CHAPTER VII

"THE NURSES' BATTLE"; AND HEALTH IN THE VILLAGE (1885-1893) Nursing cannot be formulated like engineering. It cannot be numbered or registered like population.--FLORENCE NIGHTINGALE (1890). What can be done for the health of the home without the woman of the home? In the West, as in the East, women are needed as Rural Health Missioners.--FLORENCE NIGHTINGALE (1893). The period of Miss Nightingale's life covered in this chapter includes the year of Queen Victoria's Jubilee; which was also what Miss Nightingale used to consider _her_ Jubilee Year. She fixed her effectual call at February 7, 1837. In 1887 she had thus completed fifty years vowed to service. In August, a month of many memories to her, she looked back over the past and around her in the present, and was in a despondent mood:-- (_Miss Nightingale to Mrs. S. Smith._) CLAYDON HOUSE, _Aug._ 5 [1887]. DEAREST AUNT MAI--Thinking of you always, grieved for your suffering, hoping that you have still to enjoy. In this month 34 years ago you lodged me in Harley St. (Aug. 12). And in this month 31 years ago you returned me to England from Scutari (Aug. 7). And in this month 30 years ago the first Royal Commission was finished (Aug. 7). And since then, 30 years of work often cut to pieces but never destroyed. God bless you! In this month 26 years ago, Sidney Herbert died, after five years of work for us (Aug. 2). In this month 24 years ago, the work of the second Royal Commission (India) was finished. And in this month this year it seems all to have to be done again. And in this month this year the work at St. Thomas's Hospital seems all to have to be done again--changing Matrons--after 27 years. And in this month this year my powers seem all to have failed and old age set in. May the Father Almighty, Irresistible--for Love is irresistible--whose work and none other's this is, conduct it always, as He has done, while I have misconducted it. May He do _in_ us what He would have us do. God bless you, dearest Aunt Mai. As ever your old loving FLO. And in this month, too, Florence Nightingale was to die; but nearly a quarter of a century of life was first granted to her, and for the greater part of the time she remained in full possession of her faculties. Though she might be an "old lady" to young nurses, others remarked that she looked wonderfully fresh and youthful for her years. If old age had set in, her powers had by no means failed, and in many directions her work, though sometimes sore beset, continued to prosper. We will take first in our survey her work in the nursing world. The "change of matrons" at St. Thomas's Hospital, caused by the retirement of Mrs. Wardroper, was hardly such a tragedy as it seemed to Miss Nightingale. Mrs. Wardroper had done her work, and there were younger women competent to fill the place. Mr. Jowett often begged Miss Nightingale to remember that "there is no necessary man--or woman"--"not even," as, greatly daring, he once added, "yourself." But in this case the Chief of the Nightingale School was not yet retiring, and she would still be able to supervise it--perhaps even more closely under a new Matron. For many years Miss Nightingale continued to maintain the intimate touch with her School that has been described in an earlier chapter: seeing the Sisters constantly, making the personal acquaintance of nurses, conferring with their medical instructors, reading their diaries and examination papers. Her heart was even more closely in the work when she secured the appointment, as Mrs. Wardroper's successor, of her dear friend, Miss Pringle. Presently, however, there came what was a heavy blow to Miss Nightingale. Miss Pringle joined the Roman communion, and it was necessary that she should retire from the Matronship of St. Thomas's. The months of unsettlement before the conversion was made were full of grief to Miss Nightingale. Indeed her notes and meditations suggest that the "loss" of her favourite pupil was one of the heaviest griefs of her life; but she loved her friend too well for the sorrow to leave any abiding bitterness. Over and over again in her meditations she wrote down lines from Clough's _Qua Cursum Ventus_. Miss Pringle was succeeded by Miss Gordon, an old pupil of the Nightingale School; she and Miss Nightingale speedily became the best of friends, and things went on much as before in the School. All these changes, with the delicate weighing of rival claims and sometimes with the worrying conflict of personal ambitions, caused Miss Nightingale heavy anxiety. Intensely conscientious, acutely sensitive, and seeing in every change a great potentiality of good or evil, she could not treat such things as mere matters of business. There have been Prime Ministers who could not sleep of nights under the sense of responsibility caused by ecclesiastical preferment; and to Miss Nightingale the selection of a Superintendent or a Home Sister was even as the appointment of a bishop. II The movement for District Nursing, which was always near to Miss Nightingale's heart, and which, in conjunction with Mr. Rathbone and others, she had done much to promote, received considerable extension by the action of Queen Victoria in 1887. The bulk of the sum presented as the "Women's Jubilee Gift" was devoted by the Queen to "the nursing the sick poor in their own homes by means of trained nurses." She appointed the Duke of Westminster, Sir Rutherford Alcock, and Sir James Paget to be trustees of the Fund, and to advise upon its administration. Sir James Paget consulted Miss Nightingale, who, in several conversations, impressed upon him her view that the essential things were the training of nurses for the work, and the association of them in "Homes." The lines of the "Metropolitan District Nursing Association," which had for many years been largely supported by nurses trained in the Nightingale School and by grants from the Nightingale Fund, were adopted as the basis of the "Jubilee Institute for Nurses," and the Association presently became affiliated to the Institute. In an introduction which she contributed in 1890 to a book giving account of these matters,[217] Miss Nightingale struck a warning note. "The tendency is now to make a formula of nursing; a sort of literary expression. Now, no living thing can less lend itself to a formula than nursing. Nursing has to nurse living bodies and spirits. It must be sympathetic. It cannot be tested by public examinations, though it may be tested by current supervision." The Royal Jubilee Institute in some ways advanced Miss Nightingale's cause, but she had misgivings. "_Vexilla regis prodeunt_; yes, but of which King?" Was the oriflamme, which was now beginning to wave above the nursing sisterhood, "of heavenly fire, or of terrestrial tissue?" "We are becoming the fashion," Miss Nightingale was fond of saying; "we must be on our guard. Royalty is smiling on us; we must have a care." Such misgivings were speedily to be justified. [217] See Bibliography A, No. 120. The nursing world was for some years rent in twain by a dispute about Royal Charters and Registration. The controversy lasted for seven years (1886-93); Miss Nightingale was in the thick of it, and during the more critical period of the dispute (1891, 1892) it was her main public preoccupation. In 1886 the Hospitals Association[218] appointed a Committee to inquire into the possibility of establishing a General Register of Nurses. The Committee violently disagreed; in 1887 the majority retired, and the minority founded the British Nurses Association with a view to carrying forward a scheme of Registration. In 1888 the Hospitals Association appointed a second committee which proceeded to collect opinions from the various Nurse Training Schools. These Schools were for the most part opposed to the idea of a General Register; but there was difference of opinion among leaders alike in the medical profession and in the nursing world. "I have a terror," wrote Miss Nightingale to Mr. Bonham Carter (April 20, 1889), "lest the B.N.A.'s and the anti-B.N.A.'s should form two hostile camps, judging one another by that test chiefly or alone. This would be disastrous. The Unionists and the Home Rulers show us an example of what this is. They are two hostile camps, dividing families. It is like a craze. The test, _e.g._ even of a good doctor or of an acquaintance is, to which camp does he belong? Even a doctor, canvassing for an appointment, is asked whether he is Home Ruler or Unionist. I can remember nothing so distressing since the Reform Bill, which I remember very well, when the two sides would not meet each other at dinner." I do not know that feeling between the pro-Registrationists and the anti-Registrationists went to the length of war-to-the-knife-and-fork; but the "Nurses' Battle" (as it was called in the newspapers) was hot and prolonged. From a fighting point of view, the two sides were fairly matched. On each side there were eminent doctors. The "anti's" had an