Edith Cavell

by Diana Souhami

  The Berkendael Surgical Institute “with two beautiful theaters and eleven rooms for patients” was on the opposite side of the street. Antoine Depage was forty-five, energetic, a professor at the University of Brussels, and frustrated by poor standards of hospital provision in the city and the monopoly of nursing care by nuns, notably the Sisters of Charity of St. Vincent de Paul. Despite opposition by the Catholic Church to the secularization of nursing, he campaigned in the universities and hospitals for change. In his own medical units, aided in the enterprise by his wife Marie who was also a nurse, and with Edith Cavell as head matron, he intended to set the new standard.

  Depage could not have appointed anyone more dedicated and conscientious than Edith Cavell. Her School was to be a hospital, a private nursing home, a training school for nurses and an agency for finding them employment when they qualified. She intended to bring all her good sense and determination to the challenge. But she arrived to find Depage had no effective support structure or secure funding to offer her. Single-handed she worked to impose the standards of the London Hospital and of Florence Nightingale on what started as a Belgian family concern. She was alone in an unfamiliar setting, far from work colleagues, family and friends. Though her French was fluent she had not spoken it for a decade and she had to learn a medical vocabulary.

  She took her old matron Eva Lückes as her role model and guiding light. She turned to her for support, guidance and encouragement. In her first two years in Belgium she wrote frequently to her, voicing anxieties, seeking help and advice, reporting on progress, and mainly asking her to send out qualified nurses to teach at, and staff, the School and Berkendael Surgical Institute. Eva Lückes did all she could. Despite her sharp comments, she was diligent in helping the nurses she had trained and her interest in them lasted throughout their working lives.

  The School opened, makeshift though it was, on October 1: the interconnecting doors were cut between the houses; the furniture arrived; there were four patients with more anticipated, and the four probationers began their lectures in elementary anatomy and physiology, hygiene, internal diseases, the administering of drugs and general nursing.

  Dr. Antoine Depage (1862–1925)

  Each day brought problems. In response to Depage’s request for a matron for his Surgical Institute Eva Lückes sent over a Miss Linda Maude. “I am most grateful to you,” Edith Cavell wrote, “and feel sure she will be most useful to us.” Miss Maude was to work as Edith Cavell’s assistant until the Institute was ready. But from the start her French was most peculiar and “Monsieur Depage was quite unable to understand what she said. I hoped she would soon become more proficient as she would hear it spoken but she seems to find it very difficult. Also she does not fall in easily with the manners and customs of the people. Depage thought it would give a bad impression to his clients. She’s very disappointed.” He appointed a Belgian matron and Miss Maude was made superintendent to the nurses. As for the three English-trained nurses he had asked Edith Cavell to find, he did not wait for her to achieve this, but hired three Dutch nurses instead “as they do not expect so much salary.”

  He was a difficult man to work for: impulsive and short-tempered. When there were disagreements, his wife Marie tried to conciliate. As for the Ladies’ Committee, comprised of well-heeled Brussels women, they were, Edith Cavell said, “on the whole very nice,” pleased with her management and keen for the project to succeed, but they were apt to intervene erratically or not be around when decisions needed to be made: “A few are anxious to limit one’s authority and even object to my offering tea to the people who call! I feel this is a little hard under the circumstances.”

  Nor did the doctors or patients conform to the English model. “The doctors are unused to being waited on. They even would help to make beds and draw the sheets if I would let them.” And then there were their liberal views on “passing the male catheter.” Edith Cavell asked Eva Lückes to give her opinion in writing: “The doctors here hold that all nurses should do it and that it should be part of their work. It has been brought up continually against the nuns that they are not allowed this work and unfortunately into the doctors” attitude to the question enters a little political feeling. The nuns, for them, represent the Catholic party who form the government by a vast majority and as the School is supported by liberals, the ways of the nuns are anathema. I am very anxious that we should adopt the English idea here and that the nurses should only do it under quite exceptional circumstances. If you would be so very kind as to send me your opinion on the subject (not for myself of course as I know it so well) it would have a good deal of influence. I have also written to Miss Van Eck in Holland and Miss Elston in France to know what is usual in those countries.’

