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diff --git a/old/50432-0.txt b/old/50432-0.txt deleted file mode 100644 index 7de90fe..0000000 --- a/old/50432-0.txt +++ /dev/null @@ -1,1687 +0,0 @@ -The Project Gutenberg EBook of Workhouse Nursing, by Florence Nightingale - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: Workhouse Nursing - The story of a successful experiment - -Author: Florence Nightingale - -Release Date: November 11, 2015 [EBook #50432] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK WORKHOUSE NURSING *** - - - - -Produced by MWS, Stephen Hutcheson, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive/American Libraries.) - - - - - - - - - - WORKHOUSE NURSING: - - - THE STORY OF A SUCCESSFUL EXPERIMENT. - - - _London:_ - MACMILLAN AND CO. - 1867. - - -The accompanying account of the Improvements introduced by the Select -Vestry of Liverpool into the Workhouse Hospital Wards under their -control, may perhaps be interesting to you, and possibly might prove -suggestive and serviceable, if similar improvements should be required -in your district. - - -As the time and strength of the Lady Superintendent of the Nurses -employed in the Workhouse Hospital are very fully occupied, enquiries or -requests for further information should not be addressed to her, but to -the Chairman of the Workhouse Committee of the Select Vestry (and of the -Hospital Sub-Committee), - - T. H. SATCHELL, Esq. - _48, Lord Street_, - Liverpool; - - _Or_, - - H. J. HAGGER, Esq. - _Parish Offices_, - Liverpool. - - - - - WORKHOUSE NURSING: - _THE STORY OF A SUCCESSFUL EXPERIMENT._ - - -The following pages contain a brief account of the experiment -successfully tried by the Select Vestry of Liverpool (the guardians of -the poor)—the introduction of trained Nurses into the male wards of the -Workhouse Infirmary. That experiment having resulted so successfully as -to induce the Vestry to extend the system to the remainder of the -infirmary, it may be interesting to those who are concerned in the -management of workhouses elsewhere to learn something of its history and -progress. It is the writer’s object to explain— - -1. The grounds on which the Vestry were led to undertake the experiment, -as stated in the preliminary report of Mr. Carr, the governor, and that -of the sub-committee of the Vestry appointed to consider the proposed -scheme; and the replies received to inquiries addressed by them to -institutions and persons connected with the training and employment of -skilled nurses in London and Liverpool, with letters on the subject from -Miss Nightingale and Sir John M^cNeill. - -2. The results of the experiment, so far as hitherto ascertained. - -The Liverpool Vestry had previously made considerable efforts to improve -the workhouse infirmaries. The medical men had been encouraged to make -requisition for every material appliance that could facilitate the cure -of the sick; and paid female officers were appointed at the rate of one -to each 150 or 200 beds, to superintend the giving of medicines and -stimulants, and so forth: but of course so small a number, even had they -been trained nurses, could do no real nursing, and could exercise little -supervision over the twenty drunken or unreliable[1] pauper nurses who -were under the nominal direction of each paid officer. An appeal was -made to the Vestry to consummate the good work they had thus partially -commenced, and it was urged that Liverpool should assume the lead in the -task of workhouse reform. The following considerations were submitted to -the Select Vestry:— - - “That Liverpool could commence this movement with great effect, and - with the certainty that her example would be widely followed. - - “That she had in times past taken a leading part in such reform. The - introduction of the New Poor Law produced little change in Liverpool; - so many of its wisest provisions were already in operation there, some - of them for twenty or thirty years. - - “That she had already established a system of attention to the sick - poor in their own houses, which, if only by restoring heads of - families to health and work, saved the parish many times the sum that - it cost to private benevolence. - - “That, lastly and especially, the proposed reform ought to commence in - Liverpool, because in her workhouse the guardians had already, by - their liberality, provided the sick with everything in the shape of - diet and medical comforts that could conduce to recovery; and what was - now wanting to give effect to their wise benevolence was, that their - system should be administered and their intentions carried out by - efficient and reliable nurses, in the stead of unreliable paupers.” - -The appeal further urged that— - - “Successful efforts have been made in many directions to improve the - nursing of the sick, and the workhouses must soon be the object of - similar endeavours. Those poor sufferers whose disease is protracted - and hopeless are refused admission into ordinary hospitals, and must - come to the workhouse; and the mere duration of the illness is in such - cases sufficient to reduce to poverty the most industrious, careful, - and temperate—men who, while they could work, paid regularly their - contribution to the poor-rate. Surely, these are entitled to at least - as great care as that which sickness at once assures to the imprisoned - felon, however criminal, for whom well-paid nurses are provided by the - State. - - “As to the other class of inmates of the workhouse infirmary—those - whose ailments are curable—mere economy requires that the most - efficient means should be taken to cure them as speedily as possible, - so as to preserve them and their families from becoming paupers. - - “Thus justice and expediency alike counsel the introduction into the - workhouse of the best known system of nursing. Probably nothing which - the skill and kindness of medical men can do, no food or physical - appliances which the guardians can supply, no oversight or care which - they, acting through pauper nurses, can bring to bear, are wanting in - the Liverpool workhouse; but it is to be feared that much of this - care, liberality, and thought fails of its object for want of a - sufficient number of reliable and duly qualified nurses to carry out - the instructions given, to administer food and medicine to the - patients, to dress their wounds, and so forth.” - -This appeal was supported by two letters of Miss Nightingale and Sir -John M^cNeill, G.C.B., President of the Board of Supervision (the Scotch -Poor Law Board). - - - _Letter from_ Miss Nightingale. - - 115, Park Street, W. - _February 5, 1864._ - - My dear Sir, - - I will not delay another day expressing how much I admire, and how - deeply I sympathize with the Workhouse plan. - - First let me say that Workhouse sick and Workhouse Infirmaries - require quite as much care as (I had almost said more than) - Hospital sick. There is an even greater work to be accomplished in - Workhouse Infirmaries than in Hospitals. - - In days long ago, when I visited in one of the largest London - Workhouse Infirmaries, I became fully convinced of this. - - How gladly would I have become the Matron of a Workhouse. - - But of a Visitor’s visit, the only result is to break the - Visitor’s heart. She sees how much could be done and cannot do it. - - Liverpool is of all places the one to try this great Reform in. - Its example is sure to be followed. It has an admirable body of - Guardians; it is a thorough practical people; it has, or soon will - have again, money. - - Lord Russell once said (what is quite true), that the Poor Law was - never meant to supersede private charity. - - But whatever may be the difficulties about Pauperism, in two - things most people agree—viz. that Workhouse sick ought to have - the best practical nursing, as well as Hospital sick—and that a - good wise Matron may save many of these from life-long pauperism, - by first nursing them well, and then rousing them to exertion, and - helping them to employment. - - In such a scheme as is wisely proposed, there would be four - elements. - - 1. The Guardians, one of whose functions