Rebecca Strong – Matron of Glasgow Royal Infirmary.

 

 

 

Introduction

 

On the 31 May this year a friend and I were privileged to attend the opening of a new and unique museum collection sited in Glasgow Royal Infirmary. It features the work of the great and the good such as Lord Lister, pioneer of antiseptic surgery and Sir William Macewan, the first neurosurgeon in the UK to successfully remove a brain tumour, but it also pays tribute to the work of many less well-known nurses and doctors who have worked there over the years.

 

Rebecca Strong

 

Most prominent among the nurses is Rebecca Strong, first Matron of Glasgow Royal Infirmary from 1879 – 1885 and again from 1891 – 1907. The ceremonial opening of the museum was performed by her 93 year old great grandson, Mr David Geyer. As he said, it is indeed remarkable that there is a living soul who still remembers someone born in 1843, as was Rebecca Thorogood or his ‘Granny Strong’ as he rather sweetly referred to her.

 

Rebecca Thorogood was born on 23 August 1843 in Aldgate, London, the daughter of a publican who ran the ‘Old Bull Inn’. In 1863 when she was only 19, she married Andrew Robert Strong at Whitechapel and their daughter Annie Ellen was born in mid-1864. Andrew was a mathematical instrument maker.

 

 

 

 

It is generally believed that Rebecca Strong was a young widow when she embarked upon a career in nursing but, it appears that this may not have been the case. An Andrew Robert Strong the same age as her husband and also described as a mathematical instrument maker, did not die till much later. It is a matter for conjecture whether this is a different Andrew Strong, or whether they separated or whether she was deserted by him soon after the birth of their daughter.

 

My guess is that it would have been more socially acceptable at that time for a woman to be perceived as a widow rather than separated or deserted, so that title may have been a matter of convenience. Interestingly, whilst she was on placement at Netley Military Hospital, documents describe Rebecca Strong as ‘married’ and as we shall see, at one point she refers to her husband, so it is all a bit of a mystery.

 

In 1867, Rebecca Strong chose to train in what would later become that most prestigious of establishments, The Nightingale School of Nursing at St Thomas’s Hospital in London. She was among the very early students there, something of which she was immensely and justifiably proud. That they accepted her reveals that early on in her career. she showed that she was a bright young woman who had ‘something about her’.

 

Strong emphasises that Florence Nightingale’s interest was to restore Protestant nursing. Up to then, the title ‘Sister’ had been reserved to Roman Catholic religious orders.

 

She describes how Mrs Wardroper, Matron of St Thomas’s Hospital got

 

 “…some educated women together under the title of ‘Sister’, the word ‘nurse’ being a degraded one…. These were the first Protestant nurses to bear that title…. Women titled ‘scrubbers’ were also employed to do the rough work on the ward and others of a better class were induced to act as nurses”.

 

This suggests that Strong was both educated and perceived as ‘respectable’. On entering St Thomas’s training school, she found

 

Each pupil had a cubicle for sleeping, and a common dining room with a neatly appointed table was provided… Very little was expected apart from kindliness, watchfulness, cleanliness and guarding against bed sores. A few stray lectures were given.

 

She also noted that, though Florence Nightingale had scrubbed floors and cleaned brasses, she did not ask this of her pupils. The whole time was given to the patients.

 

Strong found that learning the Latin abbreviations on medicine bottles was not difficult, but she was severely reprimanded for taking a temperature, as at that time it was a medical student’s work. Among other tasks, she was expected to bake cakes for Sunday tea and trim the bonnets of outdoor uniforms .

 

The Royal Victoria Military Hospital, Netley

 

The training course was a long six years, though not all of it was served at St Thomas’s. The rationale was that after a year, the student had acquired enough knowledge to go to another hospital to disseminate the information they had been taught. Following a period at Winchester Hospital, Strong was posted to the Royal Victoria Military Hospital in Netley with five other nurses, under the supervision of Mrs Deeble, Nurse Superintendent.

