Civil Work in England in War Time

Kai Tiaki : the journal of the nurses of New Zealand, Volume XII, Issue 3, 1 July 1919, Page 121

Civil Work in England in War Time

So much is known about the military hospitals, that it may interest some readers to hear a little of the doings of the civil hospitals during this last few years. When we realise the proportion of the medical and nursing professions that were commandeered by the military authorities, it might make anyone wonder how the civil hospitals were able to carry, on. Yet they did, and Ido not think the civil population suffered neglect either. My own personal experience was of three of them during the 2-\ years I was m England, but I knew of the workings of many others from my contact with others m the profession, and they were all going full speed too. There certainly was no difficulty m getting work, as the civil hospitals were already feeling the shortage caused by the war. I put m applications for some advertisements m the B.N.J, for resident posts and found myself m the embarassing position of being accepted right away on my own face value by two of them. I decided to go and fill a billet pro tern for a woman who had volunteered for service, and took up duty m Leicester Borough Hospital and Gilrose Auxiliary early m October, 1916.

This institution m peace time was the fever hospital and sanatorium for that big town. For the pressure of war time, it had been extended to accommodate some 200 soldiers and that part was known as the Gilrose Auxiliary.

It was a busy life — some 400 patients and two residents to do the work under the city G.O.H. as administrator. Fortunately, the inf ectious»cases were few, and it only needed a couple of blocks to accommodate the scarlet fevers, typhoids, cerebro-spinal fevers, etc. The two adjoining blocks were occupied by soldiers, but not a case of infection occurred amongst them by propinquity, a very satisfactory record. My work was mainly the infectious fevers and the children's sanatorium (as the sen. res. took the military wards), but I had also a block of advanced phthisicals and a block of small wards for any patient from the two base hospitals m Leicester that might develop an infectious disease. These were a varied assortment, e.g., a measles m one, two scarlet fevers m the next, three typhoids further on, followed by a ward for compound fractures

that had developed erysipelas. Beside these there was always a ward of a dozen or so suspected phthisis eases, who stayed till we could iind the T.B. That was the only diagnosis the military considered sure and certain, and until that was found they were labelled chronic pulmonary disease, but kept isolated, to their own vast indignation. Over and above my wards I was m charge of the dispensary and dispensed all except the stock mixtures. I had to examine my own diphtheria swabs, etc., and visited branches of the Infant Welfare Dispensaries m Leicester on two afternoons a week and supervised tho men working m a farm colony, who were convalescing sanatoria patients. All this would have been an impossible task had it not been for the efficiency of each and all of the sisters m charge of them. There was certainly not much about fever nursing that sister m charge of blocks 1 and 2 did not know, and with typhoid, S.F., and CS. fever the nursing is all important.

The children's sanatorium was up on a hill about half a mile away, and these little people were often m an advanced stage on admission. But I could rely on Sister C. to say whether it was necessary to see a child at once, or if next morning's round would do, and that was a big help when it was nearly half a mile of snow-covered paths and perhaps late at night too. The tact and kindness of sister R. to the advanced phthisical patient was past belief. They were almost always patients beyond cure, several were ex-soldiers, for whom a winter m France was the exciting cause ; yes, they all displayed the usual " spes phthisica " and were almost always hopeful that some new drug would work a cure m their case.

The farm colony was a most interesting experiment. It was started to give employment to the early consumptives, i.e., the curable cases, so as to get them back to work very gradually. Each man's work was apportioned to suit his physical condition and they were remunerated for it. The work consisted m growing fruit and flowers for the local market under a skilled gardener. They were the gardens of an estate about 1 mile from the hospital, which had been acquired by the Leicester borough for the purpose of helping its consumptives. As far as

I could judge the scheme was not succeeding, and mainly so because the patients seemed to think that they were being exploited as cheap labour. But the gardener m charge assured me that the labour they put m was of little value, as it was so irregular and half-hearted. On one occasion when I had paid a visit to see how they were getting on at work, not a man of them had turned up. On making inquiries later from the men themselves, I found that they had all gone to see a funeral m a church-yard they passed on their way to work, and they seemed to consider that a good and sufficient reason for their absence. That confirmed the gardener* s opinion for me, and I wondered if it was any use tiying to help people who would not try to help themselves !

