A History of the Evelina
The Evelina Hospital was founded 1869 by the wealthy Austrian Baron, Ferdinand de Rothschild, in memory of his English wife, Evelina who had died in childbirth three years earlier. Initially he had planned a maternity hospital in Southwark, but under the influence of his friend Dr Arthur Farre, an eminent obstetrician and physician extraordinary to the Queen, he was persuaded that the greater need was for a children’s hospital to provide for poor children south of the river Thames. Farre became Chairman of the Hospital’s management committee and directed the planning, organisation and running of the Hospital for six years.
Unlike other children’s hospitals which depended from the very beginning on public generosity, the Evelina was funded entirely from Rothschild’s personal wealth. Instead of having to make the best of inappropriate buildings, as most new children’s hospitals were forced to do, the Evelina opened as a purpose-built hospital, thanks to the Baron’s generosity. This photograph was taken in 1969, but, apart from the roof-storey (added in 1903) it looks much the same as when it opened a hundred years earlier. It was a model institution incorporating all the current thinking on hospital design and medical care. The wards were light, airy and spacious; there was a separate Out-Patients’ wing, a dispensary, isolation wards and a ‘cheerful’ playroom. Built to house 100 beds, the hospital opened with 30 cots. Expansion was envisaged as subscriptions and donations allowed.
Rothschild’s original intention had been to pump in enough of his own money to get the hospital up and running, gradually attracting public support which would transform it into a true voluntary hospital. In 1871 an appeal was made, but the local community let the Baron down and monies did not flow as anticipated. In a way Rothschild had been too successful, and rather than being considered a public charity, the Hospital appeared more akin to a personal fiefdom. Consequently, local dignitaries stayed away, and it continued to be run as a private charity by the Baron and his friends. In 1892 a more open style of management was finally introduced. A constitution gave subscribers the opportunity to be elected to the management committee, bringing the Evelina's management more into line with other public voluntary hospitals, and public money began to flow inwards. The Baron also continued his generous support, giving the Hospital the best of both worlds: a benign benefactor coupled with public management. Rothschild's final contribution was a bequest of £100,000, on his death in 1898. By 1900, the Hospital's income from legacies and public donations totalled £6,150. As outgoings were only £6,003, the Evelina seems to have been in a class of its own financially; other children's hospitals were running at a loss, according to Henry Burdett's review of hospitals in 1901. [Henry Burdett (1847-1920) was a business man and philanthropist who took a great interest in the organisation of voluntary hospitals. His annual review, Hospitals and Charities, was published every year from 1890 to beyond his death.]
But the Evelina did not grow as its founder had anticipated, and by 1900 only 66 beds were in use. This was not due to lack of demand, but a lack of sustainable funds: the large numbers of children passing through the out-patients' department is testament to this. By the turn of the century nearly 20,000 patients a year made use of the facilities, many making repeat visits.
It is perhaps not surprising that demand was so high: this was an extremely poor area of London. 'The Grotto District', in the Hospital's neighbourhood, supplied several in-patients, and no doubt countless out-patients. One of the compilers of Charles Booth's Survey of London wrote of the area in 1899 (after making a round of the district with the local policeman, Constable Barton): 'This bit is known as The Grottos: many children [in the streets], all well fed but dirty & with sores on faces: clothes ragged, too large & too small, windows broken & patched : there may be a few thieves & prostitutes but Barton does not know them as such : they make their appearance in the police court for drunks & assaults.' Ten years later, the district was marked for slum clearance by London County Council's Housing of the Working Classes Committee: 'The houses in Tabard Street and Grotto Place … were unfit for human habitation; … the narrowness, closeness, and bad arrangement of the streets and houses; the want of light, air, and ventilation were dangerous to health.' The report was back up by comparative health statistics which showed overall death-rates in Tabard Street were more than twice that in London as a whole (36.8 cf 14.9 deaths per thousand inhabitants), while death-rates from 'principle endemic diseases' were 6.07 and 1.71 respectively. (British Medical Journal 12 November 1910, p1549)
There were 28 children from Grotto Place and Lower Grotto Place in the Evelina registers. They ranged in ages from under one to twelve years old, and presented with a variety of conditions. The most common complaints were respiratory conditions such as bronchitis or pneumonia, and the results of accidents, included cuts and bruises and one case of poisoning. They reflect the conditions the children lived in, dank alleyways, close-packed houses and no where to play but the street. Most of the Grotto children survived their stay in hospital but five were not so lucky - their conditions were much more serious (diphtheria and tuberculosis for example) and they died in hospital. The stories of some of the Grotto children can be found in the patients section of Historical Background.
The Evelina was non-denominational, accepting children whatever their religion: and unusually, there was one ward (with its own kitchen) set aside for Jewish children. Another unusual feature of the hospital was the provision of an isolation ward for whooping cough patients - claimed to be the only one of its kind in London, when it opened in 1877.
