In 19th century Britain the risk of catching Typhoid and dying from it was a very real threat. The Maidstone typhoid Epidemic (September 11^th, 1897 - January 29th 1898) was the largest the UK had experienced, and from which many lessons about it’s management were learnt. In 2009-2010, there was a worldwide swine flu pandemic, which resulted in 335 deaths in the UK alone.⁽³³⁾ There was wide spread concern among the general population about the risk of catching swine flu and the resulting complications to health, especially for those with underlying health issues. Many more people had been predicted to catch it than in did, with original predictions being of over 3000 deaths in the UK alone.

Recently, for a birthday, I was the lucky recipient of a Maidstone Typhoid Medal, originally awarded to an A.L.Reeves on 8th December 1897* at a ceremony to which the Lord Mayor of London attended to mark the ending of this outbreak of typhoid *(or was posted to her if she had already left Maidstone). ⁽¹⁾ The medal was awarded to approximately 220 people; Nurses(from the Corporation of London), Salvation Army Staff (4), Maidstone Rural District Council ( Maidstone Volunteer corp.), Maidstone and Hollingbourne board of Guardians staff, the Royal Army Medical Corp (theirs are engraved with RAMC alongside their name on the medal) and "numerous" private individuals.⁽¹⁾ Notable among those who cared for the sick who did not receive a medal were the doctors (of whom 12 are listed in the South East Gazette as attending - despite several dignitaries who did (the Mayoress, Lord Mayor, the Sheriffs and Sir John Monckton). One medal was kept back to be preserved for display at the museum.⁽¹⁾ There is one on display there today. The medals, made of silver hanging on a blue and yellow ribbon presented in a maroon and cream silk lined case, cost 10s 6d each to produce, with employers of private nurses allowed to purchase them for their employees. Despite careful and systematic organization for the awarding of medals there was some discontent (recorded in the local press about the distribution of these medals).

"An Old Maidstonian disgusted " writes:-

"why was not the ex-mayor who worked so hard during his trying year of office not allowed one? But I see the doctors are quite overlooked, its only nurses who are thought of, though we nurses without doctors are worse than useless! Those who had the management of the distribution have done it very badly for there are still some district nurses paid for from the public fund who have not received them and why was only one lady from the soup kitchen staff presented with a medal?" ⁽¹⁾

The author of the above letter preferred to stay anonymous... perhaps he was also a doctor?

Front and Reverse of Maidstone Typhoid Medal

Typhoid is a common bacterial disease which is spread when people eat food and water contaminated with faeces containing the salmonella typhoid bacterium.

The outbreak in Maidstone of Typhoid was the largest ever epidemic reported in the United Kingdom, affecting 1,847 people, of which 132 died (111 dying outside hospitals - i.e. in their own homes, and 11 in hospital), amongst a population of 34,000. 'The Standard' reported an outbreak in October 1897 at University College Hospital, London, affecting 12 nurses and 6 servants, which  was not thought to be related to the Maidstone epidemic.⁽⁶⁾ The daily news also reported on September 27th another typhoid outbreak elsewhere, in Kilham in Yorkshire:-

"five deaths have occurred already. The village is properly drained, but otherwise the sanitary arrangements are primitive and require immediate reform. It is supposed that the water in the wells is contaminated" ⁽⁸⁾

The first cases of Typhoid in Maidstone  were reported in the South East Gazette on Tuesday 21st September 1897, with nearly 200 reported cases in the first eight days; the first case was thought to be that of  a servant girl who lived in the area of the Farleigh supply. Her case was the first notified to Mr Percy Adams on 13th September, (the deputy medical officer for health and son of the Medical Officer for Health who was unfortunately on holiday in Switzerland at the time). In the days before radio, television and instant media, reporting in the newspapers were one of the main ways of communication on a mass scale . The newspaper reported that:-

  "The symptoms associated with Typhoid usually include one or more of the following Diarrhoea with or without fever, vomiting, headache, pains in the limbs or stomach, attended by lassitude, loss of appetite and possibly succeeded by a few red spots of parts of the body." ⁽¹⁾

 The paper continues to calmly educate the public:-

"Typhoid is not as infectious in the same way as Scarlet fever or  Measles,

 and the suggests sensible measures which should be taken, saying that:-

"persons in attendance on patients  cannot be too careful in keeping germs out of the body”  ⁽¹⁾

advising proper precaution be taken with food preparation and that no person, juvenile of adult should share the same bad as any one suffering room the "malady"

Mr Adams, acting in the absence of his father said that the outbreak was due to a water supply problem, affecting mainly the western side of Maidstone.  He says that the supply had already been cut off, (although the date on which this did actually happen varies from journal to journal) and after much rigorous testing the supply was proved to have been from Farleigh springs (although in reality the samples had only been sent to London on the day of this interview - Monday 20th september1897, whilst houses which received their water from Boarley Springs were unaffected. (In three streets in Maidstone the houses on one side, as in the street where the Mayor of Maidstone lived, was unaffected as they received Boarley Spring water, but the people on the opposite side were, as their water was drawn from Farleigh Spring) ⁽²⁾

In the same article (which in common with the fashion at that time was on the 5th page in the newspaper, after all the adverts):- 

"Mr Adams wishes to strongly advise all the inhabitants of the borough to thoroughly boiled all milk and water used in their households, and to thoroughly cook all food before partaking of it"

The paper continues by stating that the demand for Milk had gone up to such an extent that a dairyman had sold cows for £250 above their normal price! It concludes with a rumour; the cause of the outbreak,

"A rumour (which we refer to with all reservation) is also current to the effect that the spring of water which is now under suspicion is fed from an area of land, lately the scene of a hoppers encampment, wherein disease had existed. We can only ask is it so?" ⁽¹⁾

(The hoppers were Eastenders who came down from London to pick the hops, living on the land nearby. They were given very poor living conditions, doing a job that the locals didn't appear to want to do. Some hoppers regarded it as a holiday. The practise of hoppers travelling from the East End to collect in the hope for beer production continued well in to the 20th century).

Following a special meeting of the Sanitary Committee of the Urban district Council  held on Monday 20th September 1897 at which a subcommittee was appointed to:-

"consider at once the desirability of hiring a building or buildings capable of accommodating at least 100 persons or isolation purposes."

In the event  eleven "buildings"  were used to accommodate 339 people at full capacity, as shown below.
 

Apart from the local fever Hospital, and a few beds in tents (!), local schools predominantly fulfilled the role as the local hospital - West Kent General Hospital already had Typoid patients on its wards.

Among the Doctors appointed were those from Guys Hospital, (including a Dr Washburn, a bacteriologist) the Liverpool Fever Hospital, (where 500 typhoid patients had been treated a few years before) and St Thomas's along with local General Practitioners.⁽²¹⁾

The Medical Officer for Health:-

"was instructed to procure a supply of trained nurses from London without delay" ⁽¹⁾  (within one day it is reported that 10-12 had already been "engaged").

Approximately 100 nurses were sent by the Corporation of London, including six nurses from The London Hospital and including Caroline Bell and Edith Cavell (the latter whom, although still a probationer, had done 7 months nursing at the Fountain Fever Hospital prior to her training). Both worked at Padsole Schools, lodging with a Mrs Josiah Baker at 72 bank Street, owner of the toy shop - which subsequently, in December 1897, did a good trade in toy nurse dolls.  

In fact such was the national feeling that the committee was inundated by offers of nursing help and asked the Nursing Record to publish a letter in mid October refuting the need for more nursing help:-

"I am glad to say a regular supply of certificated nurses from well known institutions has been maintained and, therefore there has been no need to engage independent nurses" ⁽²¹⁾

Many offers of nursing  had written from across the UK, and the committee apologised that they had not been able to answer these offers of help due to the workload created by the epidemic.

