By Janet Hargraves
‘The secretary tried to make some little acknowledgement of the debt the Association owed to the faithful, devoted and efficient services of Nurse Kerr.’
This emotional quote is taken from the minutes of the Arnside and District Nursing Association (ADNA) in January 1945, when Mary Little Kerr resigned due to ongoing ill health.
The minutes give a wonderfully detailed account of the first attempts to bring nursing to Arnside 1917 – 1923, and its recreation fourteen years later which ran from 1937, until its eventual closure in 1956. Mary Little Kerr was the first village nurse, appointed in September 1937, and remained until January 1945. The workload, challenges and changes that occurred in the role unfold through the pages of the minutes, meticulously (and to my relief legibly) written by the secretary Mrs Barnes.
Initially, all I knew about her lay within these written minutes, so I was left curious to know more: how did her life unfold before Arnside, what brought her from Scotland to this small village in South Cumbria, and what happened to her after she left? I set out to discover what traces of her could be found in genealogical and other records, and to understand better the sort of career she had committed her life to. Biographies of nurses tend to cluster around women in wartime or who exhibited great innovation: nurse Kerr was neither of these. Rather, she is representative of a period of community nursing in Britain that is relatively poorly researched, but was a significant social and public health phenomenon, particularly in rural areas. What there is, for example Hebridean Heroines, which documents oral histories of nurses working in the remotest Western Isles of Scotland and Town and Country Nurse, which includes a case study of the Nursing Association in Bacup, Lancashire, illustrate some of the untapped wealth of primary sources. Prior to the National Health Service in 1948 there was no statutory responsibility for anyone to provide direct nursing care in the home, despite the growing evidence that it brought significant health and social benefits. Local subscriptions, volunteer effort and pressure from organisations such as the Women’s Institute created and sustained the infrastructure in which the Queens Nursing Institute was able to provide highly skilled nurses.
I have been fortunate to find the complete set of minutes for the county-wide Westmorland Nursing Association and the local Arnside Nursing Association at the Cumbria Archive Centre in Kendal which, which along with other sources has made this biography possible. Through her biography we have the chance to see the life of an ordinary nurse, who made a very substantial difference to patient experiences at a local level.
Mary Little Kerr was born 25 March 1896 in Paisley, Scotland to Thomas Kerr and his second wife, Mary Little. Her father Thomas had moved from Lanarkshire to Cumberland with his family in the 1880s, where he married his first wife Deborah, the couple having four children. Deborah passed away in 1894 when the children were between 11 and 3 years old. By 1896 Thomas had returned to Lanarkshire in Scotland, and married Mary Little on 17 July 1896. Thomas’s fifth child and Mary’s first was named Mary Little Kerr. 
Apart from her birth the only other record of Mary’s childhood is the 1901 census which records all four of Mary’s half siblings, herself and her younger sister Elizabeth living together with her parents in Lanarkshire. However, the professional records of the General Nursing Council (GNC) and Queens Institute, plus the biographical details she gives in her application form to the ADNA, which were copied into the July 1937 minutes, show a busy and successful professional education which formed the basis of her career as a community nurse.
She commenced nurse training in 1919, spending six years, until 1925, at the Southern General Hospital in Govan, Glasgow. She was entered on the GNC for Scotland’s Register of Trained Nurses in April 1923. She continued to work at the hospital for two more years in the posts of Sister in Charge on female dermatology and gynaecological wards. She next worked for a private nursing institute at St Leonards on Sea from August to November 1925. This was many miles from home on the south coast of England, and I am left wondering if this was a holiday job, and her first opportunity to have itchy feet and travel away from her Scottish roots whilst waiting for her next training opportunity.
Soon she returned to Glasgow, and from 14 November 1925 to 17 April 1926 she completed the full course of lectures as a Queen’s nurse candidate with the Glasgow District Nursing Association. She is described by the superintendent as ‘a good nurse keen and anxious to learn’ and by the inspector ‘a nice type of woman, thorough in her work but inclined to be slow with a quiet manner’. The other qualification on her record was that she could ride a bike, an essential attribute for community work, especially in Arnside. She then immediately undertook midwifery training at the prestigious Simpson Memorial hospital in Edinburgh from 30 April to 30 August 1926. The record of her Certified Midwives Board certificate and addition to the midwives roll for Scotland, was on 3 November 1926.