The children were the bright spot of mv consumptive sections. It was amongst them that I first fully realised the amazing recuperative power of children to disease. They were sent m by the M.D. m charge of the City Tuberculosis Dispensary — sometimes almost m a dying condition. Yet time and again they rallied, and cases that were fairly advanced would be discharged as arrested m a comparatively short time, some with and some without tuberculosis treatment. They were a very happy lot these sanatorium children, about 50 of them with Sister C. to mother them. They inhabited a rambling old hill on the crest of the hill overlooking the town. So there was abundance of fresh air m their schoolroom and dormitories, with only the green fields around them. Such a contrast to the overcrowding of an industrial midland town.

I did not observe the peculiar mentality of the consumptive amongst the children — perhaps that helped m their more rapid cure. In the soldiers' block it was always m evidence. It took Sister S. all her time to manage them, and she went to no end of pains to make the soldier boys happy. But they held an indignation meeting because they had no work, yet when work was found for them they grouched at doing it ; we got so used to indignation meetings m their quarters that I came to consider them as peculiar to the consumptives. It was only a storm m the teapot always and easily smoothed over, but I have wondered since if that inadaptibility towards life is not partly responsible for the unsatisfactory progress of

phthisis m general. My colleague who had charge of the early cases among the civil patients assured.me that she had the same to contend with. After about three months of this, I had the ill-luck to contract an infection of two fingers whilst performing a tracheotomy. It took the form of an indolent ulceretius, which would not heal. After trying every remedy m the B.P. for some weeks, they healed rapidly with local applications of anti -dip, serum. That clinched the diagnosis as a "dip" wound infection, to my thinking, but m the then hurry of life, I had not made a culture at the time. It ran me clown, so I decided to spell off for a few weeks. My next sphere of usefulness was as house surgeon at Victoria Hos pi tai for children m Chelsea. I started work here just two weeks after leaving Leicester, as, when I interviewed the Board, they asked me to come on duty m advance of the advertised time, the previous H.S. having left for illness and they were understaffed. I had applied without knowing the locality. When I went there I found it was m one of the pick spots of London. It was built on a corner overlooking the Chelsea Pensioners" Hospital grounds, and the Chelsea Embankment was at the end of Tiber Street, with the Battersea Park just opposite. The Hospital consisted of 104 beds, half surgical and half medical, and an enormous out-patient department, as it supplied the Chelsea, Battersea, Pimlico, and Fulham districts. Here the work was less responsible, as there was a staff of visiting honoraries for wards, out-patients, and specialties. But all these men were doing double or treble duty as, replacing others on active service, so much of the routine work was left to the staff. I stayed on here as H.S. for twelve months, so saw several ß.O.' sand M.P.'scomeandgo. Except for two periods of a few weeks each, we were all women residents ; I enjoyed the work immensely, and found surgical children a most interesting study from the psychological side too. They suffer far less than adults, as there is not the anxiety of anticipation. They take anaesthetics exceedingly well, and often sat up and asked for supper a few hours after. Comparatively seldom was there just operative sickness, which causes quite half the suffering with adult surgery. One saw very little sepsis — that bugbear of the military surgery — ex-

cepting, of course, the empyemas, appendical abscesses and such like, and street accidents. Surgical children m civil hospitals come m and go out with an almost monotonous regularity. In 12 months one deals with innumerable ordinary operations and sees a good number of the rarer ones. The general atmosphere of a children's ward is one of contentment. They do not know how to grumble apparently, though they are often a bit fretful just before meal-times. But then they are chirpy as crickets immediately after, and except for the new arrivals they all seem very well satisfied with their surroundings. And they should be for there is a wondrous amount of loving care lavished on these children by the sisters and nurses. Sisters feel so possessive of a child they have nursed from death's door back to health again, and time and again I have known of a child not wanting to leave the sister to go to its mother when it is being discharged. Another thing that interested me much was the child's way of taking an air raid. These w r ere frequent occurrences whilst I was at Chelsea and m the early days the Board of Management considered it advisable for the children on the top floor to be moved to the basement. So as soon as the Field -Marshal's warning came through, every able-bodied person m hospital, matron, residents, sisters, nurses, and wardsmaids hurried to the top floor to assist. Recent operations and spinal and hip children had to go m their cots m the lift, two at a time. The rest were rolled m their blankets and

carried down, and as all lights were then out, it was no easy matter fumbling down three flights of stairs with one or two children if they were tiny ones. But the children were marvels. They seldom cried and generally went off to sleep again when deposited on mattresses below stairs. Those on the first and second floors were never moved, and the younger ones mostly slept through all the din. The children who were old enough to understand what was going on, were easily reassured if someone sat beside them and