Eva Luckes wrote in Edith Cavell's End of training probationers report of1898 that:-

"she did good work during the Typhoid epidemic in Maidstone" ⁽⁹⁾

Which was high praise compared to typical nursing reports at the time.

The following article, taken from "the Hospital" newspaper, reprinted in a newspaper in Leicester gives a sense of the public feeling, and the scale of the organizational  response to this epidemic. The public had seen the effects of excellent nursing care as given to injured soldiers by Florence Nightingale during the Crimea war (1856) and how that care had changed the fate of injured soldiers. This time there was no need for agitation by nurses to be allowed to go Maidstone, the Corporation of London employed Miss Annie Plowman and two assistants (Sisters E.K.Ward and E.M.Black), one District Assistant Superintendant Nurse G. Travis and 100 other nurses.

Miss Plowman had recently completed six years working at a Fever hospital as Matron in Monsall Fever Hospital. A visitor to Maidstone writing in the Nursing Record says:-

"Miss Plowman was trained at St Bartholomew's hospital, and as she had been one of my first and most intelligent probationers, trained in what are now often alluded  to as " the good old days"*..............I found Miss Plowman very busy over domestic matters, the basis of all good nursing.  I found every hospital beautifully clean and orderly and gaily decorated with a wealth of autumn flowers"⁽²¹⁾  * A phrase still used today!”

"The Nurses at Maidstone"

"the nurses are representative of a vast number of training schools both Metropolitan and Provincial. The housing of such an influx of workers has taxed the resources of the town, and various public institutions have been requisitioned for dormitories. Many nurses are being hospitably lodged by residents in the town and its outskirt. They are lucky for they are made very welcome guests and enjoy every consideration. The less comfortably housed think lightly of their drawbacks, and there is a great tendency among all to make the best of things. Brought face to face with the awful sorrow and suffering of the town, personal trials fade into insignificance. All the nurses are working heart and soul for the sick, rejoicing in each sign of recovery which manifests itself among their patients, and doing bravely and well. Every Nurse who reads "The Hospital" must now sympathise with the work now going on in Maidstone but only those who have seen it can picture accurately the terrible condition of things...The hours of the nurses vary a little but are necessarily long and busy ones. They get their meals away from work-in restaurants, at Howard de Walton Institute, and other public places. The hospitals which have been furnished and opened in such rapid succession will be described next week for they deserve an article to themselves! Miss Plowman who is supervising the whole of the emergency nursing department has her headquarters at the Station Hospital and visits the others frequently. The Corn Exchange has been converted into a huge depot for clothes and other things sent as gifts for the poor of Maidstone. Orders for these things are signed for by clergy and others. Sad are the messages that accompany some of these orders when the requisition is for "black clothes" that the petitioner may be decently clad at the funeral next day of a parent or near relative. Beef tea and milk and broth are supplied for the sick and many other things which the nature of the illness requires are forthcoming. In addition to the central stores at the Corn Exchange a little emergency stores of every kind of nursing supplies has been established and has already proved of great value to the sick by facilitating the actual work of the actual nursing. This store is merely supplementary to the other and is managed exclusively for nurses. In the first place a room was hired at the Temperance hotel to receive gifts sent for the use of the Co-operation nurses and to serve as a centre for their distribution. In the course of a few days the response to an appeal made by the secretary through the press was so liberal that the first room became quite inadequate for the purpose of storage. A large schoolroom has now been lent and there all strictly nursing necessaries are supplied" ⁽⁷⁾

The Maidstone typhoid epidemic was widely reported, even warranting newspaper space in Hobart, Australia:- 

"The typhoid epidemic at Maidstone still rages. A hundred fresh cases have been reported during the current week, and 'the mortality among juveniles is heavy. Whole streets are affected by the epidemic. A hundred London nurses and many doctors have been engaged to help the local practitioners and their aides, who find themselves utterly unable to meet the calls on their services. The parsimony of the Maidstone Municipality in refusing to have the water used by the townspeople' analysed is responsible for the outbreak."

The Special Committee met regularly, concerning themselves with every aspect of management, including that of relief stations.

On October 5th approximately the Poor Law board opened 3 relief stations:-

  "From these stations medical and other necessities are served out daily to the poor, the distribution of tickets entitling the applicants to relief being entrusted to the District Nurses." ⁽⁴⁾

Help came from many sources and in many ways; a relief fund was set up, to which people donated money from all over the country, the Queen sent £50 and the Lord Mayor's fund £4000 and by Tuesday December 7th the fund totalled £26,500. A special fund was also set up for Orphans and Widows.

"A commendable movement was set in foot last week for supplying a supply of male night nurses for typhoid cases".

Water from the Medway was used to flush the sewers and Rochester, Chatham, Gravesend and many other towns supplied water carts to help with the flushing.

On October 12th 1,565 cases had been reported with 73 deaths and a telegram from the Queen was posted on doors of town hall giving her support to the town and the Mansion house fund opened with Princess Christian offering the use of three trained nurses:-

"The three nurses selected by the Princess.. the staff of nurses in the town probably numbers more than 400. There are upwards of 90 under the control of the special Sanitary committee, the remainder being privately employed, either to attend to patients in the homes of well to do residents, or to undertake district work in conjunction with the Emergency Committee's staff ". ⁽⁵⁾

In order to help prevent further spread, on October 6th, under the authority of the Inspector of Nuisances a special laundry was opened in the grounds of Fant Lane Hospital to wash infected clothing and bedding. Every household that had a case of typhoid on their premises was entitled to free washing and disinfecting of all infected items. After washing, disinfecting by the use of high pressure steam the articles were returned in clean bags. This service handled about 62,000 items requiring 22 workers /week to process the laundry.⁽³⁴⁾ The Inspector of Nuisances was also responsible for the disinfecting and fumigating every house which had had Typhoid patients in it:-

"After the recovery or death of a patient, or his or her removal to hospital, the walls ceilings and floors, were initially sprayed with water, then sulphur, in the proportion of 40 oz to every 1,000ft of air space, was lit and allowed to burn on the sealed room for 24 hours. After the fumigation the ceilings were whitewashed and the woodwork washed with carbolic soap and water. Soiled wallpaper was removed and the walls washed with a solution of carbolic acid”. ⁽³⁴⁾

As in any epidemic there was general panic, with the trade being substantially affected in the town, the trains carrying noticeably less passengers into Maidstone (less than 30/day). It was reported nationally:-

"that trade of the town is gradually recovering from the stagnation which the epidemic produced and the inhabitants o the country districts are resuming their weekly visits to the borough"⁽³⁰⁾

Much comment was made of the incessant tolling of church bells when someone was buried it became rather unnerving for people lying ill with typhoid, and for their families caring for them.

"One of the worst consequences was 130 fresh graves in Maidstone cemetery - during one weekend alone 30 victims were interred" ⁽³⁴⁾
 

The Kent Messenger wrote:-

"All through Sunday afternoon stone street witnessed a long irregular procession of people bound for "Gods acre". The day of rest brought no rest to the grave digger." ⁽³⁴⁾

The graves from the typhoid Victims are scattered all over the cemetery at Maidstone, some were paupers so received no headstone - having a pauper’s burial into a communal grave.
 

Local and National papers reported widely on the epidemic, including reporting on "notable" and tragic typhoid infections and deaths.

