CHAPTER III

THE FOUNDER OF MODERN NURSING

(1860)

Where is the woman who shall be the Clara or the Teresa of Protestant England, labouring for the certain benefit of her sex with their ardour, but without their delusion?--SOUTHEY'S _Colloquies_ (1829).

The nineteenth century produced three famous persons in this country who contributed more than any of their contemporaries to the relief of human suffering in disease: Simpson, the introducer of chloroform; Lister, the inventor of antiseptic surgery; and Florence Nightingale, the founder of modern nursing. The second of the great discoveries completed the beneficent work of the first. The third development--the creation of nursing as a trained profession--has co-operated powerfully with the other two, and would have been beneficent even if the use of anæsthetics and antiseptics had not been discovered. The contribution of Florence Nightingale to the healing art was less original than that of either Simpson or Lister; but perhaps, from its wider range, it has saved as many lives, and relieved as much, if not so acute, suffering as either of the other two.

* * * * *

The profession of nursing is at once very old and very new; and the place of Miss Nightingale in the history of it has not always been rightly understood. Nursing--and even nursing by educated women--is very old. "She herself nursed the unhappy, emaciated victims of hunger and disease. How often have I seen her wash wounds whose fetid odour prevented every one else from even looking at them! She fed the sick with her own hands, and revived the dying with small and frequent portions of nourishment. I know that many wealthy persons cannot overcome the repugnance caused by such works of charity. I do not judge them; but, if I had a hundred tongues and a clarion voice, I could not enumerate the number of patients for whom she provided solace and care." This passage, which is not unlike some of the panegyrics showered upon Florence Nightingale's work during the Crimean War, was written, nearly fifteen centuries earlier, by St. Jerome in describing the work of Fabiola, a lady of patrician rank, who in 390 A.D. built a hospital at Rome, where she devoted herself to the care of the sick. Female nursing is as old as Christianity, and for centuries the religious Orders had sent cultivated women into the hospitals. The very name of "Sister," now applied to a rank in the nursing profession in general, recalls its historical origin in religious enthusiasm. Nor was there anything novel in the mere fact, though there was much that was novel in the method, of Miss Nightingale's service as a war-nurse. It was novel in the case of the British Army, but in that of other countries Sisters had already accompanied armies to the field. And, again, it was not an original conception on Miss Nightingale's part that nurses should be trained for their work. Her master, Theodor Fliedner, had shown the way in Germany; and in our own country Mrs. Fry's Institute of Nursing was established in 1840, and the St. John's House in 1848, Miss Nightingale's, at St. Thomas's, not till 1860.

Nevertheless, though not the founder of nursing, Florence Nightingale was the founder of modern nursing. It is not always realized how modern is the institution of nursing, on any large scale as a distinct and trained calling. I have indicated above the three lines of influence--religion, war, and science--along which the development of sick-nursing has proceeded. Miss Nightingale came at the psychological moment to give it a vast impetus upon each of those lines. Religion was tending to become less abstract, and more closely allied to the service of man. Miss Nightingale was the St. Clara or the St. Teresa of the new order, for whom Southey had called. She was prepared, by her experience, by the character of her mind, by the drift of her philosophical speculations, not to imitate old forms, but to create a new order, an order of nurses who should, indeed, be devoted to their calling, but should be organized on a secular basis. The deeply religious bent of Miss Nightingale's character, the single-mindedness of her purpose, and her constant appeal to high ideals, enabled her to give to (or at any rate to require from) the Seculars of the new order something of the devotion possessed by the religious Regulars. The Crimean War, in which Miss Nightingale was one of the central figures, gave further force to a movement for increasing the number and improving the qualification of nurses. It enlisted sentiment in the cause. The American Civil War (in which, as we shall hear presently, Miss Nightingale's example played a great part) extended the movement to the United States, and the Red Cross organization may also be considered as an outcome of her work in the Crimea. The progress of science was tending in a like direction. Medicine and surgery were on the eve of receiving great developments. Sanitary science was already making advance. At the time when Florence Nightingale was in training at Kaiserswerth, Joseph Lister was a medical student at University College. Cohn, the founder of bacteriology, was only eight years her junior. Parkes, one of the founders of modern hygiene, was almost exactly her contemporary. It was inevitable that nursing also should be developed in a scientific spirit, and no one was better qualified than Miss Nightingale to take the lead in such a movement. Her experience in the East had filled her with a passionate conviction of the importance of sanitary science. She was the centre of a circle of earnest and devoted men who were devoting themselves to it. She was personally acquainted with many of the leading physicians and surgeons of the day. And there was yet a fourth line upon which Miss Nightingale might seem to be predestined for this special work. What is called the "woman's movement" was beginning. "There is an old legend," wrote Miss Nightingale, at the beginning of her pamphlet on Kaiserswerth, "that the nineteenth century is to be the 'century of women.'" At the time when she wrote (1851), the century, she added, had not yet been theirs. But there was a spirit stirring the waters. Other notable women were at work, claiming for their sex a place in the sun of the world's work. Miss Nightingale was not wholly sympathetic to what she called "woman's missionariness." But the circumstances of her own life, as the First Part of this Memoir has shown, made her intensely interested in claiming that a woman should not be debarred from entering a walk of life to which she is fitted simply because she is a woman; and of such walks of life, nursing is obviously one. Controversy is perennial between those who ascribe the course of political or social history mainly to great men, and those who ascribe it rather to streams of tendency. It is less open to controversy to say that the great men who leave the more permanent mark upon history are those whose genius conforms to the spirit of their time, but who are yet a little in advance of their age. Among such "great men" the founder of modern nursing is to be reckoned.

