A Probationer’s Life at the Hospital for Sick Children, 1899-1902, as seen through the eyes of a probationer

Sue Hawkins

 

Introduction

In the mid-1890s, the nursing department at the Hospital for Sick Children (HSC; later renamed Great Ormond Street Hospital for Children) was undergoing a transformation, especially as regards to its attitude to nurse training.ⁱ A little later than most hospitals, it was finally beginning to think seriously about a formal approach to nurse education, incorporating lectures and examinations into their training scheme. Founded in 1852, the Hospital and its nursing department had grown considerably over its first fifty years, which created a significant challenge for the Hospital’s managers.ⁱⁱ Added to this the movement to professionalise nursing was also growing apace, and focus was turning more and more on their formal training.

In this context, this article will centre on the experience of the most junior nurses, the probationary staff, who entered the Hospital as the Hospital’s response to the changing environment was bedding in. These were young mainly middle-class women, with noble and probably romantic ideals of caring for poor sick children, but whose early expectations were in many instances swiftly dashed.

The article uses a unique first-hand account by a probationer Ada Gresham Bois, who joined the hospital as a paying probationer at the turn of the century. Ada was born in the late 1870s into a well-established middle-class family from south London. She was twenty-one (the minimum age requirement) when she entered the hospital as a ‘paying probationer’ in December 1899 and completed her training in December 1902. The HSC’s Register of Nurse Trainees described her work as ‘good’ and her conduct ‘satisfactory’; and while she did not exactly set the Hospital alight with her nursing skills, she was good enough to gain her certificate as a trained children’s nurse.ⁱⁱⁱ She passed her final exams in 1902 and could have taken up a staff nurse position but instead Ada left as soon as her time was completed to get married.^iv

Ada’s legacy to the hospital is a pair of notebooks, held in the hospital archive, in which she records her experience of being a probationary nurse at the HSC. Unlike similar accounts of life in a hospital (recorded in diary form or as memoir), Ada’s reflections are presented in 125 pages of sketches and verse.^v The two notebooks are both signed AG Bois but undated, making it impossible to say if they follow a chronological order, or if she produced them all at once, or over her three years at the hospital.^vi They are not arranged in any discernible order, but they do follow themes illustrating a selection of the challenges faced by the young recruits as they took tentative steps to escape their perhaps stultifying middle-class homes.^vii Themes such as the relationship between trainee nurses and their superiors, the stress of the work, the quality of nurses’ accommodation, and perhaps most acutely, the fear of infection, are all reflected in Ada’s work and her sketches have been used throughout this article to illustrate points of discussion.^viii

The slow journey to formal nurse training

Before introducing Ada’s work the article will briefly consider the evolution of nurse training at the Hospital from the 1860s to the mid-1890s, when a nurse training scheme which incorporated both practical and theoretical learning was first introduced.

From the 1860s there were two groups of nurse trainees: ‘Lady Pupils’ (renamed Paying Probationers in the early 1890s) who paid one guinea a week for their training, for a period of three to six months. They were destined to become nurse managers either at the HSC or at other hospitals. Working alongside them were the ordinary probationers, who were paid whilst they trained and were destined to work on the wards.

In the early days training focussed very much on practical teaching and experience-led learning, following a scheme developed by Dr Charles West, the founder of the Hospital, and his acolyte, Catherine Wood, who worked first as a ward sister and became its first Lady Superintendent (LSI) in 1879. Neither placed much emphasis on the need for theoretical medical knowledge in a children’s nurse, and it was only after these two pioneers left the hospital that the incorporation of theoretical elements into the training of the HSC’s nurses began to be discussed.^ix

