Rebecca Strong Part II.

Rebecca Strong Part II

Influences from St Thomas’s Hospital, London and the Royal Victoria Hospital Netley.

Introduction

Following on from my previous blog on Rebecca Strong, First Matron of Dundee Royal Infirmary and Glasgow Royal Infirmary, I became so fascinated by her story, I continue to research her life. A further visit to the London Metropolitan Archives uncovered some letters and random documents relating to her time at both  St Thomas’s Hospital and the Royal Victoria Military Hospital at Netley, as well as some interesting material revealing that there was discord in Montreal following the introduction of Strong’s model of nurse training in that city. With regard to the last, I will deal with this in a separate post, as it is interesting and reveals that Strong’s model of nursing education was not accepted happily and universally, and that when it ran into problems, hospital administrators consulted no less than the lady herself.

In this blog I will examine the ways in which Rebecca Strong was influenced by women such as Mrs Sarah Wardroper, Matron of St Thomas’s Hospital, and Mrs Jane Deeble, Matron of the Royal Victoria Military Hospital in Netley. In day-to-day life she had much more contact with them than she did with Florence Nightingale, who ceased to deliver nursing care after 1856.

Nightingale was involved in planning and in creating major public health initiatives. and while she set up the School of Nursing at St Thomas’s, it was Mrs Wardroper who had daily contact with the probationers. Strong came to respect Wardroper, but when she was a probationer, she and the Matron did not always see eye-to-eye.

As recounted in the previous blog, Strong hated her time at the Victoria Military Hospital in Netley to the extent that she wished to resign. An account from Mrs Deeble to Mrs Wardroper showed that she did not think much of Strong and her colleagues, believing them to be snobbish and above themselves. On discovering more, it appears that this might have been an unjust interpretation, and that Strong and her colleagues were simply the victims of an ongoing disagreement between Florence Nightingale and Mrs Deeble about the training of military nurses.

Strong’s account of working and living in St Thomas’s temporary hospital gives us further insight into influences on her subsequent career. Despite having lived within half a mile of St Thomas’s Hospital for over 20 years, I had until now, no knowledge that it had ever occupied a temporary site, so I find Strong’s writing both interesting and informative.

The various documents discussed are not necessarily related to one another but I shall do my best to create some sort of coherent piece out of them in order to tell a bit more of the story of the woman who was surely the most influential nurse in Scotland (Alumnus of Edinburgh Royal Infirmary may choose to disagree, citing Angelique Pringle, one of their early Matrons who was also a Nightingale nurse, for the title). My money is however, firmly on Rebecca Strong, though as an ex-Dundee Royal Infirmary and Glasgow Royal Infirmary nurse, I admit to my bias.

Mrs Sarah Wardroper

While Florence Nightingale is given credit for the reform of nursing in St Thomas’s Hospital in London, the beginning of these reforms was before Miss Nightingale’s time.  Miss Sarah Savery who was Matron from 1816 to 1840 set out to recruit a better class of Sister who would be more suited to delivering care and taking responsibility for the patients in the hospital.

This progress continued with the appointment of Mrs Sarah Wardroper in 1854. Wardroper was the widow of a military surgeon and mother to four children. (Any woman who can reform a major hospital while raising four children must be impressive). She was known for her efficiency and her leadership. It is often said that she began by tackling drunkenness among the nurses, which in turn improved sobriety in the patients, though the issue of the ‘Sarah Gamp’ nurse has been somewhat overstated.

While demanding disciplined behaviour, Wardroper was also keen to improve conditions for nurses. She ensured that her nurses were well fed and that they had a good standard of board and lodging. Tasks such as scrubbing floors were no longer to be done by nurses and these were hived off to domestic servants or ‘scrubbers’. Strong would later adopt this model of care for her staff in both Dundee and Glasgow Royal Infirmaries and indeed it was the lack of a decent nurse’s home that was the cause of her resignation from GRI. She would not return until this had been remedied.

When the Royal’s first nurses’ home opened in 1888 and provided eighty-eight bedrooms, linked to the main building by a glazed corridor (the chicken run) it was the catalyst for further improvements for nursing staff.

On Strong’s return to Glasgow Royal Infirmary in 1891, she found that there was still a distance to go and under her leadership, the quality of food was improved, a monthly holiday was introduced, working hours were reduced and other measures were taken to improve conditions and safeguard the health of the nurses.

By the time I was resident in the Nurses Home, though the glass corridor with its grapes and statue of Miss Nightingale remained, the place definitely had an air of faded glory. One could see though, that it must have been a splendid edifice in its day. Rebecca Strong would be deeply grieved to discover that it is now (I think), offices.

