The Life of Florence Nightingale Volume I Part 36

[312] _A Contribution_, p. 3 (Bibliography A, No. 14).

[313] _Hospital Statistics_ (Bibliography A, No. 28).

Miss Nightingale set herself to remedy this defect. With a.s.sistance from friendly doctors on the medical side, and of Dr. Farr, of the Registrar-General's Office, on the statistical, she prepared (1) a standard list, under various Cla.s.ses and Orders, of diseases, and (2) model Hospital Statistical Forms. The general adoption of her Forms would, as she wrote, "enable us to ascertain the relative mortality in different hospitals, as well as of different diseases and injuries at the same and at different ages, the relative frequency of different diseases and injuries among the cla.s.ses which enter hospitals in different countries, and in different districts of the same countries."

Then, again, the relation of the duration of cases to the general utility of a hospital had never been shown. Miss Nightingale's proposed forms "would enable the mortality in hospitals, and also the mortality from particular diseases, injuries, and operations, to be ascertained with accuracy; and these facts, together with the duration of cases, would enable the value of particular methods of treatment and of special operations to be brought to statistical proof. The sanitary state of the hospital itself could likewise be ascertained."[314] Having formed her plan, Miss Nightingale proceeded with her usual resourcefulness to action. She had her Model Forms printed (1859), and she persuaded some of the London hospitals to adopt them experimentally. Sir James Paget at St. Bartholomew's was particularly helpful; St. Mary's, St. Thomas's, and University College also agreed to use the Forms. She and Dr. Farr studied the results, which were sufficient to show how large a field for statistical a.n.a.lysis and inquiry would be opened by the general adoption of her Forms.

[314] _Hospital Statistics_. Of course the statistics would have to be interpreted.

The case was now ready for a further move. Dr. Farr was one of the General Secretaries of the International Statistical Congress which was to meet in London in the summer of 1860. He and Miss Nightingale drew up the programme for the Second Section of the Congress (Sanitary Statistics), and her scheme for Uniform Hospital Statistics was the princ.i.p.al subject of discussion. Her Model Forms were printed, with an explanatory memorandum; the Section discussed and approved them, and a resolution was pa.s.sed that her proposals should be communicated to all the Governments represented at the Congress. She took a keen interest in all the proceedings, and gave a series of breakfast-parties, presided over by her cousin Hilary, to the delegates, some of whom were afterwards admitted to the presence of their hostess upstairs. The foreign delegates much appreciated this courtesy, as their spokesman said at the closing meeting of the Congress; "all the world knows the name of Miss Nightingale," and it was an honour to be received by "the ill.u.s.trious invalid, the Providence of the English Army." The written instructions sent by "the Providence" to her cousin for the entertainment of the guests show her care for little things and her knowledge of the weaknesses of great men: "Take care that the cream for breakfast is not turned." "Put back Dr. X.'s big book where he can see it when drinking his tea." Miss Nightingale also induced her friend Mrs.

Herbert to invite the statisticians to an evening party. The feast of statistics acted upon her as a tonic. "She has been more than usually ill for the last four or five weeks," wrote her cousin Hilary (July 12); "now I cannot help thinking that her strength is rallying a little; she is much interested in the Statistical Congress." Congresses, like wars, are sometimes "muddled through" by our country, and Miss Nightingale was able here and there to smooth ruffled plumes. A distinguished friend of hers, though his name had been printed as one of the secretaries of a Section, had not received so much as an intimation of the place of meeting; he was disgusted at so unbusiness-like an omission, and was half inclined to sulk in his tents. Miss Nightingale's letter on the subject is characteristic:--

(_Miss Nightingale to Dr. T. Graham Balfour._) 30 OLD BURLINGTON ST., _July_ 12 [1860]. You are quite right in what you say. We are all of us in the same boat. And, if it were not that England _would not be_ the mercantile nation she _is_, if she had not business habits somewhere, I should wonder from my experience where they are. Certain of us, who were asked to do business for the Statistical Congress, had it all ready since December last--and were not able to get it out of the Registrar-General's Office till this week. Certain of us were asked to do business this morning, and to have it ready by to-night, which, if _not_ done, would arrest the proceedings of the Congress, and, _if_ done, must be the fruit of only five hours' consideration, when five months might just as well have been granted for it. I don't say that this is so bad as the treatment of you who are Secretary. But still it is provoking to see a great International business worked in this way.

