68. Resurrecting old Joyce Green Hospital names.

Key words/phrases: Jill Jedman - Property Information Officer of Dartford Borough Council, Dr John Burne, Dr Cameron, Sister Shaw, Norman Beater, Dr William Budd, Stan Burroughs, Mr Tuffil, Hazel Radley/Mrs Noakes, Mr Alec Walker, Miss Bingham.

No.68

I have been talking to Mrs Jill Jedman,Dartford Borough Council’s Property Information Officer this week about the naming process of the streets, buildings and open spaces on the new ‘mixed purpose’ development on the old Joyce Green Hospital site.

Apparently Mrs Jedman does her her research into the historical background of sites, people and events, draws up lists of possible names and then submits these to the Council ‘cabinet members’ who make the final decisions.

Words that could lead to confusion, names of people who are still living and other factors can lead to certain names being left off these lists but on the whole it seems that almost any name can be considered for inclusion.

One especially encouraging fact is that Mrs Jedman seems to welcome advice and suggestions from people who are familiar with the history of a particular area, previous establishments or characters and past occurences. For this reason it has proved really interesting discussing further ideas with her for possible names; in our case those associated with the Joyce Green and the so-called “River” Hospitals.

Some years ago Dr John Burne, a Consultant Pathologist at JGH, wrote an article for the “Bygone Kent” magazine (Vol 12, No.5) focussing upon the work of Harry Hopkins, the head gardener who - along with Dr Cameron, the Medical Superintendant at the time - designed, created and maintained the famous Joyce Green collection of trees, shrubs and flowers between 1919-1935.

The story of these men’s horticultural interests and work is in itself fascinating but the article also covers a lot of other ground from which I have been able to extract a collection of possible names for Jill’s lists for Phases 2-5 of “The Bridge” Project.

Just to remind you of aspects of some of JG’s rich past here are some of the words and names that I have passed on to Jill for her consideration. It actually falls to Jill to add the second part of the name or title, if she has decided to add a name to one of her lists.

Tramcar - because of the trams that used to bring patients into the hospital from the riverside in the past. So for instance she might chose to add an ending such as Tramcar Road or Tramcar Passage.

Nurseryman’s (Square ?)– another possibility relating to Harry Hopkin’s skills.

Child’s Fever (Place ?) - highlighting the use of 900 beds for children with Scarlet Fever during the period 1919-1922.

Alastrim (Rise ?) the name for a mild form of smallpox, an outbreak of which kept JGH busy in 1929.

In addition, I have also submitted the names of a number of individuals who contributed very substantially to the hospital’s work in the past.

Jill Jedman is already aware of the names of many of JGH’s “old hands” but I have also tried during the past week to draw to her attention to some other names that I thought that she might not know of ?

Some of these are : Sister Shaw, the Children’s Ward Sister, Norman Beater, a previous Superintendent Radiographer in the X-Ray Department, Dr William Budd, a Consultant Geriatrician, Stan Burroughs (or was his name spelled Burrows ?) - Departmental Charge Nurse for Geriatrics who was later promoted to “Assistant Matron” grade, Mr Tuffil, a Consultant Urological Surgeon, Hazel Radley - who became Mrs Noakes , the Principal Nurse Tutor (whose title changed with the introduction of the Salmon Report on the “Senior Nursing Staff Structure” to Senior Nursing Officer (Education), Mr Alec Walker, Nurse Tutor, Miss Bingham, Nurse Tutor.

Do you remember the names of other people whose names could be put forward for consideration ? If so now is the time to mention them : Jill’s e-mail address is : Jill.Dedman@dartford.gov.uk and her telephone number is : 01322 343206

67. Old JGH site & the naming of the new roads.

Key words/phrases: The Bridge Project, Bob Dunn Way, Rennie Drive, Halcrow Avenue, Binnie Road, Brunel Way. Doctors and nurses of yesteryear : Couzins, Birdwood, Hyde, Mitman, Waylen, Marsden,Wacher, Cameron, Morris, Chapman and Thorpe.

No.67

In view of the ‘near completion' of Phase 1 of the new Bridge Project - next to the old Joyce Green Hospital site - consideration has obviously had to be given to naming of the now completed arterial roads and the ‘secondary’ roads and streets within the residential section of this new development.

New houses for sale have already have come onto the market along what is now now known as "Bob Dunn Way" but in addition we are now getting some indication of the names that have already been selected, or are being considered for, some of the roads on this new housing estate.

The perimeter roads it seems will be named after the following bridge designers : Rennie Drive (the northerly road between Littlebrook Manor Way and Marsh Street), Halcrow Avenue (the southerly road between Littlebrook Manor Way and Marsh Street), Binnie Road (the northern road from Marsh Street through the main residential area) and Brunel Way (the south road extending from Marsh Street and through the Science Park.

However the roads and streets in the residential housing area - now nearing completion - are to be given the names of doctors and nurses associated with Joyce Green Hospital. The suffixes have not yet been decided upon but nine names are apparently going to be selected from the following eleven: Couzins, Birdwood, Hyde, Mitman, Waylen, Marsden, Wacher, Cameron, Morris, Chapman and Thorpe.

Miss Wacher, Miss Thorpe and Miss Couzins were all ex-Matrons of Joyce Green Hospital; Drs Mitman, Marsden and Cameron were medical men of previous eras but who were Birdwood, Hyde, Waylen, Morris and Chapman ?

How is your history ? Can anyone remind us who these 'stars' of Joyce Green's past were ?

66. Poultices at Joyce Green Hospital

Key words/phrases: The Nursing Record, probationer nurses, Queen Victoria, preliminary training, kaolin poultices.

No. 66

An extract that I was reading recently in an on-line copy of The Nursing Record, (Jan 10, 1889 Vol 2) declared that :

“Where possible, all probationer nurses will be given the opportunity to attend weekly lectures on nursing topics given by Matron, a sister or one of the medical staff. These will include subjects such as … (and here I have omitted the full list) … and the application of poultices.

Then, ( ... it continued ...) should she pass her “first year" examination - which is not normally difficult to do - she will be promoted to the rank of Junior Nurse and will be allowed to take temperatures, to do some of the dressings and to assist Sister with the bad cases.”

So my question here is : Do you remember being taught how to make and apply poultices ?

It certainly seems difficult to grasp that nearly 80 years further on from then - at a time when Queen Victoria was still on the throne - that student nurses were still being taught to apply kaolin poultices during their preliminary training.

However, perhaps what is even more amazing is that kaolin poultices are still available for use today in pre-prepared foil-wrapped form or in tubs.

Of course many of you reading this will recall poultices being used on the medical wards of Joyce Green Hospital, in the management of chest problems. Do you remember cutting off lengths of lint from a roll, the corners of which would then be mitred and cutting off an almost-matching sized piece of gauze (or unfolding some gauze swabs for the same purpose) ? Simultaneously you would be heating your tin of kaolin in a saucepan of boiling water or in the ward instrument-steriliser. Then with all the deftness you could muster, spreading the kaolin evenly on to the surface of the lint before putting the gauze piece on top of the kaolin to prevent it from sticking to your patient’s skin ... and finally, folding the inch-wide edges of the lint over to finish off the procedure ?

Then the poultice had to be taken as quickly as possible to the patient’s bedside and subsequently applied to his/her chest, their side or wherever the warmth was required. Perhaps you were taught to take it to their bedside between two warm dinner plates or in a pre-warmed stainless steel kidney dish or container ?

If you had half a dozen or even more of these to make and apply during your day shift or night shift no doubt you developed your own routine for getting these ready and into place ? If you were lucky you sometimes had an nursing auxiliary with you who was experienced in preparing these in the ward kitchen or clinical room ?

But setting aside your recollections of how you used to manage to fit ‘creating’ these poultices into your otherwise busy schedule, I doubt that you will have forgotten the benefit of these to some of your patients of long ago and the sheer symptomatic and psychological relief that they got from these ‘labours of love’ that were created in the wards of Joyce Green Hospital ?

65. A friend in need is a friend indeed.

Key words/phrases: Ex-nurse and novelist Monica Dickens, Charles Dickens, St Paul's Girl's School London, U.S. Naval Officer Roy Stratton of Massachusetts, Rev.Chad Varah of The Samaritans organisation, Church of St Stephen Walbrook London, Mr Catchpole, S.R.N, Joyce Green Hospital, “Emma Chisit.”

No. 65

"She fed on gossip and scandal and if you had some to impart you could always be sure of an audience from Nurse Horrocks, and when there was none, she would readily concoct some intrigue to keep herself going."

So wrote Monica Dickens, the ex-nurse and novelist, in “One Pair of Feet” (1942). Monica, a great-granddaughter of Charles Dickens, rejected her upper middle class background when she expelled from St Paul's Girl's School in London and decided to go into “service” as a cook and servant.

Soon afterwards she became a student nurse in one of the London teaching hospitals and later wrote her account of life as a trainee nurse. She left nursing soon afterwards and did various other jobs, many of which provided inspiration for her future novels.

In 1951 she married a U.S. naval officer and they moved to New England where they adopted two girls. Roy Stratton died in 1985, at which time Monica returned to the U.K. where she continued to write, until her death on Christmas Day 1992.

Many people are familiar with her down-to-earth style of writing and perhaps you are one of the many nurses who have particularly enjoyed her nursing reminiscences however, something that fewer people will perhaps be aware of is that she helped to found the first American branch of the Samaritans in Massachusetts in 1974.

I am hazarding a guess here that she was inspired by the Anglican vicar, the Rev Chad Varah, who died in England last week and who single-handedly founded the phone-line help service for people contemplating suicide.

