Fantastic Finds for Friday: A Letter from Florence Nightingale

Florence Nightingale's signature from her letter to Dr Heywood Smith, 1876.
Florence Nightingale’s signature from her letter to Dr Heywood Smith, 1876.

This month’s Fantastic Find comes courtesy of the ‘Lady of the Lamp’.

There are few nurses more well known than Florence Nightingale (12 May 1820 – 13 August 1910). Venerated as a hero of the Crimean War for her management of nurses treating wounded soldiers, Nightingale was also an author. Her book Notes on Nursing: What it is and What it is Not (originally published in 1859) offered guidance to ordinary people on good practice when nursing the sick and injured, covering the importance of hygiene and responsible bedside manner.

Florence Nightingale also had a special interest in hospital design, especially with a view to preventing cross-infection between patients. Our library holds a copy of another of her books titled: Introductory notes on lying-in institutions: together with a proposal for organising an institution for training midwives and midwifery nurses, published in 1871.

Lying in is a historical term for the period after childbirth where a new mother was placed on bedrest. Lying-in hospitals were maternity hospitals where women would receive dedicated care during pregnancy, labour and during the antenatal period. Lying-in hospitals for the care of mothers after childbirth originated in 1739 with the foundation of the General Lying-in Hospital which later became Queen Charlotte’s Hospital, London. Many others followed over the next 50 years including those in Edinburgh, Dublin, Winchester, Bristol and York.

Our copy of her 1871 book was originally gifted to Dr Heywood Smith (1837-1928) from Nightingale and is inscribed by her. Dr Smith was an Oxford educated gynaecologist who became senior physician in the British Lying-In Hospital.

The title page of Nightingale's book Introductory notes on lying-in institutions: together with a proposal for organising an institution for training midwives and midwifery nurses, published in 1871. The inscription reads: ‘Offered to Dr Heywood Smith with the earnest hope and prospect of his invaluable exertions in the training of real midwives and in the formation of real and healthy [Lying-In Institutions]. With sincere gratitude for his proffered help, by Florence Nightingale, London: 1876.’
The title page of Nightingale’s book Introductory notes on lying-in institutions: together with a proposal for organising an institution for training midwives and midwifery nurses, published in 1871. The inscription reads: ‘Offered to Dr Heywood Smith with the earnest hope and prospect of his invaluable exertions in the training of real midwives and in the formation of real and healthy [Lying-In Institutions]. With sincere gratitude for his proffered help, by Florence Nightingale, London: 1876.’
In her book, Nightingale discusses the maternal death statistics of lying-in institutions and makes suggestions, with accompanying plans, for changes to hospital layouts which could reduce rates of infection and maternal death.

When it reached our collection the book was accompanied by a letter to Dr Smith (dated 10 May 1876) written by Nightingale from her home in Park Lane, London, in response to his previous correspondence with her concerning the provision of midwifery training and instruction to women. This remarkable correspondence includes comments on statistics of deaths at lying-in institutes and the possibility of women being allowed to supersede men in midwifery practice. The letter is held in the archive collections of the RCOG and was donated (along with the book) to the College by Edward Protheroe Smith in 1933.

Referencing the shocking rates of maternal death in London hospitals Nightingale writes:

(It may be asked by some – but it is -perhaps an invidious question – what is the use of bringing these cases in at if they are only to die?)

Reflecting her reputation for pragmatism, she also makes a point of focusing on rectifying the lack of training available to female midwives and nurses before all else. Of medical practitioners she writes:

At any rate, at present, need we trouble ourselves about the men, or about their means of training? For they have some and good: the women have none – none that is, that you would condescend to call by that name.

Another interesting aspect of her letter is her repeated reference to her published text as her ‘little book’. Whether a term of endearment to her own work or an effort to keep from rousing controversy among the male-led medical establishment we cannot be sure. One thing her letter suggests, however, is that she knew the importance of getting established practitioners like Dr Smith on her side if she wanted to make progress with her work to improve conditions in maternity wards. In her letter she writes:

My little book which you are kind enough to notice was simply a sort of guide post, based on melancholy experience – a sort of Town Crier, inviting further consideration -begging and crying out for further statistics, especially from men of weight like yourself.

A full transcript of the letter can be found below:

Lying-in Institution. 35 South Street, -Park Lane, W.

May 10, 1876.

Heywood Smith, Esq., M.D., M.Ch.

Dear Sir,

I trust that you will excuse me, under the severe pressure of business and illness, from not answering, as I should have wished, your long and valuable letter of April 15 before this.

It was not from want of interest in it: I feel so humbly glad to find Physicians of eminence interested in the subject of giving first rate midwifery instruction and training to women: an object so very near my heart.

You could do so much to induce the Medical profession to turn their attention in the right direction, as regards the training of Midwives.

  1. I have always believed that the British Lying-in Hospital was on the whole a very much better specimen than others, especially in its management. To this I eagerly assent.

My little book which you are kind enough to notice was simply a sort of guide post, based on melancholy experience – a sort of Town Crier, inviting further consideration -begging and crying out for further statistics, especially from men of weight like yourself.

  1. But are not the considerations which you bring forward to combat the conclusions in that little book as to Lying-in Death-rates suppositions only: whereas those in the book are based upon facts?
  2. More accurate statistics are most important: in fact one of the main objects of my “Notes” was to invite these as materials for further investigation and consideration.

But at present is there anything in what you allege sufficient to alter the general conclusion as to the inexpediency of the present system of Lying-in Hospitals?

  1. With regard to severe abnormal cases being “sent in by Medical Men” and thus increasing the mortality, the effect of course can be proved by the facts, if properly recorded: and this, the urging that accurate and detailed statistics should be kept and published, so as that we show know whether these cases exist to swell the death rate, was again one of the main reasons for publishing the little book.

(It may be asked by some – but it is -perhaps an invidious question – what is the use of bringing these cases in at if they are only to die?)

  1. With regard to your valuable remarks as to the Medical treatment of the Patients in the British Lying-in Hospital, I can only thank you for these, for I have purposely for obvious reasons avoided entering into any discussion of Medical Questions.
  2. Lay not the question as to whether women are to be allowed to operate, or whether women are ever likely to super-sede men altogether in midwifery practice, be deferred sine die? Let ‘us’ – I am so proud to be able to say ‘us’ in a question of this kind, as including such a Coadjutor or rather Leader as yourself – let us first get the means of training women established on something like a common sense footing. Ought there to be any difficulty in having if need be, separate schools for women and men?

At any rate, at present, need we trouble ourselves about the men, or about their means of training? For they have some and good: the women have none – none that is, that you would condescend to call by that name. Earnestly thanking you for your letter and most earnestly looking forward to your invaluable efforts and to your success in this cause, which it rejoices me beyond anything to find is yours. Pray believe me, dear Sir, ever your faithful servant.

Florence Nightingale.

I shall certainly keep your kind offer of an “interview” as a pledge that I may call upon your goodness for one, at your convenience when I am a little less over-wrought.

May I venture to enclose a copy of my little book for your kind acceptance?

F.N.

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