Improvements to the nursing service at St Thomas’s Hospital meant that when Florence Nightingale returned from the Crimea, she chose to base her school of nursing there. Mrs Wardroper was put in charge of nurse training and it was she who recruited and trained the first 15 probationer nurses when the school opened in 1860. Her aim was to produce skilled nurses who were punctual, quiet, trustworthy and clean in habit. She was particularly keen to recruit the widows of military men, believing them to have the necessary qualities. We know that Strong was not in fact a widow, though she claimed to be. Did she perhaps also claim that her ‘late’ husband was a soldier, thus facilitating her entry to the Nightingale School of Nursing? This is, of course, conjecture, but it might offer an explanation as to how the daughter of an East End publican ended up a student at the most prestigious school of nursing in the country.

Mrs Wardroper’s probationers had clear standards of behaviour and to ensure they were well presented and looked professional, they wore a uniform of brown dress, white cap, and apron. It was largely due to the effort of Sarah Wardroper that Nightingale’s school led to the transformation of nursing as a respectable profession for women. Nurses who trained there went on to spread the reforms across the world. When Mrs Wardroper retired at the age of 74, over 50 future Matrons had been trained at the Nightingale School. On her death in 1892, a memorial to her was set up in the chapel at St Thomas’ Hospital. It is a depiction of the ‘Good Samaritan’ manufactured in the (then) nearby Doulton factory in Lambeth. The inscription reads

A faithful servant of God and man. The working leader in a great reform quietly and peaceably pursued by which the care of the sick took its right place as a high and holy calling that enlists the noblest qualities of heart and mind and turns to efficient use the intelligence, refinement and devotion of good women. For 33 years Mrs Wardroper rendered faithful service as matron of this hospital. Selected by Florence Nightingale as the first Superintendent of the School of Nursing established by her in this hospital. She was successful during the last 27 years in training and sending out into our own and other lands capable women worthy to carry on the good work. She retired from her post in June 1887 and died at East Grinstead on the 14th day of December, 1892 in the 80th year of her age.

One might think that with this fulsome testimonial there is little more to say, but there was far more to Mrs Wardroper than just ‘quietly and peaceably’ taking care of the sick. She was more than capable of fighting her corner in the interest of her patients and nurses, and she was the role model for generations of capable and feisty Matrons such as Rebecca Strong,

St Thomas’s Temporary Hospital, Surrey Gardens

Not long after the School of Nursing opened at St Thomas’s Hospital, the hospital was forced to leave its Southwark site due to railway engineering works at London Bridge Station. The new (and continuing) site at Albert Embankment in Lambeth had not yet been built upon so the hospital was temporarily relocated to Surrey Gardens, close to Oval Station, for almost a decade. This site was previously home to a music hall and a zoo.

Rebecca Strong gives us a detailed and sometimes amusing insight into conditions there. The following is an edited version of an article titled,  ‘Some Impressions of St Thomas’s Temporary Hospital in Surrey Gardens in the ‘Sixties’.

The fabric was a huge glass building that had been used for entertainment. It was converted by placing a floor half way up. There was a wooden partition running the length of the upper floor, some eight feet high, and another, crossing it, thus making four wards, each with 22 beds. Two were for medical, and two were for surgical patients. Two large fireplaces back to back in the middle provided heat…I leave the want of silence to the imagination!

Strong then goes on to describe how one Sister was in charge of the 88 beds. One day nurse and two probationers were allocated to each ward, along with a ‘scrubber’. During the night, there were two nurses for the 88 beds, but no supervision apart from visits by Mrs Wardroper..The top floor was completed by a bed-sitting room for the Sister and an operating room that doubled as a side room for very sick patients.

The ground floor had a large accident ward for men, an out-patient unit and a dispensary which doubled as a chapel on Sundays. (Presumably women, being still largely confined to the domestic sphere, were thought not to require the service of an accident ward.)

Strong recounts

(On the ground floor)

The kitchen was also the operating room, the mere mention of which, is I think sufficient! Imagination may complete the picture…You can readily understand the terrible results of such an arrangement – no sterilizers and none of the precautions taken today….Unfortunate wounds were treated with linseed poultices spread on tow…I am surprised the death rate was not higher.

Describing Mrs Wardroper –

(She) worked single-handedly visiting the wards occasionally at night, as well as by day. As there was no covered path from her house, she wore a bonnet and shawl. She was a woman of remarkable character which is proved by the condition of St Thomas’s compared to other hospitals. I had many talks with her and knew that there was not a sober woman in the hospital when she took over. Her only assistant was a sister in charge of the probationers.

One can imagine that Strong’s experience in the temporary hospital did much to influence her later attitude to nurse training and her insistence on good living conditions.

