The Life of Florence Nightingale Volume II Part 8

(_Miss Nightingale to Captain Galton._) _June_ 27.... Now do write to a wretched female, F. N., about _who_ is to come in _where_.

Does Gen. Peel come to the War Office? If so, will he annihilate our Civil Sanitary element? Is Sutherland to go all the same to Malta and Gibraltar this autumn? Will Gen. Peel imperil the Army Sanitary Commission? I _must_ know: ye Infernal Powers! Is Mr. Lowe to come in to the India Office? It is all unmitigated disaster to me. For, as Lord Stanley is to be Foreign Office (the only place where he can be of _no_ use to us), I shall not have a friend in the world. If I were to say more, I should fall to swearing, I am so indignant.--Ever yours furiously, F. N.

Captain Galton replied that he had it from Mr. Lowe himself that he would not join the Tories; that of the actual appointments he had not as yet heard; but that as the Secretary of State's was an impersonal office, Dr. Sutherland's commission to visit the Mediterranean would still hold good--or bad. "You say the S. of S. is an impersonal creature," replied Miss Nightingale (July 3); "I wish he wuz!" When the names of the new Ministers were announced, Captain Galton threw out a suggestion tentatively that Lord Cranborne[71] (India Office) might be approachable through Lady Cranborne. "I have a much better recommendation to him than that," wrote Miss Nightingale in some triumph (July 7), "and have already been put into 'direct communication' with him, _not_ at my own request." The letters tell the story of her introduction to new masters at the India Office and the Poor Law Board:--

(_Lord Stanley to Miss Nightingale._) ST. JAMES'S SQUARE, _July_ 6.

I shall see Lord Cranborne to-day (we go down to be sworn in) and will tell him the whole sanitary story, and also say that I have advised you to write to him as you have always done to me to my great advantage. You will find him shrewd, industrious, and a good man of business.

[71] Better known as the Marquis of Salisbury, to which t.i.tle he succeeded in 1868.

(_Miss Nightingale to Lord Cranborne._) 35 SOUTH STREET, _July_ 17.

Lord Stanley had the kindness to advise me to write to you, and to tell _me_ that he would tell _you_ that he had "advised" me "to write to" you as I "have done to" him. This is my only excuse for what would otherwise be a very great impertinence and what I fear may seem to you such even now, viz. my present application to you on the India Public Health question. I know I ought to begin, "Miss Nightingale presents her compliments to Lord Cranborne." But the "third person" always becomes confused. Lord Stanley has probably scarcely had the time to tell you my long story. I fear, therefore, I must introduce myself, by saying that my apology for what you may (justly) consider an unwarrantable interference must be--the part I have taken in the Public Health of the Army in India for the last 8 years, having been in communication with Lord Stanley, Sir C. Wood, and Lord de Grey about it, and being now in constant communication with Sir John Lawrence and others in India on the same subject.

When Lord de Grey left office, Lord Stanley, of his own accord, kindly asked whether he should "put" me "in direct communication"

with you.

This is my general apology. My particular one is: that by last mail I received some very pressing letters from India on the subject of the introduction of an efficient Public Health administration into India, which is after this wise:--the spirit of the very general recommendations made by the R. Commission which reported in 1863 (presided over by Lord Stanley) had never been completely acted up to--there have been difficulties and clashings in consequence. A Minute (of January 9, 1866) was sent home by Sir John Lawrence proposing to connect the Public Health Service with the Inspectorship of Prisons. The proposal appears to have been made without due consideration of the importance and greatness of the duties; if it were carried out, it would put an end, we believe, to any prospect of efficient progress. (I think I am correct in saying that Lord Stanley concurs in this view.) Lord de Grey was deeply impressed with this defect in the scheme; he drew up a Minute (just before he left office) in order to leave his views on record for you, setting forth generally the duties, and asking for a reconsideration of the subject in India, before the organisation was finally decided on--of the Public Health Service. I would now venture to ask your favourable consideration for this proposal, because, on the organisation of a service adequate for the object, depends the entire future of the Public Health in India.

We commit ourselves into your hands.

(_Lord Cranborne to Miss Nightingale._) INDIA OFFICE, _July 17_. I am much obliged to you for your letter; and especially for your kindness in relieving me from the literary effort of composing a letter or series of letters in the third person. Lord Stanley spoke to me about the sanitary question some days ago, and told me I should probably hear from you. I have made enquiries as to the Despatch you mention, and find that it is in the office still awaiting decision. No confirmation of it shall take place until I have communicated further with you upon the subject. I shall not be able to go into the sanitary question until I have disposed of the claims of the Indian officers, which, according to all the best authorities, are very urgently in need of immediate settlement. But as soon as that is done with, I hope that the sanitary question may be taken up without delay.