Later on the organisation became known as The Samaritans and after a period of rapid growth in Britain it provided a model for similar organisations in many other parts of the world.

In 1935 Varah conducted his first funeral whilst a young curate in Lincoln. The deceased person was a 14-year-old girl who had committed suicide because she thought that she suffering from a venereal disease whereas in fact she had simply started menstruating. The turning point for Varah however came in 1953 when he read in a newspaper that there were three suicides a day occurring in the Greater London area.

This coincided with an invitation to become the rector of St Stephen Walbrook, a Church of England benefice in the City of London. This beautiful Wren-designed church, sensitively rebuilt after wartime bombing, had no regular congregation and he accepted the appointment on the understanding that he would be free to use the crypt as the base for a new kind of outreach ministry - to desperate people.

He made it known that anyone contemplating suicide could phone him at any time of the day or night and soon calls began pouring in. Thus, what would later become a worldwide ministry was started by him and a small number of unqualified volunteers.

Chad Varah seems unlikely to be forgotten as the result of creating this lifeline organisation that has been responsible for saving millions of lives. However, it was whilst I was thinking about Monica Dickens’s account of her nursing experiences and the fact that she had formed the first branch of The Samaritans in the USA that I found myself once again thinking about the death of Mr Catchpole, SRN at Joyce Green Hospital.

He was - as some readers will know - the Theatre Superintendent in Joyce Green Hospital during the late 60s who for some reason (or reasons) took his own life in the operating theatre complex late one night.

One of the tragedies was that left a wife and several children behind but another was that he was a much-respected nurse who obviously desperately needed help but who didn’t cry out or who wasn’t heard.

In November 1964 Monica Dickens was autographing books for customers in a book shop in Sydney. She was approached by an Australian woman who handed her an open copy of a book and simply said: “Emma Chisit?” Monica misunderstood what the woman meant and inscribed the words “To Emma Chisit” inside the front cover, whereas in fact the customer was actually asking “How much is it ?”

A humorous mistake of course … but perhaps “Emma Chisit?” is still an extremely pertinent question this week as we remember the value that Chad Varah and his co-workers placed upon human life and also reflect perhaps upon the tragic loss of Mr. Catchpole at Joyce Green Hospital.

64. Poetry in motion at Joyce Green Hospital.

Poetry in motion at Joyce Green Hospital.

Key words/phrases: Head Gardener: “Mac” MacIntyre, Etienne de Grellet du Mabillier (a.k.a. Stephen Grellet), Lyon Military College, body-guard of Louis XVI, Queens District of New York City, Quakers, William Penn, George Fox, Illinois, New Orleans, Canada, Pope Pius VII, Czar Alexander 1st and the Kings of Spain and Prussia.

No. 64

I once shared an office with a health visitor who had a poster behind her desk of a sunset bearing the caption: “We don’t remember hours, we remember moments.”

Does that ring true in your experience ? Can you still remember brief experiences, thoughts or feelings that occurred long ago with an unexpected degree of clarity ? If so I suppose that this says something important about the profound impact that certain things have upon us at the time that they occur ?

One of the many things that I can remember happening to me whilst I was working at Joyce Green Hospital was being given a lift by “Mac” MacIntyre, the head gardener, in the Gardens Dept van down the main drive and out of the hospital. I was on my way to Dartford and he stopped just before the Porter’s Lodge by the main gate and offered me a lift.

It was a cold morning and I had just missed the bus that would have dropped me off at Dartford railway station. As we set off in the van, I thanked him for taking the trouble to stop and offer me a lift, to which his response was: “I shall pass this way but once.”

I asked him what he meant and in his rolling Scottish accent he said, “Do ye nae know tha ?” I shook my head to show that I didn’t, which prompted him into reciting part of a poem as he drove further down the drive. A verse of which - very strangely - has stayed in the back of my mind for the last 40 years:

“I shall pass through this world but once. Any good therefore that I can do or any kindness that I can show to any human being let me do it now. Let me not defer nor neglect it, for I shall not pass this way again.”

But why did this verse have such an impact on me, so much so that it became burnt into my memory ? I suppose that it was one another of those occasions in early adulthood when the brevity of life dawned on me and “Mac”, who was also aware of how short life can sometimes be had “walked the talk” that day in offering me a lift.

The poem, by the way, is attributed to a certain Etienne de Grellet du Mabillier who later on in life became known as Stephen Grellet.

He was the son of a well-to-do counsellor to King Louis XVI, was raised as a Roman Catholic & was educated at the Military College in Lyon. At the age of 17yrs he joined the body-guard of Louis XVI but when he was sentenced to be executed in 1795 (during the French Revolution) he escaped & fled to Newtown, now part of Queens, New York City.

In 1796, impressed by the writings of William Penn, George Fox and the Quaker faith he joined the Society of Friends. He traded in New York and used his profits to finance a series of missionary tours extending through all the settled parts of the USA, west to Illinois, north into Canada and south to New Orleans.

Driven by his faith he developed an interest in education, in prison and hospital conditions, in provision for the poor and in various other social problems and he made it his business to inquire into prevailing conditions in every country that he visited. Somewhat surprisingly he was granted meetings with various rulers and dignitaries around the globe including Pope Pius VII, Czar Alexander I and the Kings of Spain and Prussia to whom he made recommendations for improvements in conditions wherever he could.

I suppose that it dawned upon him that he was only likely to be able to influence certain situations once in his life - as he passed by - and it seems to have made him determined to take action wherever it was possible, as “Mac” did that day when he had the chance on the main drive of Joyce Green Hospital and made that small gesture.

63.Land girls sighted at Joyce Green Hospital ?

Key words/phrases: The Women’s Land Army, “The Land Girls” (1998) Director: David Leland, Angela Huth: Novelist, Voluntary Aid Detachment nurses, Joyce’s Farm, Gardens Department of Joyce Green Hospital.

No.63

Have you noticed the coverage in the U.K. press recently about the feelings of a number of elderly ex-“land girls” who are feeling that their efforts during World War II should be formally recognised by the British Government ?

As a uniformed organisation that served the nation during several wars “with as much distinction as any other group of women”, it seems that they feel that they should be allowed to march in forthcoming Armistice parades at the Cenotaph in London and elsewhere in the U.K. along with all the other uniformed organisations.

Also, have you ever watched the 1998 film “The Land Girls”, directed by David Leland and based on Angela Huth's novel: “The Land Girls” ? It's set in Dorset during 1941 and follows the life and work of three young women: a vivacious and sexy girl called Pru, a hair-stylist from Manchester; Ag, who is a quiet and unworldly Cambridge graduate and the dreamy and beautiful Stella who is engaged to Philip, a dashing naval officer.

As part of the Women’s Land Army, the three girls are replacing a number of male farm workers who have gone off to fight in the war. They are sent to work for Farmer Lawrence and billeted on his farm where they each get to know Joe, the farmer's young son. In fact it depicts far more the girl’s sexual curiosity and Joe’s willing cooperation and it provides a fascinating insight into their hard and sometimes difficult lives as the seek to define new roles for themselves in a country in which families are being torn apart by war.

Neither the demands of these elderly ex-land girls for recognition of their generous service to the nation or the film have anything directly to do with Dartford or with Joyce Green Hospital and so what’s the connection that I am attempting to make ?

Well in the same way that scores of other women served as VAD (Voluntary Aid Detachment) nurses at Joyce Green in the past, I have wondered whether any land-girls were attached to Joyce’s Farm or even to the Gardens Department of Joyce Green Hospital ?

Presumably the gardeners - many of whom we can assume were women because of the able-bodied men having left gone off to fight - were hard at work growing as much produce as possible for consumption within the hospital during these very difficult times and that they would have needed all the help that they could get ?

If you think about it it seems logical that with much of the land around the hospital needing to be used for food production and all the orchards too that existed at the time, together the existence of suitable accommodation for any land-girls that recruited - perhaps within the female staff accommodation blocks - that land-girls WERE once seen working on the Joyce Green and other hospital sites ?

But in any case, does this really matter ? Well only insofar perhaps as this MAY be part of Joyce Green Hospital's history. Do you have any thoughts or ideas about this or is this simply another part of Joyce Green’s history that may be lost forever ?

62. Nurse finds love at Joyce Green Hospital

Key words/phrases : Dartford Hospital’s Nurses’ League, St. Vincent’s Community Centre, Temple Hill, Benjamin Disraeli, Robert Browning, Tom and Peggy Priestman (née Staples), St Mary’s Church Putney, Royal Army Ordnance Corps, hookworm and malaria.

No. 62

So how was the annual general meeting and yearly get-together of the Dartford Hospital’s Nurses’ League when a substantial number of members met recently at St. Vincent’s Community Centre, Temple Hill ?

I would have loved to have been there, to have met old friends and ex-colleagues and to have joined in with some of the conversations in which so many happy memories and reminiscences were undoubtedly shared.

This type of reunion tends to be characterised by fairly fit, happy and excited people enthusiastically involved in swapping stories connected with the past and talking about things that have happened to them and their loved ones during the previous months.

I think that it was Benjamin Disraeli who referred to “that special magic in the memory of long established friendships that softens the heart and even affects the nervous system of those who have no heart” and Robert Browning who once asked “What joy is better than news of friends ?”

The other day however I was reading an account of the post-war reunion of nurse Peggy Priestman (née Staples) and her soldier husband Tom and it reminded me of the sheer relief and emotional release that occurs during some reunions.

Peggy was a 21 year old nurse at Joyce Green Hospital when she fell in love with Tom Priestman, a patient with tonsillitis who was being cared for on her ward. It was 1941 and parts of England were being pounded nightly by the German Air Force who were determined to bring Britain into subjection. Tom and Peggy used to slip out of their ward whenever they could and much of their courting took place under the night skies blanketing Joyce Green whilst London and parts of South East England were being pummelled during the Blitz.