is to check pauperism. - They could not be expected to incur greater cost than at present, - _unless_ it is proved that it cures or saves life. - - 2. The Visiting or Managing Committee of the Guardians, whose - authority must not (and need not) in any way be interfered with. - - 3. The Governor, the Medical Officer, and Chaplain. - - 4. (And under the Governor) the proposed Superintendent of Nurses - and her nursing staff. - - There is no reason why all these parts of the machine should not - work together. - - The funds are provided to pay the extra nursing for a time. - - The difficulty is to find the Lady to govern it. - - When appointed, she must be authorized—indeed appointed—by the - Guardians. She must be their Officer; and must be invested by the - Governor with authority to superintend her Nurses in conformity - with regulations to be agreed upon. - - So far, I see no more difficulty than there was in settling our - relations as Nurses to the government officials in the Crimean - War. - - The cases are somewhat similar. - - As to the funds, it is just possible that eventually the Guardians - might take all the cost on themselves, as soon as they saw the - great advantages and economy of good nursing. - - If Liverpool succeeds, the system is quite sure to extend itself. - - The Fever Hospital is one of the Workhouse Infirmaries. That is - the place to shew what skilful nursing can do. The patients are - not all paupers. How many families might be rescued from pauperism - by saving the lives of their heads, and by helping the - hard-working to more speedy convalescence! - - Hopefully yours, - (Signed) FLORENCE NIGHTINGALE. - - -_Extract from a letter from the_ Right Honourable Sir John M^cNeill, - G.C.B., _dated Granton House, Edinburgh, 28th Feb., 1864_. - - There can be no doubt, I think, that it would be a mistake to have - pauper nurses mixed up with paid nurses, and I think I expressed - that opinion when we conversed about those things. Paupers might, - however, be employed to scrub and to do other menial work, under - the orders of the paid nurses. If the paid nurses are to do much - good they must have a recognised authority in their wards. Without - authority there cannot be due responsibility, and things must get - into confusion. A nurse carrying out the instructions of the - medical officer must have authority to do so, and resistance to - that authority must be treated as a breach of discipline. - - To put this upon a right footing from the first, would be - indispensable to success. The more a nurse does by influence, and - kindly influence, the better; but dealing with the promiscuous - inmates of a workhouse, the knowledge that there is authority in - reserve to be exercised if necessary, prevents the necessity of - resorting to it, and makes the patients duly appreciate the - kindness which keeps it in reserve. - - With regard to all such matters, a great deal will depend upon the - good-will, the good sense, and good feeling of the Governor and - Matron, but especially of the Governor. He can do much to promote - or to mar the success of the experiment, and so can the medical - men; but if they be men of sense and right feeling, they cannot - fail to perceive how vast an addition to their own comfort the - permanent establishment of such a system as you propose to - introduce experimentally, must produce. - - The position of a medical man dependent for the execution of his - instructions upon nurses who are neither intelligent nor - trustworthy, is very painful, and tends to deteriorate his own - character, both as a man and as a practitioner, by rendering him - callous to preventible suffering which he is denied the proper - means of relieving, and by compelling him to forego the use of - remedies which require intelligence and conscientious care in - administering them. The house Governor, if he be a conscientious - man, must be kept in continual anxiety about the conduct of - ignorant, and often worthless pauper nurses in the hospital, and - is driven at length to be satisfied with a low moral and - intellectual standard in the nurses, and a corresponding standard - of care and comfort in the hospital. - -The Select Vestry took the subject into their serious consideration, -and instituted most careful inquiries in various quarters. Among -other steps, they called for a report on the probable operation of -the proposed system from Mr. Carr, the Governor of the Workhouse. -That report ran as follows:— - - - _Extract from the Journal of the Governor of the Workhouse._ - - Liverpool, Thursday, _April 14, 1864_. - - In compliance with the instructions of the Workhouse Committee, I - have carefully considered the proposal made to the Committee by a - Liverpool gentleman, on the subject of nursing the sick in the - Workhouse Hospital, and beg in reference thereto to report— - - That, practically, the proposal amounts to this—that there shall - not be any pauper nurses in the hospital, but that there shall be - appointed in lieu a staff of duly qualified paid nurses and - servants, with a head superintendent, under whom the whole of the - nursing of the sick shall be conducted on the best known - principles. - - This proposal rests its claim to favourable consideration on the - presumption that the present system of nursing the sick in the - Workhouse Hospital is defective. The Committee are aware what that - system is. It may thus be briefly stated. Certain wards of the - workhouse are set apart as hospital wards. They do not form an - hospital worked as a whole, but are divided into five portions, - each forming a distinct set of wards, in close proximity to the - wards of the healthy paupers, and in five different parts of the - workhouse. These five sets of wards I shall call the Workhouse - Hospital. The hospital is divided into eleven sections. At the - head of each section there is an intelligent paid superintendent - nurse, and under each such superintendent nurse there is placed a - staff of pauper nurses, with the aid of whom she is required to - work her division, according to certain rules and regulations made - and provided for that purpose. A copy of these rules is appended - hereto; from which it will be seen that the burden of the - responsibility of carrying out the orders of the medical officers, - devolves upon the head nurses or superintendents of divisions. The - pauper nurses clean up the wards, carry the food, and give general - assistance to the superintendent—the duties of nursing in detail, - that is to say, the bedside nursing, falling chiefly upon them. - They are not permitted, however, to serve any patient with - stimulants, beer, porter, or medicines requiring exactness or - care; all such duties are discharged by the superintendent nurse. - The proposal now made to the Committee, means that the paid staff - shall be increased, so that the sick shall be cared for by - responsible officers only, and not left, even partially, to the - care of pauper nurses. - - There is no doubt that pauper nurses are unreliable, inefficient, - and many of them very worthless; and it is only by careful - watching, and the utmost stringency of regulations, that they can - be made serviceable in the hospital. No stringency of regulations, - however, could guard against the most flagrant abuses, if these - women were employed to discharge duties of trust, such as serving - out the stimulants, &c. so that their services in attending upon - the sick are limited and common-place. There is therefore, in my - mind, no doubt, and I cannot see how any doubt can exist, that to - remove these women, and appoint in their places women of - character, trained as nurses, will tend to improve the position of - the sick, and more rapidly restore many of them to health. - - To displace these pauper women, however, involves a complete - change in all the hospital arrangements, and suggests the - difficulty of finding and keeping up a supply of suitable nurses - to undertake the work at, as it would no doubt often happen, short - notice. The Committee are aware, too, that owing to the fact that - the paupers have hitherto been