Nurses for the Sick

by Louisa Twining

NURSES FOR THE SICK.

WITH A

LETTER TO YOUNG WOMEN

BY LOUISA TWINING.

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I was sick, and ye visited Me."

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LONDON:
LONGMAN, GREEN, LONGMAN, AND ROBERTS.

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1861.

Price One Penny.

NURSES FOR THE SICK;

WITH A LETTER TO YOUNG WOMEN.

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My Dear Friends,

This little paper was written for a monthly periodical, at the request of the editors, who were anxious to bring the subject before their readers. Thence it was copied into a daily paper at Manchester, and one result of this was, that I received a letter from a young dressmaker there who had read it, and felt a strong desire to adopt some of its suggestions, and become a nurse. She appeared to be a person of much religious feeling, and she confessed how uncongenial she found her present occupation, and how unsatisfying it was to her heart and mind. Now this little circumstance has led to my reprinting this paper in a form more accessible to the young persons whom I wish to reach. I thought that if the heart of one reader had been touched and moved by a desire to serve God in this calling of a nurse, we might expect to find many others who would, from a pure and holy motive, wish to do so, if they were told the way. And in endeavouring to circulate this paper amongst the young women in workrooms and those engaged as needlewomen, I wish it to be distinctly understood that I do not desire to make any one discontented with that calling and life to which she may have been called, and by which she is obtaining an honest livelihood. We are told by good old George Herbert that —

"All may of Thee partake,
 Nothing can be so mean
 Which, with his tincture for Thy sake,
 Will not grow bright and clean.

"A servant with this clause.
 Makes drudgery divine,
 Who sweeps a room, as for Thy laws.
 Makes that, and the action, fine."

There will always be needlework to be done and dresses to be made, and I do not want you to think that you cannot serve God in this employment. It is from no such motive that I wish to direct the thoughts of young women to the avocation of a nurse. But we know it to be a fact, neither to be denied nor deplored, that the occupation of needlework is now far less remunerative and abundant than it has ever been before, owing to the introduction of the sewing machine. The consequence of this invention, every day becoming more and more widely adopted, must be to throw numbers of women out of employment, or to reduce them to very low and miserable earnings. The calling of governesses for the better educated classes of women, and of needlewomen for the lower, have been the two chief vocations open to those who must earn their own living, and for years past we have heard with pain, and, I must confess it, with somewhat of weariness and impatience, of the sufferings of half-starved needlewomen, hundreds of whom have, it is said, been driven to vice and crime by the insufficiency of their earnings. Emigration has been tried as a partial means of relief, but still the evil and the complaint go on, and must go on and strengthen, because the number of workers will continue to diminish by the inevitable advance of the sewing machine. Now various other occupations are being suggested as suitable for women, and these will all help us in our difficulty, in time; but some are so novel that the public mind will not soon or quickly recognise them; and meanwhile more and more poor needlewomen will be starving.

On all sides there is a cry for "employment for women." The old and very comfortable and convenient doctrine that they are, and must be, and ought to be, supported by some male relative, is, or I should hope will be soon, exploded, because it is a wrong, cruel, and utterly false statement. Those who make it must be aware that there are thousands amongst the half million of women said to be in excess of the male population of England, who cannot, and never will, be supported by relations of any kind, and who have no earthly support to look to but that of their own clever brains, or stout and willing hands. I say it is a cruel statement for any one to make; cruel when said by men, who must wilfully shut their eyes and ears to the common facts of daily life around them, though they may be able of their abundant means of remunerative work or business to provide for those who make their homes blest and happy; still more cruel when asserted by women, who thus sheltered and caressed, with every luxury brought to their homes without thought or care on their part, express so selfish and thoughtless a theory about their less favoured sisters.