Was Tom fit enough to be courting Peggy behind one of the wards at Joyce Green ? Well it seems that he was because although he was an in-patient for over three months this was actually a ploy on the part of the medical staff to protect him by rendering him “unfit for conscription”.

These two love birds were married in July 1941 at St Mary’s Church, Putney and a few weeks later Tom was shipped out to the Far East with the Royal Army Ordnance Corps.

Sadly, as was the case with so many couples, this was the beginning of a long and hard separation. Tom eventually arrived in Java only having managed to send Peggy a note and pair of silk stockings from South Africa whilst en route, after which all news of him dried up.

Peggy wrote regularly to Tom in Java but all her letters came back marked “return to sender”. She became anxious and desperate for news and then one day, about three months later, a card arrived in the post bearing the following message: “Dear Peggy, Am a prisoner, not wounded, safe & well. My thoughts are always with you and those at home. Love Tom”. He had been taken prisoner by the Japanese.

Peggy of course was elated. Her husband was alive and so now she could carry on waiting for their eventual reunion. She heard nothing from Tom for about a year until another card arrived bearing the briefest of information but she was comforted again by the fact that at least he was alive. Comforted that was until she heard about the conditions under which prisoners-of-war were being kept. Brutal guards, starvation rations, slave labour and the ever present likelihood of succumbing to disease. Prisoners were said to be dropping like flies.

Peggy received two further cards before Tom returned home in October 1945, one of which told her that his PoW camp had been liberated by Australian Forces and said “Be patient, I’ll be home eventually”.

And the end of the story ? Peggy was staying at his parents’ house in Cumbria, and was due to travel to Liverpool the next day to meet her husband. But instead she was awakened by a midnight knock at their door. Tom had arrived early and made his own way to Whitehaven.

What a reunion that must have been although Tom was in a terrible state both physically and mentally. He was grossly emaciated, riddled with hookworm, plagued with malaria and was suffering from diarrhoea. He was hospitalised on several occasions during his first post-demob year during which time Peggy described him as a “depressed zombie”. Nine months later Peggy gave birth to a baby girl, something that she believed to have been the turning point on their journey back to normality.

Who was it who once said: “In loneliness, in sickness, in confusion, the mere knowledge of friendship makes it possible to endure suffering, even where the friend is powerless to help. It is enough that the friend exists. Friendship is not diminished by distance or time, by imprisonment or war, by suffering or silence. It is in these things that it roots itself most deeply. It is from these things that it flowers”.

61. All aboard for Joyce Green Hospital

Key words/phrases: No. 490 bus service, the Downs Estate, the Fleet Estate, the Temple Hill Estate, Bow Arrow Lane, RT-class REC Regent double-decker buses, Maggie Thatcher, Nicholas Ridley, London Country Buses (South East), the firework factory on Joyce Green Lane.

No. 61

I suppose that you’ve heard the joke about the two drunks who were waiting for their bus to arrive at the bus stop at the foot of Station Approach, Dartford ? When a No.206 bus finally pulled up one of the drunks called out to at the bus conductor who was inside taking fares: 'Will ziz buz take mi to Joyce Green H-o-z-i-t-a-l ?" “No ! I’m sorry mate” the half amused conductor called back. Two seconds later the second drunk lent in - towards the bus platform and called out: “An waz about me, my good man: 'Will it take ME ?!”

Not only had the second drunk got a distorted perception of his acceptability as a potential bus passenger but of course he’d got the wrong bus, hadn’t he ?

In fact it was the No. 490 which served Joyce Green Hospital on the long running route between the Downs Estate and the Fleet Estate, via Dartford centre and the Temple Hill Estate, wasn't it ? The service was operated for years from the Dartford garage using RT-class REC Regent double-decker buses which even served Bow Arrow Lane at one point (in 1963).

In January 1970, as the result of a rationalisation plan dreamed up by Maggie Thatcher and Nicholas Ridley, the then Minister of Transport country areas around the periphery of London suddenly found themselves on their own – outside the remit of the red London Transport bus system with a fleet of very old (or “clapped-out”) vehicles, an impoverished maintenance infrastructure and very few senior managers with any real commercial experience.

From 1972 a corporate image for the National Bus Company became mandatory by which time the presentation and services provided by London Country Buses had reached an all time low. At this point a decision was also taken that the fleet vehicles would be repainted a sludgy green colour (known in the trade as Leaf Green) with white relief and I expect too that some of you who are reading can also remember the green London Transport version of the staff uniform being replaced by unrelieved grey colour uniform, which looked very drab and industrial ?

In 1985 the London Country Bus Service was divided into four sections with services in North East Kent finding themselves managed by London Country Buses (South East) although what happened to the overall service - but in particular to the service that served Joyce Green Hospital - I have no idea since I was longer working there.

Can you remember using the No. 490 service as an employee at the hospital or as a relative or visitor?

Do you remember how the bus used to make a detour each morning and evening to the isolated firework factory down on the salt marshes behind Joyce Green Hospital to deliver and pick up some of the factory workers ?

And did you ever worry about being spotted leaving work early by one of the senior Hospital Administrators or one Matron's staff peeping out from their office windows which overlooked the bus terminus in front of the main Admin Block building ?

Or do you remember the friendly bus conductors calling out: "Joyce Green Hospital, all change !”and “Mind the step as you go !”

60. Syphilis at West Hill & Joyce Green Hospitals

Key words/phrases: West Hill Park, the West Hill Hospital VD Clinic, serological tests for syphilis, Dr Pauline O'Neill (neé Ripley) Consultant Microbiologist at Joyce Green Hospital.

No.60

If you maintain an interest in any of Dartford's former hospitals I wonder if you have had a look at the new "West Hill Park" development on the http://www.barratthomes.co.uk/. website ?

Barratts plc seem to have bought the former West Hill Hospital site and are now offering 230 new homes for sale on it within a “landscaped setting”. However not only are they offering houses and apartments for sale but the company is also restoring and converting some of the original buildings into premises for small business enterprises.

Whilst looking at their website yesterday I found myself remembering the old VD clinic at West Hill Hospital where I once did a clinical placement as a student nurse. At that time the clinic was situated near to the small staff dining room beyond the hospital chapel and behind the Casualty Department. The male clinic was staffed by a visiting Consultant and a male Enrolled Nurse who formed a mini, peripatetic team that provided a sexually transmitted disease service for male patients in Dartford, Gravesend and one or two other towns.

This was at the time when several of the traditional screening tests for syphilis such as the Treponema Pallidum Immobilisation test (the TPI), the Wasserman Reaction (the WR) and the Kahn tests were coming to the end of their working lives as diagnostic tests.

Nowadays in addition to dark field microscopy where a sample of fluid or tissue from an open sore is visually checked for the pathogenic spirochete one or more of the following are likely to be used:

An ELISA (enzyme linked immunosorbent assay) test is one of the newer tests being used for screening purposes. If such a test is found to be positive then this result would need to be confirmed by one (or both) of the following tests: The VDRL (venereal disease research laboratory) test and/or the RPR (rapid plasma reagin) test.

These latter two are broad spectrum tests used to examine large numbers of samples taken from the at-risk population that can pick up the potential presence of any one of the possible treponemal infections, including yaws, pinta and syphilis. Thus if a serological reaction IS noted certain specific and confirmatory tests will be required such as the FTA-ABS (fluorescent treponemal antibody absorption) test or a TPPA (Treponema pallidum particle agglutination assay) test to complement the patient's history and medical examination findings.

Dr Pauline O'Neill (neé Ripley), who took up an appointment as a Consultant Microbiologist at Joyce Green Hospital in 1974, realised the importance of using a range of serological tests to confirm exactly what was happening in a clinical situation where someone was suspected of having syphilis.

Because of the importance of running a range of tests for syphilis on 'at risk patients' at appropriate points during the incubation period of the disease I must say that felt a degree of pride in reminding myself that Dr O'Neill was working at Joyce Green Hospital when she produced her paper "A New Look at the Serology of Treponemal Disease" for the British Journal of Venereal Diseases (Br J Vener Dis. 1976; 52 (5): 296-9.

Why ? Because syphilis remains an extremely serious problem today and because of the fact that one of the medical scientists who affirmed the need for comprehensive and accurate diagnostic serology all those years ago was a Joyce Greenite.

After Pauline O'Neill, neé Ripley (b. 9/5/26 - d. 6/3/06) qualified at St Thomas' Hospital Medical School London she went to Bermuda where she was responsible for setting up their Path Lab Services. She subsequently returned to St Thomas' Hospital to undertake further studies and then began work at Joyce Green Hospital in 1974. Later on she moved to Lewisham Hospital. She had a special interest in the serology of early syphilitic infection and re-infection. Sadly she died of primary peritoneal cancer.

59. I'm forever blowing bubbles at Joyce Green Hospital.

Key words/phrases : handwashing in the management of cross-infection, Dr. John Emsley of Cambridge University, glycerine in the manufacture of weapons, British Government supply strategies during World War I.

No.59

Not only is hot water and soap the bane of every little boy’s life -if you believe the popular myth - but according to public health experts many nurses and doctors also seem very reluctant to use these simple ingredients as often as they should.

If it is really is true that insufficient or poor hand-washing is contributing to current levels of cross-infection within hospitals perhaps mandatory basic hygiene updates are going to have to be introduced and compliance monitored.

However to avoid going down the road of criticising colleagues here you might instead be interested in going back to “basics” and reviewing what soap actually is and how it works, as a prelude to considering a situation during which soap was in short supply ?

