Those who had the good fortune to work in this beautiful building know how very fine was its conception and design. The high, large attractive wards were a model of convienience. Both the large ‘straight’ Nightingale wards and the beautiful ’round’ Nightingale type were successful in every way. They were found to be satisfactory, with only slight modifications, to take the many advances made during their period of use. They were complemented by a hospital with wide attractive corridors with great ease of access, stairs wide and gradual and the whole bright and illuminated by large and wide windows. The walls covered by white glazed tiles were clean and easily maintained. The floors of terrazzo, clean and with ease of washing. Two world wars were to pass with the building still in constant use until the onset of centralised medicine with a state organised service saw the request for altered accomodation. A fraction of the monies used to create the new Liverpool hospital complex could have been spent on the Royal Infirmary building to make it suitable for continued use. The magnificent fabric was well suitable to modification and it was in fact built with the idea that a third or fourth storey could be added if it should be found to be necessary.
The Nurses’ Home which formed part of the Liverpool Royal Infirmary was taken over from the second Infirmary. The building was to stand until the hospital closed in 1978 and was still in use as a residence. It was built around a central area, in some ways much like the penal institutions. Spiral staircases led to ground level from the numerous rooms and as these were made of iron, they added to the feeling of being in an ‘institution’. The whole could be securely locked to keep intruders out and it showed the care with which the nurse of the mid-nineteenth century was guarded and the conventional life she lived. This home had been the creation of Philip Rathbone.
[…]His wife had a prolonged and fatal illness. He was at a loss to get satisfactory nursing for her in her own home. It was impressed upon him that even with his resources it was almost impossible to get satisfactory nursing attention and he became aware that the greatest need in sickness was adequate nursing. He decided to devote himself to the provision of nursing care for the ill in their own homes. In 1859, he founded what might be called a ‘nursing service’ with one nurse, starting in his own district. This provision obviously proved to be inadequate, so he decided to establish at his own expense a body of trained nurses to nurse the sick poor in their own homes. Ginding that trained nurses of the type he required did not exist, he decided to write to Florence Nightingale to ask her advice. It was said that Rathbone was ‘austere in spite of great wealth, unselfish, tender-hearted, devoid of senti-mentality to the point of dryness’. Just the qualities that appealed to Florence. They were to become great friends and his admiration and affection for her were un-bounded.
[…] Florence well saw that the Infirmary would wish to retain nurses for its own use, so she advised that the Infirmary should be guaranteed a certain fixed percentage of the nurses so trained for its own use. The Infirmary agreed to form a school in the lines of the type started in London by Florence Nightingale, and so Liverpool became the second school of the ‘Nightingale’ nurses. The school was established at Rathbone’s own expense in 1862 and the training school was built. It was to prove to be an unqualified success and the basis of Liverpool’s future nursing eminence.p5, p6
The building of the third Infirmary, the Liverpool Royal Infirmary (1889 – 1978) was to take its form and design from the association Liverpool had made with Miss Nightingale. During the period of 1860-87, the hospitals throughout Britain were undergoing remarkable change and this change was is great measure to the influence Miss nightingale had on the nursing services of the sick in general. In order to understand what was the nature of her great influence, it is essential to study the publications she made during this period and we find that her ideas were summarised by two papers she read before the National Association for the promotion of Social Science held in Liverpool in October 1958. p9,p10
In his plans for the hospital, Waterhouse: advocated the use of both circular wards, as well as rectangular wards, because he felt that the site plan would require the use of circular wards, as they were more economical of space. He has been very impressed by the recent building of a hospital on the circular plan at Antwerp. In these wards, the space was greatest at the head of the bed; he pointed out that in the circular wards there was in fact more space at the head of the bed where ventalation was necessary.[…] In his study of hospital building, Waterhouse could not but be impressed by the efforts Florence Nightingale had made in her advice on the re-building of numerous other hospitals.p16,p17
In the circular wards, which are 56ft. in internal diameter, the 3ft. beds are 5ft. 11 ins. apart at their heads and 3ft. 11 ins. at their feet, as compared with an uniform inter-space of 5ft. in the rectangular wards. The height of these wards and the character of their windows are the same as in the rectangular wards. In addition to the bath and sink as before, two closets and two lavatory basins will be provided for each ward.