II

In what precise respect, it may be asked, did Florence Nightingale "found" modern nursing? The answer to this question may, I think, be disentangled without much difficulty from a good deal of conflicting statement. I have referred already, in connection with the fettering scruples of Miss Nightingale's parents,[318] to a conflict of evidence upon the morals of hospitals and hospital nurses in the middle of the nineteenth century. Her own opinion at that time (and she did not express it without much inquiry and observation) is given in the pamphlet, above mentioned, where she says that hospitals were "a school, it may almost be said, for immorality and impropriety--inevitable where women of bad character are admitted as nurses, to become worse by their contact with male patients and young surgeons.... We see the nurses drinking, we see the neglect at night owing to their falling asleep."[319] Such statements were indignantly denied by other authorities, equally well qualified to form a correct judgment. Controversy broke out upon the subject a few years later in connection with the Nightingale Memorial Fund. A correspondent of the _Times_, who signed himself "One who has walked a good many Hospitals," gave in 1857[320] the same kind of account that Miss Nightingale had given in 1851. He was answered, and his statements were hotly denied.[321] Obviously there were hospitals and hospitals, and still more there were nurses and nurses, and no _general_ indictment was just on the point of morals. Upon the question of drinking among nurses, both in hospitals and in private service, there is less room for doubt. Dickens was a caricaturist, but he was an effective caricaturist; and no caricature is effective in its day unless it bears considerable resemblance to the truth. In his preface he spoke of Mrs. Gamp as a fair representation, at the time _Martin Chuzzlewit_ was published, of the hired attendant on the poor; and he might have added, says his biographer, that the rich were no better off, for the original of Mrs. Gamp "was in reality a person hired by a most distinguished friend of his own a lady, to take charge of an invalid very dear to her."[322] This one can the more readily understand in the light of a remark by Lady Palmerston quoted above.[323] "'Mrs. Gamp,' said Mrs. Harris, 'if ever there was a sober creetur to be got at eighteen pence a day for working people, and three and six for gentlefolks, you are that inwallable person.'" Great ladies clearly thought that such persons existed only, and could only be expected to exist, in the world of imagination and of Mrs. Harris. In 1854, Miss Mary Stanley, or a friend of hers, sent out a circular, very possibly with the knowledge of Miss Nightingale, to various persons connected with hospitals and infirmaries, of which the object was to suggest that nurses should be instructed, on the Kaiserswerth plan, in the art of administering religious comfort to patients. The replies which were subsequently printed[324] throw much light upon the position of nurses at the time. "If I can but obtain a sober set," wrote a doctor in the North, "it is as much as I can hope for." "I enquired for Dr. X.," said another reply, "about the character of the nurses, and he says they always engage them without any character, as no respectable person would undertake so disagreeable an office. He says the duties they have to perform are most unpleasant, and that it is little wonder that many of them drink, as they require something to keep up the stimulus." The ordinary wages were £14 to £16 a year. It should be remembered, further, that hospital nurses had, as a rule, in the middle of the last century no uniform dress, and cooked their own food (which they bought for themselves), eating their meals in the ward kitchens or scullery: "If the sister happened to be partial to red herrings for breakfast, or onion-stew for dinner, or toasted cheese for supper, the consequent state of the ward may be imagined. The assistant nurses had to do all the scrubbing and cleaning of the wards, and to cook for the other nurses and themselves."[325] A side-light is thrown on the slovenliness of the arrangements by the account of what happened at King's College Hospital when the nursing was taken over in 1856 by trained nurses from St. John's House under Miss Mary Jones. "By the end of the day the new-comers, who had arrived in clean and dainty uniforms, were like a set of sweeps or char-women, in such an appalling state of disorder had they found their wards."[326] There were some excellent nurses under the old régime (apart from those trained at St. John's House), as Sir James Paget testified[327]; though it may be noted that even amongst his model Sisters, one was "not seldom rather tipsy." But "the greater part of them," he says, "were rough, dull, unobservant, untaught." The stoutest defender of the old system, the most stubborn opponent of Miss Nightingale's reforms, gives unconsciously equal support to Sir James Paget's statement that "in the department of nursing there is the greatest and happiest contrast of all." Mr. South was of opinion that all was for the best, before Miss Nightingale began to interfere, in the best of all possible nursing worlds. But his conception of the ideal nurse is this: "As regards the nurses or ward-maids, these are in much the same position as housemaids, and require little teaching beyond that of poultice-making."[328]

