This blog offers some insights into how St Barts continued to grow and the demands made on it during the Great War. Such were the demands, arising from the number of military casualties, hospitals generally needed much more than money to provide its services.
Details of the running and development of St. Barts were not covered in great depth in the press during the Great War. Apart from there being more serious matters to report there were a number of other practical reporting issues such as the lack of paper and journalists.
The following also introduces – Maud Pote-Hunt – who is probably unknown to many in Medway. However whilst she was matron of St. Barts between 1910 and 1928 she made a very significant contribution to the development of nursing and the delivery of hospital care. Her contribution was recognised with the award the Royal Red Cross (Second Class) that was presented to her by the King at an investiture held at Buckingham Palace.
St. Barts continues to grow
When the ‘modern’ St. Barts was commissioned it was to have 80 beds – although not all were available for the treatment of general patients until the Lock Wards were closed and funding was found to run new wards. Although no news reports have been discovered detailing the construction of additional wards, a news report in January 1919 stated that the hospital had 200 beds.
As mentioned in the ‘Modern St. Barts’ blog the hospital’s trustees agreed in 1900 to provide eight beds for wounded soldiers from South Africa who arrived at Chatham during the Boer War. This number was much surpassed during the Great War. At Christmas 1915 the hospital was caring for 30 wounded British and Belgium soldiers in two wards. At Christmas 1916 the two wards were described as ‘military wards’ and were accommodating 58 soldiers. The report of how Christmas was spent in 1918 suggests there were still only two military wards but only a few patients.
Nursing profession advances
Much is made of the advances in medical science but progress in treatments would not have been so successful had it not been for the way hospitals were run and care was provided; indeed so severe were many of the injuries sustained by soldiers, and civilians in industrial accidents, that hygiene, kindness and good food were perhaps all that could be relied upon to sustain a patient whilst their body repaired itself.
Many women were recognised by the Secretary of State for War for the valuable services they rendered in the course of the war. Included in a number of lists were the following who worked in local facilities:
Miss M. Pote-Hunt, Matron, Miss M. Breeze and Miss G. Farquhar both Sisters at St. Bartholomew’s; Mrs. A. Marsh of Knights Place, Private Hospital. From Fort Pitt (Central Military Hospital) the following were recognised – Miss E. Kerman, Staff Nurse, Q.A.I.M.N.S.R.; Miss W. Batt, A. P. Military Massage Corp, and Miss M. Tyrie, staff nurse, Q.A.I.M.N.S.R. (A. P. = Almeric Paget. QAIMNSR = Queen Alexandra’s Imperial Military Nursing Service; the R denoted ‘reserve’. This nursing service was established in 1902 and owes its origins to Florence Nightingale. See ‘Patient Services and Demands’ below for more about the Almeric Paget Military Massage Service.)
Hidden amongst press reports and journal articles an indication of the remarkable contribution made by Maud Pote-Hunt, at St. Bartholomew’s, can be found.
Maud Pote-Hunt was the matron of St. Barts between 1910 and 1928; as she was born around 1871 it is possible that she could have retired from nursing at the time of leaving her post at St. Barts.
Enquiries made of the archives of St Bartholomew’s, London, where Maud had trained, found that she came from Plymouth and was appointed to the hospital on 1 May 1896, aged 25 – having previously nursed sick children at Belfast’s Children Hospital. Her nursing training did not start well in that she failed her first nursing exam but was allowed to remain at the hospital. She successfully re-sat the paper in October 1897. She was awarded her nursing certificate in April 1899. She left St. Barts, London, on 30 April 1900 and on 1 September 1901 entered what was termed a “Trained Nurses Institution”. After working at Mount Vernon Hospital she became assistant matron at the National Hospital, Queen’s Square, London, before being appointed as matron at St. Barts, Rochester.