 

By this time Florence Nightingale was an invalid but prior to their placement, Strong and the other nurses each had a personal bedside interview with her where they were exhorted to take up high ideals and to work on in hope. Rebecca Strong never forget this encounter and much later in life she would say that

 

‘Miss Florence Nightingale made a foundation of rock, leaving the super structure to her disciples’.

 

In 1944, Rebecca Strong’s copy of Florence Nightingale’s ‘Notes on Nursing’ was bequeathed to St Thomas’s Hospital. On page 22 she has marked her own initials as if to stress her agreement.

 

Despite Nightingale’s exhortations, Strong was however, deeply unhappy at Netley, claiming that opportunities for nursing care were non-existent as by the time they had travelled home on the troopships, many of the men had recovered and the remaining work was monotonous.

 

Nine months before her training was due to end, she wrote a letter asking to withdraw, saying that she found the placement unsuitable. This was a big step as withdrawal meant giving up the third bursary payment that all St Thomas’s nurses received from the Nightingale Fund as well as her certificate to say that she had completed the course. She was not alone, however. Several nurses resigned at this time.

 

Strong claimed that her reason for terminating was due to boredom, but a letter from Mrs Deeble to the Matron of St Thomas’s Hospital, takes a different view.

 

Mrs Deeble believed that Sister Strong and her friend Sister Kennedy contrasted their roles as Sisters of St Thomas’s Hospital with the role they currently fulfilled at Netley, which was more like that of a hard-working Staff Nurse. She considered that Sister Kennedy found the work beneath her and that she was a strong influence on her friend, Sister Strong.

 

A very stroppy letter from Sister Kennedy to Mrs Wardroper seems to bear this out. She fumes that she is no more than a Staff Nurse and expresses surprise that she is thought no more valuable than this. It could not have helped that in the Census of that year, Kennedy, Strong and the other nurses were described as ‘servants’.

 

Strong’s resignation letter states that she has never been happy at Netley. She cannot pinpoint why she is distressed but thinks that it might be “The thought of my husband that is the secret of my unhappiness…”. Did caring for young soldiers evoke memories of her dead husband or was she mourning a marriage break up? Or is this simply an excuse because she dislikes the work?

 

In her desperation to leave, she wrote several letters to Henry Bonham Carter, cousin of Florence Nightingale, requesting to resign. That the daughter of an East End publican felt confident enough to write a letter to someone as prestigious as Bonham-Carter tells us much about her character. She was strong-willed, determined and ‘feisty’.

 

Whatever Bonham Carter’s response, Strong changed her mind about leaving, going on to qualify as a ‘Nightingale Nurse’. She continued to be associated with the School of Nursing and St Thomas’s Hospital to the very end of her life. We know this as there are letters where she writes commiserating with them about the bomb damage to the hospital in the blitz of 1940.

 

The threat of resignation became a recurring theme in Strong’s life. It is unclear whether this was due to a fierce desire to maintain and raise standards in the places in which she worked, or whether it was simply her response when she did not get her own way. Whether the former or latter, who can tell, but it is necessary to beware of writing hagiographies of these women who, like all of us, were a mixture of strengths and weaknesses.

 

Around the time of her threatened resignation, the Census of 1871 tells us that Strong’s six year old daughter, Annie, was resident with two of Rebecca’s sisters in Lambeth. She is recorded as living with Annie Thorogood a draper, and Emma Thorogood whose occupation is listed as a repository at Soho Bazaar, where crafts, gloves and lace were sold. Three of the Thorogood sisters were successfully making their way in the world. In a later census of 1881, Annie is recorded as a 16 year old schoolgirl residing at Glasgow Royal Infirmary as a ‘visitor’.

 

Nursing Conditions and Practices

 

While Strong was being exposed to the practices and philosophies of Florence Nightingale, conditions for nurses in many hospitals were grim, and the standard of nursing care was abysmal.