[318] Above, p. 60.

[319] _Kaiserswerth_, p. 15.

[320] _Times_, April 15, 1857.

[321] In a pamphlet by Mr. J. F. South, referred to below, p. 445.

[322] Forster's _Life of Dickens_, vol. ii. p. 30.

[323] Above, pp. 272-3.

[324] _Hospitals and Sisterhoods_. London, John Murray, 1854 (2nd ed., 1855). Anonymous, but known to be the work of Miss Mary Stanley.

[325] "Report on the Nursing Arrangements of the London Hospitals" (at the time and twenty years before) in the _British Medical Journal_, Feb. 28, 1874.

[326] _St. John's House: a Record_, p. 10.

[327] See his Address to the Abernethian Society in 1885 given in his _Memoir and Letters_, 1901, p. 351.

[328] _Facts relating to Hospital Nurses.... Also Observations on Training Establishments for Hospitals_, 1857, pp. 11, 16.

From all this, facts emerge which will clearly explain wherein Miss Nightingale's work as the founder of modern nursing consisted. She was not entirely alone, nor was she in point of time the first, in the field; and there were exceptional cases to which the following statements do not apply. But she was able to do on a larger scale, and on a scale and in a form which attracted general imitation, what others had attempted. And speaking generally, we may say that before Miss Nightingale appeared on the scene, nursing was, and was regarded as, a menial occupation which did not attract women of character; that it was ill-paid and little respected; that no high standard of efficiency was expected; and that no training was organized: the women picked up their knowledge in the wards. They were, as the correspondent of the _Times_ said, "meek, pious, saucy, careless, drunken, or unchaste, according to circumstances or temperament, mostly attentive, and rarely unkind"; but, with very few exceptions, they were untrained. "A poor woman is left a widow with two or three children. What is she to do? She would starve on needlework; she is unfit for domestic service; she knows nobody to give her charring, and has no money to buy a mangle. So she gets a recommendation from a clergyman, and is engaged as a Hospital Nurse." The change which has come about since Miss Nightingale's work took effect is strikingly illustrated in the Census. In 1861 there were 27,618 nurses "in hospitals, or nurses not apparently domestic servants," and they were enumerated, in the tables of Occupations of the People, under the head of "Domestic." In 1901 there were 64,214 nurses, and they were enumerated under the head of "Medicine." Miss Nightingale was the founder of modern nursing because she made public opinion perceive, and act upon the perception, that nursing was an art, and must be raised to the status of a trained profession. That was the essence of the matter. Other things, such as the opening of nursing to higher social strata, the better payment of nurses, etc., though important and interesting, were only results.

III

The means by which Miss Nightingale achieved this great work were three. She brought to bear upon it the force, successively, of her Example, her Precept, and her Practice. The first two of these aspects of her work will be considered in the remainder of the present chapter; the third is the subject of the next chapter.