The Morning Post reported on the deaths of the eight year old son of the Sanitary Inspector and also on the funeral of 19 year old Beatrice Whitehead whose father and six sisters were absent from her funeral as they all had the disease also.⁽¹⁹⁾

^"We are very sorry to hear that two of the nursing staff at Maidstone have contracted enteric fever in the discharge of their duty. One of these nurses is now practically convalescent, but the other is very seriously ill." ⁽²⁰⁾  In total four nurses were thought to have caught typhoid, and were all nursed at the West Kent General Hospital with one being sufficiently well to attend the medal presentation in Maidstone on Wednesday 8th December.⁽¹⁾

Nurses were looked after in other ways:-

"A weekly service, specially for nurses, is now held at the Old church Maidstone,  ......nearly one hundred nurses attend these restful services, and come away, we may hope, refreshed in mind and body, and invigorated to engage once more in the struggle with the dire disease" ⁽²⁷⁾

At the medal ceremonies (two presentations were made, the first at 7.30pm to the night nurses followed by an interval of music and cinematography and the second at 9pm o'clock) held at the Technical school and Museum to which the Lord Mayor of London and other dignitaries attended. Princess Christian was unable to attend and make the presentations due to a prior engagement.⁽²⁹⁾ Councillor Urmston (who had been particularly involved with the epidemic and had written to the Nursing Record to request no more volunteers) was cheered by the nurses when asked by the Mayor of Maidstone to speak on behalf of them:-

"there were many things which they wished to tender his Worship and others their most hearty and cordial thanks ...for the very handsome entertainment in their honour ...the subscribers for the medals which would be highly valued by the nurses for the rest of their lives.... It was a matter of great gratification to them that the medals had been subscribed for so spontaneously without any call on the rates or application to the relief fund committee. Then they asked him to thank the people of Maidstone for their various acts of kindness.. some who had received nurses into their homes and treated them as honoured guests. They desired to thank them and many others who had sent game, fruit and flowers, placed carriages at their disposal, lent them bicycles and sent them newspapers and magazines all of which added much to their material comfort and recreation ( from other report it seems that the nurses worked extremely hard, working long hours and would have had little time to enjoy what must have been to many of them luxuries)   .... and finally the nurses wishes to give a special vote of thanks to those connected with West Kent general Hospital who nursed four of their number back to life and strength. ⁽¹⁾

By 7th December no fresh cases of typhoid had been reported, with no further deaths for the past fortnight.⁽²⁹⁾ However eleven more cases were reported two weeks later, with one death in the last few weeks of 1897. In early January with the majority of Emergency hospitals closed down, and temporary nurses returned home thanksgiving services were held on the first Sunday in local churches.

In March 1898 following the epidemic and end of the enquiry into it Miss Plowman received a letter from the mayor of Maidstone thanking her for all her hard work:-

"I have very great pleasure in testifying to the excellent work you have carried out in Maidstone .....as superintendant of the nursing staff and temporary hospitals the organization and work that you had to undertake was very large, amounting as it did to the management of and superintendence for six months of, in all, ten emergency hospitals  containing 400 beds and a staff of about 140 nurses for hospital and district work" permitting her to use this letter "in any way she might" ..it was subsequently printed in the Nursing Record in May 1898.⁽²⁶⁾

A.L. REEVES

As many family history / historical researchers will know, tracing a name with no first name/Christian name and only an approximate year for birth is very difficult indeed. Searching records for an A. L. Reeves was very unrewarding as everybody's birth register is made with at least one first name. It was extremely fortunate, that it was recorded that A. L. Reeves was among the nurses sent by the corporation of London to help in Maidstone.

It may be a coincidence but there is one Annie Laurie Reeves, aged 27 entering the London Hospital as a probationer on October 25th 1889 - her previous occupation being a children's maid.⁽¹⁰⁾

Assuming that this is the same person as A.L. Reeves as on the typhoid medal, Annie was born in Harrietsham in 1862, the 4th child of eight. Searching on all census's (1871-1911), Annie can be found, consistently giving the same details – age, place of birth etcetera (and from 1891 is always shown as a nurse: in 1891 on the nursing staff at The London Hospital, and in 1901 and 1911 appears to be working as a Private Nurse, staying with her patients).

In her probationers record Annie completed a two year period of training on November 18th 1891 working a mixture of days and night duty, from periods of 1-3 months. Eva Luckes initialled her training record and as usual written in another hand - a job often deputised for by the assistant matrons.

"Annie Reeves was a quick steady probationer ..she was a dependable worker and was generally liked. She never looked very strong but was not often "off duty". She would have been suitable for hospital or private nursing ...(Miss Luckes had established a private nursing service at the London in January 1896 which served to publicise the work of the London and bring in much needed extra income from the fees). Later on I think that she might prove well fitted for the charge of a small cottage hospital as she was thoroughly trustworthy." ⁽¹⁰⁾

On December 19th 1891 Annie aged 29 started work as Nurse Turner, after two years as staff nurse she transferred to the Private Nursing Service in February 1893 "chiefly on account of her delicate health" ⁽¹¹⁾ 

Annie worked as a member of the Private Nursing staff at The London for two years, visiting homes across not just London but  also further afield. Warwickshire, South Woodford, Wimbledon, and Holloway were just a few of the places - and even  providing "Ward Nursing " at  The Victoria Hospital, Guernsey, for 4 weeks in July 1893.  Annie's stays lasted from a few days to 12 weeks.⁽¹²⁾  The list of conditions that Annie nurses, as did many private nurses, is extensive. Her patients suffered from a wide range of conditions, amongst them: Alcoholic poisoning; Erysipelas; Cardiac disease; Gout; Cancer; Dropsy; Diphtheria; Renal disease; Measles; Senile decay; Typhoid; Pneumonia; Lumbago; Jaundice; a patient with a tracheotomy; Uterine prolapse; and Cancer of the Face. It is interesting that some conditions still have the same name, whilst others such as dropsy, erysipelas have been renamed, and others - also thanks to modern health vaccination programmes - have been more or less eradicated (apart from the names of phials injected to young babies - DPT= diphtheria, peruses and typhoid).

People who employed trained nurses often wished to stay out of hospital, although a proportion of her patients do sometimes get admitted.

On leaving the London Hospital Private Nursing Service Annie had a favourable report (at that time language in reports was often rather harsh, and often would today be judged as a character assassination, and was not always relevant to how the person had completed a job).

"Nurses Reeves was always a favourite on the Private Staff. She had  gentle nurse-like manner which made her a great favourite with the patients and she showed  real interest in her work. I was sorry when she was persuaded by another hospital friend, who I was far less sorry to lose to join the cooperation ⁽¹²⁾

To date the search for Annie Laurie Reeves disappears when she leaves the London on November 16th 1895.

"The (Nursing ) Cooperation".

This appears to have been a group of private nurses working together. The nursing record has an editorial in March 1894 on "the Nurses Co-operation" applying to the Board of Trade for a special licence to incorporate this society. This appears to have caused much controversy, because the objective behind the Co-operation was to secure Nurses full financial rewards for their work and this appears to be contrary to the Companies Act of 1867.⁽¹⁴⁾

On the same day as Annie leaves the London an advert is published in the Nursing records advertising The Registered Nurses Society ("a cooperation of private nurses") at an address from Regent Street, London:-

"the society supplies to the Public thoroughly competent Nurses, each one of whom has passed though three years of Hospital training and has been Registered by the Royal British Nurses Association after full enquiry into her character and capacity." ⁽¹⁵⁾

After stating that:-

"The Nurses obtain their full fees less 71/2 per cent to cover the working expenses".

is an extract from the First Annual report which compares Institution salaries with those Nurses might earn working through the registered nurses society.

"the society has already been fortunate enough to secure the approval and support of 132 medical men, a fact which is eloquent proof of the high estimation in which registered nurses are now held by the medical profession”.

The pecuniary benefit of co-operation is shown by the facts that , whereas in ordinary institutions the nurses are paid salaries varying between £30 and £45/annum (the lower sum being the most usual) ... the members of the society have received an average of £2.4s  week each." ⁽¹⁵⁾

There appears to have been in existence the Registered Nurses Society, who proudly state that their members receive considerably more than £100/year, and a sister society - the Nurses Co-operation:-

"has continued its highly successful career with benefit both to the public, to its own members and to the great principle of cooperation amongst Private Nurses." ⁽¹⁶⁾

There appears to have been some dissent towards Sir Henry Burdett. In May 1900 there a letter in the Nursing Record which suggested that Sir Henry Burdett was claiming to have started the Nurses Cooperation himself (it was started by four nurses putting their own money in.) It appears that he had made some suggestions which the cooperation had refused, described as "his wild cat scheme" and that he had been waiting since then for them to go bankrupt.⁽¹⁷⁾

A year later an article again in the Nursing Record suggests that Sir Henry Burdett is trying to cause problems within the Nurses Cooperation. Sir Henry Burdett appears to have drafted the constitution of the Cooperation, and in so doing made the nurses not members but employees of the committee.

