The reform began in Liverpool, and the initiative was due to a philanthropist of that city, Mr. William Rathbone. He used to speak of Miss Nightingale as his “beloved Chief”; and she, when he died, sent a wreath inscribed “In remembrance and humblest love of one of God's best and greatest sons.” His voluminous correspondence with her began in 1861 when he was desirous of introducing a system of District Nursing among the poor of Liverpool. There were no trained nurses anywhere to be had, and he consulted Miss Nightingale. She suggested to him that Liverpool had better train nurses for itself in its own principal hospital, the Royal Infirmary. Mr. Rathbone took up the idea, and built a Training School and Home for Nurses. This institution provided nurses both for the Royal Infirmary and for poor patients in their own homes. Miss Nightingale gave to all Mr. Rathbone's plans as close and constant consideration “as if she were going to be herself the matron.”[75] The scheme was started in 1862, and it proved so great a success that Mr. Rathbone was encouraged to attempt an extension of his benevolent enterprise. The Workhouse Infirmary at Liverpool was believed to be better than most places of its kind; but there, as elsewhere, the nursing—if so it could be called—was done by able-bodied pauper women. Able-bodied women who enter workhouses are never among the mentally and morally efficient; and in a seaport like Liverpool they were of an especially low and vicious kind. The work of the nurses, selected from this unpromising material, “was superintended by a very small number of paid but untrained parish officers, who were in the habit, it was said, of wearing kid gloves in the wards to protect their hands. All night a policeman patrolled some of the wards to keep order, while others, in which the inmates were too sick or infirm to make disturbance, were locked up and left unvisited all night.”[76] On Jan. 31, 1864, Mr. Rathbone wrote to Miss Nightingale, propounding a plan for introducing a staff of trained nurses and promising to guarantee the cost for a term of years if she would help with counsel and by finding a suitable Lady Superintendent. He asked for two letters—“one for influence,” to be shown to the Vestry, the other for his private advice.[77] She and Dr. Sutherland drew up the required documents; she arranged that twelve “Nightingale Nurses” should be sent from St. Thomas's Hospital; and she selected a Lady Superintendent—a choice on which, as both she and Mr. Rathbone felt, everything would depend. The Vestry agreed in May to accept Mr. Rathbone's scheme, but many months passed before it was actually launched. “There has been as much diplomacy,” wrote Miss Nightingale to the Mother of the Bermondsey Convent (Sept. 3, 1864), “and as many treaties, and as much of people working against each other, as if we had been going to occupy a kingdom instead of a Workhouse.” The correspondence forms one of the bulkiest bundles among Miss Nightingale's Papers.
The Lady Superintendent—the pioneer of workhouse nursing—was Miss Agnes Jones, an Irish girl, daughter of Colonel Jones, of Fahan, Londonderry, and niece of Sir John Lawrence. She was attractive and rich, young and witty, but intensely religious and devoted to her work.[78] “Ideal in her beauty,” Miss Nightingale said of her;[79] “like a Louis XIV. shepherdess.” She was one of the many girls who had been thrilled by Miss Nightingale's volunteering for the Crimea. “Perhaps it is well,” she wrote, when entering St. Thomas's Hospital, “that I shall bear the name of a ‘Nightingale Probationer,’ for that honoured name is associated with my first thought of hospital life. In the winter of 1854, when I had those first longings for work and had for months so little to satisfy them, how I wished I were competent to join the Nightingale band when they started for the Crimea! I listened to the animadversions of many, but I almost worshipped her who braved them all.” In 1860 Miss Jones followed in her heroine's steps to Kaiserswerth. In 1862 she introduced herself to Miss Nightingale, who advised her to complete her apprenticeship by a year's training at St. Thomas's. “Hitherto,” the Matron reported to Miss Nightingale (Feb. 25, 1863), “I have had no lady probationer equal on all points to Miss Jones.” After completing her year's training at St. Thomas's she took service as a nurse in the Great Northern Hospital, and she was there when the invitation came to Liverpool. Miss Jones was at first diffident, but after an interview with Miss Nightingale “the conviction was borne in upon her,” as she wrote, that it was God's call and therefore must be obeyed in trust and with good hope.