No woman, I suppose, who was not canonized or who had not worn (or been deprived of) a crown, has ever excited among her sex so much passionate and affectionate admiration, and set to so many an example, as Florence Nightingale. I have tried in an earlier chapter, entitled "The Popular Heroine," to describe the effect which her work in the Crimean War produced upon the minds of her contemporaries. To get first-hand impressions, the younger readers of to-day must go to their grandmothers or great-aunts. It is they who can help us best to some imagination of the thrill which the stories of her nursing in the Crimea excited throughout the land, of the intensity of sympathetic admiration which went out towards her, of the impulse towards a fuller and worthier life which proceeded from her example. But old letters are of some assistance too. From a packet of family letters here is one, from an aunt to a niece: "_April_ 15, 1857. I fear from a line in one of the newspapers that Florence Nightingale's life is approaching an end. I have been deeply impressed by her life these last few days, which in respect of mine forms but a fragment in regard of time, and what she has accomplished! A high mission has been given her which has cost her her life to fulfil."[329] In how many other minds, young and old alike, must Florence Nightingale's example have stirred similar thoughts! A lady who had attained high distinction as a Nightingale nurse was asked after Miss Nightingale's death to record her recollections: "My first thoughts of Miss Nightingale date back to that winter of frozen rivers, when children, catching up the rumours of the street, ran about shouting _Sebastopol's taken_; or danced, listening around the old weaver's wife who had come to the door of her cottage to catch the last light, and read aloud to her husband what 'Lord Raiglan' was doing and saying; or later, in the hour before bed-time, sat at their father's feet while he told of the frozen trenches, of the 'dreary corridors of pain,' and of that 'ministering angel,' whose devotion was lightening a nation's distress; or perhaps later still in sleep, dreamed children's dreams of creeping amid sleeping Russians, stealing the golden crown from the Czar's head, and escaping with it to Florence Nightingale! Such experiences left indelibly impressed on the minds of the children of my generation the gentle and heroic figure of Miss Nightingale." Often, no doubt, the impulse was fleeting, and the broken purpose wasted in air. And often, too, the impulse was vague, and resulted in no definite action; yet not on that account, perhaps, to be cast aside as valueless. "I have a belief of my own," says one of George Eliot's characters, "and it comforts me--That by desiring what is perfectly good, even when we don't quite know what it is, and cannot do what we would, we are part of the divine power against evil." But often the force of Florence Nightingale's example was direct and practical. Among those whom it influenced in this way was Luise, the Grand Duchess of Baden, who in 1859 founded a Ladies' Society in Baden for the training of nurses. She had never seen Miss Nightingale, but a letter filled the Grand Duchess with enthusiastic gratitude. "I felt," she wrote (Sept. 1861), "that both joy and strength had come to me from your dear letter. I may try indeed to thank you for it, but I shall never succeed in expressing how deeply and how highly I felt your kindness. If there is any progress in the work I have so much at heart, it is greatly to your encouraging support I owe it." Those who saw Miss Nightingale, and who were sympathetic, felt thrilled in her presence. "She is so far more delightful in herself," wrote Clara Novello, "than in one's imagination." To nurses already engaged in work, Miss Nightingale's personal influence was an inspiration. Miss Mary Jones, of King's College Hospital, addressed her as "My beloved Friend and Mistress." "I value your nosegay too much to part with any one flower even." "I look on a visit to you as my one indulgence and greatest pleasure." But those who never saw Miss Nightingale, nor even heard from her, felt the force of her example. In what was publicly known of her career, there was, as it were, a call and a challenge to women. Here was a woman, of high ability and of social standing, who had forsaken all to be a nurse. She sought to raise nursing to the rank of a High Art. She had already in some measure done it by her example.

[329] _A Century of Family Letters_, vol. ii. p. 174.

IV

In every walk of life, however, there are those who seek the palm without the dust. Miss Nightingale had seen already in the Crimea many women who had followed her example, indeed, in desiring to nurse the sick, but into whose heads it had never entered that nursing required special gifts and careful training. Example had to be supplemented by precept. Miss Nightingale's precepts upon the Art of Nursing were first given to the world in 1859-60. Her _Notes on Nursing_--the best known, and in some ways the best, of her books--was published in December 1859. It was instantly recognized by the leaders in medical and sanitary science as a work of first-rate importance; as one of those rare books to which, within their range, the term epoch-making may rightly be applied. "I am ashamed to find," wrote Sir James Paget, "how much I have learnt from the _Notes_, more, I think, than from any other book of the same size that I have ever read." "I am delighted with them," wrote Sir James Clark. "They will do more to call attention to Household Hygiene than anything that has ever been written." "This," wrote Harriet Martineau, "is a work of genius if ever I saw one; and it will operate accordingly. It is so real and so intense, that it will, I doubt not, create an Order of Nurses before it has finished its work." This was a true prediction. Miss Nightingale was the founder of a New Model, and the _Notes on Nursing_ was its gospel.