"Sir Henry Burdett is week by week endeavouring to utilize his newspaper (Hospital World established in 1886) for the purpose of stirring up strife in the Nurses Cooperation." It  was thought that Sir Henry Burdett had delayed building of a nurses home for the cooperation by holding on to the plans (which had been passed to the management committee) ⁽¹⁸⁾

^"the nurses of the Cooperation owe their support at the present time to the committee who have so successfully managed their concerns hitherto, and that as a matter of principle , they should not allow the financial control of their affairs to be grasped by any notoriety seeking agitators^{" (18)}

At the Annual General Meeting of the Nurses Cooperation, London in 1903, general satisfaction was felt, despite ongoing negative propaganda about the Cooperation:-

"From the finance Report presented we are of the opinion that the nurses have every reason to be satisfied with the way in which their affairs have been conducted by the committee. No better answer could be given to the suggestion of mismanagement recently made in a contemporary than the report just published." ⁽¹⁸⁾ (of the 19 Committee members 12 are women (two are married, therefore would almost certainly not have been working then as nurses once married), with at least 3 doctors among the men. There are suggestions that some of the Committee were Sir Henry Burdett's friends; he also trained as a doctor).

Without finding Annie in records, (which may now not have survived) it cannot yet be proved that it was this Nurses Cooperation that  Annie joined. However given that she was living in London at the same time as this one was formed, and appears to have been one of the London Corporation nurses sent to nurse at Maidstone in 1897-1898 during the Typhoid epidemic, it seems a fair assumption that Annie Laurie Reeves and  A.L. Reeves are the one and same nurse.

 Annie is travelling to New York on 15th May 1925 "escorting boy to his parents" with her passage paid for by Mrs Hamilton (her address being given as Cranbrook). Again on 1st July 1927, UK outward passengers lists show Annie departing  at Liverpool Port, travelling to Montreal, Canada, as part of a party of 3 using the same address, Park House, Park Row, Winchester. Annie gives her occupation as a 65 year old Hospital Nurse, her travelling companions are a six year old child and a 37 year old vetinary surgeon Patrick Hamilton. Cynthia Hamilton and various combinations of relatives traverse the Atlantic frequently; 6 days later Cynthia and her father Hans Patrick Hamilton are returning to England, but minus Annie Reeves (who is shown returning about 1 month later). Perhaps she was escorting / accompanying the child in the absence of any female relatives on this occasion - the child's mother and grandmother are shown as living at Park House. This may well have been another job for Annie. She is shown in passenger registers on at least 6 occasions crossing the Atlantic, often with her berth paid for by her travelling companion (but in 2nd class generally). Perhaps that as Annie grew older she was able to continue working well past the age which is considered the norm for nurses today to retire as she was doing "escort duties". Working for an agency such as the Nurses Cooperation would have given a bigger salary, but without the protection for old age of a pension, (such as was granted, for example, to Mary Pinsent and her colleagues at the Royal Orthopaedic Hospital in the early 1930's).
 

Annie died in Cranbrook in July 1940 aged 77, with probate being granted to solicitors one month later (leaving an estate of £2600).⁽¹³⁾

L. Heale.

L.Heale is also in the same list in the South East Gazette in December 1897 ⁽¹⁾ as having received a Maidstone Typhoid Medal, however she is one of the "Non Corporation nurses", who were not sent by the Corporation of London.

Extensive searching suggests that the "best guess/assumption" is that she is:-

Lilian Frances Mary Heale, a vicars daughter (the 3rd of 11 siblings/possibly 12) born in Addington, Kent which is 9 miles from Maidstone (and only two from west Malling, a direct train line to Maidstone). At the time of the Maidstone Typhoid Epidemic, her parents were either living in Orpington, Kent or at a Parish in Bethnal Green. Lilian appears (like 2 others of her female siblings not to have been registered with a name), but there is a female Heale birth registered in Malling district for the correct quarter (to match the 1881, 1891 and 1901 census details for Lilian Heale) and Lilian Frances Mary Heale is baptised by her father, the rector Rev James Newton Heale of St Margaret of Antioch's church, Addington on December 24th 1871.⁽³⁵⁾ She was born on 6th November 1871, at Addington Rectory.

On the assumption that L.Heale as inscribed on this medal is the same person as Lilian Frances Mary Heale, it was also assumed that she may have trained locally as a nurse, prior to the epidemic (as she is named at the presentation ceremony as a local nurse). Holdings of hospital records for the period (1890-1900) are very incomplete, and there were several hospitals in Maidstone area where she might have trained: West Kent Hospital; Preston Hall Hospital; Maidstone Hospital Psychiatric Wing; The Maidstone Hospital; Kent County Ophthalmic and Aural Hospital; and the Public Fever Hospital/Fant Lane Hospital/the Isolation Hospital.

Lilian Heale is documented as having trained at West Kent General Hospital in Maidstone.⁽⁴⁷⁾  In records held at the British Library is a copy of her letter written on September 9th 1897 as the typhoid epidemic is about to strike Maidstone) requesting information about both the Army Nursing service and the Indian Nursing service. Lilian is already considering future career prospects overseas. Whether Lilian received the following response is questionable, as several years later she writes to the India Office and by inference it appears that she doesn't think she was ever told categorically that she wasn't suitable.

21st September 1897:-

"appointment cannot be considered until the candidate has fulfilled the requirements laid down in the conditions of appointment" ⁽⁴⁸⁾ (the Nurse be fully qualified).”

Lilian continues to apply, her application form submitted by Lilian in November 1897 to join the Indian Nursing Service states that she was currently training at West Kent General hospital, having started her training in December 1895. ⁽⁴⁸⁾

It was whilst looking at documents for the period that might show Lilian that a L. Heale was found living from March 1897 - December 1898 in the Stephen Monckton Nurses Home in Maidstone.⁽³⁷⁾

This was Private Nursing Institution, which provided private nursing care to local people. There is an advert in the Nursing Record in 1889 for:-

"PRIVATE NURSES wanted, at once, for the STEPHEN MONCKTON NURSES HOME- Apply, with testimonials, to the Lady Superintendant, West Kent Hospital Maidstone" ⁽³⁶⁾

It would therefore appear that Lilian is working as a private nurse whilst still a probationer nurse - and was a probationer when nursing Mr White in the typhoid epidemic.  L. Heale (and also Lilian Heale on one occasion) is recorded over the first three months as working for "The Isolation Hospital" and being sent to an address in Hollingbourne, taking over from the previous nurse, on February 26th 1897. This suggests the Isolation Hospital merely required extra staff for home nursing at that point.

From September 10th until December 16th 1897 Lilian remained with one "medical" patient, "Mr George White of Hunton" until his death. The first cases were reported on 13th September so whilst his death may have been from typhoid it is unlikely that that is why Lilian was originally asked to nurse him. (Purchasing his death certificate might answer this conundrum - but the only death which might be this gentleman in records is that of a William George White aged 17 in Maidstone in December 1897).

Her matron's reference when Lilian applies to join the army says that:-

"I can strongly recommend her - she is not only a kind careful nurse but is possessed with very good manners and tact...

In the typhoid epidemic she has acted as night nurse in one of the wards and has worked most carefully and intelligently. I ............unhesitatingly to recommend her to the favourable notice of the authorities.

