BSOMEP 
 AC 
 
 1 865- 
 Rave. 
 
 ii 
 
 THE 
 
 ^PANIZATION OF NURSING 
 
 ' i II A LARGE TOWN 
 
 ■ '■ WITH AN IMTKODUCTIOH ABD BOTES ' 
 
 FLORENCE MIGHTIUGALE
 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 LOS ANGELES 
 
 GIFT OF 
 
 DR. AND MRS. ELMER BELT
 
 iJ5 
 C 
 O 
 
 M 
 CQ 

 
 OKGANIZATION OF NUESING. 
 
 AN ACCOUNT OF THE 
 . LIVERPOOL nurses' TRAINING SCHOOL, 
 ITS FOUNDATION, PROGRESS, AND OPERATION 
 IN HOSPITAL, DISTRICT, AND PRIVATE NURSING. 
 
 A MEMBER OF THE COMMITTEE OF THE HOME k TRAINING SCHOOL. 
 
 AN INTRODUCTION, AND NOTES, 
 
 FLORENCE NIGHTINGALE. 
 
 LIVERPOOL : 
 A. HOLDEN, 48, CHURCH STREET. 
 
 LONDON : 
 
 LONGMAN, GREEN, READER, AND DYER. 
 1865.
 
 CONTENTS 
 
 AC 
 C 
 
 View of the Buildiiif; 
 Plan of the Building 
 
 Description of the Plan Page 5 
 
 Dedication to Miss Nightingale 7 
 
 Introduction by Miss Nightingale 9 
 
 Origin and Organization of Training School and Home for Nurses . . 17 
 Letter from Miss Nightingale on the Proposed Plan for the Employjnent 
 
 of Women in Hospital, District, and Private Nursing .. 25 
 
 Prospectus 27 
 
 Explanations, Authorities, and Facts in relation to the foregoing 
 
 Prospectus 33 
 
 Plan of Education for Nurses 50 
 
 List and Estimated Cost of Materials 52 
 
 Method of Working 55 
 
 Appendix: — 
 
 A. Report of the Committee for 1861 67 
 
 B. Balance Sheets, and Items of Expenditure for 1863 
 
 and 1864 72 
 
 C. Tables of Work done in Districts, 186-1 . 76 
 
 D. Arrangement with the Central Relief Society, and 
 
 Forms of Recommendation 77 
 
 E. Rules and Forms of the Training School for District 
 
 and Private Nursing . . 81 
 
 F. Memorandum submitted to Ladies when it is x'l'oposed 
 
 that they should undertake a Nursing District .... 95 
 
 G. Ladies' Superintendent Reports 95 
 
 H. Address to the Nurses on the New Year, 1864, by a 
 
 Member of the Committee 101 
 
 I. Map of Districts, as printed on the back of recommendation 103
 
 Liverpool N\ja8E8 Training Schoois ^ Home. 
 
 5 EcoiN D Floor Plan . 
 
 A s »ro^ 
 GROUND Plan. 
 
 " -^ ■o 
 
 ^f -V tf -^g 
 
 <f ^f 
 
 L I VEPPOOL
 
 DESCRIPTION OF PLAN. 
 
 The Liverpool Nurses' Training School and Home forms a pai*allelo- 
 gramic building, 85 feet by 4G feet externally. It consists of thi-ee 
 storeys, each eleven feet high from floor to ceiling. The ground 
 storey comprises an Entrance Hall, Parlour for the Lady Superin- 
 tendent and for visitors, Nurses' Dining Room, Kitchen, Pantries, 
 Store Room (serving also as Housekeeper's Sitting Room), and 
 detached Dormitories for the use of the Night Nurses during their 
 hours of rest in the day. 
 
 The centre forms on this floor an open corridor 9 ft. 9 in. wide, with 
 a stone stair leading to the gallery on the next floor, a distinct stair 
 being included in the official part of the plan for the Superintendent. 
 
 The first floor comprises a Day Room for the Nurses, Bed-rooms 
 attached to the Superintendent's dwelling, and single Dormitories for 
 Nurses, as also Bath Room, Housemaids' Closet, &c. 
 
 The Dormitories are entered from a stone gallery formed over part 
 of the ground floor rooms on the East side, and over the Night 
 Nurses' Dormitory passage on the West. 
 
 The second floor is nearly similar in arrangement and disposal to 
 the aforesaid ; but the large rooms on the South end of the building are 
 appropriated for Sick Rooms, or Bedrooms for two or three Nurses in 
 one room, and for the Servants of the Institution. 
 
 The central space, by the added width of the galleries (of which that 
 on the second floor is carried on iron brackets), becomes above the 
 ground floor 9 ft. wide. Its height, from the ground floor to the 
 ceiling above second floor, is 35 ft. 6 in., and to the top of skylight 
 41 ft. 9 in. The whole of the dormitories are ventilated into the
 
 DESCRIPTION OP BUILDING. 
 
 central space of the building, by arched openings over the doors, filled 
 in with perforated zinc, and fitted with hanging curtains. The central 
 space itself has louvred ventilating openings at each end of the large 
 skylight, occupying the middle part of its ceiling. 
 
 The Superintendent's part of the building can be shut ofi" from the 
 general body by locldng the doors of communication at the ends of the 
 galleries, while the interior can be inspected on each floor from the 
 South end ; landings opening by fenced archways into the central space. 
 The Scullery is projected into the Yai'd, which is in the greater part 
 covered with glass, and with which are connected the Larder, with 
 Cellar under it, back entrance, passage way to Koyal Infirmary area, and 
 receptacles for coal, coke, and ashes. The general warming is by 
 ordinary open fires, and two of Nettleton's (Chelsea) stoves are placed 
 in the central space, and used singly or together in cold weather, 
 having air channels opening beneath them from the outer walls, which 
 admit cold air when the stoves are not lighted. 
 
 The materials of the building are brick, with stone dressings exter- 
 nally. The inside being plastered, and Keene's cement used in the 
 lower central corridor and other principal parts. The woodwork is for 
 the most part varnished, and the entrance and lower central corridor 
 are paved with Minton's tiles, in plain coloured patterns. 
 
 HENRY P. HORNER, 
 
 Architect, 
 No. 1, Derby Square, 
 
 Liverpool.
 
 is Barratik h m\mMh bcbicatcb to 
 
 FLORENCE NIGHTINGALE. 
 
 In dedicating this short account of efforts made to 
 improve the character of professional nursing and pro- 
 vide for the better tendence of the sick to one to whom, 
 as their beloved chief, all engaged in similar endeavours 
 look for encouragement and guidance, the compiler had 
 two objects in view. 
 
 First, To call attention to the nature of the plans 
 which, carried out under her direction and advice, 
 have been attended v/ith so much success in Liverpool, 
 and to recommend others to adopt and improve upon 
 them. 
 
 Secondly, To express the warm gratitude which he 
 feels, not only as an Englishman but as an inhabitant of 
 Liverpool, for those especial benefits which his native 
 town has derived from her aid and counsel, in addition 
 to those which it shares with the countrv at larc^e.
 
 INTRODUCTION 
 
 FLORENCE NIGHTINGALE 
 
 I HAVE rend the following pages with much interest. 
 I regret that we have been so busy, and my strength 
 so over-tasked, that I have only now been able to do so ; 
 but, once taken up, I could not lay it down till I had 
 read it through in two sittings, and then I read it 
 through again. 
 
 I have studied all the Rules and Forms with the 
 greatest profit and interest to myself — as indicating 
 a master hand in securing that unity yet independence 
 of action, that personal responsibility and yet liberty, 
 which are so vitally essential to the continuance and 
 development of a great and wide charity like this. 
 
 I am asked to write a few remarks by way of preface. 
 I have some difficulty in doing this, because I am cited 
 as authority for some part of the principles. A report 
 on such a subject as the Training of Nurses, to supply 
 "lack of service'^ towards the poor afflicted and dying, 
 should of itself command attention, simply on its own 
 merits. But, if any argument were required on its
 
 10 INTRODUCTION 
 
 behalf, in this practical age, the best argument is the 
 success which has atteuclecl the efforts made in Liver- 
 pool. These most satisfactory results, though not 
 greater than you deserve, are greater than even the 
 most sanguine hopes could have foreseen. Nowhere 
 that I know of are the difficulties of organizing a system 
 for nursing the sick in their own homes likely to be 
 greater than have been there encountered, and so far 
 overcome. 
 
 There is a dense and rapidly increasing population, 
 drawn from all quarters, most of them of that lower 
 class which has to change its home in order to be able 
 to live. There has been hitherto strong religious 
 partizanship, a very great amount of sickness (as is 
 testified by the extent of local Medical Charities), a 
 lamentably high death-rate, especially among chil- 
 dren — always the readiest victims to want of good 
 nursing in sickness — and, together with all this, much 
 inevitable poverty, ignorance amongst the poor as to 
 the proper management of their sick at home (this 
 we find everywhere, but nowhere else, perhaps, so 
 much) ; often want of every appliance and nursing 
 care which should surround the sick-bed, and great, 
 though remediable, suffering as a consequence. 
 
 It is the old story, often told ! but this book opens 
 a new chapter of it. It gives us hope for a better 
 state of things. An Institution for training Nurses 
 in connection with the Infirmary has been built 
 and organized. This is a matter of necessity, 
 because all who wish to nurse efficiently must learn 
 how to nurse in a Hospital. Nursing, especially that 
 most important of all its branches — nursing of the sick
 
 BY FLORENCE NIGHTINGALE. 11 
 
 poor at home — is no amateur work. To do it as it ought 
 to be done requires knowledge, practice, self-abnega- 
 tion, and, as is so well said here, direct obedience to, 
 and activity under, the highest of all Masters, and 
 from the highest of all motives. It is an essential 
 part of the daily service of the Christian Church. It 
 has never been really otherwise. It has proved itself 
 superior to all religious divisions, and is destined, by 
 God's blessing, to supply an agency, the great value 
 of which, in our densely peopled towns, has been 
 unaccountably overlooked until within these few years. 
 
 Nothing, indeed, can afford a stronger argument for 
 the local support of the Liverpool agency, than the 
 simple fact of its past success ; while, at the same time, 
 the example should be followed among other large 
 populations, and %vill he. 
 
 It is a comparatively indifferent matter under what 
 organization a system of home-nursing of the poor is 
 carried out. It may be done, and well done, by dis- 
 tricts as in Liverpool, or by parishioners in parishes, or 
 by members of Christian Churches. The great thing 
 is, that it he done, and done well. And to those who 
 want to know how such a work can be successfully 
 carried out, in conformity with our English feeling for 
 freedom of action, I would urgently recommend a 
 careful study of this book. I need scarcely say, 
 therefore, how earnestly I press for the publishing of 
 this account of the work, as being a pioneer, rather 
 than a model, for similar Institutions all over our 
 country. 
 
 The work in Liverpool requires greater extension, 
 and more support, before all the fruits of it can ripen.
 
 12 INTRODUCTION 
 
 But, SO far as it has gone, it has proved its own future 
 possibihty by its past success, and promises to be one 
 of the most important agencies for coping with human 
 misery which the present day has put forth. Let uS' 
 all wish it God speed. 
 
 No words of mine are wanted to call attention to 
 the subsidiary benefits to the poor involved in this 
 great work. They are not new ; but they are not so 
 widely put in practice in our country as they should be. 
 
 For example : — 
 
 " They will, where it may be desirable to do so, send convalescent 
 patients for recovery to the sea-side at Southport, where they will be sup- 
 ported for three weeks' residence. To obtain such aid the same course 
 is necessary as stated above, with the addition that the certificate 
 of the medical attendant must be obtained, prescribing sea- side 
 residence or bathing for the patient." — Kdirnct of Letter to the Ladies 
 Superintendent. — p. 78. 
 
 The sending convalescent poor to the sea- side is a 
 kind of relief of which it is impossible to calculate the 
 benefit, any more than its results in diminishing 
 pauperism. 
 
 Every large town in the kingdom ought to have its 
 Convalescent Institution for the poor by the sea- side, 
 or in the country. For the rich the good of change of 
 air, nay, even its necessity, is never doubted. It is 
 ten times more necessary for the poor. Again — 
 
 " We may mention here that the owner of a house maybe compelled, 
 by application to the Inspector of Nuisances, Cornwallis Street, to 
 have it whitewashed when in an unwholesome state." — Extract of 
 Fo)'nis used in District Xursin;/. — p. 88. 
 
 " The Charity has also been of use in timely calling the attention of 
 the Board of Health to fever cases, where whole families were infected, 
 and the safety of the surrounding neighbourhood endangered." — 
 p. 97.
 
 BY FLORENCE NIGHTINGALE. 13 
 
 '' The Ladies Superintendent have in several instances called atten- 
 tion to the state of the courts and houses where sickness has been 
 prevalent, and their representations have always been well received ; 
 where urgently required, the Ladies Superintendent have themselves 
 pro^^dcd the means for purifying and cleaning dwellings, bedding, &c. 
 Two patients have been sent to Southport ; several have been provided 
 with means to go to the country ; others have been supplied with 
 clothing to fit them for respectable employment ; and the necessary 
 expenses of getting chikben into the Blue Coat School have been 
 defrayed. The Ladies Superintendent have found the Clergy, the 
 Doctors, and the authorities of the Board of Health most willing to 
 co-operate in the working of the charity." — p. 99. 
 
 These alone, if these were the only benefits, shew 
 the wisdom and efficiency of incorporating in an 
 organization the assistance of local authorities, and 
 securing the willing co-operation of charitable 
 volunteers. 
 
 I do not mean to say these efforts are new and 
 original ; but I mean that it is most satisfactory 
 to find the Ladies Superintendent and Nurses 
 exercising certain powers and influences in Sanitary 
 matters, such as obtaining the cleansing and lime- 
 washing of unhealthy houses and places. It is a wise 
 addition to their duties. It improves the domestic 
 habits of the poor. It protects their health. It pre- 
 vents disease. Similar Sanitary duties should always 
 be associated with Nursing. 
 
 Yet, even now, though '"Sanitary" has become 
 almost a cant word, of which we are tired, few educated 
 persons, even philanthropists, are practically acquainted 
 with our Health Acts, so as to call in their help in time 
 of need. Again — 
 
 "I may just add, that it occurred to me a short time ago that
 
 14 INTRODUCTION 
 
 it would be a good plan to allow some of our poor patients dinners at 
 the Workmen's Dining Rooms for a little time after their return to their 
 usual occupation. The Superintendents of the Dining Rooms are 
 prepared to supply dinners on receiving a written request to that effect 
 from the Lady Superintendent of a district, and on the production 
 by the applicant of a note in the same handwriting." — Extract of 
 Lridies'' Superintoideiit Ecpnrt. — p. 100. 
 
 Wliat a merciful suggestion is that of supplying good 
 food, properly cooked, from Workmen's Dining Rooms, 
 to poor patients recovering from sickness. It is a 
 means only second to change of air, and to be employed 
 after it in most cases. 
 
 I have taken only a few instances out of the 
 Appendix of collateral good arising from this work. — 
 I cannot better end my preface than by quoting, from 
 the "Address to the Nurses," words which I would 
 take to myself, and address to all engaged in this 
 great work : — 
 
 " If you feel that you are members of a family, you 
 will be ever desirous that the character of that family 
 should be as high as possible, that it should be a credit 
 to belong to it, that no act or word of yours should 
 bring shame upon it, but on the contrary each of you 
 will strive, by the gentleness, quietness, modesty, and 
 truthfulness of your conduct, by constantly increasing 
 proficiency in your profession, and by the thoroughness 
 and conscientiousness of your work, continually to 
 raise the character of the School, and of all belonging 
 to it, higher and higher." '•' " ''' 
 
 " There is no pride so mean, so contemptible, as that 
 which makes a person above her work. There is 
 nothing really mean, or degrading, or unclean, which
 
 BY FLORENCE NIGHTINGALE. 15 
 
 our duty calls us to do ; but if ever pride leads us to 
 leave part of our duty or work undone, or ill-done, 
 tlien indeed ice are degraded." " "■'' " 
 
 "There is work, there will be times, for which all 
 motives are too weak but one ; you can only do your 
 work as it ought to be done, if you do it as servants, 
 as brethren, of our Lord Jesus Christ." 
 
 *'If you are merely hirelings, working for man's 
 w^ages or man's praise, there will be much of your work 
 that will be distasteful, wearisome, heartless ; if all 
 your work is done as in His sight, and for His sake 
 and God's, 'how different will all appear ?' " 
 
 "Your work lies, as much of His did, among the 
 sick and suffering and dying; if you do it as feeling 
 yourselves fellow-workers with Him, it is impossible to 
 say— you will never know, no one can ever know — how 
 much good you may accomplish. Your patients may 
 be irritable and ungrateful, but if they see that, 
 patiently, and constantly, and where no master's eye 
 but God's sees you, you go quietly on with your duty, 
 neither discouraged nor weary in well doing, you may 
 be sure you are sowing good seed which will not be lost, 
 for Almighty power is working with you." 
 
 ' ' Not only the life of your patients may depend on 
 your faithfulness to duty, but by it you may also 
 influence for good their virtue and happiness, here and 
 hereafter. Remember, when wearied and perhaps 
 discouraged by ingratitude, it is not alone the poor, 
 wretched, irritable, and perhaps it may seem to you 
 worthless, sufferer you are serving— 'Inasmuch as ye 
 did it unto the least of these, ye did it unto me ;' — by 
 his suffering, which you can alleviate, the object of
 
 16 INTRODUCTION. 
 
 your care becomes to you the representative of Him 
 who died for you. Think of this, and your task will 
 become a grateful one, your labour one of love." — 
 pp. 101, 102. 
 
 I have read all this with the most intense interest, 
 and can only hope that I too shall draw from it the 
 profit which I ought — that I too shall read in it, and 
 learn well, that lesson which I ought to learn anew 
 every morning. God bless the work and the workers, 
 is the earnest prayer of 
 
 FLORENCE NIGHTINGALE. 
 
 18G5.
 
 ORIGIN AND ORGANIZATION 
 
 OF THE 
 
 LIVERPOOL 
 
 TRAINING SCHOOL AND HOME FOR NURSES. 
 
 It is rather more than three years since the Prospectus 
 of the Liverpool Training School and Home for 
 Nurses was made pubhc. The scheme therein sketched 
 out received the cordial approbation of Liverpool men. 
 A sum of c64,461 was raised by donations, and annual 
 subscriptions were offered to the amount of i'988. 
 Liverpool has been divided into eighteen districts, each 
 to have a Nurse of its own ; and residents, — sometimes 
 individual ladies, sometimes religious associations, 
 sometimes the clergy and their wives, — have undertaken 
 to provide the necessary medical stores, appliances, and 
 comforts, and the superintendence required by the 
 arrangements of the Society. Nurses have also been 
 supplied to the Infirmary and to private families. Of 
 course much has to be learnt and much to be done 
 before our organization is brought to the highest degree 
 of completeness and efficiency. Such a work is not 
 perfected in three years. But even in its present 
 imperfect condition it works well, and has fully realised 
 the expectations with which it was set on foot. 
 
 In regard to the operation of the Home and Training
 
 18 
 
 School itself, we have every reason to be thankful for 
 the fulfilment of our hopes. It has greatly ii' creased 
 the supply of thoroughly educated professional Nurses 
 for the Liverj)ool Infirmary — thus meeting a want of 
 which the managers of most hospitals are painfully 
 conscious ; and it has attracted to the work a very 
 desirable class of women, superior in character and 
 education to the generaUty of those who hitherto have 
 entered on Nursing as a profession. The Nurses 
 appreciate the cheerful home and companionship, and 
 the motherly interest and influence, of the Lady 
 Superintendent ; they take also, we believe, a whole- 
 some pride in their school and their profession ; and 
 these feelings render them so much attached to the 
 Infirmary that they generally prefer the duties of the 
 Hospital to either district or j^rivate nursing. Formerly, 
 the feeling was very different, professional Nurses being 
 wont to consider the position of a Hospital Nurse as 
 anything but desirable. 
 
 The Medical Board have expressed themselves in 
 decided terms concerning the improvement which has 
 been effected in the character and conduct of the 
 Infirmary Nurses, and affirm that this improvement 
 enables them to rely with much more confidence on 
 the results of medical treatment, and to save many 
 lives which, under less efficient nursing, must have 
 been sacrificed. That this should be the case will not 
 surprise any one who has read Miss Nightingale's work, 
 and observed the stress which a writer of such eminent 
 experience and careful accuracy lays upon the impor- 
 tance of good nursing, as often more vital even than 
 medical treatment, and always indispensable to its full 
 efficacy.
 
 19 
 
 We are inclined to believe that the period of training 
 fixed by the Liverpool scheme (twelve months) repre- 
 sents the time necessary fairly to qualify a woman of 
 average intelligence and fitness. Two years training 
 would produce still greater efficiency. Some women, 
 gifted with unusual powers of observation, learn the 
 art of Nursing very rapidly; but, even in these excep- 
 tional cases, the experience acquired during a twelve- 
 month's probation is very valuable. 
 
 After training the Nurses and supplying the Infir- 
 mary, the next object has been to bring good nursing 
 home to the poor at their own doors, through an 
 orgcinized system of District Nursing. We believe that 
 the results of this portion of the scheme have been 
 especially beneficial. It has saved many lives, and 
 alleviated much intense suffering. It has promoted 
 cleanliness and knowledge of the laws of health ; and 
 in its economical, beneficent, and religious results has 
 realised the expectations set forth in the Prospectus. 
 
 So far as mere economical considerations go, good 
 nursing is so valuable in giving efficacy to medical 
 care, and would go so far towards supplementing the 
 effect of the drugs, food, and attendance which each 
 parish is bound to provide for its poor, and making 
 them more available for the relief of suffering and the 
 cure of disease — it would do so much, moreover, to 
 lessen that large amount of pauperism which is the con- 
 sequence of sickness among the hard-working poor — 
 that it would well repay the ratepayers were they to 
 provide the wages and whole expenses of the District 
 Nurse out of the rates. But, on other grounds, we do 
 not desire to see this done. For under a system of 
 parochial payment we should lose the best and most
 
 20 
 
 useful accompaniment of private charity, the personal 
 
 interest and superintendence of the givers. So long 
 
 as the Nurse is supported by private benevolence, she 
 
 and her j^atients enjoy the inestimable advantage of 
 
 the control, advice, and aid of educated and refined 
 
 women, who naturally undertake the supervision of a 
 
 charity for which they provide the means, but who 
 
 would neither be able nor willing to interfere, if the 
 
 Nurse were a parish officer, and the nursing and food 
 
 and medicine supplied from parochial funds. We 
 
 regard this personal superintendence as an essential 
 
 part of the plan of District Nursing, the absence of 
 
 which would deprive it of half its value, and leave it 
 
 open to errors and abuses which the support and 
 
 direction of ladies effectually prevent ; and as beneficial 
 
 hardly less to her who confers, than to those who 
 
 receive the obligation. It is through the agency and 
 
 under the superintendence of the rich and charitable — 
 
 of the wives of landowners, of wealthy citizens, or even 
 
 of religious societies — that we hope to see a system by 
 
 which the sick poor may be cared for in their homes 
 
 introduced into every ward and parish in England. 
 
