In nineteenth-century Britain the risk of catching typhoid and dying from it was a very real threat. The Maidstone Typhoid Epidemic, September 11th 1897-January 29th 1898, was the largest the UK had experienced. Many lessons about water and sewage management were learnt during this epidemic. Typhoid is a common bacterial disease which is spread when people eat food and water contaminated with faeces containing the salmonella typhoid bacterium. It affected at least 1847 people, of which 132 died, with 111 dying outside hospitals and 11 in hospital, from a population of 34,000. The Standard reported an outbreak in October 1897 at University College Hospital, London which affected 12 nurses and 6 servants, but was not thought to be related to the Maidstone epidemic. 6 The daily news also reported on September 27th another typhoid out-break in Kilham, Yorkshire; 'Five deaths have occurred already. The village is properly drained, but otherwise the sanitary arrangements are primitive and require immediate reform. It is supposed that the water in the wells is contaminated.'8
Recently for a birthday I was the lucky recipient of a Maidstone Typhoid Medal, which was awarded to an A.L.Reeves on 8th December 1897 at a ceremony to which the Lord Mayor of London attended to mark the ending of this outbreak of typhoid; it is thought that it was posted to her as she had already left Maidstone.1 The medal was awarded to approximately 260 people including: Nurses from the Corporation of London; Salvation Army Staff (4); Maidstone Rural District Council: Maidstone Volunteer Corp; Maidstone and Hollingbourne Board of Guardians staff; the Royal Army Medical Corp, whose are engraved with R.A.M.C alongside their name on the medal and 'numerous' private individuals.1 Notable among those who cared for the sick, and who did not receive a medal were the Doctors, of whom 12 are listed in the South East Gazette as attending patients; despite several dignitaries who did receive a medal including the Mayoress, Lord Mayor, the Sheriffs and Sir John Monckton. One medal was kept back to be preserved for display at the museum, where there is one on display there today. The medals, made of silver hanging on a blue and yellow ribbon presented in a maroon and cream silk lined case, cost 10s 6d each to produce, with employers of private nurses allowed to purchase them for their employees. Despite careful and systematic organization for the awarding of medals there was some discontent about these descrepancies which was reported in the local press;
'An Old Maidstonian disgusted " wrote; 'Why was not the ex-mayor who worked so hard during his trying year of office not allowed one? But I see the doctors are quite overlooked, its only nurses who are thought of, though we nurses without doctors are worse than useless! Those who had the management of the distribution have done it very badly for there are still some district nurses paid for from the public fund who have not received them and why was only one lady from the soup kitchen staff presented with a medal?'1 The author of this letter preferred to stay anonymous and appears to have been a nurse.
The first cases of Typhoid in Maidstone were reported in the South East Gazette on Tuesday 21st September 1897, with nearly 200 reported cases in the first eight days. The first case was thought to be that of a servant girl, who lived in the area of the Farleigh supply; her case was notified on 13th September to Mr Percy Adams , the Deputy Medical Officer for Health and son of the Medical Officer for Health, who was unfortunately on holiday in Switzerland at the time. In the days before radio, television and instant media reporting the newspapers were one of the main ways of communication on a mass scale. The newspaper reported that; 'The symptoms associated with Typhoid usually include one or more of the following Diarrhoea with or without fever, vomiting, headache, pains in the limbs or stomach, attended by lassitude, loss of appetite and possibly succeeded by a few red spots of parts of the body.'1
The paper continues to calmly educate the public; 'Typhoid is not as infectious in the same way as Scarlet fever or Measles, and the suggests sensible measures which should be taken , saying that 'persons in attendance on patients cannot be too careful in keeping germs out of the body,' advising that proper precautions should be taken with food preparation and that no person, juvenile or adult should share the same bad as any one suffering room the 'malady'. 1
Mr Adams, acting in the absence of his father said that the outbreak was due to a water supply problem, affecting mainly the western side of Maidstone. He said that the water supply had already been cut off; although the date which this did actually happen varies from journal to journal, and after much rigorous testing the supply was proved to have been from Farleigh springs. In reality the samples had only been sent to London on Monday 20th September 1897, whilst houses which received their water from Boarley Springs were unaffected. In three streets in Maidstone the houses on one side including the street where the Mayor of Maidstone lived was unaffected as they received Boarley Spring water, but the people on the opposite side were affected as their water was drawn from Farleigh Spring.2 In the same article; 'Mr Adams wishes to strongly advise all the inhabitants of the borough to thoroughly boiled all milk and water used in their households, and to thoroughly cook all food before partaking of it.' The paper continues by stating that the demand for milk had gone up to such an extent that a dairyman had sold cows or £250 above their normal price! It concludes with a rumour about the cause of the outbreak, 'A rumour (which we refer to with all reservation)is also current to the effect that the spring of water which is now under suspicion is fed from an area of land , lately the scene of a hoppers encampment, wherein disease had existed. We can only ask is it so?'1 The hoppers were Eastenders who came down from London to pick the hops, living on the land nearby. They were given very poor living conditions,and they regarded it as a holiday. The practise of hoppers travelling from the East End to collect hops for beer production continued well in to the 20th Century.
Following a special meeting of the Sanitary Committee of the Urban district Council held on Monday 20th September 1897 at which a subcommittee was appointed to; ' Consider at once the desirability of hiring a building or buildings capable of accommodating at least 100 persons or isolation purposes.'
In the event, eleven buildings were used to accommodate 339 people at full capacity, as shown below.
BOROUGH OF MAIDSTONE, TYPHOID EMERGENCY HOSPITALS, 1897-1898
NO. HOSPITAL NO.OF BEDS WHEN FULL DATE OF OPENING DATE OF CLOSURE
1. PUBLIC FEVER 26 SEPT. 29TH STILL OPEN
2. TENTS 12 OCT.8TH STILL OPEN
3. STATION ROAD 80 SEPT.25TH STILL OPEN
4. WESLEYAN SCHOOLS 35 OCT.4TH JAN. 6TH
5. MILTON STREET MISSION 24 OCT. 6TH STILL OPEN
6. HEDLEY STREET SCHOOLS 17 OCT. 7TH DEC. 8TH
7. CONGREGATIONAL SCHOOLS 20 OCT.11TH DEC. 11TH
8. PERRY STREET MISSION 23 OCT.9TH DEC. 18TH
9. PADSOLE SCHOOLS 37 OCT. 19TH DEC. 24TH
10. ST MICHAELS SCHOOLS 33 OCT.28TH JAN.20TH
11. ST .LUKE'S MISSION 32 OCT.26TH JAN.6TH.
339
Fig 2; Table Produced for the Local Government Board of Inquiry in to the Maidstone Typhoid Epidemic.
