THE HOSPITALS AT SCUTARI
Dearth of creative brain-power showed itself in our Levantine
hospitals, for there industrious functionaries worked hard at their
accustomed tasks, and doggedly omitted to innovate at times when
not to be innovating was surrendering, as it were, at discretion to
want and misery. But happily, after a while, and in gentle, almost
humble, disguise, which put foes of change off their guard, there
acceded to the state a new power.--KINGLAKE.
Miss Nightingale reported the arrival of her expedition at
Constantinople in a short note to her parents:--
CONSTANTINOPLE, _November_ 4, on board _Vectis_.--DEAREST PEOPLE--
Anchored off the Seraglio point, waiting for our fate whether we can
disembark direct into the Hospital, which, with our heterogeneous
mass, we should prefer.
At six o'clock yesterday morn I staggered on deck to look at the
plains of Troy, the tomb of Achilles, the mouths of the Scamander,
the little harbour of Tenedos, between which and the mainshore our
_Vectis_, with steward's cabins and galley torn away, blustering,
creaking, shrieking, storming, rushed on her way. It was in a dense
mist that the ghosts of the Trojans answered my cordial hail,
through which the old Gods, nevertheless, peered down from the hill
of Ida upon their old plain. My enthusiasm for the heroes though
was undiminished by wind and wave.
We made the castles of Europe and Asia (Dardanelles) by eleven, but
also reached Constantinople this morn in a thick and heavy rain,
through which the Sophia, Sulieman, the Seven Towers, the walls,
and the Golden Horn looked like a bad daguerrotype washed out.
We have not yet heard what the Embassy or Military Hospital have
done for us, nor received our orders.
Bad news from Balaclava. You will hear the awful wreck of our poor
cavalry, 400 wounded, arriving _at this moment_ for us to nurse. We
have just built another hospital at the Dardanelles.
You will want to know about our crew. One has turned out ill,
others will do.
(_Later_) Just starting for Scutari. We are to be housed in the
Hospital this very afternoon. Everybody is most kind. The fresh
wounded are, I believe, to be placed under our care. They are
landing them now.
The Hospital, to which Miss Nightingale refers, was to be the chief
scene of her labours for the next six months, and a few particulars
about it and other hospitals, in which the nursing was under her
superintendence, must be given in order to make future proceedings
intelligible. The principal hospitals of the British army during the
Crimean War--four in number--were at Scutari (or in its immediate
neighbourhood), the suburb of mournful beauty which looks across to
Constantinople from the Asiatic side of the Bosphorus.
The first hospital to be established was in the Turkish Military
Hospital. This was made over to the British in May 1854, and was called
by them _The General Hospital_. Having been originally designed for a
hospital, and being given up to the English partially fitted, it was,
wrote Miss Nightingale, "reduced to good order early, by the unwearied
efforts of the first-class Staff Surgeon in introducing a good working
system. It was then maintained in excellent condition till the close of
the war."[83] It had accommodation for 1000 patients, but the Battle of
the Alma showed that much larger accommodation would be wanted.
[83] _Statement_, p. 13 _n._
North of the General Hospital, and near to the famous Turkish cemetery
of Scutari, are the Selimiyeh Barracks--a great yellow building with
square towers at each angle. This building was made over to the British
for use as a hospital after the Battle of the Alma, and by them was
always called _The Barrack Hospital_. This is the hospital in which Miss
Nightingale and her band of female nurses were first established, and in
which she herself had her headquarters throughout her stay at Scutari.
It is built on rising ground, in a beautiful situation, looking over the
Sea of Marmora on one side, towards the Princes' Islands on another,
and towards Constantinople and up the Bosphorus on a third. "I have not
been out of the Hospital Walls yet," wrote Miss Nightingale ten days
after her arrival, "but the most beautiful view in all the world, I
believe, lies outside." Her quarters were in the north-west tower, on
the left of the Main Guard (or principal entrance). There was a large
kitchen or storeroom, of which we shall hear more presently, and out of
it on either side various other rooms opened. Mr. Bracebridge and the
courier slept in one small room; Miss Nightingale and Mrs. Bracebridge
in another. The nurses slept in other rooms. The whole space occupied by
Miss Nightingale and her nurses was about equal to that allotted to
three medical officers and their servants, or to that occupied by the
Commandant. "This was done," she explained, "in order to make no
pressure for room on an already overcrowded hospital. It could not have
been done with justice to the women's health, had not Miss Nightingale
later taken a house in Scutari at private expense, to which every nurse
attacked with fever was removed."[84] The quarters were as uncomfortable
as they were cramped. "Occasionally," wrote Miss Nightingale, "our roof
is torn off, or the windows are blown in, and we are under water for the
night." The Hospital was infested also with rodents and vermin; and,
among other new accomplishments acquired under the stress of new
occasions, Miss Nightingale became an expert rat-killer. This skill was
afterwards called into use at Balaclava. In the spring of 1856, one of
the nuns whom she had taken with her to the Crimea--Sister Mary
Martha--had a dangerous attack of fever. Miss Nightingale nursed the
case; and one night, while watching by the sick-bed, she saw a large rat
upon the rafters over the Sister's head; she succeeded in knocking it
down and killing it, without disturbing the patient.[85] The condition
of physical discomfort in which, surrounded by terrible scenes of
suffering, she had to do her work, should be remembered in taking the
measure of her fortitude and devotion.[86]
[84] _Notes_ (Bibliography A, No. 8), sec. iii. p. xxxiii.
