CHAPTER I

WORKHOUSE REFORM (1864-1867) From the first I had a sort of fixed faith that Florence Nightingale could do anything, and that faith is still fresh in me; and so it came to pass that the instant that name entered the lists I felt the fight was virtually won, and I feel this still.-- H. B. FARNELL, Poor Law Inspector (Dec. 1866). Fifty years ago the state of things which Miss Nightingale had seen, and cured, in the military hospitals during the Crimean War was almost equalled, and was in some respects surpassed in scandal, by the condition of the peace hospitals for the sick poor at home. Those hospitals were the sick wards or infirmaries of workhouses, for the hospitals usually so-called skim only the surface of sickness in any great town. The state of the Metropolitan workhouses, as reported upon by the Poor Law Board in 1866, showed that the sick wards were for the most part insanitary and overcrowded; that the beds were insufficient and admirably contrived to induce sores; that the eating and drinking vessels were unclean; that there was a deficiency of basins, towels, brushes and combs; that the food for the patients was cooked by paupers and frequently served cold; that although the medical officers did their duty to the best of their ability, the attendance given and the salaries paid were inadequate to the needs of the sick. As for the nursing, it was done by paupers, many of whom could neither read nor write, whose love of drink often drove them to rob the sick of stimulants, and whose treatment of the poor was characterized neither by judgment nor by gentleness. This is the restrained euphemism of an official report.[74] Sometimes a patient would miss the ministration of a nurse for days because the pauper charged to give it was herself bed-ridden. The rule of one nurse was to give medicine three times a day to the very ill and once to the rather ill. It was administered in a gallipot; the nurse "poured out the medicine and judged according." Cases were reported in which a patient's bed was not made for five days and nights; in which patients had no food from 4 o'clock in the afternoon of one day to 8 o'clock in the morning of the next; in which patients died, or, to speak more correctly, were killed, by the most wanton neglect. [74] Mr. Farnall's Report, 1866, summarized in the Majority Report of the Poor Law Commission, 1909, p. 239. The statements which follow above are from _An Account of the Condition of the Infirmaries of London Workhouses, Printed for the Association for the Improvement of Infirmaries_, 1866. The dawn of a better day came with the passing of the Metropolitan Poor Act of 1867, an Act which figures in histories of the Poor Law in this country as "the starting-point of the modern development of Poor Law medical relief." Many persons contributed to this reform. In the case of London, a "Commission," instituted by the _Lancet_, under Mr. Ernest Hart, which afterwards developed into the "Association for the Improvement of the Infirmaries of London Workhouses," should especially be mentioned. But the person who inspired the proper nursing of the sick poor, and who, behind the scenes, was a prime mover in the legislation of 1867, was Florence Nightingale. II The reform began in Liverpool, and the initiative was due to a philanthropist of that city, Mr. William Rathbone. He used to speak of Miss Nightingale as his "beloved Chief"; and she, when he died, sent a wreath inscribed "In remembrance and humblest love of one of God's best and greatest sons." His voluminous correspondence with her began in 1861 when he was desirous of introducing a system of District Nursing among the poor of Liverpool. There were no trained nurses anywhere to be had, and he consulted Miss Nightingale. She suggested to him that Liverpool had better train nurses for itself in its own principal hospital, the Royal Infirmary. Mr. Rathbone took up the idea, and built a Training School and Home for Nurses. This institution provided nurses both for the Royal Infirmary and for poor patients in their own homes. Miss Nightingale gave to all Mr. Rathbone's plans as close and constant consideration "as if she were going to be herself the matron."[75] The scheme was started in 1862, and it proved so great a success that Mr. Rathbone was encouraged to attempt an extension of his benevolent enterprise. The Workhouse Infirmary at Liverpool was believed to be better than most places of its kind; but there, as elsewhere, the nursing--if so it could be called--was done by able-bodied pauper women. Able-bodied women who enter workhouses are never among the mentally and morally efficient; and in a seaport like Liverpool they were of an especially low and vicious kind. The work of the nurses, selected from this unpromising material, "was superintended by a very small number of paid but untrained parish officers, who were in the habit, it was said, of wearing kid gloves in the wards to protect their hands. All night a policeman patrolled some of the wards to keep order, while others, in which the inmates were too sick or infirm to make disturbance, were locked up and left unvisited all night."