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 •■"IR' 
 
 L I B RARY 
 
 OF THE 
 
 U N I VLR_5 ITY 
 
 or ILLl NOIS
 
 ly 
 
 ON THE EMPLOYMENT 
 
 TRAINED NURSES 
 
 AMONG THE 
 
 LABOURING POOE, 
 
 CONSIDERED CHIEFLY IN RELATION TO 
 
 SANITARY REFORM AND THE ARTS OF LIFE. 
 
 By a PHYSICIAN. 
 
 LONDON: 
 JOHN CHURCHILL, NEW BURLINGTON STREET. 
 
 MDCCCLX.
 
 •,-.*3 
 
 EKED AND PARDdiT, miXTKKS 
 I'ATKRNOS-'UB RUW.
 
 PREFACE. 
 
 During the last ten years I have seen much of the 
 sick poor, not only in hospital practice, but at their 
 own homes; and I have, therefore, had frequent 
 opportunities of witnessing their distressed and help- 
 less position when attacked with severe illness. The 
 visits and gifts of the charitable are too uncertain 
 and irregular to be of much real service, and are, 
 besides, not calculated to meet the most pressing 
 difficulties of their condition. Wliat is most wanted 
 is knowledge and skill to apply methodically the 
 means at hand, and to place the sufferers in the 
 most favourable position for recovery. I have en- 
 deavoured in the following pages to show the neces- 
 sity that exists for an organised system of nursing, 
 and which, if fairly carried out, would, I believe, be 
 attended with permanent good results ; for it would 
 combine effective assistance with practical instruc- 
 tion in the laws of health and the arts of life. 
 
 It is a subject about which I have felt deeply and 
 thought long ; and I trust that the scheme I have 
 
 a2
 
 IV 
 
 tried to advocate may meet with the approval and 
 support of those benevolent persons who wisely 
 strive to lead their poorer friends and neighbours to 
 prudent habits, and that independence and self- 
 reliance which ought to be the normal condition of 
 the industrial classes. In the words of that eminent 
 physician and good man, the late Dr. Alison, I ad- 
 dress myself, ''To those who have been accustomed 
 to look upon the poor, not as objects of disgust and 
 aversion, but as brothers and sisters in affliction, 
 who are born to the same hopes as themseh^es, look 
 up to the same Father in heaven, and trust to the 
 mediation of the same Redeemer ; to those who 
 remember that charity is the highest of Cliristian 
 duties, that oiu: Saviour himself chose to be a beggar 
 that we for his sake might not despise the poor." 
 
 u.uc;
 
 EMPLOYMEN'J 
 
 The question of employing trained and educated 
 nurses among the labouring poor in their own 
 homes, has not yet received the attention that its 
 importance demands. Nor is it an easy question 
 to handle ; for before attempting to carry out any 
 scheme in this direction, the beneficial effects of 
 which are intended to be practical and permanent, 
 it is necessary to make ourselves masters of the facts, 
 — to ascertain the actual condition of the poor, by 
 viewing their position from their own cottages. We 
 may then, perhaps, be able to form a distinct con- 
 ception of a plan which would be likely to ame- 
 liorate, to some extent at least, their sad lot. 
 
 Let us first consider the need that exists for such 
 an order of women in time of sickness. No expense 
 is spared in providing di-ugs and medical attendants 
 for the working classes ; indeed, the expenditure is 
 out of all proportion to the amount of good done ; 
 and it is difficult to form any conception of the 
 amount of talent, time, and labour that is absolutely 
 wasted from the want of an organised and efficient 
 system of nursing. The hasty visit of the doctor 
 will be of little avail, if the diet and regimen are not
 
 attended to — if tliere is no one present wlio can form 
 an intelligent comprehension of medical directions — 
 if the unfortmiate patient is breathing a poisonous 
 atmosphere, in a close, unventilated dwelling, 
 amidst dirt, confusion, and disorder — if there is no 
 one 23resent who possesses any knowledge at all of 
 the first principles of sanitary science, or the laws of 
 our common nature. 
 
 Furthermore, there is not only complete ignorance 
 of nursing and the ordinary management of the 
 sick, but the poor do not know how to prepare the 
 simple food that may be ordered in a palatable form ; 
 they do not know how to prepare or to use the appli- 
 cations that may be recommended, or how to ad- 
 minister the remedies that may be prescribed : such 
 as the preparation and administration of injections ; 
 the application of leeches, rollers, blisters, poultices, 
 fomentation ; the management of bed sores, and 
 many other requirements that I need not allude to 
 at present. In short, when severe illness with its 
 attendant difficulties and perplexities comes to 
 humble dwellings, there is no skilled assistance pro- 
 curable under existing circumstances, unless there 
 fortunately happens to be a neighbour with a little 
 more intelligence than that of the average popula- 
 tion around. Of sympathy and kindness indeed 
 there is no lack ; the clergyman calls to give reli- 
 gious consolation, and recommends patient submis- 
 sion to the dispensation of Providence, but he feels 
 himself useless as far as giving any practical help is 
 concerned; he can do nothing but give away money, 
 which the poor do not know how to use. Again,
 
 there is the lady or district visitor : she also calls 
 with a real desire to relieve, but she generally knows 
 no more how to render any effectual assistance, and 
 is as helpless and useless as the clergyman. All she 
 can do, is to send from her own kitchen some food 
 in an eatable form ; which, however, is often very 
 impro23er for the sick man, whose stomach, not being 
 accustomed to luxuries, is deranged by such an un- 
 usual abundance of nourishment, and if taken before 
 an acute disease is subdued, it may excite serious 
 complications, and he may, therefore, be literally 
 " killed with kindness." 
 
