History and Art

The Royal Belfast Hospital for Sick Children

Abelardo A. Retureta, MD; Oscar Papazian, MD; Julia M. Retureta-Soler, MD; Graciela C. Retureta, PharmD

    Belfast, in Northern Ireland, was a flourishing market town at the beginning of the nineteenth century, with a population of about 20 000. Habitants numbered 90 000 by the mid-century, and in 1900 the population was considered to be about 350 000. Belfast was considered one of the few great industrial towns that grew at such a rate. This was the result of a rapid growth in the linen industry, in shipbuilding, and in engineering at the time of the Industrial Revolution.1

But this large-scale migration from country to town caused serious problems in housing, water supply, and sanitation. By the 1840s, the Great Famine and epidemics of cholera and various fevers produced a dismal effect. In 1851, the average age of death was 9 years; one half of the population was under 20 years of age.1

In 1775, the medical needs of Belfast were served by the infirmary and dispensary instituted by the Belfast Charitable Society. In 1792, another dispensary was established. It had various stations throughout the town which supplied medical care, medicines, and necessities of life, mainly to poor children at their own habitations. The dispensary continued on a charitable basis until its replacement in the 1840s by poor-law dispensaries which continued to offer services until the inception of the National Health Service in 1948.1

In 1777, children admitted into the Poorhouse or dispensaries for care were being inoculated against smallpox by direct infection from a person with the disease. The donor received a fee of 6 d. In 1800, only two years after Edward Jenner (1749-1823) published the results of his work on cowpox vaccination, it was resolved by the managers of the Poorhouse that the experiment be tried on a few children in their care.6

Some of the medical problems and diseases of children in the care of the Charitable Society were reported in 1835. This report mentions contagious eruptive diseases, skin diseases, and various forms of scrofula, glandular affections, abscesses, water on the brain, diseases of joints, consumption, marasmus, and ophthalmia.6 In 1827, a medical charity facility for the treatment of children and diseases of the eye was established. It provided only outpatient care, and medical students attended to its practice. By 1839, this facility closed because of lack of funds.1

A Fever Hospital was opened in 1797 with six beds and a resident nurse. It is the direct ancestor of the Royal Victoria Hospital. Because none of its records exist now, we cannot know whether or not children were admitted to its wards.1

In 1817, a new Belfast Fever Hospital was opened. It had less rigidity in the admission of children than the one in London. As it was reported in 1818, "no fever patient has ever been rejected. . . children not able to take care of themselves are the only exception and even of these many have been admitted."1

In 1821, another report from the hospital mentioned: "Some of the sufferers from smallpox were of the tenderest age and unfit for separation from their parents who were admitted with them to attend to their infants."1 In that year, the number of children under the age of 10 years admitted to the wards numbered 93 (12.9% of the total). Although the hospital was called a "fever hospital" many patients were admitted who were not suffering from contagious diseases. In 1848, the hospital was relieved of its responsibility for fever patients and became a general hospital, and children seem to have been excluded more rigorously.1

The report of the new outpatient department from 1849-1851 stated, "Cases of childrens’ disorders are also numerous and, as such, are almost never admissible into the wards, they present the only opportunity to the attending pupils for studying a class of diseases which the young practitioner is especially called upon to treat."1

The Royal Belfast Hospital for Sick Children was founded in 1873.1 In the 12 months preceding the opening of the hospital, 175 children under the age of 10 years (7% of all admissions) were admitted to the General Hospital, and many of the children were accompanied into the wards by their mothers.1 During the 19th century, there was a great reluctance to admit children to general hospitals because of the prevalence of infection within the hospitals and the difficulties of feeding and nursing infants.1

There were no children’s hospitals in Belfast until 1873, but the idea of founding such a hospital was in the mind of a young physician in the General Hospital in 1847. He was Andrew Malcolm, and he was at that time conducting a charitable dispensary for poor infants and children.1

Although no further reference to Dr. Malcolm’s project have been found, suddenly in 1873, Belfast found itself with three children’s hospitals. One was for children affected with spinal disease (founded by Samuel Martin), another was the Ulster Hospital for Children which is, at present, a General Hospital with children’s beds, and the third was the Royal Belfast Hospital for Sick Children.1

By the 1870s, the population in Belfast had risen to 175 000, but living conditions remained so bad that half of the children born died before reaching 10 years of age. In 1891, the infantile mortality rate was 173 per 1000 live births compared with 147 in 1896 and 24 in 1969.1,7,8

The founders of the Royal Belfast Hospital for Sick Children took, as their model, the Hospital for Sick Children in Great Ormond Street, London. The leading figure in the foundation of the Children’s Hospital was Herbert Darbishire.1,5,7,8

The Royal Belfast Hospital for Sick Children opened in 1873. The original building was located on 25 King Street. The hospital opened with nine beds, to which nine more were added soon after.1,7,8 The institution was operated "first to provide medical treatment for the sick children of the poor; second to diffuse. . . a knowledge of the proper management of young children in health and sickness; and third, to promote the advancement of medical science with references to the diseases of infancy and childhood." "The hospital wards will be devoted to the treatment of all diseases affecting little sufferers under ten years of age." "All deserving patients will be prescribed for and get medicines gratuitously..."1,7,8

