13
MELLISH WARD
The hospital bedspreads at the London were blue-and-white check. Probationers were taught to ensure that precisely nine squares hung over the end of each bed they were making. When the squares did not align, Ethel Hope Beecher, daughter of a colonel, granddaughter of a general, and Sister of Mellish Ward from May 1897 to December 1899, would strip the covers off the beds to humiliate the recalcitrant bed maker. Eva Lückes described Ethel Beecher as “a smart sister, her nursing instincts beyond question,” but she found her excitable temperament, outbreaks of temper and lack of self-control “much to be deplored.”
In October 1899 the South African government gave an ultimatum for Britain to remove all its troops from the region within forty-eight hours. The Boer War followed Britain’s refusal to do so. The British thought the war would be over in two months. It went on for two and a half years. In December 1899, the month when Edith Cavell had her thirty-fourth birthday and started as a staff nurse on Mellish Ward, in one week there were Boer victories at Stormberg, Magersfontein and Colenso, with 2,300 British soldiers killed or wounded. Six nurses were sent from the London to tend the wounded men. Sister Beecher was one of those who sailed from Southampton on the ocean liner Dunottar Castle on Christmas Day.
Mellish Ward, a men’s surgical and accident ward, 1905
She took with her her favorite staff nurse, Elizabeth Kelso Hamilton, to Eva Lückes’s regret: “I was sorry to lose her from our own nursing staff. E. K. Hamilton was devoted to her work and to her patients. I should always be glad to receive her again should she desire to return to us in the future.” Their going left a vacuum in Mellish Ward. Ethel Mary Jordan was then appointed sister with Edith Cavell as staff nurse. Ethel Jordan was “one of those women who meant well and are always full of good works,” Eva Lückes said. But within weeks of her promotion she had a bicycling accident “which unfortunately necessitated her having her left arm amputated to the elbow.” She then worked in the matron’s office, making convalescent arrangements for patients.
Nurse Jordan’s misfortune might have forwarded Edith Cavell’s career. Had she then been made Sister of Mellish Ward her whole life would have been different. She wanted preferment at the London Hospital. But because of the year of private nursing, away from hospital work, and Eva Lückes’s reservations about her, she was consigned to another year as a staff nurse. The sister’s job went to Lilian Gough though she had arrived as a probationer a year after Edith Cavell and was four years her junior. It was hard for Edith Cavell to see younger nurses get the senior jobs. Her friend Fanny Edgecombe had been appointed Sister Victor—the sisters were known by the names of the wards they ruled—three years earlier at the age of twenty-two after two years as a probationer. Eva Lückes liked her punctuality, attention to rules and “taking manner and prepossessing appearance.” She said she was a “smart” nurse, her theoretical work good, and she would make an above-average sister, though she was “very self-opinionated and absolutely certain that she knew best … Her manner was partly due to shyness partly to conceit.”
Though meticulous and orderly, Lilian Gough—Sister Mellish—was also lesbian, and her love affairs intruded into her management of her staff. Nurses were not allowed to consort with the doctors nor to continue working if they married, but nothing was prohibited about lesbian love. There was just no mention of it.
Mellish was a men’s surgical ward with a heavy intake of emergency cases. The work was worse than dramatic. There were big breweries in the neighborhood and draymen were often admitted from them after accidents caused by drunkenness. Minor operations were carried out on the ward. Screens were drawn round the bed and as the lighting was poor—gas brackets with burners—light was achieved by a nurse holding a paraffin lamp. Ether was the usual anesthetic and was usually given through a Clover’s inhaler. Patients did not slip lightly into unconsciousness and students would be called to restrain the more muscular of them. The doctors’ rounds were occasions of ceremony. The surgeon wore a frock coat; his attendant, in a white coat, had a wooden tray round his neck with forceps, scalpels, catheters and steel dilators.
Sepsis was a huge problem. With deeply infected wounds the necessity for repeated changes of dressings wore down the patient’s morale. Severe cases were moved to the two “septic wards,” Rowsell and Blizard. Acute cellulitis was treated by making multiple incisions in the infected skin and applying hot salt poultices. House surgeons and nurses suffered frequently from abscesses and infected fingers.
