Chapter I.
The presence of thousands of daughters of Florence Nightingale in the regions devastated by the great world war, and the great service to humanity which they have rendered, have turned the thoughts of many to that other battlefield where the great need of the world for trained nurses was first impressed on the hearts of the people--an impression never to be effaced while there are suffering human beings requiring skilled care and service.
Sixty odd years ago, at the outbreak of the Crimean war there were no women nurses to minister to those who had been wounded in the service of their country. Woman’s ministry was sorely needed but not wanted by those in active command of military affairs at the seat of war. It remained for Florence Nightingale to teach the world one of its greatest lessons--a lesson from which future generations will reap increasing benefits. When the Crimean war closed, the foundation was begun on which the structure of modern nursing was to be reared.
In every age, the world has had its heroes, and Florence Nightingale would have been the last to wish to give the impression that there were not many splendid women devoting themselves to the care of the sick long before she was born. They were not trained women according to modern ideals of training, but there were women of gentle birth and breeding, refined and accomplished who served the sick with singleness of heart and rare devotion. The world will always owe its debt of gratitude to the Roman Catholic Sisters and the Deaconesses of other churches, whose tender ministries to the sick in hospitals and home, did much to lessen the sum of human suffering in the years before Miss Nightingale’s great work was begun.
No one who reads the story of the beautiful life of Florence Nightingale can fail to be impressed with the fact that the dominant motive of that life was--SERVICE. It has been aptly said that one of the first and most important lessons that a nurse needs to learn, is to spell SELF with a little s. In this she has a worthy example for forgetfulness of self seems to have been characteristic of Florence Nightingale all through her life. Service to humanity--especially service to the sick and distressed part of humanity--seems to have made its strong appeal to her almost from childhood. Organization for service, education and training for service, plans for service in a hundred different ways--filled her life, and the story of her many-sided activities, as revealed by her official biographer--has been a surprise to those who have thought of her only in connection with nursing. While she will always be best remembered as the founder of modern nursing, her great efforts in improving sanitary conditions in India, in which she labored unceasingly for many years with officials in the War Department, and her work in behalf of reform in the management of workhouses in England, were closely interwoven with her work in behalf of better nursing for the sick. Her voluminous correspondence and her literary work seem in themselves to have been sufficient to occupy her full time, after her return from the Crimea.
The popular idea of Florence Nightingale has been drawn largely from the pen picture of Longfellow in Santa Filomena, but it is far from being a true picture of her life. To fully appreciate her character and influence one must study to some extent, not alone the social and sanitary conditions that prevailed in her earlier life, but the habits of thought and even the etiquette of the times, during which her chief work was being accomplished. Of these conditions her biographer says:
“Now that the fruits of Florence Nightingale’s pioneer work have been gathered, and that nursing is one of the recognized occupations for gentlewomen, it is not altogether easy to realize the difficulties which stood in her way. The objections were moral and social, in large measure rooted to conventional ideas. Gentlewomen, it was felt, would be exposed, if not to danger and temptations, at least to undesirable and unfitting conditions. ‘It was as if I had wanted to be a kitchen maid,’ Miss Nightingale herself said in later years. Nothing is more tenacious than social prejudice. But the prejudice was in part founded on very intelligible reasons and in part was justified by the level of nursing as an occupation at that time. It will suffice to say that though there were better-managed and worse-managed hospitals, yet there was strong evidence to show that hospital nurses had opportunities which they freely used, for ‘putting the bottle to their lips’ when so disposed, also that other evils were more or less prevalent.
“The more she heard of the worst, the more was Florence Nightingale resolved to make things better; but the more her parents heard, the greater and more natural was their repugnance. Somebody must do the rough pioneer work of the world; but one can understand how the parents of an attractive daughter, to whom their own life at home seemed to them to open many possibilities of comfortable happiness, came to desire that in this case the somebody should be somebody else.”