Now there is one calling and profession that is far from being over-stocked. It is a noble, honourable, and remunerative one,—one essentially belonging to women, and yet I believe it is little known or thought of by the class of persons who might fill it so advantageously. Nurses, good nurses, are wanted everywhere, in private families, in hospitals and institutions without number; everywhere physicians are saying, "Send us good nurses, instead of the drunken women who take the wine and nourishment we order for our patients;" but they are not to be had. In one institution, sixty applications for nurses were refused in a fortnight, and every week demands have to be rejected at the training institution of St. John's House. Surely these facts cannot be known, or such a want in our social life would not be unsupplied. Young women who are toiling in needlework (whether plain work or dressmaking), sacrificing health and strength and eyesight to the labours of the short London season, and then are in miserable inactivity and poverty during many months of the year, will not shrink from the work of a nurse because of its hardships and fatigues and trials; and there is really much to recommend it to them as an occupation. A safe home and shelter are some of the advantages which are not to be despised, when we think of the fearful dangers and temptations which beset young women who go out to their daily work in great cities; and these, at least, are offered to nurses.

One benefit that would arise to the class of needlewomen by a large number being drafted off into other occupations would be, most probably, an increase of remuneration, owing to the decrease of competition. At present, when every one is struggling for employment in an overstocked market, the lowest rate of payment is readily accepted; and when work is only done to eke out a maintenance chiefly provided by other members of the family, this is comparatively unimportant; but when it is the sole provision and means of subsistence, it becomes a fearful evil, and drives persons to yield to the saddest temptations in order to avoid starvation.

In conclusion, let me mention where it is that nurses for the sick are chiefly wanted, and also where they can be taught their profession.

(1) In all the great and numerous hospitals of London.

(2) In all the county and other hospitals and infirmaries in the country. (3) In many infirmaries of Workhouses, both in London and in the country.

(4) In various smaller institutions, or homes for the sick, now beginning to be opened in various places.

It seems at the present time as if there was a mighty impulse abroad, inspiring love to God and to man, and an earnest desire to show this love by caring for the bodies as well as the souls of poor suffering creatures. "Homes" for such as are either incurably afflicted, or those who are recovering from sickness, are, thank God! being planned and carried out by many noble-hearted persons, and they will, without doubt, grow and multiply as their success is proved, and their usefulness appreciated.

(1) Besides the training provided at the usual hospitals, there are special provisions made for it by the Nightingale Fund, by which young women are received and educated for a year at St. Thomas's Hospital, and then sent out with certificates of proficiency.

(2) The Training Institution of St. John's House, 7 and 8, Norfolk-street. Strand, from whence nurses are provided for private families and for King's College Hospital. For this institution persons must be members of the Church of England, and not under twenty-five years of age.

(3) The Institution of Nursing Sisters, 4, Devonshire-square, City, for nurses for private families; and here Dissenters are admitted.

(4) Pupil-nurses are received at the Hospital for Sick Children, 49, Great Ormond-street, where, after a short training, certificates and recommendations are given which will ensure good places as nurses for children in private families.

Thus we see that there is no want of opportunities for those who are inclined to turn to this calling. It may be that there is not so much a want of inclination, as of thought and information on the subject, for it has been but little noticed or discussed in the publications which come within your reach.

I have hoped and desired by these few words to supply this want, and to tell you at least of a profession which has hitherto been far too little thought of.

Amidst much that is disheartening, and with, I sometimes fear, an increasing spirit of worldliness and folly in the young, showing itself chiefly in the love of dress and amusement, I would fain hope that there is also a growing sense of religion and a deeper earnestness awakening in the consciences and hearts of many. A conviction of the shortness and emptiness of this life and all its brightest visions may, perhaps, have already penetrated the minds of some of you, calling you to serve God while it is yet day. Oh! do not stifle that feeling of responsibility, but listen to it and obey it, and thank God if He has led you to seek an honest and most useful calling, in which you can honour your Lord and Saviour, and most effectually benefit your fellow-creatures.

I know that there are young women to spare by hundreds in the occupation of needlework, and I am sure that I am doing no injury to that calling by inviting some of you to leave it for another, which greatly needs labourers. If you determine to try it, may you find it a safe and happy occupation, bringing to you peace and satisfaction in this life, and bearing with it the promise of the life to come.

L. T.

July, 1861.

NURSES FOR THE SICK.