Apart from the local Fever Hospital, and a few beds in tents, local schools predominantly fulfilled the role as West Kent General Hospital the local hospital, had already got typhoid patients on its wards.
Among the Doctors appointed were those from Guy's Hospital, including Dr Washburn, a bacteriologist; the Liverpool Fever Hospital, where 500 typhoid patients had been treated a few years before and St Thomas's along with local G.P's. 21
The Medical Officer for Health; 'Was instructed to procure a supply of trained nurses from London without delay"(1) Within one day it is reported that 10-12 had already been "engaged". Approximately 100 nurses were sent by the Corporation of London including nine probationer nurses from The London Hospital , including Caroline Bell and Edith Cavell, who although still a probationer had done 7 months nursing at the Fountain Fever Hospital prior to her training. They both worked at Padsole Schools, lodging with a Mrs Josiah Baker at 72 Bank Street, owner of the toy shop, which in December 1897 subsequently did a good trade in toy nurse dolls.
In fact such was the national feeling that the committee was inundated by offers of nursing help and asked the Nursing Record to publish a letter in mid October refuting the need for more nursing help; "I am glad to say a regular supply of certificated nurses from well known institutions has been maintained and , therefore there has been no need to engage independent nurses.'21 Many offers of nursing had come from across the UK, and the committee apologised that they had not been able to answer these offers of help due to the workload created by the epidemic.
Eva Luckes wrote in Edith Cavell's End of training probationers report of 1898 that; 'She did good work during the Typhoid epidemic in Maidstone.' This was high praise compared to typical nursing reports at the time.9
The following article, taken from 'The Hospital' newspaper, gives a sense of the public feeling, and the scale of the organizational response to this epidemic. The public had seen the effects of excellent nursing care as given to injured soldiers by Florence Nightingale during the Crimea war (1856) and how that care had changed the fate of the injured soldiers. This time there was no need for agitation by nurses to be allowed to go Maidstone, the Corporation of London employed Miss Annie Plowman and two assistants (Sisters E.K.Ward and E.M.Black, one District Assistant Superintendant Nurse G. Travis and 100 other nurses. Miss Plowman had recently completed six years working as Matron in Monsall Fever Hospital. Mrs Bedford Fenwick visited the typhoid epidemic! and wrote in the Nursing Record said; 'Miss Plowman was trained at St Bartholomew's hospital, and as she had been one of my first and most intelligent probationers, trained in what are now often alluded to as " the good old days"..............I found Miss Plowman very busy over domestic matters , the basis of all good nursing. I found every hospital beautifully clean and orderly and gaily decorated with a wealth of autumn flowers.'21 It seems rather strange that Mrs Bedford Fenwick should have visited a major epidemic, before there was a vaccine for typhoid, but perhaps reflects her indominatable spirit!
"The Nurses at Maidstone"
'The nurses are representative of a vast number of training schools both Metropolitan and Provincial. The housing of such an influx of workers has taxed the resources of the town, and various public institutions have been requisitioned for dormitories. Many nurses are being hospitably lodged by residents in the town and its outskirt. They are lucky for they are made very welcome guests and enjoy every consideration. The less comfortably housed think lightly of their drawbacks, and there is a great tendency among all to make the best of things. Brought face to face with the awful sorrow and suffering of the town, personal trials fade into insignificance. All the nurses are working heart and soul for the sick, rejoicing in each sign of recovery which manifests itself among their patients, and doing bravely and well. Every Nurse who reads "The Hospital" must now sympathise with the work now going on in Maidstone but only those who have seen it can picture accurately the terrible condition of things...The hours of the nurses vary a little but are necessarily long and busy ones. They get their meals away from work-in restaurants, at the Howard de Walton Institute, and other public places. The hospitals which have been furnished and opened in such rapid succession will be described next week for they deserve an article to themselves! Miss Plowman who is supervising the whole of the emergency nursing department has her headquarters at the Station Hospital and visits the others frequently. The Corn Exchange has been converted into a huge depot for clothes and other things sent as gifts for the poor of Maidstone. Orders for these things are signed for by clergy and others. Sad are the messages that accompany some of these orders when the requisition is for "black clothes" that the petitioner may be decently clad at the funeral next day of a parent or near relative. Beef tea, milk and broth are supplied for the sick and many other things, which the nature of the illness requires are forthcoming. In addition to the central stores at the Corn Exchange a little emergency stores of every kind of nursing supplies has been established and has already proved of great value to the sick by facilitating the actual work of the actual nursing. This store is merely supplementary to the other and is managed exclusively for nurses. In the first place a room was hired at the Temperance hotel to receive gifts sent for the use of the Co-operation nurses and to serve as a centre for their distribution. In the course of a few days the response to an appeal made by the secretary through the press was so liberal that the first room became quite inadequate for the purpose of storage. A large schoolroom has now been lent and there all strictly nursing necessaries are supplied.'7
The Maidstone Typhoid Epidemic was widely reported, even warranting newspaper space in Hobart, Australia; 'The typhoid epidemic at Maidstone still rages. A hundred fresh cases have been re-ported during the current week, and the mortality among juveniles is heavy. Whole streets are affected by the epidemic. A hundred London nurses and many doctors have been engaged to help the local practitioners and their aides, who find themselves utterly unable to meet the calls on their services. The parsimony of the Maidstone Municipality in refusing to have the water used by the townspeople' analysed is responsible for the outbreak.'
The Special Committee met regularly, concerning themselves with every aspect of management, including that of relief stations. On October 5th approximately the Poor Law board opened 3 relief stations; 'From these stations medical and other necessities are served out daily to the poor, the distribution of tickets entitling the applicants to relief being entrusted to the District Nurses.'4
Help came from many sources and in many ways; a relief fund was set up, to which people donated money from all over the country, the Queen sent £50, and the Lord Mayor's fund £4000, and by Tuesday December 7th the fund totalled £26, 500. A special fund was also set up for Orphans and Widows.
'A commendable movement was set in foot last week for supplying a supply of male night nurses for typhoid cases'.
Water from the Medway was used to flush the sewers and Rochester, Chatham, Gravesend and many other towns supplied water carts to help with the flushing .
