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District Nursing ‘‘D istrict nursing’’1 in Nightingale’s time referred to the provision of professional nursing care in the patient’s own home, for people unable to pay for private care: the ‘‘sick poor.’’ This sort of home care was an essential component of her vision of a comprehensive system of health care: ‘‘Till we nurse not only the sick poor in workhouses but those at home we have done nothing effectual in nursing.’’ A letter Nightingale wrote William Farr in 1867 similarly stated that ‘‘Till we have such district nursing in London we shall have done nothing, even when we have reformed all the hospitals and all the workhouses.’’ She had always concurred with him that ‘‘hospitals belong to a stage of imperfect or rather of non-civilization.’’2 ‘‘I look to the abolition of all hospitals and all workhouse infirmaries,’’ again Nightingale firmly declared, looking forward to the year 2000! (see p 720 below). In her introduction to William Rathbone’s book on the subject, Nightingale went so far as to call district nursing ‘‘that most important of all its branches’’ of nursing (see p 259 above). Quantitatively there is much less material for district nursing than for hospital nursing, but this is not an indication of its importance in the overall establishment of the nursing profession. The district nurse was a ‘‘fellow worker with Providence ,’’ as Nightingale told the Diocese of Durham (see p 802 below). Nightingale considered it essential that district nurses be hospital trained, for it was only in a hospital that they could be acquainted with the range of serious illnesses and surgical cases. That district nursing 1 For background see Mary Stocks, A Hundred Years of District Nursing; Zachary Cope, ‘‘The Early History of District Nursing,’’ Nursing Times 12 August 1955:884-87; Edwin A. Pratt, Pioneer Women in Victoria’s Reign, Being Short Histories of Great Movements; and Gwen Hardy, William Rathbone and the Early History of District Nursing. 2 Letter to William Farr 22 May 1867, Wellcome Ms 5474/115. / 707 could only be established after hospital nursing was reformed was only tactical, to Nightingale. Hospitals and workhouses had to be reformed first, to provide places for nurses to be trained. Conceptually district nursing was ‘‘the final and paramount object to be attained’’ (see p 390 above). Looking back later in life and regarding an extension of district nursing, she told her great collaborator, William Rathbone that ‘‘We pray God that it may succeed, but we know already that He wishes the greatest good to this nursing of His sick poor, even more than we can. In Him therefore who inspires you we put our trust’’ (see p 809 below). People with the means to employ a private nurse did so, which was a challenge to Nightingale as she saw private nursing as skimming off the cream of the available skilled nurses. An added irritant was the fact that those nurses were often trained by the Nightingale Fund, which was intended to provide care for the sick poor. The provision of home nursing to the poor entailed the creation of some kind of an agency, often a voluntary organization, that employed the nurses. The nurses then went out to the patients, normally to a number of different homes every day. It was William Rathbone who first approached Nightingale with a proposal that would eventually lead to such a district nursing scheme in Liverpool. He realized that the nursing care his terminally ill wife had received (she died in 1859) had been enormously helpful, and he wanted that opportunity to be extended to others.3 He consulted with Nightingale, but surviving correspondence from this period is spotty. He hired the private nurse, Mary Robinson, who had looked after his wife, to go out to nurse the sick poor. Acting on Nightingale’s proposals he established a training school and nurses’ home, attached to the Liverpool Royal Infirmary, as discussed above. There were discussions with Agnes Jones about undertaking this work (she later superintended the workhouse infirmary) but discussion came to nothing at this early stage. Mary Jones, for one, thought Agnes Jones unsuitable by reason of her outspoken and (then) anti-Catholic evangelicalism (Liverpool had a substantial Catholic population). 3 William Rathbone, ‘‘Reminiscences of Miss Nightingale: Her Principles, Work and Powers,’’ undated typescript, Wellcome SA/QNI/P.10/4; see also Cope, ‘‘The Early History of District Nursing’’; Frederick F. Cartwright, ‘‘Nightingales and Eagles: The Reform of British...


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