User:Meg Parkes/sandbox

Miss Frances Ivens, CBE, MS (Lond), ChM (Liverp), FRCOG (1870 - 1944)

Hannah Mary Frances Ivens, was a pioneering doctor of the early twentieth century. A gifted doctor and teacher, Frances was a suffragist and champion of the advancement of women in medicine throughout her career. Appointed the first female consultant surgeon in Liverpool in 1907, she played a vital role in military medicine and surgery in France for the duration of World War I. Resuming her career in Liverpool post-war, Frances Ivens continued to work with and for the women of Liverpool until her retirement in 1930.

Early life
Known as Frances, she was the youngest of five surviving children born in 1870 to William and Elizabeth Ivens of Harborough Parva in Warwickshire. She and her siblings enjoyed a comfortable and relatively privileged upbringing until their mother died in 1877. The children eventually went away to boarding school and while Frances had a keen intellect, and was noted to be fun, energetic and enthusiastic, she did not excel academically at school except in French, for which she had a particular talent. However, from an early age it was apparent Frances had developed an eye for detail and organisation.

It was a chance meeting in her early twenties with family friend Margaret Joyce, who at the time was a medical student at the London (Royal Free Hospital) School of Medicine for Women (LSMW), that opened her eyes to a career in medicine.

Medical Education
The Royal Free was one of only a handful of institutions at that time willing to train women in medicine. Actively encouraged by Margaret, Frances earnestly applied herself to attaining her London matriculation; she was accepted for medical training in 1894 at the age of 24. She graduated with Honours in 1900 aged 30, awarded the London University’s Gold Medal for Obstetrics and attained Honours in medicine and forensic medicine. Two years later she graduated MBBS (Bachelor of Medicine, Bachelor of Surgery) with Honours, followed a year later with her Masters in Surgery, only the third woman at that time to be awarded this degree.

Following completion of her early training in hospitals in London Frances spent the next three years travelling, gaining experience as a surgeon and obstetrician in both Vienna and at the Rotunda Hospital in Dublin.

Liverpool
In 1907, aged 37, she had the distinction of being the first female consultant surgeon to be appointed in Liverpool, to the Stanley Hospital in Kirkdale. This hospital is listed in Thomas Bickerton’s Medical History of Liverpool as the city’s smallest voluntary hospital with 160 beds. It had a fine reputation.

Frances lived at No.1A Rodney Street, later moving to No.45, where she remained until the mid-1920s when she moved to No.15 Gambier Terrace. She took to the city, and its people took to her; colleagues and patients alike quickly responded to this caring, compassionate and highly capable doctor. She was keen to learn and throughout her medical career published papers in medical journals on various subjects, from venereal disease to Caesarian section.

Miss Ivens was instrumental in setting up clinics specifically for poor women and their babies, long before the advent of Local Authority or Child Welfare clinics. According to documents in the Liverpool Medical Institution's (LMI) archives, her first such clinic was at a house in Netherfield Road in Everton and then later, in different locations around the city.

Within her first year in Liverpool she was appointed a member of the Liverpool Medical Institution, only the seventh woman member, the others being: Mary Birrell Davies, Margaret Joyce, Vera Foley, Mary Carr, Gertrude Edis and Mary Buchanan. All had been accepted into the ranks of Liverpool’s illustrious medical world, following in the footsteps of Dr Lucy Craddock, who was the first woman doctor to be accepted as a member of the Liverpool Medical Institution in 1889.

In addition to being consultant surgeon at the Stanley Hospital, Ivens was also appointed consultant in obstetrics at the Samaritan Free Hospital, 36 Upper Parliament Street. Here she would work with Miss Margaret Joyce among others.

Frances Ivens was a vociferous champion for women in medicine, fighting for hospital posts for younger colleagues and supporting them in myriad ways. She was a member of the Northern Medical Women’s Society, formed by Manchester and Liverpool’s female doctors.