Isabel Jones.(Lady Superintendant) December 17 1917- West Kent General Hospital." ⁽⁴⁸⁾

This statement purely adds to the conundrum. Why was this medal seemingly awarded to two nurses, who are both listed as serving in the epidemic - the medal was awarded to people who were not qualified nurses such as the cook.

At what would appear to be the end of her training Lilian had 6 days leave and on 22nd December was sent to Detling to nurse the Rev John Cave-Browne, who died 6 months later, with Lilian having 3 days off for annual leave in March. Lilian thereafter has a succession of medical and surgical patients to nurse and relieves in Maidstone district for 1 month for the "Hollingworth Nurses holiday" ^(37). The last entry in the Stephen Monckton Nurses Home register is that her patient, a Miss Davis of Maidstone, a medical patient is better on December 5th 1898.

Lilian is showing as having enlisted with Princess Christians Army Nursing Service (Reserve) on October 13th 1899, with service number 103.Princess Christian sent six of her nurses to help at Maidstone, perhaps this was when Lilian heard about their work.⁽⁴⁷⁾

In 1901 Lilian Heale is living with her parents and some of her 11 siblings in Bethnal Green being described as a "trained nurse – sick - own account" ⁽¹³⁾ in the column on the census for occupation. Two of her sisters had died the year before.

Lilians work experience had been varied after qualification:-

"Staff nurse at great Ormond Street Hospital, (theatre Nurse in out-patients)-1899.

Holiday Duties at great Ormond Street Hospital, 1900.

Private Nursing Duties attached to Government Hospital – Cairo - 6 months in 1900.

Sister, female Medical section Government Hospital, Cairo, - 2 years - including acting on 1901-1903.

rota as night  superintendent...      

whilst continuing to be on Princess Christians Nursing Service Reserve." ⁽⁴⁸⁾                                                                           

The 1897 application form which Lilian filled in has 9 sections:-

1 - Age next birthday.

2 - Place of Birth. (Her father has to subsequently in 1906 send in her birth certificate which is then returned to him-Lilian being in Bangalore with her brother).

3 - Profession of father.

4 - Marital status.

5 - Place and standard of education. (Lilian records that she had German and English Governesses at  home).

6 - Member of any sisterhood or society. (To which Lilian simply answers 'no').

7 - State of health - supported by medical certificate. (Lilian writes 'Good').

8 - What Hospital did you train at? (Lilian answers 'West Kent Hospital Maidstone. Have completed two years. three years completed December 1898').

9 - Original Letters of personal recommendation -including one  from a Lady of position in society who must state that the candidate is a fit and in every way desirable person to enter a service composed of ladies of good social position with whom she will associate. ⁽⁴⁸⁾ (Lilians referees are an 'aunt- Lady Hanley, Turnely lawn, Boston Lincs, and an Uncle - Capt. H.V Wingfield Stratford (formerly of the Rifle Brigade) of Woolton House, Newbury, Hants')."  ⁽⁴⁸⁾ (Newbury is in Berks- Woolton House is 8 miles south on the Hampshire border).

It is signed By Lilian, who gives her address as Hambledown Rectory, Kent. She accompanies the form with a personal letter, on black bordered note paper (as used Victorians when in mourning), and apologises for the delay in sending in the form as she has been away from the hospital for one week.⁽⁴⁸⁾  The mourning  does not appear to be for an immediate member of the family.

In 1906 Lilian writes to the Indian Office saying that:-

"My name has been down since 1900" (although in the Indian nursing service registers of applicants Lilian was regarded as an "unsuitable candidate -M10947/03" and then "appointed M1480/06." ⁽⁴⁹⁾ But there is no letter of rejection by the Indian Nursing service Board, although her name is not listed among the candidates deemed suitable to be considered by the board). Lilian is keeping house in India for her brother R. J. W. Heale, who is the tutor to the Maharaja of Mypore's brother and is about to be married to Alice Hope.⁽⁴⁸⁾ Lilian is keen to join the service at once, suggesting that if she has returned to England before they have made their decision about her appointment or not, that the government would pay her passage back to India:-

"whereas any appointment, while I am still out here would obviate the cost." ⁽⁴⁸⁾ and states that two of her brothers have served in India (perhaps to show that they had coped with the climate therefore she would?

Her brothers are listed as:-

Capt. E.W. Heale-107 Purnees.

Lieut. R J W Heale- 46 Punjabis.

Lilians unorthodox approach to the recruitment system for the Indian nursing Service causes ripples at the India office, Whitehall. An undated letter from there says:-

"I forward the papers of the following candidates;

1) Miss L Heale, who applied in 1897 and is still wanting to know whether she can have an appointment.

She was considered unsuitable by the nursing board when first applied, but was not so informed at the time. I wrote to Miss Herbert, asking whether there was anything in the present letter that might possibly lead to a revision of that opinion who suggested I send forms to the Matron in Egypt and whichever superintendent sister in India would see Miss Heale.

Miss Heale certainly cannot be recommended off hand for appointment as she suggests. Please let me know if you concur. Miss Heale is evidently about 34 years of age. if she is to be reconsidered I will ask her for a certificate of birth." ⁽⁴⁸⁾

Lilian this time gives more referees:-

Col T J McGann - a retired physician said - "nice young woman, nice manners, good kind disposition."

W.P.Graham, Director General P.I. (probably Cairo Hospital) wrote:-

"Miss Heales work is of a most satisfactory nature -beside the ordinary duties of a sister in charge of a section she showed great aptitude in training and looking after the pupil midwives and other nurses. Miss Heale’s health was excellent and she resigned her appointment for reasons entirely unconnected with the hospital." ⁽⁴⁸⁾

Harriet Lassell, Matron at the Kasr-El- Aini Hospital/Government Hospital, Cairo is subsequently asked to fill in a statement of suitability dated November 21st 1905:-

"4. What is your opinion as to her ;

a) Intelligence -  'Above the average'.

b) Skill - 'I found her work good'.

c) capacity for management - 'Good'.

d) Conduct - 'Excellent'.

e) Tone - 'Always Good'.

f) Temper - 'Very pleasant to work with - and too live with.'" ⁽⁴⁸⁾

Subsequently on January 9th 1906 Lilian has an interview, where a Lady superintendent of the Indian Nursing Service - Miss D G Cloore arranges to meet Lilian for a 24 hour stay. Possibly in Bangalore. She again writes a statement on a printed document:-

"4. What is your opinion  as to her ;

a) Intelligence -  'She is a bright intelligent woman and has evidently seen something of life.'            

b) Skill -   'As she has not worked with me I cannot

c) Capacity for management - answer these questions':-

d) Conduct -

e) Tone - 'always Good  -  A quiet lady like manner and old enough to control respect'.    

f) Temper - "From the little I saw a pleasant tempered woman'.

5. Do you recommend her?

I have always maintained we require young strong nurses* to begin their work out in India and fresh from their three years training at home. Miss H hardly fills this requirement but nursing officers of her type are in the service so I gladly recommend her." ⁽⁴⁸⁾

 ^* Many British people failed to cope with the India climate (my father was sent home from India as a baby for this very reason). In the event, Lilian Heale was successful in her application and was appointed.

In a memorandum sent to The London gazette and Hospital world:-

"appointment of Miss L. F. M.Heale, as nursing sister in Queen Alexandra's  Military Nursing Service for India, date 21 may 1906 also to be gazetted - with the compliments of the Military secretary, India office"⁽⁵⁰⁾

The British Journal of Nursing reports on 13th October 1906 that Lilian Frances Mary Heale has been appointed as a nursing sister in the Queen Alexandra's  Military Nursing Service for India.⁽³⁸⁾

the Indian Army Quarterly List for 1 January 1912 reports that  Lilian Frances Mary Heale was first commissioned on 21st may 1906 as a Nursing Sister into the Queen Alexandra's Military Nursing Service  for India, with a note that Lilian was serving in Peshawar.⁽¹³⁾

In an online search a Nursing Sister Heale was one of 14 Nursing sisters with the Indian service, transferred in November and December 1915 to the Mediterranean Expeditionary force. ⁽⁴⁰⁾

Written by Lady Superintendant Phoebe Florence Watt,

 "Rawal Pindi  B. general Hospital, wimereux Boulogne Base- October 16th 1915.