Shortly after arriving at Rochester Matron Pote-Hunt established the custom of allowing each patient to have a visitor to their bedside. Again one can only infer her thinking but I suspect she was aware of the importance of the emotional wellbeing of patients whilst they were in hospital. It also suggests that, as she instituted this practice, nurses were taking a led role in shaping the delivery of the services in the hospital. In a later appraisal of her career (The British Journal of Nursing, January 1946) it was stated that on taking up her role at St. Barts she set about reorganising the wards and establishing a system for training nurses that proved to be a “sound preparation for the great emergency” that we now know as WW1. What these changes entailed were not covered in the press-reports I’ve discovered but it is clear that the hospital dedicated particular wards to the care and treatment of wounded soldiers.
Maud Pote-Hunt’s approach to the training of nurses, arranging wards and allowing visitors were clearly innovative as they were worthy of mention and recognition in a professional journal.
Indeed her contribution must have been beyond the ordinary – it was probably exceptional – as on November 6, 1918, she attended an Investiture in the Ball Room of Buckingham Palace where the King bestowed on her the Royal Red Cross (Second Class) for services she rendered during the war. (This award was for fully trained nurses who showed exceptional devotion and competence in the performance of her nursing duties, over a continuous and long period. The pronoun ‘her’ is used as the award was exclusively for women until 1976.)
Assistant Matron Miss Grace Farquhar
In 1912 Matron Pole-Hunt was joined by Miss Grace Farquhar as the assistant matron. Miss Farquhar left in 1919 to take up the position of matron at Tonbridge Cottage Hospital. In 1922, she secured the position of matron with the Metropolitan Hospital, Kingsland Road, Hackney, that was described as an important London Hospital to which was attached an excellent Nurse-Training School; again speculation, but Grace Farquhar would probably have taken with her some of the practices developed and adopted at St. Barts which could have then enabled her to secure a post of matron in a hospital known for its excellent nurse training.)
Medicine advances – but still not without hazards
Although knowledge, skills and facilities increased at St. Barts, as elsewhere, treatments were still rudimentary and potentially hazardous.
Cecil Harrison, a young man, died under anaesthetic at St. Bartholomew’s. The procedure was nearing completion “when respiration suddenly ceased. The usual treatment was adopted by the surgeons present but without success.” [Chloroform – if that was the anaesthetic being used – was later discontinued when it was realised that it can depress the respiratory system and cause irregularities in the heartbeat.]
Patient services and demands
In 1870 the hospital trustees reported that in the year ending 30 September, the hospital had treated a total of 9,492 patients. In 1916 St. Barts treated 31,700 patients.
In 1917 it was reported that in the previous 12 months St. Barts had received 1,051 civilian and 457 military in-patients and had a daily average bed occupancy of 104. It treated 6,082 out-patients who had a total of 24,151 attendances. 1,598 operations were performed under general anaesthetic, 592 X-ray pictures were taken and 166 patient received massage treatment. No specific details have been discovered as to the nature of the massage service or whether it was only provided to soldiers. There was though evidence that the therapeutic value of massage was being widely recognised. Commercially, Miss Woodward, 62 High Street, Rochester, was offering ‘electrical massages’ / ‘heat & massage’ / ‘radiant heat baths’ at “very moderate terms”. At Fort Pitt Hospital – just across the road to St. Barts – there was a “Almeric Paget Military Massage Service” – forerunner of the physiotherapy services provided today. This service was set up by a Mr & Mrs Almeric Paget who funded 50 fully trained masseuses to be sited in the principal Military Hospitals in the UK. The service was such a success that the numbers were quickly increased to over 100. The therapists, all of whom were women, wore a military style uniform – the belt was optional but the skirt had to be six inches from the ground.
It is interesting to see the changes over time, of the types of cases presenting at St. Barts – or being reported as attending the hospital. In my previous St. Barts blog there were regular reports of women being treated at the hospital after suffering burns, or from injuries caused by violent/abusive men. Between 1914-1918 the most reported civilian injuries taken to the hospital were traffic related. Perhaps because men were away abuse lessened, and as women’s fashions changed and less use was made of oil lamps as gas was introduced, the risk of clothing catching fire would have been reduced; conversely road traffic would have been increasing.
Some reported accidents
April 1915 – William Wells, a bus conductor, was thrown from his bus that was running between Chatham and Rochester, when the driver pulled up suddenly to avoid a collision with a motorcyclist. Wells was taken to St. Barts in a critical condition with a fractured skull.