 Under these discouraging circumstances, with so 
 many opposing forces to counteract the benefits that 
 medicine might confer, the most skilful physician 
 will be utterly baffled. He will discover that his 
 orders and du'ections are not carried out, for they 
 are neither understood nor appreciated, and he will 
 find himself beaten at every point. He therefore 
 becomes careless and indifferent as to the result of 
 his^treatment, or he retires in despair fj'oni such a 
 hopeless warfare. 
 
 Having thus shortly and imperfectly sketched the 
 helpless state of the industrial classes during severe 
 illness, let us next proceed to consider there suit of 
 their ordinary sanitary condition, and of their igno- 
 rance of the arts of life. There are but few out of the 
 ranks of the medical profession who can form any 
 idea, or indeed would credit, the vast amount of 
 human misery and pain which originates from causes 
 easily prevented, as the remedies mostly lie within 
 the power of the sufferers themselves. Putrescent
 
 8 
 
 matter, bad ventilation, and close living, are well 
 ascertained causes of the fevers which inflict such 
 terrible sufferings upon the poor ; they are uncon- 
 scious and ignorant of these well-established facts, 
 which, if known to them, might be so easily pre- 
 vented by common foresight and caution. 
 
 The most perfect machinery for cleansing and 
 draining our streets, and for insuring the inhabitants 
 an adequate supply of good aii' and good water, will 
 not reach the evils that exist in the houses of the 
 poor ; and which inspectors of nuisances, police 
 regulations, boards of health, and legislative enact- 
 ments, are unable to grapple with. Nor will im- 
 proved dwellings and sanitary laws be of any avail, 
 as long as the inhabitants of those dwellings are 
 ignorant of the common laws of health, for the real 
 causes of their misery would be still untouched : 
 such as noisome collections in private houses giving 
 out poisonous gases, uncleanness of the person, and 
 absence of ventilation. However ill-planned and 
 defective the dwelling may be, there is no reason 
 why it should be dirty, noisome, and unventilated. 
 If the best arranged house, supplied with every con- 
 venience that modern science can suggest, was in- 
 habited by ignorant persons of uncleanly habits, it 
 would very soon become a disgrace and a nuisance. 
 These evils, as I have just said, can be remedied 
 only by individuals and families, each for them- 
 selves ; and if sanitary science is not understood or 
 appreciated, they T\ill not tolerate any interference 
 of which they do not see the benefit. 
 
 After this short statement of some of the causes
 
 from which so much needless suffering and pain 
 grow, terrible in extent and agonising to bear, we 
 come to another weighty matter, and that is igno- 
 rance of the arts of life. Every rational man or 
 woman who is in the habit of visiting the cottages of 
 the poor, will confess that a great deal of the squalid 
 misery that is witnessed there does not arise so 
 much from destitution as from ignorance and bad 
 management ; and, consequently, that the condition 
 of the working classes might be very different from 
 what it is : for in most instances, the proximate cause 
 of tlieii' suffering does not arise from insufficient 
 wages, but from want of knowledge how to make the 
 most of their earnings. And it will also be granted 
 that charity does nothing but increase the evil, as it 
 tends to breed poverty and helplessness. Most 
 persons of any experience will therefore allow, that 
 nothing presses harder upon the narrow households 
 of the working classes as want of training in 
 domestic economy. From want of knowledge they 
 are much more improvident than wealthy people. 
 From want of knowledge, materials are not only 
 wasted, but the food they attempt to prepare does 
 not satisfy the palate, and frequently deranges the 
 stomach and digestion. The poor do not know 
 what kind of food is the most economical, whole- 
 some, and nourishing, and they are also deplorably 
 ignorant as to what kind of diet and regimen is most 
 suitable for young children and infants. 
 
 But to continue our postulates : The difficulties 
 that lie in the way of improvement are appalling ; 
 the greatest obstacle to be met with being the stolid
 
 10 
 
 indifference of the poor themselves, and their dis- 
 inclination to be meddled with. The reasons for 
 this are apparent enough, when we reflect upon how 
 little time they can spare from work ; their nume- 
 rous family, cares, and perplexities ; the want of 
 space and the crowded state of their narrow dwell- 
 ings. Their bodies, too, are exhausted, not only 
 from hard work, but from a deficiency of wholesome 
 and properly prepared food ; and their blood is 
 poisoned, and the action of the heart depressed, 
 from breathing a polluted atmosphere. In addition 
 to all this, the chronic state of poverty they live in 
 must be remembered, and the mental disquietudes 
 and entanglements attending it from which they can 
 see no way of escape. Innumerable evils grow out 
 of this state of things, for the victims are driven from 
 their uncomfortable, squalid, and miserable rooms to 
 the tavern, where a large proportion of their earn- 
 ings is spent ; and it must be allowed that there are 
 many excuses to be made for them. One of the 
 strongest inducements to intemperance, is that sense 
 of depression and general weakness which excites a 
 craving for stimulants, to arouse the nervous system 
 from a state of prostration induced by breathing foul 
 air, and which they know from past experience will 
 give them transient relief. Besides, we ought to recol- 
 lect that they have, in many instances, nothing worthy 
 of the name of home to go to. Too often there is 
 nothing there to encourage provident habits, or any 
 other virtue. The house is dirty, the children are 
 uncared for, every social and moral tie goes, and we 
 need not be surprised that the warm, well-liglited
 
