THE REFORMER
We have made Miss Nightingale's acquaintance, and are delighted and
very much struck by her great gentleness and simplicity, and
wonderful, clear, and comprehensive head. I wish we had her at the
War Office.--QUEEN VICTORIA (Letter to the Duke of Cambridge,
1856).
"When one reads such twaddling nonsense," wrote Dr. Hall in November
1855 from the Crimea to Dr. Andrew Smith in London, "as that uttered by
Mr. Bracebridge, and which was so much lauded in the _Times_ because the
garrulous old gentleman talked about Miss Nightingale putting hospitals,
containing three or four thousand patients, in order in a couple of days
by means of the _Times_ funds, one cannot suppress a feeling of contempt
for the man who indulges in such exaggerations, and pity for the
ignorant multitude who are deluded by these fairy tales."[125] The
contempt and pity of the Inspector-General of the hospitals in the East
were not unmixed, I think we may surmise, with a good deal of anger,
which, we may also surmise, was shared by his friend, the
Director-General of the Medical Department in London. Such feelings were
in the course of human nature, and the exaggeration in the statements
cited by Dr. Hall is palpable. Miss Nightingale was not a magician. It
would be an idle fairy tale to represent that by her exertions, either
in a couple of days, or a couple of months, she effected a complete
transformation scene. And it would be unfair to attribute solely to Miss
Nightingale the gradual improvements which, though largely due to her
initiative and resource (as described in preceding chapters), were in
fact the result of the exertions of many persons both at home and in the
East. "I have an unbounded admiration of Miss Nightingale's
qualifications," said a deputy medical inspector, "and of the manner she
applies them, but I see dozens of things placed to her credit which I
happen to know she had nothing to do with."[126] Such was doubtless the
case. Yet though in one sense Dr. Hall was perfectly right, in another
he was profoundly wrong. Neither he, however, nor any of the other
medical men who shared his views, need be blamed for their
misapprehension. The facts of the case can only be fully understood now
that access is obtainable to the private correspondence of Miss
Nightingale and other actors in the drama.
[125] _Life and Letters of Sir John Hall_, p. 403, where "Bracebridge"
is misprinted "Bainbridge."
[126] _Roebuck Committee_, Second Report, p. 723.
She did many things herself, but she was also the inspirer and
instigator of more things which were done by others. She was able of her
own initiative to institute considerable reforms; but she was a reformer
on a larger scale through the influence which she exercised. Though she
was in truth no magician, there were men on the spot who, not being able
to understand the secret and sources of her power, seemed to find
something uncanny in it. Our good friend, Colonel Sterling, who hated
the intrusion of petticoats into a campaign, was very much puzzled. The
thing seemed to him "ludicrous," as we have heard, but he had to admit
that "Miss Nightingale queens it with absolute power"; and elsewhere he
speaks of "the Nightingale power" as something mysterious and
"fabulous." The secret, however, is simple. "The Nightingale power" was
due to causes of which some were inherent in herself and others were
adventitious. The inherent strength of her influence lay in the
masterful will and practical good sense which gave her dominion over the
minds of men. The adventitious sources of her power were that she had
both the ear and the confidence of Ministers, and the interest and
sympathy of the Court. I have called this accession of influence
"adventitious," but it also accrued to her, in a secondary degree, from
the inherent force of her character.
The influence of the Court in strengthening, in speeding up, and
sometimes in chiding Ministers, especially in military matters, was,
during the reign of Victoria, very great, as all readers of memoirs of
the time are aware.[127] And from an early period of Miss Nightingale's
mission the Court had expressed a lively interest in it, and had
intimated a wish that full consideration should be paid to her
experiences and impressions. "Would you tell Mrs. Herbert," wrote the
Queen to Mr. Sidney Herbert (Dec. 6, 1854), "that I beg she would let me
see frequently the accounts she receives from Miss Nightingale or Mrs.
Bracebridge, as _I hear no details of the wounded_, though I see so many
from officers, etc., about the battlefield, and naturally the former
must interest _me_ more than any one. Let Mrs. Herbert also know that I
wish Miss Nightingale and the ladies would tell these poor, noble
wounded and sick men that _no one_ takes a warmer interest or feels
_more_ for their sufferings or admires their courage and heroism _more_
than their Queen. Day and night she thinks of her beloved troops. So
does the Prince. Beg Mrs. Herbert to communicate these my words to those
ladies, as I know that _our_ sympathy is much valued by these noble
fellows." Upon the receipt of the Queen's message, the chaplain went
through the wards reading it to the men, and copies of it were also
posted on the walls of the several hospitals. "The men were touched,"
Miss Nightingale reported to Mr. Herbert (Dec. 25). "'It is a very
feeling letter,' they said. 'She thinks of us' (said with tears). 'Each
man of us ought to have a copy which we will keep till our dying day.'
