The Life of Florence Nightingale Volume I Part 37

[324] _Hospitals and Sisterhoods_. London, John Murray, 1854 (2nd ed., 1855). Anonymous, but known to be the work of Miss Mary Stanley.

[325] "Report on the Nursing Arrangements of the London Hospitals" (at the time and twenty years before) in the _British Medical Journal_, Feb. 28, 1874.

[326] _St. John's House: a Record_, p. 10.

[327] See his Address to the Abernethian Society in 1885 given in his _Memoir and Letters_, 1901, p. 351.

[328] _Facts relating to Hospital Nurses.... Also Observations on Training Establishments for Hospitals_, 1857, pp. 11, 16.

From all this, facts emerge which will clearly explain wherein Miss Nightingale's work as the founder of modern nursing consisted. She was not entirely alone, nor was she in point of time the first, in the field; and there were exceptional cases to which the following statements do not apply. But she was able to do on a larger scale, and on a scale and in a form which attracted general imitation, what others had attempted. And speaking generally, we may say that before Miss Nightingale appeared on the scene, nursing was, and was regarded as, a menial occupation which did not attract women of character; that it was ill-paid and little respected; that no high standard of efficiency was expected; and that no training was organized: the women picked up their knowledge in the wards. They were, as the correspondent of the _Times_ said, "meek, pious, saucy, careless, drunken, or unchaste, according to circ.u.mstances or temperament, mostly attentive, and rarely unkind"; but, with very few exceptions, they were untrained. "A poor woman is left a widow with two or three children. What is she to do? She would starve on needlework; she is unfit for domestic service; she knows n.o.body to give her charring, and has no money to buy a mangle. So she gets a recommendation from a clergyman, and is engaged as a Hospital Nurse."

The change which has come about since Miss Nightingale's work took effect is strikingly ill.u.s.trated in the Census. In 1861 there were 27,618 nurses "in hospitals, or nurses not apparently domestic servants," and they were enumerated, in the tables of Occupations of the People, under the head of "Domestic." In 1901 there were 64,214 nurses, and they were enumerated under the head of "Medicine." Miss Nightingale was the founder of modern nursing because she made public opinion perceive, and act upon the perception, that nursing was an art, and must be raised to the status of a trained profession. That was the essence of the matter. Other things, such as the opening of nursing to higher social strata, the better payment of nurses, etc., though important and interesting, were only results.

III

The means by which Miss Nightingale achieved this great work were three.

She brought to bear upon it the force, successively, of her Example, her Precept, and her Practice. The first two of these aspects of her work will be considered in the remainder of the present chapter; the third is the subject of the next chapter.

No woman, I suppose, who was not canonized or who had not worn (or been deprived of) a crown, has ever excited among her s.e.x so much pa.s.sionate and affectionate admiration, and set to so many an example, as Florence Nightingale. I have tried in an earlier chapter, ent.i.tled "The Popular Heroine," to describe the effect which her work in the Crimean War produced upon the minds of her contemporaries. To get first-hand impressions, the younger readers of to-day must go to their grandmothers or great-aunts. It is they who can help us best to some imagination of the thrill which the stories of her nursing in the Crimea excited throughout the land, of the intensity of sympathetic admiration which went out towards her, of the impulse towards a fuller and worthier life which proceeded from her example. But old letters are of some a.s.sistance too. From a packet of family letters here is one, from an aunt to a niece: "_April_ 15, 1857. I fear from a line in one of the newspapers that Florence Nightingale's life is approaching an end. I have been deeply impressed by her life these last few days, which in respect of mine forms but a fragment in regard of time, and what she has accomplished! A high mission has been given her which has cost her her life to fulfil."[329] In how many other minds, young and old alike, must Florence Nightingale's example have stirred similar thoughts! A lady who had attained high distinction as a Nightingale nurse was asked after Miss Nightingale's death to record her recollections: "My first thoughts of Miss Nightingale date back to that winter of frozen rivers, when children, catching up the rumours of the street, ran about shouting _Sebastopol's taken_; or danced, listening around the old weaver's wife who had come to the door of her cottage to catch the last light, and read aloud to her husband what 'Lord Raiglan' was doing and saying; or later, in the hour before bed-time, sat at their father's feet while he told of the frozen trenches, of the 'dreary corridors of pain,' and of that 'ministering angel,' whose devotion was lightening a nation's distress; or perhaps later still in sleep, dreamed children's dreams of creeping amid sleeping Russians, stealing the golden crown from the Czar's head, and escaping with it to Florence Nightingale! Such experiences left indelibly impressed on the minds of the children of my generation the gentle and heroic figure of Miss Nightingale." Often, no doubt, the impulse was fleeting, and the broken purpose wasted in air.