 11 
 
 parlour of the public-house should be so often the 
 pleasantest home for the workmg man. The conse- 
 sequences are disastrous : for it is as certain that 
 continued misery, reckless and dissipated habits, will 
 ultimately lead to vice and crime, or to black 
 des23air, insanity,* and premature death, as that 
 continued neglect of functional irregularity leads to 
 chronic disease and organic disorder. 
 
 Now, in matters relating to the arts of life, it is 
 the women who are chiefly concerned, and it is a 
 melancholy fact, that there is nothing taught that 
 particularly form the duties of women in domestic 
 life : indeed, the women of all classes in this 
 country are brought up to be utterly incompetent 
 to the management of domestic or any other affairs, 
 and they consequently do not possess the com- 
 monest knowledge that would be required from the 
 manager of a working man's home. If the wife 
 has no knowledge of domestic economy, however 
 well educated and attractive in other respects, 
 miserable will be the doom of the man who marries 
 her. His home will be dreary and comfortless, and 
 he will in time probably be di-iven to the gin-shop. 
 His children will be brought up in squalor, and 
 
 * " An official report just published by the parochial authorities of 
 Marylebone, states that insanity has lately increased to such an 
 extent amongst the working classes, that none but those whose 
 duties bring them into contact with the sufferers can form any idea 
 of its fearful spread. There are no less than 494 chargeable to the 
 parish. In St. Pancras insanity also preA-aus to an unusual amount, 
 especially among the humbler classes. It is to be hoped that this 
 painful fact will be made the subject of official and medical inquiry, 
 with a view to tracing its origin, and to retard, if possible, its 
 progress." — Lancet, February, 1853.
 
 12 
 
 she herself will be thriftless, and will ultimately 
 become slatternly. 
 
 "Not to know of things remote 
 From use obscure and subtle, but to knoio 
 That which before us lies in daily life 
 Is the prime wisdom." 
 
 Such a state of things existing, with earnings that 
 might insm-e comfort if not prosperity, seems to 
 prove that no legislation can cure the evil. The 
 character of the labouring poor must be changed, 
 for the causes may be found in the ignorance and 
 reckless habits of the people, and the remedy must 
 be sought in the improvement of the home — not 
 only generally by means of lectures and cheap 
 literature, but by direct personal iutercoiu'se ; not 
 only by talking, but by showing the poor practically 
 '' how to set about it." 
 
 Another evil to which the poor are especially 
 liable, and which is also to some extent at least 
 remediable, is mental anxiety ; and as it is a fL'uitful 
 cause of many formidable diseases, I shall make a 
 passing allusion to it. Indeed, it is the physician 
 alone who can form any idea of the vast amount of 
 physical suffering that is caused by mental trouble ; 
 for in that may found the most active and inces- 
 sant principle of that frightful series of organic 
 changes which constitutes pathology. It is only 
 during the prevalence of epidemics, that the effects 
 are prominently seen. Anxiety depresses the 
 heart's action, diminishes nervous power, and pros- 
 trates the whole system, and the sufferer conse- 
 quently falls an easy victim to cholera, fever, or any
 
 13 
 
 other zymotic malady that may prevaih But the 
 daily care, and more especially the dread and 
 anticipation of futm^e evils, acting upon a system 
 ill nourished by unwholesome and badly cooked food, 
 does its deadly work more slowly, but as surely as 
 the poison of epidemic disease. It is unnecessary 
 to dwell on this subject, for the powerful influence 
 exercised by the mind over the body is perfectly 
 well known to every one, however ignorant he 
 may be of the structure and functions of the human 
 frame. Personal experience feelingly persuades us of 
 its truth. A sense of shame, for instance, will imme- 
 diately crimson the cheek, and fear will make the 
 heart knock against the side and paralyse the limbs. 
 Now for the plans proposed, or in operation, to 
 remedy some of the evils that I have endeavoured 
 to describe. They need not detain us long, for 
 there is hardly an attempt made to provide any 
 remedies at all, and what is done is utterly ineffi- 
 cient. The scheme of introducing into female schools 
 an education more suited for the girls in after 
 life, is the most promising. But there are many 
 difficulties in the way. Childhood is not the time 
 to learn or understand the chief branches^bf family 
 and domestic economy : and even if schools could 
 be established to give young women instruction in 
 the arts of life, on the duty involved in the care of 
 children, and in nursing the sick, many could 
 hardly be expected to attend them, for very few 
 could afford such an expensive education, as they 
 would have to find the means of living in the 
 meantime.
 