On October 12th 1,565 cases had been reported of which 73 people died. A telegram from the Queen was posted on doors of town hall giving her support to the town and the Mansion house fund opened with Princess Christian offering the use of three trained nurses; 'The three nurses selected by the Princess..the staff of nurses in the town probably numbers more than 400. There are upwards of 90 under the control of the special Sanitary committee, the remainder being privately employed, either to attend to patients in the homes of well to do residents, or to undertake district work in conjunction with the Emergency Committee's staff '.5
In order to help prevent further spread, on October 6th, under the authority of the Inspector of Nuisances a special laundry was opened in the grounds of Fant Lane Hospital to wash infected clothing and bedding . Every household that had a case of typhoid on their premises was entitled to free washing and disinfecting of all infected items. After washing, disinfecting by the use of high pressure steam the articles were returned in clean bags. This service handled about 62,000 items, which required 22 workers /week to process the laundry.34 The Inspector of Nuisances was also responsible for the disinfecting and fumigating every house which had had Typhoid patients in it; 'After the recovery or death of a patient, or his or her removal to hospital, the walls ceilings and floors, were initially sprayed with water; then sulphur in the proportion of 40 oz to every 1,000ft of air space, was lit and allowed to burn on the sealed room for 24 hours. After the fumigation the ceilings were whitewashed and the woodwork washed with carbolic soap and water. Soiled wallpaper was removed and the walls washed with a solution of carbolic acid.'34
As in any epidemic there was general panic, with the trade being substantially affected in the town, the trains carrying noticeably less passengers into Maidstone, under about 30/day. It was reported nationally; 'that trade of the town is gradually recovering from the stagnation which the epidemic produced and the inhabitants of the country districts are resuming their weekly visits to the borough.'30
Much comment was made of the incessant tolling of church bells when someone was buried it became rather unnerving for people lying ill with typhoid, and for their families caring for them; 'One of the worst consequences was 130 fresh graves in Maidstone cemetery-during one weekend alone 30 victims were interred'34
The Kent Messenger wrote; 'All through Sunday afternoon Stone Street witnessed a long irregular procession of people bound for "Gods acre". The day of rest brought no rest to the grave digger.'34
Local and National papers reported widely on the epidemic, including reporting on 'notable' and tragic typhoid infections and deaths; The Morning Post reported on the deaths of the eight year old son of the Sanitary Inspector and also on the funeral of 19year old Beatrice Whitehead whose father and six sisters were absent from her funeral as they all also had the disease.19
'We are very sorry to hear that two of the nursing staff at Maidstone have contracted enteric fever in the discharge of their duty. One of these nurses is now practically convalescent, but the other is very seriously ill.'20 In total four nurses were thought to have caught typhoid, and were all nursed at the West Kent General Hospital with one being sufficiently well to attend the medal presentation in Maidstone on Wednesday 8th December.1
Nurses were looked after in other ways; 'A weekly service, specially for nurses, is now held at the Old church Maidstone, ...nearly one hundred nurses attend these restful services, and come away, we may hope, refreshed in mind and body, and invigorated to engage once more in the struggle with the dire disease.'27
There were two medal ceremonies; the first presentation was at 7.30pm to the night nurses which was followed by an interval of music and cinematography, the second ceremony was at 9pm. The presentations which were held at the Technical school and Museum were attended by the Lord Mayor of London and other dignitaries. Princess Christian was unable to attend and present the medals due to a prior engagement.29 Councillor Urmston, who had been particularly involved with the epidemic and had written to the Nursing Record to request no more volunteers, was cheered by the nurses when asked by the Mayor of Maidstone to speak on behalf of them;
'there were many things which they wished to tender his Worship and others their most hearty and cordial thanks ...for the very handsome entertainment in their honour...the subscribers for the medals which would be highly valued by the nurses for the rest of their lives. It was a matter of great gratification to them that the medals had been subscribed for so spontaneously without any call on the rates or application to the relief fund committee. Then they asked him to thank the people of Maidstone for their various acts of kindness, some who had received nurses into their homes and treated them as honoured guests. They desired to thank them and many others who had sent game, fruit and flowers, placed carriages at their disposal, lent them bicycles and sent them newspapers and magazines all of which added much to their material comfort and recreation. ( From other reports it seems that the nurses worked extremely hard, working long hours and would have had little time to enjoy what must have been to many of them luxuries.) ...And finally the nurses wishes to give a special vote of thanks to those connected with West Kent general Hospital who nursed four of their number back to life and strength.'1
By 7th December no fresh cases of typhoid had been reported, with no deaths from typhoid in the past fortnight. 29 However eleven more cases were reported two weeks later, with one death in the last few weeks of 1897. In early January with the majority of Emergency hospitals closed down, and temporary nurses returned home, thanksgiving services were held on the first Sunday in local churches.
In March 1898 following the epidemic and end of the enquiry into it Miss Plowman received a letter from the mayor of Maidstone thanking her for all her hard work; 'I have very great pleasure in testifying to the excellent work you have carried out in Maidstone, as superintendant of the nursing staff and temporary hospitals the organization and work that you had to undertake was very large, amounting as it did to the management of and superintendence for six months of , in all, ten emergency hospitals containing 400 beds and a staff of about 140 nurses for hospital and district work' permitting her to use this letter 'In any way she might.' The letter was subsequently printed in the Nursing Record in May 1898.26
Conclusion
Apart from the loss of life, the monetary cost of the outbreak was reported to have been £45,000, the doctors fees alone being £5,200; approximately six doctors came from outside the town.26 The Local Government Board gave the Council a loan of £15,000 towards the epidemic cost, a request was made for a loan of £18,000, this lower loan was seen as rather harsh; perhaps the Local Government Board were applying their own financial penalty?