  She did not want her nurses to be obliged to handle men’s genitals—only “under quite exceptional circumstances,” presumably like unconsciousness or dementia. It was all too lax and familiar and most unlike the London. And the patients’ friends were another problem. “They go into the kitchen and return with broth or other things to give to the patients or order their meals for them. One woman I found sitting over the kitchen fire in close conference with the cook, having been there the greater part of the afternoon … Dear Matron, I hope I do not weary you with all these details.”

  Such disregard made it hard for Edith Cavell to assert her authority the way an English matron must. Her main problem was in finding young women whom she considered to be of the right class to sign on as probationers. As a profession, nursing in Belgium was held in even lower esteem than in England in the 1860s. The nuns did it as a supposed service to God, but it was not regarded as a respectable job. Nor were the salaries offered by Depage an incentive. And Edith Cavell had quickly to modify her dream that all her teaching staff and senior nurses should be trained at the London, for even had the pay been good and the work appealing, not many English nurses spoke French.

  Recruiting domestic staff was difficult too. They thought it demeaning to take orders from nurses or to serve them their meals. In the psychology of service it mattered that the served should be of superior social standing.

  By the end of 1907 Edith Cavell had five probationers: Clara Böhme who like Edith Cavell had worked as a governess, Hélène Stoops, Emilie van de Velde who was thirty-seven and left after a year because she thought she was too old, Noemie Delaunoy and Valentine de Wolf who was a relative of M. Depage but also left within a year. After their three-month trial period all five refused to sign their contracts unless the stints of night duty were altered from a month to a week. “I had eventually to yield,” Edith Cavell wrote, “or see them all depart, in which case it would have become known that they left on account of the severity of the regulations. Then I should never have been able to get anyone else.”

  None the less by Christmas a fair beginning had been made. There were patients in some of the beds, the probationers had signed their contracts, and the Ladies’ Committee provided a tree and presents for all the staff. “Two of my pupils seem likely to make excellent nurses,” Edith Cavell told Eva Lückes. “I find them unpunctual and rather noisy but the patients are devoted to them and we already have a reputation for nursing well.”

  17

  THE SCHOOL GOES ON

  “I feel glad to tell you that the School still goes on!” Edith Cavell wrote to Eva Lückes at the beginning of 1908. “As it has so many difficulties to face that single fact alone is quite a consolation in itself. I never know from day to day what may happen next.” The School building was hugely inconvenient. The basement kitchens swarmed with cockroaches and were damp; there were no lifts; meals had to be carried on trays up steep stairs, and patients needing operations in Depage’s Surgical Institute had to be carried down these stairs, out into the street and into the building opposite.

  The rooms were cramped and so poorly lit that night nurses who wanted to study went into the operating theater at the top of 145 because it was the only room with enough light. It was an awkward roo
m for surgery. It was at the top of the house, it got steamed up and it smelled of chloroform and ether. Nurses who felt faint had to leave. The patient had to be helped onto the operating table and water for sterilizing was boiled in a kettle. Edith Cavell in a long white gown would stand at a small table and hand instruments to Dr. Depage or another surgeon. In the middle of an operation a nurse might be sent out to the Clinic opposite to get some required piece of equipment.

  Edith Cavell took the edelweiss, with its connotations of purity, as the School’s symbol and designed a uniform: dark blue for herself with a starched white collar and cap, light blue for the nurses, with white linen aprons, collars, sleeves and caps. She saw this uniform as symbolic: “The contrast which they present to the nuns, in their heavy stiff robes, and to the lay nurses in their grimy apparel, is the contrast of the unhygienic past with the enlightened present.” Some probationers felt stupid in it and said workmen threw things at them when they went out. Each new probationer when she arrived was shown into Matron’s “dark little office” then taken down to the sewing room and fitted with two blue dresses with elbow-length taped sleeves with detachable white cotton extensions to make them full-length (for meals and interviews); six white bibbed aprons and six starched “Sister Dora” caps9 to be perched on her head “like Matron wears hers.” The nurses preferred them at an angle. They thought they looked prettier. Looking pretty was discouraged. Each day Edith Cavell sent one or other of them upstairs to “put her cap on properly.” At times she called them as a group into her office and made them arrange their caps in front of her—the strings tied tight at the back.