 

Many nurses were elderly and poorly paid and fed. Earning less than a domestic servant, their duties included scrubbing ward floors and doing laundry. Nursing did not extend much beyond washing the patients and feeding those who were unable to do so for themselves. It was said that, as their wages were small and they often went hungry, nurses were sometimes tempted to steal food intended for the patients.

 

William McEwan, a prosperous philanthropist who became manager of Glasgow Royal Infirmary in 1862, (not Sir William Macewen MD, LLD, the eminent surgeon with whom Rebecca Strong would later work) remembered that the nurses did not receive regular meals, but ‘got herring one day, cheese another, an egg another and on other days anything left over from the provision of the patients’.

 

The Medical Superintendent of the Fever Hospital in Glasgow stated

 

 ‘…at present nursing is the last resort of female adversity. Slatternly widows, runaway wives, servants out of place, women bankrupt of fame or fortune for whatever cause, fall back on hospital nursing’.

 

One of the hospitals so afflicted by poor nursing care was Dundee Royal Infirmary. It was said that ‘Throughout the history of the old infirmary, the illicit use of ardent spirits…continued to hamper the efforts of the Board to establish an efficient nursing service’.  

 

Dundee Royal Infirmary

 

In 1873, Dr Robert Sinclair, the Medical Superintendent of Dundee Royal Infirmary, proposed that a training school for nurses should be established, and that young women of good character and education should be attracted to the profession. They should be trained under a qualified and efficient Matron.

 

In a letter now in the London Metropolitan archives, Strong recounted

 

In 1874 through some Dundee friends I was appointed matron of Dundee Royal Infirmary and I found a medical superintendent of advanced views in regard to nursing.

 

Though only connected to Dundee for four or five years, in that time she transformed nursing conditions and training at Dundee Royal Infirmary. Her work set the standard for the future development of excellence in nursing.

 

Despite her relatively short stay, she maintained relationships with Dundee Royal Infirmary attending several nurse’s reunions. In 1936, She had the honour of opening the Prain School for Preliminary Nurse Training. Recently she was commemorated on the gates of Dudhope Park, opposite the old Dundee Royal Infirmary, as part of the Dundee Women’s Trail.

 

On being awarded the OBE is 1939, The Dundee Evening Telegraph reported that

 

 Greetings were sent (from Dundee) to ‘a lady whose name stands proud in the annals of nursing in Scotland’… ‘a pioneer for the higher education of nurses…She has seen many of her ideas adopted by hospitals all over the country.

 

The Dundee Courier recalled that until Mrs Strong’s arrival, ‘Nursing was of the Sarah Gamp order, with little or no distinction between nurses and servants. Their conduct was often in question… they had to be reminded that they must not neglect, quarrel with or insult the patients on any pretext whatsoever’.

 

Similar issues afflicted Glasgow Royal Infirmary.  As late as 1875 the managers felt it necessary to recommend that ‘the nurses throughout the house be warned that under no circumstances will slapping, whipping or threatening language towards patients be tolerated’.

 

Glasgow Royal Infirmary

 

In an attempt to combat this kind of behaviour, William McEwen, Chairman of the House Committee and a leading advocate of nursing reform at Glasgow Royal Infirmary, visited Rebecca Strong in Dundee to persuade her to move to Glasgow. In 1879 Strong thus became Matron of the largest voluntary hospital in Scotland having been headhunted for the job.

 

She was shocked to find how backward the Glasgow Royal Infirmary was in relation to both nursing care and the working conditions of nurses. She set about improving nurse training and working conditions and made an immediate impact.

 

A blog published by Carole Parry of the Royal College of Physicians and Surgeons of Glasgow details how in January 1891, William Macewen, the eminent orthopaedic and neurosurgeon, gave an address at Glasgow Royal Infirmary on the subject of “Nurses and Nursing”, a copy of which is in the RCPS archive.

 

In the lecture he said, “Cannot nursing be raised to a distinct profession, with its entrance examination, its minimum requirements, theoretical and practical, its teachers, its examiners and its diploma?” 