The first mention of lectures for nurses occurred in October 1888, with the appointment of Catherine Wood’s replacement, Philippa Hicks. Hick’s extensive previous experience had provided her with exposure to several different systems of nurse training in some major hospitals and she arrived at the HSC eager to institute change.^x Almost immediately, Hicks wrote to the Management Committee recommending that a series of lectures for probationer nurses be introduced and a month later a proposed syllabus was agreed with the Medical Committee.^xi It consisted of two courses, the first focussing on anatomy in connection with nursing, while the second focussed on physiology. The content of the proposed course of lectures closely reflected the curriculum Hicks would have received at St Thomas’, and which had been adopted in many other large training hospitals by the end of the 1880s.^xii

Despite all parties appearing to agree on the need for more formal nurse education, there was no further discussion of the subject for two years. The idea resurfaced in 1890 after the appointment of another new LSI, Kittie Close. Like Hicks, Close pushed the Medical and House Committees on the subject of nurse lectures, but discussions were continually deferred. The subject was returned to in late 1891 and again in 1893.^xiii There is no evidence that the discussions led to any positive outcome, so it seems there was a lack of interest in nursing matters within the management of the hospital. The absence of a Nursing Committee tends to reinforce that interpretation.^xiv

However, in 1891, Close did succeed in introducing a mandatory six months’ training period for all their probationer nurses in an adult hospital, possibly by persuading the managers that such a feature would enhance the Hospital’s and its nurses’ reputations.^xv

In delaying the introduction of a formal nurse education programme for so long, the Hospital for Sick Children was out of step with most other large London hospitals and several children’s hospitals.^xvi In the seven years since Hicks’ first proposal the hospital had had three different Lady Superintendents, two of whom left through ill health. If the medical officers were unenthusiastic about the project, and the LSIs were not strong enough (mentally or physically) to force the matter, this combination could explain the delay.

All this changed in 1894, when yet another new LSI was appointed. Florence Smedley had trained for three years at St Bartholomew’s Hospital and worked as ward sister from 1887 to 1893. After a brief interlude at a convalescent hospital, she was appointed LSI at the HSC in April 1894.^xvii Illustrative of the continued lack of high-quality specialist children’s hospital nurses, Smedley was appointed from a large field, despite having had no prior experience in paediatric nursing. She began immediately to pressure the Medical Committee to inaugurate a formal and structured nurse education programme. This time the move was successful.

Florence Smedley and her new training scheme

Where others had failed, Smedley ushered in a new era for nursing at the hospital. Within weeks of arriving, she had submitted proposals to overhaul the hospital’s nurse education programme. This time the Medical Committee took their LSI’s ideas more seriously and, after consultation with Smedley and other children’s hospitals, details of a new training scheme were published.^xviii It bore a distinct similarity to Hick’s plan from 1888 with courses of lectures in elementary physiology, elementary anatomy and on medical and surgical nursing. The lectures were supported by tutorials on the same subjects by the Matron, and third year probationers were expected to attend an additional six lectures by members of Honorary medical staff. Throughout their training, probationers also received demonstrations on practical nursing and attended classes to learn about the preparation of food for invalids.

There is a sketch in Ada Bois’ second notebook depicting a group of nurses attending a lecture from one of the medical staff, accompanied by the Matron. The probationers do not seem to be taking things seriously, as most are giggling behind their notepads. The lecturer has said something which he thinks is funny but Ada observes that none of the nurses laugh, ‘That’s a joke’ he says and Ada adds, ‘Everybody laughs’.

Exams were introduced for the first time: junior exams for nurses who had been in the hospital for at least eighteen months and senior exams for nurses in their third year. The pass mark was low (35 per cent), and any nurses obtaining 75 per cent or more were awarded a distinction. Paying probationers (who only signed up for one year) were not eligible to sit the exams although they were required to attend the lectures. If a paying probationer wished to complete a three-year training course in order to receive a full certificate, she was required to transfer to the ‘list of ordinary probationers’ (with the wages of an ordinary probationer) at the end of her first year. She would then take the junior and senior exams alongside the ordinary probationers to become a fully certificated nurse. Paying probationers who chose not to transfer to the ordinary probationer programme (or were deemed unsuitable by the Matron) were required to leave at the end of the year and received a simple certificate acknowledging they had worked in the hospital.^xix

