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 assistant 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 “passed 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 classes 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 institution 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.”

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 pronounced 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 institutions 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 pronounced 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 aprons 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 gratitude 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.

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 institution, 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 institution 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 are sure 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 passed 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 class. From year to year the other hospitals were assisted 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 institutions. 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.

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 anticipation 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 institution 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 passed 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 pass, 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.

In a previous chapter I have traced the development of Miss Nightingale's religious views during her earlier years, and have shown how they broadened out into a tolerance which took more account of deeds than of creeds. But, as was there said, she was interested in creeds also.[348] Her nature was profoundly religious, and she had a mind as apt for speculative as for practical thought. Her critical spirit had detected weak places, as she deemed them, in the creed alike of Protestants and of Catholics. The precise and practical bent of her mind could not be satisfied until she had found for the feelings of her heart some more logical basis. She was thus driven forward to that reconstruction of her religious creed, to which passing reference has already been made. At the beginning of her diary for 1853, on a page placed opposite January for “Memoranda from 1852,” there is this entry: “The last day of the old year. I am so glad this year is over. Nevertheless it has not been wasted, I trust. I have remodelled my whole religious belief from beginning to end. I have learnt to know God. I have recast my social belief; have them both written for use, when my hour is come.” This entry refers to the manuscripts called respectively “Religion” and “Novel” in a letter of 1852, already cited.[349] The manuscripts, after being read by one or two friends, remained for some years in Miss Nightingale's desk, though during that period of strenuous activity in the world of deeds the subject-matter, we may be sure, often occupied her thoughts. In 1858 and 1859 she took up the manuscripts again. The companionship of Arthur Hugh Clough, who at this time was much with her, was doubtless one of the causes which led to an active resumption of her theological speculations. She was rereading Mill's Logic and reading Edgar Quinet's Histoire de mes idées. Mr. Clough's notes of conversation with her show how much she was indebted in her speculations to Mill. “Quinet and J. S. Mill,” wrote Mr. Clough (March 2, 1859), “seemed, she said, the two men who had the true belief about God's laws. She referred in particular to two chapters in Mill's Logic about Free Will and Necessity, which seemed to her to be the beginning of the true religious belief. The excellence of God, she said, is that He is inexorable. If He were to be changed by people's praying, we should be at the mercy of who prayed to Him. It reminded her, she said, of what old James Martin said some years ago when she saw him—that he didn't like having dissenters praying—he liked to have the prayers all set down and arranged: he didn't know what people mightn't be praying, perhaps that the money might be taken out of his pocket and put into theirs.” She rewrote some of what had been written six or seven years before; and she added a great deal more. Towards the end of 1859 she began printing it. In the following year the whole was in type, and a very few copies were struck off. This book, entitled Suggestions for Thought, is in three volumes, comprising in all 829 large octavo pages. It was never published by her. It has with conspicuous merits equally conspicuous defects. The merits are of the substance; the defects are of form and arrangement; but Miss Nightingale never found time or strength or inclination—I know not which or how many of the three were wanting—to remove the defects by recasting the book. Unpublished, therefore, it is likely, I suppose, to remain. But as it stands it is a remarkable work. No one, indeed, could read it without being impressed by the powerful mind, the spiritual force, and (with some qualifications) the literary ability of the writer. If she had not during her more active years been absorbed in practical affairs, or if at a later time her energy or inclination had not been impaired by ill-health, Miss Nightingale might have attained a place among the philosophical writers of the nineteenth century.