In December 1897, even before the enquiry into the epidemic which started in January 1898 the Local Government Board were already acting on lessons learned from the Maidstone epidemic, issuing guidance to:
'Hints on Water Supply. The Local Government Board has issued to Town Councils, Urban District Councils and Rural District Councils a circular letter directing attention to the subject of water supply. Outbreaks of Typhoid, Clifton and Lynn have obviously led to the issue of communication for the Board point out that the Council are the body responsible for securing to their inhabitants of their district a proper and sufficient supply of water....for the wholesomeness of the water which they themselves supply .......make themselves acquainted with sources , nature and quality in all parts of their district ...and if it is unsatisfactory take such steps to supplement and improve the supplies.'31
The water company were widely censured in the press, for their lack of water testing, which due to cost saving, had been reduced in frequency. This lack of testing was blamed as one of the causes of the outbreak. Naturally at the inquiry, each party being held to blame for the epidemic, blamed the other; 'Mr Parker, on behalf of the Corporation (of Maidstone) submitted that there was insufficient evidence to support the charges made by the water company against the Corporation in regard to the drainage of the town and that it was clear that the water supply was the primary cause of the epidemic.'28
When the enquiry finally published its findings in August 1898, the commissioners said;
'The epidemic was caused by the pollution of the water supplied by the Maidstone Company from their Farleigh Sources and whilst there were grave sanitary defects in construction of some of the sewers, house drains and water closets within the borough, but the sudden and simultaneous outbreak and rapidity with which the epidemic grew cannot be accounted for by these defective conditions of sewerage and drainage. We are of the opinion that many of the typhoid cases in the borough were due to defects of drainage and sewerage with consequent pollution of soil underlying the town. The responsibility for the existence of these insanitary conditions lies with the town council whose duty it was to take steps that would lead to effective remedy of these defects. this duty they have in large measure neglected, notwithstanding that for many years the medical officer of health has repeatedly warned them of the risk to which the inhabitants of the town were exposed by the continuance of the insanitary conditions.'32
The board concluded by questioning whether the regulations are sufficient; which they feel they are, but it admited that there are discrepancies in the interpretation of the wording these regulations. Section 7 of Public Health (Water) Act 1878 imposes upon Rural District Authorities the duty to ascertain the condition of the water supply- no such application had been made on behalf of Maidstone Council, nor had Mr Adams, the Medical Officer ever made it his business under the General Order of the Board 1891 to inspect the water supplies at Farleigh!
With the advent of oral rehydration therapy, and that used alongside antibiotics the rate of death from typhoid today is approximately only 1%. However if patients with typhoid are untreated such as in Third World Countries today the death rate today remains higher at 10-30% than that experienced in Maidstone in 1897. 22,23
The Maidstone outbreak led to the first co-ordinated response to a typhoid outbreak ,the first trial of typhoid immunization among 84 nurses in a Maidstone psychiatric Hospital, none of whom caught typhoid, along with trials of water supply chlorination, and the use of the telephone by nurses and doctors in the typhoid hospitals to pass on information about new cases. All these factors contributed to a unusually low death rate from typhoid for the period, despite heavy rain, which had in recent weeks flushed impurities into the water supply.24
Whilst the hop pickers may have been the initial source of the typhoid infection, the disease would not have spread so dramatically had the Maidstone Council tested the water supply regularly, and repaired the sewage and drainage systems. It was the appalling sanitary conditions in which the hop pickers were housed that created the epidemic. History does not appear to relate whether the Hoppers encampment was improved by the following year.
It is not clear whether any regulations were tightened in the aftermath of this epidemic, it would appear that no court case for Corporate Manslaughter/negligence happened as it might well today in the light of such gross negligence by an authority. Initially some victims families started a class action, which is reported in the papers, but after a few months there is no further evidence of this. Whilst the council was given only partial financial help with the cost of the epidemic, the real sufferers were those who paid the ultimate price and died, and their families who were left behind in financially straightened circumstances, although poor relief was given out from the relief fund, the fund was closed within six months of the epidemic. Poor Law records document people being supported for years after the epidemic, some with the word 'typhoid' written beside their names.
At the presentation of Medals ceremony the Mayor of Maidstone Councillor Barker gave a speech;
'While they must be filled with regret for those who had been taken away, it was a matter of congratulation to know that the epidemic which overtook them three months ago, had been stamped out thanks to their Medical Officer, the medical men of the town, and though sturdy and gallant conduct of every inhabitant of Maidstone, and in addition to the help received from the residents in the town and neighbourhood, they had an army of trained nurses to assist them. He now wishes on the part of every inhabitant of the borough of Maidstone, to thank the nurses who had assisted them during their great trouble, and he was going to ask them to accept a small medal as a token of esteem for the work they had done.'1
References
1. South East Gazette, Tuesday 14th December 1897.
2. Irene Hales, Bygone Kent, Bygone Kent, 1985, Vol 4, number 5 .
3. The Mercury, Hobart, Tasmania, Monday October 4th 1897.
4. South East Gazette, Tuesday 5th October, 1897
5. South East Gazette, Tuesday 12th October, 1897
6. The Standard (London, England), Thursday, October 14, 1897; pg. 4; Issue 22868. 19th Century British Library Newspapers: Part II.
7 Leicester Chronicle and the Leicestershire Mercury (Leicester, England), Thursday, October 30, 1897; Issue 4525. 19th Century British Library Newspapers: Part II., quoting from the Hospital
8.Daily News (London, England), Monday, September 27, 1897; Issue 16069.
9. Royal London Hospital Archives; RLHLH/N/1/5)- London Hospital register of probationers, no.5 .
10. RLHA, RLHLH/N/1/3)- London Hospital register of probationers, no.3 .
11. RLHA, RLHLH/N/4/1)- London Hospital register of Staff Nurses, no.1
12. RLHA, RLHLH/N/5/3)- London Hospital register of Private Nurses , no.3 .
13. Ancestry.co.uk.
14. Royal College of Nursing Archives: The Nursing Record and Hospital World, march 3rd 1894
15. RCN Archives , The Nursing Record -vacant appointments etc supplement nov 16th 1895
16 RCN Archives The Nursing Record and Hospital World, Dec 28th 1895
17 RCN Archives The Nursing Record and Hospital, World, may 25th 1900 pg 423
18 RCN Archives The Nursing Record and Hospital, World, may 18 1901, pg 397-8
19 The Morning Post (London, England), Wednesday, September 29, 1897; pg. 6; Issue 39099. 19th Century British Library Newspapers: Part II.
20 .RCN Archives, The Nursing Record and Hospital World, Nov, 20th 1897, pg 415
21. .RCN Archives, The Nursing Record and Hospital World, Oct 9 th 1897, pg 287-288
22. http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.htm
24. www.ibms.org/includes/act_download.php
25 RCN Archives, The Nursing Record and Hospital World, May 14th 1898, pg402.
26 RCN Archives, The Nursing Record and Hospital World, July 23rd 1898, pg73
27 RCN Archives, The Nursing Record and Hospital World, nov 27th 1897,pg 436
28 RCN Archives, The Nursing Record and Hospital World, Feb 19th 1898, pg 159
29.South East Gazette Tuesday 7th December 1897
30. The Morning Post (London, England), Monday, December 13, 1897; pg. 6; Issue 39163. 19th Century British Library Newspapers: Part II.
31. The Morning Post (London, England), Saturday, December 18, 1897; pg. 3; Issue 39168. 19th Century British Library Newspapers: Part II.