Hard and gruelling work

Initially, this new regime seemed to have a negative effect on retention of probationers of both types. After all they were being asked to undertake their regular duties on the wards, with an added burden of twenty lectures and tutorials in their first year, and the stress of exams. Some of Ada Bois’ sketches appear to refer to these tensions. Turnover among ordinary probationers was high, while many paying probationers left within weeks of joining, and Ada’s comments on this phenomenon can be seen in Sketch 2 below. In an attempt to counter turnover among ordinary probationers, Smedley persuaded the Management Committee to change their pay structure, reducing the rate in the first year but increasing it above the previous level in the third year. The revised pay scales had no effect on the overall cost to the Hospital but offered an incentive to women to remain for their full three years. It also had the benefit to the Hospital of reducing the cost associated with those who left within two years.^xx

There were many reasons why a trainee nurse would leave before the end of her contract. The most frequent for those joining as paying probationers was ill health, followed by ‘failed’ or ‘unsuitable’.^xxi Other reasons included: ‘unhappy’, ‘to get married’ and ‘family reasons’.^xxii The new pay scales seemed to have the desired effect for ordinary probationers, with between 60 and 100 per cent achieving their three-year certificate by the end of the century. Among paying probationers (who were unaffected by the new pay scales), the record was less encouraging: completion rates for the full one-year term varied widely from year to year, sometimes being as high as 57 per cent, but dropping to a meagre 29 per cent in 1897. Only 25-30 per cent of those successfully completing their first year as paying probationers switched to the regular probationer programme.

The high drop-out rate though was somewhat compensated for by the clamour of young women applying to join the Hospital. Nursing had become a ‘fashionable’ and ‘respectable’ occupation for young middle-class women by the end of the nineteenth century, and according to Honnor Morten’s review of recruitment and training policies at various large hospitals, the Hospital for Sick Children was refusing fourteen applicants every day.^xxiii

Parental anxiety and trainee expectations

As already observed, by the time Ada joined the Hospital most of its probationers (paying or not) came from the middle classes, with few from traditional working-class backgrounds. Ada was not a typical paying probationer. While she completed her first year and then moved on to the ordinary probationer scheme, a significant number of her paying companions did not even manage to complete one year. Their inability to complete the course was in some cases probably related to social class and naive expectations – of both these young recruits and their parents; and letters from parents wishing to remove their young daughters from service suggest this is the case.

The Great Ormond Street Archive contains letters from parents on behalf of their paying-probationer daughters who wished to leave before the end of their term. Many of these letters voiced concern at the environment in which the young women were expected to live, the hours they were forced to work, and the impact the hospital had had on their daughter’s health. Most also demanded a return of part or all of the fees that had been paid for their training.

In December 1892, Henry Harrison (a medical man) wrote to the Hospital demanding the return of two months fees, after being forced to remove his fee-paying daughter after only three weeks. ‘Her health had suffered so much in consequence of the laborious hard work’, he wrote, stating that if he had been aware of the nature of the work, he would never have allowed her to join.^xxiv His request for a refund was refused, the Hospital disputing the degree of ill health suffered by Mr Harrison’s daughter. In a second letter Harrison emphasised that his medical credentials (he had been a surgeon for forty years) rendered him in the best position to judge her state of health. He added that the reason he removed her, and would not allow her to return, was the requirement that paying probationers should live in the Hospital.^xxv

It is odd that this letter, and another discussed lower down, came from medical men who, more than most, must have been aware of the working conditions their daughters were likely to encounter. Perhaps because the HSC was a children’s hospital, they had expected a gentler environment, more akin to the middle-class surroundings their daughters were used to?

