C. To place the Sick, Insane, etc., under a distinct administration, supported by a “General Hospital Rate” to be levied for this purpose over the whole Metropolitan area.
These are the ABC of the reform required.
(A) So long as a sick man, woman, or child is considered administratively to be a pauper to be repressed, and not a fellow-creature to be nursed into health, so long will these most shameful disclosures have to be made. The care and government of the sick poor is a thing totally different from the government of paupers. Why do we have Hospitals in order to cure, and Workhouse Infirmaries in order not to cure? Taken solely from the point of view of preventing pauperism, what a stupidity and anomaly this is!… The past system of mixing up all kinds of poor in workhouses will never be submitted to in future. The very first thing wanted is classification and separation.
(B) Uniformity of system is absolutely necessary, both for efficiency and for economy.
(C) For the purpose of providing suitable establishments for the care and treatment of the Sick, Insane, etc., consolidation and a General Rate are essential. To provide suitable treatment in each Workhouse would involve an expenditure which even London could not bear. The entire Medical Relief of London should be under one central management which would know where vacant beds were to be found, and be able so to distribute[134] the Sick, etc., as to use all the establishments in the most economical way.
Miss Nightingale elaborated her views in detail, going into the questions of Hospitals, Nursing, Workhouse Schools, etc. The cardinal point was what Mr. Farnall spoke of to her as “your Hospital and Asylum Rate.” The Minister was favourable to the idea. “I have conferred with Mr. Villiers,” wrote Mr. Farnall (Dec. 12), “and he has decided on adopting your scheme. He thinks it will be popular and just, and I think so also, but I think too that it will be the means of my carrying out a further reform some of these days. That is my hope and belief. If your plans are carried my struggle is half over. Under these circumstances I shall to-morrow commence a list of facts for you on which those who are to support your plan in print will be able to hang a considerable amount of flesh, for I shall furnish a very nice skeleton.” Miss Nightingale had already, through an intermediary, interested the editor of the Times in the matter, and he had been to see Mr. Villiers. Further public support came from the Association above mentioned (p. [124]), which sent a deputation to the Poor Law Board. Mr. Villiers in reply (April 14, 1866) foreshadowed legislation on Miss Nightingale's lines, and he appointed Mr. Farnall and another of her friends, Dr. Angus Smith, to inspect all the Infirmaries. Their Report has already been cited. Public opinion was ripe for radical reform; but the Whig Ministry was tottering, no fresh contentious legislation was deemed advisable, and in June 1866 Mr. Villiers was out. The opportunity had passed, and Miss Nightingale was left crying, “Alas! Alas! Alas!”
IV
She was not one, however, to waste much time in empty lamentations. She had to begin over again, that was all; and she wrote at once, as we have heard,[82] to the new Minister. She also procured an introduction for Mr. Farnall to Lord Derby, and the Prime Minister seemed sympathetic. Mr. Hardy had answered politely, but did not follow up his letter, and his first move seemed sinister. He dismissed Mr. Farnall from Whitehall and sent him to the Yorkshire Poor Law District. The anti-reform party was believed to have gained the ascendant. But now a fortunate thing happened. Mr. Hardy made a speech in which he implied that the existing laws were adequate, if properly enforced, to meet the case. Technically there was a measure of truth in this statement, but in practice it was fallacious;[83] and in any case Mr. Hardy's remark was a reflection on his predecessor's administration. This nettled Mr. Villiers greatly; he was “not going to sit down under it,” he said; he became red-hot for reform; very much on the alert, too, to trip his successor up. Miss Nightingale did not fail to add fuel to the flame. Mr. Villiers corresponded with her at great length; saw her repeatedly; reported all he was able to learn of how things were going at Whitehall, and begged her to do the like for him. “The public are led to infer,” he said to her, “that nothing was needed but a touch from Mr. Hardy's wand to set all things straight.” The public, thought Miss Nightingale also, would soon discover his mistake. Mr. Hardy would find that he had either to do nothing, or to legislate; unless indeed the Tory Ministry were overthrown first.
Now, Miss Nightingale was a Whig, and she, too, would have been glad enough to see the Tories out and Mr. Villiers in again at the Poor Law Board. But there was something that she cared about a great deal more, namely, that the neglect of the sick poor should be remedied at the earliest possible moment; and as the Tories might after all weather the storm, she must see what she could do to get a Poor Law Bill out of them. In the autumn Mr. Hardy appointed a Committee, mainly composed of doctors, to report “upon the requisite amount of space, and other matters, in relation to workhouses and workhouse infirmaries.” One of the “other matters” was nursing, and the Committee, instead of expressing an opinion on the subject themselves, asked Miss Nightingale to send them a Paper. In this Memorandum, dated Jan. 19, 1867, she made full use of her opportunity; for she pointed out that the question of nursing could not, either in logic or in effective practice, be separated from that of administration. “In the recent inquiries,” she wrote, “the point which strikes an experienced hospital manager is not the individual cases which have been made so much of (though these are striking enough), but the view which the best Matrons, the best Masters, and other officials of the workhouses give from their own lips (in evidence) of what they considered their duties. These bore as little reference to what are usually considered (not by me alone, but by all Christendom) the duties of hospital superintendents as they bear to the duties of railway superintendents. Your Committee is probably well acquainted with the administration of the Assistance Publique at Paris. No great stretch of imagination is required to conceive what they think of the system or no system reigning here.[84] I allude to the heaping up aged, infirm, sick, able-bodied, lunatics, and sometimes children in the same building instead of having, as in every other Christian country, your asylum for aged, your hospital for sick, your lunatic asylum, your union school, &c., &c., &c., each under its proper administration, and your able-bodied quite apart from any of these categories. This point is of such vital importance to the introduction and successful working of an efficient nursing system that I shall illustrate it.…” And she went on to outline her general scheme. In accordance with her usual custom, Miss Nightingale had copies of her Paper struck off separately, and circulated them among influential people. The Committee had given her a platform, but its own Report was only of subsidiary value. She put her point of view with a touch of exaggeration characteristic of her familiar letters to Captain Galton, one of the members of the Committee. “I look upon the cubic space as the least of the evils—indeed as rather a good, for it is a very good thing to suffocate the pauper sick out of their misery.” Meanwhile she thought it wholesome that the “ins” should know that the “outs” did not mean to let the subject of Poor Law Reform be shelved. “I have had a great deal of clandestine correspondence,” she wrote to a friend who might pass the information on (Oct. 28, 1866), “with my old loves at the Poor Law Board these last two months. The belief among the old loves is that the new master is bent on—doing nothing. There is only one thing of which I am quite sure. And that is that Mr. Villiers will lead Mr. Gathorne Hardy no easy life next February.”