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Title: Lessons from the life of Florence Nightingale
Author: Charlotte Albina Aikens
Release date: December 19, 2024 [eBook #74935]
Language: English
Original publication: New York: Lakeside Publishing Company
Credits: Carol Brown and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)
*** START OF THE PROJECT GUTENBERG EBOOK LESSONS FROM THE LIFE OF FLORENCE NIGHTINGALE ***
LESSONS
_from_
THE LIFE OF
Florence Nightingale
_By_ CHARLOTTE A. AIKENS
_Author of_ “Hospital Training School Methods and
the Head Nurse,” “Primary Studies for Nurses,”
“Clinical Studies for Nurses,” “Studies in Ethics for
Nurses,” etc. _Joint Author of_ Hospital Management.
_Editor_ “The Trained Nurse and Hospital Review.”
[Illustration]
Lakeside Publishing Company
38-40 West 32nd St.
New York.
[Illustration: FLORENCE NIGHTINGALE
Born in Florence, Italy, May 12th, 1820; died in London
August 13th, 1910]
SANTA FILOMENA
_By_ HENRY WADSWORTH LONGFELLOW
Whene’er a noble deed is wrought
Whene’er is spoke a noble thought
Our hearts, in glad surprise,
To higher levels rise.
The tidal wave of deeper souls
Into our inmost being rolls
And lifts us unawares
Out of all meaner cares.
Honor to those whose words or deeds
Thus help us in our daily needs.
And by their overflow
Raise us from what is low!
Thus thought I, as by night I read
Of the great army of the dead,
The trenches cold and damp,
The starved and frozen camp.
The wounded from the battle-plain
In dreary hospitals of pain,
The cheerless corridors,
The cold and stony floors.
Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.
And slow, as in a dream of bliss,
The speechless sufferer turns to kiss
Her shadow, as it falls,
Upon the darkening walls.
As if a door in heaven should be
Opened and then closed suddenly,
The vision came and went,
The light shone and was spent.
On England’s annals, through the long
Hereafter of her speech and song
That light its rays shall cast
From portals of the past.
A Lady with a Lamp shall stand
In the great history of the land
A noble type of good
Heroic womanhood.
Nor even shall be wanting here
The palm, the lily and the spear
The symbols that of yore
Saint Filomena bore.
Lessons from the Life of
Florence Nightingale
Chapter I.
The presence of thousands of daughters of Florence Nightingale in
the regions devastated by the great world war, and the great service
to humanity which they have rendered, have turned the thoughts of
many to that other battlefield where the great need of the world for
trained nurses was first impressed on the hearts of the people--an
impression never to be effaced while there are suffering human beings
requiring skilled care and service.
Sixty odd years ago, at the outbreak of the Crimean war there were no
women nurses to minister to those who had been wounded in the service
of their country. Woman’s ministry was sorely needed but not wanted
by those in active command of military affairs at the seat of war.
It remained for Florence Nightingale to teach the world one of its
greatest lessons--a lesson from which future generations will reap
increasing benefits. When the Crimean war closed, the foundation was
begun on which the structure of modern nursing was to be reared.
In every age, the world has had its heroes, and Florence Nightingale
would have been the last to wish to give the impression that there
were not many splendid women devoting themselves to the care of the
sick long before she was born. They were not trained women according
to modern ideals of training, but there were women of gentle birth
and breeding, refined and accomplished who served the sick with
singleness of heart and rare devotion. The world will always owe its
debt of gratitude to the Roman Catholic Sisters and the Deaconesses
of other churches, whose tender ministries to the sick in hospitals
and home, did much to lessen the sum of human suffering in the years
before Miss Nightingale’s great work was begun.
No one who reads the story of the beautiful life of Florence
Nightingale can fail to be impressed with the fact that the dominant
motive of that life was--SERVICE. It has been aptly said that one of
the first and most important lessons that a nurse needs to learn, is
to spell SELF with a little s. In this she has a worthy example for
forgetfulness of self seems to have been characteristic of Florence
Nightingale all through her life. Service to humanity--especially
service to the sick and distressed part of humanity--seems to have
made its strong appeal to her almost from childhood. Organization
for service, education and training for service, plans for service
in a hundred different ways--filled her life, and the story of her
many-sided activities, as revealed by her official biographer--has
been a surprise to those who have thought of her only in connection
with nursing. While she will always be best remembered as the founder
of modern nursing, her great efforts in improving sanitary conditions
in India, in which she labored unceasingly for many years with
officials in the War Department, and her work in behalf of reform in
the management of workhouses in England, were closely interwoven with
her work in behalf of better nursing for the sick. Her voluminous
correspondence and her literary work seem in themselves to have been
sufficient to occupy her full time, after her return from the Crimea.
The popular idea of Florence Nightingale has been drawn largely from
the pen picture of Longfellow in Santa Filomena, but it is far from
being a true picture of her life. To fully appreciate her character
and influence one must study to some extent, not alone the social
and sanitary conditions that prevailed in her earlier life, but
the habits of thought and even the etiquette of the times, during
which her chief work was being accomplished. Of these conditions her
biographer says:
“Now that the fruits of Florence Nightingale’s pioneer work have been
gathered, and that nursing is one of the recognized occupations for
gentlewomen, it is not altogether easy to realize the difficulties
which stood in her way. The objections were moral and social, in
large measure rooted to conventional ideas. Gentlewomen, it was
felt, would be exposed, if not to danger and temptations, at least
to undesirable and unfitting conditions. ‘It was as if I had wanted
to be a kitchen maid,’ Miss Nightingale herself said in later years.
Nothing is more tenacious than social prejudice. But the prejudice
was in part founded on very intelligible reasons and in part was
justified by the level of nursing as an occupation at that time.
It will suffice to say that though there were better-managed and
worse-managed hospitals, yet there was strong evidence to show
that hospital nurses had opportunities which they freely used, for
‘putting the bottle to their lips’ when so disposed, also that other
evils were more or less prevalent.
“The more she heard of the worst, the more was Florence Nightingale
resolved to make things better; but the more her parents heard, the
greater and more natural was their repugnance. Somebody must do the
rough pioneer work of the world; but one can understand how the
parents of an attractive daughter, to whom their own life at home
seemed to them to open many possibilities of comfortable happiness,
came to desire that in this case the somebody should be somebody
else.”
It is difficult to study her life without feeling that she was sent
into the world especially to accomplish the great tasks to which
in early middle life, her powers were chiefly devoted. It should,
however, be always remembered that during this period others besides
Miss Nightingale were making their contribution to better nursing and
better sanitary conditions in hospitals, and in the world outside.
Lord Lister, who ushered in the new era of antiseptic surgery,
was seven years younger than Florence Nightingale. “He and she,
each in the manner in which Nature or Providence fitted them, were
simultaneously inaugurating the new era, he the foster father, she
the foster mother of myriads of this generation and unthinkable
millions of those who are to be. His methods demanded the trained
nurse both for surgery and midwifery, both for the battlefield where
life is destroyed, and for the lying-in room where it is ushered into
separate existence. Her work was to provide the training and the
principles, the ideals, the enthusiasm, and the tiniest, humblest
details, whereby the modern nurse is made.”
