_THE NURSING OF THE SICK POOR_
Origin of the Liverpool Home and Training School--Interest in the
Sick Paupers--“Una and the Lion” a Tribute to Sister Agnes
Jones--Letter to Miss Florence Lees--Plea for a Home for
Nurses--On the Question of Paid Nurses--Queen Victoria’s Jubilee
Nursing Institute--Rules for Probationers.
Nursing is an Art; and if it is to be made an art, requires as
exclusive a devotion, as hard a preparation, as any painter’s or
sculptor’s work; for what is the having to do with dead canvas, or
cold marble, compared with having to do with the living body--the
temple of God’s spirit....It is one of the Fine Arts; I had almost
said, the finest of the Fine Arts.--
FLORENCE NIGHTINGALE.
There is no branch of sick nursing which appeals more strongly to Miss
Nightingale than the care of the sick poor. It was as a visitor in the
homes of her poorer neighbours at Lea Hurst and Embley that she began
her philanthropic work, and though the outbreak of the Crimean War drew
her into the public arena and concentrated her attention on the army,
she had not ceased to feel the importance of attending to the needs of
the sick poor, and repeatedly drew attention to the fact that England
was behind other nations in providing for the sick poor at home, and in
infirmaries.
She recognised also that for this work a special training was needed.
A nurse who had received a course of instruction in a hospital was not
necessarily competent to nurse the poor in their own homes. Special
knowledge and special experience were needed before a woman, however
skilled in the technical side of nursing, could become a good district
nurse.
About the same period that Miss Nightingale was establishing and
organising her Training School for Nurses at St. Thomas’s Hospital,
she was also working in conjunction with Mr. William Rathbone, M.P.,
and other philanthropic people to found a special training school for
nurses for the poor. It was at her suggestion that this branch of
pioneer work was started in connection with the Liverpool Infirmary,
which had already made some provision on similar lines. The prospectus
for the Liverpool Training Home for Nurses was made public in 1861–2,
and a commodious building was subsequently erected in the grounds of
the infirmary.
In 1865 Miss Nightingale wrote an introduction to a work describing the
“Origin and Organisation of the Liverpool School and Home for Nurses.”
“It is the old story, often told!” she writes, “but this book opens a
new chapter of it. It gives us hope for a better state of things. An
institution for training nurses in connection with the infirmary has
been built and organised. This is a matter of necessity, because all
who wish to nurse efficiently must learn how to nurse _in a hospital_.
“Nursing, especially that most important of all its branches--nursing
of the sick poor at home--is no amateur work. To do it as it ought to
be done requires knowledge, practice, self-abnegation, and as is so
well said here, direct obedience to and activity under the highest of
all Masters and from the highest of all motives. It is an essential
part of the daily service of the Christian Church. It has never been
otherwise. It has proved itself superior to all religious divisions,
and is destined, by God’s blessing, to supply an opening the great
value of which, in our densely peopled towns, has been unaccountably
overlooked until within these few years.”
With such noble words did Florence Nightingale usher in a movement
which has now spread to all parts of the kingdom. There is not now a
workhouse infirmary which has not its trained nurses in place of the
rough-handed and unskilled inmate, nor any town and few villages which
have not some provision for nursing the sick poor in their own homes,
and our beloved Queen Victoria found it the worthiest object to which
she could devote the people’s offering in commemoration of her Jubilee.
The main objects of the pioneer Training Home at Liverpool were:--
1. To provide thoroughly educated professional nurses for the poor.
2. To provide district nurses for the poor.
3. To provide sick nurses for private families.
Miss Nightingale watched the progress of the home with keen interest
and gave her advice from time to time. She was also actively engaged
in promoting workhouse reform. A sick pauper was to her a human being,
not a “chattel” to be handed over to the tender mercies of the Mr.
Bumbles and Mrs. Corneys. It afforded her great satisfaction that two
out of the first lot of nurses which left her St. Thomas’s Training
School went as matrons to workhouse infirmaries. A reform in workhouse
hospitals had been brought about by Mr. Gathorne-Hardy’s Metropolitan
Poor Act of 1867. But the introduction of trained nurses on the
Nightingale system grew directly out of the experience and information
which followed the founding of the Liverpool Training Home.
Hitherto the workhouse nurses were the pauper women, untrustworthy and
unskilled. At Brownlow Hill, Liverpool, Infirmary Mr. Rathbone relates
that there were twelve hundred beds occupied by people in all stages
of every kind of disease, and the only assistants of the two women
officers who superintended the nursing were pauper women who were
as untrustworthy as they were unskilful. This was a fair example of
workhouse infirmaries all over the country.