In October 1897, Mr Aldersmith (a surgeon at Christ’s Hospital, London) wrote at the behest of Irene Waistrell’s father. Irene had registered as a paying probationer in summer 1897, but within a week of taking up her post she developed serious eczema. Aldersmith explained she had suffered with eczema a year previously, but it had subsided. It only reappeared when she joined the hospital. Once removed the eczema disappeared and he was convinced that if she were to return the constant standing and running about would cause another flare-up. Irene’s mother followed up with a letter on 27 October enclosing a medical certificate and asking for a refund of her fees.^xxvi

Paying probationer Enid Pattison’s case caused a heated row between the Hospital and her parents. Her mother wrote a very long letter regarding Enid’s experience at the HSC. She had joined in 1898, but her health ‘had broken down’ after only ten days, due to ‘overwork and the responsibility put upon her’. Enid’s stepfather (also an established surgeon) removed her from the Hospital and she had not been well since. Her mother accused the Matron (Gertrude Payne) of misrepresenting the situation of trainee nurses. Among other complaints, she claimed Enid had been promised a room of her own but was told on arrival that would not be possible. Complaints about the accommodation were probably common, and Ada certainly had a low opinion of it, as can be seen from Sketch 14 below.

Contrary to her parents’ expectations, Enid was put straight to work and given sole responsibility for a large number of children, ‘when she had never even seen a child being washed before, being an only child herself’. Furthermore, she was allowed only fifteen minutes for her breakfast and became ill due to lack of time to perform her ‘morning habits’. Her mother summed up the situation: ‘My daughter went to the Hospital to learn nursing, not to be made a nurse straightaway.’ ^xxvii Mrs Roberts’ request for a return of fees was rejected out of hand, the reasons summarised in an unsigned draft letter found in the archive, which contradicted all the points raised by Mrs Roberts.^xxviii Interestingly, the writer of this unsigned draft claimed Enid’s stepfather had admitted that the real reason she wanted to leave was homesickness, inferring that if she had been given the chance, once she had ‘calmed down’, she may very well have changed her mind and returned to her duties.

A visual record of a probationer’s experience

There is no doubt that the work was hard, and perhaps it is not surprising that some of the young women from comfortable middle-class homes, such as Miss Harrison, found it intolerable. At this point Ada’s sketches come into their own, highlighting the dissonance between expectation and reality for these young women. She illustrates the pressure they experienced as they took their first steps into hospital work in several of her sketches. Scenes show probationers (recognised by their pink and white striped uniforms) rushing around, spilling bowls of ‘something’ as they run, seemingly in fear that they are in the wrong place at the wrong time, doing the wrong things. As Ada writes, ‘these are times of stress and trial these, when only pro’s [probationers] try to please’, which she illustrates in Sketch 1.

 

Sketch 1 [Images from GOS/11/18/9 Papers and memorabilia of Great Ormond Street Nurses. Notebooks of Ada Bois. Reproduced with permission of Great Ormond Street Hospital for Children NHS Trust, Museum and Archive Service.]

Her sketches are often accompanied by verse conveying similar sentiments, of haste and pressure, verging on hysteria:

They are times of storm and trouble these,

When folks are very hard to please

And everyone is upside down twixt work & worry tossed.

The principles are worried, all;

The nurses scarcely cool at all.

Their language is unspeakable. Their keys and tempers lost.

A large number of paying probationers failed through ill health or for reasons described in the letters above. As Enid’s mother implied, parents thought too much was being asked of their young daughters, who were not strong enough for the role. The HSC (and other children’s hospitals) accepted younger women as probationers compared to hospitals for adults, partly because the work was considered less strenuous. But the same hospitals expected their probationers to work or attend lectures for fourteen or fifteen hours a day, with only three or four hours off duty: at the HSC probationers of both types started at seven in the morning to nine at night, with only four hours for meals, prayers and relaxation. On Sundays they worked either short morning or early evening shifts.^xxix This was an incredibly strenuous schedule, and it is probably not surprising that many of the recruits found it physically hard.

