Archive for the ‘People’ Category

When researching the history of nursing, one can’t help but hesitate at over-mentioning the ubiquitous Florence Nightingale.  Throughout the process of making this website, I’ve been trying, and mainly failing, to avoid her.  This is because I think there are other nurses, especially district nurses, who have been neglected or forgotten by history.  And Florence Nightingale had her failings.  It’s well known now that she damaged Mary Seacole’s reputation beyond measure – a woman who did as much if not more than Nightingale for soldiers in the Crimea.  She was critical, difficult to work with, and always right.

Mary Seacole

Nonetheless, Florence Nightingale is simply so famous that you can’t avoid her.  To be fair, a website about the history of district nursing wouldn’t be complete without her because she was one of its earliest and most passionate advocates.  So here’s a quick potted biography of Florence.  You might not have wanted to be her friend, but no-one could really deny that she wasn’t a damn good nurse!

Florence Nightingale was born in 1820 in Florence.  No prizes for guessing why she was named Florence then.  Feel more sorry for her sister, the real victim of Mr and Mrs Nightingale’s very literal naming system.  In 1819, she was born in Naples and was called (drumroll please…) Parthenope.  The latinized name for Naples.  Oh dear.  Poor Parthenope.  Anyway, the two girls were born abroad because their parents were on a European tour.  How Victorian of them.  When they got back, with two baby girls in tow, they settled in Embley Park, Hampshire.  Florence Nightingale’s father, William, had also inherited land in Derbyshire.  In short, they weren’t short of a bob or two.

Florence Nightingale received a good education in classics, philosophy and classical languages.  Though she lived an active social life in childhood and in her teenage years, meeting many of the famous faces of the day through her socialite parents, she was very unhappy.  As a teenager, she became very depressed, feeling unworthy, as though her life has no purpose.  She even wrote that she could see ‘nothing in life but death.’  Aged sixteen, however, she had an epiphany.  Nightingale became convinced that God was calling her to something.  She began to study the Bible carefully and became interested in charity, poverty and the social issues of the day.

When, on a trip abroad, she came across religious nurses in Germany, Nightingale knew she’d found her calling.  Upon her return she refused her last suitor, putting herself at extreme odds with her parents.  Essentially, they booted her out, with a family physician having pretty much decided that she was toxic for the house and her family.  She became a Superintendant for a Nursing Institute for women in Harley Street and immediately immersed herself in studying the ins and outs of hospital administration.

In 1854, the Crimean war broke out and Nightingale took 38 nurses to the Scutari in the Crimea.  Here, she earned her fame, by forcing doctors to her will and fundamentally altering the way they managed hospitals.  She became more of an administrator than a nurse, although the soldiers were deeply reassured whenever she ventured onto the wards in their presence, the ‘Lady with the Lamp.’

‘Lo!  In that hour of misery, a Lady with a lamp I see, passing through the glimmering gloom, and flit from room to room.

Henry Longfellow ‘Santo Filomena’, 1857.

The war ended in 1857.  Florence Nightingale wrote that ‘I stand at the altar of murdered men, and while I live I will fight their cause.’  For her, there had been nothing valuable or honourable in such an appalling loss of life.  By now the most famous nurse in the country, she was at liberty to work for the causes she valued.  She wrote a report for the Queen and Prince Albert about how many deaths could have been prevented.  Whilst writing the report, in 1858, she became severely ill.  For the next twenty years, upon the advice of doctors, she would conduct much of her work from her bed.  This meant bossing around politicians and important people of the day, sending them flying with orders to build hospitals, to train nurses etc.

In 1860, Florence Nightingale’s nursing school was opened at St Thomas’s Hospital.  She was also deeply involved in midwifery and the development of maternity wards in hospitals in London.  But, for our purposes, her most interesting work conducted from her bed was her collaboration with William Rathbone on the development of district nursing.  They had their clashes.  In 1868, she wrote to a friend that ‘one cannot look upon Liverpool as being much of a success.  I believe the difficulties have been brought about by attempting too much and not starting on a sound basis.’  This was rich criticism, since William Rathbone pretty much followed her advice about nurse-training to the letter.  Nightingale was also deeply critical of Rathbone’s scheme of getting well-bred ladies to manage the nurses.  She believed firmly that nurses should manage themselves.

