"THE NURSES' BATTLE"; AND HEALTH IN THE VILLAGE
(1885-1893)
Nursing cannot be formulated like engineering. It cannot be
numbered or registered like population.--FLORENCE NIGHTINGALE
(1890).
What can be done for the health of the home without the woman of
the home? In the West, as in the East, women are needed as Rural
Health Missioners.--FLORENCE NIGHTINGALE (1893).
The period of Miss Nightingale's life covered in this chapter includes
the year of Queen Victoria's Jubilee; which was also what Miss
Nightingale used to consider _her_ Jubilee Year. She fixed her effectual
call at February 7, 1837. In 1887 she had thus completed fifty years
vowed to service. In August, a month of many memories to her, she looked
back over the past and around her in the present, and was in a
despondent mood:--
(_Miss Nightingale to Mrs. S. Smith._) CLAYDON HOUSE, _Aug._ 5
[1887]. DEAREST AUNT MAI--Thinking of you always, grieved for your
suffering, hoping that you have still to enjoy. In this month 34
years ago you lodged me in Harley St. (Aug. 12). And in this month
31 years ago you returned me to England from Scutari (Aug. 7). And
in this month 30 years ago the first Royal Commission was finished
(Aug. 7). And since then, 30 years of work often cut to pieces but
never destroyed. God bless you! In this month 26 years ago, Sidney
Herbert died, after five years of work for us (Aug. 2). In this
month 24 years ago, the work of the second Royal Commission (India)
was finished. And in this month this year it seems all to have to
be done again. And in this month this year the work at St. Thomas's
Hospital seems all to have to be done again--changing
Matrons--after 27 years. And in this month this year my powers seem
all to have failed and old age set in. May the Father Almighty,
Irresistible--for Love is irresistible--whose work and none other's
this is, conduct it always, as He has done, while I have
misconducted it. May He do _in_ us what He would have us do. God
bless you, dearest Aunt Mai. As ever your old loving FLO.
And in this month, too, Florence Nightingale was to die; but nearly a
quarter of a century of life was first granted to her, and for the
greater part of the time she remained in full possession of her
faculties. Though she might be an "old lady" to young nurses, others
remarked that she looked wonderfully fresh and youthful for her years.
If old age had set in, her powers had by no means failed, and in many
directions her work, though sometimes sore beset, continued to prosper.
We will take first in our survey her work in the nursing world.
The "change of matrons" at St. Thomas's Hospital, caused by the
retirement of Mrs. Wardroper, was hardly such a tragedy as it seemed to
Miss Nightingale. Mrs. Wardroper had done her work, and there were
younger women competent to fill the place. Mr. Jowett often begged Miss
Nightingale to remember that "there is no necessary man--or woman"--"not
even," as, greatly daring, he once added, "yourself." But in this case
the Chief of the Nightingale School was not yet retiring, and she would
still be able to supervise it--perhaps even more closely under a new
Matron. For many years Miss Nightingale continued to maintain the
intimate touch with her School that has been described in an earlier
chapter: seeing the Sisters constantly, making the personal acquaintance
of nurses, conferring with their medical instructors, reading their
diaries and examination papers. Her heart was even more closely in the
work when she secured the appointment, as Mrs. Wardroper's successor, of
her dear friend, Miss Pringle. Presently, however, there came what was a
heavy blow to Miss Nightingale. Miss Pringle joined the Roman communion,
and it was necessary that she should retire from the Matronship of St.
Thomas's. The months of unsettlement before the conversion was made were
full of grief to Miss Nightingale. Indeed her notes and meditations
suggest that the "loss" of her favourite pupil was one of the heaviest
griefs of her life; but she loved her friend too well for the sorrow to
leave any abiding bitterness. Over and over again in her meditations she
wrote down lines from Clough's _Qua Cursum Ventus_. Miss Pringle was
succeeded by Miss Gordon, an old pupil of the Nightingale School; she
and Miss Nightingale speedily became the best of friends, and things
went on much as before in the School. All these changes, with the
delicate weighing of rival claims and sometimes with the worrying
conflict of personal ambitions, caused Miss Nightingale heavy anxiety.
Intensely conscientious, acutely sensitive, and seeing in every change a
great potentiality of good or evil, she could not treat such things as
mere matters of business. There have been Prime Ministers who could not
sleep of nights under the sense of responsibility caused by
ecclesiastical preferment; and to Miss Nightingale the selection of a
Superintendent or a Home Sister was even as the appointment of a bishop.
II
The movement for District Nursing, which was always near to Miss
Nightingale's heart, and which, in conjunction with Mr. Rathbone and
others, she had done much to promote, received considerable extension by
the action of Queen Victoria in 1887. The bulk of the sum presented as
the "Women's Jubilee Gift" was devoted by the Queen to "the nursing the
sick poor in their own homes by means of trained nurses." She appointed
the Duke of Westminster, Sir Rutherford Alcock, and Sir James Paget to
be trustees of the Fund, and to advise upon its administration. Sir
James Paget consulted Miss Nightingale, who, in several conversations,
impressed upon him her view that the essential things were the training
of nurses for the work, and the association of them in "Homes." The
lines of the "Metropolitan District Nursing Association," which had for
many years been largely supported by nurses trained in the Nightingale
School and by grants from the Nightingale Fund, were adopted as the
basis of the "Jubilee Institute for Nurses," and the Association
presently became affiliated to the Institute. In an introduction which
she contributed in 1890 to a book giving account of these matters,[217]
Miss Nightingale struck a warning note. "The tendency is now to make a
formula of nursing; a sort of literary expression. Now, no living thing
can less lend itself to a formula than nursing. Nursing has to nurse
living bodies and spirits. It must be sympathetic. It cannot be tested
by public examinations, though it may be tested by current supervision."
The Royal Jubilee Institute in some ways advanced Miss Nightingale's
cause, but she had misgivings. "_Vexilla regis prodeunt_; yes, but of
which King?" Was the oriflamme, which was now beginning to wave above
the nursing sisterhood, "of heavenly fire, or of terrestrial tissue?"
"We are becoming the fashion," Miss Nightingale was fond of saying; "we
must be on our guard. Royalty is smiling on us; we must have a care."
Such misgivings were speedily to be justified.
[217] See Bibliography A, No. 120.
The nursing world was for some years rent in twain by a dispute about
Royal Charters and Registration. The controversy lasted for seven years
(1886-93); Miss Nightingale was in the thick of it, and during the more
critical period of the dispute (1891, 1892) it was her main public
preoccupation. In 1886 the Hospitals Association[218] appointed a
Committee to inquire into the possibility of establishing a General
Register of Nurses. The Committee violently disagreed; in 1887 the
majority retired, and the minority founded the British Nurses
Association with a view to carrying forward a scheme of Registration. In
1888 the Hospitals Association appointed a second committee which
proceeded to collect opinions from the various Nurse Training Schools.
These Schools were for the most part opposed to the idea of a General
Register; but there was difference of opinion among leaders alike in the
medical profession and in the nursing world. "I have a terror," wrote
Miss Nightingale to Mr. Bonham Carter (April 20, 1889), "lest the
B.N.A.'s and the anti-B.N.A.'s should form two hostile camps, judging
one another by that test chiefly or alone. This would be disastrous.
The Unionists and the Home Rulers show us an example of what this is.
