The Life of Florence Nightingale Volume I Part 38

[339] Above, p. 269.

On returning from the East, however, Miss Nightingale was in weak health, and she became absorbed in the large and manifold labours for the British Army which have already been described. She saw no early prospect of strength or time available for the superintendence of a new Inst.i.tution; she was unwilling that money subscribed for a public purpose should longer lie idle. In March 1858 she wrote in this sense to Mr. Sidney Herbert,[340] the Chairman of the Council, begging to be relieved from further responsibility in the matter, and asking that the Council should proceed to apply the Fund to such objects as it might deem best. The Council, however, pointed out that the Fund was well invested; that further delay would be partly compensated for by acc.u.mulation of resources, and that the contributors were anxious that Miss Nightingale's "mind and intention should animate the work." They, therefore, begged her to postpone a final decision, and to this suggestion she acceded. But Miss Nightingale's labours for the Army continued, and her health did not improve. Her life indeed seemed to her medical advisers to hang upon a slender thread; they thought that she could only live for a few months. She became apprehensive lest death should overtake her before she had impressed her mind and intention upon any application of the Nightingale Fund. In 1859 she set on foot preparations for doing something. A Sub-Committee of the Council was appointed, consisting of Mr. Herbert, Sir John McNeill, Sir James Clark, Dr. Bowman, and Sir Joshua Jebb, with Mr. A. H. Clough as Secretary.

[340] "Your letter strikes me," wrote Mr. Herbert (March 22), "as a little too curt for the occasion." He suggested another form of words to her which she adopted.

It was obvious to Miss Nightingale that it would be impossible for her, in view of the state of her health, to found an entirely new Inst.i.tution under her own superintendence. She saw that she must work through existing hospitals and the agency of other persons. It was this latter consideration that settled her choice of the place at which to found her Training School. She had naturally been besieged by suggestions from officials of this hospital and of that, of this charity and the other, each urging that his or hers was the one pre-eminently suited to benefactions from the Nightingale Fund. Her choice fell, for the main application of the Fund, upon St. Thomas's Hospital. The Resident Medical Officer, Mr. R. G. Whitfield, was sympathetic. The Hospital was large, rich, and well managed. But, above all, the Matron was a woman after Miss Nightingale's own heart, strong, devoted to her work, devoid of all self-seeking, full of decision and administrative ability. Of this remarkable woman, Mrs. Wardroper, who for twenty-seven years was superintendent of the Nightingale School, Miss Nightingale has left a character-sketch:--

I saw her first in October 1854, when the expedition of nurses was sent to the Crimean War. She had been then nine months matron of the great hospital in London, of which for 33 years she remained head and reformer of the nursing. Training was then unknown; the only nurse worthy of the name that could be given to that expedition, though several were supplied, was a "Sister" who had been pensioned some time before, and who proved invaluable.[341] I saw her next after the conclusion of the Crimean War. She had already made her mark; she had weeded out the inefficient, morally and technically; she had obtained better women as nurses; she had put her finger on some of the most flagrant blots, such as the night nursing, and where she laid her finger the blot was diminished as far as possible, but no training had yet been thought of....

Her power of organization or administration, her courage, and discrimination in character, were alike remarkable. She was straight-forward, true, upright. She was decided. Her judgment of character came by intuition, at a flash, not the result of much weighing and consideration; yet she rarely made a mistake, and she would take the greatest pains in her written delineations of character required for record, writing them again and again in order to be perfectly just, not smart or clever, but they were in excellent language. She was free from self-consciousness; nothing artificial about her. She did nothing, and abstained from nothing, because she was being looked at. Her whole heart and mind, her whole life and strength were in the work she had undertaken. She never went a-pleasuring, seldom into society. Yet she was one of the wittiest people one could hear on a summer's day, and had gone a great deal into society in her young unmarried life. She was left a widow at 42 with a young family. She had never had any training in hospital life, there was none to be had. Her force of character was extraordinary. Her word was law. For her thoughts, words and acts were all the same. She moved in one piece. She talked a great deal, but she never wasted herself in talking; she did what she said. Some people subst.i.tute words for acts: _she_ never. She knew what she wanted, and she did it. She was a strict disciplinarian; very kind, often affectionate, rather than loving. She took such an intense interest in everything, even in things matrons do not generally consider their business, that she never tired. She had great taste and spent her own money for the hospital. She was a thorough gentlewoman, nothing mean or low about her; magnanimous and generous, rather than courteous. And all this was done quietly.... She had a hard life, but never proclaimed it. What she did was done silently.[342]

[341] This was Mrs. Roberts: see above, pp. 185, 301.