advantage in that they included the greater number of those who had the longest and closest knowledge of nurse-training; but the "pro's" had a Princess at their head. The Princess Christian had accepted the presidency of the British Nurses Association; and when the time came for applying for a Charter, it was the Princess who petitioned the Queen. "This makes it awkward for us," said Mr. Rathbone to Miss Nightingale; and undoubtedly it did. There were courtly personages even among Miss Nightingale's devoted adherents who were inclined to trim; and there were other persons, who, having never perhaps thought out the questions, were predisposed to do as the Princess did. Let each man in the battle have such credit as is due for his personal loyalty. "In any matter of nursing, Miss Nightingale is my Pope," wrote Mr. Rathbone, "and I believe in her infallibility." "Nothing can save us," he said to Miss Nightingale herself, "except your intervention." She was not slow to give it. Suggestions were made by intimate friends--Sir Henry Acland and Sir Harry Verney--that she should see the Princess Christian and endeavour to come to terms; and later on, in 1893, when the Empress Frederick visited Miss Nightingale, they renewed the suggestion. But the Princess Christian had made no overtures; she was committed to the particular scheme advocated by the Association of which she was President; and, to Miss Nightingale, opposition to that scheme was a matter of vital principle. She threw herself into the fray with an equipment of argumentative resource derived from her unequalled experience, and with a passionate conviction inspired by long brooding over a fixed ideal. [218] An Association founded by Sir Henry Burdett, out of which came the Nurses National Pension Scheme (a scheme which Miss Nightingale much commended). She took a different view of his Directory of Nurses. The objects of the British Nurses Association were "to unite all qualified British Nurses in membership of a recognized Profession"; "to provide for their Registration on terms satisfactory to physicians and surgeons as evidence of their having received systematic training"; "to associate them for mutual help and protection and for the advantage in every way of their professional work"; and "with a view to the attainment of these objects, to obtain a Royal Charter incorporating the Association and authorizing the formation of a Register."[219] It was around the second and the fourth of these objects that the principal battle raged. The case of the Association was _prima facie_ a strong one. A Register of Nurses, duly certified as competent, would, it was argued, be a protection against impostors. The certification was to be by a Board which would insist on a certain standard of professional proficiency. Three years' training in a hospital was suggested as the preliminary test. The case, on the other side, as developed by Miss Nightingale and her allies, was that the apparent advantages of a Register were deceptive. Who was to be protected? Not the hospitals: they protected themselves, without any general register, by their own methods. If any one was to be protected, it must be the public; but the Register would rather mislead than protect them. The placing of a name on a register would, at best, only certify that at a certain date the nurse had satisfied the required tests; but the date might be long ago, and the fact of registration would tell nothing of her subsequent conduct or competence. The registration of midwives stood on a different footing from that of nurses; for in the former case, a certain definite technical skill is of the essence of the matter: in the case of nursing, character is as much of its essence as any technical qualification. As for the three years' training in a hospital, there were hospitals and hospitals, training-schools and training-schools; and who was to guarantee the guarantors? The General Register would not raise the profession of nursing; it would do an injury to the better nurses by putting them on a level with the worse, and to the profession by stereotyping a minimum standard. The British Nurses Association had published a preliminary "register." Miss Nightingale analysed it, and found that in the case of nurses "trained" at one hospital, the private Register of that Hospital excluded nearly one-third of those entered on the B.N.A.'s register; and that another Hospital's Register included, as "duly certificated," only one-third of those entered on the B.N.A.'s register as trained thereat. "You cannot select the good from the inferior by any test or system of examination. But most of all, and first of all, must their moral qualifications be made to stand pre-eminent in estimation. All this can only be secured by the current supervision, tests, or examination which they receive in their training-school or hospital, not by any examination from a foreign body like that proposed by the British Nurses Association. Indeed, those who come best off in such would probably be the ready and forward, not the best nurses."[220] The much vexed question of "internal" or "external" examination was, it will be seen, involved in this dispute. But to Miss Nightingale a larger and a more vital issue was at stake. It was a conflict between two ideals--or rather, as she would have said, between a high ideal and a material expediency. Mr. Jowett, though he agreed in her view "that nurses cannot be registered and examined any more than mothers," was distressed that she was so greatly perturbed over what seemed to him so small a matter. "It is a comparative trifle," he wrote (May 26, 1892), "among all the work which you have done, and you must not be over-anxious." To Miss Nightingale it was not a trifle, but a trial--a possible parting of the ways. It was diverting attention from training-homes to examination-tests; it was sacrificing a high calling to professional advancement. "There comes a crisis," she wrote to Mr. Jowett (May), "in the lives of all social movements, rough-hew them as you will, when the amateur and outward and certifying or registering spirit comes in on the one side, and the mercantile or buying-and-selling spirit on the other. This has come in the case of Nursing in about 30 years; for Nursing was born about 30 years ago. The present trial is not persecution but _fashion_; and this brings in all sorts of amateur alloy, and public life instead of the life of a calling, and _registering_ instead of _training_. On the other hand, an extra mercantile spirit has come in--of forcing up wages, regardless of the truism that Nursing has been raised from the sink it was, not more by training, than by making the Hospital, Workhouse Infirmary, or District Home a place of moral and healthful safe-guards, inspiring a sense of duty and love of the calling." The true way of "protecting the public" was "to extend Homes for Private Nurses on sound lines, aided by the Nurses' Training Schools and Hospitals"; not, by means of a Chartered Register, to encourage nurses "to flock to the Institutions which gave the easiest certificate at the least trouble of training." Miss Nightingale could not, then, regard the dispute as a trifle. It caused her days and nights of grievous anxiety. Her meditations are full of despondency and searchings of heart both bitter and self-reproachful. The Princess Christian, with the best intentions, was giving her name to undermine Miss Nightingale's ideal. This could not justly be attributed in blame to the Princess; the fault must have been with her, Florence Nightingale, who had misused her opportunities, and had failed to impress her ideal on other minds. She was an unprofitable servant. But here, as in all things, the sensitive reproaches of the night-watches left no trace of themselves on the work of the day; or rather, they left their trace in greater activity and devotion. [219] Proceedings of First General Meeting, February 24, 1888. [220] Letter from Miss Nightingale to Mr. Rathbone, read to the Privy Council: see p. 90 of the book cited below (p. 362 _n._). It was in 1889 that the occasion came for resolute action. The British Nurses Association announced their intention of applying for a Charter, and proceeded to enlist public support. Miss Nightingale set to work on the other side. She made the acquaintance at this time of Miss Lückes, then, as now (1913), the Matron of the London Hospital, who was strongly opposed to the idea of registration. The acquaintance speedily ripened into friendship, and henceforth Miss Nightingale was looked to for support and sympathy by the Matron of the London, hardly less than by her of St. Thomas's. Other nurse-training schools came into line, and a manifesto was issued announcing their intention to oppose any petition for a Charter. There was desultory skirmishing for some time between the Registrationists and anti-Registrationists. There was a lively polemic in the newspapers. There were as many fly-sheets and pamphlets as if it were a theological dispute in a University.