William Rathbone had written to Florence Nightingale about a staff of trained nurses being sent to the Liverpool Workhouse Infirmary. It would not be easy as the Vestry also controlled the Workhouse Infirmary. It was not until March 1865 that permission was given for nurses to work in the Liverpool Workhouse Infirmary. Two month later in May 1865 Miss Agnes Jones and twelve nurses arrived.
Miss Nightingale sent Agnes Jones to act as Superintendent. She was the daughter of Colonel Jones of Londonderry. She had spent two years at Kaiserwerth (1860 – 62), and entered the Nightingale School at St Thomas’s in 1863. On completing her training she went to the Great Northern Hospital. She tried hard to train the workhouse women to become nurses, and even arranged for them to be paid. They failed to learn anything, and could not be trusted to carry out anything without supervision. It was pointless trying to train them, so trained nurses were bought in. By 1868 she became run down (after 3 years at Brounlow). She refused to rest, and caught typhus fever and died (February 19th 1868).
Agnes Jones’s job would not be easy. The Infirmary contained 1350 patients rising at times to 1500. Her position and powers were not properly defined, the supply of food was undertaken by contract, which the doctors had no control of. She would quarrel with the governor of the Infirmary, although he supported the scheme. He felt she was too strict, and unpractical. Miss Nightingale had to intervene, and under her influence Agnes became less rigid, and changes soon took place. Even the vestry agreed that the pauper sick were better off being nursed by trained nurses. Miss Nightingale felt that it would be impossible to improve the workhouses and workhouse infirmaries, unless changes were made through an Act of Parliament. She approached Lord Palmerston directly, as she felt the Poor Law Board could never produce the necessary legislation. Lord Palmerston said that if she were to draft a bill, he would use his influence to get it through Cabinet, but this was not to be as he died on October 17th 1865
Miss Nightingale had been working on her workhouse reform with Mr Farnall the Poor Law Inspector of the Metropolitan District. With the death of Lord Palmerston, she would have to depend on the Poor Law Board and Mr Villiers. During the Autumn of 1865 she worked on a long memorandum for Mr Villiers, dealing with workhouse nursing, workhouse schools and requirements of administration and finance in workhouse infirmaries in the Metropolitan area (this was intended to be extended to other areas at a later date). She had based her scheme on three essentials which she called the ABC of workhouse reform.
The sick, insane, incurable and children must be dealt with separately in proper institutions and not mixed up together in infirmaries and sick wards as at present. The care and government of the sick poor is a thing totally different from the government of paupers. Why do we have |Hospitals in order to cure, and Workhouse Infirmaries in order not to cure- Taken solely from the point of view of preventing pauperism what a stupidity and anomaly this is! . . You must have two kinds of administration, one for sick, for infirm, aged and imbeciles and above all for children and another for paupers. Once acknowledge this principle and you must have suitable establishments for the cure of the sick and infirm.
There must be a single central administration. The entire Medical Relief of London should be under one central management which would know where vacant beds were to be found, and be able to distribute the Sick etc., as to use all the establishments in the most economical way.
For the purpose of providing suitable establishments for the care and treatment of the Sick, Insane etc., Consolidation and a General Rate are essential.
Mr Villiers received the memorandum in December, and he agreed to try at once for a new London Poor Law Bill. It seemed as though she was going to be successful, the `Lancet` sent a commissioner to enquire into the state of the London workhouse infirmaries, and as a result the `Association for the Improvement of the London Infirmaries of London Workhouses` was formed. But it was not going quite to plan as she thought, the Whig government was tottering, and Workhouse infirmary reform was a controversial subject. On June 18th the Government fell, and Mr Villiers was out of office.
Mr Gathorne Hardy was to be Mr Villiers successor on the Poor Law Board. He wanted nothing to do with Miss Nightingale and her reformers, and told them he was occupied with other business. She felt he was not on the side of reform, and to prove this even further, he had removed Mr Farnall from his post at Whitehall, and sent him to Yorkshire. A committee was appointed containing sanitary and medical experts, he did not consult Miss Nightingale. Douglas Galton was on the Committee, so she wrote to him, to ask if he would put her name forward. The committee asked her to submit a paper on nursing, this she did, putting forward her scheme of workhouse reform. She had her paper printed and sent a copy to Mr Gathorne Hardy, but still he neither consulted her, nor informed her of what he was going to do. It therefore was a surprise when in March 1867, a Bill introduced in February, became law, under the title of the `Metropolitan Poor Act`.
Miss Nightingale felt that this Act was the beginning, and more reforms could be made. Lunatics, fever, smallpox cases and remaining children were removed from the Workhouse, providing for them out of a common fund. Salaries for Medical Officers, Matrons and Nurses were paid for out of a Metropolitan rate, and not parochial. Any other sick paupers were to be removed to a separate building. The Act also established a fund for the ‘Metropolitan Common Poor Fund’ for the maintenance of asylums for the aged and insane, the cost of medicines and the maintenance of children in pauper schools.