 14 
 
 Another apparently promising plan is the one 
 adopted by the London Ladies' Association, for 
 the diffusion of sanitary knowledge among the 
 people by means of tracts. But are they read ? 
 and if read, are they understood and appreciated ? 
 It is difficult to believe it. The ignorant poor, with 
 untrained intellects, are unable to comprehend, or 
 follow written arguments, however plainly stated ; 
 and they are moreover so tied and bound by custom 
 and habits, which makes it almost impossible for 
 them to face the trouble and difficulty of learning 
 a new method of living in adult age from tract litera- 
 ture. Besides, as I have said before, they are 
 unconcerned and apathetic on the subject of sani- 
 tary knowledge, and have no solicitude whatever for 
 instruction. The tract, therefore, would pretty gene- 
 rally be considered very irksome and toilsome read- 
 ing, and would soon be thrown aside and forgotten. 
 
 Then there is the system of '' district visiting," 
 which is now so general that it has become an 
 institution of society. What is the effect of this 
 ministration among the poor ? Every one will 
 readily allow that much severe suffering is tempo- 
 rarily reMeved and prevented by these ladies; 
 but I will venture to say, that not much permanent 
 good results from their visits. On the contrary, 
 evils indirectly grow from this kind of charitable 
 interference, as it tends to discom-age self-reliance 
 and self-dependence, and there is therefore a loss 
 of self-respect. It undoubtedly tends also to en- 
 courage deceit, insincerity, and hypocrisy among 
 the recipients.
 
 15 
 
 To liolp tlie poor effectually, or rather to put 
 them in the way to help themselves, something 
 more is required tlian the uncertain, aimless though 
 well-intentioned calls of isolated district visitors, 
 without responsibility ; who, as a general rule, have 
 few or none of the qualities for the work, such 
 as special knowledge, confidence, tact, self-reliance, 
 and, above all, authority. 
 
 When the benevolent mood comes round, the lady 
 not unfrequently goes forth, like a knight-errant 
 of old, in search of charitable adventures among 
 the poor ; but, unlike the knight (who was in grim 
 earnest), she too often merely seeks benevolent enter- 
 tainment, to relieve the ennui that idleness begets, 
 or when the di-eary occupation of ''cultivating her 
 mind " has ceased to satisfy her aspirations. Arrived 
 at her destination, slie is often tempted (as I have 
 been credibly informed) to lay down the law to the 
 inhabitants, to lecture them about " thrift and care," 
 which must sound in their ears like some wild 
 strain of irony ; for with them hard work and 
 privations are a habit, and to the poor man life 
 itself can only be preserved by making self-denial 
 his practice,' and thrift must be the incessant effort 
 of his days, from the cradle to the grave. I 
 believe that she also sometimes threatens them 
 with the terrible doom that awaits them in another 
 world, and gives them a tract, which they can 
 neither profit nor benefit by, to strengthen and 
 fortify her arguments. All this is borne patiently 
 and humbly, for her hearers know from past expe- 
 rience, that after the dose of physic, '' which
 
 16 
 
 worretts and gripes them, and yet leaves them much 
 the same," something sweet will be forthcoming in 
 the shape of a shilling, or some broth and meat. I 
 believe, too, that the lady does not very often 
 consider whether she is intruding or not, when she 
 goes uninvited to a poor man's cottage. The idea 
 of intrusion, however, would be very vivid to her, 
 if she thought of paying a similar visit to a family 
 somewhat below her in the social scale, with whom 
 she was not acquainted. But do the poor them- 
 selves consider her visits intrusive ? I believe not ; 
 and it is a sad admission to make, for it is a sign 
 that they have sunk to a melancholy state of degra- 
 dation. The sacredness of home is in a measure 
 gone, and very little exists of self-respect or self- 
 reliance; while her repeated visits, with gifts of 
 money and food, tend to destroy the little of these 
 virtues that remain. 
 
 There are but few things of the truth of which I 
 am more convinced, than that officious and uncere- 
 monious charitable interference with the poor, 
 though known and felt to be active benevolence, 
 can lead to no good result; for it is the most 
 effectual way of destroying what remains of self- 
 help and self-reliance, and the most certain way of 
 reducing the victims to a degraded state of hypo- 
 crisy and beggary. Carlyle, in his forcible way, 
 and in manly and stiiTing words, says, '' Wet feet — 
 mud — frost — hunger, or what you will; but not 
 beggary ! Let us stand on our own basis at any 
 rate. On such shoes as we ourselves can get. On 
 frost and mud if you will, but honestly on that :
 
 17 
 
 on the reality and substance which Nature gives us, 
 not on the semblance, on the thing she has given 
 another than us ! " 
 
 It is indeed difficult to conceive a task more 
 saddening and heartbreaking than that which the 
 earnest but untrained district visitor has taken 
 upon herself. She may assiduously attend to her 
 duties year after year, but the longer she lives the 
 more she is convinced that very little benefit results 
 from her labours. Her once sanguine hopes of 
 doing good gradually fade away, and her round of 
 visits, which she still considers it her duty to make, 
 become more and more unsatisfactory and mono- 
 tonous. Experience has taught her how hard it is 
 to do any good without doing harm, and what 
 barriers, mountains high, are placed between her 
 and those whose condition she is fruitlessly endea- 
 vouring to improve. It is like the work of 
 Sisyphus, who was for ever doomed to roll up 
 stones, which came down again inevitably. 
 
