeoftheirgroupandequally

distressedwhentheadulthadtoleave.Heart-rendingdescriptionsofthedistressof

thesechildrenwererecordedeitherbecauseofthelossofaparentortheircarer.Miss

Freudhadtofindstudentstocontinuetolookafterthechildren(thefirstofwhomwas

JoyceRobertson).Allthoseworkinginthenurseryhadtowritedowntheirobservations

ofwhatchildrensaidanddidoncardsprovidedandputintoboxesaroundthebuildings.

EveryeveningthesewerecollectedbyMissFreudwhowouldhavediscussionsabout

thechildrenwithherstaff.

Shehadgreatconcernaboutthesechildrenandwasgladtobeabletotaketheminand

looksafterthem.Shealsoputgreatvalueontherecordofwhatthechildrensaidand

did,thebettertounderstandtheirdevelopment.Thussheeducatedthestafftomake

andrecordtheirobservationsoncards,whichshewouldcollectupeacheveningand

thenlectureontheirrelevancetothestaff,atthesametimelearningmoreaboutchild

developmentherself.ToparaphraseMissFreud,forchildren,relationshipswereas

17

importantasfoodandvitamins.Shebelievedintheimportanceofthechild’searly

attachmenttoitscaregiversforlaterdevelopment(Robertson,2013,p70).

TheHampsteadWarNurserieswereclosedattheendoftheWarandhomeswere

foundforallthechildren.Manyoftheworkersnowwantedtotraininchild

psychotherapy,andsoAnnaFreudsetuptheHampsteadChildTherapyClinic.In1949

shetookpartinaRoyalMedico-PsychologicalAssociationmeeting.Shealwayswanted

totalkwiththoseinvolvedwithchildrensuchasteachersandpaediatricianstohelp

themunderstandchilddevelopment.Fornearlythirtyyearsshehadmonthlymeetings

withmanydistinguishedpaediatriciansinherhouseinMaresfieldGardenstodiscuss

emotionalproblemstheyfoundintheirpatients.Shewasinterestedintheeffectsof

bodilyillnessonchildrenandcouldunderstandwhytheyfelttheyhadbeensentto

hospitalbecausetheywerenaughty.Thisgroupwasauniquesourceofreflectionon

childhoodexperienceofillnessandseparationforagenerationofdoctorswhohadno

othersuchopportunities.WritingofherrecollectionofthesemeetingsChristineCooper

saysMissFreud“oftenremindedusthat,achildneedsmotheringandnotjusta

mother"Cooper,C.(1983)ContemporaryHistoryofPaediatricsandPsychoanalysis-

MissAnnaFreudArchivesofDiseaseinChildhood,58,472-473.

AnnaFreud’sbeliefinthevalueofobservationwasaconsistentthemeinherwork.Ido

notthinkthatAnnaFreuddidmuchformothersinhospitalassuch,butshedidsaythat

motheringwasasimportantfortheemotionaldevelopmentasgoodnutritionwasfor

physicaldevelopment.Also,hereducationinobservationwasanessentialpartof

Robertson’scontribution.Shesupportedthefilm‘ATwoYearOldGoestoHospital’.It

mayalsobethatherregularmeetingswithpaediatricianscontributedtomothers

comingintohospitalwiththeirchildren.

18

AnnaFreudhadseenfirst-handthedevastatingeffectsofchildrenseparatedfromtheir

parents.TheeditorsoftheLancetandtheBMJintheearly1940’salso,attimes,

contributedtoageneralincreaseintheunderstandingoftheeffectsofseparation.The

Lancet,forexample,helpedraisethelevelofdebateaboutchildreninfeverhospitals,

whilsttheBMJlaterpublishedaneditorialonBakwin’spaperLonelinessinInfants.

AYRCOUNTYHOSPITAL

Althoughmostfeverhospitalshadnovisiting,inJanuary1940TheLancetpublishedan

editorialontheannouncementthatAyrCountyHospital,followingtheexamplesof

otherhospitals,haddecidednolongertoadmitvisitorstoitschildren’swards[1]dueto

cross-infectionandbecausevisitsupsetthechildren.TheconsultantatAyrbelieved

childrenquicklysettledinthehospitalandadoptedthestaffinlocoparentis.Heargued

thatvisitswereonlyfortheover-anxiousmother–childrendidnotneedthem.Being

sentimentalaboutthiswasnotagoodenoughargument.Notsurprisingly,Bowlby

respondedtoitinalettersayingthatvisitingwasessential,especiallyforyoung

children,andthatlackofvisitingmightleadtodelinquency.HarryEdelstonsupported

Bowlby.

HARRYBAKWIN

TheLonelinessofinfants

In1942HarryBakwinbecameconcernedaboutthenumberofbabiesinBellevue

HospitalinNewYorkwhodiedwithouttherebeinganyproperdiagnosis.Hispaper

‘LonelinessinInfants’(Bakwin,HLonelinessinInfantsAmericanJournalofDiseasesof

Childhood1942;63(1):30-40.)showedthatbabiesneedcontinuouscontactwithpeople

withoutwhichtheydieveryeasily.TheBMJpublishedaneditorialonBakwin’spaper.

Therewereplanstoputaquarterofamillionlittlechildreninwarnurserieswhilethe

19

motherswereworkinginfactories,buttheeditorsreportedwhatBakwinhadfound-

thatthelonelinessinvolvedinseparationfromhomemaybenotonlyundesirablebut

lethal.Bakwindescribedhowhospitalizedyoungchildrensleepless,aremoresubjectto

infectionsoftherespiratorytract,haveamarkeddullingofreactivitytoemotional

stimuli,arelistlessandapathetic,havelowerresistanceandsufferdelayed

development–thesesignsandsymptomsdisappearongoinghome.DonaldWinnicott

respondedtothiseditorialbysayingitwasthemostimportantthingtheyhadpublished

overalongperiod.Hepointedoutthatnoadvanceinknowledgeismoresignificant

todaythantherecognitionofthestrengthoftherelationshipbetweenmotherand

infant,evennewlyborn,andthatwecannottakemothersfrominfantswithout

seriouslyincreasingthepsychologicalburdenswhichthenextgenerationwillhaveto

bear(Winnicott,D.‘LonelinessinInfancy’BMJ,Oct7,1942,p.465)Inalettertothe

BritishMedicalJournal,HCScott,citingBakwin,wrotetoexpressseveredoubtsabout

thedesignandequipmentofanewchildren’shospitalinBirmingham,callingita“brave

newworldofdeprivation”(‘BabiesinaGlassCage’HCScott,BMJFeb19,1944,p.266).

ApartfromEdelston’sworktherewasstillnoindicationeitherfromthegeneralpublic–

norindeedfromstaffinthechildren’swards–thatmothersneededtostayinhospital

withtheirchildren,.Butafurtherincident,reportedinaletterwrittentotheEditorof

TheLancetin1945,wassignificant.AsmallboycomingbackfromtheUnitedStates

becameillandwasadmittedtohospital.Hismotherwantedtostaywithhimbutthis

wasnotallowed.Sheleft,stillprotesting,butcameinthenextmorningandheardfrom

hersonthathehadhadhisteddybeartakenawayfromhim,andthatthenursehad

threatenedtosmackhimifheaskedforhismotheragain.Shedidprotestaboutthisand

gavehername–LadyBertrandRussell–whereuponeverybodywasverypolitetoher,

andgaveherwhatshewanted.(Laterontheysuggestedthatshewasasocialist.)She

feltitwasinhumanthatwhenachildisadmittedtohospitalamemberofthefamilyis

notallowedtostaywiththem.

20

AnotherletteronthisthemeinTheLancetwasfromasurgeoninBrighton,L.A.Parry

whocomplainedin1947abouttheurgentneedforreformofvisitingtimesforchildren.

In1947CampbelletalstartedunrestrictedvisitinginMelbourneandfounditvery

satisfactory.Buttheirpaperreportingitwasnotpublisheduntil1955(IeversM,

CampbellK&BlanchM.Unrestrictedvisitinginachildren'swardeightyears'experience

TheLancetNov.51955266(7897)p.971-3).

THECURTISCOMMITTEE

Attheendofthewartherewerealargenumberofchildrenwhohadnofamilies–they

hadeitherdiedordisappeared.Theircarewasratherchaotic.Followingthedeathofa

childatthehandsofhisfosterparents,acommitteeunderMyraCurtiswassetupin

1946toexaminetheinstitutionalandfostercareofchildren.JamesSpencewasa

memberofthiscommittee.SusanIsaacs,JohnBowlby,DonaldWinnicottandClare

BrittenallgaveevidencetotheCommitteeaboutwhattheyhadlearntofchildrenbeing

withouttheirparentsduringthewar.Thepoorcareofchildrenwithoutfamilieswas

noted.Betterwaysoflookingafterthemwasdiscussedandeachcountymade

responsibleforthecareforsuchchildrenintheirarea,withitsownchildren’s

departmentandofficerstolookafterthem.

Althoughtheremayhavebeenmoreawarenessofchildrenandtheirneeds,andmaybe

evenenjoymentofthem,itdidnotleadtoanyimprovementinhospitalvisitinghours.

Manyreasonsweregivenwhyhospitalvisitsshouldberestricted,makingacasethat

hadprevailedsincetheopeningoftheHospitalforSickChildreninGreatOrmondStreet

suchascross-infection,disruptedwardroutines,difficultmothers,mothershaving

homecommitmentswhichtheysawasbeingmoreimportant,andthefactthatnotall

mothersaskedforadditionalvisitingtimes.

Bythistimeatraditionhadbuiltupamongstnursesthattheywereratherbetterat

lookingafterthechildrenthanthemotherswere.BeforetheNHS,mostchildrenwere

21

frompoorfamilieswhowereunabletokeeptheirchildrenaswellfed,cleanandwarm

ascouldthenurses.FollowingtheBoerWarandtheFirstWorldWar,therewasahuge

surplusofwomenwhowereunabletofindhusbandsandhavechildrenandhadinstead

goneintochildren’snursing.Althoughtheyhadwantedtocareforchildren,theyhadno

experienceoftheirdaytodaylivessowerenotawareoftheextremedistress,

especiallyintheyoungest,whentakenawayfromtheirnormalcarers.Althoughthe

childrenmadeagreatfusswhentheycamein,afterawhilethey“settled”.[Itis

generallywomen,bothathomeandontheward,whodecideonthesocial

arrangements,thereforeitisthenurseswhodecidewhocomesintotheward.]

Huntsummarisesitinhisview,“Thehospitalizedchildwasconsideredessentiallya

biologicalunit,farbetteroffwithouthisparentswho,onweeklyorbi-weeklyvisiting

hours,werefundamentallytoxicintheireffect,causingnoise,generallydisorderly

conduct,andrejectionbyhospitalpersonnel”(Hunt,A.D.‘OntheHospitalizationof

Children:AnHistoricalApproach’Pediatrics54,November1974p.542).Asayoung

doctorIdidnotseethemlikethis.

THENATIONALHEALTHSERVICE

TheNHSwascreatedin1948.Thishadseveraleffects.Overthenextfewyears,

paediatricianswereappointedineachhealthdistrictandchildren’swardswereopened

inthelocalhospitals.Thesewereforthefirsttimefree,andsograduallyusedby

everybody,includingthemiddleclasses.ConsultantswerenowpaidforbytheNHS.In

addition,becauseoftheimprovementsinmedicalcaretherewasovertimeanincrease

intheneedforchildrentobeadmittedtohospital.AsthePlattReport(below)later

stated,whenmosthospitalswerebuilttheirpurposewasmainlyinservingthesickwho

camefromabackgroundofpoverty,badhousing,ormalnutrition,whilechildrenof

better-offfamilieswerenursedathomeorinprivatenursinghomes.Withthecomingof

theNHSthesesoonclosed.Middleclassparentswhobeforethewarwouldhavepaid

forsomeonetolookaftertheirchildrennowcaredforthemthemselvesandsoknew

22

muchmoreintimatelyoftheirupsetiftheywereillandseparatedfromthemin

hospital.Parentscouldnowmakeadversecommentsaboutthecareoftheirchildren,

includingaboutvisitingtimes.Tobeginwiththishadverylittleeffectonhospital

visiting.Forinstance,in1948theannualconferenceoftheNationalFederationof

Women’sInstituteswithitshalfamillionmemberspassedamotiondeploringvisiting

restrictionsandcalleduponhospitalmanagementcommitteestomakethenecessary

changes(seeHarryHendrickChildren,ChildhoodandEnglishSociety,1880-1990,

Cambridge1997pages214-225).Notthatthestaffinthechildren’swardsknewabout

thisortookanynoticeofit,butitwasanindicationofincreasingpressurefromoutside.