Confidential report;

Rank and name; Nursing Sister Lilian M F Heale

Service: QAMNSI

Date Embark; 21.9.14

Date Mobilized; 10.8.14

Date Joining unit 10.5.15

Date Leaving  ----

cause of Departure  ----

Miss Heale is a steady reliable worker - her wards are well managed, her orderlies are well trained and her patients are nursed with skill and devotion. Her health is good.

P.F.Watt." ⁽⁴⁰⁾

It appears that Lilians war record, along with several thousand other nursing records was destroyed in the 1930's (although she was still alive - one criteria for destruction was supposedly that the person was dead).

Lilians medal card for world WWI is held at Kew. ⁽⁴¹⁾

Initially Lilian appeared to have disappeared, but with some perseverance and much supposition (which was later confirmed by  a relative) that she did marry, possibly in India, to a Henry Lionel cooper "Lionel", born like Lilian to a clergyman in Kent in 1888 (so some 12 years her junior).  Lionel in shown on the 1911 census in India, as a Lieutenant in the 1st Royal Sussex Regiment. His father had died in 1899, and mother appears to remarry and by 1932 be living in New Zealand.

Lilian and Lionel marry on December 6th 1917 in Bengal province. Lilian gives her address as Peshawar, and Lionel as a Lieutenant in the 59th Scinde Rifles (frontier force of British Indian Army - which served on the Western Front, in the Somme and also then in Mesopotamia and Bagdad). They are married with a  licence by R.Campbell in front of witnesses who included both Lilian's brother R J W Heale (major); Dorothy Boulter; H. Guy Cooper (Lionel's brother); and H. Salgown (?) - Lieut Col. ⁽⁵¹⁾

They first are shown arriving back in England as a married couple on 16th October 1920 having embarked in Bombay, with Lionel's occupation then being that of a Collector of Customs in Mesopotamia. On February 3rd 1921 Lionel is leaving London ship bound for Basra, with a cancelled berth beneath his name. The only other voyage they appear on together is coming back to England, from Basra arriving in Plymouth on 17th may 1930. (Giving their address as 5 St Marys Mansions,  London W2. ) ⁽¹³⁾

Lilian dies a widow in 1959 in Canterbury, leaving her estate, worth £30,729 to her brother in law, Sir Henry "Guy" Cooper, M.C. D.C.M. her husband having predeceased her 11 years before, leaving much less - £7159. ^{( 42)}

"Cooper - On Aug.12 1948, at Lustleigh, Devon, H.Lionel Cooper, late of Basrah and Bagdad, beloved husband of Lilian, aged 59, memorial service to be announced later" ⁽¹³⁾

Two of Lilians brothers were killed in WWI, one receiving the MC; Lilians eldest brother Ernest Newton Heale was killed in France in 1916 - he died of blood poisoning in hospital at Le Treport and  was mentioned in dispatches. Her younger brother Lieutenant George Reginald Charles Heale M.C of the 10th (Service) Battalion Duke of Wellington's (West Riding) Regiment was killed in action on the 3rd of May 1917.

Her husband also lost a brother, Hugh, a Lieutenant in 1st King Edwards Horse Regiment in the Great war - he was wounded, but died at home in 1915, being buried in Nunhaed Cemetery (war graves section). 

What may be never known is, was she awarded this medal at the ceremony? Or did she never receive it and it was passed on to E.Hogg subsequently. So far efforts to contact Lilian Heale's relatives have been fruitless.

The Indian Nursing Service /Queen Alexandra's Military Nursing Service for India.

There are extensive records held in the British Library, Indian Section, where it was possible to find out considerably more about Lilian. (All applicants, successful and not are documented in some detail , including where they trained).

"Until 1887, when the Indian Nursing Service was founded by Lady Roberts, wife of the then Commander-in-Chief India, nursing in military hospitals in India was carried out by medical orderlies detailed from regiments and other units. In 1903 the title was changed to Queen Alexandra's Military Nursing Service for India. The nurses were recruited in England and they had to pass a selection board composed of members of both the British and Indian Nursing Services." ⁽³⁹⁾

On studying the register of applicants to the Indian Nursing service, common themes appeared readily:-

Social suitability; who the applicant knew in a position of "importance"; age; and which hospital they had trained at. ^{(49. 52, 53)}

One candidate took the requirement to show that she had the desired society connections:-

"one  from a Lady of position in society" ⁽⁴⁸⁾ by stating to the interviewer that she:-

"belongs to the same clan as the well known Lord Elphinstone - candidates statement." ⁽⁵²⁾ Ironically the author is related distantly to this lady - and didn't know until seeing that record that they trained in the same hospital! The candidate later withdrew her application to the Indian Nursing service - so no record is made of whether she would have been appointed or not.

Another was rejected despite training at ST Thomas' Hospital as her:-

"social position insufficient" - her father was a gentleman farmer, butcher and seed merchant ⁽⁵²⁾ rather ironically it was at St Thomas that the author was grilled about what her father did. She was accepted.

Two ladies from St Bartholomew's and The London were rejected as "not up to previous standard" and "matrons report was unfavourable" respectively, although it appeared that more applicants were interviewed from the "bigger" London Hospitals!

One applicant was initially rejected until it was pointed out that her application was supported by Sir R Sankey, RE. and another nurse who was appointed had a surgeon as father - her  social qualities were "very good" and another nurse also appointed "social qualities good." ⁽⁵²⁾

Applicants were appointed for 5 years initially, which was extended in 5 year blocks, but only with a successful medical assessment. a pension of £50 was paid after 15 years service.

Successful applicants were allowed to have £18 to spend on uniform, which had not been increased, despite letters of complaint since 1886 - that £20 was insufficient for the specific uniform requirements. The allowance was increased to £20 in 1916. The uniform list was very extensive, and included;-

"winter-grey beige-facings scarlet cashmere,

summer-white, facings , scarlet twill cotton

CAP- handkerchief     31 inch sq - average height sister

                                      33 inch sq - tall sisters 

Evening dress- soft white satin, facings scarlet silk, scarlet silk cape" ⁽⁵⁴⁾

In 1914, following a four year consultation period, the uniform was altered to bring it more in line with that of the QAIMNS, with the newly adapted uniform requirements being sent to Shhobred and Co only, Freeman and Peebody having appeared to have lost the contract between 19010 (when they were sent a doll dressed in the correct uniform) and 1914. ⁽⁵⁵⁾

There was an additional household list including

"6 pillow cases,

2 table cloths-damask

2 afternoon tea cloths

knives, forks, spoons-sufficient for one person -required if on field service/camping" ⁽⁵⁴⁾

Specific rules were arranged for new sisters arriving in India, and their accommodation requirements.


E.HOGG

A tantalising slip of paper in with this second medal says that it was awarded to E.Hogg, who is also listed in the newspapers as receiving a medal, as one of the Corporation nurses. Perhaps it was realised that Lilians patient Mr George White (Mr William "George " White did not die from typhoid, and therefore she was not entitled to a medal!?...

Miss E. Hogg has been much harder to locate; having searched hundreds of E. Hogg's in both the 1891 and 1901 census (in the "hope" that she was a nurse in 1891, and or that she wasn't married and therefore had changed her name by 1901). I was unable to find anyone likely. Every entry was checked - for in and out of London where an E.Hogg was unmarried and also where they were a servant (often a term mistakenly used for a nurse).

