From the professional point of view, the work which came into the hospital was excellent: it was varied and full of interest, and it gave women an exceptional opportunity in the field of surgery. The responsibility for finding the medical and surgical staff rested with the Doctor-in-Charge, the War Office confirming the appointments on her recommendation. By a special arrangement these appointments were binding for six months at a time, and could then be renewed or terminated as desired. The medical officers were not commissioned, but they were graded as lieutenants, captains, majors or lieut.-colonel, and each one drew the pay and allowances, under Royal Pay Warrant, of her respective rank. They also drew uniform allowance and specialist pay, as well as the bonus and new rates of pay when these were introduced. On the termination of their service they were granted a gratuity.

Among the graduates who served at Endell Street were representatives of the Universities of England, Scotland, Canada and Australia. Some of them spent one year or two years there. Others continued for the whole period that the hospital was open. The general knowledge which all the doctors were able to have of all the work in the hospital, and especially of all the serious cases, was a great advantage. The ward officers acted as orderly officer in rotation—that is, they took casualties and night work for twenty-four hours in rotation—and had the supervision of the wards on their nights on duty. In civil hospitals members of the staff may not meet for weeks at a time; but in a military hospital surgeons and physicians attended daily, and at the morning meeting the orderly officer’s report for the previous night was read, and it was possible to talk over the various cases. A great deal of good team work was done, the surgeons, physician and pathologist concentrating on the worst cases. The pathological laboratory, which was situated in the centre of the square, was the scene of many useful consultations.

Of the five hundred and seventy-three beds, sixty were reserved for medical cases, and the other five hundred and thirteen were under the supervision of the Chief Surgeon. Each of her assistants had charge of sixty or seventy beds, and one ward was generally given to the Doctor-in-Charge, who refused to be excluded altogether from professional work.

The surgeons spent all their mornings in the wards, and most of their afternoons in the operating theatre, where it was not unusual to have a list of twenty or thirty cases on each operating day.

In 1915 large numbers of wounds of head, presenting many interesting features, were admitted. From the surgeon’s point of view they were fine cases, for they did well. One lad, who had a bullet removed 1¼ inches deep from the brain, was found sitting up sewing at his badge four days afterwards, and greatly pleased with himself.

After steel helmets came into use these injuries decreased in number, and other kinds of wounds took their place. There were always an immense number of compound fractures, for three hundred of the surgical beds were returned as orthopædic. And in 1917 one hundred and fifty-four compound fractured thighs were in the wards at the same time. These were exacting cases: a good result depended on the excellence of the nursing and the most unremitting surgical care and watchfulness. The latest forms of apparatus were manufactured by the carpenter, Mr. J. A. Campbell of Arduaine, and the masseuses toiled over the patients without ceasing. The results were very satisfactory, and it was disappointing to be told, in 1918, that in future fractures of thigh were to be grouped in special hospitals. However, that same year brought in a series of wounds of knee-joint which exercised the ingenuity and skill of all concerned. In addition, there was valuable experience with fractures of the upper arm.

The wounded owed much to the inventive genius of Mrs. Banks. She began work in the hospital mending room, and then became famous over papier mâché. No one could construct splints for the upper arm so comfortably and so effectively as she did, and her abdominal belts and other appliances were greatly appreciated. One notable case had the humerus smashed into a hundred pieces, but it ultimately united and the patient left hospital with a useful arm and some X-ray photographs which thrilled him. There were men with divided or injured nerves, and several hundreds with acute appendicitis, both interesting and satisfactory to the surgeon; besides all the more ordinary gunshot injuries, many of them with fractures, for which the operations of wiring and plating the bones were constantly undertaken.

The number of operations performed in the theatres was seven thousand, but the minor ones done in the wards or casualty room were unrecorded, and are not included in this figure.

When the wards were full of men, the actual work of dressing their wounds occupied a great deal of time; and as it was often necessary that a large number should be dressed twice a day, or even every four hours, the work was never finished.

