The endeavour to limit the admissions to serious cases would of course affect the returns, both as regards the time taken in curing, and the proportion of deaths. Even had there been no exceptional disturbing element, there is a defect in the statistics of workhouse hospitals which affects all inferences from them, in the absence of any careful classified list of cases kept by the medical officers, such as might fairly enable one to form a judgment from mere statistical tables. These, then, are not reliable as means of judgment, unless extending over a long period. The character of seasons, and nature of cases admitted, varies so much from year to year as to invalidate any deductions, unless founded on complete and minutely kept medical records. The following extracts, however, from the reports of the Governor, and the surgical and medical officers of the Workhouse, bear decisive witness to the value of the “new system,” especially as contrasted with the “old system,” which in 1865-66 still prevailed in the female wards. All these reports bear emphatic testimony to the merits and devotion of the Lady Superintendent and her staff. The medical men, it is noteworthy, speak strongly of the better discipline and far greater obedience to their orders observable where the trained nurses are employed—a point the more important because it is that on which, before experience has reassured them, medical and other authorities have often been most doubtful.
From the Report of the Governor.
Thursday, May 10, 1866.
The main feature in the new system of nursing consists in the superseding of pauper nurses, and appointing in their places competent trained nurses from the Nightingale School. These latter to have the assistance of “probationary nurses,” or in other words, women of intelligence and of good character desirous of entering upon the duties of nursing the sick as a profession. A third class was also created, designated “Assistants.” These were selected from the old pauper nurses, and it was decided that they should be paid, clothed, and receive rations equal in quality and quantity to those issued to the officers of the workhouse. The nurses, probationers, and assistants were placed under the control of a “Lady Superintendent,” who was empowered to employ them in the manner to her seeming best for the proper care of the sick.
The Committee will be prepared to hear that the change was immediately followed by the most marked improvement in every respect. The most casual observer could not avoid perceiving it. This applies not only to the state of the wards, the care of the sick, but is particularly observable in the demeanour of the patients, upon whom the humanizing influences of a body of women of character, devotedly discharging their duties, has produced evident fruits.
The question has often been asked whether the “new system is likely to succeed?” The “old system” meant nothing more than this, that old, ignorant, and unreliable pauper women, many of whom were of doubtful character, were entrusted with the discharge, without pay, of responsible duties. These have been displaced, and active, intelligent, reliable women, trained and skilled as nurses, with good characters and pay, have been appointed to supersede them. It would be a great discredit if these latter did not discharge their duties incomparably better than the former could do. That they do so I am happy to be in a position to testify.
In the opening paragraph of this report it is stated that “assistant nurses” were appointed and placed upon pay from the ranks of the paupers. This I was always opposed to. Their employment has resulted in complete failure, as the following figures will prove. The total number appointed to this date is 141. Of these sixty-seven have been dismissed through drunkenness and other misconduct, and sixteen have resigned; while it is positively true that there is not one of the whole number to whom I could entrust the duties of serving out wine or other stimulants, or, in fact, any duty requiring the exercise of integrity.
The experience of the past year renders it certain that the Poor Law, as now existing, offers no impediments to the successful working out of the most complete scheme for the efficient nursing of the sick, in the manner advocated by the best friends of hospital nursing.
(Signed) GEO. CARR.
From the Report of Robert Gee, Esq. M.D. Physician to the Workhouse Hospital.
5, Abercromby Square, Liverpool,
May 10, 1866.Sir,
In the medical wards of a general hospital the cases vary so much in nature and degree from year to year, as to render it impossible to give a reliable statistical comparison of the value of a paid as distinguished from an unpaid staff of nurses. I am, therefore, necessarily compelled to report in general terms on the nursing of the last ten months in the male medical wards; premising that what I say in approbation of the new system, and the new staff of nurses must not be construed as an unfavourable reflection on the whole of the previous staff. The paid superintending nurses of departments, and a few of the unpaid pauper nurses, deserve great credit for their conduct, though their qualifications for the service were decidedly inferior to those of the trained “Nightingale” staff.