Like other children's hospitals, the Evelina had rules which defined which categories of patients could be admitted and which could not. Patients suffering from infectious fevers (except whooping cough cases, which were admitted into the special ward) and children under two were among those supposedly prohibited from entry. In practice, however, the rules were not easy to enforce. Every year, cases of infectious fevers were admitted, albeit in small numbers; but the rule against under-twos was repeatedly flaunted by the doctors. In 1889, in a last ditch attempt to stop the practice the Management Committee issued a dictat that infants 'should be refused save under very exceptional circumstances'. Two years later, after numbers continued to grow, unabated by the management's pronouncements, it gave up the fight and rescinded the rule. By 1900 babies and toddlers accounted for 50% of all admissions.
The rule against young children may at first sight seem harsh, but there were practical reasons why such patients were undesirable. Young children required help with everything (washing, eating, dressing etc) and constant attention as they were unable to articulate their needs. This put great pressure on the nursing staff and detracted from the care they were able to give to other children. But these young children were also among the most vulnerable to the unhealthy conditions in which they lived and it was hard to turn them away when they presented at the Hospital's gates, grievously ill.
Despite the Baron's generosity, funds were always tight and much effort was put in to raising subscriptions and donations from London's wealthy inhabitants. Subscribers who promised 30 guineas a year or more could have a cot named after them. They were allowed to recommend patients for admission (or out-patient treatment), the number being determined by the value of their donation. In theory, patients were supposed to be in possession of a subscriber's letter in order to be seen, but in practice, as at other hospitals, medical need usually won out.
Unlike Great Ormond Street, the Evelina did not have its own convalescent home until well into the twentieth century. Instead it relied on a network of seaside and country homes, places paid for through a fund set up specifically for that purpose. Admission to such homes was often controlled by subscribers' letters, and the Matron at the Evelina was kept busy trying to obtain these important pieces of paper to accompany her charges to the seaside. The importance of convalescence cannot be overstressed. Having a safe and healthy retreat to which partially recovered children could be sent achieved two objectives. Firstly, on a practical note, partially recovered patients could be moved out of the Hospital to other institutions, freeing up beds needed for more acutely ill children. But, just as importantly, a period of convalescence delayed the inevitable return to the terrible environment often implicated in their diseases in the first place, giving the children a better chance to gain strength and regain their health. A local newspaper described the dilemma eloquently: 'It is piteous … to see the little ones … return to the dark, unfurnished, overcrowded rooms … One of the nurses told us the pity she felt [when] she met a child who had not long left her care clinging to a drunken mother's skirts, and following her zigzag plunges from one side of the street to the other'.
The Hospital attracted some of London's best respected physicians and surgeons to offer their services, and short biographies of some of these characters can be found in the Doctors section. Of the nurses, much less is known (as is often the case). During the latter part of the 19th century, the nursing department was led by Alice Cross who had been appointed in 1879. Almost nothing is known about this women, save she trained at St Bartholomew's. More information on the Nursing Department at the Evelina can be found in the Nurses section.
The Hospital remained much as it had been since its opening for thirty-odd years, until an extensive period of refurbishment and expansion which began in 1896 and continued into the new century. This period saw the installation of electric lighting throughout (in 1896), the addition of a new isolation ward, and improved accommodation for nurses and servants was added by replacing the old attics with a new floor (1903). By 1907, a new wing had been added which provided space for an expanded out-patient department, including operating theatre, X-ray facility and drug store; and money was raised to create a roof garden.
Like many hospitals, the war years were difficult as financial support dwindled, and after the Cave Commission reported in 1921 (recommending temporary state support for the voluntary sector, but also emphasising the importance of self-help rather than complete reliance on charity) patients at the Evelina were required to make a contribution to the cost of their treatment. Charitable fund raising continued apace however throughout the interwar years. The single most important event in this period was the opening, in 1931, of the Hospital's own convalescent home, the Eleanor Wemyss Home at Wargrave on Thames.
The outbreak of war in 1939 saw the Evelina turned into a Casualty Post, the children being either sent home or transferred to other hospitals, although the out-patient department continued to function. Throughout the war years the hospital was reopened to child patients and closed again as conditions changed. It took direct hits several times, in 1940, 1941 and 1944, but fortunately no lives were lost.
However, its days as an independent children's hospital were now numbered. With the formation of the National Health Service in 1946 the process of merging the Evelina into its nearby neighbour Guy's began in earnest. In 1948, the training of nurses and doctors for both institutions were integrated although the Evelina maintained a large degree of administrative autonomy. It took nearly 30 years for full integration to occur, when the building on Southwark Bridge Road was finally closed and the Evelina moved onto the Guy's site - in time to become just the children's ward for that hospital, its name and independence lost in the mists of time.
However, 1973 did not mark the end of the history of the Evelina. The Hospital was reborn in 2005, when a brand new building was opened across the road from St Thomas's Hospital, under the auspices of the merged Guy's and St Thomas's NHS Foundation Trust. The new building, which houses 140 beds, brings together most of the children's facilities from the two hospitals. It was designed with children in mind, includes many play areas, and is dominated by a huge atrium which gives a light and airy feel to the building. In that, the Hospital has come full circle, the new one mirroring in the 21st century the aims and ideals of its 19th century founders.
Main Sources: HE Priestley, The Evelina: the story of a London Children's Hospital 1869-1969; Elizabeth Lomax, Small and Special: the development of hospitals for sick children in Victorian England