Frances Cadd, University of Nottingham | The UKAHN Bulletin |
Volume 8 (1) 2020 | |
Introduction
This article is a partial biography of nurse and political campaigner, Avis Hutt (1917-2010, first name Elizabeth, neé Askey, formerly Clarke). It focuses on her nurse training, and first months as a staff nurse, at Mile End Hospital in the East End of London between 1935 and 1940. These early years were instrumental in influencing Hutt’s later involvement in campaigns for socialist medicine and the National Health Service, as well as her advocacy of a multidisciplinary, ‘team approach’ to care, especially in the area of care for the elderly. The sources used in this article primarily date from the 1990s and 2000s when Hutt, reflecting on her life, gave a number of biographical interviews, recorded as audio, or written-up into short articles for a number of newspapers and journals, including the Nursing Times, which dealt with various aspects of her work as a nurse and peace campaigner. This article, in its investigation of Hutt’s early experience as a nurse in Stepney in the 1930s, contributes towards a larger doctoral research project which examines Hutt’s nursing work and political activity over the course of the twentieth century.
Surrey to Stepney
On 1 July 1935, Hutt began her nurse training at Mile End Hospital in the East End of London. She had had a comfortable but humble lower-middle class upbringing in the Surrey village of East Horsley, with her adoptive parents, Henry and Elizabeth Askey, a pawnbroker and a barmaid respectively. Hutt recalled how East Horsley ‘was a typical feudal [village] … we lived in the country but we weren’t wealthy’, however, ‘I wasn’t poor in the sense that I was deprived in the way that I saw when I became a nurse in Stepney, that [being] social deprivation, material deprivation, and also spiritual [deprivation]’.1
Hutt admitted that arriving in Mile End was ‘a culture shock’ but that she did not have any doubts about the move at the time because ‘I was young, enthusiastic, full of energy, and open to every experience I could have…I accepted it, I took it, it was a new life to me’.2 As well as this distinct sense of adventure and opportunity around moving from rural Surrey to London, nursing was also a logical and practical option for Hutt, providing a degree of economic security and social stability. It was her mother who had encouraged her to consider nursing as a career option, arguing that if she went into the profession ‘[she would] have a job for life’.3
Nursing also provided Hutt with a sense of personal comfort and emotional security. At age nine, Hutt had learned she was a foundling who had been adopted by the Askeys as a baby.4 This was a formative and traumatic experience for Hutt that resulted in feelings of insecurity throughout her life.5 A recurring motif in her recollections demonstrated a desire to belong and correspondingly, she often sought out ways to feel needed, wanted and valuable as part of her personal coping strategy to prevent future abandonment.6 Nursing presented a career choice that spoke to these anxieties:
I had a caring feeling because, I suspect that those of us who become nurses…we become what we are and we do what we do because it meets a need in ourselves…Now that may relate to the circumstances in which I was found … I didn’t know until I was nine years old that I was adopted…For me, becoming a nurse with its caring context and its image, wanting to be needed, wanting to be loved, makes every kind of sense.7
Hutt found her desire to be needed, wanted and accepted, was satisfied in the close-knit community spirit of Stepney. She explained how as a nurse she was respected in the district, and recalled how she and her nursing friends, despite not being in uniform, would be recognised as they ‘sall[ied] forth’ down the Mile End Road during their off-duty time and would receive free gifts of sweets and oranges from shopkeepers, as well as declarations of gratitude from relatives of patients, ‘we had lovely lives in that sense’, she fondly remembered.8
Having won a scholarship to Guildford County School for Girls at age nine where she excelled at sports and games, Hutt’s intelligence and her ‘enormous energy’, made her a particularly desirable and sought after candidate for nurse training schools in the 1930s; a period throughout which the profession suffered a severe shortage of staff.9 Hutt recognised that her abundance of energy and measure of gumption meant that she did not wholly conform to the gentle, self-controlled ‘ministering angel’ ideal propagated by nursing leaders in the interwar period.10 On reflection, she could see that she had been a ‘cack-handed, galumphing sixth-former…jolly hockey sticks, Angela Brazil type … I perhaps wasn’t the most sensitive’.11 Her nursing record bore testament to this self-assessment, with the matron of Mile End Hospital, Gertrude Godden, describing Hutt as ‘a bright and cheerful nurse – good type – progress made until final year – inclined to be careless’.12 Hutt recalled how she would often find herself waiting outside matron’s office to be disciplined for breaking a thermometer.13 She described another instance where she attended a patient who, unbeknownst to her, had been injected with a dye to check his kidney function. She collected his bed pan, almost dropped it in amazement and ran down the ward yelling: ‘It’s blue, it’s blue!’ The consultant stopped his ward round and a terrible silence ensued. She felt, she said, like a character in a Henry Bateman14 cartoon; ‘the nurse who dared raise her voice in public’.15