[85] _Grant_, p. 174.
[86] For a lively description of like discomforts endured by her staff,
see _Eastern Hospitals_, vol. i. pp. 91-94.
The maximum number of patients accommodated at any one time (Dec. 23,
1854) in the Barrack Hospital was 2434. It was half-an-hour's walk from
the General Hospital, and an invalided soldier records that he used to
accompany Miss Nightingale from one hospital to another in order to
light her home on wet stormy nights, across the barren common which lay
between them.
Farther south of the General Hospital, in the quarter of Haidar Pasha,
was what was known as _The Palace Hospital_, consisting of various
buildings belonging to the Sultan's Summer Palace. These were occupied
as a hospital in January 1855. Miss Nightingale had no responsibility
here; but in the summer of 1855, the female nursing of sick officers,
quartered in one of these buildings, was placed under the
superintendence of Mrs. Willoughby Moore, the widow of an officer who
had died a noble death in the war, and four female nurses, sent out
specially from England.
Finally, there were hospitals at _Koulali_, four or five miles farther
north, upon the same Asiatic shore of the Bosphorus. These hospitals
were opened in December 1854. The nursing in them was originally under
Miss Nightingale's supervision, but she was presently relieved of it (p.
193 _n._). The hospitals were broken up in November 1855, when, of the
female nursing establishment, a portion went home, and the rest passed
under Miss Nightingale into the hospitals at Scutari.
There were also five hospitals in the Crimea, but particulars of these
may be deferred till the time comes for following Miss Nightingale upon
her expeditions to the front. For the nursing in the Civil Military
Hospitals (_i.e._ hospitals controlled by a civilian medical staff) at
Renkioi (on the Dardanelles) and at Smyrna, and for the Naval Hospital
at Therapia, Miss Nightingale had no responsibility, though there is
voluminous correspondence among her papers showing that she was
constantly consulted upon the site and arrangements of these hospitals.
The medical superintendent of the hospital at Renkioi was Dr. E. A.
Parkes, with whom Miss Nightingale formed a friendship which endured to
the end of his life.
II
The state of the hospitals when Miss Nightingale arrived requires some
description, which, however, need not be long. The treatment of the sick
and wounded during the Crimean War was the subject of Departmental
Inquiries, Select Committees, and Royal Commissions, which, when they
had finished sitting upon the hospitals, began sitting upon each other.
Enormous piles of Blue-books were accumulated, and in the course of my
work I have disturbed much dust upon them. The conduct of every
department and every individual concerned was the subject of charge,
answer, and countercharge innumerable. Each generation deserves, no
doubt, the records of mal-administration which it gets; but one
generation need not be punished by having to examine in detail the
records of another. Some of the details of the Crimean muddle will
indeed necessarily be disinterred in the course of our story; but all
that need here be collected from the heaps aforesaid are three general
conclusions.
The reader must remember, in the first place, that, apart from
controverted particulars, it was made abundantly manifest that there was
gross neglect in the service of the sick and wounded. The conflict of
testimony is readily intelligible. It was easy to give an account based
upon the facts of one hospital or of one time which was not applicable
to another. At Scutari, for instance, the General Hospital was from the
first better ordered than the Barrack Hospital. Then, again, different
witnesses had different standards of what was "good" in War Hospitals;
to some, anything was good if it was no worse than the standard of the
Peninsular War. Of Sir George Brown, who commanded the Light Division in
the Crimea, it was said: "As he was thrown into a cart on some straw
when shot through the legs in Spain, he thinks the same conveyances
admirable now, and hates ambulances as the invention of the Evil
One."[87] Miss Nightingale had much indignant sarcasm for those who
seemed content that the soldier in hospital should be placed in the
condition of "former wars," instead of perceiving that he "should be
treated with that degree of decency and humanity which the improved
feeling of the nineteenth century demands." But the principal reason for
the conflict of testimony was that the very facts of protest and inquiry
put all the officials concerned upon the defensive. Any suggestion of
default or defect was resented as a personal imputation. There is a
curious illustration in the letter which the Head of the Army Medical
Department wrote to his Principal Medical Officer in view of the Roebuck
Committee. "I beg you to supply me, and that immediately"--with what?