The anticipations of her friends that the _Notes_ would be popular were abundantly fulfilled. Here was a book by Florence Nightingale on the very subject to which her fame was attached. The effect produced upon many minds by _Notes upon Nursing_ was the greater because it came, as it were, as a kind of resurrection of the popular heroine. The years which had passed since Miss Nightingale's return from the Crimea were, as we now know, years of ceaseless activity; years during which she had done some of her greatest work. But it must be remembered that all this was entirely unknown to most people at the time. The common belief was that Miss Nightingale had retired into private life upon her return from the Crimea; but now after a long interval she came before the public again. And, though, as in all that she wrote for the public eye, there was a conspicuous absence of self-advertisement, there was enough in the book to connect many of its pages with scenes and episodes of the Crimean War. An enthusiastic review in a paper not generally given to enthusiasm pointed out the connection: "Hundreds of brave men attested with their dying breath how nobly Miss Nightingale's self-imposed task was fulfilled, and this little book would be almost enough to explain her success. Its tone seems to tell of the solemn scenes from which experience in such matters has to be gained. Its language is grave, earnest, and impetuous, like that of a person who has lived among sad realities, and has been face to face with almost every form of human suffering."[330] Nor was it only the general tone of the book that was suggestive of the heroine of the Crimean War. Here and there little touches of personal experience were introduced, in which every one could read the occasion between the lines. When the author talked of her "sadly large experience of death-beds," the reader thought of the Lady with the Lamp at Scutari; and when in her chapter on "Variety" she recalled "the acute suffering produced from the patient (in a hut) not being able to see out of window," the reader's mind went back to the pictures of Miss Nightingale at Balaclava. "I shall never forget," she wrote, "the rapture of fever patients over a bunch of bright-coloured flowers." She was thinking again of the Crimea. The wild flowers there are many and brilliant; and the nurses used to gather them in the early morning walk which each took in turn.[331]

[330] _Saturday Review_, Jan. 21, 1860.

[331] _Hornby_, p. 306.

The book was not cheap at first; the price was 5s. But 15,000 copies were sold in a month, and a cheaper edition at 2s. quickly followed. It was read, sooner or later, by all sorts and conditions of people; in palaces, in cottages, in factories. Queen Victoria "thanked Miss Nightingale _very much_ for the book," and sent in return a print of herself and the Prince Consort. From the Grand Duchess of Baden the book called forth an overflowing tribute. "I will not attempt to describe to you," she wrote (Oct. 9, 1860), "with how much interest and admiration I read these pages, so beautiful in their simplicity, so admirable in their true Christian spirit. Rarely has a book made so deep an impression on me. I cannot refrain from expressing the real admiration I feel for the noble English lady who has devoted so much of her life to suffering mankind, and who has given to all her sisters an example never to be forgotten." With further expressions of personal admiration, the Grand Duchess added a very just characterization of the book: "The gentle feelings of the woman are joined to experience, reflexion, and science." Miss Nightingale was urged to prepare a popular sevenpenny edition, and this appeared early in 1861 with the title _Notes on Nursing for the Labouring Classes_, and with a new chapter called "Minding Baby." "And now, girls," this chapter begins, "I have a word for you. You and I have all had a great deal to do with 'minding baby,' though 'baby' was not our own baby.[332] And we would all of us do a great deal for baby, which we would not do for ourselves." "Did I tell you," wrote Miss Nightingale to Madame Mohl (May 7, 1861), "what prompted my little chapter on _Minding Baby_? A Peckham schoolmaster asked me, saying he could always make the school-girls mind my book by telling them it was 'for baby's sake.' And several opened their parents' windows at night (greatly to the indignation of the parents, I am thinking), and removed dung-hills before the doors in consequence." In its cheap form, the book had a very large circulation. Mr. Chadwick interested himself in getting it recommended for school-reading. Benevolent persons distributed it gratuitously in villages and cities. Edition after edition was rapidly called for. Among Miss Nightingale's papers I find letters from correspondents reporting cases in which office clerks and factory hands, after reading the book, voted the windows open.

