Lord Herbert's buoyancy of spirit remained to him when physical strength

was quickly ebbing. He became worse, and, on July 25, left Spa for home.

He died at Wilton on August 2. "To the last," wrote his sister to Miss

Nightingale, "he had the same charm, that dear winning smile, that

almost playful, pretty way of saying everything." But among his last

articulate words were these: "Poor Florence! Poor Florence! Our joint

work unfinished."

II

The death of Sidney Herbert was a heavy blow to Miss Nightingale--the

heaviest, perhaps, which she ever had to suffer. It meant not only the

loss of an old friend and companion, in whose society she had constantly

lived and moved for five years. It meant also the interruption of their

joint work, which was more to her than life itself. She felt in the

severance of their alliance the true bitterness of death:--

(_Miss Nightingale to her Father._) HAMPSTEAD, _Aug._ 21 [1861].

DEAR PAPA--Indeed your sympathy is very dear to me. So few people

know in the least what I have lost in my dear master. Indeed I know

no one but myself who had it to lose. For no two people pursue

together the same object, as I did with him. And when they lose

their companion by death, they have in fact lost no companionship.

Now he takes my life with him. My work, the object of my life, the

means to do it, all in one, depart with him. "Grief fills the room

up of my absent" master. I cannot say it "walks up and down" with

me. For I don't walk up and down. But it "eats" and sleeps and

wakes with me. Yet I can truly say that I see it is better that God

should not work a miracle to save Sidney Herbert, altho' his death

involves the misfortune, moral and physical, of five hundred

thousand men, and altho' it would have been but to set aside a few

trifling physical laws to save him.... "The righteous perisheth and

no man layeth it to heart." The Scripture goes on to say "none

considering that he is taken away from the evil to come." _I_ say

"none considering that he is taken away from the good he might have

done." Now not one man remains (that I can call a man) of all those

whom I began work with, five years ago. And I alone, of all men

"most deject and wretched," survive them all. I am sure I meant to

have died.... Ever, dear Papa, your loving child, F.

Her grief was accompanied and intensified by some remorse:--

(_Miss Nightingale to Harriet Martineau._) HAMPSTEAD, _Sept._ 24

[1861].... And I, too, was hard upon him. I told him that Cavour's

death was a blow to European liberty, but that a greater blow was

that Sidney Herbert should be beaten on his own ground by a

bureaucracy. I told him that no man in my day had thrown away so

noble a game with all the winning cards in his hands. And his

angelic temper with me, at the same time that he felt what I said

was true, I shall never forget. I wish people to know that what was

done was done by a man struggling with death--to know that he

thought so much more of what he had not done than of what he had

done--to know that all his latter suffering years were filled not

by a selfish desire for his own salvation--far less for his own

ambition (he hated office, his was the purest ambition I have ever

known), but by the struggle of exertion for our benefit.

Happily for her peace of mind there came to her an almost immediate call

to be up and doing in the service of her "dear master," as in her

letters of this time she constantly named Sidney Herbert.

The newspapers had at first been somewhat grudging in their obituary

notices of him. He had been thought of in connection more with the

defects of the War Office during the early months of the Crimean War,

than with his services as a reformer. His family and his friends were

pained, and on their behalf Mr. Gladstone applied to Miss Nightingale.

She did not feel well enough to see him, and, on August 6, he wrote

explaining the case, "taking the liberty of intruding upon her for aid

and counsel," and asking "the assistance of her superior knowledge and

judgment in a matter which so much interests our feelings." Miss

Nightingale instantly set to work and wrote a Memorandum on Sidney

Herbert's work as an Army Reformer. She wrote quickly, but with her

usual care in giving chapter and verse for every statement. The

Memorandum was anonymous, and was marked "Private and Confidential"; but

she had it printed, and circulated it among Lord Herbert's friends and

various publicists. Among those who saw it was Abraham Hayward who, when

a memorial to Lord Herbert was being mooted a few weeks later, strongly

urged that she should be asked to publish the Paper. "No one," he wrote,

"could or would misconstrue her motives. Nothing has been more

remarkable in her beneficent and self-sacrificing career than its

unobtrusiveness. It has only become famous because its results were too

great and good to be shrouded in silence and retirement. Admirably as

she writes, she is obviously never thinking about her style; which, for

that very reason, is most impressive; and I feel quite sure that the

Paper in question would suggest no thought or feeling beyond conviction

and sympathy."[294]

[294] Letter (Nov. 20) to Count Strzelechi, for whom see below, p. 410.

The Memorandum, in so far as it relates to what Sidney Herbert did, has

been described and quoted above; but at the end of it, Miss Nightingale

was careful to touch upon what he had meant to do and what remained for

others to do. "He died before his work was done." The work on which his

heart was set was the preservation of the health, physical and moral, of

the British soldiers. "This is the work of his which ought to bear fruit

in all future time, and which his death has committed to the

guardianship of his country."

Having finished her Memorandum, Miss Nightingale sent it to Mr.

Gladstone. She knew how warm had been the friendship between him and

Sidney Herbert. She thought that in the friend who remained the saying

might perchance come true: _uno avulso non deficit alter_. At any rate

it was her duty to throw out the hint. So she underlined, as it were,

the closing words of her Paper by offering to talk with Mr. Gladstone

about the unfinished work which, as she knew, was nearest to Sidney

Herbert's heart. To this overture, Mr. Gladstone replied in a letter,

giving account of his friend's funeral:

(_W. E. Gladstone to Florence Nightingale._) 11 CARLTON HOUSE

TERRACE, _Aug._ 10 [1861]. The funeral was very sad but very

soothing. Simplicity itself in point of form, it was most

remarkable from the number of people gathered together, and

especially from their demeanour. Many _men_ were weeping: not one

unconcerned face among several thousands could be seen. But it all

brings home more and more the immense void that he has left for all

who loved, that is for all who knew, him.... I read last night with

profound interest your important paper. I see at once that the

matter is too high for me to handle. Like you I know that too much

would distress him, too little would not. I am in truth ignorant of

military administration: and my impressions are distant and vague.

It is your knowledge and authority more than that of any living

creature that can do him justice, at the proper time, whenever that

may be--do him justice, as he would like it, without exaggeration,

without defrauding others. I shall return the paper to you: but of

it I venture to keep a copy....

With respect to your making known to me the "three subjects" I will

beg you to exercise your own discretion after simply saying this

much; my duty is to watch and control on the part of the Treasury

rather than to promote officially departmental reforms. To him I

could personally suggest: I am not sure that I should be justified

in taking the same liberty with Sir G. Lewis, especially new to his

work. On the other hand, my desire to promote Herbert's wishes, as

his wishes, was not stronger than my confidence in his judgment as

an administrator. (If I now seem reluctant to touch that subject it

is for fear I should spoil it.) In the conduct of a department he

seemed to me very nearly if not quite the first of his

generation.--I remain, dear Miss Nightingale, Very sincerely yours,

W. E. GLADSTONE.

On the afternoon of November 28, in Willis's Rooms--in the same place

where, in the same month six years before, Mr. Herbert had spoken in

support of a memorial to Miss Nightingale's honour, a public meeting was

held to promote a memorial to him. "I think you would have been

satisfied," wrote Mr. Gladstone to her on the same evening, "even if a

fastidious judge, with the tone and feeling of the meeting to-day. I

mean as regards Herbert. As respects yourself, you might have cared

little, but could not have been otherwise than pleased. I made no

allusion to you in connection with the paper you kindly sent me,

although I made some use of the materials. I acted thus after conference

with Count Strzelechi,[295] and with his approval. I thought that if I

mentioned you along with that paper, I should seem guilty of the

assumption to constitute myself your organ." Miss Nightingale's Paper,

summarizing Lord Herbert's services to the health and comfort of the

British Army, formed, indeed, the staple of more than one of the

speeches,[296] and the long alliance between them in that cause, which

has been the subject of preceding chapters in this Memoir, was

frequently referred to at the meeting. General Sir John Burgoyne said

breezily that Lord Herbert's "hobby was to promote the health and

comfort of the soldier, and his pet was Miss Nightingale, who had for

many years devoted herself to the same pursuit." Mr. Gladstone mentioned

as Lord Herbert's "fellow-labourer" the "name of Miss Nightingale, a

name that had become a talisman to all her fellow-countrymen." And Lord

Palmerston, the Prime Minister, in associating the Commander-in-Chief

with the late Minister for War, added that "they did not labour alone.

They were not the only two; there was a third engaged in those

honourable exertions, and Miss Nightingale, though a volunteer in the

service, acted with all the zeal of a volunteer, and was greatly

assistant, as I am sure your Royal Highness will bear witness, to the

labours of your Royal Highness and Lord Herbert."

[295] Sir Paul Edmund de Strzelechi, K.C.M.G., C.B., known as Count

Strzelechi, Australian explorer, of Polish descent, though a

naturalized Englishman, was a great friend of Lord and Lady

Herbert, whom he had accompanied on their last journey abroad.

He took a prominent part in organizing the Herbert Memorial.

[296] They are collected in a pamphlet (August 1867) entitled _Memorial

to the Late Lord Herbert_.

III

The alliance which was dissolved by Lord Herbert's death is probably

unique in the history of politics and of friendship. "As for his

friendship and mine," said Miss Nightingale, "I doubt whether the same

could ever occur again."[297] For five years the politician in the

public eye, and this woman behind the scenes, were in active

co-operation; often seeing each other daily, at all times in

uninterrupted communication. There have been other instances in which

the same thing has happened, but happened with many differences. There

have been statesmen who have made confidantes of their wives, and who

have found in them wise counsellors and helpful supporters. Sidney

Herbert himself received much help in his public work from his wife, to

whom he was devotedly attached. In some pencilled jottings about her

friends, Miss Nightingale records a beautiful trait; Sidney Herbert made

it a rule, she says, to mark each anniversary of his wedding-day by

beginning some new work of kindness towards others. Yet there was room

in the ordering of his life, during the five years following the Crimean

War, for taking constant counsel from another woman--so constant as,

perhaps, in the days of his illness and over-work to cause his wife some

anxiety. Yet Miss Nightingale was as dear to the wife as she was helpful

to the husband, and affectionate friendship between her and Mrs. Herbert

was not impaired. There have been many statesmen, again, and many other

eminent men, who have found inspiration or support, no less than solace

or pleasure, in the friendship of women. But Sidney Herbert's attraction

to Miss Nightingale, and hers to him, were on a plane by themselves.

She, indeed, was susceptible, as was every man and every woman who knew

him, to Sidney Herbert's singular charm and courtesy; she admired the

brilliance of his conversation; she felt pleasure in his presence. And

he, with his quick perception, must have enjoyed the ready humour which

played around Miss Nightingale's wisdom. But they were also comrades or

colleagues even as men are. "A woman once told me," Miss Nightingale

said to an old friend, "that my character would be more sympathized with

by men than by women. In one sense I don't choose to have that said.

Sidney Herbert and I were together exactly like two men--exactly like

him and Gladstone."[298]

[297] Letter to Harriet Martineau, September 24, 1861.

[298] Letter to Madame Mohl, Dec. 13, 1861.

The secret of this rare friendship between Sidney Herbert and Miss

Nightingale is to be found, first, in the fact that the character and

gifts of the one were precisely complementary to those of the other.

