There is no branch of sick nursing which appeals more strongly to Miss Nightingale than the care of the sick poor. It was as a visitor in the homes of her poorer neighbours at Lea Hurst and Embley that she began her philanthropic work, and though the outbreak of the Crimean War drew her into the public arena and concentrated her attention on the army, she had not ceased to feel the importance of attending to the needs of the sick poor, and repeatedly drew attention to the fact that England was behind other nations in providing for the sick poor at home, and in infirmaries.

She recognised also that for this work a special training was needed. A nurse who had received a course of instruction in a hospital was not necessarily competent to nurse the poor in their own homes. Special knowledge and special experience were needed before a woman, however skilled in the technical side of nursing, could become a good district nurse.

About the same period that Miss Nightingale was establishing and organising her Training School for Nurses at St. Thomas’s Hospital, she was also working in conjunction with Mr. William Rathbone, M.P., and other philanthropic people to found a special training school for nurses for the poor. It was at her suggestion that this branch of pioneer work was started in connection with the Liverpool Infirmary, which had already made some provision on similar lines. The prospectus for the Liverpool Training Home for Nurses was made public in 1861–2, and a commodious building was subsequently erected in the grounds of the infirmary.

In 1865 Miss Nightingale wrote an introduction to a work describing the “Origin and Organisation of the Liverpool School and Home for Nurses.” “It is the old story, often told!” she writes, “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 organised. 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 poor at home—is no amateur work. To do it as it ought to be done requires knowledge, practice, self-abnegation, 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 otherwise. It has proved itself superior to all religious divisions, and is destined, by God’s blessing, to supply an opening the great value of which, in our densely peopled towns, has been unaccountably overlooked until within these few years.”

With such noble words did Florence Nightingale usher in a movement which has now spread to all parts of the kingdom. There is not now a workhouse infirmary which has not its trained nurses in place of the rough-handed and unskilled inmate, nor any town and few villages which have not some provision for nursing the sick poor in their own homes, and our beloved Queen Victoria found it the worthiest object to which she could devote the people’s offering in commemoration of her Jubilee.

The main objects of the pioneer Training Home at Liverpool were:—

1. To provide thoroughly educated professional nurses for the poor.

2. To provide district nurses for the poor.

3. To provide sick nurses for private families.

Miss Nightingale watched the progress of the home with keen interest and gave her advice from time to time. She was also actively engaged in promoting workhouse reform. A sick pauper was to her a human being, not a “chattel” to be handed over to the tender mercies of the Mr. Bumbles and Mrs. Corneys. It afforded her great satisfaction that two out of the first lot of nurses which left her St. Thomas’s Training School went as matrons to workhouse infirmaries. A reform in workhouse hospitals had been brought about by Mr. Gathorne-Hardy’s Metropolitan Poor Act of 1867. But the introduction of trained nurses on the Nightingale system grew directly out of the experience and information which followed the founding of the Liverpool Training Home.

Hitherto the workhouse nurses were the pauper women, untrustworthy and unskilled. At Brownlow Hill, Liverpool, Infirmary Mr. Rathbone relates that there were twelve hundred beds occupied by people in all stages of every kind of disease, and the only assistants of the two women officers who superintended the nursing were pauper women who were as untrustworthy as they were unskilful. This was a fair example of workhouse infirmaries all over the country.

The Select Vestry of Liverpool, having received an anonymous offer to defray the cost of the experiment for three years, consented to try Miss Nightingale’s plan. With her assistance, Miss Agnes Jones, a lady who had been trained at Kaiserswerth like Miss Nightingale, and also at the Nightingale School at St. Thomas’s, was appointed Lady Superintendent, and she brought with her a staff of twelve nurses from St. Thomas’s. At first Miss Jones tried to get extra help by training the able-bodied pauper women as nurses, but out of fifty-six not one proved able to pass the necessary examination and, worse still, the greater number used their first salary to get drunk. The painful fact was established that not a single respectable and trustworthy nurse could be found amongst the workhouse inmates, and the infirmary nursing had to be taken entirely out of their hands.

After a two years’ trial Miss Jones’s experiment with her trained and educated nurses proved so satisfactory that the guardians determined never to return to the old system, and to charge the rates with the permanent establishment of the new one. To the deep regret of every one, however, Miss Agnes Jones sank under the labours which she had undertaken, and died in February, 1868.

Miss Nightingale contributed a beautiful tribute to the memory of her friend and fellow worker in Good Words for June, 1868, under the title “Una and the Lion,” which subsequently formed the “Introduction” to The Memorials of Agnes Elizabeth Jones, by her sister.