[221] In 1891 the British Nurses Association applied to the Board of Trade to be registered as a Public Company, without the addition of the word "Limited" to its name. The Memorandum and proposed Articles of Association were duly filed, and the foremost place was again given, among the declared objects, to a register of trained nurses, and to power to determine from time to time the test for registration. Miss Nightingale and her allies took up the challenge. Through Sir Harry Verney she approached the President of the Board of Trade (Sir Michael Hicks-Beach) with a statement of the case against the Association. A counter-petition was presented; and after full consideration the Board refused the application. The first engagement had thus resulted in a victory for Miss Nightingale. In the same year there was a Committee of the House of Lords to inquire into the London Hospitals. Mr. Rathbone, coached by Miss Nightingale, gave evidence on the question of the registration of nurses, and the Committee reported against it. A second victory! But the Registrationists now brought up their most formidable reserves. Permission was obtained from the Sovereign to use the title "Royal." Thus strengthened by favour in the highest quarter, the Royal British Nurses Association petitioned the Queen for a Royal Charter. The petition was referred in the usual course to a special Committee of the Privy Council, and the two sides marshalled their forces. A campaign fund was raised by the anti-Registrationists. Miss Nightingale appealed privately to the Lord President of the Council and wrote various letters, Memoranda, Statements. She enlisted support from the medical profession. Her old pupils, now in charge of nurse-training schools throughout the country, rallied round her. Two petitions, of special weight, were presented to the Privy Council against the Charter. One was from the Council of the Nightingale Fund, the body which had been the pioneer in promoting the training of nurses. The other was the "Petition of Executive Officers, Matrons, Lady Superintendents, and Principal Assistants of the London and Provincial Hospitals and Nurse Training Schools, and of Members of the Medical Profession and Ladies directly connected with Nursing and the Training of Nurses." The list of signatures, which occupies twenty-three folio pages, was headed by "Florence Nightingale." In the preparation of these documents, Miss Nightingale had a large share, though much of the work--especially in the instruction of the lawyers, in consultations and so forth--was done by Mr. Bonham Carter. [221] On Miss Nightingale's side two of the most effective pieces were: _Is a General Register for Nurses Desirable?_ by Henry Bonham Carter (Blades, 1888), and _What will Trained Nurses gain by joining the British Nurses Association?_ by Eva Lückes (Churchill, 1889). The Committee of the Privy Council sat in November 1892 to hear the case.[222] Of the first day's proceedings Miss Nightingale wrote an account in which, as will be seen, she did not let the Registrationist dogs have the better of it, but which betrays at the same time serious anxiety about the result:-- (_Miss Nightingale to Sir Harry Verney._) 10 SOUTH STREET, _Nov._ 22 [1892]. Yesterday was the first day of the Privy Council Trial. We had to change our senior counsel at the last moment, because Mr. Finlay was engaged on an Election Committee. And our previous four days were, therefore, as you may suppose, very busy. We were fortunate enough to have Sir Richard Webster. Sir Horace Davey opened the Ball on behalf of Princess Christian. His speech was dull, and contained only the commonplaces we have heard for a year in favour of the Royal Charter. The Judges were: Lord Ripon (who only stayed half the time), Lord Monson, and two Law Lords [Lord Hannen and Lord Hobhouse]. They appeared to have been chosen as knowing nothing of the matter and as not having been on the Lords Committee on Hospitals. Our side, Sir Richard Webster, followed with a masterly speech--masterly from being that of a shrewd man of sense, without rhetoric, and from his splendid getting up of our case at short notice. He put very strongly our contention that character, _unregistrable_, rather than technical training, makes the nurse, and other of our points. The Judges adjourned till Monday in the middle of his speech where he was saying as we do--What is the use of saying that a Nurse has had 3 years' training at such a Hospital? how can you certify the Hospital? He will resume this subject and others on Monday. The Judges asked all the questions--_not_ to the point--that you can fancy men perfectly ignorant of the subject to ask, and which we have answered over and over again. Sir Richard Webster said to Bonham Carter at the end of yesterday, "The judges are dead against us." The Charter pledges itself to admit on the Register only nurses of three years' Hospital training--which the Judges pronounced could do no harm. But it provides for itself what may put into its hands the whole control of what constitutes training. Is it not wonderful these men do not see this? Well, "we are in God's hands, brother, not in theirs" (the Privy Council's). In all my strange life through which God has guided me so faithfully (O that I had been as faithful to Him as He to me!), this is the strangest episode of all--to see a number of Doctors of the highest eminence giving their names to what they know nothing at all about. Sir James Paget told me himself that the names were asked for at a Court Ball,--following each other like a flock of sheep; to see their Council of Registration made up of _Sirs_, only one of whom knows anything about nurse-training (Sir James Paget himself asked me, why can't nurses lodge out as students do!!); to see these able, good, and shrewd men ignoring that such a thing is sure to fall into a clique. They have let Princess Christian fall into such an one already. She is made a tool of by two or three people. "Lift up your heads, ye gates, and the King of Glory shall come in. Who is the King of Glory? The Lord strong in battle." O God of Battles, steel thy soldiers' hearts against happy-go-luckiness, against courtiership, fashion, and mere money-making on the part of the Nurses and their Societies! _P.S._ This trial will cost us £700 at least. [222] A verbatim report of the hearing (Nov. 21, 28) was published in 1893 entitled _The Battle of the Nurses_ (Scientific Press). The Committee took time to consider their advice to Her Majesty. In May 1893 the decision was announced. The Committee advised Her Majesty in Council to grant a Charter in accordance with a Draft revised by them. On June 6 the Charter was granted. Each side claimed the victory. The _Nursing Record_ (June 15)--an organ of the Registrationists--claimed that they had won all, and even more than all, that they asked, and declared proudly that henceforth "members of the Royal Chartered Association will hold a higher position than any others." The _Hospital_, on the other side, argued that all this was ill-founded, but if the "British Nurses" wanted to be congratulated on nothing, "we are willing to congratulate them" (June 24). The fight before the Privy Council now became a fight in the press on the meaning of the verdict. The anti-Registrationists, headed by Miss Nightingale and the Duke of Westminster, put their interpretation in a quiet letter to the _Times_ (July 3), which the Royal British Nurses Association hotly denounced as "untrue in fact and injurious in intention" (July 6). The fact was that the Lords of the Council had steered a middle course. They granted the Charter; but in it for the words "the maintenance of a list or _register_ of nurses, showing as to each nurse registered," etc., they substituted the words "the maintenance of a list of persons who may have applied to have their names entered therein as nurses," etc. There was nothing in the Charter which gave any nurse the right to call herself "chartered" or "registered." What the promoters hoped we need not discuss; what the opponents feared was a Charter in such terms as would give the Corporation an authoritative, and perhaps ultimately, an exclusive right to register nurses, and thereby would give it also indirect control over nurse-training. No such Charter was obtained; and in this sense the opposition of Miss Nightingale and her friends had prevailed. The controversy is not dead; but, so far, her view has continued to prevail,[223] and the official registration of nurses is still a pious hope to its supporters, a heresy to its opponents. Miss Nightingale greatly deplored the feud, but sought to bring good out of evil. "Forty years hence," she wrote to Mr. Rathbone (Feb. 26, 1891), "such a scheme might not be preposterous, _provided_ the intermediate time be diligently and successfully employed in levelling up, that is, in making all nurses at least equal to the best trained nurses of this day, and in levelling up Training Schools in like manner." "Great good may be done," she wrote to Mr. Jowett (May 1892), "by rousing our side to an increased earnestness about (1) providing Homes for Nurses while engaged in their work of nursing, and (2) full _private_ Hospital Registers, tracing the careers of nurses trained by them." There were no years in which Miss Nightingale herself gave more thought and trouble, than in 1891-3, to personal care for the affairs of the Nightingale School. [223] See the report of a deputation to the Prime Minister in the _Times_, April 29, 1913. In a Paper which Miss Nightingale was invited to contribute to a Congress on Women's Work, held at Chicago in 1893, she treated the whole subject of nursing.