 If the old proverb that " cleanliness is next to 
 godliness " be true, what a theme for the pulpit, 
 and what a field for practical usefulness for the 
 ministers of religion ! Unfortunately, however, the 
 majority of our religious teachers (especially among 
 dissenters) consider that spiritual remedies are suffi- 
 cient, and that ''we labour too much for the 
 perishable body." But I believe spiritual appli- 
 ances to be useless if the arts of life and the first 
 principles of sanitary science are ignored. To give 
 a tract, or to go and read the Bible, to ill-clad, half- 
 starved men and women, in a dirty room, amidst 
 
 B
 
 18 
 
 noisome smells, and with their digestion spoiled by 
 bad cookery, is a mistake ; for all the thoughts of 
 these mihappy persons are engaged in a daily 
 struggle for existence, and they have not the heart 
 or wish for elevation, spiritually or intellectually. 
 Fii'st remove the obstacles in the way ; that being 
 accomplished, spiritual instruction would be re- 
 ceived, and bear fruit in due season ; for the seed 
 of Chi'istianity would be sown in a soil prepared 
 to receive it. It is now so^ii at a vast expense 
 and great labour, amidst thorns and briers which 
 choke it. 
 
 The works of nature are frequently dwelt upon in 
 sermons, as evidences of the wisdom and goodness 
 of God ; but the beneficent, although unerring and 
 unchangeable laws which regulate the material 
 universe, as well as the equally unchangeable phy- 
 siological laws, upon which the continuance of life 
 and health depends, are seldom alluded to or 
 studied. But it is certain that these laws exist, 
 although unseen, and move sternly on ; and if we 
 ignore them, or live in opposition to them, it is 
 equally certain that we shall be crushed by 
 them. 
 
 And, furthermore, the diseases and suffering 
 which so many persons ignorantly and unconsci- 
 ously bring upon themselves, do not end with each 
 individual, but are multiplied to all time. For it 
 is a law of nature, that the sins of the fathers shall 
 be visited upon the children, and the seeds of disease 
 are thus transmitted to future generations. Indeed 
 every hereditary malady, if traced back, would be
 
 19 
 
 found to have originated in the wilful or igno- 
 rant transgression of a sanitary or physiologic 
 law. 
 
 It is, therefore, sad to reflect that so much human 
 misery and pain should arise from ignorance of a 
 few simple laws, to live in accordance with which is 
 to do the will of the great Creator of those laws ; 
 while to break them, or to live in opposition to 
 them, is to suffer the sharp and inevitable penalty 
 annexed to transgression. 
 
 If more scientific and rational views, then, of the 
 proximate causes of pain and suffering were more 
 generally held by our religious instructors, an incal- 
 culable amount of good might be done by such a 
 large body of educated men, who have so much 
 intercourse and influence with the poor. But as 
 long as epidemics, as well as other diseases, are 
 looked upon as something supernatural, and a direct 
 visitation of Providence, — and as long as scientific 
 facts, which indisputably prove the contrary, are 
 frowned upon, — the difficulties and obstacles, already 
 sufficiently numerous, which stop the way of im- 
 provement, are greatly added to. 
 
 Moreover, it is a mischievous doctrine to preach 
 that disease and physical evils are direct visitations 
 of Providence, and that they are intended to sub- 
 serve high moral ends, for the tendency of such 
 teaching is to encourage acquiescence in confusion, 
 disorder, and mismanagement. It is clearly our 
 duty to labour incessantly, and to use every means 
 to extirpate those causes which lead men and women 
 ignorantly to transgress natural laws, for the inevit- 
 
 B 2
 
 20 
 
 able result of their transgression must be misery and 
 pain. 
 
 There are, however, among the clergy of the 
 Church of England, many scientific and intellectual 
 men who earnestly devote their time and talents to 
 the promotion of sanitary and social reform, and 
 who are well aware that, as long as the physical 
 condition of the industrial classes remains as it is, 
 religious instruction cannot be received, nor can any 
 moral improvement be expected. 
 
 In a sermon recently j)ublished, the Rev. Sydney 
 Turner says, "It is a mockery to ask God to keep 
 us fi'om the pestilence that wallvcth in darkness, 
 and the sickness that destroyeth at noonday, if we 
 allow the foetid nuisances and the filthy dwellings 
 which breed disease and misery among us. It is 
 mere self-deceit to preach virtue and denounce vice 
 while we tolerate the condition of scores, both in 
 our tovra and country districts, where we know 
 promiscuous intercourse and shameless exposure 
 must deaden every sense of decency, and make 
 licence and brutality the normal state of the 
 inhabitants." 
 
 And the Rev. Cliarles Kingsley, in a paper lately 
 printed, states, that ''it is pretty generally confessed 
 that we possess sanitary knowledge sufficient (could 
 we but apply it) to exterminate pestilence, and 
 probably most forms of z^Tiiotic disease ; that we 
 could make om- cities very nearly as healthy as the 
 country — could considerabl}^ leng-then the average 
 dm-ation of human life, and could bring up the 
 rising generation under circumstances almost certain
 
 21 
 
 to produce the liighest health and vigour. But it is 
 confessed, on the other hand, that though we know 
 how to do all tliis, we are not doing it, nor are 
 likely to do it." 
 
 I have perhaps said enough to prove that some 
 organised system is urgently required, more fitted 
 to cope with the numerous evils around us than any 
 yet adoj)ted ; and also that sentimental sympathy 
 and charitable doles are nothing more than opiates 
 to palliate and give temporary relief, while we look 
 on without making any effort worthy of the name 
 to cure the disease, or to prevent its recurrence. 
 
