The Special Committee on Nursing, pursuant to resolution of the
Workhouse Committee of the 7th of March instant, report,
That the Men’s Hospital (exclusive of fever patients) is at
present exclusively nursed by skilled, _i. e._ specially trained
nurses and paid assistants, who are themselves undergoing training
as nurses; the staff consisting of the Superintendent, nine of the
nurses originally sent from the Nightingale School, five nurses
who have been trained in the Workhouse, and fifteen probationary
or assistant nurses.
Of the character of the nursing in this portion of the Workhouse,
your Committee have heard but one opinion. The Governor and the
Medical Officers concur in speaking of it in terms of the highest
praise, and throughout the whole period during which the Committee
have superintended it, no single circumstance has come to their
knowledge calculated to make them speak of it otherwise than in
terms of approval.
The nursing of the women’s wards continues to be done by paupers
under the superintendence of paid officers. The superintendence of
these officers is of necessity very imperfect, as not only has
each charge of from 150 to 200 patients, but these patients are
located in several rooms, each ward containing about twenty
patients. The only portion of the nursing, properly so called,
which these officers undertake, is the administration of
stimulants and in some exceptional cases of medicine. The bulk of
it, as the giving of medicine, the dressing of wounds, the
distribution of food, is left to be done by paupers. So much has
from time to time been said of the untrustworthiness of pauper
nurses, of the evils resulting to those patients who are placed
exclusively under them, of the mischievous consequences upon the
discipline of the Workhouse of a large number of petty offices
being filled by able-bodied women, that your Committee believe
they rightly interpret the feeling of the Select Vestry, as they
undoubtedly do that of the general public, in supposing that the
actual nursing of the sick in the Liverpool Workhouse can no
longer be left in the hands of pauper nurses.
Starting from this point, your Committee considered that they had
principally to inquire what sort of nursing can be most
advantageously substituted for that of nursing by paupers. Two
courses only appeared to be open to them—either to increase the
number of paid officers, giving to each such a number of patients
as she could reasonably be expected to look after, and treating
each as an independent officer; or to extend over the whole
hospital the system now in existence in the men’s wards. Your
Committee were much aided in forming a judgment upon this point,
by what has taken place during the last few months in the fever
hospital.
Here, originally, the paid attendants were in precisely the same
position, with precisely similar duties as the paid officers in
the women’s hospital; but the number of patients rapidly
diminishing, and no corresponding reduction taking place in the
number of officers, the staff was so large that Dr. Gee felt able
to call upon the officers to act as nurses. The result was what
might have been anticipated, that although an improvement upon the
old system of nursing by paupers was perceptible, the state of the
nursing was still far short of the standard reached in the men’s
wards.
The officers were told to nurse, and they did their best, but
never having themselves been taught, their attempts in a great
measure failed; they were paid and retained as nurses, without
being efficient nurses.
Your Committee therefore recommend that as soon as the requisite
number of trained nurses can be procured, the nursing in the
women’s hospital, and afterwards in the fever hospital, be placed
in the hands of trained and skilled nurses, acting under the
direction and control of Miss Jones, the present Superintendent.
The expenses (beyond the item of wages) attendant upon the
necessary increase in the number of nurses will not be great, as
all that will be necessary will be to convert two of the rooms now
used for sick boys into sleeping apartments for the nurses. In
making this recommendation, the Committee are glad to know that
they are fortified by the unanimous opinion of the Governor and
the Medical Officers of the Workhouse.
Your Committee are bound to add that they can produce no
statistics shewing that the nursing in the men’s hospital has been
of any economical advantage to the Parish; but as it needs no
argument to prove that the cheapest course that can be taken with
a sick pauper is to cure him as quickly as possible; as it is
evident that the care and attention of a skilled nurse must tend
to a more speedy recovery; as the order and discipline of a
well-regulated ward is more distasteful to many of the more
worthless inmates, than the laxer management of a room in the
hands of a pauper nurse; and as the abolition of a large number of
petty offices for able-bodied paupers must lead to many of them
leaving the Workhouse, there are strong grounds for hoping that
the economical results of the change cannot but be beneficial.
With regard to the future, your Committee recommend that the
Department of Nursing should be placed under the direction of a
small committee of your body, and that all changes in the staff
should be made only by them. From information they have received,
your Committee have reason to believe that if, after the Workhouse
is supplied with Nurses, the two classes of nurses, _i.e._ trained
nurses and probationers, be maintained, the cost of the Department
may be considerably lessened by training nurses for other
hospitals; the cost of the probationers being either paid for by a
Government grant, or by the bodies for whom the nurses may be
trained.
