Image credit: Extract from map of Manchester published in 1850. Reproduced in Portrait of a Hospital, W Brockbank, William Heinemann Ltd 1952 page 80.
Eileen Shepherd explores Ethel’s early career at the Manchester Royal Infirmary and discusses how this may have influenced her future career.
A young woman deciding to embark on a nursing career in the late 19th century faced the same decision as students today – where is the best place to train? However, while today’s applicants have the luxury of consulting online brochures and league tables, pioneering nurses such as Ethel Gordon Fenwick had very little information to inform their decision. In the mid to late 19th century there was a growing national debate about how nurses should be educated but, in the absence of a national curriculum and standards, the content and structure of training was decided at a local level and standards varied between institutions.
The exact dates of Fenwick’s time at the MRI are unclear however the entry on the GNC register confirms that she was in Manchester in 1879 and Brockbank (1970, p56) notes an entry in a cash book dated January 1879, which records the payment of a probationer’s fee of £6 10s.
We do not know why Fenwick chose the MRI; the attraction may have been its size, regional dominance and growing reputation as a centre for medical training but it may have been that at the young age of 22 years, she had a limited choice as some hospitals favoured mature nursing applicants over the age of 25 years.
The MRI was a well-established institution by the time Fenwick travelled to Manchester. It had opened its doors in Garden Street in 1752 with the aim of providing inpatient, outpatient and home care to the working poor and was funded by subscriptions. Brockbank (1952, p10) estimates that it initially had twelve beds however it quickly became apparent that larger premises were required and a new hospital with space for eighty beds was opened in Piccadilly Gardens in 1755.
By the mid-eighteenth century Manchester had established itself as a centre of commerce for the textile industry and Pickstone (1985 p13) suggests that with subscribers in towns across Cheshire and Lancashire, its Infirmary helped confirm Manchester’s dominance over neighbouring urban centres including Bolton and Preston. In 1830 the Earl of Stamford, on behalf of the Infirmary Board, sought Royal Patronage for the Manchester Infirmary describing it as; “what is believed to be nearly the oldest provincial establishment of a similar kind, in England – supported by voluntary contributions” (Brockbank, 1957 p57). In a response the Secretary of State acknowledged the “great importance of the town of Manchester” and assent to use the title “Royal” was granted; the Infirmary became The Manchester Royal Infirmary, Dispensary and Lunatic Hospital (Brockbank, 1952, p58).
The price of Manchester’s industrial success was born by the working class who found themselves living in squalid insanitary conditions, with poor diets and limited access to clean water. These conditions had a profound effect on health which in turn placed increasing pressure on the MRI. The size of the Infirmary had been a concern since it opened in 1752; the building had been modified on numerous occasions but by the 1860s the minutes of Hospital Board meetings noted growing concerns about the fabric of the hospital which was no longer deemed fit for purpose. Fenwick may have witnessed problems with shortages of beds and, as nurse’s accommodation was in short supply, she may have found herself housed in temporary wooden huts in the hospital grounds.
The finances of the Infirmary were also an ongoing concern and by the late nineteenth century the MRI, along with other voluntary hospitals across the country, had developed a lucrative private nursing service for wealthy patients in their own homes. However, its success depended on a supply of well-trained staff and this led to questions about the general quality of recruits; these concerns reached crisis point in 1878 just as Fenwick was planning her move to Manchester.
Fenwick arrived at the MRI in the midst of a Medical Board inquiry into the quality of nursing and the Medical Board Sub-Committee reported on 28th April 1879, “that the present arrangements are very unsatisfactory and that complete reorganisation of the nursing staff is required”.
- Frequency with which nurses were changed from ward to ward;
- Large numbers of partially instructed probationers as compared with the number of “properly qualified nurses”;
- Lack of sufficient supervision from the “head of the nursing department”.
They recommended that efforts should be made to explore how other institutions organised nursing and they wanted to employ “a lady thoroughly acquainted with the practical duties of nursing with the best method of instructing nurses”. There is no evidence in the Board minutes that nurses played a role in this investigation and it is unlikely that they were involved.
