The Nightingale Shore Murder

by Rosemary Cook

  Meanwhile, on the practical side, Liverpool was divided into 18 districts, deliberately made coterminous with parishes or groups of parishes in order to foster the cooperation of the clergy; although the service was strictly non-denominational. A lady or committee of ladies was appointed to superintend the work of each district (but not, as they were not themselves nurses, to supervise the nurses). The lady superintendent’s duties were to visit – in person or by deputy – all cases under treatment, to ensure that the nurses were ‘working faithfully and well’. She examined the nurse’s register of patients and heard reports on patients; and arranged the supply, custody and distribution of medical appliances. The superintendents also kept memoranda of expenses incurred, and articles lent. Alongside district nursing, Liverpool had instituted that much less appreciated species, the health service manager.

  As a city, Liverpool took great pride in its role in the invention of district nursing. At the 1909 Jubilee Congress, celebrating 50 years since William Rathbone’s engagement of Mrs Robinson, the Lord Mayor of Liverpool said with evident satisfaction:

  ‘I do not know that Liverpool has ever distinguished itself by any theory for the reconstruction of the world, but no town has ever been more ready to suggest or more glad to execute any practical scheme for the alleviation of any practical need, than Liverpool has been.’

  It was a friend of William Rathbone’s, Charles Langton, who instituted another practical aspect of district nursing that would shape the working lives of Florence Shore and Mabel Rogers, along with thousands of other district nurses. He suggested that, rather than being isolated in lodgings or rooms of their own, district nurses should be accommodated together in a ‘district home’, under the supervision of a professionally-qualified matron. This would allow them to support each other, and learn from each other’s experiences. It also allowed the matron to ensure that they were engaged in proper nursing and not in ‘poor relief’ – a major concern of Florence Nightingale’s, who felt that acting as welfare agents ‘demeaned the noble art of nursing’. With training, nurses’ homes and a service in place, the ‘Liverpool model’ (or the Rathbone/Nightingale model) spread rapidly to other cities. In 1868, the East London Nursing Society was founded on a similar model, although without the district homes. The Metropolitan and National Nursing Association, initiated by the Council of the Order of St John of Jerusalem, and supported by the Duke of Westminster, was set up 1874; and most of the other major cities in England followed suit. Florence Nightingale was in no doubt of the success of this new model of nursing:

  ‘As to your success’ she wrote, ‘What is not your success? To raise the homes of your patients so that they never fall back again to dirt and disorder: such is your nurses’ influence. To pull through life and death cases – cases which it would be an honour to pull through with all the appurtenances of hospitals, or of the richest in the land, and this without any sickroom appurtenances at all. To keep whole families out of pauperism by preventing the home from being broken up and nursing the bread-winner back to health. To drag the noble art of nursing out of the sink of relief doles. To show rich and poor what nursing is, and what it is not. To carry out practically the principles of preventing disease by stopping its causes and the causes of infections which spread disease. Is not this a great success?’

  William Rathbone’s own assessment of his scheme, in his history of district nursing, was simply that it was ‘the story of a successful experiment’.

  Chapter 13

  ‘Do not be discouraged’

  Successful it certainly was, but success is not always enough. The achievements of the district nursing service in each area were entirely dependent on the funds that could be raised locally by the Lady Superintendents to pay for it. Funding the training schools and the nurses’ wages and accommodation was a constant struggle, replicated in districts across the country, year in and year out. Then, as Queen Victoria celebrated the golden jubilee of her reign, everything changed for district nursing.