 To assist the poor, especially under misfortunes inflicted 
 
 not by their own fault but by the visitation of God, is 
 
 a duty imposed by religion on the Christian, and by 
 
 humanity on every human being ; and whatever care 
 
 and reserve may be necessary in ministering to the 
 
 other wants of the poor, lest we aggravate the evils we 
 
 would fain relieve, no one can fear to do harm by 
 
 giving his aid to restore a poor man to health, or to 
 
 lighten the misery of incurable disease. In this 
 
 direction, at least, benevolence may work without fear
 
 21 
 
 and without stint, unchecked by the warnings of 
 science ov the rebukes of a sterner moraUty. 
 
 In providing Nurses for the sick in private families, 
 we have been so far successful that such Nurses as we 
 have been able to supply have been highly valued ; but 
 we see little hope of being able to keep pace with the 
 demand for such assistance. Experience of the value 
 and vast superiority of educated and qualified Nurses 
 will constantly increase the demand for their services. 
 We can only hope that, as education spreads among 
 the working and lower middle class, there will be 
 found a greater number of women lit .and available for 
 the profession of Nursing ; and that, in other towns, 
 schools for training them will be established in con- 
 nection with the local hospitals. In the meantime we 
 shall be grateful to any one who will recommend to us 
 women quahiied by nature and character for such a 
 profession — women on whose truth, watchfulness, 
 gentleness, firmness, and devotion to their duty full 
 reliance can be placed. 
 
 It may assist others who may contemplate a similar 
 undertaking to know the nature of the plans which 
 were adopted in Liverjfool, and of the steps by which 
 those plans were carried into execution. But it is 
 probable that each place will present circumstances 
 pecuhar to itself, and that in each instance different 
 conditions may requiie a different system and different 
 rules. 
 
 The School was the foundation of our enterprise ; 
 and the School was of necessity dependent on the 
 Infirmary. It was necessary, therefore, to obtain the
 
 22 
 
 consent and assistance of the Committee by which that 
 Institntion is managed. This they were wilUng to 
 afford ; but they were anxious before all things, and 
 very properly anxious, that there should be no risk of 
 collision or conflict arising from divided and clashing 
 authorities. To meet this objection we placed ourselves 
 unreservedly in their hands. The Home is built on the 
 ground, and is the absolute property, of the Infirmary. 
 The Committee of the School are selected from the 
 Infirmary Committee, the Chairman and Treasurer 
 being e.v officio members. Though this subjection to 
 the authorities of the Hospital was with us a matter of 
 necessity, we should adopt it, had we the option, as a 
 matter of wisdom. Where it can be done without 
 unfairness to existing officers, it is desirable to carry 
 the union still further. The Lady Superintendent of 
 the School should also be the Matron of the Hospital, 
 and the female officers of both should be entirely under 
 her control. 
 
 Our next step was to seek for a lady able and willing 
 to undertake the office of Superintendent. This was 
 no easy task. Our organization was on a large scale; 
 and though some of its objects had elsewhere been 
 carried out singly with success, their combination was 
 a new feature in our enterprise. To take charge of 
 such an Institution from its very commencement no 
 ordinary qualities were required. A lady competent 
 for such a post must be endowed with considerable 
 energy and a hopeful spirit ; must have strong religious 
 principles, yet be free from anything like sectarian 
 jDrejudice and bigotry ; must possess a clear and sound 
 judgment ; must be devoted to her work, and have 
 skill to select, and moral and mental power to control
 
 23 
 
 and inspire, a number of young women brought together 
 under circumstances affording them great opportunities 
 of usefulness and self-improvement, but at the same 
 time exposing them to considerable temptations. We 
 were fortunate enough to find a lady who possessed the 
 requisite qualifications, and to prevail on her to under- 
 take the work. She went to the Nightingale School in 
 connection with St. Thomas's Hospital, and to King's 
 College Hospital, which is in charge of the Sisters of 
 St- John's House, to make herself acquainted with 
 the system and organization of those two Nursing 
 Schools, the method of study, and the surgical and 
 medical training therein pursued. 
 
 Matters had then reached the point at which we felt 
 ourselves prepared to introduce our plans to the public. 
 We called a public meeting, and invited and obtained 
 donations and subscriptions. The following Prospectus 
 fuUv explained our plans, and the course we intended 
 to follow. 
 
 Although out of date, it may be useful to reprint it, 
 as matter of information. The Prospectus is followed 
 by a statement of authorities and facts, and the plan of 
 education we proposed to follow. 
 
 The " method of working" our scheme is next given. 
 The details, forms, and other information are given in 
 the Appendix.
 
 PROPOSED PLAN 
 
 FOK THE 
 
 TRAINING AND EMPLOYMENT OF WOMEN 
 
 IN 
 
 HOSPITAL, DISTRICT. AND PRIVATE NURSING. iNlil. 
 
 LETTER FROM MISS NIGHTINGALE 
 
 Tu the Chairman of the Liverpool Trninimj School for Nurses. 
 
 LoMDON, November 30, 1861. 
 
 SiK, 
 
 In reply to your request for luy opinion, I can 
 only say that your plans for a IScliool and Home for 
 Nurses in Liverpool have deeply interested me from the 
 very first : they appeared to me so well considered and 
 laid out — they appeared to me so much needed, not 
 only in Liverpool but in all the earth. 
 
 Sickness is everywhere. Death is everywhere. But 
 herdly anywhere is the training necessary to teach 
 women to relieve sickness, to delay death. We consider 
 a long education and discipline absolutely necessary to 
 train our medical man ; we consider hardly any training 
 at all necessary for our nurse ; although how often does 
 not our medical man himself tell us, " I can do nothing 
 for you unless your nurse will carry out what I say." 
 
 I trust, then, that all, rich and poor, will at least 
 study your Prospectus. All, rich and poor, have sick- 
 ness among themselves at one time or another of their 
 lives. It is singular that this necessity, which, perha^js,
 
 26 
 
 no one son of Adam has ever escaped, for himself or 
 his helongings, is the only one we never provide for. 
 
 Your plans are not only practicable, but promise 
 extensive and invaluable good — good which will spread 
 to every town and district in the kingdom, if wisely 
 inaugurated in Liverpool. Your district nursing scheme 
 especially deserves interest. I suppose every one will 
 agree with me that every sick man (or woman) is better 
 at home, if only he (or she) could have the same medical 
 treatment and nursing there that he (or she) would have 
 in hospital. But not having this, of how many a rich 
 patient I have said, "Would that I could send him (or 
 her) into hospital." 
 
 Few know, except medical men in the largest prac- 
 tice, how many rich lives, as well as poor ones, are lost 
 for want of nursing, even among those who can com- 
 mand every want under the sun that money can 
 purchase. 
 
 This want you propose to supply, by training nurses 
 for all descriptions of people, as I understand. God 
 bless you, and be with you in the effort, for it is one 
 which meets one of our greatest national wants. Nearly 
 every nation is before England in this, viz , in providing 
 for nursing the sick at home. And one of the chief 
 uses of a hospital (though almost entirely neglected up 
 to the present time) is this : to train nurses for nursing 
 the sick at home. I therefore most earnestly wish you 
 success, and remain 
 
 Yours, in good hope, 
 
 FLORENCE NIGHTINGALE.
 
 PROSPECTUS. 
 
 The Liverpool Training School and Home for Nurses is 
 intended to supply a want universally felt by medical men, and 
 now generally acknowledged by tbe public. 
 
 Tbe work wbich tbe new Institution is designed to effect 
 divides itself into tbree heads, viz. : — 
 
 l.-^To provide tliorounhli/ I'diicatcd Professional Nurses for 
 the Infirmary. 
 
 2. — To provide District or Missionary Nurses for the poor. 
 3. — To provide Sick Nurses for private families. 
 
 1. — To provide thoroughly educated Professional Nurses for 
 the Infirmary.*'' There are in the Infirmary Nurses of whose 
 efficiency and kindness we cannot speak too highly, but the supply 
 of good Hospital Nurses is quite inadequate to the requirements. 
 And the misconduct of the unsuitable ones, who from necessity 
 are employed, discredits a profession which is in its nature most 
 honourable, and would otherwise attract many whose ability and 
 character would peculiarly fit them for its duties. We refer to the 
 testimony of the Medical Board on this point, and need hardly 
 point out how much might be done by a complete system of 
 nursing to save life and health, and to make the expenditure of an 
 Hospital more effective, by giving increased power to the medical 
 and other agencies, and by abridging the period requisite to effect 
 a cure. 
 
 2. — To provide District or Missionary Nurses foj- tlie Poor. — 
 
 * It has been asked why oui- Hospital work is limited to tlie Infirmary. On 
 consideration it will be evident that, if successful, the improvement wiU extend, but 
 tliat to attempt too much at once wiU ensure failure. Tlie Infirmary is the principal 
 and most comprehensive Hospital of Liverpool, and has, with a liberality unusual 
 with Hospitals, consented to allow the introduction of the new system ; and it is, of 
 course, entitled to its first advantage in the selection of Nurses.
 
 28 
 
 In cases which are not suitable for and cannot be reached by 
 Hospitals,, to do in nursing what the Dispensaries do for them in 
 medical aid. We propose to furnish Nurses to those districts 
 which will, by means of local committees or individuals, find the 
 necessary medical comforts and superintendence. The results of 
 district nursing, though only tried on a small scale, and with an 
 imperfect organization, have been invariably satisfactory. It 
 relieves an amount of suffering most intense in its character, and 
 capable of alleviation to a great extent, by a proportionately small 
 expenditure. Ft does more than this ; it teaches the people to 
 nurse their own sick, and, by introducing a knowledge of sanatory 
 laws among the working classes, tends to prevent illness and 
 strengthen health. 
 
 In a merely economical point of view, by restoring parents to 
 their work and place, it often prevents whole families from steadily 
 sinking into hopeless poverty, misery, and vice, the consequences 
 of which, in the end, take vengeance on society for its neglected 
 duties 
 
 In a moral and political point of view, aid thus given to the 
 suflFering poor does away with an irritation against God and man, 
 the extent of which is not suspected by those who have not been 
 in a position to see it. Such irritation is the frequent result of 
 extreme suffering, when unmitigated by assistance from those who 
 have the power to give it, leading men to brood bitterly over an 
 inequality of conditions to which they are not reconciled by 
 experiencing in their need the alleviation which wealth and 
 knowledge could and should have provided. Assistance thus 
 bestowed would open the hearts of the sufferers and of their 
 families to all benevolent persons in their attempts to benefit 
 the working classes, physically, morally, and religiously. 
 
 For the explanation of this, and its confirmation by experience, 
 we must refer to page 15, in the explanations, authorities, &c., 
 which, if not annexed to this, may be had gratis, on application 
 in writing to the Secretary of the Training School, Royal 
 Infirmary, Liverpool ; or at the Publisher's, Mr. Holden, 48, 
 Church Street, Liverpool, price Is 
 
 3. — To provide Sick A^tnses for prkatf fai)i'du's. It is a
 
 29 
 
 fact well known by medical men, that for more patients die 
 unnecessarily (or live with permanently impaired health) from 
 defective nursing, in families who could and would gladly pay 
 for efficient nursing if procurable, than even under the defective 
 nursing which till lately was almost general in Hospitals. Most 
 of the Hospital Nurses had at least some knov/ledge of what 
 they were about. However devoted and watchful the relative or 
 the^private Nurse may be, while she is gaining her experience of 
 what ought to bo done, the object of her care has often passed 
 out of its reach, or her own health has given way, and death 
 has thus multiplied its victims. If relieved by the aid of a trained 
 Nurse, she might with an easy mind have left her charge and 
 obtained the necessary rest. We refer to the explanations, page 
 25 of the fuller statement, for elucidation and confirmation of 
 these views. 
 
 " Before proceeding further, we applied for opinions from competent 
 judges; some of whicli we subjoin : 
 
 Extracts f rum the Minutes of the Medical Board. 
 
 "Liverpool Royal Infirmary, 
 April G, 1861. 
 "The opinioa of the Medical Board of the Liverpool Royal Lifirmary 
 having bee"!! requested respecting a proposed scheme for the improvement 
 of nursing, tlte following Resolution was agreed to: — 
 
 " ' The Medical Board of the Liverpool Royal Infirmary are of opinion 
 that women trained for hospital and district, as well as for private nmsing, 
 are very much required, and having read the scheme proposed to remedy 
 thip want, they consider it admirably adapted to meet the exigencies of the 
 case.' 
 
 " (Signed) James Vose, M. D. Henry Stubbs. 
 
 James Turnbull, M. D. James Long. 
 
 Thomas Inraan, M. D. E. W. Bickersteth." 
 
 Miss Nightingale says : — 
 
 " The public hitherto has had a very inadequate idea of what is meant 
 by musing the sick. There has been little demand for really good Nurses, 
 and consequently very few such have been available. We know more 
 clearly than heretofore that the care of the sick demands acquirements of 
 a much higher oj'der than the common Nurse can attain to. The Nurse's 
 work is in fact a very important part of medical practice, and for its due 
 exercise requires a considerable amount of knowledge, both of the laws of 
 beakli and of disease. At present a Nurse, however wUiinij, haa no ojqwr-
 
 30 
 
 tunity of arrivinri at tliis knowledge. Slie has neitlier instniction uor 
 training; and she comes to her duty with all her experience to learn, and 
 nobody quaUlied to enlighten her. Everywhere this want is felt; and in a 
 very short time it is to be hoped that every large town will make provision 
 for training its Nurses, both for rich and poor, as well as for Hospital 
 service." 
 
 Sir JoliD McNeil] says : — 
 
 " The Physician relies mainly on his means of aiding the curative 
 efforts which nature makes by the exercise of the vital powers, and every 
 demand which is made upon those powers, to counteract irritating and 
 depressing influences not necessarily consequent upon the di-:ease from 
 which the patient suffers, is so much subtracted from the forces on which 
 the Piiysician must rely for effecting a cure. When the disease is formidable 
 and the result of the struggle doubtful, the success or failure of the Phy- 
 sician will in a great measure depend upon the skill and ability with which 
 the Nurse economises and sustains the vital powers of the patient, whose 
 recovery or death will depend quite as much on the qualifications of the 
 Nurse as of the Physician. Indeed, in many cases, the Physician, who 
 sees the patients only once or twice perhaps daily, must be guided in a 
 great measure by the report of the Nurse, who is in constant attendance; 
 and he cannot hope for success in his practice unless he can rely upon the 
 fidelity and intelligence of the Nurse's report. 
 
 " The aid of trained, intelligent, and trustworthy nurses is therefore 
 indispensable to the proper treatment of the sick ; but that aid cannot now 
 be obtained, unless occasionally, and in a few cases." 
 
 Before deciding on the establishment or form of the Institution, 
 we consulted the Medical and other authorities of the Liverpool 
 Infirmary, and those elsewhere who are known to have success- 
 fully devoted much time and thought to the subject of nursing. 
 
 Miss Nightingale gave our plans the same consideration 
 as if (to use her own words) she were going to be herself the 
 matron. From the Lady Superintendent of the St. John's House 
 Nursing Institution we received the most kind and valuable 
 aid. Her experience in working successfully a Nursing Institution 
 in intimate connection with a Hospital (as we proposed to do) 
 made her advice peculiarly valuable. The Hon. Secretary of 
 Devonshire Square Nursing Institution (the first establishment 
 for training Nurses, founded by Mrs. Fry, and for more than 
 twenty years in successful operation,) also aided us with advice 
 and encouragement. We fuither had the valuable advice of
 
 81 
 
 the Right Hon. Sir J. McNeill, G. C.B., late Commissioner in 
 the Crimea ; of General Sir Joshua Jebb, K.C.B., and Mr. Clough, 
 Commissioners of the Nightingale fund ; of Mrs. Wardroper, the 
 Matron, and Mr. Whitfield, the resident Medical Officer, of St. 
 Thomas's Hospital, where the Nurses under the Nightingale fund 
 are trained ; also of several of the ladies who have admirably 
 managed a small Training Institute for private Nurses already 
 existing in Liverpool.* We cannot speak too gratefully of the 
 kindness and patience which we have experienced from these ladies 
 and gentlemen. All are agreed on the necessity of Hospital train- 
 ing for Nurses, and on the great advantages to be derived from 
 the intimate connection which we propose between the Training 
 School and the Hospital. 
 
 We appeal, therefore, with confidence, to the benevolent feel- 
 ings and enlightened judgments of the inhabitants of Liverpool to 
 place us in the position to attain the manifold advantages which 
 are open to the first who may introduce a thoroughly well- 
 organised system of nursing in the North of England. 
 
 The supply of persons suitable for the work is limited ; by 
 being first in the field we may expect to obtain the best ; and the 
 demand for their services, which will naturally arise as the move- 
 ment spreads, will afford large opportunities to the persons trained 
 in our Institution, which will continue to attract to it the most 
 eligible of those who are willing to engage in nursing. 
 
 Arrangements have been made for the erection, on the land 
 belonging to the Infirmary, of a building capable of accommo- 
 dating a staff of Nurses, with a superintendent, a deputy superin- 
 tendent if required, and three servants. Funds have been pro- 
 vided for its erection. The subsequent expenses it is impossible 
 
 * We have been asked in what relation we shall stand to the Nurses' Institute in 
 Solio Street. The present plan embraces the Hospital and District Nursing, in 
 addition to the private nursing of that valuable institution. The ladies connected 
 with Soho Street have given us the kindest assistance and most valuable information 
 in maturing our plans, and have shewn great interest in them. They are quite unable 
 to supply the demand on them for Nui'ses, and that demand increases with experience. 
 Whether ultimately it may be wise to combine the two institutions or to let them 
 work on side by side is a question which experience will probably decide. If it should 
 be desirable to unite, benefits kindly conferred on the part of the older institution 
 and cordially felt and acknowledged on ours, will have prepared the way for it.
 
 B2 
 
 to estimate exactly at the outset of an' entirely new undertaking. 
 Money is required to furnish the building, to carry on the edu- 
 cation and pay the wages of the Nurses employed, and to provi^le 
 for casualties incident to the nature of the employment. 
 
 To furnish the building entirely would cost about £1,000, 
 but we shall probably not require to furnish the whole at first. 
 
 The permanent annual in-door expenses will include the salaries 
 and maintenance of the lady superintendent, three servants, and 
 about thirl y-one nurses — the number likely to be under training 
 and engaged in the Infirmary at one and the same time. The 
 sum required for such salaries and maintenance will probably 
 exceed the sum received for nursing the Infirmary by £300. 
 
 The expenses of lighting and warming the building, taxes, &c., 
 are uncertain. 
 
 Each district or missionary nurse will cost from £30 to £40, 
 a year. 
 
 At first the whole expenditure of the Institution, over and 
 above the sum received from the Infirmary, must be met by 
 donations and subscriptions. It is to be hoped that, in time, the 
 sums received for private nursing, from those who can afford to 
 pay, will cover a considerable part of the in-door expenses. Then 
 the revenue derived from subscriptions would be devoted entirely 
 to that part of the work which is in its essence charitable and 
 gratuitous — the nursing of the poor, and of those who, though 
 educated and belonging to the middle ranks, are yet too poor to 
 provide efficient nurses for themselves. 
 
 From £800 to £1,000 a-year would probably be necessary, to 
 supply such a staff of nurses for this department of our work as 
 the town requires. To this amount the Institution must be per- 
 manently dependent on charitable support. 
 
 A large reserve ought to be accumulated during the early years 
 of the Institution, ns later there will be expenses incident to the 
 nature of the occupation. 
 
 Though we have named the above amounts as requisite for 
 the full development of our scheme, we shall do our best to make 
 the sums entrusted to us, whether great or small, available to the 
 utmost in the work for which thev are given.
 
 EXPLANATIONS, AUTHORITIES, AND FACTS, 
 
 IN RELATION TO THE FOREGOING PROSPECTUS. 
 
 We DOW proceed to give in more detail, for the information of 
 those who may have an interest in the subject, explanations of the 
 proposals made in the preceding statement, as well as the 
 authorities and facts on which we have relied. 
 
 General and Introductouy Remarks. 
 
 What we propose is no untried scheme, but a safer and more 
 humble task — that of availing ourselves of the experience of 
 those who have been successful in similar undertakings, in order 
 to discover and adopt the organization best suited to our local 
 wants. As with many other enterprises of this generation, " others 
 have laboured, and we have entered into their labours." 
 
 I'he following statements consist in great part of information 
 and suggestions extracted from the writings of those whose prac- 
 tical experience supplies the reader with knowledge in place of 
 conjecture. 
 
 The want we seek to supply has long been felt in Liverpool. 
 The subject has been repeatedly taken up by members of the 
 Infirmary Committee, but accommodation being wanting, and the 
 means of the Infirmary being absorbed in meeting evils arising 
 out of the originally defective construction of the building, it was 
 found impossible to do more than make careful selections from 
 the Nurses who offered, and enforce discipline as strictly as could 
 be done by a clever and efficient Matron. 
 
 The following extract (taken from the Rev. Dr. Howson's 
 Paper on Nursing, read at the Social Science Meeting in 1858)
 
 34 ' 
 
 must, from the names appended to it, have formed part of a 
 Prospectus issued more than thirty years ago. It shows how 
 early the want was felt, and the proper remedy seen. 
 
 " It has long been a subject of regret to those who are conversant with 
 the details of sickness, that a most inadequate or unfit provision is made for 
 the necessary attendance on the sufferer, the administration of remedies, and 
 such alleviation of pain as may result from care and tenderness, directed by 
 experienced skill. The poor are entirely without professed Nurses; even 
 the rich are, in many instances, consigned to the negligence of an ignorant 
 or unfeeling Nurse. The amount of misery which is thus occasioned is 
 such as would astonish, if it were known. 
 
 "That the misery is not irremediable, may be made evident; and, 
 by those to whom it has been so evidenced, it is believed a practical 
 remedy may be obtained : that remedy they are now seeking to find and 
 apply. 
 
 " An Association is formed, whose object is to provide Nurses in every 
 way qualified to minister to the comforts of the sick. These will be persons 
 of religious principle and habits, carefully selected from Christians of all 
 denominations holding the fundamentals of Christianity. They will be 
 educated in the Hospitals; during the course of such education they will be 
 resident in a house belonging to the Association, under the control of a 
 Matron and a visiting Committee. They will carry out testimonials, renew- 
 able by actual examinations from time to time ; and their conduct in the 
 various scenes of their future employment will be subject to the inspection 
 or inquiry of the Committee who recommend them. 
 