After seven years of work experience and training, and now thirty years old, Mary was highly qualified and seemed destined to be an unmarried, professional nurse. She had acquired the perfect cluster of qualifications for community work, but lacked experience – something she spent the next six years developing. In 1929 and 1932 Mary was registered as a midwife living in Paisley; however, this obscures her second adventure away from Scotland as a tuberculosis nurse in Canada. Her departure is not recorded, but she seems to have travelled there in late 1930 and is recorded as returning on the Duchess of Atholl from Montreal to Greenock on 6 November 1931. She had spent her time there working at the Lockwood clinic in Toronto at first and then the Canadian National Sanatorium in Muskoka, Ontario. Why she went, and why she returned after less than a year is not known but leaves me speculating about following family members who had emigrated there, a love affair or a call home due to family sickness.
On her return she worked for nine months at the Erskine Hospital in Renfrewshire, taking her to 1932. This hospital had started out as a First World War military hospital specialising in loss of limbs, but by this time was offering a wider service including convalescence and rehabilitation.
Her next move was into community nursing, as a district nurse for a nursing association in Kirkpatrick. In the 1935 midwives’ role she is registered as living in ‘Alexandra Cottage’, presumably the nurses’ home, in Kirkpatrick-Fleming, a village in South-west Scotland. This is the longest Mary had stayed in the same job since her training and is perhaps an indication that she had found her vocation, but not yet the right location, as she left after three years.
There is no genealogical record for the next couple of years, but her resumé, transcribed into the ADNA minutes, includes further tuberculosis experience at Glasgow sanatorium and maternity experience at Thornhill maternity hospital, in Johnstone Renfrewshire. Then, in June 1937, she responded to the national advertisement posted in the Nursing Mirror by ADNA:
‘District Nurse, C.M.B, State Registered, cyclist, required for September 1st for small country district. Salary £180. Apply … ’
From twelve applications, three were deemed suitable and two invited for interview. Mary was the most experienced and qualified and the committee unanimously voted to offer her the post. This was the beginning of seven years in Arnside, the third time she had sought work away from Scotland and the longest she stayed in one place in all her career. She worked tirelessly for the people of the area until she was ill in late 1944 which forced her retirement from the role in January 1945.
What brought Mary to Arnside? Firstly, she seems to have been fortunate not to have to fulfil the traditional role of spinster daughter/nurse in caring for her parents in their old age, as both died, in late 1937 and 1938 respectively, at the home they shared with Mary’s youngest, also unmarried, sister Elizabeth. Both sisters were in their early twenties at the end of the First World War and its possible both were part of the generation of women who had either lost boyfriends, or never had the opportunity for marriage in the aftermath of war. Secondly, her application for the post gives two addresses, one in Paisley, and the other in Millport, on the Isle of Cumbrae, a small island just off the west coast of Scotland in the Clyde estuary. Millport has a long maritime history but then developed into a holiday destination in the Victorian and Edwardian era, with pier and beach graced with a promenade of elegant houses. Arnside is not an island but is an estuary town of similar size with a maritime history which also became a popular ‘watering hole’. I like to think that coming to Arnside felt like a home from home.
[Figure 1] Millport Promenade. Author’s photograph
[Figure 2] Arnside Promenade. Author’s photograph
Mary’s arrival was the culmination of many years’ effort. Arnside, on the Kent estuary in the very south of Cumbria, is a mix of limestone terrain and salt marshes, which has over its history posed a challenge for public health developments. Home nursing, which had been established for decades in cities, had been spreading to less populated areas, funded by subscription organisations and local fundraising. For example Kendal, the nearest larger settlement, had its own nursing association from at least 1892.
