Maud McCarthy’s letter also signals for the first time something of the impact that nearly four years of war service had had on the now 53 year old nurse:
‘Miss Shore served at a CCS [casualty clearing station] from 20.3.18 to 18.4.18, but could not cope with the rush and strain of work in the front area, and was therefore transferred to the Base.’
Florence was moved to the 24 General Hospital at Etaples, fifteen miles south of Boulogne, in April 1918. After Florence’s death, her old Matron at the hospital wrote to Mabel Rogers:
‘She was one of my staff at 24 General Hospital, and one of the most unselfish people I have ever met, and absolutely devoted to her work. It seems terrible that one whose life was wholly given up to doing good to others should meet with such treatment.’
Florence might have struggled with the rush and strain of the casualty clearing station, but her devotion to her patients and her leadership of other nurses was undiminished. In Etaples, it was reported by the West London Observer, she was
‘one of the heroic band of nurses there who, when bombed by German aeroplanes one night in May, 1918, refused to go to the dug-outs prepared for them, but insisted on remaining to tend the patients, many of whom had been hit. As a result of their heroism, two nurses were killed and five wounded.’
Florence’s aunt, the Baroness Farina, was the source of the story. She added that, when ordered to take shelter by the commandant, Florence asked to be allowed to remain in the ward with her patients, who were unable to move. Florence’s words afterwards, according to her aunt, were: ‘I could not allow the poor fellows to be left alone’ or ‘I could not desert the boys in a moment of danger’ – her aunt gave different accounts to different journalists. Her brother Offley also knew something of the incident: he wrote to his father-in-law in June 1918 that:
‘Florence says deuced little, but I conclude came in for some of the recent Hun bombing of the hospitals tho’ she seems terrified of mentioning the occurrence! I have told her we read all about it in our newspapers.’
Sharing Florence’s experiences at 24 General Etaples around this time was the writer Vera Brittain, who arrived in August 1917 as a VAD. The hospital nursed both allied soldiers and German casualties, in separate marquees, and Vera Brittain worked first on a German acute surgical ward. The operations were mostly amputations. She reported that ‘Our own men are very good to them; they come in and see them and give them cigarettes and fetch them drinks…’ Later she moved to a medical ward, nursing men who had been gassed, which she described as ‘more wearing than anything on earth… in the end there seems nothing definite to show for it – except that one or two people are still alive who might otherwise have been dead …’
As a sister in charge of the frantically busy wards of front-line military hospitals, Florence was probably very grateful for the work of VADs like Vera Brittain. But back in England, her old school acquaintance Ethel Bedford Fenwick was vehemently opposed to them. The War had broken out 25 years into Bedford Fenwick’s personal campaign to ensure that all ‘fully trained’ nurses were listed on a national register. The aim was to end the confusion, variation in standards and risk to patients caused by anyone, with any or no training, using the title ‘nurse’ to gain employment. Nurse registration became a huge cause celebre within the profession, with rival groups of eminent nurses arguing for and against the concept – and Florence Nightingale herself in opposition. Different associations were founded to promote or oppose the measure, and even those who agreed with the idea managed to draft two different Parliamentary Bills and tout them to different MPs in the hope of getting a debate in Parliament.
The notion that women with minimal training – such as VADs – could act as nurses in any capacity was anathema to Bedford Fenwick, and she disseminated her views in part through the pages of the British Journal of Nursing, which she edited. In an editorial in January 1915, the journal stated:
‘Members of V.A.D.’s are to be used as orderlies [as opposed to nurses] in both these hospitals, let us hope in such a minority as will not interfere with the discipline of the nursing department, and that their duties will be strictly defined in print, so that they will understand before engagement what a woman orderly’s duties are. Frankly, unless they are the duties of first year probationers we are at a loss to know what they are. Anyway, unless they help with the nursing in strictly defined positions as probationers, they have no right to wear nurses’ uniform, and if they are there for that special purpose there should be no running in and out, but they should enter into a contract to serve until the end of the War, or until these hospitals are no longer required. Thoroughly trained nurses only should be employed on foreign service. It is simply a waste of money to transport untrained women in any capacity whatever. Such service in military hospitals should be the reward of the patriotism of the professional nurse who in time of peace has qualified herself for her responsible duties.’
Towards the end of the War, the enormous contribution of VADs, in both field hospitals and the temporary hospitals set up in country houses in England, was widely recognised. A BJN editorial reported in July 1918 on a procession of women war workers to pay homage to the King and Queen on their silver wedding anniversary, which was received by the Royal Family in the quadrangle of Buckingham Palace. It must have pained Bedford Fenwick to record that:
‘V.A.D. workers took precedence of all other branches of women’s work, including the Trained Nurses of the Metropolitan Asylums Board… Referring to nurses and V.A.D. workers His Majesty said, “They have often faced cheerfully and courageously great risks, both at home and overseas, in carrying on their work, and the Women’s Army has its own Roll of Honour of those who have lost their lives in the service of their country. Of all these we think to-day with reverent pride.”’