It is difficult to study her life without feeling that she was sent into the world especially to accomplish the great tasks to which in early middle life, her powers were chiefly devoted. It should, however, be always remembered that during this period others besides Miss Nightingale were making their contribution to better nursing and better sanitary conditions in hospitals, and in the world outside. Lord Lister, who ushered in the new era of antiseptic surgery, was seven years younger than Florence Nightingale. “He and she, each in the manner in which Nature or Providence fitted them, were simultaneously inaugurating the new era, he the foster father, she the foster mother of myriads of this generation and unthinkable millions of those who are to be. His methods demanded the trained nurse both for surgery and midwifery, both for the battlefield where life is destroyed, and for the lying-in room where it is ushered into separate existence. Her work was to provide the training and the principles, the ideals, the enthusiasm, and the tiniest, humblest details, whereby the modern nurse is made.”
[Illustration: LORD LISTER]
Apart entirely from the generally undesirable type of women (there were many exceptions) found in charge of the care of the sick when Florence Nightingale began her work, were the generally undesirable conditions which existed before Lord Lister’s antiseptic methods were inaugurated in 1868. Erysipelas, gangrene, pyemia, and septicemia were common complications of surgery and the death rate of maternity patients in hospitals was appalling. A nurse who was one of the pioneers in improving the care of the sick, thus describes her experience when she entered for training in an English hospital:
“New methods of nursing as well as of surgery had to contend with tremendous difficulties in the way of bad buildings, bad ventilation, old-fashioned furniture, and lack of apparatus.
“The utensils, which in the hospitals of today are of white earthenware or enamel, were of exceedingly battered tin, almost entirely denuded of their original covering of black japan, and it was absolutely impossible to keep some of them clean and sweet. Smells abounded. I have seen a visiting surgeon run through a ward to escape them, and during my first week I was much puzzled by the existence of a horrible smell in one corner of the children’s ward. I privately investigated the floor and under the beds, but could find nothing to account for it, but discovered at last that it came from a patient--a child with a diseased bone of the face, a case which nowadays would be antiseptically treated and probably isolated.
“Under the old regime the nurses had, as a rule, no uniform dress, and cooked their own meals, which they bought for themselves, in the ward kitchens or scullery, and these conditions did not at once pass away.
“The antiseptic treatment of wounds was coming into general use, and the particular method of the moment, which had been advocated by Dr. Lister, was a sort of model steam-engine, which could be carried about and placed on a table or stand by the side of a patient’s bed. When a wound was to be attended to, before the dressings were removed a lamp in this apparatus was lighted. A strong spray of diluted carbolic acid then played over the wound the whole time it was being dressed, much to the discomfort of the doctors and nurses, whose hands would be stiff with the carbolic and their ears dulled with the constant hissing and fizzing of the machine. Everything was saturated with carbolic at that time, wool, bandages, lint, gauze, etc., but in the course of a few years this treatment was entirely superseded.
“Operations were comparatively free and easy performances. We nurses wore our ordinary dresses, and were kept busy washing sponges, which were used again and again, though they were boiled between the operation days. In the medical wards enteric cases were indiscriminately mixed with others, and tuberculosis patients stalked about and expectorated freely.”
Nurses of today, in common with the rest of the world, owe a greater debt of gratitude than most of them realize to Lord Lister who, by his surgical experiments, and his demand for trained nurses, helped so much in laying the foundations for the trained nursing of today. Other workers in the realm of bacteriology were aiding greatly in the remarkable developments which medicine and surgery were making in that period.
THE SPIRIT OF VOCATION.