What I want now is to put a good face upon it before the foreigners. Let _them_ not see our short-comings and disunions. Many countries, far behind us in political business, are far before us in organization-power. If any one has ever been behind the scenes, living in the interior, of the Maison Mere of the "Sisters of Charity" at Paris, as I have--and seen their Counting House and Office, all worked by women,--an Office which has twelve thousand Officials (all women) scattered all over the known world--an office to compare with which, in business habits, I have never seen any, either Government or private, in England--they will think, like me, that it is this mere business-power which keeps these enormous religious "orders" going.

I hope that you will try to impress these foreign Delegates, then, with a sense of _our_ "enormous business-power" (in which I don't believe one bit), and to keep the Congress going. Many thanks for all your papers. I trust you will settle some sectional business with the Delegates here to-morrow morning. And I trust I shall be able to see you, if not to-morrow morning, soon.

Mind, I don't mean anything against _your_ Office by this tirade.

On the contrary, I believe it is one of the few efficient ones now in existence.

Having received the _imprimatur_ of an International Congress, Miss Nightingale circulated her paper on Hospital Statistics widely among medical men and hospital officials. Thereby she produced immediate effect. She printed large quant.i.ties of her Model Forms, and supplied them, on request, to hospitals in various parts of the country. Through the good offices of M. Mohl, she also worked upon public opinion in France. "Some months ago," she wrote to Dr. Farr (Oct. 20, 1860), "I got inserted into the leading medical journals of Paris an article on the proposed Hospital Registers; and you see they are at work." The London Hospitals took the matter up. Guy's printed a statistical a.n.a.lysis of its cases from 1854 to 1861; St. Thomas's, of its from 1857 to 1860; St.

Bartholomew's, a table of its cases for 1860. With regard to the future, a meeting was held at Guy's Hospital on June 21, 1861, and it was unanimously agreed--by delegates from Guy's, St. Bartholomew's, St.

Thomas's, the London, St. George's, King's College, the Middles.e.x, and St. Mary's--that the Metropolitan Hospitals should adopt one uniform system of Registration of Patients; that each hospital should publish its Statistics annually, and that Miss Nightingale's Model Forms should as far as possible be adopted. She called further attention to her scheme in a paper sent to the Social Science Congress at Dublin in August 1861,[315] and incorporated it in a later edition of her _Notes on Hospitals_. The statistics of the various hospitals which had accepted her Forms were published in the _Journal of the Statistical Society_ for September 1862, but I do not find that the experiment has been continued. So far from there being any uniform hospital statistics, of the kind contemplated by Miss Nightingale, even in London some of the hospitals do not keep, or at any rate do not publish, any at all. The laboriousness, and therefore the costliness, of the work of compilation, the difficulty of securing actual, as well as apparent, uniformity, and a consequent doubt as to the value of conclusions deduced from the figures are presumably among the causes which have defeated Miss Nightingale's scheme. Some limited portion of her object is perhaps attained by the statistical data which the administration of King's Hospital Fund demands, but even here there are possibilities of misleading comparison. There is probably no department of human inquiry in which the art of cooking statistics is unknown, and there are sceptics who have subst.i.tuted "statistics" for "expert witnesses" in the well-known saying about cla.s.ses of false statements. Miss Nightingale's scheme for Uniform Hospital Statistics seems to require for its realization a more diffused pa.s.sion for statistics and a greater delicacy of statistical conscience than a voluntary and compet.i.tive system of hospitals is likely to create.

[315] See Bibliography A, No. 28.

At the time she was full of hope, and, having obtained a start with medical statistics, she next pursued the subject in relation to surgical operations. Sir James Paget had been in communication with her on this point. "We want," he had written (Feb. 18, 1861), "a much more exact account and a more particular record of each case. Thus in some returns we have about 40 per cent of the deaths ascribed to 'exhaustion,' in others, referring to the same [kind of] operations, about 3 per cent or less; the truth being that in nearly all cases of 'exhaustion' there was some cause of death which more accurate inquiry would have ascertained."

Miss Nightingale (May 1, 1861) congratulated him on "St. Bartholomew's having the credit of the first Statistical Report worth having," but the table of operations was still, she thought, most unsatisfactory. "It would be most desirable that an uniform Table should be adopted in all Hospitals, including all the elements of age, s.e.x, accident, habit of body, nature of operation, after-accidents, etc., etc. Could you come in to-morrow between 2 and 4, and bring your list of the causes of death after operations? It would be invaluable, coming from such an authority, for constructing a Form." She consulted other surgeons, civil and military, and wrote a paper, with Model Forms, for the International Statistical Congress held at Berlin in September 1863. These also were included in a revised edition of _Notes on Hospitals_. The Royal College of Surgeons referred the subject to a Committee, which, however, reported adversely upon Miss Nightingale's Forms.

