expense of vital power to the sick. And so health-at-home
nursing means exactly the same proper use of the same
natural elements, with as much life-giving power as possible
to the healthy.
We have awakened, though still far from the mark, to the
need of training or teaching for nursing proper. But while
a large part of so-called civilization has been advancing
in direct opposition to the laws of health, we uncivilized
persons, the women, in whose hands rests the health of
babies, household health, still persevere in thinking health
something that grows of itself (as Topsy said, "God made
me so long, and I grow'd the rest myself"), while we don't
take the same care of human health as we do of that of our
igo Woman s Mission.
plants, which, we know very well, perish in the rooms, dark
and close, to which we too often confine human beings,
especially in their sleeping-roorns and workshops.
The life-duration of babies is the most " delicate test " of
health conditions. What is the proportion of the whole
population of cities or country which dies before it is five
years old? We have tons of printed knowledge on the
subject of hygiene and sanitation. The causes of enormous
child mortality are perfectly well known ; they are chiefly
want of cleanliness, want of fresh air, careless dieting and
clothing, want of white-washing, dirty feather-beds and
bedding in one word, want of household care of health. The
remedies are just as well known ; but how much of this know-
ledge has been brought into the homes and households and
habits of the people, poor or even rich ? Infection, germs,
and the like are now held responsible as carriers of disease.
" Mystic rites/' such as disinfection and antiseptics, take the
place of sanitary measures and hygiene.
The true criterion of ventilation, for instance, is to step
out of the bedroom or sick-room in the morning into the
open air. If on returning to it you feel the least sensation
of closeness, the ventilation has not been enough, and that
room has been unfit for either sick or well to sleep in. Here
is the natural test provided for the evil.
The laws of God the laws of life are always conditional,
always inexorable. But neither mothers, nor schoolmistresses,
nor nurses of children are practically taught how to work
within those laws, which God has assigned to the relations of
our bodies with the world in which He has put them. In
other words, we do not study, we do not practise the laws
which make these bodies, into which He has put our minds,
healthy or unhealthy organs of those minds ; we do not
practise how to give our children healthy existences.
It would be utterly unfair to lay all the fault upon us
women, none upon the buildings, drains, water-supply. There
are millions of cottages, more of town dwellings, even of the
rich, where it is utterly impossible to have fresh air.
As for the workshops, workpeople should remember that
health is their only capital, and they should come to an
understanding among themselves not only to have the means,
Sick-nursing and Health-nursing. 191
but to use the means to secure pure air in their places of
work, which is one of the prime agents of health. This
would be worth a " Trades Union," almost worth a strike.
And the crowded National or Board School in it how
many children's epidemics have their origin ! And the great
school dormitories ! Scarlet fever and measles would be no
more ascribed to " current contagion," or to " something being
much about this year," but to its right cause ; nor would
"plague and pestilence" be said to be "in God's hands,"
when, so far as we know, He has put them into our own.
The chief "epidemic" that reigns this year is "folly."
You must form public opinion. The generality of officials
will only do what you make them. You, the public, must
make them do what you want. But while public opinion, or
the voice of the people, is somewhat awake to the building
and drainage question, it is not at all awake to teaching
mothers and girls practical hygiene. Where, then, is the
remedy for this ignorance ?
Health in the home can only be learnt from the home and
in the home. Some eminent medical officers, referring to
ambulance lectures, nursing lectures, the fashionable hygienic
lectures of the day, have expressed the opinion that we do
no more than play with our subject when we "sprinkle"
lectures over the community, as that kind of teaching is not
instruction, and can never be education ; that as medicine
and surgery can, like nursing, only be properly .taught and
properly learnt in the sick-room and by the patient's side, so
sanitation can only be properly taught and properly learned
in the home and house. Some attempts have been made
practically to realize this, to which subsequent reference will
Wise men tell us that it is expecting too much to suppose
that we shall do any real good by giving a course of lectures
on selected subjects in medicine, anatomy, physiology, and
other such cognate subjects, all " watered down " to suit the
public palate, which is really the sort of thing one tries to do
in that kind of lectures.