There was no provision for the social life of the probationers, and no sitting room. Their dining room was used exclusively for meals, except for an occasional class. There was no night duty. Hours were from 8am to 8pm with two hours off in the afternoon. There were certainly no (whole) afternoons or days off unless specifically asked for. One and sixpence a week was allowed for laundry and 3oz of tea, as the probationers made their own tea. Food was prepared in a kitchen attached to the dining room. It was plentiful and good. Uniform was worn both indoors and out, the latter being the celebrated shawl and bonnet. The aprons were tied around the waist, not the smart ones of today.

I do not remember about written exams, but if there were any, they were very simple.

The probationers were interviewed each year by some relative of Miss Nightingale’s; quite a little ceremony. They were assembled in Mrs Wardroper’s house, introduced individually, then given a little address. After a year we were supposed to be fit pioneers for the reform of nursing at home and abroad.

In the last paragraph, perhaps there is more than a hint of amused cynicism, both about the ceremony and their supposed ability as nursing pioneers.

Mrs Jane Deeble (In some documents she is referred to as Mrs Deebles).

Strong first encountered Mrs Deeble at the Royal Victoria Military Hospital at Netley. She does not write of her relationship with the Matron of the Military Hospital in the same way as she writes of Mrs Wardroper, but we do know that she was distressed and unhappy during her time there and desperately wanted to leave, as did some of her colleagues..

Learning more about the politics between Mrs Deeble, Mrs Wardroper and Florence Nightingale, and the conditions in which the Sisters from St Thomas’s worked and the expectations placed upon them in the military hospital,  perhaps helps us to understand their unrest.

In an interesting blog titled ‘The Life and Times of Florence Nightingale’ Lee Higgins names the Sisters who were sent to Netley as pioneers. They were Rebecca Strong, Jane Kennedy, Jessie Lennox, Lucy Emm, Lucy Wheldon and Ann Clark.  After a short time, Lucy Emm was dismissed and replaced by Emma Berry.

Mrs Jane Deeble was widowed when her husband was killed in 1867 during the Abyssinian Campaign.. She was left with three children to raise. She entered the Military Establishment in 1869 having herself been a probationer in the Nightingale Training School at St Thomas’s Hospital. She became Superintendent of the Nursing Sisters at Netley and in 1870, Lady Superintendent of the Army Nursing Service, a post she occupied until 1889. She is said to have been a ‘homely’ type of woman and is credited with saving the Army Nursing Service as her aristocratic predecessor, Jane Shaw Stewart was not held to be a success.  Shaw Stewart had a volatile temperament, and on occasions, even physically chastised her nurses.

Deeble was appointed to the military after an interview with Florence Nightingale despite the latter reporting to an army doctor,

‘She (Mrs Deeble) is brave, sincere, courageous-but she has no observation-she is quite incapable of understanding far less of making a Regulation or an organisation… Any officer may turn her round his finger. She will be engaged in planning a nice tea for the Nurses, while she lets the Nursing go to ruin… I have not approached the subject of the Regulations yet with Mrs. Deeble. I doubt whether she has seen them. I doubt whether she is able to understand them. I doubt whether she has a glimmer of the fact that she is to have a personal relation with and report to the War Office.’

Even with this excoriating report, Deeble was appointed to the Matron’s post. This might have been because the War Office preferred to appoint  women who were the widows of army officers, believing them to be more amenable and more likely to understand and comply with army regulations.

One wonders about Nightingale’s motivation for giving Deeble such a damning report.

In order to unpack this, we need to know about the tensions and competitiveness that existed between female army nursing and female civilian nursing and the ways in which both camps struggled to be accepted by the male medical establishment. This was further complicated by the presence of religious sisterhoods in nursing..

While all three groups aimed to improve standards of nursing care, the religious sisterhoods saw nursing in terms of personal vocation and spiritual opportunity. To the dismay of both Nightingale and Deeble, the War Office was keen on the work of the sisters as they saw them as more pliable and amenable than the Nightingale or Netley nurses. There were both Anglican and Roman Catholic sisterhoods involved in the development of nursing and this also led some to express anti-Roman Catholic sentiments, not the least of whom was Florence Nightingale.

In a letter to Lady Cranworth she said

Dr Andrew Smith tells me he wishes to see female
nursing in the Victoria Hospital near Southampton but done by Nuns!!! (He
is a Roman Catholic convert …

Lady Cranworth agreed on the necessity of

…keeping all thought of these dreadful
Nuns out of Dr A. Smith’s head. 