Though of a sanguine temperament, Sidney Herbert had the politician's

caution. Miss Nightingale, though of an eminently practical genius, was

eager and full of impelling force. She supplied inspiration which he had

the means of translating into political action. Sidney Herbert had the

political mind; Miss Nightingale, the administrative. Not indeed that he

was deficient in some of the administrative gifts, or she in political

instinct. But what was peculiarly characteristic of her was the

combination of a firm grasp of general principles with a complete

command of detail; and in the particular work in which they were

engaged, her experience supplied what he lacked. "I supplied the

detail," she said herself; "the knowledge of the actual working of an

army, in which official men are so deficient; he supplied the political

weight."[299] Each was thus indispensable to the other. And they were

united by perfect sympathy in the service of high ideals. "He," wrote

Miss Nightingale of Sidney Herbert, "with every possession which God

could bestow to make him idly enjoy life, yet ran like a race-horse his

noble course, till he fell--and up to the very day fortnight of his

death struggled on doing good, not for the love of power or place (he

did not care for it), but for the love of mankind and of God."[300] He

was, "in the best sense," she wrote elsewhere, "a saver of men."[301] In

that honourable record Miss Nightingale deserves an equal place with her

friend.

[299] Letter to Harriet Martineau, Sept. 24, 1861.

[300] _Dublin_ (Bibliography A., No. 28), p. 8.

[301] _Herbert_ (Bibliography A., No. 29), p. 3.

PART IV

HOSPITALS AND NURSING

(1858-1861)

The everyday management of a large ward, let alone of a hospital,

the knowing what are the laws of life and death for men, and what

the laws of health for wards (and wards are healthy or unhealthy

mainly according to the knowledge or ignorance of the nurse), are

not these matters of sufficient importance and difficulty to

require learning by experience and careful inquiry, just as much as

any other art?--FLORENCE NIGHTINGALE: _Notes on Nursing_.

CHAPTER I

THE HOSPITAL REFORMER

(1858-1861)

It may seem a strange principle to enunciate as the very first

requirement in a Hospital that it should do the sick no harm. It is

quite necessary, nevertheless, to lay down such a principle,

because the actual mortality _in_ hospitals, especially in those of

large crowded cities, is very much higher than any calculation

founded on the mortality of the same class of diseases among

patients treated _out of_ hospitals would lead us to

expect.--FLORENCE NIGHTINGALE (1863).

The work for the health of the soldiers, which has been described in the

preceding Part, filled the larger part of Miss Nightingale's life during

the five years after her return from the Crimean War; and in 1856, 1857,

1858 it occupied nearly the whole of her time. The work lasted for

almost exactly five years, from the day of her return from Scutari

(August 1856) to the day of Lord Herbert's death (August 1861). But into

those strenuous years Miss Nightingale had crowded much other work

besides. It has been necessary, for the sake of clearness and coherence,

to treat the subject of Army sanitary reform consecutively in a single

Part. In the present Part the other main occupations of Miss

Nightingale's life during the same period, and more especially during

the years 1859, 1860, and 1861, will be described.

The story of her life and work may be divided for convenience into

separate Parts; but in her own mind each of the branches of effort into

which successively she threw herself were connected parts of a larger

whole. Her experiences in the Crimean War, and the emotions which grew

out of them, had caused her to throw her first efforts into the cause of

reform in the interest of her "children," the British soldiers. But all

the time she saw with entire clearness that the health of the Army was

only part of a larger question; namely, the health of the whole

population from which the soldiers are drawn. She had made her

reputation by work in military hospitals, and her first effort was to

improve them, but she saw that the condition of civil hospitals was the

larger and the more important matter. And she saw further still that

hospitals are at best only a necessary evil; a necessity, as some one

has said, in an intermediate stage of civilization. The secret of

national health is to be found in the homes of the people. If in a

particular town or quarter, for instance, there was excessive infant

mortality, the remedy, as she said, was not to be found in building more

children's hospitals there. She was famous throughout the world as a

war-nurse; but she knew that the difficulties which she had encountered

in that sphere were due to the fact that the art of nursing was so ill

understood at home. Her vision took wider scope, and her efforts to

improve the well-being of the people embraced, as we shall hear, both

India and the Colonies. Mr. Disraeli, in a famous speech[302] delivered

the saying _Sanitas sanitatum, omnia Sanitas_, but that was in 1864; it

was Miss Nightingale's motto many years before. When the extent of her

range and the depth of her influence are considered, the claim made for

her by an American writer will not seem exaggerated: she was "the

foremost sanitarian of her age."[303] Our immediate concern is with her

life and work, first, as a Hospital Reformer (Chaps. I., II.), and then

as the founder of Modern Nursing (Chaps. III., IV.).

[302] At Aylesbury, Sept. 21, 1864.

[303] _Nutting_, vol. ii. pp. 207-8.

* * * * *

Miss Nightingale's authority on the subject of Hospitals ruled paramount

in the years following the Crimean War--as the reference of the Netley

plans to her has already indicated. Popularity and prestige were

confirmed by a practical experience which at the time was probably

unique. "Have you," she was asked by the Royal Commission of 1857,

"devoted attention to the organization of civil and military hospitals?"

"Yes," she replied, "for thirteen years. I have visited all the

hospitals in London, Dublin, and Edinburgh, many county hospitals, some

of the naval and military hospitals in England; all the hospitals in

Paris, and studied with the 's[oe]urs de charité'; the Institution of

Protestant Deaconesses at Kaiserswerth, on the Rhine, where I was twice

in training as a nurse; the hospitals at Berlin, and many others in

Germany, at Lyons, Rome, Alexandria, Constantinople, Brussels; also the

war hospitals of the French and Sardinians." Her authority on the

subject was strengthened yet more when her Papers, already

mentioned,[304] which were read at Liverpool in October 1858, were,

early in the following year, published, with additional matter, as a

book. "It appears to me," wrote Sir James Paget, in acknowledging a copy

of the book, _Notes on Hospitals_, "to be the most valuable contribution

to sanitary science in application to medical institutions that I have

ever read." The book has not been reprinted since 1863, and is now,

perhaps, forgotten; but, if so, that is the necessary fate of many a

notable book. The pioneers of one generation are forgotten when their

work has passed into the accepted doctrine and practice of another. In

its day Miss Nightingale's _Notes on Hospitals_ revolutionized many

ideas, and gave a new direction to hospital construction.

[304] Above, p. 383.

Sir James Paget's words accurately suggest the nature of Miss

Nightingale's work in this field. Before she wrote, there was sad need

of the application of sanitary science to many of our hospitals. The

rate of mortality in them was terribly high. Hospitals created almost as

many diseases as they cured; there was hospital gangrene, hospital

pyæmia, hospital erysipelas, hospital fever, and so forth. It was even

questioned whether great hospitals were not, and must not necessarily

be, producers of disease. Miss Nightingale showed that there was no such

necessity. By the light of sanitary science, she traced back the

excessive mortality in hospitals to its true causes, in original defects

in the site, in the agglomeration of a large number of sick under the

same roof, in deficiency of space, deficiency of ventilation, deficiency

of light. In a second section of her book, going more into detail, she

enumerated "Sixteen Sanitary Defects in the Construction of Hospital

Wards," adding to the statement of each defect precise suggestions of a

remedy. She added a series of equally detailed hints on hospital

construction, illustrating them by careful plans, exterior and interior,

of some of the best modern hospitals and of the worst old ones. Some of

my readers may be acquainted only with modern hospitals, and it will be

well perhaps to describe the defects in the old style of hospital. Many

of the hospitals and infirmaries, as they existed when Miss Nightingale

started her crusade, had been built with no consideration for the

sub-soil, and the drainage of them was very imperfect. The wards were

sadly overcrowded, often as much as three or four times over, tried by

the present standard of the number of cubic feet desirable per bed.

Ventilation was defective. The wards were often low. There were

frequently more than two beds between the windows. Little attention had

been given to the supreme importance of having floors, walls, and

ceilings which were non-absorbent. The furniture of the wards, and the

utensils, were such as would be condemned to-day as hopelessly

insanitary. Miss Nightingale found it necessary to enter in some detail

upon the desirability of _iron_ bedsteads, _hair_ mattresses, and

_glass_ or _earthenware_ cups, etc. (instead of tin); as also upon that

of sanitary forethought in the construction of sinks and other places.

Hospital kitchens and laundries at home were not quite so bad as at

Scutari; but many of the kitchens were still very primitive, and many of

the laundries inspected by Miss Nightingale were "small, dark, wet,

unventilated, overcrowded, so full of steam loaded with organic matter

that it is hardly possible to see across the room." All this is now, for

the most part, a thing of the past; and the passing of it is due, in

large measure, to Miss Nightingale. Coinciding, as her book did, with a

movement for increased hospital accommodation, and coming with the

prestige of a popular heroine, her _Notes on Hospitals_ opened a new era

in hospital reform. There had, it is true, been improvement before her

time; and she was not the one and only discoverer of the simple

principles which she enunciated, and which are now the A B C of the

subject. But the general level of thought or practice does not always

rise to the height of the better opinion; it depends too often upon the

average opinion of the day. Moreover, in some matters, there was, at the

time when she wrote, a conflict of principles, in which the victory was

generally given to the wrong side. The beneficial effect of fresh air

was not always denied; but the advantage of securing warmth by shutting

the windows, and relying upon artificial methods of ventilation, was in

practice considered paramount. Miss Nightingale was a pioneer in the

consistent emphasis which she gave to the supreme necessity of fresh

air, and to the importance of "direct sunlight, not only daylight,

except perhaps in certain ophthalmic and a small number of other cases."

She based her contention in these matters on scientific principles; she

supported it from her experience and observation in the Crimean War and

in foreign hospitals. In many quarters her ideas were new and

revolutionary. We have heard already what "a bitter pill" it was to one

eminent medical official of her day to swallow the idea of "pavilions"

in hospital construction.[305] Lord Palmerston explained in the House of

Commons in 1858 that, "strange as it might appear, considering the

progress of science in every department, it was only within a few years

that mankind has found out that oxygen and pure air were conducive to

the well-being of the body."[306] And in the matter of the curative

effect of light, Miss Nightingale cited from an official publication the

case of a well-known London physician, who "whenever he enters a

sick-room, takes care that the bed shall be turned away from the light."

"An acquaintance of ours," she added, "passing a barrack one day, saw

the windows on the sunny side boarded up in a fashion peculiar to

prisons and penitentiaries. He said to a friend who accompanied him, 'I

was not aware that you had a penitentiary in this neighbourhood.' 'Oh,'

said he, 'it is not a penitentiary, it is a military hospital.'"[307]

Miss Nightingale's general principles commanded the hearty support of

the better medical opinion, and to many medical men her details, drawn

from observation in the best foreign hospitals, afforded new and useful

hints; while at the same time she commanded in a singular degree the ear

of the general public, including town councillors, guardians, and

benevolent persons. It was in this way that her book did so much to

improve the level of hospital construction and hospital arrangement in

this country.

[305] Above, p. 342.

[306] Speech on Lord Ebrington's Resolutions, May 11, 1858.

[307] _Notes on Hospitals_, 1859, pp. 100, 108.

Upon the construction of military hospitals--whether general or attached

to particular barracks--Miss Nightingale was consulted constantly and as

a matter of course. In 1859, it will be remembered, Mr. Herbert became

Secretary for War; and in 1860 Captain Galton was appointed temporary

assistant inspector-general of "Fortifications"--a department which

included works for barracks and hospitals. She respected Captain

Galton's abilities, and liked him personally very much. He and Mr.

Herbert took her advice upon all works within her province, and the

plans of the new General Hospital at Woolwich in particular owed much to

her suggestive ingenuity. She even drew up the heads of the

specifications for it. Even where she was not directly consulted or

concerned, her influence and the standard she had set up in her book had

an effect. Medical officers and military governors sought leave to be

able to quote her approval of hospitals under their charge. It would, as

one naïvely wrote to her, improve their chances of promotion.