And often, too, the impulse was vague, and resulted in no definite action; yet not on that account, perhaps, to be cast aside as valueless.

"I have a belief of my own," says one of George Eliot's characters, "and it comforts me--That by desiring what is perfectly good, even when we don't quite know what it is, and cannot do what we would, we are part of the divine power against evil." But often the force of Florence Nightingale's example was direct and practical. Among those whom it influenced in this way was Luise, the Grand d.u.c.h.ess of Baden, who in 1859 founded a Ladies' Society in Baden for the training of nurses. She had never seen Miss Nightingale, but a letter filled the Grand d.u.c.h.ess with enthusiastic grat.i.tude. "I felt," she wrote (Sept. 1861), "that both joy and strength had come to me from your dear letter. I may try indeed to thank you for it, but I shall never succeed in expressing how deeply and how highly I felt your kindness. If there is any progress in the work I have so much at heart, it is greatly to your encouraging support I owe it." Those who saw Miss Nightingale, and who were sympathetic, felt thrilled in her presence. "She is so far more delightful in herself," wrote Clara Novello, "than in one's imagination." To nurses already engaged in work, Miss Nightingale's personal influence was an inspiration. Miss Mary Jones, of King's College Hospital, addressed her as "My beloved Friend and Mistress." "I value your nosegay too much to part with any one flower even." "I look on a visit to you as my one indulgence and greatest pleasure." But those who never saw Miss Nightingale, nor even heard from her, felt the force of her example. In what was publicly known of her career, there was, as it were, a call and a challenge to women. Here was a woman, of high ability and of social standing, who had forsaken all to be a nurse. She sought to raise nursing to the rank of a High Art. She had already in some measure done it by her example.

[329] _A Century of Family Letters_, vol. ii. p. 174.

IV

In every walk of life, however, there are those who seek the palm without the dust. Miss Nightingale had seen already in the Crimea many women who had followed her example, indeed, in desiring to nurse the sick, but into whose heads it had never entered that nursing required special gifts and careful training. Example had to be supplemented by precept. Miss Nightingale's precepts upon the Art of Nursing were first given to the world in 1859-60. Her _Notes on Nursing_--the best known, and in some ways the best, of her books--was published in December 1859.

It was instantly recognized by the leaders in medical and sanitary science as a work of first-rate importance; as one of those rare books to which, within their range, the term epoch-making may rightly be applied. "I am ashamed to find," wrote Sir James Paget, "how much I have learnt from the _Notes_, more, I think, than from any other book of the same size that I have ever read." "I am delighted with them," wrote Sir James Clark. "They will do more to call attention to Household Hygiene than anything that has ever been written." "This," wrote Harriet Martineau, "is a work of genius if ever I saw one; and it will operate accordingly. It is so real and so intense, that it will, I doubt not, create an Order of Nurses before it has finished its work." This was a true prediction. Miss Nightingale was the founder of a New Model, and the _Notes on Nursing_ was its gospel.

The antic.i.p.ations of her friends that the _Notes_ would be popular were abundantly fulfilled. Here was a book by Florence Nightingale on the very subject to which her fame was attached. The effect produced upon many minds by _Notes upon Nursing_ was the greater because it came, as it were, as a kind of resurrection of the popular heroine. The years which had pa.s.sed since Miss Nightingale's return from the Crimea were, as we now know, years of ceaseless activity; years during which she had done some of her greatest work. But it must be remembered that all this was entirely unknown to most people at the time. The common belief was that Miss Nightingale had retired into private life upon her return from the Crimea; but now after a long interval she came before the public again. And, though, as in all that she wrote for the public eye, there was a conspicuous absence of self-advertis.e.m.e.nt, there was enough in the book to connect many of its pages with scenes and episodes of the Crimean War. An enthusiastic review in a paper not generally given to enthusiasm pointed out the connection: "Hundreds of brave men attested with their dying breath how n.o.bly Miss Nightingale's self-imposed task was fulfilled, and this little book would be almost enough to explain her success. Its tone seems to tell of the solemn scenes from which experience in such matters has to be gained. Its language is grave, earnest, and impetuous, like that of a person who has lived among sad realities, and has been face to face with almost every form of human suffering."[330] Nor was it only the general tone of the book that was suggestive of the heroine of the Crimean War. Here and there little touches of personal experience were introduced, in which every one could read the occasion between the lines. When the author talked of her "sadly large experience of death-beds," the reader thought of the Lady with the Lamp at Scutari; and when in her chapter on "Variety" she recalled "the acute suffering produced from the patient (in a hut) not being able to see out of window," the reader's mind went back to the pictures of Miss Nightingale at Balaclava. "I shall never forget," she wrote, "the rapture of fever patients over a bunch of bright-coloured flowers." She was thinking again of the Crimea. The wild flowers there are many and brilliant; and the nurses used to gather them in the early morning walk which each took in turn.[331]