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The Report of the Registrar-General tells us the number of persons who die annually in England. From three diseases (generally considered to be incurable) there are eighty thousand deaths. But we do not learn from this complete and accurate source of information how many sick persons there are at any one given time throughout the households and institutions of England. We are not told, but we know that those must be numbered by thousands who are suffering in various degrees from every kind of illness to which our human nature is liable. And for every individual of these thousands there must be some kind of nursing provided, whether they are sick persons in institutions or in their own homes. Statistics inform us that the number of nurses so provided is no less than twenty-five thousand four hundred and sixty-six. We have no means of ascertaining how far this number is adequate to the demand. Have we any means of knowing how far those who do undertake the office are qualified to perform it? We think the latter question is more easily answered than the former. Popular opinion and private experience give us some insight into the true state of the case, and a very discouraging and unsatisfactory insight we fear it is. Yet there seems to be every motive that nature and humanity can suggest to encourage us all to a right performance of this duty. Not only is there the selfish motive that each one of us may at some time of our lives stand in need of help in seasons of sickness, but there is another, and that the very highest motive also. The care of the sick has been left us as a most sacred legacy by our Divine Master, in words which tell us that they are in some mysterious manner His representatives, and that in visiting and succouring them we are ministering to Himself. The question, then, for us is, how have we fulfilled this duty, which devolves upon us all as members of one Christian, social body? We will inquire.

Up to within a comparatively recent period no especial teaching was thought necessary for the office of nursing the sick; the term "hospital nurse" conveyed an idea of one of the lowest workers in the social community. It raised up in our minds the image of a woman who had fallen below other occupations, and was reduced to this office by necessity. How often drunken habits formed a part of her character we need not inquire; drinking, to some degree, was thought to be a necessary accompaniment of her work. As to a religious mind being at all essential to its performance, we suppose that such an idea was hardly ever entertained. The race of old women who undertook to nurse private patients were, generally speaking, ignorant and vulgar, acting upon experience or prejudice rather than from actual knowledge.

We hardly know what led to the first stir of public opinion or action that was made upon this subject in England; but we believe the first effort that was made to improve the character of nurses for the sick was when Mrs. Fry added to her other noble efforts the establishment of a small institution for training nurses for private families. This still exists, and carries on its useful labours in London.^[1]

We are not aware of any other effort that succeeded this till the year 1848, when, under the sanction of the late Bishop of London, the "St. John's House Institution for Training Nurses" was opened. It included from the first the additional object of supplying good nurses for hospitals, but this part of the plan was only carried out much later. So difficult was it to move and interest public opinion on these matters, that the institution did not meet with very zealous support; and it was not till the year 1856 that the last and most important object was accomplished, and the admission of the nurses of St. John's House to the wards of King's College Hospital was sanctioned. Facts prove more than arguments and theories in favour of a cause, and so it has been in this case; for after years of steady and progressive work, the soundness and excellence of the principles and the practice have been established, and at the present time the services of these ladies and nurses are demanded in several other hospitals, both in London and the country.

So far, then, the fact is established, that training is necessary for the office of a nurse for the sick, and few will now venture to dispute it.

There is scarcely a family where at some time or other the need of a nurse in sickness is not felt; and who can overrate the importance, not only to the patient, but to the whole household, of having one who is fitted for, and faithful to, her duties, or the misery of admitting one into the bosom of a family who, without conscientiousness or ability, has undertaken to fulfil them? At a season of distress, and amidst the solemn scenes of sickness and death, how greatly is the trial aggravated by the presence of one who is not only ignorant of her duties, but is without any moral or spiritual power to sustain and guide her in them.

Then, again, in the homes of the poor, either in towns or villages, who does not know the urgent need that exists of some Christian women to guide and help them at times when the father or mother of the family are laid by through serious sickness, with all the cares of the little household devolving, as they generally do, upon one person? How often precious lives and strength might be saved by the timely aid brought by an active and kindly helper at such seasons of trial we need not pause to prove, because we are quite sure it must be known to every one of our readers, whether rich or poor. And this is a part of the duty undertaken by the sisters of the first institution we have noticed, and more recently by the nurses of St. John's House; and thankfully is their help welcomed in the crowded dwellings amidst which they labour, and where the latter chiefly visit the sick poor who are attended by the medical men of the neighbouring hospital as out patients.