They are two hostile camps, dividing families. It is like a craze. The
test, _e.g._ even of a good doctor or of an acquaintance is, to which
camp does he belong? Even a doctor, canvassing for an appointment, is
asked whether he is Home Ruler or Unionist. I can remember nothing so
distressing since the Reform Bill, which I remember very well, when the
two sides would not meet each other at dinner." I do not know that
feeling between the pro-Registrationists and the anti-Registrationists
went to the length of war-to-the-knife-and-fork; but the "Nurses'
Battle" (as it was called in the newspapers) was hot and prolonged. From
a fighting point of view, the two sides were fairly matched. On each
side there were eminent doctors. The "anti's" had an advantage in that
they included the greater number of those who had the longest and
closest knowledge of nurse-training; but the "pro's" had a Princess at
their head. The Princess Christian had accepted the presidency of the
British Nurses Association; and when the time came for applying for a
Charter, it was the Princess who petitioned the Queen. "This makes it
awkward for us," said Mr. Rathbone to Miss Nightingale; and undoubtedly
it did. There were courtly personages even among Miss Nightingale's
devoted adherents who were inclined to trim; and there were other
persons, who, having never perhaps thought out the questions, were
predisposed to do as the Princess did. Let each man in the battle have
such credit as is due for his personal loyalty. "In any matter of
nursing, Miss Nightingale is my Pope," wrote Mr. Rathbone, "and I
believe in her infallibility." "Nothing can save us," he said to Miss
Nightingale herself, "except your intervention." She was not slow to
give it. Suggestions were made by intimate friends--Sir Henry Acland and
Sir Harry Verney--that she should see the Princess Christian and
endeavour to come to terms; and later on, in 1893, when the Empress
Frederick visited Miss Nightingale, they renewed the suggestion. But the
Princess Christian had made no overtures; she was committed to the
particular scheme advocated by the Association of which she was
President; and, to Miss Nightingale, opposition to that scheme was a
matter of vital principle. She threw herself into the fray with an
equipment of argumentative resource derived from her unequalled
experience, and with a passionate conviction inspired by long brooding
over a fixed ideal.
[218] An Association founded by Sir Henry Burdett, out of which came the
Nurses National Pension Scheme (a scheme which Miss Nightingale
much commended). She took a different view of his Directory of
Nurses.
The objects of the British Nurses Association were "to unite all
qualified British Nurses in membership of a recognized Profession"; "to
provide for their Registration on terms satisfactory to physicians and
surgeons as evidence of their having received systematic training"; "to
associate them for mutual help and protection and for the advantage in
every way of their professional work"; and "with a view to the
attainment of these objects, to obtain a Royal Charter incorporating the
Association and authorizing the formation of a Register."[219] It was
around the second and the fourth of these objects that the principal
battle raged. The case of the Association was _prima facie_ a strong
one. A Register of Nurses, duly certified as competent, would, it was
argued, be a protection against impostors. The certification was to be
by a Board which would insist on a certain standard of professional
proficiency. Three years' training in a hospital was suggested as the
preliminary test. The case, on the other side, as developed by Miss
Nightingale and her allies, was that the apparent advantages of a
Register were deceptive. Who was to be protected? Not the hospitals:
they protected themselves, without any general register, by their own
methods. If any one was to be protected, it must be the public; but the
Register would rather mislead than protect them. The placing of a name
on a register would, at best, only certify that at a certain date the
nurse had satisfied the required tests; but the date might be long ago,
and the fact of registration would tell nothing of her subsequent
conduct or competence. The registration of midwives stood on a different
footing from that of nurses; for in the former case, a certain definite
technical skill is of the essence of the matter: in the case of nursing,
character is as much of its essence as any technical qualification. As
for the three years' training in a hospital, there were hospitals and
hospitals, training-schools and training-schools; and who was to
guarantee the guarantors? The General Register would not raise the
profession of nursing; it would do an injury to the better nurses by
putting them on a level with the worse, and to the profession by
stereotyping a minimum standard. The British Nurses Association had
published a preliminary "register." Miss Nightingale analysed it, and
found that in the case of nurses "trained" at one hospital, the private
Register of that Hospital excluded nearly one-third of those entered on
the B.N.A.'s register; and that another Hospital's Register included, as
"duly certificated," only one-third of those entered on the B.N.A.'s
register as trained thereat. "You cannot select the good from the
inferior by any test or system of examination. But most of all, and
first of all, must their moral qualifications be made to stand
pre-eminent in estimation. All this can only be secured by the current
supervision, tests, or examination which they receive in their
training-school or hospital, not by any examination from a foreign body
like that proposed by the British Nurses Association. Indeed, those who
come best off in such would probably be the ready and forward, not the
best nurses."[220] The much vexed question of "internal" or "external"
examination was, it will be seen, involved in this dispute. But to Miss
Nightingale a larger and a more vital issue was at stake. It was a
conflict between two ideals--or rather, as she would have said, between
a high ideal and a material expediency. Mr. Jowett, though he agreed in
her view "that nurses cannot be registered and examined any more than
mothers," was distressed that she was so greatly perturbed over what
seemed to him so small a matter. "It is a comparative trifle," he wrote
(May 26, 1892), "among all the work which you have done, and you must
not be over-anxious." To Miss Nightingale it was not a trifle, but a
trial--a possible parting of the ways. It was diverting attention from
training-homes to examination-tests; it was sacrificing a high calling
to professional advancement. "There comes a crisis," she wrote to Mr.
Jowett (May), "in the lives of all social movements, rough-hew them as
you will, when the amateur and outward and certifying or
registering spirit comes in on the one side, and the mercantile or
buying-and-selling spirit on the other. This has come in the case of
Nursing in about 30 years; for Nursing was born about 30 years ago. The
present trial is not persecution but _fashion_; and this brings in all
sorts of amateur alloy, and public life instead of the life of a
calling, and _registering_ instead of _training_. On the other hand, an
extra mercantile spirit has come in--of forcing up wages, regardless of
the truism that Nursing has been raised from the sink it was, not more
by training, than by making the Hospital, Workhouse Infirmary, or
District Home a place of moral and healthful safe-guards, inspiring a
sense of duty and love of the calling." The true way of "protecting the
public" was "to extend Homes for Private Nurses on sound lines, aided by
the Nurses' Training Schools and Hospitals"; not, by means of a
Chartered Register, to encourage nurses "to flock to the Institutions
which gave the easiest certificate at the least trouble of training."
Miss Nightingale could not, then, regard the dispute as a trifle. It
caused her days and nights of grievous anxiety. Her meditations are full
of despondency and searchings of heart both bitter and self-reproachful.
The Princess Christian, with the best intentions, was giving her name to
undermine Miss Nightingale's ideal. This could not justly be attributed
in blame to the Princess; the fault must have been with her, Florence
Nightingale, who had misused her opportunities, and had failed to
impress her ideal on other minds. She was an unprofitable servant. But
here, as in all things, the sensitive reproaches of the night-watches
left no trace of themselves on the work of the day; or rather, they left
their trace in greater activity and devotion.
[219] Proceedings of First General Meeting, February 24, 1888.
[220] Letter from Miss Nightingale to Mr. Rathbone, read to the Privy
Council: see p. 90 of the book cited below (p. 362 _n._).
It was in 1889 that the occasion came for resolute action. The British
Nurses Association announced their intention of applying for a Charter,
and proceeded to enlist public support. Miss Nightingale set to work on
the other side. She made the acquaintance at this time of Miss Lückes,
then, as now (1913), the Matron of the London Hospital, who was strongly
opposed to the idea of registration. The acquaintance speedily ripened
into friendship, and henceforth Miss Nightingale was looked to for
support and sympathy by the Matron of the London, hardly less than by
her of St. Thomas's. Other nurse-training schools came into line, and a
manifesto was issued announcing their intention to oppose any petition
for a Charter. There was desultory skirmishing for some time between the
Registrationists and anti-Registrationists. There was a lively polemic
in the newspapers. There were as many fly-sheets and pamphlets as if it
were a theological dispute in a University.[221] In 1891 the British
Nurses Association applied to the Board of Trade to be registered as a
Public Company, without the addition of the word "Limited" to its name.
