It would be easy to believe that effective medical care for indigent children with physical difficulties at the turn of the twentieth century was virtually non-existent in the United Kingdom. At a time before the discovery, widespread adoption, and use of antibiotics, when instances of both infectious disease and illness from malnutrition were quite high, what could doctors be expected to do for young patients even if those patients did have access to hospitals? With the short documentary film Now Walks Like Others, Dr Andrew N. Williams (BA, MSc, PhD, MRCP, MRCPCH, FRHistS) seeks to educate viewers about the availability and effectiveness of therapeutic care for poor children in Northampton in the early decades of the twentieth century.
Now Walks Like Others delves into the history of the Northampton Crippled Children’s Fund (NCCF), which helped to provide ongoing medical treatment to poor children with physical difficulties from its inception in 1893 until it was made permanent in 1925 with the opening of the Manfield Orthopaedic Hospital. At this later point of transition, nearly three thousand children under the age of seventeen in the town of Northampton were receiving regular care through the auspices of the NCCF. Just after the turn of the century, Northampton was a light industrial town with large numbers of indigent residents without the resources to maintain a healthy diet or to pay for medical treatment in cases of illness or injury. Poverty and living conditions contributed to high rates of infectious disease and other maladies. As one example, the infant mortality rate in Northampton in 1908 was ninety-six for every one thousand births, whereas today that number is approximately four out of every one thousand. In the early 1890s, the Northampton Young Ladies Sewing Club began to hold events such as the Crippled Children’s Christmas Tea to benefit needy children. Of course, individual events of this sort were unable to meet the constant demand for care, and the particular long-term nature of treatment and prevention for many of these conditions necessitated a different approach. As a result, organisers set about establishing a fund that could support the ongoing needs of young patients. The resulting NCCF made it possible for children to be seen by physicians in the outpatient department and for doctors to visit children in their homes. The financial records of the fund indicate that support was both strong and wide, with substantial contributions coming from individual subscriptions, social clubs, and, later on, from legacies as well.
Dr Williams and his assembled team set about answering their central questions, what were doctors able to do for poor children with physical difficulties, and were these measures effective, by referring to the records of the NCCF housed in the archives of Northampton General Hospital. Specifically, the documentary focuses on records of treatment from 1908, at roughly the mid-point of the NCCF’s lifespan. To get a detailed impression of patient care and outcomes, Williams selects twenty consecutive cases from the hospital ledger. These cases involve an equal number of boys and girls between the ages of two and thirteen years, and they reveal the relative prevalence of conditions like rickets and tuberculosis. The records also show that the standard treatments for these conditions included good nutrition (whole milk and porridge), sunlight (often via seaside holidays), and cod liver oil, though doctors also sometimes administered doses of turpentine or mercury. These latter therapies, we now know, would not have had any salutary effects and were much more likely to be harmful. The general view of pre-welfare state children with physical and mental impairments is that they were pushed to the side. The film points out that some social historians view funds like the NCCF as part of a system founded on the ‘moral condemnation’ of the poor. But the archival record suggests that at least children with physical impairments could do much better than commonly assumed and that the therapies they received were as a result of local communities pushing hospitals to provide better care to the indigent.
Now Walks Like Others is stylistically very similar to Dr Williams’s last film, The First Day. It is primarily a mixture of professional ‘talking head’ presenters like Ian Spiby (very engaging), several young people (Reagan Munnelly, Mazahir Awan, and Euan Langford) offering leading narration through scripted conversations, as well as historical reenactments depicted in black and white. In addition, the film presents some of its information using modern health experts from Northampton General and other institutions. Notably, Dr Rajan Natarajan (MS FRCS) diagnoses several children who have been professionally made up (by Julia Hyland) to present symptoms doctors would commonly encounter over one hundred years ago in cases of tuberculosis, rickets, and osteomyelitis. Likewise, we hear from a nutritionist that the standard treatments administered in response to these symptoms would have been an effective means of increasing necessary levels of vitamins A and D. The variety of presenters and situations helps to maintain the viewer’s attention and interest. Unlike the last film, Now Walks Like Others makes more use of the young narrators, including an early discussion between them about the propriety of using the term ‘cripple,’ during which they explain both the term’s historical accuracy and the change it has undergone in connotation.
The increase in screen time for the young narrators highlights an impressive facet of the film that might otherwise remain obscure. Dr Williams is not only a medical historian (curator of the NGH Archives) and filmmaker in this instance; he is also a paediatrician. While his films make use of professional and community theatrical and film artists and technicians, they also provide unique opportunities for his patients and their parents to be part of public educational outreach. This participation is most obvious with the young narrators, but this film also incorporates brief sequences of animation designed by Nicola Scudamore, a parent of one of the patients who appears in a number of the re-enactment sequences. Dr Williams’s commitment to joining together with his patients and his community in order to more effectively convey the importance of paediatric history lends this film a more profound value.
As with Dr Williams’s previous documentary short, The First Day, this film will be of particular interest to viewers with a broad curiosity about the history of children’s health and welfare. It also offers a laudable example of using the production of media about the history of therapeutic medical care as an instance and extension of contemporary therapeutic treatment.