On the basis that several hospitals in London sent a few nurses (The London sent 6) I asked the Archivist at The London, and although Miss E Hogg did not appear, unlike A.L. Reeves to have trained there, the following was found in Burdett's Official Nursing Directory, 1899:-

"Hogg, Emily Susannah

Nurses' Cooperation, 8 New Cavendish Street, W

PRIVATE NURSE since November 1893

PROBATIONER, Royal Hampshire County Hospital (certified 3 years' training) March 1889 to March 1890

PRIVATE NURSE, Fitzroy House to November 1893" ⁽⁴³⁾

This, until other evidence to support that this is/wasn't the E.Hogg on the medal, it is felt this a best guess.

What is interesting is, that like A.L. Reeves, Emily Hogg was also a member of the nurses’ cooperation in London - a private nursing cooperative might have been able to send several nurses urgently in an emergency such as the Typhoid Epidemic in Maidstone.

Emily S Hogg is born in the December registration quarter of 1866 on the Isle of Wight. She appears as a servant in 1891 census, although describes herself as a trained nurse, and appears to be caring for a Martha Richards (an 88yr old widow) and/or her companion Helen Willis (49 yrs old, unmarried) in Paddington.

Apart from several journeys to and from South Africa, Emily doesn't appear to be in either the 1901 or 1911 census, although she does describe herself as a nurse.

Emily and her friend Edith are both found on a South Africa medal Roll  serving as nursing sisters in No 9 Stationary Hospital:-

"engaged in the colony".."all these nurses were only employed here a short time and transferred elsewhere-" ⁽⁴⁵⁾

and are then found on a medal roll for Bulawayo Memorial Hospital, South Africa, and are mentioned as Nursing Sisters "under" the RAMC, Queenstown, being issued with their medals in 1.1.02 (Ist January 1902).⁽⁴⁶⁾ Edith appears to have remained as a locally employed nurse, although she served in Burgher camp as a nursing sister (Transvaal). ⁽⁴⁷⁾

Emily served in Burgher Camp, as:-

"Hospital and Camp Matron(Transvaal)" - her final grade being given as Sister.⁽⁴⁷⁾

Emily would have appeared to transferred to QAIMNS, as she has a medal card at Kew for the Great war, working at the West General Hospital. ⁽⁴⁴⁾

In 1931 Emily S Hogg dies at St Thomas Hospital, Lambeth, London, although her probate records state that:-

"HOGG-Emily Susannah of ...... Middlesex, spinster died 11 May 1931 on the way to ST Thomas Hospital Surrey." ⁽¹³⁾

She left an estate of approx £6,779 to Edith Lee Mertens, spinster. Edith Mertens appears at least once travelling with Emily in October 1925 boarding in London a ship for South Africa. They both give no occupation, and state their ages as 52 and 55 years respectively, and share the same address in Golders Green. Edith appears to continue travelling after her friend's death, before dying in 1964 with an estate of £27,000. She too is difficult to find in both 1901 and 1911 census....and both seem to enjoy travelling to and from South Africa.... which appears to be prompted when they both served in the Boer War.

Boer war/Military Nursing.

The Boer Wars: 1880 -1881 and 1899 -1902 were fought by the British against the Dutch Boers (farmers) - settlers of two Boer republics; the Orange Free State and Transvaal Republic. The success of Florence Nightingale and her team of nurses in the Crimea led to the formation of the Army Nursing Service (Queen Alexandra's Imperial Military Nursing Service replaced the Army Nursing Service in 1902). The  Army Nursing Service was established to provide a body of trained and competent nurses to give care both at home and overseas - at the start of the war in South Africa it had:-

1 Lady Superintendent; 19 Superintendent Sisters, and 68 Sisters.

The formation of the Princess Christian's Army Nursing Service Reserve enabled the eventual deployment of over 1,400 trained nurses from Great Britain.⁽⁵⁷⁾ Although Lilian Heale was a Princess Christians reservist she does not appear to have worked in South Africa.

The nurses worked not only worked in Field, General and Stationary Hospitals, but were also deployed in the burgher camps (concentration camps for the Boer civilian women, children and men unfit for service):-

"where the British attempted to impose, not only a public health regime, but a new domesticity. Although the teachers and nurses in the camps did not entirely fulfil this ideal, for they were "new women", carving careers for themselves, the male camp officials also expected them to act as models of femininity. It was in this sense that the Transvaal director of burgher camps wrote that the nurses:-

"have created a very favourable impression, being physically strong and attractive, and presenting by ocular demonstration, to the inmates of the Camps, examples of British womanhood. The moral effect of the association of these earnest noble-minded and cultivated ladies, with the people of the veld ... cannot fail to be productive of much good in many ways" ⁽⁵⁸⁾

Initially the camps were refugee camps for Burgher families who had surrendered freely, but quickly burgher families were forcibly sent to them and the camps became concentration camps with both poor hygiene and little food. The awful conditions caused the deaths of 4,177 women, 22,074 children under sixteen and 1,676 men, mainly those too old to be in service.⁽⁵⁸⁾
 

Conclusion

Apart from the loss of life, the monetary cost  of the Maidstone Typhoid outbreak was reported to have been £45,000, the doctors fees alone being £5,200 ( approximately six doctors came from outside the town). ⁽²⁶⁾ The Local Government Board gave the Council a loan of £15,000 towards the epidemic cost (a request was made for a loan of £18,000 - this lower loan was seen as rather harsh - perhaps the Local Government Board were applying their own financial punishment?

In December 1897, even before the enquiry started in January 1898 the Local Government Board were already acting on lessons learned from the Maidstone epidemic, issuing guidance to:-

"Hints on Water Supply.

The Local Government Board has issued to Town Councils, Urban District Councils and Rural District Councils a circular letter directing attention to the subject of water supply. Outbreaks of Typhoid, Clifton and Lynn have obviously led to the issue of communication for the Board point out that the Council are the body responsible for securing to their inhabitants of their district a proper and sufficient supply of water....for the wholesomeness of the water which they themselves supply .......make themselves acquainted with sources , nature and quality in all parts of their district ...and if it is unsatisfactory take such steps  to supplement and improve the supplies." ⁽³¹⁾

The water company were widely censured in the press, for their lack of water testing, which due to cost saving had been reduced in frequency. This lack of testing was blamed as one of the causes of the outbreak. Naturally at the inquiry, each party being held to blame for the epidemic, blamed the other:-

" Mr Parker, on behalf of the Corporation (of Maidstone) submitted that there was insufficient evidence to support the charges made by the water company against the corporation in regard to the drainage of the town and that it was clear that the water supply was the primary cause of the epidemic." ⁽²⁸⁾

When the enquiry finally published its findings in August 1898, the commissioners said:-

"The epidemic was caused by the pollution of the water supplied by the Maidstone Company from their Farleigh Sources and whilst there were grave sanitary defects in construction of some of the sewers, house drains and water closets within the borough, but the sudden and simultaneous outbreak and rapidity with which the epidemic grew cannot be accounted for by these defective conditions of sewerage and drainage. We are of the opinion that many of the typhoid cases in the borough were due to defects of drainage and sewerage with consequent pollution of soil underlying the town. The responsibility for the existence of these insanitary conditions lies with the town council whose duty it was to take steps that would lead to effective remedy of these defects. This duty they have in large measure neglected, notwithstanding that for many years the medical officer of health has repeatedly warned them of the risk to which the inhabitants of the town were exposed by the continuance of the insanitary conditions." ⁽³²⁾

The board conclude by questioning whether the regulations are sufficient-which they feel they are, but it admit that there are discrepancies in the interpretation of the wording these regulations. Section 7 of Public Health (Water) Act 1878 imposes upon Rural District Authorities the duty to ascertain the condition of the water supply- no such application had been made on behalf of Maidstone Council, nor had Mr Adams (Senior Medical Officer) ever made it his business under the General Order of the Board 1891 to inspect the water supplies at Farleigh!

With the advent of oral rehydration therapy, and that used alongside antibiotics the rate of death from typhoid today is approximately only 1% ⁽²²⁾ - however, if untreated the death rate remains higher than that experienced in Maidstone in 1897 of between 10-30%.⁽²³⁾ (As might happen in Third World Countries today).