[76] On Jan. 31, 1864, Mr. Rathbone wrote to Miss Nightingale, propounding a plan for introducing a staff of trained nurses and promising to guarantee the cost for a term of years if she would help with counsel and by finding a suitable Lady Superintendent. He asked for two letters--"one for influence," to be shown to the Vestry, the other for his private advice.[77] She and Dr. Sutherland drew up the required documents; she arranged that twelve "Nightingale Nurses" should be sent from St. Thomas's Hospital; and she selected a Lady Superintendent--a choice on which, as both she and Mr. Rathbone felt, everything would depend. The Vestry agreed in May to accept Mr. Rathbone's scheme, but many months passed before it was actually launched. "There has been as much diplomacy," wrote Miss Nightingale to the Mother of the Bermondsey Convent (Sept. 3, 1864), "and as many treaties, and as much of people working against each other, as if we had been going to occupy a kingdom instead of a Workhouse." The correspondence forms one of the bulkiest bundles among Miss Nightingale's Papers. [75] Rathbone's _Organization of Nursing in a Large Town_, p. 30. [76] _William Rathbone: a Memoir_, p. 166. [77] The public letter (Feb. 5, 1864) is printed in Mr. Rathbone's _Workhouse Nursing: The Story of a Successful Experiment_ (Macmillan, 1867). The Lady Superintendent--the pioneer of workhouse nursing--was Miss Agnes Jones, an Irish girl, daughter of Colonel Jones, of Fahan, Londonderry, and niece of Sir John Lawrence. She was attractive and rich, young and witty, but intensely religious and devoted to her work.[78] "Ideal in her beauty," Miss Nightingale said of her;[79] "like a Louis XIV. shepherdess." She was one of the many girls who had been thrilled by Miss Nightingale's volunteering for the Crimea. "Perhaps it is well," she wrote, when entering St. Thomas's Hospital, "that I shall bear the name of a 'Nightingale Probationer,' for that honoured name is associated with my first thought of hospital life. In the winter of 1854, when I had those first longings for work and had for months so little to satisfy them, how I wished I were competent to join the Nightingale band when they started for the Crimea! I listened to the animadversions of many, but I almost worshipped her who braved them all." In 1860 Miss Jones followed in her heroine's steps to Kaiserswerth. In 1862 she introduced herself to Miss Nightingale, who advised her to complete her apprenticeship by a year's training at St. Thomas's. "Hitherto," the Matron reported to Miss Nightingale (Feb. 25, 1863), "I have had no lady probationer equal on all points to Miss Jones." After completing her year's training at St. Thomas's she took service as a nurse in the Great Northern Hospital, and she was there when the invitation came to Liverpool. Miss Jones was at first diffident, but after an interview with Miss Nightingale "the conviction was borne in upon her," as she wrote, that it was God's call and therefore must be obeyed in trust and with good hope. [78] See "Una and the Lion," in _Good Words_, June 1868 (Bibliography A, No. 51). [79] Letter to Madame Mohl, June 13, 1868. In the history of modern nursing in this country the Sixteenth of May 1865 is a date only less memorable than the Twenty-fourth of June 1860. On the earlier day the Nightingale Training School was opened at St. Thomas's; on the latter twelve trained Nightingale nurses began work in the Liverpool Infirmary, and the reform of workhouse nursing was therein inaugurated. Miss Jones herself had arrived a few weeks earlier. Mr. Rathbone felt the importance of the occasion, and marked it by a pretty attention to Miss Nightingale. "I beg," he wrote (May 12, Miss Nightingale's birthday), "to be allowed to constitute myself your gardener to the extent of doing what I have long wished--providing a flower-stand for your room and keeping it supplied with plants. I hope you will not be offended with my presumption or refuse me the great pleasure of thinking that in your daily work you may have with you a reminder of my affectionate gratitude for all you have done for our town and for me. If the plants will only flourish, as the good seed you have planted here is doing, they will be bright enough; and as for my personal