Sir,
I am afraid you will think my writing to you an impertinence in any case.
I am not sure that I should much diminish that impertinence by enclosing
letters of introduction from "mutual" friends.
I prefer launching at once into my only real excuse for writing to you on the
reform of Workhouse Infirmaries, which is: - that I have been in communication with
the Poor Law Board for some time past on the subject -
besides having had opportunities of discussing it with Mr. Villiers personally.
But my immediate reason for assaulting you at such short notice is the reading of
Dr. Edward Smith's report. And I need scarcely say that if I agreed with its practical proposals,
I should probably be the only person who did. He appears to be unacquainted with the
centuries of consecutive experience which have led to the adoption of a certain minimum
of space for the sick. And he rests his argument for returning to the hospital construction
of the middle ages on certain experiments of Dr. Angus Smith as to the amount of carbonic
acid in sick wards, which are not new, and
which moreover have little or nothing to do with the question at issue.
The proposal made by the chief leading medical authorities in London to Mr. Villiers to give
1,000 cubic feet per bed remains in no sense invalidated by
Dr. Edward Smith's report.
Also, Dr. E. Smith appears not to have sufficiently considered the fact that, when
extensive alterations and additions have to be made to defective buildings, it becomes
really more economical to build anew -
and thus to introduce all the known and established principles of healthy construction into the plans.
In as far as regards the nursing and management of sick in workhouses, I speak from a
life experience - and say that if any improvement in this direction is to be carried out,
it must be done under a separate organization and management from that of the workhouse.
You may perhaps also be aware that, at the Liverpool workhouse, - by the munificence of
Mr. William Rathbone - an experiment is being tried of introducing trained nurses and training
others in the infirmary. We (i.e. the Nightingale Training School) supplied a Lady
Superintendent and twelve Head Nurses for the purpose. [This has been at work above a year.]
The Liverpool workhouse governor is an excellent officer - the committee in charge are willing.
But we have had practical experience already that, altho? the nursing has been a success, the
administration has been far from satisfactory. And all sides, I believe, consider that the
best thing to
do would be to separate the sick administration altogether from the workhouse administration.
The main object we had in trying this experiment was to introduce trained nursing into
the London workhouses. But, unless the administrative and structural
improvements required are carried out, it will be absolutely useless to make the attempt.
The antecedents of all the London workhouse authorities appear to be opposed to improvement
- and this difficulty can only be overcome by beginning from the foundation - Classification of
workhouse inmates - Separation of the sick - Consolidation of sick wards into hospitals with a
separate administration
- are absolutely necessary to success.
These opinions I have already expressed both to Mr. Villiers and Mr. Farnall. And if I
could venture to hope that you might think me capable of rendering you even the slightest
assistance in the great work on which you are about to enter, I need hardly say that I should
esteem it a privilege to be called upon by you and do so,
as far as my feeble health (for I am entirely a prisoner to my room from illness) will enable me.
I beg that you will believe me sir, with great truth,
Your very faithful servant,
Florence Nightingale
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