32. The Times (London, England), Saturday, Aug 27, 1898; pg. 9; Issue 35606.
Copyright: Sarah Rogers 16/03/2014.
Recently for a birthday I was the lucky recipient of a Maidstone Typhoid Medal, which was awarded to an A.L.Reeves on 8th December 1897 at a ceremony to which the Lord Mayor of London attended to mark the ending of this outbreak of typhoid; it is thought that it was posted to her as she had already left Maidstone.1 The medal was awarded to approximately 260 people including: Nurses from the Corporation of London; Salvation Army Staff (4); Maidstone Rural District Council: Maidstone Volunteer Corp; Maidstone and Hollingbourne Board of Guardians staff; the Royal Army Medical Corp, whose are engraved with R.A.M.C alongside their name on the medal and 'numerous' private individuals.1 Notable among those who cared for the sick, and who did not receive a medal were the Doctors, of whom 12 are listed in the South East Gazette as attending patients; despite several dignitaries who did receive a medal including the Mayoress, Lord Mayor, the Sheriffs and Sir John Monckton. One medal was kept back to be preserved for display at the museum, where there is one on display there today. The medals, made of silver hanging on a blue and yellow ribbon presented in a maroon and cream silk lined case, cost 10s 6d each to produce, with employers of private nurses allowed to purchase them for their employees. Despite careful and systematic organization for the awarding of medals there was some discontent about these descrepancies which was reported in the local press;
'An Old Maidstonian disgusted " wrote; 'Why was not the ex-mayor who worked so hard during his trying year of office not allowed one? But I see the doctors are quite overlooked, its only nurses who are thought of, though we nurses without doctors are worse than useless! Those who had the management of the distribution have done it very badly for there are still some district nurses paid for from the public fund who have not received them and why was only one lady from the soup kitchen staff presented with a medal?'1 The author of this letter preferred to stay anonymous and appears to have been a nurse.
The first cases of Typhoid in Maidstone were reported in the South East Gazette on Tuesday 21st September 1897, with nearly 200 reported cases in the first eight days. The first case was thought to be that of a servant girl, who lived in the area of the Farleigh supply; her case was notified on 13th September to Mr Percy Adams , the Deputy Medical Officer for Health and son of the Medical Officer for Health, who was unfortunately on holiday in Switzerland at the time. In the days before radio, television and instant media reporting the newspapers were one of the main ways of communication on a mass scale. The newspaper reported that; 'The symptoms associated with Typhoid usually include one or more of the following Diarrhoea with or without fever, vomiting, headache, pains in the limbs or stomach, attended by lassitude, loss of appetite and possibly succeeded by a few red spots of parts of the body.'1
The paper continues to calmly educate the public; 'Typhoid is not as infectious in the same way as Scarlet fever or Measles, and the suggests sensible measures which should be taken , saying that 'persons in attendance on patients cannot be too careful in keeping germs out of the body,' advising that proper precautions should be taken with food preparation and that no person, juvenile or adult should share the same bad as any one suffering room the 'malady'. 1
Mr Adams, acting in the absence of his father said that the outbreak was due to a water supply problem, affecting mainly the western side of Maidstone. He said that the water supply had already been cut off; although the date which this did actually happen varies from journal to journal, and after much rigorous testing the supply was proved to have been from Farleigh springs. In reality the samples had only been sent to London on Monday 20th September 1897, whilst houses which received their water from Boarley Springs were unaffected. In three streets in Maidstone the houses on one side including the street where the Mayor of Maidstone lived was unaffected as they received Boarley Spring water, but the people on the opposite side were affected as their water was drawn from Farleigh Spring.2 In the same article; 'Mr Adams wishes to strongly advise all the inhabitants of the borough to thoroughly boiled all milk and water used in their households, and to thoroughly cook all food before partaking of it.' The paper continues by stating that the demand for milk had gone up to such an extent that a dairyman had sold cows or £250 above their normal price! It concludes with a rumour about the cause of the outbreak, 'A rumour (which we refer to with all reservation)is also current to the effect that the spring of water which is now under suspicion is fed from an area of land , lately the scene of a hoppers encampment, wherein disease had existed. We can only ask is it so?'1 The hoppers were Eastenders who came down from London to pick the hops, living on the land nearby. They were given very poor living conditions,and they regarded it as a holiday. The practise of hoppers travelling from the East End to collect hops for beer production continued well in to the 20th Century.
Following a special meeting of the Sanitary Committee of the Urban district Council held on Monday 20th September 1897 at which a subcommittee was appointed to; ' Consider at once the desirability of hiring a building or buildings capable of accommodating at least 100 persons or isolation purposes.'
In the event, eleven buildings were used to accommodate 339 people at full capacity, as shown below.
BOROUGH OF MAIDSTONE, TYPHOID EMERGENCY HOSPITALS, 1897-1898
NO. HOSPITAL NO.OF BEDS WHEN FULL DATE OF OPENING DATE OF CLOSURE
1. PUBLIC FEVER 26 SEPT. 29TH STILL OPEN
2. TENTS 12 OCT.8TH STILL OPEN
3. STATION ROAD 80 SEPT.25TH STILL OPEN
4. WESLEYAN SCHOOLS 35 OCT.4TH JAN. 6TH
5. MILTON STREET MISSION 24 OCT. 6TH STILL OPEN
6. HEDLEY STREET SCHOOLS 17 OCT. 7TH DEC. 8TH
7. CONGREGATIONAL SCHOOLS 20 OCT.11TH DEC. 11TH
8. PERRY STREET MISSION 23 OCT.9TH DEC. 18TH
9. PADSOLE SCHOOLS 37 OCT. 19TH DEC. 24TH
10. ST MICHAELS SCHOOLS 33 OCT.28TH JAN.20TH
11. ST .LUKE'S MISSION 32 OCT.26TH JAN.6TH.
339
Fig 2; Table Produced for the Local Government Board of Inquiry in to the Maidstone Typhoid Epidemic.
Apart from the local Fever Hospital, and a few beds in tents, local schools predominantly fulfilled the role as West Kent General Hospital the local hospital, had already got typhoid patients on its wards.
Among the Doctors appointed were those from Guy's Hospital, including Dr Washburn, a bacteriologist; the Liverpool Fever Hospital, where 500 typhoid patients had been treated a few years before and St Thomas's along with local G.P's. 21
The Medical Officer for Health; 'Was instructed to procure a supply of trained nurses from London without delay"(1) Within one day it is reported that 10-12 had already been "engaged". Approximately 100 nurses were sent by the Corporation of London including nine probationer nurses from The London Hospital , including Caroline Bell and Edith Cavell, who although still a probationer had done 7 months nursing at the Fountain Fever Hospital prior to her training. They both worked at Padsole Schools, lodging with a Mrs Josiah Baker at 72 Bank Street, owner of the toy shop, which in December 1897 subsequently did a good trade in toy nurse dolls.