In July 1916, at a time when the hospital was very crowded and dressing was going on practically all day, Professor R. Morrison, of Newcastle on Tyne, wrote to the pathologist, asking that his method of using ‘Bipp’ might have a trial. Doctors, nurses and patients alike were finding the constant changing of dressings exhausting, and suggestions were welcome. ‘Bipp’ was a paste which, after being rubbed into the wound, could be left untouched for ten or even twenty-one days. A chemical reaction kept up an antiseptic effect, and the undisturbed tissues healed rapidly. The first results were so romantic that an extended trial was given to the method; and before long ‘Bipp’ came into general use in the hospital and held its position first amongst all other disinfectants. The work in the wards at once became manageable; the number of dressings fell 80 per cent, and the results were splendid. The men appreciated the rest and relief from painful dressings and were also proud of their rapid progress. New-comers might look doubtful when they heard that their wounds would be left alone for ten days, and would murmur that in the last hospital they were dressed every day; but their neighbours had learnt to comment on old-fashioned ways, and laughed them out of their fears. ‘Bipp’ metamorphosed the work of the hospital. The surgeons relied on it so confidently that they never hesitated to operate on septic fractures or joints; and on one occasion a scalp abscess was evacuated, the skull trephined and a bullet extracted from the brain, in the complete assurance that ‘Bipp’ would save the situation, as it did.

In the autumn of the year 1916 Sir Alfred Keogh paid his first and only visit to Endell Street. He came, accompanied by the Deputy Director of Medical Services for the London District, to see the results obtained by the use of ‘Bipp’; for the War Office had heard of the method and was considering introducing it into the Army hospitals and casualty clearing stations abroad. Endell Street was the only hospital in London which had given it an extensive trial, and it was a proud moment when the Chief Surgeon led the Director General from ward to ward, displaying one good surgical result after another, showing normal temperature charts and healed wounds, with conservation of tissues and good movements. At last he said that he had seen enough and was convinced, and when he took his leave, he congratulated the staff upon the success of the hospital.

‘I knew you could do it,’ he said. ‘We were watched, but you have silenced all critics.’

In his busy life, Sir Alfred Keogh had not time to see the hospital again, but he kept himself informed of its progress, and when the time came that he left the War Office, he wrote as follows:

It was characteristic of the Women’s Hospital Corps that, when the Director General had left the hospital—or, indeed, after any official visitor had left—various members of the staff would come to the office, one after the other, to ask how the inspection had gone, and to rejoice over any little word of praise or appreciation which might have been given to their hospital.

About three weeks after the hospital opened two severe cases of acute mania were admitted. As there was no ground-floor ward and no window with any protection, they were a source of anxiety to the medical staff. One of them was blasphemous and homicidal, the other deeply religious and suicidal; both were violent and noisy and had to be detained in a small room by themselves, with several R.A.M.C. men in constant attendance. The hospital telephoned to the Horse Guards, reporting the matter and asking instructions as to their disposal, and was told that instructions would be sent. The next day the hospital telephoned again for instructions, and the reply was that the men must not be certified. On the third day the hospital telephoned urgently and inquired about disposal. It was told that the question was under consideration and that information would be sent. On the fourth day the hospital telephoned still more urgently and received the same reply. It telephoned again the same afternoon, and this time was told that Colonel H—— would come and see the Doctor-in-Charge.

Towards five o’clock, a gentle and very elderly colonel arrived. Evidently, he was under the impression that women doctors were unaccustomed to lunatics and were unduly alarmed.

‘Yes, mental cases,’ he said, ‘rather worry you, don’t they? Yes, yes, not nice cases for ladies. I will just go up and say a soothing word to them—poor fellows.’

The Doctor-in-Charge and Chief Surgeon looked at each other and then led the colonel upstairs.