 " The design of the Association is to extend itself, so that in time its 
 objects may be obtained generally throughout the kingdom ; with which 
 view, subscriptions will be sought generally from the first. Its actual 
 operations will commence in Liverpool, under the auspices of the Public 
 Infirmary (and other medical establishments) of that town. 
 
 " The names of the gentlemen who have attended at meetings already 
 held for the purpose of preliminary arrangements, are — 
 
 "Dr. Renwick, , Rev. W. Rawson, 
 
 Dr. Briggs, j Rev. 0. J. Swainson, 
 
 Dr. Brandreth, 
 Dr. Traill, 
 Mr. Bickersteth, 
 Mr. Batty, 
 Rev. A. Campbell, 
 Rev. R. P. Buddicom, 
 
 Rev. Josh. J. Hornby, 
 Ohas. Lawrence, Esq., 
 James Cropper, Esq., 
 John Moss, Esq., 
 Adam Hodgson, Esq., 
 William Jones, Esq." 
 
 We have already mentioned the principal authorities on these
 
 85 
 
 subjects, and we give below" the titles of publications from which 
 we shall sometimes quote, and to which, when accessible in the 
 original, we would strongly urge those interested in the subject 
 to refer. Many of our quotations, however, are from the private 
 letters and advice of Miss Nightingale and other authorities 
 referred to. 
 
 The following are our reasons for believing that the want we 
 seek to supply is a real want, and that the organization we pro- 
 pose is the one to supply it. 
 
 In watching disease, both in private houses and in public hospitals, 
 the thing which strikes the experienced observer most forcibly is this: that 
 the symptoms or the sufferings generally considered to be inevitable and 
 incident to the disease, are very often not symptoms of the disease at all, 
 but of something quite different, — of the want of fresh air, or of light, or of 
 warmth, or of quiet, or of cleanliness, or of punctuality and care in the 
 administration of diet, of each or of all of these, — and this quite as much 
 in private as in hospital nursing." 
 
 At the census of 1851, 25,466 women were returned as Nurses 
 by profession, exclusive of 39,139 Nurses in domestic service, 
 and 2,822 Midwives. Yet, till recently, so little had been done 
 to fit this important class for duties on the fulfilment of which 
 life or death may depend, that sobriety was comparatively a rare 
 virtue in the Hospital or Sick Nurse, and consequently the inex- 
 perienced and ignorant care of any honest women was preferred 
 where attainable. 
 
 In a celebrated hospital where the new system had been intro- 
 duced, and where respectability was insisted on, all the Nurses, 
 
 * Miss Nightingale's Notes ou Nursing. New edition, revised and enlarged. 
 Harrison, Pall Mall. 
 
 The Reports of the Institution for Nursing Sisters, Devonshii'e Square. H. Teape 
 & Son, Tower HiU. 
 
 The Reports of St. John's House Training Institution for Nurses. Harrison & 
 Sous, St. Martin's Lane ; and of liing's CoUege Hospital (nursed hy St. John's House 
 Institution). Richard Clay, Bread Street HUl. 
 
 The Institution of Kaiserswerth ou the Rhine. HooMiam & Sons, 15, Old Bond 
 Street. 
 
 On the employment of Trained Nurses among the Labouring Poor, considered 
 chiefly in relation to Sanitai-y Reform and the Arts of Life. By a Physician. John 
 Churchill, New Burlington Street. 
 
 Quai-terly Review, October, 1S6U.
 
 36 
 
 except four, forfeited their situations by repeated acts of drunken- 
 ness during the first three months. On the other hand, the 
 insufficient training and consequent ineflficiency of the Nurses, 
 who formed the majority of the above 25,466, are shown by the 
 constant complaints of the medical men The fact that the Nurs- 
 ing Institutions now existing are quite unable to supply applications 
 for those willing to pay for the superior Nursing, shews that the 
 public are becoming aware of its importance. 
 
 One single Institution, in the space of six months, was compelled 
 to reject fifty applications. People willingly bring Nurses from 
 London Institutions to Liverpool, and from the Liverpool Institu- 
 tion to London, at great additional expense, rather than, having 
 once experienced the benefit of trained service, be obliged to fall 
 back on the aid of the untaught. 
 
 Miss Nightingale {" Notes on Nursing," p 219) says : — 
 
 " As to nursing, I have had, during the last three years, several hui)- 
 dreds of applications to recommend qualified matrons or superintendents of 
 institutions, qualified missionary or parish nurses, (i e. to nurse in a 
 parish, with a salary derived not from boards of guardians, but from pro- 
 prietors in the parish,) qualified sick nurses for private families, for hospi- 
 tals, and workhouses. Now in all this the lack was of qualified nurses to 
 fill the places, not of places for the nurses to fill " 
 
 Yet, while there are thus constant openings for properly 
 qualified women, the evils arising from the want of sufficient 
 employment for women are of frightful magnitude and intensity, 
 and none can doubt the correctness of Miss Nightingale's view, 
 that 
 
 " It will be a great good if you can promote the honest employment of 
 a number of poor women, in a way which shall protect, restrain, and elevate 
 them. This T believe you will do effectually, if you can systematically train 
 and improve the large class of women who wish to support themselves by 
 nursing. You may hope in time to lead some to seek not mere mainte- 
 nance in their work, but usefulness to man, and the service of God." 
 
 It is not unlikely, that when respectable accommodation and 
 freedom from immoral companionship are provided, and the real 
 usefulness of the work is better appreciated, many women, daugh- 
 ters and widows of the middle classes, who would become valuable
 
 37 
 
 assistants to the work, would find in it not only the maintenance 
 which their circumstances require, but also a happy exercise for 
 their faculties and affections. 
 
 While, however, recommending this work as one which will 
 find employment for many women from the diflferent classes of 
 society, we must caution those interested against the supposition 
 that most women can easily become really good Nurses. 
 
 This is far from the fact. To be a really efficient Nurse 
 requires quietness, patience, watchfulness, method, accuracy of 
 observation and report, gentleness, firmness, chaerfuiuess, devoted- 
 ness, a sense of duty. Great care must therefore be exercised in 
 recommending or selecting women for the work. See Notes on 
 Nursing, new edition, "What is a Nurse?" — pp 196 — 203. 
 
 " With regard to an oft-disputed question, whether it is desirable to 
 train probationers entirely in a public hospital, 1 should say (without hesita- 
 tion) it is there only i\vAt they ca/i be trained; and every ^ell-judging 
 superintendent will tell you that the students, governors, steward, &c., &c. 
 (disagreeable as the collisions with them sometimes are) are the most 
 valuable assistants in the training of her nurses. Whether in opposition 
 or in kindness, she hears of all their short comings through the secular 
 by-standers, which she would hear of in no other way. I have rarely known 
 a nurse worth the bread she ate, whether religious or secular, whether 
 Roman Catholic Nun, Lutheran Deaconess, Anglican Sister, or paid Nurse, 
 who had not been trained under a hospital discipline, consisting partly of 
 the secular man authorities of the hospital, and partly of her own female 
 superior. I don't know which is the worst managed — the hospital which is 
 entirely under the secular men heads, or the hospital which is entirely 
 under the superior of the nurses, whether religious or secular, whether male 
 or female.'— iV/iss Nii/htiti<jalc. 
 
 Perhaps one of the most important results of the Hospital 
 Training of Nurses will be the acquired habit of strict subordina- 
 tion on the part of the Nurse to the medical authority. On the 
 importance of a nursing institution being directly connected 
 with a hospital, and nursing its patients when practicable, the 
 Honorary Secretary of Devonshire Square, the Lady Superin- 
 tendent of St. John's House, and the Ladies of the Liverpool 
 Nursing Institution express a decided opinion. 
 
 To take our objects in detail :—
 
 38 
 
 1. Hospital Nukses. 
 
 The importance of our work for this object must be evident, 
 from the above remarks. The unanimous authority of the Medical 
 Board, and the fact that the Infirmary Committee have, after 
 most careful enquiry and consideration, consented to our under- 
 taking to nurse the Hospital, shew conclusively the opinion of 
 those who, from their position and means of observation, are best 
 able to form a sound judgment on the subject. 
 
 In King's College Hospital, London, the St. John's House 
 Training Institution for Nurses has for some years maintained a 
 similar connection to that we now propose. The nursing there is, 
 to use the expression we have heard from more than one high 
 authority, nearer perfection than before was thought possible. 
 Each report of the Council of the Hospital, since the connexion 
 of the two institutions began, contains grateful acknowledgments 
 of the resulting advantages. The following extract from the 
 report of King's College Hospital, issued in 1859, will be suffi- 
 cient, as proving their sense of those advantages by the practical 
 test of willingness to pay for them. 
 
 " The committee, fully alive to the numerous and important advantages 
 which the hospital has derived from its connection with St. John's House, 
 and feeling that they ought not to expect that that institution should 
 continue the connection at a considerable pecuniary loss, readily consented 
 to reconsider the terms of arrangement. A meeting accordingly took place 
 between a deputation of the committee and the council of St. John's 
 House, at which the terms of agreement were readjusted — the committee 
 undertaking to pay ^1,100 per annum, instead of ^800, as formerly. The 
 committee consider this arrangement a just and equitable one; and 
 they feel assured that the governors will unite with them in congratulating 
 the hospital upon having secured a continuance of the services of a staff of 
 ladies and nurses, of whose exertions it is impossible to speak too highly, 
 and whose earnest zeal and self denying devotion have earned the gratitude 
 of the patients and the committee, and contributed in no small degree to 
 the high reputation which the hospital so deservedly enjoys." 
 
 2. District or Missionary Nurses. 
 
 If there has been so much neglect in the application of available 
 means for the recovery of health and for the alleviation of suffering
 
 39 
 
 among the educated and rich, how fearful is, and must be, the 
 unavoidable waste of human life and health, how incalculable 
 the unnecessary misery among the uneducated and poor. It is not 
 surprising, then, that as soon as attention was directed to the 
 importance of nursing, the idea occurred to many that some effort 
 should be made to mitigate this evil ; and experiments have been 
 tried in many quarters, in ignorance of such attempts elsewhere. 
 
 "No expense is spared iii providing drugs and medical attendance for 
 the worldng classes. Indeed, the expenditiu-e is out of all proportion to the . 
 amount of good done ; and it is difficult to form any conception of the 
 amount of talent, time and laboiu- that is absolutely wasted, from the want 
 of an organized and efficient system of nursing. The hasty visit of the 
 doctor will be of little avail if the chet and regimen are not attended to ; if 
 there is no one present who can form an intelligent comprehension of 
 mecUcal directions; if the mrfortunate patient is breatliing a poisonous 
 atmosphere, in a close, unventilated dwelling, amidst dirt, confusion, and 
 disorder; if there is no one present who possesses any Imowledge at all of 
 the lirst prmciples of sanatory science, or the laws of oiu* common nature. 
 
 " The poor do not Imow how to prepare the simple food which may be 
 ordered m a palatable form ; they do not laiow how to prepare or use the 
 applications which may be prescribed, such as the preparation and achnuiis- 
 tration of hxjections, the apx)hcation of leeches, rollers, blisters, poultices, 
 fomentations, the management of bed sores, and many other requii-ements 
 I need not allude to at .present. 
 
 "Under these ckcumstances, ■vnth so many opposing forces to counteract 
 the benefits which medicine might confer, the most sldlful phj'siciau -snll 
 be utterly baffled. He therefore becomes careless or uichfferent about the 
 result of his treatment, or he retu'es m despair from such a hopeless war- 
 fare." — Trained Nurses among the Labouring Poor. By a Phj'sician. John 
 Churchill. London: 1860. 
 
 The admirable pamphlet from which the above extract was taken 
 enters more into explanations and details than we can venture 
 upon here. Any one not already convinced of the fearful extent 
 and remediable nature of the evils we propose to deal with will 
 find in it irresistible reasoning on both points. 
 
 We believe we are correct in stating that the result of these 
 independent experiments invariably shews not only that the relief 
 given, in proportion to the expense, &c., has surprised all those 
 engaged in the work, but that the unexpected and incidental
 
 40 
 
 advantages arising from it are greater than its more immediate and 
 evident effects. This will, perhaps, be most easily made clear by 
 an example. 
 
 In Liverpool, experience of sickness led to this desire to lessen, 
 in some measure, the avoidable disease, pain and death, in the 
 homes of the poor ; an experienced Nurse was furnished with a 
 few cushions, blankets, an iron bedstead, bed rest, &c., and sent to 
 visit sick cases pointed out to her, within certain districts, by 
 parties whose judgment could be relied upon ; she was to show the 
 people how to manage their sick better, and help them to do so. 
 The wife of one of the Scripture Eeaders kindly undertook the 
 preparation and issue of sago and other medical comforts to those 
 so visited. The success attained has been far beyond the most 
 sanguine hopes which any of those who made the attempt ventured 
 to form. Though at first the attention of the Nurse was mainly 
 given to consumptive cases, (as those which cannot well be pro- 
 vided for by any of our Liverpool Hospitals,) with the idea of 
 mitigating the extreme misery often attending the last stages of 
 that fearful complaint, yet the numl)er of cases in which apparently 
 hopeless disease was arrested, and heads of families were enabled 
 to return to their work, would, in an economical point of view 
 alone, have repaid a far larger expenditure than was incurred. Of 
 course, in dealing with consumption, the cases were still more 
 numerous where great suffering and often consequent bitterness 
 and hardened discontent were changed into comparative ease, 
 peace, and thankfulness. 
 
 There is surely something horrible even to human feelings in 
 the idea that a fellow-creature's last hours should be passed in 
 suffering, enmity, and bitterness, which our care might have pre- 
 vented. The Nurse, — who, after the first week's visiting, came 
 back crying, saying that she could not bear the scenes she had to 
 witness,— soon found that the good she could do was so clear and 
 satisfactory that she is happy and contented, and has quite given 
 up her wish to return to her former work of nursing the rich. But 
 in addition to alleviating pain and restoring health, the plan was 
 found the most natural and efficient means of conveying to the 
 poor increased sanatory knowledge, improved habits of cleanliness.
 
 41 
 
 and neatness in their houses. Instruction, coming as a natural 
 and necessary part of the Nurse's duty to the sick, is felt as no 
 interference, raises no opposition, and its authority is enforced by 
 the visible and immediate improvement effected by the Nurse in 
 the health or comfort of the patient. 
 
 Nor is the evil stayed and the good done merely sanatory. The 
 effect of hopeless misery is often to produce recklessness and crime 
 in those in contact with it. 
 
 The Nurse had two cases in six months, where, the wife's sick- 
 ness having thrown the household into disorder, the husband, 
 unable to witness misery which he did not know how to alleviate, 
 or to bear the utter wretchedness of his home, had taken to drinking. 
 The nurse shewed what might be done to alleviate suffering and 
 restore order ; the husbands, who were kind, industrious men, 
 became sober agnin, and they and their families were saved. 
 
 In another case the Nurse washed and reduced to order the 
 child of a sick mother, and got it sent to school, &c., &c. 
 
 The attention of the Nurse was naturally most frequently 
 directed to the cases requiring her care by the various ministers 
 of religion ; and the feeling that Christian sympathy and kindness 
 have sought out and alleviated the physical diseases of the poor 
 proves a most efficient preparation for the more important work 
 of religion. From the way, moreover, in which cases are brought 
 under the notice of the Nurse, (being sought out, not having 
 sought relief,) or from its being less easy to deceive the doctor 
 thau it often is the charitable rehever of destitution, the work 
 has, so far, seemed remarkably free from imposition, or discontent; 
 the visits of the Nurse, and the material aid given, though often 
 very small in quantity, have been received with gratitude, and 
 without the usual grumbling as to their insufficiency. Little 
 extras or luxuries ( for so they appear to the poor ) have seemed 
 natural expressions of goodwill, and are not calculated to wound 
 those feelings of self-respect and independence which are more 
 important than health itself. 
 
 As few families are without sickness at one time or other, it 
 is difficult to over-estimate the amount of good, physical and 
 moral, which might be done in this manner.
 
 42 
 
 Gradually, as this became more apparent, it was souglit to 
 extend the experiment. 
 
 On enquiry, with a view to see how the work might be ex- 
 tended, it was found that similar experiments had been equally 
 successful and satisfactory elsewhere, and all agreed as to their 
 importance. The report, in 1859, of the Devonshire Square 
 Nursing Sisters (Mrs. Fry's) says : — 
 
 " The services of several Sisters are also now granted by the Committee, 
 to devote the whole of their time to visiting the sick poor, under the direction 
 of the clergy of the parish to which they are appointed. 
 
 " This branch of their labours is found to be of peculiar importance." 
 
 The Lady Superintendent of St. John's House Institution, 
 speaking of Missionary Nurses, says : — 
 
 If a better system can be established in the dwellings of the poor; if 
 liglit, ventilation, and cleanliness can, by Christian sympathy, kindness, and 
 sound teaching, be better understood ; much will be gained in the war with 
 epidemics at least, to say nothing of increased comfort and self-respect 
 among the poorer labouring classes." 
 
 King's College Hospital has a large number of out-patients, and 
 encouraged by the success of the missionary nursing, where tried 
 by St. John's House Nurses, the Lady Superintendent has 
 established a system of out-nursing for the out-patients reported 
 as requiring it by the medical men. 
 
 In an account of the institution of Kaiserswerth on the Khine, 
 where the works we propose have been admirably carried out, we 
 find the following statement: — 
 
 " Parish Deaconesses. 
 
 " One of the Kaiserswerth Sisters is Deaconess of the parish of Kaisers- 
 werth ; and many have been sent out as such to distant parishes, at the 
 request of pastors or of visiting societies. 
 
 " We know how much the want of capacity to visit well depresses and 
 discourages our best-meant eflForts. We say to ourselves, ' But what good 
 do 1 do? I ask the mother how many children go to school; perhaps I 
 preach a little; I give a little broth and a blanket; I read a chapter out of 
 the Bible, which they don't understand , if somebody is ill, I send the 
 doctor, who opens tlie ulcer too soon, that he may not have the trouble of 
 coming again. How deplorable this sort of intercourse is. I see disorder, 
 dirt, unthrift, want of management, but I don't know how to help it. What
 
 43 
 
 right have I to find fault with them? and I am too ignorant myself to show 
 them how to do better. I see illness, but I don't know how to manage it. 
 And yet that would be the very thing I should like to do, through the body 
 to find the way to the heart of the patient. What I want is something to 
 do in the cottage; to sit on i chair, and ask questions, is not the way to 
 have real intercourse from heart to heart with the poor^ or with anybody. 
 But if I knew how to nurse them, opportunities for doing more would arise 
 of themselves, and I should have some definite errand to take me in. What 
 is said with intention rarely does good; it is only what says itself, in the 
 natural every-day intercourse, which strikes and bears fruit. Everybody 
 knows this from their own experience of what has most influenced them- 
 selves in life.' 
 
 "The question is now, liow to educate ourselves so as to supply this our 
 deficiency. Such an education the Kaiserswerth parish deaconesses receive. 
 In the hospital, the school, the asylum, the household, they learn the wants 
 of the poor, the wants in themselves, and how to treat them, [t is beautiful 
 to see the accomplished parish deaconess visiting : she makes her rounds 
 in the morning; she performs little ofiices for the sick, which do not require 
 a nurse living in the house, but which the relations cannot do well ; she 
 teaches the children little trades — knitting, making list shoes, &c.; — and 
 all this with a cordiality and charm of manner which wins sufficient con- 
 fidence from the parents to induce them to ask to be taught to sweep, and 
 cook, and put their house in order. The parish deaconess at Kaiserswerth 
 is continually receiving curious little notes, written to ask lier advice upon 
 such-and-such household matters; and, wherever she goes, the cottage 
 gradually puts on a tidy appearance. 
 
 " How often a parish clergyman sighs for such an assistant! how often 
 lady visitors sigh to be able to render such assistance! 
 
 " It may he a question whether it would not be better for each parish tc 
 send one of its own inhabitants to such an institution as Kaiserswerth to 
 learn, than for a stranger to be sent out from thence. She would probably 
 be mora at home among the people ; but this is a matter of opinion. The 
 fact remains that we must learn to visit, that we must be qualified to teach. 
 
 "It has sometimes been said that Protestants can never be found to 
 expose themselves to death in the way in which Roman Catholics will do, 
 because the former do not believe that they shall win Heaven by such 
 martyrdom. This has been proved to be false by the undaunted heroines 
 who have gone out from Kaiserswerth, wherever cholera, typhus fever, or 
 other infectious diseases have raged; and, after saving many hundreds of 
 lives, have died at their post. Last year, twenty-one Sisters were engaged 
 in i\ursing in towns wasted by the cholera. Most of them caught the 
 infection; two, having 'fought the good fight and finished their course, 
 went to their eternal home."
 
 44 
 
 Besides Kaiserswerth, the success ofwhich has been remarkable, 
 we are mformed by the Rev. Dr. Howsoii, that, since 1835, twenty 
 independent Protestant Deaconess Institutions have come into 
 operation on the Continent : they have spread from Grermany into 
 France, Switzerland, Sweden and Holland. Those belonging to 
 Kaiserswerth alone have 303* women (ladies and others) employed. 
 The growth has been steady, having increased 35 in 1859. In 
 Strasbui'g, they began in 1843 with 3 women, and have now over 
 80. St. Loup began with 4, has now 35, exclusive of proba- 
 tioners, &c., &c. Kaiserswerth alone has 76 i stations — mostly in 
 Germany; but its Nurses are working far and wide I — 5, at Alex- 
 andria, 5 at Jerusalem, 8 at Smyrna, 5 at Bucharest ; while in 
 the Protestant Hospital at Genoa English sailors have experienced 
 the care of the well-trained Swiss Nurses of St. Loup. 
 
 Any opinion of Miss Nightingale's upon nursing carries weight 
 Avitli Englishmen; but when she places Missionary Nursing in 
 importance above those branches of nursing in which her life has 
 been spent and her health sacrificed, the most sceptical would 
 allow that the authority for such superior importance is unim- 
 peachable. She says : — 
 
 " I quite agree with you that missionary nurses are the end and aim of 
 all our work; hospitals are, after all, but an intermediate stage of civiliza- 
 tion. While devoting my life to hospital work, to this conclusion I have 
 always come, viz., that hospitals were not the best place for the sick poor, 
 except for severe surgical cases." 
 
 Having shewn the existence of the want, we will now explain 
 the organization by which we propose to supply it ; why we propose 
 only to train and supply the Nurses ; and why we propose to leave 
 to local efforts the supply of the necessary medical comforts and 
 the local superintendence of their work. 
 
