LESSONS
_from_
THE LIFE OF
Florence Nightingale
_By_ CHARLOTTE A. AIKENS
_Author of_ “Hospital Training School Methods and
the Head Nurse,” “Primary Studies for Nurses,”
“Clinical Studies for Nurses,” “Studies in Ethics for
Nurses,” etc. _Joint Author of_ Hospital Management.
_Editor_ “The Trained Nurse and Hospital Review.”
[Illustration]
Lakeside Publishing Company
38-40 West 32nd St.
New York.
[Illustration: FLORENCE NIGHTINGALE
Born in Florence, Italy, May 12th, 1820; died in London
August 13th, 1910]
SANTA FILOMENA
_By_ HENRY WADSWORTH LONGFELLOW
Whene’er a noble deed is wrought
Whene’er is spoke a noble thought
Our hearts, in glad surprise,
To higher levels rise.
The tidal wave of deeper souls
Into our inmost being rolls
And lifts us unawares
Out of all meaner cares.
Honor to those whose words or deeds
Thus help us in our daily needs.
And by their overflow
Raise us from what is low!
Thus thought I, as by night I read
Of the great army of the dead,
The trenches cold and damp,
The starved and frozen camp.
The wounded from the battle-plain
In dreary hospitals of pain,
The cheerless corridors,
The cold and stony floors.
Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.
And slow, as in a dream of bliss,
The speechless sufferer turns to kiss
Her shadow, as it falls,
Upon the darkening walls.
As if a door in heaven should be
Opened and then closed suddenly,
The vision came and went,
The light shone and was spent.
On England’s annals, through the long
Hereafter of her speech and song
That light its rays shall cast
From portals of the past.
A Lady with a Lamp shall stand
In the great history of the land
A noble type of good
Heroic womanhood.
Nor even shall be wanting here
The palm, the lily and the spear
The symbols that of yore
Saint Filomena bore.
Lessons from the Life of
Florence Nightingale
Chapter I.
The presence of thousands of daughters of Florence Nightingale in
the regions devastated by the great world war, and the great service
to humanity which they have rendered, have turned the thoughts of
many to that other battlefield where the great need of the world for
trained nurses was first impressed on the hearts of the people--an
impression never to be effaced while there are suffering human beings
requiring skilled care and service.
Sixty odd years ago, at the outbreak of the Crimean war there were no
women nurses to minister to those who had been wounded in the service
of their country. Woman’s ministry was sorely needed but not wanted
by those in active command of military affairs at the seat of war.
It remained for Florence Nightingale to teach the world one of its
greatest lessons--a lesson from which future generations will reap
increasing benefits. When the Crimean war closed, the foundation was
begun on which the structure of modern nursing was to be reared.
In every age, the world has had its heroes, and Florence Nightingale
would have been the last to wish to give the impression that there
were not many splendid women devoting themselves to the care of the
sick long before she was born. They were not trained women according
to modern ideals of training, but there were women of gentle birth
and breeding, refined and accomplished who served the sick with
singleness of heart and rare devotion. The world will always owe its
debt of gratitude to the Roman Catholic Sisters and the Deaconesses
of other churches, whose tender ministries to the sick in hospitals
and home, did much to lessen the sum of human suffering in the years
before Miss Nightingale’s great work was begun.
No one who reads the story of the beautiful life of Florence
Nightingale can fail to be impressed with the fact that the dominant
motive of that life was--SERVICE. It has been aptly said that one of
the first and most important lessons that a nurse needs to learn, is
to spell SELF with a little s. In this she has a worthy example for
forgetfulness of self seems to have been characteristic of Florence
Nightingale all through her life. Service to humanity--especially
service to the sick and distressed part of humanity--seems to have
made its strong appeal to her almost from childhood. Organization
for service, education and training for service, plans for service
in a hundred different ways--filled her life, and the story of her
many-sided activities, as revealed by her official biographer--has
been a surprise to those who have thought of her only in connection
with nursing. While she will always be best remembered as the founder
of modern nursing, her great efforts in improving sanitary conditions
in India, in which she labored unceasingly for many years with
officials in the War Department, and her work in behalf of reform in
the management of workhouses in England, were closely interwoven with
her work in behalf of better nursing for the sick. Her voluminous
correspondence and her literary work seem in themselves to have been
sufficient to occupy her full time, after her return from the Crimea.