obligations, you can never know how great they are to you for guiding me to and in this work." Mr. Rathbone and other kindly Liverpool men (among whom Mr. J. W. Cropper should be remembered) were equally thoughtful of Miss Jones. At their own expense they furnished rooms for her in the workhouse, and made them bright with flowers and pictures. But it was a formidable task to which she was called, and the pleasantness of her rooms made the workhouse wards look yet more terrible, she said, by contrast. A young woman, well-bred, sensitive, and refined, accustomed as yet only to well-appointed hospitals, was thrown into the rough-and-tumble of great pauper wards, where the officials, though well-intentioned, had necessarily caught something of the surrounding atmosphere. "Your kind letter," she had written to Miss Nightingale, after a preliminary visit (Aug. 1864), "came in answer to earnest prayer, and gave me courage so that even now while waiting for the committee I do not feel nervous. The governor has promised me every co-operation and told me 'not to be down-hearted if the undertaking seemed formidable at first, as he would pull me through everything.' You will laugh when I tell you how at first his want of refinement prejudiced me, but his earnest hearty initiative in the whole work has quite won me." Their relations afterwards were only indifferently good. Miss Jones's standard was too strict, he thought, for rough workhouse ways. The greatest shock to Miss Jones, however, was the nature of the human beings whom she was sent to nurse. Sin and wickedness, she said, had hitherto been only names to her. Now she was plunged into a sink of human corruption. The foul language, the drunkenness, the vicious habits, the bodily and mental degradation on all sides appalled her. The wards, she said in her first letter from the workhouse, are "like Dante's _Inferno_." "Una and the Lion"[80] was the title given by Miss Nightingale to her account of Agnes Jones and her paupers, "far more untamable than lions." She had, it is true, the help of twelve trained nurses, devoted alike to her and to their work; but there were 1200 inmates, and of the other "nurses" some were probationers of an indifferent class, and the rest "pauper nurses," of whom Miss Jones had to dismiss 35 in the first few months for drunkenness. Then, the standard of workhouse cleanliness was sadly low. She found that the men wore the same shirts for seven weeks. Bed-clothes were sometimes not washed for months. The diet was hopelessly meagre compared to a hospital standard. It is "Scutari over again," wrote Miss Nightingale, and Miss Jones was strengthened by the thought that the disciple was experiencing some of the difficulties which had beset the Mistress. By way of smoothing things over, Miss Nightingale had written to the governor of the workhouse saying, in effect, that the eyes of the world were upon him as the leader in a great reform; and he "seemed so gratified and flattered by your letter," reported Miss Jones. Miss Nightingale was constant in advice and encouragement to her disciple. "No one ever helps and encourages me as you do." "I could never pull through without you." "God bless you for all your kindness." Such expressions show how welcome and how unfailing was Miss Nightingale's help. And in every detail she was consulted. There was all the friction which usually accompanies a new experiment. There were disputes of every kind, and all were referred to Miss Nightingale--sometimes by Mr. Rathbone, sometimes by Miss Jones, sometimes by both. When things seemed critical, Mr. Rathbone would come up to see Miss Nightingale in person; on less serious occasions he would write. Miss Nightingale and Dr. Sutherland would then sit as a kind of Conciliation Board, and see how matters could be adjusted. In one of Dr. Sutherland's draft judgments submitted for Miss Nightingale's concurrence there is a blank left for her to fill, as the note explains, with "soft sawder." His breezy manner may sometimes have been of comfort to his friend. On one occasion, when everything at Liverpool seemed to be at sixes and sevens, his note to Miss Nightingale was: "I don't despair by any means. The entire proceeding has in it the elements of an Irish row, for they are all more or less Hibernian there, and they will cool down." And so they did. Miss Jones, who was at first a little too stiff-necked, soon found out a more excellent way, and there is "the Nightingale touch" in many of her later reports. "To-day they were a little cross, but I got my way all the same." She is "much amused at the manner in which she now gets all she asks for." She suggests things. She is laughed at. She persists. A