Part 2

How gladly would I have become the Matron of a Workhouse.

But of a Visitor’s visit, the only result is to break the Visitor’s heart. She sees how much could be done and cannot do it.

Liverpool is of all places the one to try this great Reform in. Its example is sure to be followed. It has an admirable body of Guardians; it is a thorough practical people; it has, or soon will have again, money.

Lord Russell once said (what is quite true), that the Poor Law was never meant to supersede private charity.

But whatever may be the difficulties about Pauperism, in two things most people agree—viz. that Workhouse sick ought to have the best practical nursing, as well as Hospital sick—and that a good wise Matron may save many of these from life-long pauperism, by first nursing them well, and then rousing them to exertion, and helping them to employment.

In such a scheme as is wisely proposed, there would be four elements.

1. The Guardians, one of whose functions is to check pauperism. They could not be expected to incur greater cost than at present, unless it is proved that it cures or saves life.

2. The Visiting or Managing Committee of the Guardians, whose authority must not (and need not) in any way be interfered with.

3. The Governor, the Medical Officer, and Chaplain.

4. (And under the Governor) the proposed Superintendent of Nurses and her nursing staff.

There is no reason why all these parts of the machine should not work together.

The funds are provided to pay the extra nursing for a time.

The difficulty is to find the Lady to govern it.

When appointed, she must be authorized—indeed appointed—by the Guardians. She must be their Officer; and must be invested by the Governor with authority to superintend her Nurses in conformity with regulations to be agreed upon.

So far, I see no more difficulty than there was in settling our relations as Nurses to the government officials in the Crimean War.

The cases are somewhat similar.

As to the funds, it is just possible that eventually the Guardians might take all the cost on themselves, as soon as they saw the great advantages and economy of good nursing.

If Liverpool succeeds, the system is quite sure to extend itself.

The Fever Hospital is one of the Workhouse Infirmaries. That is the place to shew what skilful nursing can do. The patients are not all paupers. How many families might be rescued from pauperism by saving the lives of their heads, and by helping the hard-working to more speedy convalescence!

Hopefully yours, (Signed) FLORENCE NIGHTINGALE.

Extract from a letter from the Right Honourable Sir John M^cNeill, G.C.B., dated Granton House, Edinburgh, 28th Feb., 1864.

There can be no doubt, I think, that it would be a mistake to have pauper nurses mixed up with paid nurses, and I think I expressed that opinion when we conversed about those things. Paupers might, however, be employed to scrub and to do other menial work, under the orders of the paid nurses. If the paid nurses are to do much good they must have a recognised authority in their wards. Without authority there cannot be due responsibility, and things must get into confusion. A nurse carrying out the instructions of the medical officer must have authority to do so, and resistance to that authority must be treated as a breach of discipline.

To put this upon a right footing from the first, would be indispensable to success. The more a nurse does by influence, and kindly influence, the better; but dealing with the promiscuous inmates of a workhouse, the knowledge that there is authority in reserve to be exercised if necessary, prevents the necessity of resorting to it, and makes the patients duly appreciate the kindness which keeps it in reserve.

With regard to all such matters, a great deal will depend upon the good-will, the good sense, and good feeling of the Governor and Matron, but especially of the Governor. He can do much to promote or to mar the success of the experiment, and so can the medical men; but if they be men of sense and right feeling, they cannot fail to perceive how vast an addition to their own comfort the permanent establishment of such a system as you propose to introduce experimentally, must produce.

The position of a medical man dependent for the execution of his instructions upon nurses who are neither intelligent nor trustworthy, is very painful, and tends to deteriorate his own character, both as a man and as a practitioner, by rendering him callous to preventible suffering which he is denied the proper means of relieving, and by compelling him to forego the use of remedies which require intelligence and conscientious care in administering them. The house Governor, if he be a conscientious man, must be kept in continual anxiety about the conduct of ignorant, and often worthless pauper nurses in the hospital, and is driven at length to be satisfied with a low moral and intellectual standard in the nurses, and a corresponding standard of care and comfort in the hospital.

The Select Vestry took the subject into their serious consideration, and instituted most careful inquiries in various quarters. Among other steps, they called for a report on the probable operation of the proposed system from Mr. Carr, the Governor of the Workhouse. That report ran as follows:—

Extract from the Journal of the Governor of the Workhouse.

Liverpool, Thursday, April 14, 1864.