'To think of her thinking of us,' said another; 'I only wish I could go
and fight for her again.'" The Queen's message was followed by more
substantial proof of Her Majesty's interest, and here again Miss
Nightingale was made the intermediary between the throne and the
soldiers. Through Mr. Sidney Herbert, the Queen had ascertained from
Miss Nightingale the kind of comforts which would be useful to the
wounded, and the following letter was sent to her by the Keeper of the
Queen's Purse:--
WINDSOR CASTLE, _December_ 14 [1854]. MADAM--I have received the
commands of Her Majesty the Queen to forward by the ship _Eagle_
some packages containing some comforts and useful articles which
Her Majesty wishes to be placed in your hands for distribution, as
you may think fit, amongst the wounded and sick at Scutari.
Her Majesty has wished to mark by some private contribution from
herself her deep personal sympathy for the sufferings of these
noble soldiers, and her admiration of the patience and fortitude
with which they have suffered both wounds and hardships.
The Queen has directed me to ask you to undertake the distribution
and application of these articles, partly because Her Majesty
wished you to be made aware that your goodness and self-devotion in
giving yourself up to the soothing attendance upon these wounded
and sick soldiers had been observed by the Queen with sentiments of
the highest approval and admiration; and partly because, as the
articles sent did not come within the description of Medical or
Government stores, usually furnished, they could not be better
entrusted than to one who, by constant personal observation, would
form a correct judgment where they would be most usefully employed.
[127] The classical passage in this sense is in the _Life and
Correspondence of the Rt. Hon. Hugh C. E. Childers_, 1901,
vol. ii. p. 104, where it is said, in relation to the Egyptian
Expedition of 1882: "The Queen with her well-known solicitude for
the welfare of her Army, wrote many letters at this time to
Mr. Childers to satisfy herself that all precautions were being
taken for the health and comfort of the troops: one day alone
brought seventeen letters from Her Majesty, or her private
secretary, Sir Henry Ponsonby."
The Queen sent presents of warm scarves and the like to Miss
Nightingale's nurses. The position of Almoner of the Free Gifts and the
confidence thus shown by the Sovereign greatly extended the prestige of
Miss Nightingale, who was already known to command influence with the
Government, to have the favour of the Press, and to be the darling of
popular opinion. Officials might feel sore, and old fogeys might
grumble, but the fact became palpable that "the Nightingale power" had
to be reckoned with.
II
It was, however, behind the scenes that Miss Nightingale's activity as a
reformer was most powerfully exercised. In accordance with Her Majesty's
command, reports from Miss Nightingale were forwarded to the Queen, and
by her were sent on to the Duke of Newcastle. The Duke, writing to the
Queen on December 22, 1854, assured Her Majesty that the condition of
the Hospitals at Scutari, and the entire want of all method and
arrangement in everything which concerns the comfort of the army, were
subjects of constant and most painful anxiety to him. "Nothing can be
more just," he added, "than all your Majesty's comments upon the state
of facts exhibited by these letters, and the Duke of Newcastle has
repeatedly, during the last two months, written in the strongest terms
respecting them--but hitherto without avail, and with little other
result than a denial of charges, the truth of which must now be
considered to be substantiated."[128] It remained for Ministers to do
what was possible to remedy the evils.
[128] _The Letters of Queen Victoria_, vol. iii. p. 79.
Mr. Sidney Herbert, who (as already stated) had relieved the Duke of
Newcastle of hospital matters, needed no compulsion to zeal, and Miss
Nightingale's letters to him showed in what directions his zeal could
most usefully be employed. The Government of Lord Aberdeen, defeated on
the motion appointing the Roebuck Committee, resigned in January 1855,
and Lord Palmerston became Prime Minister. The offices of Secretary
_for_ War and Secretary _at_ War were amalgamated, and Lord Panmure
became Secretary of State in place of the Duke of Newcastle. Mr. Herbert
became for a short time Secretary of State for the Colonies, and then
resigned. But Mr. Herbert begged Miss Nightingale to continue writing to
him, promising to forward her representations to the proper quarters.
Lord Palmerston knew her personally, and Lord Panmure paid deference to
her wishes and opinions, so that the change of Government did not weaken
her position. I have before me copies of a long series of letters
addressed by Miss Nightingale to Mr. Herbert between November 1854 and
May 1855. He had given her private instructions that she was to act as
eye and ear for him in the East. Of her letters a few were printed by
Lord Stanmore in his _Memoir of Sidney Herbert_, where also a series of
Mr. Herbert's letters, both to her and to various officials concerned,
is given. A comparison of the one set with the other shows very clearly
how much of the improvements which the Government of Lord Aberdeen and
its successor were able to effect was due to the suggestions, the
remonstrances, the entreaties of Miss Nightingale. Her letters are
written with complete freedom and often in great haste. It would be
possible to make isolated extracts from them which would suggest that
the writer was a censorious and uncharitable scold. But such a selection
would convey a misleading impression. Miss Nightingale wrote
unreservedly about individuals, because she saw, as Mr. Herbert himself
saw also, that the _personnel_ was at fault, and that the most admirable
instructions from home would be useless unless there were men of some
initiative and vigour to carry them out on the spot. She wrote in anger,
because she saw, what Mr. Herbert soon came to know, that such men were
not forthcoming. "I write all this savagery," she said (March 5, 1855),
"because of the non-success of your unwearied efforts for the good of
these poor Hospitals." And then something must be allowed to the caustic
humour which, when Miss Nightingale had a pen in her hand, could not be
denied. "I shall make no further remark about him," she writes of a
certain individual, "than that he is a fossil of the pure Old Red
Sandstone." "Some newspaper has said of me," she writes on another
occasion, "that I am the fourth woman (query, Old Woman) that has had to
do with the war. Who are the other three?" And she goes on for Mr.