with the truth, the whole truth, and nothing but the truth? No--"with
every kind of information which you may deem likely to enable me to
establish a character for it [the Department], which the public appear
desirous to prove that it does not possess."[88] But though there was
much conflict of evidence, the final verdict was decisive. What Greville
wrote in his Journal--"the accounts published in the _Times_ turn out to
be true"--was established by official inquiry and admitted by Ministers.
In consequence of the indictment in the _Times_, a Commission of Inquiry
was dispatched to the East by the Secretary of State. The Commission
arrived at Constantinople simultaneously with Miss Nightingale, and four
months later it reported to the Duke of Newcastle.[89] I need not
trouble the reader here with many particulars of its Report; for they
were adopted and confirmed by a Select Committee of the House of Commons
a few months later (the famous "Roebuck Committee"), which pronounced
succinct sentence that "the state of the hospitals was disgraceful." The
ships which brought the sick and wounded from the Crimea were painfully
ill-equipped. The voyage from Balaclava to Scutari usually took eight
days and a half. During the first four months of the war, there died on
a voyage, no longer than from Tynemouth to London, 74 out of every 1000
embarked. The landing arrangements added to the men's sufferings. To an
unpractised eye the buildings used as hospitals at Scutari were
imposing and convenient; and this fact accounts for some of the
rose-coloured descriptions by which persons in high places were for a
time misled. Even the Principal Medical Officer on the spot was naïvely
content with whitewash as a preparation to fit the Barrack for use as a
hospital. In fact, however, the buildings were pest-houses. Underneath
the great structures "were sewers of the worst possible construction,
loaded with filth, mere cesspools, in fact, through which the wind blew
sewer air up the pipes of numerous open privies into the corridors and
wards where the sick were lying."[90] There was also frightful
overcrowding. For many months the space for each patient was one-fourth
of what it ought to have been. And there was no proper ventilation. "It
is impossible," Miss Nightingale told the Royal Commission of 1857, "to
describe the state of the atmosphere of the Barrack Hospital at night. I
have been well acquainted with the dwellings of the worst parts of most
of the great cities in Europe, but have never been in any atmosphere
which I could compare with it." Lastly, hospital comforts, and even many
hospital necessaries, were deficient.[91] The supply of bedsteads was
inadequate. The commonest utensils, for decency as well as for comfort,
were lacking. The sheets, said Miss Nightingale, "were of canvas, and so
coarse that the wounded men begged to be left in their blankets. It was
indeed impossible to put men in such a state of emaciation into those
sheets. There was no bedroom furniture of any kind, and only empty beer
or wine bottles for candlesticks." Necessary surgical and medical
appliances were often either wanting or not forthcoming. There was no
machinery, until Miss Nightingale came, for providing any hospital
delicacies. The result of this state of things upon patients arriving
after a painful voyage in an extreme state of weakness and emaciation,
from wounds, from frost-bite, from dysentery, may be imagined, and it
is no wonder that cholera and typhus were rife. In February 1855 the
mortality per cent of the cases treated was forty-two. No words are
necessary to emphasize so terrible a figure.
[87] J. B. Atkins, _Life of Sir W. H. Russell_, vol. i. p. 143.
[88] _Notes_, sec. i. p. xxii.
[89] This Commission is referred to on later pages as "The Duke of
Newcastle's."
[90] _Notes_, sec. iii. pp. iii., ix.
[91] If any reader desires to be sickened, I recommend to him the Report
on the Hospitals by the Sanitary Commissioners of 1855. And if any
one desires to find painful details under some of these heads
detailed above, without recourse to Blue-books, he may be referred
to the report in Hansard of the speech made by Mr. Augustus Stafford
(an eye-witness of what he described) in the House of Commons,
Jan. 29, 1855.
Mr. Herbert had not waited for the reports of Commission and Committee
to reach the conclusion that things were wrong:--
"I have for some time," he wrote on December 14, 1854, to the
Commandant at Scutari, "been very anxious and very much
dissatisfied as to the state of the hospital. I believe that every
effort has been made by the medical men, and I hear that you have
been indefatigable in the conduct of the immediate business of your
department. But there has been evidently a want of co-operation
between departments, and a fear of responsibility or timidity,
arising from an entire misconception of the wishes of the
Government. No expense has been spared at home, and immense stores
are sent out, but they are not forthcoming. Some are at Varna, and
for some inexplicable reason they are not brought down to Scutari.