It is surely not enough to say, "The people are much
interested in the lecture." The point is, Did they practise the
lecture in their own homes afterwards ? did they really apply-
192 Women's Mission.
themselves to household health and the means of improving
it ? Is anything better worth practising for mothers than the
health of their families ?
The work we are speaking of has nothing to do with
nursing disease, but with maintaining health by removing the
things which disturb it, which have been summed up in the
population in general as "dirt, drink, diet, damp, draughts,
But in fact the people do not believe in sanitation as
affecting health, as preventing disease. They think it is a
"fad" of the doctors and rich people. They believe in
catching cold and in infection, catching complaints from
each other, but not from foul earth, bad air, or impure water.
May not some remedy be found for these evils by direct-
ing the attention of the public to the training of health-
nurses, as has already been done with regard to the training
of sick-nurses ?
The scheme before referred to for health-at-home nursing
has arisen in connection with the newly-constituted adminis-
tration of counties in England, by which the local authority
of the county (County Council) has been invested by Act
of Parliament with extended sources of income applicable to
the teaching of nursing and sanitary knowledge, in addition
to the powers which they already possessed for sanitary
inspection and the prevention of infectious diseases. This
scheme is framed for rural districts, but the general principles
are also applicable to urban populations, though, where great
numbers are massed together, a fresh set of difficulties must
be met, and different treatment be necessary.
The scheme contemplates the training of ladies, so-called
health missioners, so as to qualify them to give instruction
to village mothers in: (i) The sanitary condition of the
person, clothes and bedding, and house. (2) The manage-
ment of health of adults, women before and after confine-
ments, infants and children. The teaching by the health
missioners would be given by lectures in the villages, followed
by personal instruction by way of conversation with the
mothers in their own homes, and would be directed to : (i)
The condition of the homes themselves in a sanitary point
of view ; (2) the essential principles of keeping the body in
Sick-nursing and Health-nursing. 193
health, with reference to the skin, the circulation, and the
digestion ; and (3) instruction as to what to do in cases of
emergency or accident before the doctor comes, and with
reference to the management of infants and children.
In the addendum to this paper will be found a scheme
for training health-at-home missioners, a syllabus of lectures
given by the medical officer to the health missioners, and a
syllabus of health lectures given by the health missioners to
IV. Dangers. After only a generation of nursing arise
the dangers : ( i ) Fashion on the one side, and its conse-
quent want of earnestness. (2) Mere money-getting on the
other. Woman does not live by wages alone. (3) Making
nursing a profession, and not a calling.
What is it to feel a calling for anything ? Is it not to do
our work in it to satisfy the high idea of what is the right,
the best, and not because we shall be found out if we don't
do it ? This is the " enthusiasm " which every one, from a
shoemaker to a sculptor, must have in order to follow his
" calling " properly. Now, the nurse has to do not with shoes
or with marble, but with living human beings.
How, then, to keep up the high tone of a calling, to
" make your calling and election sure " ? By fostering that
bond of sympathy (esprit de corps] which community of aims
and of action in good work induces. A common nursing
home in the hospital for hospital nurses and for probationer
nurses ; a common home for private nurses during intervals
of engagements, whether attached to a hospital, or separate ;
a home for district nurses (wherever possible), where four or
five can live together ; all homes under loving, trained, moral,
and religious, as well as technical, superintendence, such as
to keep up the tone of the inmates with constant supply of
all material wants and constant sympathy. Man cannot live
by bread alone, still less woman. Wages is not the only
question, but high home-helps.