[Illustration: LORD LISTER]
Apart entirely from the generally undesirable type of women (there
were many exceptions) found in charge of the care of the sick when
Florence Nightingale began her work, were the generally undesirable
conditions which existed before Lord Lister’s antiseptic methods were
inaugurated in 1868. Erysipelas, gangrene, pyemia, and septicemia
were common complications of surgery and the death rate of maternity
patients in hospitals was appalling. A nurse who was one of the
pioneers in improving the care of the sick, thus describes her
experience when she entered for training in an English hospital:
“New methods of nursing as well as of surgery had to contend
with tremendous difficulties in the way of bad buildings, bad
ventilation, old-fashioned furniture, and lack of apparatus.
“The utensils, which in the hospitals of today are of white
earthenware or enamel, were of exceedingly battered tin, almost
entirely denuded of their original covering of black japan, and it
was absolutely impossible to keep some of them clean and sweet.
Smells abounded. I have seen a visiting surgeon run through a ward
to escape them, and during my first week I was much puzzled by the
existence of a horrible smell in one corner of the children’s ward. I
privately investigated the floor and under the beds, but could find
nothing to account for it, but discovered at last that it came from
a patient--a child with a diseased bone of the face, a case which
nowadays would be antiseptically treated and probably isolated.
“Under the old regime the nurses had, as a rule, no uniform dress,
and cooked their own meals, which they bought for themselves, in the
ward kitchens or scullery, and these conditions did not at once pass
away.
“The antiseptic treatment of wounds was coming into general use, and
the particular method of the moment, which had been advocated by Dr.
Lister, was a sort of model steam-engine, which could be carried
about and placed on a table or stand by the side of a patient’s
bed. When a wound was to be attended to, before the dressings were
removed a lamp in this apparatus was lighted. A strong spray of
diluted carbolic acid then played over the wound the whole time it
was being dressed, much to the discomfort of the doctors and nurses,
whose hands would be stiff with the carbolic and their ears dulled
with the constant hissing and fizzing of the machine. Everything was
saturated with carbolic at that time, wool, bandages, lint, gauze,
etc., but in the course of a few years this treatment was entirely
superseded.
“Operations were comparatively free and easy performances. We
nurses wore our ordinary dresses, and were kept busy washing
sponges, which were used again and again, though they were boiled
between the operation days. In the medical wards enteric cases were
indiscriminately mixed with others, and tuberculosis patients stalked
about and expectorated freely.”
Nurses of today, in common with the rest of the world, owe a greater
debt of gratitude than most of them realize to Lord Lister who, by
his surgical experiments, and his demand for trained nurses, helped
so much in laying the foundations for the trained nursing of today.
Other workers in the realm of bacteriology were aiding greatly in the
remarkable developments which medicine and surgery were making in
that period.
THE SPIRIT OF VOCATION.
An English writer, Miss Margaret Fox, in an address to nurses has
called attention to the great need of the spirit of vocation in the
nurses of today. “Look at it what way you will,” she states, “the
fact remains that nursing is work demanding something more than mere
business qualities, more than an active intelligence, more than even
sympathy and kindness of heart. The latter, precious though it is,
may be worn very threadbare in the constant daily contact with all
sorts of unlovely natures suffering from every variety of trying
ailment. Patients are not all grateful, or appreciative, and you will
find some of them by no means ready to kiss your shadow as you pass
on your rounds. Sometimes they are inclined to grumble because they
do not immediately get all they want. Their disease may make them
irritable, captious even, sometimes, repulsive. These people need
more than ordinary everyday good qualities in a nurse. They need one
who, over and above her professional ability, looks upon her work as
a vocation, ‘a calling by the will of God.’ It was that spirit which
made the best of the pioneers of other days what they were. Nursing
was undertaken by them as a definite life-work. It cost them so much
to enter upon it, that they were unlikely to throw it up without some
very cogent reason. Work was not then considered so much a means to
an end. It was the ultimate achievement. Nursing is a mission; and
wherever it is done, it needs the same spirit of true vocation to do
it well, and to persevere in spite of difficulties.
“There would be fewer restless, discontented nurses, if each
possessed the spirit of vocation. It is a spirit that gives one the
calm, quiet feeling of being in the only possible place and doing the
only possible work. It stirs in one a large-hearted charity towards
all such as be sorrowful, sick or poor. It makes one feel, ‘Well,
whoever fails, I must not.’ It helps wonderfully when things are
crooked and the work is hard, or uninteresting. One simply can’t help
making things look nice, or doing the little extra bit which just
makes all the difference.”
The motives which influence an individual to undertake a task are
tremendously important factors in real and full success, and it is
well, in such work as nursing, that all who enter on it analyze
carefully their own motives in so doing.
There can be no mistaking the motives which led Florence Nightingale
to enter on her career under the distressing conditions which
then prevailed. Born and reared in refined surroundings, in an
intellectual atmosphere, with all the educational advantages
the times afforded, if she had fulfilled parental and popular
expectations, she would have been satisfied to have spent her
girlhood life chiefly in a round of gay social functions, with ample
leisure for study and travel, and to have married at an early age a
man belonging to her own social circle. That she was not satisfied
with this sort of existence is seen in this typical extract from
one of her letters, written when she was twenty-six years of age:
“The thoughts and feelings that I have now,” she wrote, “I can
remember since I was six years old. It was not _I_ that made them. A
profession, a trade, a necessary occupation, something to fill and
employ all my faculties, I have always felt essential to me, I have
always longed for, consciously or not. * * * The first thought and
the last thought I can remember was nursing work, but for this I have
had no education myself. * * *” Later she wrote: “In my thirty-first
year I see nothing desirable but death. Why do I wish to leave this
world? God knows I do not expect a greater heaven beyond, but that He
would now set me down in St. Gile’s, or at a Kaiserwerth, there to
find my work, and my salvation in my work.”
To her, life was earnest--it was a serious thing, and her struggle
for many long, weary years to free herself, to overcome the obstacles
that closed in around her, so that she might accomplish the kind of
work she felt God wanted her to do--her long-continued effort to gain
her relatives’ consent for her to even attempt nursing--forms one of
the most interesting chapters in her life story. Nursing to her was
always “God’s business.”
How much this sense of vocation, this strong feeling that she was
called to do the will of God in this form of service, had to do
with her success, no one can fully determine, but that it helped
tremendously in carrying her over difficult places cannot be doubted.
As one looks back over her wonderful life and tries to discern the
secret of her remarkable influence, one cannot but feel that the
spirit in which she did her work, her absolute devotion to the cause
to which she was giving her best powers, accounts in large measure
for her name being honored, and her memory kept green all over the
civilized world. “The sweetest character in all British history,” was
a noted man’s comment on her, yet the sweetness was always combined
with strength, and courage, and a quiet determination not to give up
because things were harder or more difficult than she had expected.
Her work was not lightly undertaken, and as lightly abandoned, as
nursing is by many young women today.
