Silent in an Evil Time (3 page)

She wrote about the training of nurses in
Notes on Nursing
, a book that was accepted as the last word on the matter and that remained in print for decades. The book changed the nature of nursing forever. Nurses in England would no longer be excessively religious or hopelessly alcoholic. Instead, they would be women who received training in the lessons of effective patient care. They would be taught to understand the instructions of doctors and surgeons. They would be dedicated professionals.

This was the kind of nurse who graduated from the school established at St. Thomas' Hospital in London in the late 1850s. The school, which was named the Nightingale Training Hospital for Nurses, adopted Florence's lessons, and the nurses who graduated from it, and from all the other hospital teaching institutions just like it, became the nursing profession's models. Through her ideas and influence, Florence Nightingale became the founder of modern nursing.

Edith Cavell never met Florence Nightingale, and it's unlikely that they ever corresponded, though Nightingale was a prodigious letter-writer. When Edith set off on a career in nursing in 1896, Florence was seventy-six years old and past the period of her greatest activity. Still, Edith was as aware as any other young Englishwoman of Florence's influential work. She would soon study
Notes on Nursing
as part of her training. She would come to understand the Nightingale principles because they were the basis of the profession that Edith had come to choose for her own.

OPPOSITE:
After her return from the Crimean War, Florence wrote countless reports and books about health care and the training of nurses. Her influence changed the profession of nursing forever.
(The Library of Congress, Washington, D.C.)

From her childhood to her adult years, Edith loved to sketch and to paint in water-color She drew this unidentified London scene in 1902, when she was night superintendent at London's St. Pancras Infirmary.
(The Royal London Hospital Archives)

O
n September 3, 1896, at the age of thirty, Edith entered the London Hospital (known simply as the London) to begin four years of training. The London occupied many buildings on acres of land on Whitechapel Road, a wide and chaotic street that ran through the slums of the city's East End. Traditionally, the East End was the first home for poor immigrants to England, and in Edith's time, the area took in the country's largest population of Jewish refugees from eastern Europe. Edith could have done her training at a hospital in a more prosperous neighborhood. But she chose to work and live at the London, where she knew she would be nursing the poorest patients.

The London opened its doors in 1740. One of its early surgeons, Sir William Blizard, gave the hospital its motto:
THE PATIENT COMES FIRST
. As the words suggest, the London grew famous for the unselfishness of its surgeons, including Sir William, who must have had astonishingly hardy health since he didn't retire until he passed his ninetieth birthday But Sir William's durability made him an exception among early surgeons; as a group, they tended to die young. In the days of primitive instruments and of diagnoses that were far from scientific, surgeons put in weary days of performing operations with a high rate of failure. Though surgical techniques greatly improved in the late nineteenth century, surgeons' lives were, more often than not, short and hard. The pattern seemed to have been set by John Harrison, the London's very first surgeon, who took up his practice at age twenty-two and died just thirteen years later. The official cause of death was overwork.

The demands on the nurses at the London were just as unforgiving. When Edith started out as a probationary nurse, one of the staff of six hundred nurses, her day opened with the ringing of a bell at 6:00 in the morning, and it didn't end until 9:20 at night, when she went off duty and ate her supper. She was never idle during all those hours. She learned the skills of nursing by working alongside senior nurses, who were in charge of wards of patients, fifty-six beds to each ward. Edith attended lectures, absorbing the principles that had been developed by Florence Nightingale. As a probationer, she had the responsibility of cleaning and dusting the wards. Since each ward was heated by a large fireplace, clearing the soot was an endless task.

In theory, Edith was allowed time for meals during the day, but in a busy hospital, the reality was that nurses were lucky if they could leave their patients long enough for tea and a bun. Porridge turned up at every meal: porridge at breakfast, porridge and mincemeat at dinner, porridge and cold beef on Sundays. The one treat at the evening meal was a choice of beer or stout, and Edith didn't say no to the occasional beer.

She had one day off every two weeks, and used the free day for doing her laundry, writing letters, and taking walks. Social life was almost nonexistent, and nurses were absolutely forbidden from associating with
doctors and other men in the hospital, except in the line of duty. If a nurse so much as sighed in the presence of a handsome surgeon, it was reason for dismissal.

Nurses at the London Hospital worked hard to keep the wards clean, bright, and cheery. Above is Sophia Ward, named after an eighteenth-century English princess.
(The Royal London Hospital Archives)

Partway into her second year as a probationer, Edith was assigned to three months' emergency service in the town of Maidstone, southeast of London. A terrible epidemic of typhoid fever broke out in the town during the autumn of 1897. Edith was later remembered as the nurse who brought toys to Maidstone's children.

The location of the London Hospital, shown here in the 1890s shortly before Edith arrived to take her training, placed it among the city's poorest citizens in the East End.
(The Royal London Hospital Archives)

For her third year, Edith was placed on the London's private nursing staff and attended patients in their homes. Back at the London full-time for her fourth and final year, Edith was appointed staff nurse in the hospital's Mellish Ward, where she had the bad luck to work under a bullying senior nurse named Lillian Gough. Edith wasn't happy to be singled out for Gough's harsh criticism, but she turned the senior nurse's treatment into one of the wry jokes she was noted for. She gave Mellish Ward a nickname: Hellish.

But the person at the London who struck fear into the heart of every nurse was Eva Luckes. From 1880 to 1919, Luckes was employed as the hospital's Matron, the official with the responsibility of training and grading each nurse. Luckes knew her business. She gave lectures on nursing techniques. She had powerful influence with the doctors and administrators at the hospital. And she kept the probationary nurses under such close observation that she felt confident in writing long reports on every woman who passed through the hospital's system.

The imposing woman in black is Eva Luckes, the often-feared Matron at the London Hospital. The class shown here is from 1892, four years before Edith arrived at the hospital to begin her nurse's training.
(The Royal London Hospital Archives)

Luckes looked and behaved like a younger Queen Victoria. She was plump and bossy. She had strong opinions, particularly about her nurses, and would never listen to a view different from her own. She was often harsh in her judgments, and though it was the last thing Luckes would admit, she could be mistaken in her written assessments.

Luckes' final report on Edith, at the end of her four years of training, put Edith in a poor light. “Cavell was not a success as a Staff Nurse,” Luckes
wrote. “She was not methodical nor observant and she over-estimated her own powers. Her intentions were excellent, and she was conscientious without being quite reliable as a Nurse.” Few of the women at the London came in for generous words from their Matron, but in Edith's case, Luckes got her report spectacularly wrong. Everything about Edith's later career showed her to possess all the qualities that Luckes was unable to detect. If Edith weren't methodical, observant, and reliable, she would never have succeeded as Matron of the Brussels clinic.

It may have been that Luckes used her blunt reports on the nurses to spur those she criticized so sharply to higher accomplishments. But it's beyond question that Edith admired Luckes as an administrator and used her as the model when Edith later became the Matron in Brussels. Edith seems to have had respect, and even affection, for Luckes. Over the years, she stayed in touch with her by mail, keeping Luckes up to date on her life after the London. Edith's correspondence had a friendly and confiding tone. One letter in July 1901 reported an incident of a man robbing Edith of her money in a London street. Other letters asked Luckes for help in finding better nursing posts. Luckes always responded, and it was she who arranged Edith's first nursing position in January 1901.