 The poor have a right to some treatment quite 
 different than this at our hands. They have a right 
 to call u]3on us who profess to believe in the Chris- 
 tian faith, and who have the power and the means 
 to remove some of the most pressing difficulties 
 which impede and distract them at every step, 
 and to show them how to find a field, free from 
 deadly obstructions, for the battle of life. It is not 
 our money, but our knowledge and our science that 
 they have a claim upon, and if we continue to refuse 
 them that (which makes them poor indeed) a day of 
 retribution will come ; for our boasted Christianity 
 and civilization will be discovered to be a sham, if 
 the upper twenty thousand misapply the knowledge 
 and advantages bestowed upon them, and allow the 
 lower twenty millions to struggle on as best they 
 can, in a pit of dark despair, disease, and early • 
 death.* The labouring poor liave a right to be 
 
 * The following table is taken from Mr. Chadwick's Eeport on the
 
 22 
 
 taught how to escape from the terrible epidemics 
 and other diseases which daily work such havoc 
 among them. Why, they know not. But we know, 
 and we also know, that the causes are removable. 
 Shall we, then, not try to remove them? It is 
 breaking human hearts that appeal to us, — E-achel 
 weeping for her children, because they are not. 
 
 After this short survey of the present helpless 
 state of the labouring poor in times of sickness, as 
 well as of the ill effects arising from ignorance of 
 sanitary laws, and of the arts of life, I come to the 
 important and difficult question of a remedy for 
 those disorders which are curable. 
 
 As I have already hinted, no real practical help 
 can be given with any prospect of success except by 
 persons possessing special knowledge, and who have 
 been trained for the work. It is absolutely neces- 
 sary that they should have some acquaintance with 
 sanitary science, the laws of the human fi^ame, and 
 with the arts of life ; for before the remedy can be 
 applied, the causes must be explained, and when 
 that is accomplished, much future misery will be 
 
 Sanitary Condition of Great Britain. The figures tell their own tale, 
 and require no comment : — 
 
 AVERAGE AGE AT DEATH. 
 
 .Gentry and 
 their families. 
 
 Rutlandshire 52 
 
 Derby 49 
 
 Bethnal Green .... 45 
 
 Leeds 44 
 
 Manchester 38 
 
 Bolton 34 
 
 Liverpool 35 
 
 Labourers. 
 
 38 
 21 
 18 
 19 
 17 
 18 
 15
 
 23 
 
 prevented, Avlieii ignorance or thoughtlessness is the 
 remote cause. 
 
 " For evil is wrouglit hj want of thouglit 
 As well as want of heart." 
 
 Clearly, then, the work, if done at all, can only 
 be done by women specially trained, qualified, and 
 paid for their services ; in fact, missionaries of 
 health and domestic economy. And their business 
 would be a serious one, and not to be pursued in a 
 random, irregular, inconstant way, but with just as 
 much settled purpose, in as regular and distinct 
 method, as any other profession or business to which 
 we devote ourselves, and by means of which we 
 live. 
 
 Before I proceed to consider the best and most 
 practicable way of carrying out in detail the object 
 in view, the important preliminary question presents 
 itself — Can such women be found ? After full 
 inquiry, I reply that they are ready made to our 
 hands if we would only employ them. There are 
 at the present time two large institutions in London 
 established for the purpose of educating and training 
 intelligent women of high character as nurses. 
 These '^ sisters " are trained in the London hospitals, 
 and they are in every way qualified to perform all 
 the various duties that would be required of them. 
 Should there be a general demand for such an order 
 of nurses, a wide field of useful and honourable 
 labour would be opened for women, and a sufficient 
 supply to meet it would, doubtless, be forthcoming. 
 But there is, as yet, no demand for them, except 
 among the higher classes.
 
 24 
 
 Now, having secm-ed a niu'se properly qualiiied, 
 how can she be introduced to those who are most in 
 need of her services ? Before anything can be done, 
 there must be not only local effort, but the guidance 
 and encoui'agement of organised association ; a 
 system which could give weight and authority. It 
 would be chiefly, therefore, through means of insti- 
 tutions mtli established machinery — medical cha- 
 rities, for instance, and especially provident dispen- 
 saries — that such persons could be effectively intro- 
 duced. For it is a great point gained, when the 
 working man and his family have been induced to 
 become members of a body ; to have their names 
 written down in a book ; to have cards in their pos- 
 session to show that they are members of a society 
 which is supported by their own contributions. This 
 being gained, a bond of union is established between 
 all parties for their mutual benefit. There is an 
 esprit de corps which tends more than anything else 
 to lift men above theii* natm-e. It also keeps up 
 fellow-feeling, for all the members have a common 
 interest and a connnon duty which is undeniable, 
 plain, and easy. It has, in addition, a direct ten- 
 dency to foster provident habits, self-reliance, and 
 self-respect, mthout any sacrifice of independence ; 
 and, what is above all, it does away with the sense 
 of degradation wliich must always attend the recep- 
 tion of gratuitous charity. These great advantages 
 being secured, there would be a better chance of 
 obtaining the ^agorous co-operation of the working 
 classes themselves ; for without their own co-opera- 
 tion nothing can be done at all.
 
