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 institutions, 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 passion 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 “passionate statistician.” And the passion, as will appear in a later chapter,[316] was even a religious passion.
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 circumscribed 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 Muff.” 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 God 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 passionate 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 assembly 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.
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 sex 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 anæsthetics 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 passage, 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 Institute 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 institution 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 passionate 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 sex 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 circumstances 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.