One of the outstanding qualities of this great woman was her
individuality, a quality which some one has aptly said is close
kin to honesty. She did her own thinking, and the results of that
independent thinking were evident all through her career. In
commenting on this quality of individuality, a recent writer, Byron
H. Stauffer, has said:
“It burst out in a letter written when she was eight, which she
closes with: ‘My love to all except Miss W--.’ It developed in her
despising, early in life, the silly conventionalities of the high
society of the day. It sparkled in explaining why she tittered during
a ritualistic service: ‘The rector was praying “That it may please
Thee to have mercy on all men,” and the ridiculousness of that prayer
broke upon me. Think of it! If I asked you to have mercy on your own
boy, you’d knock me down.’ Another instance of her nonconformity to
the religious conventions lies in her declaration: ‘I never prayed
for George IV; I always thought that people were very, very good who
could pray for him. It was a wonder to me how he could possibly be
any worse if nobody prayed for him. I prayed a little for William IV.
For the young Victoria I prayed with rapture.’”
THE PRICE OF SKILL.
One of the tendencies of this age in nurses is to expect and apply
for positions of responsibility for which they have not taken any
special or definite pains to fit themselves. Their estimate of their
own ability is often much greater than conditions justify; they often
want the best positions without paying the price of special skill.
The determination of Florence Nightingale to secure for herself the
best instruction the world afforded at that time, and her conviction
that if she was ever to accomplish anything worth while she must
first learn all that was possible under the circumstances for her to
learn about the business of caring for the sick, is a fine example
for those who really desire to do worth while things in this world.
It has been well said that ability depends greatly on preparation,
and that opportunity is largely dependent on ability. It was by no
accident that Florence Nightingale became “the angel of the Crimea.”
Nothing that she could do to fit herself for such a task had been
omitted, though she could not know how great were the opportunities
that were to be afforded her to use the knowledge and experience
she was so determined to secure. She fully realized that to do good
required more than good desires or intentions. To do good in the way
that she wished required some skill. To be the best possible nurse,
to fit herself in the best way, however long it might take, or how
hard the way might be, meant much greater difficulties then than it
could possibly mean now.
When in later years she expressed herself as follows, she was simply
expressing the convictions which had been with her all through life:
“Nursing is an art, and if it is to be made an art, it requires as
hard preparation as is required for any painter’s or sculptor’s work;
for what is having to do with dead canvas or cold marble compared
with caring for the living body?”
How to obtain the needed skill was a problem which she had studied
for many years. The difficulties and moral dangers that stood in the
way of a refined woman securing experience in nursing in a hospital
seemed for years insuperable, and can hardly be appreciated by the
nurses of today.
AT KAISERWERTH.
Through a friend, Miss Nightingale learned of an institution for
deaconesses at Kaiserwerth, Germany, where there was a school, a
hospital and a prison, under the management of deaconesses. It had
a decidedly higher tone and reputation than prevailed in hospitals
in general, she was told; and Pastor Fliedner’s annual reports
of the work of the institution were eagerly studied, and used to
silence parental objections. The opportunity to spend a few months at
Kaiserwerth was delayed, but finally came when her mother and sister,
in search of health, went to Carlsbad, and to travel. In commenting
afterward on the new departure of giving some months of training in
the care of the sick, inaugurated at Kaiserwerth, Miss Nightingale
called special attention to the fact that the Kaiserwerth
institutions had begun, not with programs or fullfledged schemes
set forth in a prospectus, but with individual cases and personal
devotion--and later years showed that her own great work began,
also, not with a prospectus or prearranged program, but with actual
doing of the thing she felt needed to be done when the opportunity
came. The real training in nursing given at Kaiserwerth was far from
satisfactory to her, but the atmosphere, the spirit of consecrated
service, impressed her deeply.
Later she returned to Kaiserwerth for further apprenticeship in
nursing and followed this experience by spending some time in the
hospitals of Paris presided over by the Roman Catholic sisters.
It is very evident that she did not expect to have everything she
wished to know, prepared and presented to her to study. Her powers of
observation were wonderful, and she proved an indefatigable collector
of pamphlets, reports, statistics, methods of work and plans of
hospital organization and management.
One criticism which is often heard of present day nurses in
training is that they so quickly get into ruts in the matter of
observation--that they see so much in a hospital ward which they
fail to _perceive_--that they fail to gather practical knowledge
pertaining to their work which is all around them waiting to be
picked up. If Florence Nightingale had been the type of woman who had
to have all the nursing knowledge which she obtained duly imparted
to her by somebody else appointed for that purpose, her influence on
the conditions which then prevailed would have been small indeed.
Instead, she was constantly getting hold of facts, reading medical
books, continually studying into the “why” of things, and how they
might be improved, so that better general results might be obtained
in the care of the sick. Her private notebooks were filled with
facts, ideas, and suggestions gathered here, there and elsewhere,
which she was later to use in laying broad foundations for the
improvement of nursing, and of hospital management in general. Her
attention to small details, as found in her notebooks preserved to
the present day, was characteristic of all her work, and accounts in
no small degree for its success.
TACT AND SENSE OF HUMOR.
Among the indispensable qualities for successful nursing, we place
“TACT” very close to the top of the list. To get along with people
without friction, to get needful things done without arousing
antagonism, to have that keenness of perception, that ready power
of appreciating and of doing or saying what is most fitting under
the circumstances; to maintain, withal, that quality of mind
which enables one to see the humorous side to otherwise difficult
situations, are qualities to be coveted by every nurse.
How Florence Nightingale succeeded in managing committees with whom
she had to work, as well as the sense of humor which helped to carry
her over difficult situations, are admirably shown in extracts
from her private letters, written soon after she returned from
Kaiserwerth. She had been importuned to undertake the management of
an institution known as an “Establishment for Gentlewomen During
Illness,” which had been started, but had been so grossly mismanaged
that it had been threatened with closure. A change of location had
finally been decided on when Miss Nightingale agreed to undertake
its management. One of the first difficulties which confronted her
is described in the extract from a private letter to a friend which
follows:
“My committee refused me to take in Catholic patients--whereupon
I wished them good morning, unless I might also take in Jews and
their Rabbis to attend them. So now it is settled, _and in print_,
that we are to take in all denominations, whatever, and allow them
to be visited by their respective priests and Muftis, provided _I_
will receive (in any case whatsoever that is _not_ of the Church
of England) the obnoxious animal at the door, take him upstairs
myself, remain while he is conferring with his patient, make myself
responsible that he does not speak to, or look at, any one else, and
bring him downstairs in a noose, and out into the street. And to this
I have agreed! And this is in print!
“Amen. From committees, charity and schism--from the Church of
England and other deadly sins--from philanthropy and all the deceits
of the Devil--Good Lord deliver us!”
To her father in 1853, she wrote another characteristic letter
which affords a glimpse of the experience in “managing” people she
was getting at this time, and which was later to be most helpful
in her great task of helping to reorganize the affairs of the army
hospitals. In this letter, she says:
“You ask for my observations upon my line of statesmanship. I have
been so very busy that I have scarcely made any resume in my own mind.
“When I entered into service here, I determined that, happen what
would, I never would intrigue among the committees. Now I perceive
that I do all my business by intrigue. I propose in private to A, B
or C, the resolution I think A, B or C most capable of carrying in
committee, and then leave it to them, and I always win. * * * I have
observed that the opinions of others concerning you depend not at
all, or very little, upon what _you_ are, but upon what _they_ are.