required to attend upon the sick, - the accommodation for paid officers is very limited, and that the - adoption of the proposal would render it necessary at once to - provide additional rooms for the additional staff. The Committee - are also aware that the Workhouse Hospital differs from other - hospitals in this—that it forms a part only of a mixed - establishment, and that there are great difficulties to be - overcome in completely cutting off every connexion or species of - intercourse between the hospital departments and the healthy - inmates, without which the scheme under consideration could hardly - succeed. If any good is to result from the adoption of this - proposal, the sick should be placed absolutely and entirely in the - hands of a paid staff, without the assistance, in any form, of any - one of the pauper inmates. Cut off the hospital department from - the healthy wards; and do not, under any pretext, suffer - communication between the sick and the healthy, and you strike at - the root of every species of workhouse abuse; but if, under any - pretext, you suffer a large number of healthy paupers to pass - daily into the sick departments, as they now do, the adoption of - the proposal will effect little good. - - But the question has to be still further investigated on the - ground of expense; and it has to be decided the number, pay, - allowances, and accommodation of the necessary staff to work it - out. Now, although I entertain very strong opinions as to the - undesirability of employing paupers to discharge responsible - duties of any kind, because to do so destroys the value of the - workhouse test, and tends to reconcile them to pauperism; and - although I view the particular work of nurse-tending as the very - worst kind of work for paupers, inasmuch as, while so employed, - they are better fed, have more freedom of action than they - otherwise would, and can make their places emolumental—thereby - holding out a positive inducement to pauperism; and although I - have no doubt that the displacement of these women would be - followed by the immediate application for discharges by a large - per-centage of them; and although, at this moment, many other - weighty considerations press upon me in favour of the immediate - adoption of the proposal under consideration, I feel unwilling, in - view of the difficulties to be overcome, some of which I have - indicated, to incur the weighty responsibility of recommending - such a course on my own unaided judgment. I have abstained, - therefore, from taking up the question of expense, &c. but take - the liberty respectfully to suggest, that a sub-committee be - appointed to report upon the whole question in all its details. It - shall be my anxious desire and pleasure to assist the labours of - such sub-committee by every means in my power. - -According to the recommendation of Mr. Carr, a Sub-Committee was -appointed, consisting of men of great experience in parochial -business, who went up to London, and had interviews with the medical -and other officers of the two metropolitan hospitals where nursing -has been brought to the greatest perfection—St. Thomas’s and King’s -College Hospitals. Finding that some of these gentlemen wished for -more information respecting the Workhouse Hospital system before -they would venture to express decided opinions as to the economical -results of the proposed reform, the Liverpool Visitors drew up a -statement on several points affecting this question, with written -inquiries, to which answers were returned, verbally or in writing, -by the gentlemen consulted. This statement, with the replies which -it elicited, is here given at length:—[2] - - - STATEMENT AND QUESTIONS OF THE LIVERPOOL SUB-COMMITTEE. - - The population of the Parish of Liverpool is about 270,000. - - The expenditure from the poor’s-rate in and about the relief of - the poor is about 100,000_l_. per annum. - - Of this about 40,000_l_. is distributed in out-door relief as - money and bread. (Of course sickness is one great cause of persons - seeking relief, though to what extent this cause operates, even - directly, I cannot on so short a notice ascertain or even - estimate.) - - The expenses (direct) of treating the out-door sick are:— - - Salaries of Medical Officers, &c. £1,800 - Medicines, &c. 1,378 - £3,178 - - The cost of maintaining the Workhouse Hospital may be estimated as - follows:— - - Maintenance of Patients £9,700 - Salaries of Medical Officers 485 - Medicines, &c. 1,050 - £11,235 - - The Hospital contains accommodation for over 1,000 patients, and - has often 1,000 in it. The cases at present are:— - - Medical 485 - Surgical 345 - Fever 120 - Smallpox 20 - - The weekly discharges are from twenty to thirty per cent. of the - whole number in the hospital.[3] - - The present workhouse staff consists of fourteen paid officers - (who are superintendents, but not trained nurses), and about 150 - paupers acting as nurses, but not paid. It has been proposed to - add a trained hospital matron and trained nurses, such as those - trained in the Nightingale School, and assistant nurses, so as to - give one trained day-nurse and one paid assistant to about every - three pauper nurses, and a trained night-nurse on every flat; it - is further proposed to pay the paupers who act as nurses, wages. - The cost of this would be about 2,000_l_. per annum. - - Does your experience of hospitals lead you to believe that the - cost of this improved system would be “in part,” “wholly,” or - “more than” repaid to the ratepayers by curing people more - quickly, by curing those who otherwise might have become chronic - cases, and by enabling those to resume their work who must - otherwise have remained or died, and by thus diminishing the - duration or amount of that part of pauperism which is the result - of sickness? - - - REPLIES OF PHYSICIANS, &c. OF ST. THOMAS’S HOSPITAL. - - -1. _Reply of_ R. H. Goolden, Esq., M.D. - - -“I have no doubt but that the plan suggested, if properly carried -out, would be in the end a saving to the ratepayers, the restoration -to health relieving the parish of constant burdens.” - - -2. _Reply of_ John Simon, Esq. - - -“I do not feel myself competent to measure at all exactly what might -be the pecuniary result of the proposed system. But in my opinion -the substitution of skilled for unskilled attendance would be of -great advantage to the sick, and would of course tend to diminish -that part of the pauperism which results from sickness.” - - -3. _Reply of_ Sydney Jones, Esq., M.B. - - -“In my opinion the improved system of nursing recommended would -amply repay the expense incurred.” - - -4. _Reply of_ J. S. Bristowe, Esq., M.D. - - -“I believe that the introduction of paid nurses into the Liverpool -Workhouse Infirmary would be of inestimable benefit to the sick poor -received into the institution, and would thus amply justify the -expense which it is proposed to incur. I also think it very probable -that the cost of nursing would be repaid in many other ways to the -ratepayers.” - - -5. _Reply of_ Edward Clapton, Esq., M.D. - - -“I believe it would be quite repaid.” - - - REPLIES FROM THE PHYSICIANS, &c. OF KING’S COLLEGE HOSPITAL. - - -1. _Reply of_ Henry Smith, Esq. _Assistant Surgeon_. - - -“I believe, from a long experience of hospitals and other -institutions, that the cost of an improved system of nursing as -proposed for the Liverpool Workhouse Hospital would certainly be ‘in -part’ repaid by restoring the patients to health more quickly.” - - -2. _Copy of a Letter from_ Miss Jones, _Lady Superintendent of St. -John’s House Nursing Schools, and Matron of King’s College -Hospital_. - - King’s College Hospital, _May 4, 1864_. - - Dear Sir, - - The inclosed paper was sent to me yesterday, with the request that - I would obtain from some of the medical staff of this Hospital - answers to the question proposed at the end of the paper, in order - to enable the Vestry in some degree to judge whether that body - would be justified, or otherwise, in sanctioning the introduction - to their Workhouse Hospital of an improved system of nursing the - sick, at the probable