Herbert's amusement to nominate three of his principal subordinates for
the distinction. It would argue a lack of humour to take such epistolary
diversions with no grain of salt. But I do not propose to follow the
example of a previous writer, who has had access to these letters, in
recording Miss Nightingale's remarks on individuals. I desire rather to
illustrate from the letters, and from other sources, first, the
practical contributions to reform which Miss Nightingale made in some
matters of detail, and then her firm grasp of the large principles of
sound administration.
III
Miss Nightingale performed the duties, as we have seen, of a Purveyor to
the sick and wounded portion of the British army. The duty was assumed
by her only because the home authorities had been deficient in
foresight, or the authorities on the spot were inefficient and hampered
by official restrictions. Hence her earlier letters to Mr. Herbert were
largely filled with urgent suggestions for the sending of Government
stores. She begs for "hair mattresses, or even flock, as cheaper." The
French hospitals were furnished throughout with hair mattresses; the
British soldier was suffering terribly from bed-sores. She pleads for
knives and forks: "the men have to tear their meat like wild beasts."
She suggests mops, plates, dishes, towelling, disinfectants, and so
forth,--obvious requirements, no doubt, but, as Mr. Herbert said, the
responsible authorities seem to have shrunk sometimes from making
requisitions lest they should thereby confess the inadequacy of their
preparations. It was Miss Nightingale, again, who suggested the need of
carpenters to do odd jobs in the vast and imperfectly equipped Turkish
buildings which served for the British hospitals. She expressed herself
most gratefully for an "invaluable reinforcement" of them which Mr.
Herbert had sent out; but their arrival necessitated a depletion in one
department of her private stores. "These men," she wrote (Feb. 19,
1855), "I had to find with knives, forks, and spoons, in default of the
Purveyor, who besides would not provide them with rations unless the
Officer of Engineers wrote 'urgent' and asked it 'as a favour.'"
Some building operations, Miss Nightingale, as we have seen, took it
upon herself to carry out; and some sanitary reforms she was able, by
her personal influence with the orderlies, to effect.[129] "The
instruction of the Orderlies in their business was," she said,[130] "one
of the main uses of us in the War Hospitals." Other sanitary engineering
works, on a larger scale, were ultimately carried out, thanks in part to
her urgent and detailed representations to the authorities at home. She
had pointed out repeatedly to them that the mere issuing of orders was
insufficient; it was essential that executive powers should be placed in
the hands of officials directly responsible for immediate action. When
the Government was reconstituted after the fall of Lord Aberdeen, with
Lord Panmure as Secretary for War, this lesson was taken faithfully to
heart, and a Commission of Three--Dr. John Sutherland, Dr. Hector
Gavin, and Mr. Robert Rawlinson, C.E.--was sent out to the East with
full executive powers. They received their instructions on February 19,
1855, and within three days they sailed. "The tone of the instructions,"
says Kinglake, "is peculiar, and such as to make one believe that they
owed much to feminine impulsion. The diction of the orders is such that,
in housekeeper's language, it may be said to have 'bustled the
servants.'" The credit for the bustling at home belongs, however, to
Lord Shaftesbury, who had pressed the appointment of the
Commissioners upon Lord Panmure, and who was employed to draft their
instructions.[131] The duties of these Sanitary Commissioners were laid
down with a minuteness of detail which Miss Nightingale herself could
not have excelled; and they were then told that "the utmost expedition
must be used in the execution of all that is necessary at the place of
your destination. It is important that you be deeply impressed with the
necessity of not resting content with an order, but that you see
instantly, by yourselves or your agents, to the commencement of the work
and to its superintendence day by day until it is finished."[132] It is
from the Report of the Sanitary Commissioners that I drew many of the
statements about the condition of the hospitals given in an earlier
chapter. They set about the work of sanitary engineering with great
dispatch, and the death-rate in the hospitals fell, as the result of
their reforms, with remarkable rapidity.[133] "The sanitary conditions
of the hospitals of Scutari," Miss Nightingale told the Royal Commission
of 1857, "were inferior in point of crowding, ventilation, drainage, and
cleanliness, up to the middle of March 1855, to any civil hospital, or
to the poorest homes of the worst parts of the civil population of any
large town that I have ever seen. After the sanitary works undertaken at
that date were executed (June), I know no buildings in the world which I
could compare with them in these points, the original defects of
construction of course excepted." It was this Commission, as Miss
Nightingale said afterwards to Lord Shaftesbury, that "saved the
British Army." In Dr. Sutherland, the head of the Sanitary Commission,
Miss Nightingale found a warm admirer and a stout supporter. During his
stay at Scutari he acted as her physician. On her return to England she
was on terms of intimate friendship with him and his wife; and Dr.