[224] This paper embodies in a methodical form her characteristic views, and in it she takes occasion in several places to touch obliquely upon the controversy described in preceding pages. "A new art, and a new science, has been created since and within the last forty years. And with it a new profession--so they say; we say, _calling_." She dwells on the conditions necessary to make a good training school for nurses. She dilates upon the dangers to which nursing is subject. These are "Fashion on the one side, and a consequent want of earnestness; mere money-getting on the other side; and a mechanical view of nursing." "Can it be possible that a testimonial or certificate of three years' so-called training or service from a hospital--_any_ hospital with a certain number of beds--can be accepted as sufficient to certify a nurse for a place in a public register? As well might we not take a certificate from any garden of a certain number of acres, that plants are certified valuable if they have been three years in the garden?" Then there was "imminent danger of stereotyping instead of progressing. No system can endure that does not march. Objects of registration not capable of being gained by a public register!" The whole paper is written with a good deal of gusto. The volume in which it appeared was dedicated to Princess Christian. [224] Bibliography A, No. 131. In the following year Miss Nightingale had some correspondence with the Princess, who, as President of the Royal British Nurses Association, had made a scheme for enrolling a "War Nursing Reserve" through the Hospitals, and had written to consult Miss Nightingale about it. The Hospital Sisters were according to this scheme to be placed "in subordination to the Army Sisters"--nurses with the larger experience under those with the smaller. This seemed to Miss Nightingale a mistake; and she noted other details in which the scheme appeared to her inadequately considered. She pointed these things out faithfully to the Princess, but the correspondence on both sides was cordial. The letters from the Princess made Miss Nightingale exclaim, "How gracefully Royalty can do things!" And on her part she desired to be conciliatory. "We should, I think, be earnestly anxious," she wrote, "to do what we can for Princess Christian as she holds out the flag of truce, in order to put an end as far as we can to all this bickering, which does such harm to the cause." There were thoughts in Miss Nightingale's mind throughout this controversy still deeper than any which have yet been noticed. She had an esoteric conception of Nursing which made her regard the view of it as a registrable business in the light almost of sacrilege. "A profession, so they say; we say, _calling_." And not only a calling, but a form through which religious satisfaction might be found. Her view comes out in a letter which she wrote to Mr. Jowett in 1889 in the course of a discussion with him upon the necessity of external forms for the religious life: "You say that 'mystical or spiritual religion is not enough for most people without outward form.' And I may say I can never remember a time when it was not the question of my life. Not so much for myself as for others. For myself the mystical or spiritual religion as laid down by St. John's Gospel, however imperfectly I have lived up to it, was and is enough. But the two thoughts which God has given me all my whole life have been--First, to infuse the mystical religion into the forms of others (always thinking they would show it forth much better than I), especially among women, to make them the 'handmaids of the Lord.' Secondly, to give them an organization for their activity in which they could be trained to be the 'handmaids of the Lord.' (Training for women was then unknown, unwished for, and is the discovery of the last thirty years. One could have taken up the school education of the poor, but one was specially called then to hospitals and nursing--both sanitation and nursing proper.) This was then the 'organization' which we had to begin with, to attract respectable women and give religious women a 'form' for their activity.... When very many years ago I planned a future, my one idea was not organizing a Hospital, but organizing a Religion." Now, "handmaids of the Lord" cannot be certified by external examiners, nor can a religious service be guaranteed by registers. Does this view of the matter seem a little transcendental? It was in accord, at any rate, with another of Miss Nightingale's fundamental doctrines, which in its application to the controversy had a severely practical force. Nursing, she held, is a progressive art, in which to stand still is to go back. No note is more often struck in her Addresses to Nurses. She held, as may already have been gathered from the foregoing summary of her case, that the Registrationists, consciously or unconsciously, had lost hold of that essential truth about nursing. It was right that precautions should be taken against impostors, and that the fullest inquiries should be made. Miss Nightingale's objection was not to the precautions, but to their misleading nature; not to the tests, but to their inadequacy. The only real and sufficient guarantee, in the case of an art in which the training, both technical and moral, is a continuous process, was, she held, that the public should be able to obtain a _recent_ recommendation of the nurse, who was to be passed on from one doctor, hospital, or superintendent to another with something of the same elaborate record of work and character that she herself required in the case of Nightingale Probationers and Nurses. III The fate of Miss Nightingale's work in the cause of Public Health both in India and at home was chequered during these years, even as was that in the cause of trained nursing, but here again substantial advance was made in several directions. There was once a Secretary of State who entered the India Office possessed by a strong and personal interest in sanitation. There was some excitement in the Office. There were one or two men around the Minister who heartily approved; there were more who shook their heads. The Minister must have been listening, they thought, directly or indirectly, to a certain lady's "beautiful nonsense." He was too impressionable. He was anxious to do things, in spite of the claims of economy. He was too much in a hurry. They took him in hand in order to quiet him down. They thought to have succeeded in making him satisfied to leave things as they were. The other side became conscious of a change. "It is essential," wrote one of them to a certain lady, "that you should see him at once." The lady, who was the hope of one side and the fear of the other, was Miss Nightingale. The Minister need not be identified; for these things, though true also of a particular case and time, are here given as a general allegory. For thirty years and more, through all changes and chances in the political world, Miss Nightingale was a permanent force, importuning, indoctrinating, inspiring, in the interests of better sanitary administration. For some time after the early months of 1885 the political situation was very unsettled. The Government formed by Lord Salisbury after the defeat of Mr. Gladstone in June was only a "Cabinet of Caretakers," and it was not worth Miss Nightingale's while to approach any of them. Besides, she instinctively recognized the Secretary of State for India as a hopeless subject. She was right. Lord Randolph Churchill was all against Lord Ripon, and all for economy. When Lord Salisbury's Government was in turn overthrown, after the general election in December, Miss Nightingale, through various channels, approached Mr. Gladstone, and begged him to send Lord Ripon to the India Office. He returned polite but evasive answers, and so controversial an appointment was obviously improbable. Lord Ripon went to the Admiralty. The excitement of the first Home Rule Bill followed; the Government was defeated; another general election was necessary, and all was in confusion. Dr. Sutherland, anxious to retire from the public service (for he was now nearly 80), was pressing Miss Nightingale to devise measures