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 WOBKHOUSE NUESING: 
 
 THE STORY OF A SUCCESSFUL EXPERIMENT.
 
 ^ 
 
 WORKHOUSE NURSING 
 
 THE STORY OF A SUCCESSFUL EXPERIMENT. 
 
 MACMILLAN AND CO. 
 
 1867.
 
 The accompanying account of the hnprovements 
 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 Superin- 
 tendent of the ISTurses employed in the Workhouse 
 Hospital are very fully occupied, enquiries or requests 
 for further information should not be addressed to her, 
 l»ut to the Chairman of the Workhouse Committee of 
 the Select Vestry (and of the Hospital Sub- Committee), 
 
 T. H. SATCHELL, Esq. 
 
 4-8, Lord Street, 
 
 LiVEHPOOL ; 
 Or, 
 
 H. .]. HAGGEK, ]Lm. 
 
 P'trfWi Offices, 
 
 LlVEUPOOL.
 
 WOEKHOUSE NUESING 
 
 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 introduc- 
 tion of trained Nurses into the male wards of the 
 Workhouse Infirmary. That experiment having re- 
 sulted 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 in- 
 quiries 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'^NeilJ. 
 
 B
 
 2. The results of the experiment, so far as hitherto 
 ascertained. 
 
 The Liverpool Vestry had previously made con- 
 siderable efforts to improve the workhouse infirmaries. 
 The medical men had been encouraged to make requi- 
 sition 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'" 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 atten- 
 
 * Liverpool is a seaport, and a receptacle where the poverty and vice of 
 Great Britain and Ireland seem to accnmnlate ; and it is probably on this 
 account that the able-bodied female paupers are peculiarly vicious and 
 worthUss. o»i«&v 
 
 <f \
 
 tion 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 work- 
 house the guardians had already, by their liberality, pro- 
 vided 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 adminis- 
 tered 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 direc- 
 tions to improve the nursing of the sick, and the 
 workhouses must soon be the object of similar en- 
 deavours. 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 w^orkhouse 
 infirmary — ^those whose ailments are curable — mere 
 economy requires that the most efficient means should 
 
 B 2
 
 4 
 
 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 McNeill, G.C.B., President 
 of the Board of Supervision (the Scotch Poor Law 
 Board). 
 
 Letter from Miss Nightingale. 
 
 115, Park Street, W. 
 My dear Sir, February 5, 1864. 
 
 I will not delay another day expressing how much 
 I admire, and how deeply I sympathize with the Work- 
 house 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 Eeform 
 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 Eussell 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 employ- 
 ment. 
 
 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 ap-
 
 pointed — ^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 I 
 
 Hopefully yours, 
 
 (Signed) FLOEENCE NIGHTINGALE. 
 
 Extract from a letter from the Eight Honoukable Sir 
 John McNeill, 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 tlie Governor. He 
 can do much to promote or to mar the success of the experi- 
 ment, 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 esta- 
 blishment 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 theii* 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 Work- 
 house. That report ran as follows : — 
 
 Extract from the Journal of the Governor of the 
 Workhouse. 
 
 Liverpool, Thuksday, April 14, 1864, 
 
 In comjDliance 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 tliere 
 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 
 hi the Workhouse Hospital is defective. The Committee are 
 aware what that system is. It may thus be briefly stated. 
 Certam 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
 
 9 
 
 divisions. The pauper nurses clean up tlie 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 medi- 
 cines requiring exactness or care ; all such duties are dis- 
 charged 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, ineffi- 
 cient, 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 strin- 
 gency 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 com- 
 mon-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 imrses, w^ill 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 com- 
 plete 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 hos- 
 pital departments and the healthy inmates, without which the 
 scheme under consideration could hardly succeed. If any
 
 10 
 
 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 tlie 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, inas- 
 much 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 recom- 
 mending 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 ques- 
 tion 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.
 
 11 
 
 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 in- 
 formation 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: — * 
 
 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,OOOZ. per annum. 
 
 Of this about 40,000^. 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.) 
 
 * Among the replies of the Loudon 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 slcilled nurses, 
 which would you choose ? " "To pay for skilled nurses, certainly," was the 
 unhesitatiufc answer.
 
