Read The Nightingale Shore Murder Online
Authors: Rosemary Cook
Successful it certainly was, but success is not always enough. The achievements of the district nursing service in each area were entirely dependent on the funds that could be raised locally by the Lady Superintendents to pay for it. Funding the training schools and the nurses' wages and accommodation was a constant struggle, replicated in districts across the country, year in and year out. Then, as Queen Victoria celebrated the golden jubilee of her reign, everything changed for district nursing.
The âWomen's Jubilee Fund' was set up to collect money from across the country as a celebratory offering to the Queen; and in 1887, the Queen assigned the bulk of it to support the work of trained nurses caring for the sick in their own homes. A committee of three Trustees was appointed, headed by the Duke of Westminster, to decide how best the funds should be used to achieve this. In 1888, Sir Rutherford Alcock, one of the Trustees, wrote to The Times newspaper, enclosing the Report of the Committee. It recommended that the Women's Jubilee Fund of £70,000, producing income of around £2,000 a year, should be applied â
to found an institution for the education and maintenance of nurses for tending the sick poor in their own homes
'. A provisional committee, including William Rathbone, who was by now an MP, was appointed by the Queen to settle details of the projected charity. The Metropolitan and National Nursing Association was established as the core of the London training school, with the Liverpool Association affiliated to it. The following year the âQueen Victoria Jubilee Institute for Nurses' was established by a Royal Charter, and William Rathbone became Vice President to the first Council of Trustees of the Institute. The principal charitable objectives of the new Institute were set out in the Charter:
âThe training, support, maintenance and supply of women to act as nurses and midwives for the sick poor and the undertaking of preventive and supervisory work for securing their health and the health of their children.
The establishment (if thought fit) of a home or homes (including training homes) for such nurses and midwives and of maternity hospitals for the instruction of such nurses and midwives and clinics for their instruction in child welfare.
The co-ordination and supervision of centres for any of the aforesaid purposes and generally the promotion and provision of improved means for nursing the sick poor and securing their health and the health of their children.
To co-operate with other Corporations, bodies and persons in carrying out any of the above objects with power to make grants of money to such Corporations bodies and persons in furtherance of such objects.
To establish branches of the Institute in the United Kingdom or elsewhere with a view to aiding or advancing the main objects of the Institute.'
It was to this Institute, just eight years after it opened its doors, that Florence and Mabel came for district nurse training mid-way through 1897.
Florence Nightingale had had a lot to say about the selection and training of district nurses. Specifically, she considered that the district nurse:
â⦠must be of a yet higher class and of a yet fuller training than a hospital nurse, because she has not the doctor always at hand; because she has no hospital appliances at hand at all; and because she has to take notes of the case for the doctor, who has no one but her to report to him.
In hospitals and infirmaries they may say “Where everything is provided, it is easy to be clean and airy, orderly and godly, but look at us in our one room â and a sick person in it into the bargain â and with no appliances”. Here the trained district nurse steps in. Here, in the family, she meets them on their own ground.'
She was also very keen on the potential for district nurses to be what she called âhealth missioners' â teaching people how to look after their health and to care for themselves when sick, and showing by example the standards of cleanliness and good order which would speed recovery and prevent complications.
âWe hear much of âcontagion and infection' in disease' she wrote in 1890. âMay we not also come to make health contagious and infectious? The germs of disease may be changed into the germs of health.'
So Florence and Mabel's district nurse training at the Jubilee Institute covered not only the understanding of diseases and treatments, but also how to âput the room in nursing order', and the principles and practicalities of public health. The examination in hygiene in 1898 tested candidates with the following questions:
âWhat are the two particular dangers against which we have to guard in the case of indoor air? Mention Nature's chief agencies for keeping outdoor air fresh, and how far we must copy these indoors.'
(The answers were âImpurity and Stagnation' and âWind and Rain', with emphasis on ventilating the sick room in order to change the air three times an hour.)