 

He also stated: “Nursing is, beyond all cavil, a sphere for women’s work; . . . one can scarcely expect a man to be a nurse, as his instincts and training do not suit him for it . . .  A woman possesses such a magnificent compass of susceptibilities, is so full of human sympathies and soft compassions, if her life is not to be a barren wilderness, she requires opportunities to enable these to expand”.

 

While confirming sexist stereotypes of nurturing womanhood, Macewen redeems himself in recognising that these very attributes could provide a career opportunity for women.

 

With the support of Macewen, Rebecca Strong set about creating a system of nurse training. Instead of nurses being expected to attend lectures whilst also working on the wards, they would have study blocks interspersed with periods of practice on the wards. This block system of nurse training was gradually adopted by places as far afield as Yale in the United States and was still in operation in most places in the UK right up until nurses began to undertake undergraduate courses. In May 1978, when I embarked upon a career in nursing, we still had block training.

 

The pioneering Preliminary Training School was opened in January 1893 under an arrangement between Glasgow Royal Infirmary and St Mungo’s Medical College. The syllabus comprised of classes on elementary Anatomy, Physiology and Hygiene.

 

Strong sought to provide better living accommodation and working conditions for nurses too, and this was a bone of contention between her and the hospital authorities. The refusal to provide a nurse’s home at Glasgow Royal Infirmary was the cause of her resignation in 1885.   The rapid pace of change that she demanded may have been too much for the authorities and later, she was to say

 

I am afraid I was rather a troublesome woman. as soon as one step was taken, I proposed another.

 

After her resignation, she set up a small private nursing home in Elmbank Crescent. Many of her patients were referred by Sir William Macewan.

 

 

The 1891 census shows her at that address and records her occupation as Head of a Private Hospital. Also present are a housekeeper, two servants, two nurses and four patients. The patients are three adult women and one teenage boy so it is not possible to deduce whether the hospital had any particular speciality. Shortly after, she would once more be appointed as Matron of Glasgow Royal Infirmary, happy in the knowledge that the Nurse’s home she had fought for, had now been built.

 

Strong continued to work for the improvement of conditions for nurses even after retirement and in 1918, the Scottish Nurses Club was opened in Bath Street, Glasgow.

 

Strong’s relationship with Sir William Macewen is complex and confusing at times. Correspondence between them in the Royal College of Physicians and Surgeons in Glasgow reveals that Strong was certainly not inhibited in expressing her views to Sir William whilst at the same time the bond of respect and even affection between them, is apparent.  

 

The confusion in unpicking what is going on in any particular situation is added to by the fact that the Hospital Chairman and administrator was also named William McEwan, and Strong’s spelling of the names is not always consistent. She frequently gives both men the ‘Mac’ prefix and it can be difficult to discern between them.

 

Poor staffing levels were frequently a cause of tension (One might say What’s new?) and correspondence in the RCPS archives illustrates this. It also illustrates Strong’s own desperate need to be thought well of, particularly by Sir William. Typically, she threatens to resign over the matter, with the letter providing some insight into her state of mind.

 

Dear Dr McEwen

 

In the quietness of the night I wonder what the mystery of the last week has been. Everything in your wards seems to have gone wrong...

 

I have no doubt in my present state of health I may be unduly sensitive, and apt to magnify evils. I felt you were at enmity with me, and simply could not endure it after your true friendship towards me, and suddenly made up my mind to go away for a fortnight, hoping things will right themselves a little… as if your mind were being poisoned by someone, and if your own judgement after a three and a half years knowledge of me cannot stand it’s ground, then I must experience all the bitterness of a misplaced confidence-

 

I have quite made up my mind that April is to see the last of me in the GRI. I did not think it possible to have laboured as much as I have done & been so much misunderstood.

 

…We have been so accustomed to a pleasant look and word from you we cannot understand anything else… I should be glad to have a line from you to say if I have done anything to offend you.