In1949,accordingtoasurveyofLondonhospitalsbyMunro-Davies,themajority

allowedvisitingatbestforoneortwohoursaweek,andtwohospitalshadnovisitingat

allforchildrenunderthree(Munro-Davies,H.G.‘VisitstoChildreninHospital’,

Spectator,18March1949).TheMinistryofHealthissuedthefirstofthreerequestsfor

increasedvisitinghoursin1949;furtherrequestsweremadein1953and1956.

In1949theRMPAorganisedameetingbetweenpaediatriciansandpsychiatriststo

discusstheneedsofchildreninhospital.Thismeetingshowedupthelargegaps

betweentheirviewsofwhatchildrenneeded.Thepaediatricianisconcernedwiththe

child’sillnessandthechildpsychiatristisconcernedwiththeemotionaldistressofthe

childbeingawayfromitsfamily.TheLancetreportedMissFreud’scontribution:“the

problemismostacuteintheveryyoungchildstayingalongtimeinhospital,andshe

describedhisemotionalexperiencesatlength,beginningatthepointwheredamage

firstoccurs-onadmission.Tothedistressoftheillnessisaddedthedistressof

separationfromhome.andthechildisquitedefenceless.Hesubmitswithhisbody,but

retreatswithhismind;ifthisretreatisunchecked,hismentalunfoldingistemporarily

arrested.Headaptseasilythroughbodilysurrender,andhismemoryisinanycase

short:hehasnothadtimetoforgealinkwithhomewhichcanwithstandlongstrain.He

livesfromdaytoday,hedependsontheevidenceofhissense,andhisunderstandingof

thesituationisfragmentaryatbest.Alovingmotherwhoremainsabsentisafigure

whomheisincapableofconceiving;hisownlovedemandsthenearnessofthebeloved

23

person,andifshewithholdsherselfshelackstheonlyproofofloveheknowsandcan

understand.Hisoutwardcalmhidesdejectionandafeelingofhavingbeenabandoned

bythosehemostcaresabout;hebecomesinwardlyapathetic,thoughcapableof

interestandanimationonthesurface.Hisrootsinhomearedyingforlackof

nourishmentandheislearningtodowithoutthemattheexpenseofhisnormal

emotionallifeanddevelopment”(TheLancet,ChildreninHospital,May7,1949p.785).

Asnow,therewaslittleunderstandingbetweenpaediatricsandchildpsychiatry.

InJuly1949,Maclennan,apsychologist,wroteoftheneedforchangeinthe

arrangementsofchildreninlong-stayhospitals,butisconcernedmorewithdiscipline

ontheward,ratherthantheemotionaldistressofchildreninhospitalawayfromhome

andfamily(Maclennan,B.W.,‘NonMedicalcareofChronicallyIllChildreninHospital’,

TheLancet,July30,1949,p.209).

THEPICKERILLS

Plasticsurgeonswhosechildpatientshealedhappilybecausetheirmothersstayedwith

theminhospital

ThePickerillsalsohadmothersinhospitalbetweenthewars;theydidnothavetopick

andchoose-allmotherswereadmitted.TheywereplasticsurgeonsinNewZealand

mainlyoperatingoncongenitaldeformitiesinbabiessuchasharelipandcleftpalate.

Theywereconcernedaboutcross-infectioninthegeneralwardwhichsometimeslead

tofatalresults.Initially,theysentthechildrenhome,asNichollhaddone,butchildren

stillgotinfected.Later,theirpaperdescribedhowtheyhadsucceededineliminating

cross-infection.Theydidthisbygivingeachmotherandinfanttheirownroom,bringing

inthemothertonursethechild(Pickerill,CM&Pickerill,HP‘EliminationofHospital

24

Cross-InfectioninChildren-NursingbytheMother’Lancet.1954266(6809):425-9.).The

Pickerillsboughtahouseandmadeanumberofsmallroomswherethemotherswere

supervisedbydoctorsandnurseswhowerealsoconcernedforthewellbeingofthe

mother.Threeyearslater,therehadbeennocross-infection,andapparentlythebabies

wereveryhappywhichnodoubtcontributedtothemhealingsowell.Manyyearslater,

inresponsetoapaperbyMacCarthy,LindsayandMorris(MacCarthyD,LindsayM,

MorrisI.Childreninhospitalwithmothers.Lancet.19621(7230):603-8.)Michael

OldfieldofLeedswrotetoTheLancetthathehadbeendoingitfor25yearsand

describedhowwellithadworked(Oldfield,M.C.‘ChildreninHospitalwithMothers’

LettertoTheLancet,April21,1962,p.857).

Therewasverylittlevisitinginchildren’swards.Oneofthereasonsgivenwasthat

motherswouldbringininfection.But,infact,amajorreviewoftherecordsofchildren

admittedto26wards,in14hospitals,overan11-monthperiodshowednocorrelation

betweenratesofcrossinfectionandvisiting(Watkins,A.G.&Lewis-Fanning,E.

‘IncidenceofCross-InfectioninChildren’sWards’,BMJ,17September1949,p.616-

619).

NORMANJACOBY

Itwasin1949thatNormanJacoby,apaediatricianinPemburyHospital,startedhaving

unrestrictedvisitingandsomemothersstayingovernight,originallytopreventcross-

infection;buthefounditwassosatisfactorythathecontinuedwithit.Howeverhekept

thistohimselfandnevermadethispublicuntil1955.Atdinnerpartiesheheardfrom

themotherswhosechildrenhadbeeninhospitalhowextraordinarilydistressedand

difficulttheywerewhentheycamehome.Jacobywasprobablythefirstpersoninthe

UKtohavemothersstayinginhospital,buthecouldnottalkorwriteaboutitbecauseit

wasnotofficialpolicy.(Feedingthemotherswasquitetricky;theyhadtobehiddenin

cupboardswhenthematroncameround).Jacoby’sfirstpublicmentionofhaving

mothersinhospitalwashisletterintheLancetsixyearslater(Nov26,1955,p.1141).

25

Inthelate1930s,HarryEdelston(above)haddocumentedthetraumaofchildrenwho

hadbeeninhospital.Itwouldtakeanotherthirtyyearsforpeoplelivingoutsidethe

children’swardandthoselivingwithinthechildren’swardtocometoagreement.By

1949,JohnBowlbyandJamesRobertsonhadbeenworkingtogetherattheTavistock

Clinicforayear.WithoutBowlbyandthefacilitiesthatheprovidedforRobertsonit

wouldhavetakenmuchlongerforanunderstandingofthechild’sneedforitsmother

whenillinhospitaltoberecognised.

JOHNBOWLBY

Documentedthelongtermeffectsofparentalseparation,fromwhichgrewattachment

theory

Bornintotheuppermiddle-classworldofManchesterSquare,JohnBowlby(1907-1990)

wasbroughtupinthenursery,andlosthisownparticularnanny,Minnie,whenhewas

agedfour,“distressingnotdamaging”hesaid.Thiswasnotdamaging,indeed,because

theheadnannyhadcaredforhimforhisfirsttwoyearsandshecontinuedinthe

nurserytocareforhimthroughouthischildhood).Becauseofthezeppelins,hewentto

boardingschoolat10whichhehated,andthenat13totheRoyalNavalCollegeat

Dartmouth,whichheloved.(Afterwardshewasneverwithoutaboat).These

experiencescontributedtohisinterestinseparation.

TheNavy,havinglostmuchinthe‘WarToEndAllWars’wasdownsizing,andwasonly

toopleasedtoaccepthisfather,SirAnthonyBowlby,buyingoutJohn’scommission.He

followedhisfatherandwentuptoTrinityCollege,Cambridgetoreadnaturalsciences.

QuitedifferentfromAnthony’sexperienceagenerationearlier,Cambridgewasawash

withpsychoanalysis.“Weareallpsychoanalystsnow,”saidtheSpectator.Even

Bowlby’stutorswereinterested.Hisfather,whohadbeenasurgeontotheRoyal

Householdwouldhavebeenappalledbyhisson’sinterestinpsychoanalysis,buthedied

in1929.Bowlbygotfirst-classhonoursinhispre-clinicalTripos.Thisenabledhimto

haveasmallscholarship,tostayonanotheryear,andtoreadphilosophyand

psychology.Thelatterwasadisappointmentbecauseitdidnotincludedevelopmental

26

psychology.Tryingtofindoutmoreaboutthis,heeventuallywenttoworkinaschool

formaladjustedchildren.PrioryGateinNorfolk,wasrunonlinesderivedfromFreud

andrecentadvancesineducation,andprovidedhimwithwhathewanted.Bowlbysaid

itwas,“themostimportantsixmonthsofhislife”.

HealsometJohnAlford,anothermemberofstaffattheschooloneofthemost

importantinfluencesinhiscareer.AlfordhadbeenbadlytraumatisedintheFirstWorld

Warbuthadreceivedtreatment.ToBowlby,hewastheonlymanwhoknewmore

aboutwhathewantedtoknowthananyoneelsehehadmet.Alfordbecameamentor

andencouragedhimtocontinuehismedicaleducationandtotakeupatraining

analysis.Hestartedbothofthesewhenhewas22.HequalifiedatUniversityCollege

Hospital,andtookapsychiatrictrainingpostattheMaudsleyHospital,which,asaresult

oftheworkhedidthere,gavehimanM.D.in1939[Bowlby,J.PersonalityandMental

Illness,InternationalLibraryofPsychology,Routledge,1940).

InhistraininganalysiswithJoanRivierehedidnotalwaysagreewithher.Hequestioned

everything,whichshefoundquitedifficult,andittooksevenyears.Hewassupervised

ononeofhischildpatientsbyMelanieKleinherself.

From1936onwardsBowlbyhadbeenworkingasachildpsychiatristintheLondonChild

GuidanceClinicinCanonbury.Therehehadreferredtohimanumberofchildren,some

ofwhomwerestealing.Thesepatientshadhadmanyadversitiesbut,statistically

speaking,theoneexperiencetheyhadallsharedwasseparationfromtheirmothers

beforetheywerefive.Hispaperreportingthisseriesestablishedforthefirsttimethe

impactofmaternalseparationonchildbehaviourandemotionaldisorders.Bowlby’s

innovationwastodescribeactualeventsinthesechildren’slives.Byfocussingon

separationasakeyvariablehecouldrecordsomethingmeasurable.Thiswasdifferent,

andpossiblymoreimportant,thanwhatthepatientshadtoldtheiranalystsduringtheir

sessions.

27

Thismaterial(laterpublishedas‘TheInfluenceofEarlyEnvironmentinthe

DevelopmentofNeurosisandNeuroticCharacter’–Bowlby,J.Theinfluenceofearly

environmentinthedevelopmentofneurosisandneuroticcharacter.TheInternational

JournalofPsychoanalysis,1940;21:154-178.)wasgiventotheBritishPsychoanalytical

SocietyinJune1939.Itsemphasisontheimportanceofthedirectstudyoftheearly

environmentwascompletelynewtotheBritishPsychoanalyticSociety.Itsacceptance

madeenablehimtobecomeavotingmemberoftheSociety.Alaterversionofbecame

Bowlby’smostearlyfamousscientificstudy‘44JuvenileThieves’.(Bowlby,J.(1944).

Forty-FourJuvenileThieves:TheirCharactersandHome-Life.InternationalJournalof

Psycho-Analysis,25:19-53)

In1939alone,Bowlbyhadmarriedandhadhisfirstchild,andhadpublished(or

completedthemanuscriptsof)HysteriainChildren’,PersonalityandMentalIllness:An

EssayinPsychiatricDiagnosisforwhichhewasawardedMD(ahighermedicaldegree),

“Theinfluenceofearlyenvironmentinthedevelopmentofneurosisandneurotic

character”and(withhisbestfriendthepoliticianEvanDurbin)co-editedthebook

PersonalAggressivenessandWar.

Therewasalotofresearchgoingonabouttheemotionalneedsofchildren,butnobody

inthehospitalknewaboutit;atthetime,therewasmoreconcernaboutevacuation.