decent interval is allowed to elapse; and then the things are suggested to her by the officials; she says the suggestions are excellent, and the things are done. It is obvious to Miss Nightingale and Dr. Sutherland that sooner or later the powers of the Lady Superintendent must be better defined; obvious, too, that the worthless probationers and drunken pauper "nurses" must be cleared out; but that is just one of the things that the experiment is meant to prove, and meanwhile it is enough to drive in the thin end of the wedge. So well does Miss Jones do her work that opinion, in the workhouse and outside, begins even to be impatient for the thicker end. The experiment has so far been limited to the male wards. The doctors go to Miss Jones and ask eagerly when she and more Nightingale nurses are to be given charge of the female wards also. Old women who go in to see their husbands or brothers report wonderful changes in the House since "the London nurses" came. Visiting ladies report to the same effect. The experiment is becoming popular; and the Liverpool Vestry begins to wonder whether the cost hitherto borne by Mr. Rathbone's private purse should not be thrown upon the rates. Miss Nightingale has good cause to be pleased. She has been throwing herself into the work, not only in order to make the particular experiment a success, but also because she wants to use it as a lever for promoting larger reforms. [80] See Book I. chap. iii. stanzas 4 _seq._ of _The Faerie Queene_:-- "Her angel's face As the great eye of heaven shyned bright, And made a sunshine in the shady place, etc." III Liverpool had shown the way, and Miss Nightingale resolved in her own mind that the way should be followed in London. The struggle was long and arduous; the fortune of political war went at a critical moment against her; the victory of 1867 was only partial, and indeed there are other parts of her designs which even to this day await fruition. But the insight with which from the very first, as her Papers show, she seized the essential positions was masterly. I can understand how it was that Mr. Charles Villiers, not usually given to such outbursts of admiration, exclaimed to a friend: "I delight to read the Nightingale's song about it all. If any of them had the tenth part of her vigour of mind we might expect something." The opening move in her campaign was made in December 1864. There had been an inquest on the death of one Timothy Daly, which had figured in the newspapers as "Horrible Treatment of a Pauper." The facts, as ultimately sifted, were not in this particular case as bad as they were painted in the press, but the circumstances were distressing and public opinion was excited. The situation was in that favourable condition for moving Ministers when there is a feeling in the air that "something must be done." Miss Nightingale seized the opportunity to open communications with the President of the Poor Law Board, Mr. Villiers. She did not in this first letter disclose her whole scheme, though she said just enough to show that she had considered the subject in its larger bearings. She knew the art of beginning on a moderate, and even a humble, note. She presumed to write because the case involved a question of nursing, in which matter she had had some practical experience; she had, moreover, been "put in trust by her fellow-countrymen with the means of training nurses." She described what was to be done in the Liverpool Infirmary by a Matron who had been trained under the "Nightingale Fund," and she invited the Minister's attention to the possibility of preventing the scandals, with which the newspapers were ringing, by starting some scheme of a like kind in London. This letter, in the composition of which Dr. Sutherland had a hand, went straight to its mark. Mr. Villiers at once replied (Dec. 31, 1864) that he would like to communicate with Miss Nightingale personally on the subject. In January the interview took place, and this was the beginning of a long series of personal and written communications between them during the next few years. On one occasion early in 1865 Mr. Villiers, being prevented by official business from keeping an appointment with Miss Nightingale, begged her to receive in his place his right-hand man, Mr. H. B. Farnall, Poor Law Inspector for the Metropolitan district. Mr. Farnall called, and he and Miss Nightingale became as thick as conspirators in no time. For Poor Law purposes he soon became the Chief of her Staff. Mr. Farnall was a man after her own heart. He not only knew the facts with which he had to deal, but he felt them, with something of her "divine impatience." "It's intolerable to me," he said, "to know that there are some 