(_Mr. Gathorne Hardy to Miss Nightingale._) POOR LAW BOARD, _July_ 25. You owe me no apology for calling my attention to material points connected with the subject in the consideration of which you are so much engaged. I should say this to any one who wrote in the same spirit as yourself, but I am really indebted to you who have earned no common t.i.tle to advise and suggest upon anything which affects the treatment of the sick. Your note arrived at the very instant when a gentleman was urging me to lay before you questions relating to Workhouse Infirmaries, and I should not have hesitated to do so if needful even without the cordial invitation which you give me to ask your a.s.sistance. At present I have not advanced very far from want of time, as while Parliament is sitting I am necessarily very much occupied with other business, and I am anxious to remedy, if possible, present and urgent grievances before I enter thoroughly upon legislation for the future. I shall bear in mind the offer which you have made and in all probability avail myself of it to the full.

So, then, perhaps Miss Nightingale would not be left wholly friendless after all. She was to have new masters. Would they, or would they not, accept her service? We shall hear in due course.

V

Meanwhile Miss Nightingale had been very busily engaged with the correspondence and other tasks thrown upon her by the outbreak of war in Europe. "Saw Florence for half an hour this morning," reported her father (June); "over-fatigued certainly, but speaking with a voice only too loud and strong. Princess [Alice of] Hesse writes to her to ask for instructions for the hospitals there, and Sutherland's joke is 'There's nothing left for _you_, all is gone to Garibaldi.'" She had been applied to by representatives of all three combatants. Prussia, as usual, was the better prepared, and the Crown Princess had written to Miss Nightingale in March (three months before hostilities actually began) asking for her a.s.sistance and advice about hospital and nursing arrangements. A Prussian manufacturer communicated with her about the best form of hospital tents for field-service. The two sisters of the British Royal House were on opposite sides in this war, for Hesse-Darmstadt had thrown in its lot with Austria; but it was not till after the outbreak of hostilities that the Princess Alice wrote to Miss Nightingale through Lady Ely[72] for advice about war hospitals. Miss Nightingale at once sent it. Her Memorandum, she was told (July 3), had been forwarded to Prince Louis for use at Headquarters, and the Princess begged her to send further information for use by the hospital authorities in Darmstadt. The Italians had been earlier in "going to Miss Nightingale." The Secretary of the "Florence Committee for helping the Sick and Wounded" had written to her for advice in May. Her reply caused great delight, as an English correspondent at Florence recorded.

"I have read the letter," he wrote, "which will be translated and inserted in the _n.a.z.ione_. Miss Nightingale gives, with her accustomed clearness and precision, excellent advice to the Committee, which some of them very much need. At the same time she expresses her cordial sympathy with the Italian cause. She recalls the admirable condition in which the Sardinian army was landed in the Crimea, and the praise which its appearance extorted from Lord Clyde. And she concludes her letter by saying that if the sacrifice of her poor life would hasten their cause by one half-hour, she would gladly give it them. But she is a miserable invalid."[73] The Committee had asked whether she would not come to Italy "were it but for one day" in order to inspire them by her presence. Her piece of "froth" (as she called it) was widely printed in the Italian press. She had deplored the outbreak of the war, but when it resulted in an extension of the boundaries of free Italy she felt that there were compensations. Miss Nightingale also joined the Committee of the "Ladies' a.s.sociation" formed in this country "for the Relief of the Sick and Wounded of all nations engaged." She advised the Committee on the form of aid most requisite, and at the end of the war, in thanking the Crown Princess of Prussia for a letter, she gave Her Royal Highness an account of what had been done by the English Committee. The correspondence with the Princess was long, and it formed a new tie between Miss Nightingale and Mr. Jowett, who was a great favourite with the Crown Princess and who entertained a very high opinion of her abilities. The answering letter from the Princess covers eighteen pages, containing (as Dr. Sutherland said of it) "just the kind of practical information which a person who has had experience in these matters desires to obtain." A characteristic extract or two from the correspondence on each side must here suffice:--