Sutherland was, as we shall hear, one of her close allies in the battle
for reform in army hygiene. With Mr. (afterwards Sir Robert) Rawlinson
she also formed a friendship which lasted to the end of his life. Dr.
Gavin died in the Crimea during the work of the Commission.
[129] See, on these two points, above, p. 206, and below, p. 242.
[130] In a letter to Colonel Lefroy, Aug. 25, 1856.
[131] Hodder's _Life of Lord Shaftesbury_, pp. 503 _seq_.
[132] _Report of the Sanitary Commission_, March 1857.
[133] For the figures, see below, pp. 254, 314.
In the matter of stores, whatever suggestions or requisitions Miss
Nightingale sent home were complied with by Government. But it was one
thing to send stores out, and quite another to secure that they should
arrive when and where they were wanted. "Sidney," wrote Mrs. Herbert to
Mrs. Bracebridge (Nov. 17, '54), "has sent heaps of armchairs, etnas,
and other comforts, but is in terrible fear that they may have been
carried on with the troops to Balaclava from some blunder." Miss
Nightingale's unerring eye for detail and perception of the point saw
where the evil lay. First, there was no co-ordination among the
departments at home in packing the things. The _Prince_ (the wreck of
which in the famous hurricane of November 14 was disastrous to the
welfare of the soldiers) "had on board," she wrote, "a quantity of
medical comforts for us, which were so packed under shot and shell as
that it was found impossible to disembark them here, and they went to
Balaclava and were lost." But there was a second obstacle. The army had
encamped at Scutari as early as May 1854, but it had occurred to nobody
to establish either there or at Constantinople an office for the
reception and delivery of goods. Packages, intended for the army or the
hospitals, if they arrived in merchant vessels, were detained in the
Turkish Custom House, from which they were never extracted without much
delay, difficulty, and confusion; many were partially or entirely
destroyed; and many abstracted and totally lost. "The Custom House,"
said Miss Nightingale, "was a bottomless pit, whence nothing ever issued
of all that was thrown in." In the case of ships chartered by the
Government, great masses of goods were necessarily landed together and
stowed away promiscuously for want of time and space for sorting, and
were often delayed by an unnecessary trip to Balaclava and back again.
There were occasions in which vessels containing hospital stores, as
well as munitions of war, made three voyages to and fro before the
former were landed at Scutari. Sometimes when Miss Nightingale happened
to hear of an incoming vessel betimes, she was able, by special petition
to the military authorities, to intercept hospital stores; but she saw
(what no one else seems to have done) that the whole system was at
fault. "It is absolutely necessary," she wrote, "that there should be a
Government Store House, in the shape of a hulk, where stores for the
British, from whatever ships, could be received at once from them, and
be delivered on the ship-store-keeper's receipt. There are no
store-houses to be had by the water's-edge, and porterage is very
expensive and slow." In March 1855 Miss Nightingale's solution was
adopted.[134]
[134] _Statement to Subscribers_, pp. 9-10, and letter to Sidney
Herbert, January 22, 1855.
As Purveyor, Miss Nightingale was directly concerned only with the sick
and wounded; but the condition in which the men arrived at Scutari
enabled her to learn the state of things at the front, and she urged
upon Mr. Herbert the necessity of sending out warm clothing to the army
in the Crimea. "The state of the troops who return here, particularly
those 500 who were admitted on the 19th, is frost-bitten, demi-nude,
starved, ragged. If the troops who work in the trenches are not supplied
with warm clothing, Napoleon's Russian campaign will be repeated here."
The terrible experiences of the British army before Sebastopol during
the winter of 1854-55 were some fulfilment of her prediction. When
opportunity offered she similarly sent suggestions to Lord Panmure;
then, in reply to a letter of kind inquiries from him about her health
(Aug. 1855), she called attention to the disproportionate number of
patients which came from the Artillery, and threw out hints for
economizing the men's labour.[135] On a matter of the soldiers' pay, she
was the means of remedying a hardship which had struck her at Scutari.