for safeguarding his department after he was gone. She pressed him to stay on yet a while. "During the political earthquakes of the last 8 months, still continuing, no permanent interest can be expected," she wrote to him (July 20, 1886), "in those who are so little permanent. The subject excruciates me." Lord Ripon, who came to see her ten days later, thought that the times were unpropitious generally for good causes--an opinion which defeated Ministers are apt to hold. "There are waves in these matters," he said. "The thing is to come in upon the crest of the waves. You would have done nothing for the Army and Sanitation if it had not been for the crash in the Crimea. Now, the wave is against India." Miss Nightingale, however, did not allow herself to be tempted into inactivity by this wave-theory. For the moment, indeed, there was nothing to be done with Ministers at home; but she had not been neglectful of cultivating relations with Anglo-Indians and Indians in positions of influence. In 1885 she had added Sir Neville Chamberlain and Sir Peter Lumsden to her list of Anglo-Indian acquaintances. Lord Reay had called upon her (March 1885) before leaving to take up the governorship of Bombay, and she corresponded with him frequently on sanitary subjects. In October, Lord Roberts came before going out to India as Commander-in-Chief. Miss Nightingale took great pains with this interview, Dr. Sutherland having furnished her in advance with an admirable synopsis of what might still be done to improve the health and welfare of the troops. Lord Roberts's command was fruitful of some reforms in which Miss Nightingale had been a pioneer. He established a club or institute in every British regiment and battery in India. He closed canteens. He opened coffee-stalls. He established an Army Temperance Association.[225] No letter which Miss Nightingale received in her Jubilee Year can have pleased her more than one which the Commander-in-Chief in India sent her from Simla on August 6. In this letter Lord Roberts told her that the Government of India had sanctioned the employment of female nurses in the Military Hospitals. A commencement was to be made at the two large military centres of Umballa and Rawalpindi, and 18 nurses, with lady superintendents in each case, were to be sent out from England at once. The selection of nurses was entrusted to Surgeon-General Arthur Payne, who in the following month had several interviews with Miss Nightingale. Thus, after twenty-two years, was the scheme which she had put before Sir John Lawrence brought to fruition. Miss Nightingale saw the Superintendents before they went out, and letters from them were now added to the pile of those which she received from hospitals throughout the world, reporting progress or asking advice. Miss C. G. Loch wrote from Rawalpindi (April 12, 1888) describing how she had found that, as Miss Nightingale always said, the education of the Orderlies was the most important thing for the nurses to do. [225] See his _Forty-one Years in India_, chap. lxvi. The official introduction of female nursing into the Indian military hospitals was by no means the only satisfaction which Miss Nightingale received during Lord Dufferin's Viceroyalty. He had declared himself ignorant of Indian sanitary things, but had promised to learn; and not only was he as good as his word, but Lady Dufferin was keenly interested also. She founded the "National Association for Supplying Medical Aid to the Women of India." Miss Nightingale had long been interested in the subject, and Lady Dufferin consulted her at every stage. One of the first things needful, Lady Dufferin had written (Sept. 19, 1885), was a supply of Sanitary Tracts. "In using the word tract, I am thinking of some little books in Hindustani written by A.L.O.E. which I am obliged to read as part of my studies in the language. They are stories with a moral, and I don't see why something of the kind might not be published with health as a moral." Miss Nightingale took great pains in collecting suitable raw material, and during the remainder of Lord Dufferin's Viceroyalty wrote to her by almost every mail. IV Yet more was to be "fired," during Lord Dufferin's Viceroyalty, of sanitary "shot" supplied, as he had requested, by Miss Nightingale; but we must now turn back to London, where, partly from circumstances and partly of necessity, Miss Nightingale was presently engaged in a vigorous campaign. There is a large bundle of correspondence during these years upon a matter which is referred to in some of the letters as "The Sutherland Succession." Now, Dr. Sutherland was in Miss Nightingale's eyes the indispensable man. Not any longer in the personal sense, as described in an earlier chapter; for he was now a very old man, and was only able to help her on rare occasions. She had already found a successor in this personal sense, or rather she had put Dr. Sutherland's place into commission. Sir William Wedderburn was during these later years her most constant collaborator in Indian matters, and for the rest she relied upon Sir Douglas Galton.[226] She had often chafed at Dr. Sutherland's delays, but I expect that when Sir Douglas succeeded to him she may in one respect have parodied to herself the well-known Cambridge epigram, and said, "Poor Dr. Sutherland! we never felt his loss before." For Sir Douglas Galton, though devoted also to Miss Nightingale's service, was an exceedingly busy and much-travelling man, and she had to be content with the crumbs of his time. "As it was some time in the dark ages," she wrote (May 13, 1887), "since I saw you last--my memory impaired by years cannot fix the date within a decade--I seize the first day you kindly offer." And again (Dec. 3, 1889): "I must take your leavings, as beggars must not be choosers. Yes, please, your dog will see you to-morrow on your way from Euston for as long as you can stop." Miss Nightingale relied greatly on Sir Douglas Galton's advice; she had a very high opinion, not only of his thorough knowledge of all sanitary subjects, but of his sound judgment generally. From the personal point of view, then, Dr. Sutherland was gone already; but in his official capacity he was still indispensable. He was the mainspring of the system of sanitary administration, both for the home Army and for India, which Miss Nightingale had built up. He was the one paid working member, and he was also the working brain, of the Army Sanitary Committee, and it was to that Committee that Indian sanitary reports were referred. But he was impatient to retire. At any moment his health might become worse, and he might send in his resignation before arrangements had been made for the appointment of a successor. So long as he remained at his post, no changes were likely to be made; but if he retired, it was very probable that no successor would be appointed, and that the whole system would collapse. That the heads of the Army were ignorant of Dr. Sutherland's services, had been burnt in upon Miss Nightingale's mind a few years before. In discussing some matter of army nursing with the minister of the day, she had suggested the reference of it to Dr. Sutherland. "Who is he?" said the minister; "I have never heard of him." At the India Office it was much the same. "I don't think," wrote a friend (Sept. 8, 1886), "that this office in general appreciates the importance of those reviews of Indian sanitary matters of which Dr. Sutherland has been the real author hitherto." The whole system would lapse, he feared, unless she was able to do something. [226] Captain Galton was knighted in 1887. Nor was this all. The sanitary service in India itself was in danger. The annexation of Burma had made retrenchment necessary; a Finance Committee was at work in recommending economies; and Miss Nightingale received private information that the Sanitary Commissioners were marked down by the Committee for destruction. The whole edifice thus seemed to be crumbling. This was what she had in her mind when, in the Jubilee retrospect quoted at the beginning of the chapter, she said that the work of thirty years had all to be done again. She turned with all her old energy to efforts commensurate to the threatened calamity. In accordance with her usual method, she first consulted many influential friends (Lord Ripon amongst others), and then acted with great energy. She wrote a long statement to Lord Dufferin (Nov. 5). "I have sent your letter _in extenso_," he replied (Jan. 18, 1887), "to the head of the Finance Committee. You should understand that it does not at all follow, because the Committee recommend a thing, that their recommendation will, as a matter of course, be accepted by the Government. On the contrary, I will go most carefully into this question in which you naturally take so deep an interest, and will be careful to have it thoroughly discussed in Council by my colleagues with the advantage of having had your views placed before them." A few months