In fact such was the national feeling that the committee was inundated by offers of nursing help and asked the Nursing Record to publish a letter in mid October refuting the need for more nursing help; "I am glad to say a regular supply of certificated nurses from well known institutions has been maintained and , therefore there has been no need to engage independent nurses.'21 Many offers of nursing had come from across the UK, and the committee apologised that they had not been able to answer these offers of help due to the workload created by the epidemic.
Eva Luckes wrote in Edith Cavell's End of training probationers report of 1898 that; 'She did good work during the Typhoid epidemic in Maidstone.' This was high praise compared to typical nursing reports at the time.9
The following article, taken from 'The Hospital' newspaper, gives a sense of the public feeling, and the scale of the organizational response to this epidemic. The public had seen the effects of excellent nursing care as given to injured soldiers by Florence Nightingale during the Crimea war (1856) and how that care had changed the fate of the injured soldiers. This time there was no need for agitation by nurses to be allowed to go Maidstone, the Corporation of London employed Miss Annie Plowman and two assistants (Sisters E.K.Ward and E.M.Black, one District Assistant Superintendant Nurse G. Travis and 100 other nurses. Miss Plowman had recently completed six years working as Matron in Monsall Fever Hospital. Mrs Bedford Fenwick visited the typhoid epidemic! and wrote in the Nursing Record said; 'Miss Plowman was trained at St Bartholomew's hospital, and as she had been one of my first and most intelligent probationers, trained in what are now often alluded to as " the good old days"..............I found Miss Plowman very busy over domestic matters , the basis of all good nursing. I found every hospital beautifully clean and orderly and gaily decorated with a wealth of autumn flowers.'21 It seems rather strange that Mrs Bedford Fenwick should have visited a major epidemic, before there was a vaccine for typhoid, but perhaps reflects her indominatable spirit!
"The Nurses at Maidstone"
'The nurses are representative of a vast number of training schools both Metropolitan and Provincial. The housing of such an influx of workers has taxed the resources of the town, and various public institutions have been requisitioned for dormitories. Many nurses are being hospitably lodged by residents in the town and its outskirt. They are lucky for they are made very welcome guests and enjoy every consideration. The less comfortably housed think lightly of their drawbacks, and there is a great tendency among all to make the best of things. Brought face to face with the awful sorrow and suffering of the town, personal trials fade into insignificance. All the nurses are working heart and soul for the sick, rejoicing in each sign of recovery which manifests itself among their patients, and doing bravely and well. Every Nurse who reads "The Hospital" must now sympathise with the work now going on in Maidstone but only those who have seen it can picture accurately the terrible condition of things...The hours of the nurses vary a little but are necessarily long and busy ones. They get their meals away from work-in restaurants, at the Howard de Walton Institute, and other public places. The hospitals which have been furnished and opened in such rapid succession will be described next week for they deserve an article to themselves! Miss Plowman who is supervising the whole of the emergency nursing department has her headquarters at the Station Hospital and visits the others frequently. The Corn Exchange has been converted into a huge depot for clothes and other things sent as gifts for the poor of Maidstone. Orders for these things are signed for by clergy and others. Sad are the messages that accompany some of these orders when the requisition is for "black clothes" that the petitioner may be decently clad at the funeral next day of a parent or near relative. Beef tea, milk and broth are supplied for the sick and many other things, which the nature of the illness requires are forthcoming. In addition to the central stores at the Corn Exchange a little emergency stores of every kind of nursing supplies has been established and has already proved of great value to the sick by facilitating the actual work of the actual nursing. This store is merely supplementary to the other and is managed exclusively for nurses. In the first place a room was hired at the Temperance hotel to receive gifts sent for the use of the Co-operation nurses and to serve as a centre for their distribution. In the course of a few days the response to an appeal made by the secretary through the press was so liberal that the first room became quite inadequate for the purpose of storage. A large schoolroom has now been lent and there all strictly nursing necessaries are supplied.'7
The Maidstone Typhoid Epidemic was widely reported, even warranting newspaper space in Hobart, Australia; 'The typhoid epidemic at Maidstone still rages. A hundred fresh cases have been re-ported during the current week, and the mortality among juveniles is heavy. Whole streets are affected by the epidemic. A hundred London nurses and many doctors have been engaged to help the local practitioners and their aides, who find themselves utterly unable to meet the calls on their services. The parsimony of the Maidstone Municipality in refusing to have the water used by the townspeople' analysed is responsible for the outbreak.'
The Special Committee met regularly, concerning themselves with every aspect of management, including that of relief stations. On October 5th approximately the Poor Law board opened 3 relief stations; 'From these stations medical and other necessities are served out daily to the poor, the distribution of tickets entitling the applicants to relief being entrusted to the District Nurses.'4
Help came from many sources and in many ways; a relief fund was set up, to which people donated money from all over the country, the Queen sent £50, and the Lord Mayor's fund £4000, and by Tuesday December 7th the fund totalled £26, 500. A special fund was also set up for Orphans and Widows.
'A commendable movement was set in foot last week for supplying a supply of male night nurses for typhoid cases'.
Water from the Medway was used to flush the sewers and Rochester, Chatham, Gravesend and many other towns supplied water carts to help with the flushing .