The popular idea of Florence Nightingale has been drawn largely from
the pen picture of Longfellow in Santa Filomena, but it is far from
being a true picture of her life. To fully appreciate her character
and influence one must study to some extent, not alone the social
and sanitary conditions that prevailed in her earlier life, but
the habits of thought and even the etiquette of the times, during
which her chief work was being accomplished. Of these conditions her
biographer says:
“Now that the fruits of Florence Nightingale’s pioneer work have been
gathered, and that nursing is one of the recognized occupations for
gentlewomen, it is not altogether easy to realize the difficulties
which stood in her way. The objections were moral and social, in
large measure rooted to conventional ideas. Gentlewomen, it was
felt, would be exposed, if not to danger and temptations, at least
to undesirable and unfitting conditions. ‘It was as if I had wanted
to be a kitchen maid,’ Miss Nightingale herself said in later years.
Nothing is more tenacious than social prejudice. But the prejudice
was in part founded on very intelligible reasons and in part was
justified by the level of nursing as an occupation at that time.
It will suffice to say that though there were better-managed and
worse-managed hospitals, yet there was strong evidence to show
that hospital nurses had opportunities which they freely used, for
‘putting the bottle to their lips’ when so disposed, also that other
evils were more or less prevalent.
“The more she heard of the worst, the more was Florence Nightingale
resolved to make things better; but the more her parents heard, the
greater and more natural was their repugnance. Somebody must do the
rough pioneer work of the world; but one can understand how the
parents of an attractive daughter, to whom their own life at home
seemed to them to open many possibilities of comfortable happiness,
came to desire that in this case the somebody should be somebody
else.”
It is difficult to study her life without feeling that she was sent
into the world especially to accomplish the great tasks to which
in early middle life, her powers were chiefly devoted. It should,
however, be always remembered that during this period others besides
Miss Nightingale were making their contribution to better nursing and
better sanitary conditions in hospitals, and in the world outside.
Lord Lister, who ushered in the new era of antiseptic surgery,
was seven years younger than Florence Nightingale. “He and she,
each in the manner in which Nature or Providence fitted them, were
simultaneously inaugurating the new era, he the foster father, she
the foster mother of myriads of this generation and unthinkable
millions of those who are to be. His methods demanded the trained
nurse both for surgery and midwifery, both for the battlefield where
life is destroyed, and for the lying-in room where it is ushered into
separate existence. Her work was to provide the training and the
principles, the ideals, the enthusiasm, and the tiniest, humblest
details, whereby the modern nurse is made.”
[Illustration: LORD LISTER]
Apart entirely from the generally undesirable type of women (there
were many exceptions) found in charge of the care of the sick when
Florence Nightingale began her work, were the generally undesirable
conditions which existed before Lord Lister’s antiseptic methods were
inaugurated in 1868. Erysipelas, gangrene, pyemia, and septicemia
were common complications of surgery and the death rate of maternity
patients in hospitals was appalling. A nurse who was one of the
pioneers in improving the care of the sick, thus describes her
experience when she entered for training in an English hospital:
“New methods of nursing as well as of surgery had to contend
with tremendous difficulties in the way of bad buildings, bad
ventilation, old-fashioned furniture, and lack of apparatus.
“The utensils, which in the hospitals of today are of white
earthenware or enamel, were of exceedingly battered tin, almost
entirely denuded of their original covering of black japan, and it
was absolutely impossible to keep some of them clean and sweet.
Smells abounded. I have seen a visiting surgeon run through a ward
to escape them, and during my first week I was much puzzled by the
existence of a horrible smell in one corner of the children’s ward. I
privately investigated the floor and under the beds, but could find
nothing to account for it, but discovered at last that it came from
a patient--a child with a diseased bone of the face, a case which
nowadays would be antiseptically treated and probably isolated.
“Under the old regime the nurses had, as a rule, no uniform dress,
and cooked their own meals, which they bought for themselves, in the
ward kitchens or scullery, and these conditions did not at once pass
away.
“The antiseptic treatment of wounds was coming into general use, and
the particular method of the moment, which had been advocated by Dr.
Lister, was a sort of model steam-engine, which could be carried
about and placed on a table or stand by the side of a patient’s
bed. When a wound was to be attended to, before the dressings were
removed a lamp in this apparatus was lighted. A strong spray of
diluted carbolic acid then played over the wound the whole time it
was being dressed, much to the discomfort of the doctors and nurses,
whose hands would be stiff with the carbolic and their ears dulled
with the constant hissing and fizzing of the machine. Everything was
saturated with carbolic at that time, wool, bandages, lint, gauze,
etc., but in the course of a few years this treatment was entirely
superseded.
