Florence Nightingale

“ I am sure that the Workhouse Committee must rejoice and feel thankful that there is such a change in the condition of the poor creatures brought under their rule.
Miss Jones, and her nurses and probationers, must have had much difficulty at first—indeed their work is still very trying; but the improved demeanour of the men must be highly gratifying and encouraging to them. I walked through the female sick wards; they were clean and sweet, but I could not help contrasting the pauper nurses who attended them, with the intelligent-looking respectable attendants of the men. ”

“ 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. ”

“ If any good is to result from the adoption of this proposal, the sick should be placed absolutely and entirely in the hands of a paid staff, without the assistance, in any form, of any one of the pauper inmates. Cut off the hospital department from the healthy wards; and do not, under any pretext, suffer communication between the sick and the healthy, and you strike at the root of every species of workhouse abuse; but if, under any pretext, you suffer a large number of healthy paupers to pass daily into the sick departments, as they now do, the adoption of the proposal will effect little good. ”

“ I have been told that the police officers, who sometimes come to the Workhouse on business, and who see the sick paupers, are much astonished. They see the men whom they have known as the very worst characters, conducting themselves with propriety and decency, and giving no cause of complaint. ”

“ It conclusively established two facts: that such women are utterly unfit to be trusted as nurses; and that their employment in that capacity does not effect all the saving that might be supposed. It might be thought that the choice lay between such employment and maintaining the pauper in idleness, while paying a nurse in her stead. But it was found—as the Governor had always predicted—that when sent back from the hospital to the able-bodied wards, nearly the whole of these women left the Workhouse, and relieved the parish from the charge of their maintenance. ”

“ Many of these women, when employed as nurses, remain in the Workhouse for the sake of what they can pick up or extort. And moreover, when they left it, the training they had received, such as it was, rendered them more intelligent, and perhaps not more unreliable nurses than those usually employed by the poor. It is not unlikely that in country places the unfitness of able-bodied paupers to become assistant nurses may be far less than it has been found to be in a great seaport town like Liverpool. ”

“ This applies not only to the state of the wards, the care of the sick, but is particularly observable in the demeanour of the patients, upon whom the humanizing influences of a body of women of character, devotedly discharging their duties, has produced evident fruits.
The question has often been asked whether the "new system is likely to succeed?" The "old system" meant nothing more than this, that old, ignorant, and unreliable pauper women, many of whom were of doubtful character, were entrusted with the discharge, without pay, of responsible duties. ”

“ To the Liverpool Vestry and its officers belongs the credit of having overcome all the difficulties, and persevered in spite of all the discouraging incidents, which necessarily attended an attempt to introduce a new system of management into such an institution as a Workhouse Hospital, combining as it does two subjects so different in their aspects and conditions of treatment, so difficult to deal with together, as pauperism and sickness. ”

“ Many of the inmates of a pauper hospital are persons of the worst character, and its wards, under the control of pauper nurses, often present scenes so disgusting that the respectable poor shrink from them with utter abhorrence, and after once becoming acquainted with them, will often rather die than return thither. ”

“ The paramount object must be to make the workhouse, if not absolutely unpleasant, less agreeable than the condition of laborious and striving poverty. On the other hand, in a hospital the paramount and almost the only object is to promote recovery and to mitigate suffering ”

“ 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. ”

“ He said, "I have no hesitation in saying that the saving would be certain and great."
The Assistant Physician Accoucheur, who has until last week had charge of the medical patients here, as House Physician (Mr. H. L. Kempthorne) , says, "The value of trained efficient nursing cannot be overrated in the management of acute diseases, and especially fevers, and would speak for itself in the saving of life, humanly speaking.
"In chronic cases, the eye of the trained nurse would soon detect the malingerer, and thus save the parish the expense of maintaining one who could well keep himself. ”

“ The moral influence of the trained nurses by precept and example must in time diffuse itself through the medium of the pauper nurses to the paupers in hospital, the workhouse, and thence to the parish at large. ”

“ In all unions or parishes where additional accommodation may be required, whether for patients or for healthy paupers, it is eminently desirable that in providing it regard should be had to the entire separation, at once or at a future time, of the sick and infirm from the able-bodied, as will be the case, at least partially, under the new régime introduced in the Metropolis by Mr. Gathorne Hardy's Bill. Miss Nightingale has from the first held and expressed a strong opinion in favour of the separation of the hospital and workhouse administrations. ”

“ The introduction of workhouse tricks into a hospital, where they cannot be met by workhouse control, must bring in an element of confusion, disorder, and waste, and therefore the intercommunication which might introduce those tricks should be as effectually prevented as possible, which it cannot be while the two institutions are, as at present, combined. ”

“ 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. ”