The Maidstone  outbreak  led to the first coordinated response to a typhoid outbreak, the  first  trial of typhoid immunization (among 84 nurses in a Maidstone psychiatric Hospital, none of whom caught Typhoid) along with trials of water supply chlorination, and the use of the telephone by nurses and doctors in the typhoid hospitals to pass on information about new cases. All these factors contributed to a unusually low death rate from Typhoid for the period despite heavy rain - which had in recent weeks flushed impurities into the water supply. ⁽²⁴⁾

Whilst the hop pickers may have been the initial source of the Typhoid infection, the disease would not have spread so dramatically had the Maidstone Council tested the water supply regularly, and repaired the sewage and drainage systems. It was the appalling sanitary conditions in which the hop pickers were housed that created the epidemic. History does not appear to relate whether the Hop pickers encampment was improved by the following year.

It is not clear whether any regulations were tightened in the aftermath of this epidemic. It would appear that no court case for Corporate Manslaughter/negligence happened as it might well today in the light of such gross negligence by an authority. Whilst the council was given only partial financial help with the cost of the epidemic, the real sufferers were those who paid the ultimate price and died, and their families who were left behind in financially straightened circumstances (although poor relief was given out from the relief fund it is not clear how long this was able to be done for).

At the presentation of Medals ceremony the Mayor of Maidstone Councillor barker gave a speech:

"While they must be filled with regret for those who had been taken away..it was a matter of congratulation to know that the epidemic which overtook them three months ago , had been stamped out thanks to their Medical Officer, the medical men of the town, and though sturdy and gallant conduct of every inhabitant of Maidstone ..and in addition to the help received from the residents in the town and neighbourhood, they had an army of trained nurses to assist them...He now wishes on the part of every inhabitant of the borough of Maidstone, ..to thank the nurses who had assisted them during their great trouble ...and he was going to ask them to accept a small medal as a token of esteem for the work they had done.." ⁽¹⁾

References

1. South-East Gazette Tuesday 14th December 1897

2. Bygone Kent, Vol 4/ number ? 5.

3. The Mercury, Hobart , Tasmania, Monday October 4th 1897

4. South-East Gazette Tuesday 5th October  1897

5. South-East Gazette Tuesday 12th October  1897

6. The Standard (London, England), Thursday, October 14, 1897; pg. 4; Issue 22868. 19th Century British Library Newspapers: Part II.

7. Leicester Chronicle and the Leicestershire Mercury (Leicester, England), Thursday, October 30, 1897; Issue 4525. 19th Century British Library Newspapers: Part II., quoting from the Hospital

8. Daily News (London, England), Monday, September 27, 1897; Issue 16069.

9. RLHLH/N/1/5)- London Hospital register of probationers, no.5 .Royal London hospital Archives

10. RLHLH/N/1/3)- London Hospital register of probationers, no.3 .Royal London hospital Archives

11. RLHLH/N/4/1)- London Hospital register of Staff Nurses, no.1 .Royal London hospital Archives

12. RLHLH/N/5/3)- London Hospital register of Private Nurses , no.3 .Royal London hospital Archives

13. Ancestry.co.uk

14. RCN Archives: The Nursing Record and Hospital World, march 3rd 1894

15. RCN Archives , The Nursing Record -vacant appointments etc supplement nov 16th 1895

16. RCN Archives  The Nursing Record and Hospital World, Dec 28th 1895

17. RCN Archives  The Nursing Record and Hospital,  World, may 25th 1900 pg 423

18. RCN Archives  The Nursing Record and Hospital,  World, may 18 1901, pg 397-8

19. The Morning Post (London, England), Wednesday, September 29, 1897; pg. 6; Issue 39099. 19th Century British Library Newspapers: Part II. 

20 .RCN Archives  The Nursing Record and Hospital  World, Nov, 20th 1897, pg 415

21. RCN Archives  The Nursing Record and Hospital World, Oct 9 th 1897, pg 287-288

22. (http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.htm)

23. http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html

24. www.ibms.org/includes/act_download.php

25. RCN Archives  The Nursing Record and Hospital World, May 14th 1898, pg402.

26. RCN Archives  The Nursing Record and Hospital World, July 23rd 1898, pg73

27. RCN Archives  The Nursing Record and Hospital World, nov 27th 1897,pg 436

28. RCN Archives  The Nursing Record and Hospital World, Feb 19th 1898, pg 159

29. South-East Gazette Tuesday 7th December 1897

30. The Morning Post (London, England), Monday, December 13, 1897; pg. 6; Issue 39163. 19th Century British Library Newspapers: Part II.

31. The Morning Post (London, England), Saturday, December 18, 1897; pg. 3; Issue 39168. 19th Century British Library Newspapers: Part II.

32. The Times (London, England), Saturday, Aug 27, 1898; pg. 9; Issue 35606. (791 words)

33.  http://www.whitehavennews.co.uk/news/list_of_swine_flu_deaths_in_the_uk_updated_1_608462

34. Irene Hales- Bygone Kent, 198.....

35. Kent History Centre-CKS-P2/18, Parish records of St Margret's Addington.

36.  rcnarchive.rcn.org.uk/data/VOLUME003-1889/page144-volume003-29august1889.pdf

37.  Kent History Centre-CKS-MH-Md1/AS1-Records of Stephen Monckton nurses Home, Maidstone.

38. rcnarchive.rcn.org.uk-The British Journal of Nursing 13th October 1906, pg 293

39c.. British Library,

40. British Library, Asia, Pacific and Africa Collections;IOR/L/MIL/7/11447- European War 1914, Confidential Reports on 14 Nursing Sisters.

41. The National Archives,Kew- WO 372/23/18917; Medal card of Heale, Lilian Frances Mary, Queen Alexandra's Medical Nursing Service India-Nursing Sister

42. http://www.cwgc.org/find-war-dead/casualty

43: Royal London hospital Archives-Burdett's Official Nursing Directory, 1899

44. The National Archives,Kew WO 372/23/19957 Medal card of Hogg, Emily

45. The National Archives,Kew WO 100/229

46. The National Archives,Kew, WO 100; Piece: 229.

47. http://www.boerwarnurses.com

48.c. The British Library;IOR/L/MIL/7/11723-Indian Nursing Service Miss LM Heale part 108

49. c. The British Library;IOR/L/MIL/9/430- Indian Nursing Service Register of Applicants

50. c. The British Library;IOR/L/MIL/7/11391- Indian Nursing Service-memorandum from Military Dept, Indian Office; M8571/1906

51. The British Library;IOR/N/1/425 ; Marriages in bengal Province.- 1948

52. The British Library;IOR/L/MIL/9/431- Indian Nursing Service Register of Applicants

53. The British Library;IOR/L/MIL/9/432- Indian Nursing Service Register of Applicants

54. The British Library L/MIL/7/11361

55. The British Library;IOR/L/MIL/7/11393

56. The British Library;IOR/L/MIL/7/11397

57. http://www.boerwarnurses.com/web/background.html

58. J.C. Otto, Die Konsentrasiekampe (Protea Boekhuis, Pretoria, 2005, orig. 1954), p 139

Illustrations

1. 'Backman'@schoolsofnursing.

2. Fig 2; Table Produced for the Local Government Board o Inquiry in to the Maidstone Typhoid Epidemic.

3,4  Front and Reverse of  Maidstone Typhoid Medal - Copyright Author/(2)SoN.

5,6 Maidstone Cemetery -Typhoid graves - Copyright Author.

7. Copyright - Harry Rogers.

Acknowledgements

With many thanks to all those who helped me with this article: My Husband Harry, The Royal London Hospital archivists, the RCN  archivists,  Welcome Library and trust, Kent history centre and staff, Maidstone Museum and the London Metropolitan Museum. 

Copyright: Sarah Rogers 23/05/13