“Operations were comparatively free and easy performances. We
nurses wore our ordinary dresses, and were kept busy washing
sponges, which were used again and again, though they were boiled
between the operation days. In the medical wards enteric cases were
indiscriminately mixed with others, and tuberculosis patients stalked
about and expectorated freely.”
Nurses of today, in common with the rest of the world, owe a greater
debt of gratitude than most of them realize to Lord Lister who, by
his surgical experiments, and his demand for trained nurses, helped
so much in laying the foundations for the trained nursing of today.
Other workers in the realm of bacteriology were aiding greatly in the
remarkable developments which medicine and surgery were making in
that period.
THE SPIRIT OF VOCATION.
An English writer, Miss Margaret Fox, in an address to nurses has
called attention to the great need of the spirit of vocation in the
nurses of today. “Look at it what way you will,” she states, “the
fact remains that nursing is work demanding something more than mere
business qualities, more than an active intelligence, more than even
sympathy and kindness of heart. The latter, precious though it is,
may be worn very threadbare in the constant daily contact with all
sorts of unlovely natures suffering from every variety of trying
ailment. Patients are not all grateful, or appreciative, and you will
find some of them by no means ready to kiss your shadow as you pass
on your rounds. Sometimes they are inclined to grumble because they
do not immediately get all they want. Their disease may make them
irritable, captious even, sometimes, repulsive. These people need
more than ordinary everyday good qualities in a nurse. They need one
who, over and above her professional ability, looks upon her work as
a vocation, ‘a calling by the will of God.’ It was that spirit which
made the best of the pioneers of other days what they were. Nursing
was undertaken by them as a definite life-work. It cost them so much
to enter upon it, that they were unlikely to throw it up without some
very cogent reason. Work was not then considered so much a means to
an end. It was the ultimate achievement. Nursing is a mission; and
wherever it is done, it needs the same spirit of true vocation to do
it well, and to persevere in spite of difficulties.
“There would be fewer restless, discontented nurses, if each
possessed the spirit of vocation. It is a spirit that gives one the
calm, quiet feeling of being in the only possible place and doing the
only possible work. It stirs in one a large-hearted charity towards
all such as be sorrowful, sick or poor. It makes one feel, ‘Well,
whoever fails, I must not.’ It helps wonderfully when things are
crooked and the work is hard, or uninteresting. One simply can’t help
making things look nice, or doing the little extra bit which just
makes all the difference.”
The motives which influence an individual to undertake a task are
tremendously important factors in real and full success, and it is
well, in such work as nursing, that all who enter on it analyze
carefully their own motives in so doing.
There can be no mistaking the motives which led Florence Nightingale
to enter on her career under the distressing conditions which
then prevailed. Born and reared in refined surroundings, in an
intellectual atmosphere, with all the educational advantages
the times afforded, if she had fulfilled parental and popular
expectations, she would have been satisfied to have spent her
girlhood life chiefly in a round of gay social functions, with ample
leisure for study and travel, and to have married at an early age a
man belonging to her own social circle. That she was not satisfied
with this sort of existence is seen in this typical extract from
one of her letters, written when she was twenty-six years of age:
“The thoughts and feelings that I have now,” she wrote, “I can
remember since I was six years old. It was not _I_ that made them. A
profession, a trade, a necessary occupation, something to fill and
employ all my faculties, I have always felt essential to me, I have
always longed for, consciously or not. * * * The first thought and
the last thought I can remember was nursing work, but for this I have
had no education myself. * * *” Later she wrote: “In my thirty-first
year I see nothing desirable but death. Why do I wish to leave this
world? God knows I do not expect a greater heaven beyond, but that He
would now set me down in St. Gile’s, or at a Kaiserwerth, there to
find my work, and my salvation in my work.”
To her, life was earnest--it was a serious thing, and her struggle
for many long, weary years to free herself, to overcome the obstacles
that closed in around her, so that she might accomplish the kind of
work she felt God wanted her to do--her long-continued effort to gain
her relatives’ consent for her to even attempt nursing--forms one of
the most interesting chapters in her life story. Nursing to her was
always “God’s business.”
How much this sense of vocation, this strong feeling that she was
called to do the will of God in this form of service, had to do
with her success, no one can fully determine, but that it helped
tremendously in carrying her over difficult places cannot be doubted.
As one looks back over her wonderful life and tries to discern the
secret of her remarkable influence, one cannot but feel that the
spirit in which she did her work, her absolute devotion to the cause
to which she was giving her best powers, accounts in large measure
for her name being honored, and her memory kept green all over the
civilized world. “The sweetest character in all British history,” was
a noted man’s comment on her, yet the sweetness was always combined
with strength, and courage, and a quiet determination not to give up
because things were harder or more difficult than she had expected.
