In our Hello, History series, we turn back the clock to look at significant periods for the emergency services.

Laura Blott is an MA student in Public History at Royal Holloway, University of London.

She’s agreed to take us on a whistle-stop tour of The Royal London Hospital during the Second World War, detailing the impact of the Emergency Medical Service from 1939 to 1941.  Catch up on Part 1, Part 2, Part 3 and Part 4 – this is the final part!

Although the Emergency Medical Service arguably aided ‘The London’ in its ability to treat the most necessary cases, there was much comment concerning the disruption it caused the medical school in particular and other departments such as dentistry, in continuing its work.  The panic and quick dispersal of staff and students did little to aid teaching comforts.

When the ‘War Stations’ notice was sent out, many of the pre-clinical students were scattered about – some were on holiday, some at home, some in the hospital grounds. Within days they had been relocated to St Catherine’s College Cambridge which was a remarkable achievement. However, once there, “The main advantage of living in College was that one could use the common-room. When the Cambridge students came up the privilege was withdrawn. Since then we have been without a Common-room.”

As students were separated, the quality of learning could not be guaranteed. Perhaps the only benefit to come from the reshuffle of war was that lecture demonstrations at ‘The London’ changed. Lectures now took place in the Bearsted Lecture Theatre rather than at the bedside, in place of the familiar ‘public ward rounds’. In their Editorial, Miln and Haggie commented that, “Although nobody would advocate the teaching of clinical medicine rather than by the bedside, in this special case advantage is gained by transfer.”

It took time for the transferred departments to settle as it was not just staff who were scattered but equipment also. “All the equipment (bodies, bones, coat lockers etc.) was brought from ‘The London’ in a lorry” but with over forty hospitals to receive equipment this also presented a struggle. The nurses found this a particular task as they were responsible for getting each hospital in order and ready for contingency. They found that equipment, “was most difficult to obtain and tended to foster a ‘beg, borrow, or steal’ attitude to meet immediate necessities.”

An example of those who found the sector hospitals of the utmost importance were those who dealt with the complicated arena of head injuries and the most complex of operations. D. W. C. Northfield noted that they needed quite surroundings and surgical supervision over a long period of time. This was something that could not be provided by, “the hospitals in the centre of London, which, it is supposed, will bear the brunt of enemy aircraft attack.”

The impact of the Emergency Medical Service on the health services of The London Hospital was great. Without the EMS, ‘The London’ would not have been able to respond to air-raid casualties as effectively as it did.  Although ‘The London’ received fewer casualties than expected, it was still a significant number.  The bombing raids came infrequently and some for nights at a time.  So many places of significance were hit that the casualties were major and frequent. ‘The London’, because of its location, was arguably one of the most important to its country during the period 1939 to 1941.

The London Hospital did not escape attack itself and the evacuation of as many patients as possible did the civilians a great service. It reduced the risk of many hundreds of lives being lost.  The numbers of evacuated staff and equipment was great and it was the Emergency Medical Service that allowed the administration to adjust carefully and accordingly. Without it, the hospital would have been a disorganised mess with a complete misallocation of vital resources.

The EMS relieved a financial burden that would have hung over the hospital as it received funding from the Ministry of Health. It also created a stable plan for the introduction of the National Health Service that to this day, aims to help those most in need of medical attention with the greatest possible ease. This was very much the tradition of ‘The London’ – a voluntary institution that catered for the needs of the sickly poor. It was the staff of institutions such as ‘The London’ who were often the guardians of morale and who wore what must have been a burden as a simple duty.

“We who are engaged in district nursing and public health service now have to undertake our greatest task. We are the army behind the fighting services. We may not be in the limelight, but we are the guardians of the morale of the civilian.”

In effect, the Emergency Medical Service in Sectors I and II was ‘The London’ and it’s ‘sister hospitals’. The needs of the EMS were met by willing and able practitioners at ‘The London’. They were able to take on the task of planning and of implementing change effectively. The EMS challenged ‘The London’ to adapt services to meet the predicted consequences of bombing on London. ‘The London’ rose to the challenge admirably providing many pathways for a more comprehensive peacetime provision of health services nationally.

In our Hello, History series, we turn back the clock to look at significant periods for the emergency services.

Laura Blott is an MA student in Public History at Royal Holloway, University of London.

She’s agreed to take us on a whistle-stop tour of The Royal London Hospital during the Second World War, detailing the impact of the Emergency Medical Service from 1939 to 1941.  Catch up on Part 1, Part 2 and Part 3!

The shock of the attacks in September prompted a hurried evacuation of as many patients as possible.  Attacks were not just focussed on the docks but on London itself. On the 7^th of September 1940, a bomb was dropped very close to ‘The London’,

“A bomb fell at the end gates. Away went the windows of the long facade, and the great Elliot clock face, which told the time for one-hundred-and-eighty-three years, became just a large cavity.”