It seems that our forebears used to take dollops of greasy animal fat from the bottom of their cooking pans, add some wood ash from the fire, mix them together and then use the resulting “goo” to clean themselves.

This is the essence of soap. Obviously although today’s soaps are slightly more sophisticated this seems to be how our ancestors made it. In due course someone also cottoned on to the fact that if you boil and cool the mixture several times it will eventually go hard, thus becoming even more practical to use.

Dr. John Emsley, previously of Cambridge University, says that it is worth remembering that "soap molecules have a head and a tail." "The head likes to attach itself to water; the tail likes to attach itself to grease and so when soap is put into water, it will find the grease, attach itself to it and will pull it into the water whereupon the grease can be washed away."

Emsley reminded interested parties that "all kinds of oils and fats can be used to make soap including mutton fat, tallow from cattle, palm kernel oil, coconut oil, olive oil, palm oil and fish oil.” “However”, he says, “if you want the soap to last a long time it is better to use a saturated fat because using unsaturated fats in the manufacturing process will - in time - cause the soap to go rancid whereas soaps that are made from saturated fats will last for years."

Another of the natural ingredients found in soap was (and still is) glycerine which is also used in the manufacture of explosives. So I wonder if you realise that during WWI the government regulated and subsidised the supply of oil and fat in order to ensure that commercial soap makers had enough material with which to carry on making their soap, from which the glycerine was extracted to be sent to munitions factories ?

Does this mean then that hospitals, including Joyce Green, never experienced shortages of hand soap, floor soap and laundry soap during the First World War because of positive government strategies aimed at maintaining the supply of these products as well as the supply of glycerine for weapons manufacture and does this also mean that adequate supplies of soap in hospitals and an old-fashioned commitment to hand washing meant that less cross-infection occurred ?

I don’t have any data to hand to support the notion that there was less cross-infection in UK hospitals during the First World War but with fewer anti-microbials (and/or supplies of them) in existence it would certainly be interesting to read anything relevant that has been written by staff who worked at Joyce Green Hospital during that era, don’t you think ?

58. Alms at Joyce Green Hospital

Key words/phrases: Dame Cecily Saunders, Ida Maude Cannon, St Thomas’ Hospital, London, The St. Paul City & County Hospital Training School, Minnesota, Boston School for Social Workers, The Simmons College Boston, Dr Richard Cabot, Massachusetts General Hospital, Medical Social Work Department at Joyce Green, Lady Almoners, The Almoner’s Office, Royal Free Hospital London, the River Hospitals

No.58

Although neither Dame Cecily Saunders nor Ida Maude Cannon ever worked at Joyce Green Hospital I think that we can accept the fact that they had a lot in common with several members of Joyce Green staff.

Both of them began their professional lives as nurses, both became frustrated by their inability to meet patient’s psychosocial needs and both subsequently went on to become medical social workers.

Cecily Saunders, the well-known pioneer of the British hospice movement, began her career by qualifying as an S.R.N. at St Thomas’ Hospital, London in 1944. Next she qualified as a social worker in 1947 and then finally she went on to study medicine before opening the UK’s first Hospice in Sydenham, South London in 1948.

Ida Cannon trained at the St. Paul City & County Hospital Training School, Minnesota between 1896-98 and then worked in a state school for the ‘feeble-minded’ during which time she studied sociology and psychology at the University of Minnesota.

Between 1903-06 she was the first ever “visiting nurse” for the St. Paul Associated Charities and seeing the home conditions in which the sick and poor lived first-hand helped her to understand the interconnectedness of illness, poverty and other social ills.

Following a failed romance in 1906, her sister-in-law persuaded her to enrol at the new Boston School for Social Workers (now The Simmons College) and in 1907 she accepted Richard Cabot’s offer to become the fourth full-time social worker at The Massachusetts General Hospital. Dr Cabot, a physician, had just established the first ever hospital social service department in America there in 1905.

From its very inception the outlook of department was very outward looking and its members encouraged the participation of doctors, nurses, teachers and volunteers. Ms. Cannon insisted however that social workers needed to have sufficient medical training and that nurses who wanted to be part of the department should receive training in casework and other social work skills.

Her department was extremely innovative and created programmes that included such activities as clay-modelling classes for patients with "nervous disorders" and "hygiene education" classes for adolescent girls and young mothers. They set up a low-cost lunch counter for patients and staff and organised country outings for those receiving psychiatric care.

This new department focused strongly upon “the social element” as a vital part of the medical treatment plan and in particular they initiated what today are known as "rounds" and implemented systems to measure social work interventions, even documenting these using charts.

Ida Cannon subsequently went on to become a leading figure in the hospital social work movement influencing the development of medical social work throughout the U.S.A. and becoming a Florence Nightingale equivalent of social work.

Both of these women were strongly influenced by their religious beliefs and following a well established precedent in Christian society they might well have become known as social work missioners (early probation officers you may recall were referred to as police court missionaries and health visitor’s forebears as sanitary missioners) but instead they became known as Lady Almoners and later on as almoners.

And this is the link with Joyce Green Hospital because the Medical Social Work Department at Joyce Green was still called “The Almoner’s Office” when I worked in the Admission’s Office (or the Registry Office as it was known then) in 1964.

Originally of course an almoner was an official whose job it was to distribute alms to the poor and historically they were either crown officials, belonged to religious bodies or worked within English church parishes however it seems that the first attempt to introduce social work into hospitals in England occurred with the establishment of Lady Almoners in the out-patient sections of one or two of the larger London hospitals. The first one in fact appears to have been appointed at the Royal Free Hospital in 1895.

But as to when the first almoner was appointed within any of the River Hospitals or at Joyce Green Hospital must for the moment remain a matter of speculation. But maybe you have some recollections of the hospital social workers at Joyce Green during the time that you spent working within the hospital ?

I can certainly remember a very pleasant and seemly effective almoner based in her office next door to the Admissions Office (or “The Registry”), who also came to lecture us as student nurses in the Preliminary Training School although I have no recollection whatsoever of her name. So what do you remember about the Social Work Department at Joyce Green Hospital ? Anything ?

57. Possible infectious disease outbreak near Joyce Green Hospital ?

Key words/phrases: mosquito bites, NHS Direct, West Nile and Dengue viruses, North Kent marshes, Professor Christopher Curtis, London School of Hygiene and Tropical Medicine, malarial epidemics, River Thames, Long Reach, Joyce Green Hospital, Temple Hill Estate.

No. 57

Having suffered from heavy rain and floods in parts of England this summer it now seems that people in certain parts of Great Britain are also suffering from being bitten by mosquitoes more frequently than usual.

Figures released from the NHS Direct organisation show that their helpline received 1,491 mosquito bite-related calls in the first 12 days of August compared with 1,157 over the same period in 2006, with a 28% rise in enquiries in England alone.

Whilst many Britons have been battling with the exceptionally bad weather and its results it appears that the mosquito population has been benefiting from the warm damp conditions.

Apart from mild degrees of physical and social irritation our indigenous species don’t usually create any serious health problems for Britons. That however might be about to change in the light of sightings of various ‘foreign’ species of blood-sucking insects - including the Asian tiger mosquito which can carry the potentially fatal West Nile and Dengue viruses.

Cast iron proof of the latter has yet to be confirmed but the Anopheles atroparvus mosquito, now well established on the North Kent marshes and Anopheles plumbeus, that is widespread in both the South East of England and in London,have the potential, according to Professor Chris Curtis of the London School of Hygiene and Tropical Medicine, to carry the malaria virus.

Prior to now 99% of cases of malaria diagnosed in Great Britain have been restricted to people returning from mosquito-infested countries. This is because in order for someone to contract malaria here the individual would need to have been bitten in the UK by a mosquito that had recently fed on the blood one of the 2,000 infected people coming into England from abroad.

Now however, because disease-inducing mosquitoes are thought to be coming into the UK amidst cargo, on aircraft and by other means, it appears that the UK is at risk again of the type of malarial epidemics that were common in England before World War I.

Thus this increase in the number of types of malaria-spreading mosquitoes now present in the British Isles and the reminder about the already-established presence of both the Anopheles atroparvus and the Anopheles plumbeus species on the North Kent marshes, in the London area and in the South East of England generally has made me wonder if Dartford could feature in the news soon as one of the areas producing cases of malaria ?

After all it seems quite possible that malarial-carrying mosquitoes could piggy-back their way up the River Thames on cargo vessels and disembark in the Long Reach area and then settle on the marshes near to the old Joyce Green Hospital site. Thus it seems to me not entirely beyond the bounds of possibility that Dartfordians in general and residents of the Temple Hill Estate in particular could become the focus of these pest’s attentions. What do you think ?

Obviously I hope that I am wrong and that the Joyce Green area of Dartford does NOT once again become known as an area characterised by the presence of infectious diseases, and that history does NOT repeat itself again, albeit in a slightly different form.

56. The Silly Season and Joyce Green Hospital

Key words & phrases: The silly season, Philippe Petit, the Twin Towers (World Trade Centre, N.Y.), Notre Dame Cathedral of Paris, Sydney Harbour Bridge, the Cathedral of St. John the Divine (N.Y)

No. 56

August forms part of the silly season, that mid to late summer period when Parliament and the Law Courts are not sitting and when serious news seems hard to come by. Newspaper sales usually slump at this time because of the reduction in political & business material and because readers often allow the delivery of their regular newspaper to lapse whilst they are away on holiday. Thus in order to retain customers, editors often have to resort to printing attention-grabbing headlines and articles to boost their sales even if the quality of the news is of questionable quality.

