Did specialised health care for children exist in England prior to the nineteenth century? If so, what was it like, and how would it compare with modern paediatrics? These are the guiding questions at the heart of The First Day (2015), a documentary short that reconstructs ‘the history of paediatrics before paediatricians’ through the lens of the Northampton General Infirmary.
The film’s presenter, Will Adams, contextualises the film’s topic by pointing out that historians often think of paediatrics as having started in the middle of the nineteenth century with the advent of specialised children’s hospitals and formalised professional organisations for paediatric doctors. However, The First Day goes beyond this broader institutional approach and investigates the paediatric care offered by the Northampton General Infirmary from the first day it opened in March of 1744. In its first year of operation, over 25% of the infirmary’s admitted patients were under the age of 16, and there were a number of formalised procedures for handling children at the hospital. The information in the film is not presented as generalisable knowledge about eighteenth-century paediatrics, but rather as historical fact refuting commonly held understanding.
The First Day uses three primary through lines for its structure. The first is the story of the hospital’s very first admitted patient, Thomasin Grace. Thomasin’s experience at the infirmary sketches a more vivid picture of mid-eighteenth-century paediatrics, and this sketch is assisted by a dramatic re-enactment of the opening of the hospital featuring children and adults dressed in period costume. These short sequences are filmed in black and white in front of and inside the original infirmary building, and they depict Thomasin presenting herself at the front of the line of potential patients. She is greeted by the hospital doorman, who reacts with exaggerated disgust to her visible symptoms of ‘scald head’ (ie., ringworm). We then learn how long she stayed in hospital, that she was released as ‘cured’, and in a nice bit of follow-up, we also learn that she was re-admitted years later with broken bones, that she eventually moved to London and married and subsequently died decades later. There is even some speculation that her time in the infirmary, where literate patients were encouraged to teach others to read and write, may explain Thomasin’s ability to sign her own name on her marriage record.
The film also offers a general history of the Northampton County General Infirmary. The viewer learns about how the Revd Dr Phillip Doddridge gave an inspiring sermon in 1743 on the need for a general infirmary in Northampton. Publishing the sermon to a wider audience helped raise the funds necessary to start the hospital the following year. The facility began with thirty beds under the care of Dr Sir James Stonhouse and quickly found itself tasked to its limits. The hospital moved to much a much larger facility built for the purpose in 1793.
Finally, the film also calls on a number of sources to shed more light on what patient experience was like in 1744, with particular attention to how that experience differs from a modern one. In fact, Dr Stonhouse wrote a treatise on patient care and conduct that was widely read at the time, and it advocated activities like expecting patients to assist with washing and cleaning, as well as the aforementioned reading and writing instruction. The hospital archives make it clear that the pharmacy was well stocked with chemicals like (the then medicinal) mercury and arsenic. The infirmary also had a robust herb garden on the premises. Various non-medical treatments, like enemas and bleeding, were also standard procedure. New patients had to be referred by a subscribing doctor; no patient under 7 would be admitted for inpatient treatment, and the ward refused to house patients with conditions considered infectious. Perhaps the most interesting part of this section is the discussion of patient diets. Dietician Sue Thornton lists four different prescribed diets for admitted patients. She also indicates that a nutritional analysis indicates that all of these diets meet modern criteria for adequate nutrition. The filmmakers even go so far as making some of the dishes and serving them to a group of Northampton children to get their reactions.
Overall, The First Day is an engaging and interesting short documentary subject. The film’s presenter makes the purpose of the documentary clear and then the film sets about fulfilling that purpose. There is a good mix of talking head shots, dramatic re-enactments, archival images, and more to keep the viewer’s interest beyond the strict historical content of the film. The dramatic re-enactments help put the viewer in mind of what the inpatient experience must have been like in the mid-eighteenth century, and the judicious use of various modern experts helps us get a more accurate sense of the differences between that experience and those of current patients. The filmmakers do not skimp on sharing primary sources onscreen when appropriate (there is an extensive list of both primary and secondary sources in the film’s credits), and they even manage to work in archival film of the newborn babies’ nursery from 1934, as well as a newspaper photo of the Queen visiting the infirmary in 1957. All these details help to convince the viewer of the importance of paediatric care to the hospital and to the Northampton community, even as it strays briefly from the primary focus on ‘paediatrics before paediatricians’. In fact, the only false note in the film comes when the filmmakers arrange for a group of children to taste test samples from the original prescribed diets. The children’s mostly glowing reactions seem scripted rather than natural. The main point of the section on nutrition is that the prescribed diets were perfectly adequate nutritionally; there seems no need to over-emphasise the point with scripted reviews. On the other hand, the film does an excellent job of stepping back and reminding the viewer that the real reasons most of the infirmary’s patients were admitted were grinding poverty and malnutrition.
The First Day will be useful for instructors seeking a brief and interesting opening anecdote about eighteenth-century medical history for their students. It will also be of interest to anyone with a broader historical interest in children’s medical care.
The film is written and directed by Dr Andrew N. Williams (BA, MSc, PhD, MRCP, MRCPCH, FRHistS) as part of a Virtual Academic Unit (VAU) dedicated to advancing children’s health services in the United Kingdom.