Warwascomingandtownswouldbebombed.Planswerethereforemadeforthe

evacuationofchildren.Variousgeneralpractitioners,concernedabouttheprospectof

thisevacuation,warnedintheBMJandTheLancetin1939,ofthesocialandemotional

problemsthatwouldarise.Bowlby,DonaldWinnicottandEmmanuelMiller,concerned

abouttheeffectonthefamilies,alsowrotetotheBMJ,“Theevacuationofsmall

childrenwithouttheirmotherscanleadtoaveryseriousandwidespreadpsychological

disorder.Forinstanceincanleadtoabigincreaseinjuveniledelinquencyinthenext

decadebetweentheagesof2-5yearsintroducingmajorpsychologicalproblems.…

Schemesforevacuationarebeingthoughtout,andbeforetheyarecompleted,wewish

28

todrawattentiontotheseproblems”(BritishMedicalJournal,December16,1939).The

evacuationcertainlysavedmanylives.Unfortunately,thoseinchargeoftheevacuation

planswerenotsufficientlyawareofthestrengthoffamilyties.DonaldWinnicottandhis

wifeClaire,alongwithSusanIsaacs,andpossiblyBowlbyhimself,contributedtothe

careofsomeofthesechildren,butstillmuchemotionaldamagewasdone.

HadthewarnotintervenedBowlbymighthavecontinuedthisworkuninterruptedbut

soonhejoinedtheRoyalArmyMedicalCorpsandcameintocontactwithsomeofthe

majorfiguresofthepostwarTavistockClinicandTavistockInstitute,EricTrist,John

Rickman,WilfredBion,JockSutherlandandIsobelMenzieswhowereworkingonnew

groupmethodsofofficerselectionforthearmy.BowlbycitesEricTristinparticularasa

brilliantmindthatinspiredhim.

AftertheWar,hisstaturewassuchthathewasnotonlymadeDeputyDirectorofthe

newlyorganizedTavistockClinic,butalsogivendirectorshipofthechildren’s

department,inwhichhedecidedtoincludeadedicatedunittostudytheeffectof

separation.Havingdonehisretrospectivestudyoftheconsequencesofmaternal

separation(44JuvenileThieves)hewantedtodoaprospectivestudytoobserveand

understandthechild’sexperienceofseparationfromparents.Heneededwhathecalled

afieldworkerandwasfortunatetofindJamesRobertsonwhohadworkedwithAnna

FreudattheHampsteadNurseriesduringtheWar.

Bowlby’smostfamousworkisChildCareandtheGrowthofLove,basedonhisreportto

theWHO.Now65yearsoldhisconclusionhasnotdatedatall:

“Whatisbelievedtobeessentialformentalhealthisthataninfantandyoungchild

shouldexperienceawarm,intimateandcontinuousrelationshipwithhismother(or

permanentmothersubstitute)–onepersonwhosteadily‘mothers’himinwhichboth

findsatisfactionandenjoyment.Itisthiscomplex,richandrewardingrelationshipwith

29

themotherinearlyyears,variedincountlesswayswiththefatherandwiththebrothers

andsisters,thatchildpsychiatristsandmanyothersnowbelievetounderliethe

developmentofcharacterandofmentalhealth."

Fromchapter1inBowlby,J.(1953)ChildCareandtheGrowthofLove

JAMESROBERTSON

HisearlyexperienceofchildobservationinMissFreud’snurseries

JamesRobertson(1911-1988),theeldestofsixchildren,broughtupinthetenementsof

Glasgowwherehisfatherworkedontheassemblylineofalocalfactory.Leavingschool

at14,hisfatheradvisedhimtoworkinajobinwhichhedidnothavetotakehisjacket

off,sohewenttotheadministrativesideofhisfather’sfactory.Heworkedhard,

attendedWEAlectures,becameaQuakerandlostthesightinoneeye.Hewenttothe

WEACollegeinBirmingham,andtheremethisfuturewife,JoyceUsher,atthe

beginningofthewar.In1940James,whoasaQuakerwasaconscientiousobjector,

wenttoLondontohelpduringthedevastationandchaosoftheblitz.Joycejoinedhim

inJanuary1941,whentheyheardof"awomaninHampstead"whoprovided

accommodationforbombedoutmothersandchildren.Thiswoman,ofcourse,was

AnnaFreud.JoycewenttoworkforMissFreudasastudentlookingafterbabies.While

courtingJoyce,JamesmetMissFreudandsheappointedhimasboilerman,firewatcher

andgardener.Gradually,heworkedmoreinthehouseand,bytheendofthewarhe

hadbecomethesocialworkertothenursery,talkingtotheparents.

Asamemberofstaff,Robertsonhadtomakeobservationsandwritethemdownon

cardsprovidedandputthemintoboxeswhichwerecollectedeacheveningbyAnna

Freudwhohaddiscussionswiththestaffandalsogavelectures.JamesandJoyce

Robertsongotmarriedin1941andhadababy.Agedtwelvemonths,thebabybecame

30

illandneededtogotoGreatOrmondStreetHospitalforaweek.Thiswasaverydifficult

timeforJoyceandherbaby,becauseJoycewasnotallowedtovisitherorworkinthe

ward.

AftertheWar,RobertsonwonascholarshiptotheLondonSchoolofEconomics,

qualifyingasapsychiatricsocialworkerandthenstartedatraininganalysistobecomea

psychoanalyst.ItwasatthisstagethatBowlbywaslookingforafield-workerforhis

prospectivestudyofchildrenandhowtheybehavedatthetimeofseparationfrom

theirmothersandafterwards.HischoiceofRobertsonwas,inpart,arecommendation

ofoneoftheworkersattheHampsteadNurseries.HisexperienceattheHampstead

WarNurseriesmadehimanidealchoice.RobertsonremainedworkinginBowlby’s

Departmentuntilheretiredin1976.

Robertsonobservedchildreninbothshortstayandlongstayhospitals.

ROBERTSONWORKINGINBOWLBY’SDEPARTMENT

In1948RobertsonwasappointedtoBowlby’sdepartmentattheTavistockClinic.

Bowlbywantedhimtoobservechildrenseparatedfromtheirparents.Theydiscussed

wheresuchchildrencouldbefound;forinstancecaseswheremotherhavingtoleave

home-butthesewerefoundtobeunsuitablebecausetheyweresofewandfar

between-soeventuallydecidedthatchildren’swardsinlocalhospitalswereplaces

whereeasyaccesstoyoungchildreninseparatedfromtheirmothercouldbefound.

NeitherRobertsonnorBowlbywereawarethatyoungchildreninhospitalpresented

anyparticularproblem,eventhoughtheyseldomsawtheirparents.

Visitingapaediatricward,Robertsonwasgreetedbytheconsultantandwardsisterand

toldthatthiswas“ahappychildren’sward”.Henoticedeverythingappearedorderly

andundercontrol,butsoonsawthatthiswasnotthecase.Theolderchildrencould

manage,butthoseunderfive,andparticularlythoseunderthree,couldnot.These

youngeronessatontheircotdesolateanddeeplysilent.AsRobertsonsaid,“Theydid

31

notunderstandwhytheparentswhohadcaredforthemwerenotthere;theirneeds

wereimmediateandtheyhadnotimesensetohelpthemunderstandthattheirparents

wouldcometomorroworthenextday.Theywereoverwhelmed,”(Robertson,1989,

p.11).Ifanursestoppedbyoneofthesechildrentheywouldstarttocry,thenurse

wouldberebukedfor‘makinghimcry’whenshewasmerelydiscoveringhisdistress.

Thenurses,ofcourse,wereworkingonajob-assignmentbasiswhichmeantthe

childrenhadnumerouscarerslookingafterthem.Healsosawthatthenursesand

doctorsdidnotseethedistressofthechildren.Robertsonrealizedthatdealingwiththis

wasgoingtobehisworkformanyyearstocome.

Robertsonmadedetaileddescriptionsofhowthechildrenbehavedwiththeirmother,

whentheywereseparated,thenonintheward.Healsofollowedupchildrenafterthey

wenthome.

BowlbyandRobertsonbetweenthemdescribedthreestagesthroughwhichyoung

childrenpass.ThefirstisProtest,wherethechildcries,rocksinthecotandlooksforany

signoftheirparentsreturning,thesecondisDespair,wherethechildwillsitinthecot

withoccasionalsobsandnotmakinganydemandontheenvironmentatall.Butthereis

onlyacertainamountofsuchpainachildcanstand,and,inthethirdstage,

Denial/Detachment,thechildgraduallybecomesincreasinglydetachedfromhisorher

parents,and,inthelongstayhospitals,thisbecomesapparentcheerfulnessandno

concernfortheparentsatallwhentheyvisit.

Followingupthechildrenunderfive,hefoundthatallofthem,althoughsometimes

theymayhaveseemedsettledinhospital,wereontheirreturnhomenearlyall

disturbedanddistressed,displayingsleepproblems,fearofaparentleaving,angerwith

themother,andlossofbladderandbowelcontrol.Sometimesthesesymptomswere

short-livedbutformanychildrentheylastedforsometime,evenenduringinto

adulthoodandshownbyvaryingdegreesofanxiety.[Anecdotally,Iknewofthree

32

peoplewhoseyoungersiblingswerepermanentlychangedafterastayinhospitalof

threeorfourweeks].

Goingaroundvariouschildren’swardsinLondonteachinghospitals,hefoundthesame

situation-staffinattentiontodistressinyoungpatientsbecauseitwasthought

unimportant.

RobertsonalsowenttoHarefield,alongstayhospital,wherechildrenwouldbe

admittedforuptothreeorfouryearswith,forexample,TBorrheumaticfever.These

hospitalsnolongerexist,buttheydidcausemanyproblemsinthepast.Thechildren,

withsomanypeoplelookingafterthem,hadlostthewishortheartofrelatingtoother

people.Theyarrivedhomefindingitdifficulttoacceptaffection,butjealousofother

childrenwhogotit.Thisratherself-centredattitudewasdifficultforthemtochange.

(Interestingly,thelongstayhospitalswerenottoucheduponinthePlattreport).He

alsoreportedonthefeverhospitalswheretherewasusuallynovisitingatall;thechild

wouldbebroughtinandmotherwastoldtocollectitinsixweekstime.Anyenquiries

shouldbemadetotheporter.

Robertsonreported,withdetaileddescriptionsbasedonobservation,howeachchild

behavedatthelossoftheirmotheratdifferentagesandstagesofdevelopment,and

howtheirbehaviourchangedduringtheirtimeinhospitalandafterreturninghome.

Sadly,thedetailsofeachchildhavebeenlost.Thisresearchhadneverbeendone

beforeandhasneverbeenreplicatedsince.

BowlbyusedRobertson’sfindingsofthechildrenseparatedinthewardsforhisown

work,whilstRobertsonusedthefindingstotryandconvincepeoplethattheseyoung

childrenneededmorevisitingandmoretimewiththeirmotherthanwaspresently

beinggiventothem.Althoughthereisadebatewhetherthisworkhadanyeffecton

33

improvingthesituationforchildreninhospital,itistheonlyresearchthathasbeen

done.

Robertsontriedtoexplainhisanxietiestothemedicalandnursingstaffabouttheyoung

childrenbutnobodycouldunderstandtheproblem-evenhisowndepartmentatthe

Tavistockwerenotparticularlyinterested.BowlbyandRobertsonformedanadvisory

committeebutnothingcameofitexceptthepaediatricianAlanMoncrieff’sinvitationto

RobertsontotheBPAmeetingin1951.However,asaresultofthiscommitteeMoncrieff

wroteapaperrecommendingthatmothersvisitdailybetween5and6p.m.tolook

afterthechildastheywouldathomeduringthehourbeforebedtime(Moncrieffand

Walton‘VisitingChildreninHospital’,BMJ,Jan5,1952,pp43-44).Oneproblemwas

thatMoncrieffbelievedthatthedistresswastransitoryandtherewerenoaftereffects

(possiblytheyneverasked).

ATWOYEAROLDGOESTOHOSPITAL

Arevolutionaryvisualdocument

RobertsonhaswrittenabouttwomeetingswithSpence-oneattheBPAwhenSpence

ridiculedhisdescriptionoftheemotionaldistressofchildren,andtheotherat

NewcastlewhenSpenceexplainedthatchildrenonlyneededtoseethemotherforhalf

anhoureveryweek.ItwasthelattermeetingthatpersuadedRobertsontomakeafilm.

ItwasonthewaybackfromseeingSpenceinNewcastle,asmentioned,thatRobertson

rememberedthatfilmcouldsometimespiercethedefencesinwaysthattalkingcannot.