It was a demanding ward and required good team work from the nurses. This was not achieved under Lilian Gough. Adjoining the ward was her private sitting room with comfortable chairs and a coal fire. Each sister furnished the room according to her own taste, for it was her home for what might be twenty years. She had her meals in it and entertained her female friends.
At first Lilian Gough seemed to favor the night staff nurse, Nora Daly. Eva Lückes noted that Nurse Daly was for a time “much liked” and “rather spoilt” by the sister. But then Sister Mellish fell in love with the sister on Davis Ward—Lizzie McLellan. Eva Lückes wrote in her register that they “struck up one of those morbid friendships.” Lizzie McLellan was thirty-one, widowed, and a good ward manager who taught the probationers well, but, the matron said, “She was never conscientious or reliable, did not obey the rules and had encouraged a staff nurse to break a rule in a quite unheard of fashion.”
Nora Daly went to Eva Lückes to complain about the working conditions on Mellish Ward and to tell her she had no intention of obeying Sister Gough. Eva Lückes came down on the side of rank and did not investigate what dramas were going on, or what the practical implications were for the other staff of this “morbid friendship.” She told Nurse Daly that if she did not “obediently carry out the duties entrusted to her in accordance with the sister’s wishes, she would be unable to retain her post.”
Edith Cavell was not given to asking for intervention or help. But the atmosphere was intolerable. Lilian Gough criticized and disliked her, was unfair in the division of work, and allocated tasks to her that should have gone to a probationer.
Edith Cavell put up with it for a year then went to Eva Lückes to tell her she wanted to leave the hospital. “She is convinced that the ward sister has a prejudice against her,” Eva Lückes wrote in her matron’s register, “and after carefully going into this matter I could not but fear that there was some grounds for this conviction.” But she did not record how this prejudice manifested itself or suggest moving Edith Cavell to another ward. She advised her to resume private nursing, which Edith Cavell did not want to do. She also criticized the quality of her work: “Edith Cavell is not a success as a staff nurse … She is not methodical or observant and she over-estimates her own powers. Her intentions are excellent and she is conscientious but without being quite reliable as a nurse. If she had been happier in her ward I do not think she would have wanted to leave the Hospital… . Edith Cavell is steady and nice-minded.”
Eva Lückes found her another job when Miss Moir, Matron of St. Pancras Infirmary, asked her to recommend two night superintendents. “I thought that Nurse Berridge and Edith Cavell would make an excellent combination and work well together. I recommended them accordingly. They obtained the appointment and Edith Cavell left the London Hospital on 3rd January 1901.” Three months later, in April, Nora Daly left the London Hospital too. She went to Liverpool as theater sister at the women’s hospital there. Eva Lückes might have wondered why two good staff nurses left because of their experience on Mellish Ward under Lilian Gough. Had she had time, she might have looked into what was going on.
That same month Sisters Gough and McLellan asked for permission to take their holiday leave together. Eva Lückes allowed this, though it was “arranged with particular inconvenience.” When they got back Sister Gough, who was extremely nervous about her own health, had a small cyst removed from her groin because she was convinced it was something serious. “She
made a good recovery up to the tenth day when she suddenly became very ill with a curious heart attack. For a few days we were intensely anxious. Her friends were summoned and her father, who had already had one seizure a few months previously, had another owing to the excitement of the journey and his anxiety about his daughter, so that he had to be warded in a little room in Cotton, while his married daughter and her husband remained here for some time extremely anxious about both patients. Fortunately both made a good recovery.” Neither the physicians nor the surgeons could find anything wrong with Lilian Gough or the reason for her curious heart attack. None the less, during the “anxious stage” of this seeming illness her lover Lizzie McLellan was allowed to sit with her at nights, and a replacement sister had to cope with Davis Ward. And Eva Lückes promised that, when Lilian Gough recovered, she and Lizzie McLellan could again go on holiday together.