The Select Vestry of Liverpool, having received an anonymous offer
to defray the cost of the experiment for three years, consented to
try Miss Nightingale’s plan. With her assistance, Miss Agnes Jones, a
lady who had been trained at Kaiserswerth like Miss Nightingale, and
also at the Nightingale School at St. Thomas’s, was appointed Lady
Superintendent, and she brought with her a staff of twelve nurses from
St. Thomas’s. At first Miss Jones tried to get extra help by training
the able-bodied pauper women as nurses, but out of fifty-six not one
proved able to pass the necessary examination and, worse still, the
greater number used their first salary to get drunk. The painful fact
was established that not a single respectable and trustworthy nurse
could be found amongst the workhouse inmates, and the infirmary nursing
had to be taken entirely out of their hands.
After a two years’ trial Miss Jones’s experiment with her trained and
educated nurses proved so satisfactory that the guardians determined
never to return to the old system, and to charge the rates with the
permanent establishment of the new one. To the deep regret of every
one, however, Miss Agnes Jones sank under the labours which she had
undertaken, and died in February, 1868.
Miss Nightingale contributed a beautiful tribute to the memory of her
friend and fellow worker in _Good Words_ for June, 1868, under the
title “Una and the Lion,” which subsequently formed the “Introduction”
to _The Memorials of Agnes Elizabeth Jones_, by her sister.
“One woman has died,” writes Miss Nightingale, “a woman, attractive and
rich, and young and witty; yet a veiled and silent woman, distinguished
by no other genius but the divine genius--working hard to train herself
in order to train others to walk in the footsteps of Him who went
about doing good.... She died, as she had lived, at her post in one
of the largest workhouse infirmaries in this kingdom--the first in
which trained nursing has been introduced.... When her whole life and
image rise before me, so far from thinking the story of Una and her
lion a myth, I say here is Una in real flesh and blood--Una and her
paupers far more untamable than lions. In less than three years she had
reduced one of the most disorderly hospital populations in the world to
something like Christian discipline, and had converted a vestry to the
conviction of the economy as well as humanity of nursing pauper sick by
trained nurses.”
We must refrain from quoting more of this singularly fine tribute of
the Chief to one of her ablest generals in the army of nursing reform,
with the exception of the beautiful closing words: “Let us add living
flowers to her grave, ‘lilies with full hands,’ not fleeting primroses,
not dying flowers. Let us bring the work of our hands and our heads
and our hearts to finish her work which God has so blessed. Let us not
merely rest in peace, but let hers be the life which stirs up to fight
the good fight against vice and sin and misery and wretchedness, as she
did--the call to arms which she was ever obeying:--
The Son of God goes forth to war,
Who follows in His train?
Oh, daughters of God, are there so few to answer?”
[Illustration: MRS. DACRE CRAVEN (NÉE FLORENCE LEES).
(_From a drawing by the Crown Princess of Germany (the late Empress
Frederick), when Miss Lees had charge of the Crown Princess’s
Lazaretto at Homburg during the Franco-German War._)
[_To face p. 304._
]
One cannot leave the subject without a reference to the influence which
Miss Nightingale’s own early example had had on the gifted woman whose
memory she extolled. On the eve of going into training at St. Thomas’s
Miss Agnes Jones wrote: “It is well that I shall, at my first outset
in hospital work, bear the name of ‘Nightingale Probationer,’ for that
honoured name is associated with my first thought of hospital life.
In the winter of ’54, when I had those first earnest longings for
work, and had for months so little to satisfy them, how I wished
I were competent to join the Nightingale band when they started for
the Crimea! I listened to the animadversions of many, but I almost
worshipped her who braved all, and I felt she must succeed.”
The system inaugurated by Miss Agnes Jones at Liverpool Infirmary
spread over the country, and Miss Nightingale had the satisfaction of
seeing in a comparatively short time a great improvement in the nursing
and treatment of the sick in workhouses. Gaols had long been visited
and reformed, lunatic asylums opened to inspection, and it seemed
unaccountable that the misery of sick workhouse paupers should have
been so long overlooked.[B]
[B] Miss Louisa Twining in 1854 began her pioneer efforts
in workhouse reform, which resulted in 1874 in the
establishment of the Workhouse Nursing Association.
The success of the introduction of trained nurses into workhouses
gave an impulse to sick poor nursing generally, and in 1868 the East
London Nursing Society was founded by the Hon. Mrs. Stuart Wortley and
Mr. Robert Wigram. In 1874 the movement received a further important
impulse from the formation of the National Nursing Association, to
provide skilled nurses for the sick poor in their own homes, to
establish district organisations in London and in the country, and to
establish a training school for district nurses in connection with one
of the London hospitals.
This work appealed most strongly to Miss Nightingale, and she expressed
her sympathy in the following letter to that devoted pioneer of
district nursing, Miss Florence Lees,[C] now Mrs. Dacre Craven, who
was the indefatigable honorary secretary of the newly founded National
Nursing Association.