It is intended that all the wards shall be lined with glazed light-coloured bricks, and the floors made of oak blocks set in Stockholm tar upon the fireproof concrete floor, so as to increase the fire-resisting character of the building, and do away with all the dust harbouring interstices and spaces between the floor joists.p21
Fresh air would also be brought in from both sides of the wards by channels below the floor to the centres of theses circular radiators. Fresh air would also be brought in a similar manner, to the backs of the various open fireplaces shown on the plans in the centre of the wards. All these air flues could be swept free from dust and lime-washed with ease from the exterior of the building. The fireplace in the rectangular wards are back to back, the smoke flues being between them. p22
1891 The idea that photography would help in the recording of cases was a new idea. Clinical photography was born. The Royal felt that they must adopt this excellent idea and it was thought that photographs of operations would be an innovation. It was proposed, therefore, that there should be a dark room attached to the the theatre. It was resolved that the lavatory attached to the theatre should be used an modified as a dark room, provided that it should still be used as a lavatory in connection with the theatre. The Medical Board obviously wished to get the best of two worlds! p33
1893 Complaints were made that much time was wasted in the taking of temperatures when they were of no importance, the patient being afebrile. The ward records of the day were, however, very complete and all nurses vied with one another as to who had the best records. The temperatures were plotted in coloured inks on the case sheets. The Medical Board, however, felt that it would be better if full temperature records were only kept in acute cases. In this they were not supported by the nursing staff, who continued to keep full temperature records in all cases.
The medical wards were principally concerned with acute respiratory diseases, cardiac and nervous diseases. The mortality was very high, particularly in the acute respiratory emergency. In order that the mortality might not look to be too high, it was usual to exclude all deaths taking place in the first 24 hours, as the hospital could not be held responsible for these cases. […] Medical treatment was by simple medical remedies as in general use, general nursing care and strict routine to which great attention was paid, coupled with a suitable diet and rest. Scientific medicine had not yet arrived, but advances in bacteriology and pathology were soon to make considerable advances. p42
(1913) The central organisation was very small and efficient and all the actual running of the various hospital departments came under the special care of a suitable nursing sister. Ward sisters were responsible to see that theactual wards ran efficiently. They were inspected daily by a senior member of the nursing profession. The Sister and the ward nursing staff recieved a small remuneration, they being part of the organised nurses survice to whom a grant of £3,000 annually was made. Home Sister ran the Nurses’ Home. A Sister organised the laundry and linen. Nursing instruction and lectures were under a Nursing Sister (Tutor). The cleaning staff and maids were supervised and controlled by Matron’s Office. Over all was the Matron herself. The nursing care of all patients was under the care of Matron who, through her staff, implemented the wishes and treatment ordered by the medical staff. No other body divided the responsibility which was absolute. It was a most efficient and excellent arrangement, by means of which the greatest efficiency was reached with a minimum of cost. Such were the arrangements in force from the opening of the hospital to the onset of the Great War.p62
The excellent hospitals were now able to make use of all these advances which, combined with the new nursing care, revolutionised the mortality of disease and gave hope where none had previously been possible. The public responded to these changes by giving implicity faith to its medical attendants and nursing sisters. Nothing was too good for medical care. All materials used to be of the very best and the very highest demands were made of personal morality, self-denial and ability to work for little recompense. Religion played a major part during this time. There was still great belief in the effect of prayer and most persons concerned were deeply religious. Prayers were said in all wards morning and evening. Hospital chapel was always full to overflowing. The idea that disease ‘came from God’ and therefore must be endured was obviously untenable and the attitude to the pregnant woman as a ‘sin’ altered. There was, however , a deeply religious background to hospital practice and this was marked at the time the Great War started.