(_Miss Nightingale to the Crown Princess of Prussia._) 35 SOUTH STREET, _Sept._ 22 [1866].... I think your Royal Highness may be pleased to hear even the humble opinion of an old campaigner like myself about how well the Army Hospital Service was managed in the late terrible war. Information reached me through my old friends and trainers of Kaiserswerth. The Knights of St. John of Jerusalem took charge of all the Deaconesses and all the offers of houses and rooms made to them. The system seems to me to have been admirably managed--especially the sending away the wounded in hundreds to towns where rooms and houses and nursing were offered. The overcrowding and ma.s.sing together of large numbers of wounded is always more disastrous than battle itself. From many different quarters I have heard of the great devotion, skill and generous kindness of the Prussian surgeons--to all sides alike.... On this, the day of Manin's death nine years ago, the exiled Dictator of Venice and one of the purest and most far-seeing of statesmen, who fought so good a battle for the freedom of Venice, but who did not live to see its accomplishment, I cannot but congratulate your Royal Highness, at the risk of impertinence, at seeing the fulfilment of that liberation brought about by Prussian arms.

[72] Lady Ely as lady-in-waiting on Queen Victoria had made Miss Nightingale's acquaintance at Balmoral in 1856.

[73] _Daily Telegraph_ (foreign intelligence), June 12, 1866.

(_The Crown Princess of Prussia to Miss Nightingale._) NEW PALACE, POTSDAM, _Sept._ 29. I was delighted to receive your long and interesting letter yesterday, and hasten to express my warmest thanks for it. Every appreciation of Prussia in England can but give me the greatest pleasure.... As you are such an advocate for fresh air, I cannot refrain from telling you what I have myself _seen_ in confirmation of your opinion on the subject, and what I am sure would interest dear Sir James Clark, who is your great ally on this point.

In a small well-kept Hospital, where wounded soldiers had been taken care of for some time, the wounds in several cases did not seem to improve, the general state of health of the patients did not show any progress. They were feverish, and the appearance of the wounds was that of the beginning of mortification. In the garden of the Hospital there was a shed or summer-house of rough boards, with a wooden roof; the little building was quite open in front and on the other sides closed up with boards but with an aperture of two feet all the way under the roof--so that it was like being out of doors.

Six patients were moved down into this shed (sorely against their will, they were afraid of catching cold). The very next day they got better; the fever left them, the condition of the wounds became healthy; they enjoyed their summer-house--in spite of two violent storms which knocked down the tables; and all quickly recovered! I had seen them every day upstairs and saw them every day in the garden; the difference was incredible.... The Crown Prince wishes me to say what pleasure it gives him to hear you speak in praise of our Prussian army surgeons.... I remain ever, dear Miss Nightingale, yours sincerely, PRINCESS ROYAL.

Among other details, a particular kind of field-ambulance was mentioned by the Crown Princess as having proved very useful. Miss Nightingale at once put Dr. Longmore, of our own hospital service, in possession of the facts.

It will have been seen that Miss Nightingale's experience was much requisitioned in the War of 1866; but the organization of war-nursing under the Red Cross had not then attained full development owing to the fact that the Austrian Government had not ratified the Geneva Convention of 1864. In 1867 a gold medal was awarded to Miss Nightingale by the Conference of Red Cross Societies at Paris. In 1870 (March 31) the Austrian Patriotic Society for the Relief of Wounded Soldiers elected her an Honorary Member.

VI

The year 1866 was, then, one of great activity with Miss Nightingale; but by the middle of August her work was not at such high pressure as in the preceding months. Parliament was up, and the new Ministers, with whom she had established friendly relations, were turning round. At this time a home call came to Miss Nightingale. Her mother was reported to be ailing. She was disinclined to make the usual move with her husband from Hampshire to Derbyshire; so, while the father went to Lea Hurst, Miss Nightingale decided to stay with her mother at Embley. It was an event in the family circle, for Florence had not been to either of the homes for ten years. There was much correspondence and many preparations.

Father and mother were equally delighted, and the journey in an invalid carriage did the daughter no serious harm. She stayed at Embley from the middle of August till the end of November. It was the first holiday she had taken, for ten years also; but it was not much of a holiday either.