 From these general remarks it will be understood that Nurses 
 can be best trained in a hospital. From the combinations of the 
 different plans and consequent concentration of Nurses, it will be 
 more easy to apportion to each Nurse her most suitable work. 
 Belonging all to one body, there will be more esprit de corps 
 
 * 131 in 1864. — Florence Nightingale. 
 + 105 in 1864. — Florence Nightingale. 
 { From North America to Italy and Constantinople. — Florence Nightingale,
 
 45 
 
 among them, and tliegeneml experience will become available for 
 the use of each, so that improvement and education need not 
 entirely cease after the Nurses' first training. It is hoped that, 
 through the connection of the District Nurse with the parent insti- 
 tution, and her attachment to it, it will be possible to keep up a 
 higher standard of character, and encourage more active efforts. 
 But in the supply of medical comforts, and the superintendence of 
 their distribution, the advantages are all in favour of local and 
 individual, as compared with central, effort. A central association 
 would not have the local knowledge necessary for such work ; it 
 requires the utmost caution and economy to prevent a waste, 
 which would (as too many other intended charities do) effect a 
 moral evil, and fail even in the material good sought. If the 
 labouring classes could only feel the importance of providing for 
 sickness by self-supporting Provident Disj)ensaries, with Nurses 
 attached, this arrangement would be the best in every way ; till 
 this can be done, the more individual the work the better the 
 effect, morally and materially. Those it is sought to benefit will 
 be less inclined or able to impose on individuals than on a large 
 public. society ; there will be a keener sense of personal kindness, 
 more willingness to follow instruction, less injury to self-respect 
 from receipt of individual benefits than of public charity. Besides, 
 this is a new work, in which much is yet to be learned ; and 
 if, as we propose, a local committee or individual is left to 
 work the district undertaken in their or his own way, it will be 
 fouud, when they bring that local individual experience into a 
 common stock, that much has been gained for the common object. 
 The good does not end here, nor is it by any means confined to 
 the poor. Much has been said and written of the duty and 
 importance of more sympathy and intercourse between rich and 
 poor, of the dangerous tendency of civilisation, and its sub- 
 division of labour in widening the separation between them ; but 
 to do any good, such connection and intercourse must be natural 
 and enforced. Now, in sickness and death, rich and poor are on 
 common ground. In this work the sympathy between them is so 
 natural, the results are so apparent, so immediate and satisfactory, 
 that, if the proper Nurses could be furnished, we believe there 
 would be comparatively little difficulty in interesting kindly disposed
 
 46 
 
 persons connected with the different districts of Liverpool in the 
 work of superintending and furnishing (or collecting) for their 
 own district the necessary appliances and comforts. If once the 
 feelings are interested, the power of and desire for usefulness 
 rapidly increase ; instances of modest, uncomplaining striving are 
 brought naturally under notice — cases which can be helped, 
 and which it is a pleasure to help, with advice or temporary 
 assistance — and in this quiet, unknown work, unsatisfied or 
 bereaved affection, or minds sick with the failure of more am- 
 bitious, and perhaps less unselfish, plans of usefulness would 
 often find a peace and happiness at least as great as that they 
 bestowed. For these reasons we propose to furnish and pay the 
 wages of Nurses for the different districts of Liverpool as soon 
 as we can supply suitable trained Nurses, and so far as our means 
 will admit ; but we shall only do so where individuals or district 
 committees satisfy us that they are prepared to find a suitable 
 lodging for the Nurse, if required, and to supply medical comforts 
 and superintend their distribution. We shall further leave the 
 mode of working each district entirely to the individual or local 
 committee under whose orders the Nurse is to act. If we consider 
 a district is so badly worked as to waste the Nurse's services, we 
 shall reserve to ourselves the right of recall. 
 
 In the districts worked hitherto the Clergy, Scripture Readers, or 
 other Ministers of religion, have reported the cases to the Nurse or 
 superintending lady, and the Nurse has then visited and aided them. 
 
 The following are Eeports of the Nursing : — 
 
 District No. I. — Report of the Superintendent. 
 
 "The following examples will serve to show the nature oi the object we 
 have had in hand for some lime past, viz., the mitigation of such unnecessary 
 suffering, arising from want of attention, ignorance of proper remedies, 
 want of cleanliness, &g., as prevails to such an extent among the sick poor. 
 
 Example No. 1. — "AflBicted with asthma, and other diseases. Found 
 lying on the floor, covered with bed sores, and so thin that she had to be 
 lifted on a sheet ; her husband is a porter, with two children, unable to pay 
 for nursing; she was attended by the Dispensary Doctor, but in other 
 respects was left to the mercy of the world in a low neighbourhood, in dirt 
 and bad ear, wretched in body and mind, causing her husband to feel 
 wretched also on coming home and finding his house in such a condition ;
 
 47 
 
 to use the man's own expression, he thought he was forsaken both by God 
 and man. Our Nurse comes in, washes her, and lends bedstead and 
 bedding, and shews how to use an air-cushion, changes her linen, &c., 
 cleans the house, persuades the husband to whitewash the apartments; 
 suitable nourishment is sent, and she and the household are now in com- 
 parative comfort; she is able to get up. The man is now helpful and hope- 
 fid, and has added by his own exertions and savings to the comfort of his 
 home." 
 
 " Example No. 2. — Afflicted with cancer internally. What was wanted 
 here in this case was a nurse, to attend tlie surgical operation which took 
 place, and carry out the remedies towards recovery, which she did. The 
 woman is now able to resume her work." 
 
 " Example No. 3. — Paralysis. The nurse attended, gave suitable 
 instructions, and taught them how to apply them, and by sending nourish- 
 ment he is apparently entirely recovered, and now follows his work." 
 
 District No. II. — Report of the Nurse. 
 
 "Since I first undertook my duties as Nurse, in November, 1859, I have 
 had cases of consumption, dropsy, &c., under my care. The people whom 1 
 have had to do with are most of them so ignorant that they do not know 
 how to take care of themselves, or even prepare the common necessaries of 
 life. I find by suitable advice that there is very great improvement in 
 many houses as to cleanliness, particularly in their bedding, and more air, 
 and in cooking in a common way. I give you below a few of the cases 
 which I have had to contend with. 
 
 "Example No. 1. — Man with wife and six children. Symptoms of 
 consumption; was too weak to work ; and the whole family really were 
 starving. I lent them a few shillings (since repaid), procured the woman a 
 little needlework, supplied warm clothing, flannels, and nourishment. The 
 man is now apparently quite well, and gone to his work. 
 
 "Example No. 2. — Consumption: This girl was under two medical 
 men, who said it was a decided case of consumption. (Father paralytic, 
 mother keeps a mangle.) She was so weak she had to be carried, and was 
 refused admittance into hospital as too far gone. I supplied her with beef 
 tea, wine, sago, and cod liver oil, and in the course of one month the girl 
 was able to come to my house, and is now quite recovered. 
 
 Example No. 3. — A boy with abscesses, and one of them over the 
 heart, for which the medical man ordered nourishment. I supplied him 
 with beef tea, sago, &c. The boy is now quite recovered and healthy, and 
 able to resume his work. He earns six shillings per week, and came 
 expressly (with his mother) to return thanks for the benefit he had received. 
 His sister was also ill with typhus; was supplied like her brother, and 
 recovered."
 
 48 
 III. — Sick Nurses for Private Families. 
 
 It is almost unnecessary to add anything under this head. The 
 following remarks, extracted from Miss Nightingale's " Notes on 
 Nursing," would be amply confirmed by any physician in large 
 practice among the rich. 
 
 " I am bound to say that I ihink more patients are lost by want of care 
 and ingenuity in these momentous minutiae (attention to diet), in private 
 nursing than in public hospitals; and I think there is more ol' the entente 
 conUfde to assist one another's hands, between the doctor and his head 
 nurse in the latter institutions, than between the doctor and the patient's 
 friends in the private bouse." (See page 91.) 
 
 Again, speaking of the management of the sick room, and 
 injury to the patient from the ignorance or during the temporary 
 absence of the frieud or Nurse, and her neglect to leave proper 
 directions, she says^ — 
 
 "AH the results of good nursing, as detailed in these notes, may be 
 spoiled or utterly negatived by one defect, viz., in petty management, or, in 
 other words, by not knowing how to manage that what you do when you 
 are there shall be done when you are not there. The most devoted friend 
 or nurse cannot be always tliere, nor is it desirable she should ; and she 
 may give up her health, all her other duties — and yet, for want of a little 
 management, be not half so efficient as another who is not half so devoted, 
 but who has the art of multiplyiug herself; that is to say, the patient of 
 the first be not really so well cared for as the patient of the second." (See 
 page 49.) 
 
 " In institutions where many lives would be lost, and the efi'ects of such 
 want of management would be terrible and patent, there is less of it than in 
 the private house." (See page 55.) 
 
 It is because in hospitals the effect of such neglect would be so 
 patent and terrible, and it is therefore guarded against, that they 
 are the best training schools for Nursing. 
 
 The steady increase in the receipts of the various Nursing 
 Institutions from private Nursing is the best proof of the spread 
 of sound opinion on this point. In St. John's House the receipts 
 from, and numbers employed in, private Nursing, have been as 
 follows, in the years ending 31st March. 
 
 1855 25 Nurses £500 | 1858 22 Nurses £754 
 
 1856 26 717 1859 23 971 
 
 1857 19 735 1860 23 1102
 
 49 
 
 In the Liverpool Institution the progress has heen : — 
 
 lM5f) 10 Nurses £21 o I 185W l(i Nm-ses £578 
 
 1H57 IS 4=88 I 1859 -^O „ 764 
 
 We trust we have shown the importance and practicability of 
 the work we j)ropose to ourselves ; but in asking assistance for it, 
 we must guard against the disappointment which, without faith 
 and patience on the part of those who wish to aid in it, must in- 
 evitably be felt. Any work, to be thorough, good, and permanent, 
 must grow, and, for the most part, grow slowly. We have to 
 begin from the beginning ; and though, to prevent waste, it is 
 well to lay down a complete scheme and work up to it, each part 
 will have to be worked out separately and slowly, bit by bit. Miss 
 Nightingale's advice to us is — 
 
 " Do notliiiig rashly ; do not fetter j'^oiirselves "with many rules at first. 
 Wait to see how tilings work, and what is found to answer best. Be pre- 
 pared for all sorts of disappointments. Do yoiu* duty, and trust the event 
 to God. ' In qiuetness and conhdence shall he yoiu* strength. 
 
 This is essentially a quiet, unostentatious work. We wish to 
 appeal only to love of God and man, and faith in what woman can 
 accomplish when influenced by a right spirit and doing her natural 
 work. ^\Tiere women have families, there is their proper field, 
 and we seek no help at the cost of neglected duties. We claim no 
 preference for this work, as nobler or greater. All we say is that 
 for those who, possessing the natural abilities and affections for 
 this work, have not such family cares, or whose families no longer 
 fully occupy such talents, here is their natural work — a work in 
 which, as in families, woman's self-sacrificing, trustful love and 
 care, can change pain and irritation and unrest into ease, peace, 
 gratitude, faith, and hope; where, long suffering and kind, seeking 
 not her ovm, not easily provoked, bearing all things, believing all 
 things, hoping all things, her work however humble, amid duties 
 however apparently small, will endure. The cup of cold water 
 given, or caused to be given, in this spirit to the object of her 
 care, may, with God's blessing, awaken feelings whose effect in 
 ever- widening circles of blessing here, or whose eternal fruit in 
 heaven, she cannot know, till she hears the voice say, " Come, ye 
 blessed of my Father ; inasmuch as ye did it to one of the least of 
 these, ye did it unto me."
 
 50 
 
 PLAN OF EDUCATION PROPOSED FOR NURSES. 
 
 This must at first necessarily be imperfect, and only sugges- 
 tive, to be worked out and modified by the Committee and Super- 
 intendent, as the work goes on and experience increases. 
 
 We propose to have five or six head or training Nurses, say 
 one to about every forty patients. This Nurse to have charge of 
 the whole nursing of the hospital flat, and to be herself Nurse of 
 the central or most important ward; and to have charge of, and 
 be responsible for, the administration of the medicines and stimu- 
 lants on the flat. In her OAvn ward, we propose that she should 
 have a probationer or assistant Nurse. 
 
 We propose that, having first ascertained, as far as we can, 
 that the person seeking to be a Nurse is suitable in character and 
 ability, she should become probationer, first for two months in 
 a surgical ward, then for tAvo months in a medical ward ; then, 
 if sufficiently trained, that, under the superintendence of the head 
 Nurse, she should serve four months as Nurse of a surgical, and 
 four months as Nurse of a medical ward — in all twelve months' 
 training. All this, however, must be subject to modification by 
 the superintendent. 
 
 We propose to have no night Nurses, but that each should 
 take her share of night duty when sufficiently trained to be 
 trusted with it, which we hope will be after the first four months. 
 We propose to engage the Nurses (subject to good behaviour 
 and competency) for three years, including the year in the hos- 
 pital, and to employ them in hospital, district, or private nursing, 
 as their talents or the want of their services may require. 
 They will, however, be told off for the separate works into dis- 
 tinct bodies, and after they leave the hospital, to engage in 
 district or private nursing, all connection with the hospital will 
 cease, and they will not be allowed to enter it. The District
 
 51 
 
 Nurses will reside in their district, and the private Nurses, when 
 not engaged, will reside in the home. 
 
 With from two to three months in a hospital, those nursing- 
 institutes not immediately connected with hospitals have managed 
 to give an amount of training which has been very useful. But, 
 in the first place, the amount of personal attention required from 
 the benevolent ladies who have managed them has been very 
 great ; and in laying down a plan, with a view to its working well 
 in permanence, and under various circumstances, it is not well to 
 make it more than necessarily dependent on a continuance of such 
 gratuitous and efficient services. And, in the second place, all 
 the professional authorities agree that, with the majority of 
 women, two or three months is not a sufficient time to enable 
 them to acquire those habits of watchful, intelligent, and minute 
 attention to the directions of the physician which is necessary ; 
 while the amount of experience which can be gained in so short 
 a time must be very limited. We believe, however, that after 
 twelve months' training, under the medical officers of the hospital 
 and an able superintendent (the key-stone of the whole work), we 
 shall be able to supply Nurses who will command confidence.* 
 
 * On the above topics the lady superinteudeut of St. John's House writes, 
 " I have been mnch interested in your account of the missionary nursing ah'eady 
 done in Liverpool, and am very glad that you have been able to collect so much 
 evidence of the good already done, and of the necessity and importance of an 
 extension of such work. I do not think it is jDossible to over-estimate its impor- 
 tance, in any considerations for the well-being of the sick poor specially, and of 
 societ;' generally. If well organized and well conducted, such work must be the 
 groitndwork of improvements in very many respects among our poorer neighbours 
 which, without the aid of such kindly ministrations, it would be next to impos- 
 sible to effect. I would like to see a branch working well imder the care and 
 conduct of evei7 clergyman of a parish or district throughout our land. The 
 nursing in private families of the higher classes is the most unsatisfactory of the 
 three objects you have in view. Here there are more hindrances in the way of 
 continued steady improvement, but even here we must not be hopeless. 
 
 " Miss Nightingale's book has done very much, in shewing what nursing 
 ought to be. I trust by and by we shall see its fruit in an improved state of 
 things, to the great advantage of the Nurses so employed, and the greater 
 benefit and comfort of the sick and suffering whom they are called to attend. 
 
 " I need scarcely say that the hospital itself is the only field for training 
 Niu'ses, whether for rich or poor, whether to be employed in hospitals or infir- 
 maries, in the houses of the rich or the dwellings of the poor ; and I confess 
 to so deep an anxiety on this subject, that it is great joy to me to hear of any 
 fresh effort to make hospitals more what they ought to be."
 
 52 
 
 After the expiration of the first three years, it will be open 
 to the Institution and to the Nurses to re-engage for the same 
 period. 
 
 LIST AND ESTIMATED COST OF MATEEIALS. 
 
 To be provided by a Local Committee or Individual for a District Nuese, sup- 
 posing an average of Twelve Cases on hand at a time, imable to pay for 
 medical comforts. 
 
 Items of Lending Stock Bequired in Commencing. 
 
 1 Iron Bedstead and Mattress 
 
 £1 
 
 
 
 6 Pairs of Sheets 
 
 1 4 
 
 
 
 6 Blankets 
 
 1 10 
 
 
 
 2 Air Cushions ...... 
 
 8 
 
 
 
 1 Bed Best 
 
 15 
 
 
 
 6 Bed Gowns ...... 
 
 4 
 
 6 
 
 12 Chemises ...... 
 
 12 
 
 
 
 Flannel — 2 Singlets each for 4 cases 
 
 1 5 
 
 
 
 
 £6 18 
 
 6 
 
 We have been recommended to add the following : — 
 
 An India Rubber Lavement Apparatus. 
 A common Eespirator. 
 A Hot-water Bottle for the Feet. 
 A "Water Pad for the Abdomen. 
 
 The bed gowns, chemises, and flannel are things that will 
 require renewing occasionally. 
 
 Weekly Expenses. 
 
 1 Bottle of Wine at 2s. 
 
 Beef for tea, 6 lbs. at 5d. 
 
 Sugar, 3 lbs. at 5d. 
 
 Milk, 6 quarts at 3d. 
 
 Sago, 6 lbs. at 2id. 
 
 Bread, say 48 cobs, at |d. each 
 
 Coals, Nutmegs, &c. 
 
 
 
 2 
 
 
 
 
 
 2 
 
 6 
 
 
 
 1 
 
 3 
 
 
 
 1 
 
 6 
 
 
 
 1 
 
 3 
 
 
 
 2 
 
 
 
 
 
 1 
 
 6 
 
 £0 12 per week, 
 
 Or £31 4 per ann.
 
 53 
 
 In addition, there will be required for the year 
 
 Preserves, average 1 jar per week, at lid. 
 Raspberry Vinegar, 1 bottle ,, at Is. 
 
 Cod Liver Oil, 1 bottle ,, 
 
 2 tins Arro^TOot, weighing 28 lbs., at 9d. 
 Stone Jars for boiling Sago, &c. 
 
 . £2 7 
 
 6 
 
 2 12 
 
 
 
 2 
 
 
 
 1 1 
 
 
 
 4 
 
 
 
 £39 8 6 
 
 It need hardly be mentioned that a greater amount of nourish- 
 ment, &c., would often be advantageous where means will allow 
 it. Many may be willing to send preserves, bits of meat, vege- 
 tables, &c., instead of money. 
 
 The dispensaries supply cod liver oil to those who cannot 
 aiford to buy it, on payment of one penny per bottle. 
 
 LETTER FROM CLERICAL SUPERINTENDENT OF THE CHURCH OF 
 
 ENGLAND SCRIPTURE READERS SOCIETY, 
 
 67, bedford street, south. 
 
 11, Peel Tebeace, Falknek Square, 
 Liveijwol, November 20, 1860. 
 My Deak Sib, 
 
 I cheerfully testify to the value of the efforts to provide competent 
 Nurses for the sick among our poorer classes at their own homes. 
 
 Viewing the matter in its religious bearing, it is scarcely possible to 
 exaggerate its importance, for the consolations of oiu- holy faith are then 
 most readily received, when the sufferer feels that his bodily infirmities are the 
 objects of thoughtful and tender care. 
 
 I enclose, with very sincere pleasure, the statements of those Scripture 
 Readers in whose districts the agency is already in operation. 
 
 Faithfully yovirs, 
 
 ARTHUR GORE, 
 Clerical Supei'iuteudent Scripture Readers Society.
 
 55 
 
 METHOD OF WORKING. 
 
 After the Lady Superintendent had, as above stated, 
 passed some tune at Kmg's College and St. Thomas's 
 Hospitals, and was ready to midertake her duties, we 
 obtained the assistance, as Training Nurses, of several 
 of those educated in the School in connection with the 
 latter Institution, established by the trustees of the 
 Nightingale Fund. Of the system under which these 
 Nurses had been educated, whether as regards disci- 
 pline or medical instruction, we cannot speak too 
 highly ; nor can we too gratefully acknowledge the 
 benefits we, through their assistance, derived from it. 
 Under these Training Nurses were placed the young 
 women selected for education in the School, applicants 
 of from twenty-five to thirty-five being preferred. These 
 probationers received, while under training, fourteen 
 guineas a-year, and afterwards were employed in the 
 Infirmary, in District Nursing or private families, at a 
 rate of wages varying with efficiency and length of 
 service. 
 
 The Hospital and Private Nursing is entirely under 
 the direction of the Lady Superintendent, by whom it 
 is managed in conformity with the rules laid down by 
 the Infirmary and School Committees.* 
 
 With a view to the organization of the District 
 Nursing, the town was divided into sixteen (now 
 increased to eighteen) districts, each containmg two or 
 more ecclesiastical districts. We adhered, as far as 
 possible, to ecclesiastical boundaries, because, while 
 
 • For particulars of Rules and Forms in use, refer to Appendix, E, p. 81.
 
 56 
 
 the limitation of the district was a matter of indifference 
 to the Dissenters, the coincidence of its hmits with 
 those of their cures much facihtated the co-operation 
 in our work of the clergy of the Established Church. 
 Each Nursing District contains from 11,500 to 41,347 
 inhabitants, the average being 24,929. The number 
 of cases under a Nurse's care at one time varies very 
 much, being greater in winter than in summer ; some, 
 it must be observed, require only occasional visits. 
 Particulars of the work done in 1863--4 will be found 
 in the Appendix, pp. 76, 77. 
 
 The Central Society only undertakes to pay the 
 wages of the District Nurse. It was necessary, there- 
 fore, to find in each District ladies able and willing not 
 only to superintend her work, but to provide or raise 
 the funds required to pay for the Nurse's lodging, for 
 medicine, food, and comforts for her patients, and so 
 forth. In 1864 the expenditure under these heads 
 averaged J680 a district, particulars of which will be 
 found in the Appendix.^'' Elsewhere f I have given a 
 Memorandum which in several cases was laid before 
 ladies when proposing to them to undertake this 
 onerous charge. 
 
 This district expenditure is met as follows : — In 
 three districts the funds are provided by members of the 
 religious congregation to which the local Lady Super- 
 intendent belongs. In one, the wife of a clergyman, 
 whose cure is included within the district, is Lady 
 Superintendent, and raises the funds by subscription. 
 In one, the clergyman, aided by three non-resident 
 subscribers of <£10 each, has become responsible for the 
 funds, and a lady parishioner for the superintendence. 
 In one, the wife of the minister of a large dissenting 
 
 * Report of 1864, p. 70. | Appendix, p. 95.
 
 57 
 
 congregation lias undertaken the Superintendent's duty, 
 and her husband has engaged to raise one-half the 
 cost by sul)scriptions from his congregation, the other 
 half being provided by employers of labour within the 
 district, and other men of property. In one, subscrip- 
 tions of from jC2 to ,£10 from employers of labour 
 within the district, and men of fortune unconnected 
 with it, provide the requisite funds. In one, a gentleman 
 who has ceased to reside in Liverpool furnishes £40 
 a-year, the Lady Superintendent finding the rest. In 
 one, a mercantile firm pays the cost. In seven, the Lady 
 Superintendent or her family pay the whole or the 
 principal part. 
 