Pte. T—— was sitting up in bed, cadaverous and morose, and behind the screen the orderlies were struggling to prevent Pte. W—— from choking himself while he recited his prayers. The colonel spoke soothingly to Pte. T——, but obtained no response. Pte. T—— only continued to glare fiercely. So he passed round the screen to see Pte. W——. Immediately, Pte. T——, stealthily and rapidly, got out of bed, and prowling after the colonel, seized him from behind! The orderlies interfered and a regular scrimmage ensued, until the doctors, who were almost helpless with laughter, seeing that the officer was being roughly used, called in further help, and a dishevelled, flustered colonel was assisted out of the room.

‘Dear me, they are indeed dangerous fellows,’ he said. ‘We had no idea they were so bad.’

He went straight back to the Horse Guards. And very promptly orders were sent for the removal of the patients to safer quarters without delay.

The work in the medical wards was perhaps less dramatic than on the surgical side, but it was not less severe. Many cases of rheumatism, gastric ulcer and cardiac disease spent weeks in the hospital, and pleurisy and empyema were constantly admitted. There were painful cases of gas poisoning and malaria, and others of mental disturbance; but pneumonia dominated the wards in numbers and in severity. They were anxious cases, occurring constantly among New Zealand and Australian men, whose distance from their homes made a further claim on the sympathies of the staff. Recovery depended largely upon the nursing, and many of them owed their lives to the devoted work of Sister Hughes and Sister Exell, who were in charge of St. Felicitas and St. Geneviève wards.

During the first two years the physician in charge of the medical side was Dr. Louisa Woodcock. When she died in February 1917, the staff lost one of its most brilliant and successful members. She was a woman of high professional attainment, of scientific mind and of noble character. Her influence in the hospital was always helpful, and her friendship was greatly valued and greatly missed by her colleagues. She was succeeded by Dr. Margaret Thackrah, who was appointed in May, and when the number of medical beds was increased in 1919, Dr. Ellen Pickard also joined the staff.

The women’s wards, at the top of the East Block, were the best in the hospital, and as the women were less destructive than men, it was easy to make them homelike and comfortable. The arrangement to take women was initiated as a temporary measure, but it continued for more than two years. The work was both surgical and medical. The recruiting for the women’s units had not always been prudent, and many women were sent home unfit, as the result of illnesses or operations occurring before enlistment. Most of these came before Invaliding Boards and were discharged. But the greater number of the patients sent home from France were debilitated, or anæmic and fatigued by long hours and an unaccustomed diet, and needed rest and good conditions to make them ready for service again. A rather large proportion of mental cases, all of whom had had previous attacks, and some serious injuries owing to accidents and to the bombing of camps, were received. The women’s wards were the most responsive wards in the hospital. They were credulous of rumours and false reports, susceptible to the influence of a ‘grouser’ or a change of Sister, but on the other hand they responded readily to wise handling, and were led and guided by their ward visitor, Mrs. Prior.

During the influenza epidemics of 1918 and 1919 men and women suffering from the disease trooped into the casualty room or sent messages for ambulances to fetch them. The extra beds were all full, and the number of men seriously ill with pneumonia might be fifty or sixty each day. The staff slaved over them. Extra nurses were procured; the doctors knew no rest. But the mortality was tremendous. In the months of November and December 1918 twenty-four men and women died; and in February 1919 thirty died. The hospital was accustomed to a death rate of eight per thousand per annum, and was aghast over three deaths in one day. Sorrowing and anxious relatives sat in the square and passages, watching the doctors’ faces as they went in and out of the wards, and patiently accepting the issue. Old people who had never been out of Ireland came over, and would not venture in the streets in case they should be lost or run over. Grey-haired fathers and mothers came from Scotland to sit, silent and enduring, beside the beds. The habitual gaiety of the place was hidden under the cloud. The staff could only work and wait. A dear old uncle and aunt arrived from the country to see a precious nephew, whose life hung in the balance for some days. One morning the doctor met them in the square and told them that their boy was better and should do well now. They both burst into tears, and presently the old lady, through her sobs, begged the doctor to excuse ‘Uncle,’ for ‘he was always so silly and took on so.’

