[Sidenote: Rules.]
13. Their rules should be simple, very definite, should leave them at
the absolute disposal of the surgeon as to ward matters, and at the
absolute disposal of the Female Superintendent in all other matters.
Their dress should be uniform.
[Sidenote: Duties.]
14. Their duties should be strictly defined, and be consistent with
the Code of Army Hospital Regulations, the revision of which has been
announced.
[Sidenote: Means of Steadying them.]
15. Give them plenty to do, and great responsibility--two effectual
means of steadying women.
[Sidenote: Lodging.]
16. The nurse’s lodging in view of her ward renders her far more
efficient; but this requires some special arrangement. It would not do
to have the chance of the nurse’s being suddenly taken ill, with only
patients and orderlies within immediate reach. Were the nurses’ rooms
so arranged that two or more were on one floor (as is the case in all
Hospitals), and so arranged as to be entirely separate, and yet, when
so desired, easily accessible to each other, which might easily be
contrived, this would probably answer all purposes.
[Sidenote: Food.]
17. Their food should be sent them cooked with some slight variety.
With the plainest intentions nature often revolts from the perpetual
joint of excellent meat in Hospital air and life. The occasional
“potage,” fish, &c., of other systems, are in fact, a refreshing and
palatable change. If, however, avoiding names that shock and frighten,
some slight change of diet could be contrived, the effect would be
good. This is practical and not at all romantic, though it may look the
latter.
[Sidenote: Opinion of honest Military Authority desirable.]
18. Could the honest opinions be had of a few good Military and
Surgical Authorities before beginning, it would be good.
[Sidenote: Female Superintendent-General.]
19. The Female Superintendent-General’s own powers and responsibilities
must be absolutely fixed, and so as not to clash with those of the
Officer (should such an Officer be appointed, as has been elsewhere
recommended), who shall superintend the Hospital attendants.
[Sidenote: Confidential Reports.]
20. Confidential reports must be so modified, as far as women are
concerned, that the humble boon granted to pickpockets, of being
informed of accusations laid to their charge, must be extended to Her
Majesty’s nurses.
[Sidenote: Permanency of the System.]
21. In framing the system and the Superintendent’s own office, let it
be attempted to secure the permanent efficient working, please God, in
ordinary hands. To aim at the best conceivable may lead to failure.
Genius works with ordinary materials, but never constructs an edifice
which it alone can inhabit.
[Sidenote: Quietness.]
22. “In quietness and in confidence shall be your strength.” Quietness
has been from the beginning of its publicity the one thing wanting in
this work. I know the fuss, which from its beginning surrounded it, was
abhorrent to us and was the act of others: but the work, which is all
we care for, has throughout suffered from it. It is equally injurious
and impeding as regards surgeons, nurses, and people, who are neither.
External help in this coarse, repulsive, servile, noble work, for it
is all these things, is truly the reed which pierced the hand that
leant upon it. One hospital, naval, military, or civil, nursed well,
and gradually training a few nurses, would do more good to the cause
than an endless amount of meetings, testimonials, pounds, and speeches,
to say nothing of newspaper puffings, which to-morrow might turn into
revilings. This never will, never can be a popular work. Few good
ones are, for few are without the stern fructifying element of moral
restraint and influence; and though the streams of this are many, its
source is one. Hearts are not touched without Religion. Religion was
not given us from above in impressions and generalities, but in habits
of thought and action, in love of God and of mankind, carried into
action.
* * * * *
[Sidenote: Various Systems of Female Nursing compared.]
A very short comparison will here be made between the methods of Female
Nursing in the Military Hospitals of
Russia,
England,
France, and
Sardinia,
as exemplified in the last War.
[Sidenote: French and Sardinian Hospital Service.]
To do this, a sketch must be partly repeated, which has been already
given, of the organic difference between the Hospital Service of each
nation.
The essential characteristic of the French is, the importance given in
the field to the Divisional Hospital Service over the Regimental.
The Regimental Medical Service treats only those ephemeral cases which
are to be exempted from duty for a day or two. Cases of wounds or
disease likely to last for a term of weeks are sent to the Divisional
Ambulance in the field; those, where disease may possibly last for
months, to the General Hospitals at the base of operations.
The Medical Service of the Sardinians closely resembles the above
in its formation. In the late War, their General Ambulances were at
Balaklava; their General Hospitals at Jeni Koi on the Bosphorus. They
had no Divisional or Regimental Hospitals.
[Sidenote: English.]
In our Army, as is well known, the Regiment establishes its Regimental
Hospital wherever it goes. Theoretically, it is exclusively a
Regimental system of Hospitals; however much, practically, it breaks
down.
[Sidenote: Russian.]
The Russian system can scarcely bear a comparison with ours;
because their Regiments are Divisions. They had a regular system of
transporting the sick and wounded upon the North side of Sebastopol,
then upon Mackenzie’s Heights, then upon Bakschi-Serai, and lastly upon
Simpheropol.