An English writer, Miss Margaret Fox, in an address to nurses has called attention to the great need of the spirit of vocation in the nurses of today. “Look at it what way you will,” she states, “the fact remains that nursing is work demanding something more than mere business qualities, more than an active intelligence, more than even sympathy and kindness of heart. The latter, precious though it is, may be worn very threadbare in the constant daily contact with all sorts of unlovely natures suffering from every variety of trying ailment. Patients are not all grateful, or appreciative, and you will find some of them by no means ready to kiss your shadow as you pass on your rounds. Sometimes they are inclined to grumble because they do not immediately get all they want. Their disease may make them irritable, captious even, sometimes, repulsive. These people need more than ordinary everyday good qualities in a nurse. They need one who, over and above her professional ability, looks upon her work as a vocation, ‘a calling by the will of God.’ It was that spirit which made the best of the pioneers of other days what they were. Nursing was undertaken by them as a definite life-work. It cost them so much to enter upon it, that they were unlikely to throw it up without some very cogent reason. Work was not then considered so much a means to an end. It was the ultimate achievement. Nursing is a mission; and wherever it is done, it needs the same spirit of true vocation to do it well, and to persevere in spite of difficulties.
“There would be fewer restless, discontented nurses, if each possessed the spirit of vocation. It is a spirit that gives one the calm, quiet feeling of being in the only possible place and doing the only possible work. It stirs in one a large-hearted charity towards all such as be sorrowful, sick or poor. It makes one feel, ‘Well, whoever fails, I must not.’ It helps wonderfully when things are crooked and the work is hard, or uninteresting. One simply can’t help making things look nice, or doing the little extra bit which just makes all the difference.”
The motives which influence an individual to undertake a task are tremendously important factors in real and full success, and it is well, in such work as nursing, that all who enter on it analyze carefully their own motives in so doing.
There can be no mistaking the motives which led Florence Nightingale to enter on her career under the distressing conditions which then prevailed. Born and reared in refined surroundings, in an intellectual atmosphere, with all the educational advantages the times afforded, if she had fulfilled parental and popular expectations, she would have been satisfied to have spent her girlhood life chiefly in a round of gay social functions, with ample leisure for study and travel, and to have married at an early age a man belonging to her own social circle. That she was not satisfied with this sort of existence is seen in this typical extract from one of her letters, written when she was twenty-six years of age: “The thoughts and feelings that I have now,” she wrote, “I can remember since I was six years old. It was not _I_ that made them. A profession, a trade, a necessary occupation, something to fill and employ all my faculties, I have always felt essential to me, I have always longed for, consciously or not. * * * The first thought and the last thought I can remember was nursing work, but for this I have had no education myself. * * *” Later she wrote: “In my thirty-first year I see nothing desirable but death. Why do I wish to leave this world? God knows I do not expect a greater heaven beyond, but that He would now set me down in St. Gile’s, or at a Kaiserwerth, there to find my work, and my salvation in my work.”
To her, life was earnest--it was a serious thing, and her struggle for many long, weary years to free herself, to overcome the obstacles that closed in around her, so that she might accomplish the kind of work she felt God wanted her to do--her long-continued effort to gain her relatives’ consent for her to even attempt nursing--forms one of the most interesting chapters in her life story. Nursing to her was always “God’s business.”
How much this sense of vocation, this strong feeling that she was called to do the will of God in this form of service, had to do with her success, no one can fully determine, but that it helped tremendously in carrying her over difficult places cannot be doubted. As one looks back over her wonderful life and tries to discern the secret of her remarkable influence, one cannot but feel that the spirit in which she did her work, her absolute devotion to the cause to which she was giving her best powers, accounts in large measure for her name being honored, and her memory kept green all over the civilized world. “The sweetest character in all British history,” was a noted man’s comment on her, yet the sweetness was always combined with strength, and courage, and a quiet determination not to give up because things were harder or more difficult than she had expected. Her work was not lightly undertaken, and as lightly abandoned, as nursing is by many young women today.
One of the outstanding qualities of this great woman was her individuality, a quality which some one has aptly said is close kin to honesty. She did her own thinking, and the results of that independent thinking were evident all through her career. In commenting on this quality of individuality, a recent writer, Byron H. Stauffer, has said:
“It burst out in a letter written when she was eight, which she closes with: ‘My love to all except Miss W--.’ It developed in her despising, early in life, the silly conventionalities of the high society of the day. It sparkled in explaining why she tittered during a ritualistic service: ‘The rector was praying “That it may please Thee to have mercy on all men,” and the ridiculousness of that prayer broke upon me. Think of it! If I asked you to have mercy on your own boy, you’d knock me down.’ Another instance of her nonconformity to the religious conventions lies in her declaration: ‘I never prayed for George IV; I always thought that people were very, very good who could pray for him. It was a wonder to me how he could possibly be any worse if nobody prayed for him. I prayed a little for William IV. For the young Victoria I prayed with rapture.’”