12,000 gasping and miserable sick poor whom we might solace and perhaps in some 5000 cases save, and yet that we have to let them wait while the world gets ready to get out of bed and think about it all." He was a keen and broad-minded reformer, and Miss Nightingale's ideas were upon lines which he too had considered. He was an old official hand, but he hated official obstruction: "all this is treason to King Red Tape, but I know that the old King is always happy _after_ a change, though he gets very red while the change progresses." Miss Nightingale instantly set her new ally to work. Here, as in all that she undertook, she knew that the first thing needful was to collect the facts. She drew up a schedule of inquiries, to be filled up with regard to all the sick-wards and infirmaries in London. "I will immediately issue your Forms," wrote Mr. Farnall (Feb. 16, 1865). He required them to be filled up in duplicate, and Miss Nightingale's set of them is preserved amongst her Papers. Throughout the year she and Mr. Farnall were engaged in the work of inspiring and incensing Mr. Villiers in the direction of radical reform. He was throughout very willing, but he was becoming an old man, he had many other things to think about, and he was apt to see lions in the path. Moreover, not all the officials at the Poor Law Board were reformers; there were those, more highly placed than Mr. Farnall, who were of a very different opinion; and some of the medical officers were inclined to dispute the necessity of any radical changes. However, on the subject of workhouse nursing, Mr. Villiers promptly authorized Mr. Farnall to press upon the Guardians the importance of employing competent nurses, and he told the House of Commons (May 5) that "in consequence of communications lately received at the Poor Law Board from Miss Nightingale, who was now taking much interest in the matter," he was hopeful that great reforms in nursing might come about. She, however, knew perfectly well that the only way to such reform was by reform also in administration and finance. In the following month Mr. Farnall persuaded his Chief to insinuate into an innocent little "Poor Law Board Continuation Bill," a clause which would enable the Board to _compel_ Guardians to improve their workhouses; but the clause was struck out, Mr. Farnall was disappointed, and Miss Nightingale wrote to reassure him. They must work all the harder to secure, not by a side-wind, but by a direct move in the next session of Parliament, a full and far-reaching measure of reform. "Your kind note," said Mr. Farnall (July 3), "has done me a world of good; there is not a single expression or hope in it which I cannot make my own. So we hope together for next year's ripened fruit. I hope, too, that we may really taste it. I pledge myself to you to relax in nothing till the task is done. It is something to live for, and something to have heard you say that such a victory will some day be claimed by me. It is a pleasant thing to think of, and I shall think of it as a soldier thinks of his Flag." So, then, Miss Nightingale set to work, with the help of Mr. Farnall and Dr. Sutherland, in elaborating a scheme for 1866. There are several drafts in her handwriting for the Memorandum finally submitted to Mr. Villiers, and many notes and emendations by Dr. Sutherland. The scheme was sent also (at a later date) to Mr. Chadwick (one of the few survivors of the famous Poor Law Commission of 1834) in order that he might submit it to John Stuart Mill, whom Miss Nightingale sought to enlist in the cause.[81] The essential points and considerations were these:-- A. To insist on the great principle of separating the Sick, Insane, "Incurable," and, above all, the Children, from the usual population of the Metropolis. B. To advocate a single Central Administration. 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 the Sick, etc., as to use all the establishments in the most economical way. [81] Mill was at the time a member of a Select Committee on the Local Government and Local Taxation of the Metropolis; see above, p. 106. The Committee did not, however, touch Poor Law Administration. 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. [82] Above, p. 115. [83] Previous legislation had _empowered_ Guardians to separate the sick, etc., but had set up no administrative or financial machinery. 