  The ‘Women’s Jubilee Fund’ was set up to collect money from across the country as a celebratory offering to the Queen; and in 1887, the Queen assigned the bulk of it to support the work of trained nurses caring for the sick in their own homes. A committee of three Trustees was appointed, headed by the Duke of Westminster, to decide how best the funds should be used to achieve this. In 1888, Sir Rutherford Alcock, one of the Trustees, wrote to The Times newspaper, enclosing the Report of the Committee. It recommended that the Women’s Jubilee Fund of £70,000, producing income of around £2,000 a year, should be applied ‘to found an institution for the education and maintenance of nurses for tending the sick poor in their own homes’. A provisional committee, including William Rathbone, who was by now an MP, was appointed by the Queen to settle details of the projected charity. The Metropolitan and National Nursing Association was established as the core of the London training school, with the Liverpool Association affiliated to it. The following year the ‘Queen Victoria Jubilee Institute for Nurses’ was established by a Royal Charter, and William Rathbone became Vice President to the first Council of Trustees of the Institute. The principal charitable objectives of the new Institute were set out in the Charter:

  ‘The training, support, maintenance and supply of women to act as nurses and midwives for the sick poor and the undertaking of preventive and supervisory work for securing their health and the health of their children.

  The establishment (if thought fit) of a home or homes (including training homes) for such nurses and midwives and of maternity hospitals for the instruction of such nurses and midwives and clinics for their instruction in child welfare.

  The co-ordination and supervision of centres for any of the aforesaid purposes and generally the promotion and provision of improved means for nursing the sick poor and securing their health and the health of their children.

  To co-operate with other Corporations, bodies and persons in carrying out any of the above objects with power to make grants of money to such Corporations bodies and persons in furtherance of such objects.

  To establish branches of the Institute in the United Kingdom or elsewhere with a view to aiding or advancing the main objects of the Institute.’

  It was to this Institute, just eight years after it opened its doors, that Florence and Mabel came for district nurse training mid-way through 1897.

  Florence Nightingale had had a lot to say about the selection and training of district nurses. Specifically, she considered that the district nurse:

  ‘… must be of a yet higher class and of a yet fuller training than a hospital nurse, because she has not the doctor always at hand; because she has no hospital appliances at hand at all; and because she has to take notes of the case for the doctor, who has no one but her to report to him.

  In hospitals and infirmaries they may say “Where everything is provided, it is easy to be clean and airy, orderly and godly, but look at us in our one room – and a sick person in it into the bargain – and with no appliances”. Here the trained district nurse steps in. Here, in the family, she meets them on their own ground.’

  She was also very keen on the potential for district nurses to be what she called ‘health missioners’ – teaching people how to look after their health and to care for themselves when sick, and showing by example the standards of cleanliness and good order which would speed recovery and prevent complications.

  ‘We hear much of ‘contagion and infection’ in disease’ she wrote in 1890. ‘May we not also come to make health contagious and infectious? The germs of disease may be changed into the germs of health.’

  So Florence and Mabel’s district nurse training at the Jubilee Institute covered not only the understanding of diseases and treatments, but also how to ‘put the room in nursing order’, and the principles and practicalities of public health. The examination in hygiene in 1898 tested candidates with the following questions:

  ‘What are the two particular dangers against which we hav
e to guard in the case of indoor air? Mention Nature’s chief agencies for keeping outdoor air fresh, and how far we must copy these indoors.’ (The answers were ‘Impurity and Stagnation’ and ‘Wind and Rain’, with emphasis on ventilating the sick room in order to change the air three times an hour.)

  ‘What are the three essentials to absolute safety in the water carriage system of drainage, and describe each.’ (The soil pipe must be outside and the pipe under the closet must be trapped; there must be good ventilation around the soil pipe; the soil pipe should be as straight as possible, made of lead, with perfectly fitting joints. Overflow pipes ‘should be warning pipes … to tell when water is wasting from too full cisterns, baths, etc; they should not be connected with waste-water pipes, but be carried straight through the outside wall over a drawing room window or anywhere that they will attract notice to waste going on.’)