Hutt objected to the imposition of social barriers and hierarchies that served to isolate and distinguish between various grades of hospital staff, believing that it contributed to an inefficient health service. She deplored how ordinary, rank-and-file nurses, like herself, were discouraged from directly communicating with medical staff, describing how instead there was a chain of command: ‘If a telephone message came for one of the doctors, then a junior nurse wasn’t allowed to relay it herself. She spoke to the staff nurse who spoke to the sister and so on up the chain of command until the message finally reached the Great Man’.16 She continued, ‘Nurses were seen as the lowest of the low and doctors were the highest of the high…it was a class thing’17
Whilst Hutt recognised that a degree of self-discipline and obedience was essential for a nurse, she was not afraid to raise her voice and speak out if she believed she was doing so in best interests of her patients. Looking back over her life, she explained: ‘I was amenable to being responsible because of being aware of what I was doing for the patients, but I wasn’t, and I never have been totally conformist…I’ve done a lot of writing and I’m a pioneer’.18
Becoming a ‘political animal’
The social, cultural and political milieu of the East End exposed Hutt to a number of movements, causes, organisations and people that encouraged her to form a social and political consciousness. The first to have a profound affect on Hutt was the anti-Fascist movement. Hutt described Mile End as being ‘in the heart of political ferment… it was going on all around you, you could see it just walking down the Mile End Road…and even in the wards, patients on one side would be reading the Communist Daily Worker and on the other the Fascist paper Action…we had to pick a side, so there was no chance that I wasn’t going to be active in some way’.19 Her view that she ‘had to pick a side’ in this political battle was unusual for a nurse in this period. Nurses were expected to remain politically neutral to ensure fair and equal treatment of every patient.20 Hutt framed her political involvement as less a wilful choice and more as an unavoidable obligation through her use of the phrase ‘had to’. The idea that she unwittingly ended up in this political conflict is further emphasised by her statement: ‘we got swept up into the political life simply because of the times that it was’.21
But Hutt’s deep socialist convictions were sparked whilst she was working on the casualty ward on the evening of 4 October 1936. She explained: ‘the thing that really awoke me and made me a political animal, which I have been all my life since, a socialist, absolutely committed…was the Cable Street March’.22 She remembered being horrified by the results of anti-Semitism as she tended to the wounds of the victims of Fascist brutality admitted to Mile End Hospital. This was in stark contrast to the kindness, kinship and support she experienced from her encounters with the Jewish community in the East End, explaining that ‘the richness of Jewish family life…made me feel at home…and I felt I belonged’ and was treated like a family member, being invited to dinners and weddings.23
Since the East End had historically been a site for migrant and refugee communities, it had a particularly international outlook, with many anti-Fascist organisations being active in the area. Being a nurse, the Spanish Medical Aid Committee (SMAC), appealed to Hutt, and she attended many of the committee’s meetings held by former teacher, Isobel Brown, a founding member and secretary of SMAC.24 Unable to join the brigades in Spain, having not completed her nursing training at the time of the war, she participated by collecting money for SMAC and spending her summers volunteering in a refugee camp for Basque children in the south of England.25 She recalled that ‘’Boycott Japanese Goods’ was my first demo, and I went with great high-heels [laughter], I learned a thing or two about marching then!’26
Hutt also marched on the streets as a trade unionist on 5 April 1938. She was one of twelve London County Council (LCC) nurses affiliated to the Guild of Nurses trade union, who, wearing medical coats and black masks to hide their identity, took to the streets to air their grievances with their working and living conditions for the first time in the history of general nursing.27 In an interview with nursing historian, Stephanie Kirby in 1998, Hutt confessed that she had taken part in what the Daily Mail called ‘The March of the Masked Nurses’ because it gave her the chance to publicly protest about the ‘petty victimisation’ experienced by nurses, like herself, for participating in Leftist-political activity, as members of trade unions or political organisations.28 Nurse leaders believed that such political activity, associated with the working-classes, compromised nursing’s developing status as a middle-class profession, modelled on Florence Nightingale’s vocational tradition.29 Hutt was of a generation of nurses that felt the strain of a severe nursing shortage in the interwar years and recognised that a compromise must be found between the profession’s vocational tradition and the need to make nursing an attractive career choice that met the social aspirations of modern women.30 She explained that:
I’m an enormous admirer of Florence Nightingale but she was invoked as the Victorian middle-class woman, as the archetypal nurse that we should all aspire to, and the question of having a decent wage, and decent living, and decent hours, and the rest of it…was regarded as not right for nurses who were supposed to be respectable.31
Hutt joined two trade unions, established exclusively for nurses; Thora Silverthorne’s Association of Nurses and Iris Brook’s Guild of Nurses, both formed in 1937. These unions argued that an insufficient nursing staff, stretched to the bare bones, had an adverse effect on the quality of care that could be provided for patients, and that only by improving nurses’ status and conditions of work could more applicants be attracted to the career, and consequently, ensure a good service for patients.32
However, Hutt came to realise that a better nursing service alone did little to really help many of her patients. She witnessed first-hand the poor working and living conditions that left those living in the slums of Stepney, known as ‘the Brady Mansions’, suffering from illnesses caused by poverty and deprivation. One particularly poignant memory for Hutt, was that of her first ward, a brand new tuberculosis ward, filled with ‘young men, beautiful young men, shiny eyes, high male flush, coughing; they’d all be dead in 2 weeks, 3 weeks, a month and so on, whole ward of them…’.33 Despite improvements in hospital facilities to treat diseases like tuberculosis, she felt like she was fighting a losing battle as the root causes of many of the illnesses she saw in her patients – poverty, deprivation and poor standards of living – were not being tackled:
The ones [patients] we had were the indigenous Stepneyites, the people who worked on the docks and so on. The people with what was then called marasmus which was undernourishment and malnutrition, who would come in and we would give them good nursing care, ensure that they took their meals … We would get them better, send them home, they’d be back again, it was a revolving door. It was that that made me see the injustice of society.34
Hutt also explained how a large proportion of the illnesses she treated had been caused by patients actively avoiding hospital care ‘because of the financial thing’.35 Workers were afraid to take days off from work if ill or injured because they could not afford to lose pay for the days not worked which exacerbated their condition and delayed recovery. In addition, she recalled how sepsis was a huge problem because of patients going for ‘back-street abortions’ and other operations rather than going to a hospital in the first place because they could not afford to pay medical fees and charges.36
In 1938, Hutt met a likeminded surgeon who had taken up a Junior Surgical Officer position at Mile End Hospital that October. Alan Ruscoe Clarke (1908-1959), Hutt’s future husband, introduced her to the Socialist Medical Association (SMA), a left-wing political group for medical and hospital staff.37 The SMA consisted of healthcare workers who, like Hutt, had grown frustrated by their inability to make a lasting difference to the health of their working-class patients as a result of poor social conditions and lack of medical and health provisions available to non-paying patients.38 It was as a member of this group that Hutt began discussing and developing ideas, with other doctors, nurses, and hospital workers from local East End municipal and voluntary hospitals, for health service reform. She remembered campaigning for a salaried state medical service to provide comprehensive care for all, free at the time of need39. The idea of health centres in which a health team could work in partnership to provide primary health care, was central to their discussions.40 Hutt explained that the SMA actively sought to encourage a team approach to healthcare, offering ‘the only platform where a nurse could go and talk on a level playing field with doctors and other health workers’.41 This was accomplished by holding meetings away from the strict social hierarchies of the hospital, and instead in member’s flats in Shoreditch and Stepney, or in buildings at University College London.42