A more direct result of the publication of _Notes on Hospitals_ was to

bring in upon Miss Nightingale copious requests for advice from the

committees or officials of civic hospitals and infirmaries throughout

the country. To all such requests she readily responded. Writing was

with her a means to action; and when she was given any chance of

translating "Notes" into deeds, no trouble was too great for her. She

had decided views of her own, but in particular cases she often

consulted other experts. Dr. Sutherland, one of the leading authorities

in such matters, was, as we have seen, constantly with her. To her

kinsman by marriage, Captain Galton, she frequently referred; and she

sometimes engaged Sir Robert Rawlinson professionally to prepare plans

and specifications for her to submit to those who asked her advice. He

on his part often consulted her in regard to hospitals and infirmaries

on which he had been called in to advise. Her advice was sought both by

those who were actually projecting new hospital buildings and by those

who were leading crusades for the reconstruction of their local

institutions. Among her papers there is a mass of correspondence,

specifications, plans, memoranda of all sorts, referring to such

matters. Technical details are often relieved by touches of Miss

Nightingale's humour. Here are two examples from her letters to Captain

Galton--(March 24, 1861): "I understand that Baring[308] won't ventilate

the Barracks in summer because the grates are not hot enough in winter.

Why are the men to die of foul air in August because they are too cold

at Christmas? I think Baring must be an army doctor." (June 20, 1861):

"Is the Architect's ideal the profile of a revolver pistol? If you look

at the block plan in this point of view, it is very good. But as he asks

my opinion, it is that I would much rather be shot outside than in. As

Hospital principles are beginning to be well known, it would be quite

enough to engrave this plan on the card of solicitation to stop all

subscriptions. No patient will ever get well there. And as I don't

approve of the principle of Lock Hospitals, I had much better let it go

on." The correspondence about hospital plans ranges in place and scale

from Glasgow, from which city she was asked to advise upon cement for

the walls of the Infirmary wards, to Lisbon, where a new institution was

to be built according to her ideas. In 1859 the King of Portugal asked

Miss Nightingale through the Prince Consort to advise and report upon

the plans for a hospital which he desired to build in memory of his

wife, the Princess Stephanie of Hohenzollern. This affair occupied some

of her attention during two years, and caused her not a little

impatience. With Dr. Sutherland's help, she went laboriously through the

plans submitted by the King's architect on the assumption that the

hospital was intended for adults. It then appeared that what the King

wanted was a Children's Hospital. The Prince Consort, through Colonel

Phipps, was deeply grieved at "the waste of Miss Nightingale's time and

of her strength, so precious." Dom Pedro V., taking an easier view, did

not see that it mattered. A hospital, constructed for adults, but

intended for children, would, His Majesty pleasantly suggested, "only

give the children more room and more air." The King had to be given a

lesson in the niceties of hospital construction. The architect and Miss

Nightingale set to work again on amended plans. Her suggestions were

warmly approved, on the Prince Consort's behalf, by Sir James Clark, and

Dom Pedro sent her a cordial letter of thanks.

[308] Under-Secretary for War, when Mr. Herbert was made a Peer.

At home she took similar pains with plans for the Bucks County Infirmary

at Aylesbury; but here it was easier sailing, for the chairman of the

Committee was her brother-in-law, Sir Harry Verney, and it was promptly

decided (1860) to rebuild the Infirmary "in accordance with the

requirements specified in Miss Nightingale's _Notes on Hospitals_." In

another county hospital, that at Winchester, she took the more interest,

because one of her father's properties (Embley) was in the county. There

is a specially voluminous correspondence on the subject, largely with

Sir William Heathcote (chairman of the Governors),[309] extending over

several years. The old hospital was admittedly bad, but the first idea

was to patch it up. Miss Nightingale took infinite pains in working up

the case against this course. She studied the report which Sir Robert

Rawlinson, the sanitary engineer, had sent in; and she tabulated the

statistics of mortality, comparing them with those of well-appointed

hospitals on healthy sites. Thus armed, she told the Committee roundly

that they were proposing to sink money in patching up a "pest-house,

where a number of people are exposed to the risk of fatal illness from a

special hospital disease." Was Hampshire eager, she asked, to emulate

the evil fame of Scutari? Then she tackled the financial problem. She

compared the estimated cost of "adaptation" with that of building a new

hospital on a better site. She submitted plans and details of her

estimate. She promised the advice of Dr. Sutherland in the choice of a

new site. "I understand," she wrote, "that Lord Ashburton will give

£1000 towards a new hospital, if built upon a new site; if not,

nothing." As Lady Ashburton was one of her dearest friends, this

condition was probably not unprompted. On the same condition, she

promised contributions from herself and her father. She collected and

sent in the opinions of eminent experts--civil engineers and medical

officers--on the question. She prodded friends possessing local

influence: "Would you please," she wrote to Captain Galton (Feb. 10,

1861), "devote the first day of every week until further notice in

driving nails into Jack Bonham Carter,[310] M.P., about the Winchester

Infirmary?" In the end she carried her point, and a new hospital was

built by Mr. Butterfield on a higher and healthier site. "It is the

greatest pleasure," the architect wrote to her (Dec. 1863), "to try and

work out the views of one who is ably and earnestly endeavouring to make

a reformation." Among other institutions upon which she advised, in this

(1860) or immediately ensuing years, were the Birkenhead Hospital, the

Chorlton Union Infirmary, the Coventry Hospital, the Guildford (Surrey

County) Hospital, the Leeds Infirmary, the Malta (Incurables) Hospital,

the Putney Royal Hospital for Incurables, the North Staffordshire

Infirmary, and the Swansea Infirmary. Correspondence from foreign

countries, and a collection of tracts upon Hospital Construction (1863)

sent to her from France and Belgium, show that the "reformation" was

widespread. In India also her book was found useful. "It arrived in the

nick of time," wrote Sir Charles Trevelyan, the Governor of Madras (Aug.

10, 1859), "as you will see by the accompanying note from Major Horsley,

the engineer entrusted with the preparation of the plan of the addition

to our General Hospital."

[309] Mr. Nightingale bought Embley from the Heathcote family.

[310] Eldest son of the John Bonham Carter mentioned above (p. 29); M.P.

for Winchester; first cousin of Miss Nightingale and of Mrs.

Galton.

II

Like other reformers, Miss Nightingale encountered an occasional defeat.

One was at Manchester in a cause wherein she was enlisted by a friend of

Cobden, Mr. Joseph Adshead. He saw something of Miss Nightingale during

these years, and corresponded voluminously with her. He is the subject

of one of her clever and vivid character-sketches--a sketch which throws

interesting side-lights on her own character too:--

(_Miss Nightingale to Samuel Smith._) BURLINGTON, _Feb._ 25,

[1861]. DEAR UNCLE SAM--Adshead of Manchester is dead--my best

pupil.... How often I have called him my "dear old Addle-head," and

now he is dead. He was a man who could hardly write or speak the

Queen's English; I believe he raised himself, and was now a kind of

manufacturer's agent in Manchester. He was a man of very ordinary

abilities and commonplace appearance--vulgar, but never

unbusiness-like, which is, I think, the worst kind of vulgarity.

Having made "a competency," he did not give up business, but

devoted himself to good works for Manchester. And there is scarcely

a good thing in Manchester, of which he has not been the

main-stay or the source--schools, infirmary, paving and draining,

water-supply, etc., etc. At 60, he takes up an entirely new subject,

Hospital Construction, fired by my book, and determines to master it.

This is what I think is peculiarly Anglo-Saxon. He writes to me

whether I will teach him (this is about 18 months ago), and composes

some plans for a Convalescent Hospital _out of_ Manchester, to become

their main Hospital if the wind is favourable. He comes up to London

to see me about these. The working plans passed eight times thro' my

hands and gave me more trouble than anything I ever did. Because

Adshead would not employ a proper builder, but would do them himself--

which is part of the same character, I believe. The plans are now

quite ready, but nothing more. He meant to _beg in person_ all over

Lancashire, and had already some promises of large sums. He had been

asking for about a year, but never intermitted anything. I don't know

whether you remember that I had a three-months' correspondence with

him (and oh! the immense trouble he took) about the transplantation of

the Spitalfields and Coventry weavers to Manchester, Preston,

Burnley, etc.[311] ... It never came to anything.... He was 61 when

he died. This is the character which I believe is quite peculiar to

our race--a man, a common tradesman, who--instead of "retiring from

the world" to "make his salvation," or giving himself up to science

or to his family in his old age, or founding an Order, or building

a housewill patiently (at 60) learn new dodges and new-fangled

ideas in order to benefit his native city.... How I do feel that it

is the strength of our country and worth all the R. Catholic

"Orders" put together. I hate an "Order," and am so glad I was

never "let in" to form one....

[311] Miss Sellon had called her attention to the sad plight through

unemployment of the Spitalfields weavers, as had Mr. and Mrs.

Bracebridge to that of those at Coventry. Miss Nightingale, with

help from Mr. Bracebridge, enlisted Mr. Adshead in a scheme for

migrating them to Lancashire. He and she took infinite pains in

the matter, but the scheme came to little. When it reached the

point, Miss Sellon's friends were not ready to go.

Mr. Adshead had taken a prominent part in a movement to get the

Manchester Royal Infirmary condemned as insanitary, and to rebuild it in

better air outside the city boundaries. Miss Nightingale, though she did

not join publicly in the controversy, plied Mr. Adshead with powder and

shot. But they were defeated. Manchester decided to patch and not to

rebuild.

In the case of St. Thomas's Hospital in London, which was confronted

from a different cause with the same choice, she was successful.

Hospital officials, when in difficulty, not infrequently "went to Miss

Nightingale." This was the case with Mr. Whitfield, the Resident Medical

Officer of St. Thomas's (then on its ancient site in the Borough), when

the future of the Hospital was threatened by the projected extension of

the South-Eastern Railway from London Bridge to Charing Cross. The

Railway Company sought powers to take some of the Hospital's land, and

the opinion of the Governors was likely to be divided on the policy to

be pursued. Mr. Whitfield was from the first in favour of the course

which ultimately prevailed; the Railway Company should be compelled to

buy all the Hospital's land or none, and in the former event the

Hospital should be rebuilt on a healthier site and on an improved plan.

But there were others who were disposed to take the line of least

resistance, and to be content with rebuilding on the old or an adjacent

site so much as the railway works made necessary. Mr. Whitfield opened

the case to Miss Nightingale in February 1859, and besought her aid; she

entirely agreed with him, and threw herself whole-heartedly into the

matter. Among the Governors of the Hospital was the Prince Consort, to

whom she sent a careful memorandum. The Prince went into the case with

his usual thoroughness, and ultimately concurred in Miss Nightingale's

views. He was scrupulous, as the correspondence shows, to avoid any

interference with the parliamentary side of the case, but he let it be

known, among his colleagues on the Board of Governors, what his opinion

was upon the best policy for the Hospital to pursue, in the event of

Parliament leaving it any option. "Your intervention with Prince

Albert," wrote Mr. Whitfield presently to Miss Nightingale, "has wrought

wonders." But there were still two opinions. There was a strong party

which attached more importance to retaining the Hospital on its old

site, "in the midst of the people whom it served," than to removing it

to one which might be more salubrious, but must be more distant. This is

a controversy which continually recurs. Miss Nightingale took immense

pains in working up the case for removal. She resorted, as usual, to a

statistical method. She analysed the place of origin of all the cases

received; tabulated the percentages in various radii; and showed that

the removal of the hospital to such and such distances would affect a

far smaller percentage of patients than was commonly supposed. Then she

made out sums in proportion, setting, on the one side, so much

inconvenience and conceivable danger in making a smaller number of

patients take a little longer time in reaching the Hospital; and, on the

other, the greater convenience and larger chance of recovery which all

the patients alike would have in better surroundings. At the end of 1860

the critical moment arrived. The Railway Company had served the Hospital

with notice to decide within twenty-one days. Mr. Whitfield wrote to

Miss Nightingale in a state of considerable flurry. He was by no means

certain how the voting would go; every vote and every influence were

important; could she not whisper once more in the Prince Consort's ear?

She wrote to the Palace forthwith; and the Prince communicated his views

to the Court of Governors on her side. And not only on her side. "You

will find in the Prince's letter," she was told by one of those behind

the scenes, "your own arguments and sometimes even your own words

embodied." Ultimately the Governors decided as Miss Nightingale wished.

