District Nursing

In 1859, Mr William Rathbone of Liverpool, founded District Nursing, which he funded himself. He began in his own district with one trained nurse, a Mrs Robinson (she was the former private nurse of his late wife). The idea had come to him when his wife was ill, and he employed a nurse to look after her. He knew what a comfort it was for her to be nursed at home.

It was the fact that their was a shortage of trained nurses, that he wrote to Miss Nightingale asking her for help. She suggested that the Royal Liverpool Infirmary should be approached regarding the training of District Nurses. Mr Rathbone financed a nurse`s home built near Liverpool Hospital. Nurses were to be trained for both hospital and district nursing. He sent two ladies; Misses Merryweather to St Thomas`s as observers. Under the Merryweather Superintendence nurses were trained to work in the Liverpool Royal Infirmary and the eighteen districts which Liverpool was divided, with a nurse working in each.

Manchester and Salford followed on similar lines in 1864, and Leicester in 1867, while the East London Nursing Society, the first in London, was formed in 1868. In the same year “The London Biblewomen’s and Nurses’ Mission” was founded by Mrs Ranyard. Birmingham appointed its first nurse in 1870; Glasgow the pioneer of district nursing in Scotland, in 1875; and other towns about the same date.

Mr Rathbone`s district nursing was spreading to London. Miss Nightingale was unable to spend much time on District Nursing, although she had constant correspondence with Mr Rathbone. She felt that there had not been enough information to prove if a District Nursing Association was necessary. Miss Nightingale had a questioner printed to look at the current home nursing practises by various sisterhoods, religious organisations and other nursing associations.

The results of this survey appeared `The Report of the National Association for providing Trained Nurses for the sick poor
There were 26 District Nursing Institutions in London which included:

St John`s Sisterhood – trained at Kings College and Charing Cross Hospital
British Nursing Association – trained at Middlesex and Royal Free Hospital
East London Nursing Society – a years training at London Hospital
Bible Women Mission- trained at Guys
Milmay Park Institute – trained at Guys

Only 11 of the 26 Institutions provided trained nurses.

The foundation of the Metropolitan and National Nursing Association in London in 1874 gave a fresh impetus to the work of district nursing, and raised the standard by demanding higher social and educational qualifications in the nurses employed. It was initiated by the Order of St. John of Jerusalem, and Miss Lees (Mrs Dacre Craven). Miss Lees had made a full enquiry into the conditions of nursing in London and Provincial towns, and was appointed Superintendent of the Home, which was established at 23 Bloomsbury Square with the funds gathered through an appeal made by Miss Nightingale and Mr. Rathbone. This Association was the first which undertook to give nurses already trained in hospital the special district training necessary for their work. The probationers would serve an initial month in the Central Home, then trained in the hospital for a year then returning to the Central Home for specialised training.

Miss Nightingale felt it was important that District Nurses should be aware of the importance of their work. She was not there just to give gifts, but teach cleanliness and nursing. In 1882, she discovered that the District Nurses at Holloway near Lea Hurst her Derbyshire home, were taking paying patients, instead of doing their work. In 1876 she had written a pamphlet `On trained Nursing for the Sick Poor`.

In 1877 Homes were started in Holloway and Paddington, and a gradually increasing number of nurses began to be employed, until in 1887 Queen Victoria’s gracious gift of £70,000 (part of the Women’s Jubilee Offering) for the furtherance of district nursing consolidated the work and raised it from the sphere of individual effort to that of a national institution. A provisional Committee was formed including the Duke of Westminster, Sir Rutherford Alcock, and Sir James Paget, with whom were associated Mr William Rathbone and Mr Bonham Carter as Hon Secretaries; and it decided:

To train nurses in district work in order to supply affiliated Nursing Associations with thoroughly equipped workers
To supervise them and afterwards in their posts
To adopt the Metropolitan and National Nursing Association as the Central Training Home and the nucleus of district nursing throughout the Kingdom

The training was standardised; the high educational standard already in existence was maintained, and reformed methods were introduced.
By the Royal Charter which in 1889 incorporated Queen Victoria’s Jubilee Institute for Nurses, a link was formed with the ancient foundation of St. Katherine’s Royal Hospital, and the offices of the Institute were within its precincts till 1903, when this accommodation became too limited and larger premises were taken at 120 (and later at 58) Victoria Street. In 1904 a supplementary charter was granted by King Edward VII, by which Queen Alexandra, became Patron, and the official connection with St Katherine’s Hospital came to an end.

The pioneer of county nursing was the Rural Nursing Association which was started in the West of England in 1888 by Mrs Malleson, and the first County nursing Associations were those of Hampshire, founded in 1891, and Lincolnshire in 1894. These owe their inception to the increasing need for nurses and midwives in country district and their main objects are to provide improved means of nursing in their own homes those who are unable to employ a private nurse, and to supply certified midwives, by:

Encouraging the formation of local Nursing Associations throughout the country
Raising funds locally for training and support of nurses and midwives in the county
Seeking out and training suitable women either as Queen’s Nurses or as Village Nurse-Midwives
Supervising the work of the nurses in the county through a qualified Superintendent.
When a midwife settled in a district it was found that the whole population turned to her for advice and assistance in all cases of sickness. It was, therefore, not only desirable but very necessary that, in addition to midwifery training, she should be given instruction in elementary sick nursing, hygiene, the care of young children and similar subjects, and this was taken in hand by County Nursing Associations, with Plaistow as the chief training Home. The women selected for training as “Village Nurse-Midwives” were generally those belonging to the county in which they were to work. They were sent to areas where neither nor funds would permit of fully trained nurses being employed, or to work as assistants to Queen’s Nurses. They carried out their duties under the close supervision of Superintendent who was herself a thoroughly trained and experienced Queen’s Nurse.

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