Sixteen Sisters and nurses now went into the Army and four Sisters went into the Liverpool Merchants Mobile Hospital. A further eight Sisters joined the Admirality. There was difficulty in getting probationers. There had always been too many applicants to become nurses and choice had been very strict. Height was thought to be essential and all had to be at least 5 ft. 6 ins. Now it was found necessary to accept almost all who applied. p63
Matters had not greatly altered or improved by 1862 – the year in which the nurses belonging to the Infirmary were given over to the Nurses’ Training School – but the number had increased to 20, with the five helps as before. The then salaries varied from nine pounds to sixteen guineas per annum. One extra special surgical nurse recieved £25, which was obviously too much for her, as she left a few months for ‘want of steadiness’. The Physician before alluded to, says that of the nurses of his day (1849 – 50) were a ‘very scratch lot’, and the ‘want of steadiness’ was apparently contagious for it accounted for the dismissal for a good many. These were the days of the ‘Sairey Gamp’ type of nurse, and Florence Nightingale’s assertion ‘that nursing was a work for gentlewomen fell like a bomb upon the people of England’.p68
Ward themometers always proved to be be a ‘bone of contention’. Breakages were the responsibility of the nurse in question and the themometers had to be replaced by the nurse at her own expense. It was now decided that a separate themometer should be provided for each patient, as funds became available and that the responsibilty should be transferred from the nurses in question to the ‘ward in general’. Syringes were also reviewed, it being decided that the present type should be replaced by one in which the piston could be interchanged as the outer cases became broken. p112
Gas fires were to replace the open fires and wards. These open fires were as installed when the hospital was built. The gas fires were a very great improvement, particularly in regard to cleanliness. The hearths, kerbs and fireplaces in all the wards were in a dilapidated condition, having been used for coal fires since the hospital had been built. It was necessary to replace all these fireplaces when the new gas fires were installed. The cost of these changes was some £2,000. The gas fires remained in satisfactory condition until the hospital was closed. p115
The general interest in football was increasing. There were repeated requests for the broadcasting of football commentaries by the hospital radio. It was decided that arrangements be made for this to be done and by December these arrangements had been completed.
New gas fires had now been fitted to the existing fireplaces in all the general wards. New bed curtains were fitted to all wards. A new non-slip plastic finish was applied to the floors of many wards and thus relieved some of the ward cleaning and maintenance.p117
1963 It was the practice to signal the end of visiting time in the wards by ringing a bell. This had been used since 1896 as a method of closing the hospital to visitors to leave and it was now decided that each ward would indicate to visitors that they should leave. The general use of the ‘bell’ was discontinued. Sisters immediately began to complain that they were having trouble getting patients’ relatives to leave the wards and a general request was made that the ‘bell’ be reintroduced. Never mind if it did appear to be of an ‘institutional’ nature, at least it did get the ward clear of vistors in a very short time. Once again the old bell rang out and was continued to be used to indicate that visiting time was passed. p126
The Royal found that it was behind hand in organising ward meals to allow the patients a choice. At all the other hospitals of the United Board, a choice was available at all major meals. A decision to introduce this amenity was taken and it was introduced without delay. It is somewhat difficult to understand, as there was so little difficulty in the introduction of choice, why it had not been introduced some time before. p129
The end of the year was marked by a complaint from the Sisters in general that the cleanliness of the hospital was not satisfactory. This was noted in the Vistors’ Report and Matron took up the matter with the domestic supervisor. It was, however, an indication as to how much the hospital had altered in the last few years and was most regrettable. p130
Samples of various name badges used by various teaching hospitals throughout the country were shown to the Committee and it was agreed that the badges, as selected should be purchased as soon as possible, as it was felt that all members of the Infirmary should wear badges whenever on duty.p131
(1967) Television sets were installed in the wards. Sound could be recieved by the head sets at each patient’s bed, so that there was no need for excessive noise or distraction.p134
The names such as Matron, Assistant Matron etc. were to be abolished. It was also hoped that the changes would improve patient care by giving a clearer pattern of nursing aadministration, enable the nurse to make a more effective contribution to the management of hospitals and provide an improved career structure for nurses. These aims had become necessary with the altered conditions of hospital service. No longer were there many devoted, usually spinster lasies who were willing to devote their whole life to nursing. It was fast becoming a ‘job’ and as such required a career structure clearly defined and better paid. The pay was to become an important part of nursing, a part which it had never played. Payment had always been of very secondary importance. From 1968 onwards, the nurse was to demand better payment and hours of service. She was to have a limited working week, she was no longer willing to work the long hours which had been assumed her lot.”
The report altered the ‘spirit’ of nursing as well as the career structure. From this time onwards the nurse changed and the Nightingale Nurse was replaced by a career which was to demand high payment. This would naturally need greater finance from the Health Service and it would also produce a limitation on the number of nurses who could be employed, the limitation being from the cost involved. p135