Sketch 2

Ada had little patience with the type of woman referred to in the letters above. In Sketch 2 a paying probationer is being interviewed by the Matron. The title of the sketch is, ‘This is the nurse who wishes the matron to allow her to go back to be a Lady again.’ In it the Matron (Gertrude Payne) is shown interviewing a new paying probationer who wants to leave. Ada inscribes it with a damning description:

This new ‘pro’ all rough work declined;

For to rub and scrub she’d no mind.

She said “I’m not slack but I think I’ll go back

And once more be a Lady refined.”

Ada seems to capture the essence of the reaction of some paying probationers to their new surroundings, who perhaps joined the hospital because it was fashionable, or for naive reasons of sentimentality, without considering the nature of the work.^xxx

Negotiating Hospital Hierarchies: management

As mentioned previously, most of the probationers of both types would have come from comfortable middle-class homes, often with one or two servants. For such women, arriving at an institution where they would suddenly find themselves at the bottom of the hierarchy, must have been a shock, and a challenge they had to learn to navigate quickly. Probationers were on the bottom rung of the staff – with the kitchen staff and servants only marginally below them. They were completely outranked by the ‘professional’ staff – that is the Hospital Managers, Medical Practitioners and senior nursing staff. But for paying probationers, who may have seen themselves socially as on a par with the ‘professionals’, this must have been even more of a shock.

   

 Sketch 3                                                                                          Sketch 4

The theme of tensions relating to social class recur throughout Ada’s notebooks. One of her sketches depicts the countless numbers of visitors who passed through the hospital, being waited upon by probationary staff. Despite their skilled work, in these sketches probationers are ignored by the visitors, seen merely as maids or servants. Sketches 3 and 4 show the probationers waiting on visitors to the Hospital. These are men and women of high social standing, as indicated by their smart clothes and showy dresses. In Sketch 3 a lady visitor is being guided around on the arm of Adrian Hope, the hospital secretary, as two probationers hover with cups of tea. ‘We greatly enjoy waiting on the distinguished visitors and Adrian Hope’, says Ada, with her tongue firmly in her cheek. It is clear from her words and her drawing that she resents being made to feel subservient to these strangers, to whom the probationers are expected to defer.

In Sketch 4 a well-dressed lady descends the stairs, as Adrian Hope welcomes another group of lady visitors. The expectation is that she is another visitor, but in fact she is an off-duty nurse dressed in very similar fashion to the visitors below. As she walks past them, the off-duty nurse says ‘Please don’t trouble to smile, I’m one of the nurses, such a waste’.

The hospital was always swarming with visitors: not patients’ families, but members of the upper circles who were a key source of income for the Hospital which was constantly battling debt.^xxxi It is easy to imagine how resentful the probationers might be of these visitors, who interrupted their hectic schedules and expected to be waited on hand and foot; but these visitors were potential donors, and the probationers were partly there to provide a good show.^xxxii

The treatment of probationers as a secondary waiting-on force was repeated in another of Ada’s sketches, a scene from a Bazaar held to celebrate the HSC’s golden jubilee in 1902. (See Sketch 5) It was held at Regents Park on a typical July day in London: a gale is blowing, children, hats and umbrellas are being carried away by the wind and nurses (who are of course serving the tea) are trying gamely to hold everything together. As Ada says: ‘Tea was not at all a tame affair; To provide one’s friends with their refreshment one laid oneself open to serious bodily injury!’

Sketch 5

This theme of being undervalued by the hospital managers recurs throughout the two notebooks and Ada seems to express in her notebooks a real feeling of disgruntlement within the junior nursing staff of being firmly placed at the bottom of the pile.

Negotiating Hospital Hierarchies: doctors and other members of staff

If the nurses had a strained relationship with the hospital managers, it seems from Ada’s sketches that their relationship with doctors was no better. Where they appear, the doctors are characterised by Ada as uncommitted to their work: they are late for ward rounds, enjoy upsetting the nurses, constantly unavailable and do not take their work seriously.