 In December, 1864, the Liverpool Central Relief 
 Society agreed in certain cases to give meat to patients 
 under the charge of the District Nurses, to send con- 
 valescents to the sea-side when desirable, and to relieve 
 the families of patients, if found deserving.* 
 
 The Lady Superintendent for each district being 
 found, funds provided, and a Trained Nurse established 
 there, it only remains for the Central Society to ascer- 
 tain, by periodical inspection, the efficiency of the 
 Nurses, and the due execution of the intentions of its 
 subscribers. t In other respects, all duties of manage- 
 ment and direction in District Nursing devolve upon 
 the Local Superintendents, each lady being supreme in 
 her own district, and solely responsible for its manage- 
 
 * Particulars of this arrangemeut, aud the form of rccoinmeuclatiou required under 
 it, are given in the Appendix, p. 77. 
 
 + This is done very effectively by the Assistant- Secretary and Out-door Inspector 
 of Nurses — a Lady whose duty is solely to inspect the Nurses, and in no way to 
 criticise the management of the district ; or, unless requested by the Local Superin- 
 tendent, to take any part in its arrangements. She is, however, often of great use in 
 maldng arrangements or inquiries at the parish offices and other institutions ; or, in 
 the absence and at the request of the Lady Superintendent, taking the charge of 
 the district.
 
 58 
 
 ment. The first point is to find a lodging for the 
 Nurse ; the next, to find some one to take charge of 
 the stores, and to cook the sago, rice, beef tea, and so 
 forth, for the patients. It is desirable that both the 
 place for cooking and the Nurse's lodging should be in 
 a central position ; and this is especially important in 
 regard to the cooldng, as, though some member of the 
 sufferer's family, or a friendly neighbour, can generally 
 bring the food from a short distance, they often cannot 
 go far for it. If a respectable tradesman's wife, or 
 some other resident in the district, can be found to 
 undertake the cooking from a wish to take a share in 
 the good work, nothing better can be desired ; but it 
 is rarely that the same person has both the will and 
 the means to undertake such an office. In many cases 
 the Nurse does the cooking. But this is not desirable 
 where it can be avoided, as it takes up time which she 
 can employ to better purpose. Moreover, where the 
 same person makes the requisitions and supplies them, 
 there is neither check nor voucher ; and thus the 
 Nurse is exposed on the one hand to temptation, and 
 on the other to suspicions which, however groundless, 
 she has no means of refuting. When the Nurse and 
 cooking-place are established, it is time to make the 
 operation of the system generally understood. Either 
 a meeting is called, to which the ministers of religion, 
 medical officers of the district, and others likely to be 
 interested in the cause are invited, and explanations 
 upon the object and mode of worldng are publicly 
 given ; or such explanations are made privately, by visits 
 or by letter. The forms given in the Appendix * will 
 explain the working of the district system in detail. 
 Every quarter the Ladies Superintendent of districts 
 
 * Appendix, pp. 87 — 94.
 
 59 
 
 draw up a report of their operations for the information 
 of the Committee and of each other, and meet to 
 discuss the wants or difficulties which may have arisen. 
 Specimens of these reports, and extracts, noticable 
 for the suggestions they contain, are given in the 
 Appendix.* 
 
 At their annual meeting in 1863 they reported as 
 follows : — 
 
 " The Ladies Superintendent wish to report that the objects of the 
 District Nursing have been much more satisfactorily attained during 
 the past year than in 1862. There has been more of actual nursing, 
 and less of mere relief. They believe that its usefulness mil be still 
 further increased as more complete co-operation is established with 
 the medical authorities and ministers of religion, and as the plan is 
 better undca-stood. 
 
 " They wish, however, to call attention to the fact, that in most of 
 the districts there have been no contributions towards the medical 
 comforts received through the ministers of religion of the district, 
 though they understood the districts were as much as possible so 
 arranged that they might include congregations capable of aiding." 
 
 In 1864:- 
 
 " The Ladies Superintendent wish to report that the usefulness of 
 the District Nursing has been much increased, and in most of the 
 districts they have received the most kind and efficient co-operation 
 from the medical men. The Ladies Superintendent earnestly invite 
 contributions to the district funds, either in money, clothing, flannel, 
 old or new blankets, old linen, wine, fruit, or delicacies suitable for 
 the sick. It is requested that money may be sent to the Lady 
 Superintendent of each district direct : other things can be sent to the 
 Nurse ; but it is requested, and particularly in the case of wine, that 
 a list of the articles should be sent to the Lady Superintendent." 
 
 In consequence of the suggestion above cited, the 
 
 Chairman and Secretary of the Central Society invited 
 
 . the medical men in charge of the dispensaries and 
 
 parochial districts to meet the Ladies Superintendent. 
 
 * Appendix, pp. 95—100.
 
 60 
 
 A discussion took place and explanations were given 
 which have led in most districts to cordial and very 
 beneficial co-operation. 
 
 In a recent letter Miss Nightingale asks, "Will not 
 the extension of Parish Nursing very soon make neces- 
 sary some careful consideration of the subject of 
 finance ? Every parish or district should, as a rule, 
 pay for its own Nurses. But this must vary in different 
 places. Is it not required that some consistent prin- 
 ciple should be established, either by church collection, 
 donation, or otherwise ? " 
 
 This is a most important but most difficult question. 
 There are two dangers to be studiously avoided. On 
 the one hand half the virtue of the system is lost if the 
 personal character of the work is impaired — if anything 
 should be allowed to lessen the directness of the 
 relation between the giver and the receiver. Much of 
 the value of the District Nursing depends on the 
 personal intercourse between the educated, refined and 
 virtuous woman who gives of her abundance of means, 
 mind, and heart, and the poor, ignorant, and often 
 erring whom her bounty relieves and her sympathy 
 soothes : while she receives, in return, that peace and 
 enlargement of soul which I believe the rich can hardly 
 obtain, save by taking personal interest in and care of 
 their poorer neighbours. Every observant student of 
 human nature must be struck with the amount of 
 mischief caused to both rich and poor by the marked 
 separation between their lives and interests — a separa- 
 tion which the organization of civilized society ever tends 
 to widen more and more. The poor are pauperised 
 and degraded when they receive from the mechanical 
 operation of organized societies that dole into which no 
 feeling of true charity, of Christian brotherhood and
 
 . 61 
 
 personal kindness, enters, to soften the sting of 
 dependence and create a sense of personal affection ; or 
 receive that dole almost as they receive the parish 
 allowance, with as little thankfulness, and as little sense 
 of the duty of enabling themselves speedily to do 
 without it. The rich, on the other hand, who deal 
 with the poor only through such societies, find no relief 
 in this kind of mechanical charity from the narrowness, 
 timidity, and unrest which riches so often create, and 
 which are the natural fruits of hearts and intellects 
 starved and stunted for want of that nourishment and 
 exercise, in personal well-doing and in kind offices to 
 living individuals, not to a class in the abstract, which 
 God intended to correct the benumbing influences of 
 wealth. It would therefore be very lamentable if the 
 personal tie between the Lady Superintendent and 
 her district should be weakened or superseded by a 
 mechanical organization. On the other hand, the amount 
 of money required to meet the expenses of a district is 
 such that, if it is to be provided by the Lady Superin- 
 tendent alone, the choice is too narrowly limited by the 
 small number of those who can and will afford such an 
 outlay. And if, by the death or removal of one Super- 
 intendent, the district organization is for a moment 
 interrupted, its permanence may be endangered by the 
 difficulty of finding a successor with suitable qualifica- 
 tions, leisure, and fortune. Perhaps the best way of 
 meeting this difficulty would be by combining personal 
 responsibility with social organization, an individual 
 undertaking the duties of superintendence and pro- 
 viding a certain proportion of the funds, and an 
 organization, charitable or religious, the rest. 
 
 Liverpool had several unconnected societies for alms- 
 giving, whose separate operation led to great abuses.
 
 62 
 
 These have been latterly combmed into the Central 
 Belief Society. Of the objects of that Society, the 
 relief of the sick poor, now undertaken by the system 
 of District Nursing, was one. A more intimate con- 
 nection between the Societies would probably be 
 desirable. The experience of the agents of the Central 
 Relief Society would render material assistance in 
 detecting imposture ; while the aid of the district 
 organization would probably enable that Society to use 
 its funds to still greater advantage. If it were arranged 
 that the Central Relief Society should pay one-half the 
 expense of a district, while the Lady Superintendent, 
 representing either a family or a congregation, should 
 pay the remainder, this might probably be found a good 
 method of combining personal care and interest, economy 
 and efficiency, with the adequacy of means and perma- 
 nence which characterise the working of an organized 
 charity. In other cases church collections might come 
 to the aid of private benevolence, and bear a similar 
 proportion of the cost ; or the expense might be defrayed 
 by a large employer of labour, a landowner, or a 
 subscription. Where no such arrangement could be 
 effected, although the loss of the personal superinten- 
 dence of an educated and independent woman would be 
 a great di*awback, it would still be good economy for 
 the parish to retain the services of a trained District 
 Nurse as one of its regular staff. 
 
 One point has occasionally been raised to which it 
 may be well to advert. Some have objected to allow 
 the ladies of their family to take part in the work for 
 fear of mfection. With very slight precautions, this 
 risk is much less than that incurred by calling in a 
 doctor. The Nurse can always tell the Lady Superin- 
 tendent where she may safely go, and can avoid visiting
 
 63 
 
 her on days when, or in clothes in which, she has 
 attended infectious cases ; whereas the doctor must go 
 from patient to patient without any such precautions. 
 But if the risk were greater than it is, we should have 
 no right to flinch from it. Life was given not to be 
 hoarded, but to be carefully and wisely spent. The rich 
 and their children enjoy all the benefits of knowledge 
 and of wealth ; among others, all the appliances that 
 knowledge can devise and wealth can purchase to avert 
 or to cure disease. Incumbent on the possession of 
 wealth and knowledge is the duty of ministering to 
 those who have them not, and the risks incident to 
 that duty we are not at liberty to shun.'' 
 
 "A religious organization," it has been suggested, "is 
 necessary to the perfect success of your undertaking." 
 A religious organization, in the best sense of the phrase, 
 I trust that we possess ; but what is too often meant by 
 the words is a dogmatic or sectarian bond. This I 
 believe to be neither necessary nor desirable. The Lady 
 Superintendent of the Home and Training School has 
 always endeavoured to instil religious motives and a 
 religious sense of professional duty into the minds of 
 her pupils ; and though among these are members of 
 many different sects, we are never troubled with religious 
 discord. Good work, faithfully performed, has a 
 tendency to enlarge the mind of a Christian, and purify 
 his spirit from sectarian bigotry ; to bring into strong 
 relief those principles of faith and practice, which, as 
 the Great Judge has assured us, will guide His judgment ; 
 and to indispose the labourers to "judge " one another. 
 
 * " True niu'siiig lmo\\-s nothing of infection, except to prevent it. Clean- 
 liness, fresh an- from open -iraidows, -with unremitting attention to the 
 patient are the only defence a true niu'se either asks or needs. Wise and 
 Immane management of the patient is the best safeguard against infection." 
 — jiliss Xiijhtiiiijiih's Notes on Xursuiij.
 
 64 
 
 No doubt religious sisterhoods have an advantage in 
 this kind of work, tending, as they do, to merge all 
 personal action and avoid anything like individual 
 prominence. But such sisterhoods are regarded with 
 deep and unreasoning mistrust by the great majority of 
 Protestant Englishmen, and will probably remain subject 
 to such mistrust until some one as perfectly free from 
 sectarian bias or religious extravagance — as able, 
 energetic, and discreet as Pastor Fliedner, and as 
 remarkable for that tact in which some of the promoters 
 of English sisterhoods have been so unhappily deficient, 
 shall undertake their organization. It is most desirable 
 that in an office like that of nursing, where a sense of 
 duty, not a hope of praise, must be the moving principle ; 
 where, *' in quietness and in confidence must be the 
 strength" of the labourer, everything that tends to give 
 prominence to the individuality of those who undertake 
 work should be studiously avoided. It will be 
 observed that in the reports, in all accounts of individual 
 cases, and in everything except the mere statistics of 
 districts, we have never mentioned the names either of 
 the writers or the subjects of the examj^les we have cited. 
 The Society is obliged to publish the names of the 
 Committee, and of the Ladies Superintendent of districts, 
 together with details of the work done, in order to keep 
 up the public interest and the confidence of subscribers. 
 But I believe that most of those engaged in the work 
 would be glad if such parade could be avoided, and if 
 it could be carried on vi silence and unnoticed ; would 
 wish it to be impersonal as regards the public, and 
 personal only in the relations between those who confer 
 and those who receive its benefits. The profusion of 
 flattery which attends the philanthropic efforts of the 
 present day demoralises all whom it does not disgust.
 
 65 
 
 and often ends by exercising a pernicious effect even on 
 those who, conscious how far they fall short of their o^vn 
 aspirations and sense of duty, are at first repelled by it. 
 
 In the Appendix * will be found an address delivered 
 to the Nurses by one of the Committee on the first New 
 Year's entertainment in the Home. In its sentiments 
 I believe that " all who profess and call themselves 
 Christians " could cordially unite. In working among 
 the poor, we cannot be too careful to avoid the suspicion 
 of any latent or subsequent purpose — any object other 
 than that openly professed, which, in the present case, 
 is that of curing their sick, alleviating their sufferings, 
 and teaching them the rules of health. In this, as in 
 most things, " singleness of eye" is necessary to success. 
 If the poor suspect that a benefactor seeks to gain them 
 over to any sect, or induce them to attend any particular 
 Church, they at once set down his kindness to selfish 
 and insidious motives, and are neither grateful nor 
 edified. Of course this feeling on their part is exagge- 
 rated and unreasonable ; for even their conversion is 
 desired as tending to their own happiness. But such is 
 their feeling ; and since it is so, we cannot too carefully 
 avoid any indication of sectarianism or proselytism. Of 
 course, in proportion as this and our other duties are 
 well performed, will be the influence of our example, and 
 the disposition of the poor among whom we work to 
 respect and adhere to the faith that bears such fruits; 
 but to desire or seek for any more direct results of this 
 kind in the work of healing or relieving the sick is to 
 insure disappointment, and is certainly to depart widely 
 from the practice of our Master. 
 
 Prefixed to this sketch will be found a plan and descrip- 
 tion of the Home. It was cheap, and has been found to 
 
 * Appendix, H. p. lOl.
 
 66 
 
 answer very well, being airy, light, and cheerful. To 
 visitors I may as well say that the decoration and orna- 
 ments, which might seem unnecessary, have not been 
 executed or furnished at the expense of the Institution, 
 but have been given by its friends, or those of the 
 Lady Superintendent. I think, moreover, that such 
 ornaments have been by no means useless, in attracting 
 the Nurses and attaching them to their home. Ugly 
 and ungraceful habitations are hardly economical, where 
 it is desired to inspire a feeling of pride and affection in 
 those who are to live and be educated there. 
 
 In addition to the papers above mentioned, there will 
 be found in the Appendix the balance-sheets and parti- 
 culars of expenditure for 1863 and 1864,''' and the Report 
 of the Committee for the latter year. f That Committee 
 consists not of benevolent enthusiasts or philanthropists 
 by profession, but of practical men of business, who have 
 abundant work and large experience in commerce, in 
 politics, and in life, who Imow the value of time and 
 money, and would not bestow either on an enterprise in 
 which they did not find the results proportionate to the 
 expenditure. 
 
 All who value their own health and that of their 
 families ; all who care for the limitation of pauperism 
 and its attendant evils; all who feel a sense of duty 
 towards or interest in their poorer neighbours ; will find 
 themselves amply repaid for the time, trouble, and 
 money it may cost them to introduce a similar organiza- 
 tion into their own town or neighbourhood. 
 
 * Appendix, B. pp. 7'2 — 75. I- Apiieiulix, A. p. 67.
 
 APPENDIX. 
 
 A. 
 
 REPORT OF THE COMMITTEE FOR 1864. 
 
 This is the first year in which we can be said to have been at full work 
 in the Hospital, and in the greater part of the Town. Our Staff of Nurses 
 is still insuflBoient to meet even the pi'esent demands upon us, while 
 experience of the value of the services of trained Nurses seems to increase 
 the demand far more rapidly than we can hope to find and train women 
 suitable for the work. Success in the past year gives us confidence that 
 every year will increase the efficiency and usefulness of each branch of our 
 undertaking. The Lady Superintendent's care of tlie young women under 
 her charge gains their respect and affection, and retains most entirely the 
 confidence af the Committee and Medical authorities. The Report of the 
 Lady Superintendent is as follows : — 
 " Gentlemen, 
 
 " Since the beginning of 1864, 33 }oung women have been admitted as 
 Probationers ; five of these nave left, being unsuitable for the occupation. 
 Besides these, several older women have been engaged as Assistant Nurses, or 
 with a hope that tbey would prove useful as District Nurses, but the need of 
 earlier training has, in almost everj- case, become a barrier to their continuing 
 in the service. 
 
 " The most efi"ectual help has been given us in finding suitable candidates, by 
 Ladies and Gentlemen in various parts of the country, who have communicated 
 with the Superintendent ; and latterly, when vacancies have occurred, we have 
 had no difficulty, by this means, in procuring those who could fill them. Many 
 have been introduced through the Nurses and Probationers already here. At 
 present we have no vacancy in the House, and there are several applicants on 
 the Ust, for whom we have no room. Our staff" of Nurses, exclusive of the 28 
 Probationers, consists of 14 in the Infirmary, 10 sent out to nurse in private 
 houses, and 14 placed in the various Districts of Liverpool to nurse the poor. 
 
 " No considerable additions have been made to the library, the books of 
 which have been pretty generally read, and more would be acceptable. 
 
 "Evening Classes have been held twice a week in the House for Probationers. 
 
 " Amongst so large a number of young persons, it is unlikely that all would 
 prove equally good and useful ; but I have pleasure in assuring you that on the 
 whole I have reason to consider the conduct and efficiency of our women 
 satisfactory. There has been a great deal of quiet and steady self-sacrifice in
 
 OS 
 
 their work, as well as hearty ohedience to those they serve. I hope and helieve 
 that almost without exception they become attached to their employment, and to 
 their Home; and that the foundation is thus laid for the permanent welfare of 
 the Institution. 
 
 "I am, Gentlemen, 
 
 " Yours faithfully, 
 (Signed) « M. MERRYWEATHER, 
 
 " Lady Superintendent.''' 
 
 ROYAL INFIRMARY. 
 
 We have to record our sincere thanks to the Members of the Medical 
 Board, and to the House Surgeon, for the confidence and assistance the 
 Lady Superintendent and Nurses have received from them. They have 
 often spoken with approval of the conduct and efficiency of the Nurses ; 
 qualities in which we hope each year will show further progress. 
 
 Miss E. Merryweather has again most kindly spent nearly the whole of 
 the year in helping her sister, and her experience and knowledge of nursing, 
 and unwearied gentleness and kindness, have been most useful, and deserve 
 the gratitude of this Society. 
 
 DISTRICT NURSING. 
 
 Some alterations have been made in the boundaries of some of the 
 districts, to meet alterations in the Ecclesiastical boundaries, as we are 
 most anxious to facilitate the co-operatiou of the Clergy of the Church of 
 England, as well as of all other denominations of Christians. The Map of 
 Districts will be found at the end of this Report. 
 
 Only 14 of the 17 districts have been at work in 1864, but No. 12 is 
 now undertaken by a Lady, aided by the Churches in it; and No. 11 by 
 members of an influential Congregation, assisted by the employers of labour 
 in that district. Pecuniary aid has also been promised for the remaining 
 district, No. 17, so that before the expiration of two months we hope the 
 whole town will have the benefit of an organized system of district nursing. 
 We have again to report a decided improvement in both the quantity and 
 the quality of the work done; and our opinion is confirmed, that with 
 increased exjjerience, and as we find and thoroughly train entirely suitable 
 women, the extent and usefulness of our work will increase year by year. 
 
 The number of patients who attended has been 2,358, being an increase 
 of 582 over 186B. 
 
 In addition to the sums expended by this Society in wages of District 
 Nurses, the Ladies Superintendent of districts have expended in 1864 about 
 ^1,100 in the medical comforts, food, wine, &c , necessary for the sick, and 
 in lodgings for the Nurses. This large sum, averaging over ^81 per dis- 
 trict, has to be provided out of her own means, or raised by the Lady Super-
 
 69 
 
 intendent of each district. It will be evident that nothing but experience 
 of the great value of the work done would induce the Ladies to meet, as 
 they have dune cheerfully, such a large and increasing tax on their time 
 and means. We are happy to say that there have been, in two instances, 
 Church collections made in aid of the funds of districts ; and in 1865 two 
 districts will be added to those in which members of a comparatively 
 wealthy congregation combine to supply funds for a district; but too many 
 are left to depend entirely on the contribution of the Lady Superintendent 
 of the district and her family and friends, without that aid which such a 
 work may rightly claim from those who have means, and either worship or 
 carry on business in the districts. 
 
 The following communication was agreed upon by the Ladies Superin- 
 endent of Districts at their Annual Meeting: — 
 
 "The Ladies Superintendent wish to report that the usefulness of the 
 district nursing has been much increased, and in most of the districts they 
 have received the most kind and eflBcient co-operation from the medical 
 men. The Ladies Superintendent earnestly invite contributions to the 
 district funds, either in money, clothing, flannel, old or new blankets, old 
 linen, wine, fruit, or delicacies, suitable for the sick. It is requested that 
 money may be sent to the Lady Superintendent of each district direct : other 
 things can be sent to tlie Nurse ; but it is requested, and particularly in the 
 case of wine, that a list of the articles should be sent to the Lady Superin- 
 tendent." 
 
 It may interest some of those disposed to send assistance to the Ladies 
 Superintendent of districts, as well as those contemplating similar work 
 elsewhere, to know in what the expenditure of the districts consists. The 
 expenditure is the same in kind as that required in hospitals, except that 
 whereas the latter supply all the nourishment and medicines, the Lady 
 Superintendent of a district only supplements in food the resources of the 
 patients, and that only when necessary, while medicines are generally 
 supplied by the parish or dispensaries. The expenditure varies in different 
 districts from ^30 to i'160, and the difference arises not only from the 
 number of sick, but also from the number of other agencies at work in the 
 district, and the degree in which the work is limited to strict nursing. Thus 
 two districts, both similar in poverty, both efficiently worked and carefully 
 looked after, have furnished about the same number of cases in 18(54 ; in 
 one under ^60 and in the other over ^160 has been expended, and yet 
 there has been care to do as much good as possible in the one, and to avoid 
 waste in the other. In the apparently cheaper district the cases have been 
 treated as they would have been in an hospital, that is, referred to other 
 agencies where hopeless of cure, and needing rather the kind aid of charity 
 than the tending of the Nurse ; those other agencies were at band, provided 
 for the most part out of the same purses, and superintended to a great 
 extent by the same Ladies, to do what was needed. In the other district,
 
 70 
 
 and in many of the districts, if clothes were wanted to prevent the children 
 of consumptive parents from heing added to the list of sick, or to send 
 convalescents to their work, or if cases of chronic sickness, such as furnish 
 the inmates of the infirm wards oi workhouses, were to he made less 
 wretched, the expense was provided out of the same fund as the nursing. 
 Between the districts in question it is more a matter of account-keeping 
 than actual difference, but, as such, very interesting, showing how much 
 good may he done even with moderate means, if strictly limited to the most 
 important part of nursing ; and, on the other hand, how much more good 
 may advantageously he done, and how much money well spent, (as we are 
 assured it is,) under the guidance of the information which the district 
 work furnishes to those engaged in it. 
 