Clarke impressed Hutt by his implementation of the SMA’s principles of a team approach to care within the hospital. She explained how after his lectures on surgical nursing, he ‘did what no other doctor ever did and used to walk back from the lecture hall over to the nurses’ home with us and talk to us and have coffee with us, and we’d never met a doctor like that before. I drew the short straw’, she laughed, ‘I got him’.43 Hutt proudly recalled how, as their romantic relationship blossomed, they went out of their way to shock and scandal, traversing the imposed social boundaries between doctors and nurses from within the hospital grounds, but only ever during their off-duty time, never whilst working on the wards. She remembered how at the hospital’s Christmas party, after stealing a bottle of cooking sherry from a ward kitchen, Clarke and herself, along with her two nursing friends and their boyfriends, jumped over the chair and table barricades matron had laid out to block access to the nurses’ quarters, and sneaked up to her room.44 They would also frequently return to Mile End after a weekend away, strolling up to the main entrance to the hospital arm-in-arm and with their ‘little bag’, completely visible to all on the wards, ‘we didn’t give a damn’, she said, ‘I was a natural rebel, spurred on by love’.45
Despite the derisiveness of their minor disobediences, Hutt and Clarke were seriously committed to the cause of socialist medicine, which they saw as inextricably intertwined with their relationship. Writing in the spring of 1939, Clarke wrote to Hutt explaining that he saw how their relationship was evolving and becoming ‘centred less and less on what we think of each other and more and more on what we are going to do together’.46 In their letters, they discussed how they felt that by working in a healthcare system that charged patients fees for treatment they were ‘frustrated in a hundred ways’ and ‘could never be as medical people what we are capable of’.47 Instead they longed to be ‘working together in a real socialist hospital, doing the work we started out to learn to do’, believing that ‘any other way would be disastrous for our love and our life’.48 ‘[N]ever again could you or I work in oblivion of the possibilities that are not ours under capitalism’, wrote Clarke.49
Yet, their dream of working together, practicing socialist medicine, could have easily been thwarted by the marriage bar that was in operation for nurses in the 1930s. In order to give Hutt the best chances of continuing her nursing work, the couple married in secret at Stepney registry office on 21 July 1939. Hutt had passed her General Nursing Certificate and London County Council nursing exams in February 1939, and had been doing a spate of night-shifts, which enabled her to sneak-off to be married during the day.50 Her absence was discovered and on her return to the hospital she was ‘hauled up to matron’s office’ expecting to be dismissed. However, matron said: ‘in my day we could no longer have kept you on as a nurse, but in view of the fact that we’re in the semi-finals [of the Nursing Times Tennis Cup], that’s how it goes but please be discreet’.51 Hutt explained that because she was on the hospital team in the tennis tournament, ‘it would have been bad form to have dismissed someone representing the hospital at that level’.52 She also added that the outbreak of the Second World War was imminent at this time, and that matron had admitted that good, qualified nurses like her would be needed in the hospital, so there was no real chance that she would have been dismissed.53
The End of Mile End
Despite having evaded the marriage bar, Hutt and Clarke decided to leave Mile End when they came to believe that socialised medicine could not be realised in a London County Council (LCC) hospital. Clarke had grown frustrated with the LCC’s administration of its medical services, believing the local authority was more interested in improving its hospitals to attract middle-class rate-paying patients and thus, generate a profit, rather than to provide a better service and facilities for more vulnerable and needy members of society.54 He resigned his position in October 1939, taking a position as Senior Causality Officer at the Central Middlesex Hospital, in March 1940. Hutt, pregnant with their first son, and desiring the stability and financial security of her contracted position as a staff nurse, stayed on at Mile End, leaving upon giving birth in June 1940.55 She then joined Clarke at Central Middlesex Hospital, working with her husband as a part-time staff nurse on the casualty ward.56 Shortly after the birth of her second son, Nick, in April 1942, Clarke was called-up for war service in the Royal Army Medical Corps and was posted to North Africa.57 This signalled the end of Hutt’s time nursing in a general hospital. She moved into industrial nursing, working at Hooper & Co, coachbuilders, who at the time were building fuselage sections for Mosquito bombers, in order to qualify for free state childcare for her two young boys, offered by the government to women in industry contributing towards the war effort.58
Her nurse training in the East End from 1935 to 1939 and her subsequent experience as a staff nurse until June 1940 had been invaluable, opening her eyes to the low social position of nurses and the need for health system reform to better combat poverty related disease. Her romantic relationship with Clarke went some way in providing the opportunity to overcome the barriers enforced between grades of hospital personnel, whilst her activities in the trade unions and the SMA allowed her to fight for better conditions and rights, both for herself and her profession, but more crucially for Hutt, for her patients.