later came welcome news:-- (_Lord Dufferin to Miss Nightingale._) SIMLA, _August_ 20 [1887]. I write you a little line to tell you that the Indian Government have finally determined not to sanction the proposals of the Finance Commission for the abolition of the Sanitary Commissioners, about which you were naturally alarmed. There is no doubt that the Finance Commission was in a position to prove that these officers had been able to do very little, owing to the unwillingness, or rather the inability of the local Authorities to supply funds, and in some cases to their own listlessness and want of energy. We are now, however, taking the question up, and the result of the attack upon your protégés will be, not their disappearance, but their being compelled to give us the worth of the money we spend upon them. I am also inviting all the local governments to put the whole subject of sanitation upon a more satisfactory footing, and to establish a system of concerted action and a well-worked-out programme in accordance with which from year to year their operations are to be conducted. I cannot say how grateful I am to Sir Harry Verney for his kindness in writing me such interesting and pleasant letters. In them he tells me from time to time, I am afraid I cannot say of your well-being, but of your unflagging energy in the pursuit of your noble and useful aims. Meanwhile Miss Nightingale had been busy with Ministers at home. In the latter half of 1886 Lord Salisbury's Government was firmly seated, and she received visits from the Secretaries of State for India and for War (Lord Cross and Mr. W. H. Smith). She found Lord Cross most sympathetic; he saw her from time to time during following years, and they had a good deal of correspondence. To Mr. W. H. Smith she paid her highest compliment; in some ways he reminded her, she said in her notes, of Sidney Herbert. Superficially, and in several of their real characteristics, no two men could be more unlike; but in certain respects Mr. Smith resembled her ideal of a War Minister. He had a sincere concern for the welfare, alike physical and moral, of the soldiers; and he showed a quick and industrious aptitude for administrative detail. She saw Mr. Smith several times, and at his request had an interview with the Chaplain-General.[227] It seemed as if the work, which she had done with Sidney Herbert, might be resumed with Mr. Smith, when there was a thunder-clap from a clear sky. Lord Randolph Churchill resigned. The Ministry was for a while in confusion, and Miss Nightingale in despair. "We _are_ unlucky," she wrote to Sir Douglas Galton (Dec. 23). "As soon as we seem to have got hold of two Secretaries of State, this Randolph goes out! The Cabinet will have to be remodelled, and perhaps we shall lose our men. All the more reason for doing something at once." Of her two "men," the one was taken, the other left. Mr. W. H. Smith became First Lord of the Treasury, but Lord Cross remained at the India Office. "I am very sorry to give up the War Office," said Mr. Smith to Miss Nightingale, "but I am told it is my duty, and duty leaves no choice." She begged him to indoctrinate his successor, Mr. Edward Stanhope. She was already acquainted with him, and presently he came to see her. It was with peculiar satisfaction that she presently heard of the Government's intention to take a loan for four millions for the building of new barracks and the reconstruction of old ones. This was a resumption of the work of Sidney Herbert, thirty years after.[228] [227] It was a subject of recurring self-reproach to Miss Nightingale in subsequent years that she had not found time to follow up this latter opening and organize a new crusade for the spiritual and moral welfare of the soldiers. She had already done much in that sort; and Mr. Jowett's equally recurring comment was to the point: "Why complain because you cannot do more than you do, which is already more than any other ten women could do?" [228] A succinct statement of such reforms, up to 1899, was compiled by Mr. Frederick on his retirement from the War Office and was issued as a Blue-book: _Record of Recommendations regarding Sanitary Improvements in Barracks and Hospitals together with the Actual Improvements carried out during the last 50 years_. An early intimation of this policy made Miss Nightingale the more anxious about the fate of the Army Sanitary Committee. If the sanitary condition of the barracks was to be improved, it was all-important that a strong Sanitary Committee should be in existence to supervise the work. At first, however, she had been unable to secure any promise about the Sutherland Succession. The War Office would not consider the matter until a vacancy occurred; the India Office would do nothing until it knew what the War Office meant to do. In 1888 the long threatened thing happened. Dr. Sutherland resigned. No successor was appointed. The whole subject, she was informed, was under consideration, and then under reconsideration. Ultimately Mr. Stanhope, after interviews with Miss Nightingale, reconstituted the Committee (June 1890). Sir Douglas Galton remained upon it. Dr. J. Marston was appointed paid member in succession to Dr. Sutherland, and Miss Nightingale's friend and ally, Surgeon-General J. W. Cunningham (formerly Sanitary Commissioner with the Government of India) was appointed as an Indian expert. Her friend Mr. J. J. Frederick retained his post as Secretary to the Committee. The danger was overpast. V Sanitary reports from India were still to be referred to the Committee, but Miss Nightingale and some of her friends thought that the time had come for an advance in India. Lord Cross was so sympathetic that the occasion seemed opportune for reviving her former plea for a sanitary department in India which should be more directly _executive_. Sir Henry Cunningham (married to a niece of Sir Harry Verney) had been in communication with her for some years. He was a judge of the High Court of Calcutta, and had taken an active part in the cause of sanitation in that city. He now prepared a memorandum advocating a forward policy. Miss Nightingale's ally on the India Council, Sir Henry Yule, prepared another, which was so far approved by the Secretary of State that he ordered it to be circulated in the Office as the draft of a proposed dispatch to the Government of India. This draft was, in fact, the joint production of Sir Henry Cunningham, Colonel Yule, and Miss Nightingale. It went the rounds. It was minuted on. It was considered and reconsidered; printed and reprinted. Sometimes the report to Miss Nightingale was that it would be adopted and sent; at other times, that it had been postponed for further revision, recirculation, and reconsideration. Ultimately it became in some sort out of date, because the Government of India took a step on its own motion, in accordance with the intention which Lord Dufferin had already communicated to Miss Nightingale (p. 373). By Resolution, dated July 27, 1888, the Government of India provided for the constitution of a Sanitary Board in every province, which would not only advise the Government and local authorities upon sanitary measures, but would also be an executive agency. The passages in which the latter point is insisted upon might have been written by Miss Nightingale herself.[229] Lord Dufferin's term of office was now drawing to a close. He had proved himself an apt pupil of the "Governess of Governors-General." As on the voyage out he had promised to do her bidding, so now on the voyage home he gave some account of his stewardship:-- (_Lord Dufferin to Miss Nightingale._) SS. KAISER-I-HIND _at sea, Dec._ 26 [1888]. We are now on our way home and are having a beautiful passage, thanks to which we are all picking up wonderfully, and shall arrive in Europe quite rejuvenated. This is merely a line to apologise for having sent you the Report of a speech I made at Calcutta recently. I would not have troubled you with it, were it not that on page 15 I have tried to give a parting lift to sanitation.