[342] _British Medical Journal_, Dec. 31, 1892. Mrs. Wardroper retired in 1887, and died in 1892.

Every artist, it has been said, in painting the portrait of a sitter, paints also something of his own portrait. Miss Nightingale's vigorous character-sketch of her "dear Matron" is, I think, a case in point.

After much consultation with Mrs. Wardroper and Mr. Whitfield of St.

Thomas's Hospital, and with Sir John McNeill and others outside, Miss Nightingale formulated a scheme. The Committee of her Council met the Governors of the Hospital, and an agreement was arrived at for the foundation of the Nightingale School. The basis of the agreement was that the Hospital was to provide facilities for the training, and the Nightingale Fund to pay the cost, including the payment of the nurses themselves. In May 1860, advertis.e.m.e.nts were inserted in the public press inviting candidates for admission, and on June 24 fifteen probationers were admitted for a year's training. Thus on a modest scale, but with a vast amount of forethought, was launched the scheme which was destined to found the modern art and practice of nursing.

II

The essential principles of the scheme were stated by Miss Nightingale to be two: "(1) That nurses should have their technical training in hospitals specially organized for the purpose; (2) That they should live in a home fit to form their moral life and discipline."[343] The scheme was carefully adjusted to these two ends. The pupils served as a.s.sistant nurses in the wards of the Hospital. They received instruction from the Sisters and the Resident Medical officer. Other members of the Medical Staff--namely, Dr. Bernays, Dr. Brinton, and Mr. Le Gros Clark--gave lectures. How seriously the pupils were expected to undertake their studies, how strictly their superiors would watch their progress, is shown by the formidable "Monthly Sheet of Personal Character and Acquirements of each Nurse" which Miss Nightingale drew up for the Matron to fill in. The Moral Record was under five heads: punctuality, quietness, trustworthiness, personal neatness and cleanliness, and ward management (or order). The Technical record was under fourteen main heads, some of them with as many as ten or twelve sub-heads: "observation of the sick" was especially detailed in this manner.

Against each item of personal character or technical acquirement, the nurse's record was to be marked as Excellent, Good, Moderate, Imperfect, or 0. Those who "pa.s.sed the examiners," as it were, at the end of their year's course, were placed on the Hospital Register as Certificated Nurses. As rewards for good conduct and efficiency, the Council offered gratuities of 5 and 3, according to two cla.s.ses of efficiency, to all their certificated nurses, on receiving evidence of their having served satisfactorily in a Hospital during one entire year succeeding that of their training. Decidedly Miss Nightingale emphasized the educational side of her new experiment. No public school, university, or other inst.i.tution ever had so elaborate and exhaustive a system of marks.

Equally thorough and scientific are the "General Directions" which the Resident Medical Officer presently drew up at Miss Nightingale's earnest request, "For the Training of the Probationer Nurses in taking Notes of the Medical and Surgical Cases in Hospitals."

[343] _British Medical Journal_, Dec. 31, 1892.

Equal care was taken to ensure Miss Nightingale's second principle. The Hospital was to be a home as well as a school. The upper floor of a new wing of St. Thomas's Hospital was fitted up for the accommodation of the pupils, so as to provide a separate bedroom for each, a common sitting-room, and two rooms for the Sister in charge of them. No pupil was admitted without a testimonial of good character. Their board, lodging, washing, and uniform were provided by the Fund. They were given 10 for their personal expenses. The chaplain addressed them twice a week. They were placed under the direct authority of the Matron, whose discipline (as will have been gathered from Miss Nightingale's character-sketch) was strict. The least flightiness was reprimanded, and any p.r.o.nounced flirtation was visited with the last penalty. "Although,"

wrote the Matron to Miss Nightingale, with regard to one probationer, "I have not the smallest reason to doubt the correctness of her moral character, her manner, nevertheless, is objectionable, and she uses her eyes unpleasantly; as her years increase, this failing--an unfortunate one--may possibly decrease." A girl who was detected in daily correspondence, and in "walking out," with a medical student was dismissed. The nurses were only allowed to go out two together. "Of course we part as soon as we get to the corner," said one of them at a later time.