[330] _Sat.u.r.day Review_, Jan. 21, 1860.

[331] _Hornby_, p. 306.

The book was not cheap at first; the price was 5s. But 15,000 copies were sold in a month, and a cheaper edition at 2s. quickly followed. It was read, sooner or later, by all sorts and conditions of people; in palaces, in cottages, in factories. Queen Victoria "thanked Miss Nightingale _very much_ for the book," and sent in return a print of herself and the Prince Consort. From the Grand d.u.c.h.ess of Baden the book called forth an overflowing tribute. "I will not attempt to describe to you," she wrote (Oct. 9, 1860), "with how much interest and admiration I read these pages, so beautiful in their simplicity, so admirable in their true Christian spirit. Rarely has a book made so deep an impression on me. I cannot refrain from expressing the real admiration I feel for the n.o.ble English lady who has devoted so much of her life to suffering mankind, and who has given to all her sisters an example never to be forgotten." With further expressions of personal admiration, the Grand d.u.c.h.ess added a very just characterization of the book: "The gentle feelings of the woman are joined to experience, reflexion, and science." Miss Nightingale was urged to prepare a popular sevenpenny edition, and this appeared early in 1861 with the t.i.tle _Notes on Nursing for the Labouring Cla.s.ses_, and with a new chapter called "Minding Baby." "And now, girls," this chapter begins, "I have a word for you. You and I have all had a great deal to do with 'minding baby,'

though 'baby' was not our own baby.[332] And we would all of us do a great deal for baby, which we would not do for ourselves." "Did I tell you," wrote Miss Nightingale to Madame Mohl (May 7, 1861), "what prompted my little chapter on _Minding Baby_? A Peckham schoolmaster asked me, saying he could always make the school-girls mind my book by telling them it was 'for baby's sake.' And several opened their parents'

windows at night (greatly to the indignation of the parents, I am thinking), and removed dung-hills before the doors in consequence." In its cheap form, the book had a very large circulation. Mr. Chadwick interested himself in getting it recommended for school-reading.

Benevolent persons distributed it gratuitously in villages and cities.

Edition after edition was rapidly called for. Among Miss Nightingale's papers I find letters from correspondents reporting cases in which office clerks and factory hands, after reading the book, voted the windows open.

[332] "The chapter on Minding the Baby," wrote Mr. Jowett (Aug. 24, 1868), "is excellent. I particularly like the parenthesis ('though he's not our baby') in which a world of morality is contained."

The book was read, not only by all sorts and conditions of people at home, but also in many countries and in many tongues abroad. It had instantly been reprinted in America. It was translated into German, into French (with a preface by Miss Nightingale's old acquaintance, M.

Guizot),[333] and into most of the other European languages. If the book be out of print, it ought to be included in one of the cheaper series of the day. It can never be out of date, and no one who has read it has ever found it dull.

[333] Bibliography A, No. 32.

V

Miss Nightingale was essentially a "man of action," not a writer. Yet her writings are very characteristic of her work, and none is more pleasantly so than _Notes on Nursing_. Not the whole of her nature "breaks through language and escapes" into it, but this little book alone would be enough to explain to an understanding reader several characteristics of her mind and work. It is an incomparable treatise on the art of nursing; but, as Sir James Paget indicated, it is more than that: it is an alphabet of Household Hygiene. Miss Nightingale's treatment of the subject reveals at the outset her philosophical grasp.

"Shall we begin," she says, "by taking it as a general principle that all disease, at some period or other of its course, is more or less a reparative process, not necessarily accompanied with suffering: an effort of nature to remedy a process of poisoning or decay, which has taken place weeks, months, sometimes years beforehand, unnoticed, the termination of the disease being then, while the antecedent process was going on, determined? If we are asked, Is such or such a disease a reparative process? Can such an illness be unaccompanied by suffering?