Sketch 6                                                                  Sketch 7

 

Sketches 6 and 7 hint at this difficult relationship. In Sketch 6, Ada satirizes the respect in which nurses were expected to hold their medical colleagues. The title of the sketch is ‘Summary punishment of a nurse who forgot her crepe band’ and the comment below reads: ‘The crepe bands worn for our late Queen are again in use on departure of the RMO [Resident Medical Officer].’ The sketch shows a probationer nurse hanging from a light fitting surrounded by a group of her colleagues. While two of them hold the rope from which she is suspended, one of the sisters looks on but noticeably does not intervene. This is a rather gruesome image, which possibly refers to the deference expected from nurses towards their medical colleagues. In this case the hanging of the nurse is in punishment for not grieving for the departure of their RMO.^xxxiii There is another sketch (not included) where the RMO is being presented with a Victoria Cross by a group of ‘germs’, watched on from a balcony by a large group of probationers. The lead ‘germ’ says: ‘I have great pleasure etc etc for services rendered’. (The ‘germs’ will be discussed below in more detail.)

In a further depiction of this fraught relationship, Sketch 7 shows a doctor being dragged into the ward by a porter, while the nurse looks patiently on. ‘Here you are nurse’, says the porter, ‘I’ve brought him to make his round’; and in a further image (not reproduced here), a group of doctors are shown dancing in a ring in the middle of the ward, with a caption which reads ‘Early Rounds. Here we go round the mulberry bush’. Two more of Ada’s germs look on, laughing at the doctors’ antics; the message appearing to be ‘who would be frightened of them’! In her choice of song (here we go ROUND the mulberry bush) Ada appears to suggest that the doctors do not treat the ward rounds seriously.^xxxiv

These tensions between medical staff and nurses were common and increased as the movement for the registration of nurses gathered pace. The medical profession felt threatened by this move to professionalise nursing, a feeling which was enhanced by the increasing numbers of middle-class women who entered the hospitals as nurses – often coming from similar or even more elite backgrounds than the young doctors themselves. Alison Bashford discussed these issues in her work, Purity and Pollution, where she described the very detailed instructions given to nurses at the turn of the century regarding their behaviour towards doctors.^xxxv These included instructions as to where they should stand in a room in relation to any doctors present; always allowing doctors to go through a door first (in direct contradiction of societal etiquette of the time); and that they should always stand until told otherwise in the presence of doctors (including students and dressers). It is easy to see how the young nurses may feel belittled by such rules, and Ada’s sketches capture some of these tensions.

She also captured tensions between other groups of staff. In Sketch 8, the sisters have been gathered together for a group photograph, organised by the Matron. In the background are a number of probationers peering over a balcony watching the proceedings. The picture is captioned, ‘A sight for the gods rather than mere mortals’ and the Matron instructs the watching probationers ‘Go back nurses the sisters don’t like you watching them.’

Sketch 8

Infection

Navigating difficult hospital hierarchies and coping with the extreme demands of the job must have been difficult enough for young women, but there was one challenge which among all others dominated Ada’s notebooks: fear of infectious fevers. The topic runs throughout her commentary, with many of her sketches illustrating the nurses’ awareness (especially during the winter months) of infections such as scarlet fever, diphtheria and whooping cough, which raged through the Hospital. General ill health, as has already been highlighted, was one the main reasons for a probationer failing to complete the course, but the risks posed by infectious fevers warranted special attention.