From 1917 to 1921 an Arnside Nursing Association was initially successful but started to collapse in 1921 due to nursing shortages and closed in 1923. In the intervening years more associations formed and by 1933 the county-wide Westmorland Nursing Association reported that Arnside was one of only two remaining ‘un-nursed’ places in the county. Campaigning by the Women’s Institute, fundraising and negotiation with the adjacent village, Storth, to share the costs led to the timely and very welcome arrival of Mary, the first full time, dedicated village nurse Arnside had seen.
This was a triple duty post which included general sick nursing, midwifery, statutory responsibilities for children in the two infant schools, ante- and post-natal visits plus surveillance for TB and other infections. With just a pedal bike for transport, she initially covered 330 subscribing households, rising to 440. It is difficult to calculate the exact proportion of the population covered, as the two villages and outlying farms do not constitute a unit for census returns. However, this represents most residents. Houses and farms were scattered over a convoluted route of steep, narrow country roads. She lived in the heart of the village, in a house that was purchased by a committee member and rented to her.
Her monthly reports to the committee show that in her first four months she averaged 198 visits per month caring for sixty patients including medical, surgical, maternity and gynaecology. In addition, the County Medical Officer for Health commends the Westmorland nurses for chasing up school absenteeism during a scarlet fever outbreak. Thus, she was averaging around seven home visits over an eight or nine-hour day, with additional statutory health visiting duties, urgent cases on Saturday and on-call for exceptional cases on Sunday.
This, and her location in the heart of the community, meant she was quite isolated, lacked direct supervision and comradely support from other nurses and was constantly visible and on call. The minutes repeatedly illustrate the care they took in trying to ensure she was able to take her off duty time and to support her, for example reiterating that requests for help had to be in advance.
Nevertheless, it is not surprising that by April 1938 she was exhausted and given three weeks complete rest by the doctor. The committee rallied round to find cover for her role and to respond to the doctor’s strong recommendation that Mary needed a car! Although car usage was still relatively new, there was a steady increase in their use, particularly in rural areas and county – wide resources were available to assist with purchase, although the bulk of the responsibility remained with voluntary effort. A garden sale raised £170 – enough money to purchase a grey two-seater Austin Seven and by Christmas, Mary had passed her test and was on the road.
The next challenge came with World War Two. Arnside and Storth took their share of evacuee children, with or without their mothers, which is reflected in the October 1939 report to the committee showing a record 465 visits, of which 280 are children. In addition, the committee record their concerns regarding the insanitary conditions in the temporary school provided for them, indicating nurse Kerr’s increasing public health role.
Rationing, particularly of petrol, stretched resources, and relief cover for Mary kept the committee constantly busy. This band of hard-working women, who were clearly supporting not just Mary but all the village war effort, stepped in to help. When cod liver oil and fruit juice supplements for children were introduced, they collected and distributed these. One member trained with the civil reserve and regularly stood in for Mary when no qualified cover was available.
More initiatives came as the war progressed and plans for an integrated national service developed. In 1940 free diphtheria vaccine was given to all British children: promoting and delivering this agenda fell to the nursing association nurses across the region and in the 1942 annual report they are praised for achieving an above national average of 80 percent immunisation, with 100 percent in some villages. In 1941 quarterly weighing and measuring of all school children was successfully added to Mary’s busy clinic schedule. In addition, the Central Midwives’ Board had been lobbied to change their ruling on the use of gas and air in the community. Although this added a new task and training requirement (Mary gained her certificate in 1943) it greatly improved home births.
Mary threw herself wholeheartedly into the role and was well liked and respected. The class differences between committee and nurse could cause tensions. However there is no sign of this for Mary and maybe this is one of the reasons she stayed so long and worked so hard. However, by late September 1944, now forty-eight-year-old Mary was once again ill, needing surgery and rest. The county helped to supply an emergency replacement whilst Mary had surgery in Liverpool, and convalesced in Windermere, Paisley and Grange-Over-Sands. To the great sadness of the association, following the consultant’s advice, Nurse Kerr resigned in January 1945.
The ADNA continued until the 1950s, as it handed over to, and supported the fledgling National Health Service, but the minutes give no hint of where Mary went or what she did next, other than a unanimous agreement in 1948 to gift £100 of their remaining funds to her.