In the history of modern nursing in this country the Sixteenth of May 1865 is a date only less memorable than the Twenty-fourth of June 1860. On the earlier day the Nightingale Training School was opened at St. Thomas's; on the latter twelve trained Nightingale nurses began work in the Liverpool Infirmary, and the reform of workhouse nursing was therein inaugurated. Miss Jones herself had arrived a few weeks earlier. Mr. Rathbone felt the importance of the occasion, and marked it by a pretty attention to Miss Nightingale. “I beg,” he wrote (May 12, Miss Nightingale's birthday), “to be allowed to constitute myself your gardener to the extent of doing what I have long wished—providing a flower-stand for your room and keeping it supplied with plants. I hope you will not be offended with my presumption or refuse me the great pleasure of thinking that in your daily work you may have with you a reminder of my affectionate gratitude for all you have done for our town and for me. If the plants will only flourish, as the good seed you have planted here is doing, they will be bright enough; and as for my personal obligations, you can never know how great they are to you for guiding me to and in this work.” Mr. Rathbone and other kindly Liverpool men (among whom Mr. J. W. Cropper should be remembered) were equally thoughtful of Miss Jones. At their own expense they furnished rooms for her in the workhouse, and made them bright with flowers and pictures. But it was a formidable task to which she was called, and the pleasantness of her rooms made the workhouse wards look yet more terrible, she said, by contrast. A young woman, well-bred, sensitive, and refined, accustomed as yet only to well-appointed hospitals, was thrown into the rough-and-tumble of great pauper wards, where the officials, though well-intentioned, had necessarily caught something of the surrounding atmosphere. “Your kind letter,” she had written to Miss Nightingale, after a preliminary visit (Aug. 1864), “came in answer to earnest prayer, and gave me courage so that even now while waiting for the committee I do not feel nervous. The governor has promised me every co-operation and told me ‘not to be down-hearted if the undertaking seemed formidable at first, as he would pull me through everything.’ You will laugh when I tell you how at first his want of refinement prejudiced me, but his earnest hearty initiative in the whole work has quite won me.” Their relations afterwards were only indifferently good. Miss Jones's standard was too strict, he thought, for rough workhouse ways.
The greatest shock to Miss Jones, however, was the nature of the human beings whom she was sent to nurse. Sin and wickedness, she said, had hitherto been only names to her. Now she was plunged into a sink of human corruption. The foul language, the drunkenness, the vicious habits, the bodily and mental degradation on all sides appalled her. The wards, she said in her first letter from the workhouse, are “like Dante's Inferno.” “Una and the Lion”[80] was the title given by Miss Nightingale to her account of Agnes Jones and her paupers, “far more untamable than lions.” She had, it is true, the help of twelve trained nurses, devoted alike to her and to their work; but there were 1200 inmates, and of the other “nurses” some were probationers of an indifferent class, and the rest “pauper nurses,” of whom Miss Jones had to dismiss 35 in the first few months for drunkenness. Then, the standard of workhouse cleanliness was sadly low. She found that the men wore the same shirts for seven weeks. Bed-clothes were sometimes not washed for months. The diet was hopelessly meagre compared to a hospital standard. It is “Scutari over again,” wrote Miss Nightingale, and Miss Jones was strengthened by the thought that the disciple was experiencing some of the difficulties which had beset the Mistress. By way of smoothing things over, Miss Nightingale had written to the governor of the workhouse saying, in effect, that