talked to them. Later on m the winter, thc Board decided that it would be better not to move the children at all. It had

been proved by them that bombs had as often destroyed the basement as the top floor, and the danger of the children catching cold m draughty passages had to be taken into account. Then the personnel of

the hospital went to their respective wards as soon as the " take cover " was given and passed the waiting time chatting round the ward fires and drinking tea till the " all clear " sounded. But we saw more of the effect of raids on the children m the O.P. Dept., a good number of them developed ' nerves," a natural result after some nights of alarm or even panic, which had spread from their elders, I believe. Just after I left Chelsea a bomb dropped on the Royal Hospital Buildings. It wrecked the quarters of one of the hospital officials, killing the three adults who were downstairs and one child. Other three children who were asleep upstairs were uninjured, though m the wreckage the youngest child was blown into a bush m the vicinity. Towards the end of my time at Victoria Hospital, I had many offers of new billets. Service abroad and munition work at home were both making big claims on women medically by then, but I considered that the civil hospitals were most m need of help. So, after a two weeks' rest at Torquay I took up duty again as R.M.O. at Putney Hospital. This was a small general hospital, where I was the sole resident officer. There were only 23 beds, divided into four wards, male, female, children's and an emergency ward. It was one of the latest things m hospital construction, and everything was beautifully appointed. It was situated on Putney Common, an ideal spot, having open country all round. It had been bequeathed to the poor of Putney by a patriotic resident, and was called after him, The Chester Bequest. In the foundation it was stipulated that the poor of our district, Putney. Barnes, and lvoehampton should have first claim to a vacant bed. There was attached an O.P. department, which was small, as we were on the outskirts of London, but the casualty department was considerable. It had been very large m the days of motor joy riding, when a continuous stream of traffic crossed the Common. During my term of office it was chiefly a small boy casualty department, as m the darkened streets on the city side they were constantly being run down by the motor traffic. During the Christmas of 1918 the male ward of eight beds was occupied by boys from 7 years to 17 years, nearly all fractures or concussions. It was always said that the casualties m London due to the darkened streets

far outnumbered the casualties from air raids, and my observations confirmed that. By this time the civil hospitals were experiencing great difficulty m filling the gaps m their nursing staff, so we were often two or three short. Still we carried on, Matron and the others just filling m the gaps. Several of the nurses were bonafide war workers, but it would be a pity if they did not continue. For operation days matron often had to make shift with outside help, a couple of married nurses and a V.A.D. m the neighbourhood lending a hand at such times. But if the nursing staff was hard to fill, the domestic staff was more so. Wardsmaids came and went and m the gaps between, Mrs. Tommy Atkins was the standby. And she worked honourably. In England the separation allowance was small m comparison to the cost of living, and a woman with several children was glad of something to eke it out. One of these did porter's duty for some time. Of men for such a post only C.O.s and medically unfit were left One of each was tried, but did not answer the purpose and a woman filled m the breach again. For such a small hospital there was a full staff of honoraries, two surgeons, 1 gynecologist, a physician, and a radiologist. As the physician had been called up, the bulk of the work was surgical, which meant a 2 to 3 weekly refill of the beds as a rule, so the output really was quite considerable. During the influenza epidemic of September

and October, several secondary pnuemonics were admitted, but we had no luck with them and later on the consensus of opinion was that there was considerable risk m moving such patients. I saw a good deal of the work that was done by the general practitioner during the epidemic. All through the summer of 1918 they had had a very busy time, and all the younger men had been called up from the district. During the epidemic the others worked unceasingly — often their rounds did not finish till 9 or 10 p.m., and after that they might have two or three night calls. They got no D.S.O. or V.C, but I feel sure that if I have the luck to meet some of them m a future state, that they will certainly have haloes for it. Then the war came to a suden and dramatic stop. Out at Putney this was notified to the public at large by the firing of the maroons at about 11 a.m. on a Monday morning. That was our usual " take cover ' : signal, and we thought for a few minutes that it was a final effort to damage London before the end. But the good news soon spread, and by the evening even the remotest back streets were flying flags and doing their best to illuminate the world with some fairy lamps. To those of us whose men were fighting, it was enough that the slaughter had ceased, and as the sick are always with us I carried on there till the end of the year 1918. In the first week of 1919 we left London en route for New Zealand. — K. N.