Again and again she recorded the importance of cleanliness and disinfecting. She noted how, when nursing diphtheria patients, she herself should gargle with chloride of potash and carefully cover any cut or abrasion. She wrote of how to read the signs of approaching death and of how to lay out the dead—straighten the dead person’s limbs, close their eyes and jaw, wash their body, arrange their hair, attend to their nails, plug their mouth and rectum with cotton wool and if needs be the uterus too. Throughout her career she was to do this time and again so that no person should lose their dignity in death. She did it out of respect for every human life. The pity was that when she died no one was to do it for her.
The nurses’ garden created by Eva Lückes. They called it the Garden of Eden
As a nurse, hers was an institutionalized life: the terms dictated, every hour accounted for. The work was exacting, the demand for vigilance high. There was no privacy except for hours of sleep, no solitude except what she could find in meditation. When she was ill in December 1896 she was cared for on one of the wards. There was little time for a life outside the hospital. Nurses were forbidden to socialize or go out with doctors or medical students and were dismissed if they did so.
Eva Lückes asked for the provision of a garden for the nurses. They called it the Garden of Eden. It had fountains, hammocks, rose bushes, doves and ducks and deckchairs and a penny-in-the-slot machine for boiling water for tea. Recreation was a walk around it, a ride on a horse-drawn bus, a launch trip down the river to Tilbury.
After three months on the wards Edith Cavell signed a contract agreeing to complete the two-year training course with the hospital and, if she qualified, to stay on for a third year as a staff nurse, or as a private staff nurse in the homes of patients under the hospital’s care. The hospital did not want to pay for protracted training of nurses only to have them leave without practicing all they had learned.
Edith Cavell curried favor with no one. “Good” or “very good” were the usual comments against her written work. She displayed no ego of her own. The ward sisters thought her reserved and unforthcoming and often were cool in their assessment of her. The patients found her kind. When John Bancroft had an operation on his spine without anesthetic, for three days she sat with him at every available moment. On the black endpaper of his Bible she painted a spray of apple blossom and one of the many Thomas à Kempis quotes she had memorized: If thou canst hold thy peace and suffer then shalt thou see without doubt the help of the Lord. The compassion of her belief was that there was redemption beyond suffering and that where there was suffering there was holy ground.
Entertainment for patients, their families and nurses in the London Hospital grounds, c. 1900
There was no brag or bluster about her, no vanity or indulgence. She asked little for herself. Eva Lückes, who liked a bit of flamboyance and theater in her nurses, was critical in her reports on her: “Edith Cavell had a self-sufficient manner,” she wrote of her, “which was very apt to prejudice people against her.” It was a curious comment, perceptive yet elusive, for Edith Cavell had scant reference to self, and paradoxically her self-sufficient manner came from her detachment from self-regard.
11
MAIDSTONE
In mid August 1897 a typhoid epidemic began in Maidstone. By October 9, 1,200 cases of the disease had been confirmed and forty-two people had died. On October 15 Edith Cavell, with five other nurses from the London Hospital, was sent by Eva Lückes to help in the emergency.
Maidstone, on the banks of the River Medway, in the 1890s was a thriving market town with a population of about 34,000 and a lower than average death rate. Brewing beer was its main industry and each summer from August to late September hordes of itinerant workers camped in the surrounding fields and picked hops for a pittance wage. Referred to locally as “strangers,” many of them came from London’s East End or from Ireland. They were dock laborers, costermongers, woodcutters, hawkers, fish-basket makers … On the hop farms they survived in miserable conditions, there was prejudice against them and they were accused of theft and spreading disease.
The town’s water was supplied by the Maidstone Water Company. By an Act of 1860 the company was not allowed to take water from the River Medway because this might be “detrimental to navigation” so the main supply came from a reservoir and four springs. One of these, the Farleigh Springs, flowed into a millpond where the hop pickers washed. In mid August 1897 this millpond became polluted.