 12 
 
 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 
 
 SmaUpox 20 
 
 The weekly discharges are from twenty to thirty per cent, 
 of the whole number in the hospital.* 
 
 ' 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 
 
 * In the opinion of the medical men of the Liverpool Workhouse Hospital, 
 647 of its present nnniher of patients would be admissible to an ordinary 
 and 
 
 Men— Medical 40 
 
 ,, Surgical 80 
 
 "Women — Medical .... 40 
 ,, Surgical .... 60 
 
 220 would not be admissible.
 
 IB 
 
 paid assistant to about every three pauper nurses, and a 
 trained niglit-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^. 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. Rephj ofR. 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. Re;ply o/ 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 o/ Sydney Jones, Esq., M.B. 
 
 " In my opinion the improved system of nursing recom- 
 mended would amply repay the expense incurred." 
 
 4. Reply of J. S. Bristoave, 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
 
 14 
 
 to incur. I also think it very probable that the cost of 
 nursing would be repaid in many other ways to the rate- 
 payers." 
 
 5. Reply 0/ 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. Co2jy of a Letter from Miss Jones, Lady Superintendent 
 of St, John's House Nursing Schools, and Matron of Kings 
 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. 0. 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
 
 15 
 
 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. 
 
 SuperinteTident 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
 
 16 
 
 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 accommoda- 
 
 tion 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 expendi- 
 ture of from 2,000?. to 2,500Z. 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 SOOl. 
 per annum would be found sufficient for the purpose. Evi- 
 dence 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 Com- 
 mittee 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 in- 
 creased cost of the nursing staff; though your Committee
 
 17 
 
 can offer no decided opinion as to the probable extent of the 
 savinf^ 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 l)e provided in the Workhouse at a 
 moderate outlay. It is estimated that, for the male hospital, 
 a sum of from 400Z. to 500/, 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 grea.t 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 confi- 
 dence, 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 Sulj-Conimittee met with the 
 approval of the Vestry. Some delay in the adoption 
 of its recommendations was caused by a severe out- 
 break of fever in the town, which for the time 
 absorbed all the resources of the A^estry and its 
 officers. But on the 18th of May, 1865, a Lady 
 Superintendent who had received a thorough train- 
 ing at Kaiserswerth and St. Thomas's, twelve Night- 
 ingale nurses from St. Thomas's, eighteen probationers, 
 
 c .
 
 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 AYorkhouse. It was hoped that 
 by taking the best of the able-bodied inmates, sepa- 
 rating them from the other paupers, and paying 
 them small wages (say 5/. 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 imrses 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 Work- 
 house who are either tainted in character, or are 
 exceptionally ill-educated and inefficient. The ex- 
 periment, however, was not wholly useless. It con- 
 clusively 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 employ- 
 ment and maintaining the pauper in idleness, while 
 paying a nurse in her stead. But it was found — as 
 the Governor had always pi-edicted — that when sent
 
 19 
 
 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 ex- 
 perience. 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.* With the exception of the failure of 
 the nurses taken from the pauper class, the first 
 
 * 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. 
 
 c 2
 
 20 
 
 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 evi- 
 dence 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 followiug 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 dis- 
 turbing 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 
 iuvalidate any deductions, unless founded on com-
 
 21 
 
 plete and minutely kept medical records. The fol- 
 lowing 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 pau2)er 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 controlof a " Lady Super- 
 intendent," who was empowered to employ them in the 
 manner to her seeming best for the proper care of the sick.
 
 22 
 
 The Oonimittee will be prej)ared to hear that the change 
 was immediately followed by tlie 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 dis- 
 charging their duties, has produced evident fruits. 
 
 The question lias 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 
 tlieir 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 wdiole 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. CAIiK.
 
 23 
 
 From the Report of Robert Gee, Esq. M.D. Pltysician to the 
 Workhouse Kospital. 
 
 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 com- 
 parison 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 ivhole 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 qualifica- 
 tions for the service were decidedly inferior to those of the 
 trained " Ni^htino-ale " staff. 
 
 o o 
 
 With regard to the latter I can cordially bear testimony 
 to their ability, a.nd 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 
 efiiciently 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 tlie whole department. I believe 
 further, that every patient leaving the wards has been more 
 or less morally elevated during his location there.
 