The Memorandum and proposed Articles of Association were duly filed, and
the foremost place was again given, among the declared objects, to a
register of trained nurses, and to power to determine from time to time
the test for registration. Miss Nightingale and her allies took up the
challenge. Through Sir Harry Verney she approached the President of the
Board of Trade (Sir Michael Hicks-Beach) with a statement of the case
against the Association. A counter-petition was presented; and after
full consideration the Board refused the application. The first
engagement had thus resulted in a victory for Miss Nightingale. In the
same year there was a Committee of the House of Lords to inquire into
the London Hospitals. Mr. Rathbone, coached by Miss Nightingale, gave
evidence on the question of the registration of nurses, and the
Committee reported against it. A second victory! But the
Registrationists now brought up their most formidable reserves.
Permission was obtained from the Sovereign to use the title "Royal."
Thus strengthened by favour in the highest quarter, the Royal British
Nurses Association petitioned the Queen for a Royal Charter. The
petition was referred in the usual course to a special Committee of the
Privy Council, and the two sides marshalled their forces. A campaign
fund was raised by the anti-Registrationists. Miss Nightingale appealed
privately to the Lord President of the Council and wrote various
letters, Memoranda, Statements. She enlisted support from the medical
profession. Her old pupils, now in charge of nurse-training schools
throughout the country, rallied round her. Two petitions, of special
weight, were presented to the Privy Council against the Charter. One was
from the Council of the Nightingale Fund, the body which had been the
pioneer in promoting the training of nurses. The other was the "Petition
of Executive Officers, Matrons, Lady Superintendents, and Principal
Assistants of the London and Provincial Hospitals and Nurse Training
Schools, and of Members of the Medical Profession and Ladies directly
connected with Nursing and the Training of Nurses." The list of
signatures, which occupies twenty-three folio pages, was headed by
"Florence Nightingale." In the preparation of these documents, Miss
Nightingale had a large share, though much of the work--especially in
the instruction of the lawyers, in consultations and so forth--was done
by Mr. Bonham Carter.
[221] On Miss Nightingale's side two of the most effective pieces were:
_Is a General Register for Nurses Desirable?_ by Henry Bonham
Carter (Blades, 1888), and _What will Trained Nurses gain by
joining the British Nurses Association?_ by Eva Lückes
(Churchill, 1889).
The Committee of the Privy Council sat in November 1892 to hear the
case.[222] Of the first day's proceedings Miss Nightingale wrote an
account in which, as will be seen, she did not let the Registrationist
dogs have the better of it, but which betrays at the same time serious
anxiety about the result:--
(_Miss Nightingale to Sir Harry Verney._) 10 SOUTH STREET, _Nov._
22 [1892]. Yesterday was the first day of the Privy Council Trial.
We had to change our senior counsel at the last moment, because
Mr. Finlay was engaged on an Election Committee. And our previous
four days were, therefore, as you may suppose, very busy. We were
fortunate enough to have Sir Richard Webster. Sir Horace Davey
opened the Ball on behalf of Princess Christian. His speech was
dull, and contained only the commonplaces we have heard for a year
in favour of the Royal Charter. The Judges were: Lord Ripon (who
only stayed half the time), Lord Monson, and two Law Lords [Lord
Hannen and Lord Hobhouse]. They appeared to have been chosen as
knowing nothing of the matter and as not having been on the Lords
Committee on Hospitals. Our side, Sir Richard Webster, followed
with a masterly speech--masterly from being that of a shrewd man
of sense, without rhetoric, and from his splendid getting up of our
case at short notice. He put very strongly our contention that
character, _unregistrable_, rather than technical training, makes
the nurse, and other of our points. The Judges adjourned till
Monday in the middle of his speech where he was saying as we
do--What is the use of saying that a Nurse has had 3 years'
training at such a Hospital? how can you certify the Hospital? He
will resume this subject and others on Monday. The Judges asked all
the questions--_not_ to the point--that you can fancy men perfectly
ignorant of the subject to ask, and which we have answered over and
over again. Sir Richard Webster said to Bonham Carter at the end of
yesterday, "The judges are dead against us." The Charter pledges
itself to admit on the Register only nurses of three years'
Hospital training--which the Judges pronounced could do no harm.
But it provides for itself what may put into its hands the whole
control of what constitutes training. Is it not wonderful these men
do not see this? Well, "we are in God's hands, brother, not in
theirs" (the Privy Council's). In all my strange life through which
God has guided me so faithfully (O that I had been as faithful to
Him as He to me!), this is the strangest episode of all--to see a
number of Doctors of the highest eminence giving their names to
what they know nothing at all about. Sir James Paget told me
himself that the names were asked for at a Court Ball,--following
each other like a flock of sheep; to see their Council of
Registration made up of _Sirs_, only one of whom knows anything
about nurse-training (Sir James Paget himself asked me, why can't
nurses lodge out as students do!!); to see these able, good, and
shrewd men ignoring that such a thing is sure to fall into a
clique. They have let Princess Christian fall into such an
one already. She is made a tool of by two or three people. "Lift up
your heads, ye gates, and the King of Glory shall come in. Who is
the King of Glory? The Lord strong in battle." O God of Battles,
steel thy soldiers' hearts against happy-go-luckiness, against
courtiership, fashion, and mere money-making on the part of the
Nurses and their Societies! _P.S._ This trial will cost us £700 at
least.
[222] A verbatim report of the hearing (Nov. 21, 28) was published in
1893 entitled _The Battle of the Nurses_ (Scientific Press).
The Committee took time to consider their advice to Her Majesty. In May
1893 the decision was announced. The Committee advised Her Majesty in
Council to grant a Charter in accordance with a Draft revised by them.
On June 6 the Charter was granted.
Each side claimed the victory. The _Nursing Record_ (June 15)--an organ
of the Registrationists--claimed that they had won all, and even more
than all, that they asked, and declared proudly that henceforth "members
of the Royal Chartered Association will hold a higher position than any
others." The _Hospital_, on the other side, argued that all this was
ill-founded, but if the "British Nurses" wanted to be congratulated on
nothing, "we are willing to congratulate them" (June 24). The fight
before the Privy Council now became a fight in the press on the meaning
of the verdict. The anti-Registrationists, headed by Miss Nightingale
and the Duke of Westminster, put their interpretation in a quiet letter
to the _Times_ (July 3), which the Royal British Nurses Association
hotly denounced as "untrue in fact and injurious in intention" (July 6).
The fact was that the Lords of the Council had steered a middle course.
They granted the Charter; but in it for the words "the maintenance of a
list or _register_ of nurses, showing as to each nurse registered,"
etc., they substituted the words "the maintenance of a list of persons
who may have applied to have their names entered therein as nurses,"
etc. There was nothing in the Charter which gave any nurse the right to
call herself "chartered" or "registered." What the promoters hoped we
need not discuss; what the opponents feared was a Charter in such terms
as would give the Corporation an authoritative, and perhaps ultimately,
an exclusive right to register nurses, and thereby would give it also
indirect control over nurse-training. No such Charter was obtained; and
in this sense the opposition of Miss Nightingale and her friends had
prevailed. The controversy is not dead; but, so far, her view has
continued to prevail,[223] and the official registration of nurses is
still a pious hope to its supporters, a heresy to its opponents. Miss
Nightingale greatly deplored the feud, but sought to bring good out of
evil. "Forty years hence," she wrote to Mr. Rathbone (Feb. 26, 1891),
"such a scheme might not be preposterous, _provided_ the intermediate
time be diligently and successfully employed in levelling up, that is,
in making all nurses at least equal to the best trained nurses of this
day, and in levelling up Training Schools in like manner." "Great good
may be done," she wrote to Mr. Jowett (May 1892), "by rousing our side
to an increased earnestness about (1) providing Homes for Nurses while
engaged in their work of nursing, and (2) full _private_ Hospital
Registers, tracing the careers of nurses trained by them." There were no
years in which Miss Nightingale herself gave more thought and trouble,
than in 1891-3, to personal care for the affairs of the Nightingale
School.