THE PRICE OF SKILL.
One of the tendencies of this age in nurses is to expect and apply for positions of responsibility for which they have not taken any special or definite pains to fit themselves. Their estimate of their own ability is often much greater than conditions justify; they often want the best positions without paying the price of special skill. The determination of Florence Nightingale to secure for herself the best instruction the world afforded at that time, and her conviction that if she was ever to accomplish anything worth while she must first learn all that was possible under the circumstances for her to learn about the business of caring for the sick, is a fine example for those who really desire to do worth while things in this world.
It has been well said that ability depends greatly on preparation, and that opportunity is largely dependent on ability. It was by no accident that Florence Nightingale became “the angel of the Crimea.” Nothing that she could do to fit herself for such a task had been omitted, though she could not know how great were the opportunities that were to be afforded her to use the knowledge and experience she was so determined to secure. She fully realized that to do good required more than good desires or intentions. To do good in the way that she wished required some skill. To be the best possible nurse, to fit herself in the best way, however long it might take, or how hard the way might be, meant much greater difficulties then than it could possibly mean now.
When in later years she expressed herself as follows, she was simply expressing the convictions which had been with her all through life:
“Nursing is an art, and if it is to be made an art, it requires as hard preparation as is required for any painter’s or sculptor’s work; for what is having to do with dead canvas or cold marble compared with caring for the living body?”
How to obtain the needed skill was a problem which she had studied for many years. The difficulties and moral dangers that stood in the way of a refined woman securing experience in nursing in a hospital seemed for years insuperable, and can hardly be appreciated by the nurses of today.
AT KAISERWERTH.
Through a friend, Miss Nightingale learned of an institution for deaconesses at Kaiserwerth, Germany, where there was a school, a hospital and a prison, under the management of deaconesses. It had a decidedly higher tone and reputation than prevailed in hospitals in general, she was told; and Pastor Fliedner’s annual reports of the work of the institution were eagerly studied, and used to silence parental objections. The opportunity to spend a few months at Kaiserwerth was delayed, but finally came when her mother and sister, in search of health, went to Carlsbad, and to travel. In commenting afterward on the new departure of giving some months of training in the care of the sick, inaugurated at Kaiserwerth, Miss Nightingale called special attention to the fact that the Kaiserwerth institutions had begun, not with programs or fullfledged schemes set forth in a prospectus, but with individual cases and personal devotion--and later years showed that her own great work began, also, not with a prospectus or prearranged program, but with actual doing of the thing she felt needed to be done when the opportunity came. The real training in nursing given at Kaiserwerth was far from satisfactory to her, but the atmosphere, the spirit of consecrated service, impressed her deeply.
Later she returned to Kaiserwerth for further apprenticeship in nursing and followed this experience by spending some time in the hospitals of Paris presided over by the Roman Catholic sisters. It is very evident that she did not expect to have everything she wished to know, prepared and presented to her to study. Her powers of observation were wonderful, and she proved an indefatigable collector of pamphlets, reports, statistics, methods of work and plans of hospital organization and management.
One criticism which is often heard of present day nurses in training is that they so quickly get into ruts in the matter of observation--that they see so much in a hospital ward which they fail to _perceive_--that they fail to gather practical knowledge pertaining to their work which is all around them waiting to be picked up. If Florence Nightingale had been the type of woman who had to have all the nursing knowledge which she obtained duly imparted to her by somebody else appointed for that purpose, her influence on the conditions which then prevailed would have been small indeed. Instead, she was constantly getting hold of facts, reading medical books, continually studying into the “why” of things, and how they might be improved, so that better general results might be obtained in the care of the sick. Her private notebooks were filled with facts, ideas, and suggestions gathered here, there and elsewhere, which she was later to use in laying broad foundations for the improvement of nursing, and of hospital management in general. Her attention to small details, as found in her notebooks preserved to the present day, was characteristic of all her work, and accounts in no small degree for its success.
