ICU and You · A View from England · Number 1
London, 1741 — a hospital that raised children, and the day it stopped
England, specifically. Not Britain, which is a different and larger argument, and not the United Kingdom, which is a constitutional arrangement rather than a place. Scotland, Wales and Ireland have their own stories and will get their own columns when there is somebody to write them properly.
This one is a melange — English perspectives on themselves, and English perspectives on everybody else, which are frequently the same thing wearing a different hat. A great deal of what Australian medicine assumes is inherited English practice that nobody here has re-examined since it arrived, and some of it was odd when it left.
We open with a charity that is still operating after 287 years, and with the part of its story that its own founder would have found hardest to read.
This is not a travel column. The people in our unit come from everywhere, and so do the people who work in it. On any given shift the registrar trained in Dublin or Chennai, the nurse who grew up speaking Tagalog, the family who are more comfortable in Arabic and the patient whose grandmother is Gumbaynggirr are all in the same twelve square metres. That is not an unusual day. It is every day, and it has been for years.
Superdiversity is not a policy word for somebody else's problem. It is a description of the room you are standing in. Which means that knowing how medicine is done elsewhere is not general knowledge or broadening — it is local knowledge about your own colleagues and your own patients.
And there is a second reason, which matters more. Everything we do here was decided by somebody. The way we consent, who answers an emergency call, what we count as a fever, how we speak to a dying person's family: all of it looks inevitable from inside and turns out to be one option among several the moment you look at another country. Nothing shows you your own assumptions faster than watching competent people make different ones.
Some of these columns will change your practice. Most will not. All of them should make the familiar look slightly less obvious, which is the whole point.
On the night of 25 March 1741, in a temporary house in Hatton Garden, the Foundling Hospital opened its doors at eight o'clock and admitted thirty children. Of those thirty, six lived long enough to be apprenticed.
That is not the sentence the story is usually told with, and it is the one to start from, because everything else about the Foundling Hospital — the Hogarths on the wall, Handel conducting in the chapel, the most famous act of charity in eighteenth-century London — has to be held alongside it.
Thomas Coram was a sea captain and shipwright from Lyme Regis who spent a decade in Massachusetts building ships at Taunton and being thoroughly disliked by his Puritan neighbours for being an Anglican. He came home, and then spent, in his own words, “seventeen years and a half's contrivance, labour and fatigue” obtaining a charter for a hospital for abandoned children.
One thing the story usually says that nobody can actually verify. You will read that Coram was moved to act by repeatedly seeing infants left dying by the roadside on his walk into London. It is a nineteenth-century account, and the Foundling Museum itself declines to assert it — their position is that we simply do not know what moved him. Infant exposure and appalling illegitimate-infant mortality in London were real and documented. Coram's particular moment of conversion is tradition, and worth enjoying as tradition.
What is documented is how English the mechanism was. He could not get anywhere for years, so in 1735 he went round the aristocracy and produced a petition signed by twenty-one titled women — the Ladies' Petition — and then, in 1737, a gentlemen's petition with some 375 signatures. George II granted the charter on 17 October 1739. The full name is worth having: the Hospital for the Maintenance and Education of Exposed and Deserted Young Children.
Note that education. We will come back to it.
The Hospital needed money, and the way England raised money was to make the charity fashionable and then let people come and look at it.
William Hogarth was a founding governor. He designed the coat of arms and the children's uniform, painted Coram's portrait — his first full-length grand-manner portrait, of a merchant seaman rather than a peer, which was itself a statement — and then persuaded other artists to donate work. What resulted was the first permanent public display of contemporary British art in Britain, and a direct ancestor of the Royal Academy. Handel gave the chapel its organ, conducted a benefit concert in the unfinished chapel in 1749, and from 1 May 1750 performed Messiah there annually until his death. He raised something over six and a half thousand pounds in his lifetime, and left the Hospital a fair copy of the score and parts in a codicil to his will.
So far, so admirable. Now the part that is harder to read.
From October 1742, more mothers applied than there were places, so admission was decided by lottery. A mother drew a ball from a bag. White meant the child was admitted, subject to passing a medical inspection. Black meant refused, and she took her baby home. A third colour — usually given as red — meant a place on the waiting list, to be used only if a white-ball child failed the examination.