February 1917 – a steam motor lorry belonging to the Royal Naval Ordinance collided with a parked ‘horse & wagon’ causing the driver to fall from his seat and under the vehicle of which he was in charge. He sustained a fractured arm and other injuries. He was conveyed to St. Bartholomew’s Hospital on the police ambulance in a critical condition.
September 1917 – Louisa Lynch of 5 Boley Hill, accidentally drank a fatal draught on the night of the air raid that included the bombing of the Drill Hall in the Dockyard, (3 Sept. 1917) and suffered a most distressing death in St. Bartholomew’s. [In a private letter sent by a doctor who attended Louisa he said she had deliberately drank the disinfectant. Clearly she had been badly distressed by the bombs and artillery fire but all ‘colluded’ to present her death as an accident as attempted suicide was illegal until 1961, and people who committed suicide were denied a full Christian funeral until 2015.)
August 1918 – a steam tractor belonging to Messrs. Style & Winch while turning the corner from Gas House Lane into Corporation Street, became unmanageable and crashed into a wall. The driver was shaken but his mate needed to be conveyed to St. Barts where he was destined.
Venereal diseases (VD) (STI)
The need to treat and control the spread of venereal diseases was important to the military as it diminished the military’s efficiency, and for public health (and the repopulating of the Empire) as it was the cause of many infant mortalities. The previous approach to ‘treating’ VD in Chatham and other military towns, was highly contentious – what with the use of Lock Ward such as those that were at St. Barts in which infected women could be detained. When the Local Government Board offered to provide 75% of the cost of running VD treatment centres the Mayor of Rochester went on record to stress that powers to detain patients were not being reintroduced. The 1916 Public Health (Venereal Diseases) Regulation Act established a network of clinics offering free confidential diagnosis and treatment – one of which was to be at St. Barts, Rochester. There may have been some reluctance to provide this service as the introduction was slow in Rochester. However by early 1918 a VD Clinic was run from St Barts. Total confidence was assured. The clinic was open for men on Tuesdays and Thursdays between 5:30 to 7:30pm, and for women Thursdays between 3pm and 5pm. There also seems to have been some reluctance on the part of doctors to use the service as an appeal needed to be made in the press for them to use it – stressing that it was free.
Caring for the wounded
Meeting the needs of wounded soldiers required more than hospital based services – the hospital had a huge and fluctuating need for medical supplies. Hospitals during the war could not operate in isolation of other services. St. Barts and the other local hospitals depended on the local Health Munition Service / Rochester Red Cross Depot that was set up in the Technical Institute of Rochester. Here, making use of the workshops 100 volunteers, mostly women would meet Monday & Tuesday evenings / and Thursday and Saturday afternoons, to pack or make items for the hospitals. There were ‘soft- munitions’ such as dressings, slings, flannels, swabs and mitten boots for treating trench foot etc., and ‘hard-munitions’ such as bed-cradles, cabinets, crutches etc. Volunteers not only made the items they also needed to raise funds to purchase the materials they needed. Following a major military offensive – which could not be pre-announced – there was a significant increase in demand for ‘health munitions’ as well as for the funding to purchase materials
The Non-Royal Visit!
In October 1914 the King & Queen paid a visit to Fort Pitt hospital where they inspected the new facilities and met wounded soldiers, and in another part of the building wounded German prisoners of war. There were those who thought the King might call into St. Bartholomew’s where it was known there lay some of the British wounded from the Battle of Aisne that took place during September – but he did not. However some nurses and one or two patients who were able to rise to the windows saw the King go by; a party of sisters also stood at the entrance to watch the Royal party go by.
Christmases at St. Barts
The following accounts give a little insight into the way the hospital was being run. The tradition of the nurses at St. Barts going around the wards early Christmas morning, singing carols, continued for many years – well into the 1960s and perhaps beyond?