[Sidenote: Female Nurses.]
The adaptation of Female Nursing to the different systems in the
French,
Sardinian,
Russian, and
English Armies
has now to be noticed.
[Sidenote: Sardinian and French Female Nurses.]
The Sardinians had Sisters of Charity, both in the General Ambulances
in the Crimea, and in the General Hospitals on the Bosphorus.
The principal duties of these admirable women appear to have been the
care of the linen and small stores, and the cooking, much of which they
did with their own hands, for sick officers and men. These duties were
admirably performed. They appeared, besides, to have a certain charge
in the wards, the power of giving “_douceurs_,” the administration
of extras, the seeing to the cleanliness of beds and patients, and
something more precise with regard to sick Officers; but their duties
seemed to be somewhat undefined in their relation to the Infirmiers.
Whether the Sœur or the Infirmier Major were in charge, to see the
duties about the patient properly executed, was rather a problem.
This was still more the case in the French Hospitals, where the “Sœur”
in the wards appeared more of a “consolatrice” and an administratrix of
extras: although, out of the wards, her admirable housekeeping, both in
the kitchen and the linen-store, was predominant.
The French “Sœurs” were not admitted to the Divisional Ambulances
in the front: it was whispered, because of the corruption of
the French Intendance, upon whom they tacitly exercised a very
inconvenient “surveillance.” They served in all the General Hospitals
at Constantinople; and to their admirable services, M. Baudens,
Inspecteur-Général en Crimée, has rendered an “_éclatant témoignage_”
in his “Mission Médicale en Orient,” published in the numbers of the
“Revue des Deux Mondes,” of February 15, April 1, and June 1, 1857.
In these French Hospitals of Constantinople, the “Sœurs” appeared to do
all the cooking for the sick Officers and that of the extras for the
men.
I do not think that, in either French or Sardinian Hospitals, the
care of bed-sores and such like, which can only be done by women, was
sufficiently given to the “Sœurs.”
I have heard complaints made of this kind both by Officers and men; and
“Sœurs,” both French and Sardinian, have been to me to look at the way
in which we treated bed-sores, and to borrow air-pillows and water-beds.
There is such a difference however in different Hospitals, in time of
war and of peace, &c., that I would not be understood to mean that any
of these remarks apply absolutely or generally, but only to Hospitals I
have seen.
It may be as well to mention that, talking of “French” and “Sardinian”
Sisters, they all come from one “Maison Mère,” that of the “Filles
de la Charité de S. Vincent de Paule,” at Paris. There is a “Maison
Succursale,” at Turin. But all are of the same Order, and under the
same head.
Let me mention Sœur Cordero, the excellent Superioress of all the
Sisters employed in the Sardinian Hospitals of the war, with the
warmest affection and respect. She was a woman of high rank, of the
most captivating manners, but of the utmost simplicity of character,
and of unfailing devotion to right and to God.
[Sidenote: Russian.]
It remains to mention the Russian system, which, as regards the
organization of the duties of the “Sisters,” appeared to me by far the
best I have known. I am at a loss to conceive what is meant by the
following sentence in the Report by two of our Army Medical Officers on
the “Russian Medical Department,” presented to the House of Commons.
Speaking of the Sisters of Mercy, who are generally widows of officers,
it is said “their chief duties appeared to be in taking charge of the
linen and superintending the issue of extras.” This is founded on error
of observation--as the Russian system seems to be the only perfectly
organized system of female attendance in Military Hospitals, which was
developed in the Crimean War. In it, the Sister has charge of all that
relates to the bed-side of the patient; she receives the orders from
the Medical Officer, attends him in his rounds; he confers with her
afterwards; she even reports the “felchers” or dressers, as also the
orderlies, as far as regards their discharge of duties at the bed-side
of the patient. The orderlies are, of course, under the control of a
Non-commissioned Officer, in all that pertains to discipline, clothing,
meals, &c. The “felchers” are under a superior “felcher,” and under the
Medical Officers.
There are female nurses, wives and widows of soldiers, under the
“Sisters,” who are generally, as has been stated, widows of Officers.
This appears the nearest approach to good organization I have met with.
But again I say there may be much difference among the Russian Military
Hospitals. I would not be considered as laying down an absolute
experience.
[Sidenote: English.]
It has been said elsewhere what was the system or no system pursued
in the English Military Hospitals, as to Female Nursing. It was a
new thing, and no General Order or Warrant was ever issued as to the
duties of the nurses. Many duties clearly devolved upon the Female
Superintendent-General, as she was afterwards called in “General
Orders,” which never should devolve upon her again.
[Sidenote: Proposed Duties of Female Nurses in Military Hospitals.]