Only eighteen months before Ada joined the hospital, there had been an outbreak of scarlet fever among the nurses and several had been moved to the London Fever Hospital to recover.^xxxvi Annie Esplin, was one of them, and when she died at the Fever Hospital her death must have been embedded in the nursing staff’s collective memory. A letter to the Management Committee (possibly from Matron Payne – the letter is unsigned) informed them of the Annie’s death and urged a rapid review of sanitary procedures. It transpired that a ward (which only four days previously had been used to house infectious cases) had been repurposed as a bedroom for nurses and in the following days two of its occupants had acquired scarlet fever. Both recovered; but a few days later Annie, who had not actually slept in the room, also contracted scarlet fever. She was not so lucky as the others, and she died on 17 May, after only four days illness.^xxxvii

In her sketches, Ada, possibly as a coping mechanism, turned the fear of infection into a running joke, which ran through a number of related sketches. In Sketch 9, part of long series about avoiding ‘germs’, the nurses are seen entering a lottery to decide which fever they will ‘win’. As the caption says: ‘The nurses all are choosing things; and having them in turns; And she who draws the largest prize, with pride and glory burns.’

Sketch 9

The winning ticket is diphtheria, and Sketch 10 shows two nurses comparing their tickets, one running off waving a ticket clearly marked ‘Diphtheria’. Ada annotates this as follows:

‘A catch like Diph of all things,

is deserved of course by few,

and most are quite contented with the latest thing in flu’.

Sketch 10

The fear of infection is represented most vividly in these sketches by the appearance of Ada’s ‘germs’. Throughout a long sequence, situated in the Isolation Ward, Ada’s humorous approach belies what is clearly a rising fear of what the winter will bring in terms of threat of infectious diseases. Throughout the 1890s cases of infectious fevers were on the rise in the Hospital, reaching nearly 20 per cent of all admissions in 1902.^xxxviii

Sketch 11

Sketch 11 introduces readers to Ada’s ‘germs’. They appear throughout the first notebook, crawling up walls, chasing nurses and clinging onto their skirts. The nurses do everything they can to avoid being caught by the germs which are represented as evil little playful things: sometimes red, sometimes black – but always shown chasing nurses. As Ada writes:

I’ve just knocked into ‘Scarlet’

And just avoided ‘Diph’

It’s not an easy matter though

To give the germs the slip.

One of her final sketches on this subject (Sketch 12) shows a scene from a nurse’s bedroom. The nurse is ill in bed, and a crowd of her colleagues surround her. Ada’s annotation reads: ‘The nurses show their sympathy for a nurse who is query SF’ and the title of the image is ‘Ancient history: drawn from life’. Attached to the wall above the sick nurse’s head is a sword (of Damocles, perhaps?), and one of the nurses is saying ‘Don’t mind the brute’. Whether this refers to the ‘germ’ or to the doctor who is shown standing outside the room is unclear. If it is the latter it re-enforces the arguments made above about the relationship between the nurses and doctors.

Sketch 12

Accommodation

Referring back to some of the criticisms levelled at the Hospital by angry parents, Ada addressed the nurses’ general living conditions in the hospital, which are not described with any warmth. In Sketch 13, a nurse is shown (with a ubiquitous germ clinging to her uniform) standing over a smoky fire. ‘All the fires smoke’, states the caption for this image, and elsewhere there is reference to nurses coughing and gasping for breath, which could be due to smoky fires, the all-pervading infections or to the general rushing around, which in her sketches resembles nothing short of chaos!

Sketch 13

Enid’s mother (whose letter regarding her daughter’s poor experience as a paying probationer was discussed earlier) may have had a point about the nurse accommodation. Ada was none-too complimentary about it either. The hospital was always short of nurse accommodation.^xxxix There are references throughout the Minute Books to the shortage of accommodation and it was certainly one of the limiting factors for boosting the numbers (and revenue-generating potential) of Lady Pupils in the 1860s and 70s. There was always a balancing act to perform between using space for extra patient beds versus extra accommodation for the nurses needed to care for them. As seen in Annie Esplin’s case, this was often addressed by changing the use of particular room according to need: sometimes it was a ward becoming a nurses’ dormitory, sometimes it was hastily put together nurse accommodation in an attic. For a while in the late 1870s the pressure was somewhat reduced when the new building was erected, which provided additional nurse accommodation – but the problem quickly reappeared and reached a crisis point in the mid-1890s.^xl In 1897, the Management Committee decided to purchase an empty building next door which had housed the hospital and convent of St John & St Elizabeth. The purchase was completed and the building refashioned to form accommodation for its nurses which opened in 1898.^xli It is probably fair to suggest that the hospital did not spend a lot of money converting the old hospital – the ‘grim accommodation for its nuns’ probably transformed into ‘grim accommodation’ for the HSC’s nurses, if Ada’s sketches are to be are to be believed.^xlii