1914: The festive season at St. Bartholomew’s was a quite different matter compared with the past years, for under the same roof were 30 wounded British and Belgium soldiers, and all the other beds for civilians were full. The first event on Christmas Day was the singing of carols by the sisters and nurses, who, with lighted tapers, went from ward to ward, and when day broke each patient found the customary gift lying on his or her locker. There were no decorations except in the soldiers’ two wards where the patients had expressed a special wish to see some evergreen.
1916: The nurses heralded Christmas Day at 5am by going from ward to ward singing carols. Thence after events were held so patients, civilian and military alike, had a very memorable Christmas. Despite the war, dinner did include turkey and Christmas pudding. All the wards were tastefully decorated but the two military wards that accommodated 58 soldiers, were particularly well done out in this respect.
1917: The patients had as good a time as their pain and suffering would allow. On Christmas morning (Tuesday) at 5am carols were sung by members of the nursing staff carrying tapers. Presents were provided for all patients and stockings for children. The fare at dinner included turkey and Christmas pudding; Ald. Willis and Drs. Fairweather, Smith, Dartnell and Cotman assisted with the carving. The Dean and Mrs. Storrs visited the hospital in the afternoon. Mr. Luxon attended with his gramophone. There was also Christmas tree entertainment on Thursday for the children. On Friday a celebration was held in the outpatient department.
1918: Christmas Day opened with carols by the staff who between 5am and 6am went from ward to ward singing. There were presents for all. All the civilian beds were full with several emergencies being admitted during the day; there few inmates in the military wards.The decorations were far more extensive than in previous years and in this respect Florence and Constance Wards call for special mention. In Florence, the male surgical ward, the nursing staff and patients had constructed a number of miniature aeroplanes and these with festive balloons formed the main feature in the centre of the ward. Over each bed was hung a tiny aeroplane and parachute, and when the whole were electrically illuminated in the evening the effect was an extremely pleasing one. The larger aeroplanes were not introduced into Constance Ward, but the whole arrangement was an exceedingly delightful one. There were many visitors throughout the day. The day came to an appropriate conclusion at 7pm by the singing of the Doxology.
Now for the bit that many could skip – but somewhat disappointingly, to me anyway, the following shows that for over 100 years we don’t seem to have come up with a sustainable way to fund health services. Since its inception St. Barts had to cope with growing numbers and demands, inflation, need to pay premiums to attract staff, and to meet the cost of advances in medicine – a trend that has not changed across the decades.
Hospital finances (As a rough rule of thumb £1 at this time would be roughly be the equivalent to £100 today. For the post-decimal generation: 20 shillings = £1, and 12d = 1 shilling.)
Raising the money to keep the hospital running was a full time complex process dependent on the support and generosity of the public. However, with the declaration of war many other organisations competed for the public’s support. In 1918 when the Government was struggling to meet the cost of the war, it pushed a war savings scheme that offered a very good return – thus potentially further ‘soaking-up’ any spare cash the public may have had to donate? There appears to have also been a finite number of fundraisers – with some having to double-up on causes.
The Watts’ Charity continued to provide £4,000/year to support St. Barts but the additional demands placed on the hospital’s finances by the war were considerable. The costs of provisions and medicines went up – qualitatively and qualitatively – and higher salaries had to be offered to secure the services of doctors and surgeons; between the time of the war being declared and February 1915, St. Barts only has one resident medical officer. Although no reference has been found to ‘war bonuses’ being paid to St. Barts nurses, bonuses were paid to nurses at the Medway and Strood Unions so probably St. Barts would have needed to match these in order to retain staff?
The hospital continued to receive bequests. Thomas Hellyar Foord who in 1903 funded the provision of a nurses home at the hospital also left £10,000 to the hospital in his will in 1917.
The hospital regularly published the desperate details of its accounts – presumably to make a political point but also to encourage people to continue to donate or perhaps increase their donations.
From the news reports it has not been possible to determine whether subscribers continued to have the right to nominate patents for treatment. I suspect this may have ended before the outbreak of the war as the catchment area and types of services provided, had extended beyond those that were to be funded by the Watts Charity. However the hospital would have been dependent on having a a core of regular subscribers as they provided some certainty to the income that would flow into the hospital.