On October 12th 1,565 cases had been reported of which 73 people died. A telegram from the Queen was posted on doors of town hall giving her support to the town and the Mansion house fund opened with Princess Christian offering the use of three trained nurses; 'The three nurses selected by the Princess..the staff of nurses in the town probably numbers more than 400. There are upwards of 90 under the control of the special Sanitary committee, the remainder being privately employed, either to attend to patients in the homes of well to do residents, or to undertake district work in conjunction with the Emergency Committee's staff '.5
In order to help prevent further spread, on October 6th, under the authority of the Inspector of Nuisances a special laundry was opened in the grounds of Fant Lane Hospital to wash infected clothing and bedding . Every household that had a case of typhoid on their premises was entitled to free washing and disinfecting of all infected items. After washing, disinfecting by the use of high pressure steam the articles were returned in clean bags. This service handled about 62,000 items, which required 22 workers /week to process the laundry.34 The Inspector of Nuisances was also responsible for the disinfecting and fumigating every house which had had Typhoid patients in it; 'After the recovery or death of a patient, or his or her removal to hospital, the walls ceilings and floors, were initially sprayed with water; then sulphur in the proportion of 40 oz to every 1,000ft of air space, was lit and allowed to burn on the sealed room for 24 hours. After the fumigation the ceilings were whitewashed and the woodwork washed with carbolic soap and water. Soiled wallpaper was removed and the walls washed with a solution of carbolic acid.'34
As in any epidemic there was general panic, with the trade being substantially affected in the town, the trains carrying noticeably less passengers into Maidstone, under about 30/day. It was reported nationally; 'that trade of the town is gradually recovering from the stagnation which the epidemic produced and the inhabitants of the country districts are resuming their weekly visits to the borough.'30
Much comment was made of the incessant tolling of church bells when someone was buried it became rather unnerving for people lying ill with typhoid, and for their families caring for them; 'One of the worst consequences was 130 fresh graves in Maidstone cemetery-during one weekend alone 30 victims were interred'34
The Kent Messenger wrote; 'All through Sunday afternoon Stone Street witnessed a long irregular procession of people bound for "Gods acre". The day of rest brought no rest to the grave digger.'34
Local and National papers reported widely on the epidemic, including reporting on 'notable' and tragic typhoid infections and deaths; The Morning Post reported on the deaths of the eight year old son of the Sanitary Inspector and also on the funeral of 19year old Beatrice Whitehead whose father and six sisters were absent from her funeral as they all also had the disease.19
'We are very sorry to hear that two of the nursing staff at Maidstone have contracted enteric fever in the discharge of their duty. One of these nurses is now practically convalescent, but the other is very seriously ill.'20 In total four nurses were thought to have caught typhoid, and were all nursed at the West Kent General Hospital with one being sufficiently well to attend the medal presentation in Maidstone on Wednesday 8th December.1
Nurses were looked after in other ways; 'A weekly service, specially for nurses, is now held at the Old church Maidstone, ...nearly one hundred nurses attend these restful services, and come away, we may hope, refreshed in mind and body, and invigorated to engage once more in the struggle with the dire disease.'27
There were two medal ceremonies; the first presentation was at 7.30pm to the night nurses which was followed by an interval of music and cinematography, the second ceremony was at 9pm. The presentations which were held at the Technical school and Museum were attended by the Lord Mayor of London and other dignitaries. Princess Christian was unable to attend and present the medals due to a prior engagement.29 Councillor Urmston, who had been particularly involved with the epidemic and had written to the Nursing Record to request no more volunteers, was cheered by the nurses when asked by the Mayor of Maidstone to speak on behalf of them;
'there were many things which they wished to tender his Worship and others their most hearty and cordial thanks ...for the very handsome entertainment in their honour...the subscribers for the medals which would be highly valued by the nurses for the rest of their lives. It was a matter of great gratification to them that the medals had been subscribed for so spontaneously without any call on the rates or application to the relief fund committee. Then they asked him to thank the people of Maidstone for their various acts of kindness, some who had received nurses into their homes and treated them as honoured guests. They desired to thank them and many others who had sent game, fruit and flowers, placed carriages at their disposal, lent them bicycles and sent them newspapers and magazines all of which added much to their material comfort and recreation. ( From other reports it seems that the nurses worked extremely hard, working long hours and would have had little time to enjoy what must have been to many of them luxuries.) ...And finally the nurses wishes to give a special vote of thanks to those connected with West Kent general Hospital who nursed four of their number back to life and strength.'1
By 7th December no fresh cases of typhoid had been reported, with no deaths from typhoid in the past fortnight. 29 However eleven more cases were reported two weeks later, with one death in the last few weeks of 1897. In early January with the majority of Emergency hospitals closed down, and temporary nurses returned home, thanksgiving services were held on the first Sunday in local churches.
In March 1898 following the epidemic and end of the enquiry into it Miss Plowman received a letter from the mayor of Maidstone thanking her for all her hard work; 'I have very great pleasure in testifying to the excellent work you have carried out in Maidstone, as superintendant of the nursing staff and temporary hospitals the organization and work that you had to undertake was very large, amounting as it did to the management of and superintendence for six months of , in all, ten emergency hospitals containing 400 beds and a staff of about 140 nurses for hospital and district work' permitting her to use this letter 'In any way she might.' The letter was subsequently printed in the Nursing Record in May 1898.26
Conclusion
Apart from the loss of life, the monetary cost of the outbreak was reported to have been £45,000, the doctors fees alone being £5,200; approximately six doctors came from outside the town.26 The Local Government Board gave the Council a loan of £15,000 towards the epidemic cost, a request was made for a loan of £18,000, this lower loan was seen as rather harsh; perhaps the Local Government Board were applying their own financial penalty?
In December 1897, even before the enquiry into the epidemic which started in January 1898 the Local Government Board were already acting on lessons learned from the Maidstone epidemic, issuing guidance to:
'Hints on Water Supply. The Local Government Board has issued to Town Councils, Urban District Councils and Rural District Councils a circular letter directing attention to the subject of water supply. Outbreaks of Typhoid, Clifton and Lynn have obviously led to the issue of communication for the Board point out that the Council are the body responsible for securing to their inhabitants of their district a proper and sufficient supply of water....for the wholesomeness of the water which they themselves supply .......make themselves acquainted with sources , nature and quality in all parts of their district ...and if it is unsatisfactory take such steps to supplement and improve the supplies.'31
The water company were widely censured in the press, for their lack of water testing, which due to cost saving, had been reduced in frequency. This lack of testing was blamed as one of the causes of the outbreak. Naturally at the inquiry, each party being held to blame for the epidemic, blamed the other; 'Mr Parker, on behalf of the Corporation (of Maidstone) submitted that there was insufficient evidence to support the charges made by the water company against the Corporation in regard to the drainage of the town and that it was clear that the water supply was the primary cause of the epidemic.'28
When the enquiry finally published its findings in August 1898, the commissioners said;
'The epidemic was caused by the pollution of the water supplied by the Maidstone Company from their Farleigh Sources and whilst there were grave sanitary defects in construction of some of the sewers, house drains and water closets within the borough, but the sudden and simultaneous outbreak and rapidity with which the epidemic grew cannot be accounted for by these defective conditions of sewerage and drainage. We are of the opinion that many of the typhoid cases in the borough were due to defects of drainage and sewerage with consequent pollution of soil underlying the town. The responsibility for the existence of these insanitary conditions lies with the town council whose duty it was to take steps that would lead to effective remedy of these defects. this duty they have in large measure neglected, notwithstanding that for many years the medical officer of health has repeatedly warned them of the risk to which the inhabitants of the town were exposed by the continuance of the insanitary conditions.'32
The board concluded by questioning whether the regulations are sufficient; which they feel they are, but it admited that there are discrepancies in the interpretation of the wording these regulations. Section 7 of Public Health (Water) Act 1878 imposes upon Rural District Authorities the duty to ascertain the condition of the water supply- no such application had been made on behalf of Maidstone Council, nor had Mr Adams, the Medical Officer ever made it his business under the General Order of the Board 1891 to inspect the water supplies at Farleigh!