She set to work on the health of Romsey, the nearest town, and of Winchester, the county town. She wrote up to her friend Dr. Farr at the Registrar-General's Office for the mortality tables, found the figures for those towns above the average, and bade the citizens look to their drains. Then she commanded Dr. Sutherland to Embley for the transaction of business in view of next year's session. She found her mother happy and cheerful. "I don't think my dear mother was ever more touching or interesting to me," she wrote to Madame Mohl (Aug. 21), "than she is now in her state of dilapidation. She is so much gentler, calmer, more thoughtful." She was a little critical, however, of her mother still, and thought her habits self-indulgent. Poor lady! she was 78; she had been shaken and bruised in a carriage accident, and was threatened with the loss of her eye-sight. Certainly, Florence was not always able to make due allowances for other people. But if she was critical of others, she was yet more severe with herself. During this holiday at Embley, she resumed those written self-examinations and meditations for which, frequent in her earlier years, she seems to have found little time during the strenuous decade 1856-66. "I never failed in energy," she said once in later years; "but to do everything from the best motive--that is quite another thing." In reviewing her past life on October 21, 1866, the anniversary of her departure for the Crimea, and on subsequent days, she seems to have had a like thought. Her meditations were not so much of what she had done as of what she had done amiss; her resolutions were of greater purity of motive, and greater peace, through a more entire trust in G.o.d: "Called to be the 'handmaid of the Lord,' and I have complained of my suffering life! What return does G.o.d expect from me--with what _purity of heart_ and _intention_ should I make an offering of myself to Him! The word of the Lord unto thee: He was oppressed and he was afflicted, yet he opened not his mouth.... But, when we are ill, how can we be like G.o.d? I look up and see the drops of dew, blue, golden, green, and red, glittering in the sun on the top of the deciduous cypress--_that_ is like G.o.d. We see Him for a moment--we perceive His beauty. It lights us, even when we lie here prostrate.... Blessed are the pure in heart: for they shall see G.o.d--in all temptation, trials, and aridities, in the agony and b.l.o.o.d.y sweat, in the Cross and Pa.s.sion: this is not the prerogative of the future life, but of the present."

PART VI

MANY THREADS

(1867-1872)

I beg of you and pray you to look back upon the past with thankfulness and upon the future with hope--when there has been so much done and there is so much to do ... many beginnings and ravelled threads to be woven in and completed.--BENJAMIN JOWETT (_Letter to Miss Nightingale_, 1867).

CHAPTER I

WORKHOUSE REFORM

(1864-1867)

From the first I had a sort of fixed faith that Florence Nightingale could do anything, and that faith is still fresh in me; and so it came to pa.s.s that the instant that name entered the lists I felt the fight was virtually won, and I feel this still.-- H. B. FARNELL, Poor Law Inspector (Dec. 1866).

Fifty years ago the state of things which Miss Nightingale had seen, and cured, in the military hospitals during the Crimean War was almost equalled, and was in some respects surpa.s.sed in scandal, by the condition of the peace hospitals for the sick poor at home. Those hospitals were the sick wards or infirmaries of workhouses, for the hospitals usually so-called skim only the surface of sickness in any great town. The state of the Metropolitan workhouses, as reported upon by the Poor Law Board in 1866, showed that the sick wards were for the most part insanitary and overcrowded; that the beds were insufficient and admirably contrived to induce sores; that the eating and drinking vessels were unclean; that there was a deficiency of basins, towels, brushes and combs; that the food for the patients was cooked by paupers and frequently served cold; that although the medical officers did their duty to the best of their ability, the attendance given and the salaries paid were inadequate to the needs of the sick. As for the nursing, it was done by paupers, many of whom could neither read nor write, whose love of drink often drove them to rob the sick of stimulants, and whose treatment of the poor was characterized neither by judgment nor by gentleness. This is the restrained euphemism of an official report.[74]

Sometimes a patient would miss the ministration of a nurse for days because the pauper charged to give it was herself bed-ridden. The rule of one nurse was to give medicine three times a day to the very ill and once to the rather ill. It was administered in a gallipot; the nurse "poured out the medicine and judged according." Cases were reported in which a patient's bed was not made for five days and nights; in which patients had no food from 4 o'clock in the afternoon of one day to 8 o'clock in the morning of the next; in which patients died, or, to speak more correctly, were killed, by the most wanton neglect.

[74] Mr. Farnall's Report, 1866, summarized in the Majority Report of the Poor Law Commission, 1909, p. 239. The statements which follow above are from _An Account of the Condition of the Infirmaries of London Workhouses, Printed for the a.s.sociation for the Improvement of Infirmaries_, 1866.

The dawn of a better day came with the pa.s.sing of the Metropolitan Poor Act of 1867, an Act which figures in histories of the Poor Law in this country as "the starting-point of the modern development of Poor Law medical relief." Many persons contributed to this reform. In the case of London, a "Commission," inst.i.tuted by the _Lancet_, under Mr. Ernest Hart, which afterwards developed into the "a.s.sociation for the Improvement of the Infirmaries of London Workhouses," should especially be mentioned. But the person who inspired the proper nursing of the sick poor, and who, behind the scenes, was a prime mover in the legislation of 1867, was Florence Nightingale.