By 1915 the number of subscribers had significantly diminished and the value of their subscriptions would have been eroded through inflation. The hospital reported in late 1915 that out of a population of 130,000 people that it served, there were only 600 subscribers paying 10s 6d / year. (Although only 52.5p in decimal currency, this was roughly the equivalent of £50/year.) The concern was that less than 0.5% of the hospital’s catchment population subscribed to supporting the hospital. The hospital therefore made regular appeals for more subscribers and for existing subscribers to increase their subscriptions.
Donations – cash & kind
Many organisations made donations to support local war-causes, including hospitals. This may have alleviated pressure on service organisations to organise fundraising events. For instance in 1917, a sale organised in Rochester by the Red Cross raised £1,589 14s. To this was added £794 17s from the British Farmers’ Red Cross fund. This money was then divided between seven hospitals in the Rochester and Gravesend area.
A number of news reports – particularly towards the end of the war – suggested ‘giving fatigue’ was setting in.
Hospital Sundays – collections at specific church services were distributed to various hospitals.
House-to-house collections – although door-to-door collections were regularly undertaken before the war, the secretary of St. Barts decided in October 1914 to abandon plans for a house-to-house collection that year in recognition of the other collections being undertaken.
With a debt of around £3,000 in 1915 – that was expected to rise to £9,000 in 1916 – it was decided that a house-to-house collection of 40,000 houses would be arranged between 18 and 25 October 1915. The results of this collection do not appear to have been reported but the 1916 collection raised £606 4s 4d. This was less than what was collected in 1915 – with the greatest fall-off being in Rochester. The 1916 collection was supported by volunteers who raised money for other causes. For instance, St. Barts approached Cliffe Parish Council for help, who in turn asked the ladies who collected for the Prisoner of War Fund to undertake a collection on behalf of the hospital.
Street collections – in June 1915 roses were sold in Rochester to raise money for the hospitals. The collection raised £128; £20 more than last year. A similar activity was also held in Chatham and Gillingham. The money collected was divided between St. Bartholomew’s, Strood VAD and the local nursing association.
Concerts & Events
A collection held at Gillingham football ground in September 1915 raised £31 3s 10d. It was distributed between the West Kent Comfort Fund (£21 12s 10d); St. Bartholomew’s hospital (£5 5s) and the Maidstone Eye Hospital (£4 6s).
Matinee performance was held at the Chatham Empire in November 1915 to raise funds for St. Bartholomew’s. Between three or four hundred women were invited to the Empire where they were served with tea whilst a band played. The women when then each given a card on which they could request a number of tickets that they would sell. The lady who took the largest sum of money by way of the sale of the tickets, was to be rewarded with £10.
Donations in Kind
Many individuals donated items for the comfort of soldiers. These were frequently recognised in the press. For instance in May 1915, the matron most gratefully acknowledged the gifts of bed socks, newspapers, lilac, tea & stationary, oranges and books – all from individuals named in the press. In acknowledging these gifts the matron said she would be glad to receive further gifts of cake, tea, fruit and jam. (As an aside the matron of Strood VAD at one time needed to plead for “no more rhubarb!)
The girls of the Girls’ Grammar School were particularly supportive of St. Barts and Fort Pitt Hospital. Amongst the various gifts from the girls were eggs, flowers and vegetables.
The hospital trustees invested £8,000 in War Bonds, of the £10,000 bequeathed to them from the estate of Thomas Foord. It would appear that £2,000 could have been used to shore-up the hospital’s revenue budget, and by investing the remainder they gained time to plan its use. War Bonds did offer a good return – presumably only if the war was won – but they also tied up money for five years.
When there was a large bequest this strategy seems acceptable, however I’m not so sure that it was acceptable for the hospital to hold a ‘flag-day’ with the intention of investing the collection in war savings – particularly when there was an immediate need to fund many services and donors’ money may have been short. [A flag day was a street collection and on making a donation you would receive a flag to pin on your clothing to show others that you had made a donation – and presumably to let other flag-sellers not to approach you again?]
16 August 2018.
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