Thursday, 2 July 2015

Nurses and Bravery - two years on




Two years ago I wrote about nurses being regarded as 'brave' for their work during wartime and suggested that they were many other things above 'brave.'  Since then, with the coming of the Centenary of the First World War, a great deal more has been written about nurses, mainly untrained VADs, and the concept that nurses were angels and heroines has become a strong thread running through their stories in books, the popular press and on television.  So two years on I'm taking the liberty of repeating my thoughts of August 2013 on what motivated nurses to engage with the war and where bravery stood on their list of attributes. 

***

     I've always had quite strong views on Great War nurses being described as angels and heroines, and the assertion that they were all  'brave.'So I was interested in a thread on Twitter which went as follows:

Tweeter A.  Army Nurse Corps took hot water bottles to bed with them then made tea with that hot water next morning!
Tweeter B.  Some WW stories would be amazing to collate a brave history that we are loosing [sic] day by day
Tweeter C.  Perhaps bravery comes behind professionalism, stoicism, determination and skill
Tweeter A.  Bravery, the right choice under terrible circumstances, against all odds.

     Obviously A. felt that brave was the best word to describe these military nurses but it made me think again about war, nurses, and bravery. The early 20th century was a time when British nurses were fighting to have their qualifications officially recognised through a process of registration, to ensure that poorly trained and inexperienced women could no longer pass themselves off as fully-trained nurses. Many of them relished the chance that war gave them - to know that they would at last have a platform to show off their skills in a public and wide-ranging manner - the eyes of the nation and the wider world were on them as they were released from the anonymity of their peacetime role.

     I doubt if they were thinking about being brave when they first put on their new uniform and entered the doors of a military hospital. More likely they were thinking about being tested in a strange environment; about what skills they would need; how this new experience would give them an advantage in years to come as they climbed the nursing ladder. They must have wondered who would be working alongside them? Would there be any familiar faces from their training days? Would their pay and conditions be comparable to what they were already getting and would Army discipline defeat them? And when a few months later they added their names to the list of those wishing to go on active service overseas, did they do it because they were brave? I suggest that most of them were desperate to get nearer the action; to feel closer to their brothers, fathers and friends who were already abroad; to grasp the opportunity to visit places and see things they had never contemplated before. Nursing in France had an urgency and importance about it which was lacking in home hospitals - it made them special. And they wanted to be seen as being special.

     They knew how hard the work could be - the rushes, the pushes, the pauses; the long hours and early mornings; the boring patches and the restrictions.  They knew that if they asked to be considered for duty nearer the front, at a casualty clearing station, they were nearer the guns, nearer danger, nearer the most badly wounded men. Did they go because they wanted to be brave?  My view is they went because they wanted to make a difference, and to be seen as making a difference.

     One of the few nurses who died as a result of enemy action is universally described as 'brave.'  Nellie Spindler died in her bed, while sleeping, the result of a shrapnel wound during an enemy bombing raid on her casualty clearing station. Can 'brave' be the best word to describe her? Unlucky, certainly, but hardly brave.

     There were nurses of all sorts, good, indifferent, and some very bad - bad behaviour, poor nursing skills, lack of tact, no sense of discipline. They were not all heroines, and of course, none of them were angels. Angels don't actually exist and trained nurses are very much of the real world. While there were undoubtedly individual acts of bravery by nurses during the war, it was not the lot of the majority. When they were in dangerous and difficult situations, being bombed or shelled or retreating with the enemy at their heels, they relied on their long experience, their skill, their confidence, determination, dedication and fortitude, and on an instant learnt response to emergencies. I would still say that all these came before bravery.