The furnishings and equipment of the hospital were supervised by Mrs. Hay, the first matron of the Royal Edinburgh Hospital for Sick Children. The first matron at the Royal Belfast Hospital for Sick Children was Miss Lennox, who had been a pupil in the Nightingale School of Nursing in London.1,7,8 This School for Nurses was founded by Miss Florence Nightingale (1820-1910) at Saint Thomas Hospital in London in 1860.5

When the Royal Belfast Hospital for Sick Children opened in 1873, the honorary medical staff consisted of James W.T. Smith, consulting physician; Samuel Browne, consulting surgeon; Brice Smyth, attending physician; John Fagan, attending surgeon; and Reuben Bolton, pharmacist. The consultants played no active part in the clinical work of the hospital but they were men of great eminence and influence in Belfast.1,7,8

James W. T. Smith was born in Belfast in 1830. He was a student at Queen’s College and University in Ireland and graduated with a medical degree in 1853. He was a very popular clinical teacher. He died in 1890.7

Samuel Browne was the son of Reverend Solomon Browne of Castledawson. He obtained his diplomas in 1830, 1851, and 1881. He served in the Royal Navy as an Assistant Surgeon from 1830 until he retired in 1868. In 1844 he established the Belfast Ophthalmic Institution and Children’s Dispensary on Mill Street, which he conducted along with Dr. A. G. Malcolm. He was Mayor of Belfast in 1870. He was a surgeon at the Royal Belfast Hospital for Sick Children for 25 years.7

John Fagan was born in Westmeath in 1843 and received his medical education at the Catholic University in Dublin, Ireland. He obtained his diplomas in 1865, 1866, and 1874. He also studied in London, Paris, and Vienna. He served as an attending surgeon, and later as a consulting surgeon, until his death on March 17, 1930.7

Brice Smyth was born in Banbridge in 1838. He received his medical education in Dublin at Trinity College and Dublin University. He was also a member of the staff of the Union Infirmary and the Lying-in Hospital and was a pioneer in child welfare. He served as an attending physician and later as a consulting physician at the Children’s Hospital until his death in 1922.7

The first chairman appointed for the hospital was William Robertson who was to serve for two periods: 1873-1883 and 1890 to 1896. The first honorary secretary was Herbert Darbishire, and the first honorary treasurer was Robert S. Craig.7 The first President of the hospital was the Reverend William, first Baron O’Neill of Shane’s Castle, Antrim. After his death in 1883, three other members of the O’Neill family continued to hold the presidency for a total period of 75 years as a voluntary institution and until 1948 when the hospital became a part of the National Health Service.7

The hospital was opened for outpatients on June 2, 1873, and on August 4, 1873, the first inpatients were admitted. During the 7 months ending December 31, 1873, 1617 new patients attended the outpatient department for a total of 3345 consultations. The most common diseases were diarrhea, bronchitis, fevers, and tuberculosis in its different forms including lupus, phthisis, tabes mesenterica, struma, and hip and spinal diseases. Tuberculosis was also the greatest cause of morbidity and accounted for 18% of the total number of new patients. Syphilis was diagnosed in 28 children and rickets in 2.7

The number of children admitted as inpatients during that same period was 110. They suffered from bronchitis (14), tuberculosis (13), different wounds (6), fractures (2), and other conditions. There is no mention of burns or scalds. The children received good physical and emotional care, the rooms were perfectly clean, well ventilated, and comfortable.7

In the last complete year on King Street (1878), there were 6553 new outpatients and 217 inpatients, of which 128 required medical treatment and 89 required surgery.7 From its opening until the end of 1878, only 22 children died in the King Street hospital.7

In 1967, Brett described the Queen Street Hospital as "a distinguished building in Scotting Renaissance type. . . much more successful than the Belfast Town Hall (also designed by Thomas Jackson and Son)."8

There had been two nurses when the hospital moved to its second building on Queen Street. Miss Lennox served as matron for 18 years until she resigned in 1891 due to health problems. Many other matrons followed: Beatrice Colborne; Amy Isobel McTaggart, who married Dr. Robert Campbell; Constance Rome, who married Dr. Thomas Sinclair Kirk; Miss Lockwood, a newspaper photograph of 1911 shows her with a staff of 11 nurses; and Annie P. Knox, who was the first locally trained nurse to be appointed Matron of the Children’s Hospital. Miss Knox served for 35 years until 1948.8