[223] See the report of a deputation to the Prime Minister in the
_Times_, April 29, 1913.
In a Paper which Miss Nightingale was invited to contribute to a
Congress on Women's Work, held at Chicago in 1893, she treated the whole
subject of nursing.[224] This paper embodies in a methodical form her
characteristic views, and in it she takes occasion in several places to
touch obliquely upon the controversy described in preceding pages. "A
new art, and a new science, has been created since and within the last
forty years. And with it a new profession--so they say; we say,
_calling_." She dwells on the conditions necessary to make a good
training school for nurses. She dilates upon the dangers to which
nursing is subject. These are "Fashion on the one side, and a consequent
want of earnestness; mere money-getting on the other side; and a
mechanical view of nursing." "Can it be possible that a testimonial or
certificate of three years' so-called training or service from a
hospital--_any_ hospital with a certain number of beds--can be accepted
as sufficient to certify a nurse for a place in a public register? As
well might we not take a certificate from any garden of a certain number
of acres, that plants are certified valuable if they have been three
years in the garden?" Then there was "imminent danger of stereotyping
instead of progressing. No system can endure that does not march.
Objects of registration not capable of being gained by a public
register!" The whole paper is written with a good deal of gusto. The
volume in which it appeared was dedicated to Princess Christian.
[224] Bibliography A, No. 131.
In the following year Miss Nightingale had some correspondence with the
Princess, who, as President of the Royal British Nurses Association, had
made a scheme for enrolling a "War Nursing Reserve" through the
Hospitals, and had written to consult Miss Nightingale about it. The
Hospital Sisters were according to this scheme to be placed "in
subordination to the Army Sisters"--nurses with the larger experience
under those with the smaller. This seemed to Miss Nightingale a mistake;
and she noted other details in which the scheme appeared to her
inadequately considered. She pointed these things out faithfully to the
Princess, but the correspondence on both sides was cordial. The letters
from the Princess made Miss Nightingale exclaim, "How gracefully Royalty
can do things!" And on her part she desired to be conciliatory. "We
should, I think, be earnestly anxious," she wrote, "to do what we can
for Princess Christian as she holds out the flag of truce, in order to
put an end as far as we can to all this bickering, which does such harm
to the cause."
There were thoughts in Miss Nightingale's mind throughout this
controversy still deeper than any which have yet been noticed. She had
an esoteric conception of Nursing which made her regard the view of it
as a registrable business in the light almost of sacrilege. "A
profession, so they say; we say, _calling_." And not only a calling, but
a form through which religious satisfaction might be found. Her view
comes out in a letter which she wrote to Mr. Jowett in 1889 in the
course of a discussion with him upon the necessity of external forms for
the religious life: "You say that 'mystical or spiritual religion is not
enough for most people without outward form.' And I may say I can never
remember a time when it was not the question of my life. Not so much for
myself as for others. For myself the mystical or spiritual religion as
laid down by St. John's Gospel, however imperfectly I have lived up to
it, was and is enough. But the two thoughts which God has given me all
my whole life have been--First, to infuse the mystical religion into the
forms of others (always thinking they would show it forth much better
than I), especially among women, to make them the 'handmaids of the
Lord.' Secondly, to give them an organization for their activity in
which they could be trained to be the 'handmaids of the Lord.' (Training
for women was then unknown, unwished for, and is the discovery of the
last thirty years. One could have taken up the school education of the
poor, but one was specially called then to hospitals and nursing--both
sanitation and nursing proper.) This was then the 'organization' which
we had to begin with, to attract respectable women and give religious
women a 'form' for their activity.... When very many years ago I planned
a future, my one idea was not organizing a Hospital, but organizing a
Religion." Now, "handmaids of the Lord" cannot be certified by external
examiners, nor can a religious service be guaranteed by registers.
Does this view of the matter seem a little transcendental? It was in
accord, at any rate, with another of Miss Nightingale's fundamental
doctrines, which in its application to the controversy had a severely
practical force. Nursing, she held, is a progressive art, in which to
stand still is to go back. No note is more often struck in her Addresses
to Nurses. She held, as may already have been gathered from the
foregoing summary of her case, that the Registrationists, consciously or
unconsciously, had lost hold of that essential truth about nursing. It
was right that precautions should be taken against impostors, and that
the fullest inquiries should be made. Miss Nightingale's objection was
not to the precautions, but to their misleading nature; not to the
tests, but to their inadequacy. The only real and sufficient guarantee,
in the case of an art in which the training, both technical and moral,
is a continuous process, was, she held, that the public should be able
to obtain a _recent_ recommendation of the nurse, who was to be passed
on from one doctor, hospital, or superintendent to another with
something of the same elaborate record of work and character that she
herself required in the case of Nightingale Probationers and Nurses.
III
The fate of Miss Nightingale's work in the cause of Public Health both
in India and at home was chequered during these years, even as was that
in the cause of trained nursing, but here again substantial advance was
made in several directions. There was once a Secretary of State who
entered the India Office possessed by a strong and personal interest in
sanitation. There was some excitement in the Office. There were one or
two men around the Minister who heartily approved; there were more who
shook their heads. The Minister must have been listening, they thought,
directly or indirectly, to a certain lady's "beautiful nonsense." He was
too impressionable. He was anxious to do things, in spite of the claims
of economy. He was too much in a hurry. They took him in hand in order
to quiet him down. They thought to have succeeded in making him
satisfied to leave things as they were. The other side became conscious
of a change. "It is essential," wrote one of them to a certain lady,
"that you should see him at once." The lady, who was the hope of one
side and the fear of the other, was Miss Nightingale. The Minister need
not be identified; for these things, though true also of a particular
case and time, are here given as a general allegory. For thirty years
and more, through all changes and chances in the political world, Miss
Nightingale was a permanent force, importuning, indoctrinating,
inspiring, in the interests of better sanitary administration.
For some time after the early months of 1885 the political situation was
very unsettled. The Government formed by Lord Salisbury after the defeat
of Mr. Gladstone in June was only a "Cabinet of Caretakers," and it was
not worth Miss Nightingale's while to approach any of them. Besides, she
instinctively recognized the Secretary of State for India as a hopeless
subject. She was right. Lord Randolph Churchill was all against Lord
Ripon, and all for economy. When Lord Salisbury's Government was in turn
overthrown, after the general election in December, Miss Nightingale,
through various channels, approached Mr. Gladstone, and begged him to
send Lord Ripon to the India Office. He returned polite but evasive
answers, and so controversial an appointment was obviously improbable.
Lord Ripon went to the Admiralty. The excitement of the first Home Rule
Bill followed; the Government was defeated; another general election was
necessary, and all was in confusion. Dr. Sutherland, anxious to retire
from the public service (for he was now nearly 80), was pressing Miss
Nightingale to devise measures for safeguarding his department after he
was gone. She pressed him to stay on yet a while. "During the political
earthquakes of the last 8 months, still continuing, no permanent
interest can be expected," she wrote to him (July 20, 1886), "in those
who are so little permanent. The subject excruciates me." Lord Ripon,
who came to see her ten days later, thought that the times were
unpropitious generally for good causes--an opinion which defeated
Ministers are apt to hold. "There are waves in these matters," he said.
