1. The grounds on which the Vestry were led to undertake the experiment, as stated in the preliminary report of Mr. Carr, the governor, and that of the sub-committee of the Vestry appointed to consider the proposed scheme; and the replies received to inquiries addressed by them to institutions and persons connected with the training and employment of skilled nurses in London and Liverpool, with letters on the subject from Miss Nightingale and Sir John McNeill.
2. The results of the experiment, so far as hitherto ascertained.
The Liverpool Vestry had previously made considerable efforts to improve the workhouse infirmaries. The medical men had been encouraged to make requisition for every material appliance that could facilitate the cure of the sick; and paid female officers were appointed at the rate of one to each 150 or 200 beds, to superintend the giving of medicines and stimulants, and so forth: but of course so small a number, even had they been trained nurses, could do no real nursing, and could exercise little supervision over the twenty drunken or unreliable[1] pauper nurses who were under the nominal direction of each paid officer. An appeal was made to the Vestry to consummate the good work they had thus partially commenced, and it was urged that Liverpool should assume the lead in the task of workhouse reform. The following considerations were submitted to the Select Vestry:—
“That Liverpool could commence this movement with great effect, and with the certainty that her example would be widely followed.
“That she had in times past taken a leading part in such reform. The introduction of the New Poor Law produced little change in Liverpool; so many of its wisest provisions were already in operation there, some of them for twenty or thirty years.
“That she had already established a system of attention to the sick poor in their own houses, which, if only by restoring heads of families to health and work, saved the parish many times the sum that it cost to private benevolence.
“That, lastly and especially, the proposed reform ought to commence in Liverpool, because in her workhouse the guardians had already, by their liberality, provided the sick with everything in the shape of diet and medical comforts that could conduce to recovery; and what was now wanting to give effect to their wise benevolence was, that their system should be administered and their intentions carried out by efficient and reliable nurses, in the stead of unreliable paupers.”
The appeal further urged that—
“Successful efforts have been made in many directions to improve the nursing of the sick, and the workhouses must soon be the object of similar endeavours. Those poor sufferers whose disease is protracted and hopeless are refused admission into ordinary hospitals, and must come to the workhouse; and the mere duration of the illness is in such cases sufficient to reduce to poverty the most industrious, careful, and temperate—men who, while they could work, paid regularly their contribution to the poor-rate. Surely, these are entitled to at least as great care as that which sickness at once assures to the imprisoned felon, however criminal, for whom well-paid nurses are provided by the State.
“As to the other class of inmates of the workhouse infirmary—those whose ailments are curable—mere economy requires that the most efficient means should be taken to cure them as speedily as possible, so as to preserve them and their families from becoming paupers.
“Thus justice and expediency alike counsel the introduction into the workhouse of the best known system of nursing. Probably nothing which the skill and kindness of medical men can do, no food or physical appliances which the guardians can supply, no oversight or care which they, acting through pauper nurses, can bring to bear, are wanting in the Liverpool workhouse; but it is to be feared that much of this care, liberality, and thought fails of its object for want of a sufficient number of reliable and duly qualified nurses to carry out the instructions given, to administer food and medicine to the patients, to dress their wounds, and so forth.”
This appeal was supported by two letters of Miss Nightingale and Sir John McNeill, G.C.B., President of the Board of Supervision (the Scotch Poor Law Board).
Letter from Miss Nightingale.
115, Park Street, W.
February 5, 1864.My dear Sir,
I will not delay another day expressing how much I admire, and how deeply I sympathize with the Workhouse plan.
First let me say that Workhouse sick and Workhouse Infirmaries require quite as much care as (I had almost said more than) Hospital sick. There is an even greater work to be accomplished in Workhouse Infirmaries than in Hospitals.
In days long ago, when I visited in one of the largest London Workhouse Infirmaries, I became fully convinced of this.
How gladly would I have become the Matron of a Workhouse.
But of a Visitor’s visit, the only result is to break the Visitor’s heart. She sees how much could be done and cannot do it.
Liverpool is of all places the one to try this great Reform in. Its example is sure to be followed. It has an admirable body of Guardians; it is a thorough practical people; it has, or soon will have again, money.
Lord Russell once said (what is quite true), that the Poor Law was never meant to supersede private charity.
But whatever may be the difficulties about Pauperism, in two things most people agree—viz. that Workhouse sick ought to have the best practical nursing, as well as Hospital sick—and that a good wise Matron may save many of these from life-long pauperism, by first nursing them well, and then rousing them to exertion, and helping them to employment.
In such a scheme as is wisely proposed, there would be four elements.
1. The Guardians, one of whose functions is to check pauperism. They could not be expected to incur greater cost than at present, unless it is proved that it cures or saves life.
2. The Visiting or Managing Committee of the Guardians, whose authority must not (and need not) in any way be interfered with.
3. The Governor, the Medical Officer, and Chaplain.
4. (And under the Governor) the proposed Superintendent of Nurses and her nursing staff.
There is no reason why all these parts of the machine should not work together.
The funds are provided to pay the extra nursing for a time.
The difficulty is to find the Lady to govern it.
When appointed, she must be authorized—indeed appointed—by the Guardians. She must be their Officer; and must be invested by the Governor with authority to superintend her Nurses in conformity with regulations to be agreed upon.
So far, I see no more difficulty than there was in settling our relations as Nurses to the government officials in the Crimean War.
The cases are somewhat similar.
As to the funds, it is just possible that eventually the Guardians might take all the cost on themselves, as soon as they saw the great advantages and economy of good nursing.
If Liverpool succeeds, the system is quite sure to extend itself.
The Fever Hospital is one of the Workhouse Infirmaries. That is the place to shew what skilful nursing can do. The patients are not all paupers. How many families might be rescued from pauperism by saving the lives of their heads, and by helping the hard-working to more speedy convalescence!
Hopefully yours,
(Signed) FLORENCE NIGHTINGALE.