[332] "The chapter on Minding the Baby," wrote Mr. Jowett (Aug. 24, 1868), "is excellent. I particularly like the parenthesis ('though he's not our baby') in which a world of morality is contained."

The book was read, not only by all sorts and conditions of people at home, but also in many countries and in many tongues abroad. It had instantly been reprinted in America. It was translated into German, into French (with a preface by Miss Nightingale's old acquaintance, M. Guizot),[333] and into most of the other European languages. If the book be out of print, it ought to be included in one of the cheaper series of the day. It can never be out of date, and no one who has read it has ever found it dull.

[333] Bibliography A, No. 32.

V

Miss Nightingale was essentially a "man of action," not a writer. Yet her writings are very characteristic of her work, and none is more pleasantly so than _Notes on Nursing_. Not the whole of her nature "breaks through language and escapes" into it, but this little book alone would be enough to explain to an understanding reader several characteristics of her mind and work. It is an incomparable treatise on the art of nursing; but, as Sir James Paget indicated, it is more than that: it is an alphabet of Household Hygiene. Miss Nightingale's treatment of the subject reveals at the outset her philosophical grasp. "Shall we begin," she says, "by taking it as a general principle that all disease, at some period or other of its course, is more or less a reparative process, not necessarily accompanied with suffering: an effort of nature to remedy a process of poisoning or decay, which has taken place weeks, months, sometimes years beforehand, unnoticed, the termination of the disease being then, while the antecedent process was going on, determined? If we are asked, Is such or such a disease a reparative process? Can such an illness be unaccompanied by suffering? Will any care prevent such a patient from suffering this or that?--I humbly say, I do not know. But when you have done away with all that pain and suffering, which in patients are the symptoms, not of their disease, but of the absence of one or all of the essentials to the success of Nature's reparative processes, we shall then know what are the symptoms of, and the sufferings inseparable from, the disease." This is, surely, sound philosophy; not overthrown by any later discoveries about germs and microbes. It is the philosophy of eliminating the known as a preliminary to investigating the unknown. It leads Miss Nightingale to insist on the importance, as she calls it, of "nursing the well" before they become the sick; or in other words, to the principles of domestic hygiene--ventilation, warming, drains, light, cleanliness. In all this her book had more originality than the younger readers of to-day will realize without some effort of retrospective imagination. The homes of the poor were in her day those that were not very much caricatured by Dickens and Cruickshank. The schools of the poor, which have taught some of the principles of hygiene directly, and have had a yet wider influence indirectly by setting an example of airy rooms and cleanliness, were still in the future. Working people in those days could, moreover, hardly be reached by writings. It was the popular fame of Florence Nightingale that won for her _Notes on Nursing_ an audience from "the Labouring Classes." Nor is it only among those classes that great changes in current ideas and practice about domestic hygiene have been effected. At the time when Miss Nightingale wrote, stuffiness characterized the most genteel interiors. She was a pioneer in establishing the principles of modern hygiene; and perhaps even to-day there is still room for a wider acceptance of her doctrine that "nursing the well" is even more important than nursing the sick--preventive hygiene, than curative medicine.

A characteristic of Miss Nightingale's mind, and of her methods in action is, as has been noticed already, her combination of general grasp with minute attention to detail, and this is particularly remarkable in her _Notes on Nursing_. In the chapter dealing with nursing, in the more common acceptance of the term, one is struck on almost every page with this rare combination of gifts. Nothing is too minute for her touch, but everything is referred to a general principle. Her philosophy of "Noises," with the detailed injunctions which she bases upon it, is alone enough to entitle her to the eternal gratitude of invalids.

The book is no less remarkable for delicacy of observation and fineness of sympathy. "Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion. Remember, he is face to face with his enemy all the time, internally wrestling with him, having long imaginary conversations with him. You are thinking of something else. Rid him of his adversary quickly is a first rule with the sick." "People who think outside their heads, who tell everything that led them towards this conclusion and away from that, ought never to be with the sick." "A sick person intensely enjoys hearing of any _material_ good, any positive or practical success of the right. Do, instead of advising him with advice he has heard at least fifty times before, tell him of one benevolent act which has really succeeded practically--it is like a day's health to him. You have no idea what the craving of the sick, with undiminished power of thinking but little power of doing, is to hear of good practical action, when they can no longer partake in it." The whole chapter, entitled "Chattering Hopes and Advices," from which this last extract is taken, is full of wit and wisdom. It could only have been written as the expression of an understanding mind and a sympathetic heart; just as the following chapter, "Observation of the Sick," with its directions in the finer technique of nursing, could only have come from one of long and varied experience in the practice of it.