Sunday, 31 May 2015

Male Nurses in the 1920s


Imperial War Museum: Army/Training 25/10


     As part of a transcription of the General Nursing Council Register (England and Wales) for 1928, I've compiled a list of male nurses who were included on a separate part of the Register. In today's NHS male nurses are so numerous and prominent that there are a great many people who don't remember a time when they were virtually absent from general nursing, so I thought it would be interesting to post some details of those few who were employed in the role more than ninety years ago.  In 1928 there were over 40,000 trained female nurses included by the GNC on the general part of the Register, and separate sections for fever nurses, children's nurses, mental nurses and male nurses. Although the names of several thousand men can be found in the section for mental nurses, there were just two hundred considered qualified as 'general' trained male nurses. Inclusion in any of these categories was subject to stringent conditions laid down by the GNC which varied from section to section and male nurses had to satisfy the following conditions to be included on the roll of 'Male Nurses':

(a) A certificate that the applicant has had not less than three years' training before the 1st November, 1919, in a Hospital or Institution approved by the Council for the training of male nurses, or evidence that he has had not less than three years' training before the date aforesaid, as a male nurse in the service of the Admiralty, the Army Council or the Air Council, or that as to part of the period aforesaid, he has had training as a male nurse in such Hospital or Institution, and as to the remainder, training as a male nurse in such service as aforesaid;

or

(b) Evidence that the applicant has had not less than one year's training in a Hospital or Institution approved by the Council for the training of male nurses, or evidence that he has had not less than one year's training as a male nurse in the service of the Admiralty, Army Council or the Air Council, accompanied by evidence in either case that he has subsequently been bona fide engaged in practice as a male nurse in the attendance on the sick for not less than two years before the 1st November, 1919.

In addition, in common with female nurses, those who started their training after 1922 were required to pass a written and practical examination.

     Of the two hundred men named as registered general nurses active in 1928, roughly three-quarters had received their nurse training in military hospitals, having previously served in either the Royal Army Medical Corps, the Royal Navy, the Royal Air Force Medical Service or the Indian Medical Service. The majority of these men received their training prior to the First World War, some as early as the 1880s, and no doubt most were actively engaged with the military medical forces in wartime. In two cases the training was split between the pre-war and post-war periods which maybe suggests that their wartime service was with some other corps or regiment of the army.

     Of the total number, 133 men qualified on the basis of holding a certificate of three years' training, while the others had a variety of training and experience that met with the conditions in paragraph (b) above. The remaining forty-six men provide an interesting insight as to which civil hospitals and institutions in England were actively training men as general nurses at that time and are as follows:

Hackney Hospital and Infirmary:  18
H.M. Prison, Parkhurst:  10
National Hospital, Queen Square, London:  8
Bradford, Municipal General/St. Luke's Hospitals:  7
Erdington Infirmary, Birmingham:  1
New End Hospital, London:  1
Royal Berkshire Hospital, Reading:  1

     It seems apparent from the addresses given that Parkhurst held responsibility for training men for the nursing service in prisons across the country, and understandable that the National Hospital, Queen Square, needed male nurses when its official title at that time was 'The National Hospital for the Relief and Cure of the Paralysed and Epileptic.'  As for the rest, it seems likely that one or two solitary men qualified on the basis of their experience in Birmingham and Reading.  However, there did seem to be a definite aim at both Hackney and Bradford to offer formal general nurse training for men both pre and post-war and who, after 1922, were qualifying by examination and not simply on the basis of previous experience.

     By 1942 the number of general trained male nurses had increased slowly, but still only stood at about 600 nationally (England and Wales).  A brief check shows that the same hospitals were still prominent in training men for the general register, but that's for a future project!

Monday, 4 May 2015

Ministering Angels - A History of Nursing from the Crimea to the Blitz




     A new edition of Stella Bingham's 1979 book 'Ministering Angels' has just been released by Dean Street Press in e-book format.  It covers the history of nursing from its early beginnings through to the 1970s and brings together most of the important advances within the British nursing profession during that time. It's an informative and well-written account ranging over four major wars, and presents the facts clearly and in depth without relying on a mass of over-sentimentalised or dramatic quotes. The nursing services of the First World War are in fashion at present and this book places them in the context of what came before and after, thus giving a fuller and more rounded view. Although it lacks the photographs which appear in the original, this e-book version is a welcome addition and makes it easily available to a new and modern audience.


