Letter to Dear Sir
1873-11-01

[Page 1 of 10]
Private
35 South Street
Park Lane
W.
Nov. 1/73
My dear Sir
Your kind packet of Oct 7
- including a Memo. Of Dr. Bridges
which I return, was put
into my hands just as I was
leaving Derbyshire.
I wrote my answer as soon
as I possibly could: but then
I saw that you were not in
London. And now I am
sure that you will think that
I have rather to apologize for
The Right Honbl.
James Stansfeld MP
[Page 2 of 10]
my answer than for its absence.
This answer is so long that I will
only venture to add to you
2 things:
1. The very same difficulties
which now trouble you in the
Nursing of "Pauper Sick
Asylum" had been, if
possible, still more rife in
Military Hospitals.
These have solved them,
it appears, victoriously.
To return to your case:
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Should not the Matron be
responsible directly to the
Managers for the efficiency
of the Nursing Establishment?
That is to say: the Matron
who is the proper head of the
female Staff, who (& not
the Medical Officer) ought
to know what Nursing is.
She is not merely to "aid"
him in doing her duty: but
to be directly responsible to
the chief authorities for the
efficient carrying out of his
directions.
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N.B. This has come to be the
result in practice, in spite
of Regulations to the Contrary,
where there is an efficient
trained Matron, (e.g. Highgate)
Why should her efficiency be
marred by the possible -
- probable indiscreet interference
(supported by Rule) of the
Medical Officer as has
happened?
If the Matron is not efficient,
she should be dismissed.
Is it not a lame conclusion
to trust to the "discretion" of
the Medical Officer not to
act upon the Regulations?
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2
Note. As to "complaints": -
is it not clearly right if the
Matron is to hold the
position we contend for
that these, whether coming
from her own subordinates,
or from other Departments,
should be made to the
chief authority: not to the
Medical Officer.
His duties might necessitate
frequent complaints on his
part against her & her
Nurses. If there is inefficiency,
Is he to be also the
Judge - the Court of Appeal?
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II. You are good enough
to ask me for "suggestions"
for the proposed
"Instructional Letter".
If what I have tried to set
forth, in my (too long)
pencil Memo., be correct:
would not the "Instructional
Letter" become like the
Chapter on Snakes in Iceland:
There are no Snakes
in Iceland.
The "Instructional Letter" would in
fact be: 'None of the
above Regulations are to
be kept'.
This would be the real English,
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would it not? - of leaving
the existing Articles &
over-riding them by an
Instructional Letter?
Dr. Bridges suggests "the the
Matron should be regarded
as chief of a Sub-Department:
- the Medical Officer to refrain
from interfering in details -
-to support the Matron in
all save very exceptional cases
but that his authority should
remain in the last resort
in the absence of the Committee
Supreme" -
How is this position to be defined
by Rules?
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The Medical Officer cannot
"govern & control" the Matron,
if she is to be directly responsible
to the Managers:
he cannot "govern & control"
 the Nurses, if they are to
be responsible to the Matron.
He must not "report" to the
Board any "negligence or
misconduct" etc. of the Nurses,
if this is the duty of the 
Matron.
[N.B. This seems to be
admitted in the expression
made use of by Dr. Bridges
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3
that the Medical Officer should
in the absence of the Committee
be supreme.
Perhaps this object might be
attained by providing that
"in the absence of the Committee
the Med: Officer shall in
any case of emergency be
empowered to exercise the
powers of the Committee".]
Otherwise; - if what I have said
is true, must not the
definition of the Medical
Officer's duties be altogether
recast: not over ridden by
an Instructional Letter?
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I will not lengthen my
offence by lengthening this
letter with apologies:
but pray believe me
my dear Sir
ever your faithful & grateful
servt.
Florence Nightingale