HethereforedecidedthatifSpence,ofallpeople,couldnotunderstandtheemotional

needsofsmallchildrenthenhewouldhavetomakeafilm.

HewenttoBowlbywhowasenthusiasticabouttheidea(Bowlbyhimselfwasan

excellentphotographer),andtheydiscussedhowitshouldbemanaged.TomMainfrom

theCasselHospitalgotmoneyforaBellandHowell16mmmoviecamera,alongwith

eightyminutesoffilm.Achildwaschosenbystickingapinintothesurgicalwaitinglist

34

attheCentralMiddlesexHospital.WhenRobertsonmetLaura,agedtwoyearseight

months,hesawthatshewasnotthetypicalchild,muchmoreself-containedthanusual,

buthecouldnotchangeherforanotherchild,otherwisehewouldbeaccusedof

choosinghischildtomakehiscase.Infact,whatresultedwasapictureofavery

unhappylittlegirlwhocontainedherfeelingsremarkably.WhenRobertsonandBowlby

sawthefilm,‘ATwoYearOldGoestoHospital’atRobertson’shome,theynearly

decidedtogiveup,becauseshewasnotcrying.Fortunately,JoyceRobertsonwasthere

-sheknewhowextraordinarilyirritatingchildrencryingcanbe,evenwhentheyhave

goodreason,andthatthisfilmwasmuchmorepoignantpreciselybecauseshewasnot

crying.

ThefilmwasscreenedinNovember1952ataspeciallyconvenedmeetingofthe

PaediatricSectionoftheRoyalSocietyofMedicine.Allchildren’sphysicians,surgeons

andwardsisterswereinvited.ThefilmwasintroducedbyBowlbywho,describingitas

partoftheresearchoftheTavistockClinic,saidthatitwasaboutatwoyearoldchild

frettinginhospital,whichwassomethingworthyofscientificstudybecauseitoften

gaverisetoemotionaldisturbancelater.Robertsondescribedhisworkofobserving

childreninhospitalandhowheandthestaffcouldnotalwaysagreeonwhatwas

actuallyhappeningtoaparticularchild.Hehopedthatthisfilmwouldmakeitclearer.

Afterthefilm,Winnicott,thePresident,welcomedthefilm-“Here,ashesawit,wasa

normalchild.Shecameintohospitalandgraduallybecameaffectedasanormalchild

must.Shewasfortunatelysparedthatphaseoffalserecoverytowhichthechildreaches

ifthebreakfromthehomelaststoolong,andwhichmaymakethechildclingtothe

nurseinfearwhenatlastthemotherorfathercomestotakethechildhome…from

longexperiencehe[Winnicott]couldsaythatthisfilmwasdefinitelyarealproblem.The

effectofseparationofsmallchildrenfromtheirmotherswassooftenserious,even

producingirreversiblechanges,thateverytimewhenachildistobetakenintohospital

thereoughttobeacarefulweighingupofthevalueonthephysicalsideagainstthe

dangeronthepsychiatricside.Theprincipleisnotvitiatedbytheundoubtedfactthatin

certaincircumstancescertainchildren(notyoungones)derivebenefitandeven

35

enrichmentfromastayinhospital-perhapsbecauseofthereliefthatthisaffordson

accountofaparent’sanxietystateordepressionmood”(ATwo-Year-OldGoesto

Hospital,ProceedingsoftheRSM,November28,1952,Vol46,425,p.11).

Thereceptionofthefilmwashostile;theLancetandBMJtoneddowntheangerofthe

audience,butRobertsonrememberstheabsoluteragethatengulfedhimashestoodon

theplatform.Theywereangryanddistressedbybeingtoldthatchildrenintheirwards

werenotashappyastheythoughttheywere.Theaudiencewantedthefilmstopped.

Later,Bowlbydecidedthatthefilmshouldonlybeshowntodoctors,nursesand

studentsasitwastoocontroversialtobeshowninpublicatthemoment-hedidnot

wantthepublicandthemedicalstafftobeinaconflictthatwouldbedamagingand

unhelpfultoboth;eachhadtolearnmoreabouttheother.

inEurope,asintheUK,Robertsonshowedthefilmtoprofessionalaudiences.Visiting

Denmark,France,Germany,Holland,NorwayandYugoslaviahemetwithmuchthe

sameresistance,especiallywiththemoreseniordoctors.

ThepaediatricianRonaldMacKeithwassympathetictotheideathatchildrenshouldsee

moreoftheirmothers,butitwasDermodMacCarthywhowastheonlypaediatricianat

themeetingtochangehispracticeofparentalvisitingafterseeingthefilm,butonly

afterdiscussionwithhiswardsister,IvyMorris,whohadalsoseenit.

DERMODMACCARTHY

Anunsungheroofthissaga

DermodMacCarthy(1911-1986),ashasbeenmentioned,wastheonlypersonwhose

practicewasimmediatelychangedbyhavingseenRobertson’sfilm.Hedecidedtoinvite

36

allmothersofchildrenunderfive,orothervulnerablechildren,tocomeintohospitalto

lookafterthem.

MacCarthywasbroughtupinthequestioningworldoftheBloomsburyGroup.His

fatherwasliteraryeditortotheSundayTimesandknewalltheauthorsofthedayand

wassaidtobeawonderfulconversationalist.Hismotherwroteadelightfulbook,‘A

NineteenthCenturyChildhood’aboutherselfwhenyoung.Twopicturesinthisbookare

paintedbyMacCarthy.DermodqualifiedinmedicinefromBartsin1934andwentasa

ship’sdoctortotheFarEastbeforesettlingdownatGreatOrmondStreettodo

paediatricsin1939.TherehewasjuniordoctortoWilfridSheldonandhelpedhimwith

partoftheevacuationofchildrentoHemelHempsteadbecauseoftheBlitz.Afterthree

furtheryearsintheNavyhecamebacktoGreatOrmondStreetbeforebeingappointed

consultantinAylesbury,AmershamandHighWycombehospitalsin1950.

MacCarthywasthepaediatricianatMargaretLowenfeld’sclinicandwasoneofthe

groupofpaediatricianswhometmonthlyatMissFreud’shousefrom1956untilher

deathtodiscusstheemotionalproblemsoftheirpatients.HebecamePresidentofthe

PaediatricSectionoftheRSM,and,afterrepresentingtheUKattheEuropeanSocietyof

PaediatricResearch(ESPR)becameitsPresidentin1975.Hewas,ofcourse,thefirst

personwhoeverhadmotherswithchildrenunderfive,orvulnerablechildren,coming

intothewardspecificallytoavoidthedamageofseparationandtohelpcarefortheir

children.HisfirstmentionofthiswasinalettertoTheLancetin1955,buthismain

paperaboutitwasnotuntil1962(interestingly,SpenceandthePickerillsarebetter

knownfortheirwork).

Amongsthisotherinterestswasfailuretothriveininfantsforwhichhewroteachapter

inthemonumentaltextScientificFoundationsofPaediatricseditedbyJohnDavisand

JohnDobbing(Saunders1974).In1982,theBritishPaediatricAssociationawardedhim

37

theJamesSpencemedal,thehighesthonourforBritishpaediatricians.Hisbook‘Sailing

withMrBelloc’isexcellentreading.

MacCarthyfeltstronglythatifyouweregoingtohaveanythingtodowithchildren,you

oughttorememberyourownchildhood.AfterlecturingonthesubjectattheOxford

MedicalSchool,hewroteapaper,‘RememberingYourChildhood’(TheLancet,Sept18,

1954,267(6838):595-7).Hewasconstantlytryingtoensurethatthechildreninhospital

werehappy,and,havingseenthefilmATwoYearOldGoestoHospital,henowknew

whattolookfor.

ItwasinthecarafterthemeetingattheRSM,thatMacCarthyspokecrosslyabout

‘Robertson’whohadsaidsuchuntruethingsaboutchildreninhospital.SisterMorris,his

wardsisteratAmersham,whohadaccompaniedhimtotheshowingofthefilmsaid,

“MisterRobertsonwasright,theseyoungchildrendoneedtheirmotherswiththem,

andwhenyouarenotintheward,Ioftenhavethemotherscomingintobewiththeir

youngchildren”.Althoughsurprised,MacCarthylistened.Nextday,whenhedidhis

wardround,hesawLauraandherbrothersandsisterswhowereunhappy,justasthe

filmhadshown.

Asithappened,theAmershamwardhadcubiclesthatcouldtakeabedbesidethecot.

MacCarthyhadalwaysbeenquiterelaxedaboutvisiting,allowingtheoccasionalmother

tostayovernight,and,inJanuary1953,,decided–feelinghiswaywithonemotherata

time–toinviteallthemothersofchildrenunderfivetocomeintohospitalwiththem.

Hedidnotpickandchoosebetweenthem,butacceptedallthemothers,realisingthatit

wasessentialforallyoungchildren.Olderchildrenwhoneededtheirmotherwerealso

abletostay.Inthepaperhe,IandsisterMorrislaterwrotein1962aboutmothersin

hospitalwedescribedhoweachmotherdidwhatshefeltshecoulddo,andsometimes

learnthowtodoabitmore(ChildreninHospitalwithMothers,MacCarthy,Lindsay&

Morris,Lancet,March24,1962pp.603-608).Themotherscouldseewhatwasgoing

38

on,andwerevisibletostaffandotherpatients.Inpreparationfortheirchildren’sreturn

hometheywereshownhowtorecordtemperaturesandtoadministermedicines.There

wasawonderfulrelaxedfeelingintheward.OneChristmasitwasfulloffatherssetting

uptrainsets.Themotherssometimesneededsomecarethemselvesandinone

thousandadmissionsonlyonemotherwalkedout.

DescribingwhatwashappeningatthattimeatAmersham,atthebeginningof1953,

MacCarthywrote,“Wehavebeenadmittingmothersofthefretfulageintoourcubicles,

wherewehavejustroomforanadultbedbesidethecot.Themotherisbyherinfantor

childdayandnight.Therearenoamenitiesspeciallydesignedformothers.Theirmeals

arebroughttothembynursesororderliesasifforapatient.Theyarenot,atfirst,asked

todoanythingbutstaywiththeirchild.Theyarenotprisonersintheircubiclesbutthey

seldom,infact,wanttostayawayformorethanabriefrest.Thesemothersseethe

wholetreatmentoftheirchildandtakepartinitasfaraspossible,helpinginmany

smallusefulways,”(MacCarthy,Lindsay,Morris,LancetNov,26,1955,p.1141).

MacCarthyreferstothe“greatbenefitsallround”andnotedthattherewere“things

whichapplyspeciallytothesmallerchildren.Whentreatmentiscomplexordisturbing,

nursingmaysometimesbemoredifficultowingtotheclingingattitudeofthechildto

themother.Wehavenotyethadenoughexperiencetomakeanygeneralisationsabout

thisexcepttosaythatwethinkitdoesnotmatter;whereaswhenthechildhasto

endurethesethingsaloneandcannotclingtoanyone,harmmaybedone”.Oneofmy

jobsastheregistrarwastotalkwiththemothersafterthewardroundandexplainwhat

theconsultanthadsaid.

RobertsonrecognizedthevalueofMacCarthy’sapproach;helatersaid,“UnlikeSpence,

hedidnotpickandchoosebetweenthemongroundsthatsomeweremoresuitable

thanothers;familydoctorsinthecommunitycouldtellthemotherofanyyoungchild

theyweresendingtohospitalthatshecouldstaywithhim.IntheopinionofDr

MacCarthyandhislike-mindedcolleagues,theyoungpatientneededhismother;no

39

matterwhatthestaff’sviewofhermightbe,theirtaskwastogetonwithhealingthe

illnessandtokeepmotherandchildtogether.Whenbroughtfullyintotheirchildren’s

care,mostmotherswereascompetentandsensibleinthewardastheywereathome.

Theoccasionalonewhowasfecklessorfearfulgotmorenursingsupport,therewasno

questionofexcludingher.Theanxietyaboutmotherswhofedsweetsandcakestotheir

childrenhadbeendispelled;motherswhoseaffectionandconcernwerenotobstructed

byrestrictionshadlessneedtobringsweetthings.Therewasnoincreaseininfection.

Studentnurseswereagreatersourceofinfectionthanweremotherstotheirown

children…Accommodationwasnotrestrictedtotheage-group(underfives).The

motherwhofeltanolderchildneededhertostaycoulddoso;sometimestherewas

specialneedbecausethechildwasfearfulafterhavingbeenaloneinhospitalwhen

younger.Andasthepresenceofmother(orfather)wasnotanamenitybutessentialfor

thecontentmentoftheirchildren,therewasnochargeforaccommodationormeals.