Nonetheless, knowing how terrible welfare provisions for the poor were – she wrote to Rathbone in 1867 describing the Poor Law as ‘rotten to the core’ – Nightingale believed the most good nursing could do would be in the home.  She even once said ‘never think you have done anything effective in nursing until you have nursed not only the sick poor in workhouses, but those at home.’  She was instrumental in bringing District Nursing to London and had the foresight to hand over the reins of the profession to Florence Lees. Florence Nightingale, whom Queen Victoria had prayed for when she became ill in the Crimea, was doubtless the prime-mover behind the decision to give Queen Victoria’s Diamond Jubilee money to the cause of District Nursing.

Florence Nightingale died in 1910 at the age of ninety.  This year marks her centenary, click here for details.  There can be no doubt that she trod on some people on the way up, but she did a lot for district nursing.  Let’s celebrate Florence: enigmatic, difficult to please, bossy, but wholly devoted to the cause of nursing.


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Rosalind Paget

Spot a family resemblance? William Rathbone's Grandaughter, Dame Rosalind Paget.

In 1889, the Queen Victoria Jubilee Institute of Nurses was established.  Its aim was to provide training, support and maintenance for district nurses treating the sick poor.  With the most prominent of district nurses, Florence Lees, now married and raising children, there was a gap in the market for the Institute’s first ‘Inspector.’  The position went to Rosalind Paget, William Rathbone’s Grandaughter. 

The Rathbones might be accused of a bit of nepotism, but that would be unfair.  In fact, Rosalind’s upbringing made her infinitely well-suited to the position as effectively the country’s chief district nurse.  She’d been born in her Grandfather’s house at Greenbank, Liverpool and like most of his family, inherited his zeal for social reform.  Her father was a Police Magistrate and so, thoroughly middle-class.  Having been brought up in a family which respected women as professional people, Rosalind decided she wanted to work and do some good at the same time.  Nursing was the obvious profession.

At the age of twenty, in 1875, Rosalind Paget studied nursing under the Nightingale training scheme at Westminster Hospital, London.  She discovered Midwifery was her passion and gained a diploma from the London Obstetrical society in 1885, from Endell Street Lying-in Hospital.   She has gone down in history as an advocate for midwifery reform, and rightly so.  Midwives had an even more difficult time than regular nurses.  Their work was not mentioned in polite society, and they often competed with doctors for patients.

Rosalind Paget changed all this.  She helped to establish the London Midwives ‘club’ and was determined to give midwives a sense of professionalism and respectability in society.  As the club’s treasurer, she organised for midwives to receive proper lectures from eminent doctors and founded a library for their consultation.  In order for midwives to be taken more seriously as professionals, they needed a higher standard of education.  Paget campaigned for many years for midwives to be listed on a national register, to avoid substandard care.  In 1902, she suceeded in getting her wishes onto the statute book in the 1902 Midwives Act.

It is largely thanks to her Paget that midwifery is taken seriously as a profession today.  Her determination to see that conditions for midwives bears many similarities to the way in which Florence Lees campaigned tirelessly for district nursing to be respected in society and carried out by educated, competant women.  We owe these pioneers a lot!

Before you think I’ve gone totally off on a tangent, yes, Rosalind Paget did become the first Inspector of district nurses in 1890.   Before she did so, she spent a month training at the Queen’s Nurses’ headquarters in Bloomsbury Square.  Queen’s Nurses were subject to constant inspection.  Paget travelled round England at the beginning of the 1890s, assessing their work and insuring that everyone was treating their patients up to her high standards.  It was the family business after all!  She was noted for being a good teacher, who had patience with probationers.  Though she resigned quickly, in 1891, she continued to be involved with the Queen’s Institute for the rest of her life, sitting on its council, with a particular responsibility for midwifery. 