  Edith Cavell with her staff nurse and probationers, Brussels c. 1909

  The probationer’s day began at 5:30 a.m. She filled water jugs, cleared the locker tops, washed her patients’ hands and feet, found out what they must have for breakfast and carried it up from the kitchen on trays. Her own breakfast was at 7:00. Edith Cavell was there at all meals. She sat at the head of the dining table with a watch beside her noting who was late.

  Each probationer had patients assigned to her. A later probationer, Nurse Moore, described the challenge of her first patient. She had not seen a naked man before. She had to do everything for him, feed him, wash him all over. She used a large toweling sheet over a waterproof and asked him to wash his genitals himself.

  As at the London, practical nursing at probationer level involved a great deal of cleaning: the tops of wardrobes, ledges, lockers, mantel-pieces, the iron bedsteads and rails, the floors to be mopped with a bucket and long-handled scrubbing brush, covered first in a wet cloth, then a dry one. On her ward rounds Edith Cavell would run her finger over a surface to check for dust then say, “The dusting should be done by ten, nurse.” Cleaning the operating theater was the worst job: the smell of chloroform, bloodstained linen to be removed, everything to be washed and scoured—the tiled floor, shelves, bottles, lockers.

  At 10:00 the probationer had a coffee break, made her own bed and put on a clean apron before accompanying the doctor on his rounds.

  Each nurse had her own room with a single bed and a stove. Ruth Moore described the delight of two hours’ free time a day “to lie on one’s bed with a book, throw off one’s uniform, go out, buy a new hat …”

  Edith Cavell’s attention to detail in setting up the School was unremitting. She oversaw care of patients, nurses and probationers; instructed domestic staff; planned and implemented projects with Depage and the committee; interviewed prospective nurses; lectured the nurses and went to the doctors’ lectures given to them; did all the administrative work and accounting and sending of bills to patients and their relatives. If there was an operation she assisted the surgeon.

  Her main and ongoing problem, on which the success of the enterprise depended, was recruiting probationers and nursing staff. Her dream of “a colony” of English matrons and sisters, as heads of branches of nursing throughout the city, was elusive. In January 1908 she looked for a teaching sister. Helen Graham, a nurse working in Bruges, and recommended by Eva Lückes, agreed to work for six months at the School. “I was very glad to take her,” Edith Cavell wrote, “as I should feel so sure of her teaching and her work and only hope she may feel inclined to stay longer when she has been with us a little while. The air is very good and bracing and the work not so hard, so she will be able to recruit at the same time.” Miss Graham was not inclined to stay. She was “a great help” but in the summer went back to London and got married.

  In April 1908, in the hope of attracting probationers, Edith Cavell published an account of the School in London’s Nursing Mirror:

  One house has been fitted up as a home for twelve nurses. They have a sitting room with a piano. The three adjoining houses provide twenty-four bedrooms for patients each of whom pay 5–8 francs a day. There are gas rings in the bathrooms for boiling water and sterilising instruments. Five pupils have had the courage to come forward and they are already settling down to their new life and seem happy at their work. Each one has five patients to look after. They breakfast at 7 a.m. Then they wash their patients and give them their breakfasts. During the morning they accompany the doctor on his rounds and carry out the treatments which he orders.

  Our probationers must be between twenty and thirty-five. They can be of any nationality but French is spoken. Uniform is provided—outdoor uniform is not worn—and they are paid 180 francs their first year, 240 their second, and 300 their third. During their fourth and fifth years they will be paid in proportion to the work they do for the School.

  After two months’ trial each one is required to sign on for five years. The first three years will be devoted entirely to training; the first in the School, mainly medical nursing; the second in a surgical clinic; the third to the nursing of infectious cases and to midwifery. They will then be required to pass an examination and, if successful, will be granted diplomas after which they will be employed in private nursing homes, as the commitments of the School dictate.

