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 !