Cover of original 1979 edition

Ministering Angels, Stella Bingham
Dean Street Press, May 2015
ISBN: 978 1 910570 13 5
For Kindle, Kobo, Nook, iPad and GooglePlay

*****


Sunday, 3 May 2015

Top of the Pops ... oops! Sorry, 'Posts'


I've just been checking down the list of posts I've made since the blog started more than eight years ago to see what was popular and what bombed.  The range of 'views' for individual entries is enormous, from less than twenty to well over five thousand, but here are the top five again. The figures suggest that not surprisingly posts with photos are the best received. The top five, in reverse order are:


5.  Some Hospital Visiting for the New Year

4. 13 Stationary Hospital, Boulogne

3.  Etaples and Camiers

2.  The Trained Nurse and the VAD

And in first place way ahead of anything else, though I'm not sure why, with more than five thousand views:

1. The Casualty Clearing Station

A pity that external links have now been changed or removed, but the post still valid I think.  These five are in no way my personal favourites and only reflect the number of views each one has had - maybe my own will come later.

Thursday, 16 April 2015

Nurses - Training and Registration

   
     At the time of the Great War there was still no national registration of nurses in the United Kingdom nor any official registers of who they were and where they were trained. Family historians trying to trace pre-war nurse ancestors still have to rely on information, letters and photos passed down over the generations. Census returns might yield up some information if caught at just the right moment, but even then only give a snapshot of where a nurse was working on one single day. Although nurses trained between 1860 and 1890 were likely to have completed just one year in hospital, by the turn of the twentieth century a three year training had become the standard required in hospitals throughout the country. As there were no national standards for nurses, those with a lesser training, or even no training at all could continue to nurse as long as they worked within the law and proved themselves safe - trained on the hedgerows of life.

Nurses in the classroom in 1900

     Nurses trained in hospitals received a certificate at the end of their one or three year period which was precious as it provided proof for future employers of their training and experience. Some hospitals insisted that nurses stayed on for a further year at the end of their training before receiving their certificate. Hospitals considered they'd spent a lot of time and effort on the training and the fourth year ensured they would retain a good supply of newly-trained nurses on their staff, at least in the short term.  Women were not compelled to stay for a fourth year but to leave without their certificate could have serious implications for their future careers.

     The fight for the national registration of nurses continued over more than three decades and was not universally supported by hospitals, doctors or nurses themselves. Ideas and suggestions as to the need for highly-educated nurses at that time throw up alarmingly similar parallels to the current debate on whether nursing has been improved by making it an all-degree profession. In 'The Lamp and the Book' Gerald Bowman writes of nurse reformer Ethel Bedford Fenwick:

'She was a crusader of almost fanatical spirit, a close friend of Mrs. Pankhurst who was leading the campaign for the women's vote.  She believed that only educated women could have a chance of winning freedom for womankind who were debarred from almost all professions and who, until 1882, five years beforehand, had no legal right to their own money after marriage.  She wanted her own profession of nursing to be brought into the same category, if not on a level with, the profession of medicine. That was the object of her first proposed state register to be exclusive to those who were fully trained and could pass an examination demanding a high educational standard. Only those women were to bear the honoured title of Nurse.  For the rest, her original proposal was that those who could not or would not train and sit for the examination, no matter how efficient they had been in practice, should drop the work.' **

     By the time the Nurses' Registration Act passed into law on the 23rd December 1919 the conditions for inclusion in the register were far broader than Mrs. Bedford Fenwick had desired. In addition to those nurses who held hospital certificates it was also possible for both women and men to be included if they had been in practice for a minimum of three years prior to November 1919 and had adequate knowledge and experience of nursing the sick.  The Act contained various clauses with regard to training, but it was Rule 9(1)g which set out the conditions by which a nurse without a hospital training or certificate could be registered:

'In the case of a nurse who was at 1st November 1916, engaged in actual practice and who produces the following evidences of knowledge and experience:
(a)  a certificate of good character;
(b)  a certificate signed by the matron of a general hospital or an infirmary or by two medical men setting out that the applicant has been in attendance upon the sick in the capacity of a nurse for a period of not less than three years prior to the 1st November, 1919; and
(c)  a certificate signed by a registered nurse and by two medical men, one of whom shall be on the staff of a general hospital, setting out that the applicant has adequate knowledge and experience of medical and surgical nursing and is competent to attend upon the sick in the capacity of a nurse.