Nightingale had been consulted on the planning of the Royal Victoria Hospital at Netley, but on her return from Crimea she found that the building was well underway and her suggestions had not been adopted.. She wanted the 1000 bed hospital to be built in a series of separate pavilions as a means of infection control,  but this idea was side lined in favour of one enormous building with one long main corridor. Aggrieved and angry, she demanded that construction be halted and that her original design be reverted to. The War Office refused on the grounds that they had already spent £70,000 on the building but after protracted discussions resulting in minor modifications, an uneasy truce was reached.

This incident resulted in Nightingale’s relationship with the military becoming strained. It was not improved by the appointment of Mrs Deeble as Matron of the new hospital.

Deeble believed that Netley was the only place capable of training army nurses, whereas Florence Nightingale felt that all nurses should first be trained in St Thomas’s Hospital before military deployment. She was incensed that the War Office agreed with Mrs Deeble that military nurses ought to be trained at  Netlley.

In 1882. Mrs Deeble took a combined group of fourteen Netley and Nightingale trained nurses to South Africa during the Zulu War. They went on to do great things and Mrs Deeble was commended for ‘conspicuously good service’.

She was decorated by Queen Victoria and as I write, her South Africa Campaign Royal Red Cross medal pair is currently up for sale. Much as I might wish to bid for them, I am grateful to Noonans Mayfair Auctioneers, who have kindly allowed me to use their catalogue image in this blog instead. These medals were the second set to be awarded to a nurse, the first being awarded to Florance Nightingale.

It is hard to say whether Nightingale was pleased or put out by Deeble’s success, but it was against the background of the competitiveness between military nurses, civilian nurses and religious nursing sisters, that Strong and her colleagues were sent to Netley. In retrospect it all seems a bit daft, as all three were only interested in improving the quality of nursing care, but as we know, significant developments of most types are rarely straightforward and they are often subject to competitiveness and squabbles.

A document in the London Metropolitan Archives reveals that the rules and regulations at Netley were strict. Not only were they formulated to encourage high quality nursing and disciplined behaviour, they show that on the introduction of female nurses to military hospitals, there was an underlying fear of fraternisation and immorality occurring. In this edited version, one can see how young women, even at that period in history, might have found the rules irksome.

Regulations for the Nursing Service at Royal Victoria Hospital Netley

No Sister was to be appointed under 30 or over 40 years of age.

No gifts to be accepted from patients or relatives.

Nurses must be literate and of good conduct

Sisters will be issued with a badge and a regulation dress to be worn at all times…three good grey gowns, six aprons, six caps, six collars, one bonnet annually, one summer and one winter cloak every three years.

Those dismissed for misconduct will forfeit all regulation clothing, those leaving voluntarily will forfeit everything issued in the past year.

Hours of recreation and exercise are to be set by the Superintendent.

Sisters require written permission to leave the hospital outside prescribed exercise time.

Guests are permitted only on days and times prescribed by the superintendent.

Sisters are to have eight hours sleep and two hours recreation daily in the fresh air, when possible.

A Sister will be appointed to every ward except venereal and convalescent. (It was thought improper for women to nurse men with venereal disease, and it was believed that there was a greater risk of convalescent men forming relationships with Sisters.)

Sister are to work the hours the Superintendent dictates.

Sisters are to report any orderly breaching discipline to the superintendent. Foul language on the part of an orderly or a patient are also to be reported.

Medicines, wines, spirits and malt liquors are to be administered by the Sister in conformity with the orders of the medical officers.

Sisters are to limit communications with officers as far as possible. They are to combine personal reserve with strict and respectful obedience to officers, and to show courtesy and kindness to NCOs and men.

The somewhat daunting list of edicts must have been a challenge as even minor infringements were penalised. Given that many of the sisters, including Rebecca Strong, had been married women coping with the demands of husbands, households and children, this rather infantilising moral guardianship approach must have been especialy irksome and frustrating.

In conclusion, I think we can see from these various documents, some of the influences for good that Strong carried forward into her own time as hospital matron and nurse educator, as well as finding a possible explanation for her unhappiness whilst a sister at the Royal Victoria Hospital, Netley.

Some Resources

An account of St Thomas’s temporary hospital by Rebecca Strong. The Nightingale Fellowship Journal Commemorative Number XIII (May 1935)  London Metropolitan Archives

Palace of Pain: Netley, the hospital built for an empire of soldiers. ‘The Guardian’ 21 Aug 2014

Regulations for the nursing service at Royal Victoria Military Hospital  Netley – London Metropolitan Archives.

‘The Life and Times of Florence Nightingale’ – Lee Higgins Blog

Women as voluntary and professional military nurses in Great Britain 1854-1914 Summers, Anne (1986) PhD Thesis, Open University.

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