"The thing is to come in upon the crest of the waves. You would have
done nothing for the Army and Sanitation if it had not been for the
crash in the Crimea. Now, the wave is against India."
Miss Nightingale, however, did not allow herself to be tempted into
inactivity by this wave-theory. For the moment, indeed, there was
nothing to be done with Ministers at home; but she had not been
neglectful of cultivating relations with Anglo-Indians and Indians in
positions of influence. In 1885 she had added Sir Neville Chamberlain
and Sir Peter Lumsden to her list of Anglo-Indian acquaintances. Lord
Reay had called upon her (March 1885) before leaving to take up the
governorship of Bombay, and she corresponded with him frequently on
sanitary subjects. In October, Lord Roberts came before going out to
India as Commander-in-Chief. Miss Nightingale took great pains with this
interview, Dr. Sutherland having furnished her in advance with an
admirable synopsis of what might still be done to improve the health and
welfare of the troops. Lord Roberts's command was fruitful of some
reforms in which Miss Nightingale had been a pioneer. He established a
club or institute in every British regiment and battery in India. He
closed canteens. He opened coffee-stalls. He established an Army
Temperance Association.[225] No letter which Miss Nightingale received
in her Jubilee Year can have pleased her more than one which the
Commander-in-Chief in India sent her from Simla on August 6. In this
letter Lord Roberts told her that the Government of India had sanctioned
the employment of female nurses in the Military Hospitals. A
commencement was to be made at the two large military centres of Umballa
and Rawalpindi, and 18 nurses, with lady superintendents in each case,
were to be sent out from England at once. The selection of nurses was
entrusted to Surgeon-General Arthur Payne, who in the following month
had several interviews with Miss Nightingale. Thus, after twenty-two
years, was the scheme which she had put before Sir John Lawrence brought
to fruition. Miss Nightingale saw the Superintendents before they went
out, and letters from them were now added to the pile of those which she
received from hospitals throughout the world, reporting progress or
asking advice. Miss C. G. Loch wrote from Rawalpindi (April 12, 1888)
describing how she had found that, as Miss Nightingale always said, the
education of the Orderlies was the most important thing for the nurses
to do.
[225] See his _Forty-one Years in India_, chap. lxvi.
The official introduction of female nursing into the Indian military
hospitals was by no means the only satisfaction which Miss Nightingale
received during Lord Dufferin's Viceroyalty. He had declared himself
ignorant of Indian sanitary things, but had promised to learn; and not
only was he as good as his word, but Lady Dufferin was keenly interested
also. She founded the "National Association for Supplying Medical Aid to
the Women of India." Miss Nightingale had long been interested in the
subject, and Lady Dufferin consulted her at every stage. One of the
first things needful, Lady Dufferin had written (Sept. 19, 1885), was a
supply of Sanitary Tracts. "In using the word tract, I am thinking of
some little books in Hindustani written by A.L.O.E. which I am obliged
to read as part of my studies in the language. They are stories with a
moral, and I don't see why something of the kind might not be published
with health as a moral." Miss Nightingale took great pains in collecting
suitable raw material, and during the remainder of Lord Dufferin's
Viceroyalty wrote to her by almost every mail.
IV
Yet more was to be "fired," during Lord Dufferin's Viceroyalty, of
sanitary "shot" supplied, as he had requested, by Miss Nightingale; but
we must now turn back to London, where, partly from circumstances and
partly of necessity, Miss Nightingale was presently engaged in a
vigorous campaign. There is a large bundle of correspondence during
these years upon a matter which is referred to in some of the letters as
"The Sutherland Succession." Now, Dr. Sutherland was in Miss
Nightingale's eyes the indispensable man. Not any longer in the personal
sense, as described in an earlier chapter; for he was now a very old
man, and was only able to help her on rare occasions. She had already
found a successor in this personal sense, or rather she had put Dr.
Sutherland's place into commission. Sir William Wedderburn was during
these later years her most constant collaborator in Indian matters, and
for the rest she relied upon Sir Douglas Galton.[226] She had often
chafed at Dr. Sutherland's delays, but I expect that when Sir Douglas
succeeded to him she may in one respect have parodied to herself the
well-known Cambridge epigram, and said, "Poor Dr. Sutherland! we never
felt his loss before." For Sir Douglas Galton, though devoted also to
Miss Nightingale's service, was an exceedingly busy and much-travelling
man, and she had to be content with the crumbs of his time. "As it was
some time in the dark ages," she wrote (May 13, 1887), "since I saw you
last--my memory impaired by years cannot fix the date within a decade--I
seize the first day you kindly offer." And again (Dec. 3, 1889): "I must
take your leavings, as beggars must not be choosers. Yes, please, your
dog will see you to-morrow on your way from Euston for as long as you
can stop." Miss Nightingale relied greatly on Sir Douglas Galton's
advice; she had a very high opinion, not only of his thorough knowledge
of all sanitary subjects, but of his sound judgment generally. From the
personal point of view, then, Dr. Sutherland was gone already; but in
his official capacity he was still indispensable. He was the mainspring
of the system of sanitary administration, both for the home Army and for
India, which Miss Nightingale had built up. He was the one paid working
member, and he was also the working brain, of the Army Sanitary
Committee, and it was to that Committee that Indian sanitary reports
were referred. But he was impatient to retire. At any moment his health
might become worse, and he might send in his resignation before
arrangements had been made for the appointment of a successor. So long
as he remained at his post, no changes were likely to be made; but if he
retired, it was very probable that no successor would be appointed, and
that the whole system would collapse. That the heads of the Army were
ignorant of Dr. Sutherland's services, had been burnt in upon Miss
Nightingale's mind a few years before. In discussing some matter of army
nursing with the minister of the day, she had suggested the reference of
it to Dr. Sutherland. "Who is he?" said the minister; "I have never
heard of him." At the India Office it was much the same. "I don't
think," wrote a friend (Sept. 8, 1886), "that this office in general
appreciates the importance of those reviews of Indian sanitary matters
of which Dr. Sutherland has been the real author hitherto." The whole
system would lapse, he feared, unless she was able to do something.
[226] Captain Galton was knighted in 1887.
Nor was this all. The sanitary service in India itself was in danger.
The annexation of Burma had made retrenchment necessary; a Finance
Committee was at work in recommending economies; and Miss Nightingale
received private information that the Sanitary Commissioners were marked
down by the Committee for destruction. The whole edifice thus seemed to
be crumbling. This was what she had in her mind when, in the Jubilee
retrospect quoted at the beginning of the chapter, she said that the
work of thirty years had all to be done again.