[230] My ladies go home at once, but I, alas, am compelled to take up my business at Rome, so that I shall not get my holiday for another two or three months. Amongst the first persons whose hands I hope to come and kiss will be yours. [229] The Resolution is printed at pp. 38-42 of vol. xx. of the annual _Report of Sanitary Measures in India_ (1888). It contains on the administrative side a history of the movement which was set on foot by Miss Nightingale's "second Royal Commission" (1863). The Secretary of State's dispatch (Jan. 10, 1889), approving of the Resolution, is full of "the Nightingale influence" (vol. xxi. p. 173): Colonel Yule's Minute was forwarded as an enclosure with the dispatch (pp. 173-184). [230] "The Government has recently given its serious attention to the subject of Sanitation, and has laid down the lines upon which, in its opinion, sanitary reform should be applied to our towns and villages. It has given Sanitation a local habitation and a name in every great division of the Empire; and it has arranged for the establishment of responsible central agencies from one end of the country to the other, who will be in close communication with all the local authorities within their respective jurisdictions" (Speech at Calcutta, Nov. 30, 1888). Lord Dufferin was succeeded by Lord Lansdowne, who was introduced to Miss Nightingale by Mr. Jowett. She saw Lord Lansdowne twice before he left for India, and they corresponded frequently on sanitary affairs. "He did much for us in every way" is her comment on his Viceroyalty. VI The constitution of the Sanitary Boards in India proceeded with due regard to "the periods of Indian cosmogony," and Miss Nightingale watched their formation and their proceedings carefully, putting in words of encouragement, expostulation, or reminder, whenever and wherever an opportunity was offered or could be made. It was soon apparent that the great obstacle to sanitary progress among the masses of India lay, where perhaps for many generations it is still likely to lie, in the immobility of immemorial custom, especially in the villages. Education was making some slight impression, but the force of passive resistance, combined with lack of funds, prevented the hope of any rapid or signal advance. Recognition of these factors now led Miss Nightingale to concentrate her efforts upon Village Sanitation, and a scheme for combining the power of education with a financial expedient formed the motive for the last of her Indian campaigns. Miss Nightingale had been watching with the closest attention the Bombay Village Sanitation Bill, a measure first projected in 1887. She analysed and criticized it, and sent her views to Lord Cross at the India Office, and to Lord Lansdowne and Lord Reay in India. Her main objection was to the exclusion from the scope of the Bill of the smaller villages, an exclusion which did not figure in the revised draft of 1889. She wrote letters for circulation in India to Native Associations in explanation and support of Village Sanitation.[231] There was some slight stirring of Indian opinion, and Miss Nightingale's next concern was to give to it articulate expression in London. The holding of an International Congress of Hygiene and Demography in the autumn of 1891 furnished an opportunity. Sir Douglas Galton was Chairman of the Organizing Committee of the Congress, so that there was no difficulty in arranging for an Indian section. Miss Nightingale then circularized the Native Association in Bombay, begging that representatives might be sent to the Congress, and papers be contributed by Indian gentlemen. This was done, and Miss Nightingale interested herself greatly in the Congress. "Sir Harry Verney," she wrote to Sir Douglas Galton (Aug. 1, 1891), "renews his invitations to Claydon to the native Indian delegates, 'three or four at a time.' I have seen Mr. Bhownaggree, who seems to be acting for the other native gentlemen, not yet come, and asked him to manage this, as is most suitable to these gentlemen. I may hope to see them one by one, if I am able to be there. I have also seen (of Delegates) Sir William Moore and Dr. Payne and Sir W. Wedderburn. Mr. Digby seems to be doing a great work.[232] Do you remember that it is 30 years to-morrow since Sidney Herbert died?" The Congress was opened by the Prince of Wales (Aug. 10), whose speech on the occasion formed the text of many leading articles in the press. People talked, he said, of "preventable diseases"; but "if preventable, why not prevented?" It was, however, in the Indian section that Miss Nightingale was most interested, and she used it to promote her schemes. The Bombay Village Sanitation Act was failing to produce the desired results because there were no funds definitely allocated to sanitation. Sanitary education was making some little progress, but not enough, in view of the poverty of Indian villages, to make it likely that _additional_ taxation would be borne. In these circumstances might not some portion of the _existing_ taxation (the village "cesses") be appropriated to sanitation as a first charge? "Until the minimum of sanitation is completed, until the cess of a particular village has been appropriated to it, while typhoidal or choleraic disease is still prevalent, should not the claims for any general purposes be postponed?" Such was Miss Nightingale's case. She had a memorandum drawn up embodying it in short form, and canvassed for signatures to it among members of the Indian section of the Congress. Sir Douglas Galton, Sir George Birdwood, Sir William Guyer Hunter, Sir William Wedderburn, Dr. Corfield, and Dr. Poore were among those who signed it. Miss Nightingale then forwarded the Memorandum, with a covering letter going more fully into the case, to the Secretary of State. She wrote at the same time to the Governor-General and to the Governor of Bombay. Lord Cross received the communication very sympathetically, and forwarded it at once (April 1892) to the Government of India. Lord Lansdowne then circulated Miss Nightingale's dispatch among the Local Governments, and during following years a formidable mass of printed Papers accumulated, "Reporting on the Proposals made by Miss Nightingale, relative to the Better Application of the Proceeds of Village Cesses to the purposes of Sanitation." The official view, though not unsympathetic to Miss Nightingale's object, was opposed to her financial expedient; it was thought that other purposes, especially the improvement of roads, etc., had a claim prior to sanitation. "It seems clear," wrote Sir William Wedderburn to her (July 7, 1893), "that you have most effectively drawn attention to the subject. The official replies are what we might naturally expect, but reading between the lines I think they admit the justice of our contention, and have been impressed by your action." Perhaps this was to some extent the case. "You have most effectively drawn attention to the subject"; that was, perhaps, the main service which during these years Miss Nightingale rendered to the cause of Indian sanitation. Certainly she was importunate in asking successive Governors-General for reports of progress; her importunity often caused them to jog the elbows of Local Governments; and she may thus not unjustly be credited with such gradual progress as was made. The final reply to Miss Nightingale's immediate suggestion was sent in a dispatch to the Secretary of State (Mr. Fowler) from the Government of India in 1894 (March 28), enclosing letters on her Memorandum from the several Local Governments. The Government of India declined for various reasons to adopt her suggestion; but admitting that something ought to be done, considered that "sanitation in its simplest form of a pure water-supply and simple latrine arrangements should be regarded as having to some extent a claim on Provincial revenues," and it promised "to press this claim upon Local Governments and Administrations as opportunity offers." A covering letter to Miss Nightingale from the Secretary of State (May 9, 1894), while informing her that Mr. Fowler "is disposed to accept the view taken by the Government of India," expressed the belief "that India will benefit by the renewed attention which your action has caused to be given to the important subject of rural sanitary reform." There are passages in some of the replies from Local Governments, enclosed in the dispatch, which bear out this belief. [231] See Bibliography A, Nos. 115, 118, 119, 122, 123. [232] Mr. S. Digby was acting as Hon. Secretary to the Indian Section of the International Conference. Miss Nightingale, on her own part, was diligent in appeals to Indian gentlemen to bestir themselves. She had an ally at this time in Sir William Wilson Hunter, who, in his fortnightly summary of "Indian Affairs" in the _Times_, sometimes enforced her points or called attention to her writings. She had urged her friend to write a detailed description of the actual working of Indian administration, and this he did in 1892.[233] The Preface to his book was a dedicatory letter to Miss Nightingale. In it he says that the book was written at her request, describes its scope, and thus concludes: "Now that the work is done, to whom can I more fitly dedicate it than to you, dear Miss Nightingale--to you whose life has been a long devotion to the stricken ones of the earth--to you whose deep sympathy with the peoples of India no years of suffering or of sickness are able to abate?" In her own pieces written at this date, Miss Nightingale preached more especially the gospel of Health Missionaries for Rural India.[234] Some reference to progress made in this respect will be found in a later chapter (p. 406). She believed in State action, but no less in Self-help, and this point of view is emphasized in a retrospect of her work for India which she wrote, or partly wrote, probably as hints for some vernacular publication, in 1889.