     Registers of the General Nursing Council for England and Wales were published yearly from 1921 and from then all newly qualified nurses could apply to be included.  After 1923 it was a requirement that all women and men undertaking nurse training must pass a written and practical examination at the end of their course and from 1927 the GNC Register shows nurses qualified 'by certificate,' 'by examination' or by one of the other avenues, usually Rule 9(1)g.

A page from the General Nursing Council Register for 1928 showing nurses trained in the three ways mentioned above (click to enlarge)

     Almost one hundred years later medical care has advanced and nursing care has had to keep pace. However, the parallels in nurse training are still present; there are nurses working in hospitals today with various levels of educational achievement and training according to the regulations in place at the time. There are men and women with degrees, diplomas and still some qualified by examination at the end of their course. The latter group are fading fast as they work their way toward retirement. With nursing currently an all degree profession for new entrants in the United Kingdom, one hundred years on Ethel Bedford Fenwick finally seems to have come into her own. Of course, as might be expected, not everybody agrees with her, neither then nor now.

***

** The Lamp and the Book, the story of the RCN, 1916-1966; Gerald Bowman; The Queen Anne Press Ltd., 1967

Tuesday, 17 March 2015

Naval Nurses - The Problems with the Records



Royal Naval Hospital, Granton [IWM Q18930]


     With an increasing number of records being made available online, it's now possible to find service records for almost every First World War soldier, sailor and female worker as long as they've survived both the Blitz and the rather random 'weeding' process of previous decades. In addition to soldiers' service records which can be found on genealogy sites such as Ancestry and Find My Past, The National Archives have digitised and made available a whole range of records relating to personnel who served in the First World War and it's been made easy to search for individuals and to download any available record for a fee.

     However, one exception are the records of members of Queen Alexandra's Royal Naval Nursing Service who served between 1894 and 1929, the majority being records of nurses with wartime service. These records are held on individual pages of large ledgers and I have to admit they were originally created in a rather slapdash manner, often a single record ranging over several pages in different volumes, squeezed into tiny gaps and with different women appearing on a single page. The Royal Navy were certainly keen on economising on paper.  In total, there are records for 244 members of the regular QARNNS, and another 394 for members of the wartime Reserve.  So not an enormous number, but it seems that The National Archives have decided not to make these available as single records and I can only assume that's because it's simply too much time and trouble for too little eventual financial return. Queen Alexandra's Royal Naval Nursing Service is doomed to stay firmly shut in the cupboard.

     So in answer to the question of how you negotiate the records to find out about great-aunt Gertie's daring deeds, I have to say it's only with the greatest difficulty.  When I asked a question on Twitter recently about the possibility individual records being made available, I was told 'Hello, thanks for your query - the nursing service register is available to download here:

Nursing Service Register, Royal Navy

Unfortunately, whoever's in charge of the Twitter feed at TNA isn't familiar with the records as that link only gets you to a small portion of the whole.  If you click on the link you'll notice that even this small part adds up to a download of more than 500Mb and your chances of finding Aunt Gertie are pretty slim as in addition there are another eight files available which you haven't been told about. There is another way if you search hard enough, and this TNA guide leads you on to the full range:

Looking for records of a Royal Navy Nurse?

     Before you start, note the warning on the page 'Please be aware that these are very large files and only suitable for download on a fast and unlimited broadband connection.'  That's OK though because we've all got one of those these days, haven't we?  Having attempted the downloads, failed, contacted TNA for help on a couple of occasions and grown a few more grey hairs, you're now the proud possessor of eleven very large .pdf documents totalling just under 2 gigabytes in size, but whereabouts is Auntie Gertie?

     There are rather rough indexes to the volumes, so you can browse through the pages of each one to see if you can find her, but the problems are not nearly over.  Some women have entries on as many as five different pages, covering three different .pdf downloads and I would bet my week's supply of doughnuts that there are no more than a handful of nurses who might be considered easy to find. I would challenge members of TNA's staff who are familiar with records in general to find Gertie among that lot without going off sick with stress; the general public are in a far worse position.