Once socialised healthcare had been realised in the National Health Service Act of 1946, she turned her attentions to improving the occupational health of workers through industrial nursing in the 1940s and 1950s, and then towards campaigns for better elderly care in the 1960s and 1970s. Hutt’s political engagement and activity, in the name of providing quality care for her patients and the most vulnerable members of society, marked the entirety of her nursing career. She realised that her political involvement made her unusual in her profession but still hoped that through leading by example nurses would realise the importance of their advocacy work on behalf of the poor. As she said,
nurses, wherever their place of work, have an important part to play in becoming articulate and vocal about what they see and what are the things which most affect those they care for…Don’t run away from things because they seem political. Health has always been, and now more than ever is, a political issue.59
All images reproduced by kind permission of the Clarke family
References
- Avis Hutt interviewed by Kevin Morgan, British Library (hereafter BL), C1049/70. T1-T2 (29 November 2002).
- Avis Hutt interviewed by Stanley Holder, Royal College of Nursing Archive (hereafter RCN Archive), T123/B (1998).
- Hutt interviewed by Morgan, BL.
- Home video interview produced by Hutt’s grandson, Matt Clarke, in celebration of her 90th birthday, Unarchived, July 2007.
- Home video interview produced by Clarke, 90th birthday celebration.
- Sue Clarke, daughter of Avis Hutt, in conversation with Frances Cadd, Unarchived, 10 January 2019.
- Hutt interviewed by Holder, RCN Archive.
- Information combined from two interviews: Avis Hutt interviewed by Stephanie Kirby, RCN Archive, T123/A (1998); and Hutt interviewed by Holder, RCN Archive.
- Hutt interviewed by Kirby, RCN Archive. For more information on the nursing shortage in interwar Britain see Brian Abel-Smith, A History of the Nursing Profession (London: Heinemann, 1960); Anne-Marie Rafferty, The Politics of Nursing Knowledge (Oxford: Routledge, 1996); and Julia Hallam, Nursing the Image: Media, Culture and Professional Identity (London: Routledge, 2000), 89.
- Anne Summers, ‘Ministering Angels: Victorian Ladies and Nursing reform’, in Gordon Marsden (ed.), Victorian Values: Personalities and Perspectives in Nineteenth Century Society (London: Longmans, 1990), 121-133; and Hallam, Nursing the Image.
- Information combined from two interviews: Hutt interviewed by Holder, RCN Archive; and Hutt interviewed by Morgan, BL.
- Record of service and conduct of probationer nurses, 1927-1949: Askey, Elizabeth, Royal London Hospital Archives, RLHME/N/1/1. (This is Avis Hutt’s record of service, under her maiden name, Elizabeth Askey.
- Julie Tomlin, ’50 years of the national health service’, Camden New Journal, 18 June 1998, 16.
- Henry Mayo Bateman (15 February 1887 – 11 February 1970) was a British artist and cartoonist best known for his satirical cartoon series, ‘The Man Who…’, published in Punch magazine throughout the interwar years, which depicted comically exaggerated reactions to minor human foibles, and usually, upper-class social gaffes. For more information see Anthony Anderson, The Man who was HM Bateman (Exeter: Webb & Bower); and John Jensen, ‘Bateman, Henry Mayo (1887-1970)’, Oxford Dictionary of National Biography(2004). Available at: https://doi.org/10.1093/ref:odnb/30636 .
- John Collee, ‘Dr John Collee reflects on the soul of medicine under socialism’, The Observer, 24 December 1995, 46.
- Collee, ‘Dr John Collee reflects’.
- Home video interview produced by Clarke, 90th birthday celebration.
- Hutt interviewed by Holder, RCN Archive.
- Information combined from three interviews: Hutt interviewed by Kirby, RCN Archive; Hutt interviewed by Stanley, RCN Archive; and Hutt interviewed by Morgan, BL.
- Megan-Jane Johnstone, Bioethics: A Nursing Perspective (Chatswood: Elsevier, 2019), 304.
- Hutt interviewed by Morgan, BL.
- Information combined from two interviews: Hutt interviewed by Kirby, RCN Archive; Hutt interviewed by Holder, RCN Archive.