Many famous physicians—including pediatricians and pediatric subspecialists, worked at the Children’s Hospital. Among those who contributed most to improving the care of children is John McCaw, who succeeded Brice Smyth after his resignation in 1883. Dr. McCaw is regarded as the first specialist in diseases of children in Belfast, and in 1893, he published the first edition of his book "Aids to Diseases of Children." He also wrote "Aids to Infant Feeding and Hygiene" in 1905. Others include Joseph Nelson, an oculist and aurist; John J. Andrew, a dental surgeon; Francis Howard Sinclair, best known for his interest in pulmonary tuberculosis and for his paper on the treatment of tuberculosis with tuberculin; John St. Clair Boyd, assistant surgeon; John Campbell (later Sir John), who in 1891 succeeded Dr. Boyd as assistant surgeon; Edward Churchill Stack, who in 1893 succeeded John Fagan as honorary attending surgeon; Sidney Brice Smyth, a son of Brice Smyth; John Smith Morrow, assistant surgeon; William C. Steen, assistant physician; Thomas Sinclair Kirk, assistant surgeon who served the hospital for 41 years, James Lorrain Smith, pathologist; Robert R.L. Leathem, assistant physician; and Brian O’Brien, assistant surgeon.8

In 1895, the outpatient department was reorganized and Sister Janet was appointed. She organized a program of physical exercise and massage for children and developed a physiotherapy department.8

Advances in surgery for children led to increased admissions to the surgical ward from 109 in 1880, to 248 in 1900. A child with acute abdomen because of intussusception was admitted in 1898, and another in 1899. The first mention to appendicitis was in 1902. In 1902, the Children’s Hospital opened two additional wards—one medical and one surgical—each with six beds. The first anesthetist, Isaac Davidson, was appointed.8

In the early 1900s, Robert Campbell, younger brother of John, developed the practice of outpatient surgery at the Children’s Hospital. "The best nurse for a child is its mother, and the best place for it to be ill is at home," he stated.8,9

Dr. Robert Campbell was the grand nephew of Reverend Robert Campbell of Templepatrick Presbyterian Church installed in 1796. Dr. Robert Campbell served the Children’s Hospital at Queen Street for almost 23 years. He was appointed honorary assistant attending surgeon in September 1897, and a year later he became full surgeon. In 1906, he married Miss Amy Isobel McTaggart, matron of the Children’s Hospital.7,8

Dr. Robert Campbell died in 1920 "full of honour if not of years."7

In 1907, Malcolm Brice Smyth was appointed assistant physician, and he was the third member of his family to be elected to the Children’s Hospital staff. In the 1920s and 1930s, Joseph Tegart Lewis (bacteriologist); Ivan Henry McCaw (dermatologist), the son of John McCaw; Richard McCulloch (radiologist); and J.C. McNeill (dental surgeon) were appointed to the Children’s Hospital.8

The Third Hospital (1932-Present)

In April 1932, exactly 53 years after the opening of the Queen Street location, the hospital moved to its third and present location on 180-184 Falls Road, on the main medical campus of Belfast.8

At present, the Royal Belfast Hospital for Sick Children is one of Northern Ireland’s teaching hospitals, where medical students as well as junior medical staff are trained up to consultant grade, in both general pediatrics and in all pediatric subspecialties.10

We would like to thank Dr. H. Love from The Royal Belfast Hospital for Sick Children for providing the photograph of the hospital. We also acknowledge the literature review prepared by Mrs. Sylvia Diaz and the preparation of the manuscript by Ms. Sandy Allen. Without their help, this work would never have been completed.

References

1. Calwell HG. Care of sick children in Belfast in the nineteenth century. J Royal Soc Med. 1979;72:706-708.
2. Besser FS, Calwell HG. Hospitals for sick children. Br Med J. 1979;1:1421-1422.
3. Langdon-Davies J. Shaftesbury and the Working Children, Jackdaw No 7. London, Jonathan Cape, 1964. Cited by Besser FS, Calwell HG. Hospitals for sick children. Br Med J. 1979;1:1421-1422.
4. Trevelyan GM. Illustrated English Social History. Harmondsworth, Penguin Books, 1964. Cited by Besser FS, Calwell HG. Hospitals for sick children. Br Med J. 1979;1:1421-1422.
5. Retureta A, Papazian O, Retureta J, Retureta G. The Hospital for Sick Children, Great Ormond Street. Int Pediatr. 1997;12:124-127.
6. Strain RWM. Belfast and Its Charitable Society. Oxford University Press, London: 1961. Cited by Calwell HG. Care of sick children in Belfast in the nineteenth century. J Royal Soc Med. 1979;72:706-708.
7. Calwell HG. The foundation and early development of the Royal Belfast Hospital for Sick Children. The Robert Campbell Memorial Oration delivered to the Ulster Medical Society, January 16, 1969. The Ulster Med J. 1969;38:101-118.
8. Calwell HG. The history of the Royal Belfast Hospital for Sick Children. The Queen Street days. The Ulster Med J. 1971;40:85-110.
9. Higgins TT. Robert Campbell Memorial Oration 1955. The Ulster Med J. Cited by Calwell HG. The history of the Royal Belfast Hospital for Sick Children. The Queen Street days. The Ulster Med J. 1971;40:85-110.
10. Belfast Royal Hospitals. http://www.royalhospitals.ac.uk/ December 1997.

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