II

The reform began in Liverpool, and the initiative was due to a philanthropist of that city, Mr. William Rathbone. He used to speak of Miss Nightingale as his "beloved Chief"; and she, when he died, sent a wreath inscribed "In remembrance and humblest love of one of G.o.d's best and greatest sons." His voluminous correspondence with her began in 1861 when he was desirous of introducing a system of District Nursing among the poor of Liverpool. There were no trained nurses anywhere to be had, and he consulted Miss Nightingale. She suggested to him that Liverpool had better train nurses for itself in its own princ.i.p.al hospital, the Royal Infirmary. Mr. Rathbone took up the idea, and built a Training School and Home for Nurses. This inst.i.tution provided nurses both for the Royal Infirmary and for poor patients in their own homes. Miss Nightingale gave to all Mr. Rathbone's plans as close and constant consideration "as if she were going to be herself the matron."[75] The scheme was started in 1862, and it proved so great a success that Mr. Rathbone was encouraged to attempt an extension of his benevolent enterprise. The Workhouse Infirmary at Liverpool was believed to be better than most places of its kind; but there, as elsewhere, the nursing--if so it could be called--was done by able-bodied pauper women.

Able-bodied women who enter workhouses are never among the mentally and morally efficient; and in a seaport like Liverpool they were of an especially low and vicious kind. The work of the nurses, selected from this unpromising material, "was superintended by a very small number of paid but untrained parish officers, who were in the habit, it was said, of wearing kid gloves in the wards to protect their hands. All night a policeman patrolled some of the wards to keep order, while others, in which the inmates were too sick or infirm to make disturbance, were locked up and left unvisited all night."[76] On Jan. 31, 1864, Mr.

Rathbone wrote to Miss Nightingale, propounding a plan for introducing a staff of trained nurses and promising to guarantee the cost for a term of years if she would help with counsel and by finding a suitable Lady Superintendent. He asked for two letters--"one for influence," to be shown to the Vestry, the other for his private advice.[77] She and Dr.

Sutherland drew up the required doc.u.ments; she arranged that twelve "Nightingale Nurses" should be sent from St. Thomas's Hospital; and she selected a Lady Superintendent--a choice on which, as both she and Mr. Rathbone felt, everything would depend. The Vestry agreed in May to accept Mr. Rathbone's scheme, but many months pa.s.sed before it was actually launched. "There has been as much diplomacy," wrote Miss Nightingale to the Mother of the Bermondsey Convent (Sept. 3, 1864), "and as many treaties, and as much of people working against each other, as if we had been going to occupy a kingdom instead of a Workhouse." The correspondence forms one of the bulkiest bundles among Miss Nightingale's Papers.

[75] Rathbone's _Organization of Nursing in a Large Town_, p. 30.

[76] _William Rathbone: a Memoir_, p. 166.

[77] The public letter (Feb. 5, 1864) is printed in Mr. Rathbone's _Workhouse Nursing: The Story of a Successful Experiment_ (Macmillan, 1867).

The Lady Superintendent--the pioneer of workhouse nursing--was Miss Agnes Jones, an Irish girl, daughter of Colonel Jones, of Fahan, Londonderry, and niece of Sir John Lawrence. She was attractive and rich, young and witty, but intensely religious and devoted to her work.[78] "Ideal in her beauty," Miss Nightingale said of her;[79] "like a Louis XIV. shepherdess." She was one of the many girls who had been thrilled by Miss Nightingale's volunteering for the Crimea. "Perhaps it is well," she wrote, when entering St. Thomas's Hospital, "that I shall bear the name of a 'Nightingale Probationer,' for that honoured name is a.s.sociated with my first thought of hospital life. In the winter of 1854, when I had those first longings for work and had for months so little to satisfy them, how I wished I were competent to join the Nightingale band when they started for the Crimea! I listened to the animadversions of many, but I almost worshipped her who braved them all." In 1860 Miss Jones followed in her heroine's steps to Kaiserswerth. In 1862 she introduced herself to Miss Nightingale, who advised her to complete her apprenticeship by a year's training at St.

Thomas's. "Hitherto," the Matron reported to Miss Nightingale (Feb. 25, 1863), "I have had no lady probationer equal on all points to Miss Jones." After completing her year's training at St. Thomas's she took service as a nurse in the Great Northern Hospital, and she was there when the invitation came to Liverpool. Miss Jones was at first diffident, but after an interview with Miss Nightingale "the conviction was borne in upon her," as she wrote, that it was G.o.d's call and therefore must be obeyed in trust and with good hope.

[78] See "Una and the Lion," in _Good Words_, June 1868 (Bibliography A, No. 51).