She pressed earnestly upon Mr. Herbert that hospital stoppages against
the daily pay of the _sick_ soldier (9d.) should be made equal to the
hospital stoppage against the _wounded_ soldier (4-1/2.), provided that the
sickness be incurred while on duty before the enemy. She made this
representation in December 1854, not only to Mr. Herbert, but to the
Queen. On February 1, 1855, she heard with great satisfaction that her
suggestion had been adopted, and that the soldiers' accounts were to be
rectified in that sense as from the Battle of the Alma.
[135] See _Panmure_, vol. i. p. 356.
IV
The Queen had asked Miss Nightingale to make suggestions as to what Her
Majesty could do "to testify her sense of the courage and endurance so
abundantly shown by her sick soldiers." One of the suggestions submitted
was the rectification just mentioned. Another suggestion was that a
Firman should be immediately asked of the Sultan granting the military
cemetery at Scutari to the British, and that Her Majesty should have it
enclosed by a stone wall. "There are already, alas!" wrote Miss
Nightingale, "about a thousand lying in this cemetery. Nine hundred were
reported last week. We have buried one hundred in the last two days
only. The spot is beautiful, overlooking the Sea of Marmora, and
occupies the space between the General Hospital wall and the edge of the
sea-cliff." The suggestion must have gone straight to the Queen's heart,
for Miss Nightingale was informed that Her Majesty had written on the
subject both to Lord Clarendon, the Secretary of State for Foreign
Affairs, and to the British Ambassador to the Porte. The Firman was
obtained in due course, and the well-kept British enclosure attracts the
attention of travellers to this day by contrast with the Oriental
burial-places. It was again at Miss Nightingale's suggestion that a
memorial obelisk, far seen in lonely splendour, was erected "by Queen
Victoria and her people."[136]
[136] In 1865 Miss Nightingale, after an energetic correspondence with
the War Office, secured payment, long before promised, to an
English custode.
But I must not linger further over points of detail. Miss Nightingale's
eye for detail did not prevent her from taking comprehensive views,
and from time to time she sent to Mr. Herbert schemes of reorganization.
In the following letter, of January 8, 1855, she exposed the extent and
nature of the evil in the hospitals, and the kind of reform which was
needed to remedy them:--
As the larger proportion of the army (in which we are told that
there are not two thousand sound men) is coming into hospital--as
there are therefore thousands of lives at stake--as, in a service
where the future of the official servants is dependent upon the
personal interest of one man, these cannot be expected to peril
that future by getting themselves shelved as innovators.
I feel that this is no time for compliments or false shame; and
that you will never hear the whole truth, troublesome as it is,
except from one independent of promotion....
I subjoin a rough estimate of what has been given out by me during
one month--_the whole at the "requisition" of the Medical Men_--all
of which I have by me (merely in order to substantiate the facts of
the destitution of these hospitals).
Since the 17th December, we have received 3400 sick, and I have
made no sum total as yet of what has been done for these new-comers
by us--excepting for one corridor, which I enclose.
(1) Thus the Purveying is _nil_--that is the whole truth, beyond
bedding, bread, meat, cold water, fuel.
Beyond the boiling _en masse_ in the great coppers of the general
kitchen the meat is not cooked, the water is not boiled except what
is done in my subsidiary kitchens. My schedule will show what I
have purveyed.
I have refused to go on purveying for the third Hospital, the
Sultan's Serail[137]--the demands upon me there having been begun
with twelve hundred articles, including shirts, the first night of
our occupying it. I refer you to a List of what was _not_ in store,
and to a copy of one requisition upon me sent last letter.
[137] This is the "Palace Hospital." See above, p. 174.
(2) The extraordinary circumstance of a whole army having been
ordered to abandon its kits, as was done when we landed our men
before Alma, has been overlooked entirely in all our system. The
fact is, that I am now clothing the British Army. The sick were
re-embarked at Balaclava for these Hospitals, without resuming
their kits, also half-naked besides. And when discharged from here,
they carry off, small blame to them, even my knives and
forks--shirts, of course, and Hospital clothing also. The men who
were sent to Abydos as convalescents were sent _in their Hospital
dresses_, or they must have gone naked. The consequence is that not
one single Hospital dress is now left in store, and I have
substituted Turkish dressing-gowns from Stamboul (three bales in the
passage are marked Hospital Gowns, but have not yet been "_sat
upon_"). To purvey this Hospital is like pouring water into a sieve;
and will be, till regimental stores have been sent out from England
enough to clothe the naked and refill the kit.
I have requisitions for _Uniform trousers_, for each and all of the
articles of a kit, sent in to me.
We have not yet heard of boots being sent out; the men come into
Hospital half-shod.
In a time of such calamity, unparalleled in the history, I believe,
of calamity, I have a little compassion left even for the wretched
Purveyor, swamped amid demands he never expected. But I have no
compassion for the men who would rather see hundreds of lives lost
than waive one scruple of the official conscience.
(3) The Hospital and Army Stores come out in the same vessels--and
up go our stores to Balaclava, and down they never come again, or
have not yet.