Parentsbecamevaluedmembersofthecare-givingteam”(Robertson,1989,p.54).

Itwasthewardsister,IvyMorris,inAmershamthatreallysawtheimportanceofthe

mothers.Herworkattractednationalpresscoverage.SheandMacCarthywerealsoon

televisionin1961.Thoughtheyonlystartedwithafewatatime,bythetimeIgotthere,

therewerealwayssomemothersstaying.ThiswasduetothefactthatSisterMorris

reallywantedthem.Inhisotherward,thewardsisterwaslessenthusiastic,andeven

whensheaskedthemothersiftheywouldliketostay,somehowtherewerelessof

them;thismaybebecausethecatchmentareawasmuchlarger.Fromthis,itbecame

ratherclearthatitwasthewardsisterwhodecidedonthesemattersratherthanthe

consultant.[Whenwefirststartedgoingintothewardsweweretoldtoalwaysdowhat

sistersaid-Ididsometimeswonderifthiseverstopped].

UnlikeSpence,MacCarthywasabletoadmitallthemothersandthereisnodoubtthat,

asSpencesaid,mothersandnurseswereabletolearnfromeachother.Inthewider

hospitalcommunity,itdependedentirelyonthestaffwhohappenedtobeoneach

wardastowhatthearrangementswere.

40

By1956,RobertsonhadmadeanumberofvisitstoAmersham.Hesaidthewardwas

“heart-warmingtosee.Whenbroughtfullyintotheirchildren’scare,mostmothers

wereascompetentinthewardastheywereathome”(J&JRobertson,Separationand

theVeryYoung’,1989).Hewassufficientlyimpressedwiththesituationthathe,along

withBowlby,arrangedwithMacCarthytomakeasecondfilm‘GoingtoHospitalwith

Mother’.ThefilmwasmadeinFebruary1956andreleasedtwoyearslater.

ThechildselectedwasSally,aged21months,takenoffthewaitinglistasLaurahad

been.Asithappened,sheandthefamilywereideal.Thefilmshowedthathaving

motherinhospitaliseasytoarrange,protectsthechildfromanxiety,andsothechildis

notdistressedafterwards.

RobertsonandBowlbyhadbeenworriedthatLaura,thesubjectoftheirfirstfilm,did

notcry.Forthesecondfilm,duringtheinitialexaminationIwasworriedthatSallywas

makinganalmightyfussaboutit.IremembergettingRobertsonintoasidewardand

assuringhimthatwecouldnotcontinuewiththisfilmbecauseSallywascryingsomuch.

Robertsonhadalreadyseenhowangrythechildgotabouthavingherfacewashedat

home,andassuredmethatthiswasonlytemporary-shewaswithhermother,andher

motherwouldcomfortherafterwards.IlearntmuchfromRobertson.Sally’sstayin

hospitalwentwellandattheendIrememberhersittingonthebedgoingbackwards

andforwardsandsingingwithhermotherfondlylookingon-shewasperfectlyhappy

and,thoughshedidnotknowit,justabouttogohome.

Thus,RobertsonhadpresentedaproblemwithLaura,andnowhadthesolutionwith

Sally.

PROFESSIONALANDPUBLICDEBATE

inthemeantime...

41

In1953therewasanotherrequestfromtheCentralHealthServicesCounciltoincrease

visitinghours,although,again,toonlyslighteffect.Butintheworldoutsidemedicine,

therewasincreasinginterest.Bowlby’sWHOReport,MaternalCareandMental

Health[2],hadcomeouton1stMarch1951.ThiswasthebeginningofBowlbybecoming

arenownedinternationalfigurewithsomeofhisideasreportedinthepress.

InthemedicalpressCampbelletalpublishedtheirpaperaboutunrestrictedvisitingina

Melbournehospital(TheLancetNov.51955,p.971citedabove).Therewasverylittle

commentaboutthisotherthanMacCarthyetal’sletterabouthiswardwithmothers

beingadmittedwithchildrenofthe‘fretfulage’,andhowsatisfactoryitwas,aswellas

NormanJacoby’slettersayingthathehadbeenhavingmothersinatPemburyHospital.

Therewere,ofcourse,doctorswhocompletelydisagreedwithfrequentvisitingbecause

theydidnotunderstandtheneedsofyoungchildrentoremaininclosecontactwith

theirmothers.Amongstothers,ProfessorP.J.Moir,consultingsurgeontotheUnited

LeedsHospital,forexample,wasquotedinTheLancetassaying,“Ithinkthereisalotof

sloppysentimenttalkedaboutthis.Ifchildrenareleftaloneforadayortwotheyforget

theirparents,”(TheLancet,March28,1953,p.656).

In1954JamesRobertson’sdaughter,Jean,agedfour,hadneededtohavehertonsils

out.JoyceRobertson,cameinwithherandwroteaverydetaileddescriptionofher

experiencefromthetimeshewastoldshewasgoingtohavehertonsilsoutuntilshe

gotbetterafewweekslater(rememberthatshetoohadworkedattheHampstead

NurserieswithAnnaFreud).ItwaspublishedintheNursingTimeswithacommentby

AnnaFreudandshowedhowimportantthemotherwastothischildduringher

tonsillectomy.Joyce’sdescriptionofherdaughtershowedhowcuriousand

apprehensivechildrenare,andhowmuchtheyneedsomeonewiththemnearlyallthe

timetoexplainwhatwashappening,whathadhappened,andwhatwasgoingto

happen.Eventhoughthemedicalstaffsaidthatthechildwouldnotrememberanything

immediatelyaftershecameoutoftheatre,intheevent,thechildwasveryrestless,her

motherkepttellinghertoliedown,andlateronsherecalled“Mummy,youkepton

42

tellingmetoliedown!”Thechildcamehomeandwasabletostartnurseryschoolsoon

afterwards,whileherfriendnextdoor,whohadnothadhermotherwithherduring

tonsillectomywaspoorlyforsometime.AnnaFreud,inhercommentsafterwards,

confirmedhowimportantthemotherspresenceis.

ShortlyafterthefirstshowingofRobertson’sfilminScotland,thechildpsychiatristFred

Stone-havingrecentlyreturnedfromtwoyearsinBoston-wasofferedaresearch

grantbyhiscolleaguesatGlasgow’sRoyalHospitalforSickChildrento‘disproveallthis

Bowlbynonsense’(Karen,1994,pp80,81[3]Instead,hedecidedtohavetwosimilar

wardsinthechildren’shospital,onewithunrestrictedvisiting,andtheothercontinuing

withitsusualarrangements.Therewasagreatuproar,indeedonenurseresigned

sayingshewasn’tgoingtobeinvolvedwithanysuchnonsense-“Doyoumeantosay,

thatthemothersaregoingtoseethatthechildrenarenotalwayscleanand

tidy?”Parentswerenotwelcomeinthechildren’swards.Stonedecidedthatthetwo

wardsshouldtakepartinacomparativetrial.Therewouldberegularmeetingsto

discussprogress.ThoughFredStonewaited,noregularmeetingswererequested.After

afewmonths,heheardthatthewholeoftheRoyalHospitalforSickChildrenin

Glasgowhadgraduallychangedtounrestrictedvisiting.

Herzogwasoneofmanywhocomplainedaboutthe“propaganda”bypsychiatriststhat

forcedhimtoincreasevisitingfromonetothreetimesaweekandwasscornfulabout

mothersinhospitalandconsideredthat,“difficulties,properlymet,ennoblethe

character”(Herzog,E.G.,‘ChildreninHospital’,LettertotheEditor,TheLancet,

September6,1958p.522-23&October25p.903-4)StephenandWhatley(1958)

wonderedwhethertheadvantagesoffrequentvisitingoutweighedthedisadvantages,

citingneglectofhusbandandotherchildren.

43

Thealternativetohavingmothersinhospitalisthatthehospitalgoestothehome.In

1954,anextensionofthepaediatricdepartmentatStMary’sHospitalstartedupa

homecareservicewheretheGPaskedthehospitalteamtoconsidertakingoverthe

careofachild,possiblyafteraconsultationwiththeconsultant.Itwasthefirstofits

kind,andIthinkisstillrunning.ThepaperwrittenbyLightwoodetaldescribesitwell

andtheysummariseitwell,“Homecareislessexpensivethanhospitalcare,andhasan

educationalvalue.Bothhospitalpersonnelandgeneralpractitionerscanbenefitfrom

cooperatingdirectlyinthecareofapatient.Homecarerequirestheexerciseoftact,

sympathy,andahighstandardofmedicaletiquetteinordertoprevent

misunderstandingsandovercomedifficulties,”(Lightwoodetal,‘ALondonTrialofHome

CareforSickChildren’TheLancet,Feb9,1957p.316).ApaperbyAlisonWhileshows

howhomenursinghasflourished(‘AnEvaluationofPaediatricHomeCareScheme’

JournalofAdvancedNursing,1991,16,p.1413-1421).

Thisservicedifferedfromtheearlierhomenursingservicesinwhichnursescarryout

theinstructionsofGPs,forexamplethehomenursingunitatRotherham(GilletJ.A.,

1954,BMJi,864)andthesimilarschemeinBirmingham(SmellieJ.M.,BMJI,suppl.

P.256,1956).

Inthemeantime,outsidemedicine,therewasmoreawarenessofchildren’sneedsat

thistimethanisoftenrealised.Forexample,inanarticletitled‘MothersTold:Revolton

HospitalBan’theNewsChroniclereportedontheideaofaparents’revoltagainstthe

restrictedvisitingontheirstayinginhospitalwiththeirchildren.ItwasEdithHonorEarl,

nieceofSomersetMaugham,whoputtherevoltideaforward-shesaid“Ifmyboys…

hadtobeinhospitalwhentheywereyoung,nobodycouldhavekeptmeaway.Ihave

seenmuchevidenceontheterribleeffectsofseparation”(NewsChronicle,16March,

1953).Shesaidthatasaportraitpainterofchildrenshecouldalwaystellwhenachild

hadbeeninhospitalforsometime.

44

Inthecommunity,thenewspapers,pickinguponBowlby’sideas,hadbeguntotakeup

theissueofyoungchildren’sseparationfromthemotherandhowemotionally

damagingthiscanbe.NewspapersandperiodicalsasdiverseastheNewsChronicle,

DailyTelegraph,NorthernEcho,theStar,Housewife,DailyMail,TheTimes,Churchof

EnglandNewspaperandtheCatholicTimesallcarriedarticlesonthethemeofmother

childseparation.Forexample,anarticleintheDailyMaildiscussingtheeffectsof

separation,statesthatfollowingashortstayhospitaladmissionachildreturninghome

is,“emotionallyfrozen,thenthawbringstears,hysteria,andoftenthatheart-rending

pleaforcomfortandrenewedsecurity:‘Mummywhydidyousendmeaway?’”(‘What

MakesaChildGrowUpGoodorBad?’,DailyMail,8April,1952inShapira,M.TheWar

Inside,Psychoanalysis,totalwar,andthemakingofthedemocraticselfinpostwar

Britain,CambridgeUniversityPress,2013).AnarticleinthepopularHousewife

magazineentitled‘MummyWhereAreYou?’,presumablyreferringtochildrenunder

five,describedthe‘shock’ofseparationconcluding-basedoninterviewswithmedical

andnursingstaff-that“moreup-to-datehospitals”admittedthatregularvisitswere

important,despitedifficulties(Housewife,5March,1953,p.40).

THEPLATTREPORT

TheWelfareofChildreninHospital,HMSO1959

Bythistime,therehadbeensomediscussionaboutthevisitingofyoungchildrenin

hospitalinmedicaljournals,suchasTheBMJandLancet,whileinthepopularpress

therewasfairlywidediscussion.Someweresayingthatitwasurgentthereshouldbean

increaseinaccess,butthepaediatriciansandnursesworkinginthechildren’swardssaw

noreasonforanychange.ThefirstofseveralcircularshadbeenissuedbytheMinistry

ofHealthin1949,alongwiththefirstofthreerequestsformorevisitingforchildrenin

hospital.In1956,thegovernmentissueditsthirdrequestthatthereshouldbemore

visiting,tonoavail.Althoughhospitalstafffeltstronglythattherewasnoneedforany

improvementinvisitinghours,thepublicwerebecomingincreasinglyconcerned.