The Railway Company was required to take all or none of the Hospital's

land. It took all and, as usually happens in railway cases, the price

was not suffered to err on the side of moderation. St. Thomas's Hospital

was removed to temporary buildings on the old Surrey Gardens, and there

remained till the present Hospital was completed in 1871.

A fair American visitor, taking tea upon the terrace of the Houses of

Parliament, and looking across the river to the sevenfold splendours

opposite, is said to have inquired, "Are those the mansions of your

aristocracy?" They are only instances of the reform which Miss

Nightingale introduced in Hospital construction, being the "pavilions"

of St. Thomas's. But Miss Nightingale was never consulted, I feel sure,

upon the architectural ornament of the parapets. Her sense of humour

would have made short work of the urns which, as some one has suggested,

seem waiting for the ashes of the patients inside.

CHAPTER II

THE PASSIONATE STATISTICIAN

(1859-1861)

Full and minute statistical details are to the lawgiver, as the

chart, the compass, and the lead to the navigator.--LORD BROUGHAM.

I remember hearing the first Lord Goschen make a speech in Whitechapel

many years ago, in which he avowed that for his part he was "a

passionate statistician." "Go with me," he said, "into the study of

statistics, and I will make you all enthusiasts in statistics." Mr.

_Punch_ parodied Marlowe thereupon, and invited his readers to "all the

pleasures prove That facts and figures can supply Unto the Statist's

ravished eye." I do not know whether any large response to the

invitation was forthcoming from Lord Goschen's hearers or Mr. _Punch's_

readers; though, since the day when Lord Goschen spoke, social reformers

have more and more guided their schemes by the chart and compass of

statistics. If Miss Nightingale saw the speech, it fell upon eyes long

ago opened. A fondness for statistical method, a belief in its almost

illimitable efficacy, was one of her marked characteristics.

* * * * *

Few books made a greater impression on Miss Nightingale than those of

Adolphe Quetelet, the Belgian astronomer, meteorologist, and

statistician; and she had few friends whom she valued more highly than

Dr. William Farr, the leading statistician of her day in this country.

From his meteorological studies, Quetelet deduced a law of the flowering

of plants. One of his cases was the lilac. The common lilac flowers,

according to Quetelet's law, when the sum of the squares of the mean

daily temperatures, counted from the end of the frosts, equals 4264°

_centigrade_. Miss Nightingale was greatly interested in such

calculations, and the lilac had a special place in her year. Lady

Verney's birthday was April 19, and a branch of flowering lilac was

Florence's regular birthday present to her sister. Miss Nightingale used

to talk of Quetelet's law with great delight, and commended it to

gardening friends for verification in their Naturalist's Diaries. But

this is a lighter example of Quetelet's researches. What fascinated Miss

Nightingale most was his _Essai de physique sociale_ (first published in

1835), in which he showed the possibility of applying the statistical

method to social dynamics, and deduced from such method various

conclusions with regard to the physical and intellectual qualities of

man. In regard to sanitation, we have heard already of the reforms which

Miss Nightingale was instrumental in carrying out in Army Medical

Statistics. She turned next to the question of Hospital Statistics,

where improvement seemed desirable both for the surer advance of medical

knowledge and in the interests of good administration.

Miss Nightingale had been painfully impressed during the Crimean War

with the statistical carelessness which prevailed in the military

hospitals. Even the number of deaths was not accurately recorded. "At

Scutari," she said, "three separate registers were kept. First, the

Adjutant's daily Head-roll of soldiers' burials, on which it may be

presumed no one was entered who was not buried, although it is possible

that some may have been buried who were not entered. Second, the Medical

Officers' Return, in regard to which it is quite certain that hundreds

of men were buried who never appeared upon it. Third, the return made in

the Orderly Room, which is only remarkable as giving a totally different

account of the deaths from either of the others."[312] When Miss

Nightingale came home, and began examining Hospital Statistics in

London, she found, not indeed such glaring carelessness as this, but a

complete lack of scientific co-ordination. The statistics of hospitals

were kept on no uniform plan. Each hospital followed its own

nomenclature and classification of diseases. There had been no reduction

on any uniform model of the vast amount of observations which had been

made. "So far as relates," she said, "either to medical or to sanitary

science, these observations in their present state bear exactly the same

relation as an indefinite number of astronomical observations made

without concert, and reduced to no common standard, would bear to the

progress of astronomy."[313]

[312] _A Contribution_, p. 3 (Bibliography A, No. 14).

[313] _Hospital Statistics_ (Bibliography A, No. 28).

Miss Nightingale set herself to remedy this defect. With assistance from

friendly doctors on the medical side, and of Dr. Farr, of the

Registrar-General's Office, on the statistical, she prepared (1) a

standard list, under various Classes and Orders, of diseases, and (2)

model Hospital Statistical Forms. The general adoption of her Forms

would, as she wrote, "enable us to ascertain the relative mortality in

different hospitals, as well as of different diseases and injuries at

the same and at different ages, the relative frequency of different

diseases and injuries among the classes which enter hospitals in

different countries, and in different districts of the same countries."

Then, again, the relation of the duration of cases to the general

utility of a hospital had never been shown. Miss Nightingale's proposed

forms "would enable the mortality in hospitals, and also the mortality

from particular diseases, injuries, and operations, to be ascertained

with accuracy; and these facts, together with the duration of cases,

would enable the value of particular methods of treatment and of special

operations to be brought to statistical proof. The sanitary state of the

hospital itself could likewise be ascertained."[314] Having formed her

plan, Miss Nightingale proceeded with her usual resourcefulness to

action. She had her Model Forms printed (1859), and she persuaded some

of the London hospitals to adopt them experimentally. Sir James Paget at

St. Bartholomew's was particularly helpful; St. Mary's, St. Thomas's,

and University College also agreed to use the Forms. She and Dr. Farr

studied the results, which were sufficient to show how large a field for

statistical analysis and inquiry would be opened by the general adoption

of her Forms.

[314] _Hospital Statistics_. Of course the statistics would have to be

interpreted.

The case was now ready for a further move. Dr. Farr was one of the

General Secretaries of the International Statistical Congress which was

to meet in London in the summer of 1860. He and Miss Nightingale drew up

the programme for the Second Section of the Congress (Sanitary

Statistics), and her scheme for Uniform Hospital Statistics was the

principal subject of discussion. Her Model Forms were printed, with an

explanatory memorandum; the Section discussed and approved them, and a

resolution was passed that her proposals should be communicated to all

the Governments represented at the Congress. She took a keen interest in

all the proceedings, and gave a series of breakfast-parties, presided

over by her cousin Hilary, to the delegates, some of whom were

afterwards admitted to the presence of their hostess upstairs. The

foreign delegates much appreciated this courtesy, as their spokesman

said at the closing meeting of the Congress; "all the world knows the

name of Miss Nightingale," and it was an honour to be received by "the

illustrious invalid, the Providence of the English Army." The written

instructions sent by "the Providence" to her cousin for the

entertainment of the guests show her care for little things and her

knowledge of the weaknesses of great men: "Take care that the cream for

breakfast is not turned." "Put back Dr. X.'s big book where he can see

it when drinking his tea." Miss Nightingale also induced her friend Mrs.

Herbert to invite the statisticians to an evening party. The feast of

statistics acted upon her as a tonic. "She has been more than usually

ill for the last four or five weeks," wrote her cousin Hilary (July 12);

"now I cannot help thinking that her strength is rallying a little; she

is much interested in the Statistical Congress." Congresses, like wars,

are sometimes "muddled through" by our country, and Miss Nightingale was

able here and there to smooth ruffled plumes. A distinguished friend of

hers, though his name had been printed as one of the secretaries of a

Section, had not received so much as an intimation of the place of

meeting; he was disgusted at so unbusiness-like an omission, and was

half inclined to sulk in his tents. Miss Nightingale's letter on the

subject is characteristic:--

(_Miss Nightingale to Dr. T. Graham Balfour._) 30 OLD BURLINGTON ST.,

_July_ 12 [1860]. You are quite right in what you say. We are

all of us in the same boat. And, if it were not that England _would

not be_ the mercantile nation she _is_, if she had not business

habits somewhere, I should wonder from my experience where they

are. Certain of us, who were asked to do business for the

Statistical Congress, had it all ready since December last--and

were not able to get it out of the Registrar-General's Office till

this week. Certain of us were asked to do business this morning,

and to have it ready by to-night, which, if _not_ done, would

arrest the proceedings of the Congress, and, _if_ done, must be the

fruit of only five hours' consideration, when five months might

just as well have been granted for it. I don't say that this is so

bad as the treatment of you who are Secretary. But still it is

provoking to see a great International business worked in this way.

What I want now is to put a good face upon it before the

foreigners. Let _them_ not see our short-comings and disunions. Many

countries, far behind us in political business, are far before us in

organization-power. If any one has ever been behind the scenes, living

in the interior, of the Maison Mère of the "Sisters of Charity" at

Paris, as I have--and seen their Counting House and Office, all worked

by women,--an Office which has twelve thousand Officials (all women)

scattered all over the known world--an office to compare with which,

in business habits, I have never seen any, either Government or

private, in England--they will think, like me, that it is this mere

business-power which keeps these enormous religious "orders" going.

I hope that you will try to impress these foreign Delegates, then,

with a sense of _our_ "enormous business-power" (in which I don't

believe one bit), and to keep the Congress going. Many thanks for

all your papers. I trust you will settle some sectional business

with the Delegates here to-morrow morning. And I trust I shall be

able to see you, if not to-morrow morning, soon.

Mind, I don't mean anything against _your_ Office by this tirade.

On the contrary, I believe it is one of the few efficient ones now

in existence.

Having received the _imprimatur_ of an International Congress, Miss

Nightingale circulated her paper on Hospital Statistics widely among

medical men and hospital officials. Thereby she produced immediate

effect. She printed large quantities of her Model Forms, and supplied

them, on request, to hospitals in various parts of the country. Through

the good offices of M. Mohl, she also worked upon public opinion in

France. "Some months ago," she wrote to Dr. Farr (Oct. 20, 1860), "I got

inserted into the leading medical journals of Paris an article on the

proposed Hospital Registers; and you see they are at work." The London

Hospitals took the matter up. Guy's printed a statistical analysis of

its cases from 1854 to 1861; St. Thomas's, of its from 1857 to 1860; St.

Bartholomew's, a table of its cases for 1860. With regard to the future,

a meeting was held at Guy's Hospital on June 21, 1861, and it was

unanimously agreed--by delegates from Guy's, St. Bartholomew's, St.

Thomas's, the London, St. George's, King's College, the Middlesex, and

St. Mary's--that the Metropolitan Hospitals should adopt one uniform

system of Registration of Patients; that each hospital should publish

its Statistics annually, and that Miss Nightingale's Model Forms should

as far as possible be adopted. She called further attention to her

scheme in a paper sent to the Social Science Congress at Dublin in

August 1861,[315] and incorporated it in a later edition of her _Notes

on Hospitals_. The statistics of the various hospitals which had

accepted her Forms were published in the _Journal of the Statistical

Society_ for September 1862, but I do not find that the experiment has

been continued. So far from there being any uniform hospital statistics,

of the kind contemplated by Miss Nightingale, even in London some of the

hospitals do not keep, or at any rate do not publish, any at all. The

laboriousness, and therefore the costliness, of the work of compilation,

the difficulty of securing actual, as well as apparent, uniformity, and

a consequent doubt as to the value of conclusions deduced from the

figures are presumably among the causes which have defeated Miss

Nightingale's scheme. Some limited portion of her object is perhaps

attained by the statistical data which the administration of King's

Hospital Fund demands, but even here there are possibilities of

misleading comparison. There is probably no department of human inquiry

in which the art of cooking statistics is unknown, and there are

sceptics who have substituted "statistics" for "expert witnesses" in

the well-known saying about classes of false statements. Miss

Nightingale's scheme for Uniform Hospital Statistics seems to require

for its realization a more diffused passion for statistics and a greater

delicacy of statistical conscience than a voluntary and competitive

system of hospitals is likely to create.