Another of Miss Nightingale's characteristics--her taste for epigrammatic and often pungent expression--is conspicuous in _Notes on Nursing_. "Feverishness is generally supposed to be a symptom of fever; in nine cases out of ten, it is a symptom of bedding." "No _man_, not even a doctor, ever gives any other definition of what a nurse should be than this--'devoted and obedient.' This definition would do just as well for a porter. It might even do for a horse. It would not do for a policeman." "Some 'obedient' nurses know no medium between 'Now no fire,' 'Now fire,' as if they were volunteer riflemen." "It seems a commonly received idea among men, and even among women themselves, that it requires nothing but a disappointment in love, or incapacity in other things, to turn a woman into a good nurse. This reminds one of the parish where a stupid old man was set to be schoolmaster because he was 'past keeping the pigs.'" There is lively humour, too, in many of the personal descriptions. Miss Nightingale quotes Lord Melbourne's saying: "I would rather have men about me when I am ill; I think it requires very strong health to put up with women."[334] "I am quite of his opinion," she adds, and she gives some little word-pictures of the female nurse (old style). "Compelled by her dress, every woman now either shuffles or waddles--only a man can cross the floor of a sick room without shaking it." She was writing in the days of crinolines, and draws a picture of "respectable elderly women stooping forward," when invested therein. Another picture is of the nurse who is supposed, "like port-wine," to improve with age. We are not told the circumstances, but we are assured that it was a "fact" that a nurse, when ordered to administer brandy-and-water to a fainting patient, supplied the last week's _Punch_. Then there is a description of the mincing nurse, with "an affectedly sympathizing voice, like an undertaker's at a funeral." All Miss Nightingale's pictures were drawn from life. "I wonder," wrote one of her friends, "if the originals will recognise themselves."

[334] The saying is recorded in C. R. Leslie's _Autobiographical Recollections_, vol. i. p. 169, as made to Lady Holland. "Oh!" said the lady, tapping him with her fan, "you have lived among such a rantipole set." "I happen to know," wrote Monckton Milnes to Miss Nightingale, "who Lord Melbourne's nurse was."

No one, then, could read the _Notes on Nursing_ without perceiving that the author was a woman of marked ability, of wisdom, and of true goodness. The book does not of itself prove Miss Nightingale's power of administration or resolute will; for a woman, or a man, may be decisive of speech without being masterful in action; but with this exception the reviewer was right who said that the book was "enough to explain the success" which Miss Nightingale had attained. The book points even more clearly to one of the main lines on which she was to work in the future. No one could read it without perceiving that nursing, as explained and taught by Miss Nightingale, must be a very delicate, and a very difficult, art. It required a sound mastery of the laws of household hygiene, some knowledge of medicine or surgery, and, above all, an acute and sympathetic faculty of observation. "Merely looking at the sick is not observing." It was obvious that if Miss Nightingale's ideal of nursing was to be realized, the nurse required both training and inspiration. Nursing was an art, and like any other art, "from a shoemaker's to a sculptor's, needed in its votaries the sense of a 'calling,' and then a diligent apprenticeship." The way in which Miss Nightingale translated her precepts into practice is the subject of the next chapter. In _Notes on Nursing_, as in nearly everything that came from her pen, what she wrote had direct reference to action.

In a characteristic appendix to her _Notes on Nursing_, Miss Nightingale discusses "Some Errors in Novels," pointing out, among other things, the untruth of death-bed scenes in works of fiction. "Shakespeare," she says, "is the only author who has ever touched the subject with truth, and his truth is only on the side of art." "The best definition of a Nurse," she wrote elsewhere,[335] "can be found, as always, in Shakespeare." It is in _Cymbeline_ that the ideal of a Nightingale nurse was prefigured:--

So kind, so duteous, diligent, So tender over his occasions, true, So feat, so nurse-like.

[335] Reprint from Quain's _Dictionary_, p. 12.