“Last General Committee I executed a series of Resolutions on five
subjects and presented them as coming from medical men:
“1. That the successor to our house surgeon (resigned) should be a
dispenser, thus saving our bill at the druggists of 150 pounds per
annum.
“2. A series of House Rules, of which I send you the rough copy.
“3. A series of resolutions about not keeping patients.
“4. A complete revolution as to diet, which is shamefully abused at
present.
“5. An advertisement for the Institution.
“All these I proposed and carried in committee without telling them
that they came from me, and not from the medical men; and then, and
not till then, I showed them to the medical men, without telling them
that they were already passed in committee.
“It was a bold stroke, but success is said to make an insurrection
into a revolution. The medical men have had two meetings upon them
and approved them all, and thought they were their own. And I came
off with flying colors, no one suspecting my intrigue.
“I have also carried my point of having good, harmless Mr. ---- as
chaplain, and no young curate to have spiritual flirtations with my
young ladies. So much for the earthquakes in this little mole-hill of
ours.”
Happy though Miss Nightingale was in this new work, it did not offer
her the wide opportunity for training nurses, which she greatly
longed to do--somewhat along the lines pursued at Kaiserwerth.
[Illustration]
The Call to Service in the Crimean War
Chapter II.
When the Crimean war broke out in 1854, it can easily be imagined
that there was no woman in England so well fitted to take charge of
the chaotic situation which soon developed in regard to the care of
the wounded. The employment of women nurses in the army was an entire
innovation. It excited jealousy in medical men, and strong criticism
from military officers. In spite of the fact that the idea was
certain to be branded as unwomanly by her own sex, and by the world
in general, she offered her services, and her letter crossed in the
mails a formal offer from Sir Sidney Herbert of the War Department
of the position of director of a party of women nurses who were to
be sent to nurse the sick. From France, a devoted company of Sisters
of Charity had gone, who were rendering excellent service to the
wounded, and it was felt by some officials who were not bound hand
and foot by routine and precedent, that a company of women nurses
from England might be sent to assist in the emergency that had
arisen. Her services at this time are well known. The main facts were
tersely summed up in the following paragraphs, published at the time
of her death:
“The death rate at Scutari was 42 per cent. In one hospital
it rose to 56. Eighty per cent of those whose limbs were
amputated died of gangrene. The sick list amounted to over
13,000. In the Turkish barracks on the Bosphorus there
were two miles of sick beds, in a double file along the
corridors. The rats ran over the wounds of the helpless
patients.
“Miss Nightingale assembled a party of 41 volunteer nurses,
including ten Catholic nuns and eight sisters of mercy of
the Anglican church, and took them to the Crimea. Upon her
arrival at Scutari the “Lady of the Lamp” went straightway
to work to bring order out of confusion, life out of the
jaws of death, heaven on earth from a veritable hell. The
day after her arrival they brought in the wounded survivors
of the charge of the Light Brigade at Balaklava; the next
day came the wounded from the bloody field of Inkerman.
‘Red tape’ insisted that all stores should be inspected
ere being issued to the troops. When she found that the
inspection would take three days Miss Nightingale broke
down the doors and commandeered the supplies. She had
soon reduced the death rate from 42 to 2 per cent. The
wounded and the dying followed her with their eyes in her
progress from cot to cot, as though she were an angel
visitant. When, at the close of the war, a dinner was
given the military and naval officers, those present voted
for the one whose services would longest be remembered
by posterity. There was but one name on every slip of
paper--that of Florence Nightingale.
“She went back to England under an assumed name, and
reached her home before it was known that she had left
Turkey. The queen sent for her and thanked her in person at
Balmoral. Every soldier in the army contributed a day’s pay
to a fund of $250,000 for their benefactor, but she gave it
all to found the Florence Nightingale Training School for
Nurses in London. The Geneva convention and the Red Cross
Society were the eventual outcome of her labors in the
east.”
The difficulties which she had to contend with can never be fully
appreciated at this time when women’s service as nurses in the army
in most civilized countries is well established. Her biographer
writing of that period says:
“Miss Nightingale’s work in the Crimea was attended by
ceaseless worry. She had to fight her way into full
authority. She knew that she would win, but her enemies
were active, and were for the moment in possession of the
field. ‘There is not an official,’ she said, ‘who would
not burn me like Joan of Arc, if he could, but they know
that the War Office cannot turn me out because the country
is with me. * * * The real grievance against us is that
though subordinate to the medical chiefs in office, we are
superior to them in influence, and in the chance of being
heard at home.’”
It is not easy to suggest the many qualities of character in Miss
Nightingale which the experiences in the Crimea brought out into bold
relief--qualities which are just as much needed in nursing today as
they were then. Her unflinching endurance of the hardships which the
conditions forced upon her; her generous recognition of the work of
others; her thoughtful care of the nurses who had been entrusted to
her, under the most difficult conditions--should be remembered quite
as much as her wonderful organizing qualities, her keen insight into
situations, and her general ability to produce results--to bring
things to pass. It was a recognition of these latter qualities that
led Queen Victoria to exclaim: “Such a clear head! I wish we had her
at the War Office.”
After the war was over and a general inquiry as to conditions and
methods of sanitary improvement in regard to the army had been
started in London, an army doctor writing of her said: “It may
surprise many persons to find from Miss Nightingale’s evidence that,
added to feminine graces, she possesses not only the gift of acute
perception, but that on all the points submitted to her she reasons
with a strong, acute, most logical, and if we may say so, _masculine
intellect_, that may well shame other witnesses. They maunder through
their subject, as if they had by no means made up their minds on
any one point--they would, and they would not; and they seem almost
to think that two parallel roads may sometimes be made to meet,
by dint of courtesy and good feeling, amiable motives that should
never be trusted to in matters of duty. When you have to encounter
hydra-headed monsters of officialism and ineptitude, straight hitting
is the best mode of attack. Miss Nightingale shows that she not only
knows her subject, but feels it thoroughly. There is, in all she
says, a clearness, a logical coherence, a pungency and abruptness, a
ring as of true metal, that is altogether admirable.”
To have failed in appreciation of the part her assistant nurses
played, during the excitement of wartime conditions, would have been
easy and, to a degree, excusable--but she did not fail. To take the
whole credit for achievement to oneself is a very human failing, but
it was not one of Florence Nightingale’s failings.
One illustration of her appreciation of her associates in the
campaign shows this characteristic plainly. Of one woman whom she had
placed in a position of more than ordinary responsibility, she wrote:
“Without her, our Crimean work would have come to grief--without her
judgment, her devotion, her unselfish, consistent looking to the
one great end--the carrying out of the work as a whole--without her
untiring zeal, her accuracy in all trusts and accounts, her truth,
her faithfulness. Her praise and reward are in higher hands than
mine.”