So American and international newspaper publishers must have been delighted when the 24-year-old French high-wire artist Philippe Petit decided to walk a tightrope suspended between the still unfinished Twin Towers of the World Trade Centre in New York on 7 August 1974.

After six years of learning everything possible about the buildings Petit spent about 45 minutes walking, running, dancing, hopping and even lying down on the wire, which was less than an inch in diameter, with some 100,000 people watching. He made his illegal journey between the towers, a quarter mile above the ground, eight times even stopping to kneel and to salute on occasion. Then he descended into the arms of the police.

Prior to his Twin Towers stunt Petit did a similar walk across a wire strung between two spires of the Notre Dame Cathedral in Paris and again between two pylons on the Sydney Harbour Bridge. In 1986, in a gesture to promote peace between Israel and the Palestinians, he also walked a wire from a church in west Jerusalem across a valley to the wall of Jerusalem's Old City.

Petit still lives in New York City where he is apparently artist-in-residence at the Cathedral of St. John the Divine. Why ? Because according to Petit he is first and foremost an artist and not an adrenaline junkie.

So here’s a gap-filler of a question for the silly season ? Although you may not recall anyone hang-gliding off the top of the highest building on the site, do you remember anyone taking part in any dare-devil feats at Joyce Green Hospital whilst you were there ?

55. Dear Matron, Having a lovely time".

Key words/phrases: Fixed versus inflexible holiday periods, factory fortnights, work's weeks, summer closures, School of Nursing, clinical areas, British hospitals, Nursing Admin Office,

No. 55

The concept of fixed holiday periods within the nursing profession and for most other groups of health service staff has hardly ever existed because of the very nature of the work that occurs in hospitals, with the exception of student and pupil nurses perhaps who were compelled to take their holidays during times that suited both the School of Nursing and the clinical (training) areas. Thus institutionalised holiday periods such as "factory fortnights", "work's weeks" and "summer closures" have never really featured in the world of British hospitals.

Nonetheless the start of the peak holiday season in the UK this week did remind me of one particular ritual which used to affect nurses at Joyce Green Hospital for quite a few years. Although whether this was something that was imposed solely upon trainee nurses or whether it was inflicted upon qualified members of nursing staff too I can't really remember now.

And the nature of the ritual ? Well, although not a very onerous task, there was a requirement towards the end of any holiday period that the trainee wrote to Matron from his/her holiday destination to advise her of his/her intention to return from holiday - as planned - on such and such a date !

Thus not only were the starting dates and finishing dates of the holidays of student and pupil nurses predetermined but to reassure Matron that you expected to recommence work on the prearranged date you also had to write to her whilst you were on holiday warning her of your expected return three or four days later !

If you had simply "gone home" for your holiday a short courtesy note would suffice whereas if you had gone further afield, say to a British seaside resort or more daringly "abroad", a coloured postcard was allowable.

However it always struck me as strange that (a) Matron required this reassurance in the first place because it seemed to me that if one either couldn't or didn't expect to return at the last moment for any reason a telephone call to the Nursing Administration Office would have sufficed equally as well and (b) the if one had only taken a fortnight's holiday, no sooner had the first week passed, than you would have to be take steps to announce the end of your holiday, a fact which you didn't usually want to remind yourself about!

So what did Matron or her deputies at Joyce Green Hospital do with all those letters and picture postcards - having taken note of their contents - which they could have anticipated in 99% of cases anyway ? File them vertically probably !

54. Bridge over troubled water at Joyce Green Hospital

Key words/phrases: The Bridge Project, George Wimpey plc, First Time Buyer’s Initiative, Wayne Hemingway, The Bluewater Shopping Centre, Darent Valley Hospital, The Crossways Business Park, Temple Hill, Dartford Station

No. 54

In view of the fact that large parts of England are severely flooded at the moment - an almost unprecedented situation - and with the threat of further flooding still hanging precariously over swathes of countryside near to other rivers, including the Thames, it is perhaps encouraging to hear some good news about some progress relating to “The Bridge Project” on the old Joyce Green Hospital and Littlebrook lakes sites ?

However, with this “new English Lake District” peering out at us from our television screens and national newspapers, one cannot helping wondering how safe from flooding “The Bridge Project” site will be, given the history of flooding in this area in the past.

Ex-members of Joyce Green staff, ex-patients and anyone else with an interest in the area and for those who might be contemplating purchasing property alongside that part of the river, may be interested to hear that the first batch of houses has been completed and are currently on sale with one-bedroom apartments starting at £175,000.

To help first-time buyers to purchase homes on “The Bridge” estate, George Wimpey plc. has teamed up with English Partnerships to offer properties via the new First Time Buyer’s Initiative that will allow first time buyers to obtain an equity loan for up to half a property’s value - thus enabling them to get on to the U.K. property ladder when otherwise they might not have been able to afford to do so.

During the next seven years the 264 acre site is scheduled to see the appearance of 1,100 new homes within an existing environment of mature trees and water features and Wayne Hemingway, one of the housing designers involved who seems committed to ensuring that landscaping and green spaces are a major part of the various residential segments was quoted recently as saying "that green spaces have been ignored in the overall design of large housing developments for far too long”.

“We believe, "he continued "that not only is such landscaping important in environmental terms but that it can also help in the creation of a caring society”. "I also believe,” he said, “that house builders and urban designers have positive roles to play in combating our 21st century ‘couch potato culture' which can result in health and behavioural problems”.

“But the economic value of landscaping is also significant,” he says, “because green spaces can add value to a property with recent studies in Chicago, Amsterdam and the UK showing that properties overlooking green open spaces often attract significantly higher prices”.

In terms of communication links there is to be a new fast-track transport system connecting hubs such as Dartford and Gravesend town centres, the nearby Bluewater Shopping Centre, Darent Valley Hospital and the Crossways Business Park and in addition a new bridge is going to be constructed over the M25 to provide to connect “The Bridge” estate and the Crossways Business Park with Temple Hill and Dartford Station.

How different the old Joyce Green Hospital and Littlebrook areas is going to look in 2012 or 2013 when the development is completed, although in view of the flooding that is currently affecting many people in parts of southern England one can only hope that global warming and climatic changes will not cause havoc on “The Bridge” estate in years to come !

53. Ophthalmic care at Joyce Green Hospital

Key phrases/words : Horatio Nelson, HMS Agamemnon, Corsica & Calvi, Lord Hood, the ophthalmic ward at Joyce Green Hospital, cranial immobilisation with sandbags, Mr. Owen - ophthalmic surgeon,

No. 53

This week, 213 years ago, must have been a very uncomfortable week for Horatio Nelson, the famous British naval officer from Norfolk.

In 1793, once Britain had entered the French Revolutionary Wars, Nelson and his ship H.M.S Agamemnon found themselves serving in the Mediterranean off the small northern Corsican town of Calvi.

Earlier on the British navy had been holding this garrison town under siege but on the 12th July 1794 the time had arrived for the British to press home their attack against the enemy.

Nelson and his men reached the local shore in a number of small boats carrying a number of small cannons with them but while some of his men were in the process of setting up a gun battery, with Nelson directing the way that some of these should be pointing, a French shot struck the battery rampart immediately in front of him sending a shower of earth, sand and pebbles into his face, lacerating it and badly damaging his right eye at the same time.

It seems that he made light of the incident in his letters home and to Lord Hood his commander-in-chief however a recently discovered letter has revealed that Nelson had to be carried away from the battery to his tent, suggesting that his injuries were much more disabling than he initially admitted.

The lacerations apparently healed leaving nothing more than a partially-erased eyebrow but his eye never recovered. Modern-day ophthalmologists have tried to reconstruct exactly what caused his subsequent partial-sightedness and the most likely causes suggested have been a severe internal haemorrhage or a detached retina.

What is certain however is that eye itself remained intact and that it looked undamaged. But to the end of his life he could only distinguish light from dark with it and so although not technically blind this eye was virtually useless to him for the remaining 11 years of his life.

Who knows though - perhaps if he had been treated in modern times and in a modern ophthalmic unit such as the one at Joyce Green Hospital perhaps his sight reduction could have been minimised ?

Do you remember the ophthalmic ward at Joyce Green ? I can certainly remember working on that small-but-perfectly formed unit, complete with its own integral operating theatre and headed-up at the time by Mr. Owen, the ophthalmic surgeon.

But I suppose the one thing that sticks in my mind most clearly is the high degree of attention that was paid to the regime of “complete bed-rest” following the type of surgery that was carried out there.

I particularly remember sand-bags being used to maintain patient’s heads absolutely still post-operatively and having to spoon feed patients with semi-liquid food that didn’t require them to masticate.

Oh yes, bedrest meant bedrest and neither were the patients allowed to get out of bed to use a commode until much later on following their surgery. A far cry from contemporary ophthalmic practice these days I suspect ?

Perhaps you have memories of that ward, the staff who worked on it or recollections of some of the patients that were cared for on it ?

In closing, who can say what type of intervention and care Horatio Nelson would have received if he had been admitted to Joyce Green Hospital ophthalmic unit with that particular injury -all those years later ?

52. Image & Joyce Green Hospital

Key words/phrases: The Royal Ballet Company of London, Edward Watson -Principal Male Dancer, Mary Clarke -Editor of The Dancing Times, The Royal Opera House, Great Ormond St Children's Hospital, Peter Pan, George Bush Jnr., Tony Blair,

No. 52

The Royal Ballet Company in London has been accused this week of “sexing up” its advertising material and as a consequence of this Dartford’s name has been thrust into the limelight once again.