[315] See Bibliography A, No. 28.

At the time she was full of hope, and, having obtained a start with

medical statistics, she next pursued the subject in relation to surgical

operations. Sir James Paget had been in communication with her on this

point. "We want," he had written (Feb. 18, 1861), "a much more exact

account and a more particular record of each case. Thus in some returns

we have about 40 per cent of the deaths ascribed to 'exhaustion,' in

others, referring to the same [kind of] operations, about 3 per cent or

less; the truth being that in nearly all cases of 'exhaustion' there was

some cause of death which more accurate inquiry would have ascertained."

Miss Nightingale (May 1, 1861) congratulated him on "St. Bartholomew's

having the credit of the first Statistical Report worth having," but the

table of operations was still, she thought, most unsatisfactory. "It

would be most desirable that an uniform Table should be adopted in all

Hospitals, including all the elements of age, sex, accident, habit of

body, nature of operation, after-accidents, etc., etc. Could you come in

to-morrow between 2 and 4, and bring your list of the causes of death

after operations? It would be invaluable, coming from such an authority,

for constructing a Form." She consulted other surgeons, civil and

military, and wrote a paper, with Model Forms, for the International

Statistical Congress held at Berlin in September 1863. These also were

included in a revised edition of _Notes on Hospitals_. The Royal College

of Surgeons referred the subject to a Committee, which, however,

reported adversely upon Miss Nightingale's Forms.

II

Before the International Congress at London in 1860 separated, Miss

Nightingale addressed a letter to Lord Shaftesbury (President of the

Second Section), which was read to the whole Congress, and adopted by it

as a resolution. The point of it was to impress upon Governments the

importance of publishing more numerous abstracts of the large amount of

statistical information in their possession. She gave various instances

in which useful lessons might thus be enforced upon the public mind, and

cited Guizot's words: "Valuable reports, replete with facts and

suggestions drawn up by committees, inspectors, directors, and prefects,

remain unknown to the public. Government ought to take care to make

itself acquainted with, and promote the diffusion of all good methods,

to watch all endeavours, to encourage every improvement. With our habits

and institutions, there is but one instrument endowed with energy and

power sufficient to secure this salutary influence--that instrument is

the press." With Miss Nightingale statistics were a passion and not

merely a hobby. They did, indeed, please her, as congenial to the nature

of her mind. Her correspondence with Dr. Balfour and Dr. Farr shows how

she revelled in them. "I have a New Year's Gift for you," wrote Dr. Farr

(Jan. 1860); "it is in the shape of Tables, as you will conjecture." "I

am exceedingly anxious," she replied, "as you may suppose, to see your

charming Gift, especially those Returns showing the deaths, admissions,

diseases," etc., etc. But she loved statistics, not for their own sake,

but for their practical uses. It was by the statistical method that she

had driven home the lessons of the Crimean hospitals. It was the study

of statistics that had opened her eyes to the preventable mortality

among the Army at home, and that had thus enabled her to work for the

health of the British soldier. She was already engaged on similar

studies in relation to India. She was in very serious, and even in

bitter, earnest a "passionate statistician." And the passion, as will

appear in a later chapter,[316] was even a religious passion.

[316] See below, p. 480.

Miss Nightingale made a valiant attempt to extend the scope of the

Census of 1861 in the interest of collecting statistical data for

sanitary improvements. There were two directions in which she desired to

extend the questions. One was to enumerate the numbers of sick and

infirm on the Census day. For sanitary purposes it would be extremely

useful to determine the proportion of sick in the different parts of the

country. To those who said that it could not be done, because the people

would not give the information, the answer was that it had been done in

Ireland. The other point was to obtain full information about house

accommodation; facts which, as would now be considered obvious, have a

vital bearing on the sanitary and social conditions of the people. This

point also had been covered in the Irish Census. Dr. Farr entirely

agreed with Miss Nightingale, but he could not persuade Sir George

Lewis, the Home Secretary, to include these provisions in the Census

Bill (1860). Miss Nightingale thereupon drew up a memorandum on the

subject, and, through Mr. Lowe (Vice-President of the Council),

submitted it to the Home Secretary. Mr. Lowe may have agreed with her,

but he failed to persuade his colleague. "Whenever I have power," wrote

Mr. Lowe (May 9), "you can always command me, but official omnipotence

is circumscribed in the narrow limits of its own department." Sir George

Lewis replied that "both of Miss Nightingale's points had been duly

considered before the Census Bill was introduced. It was thought that

the question of health or sickness was too indeterminate." "With regard

to an enumeration of houses, it was thought that this is not a proper

subject to be included in a Census of population." A very official

answer! But Sir George added that he did not see how the result of such

enumeration could be "peculiarly instructive"--an avowal which he also

made in the House of Commons. The cleverest of men are sometimes dense;

and this remark of Sir George Lewis, added to his subsequent conduct of

the War Office, earned for him, in Miss Nightingale's familiar

correspondence, the sobriquet of "The Muff." In communicating the result

of her first attempt to Dr. Farr, she said, "If you think that anything

more can be done, pray say so. I'm your man." But she had not waited to

be spurred on. She had already bethought herself of a second string in

the House of Lords. Lord Shaftesbury, to whom she had appealed, promised

to do all he could. Lord Grey did the same, and asked her to send Dr.

Farr to coach him. She began to "thank God we have a House of Lords":--

(_Miss Nightingale to Robert Lowe._) OLD BURLINGTON ST., _May_ 10

[1860]. I cannot forbear thanking you for your letter and for your

exertions in our favour. Sir George Lewis's letter, _being

interpreted_, means: "Mr. Waddington does not choose to take the

trouble." It is a letter such as I have scores of in my possession,

from Airey, Filder, and alas! from Lord Raglan, from Sir John Hall

(the doctor) and from Andrew Smith. It is a true "Horse Guards"

letter.

They are the very same arguments that Lord John used against the

feasibility of registering the "cause of death" in '37--which has now

been the law of the land for 23 years. He was beaten in the Lords. And

we are now going to fight Sir George Lewis in the Lords. And we hope

to beat him too. It is mere child's play to tell us that what every

man of the millions who belong to Friendly Societies does every day of

his life, as to registering himself sick or well, cannot be done in

the Census. It is mere childishness to tell us that it is not

important to know what houses the people live in. The French Census

does it. The Irish Census tells us of the great diminution of mud

cabins between '41 and '51. The connection between the _health_ and

the _dwellings_ of the population is one of the most important that

exists. The "diseases" can be obtained approximately also. In all the

more important--such as smallpox, fevers, measles, heart-disease,

etc.--all those which affect the _national_ health, there will be

very little error. (About ladies' nervous diseases there will be a

great deal.) Where there is error in these things, the error is

uniform, as is proved by the Friendly Societies; and corrects

itself....

The passionate statisticians were, however, hopelessly out-voted in the

House of Commons. Mr. Caird moved in her sense on the subject of fuller

detail about house-accommodation, and in sending her the printed notice

of his amendment, said that "his position would be greatly strengthened

with the House if he could obtain Miss Nightingale's permission to quote

her name in favour of the usefulness of such an inquiry." I do not know

whether she gave permission; the debate is reported very briefly in

Hansard. But in any case Mr. Caird's amendment was promptly negatived.

As for the House of Lords, Miss Nightingale's reliance upon a better

love of statistics in that assembly was cruelly falsified. The Census

Bill came up late in the session, and I do not find that either Lord

Grey or Lord Shaftesbury said a word upon the subject. The only critical

contribution made to the debate proceeded from Lord Ellenborough, who,

so far from wanting the Census Bill to include provision for more

statistical data, proposed to exclude most of those that were already

in. He could not for the life of him see what was the use of asking

people so many questions.[317] Here, then, Miss Nightingale was in

advance of the time; in one case, by a generation, in the other, by two

generations. Recent Censuses have included more particulars of the

housing of the people, though still not so many as she wanted. Official

statistics of the local distribution of sickness will presently be

obtained, I suppose, in a different way, through the machinery of the

National Health Insurance Act.

[317] Lords' debate, July 24; principal Commons' debate, July 12, 1860.

* * * * *

Deprived by the recalcitrance of the Home Secretary and Parliament of a

fuller feast of statistics at home, Miss Nightingale turned to the

Colonies and Dependencies. The Secretary for the Colonies gave her

facilities for collecting much curious and instructive information; and

the Secretary for India accepted her aid in collecting and tabulating

facts and figures which were the foundation of some of the most notable

and beneficent of her labours. But, though she was already (1860-1)

engaged in these inquiries, they belong in the main to a later period;

and we must now turn to another side of Miss Nightingale's work for the

improvement of the National Health.

CHAPTER III

THE FOUNDER OF MODERN NURSING

(1860)

Where is the woman who shall be the Clara or the Teresa of Protestant

England, labouring for the certain benefit of her sex with their

ardour, but without their delusion?--SOUTHEY'S _Colloquies_ (1829).

The nineteenth century produced three famous persons in this country who

contributed more than any of their contemporaries to the relief of human

suffering in disease: Simpson, the introducer of chloroform; Lister, the

inventor of antiseptic surgery; and Florence Nightingale, the founder of

modern nursing. The second of the great discoveries completed the

beneficent work of the first. The third development--the creation of

nursing as a trained profession--has co-operated powerfully with the

other two, and would have been beneficent even if the use of anæsthetics

and antiseptics had not been discovered. The contribution of Florence

Nightingale to the healing art was less original than that of either

Simpson or Lister; but perhaps, from its wider range, it has saved as

many lives, and relieved as much, if not so acute, suffering as either

of the other two.

* * * * *

The profession of nursing is at once very old and very new; and the

place of Miss Nightingale in the history of it has not always been

rightly understood. Nursing--and even nursing by educated women--is very

old. "She herself nursed the unhappy, emaciated victims of hunger and

disease. How often have I seen her wash wounds whose fetid odour

prevented every one else from even looking at them! She fed the sick

with her own hands, and revived the dying with small and frequent

portions of nourishment. I know that many wealthy persons cannot

overcome the repugnance caused by such works of charity. I do not judge

them; but, if I had a hundred tongues and a clarion voice, I could not

enumerate the number of patients for whom she provided solace and care."

This passage, which is not unlike some of the panegyrics showered upon

Florence Nightingale's work during the Crimean War, was written, nearly

fifteen centuries earlier, by St. Jerome in describing the work of

Fabiola, a lady of patrician rank, who in 390 A.D. built a hospital at

Rome, where she devoted herself to the care of the sick. Female nursing

is as old as Christianity, and for centuries the religious Orders had

sent cultivated women into the hospitals. The very name of "Sister," now

applied to a rank in the nursing profession in general, recalls its

historical origin in religious enthusiasm. Nor was there anything novel

in the mere fact, though there was much that was novel in the method, of

Miss Nightingale's service as a war-nurse. It was novel in the case of

the British Army, but in that of other countries Sisters had already

accompanied armies to the field. And, again, it was not an original

conception on Miss Nightingale's part that nurses should be trained for

their work. Her master, Theodor Fliedner, had shown the way in Germany;

and in our own country Mrs. Fry's Institute of Nursing was established

in 1840, and the St. John's House in 1848, Miss Nightingale's, at St.

Thomas's, not till 1860.