(4) The total inefficiency of the Hospital Orderly System as now
is. The French have a permanent system of Orderlies, trained for
the purpose, who do not re-enter the ranks. It is too late for us
to organize this. But if the convalescents, being good Orderlies,
were not sent away to the Crimea as soon as they have learnt their
work--if the Commander-in-Chief would call upon the Commanding
Officer of each Regiment to select ten men from each as Hospital
Orderlies to form a depot here (not young soldiers, but men of good
character), this would give some hope of organizing an efficient
corps. Above all, that the class of Ward-Master I shall mention
should be sent out from England.
We require:--
(1) An effective staff of Purveyors out from England--but beyond
this,
(2) _A head_, some one with _authority_ to mash up the departments
into uniform and rapid action. He may as well stay at home unless
he have power to modify the arrangements of departments made
expressly by Sir C. Trevelyan with Mr. Wreford before he came away
in May.
(3) We want Medical Officers.
(4) Three Deputy Inspectors-General (whereas we have only one)....
It is obvious from what has been said in former letters _who_, if
there are two Deputy Inspector-Generals made to these Hospitals,
should be made Deputy Inspector-General of this Barrack Hospital,
past and present efficiency being considered.
(5) We want discharged Non-Commissioned Officers, not past the
meridian of life--not the Ambulance Corps, who all died of delirium
tremens or cholera--but the class of men employed as Ward-Masters
of Military Prisons, or as Barrack Sergeants, or Hospital Sergeants
of the Guards who can be highly recommended.
We want these men as Ward-Masters and Assistant Ward-Masters as
Stewards. They must be under the orders of the Senior Medical
Officer, removable by him; they must be well paid so as to make it
worth their while,--say 5s. per day, 1st class, 2s. 6d. per day 2nd
class--for they must be superior men, not the rabble we have now.
(_N.B._--There are three Ward-Masters to each division of this
Hospital--of which there are three--containing 800 and odd sick in
each.)
The book of Hospital regulations, admirable in time of peace,
contains nothing for a time of war, much less a time of war like
this, unexampled for calamity.
The Hospital Sergeants are, of course, up in the Crimea with their
regiments,--and we have nothing but such raw Corporals and
Sergeants as can be spared, new to their work, to place in charge
of the divisions and wards. And these Lord Raglan complains of our
keeping. We must have Hospital Sergeants if there is to be the
remotest hope of efficiency among the Orderlies here.
(6) The Orderlies ought to be well paid, well fed, well housed.
They are now overworked, ill fed, and underpaid. The sickness and
mortality among them is extraordinary--ten took sick in one
Division to-night....
I had written a plan for the systematic organization of these
Hospitals upon a principle of centralization, under which the
component parts might be worked in unison. But, on reconsideration,
deeming so great a change impracticable during the present heavy
pressure of calamities here, I refrain from forwarding it, and
substitute a sketch of a plan, by which great improvement might be
made from within, without abandoning the forms under which the
service is carried on....
This further scheme may, however, be given more shortly from a later
letter (Jan. 28):--
As the Purveying seems likely to come to an end of itself, perhaps
I shall not be guilty of the murder of the Innocents if I venture
to suggest what may take the place of the venerable Wreford.
Cornelius Agrippa had a broom-stick which used to fetch water for
his use. When the broom-stick was cut in two by the axe of an
unwary student, each end of the severed broom, catching up a
pitcher, began fetching water with all its might. Were the Purveyor
here cut in three, we might conceive some hope of having not only
water, but food also, and clothing fetched us. Let there be three
distinct offices instead of one indistinct one:--
(1) To provide us with food.
(2) With Hospital furniture and clothing.
(3) To keep the daily routine going.
These are now the three offices of the unfortunate Purveyor; and
none of them are performed.
But the Purveyor is _supposed_ to be only the channel through which
the Commissariat stores _pass_. Theoretically, but not practically,
it is so. (For practically Wreford gets nothing through the
Commissary, but employs a contractor.)
Now, why should not the _Commissariat purvey_ the Hospital with
food? perform the whole of Purveyor's office, No. 1? The practice
of drawing _raw_ rations, as here seen, seems invented on purpose
to waste the time of as many Orderlies as possible, who stand at
the Purveyor's office from 4 to 9 A.M. drawing the patients'
breakfast, from 10 to 12, drawing their dinner--and to make the
patients' meals as late as possible--because it is impossible to
get the diets, thus drawn, cooked before 3 or 4 o'clock. The scene
of confusion, delay, and disappointment where all these raw diets
are being weighed out by twos, and threes, and fours, is impossible
to conceive, unless one has seen it, as I have, day after day. And
one must have been, as I have, at all hours of the day and night in
this Hospital to conceive the abuses of this want of system--raw
meat, drawn too late to be cooked, standing all night in the wards,
etc., etc., etc. Why should not the Commissariat send _at once_ the
amount of beef and mutton, etc., etc., required into the kitchens,
without passing through this intermediate stage of drawing by
Orderlies?