annual money cost named in the inclosed - paper. - - I have accordingly submitted the paper to as many of the medical - staff as I could see in the short time. - - I inclose a note from Mr. Henry Smith, one of the surgeons, who - has had considerable experience as to the loss and gain of good - and bad nursing. - - Dr. Wm. O. Priestly, the Physician Accoucheur to this Hospital, - formerly of Middlesex Hospital, had not time during his visit to - do more than read the paper and give me a verbal answer. He said, - “I have no hesitation in saying that the saving would be certain - and great.” - - The Assistant Physician Accoucheur, who has until last week had - charge of the medical patients here, as House Physician (Mr. H. L. - Kempthorne), says, “The value of trained efficient nursing cannot - be overrated in the management of acute diseases, and especially - fevers, and would speak for itself in the saving of life, humanly - speaking. - - “In chronic cases, the eye of the trained nurse would soon detect - the malingerer, and thus save the parish the expense of - maintaining one who could well keep himself. - - “In the prevention and amelioration of disease this plan would - soon show its importance in the effects of cleanliness, - ventilation, and other points carried out systematically and - intelligently. - - “The moral influence of the trained nurses by precept and example - must in time diffuse itself through the medium of the pauper - nurses to the paupers in hospital, the workhouse, and thence to - the parish at large.” - - I regret my inability to obtain fuller testimony to-day, but - professional men are busy, and their visits to the hospital only - on stated days. - - If I can be of further use in any way, pray command me. - - I am, Sir, - Very faithfully yours, - (Signed) M. J. - _Superintendent of St. John’s._ - -After collecting and considering all the information within their -reach, the Sub-Committee reported as follows:— - - The Sub-Committee appointed on the 14th ultimo to consider and - report as to a suggested alteration in the Staff of the Workhouse - Hospital, report, - - That the superiority, as nurses, of trained, experienced, and - responsible women to the pauper women upon whom, under the present - system, the actual nursing of the sick inmates of the workhouse - devolves, is so apparent, that they conceive it to be unnecessary - to offer any further observations upon this part of the subject. - The points which have mainly occupied your Committee’s attention - are the following:— - - 1. The cost of introducing a staff of trained nurses into the - Workhouse Hospital, or any portion thereof. - 2. The practicability of providing sufficient accommodation in the - Workhouse for such an increase of officers. - 3. The supply of trained nurses. - -1. Your Committee are of opinion that the substitution throughout -the Workhouse Hospital of trained nurses, for the present pauper -nurses, would involve a direct expenditure of from 2,000_l._ to -2,500_l._ per annum. Should it be decided, in the first instance, to -introduce the nurses into the male hospital only, it is probable -that a sum of 800_l._ per annum would be found sufficient for the -purpose. Evidence has been laid before the Committee to show that in -those hospitals where the improved system of nursing has been -introduced, the increased cost thereof has been more than -compensated for by the saving, from the reduction of the time during -which the patients are under treatment—the effect, as is alleged, of -good and efficient nursing. Whilst your Committee admit the force of -the argument, that if this be so in the case of hospitals, where the -sick only are burdens upon the funds of the institution, much more -must it be so in the case of the parish, where, as often happens, -the whole family are chargeable upon the rates in consequence of the -sickness of its head; they think it necessary to point out that one -great difference between the workhouse hospital and an ordinary -infirmary consists in this, that while in the latter (as a rule) -none but acute and supposed curable cases are admitted, the former -is, in many cases, the refuge of those who, as incurables, cannot -gain admittance to other asylums. There can, however, be no doubt -that the saving resulting from the rapidity and completeness of the -cures effected by good nursing, will be a considerable set-off -against the increased cost of the nursing staff; though your -Committee can offer no decided opinion as to the probable extent of -the saving so effected. - -2. Your Committee believe that accommodation equal at least, if not -superior, to that afforded to the nurses in the London hospitals, -can be provided in the Workhouse at a moderate outlay. It is -estimated that, for the male hospital, a sum of from 400_l._ to -500_l._ would suffice to provide the rooms and to furnish them. - -3. With reference to the supply of suitable nurses, your Committee -have to report that, as the authorities of the Nightingale Training -School for nurses have offered to render to the Select Vestry all -the assistance in their power in obtaining trained nurses, no great -difficulty on this point need be apprehended. - -Were your Committee as sanguine as some of the hospital authorities -whom they have consulted, as to the happy results to be expected -from the introduction of trained nurses into the Workhouse, they -would at once, with the utmost confidence, recommend that the whole -of the hospital should, at the cost of the parish, be supplied with -this class of officers; but, looking upon it as they do, as an -experiment (at least in its economical results), they unanimously -recommend that the system should, in the first instance, be tried in -the male hospital. - - J. W. CROPPER, _Chairman_. - -_May 5, 1864._ - -The report of the Sub-Committee met with the approval of the Vestry. -Some delay in the adoption of its recommendations was caused by a -severe outbreak of fever in the town, which for the time absorbed -all the resources of the Vestry and its officers. But on the 18th of -May, 1865, a Lady Superintendent who had received a thorough -training at Kaiserswerth and St. Thomas’s, twelve Nightingale nurses -from St. Thomas’s, eighteen probationers, and fifty-two of the old -pauper nurses were placed in charge of the patients in the male -wards of the Workhouse Infirmary. By the judicious management of Mr. -Carr, the most admirable arrangements were made for the -accommodation of the nurses. Each superior nurse had a little room -to herself, and the ex-pauper nurses were entirely separated from -the other inmates of the Workhouse. It was hoped that by taking the -best of the able-bodied inmates, separating them from the other -paupers, and paying them small wages (say 5_l._ a year) they might -be made available as assistant nurses, and that many of them might -be elevated into independence and usefulness. It will be seen from -the foregoing report of the Governor (p. 10), that he always -distrusted this part of the plan adopted; and after the system had -been at work a year, this attempt to utilize pauper nurses in a -workhouse hospital was found to have utterly failed. It was proved -that in a town like Liverpool, with very few exceptions, those -able-bodied women only become inmates of the Workhouse who are -either tainted in character, or are exceptionally ill-educated and -inefficient. The experiment, however, was not wholly useless. It -conclusively established two facts: that such women are utterly -unfit to be trusted as nurses; and that their employment in that -capacity does not effect all the saving that might be supposed. It -might be thought that the choice lay between such employment and -maintaining the pauper in idleness, while paying a nurse in her -stead. But it was found—as the Governor had always predicted—that -when sent back from the hospital to the able-bodied wards, nearly -the whole of these women left the Workhouse, and relieved the parish -from the charge of their maintenance. Many of these women, when -employed as nurses, remain in the Workhouse for the sake of what -they can pick up or extort. And moreover, when they left it, the -training they had received, such as it was, rendered them more -intelligent, and perhaps not more unreliable nurses than those -usually employed by the poor. It is not unlikely that in country -places the unfitness of able-bodied paupers to become assistant -nurses may be far less than it has been found to be in a great -seaport town like Liverpool. They may probably be less universally -tainted in character, and after a year or two of employment as -under-nurses they may be able to maintain themselves in that -capacity out-of-doors, thus not only relieving the parish of their -own maintenance, but assisting to diminish sickness and pauperism -among their neighbours. The point is one which must be left to local -knowledge and experience. It might be well, however, not to promise -them payment till after some length of probationary service. It was -always after pay-day that the ex-pauper nurses were most liable to -get drunk and misbehave.