Pte. B——, a Scottish shepherd, had wounds of hip and knee, and was so ill that his wife was sent for. She travelled all night, and for twenty-four hours sat steadily beside his bed. When it was suggested to her that she was tired and should lie down, Pte. B—— opened his eyes to say, ‘Och! the wife’s enjoying herself fine, sitting beside me here.’

The relatives were very brave and very pathetic. The men clung to their mothers, and many a careworn, weary woman sat night after night by the side of her son, grateful because she was allowed to be there.

The hospital had its share of malingerers and self-inflicted injuries, and one or two cases of fraud. The cleverest of these was a man admitted for some slight ailment, who had only one arm, and who stated that he was awaiting admission to a limbless hospital. He was in the ward for ten days, and might have left undetected but for the thoroughness of the Chief Surgeon, who insisted upon seeing whether the stump was in a good condition before he left. The Sister said he was a very modest man and did not like to show his arm to ladies.

‘Surely he need not be modest about an arm,’ said the Surgeon. And the Sister unfastened his jacket.

‘Which arm did you say, Sister?’ she continued. ‘He seems to have the usual number.’

And so he had. He stood abashed before a half-fainting Sister, while Dr. Garrett Anderson and the orderlies pealed with laughter, and the whole ward joined in the joke.

The amount of clerical work required of the doctors was no light matter. They had to keep all the notes for their own beds, and as the turn-over was generally fairly rapid, the writing was incessant. Convalescent men reported to the office of the Doctor-in-Charge for discharge on two days a week, and history sheets had to be made up for every one who left or was transferred. The monthly turn-over varied between four hundred and eight hundred cases, and each admission and each discharge or transfer entailed the preparation and despatch of several forms. Invaliding Boards were held regularly, and thirty-nine different forms had to be filled up and signed for each man who came before the Board. As time went on, the work of these Boards became heavier; for the Army Council was clever at inventing new forms. But when once the Ministry of Pensions got into its stride, these were triplicated and amplified, and the hospital’s responsibilities in clothing, equipping and providing for the men were largely increased.

The War Office had a habit of issuing numbers of circular instructions to hospitals, many of which dealt with medical subjects. These were known at Endell Street as ‘purple papers,’ from the colour of their ink, and it was usual to post them in the Staff Room, where they sometimes gave rise to amusement. One circular warned surgeons against using syringes without sterilising them first, and suggested that for this purpose ‘a little warm oil’ should be used; another pointed out that they should not make a practice of amputating the right arm, unless it were absolutely necessary to do so; while a third informed them that ‘death under an anæsthetic’ should in future be regarded as part of the treatment.

The Army has a wonderful way of having an official name and number for each disease. These are to be found in the official ‘Nomenclature of Diseases,’ and no patient may have any disease not mentioned in the book. For instance, the Army does not recognise rheumatism, and many soldiers had to have ‘37 Rheumatic Fever’ or ‘931 Myalgia’ instead. On the other hand, the book had some nice comprehensive diagnoses, such as ‘952 I.C.T. (inflammation of connective tissue)’ and ‘21 P.U.O. (Pyrexia of uncertain origin),’ which were very useful in haste. The proper nomenclature and numbers were much insisted upon by the Medical Statistical Department, and tired doctors sometimes felt that the extra work which had to be done for this department was almost the last straw.

Three auxiliary V.A.D. hospitals—at Dollis Hill, under the Commandant, Mrs. Richardson, O.B.E., and at Highgate, under the Commandant, Lady Crosfield, R.R.C.—were a great source of pleasure and benefit to the men. When fully expanded, these hospitals provided, under fine conditions, a hundred and fifty beds for the more convalescent cases. They were very popular with the men, who were well cared for and very happy in them; and as an important factor in recovery they were greatly appreciated by the medical staff.