This week we arrive in Liverpool, England circa 1859 and the creation of the first of district nursing program, upon which Abbie Howes and Phebe Adam modeled the Instructive District Nursing Association of Boston in 1886. William Rathbone VI (Feb 1819 – Mar 1902), of the Rathbone family featured in last week’s blog, is considered to be the founder of modern district nursing, and the focus of this week’s post.
In 1859, Rathbone’s first wife became gravely ill and he hired a nurse, Mary Robinson, who came into their home and greatly eased the pain and suffering of her last days. It occurred to Rathbone that this service would provide tremendous relief to the sick poor whose difficult and harsh lives often prevented them from seeking medical care. He asked Robinson if she would be willing to take part in a 3 month trial of nursing the sick poor in their homes, a pilot which he would organize and fund. She agreed and Rathbone set about arranging for the necessary equipment, medicines and nourishments.
Given his familiarity with the situation of the poor citizens of Liverpool, he believed the district nurse would have the greatest impact if she not only attended to the immediate physical ailments of the patient, but also took into consideration their social and family situation as well. His vision was that the nurse would not simply provide short-term relief, but that she would also plant a seed of long-term and widespread improvement by educating the patient and the family to caring for their own sick and instill in them the importance of healthy living and the principles of proper hygiene.
After just one month of work, Robinson asked Rathbone to be released from her contract. Although she was accustomed to sickness and death, the level of suffering and squalor she faced in serving the sick poor of Liverpool was overwhelming. She felt that her efforts were hopeless and were dwarfed by the level of need. Rathbone urged her to continue, and tried to impart in her his belief in the tremendous positive effect her work would have on the lives of those she cared for. “He showed her how much relief from suffering her care brought to the sick; how her teaching and example, must, in time, bear fruit; and that the satisfaction of knowing she had been instrumental in putting even a few families on their feet, and of blazing the path in a new field of work, would compensate her for all her present discouragements” (Brainard, The Evolution of Public Health Nursing, 1922, p 108).
Rathbone’s strong belief in the merits to the plan convinced Robinson, and she continued through her 3 month contract at which time Rathbone’s hopes were fulfilled. She was able to see her success in not only addressing the immediate ailments of the patient, but also in achieving permanent improvements in their health and standard of living. Also, in many cases, the improvement were not limited to the patient, but also their families, whose well being depended on the presence of both a mother and father as caretakers and breadwinners, and also on the community who saw the positive impact on their neighbors and changed their own behaviors. Thus it was at the end of the three month period, Robinson resolved to make district nursing her life’s work.
Rathbone felt confident that his experiment had amply demonstrated the potential benefit district nursing would bring to better the health and stability of those whose grim lives were often shadowed by loss and despair; people who would have otherwise been thought of as hopeless cases. Rathbone was determined to expand the service, but faced several barriers, including the skepticism of his peers. The prevailing opinion was that the problems faced by the multitudes of low-wage workers were insurmountable and that it would be a hopeless exercise for a nurse to try to make a difference. Also, many in the medical community did not believe that proper care could be provided in the busy and dirty conditions of the home and suggested that a hospital was only appropriate venue for care. And, even if Rathbone could convince people to support the project, finding a supply of trained nurses to provide this service throughout the impoverished districts of Liverpool was going to be almost impossible.
Next week we will see how Rathbone overcame these difficulties through a deep and persistent belief in the usefulness of the plan, by widely sharing his enthusiasm for the effort and by turning to Florence Nightingale for help and advice. Rathbone and Nightingale ended up becoming close friends each with a great admiration and respect for the work and ideas of the other.