II

Before the International Congress at London in 1860 separated, Miss Nightingale addressed a letter to Lord Shaftesbury (President of the Second Section), which was read to the whole Congress, and adopted by it as a resolution. The point of it was to impress upon Governments the importance of publishing more numerous abstracts of the large amount of statistical information in their possession. She gave various instances in which useful lessons might thus be enforced upon the public mind, and cited Guizot's words: "Valuable reports, replete with facts and suggestions drawn up by committees, inspectors, directors, and prefects, remain unknown to the public. Government ought to take care to make itself acquainted with, and promote the diffusion of all good methods, to watch all endeavours, to encourage every improvement. With our habits and inst.i.tutions, there is but one instrument endowed with energy and power sufficient to secure this salutary influence--that instrument is the press." With Miss Nightingale statistics were a pa.s.sion and not merely a hobby. They did, indeed, please her, as congenial to the nature of her mind. Her correspondence with Dr. Balfour and Dr. Farr shows how she revelled in them. "I have a New Year's Gift for you," wrote Dr. Farr (Jan. 1860); "it is in the shape of Tables, as you will conjecture." "I am exceedingly anxious," she replied, "as you may suppose, to see your charming Gift, especially those Returns showing the deaths, admissions, diseases," etc., etc. But she loved statistics, not for their own sake, but for their practical uses. It was by the statistical method that she had driven home the lessons of the Crimean hospitals. It was the study of statistics that had opened her eyes to the preventable mortality among the Army at home, and that had thus enabled her to work for the health of the British soldier. She was already engaged on similar studies in relation to India. She was in very serious, and even in bitter, earnest a "pa.s.sionate statistician." And the pa.s.sion, as will appear in a later chapter,[316] was even a religious pa.s.sion.

[316] See below, p. 480.

Miss Nightingale made a valiant attempt to extend the scope of the Census of 1861 in the interest of collecting statistical data for sanitary improvements. There were two directions in which she desired to extend the questions. One was to enumerate the numbers of sick and infirm on the Census day. For sanitary purposes it would be extremely useful to determine the proportion of sick in the different parts of the country. To those who said that it could not be done, because the people would not give the information, the answer was that it had been done in Ireland. The other point was to obtain full information about house accommodation; facts which, as would now be considered obvious, have a vital bearing on the sanitary and social conditions of the people. This point also had been covered in the Irish Census. Dr. Farr entirely agreed with Miss Nightingale, but he could not persuade Sir George Lewis, the Home Secretary, to include these provisions in the Census Bill (1860). Miss Nightingale thereupon drew up a memorandum on the subject, and, through Mr. Lowe (Vice-President of the Council), submitted it to the Home Secretary. Mr. Lowe may have agreed with her, but he failed to persuade his colleague. "Whenever I have power," wrote Mr. Lowe (May 9), "you can always command me, but official omnipotence is circ.u.mscribed in the narrow limits of its own department." Sir George Lewis replied that "both of Miss Nightingale's points had been duly considered before the Census Bill was introduced. It was thought that the question of health or sickness was too indeterminate." "With regard to an enumeration of houses, it was thought that this is not a proper subject to be included in a Census of population." A very official answer! But Sir George added that he did not see how the result of such enumeration could be "peculiarly instructive"--an avowal which he also made in the House of Commons. The cleverest of men are sometimes dense; and this remark of Sir George Lewis, added to his subsequent conduct of the War Office, earned for him, in Miss Nightingale's familiar correspondence, the sobriquet of "The m.u.f.f." In communicating the result of her first attempt to Dr. Farr, she said, "If you think that anything more can be done, pray say so. I'm your man." But she had not waited to be spurred on. She had already bethought herself of a second string in the House of Lords. Lord Shaftesbury, to whom she had appealed, promised to do all he could. Lord Grey did the same, and asked her to send Dr.

Farr to coach him. She began to "thank G.o.d we have a House of Lords":--

(_Miss Nightingale to Robert Lowe._) OLD BURLINGTON ST., _May_ 10 [1860]. I cannot forbear thanking you for your letter and for your exertions in our favour. Sir George Lewis's letter, _being interpreted_, means: "Mr. Waddington does not choose to take the trouble." It is a letter such as I have scores of in my possession, from Airey, Filder, and alas! from Lord Raglan, from Sir John Hall (the doctor) and from Andrew Smith. It is a true "Horse Guards"

letter.