 25 
 
 The important services that an educated and 
 trained nurse would be able to confer in times of 
 sickness could not fail to be valued and appreciated ; 
 and she would, undoubtedly, soon become the most 
 popular and trusted officer in connexion with the 
 institution that employed her. She would co-operate 
 with the medical attendant in the most efficient 
 manner to accelerate the recovery of the sick by 
 eifectively carrying out his orders and directions ; 
 while she could, at the same time, teach the younger 
 members of the household the way to do it ; and 
 the lesson under such circumstances would not be 
 easily forgotten. Moreover, her presence would 
 inspire the sufferer with confidence, and she would 
 be the means of diffusing happiness and satisfaction, 
 and restoring peace and order to a distracted house- 
 hold. 
 
 When thus fairly introduced to families who are 
 in sore need of her services, what a field for practical 
 usefulness lies before her ! and what opportunities 
 she would have for practically instructing them in 
 the laws of health and the arts of life ; without the 
 slightest chance, too, of exciting in their minds any 
 sense of intrusion ; for she would not go to them in 
 the garb of charity, as they would have the same 
 right to her services as they have to the attendance 
 of the medical officer provided for them. Besides, 
 she would only go where she was really wanted. 
 But, as severe illness, with all its perplexities and 
 miseries, is seldom long absent from humble dwell- 
 ings, there would be no lack of opportunities for 
 bestowing her useful aid. Again, by the skilful per-
 
 26 
 
 formance of kindly offices, feelings of mutual confi- 
 dence^could not fad to be established between her 
 and the working man, which could never or seldom 
 exist between him and the district visitor, whose 
 visit is an act of condescension ; for he feels that 
 the lady can do nothing for him but give him cha- 
 rity, and question him, kindly it may be, but magis- 
 terially, about his household economy, his income, 
 and the outward details of his life. 
 
 It is clear that the niu'se would in this way obtain 
 great influence over the family, and that frequent 
 oppoi-tunities would be presented to her for rescuing 
 many from the degi'adation and squalid misery they 
 live in, by instructing them how to avoid the evils 
 which ignorance necessarily entails, and which 
 knowledge will certainly prevent. She would, for 
 instance, be able to explain to them effectively that 
 the fevers and other sickness that afflict them are 
 caused by the absence of cleanliness and ventilation, 
 — ^by the filth and dii't around them sending forth 
 poisonous exhalations. If the working classes could 
 only be made to know and understand that a great 
 amount of the disease and suffering they undergo 
 arises fr*om the unhealthy state of the atmosphere 
 breathed in theii' own homes, there cannot be a 
 doubt but that they would, without any hesitation, 
 use the means within their reach for remedying so 
 great an evil. 
 
 If, therefore, the assistance of intelligent nm^ses 
 could be secm-ed, it is difficult to believe that they 
 would leave any house they once entered exactly in 
 the same state as they found it: some amount of
 
 27 
 
 permanent good must have been accomplished ; some 
 useful knowledge must have been gained, however 
 ignorant and degraded the inhabitants may have 
 been ; for there are but few instances in which 
 simple sanitary rules cannot be intelligibly explained 
 and carried into effect, so that ignorance need not 
 be pleaded as an excuse for the neglect of the duties 
 enjoined. If, however, after every effort has been 
 made to explain the ordinary laws of health and 
 disease, the labouring poor still continue to ignore 
 them and live in opposition to them, their sufferings 
 will be deserved, for they then become the chastise- 
 ment which follows sin. '' To him that knoweth 
 the good, and doeth it not, to him it is sin." 
 
 Again, if the sanitary condition of the poor were 
 in a more satisfactory state, and if an efficient 
 system of nursing were adopted, another great 
 advantage would be gained ; for there would then 
 be less need for removing the sick from their own 
 homes and friends, into our over- crowded public 
 hospitals, where they run the risk of contracting 
 and dying fr'om diseases peculiar to those institu- 
 tions; such as hospital fever, hospital gangrene, 
 and erysipelas. The accumulation of a large number 
 of diseased persons in one building is indeed a 
 great evil, for the diseases just mentioned, as well 
 as others, are absolutely manufactured in those pre- 
 mises, and which are unknown elsewhere. The 
 utility, therefore, of our ill-arranged and badly- 
 ventilated English hospitals as curative institutions, 
 are exceedingly equivocal. 
 
 But to return to the nurse : — From what has been
 
 28 
 
 'already said, it is clear that the kind of person 
 contemplated is to be not only an attendant upon 
 the sick, but the friend and adviser of the poor, in 
 all that concerns their daily life and temporal 
 welfare. She should therefore be well informed in 
 all matters that conduce to make the life of the 
 working man a more successful affair than he makes 
 of it at present. She ought, for instance, to be able 
 to give information concerning the rules and regu- 
 lations of provident and friendly societies ; of all 
 kinds of clubs; questions concerning the pawn- 
 brokers' shops ; lending libraries, and cheap period- 
 icals, of a wholesome tendency. It would also be 
 very desii'able if she had some knowledge of law, as 
 far as it concerns the poor, such as the law of 
 settlement and removal; marriage and judicial 
 separation ; the recovery of debts, and other similar 
 questions. 
 