Let a Commissariat Officer reside here--let the Ward-Masters make a
total from the Diet Rolls of the Medical Men--so many hundred full
diets--so many hundred half-diets--so many hundred spoon diets, and
give it over to the Commissariat Officer the day before. The next
day the _whole_ quantity, the _total_ of all the Ward-Masters'
totals, is given into the kitchens direct.
It should be all carved in the kitchens on hot plates, and at
meal-times the Orderlies come to fetch it for the patients--carry
it through the wards, where an Officer tells it off to every bed,
according to the Bed-ticket, on which he reads the Diet, hung up at
every bed. The time and confusion thus saved would be incalculable.
Punctuality is now impossible; the food is half-raw, and often many
hours after time. Some of the portions are all bone, whereas the
meat should be boned in the kitchen, according to the plan now
proposed, and the portions there carved contain meat only. Pray
consider this.
There might be, _besides_, an Extra Diet Kitchen to each division;
a teapot, issue of tea, sugar, etc., to every mess, for which
stores make the Ward-Master responsible; arrow-root, beef-tea, etc.,
to be issued from the Extra Diet Kitchens.
But into these details it is needless to enter to you.
(2) The second office of the Purveyor now is to furnish, _upon
requisition_, the Hospital with utensils and clothing. But let the
Hospital be furnished at once, as has been already described in
former letters. If 2000 beds exist, let these 2000 beds have their
appropriate complement of furniture and clothing, stationary and
fixed. Whether these be originally provided by a Commissary or a
storekeeper, let those who are competent decide. The French appear
to give as much too much power to their Commissariat, who are the
real chiefs of their Hospitals, while the Medical Men are only
their slaves, as we give too little. But the Hospital being once
furnished, and a store-keeper appointed to each division to supply
wear and tear, let the Ward-Masters be responsible. Let an inventory
hang on the door of each ward of what _ought_ to be found there. Let
the Ward-Masters give up the dirty linen every night and receive the
same quantity in clean linen every morning. Let the Patient shed his
Hospital clothing like a snake when he goes out of Hospital, be
inspected by the Quarter-Master, and receive, if necessary, from
Quarter-Master's store what is requisite for his becoming a soldier
again. While the next patient succeeds to his bed and its furniture.
(3) The daily routine of the Hospital. This is now performed, or
rather _not_ performed by the Purveyor. I am really cook,
housekeeper, scavenger (I go about making the Orderlies empty huge
tubs), washer-woman, general dealer, store-keeper. The Purveyor is
supposed to do all this, but it is physically impossible. And the
filth, and the disorder, and the neglect, let those describe who saw
it when we first came....
Let us have a Hotel-keeper, a House-steward, who shall take the
daily routine in charge--the cooking, washing and cleaning us--the
superintending the housekeeping, in short, be responsible for the
cleanliness of the wards, now done by one Medical Officer, Dr.
M'Grigor, by me, or by no one--inspect the kitchens, the
wash-houses, be what a housekeeper ought to be in a private Asylum.
With the French the _chef d'administration_, the Commissary, as we
should call him, is the master of the Orderlies. And the Medical
Men just come in and prescribe, as London physicians do, and go
away again. With us the Medical Officers are everything, and have
to do everything, however heterogeneous. The French system is bad,
because, though there may be twenty things down on the Carte for
the Medical Man to choose his patient's diet from, _nominally_,
the Chef d'Administration may have provided only two, and the
Patient has no redress.
Whether, in any new plan, the House Stewards have the command of
the Orderlies, or the Medical Man, which I am incompetent to
determine, whichever it be let us have a Governor of the Hospital.
As it is a Military Hospital, a Military Head is probably necessary
as Governor.
On September 20, 1855, a Royal Warrant was issued, reorganizing the
Medical Staff Corps, "for the better care of the sick and wounded,"
revising the duties of the several officers, and improving their pay.
Any one who cares to refer to this Warrant, and to compare it with Miss
Nightingale's letters just given, will see that in large measure her
suggestions were adopted by the War Department.
Miss Nightingale was careful, as we have seen, not to interfere with the
doctors, and, though she thought that as administrators some of them
were ineffective, she bore willing testimony to their skill and devotion
(with some few exceptions) in their proper work. But she could not
abstain from deploring one great omission, and she offered to subscribe
largely towards repairing it:--
"One thing which we much require," she wrote to Mr. Herbert (Feb.