They are the very same arguments that Lord John used against the feasibility of registering the "cause of death" in '37--which has now been the law of the land for 23 years. He was beaten in the Lords. And we are now going to fight Sir George Lewis in the Lords. And we hope to beat him too. It is mere child's play to tell us that what every man of the millions who belong to Friendly Societies does every day of his life, as to registering himself sick or well, cannot be done in the Census. It is mere childishness to tell us that it is not important to know what houses the people live in. The French Census does it. The Irish Census tells us of the great diminution of mud cabins between '41 and '51. The connection between the _health_ and the _dwellings_ of the population is one of the most important that exists. The "diseases" can be obtained approximately also. In all the more important--such as smallpox, fevers, measles, heart-disease, etc.--all those which affect the _national_ health, there will be very little error. (About ladies' nervous diseases there will be a great deal.) Where there is error in these things, the error is uniform, as is proved by the Friendly Societies; and corrects itself....

The pa.s.sionate statisticians were, however, hopelessly out-voted in the House of Commons. Mr. Caird moved in her sense on the subject of fuller detail about house-accommodation, and in sending her the printed notice of his amendment, said that "his position would be greatly strengthened with the House if he could obtain Miss Nightingale's permission to quote her name in favour of the usefulness of such an inquiry." I do not know whether she gave permission; the debate is reported very briefly in Hansard. But in any case Mr. Caird's amendment was promptly negatived.

As for the House of Lords, Miss Nightingale's reliance upon a better love of statistics in that a.s.sembly was cruelly falsified. The Census Bill came up late in the session, and I do not find that either Lord Grey or Lord Shaftesbury said a word upon the subject. The only critical contribution made to the debate proceeded from Lord Ellenborough, who, so far from wanting the Census Bill to include provision for more statistical data, proposed to exclude most of those that were already in. He could not for the life of him see what was the use of asking people so many questions.[317] Here, then, Miss Nightingale was in advance of the time; in one case, by a generation, in the other, by two generations. Recent Censuses have included more particulars of the housing of the people, though still not so many as she wanted. Official statistics of the local distribution of sickness will presently be obtained, I suppose, in a different way, through the machinery of the National Health Insurance Act.

[317] Lords' debate, July 24; princ.i.p.al Commons' debate, July 12, 1860.

Deprived by the recalcitrance of the Home Secretary and Parliament of a fuller feast of statistics at home, Miss Nightingale turned to the Colonies and Dependencies. The Secretary for the Colonies gave her facilities for collecting much curious and instructive information; and the Secretary for India accepted her aid in collecting and tabulating facts and figures which were the foundation of some of the most notable and beneficent of her labours. But, though she was already (1860-1) engaged in these inquiries, they belong in the main to a later period; and we must now turn to another side of Miss Nightingale's work for the improvement of the National Health.

CHAPTER III

THE FOUNDER OF MODERN NURSING

(1860)

Where is the woman who shall be the Clara or the Teresa of Protestant England, labouring for the certain benefit of her s.e.x with their ardour, but without their delusion?--SOUTHEY'S _Colloquies_ (1829).

The nineteenth century produced three famous persons in this country who contributed more than any of their contemporaries to the relief of human suffering in disease: Simpson, the introducer of chloroform; Lister, the inventor of antiseptic surgery; and Florence Nightingale, the founder of modern nursing. The second of the great discoveries completed the beneficent work of the first. The third development--the creation of nursing as a trained profession--has co-operated powerfully with the other two, and would have been beneficent even if the use of anaesthetics and antiseptics had not been discovered. The contribution of Florence Nightingale to the healing art was less original than that of either Simpson or Lister; but perhaps, from its wider range, it has saved as many lives, and relieved as much, if not so acute, suffering as either of the other two.

The profession of nursing is at once very old and very new; and the place of Miss Nightingale in the history of it has not always been rightly understood. Nursing--and even nursing by educated women--is very old. "She herself nursed the unhappy, emaciated victims of hunger and disease. How often have I seen her wash wounds whose fetid odour prevented every one else from even looking at them! She fed the sick with her own hands, and revived the dying with small and frequent portions of nourishment. I know that many wealthy persons cannot overcome the repugnance caused by such works of charity. I do not judge them; but, if I had a hundred tongues and a clarion voice, I could not enumerate the number of patients for whom she provided solace and care."