Nevertheless, though not the founder of nursing, Florence Nightingale

was the founder of modern nursing. It is not always realized how modern

is the institution of nursing, on any large scale as a distinct and

trained calling. I have indicated above the three lines of

influence--religion, war, and science--along which the development of

sick-nursing has proceeded. Miss Nightingale came at the psychological

moment to give it a vast impetus upon each of those lines. Religion was

tending to become less abstract, and more closely allied to the service

of man. Miss Nightingale was the St. Clara or the St. Teresa of the new

order, for whom Southey had called. She was prepared, by her experience,

by the character of her mind, by the drift of her philosophical

speculations, not to imitate old forms, but to create a new order, an

order of nurses who should, indeed, be devoted to their calling, but

should be organized on a secular basis. The deeply religious bent of

Miss Nightingale's character, the single-mindedness of her purpose, and

her constant appeal to high ideals, enabled her to give to (or at any

rate to require from) the Seculars of the new order something of the

devotion possessed by the religious Regulars. The Crimean War, in which

Miss Nightingale was one of the central figures, gave further force to a

movement for increasing the number and improving the qualification of

nurses. It enlisted sentiment in the cause. The American Civil War (in

which, as we shall hear presently, Miss Nightingale's example played a

great part) extended the movement to the United States, and the Red

Cross organization may also be considered as an outcome of her work in

the Crimea. The progress of science was tending in a like direction.

Medicine and surgery were on the eve of receiving great developments.

Sanitary science was already making advance. At the time when Florence

Nightingale was in training at Kaiserswerth, Joseph Lister was a medical

student at University College. Cohn, the founder of bacteriology, was

only eight years her junior. Parkes, one of the founders of modern

hygiene, was almost exactly her contemporary. It was inevitable that

nursing also should be developed in a scientific spirit, and no one was

better qualified than Miss Nightingale to take the lead in such a

movement. Her experience in the East had filled her with a passionate

conviction of the importance of sanitary science. She was the centre of

a circle of earnest and devoted men who were devoting themselves to it.

She was personally acquainted with many of the leading physicians and

surgeons of the day. And there was yet a fourth line upon which Miss

Nightingale might seem to be predestined for this special work. What is

called the "woman's movement" was beginning. "There is an old legend,"

wrote Miss Nightingale, at the beginning of her pamphlet on

Kaiserswerth, "that the nineteenth century is to be the 'century of

women.'" At the time when she wrote (1851), the century, she added, had

not yet been theirs. But there was a spirit stirring the waters. Other

notable women were at work, claiming for their sex a place in the sun

of the world's work. Miss Nightingale was not wholly sympathetic to what

she called "woman's missionariness." But the circumstances of her own

life, as the First Part of this Memoir has shown, made her intensely

interested in claiming that a woman should not be debarred from entering

a walk of life to which she is fitted simply because she is a woman; and

of such walks of life, nursing is obviously one. Controversy is

perennial between those who ascribe the course of political or social

history mainly to great men, and those who ascribe it rather to streams

of tendency. It is less open to controversy to say that the great men

who leave the more permanent mark upon history are those whose genius

conforms to the spirit of their time, but who are yet a little in

advance of their age. Among such "great men" the founder of modern

nursing is to be reckoned.

II

In what precise respect, it may be asked, did Florence Nightingale

"found" modern nursing? The answer to this question may, I think, be

disentangled without much difficulty from a good deal of conflicting

statement. I have referred already, in connection with the fettering

scruples of Miss Nightingale's parents,[318] to a conflict of evidence

upon the morals of hospitals and hospital nurses in the middle of the

nineteenth century. Her own opinion at that time (and she did not

express it without much inquiry and observation) is given in the

pamphlet, above mentioned, where she says that hospitals were "a school,

it may almost be said, for immorality and impropriety--inevitable where

women of bad character are admitted as nurses, to become worse by their

contact with male patients and young surgeons.... We see the nurses

drinking, we see the neglect at night owing to their falling

asleep."[319] Such statements were indignantly denied by other

authorities, equally well qualified to form a correct judgment.

Controversy broke out upon the subject a few years later in connection

with the Nightingale Memorial Fund. A correspondent of the _Times_, who

signed himself "One who has walked a good many Hospitals," gave in

1857[320] the same kind of account that Miss Nightingale had given in

1851. He was answered, and his statements were hotly denied.[321]

Obviously there were hospitals and hospitals, and still more there were

nurses and nurses, and no _general_ indictment was just on the point of

morals. Upon the question of drinking among nurses, both in hospitals

and in private service, there is less room for doubt. Dickens was a

caricaturist, but he was an effective caricaturist; and no caricature is

effective in its day unless it bears considerable resemblance to the

truth. In his preface he spoke of Mrs. Gamp as a fair representation, at

the time _Martin Chuzzlewit_ was published, of the hired attendant on

the poor; and he might have added, says his biographer, that the rich

were no better off, for the original of Mrs. Gamp "was in reality a

person hired by a most distinguished friend of his own a lady, to take

charge of an invalid very dear to her."[322] This one can the more

readily understand in the light of a remark by Lady Palmerston quoted

above.[323] "'Mrs. Gamp,' said Mrs. Harris, 'if ever there was a sober

creetur to be got at eighteen pence a day for working people, and three

and six for gentlefolks, you are that inwallable person.'" Great ladies

clearly thought that such persons existed only, and could only be

expected to exist, in the world of imagination and of Mrs. Harris. In

1854, Miss Mary Stanley, or a friend of hers, sent out a circular, very

possibly with the knowledge of Miss Nightingale, to various persons

connected with hospitals and infirmaries, of which the object was to

suggest that nurses should be instructed, on the Kaiserswerth plan, in

the art of administering religious comfort to patients. The replies

which were subsequently printed[324] throw much light upon the position

of nurses at the time. "If I can but obtain a sober set," wrote a doctor

in the North, "it is as much as I can hope for." "I enquired for Dr.

X.," said another reply, "about the character of the nurses, and he

says they always engage them without any character, as no respectable

person would undertake so disagreeable an office. He says the duties

they have to perform are most unpleasant, and that it is little wonder

that many of them drink, as they require something to keep up the

stimulus." The ordinary wages were £14 to £16 a year. It should be

remembered, further, that hospital nurses had, as a rule, in the middle

of the last century no uniform dress, and cooked their own food (which

they bought for themselves), eating their meals in the ward kitchens or

scullery: "If the sister happened to be partial to red herrings for

breakfast, or onion-stew for dinner, or toasted cheese for supper, the

consequent state of the ward may be imagined. The assistant nurses had

to do all the scrubbing and cleaning of the wards, and to cook for the

other nurses and themselves."[325] A side-light is thrown on the

slovenliness of the arrangements by the account of what happened at

King's College Hospital when the nursing was taken over in 1856 by

trained nurses from St. John's House under Miss Mary Jones. "By the end

of the day the new-comers, who had arrived in clean and dainty uniforms,

were like a set of sweeps or char-women, in such an appalling state of

disorder had they found their wards."[326] There were some excellent

nurses under the old régime (apart from those trained at St. John's

House), as Sir James Paget testified[327]; though it may be noted that

even amongst his model Sisters, one was "not seldom rather tipsy." But

"the greater part of them," he says, "were rough, dull, unobservant,

untaught." The stoutest defender of the old system, the most stubborn

opponent of Miss Nightingale's reforms, gives unconsciously equal

support to Sir James Paget's statement that "in the department of

nursing there is the greatest and happiest contrast of all." Mr. South

was of opinion that all was for the best, before Miss Nightingale began

to interfere, in the best of all possible nursing worlds. But his

conception of the ideal nurse is this: "As regards the nurses or

ward-maids, these are in much the same position as housemaids, and

require little teaching beyond that of poultice-making."[328]

[318] Above, p. 60.

[319] _Kaiserswerth_, p. 15.

[320] _Times_, April 15, 1857.

[321] In a pamphlet by Mr. J. F. South, referred to below, p. 445.

[322] Forster's _Life of Dickens_, vol. ii. p. 30.

[323] Above, pp. 272-3.

[324] _Hospitals and Sisterhoods_. London, John Murray, 1854 (2nd ed.,

1855). Anonymous, but known to be the work of Miss Mary Stanley.

[325] "Report on the Nursing Arrangements of the London Hospitals" (at

the time and twenty years before) in the _British Medical Journal_,

Feb. 28, 1874.

[326] _St. John's House: a Record_, p. 10.

[327] See his Address to the Abernethian Society in 1885 given in his

_Memoir and Letters_, 1901, p. 351.

[328] _Facts relating to Hospital Nurses.... Also Observations on

Training Establishments for Hospitals_, 1857, pp. 11, 16.

From all this, facts emerge which will clearly explain wherein Miss

Nightingale's work as the founder of modern nursing consisted. She was

not entirely alone, nor was she in point of time the first, in the

field; and there were exceptional cases to which the following

statements do not apply. But she was able to do on a larger scale, and

on a scale and in a form which attracted general imitation, what others

had attempted. And speaking generally, we may say that before Miss

Nightingale appeared on the scene, nursing was, and was regarded as, a

menial occupation which did not attract women of character; that it was

ill-paid and little respected; that no high standard of efficiency was

expected; and that no training was organized: the women picked up their

knowledge in the wards. They were, as the correspondent of the _Times_

said, "meek, pious, saucy, careless, drunken, or unchaste, according to

circumstances or temperament, mostly attentive, and rarely unkind"; but,

with very few exceptions, they were untrained. "A poor woman is left a

widow with two or three children. What is she to do? She would starve on

needlework; she is unfit for domestic service; she knows nobody to give

her charring, and has no money to buy a mangle. So she gets a

recommendation from a clergyman, and is engaged as a Hospital Nurse."

The change which has come about since Miss Nightingale's work took

effect is strikingly illustrated in the Census. In 1861 there were

27,618 nurses "in hospitals, or nurses not apparently domestic

servants," and they were enumerated, in the tables of Occupations of the

People, under the head of "Domestic." In 1901 there were 64,214 nurses,

and they were enumerated under the head of "Medicine." Miss Nightingale

was the founder of modern nursing because she made public opinion

perceive, and act upon the perception, that nursing was an art, and must

be raised to the status of a trained profession. That was the essence

of the matter. Other things, such as the opening of nursing to higher

social strata, the better payment of nurses, etc., though important and

interesting, were only results.

III

The means by which Miss Nightingale achieved this great work were three.

She brought to bear upon it the force, successively, of her Example, her

Precept, and her Practice. The first two of these aspects of her work

will be considered in the remainder of the present chapter; the third is

the subject of the next chapter.

No woman, I suppose, who was not canonized or who had not worn (or been

deprived of) a crown, has ever excited among her sex so much passionate

and affectionate admiration, and set to so many an example, as Florence

Nightingale. I have tried in an earlier chapter, entitled "The Popular

Heroine," to describe the effect which her work in the Crimean War

produced upon the minds of her contemporaries. To get first-hand

impressions, the younger readers of to-day must go to their grandmothers

or great-aunts. It is they who can help us best to some imagination of

the thrill which the stories of her nursing in the Crimea excited

throughout the land, of the intensity of sympathetic admiration which

went out towards her, of the impulse towards a fuller and worthier life

which proceeded from her example. But old letters are of some assistance

too. From a packet of family letters here is one, from an aunt to a

niece: "_April_ 15, 1857. I fear from a line in one of the newspapers

that Florence Nightingale's life is approaching an end. I have been

deeply impressed by her life these last few days, which in respect of

mine forms but a fragment in regard of time, and what she has

accomplished! A high mission has been given her which has cost her her

life to fulfil."[329] In how many other minds, young and old alike, must

Florence Nightingale's example have stirred similar thoughts! A lady who

had attained high distinction as a Nightingale nurse was asked after

Miss Nightingale's death to record her recollections: "My first thoughts

of Miss Nightingale date back to that winter of frozen rivers, when

children, catching up the rumours of the street, ran about shouting

_Sebastopol's taken_; or danced, listening around the old weaver's wife

who had come to the door of her cottage to catch the last light, and

read aloud to her husband what 'Lord Raiglan' was doing and saying; or

later, in the hour before bed-time, sat at their father's feet while he

told of the frozen trenches, of the 'dreary corridors of pain,' and of

that 'ministering angel,' whose devotion was lightening a nation's

distress; or perhaps later still in sleep, dreamed children's dreams of

creeping amid sleeping Russians, stealing the golden crown from the

Czar's head, and escaping with it to Florence Nightingale! Such

experiences left indelibly impressed on the minds of the children of my

generation the gentle and heroic figure of Miss Nightingale." Often, no

doubt, the impulse was fleeting, and the broken purpose wasted in air.