  The object of the School is threefold; first to create a profession for women; secondly to forward the cause of science; thirdly to provide the best possible help for the sick and suffering. These first nurses of ours will in the years which lie ahead teach, as no others have ever had the opportunity of doing, the laws of health and the methods of treating disease. They will also prove to their countrymen that education and position do not constitute a bar to an independent life for a woman, as so many seem to suppose over here. Indeed they will show them that education and position are in point of fact good and solid foundations on which to build a career which demands the best and highest qualities that womanhood can offer.

  It was hard for Edith Cavell to persuade others to share her view that exacting unremunerative work was worth doing for its own sake. The stigma was ingrained that this was a menial job on a par with cleaning. Probationers served a three-month trial. They paid a fee for this, returnable when they then signed their contracts. Some sacrificed the money and left before their trial time finished. It was particularly hard to find Belgian probationers. Respectable mothers no more wanted their daughters to train as nurses than to go on the stage. The cooks and servants balked at serving nurses and the doctors treated them as menials. “I thank you Madame for your letter explaining your daughter’s difficulties,” Edith Cavell wrote caustically to a mother whose daughter felt demeaned by the work she was expected to do. “Such difficulties are unavoidable with all young girls of the wealthier class until they come to recognize that work is not a social stigma … Fortunately, in other countries, women of the same class, who have chosen nursing, understand that the only way to elevate the profession to the dignity which it deserves is to put into it all their devotion and their effort. I hope that in time the several excellent foreign students here will encourage the Belgian girls themselves to set an example which will promote and popularize the nursing profession in many ways. We cannot necessarily hope that the girls of the lower classes will progress as swiftly or
as well. But we are none the less grateful for the efforts they put forth. I will be pleased to see you during your visit to Brussels. Rest assured that our pupils, far from suffering physically, generally become more robust.”

  In September 1908 she went for a few weeks to Swardeston. It was hardly a holiday. She heard that the baby born to Eveline Dickinson, now Mrs. McDonnell, had died. “It is a great grief.”10 On the School’s notepaper she urged Eva Lückes to find her another London Hospital-trained sister now that Sister Graham had left. Her replacement was “not a good nurse and still less a good teacher. I am afraid I shall never be satisfied with any other than a Londoner to train the probationers. Other methods do not please me and I am anxious to introduce the very best into Belgium. Have you a nurse you could spare? One who would come out soon and would take an interest in the nurses and the work for its own sake? The salary is £40 a year with uniform and washing… . The School seems likely to be a success but the difficulties are innumerable and the greatest is the character of the women—unused to liberty they abuse what they have and the most constant supervision is necessary.”

  Eva Lückes sent out Sister Eleanor Evans, who proved “most satisfactory,” and a number of staff nurses to work at the School or with private patients. But however many nurses her matron provided, Edith Cavell needed more. She sent a resistible request for a private nurse who spoke no French: “The patient is a woman of 40 suffering from hysteria. She weeps and is unable to walk and is hypersensitive. The relations however are the worst feature and they are going unfortunately to Cannes with the patient in January for 3 or 4 months. They will want a nurse to stay with them the whole time and I really think it would be just as well if she spoke no French as she would not understand all they have to say.”

  Toward the end of 1908 Edith Cavell’s hard work began to show results. “People are beginning to realize the necessity of better nursing and are coming round to English methods,” she wrote. The School became a model of good practice with a reputation for high standards of training and provision. A Dr. Pierart asked Edith Cavell to find a matron for the Hospital St. Jean in Brussels. Two years earlier lay nurses had been introduced in two wards there. There were five of them looking after fifty beds with no one to supervise them. The work needed courage, firmness and tact to avoid conflict with the nuns. Sister Evans took the challenge, became the matron and proved a great success, “in every way devoted.” Her starting salary was £80 a year. In time she started a teaching school at that hospital too. Her going left Edith Cavell again without an assistant matron. “If you could recommend me someone …”