[C] Miss Lees was described by Kinglake as “the gifted
and radiant pupil” of Florence Nightingale. She was a
probationer at the St. Thomas’s Training School when it was
temporarily located in the old Surrey Gardens.
“As to your success,” writes Miss Nightingale, “what is not your
success? To raise the homes of your patients so that they never fall
back again to dirt and disorder: such is your nurses’ influence. To
pull through life and death cases--cases which it would be an honour to
pull through with all the appurtenances of hospitals, or of the richest
in the land, and this without any sick-room appurtenances at all. To
keep whole families out of pauperism by preventing the home from being
broken up, and nursing the bread-winner back to health.”
The next point in Miss Nightingale’s letter was one which was at the
root of the movement and which she invariably emphasised: “To drag the
noble art of nursing out of the sink of relief doles.” It was believed
that nothing would so effectually stop the pauperising of the people by
indiscriminate charity as the trained nurse in the homes of the sick
poor, who would teach her patients how best to help themselves. “To
carry out,” continues Miss Nightingale, “the practical principles of
preventing disease by stopping its causes and the causes of infections
which spread disease. Last but not least, to show a common life able
to sustain the workers in this saving but hardest work under a working
head, who will personally keep the training and nursing at its highest
point. Is not this a great success?
“District nursing, so solitary, so without the cheer and the stimulus
of a big corps of fellow-workers in the bustle of a public hospital,
but also without many of its cares and strains, requires what it has
with you, the constant supervision and inspiration of a genius of
nursing and a common home. May it spread with such a standard over the
whole of London and the whole of the land.”
Two years later (1876) Miss Nightingale made an eloquent plea in a long
letter to _The Times_ for the establishment of a Home for Nurses in
connection with the National Society for Providing Trained Nurses for
the Poor. This letter was later reprinted as a pamphlet on _Trained
Nursing for the Sick Poor_. In specially pleading for a Central Home
for Nurses, she wrote, “If you give nurses a bad home, or no home at
all, you will have only nurses who live in a bad home, or no home at
all,” and she emphasises the necessity for the district nurse to have a
knowledge of how “to nurse the home as well as the patient,” and for
that reason she should live in a place of comfort herself free from the
discomforts of private lodgings.
Miss Nightingale’s plea bore fruit in the establishment of the Central
Home for Nurses, 23, Bloomsbury Square, under the able management of
Miss Florence Lees. Nothing pleased Miss Nightingale better than to
get reports of the experience of the district nurses amongst the poor,
and to hear how the people received their visits and what impression
they were able to make on the habits of the people. She was specially
delighted with the story of a puny slum boy who vigorously rebelled
against a tubbing which Miss Lees was administering.
“Willie don’t like to be bathed,” he roared; “oo may bath de debil, if
oo like!” The implication that Miss Lees was capable of washing the
devil white Miss Nightingale pronounced the finest compliment ever paid
to a district nurse.
She has always impressed upon district nurses the need not only of
knowing how to give advice, but how to carry it out. The nurse must
be able to show how to clean up a home, and Miss Nightingale used
frequently to quote the case of a bishop who cleansed the pigsties of
the normal training school, of which he was master, as an example--“one
of the most episcopal acts ever done,” was her comment.
At first the district nurses were recruited almost entirely from
the class known as “gentlewomen,” as it was thought both by Miss
Nightingale and Miss Lees that it required women of special refinement
and education to exercise influence over the poor in their own homes.
Also, one of the objects of the National Association was to raise the
standard of nursing in the eyes of the public. It was soon proved
that the lady nurses did not shirk any of the disagreeable and menial
offices which fall to the lot of the district nurse. Broadly speaking,
it is only the educated women with a vocation for nursing who will
undertake such duties; the woman who merely wants to earn an income
will choose hospital or private nursing. In the earlier stages of the
movement the district nurses received high remuneration, and on this
question of fees the Queen of Nurses may be quoted:--
“I have seen somewhere in print that nursing is a profession to be
followed by the ‘lower middle-class.’ Shall we say that painting or
sculpture is a profession to be followed by the ‘lower middle-class’?
Why limit the class at all? Or shall we say that God is only to be
served in His sick by the ‘lower middle-class’?
“It appears to be the most futile of all distinctions to classify as
between ‘paid’ and unpaid art, so between ‘paid’ and unpaid nursing--to
make into a test a circumstance as adventitious as whether the hair is
black or brown, viz., whether people have private means or not, whether
they are obliged or not to work at their art or their nursing for a
livelihood. Probably no person ever did that well which he did only for
money. Certainly no person ever did that well which he did not work at
as hard as if he did it solely for money. If by amateur in art or in
nursing are meant those who take it up for play, it is not art at all,
it is not nursing at all. You never yet made an artist by paying him
well; but an artist ought to be well paid.”