‘The London’ had its own physical problems as well as having to deal with the large number of casualties that began to pour in. The raid continued throughout the night and luckily, although the Alexandra and Luckes nurses’ homes were hit, no-one was hurt and the fire was quickly extinguished. Clark-Kennedy recalls how, “Water had got into the gas pipes and breakfast the next morning was cooked on a battery of primus stoves.” The efforts of The London Hospital staff did not waver and the spirit displayed was invaluable to those who were injured in the attacks. ‘The London’ had played its part in the Battle of Britain which eventually repelled the Luftwaffe.

While such raids were being carried out, it was difficult to resume the practice of evacuation under the Emergency Medical service. In a nurses review of air-raid casualties in 1941, ‘old Londoners’ were told of the interrupted routines, “We planned that the patients be brought in on the now familiar green wire stretchers, splints applied, tea and perhaps cigarettes distributed; and then outside there would be many Green Line coaches waiting to convey these very ill and badly injured patients to the sector hospitals; meanwhile, the air raid would be in progress and travelling by road most unsuitable and dangerous.”

In our Hello, History series, we turn back the clock to look at significant periods for the emergency services.

Laura Blott is an MA student in Public History at Royal Holloway, University of London.

She’s agreed to take us on a whistle-stop tour of The Royal London Hospital during the Second World War, detailing the impact of the Emergency Medical Service from 1939 to 1941.  Catch up on Part 1 and Part 2!

An observer wrote a detailed account of the evacuation for ‘The London Hospital Illustrated’ detailing the professionalism of the staff. It evidences the great effort put into planning such an operation. The evacuation began at nine o’clock on September the 1^st and, “The work of evacuation was completed by five-thirty pm. There were no untoward incidents, and whether on a stretcher, or in a wheelchair…patients bore their journeys very well.” There is reason to believe that ‘The London Hospital Illustrated’ might be particularly kind about the operation, but the detail  behind it is enough to convince one that it did, in fact, go to plan unhindered. Coloured labels were attached to the diet rack above each patient’s head in order to categorise them according to evacuation. In addition, “one-hundred-and-fifty patients were taken to a railway terminus where ambulance trains awaited them. At the station, doctors, nurses and stretcher-bearers received the evacuee-patients, who were conveyed by rail to an inland town.” Not only did evacuation by rail occur all in one day, but thirty students accompanied by four doctors transported a further one hundred –and-fifty patients by motorcar while, “Under the supervision of two or three doctors a company of fifty students from the Medical School began to take stretcher cases from the wards, and then to wheel them on trolleys through the great quadrangle to the waiting bus-ambulances.” Three-hundred-and-fifty patients were dispersed in one day’s efforts which was a very commendable act performed by the staff and students to ensure that the evacuation to Sectors I and II went according to plan.

With fewer beds but no greater ‘emergency demand’, it seemed sensible to those at ‘The London’ that they might open the out-patients department on a much larger scale. The number of beds was reduced and many dispersed to sector hospitals found that only part-time work was necessary and that they might continue their ward rounds back at ‘The London’ itself as more patients began to trickle back to Whitechapel. The emergency of war that the Emergency Medical Service had been created for was, in reality, not particularly visible until the July of 1940.

‘The London’ had been encouraged to expect war during 1939 and many personnel were dispersed as the sector governor and ministry deemed fit. It caused particular problems for the medical school whose students were far flung and without the necessary facilities.  It was becoming clear that the mass evacuation to cater for air-raid casualties was not immediately necessary to solve the problems at hand. The sick and poor of East London still relied greatly on the services provided at ‘The London’.

In an interview with ‘The London Hospital Illustrated’, Sir William Goschen, Chairman of The London Hospital, understood that:

“We were required to close the Hospital and Out-Patient Department for a time when war came, but the needs of the civilian sick were very real: and soon we were permitted to re-open. Remedial work, therefore, continues in a limited way, and I know, in the case of the very poor, it has been a God-send to them.”

As the article continues, Sir Goschen defends ‘The London’s’ scaled back services. He prepares readers for the reality of an attack on London. He states, “Only one-third of the Hospital, under war conditions, is now available for urgent cases for which we keep open a certain number of wards.” Goschen continues to describe the current state of the Hospital, “Our once large staff now consists of only thirty doctors and about one-hundred-and-forty sisters and nurses. The rest are scattered among numerous other hospitals in two counties. Other wards are stripped, or else are in readiness, fully equipped, for civilian casualties.”

In our Hello, History series, we turn back the clock to look at significant periods for the emergency services.

Laura Blott is an MA student in Public History at Royal Holloway, University of London.

She’s agreed to take us on a whistle-stop tour of The Royal London Hospital during the Second World War, detailing the impact of the Emergency Medical Service from 1939 to 1941.  Catch up on Part 1!

The government, and it’s associated ministries at the time, had failed to consider what might be done about the provision of coordinated emergency services to cope with air-raid casualties until late-1938.

In response, ‘The London’ formed a committee chaired by senior surgeon Russell Howard to undertake localised emergency planning. ‘The London’ was exceptionally close to the industrial East End docks, which meant that it would be under significant threat from the Blitzkrieg.  Fire-fighting squads were organised by this committee, using the medical students and porters.

