Feature

William Rathbone VI (1819-1902), Father of English District Nursing

How a philanthropist, Florence Nightingale and Queen Victoria Revolutionized Public Health

Although he himself was neither nurse nor physician, William Rathbone was one of the most important figures in British nursing in the Victorian era, revolutionizing healthcare for England’s poor and establishing a new model of nursing practice.

Faith, Grief and Philanthropy

William Rathbone VI was the eldest son of a successful Liverpool mercantile family also known for its many charitable works. Rathbone’s ancestors had been Quakers and his parents continued that tradition of public service, supporting a range of causes from slave emancipation to public education. The family’s motto was, “What ought to be done, can be done.”

As a young man, Rathbone became a Unitarian, inspired by his eloquent brother-in-law, the Rev. John H. Thom. Rathbone believed that affluence only increased one’s obligation to serve others, describing material wealth as “a trust for which [a man] owes an account to himself, to his fellow-men and to God.”

Rathbone’s involvement with nursing began in personal tragedy. In 1858, his first wife, Lucretia, became seriously ill while pregnant with their fifth child. Rathbone hired a private-duty nurse, Mary Robinson, to care for her, but Lucretia died on May 29, 1859, leaving him devastated.Rathbone’s involvement with nursing began in personal tragedy.

In 1858, his first wife, Lucretia, became seriously ill while pregnant with their fifth child. Rathbone hired a private-duty nurse, Mary Robinson, to care for her, but Lucretia died on May 29, 1859, leaving him devastated.

As he came to terms with his grief, Rathbone reflected on the comfort Robinson had provided his wife during Lucretia’s illness and considered the good such skilled care might do for others in need. Several months later, he decided to hire Robinson for a new assignment: in his own words, “to go into one of the poorest districts of Liverpool and try, in nursing the poor, to relieve suffering and to teach them the rules of health and comfort.” Naturally, he paid all her expenses.

A Letter to Florence Nightingale

At first, Robinson found this work almost too overwhelming to bear, but by the end of her initial three-month engagement, Rathbone said, “she came back saying that the amount of misery she could relieve was so satisfactory that nothing would induce her to go back to private nursing, if I were willing to continue the work.”

Rathbone was willing and eager to expand this project to other areas of Liverpool, but he soon discovered that finding additional nurses of Robinson’s caliber was no easy task. There was still no standardized nurse training, licensure or registration in Great Britain, so the quality of individual nurses varied widely.

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In 1861, Rathbone wrote to Florence Nightingale at St. Thomas’s Hospital in London, asking for her advice. She dismissed the idea of trying to recruit experienced nurses, suggesting that he establish a brand-new training program instead. Rathbone followed Nightingale’s recommendations with a will. Within a year, he had founded the Liverpool Training School and Home for Nurses at the Royal Liverpool Infirmary, entirely at his own expense.

Although Nightingale was not directly involved in this project beyond her initial proposal, she and Rathbone went on to become lifelong correspondents and friends. “In any matter of nursing, Miss Nightingale is my Pope and I believe in her infallibility,” he later wrote.

The District Nurse

By 1863, Rathbone’s program had produced 18 trained nurses. Each was assigned to a specific Liverpool district, reporting to a lady superintendent who was responsible for each nurse’s room and board. Rathbone’s second wife, Emily, whom he married in February 1862, later became one of these lady superintendents. (Later in life, she also became a crusader for school nursing in Liverpool.)

From the beginning, the role of the district nurse was to promote health rather than simply treating the sick. Guidance in proper nutrition, adequate heat and housekeeping was as important to the work as were poultices and bandages. Mary Robinson noted in 1860 that “by suitable advice there is a very great improvement in many houses as to cleanliness.”

The most essential aspect of district nursing was that the nurses cared for patients in their homes, making skilled nursing care available to a whole range of people who could not (or would not) go to a hospital or hire a private physician. This model of nursing had little direct precedent in England, particularly since it was tied to no specific church or religious order. However, it proved very successful and was soon imitated outside Liverpool.

Rathbone’s experiment also inspired Nightingale, who began to lobby Parliament for legal reforms and new laws to improve healthcare for the nation’s paupers. Several of those reforms passed in 1867, by which time three other cities had established their own district nursing programs. Meanwhile, Rathbone had taken on an even tougher task: improving the standards of care in Liverpool’s poorhouse infirmaries.

In 1865, he hired 12 more nurses for that effort, including former Nightingale Nurse Agnes Jones. Again, this difficult but successful project was undertaken at Rathbone’s own expense. [Editor’s note: You can read more about the workhouse infirmaries in our profile of Agnes Jones, available at WorkingNurse.com.]

Nursing Education

Friends in High Places

Although he remained a partner in the family business until 1885, Rathbone decided to pursue his social interests in the English House of Commons, successfully standing as a member of Parliament in 1868. He would sit as a Liberal MP — first for Liverpool, later for Carnarvonshire and North Carnarvonshire — until 1895.

Rathbone remained keenly interested in district nursing. In 1874–75, he helped to establish London’s Metropolitan and National Nursing Association for Providing Trained Nurses to the Sick Poor, with Florence Lees, another former Nightingale Nurse, as its superintendent.

Similar associations appeared in Glasgow, Scotland, and Dublin, Ireland, within a year. In a letter to Rathbone in April 1875, Nightingale, by now a strong proponent of the district nursing model, remarked that there was enough demand to justify hiring “10 times the number of nurses,” noting “[t]he extreme severity of the cases nursed by the district nurses.”

The Queen’s Nurses

Until the 1880s, district nursing was still primarily a privately funded local endeavor. However, in 1887, Queen Victoria announced that she would contribute £70,000, the bulk of the money raised for her Golden Jubilee, to nursing-related causes.

Rathbone, Lees and Nightingale pushed for that money to be used in establishing a national institute for district nursing. The queen eventually agreed and the Queen Victoria’s Jubilee Institute for Nursing was incorporated in September 1889. District nurses would now be formally known as the Queen’s Nurses, with uniforms and caps selected by Victoria herself. Queen’s Nurses also received an annual salary.

Although the initial £70,000 endowment had been a substantial sum for that era — the equivalent of about $11 million today — the institute’s work was expensive, especially as the number of district nurses grew. In 1897, Rathbone persuaded the queen to contribute an additional £68,000 from her Diamond Jubilee fund.

Nursing Legacy

By the time Rathbone died in March 1902, there were about 1,000 Queen’s Nurses across Great Britain, as well as almost three dozen affiliated organizations. Those figures would double by the start of World War One.

The creation of the royal institute, today called the Queen’s Nursing Institute (QNI), was a watershed moment for British nurses, firmly establishing district nursing as not only an effective model of care for low-income communities, but also a respectable, well-paid profession for women.

To the end of his life, Rathbone was justifiably proud of the district nurses and their achievements. In 1901, months before his death, he wrote a Christmas message for the Queen’s Nurses, remarking, “You are not inferior servants, doing inferior work for inferior wages, but trained and skilled workers carrying out intelligently the treatments prescribed by Doctors.”

Florence Nightingale had similarly high praise for Rathbone himself, extolling his aptitude for “securing unity yet independence of action … so essential to the continuance and development of a great charity.” After his death, she called him “one of God’s best and greatest sons.”

To learn more about the history of the Queen’s Nursing Institute, visit https://qniheritage.org.uk/ 


Aaron Severson is the associate editor of Working Nurse.

 


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