With regard to the latter I can cordially bear testimony to their ability, and to their unwearied and uniformly kind attention to the patients under their charge. As to their nursing in its specific sense, I may state my belief that in every case my directions and those of the House Surgeons have been rigidly carried out. The medicines, stimulants, &c. &c. have been carefully administered, and the other numerous but less agreeable duties have been faithfully and efficiently attended to. Under their charge I have perceived a marked improvement in the demeanour of the patients—in fact, the discipline of the wards is completely changed. There has been no disorder or irregularity, but a sense of comfort, order, and quiet pervades the whole department. I believe further, that every patient leaving the wards has been more or less morally elevated during his location there.
From the Report of J. H. Barnes, Esq., Surgeon.
March 21, 1866.
Since my connexion with the hospital last August we have had somewhat approaching a hundred operations, many of them of a serious and dangerous character, requiring not only prompt assistance at the time, but most persevering attention night and day for a long time after. Almost all these operations have been in the male hospital, and I have no hesitation in saying that what success has attended them has been greatly owing to the most efficient assistance rendered by the trained nurses; and from my experience of the assistance received from the pauper nurses, in the few cases of operation performed in the female hospital, I should feel great diffidence in undertaking on that side such operations as I have had on the other side: indeed on one or two occasions the pauper nurses ran away, and when induced to assist were so nervous and frightened as to be of little service.
Without any wish to speak harshly of the unpaid nurses employed on the female side of the hospital (who, I believe, strive to do their best, more especially since a feeling of emulation has been set up by the introduction of the paid trained nurses, of whom they are jealous), I am compelled to state my conviction that on that side my directions are not carried out with that necessary promptitude and skill that they are on the other side, and that in all I do there I feel as if I were working with blunted instruments. There is no want of inclination, but simply a want of ability. That integrity of disposition, promptitude of action, tact in manipulation, gentleness of demeanour and kindly consideration necessary to make a nurse are not found, or to be found in the inmates of a workhouse, and no amount of education can work out of them what never was in them. Almost always obtuse, and too often unprincipled, as a class they are thoroughly unreliable, and quite unfitted to take charge of the sick and helpless, or the stimulants necessary for them. On this last point I have been informed by a former resident surgeon that he has known the pauper nurses appropriate the patient’s stimulants, or withhold giving to a dying patient that ordered for him, that they might take it themselves after his death. It is difficult to bring home and prove these things, and I do not wish to say they now occur, but if we wish to put such conduct out of the region of possibility it can only be done by the employment of persons superior to the temptation so to act.
Persons of one class, as a rule, favour their own class, and there is a far better chance of double-dealers being detected when under the observation and care of a trained nurse, than when under the care of one of themselves. That such is the case my own experience testifies.
As far, therefore, as my experience extends of the system of trained nurses, whether regarding the saving of life, the restoration to health, or the relief of the suffering, it has been an undoubted success.
These reports were duly considered by the authorities; and after some discussion, it was resolved entirely to discontinue, in the male hospital ward, the employment of paupers as assistant nurses, and to substitute an additional number of probationers. A Sub-Committee of the Workhouse Committee was appointed to superintend and report upon the working of the system. These gentlemen devoted much time and attention to the subject, and at the close of the year undertook a minute inquiry into the operation of the old and new systems; examining personally the various officers of the Workhouse, from the Governor down to the pauper nurses in the female wards. Increased experience brought out in a yet stronger light the superior advantages of the employment of trained nurses. The very able, clear, and conclusive report of the Sub-Committee leaves little more to be said on the subject. It determined the Vestry to adopt the system in permanence, and to extend it to the whole of the Workhouse Infirmary, a year before the period fixed for the trial of the experiment had expired. It will be seen that the report of the second year’s experience has a peculiar value, as bearing on the question whether, or how far, women may be competent to undertake one of the most delicate and difficult kinds of feminine work—one requiring special knowledge as well as special habits of punctual regularity, obedience, and thoughtfulness—without receiving any special training or education for such a duty. If the reforms about to be introduced into the pauper hospitals in London and elsewhere are not to end in failure and disappointment, provision must be made for training the nurses to be employed there, either before they enter the hospitals or within them.
The report of the Sub-Committee of Superintendence is as follows:—