The drawing was conducted in public, and spectators were admitted to watch.
Read that alongside the chapel concerts and the picture gallery and a pattern appears. The art, the music and the children were the same asset. Visitors came to hear Messiah, admire the Hogarths, watch the foundlings file into chapel in their uniforms and, at certain seasons, watch women draw lots for their children's futures. The charity's revenue model depended on the children being looked at.
A place was not a right and it was not granted on need. It was granted on an assessment of the mother's respectability — specifically, of whether she could be salvaged.
Women collected petition forms at the gate from the porter, who made a first judgement on their clothing, speech and manner. Those who got further were questioned by committee: whether the father was married, whether there had been deception or force, whether she had resisted, when she had disclosed the pregnancy. The governing test, in the Hospital's own framing, was whether — relieved of the child — she might be restored in the course of virtue. Later policy put it plainly: admission was for the child of a woman of previous good character, with the exception of this one fall.
Every admitted child was baptised and renamed, which was presented as protecting the mother's anonymity and was also a complete severance from origin. The earliest were named for the Hospital's own patrons — the first child was christened Eunice Coram, after the founder's wife. Later ones took names from history, geography and the natural world. Children left carrying the names of the people who had paid for them.
Mothers could reclaim a child, and a few did. Esther Doherty left her three-month-old son in June 1757, came back a fortnight later, and was charged one pound fifteen shillings for his nursing and transport. Reclamation was rare: the surviving figures do not reconcile well enough to give a proportion, but on any of them it is a fraction of admissions.
The charter said education. The 1746 regulations said the children's work should be simple and laborious, suited to accustom them to the lowliest and most laborious of professions. Both are true, and the second is the operative one.
Reading was taught, because reading meant the Bible and the catechism. Writing was another matter. When critics in Parliament complained that educating foundlings was making them less fit for useful labour, the Hospital's response in 1765 was not to defend education. It was to publish a denial that it provided any — rebutting claims that the children were taught French, or drawing, or even to write.
Among the poor Foundlings I do not know of one of them taught to write, in the hospital, except by accident.
That is Jonas Hanway, a governor, in 1767. Writing was restored for boys ten years later, and the governors justified it on the ground that a shopkeeper's apprentice needs to keep accounts. Girls were not routinely taught to write until 1800.
A charity that publicly denied teaching its children to write, in order to protect its funding, is not a charity that had failed at education. It is one that had understood exactly what its subscribers were buying.
And now the part this column is actually about.
Foundling children were sent to wet nurses in the country as infants and came back to the Hospital at around three, or from the 1770s at five or six. They were fed, clothed, drilled, prayed over, taught to read and set to work. And then, at an age the Hospital set for itself, they were bound out — apprenticed to a master — and the institution's obligation ended.
The age moved about, and the direction of travel tells you what it was for. The first cohorts went at ten. By 1766 children as young as eight were being bound. A resolution in 1806 set a floor of fourteen. By the mid-nineteenth century girls rarely went before sixteen.
Boys went to sea, to husbandry, and to trades — glazier, candlemaker, baker, tailor; about half of the earliest foundlings went to sea, as Coram had. From 1847 the Hospital ran a boys' band, which fed directly into the bands of the Household Troops. Girls went, overwhelmingly, into domestic service.
In 1769 the governors recorded that girls were “more difficult to apprentice.” By 1799 the rules included a condition that no girl be apprenticed to an unmarried man.
Rules of that kind are written for a reason, and the reason is always something that has already happened.
Was anybody watching afterwards? Very nearly not. The Hospital ran a genuinely impressive district inspectorate over its country wet nurses — named local inspectors, about two in five of them women, choosing nurses, paying them, supervising medical care, arranging funerals; Hogarth himself inspected at Chiswick. That system was for babies. There was no equivalent standing inspection of apprenticed adolescents. Oversight was reactive: a complaint, a letter, a child who ran.
Here is the Hospital's own return for 1805. Of fifty-three children bound out that year:
26 were doing well · 4 had been sent to sea for misconduct · 3 were complained of for misbehaviour but had promised amendment · 14 had absconded and gone to sea · 6 had been apprenticed to their friends.
Fewer than half were doing well. More than a quarter had run away.