First World War
At the outbreak of war in August 1914 Ivens, then aged 44, was an established and much-respected consultant obstetrician and gynaecologist working in Liverpool. She made an initial though unsuccessful attempt to join British medical staff in Belgium. Due to the rapid German advance the ship she was on had to turn back before docking. Undeterred she immediately offered her services to her friend and fellow suffragist, Dr Elsie Maud Inglis, the founder of the Scottish Women’s Hospital. This all-female organisation, was established by Inglis an Edinburgh-trained physician, surgeon and suffragist. On the outbreak of war initially offered mobile medical units to both the British Red Cross and the War Office, but was dismayed when told, “My good lady, go home and sit still”. Undeterred, she approached the French Red Cross, offering a unit to the French military. Their response was to ask how quickly the hospital could be established! From the outbreak of the Great War, Dr Inglis was determined that women doctors would take their place along with their male colleagues, working with the military overseas. Her pioneering organisation was part-funded by the National Union of Women’s Suffrage Societies. By early November, with the funds coming in, staff were being appointed to run the first unit in France. After hasty communications between Inglis and Madame de la Panouse, President of the French Red Cross, on 27 November the 13th century Cistercian Abbey at Royaumont, about 30 kms to the north east of Paris, was selected as its base.

Dr Inglis appointed Ivens as Chief Medical Officer of what was shortly to become an official French military hospital, Hôpital Auxiliare 301 (or HA 301). It was an inspired choice. Her natural leadership qualities and organisational skills were well-known. They were now to come to the fore, as never before. To the French authorities she was Mèdecin-Chef; to her staff and patients she was, “Madame la Colonelle”.

The first Royaumont team – 7 doctors, 10 nurses, 7 orderlies, 2 cooks, 2 maids, a clerk, administrator and 4 chauffeurs (two of whom were men who were soon replaced by two women) – gathered at Folkestone in early December, heading first to Boulogne, then to Paris and finally on to Royaumont.

At first sight, though magnificent the Abbey was far from ideal for conversion into a hospital. With no heating, lighting or sanitation it was daunting for the newly-arrived team. However, wasting no time and with her sleeves rolled up, Miss Ivens led the staff in the mammoth task of clearing, cleaning and moving huge pieces of old furniture around the ancient abbey. This was her great skill and the thing she would be most remembered for: she never asked anyone to do anything that she wasn’t prepared to do herself.

Once that task was underway the Mèdecin-Chef focused her time and attention on winning the support of the French authorities, both locally and in Paris to enable them to become operational. It is a testament to her abilities that this was achieved by the end of January 1915 when the first 100 beds were ready.

Little did anyone realise then, that under her leadership Royaumont would to become the largest, continuously working, British voluntary hospital in France during WWI. By 1918 Hôpital 301 cared for 600 patients. It was a phenomenal achievement.

From 1915 to 1919 a thousand women, from all backgrounds and countries, came and went, working for varying lengths of time, some making repeated visits. Miss Ivens was one of only a handful who remained in post continuously, from December 1914 through to March 1919.

In addition to being Director, Frances Ivens worked tirelessly as a surgeon at Royaumont. She expected much from her colleagues, matched only by what she was prepared to do herself and in so doing earned their respect and unfailing support. There were many times when the operating theatres worked ceaselessly for days on end and staff were exhausted. But they continued, as she did with them, until the work was done. And still more volunteered to help.

In early 1916, with casualties mounting, she was asked by the French to establish a satellite hospital closer to the Front, at Villers-Cotterets. However, in May 1918 she oversaw the hurried evacuation of this hospital, just ahead of the rapid German advance at Soissons.

To cope with the different types of surgery she and her colleagues would be faced with (most women doctors having only been allowed to develop their expertise in treating women and children at that time), before leaving Liverpool and throughout her years in France, she read widely keeping up-to-date with new developments in the treatment of gunshot wounds and blast injuries. She kept in close touch with her friend and Liverpool colleague, the pioneering orthopaedic surgeon Sir Robert Jones (who was knighted in 1917), and he visited Royaumont on at least one occasion.

Margaret Joyce and Vera Foley were two of Miss Ivens’ Liverpool colleagues who both used annual holiday entitlement to work at Royaumont. Dr Margaret Joyce, an obstetrician and gynaecologist at the Samaritan Hospital and Dr Vera Foley, a specialist in neo-natal and infant medicine, both in Liverpool and from 1917 at a temporary hospital opened at Leasowe in Wirral (later transferred to Woolton).

Legacy of Royaumont
One of the outstanding achievements of Royaumont was a pioneering new approach to the treatment of gas gangrene, one of the biggest killers among their patients. It combined the use of X-ray, bacteriology, surgery to remove affected tissue, and the use of antiserum therapy. The antisera was provided by Dr Weinberg, an eminent bacteriologist at the Pasteur Institute in Paris, who was impressed with the knowledge and dedication of the British medical team at Royaumont. Their collaboration prevented countless men from dying or suffering amputations needlessly.