[4] With the exception of the failure of the -nurses taken from the pauper class, the first year’s trial was -sufficiently successful to induce a continuance of the experiment. -It was impossible, however, to judge the result by statistics. None -that were available could be considered as an evidence of success or -failure, for several reasons. The season was very unhealthy, and to -relieve the pressure on the space and resources of the hospital, -steps were taken to treat slight cases outside, as will be seen from -the following extract from the Minutes of the Finance Committee, -24th November, 1865:— - - “The district medical officers, Dr. Gee, Mr. Barnes, and the - Governor of the workhouse being in attendance, pursuant to - resolution of the Workhouse Committee at its meeting yesterday, - the practicability of limiting the admissions to the Workhouse - Hospital was considered, and the district medical officers were - requested to co-operate with the relieving officers in limiting - such admissions to those cases that cannot be properly treated - outside the Workhouse.” - -The endeavour to limit the admissions to serious cases would of -course affect the returns, both as regards the time taken in curing, -and the proportion of deaths. Even had there been no exceptional -disturbing element, there is a defect in the statistics of workhouse -hospitals which affects all inferences from them, in the absence of -any careful classified list of cases kept by the medical officers, -such as might fairly enable one to form a judgment from mere -statistical tables. These, then, are not reliable as means of -judgment, unless extending over a long period. The character of -seasons, and nature of cases admitted, varies so much from year to -year as to invalidate any deductions, unless founded on complete and -minutely kept medical records. The following extracts, however, from -the reports of the Governor, and the surgical and medical officers -of the Workhouse, bear decisive witness to the value of the “new -system,” especially as contrasted with the “old system,” which in -1865-66 still prevailed in the female wards. All these reports bear -emphatic testimony to the merits and devotion of the Lady -Superintendent and her staff. The medical men, it is noteworthy, -speak strongly of the better discipline and far greater obedience to -their orders observable where the trained nurses are employed—a -point the more important because it is that on which, before -experience has reassured them, medical and other authorities have -often been most doubtful. - - - _From the Report of the Governor._ - - Thursday, _May 10, 1866_. - - The main feature in the new system of nursing consists in the - superseding of pauper nurses, and appointing in their places - competent trained nurses from the Nightingale School. These latter - to have the assistance of “probationary nurses,” or in other - words, women of intelligence and of good character desirous of - entering upon the duties of nursing the sick as a profession. A - third class was also created, designated “Assistants.” These were - selected from the old pauper nurses, and it was decided that they - should be paid, clothed, and receive rations equal in quality and - quantity to those issued to the officers of the workhouse. The - nurses, probationers, and assistants were placed under the control - of a “Lady Superintendent,” who was empowered to employ them in - the manner to her seeming best for the proper care of the sick. - - The Committee will be prepared to hear that the change was - immediately followed by the most marked improvement in every - respect. The most casual observer could not avoid perceiving it. - This applies not only to the state of the wards, the care of the - sick, but is particularly observable in the demeanour of the - patients, upon whom the humanizing influences of a body of women - of character, devotedly discharging their duties, has produced - evident fruits. - - The question has often been asked whether the “new system is - likely to succeed?” The “old system” meant nothing more than this, - that old, ignorant, and unreliable pauper women, many of whom were - of doubtful character, were entrusted with the discharge, without - pay, of responsible duties. These have been displaced, and active, - intelligent, reliable women, trained and skilled as nurses, with - good characters and pay, have been appointed to supersede them. It - would be a great discredit if these latter did not discharge their - duties incomparably better than the former could do. That they do - so I am happy to be in a position to testify. - - In the opening paragraph of this report it is stated that - “assistant nurses” were appointed and placed upon pay from the - ranks of the paupers. This I was always opposed to. Their - employment has resulted in complete failure, as the following - figures will prove. The total number appointed to this date is - 141. Of these sixty-seven have been dismissed through drunkenness - and other misconduct, and sixteen have resigned; while it is - positively true that there is not one of the whole number to whom - I could entrust the duties of serving out wine or other - stimulants, or, in fact, any duty requiring the exercise of - integrity. - - The experience of the past year renders it certain that the Poor - Law, as now existing, offers no impediments to the successful - working out of the most complete scheme for the efficient nursing - of the sick, in the manner advocated by the best friends of - hospital nursing. - - (Signed) GEO. CARR. - - - _From the Report of_ Robert Gee, Esq. M.D. _Physician to the - Workhouse Hospital_. - - 5, Abercromby Square, Liverpool, - _May 10, 1866_. - - Sir, - - In the medical wards of a general hospital the cases vary so much - in nature and degree from year to year, as to render it impossible - to give a reliable statistical comparison of the value of a paid - as distinguished from an unpaid staff of nurses. I am, therefore, - necessarily compelled to report in general terms on the nursing of - the last ten months in the male medical wards; premising that what - I say in approbation of the new system, and the new staff of - nurses must not be construed as an unfavourable reflection on the - _whole_ of the previous staff. The paid superintending nurses of - departments, and a few of the unpaid pauper nurses, deserve great - credit for their conduct, though their qualifications for the - service were decidedly inferior to those of the trained - “Nightingale” staff. - - With regard to the latter I can cordially bear testimony to their - ability, and to their unwearied and uniformly kind attention to - the patients under their charge. As to their nursing in its - specific sense, I may state my belief that in every case my - directions and those of the House Surgeons have been rigidly - carried out. The medicines, stimulants, &c. &c. have been - carefully administered, and the other numerous but less agreeable - duties have been faithfully and efficiently attended to. Under - their charge I have perceived a marked improvement in the - demeanour of the patients—in fact, the