Written by Staff Blogger Vicky
Nestled between Morris and South Streets, the City Hospital opened its doors to the people of Halifax in 1859. The building was a major step forward in medical service for Halifax citizens.
Up until this time the city's so-called hospitals were small, ramshackle structures to whom time had not been kind. More often than not, people were receiving medical treatment in another person's front room. The City Hospital - later renamed the Provincial and City Hospital (1864), then the Victoria General (VG) Hospital (1867) - was the first real medical institution the people had seen. The original hospital building could hold 40 patients, but by the late 1800s it had expanded to allow for more than 100. For its time, it was state of the art with the latest surgical and diagnostic techniques being practiced.
In 1891, priorities placed on medical care were taken a step further when the Victoria General Training School for Nurses (VGTSN) was established. The school taught a two-year nursing program, which provided students with not just a valuable skill, but the the opportunity to enter the workforce to support themselves and their families. This was especially important to young women of the time.
It is in this school that we meet Charlotte "Lottie" Clarke, a fictional, twenty-one year old nursing student. It is early spring of 1893, and Lottie is in her second year of study at the VGTSN.
(Please note: medical treatments mentioned in this article are more than 130 years old. Do not assume they are right for you. If you have a medical issue, please consult a doctor.)
Oh, What a Beautiful Morning
The sun rises over the stately brick of the nurses' dormitory. It is 6am, but already Lottie can hear the sounds of the other girls shuffling in the hallway. Within moments, a set of heavy footsteps cuts through the murmurs. There's a rapid knock on the door.
"Up at at 'em, Nurse Clarke." Miss Julia A. Purdy - the Lady Superintendent of Nurses - chimes. "We cannot save lives from our beds now, can we?"
Lottie rises with a stretch. She begins to untie the silk bow at the bottom of her braid and then runs her fingers through each section until the braid is undone. Free from captivity, she gives her hair a shake to release the gentle waves. She places the silk tie neatly in a box on her dresser. Her eyes wander, carefully examining the room: the dresser top, the floor, the baseboards, the ceiling. Perhaps she could get away without dusting this morning, although Superintendent Purdy would surely check to see if it was done. Any speck of dust she found would earn Lottie a stern talking to at the very least. She decides perhaps it is best to just do it and save herself a day of worry. After a quick clean, Lottie carefully makes her bed. It's possible she could have gotten away without dusting, but not making the bed was a rule she dared not break.
A quick splash of water on her face, a meticulous pinning of her hair, and she's ready to get dressed. She removes her blue and white striped skirt with matching bodice from the wardrobe. It's not beautiful, but the uniform could be worse. The sleeves of the bodice have a small puff at the shoulder and taper down to the wrist; an additional white cuff is added to the sleeve when not participating in patient care. A white starched collar fit high on Lottie's neck. She sets her white cotton cap into her hair with even more pins, and ties on her apron. Were it not for her boots, her skirt would drag on the floor, but their height saves her from needing to hem.
Lottie looks at the clock. 6:45am. She had better run. The doors of the breakfast hall are locked at 7:00am. If you're not inside, you do not eat. Before she runs out the door, Lottie opens her bedroom window to air out the room.
The Morning
Under her arm Lottie carries her copies of Text Book on Nursing by Clara Weeks, The Human Body by Henry Martin, and Notes on Nursing by Florence Nightingale. They are just a few of the books she has had to study intensely over the past year. Weeks' book is Lottie's favourite text.
Getting into the VGTSN was difficult. Not only did she have to submit reference letters from the pastor at her church, along with her health and dental records, and her birth certificate, she needed grades above 65% in her grade 10 school subjects. Her writing grade was a close call at a 67%; she'd always been a poor speller. She did, however, have a head for numbers, and a good memory. These talents served her well at the VGTSN, as much of her classwork revolved around memorization and recitation in addition to demonstrations.
Bones of the Cranium: Frontal, Occipital, the L'arietals, the Temporals, Sphenoid, and the Ethmoid. ... A healthy adult ordinarily breaths about eighteen times per minute, taking in each time some twenty cubic inches of air. ... The constitutional symptoms of haemorhage are pallor, coldness of the extremities, clammy sweat, feeble of sighing respiration, small and rapid pulse, restlessness and thirst, vertigo, dimness of vision, ringing in the ears, difficulty in articulation... Before applying a tourniquet, elevate the limb as high as possible, make a few turns of bandage about it to protect the skin, and place a hard pad directly over the course of the artery.
Lottie could almost recite Weeks' entire textbook by heart!
Lottie and the other pupils check in with the Night Supervisor. They're given a concise overview of the evening's events. At the end of her speech, the Night Supervisor informs the class that the doctor on duty has just admitted an elderly patient suffering from a terrible cough, congestion, a sore throat, and the chills. Lottie is assigned to check them for lice and give them a bath. Clara Weeks' instructions fly through Lottie's brain:
To put a feeble patient in a bath, wrap him in a sheet and lower it gently into the water. Have a warm dry sheet ready to roll him in when he leaves the bath. Over this fold a blanket, and, putting him in a well protected bed, leave him wrapped in them for a few minutes. In this way he will be made dry without extra fatigue.