However, Mary continued to register as a nurse with the GNC so we know that by 1948 she was back living in Millport. Although she would have had a modest pension, at 52 she would not have been claiming it, so it’s reasonable to assume she was living with a family member and working locally. She may have taken private nursing posts, but Millport has a small hospital, and at the time also had a TB unit of open-air huts in the grounds of the old Battery.
In 1950 she registered at the same address but then, at age fifty-four, she married sixty-one-year-old James French Knight. James Knight was born and bred on Cumbrae and trained as a marine engineer. Records are patchy, but he travelled to New York as first engineer on the Clan McWhirter in 1939 and received a US pension when he was seventy, suggesting he may have worked there. To date I have no further insights into their meeting: they could well have known each other earlier in their lives and been reunited, or James could have engaged her nursing services and their relationship grew from there.
Mary registered twice more with the GNC, in 1955 and 1957, now sharing the same address as James Knight in Millport. Sadly, in 1961 James died at home in Cumbrae and the final record for Mary is that she died in 1975 at the age of seventy nine, not far away on the Scottish mainland in Saltcoats, Ayrshire.
Mary Little Kerr was neither famous nor extraordinary. She was, however, a fine example of the remarkable triple duty nurses of the early twentieth century who lived with and cared for communities all over Britain from the cradle to the grave.
 All references to the Arnside, and Westmorland Nursing Association Minutes can be found at the Cumbria Archive Centre Kendal WC/H/N/1 and WC/H/N/2.
 Catherine Morrison, Hebridean Heroines (Laxsay: Islands Book Trust, 2017); Helen Sweet, ‘Town and Country Nurse. Viewing an early Twentieth Century district nursing landscape’, in Women in the Professions: Politics and Philanthropy, 1840–1940, ed. by Katherine Bradley and Helen Sweet (Victoria: Trafford Publishing, 2009), 150-184.
 Enid Fox, ‘District Nursing in England and Wales before the NHS’. Medical History 38 (1994), 303-321; Helen Sweet and Rona Dougal, Community Nursing and Primary Healthcare in Twentieth-Century Britain (London: Routledge, 2008).
 Jane Ronson, Archives of the Erskine Hospital Ltd, veterans charity, Renfrewshire, Scotland, Archives Hub (2017). Available at: https://blog.archiveshub.jisc.ac.uk/2017/06/02/archives-of-the-erskine-hospital-ltd-veterans-charity-renfrewshire-scotland/ [Accessed 4 December 2023].
 Arnside Nursing Association Minutes. Entry for July 1937, Cumbria Archive Centre Kendal WC/H/N/1 and WC/H/N/2
 Victoria Nicholson, Singled Out: How Two Million British Women Survived Without Men after the First World War (Oxford: Oxford University Press, 2008).
 The Queens Nursing Institute [n.d], History of the Queen’s Nursing Institute. Available at: https://qni.org.uk/explore-qni/history-of-the-qni/ [Accessed 4 December 2023]; Institute of Health Visiting [n.d.], History of Health Visiting. Available at: https://ihv.org.uk/about-us/history-of-health-visiting/ [Accessed 4 December 2023]. William Rathbone’s ‘Queens Nurses’ in Liverpool and the Manchester and Salford Sanitary Reform Society both date from the 1850s and 1860s.
 A report of the Annual General Meeting in 1898 indicates that the association has been successfully running for 6 years. Anonymous, ‘Kendal Nursing Association: Annual Meeting’, Westmorland Gazette, 5 February 1898, 6. Available at: https://www.britishnewspaperarchive.co.uk [Accessed 4 December 2023].
 ’Un nursed’ is the phrase used in the Westmorland Nursing Association Minutes to describe a town or village that has no resident nurse in attendance. Cumbria Archive Centre Kendal WC/H/N/1 and WC/H/N/2.
 Sweet and Dougal, Community Nursing, 114-124.
 Arnside Nursing Association Minutes 1940-1943 and Westmorland Nursing Association Minutes annual report 1942 can be found at the Cumbria Archive Centre Kendal WC/H/N/1 and WC/H/N/2
 Sweet, ‘Town and Country Nurse’, 158-162.