âWhat are the three essentials to absolute safety in the water carriage system of drainage, and describe each
.' (The soil pipe must be outside and the pipe under the closet must be trapped; there must be good ventilation around the soil pipe; the soil pipe should be as straight as possible, made of lead, with perfectly fitting joints. Overflow pipes â
should be warning pipes ... to tell when water is wasting from too full cisterns, baths, etc; they should not be connected with waste-water pipes, but be carried straight through the outside wall over a drawing room window or anywhere that they will attract notice to waste going on.'
)
âWhat do you understand by cubic space? How large must a room be for safety if three people, one child and one dog are to sleep in it, and it is lighted by one ordinary gas-burner?'
(Cubic space is
âthe amount of space obtained by length, breadth and height together ... a person should have 1,000 cubic feet of air space with proper ventilation in a sleeping chamber ... and this amount of air space is what is demanded for every prisoner in England by law
.' The room should be 25ft by 25ft by 12ft, to contain three people, one child, one dog and one gas burner. A dog, the nurses were required to know, needs 300 cubic feet of air.)
A Queen's Nurse textbook from 1889 illustrates the breadth of practical knowledge and skills, and the spirit of resourcefulness and invention, to be instilled into the students. It was written by Mrs Dacre Craven, formerly Florence Lees, a âNightingale nurse' from St Thomas' Hospital, and the first Superintendent General of the Metropolitan and National Nursing Association. Her book, âA Guide to District Nurses and Home Nursing' was written for trained district nurses, and starts by repeating Florence Nightingale's assertion that â
For district nursing, a better class of woman and a higher education are needed than for a hospital nurse, or even for a hospital Superintendent
.'
Its contents include, under âPersonal qualifications', chapters on âManagement and Tact', and âThe Nurse as Sanitary Agent'. In the section on âArrangement of the Sickroom', there are chapters on âHow to remove Furring and Stains from Utensils and from Pans of WCs'; and âExtemporary Outside Blinds'. The section on âCleanliness' is lengthy and includes âCleansing teeth and gums', âPreventing Bed-sores', âHow to get rid of Vermin that may infest Beds and Bedding', and âHow to extemporise Bedpans, Urinals and Spittoons'. Amongst the more clinical tasks, it covers âHow to perform Last Offices for the Dead in a room occupied by the Living'.
Fortified with this knowledge, Florence Shore and Mabel Rogers passed their Institute exams and were entered onto the Roll of Queen's Nurses in December 1897. Florence was Queen's Nurse number 947; Mabel's Roll number was 915.
It was the practice of the Institute, once a nurse had completed her district training and been entered on the Roll, to deploy her wherever there was a vacancy. Since district nurse posts had to be paid for by funds raised locally, and success in doing so relied on the energy, inventiveness and persistence of the local Lady Superintendent, the availability of posts did not necessarily match the degree of local need. Nor did it matter where a nurse might want to work. If funds could not support a Queen's Nurse (and lodgings, and a horse or donkey and trap for their travel), then there might only be a âvillage nurse' instead. These were local nurses who had received less training, and were not regarded with nearly the same respect as Queen's Nurses.
So it was almost certainly not by choice that, when Florence and Mabel completed their training as Queen's Nurses in 1897, Mabel was sent to work in Sunderland, while Florence went to Reading. This must have been a wrench for the two women, who had been great friends, and worked and studied together almost continuously for the last four years. Perhaps it was this separation, and the prospect of starting a new job alone in a new town, that affected Florence's mood, and led to the words of encouragement contained in another letter from her godmother, dated 8
th
December 1897:
âMy dear Florence Shore â If you will allow me to call you so. I am very fond of the name of Shore. Thanks for your kind letter. Let me send you £2 2s for your little clock. I hope this will be enough to get you a serviceable clock. Do not be discouraged, for you are discouraged. You will find the real joys begin when you are actually at work, or rather, perhaps, you will find then that you do not want joys. I should like to hear from you from Reading if you are so good as to write to me. I think District Work brings one more in heartfelt contact with one's fellow creatures than anything else. And when one knows that doctors who know say that the mere visit of the Nurse diminishes the mortality, one thanks God who puts such God-like powers into our hands, provided they are genial hands. Excuse haste and pencil â Ever yours, F. Nightingale.'