22, 1855), "might easily be done. This is the formation of a
Medical School at Scutari. We have lost the finest opportunity for
advancing the cause of Medicine and erecting it into a Science
which will probably ever be afforded. There is here no operating
room, no dissecting room; post-mortem examinations are seldom made,
and then in the dead-house (the ablest Staff Surgeon here told me
that he considered that he had killed hundreds of men owing to the
absence of these) no statistics are kept as to between what ages
most deaths occur, as to modes of treatment, appearances of the
body after death, etc., etc., etc., and all the innumerable and
most important points which contribute to making Therapeutics a
means of saving life, and not, as it is here, a formal duty. Our
registration generally is so lamentably defective that often the
only record kept is--_a man died_ on such a day. There is a kiosk
on the Esplanade before the Barrack Hospital, rejected by the
Quarter-Master for his stores, which I have asked for and obtained
as a School of Medicine. It is not used now for any purpose--£300
or £400 (which I would willingly give) would put it in a state of
repair. It is not overlooked and is in every way calculated for the
purpose I have named. The Medical teaching duties could not be
carried on efficiently with a less staff than two lecturers on
Physiology and Pathology, and one lecturer on Anatomy, who will be
employed in preparing the subject for demonstration, and performing
operations for the information of the Juniors."
This suggestion also was in part adopted. An excellent dissecting-room
was built, provided with numerous instruments, microscopes and other
apparatus.[138]
[138] See _Pincoffs_, p. 55.
V
And so this woman of ideas went on, week by week, month by month,
pouring in requisitions, hints, plans, to the Government at home;
sometimes getting things done as she wanted, at others making
suggestions which, had they been adopted, would still more have conduced
to efficiency. Something of that calm and clear sagacity, which
impressed Queen Victoria and Prince Albert when they made her personal
acquaintance,[139] was reflected in her appearance and demeanour as
observed by eye-witnesses at Scutari. "In appearance," wrote Mr.
Osborne, "Miss Nightingale is just what you would expect in any other
well-bred woman, who may have seen perhaps rather more than thirty years
of life; her manner and countenance are prepossessing, and this without
the possession of positive beauty; it is a face not easily forgotten,
pleasing in its smile, with an eye betokening great self-possession, and
giving, when she wishes, a quiet look of firm determination to every
feature. Her general demeanour is quiet and rather reserved; still, I am
much mistaken if she is not gifted with a very lively sense of the
ridiculous. In conversation, she speaks on matters of business with a
grave earnestness one would not expect from her appearance. She has
evidently a mind disciplined to restrain under the principles of the
action of the moment every feeling which would interfere with it. She
has trained herself to command, and learned the value of conciliation
towards others and constraint over herself. I can conceive her to be a
strict disciplinarian; she throws herself into a work as its head. As
such she knows well how much success must depend upon literal obedience
to her every order."[140]
[139] See the words cited at the head of this chapter, and below,
pp. 324, 325.
[140] _Scutari and its Hospitals_, p. 25.
It was soon perceived at Scutari that Miss Nightingale was a power. She
mentioned incidentally at a later period a curious fact, which shows the
way in which officers appealed to her as a kind of emergency-man. In
1862 she was pressing the War Office to separate the function of Banker
from that of Purveyor, and she illustrated the confusion caused by the
amalgamation from her own experience. Among the instances was this: "I
had at Scutari thousands of sovereigns at a time in my bedroom,
entrusted to me by officers who preferred making me their banker because
of the perpetual discord. 'Offend the Commissary or Purveyor, and you
won't be able to get your money.'"[141] It was soon perceived also that
Miss Nightingale was the person who, if any one, could get things done,
and any official who had an idea took it to her. In the letters to
Sidney Herbert she sometimes bids him know that what she says does not
merely come from "poor me," but represents the views "of all the best
men here." But she, I think, was the best man of them all.[142] Such was
the opinion, at any rate, of a man among men, the redoubtable Sydney
Godolphin Osborne. "Every day," he wrote in describing his experience at
Scutari, "brought some new complication of misery to be somehow
unravelled. Every day had its peculiar trial to one who had taken such a
load of responsibility, in an untried field, and with a staff of her own
sex, all new to it. Hers was a post requiring the courage of a Cardigan,
the tact and diplomacy of a Palmerston, the endurance of a Howard, the
cheerful philanthropy of a Mrs. Fry. Miss Nightingale fills that post;
and, in my opinion, is the one individual who in this whole unhappy war
has shown more than any other what real energy guided by good sense can
do to meet the calls of sudden emergency."[143] And hence it was, too,
that any official who felt the urgency of some particular need in his
own department carried his case to the Lady-in-Chief. Did a surgeon want
some point represented with special urgency to the authorities at home?
He went to Miss Nightingale. Did a purveyor want some special authority
from the military to facilitate his task? He went to Miss Nightingale.
The centre of initiative at Scutari was in the Sisters' Tower; and going
to Miss Nightingale had something of the magic that in earlier days was
found in "going to Mr. Pitt."[144]
[141] Letter to Captain Galton, June 28, 1862. On the general question,
see vol. ii. p. 64.
[142] It was a _mot_ of Mr. Stafford's that he had only met two men in
the East, Omar Pacha (the Turkish Commander) and Florence
Nightingale.
[143] _Scutari and its Hospitals_, p. 27.
[144] See _Kinglake_, vol. vi. pp. 43, 436.