[235] Some passages from the document, here rearranged, may fitly close this account of her later Indian work. [233] _Bombay, 1885-1890: A Study in Indian Administration._ [234] Bibliography A, Nos. 132, 135. [235] The document, unfortunately not complete, is in part typewritten (with a few pencilled notes in Miss Nightingale's hand) and in part in the handwriting of a lady who at this time rendered her some secretarial assistance. "Miss Nightingale saw in the Queen's Proclamation of 1858 a text and a living principle to fulfil. Every Englishman and Englishwoman interested in India were bound in duty and in honour to do their utmost to help British subjects to understand the principle and to practise the life. To this she has adhered through illness and overwork for thirty-one years. First attracted to India by the vital necessity of health for 200 or 250 millions, imperilled by sanitary ignorance, apathy, or neglect, she believed it to be a fact that since the world began, criminals have not destroyed more life and property than do epidemic diseases (the result of well-known insanitary conditions) every year in India. The protection of life and property from preventable epidemics ranks next to protection from criminals, as a responsibility of Government, if indeed it is not even higher in importance. The first thing was to awaken the Government. This was done by the Royal Commission upon the Sanitary State of the Army in India, which was the origin of practical action for the vast native population. But the difficulties were enormous. You must have the people on your side. And the people, alas, did not care. You cannot give health to the people against their wills, as you can lock up people against their wills. Impressed by these facts, Miss Nightingale saw the necessity of Sanitary Missionaries among the people--of sanitary manuals and primers in the schools ('Give me the--schools--of a country and I care not who makes its laws'); of sanitary publications of all kinds, for man, woman, and child. The Sanitary Commissioner, in one instance at least,[236] has been a Sanitary Missionary, crying out, 'Bestir yourselves, gentlemen, don't you see we are all dying?' The people must be awakened, not to call on the Goddess of Epidemics, but to call upon the Sirkar to do its part, and also to bestir themselves to do theirs in the matter of cleanliness and pure water. Miss Nightingale found in Local Government the only remedy; in Local Government combined with Education." The Paper touches also upon Miss Nightingale's interest in irrigation, land-tenure, usury, agriculture, and in all these matters connects State action with Self-help. "To the native gentlemen it is that Miss Nightingale appeals. She appeals to them also on the Sanitary point. And first of all it is for them to influence their ladies. Let them lead in their own families in domestic sanitation. Then, doubtless, the lady will lead in general sanitation in India as she does in England." Another passage gives incidentally an autobiographical summary. "Miss Nightingale has deeply sympathized with the honourable efforts of the National Congress which has now held three Sessions, in which its temperate support of political reforms has been no less remarkable for wisdom than for loyalty. But her whole life has been given deliberately, _not_ for political, _but_ for social and administrative progress." [236] She refers no doubt to Dr. Hewlett. VII At the time when Miss Nightingale's Indian work was thus largely concentrated upon village sanitation, she was no less busily employed, though in a different way, upon work of a like kind at home. Her interest in local affairs at Claydon has already been touched upon, and this was much increased after the death of her sister in 1890. Lady Verney had been a sufferer for many years, but had borne her illness with unflagging spirit. In May 1890 she was in London, very ill, and was counting the hours to her removal to Claydon, but she would not give up a Sunday in town--a day which Florence now kept sacred for her sister. On Sunday May 4 Lady Verney was carried into Florence's room, and the sisters did not see each other again. On Monday Lady Verney was moved to Claydon, and there, a week later, on Florence's birthday, she died. "You contributed more than anyone," wrote Sir Harry (May 15), "to what enjoyment of life was hers. I have no comfort so great as to hold intercourse with you. You and I were the objects of her tender love, and her love for you was intense. It was delightful to me to hear her speak of you, and to see her face, perhaps distorted with pain, look happy when she thought of you." Miss Nightingale at once went to Claydon, where she remained for several months. Sir Harry, now in his 90th year, relied greatly upon his sister-in-law, and for the remainder of his life she devoted herself to him with constant solicitude. He was never happy if many days passed without sight of her or hearing from her. The butler always put Miss Nightingale's letter on the top of his master's morning pile, and no mouthful of breakfast was eaten till he had read it through. When he was in the country and she in London, he was always wanting to run up to town for the day--to buy a new waistcoat, or to consult his solicitor: any excuse would serve so that he could see his sister-in-law in South Street. They used to say at Claydon that there was a sure way of discovering whether Sir Harry found a new guest sympathetic or not: if he did, the conversation was invariably turned to Miss Nightingale. Upon the death of her sister, Claydon became Miss Nightingale's country-home, and she brought her managerial thoroughness into play there. She looked into Sir Harry's affairs, interested herself greatly in the estate, inquired into the conditions of surrounding village life, made acquaintance with local doctors. These interests brought home to her the conviction that village sanitation was necessary to civilize England hardly less than India, and she saw that as in India, so in England, education must be one at least of the civilizing agencies. She set herself to make a beginning where her lot now happened to be cast, in Buckinghamshire. The time was favourable to a new experiment. County Councils had been established by the Act of 1888. In 1889 they were empowered to levy and expend money upon Technical Education. By the Local Taxation Act of 1890 they received a windfall for the same purpose from what was known as the "Whisky Money." Funds were thus available, and the definition of "technical" education was wide. Why should not some of it be used for education in the science of "Health at Home"? Mr. Frederick Verney was chairman of the Technical Education Committee of North Bucks, and with Miss Nightingale, as he said, "to inspire, advise, and guide," the thing was done. She was already, as we have heard, possessed by the idea of the district nurse as health missioner. It now occurred to her to institute an order of health-missioners as such. The Health Officer for the district (Dr. De'Ath) was first employed to train ladies for the work by means of lectures and classes. The instruction was practical as well as theoretical, for the doctor took his pupils with him to some of the villages, introduced the ladies to the village mothers, and pointed out particular matters in which knowledge sympathetically given might be invaluable to the cottagers. An independent examination followed, and the ladies who passed it satisfactorily were, after a period of probation in practical work, granted certificates as Health Missioners, in which capacity some of them were engaged by the Technical Education Committee to visit and lecture in the country villages. The scheme, started in the spring of 1892, was a simple one, but it involved Miss Nightingale, as huge bundles of documents attest, in much labour for two or three years. She enlisted recruits; collected the best that was known and thought about simple sanitary instruction; considered syllabuses and examination papers; corresponded with other Technical Education Committees; wrote memoranda and letters on the subject.[237] To the Women Workers' Conference, held at Leeds in November 1893, she sent a paper dealing exhaustively with the whole subject of Rural Hygiene--a paper which is unhappily by no means out of date to-day, though the work, in which Miss Nightingale was a pioneer, has branched out in many directions. "We want duly qualified Sanitary Inspectors," she wrote, and she was delighted when she heard a few years later of the good work done by some women sanitary inspectors in the north. Full qualification, practical training, she insisted upon; and then something else was wanted also. Her last word to the Health Missioner was the same as to the Nurse. "The work that tells is the work of the skilful hand, directed by the cool head, and inspired by the loving heart." [237] See Bibliography A, Nos. 126, 133, 134.