[Sidenote: Definite Objects: road to them to be found out.]
1. It would appear desirable to consider that definite objects are to
be attained; and that the road leading to them is to a large extent to
be found out--therefore to consider all plans and rules, for some time
to come, as in a great measure tentative and experimental.
[Sidenote: Presumed Main Object.]
2. The main object I conceive to be, to improve hospitals, by improving
hospital-nursing; and to do this by improving, or contributing towards
the improvement, of the class of hospital-nurses, whether nurses or
head-nurses.
[Sidenote: Presumed Intentions.]
3. This I propose doing, not by founding a Religious Order;
but by training, systematizing, and morally improving as far
as may be permitted, that section of the large class of women
supporting themselves by labour, who take to hospital-nursing for
a livelihood,--by inducing, in the long run, some such women to
contemplate usefulness, and the service of God in the relief of man,
as well as maintenance, and by incorporating with both these classes
a certain proportion of gentlewomen who may think fit to adopt this
occupation without pay, but under the same rules, and on the same
strict footing of duty performed under definite superiors. These two
latter elements, if efficient (if not, they would be mischievous rather
than useless), I consider would elevate and leaven the mass.
[Sidenote: Religious Orders.]
4. It may or may not be desirable to incorporate into the work, either
temporarily or permanently, members of Religious Orders, whether
English or Roman Catholic, or both, who may, with the consent of their
Superiors, enter hospitals nursed under the above system, upon the
definite understanding of entire obedience to secular authorities in
secular matters, and of abstinence from proselytism.
[Sidenote: Their Advantages.]
5. Great and undoubted advantages as to character, decorum, order,
absence of scandal, protection against calumny, together with,
generally speaking, security for some amount of religious fear, love,
and self-sacrifice, are found in the system of female Religious Orders.
[Sidenote: Advantages of Hired Labour.]
6. On the other hand, the majority of women in all European countries
are, by God’s providence, compelled to work for their bread, and are
without vocation for Orders.
In England the channels of female labour are few, narrow, and
over-crowded. In London and in all large towns, there are accordingly a
large number of women who avowedly live by their shame; a larger number
who occupy a hideous border-land, working by day and sinning by night;
and a large number, whether larger or smaller than the latter class is
a doubtful problem, who preserve their chastity, and struggle through
their lives as they can, on precarious work and insufficient wages.
Vicious propensities are in many cases the cause, remediless by the
efforts of others, of the two first classes: want of work, insufficient
wages, the absence of protection and restraint, are the cause in many
more.
Perhaps the work most needed now is rather to aim at alleviating the
misery, and lessening the opportunities and the temptations to gross
sin, of the many; than at promoting the spiritual elevation of the few,
always supposing that this latter object is best effected in an Order.
At any rate, to promote the honest employment, the decent maintenance
and provision, to protect and to restrain, to elevate in purifying, so
far as may be permitted, a number, more or less, of poor and virtuous
women, is a definite and large object of useful aim, whether success be
granted to it or not.
The Orders remain for the reception of those women who either are or
believe themselves drawn to enter them, or who experience their need of
them.
[Sidenote: Main Object of Hospitals: Distinct Functions of Hospital
Clergy and Hospital Nurses.]
7. The care of the sick is the main object of hospitals. The care of
their souls is the great province of the clergy of hospitals. The care
of their bodies is the duty of the nurses. Possibly this duty might
be better fulfilled by religious nurses than by Sisters of any Order;
because the careful, skilful, and frequent performance of certain
coarse, servile, personal offices is of momentous consequence in many
forms of severe illness and severe injury, and prudery, a thing which
appears incidental, though not necessarily so, to Female Orders, is
adverse to or incompatible with this.
[Sidenote: Objections to Amalgamating Members of Orders with Secular
Nurses.]
8. Grave and peculiar difficulties attend the incorporation of members
of Orders, especially of Roman Catholic Orders, into the work. And,
both with reference to the Queen’s hospitals, and still more to
the civil hospitals, I humbly submit that much thought, and some
consultation with a few impartial and judicious men, should precede
the experiment of their introduction. This appears to me one of the
most important questions for decision. Should it be decided in favor
of their introduction, I trust it may be resolved to do so only
tentatively and experimentally.