Note that Phoebe Gill's record started on a previous page, and is then continued in another volume of the register - a total of three different pages over two volumes [ADM104/163/1/folio 48] *


     Downloading 2Gb of data to find a couple of pages on Aunt Gertie is simply not practical, and anyway it just doesn't work in practice.  So wouldn't it be helpful if TNA could at least produce an index giving the volume and page references for each woman thus reducing the downloads needed to the minimum?  It would be even better if they could split the .pdfs into single pages and make each woman's pages available online as a single download. Sitting here in my little back room I've managed to create an index of individuals without much difficulty and I can whip off the pages I need using the simplest online tools - it's really not that hard!

     I asked again at yesterday's 'webinar' if there were any plans to index or digitise these records and was told that there was nothing in the foreseeable future. As far as TNA are concerned, Queen Alexandra's Royal Naval Nursing Service is destined to stay firmly locked in that cupboard.

*****
* Image fee paid to TNA for online use of documents

Friday, 13 February 2015

Evacuation from Dunkirk

Geoffrey Moulson, who appears in the previous post, served for nearly forty years as a medical officer in the Royal Army Medical Corps. During the First World War he initially worked in Mesopotamia and later in India, a place he knew well from his childhood. During the inter-war years he rose rapidly through the ranks and on the outbreak of war in 1939 he was posted to France as Commanding Officer of both No.4 Casualty Clearing Station and No.203 Field Ambulance - the 'sharp end.' Following the German invasion of the Low Countries in May 1940 his medical unit was one of many that had to take action to avoid the enemy advance, and eventually make their way back to the United Kingdom through the Channel ports.  After the evacuation was complete and all the nursing staff safely home, the Matron-in-Chief, Katharine Jones, asked some nursing sisters to write accounts of their experiences of the evacuation and two were submitted by staff of No.4 CCS of which Geoffrey Moulson was Commanding Officer. The following was written by Sister Annie Trethewey* Territorial Army Nursing Service, to Geraldine Ball** Principal Matron at the War Office.

*****




No.4 CASUALTY CLEARING STATION

Sisters’ Quarters,
Military Hospital,
Holywood,
Co. Down.
20th January, 1941.

Dear Miss Ball,
Your letter of the 11th instant just to hand and I am pleased to accede to Miss Jones’ request and give you an account of my very interesting, if not always useful experiences with the B.E.F. after the invasion of the Low Countries. How well I remember the news at midnight on the 9th May of the invasion. I was on night duty at the time and our Colonel brought me the news, after listening to the announcement, with the remark as he retired for the night “I shall probably see you again before morning”.

May 10th – 5 a.m.
Our first “alert” since the previous October. Our C.C.S. was in a Chateau with a basement for the evacuation of walking patients, but our stretcher patients had to remain in their beds which we pulled into the middle of the wards away from windows, and during the remainder of our stay there I marvelled at the calm with which the men, mostly Air Force, behaved during “alerts”.

May 11th
The “Dawn Patrol” becoming a daily habit and our C.C.S. becoming very busy with air casualties.

May 12th
We evacuated 115 patients at 1.30 a.m.

May 13th
Much confusion in the town of Epernay with constant alerts and continual streams of refugees, such pathetic sights, while convoys of French Troops were going through the town and up the line.

May 14th
The Hospital getting busier every hour – such fine men to nurse – I have remarked in my diary “Makes one proud to be British”.

May 15th
Rumours of our evacuating the Hospital, so I get my packing done before going to bed. By this time I had given up hoping for much sleep but I usually managed to stay in my bed and rest unless there was too much activity overhead. When I arrived on duty at 8 p.m. all patients were on stretchers ready for the evacuation and we were supposed to be 'closed' to admissions, notwithstanding we admitted patients all night and the Theatre was busy the whole time. There was a very anxious night ahead of us; the Red X train, which was due at 1 a.m. got delayed owing to enemy action further along the line; at 5 a.m. the Colonel decided to let the patients travel all the way to the Base by ambulance so arrangements were made accordingly and by 8 a.m. the Convoy was ready for a start when the news that a train would soon be through to take them arrived, cancelling the road transport (many of the patients were too ill for a long journey by road).