Sketch 14

She shares her opinion of what was on offer in Sketch 14: ‘You are sure to delight in a room, that has never known duster or broom. A bed you’ll find there, and perhaps half a chair, so you see there’s no reason for gloom’, she wrote, followed by ‘I try to speak gently while the squalor oppresses me … and the [accommodation] Block ‘s just a d*****d dirty hole.’^xliii Many of the probationers must have found it hard to come to terms with these grim conditions.

The sketches discussed in this article are just a small sample of those contained in the two notebooks. Other subjects include a fire in the new nurses’ home, images of the nurses been driven to the Bazaar, and most oddly a long series about a tankful of pet goldfish which escape from Alice Ward in an ultimately failed search for better accommodation!

Conclusion

The main focus of this article has been to present a new source in the history of children’s nursing; a set of sketches and verse composed by a probationer nurse at the Hospital for Sick Children, Great Ormond Street. The source has been used particularly to expand upon the usually terse reports on nursing to be found in official archival sources. While Ada Bois (the creator) presents her material through a humorous (or even satirical) lens, a deeper reading set against official accounts of the hospital’s nurses at this time, suggests a young woman who faced some significant challenges during her three years at the Hospital and was perhaps, to a certain extent, traumatised by her time there. The subjects she brings to the readers’ attention, including danger of infection and the various relationships she (and her fellow probationers) had to navigate are portrayed in relation to the hospital’s own accounts. It is impossible to know why she created these notebooks or who she created them for, as they are not accompanied by any explanatory material. It is not even known how they came to be in the Hospital archive: whether they were left behind when she left or were donated to the Hospital by her family or some other actor after her death. There is no record of the notebooks arriving in the archive: they are an enigma in that respect.

The overwhelming impression given by the notebooks and official records is of an institution attempting to develop an organisational structure which can deliver its objectives, counterbalanced by the need to attract and retain high quality staff. Its managers are never working in a vacuum and are challenged constantly by changing medical orthodoxies and public opinion, especially as far as their largest body of staff is concerned, the nurses. And all at a time when the role and status of nurses is in flux, experiencing a period of great change, but where the final outcome is far from decided. Ada’s notebooks shine a unique light on these issues, particularly as they affect probationary nurses – a group of hospital workers all too often entirely overlooked by hospital records and by historians alike. What is missing from Ada’s account is just as interesting as what she chose to include, and curious, in terms of trying to understand her purpose in producing it. There is virtually no mention of the hospital’s patients and very little about the nursing work she and her colleagues undertook, except to imply there is too much; there is only a brief mention of the lectures and only passing reference to the exams which had been a bone of contention for the managers in the hospital for years, and of which she was an early recipient. It is difficult to imagine why these key subjects eluded her examination.

The use of such personal resources does not come without risk. They raise questions which cannot be ignored, about how much they can be relied upon to open up a window into the lived experience of a group of people. Can they be trusted to bring a new and richer interpretation of the day-to-day events they convey, which official histories of institutions frequently ignore? It is especially difficult when the reason for their creation and their journey to the archive is unknown. However, by examining the notebooks alongside official records it is clear that some of the events discussed by Ada did occur when she was in the Hospital. The official records tell us what happened, and perhaps Ada’s notebooks tell us how it ‘felt’ to be there.

I would like to express my thanks to Nick Baldwin, archivist at the Great Ormond Street Hospital for Sick Children, for his great support while I was writing this article and for his permission to reproduce the material from Ada Bois’ notebooks.

Endnotes