The Life of Florence Nightingale, vol. 1 of 2

by Sir Edward Tyas Cook

It was obvious to Miss Nightingale that it would be impossible for her, in view of the state of her health, to found an entirely new Institution under her own superintendence. She saw that she must work through existing hospitals and the agency of other persons. It was this latter consideration that settled her choice of the place at which to found her Training School. She had naturally been besieged by suggestions from officials of this hospital and of that, of this charity and the other, each urging that his or hers was the one pre-eminently suited to benefactions from the Nightingale Fund. Her choice fell, for the main application of the Fund, upon St. Thomas's Hospital. The Resident Medical Officer, Mr. R. G. Whitfield, was sympathetic. The Hospital was large, rich, and well managed. But, above all, the Matron was a woman after Miss Nightingale's own heart, strong, devoted to her work, devoid of all self-seeking, full of decision and administrative ability. Of this remarkable woman, Mrs. Wardroper, who for twenty-seven years was superintendent of the Nightingale School, Miss Nightingale has left a character-sketch:—

I saw her first in October 1854, when the expedition of nurses was sent to the Crimean War. She had been then nine months matron of the great hospital in London, of which for 33 years she remained head and reformer of the nursing. Training was then unknown; the only nurse worthy of the name that could be given to that expedition, though several were supplied, was a “Sister” who had been pensioned some time before, and who proved invaluable.[341] I saw her next after the conclusion of the Crimean War. She had already made her mark; she had weeded out the inefficient, morally and technically; she had obtained better women as nurses; she had put her finger on some of the most flagrant blots, such as the night nursing, and where she laid her finger the blot was diminished as far as possible, but no training had yet been thought of.…

Her power of organization or administration, her courage, and discrimination in character, were alike remarkable. She was straight-forward, true, upright. She was decided. Her judgment of character came by intuition, at a flash, not the result of much weighing and consideration; yet she rarely made a mistake, and she would take the greatest pains in her written delineations of character required for record, writing them again and again in order to be perfectly just, not smart or clever, but they were in excellent language. She was free from self-consciousness; nothing artificial about her. She did nothing, and abstained from nothing, because she was being looked at. Her whole heart and mind, her whole life and strength were in the[459] work she had undertaken. She never went a-pleasuring, seldom into society. Yet she was one of the wittiest people one could hear on a summer's day, and had gone a great deal into society in her young unmarried life. She was left a widow at 42 with a young family. She had never had any training in hospital life, there was none to be had. Her force of character was extraordinary. Her word was law. For her thoughts, words and acts were all the same. She moved in one piece. She talked a great deal, but she never wasted herself in talking; she did what she said. Some people substitute words for acts: she never. She knew what she wanted, and she did it. She was a strict disciplinarian; very kind, often affectionate, rather than loving. She took such an intense interest in everything, even in things matrons do not generally consider their business, that she never tired. She had great taste and spent her own money for the hospital. She was a thorough gentlewoman, nothing mean or low about her; magnanimous and generous, rather than courteous. And all this was done quietly.… She had a hard life, but never proclaimed it. What she did was done silently.[342]

Every artist, it has been said, in painting the portrait of a sitter, paints also something of his own portrait. Miss Nightingale's vigorous character-sketch of her “dear Matron” is, I think, a case in point.

After much consultation with Mrs. Wardroper and Mr. Whitfield of St. Thomas's Hospital, and with Sir John McNeill and others outside, Miss Nightingale formulated a scheme. The Committee of her Council met the Governors of the Hospital, and an agreement was arrived at for the foundation of the Nightingale School. The basis of the agreement was that the Hospital was to provide facilities for the training, and the Nightingale Fund to pay the cost, including the payment of the nurses themselves. In May 1860, advertisements were inserted in the public press inviting candidates for admission, and on June 24 fifteen probationers were admitted for a year's training. Thus on a modest scale, but with a vast amount of forethought, was launched the scheme which was destined to found the modern art and practice of nursing.

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.