How ? Well rather than using a traditional image of a female ballet dancer in a tutu, underscored by a plain slogan of the: “Why not come to the ballet”, the Royal Opera House has launched a new poster depicting it’s principal male dancer gazing into the camera’s lens with his lips forming a gentle pout. Then underneath the image there is a caption that reads : "Meet Ed. Fact: When he's dancing, pound for pound, he's stronger than a rhino. Superheroes really do wear tights".

So how and why is Dartford associated with this controversial advertising campaign ? Well because Edward Watson, the 31yr old red-headed male principal dancer is a Dartford lad who was born and bred in Longfield and is someone who still counts Dartford as his home town.

Mary Clarke, the editor of the Dancing Times, has deemed such treatment of a serious artist as “appalling” and as “a tacky advertising ploy that will cheapen the image of the company”. The Royal Opera House however has described its advertising campaign as “up close and personal” and “something that seeks to celebrate the physicality of its performers as well as challenging people's perceptions of ballet dancers as distant figures in tutus”.

Their director of marketing is quoted in a number of English newspapers as saying: “Whilst I have an imperative to sell seats, an even bigger imperative is to have the right image for the organisation and to change people's perceptions of it so that they realise that we are not intimidating but engaging and welcoming”.

It was this disagreement involving such a well-known company that made me begin to think about the images which hospitals have and sometimes seek to project.

If I were to ask you to name a well-known London children’s hospital you are more than likely to reply: “Great Ormond Street”. Equally, if YOU were to ask a member of the British public to name a “heart hospital”, you wouldn’t be at all surprised would you if they answered: “Harefield”.

What actually happens - clinically - in any hospital does seem to be one of the keys to shaping the image that it has in the public’s eye. In turn this led me on to thinking about the image that Joyce Green used to have and how that image was nurtured and maintained.

The name of a hospital, its historical background, its crest and its motto may all be important. (“The child first and always", being Gt. Ormond Street’s motto and the facts relating to it’s possession of the “Peter Pan” royalty-rights legacy being known to most people) but in fact it’s usually the good work that has gone on in any hospital over the years that is most effective in building up the reputation of the hospital.

So here’s a question that is perhaps worth re-asking :Did Joyce Green Hospital have a good reputation for the treatment, the care and the services that it provided and if so, on what was that reputation based ?

Do you remember particular wards or departments and their associated teams of staff who won reputations as providers of excellent treatment ? Or at a simpler level can you remember teams of people within the hospital who came to be known for the quality of the patient care that they provided ?

When “The Great Book of World Politics” comes to be written although George Bush Jnr and Tony Blair are most likely to remembered as key figures in “sexing up” the case for war against Iraq at least the consequences of their manipulations have now caused many top class leaders to re-think just how wise it is to “sex up” political, business and management evidence as a means of achieving their objectives.

Perhaps at the end of the day what really matters when it comes to providing what the public wants are … skills before sound-bites, integrity before artificially inflamed descriptions and results, reliability before razzmatazz and hope before hype ?

So even though Joyce Green Hospital never achieved 1st Division status in the world of well-known hospitals, I remain convinced that - in the main - it provided a standard of care that many patients and their families truly appreciated.

51. The Hospital Library at Joyce Green.

Key words/phrases: Joyce Green library, Charlotte Berry (née Dobbs), Clarice & F.L Dodds, Bow Arrow & Darenth Park Hospitals, Garrison Keillor, Charles Medawar, “Toohey’s Medicine for Nurses”, Preliminary Training School (P.T.S.), Henoch-Schonlein’s purpura, Ward 9A, Norman Cousins, Jesse Boot, “Chalkie” White.

No.51

Do you remember the library at Joyce Green Hospital ? Situated north of the large courtyard behind the Nursing Administration block on one of the corridors that led away from the administrative hub of the hospital and leading towards the wards ?

Charlotte Berry (née Dobbs) - who now lives in Greymouth, New Zealand - and I trained together as student nurses in the late 60s and because Charlotte is the stepdaughter of Clarice, the librarian, I have been able to talk to her recently about Clarice and the Joyce Green library.

In passing - you might remember Charlotte’s father, Fred Lesley Dobbs, too? At one time he was Finance officer for the Dartford Group of Hospitals based at Bow Arrow Hospital and later on he became the Finance Officer for the Darenth Park Group of Hospitals. He married Clarice in 1968.

But if you worked at Joyce Green during the 60s and beyond you’ll almost certainly remember Clarice and her cross-bred spaniel Toby ?

Referring to librarians in his book ‘Lives of the Cowboys’, Garrison Keillor once said “that librarians possess a vast store of politeness. They regularly get asked the dumbest questions on God's green earth and they tolerate every kind of crank, eccentric and mouth-breather there is”, whereas Charles Medawar once said: “Whilst librarians are almost always very helpful and absurdly knowledgeable, their skills are very underestimated and largely under-employed”.

Did this cap fit in Clarice’s case ? Yes, I believe it does.

Student nurses who were about to enter the Preliminary Training School (P.T.S.) at Joyce Green each had to purchase their own copy of a medical and a surgical nursing text book for use during the course. “Toohey’s Medicine for Nurses” was the name of the medical nursing textbook although I can’t remember what the surgical nursing textbook was called.

However it was to the hospital library - so expertly run by Clarice - that most of us went to in order to read up on all the other material that we needed access to during our studies since web-searching and the internet hadn’t been heard of then, at least not in Dartford. I certainly have memories of wading through material on Henoch-Schonlein’s purpura in the library in order to bolster the content of a case study relating to a little boy that was being nursed on Ward 9A at the time and valuing the help of the library staff.

The library at Joyce Green was a mixed library containing medical and paramedical texts & journals plus fiction and non-fiction for both patients and staff . In addition a library trolley was pushed around the wards once a week for the benefit of bed-bound patients.

The library itself had one large room containing nursing textbooks and recreational reading material books and then there was a medical-orientated library off of the this main room with Clarice's office off of that.

In addition Charlotte Charlotte has reminded me that Clarice also used to go up to London occasionally to select and borrow paintings that would subsequently be hung in strategic positions around the hospital. Do ever remember, for instance, having an after-lunch cup of coffee in the nurses’ sitting room - above the main dining room - and glancing at one of the pictures that Clarice had selected or seeing pictures elsewhere in the hospital ?

The American writer, editor, citizen-diplomat and unflagging optimist Norman Cousins (1915-1990) once said “that a one of the roles of a library should be … as a delivery room for the birth of ideas …”.

Since he was also very passionate about promoting health and wholeness and was an advocate of holistic healing who would be better perhaps, were we to decide to select a cheer-leader for hospital libraries, than him ?

Later on during his life Cousins was diagnosed with a form of arthritis but he refused to become an invalid to his condition and in addition to the standard treatment regimes of the time he experimented with high doses of Vitamin C and the regular use of what he referred to as “laughter therapy”. Later on he suffered a myocardial infarction but subsequently he went on to chronicle his views in his best-seller : “Anatomy of an Illness as Perceived by the Patient: Reflections on Healing and Regeneration” (1979).

In conclusion - and following on from the piece I wrote a couple weeks ago about Jesse Boot and Chalkie White, the Joyce Green pharmacist - did you realise that Jessie’s wife, Florence was responsible for setting up the Boot’s Book-Lover’s Libraries in her husband’s chemist shops ?

She charged borrowers 2d per book which obviously helped to boost the trade of Boots, The Chemists, but her motives were far from simply financial and she became a staunch advocate of higher education for women ... particularly in Nottingham where she financed the building of a Hall of Residence for women at Nottingham University in 1928.

I’m sure that Florence Boot and Clarice Dobbs would have had a lot to talk about together ?

50. Salaries & Wages at Joyce Green Hospital.

Key words/phrases: Pay Day, pay packets, pay slips, pay rises, ATMs, definition of a wage and a salary, Project 2000, nursing as an art or a science, John Shepherd-Barron - former director of the De la Rue finance company, Barclays Bank plc (Enfield branch), Seattle and Spokane, USA

No. 50

Understandably “Pay Days” have always been popular days with employees and they are undoubtedly likely to remain so. Do you have lots of memories of people talking about “pay day”, “pay packets”, “pay slips” and even “pay rises” at Joyce Green ?

Noticing that this week marks the 40th anniversary of the installation of the first ATM (Automatic Teller Machine) in England prompted me into thinking about salaries and wages at Joyce Green.

A wage, by the way, has been defined as “a fixed payment typically paid on a daily or weekly basis to someone who has completed a task requiring the use of physical skills or physical strength, whereas as a salary is defined as “the regular renumeration paid as wages + benefits for services rendered, to a professional person or a white collar worker”.

Thus, arising from these definitions a differentiation between ancillary staff and professional and technical staff seems undeniably obvious until one recalls that nurses and student nurses have traditionally used words and phrases such as: “pay”, “pay packet” and “wage slip” when talking about their renumeration !

This tendency to slip in and out of using the terms pay & wages versus the word salary seems to me to highlight an unresolved dilemma of the 50s - 60s (and later) about whether “nursing was a job or a profession”.

I shall certainly never forget overhearing a conversation between two nurses - not at Joyce Green I hasten to add - that went something like this:

“Where did you train ?” “Me ? I’ve never b-e-e-n trained. That’s what they do to circus animals ! But I was EDUCATED at the Blah-di-blah School of Nursing”.

How does that exchange strike you ? As pretentious perhaps ? Nevertheless what it did seem to me to do was to encapsulate the prevailing desire of some nurses to see their occupational preparation and work elevated into the world of fully fledged professionals.

This urgency to change from one social class group into another was probably - at least in part - behind the proactive efforts years later by some very senior nurses to encourage acceptance of the Project 2000 approach to nurse education.