A most important outcome of the introduction of a system of trained
nurses for the sick poor was the establishment of the Queen’s Jubilee
Nurses. Queen Victoria, moved by the great benefit which the National
Nursing Association had conferred, decided, on the representations
of the Committee of the Women’s Jubilee Fund, furthered by Princess
Christian, to devote the £70,000 subscribed, to the extension of this
work.[D] The interest of the fund, amounting to £2,000 per annum, was
applied to founding an institution for the education and maintenance
of nurses for tending the sick poor in their own homes, with branch
centres all over the kingdom. The charter for the new foundation was
executed on September 20th, 1890.
[D] Mrs. Dacre Craven had in 1877 proposed, in a letter laid
before Queen Victoria, that a part of the fund of St.
Katharine’s Royal Hospital should be devoted to founding a
Training Institute for District Nurses of gentle birth, to
be called “Queen’s Nurses.”
The central institute was at first connected with St. Katharine’s
Royal Hospital, Regent’s Park, an institution which had always been
under the patronage of the Queens of England since it was founded by
Queen Matilda, the wife of Stephen, at St. Katharine’s Wharf, near the
Tower of London. Subsequently the headquarters of the Queen Victoria’s
Jubilee Nursing Institute was removed to Victoria Street. Central homes
have also been established at Edinburgh, Dublin, and Cardiff, and
district homes all over the kingdom are affiliated to the Institute.
The National Association for Providing Trained Nurses for the Sick
Poor, in which Miss Nightingale had so deeply interested herself, was
affiliated to the Queen Victoria’s Jubilee Institute, but it still has
its original headquarters at the Nurses’ Home, 23, Bloomsbury Square,
so ably managed by the present Lady Superintendent, Miss Hadden. The
Chairman of the Executive Committee is Henry Bonham Carter, Esq.,
an old friend and fellow worker of Miss Nightingale, while the Hon.
Secretary is the Rev. Dacre Craven, Rector of St. Andrew’s, Holborn,
whose wife was Miss Florence Lees, the first Superintendent-General of
the home and branches, and one of Miss Nightingale’s devoted friends.
Her Royal Highness Princess Christian is President of the Association.
There is probably no movement which has spread over the country so
rapidly, and which appeals to the goodwill of all classes, as the
nursing of the sick poor in their own homes, and its success has been
one of the chief satisfactions of Miss Nightingale’s life. She is
always eager to hear of fresh recruits being added to the nursing army
of the sick poor, and it may prove of interest to quote the regulations
issued by the National Association:--
REGULATIONS FOR THE TRAINING OF NURSES FOR THE SICK POOR,
AND THEIR SUBSEQUENT ENGAGEMENT
1. A Nurse desiring to be trained in District Nursing must have
previously received at least two years’ training in a large general
Hospital, approved by the Committee, and bring satisfactory
testimonials as to capacity and conduct.
2. If considered by the Superintendent likely to prove suitable
for District Nursing, she will be received on trial for one month.
If at the end of that time she is considered suitable, she will
continue her course of training, with technical class instruction
for five months longer.
3. The Nurse will, at the end of her month of trial, be required
to sign an agreement with the Queen Victoria’s Jubilee Institute
that she will, for one year from the date of the completion of her
District training, continue to work as a District Nurse wherever
the District Council of the Queen’s Institute may require her
services.
4. While under training, the Nurse will be subject to the authority
of the Superintendent of the Training Home, and she must conform to
the rules and regulations of the Home. She will be further subject,
as to her work, to the inspection of the Inspector of the Queen’s
Institute.
5. If, during the time of her training, the Nurse be found
inefficient, or otherwise unsuitable, her engagement may, with the
consent of the Inspector of the Queen’s Institute, be terminated
by the Superintendent of the Training Home, at a week’s notice. In
the case of misconduct or neglect of duty she will be liable to
immediate dismissal by the Superintendent of the Training Home,
with the concurrence of the Inspector of the Queen’s Institute.
6. During her six months’ training she will receive a payment of
£12 10_s._, payable, one-half at the end of three months from
admission, and the remainder at the end of six months; but should
her engagement be terminated from any cause before the end of
her training, she will not, without the consent of the Queen’s
Institute, be entitled to any part payment. She will be provided
with a full board, laundry, a separate furnished bedroom or
cubicle, with a sitting room in common, as well as a uniform dress,
which she will be required to wear at all times when on duty. The
uniform must be considered the property of the Institute.
7. On the satisfactory completion of her training, the Nurse will
be recommended for engagement as a District Nurse, under some
Association affiliated to the Queen’s Institute, the salary usually
commencing at £30 per annum.