45

Lettersinthemedicalpressandpublicpresshadstrongbutdifferentviews.The

DepartmentofHealthandSocialSecuritysetupacommitteeontheWelfareofChildren

inHospital.OneJune1st1956,HarryPlatt(1886-1986),PresidentoftheRoyalCollege

ofSurgeons,wasappointedasthechairman.

ItwastheinfluenceofRobertJones,whohadlookedafterhimasachild,thatledPlatt

intomedicineandthenintoorthopaedics.HisorthopaedictrainingwasdoneinLondon

andBoston.In1914,hejoinedtheRAMCandRobertJonesappointedhimto

Manchesterwherehewasinchargeofthefirstfractureclinic,andalsooftreatment

andrehabilitationofthewoundedfromFrance.HewastheconsultantattheRobert

JonesAgnesHuntOrthopaedicChildren’sHospital,and,in1939,firstProfessorof

OrthopaedicSurgeryatManchesterRoyalInfirmary.DuringtheSecondWorldWarPlatt

wasconsultantadviserinorthopaedicsurgerytotheEMS.Hewasanactivememberof

innumerablegovernmentcommittees(hethought‘acommitteeofone’wasthebest

waytogetthingsdone),receivedmanyhonorarydegreesandfellowshipsfromaround

theworld,wasPresidentoftheRSMfrom1931to1932,andthefirstorthopaedic

surgeontobePresidentoftheRoyalCollegeofSurgeons,from1954to1957.Hewas

knowntobeagreatorganiserwithafar-seeingphilosophicaloutlook.Althougha

surgeon,healwaysfelthimselftobeacontemplativeman,moreofaphysicianthana

craftsmenbecausehehadhadeverythingdoneforhimasachild.

Likemostorthopaedicsurgeons,Plattwouldhaveseenmanychildrenandhada

particularinterestincongenitaldislocationofthehips(CDH).WhileatBostonbefore

theFirstWorldWarhehadlearnedthatyouhadtolookatthewholechild,notjustthe

orthopaedicproblem.Itwasprobablyhisabilityasacommitteemanthatledtohis

appointmentaschairmanoftheWelfareofChildreninHospitalcommittee.Helearned

muchfromJamesRobertsonwhoserecommendationsfromtheTavistockClinictothe

committeewereallaccepted.

46

TheremitofthisCommitteewas,“tomakeaspecialstudyofthearrangementsmadein

hospitalsforthewelfareofillchildren-asdistinctfromthemedicalandnursing

treatment-andtomakesuggestionswhichcouldbepassedontohospitalauthorities,”

(TheWelfareofChildreninHospital1959:1).TheCommitteeincludedtwo

paediatricians(oneofwhichwasWilfridSheldon,twosurgeons,onenurse/midwifeand

oneRegisteredSickChildren’sNurse.

WilfridSheldon(1901-1983)waspossiblythemostimportantpersonontheCommittee.

HewaspaediatriciantotheRoyalHouseholdatthattime.HehadvisitedSpenceatthe

BabiesHospitalinNewcastleandhadseenthearrangementsformotherscominginto

hospitalwiththeiryoungchildren.

From1956to1958,theCommitteemettwentytimesandtookreportsfrommany

organisationsconcernedwithchildren,includingtheRoyalColleges,TheTavistock

InstituteforHumanRelationsandtheNationalAssociationforMaternalandChild

Welfare.

ThememorandumfromtheTavistockwaspresentedbyJamesRobertson.Itseems

likelythat,oncePlatthadseenthismemorandum,hemaywellhaverealisedthatthis

wasthebasisoftheReportwhichhehadbeenrequestedtoproduce.Hesuggestedto

Robertsonthatthememorandumshouldbepublishedasabooktocomeoutbeforehis

Report.

Robertson’sbook,YoungChildreninHospital(1958)describedhisobservationsof

childreninshortstayhospitals,showingtheirpsychologicalneedsandhowdistressed

theywereafterwards,andshowinghowimportantitwasthatmothersaccompanied

theirchildrenintohospital.HealsodescribeswhathehadseenatAmershamHospital,

wherehehadmadethefilmGoingtohospitalwithmother,andhowsatisfactoryitwas.

Inhisbookitoccasionallysoundedasifitwashappeninginotherhospitals,butitwas

onlyhappeningatAmersham.Hepointedoutthatthisarrangementdependedentirely

47

onthepeoplewhowereworkingonthewardatthetime.Hemademanyother

suggestions,includingthatthereshouldbebettereducationfordoctorsandnursesin

theemotionaldevelopmentandneedsofyoungchildren.AsPlatthadhopedthebook

reachedalargeaudienceandwastranslatedintoseveralEuropeanlanguagesaswellas

Japanese.

RobertsonwasinvitedtomeettheCommittee.HebroughtMacCarthyandshowedthe

twofilms‘ATwoYearOldGoestoHospital’,and,‘GoingtoHospitalwithMother’.Itis

generallyacceptedthatPlattgotonwellwithRobertson.WilfridSheldonalsoknew

MacCarthyquitewell.

Therecommendationswereradicalforthetime-thatthereshouldbeunrestricted

visiting;thatparentswithchildrenunderfiveshouldbeabletostayinhospital;children

shouldbenursedinchildren’swardsandadolescentsinadolescentwards;thatnochild

shouldbeadmittedunlessitwasabsolutelynecessary;and,thatconsiderationshould

begiventofurthereducationfordoctorsandnursesaboutchildren’semotional

development.Othersuggestionswerethatchildrenshouldbeallowedtobringintheir

owntoys,thefoodshouldbeflavoursomeandthatthehospitalclothesshouldbe

suitable.

AsdescribedintheBritishMedicalJournalby“GEG”(unnamedapartfrominitials)“It

wasanabsorbingexperiencetositbesidehimandwatchthewayheguideddiscussion

whilehisownviewscrystallised”(GEG,SirHarryPlatt’obituary,BMJvol294,10Jan

1987,p.130)ItiscuriousthatPlattceasedtobeChairmanonthe13thofJuly1957

whenhispresidentialtermcametoanend.Givenhisdominantroleintheprocess

perhapsmostoftheworkhadbeendonebythen.Fromhisearlygoodchildhood

experiencesasapatientitseemsthatPlatthadbeenlovedenoughtobeabletoidentify

withchildpatientsandtohearwhatJamesRobertsonwastellinghim.

Thereport,officiallyknownas‘TheWelfareofChildreninHospital’laterknownsimply

as‘thePlattReport’,hadlittleornoeffect.Itwascirculatedtoallhospitals.The

48

administratorstooknonoticeofitatallanditwasputtoonesidetogatherdust,be

coveredoverand‘lookedattomorrow’.

Thefilm‘atwoyearoldgoestohospital’wassubjudicewhilethePlattCommitteewere

sittingwhichhadfrustratedRobertsongreatly.Nowhewasableto‘gopublic’,writingin

thenewspapers,andshowingthefilm.In1961,hewrotethreearticlesaboutmothers

comingintohospitalwiththeiryoungchildreninTheObserver.TheObserveratthe

timewasownedbyDavidAstor.Iknewhiswidowwhotoldmethatitwasoneofthe

proudestmomentsofhislifethathemanagedtopersuadetheEditoroftheWomen’s

pagetoacceptRobertson’sthreearticles.Someweekslaterhewroteanarticleinthe

ManchesterGuardian.

THEBIRTHOFNAWCH

NationalAssociationfortheWelfareofChildreninHospital

TheBBC,inaone-hourtelevisionprogrammebroadcasttwomonthslater,showedpart

ofthetwofilms‘ATwoYearOldGoestoHospital’and‘GoingtoHospitalwithMother’.

Robertson,alongwithhiswifeJoyce,DrMacCarthy,SisterIvyMorrisandDrRonald

MacKeithwereinvitedtotakepartinthebroadcast.Robertsonexplainedaboutthe

needformotherstobeinhospitalwiththeiryoungchildren.Attheendofthelive

broadcast,ignoringdirectionsfromtheproducer,hewenttothemicrophoneandasked

parentstotellhimabouttheirexperiences,goodandbad,inpaediatricwards.The

programmehadbeenwatchedbyJaneThomas,PegBelsonandothermothersin

Battersea.Afterwards,oneofthemwenttoseeRobertsonattheTavistockClinicand

askedhimwhattheyshoulddo.Hisadvicewastoformagroup,nottousehisnamein

anyway,buttoexpresswhattheyfeltabouttheirchildrenbeingawayfromthemin

hospitalbythemselves.Hewouldalwaysbetheretoadvise,buttheyhadtoformthe

49

groupthatsuitedthem.ThisleadtotheMotherCareforChildreninHospital

organisationin1961,

In1962,MacCarthy,LindsayandMorrisatlastpublishedtheirexperiencesatAmersham

intheLancet,havinghadathousandmothersin,showinghowsatisfactorythe

arrangementwasforallconcernedincludingtheyoungchildren.Thougha“stillrather

controversialsubject”,wewereabletoshowthatindeedallmotherscouldbeadmitted

alongsidetheirchildren(particularlythoseunderfive,butolderchildrenwhere

necessary)intheordinarycubiclesofastandardchildren’sward.Fourmainbenefitsof

thisnewsystemwereapparent,“thepreventionofunhappinessinthechild,the

benefitsofnursingbythemother…themother’sneedtodothisnursing…[and]the

preventionofnervousafter-effects”(‘ChildreninHospitalWithMothers’,TheLancet,

Vol1,Issue7230,March,1962,pp.603-608).Althoughnoalterationofwardstructure

wasnecessary,wedidrecommendthatfuturechildren’swarddesignsshouldbelarge

enoughtoaccommodatemothersaspartoftheward.

TherewereonlysevenresponsesintheLancet;thislackofresponseindicatesthelack

ofinterestinthesubjectatthistime,inspiteofthePlattReport.Oneletter,as

previouslymentioned,wasfromMichaelOldfieldatLeedsInfirmarywhowasoneofthe

fewpeopleintheUKwhohademulatedthePickerillsinhavingamotherintolookafter

theirchildfollowingplasticsurgery,andwasthusnotrelatedtoMacCarthy’swork

(Oldfield,MTheLancet,‘ChildreninHospitalwithMothers’April21,1962p.857).

AnotherwasfromDonaldGarrowwhoemulatingMacCarthy,startingwith14in1958

hehad148by1961(thenfollowedMacCarthytoAmershamHospital),hadmothersin

thechildren’swardattheVictoriaHospitalforChildreninTiteStreet,Chelsea9

(Garrow,D.TheLancet,LetterstotheEditorApril21,1962,p.857).DavidMorrisat

BrookHospital,Londonfoundthat,whenaskedneutrallywhethertheywantedtostay,

only20mothersoutof85whohadchildrenunderfiveaccepted,andaskedifweshould

bemorepersistent?(TheLancet,May5,1962,p.978).AsurveyfromLeicestershowed

50

thatof30hospitals,onlyfivehadunrestrictedvisiting,andtherewasno

accommodationformothers(Kidd,H.B.TheLancet,May12,1962,p.1023).Illingworth,

ProfessorofPaediatrics,wrotesayingchildrenshouldbeallowedtoseetheirmothersin

hospital:hedidnotbelieveintheaftereffectsofhospitalisationofchildren(TheLancet,

May26,1962,p.1131).ValerieElder,SecretaryofMotherCareforChildreninHospital,

wroteinremindingusthatmothersknewwelltheaftereffectsofhospitalseparation

andhopedthat,withthisnewevidence,morehospitalswouldfinallyacceptmothers

cominginwiththeiryoungchildren(Elder,V.‘ChildreninHospitalwithMothers’The

LancetApril28,1962,p.912).