discipline of the wards is - completely changed. There has been no disorder or irregularity, - but a sense of comfort, order, and quiet pervades the whole - department. I believe further, that every patient leaving the - wards has been more or less morally elevated during his location - there. - - - _From the Report of_ J. H. Barnes, Esq., _Surgeon_. - - _March 21, 1866._ - - Since my connexion with the hospital last August we have had - somewhat approaching a hundred operations, many of them of a - serious and dangerous character, requiring not only prompt - assistance at the time, but most persevering attention night and - day for a long time after. Almost all these operations have been - in the male hospital, and I have no hesitation in saying that what - success has attended them has been greatly owing to the most - efficient assistance rendered by the trained nurses; and from my - experience of the assistance received from the pauper nurses, in - the few cases of operation performed in the female hospital, I - should feel great diffidence in undertaking on that side such - operations as I have had on the other side: indeed on one or two - occasions the pauper nurses ran away, and when induced to assist - were so nervous and frightened as to be of little service. - - Without any wish to speak harshly of the unpaid nurses employed on - the female side of the hospital (who, I believe, strive to do - their best, more especially since a feeling of emulation has been - set up by the introduction of the paid trained nurses, of whom - they are jealous), I am compelled to state my conviction that on - that side my directions are not carried out with that necessary - promptitude and skill that they are on the other side, and that in - all I do there I feel as if I were working with blunted - instruments. There is no want of inclination, but simply a want of - ability. That _integrity of disposition, promptitude of action, - tact in manipulation, gentleness of demeanour and kindly - consideration_ necessary to make a nurse are not found, or _to be_ - found in the inmates of a workhouse, and no amount of education - can work out of them what never was in them. Almost always obtuse, - and too often unprincipled, as a class they are thoroughly - unreliable, and quite unfitted to take charge of the sick and - helpless, or the stimulants necessary for them. On this last point - I have been informed by a former resident surgeon that he has - known the pauper nurses appropriate the patient’s stimulants, or - withhold giving to a dying patient that ordered for him, that they - might take it themselves after his death. It is difficult to bring - home and prove these things, and I do not wish to say they now - occur, but if we wish to put such conduct out of the region of - possibility it can only be done by the employment of persons - superior to the temptation so to act. - - Persons of one class, as a rule, favour their own class, and there - is a far better chance of double-dealers being detected when under - the observation and care of a trained nurse, than when under the - care of one of themselves. That such is the case my own experience - testifies. - - As far, therefore, as my experience extends of the system of - trained nurses, whether regarding the saving of life, the - restoration to health, or the relief of the suffering, it has been - an undoubted success. - -These reports were duly considered by the authorities; and after -some discussion, it was resolved entirely to discontinue, in the -male hospital ward, the employment of paupers as assistant nurses, -and to substitute an additional number of probationers. A -Sub-Committee of the Workhouse Committee was appointed to -superintend and report upon the working of the system. These -gentlemen devoted much time and attention to the subject, and at the -close of the year undertook a minute inquiry into the operation of -the old and new systems; examining personally the various officers -of the Workhouse, from the Governor down to the pauper nurses in the -female wards. Increased experience brought out in a yet stronger -light the superior advantages of the employment of trained nurses. -The very able, clear, and conclusive report of the Sub-Committee -leaves little more to be said on the subject. It determined the -Vestry to adopt the system in permanence, and to extend it to the -whole of the Workhouse Infirmary, a year before the period fixed for -the trial of the experiment had expired. It will be seen that the -report of the second year’s experience has a peculiar value, as -bearing on the question whether, or how far, women may be competent -to undertake one of the most delicate and difficult kinds of -feminine work—one requiring special knowledge as well as special -habits of punctual regularity, obedience, and thoughtfulness—without -receiving any special training or education for such a duty. If the -reforms about to be introduced into the pauper hospitals in London -and elsewhere are not to end in failure and disappointment, -provision must be made for training the nurses to be employed there, -either before they enter the hospitals or within them. - -The report of the Sub-Committee of Superintendence is as follows:— - - The Special Committee on Nursing, pursuant to resolution of the - Workhouse Committee of the 7th of March instant, report, - - That the Men’s Hospital (exclusive of fever patients) is at - present exclusively nursed by skilled, _i. e._ specially trained - nurses and paid assistants, who are themselves undergoing training - as nurses; the staff consisting of the Superintendent, nine of the - nurses originally sent from the Nightingale School, five nurses - who have been trained in the Workhouse, and fifteen probationary - or assistant nurses. - - Of the character of the nursing in this portion of the Workhouse, - your Committee have heard but one opinion. The Governor and the - Medical Officers concur in speaking of it in terms of the highest - praise, and throughout the whole period during which the Committee - have superintended it, no single circumstance has come to their - knowledge calculated to make them speak of it otherwise than in - terms of approval. - - The nursing of the women’s wards continues to be done by paupers - under the superintendence of paid officers. The superintendence of - these officers is of necessity very imperfect, as not only has - each charge of from 150 to 200 patients, but these patients are - located in several rooms, each ward containing about twenty - patients. The only portion of the nursing, properly so called, - which these officers undertake, is the administration of - stimulants and in some exceptional cases of medicine. The bulk of - it, as the giving of medicine, the dressing of wounds, the - distribution of food, is left to be done by paupers. So much has - from time to time been said of the untrustworthiness of pauper - nurses, of the evils resulting to those patients who are placed - exclusively under them, of the mischievous consequences upon the - discipline of the Workhouse of a large number of petty offices - being filled by able-bodied women, that your Committee believe - they rightly interpret the feeling of the Select Vestry, as they - undoubtedly do that of the general public, in supposing that the - actual nursing of the sick in the Liverpool Workhouse can no - longer be left in the hands of pauper nurses. - - Starting from this point, your Committee considered that they had - principally to inquire what sort of nursing can be most - advantageously substituted for that of nursing by paupers. Two - courses only appeared to be open to them—either to increase the - number of paid officers, giving to each such a number of patients - as she could reasonably be expected to look after, and treating - each as an independent officer; or to extend over the whole - hospital the system now in existence in the men’s wards. Your - Committee were much aided in forming a judgment upon this point, - by what has taken place during the last few months in the fever - hospital. - - Here, originally, the paid attendants were in precisely the same - position, with precisely similar duties as the paid officers in - the women’s hospital; but the number of patients rapidly - diminishing, and no corresponding reduction taking place in the - number of officers, the staff was so large that Dr. Gee felt able - to call upon the officers to act as nurses. The result was what - might have been anticipated, that although an improvement upon the - old system of nursing by paupers was perceptible, the state of the - nursing was still far short of the standard reached in the men’s - wards. - - The officers were told to nurse, and they did their best, but - never having themselves been taught, their attempts in a great - measure failed; they were paid and retained as nurses, without - being efficient nurses. - - Your Committee therefore recommend that as soon as the requisite - number of trained nurses can be procured, the nursing in the - women’s hospital, and afterwards in the fever hospital, be placed - in the hands of trained and skilled nurses, acting under the - direction and control of Miss Jones, the present Superintendent. - The expenses (beyond the item of wages) attendant upon the - necessary increase in the number of nurses will not be great, as - all that will be necessary will be to convert two of the rooms now - used for sick boys into sleeping apartments for the nurses. In - making this recommendation, the Committee are glad to know that - they are fortified by the unanimous opinion of the Governor and - the Medical Officers of the Workhouse. - - Your Committee are bound to add that they can produce no - statistics shewing that the nursing in the men’s hospital has been - of any economical advantage to the Parish; but as it needs no - argument to prove that the cheapest course that can be taken with - a sick pauper is to cure him as quickly as possible; as it is - evident that the care and attention of a skilled nurse must tend - to a more speedy recovery; as the order and discipline of a - well-regulated ward is more distasteful to many of the more - worthless inmates, than the laxer management of a room in the - hands of a pauper nurse; and as the abolition of a large number of - petty offices for able-bodied paupers must lead to many of them - leaving the Workhouse, there are strong grounds for hoping that - the economical results of the change cannot but be beneficial. - - With regard to the future, your Committee recommend that the - Department of Nursing should be placed under the direction of a - small committee of your body, and that all changes in the staff - should be made only by them. From information they have received, - your Committee have reason to believe that if, after the Workhouse - is supplied with Nurses, the two classes of nurses, _i.e._ trained - nurses and probationers, be maintained, the cost of the Department - may be considerably lessened by training nurses for other - hospitals; the cost of the probationers being either paid for by a - Government grant, or by the bodies for whom the nurses may be - trained. - - THOMAS H. SATCHELL, - RICHARD BRIGHT, - THOMAS OWEN. - - _March 15, 1867._ - -This report was unanimously adopted by the Workhouse Committee and -by the Vestry; and already the new system has been extended to the -Female Wards. It is in contemplation to extend it also to the Fever -Hospital, as soon as a sufficient number of suitable nurses shall -have been trained. - -It will be observed that the report contemplates the training of -probationers for other Workhouse Infirmaries. And it is, indeed, to -be hoped that in this and other ways the Liverpool Workhouse -Hospital may serve as a normal school, from which the system there -adopted may spread. The _special_ expenses of such a school would -naturally be borne by the parishes which profited by its services in -educating nurses for them, or by the Government. But this point is -one which, as yet, has hardly demanded practical consideration. - -The experiment whose results have been recorded, could hardly have -been tried at all—certainly could not have achieved such rapid -success—had it not been for the powerful and liberal assistance of -Miss Nightingale, and the Trustees of the Nightingale Fund. Feeling -how very important was the extension of the system of superior -professional nursing, now gradually gaining ground in general -hospitals, to workhouses, they sent, to assist in the initial -experiment made in this direction, a lady superintendent and twelve -superior nurses—a very expensive and quite invaluable contribution. -To the Liverpool Vestry and its officers belongs the credit of -having overcome all the difficulties, and persevered in spite of all -the discouraging incidents, which necessarily attended an attempt to -introduce a new system of management into such an institution as a -Workhouse Hospital, combining as it does two subjects so different -in their aspects and conditions of treatment, so difficult to deal -with together, as pauperism and sickness. Of the Lady Superintendent -I shall say little. When a lady leaves a happy home, and goes -through a long and laborious course of training to fit herself for -such a situation, purely because, feeling that she possessed the -capacity for nursing, and the requisite health, energy, strength, -and spirits, she desired to devote such powers to the service of -those who stood most in need of them, human praise or criticism of -her choice is out of place. One of the incidental results of her -exertions has to her, no doubt, been even a higher reward than that -improvement in the condition of the sick, in their progress towards -recovery, and their material comfort, which has been the direct -object of her labours. The improvement in the tone and behaviour of -the patients has been wonderful. Many of the inmates of a pauper -hospital are persons of the worst character, and its wards, under -the control of pauper nurses, often present scenes so disgusting -that the respectable poor shrink from them with utter abhorrence, -and after once becoming acquainted with them, will often rather die -than return thither. When the trained nurses were first introduced, -the most offensive language was frequently heard in the wards; and -the Lady Superintendent has repeatedly been obliged to call upon the -Governor two or three times during one Sunday to use his authority -to put a stop to actual fighting. Now, though his support is always -promptly rendered, she is rarely compelled to apply for it; the -feeling of the wards promptly suppresses all offensive language or -unseemly behaviour in the presence of the nurses. The following -letter from Sir H. Verney, Chairman of the Nightingale Committee, -serves to illustrate the influence of the nurses upon the conduct of -the patients; he came down to Liverpool to inspect the Hospital, and -ascertain the progress of the work:— - - Liverpool, _October 3, 1866_. - - My dear Sir, - - By the kindness of Mr. Carr I have paid a visit to the Workhouse, - and have been greatly interested by remarking the change among the - male pauper sick, effected since I was here about two years since. - I conclude that this is owing to the nursing by a class of females - so entirely different to those who nursed the male paupers at that - time, and who still nurse the female sick. I have always seen that - the influence of respectable and well-educated females over the - most debased men is very striking. Men of that character, - accustomed to intercourse with only degraded women, feel the - restraining and humanizing power of virtuous and well-mannered - females. They have never been admitted into intercourse with such - before, and they are most beneficially affected by it. I have been - told that the police officers, who sometimes come to the Workhouse - on business, and who see the sick paupers, are much astonished. - They see the men whom they have known as the very worst - characters, conducting themselves with propriety and decency, and - giving no cause of complaint. - - I am sure that the Workhouse Committee must rejoice and feel - thankful that there is such a change in the condition of the poor - creatures brought under