“ Thus justice and expediency alike counsel the introduction into the workhouse of the best known system of nursing. Probably nothing which the skill and kindness of medical men can do, no food or physical appliances which the guardians can supply, no oversight or care which they, acting through pauper nurses, can bring to bear, are wanting in the Liverpool workhouse ”

“ Evidence has been laid before the Committee to show that in those hospitals where the improved system of nursing has been introduced, the increased cost thereof has been more than compensated for by the saving, from the reduction of the time during which the patients are under treatment—the effect, as is alleged, of good and efficient nursing. ”

“ The proposal now made to the Committee, means that the paid staff shall be increased, so that the sick shall be cared for by responsible officers only, and not left, even partially, to the care of pauper nurses.
There is no doubt that pauper nurses are unreliable, inefficient, and many of them very worthless; and it is only by careful watching, and the utmost stringency of regulations, that they can be made serviceable in the hospital. ”

“ Almost always obtuse, and too often unprincipled, as a class they are thoroughly unreliable and quite unfitted to take charge of the sick and helpless, or the stimulants necessary for them. On this last point I have been informed by a former resident surgeon that he has known the pauper nurses appropriate the patient's stimulants, or withhold giving to a dying patient that ordered for him, that they might take it themselves after his death. ”

“ Carr I have paid a visit to the Workhouse, and have been greatly interested by remarking the change among the male pauper sick, effected since I was here about two years since. I conclude that this is owing to the nursing by a class of females so entirely different to those who nursed the male paupers at that time, and who still nurse the female sick. I have always seen that the influence of respectable and well-educated females over the most debased men is very striking. ”

“ Certain wards of the workhouse are set apart as hospital wards. They do not form an hospital worked as a whole, but are divided into five portions, each forming a distinct set of wards, in close proximity to the wards of the healthy paupers, and in five different parts of the workhouse. ”

“ 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. ”

“ Successful efforts have been made in many directions to improve the nursing of the sick, and the workhouses must soon be the object of similar endeavours. Those poor sufferers whose disease is protracted and hopeless are refused admission into ordinary hospitals, and must come to the workhouse ”

“ I believe, from a long experience of hospitals and other institutions, that the cost of an improved system of nursing as proposed for the Liverpool Workhouse Hospital would certainly be 'in part ' repaid by restoring the patients to health more quickly. ”

“ Another most serious evil is entailed upon the hospital by connexion with the workhouse. The habits and traditions prevalent among the habitual paupers—able-bodied paupers—in the workhouse (at least in the workhouse of a large town) , are too often deeply infected with cunning, deception, and dishonesty of all sorts, against which strict precaution and stern repression are requisite ”

“ It will be seen that the report of the second year's experience has a peculiar value, as bearing on the question whether, or how far, women may be competent to undertake one of the most delicate and difficult kinds of feminine work—one requiring special knowledge as well as special habits of punctual regularity, obedience, and thoughtfulness—without receiving any special training or education for such a duty. ”

“ No stringency of regulations, however, could guard against the most flagrant abuses, if these women were employed to discharge duties of trust, such as serving out the stimulants, &c. so that their services in attending upon the sick are limited and common-place. There is therefore, in my mind, no doubt, and I cannot see how any doubt can exist, that to remove these women, and appoint in their places women of character, trained as nurses, will tend to improve the position of the sick, and more rapidly restore many of them to health. ”

“ All these reports bear emphatic testimony to the merits and devotion of the Lady Superintendent and her staff. The medical men, it is noteworthy, speak strongly of the better discipline and far greater obedience to their orders observable where the trained nurses are employed—a point the more important because it is that on which, before experience has reassured them, medical and other authorities have often been most doubtful. ”

“ HARRY VERNEY. Such, and so entirely satisfactory to the Guardians, were the results of the experiment of nursing by trained nurses, as tried for two years in the Male Wards of the Liverpool Workhouse Infirmary. ”

“ 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 latter are apt to delegate to the paupers much of the hard but most instructive part of their work. In ordinary workhouse hospitals, when there are no probationers, a certain number of pauper assistants may perhaps be useful in aiding thoroughly trained nurses. ”

“ Of these sixty-seven have been dismissed through drunkenness and other misconduct, and sixteen have resigned; while it is positively true that there is not one of the whole number to whom I could entrust the duties of serving out wine or other stimulants, or, in fact, any duty requiring the exercise of integrity. ”

“ Men of that character, accustomed to intercourse with only degraded women, feel the restraining and humanizing power of virtuous and well-mannered females. They have never been admitted into intercourse with such before, and they are most beneficially affected by it. ”

“ The very able, clear, and conclusive report of the Sub-Committee leaves little more to be said on the subject. It determined the Vestry to adopt the system in permanence, and to extend it to the whole of the Workhouse Infirmary, a year before the period fixed for the trial of the experiment had expired. ”