Her work was not lightly undertaken, and as lightly abandoned, as
nursing is by many young women today.
One of the outstanding qualities of this great woman was her
individuality, a quality which some one has aptly said is close
kin to honesty. She did her own thinking, and the results of that
independent thinking were evident all through her career. In
commenting on this quality of individuality, a recent writer, Byron
H. Stauffer, has said:
“It burst out in a letter written when she was eight, which she
closes with: ‘My love to all except Miss W--.’ It developed in her
despising, early in life, the silly conventionalities of the high
society of the day. It sparkled in explaining why she tittered during
a ritualistic service: ‘The rector was praying “That it may please
Thee to have mercy on all men,” and the ridiculousness of that prayer
broke upon me. Think of it! If I asked you to have mercy on your own
boy, you’d knock me down.’ Another instance of her nonconformity to
the religious conventions lies in her declaration: ‘I never prayed
for George IV; I always thought that people were very, very good who
could pray for him. It was a wonder to me how he could possibly be
any worse if nobody prayed for him. I prayed a little for William IV.
For the young Victoria I prayed with rapture.’”
THE PRICE OF SKILL.
One of the tendencies of this age in nurses is to expect and apply
for positions of responsibility for which they have not taken any
special or definite pains to fit themselves. Their estimate of their
own ability is often much greater than conditions justify; they often
want the best positions without paying the price of special skill.
The determination of Florence Nightingale to secure for herself the
best instruction the world afforded at that time, and her conviction
that if she was ever to accomplish anything worth while she must
first learn all that was possible under the circumstances for her to
learn about the business of caring for the sick, is a fine example
for those who really desire to do worth while things in this world.
It has been well said that ability depends greatly on preparation,
and that opportunity is largely dependent on ability. It was by no
accident that Florence Nightingale became “the angel of the Crimea.”
Nothing that she could do to fit herself for such a task had been
omitted, though she could not know how great were the opportunities
that were to be afforded her to use the knowledge and experience
she was so determined to secure. She fully realized that to do good
required more than good desires or intentions. To do good in the way
that she wished required some skill. To be the best possible nurse,
to fit herself in the best way, however long it might take, or how
hard the way might be, meant much greater difficulties then than it
could possibly mean now.
When in later years she expressed herself as follows, she was simply
expressing the convictions which had been with her all through life:
“Nursing is an art, and if it is to be made an art, it requires as
hard preparation as is required for any painter’s or sculptor’s work;
for what is having to do with dead canvas or cold marble compared
with caring for the living body?”
How to obtain the needed skill was a problem which she had studied
for many years. The difficulties and moral dangers that stood in the
way of a refined woman securing experience in nursing in a hospital
seemed for years insuperable, and can hardly be appreciated by the
nurses of today.
AT KAISERWERTH.
Through a friend, Miss Nightingale learned of an institution for
deaconesses at Kaiserwerth, Germany, where there was a school, a
hospital and a prison, under the management of deaconesses. It had
a decidedly higher tone and reputation than prevailed in hospitals
in general, she was told; and Pastor Fliedner’s annual reports
of the work of the institution were eagerly studied, and used to
silence parental objections. The opportunity to spend a few months at
Kaiserwerth was delayed, but finally came when her mother and sister,
in search of health, went to Carlsbad, and to travel. In commenting
afterward on the new departure of giving some months of training in
the care of the sick, inaugurated at Kaiserwerth, Miss Nightingale
called special attention to the fact that the Kaiserwerth
institutions had begun, not with programs or fullfledged schemes
set forth in a prospectus, but with individual cases and personal
devotion--and later years showed that her own great work began,
also, not with a prospectus or prearranged program, but with actual
doing of the thing she felt needed to be done when the opportunity
came. The real training in nursing given at Kaiserwerth was far from
satisfactory to her, but the atmosphere, the spirit of consecrated
service, impressed her deeply.
Later she returned to Kaiserwerth for further apprenticeship in
nursing and followed this experience by spending some time in the
hospitals of Paris presided over by the Roman Catholic sisters.
It is very evident that she did not expect to have everything she
wished to know, prepared and presented to her to study. Her powers of
observation were wonderful, and she proved an indefatigable collector
of pamphlets, reports, statistics, methods of work and plans of
hospital organization and management.