“One woman has died,” writes Miss Nightingale, “a woman, attractive and rich, and young and witty; yet a veiled and silent woman, distinguished by no other genius but the divine genius—working hard to train herself in order to train others to walk in the footsteps of Him who went about doing good.... She died, as she had lived, at her post in one of the largest workhouse infirmaries in this kingdom—the first in which trained nursing has been introduced.... When her whole life and image rise before me, so far from thinking the story of Una and her lion a myth, I say here is Una in real flesh and blood—Una and her paupers far more untamable than lions. In less than three years she had reduced one of the most disorderly hospital populations in the world to something like Christian discipline, and had converted a vestry to the conviction of the economy as well as humanity of nursing pauper sick by trained nurses.”

We must refrain from quoting more of this singularly fine tribute of the Chief to one of her ablest generals in the army of nursing reform, with the exception of the beautiful closing words: “Let us add living flowers to her grave, ‘lilies with full hands,’ not fleeting primroses, not dying flowers. Let us bring the work of our hands and our heads and our hearts to finish her work which God has so blessed. Let us not merely rest in peace, but let hers be the life which stirs up to fight the good fight against vice and sin and misery and wretchedness, as she did—the call to arms which she was ever obeying:—

Oh, daughters of God, are there so few to answer?”

One cannot leave the subject without a reference to the influence which Miss Nightingale’s own early example had had on the gifted woman whose memory she extolled. On the eve of going into training at St. Thomas’s Miss Agnes Jones wrote: “It is well that I shall, at my first outset in hospital work, bear the name of ‘Nightingale Probationer,’ for that honoured name is associated with my first thought of hospital life. In the winter of ’54, when I had those first earnest longings for work, and had for months so little to satisfy them, how I wished I were competent to join the Nightingale band when they started for the Crimea! I listened to the animadversions of many, but I almost worshipped her who braved all, and I felt she must succeed.”

The system inaugurated by Miss Agnes Jones at Liverpool Infirmary spread over the country, and Miss Nightingale had the satisfaction of seeing in a comparatively short time a great improvement in the nursing and treatment of the sick in workhouses. Gaols had long been visited and reformed, lunatic asylums opened to inspection, and it seemed unaccountable that the misery of sick workhouse paupers should have been so long overlooked.B

The success of the introduction of trained nurses into workhouses gave an impulse to sick poor nursing generally, and in 1868 the East London Nursing Society was founded by the Hon. Mrs. Stuart Wortley and Mr. Robert Wigram. In 1874 the movement received a further important impulse from the formation of the National Nursing Association, to provide skilled nurses for the sick poor in their own homes, to establish district organisations in London and in the country, and to establish a training school for district nurses in connection with one of the London hospitals.

This work appealed most strongly to Miss Nightingale, and she expressed her sympathy in the following letter to that devoted pioneer of district nursing, Miss Florence Lees,C now Mrs. Dacre Craven, who was the indefatigable honorary secretary of the newly founded National Nursing Association.

“As to your success,” writes Miss Nightingale, “what is not your success? To raise the homes of your patients so that they never fall back again to dirt and disorder: such is your nurses’ influence. To pull through life and death cases—cases which it would be an honour to pull through with all the appurtenances of hospitals, or of the richest in the land, and this without any sick-room appurtenances at all. To keep whole families out of pauperism by preventing the home from being broken up, and nursing the bread-winner back to health.”

The next point in Miss Nightingale’s letter was one which was at the root of the movement and which she invariably emphasised: “To drag the noble art of nursing out of the sink of relief doles.” It was believed that nothing would so effectually stop the pauperising of the people by indiscriminate charity as the trained nurse in the homes of the sick poor, who would teach her patients how best to help themselves. “To carry out,” continues Miss Nightingale, “the practical principles of preventing disease by stopping its causes and the causes of infections which spread disease. Last but not least, to show a common life able to sustain the workers in this saving but hardest work under a working head, who will personally keep the training and nursing at its highest point. Is not this a great success?

“District nursing, so solitary, so without the cheer and the stimulus of a big corps of fellow-workers in the bustle of a public hospital, but also without many of its cares and strains, requires what it has with you, the constant supervision and inspiration of a genius of nursing and a common home. May it spread with such a standard over the whole of London and the whole of the land.”

Two years later (1876) Miss Nightingale made an eloquent plea in a long letter to The Times for the establishment of a Home for Nurses in connection with the National Society for Providing Trained Nurses for the Poor. This letter was later reprinted as a pamphlet on Trained Nursing for the Sick Poor. In specially pleading for a Central Home for Nurses, she wrote, “If you give nurses a bad home, or no home at all, you will have only nurses who live in a bad home, or no home at all,” and she emphasises the necessity for the district nurse to have a knowledge of how “to nurse the home as well as the patient,” and for that reason she should live in a place of comfort herself free from the discomforts of private lodgings.