She turned with all her old energy to efforts commensurate to the
threatened calamity. In accordance with her usual method, she first
consulted many influential friends (Lord Ripon amongst others), and then
acted with great energy. She wrote a long statement to Lord Dufferin
(Nov. 5). "I have sent your letter _in extenso_," he replied (Jan. 18,
1887), "to the head of the Finance Committee. You should understand that
it does not at all follow, because the Committee recommend a thing, that
their recommendation will, as a matter of course, be accepted by the
Government. On the contrary, I will go most carefully into this
question in which you naturally take so deep an interest, and will be
careful to have it thoroughly discussed in Council by my colleagues with
the advantage of having had your views placed before them." A few months
later came welcome news:--
(_Lord Dufferin to Miss Nightingale._) SIMLA, _August_ 20 [1887]. I
write you a little line to tell you that the Indian Government have
finally determined not to sanction the proposals of the Finance
Commission for the abolition of the Sanitary Commissioners, about
which you were naturally alarmed. There is no doubt that the
Finance Commission was in a position to prove that these officers
had been able to do very little, owing to the unwillingness, or
rather the inability of the local Authorities to supply funds, and
in some cases to their own listlessness and want of energy. We are
now, however, taking the question up, and the result of the attack
upon your protégés will be, not their disappearance, but their
being compelled to give us the worth of the money we spend upon
them. I am also inviting all the local governments to put the whole
subject of sanitation upon a more satisfactory footing, and to
establish a system of concerted action and a well-worked-out
programme in accordance with which from year to year their
operations are to be conducted. I cannot say how grateful I am to
Sir Harry Verney for his kindness in writing me such interesting
and pleasant letters. In them he tells me from time to time, I am
afraid I cannot say of your well-being, but of your unflagging
energy in the pursuit of your noble and useful aims.
Meanwhile Miss Nightingale had been busy with Ministers at home. In the
latter half of 1886 Lord Salisbury's Government was firmly seated, and
she received visits from the Secretaries of State for India and for War
(Lord Cross and Mr. W. H. Smith). She found Lord Cross most sympathetic;
he saw her from time to time during following years, and they had a good
deal of correspondence. To Mr. W. H. Smith she paid her highest
compliment; in some ways he reminded her, she said in her notes, of
Sidney Herbert. Superficially, and in several of their real
characteristics, no two men could be more unlike; but in certain
respects Mr. Smith resembled her ideal of a War Minister. He had a
sincere concern for the welfare, alike physical and moral, of the
soldiers; and he showed a quick and industrious aptitude for
administrative detail. She saw Mr. Smith several times, and at his
request had an interview with the Chaplain-General.[227] It seemed as if
the work, which she had done with Sidney Herbert, might be resumed with
Mr. Smith, when there was a thunder-clap from a clear sky. Lord Randolph
Churchill resigned. The Ministry was for a while in confusion, and Miss
Nightingale in despair. "We _are_ unlucky," she wrote to Sir Douglas
Galton (Dec. 23). "As soon as we seem to have got hold of two
Secretaries of State, this Randolph goes out! The Cabinet will have to
be remodelled, and perhaps we shall lose our men. All the more reason
for doing something at once." Of her two "men," the one was taken, the
other left. Mr. W. H. Smith became First Lord of the Treasury, but Lord
Cross remained at the India Office. "I am very sorry to give up the War
Office," said Mr. Smith to Miss Nightingale, "but I am told it is my
duty, and duty leaves no choice." She begged him to indoctrinate his
successor, Mr. Edward Stanhope. She was already acquainted with him, and
presently he came to see her. It was with peculiar satisfaction that she
presently heard of the Government's intention to take a loan for four
millions for the building of new barracks and the reconstruction of old
ones. This was a resumption of the work of Sidney Herbert, thirty years
after.[228]
[227] It was a subject of recurring self-reproach to Miss Nightingale in
subsequent years that she had not found time to follow up this
latter opening and organize a new crusade for the spiritual and
moral welfare of the soldiers. She had already done much in that
sort; and Mr. Jowett's equally recurring comment was to the point:
"Why complain because you cannot do more than you do, which is
already more than any other ten women could do?"
[228] A succinct statement of such reforms, up to 1899, was compiled by
Mr. Frederick on his retirement from the War Office and was issued
as a Blue-book: _Record of Recommendations regarding Sanitary
Improvements in Barracks and Hospitals together with the Actual
Improvements carried out during the last 50 years_.
An early intimation of this policy made Miss Nightingale the more
anxious about the fate of the Army Sanitary Committee. If the sanitary
condition of the barracks was to be improved, it was all-important that
a strong Sanitary Committee should be in existence to supervise the
work. At first, however, she had been unable to secure any promise about
the Sutherland Succession. The War Office would not consider the matter
until a vacancy occurred; the India Office would do nothing until it
knew what the War Office meant to do. In 1888 the long threatened thing
happened. Dr. Sutherland resigned. No successor was appointed. The whole
subject, she was informed, was under consideration, and then under
reconsideration. Ultimately Mr. Stanhope, after interviews with Miss
Nightingale, reconstituted the Committee (June 1890). Sir Douglas Galton
remained upon it. Dr. J. Marston was appointed paid member in succession
to Dr. Sutherland, and Miss Nightingale's friend and ally,
Surgeon-General J. W. Cunningham (formerly Sanitary Commissioner with
the Government of India) was appointed as an Indian expert. Her friend
Mr. J. J. Frederick retained his post as Secretary to the Committee. The
danger was overpast.
V
Sanitary reports from India were still to be referred to the Committee,
but Miss Nightingale and some of her friends thought that the time had
come for an advance in India. Lord Cross was so sympathetic that the
occasion seemed opportune for reviving her former plea for a sanitary
department in India which should be more directly _executive_. Sir Henry
Cunningham (married to a niece of Sir Harry Verney) had been in
communication with her for some years. He was a judge of the High Court
of Calcutta, and had taken an active part in the cause of sanitation in
that city. He now prepared a memorandum advocating a forward policy.
Miss Nightingale's ally on the India Council, Sir Henry Yule, prepared
another, which was so far approved by the Secretary of State that he
ordered it to be circulated in the Office as the draft of a proposed
dispatch to the Government of India. This draft was, in fact, the joint
production of Sir Henry Cunningham, Colonel Yule, and Miss Nightingale.
It went the rounds. It was minuted on. It was considered and
reconsidered; printed and reprinted. Sometimes the report to Miss
Nightingale was that it would be adopted and sent; at other times, that
it had been postponed for further revision, recirculation, and
reconsideration. Ultimately it became in some sort out of date, because
the Government of India took a step on its own motion, in accordance
with the intention which Lord Dufferin had already communicated to Miss
Nightingale (p. 373). By Resolution, dated July 27, 1888, the Government
of India provided for the constitution of a Sanitary Board in every
province, which would not only advise the Government and local
authorities upon sanitary measures, but would also be an executive
agency. The passages in which the latter point is insisted upon might
have been written by Miss Nightingale herself.[229] Lord Dufferin's term
of office was now drawing to a close. He had proved himself an apt pupil
of the "Governess of Governors-General." As on the voyage out he had
promised to do her bidding, so now on the voyage home he gave some
account of his stewardship:--
(_Lord Dufferin to Miss Nightingale._) SS. KAISER-I-HIND _at sea,
Dec._ 26 [1888]. We are now on our way home and are having a
beautiful passage, thanks to which we are all picking up
wonderfully, and shall arrive in Europe quite rejuvenated. This is
merely a line to apologise for having sent you the Report of a
speech I made at Calcutta recently. I would not have troubled you
with it, were it not that on page 15 I have tried to give a parting
lift to sanitation.[230] My ladies go home at once, but I, alas, am
compelled to take up my business at Rome, so that I shall not get
my holiday for another two or three months. Amongst the first
persons whose hands I hope to come and kiss will be yours.
[229] The Resolution is printed at pp. 38-42 of vol. xx. of the annual
_Report of Sanitary Measures in India_ (1888). It contains on the
administrative side a history of the movement which was set on foot
by Miss Nightingale's "second Royal Commission" (1863). The
Secretary of State's dispatch (Jan. 10, 1889), approving of the
Resolution, is full of "the Nightingale influence" (vol. xxi.
p. 173): Colonel Yule's Minute was forwarded as an enclosure with
the dispatch (pp. 173-184).