  ‘What do you understand by cubic space? How large must a room be for safety if three people, one child and one dog are to sleep in it, and it is lighted by one ordinary gas-burner?’ (Cubic space is ‘the amount of space obtained by length, breadth and height together … a person should have 1,000 cubic feet of air space with proper ventilation in a sleeping chamber … and this amount of air space is what is demanded for every prisoner in England by law.’ The room should be 25ft by 25ft by 12ft, to contain three people, one child, one dog and one gas burner. A dog, the nurses were required to know, needs 300 cubic feet of air.)

  A Queen’s Nurse textbook from 1889 illustrates the breadth of practical knowledge and skills, and the spirit of resourcefulness and invention, to be instilled into the students. It was written by Mrs Dacre Craven, formerly Florence Lees, a ‘Nightingale nurse’ from St Thomas’ Hospital, and the first Superintendent General of the Metropolitan and National Nursing Association. Her book, ‘A Guide to District Nurses and Home Nursing’ was written for trained district nurses, and starts by repeating Florence Nightingale’s assertion that ‘For district nursing, a better class of woman and a higher education are needed than for a hospital nurse, or even for a hospital Superintendent.’

  Its contents include, under ‘Personal qualifications’, chapters on ‘Management and Tact’, and ‘The Nurse as Sanitary Agent’. In the section on ‘Arrangement of the Sickroom’, there are chapters on ‘How to remove Furring and Stains from Utensils and from Pans of WCs’; and ‘Extemporary Outside Blinds’. The section on ‘Cleanliness’ is lengthy and includes ‘Cleansing teeth and gums’, ‘Preventing Bed-sores’, ‘How to get rid of Vermin that may infest Beds and Bedding’, and ‘How to extemporise Bedpans, Urinals and Spittoons’. Amongst the more clinical tasks, it covers ‘How to perform Last Offices for the Dead in a room occupied by the Living’.

  Fortified with this knowledge, Florence Shore and Mabel Rogers passed their Institute exams and were entered onto the Roll of Queen’s Nurses in December 1897. Florence was Queen’s Nurse number 947; Mabel’s Roll number was 915.

  It was the practice of the Institute, once a nurse had completed her district training and been entered on the Roll, to deploy her wherever there was a vacancy. Since district nurse posts had to be paid for by funds raised locally, and success in doing so relied on the energy, inventiveness and persistence of the local Lady Superintendent, the availability of posts did not necessarily match the degree of local need. Nor did it matter where a nurse might want to work. If funds could not support a Queen’s Nurse (and lodgings, and a horse or donkey and trap for their travel), then there might only be a ‘village nurse’ instead. These were local nurses who had received less training, and were not regarded with nearly the same respect as Queen’s Nurses.

  So it was almost certainly not by choice that, when Florence and Mabel completed their training as Queen’s Nurses in 1897, Mabel was sent to work in Sunderland, while Florence went to Reading. This must have been a wrench for the two women, who had been great friends, and worked and studied together almost continuously for the last four years. Perhaps it was this separation, and the prospect of starting a new job alone in a new town, that affected Florence’s mood, and led to the words of encouragement contained in another letter from her godmother, dated 8th December 1897:

  ‘My dear Florence Shore – If you will allow me to call you so. I am very fond of the name of Shore. Thanks for your kind letter. Let me send you £2 2s for your little clock. I hope this will be enough to get you a serviceable clock. Do not be discouraged, for you are discouraged. You will find the real joys begin when you are actually at work, or rather, perhaps, you will find then that you do not want joys. I should like to hear from you from Reading if you are so good as to write to me. I think District Work brings one more in heartfelt contact with one’s fellow creatures than anything else. And when one knows that doctors who know say that the mere visit of the Nurse diminishes the mortality, one thanks God who puts such God-like powers into our hands, provided they are genial hands. Excuse haste and pencil – Ever yours, F. Nightingale.’

  Florence Shore wrote back quickly:

  ‘Thank you very much for your very handsome present: indeed it is much more than I expected. I shall value my little clock very much indeed. Thank you too for your kind words of comfort. I do indeed mean to put my whole heart into my work and hope that I may be permitted to be of a little use and comfort to some of my fellow creatures. I am going to Reading next Thursday.’