In describing to the Secretary of State certain sanitary reforms
which she carried out in the hospitals of Scutari, she wrote: “I must
pay my tribute to the instinctive delicacy, the ready attention of
orderlies and patients during all that dreadful period. For my sake
they performed offices of this kind (which they neither would for the
sake of discipline, nor for that of importance to their own health,
which they did not know), and never was there one word nor one look
which a gentleman would not have used; and while paying this humble
tribute to humble courtesy, the tears come into my eyes as I think
how amidst scenes of loathsome disease and death, there rose above it
all the innate dignity, gentleness, and chivalry of the men, shining
in the midst of what must be considered the lowest sinks of human
misery, and preventing, instinctively, the use of one expression
which could distress a gentlewoman.”
It is easy to think of Miss Nightingale as a great organizer and
executive--it is less easy to imagine how she found time to give
the personal attention to the individual patient that she did give.
“She was wonderful,” said one, “at cheering up any one who was a bit
low.” In the midst of her manifold responsibilities she found time
to write hundreds of letters, to relatives at home, for those unable
to write, and to instill in the nurses associated with her the same
spirit. There was nothing mechanical in the nursing of that period.
Every patient was a human being with relatives and anxious friends
rightfully interested, who must be kept informed as to his condition,
as far as possible.
TEACHING A COUNTRY BY DEMONSTRATION.
Nowadays when women of many classes are contending that legislation
is necessary before real reforms can be brought about, it is
interesting to note that Florence Nightingale’s reforms were
initiated mainly by demonstration of the way a thing could be
accomplished. Her biographer, in writing of this, says that “it was
a common belief of the time that it was in the nature of the British
soldier to be drunken. The same idea was entertained of the British
nurse. Miss Nightingale utterly refused to believe it.” Writing to
a friend, while in Scutari, she remarks: “I have never been able
to join in the popular cry about the recklessness, sensuality and
helplessness of the soldiers. On the contrary, I should say that
I have never seen so teachable and helpful a class as the army
generally. Give them opportunity, promptly and securely, to send
money home and they will use it. Give them schools and lectures and
they will come to them. Give them books and games and amusements and
they will leave off drinking. Give them suffering and they will bear
it. Give them work to do and they will do it.”
Acting on this belief, we find Miss Nightingale, in addition to
her work in improving the nursing in the army, arranging plans by
which soldiers might remit money to their relatives, by forming an
extempore money order office where, on four afternoons each month,
she personally received money from soldiers and arranged for sending
it to relatives in England. Soon the government took the hint which
she thus gave them--and established money order offices at different
points where the troops were stationed.
Along the same practical line was her effort to combat the drink
habit by establishing a coffee house, the details of which she
arranged. Her next practical step was the establishment of reading
rooms and class rooms--which were fitted up with textbooks, copy
books, prints, maps, games, etc., secured from personal friends in
the home land. On her request, two schoolmasters were sent out from
England to take charge of “the education of the army.”
Scarcely had she returned from the Crimea than she began her long
campaign for better sanitary conditions in the army, wherever it
might be called in the future. “We can do no more,” she said, “for
those who have suffered and died in their country’s service; they
need our help no longer; their spirits are with God who gave them.
It remains for us to strive that their sufferings may not have been
endured in vain--to endeavor so to learn from experience as to lessen
such sufferings in future by forethought and wise management.”
[Illustration]
“Notes on Hospitals”
Chapter III.
“It may seem a strange principle to enunciate,” wrote Miss
Nightingale in 1863, “as the very first requirement in a hospital
that it should do the sick no harm. It is quite necessary,
nevertheless, to lay down such a principle, because the actual
mortality in hospitals, especially in those of large crowded cities
is very much higher than any calculation founded on the mortality of
the same class of diseases among patients out of hospitals would lead
us to expect.”
At the time Miss Nightingale returned from the Crimea, the death rate
in hospitals was lamentably high, and it was but natural that she
should turn her attention to remedying such conditions, or at least
to call attention to them. In 1858 her book, “Notes on Hospitals,”
was issued. A noted man in acknowledging receipt of a copy stated
that it appeared to him to be the most valuable contribution to
sanitary science in application to medical institutions, that
he had ever seen. In this book we find her calling attention to
overcrowding, lack of drainage under hospitals, to ventilation,
to the necessity of having non-absorbent floors and walls, to the
desirability of iron beds, hair mattresses, and glass or earthen
ware cups, instead of tin--also to needed improvements in hospital
kitchens and laundries, to the curative effects of light--all of
which ideas are today regarded as essentials in hospitals, but which
were then years in advance of general practice. It is easy to point
out defects--not always so easy to produce practical plans for
correcting them, but Miss Nightingale not only called attention to
the defects but at the same time showed how to remedy them. In the
second edition of the book she enumerated “Sixteen Sanitary Defects
in the Construction of Hospital Wards”--accompanying each statement
with definite plans for correcting the defect. The publication of
this little book on hospitals brought to her numerous requests for
consultation regarding the construction of new hospitals which were
being planned and more than a dozen hospitals constructed, soon after
that time, had the benefit of her advice and detailed consideration
of the architect’s plans. The questions as to the desirability of
pavilion construction and whether a hospital should be built in the
midst of a well-populated section, and among the class of people it
is expected to serve--or in a more distant location, where better
light and air are to be had--which are still debated among hospital
people, were then as hotly debated as now. It was not unusual to
find her making out the main specifications for an entire hospital
building regarding which her advice had been sought, and architects
and sanitary engineers were very glad to be able to quote her
approval of their plans. Sir Edward Cook, her biographer, states that
“in its day, Miss Nightingale’s Notes on Hospitals revolutionized
many ideas, and gave a new direction to hospital construction.”
“NOTES ON NURSING.”
Between the return of Miss Nightingale from the Crimea, and the
starting of the first real training school for nurses some three
or four years elapsed, which were largely devoted to the securing
of better sanitary conditions for the army--and in tedious and
exhaustive work with military officials and legislators, in addition
to her work in improving hospital buildings and methods.
During this time, her book, Notes on Nursing, was issued, in order
to deepen the impression she was trying to make, that nursing skill
was not something simply to be “picked up” by any woman, but that
it required special gifts, special training--training by precept, as
well as by example. The book furnished the precept teaching for that
time, and was immensely popular. It is safe to say that no book on
nursing which has appeared since, or which probably ever will appear,
was received with the enthusiasm, that this book of hers aroused
among all sorts of people, from the queen down to the laborer’s wife.
It many ways, it was a remarkable book--remarkable in the underlying
principles set forth, now, well understood and accepted, yet then a
new story--and remarkable for its keen appreciation of the needs of
the sick. Nurses of today, even graduates, might very profitably try
to really learn and practice some of the lessons contained in that
little book, written more than half a century ago. Her gospel of
fresh air, and its application to health, was a new gospel at that
time--yet after all these years it is still unheeded in many homes.
QUOTATIONS FROM HER “NOTES ON NURSING.”
“Do you ever go into the bedrooms of any persons of any class,
whether they contain one, two or twenty people, whether they hold
sick or well at night, or before the windows are opened in the
morning and ever find the air anything but unwholesomely close and
foul? And why should it be so? During sleep the human body even when
in health, is far more injured by the influence of foul air than
when awake. Why can’t you keep the air all night, then, as pure as
the air without in the rooms you sleep in? But for this you must
have sufficient outlet for the impure air you make yourselves, to go
out; and sufficient inlet for the pure air from without to come in.