THOMAS H. SATCHELL,
RICHARD BRIGHT,
THOMAS OWEN.
_March 15, 1867._
This report was unanimously adopted by the Workhouse Committee and
by the Vestry; and already the new system has been extended to the
Female Wards. It is in contemplation to extend it also to the Fever
Hospital, as soon as a sufficient number of suitable nurses shall
have been trained.
It will be observed that the report contemplates the training of
probationers for other Workhouse Infirmaries. And it is, indeed, to
be hoped that in this and other ways the Liverpool Workhouse
Hospital may serve as a normal school, from which the system there
adopted may spread. The _special_ expenses of such a school would
naturally be borne by the parishes which profited by its services in
educating nurses for them, or by the Government. But this point is
one which, as yet, has hardly demanded practical consideration.
The experiment whose results have been recorded, could hardly have
been tried at all—certainly could not have achieved such rapid
success—had it not been for the powerful and liberal assistance of
Miss Nightingale, and the Trustees of the Nightingale Fund. Feeling
how very important was the extension of the system of superior
professional nursing, now gradually gaining ground in general
hospitals, to workhouses, they sent, to assist in the initial
experiment made in this direction, a lady superintendent and twelve
superior nurses—a very expensive and quite invaluable contribution.
To the Liverpool Vestry and its officers belongs the credit of
having overcome all the difficulties, and persevered in spite of all
the discouraging incidents, which necessarily attended an attempt to
introduce a new system of management into such an institution as a
Workhouse Hospital, combining as it does two subjects so different
in their aspects and conditions of treatment, so difficult to deal
with together, as pauperism and sickness. Of the Lady Superintendent
I shall say little. When a lady leaves a happy home, and goes
through a long and laborious course of training to fit herself for
such a situation, purely because, feeling that she possessed the
capacity for nursing, and the requisite health, energy, strength,
and spirits, she desired to devote such powers to the service of
those who stood most in need of them, human praise or criticism of
her choice is out of place. One of the incidental results of her
exertions has to her, no doubt, been even a higher reward than that
improvement in the condition of the sick, in their progress towards
recovery, and their material comfort, which has been the direct
object of her labours. The improvement in the tone and behaviour of
the patients has been wonderful. Many of the inmates of a pauper
hospital are persons of the worst character, and its wards, under
the control of pauper nurses, often present scenes so disgusting
that the respectable poor shrink from them with utter abhorrence,
and after once becoming acquainted with them, will often rather die
than return thither. When the trained nurses were first introduced,
the most offensive language was frequently heard in the wards; and
the Lady Superintendent has repeatedly been obliged to call upon the
Governor two or three times during one Sunday to use his authority
to put a stop to actual fighting. Now, though his support is always
promptly rendered, she is rarely compelled to apply for it; the
feeling of the wards promptly suppresses all offensive language or
unseemly behaviour in the presence of the nurses. The following
letter from Sir H. Verney, Chairman of the Nightingale Committee,
serves to illustrate the influence of the nurses upon the conduct of
the patients; he came down to Liverpool to inspect the Hospital, and
ascertain the progress of the work:—
Liverpool, _October 3, 1866_.
My dear Sir,
By the kindness of Mr. Carr I have paid a visit to the Workhouse,
and have been greatly interested by remarking the change among the
male pauper sick, effected since I was here about two years since.
I conclude that this is owing to the nursing by a class of females
so entirely different to those who nursed the male paupers at that
time, and who still nurse the female sick. I have always seen that
the influence of respectable and well-educated females over the
most debased men is very striking. Men of that character,
accustomed to intercourse with only degraded women, feel the
restraining and humanizing power of virtuous and well-mannered
females. They have never been admitted into intercourse with such
before, and they are most beneficially affected by it. I have been
told that the police officers, who sometimes come to the Workhouse
on business, and who see the sick paupers, are much astonished.
They see the men whom they have known as the very worst
characters, conducting themselves with propriety and decency, and
giving no cause of complaint.
I am sure that the Workhouse Committee must rejoice and feel
thankful that there is such a change in the condition of the poor
creatures brought under their rule.
