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.
II
In what precise respect, it may be asked, did Florence Nightingale “found” modern nursing? The answer to this question may, I think, be disentangled without much difficulty from a good deal of conflicting statement. I have referred already, in connection with the fettering scruples of Miss Nightingale's parents,[318] to a conflict of evidence upon the morals of hospitals and hospital nurses in the middle of the nineteenth century. Her own opinion at that time (and she did not express it without much inquiry and observation) is given in the pamphlet, above mentioned, where she says that hospitals were “a school, it may almost be said, for immorality and impropriety—inevitable where women of bad character are admitted as nurses, to become worse by their contact with male patients and young surgeons.… We see the nurses drinking, we see the neglect at night owing to their falling asleep.”[319] Such statements were indignantly denied by other authorities, equally well qualified to form a correct judgment. Controversy broke out upon the subject a few years later in connection with the Nightingale Memorial Fund. A correspondent of the Times, who signed himself “One who has walked a good many Hospitals,” gave in 1857[320] the same kind of account that Miss Nightingale had given in 1851. He was answered, and his statements were hotly denied.[321] Obviously there were hospitals and hospitals, and still more there were nurses and nurses, and no general indictment was just on the point of morals. Upon the question of drinking among nurses, both in hospitals and in private service, there is less room for doubt. Dickens was a caricaturist, but he was an effective caricaturist; and no caricature is effective in its day unless it bears considerable resemblance to the truth. In his preface he spoke of Mrs. Gamp as a fair representation, at the time Martin Chuzzlewit was published, of the hired attendant on the poor; and he might have added, says his biographer, that the rich were no better off, for the original of Mrs. Gamp “was in reality a person hired by a most distinguished friend of his own a lady, to take charge of an invalid very dear to her.”[322] This one can the more readily understand in the light of a remark by Lady Palmerston quoted above.[323] “‘Mrs. Gamp,’ said Mrs. Harris, ‘if ever there was a sober creetur to be got at eighteen pence a day for working people, and three and six for gentlefolks, you are that inwallable person.’” Great ladies clearly thought that such persons existed only, and could only be expected to exist, in the world of imagination and of Mrs. Harris. In 1854, Miss Mary Stanley, or a friend of hers, sent out a circular, very possibly with the knowledge of Miss Nightingale, to various persons connected with hospitals and infirmaries, of which the object was to suggest that nurses should be instructed, on the Kaiserswerth plan, in the art of administering religious comfort to patients. The replies which were subsequently printed[324] throw much light upon the position of nurses at the time. “If I can but obtain a sober set,” wrote a doctor in the North, “it is as much as I can hope for.” “I enquired for Dr. X.,” said another reply, “about the character of the nurses, and he says they always engage them without any character, as no respectable person would undertake so disagreeable an office. He says the duties they have to perform are most unpleasant, and that it is little wonder that many of them drink, as they require something to keep up the stimulus.” The ordinary wages were £14 to £16 a year. It should be remembered, further, that hospital nurses had, as a rule, in the middle of the last century no uniform dress, and cooked their own food (which they bought for themselves), eating their meals in the ward kitchens or scullery: “If the sister happened to be partial to red herrings for breakfast, or onion-stew for dinner, or toasted cheese for supper, the consequent state of the ward may be imagined. The assistant nurses had to do all the scrubbing and cleaning of the wards, and to cook for the other nurses and themselves.”[325] A side-light is thrown on the slovenliness of the arrangements by the account of what happened at King's College Hospital when the nursing was taken over in 1856 by trained nurses from St. John's House under Miss Mary Jones. “By the end of the day the new-comers, who had arrived in clean and dainty uniforms, were like a set of sweeps or char-women, in such an appalling state of disorder had they found their wards.”[326] There were some excellent nurses under the old régime (apart from those trained at St. John's House), as Sir James Paget testified[327]; though it may be noted that even amongst his model Sisters, one was “not seldom rather tipsy.” But “the greater part of them,” he says, “were rough, dull, unobservant, untaught.” The stoutest defender of the old system, the most stubborn opponent of Miss Nightingale's reforms, gives unconsciously equal support to Sir James Paget's statement that “in the department of nursing there is the greatest and happiest contrast of all.” Mr. South was of opinion that all was for the best, before Miss Nightingale began to interfere, in the best of all possible nursing worlds. But his conception of the ideal nurse is this: “As regards the nurses or ward-maids, these are in much the same position as housemaids, and require little teaching beyond that of poultice-making.”[328]
From all this, facts emerge which will clearly explain wherein Miss Nightingale's work as the founder of modern nursing consisted. She was not entirely alone, nor was she in point of time the first, in the field; and there were exceptional cases to which the following statements do not apply. But she was able to do on a larger scale, and on a scale and in a form which attracted general imitation, what others had attempted. And speaking generally, we may say that before Miss Nightingale appeared on the scene, nursing was, and was regarded as, a menial occupation which did not attract women of character; that it was ill-paid and little respected; that no high standard of efficiency was expected; and that no training was organized: the women picked up their knowledge in the wards. They were, as the correspondent of the Times said, “meek, pious, saucy, careless, drunken, or unchaste, according to circumstances or temperament, mostly attentive, and rarely unkind”; but, with very few exceptions, they were untrained. “A poor woman is left a widow with two or three children. What is she to do? She would starve on needlework; she is unfit for domestic service; she knows nobody to give her charring, and has no money to buy a mangle. So she gets a recommendation from a clergyman, and is engaged as a Hospital Nurse.” The change which has come about since Miss Nightingale's work took effect is strikingly illustrated in the Census. In 1861 there were 27,618 nurses “in hospitals, or nurses not apparently domestic servants,” and they were enumerated, in the tables of Occupations of the People, under the head of “Domestic.” In 1901 there were 64,214 nurses, and they were enumerated under the head of “Medicine.” Miss Nightingale was the founder of modern nursing because she made public opinion perceive, and act upon the perception, that nursing was an art, and must be raised to the status of a trained profession. That was the essence of the matter. Other things, such as the opening of nursing to higher social strata, the better payment of nurses, etc., though important and interesting, were only results.
III
The means by which Miss Nightingale achieved this great work were three. She brought to bear upon it the force, successively, of her Example, her Precept, and her Practice. The first two of these aspects of her work will be considered in the remainder of the present chapter; the third is the subject of the next chapter.