When the probationers had finished their training, they were expected to enter into service as hospital nurses, or in such other situations in public inst.i.tutions as through the Council or otherwise might be offered to them. It was not intended that they should enter upon private nursing. This was an important point in Miss Nightingale's scheme. She had it in her mind from the first that her Training School should in its turn be the means of training elsewhere. She wanted to sow an acorn which might in course of time produce a forest.

III

Such, then, was the scheme which was started on June 24, 1860. Miss Nightingale, confined to her room, was unable to visit the Hospital; but every detail was thought out by her. She took constant counsel from her friend Miss Mary Jones, at King's College Hospital, who gave her valuable suggestions, and she had eyes and ears to serve her everywhere.

Her friend Mrs. Bracebridge visited the dormitory, and p.r.o.nounced it excellent. On the day after the opening, Mrs. Wardroper reported that Dr. Whitfield was as hearty in the cause as herself. They both felt it to be an honour that St. Thomas's had been selected for the experiment, though it was an honour which "would subject them to rather harsh criticism." Outside opinion, however, was favourable. "I must send a few lines," wrote Sir William Bowman (Aug. 25, 1860), "to say how much satisfied I was yesterday with all I saw of your nurses at St. Thomas's.

As far as a cursory inspection could go, everything seemed perfect as to order, cleanliness, and propriety of demeanour. Your costume I particularly liked,--I suppose I must not say, admired. Two or three of your probationers whom I spoke to impressed me favourably. They seemed earnest and simple-minded, intelligent and nice-mannered. Altogether the experiment seemed to be working well, considering the difficulties it is being tried under. The 'sisters' I could judge nothing about. Mrs.

Wardroper I was much pleased with, and wish she had sole charge without 'mediums.' The dormitory I liked much." A writer in a popular magazine gave a glowing account of the Nightingale School. "The nurses wore a brown dress, and their snowy caps and ap.r.o.ns looked like bits of extra light as they moved cheerfully and noiselessly from bed to bed."[344]

Miss Nightingale sent books, prints, maps, and flowers for the nurses'

quarters. "I do not for one moment think," wrote Mrs. Wardroper, "that you wish to spoil them by over indulgence, but I very much fear they will sadly miss your considerate kindness when they go from us."

Already (Jan. 1861), the Matron was receiving applications from country hospitals for nurses to be sent after the year's training. Miss Nightingale's demand for detailed information was almost insatiable.

Even the Monthly Report, with all its amplitude of heads and sub-heads, was not enough. Mrs. Wardroper supplemented it by private reports. Miss Nightingale suggested to her that she should encourage the nurses to keep diaries which might afterwards be inspected. "I am very pleased,"

wrote Mrs. Wardroper, after two or three years' trial (Jan. 11, 1863), "that you approve of the diaries, and I am sure your approbation will stimulate them to increased perseverance." When Miss Nightingale detected bad spelling, a probationer was given dictation lessons. Miss Terrot, a friend of Miss Nightingale, obtained admission to the Hospital as a supernumerary, and supplemented the Matron's reports. "I am sorry,"

she wrote in one of many letters, "that the Probationers have lately been disposed to quarrel among themselves; I suppose where women live together, there will be jealousies and dislikes." Are sets and cliques and dislikes unknown where men live together? The first year's working of the experiment augured well, however, for the success of the scheme.

All the probationers who completed their course (13 out of the 15) expressed their grat.i.tude for the benefits they had received. Six were admitted as full nurses in St. Thomas's Hospital. Two were appointed nurses in Poor Law Infirmaries, and applications were under consideration for the placing of others.[345] The seed had been sown on good ground.

[344] _St. James's Magazine_, April 1861. The writer was Mrs. S. C.

Hall.