This pa.s.sage, which is not unlike some of the panegyrics showered upon Florence Nightingale's work during the Crimean War, was written, nearly fifteen centuries earlier, by St. Jerome in describing the work of Fabiola, a lady of patrician rank, who in 390 A.D. built a hospital at Rome, where she devoted herself to the care of the sick. Female nursing is as old as Christianity, and for centuries the religious Orders had sent cultivated women into the hospitals. The very name of "Sister," now applied to a rank in the nursing profession in general, recalls its historical origin in religious enthusiasm. Nor was there anything novel in the mere fact, though there was much that was novel in the method, of Miss Nightingale's service as a war-nurse. It was novel in the case of the British Army, but in that of other countries Sisters had already accompanied armies to the field. And, again, it was not an original conception on Miss Nightingale's part that nurses should be trained for their work. Her master, Theodor Fliedner, had shown the way in Germany; and in our own country Mrs. Fry's Inst.i.tute of Nursing was established in 1840, and the St. John's House in 1848, Miss Nightingale's, at St.

Thomas's, not till 1860.

Nevertheless, though not the founder of nursing, Florence Nightingale was the founder of modern nursing. It is not always realized how modern is the inst.i.tution of nursing, on any large scale as a distinct and trained calling. I have indicated above the three lines of influence--religion, war, and science--along which the development of sick-nursing has proceeded. Miss Nightingale came at the psychological moment to give it a vast impetus upon each of those lines. Religion was tending to become less abstract, and more closely allied to the service of man. Miss Nightingale was the St. Clara or the St. Teresa of the new order, for whom Southey had called. She was prepared, by her experience, by the character of her mind, by the drift of her philosophical speculations, not to imitate old forms, but to create a new order, an order of nurses who should, indeed, be devoted to their calling, but should be organized on a secular basis. The deeply religious bent of Miss Nightingale's character, the single-mindedness of her purpose, and her constant appeal to high ideals, enabled her to give to (or at any rate to require from) the Seculars of the new order something of the devotion possessed by the religious Regulars. The Crimean War, in which Miss Nightingale was one of the central figures, gave further force to a movement for increasing the number and improving the qualification of nurses. It enlisted sentiment in the cause. The American Civil War (in which, as we shall hear presently, Miss Nightingale's example played a great part) extended the movement to the United States, and the Red Cross organization may also be considered as an outcome of her work in the Crimea. The progress of science was tending in a like direction.

Medicine and surgery were on the eve of receiving great developments.

Sanitary science was already making advance. At the time when Florence Nightingale was in training at Kaiserswerth, Joseph Lister was a medical student at University College. Cohn, the founder of bacteriology, was only eight years her junior. Parkes, one of the founders of modern hygiene, was almost exactly her contemporary. It was inevitable that nursing also should be developed in a scientific spirit, and no one was better qualified than Miss Nightingale to take the lead in such a movement. Her experience in the East had filled her with a pa.s.sionate conviction of the importance of sanitary science. She was the centre of a circle of earnest and devoted men who were devoting themselves to it.

She was personally acquainted with many of the leading physicians and surgeons of the day. And there was yet a fourth line upon which Miss Nightingale might seem to be predestined for this special work. What is called the "woman's movement" was beginning. "There is an old legend,"

wrote Miss Nightingale, at the beginning of her pamphlet on Kaiserswerth, "that the nineteenth century is to be the 'century of women.'" At the time when she wrote (1851), the century, she added, had not yet been theirs. But there was a spirit stirring the waters. Other notable women were at work, claiming for their s.e.x a place in the sun of the world's work. Miss Nightingale was not wholly sympathetic to what she called "woman's missionariness." But the circ.u.mstances of her own life, as the First Part of this Memoir has shown, made her intensely interested in claiming that a woman should not be debarred from entering a walk of life to which she is fitted simply because she is a woman; and of such walks of life, nursing is obviously one. Controversy is perennial between those who ascribe the course of political or social history mainly to great men, and those who ascribe it rather to streams of tendency. It is less open to controversy to say that the great men who leave the more permanent mark upon history are those whose genius conforms to the spirit of their time, but who are yet a little in advance of their age. Among such "great men" the founder of modern nursing is to be reckoned.