London was to be divided into ten administrative sectors, radiating from the centre of London, which was estimated to be Charing Cross.  Senior consultants were appointed as group officers who could advise the ministry on the synchronization of all the voluntary and municipal hospitals in their sector.

These consultants were also responsible for the deployment of the staff, from the voluntary hospitals within the sector, into a salaried Emergency Medical Service. The appointment of these group officers meant that, although they had no executive power, panicked minds of London civilians concerned by air-raid casualties were put to rest.

Sir Ralph Wedgwood (chairman of the Formation Committee of the League) in particular called for the speeding-up of air-raid provision measures. In 1939 he suggested in ‘Nursing Illustrated’ that, “Saint Thomas’ and Westminster are close to Battersea Power Station, which will be a target. Others are fatally close to the Thames. It would be much more sensible to establish a ring of casualty stations on the outskirts of London, to which the injured could be quickly transported.”

Administrative Sectors

‘The London’ was entrusted with sectors I and II, which encompassed East London, Essex, along with parts of Middlesex and Hertfordshire. Russell Howard was appointed group officer and, together with the help of A. E. Clark-Kennedy, embarked on the great task of researching the grand list of hospitals presented to them for the area.

These hospitals would provide for air-raid victims and evacuees whilst also being the new workplace of the voluntary staff evacuated from ‘The London’. This was by no means a quick or easy task.  Sectors I and II were the largest sectors and were expected to be covered by one hospital – ‘The London’.

The Emergency Medical Service (EMS) had a dramatic effect on ‘The London’ Hospital.  A. E. Clark-Kennedy spent much of his time vetting the different hospitals in sectors I and II. As a consequence of the introduction of the EMS, ‘The London’ was required to expand into the sector hospitals.

These hospitals were not ready for war and many had previously provided basic local services, or services for the chronically ill. Although many of the voluntary hospitals in the area would continue their work with little alteration, ‘The London’ was presented with the sensitive task of taking over the one time poor-law infirmaries, which included two large fever hospitals that would provide a large reserve of beds for casualties. There were also general and county mental hospitals in Essex and Hertfordshire that were expanded and this new responsibility fell entirely to staff at ‘The London’.

The Ministry provided the funding for EMS beds and other necessary services as well as doctors salaries but ‘Londoners’ themselves carried out the practical planning. These preparations were all made in the early months of 1939. By July 1939, it was documented in the magazine ‘Nursing Illustrated’ that, “with regard to the transport of personnel and equipment, arrangements were being made with the London Passenger Transport Board for the provision of sufficient ‘Green Line’ coaches to convey nurses and other personnel who had to be transferred from central London”.

It was also arranged that each sector would have six five-ton lorries at their disposal throughout the emergency. The EMS would be a necessity to the survival of the medical services throughout the War.

Although war had not struck yet, some began to realise that changes at ‘The London’ made a significant impact on – as Clark-Kennedy said in his prize-giving speech at the college in June 1939 – “the permanent structure of the country, and…in making preparations for war, we are laying the foundation of a more efficient system in place.”

This was something that ‘The London’ proved as the end of the Second World War gave birth to a new Emergency Medical Services system and the establishment of what would be known as the National Health Service.  Perhaps the greatest impact of the EMS on The London Hospital would be in developing a blueprint for health service provision on a national scale.

As soon as a declaration of war seemed imminent, the implementation of the EMS and major evacuation process was underway. Buses and trains were converted into ambulances and there was a real sense of teamwork and professionalism as the dispersal of at least 350 patients a day began at ‘The London’ on 1^st September 1939.

Part 3 will be published next week!

In our Hello, History series, we turn back the clock to look at significant periods for the emergency services.

Laura Blott is an MA student in Public History at Royal Holloway, University of London.

She’s agreed to take us on a whistle-stop tour of The Royal London Hospital during the Second World War, detailing the impact of the Emergency Medical Service from 1939 to 1941.

The Royal London Hospital was founded in 1740 by a group of philanthropists led by a 22 year old surgeon, John Harrison. It was once Britain’s largest general hospital and has been located on its present site at Whitechapel Road, since 1757. The hospital has been a teaching hospital since 1785 and was granted a Royal title by Her Majesty the Queen in 1990 on the hospital’s two-hundred-and-fiftieth anniversary.

‘The London’ proved its professionalism during the Second World War.  Its staff successfully helped to organise the implementation of the Emergency Medical Service to the north and east of London. The London Hospital saw the mass evacuation of its patients and staff to sector hospitals outside of the city and into less targeted areas.

Throughout the period, however, the essential departments such as midwifery, accident and emergency as well as outpatients remained open at ‘The London’. Although the hospital suffered damage at the hands of the Luftwaffe during The Blitz, ‘The London’ still continued to its very best to provide excellent services for those in need. This was by no means an easy task.

Although the Emergency Medical Service had been established, it was difficult to know just how relieved the hospital would be and what challenges the Second World War would hurl at ‘The London’ and its staff.

Part 2 will be published next week!