 AVERAGE EXPENDITURE PEE CASE, AND PER DISTRICT, OF TWO HUNDRED CASES, UNDER 
 SUNDRY HEADS, IN 1864, FROM THE RETURNS OF NINE DISTRICTS. 
 
 Meat 
 
 Bread 
 
 Beer, Wine, Spirits— Brewers . . 
 
 Milk 
 
 Groceries, Sago, Eice, ^:c 
 
 Cod Liver Oil, Drugs, &c 
 
 Coal 
 
 Cooking and Lodgings of Nurse 
 Clothing 
 
 Total 
 
 Average Expense 
 per Case. 
 
 d. 
 
 8.437 
 9.385 
 
 10.765 
 7.926 
 
 11.476 
 3 305 
 3.709 
 3 250 
 5.350 
 
 9 3.603 
 
 Average 
 Expense per 
 
 Annum 
 per District. 
 
 £ S. 
 27 
 
 7 16 
 
 8 19 
 6 12 
 
 9 11 
 
 2 15 
 
 3 1 
 12 14 
 14 9 
 
 92 19 11 
 
 We give, in a tabular form, the result of the district nursing in 186-4, and 
 we also print some extracts from the valuable Reports of the Ladies, 
 pp. 95—100. 
 
 We have also to report the appointment of Miss Hunt as Assistant 
 Secretary, and Out-door Inspector of Nurses. This appointment has 
 already produced decided improvement in the efficiency of the District 
 Nurses, whom she has counselled and encouraged; and some of the Ladies 
 Superintendent have, where it has been requested, found her aid most 
 valuable. We have further the pleasure to report that our operations have 
 been, to a certain extent, combined with those of the Central Relief Society, 
 the Committee of which have found our agency useful in dealing with the 
 objects of their bounty, and have kindly enabled our District Nurses to 
 make additions to the benefits which their attendance confers upon the 
 sick poor placed luider their care.
 
 71 
 
 PRIVATE NURSING. 
 The amount we have been able to do in this branch of our work has 
 increased; but, we must repeat, it is only slowly that we can find and train 
 a staff of suitable Nurses. At the date of last report we had only four 
 Nurses engaged in Private Nursing; now we have ten, and at the end of 
 1865 we hope to have at least a similar increase to our staff. The services 
 of the Nurses are highly appreciated and anxiously sought for We ask 
 the aid of our friends in finding women suitable for Nurses. We repeat 
 our belief that, when developed, this branch of the School will amply repay 
 the subscribers or their families, by life and suffering saved, for their share 
 in establishing the School 
 
 FINANCES AND SUPERANNUATION FUND. 
 
 The accounts of the past year show an increase in the deficiency from 
 i'846 Is. lOd. to i'469 17s. 2d., and we earnestly hope that the liberality 
 of the public will enable us to extinguish the debt during the year. 
 
 With regard to the future, besides the causes of decay which affect every 
 Subscription List, and necessitate constant accessions to maintain its 
 amount, we have a further reason for anxiety. The experience we have 
 acquired makes it evident that, in order to carry out fully the new system, 
 the chief feature of which is the enrolment of a higher class of women for 
 the work of nursing, we must offer inducements which will cause it to be 
 regarded as a permanent, not a temporary service; the main requisite for 
 this purpose is the establishment of Superannuation allowances for disabled 
 Nurses, to which thoughtful women may look forward. Such a fund 
 exists, and is regarded as essential, in siinikr London establishments, where 
 it is reported to be attended with the best results. We are so impres&ed 
 with the necessity of this measure, that we have deternjiued to open a 
 Superannuation Fund, (without as yet fixing its exact regulation,) and to 
 appropriate thereto a sum of i£ 100 out of the income of the present year. 
 We have therefore earnestly to appeal to the public for more extended 
 support, both to enable us to keep up the expenditure required for the 
 general purposes of the Society, and also for the special object of the 
 Superannuation Fund.
 
 72 
 
 
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 73 
 
 EXPENSES OF THE SCHOOL AND HOME, 1863. 
 
 Butchers' Meat, PoiUtiy, Egf»s, and Fish £174 
 
 Bread and Flom- 70 8 
 
 Milk and Butter , 60 13 
 
 Cheese and Bacon 24 3 9 
 
 Potatoes, Fruit, and Vegetables 34 17 10 
 
 Groceries, Soap, and Candles 75 8 10 
 
 Ale, Beer, and Porter 102 3 
 
 Wine and Spuits 
 
 Coals and Coke 26 13 1 
 
 Gas 8 9 6 
 
 Printing, Stationery, and Advertising 39 6 5 
 
 Insurance against Fire 5 12 6 
 
 Water Rent 6 15 4 
 
 Salaries and Wages 52 3 
 
 Travelling Expenses of the Nurses 9 7 9 
 
 Washing 87 5 1 
 
 Incidental Expenses , 16 11 8 
 
 Cleaning and preparing the new House 12 10 5 
 
 £806 9 2
 
 74 
 
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 75 
 
 EXPENSES OF THE SCHOOL AND HOME, 1861. 
 
 Butchers' Meat, Poiiltiy, Eggs, and Fish £309 9 10 
 
 Bread and Flour , 99 8 8 
 
 Milk and Butter 123 3 11 
 
 Cheese and Bacon 55 14 
 
 Vegetables and Fruit 47 11 2 
 
 Groceries, Soap, and Candles 147 6 8 
 
 Ale, Beer, and Porter 142 16 6 
 
 Wine and Spirits ... .... 
 
 Coals and Coke 15 10 
 
 Gas 20 9 3 
 
 Furniture and Linen 55 14 
 
 Earthenware and Glass 3 3 
 
 Ironmongery, &c 10 18 6 
 
 Joiners' Work . . 3 9 
 
 Plumbing, Painting, &c 7 9 9 
 
 Whitewashing 21 8 7 
 
 Stationery, Printing, and Advertising 44 19 
 
 Insurance against Fire 7 12 6 
 
 Water Rent 5 5 
 
 Incidental Expenses 19 5 4 
 
 Salaries and Wages 74 3 10 
 
 Travelling Expenses of Nurses 4 13 2 
 
 Washing 165 13 3 
 
 Books 4 13 
 
 £1,389 15 2
 
 76 
 
 C. 
 
 TABLES OF WORK DONE IN DISTEICTS, 1864. 
 
 THE FOLLOWING IS THE ABSTRACT OF SICK CASES VISITED DURING 1864, IN THE 
 THIETEEN DISTRICTS WHICH HAVE COMMENCED WORKING: SOME OF THEM HAVE 
 NOT BEEN AT WORK THE WHOLE YEAR : — 
 
 No. 1 District. 
 
 Apparently cured 
 
 Paitially cured, suffi- 
 ciently to resume 
 their duties 
 
 Cases of alleviation of 
 suffering — since dead 
 
 Under treatment, -with 
 hope of complete or 
 partial cure 
 
 Probably hopeless as to 
 cure, but under treat- 
 ment for alleviation 
 of misery 
 
 Dismissed for inatten- 
 tion to advice of the 
 Nurse, or as unsuit- 
 able cases, or removed 
 out of the district or 
 to Hospital 
 
 i^ < 
 
 si' §■ 
 
 20 I 1 
 
 5 1 
 
 2 3 
 
 2 1 
 
 4 i 6 
 
 Total . 
 
 4 6 I 3 31 ' 24 
 
 62 
 
 34 
 
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 M 
 
 3 ! 9 
 
 2 
 1 
 
 102 
 
 42 
 30 
 
 27 
 
 261242 
 
 SIMILAR TABLES ARE PRINTED OF EACH DISTRICT, AND SUMMED UP AS FOLLOWS : 
 SUMMARY OF THE TABLES, 1864. 
 
 ,1^ 
 
 ti4 rs 
 
 gs 
 
 Apparently cured 
 
 Partially cured, suffi- 
 ciently to resume 
 their duties 
 
 Cases of alleviation of 
 suffering — since dead 
 
 Under treatment, with 
 hope of complete or 
 partial cure 
 
 Probably ho; eless as to 
 cure, but under treat- 
 ment for alleviation 
 of misery 
 
 Dismissed for inatten- 
 tion to advice of the 
 Nurse, or as unsuit- 
 able cases, or removed 
 out of district or to 
 Ho spital 
 
 Total il05 80 
 
 89 
 
 17 
 
 10 
 
 32 
 
 
 141 
 
 12 
 
 17 
 
 1 
 
 32 
 
 12 
 
 12 
 
 15 
 
 43 
 
 12 
 
 2 
 
 14 
 
 14 
 
 9 
 
 7 
 
 152 
 
 12 
 
 4 
 
 8 
 
 6 
 
 4 
 
 10 
 
 6 
 
 7 
 
 1 
 
 8 
 
 
 6 
 
 1 
 
 25 
 
 18 
 
 5 
 
 8 
 
 8 ' 7 
 
 8 
 
 54 
 
 105 
 
 80 
 
 80 
 
 72 
 
 3 
 
 182 
 
 292 
 
 18G 
 
 7 
 
 13 
 
 55 
 
 11 
 
 18 
 
 6 
 
 23 
 
 25 
 
 2 '10 
 
 11 ' 8 7 1 i 24 
 
 103] 18 
 
 52 
 23 
 
 7 21,65 
 
 456 
 403 
 
 180 
 
 96 53 69 53'503^236 
 
 289 
 22| 88100138912358
 
 77 
 
 SUMMARY OP THE TABLES, 1863. 
 
 1^ 
 
 Apparently cured ! 19 
 
 Partially cured, suffi- 
 ciently to resume 
 their duties '• 20j 22 
 
 Cases of alleviation of 
 suffering- since dead 155] 2 20 
 
 Under treatment, with 
 hope of complete or 
 partial cure ■ • 14 10 12 
 
 Probably hopeless as to 
 cure, but under ti-eat- 
 meat for alleviation of i j 
 
 misery 41 21 3 
 
 Dismissed foi' inatten- ' [ 
 
 tion to advice of the ; 
 
 Nurse, or as unsuit- 
 able cases, or removed ' 
 out of district or to I j 
 Hospital 92l 4 I 4 
 
 I 15 
 
 I 7 
 
 I 11 
 
 7 6! 
 
 30 19' 1 
 
 10 
 
 20 1 9 4i 20 
 
 • 1 
 
 4 5 18 8 
 
 10 
 
 81 2 11 
 
 174 
 
 10 
 
 18. 30 
 
 Total 2711 59 
 
 47 40 72 78 
 
 46 26 59 28 128 214 251 
 
 
 
 
 
 ^ 
 
 ^ 
 
 
 
 
 
 t/J 
 
 
 152 672 
 
 79'325 
 837 
 
 139 
 
 19 
 
 39 
 
 124 
 
 179 
 
 358 1776 
 
 D. 
 
 ARRANGEMENT WITH THE CENTRAL RELIEF SOCIETY, 
 
 AND FORMS OF RECOMMENDATFON. 
 
 LETTER TO THE .LADIES SUPERESTTENDENT, FROM THE SECRETARY 
 OF THE NURSES TRAINING SCHOOL. 
 
 NuKSES Training School and Home, 
 8th December, 1804. 
 
 Dkar Madam, — Tlie Central Relief Committee, fiuding that the work 
 performed by the District Nurses, and relief afforded through them to the 
 sick, is an important branch of relief of the deserving poor, have decided to 
 try whetiier a more united action of their Society v?ith that of the District 
 Nurses may not be beneficial, and they have therefore resolved to extend 
 to the sick under the care of the Nurses, and to their families, aid in three 
 ways; subject however to a fundamental rule of the Central Relief Society, 
 that such aid must be given only after visitation by their own officers. 
 
 I. They will relieve for a period not exceeding four weeks, to such extent 
 as in each case may seem to them to be desirable, the families of those who 
 are sick, and under the care of the District Nurse. To obtain such aid, an 
 ordinary form of recommendation signed by the Lady Superintendent, or 
 her representative, will be attended to by the visitor of the special cases of 
 the Central Relief Society, on whose report they will act. Cases so relieved 
 are subject to a weekly visitation, but a fresh recommendation is not 
 required weekly.
 
 78 
 
 2. They will, where it may be desirable to do so, send convalescent 
 patients for recovery to the sea-side at Southport, where they will be supported 
 for three weeks' residence.* To obtain such aid the same course is necessary 
 as stated above, with the addition that the certificate of the medical atten- 
 dant must be obtained, prescribing sea-side residence or bathing for the 
 patient. 
 
 3. They will where, in addition to the ordinary articles of nourishment 
 given in a prepared or cooked state, extra nourishment in the form of 
 butchers meat may be desirable, give it as soon as they can satisfy them- 
 selves from the report of their own officer, that the cases are deserving of 
 such aid. The Committee, however, consider that great care will be neces- 
 sary to prevent imposition on the Lady Superintendent, and on themselves. 
 They will therefore require, 1st, that the recommendation of the Lady Super- 
 intendent or Nurse should be accompanied by a certificate from the Doctor, 
 that meat is ordered by him for the patient; and, to save trouble in this 
 respect, printed forms will be furnished by the Secretary of the Central 
 Relief Committee if desired. Moreover, as considerable additional work 
 will by this arrangement be thrown upon the Special Visitor, it will be ne- 
 cessary for the Lady Superintendent, in cases requiring immediate relief in 
 the form of meat, still to give it herself, until the Special Visitor has had 
 time to investigate the case, while in that part of the town on his other 
 duties ; this delay however will not exceed a week, and will be made as 
 short as possible. It may happen that the Lady Superintendent or Nurse 
 may differ from the Officer of the Central Relief Committee as to particular 
 cases being desirable ones for this relief, and while the Committee must act 
 on their own judgment, it is of course still open to tiie Lady Superintendent 
 to give meat herself, as she would have done before this arrangement. 
 
 Any Lady Superintendent wishing to avail herself of the aid of the 
 Central Relief Committee, as stated above, will no doubt communicate with 
 Mr. Heath, the Secretary, 7, Dale Street, that he may make the necessary 
 arrangements for the supply of meat. It Avill probably be desirable that 
 the orders for meat for each district should be sent from the Central Relief 
 Society to the Nurse, and not to the patient direct, that she may secure, as 
 much as possible, that it is given in the quantities and at the times directed, 
 and that it really reaches the patient. 
 
 It will be a great aid to our work, that a very expensive and important 
 part of it should be undertaken by a powerful Central Society, whose per- 
 manence will I trust make our existence less liable to be affected by 
 individual deaths or removals ; and I have assured the Committee that they 
 will find the Ladies Superintendent most anxious to make their assistance 
 produce as much good as possible, and to guard it from extravagance and 
 abuse. I dare say it will seem occasionally as if the Committee might 
 
 * "A kind of relief of wliich it is impossible to calculate the benefit to the sick poor, 
 or the result in diminishing pauperism." — Florence Nightingale.
 
 70 
 
 trust to our knowledge aud judgment of cases which we were visiting con- 
 stantly, instead of acting on the report of their own Visitor; but on the 
 other hand I feel sure that, upon the whole, we shall derive great benefit 
 from such visits, for I have found in the district which I visit, and with 
 cases the Nurse thought she knew tlioroughly, and where I had repeatedly 
 visited myself, that the information and experience of which the Eelief 
 Committee are the centre were of essential assistance to me. 
 
 The Central Relief Committee only consented to undertake the supply 
 of meat as an experiment, of the advisability of which they were not 
 assured; and they did so with the understanding that if they did not think 
 it successful they might discontinue it, without giving reasons for their 
 decision. 
 
 I have been requested to mention that the Central Relief Society do not 
 as a rule profess to deal with chronic cases of distress, suitable for Parish 
 relief, and although in cases of sickness they are willing in some instances 
 to give aid in addition to the Parish allowance, they require that the latter 
 be first applied for in such cases. 
 
 If any difficulties should arise in working with the Central Relief Society, 
 I shall be much obliged if the Ladies Superintendent, instead of writing 
 direct to the Secretary or Committee, would write to ]\Iiss Hunt or to me, 
 and leave us to arrange them. As the same difficulties are likely to arise 
 in different districts, they can be arranged through our Central organization 
 with tliB least possible trouble to all concerned, and the least risk to the 
 successful and harmonious working of the arrangement. 
 Your faithful Servant. 
 
 SOUTHPORT HOSPITAL FORMS. 
 Ladies and Gentlemen recommending Patients are requested carefully to 
 peruse the Form below, to which they are about to append their names, 
 he/ore they siyn it. 
 
 MEDICAL CERTIFICATE. 
 
 I have examined of whom I find afl9icted 
 
 with and I believe likely to be benefited by sea air and 
 
 bathing. Age? How long ill? 
 
 Physician or Surgeon. 
 
 TO THE COMMITTEE OF THE SOUTHPORT CONVALESCENT HOSPITAL AND 
 SEA-BATHING INFIRMARY. 
 
 I beg leave to recommend of to be admitted into 
 
 your institution. 
 
 I have inquired into circumstances, and I believe to be a 
 
 proper object for the benefit of the charity. The patient has not furnished 
 any part of the cost of the recommendation. 
 Dated day of 186 . 
 
 ( Recom mender's 
 Name, 
 Postal Address.
 
 80 
 
 N. B. — The above Recommendation will be forfeited should it appear 
 that it has been used to assist begging applications of any kind. 
 
 Patients are desired to Take Notice that the Days of Admission are 
 Thursdays only, at two o'clock p.m. 
 
 EXTRACTS FROM THE LAWS. 
 
 GOVERNORS. 
 
 L\w 4. Every benefactor who may hereafter give twenty guineas or 
 upwards at one time, and also any clergyman or minister who shall collect 
 from his congregation at one time for this charity twenty guineas or up- 
 wards, shall be a Governor during life ; and every subscriber of one guinea 
 annually shall be a Governor during payment of such subscription. The 
 Medical Officers of the Institution shall be Honorary Governors while they 
 remain in office. 
 
 Law 22. All recommendations shall be issued at the rate of thirty 
 shillings for each recommendation, excepting that every Life Governor who 
 has at one time given to the charity twenty guineas, in conformity with 
 rule 4, shall be entitled to recommend one patient each year without charge. 
 
 PATIENTS. 
 
 Law 23. Each patient, in addition to the recommendation, shall bring 
 a certificate from a Medical Practitioner, stating the complaint of the 
 patient, and that such patient is likely to be benefited by sea-bathing or by 
 temporary residence at the sea-side. 
 
 Law 24. Each patient approved by the Committee shall be entitled to 
 board, lodging, baths, and medicine for three weeks : and each patient not 
 residing in the house shall be entitled to receive eight shillings per week, 
 instead of board and lodgings, for the same period. 
 
 Law 25. No person suffering from the last stage of consumption, or from 
 any infectious or objectionable disease, or incapable of attending to himself, 
 shall be admitted as a patient of this charity; and in case any person 
 recommended be deemed on any of these accounts an improper case for 
 admission, a letter signed by the Cliairman or one of the Honorary Secre- 
 taries shall be sent to the subscriber recommending sucli patient, stating 
 the reason for non-admission. 
 
 EXTRACTS FROM THE BYE-LAWS. 
 
 Every patient will be required to bring a proper change of clean linen, 
 and to come provided with money for travelling expenses to and from the 
 charity. 
 
 Every patient is expected to render occasional assistance in the establish- 
 ment when required, unless specially exempted by one of the Medical 
 Officers of the institution. 
 
 N. B. — It may be desirable to draw the attention of the jiublic to the 
 fact that the winter climate of Southport is peculiarly suited to all those 
 classes of complaints in which a mild climate would be beneficial.
 
 81 
 CENTRAL RELIEF SOCIETY'S FORMS. 
 
 TO THE LIVEBPOOI, CENTRAL RELIEF SOCIETY. 
 
 I recommend that residing at be allowed 
 
 butcher's meat, as follows, viz : — to be given a week 
 
 for a period of 
 
 Surgeon, &c. 
 
 Date, 186 
 
 I believe the above case to be a deserving one, and that, to the best of 
 my knowledge, the meat prescribed is not supplied or ordered for the patient 
 by the parish authorities. 
 
 Date, 186 Lady Superintendent of District No. 
 
 Applications for relief are not permitted to be made a t the Society's Office . 
 
 LIVERPOOL CENTRAL RELIEF SOCIETY. 
 Established for Visiting and Relieving Deserving Persons in Temporary Distress. 
 I recommend residing at to be visited, and 
 
 relieved if found a deserving object of this charity. 
 
 (Signature and 
 Address, &c., 
 of party 
 recommending. 
 
 Date Iftb 
 
 N.B. — Be careful to insert the correct address of the applicant, and the 
 name of the head of the family. 
 
 Instructions. — To insure being visited the same day, this note should 
 be taken before eleven o'clock in the forenoon, and deposited in the receiving 
 box for the district in which the applicant resides. The shops appointed 
 for each district are as follows, viz. — First District — Messrs. Pegram & Co., 
 35, Currie Street, near Scotland Road Market. Second District — Mr. John 
 Innes, 181, Richmond Row, end of Soho Street. Third District — Mr. Wm. 
 Davis, 78, Whitechapel, and Mr. Thomas Frith, 71, Paddington. Fourth 
 District — Mrs. Mary Rowland, 30, Northumberland Street. 
 
 E. 
 
 RULES AND FORMS OF THE TRAINING SCHOOL FOR 
 DISTRICT AND PRIVATE NURSING. 
 
 RULES OF THE LIVERPOOL NURSES TRAINING SCHOOL, DOVER STREET, 
 
 LIVERPOOL, 
 The Rules of the Society are — 
 
 Rule I. That the Nurses are to attend the sick, both rich and poor, at 
 
 F
 
 82 
 
 hospitals or private houses, as the Coramittee or Lady Superintendent may 
 appoint. 
 
 Rule 2. That when sent from the Home to attend a patient, they 
 receive their instructions from the Lady Superintendent, and do not leave 
 the case without communicating with her ; this they can do by letter at 
 any time. 
 
 Rule 3. That no present or gratuity of any kind be accepted by a Nurse 
 beyond some very trifling remembrance from or of the patient. 
 
 Rule 4. That nothing belonging to a deceased patient is to be accepted 
 by the Nurse. 
 
 Rule 5. That while on duty in the Home, at the Infirmary, or in private 
 houses, the regulations of the establishment with regard to dress are to be 
 observed by the Nurse. 
 