Five years earlier, in 1892, the chief medical officer could not have been ruder about the town’s sanitary arrangements. In a report he wrote:
Nearly half the houses in the town have water closets which have no mechanical means of flushing … Year by year, for twelve years, I have again and again endeavoured to show the folly that underlies the faith that a system of sewerage such as ours can be made to work satisfactorily without an adequate water-supply properly applied …
In Maidstone we have about 6,000 dwellings. Without hesitation I say that at the very least 4,000 of these dwellings have closets attached to imperfectly flushed drains, each of which is nothing better than an elongated cesspool charged with foul, festering filth, that is perpetually producing air-polluting and disease provoking vapours that escape from those drains wherever an outlet presents itself.
Inspection of the water supply was the responsibility of the town council. Mr. A. Adams was the officer in charge of the sanitary department. In September 1897 he was on holiday in Switzerland, and his son Percy was standing in for him. On September 13 Percy Adams noted that in the preceding four weeks there had been nineteen deaths from diarrhea and seven confirmed cases of typhoid fever. A week later this went up to 206 confirmed cases. He checked with the office of the water company and found that all those afflicted lived in an area high in the town with their water supplied by the Farleigh Springs.
He “communicated his suspicions” to Mr. Ware, the manager of the waterworks, and together they went to inspect the area. It was where parties of hop pickers had camped. Earthenware pipes from the springs went to underground catch pits. In one catch pit he found two dead rabbits and human feces. The Tutsham-in-Orchard spring was fifty yards from the hop pickers’ privy which “was in a disgraceful condition with feces decomposing and flooding the ground.” The rainfall in August had been heavy, and he found lots of human excrement in the fields and particularly near the hedges.
Mr. Adams senior hurried home from Switzerland. The Farleigh water supply was cut off and so were most of the other springs. Water was diverted from the West Kent Company supply. The Maidstone Corporation hired carts and flushed the sewers with river water. They laid a mile and a quarter of new mains drainage in a week, and appointed Dr. Sims Woodhead to inquire into the outbreak and advise what to do. He recommended sterilizing the reservoirs with chloride of lime. Billboards were posted and printed notices delivered to all houses cautioning them about drinking untreated water.
By the time Edith Cavell arrived the source of the epidemic had been treated, but the disease was still spreading. According to Dr. Woodhead this was “through mischance in nursing, ignorant or careless handling of patients, their soiled clothing, excreta, the pollution of water closets, infected milk … house drains … the disgusting vapors issuing from the street ventilators and all the filthy pent-up stuff being driven pell-mell along the sewers.”
A special committee was appointed to oversee the treatment of patients. The West Kent hospital could not cope. Seven improvised hospitals were set up in schools and other buildings. Patients were also nursed at home.
Edith Cavell nursed at the Padsole Emergency Hospital and in people’s homes. Though she had been seven months at the fever hospital in Tooting, she had not seen a full-blown typhoid epidemic. Patient survival depended on nursing efficiency and the drive to restrict contagion: clean linen, no sharing of towels, much washing with carbolic in clean, well-ventilated rooms, the use of bedpans treated with disinfectants of corrosive acid and hydrochl
oric acid. The Sanitary Authority washed and disinfected bedding and clothing free of charge. It was all collected, numbered and taken in canvas bags to the laundry. The Inspector of Nuisances superintended the disinfection of every house in which typhoid had occurred. Walls, ceilings and floors of infected rooms were sprayed with water, then fumigated with sulfur. Woodwork was washed with carbolic, ceilings were distempered and wall-paper stripped. Notices were pasted up saying that anyone suffering from typhoid could get food, clothing and relief if sanctioned by any clergyman, doctor or member of the town council.
The incubation period was two to three weeks. The symptoms were fever, diarrhea and aching limbs. Sufferers were isolated, confined to bed and not allowed to sit up. They were kept quiet, sponged with iced water and allowed no solid food. Beef tea was thought to be good for them, and Brand’s Essence and broth jelly. And milk. And brandy. Opium was given to relieve pain and quinine to lower their temperatures. To clean their mouths a piece of linen was dipped in glycerine and lemon juice. A relief committee sent convalescents off for a change of air.