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." [84] M. Husson, Director of the _Assistance Publique_, had been in London in 1865. Miss Nightingale had procured him various introductions and facilities, and he had reported his impressions to her. V Mr. Hardy kept his own counsel and made no sign. As the session drew near, Miss Nightingale became anxious and she poured in letters and memoranda upon him. In one of these she made what turned out to be an unfortunate mistake. She was too frank. She was pressing upon Mr. Hardy's attention the importance of the Liverpool experiment, and in the course of her exposition she said incidentally that there had been difficulties. Mr. Hardy misinterpreted the remark and made use of it to explain in the House of Commons why he did not propose to take any direct action in the matter of nursing reform. Indirectly, however, his proposals did a great deal. On February 8, 1867, Mr. Hardy introduced his Bill. So, legislation had, after all, been found necessary to meet the demand that something must be done. To that extent, then, Mr. Villiers had no need to make Mr. Hardy's life a burden to him. The question was, How much did the Bill do? and was what it did, good or bad? Those who had been working for reform were anxious to know what Miss Nightingale thought. "I should amazingly like to hear," wrote Mr. Villiers to her, "what you say to this seven months' child born in the workhouse at Whitehall." Mr. Ernest Hart's Association, whose attitude was summed up by Mr. Villiers as "silenced but not satisfied," applied for her opinion. Her journalistic friends wanted hints. Dr. Sutherland was told, in a note requiring his instant attention, that "X. wants to know in what tone he is to write his article in the _Daily News_," and that "Y. will write an article in the _Pall Mall_ in any sense we wish." Now, whenever a Bill is introduced touching a question which demands, or admits of, large reforms, there are two points of view from which it may be regarded. One man compares what is proposed with the existing state of things, and asks himself, Is there any decided improvement? Another, comparing the proposals with what might exist in the future, asks, Does the Bill approximate to the ideal? The former is the view which "practical politicians" take; the latter, the view which is apt to be taken by administrative enthusiasts. Miss Nightingale's administrative mind saw chiefly, and at first saw only, the points at which, and the measure in which, Mr. Hardy's Bill fell short of logical perfection. It was a tentative measure; it was largely permissive; it did something to separate the sick and the children from the ordinary paupers, but it did not do all. Moreover, so far as direct and express enactment went, it did nothing to improve workhouse nursing. Miss Nightingale pronounced the Bill, therefore, "a humbug." Its principles were "none"; its details, "beastly." She tried hard to get the Bill amended and extended. Sir Harry Verney, who might perhaps be described as "Member of Parliament for Miss Nightingale," gave every assistance that was possible; and Mr. Mill, inspired largely by his old friend Mr. Chadwick (with whom Miss Nightingale also was in constant correspondence), took a prominent part in the debates to the same end. But he seldom pressed his points to a division, and there was little life in the opposition. Mr. Villiers was as critical as he could reasonably be, but the real fact was that the Bill made a great and a surprising step in the direction which Miss Nightingale had pressed upon him. These were days in which Disraeli was educating his party in the political art of dishing the Whigs, and the difficulty was, as Mr. Jowett wrote to Miss Nightingale, to discover any clear difference between a Tory and a Radical. Mr. Mill, with the candour that became a philosopher, "had no doubt that the Bill would effect a vast improvement"; Mr. Villiers, with the determination of the politician to score a point, admitted that "the Bill would set the ball rolling," and reflected that anything might presently come from a party which had been converted "from pure Conservatism to Household Suffrage in 48 hours"; and Mr. Hardy, in his conduct of the measure, was careful to conciliate the other side. He agreed to all the objections "in principle," pleaded the difficulty of doing everything in a moment, and claimed for his Bill that it was "only a beginning." And so, in fact, it turned out; while, even at the time, the reforms made by the Bill, which became an Act on March 29, 1867, were sufficiently beneficent. The whole of the unions and parishes in London were formed, by an Order under the Act, into one district, "The Metropolitan Asylum District," for the treatment of insane, fever, and small-pox cases, which had hitherto been dealt with in the workhouses. Separate infirmaries were formed for the non-infectious sick, with a greatly enlarged cubic space per inmate. Dispensaries were established throughout the metropolis. Above all, the "Metropolitan Common Poor Fund" (the "Hospital and Asylum Rate" of Miss Nightingale's Memorandum) was established, and to it were charged the maintenance of the "asylums," medicines, etc., and the maintenance of pauper children in separate schools. When the battle was lost--or won--Miss Nightingale counted up the gains, and said, "This is a beginning; we shall get more in time."