I confess that, subject to correction or modification from further
experience or information, my belief, the result of much anxious
thought and actual experience, is, that their introduction is certain
to effect far more harm in some ways than it can effect good in
others; that a great part of the advantages of the system of Orders
is lost when their members are partially incorporated in a secular,
and therefore, as they consider, an inferior system; and that their
incorporation, especially as regards the Roman Catholic Sisters, will
be a constant source of confusion, of weakness, of disunion, and of
mischief.
Saint Vincent de Paule well knew mankind, when he imposed, amongst
other things, the rule on the Sisters of his Order never to join in
any work of charity with the Sisters of any other Order. This rule was
mentioned to me on an occasion which gave it weight, by the Superior
of the Sisters of Charity of one of the two Sardinian Hospitals on the
Heights of Balaklava, in the spring of 1856, and by the _Mère Générale_
at Paris, October 1854, when she was solicited by me, with the assent
and sanction, both of the English and of the French Governments, to
grant some of her Sisters to us at Scutari.
[Sidenote: Ladies]
9. As regards ladies, not members of Orders, peculiar difficulties
attend their admission: yet their eventual admixture to a certain
extent in the work is an important feature of it. Obedience,
discipline, self-control, work understood as work, hospital service
as implying masters, civil and medical, and a mistress, what service
means, and abnegation of self, are things not always easy to be learnt,
understood, and faithfully acted upon, by ladies. Yet they cannot fail
in efficiency of service or propriety of conduct--propriety is a large
word--without damaging the work, and degrading their element. Their
dismissal (like that of Sisters) must always be more troublesome, if
not more difficult than that of the other nurses.
It might be better not to invite this element; to let it come if it
will learn, understand, and do what has to be learnt, understood, and
done: if not, it is better away.
It appears to me, but I may be quite mistaken, that, in the beginning,
many such persons will offer themselves, but few persevere; that in
time a sufficient number will form an important element of the work;
more is not desirable.
It seems to me important that ladies, as such, should have no separate
status; but should be merged among the head-nurses, by whatever name
these are called. Thus efficiency would be promoted, sundry things
would be checked, and the leaven would circulate.
There are many women, daughters and widows of the middle classes, who
would become valuable acquisitions to the work, but whose circumstances
would compel them to find their maintenance in it. These persons would
be far more useful, less troublesome, would blend better and more
truly with women of the higher orders, who were in the work, and would
influence better and more easily the other nurses, as head-nurses, than
as ladies. Whether or not the better judgment of others agrees with
mine, my meaning will be understood.
In truth the only lady in a hospital should be the chief of the women,
whether called Matron or Superintendent. The efficiency of her
office requires that she should rank as a lady and an officer of the
hospital. At the same time, I think it important that every Matron and
Superintendent, (unless during war-service, when the rough-and-ready
life and work required will probably be best undergone by women of a
higher class) should be a person of the middle classes, and if she
requires and receives a salary, so much the better. She will thus
disarm one source of opposition and jealousy, and enough will remain,
inseparable from her office.
The quasi-spiritual dignity of Sisters of Mercy is a thing _sui
generis_. But the real and faithful discharge of the duties of the
wards of a General Hospital, whether with reference to superiors,
companions, or patients, is incompatible with the status, as such,
of ladies. The real dignity of a gentlewoman is a very high and
unassailable thing, which silently encompasses her from her birth to
her grave. Therefore, I can conceive no woman who knows, either from
information or from experience, what hospital duties are, not feeling
as strongly as I do, that either the assertion or the reception of the
status as such of a lady, is against every rule and feeling of common
sense, of the propriety of things, and of her own dignity.
[Sidenote: Religion.]
10. The question of the mode of Religion is an all-important one, and
the choice of a mode bears far more directly upon this work than may,
at first sight, appear. To give up the common ground of membership of
the National Church is to give up a great source of strength.
[Sidenote: St. John’s House.]