The nurses worked quite literally until they dropped. At the end of a day Edith Cavell was so exhausted she would step out of her clothes and collapse into bed, so her roommate Caroline Bell, another London Hospital probationer, said. The two of them lodged with a large, boisterous lady who ran the town’s toyshop, liked vulgar jokes and rum punch and grieved that her guests did not eat enough. Toward Christmas time they all dressed some of the toyshop dolls in nurses’ uniforms and these sold well as Christmas presents.
By December the epidemic had died down. Out of a total of 1,847 cases 132 people had died. This was a low mortality rate for a typhoid epidemic. The townspeople were truly grateful. They organized a collection for the 166 nurses who had come to their town and worked so hard and saved so many lives. With the money raised, silver medals were struck with the arms of Maidstone on one side, the name of each nurse on the other and the inscription “with gratitude for loving services 1897.”
Which was what it was. Loving services. Edith Cavell, like the other nurses, had risked danger and worked all hours to save lives and alleviate suffering. On December 8 a grand reception was held for them in the town’s museum and the medals distributed. The Lord Mayor of London officiated in his robes and chains; so did the mayors of Maidstone, Gravesend, Chatham, Colchester, Rochester, Dover and Queensborough and all the local magnates. The speeches went on so long the nurses had to leave to get back to the hospital before the entertainments began: “music, refreshments and a cinematograph”—films of Queen Victoria’s diamond jubilee, pelicans being fed at London Zoo and the Flying Scotsman traveling at 60 miles an hour.
12
BACK TO THE LONDON
Edith Cavell returned to the London Hospital in January 1898. Improvements under the chairmanship of Sydney Holland were fast moving. He received £25,000 from the shipping magnate Alfred Yarrow for a new outpatient building, £22,000 from John Fielden for an isolation block, a large annual subscription from James Hora for maternity wards and £10,000 from Edward Raphael for segregated wards for Jewish patients. (Jews were thought to be as different in their ways as women were from men.) Money flowed in. Two stories were added to the hospital. There were new wards, new operating theaters, a separate laundry, an X-ray room “and the most magnificent operating theaters in the whole of England.”
For another year Edith Cavell gained experience in every aspect of nursing. By the end of it she had nursed children with scurvy and rickets; mothers with mania in pregnancy; patients with concussion, sarcoma of the hip, amputated thighs and arms and with cut throats—a common method of attempting murder or suicide. She knew how to give enemas, bottle-feed a new baby, stem bleeding, apply dressings and distinguish between typhoid and scarlet fever. She had worked on the Charlotte, Cotton and Sophia wards and in the Electrical Department where X-ray apparatus run by batteries had been installed and “light therapy” was used to treat rheumatism. Such techniques were experimental. The first technicians to work with X-rays at the London, Dr. Harnack and Dr. Suggers, both suffered X-ray burns and died of cancer. Harnack had both his arms amputated.
A close friend of Edith Cavell’s, Eveline Dickinson, was chosen by Sydney Holland to go with another nurse to Copenhagen to learn the innovative methods used in “Dr. Finsen’s Light Treatment for Lupus.” “She was particularly well-suited for anything of this kind,” Eva Lückes wrote of Eveline Dickinson in her register, “being keenly interested in the intellectual side of the work and very capable of excelling in any details requiring neatness and finish in execution.” On her return Eveline Dickinson became Sister of the Light Treatment Ward at the London and published articles about it in the nursing journals.
The Finsen Light, used at the London Hospital for the treatment of tuberculosis of the skin, c. 1900
In September 1898 Edith Cavell passed the examinations for her London Hospital certificate, which meant she qualified as a staff nurse. Eva Lückes gave a starchy evaluation of her in her Register: “Edith Cavell had plenty of capability for her work when she chose to exert herself, but she was not very much in earnest, not at all punctual and not a Nurse that could altogether be depended upon. She did good work during the Typhoid Epidemic at Maidstone and had sufficient ability to become a fairly good nurse by the end of her training. Her theoretical work was superior to her practical. She attained an average standard in the latter, giving a general impression that she could have reached a higher standard if she had put her whole heart into the work. I thought her best fitted for the Private Nursing Staff and she was accordingly appointed in that capacity for her third year of service.”