  Florence bought a Mappin carriage clock with her godmother’s gift. She also had another, more important wish granted – after a year at Reading, in December 1898, Florence joined Mabel at the Sunderland District Nursing Association. The two women worked there together for most of the next fourteen years. Most, but not all, because it was during this time that Florence and Mabel joined the Army Nursing Reserve. Less than two years into their time at Sunderland, they embarked on their first overseas nursing experience, when they were sent to South Africa during the second Boer War.

  Chapter 14

  ‘Many honourable women’

  Many nurses from the Army Nursing Service were already war veterans by the time the second South African war started in 1899. The Service had been formed in 1881, and its members had served in Egypt and the Sudan. They included many who would become famous names in the First World War in due course, including Maud McCarthy, later Matron in Chief of the British Expeditionary Force in France. By the time the Second Boer War began, in 1899, Queen Victoria’s daughter Princess Christian had formed an Army Nursing Reserve, which Florence and Mabel joined. Nurses from both the main service and the reserves were sent to help tend the wounded and nurse the local people held in the British-run refugee or ‘concentration’ camps in South Africa. They also helped to staff field hospitals close to the front lines of the war. The Nursing Notes journal of 1904 had no doubt about the need for the new service, and in particular the service of the women nurses:

  ‘One very definite good has been a direct outcome of the war in South Africa, and that is the reorganisation of Army Nursing upon a basis which gives every promise of excellent results in the near future. The absolute inadequacy of the Army Nursing Service to meet the requirements of war on a large scale, became evident within the first few weeks of the Boer War. Up to that time there had been some obstinate clinging to the old prejudice against the presence of women within sight or sound of battle; those in authority refused to recognise the fact that times had changed, and that with the next serious war the services of fully trained nurses would surely be demanded. The employment of Civil Surgeons, accustomed to depend largely on the help of the nurse for the best results from their own skill, undoubtedly hastened the severance of the red tape swathings which had hitherto prevented the expansion of the Service. South Africa proved once and for all that where there are wounds and sickness there also must be the trained nurse…

  When we realise that the Army Nurses available for active service at the beginning of the war numbered less than 100 all told, that the Army Nursing Reserve consisted of only some 200, and that the to
tal number of nurses employed in South Africa amounted in round figures to something like 800 before the struggle ended, instead of being surprised at the failures which occurred we can only wonder that the ‘undesirables’ were on the whole so few.’

  The Second Anglo-Boer War, or South African War, began in October 1899, after years of tension between the British and the Boer South African leaders. First Transvaal and then the Orange Free State declared war on Britain. It lasted until the Surrender of Boer Independence in May 1902. Joseph Chamberlain, who, as Secretary of State for the Colonies was formally responsible for South African affairs, is quoted as saying that the man in the street ‘knows perfectly well that we are going to war in defence of principles [such as peace and good governance] – principles upon which this Empire has been founded and upon which alone it can exist.’ This was not, however, the whole story. One commentator added:

  ‘Chamberlain did not however, mention the need to preserve British authority in an area containing one of the principal life-lines of the Empire in the Cape sea route to India, the Government’s desire to stop foreign infiltration into that region, and its wish to see that if the Transvaal continued the strongest province in Southern Africa it should do so under British auspices.’

  So war was engaged in South Africa, and after some serious initial setbacks, the British troops began to prevail. It was in 1900 that Brigadier General E Y Brabant suggested setting up protected camps for those townspeople who had surrendered, and for the families of neutrals, non-combatants, and men ‘on commando’ – that is, fighting outside of the organised ranks of the South African forces. The need for such refugee camps was exacerbated by the British ‘scorched earth’ policy, which destroyed homes and farms, leaving the families homeless and unable to grow food to feed themselves. In addition, some families were removed to the camps with the idea that this would persuade their menfolk to stop fighting in order to retrieve and look after them.