We have spoken of the need of good nurses in hospitals and private families, and of the efforts that are being made to meet it. But there is another class of institutions where vast numbers of our fellow-creatures die annually in utter helplessness and dependence, or else linger out years of misery on beds of suffering, at the mercy of the nurses who tend them; we allude to our workhouses. In one year alone, upwards of 50,000 sick persons passed through the metropolitan workhouses, of which there are between forty and fifty in London and the immediate neighbourhood. Of the 80,000 whom we said die annually of three mortal diseases (dropsy, cancer, and consumption), it may be supposed that a large proportion end their days in these public institutions supported by the poor-law, because those who are found to be incurable of any disease are turned out of hospitals, which are intended only to receive cases of temporary and curable illness. We know but of one entire hospital^[2] for the reception of cases who must die after years of suffering, and but of one London hospital^[3] that reserves a ward for such sufferers, who, at the bitterest moment of their lives, when hope is gone and years perhaps of suffering are before them, are told that medical help can do no more for them.

If the hospital nurse was till lately untrained and untrustworthy, what must the workhouse nurse be, in the still lower depth of social life from which she is taken? It is a fact that those who have once been employed in hospitals come, as a last resource, to the workhouse, and are there set in office over wards of sick and dying persons. Drunkenness, or failing health, or old age have compelled the nurse's dismissal from the hospital, but she is still considered to be competent for these duties. Ignorant, degraded by vice of some kind, and of intemperate habits, the workhouse nurse may, with few exceptions, be said to be; for none would descend to the lowest depth of the social scale if there was any possibility of their services receiving remuneration out of doors. We have one such individual of this class now before our mind's eye, who, having filled the office of hospital nurse, came with her drunken habits, her coarse and evil language, to the workhouse. When her conduct there was at length discovered to be intolerable, even for such a post, she descended to the "oakum shed," where she spent a few years in congenial companionship; she is now once more in the sick ward, dying in the agonies of a mortal complaint, in the scene where many an afflicted sufferer has endured hardness and neglect from her hands. This will show that it is no imaginary picture of either a hospital or a workhouse nurse that we are giving, but one which is strictly true and taken from the life. We could tell too many stories of cruelties practised and deaths hastened by these women in workhouse wards, where they have nearly unlimited power, the one visit of the matron daily having but little power to check, or even discover, such evils as we are describing'. When we have said that workhouse nurses are, as a rule, either old and infirm or else able-bodied and vicious, and both equally ignorant and untrained, we think we need add no more to prove their worse than inefficiency, and the absolute necessity that there is for a change in our system if we would correct a crying and national disgrace.^[4]

We have seen the great need there is of earnest efforts in this cause, and have noticed some of the endeavours that have been made to meet it at home. But we are yet far behind all other European countries in these efforts, not only Roman Catholic but Protestant. The organizations of the communities of the Romish church for the purpose of supplying nurses for the sick number their members by thousands, while Protestant France and Germany have for twenty or thirty years endeavoured to provide for this great social want by instituting orders of women whom they have called deaconesses, after the custom of the early Christian church, to minister to the necessities of their suffering fellow-creatures. It only remains for us to ask the question why we have not followed their example, or rather, why we should not do so without further delay? We are well aware that the question of paid and unpaid labour is one that is not easy of solution in this country. All the foreign institutions, both Roman Catholic and Protestant, have acted on the principle of unpaid labour, providing only the present means of subsistence and a prospect of future maintenance in old age as inducements for the devotion of life and service to this cause. Is it because England is pre-eminently the country of the worship of Mammon that the principle is more difficult of adoption here, and that wages in actual money are thought to be absolutely essential to the performance of the work? However this may be, we will not dwell upon, or attempt to decide, the point. We will grant that there may be labourers of both kinds admitted to this work; some who have no earthly ties for whom to make provision may cheerfully and gladly devote themselves to it from the highest motives of love and self-sacrifice alone, while others there may be to whom present remuneration appears necessary. But for both classes of workers we must make this stipulation: there must be, over and above, or perhaps rather beneath, every other motive, the one conviction that it is work for God that they are called upon to do. Whether or not it can be best done by those who look for no reward here, we are quite sure that a very high tone of feeling and source of action is necessary for those who enter upon this difficult, but noble profession. Yet it is one which offers to those who undertake it in the right spirit the very highest gratifications, and the peace of mind which is granted to those who truly labour for their Divine Master.