Florence Shore wrote back quickly:
âThank you very much for your very handsome present: indeed it is much more than I expected. I shall value my little clock very much indeed. Thank you too for your kind words of comfort. I do indeed mean to put my whole heart into my work and hope that I may be permitted to be of a little use and comfort to some of my fellow creatures. I am going to Reading next Thursday.'
Florence bought a Mappin carriage clock with her godmother's gift. She also had another, more important wish granted â after a year at Reading, in December 1898, Florence joined Mabel at the Sunderland District Nursing Association. The two women worked there together for most of the next fourteen years. Most, but not all, because it was during this time that Florence and Mabel joined the Army Nursing Reserve. Less than two years into their time at Sunderland, they embarked on their first overseas nursing experience, when they were sent to South Africa during the second Boer War.
Many nurses from the Army Nursing Service were already war veterans by the time the second South African war started in 1899. The Service had been formed in 1881, and its members had served in Egypt and the Sudan. They included many who would become famous names in the First World War in due course, including Maud McCarthy, later Matron in Chief of the British Expeditionary Force in France. By the time the Second Boer War began, in 1899, Queen Victoria's daughter Princess Christian had formed an Army Nursing Reserve, which Florence and Mabel joined. Nurses from both the main service and the reserves were sent to help tend the wounded and nurse the local people held in the British-run refugee or âconcentration' camps in South Africa. They also helped to staff field hospitals close to the front lines of the war. The
Nursing Notes
journal of 1904 had no doubt about the need for the new service, and in particular the service of the women nurses:
âOne very definite good has been a direct outcome of the war in South Africa, and that is the reorganisation of Army Nursing upon a basis which gives every promise of excellent results in the near future. The absolute inadequacy of the Army Nursing Service to meet the requirements of war on a large scale, became evident within the first few weeks of the Boer War. Up to that time there had been some obstinate clinging to the old prejudice against the presence of women within sight or sound of battle; those in authority refused to recognise the fact that times had changed, and that with the next serious war the services of fully trained nurses would surely be demanded. The employment of Civil Surgeons, accustomed to depend largely on the help of the nurse for the best results from their own skill, undoubtedly hastened the severance of the red tape swathings which had hitherto prevented the expansion of the Service. South Africa proved once and for all that where there are wounds and sickness there also must be the trained nurse...
When we realise that the Army Nurses available for active service at the beginning of the war numbered less than 100 all told, that the Army Nursing Reserve consisted of only some 200, and that the total number of nurses employed in South Africa amounted in round figures to something like 800 before the struggle ended, instead of being surprised at the failures which occurred we can only wonder that the âundesirables' were on the whole so few.'
The Second Anglo-Boer War, or South African War, began in October 1899, after years of tension between the British and the Boer South African leaders. First Transvaal and then the Orange Free State declared war on Britain. It lasted until the Surrender of Boer Independence in May 1902. Joseph Chamberlain, who, as Secretary of State for the Colonies was formally responsible for South African affairs, is quoted as saying that the man in the street â
knows perfectly well that we are going to war in defence of principles
[such as peace and good governance] â
principles upon which this Empire has been founded and upon which alone it can exist
.' This was not, however, the whole story. One commentator added:
âChamberlain did not however, mention the need to preserve British authority in an area containing one of the principal life-lines of the Empire in the Cape sea route to India, the Government's desire to stop foreign infiltration into that region, and its wish to see that if the Transvaal continued the strongest province in Southern Africa it should do so under British auspices.'
So war was engaged in South Africa, and after some serious initial setbacks, the British troops began to prevail. It was in 1900 that Brigadier General E Y Brabant suggested setting up protected camps for those townspeople who had surrendered, and for the families of neutrals, non-combatants, and men âon commando' â that is, fighting outside of the organised ranks of the South African forces. The need for such refugee camps was exacerbated by the British âscorched earth' policy, which destroyed homes and farms, leaving the families homeless and unable to grow food to feed themselves. In addition, some families were removed to the camps with the idea that this would persuade their menfolk to stop fighting in order to retrieve and look after them.