The report marked the start of a few years of instability in nurse leadership at the MRI as Alice Dannatt, who had been the Lady Superintendent since 1876, resigned. She was replaced by Miss K Mackenzie from East London Hospital for Sick Children who started the first register of nurses at the Infirmary. Miss Mackenzie left in 1880 and Miss Agnes Dunlop McKie was appointed in 1881 and remained in post until 1886.
Fenwick met Alice Dannatt at the MRI and Dannatt became a regular contributor to The Nursing Record and Hospital World which Fenwick edited from 1893. It is interesting to note that she was usually assigned the by-line “Formerly Lady Superintendent at Manchester Royal Infirmary” but it is unclear why this title was adopted as, following her resignation from the MRI, Dannatt went onto hold several nursing posts including Matron at Preston Royal Infirmary. It could signify the high regard Dannatt had for the MRI and its growing reputation for training nurses, but there is no documentary evidence to support this.
In an obituary to Dannatt in 1898 Fenwick wrote “Life has taught me many lessons in these intervening years – yet none of more value than those learned from observing day by day, the devotion to duty practised in small things for the general good, by this truly noble woman” (Gordon Fenwick, 1898).
We do not know what Fenwick’s training at the MRI involved and there is no evidence that she took a formal examination but it is likely that she received instructions from medical staff and supervision from senior nurses. A Certificate of Efficiency for nurses was introduced in 1882 and in 1885 a Certificate of Proficiency was granted to nurses after an examination.
Fenwick was a paying probationer but it is unclear how many of her contemporaries at the MRI also paid for their training. Maggs’ (1983) study of The Origins of General Nursing analysed the nursing registers at the MRI between 1881 and 1921 and identified that the majority of recruits were working women who needed to earn a living. This may have been Fenwick’s first experience of working with salaried probationers as the Board of Nottingham Children’s Hospital favoured paying probationers whose fees were vital for the continued running of the hospital service. It is interesting to speculate how the experience of working with salaried probationers, in a service where there were concerns about standards of nurse training and patient care, may have influenced Fenwick’s views on professionalisation and registration. It is worth noting that during her time as Matron at St Bartholomew’s Hospital between 1881-1887, Fenwick introduced a system of fee-paying “special” probationers which has been described as an attempt at “gentrification” (Dingwall et al, 1988). Later, as part of the campaign for registration, Fenwick championed nursing as a high-status occupation and she argued in favour of recruiting potential nurses from the “daughters of higher social classes” who could afford to pay for their training (Abel-Smith, 1960 p63).
Fenwick, like many paying probationers in other institutions, was being prepared to take charge of nursing services. This is evident in entries on the RBNA register suggesting that during her time at the MRI Fenwick spent eight weeks in charge of a surgical unit and was also acting matron at Barnes Convalescent Hospital, Cheadle, which had opened in 1875 and at the time was considered a “model hospital” building. This was a substantial post for Fenwick and it would have prepared her for her next role as sister of Charlotte Ward at the London Hospital.
It would be interesting to ask Fenwick what she learnt from her time at the MRI. The nursing service was undergoing a transition; a nursing register was introduced in 1880 and the foundations of a standardised approach to training in 1882, yet references to nursing in hospital board minutes are scant. During her short time at the hospital Fenwick must have witnessed concerns about the poor quality of nursing and the drive to develop a skilled nursing workforce but she may have been unaware that this interest was driven primarily by a need to capitalise on the financial success of private nursing services which required a continuous supply of skilled nurses. If and how Fenwick’s experiences influenced her views on nursing is unclear, but her early career and those of her contemporaries warrants further research.
Eileen Shepherd is a member of Nottingham Nurses History Group and Clinical Editor, Nursing Times.
Abel-Smith B (1960) A history of the nursing profession. Heinemann Educational Books Ltd.
Brockbank W (1970) The History of Nursing at the MRI 1752-1929. Manchester University Press.
Brockbank W (1952) Portrait of a Hospital. William Heineman Ltd.
Dingwall R, Rafferty AM, Webster C (1988) An Introduction of the Social History of Nursing. Routledge.
Gordon Fenwick E (1898) A Noble Woman. Nursing Record and Hospital World; Dec 10: 474.
Maggs C (1983) The origins of general nursing. Croom Helm.
Pickstone J (1985) Medicine and Industrial Society. A history of hospital development in Manchester and its Region, 1752-1946. Manchester University Press.