the eyes of the world were upon him as the leader in a great reform; and he “seemed so gratified and flattered by your letter,” reported Miss Jones. Miss Nightingale was constant in advice and encouragement to her disciple. “No one ever helps and encourages me as you do.” “I could never pull through without you.” “God bless you for all your kindness.” Such expressions show how welcome and how unfailing was Miss Nightingale's help. And in every detail she was consulted. There was all the friction which usually accompanies a new experiment. There were disputes of every kind, and all were referred to Miss Nightingale—sometimes by Mr. Rathbone, sometimes by Miss Jones, sometimes by both. When things seemed critical, Mr. Rathbone would come up to see Miss Nightingale in person; on less serious occasions he would write. Miss Nightingale and Dr. Sutherland would then sit as a kind of Conciliation Board, and see how matters could be adjusted. In one of Dr. Sutherland's draft judgments submitted for Miss Nightingale's concurrence there is a blank left for her to fill, as the note explains, with “soft sawder.” His breezy manner may sometimes have been of comfort to his friend. On one occasion, when everything at Liverpool seemed to be at sixes and sevens, his note to Miss Nightingale was: “I don't despair by any means. The entire proceeding has in it the elements of an Irish row, for they are all more or less Hibernian there, and they will cool down.” And so they did. Miss Jones, who was at first a little too stiff-necked, soon found out a more excellent way, and there is “the Nightingale touch” in many of her later reports. “To-day they were a little cross, but I got my way all the same.” She is “much amused at the manner in which she now gets all she asks for.” She suggests things. She is laughed at. She persists. A decent interval is allowed to elapse; and then the things are suggested to her by the officials; she says the suggestions are excellent, and the things are done. It is obvious to Miss Nightingale and Dr. Sutherland that sooner or later the powers of the Lady Superintendent must be better defined; obvious, too, that the worthless probationers and drunken pauper “nurses” must be cleared out; but that is just one of the things that the experiment is meant to prove, and meanwhile it is enough to drive in the thin end of the wedge. So well does Miss Jones do her work that opinion, in the workhouse and outside, begins even to be impatient for the thicker end. The experiment has so far been limited to the male wards. The doctors go to Miss Jones and ask eagerly when she and more Nightingale nurses are to be given charge of the female wards also. Old women who go in to see their husbands or brothers report wonderful changes in the House since “the London nurses” came. Visiting ladies report to the same effect. The experiment is becoming popular; and the Liverpool Vestry begins to wonder whether the cost hitherto borne by Mr. Rathbone's private purse should not be thrown upon the rates. Miss Nightingale has good cause to be pleased. She has been throwing herself into the work, not only in order to make the particular experiment a success, but also because she wants to use it as a lever for promoting larger reforms.
III
Liverpool had shown the way, and Miss Nightingale resolved in her own mind that the way should be followed in London. The struggle was long and arduous; the fortune of political war went at a critical moment against her; the victory of 1867 was only partial, and indeed there are other parts of her designs which even to this day await fruition. But the insight with which from the very first, as her Papers show, she seized the essential positions was masterly. I can understand how it was that Mr. Charles Villiers, not usually given to such outbursts of admiration, exclaimed to a friend: “I delight to read the Nightingale's song about it all. If any of them had the tenth part of her vigour of mind we might expect something.”