You must have open chimneys, open windows or ventilators; no close
curtains round your beds; no shutters or curtains to your windows;
none of the contrivances by which you undermine your own health or
destroy the chances of recovery of the sick.”
* * * * *
“Let no one ever depend upon fumigations, ‘disinfectants,’ and the
like for purifying the air. The offensive thing, not its smell,
must be removed. A celebrated medical lecturer began one day,
‘Fumigations, gentlemen, are of essential importance. They make such
an abominable smell that they compel you to open the windows.’”
* * * * *
“True nursing ignores infection except to prevent it. Cleanliness
and fresh air from open windows with unremitting attention to the
patient, are the only defence a true nurse either needs or asks.”
* * * * *
“The very first canon of nursing, the first and the last thing upon
which a nurse’s attention must be fixed, the first essential to a
patient, without which all the rest you can do for him is as nothing,
with which I had almost said you may leave all the rest alone, is
this: To keep the air he breathes as pure as the external air,
without chilling him.”
* * * * *
“The time when people take cold (and there are many ways of taking
cold, besides a cold in the nose), is when they first get up after
the two-fold exhaustion of dressing and of having had the skin
relaxed by many hours, perhaps days, in bed, and thereby rendered
more incapable of reaction. Then the same temperature which refreshes
the patient in bed may destroy the patient just risen. And common
sense will point out, that, while purity of air is essential, a
temperature must be secured which shall not chill the patient.”
“Of all methods of keeping patients warm the very worst certainly is
to depend for heat on the breath and bodies of the sick.”
* * * * *
“To be ‘in charge’ is certainly not only to carry out the proper
measures yourself, but to see that every one else does so too; to see
that no one either wilfully or ignorantly thwarts or prevents such
measures. It is neither to do everything yourself nor to appoint a
number of people to each duty, but to ensure that each does that duty
to which he is appointed.”
* * * * *
“Conciseness and decision are, above all things, necessary with the
sick. Let your thought expressed to them be concisely and decidedly
expressed. What doubt and hesitation there may be in your own mind
must never be communicated to theirs.”
* * * * *
“‘What can’t be cured must be endured,’ is the very worst and
most dangerous maxim for a nurse which ever was made. Patience
and resignation in her are but other words for carelessness or
indifference--contemptible, if in regard to herself; culpable, if in
regard to her sick.”
* * * * *
“I would appeal most seriously to all friends, visitors, and
attendants of the sick to leave off this practice of attempting to
‘cheer’ the sick by making light of their danger and by exaggerating
their probabilities of recovery.”
* * * * *
“A sick person intensely enjoys hearing of any material good, any
positive or practical success of the right. He has so much of books
and fiction, of principles, and precepts, and theories; do, instead
of advising him with advice he has heard at least fifty times
before, tell him of one benevolent act which has really succeeded
practically,--it is like a day’s health to him. You have no idea what
the craving of sick with undiminished power of thinking, but little
power of doing, is to hear of good practical action, when they can no
longer partake in it.”
* * * * *
“The most important practical lesson that can be given to nurses is
to teach them what to observe--how to observe--what symptoms indicate
improvement--what the reverse--which are of importance--which are of
none--which are the evidence of neglect--and of what kind of neglect.
All this is what ought to make part, and an essential part, of the
training of every nurse.”
* * * * *
“Courts of justice seem to think that anybody can speak ‘the whole
truth, and nothing but the truth,’ if he does but intend it. It
requires many faculties combined of observation and memory to speak
‘the whole truth,’ and to say ‘nothing but the truth.’
“‘I knows I fibs dreadful, but believe me, Miss, I never finds out I
has fibbed until they tells me so,’ was a remark actually made. It is
also one of much more extended application than most people have the
least idea of.”
* * * * *
“There may be four different causes, any of which will produce the
same result, viz., the patient slowly starving to death from want of
nutrition:
1. Defect in cooking;
2. Defect in choice of diet;
3. Defect in choice of hours for taking diet;
4. Defect of appetite in patient.
Yet all these are generally comprehended in the one sweeping
assertion that the patient has ‘no appetite.’”
* * * * *
“If you cannot get the habit of observation one way or other, you had
better give up the being a nurse, for it is not your calling, however
kind and anxious you may be.”
“It appears that scarcely any improvement in the faculty of
observing is being made. Vast has been the increase of knowledge in
pathology--that science which teaches us the final change produced by
disease on the human frame--scarce any in the art of observing the
signs of the change while in progress. Or, rather, is it not to be
feared that observation, as an essential part of medicine, has been
declining?”
“In dwelling upon the vital importance of sound observation, it
must never be lost sight of what observation is for. It is not for
the sake of piling up miscellaneous information or curious facts,
but for the sake of saving life and increasing health and comfort.
The caution may seem useless, but it is quite surprising how many
men (some women do it too), practically behave as if the scientific
end were the only one in view, or as if the sick body were but a
reservoir for stowing medicines into, and the surgical disease only
a curious case the sufferer has made for the attendant’s special
information.”
* * * * *
“Pathology teaches the harm that disease has done. But it teaches
nothing more. We know nothing of the principle of health, the
positive of which pathology is the negative, except from observation
and experience. And nothing but observation and experience will teach
us the ways to maintain or to bring back the state of health.”
* * * * *
“Unnecessary noise, then, is the most cruel absence of care which
can be inflicted on the sick or well. Unnecessary (although slight)
noise injures a sick person much more than necessary noise, of a much
greater amount. A good nurse will always make sure that no door or
window in her patient’s room shall rattle or creak; that no blind or
curtain shall, by any change of wind through the open window, be made
to flap. If you wait till your patients tell you of these things,
where is the use of their having a nurse.”
* * * * *
“Always sit within the patient’s view, so that when you speak to him
he has not painfully to turn his head round in order to look at you.
Everybody involuntarily looks at the person speaking. If you make
this act a wearisome one on the part of the patient, you are doing
him harm.”
* * * * *
“Volumes are now written and spoken upon the effect of the mind upon
the body. Much of it is true. But I wish a little more was thought
of the effect of the body on the mind. * * * A patient can just
as much move his leg when it is fractured, as change his thoughts
when no external help from variety is given him. * * * It is an
ever-recurring wonder to see educated people who call themselves
nurses, acting thus. They vary their own objects, their own
employments, many times a day; and while _nursing_ (?) some bedridden
sufferer they let him lie there staring at a dead wall, without any
change of object to enable him to vary his thoughts; and it never
occurs to them, at least to move his bed so that he can look out of
the window.”
* * * * *
“It is often thought that medicine is the curative process. It is no
such thing; medicine is the surgery of functions, as surgery proper
is that of limbs and organs. Neither can do anything but remove
obstructions; neither can cure. _Nature alone cures._”
* * * * *
“A celebrated man has told us that one of the main objects in the
education of his son, was to give him a ready habit of accurate
observation, a certainty of perception and that for this purpose one
of his means was a month’s course as follows: He took the boy rapidly
past a toy-shop; the father and son then described to each other as
many of the objects as they could, which they had seen in passing
the windows, noting them down with pencil and paper and returning
afterward to verify their own accuracy. I have often thought how wise
a piece of education this would be for higher objects; and in our
calling of nurses the thing itself is essential. For it may safely
be said not that the habit of ready and correct observation will by
itself make us useful nurses, but that without it we shall be useless
with all our devotion.”