But, she noted in her register, neither of them behaved very nicely during this period of convalescence, which she thought ungrateful, after all the care and consideration bestowed on them both. And then when Lilian Gough recovered she said she must leave the London because her own physician at Clifton had impressed on her the necessity of giving up hospital work entirely. A day after she left, Lizzie McLellan resigned saying she was ill and needed a long rest and “owed it to her father to spend some months at home.” Dr. Warner examined her but could find nothing wrong with her either. Lizzie McLellan and Lilian Gough then ran off together. They stayed first in Bristol, then alone in “a quiet place” in Devon.
So five months after causing Edith Cavell to leave, Lilian Gough was ensconced in the Devon countryside with her lover, and Mellish Ward was again in need of a sister. A year later Sister Gough visited Eva Lückes who was glad to see her looking remarkably well. She spoke with great regret of having had to leave the London and told her she was doing private nursing, which she did not like, though she had no difficulty in getting work. Dr. Samuel Fenwick, who specialized in diseases of the abdomen at the London, had written offering to recommend her for the matronship of a small hospital, but she had not felt it would be wise to apply.
Caught in the fallout of the dramas on Mellish Ward, Edith Cavell had felt compelled to leave the London. It was a disappointment to her not to be made a sister there and to leave in a strained, unpleasant way. She was always to refer to it as “the dear old hospital.” It was hard for her to achieve promotion for she did not flaunt herself, criticize others, or curry favor. In becoming a night superintendent at the St. Pancras Infirmary, a Poor Law institution for the destitute chronically sick, she took on a nursing task of the most demanding sort.
14
THE INFIRMARIES
The infirmaries marked the beginning of state hospitals. They evolved out of concern for the poor, Florence Nightingale’s crusade for improved workhouse nursing, and fear that the infections of the destitute sick would spread throughout the population.
The Gathorne Hardy Act of 1867, passed by the Home Secretary, Gathorne Hardy, gave statutory free medical provision to people with no money. After it, boroughs set aside part of their existing workhouse accommodation, or in time built new places, for the sick poor. The St. Pancras Infirmary was built in 1885 and Florence Nightingale recommended many of its nursing arrangements.
The infirmaries were maintained, with minimal investment, out of the rates. No destitute patient was refused if he or she lived in the borough, and no patient was admitted if he or she could afford to go elsewhere. After the Act, those for whom the voluntary hospitals could or would do nothing went to the infirmaries. Before it they would have gone to the workhouse, along with the “aged infirm, the blind, the idiotic, the lunatic, the bastard child and the vagrant.”
Edith Cavell as Night Superintendent at the St. Pancras Infirmary, c. 1901
The infirmaries remained, though, sinks of misfortune. They were staffed by medical superintendents, the less able doctors worked in them, and in a class-conscious society degradation was attached to them. Herded together were the senile; the mentally ill; un-married mothers; people with venereal disease, inoperable cancer, diabetic gangrene; children with measles, whooping cough, broncho-pneumonia.
When Edith Cavell went to work at the St. Pancras Infirmary in 1901 the borough had a population of 235,317 of whom 6,307 were listed as paupers. In her first year there were 1,614 admissions of whom one in five died. There were high casualty rates from complications in pregnancy, from epidemics of diarrhea in summer because of squalid sanitation, and from respiratory disease in winter caused by the city’s fog.
As the two night superintendents, Edith Cavell and Emma Berridge were each responsible for 250 beds. The Infirmary, set in parkland, was in north London near Highgate cemetery. Edith had a room at the top of the building up many stairs. She came on duty at 8:30 in the evening before the day staff left. The patients, of all ages, had disparate illnesses, there were only three doctors and there was little specialist care. If a patient’s condition became acute, she had to rouse the doctor on call. If a patient was dying the police fetched “next of kin.” At the London the emphasis was on skilled treatment and cure. Patients were not accepted if medical or nursing treatment held no hope. Few stayed more than a month, they either died or left. The Infirmaries took the elderly, the paralyzed, the demented, the inoperable. That there was nowhere for most of them to go when they left, was a constant problem. Those who left alive went to the workhouse, to friends, to “outdoor relief,” or to a fever hospital if a place could be found.