By the end of the war, there were more than 40 camps for white people, with more than 116,000 inmates. More than 27,000 people died in these camps. There were at least another 60 camps for black people, with almost as many inmates, of whom 14,000 died. In both camps, the vast majority of deaths were amongst the children.
Lucy Watchorn, a Queen's Nurse who spent a year in South Africa nursing in the Boer camps, wrote an article for the Queen's Nurses' magazine about her experiences. She describes the camps as â
quite unorganised as far as the nursing was concerned'
when the British nurses first arrived, which meant that â
the sisters started with a free hand'
. Very soon, it appears from her account, the nurses had instigated the kind of order and routine that their own training had taught them was essential to good nursing care:
âA year in a country like S. Africa, everything quite fresh â the whole country and life there making new impressions and giving new thoughts daily â charms and fascinates in a way which can never be forgotten and leaves in one's mind a seemingly endless train of thought.
The glorious sun soaks through you, and the pure, fresh air makes you feel you have never really breathed before. The sunsets, the thunderstorms and the nights of South Africa are living things in one's memory. In the Autumn of 1902 English trained nurses were sent out by the British Government to nurse the Boer women and children of the Concentration Camps in Orange River Colony. Thirty sisters left England for this duty and upon arrival were drafted off in twos and threes to the various Concentration Camps in the Colony...
The week we landed the mortality in the camps varied from eight to twenty-seven deaths a day. One must, however, take into consideration that the infant mortality among the Boers is always very high and also that had they themselves been a little less calvanistic and a little more energetic they would most certainly not have lost so many of their dear ones. We divided the camp roughly into camp and hospital. The camp consisted of long rows of single bell tents in an irregular square. Each tent was the property of one family. Everything except cooking was done in this tent, the space not being so limited when one understands that the whole undressing that a Boer considers necessary is accomplished when he has taken off his shoes. The cooking is done in little mud ovens built outside, which were on the same principle as our old country âstick' ovens, where sticks are placed in the oven, lit, allowed to burn, then raked out and the bread put in. The rest of the food, meat, potatoes, onions and vegetables, were all cooked together in one utensil over an open fire...
The Camp Sister trained twelve Boer girls to take temperatures, make poultices, give fomentations, sponge and do slight dressings. Each girl had two âlines' [of tents] which must be visited every morning before nine, every tent entered, and the temperature of any suspicious case taken. The sister had a small bell tent in which solutions, simple remedies and dressings were kept, and here she met her nurses and took their reports, visiting any serious case herself and reporting to the doctor. If the temperature of the patient was found to be 102 he was promptly removed to hospital.
The sister then went to the dressing tent where surgical dressings were done and medicines given out. After this she went with her nurses to show them any fresh treatment, or to dress any case confined to bed in the tents. Then to the soup kitchen, where soup was made daily and served to all the children of the camp, and beef tea and benger prepared for the camp invalids.
The nurses meanwhile helped in the tents, nursing under the sisters' directions, helping with the children and cooking for those too ill to look after their own duties, and being generally useful...
The hospital consisted of marquees which could have the sides removed partly or as a whole. This let us have plenty of fresh air. Throughout the whole war the sun and healing air were the sisters' best allies. When we found it impossible to get the blankets washed we put them out in the sun, which baked them through and through. The mattresses also we had to disinfect in this manner. At the end of the campaign these small camp hospitals were as well equipped and managed as a cottage hospital at home.
The Boer nurses in the hospital â trained by the sister â had each charge of a marquee. It took the sister an hour to go round to each case under her care, this, of course, was without doing anything for the patient. However, we found the Boer girls most trustworthy and most anxious to make good nurses. We had a great variety of diseases, measles in a most virulent form ending in chancre mores being our most trying sickness. We had enteric [fever], dysentery, pneumonia, cancer, phthisis [TB], diphtheria, gangrene, burns â many of the most serious caused by lightning, etc, etc.
