Profiles In Nursing

Agnes Jones (1832-1868), English Workhouse Infirmary Reformer

In the age of Dickens, her efforts led to the reform of English public healthcare

Illustration of Agnes Jones portrait in the center, with images of different urban and rural scenery around her

Born wealthy, Agnes Jones dedicated her short life to caring for some of England’s most desperate citizens. Her tenacity, will and faith helped to transform English healthcare, earning her the deep personal regard of Florence Nightingale herself.

The Horrors of the Workhouse

If you’ve ever read the novels of Charles Dickens, you might recall his vivid depiction of English workhouses. Originally conceived as a form of public relief for the poor, workhouses eventually became little better than prisons where the destitute paid for their meager room and board — which they were rarely allowed to leave — with endless, menial manual labor. Children as young as 9 were put to work picking cotton or weaving. The elderly could be forced to work until the age of 80.

Workhouse hospitals were the grimmest of all. Intended to segregate the sick from healthier inmates who could still be made to work, the hospitals were only for the desperate. For many, to die in the street was a more appealing prospect than to die in a workhouse hospital. Nursing in these hospitals was usually assigned to able-bodied female inmates, who had no training and little enthusiasm for the unpleasant, dangerous work, consoling themselves with drink and petty theft. The wards were packed with hundreds of patients, sometimes crammed three to a bed, waiting to die.

Healing Ministry

Agnes Jones’s early life was a far cry from the workhouses. The child of a British Army officer and an Irishwoman, she spend much of her childhood in Mauritius and then a country house in Fahan, County Donegal, Ireland. She went to school in Stratford-upon-Avon (birthplace of William Shakespeare) and at 19 became a teacher in Dublin.

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This was the era of the terrible Irish Potato Famine, which killed more than 10 percent of the Irish population and left millions dispossessed. Jones became a lay nurse, treating sick or injured children in her area. At age 14, she wrote, “Father says I should know a path my life is taking. I believe my life will be spent caring for the sick.”

Jones had been deeply religious since childhood, so she regarded nursing as a form of ministry, often administering bible readings along with bandages. In 1860, she entered the Kaiserwerth Deaconess Institute near Düsseldorf, Germany, where Florence Nightingale had trained some years earlier.

Although her mother was not enthusiastic about her religious calling or interest in caring for the poor and the sick — Jones was an attractive, well-spoken young woman of marriageable age — Jones continued pursuing her calling at the London Bible and Domestic Female Mission. In 1862, she joined St. Thomas’s Hospital as a Nightingale Nurse, whom Nightingale later described as one of her “best pupils.” By the winter of 1864, Jones had already been the superintendent of three different small hospitals, with a focus on what we would now call critical care.

The Matron of Brownlow Hill

The previous challenges of her short nursing career paled before what awaited Jones at her next job: as superintendent of the infirmary at Brownlow Hill, one of Liverpool’s three workhouses. Overcrowded, understaffed and filthy, the Brownlow Hill hospital was one of the worst hospitals in England.

Nursing Education

Many respectable Englishmen of the time felt the terrible conditions of the workhouses were only what paupers deserved. Even Nightingale condescendingly dismissed the workhouse inmates as “more untameable [sic] than lions.”  However, a local merchant, William Rathbone, felt otherwise and began privately funding the training of nurses to care for the poor in his district. At Nightingale’s suggestion, Rathbone hired Jones as matron of the Brownlow Hill hospital, leading a staff of 12 Nightingale Nurses to begin transforming the fetid infirmary into a proper hospital.

Although Jones believed in the cause, she was not enthusiastic about this daunting task. The infirmary’s nurse/patient ratio in the early days was 1:100. Not surprisingly, patient acuity was disastrously high and staff morale decidedly low. “I am almost distracted between sickness and anxiety and [staff] drunkenness,” Jones wrote. “How little I can do!”

Despite her doubts, she gave it her all, working grueling 18-hour days. In addition to nursing, administration and training, she took the time to give weekly (and later daily) bible readings and even arranged for patients to receive fresh bread. Inspired by this effort, Nightingale began pushing for nationwide legal reforms.

In 1867, Parliament amended the Poor Law to provide a taxpayer-financed medical relief fund, separate from the workhouses.

Death and Remembrance

Unfortunately, Jones could not enjoy the fruits of this victory. In early 1868, she contracted typhus from one of her nurses and died on February 19. She was only 35 years old. Nightingale gave the eulogy at her funeral. The Lady Chapel of Liverpool’s Anglican cathedral later commemorated Jones’s life with a stained glass window.

No static monument could really capture the scope of her achievement: a dramatic elevation of the standard of care for England’s poorest patients. Jones had once written, “There is no reason whatsoever why workhouse hospitals should not be like the best private hospitals for the sick.” In just three years, she made hers exactly that.

AMANDA GHOSH is a freelance writer specializing in the healthcare industry. She has worked as a wellness director, adjunct instructor, and contributed to public health initiatives on three continents.

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