Paget remained busily involved with nursing for the rest of her life.  Having founded the Journal, Nursing Notes, in 1887, she co-edited it for the next forty years.  Policy-makers and statesmen consulted her regularly about matters of public health and hygiene, she even sat on government committees.  A devoted feminist, she worked all her life for the cause of women’s rights.  In 1938, in recognition of her immense national service, she was made a Dame.  Totally immersed in her work, she never married and died at the ripe old age of 93 in 1948.

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Politician, philanthropist, tireless campaigner for nurses.

‘A master hand in securing unity yet independence of action, that personal responsibility and yet liberty so essential to the continuance and development of a great charity.’

                                                                                                                                                                                             Florence Nightingale.

It’s time we talk about William Rathbone.  The man who started it all.  The guy who invented district nursing.  Who was he?  Why did he do it? 

William Rathbone was born on the 11th of February 1819, in Liverpool.  Whether or not he had a Scouse accent, I can’t really tell you, but I doubt he did, sadly.  Like most rich men in Liverpool, he was a merchant who made his money from imports and exports out of the city’s port. He owned shipyards.  Rathbone was also a religious man – a Quaker who subsequently became a Unitarian under the influence of a passionate Pastor named John Hamilton Thorne.  What did this mean for his beliefs?  Well, William Rathbone didn’t simply want to be rich.  He believed his wealth was a ‘trust’, something which he needed to use to help those less fortunate than himself.  In short, he believed in social action. 

He worked tirelessly for charity causes and workhouse reform in Liverpool and donated lots of money to them too.  But the crowning achievement of his life was to be brought about by one of its tragedies.  In 1847 he had married Lucretia Wainwright Gair, the daughter of one of his fellow merchants.  They had four sons and one daughter.  In 1858 his wife became ill.    When he realised her illness was to be terminal, Rathbone was determined to keep her with him at their home.  He engaged a nurse named Mary Robinson to care for her.  After Lucretia’s death, which he described himself as ‘the most crushing blow I have ever experienced’, he thought about how much Nurse Robinson had helped him and his family.  Infinitely practical, he realised that such care could be life-changing for the sick poor to whom he had already dedicated so many of his charitable efforts.

Perhaps Rathbone’s greatest skill was his ability to take advice.  He didn’t mind being told what to do by a woman and took all his cues about nursing from the expert, Florence Nightingale.  District nursing became a success because he agree with her – the nurses needed to be professionally trained.  After consultation with Florence Nightingale, he set up his own nursing school at Liverpool Royal Infirmary.  After it opened in 1862, he bore the entirety of its expenses, keeping 18 nurses, each with their own ‘district.’  When it became clear the scheme was a success, it was rolled out across the country, from Birmingham to Manchester and finally to London, where the Metropolitan and National Association for Providing Trained Nurses For the Sick Poor was established in 1874.  Rathbone was its Vice-President and Honorary Secretary after the Duke of Westminster.  (See the 1874-1889 section for more details)

In 1862, Rathbone had married Emily Acheson Lyle and they had two daughters and four sons together.  One of their daughters, Eleanor, would go on to be an acclaimed feminist and one of the first female members of Parliament.  The couple were passionately involved in a variety of causes related to nursing: for example, they also both fought for the reform of nursing in the workhouse.  In 1868, Rathbone was elected as a Liberal MP for Liverpool (one of three).  He used his political contacts constantly to further his ambitions for district nursing.

In the 1880s, Rathbone’s prodigious abilities were focused upon the cause of education.  He helped to found Liverpool University College in January 1882 and endowed the King Alfred chair of English Literature.  From 1892 he was President of the college.  He was also devoted to the cause of education in Wales, where he helped establish the University College of North Wales, of which he was President from 1891.

Historians praise Rathbone for his unselfishness, for his ability to organise and delegate to others.  District nursing simply would not have existed without his early drive to make it work.  When Mary Robinson, the first official DN came to him in tears, saying she could not stand the task he’d set her, he persuaded her the work was valuable.  If district nurses needed money, he would provide it.  If district nursing needed political support, he obtained it (he lobbied hard for the money given to Queen Victoria for her Diamond Jubilee to be used to establish a fund for district nurses.)  He was a passionate advocate of women’s rights.  Eleanor Rathbone, addressing a feminist organisation in 1929, explained that ‘There was something invigorating about his high standard of expectation, especially perhaps from its unwontedness, to women.’  He brought his daughters up to believe women were equally as capable of being dedicated to their work as men were.