 Rule 6. That no male visitors to the Nurses be admitted at the Home 
 without special permission from the Lady Superintendent. 
 
 Rule 7. That the Nurses shall not take more than 1^ pints each of 
 table beer in the twenty-four hours, and no wine or spirits, without a 
 medical order; and that they shall carefully avoid adding unnecessarily to 
 the expenses of a household, either in board or washing. 
 
 Rule 8. That a Nurse is always to bring back with her a certificate of 
 conduct and efficiency from the family of her patient, or from the Medical 
 Attendant. 
 
 It is expected that the Nurses will bear in mind the importance of the 
 situation they have undertaken, and will evince, at all times, the self-denial, 
 forbearance, gentleness, and good temper, so essential in their attendance 
 on the sick, and also to their character as Christian Nurses. They are to 
 take the whole charge of the sick room, doing everything that is requisite in 
 it, when called upon to do so. When nursing in families where there are 
 no servants, if their attention be not of necessity wholly devoted to their 
 patient, they are expected to make themselves generally useful. They are 
 also most earnestly chai-ged to hold sacred the knowledge which, to a certain 
 extent, they must obtain of the private affairs of such households or 
 individuals as they may attend. 
 
 Commun'cations from or on the subject of Nurses may be made per- 
 sonally, or by letter, to the Lady Superintendent, Nurses' Home, Dover 
 Street, Liverpool. 
 
 rules and forms for admission and training of probationer nurses. 
 
 Regulations as to Training /'robationer Nurses, at the Liverpool Training 
 School and Home for Nurses. 
 1, The Committee of the Liverpool Nurses' Training School have made 
 arrangements with the authorities of the Royal Infirmary for training women 
 desirous of working as Hospital, District, or Private Sick Nurses.
 
 83 
 
 2. Womeu desirous of receiving this training should apply to Miss 
 Merryweather, the Lady Siiperiuteudent of the Training School, and if they 
 are suitable, and there are vacancies, they will be received into the Home 
 and School as Probationers. The age considered desirable for Probationers 
 is from 25 to 85. A certificate of age and health, and testimonials of 
 character, according to the forms supplied by the Lady Superintendent will 
 be required. 
 
 3. — The Probationers will be under the authority of the Lady Superin- 
 tendent, and they will be subject to the rules of the Royal Infirmary and 
 the Training School for Nurses. 
 
 4. — They will be supplied with board (including tea and sugar), lodging 
 and washing. 
 
 5. — If retained, the wages of a Probationer during her year of probation 
 will be ^14 4s., paid thus— £i at the end of the first quarter, £S 10s. at 
 the end of the second quarter, ^£4 at the end of the third quarter, and £i 14s. 
 at the end of the fourth quarter. The Probationers will be required to con- 
 form to any regulations in regard to uniformity of outer clothing, and if 
 supplied with materials for the same by the Institution, the cost (to an 
 extent not exceeding .£4 4s.) is to be retained froui their wages. 
 
 6. — It is expected that at the end of a year they will be fitted for Nurses, 
 and their engagement will require them to serve two years more in Hospital, 
 District, or private nursing. 
 
 7. — At the expiration of three months from the date of entry, every Pro- 
 bationer will be required to write a letter to the following effect: — 
 
 To THE Chairman of the Committee of the Livekpooi. Nursks' 
 Training School. 
 
 Sir, 
 
 Havii,g now become practically acquainted iritli tlte duties required of a Nurac, 
 1 am satisfied thai I shall be able and willing, on the completion of my year's trairdng, to enter 
 into service as a Nurse in a Hospital, District, or in private houses, and I promise to continue 
 in such service for the space of at least two years, in whatever situations the Committee shall 
 think suitable for my abilities, it being my intention from henceforth to devote myself to nursing 
 
 the sick. 
 
 I am. Sir, 
 
 8. — The names of the Probationers will be entered on a Register, in 
 which a record will be kept of their conduct and qualifications. At the end 
 of every month this record will be submitted to the Committee of the 
 Institution. 
 
 0. — The Probationers will be subject to be discharged at any time by the 
 Lady Superintendent in case of misconduct, or should she consider them 
 inefficient or negligent in their duties. 
 
 10. — The Nurse or Probationer must be able to read written instructions 
 and to write.
 
 84 
 
 11. — The Nurse or Probationer is to keep the apartment allotted to her 
 use neat, clean, and in proper order, and at all times to sweep, dust, and 
 do all that is necessary in the Home, as well as to assist in the needlework 
 there. 
 
 12.— The duties of the Nurses will be to attend the sick, both rich and 
 poor, at Hospitals or private houses, as the Committee or Superintendent 
 may appoint. 
 
 13. — All money received for the services of Nurses will belong to the 
 Fund of the Training School. No Nurse will be permitted to receive any 
 private remuneration in money or clothing. This would defeat the object 
 of the Institution, which is to encourage unselfish and disinterested exertion 
 on the part of the Nurse. 
 
 14. — The Nurses and Probationers will be required to attend public 
 worship when at the Home. 
 
 15. — All Nurses and Probationers will be provided with a sufficient 
 allowance of beer or porter to take at meal times; but they will not be 
 allowed to procure or ask for wine or spirits without the express recommen- 
 dation of a medical man, either at the Home, the Infirmary, or in private 
 houses where they may be nursing, and any infraction of this rule will 
 subject them to dismissal. 
 
 Applications should he made to the Lady SripemUendent, Training School 
 and Home for Nurses, Royal Infirmary, Liverpool. 
 
 LIVEKPOOL TRAINING SCHOOL AND HOME FOE NURSES. 
 Form to he filled up by Persons applying jor Admission as Probationers. 
 
 Age. iPlace of Birth. 
 
 Previous 
 Occupation. 
 
 Whether 
 
 Single or 
 
 Married, or 
 
 Widow.* 
 
 If Manied, or 
 
 a Widow. 
 
 whether with 
 
 Children, and 
 
 if so, with how 
 
 many. 
 
 The J'i'.rrlage Certificate will be required. 
 
 T declare Hit, above stalemenls to be oorrecl. 
 Signature
 
 85 
 
 DUTIES OF PROBATIONER IN THE LIVERPOOL TRAINING SCHOOL AND HOME 
 
 FOR NURSES. 
 
 You are expected to be sober, bonest, truthful, trustworthy, punctual, 
 quiet and orderly, cleanly and neat. 
 
 You are expected to undertake night duty when required, and to become 
 skilful — 
 
 1. fn the dressing of blisters, burns, sores, wounds, and in applying 
 fomentations, poultices, and minor dressings. 
 
 2. In the application of leeches, externally and internally. 
 
 3. In the administration of enemas for men and women. 
 
 4. In the management of trusses, and appliances in uterine complaints. 
 
 5. In the best method of friction to the body and extremities. 
 
 6. In the management of helpless Patients, i. e., moving, changing, 
 personal cleanliness of, feeding, keeping warm (or cool), preventing and 
 dressing bed sores, managing position of. 
 
 7. In bandaging, making bandages and rollers, lining of splints, &c. 
 
 8. In making the beds of the patients, and removal of sheets while 
 the patient is in bed. 
 
 You are required. — 
 
 !). To attend at operations. 
 
 10. To be competent to cook gruel, arrowroot, egg flip, puddings, and 
 drinks for the sick. 
 
 11. To understand ventilation, or keeping the ward fresh, by night as well 
 as by day. 
 
 12. To be careful that great cleanliness is observed in all the utensils; 
 those used for the secretions as well as those required for cooking. 
 
 13. To make strict observation of the sick in the following particulars: — 
 
 The state of secretions, expectoration, pulse, skin, appetite, 
 intelligence, as delirium or stupor; breathing, sleep, state of 
 wounds, eruptions, formation of matter, effect of diet, or oi' 
 stimulants, and of medicines. 
 
 14. To learn the management of convalescents. 
 
 Liverpool Eotal Infirmary, 186 
 
 Sir, — Having been referred by the Lady Superintendent of the Liverpool 
 
 Training School and Home for Nurses to you as the Medical attendant of 
 
 and family, will you kindly reply to the questions required 
 
 by the Gouncil from each Candidate, before she can be appointed n 
 
 Probationer. 
 
 As you will readily understand how indispensable it is, for the successful 
 training of young women, that they should be not only morally, but 
 physically and mentally, competent to undertake the duties of Hospital
 
 86 
 
 Nursing, I will not apologise for giving you the trouble to fill up and 
 return the Medical Certificate to me (by post) at your earliest coiivenience. 
 I have the honor to be, 
 
 Your obedient Servant, 
 
 House Surgeon. 
 
 MEDICAL CERTIFICATE. 
 
 1. How long have you been acquainted with 
 
 2. Is she intelligent and of active habits? 
 
 8. What is her general appearance, configuration, height, weight? 
 
 4. General health ? 
 
 5. Any illness of importance ? 
 
 When ? 
 What? 
 
 6. If fulness of habit, or subject to head affections ? 
 
 7. Any tendency to pulmonary or scrofulous disease? 
 
 Cough or shortness of breath ? 
 
 8. If any time spitting of blood ? 
 9; If any heart disease ? 
 
 10. If vaccinated? 
 
 11. Are her parents living? 
 
 12. Has there been any insanity in her family? 
 
 I have this day of 186 examined and hereby 
 
 certify that she is apparently in good health, that she is not labouring under 
 any deformity, and is, in my ojnnion, both physically and mentally com- 
 petent to undertake the duties of Nurse in a general Hospital. 
 
 (Signed) 
 
 Date 
 
 Address 
 
 LIVERPOOL nurses' TRAINING SCHOOL, DOVER STREET, LIVERPOOL. 
 
 J. Date 
 
 2. Name 
 
 3. Have you read the Rules? 
 
 4. Are you willing to attend on the poor as well as on the rich? 
 
 5. Do you understand cleiuly that you are not to accept any present 
 from patients, or their friends, without the consent of the Committee, 
 except it be some article of small value (such as a book) as a remem- 
 brance of a patient? 
 
 6. Do you understand also that, in case of the death of a patient, you 
 are strictly forbidden to accept of anything belonging to the deceased ? 
 
 7. W^ill you, both when in the Home and on duty, always wear the dress 
 prescribed by the Committee?
 
 87 
 
 8. Are you quite willing to conform strictly to every Rule of the Training 
 School ? 
 
 9. Are you aware that any transgression of the Rules of this Establish- 
 ment will subject a Nurse to instant dismissal? 
 
 FORMS AND RULES USED IN DISTRICT NURSING. 
 
 ro LADIES SUPERINTENDENT. 
 
 T he following suggestions for organising a District are necessarily very incom- 
 jdete ; it is to the Ladies Superintendent we must look to work out a more 
 complete system of ojierations. 
 
 When a lady becomes the Superintendent of a district, a trained Nurse 
 will be provided, receiving a salary from the Institution. The Lady Super- 
 intendent undertakes to find the medical comforts, and also to provide the 
 Nurse with lodgings in a good central situation. 
 
 I. — When commencing a district, it may be desirable to call a Meeting 
 of the various Ministers of religion in the district, to explain to them the 
 objects proposed, give to them the power of recommending cases, requiring, 
 at the same time, that the greatest care should be taken to recommend 
 suitable cases only, excluding such as would be better dealt with in 
 hospitals or the workhouse, or where the parties are able to help themselves. 
 Want of care in this respect would necessitate the withdrawal of the power 
 of recommendation, as it would involve the waste of means and time. Their 
 kindly aid should be asked in interesting their parishioners and friends in 
 the work, and in bespeaking personal assistance, contributions to the funds 
 of the Institution, or gifts of food, wine, clothes, old linen, &c. The Lady 
 Superintendent will also have to arrange ibr the custody aud preparation of 
 medical comforts. This may be done in various ways — 
 
 Jjt. By the Nurse herself merely consulting with the Superintendent; 
 
 this is not the best way, for obvious reasons. 
 iJnd. It has been done by paying a weekly sum for local superintendence 
 and cooking, with the expense of firing, and the extra help necessary 
 to the person who undertakes these duties. A better plan, if possible, 
 is to find in the neighbourhood the kind intelligent wife of a clerk or 
 shop-keeper, who, for love of the work, would undertake this department 
 of local superintendence. 
 II — The Lady Superintendent should either visit herself, or depute some 
 one to visit for her, so as to enable her to satisfy herself that the Nurse is 
 working faithfully and sufficiently. 
 
 III. — At fixed times, at least once a month, she should examine the 
 Nurse's Register, consult with her on fresh cases, and hear the report of 
 ibrmer ones. She would find it desirable to keep memoranda of expenditiu-e, 
 and of the articles lent, and to see that they were all marked indelibly "lent
 
 88 
 
 not to be pawned." The accounts should be kept in her name; and it has 
 been found best to pay all bills monthly. In any case of diflBculty or 
 importance it might be desirable to consult with the person who recom- 
 mended the case. 
 
 IV. — The Lady Superintendent will be provided with — 1. A Nurse's 
 Eegister Book. 2. A Map of the district. 8. Forms of Recommendation 
 to be given to those authorised to recommend. 4. Form of Application for 
 power to recommend, which must be signed by a Minister of Religion, 
 Medical man, or other party authorised by the Lady Superintendent to 
 recommend. 5. Forms for advising the party signing the recommendation, 
 that the case is found unsuitable ; the Lady Superintendent will probably 
 find it desirable to fill up this Form, and return it in all such cases. 6. 
 Rules for District Nurses. 7. Rules for Patients and their friends. 8. 
 Slates and Pencils for Nurses. 
 
 V. — At certain periods there may be extra pressure on the Nurse, and 
 watchfulness must be exercised that her strength is not over-taxed. 
 Additional assistance can generally be found in some woman competent to 
 act under the Nurse. This must be done by the district itself, as the Society 
 has not at present extra Nurses. It may also be occasionally desirable to 
 employ some strong person to clean out a dwelling. We may mention here 
 that the owner of a house may be compelled, by ajiplication to the Inspector 
 of Nuisances, Cornwallis Street, to have it whitewashed when in an 
 unwholesome state.* 
 
 VI. — The Weekly Register Book of the Nurse is required to be taken to 
 the Central OfiBce, once a month, and given up to the Society at the end of 
 the year. 
 
 VII. — It is impossible here to enter into details; but, perhaps, even from 
 this sketch, it may be gathered that the work is peculiarly susceptible of 
 co-operation — one in which several friends may join, and prevent the 
 burden falling too heavily on any, and all find their own vocation, from the 
 wealthy merchant, to the widow with her mite ; from the child who gives 
 its untasted orange or its broken toy, to the experienced mother, who with 
 her kindly presence brings more substantial aid to the sick little one. 
 Those, too, on whom God has laid His hand, and withdrawn from active 
 life, may have their vocation here. Many are the comforts devised and 
 sent to poorer brethren from the thoughtful bed of sickness, with alleviations 
 ■md pleasant books to beguile the weary hours of suffering. 
 
 RULES FOR DISTRICT NURSES. 
 
 1. It is expected that each Nurse shall devote at least five to six hours a 
 day to visiting the sick poor. 
 
 • "A very important point for other places. It is very important to direct the 
 ' attention of ladies ('. c. educated women) in all places to this, viz : To ascertain what 
 power of this kind is given by local acts. They are lamentably ignorant on this point. 
 So indeed are the ministers of religion." — Flokenck Nightingale.
 
 89 
 
 2. Some cases require to be seen daily, but most not so frequently. 
 
 3. A Weekly Register is to be kept by the Nurse, in which each case is to 
 be entered, and the Register taken to the Superintendent of the district at 
 the times fixed by her, and when required submitted to the Central Society. 
 
 4. All recommendations of cases to be made by the Ministers of Religion, 
 or by a Medical Man, or other authorised persons of the district, on a 
 printed form, furnished by the Society for that purpose. This recommenda- 
 tion to be taken to the Superintendent on the first opportunity, and to be 
 kept and filed by her. 
 
 5. The Nurse to visit all cases so recommended as soon as possible, and 
 report them to and consult the Superintendent upon them, at the earliest 
 opportunity. Any difficult point that may arise to be of course submitted 
 to the Superintendent.* 
 
 6. The Nurse is to report immediately to the Superintendent any case in 
 which she judges that meat or other extra nourishment would restore heads 
 of families more quickly to their work ; or which she thinks could be 
 better or more suitably dealt with in an Hospital or Workhouse ; or where 
 the family visited are able to obtain otherwise for themselves the relief 
 required ; or where the neglect or disobedience of the Patients or their 
 friends render her visits useless. No case duly recommended is to be left 
 unattended to, without the knowledge and direct sanction of the Superin- 
 tendent. 
 
 7. The Nurse to be ready and willing to render every assistance in any 
 operation which the Surgeon may require. 
 
 8. The Nurse to render to the patients under her care such aid and 
 instruction as may be necessary, and to urge upon them the great importance 
 of cleanliness in person and dwelling, of the immediate removal of all things 
 offensive both from the bed and room, and of care to keep the sick room 
 clean and fresh at all times; of ventilation (fresh air), of giving nourish- 
 ment and medicine at the right, time, as directed, and of strict obedience to 
 the orders of the medical attendant. She will often have to do what is 
 necessary for the patient herself, and in most cases to instruct and enforce 
 her instructions on the relations or attendants. She will tell them when 
 and where to send for nourishment or comforts which are to be supplied to 
 them. 
 
 9. No blankets, sheets, cushions, or other like articles, to be lent matU 
 fully marked. The articles lent are to be entered by the Nurse, with the 
 date of the loan, and a corresponding list given to the responsible person 
 receiving them, requiring that such articles be returned clean and in good 
 order, at such times as the Nurse or Superintendent may appoint. 
 
 * " I entirely appreciate the manner in wliicli tlie permanence of tliis great charity 
 is provided for, by renderuig responsibility as far as possible local, instead of keeping 
 it in the hands of the original foiinder or founders : also by interesting in it as many 
 persons as possible, and securing to them so much independence of action, while keeping 
 up so much necessary (and no unnecessary) uniformity." — Florence Nightingale.
 
 90 
 
 10. A slate and pencil to be hung up in the patient's room, on which the 
 doctor can write his instructions, and can, if he wishes, make an appoint- 
 ment with the Nurse, and on which she can enter any facts or ask any 
 questions she may think desirable. 
 
 11. The Nurse herself to be an example of neatness, order, cleanliness, 
 and sobriety. She must be most cai'eful to avoid and to discourage any 
 tale-bearing, scandal, or other unprofitable conversation. She must not 
 interfere tvith anyone s religious oinnions. Strict obedience on the part of the 
 Nurse to the directions of the medical man is indispensable. 
 
 FORM OF APPLICATION FOR FORMS OF RECOMMENDATION OF PATIENTS 
 TO DISTRICT NURSES. 
 
 To Mrs. Lady Superintendent of District No. 
 
 Madam, — I shall be obliged if you will furnish me with Forms of Recom- 
 mendation for Patients to the Nurse of your district. I have read, and 
 assent to, the stipulations at the foot of this letter, which shall be carefully 
 
 attended to by me. 
 
 I am, Madam, 
 
 Your obedient Servant, 
 
 Careful enquiry to be made previous to Recommendation, to ascertain — 
 
 1. That the Patient cannot otherwise obtain the relief required. 
 
 2. That the case is one inadmissible, or undesirable to send into an 
 Hospital or Workhouse. 
 
 If the Nurse should discover that there has been a mistake or. either of 
 the above points, or that neglect, or disobedience, on the part of the 
 Patients or their friends render her visits useless, she will report it to the 
 Superintendent, who will direct her to discontinue her visits. The Lady 
 Superintendent, being alone responsible, is not to be called upon for reasons 
 in such cases. 
 
 FORM OF RECOMMENDATION.* 
 
 To Nurse of District No. Address 
 
 Name of Patient 
 
 Address of do. 
 
 Disease 
 
 Circumstances 
 
 Enquired into and Recommended by 
 
 Signature 
 
 Profession 
 Address 
 Date 
 This recommendation is only in force for one month ; if the Nurse's 
 
 * On tlie back of this recommeudation is printed a plan of the Town, and the Nursing 
 Districts into which it is divided.
 
 91 
 
 attendance is required beyond that time, a fresh recutumendation should be 
 obtained. 
 
 FORM USED WHEN IT IS DESIRABLE TO INFORM THE SIGNER OF A 
 RECOMMENDATION WHY THE PATIENT CANNOT BE TAKEN ON. 
 
 Sir, 
 
 The Case of 
 Name 
 Address 
 
 has been visited, but does not appear to be a case for the Nurse's visits. 
 1 am, your obedient Servant, 
 
 Lady Superintendent. 
 
 Able to obtain otherwise the necessary relief. 
 More suitable for Hospital or Workhouse. 
 Patient or friends careless or disobedient. 
 The Lady Su23erintendent to draw her pen through all the reasons but 
 the one she has to give, or through all if she wishes to give no reason. 
 
 FORM PRINTED ON A CARD, AND HUNG IN PATIENTS ROOM 
 
 To Patients and their Friends. 
 
 Ventilation, or the due admission of fresh air to the sick-room ; punctu- 
 ality in giving medicine or food; and perfect cleanliness of the room, bed, 
 and person, being so absolutely necessary to the well-being and recovery of 
 sick persons, you are expected to aid the efforts of your Medical man and 
 the district Nurse by strict attention to the following points : — 
 
 1st. Strict attention to the directions of your Medical man as to the time 
 and manner of giving medicines, etc.,* and other particulars relating to 
 the sick room. 
 
 •2nd. Particular care as to the cleanliness of the sick, both in person f and 
 clothing. 
 
 3rd. The immediate removal of ell things offensive, both from the bed 
 and room ; and care to keep the sick room quite clean and fresh at all times.j 
 
 * " Food and drink." — Floeence Nightingale. 
 
 t " Bed linen " — Florence Nightingale. 
 
 I 4tli. "Preserving quietness in the sick room, and avoiding everything likely to 
 excite or exhaust the patient. Take care that, as far as practicable, nothing in the 
 way of food, drink, or medicine is given to the patient except under the direction of 
 the Doctor or Nurse." — Floeence Nightingale,
 
 92 
 
 It is a part of the Nurse's duty, in her visits, to see that these necessary 
 things are properly carried out ; and she will give you suitable advice and 
 directions in these ar.d all other particulars concerning the proper care of 
 the sick person. 
 
 Neglect of these instructions will make the Nurse's visits useless, and she 
 is directed in such case to discontinue ihem. 
 
 FORM OF RKCORD KEPT BY INSPECTOR OF NURSES, OF NURSE's CONDUCT 
 AND EFFICIENCY. 
 
 No. of District, -22. 
 
 Name of Nurse, Mrs. — — 
 
 Days when visited. 
 
 Regularity 
 
 Reliability 
 
 Method iu Work 
 
 General Ability and Insight 
 
 Personal Neatness and Cleanliness. . . . 
 
 Tenderness towards Patient 
 
 Sick Cooking 
 
 Management of Patient and Family. . . . 
 