The admiration expressed by the King (and the Red Cross, the Order of St John and the country at large) for the VADs did not change Bedford Fenwick’s view of them, or her conviction that they constituted a threat to ‘proper’ nurses.
‘Owing largely to the glorification of the semi-trained war worker by the Nurses’ Department in the Red Cross Office,’ she wrote in 1918, ‘competition with the certificated nurse has already become a serious menace to our professional ideals.’
A Bill to introduce registration for trained nurses was finally passed in 1919, with Bedford Fenwick sitting in the public gallery of the House of Commons to see it. When the Roll of Nurses was opened, she was entered onto it as Registered Nurse No 1.
With her Parliamentary connections, it is possible that Bedford Fenwick had some influence on a written Parliamentary Question put by Brigadier-General Croft, MP for Bournemouth, the following year.
‘[He] asked the Secretary of State for War whether his attention has been called to the fact that a great many trained nurses who served as nursing sisters on active service continuously from August, 1914, onwards have now been released from service without any official expression of gratitude for their services; whether he is aware that several cases of nurses who were recommended in the strongest terms by their commanding officers for the Royal Red Cross, First Class, in recognition of exceptional services in the actual war zone, have been passed over, whilst nurses in many cases untrained, and who never left Home duty, have received this honour; and whether, in view of these facts, he will cause inquiry to be made with a view to securing justice to those who have been strongly recommended for this honour.
Mr. CHURCHILL
All trained nurses who served under the War Office as nursing sisters on active service have, on being demobilised, received an official letter conveying thanks for their services. Recommendations for the award of the Royal Red Cross, whether at home or abroad, are in all cases made by the General Officer Commanding under whom the person recommended has served, and so far as I am aware there have been no cases in which nurses serving abroad, who have been so recommended, have not been given the decoration.
Florence finished he
r army nursing service working on No 5 Ambulance Train in 1919, taking wounded Germans back to Cologne. Here again she shared the experience with Sister Kathleen Luard, who wrote about their work in her diary:
‘Imagine a hospital as big as King’s College Hospital all packed into a train, and having to be self-provisioned, watered, sanitated, lit, cleaned, doctored and nursed and staffed and officered, all within its own limits. No outside person can realise the difficulties, except those who try to work it…
Three trains full of wounded, numbering altogether 1,175 cases, have been dressed at the station today … the train I was put to had 510 cases …the platform was soon packed with stretchers with all the bad cases waiting patiently to be taken to the Hospital… The staple dressing is tincture of iodine; you don’t attempt anything but swabbing with Lysol, and then gauze dipped in iodine. They were nearly all shrapnel shell wounds – more ghastly than anything I have ever seen or smelt; the Mauser wounds of the Boer War were pin-pricks compared with them…
They were bleeding faster than we could cope with it; and the agony of getting them off the stretchers on to the top bunks is a thing to forget. We were full up by about 2am, and then were delayed by a collision up the line, which was blocked by dead horses as a result… the head cases were delirious, and trying to get out of the window, and we were giving strychnine and morphia all round. Two were put off dying at St Omer, but we kept the rest alive to Boulogne.’
Florence was awarded the Royal Red Cross medal, created by Queen Victoria in 1883, for her work during the War. The decoration, in the shape of a cross enamelled in red and gold, with a medallion in the centre bearing the head of the reigning monarch, was intended for ‘any ladies, whether subjects or foreign persons, who may be recommended by Our Secretary of State for War for special exertions in providing for the nursing of sick and wounded soldiers and sailors of Our Army and Navy’.
*
Florence’s godmother, Florence Nightingale, had been the first recipient, for her work at Scutari hospital in the Crimea. Receiving the Royal Red Cross made Florence Shore automatically eligible for the French Croix de Guerre as well. But Florence never received her Red Cross medal. She was due to be presented with it by the King at Buckingham Palace in March 1920; but by then she was dead. The decoration was sent instead to her brother Offley in California. She did receive other medals – the QA Star, British War Medal, Victory medal and her French war medal – all of which are now in the Florence Nightingale Museum.
*
Florence was demobilised at the beginning of November 1919. On 27th October, she moved to the nurses’ hostel at Boulogne. She signed a form on 1st November declaring that her military service had not rendered her disabled, and received her Dispersal Certificate indicating that she would be disembarking at Folkestone on 3rd November. She would be proceeding to Hammersmith in London, and her formal date of dispersal was 11th November 1919. After five years of extreme danger, considerable privations and long exposure to all the horrors of war, Florence returned to Carnforth Lodge to be reunited with Mabel and the nurses of the Hammersmith and Fulham District Nursing Association. The Lodge would prove to be her last home: she would live there for just eight weeks.
The Army nurses had returned to a very different England. Women had replaced men in factories, on railways and in some police forces at home, while the men were away; and they had nursed, and some had died, on battlefields, trains and ships in the war zone. Girls who had grown up with the still strict protocols of Edwardian England found freedom in the wards, tents and hospitals of Europe and beyond, which could not be easily laid down. The end of the war was the beginning of new era in the development of women’s role in society: Florence and her colleagues stood at the threshold of a new phase of their personal and professional lives. But she would not go forward with them.