Will any care prevent such a patient from suffering this or that?--I humbly say, I do not know. But when you have done away with all that pain and suffering, which in patients are the symptoms, not of their disease, but of the absence of one or all of the essentials to the success of Nature's reparative processes, we shall then know what are the symptoms of, and the sufferings inseparable from, the disease." This is, surely, sound philosophy; not overthrown by any later discoveries about germs and microbes. It is the philosophy of eliminating the known as a preliminary to investigating the unknown. It leads Miss Nightingale to insist on the importance, as she calls it, of "nursing the well"

before they become the sick; or in other words, to the principles of domestic hygiene--ventilation, warming, drains, light, cleanliness. In all this her book had more originality than the younger readers of to-day will realize without some effort of retrospective imagination.

The homes of the poor were in her day those that were not very much caricatured by d.i.c.kens and Cruickshank. The schools of the poor, which have taught some of the principles of hygiene directly, and have had a yet wider influence indirectly by setting an example of airy rooms and cleanliness, were still in the future. Working people in those days could, moreover, hardly be reached by writings. It was the popular fame of Florence Nightingale that won for her _Notes on Nursing_ an audience from "the Labouring Cla.s.ses." Nor is it only among those cla.s.ses that great changes in current ideas and practice about domestic hygiene have been effected. At the time when Miss Nightingale wrote, stuffiness characterized the most genteel interiors. She was a pioneer in establishing the principles of modern hygiene; and perhaps even to-day there is still room for a wider acceptance of her doctrine that "nursing the well" is even more important than nursing the sick--preventive hygiene, than curative medicine.

A characteristic of Miss Nightingale's mind, and of her methods in action is, as has been noticed already, her combination of general grasp with minute attention to detail, and this is particularly remarkable in her _Notes on Nursing_. In the chapter dealing with nursing, in the more common acceptance of the term, one is struck on almost every page with this rare combination of gifts. Nothing is too minute for her touch, but everything is referred to a general principle.

Her philosophy of "Noises," with the detailed injunctions which she bases upon it, is alone enough to ent.i.tle her to the eternal grat.i.tude of invalids.

The book is no less remarkable for delicacy of observation and fineness of sympathy. "Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion. Remember, he is face to face with his enemy all the time, internally wrestling with him, having long imaginary conversations with him. You are thinking of something else. Rid him of his adversary quickly is a first rule with the sick." "People who think outside their heads, who tell everything that led them towards this conclusion and away from that, ought never to be with the sick." "A sick person intensely enjoys hearing of any _material_ good, any positive or practical success of the right. Do, instead of advising him with advice he has heard at least fifty times before, tell him of one benevolent act which has really succeeded practically--it is like a day's health to him. You have no idea what the craving of the sick, with undiminished power of thinking but little power of doing, is to hear of good practical action, when they can no longer partake in it." The whole chapter, ent.i.tled "Chattering Hopes and Advices," from which this last extract is taken, is full of wit and wisdom. It could only have been written as the expression of an understanding mind and a sympathetic heart; just as the following chapter, "Observation of the Sick," with its directions in the finer technique of nursing, could only have come from one of long and varied experience in the practice of it.

Another of Miss Nightingale's characteristics--her taste for epigrammatic and often pungent expression--is conspicuous in _Notes on Nursing_. "Feverishness is generally supposed to be a symptom of fever; in nine cases out of ten, it is a symptom of bedding." "No _man_, not even a doctor, ever gives any other definition of what a nurse should be than this--'devoted and obedient.' This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman." "Some 'obedient' nurses know no medium between 'Now no fire,' 'Now fire,' as if they were volunteer riflemen." "It seems a commonly received idea among men, and even among women themselves, that it requires nothing but a disappointment in love, or incapacity in other things, to turn a woman into a good nurse. This reminds one of the parish where a stupid old man was set to be schoolmaster because he was 'past keeping the pigs.'" There is lively humour, too, in many of the personal descriptions. Miss Nightingale quotes Lord Melbourne's saying: "I would rather have men about me when I am ill; I think it requires very strong health to put up with women."[334] "I am quite of his opinion," she adds, and she gives some little word-pictures of the female nurse (old style). "Compelled by her dress, every woman now either shuffles or waddles--only a man can cross the floor of a sick room without shaking it." She was writing in the days of crinolines, and draws a picture of "respectable elderly women stooping forward," when invested therein. Another picture is of the nurse who is supposed, "like port-wine," to improve with age. We are not told the circ.u.mstances, but we are a.s.sured that it was a "fact" that a nurse, when ordered to administer brandy-and-water to a fainting patient, supplied the last week's _Punch_. Then there is a description of the mincing nurse, with "an affectedly sympathizing voice, like an undertaker's at a funeral."