At a time when the subject of the employment of women is pressing upon us on all sides, we ask with astonishment why comparatively few are found to undertake this most urgent and pressing duty of caring for the sick? We fear that one answer may be found in the love of liberty and the love of dress which are now so fatally prevalent amongst the young women of the lower and middle classes of society, both of which are felt to be utterly inconsistent with the office. We are far from supposing that every woman is fitted to undertake it. Even a kindly heart and disposition alone are not sufficient, indispensable as they may be to the character of a nurse. The Notes on Nursing, lately published by one who has had a larger and more extensive experience of the subject on which she writes than any other woman, tells us what these trials and difficulties of the life are, as well as the various qualifications which are essential to the nurse's character.^[5] Many of us who have been accustomed to look upon the nurse's occupation as one that may be undertaken when all other means of subsistence fail, without previous knowledge or training, must have been astonished to find what are the requisites for making a nurse in the best sense of the word. The lowest order of minds and the meanest capacities are not fitted for the office, and to such it should not be consigned. There must be the higher love and the more exalted principle which true religion alone can give, if we would elevate the office above that of the merest hireling. The love of humanity alone will not suffice: it must be the love of the Saviour prompting to works of love for His sake which will alone render the work acceptable to Him who can read the heart.

Let us each bestir ourselves in our separate spheres to do what we may be able in this great cause. Let us endeavour, by showing our respect and sympathy for the office, to induce others to enter upon so high and holy a calling, even if none of us are able to undertake it ourselves. Let us encourage and sympathize with those who have already entered upon it; let us, at least, impress upon all the greatness of the need that we should redeem our national reputation in respect of the character of our nurses. Let us hope that the race of Mrs. Gamps, now dying out, will rapidly become extinct, to be remembered only with shame and confusion of face that we ever suffered them to exist. Even now it is almost impossible to realize that such thing's once were.

When we see the modest women, attired as Christian women should be, who now, thank God, are to be found in the wards of some of our hospitals, and hear of the pains that are bestowed upon their training, it is difficult to imagine how the work was ever accomplished under a former and very different system. In one such institution we find the instruction of the nurses in turn undertaken every evening by the lady who has the superintendence of the whole establishment; not only is religious instruction carefully imparted to them by her and the chaplain, but simple lessons are also given on the structure and functions of the body, which not only are found to give increased interest to their work, but also greatly strengthen their efficiency in the treatment of their patients.

We are thankful to find that the desire to help in this cause is springing up in many hearts. The want has been shown, and the means to supply it are forthcoming.

Each country must do its work in its own way, and according to its own national inclinations; but it is desirable to have some leading idea in our mind, on which to act in carrying out our designs, and such, we think, may well be found in some of the institutions of the continent for the training of deaconesses. We have not space to enter upon the details of these, interesting as they would be to our readers. We can only most earnestly commend to them the consideration of their principles, and the importance of the subject generally, heartily wishing God-speed to every one who labours in this cause.

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I began with a few words to young women, who might, I hoped, become nurses for the sick. I would end with a few more words to those whose education has fitted them for other offices of usefulness, which are not less urgently required to be filled. There is work for every class of women, and for every individual to whom God has given health and strength, and mental capacity for serving Him. Yet some lives are being sadly wasted. Many are calling out for work, and know not where to find it. Many more are equally wanting it, yet know not the cause of their weariness, their dissatisfaction, their vague craving after unrealized objects, and vain endeavours after happiness. Of all the sufferers in this busy world, I am. inclined to think that these are the most deserving of our pity, and I earnestly desire to help them, if I can.^[6] For such, there must be definite advice, and a definite plan laid down.