St. John’s House, if it steers clear of the rock of prudery,
undoubtedly possesses great advantages over a system of hospital
nursing by promiscuous instruments. Not because it includes a
Sisterhood, a system, in which I, for one, humbly but entirely
disbelieve; but because the laborious, servile, anxious, trying
drudgery of real hospital work (and to be anything but a nuisance it
must ever remain a very humble and very laborious drudgery), requires,
like every duty, if it is to be done aright, the fear and love of God.
And in practice, apart from theory, no real union can ever be formed
between sects. The work now proposed, however, must essentially forbear
to avail itself of the bond of union of the National Church.
[Sidenote: Only Women of Unblemished Character should be employed.]
11. None but women of unblemished character should be suffered to
enter the work, and any departure from chastity should be visited with
instant final dismission. All applications on behalf of late inmates of
penitentiaries, reformatories, of all kinds and descriptions, should be
refused. The first offence of dishonesty, and, at the very furthest,
the third offence of drunkenness, should ensure irreversible dismissal.
No nurse dismissed, from whatever cause, should be suffered to return.
[Sidenote: Provision for Old Age.]
12. It is very important, if possible, to make provision for the
disabled age of deserving nurses. It does not seem to me, I speak
very diffidently, desirable to concentrate them in one or more large
buildings. I believe half the inmates of half the alms-houses, &c.,
are not on speaking terms with each other. John Bull is of a peculiar
idiosyncrasy: nowhere are there such homes as in England, but life in
community does not seem congenial here. A pension and the option of
ending their days in solitary quiet, or with some friend or relation,
would probably be the most comfortable arrangement for nurses.
[Sidenote: Progressive Increase of Wages.]
13. Many women are valuable as nurses, who are yet unfit for promotion
to head-nurses. It appears to me that it would be very desirable to
have an intermediate recompense: say, after ten years’ good service, to
raise nurses’ wages; after a second ten years, to raise them further.
[Sidenote: Fixed Age for Admission and Retirement.]
14. There should be an age for the reception and for the retirement
both of nurses and head-nurses. I think no head-nurse should be under
thirty.
[Sidenote: Simplicity of Rules, Definition of Authorities.]
15. Simplicity of rules, placing the nurses, in some respects,
absolutely under the Medical man, and, in others, absolutely under the
Female Superintendent, is very important; also, at the outset, to have
a clear and recorded definition of these respective limits.
[Sidenote: Economy.]
16. Economy is very important, with regard to the eventual extension of
the work.
[Sidenote: Commencement: Training.]
17. In the event of the nurses not being trained in Her Majesty’s
service, advantage, it seems to me, would attend their beginning in a
great established hospital; unless indeed it should be judged best to
select and train a staff of nurses first in a smaller and quieter one.
Yet much that would be unpleasant in the larger place would probably
be beneficial. The restraint, control, contact with the masters, work,
and order of things of a great and settled place, would materially help
with reference to the nurses.
[Sidenote: Limits.]
18. Common sense will assuredly make the fixed resolve; both to fulfil
one’s duty, and to keep within it. It is as essential to do the latter
as the former, and often more difficult, especially for women; most
especially for hospital-nurses.
[Sidenote: Encumbrance of Public Support or Patronage.]
19. It appears to me most important to be free, once and for ever, from
the injurious, untrue, and derogatory appendage of public patronage:
what is called support in these days always ends in patronage. This
work, truly understood, never has been, never will be, never can be, a
popular work; for many reasons, one of which is that the public, of all
orders, never can know anything of the real nature of hospital-work.
With the best intentions, it will therefore make perpetual and impeding
mistakes in “supporting” or patronizing it. Its support and patronage
are equally injurious in different ways as regards our masters the
medical men, ourselves the nurses, and people who are neither medical
men nor nurses.
[Sidenote: Caution, Non-expectation, and Trust.]
20. I end as I began. Let nothing be done rashly. Let us not be
fettered with many rules at first. Let us take time to see how things
work; what is found to answer best; how the work proceeds; how far it
pleases God to accept and bless it. Let us be prepared, as I know well
we must be, for disappointments of every sort and kind. What can any of
us do in anything, what are any of us meant to do in anything, but our
duty, leaving the event to God? His Will be done in earth, as it is in
Heaven.