IWM H1642


May 16th
Eventually the train arrived at midday and the Sisters and half of the R.A.M.C. Personnel also went on the train for a journey of about 20 miles to the town of Chateau Thierry where we said 'Goodbye' to our patients while they went on to the Base and safety, we hoped. Here we found a curious reception, the French were rather afraid to let us stay in the town as up to then they had not had any raids, so our Officer who was in charge decided with the aid of the Interpreter to find us billets in the village of Chiery, two miles away, and how we welcomed the peace after our recent experiences; but alas, it was not for long and on...

May 17th
… the Enemy reached that spot.

May 18th
After 36 hours of fairly heavy raiding and wondering where the other half of our Unit was, it was a great relief when the Colonel arrived to take us to our new home and so we hoped Hospital. We had a long and chequered journey through convoys of refugees going in the same direction as ourselves, with convoys of French troops coming in the opposite direction, but fortunately it was peaceful from the air. We reached our destination – Ville Neuve – to find we were going to live in a cottage attached to the Chateau which was to be our Hospital and delightfully situated in the woods. Alas our Hospital did not materialize and although we all appreciated the quiet and rest at first, we soon began to wonder what was happening to our wounded and feeling rather useless. For some days we stayed there and I am afraid found it very difficult to believe 'They also serve who only stand and wait'. We were finding it most trying not to be up and doing, knowing that so many of our own men must be wanting attention.

June 2nd
Various signs that we were on the move again.

June 3rd
Up at 5 a.m., breakfast and packing done, ready for a start at 7 a.m. It was a lovely day and the Motor Ambulance Column had provided most comfortable transport for our 150 miles drive; our destination was once more a chateau with a view to making it into a hospital, in a small village near Bauge, but not only was the chateau inadequate, the grounds were unsuitable for tented extension.

June 5th
We move again, this time by ambulance and reach our new home, which is to be tented in some very nice grounds near Chateau du Loir. For a week we lived in tents at this delightful spot and our wards were being got ready for occupation, but, alas, on …

June 13th
… we packed once more and left on …

June 14th
… travelling in convoy by ambulance to Nantes, and spending the night in our ambulance, too near a munition dump for our popularity with the French Authorities.

June 15th
We were up early, waiting for orders which we received from an unexpected quarter; the French Authorities having given the order for us to move out of the field. As our Colonel is away on business, there is no alternative for the Second-in-Command but to have the convoy draw out on to the roadside and await the return of the Commanding Officer. At 1 p.m. the order came through for the Sisters from Nantes to go to La Baule to join the Staff there. It was with great regret we left our Unit and travelled the remainder of the journey in one ambulance. We were received by the Matron of No.4 General Hospital and given accommodation for the night.


HMHS 'Somersetshire' from IWM FL19182


June 16th
A long day of waiting and at 4 p.m. left La Baule on the hospital train for embarkation at St. Nazaire; a raid was in progress during the journey and for some hours while the Hospital Ship “Somersetshire” was being loaded at the port, but we got safely away at 4.30 a.m. on …

June 17th
During the homeward journey we once more had a visit from the enemy and two bombs were dropped close enough to shake the ship from end to end, but we reached Southampton safely on the evening of June 18th. Although during the whole of our journeying we had quite a fair amount of aerial activity to contend with, we travelled very comfortably and I realize only too acutely that after the invasion of the Low Countries, when we had hoped to be useful to our Unit, it was quite the reverse and we were an additional responsibility.

*****

* Annie Mary Trethewey was born in Cornwall at the turn of the century. She trained as a nurse at the Royal Cornwall Infirmary, Truro, completing her training in 1925. 

** Geraldine Catherine Ball trained at the West London Hospital, Hammersmith between 1909 and 1912 and served with QAIMNS Reserve during FWW, later joining the permanent service.

Account taken from documents at The National Archives, WO222/2143