Similarly the transfer of nurse education (and midwifery & health visiting education too) into Universities in the 1990s could also be viewed as a further strategy aimed at consolidating in this change of status ?

That consideration of the "proper" status of nurses, midwives and health visitors perhaps stemmed from earlier discussions about whether nursing is actually an art or a science and thus, whether nurses are purely and simply knowledgeable and skilled craftsmen (or craftspeople) or whether they are scientifically-directed professionals of a higher order ?

Maybe this dilemma has been resolved now ? Or perhaps such pertinent discussions are still continuing - unbeknown to me ? However one question that I do wonder about is this: When nurses discuss their end-of-the-month recompense do they still refer to their renumeration as their “pay” and equally do they still refer to “pay slips” or do they now use the terms “salary” and “salary advice slips”.

The reason that I ask this is because this may give some indication (albeit unintentionally) about how modern day nurses view their occupational status, i.e. as ‘semi-skilled or skilled ‘workers’ or as pucker professionals if indeed it's true that one social class tends to use one group of pay-related words whilst another groups uses a different set of salary-related words?

But let’s return now to the topic of ATMs because although the Scotsman John Shepherd-Barron, a former director of the De la Rue finance company claims to have developed the first on-line electronic ATM it seems that a Turkish man called Luther George Simjian designed the first ever non-automatic cash dispenser in 1939, which was installed in New York.

It was a stand-alone mechanical dispenser with no link to it's host business, the City Bank of New York but since customers didn’t appear to be very keen to use it it was removed after 6 months. Simjian incidentally had originally intended to study medicine at Yale but it seems that he finally went into medical photography, eventually becoming the Director of the University’s Medical School Photography Department.

Following this commercial failure there then followed a 28 year pause in the history of ATMs until the De La Rue company launched their first electronic ATM at the Enfield Barclays branch on 27 June 1967.

This second-ever model was electronic however because plastic cards bearing encoded details had yet to beinvented customers had to feed special non-returnable personal cheques into the machine in order to withdraw the maximum allowable amount - £10 at the time. In fact the first on-line ATMs (the TABS 550s) were installed in Seattle and Spokane USA in the 70s.

So what had this to do with staff at Joyce Green Hospital accessing funds that they had previously banked ? Well nothing really because as far as I can remember none of the ‘big five’ banks had any sort of presence at Joyce Green - at least not in the 60s - and therefore most employees continued to receive “wage packets” on a weekly or monthly basis for a good many years after the launch of the Enfield “hole in the wall” in 1967.

Perhaps though someone reading this might be able to tell us if an ATM was ever installed at Joyce Green Hospital ?

49. Celebrities at Joyce Green Hospital.

Key words/phrases : Nicole Kidman, Virginia Wolfe, “The Hours”, Ward 2B, “Z Cars”, geriatric wards, Her Majesty’s pleasure.

No. 49

Nicole Kidman the Australian film actress (who was actually born in Honolulu, Hawaii) is 40yrs old today and whilst I was thinking about her role as Virginia Wolfe in the film “The Hours” earlier today I found myself wondering how many previous members of staff were ever involved in caring for a celebrity or someone related to a well-known personality on one or other of the wards at Joyce Green Hospital ?

I can certainly remember as I was a student nurse helping to care for the elderly father of a popular British variety-show artist on one of the medical wards and then each of the nurses (yes, even the male members of the team) being left a box of women’s tights by this famous comedian/singer & dancer because he had not realised that there were also male nurses involved in looking after his father.

I also recall being a very junior student nurse on Ward 2B when a well-known British actor (of stage & screen) from the police crime series “Z Cars” was admitted for a haemorrhoidectomy. Quite understandably he came across as somewhat less of a hero in real life, but nonetheless he was very grateful for all the care and attention he received. He was cared for in one of the ward side rooms but I always wondered why he didn’t chose a private Hospital in which to be treated ? Perhaps he felt that his "cover" could be better secured in a provincial hospital ?

Finally I can remember feeling particularly sorry for the elderly father of a traitor who compromised British defence integrity during the 60s and who ended up in jail. His father was being nursed on one of the Geriatric wards at Joyce Green (although I confess to hating the label “geriatric”) and just when he his elderly father needed him most his son was unable to visit him because of being detained at Her Majesty’s pleasure.

Perhaps YOU can remember other celebrities who passed through Joyce Green Hospital whilst you were there … or perhaps you think of all patients as celebrities in their own right ?

48. Joyce Green Hospital's own "Boots, The Chemist"

Key words/phrases: Boots, The Chemist, John and Jesse Boot of Nottingham, Methodist social conscience, E.S.Waring, Nottingham Daily Express, apothecary William Weston of St Bartholomew's Hospital London, the role of head dispenser, John (Chalky) White of the River Hospitals, Joyce Green Hospital Pharmacy.

No. 48

If you stop someone in the street of any largish English town and ask him or her to direct you to a chemist’s shop the chances are extremely high that they will point you in the direction of the nearest “Boots, The Chemist”.

Although John Boot, the herbalist-shop owner of Nottingham was the original Mr Boot, it was his son Jesse who turned the family business into the well-known chain of British retail chemist shops. John Boot died when his son was still a child and so at the age of thirteen Jesse left school to help his mother run their herbalist shop. He decided to study pharmacy in his spare-time and in 1877 he opened his own chemist’s shop.

Prior to the advent of chemist shops doctors made up their own prescriptions after diagnosing a patient’s ailment however during this period of time there was still a major problem for poor families because even if they could afford to pay the doctor for their consultation most of them couldn’t afford the medicines that he offered to make up. Thus the diagnosis, prescription and treatment cycle could not always be completed with obvious consequences for both personal and public health.

Even when chemist’s shops began to appear the charges made for medicines were still very high and Jesse Boot realised that established chemists in Nottingham had quietly introduced a cartel with a prohibitive price-fixing policy. Thus being both a Methodist Christian (with a strong social conscience) and a businessman he decided to do something to break this monopoly and at the same time to improve his own business prospects too.

By employing a young chemist called E.S.Waring to dispense patient’s prescriptions at half the price that G.Ps and local chemists usually charged both Boot and a high percentage of Nottingham patients benefited.

He went on to advertise via the “Nottingham Daily Express” that over 100 items in his shop at Goose Gate were being sold more cheaply and even employed a bell-ringer to tour the local streets informing the public about these offers. Not surprisingly these social and business strategies were so successful that within a month the takings of the shop - which he later renamed “The People's Store”- had doubled. “And the rest” … as they say … “is history” with Boot’s The Chemists expanding into a prosperous and nationally-renowned chain of quality chemist shops.

But what of the history of hospital pharmacies ?

The first recorded apothecary at St Bartholomew's Hospital, London, as an example, was William Weston in 1571 who apparently supplied drugs paid for out of his own salary.

In 1847 the role of the St Bart’s apothecary was revised and it was agreed that the apothecary “should attend the physicians on their rounds if required, visit patients in the wards each morning and night, as well as attending casualties”.

Frederick Wood, the last St Bart’s apothecary, retired in 1868. The post was then abolished and the duties were divided between the house physicians and a person fulfilling the new role of ‘Head Dispenser’, i.e someone who took over all of the pharmaceutical duties.

The head dispenser’s title was changed to that of pharmacist in 1927 although the dispensary itself did not become known as the pharmacy until as late as 1967.

As far as Joyce Green Hospital was concerned John White (or “Chalky” as he was affectionately known) qualified as a pharmacist in 1938 and he came to Joyce Green Hospital in 1953 as Chief Pharmacist for the River Hospitals.

I am struggling at present to remember exactly where the Pharmacy was at Joyce Green Hospital (believing for the moment that it’s last resting place was near to the hospital library, on the corridor leading away from Nursing Admin ?) but I certainly have crystal clear memories of Mr White peddling around the hospital on a bike delivering urgent items to the wards, wearing a long white open fronted hospital-issue long jacket or coat.

I wonder if you have any memories of the pharmacy services at Joyce Green or of Mr White and his staff ?

47. Aussie v. pommie tensions : Joyce Green Hospital.

Key words/phrases : Aussie and pommie soldiers, the Australian Army Nursing Service, Sydney Hospital School of Nursing, the 3rd Australian Army Auxiliary Hospital, Jessie Tomlin, Fred Tomlin, 1st Australian Light Horse Regiment, war-related nerves and neurotic conditions, Joyce Green Hospital cricket ground, The Orchard Military Convalescent Hospital, stone-throwing Dartford civilians.

No. 47

“There have been riots in Dartford between Aussie soldiers and civilians during the past three nights and extra police and others have now been drafted into the town to keep order. In fact Dartford town centre is now completely out of bounds to us Aussies. We, the other sisters and I, now have to get signed passes from our Commanding Officer before we can leave the hospital and for our own safety we all have to be back here by 7.0 p.m. and so going to the theatre and some of the other things we enjoy are completely out of the question at the moment.

An ambulance was held up by pommie civilians last night too and it was only because a couple of our Sisters were on board that was it allowed to continue on its journey, and even then it was stoned as it moved on !”

Race riots in Dartford ?! Not exactly ! No ... these words formed part of a letter from an Australian nurse working on the combined Orchard Hospital/Joyce Green Hospital site to her brother during the Spring of 1919.

Jessie Tomlins (whose Father originally moved to Australia from Shropshire) had joined the Australia Army Nursing Service in 1919 - after completing her nurse’s training at Sydney Hospital - and had promptly been posted to Dartford to work in the 3rd Australian Army Auxiliary Hospital (which was what the Orchard Hospital was called at that time).