- Ibid.
- Hutt interviewed by Morgan, BL.
- Hutt interviewed by Kirby, RCN Archive.
- Hutt interviewed by Morgan, BL.
- Mick Carpenter, Working for Health: The History of the Confederation of Health Service Employees(London: Lawrence & Wishart, 1988); Chris Hart, Behind the Mask: Nurses Their Unions and Nursing Policy (London: Bailliere Tindall, 1994).
- Hutt interviewed by Kirby, RCN Archive; and Frances Cadd, ‘‘The March of the Masked Nurses’: Remaking nursing’s tradition of vocation through public protest in 1930s Britain’, Women’s History 2/14 (2019), pp.4-8.
- Rafferty, The Politics of Nursing Knowledge; and Robert Dingwall, Anne Marie Rafferty, and Charles Webster, An Introduction to the Social History of Nursing (London: Routledge, 2002).
- Cadd, ‘‘The March of the Masked Nurses’’; and Carpenter, Working for Health.
- Hutt interviewed by Morgan, BL.
- Anonymous, ‘Status of Nurses: Appeal for Collective Bargaining’, The Times, 24 November 1937, 19; Michael Walker and Chris Hart, ‘United Voices’, Nursing Times, 17 July 1996; see also Cadd, ‘‘The March of the Masked Nurses’’; and Carpenter, Working for Health; Carpenter, Working for Health; and Hart, Behind the Mask.
- Hutt interviewed by Kirby, RCN Archive.
- Information combined from two interviews: Hutt interviewed by Kirby, RCN Archive; and Hutt interviewed by Holder, RCN Archive.
- Hutt interviewed by Kirby, RCN Archive.
- Ibid.
- John Stewart, The Battle for Health: A Political History of the Socialist Medical Association, 1930-51 (Aldershot: Ashgate, 1999). For further information about the Socialist Medical Association see John Stewart, ‘”For a Healthy London”: the Socialist Medical Association and the London County Council in the 1930s’, Medical History 41/4 (1997), 417-436; and John Stewart, ‘Socialist Proposals for Health Care Reform in Inter-War Britain: the Case of Somerville Hastings’, Medical History 39/3 (1995), 338-357.
- Avis Hutt interviewed by Ian Hislop in ‘Pennies from Bevan’, documentary film produced by Twenty Twenty Television (1998); and Avis Hutt interviewed in ‘The NHS: A Difficult Beginning’, documentary film produced by Blast! Films (2008).
- Ibid.; and Craig Kenny, ‘The Pioneers’, Nursing Times, 1 July 1998.
- Kenny, ‘The Pioneers’.
- Ibid.
- Ibid.
- Hutt interviewed by Kirby, RCN Archive.
- Home video interview produced by Clarke, 90th birthday celebration; Hutt interviewed by Morgan, BL; and Collee, ‘Dr John Collee reflects’.
- Chris Hart and Michael Walker, ‘High-Flying Activist’, Nursing Times, 17 December 1997, 38; Home video interview produced by Clarke, 90th birthday celebration; and Kenny, ‘The Pioneers’.
- Letter from Alan Ruscoe Clarke to Avis Hutt, Unarchived, c. spring 1939.
- Letter from Alan Ruscoe Clarke to Avis Hutt, Unarchived, c. November 1939.
- Ibid.
- Ibid.
- Hutt interviewed by Morgan, BL.
- Hart and Walker, ‘High-Flying Activist’.
- Ibid.
- Home video interview produced by Clarke, 90th birthday celebration.
- Letter from Alan Ruscoe Clarke to Avis Hutt, Unarchived, c. September 1939. See also Hutt interviewed by Kirby, RCN Archive.
- Elizabeth Avis Hutt, Curriculum Vitae, Unarchived, c.2002.
- Ibid.
- Alan Ruscoe Clarke, Curriculum Vitae, Unarchived, 22 January 1959; and Hutt, Curriculum Vitae.
- Hutt interviewed by Morgan, BL See also Penny Summerfield, Women Workers in the Second World War: Production and Patriarchy in Conflict (Oxon: Routledge, 2013), 67-68.
- Avis Hutt quoted in Heather Heath, ‘Stand Up and Be Counted’, Nursing Older People, 17/8 (2005), 39.