[230] "The Government has recently given its serious attention to the
subject of Sanitation, and has laid down the lines upon which, in
its opinion, sanitary reform should be applied to our towns and
villages. It has given Sanitation a local habitation and a name in
every great division of the Empire; and it has arranged for the
establishment of responsible central agencies from one end of the
country to the other, who will be in close communication with all
the local authorities within their respective jurisdictions"
(Speech at Calcutta, Nov. 30, 1888).
Lord Dufferin was succeeded by Lord Lansdowne, who was introduced to
Miss Nightingale by Mr. Jowett. She saw Lord Lansdowne twice before he
left for India, and they corresponded frequently on sanitary affairs.
"He did much for us in every way" is her comment on his Viceroyalty.
VI
The constitution of the Sanitary Boards in India proceeded with due
regard to "the periods of Indian cosmogony," and Miss Nightingale
watched their formation and their proceedings carefully, putting in
words of encouragement, expostulation, or reminder, whenever and
wherever an opportunity was offered or could be made. It was soon
apparent that the great obstacle to sanitary progress among the masses
of India lay, where perhaps for many generations it is still likely to
lie, in the immobility of immemorial custom, especially in the villages.
Education was making some slight impression, but the force of passive
resistance, combined with lack of funds, prevented the hope of any rapid
or signal advance. Recognition of these factors now led Miss Nightingale
to concentrate her efforts upon Village Sanitation, and a scheme for
combining the power of education with a financial expedient formed the
motive for the last of her Indian campaigns.
Miss Nightingale had been watching with the closest attention the Bombay
Village Sanitation Bill, a measure first projected in 1887. She analysed
and criticized it, and sent her views to Lord Cross at the India Office,
and to Lord Lansdowne and Lord Reay in India. Her main objection was to
the exclusion from the scope of the Bill of the smaller villages, an
exclusion which did not figure in the revised draft of 1889. She wrote
letters for circulation in India to Native Associations in explanation
and support of Village Sanitation.[231] There was some slight stirring
of Indian opinion, and Miss Nightingale's next concern was to give to it
articulate expression in London. The holding of an International
Congress of Hygiene and Demography in the autumn of 1891 furnished an
opportunity. Sir Douglas Galton was Chairman of the Organizing Committee
of the Congress, so that there was no difficulty in arranging for an
Indian section. Miss Nightingale then circularized the Native
Association in Bombay, begging that representatives might be sent to the
Congress, and papers be contributed by Indian gentlemen. This was done,
and Miss Nightingale interested herself greatly in the Congress. "Sir
Harry Verney," she wrote to Sir Douglas Galton (Aug. 1, 1891), "renews
his invitations to Claydon to the native Indian delegates, 'three or
four at a time.' I have seen Mr. Bhownaggree, who seems to be acting for
the other native gentlemen, not yet come, and asked him to manage this,
as is most suitable to these gentlemen. I may hope to see them one by
one, if I am able to be there. I have also seen (of Delegates) Sir
William Moore and Dr. Payne and Sir W. Wedderburn. Mr. Digby seems to be
doing a great work.[232] Do you remember that it is 30 years to-morrow
since Sidney Herbert died?" The Congress was opened by the Prince of
Wales (Aug. 10), whose speech on the occasion formed the text of many
leading articles in the press. People talked, he said, of "preventable
diseases"; but "if preventable, why not prevented?" It was, however, in
the Indian section that Miss Nightingale was most interested, and she
used it to promote her schemes. The Bombay Village Sanitation Act was
failing to produce the desired results because there were no funds
definitely allocated to sanitation. Sanitary education was making some
little progress, but not enough, in view of the poverty of Indian
villages, to make it likely that _additional_ taxation would be borne.
In these circumstances might not some portion of the _existing_ taxation
(the village "cesses") be appropriated to sanitation as a first charge?
"Until the minimum of sanitation is completed, until the cess of a
particular village has been appropriated to it, while typhoidal or
choleraic disease is still prevalent, should not the claims for any
general purposes be postponed?" Such was Miss Nightingale's case. She
had a memorandum drawn up embodying it in short form, and canvassed for
signatures to it among members of the Indian section of the Congress.
Sir Douglas Galton, Sir George Birdwood, Sir William Guyer Hunter, Sir
William Wedderburn, Dr. Corfield, and Dr. Poore were among those who
signed it. Miss Nightingale then forwarded the Memorandum, with a
covering letter going more fully into the case, to the Secretary of
State. She wrote at the same time to the Governor-General and to the
Governor of Bombay. Lord Cross received the communication very
sympathetically, and forwarded it at once (April 1892) to the Government
of India. Lord Lansdowne then circulated Miss Nightingale's dispatch
among the Local Governments, and during following years a formidable
mass of printed Papers accumulated, "Reporting on the Proposals made by
Miss Nightingale, relative to the Better Application of the Proceeds of
Village Cesses to the purposes of Sanitation." The official view, though
not unsympathetic to Miss Nightingale's object, was opposed to her
financial expedient; it was thought that other purposes, especially the
improvement of roads, etc., had a claim prior to sanitation. "It seems
clear," wrote Sir William Wedderburn to her (July 7, 1893), "that you
have most effectively drawn attention to the subject. The official
replies are what we might naturally expect, but reading between the
lines I think they admit the justice of our contention, and have been
impressed by your action." Perhaps this was to some extent the case.
"You have most effectively drawn attention to the subject"; that was,
perhaps, the main service which during these years Miss Nightingale
rendered to the cause of Indian sanitation. Certainly she was
importunate in asking successive Governors-General for reports of
progress; her importunity often caused them to jog the elbows of Local
Governments; and she may thus not unjustly be credited with such gradual
progress as was made. The final reply to Miss Nightingale's immediate
suggestion was sent in a dispatch to the Secretary of State (Mr. Fowler)
from the Government of India in 1894 (March 28), enclosing letters on
her Memorandum from the several Local Governments. The Government of
India declined for various reasons to adopt her suggestion; but
admitting that something ought to be done, considered that "sanitation
in its simplest form of a pure water-supply and simple latrine
arrangements should be regarded as having to some extent a claim on
Provincial revenues," and it promised "to press this claim upon Local
Governments and Administrations as opportunity offers." A covering
letter to Miss Nightingale from the Secretary of State (May 9, 1894),
while informing her that Mr. Fowler "is disposed to accept the view
taken by the Government of India," expressed the belief "that India will
benefit by the renewed attention which your action has caused to be
given to the important subject of rural sanitary reform." There are
passages in some of the replies from Local Governments, enclosed in the
dispatch, which bear out this belief.
[231] See Bibliography A, Nos. 115, 118, 119, 122, 123.
[232] Mr. S. Digby was acting as Hon. Secretary to the Indian Section of
the International Conference.
Miss Nightingale, on her own part, was diligent in appeals to Indian
gentlemen to bestir themselves. She had an ally at this time in Sir
William Wilson Hunter, who, in his fortnightly summary of "Indian
Affairs" in the _Times_, sometimes enforced her points or called
attention to her writings. She had urged her friend to write a detailed
description of the actual working of Indian administration, and this he
did in 1892.[233] The Preface to his book was a dedicatory letter to
Miss Nightingale. In it he says that the book was written at her
request, describes its scope, and thus concludes: "Now that the work is
done, to whom can I more fitly dedicate it than to you, dear Miss
Nightingale--to you whose life has been a long devotion to the stricken
ones of the earth--to you whose deep sympathy with the peoples of India
no years of suffering or of sickness are able to abate?" In her own
pieces written at this date, Miss Nightingale preached more especially
the gospel of Health Missionaries for Rural India.[234] Some reference
to progress made in this respect will be found in a later chapter
(p. 406). She believed in State action, but no less in Self-help, and
this point of view is emphasized in a retrospect of her work for India
which she wrote, or partly wrote, probably as hints for some vernacular
publication, in 1889.[235] Some passages from the document, here
rearranged, may fitly close this account of her later Indian work.