[85] And such has been the case. The Act of 1867 was the foundation on which many improvements in medical relief under the Poor Law have been laid,[86] and the principles implied in the Act--the separation of the sick from the paupers, and in the case of London the making medical relief a common charge--are likely to receive yet further recognition. They are the principles for which Miss Nightingale contended. Her influence in forming the public opinion which made the legislation of 1867 possible was referred to in both Houses of Parliament.[87] [85] Letter to the Rev. Mother of Bermondsey, March 1867. [86] The history of the matter is succinctly told in the Majority Report of the Poor Law Commission, 1909, pp. 235 _seq._ [87] By Mr. Villiers in the House of Commons, February 21; and in the House of Lords on March 19 by the Earl of Devon, who, in moving the second reading of Mr. Hardy's Bill, said: "It would be improper on such an occasion to omit reference to the improved feeling on the subject which had resulted from the admiration the country must feel for the exertions of that excellent and gifted woman, Miss Nightingale, whose name would always be received with that respect which was due to her Christian activity and self-devotion." VI Soon after the Act of 1867 came into operation, to the improvement of London workhouses, the pioneer of improved workhouse nursing died in Liverpool. The work of Miss Agnes Jones, whose early difficulties have been described above, had gone ahead with ever-increasing success. The difficulties indeed continued, and throughout 1867 Miss Nightingale was still busy in giving encouragement and advice; but the results of the work were so satisfactory that in March 1867 the Liverpool Vestry decided to extend the trained nursing to the female wards and to throw the whole cost upon the rates. When the strain of the increased work was at its severest point, Miss Jones was attacked by fever, and she died on February 19, 1868. To _Good Words_ in the following June Miss Nightingale contributed a touching paper in memory of her friend and disciple:-- She died as she had lived, at her post in one of the largest workhouse infirmaries in the Kingdom. She lived the life, and died the death, of the saints and martyrs; though the greatest sinner would not have been more surprised than she to have heard this said of herself. In less than three years she had reduced one of the most disorderly hospital populations in the world to something like Christian discipline, such as the police themselves wondered at. She had converted a vestry to the conviction of the economy as well as humanity of nursing pauper sick by trained nurses. She had converted the Poor-Law Board--a body, perhaps, not usually given to much enthusiasm. She had disarmed all opposition, all sectarian zealotism; so that Roman Catholic and Unitarian, High Church and Low Church, all literally rose up and called her "blessed." All, of all shades of religious creed, seemed to have merged their differences in her, seeing in her the one true essential thing, compared with which they acknowledged their differences to be as nothing. And aged paupers made verses in her honour after her death. In less than three years--the time generally given to the ministry on earth of that Saviour whom she so earnestly strove closely to follow--she did all this. She had the gracefulness, the wit, the unfailing cheerfulness--qualities so remarkable but so much overlooked in our Saviour's life. She had the absence of all asceticism, or "mortification," for mortification's sake, which characterized His work, and any real work in the present day as in His day. And how did she do all this? She was not, when a girl, of any conspicuous ability, except that she had cultivated in herself to the utmost a power of getting through business in a short time, without slurring it over and without fid-fadding at it;--real business--her Father's business. She was always filled with the thought that she must be about her "Father's business." How can any undervalue business-habits? as if anything could be done without them. She could do, and she did do, more of her Father's business in six hours than ordinary women do in six months, or than most of even the best women do in six days.... What she went through during her workhouse life is scarcely known