One criticism which is often heard of present day nurses in
training is that they so quickly get into ruts in the matter of
observation--that they see so much in a hospital ward which they
fail to _perceive_--that they fail to gather practical knowledge
pertaining to their work which is all around them waiting to be
picked up. If Florence Nightingale had been the type of woman who had
to have all the nursing knowledge which she obtained duly imparted
to her by somebody else appointed for that purpose, her influence on
the conditions which then prevailed would have been small indeed.
Instead, she was constantly getting hold of facts, reading medical
books, continually studying into the “why” of things, and how they
might be improved, so that better general results might be obtained
in the care of the sick. Her private notebooks were filled with
facts, ideas, and suggestions gathered here, there and elsewhere,
which she was later to use in laying broad foundations for the
improvement of nursing, and of hospital management in general. Her
attention to small details, as found in her notebooks preserved to
the present day, was characteristic of all her work, and accounts in
no small degree for its success.
TACT AND SENSE OF HUMOR.
Among the indispensable qualities for successful nursing, we place
“TACT” very close to the top of the list. To get along with people
without friction, to get needful things done without arousing
antagonism, to have that keenness of perception, that ready power
of appreciating and of doing or saying what is most fitting under
the circumstances; to maintain, withal, that quality of mind
which enables one to see the humorous side to otherwise difficult
situations, are qualities to be coveted by every nurse.
How Florence Nightingale succeeded in managing committees with whom
she had to work, as well as the sense of humor which helped to carry
her over difficult situations, are admirably shown in extracts
from her private letters, written soon after she returned from
Kaiserwerth. She had been importuned to undertake the management of
an institution known as an “Establishment for Gentlewomen During
Illness,” which had been started, but had been so grossly mismanaged
that it had been threatened with closure. A change of location had
finally been decided on when Miss Nightingale agreed to undertake
its management. One of the first difficulties which confronted her
is described in the extract from a private letter to a friend which
follows:
“My committee refused me to take in Catholic patients--whereupon
I wished them good morning, unless I might also take in Jews and
their Rabbis to attend them. So now it is settled, _and in print_,
that we are to take in all denominations, whatever, and allow them
to be visited by their respective priests and Muftis, provided _I_
will receive (in any case whatsoever that is _not_ of the Church
of England) the obnoxious animal at the door, take him upstairs
myself, remain while he is conferring with his patient, make myself
responsible that he does not speak to, or look at, any one else, and
bring him downstairs in a noose, and out into the street. And to this
I have agreed! And this is in print!
“Amen. From committees, charity and schism--from the Church of
England and other deadly sins--from philanthropy and all the deceits
of the Devil--Good Lord deliver us!”
To her father in 1853, she wrote another characteristic letter
which affords a glimpse of the experience in “managing” people she
was getting at this time, and which was later to be most helpful
in her great task of helping to reorganize the affairs of the army
hospitals. In this letter, she says:
“You ask for my observations upon my line of statesmanship. I have
been so very busy that I have scarcely made any resume in my own mind.
“When I entered into service here, I determined that, happen what
would, I never would intrigue among the committees. Now I perceive
that I do all my business by intrigue. I propose in private to A, B
or C, the resolution I think A, B or C most capable of carrying in
committee, and then leave it to them, and I always win. * * * I have
observed that the opinions of others concerning you depend not at
all, or very little, upon what _you_ are, but upon what _they_ are.
“Last General Committee I executed a series of Resolutions on five
subjects and presented them as coming from medical men:
“1. That the successor to our house surgeon (resigned) should be a
dispenser, thus saving our bill at the druggists of 150 pounds per
annum.
“2. A series of House Rules, of which I send you the rough copy.
“3. A series of resolutions about not keeping patients.
“4. A complete revolution as to diet, which is shamefully abused at
present.
“5. An advertisement for the Institution.
“All these I proposed and carried in committee without telling them
that they came from me, and not from the medical men; and then, and
not till then, I showed them to the medical men, without telling them
that they were already passed in committee.
“It was a bold stroke, but success is said to make an insurrection
into a revolution. The medical men have had two meetings upon them
and approved them all, and thought they were their own. And I came
off with flying colors, no one suspecting my intrigue.
“I have also carried my point of having good, harmless Mr. ---- as
chaplain, and no young curate to have spiritual flirtations with my
young ladies. So much for the earthquakes in this little mole-hill of
ours.”
Happy though Miss Nightingale was in this new work, it did not offer
her the wide opportunity for training nurses, which she greatly
longed to do--somewhat along the lines pursued at Kaiserwerth.
[Illustration]
The Call to Service in the Crimean War