By1962MotherCareforChildreninHospitalhadtengroups.Followingsympathetic

articlesbyMaryStottintheGuardian,thetotalnumberhadrisento23bytheendof

thatyear.Theorganisationchangeditsnamein1965totheNationalAssociationforthe

WelfareofChildreninHospital(NAWCH)soastoincludetheprofessionalmemberswho

wantedtojoin.Quickly,branchesbegantospringupallovertheUK.Parentswerenow

talkingtotheirlocalpaediatricianandwardsistersandemphasizinghowmuchthey

wantedtocomeintohospitalwhentheirchildrenwereill.Thispersonalapproachwas

quitesuccessful.SoontherewasanannualmeetinginWestminster.Theyusually

managedtogetanMPtocomeandtalkalongwithdoctorsandafewnurseswhowere

sympathetictotheircause.Byconductingtheirownearlysurveys,NAWCHcould

challengeofficialfigures-informationcollectedatwardlevelsuggestedthatonly23%of

children’swardsallowedunrestrictedvisiting,ratherthanthe75%thatwasusually

officiallystated.Theseearlysurveysrevealedasurprisingvarietyofmeaningsof

‘unrestricted’.Forexample,‘Itisouraimtohaveunrestrictedvisiting,butvisitinginthe

morningisnotencouraged’;‘Visitingonthiswardisunrestricted,butdon’tstaymore

thanhalfanhour’;‘VisitingonoperationdayisatSister’sdiscretion,andisdiscouraged

tosaveparentsanyunnecessarydistress’(PegBelson,2009,‘TheCelebrationofa

Transformation’).By1966,NAWCH,throughdiscussionswithgovernmentministersand

questionsraisedbyMPsintheHouseofCommons,hadsucceededinestablishinga

51

cleardefinitionofvisitingarrangements-HospitalMemorandum(66/18).JeanLovell-

Davis,DirectorofNAWCHforeightyears,sumsuptheroleoftheorganisation,“This

wasauniquepressuregroupdedicatedtopromotingthemessagethatsickchildren

needmorethanclinicalattention,theyneedthecontinuingcareofthosewhoare

closesttothem”(BrandonS,LindsayM,Lovell-DavisJ,KraemerS.“Whatiswrongwith

emotionalupset?”–50yearsonfromthePlattReport.ArchivesofDiseaseinChildhood

2009;94:173-177,p176)

AresultofthearticlesintheObserverandGuardian,andtheBBCprogrammewasthat

Robertsonreceivedabout400letters.Theseweremadeintoabookwithaprefaceby

HarryPlatt,‘HospitalsandChildren:AParent’s-eyeView’(Robertson,1962),(essential

readingforanyonegoingtoworkinachildren’sward).Ittook40yearsormoreformost

oftherecommendationsofthePlattReporttobeimplemented.Thechangecame

aboutmainlyfromNAWCH,butalsofromretirementsandnewappointments,thelatter

beingmoreawareofchildren’sneedsthantheirpredecessors.Thisimprovementalso

cameaboutbymuchdedicatedcampaigningbybothRobertsonandMacCarthy.

RobertsonspokeaboutmothersinhospitalonBBCradioandthisledtomanymore

lettersandphonecalls.Hetookbothfilmsandconductedpublicmeetingsthroughout

Britaintalkingabouttheneedthatyoungchildreninhospitalhavefortheirmothers.

MacCarthyalsodidhisowncampaigning,whathecalledhis“barrel-organ”butwithout

themonkey,andwouldoftenspeakattheannualNAWCHconferences.Heshowedthe

films,talkedtotheaudienceandansweredquestions.Hewasagoodspeaker,very

charming,andapaediatricianwhohadactuallydoneit,andsoitwasmoreacceptable.

Peoplecouldnotsaytohim‘butDermod,thisisrubbish’.Asaresult,some

paediatriciansdidlistenandstartedlookingaroundtheirwards.DonaldGarrowtook

overtheAmershamwardfromMacCarthyin1962andtookthechildren’swardoverto

HighWycombewhenthenewhospitalwasbuilt,withofcoursefacilitiesforthe

motherstostayin.Healsohadbuiltinthehospitalawardformothersofthebabies

whowereinthespecialcarebabyunitwhichhadnotbeendonebefore.

52

Heinsistedthatthebabiesshouldgostraighttothemotherassoonastheywereborn,

placentaandall,inthewaythatKlausandKennell(1976)hadsuggested.The

importanceofmotherinfantattachmenthadearlierbeenmentionedbyMargaretMead

in1957atthe8thErnestJonesLectureoftheBritishPsycho-AnalyticalSocietywhenshe

discussedhowimportantwastherelationshipbetweenthenewbornbabyandthe

motherandhowimportantitwasforthefutureemotionaldevelopmentofthechild

(‘MotherandChild’TheLancet,Feb9,1957,p.317).

Fromthe1960’s,specialisedneonatalunitsforthetreatmentofsickpretermbabieshad

beensetupinmostmajorneonatalcentres.Intheearlyyearstheseunitsdidlittleto

preventseparationofparentsandbabiesandevidenceaccumulatedoftheilleffectsof

thissituation.Inaddition,thedifficultiesofbuildingarelationshipwithasickor

immaturebabygraduallybecomeapparent,evenundermoreidealcircumstances.Itis

nowgenerallyacceptedthatmothersandnewbornbabiesneedtobekepttogetherto

ensurethatthefuturerelationshipbetweenthemisnotimpaired.

MacCarthy’scampaigningincludedseveralpapers.‘AParent’sVoice’(1965),written

withDrRonaldMacKeith,reproducedamother’sletterwrittentoNAWCHconcerning

thedeathofherthreeyearoldchildfollowingatonsillectomywhichseemstobemostly

duetothefactthatthechildwascryingandthemotherwasnotallowedtobethere,

despitemanyrequests(TheLancet,1965,ii:1289-91).Thepaperraisedacertainamount

ofdiscussion,andwasconsideredsoimportantthatitwasreprintedtwentyyearslater

intheArchivesofDiseaseinChildhood.Anotherpaper,writteninFrench,waspublished

in1965(MacCarthy,D.‘LesParentsaL’Hopital’Probl.Act.Pediat.,1965,Vol9,pp.191

–203).

AsChairmanoftheEuropeanSocietyofPaediatricResearch(ESPR)from1975to1976

hetriedtopersuadepaediatriciansinEuropetohavemothersinhospital,writingtwo

articlesinFrench.HispaperinTheNursingTimesin1981(‘TheUnderFivesinHospital’

53

Supplement1,NursingTimes,July22,1981)waswrittenbyhimforchildren’sdoctors

andnurses.Itismoreofadetailed,practicalmanualofwhytheyshouldhavemothers

inhospitalwiththeiryoungchildren.

Then,asRuthDavies[4]says,oncethemotherswereinhospital,theproblemswere,as

GeorgeArmstrongpredictedin1772,thedifficultiesbetweenmothersandnurses.

NURSESANDDOCTORS

Nobodyinthewardsknewmuchaboutthedaytodaylivesofchildren.Upuntilthe

1960’snurseswouldhavehadtogiveupnursingoncetheygotmarried.Fordoctors,

medicalworkwassuchthattheyoftengothomelateandthenwereondutyat

weekends.Thus,thestaffinthechildren’swardwerenotreallyawareofthedaytoday

livesofchildren.Medicalstudentswerenevertaughtanythingabouttheemotional

developmentofchildren(andnotmuchabouttheirphysicaldevelopmenteither).When

theysawchildrencrying,itwasdistressing,butlaterontheyseemedtosettle.Neither

doctorsnornursesrealisedthatthechildrenwereinastateofdespair;theydidnot

havemuchtimetolookandifthechildstayedinlongenoughtheyseemedtobecome

quitefriendlyandchatty.Ofcourse,thechildrendidnothavethelanguagetotellus

howupsettheywere,anymorethanthechildreninthedaysofGeorgeArmstrong

couldtelldoctorswhatwaswrongwiththem.

Throughoutthisstoryoneproblemwasclear-somemotherswerenotabletolookafter

theirchildren,theirchildrengotsick,andtheythereforehadtotakethemtohospitals.

Thenursingstaffsawthemothersasnotbeingabletolookaftertheirchildrenproperly,

andthisstarteduparatherunfortunatetraditionthatthenursingstaffthemselvesfelt

betterabletolookafterthechildrenthanthemothers.Itwasnotuntilthe70’sor80’s

thatseniornurseswouldhavehadtheirownchildren.Whileuptothennurseshadno

realdirectexperiencewithchildrenyettheylovedthemandbecameratherpossessive.

Theyalsolovedtidiness,cleanlinessandorder;themother’spresencesometimes

54

interferedwiththis.Theotherproblemwasthatthechildrenwouldbeverydistressed

whentheyfirstcameintohospital,andwouldthengointodespairbeforeappearingto

becomesettled.Whenthemothersreturned,thechildren,especiallythoseunderthe

agesof3or4,couldnotstopcryingeachtimetheirmotherleftthem.Soitseemedthat

themotherswerebadforthechildrenandthatwaswhyvisitingwasconstantlybeing

keptatalowlevel.Nursesalsohadalotoftroubleafterthemothershadvisited-the

childrenwouldn’tsleep,theycriedandthisitselfbecameaproblem.Fromtheoutside,

peopleonlysawthechildrenbeingdistressedandunhappy,andtheparentsnotbeing

abletocomfortthem.

Intime,thedoctorsandnursesthatweretherewhenLaurawentintohospital

eventuallyretiredandanewgenerationofstafftookover.Nobodyeverreallyhadtheir

viewschangedbyanythingthathappened,butnewstaffcameinwithmoremodern

ideasabouttheimportanceofconsistentandattentiveparenting.Althoughthenurses

rantheward(inthesamewaythatthewifeusuallyarrangesthesociallifeofthehome)

thedoctorsalsohadsomeparttoplay.Sincethe1870’s,mostofthemwouldhavebeen

sentawaytoboardingschoolattheageofeight(goodforrunningtheempire,butnot

sogoodforemotionalrelationshipslateron),thenofftopublicschoolattheageof13,

uptouniversitytoreadmedicine,and,oncequalified,livinginthedoctor’shome,then

gotmarried,boughtahouse,andhadsomechildren.Butbusyastheywereinthe

hospital,doctors,particularly,wouldhavelesstodowiththedaytodayupbringingof

theirchildren(thesonofawell-knownQuakerpaediatricianoncetoldme‘weonlysaw

ourfatherformeetingsonSunday’).Sotheyreallyknewverylittleabouttheemotional

needsofsmallchildren.

WARDGRANNYSCHEME

Althoughitisnowgenerallyacceptedthatmotherscancomeintolookaftertheir

children,therearestillsomechildrenwhocomeintohospitalandcannotbelooked

afterconsistentlybyanybodyinthehospital.Itisnotpossiblefornursingstafftogive

55

full-timecaretoasickchild.JamesandJoyceRobertson(‘SubstituteMothering’Nursing

Times,29November1973)thoughtupaschemeforfostermotherstoberecruitedto

dothis.JuneJollyagreedthattheywerenecessary,pointingoutthehugenumberof

peoplewhowouldbevisitingeachchildeachdayandpointingouthownecessaryit

was,butatthesametimesayingitwasimpossibletofindsufficientpeopletodothis

eitheronapaidorvoluntarybasis(Jolly,J.‘TheWardGrannyScheme’NursingTimes11

April,1974).Shealsoaddedthatthewardgrannycouldbeathreattothemother.Thus

parentsneedtobeencouragedtocomeintohelplookaftertheirchildren.AsJuneJolly

says,“Perhaps…weshouldfollowtheexampleofpeoplefromtheunderdeveloped

countrieswhowilloftennotadmitachildtohospitalwhocannotfeedhimself,unless

hebringssomeonewithhimwhocandothisforhim”.

MYOWNEXPERIENCES

BeforeIcametoAmershamandAylesburywithDrMacCarthy,whowasalreadyhaving

mothersinhospital,IhadhadfifteenmonthsinBelfastandLondonasaJuniorDoctorin

children’swards.Ineverrememberbeingconcernedaboutthechildren.Certainly,they

criedwhentheycamein,butafterthattheyseemedtosettle,andIthinkweallstopped

hearingthechildrencryifwewereworkingintheward-wehadto,inthesameway

youtendtostophearinganycontinuousnoise,suchasamotorway.Goingforawalk

onemaynoticetheflowers,butuntilyouknowmoreaboutthem,theyonlyplayalittle

partinyourwalk(seepictureofJack).Maybeweweredefendingourselvesabout

seeingthechildren’sdistress.Noneofusknewanythingabouttheemotional

developmentofsmallchildrenandtheirneeds.Robertsonconstantlytalksaboutthe

resistancewehadatseeingthis.Ineverhadtimetoactuallytalktothechildren.We

tookourunderstandingofwhatwashappeningtothechildrenfromSister(‘alwaysdo

whatSistersays’).

56

Theproblemwas,thatnoneofushadbeentaughtanythingaboutdevelopmental

psychology.Wemayhavehadyoungerbrothersandsisters,butweneverhadanyidea

ofhowayoungchild,awayfromitsnormalcarer,wouldbefeeling.Wenevernoticed

thatthechildrenwereunhappy.Weweretoobusy.Weacceptedachild,listenedtothe

mother’shistory,examinedthechild,probablytooksomebloodasonedidinthefifties,

wroteoutinvestigations,prescribeddrugsandsawthechildonceadayontheward

roundunlessitwasill.