TACT AND SENSE OF HUMOR.
Among the indispensable qualities for successful nursing, we place “TACT” very close to the top of the list. To get along with people without friction, to get needful things done without arousing antagonism, to have that keenness of perception, that ready power of appreciating and of doing or saying what is most fitting under the circumstances; to maintain, withal, that quality of mind which enables one to see the humorous side to otherwise difficult situations, are qualities to be coveted by every nurse.
How Florence Nightingale succeeded in managing committees with whom she had to work, as well as the sense of humor which helped to carry her over difficult situations, are admirably shown in extracts from her private letters, written soon after she returned from Kaiserwerth. She had been importuned to undertake the management of an institution known as an “Establishment for Gentlewomen During Illness,” which had been started, but had been so grossly mismanaged that it had been threatened with closure. A change of location had finally been decided on when Miss Nightingale agreed to undertake its management. One of the first difficulties which confronted her is described in the extract from a private letter to a friend which follows:
“My committee refused me to take in Catholic patients--whereupon I wished them good morning, unless I might also take in Jews and their Rabbis to attend them. So now it is settled, _and in print_, that we are to take in all denominations, whatever, and allow them to be visited by their respective priests and Muftis, provided _I_ will receive (in any case whatsoever that is _not_ of the Church of England) the obnoxious animal at the door, take him upstairs myself, remain while he is conferring with his patient, make myself responsible that he does not speak to, or look at, any one else, and bring him downstairs in a noose, and out into the street. And to this I have agreed! And this is in print!
“Amen. From committees, charity and schism--from the Church of England and other deadly sins--from philanthropy and all the deceits of the Devil--Good Lord deliver us!”
To her father in 1853, she wrote another characteristic letter which affords a glimpse of the experience in “managing” people she was getting at this time, and which was later to be most helpful in her great task of helping to reorganize the affairs of the army hospitals. In this letter, she says:
“You ask for my observations upon my line of statesmanship. I have been so very busy that I have scarcely made any resume in my own mind.
“When I entered into service here, I determined that, happen what would, I never would intrigue among the committees. Now I perceive that I do all my business by intrigue. I propose in private to A, B or C, the resolution I think A, B or C most capable of carrying in committee, and then leave it to them, and I always win. * * * I have observed that the opinions of others concerning you depend not at all, or very little, upon what _you_ are, but upon what _they_ are.
“Last General Committee I executed a series of Resolutions on five subjects and presented them as coming from medical men:
“1. That the successor to our house surgeon (resigned) should be a dispenser, thus saving our bill at the druggists of 150 pounds per annum.
“2. A series of House Rules, of which I send you the rough copy.
“3. A series of resolutions about not keeping patients.
“4. A complete revolution as to diet, which is shamefully abused at present.
“5. An advertisement for the Institution.
“All these I proposed and carried in committee without telling them that they came from me, and not from the medical men; and then, and not till then, I showed them to the medical men, without telling them that they were already passed in committee.
“It was a bold stroke, but success is said to make an insurrection into a revolution. The medical men have had two meetings upon them and approved them all, and thought they were their own. And I came off with flying colors, no one suspecting my intrigue.
“I have also carried my point of having good, harmless Mr. ---- as chaplain, and no young curate to have spiritual flirtations with my young ladies. So much for the earthquakes in this little mole-hill of ours.”
Happy though Miss Nightingale was in this new work, it did not offer her the wide opportunity for training nurses, which she greatly longed to do--somewhat along the lines pursued at Kaiserwerth.
[Illustration]
The Call to Service in the Crimean War