Miss Nightingale’s plea bore fruit in the establishment of the Central Home for Nurses, 23, Bloomsbury Square, under the able management of Miss Florence Lees. Nothing pleased Miss Nightingale better than to get reports of the experience of the district nurses amongst the poor, and to hear how the people received their visits and what impression they were able to make on the habits of the people. She was specially delighted with the story of a puny slum boy who vigorously rebelled against a tubbing which Miss Lees was administering.

“Willie don’t like to be bathed,” he roared; “oo may bath de debil, if oo like!” The implication that Miss Lees was capable of washing the devil white Miss Nightingale pronounced the finest compliment ever paid to a district nurse.

She has always impressed upon district nurses the need not only of knowing how to give advice, but how to carry it out. The nurse must be able to show how to clean up a home, and Miss Nightingale used frequently to quote the case of a bishop who cleansed the pigsties of the normal training school, of which he was master, as an example—“one of the most episcopal acts ever done,” was her comment.

At first the district nurses were recruited almost entirely from the class known as “gentlewomen,” as it was thought both by Miss Nightingale and Miss Lees that it required women of special refinement and education to exercise influence over the poor in their own homes. Also, one of the objects of the National Association was to raise the standard of nursing in the eyes of the public. It was soon proved that the lady nurses did not shirk any of the disagreeable and menial offices which fall to the lot of the district nurse. Broadly speaking, it is only the educated women with a vocation for nursing who will undertake such duties; the woman who merely wants to earn an income will choose hospital or private nursing. In the earlier stages of the movement the district nurses received high remuneration, and on this question of fees the Queen of Nurses may be quoted:—

“I have seen somewhere in print that nursing is a profession to be followed by the ‘lower middle-class.’ Shall we say that painting or sculpture is a profession to be followed by the ‘lower middle-class’? Why limit the class at all? Or shall we say that God is only to be served in His sick by the ‘lower middle-class’?

“It appears to be the most futile of all distinctions to classify as between ‘paid’ and unpaid art, so between ‘paid’ and unpaid nursing—to make into a test a circumstance as adventitious as whether the hair is black or brown, viz., whether people have private means or not, whether they are obliged or not to work at their art or their nursing for a livelihood. Probably no person ever did that well which he did only for money. Certainly no person ever did that well which he did not work at as hard as if he did it solely for money. If by amateur in art or in nursing are meant those who take it up for play, it is not art at all, it is not nursing at all. You never yet made an artist by paying him well; but an artist ought to be well paid.”

A most important outcome of the introduction of a system of trained nurses for the sick poor was the establishment of the Queen’s Jubilee Nurses. Queen Victoria, moved by the great benefit which the National Nursing Association had conferred, decided, on the representations of the Committee of the Women’s Jubilee Fund, furthered by Princess Christian, to devote the £70,000 subscribed, to the extension of this work.D The interest of the fund, amounting to £2,000 per annum, was applied to founding an institution for the education and maintenance of nurses for tending the sick poor in their own homes, with branch centres all over the kingdom. The charter for the new foundation was executed on September 20th, 1890.

The central institute was at first connected with St. Katharine’s Royal Hospital, Regent’s Park, an institution which had always been under the patronage of the Queens of England since it was founded by Queen Matilda, the wife of Stephen, at St. Katharine’s Wharf, near the Tower of London. Subsequently the headquarters of the Queen Victoria’s Jubilee Nursing Institute was removed to Victoria Street. Central homes have also been established at Edinburgh, Dublin, and Cardiff, and district homes all over the kingdom are affiliated to the Institute.

The National Association for Providing Trained Nurses for the Sick Poor, in which Miss Nightingale had so deeply interested herself, was affiliated to the Queen Victoria’s Jubilee Institute, but it still has its original headquarters at the Nurses’ Home, 23, Bloomsbury Square, so ably managed by the present Lady Superintendent, Miss Hadden. The Chairman of the Executive Committee is Henry Bonham Carter, Esq., an old friend and fellow worker of Miss Nightingale, while the Hon. Secretary is the Rev. Dacre Craven, Rector of St. Andrew’s, Holborn, whose wife was Miss Florence Lees, the first Superintendent-General of the home and branches, and one of Miss Nightingale’s devoted friends. Her Royal Highness Princess Christian is President of the Association.

There is probably no movement which has spread over the country so rapidly, and which appeals to the goodwill of all classes, as the nursing of the sick poor in their own homes, and its success has been one of the chief satisfactions of Miss Nightingale’s life. She is always eager to hear of fresh recruits being added to the nursing army of the sick poor, and it may prove of interest to quote the regulations issued by the National Association:—