When the patient is clean, Lottie dresses them and settles them into a fresh bed. Miss Purdy watches as Lottie adjusts the patient's sheets and pillows. The Superintendent then hands Lottie a monaural stethoscope and tells her to listen to the patient's chest. His lungs sound as if they are rattling inside, and his breaths have a distinct wheeze.
"What would you say was the doctor's diagnosis, Nurse Clarke?" Miss Purdy asks.
"Bronchitis." Lottie responds confidently.
"Correct. And what treatment is recommended for bronchitis?"
"Steam to help the cough and a mustard plaster for the pain."
"Well done. Hop to it."
Lottie heads to the supply cupboard and takes a steam inhaler from the shelf. She fills the steamer with hot water, and tells her patient to breathe in the warm vapours. She then begins to construct the mustard plaster:
To make a mustard plaster or sinapism, take one part of powdered mustard and from two to five times the quantity of flour, according to the strength desired. Mix into a paste with tepid water, and spread it evenly between two pieces of muslin.
When applied to the patient's chest, the plaster will initially feel rather cool, but will soon begin to feel warm and help relieve the pain. However, if left on too long, the mustard plaster can cause painful blisters that are difficult to heal. As Lottie applies the plaster to the patient's chest, she checks the clock. She will need to return in no more than 30 minutes to take the plaster away.
One of the senior nurses taps Lottie on the shoulder. A fisherman docking at the Queen's Wharf has fallen from the rigging of his sloop and has arrived with a broken leg. The doctor is requesting a nurse to set the bone. "I'll keep an eye on your plaster," the senior nurse assures her. "You go and take care of the leg."
Lottie walks briskly down the Public Patient Ward. The fisherman is easy to spot: his knit sweater is covered in sea salt and fish scales and his pant leg is rolled up above the knee. His leg is suspended in traction. Another nursing pupil rolls a cart to the side of the bed. The cart has a large bucket, a length of flannel, and a stack of brown gauze. "The doctor asked me to mix the Plaster-of-Paris." She taps the bucket gently. "He has already positioned the bone into place. It just needs the cast."
Lottie washes her hands in a nearby basin. Carefully, she wraps the leg in the piece of flannel. She then dips her hands into the bucket and begins to soak the gauze in Plaster-of-Paris. Meticulously, so as not to disturb the pieces of bone, she begins to roll the wet and sticky strips of gauze around the fisherman's leg.
The fisherman is chatty. He asks Lottie about working at the hospital and about her family. He asks her what she likes to do for fun and he asks if he could take her for a walk in the Public Gardens while he's in town (and so much as he's now able to walk). Lottie pauses for a moment. The fisherman seems nice enough, but the punishment for fraternization can be harsh. Other nurses have had time added to their training, or have been dismissed from the school completely for undignified conduct with men. Uncertain of exactly what qualifies as undignified conduct to Miss Purdy, Lottie decides it's not worth the risk. She politely declines his invitation.
Lottie finishes her work wrapping the fisherman's leg. The limb is taken out of traction, and put on the bed. She sits heated bags of sand on each side of his calf to keep the leg in place and help the plaster to dry. She tells the fisherman he needs to sit still for up to 12 hours for the plaster to set. As the fisherman begins to bemoan this, Lottie is tapped on the shoulder once again and told to break for lunch.
The Afternoon
It's not long after a simple but hearty lunch that Lottie is approached by Miss Purdy. They've received word from the Poor Asylum next door that one of their residents has gone into labour. Lottie is directed to gather what she needs to attend to the expectant mother, and further more: to hurry. The woman's water had broken several hours earlier, but she hid the event from members of staff. They have no idea how far along the woman is, only that the baby is on its way. The doctor is indisposed, but will follow Lottie to the Asylum as soon as he is able.
Lottie is thrilled. It is not often that nurses gain practical obstetrics experience as many women prefer to give birth at home. The Poor Asylum and the Victoria General Hospital have an arrangement that should birthing care be required the nursing students would be brought in for training purposes. Lottie has read and re-read the chapters in her textbooks on labour, and has attended Dr. Matthew A. Curry's class on Obstetrical Nursing, but she has not yet been present at a birth. Lottie rushes to the equipment room and grabs a sterilized obstetrics kit, cotton batting, flannel wraps and bags, gauze, a syringe, a catheter, chloroform, bichloride of mercury, and vaseline. Will she need all of these items? She doesn't know, but it's better to be over-prepared. She prays the Asylum will have the other simple items she might require. Lottie runs down the street carrying her heavy bag. Thankfully, it only takes a few minutes to reach the door of the Asylum. She is hurried in and brought to the patient's room.