All Miss Nightingale's pictures were drawn from life. "I wonder," wrote one of her friends, "if the originals will recognise themselves."

[334] The saying is recorded in C. R. Leslie's _Autobiographical Recollections_, vol. i. p. 169, as made to Lady Holland. "Oh!" said the lady, tapping him with her fan, "you have lived among such a rantipole set." "I happen to know," wrote Monckton Milnes to Miss Nightingale, "who Lord Melbourne's nurse was."

No one, then, could read the _Notes on Nursing_ without perceiving that the author was a woman of marked ability, of wisdom, and of true goodness. The book does not of itself prove Miss Nightingale's power of administration or resolute will; for a woman, or a man, may be decisive of speech without being masterful in action; but with this exception the reviewer was right who said that the book was "enough to explain the success" which Miss Nightingale had attained. The book points even more clearly to one of the main lines on which she was to work in the future.

No one could read it without perceiving that nursing, as explained and taught by Miss Nightingale, must be a very delicate, and a very difficult, art. It required a sound mastery of the laws of household hygiene, some knowledge of medicine or surgery, and, above all, an acute and sympathetic faculty of observation. "Merely looking at the sick is not observing." It was obvious that if Miss Nightingale's ideal of nursing was to be realized, the nurse required both training and inspiration. Nursing was an art, and like any other art, "from a shoemaker's to a sculptor's, needed in its votaries the sense of a 'calling,' and then a diligent apprenticeship." The way in which Miss Nightingale translated her precepts into practice is the subject of the next chapter. In _Notes on Nursing_, as in nearly everything that came from her pen, what she wrote had direct reference to action.

In a characteristic appendix to her _Notes on Nursing_, Miss Nightingale discusses "Some Errors in Novels," pointing out, among other things, the untruth of death-bed scenes in works of fiction. "Shakespeare," she says, "is the only author who has ever touched the subject with truth, and his truth is only on the side of art." "The best definition of a Nurse," she wrote elsewhere,[335] "can be found, as always, in Shakespeare." It is in _Cymbeline_ that the ideal of a Nightingale nurse was prefigured:--

So kind, so duteous, diligent, So tender over his occasions, true, So feat, so nurse-like.

[335] Reprint from Quain's _Dictionary_, p. 12.

CHAPTER IV

THE NIGHTINGALE NURSES

(1860-1861)

Life is short and the art of healing is long.--HIPPOCRATES.

"The value of Hospitals as schools of surgery and medicine is hardly greater than is their usefulness as a training for nurses, and the field is no less large. It is an employment suited to women. There has been an astonishing change in this matter since Miss Nightingale volunteered.

This change is perhaps the best fruit the past half century has to show."[336] So writes one who has devoted laborious years to the "Condition of England question." If it be as Mr. Charles Booth says, then June 24, 1860, is a memorable day in the history of the nineteenth century[337]; for it is the day on which the Nightingale Training School for Nurses was opened at St. Thomas's Hospital.

[336] _Life and Labour of the People in London._ Final volume, 1903, p. 154.

[337] The 50th anniversary of the event, not noticed, I think, in England, was celebrated in America: see Vol. II. p. 421.

This School was a direct outcome of Miss Nightingale's services in the Crimean War. The Nightingale Fund, amounting to 44,000, was a tribute from the British Empire to the Popular Heroine. The capital sum, after defrayment of some expenses, was invested in the name of trustees, and a Council[338] was nominated by Miss Nightingale for the administration of the Trusts to enable her to establish "an Inst.i.tution for the training, sustenance, and protection of Nurses and Hospital attendants." She intended, as we have heard,[339] to found or conduct such an Inst.i.tution on her own lines, and her first idea had been to become the Superintendent of it herself.

[338] The Council consisted of Mr. Herbert, Mr. Bracebridge, Lord Ellesmere, Sir Joshua Jebb, Sir James Clark, Dr. Bowman, the Dean of Hereford, Sir John McNeill, and Dr. Bence Jones.