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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:[email protected]
SickChildrenandtheirParents
Smallchildrenadmittedtohospitalwillnotthrivewithouthavingaparentwiththem.
Thishasbeendimlyunderstoodbypaediatriciansforatleast250yearsbutonlysince
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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.
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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.
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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
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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,
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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
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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
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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.
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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
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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)
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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
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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).