With the advent of oral rehydration therapy, and that used alongside antibiotics the rate of death from typhoid today is approximately only 1%. However if patients with typhoid are untreated such as in Third World Countries today the death rate today remains higher at 10-30% than that experienced in Maidstone in 1897. 22,23
The Maidstone outbreak led to the first co-ordinated response to a typhoid outbreak ,the first trial of typhoid immunization among 84 nurses in a Maidstone psychiatric Hospital, none of whom caught typhoid, along with trials of water supply chlorination, and the use of the telephone by nurses and doctors in the typhoid hospitals to pass on information about new cases. All these factors contributed to a unusually low death rate from typhoid for the period, despite heavy rain, which had in recent weeks flushed impurities into the water supply.24
Whilst the hop pickers may have been the initial source of the typhoid infection, the disease would not have spread so dramatically had the Maidstone Council tested the water supply regularly, and repaired the sewage and drainage systems. It was the appalling sanitary conditions in which the hop pickers were housed that created the epidemic. History does not appear to relate whether the Hoppers encampment was improved by the following year.
It is not clear whether any regulations were tightened in the aftermath of this epidemic, it would appear that no court case for Corporate Manslaughter/negligence happened as it might well today in the light of such gross negligence by an authority. Initially some victims families started a class action, which is reported in the papers, but after a few months there is no further evidence of this. Whilst the council was given only partial financial help with the cost of the epidemic, the real sufferers were those who paid the ultimate price and died, and their families who were left behind in financially straightened circumstances, although poor relief was given out from the relief fund, the fund was closed within six months of the epidemic. Poor Law records document people being supported for years after the epidemic, some with the word 'typhoid' written beside their names.
At the presentation of Medals ceremony the Mayor of Maidstone Councillor Barker gave a speech;
'While they must be filled with regret for those who had been taken away, it was a matter of congratulation to know that the epidemic which overtook them three months ago, had been stamped out thanks to their Medical Officer, the medical men of the town, and though sturdy and gallant conduct of every inhabitant of Maidstone, and in addition to the help received from the residents in the town and neighbourhood, they had an army of trained nurses to assist them. He now wishes on the part of every inhabitant of the borough of Maidstone, to thank the nurses who had assisted them during their great trouble, and he was going to ask them to accept a small medal as a token of esteem for the work they had done.'1
References
1. South East Gazette, Tuesday 14th December 1897.
2. Irene Hales, Bygone Kent, Bygone Kent, 1985, Vol 4, number 5 .
3. The Mercury, Hobart, Tasmania, Monday October 4th 1897.
4. South East Gazette, Tuesday 5th October, 1897
5. South East Gazette, Tuesday 12th October, 1897
6. The Standard (London, England), Thursday, October 14, 1897; pg. 4; Issue 22868. 19th Century British Library Newspapers: Part II.
7 Leicester Chronicle and the Leicestershire Mercury (Leicester, England), Thursday, October 30, 1897; Issue 4525. 19th Century British Library Newspapers: Part II., quoting from the Hospital
8.Daily News (London, England), Monday, September 27, 1897; Issue 16069.
9. Royal London Hospital Archives; RLHLH/N/1/5)- London Hospital register of probationers, no.5 .
10. RLHA, RLHLH/N/1/3)- London Hospital register of probationers, no.3 .
11. RLHA, RLHLH/N/4/1)- London Hospital register of Staff Nurses, no.1
12. RLHA, RLHLH/N/5/3)- London Hospital register of Private Nurses , no.3 .
13. Ancestry.co.uk.
14. Royal College of Nursing Archives: The Nursing Record and Hospital World, march 3rd 1894
15. RCN Archives , The Nursing Record -vacant appointments etc supplement nov 16th 1895
16 RCN Archives The Nursing Record and Hospital World, Dec 28th 1895
17 RCN Archives The Nursing Record and Hospital, World, may 25th 1900 pg 423
18 RCN Archives The Nursing Record and Hospital, World, may 18 1901, pg 397-8
19 The Morning Post (London, England), Wednesday, September 29, 1897; pg. 6; Issue 39099. 19th Century British Library Newspapers: Part II.
20 .RCN Archives, The Nursing Record and Hospital World, Nov, 20th 1897, pg 415
21. .RCN Archives, The Nursing Record and Hospital World, Oct 9 th 1897, pg 287-288
22. http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.htm
24. www.ibms.org/includes/act_download.php
25 RCN Archives, The Nursing Record and Hospital World, May 14th 1898, pg402.
26 RCN Archives, The Nursing Record and Hospital World, July 23rd 1898, pg73
27 RCN Archives, The Nursing Record and Hospital World, nov 27th 1897,pg 436
28 RCN Archives, The Nursing Record and Hospital World, Feb 19th 1898, pg 159
29.South East Gazette Tuesday 7th December 1897
30. The Morning Post (London, England), Monday, December 13, 1897; pg. 6; Issue 39163. 19th Century British Library Newspapers: Part II.
31. The Morning Post (London, England), Saturday, December 18, 1897; pg. 3; Issue 39168. 19th Century British Library Newspapers: Part II.
32. The Times (London, England), Saturday, Aug 27, 1898; pg. 9; Issue 35606.
Copyright: Sarah Rogers 16/03/2014.
Photograph Copyright, Maidstone Museum.
Photograph Copyright; Maidstone Museum.
Photograph Copyright; Maidstone Museum.
Photograph Copyright; Maidstone Museum.
Photograph Copyright; Maidstone Museum.
Photograph Copyright; Maidstone Museum.
Nurses outside tents; Photograph Copyright; Maidstone Museum.
An ambulance with a patient outside tents; Photograph Copyright; Maidstone Museum.
Food stores; Photograph Copyright; Maidstone Museum.
Photograph Copyright; Maidstone Museum.
Photograph Copyright; Maidstone Museum.
Photograph Copyright; Maidstone Museum.