And often, too, the impulse was vague, and resulted in no definite

action; yet not on that account, perhaps, to be cast aside as valueless.

"I have a belief of my own," says one of George Eliot's characters, "and

it comforts me--That by desiring what is perfectly good, even when we

don't quite know what it is, and cannot do what we would, we are part of

the divine power against evil." But often the force of Florence

Nightingale's example was direct and practical. Among those whom it

influenced in this way was Luise, the Grand Duchess of Baden, who in

1859 founded a Ladies' Society in Baden for the training of nurses. She

had never seen Miss Nightingale, but a letter filled the Grand Duchess

with enthusiastic gratitude. "I felt," she wrote (Sept. 1861), "that

both joy and strength had come to me from your dear letter. I may try

indeed to thank you for it, but I shall never succeed in expressing how

deeply and how highly I felt your kindness. If there is any progress in

the work I have so much at heart, it is greatly to your encouraging

support I owe it." Those who saw Miss Nightingale, and who were

sympathetic, felt thrilled in her presence. "She is so far more

delightful in herself," wrote Clara Novello, "than in one's

imagination." To nurses already engaged in work, Miss Nightingale's

personal influence was an inspiration. Miss Mary Jones, of King's

College Hospital, addressed her as "My beloved Friend and Mistress." "I

value your nosegay too much to part with any one flower even." "I look

on a visit to you as my one indulgence and greatest pleasure." But those

who never saw Miss Nightingale, nor even heard from her, felt the force

of her example. In what was publicly known of her career, there was, as

it were, a call and a challenge to women. Here was a woman, of high

ability and of social standing, who had forsaken all to be a nurse. She

sought to raise nursing to the rank of a High Art. She had already in

some measure done it by her example.

[329] _A Century of Family Letters_, vol. ii. p. 174.

IV

In every walk of life, however, there are those who seek the palm

without the dust. Miss Nightingale had seen already in the Crimea many

women who had followed her example, indeed, in desiring to nurse the

sick, but into whose heads it had never entered that nursing required

special gifts and careful training. Example had to be supplemented by

precept. Miss Nightingale's precepts upon the Art of Nursing were first

given to the world in 1859-60. Her _Notes on Nursing_--the best known,

and in some ways the best, of her books--was published in December 1859.

It was instantly recognized by the leaders in medical and sanitary

science as a work of first-rate importance; as one of those rare books

to which, within their range, the term epoch-making may rightly be

applied. "I am ashamed to find," wrote Sir James Paget, "how much I have

learnt from the _Notes_, more, I think, than from any other book of the

same size that I have ever read." "I am delighted with them," wrote Sir

James Clark. "They will do more to call attention to Household Hygiene

than anything that has ever been written." "This," wrote Harriet

Martineau, "is a work of genius if ever I saw one; and it will operate

accordingly. It is so real and so intense, that it will, I doubt not,

create an Order of Nurses before it has finished its work." This was a

true prediction. Miss Nightingale was the founder of a New Model, and

the _Notes on Nursing_ was its gospel.

The anticipations of her friends that the _Notes_ would be popular were

abundantly fulfilled. Here was a book by Florence Nightingale on the

very subject to which her fame was attached. The effect produced upon

many minds by _Notes upon Nursing_ was the greater because it came, as

it were, as a kind of resurrection of the popular heroine. The years

which had passed since Miss Nightingale's return from the Crimea were,

as we now know, years of ceaseless activity; years during which she had

done some of her greatest work. But it must be remembered that all this

was entirely unknown to most people at the time. The common belief was

that Miss Nightingale had retired into private life upon her return from

the Crimea; but now after a long interval she came before the public

again. And, though, as in all that she wrote for the public eye, there

was a conspicuous absence of self-advertisement, there was enough in the

book to connect many of its pages with scenes and episodes of the

Crimean War. An enthusiastic review in a paper not generally given to

enthusiasm pointed out the connection: "Hundreds of brave men attested

with their dying breath how nobly Miss Nightingale's self-imposed task

was fulfilled, and this little book would be almost enough to explain

her success. Its tone seems to tell of the solemn scenes from which

experience in such matters has to be gained. Its language is grave,

earnest, and impetuous, like that of a person who has lived among sad

realities, and has been face to face with almost every form of human

suffering."[330] Nor was it only the general tone of the book that was

suggestive of the heroine of the Crimean War. Here and there little

touches of personal experience were introduced, in which every one could

read the occasion between the lines. When the author talked of her

"sadly large experience of death-beds," the reader thought of the Lady

with the Lamp at Scutari; and when in her chapter on "Variety" she

recalled "the acute suffering produced from the patient (in a hut) not

being able to see out of window," the reader's mind went back to the

pictures of Miss Nightingale at Balaclava. "I shall never forget," she

wrote, "the rapture of fever patients over a bunch of bright-coloured

flowers." She was thinking again of the Crimea. The wild flowers there

are many and brilliant; and the nurses used to gather them in the early

morning walk which each took in turn.[331]

[330] _Saturday Review_, Jan. 21, 1860.

[331] _Hornby_, p. 306.

The book was not cheap at first; the price was 5s. But 15,000 copies

were sold in a month, and a cheaper edition at 2s. quickly followed. It

was read, sooner or later, by all sorts and conditions of people; in

palaces, in cottages, in factories. Queen Victoria "thanked Miss

Nightingale _very much_ for the book," and sent in return a print of

herself and the Prince Consort. From the Grand Duchess of Baden the book

called forth an overflowing tribute. "I will not attempt to describe to

you," she wrote (Oct. 9, 1860), "with how much interest and admiration I

read these pages, so beautiful in their simplicity, so admirable in

their true Christian spirit. Rarely has a book made so deep an

impression on me. I cannot refrain from expressing the real admiration I

feel for the noble English lady who has devoted so much of her life to

suffering mankind, and who has given to all her sisters an example never

to be forgotten." With further expressions of personal admiration, the

Grand Duchess added a very just characterization of the book: "The

gentle feelings of the woman are joined to experience, reflexion, and

science." Miss Nightingale was urged to prepare a popular sevenpenny

edition, and this appeared early in 1861 with the title _Notes on

Nursing for the Labouring Classes_, and with a new chapter called

"Minding Baby." "And now, girls," this chapter begins, "I have a word

for you. You and I have all had a great deal to do with 'minding baby,'

though 'baby' was not our own baby.[332] And we would all of us do a

great deal for baby, which we would not do for ourselves." "Did I tell

you," wrote Miss Nightingale to Madame Mohl (May 7, 1861), "what

prompted my little chapter on _Minding Baby_? A Peckham schoolmaster

asked me, saying he could always make the school-girls mind my book by

telling them it was 'for baby's sake.' And several opened their parents'

windows at night (greatly to the indignation of the parents, I am

thinking), and removed dung-hills before the doors in consequence." In

its cheap form, the book had a very large circulation. Mr. Chadwick

interested himself in getting it recommended for school-reading.

Benevolent persons distributed it gratuitously in villages and cities.

Edition after edition was rapidly called for. Among Miss Nightingale's

papers I find letters from correspondents reporting cases in which

office clerks and factory hands, after reading the book, voted the

windows open.

[332] "The chapter on Minding the Baby," wrote Mr. Jowett (Aug. 24,

1868), "is excellent. I particularly like the parenthesis ('though

he's not our baby') in which a world of morality is contained."

The book was read, not only by all sorts and conditions of people at

home, but also in many countries and in many tongues abroad. It had

instantly been reprinted in America. It was translated into German, into

French (with a preface by Miss Nightingale's old acquaintance, M.

Guizot),[333] and into most of the other European languages. If the book

be out of print, it ought to be included in one of the cheaper series of

the day. It can never be out of date, and no one who has read it has

ever found it dull.

[333] Bibliography A, No. 32.

V

Miss Nightingale was essentially a "man of action," not a writer. Yet

her writings are very characteristic of her work, and none is more

pleasantly so than _Notes on Nursing_. Not the whole of her nature

"breaks through language and escapes" into it, but this little book

alone would be enough to explain to an understanding reader several

characteristics of her mind and work. It is an incomparable treatise on

the art of nursing; but, as Sir James Paget indicated, it is more than

that: it is an alphabet of Household Hygiene. Miss Nightingale's

treatment of the subject reveals at the outset her philosophical grasp.

"Shall we begin," she says, "by taking it as a general principle that

all disease, at some period or other of its course, is more or less a

reparative process, not necessarily accompanied with suffering: an

effort of nature to remedy a process of poisoning or decay, which has

taken place weeks, months, sometimes years beforehand, unnoticed, the

termination of the disease being then, while the antecedent process was

going on, determined? If we are asked, Is such or such a disease a

reparative process? Can such an illness be unaccompanied by suffering?

Will any care prevent such a patient from suffering this or that?--I

humbly say, I do not know. But when you have done away with all that

pain and suffering, which in patients are the symptoms, not of their

disease, but of the absence of one or all of the essentials to the

success of Nature's reparative processes, we shall then know what are

the symptoms of, and the sufferings inseparable from, the disease." This

is, surely, sound philosophy; not overthrown by any later discoveries

about germs and microbes. It is the philosophy of eliminating the known

as a preliminary to investigating the unknown. It leads Miss Nightingale

to insist on the importance, as she calls it, of "nursing the well"

before they become the sick; or in other words, to the principles of

domestic hygiene--ventilation, warming, drains, light, cleanliness. In

all this her book had more originality than the younger readers of

to-day will realize without some effort of retrospective imagination.

The homes of the poor were in her day those that were not very much

caricatured by Dickens and Cruickshank. The schools of the poor, which

have taught some of the principles of hygiene directly, and have had a

yet wider influence indirectly by setting an example of airy rooms and

cleanliness, were still in the future. Working people in those days

could, moreover, hardly be reached by writings. It was the popular fame

of Florence Nightingale that won for her _Notes on Nursing_ an audience

from "the Labouring Classes." Nor is it only among those classes that

great changes in current ideas and practice about domestic hygiene have

been effected. At the time when Miss Nightingale wrote, stuffiness

characterized the most genteel interiors. She was a pioneer in

establishing the principles of modern hygiene; and perhaps even to-day

there is still room for a wider acceptance of her doctrine that "nursing

the well" is even more important than nursing the sick--preventive

hygiene, than curative medicine.

A characteristic of Miss Nightingale's mind, and of her methods in

action is, as has been noticed already, her combination of general

grasp with minute attention to detail, and this is particularly

remarkable in her _Notes on Nursing_. In the chapter dealing with

nursing, in the more common acceptance of the term, one is struck on

almost every page with this rare combination of gifts. Nothing is too

minute for her touch, but everything is referred to a general principle.

Her philosophy of "Noises," with the detailed injunctions which she

bases upon it, is alone enough to entitle her to the eternal gratitude

of invalids.

The book is no less remarkable for delicacy of observation and fineness

of sympathy. "Apprehension, uncertainty, waiting, expectation, fear of

surprise, do a patient more harm than any exertion. Remember, he is face

to face with his enemy all the time, internally wrestling with him,

having long imaginary conversations with him. You are thinking of

something else. Rid him of his adversary quickly is a first rule with

the sick." "People who think outside their heads, who tell everything

that led them towards this conclusion and away from that, ought never to

be with the sick." "A sick person intensely enjoys hearing of any

_material_ good, any positive or practical success of the right. Do,

instead of advising him with advice he has heard at least fifty times

before, tell him of one benevolent act which has really succeeded

practically--it is like a day's health to him. You have no idea what the

craving of the sick, with undiminished power of thinking but little

power of doing, is to hear of good practical action, when they can no

longer partake in it." The whole chapter, entitled "Chattering Hopes and

Advices," from which this last extract is taken, is full of wit and

wisdom. It could only have been written as the expression of an

understanding mind and a sympathetic heart; just as the following

chapter, "Observation of the Sick," with its directions in the finer

technique of nursing, could only have come from one of long and varied

experience in the practice of it.