The woman is in her bed gritting her teeth through an obvious contraction. A young Asylum orderly is holding her hand. He looks terrified. Lottie is too, but she will not show it. She introduces herself and tells the orderly to bring clean towels, hot water, and soap as quickly as he's able. He disappears with a sigh of relief. Lottie takes the woman's wrist and checks her pulse. It is steady and strong, if not a little rushed. Using Leopold Maneuvers, she probes the woman's belly to see how the baby is positioned. Cephalic presentation - the head is pointed down. "Is it ok?" the mother asks. Lottie smiles and tells her the baby is exactly where they want it to be.
The young orderly returns with towels under one arm, a box of soap under his chin, and a bucket of warm water in each hand. Lottie sets one bucket aside. She takes the other to a nearby table, grabs a basin and fills it with a mixture of bichloride of mercury and water. The orderly passes her the soap and she thoroughly washes her hands in the water remaining in the bucket. When she is satisfied that they are clean, she plunges her hands into the bichloride to disinfect them. Now certain that she is clean, she checks on the status of the labour. The delivery is much further along than Lottie had thought. The child is crowning. Lottie looks around the room. The doctor has not yet arrived.
There is no time to wait.
Half of Clara Weeks' instructions go out the window. It is too late to prepare the bed with a rubber sheet and clean linens, or to change the patient into a fresh nightdress. Lottie tells the orderly to take the woman's hand yet again, and to help keep her calm. Lottie then guides the woman to push. As the head of the child begins to emerge, Lottie checks to makes sure the baby is not tangled in the umbilical cord.
The door opens and the doctor rushes in. He begs forgiveness from both the patient and Lottie as he disinfects his own hands. He thanks Lottie for her work thus far as he takes over the procedure. Lottie readies a cleaning station for the child. Before long, a loud cry fills the room. A baby girl is born. After the cord is cut, Lottie washes the baby as the mother rests.
After a few hours, the doctor gives both mother and baby a clean bill of health and takes his leave. Lottie stays to bathe the new mother. She also helps the mother feed her baby for the first time. It is not easy, but eventually the baby girl begins to suckle. Lottie makes a note of the mother's pulse and tells her she will be back tomorrow to check on her.
On her way out, Lottie gives instructions to the orderlies at the Asylum that the patient will need care in her absence. The mother is not to move from her bed, but must be given a sponge bath every day. She will also need lots of fresh air, but must not catch a chill. It is also essential that they watch for the mother showing signs of a haemorrhage. If she does, they must contact the hospital immediately.
On the walk back to the hospital, Lottie feels relieved that the birth went well and that mother and daughter appear to be happy and healthy. She does, however, worry about what their future will be like. The Poor Asylum is no place for a baby.
The Evening
The day has been long, but it's not over yet. After dinner, Lottie attends Dr. Edward Farrell's lecture Nursing in Surgical Operations. She takes vigorous notes, committing them to memory as she writes.
"Nurse Clarke?" calls the doctor. "How does one sterilize silk for surgery?"
"The silk is rendered aseptic by boiling for an hour in a five-per-cent carbolic solution, and is kept in a similar solution, or in alcohol, until wanted." Lottie quotes from Weeks' textbook.
"Good." The lecture continues.
It is well after dark before Lottie makes it back to the dormitory. After saying goodnight to Miss. Purdy, she climbs the stairs to her room. The room is chilly now as the evening breeze creeps in. She closes the window and draws the curtains. Sitting on the bed, she unties her boots and takes a moment to rub her swollen feet. She places her uniform and apron into her laundry bag. She counts the articles inside: 24. That's the most she can take to the laundry room for service. She makes a mental note to take the bag with her tomorrow. If she does not take it, it will be several days before she will have another chance to have them cleaned. After putting on her nightgown, she unpins her hair, brushes it thoroughly, and takes up the folded piece of silk from its resting place on the dresser. A quick braid later, Lottie pulls back the sheets and falls into bed.
It is 10:00pm. The doors of the residence are locked.
Tomorrow is another day, and it will come all too soon.
Library Sources
Annual Report - Victoria General Hospital
Outside Sources
Concrete Sewer Blocks made at the Halifax Poor Asylum, Halifax, NS, 1899, Nova Scotia Archives
Dr. Edward Farrell, Nova Scotia Archives
Home Medicine - Dr. Nelson's Inhaler, Worcester Medical Museums
The Long Struggle of the Victoria General Hospital, Halifax, NS, Halifax VGH Nurses Alumni
Night-Time Hair Routine - Victorian and Edwardian Hair Care, Sew Historically
Notes on Nursing, Bauman Rare Books
Obstetrical instrument set, England, 1851-1900, Science Museum Group
Part 3: Ellen Shelley and the Lying-In Hospital, The Cow Keepers Wish
A Short History of Stephoscopes, Melnick Medical Museum
A text-book of Nursing, Second Edition, 1898, HathiTrust
Text Book on Nursing, Tavistock Books
The Third Residence, VGH - Bethune Building, Halifax VGH Nurses Alumni
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