At the same time Jessie’s brother Fred was a soldier in the 1st Australian Light Horse Regiment in Palestine and/or Egypt and the lines penned above were some of the many written by this young Australian nurse (although in fact she was a commissioned officer), to her brother who was serving in the Middle East.

Jessie Tomlins was based on the Orchard/Joyce Green Hospital site for two months between 27 April - 27 June 1919 alongside a contingent of Aussie nurses.

World War I had produced thousands of wounded soldiers in Europe and many, many of them had been evacuated to England for treatment or simply to recover.

Not many of us are aware of the fact but the total number of world-wide casualties arising from the 1st World War was - wait for it - 27.5 MILLION souls ! Not only is this a breathtaking figure in its own right but perhaps it is also begins to give some slight idea of the scope of the evacuation programme that was required to get vast numbers of injured servicemen and women out of the various continental battle zones and into more peaceful surroundings.

According to Army records the results of this conflictproduced countless soldiers suffering from “war-related nerves and neurotic conditions” and from historical accounts it seems that the Orchard Hospital (which was situated on the area of the Joyce Green Hospital cricket ground) earned itself a reputation for its good work in this particular sphere of rehabilitation.

What was once called The Orchard Military Convalescent Hospital (which contained 1,200 beds in 75 ‘huts’ built on either side of a central roadway) was loaned by the British government to the Australian military authorities in 1916 and eventually numbered 1,400 beds.

However to return to Jessie Tomlin’s earlier comments it seems that one of the results of having an Army Hospital based on the Joyce Green site was the creation of a palpable degree of social unrest. Why was this ? Well because on returning to Dartford a large number of “Tommy” soliders found that some of their sweethearts had either ‘become engaged to’ or had married Aussie soldiers !

It’s not hard to imagine that dealing with stone-throwing Dartfordians was NOT something that Jessie Tomlin and her fellow nurses had been taught how to deal with during their nurse’s training at the Sydney Hospital School of Nursing .

It seems that Sister Tomlin only stayed at the Orchard Hospital for 2 months before she was transferred elsewhere but I wonder what long-term memories of Dartford and these two hospitals remained with her when she left England and returned to live in Australia ?

Her letters at least tell us that she was certainly touched by the calm and natural beauty of the apple orchards on the site, after which the Orchard Hospital was named. Maybe the orchards inspired some of the mentally traumatised soldiers too ?

I'm sure though that these physically and mentally scarred men would have been glad to have received at least some of their care from Australian nurses such as Jessie Tomlin ?

46. Not well at all at Joyce Green Hospital !

Key phrases/words: Critical versus serious condition, Joint Casualty and Compassionate Centre, incapacitating illness or injury, critical condition, grave condition, extended visiting passes, late passes, the gate porter at Joyce Green Hospital.

No. 46

Hearing doctors and nurses - or occasionally a hospital spokesperson - describing the status of a patient on the bad-to-very-bad scale in relation to their progress is not something that we are likely ever stop hearing periodically, is it ?

But have you wondered about the terms and phrases that are used in these pronouncements. A number of things have crossed my mind recently. For example, what do the phrases “critical but stable” and “in a serious condition” really mean and how much uniformity is there in their use and finally where did they originate from ?

It seems highly likely that some of these descriptions arose from within the Armed Forces in an attempt to categorise wounded servicemen and women who were being despatched to hospitals or transferred to other centres during and after the two major World Wars.

Indeed an institution referred to as the Joint Casualty and Compassionate Centre now uses the following definitions:

“Having an incapacitating illness or injury” applies to an individual whose illness or injury requires hospitalisation but who does not warrant classification as either seriously ill or very seriously ill but whose illness or injury renders them physically or mentally unable to communicate with friends or relatives.

“Seriously ill”. This term applies to an individual whose illness or injury is of such severity that there is definitely cause for immediate concern but without there being any imminent danger to the life of the person concerned.

Finally the term “very seriously ill” is applied to an individual whose illness or injury is of such severity that his or her life is imminently endangered.

But what about some of the terms that are sometimes used within civilian health services to relatives or in public announcements when these can’t be avoided ?

As most readers will appreciate these words and phrases arise from an attempt to give the listeners a bite-sized description of the patient’s condition without breaking any confidences and without the necessity of having to describe what is actually happening in the clinical situation. Thus shorthand comes into play here and the patient's condition comes to be described as critical, serious, etc.

Being “in a critical condition” or being in a grave condition” usually means that there is a strong possibility of the patient dying within the next 24 hours even with the use of continuous intensive intervention and/or life support, whereas being “in a serious condition” seems to be used to indicate a reduced risk of death within the following 24 hours albeit that the patient still requires active intervention and close observation.

“Critical but stable” and “in a serious but stable condition” aim to be slightly more descriptive and therefore reassuring to either family members or to the media.

Interestingly, from accounts of the work of nurses who preceded many of us, it seems that it was quite normal for hospitals to keep up-to-date lists of “dangerously ill”, “seriously ill” and “critically ill” patients and also for relatives to be issued with “extended visiting passes” authorising gate-porters to allow them into hospitals outside of the otherwise very restricted visiting periods. In fact hospital personnel addressing the media can sometimes still be heard saying that “s/he is now off the critical list”.

Another type of paper “pass” that hospital gate-porters had to check in bygone days were “late passes” issued to resident nurses to allow them back into the hospital (usually "no later than 10.30 p.m.") when they had received permission from Matron or her deputy to go out for the evening !

This must have meant that the gate porters at Joyce Green Hospital were given lists of very ill patients - and of temporarily absent nurses too - and that they must have been required to check-in individuals against his lists until that moment in time when those activities disappeared from gate porters' job descriptions ?

45. Pay-As-You-Eat at Joyce Green Hospital

Key words/phrases: National Health Service, hospital dining rooms & waitresses, West Hill Hospital & Livingstone Hospital Dartford, the “pay as you eat” system, split-shifts, hospital cafeteria,

No. 45

If you were employed AND resident at Joyce Green Hospital prior to 1967- 68 the accommodation that you were given and the meals that you received were, like the National Health Service itself, “free at the point of receipt”.

Historically, charges for board and lodging within the British NHS had always been deducted at source, i.e. taken directly from the employee’s wages and so all resident members of staff - no matter what profession or trade the individual belonged to - simply enjoyed (if that’s the correct word !) the accommodation that they were given and the meals that they were served, “free” at the moment of use or consumption.

I say “served” in relation to their meals because some people reading this will be able to remember when meals were served to them in hospital dining rooms. I can certainly remember being ‘served’ meals by uniformed waitresses in the main dining rooms of both the West Hill Hospital and the Livingstone Hospital in Dartford although not at Joyce Green. In addition and by tradition ward sisters and medical staff had long had their meals served to them by waitresses in separate dining rooms.

However somewhere between 1967-68, a Government edict descended from on high dictating that this deductions-at-source approach to reimbursing the NHS for “meals taken” was going to be scrapped and a “pay as you eat” system introduced into all hospitals. This was done in an attempt to make staff accountable for exactly what they ate rather than deducting a one-price-for-all figure ffrom the salaries of all staff of the same grade and was aimed of course at reducing each hospital's catering budget.

Thus on the appointed day special, separate dining rooms for Ward Sisters and Medical staff were abolished and “Waitress Service” dining rooms arose in their place for those members of staff of any type or grade who wished to pay a small add-on charge for having an individual meal served to them.

Most people however continued to eat their meals in Joyce Green’s main dining room, but - and here was the rub - every item of food that they ate or beverage that they drank after Day 1 was individually priced and had to be paid for at a newly installed cashier’s till in the cafeteria immediately prior to it’s consumption, as in self-service cafeterias in the public domain.

For most employees, but particularly for resident staff, this was completely different to anything that many of us had been used to. Some of you reading this will be able to remember the shock of seeing the cost of the items on their lunch tray mounting up on the till roll ? “Meat x 1 portion = 1/-, portion of potatoes = 2d, portion of carrots = 2d, glass of orange squash = 2d, portion of treacle sponge and custard = 6d” and so on, right down to the halfpenny charged for a pat of butter for one’s slice of toast or slice of bread !

Not only were most staff totally unused to monitoring the cost of the dining room food that they were about to consume but many long-standing members of staff were also institutionalised to the extent that they were not used to handling money on a daily basis. In fact there were some older members of nursing staff “in post” to whom life and the ‘service’ that they rendered was something akin to living within a closed religious order, that is to say, they only left the hospital on rare occasions.

I can certainly remember dedicated ward sisters who seemed to spend most of their lives within the confines of the hospital and who frequently worked split-shifts on their wards (i.e. a morning and an evening shift in the same day) as a feature of their ‘calling’, who struggled to come to terms with the introduction of this new pay-as-you-go system because they were completely unused to budgeting and handling money.

Thus paying their bus or train fare in order to go and visit their family whilst taking a “day off” didn’t create a problem - because they were used to budgeting for this type of special, regular or occasional event – but having to calculate what the food that they had selected on their cafeteria tray was going to cost them and marshalling the necessary coins with which to pay for their meal was much more difficult for them in this brave new world, at least at the outset.

For us as students handling money and paying for food at the hospital cafeteria check-out wasn’t the problem. No our problem was that we didn’t earn very much and yet suddenly found ourselves having to control our appetites and our spending instead of eating to our heart’s content in the hospital dining room, as we had been used to doing up until then.

But here’s a question that I haven’t been able to answer yet. Prior to the arrival of the pay-as-you-eat system how did hospital authorities get back the cost of meals eaten in hospital dining rooms by non-resident staff ? Was a small sum of money routinely deducted from their wage packets as a contribution towards the costs of their meals whilst they were on-duty or were their meals a gift from the bosom of the NHS ? Maybe you can remember ?