When stores are in the hospital, they are not issued without forms
so cumbrous as to make the issue unavailing through delay. The
Purveyor's staff is said to be insufficient. The Commissariat staff
is said to be insufficient, your own staff is said to be
insufficient," etc.
By admission, then, and by official sentence, there were things amiss at
Scutari which urgently called for amendment. This is the first general
conclusion which has to be remembered in relation to Miss Nightingale's
work.
To what individuals the disgrace of "a disgraceful state of things"
attached, it is happily no concern of ours here to inquire. But as I
have called Mr. Sidney Herbert as a witness to the fact of the disgrace,
I must add my conviction that his own part in the business was wholly
beneficent. Some research among the documents entitles me, perhaps, to
express entire agreement with Mr. Kinglake's remark upon "what might
have been if the Government, instead of appointing a Commission of
_enquiry_ on the 23rd of October, had then delegated Mr. Sidney Herbert
to go out for a month to the Bosphorus, and there _dictate_ immediate
action." At home, Mr. Herbert was a good man struggling in the toils.
The fact is that, though there were some individuals palpably to blame,
the real fault was everybody's or nobody's. It was the fault of a
vicious system, or rather the vice was that there was no system at all,
no co-ordination, but only division of responsibility. The remarks of
Mr. Herbert, just quoted, point to the evil, and on every page of the
Blue-books it is written large. There were at least eight authorities,
working independently of each other, whose co-operation was yet
necessary to get anything well done. There was the Secretary of State;
there was the War Office (under the Secretary-_at_-War); there were the
Horse Guards, the Ordnance, the Victualling Office, the Transport
Office, the Army Medical Department, and the Treasury. The
Director-General of the Medical Department in London told the
Roebuck Committee that he was under five distinct masters--the
Commander-in-Chief, the Secretary of State, the Secretary-_at_-War, the
Master-General of Ordnance, and the Board of Ordnance. The Secretary of
State said that he had issued no instructions as to the hospitals; he
had left that to the Medical Board. But the Medical Director-General
said that it would have been impertinent for him to take the first
step.[92] If I were writing the history of the Crimean War, or of the
Government Offices, other fundamental reasons for the disgraceful state
of things in the hospitals--notably the miscalculated plan of military
campaign--would have to be taken into account; but I am writing only the
life of Miss Nightingale, and all that under this head the reader need
be asked to bear in mind is this: That the root of the evils which had
to be dealt with was division of responsibility, and reluctance to
assume it.
[92] _Roebuck Committee_, Fifth Report, pp. 17, 19.
The third conclusion of the official inquiries, which I want to
emphasize, is contained in a passage in the Roebuck Committee's Report,
which prefaced a reference to Miss Nightingale's mission: "Your
Committee in conclusion cannot but remark that the first real
improvements in the lamentable condition of the hospitals at Scutari are
to be attributed to private suggestions, private exertions, and private
benevolence."
So, then, we see that there were disgraceful evils at Scutari needing
amendment, and that in order to amend them what was needed was bold
initiative. This it was that Miss Nightingale supplied. The popular
voice thought of her only or mainly as the gentle nurse. That, too, she
was; and to her self-devotion in applying a woman's insight to a new
sphere, a portion of her fame must ever be ascribed. But when men who
knew all the facts spoke of her "commanding genius,"[93] it was rather
of her work as an administrator that they were thinking. "They could
scarcely realize without personally seeing it," Mr. Stafford told the
House of Commons, "the heartfelt gratitude of the soldiers, or the
amount of misery which had been relieved" by Miss Nightingale and her
nurses; and, he added, "it was impossible to do justice, not only to the
kindness of heart, but to the clever judgment, the ready intelligence,
and the experience displayed by the distinguished lady to whom this
difficult mission had been entrusted." These were the qualities which
enabled her to reform, or to be the inspirer and instigator of reforms
in, the British system of military hospitals. She began her work, where
it lay immediately to her hand, in the Barrack Hospital at Scutari. She
did the work in three ways. She applied an expert's touch and a woman's
insight to a hospital hitherto managed exclusively by men. She boldly
assumed responsibility, and did things herself which she could find no
one else ready to do. And, thirdly, she was instant and persistent in
suggestion, exhortation, reproaches, addressed to the authorities at
home. It will not be possible to keep these three branches of our
subject entirely distinct; but in the main they will form the topics
successively of the next three chapters.
[93] Dean Stanley, _Memorials of Edward and Catherine Stanley_, 2nd ed.,
p. 335. So, too, Mr. Sidney Herbert, in his speech at Willis's Rooms
on Nov. 29, 1855, referred to her as "a woman of genius."