Miss Jones, and her nurses and probationers, must have had much
difficulty at first—indeed their work is still very trying; but
the improved demeanour of the men must be highly gratifying and
encouraging to them. I walked through the female sick wards; they
were clean and sweet, but I could not help contrasting the pauper
nurses who attended them, with the intelligent-looking respectable
attendants of the men.
I thank you for the note of introduction which procured admission
for me, and
I am,
Yours very faithfully,
HARRY VERNEY.
Such, and so entirely satisfactory to the Guardians, were the
results of the experiment of nursing by trained nurses, as tried for
two years in the Male Wards of the Liverpool Workhouse Infirmary. It
is in order to render those results, the experience acquired in this
initiatory attempt, available for the assistance and encouragement
of others, that they have been thus briefly recorded. Much more
might have been said; but what is here set down is sufficient to
explain all that practical men would wish to know, and it would be
presumption to waste the time of such men with comments and
inferences which they are perfectly able to make for themselves.
One suggestion, in conclusion, I may be permitted to offer. In all
unions or parishes where additional accommodation may be required,
whether for patients or for healthy paupers, it is eminently
desirable that in providing it regard should be had to the entire
separation, at once or at a future time, of the sick and infirm from
the able-bodied, as will be the case, at least partially, under the
new régime introduced in the Metropolis by Mr. Gathorne Hardy’s
Bill. Miss Nightingale has from the first held and expressed a
strong opinion in favour of the separation of the hospital and
workhouse administrations. The Governor of the Liverpool Workhouse,
Mr. Carr, expressed himself decidedly in the same sense; and the
Chairman of the Workhouse Committee and of the Sub-Committee
appointed to superintend the Hospital, has been induced by practical
experience warmly to advocate the absolute separation of the
Workhouse and the Infirmary. So large a proportion of the
able-bodied inmates of the workhouse are drunken, lazy, and vicious,
that, if the poor-law relief is not to become a temptation and an
injury to the honest and struggling poor, the discipline must be
almost of a penal character. The paramount object must be to make
the workhouse, if not absolutely unpleasant, less agreeable than the
condition of laborious and striving poverty. On the other hand, in a
hospital the paramount and almost the only object is to promote
recovery and to mitigate suffering; all other considerations yield
to this, and consequently the treatment must necessarily be liberal
in spirit and indulgent in fact. The modes of treatment necessary
for the good management of the hospital patient and of the
able-bodied pauper, respectively, are distinct—almost opposite: the
infirmary and the workhouse must be controlled on divergent, and
even contrary principles; and by bringing the two together under one
roof and one administration, they injure each other. The indulgence
of the infirmary creeps into the workhouse, or the sternness of
workhouse rules cripples the benevolent energy which should rule the
infirmary. And the treatment of the able-bodied pauper becomes too
lax, or he is tempted to scheme, and does scheme, to get himself
transferred to the more comfortable quarters close at hand; a desire
so prevalent as to give rise to malingering—the wilful production of
disease: while, partly no doubt in order to counteract this
tendency, there is in such mixed establishments an unconscious
disposition to treat the hospital patient with the same stern
economy that is justly made the rule in dealing with able-bodied
pauperism, but which, in the infirmary, is not only cruel, but in
the long run is not truly economical. Another most serious evil is
entailed upon the hospital by connexion with the workhouse. The
habits and traditions prevalent among the habitual
paupers—able-bodied paupers—in the workhouse (at least in the
workhouse of a large town), are too often deeply infected with
cunning, deception, and dishonesty of all sorts, against which
strict precaution and stern repression are requisite; and it is most
important that no communication should be allowed, whereby these
habits of vice and stratagem might be introduced into the hospital,
where indulgence is the rule, and where many things strictly denied
to the inmates of the workhouse, as stimulants for instance, are
necessarily permitted. The introduction of workhouse tricks into a
hospital, where they cannot be met by workhouse control, must bring
in an element of confusion, disorder, and waste, and therefore the
intercommunication which might introduce those tricks should be as
effectually prevented as possible, which it cannot be while the two
institutions are, as at present, combined. The two systems—to use an
English word in its French sense—demoralize each other; and even in
the English sense, their union demoralizes the individuals subject
to each.
When this is better understood and more clearly apprehended, as it
soon will be, through the experience of several Unions in which the
separation has been already resolved on—it is probable that it will
be enforced by law. This may be expected to take place in no very
long time; and then it will be found that any expenditure incurred
in providing increased accommodation on a plan which does not
recognise the necessity of separation has been, in part at least,
thrown away; and the work will have to be done, and the money to be
spent, over again.