I have shown that there are openings for those who, in the humbler classes, are desiring to do some useful work in a particular vocation.

The number and variety of callings which educated women are needed to fill, I cannot pretend to recount. But I may say, without fear of contradiction, that there is not a hospital, a prison, a workhouse, or an institution of any kind, where the presence of an educated and Christian woman would not be a blessing. In some institutions they are required, not singly, but by tens, twenties, or more. I do not say that they are universally desired as yet. That time is still to come. But supposing they were wanted, are they to be had? If not, let us be preparing for the time when they will assuredly be called for.

One reason why the demand is not yet made, is that we know the right persons would not be forthcoming. And why is this, but because there is, and has been, no possibility of their being trained to useful work of any kind?

I suppose I am not wrong in saying that there is really nothing of an industrial or useful character taught in the present girls' schools for the upper classes. Some supplementary education would surely, therefore, be desirable for such as look forward to the management of their own households, or to practical life in any sphere.

The remedy is equally necessary for the help of institutions and for women.

I would suggest, therefore, that there should be a Training or Deaconess institution,^[7] or Parish House, or House of Charity, in every district or large parish, which would form a centre for all works of benevolence in that parish or district. In it there would be residents, or constant workers, as well as another class consisting of associates, or assistants, who should not live in the house, but attend for a few hours daily, as their parents or other relations could spare them.^[8] There would be an opportunity of learning all the useful arts of life, useful equally for the future wife and mother, as for the parish helper or assistant in an institution. In the house there would be teaching in cookery, needlework, keeping of stores, accounts, and all domestic occupations, besides visiting the poor at their own homes, under the care and direction of experienced persons. But the chief point on which I wish to dwell, is the opportunity that would be afforded of training for permanent employment in our various institutions. The boarders in such a college or home should in turn go out to learn the work in hospitals, prisons, workhouses, and schools, for only on the spot can the work be learnt. It is useless to talk of superseding the present race of matrons and managers unless we have first provided persons who have acquired something of their method and practical knowledge. Ladies, with the best intentions and highest motives, would at present find themselves grievously at a loss if they were placed in institutions in any post of responsibility. We do indeed require all that educated women would bring to the supervision of institutions where the control of human beings forms part of the work, but then this must not supersede another kind of knowledge, but be added to it; or else all will soon be disorder and confusion.

In the establishment of such institutions or homes, I see a prospect of increasing happiness and a boundless sphere of occupation for women; though probably a diminution in the number of readers for the circulating libraries, and a decrease of fancy workers may be anticipated.

But we shall hear less of the want of "employment for women," as well as of their sorrows, real or imaginary, physical or mental.

1. The Institution for Nursing Sisters, 4, Devonshire-square, London. Established 1840. Seventy-one sisters are now on its list, and eight are superannuated. None can be admitted under twenty-eight years of age.—See Report for 1860.
2. The Royal Hospital for Incurables at Putney, near London, containing a hundred and twenty patients, about half of whom pay for their support.
3. The Westminster. The Middlesex Hospital has a cancer ward, in which persons are retained till death.
4. For further particulars on this subject, see Journal of the Workhouse Visiting Society, which is supplied to members paying an annual subscription of five shillings. Address to Miss L. Twining, 13, Bedford-place, London, W.C.
5. See Notes on Nursing for the Labouring Classes. By Florence Nightingale. 6d. London: Harrison, 59, Pall-mall.
6. Since writing this I have heard the story of a young lady who was visited by a friend in her illness. Her age was twenty-five, and her words were these: "I am weary of my life; I do not desire to live." What a revelation does this convey of the manner in which that life had been spent!
7. This suggestion is quite compatible with that of a central institution, like that at Kaiserswerth, from which women are sent out to all parts of Germany and other countries. There is some hope of this plan being shortly begun in London on a small scale, under the sanction of the Bishop, the Rev. Canon Champners, etc. Further information about it can be obtained from the Rev. T. P. Dale, 5, Woburn-square.
8. The obvious and natural beginning of this plan would be for the bible or mission-women and some of their lady-superintendents to be gathered into such a home.