II

In what precise respect, it may be asked, did Florence Nightingale "found" modern nursing? The answer to this question may, I think, be disentangled without much difficulty from a good deal of conflicting statement. I have referred already, in connection with the fettering scruples of Miss Nightingale's parents,[318] to a conflict of evidence upon the morals of hospitals and hospital nurses in the middle of the nineteenth century. Her own opinion at that time (and she did not express it without much inquiry and observation) is given in the pamphlet, above mentioned, where she says that hospitals were "a school, it may almost be said, for immorality and impropriety--inevitable where women of bad character are admitted as nurses, to become worse by their contact with male patients and young surgeons.... We see the nurses drinking, we see the neglect at night owing to their falling asleep."[319] Such statements were indignantly denied by other authorities, equally well qualified to form a correct judgment.

Controversy broke out upon the subject a few years later in connection with the Nightingale Memorial Fund. A correspondent of the _Times_, who signed himself "One who has walked a good many Hospitals," gave in 1857[320] the same kind of account that Miss Nightingale had given in 1851. He was answered, and his statements were hotly denied.[321]

Obviously there were hospitals and hospitals, and still more there were nurses and nurses, and no _general_ indictment was just on the point of morals. Upon the question of drinking among nurses, both in hospitals and in private service, there is less room for doubt. d.i.c.kens was a caricaturist, but he was an effective caricaturist; and no caricature is effective in its day unless it bears considerable resemblance to the truth. In his preface he spoke of Mrs. Gamp as a fair representation, at the time _Martin Chuzzlewit_ was published, of the hired attendant on the poor; and he might have added, says his biographer, that the rich were no better off, for the original of Mrs. Gamp "was in reality a person hired by a most distinguished friend of his own a lady, to take charge of an invalid very dear to her."[322] This one can the more readily understand in the light of a remark by Lady Palmerston quoted above.[323] "'Mrs. Gamp,' said Mrs. Harris, 'if ever there was a sober creetur to be got at eighteen pence a day for working people, and three and six for gentlefolks, you are that inwallable person.'" Great ladies clearly thought that such persons existed only, and could only be expected to exist, in the world of imagination and of Mrs. Harris. In 1854, Miss Mary Stanley, or a friend of hers, sent out a circular, very possibly with the knowledge of Miss Nightingale, to various persons connected with hospitals and infirmaries, of which the object was to suggest that nurses should be instructed, on the Kaiserswerth plan, in the art of administering religious comfort to patients. The replies which were subsequently printed[324] throw much light upon the position of nurses at the time. "If I can but obtain a sober set," wrote a doctor in the North, "it is as much as I can hope for." "I enquired for Dr.

X.," said another reply, "about the character of the nurses, and he says they always engage them without any character, as no respectable person would undertake so disagreeable an office. He says the duties they have to perform are most unpleasant, and that it is little wonder that many of them drink, as they require something to keep up the stimulus." The ordinary wages were 14 to 16 a year. It should be remembered, further, that hospital nurses had, as a rule, in the middle of the last century no uniform dress, and cooked their own food (which they bought for themselves), eating their meals in the ward kitchens or scullery: "If the sister happened to be partial to red herrings for breakfast, or onion-stew for dinner, or toasted cheese for supper, the consequent state of the ward may be imagined. The a.s.sistant nurses had to do all the scrubbing and cleaning of the wards, and to cook for the other nurses and themselves."[325] A side-light is thrown on the slovenliness of the arrangements by the account of what happened at King's College Hospital when the nursing was taken over in 1856 by trained nurses from St. John's House under Miss Mary Jones. "By the end of the day the new-comers, who had arrived in clean and dainty uniforms, were like a set of sweeps or char-women, in such an appalling state of disorder had they found their wards."[326] There were some excellent nurses under the old regime (apart from those trained at St. John's House), as Sir James Paget testified[327]; though it may be noted that even amongst his model Sisters, one was "not seldom rather tipsy." But "the greater part of them," he says, "were rough, dull, un.o.bservant, untaught." The stoutest defender of the old system, the most stubborn opponent of Miss Nightingale's reforms, gives unconsciously equal support to Sir James Paget's statement that "in the department of nursing there is the greatest and happiest contrast of all." Mr. South was of opinion that all was for the best, before Miss Nightingale began to interfere, in the best of all possible nursing worlds. But his conception of the ideal nurse is this: "As regards the nurses or ward-maids, these are in much the same position as housemaids, and require little teaching beyond that of poultice-making."[328]

[318] Above, p. 60.

[319] _Kaiserswerth_, p. 15.

[320] _Times_, April 15, 1857.

[321] In a pamphlet by Mr. J. F. South, referred to below, p. 445.

[322] Forster's _Life of d.i.c.kens_, vol. ii. p. 30.

[323] Above, pp. 272-3.