their rule. - - Miss Jones, and her nurses and probationers, must have had much - difficulty at first—indeed their work is still very trying; but - the improved demeanour of the men must be highly gratifying and - encouraging to them. I walked through the female sick wards; they - were clean and sweet, but I could not help contrasting the pauper - nurses who attended them, with the intelligent-looking respectable - attendants of the men. - - I thank you for the note of introduction which procured admission - for me, and - - I am, - Yours very faithfully, - HARRY VERNEY. - -Such, and so entirely satisfactory to the Guardians, were the -results of the experiment of nursing by trained nurses, as tried for -two years in the Male Wards of the Liverpool Workhouse Infirmary. It -is in order to render those results, the experience acquired in this -initiatory attempt, available for the assistance and encouragement -of others, that they have been thus briefly recorded. Much more -might have been said; but what is here set down is sufficient to -explain all that practical men would wish to know, and it would be -presumption to waste the time of such men with comments and -inferences which they are perfectly able to make for themselves. - -One suggestion, in conclusion, I may be permitted to offer. In all -unions or parishes where additional accommodation may be required, -whether for patients or for healthy paupers, it is eminently -desirable that in providing it regard should be had to the entire -separation, at once or at a future time, of the sick and infirm from -the able-bodied, as will be the case, at least partially, under the -new régime introduced in the Metropolis by Mr. Gathorne Hardy’s -Bill. Miss Nightingale has from the first held and expressed a -strong opinion in favour of the separation of the hospital and -workhouse administrations. The Governor of the Liverpool Workhouse, -Mr. Carr, expressed himself decidedly in the same sense; and the -Chairman of the Workhouse Committee and of the Sub-Committee -appointed to superintend the Hospital, has been induced by practical -experience warmly to advocate the absolute separation of the -Workhouse and the Infirmary. So large a proportion of the -able-bodied inmates of the workhouse are drunken, lazy, and vicious, -that, if the poor-law relief is not to become a temptation and an -injury to the honest and struggling poor, the discipline must be -almost of a penal character. The paramount object must be to make -the workhouse, if not absolutely unpleasant, less agreeable than the -condition of laborious and striving poverty. On the other hand, in a -hospital the paramount and almost the only object is to promote -recovery and to mitigate suffering; all other considerations yield -to this, and consequently the treatment must necessarily be liberal -in spirit and indulgent in fact. The modes of treatment necessary -for the good management of the hospital patient and of the -able-bodied pauper, respectively, are distinct—almost opposite: the -infirmary and the workhouse must be controlled on divergent, and -even contrary principles; and by bringing the two together under one -roof and one administration, they injure each other. The indulgence -of the infirmary creeps into the workhouse, or the sternness of -workhouse rules cripples the benevolent energy which should rule the -infirmary. And the treatment of the able-bodied pauper becomes too -lax, or he is tempted to scheme, and does scheme, to get himself -transferred to the more comfortable quarters close at hand; a desire -so prevalent as to give rise to malingering—the wilful production of -disease: while, partly no doubt in order to counteract this -tendency, there is in such mixed establishments an unconscious -disposition to treat the hospital patient with the same stern -economy that is justly made the rule in dealing with able-bodied -pauperism, but which, in the infirmary, is not only cruel, but in -the long run is not truly economical. Another most serious evil is -entailed upon the hospital by connexion with the workhouse. The -habits and traditions prevalent among the habitual -paupers—able-bodied paupers—in the workhouse (at least in the -workhouse of a large town), are too often deeply infected with -cunning, deception, and dishonesty of all sorts, against which -strict precaution and stern repression are requisite; and it is most -important that no communication should be allowed, whereby these -habits of vice and stratagem might be introduced into the hospital, -where indulgence is the rule, and where many things strictly denied -to the inmates of the workhouse, as stimulants for instance, are -necessarily permitted. The introduction of workhouse tricks into a -hospital, where they cannot be met by workhouse control, must bring -in an element of confusion, disorder, and waste, and therefore the -intercommunication which might introduce those tricks should be as -effectually prevented as possible, which it cannot be while the two -institutions are, as at present, combined. The two systems—to use an -English word in its French sense—demoralize each other; and even in -the English sense, their union demoralizes the individuals subject -to each. - -When this is better understood and more clearly apprehended, as it -soon will be, through the experience of several Unions in which the -separation has been already resolved on—it is probable that it will -be enforced by law. This may be expected to take place in no very -long time; and then it will be found that any expenditure incurred -in providing increased accommodation on a plan which does not -recognise the necessity of separation has been, in part at least, -thrown away; and the work will have to be done, and the money to be -spent, over again. - - - - - Footnotes - - -[1]Liverpool is a seaport, and a receptacle where the poverty and - vice of Great Britain and Ireland seem to accumulate; and it is - probably on this account that the able-bodied female paupers are - peculiarly vicious and worthless. - -[2]Among the replies of the London medical officers, one which - seemed especially to impress the Sub-Committee was given by the - senior honorary medical officer of St. Thomas’s. Mr. Hagger - asked him, “If you had to cure the sick by contract at so much a - head, and had to choose between unpaid pauper nurses allotted to - you gratis, or paying yourself for skilled nurses, which would - you choose?” “To pay for skilled nurses, certainly,” was the - unhesitating answer. - -[3]In the opinion of the medical men of the Liverpool Workhouse - Hospital, 647 of its present number of patients would be - admissible to an ordinary hospital, and - - Men—Medical 40 - ” Surgical 80 - Women—Medical 40 - ” Surgical 60 - 220 would not be admissible. - -[4]In a training school for superior nurses, it will _never_ be - desirable to employ pauper under-nurses, as they interfere with - the efficiency of the probationers, who are being trained as - superior nurses. The latter are apt to delegate to the paupers - much of the hard but most instructive part of their work. In - ordinary workhouse hospitals, when there are no probationers, a - certain number of pauper assistants may perhaps be useful in - aiding thoroughly trained nurses. - - - LONDON: R. CLAY, SON, AND TAYLOR, PRINTERS. - - - - - Transcriber’s Notes - - ---Retained publication information from the printed exemplar (this - eBook is in the public domain in the country of publication.) - ---Only in the text versions, delimited italicized text with - _underscores_. - ---Silently corrected several typos. - - - - - - - -End of Project Gutenberg's Workhouse Nursing, by Florence Nightingale - -*** END OF THIS PROJECT GUTENBERG EBOOK WORKHOUSE NURSING *** - -***** This file should be named 50432-0.txt or 50432-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/0/4/3/50432/ - -Produced by MWS, Stephen Hutcheson, and the Online -Distributed Proofreading Team at http://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive/American Libraries.) - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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