She shared their findings widely, despite not being allowed to actually read her own paper in France… because she was a woman. In December 1917 she presented a paper entitled, “A Clinical Study of Anaerobic Wound Infection, with an analysis of 107 cases of gas gangrene” at the Royal Society of Medicine. She waited almost a year for it to appear in the BMJ. “The preventative and curative treatment of gas gangrene by mixed serums” was published on 19 October 1918, just three weeks before the Armistice.

In autumn 1917, Miss Ivens was the first foreign-born woman to be awarded the Legion d’Honneur, France’s highest honour. Thirty other staff members who worked at Royaumont were awarded the Croix de Guerre. In December 1918, Frances received the Croix de Guerre with palm.

Slide 8: oil painting 1920, Ivens inspecting the patients

Despite all that was achieved by the women of Royaumont for over four years, no mention of their contribution appeared in the British Official Medical History of the War, and no British medals were given to any of the staff.

In the Foreword to Dr Eileen Crofton’s compelling history, The Women of Royaumont (published in 1997), Dr Ruth Bowden, a former President of the Medical Women’s Federation, stated:

''“In all, 10,861 patients were admitted to Royaumont and the ancillary hospital at Villers-Cotterets. 8,752 were soldiers, mainly French… the death rate among the injured servicemen was 1.82%, a tribute to the surgical and nursing skills of the staff…”''

Regrettably, time does not permit delving any deeper into this fascinating history. I’ll finish with a brief biography of Frances Ivens’ achievements, both pre- and post-war.

After the First World War ended, Miss Ivens remained at Royaumont until March 1919, when she finally returned to Liverpool and, after a brief holiday, to her practice. On Wednesday 28 January 1920, she was the special guest of the XX Club at a dinner held at a Dr MacKenna’s home at 76 Rodney Street. This club, one of the oldest medical dining societies in Britain, was founded in 1908. The minutes of that meeting record that Miss Ivens “read a paper of her four years in France.” She detailed her research into the treatment of gas gangrene.

Professional appointments
In 1924 she was appointed President of the Medical Women’s Federation and in 1926 she was the first woman elected vice-President of the LMI. She advised on both the building of Liverpool’s new women’s hospital in Catherine Street and the planned new maternity hospital in Oxford Street.

In 1929 she was awarded the CBE, in recognition of her work.

A year later, and by then aged 60, Frances married life-long friend, London barrister and widower, Charles Matthew Knowles. Their wedding was held in the Lady Chapel of Liverpool’s Anglican Cathedral. As a mark of the woman, and the doctor, guests to the tea party held afterwards at the Cathedral, included 250 of her former patients.

The Knowles’ lived in London before finally retiring to Killagorden near Truro, Cornwall, where Mrs Frances Ivens-Knowles continued to live a full, active life until her death in 1944.

Former Liverpool radiologist and medical historian Dr James Carmichael, remembers meeting Mrs Ivens-Knowles in the mid-1930s in the West Country, while on holiday with his stepmother, Liverpool doctor Dr Hilda Cantrell. Though considerably younger, she had worked with Frances Ivens in Liverpool. He described Frances as “a Grande Dame, as she was entitled to be! She was a tremendous leader.”

First, a brief outline of her extraordinary contribution to the medical care of military personnel in France during WWI, followed by an outline of her professional life in Liverpool. Three years ago, while researching the LMI and 208’s Then and Now WWI Centenary event (held in October 2014), I came across mention of the Scottish Women’s Hospital Units for the first time.

This all-female organisation was established by Dr Elsie Maud Inglis, an Edinburgh-trained physician, surgeon and suffragist. Her pioneering organisation was part-funded by the National Union of Women’s Suffrage Societies and from the outbreak of the Great War she was determined that women doctors would take their place along with their male colleagues, working with the military overseas.

Frances Ivens, a fellow suffragist and friend, offered her services to the Scottish Women’s Hospital in September 1914. By then, and aged 44, Miss Ivens was an established and much-respected consultant surgeon, an obstetrician and gynaecologist, who had worked in Liverpool since 1907. She had already made an unsuccessful attempt to join British medical staff in Belgium at the outbreak of war in early August. Due to the rapid German advance her ship had been turned back before docking.

Back in Edinburgh, having offered mobile medical units to both the British Red Cross and the War Office, Elsie Inglis had been dismayed to be told, “My good lady, go home and sit still”. Undeterred, she approached the French Red Cross, offering a unit to the French military. Their response was to ask how quickly the hospital could be established!