 Ventilation and Cleanliness in Sick 
 Room 
 
 Ameliorating Appliances 
 
 Working well with jMedieal Men 
 
 Dressings and other Appliances under 
 Medical direction 
 
 Management of Convalescents 
 
 Observations on the Sick 
 
 June 1. 
 
 V. G. 
 IND. 
 
 V. G. 
 IMP. 
 
 July 6. 
 
 IMP. 
 V. G. 
 
 V. G. 
 
 IMP. 
 
 July 30. 
 
 V. G. 
 V. G. 
 
 v. G. Very Good. G. Gooa. M. Middling. IMP. Improved. IND. Indifferent. B. Bad. 
 No opportunity of judging on that visit. 
 
 GENERAL REMARKS. 
 
 There have been 35 Patients on the Book for 22 District this month, 19 Medical 
 and 16 Surgical cases. The Nurse heing a good Surgical Nurse, her cases in this line 
 are increasing. Her District lies in a low .dirty part of the town, so that she has more 
 difficulty in keeping her clothes, &c., clean than some of the others.
 
 93 
 
 
 3 
 
 
 Date. 
 Name. 
 
 
 Eesidenee. 
 
 
 Abscess. 
 
 
 Asthma. 
 
 
 -Oronchitis 
 
 
 Cancer. 
 
 
 Child Birth. 
 
 
 Consumption, and tendency 
 to Consumption. 
 
 
 Disease of the Heart. 
 
 
 Dropsy. 
 
 
 Erysipelas. 
 
 
 General Debility. 
 
 
 Inflammation. 
 
 
 Paralysis. 
 
 
 Recovery from Fever. 
 
 
 Eheumatism and Burns. 
 
 
 Ulcers and Wounds. 
 
 
 Sundries. 
 
 
 No. of Family. 
 
 
 Parish Relief, or how 
 Supported. 
 
 
 Times Visited. 
 
 
 ^ a 
 g S 
 
 
 1 
 
 1
 
 94 
 
 FORM SENT WITH NURSE, WHEN GOING TO NURSE PRIVATE PATIENTS. 
 
 Liverpool Training School and Home for Nurses, Dover Street. 
 Date, 18() 
 
 This day the Nurse has been sent on the recommendation 
 
 of to niu'se in the case of 
 
 Signed, 
 
 Lady Superintendent. 
 
 The rate of remuneration for attendance of the Nurses is fixed at ^1 Is. 
 per week ; traveliing expenses and washing to be paid by the family em- 
 ploying the Nurse. In infectious cases 15/ to be paid, to provide 
 tempornry Lodgings for the Nurse, as she cannot be allowed to return to 
 the Home immediately. 
 
 After four weeks, if it be wished to retain the Nurse longer, a communi- 
 cation to be made, either by letter or personally, to the Lady Superintendent. 
 
 Tt is particulai'ly requested, — 
 
 1. That the Nurse should in no case be informed of the sum paid to the 
 Institution for her services. 
 
 2. That no gratuity be offered to the Nurse, the receipt of such payments 
 being strictly forbidden by the rules, as they have always been found to be 
 most prejudicial to the discipline and good conduct of Nurses. A book or other 
 article of small value, as a token of remembrance of a patient, may, however, 
 be accepted by a Nurse without infringing this rule. Patients, or their 
 friends, who wish to express gratitude for benefits received, can do so most 
 effectually by donations towards a fund for the re»vard of good service 
 amongst the Nurses, and for their support in sickness and old age. It is 
 also hoped that by contributions to the general funds of the charity they 
 will assist in enabling it to afford the advantage of gratuitous nursing to the 
 poor, which is one of the objects for which it was established. 
 
 3. That no wine or spirits be given to the Nurse, unless at the request of 
 the Medical Attendant. 
 
 4. That the Nurse be allowed to rest every third night, if possible, 
 especially in along illness; and that when her services are needed for 
 several consecutive nights, she be allowed at least six hours rest in the day 
 out of the sick-room. 
 
 5. That when the Nurse's services are no longer required, tbis sheet of 
 paper may be returned, sealed up, with a candid statement, on the fly-leaf, 
 of her conduct and efficiency, either from one of the family or the Medical 
 Attendant; together with information of the amount intended to be paid, 
 and whether it is enclosed, or will be paid at the Institution. 
 
 Date, 186 
 
 The services of the Nurse being no longer required, she is 
 
 this day set at liberty to return home, and the sum of £, being the 
 
 remuneration for her attendance, is enclosed. 
 
 CONDUCT AND EFFICIENCY, OR OTHER REMARKS.
 
 95 
 MEMORANDUM 
 
 WHICH IN SEVERAL CASES WAS SUBMITTED TO LADIES WHEN IT WAS 
 PROPOSED THAT THEY SHOULD UNDERTAKE A NURSING DISTRICT. 
 
 NURSING. 
 
 The introduction of trained Nurses into tlie houses of the sick poor 
 is calculated not only to lieal the sick and prevent a great deal of needless 
 misery, but also to promote cleanliness and ventilation in their dwellings, 
 and to prevent as well as cure. Most people have doubtless experienced, in 
 their efforts to make the poor sharers in their prosperity, how difficult it is 
 to avoid doing harm, and in this respect this work will be found peculiarly 
 satisfactory: the objects of the nurses' care come generally recommended, 
 either by visitors from whom they expect no physical relief (Clergymen, 
 Scripture Readers, Town Missionaries,) or by the Parish ^nd Dispensary 
 Doctors, whom they cannot deceive; the call for relief (sickness) is one 
 ascertainable, and in most cases not permanent; help in such cases is not 
 felt a degradation or humiliation, any more than a present of grapes in sick- 
 ness, from an equal who might happen to have them when we had not, 
 would be an offence; sickness seems, to both giver and receiver, a reminder 
 of their common humanity, and to give a right to mutual help. When the 
 sickness and call for help ceases, so naturally does the help. There is not 
 the otherwise frequent difficulty of knowing when to stop, and fear of 
 making peo])le careless and dependent. The work has also the advantage 
 of bringing naturally, and without forcing, rich and poor into a communi- 
 cation beneficial to both, where civilisation, by subdivision of duties and 
 labours, has destroyed the connection which formerly existed. If each 
 prosperous family, in a laige town, who may be fortunate enough to have 
 some efficient ladies among their treasures, would undertake the super- 
 intendence and supply of medical comforts in a district, the good that 
 might be done is incalculable. I am convinced that after trial they 
 would admit that no expenditure of time or money gave them more 
 satisfaction ; they would get the same sort of interest in their district that 
 a benevolent landlord has in the poor on his estate. It is difficult to 
 limit the extent of influence for good which women of refinement and 
 kindliness diftuse in such a position of Motherhood. If these remarks 
 savour of enthusiasm, it is not the enthusiasm of imagination, but of 
 experience of a work, the scope of which was unsuspected when it was 
 begun. 
 
 G. 
 
 LADIES' SUPERINTENDENT REPORTS. 
 
 Every quarter the Ladies Superintendent of Districts draw up Repo'-ts of
 
 96 
 
 the working of their districts, for the information of the Committee, and for 
 
 mutual information, and meet to discuss the wants or difficulties which 
 
 may have arisen. The following extracts are selected as either explanatory 
 
 of the work, or suggestive of improvements. The suggestions thus conveyed 
 
 have already proved very useful. 
 
 September, 1862. 
 
 It is always desirable that men who have families should get to work 
 as soon as possible. To such, when recommended by the Medical man, 
 or seen to be desirable by the Nurse or visiting Superintendent, more 
 strengthening food has been given in mutton chops and porter, and the 
 Nurse has received instructions, where necessary, to cook the chops herself, 
 and satisfy herself that the patient has the benefit of them. This treat- 
 ment has proved successful in several cases which otherwise might have 
 lingered a long time. 
 
 December, 1862. 
 Since the beginning of the quarter we have adopted the plan of limiting 
 the time for which a patient can be recommended to one month. We find 
 that we have had to make a large number of renewals, but think, never- 
 theless, that the time is sufficiently long, as in many instances it is 
 rather a good thing than not that a gentle reminder should be given, by 
 the renewal, that the assistance is not to be indefinitely claimed as a right. 
 
 December, 1862. 
 The Nurse has given great satisfaction to her patients, and also to the 
 ladies; she has frequently been complimented on the change she has 
 effected in the cleanliness of the sick room, one gentleman remarking 
 " that she had accomplished more in one week than he had been able to 
 do in three years;" she has a quiet firmness which gains its ends. 
 
 December, 1862. 
 Those in my district are often very destitute, and all the bad cases I 
 relieve every day; but I have never given any wine; I have found an 
 ample supply of milk has done quite well in most cases. Of those we 
 have lost, ten were quite hopeless when they were found. 
 
 September, 1862. 
 There is sometimes a difficulty in taking the names off the nurse's book 
 in cases of general debility, recovery from fever, &c. Might it not be a 
 good plan to put the names on for a certain time, and then renew the 
 term of relief? One gcod effected by the Nurses is the rousing of the 
 sick poor to active means for their recovery. They often sink * into a 
 
 * " Most true. Disease among the poor is generally the last stage of the process. 
 It is the point at which the patient's friends begin to interfere, the patient having long 
 ceased to think for himself. It is therefore the more necessary for the Nurse to rouse 
 him (the patient) to active means for his recovery." — Flobence Nightingale.
 
 97 
 
 helpless, despondent state, partly from a sense of inability to get the 
 necessary food or pay the doctor, and go on for months, not even using 
 the means they have, or making any exertion, when a few weeks of more 
 active measures would effectually set them up, and enable them to go to 
 work again. Many cases linger through long months if no friendly 
 visitor like the Nurse goes to give them heart and help. Several cases 
 of this description have occurred in this district. 
 
 1863. 
 
 Much advantage has been found from lending sheets, blankets, and linen 
 to the patients, which are changed twice or thrice a week, as the case may 
 require. A lady has kindly undertaken to defray the expense of supplying 
 and washing those articles. The lending of pillows and spitting-cups has 
 also been found beneficial ; and in cases of recovery from fever, where 
 white-washing was required, we have sometimes lent brushes and supplied 
 lime. 
 
 The water-beds have been of great service in many cases of severe 
 rheumatism and consumption. 
 
 The Charity has also been of use in timely calling the attention of the 
 Board of Health to fever cases, where whole families were infected, and the 
 safety of the surrounding neighbourhood endangered.* 
 
 The following reports were received in two different years from the same 
 lady ; and aflPord an example of the difference in the results obtained and 
 reports sent in, according to the efficiency or inefficiency of the Nurse. 
 Wherever it is found that there is an absence or great scarcity of surgical 
 cases, or those requiring actual nursing rather than relief, on the list, this 
 lact alone should almost suffice to cause the dismissal of the Nurse. If 
 her heart is in her work, she will find no lack of such cases. The para- 
 graphs in italics contain the remarks of the Secretary: — 
 
 December, 1863. 
 I have but few remarks to make respecting this district, indeed I wish 1 
 had more to say, for I fear we are getting into a routine which results 
 mainly in dispensing chops, beef-tea, sago, rice, tea, and sugar. Almost all 
 our patients come to us either in the last stages of consumption or age; of 
 the latter, many are no doubt more suitable for the workhouse, and would 
 be better ofi' there if they could be persuaded to leave their miserable 
 dwellings. We have scarcely any cases which promise even partial cure, 
 though some few of our patients may rally sufficiently to be put off our 
 books for a time, when warm weather comes. There is the satisfaction of 
 feeling that we no doubt alleviate a considerable amount of misery ; but I 
 think it right to state distinctly, that in this district I do not believe the 
 
 * " Tlie attention of Ladies Superintendents of districts, and of the frieuds of the 
 cause elsewhere, should be called to this." — Florence Nightingale. 
 
 G
 
 98 
 
 right class of cases come into our hands. I am completely at a loss to 
 account for this. 
 
 The Secretary would remark on this report, that the Gom2')laint made is 
 one the cause of which is generally removed as the nature of the work becomes 
 knoivn. In the district in question it has continued longer than usual, because 
 the heart of the Nurse is not in her work, and unless a decided change takes 
 place in this respect, she tvill be dismissed as soon as a more efficient one can be 
 supplied. 
 
 1864. 
 
 The following report is most satisfactory, as coming from a Lady Superin- 
 tendent who, when she first began with a kind and good but not thoroughly 
 trained Nurse, reported in the jdainest terms that she was doing more the 
 work of a charitable Society than that of Nursing, at an expense dispropor- 
 tioned to results. Noiv, with a trained and efficient Nurse, she is meeting a 
 greatly increased expenditure, with satisfaction to herself and great benefit to 
 
 her District, and reports : — 
 
 3ist December, 1864. 
 
 Some of the most satisfactory cases have been those recovering from fever, 
 the nourishment and comforts supplied having effected a good many real 
 cures; one or two cases of alleviation have been very encouraging. One 
 woman, who is dying of cancer, has expressed much gratitude for the relief 
 that has been given her; another, who is suffering from internal illness, 
 has been enabled to sit up for the first time for two years, in consequence 
 of having been provided with an air-cushion; others have obtained much 
 benefit from supplies of flannel; and many have derived great comfort from 
 the Nurse's assistance, who, wherever it has been necessary, has applied 
 poultices, bandages, &c., washed the patients, made their beds, &c. Many 
 of those, under the head of partially cured, will probably be on again before 
 long, and continue on and off most of the winter. The latter part of this 
 year has been very satisfactory. There have been more cases of real 
 nursing, not simply relieving, than we have ever yet had, which is prin- 
 cipally, I think, to be attributed to the efficiency and earnestness of the 
 Nurse, who seems most anxious to give every assistance in her jiower to 
 those who require nursing ; she is in all respects very satisfactory. 
 
 February, 1865. 
 
 The working of this district has on the whole been very satisfactory. 
 As the objects of the Institution become betler understood, a larger 
 proportion of suitable cases is received — by suitable cases meaning 
 such as require the personal services of the Nurse. The difficulty of 
 dealing with the other class of chronic and hopeless cases, and of pre- 
 venting our Charity being made merely a supplement to the workhouse, 
 still, however, exists. It becomes daily more evident how much the 
 services of the Nurse are appreciated by the poor; she is constantly
 
 99 
 
 sought for in cases of sudden need; her advice and instructions are 
 readily followed, and she is everywhere cordially received. To her 
 Ladies Superintendent the Nurse has given great satisfaction; she has 
 been unwearied in her exertions, never grudging time nor trouble on 
 behalf of her patients, and in every way she has been ready to assist 
 the suffering and distressed with whom she has been brought into contact. 
 The poor know so little how help is to be obtained in time of need, that 
 merely as a medium of communication with the medical men and the 
 Parish Authorities, the Nurse's services are very valuable. The Ladies 
 Superintendent have in several instances called attention to the state of 
 courts and houses where sickness has been prevalent, and their representa- 
 tions have always been well received ; where urgently required, the Ladies 
 Superintendent have themselves provided the means for purifying and 
 cleaning dwellings, bedding, &c. Two patients have been sent to 
 Southport; several have been provided with means to go to the country; 
 others have been supplied with clothing to fit them for respectable 
 employment ; and the necessary expenses of getting children into the 
 Blue Coat School have been defrayed* The Ladies Superintendent 
 have found the Clergy, the Doctors, and the Authorities of the Board of 
 Health most willing to co-operate in the working of the Charity. 
 
 31st December, 1864. 
 The majority of the cases we have treated arise from consumption and 
 jfeneral debility; of the former two-thirds die, and of the latter three-fourths 
 recover. In the former, the patients persevere in their daily labour until 
 strength fails, and then, after a few weeks, they die; the utmost we can do 
 is to contribute some addition to their diet and clothing in the way of 
 physical comfort; but the Ladies of this district believe that the numerous 
 expressions of the grateful sense of sympathy are heartfelt by the dying 
 patients, and the visits of the Nurse diffuse a sense of moral comfort in 
 homes otherwise cheerless, which fully repays the cost of their district. 
 The cases of debility arise from insufBcient food and neglect; these are 
 soon restored to a state of comparative health by a little nourishment. 
 
 February, 1865. 
 There has been a great improvement in this district this year, and in the 
 Nurse, owing I believe to regular visiting by a relative, and also to Miss 
 Hunt's visits. The Nurse, who always understood the professional part of 
 her work, but took little interest in it, has become much more interested in 
 her patients, and more suggestive. She has sent children that were run- 
 ning to waste in the streets to school; she has found out and suggested cases 
 
 « " This alone, if this were the only benefit, shows the wisdom and efficiency of the 
 organization by which the assistance of local authorities and charitable volunteers is 
 incorporated in the system of the charity, and tlieir wUling co-operation secur'ed." 
 -Florence Nightingale.
 
 100 
 
 where the provision of flannel or other necessaries to children of sick 
 parents checked incipient disease, and in one case she has at least given 
 us some hope of saving a whole family from worse than death. A woman 
 with three children, was deserted by her husband, and had fallen into the 
 most wretched poverty, and, we fear, vice. She was ill ; one child was 
 sinking into a decline, but now is wonderfully better, and another, running 
 about the streets, is at school ; the woman has been removed from a 
 house in which the Visitors and Nurse one day found all the other 
 inmates, including apparently even the children, riotously drunk ; being 
 provided with decent clothes, the woman is able to seek work, and, being 
 a good workwoman, at least the chance is given her of profiting by her past 
 misery and retrieving herself. I may just add, that it occurred to me a 
 short time ago that it would be a good plan to allow some of our poor 
 patients dinners at the Workmen's Dining Rooms for a little time after 
 their return to the usual occupation. The Superintendents of the Dining 
 Rooms are prepared to supply dinners, on receiving a written request to 
 that effect from the Lady Superintendent of a district, and on the produc- 
 tion by the applicant of a note in the same handwriting. * 
 
 * " It is needless for me to testify what incalculable good is effected by tliis in pre- 
 renting relapses, too often incurred by returning too soon to indispensable work." 
 — Florence Nightingale.
 
 101 
 
 H. 
 
 ADDRESS TO THE NURSES ON THE NEW YEAR, 1864, 
 BY A MEMBER OF THE COMMITTEE. 
 
 For the first time the New Year finds our family gathered together in a 
 Home of our own, under the kind and motherly care of its valued head. 
 
 We hope that you have found your Home cheerful, comfortable, and 
 convenient. We have spared no trouble to make it so, for we have felt 
 that your work, if thoroughly and heartily done, must often be anxious and 
 trying, and we are desirous that when it is over, you should return to a 
 cheerful, comfortable Home. Moreover, we require from you, that whether 
 you work in the Hospital, in private families, or among the poor, you 
 should be models of cleanliness and neatness ; that when you go into the 
 houses of the poor to nurse them — and all of you are bound to go there if 
 sent, and I trust will ever consider it the noblest and best part of your 
 work — when you go there, we hope that you will enforce cleanliness, ven- 
 tilation, and all those rules of health the observance of which might make 
 their homes so different from what they are ; might not only materially 
 promote health, but often pi-event the poor man from being driven to the 
 public-house, as a refuge from a place more fitted for a pigstye than a 
 human dwelling. By giving you every facility for order and cleanliness 
 here, we trust to strengthen your love for them. 
 
 Tn the Lady Superintendent you have one in whom you will ever find a 
 most kind guardian and friend, if you seek to do your duty. She left a 
 position in which she had the promise of all which would seem most likely 
 to gratify her tastes and feeUngs, and friends who were most anxious to 
 keep her; she left it and them because she felt that here she was liliely to 
 be even more useful, and that therefore here her Lord and Master willed 
 that she should be. If you feel, as she is most anxious you should, tliat 
 you are members of a family, you will be ever desirous that the character of 
 that family should be as high as possible, that it should be a credit to 
 belong to it, that no act or word of yours should bring shame upon it, but 
 on the contrary each of you will strive, by the gentleness, quietness, modesty, 
 and truthfulness of your conduct, by constantly increasing proficiency in 
 your profession, and by the thoroughness and conscientiousness of your 
 work, continually to raise the character of the School, and of all belonging 
 to it, higher and higher. 
 
 The character and position of Sick Nurses has not been always what it 
 should be, or might be, because neither the Nurses themselves nor others 
 considered how much depended on, how much might be done by, the Nurse. 
 
 Miss Nightingale has shown the world its error, it remains with the 
 Nurses themselves to do the rest. I hope we shall all work he tily to do
 
 102 
 
 our part. But here I must give you one caution — we must beware lest a 
 proper respect for our profession should degenerate into a cloak for a 
 wretched pride. There is no pride so mean, so contemptible, as that which 
 makes a person above her work. There is nothing really mean, or degrad- 
 ing, or unclean, which our duty calls us to do ; but if ever pride leads us to 
 leave part of our duty or work undone or ill done, then indeed we are 
 degraded. But, after all, gratitude for what lias been done, or the care and 
 affection of your Lady Superintendent, or pride in and fondness for your 
 profession and your work, may help you to do well, but they are motives 
 which, unaided, cannot make you what you ought to be as Nurses — cannot 
 make your work all it ought to be. 
 
 There is work, there will be times, for which all motives are too weak 
 but one ; you can only do your work as it ought to be done, if you do it as 
 servants, as brethren of our Lord Jesus Christ. His eye will be ever upon 
 you. His hand ever near you ; His example should be ever before you. If 
 you are merely hirelings, working for man's wages or man's praise, there 
 will be much of your work that will be distasteful, wearisome, heartless; if 
 all your work is done as in His sight, and for His sake and God's, how 
 different will all appear! Your work lies, as much of His did, among the 
 sick, and suffering, and dying; if you do it as feeling yourselves fellow 
 workers with Him, it is impossible to say — you will never know, no one 
 can ever know — how much good you may accomplish. Your patients may 
 be irritable and ungrateful, but if they see that, patiently, and constantly, 
 and when no master's eye but God's sees you, you go quietly on with your 
 duty, neither discouraged nor weary in well doing, you may be sure you are 
 sowing good seed, which will not be lost, for Almighty power is working 
 with you. The long hours of sickness, the pain and the danger, often 
 cause things to be remernbered and thought of, which in the hurry of life 
 and health would be forgotten. 
 
 Not only the life of your patients may depend on your faithfulness to 
 duty, but by it you may also influence for good their virtue and happiness, 
 here and hereafter. Remember, when wearied and perhaps discouraged by 
 ingratitude, it is not alone the poor, wretched, irritable, and perhaps it may 
 seem to you worthless, sufferer you are serving—" Inasmuch as ye did it 
 unto the least of these, ye did it unto Me" — by his suffering which you can 
 alleviate, the object of your care becomes to you the representative of Him 
 who died for you. Think of this, and yo r task will become a grateful 
 one, your labour one of love. 
 
 The choice is before you. Will you be mere hirelings, or will you be 
 respected members of a happy family on earth, and a still happier family 
 hereafter ?
 
 103 
 
 aiAP OF DISTRICTS, AS PRINTED ON THE BACK OF FORM 
 OF RECOMMENDATION.
 
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