* * * * *
“It seems a commonly received idea among men and even among women
themselves that it requires nothing but a disappointment in love, the
want of an object, a general disgust, or incapacity for other things,
to turn a woman into a good nurse. This reminds one of the parish
where a stupid old man was sent to be schoolmaster because he ‘was
past keeping the pigs’.”
* * * * *
“And remember every nurse should be one who is to be depended upon,
in other words, capable of being a ‘confidential’ nurse. She does not
know how soon she may find herself placed in such a situation; she
must be no gossip, no vain talker; she should never answer questions
about her sick except to those who have a right to ask them; she
must, I need not say, be strictly sober, and honest; but more than
this, she must be a religious and devoted woman; she must have a
respect for her own calling because God’s precious gift of life is
often literally placed in her hands; she must be a sound and close
and quick observer; and she must be a woman of delicate and decent
feeling.”
* * * * *
“The everyday management of a large ward let alone of a hospital--the
knowing what are the laws of life and death for men and what the laws
of health for wards--are not these matters of sufficient importance
and difficulty to require learning by experience and careful inquiry,
just as much as any other art? They do not come by inspiration to the
lady disappointed in love, nor to the poor workhouse drudge hard up
for a livelihood.”
* * * * *
“To revert to children. They are much more susceptible than grown
people to all noxious influences. They are affected by the same
things, but much more quickly and seriously, viz., by want of fresh
air, or proper warmth, want of cleanliness, in house clothes, bedding
or body, by startling noises, improper food, or want of punctuality;
by dulness and by want of light; by too much or too little covering
in bed; or when up, by want of the spirit of management generally
in those in charge of them. One can therefore, only press the
importance, as being yet greater in the case of children, greatest in
the case of sick children, of attending to these things.”
The Nightingale Training School For Nurses
Chapter IV.
Deep as was the desire of Miss Nightingale to institute plans for the
training of hospital nurses, her health, after her return from the
army service, was so impaired, that to undertake the task herself was
impossible. The fund of $250,000 had been placed in charge of a board
of trustees and invested for the purpose of establishing a school of
which she expected to be the superintendent. Her health, however,
grew worse rather than better, and after two years had passed, she
wrote to the Chairman of the Council of the Nightingale Fund, of her
inability to carry out the plans. It became necessary to find other
persons through whom she might work, without having to carry the
everyday details. Her choice fell on St. Thomas’ Hospital--largely
because “the matron of the hospital, Mrs. Wardroper, 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:
[A]“I saw her,” she says, “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 nursing. Training was
then unknown; the only nurse worthy of the name that could be given
to the expedition was a ‘Sister’ who had been pensioned some time
before and who proved invaluable. I saw her next after the conclusion
of the 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, her courage and discrimination in
character, were alike remarkable. She was straightforward, true,
upright. She was decided. Her judgment of character came by
intuition, at a flash, not by 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. 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 were in the work she had undertaken.
“She was left a widow at 42 with a young family. She had never had
any training in hospital life for there was none to be had. Her force
of character was extraordinary. Her word was law. * * * She knew
what she wanted and did it. She was a strict disciplinarian; very
kind, often affectionate rather than loving. * * * She was a thorough
gentle-woman, nothing mean or low about her; magnanimous and generous
rather than courteous. All this was done quietly. She had a hard life
but never proclaimed it. What she did was done silently.”
[A] British Medical Journal, Dec. 31. 1892.
Such was Miss Nightingale’s estimate of the first superintendent of
a training school for nurses organized according to her own ideas.
Mrs. Wardroper retired in 1887 and died in 1892. The plans for the
training school were of Miss Nightingale’s making--the carrying
of them out devolved almost wholly on Mrs. Wardroper, and on the
Resident Medical Officer of the hospital, R. G. Whitfield.
There were two essential principles to the plan: The nurses were to
have their technical training in hospitals specially organized for
the purpose. They should live in a home fit to form their moral life
and discipline. Plans for lectures were carefully made and carried
out, and a “Monthly Sheet of Personal Character and Acquirements”
of each nurse was arranged by Miss Nightingale herself, for the
Matron to fill in. The character record was to be noted under five
heads: punctuality, quietness, trustworthiness, personal neatness and
cleanliness, and ward management.
The records in regard to nursing technique were made out on forms
carefully prepared by Miss Nightingale under numerous headings, with
copious subheadings. At her request, the Resident Medical Officer
prepared a form of General Directions which were to aid the nurses in
taking notes of the medical and surgical cases in the hospitals.
The school opened June 24th, 1860. The course of training was to
extend over one year. The writer has in her possession a copy of
the first set of “Rules and Regulations for Probationers Under the
Nightingale Fund”--and they bear a close resemblance to regulations
in force today. She laid foundations which have stood the test of
time.
In the first report of the Committee in charge of the training
school, one finds the details of the qualifications expected, set
forth as follows, with the added statement that all important details
for the working of the plan have been suggested by Miss Nightingale,
or submitted to her for approval:
“DUTIES OF PROBATIONERS UNDER THE
NIGHTINGALE FUND.”
You are required to be
Sober
Honest
Truthful
Punctual
Quiet and Orderly
Cleanly and Neat.
You are expected to become skilful in--
1. In the dressing of blisters, burns, sores, wounds, and in applying
fomentations, poultices, and minor dressings.
2. In the application of leeches, externally and internally.
3. In the administration of enemas for men and women.
4. In the management of trusses and appliances in uterine complaints.
5. In the best method of friction to the body and extremities.
6. In the management of helpless patients, i.e., moving, changing,
personal cleanliness, of feeding, keeping warm (or cool), preventing
and dressing bedsores, managing position of.
7. In bandaging, making bandages and rollers, lining of splints, etc.
8. In making the beds of patients, and removal of sheets whilst
patient is in bed.
9. You are required to attend at operations.
10. To be competent to cook gruel, arrowroot, eggflip, puddings,
drinks for the sick.
11. To understand ventilation, or keeping the ward fresh by night
as well as by day; you are to be careful that great cleanliness is
observed in all the utensils; those used for the secretions as well
as those required for cooking.
12. To make strict observation of the sick in the following
particulars:
The state of secretions, expectorations, pulse, skin, appetite;
intelligence, as delirium or stupor; breathing, sleep, state of
wounds, eruptions, formation of matter; effect of diet or of
stimulants, and of medicine.
13. And to learn the management of convalescents.
IDEALS OF TRAINING.
Her ideals of training, what she hoped training might accomplish,
are embodied, in part at least, in the following quotations from her
writings at a later period.
What is training? Training is to teach the nurse to help the patient
to live. Nursing the sick is an art and an art requiring an organized
practical and scientific training; for nursing is the skilled servant
of medicine, surgery and hygiene. A good nurse of twenty years ago
had not to do the twentieth part of what she is required by her
physician or surgeon to do now; and so after the year’s training she
must be still training under instruction in her first and even second
year’s hospital service. The physician prescribes for supplying the
vital force, but the nurse supplies it.