 

Our number of nurses will be made up on Monday and you can get a little more help if the need still remains – I do think you were a little hard upon me – It would be quite easy for me to take the first woman who offers purely when a vacancy occurs. If I can get a better by waiting a few days, I prefer doing so.

 

Dr Macewen must have responded positively, as Strong replied

 

Your kindly note was most welcome. I shall now desire more benefit from my change. I hope to return to my work in a more healthy frame of mind than that in which I left it – I fancy molehills were becoming mountains to me.

 

She repeatedly expresses concern for the welfare of her nurses.

 

They have made no complaint but I noticed that they appeared a good deal fatigued. If … I ask if they are going out regularly, (they respond). “Well you see it is difficult, Dr Macewen’s visit is generally a long one & he does not like us to leave, & if we ask to do so, we are afraid he will think we have no interest in our work.

 

She explains how things have changed under her regime

 

…Night duty is not what it used to be. There is no taking of sleep during the night. All easy chairs are strictly forbidden & they have to be on the alert the whole night. 12 consecutive hours of this from 10 to 10 is very fatiguing. I speak from experience.

 

I have no probationers ready till March 1^st. ..The health of the 3 (other nurses) considerably improved after the lessening of the work, it seems a pity to overtax them again.

 

Strong’s relationships with junior medical staff were often fraught, with both parties engaging in a power struggle. She makes Dr Macewan aware of the situation and is clear that in the interest of harmony and patient care, he needs to do something to alter it.

 

I told Nurse McDonald yesterday she would be required to sit beside the patient in the side room of 22…Nurse McDonald refused, saying she took her orders from Dr Potts, & not Mrs Strong.

 

Nurse McDonald… distinctly states Dr Potts told her to disobey me – This is the second recurrence of this kind.

 

I told you on Sunday Nurse Ewing felt the work too much for her & that I would send Nurse Fraser … Dr Potts told her (Nurse Ewing) she was not to go (off duty) – I told her to change, and I would make the matter right… I leave you to judge whether it is seemly even in the event of a blunder to have any instruction disrespected.

 

…I do not think you can have peace in your wards unless some arrangement can be made whereby me & me only receives your instructions for arrangements.

 

While on her own admission, Strong was at times a ‘difficult woman’, there is no doubting her care for both the patients and the nursing staff. She sought to improve conditions for both, even when it involved taking on the hospital authorities and Sir William Macewan who she held in such high regard.

 

Rebecca Strong retired in 1907 at the age of 64 but continued to work to raise the status and conditions of the nursing profession. As a tribute, a Rebecca Strong Bursary was inaugurated for nurses’ post-graduate training.

 

Strong received an unexpected windfall the year after retirement. David McGowan, a well-known Glasgow confectioner, left her £6000 in his will. ( A not inconsiderable sum in those days). Whether he had benefitted from care in Glasgow Royal Infirmary, or whether it was simply a philanthropic bequest is not clear. McCowan also left similar amounts to his domestic servants.

 

Rebecca Strong supported the State Registration of nurses, something that brought her into conflict with the leading surgeons of the day. This eventually came about in 1919. Years after her retirement, she continued to promote an organised and professional system of nurse training.

 

At the age of 92 she spoke to a meeting at Glasgow Royal Infirmary before presenting exam prizes to nurses. She called for nurses to organise themselves more efficiently as a profession, reminding them that the medical profession had been just as disorganised in the past, so it was possible to make changes. From the foundation of the first course for student nurses in 1893…Glasgow Royal Infirmary nurses were now doing well in State Examinations and were obtaining Sisters and Matrons posts. The Scotsman reported that she spoke with ‘real vigour’ for one of her years.

 

In 1929 she went to Canada to address the International Council of Nurses in Montreal. (She would have been 95) and at the age of 96, Stong made a speech at a meeting in Glasgow Royal Infirmary. The newspapers reported that ‘She was remarkably active for a centenarian’.

