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cence noted. She described the pleasure she had in being ‘‘allowed’’ to visit Nightingale every year: She used to receive me in her charming room at 10, South Street. She was lying on a sofa, and I used to sit beside her and answer her questions and tell her all about my work. This went on for years. Her memory was wonderful and her interest never failed. Gradually , however, her increasing age became very noticeable, as she was both physically and mentally weaker. Hughes characteristically ended on a more positive note, quoting from a letter Nightingale had sent Florence Nightingale Shore: I think district work brings one more in heartfelt contact with one’s fellow creatures than anything else. And when one knows that doctors who know say that the mere visits of the nurses diminish the mortality, one thanks God Who puts such Godlike powers into our hands, provided they are genial hands.127 A note to Hughes in 1900 thanked her for a red rose tree: Wishing all joy to the co-operatives (is the red rose tree a co-operative?) I am all yours. . . . I hope the co-operative nurses approved their new quarters on inspection and their nice little separate rooms. God speed them all.128 Extending District Nursing in Britain Editor: Separate sections are provided here with material on the introduction of district nursing to areas outside London, elsewhere in England , then to Scotland, Ireland, Germany and Canada, with a brief miscellaneous section at the end. Birmingham Source: From a letter to Mrs G.C. Matthews, Boston University 1/4/55 7 November 1868 Private. I feel some difficulty, in answering your note, from the want of any definite question to answer. Every institution in the world that has succeeded has begun from a very small beginning—enlarging as it gathered experience—and almost 127 Undated late note, Wellcome Ms 5478/20. 128 Letter 17 May 1900, Wellcome Ms 5478/18. District Nursing / 853 always through the efforts of one or two devoted practical persons who have worked on in obscurity till they could command the sympathy and support of their fellow residents. The Liverpool institution to which you allude began and worked for years before it commanded the ‘‘public feeling’’ to which you refer, and was supported by one solitary individual [William Rathbone ] till it attained the power of securing ‘‘the large amount of expenditure ’’ which you mention. I presume, from your reference to Liverpool, that the ‘‘Training School for Nurses in Birmingham’’ is likewise to send out district nurses for the poor. May I mention, as you ask my advice, that it is a condition which, according to my experience, is indispensable, that the nurses must be trained and live in the hospital under the eye of their own trained lady superintendent, who must therefore have a certain jurisdiction in the hospital, and that the house which is to be ‘‘hired’’ for them must be in the immediate neighbourhood of the hospital where they are trained, as is the case at Liverpool. This is a ‘‘must,’’ not ‘‘may.’’ All other training is a mere fiction, experience tells us. And there must be tests and a regular organized system to secure and to ascertain the progress of each nurse’s training , as she goes through her courses. I venture to send you a paper (which I wrote by order of the Poor Law Board) which, although not strictly applicable for your purpose, inasmuch as it is chiefly for hospital and workhouse nurses, nevertheless may contain some hints which may be useful. Manchester Editor: Primary sources are largely lacking on district nursing in Manchester , as well as for hospital and workhouse infirmary work there. A secondary source states that four women destined for district work ca. 1867 went from Manchester for training at St Thomas’ and King’s College Hospital, paid for by the Nightingale Fund.129 Correspondence has been reported above with one major matron, C.E. Barff, as superintendent of the Manchester and Salford Sick Poor and Private Nursing Institute (see p 814 above). When she left to marry, Nightingale received a request for a replacement (first item below). She consulted Henry Bonham Carter and Amy Hughes about a successor. 129 Leeson, ‘‘District Nursing in Manchester Ninety Years Ago.’’ 854 / Florence Nightingale: Extending Nursing Source: From a draft letter to Louisa Potter, Add Mss 45812 f170 26 July [1894] Dear Madam, In answer to your note,130 most earnestly...


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