Another of Miss Nightingale's characteristics--her taste for

epigrammatic and often pungent expression--is conspicuous in _Notes on

Nursing_. "Feverishness is generally supposed to be a symptom of fever;

in nine cases out of ten, it is a symptom of bedding." "No _man_, not

even a doctor, ever gives any other definition of what a nurse should

be than this--'devoted and obedient.' This definition would do just as

well for a porter. It might even do for a horse. It would not do for a

policeman." "Some 'obedient' nurses know no medium between 'Now no

fire,' 'Now fire,' as if they were volunteer riflemen." "It seems a

commonly received idea among men, and even among women themselves, that

it requires nothing but a disappointment in love, or incapacity in other

things, to turn a woman into a good nurse. This reminds one of the

parish where a stupid old man was set to be schoolmaster because he was

'past keeping the pigs.'" There is lively humour, too, in many of the

personal descriptions. Miss Nightingale quotes Lord Melbourne's saying:

"I would rather have men about me when I am ill; I think it requires

very strong health to put up with women."[334] "I am quite of his

opinion," she adds, and she gives some little word-pictures of the

female nurse (old style). "Compelled by her dress, every woman now

either shuffles or waddles--only a man can cross the floor of a sick

room without shaking it." She was writing in the days of crinolines, and

draws a picture of "respectable elderly women stooping forward," when

invested therein. Another picture is of the nurse who is supposed, "like

port-wine," to improve with age. We are not told the circumstances, but

we are assured that it was a "fact" that a nurse, when ordered to

administer brandy-and-water to a fainting patient, supplied the last

week's _Punch_. Then there is a description of the mincing nurse, with

"an affectedly sympathizing voice, like an undertaker's at a funeral."

All Miss Nightingale's pictures were drawn from life. "I wonder," wrote

one of her friends, "if the originals will recognise themselves."

[334] The saying is recorded in C. R. Leslie's _Autobiographical

Recollections_, vol. i. p. 169, as made to Lady Holland. "Oh!" said

the lady, tapping him with her fan, "you have lived among such a

rantipole set." "I happen to know," wrote Monckton Milnes to Miss

Nightingale, "who Lord Melbourne's nurse was."

No one, then, could read the _Notes on Nursing_ without perceiving that

the author was a woman of marked ability, of wisdom, and of true

goodness. The book does not of itself prove Miss Nightingale's power of

administration or resolute will; for a woman, or a man, may be decisive

of speech without being masterful in action; but with this exception the

reviewer was right who said that the book was "enough to explain the

success" which Miss Nightingale had attained. The book points even more

clearly to one of the main lines on which she was to work in the future.

No one could read it without perceiving that nursing, as explained and

taught by Miss Nightingale, must be a very delicate, and a very

difficult, art. It required a sound mastery of the laws of household

hygiene, some knowledge of medicine or surgery, and, above all, an acute

and sympathetic faculty of observation. "Merely looking at the sick is

not observing." It was obvious that if Miss Nightingale's ideal of

nursing was to be realized, the nurse required both training and

inspiration. Nursing was an art, and like any other art, "from a

shoemaker's to a sculptor's, needed in its votaries the sense of a

'calling,' and then a diligent apprenticeship." The way in which Miss

Nightingale translated her precepts into practice is the subject of the

next chapter. In _Notes on Nursing_, as in nearly everything that came

from her pen, what she wrote had direct reference to action.

In a characteristic appendix to her _Notes on Nursing_, Miss Nightingale

discusses "Some Errors in Novels," pointing out, among other things, the

untruth of death-bed scenes in works of fiction. "Shakespeare," she

says, "is the only author who has ever touched the subject with truth,

and his truth is only on the side of art." "The best definition of a

Nurse," she wrote elsewhere,[335] "can be found, as always, in

Shakespeare." It is in _Cymbeline_ that the ideal of a Nightingale nurse

was prefigured:--

So kind, so duteous, diligent,

So tender over his occasions, true,

So feat, so nurse-like.

[335] Reprint from Quain's _Dictionary_, p. 12.

CHAPTER IV

THE NIGHTINGALE NURSES

(1860-1861)

Life is short and the art of healing is long.--HIPPOCRATES.

"The value of Hospitals as schools of surgery and medicine is hardly

greater than is their usefulness as a training for nurses, and the field

is no less large. It is an employment suited to women. There has been an

astonishing change in this matter since Miss Nightingale volunteered.

This change is perhaps the best fruit the past half century has to

show."[336] So writes one who has devoted laborious years to the

"Condition of England question." If it be as Mr. Charles Booth says,

then June 24, 1860, is a memorable day in the history of the nineteenth

century[337]; for it is the day on which the Nightingale Training School

for Nurses was opened at St. Thomas's Hospital.

[336] _Life and Labour of the People in London._ Final volume, 1903,

p. 154.

[337] The 50th anniversary of the event, not noticed, I think, in

England, was celebrated in America: see Vol. II. p. 421.

This School was a direct outcome of Miss Nightingale's services in the

Crimean War. The Nightingale Fund, amounting to £44,000, was a tribute

from the British Empire to the Popular Heroine. The capital sum, after

defrayment of some expenses, was invested in the name of trustees, and a

Council[338] was nominated by Miss Nightingale for the administration of

the Trusts to enable her to establish "an Institution for the training,

sustenance, and protection of Nurses and Hospital attendants." She

intended, as we have heard,[339] to found or conduct such an

Institution on her own lines, and her first idea had been to become the

Superintendent of it herself.

[338] The Council consisted of Mr. Herbert, Mr. Bracebridge, Lord

Ellesmere, Sir Joshua Jebb, Sir James Clark, Dr. Bowman, the Dean

of Hereford, Sir John McNeill, and Dr. Bence Jones.

[339] Above, p. 269.

On returning from the East, however, Miss Nightingale was in weak

health, and she became absorbed in the large and manifold labours for

the British Army which have already been described. She saw no early

prospect of strength or time available for the superintendence of a new

Institution; she was unwilling that money subscribed for a public

purpose should longer lie idle. In March 1858 she wrote in this sense to

Mr. Sidney Herbert,[340] the Chairman of the Council, begging to be

relieved from further responsibility in the matter, and asking that the

Council should proceed to apply the Fund to such objects as it might

deem best. The Council, however, pointed out that the Fund was well

invested; that further delay would be partly compensated for by

accumulation of resources, and that the contributors were anxious that

Miss Nightingale's "mind and intention should animate the work." They,

therefore, begged her to postpone a final decision, and to this

suggestion she acceded. But Miss Nightingale's labours for the Army

continued, and her health did not improve. Her life indeed seemed to her

medical advisers to hang upon a slender thread; they thought that she

could only live for a few months. She became apprehensive lest death

should overtake her before she had impressed her mind and intention upon

any application of the Nightingale Fund. In 1859 she set on foot

preparations for doing something. A Sub-Committee of the Council was

appointed, consisting of Mr. Herbert, Sir John McNeill, Sir James Clark,

Dr. Bowman, and Sir Joshua Jebb, with Mr. A. H. Clough as Secretary.

[340] "Your letter strikes me," wrote Mr. Herbert (March 22), "as a

little too curt for the occasion." He suggested another form of

words to her which she adopted.

It was obvious to Miss Nightingale that it would be impossible for her,

in view of the state of her health, to found an entirely new Institution

under her own superintendence. She saw that she must work through

existing hospitals and the agency of other persons. It was this latter

consideration that settled her choice of the place at which to found

her Training School. She had naturally been besieged by suggestions from

officials of this hospital and of that, of this charity and the other,

each urging that his or hers was the one pre-eminently suited to

benefactions from the Nightingale Fund. Her choice fell, for the main

application of the Fund, upon St. Thomas's Hospital. The Resident

Medical Officer, Mr. R. G. Whitfield, was sympathetic. The Hospital was

large, rich, and well managed. But, above all, the Matron was a woman

after Miss Nightingale's own heart, strong, devoted to her work, devoid

of all self-seeking, full of decision and administrative ability. Of

this remarkable woman, Mrs. Wardroper, who for twenty-seven years was

superintendent of the Nightingale School, Miss Nightingale has left a

character-sketch:--

I saw her first in October 1854, when the expedition of nurses was

sent to the Crimean War. She had been then nine months matron of

the great hospital in London, of which for 33 years she remained

head and reformer of the nursing. Training was then unknown; the

only nurse worthy of the name that could be given to that

expedition, though several were supplied, was a "Sister" who had

been pensioned some time before, and who proved invaluable.[341] I

saw her next after the conclusion of the Crimean War. She had

already made her mark; she had weeded out the inefficient, morally

and technically; she had obtained better women as nurses; she had

put her finger on some of the most flagrant blots, such as the

night nursing, and where she laid her finger the blot was

diminished as far as possible, but no training had yet been thought

of....

Her power of organization or administration, her courage, and

discrimination in character, were alike remarkable. She was

straight-forward, true, upright. She was decided. Her judgment of

character came by intuition, at a flash, not the result of much

weighing and consideration; yet she rarely made a mistake, and she

would take the greatest pains in her written delineations of

character required for record, writing them again and again in

order to be perfectly just, not smart or clever, but they were in

excellent language. She was free from self-consciousness; nothing

artificial about her. She did nothing, and abstained from nothing,

because she was being looked at. Her whole heart and mind, her

whole life and strength were in the work she had undertaken. She

never went a-pleasuring, seldom into society. Yet she was one of

the wittiest people one could hear on a summer's day, and had gone

a great deal into society in her young unmarried life. She was left

a widow at 42 with a young family. She had never had any training

in hospital life, there was none to be had. Her force of character

was extraordinary. Her word was law. For her thoughts, words and

acts were all the same. She moved in one piece. She talked a great

deal, but she never wasted herself in talking; she did what she

said. Some people substitute words for acts: _she_ never. She knew

what she wanted, and she did it. She was a strict disciplinarian;

very kind, often affectionate, rather than loving. She took such an

intense interest in everything, even in things matrons do not

generally consider their business, that she never tired. She had

great taste and spent her own money for the hospital. She was a

thorough gentlewoman, nothing mean or low about her; magnanimous

and generous, rather than courteous. And all this was done

quietly.... She had a hard life, but never proclaimed it. What she

did was done silently.[342]

[341] This was Mrs. Roberts: see above, pp. 185, 301.

[342] _British Medical Journal_, Dec. 31, 1892. Mrs. Wardroper retired

in 1887, and died in 1892.

Every artist, it has been said, in painting the portrait of a sitter,

paints also something of his own portrait. Miss Nightingale's vigorous

character-sketch of her "dear Matron" is, I think, a case in point.

After much consultation with Mrs. Wardroper and Mr. Whitfield of St.

Thomas's Hospital, and with Sir John McNeill and others outside, Miss

Nightingale formulated a scheme. The Committee of her Council met the

Governors of the Hospital, and an agreement was arrived at for the

foundation of the Nightingale School. The basis of the agreement was

that the Hospital was to provide facilities for the training, and the

Nightingale Fund to pay the cost, including the payment of the nurses

themselves. In May 1860, advertisements were inserted in the public

press inviting candidates for admission, and on June 24 fifteen

probationers were admitted for a year's training. Thus on a modest

scale, but with a vast amount of forethought, was launched the scheme

which was destined to found the modern art and practice of nursing.

II