The want of these is more especially felt among private
nurses. The development in recent years of trained private
nursing, z>. of nursing one sick or injured person at a time
at home, is astonishing. But not less astonishing the want
of knowledge of what training is, and, indeed, of what
194 Woman's Mission.
woman is. The danger is that the private nurse may become
an irresponsible nomad. She has no home. There can be
no esprit de corps if the " corps " is an indistinguishable mass
of hundreds, perhaps thousands, of women unknown to her,
except, perhaps, by a name in a register. All community of
feeling and higher tone absents itself. And too often the
only aim left is to force up wages. Absence of the nursing
home is almost fatal to keeping up to the mark. Night
nurses even in hospitals, and even district nurses (another
branch of trained nursing of the sick poor without alms-
giving, which has developed recently),* and, above all, private
nurses, deteriorate if they have no esprit de corps, no com-
mon home under wise and loving supervision for intervals
between engagements. What they can get in holidays, in
comforts, in money, these good women say themselves, is an
increasing danger to many. In private nursing the nurse
is sometimes spoilt, sometimes " put upon," sometimes both.
In the last few years, private trained nursing, district
trained nursing, have, as has been said, gained immeasurably
in importance, and with it how to train, how to govern (in
the sense of keeping up to the highest attainable in tone and
character, as well as in technical training), must gain also
immeasurably in importance, must constitute almost a new
starting-point. Nursing may cease to be a calling in any
better sense than millinery is. To have a life of freedom,
with an interesting employment, for a few years to do as
little as you can and amuse yourself as much as you can, is
possibly a danger pressing on.
(4) There is another danger, perhaps the greatest of all.
It is also a danger which grows day by day. It is this : as
literary education and colleges for women to teach literary
work start and multiply and improve, some, even of the
very best women, believe that everything can be taught by
book and lecture, and tested by examination that memory
is the great step to excellence.
Can you teach horticulture or agriculture by books, e.g.
describing the different manures, artificial and natural, and
their purposes ? The being able to know every clod, and
adapt the appropriate manure to it, is the real thing. Could
* See Addendum.
Sick-nursing and Health-nursing. 195
you teach painting by giving, e.g., Fuseli's " Lectures " ? Fuseli
himself said, when asked how he mixed his colours, " With
brains, sir " that is, practice guided by brains. But you have
another, a quite other sort of a thing to do with nursing ;
for you have to do with living bodies and living minds, and
feelings of both body and mind.
It is said that you give examinations and certificates to
plumbers, engineers, etc. But it is impossible to compare
nurses with plumbers, or carpenters, or engineers, or even
with gardeners. The main, the tremendous difference is that
nurses have to do with these living bodies and no less living
minds ; for the life is not vegetable life, nor mere animal life,
but it is human life with living, that is, conscious forces,
not electric or gravitation forces, but human forces. If you
examine at all, you must examine all day long, current
examination, current supervision, as to what the nurse is
doing with this double, this damaged life entrusted to her.
The physician or surgeon gives his orders, generally his
conditional orders, perhaps once or twice a day, perhaps not
even that. The nurse has to carry them out, with intelligence
of conditions, every minute of the twenty-four hours.
The nurse must have method, self-sacrifice, watchful
activity, love of the work, devotion to duty (that is, the
service of the good), the courage, the coolness of the soldier,
the tenderness of the mother, the absence of the prig (that is,
never thinking that she has attained perfection or that there
is nothing better). She must have a threefold interest in her
work an intellectual interest in the case, a (much higher)
hearty interest in the patient, a technical (practical) interest in
the patient's care and cure. She must not look upon patients
as made for nurses, but upon nurses as made for patients.
There may also now I only say may with all this depend-
ence on literary lore in nurse-training, be a real danger of
being satisfied with diagnosis, or with looking too much at
the pathology of the case, without cultivating the resource or
intelligence for the thousand and one means of mitigation,
even where there is no cure.
And never, never let the nurse forget that she must look
for the fault of the nursing, as much as for the fault of the
disease, in the symptoms of the patient.