[345] _Report of the Committee of the Council of the Nightingale Fund for the year ending June 24, 1861._

IV

A little later, Miss Nightingale applied a portion of the Fund to another purpose, which she had much at heart. This was the training of midwives for service among the poor. Here, again, she worked through an existing inst.i.tution, and by the agency of a woman already known to her.

The Hospital selected for this experiment was that of King's College, where Miss Nightingale herself, before her call to the Crimea, had been inclined to serve. The nursing at King's College Hospital was undertaken by nurses trained at the St. John's House--an inst.i.tution which had furnished a contingent to Miss Nightingale's Crimean expedition. The nature of the experiment was explained by Miss Nightingale in a letter to Miss Harriet Martineau (Sept. 24, 1861):--

They are to be persons selected by country parishes between 26 and 35 years of age, of good health and good character, to follow a course of _not less_ than 6 months' practical training, and to conform to all the rules of St. John's House which nurses at King's College Hospital. No further obligation is imposed upon them by us.

They are supposed to return to their parishes and continue their avocation there. I am sorry that we shall be obliged to require a weekly sum for the board which will be merely the cost price--not less than 8s. or more than 9s. a week. Our funds do not permit us, at least at first, to do this cost free. For (the Hospital being very poor) we have had to furnish the Maternity Ward and are to maintain the Lying-in beds. In fact, we establish this branch of the Hospital which did not exist before. The women will be taught their business by the Physician-Accoucheurs themselves, who have most generously entered, heart and soul, into the plan, at the bed-side of the Lying-in patients in this ward, the entrance to which is forbidden to the men-students. And they will also deliver poor women at their own homes, out-patients of the Hospital. The Head Nurse of the Ward, who is paid by us, will be an experienced midwife, so that the pupil-Nurses will never be left to their own devices. They will be entirely under the Lady Superintendent--certainly the best moral trainer of women I know. They will be lodged in the Hospital, close to her. If I had a young sister, I should gladly send her to this school--so sure am I of its moral goodness; which I mention, because I know poor mothers are quite as particular as rich ones, not merely as to the morality but as to the prosperity of their daughters.

In nearly every country but our own there is a Government School for Midwives. I trust that our School may lead the way towards supplying a want long felt in England. Here we experiment; and if we succeed, we aresure of getting candidates. I am not sure this is not the best way.

The quiet beginning and the principle that nothing second-best is good enough for the people are very characteristic.

V

The experiment at King's College Hospital, which began in October 1861, had to be abandoned after six years' successful working owing to an epidemic of puerperal fever in the wards; but that at St. Thomas's flourishes to this day on an enlarged scale, and throughout Miss Nightingale's active years occupied a constant share of her thoughts and personal attention. From 1872 onwards she wrote, as we shall hear later, a New Year's Address, whenever health and time permitted, to the Nightingale Nurses, constantly inculcating high ideals, and giving personal inspiration to the order which bore her name. Every year as it pa.s.sed carried into wider circles her scheme of affording to women desirous of working as hospital nurses the means of obtaining a practical and scientific training, and of raising by degrees the standard of education and character among nurses as a cla.s.s. From year to year the other hospitals were a.s.sisted from the mother school with trained superintendents and staff, and new centres were formed with the same objects,[346] and it may well be said that the seed thus sown by Miss Nightingale through the means of the Fund has been mainly instrumental in raising the calling of nurses to the position it now holds. So said the Council of the Fund in their Report for the year in which Miss Nightingale died; and the facts collected in histories of modern nursing fully bear out their statement. In many cases Nightingale nurses were sent out in groups, as we shall hear in a later chapter, to initiate reform in other inst.i.tutions. In the British Colonies and the United States the "Nightingale power" worked in a similar way. Colonial hospitals went to the Nightingale School for their superintendents.

"Miss Alice Fisher, who regenerated Blockley Hospital (Philadelphia), was a Nightingale nurse, and Miss Linda Richards, the pioneer nurse of the United States, enjoyed the advantage of post-graduate work in St.

Thomas's, and of Miss Nightingale's personal kindly interest and encouragement."[347] Nor was the influence of her scheme confined to the Anglo-Saxon world. In Germany, in France, in Austria, and in other countries, the training of nurses similarly followed Miss Nightingale's lead. Thus did the seed which Florence Nightingale transplanted from Kaiserswerth grow up in other soil and with different development into a mighty tree with many branches.