 

On being awarded the O.B.E. in 1939, Strong received congratulations from Lord Provost Patrick Dollan, who stated that the award was not just ‘a great compliment to Scotland, but to the nursing profession as a whole’.

 

In 1942, the Mrs Strong medal in Medical Nursing was established at Glasgow Royal Infirmary and the following year she celebrated her 100th birthday on 23 August 1943. She received a telegram and a signed photo from the Queen. Dundee Royal Infirmary also presented her with an illuminated address. In the correspondence in the archive of the Royal College of Physicians and Surgeons in Glasgow there is a letter from Strong responding to congratulations sent by Sir William Macewen on the occasion of her birthday, acknowledging her debt of gratitude to him.

 

(I am) Very grateful for your kind congratulations. It was a very happy day surrounded by many tokens of loving remembering….I owe my success most of all to your family.

 

In a letter to another medic we glimpse her sense of humour in the midst of WWII rationing.

 

‘It was a very happy one….and (I) was able to join in a most sumptuous feast. Think the Ministry of Food might not have approved. The dear old GRI is never long out of my thoughts’

 

The Glasgow Herald of Friday Aug 20, 1943 published a feature on her life, outlining her biography and some of her post-retirement work, stating that she had travelled all over the world attending nursing conferences in Canada, Finland and other countries. She had met Mussolini, had a jamboree held in her honour at Banff in the Rocky Mountains, and for a time she had run a nurse’s home in Jerusalem.

 

Despite her advanced years, her attitude to modern nurses was progressive

 

‘I think they are just marvellous. I rejoice at the developments that are aimed at the improvement of nurses’ conditions. The modern and skilled nurse is a marvellous evolution…I have nothing but admiration for them’.

 

When asked to what she attributed her longevity, she responded

 

“Austerity! Hard work and simple living,”

 

Her nephew, Dr Charles Tisdall, reported that his aunt had shown the greatest interest in the Rushcliffe Report, which embodied many of her ideas for the profession. ‘But she has a dread of the profession becoming too standardised in the way of working hours and remuneration’ he said, It is also a horrible idea to her that owing to war conditions, women should be directed into nursing. She regards it as essentially a vocation to which one is called.

 

For all her complexities and agitations, and despite being ‘a troublesome woman’ it is clear that Rebecca Strong not only believed nursing was a vocation, she lived that vocation. While Nightingale, her mentor, is known to most schoolchildren, the name of Rebecca Strong and her enormous contribution to the health and care of the people of Dundee and Glasgow and beyond should be known throughout Scotland.

 

Strong died almost a year after her 100th birthday, on 24 April 1944. At the time of her death, she was living with her nephew, Dr Tisdall, at Vicar’s Cross in Cheshire, having moved there after her own property in Glasgow was damaged during the blitz in 1941. In her will she left £5,843.

 

Sources.

 

Letters from Rebecca Strong can be found in the papers of Sir William Macewen in the archives of the Royal College of Physicians and Surgeons, Glasgow. Access by appointment only.

 

The library of the Royal College of Physicians and Surgeons of Glasgow holds books on the history of Glasgow Royal Infirmary and also has some archive material relating to the hospital. They also have an excellent heritage section on their website. Further information can be found on their blog : Rebecca Strong – Remarkable Nursing Pioneer, written by Carol Parry

 

 

 

Further biographical details about Rebecca Strong can also be found on the Royal College of Nursing website

 

The London Metropolitan Archive also holds letters and other material about Rebecca Strong in the St Thomas’s Hospital Group – Nightingale Collection and in the letters of Henry Bonham Carter. Access by membership and pre-booking of material is safest if not local.

The museum at Glasgow Royal Infirmary established by the Friends of Glasgow Royal Infirmary also holds material about Rebecca Strong, Sir William Macewan, Joseph Lister and many other figures of note. Check their website for opening hours.

 

 

 

This piece is published with many thanks to to the archivists and staff of The Royal College of Physicians and Surgeons in Glasgow, and the London Metropolitan Archives, for allowing access to the collections and for their patience and assistance.