 If boards of guardians could be induced to em- 
 ploy such an order of nurses, they would come 
 officially and most usefully in contact with the 
 lowest and most degraded classes of the community. 
 But it is probably hopeless to expect them to adojit 
 any such scheme, on account of the expense that it 
 would necessarily entail : and it would be mere waste 
 of time to make any appeal to them on Christian 
 principles, or on the score of humanity. If, how- 
 ever, they could be persuaded to believe the well- 
 established fact, that money spent to guard against 
 disease, is the greatest economy; that prevention 
 is cheaper than cure ; and that a large amount of 
 the poor-rate is referrible to the item of disease
 
 2& 
 
 which Is preventible ; that it is a pecuniary mistake, 
 not to remedy a system attended by such disastrous 
 consequences, — and, moreover, if they would only 
 consider the inestimable value of health, how utterly 
 empty all other advantages are when that has gone, 
 and that there is nothing in this world that can 
 compensate for it — we might hojje to see some such 
 plan as I have endeavoured to sketch, adopted by 
 every board of guardians in populous districts 
 throughout England. 
 
 Many influential people are of opinion, that the 
 kind of work described should be done for love, and 
 not for money ; in fact, from religious motives 
 only. But if we look around and contemplate the 
 numerous religious sects and parties existing in this 
 country, and attended too by so much bitter animo- 
 sity, it will be granted by most unprejudiced 
 persons, that an element of failure would be intro- 
 duced which would be fatal. The duties of the 
 nurse should therefore be strictly confined to the 
 affairs of this present life, and she should be respon- 
 sible only to the committee who employed her. 
 Besides, in England we require to be paid for what 
 we do, and there are many objections to unpaid 
 labour, even if there was a sufficient supply of what 
 is required, which is not the case. There are very 
 few ladies who could undertake the menial duties 
 that would be required of them, and none at all 
 who are qualified for the work by special training. 
 After much thought, I believe that all ideas about 
 gratuitous services from religious motives, in con- 
 nexion with our public institutions, must be
 
 30 
 
 abandoned; as the system would be altogether 
 impracticable, and, as far as out-door work is con- 
 cerned, undesirable ; for it would be opposed to the 
 spirit of self-help and self-dependence. 
 
 I do not think it can be fairly said that I have 
 been exaggerating the importance of one peculiar 
 scheme of usefulness to the depreciation of others ; 
 for, after much consideration, I feel convinced, that 
 unless some such organised system as I have imper- 
 fectly indicated can be carried out on a large scale, 
 the question of im^^roving the sanitary condition of 
 the labouring poor is a hopeless one. I believe that 
 no other way can be devised so likely to overcome 
 the gross ignorance of the laws of health among the 
 industrial classes ; and that no machinery can be 
 planned so likely to conquer the steady and deter- 
 mined opposition to all improvement, which always 
 accompanies ignorance. 
 
 If the clergy, ladies, and other benevolent per- 
 sons, are to be anything more than relieving officers 
 to the poor, they will cease to waste so much of 
 their time and money in giving casual relief in a 
 hap-hazard way, which encom-ages nothing but beg- 
 gary; and if they will devote their money and 
 benevolent zeal to forming and efficiently carrying 
 out some well-considered scheme on the principles I 
 have tried to advocate, I will venture to assert 
 that marked results would follow their efforts. 
 Neatness and cleanliness of the dwelling, as well as 
 of the person, might in time be reasonably looked 
 for. Food would be prepared in a way to nom'ish 
 and sustain, instead of being the fruitful cause of
 
 31 
 
 indigestion, and the train of evils that follow in its 
 wake. The importance of fresh air and ventilation 
 would be perseveringly dwelt upon ; the rules for 
 preserving health would be explained and made 
 intelligible ; in fact, some improvement of the home 
 would be accomplished ; and a pleasant home life is 
 indeed everything, for, without it, I believe it to be 
 utterly useless to take any steps towards the moral 
 improvement of the working classes. The advan- 
 tages to those benefits would be so ajiparent, that 
 their example would be gradually followed, for 
 example is more eloquently persuasive than speech. 
 The poor would, after a time, find that it was their 
 interest, in every possible way, to adopt every 
 possible sanitary improvement. 
 
 By thus co-operating, we may minimize the exist- 
 ing causes of misery and suffering, and we may be 
 able to counteract the evils, and check their rate of 
 increase. And by so doing, we shall certainly save 
 many unfortunate men and women, otherwise 
 doomed to disease, destitution, and death. And 
 this co-operation to teach the people how to live, 
 will help to nourish the spirit which should ever 
 urge us to love our neighbours as ourselves. More- 
 over, while we cheerfully and actively seek to carry 
 out those beneficent laws, by which we live and 
 move and have our being, and which give disease 
 if we live in opposition to them, and health if in 
 accordance with them, — we may insure to ourselves 
 a hopeful and contented spii'it, sustained by the 
 sense of doing our duty as well as we can, and by 
 so doing, we best prepare ourselves to submit cheer-
 
 32 
 
 fully to the decrees of Providence, and whatever 
 destiny may await us. 
 
 Not enjoyment, and not sorrow, 
 Is our destined end or way ; 
 
 But to act, that each, to-morrow 
 Finds us farther than to-day. 
 
 ' Let us, then, be up and doing. 
 With a heart for any fate ; 
 Still achieving, still pursuing, 
 Learn to labour and to wait." 
 
 Lotodon : Reed and Pardon, Printers, Paternoster Row.
 
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