The opening move in her campaign was made in December 1864. There had been an inquest on the death of one Timothy Daly, which had figured in the newspapers as “Horrible Treatment of a Pauper.” The facts, as ultimately sifted, were not in this particular case as bad as they were painted in the press, but the circumstances were distressing and public opinion was excited. The situation was in that favourable condition for moving Ministers when there is a feeling in the air that “something must be done.” Miss Nightingale seized the opportunity to open communications with the President of the Poor Law Board, Mr. Villiers. She did not in this first letter disclose her whole scheme, though she said just enough to show that she had considered the subject in its larger bearings. She knew the art of beginning on a moderate, and even a humble, note. She presumed to write because the case involved a question of nursing, in which matter she had had some practical experience; she had, moreover, been “put in trust by her fellow-countrymen with the means of training nurses.” She described what was to be done in the Liverpool Infirmary by a Matron who had been trained under the “Nightingale Fund,” and she invited the Minister's attention to the possibility of preventing the scandals, with which the newspapers were ringing, by starting some scheme of a like kind in London. This letter, in the composition of which Dr. Sutherland had a hand, went straight to its mark. Mr. Villiers at once replied (Dec. 31, 1864) that he would like to communicate with Miss Nightingale personally on the subject. In January the interview took place, and this was the beginning of a long series of personal and written communications between them during the next few years. On one occasion early in 1865 Mr. Villiers, being prevented by official business from keeping an appointment with Miss Nightingale, begged her to receive in his place his right-hand man, Mr. H. B. Farnall, Poor Law Inspector for the Metropolitan district. Mr. Farnall called, and he and Miss Nightingale became as thick as conspirators in no time. For Poor Law purposes he soon became the Chief of her Staff. Mr. Farnall was a man after her own heart. He not only knew the facts with which he had to deal, but he felt them, with something of her “divine impatience.” “It's intolerable to me,” he said, “to know that there are some 12,000 gasping and miserable sick poor whom we might solace and perhaps in some 5000 cases save, and yet that we have to let them wait while the world gets ready to get out of bed and think about it all.” He was a keen and broadminded reformer, and Miss Nightingale's ideas were upon lines which he too had considered. He was an old official hand, but he hated official obstruction: “all this is treason to King Red Tape, but I know that the old King is always happy after a change, though he gets very red while the change progresses.” Miss Nightingale instantly set her new ally to work. Here, as in all that she undertook, she knew that the first thing needful was to collect the facts. She drew up a schedule of inquiries, to be filled up with regard to all the sick-wards and infirmaries in London. “I will immediately issue your Forms,” wrote Mr. Farnall (Feb. 16, 1865). He required them to be filled up in duplicate, and Miss Nightingale's set of them is preserved amongst her Papers. Throughout the year she and Mr. Farnall were engaged in the work of inspiring and incensing Mr. Villiers in the direction of radical reform. He was throughout very willing, but he was becoming an old man, he had many other things to think about, and he was apt to see lions in the path. Moreover, not all the officials at the Poor Law Board were reformers; there were those, more highly placed than Mr. Farnall, who were of a very different opinion; and some of the medical officers were inclined to dispute the necessity of any radical changes. However, on the subject of workhouse nursing, Mr. Villiers promptly authorized Mr. Farnall to press upon the Guardians the importance of employing competent nurses, and he told the House of Commons (May 5) that “in consequence of communications lately received at the Poor Law Board from Miss Nightingale, who was now taking much interest in the matter,” he was hopeful that great reforms in nursing might come about. She, however, knew perfectly well that the only way to such reform was by reform also in administration and finance. In the following month Mr. Farnall persuaded his Chief to insinuate into an innocent little “Poor Law Board Continuation Bill,” a clause which would enable the Board to compel Guardians to improve their workhouses; but the clause was struck out, Mr. Farnall was disappointed, and Miss Nightingale wrote to reassure him. They must work all the harder to secure, not by a side-wind, but by a direct move in the next session of Parliament, a full and far-reaching measure of reform. “Your kind note,” said Mr. Farnall (July 3), “has done me a world of good; there is not a single expression or hope in it which I cannot make my own. So we hope together for next year's ripened fruit. I hope, too, that we may really taste it. I pledge myself to you to relax in nothing till the task is done. It is something to live for, and something to have heard you say that such a victory will some day be claimed by me. It is a pleasant thing to think of, and I shall think of it as a soldier thinks of his Flag.”
So, then, Miss Nightingale set to work, with the help of Mr. Farnall and Dr. Sutherland, in elaborating a scheme for 1866. There are several drafts in her handwriting for the Memorandum finally submitted to Mr. Villiers, and many notes and emendations by Dr. Sutherland. The scheme was sent also (at a later date) to Mr. Chadwick (one of the few survivors of the famous Poor Law Commission of 1834) in order that he might submit it to John Stuart Mill, whom Miss Nightingale sought to enlist in the cause.[81] The essential points and considerations were these:—
A. To insist on the great principle of separating the Sick, Insane, “Incurable,” and, above all, the Children, from the usual population of the Metropolis.
B. To advocate a single Central Administration.