Conclusions

'The Village Doctor' Girardet Brothers. From the Disbrow Collection. National Library of Medicine, Bethesda, U.S.A.

Concise conclusions cannot be made from this work. The life of August Schoepf Merei, although short (54 years), was complex, and little information is available on his life and work in Hungary and other European countries before his immigration to England. His work in England is also little documented by any but himself and his close friend, James Whitehead. He died too early to gain the respect that fellow immigrant Louis Borchardt gained for his work with the General Dispensary for Children even though Merei’s work appears to have been far more scientifically orientated. The annual reports for the Clinical Hospital which Merei wrote contain far more observations and data than the equivalent reports by Borchardt for the General Dispensary.

The question still remains as to why Merei and Whitehead opened yet another specialist hospital in Manchester. They give very clear, detailed reasons in their ‘Suggestions’ pamphlet and within the annual reports, both discussed within Chapter Two, above. However, it would be naive to accept at face value the reasons published by the doctors without taking into account the trend towards founding specialist hospitals at that time. As Abel-Smith comments in his book, The Hospitals, 1800-1948:

“The new hospitals met the needs of their founders in a variety different ways. They provided clinical material and resources for the development of skill unhampered by the obstruction and surveillance of the ‘great men’. Secondly, they could be used to attract private patients. An advertisement extolling the work of a hospital was a legitimate means of raising money to help the sick poor, but it had the effect of enhancing the reputation of the doctor who ran it. Some of the specialists were indirect beneficiaries of the charities they created,” [1].

Lindsay Granshaw makes a similar argument in her article, ‘Fame and Fortune by Means of Bricks and Mortar’: The Medical Profession and Specialist Hospitals in Britain, 1800-1948. She documents a British Medical Journal campaign made on behalf of general hospital doctors and general practitioners during the early 1860’s: “Half the special hospitals [were] founded in the grossest self-seeking on the part of the individual – An energetic surgeon makes up his mind to step to fame and fortune by means of bricks and mortar,” [2].

However, I would argue that Merei and Whitehead were not of this ilk. They funded the founding of the Clinical Hospital for the Diseases of Children from their own resources, of which Merei had very little since he had abandoned his prospects in Hungary. The whole enterprise seems to be more of a private experiment, mainly motivated by Merei’s interest in growth and development of children and the common diseases which affected them. This would also account for the detailed annual reports which were produced in the first two years, possibly meant as a form of experimental results.

Although the subjects of experiment, child growth statistics and infant feeding, were those which were to occupy public thought and debate later in the century there is little evidence that Merei and Whitehead’s data were used or publicised by many. One exception to this was Dr. C.H.F. Routh of the Samaritan Free Hospital for Women and Children in London whose book, Infant Feeding and its Influence on Life; Or the Causes and Prevention of Infant Mortality, was first published shortly after Merei’s death in 1860 and ran to three editions, the last appearing in 1876. In this book, Routh reviews data collected by others from around the country to support his own ideas on infant welfare. In addition to the Manchester data on infant feeding (presented in the Appendix, starting p65) he compares mortality data from Brighton, which was “kindly forwarded to [him] by a lady correspondent, who is deeply interested in all efforts made for improving the sanitary condition among the lower classes.” Of the fifty cases of death reported, he classified them as follows:

Table 5: Infant deaths attributable to diet in Brighton [3].
Convulsions (in 7 coroner’s inquests, verdicts “over feeding:” several not investigated) 22
Diarrhoea, and other disorders of stomach and bowels 12
Total cases traceable to over-feeding and injudicious feeding 34
Or per cent 68
The other 16 cases were affected with hereditary, structural, developmental, and epidemic cases: most probably in these cases death was wholly independent of diet.
Table 6: Type of diet of infants in mortality statistics in Brighton [3].
Fed on bread-food without the bottle; some having the breast in addition to bread-food; some having other food, as sago, arrowroot, etc.; dying of convulsions or of diarrhoea 24
Fed entirely from mother’s breast 11
Fed from the bottle 1
Fed entirely on cow’s milk and water 2

Aside from Dr. Routh the only trace to Merei and Whitehead’s data comes from later publications from the Clinical Hospital itself. The influence of the findings can be seen in a pamphlet produced and distributed free to the mothers of all its patients by the hospital in 1885 and reproduced in The Health Journal:

“Rules for the Management of Children.

Cleanliness: Wash them all over with soap and warm water every day.

Dress: Clothe them warmly, but let clothing be loose. Never let the arms or legs be bare.

Fresh Air: See that your rooms have plenty of fresh air let into them. Take children out every day when the weather is fine, but never take young children out at night, nor on cold or wet days.

Sleep: Children require plenty of sleep. They should sleep in a cot, and not in their mother’s arms. Never give sleeping medicines; if children cannot sleep they are ill and should be seen by a doctor.

Food: Give nothing but milk to infants less than 8 months old. If possible the breast should be given; if not, then equal parts of cows milk and water, from a bottle. If there is not enough breast milk, cow’s milk and water can be given at the same time. No bread, corn flour, or other food of the same kind must be given under 8 months old. Use the old-fashioned feeding bottle, without any tube. See that it is clean; smell it before you use it. For the first 6 weeks, infants should be fed every 2 hours in the day, every 3 or 4 hours at night. Do not feed children to keep them quiet, but always at the proper times. When older, children may be fed less frequently.

Weaning: Begin to wean at 8 months, and then gradually give light food, such as bread, rusks or milk biscuits added to the milk, and a little broth or beef tea in the middle of the day. Children should be weaned entirely by the time they are 10 months old.” [4].

Thus it can be seen that although not directly referred to, Merei’s work and philosophy of childcare outlasted him. His hospital in Manchester also outlasted him but, as John Pickstone comments, it remained a ‘district charity’ for the north of Manchester in comparison to the success of the General Dispensary for Children [5]. It was also forced to compromised greatly on Merei’s initial objectives, at first appointing a committee to fundraise for and manage the establishment, and then becoming a joint institution for women’s and children’s diseases, rather than a dedicated children’s hospital. August Schoepf Merei was too advanced to attract much interest in his ideas in England, lamenting that the, “moral function of the English is very much less shaken and less impaired by the same causes than that of continental nations,” [6]. However, as can be seen by current thinking on infant nutrition and its relationship to growth and health, his researches and work at the Clinical Hospital for the Disease of Children were very important for the children of north Manchester during the middle of the nineteenth century.

References

  1. Abel-Smith, B. The Hospitals 1800-1948. p28. Heineman, London, 1964.
  2. Granshaw, L. ‘Fame and Fortune by means of bricks and mortar’: the medical profession and specialist hospitals in Britain, 1800-1948. Chapter 8 in The Hospital in History. pp181-197. (Ed. L. Granshaw & R. Porter.) Routledge, London, 1989.
  3. Routh, C. H. F. Infant Feeding and its Influence on Life; Or the Causes and Prevention of Infant Mortality. 3rd edition. pp28-29. Churchill, London, 1876.
  4. Clinical Hospital for the Diseases of Children. “Rules for the Management of Children.” The Health Journal, July 1885: 22.
  5. Pickstone, J. V. Medicine and Industrial Society: A History of Hospital Development in Manchester and its Region, 1752-1946. p122. Manchester University Press, 1985.
  6. Merei, A. S. On the Disorders of Infantile Development and Rickets; Preceded by Observations on the Nature, Peculiar Influence and Modifying Agencies of Temperaments. p90. Churchill, London, 1855.

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