[346] On April 11, 1861, Sir James Paget wrote to Miss Nightingale begging her to send him a scheme as "Bartholomew's is beginning to consider the training of nurses."

[347] _History of Nursing_, vol. ii. p. 184.

In these days, when all our great hospitals have their training schools for nurses, when the tendency is towards increasing the requirements beyond the standard described in this chapter, and when nursing has become a highly organized profession, it requires some effort to realize how novel, and even how daring, was the work of the founder of modern nursing. Just as a Colonel of the old school helped us to understand the difficulties of Miss Nightingale's experiment in the Crimean War, so a Surgeon of the old school wrote a little book which is invaluable in helping us to realize the novelty of her experiment in St. Thomas's Hospital. This is the book by Mr. South, to which I have already referred. He was of the highest distinction in his profession; Hunterian orator and twice President of the College of Surgeons. He was also Senior Surgeon at St. Thomas's Hospital, a fact which perhaps explains Mrs. Wardroper's antic.i.p.ation of "rather harsh criticism"; for Mr. South was strongly, and even bitterly, opposed to the whole idea of the Nightingale Fund, and of any new provision for the training of nurses.

He was "not at all disposed to allow that the nursing establishments of our hospitals are inefficient, or that they are likely to be improved by any special inst.i.tution for training." He believed that the nursing at St. Thomas's was good (as indeed in many respects it was), and he did not perceive that what the Nightingale Fund had in view was to raise the general level, and to send out from St. Thomas's trained nurses, who in their turn would train other nurses elsewhere. Perhaps, if he had perceived this, he would have regarded it as superfluous. His point of view was that of the man who finds the world very well as it is. I have cited the pleasure with which certain army doctors in the East found in the fact that few of their colleagues had subscribed to the Nightingale Fund. Mr. South found similar satisfaction in scanning the subscription list at home. "That this proposed hospital nurse-training scheme has not met with the approbation or support of the medical profession is," he wrote, "beyond doubt. The very small number of medical men whose names appear in the enormous list of subscribers to the fund cannot have pa.s.sed unnoticed. Only three physicians and one surgeon from one (London) hospital, and one physician from a second, are found among the supporters." Miss Nightingale's nursing work had the support of some leading doctors, but I suppose we must take Mr. South's word for it that the medical profession as a whole was unsympathetic or hostile towards reforms which in a later generation received general approbation. The doctors do not stand alone among the professions in a tendency to oppose reforms. The hostility of lawyers to legal reform is almost proverbial; and as for the politicians, one-half of them is professionally engaged in predicting dire results from reforms introduced by the other half.

And so it continues until the paradoxes of one generation become the commonplaces of the next.

But if the course of political and social progress is strewn with the wrecks of predictions of ruin, neither is it free from the disillusionments of reformers. Fears may be liars, but hopes are sometimes dupes. Miss Nightingale, as the founder of modern nursing, achieved great and beneficent results, but she lived to experience some disappointments. Her standard was so high that she was more conscious of shortcoming than of achievement. We shall perhaps better understand her mind when we pa.s.s, in the next chapter, to consider the religious sanction and the ideal of human perfectibility which she had worked out for herself in the world of thought, and which inspired her efforts in the world of action.

CHAPTER V

THE RELIGIOUS SANCTION: "SUGGESTIONS FOR THOUGHT"

(1860)

It fortifies my soul to know That, though I perish, Truth is so: That, howsoe'er I stray and range, Whate'er I do, Thou dost not change.

I steadier step when I recall That, if I slip, Thou dost not fall.

A. H. CLOUGH.

The life and work of Miss Nightingale, as described in the foregoing chapters of this Memoir, were such as were unlikely to have proceeded from any one who was not possessed by some strong spiritual impulse. It was a life devoted to work, and in that work she sought and found herself. Yet from what is ordinarily called "self-seeking" her work was conspicuously free. The body was so weak that the wonder is how a woman in delicate health was able to perform so much of what Sidney Herbert called "a man's work" in the world. She was supported, sustained, inspired by great spiritual force and energy, which drove her to seek self-satisfaction in a dedicated life of work, and which in its turn found expression in a form of religion, independently attained and intensely held.