From the start, Edith Cavell had reservations about working nights—not in shifts but permanently. It meant she was out of kilter with the hours of most people and cut off from the world. She maintained her friendships with nurses from the London, with Fanny Edgecombe and Eveline Dickinson, but it was hard for free time to coincide. She had reservations too about how much she could learn in such an underfinanced, understaffed setting. Within three months she answered an advertisement for a nursing vacancy at Swansea General Hospital, but was not interviewed.
An East End London street, c. 1900
She took such breaks as she could. Her sister Florence was night superintendent at an infirmary in Hendon in northwest London. She met up with her, went home to Swardeston or to the country with Emma Berridge, she spent Easter in Haslemere with friends, walking and sketching. On Sunday June 30, after a day in the country, she returned rather late to London. It was raining heavily. She was mugged near Liverpool Street and her purse stolen. She was easy prey, a lone woman at dusk in the wet streets of the city. The Infirmary was in north London and it was too far to walk and too wet a night. She walked to the London Hospital and the night staff gave her a bed and money so she could return to the St. Pancras in the morning. In her self-effacing way she wrote to Eva Lückes apologizing for her own misfortune: “You will have heard how very unfortunately I was placed on Sunday night … If I had had anywhere else to go I would not have returned to the hospital to trespass on the time of the night sisters … but it was too wet to walk and there seemed nothing else to do.” And there was nowhere else to go. She returned to the demands of night superintendent but thereafter scanned the Nursing Mirror for vacancies.
For a month in August she stood in as matron of Cheshunt Cottage Hospital in Hertfordshire while the permanent matron was on leave. She was interviewed for the post of matron at Tavistock Hospital, but was unsuccessful. In October she applied for a job that sounded as demanding as the one she had: Assistant Superintendent at the Farm-field Reformatory for Female Inebriates at Charlwood in Surrey. The salary was £50 a year—less than she was getting at the St. Pancras, but she was compassionate toward distress, wanted to get as wide experience as she could of all aspects of nursing, and she would not have been working nights. Eva Lückes gave her a bland reference: “I believe Edith Cavell well fitted in every respect for the position she is seeking … She has good health and a gentle nurselike manner … She is thoroughly interested in her work.” She did not get th
e job. All senior nursing posts were heavily contested and she had come to the profession late. It was November 1903 before she had success with an application and she wrote of her hopes from it to Eva Lückes: “You will I think be pleased to hear that I was elected yesterday to the post of Assistant Matron at Shoreditch Infirmary. I am glad to have obtained day work after my three years on night duty. Also I hope the position will prove a help for the future and the salary is better than the one I am receiving. I shall have the supervision of the wards, under Miss Inglis the Matron and be able to teach the probationers and improve their work; also charge of the linen room, and the laundry. It will be a new experience and I hope to learn much from it.” She was already looking toward the next step. She wanted to be a matron, teach, change people’s lives and make a notable contribution.
The main entrance to the Shoreditch Infirmary6, which was adjacent to the workhouse and had evolved from it, was off Hoxton Street in the heart of London’s East End. It was a crowded, insanitary area of slum dwellings, brothels, small workshops and large warehouses, with a population of about 120,000. It was the center of Jewish immigration and the furniture trade.7 Charles Booth, in Life and Labor of the People in London, in 1902 described it as an area of high poverty, prostitution and thieves. “The character of the whole locality is working-class. Poverty is everywhere with a considerable admixture of the very poor and vicious.” People eked a living. “Clobberers” patched clothes, “dippers” stole handkerchiefs, watches and wallets, hawkers sold whatever anyone would buy, “crawlers” begged for such food as they could get. There were timber merchants, pawnbrokers, egg merchants, tailors, coffee houses, herbalists, human hair merchants … Charles Dickens used to walk the area. He placed Oliver Twist in South Shoreditch and Mr. Micawber in City Road.
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