196 Woman s Mission.
(5) Forty or fifty years ago a hospital was looked upon
as a box to hold patients in. The first question never was,
Will the hospital do them no harm ? Enormous strides have
had to be made to build and arrange hospitals so as to do
the patients no sanitary or insanitary harm. Now there is
danger of a hospital being looked upon as a box to train
nurses in. Enormous strides must be made not to do them
harm, to give them something that can really be called an
" all-round " training.
Can it be possible that a testimonial or certificate of three
years' so-called training or service from a hospital any
hospital with a certain number of beds can be accepted as
sufficient to certify a nurse for a place in a public register ?
As well might we not take a certificate from any garden of
a certain number of acres, that plants are certified valuable
if they have been three years in the garden.
(6) Another danger that is, stereotyping, not progress-
ing. " No system can endure that does not march." Are we
walking to the future or to the past ? Are we progressing
or are we stereotyping ? We remember that we have
scarcely crossed the threshold of uncivilized civilization in
nursing : there is still so much to do. Don't let us stereo-
To sum up the dangers :
i. On one side, fashion, and want of earnestness not
making it a life, but a mere interest consequent on this.
ii. On the other side, mere money-getting ; yet man does
not live by bread alone, still less woman.
iii. Making it a profession, and not a calling. Not making
your " calling and election sure ; " wanting, especially with
private nurses, the community of feeling of a common
nursing home,* pressing towards the "mark of your high
calling," keeping up the moral tone.
iv. Above all, danger of making it book-learning and
lectures not an apprenticeship, a workshop practice.
v. Thinking that any hospital with a certain number of
beds may be a box to train nurses in, regardless of the
* In the United States it is probable that private nurses are of higher edu-
cation than in England. On the other hand, they have the doubtful dignity of
Sick-nursing and Health-nursing. 197
conditions essential to a sound hospital organization, especially
the responsibility of the female head for the conduct and
discipline of the nurses.
vi. Imminent danger of stereotyping instead of progress-
ing. " No system can endure that does not march." Objects
of registration not capable of being gained by a public
register. Who is to guarantee our guarantors ? Who is to
make the inquiries ? You might as well register mothers as
nurses. A good nurse must be a good woman.
V. The health of the unity is the health of the com-
munity. Unless you have the health of the unity there is
no community health.
Competition, or each man for himself, and the devil
against us all, may be necessary, we are told, but it is the
enemy of health. Combination is the antidote combined
interests, recreation, combination to secure the best air, the
best food, and all that makes life useful, healthy, and happy.
There is no such thing as independence. As far as we are
successful, our success lies in combination.
The Chicago Exhibition is a great combination from all
parts of the world to prove the dependence of man on man.
What a lesson in combination the United States have
taught to the whole world, and are teaching !
In all departments of life there is no apprenticeship except
in the workshop. No theories, no book-learning can ever
dispense with this or be useful for anything, except as a
stepping-stone. And rather more, than for anything else, is
this true for health. Book-learning is useful only to render
the practical health of the health workshop intelligent, so
that every stroke of work done there should be felt to be an
illustration of what has been learnt elsewhere a driving
home, by an experience not to be forgotten, what has been
gained by knowledge too easily forgotten.
Look for the ideal, but put it into the actual. " Not by
vague exhortations, but by striving to turn beliefs into
energies that would work in all the details " of health. The
superstitions of centuries, the bad habits of generations,
cannot be cured by lecture, book, or examination.
VI. May our hopes be that, as every year the technical
qualifications constituting a skilful and observing nurse meet
198 Woman's Mission.
with more demands on her from the physicians and surgeons,
progress may be made year by year, and that, not only in
technical things, but in the qualifications which constitute a
good and trustworthy woman, without which she cannot be
a good nurse. Examination papers, examinations, public
registration, graduation, form little or no test of these quali-
fications. The least educated governess, who may not be a
good nurse at all, may, and probably will, come off best in
examination papers ; while the best nurse may come off
worst. May we hope that the nurse may understand more
and more of the moral and material government of the
world by the Supreme Moral Governor, higher, better,
holier than her " own acts," that government which enwraps
her round, and by which her own acts must be led, with
which her'own acts must agree in their due proportion, in order
that this, the highest hope of all, may be hers ; raising her
above, i.e. putting beneath her, dangers, fashions, mere money-
getting, solitary money-getting, but availing herself of the
high helps that may be given her by the sympathy and
support of good " homes ; " raising her above intrusive per-
sonal mortifications, pride in her own proficiency (she may
have a just pride in her own doctors and training-school),
sham, and clap-trap ; raising her to the highest " grade " of
all to be a fellow-worker with the Supreme Good, with God !