but to God and to one or two. Yet she said that she had "never been so happy in all her life." All the last winter she had under her charge above 50 nurses and probationers, above 150 pauper scourers, from 1290 to 1350 patients, being from two to three hundred more than the number of beds. All this she had to provide for and arrange for, often receiving an influx of patients without a moment's warning. She had to manage and persuade the patients to sleep three and four in two beds; sometimes six, or even eight children had to be put in one bed; and being asked on one occasion whether they did not "kick one another," they answered, "Oh, no, ma'am, we're so comfor'ble." Poor little things, they scarcely remembered ever to have slept in a bed before. But this is not the usual run of workhouse life. And, if any one would know what are the lowest depths of human vice and misery, would see the festering mass of decay of living human bodies and human souls, and then would try what one loving soul, filled with the spirit of her God, can do to let in the light of God into this hideous well (worse than the well of Cawnpore), to bind up the wounds, to heal the broken-hearted, to bring release to the captives--let her study the ways, and follow in the steps of this one young, frail woman, who has died to show us the way--blessed in her death as in her life. The death of Miss Jones involved Miss Nightingale in much anxiety and additional responsibility. "The whole work of finding her successor has fallen upon me," she wrote to Madame Mohl (March 20); "and in addition they expect me to manage the Workhouse at Liverpool from my bedroom." And again (April 30): "I have seven or eight hours a day additional writing for the last two months about this Liverpool workhouse." The bundle of correspondence on the subject makes this statement quite credible. "I believe I have found a successor[88] at last. I don't think anything in the course of my long life ever struck me so much as the deadlock we have been placed in by the death of one pupil--combined, you know, with the enormous _jaw_, the infinite female ink which England pours forth on 'Woman's Work.' It used to be said that people gave their _blood_ to their country. Now they give their _ink_." Miss Nightingale's first concern was to put heart and strength into the nurses who were now deprived of their Chief. Writing as their "affectionate friend and fellow-sufferer," she called upon them to fight the good fight without flinching. "Many battles which seemed desperate while the General lived have been fought and won by the soldiers who, when they saw their General fall, were determined to save his name and win the ground he had died for. And shall we fight a heavenly battle, a battle to cure the bodies and souls of God's poor, less well than men fight an earthly battle to kill and wound?" "The nurses have been splendid," she was able to report presently. Miss Nightingale concluded her paper in _Good Words_ with a stirring appeal to others--Poor Law officials, on their part, and devoted women, on theirs--to go and do likewise. "The Son of God goes forth to war, who follows in his train? Oh, daughters of God, are there so few to answer?" The appeal awoke a response in at least one heart. One of the most valued of Miss Nightingale's disciples ascribed her call to this article in _Good Words_. "Some of us," she says, "who were children in the days of the Crimean War when Miss Nightingale's most famous work was done, were responsible girls at home, nursing as occasion arose in our families, by the light of her _Notes_, to the music of Longfellow's verse, when once again she came before us, flashing out of her retirement with the trumpet-call of 'Una.'" Many are now called to such work, but few, I suppose, are chosen--in the sense of being found worthy to do the work in the spirit of Agnes Jones. The Liverpool experiment, rendered successful by her devotion, rapidly made its mark. In ten years' time the system of employing pauper inmates as nurses had been entirely superseded, in all sick asylums and separate infirmaries, by paid nurses. In 1897 the employment of pauper nurses in any workhouse was forbidden, and the training of the paid nurses has been continuously improved.[89] To Miss Nightingale, here as in all her undertakings, each point gained was only a step on the road to perfectibility. Among some communings with herself, written in 1867, there is this entry: "Easter Sunday. Never think that you have done anything effectual in nursing in London till you nurse, not only the sick poor in workhouses, but those at home." [88] Miss L. Freeman. [89] For details on this subject, see Majority Report, 1909, pp. 240-242.