Our water supply was limited, but we were always able to get enough for hospital purposes. All excreta was carried right away from the hospital, boiled in huge boilers and afterwards buried. At first one great grief was that we could get no fresh milk; this was afterwards remedied. Goats' dung was the chief remedy used by the Boers; this was applied irrespective of the cause or nature of the wound; proving ineffectual, the patient was considered doomed by fate for an early grave and no further effort was made to avert this destiny.
Sandstorms were a great trial to us. They rose in a few minutes without any warning, tore wildly along in thick clouds of dust, wrenched the tents from their fastenings, and often carried them off bodily. Upon the first sign of these storms, we had to rush out, tighten all the ropes and close the marquees as quickly as possible, but in spite of all precautions, beds and patients were thick with dust, and all one's morning work had to be done over again. Other storms we had of hail. Hailstones the size of pigeon's eggs and larger, fell with a hard rattle on the ground sometimes when falling on the tents ripping through the canvas. The farmers told us the hailstones, on account of their hardness, the rapidity and force with which they descended, were a considerable danger to cattle.
The Boers were very kind to us â âthe good and lovely English sisters who so far have come to nurse our loved ones' â and the Boer girls we found most anxious to improve themselves...
The girls are fond of sewing and make their own clothes. They were delighted to learn new stitches from us. They have their own little daintinesses, always wear huge caps to protect their faces, and big pinafores of Kate Greenaway cut, their hands always covered, if only with mittens made of roughest leather. They marry young and age rapidly, lose their neat figures, and are old women at thirty. The young boys are most attractive, with their strong brown limbs, round smiling faces, blue eyes and lint white locks. They are clever fingered and quick witted. Out of old milk tins, under their nimble fingers, grow candle-sticks and cups and vases, out of wooden boxes, chairs and stools, out of bones, brooches and pen holders, out of coins, rings â and out of clay, quaintly modelled figures, sometimes as elaborate as an ox-wagon with a span of oxen. When taught games of draughts and marbles, their eager brains soon grasped the play, and one diplomatically disappeared after the first shrill shriek of delight proclaimed âsister' was beaten...
We have left all this behind, and the whole often seems as if it had never been. The Boers are back to their farms and are slowly gathering up the threads of life where they had dropped them three years before. One wonders sometimes, knowing that in the great scheme of the Universe we can never trace the end of an action, how far the double influence of our lives on theirs and theirs on ours will extend.'
Another nurse, Miss Cross, working in one of the largest concentration camps in South Africa, also wrote proudly of the impact of the English nurses, and in particular the â
splendid management of the Sister-Matron, who reduced chaos and confusion to order and regularity'
, so that the camp at Potchefstroom in the Transvaal â
headed the list in the General Inspector's reports
'. The scale of the operation of the larger camps is evident from the reports from Potchefstroom, which had between 8,000 and 9,000 inmates, and included general hospitals and a maternity hospital. It was divided into five camps, each with three sections, and each with a camp nurse reporting to the head nurse. It had a swimming bath â
where two or three dozen can comfortably bathe together in constantly running water
', baking ovens, a soup kitchen, and two stores â
for those who wish to buy without going to town
.' It even had schools, with sixteen teachers.
Florence's service in South Africa lasted from April to September 1900; and coincidentally, her brother Offley was in the country at the same time. He had been suffering from tuberculosis, and, following treatment in Switzerland, was recommended the climate of South Africa in preference to a return to Russia or India, where he had previously served. Florence's nursing service was not in the concentration camps, but as a Sister at the Imperial Yeomanry Hospital, Deelfontein; Mabel Rogers was a Sister at the same hospital.
Deelfontein was a village in the Northern Cape, 29 miles south of De Aar, one of the centres of the hostilities, and nearly 4,500 feet above sea level. The planned military field hospital was funded by subscriptions raised from the British public, with fundraising efforts for the âImperial Yeomanry Hospital Fund' led by Lady Georgiana Curzon. She wrote letters to newspapers early in 1900 asking for donations, saying:
âI am very anxious to bring before the notice of the British Public that £50 will equip a bed in the Yeomanry field hospital. May I suggest that subscriptions should be raised in big towns or groups of villages to equip beds, and that these beds should be called after the town or village that equips them?'