That she may be a " graduate " in this, how high ! that she
may be a "graduate " in words, not realities, how low !
We are only on the threshold of nursing.
In the future, which I shall not see, for I am old, may a
better way be opened ! May the methods by which every
infant, every human being, will have the best chance of
health the methods by which every sick person will have
the best chance of recovery, be learned and practised !
Hospitals are only an intermediate stage of civilization,
never intended, at all events, to take in the whole sick
May we hope that the day will come when every mother
will become a health-nurse, when every poor sick person will
have the opportunity of a share in a district sick-nurse at
home ! But it will not be out of a register ; the nurse will
not be a stereotyped one. We find a trace of nursing here,
Sick-nursing and Health-nursing. 199
another there ; we find nothing like a nation, or race, or
class who know how to provide the elementary conditions
demanded for the recovery of their sick, whose mothers know
how to bring up their infants for health.
May we hope that, when we are all dead and gone, leaders
will arise who have been personally experienced in the hard,
practical work, the difficulties and the joys of organizing
nursing reforms, and who will lead far beyond anything we
have done ! May we hope that every nurse will be an atom
in the hierarchy of the ministers of the Highest ! But then
she must be in her place in the hierarchy, not alone, not an
atom in the indistinguishable mass of the thousands of nurses.
High hopes, which will not be deceived !
It is necessary to say a word about district nursing, with its
dangers like private nursing, and its danger of almsgiving.
District nurses nurse the sick poor by visiting them in their
own homes, not giving their whole time to one case, not
residing in the house. They supply skilled nursing without
almsgiving, which is incompatible with the duties of a skilled
nurse, and which too often pauperizes the patient or the
patient's family. They work under the doctor, who, however,
rarely comes more than once a day, if so often. The district
nurse must be clinical clerk, and keep notes for him, and
dresser as well as nurse. She must, besides, nurse the room
often in towns the family's only room that is, put it in good
nursing order, as to ventilation, cleanliness, cheerfulness for
recovery ; teach the family, the neighbour, or the eldest child
to keep it so ; report sanitary defects to the proper authority.
If the patient is the wage-earner, and the case is not essen-
tially one for the hospital, she often thus prevents the whole
family from being broken up, and saves them from the work-
house. If essentially a case for the hospital, she promotes its
Though the district nurse gives nothing herself, she knows,
or ought to know, all the local agencies by whom indispen-
2OO Woman's Mission.
sable wants may be supplied, and who are able to exercise a
proper discrimination as to the actual needs.
Having few or no hospital appliances at her disposal, she
must be ingenious in improvising them.
She must, in fact, be even more accomplished and respon-
sible than a nurse in a hospital.
She may take, perhaps, eight cases a day, but must never
mix up infectious or midwifery nursing with others.
She must always have the supervision of a trained
superior. She should, whenever possible, live in a nursing
home with other district nurses, under a trained super-
intendent, not in a lodging by herself, providing for herself,
and so wasting her powers and deteriorating. This is, of
course, difficult to manage in the country, and especially in a
sparsely populated country, e.g. like Scotland. Still approxi-
mations may be made ; e.g. periodical inspection may take the
place of continuous supervision. She also should be a health
missioner as well as a sick-nurse.
The scheme for health-at-home training and teaching to
health missioners may be summarized as follows :
(1) A rural medical officer of health selected by the proper
local authority for his fitness and experience.