She had returned to find the country in the grip of a fearsome winter – one night the temperature plunged to minus 23 degrees – and ravaged not only by war, but by the world-wide pandemic of influenza. The ‘Spanish flu’ had killed tens of thousands more people than the whole four years of war; and its British death toll included some of Florence’s fellow Queen’s Nurses, who had died whilst nursing its victims.
Chapter 19
‘Part of their day’s work’
‘I have nursed most infectious and contagious illnesses mentioned in textbooks,’ wrote Ellen Hancox, Superintendent of the Sheffield District Nursing Association in 1919, ‘but I have never seen anything to equal this most horrible complaint, the complications of which baffled the skill and ingenuity of the most experienced. In some instances the mental condition of the patient was not only a thing to be dreaded but was beyond all description, the language and behaviour being what one would expect to find only in the most depraved.
In some cases the eyes swelled and burst, and the patient died after acute suffering. In others there would be an acute form of stomatitis [inflammation in the mouth], the tongue, uvulae and soft parts sloughing away, in spite of most constant and careful treatment.’
What Miss Hancox was describing was the deadly influenza epidemic that swept around the world between 1918 and 1920. It became known at the time as the ‘Spanish flu’: not because it originated in Spain, but because the Spanish press, unconstrained by wartime censorship as other countries were, reported it more thoroughly. As it coincided with the final year of the First World War, many people were suspicious of the sudden arrival of such a virulent killer disease. In the United States, where the flu broke out first in huge military training camps, there were rumours that plague germs had been inserted into aspirin tablets made by a German pharmaceutical firm; that it had been brought into Boston harbour on a German ship; or that the Germans had released vials of the germs in American theatres.
In fact, the Germans were suffering just as badly, with what they called ‘Flanders fever’. It had started in Spring 1918 with a more normal flu outbreak. The British army called it ‘three day fever’, and treated the sufferers alongside the wounded in their hospitals. But the second wave of the epidemic was different. It was much more virulent, infecting a large percentage of the population. In the US, 28% of the population became ill, with 40% of the navy personnel and 36% of the army succumbing. While the first wave of the flu had mostly bypassed Africa, South America and Canada, the second did not. By August it had affected India, South East Asia, Japan, China and Southern and Central America. It peaked in England in June. Worldwide, it is estimated that up to one third of people caught the disease.
The second wave also killed a much higher proportion of its victims: it is estimated that this flu killed 10-20% of the people who caught it. The toll of world-wide deaths is reported very variably, at figures from 20 million to 100 million – in comparison, total deaths in the First World War (military and civilian) were around 15 million.
There were no antibiotics or effective flu vaccines to help the sufferers or protect the population. Vaccination was tried using bodily fluids from sufferers injected into healthy people, but did not work. The only way to try to contain the spread of the flu was through public health and control measures. Many countries banned public meetings and closed theatres. Others introduced byelaws against spitting and coughing in public, or enforced the wearing of gauze masks by anyone out in public. There is a famous picture of an American baseball game in progress with every player and everyone in the crowd wearing masks. While the number of sufferers climbed exponentially, the most important tasks were the nursing of the sick, and the removal and burial of the dead: and there were barely enough well people to do this.
‘As several of the nurses were away for their holidays’, Ellen Hancox wrote, ‘we were short of staff, and it was with greatest difficulty that we were able to cope with the rush of work. In many instances every member of the household would be ill in bed, and often the doctor who should have been in attendance was incapacitated as well. Some of our experiences at this time were tragic to a degree, but b
ad as they were they were nothing to what we were to experience later. No one who had anything to do with nursing or visiting the sick will ever forget the closing weeks of September and the months of October and November, with one special time which marred Victory week for so many Sheffield people! For it was not possible to enter into the spirit of such rejoicing when those one loved were either dying or lying dead in the house. At one time it was only on very rare occasions that we entered a house which had not been visited by the Angel of Death, and we frequently had to superintend the removal of the dead from the bed before we could start nursing the living.’
Superintendent Hancox also noticed the different and alarming nature of this flu pandemic:
‘All three epidemics proved disastrous for expectant and young mothers. Old people and young children generally recovered, while young working people from about 18 to 30 years of age died in most extraordinary numbers. In Sheffield a peculiar fact was noticeable, namely that districts in the highest parts of the City (and Sheffield is very hilly!) suffered more acutely than those on the lower areas.’
The speed with which the illness developed and often killed its victims was also apparent, and astonishing, to this experienced nurse:
‘Although we always visited every patient as soon as possible after the case was sent in (we have a reputation for being extremely prompt) we often found them dead when we arrived. One of the big firms asked for a nurse to visit the wife of one of their workmen. The case came in rather late in the morning, so I went myself, early in the afternoon, and found the father, mother, husband and four children had all died in about a week, the wife and her sister being the only two of the family left. This woman was a widow for a second time, her first husband having been killed some months previously. When I saw her, she was in a state of profound coma, with a temperature of 106. However, she ultimately recovered.’
The Nightingale Shore Murder Page 17