It was a disappointment to Edith Cavell to begin her stint as a staff nurse in the private sector. She would have preferred for her third year to work as a staff nurse within the hospital structure. Private nurses, set apart by a green uniform, were sent to the homes of the doctors’ paying patients—the ones they saw in their West End surgeries. The scheme was approved by the Hospital Committee because it brought funds to the hospital. For Edith Cavell it was reminiscent of her time as a governess. Again it was a dislocation. She went where she was sent, to areas where she knew no one, to live as a working guest in the closed confines of a well-off family house.
The matron’s view of her sounded damning but was a typical Miss Lückes report. A musing aloud. In her first two years Edith Cavell was marked late forty-six times. It did not mean she was late on the wards. Quite possibly she was giving extra time to patients who needed it. It was simply the time she was marked in for her own meals.
With a constant flow of nurses the matron was too busy to get to know many of them well. She seemed to favor them if they were upper class, good looking and extrovert. She held an open evening on Tuesdays in her rooms where nurses could confide their worries, but Edith Cavell was reserved and uncomplaining and made no particular impression on her. Her reserve was often misinterpreted, and being a probationer nurse at the age of thirty-three set her apart from the others.
Eva Lückes seldom gave unequivocal praise or blame in her recorded comments. She viewed her nurses as girls, wanted them all to succeed and helped their careers in every way she could, but often they proved a bar to the excellence she wanted for her hospital. She found them unrelentingly human: Amelia Brandon was “big and clumsy …,” Elizabeth Margaretta Rees was “slovenly and untidy.” Elizabeth Herbert went off with a man and became engaged. Fanny Eastland contracted typhoid fever. Ruth Gow was fetched away abruptly by her parents. “They collected her and her father shouted at everybody.” Winifred Livingstone was “an excitable sort of girl, not well-adapted to Hospital work. She did not get on well with her fellow workers and they were under the impression, apparently with some justification, that whenever there was extra work to be done she retired with a headache! She was threatened with flat feet …” Eliza Crowe stole another probationer’s clothes and left to go to the Metropolitan Hospital. Dora Morris was careless i
n breaking hospital property. Annie Simpson Sinclair was summoned to nurse her father after two months at the hospital. “She simply did not return and we heard no more of her.” Gwendoline Harman was “intensely conceited and not very clever. She expended more time over professing to love the work than in endeavoring to make her individual share of it thorough.” Bertha Waterhouse was vague and self-absorbed, walked in her sleep and had “a morbid mental condition.” Sophia Jewell was a very capable probationer and had “the distinction of being the first Jewess holding our certificate. This was not because Jewesses have never entered for training before, but they have lacked either the health or the energy to succeed.” So it went on. A stream of young women who remorselessly fell short of perfection.
As a private staff nurse Edith Cavell went first to Ilford in Essex to nurse a man with terminal cancer and his distraught wife. He died after three weeks. She was then sent to Tottenham for a fortnight to look after a woman with pleurisy and pneumonia then, for three months, to nurse a fourteen-year-old boy with typhoid in West Norwood. He recovered and she was sent to St. Mary’s Vicarage in Marlborough where the eight-year-old son of the Bishop had appendicitis. Then it was heart failure in Lewes, cancer at Woburn, an eighty-year-old with gout in Gloucester and, at the end of the year, three weeks at the Royal London Ophthalmic Hospital because the matron there was short of staff. She then took her allotted two weeks’ holiday in Swardeston: country air, family, and a short break from obligation. For her fourth year, Miss Lückes needed her to return to the hospital as Staff Nurse on Mellish Ward, a men’s surgical and accident ward. Her hours on duty were 7:00 in the morning until 9:30 in the evening with three free hours. The pay was £24 a year. It was to prove a difficult time.
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