 24 
 
 From the liepurt of J. H. Baknes, Esq., Hunjeou. 
 
 March 21, 1866. 
 
 Since my coDuexioii 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 opera- 
 tions 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 o]i 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 disiiosition, 'prom'ptitnde of action, tact in manipu- 
 lation, gentleness of demeanoui' and Idiidly consideration 
 necessary to make a nurse are not found, or to he found 
 in tlie inmates of a workhouse, and no amount of education 
 can work out of them w^hat never was in them. Almost 
 always obtuse, and too often unprincipled, as a class they are 
 thoi'ouglily unreliabk% and quite unfitted to take charge of 
 the sick and helpless, or Hie stimulants necessary for them.
 
 25 
 
 On this last point I have been informed by a former resident 
 surgeon that he has known the pauper nurses approjDriate 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 tempta- 
 tion 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 re- 
 solved entirely to discontinue, in the male hospital 
 ward, the employment of pauj^ers 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 clown to the pauper nurses in the female 
 wards. Increased experience brought out in a yet 
 stronger light the superior advantages of the employ- 
 ment of trained nurses. The very aljle, clear, and
 
 26 
 
 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 train- 
 ing 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, jmrsuant to resohition 
 of the Workhouse Committee of tlie 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 Worlvhouse, and 
 fifteen probationary or assistant nurses. 
 
 Of the character of the nursing in this portion of the Work- 
 house, your Committee have heard but one opinion. The 
 Governor and the Medical OfHcers 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 imper- 
 fect, 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
 
 28 
 
 place in the number of officers, the staff was so large that Dr. 
 Gee i^lt able to call upon the officers to act as nurses. The 
 result was what might have been anticipated, that although 
 an improvement upon the okl 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 w^ell-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
 
 29 
 
 tliat the Department of Nursing sliould 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 consider- 
 ably 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, 
 EICI-IARD BEIGHT, 
 THOMAS OWEN. 
 
 March 15, 1867. 
 
 This report was unanimously adopted by the 
 Workhouse Committee and by the Vestry ; and al- 
 ready 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 W^orkhouse 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
 
 30 
 
 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 ex- 
 periment made in this direction, a lady superinten- 
 dent 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 dif- 
 ficult 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
 
 31 
 
 y 
 tone and behaviour of the patients has been wonder- \ 
 
 ful. 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 ac- 
 quainted with them, will often rather die than return 
 thither. When the trained nurses were first intro- 
 duced, the most offensive language was frequently 
 heard in the w^ards ; and the Lady Superintendent 
 has repeatedly been obliged to call upon the Governor 
 two or three times duiing 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 ofiensive language or 
 unseemly behaviour in the presence of the nurses. 
 The following letter from Sir H. Yerney, 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, 186^. 
 
 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 en- 
 tirely 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
 
 32 
 
 striking. Men of that character, accustomed to intercourse 
 with only degraded women, feel the restraining and human- 
 izing 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 com- 
 plaint. 
 
 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, 
 
 HAEKY VEENEY. 
 
 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 tlius briefly recorded. Much more might 
 have been said ; but what is here set down is sufficient
 
 33 
 
 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 regime introduced 
 in the Metropolis by Mr. Gathorne Hardy's Bill. 
 Miss Nightingale has from the first held and ex- 
 pressed a strong opinion in favour of the separation 
 of the hospital and workhouse administrations. The 
 Governor of the Liverpool Workhouse, Mr. Carr, ex- 
 pressed 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 hos- 
 pital the paramount and almost the only object is 
 
 D
 
 to promote recovery and to mitigate suffering ; all 
 other considerations yield to tins, and consequently 
 tlie 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 hy 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 tlie 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 cuniiing, deception, and dishonesty of 
 all sorts, agaiiist \\hi('h slrict 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 intro- 
 duced 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 con- 
 fusion, disorder, and waste, and therefore the inter- 
 communication 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 vfill 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 ac- 
 commodation 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. 
 
 LONDON; R, (.LAV, SON, AND TAVtoi!, rniNii;r;s.
 
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 ^tt^^i^l 
 
 :^^^M 
 
 'i^%i-< 
 
 ^/:^