And it was not, mostly, the children. Sir Thomas Bernard, the Hospital's own reformer, conceded in 1799 that while some failures came down to the children's bad dispositions, most were caused by the “impatience or caprice of their masters.” That is the institution grading its own placements.
The archive holds the individual versions. Thomas Waugh was admitted in 1758, nursed by Elizabeth Taylor at Sandridge in Hertfordshire, and apprenticed in May 1769, aged ten, to a glazier in Lawrence Lane. He was beaten. He absconded repeatedly, and each time he ran, he ran back to his nurse — against the Hospital's wishes. The record does not say how it ended. John Coldfield was apprenticed at ten, two days after returning to the Hospital, to a candlemaker in Rose Lane. He was beaten badly enough to have holes in his legs. He absconded repeatedly, and the Hospital threatened to whip him for it.
A correction to a story you may meet. Elizabeth Brownrigg was hanged at Tyburn in 1767 for the murder of a servant girl she starved, chained and flogged. The case is often told as a Foundling Hospital story and largely is not: of the three girls in that house, only Mary Jones came from the Hospital. Mary Clifford, who died, was a parish apprentice from Whitefriars.
But the Foundling half of it is the part that matters here. Mary Jones escaped and got back to the Hospital. A surgeon examined her and found her wounds of a most alarming nature. The governors instructed their solicitor to write to the Brownriggs threatening prosecution — obtained Mary Jones's discharge from the indenture — and then let the matter drop.
Two years later, in the same house, Mary Clifford died.
Because it is the same problem, and the Foundling Hospital had it first.
An institution took responsibility for a young person, discharged that responsibility well by the standards of its day, and then stopped — at an age it had chosen for reasons of its own, with no transition, no follow-up and no plan for what happened next. Everything before the indenture was thought about carefully. Everything after it was somebody else's business.
This fortnight's journal club is 37,320 adolescent intensive care admissions in the United Kingdom, and the finding is that at fifteen three in four are in a children's unit and at sixteen three in four are in an adult one. Nothing happens to a person on that birthday. The line is drawn where it suits the institutions.
I am not suggesting our transitions are the eighteenth century's. Nobody is being bound to a candlemaker. But the shape is recognisable: a date chosen for the service rather than the young person, an assumption that whatever is on the other side will hold, and a system that is much better at recording what it did than at finding out what happened afterwards. The 1805 return is a follow-up study, and a rather good one. Most units could not produce its equivalent for the adolescents they discharged last year.
The Hospital sold the Bloomsbury site in the 1920s and the great building came down. The children went to Redhill and then in 1935 to a purpose-built school at Berkhamsted; residential care ended in the mid-1950s, when the charity became the first in the country to close its home and place every child in its care with a foster family.
Seven acres of the original fifty-six were saved by public campaign and opened in 1936 as Coram's Fields. The Tuscan colonnades that flank it are the Hospital's own, from the rope walks where boys were taught net-making for the fishing fleet. It is a children's playground, and it has one rule that visitors always remember: no adult may enter without a child.
Round the corner at 40 Brunswick Square, the Foundling Museum holds the Court Room, the paintings, Handel's will, and the tokens — the scraps of fabric, ribbons, buttons and halved coins mothers left so a child could be identified if they ever came back. They are the most affecting objects in London, and worth one honest caveat: from 1758 the Hospital itself cut a square of cloth from the child's own clothing to pin to the record, so some of what survives is filing rather than farewell.
And Coram is still going, 287 years on, doing adoption, legal advocacy and children's rights from the same square. Which is the English thing entire, really: an institution that got a great deal wrong, wrote most of it down, and is still there.
Who finds out what happened to the adolescents you discharged last year?
Not the readmissions, which somebody counts. The rest of it: whether they went back to school, whether the diabetes team ever saw them again, whether the follow-up letter went to a parent who no longer lives with them. The Foundling Hospital managed a return in 1805 saying how many of its fifty-three apprentices were doing well and how many had run away to sea. Could your unit produce the equivalent?
If the answer is no, say so — it is the commonest answer and it is the one worth publishing. And the standing invitation of this whole section holds: if something characteristic of where you come from belongs on this site, tell me and we will put it here, with your name on it or without, entirely as you prefer. Several of these columns exist because somebody wrote in.
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