In Christmas, 1901, terminally ill, William Rathbone wrote his last letter to the Queen’s Nurses.  In it, one senses, he was conscious and proud of the achievements they had made together.

‘Formerly, the very name of nurse conveyed to the world the idea of dirt, drink and imcompetence.  How different is the honourable position you now enjoy.  You are not inferior servants, doing inferior work for inferior wages, but trained and skilled workers carrying out intelligently the treatments prescribed by Doctors.’

Touchingly, until his death in 1902, William Rathbone sent the convalescent Florence Nightingale a bouquet of fresh flowers every week.  I think this sums up perfectly the kind of man he was.  Devoted and dedicated to his cause, he was willing to give both his money and his time to help nurses carry out their valuable work.

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'The Angel of Mons'

Like Florence Nightingale, Edith Cavell is a name which has gone down in nursing history.  A remarkably brave woman, she found herself behind enemy lines at the beginning of WW1, when the British retreated from Mons in Belgium.  She helped to smuggle around 200 Allied soldiers over the border.  Sadly, she was captured and executed by the German authorities in October 1915.  A nurse to admire and remember, who once said that ‘Patriotism is not enough.’

A less well known fact is that WW1 affected district nursing too.  Many nurses immediately signed up to join the Red Cross and were immediately moved to the South Coast, where, in crowded hospitals, they cared for the injured soldiers returning from France, under difficult conditions.  One nurse wrote to the Queen’s Nurses’ Magazine in July 1914.  After having spent weeks setting up the hospital, it was suddenly flooded by 3000 injured soldiers returning from Mons.  Perhaps some had even been sent by the unfortunate Miss Cavell.  From the nurse’s letter one can sense the initial excitement of war, the feeling of fulfilling one’s patriotic duty which many of these women must have felt.  When the soldiers arrived, she writes, ‘the change in us was electrical.  Our spirits rose to abnormal heights.’

The excitement of war would soon turn to horror as Britain slowly came to realise how many of its young men were being sent out to France to die.  Some district nurses had kept their feet more firmly on the ground.  A Miss Hoad, from Norton Fitzwarren, Somerset, wrote to the Queen’s Nurses’ Magazine in 1915.

‘Although one has had the wish to volunteer for service at the front, it is impossible not to recognise that our work lies at home just under our hands.

When Miss Budd and I came here three years ago we were asked to help with the scouts and we taught them first aid work, home nursing and also physical exercises with dumb bells and Indian Clubs.  One of our big lads, who has volunteered for Kitchener’s army, told me the drill was nearly the same as we had done in Scouts! 

This week, fresh work has cropped up.  Green vegetables were asked to be sent to the troops on Salisbury Plain.  We have been collecting them and packing fruit for goods trains, and vegetables for passenger trains, so they may arrive fresh.

One poor lady of 91 cried for fear the Germans would kill her, so I had to promise to take good care of her.’

There’s always room for common sense at home.  These district nurses, who held fractured communities together in a time of extreme crisis, deserve as much praise and recognition as we heap upon women like Edith Cavell.

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The Lady With the Lamp.

Florence Nightingale - a woman who helped shape modern District Nursing.

On this blog I’m in the business of celebrating nursing, so couldn’t let it go without a mention that Florence Nightingale has celebrated an anniversary recently.  It’s now 100 years since her death – 100 years in which her Nursing School at St Thomas’s has continue to flourish.  After 100 years, her influence on nursing – the way in which she shaped and moulded it into a serious profession – remains as strong as ever.

If you want to know more about Florence, the era in which she lived and her famous time in the Crimea, why not visit her new Museum?  From the slate she used as a child, to the stuffed pet owl she kept in her pocket at the Hospital in Scutari, it’s a wonderful way to find out more about the most influential nurse of all time.

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When it comes to the history of nursing, one name springs to mind.  Florence Nightingale.  Her importance to district nursing is enormous, as we will discover.  But did you know that district nursing has its own Florence?  I think it’s about time she got the recognition she deserves.  It is her 170th birthday this year, after all.