Notonlydidwenoticenothing,andknownothing,Ineverinthewholetimebetween

1951-1958whenIleftmedicine-andwasinchildren’swardsfor5½years-remember

anydiscussionaboutvisitingapart,ofcourse,whenIwasworkingwithMacCarthy.In

theoutsideworld,whateverpeoplewerewritingintheBMJandTheLancet,wedidn’t

readthem.Whenwewerenotworking,wewereeithersocialisingorsleeping,orwe

wereworkingforanexam.Theseexamsneverhadanyquestionsabouttheemotional

needsofsmallchildren.Wenowknowmuchmoreabouttheiremotionaldevelopment

andtheirneedsinhospital.

Iheardnothing,knewnothing,andsawnothingeitheraboutwhathappenedinthe

ward,orhowthechildrenwerewhentheywenthome.Themotherswouldoccasionally

tellthewardsisteraboutthechildren’sdifficultbehaviour,andthewardsisterwould

saythattheyknewmoreaboutmanagingchildrenthandidtheparents(MacCarthywas

alwaysdisappointedthathehadnotbeentoldbythemothershowdistressedthe

childrenwere).TheonlycommentIeverhadwasfromawardsisterinOxfordwhosaid

“ifIknewtherewasgoingtobemothersaround,Iwouldneverhavetakenupchildren’s

nursing”.

Parentalaccesstothechildren’swardwasagoingconcernwhenIarrivedasaregistrar

atthebeginningof1954.SisterMorrisprovidedinthiswardsomethingquitespecial–

wealllovedher,shewasalwaysscoldingusbutshelovedusandlookedafterus;I’m

57

surethiswarmthandaffectionthatshecontributedtothewardhelpedthemothersto

enjoybeingthere.Someonewhowasacadetthereatthesametimesaidtheyloved

workinginthatwarmandhappyward,andIcompletelyagree.However,eventhen,

therewereoccasionaldisputes,usuallyataboutoneinthemorningwhentheyseemed

tothinkthatitwouldbeagoodideaformetocomedown.MaybethetimeIspent

gettingthere,andthefactthatsomebodywascoming,enabledthedisputetobecome

easilymanaged,althoughthatonlyhappenedinthefirstyear,andonlyoccasionally.

Althoughtherewasnostatisticalfollow-upstudyofchildrenafterseparationinhospital,

myownanecdotalevidencefrompatientsandfriendssuggeststhat,iftheyhadbeen

admittedundertheageoffourforanylengthoftime,theywerequitedisturbedfor

sometimeafterwards.Parentsdidnotliketotellthedoctorsabouttheirchildren’s

distress,butiftheytoldthenursesthereplywouldbethattheirchildwasperfectly

happyinthewardandthatthenurseswerebetteratlookingafterthemthanthe

mothers.Themothersweresorelievedtohavethembackthattheyspoiltthem.

Forexample,in1963thetwoyearoldsonofacolleagueofminehadahigh

temperatureandhadtobeadmittedtohospitalovernight.Sheknewverywellthathe

neededherwithhim(aviewconfirmedbythememoryofayoungerbrotherwho,atthe

ageoffive,hadbeenadmittedforseveraldaysfollowingatonsillectomy,andhad

changedfromacheerful,confidentboy,toonethatwasscaredandtoofrightenedto

comehomefromschoolbyhimselfandneededtogohomewithher).Shehadtositup

inachair,andcouldhearthechildrenintheward‘wooing’allthroughthenight.She

mentionedthistoRobertHindelaterwhosaidthiswasanindicationthatthechildren

werenotsleepingdeeply.Mycolleague,whoknewthathersonwassleepingdeeply

becauseheknewshewasbesidehim,realisedthatthenursesweretoobusytohear

this.

AsaformerpaediatricianwhobecameachildpsychiatristInotethataftertheirfirst

meetingin1949howlittlechildpsychiatristsandpaediatricianshavehadtodowith

eachother.In1986LionelHersovwhohadworkedwithVictorDubowitzatthe

58

HammersmithHospital,notedthatMildredCreak“haddescribedchildpsychiatryasthe

productofabrokenmarriagebetweenorthodoxpsychiatryandpsychoanalysisand

askedwhetherpaediatricsmightnotfilltheroleofthethirdparty.Fouryearslater

DonaldWinnicottconcludedthatpaediatricshadfailedasaparentalfigureforchild

psychiatry,ashadgeneralpsychiatry.In1968JohnApleywasstillhopingtomakean

honestwomanofchildpsychiatry:"Therehasbeenalonganddesultoryflirtation

betweenthembutitishightimetheyweremarried—ifonlyforthesakeofthe

children."Hefeltstronglythatthetwodisciplinesshouldnotcompetebutcomplement

eachotherbycloserlinks.”(Hersov,L.(1986).ChildpsychiatryinBritain–thelast30

years.JournalofChildPsychologyandPsychiatry,27,781–801,p.788.)Thirtyyears

later,thoughcollaborativeclinicalworkhasincreasedgreatly,Kraemerwritesan

‘institutionalblindspot’remains.Acriticalmassforcreatingjoinedupworkinghasnot

yetbeenachieved,leavingthechildhealthprofessionsinacollectivestateof

ambivalence”(Kraemer,S(2016)‘Theviewfromthebridge;bringingathirdpositionto

childhealth’in(eds.)SarahCampbell,RogerCatchpole&DinahMorley,Child&

AdolescentMentalHealth:newinsightstopractice.PalgraveMacmillan).

Parentalaccesstochildreninhospitalisnowwidelyaccepted,butfewyounger

paediatriciansknowanythingofthehistoricstrugglesthatwereneededtoachievethis.

Theyremainprimarilypreoccupied,asindeedtheysooftenneedtobe,withchildhood

diseaseratherthanchildhoodexperience.

EXPERIENCESOFMIDDLECLASSCHILDRENBEFORETHEWAR

MyhusbandTonyBalfourin1927,aged6months,swallowedanopensafetypin.He

hadtwolaparotomiesonthekitchentableathometotryandfindthepinwhich

eventuallycameoutinhispotty,buthewasnotawayfromhomeandhadthesame

carersashehadalwayshad.In1930,Ihadamiddleearinfectionwithabulging

eardrum.Lefttoitselfthiswouldhaveburstanddamagedtheeardrumandsoneeded

lancing-amyringotomy-whichwasdoneathome.Mybedwasmovedintothe

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nursery.Thechloroformanaestheticnightmarelastedforashorttime.AfterwardsIwas

fine-lyinginbedwithanurseryfireblazingawayatmidnightwithanurseoppositeme

availableforcomfort,drinksanddropsinmyear.Mymothercameintovisitme

frequently,duringthedayandinherdressinggownatnight.IdidfeelheranxietybutI

gotbetter.Ilearnedhowtomakebedsliketheydoinhospitalandwentbacktomy

bedroom.Itwasaltogetheraveryenjoyableexperience.Iknowthreepeoplewhohad

theirtonsilsandadenoidsremovedathomeonthekitchentable.Minewereremoved

whenIwasnineinaprivateroominanursinghomewhereIwaswelllookedafterand

happy.In1936,mybabybrotheraged3monthshadaninguinalhernianeedingrepair.

Thiswasdoneinourholidayhome.Thesurgeoncame60milesupfromBelfast,had

lunch,didtheoperationandwenthome.IthinkIwas8whenIgotscarletfever.My

mothersaidshewasprobablyinfectedtooandcouldnotpossiblystayinschoolandso

wedecampedtooneoftheemptyhousesonthegroundsandIrememberfourweeks

ofadelightfultimewithher.

LEARNINGTOOBSERVECHILDRENANDTHEIRPARENTS

“Mummy’sgoneawayandleftmebehind!”Observationandunderstandingneedtobe

taught,andlearned.

Afewdaysbeforewarwasdeclared,itwassuddenlydecidedthatmyfamilystayingin

ourholidayhouseinNorthernIrelandshouldgobackearly.Theyleftthenextmorning

at6am,leavingbehindmeaged13,Jackaged7andRichardaged3.Richardspentthe

dayinmyarmscryingandsaying,“Mummy’sgoneawayandleftmebehind!”[Thiswas

thebeginningoftwoyearsofbeingevacuated].

Muchlateron,whenIsawthetoddlerscryingdesperatelyintheircotsinthewardIdid

notassociatethemwithRichard.Theywerenomoreabletoexplaintheirpredicament

thanwerethechildreninthedaysofGeorgeArmstrong.Thewardsistertoldusthatthe

childrenalwayscriedwhentheycamein,thenthey‘settled’,afterawhilebecamequite

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friendly,andoccasionallydidnotwanttogohome-wewerenottoworry.Shegot

Robertson’sthreestagesright,butdidnotunderstandthem.Itwasresearch,atfirstnot

believed,thengraduallyaccepted,intotheemotionaldevelopmentandneedsofyoung

children-showinghowimportantwasthepresenceofthemother-thatleadto

mothersbeingadmittedwiththeirchildren(althoughMacCarthyhadmothersinin

ordertostopthechildrenbeingunhappy).

Observationandunderstandingneedtobetaughtawayfromthecotandinthe

classroom,preferablyaspartofaninterestinglectureontheemotionaldevelopment

andneedsofyoungchildrengivenbyaseniorpersoninyourowndiscipline,followedby

reflectivediscussion(seeWaddell, M. (2006) Infant observation in Britain: The

Tavistock approach. The International Journal of Psychoanalysis, 87: 1103–1120.)

Theywerenotsufferingfromaninfectionthatneededanantibiotic,butfromthe

despairanddistressofbeingseparatedfromtheirmotherforwhichthetreatmentwas

theirmother,sothatmotherbecomesaconcretetreatment.

LastyearpeoplestayinginPortballintraewithmewentforwalkswhichtheyenjoyed,

butaftertheywentforawalkwithmybrotherJack,whoknewallaboutflowersand

taughtthemwhatheknewandhowtoobserve,theysaidtheirwalksbecame

considerablyenriched.Observationneedstobetaughtandlearnt.

CONCLUDINGCOMMENTS

‘TheTwoYearOld’presentsaproblem,’GoingtoHospital’isthesolution.

WithoutBowlbyprovidingthefacilitiesforRobertsontoworkinhisdepartment,Anna

Freud’seducationofRobertson,andMacCarthyprovidingtheanswertothedistressof

thechildren,PlattandhisCommitteewouldhavehadverylittleonwhichtobasetheir

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recommendations.Robertsongetsalotofcreditforhisfilms,butcomparedtoSpence

andthePickerills,MacCarthyrarelyornevergetsmentioned.

REFERENCES

Bowlby,J.(1944).Forty-FourJuvenileThieves:TheirCharactersandHome-Life.

InternationalJournalofPsycho-Analysis,25:19-53

Edelston,H.(1943).Separationanxietyinyoungchildren:Astudyofhospitalcases.

GeneticPsychologyMonographs,28,1,3-95

LightwoodR,BrimblecombeF,Reinhold,Burnard&DavisJ‘ALondonTrialofHomeCare

forSickChildren’,TheLancet,Feb91957p.313–317

WhileA.(1991)‘AnEvaluationofaPediatricHomeCareScheme’,JournalofAdvanced

Nursing,16p1413-1421

[1]Itisnotclearwhycross-infectionwassuchanissuesincenofeverhospitalsever

allowedvisiting-mothersdeliveredtheirchildrenandwereaskedtopickthemupsix

weekslater.Theonlywaythemothercouldfindouthowthechildwas,wasthroughthe

porter.Sometimestheywereallowedtopeepattheirchildrenthroughaglasswindow

whentheywereasleep.

[2]laterpublishedinpaperbackformabridgedandeditedbyMargeryFry,Bowlby,J.

ChildCareandtheGrowthofLove,Penguin1953

[3]Karen,R.(1994)Becomingattached.Oxford:OxfordUniversityPress,pp.80–81.

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[4]RuthDavies,alecturerinhealthscienceatSwansea,saidthePlattReportwas,

“timelyandbroughtaboutbyaconvergenceinpublicopinionduetochangesinsociety

andsystemsofhospitalcare–notleastdevelopmentsinpsychologicalresearchwhich

challengedtheestablishedorthodoxiesofboththenursingandmedicalprofessions,”

(DaviesVol14,p.6-23,JournalofChildHealthCare,2010).