Training is to teach the nurse how God makes health and how He makes
disease.
Training is to teach a nurse to know her business, that is to observe
exactly in such stupendous issues as life and death, health and
disease.
Training has to make her not servile, but loyal to medical orders and
without the independent sense or energy of responsibility which alone
secures real trustworthiness.
Training is to teach the nurse how to handle the agencies within
our control which restore health and life, in strict intelligent
obedience to the physician’s or surgeon’s power and knowledge, how to
keep the health mechanism prescribed to her in gear.
Training must show her how the effects on life of nursing may be
calculated with nice precision, such care or carelessness, such a
sick rate, such a duration of case, such a death rate.
In 1871, St. Thomas’ Hospital removed to the large new buildings
in its present location near the Houses of Parliament, London,
and with the occupation of the new building, the number of nurses
and probationers in the Nightingale School greatly increased. New
problems in management were created and Miss Nightingale feared that
her high ideals for the nurses were not being realized as fully
as she desired. Her health having improved, she determined on a
closer supervision of the school, by herself. One result of this
supervision, as she herself afterward stated, was that “the training
school became a Home--a place of moral, religious and practical
training--a place of training character, habits, and intelligence,
as well as of acquiring knowledge.” She knew as much, probably, as
any hospital superintendent knows today, of the problem of securing
the right kind of young women to be trained, and she was fully
convinced that a good nurse must be first of all a good woman. When
applications came to her from smaller cities and towns for trained
nurses to take charge of the nursing, she was accustomed to reply,
“Have you sent me any probationers? I can’t stamp material out of the
ground.”
Her character sketches, as preserved among her papers, of some of
the probationers she had to deal with in those days, show her keen
insight into human nature. “Miss A. Tittupy, flippant, pretension-y,
veil down, ambitious, clever, not much feeling, talk-y, underbred,
no religion, may be persevering from ambition to excel but takes the
thing up as an adventure.” “Nurse B. A good little thing, spirited,
too much friends with G., shares in her flirtations.” “Miss X. More
cleverness than judgment, more activity than order, more hard sense
than feeling, never any high view of her calling, always thinking
more of appearances than of the truth, more flippant than witty,
more petulance than vigor.” These are typical of her notes written
after personal conversation with different probationers. The great
necessity of some such notes is shown in the enormous demand that
had been created for trained nurses for other hospitals--to fill
responsible positions where they would have the choosing and training
of other nurses. These demands came to her unceasingly in the earlier
years of trained nursing.
Through her influence an assistant superintendent of the Nightingale
training school had been appointed to whom was given the title of
Home Sister. The duties of the Home Sister were varied, but among
other things she was expected to supplement the lectures and bedside
teaching and demonstration by regular classes. She was also to
“encourage general reading, to arrange Bible classes, to give wider
interests to the nurses,” in order, as Miss Nightingale said, to keep
them above the mere scramble for a remunerative place. She regarded
the influence of the Home Sister on the moral and spiritual side of
the school as more important than her technical instruction.
It is stated that the besetting sin of the Nightingale Nurses in
those earlier days was self-sufficiency. “They knew,” says a writer,
“that their training school was the first of its kind, and they were
apt to give themselves airs.” This tendency in them was vigorously
combated by Miss Nightingale. The picking and choosing of places or
cases in order to select the one which afforded the prospects of an
easy time, she especially condemned.
“Our brains are pretty nearly useless,” she said, in one of her
annual addresses to the nurses, “if we only think of what we want and
should like ourselves; and not of what posts are wanting _us_, or
what our posts are wanting _in_ us. What would you think of a soldier
who, if he were put on duty in the honorable post of difficulty,
as sentry, may be, in the face of the enemy (and we nurses are
always in the face of the enemy, always in the life and death of our
patients)--were to answer his commanding officer, ‘No, he had rather
mount guard at the barracks or study musketry;’ or if he had to go as
pioneer, or on a forlorn hope, were to say, ‘no that don’t suit my
turn’.”
It was her custom for some years to issue an annual address to the
nurses of the Nightingale School, and for many years the authorities
of the school insisted on every probationer studying the first of
these addresses, issued in 1872, the year in which she began her
closer supervision of the details of training. In these addresses
she dwelt strongly on the ideals of nursing she had from the
beginning--that it requires a strong sense of vocation or a special
call; that it needs a religious basis; that it is an art; that there
must be constant progress or stagnation; that the nurse should be
extremely careful of her moral influence. She had no use for the
woman who thought she was making a sacrifice in taking up nursing;
nor for the woman who thought any kind of service which had to do
with nursing was beneath her--neither had she any patience with the
sentimental “ministering angel” type of nurse. “If we have not true
religious feeling and purpose,” she said in one of her addresses,
“hospital life, the highest of all things _with_ these becomes
_without_ them, a mere routine and bustle and a very hardening
routine and bustle.”
No one who studies Miss Nightingale’s life and ideals can be left
in doubt, that, in her mind, in the choice of nurses, the first and
greatest thing to be considered was the character of the applicant.
She did not undervalue education but she believed that the spirit of
the woman was of supreme importance.
It is absolutely certain that it was not her medical or surgical
knowledge, (though this was in advance of the times) that accounted
for the remarkable and enduring influence which she exerted, _and
is still exerting_--even though we may seem to have shifted the
emphasis from some things which to her were of tremendous importance,
and placed it on other things which, to her mind, were of secondary
consideration. It is an interesting exercise to analyze the varying
qualities in her great and beautiful life which still exerts its
influence on countless other lives. But after all, the secret of her
success must be summed up in that combination of qualities, that
subtle something which we call Personality. Her studious avoidance
of honors of all kinds, her purity of motive, the absolute lack of
self-seeking, of honor, prestige or profit for herself, her courage,
tact and quiet perseverance are qualities on which nurses of the
twentieth century may wisely meditate. Nothing is more needed among
nurses today, than that her spirit, her ideals of life and character,
may be perpetuated. Few of us can render any greater service to our
generation than to exert ourselves to keep her spirit alive in the
nursing profession.
Author’s note.--For many of the facts, which form the foundation
of this sketch, the author is indebted to the authorized biography
entitled “The Life of Florence Nightingale,” by Sir Edward Cook,
published in two volumes by the McMillan Co., 1913. Quotations have
been made from clippings, in several instances, in which the name
of the journal in which they first appeared has been lost. Grateful
acknowledgment is hereby made for all such unknown sources of aid
used in preparing these biographical notes.
Transcriber’s Note:
Words may have inconsistent hyphenation in the text. These have been
left unchanged, as were obsolete and alternative spellings. The book
uses spaced asterisks as ellipses.
Words and phrases in italics are surrounded by underscores, _like
this_. One footnote was moved to the end of the related citation.
Printing errors, such as partially printed letters and punctuation,
were corrected. Final stops missing at the ends of sentences and
abbreviations were added.
The following items were changed:
“witnesseses” to “witnesses,” ... shame other witnesses.
“nuse’s” to “nurse’s” ... which a nurse’s attention...
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