Florence Lees was born in Blandford, Dorset in 1840.  Her father was a doctor, her grandfather a surgeon.  William Rathbone described her as ‘by birth and upbringing every inch a lady.’  Nonetheless, Florence didn’t have an easy start by any stretch of the imagination.  Her father, being unreliable (like most doctors?!) ran away when she was a child.  She and her three brothers and two sisters were taken in by their half-brother.  The family relocated to St Leonards, where Florence would regularly visit the sick with her mother.  This experience had a huge effect on the young girl, who later dedicated her ‘Guide to District Nurses’ to her mother, ‘to whose early teaching and example I owe my first and best training in the service of the sick poor.’

By 1866, aged 26, Lees had decided she wanted to be a nurse.  She attended Florence Nightingale’s nursing school at St Thomas’ Hospital, even though her mother would not let her become a probationer.  Subsequently she escaped to Germany to study healthcare and nursing abroad.  In 1870, the Franco-Prussian war broke out whilst she was still in Germany.  Finally, she could stop studying and put her nursing skills into action.  She volunteered for military nursing and quickly caught the eye of the Crown Princess of Germany, Queen Victoria’s oldest daughter.  Who, confusingly, was also named Victoria.  The Princess put Florence in charge of two hospitals: Marange and Homburg. 

Upon her return to England in 1873 Florence Lees had become something of a nursing expert.  She made a point of studying nursing all over the world and had visited all the chief hospitals in Holland, Belgium, Denmark, Austria, Italy, and France.  She’d even been to the US to find out about medicine on another continent!  When she returned, she took up a post in charge of the male and female surgical wards at King’s College Hospital, London.  It wasn’t long before she was called upon by Florence Nightingale and William Rathbone to look into the prospect of transferring district nursing  to London.

In 1874 Florence Lees conducted a survey into community nursing in London.  She reported that, although London was full of enthusiastic amateurs, there was a dire shortage of trained nurses.  As far as she was concerned, this was dangerous for the ‘sick poor’ being treated, who were easily influenced.  She called for obligatory preliminary training for nurses, under hospital conditions.  As far as Florence Lees was concerned, nursing was a profession for educated women, who might educate those under their supervision, whilst treating them.  She fundamentally disagreed with William Rathbone and was keen to see district nursing in London run by professional nurses, rather than his ‘Lady Superintendants.’  The two Florences had their disagreements too – whilst Florence Nightingale was completely against the creation of ‘medical women’, Florence Lees wanted the district nurse to be an independent medical professional in her own right.

In 1875 the first district nurses in London set up home at 23 Bloomsbury Square.  Florence Lees was their first Superintendant.  She was also district nursing’s most passionate defender.  In 1876, the Lancet launched an attack upon her vision of district nursing as a profession for educated ladies, claiming that ‘such work is better entrusted to strong, properly trained women of the lower class who have been accustomed to dirty work from their youth up.‘    Angry, Florence replied, ‘The poor never seem to have any idea we are ladies.‘  Their class was not the point.  Their skill as nurses was.

In 1879, Florence Lees married the Reverend Dacre Craven.  Like all women of her age, she gave up her work after she married and had children – two sons with illustrious Godparents – Florence Nightingale and the Empress of Germany.  This was by no means the end of her involvement with district nursing.  She infected her husband with her fervent passion for her profession and he became the secretary to the home for district nurses in Bloomsbury Square.  In the 1880s, when financial support for the nurses was dwindling, the Dacre Cravens campaigned to keep them afloat.  It was Florence Lees, along with Florence Nightingale and William Rathbone, who persuaded Queen Victoria to give the money raised by women of England for her Diamond Jubilee to the cause of district nursing.

Lees died in Essex in 1922, only two months after her husband, claiming she could not live without him.  She left for district nurses a lasting legacy, one summarised neatly in her 1889 work, ‘A Guide to District Nurses.’  The profession as it stands today owes everything to Florence Lees.

Call back soon to hear some of her words of wisdom!  I’m desperately looking for a picture of her – if anyone knows where I can find one, let me know!

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