[233] _Bombay, 1885-1890: A Study in Indian Administration._
[234] Bibliography A, Nos. 132, 135.
[235] The document, unfortunately not complete, is in part typewritten
(with a few pencilled notes in Miss Nightingale's hand) and in part
in the handwriting of a lady who at this time rendered her some
secretarial assistance.
"Miss Nightingale saw in the Queen's Proclamation of 1858 a text and a
living principle to fulfil. Every Englishman and Englishwoman interested
in India were bound in duty and in honour to do their utmost to help
British subjects to understand the principle and to practise the life.
To this she has adhered through illness and overwork for thirty-one
years. First attracted to India by the vital necessity of health for 200
or 250 millions, imperilled by sanitary ignorance, apathy, or neglect,
she believed it to be a fact that since the world began, criminals have
not destroyed more life and property than do epidemic diseases (the
result of well-known insanitary conditions) every year in India. The
protection of life and property from preventable epidemics ranks next to
protection from criminals, as a responsibility of Government, if indeed
it is not even higher in importance. The first thing was to awaken the
Government. This was done by the Royal Commission upon the Sanitary
State of the Army in India, which was the origin of practical action for
the vast native population. But the difficulties were enormous. You must
have the people on your side. And the people, alas, did not care. You
cannot give health to the people against their wills, as you can lock up
people against their wills. Impressed by these facts, Miss Nightingale
saw the necessity of Sanitary Missionaries among the people--of sanitary
manuals and primers in the schools ('Give me the--schools--of a country
and I care not who makes its laws'); of sanitary publications of all
kinds, for man, woman, and child. The Sanitary Commissioner, in one
instance at least,[236] has been a Sanitary Missionary, crying out,
'Bestir yourselves, gentlemen, don't you see we are all dying?' The
people must be awakened, not to call on the Goddess of Epidemics, but to
call upon the Sirkar to do its part, and also to bestir themselves to do
theirs in the matter of cleanliness and pure water. Miss Nightingale
found in Local Government the only remedy; in Local Government combined
with Education." The Paper touches also upon Miss Nightingale's interest
in irrigation, land-tenure, usury, agriculture, and in all these matters
connects State action with Self-help. "To the native gentlemen it is
that Miss Nightingale appeals. She appeals to them also on the Sanitary
point. And first of all it is for them to influence their ladies. Let
them lead in their own families in domestic sanitation. Then, doubtless,
the lady will lead in general sanitation in India as she does in
England." Another passage gives incidentally an autobiographical
summary. "Miss Nightingale has deeply sympathized with the honourable
efforts of the National Congress which has now held three Sessions, in
which its temperate support of political reforms has been no less
remarkable for wisdom than for loyalty. But her whole life has been
given deliberately, _not_ for political, _but_ for social and
administrative progress."
[236] She refers no doubt to Dr. Hewlett.
VII
At the time when Miss Nightingale's Indian work was thus largely
concentrated upon village sanitation, she was no less busily employed,
though in a different way, upon work of a like kind at home. Her
interest in local affairs at Claydon has already been touched upon, and
this was much increased after the death of her sister in 1890. Lady
Verney had been a sufferer for many years, but had borne her illness
with unflagging spirit. In May 1890 she was in London, very ill, and was
counting the hours to her removal to Claydon, but she would not give up
a Sunday in town--a day which Florence now kept sacred for her sister.
On Sunday May 4 Lady Verney was carried into Florence's room, and the
sisters did not see each other again. On Monday Lady Verney was moved to
Claydon, and there, a week later, on Florence's birthday, she died. "You
contributed more than anyone," wrote Sir Harry (May 15), "to what
enjoyment of life was hers. I have no comfort so great as to hold
intercourse with you. You and I were the objects of her tender love, and
her love for you was intense. It was delightful to me to hear her speak
of you, and to see her face, perhaps distorted with pain, look happy
when she thought of you." Miss Nightingale at once went to Claydon,
where she remained for several months. Sir Harry, now in his 90th year,
relied greatly upon his sister-in-law, and for the remainder of his life
she devoted herself to him with constant solicitude. He was never happy
if many days passed without sight of her or hearing from her. The butler
always put Miss Nightingale's letter on the top of his master's morning
pile, and no mouthful of breakfast was eaten till he had read it
through. When he was in the country and she in London, he was always
wanting to run up to town for the day--to buy a new waistcoat, or to
consult his solicitor: any excuse would serve so that he could see his
sister-in-law in South Street. They used to say at Claydon that there
was a sure way of discovering whether Sir Harry found a new guest
sympathetic or not: if he did, the conversation was invariably turned to
Miss Nightingale. Upon the death of her sister, Claydon became Miss
Nightingale's country-home, and she brought her managerial thoroughness
into play there. She looked into Sir Harry's affairs, interested herself
greatly in the estate, inquired into the conditions of surrounding
village life, made acquaintance with local doctors. These interests
brought home to her the conviction that village sanitation was necessary
to civilize England hardly less than India, and she saw that as in
India, so in England, education must be one at least of the civilizing
agencies. She set herself to make a beginning where her lot now happened
to be cast, in Buckinghamshire.
The time was favourable to a new experiment. County Councils had been
established by the Act of 1888. In 1889 they were empowered to levy and
expend money upon Technical Education. By the Local Taxation Act of 1890
they received a windfall for the same purpose from what was known as the
"Whisky Money." Funds were thus available, and the definition of
"technical" education was wide. Why should not some of it be used for
education in the science of "Health at Home"? Mr. Frederick Verney was
chairman of the Technical Education Committee of North Bucks, and with
Miss Nightingale, as he said, "to inspire, advise, and guide," the thing
was done. She was already, as we have heard, possessed by the idea of
the district nurse as health missioner. It now occurred to her to
institute an order of health-missioners as such. The Health Officer for
the district (Dr. De'Ath) was first employed to train ladies for the
work by means of lectures and classes. The instruction was practical as
well as theoretical, for the doctor took his pupils with him to some of
the villages, introduced the ladies to the village mothers, and pointed
out particular matters in which knowledge sympathetically given might be
invaluable to the cottagers. An independent examination followed, and
the ladies who passed it satisfactorily were, after a period of
probation in practical work, granted certificates as Health Missioners,
in which capacity some of them were engaged by the Technical Education
Committee to visit and lecture in the country villages. The scheme,
started in the spring of 1892, was a simple one, but it involved Miss
Nightingale, as huge bundles of documents attest, in much labour for two
or three years. She enlisted recruits; collected the best that was known
and thought about simple sanitary instruction; considered syllabuses and
examination papers; corresponded with other Technical Education
Committees; wrote memoranda and letters on the subject.[237] To the
Women Workers' Conference, held at Leeds in November 1893, she sent a
paper dealing exhaustively with the whole subject of Rural Hygiene--a
paper which is unhappily by no means out of date to-day, though the
work, in which Miss Nightingale was a pioneer, has branched out in many
directions. "We want duly qualified Sanitary Inspectors," she wrote, and
she was delighted when she heard a few years later of the good work done
by some women sanitary inspectors in the north. Full qualification,
practical training, she insisted upon; and then something else was
wanted also. Her last word to the Health Missioner was the same as to
the Nurse. "The work that tells is the work of the skilful hand,
directed by the cool head, and inspired by the loving heart."
[237] See Bibliography A, Nos. 126, 133, 134.