But it may be now clearly enunciated what the duties of Female Nurses
should be, and many reasons will subsequently be given why there never
will be discipline in Military Hospitals till they are as follow:
Women only of the character, efficiency, and responsibility of Head
Nurses in other Hospitals should be admitted into Military ones. They
should have charge and be responsible for all that pertains to the
bed-side of the patient; for his cleanliness, and that of his linen,
bed, and utensils; for all the minor dressings, not performed by
Surgeons or Dressers; for the administration of medicines, and of the
meals; for the obedience of the patient and orderlies to the orders of
the Medical Officer. They should receive the orders of the latter, and
always attend him in his visits.
Till the above is done by women, the same want of discipline, now to
be observed in Military Hospitals, and often already noticed, will
continue,--such is my firm belief, the result of much experience.
[Sidenote: Duties which should be left to men.]
There will be abundance left for the Ward Master or Serjeant to do
in taking Military charge of the Hospital and its inhabitants, in
being Office Clerk, &c., _i. e._, keeping the Admission books, making
States, Returns, Accounts, and other documents, without his being
Head-Nurse, without his superintending the Orderlies at the bed-side,
his administering medicines, &c., which can only be satisfactorily done
by a woman. And, when done by her, there will still be ample work for
two men, where one does now the work of three.
The first should do the Military part, the second should compound,
take charge of Medical and Surgical stores, of Returns and Accounts
connected with these; and, where there is no Purveyor, of Purveyor’s
and Barrack stores, provisions, cooking, washing, diets, and extras,
including Returns and Accounts connected with these.
As it is, there is one Hospital Serjeant, who is Ward-Master, Serjeant,
Steward, Clerk, Dispenser, Purveyor’s Clerk, and Head-Nurse--a kind of
“Maître Jacques,” as in Molière’s “Avare.”
One man cannot do all these things.
A Female should be the Head-Nurse--a Serjeant should be the Serjeant
and Clerk--a Ward-Master the Steward, Dispenser, Ward-Master, and
Purveyor’s Clerk.
And here I must deplore the confusion unavoidable in these definitions
of proposed duties, while we have no separate system for Regimental and
General Hospitals.
What Dr. Menzies declared, in his evidence as to the General Hospitals
at Scutari, is strictly true, and one great cause of our failure at
Scutari:--“I have followed the general rules for Regimental Hospitals,
so far as I could.”
While Regimental Hospitals are what they are, females never can be
admitted there. On the other hand, if General Hospitals be established,
one happy consequence will be that the cooking and washing will
be taken out of the hands of the Hospital Serjeant, and regularly
organized, it is hoped under a Captain-Superintendent of Orderlies. All
Purveyor’s and Barrack stores, that is, Hospital stores and furniture
will, it is hoped, fall under the charge of a Steward; Medical and
Surgical stores under that of an Apothecary.
It will only remain to place a female Head-Nurse in charge of all that
concerns the bed-side of a patient, and the duties of the Orderlies
about the bed-side, and a Ward-Master in charge of everything else
belonging to the Orderlies and Patients.
But, if it should be determined to retain everywhere the old Regimental
system, it is only just to add this very strong testimony and appeal in
favour of the old Hospital Sergeant, who indeed deserves it:--
“I may take this opportunity of stating my conviction that, from
the very arduous, constant, and responsible duties of the Hospital
Sergeant, and his influence for good or ill among the non-commissioned
officers and men of the regiment, it is particularly required for the
good of the service that he should be put at least on the same footing
in rank and pay as a first-class staff sergeant. He ought to pass
an examination by a Board of Medical Officers as to his fitness for
compounding medicines on the same footing as a druggist in England. My
Hospital Sergeant, who has been eight years a sergeant, three of which
as Hospital Sergeant, receives at present 1_s._ 10_d._ pay per diem,
and an allowance of 4_d._ per diem as Hospital Orderly; at the same
time that there are sergeants in the ranks of the regiment four years
junior to him as a non-commissioned officer who are receiving 2_s._
10_d._ pay per diem.
“My experience leads me to consider that the regimental bandsmen are
not, as a body, likely to be sufficiently strong or able men for the
duty of carrying the wounded to be consigned to them.
“(Signed)
THOMAS LONGMORE,
“_Surgeon 19th Regiment_.”
NOTE IN REGARD TO THE RUSSIAN NURSES EMPLOYED IN THE WAR-HOSPITALS OF
THE CRIMEA.
The Russian nurses, in the opinion of their Master, the famous
surgeon, Pirogoff, did other things besides what the Army Medical
Director-General told the House of Commons they did. But it is to be
observed--
In the first place, that much allowance is to be made for the confusion
incident to Scotch and Russian surgeons talking French together, and
going over many subjects in a very short time.
And in the second, that very likely some extra confusion arose in
the minds of our Army Medical Officers from the fact of two entirely
different sets of women having served in the Russian War Hospitals,
viz.:
(1.) The Sisters of the Elevation of the Cross.
(2.) The “Frauen des Barmherzigen Wittwen Instituts,” (mentioned
in a very cold manner in pages 4, 26, and implicitly, 27, of
Professor Pirogoff’s pamphlet, “Die Gemeinschaft der Schwestern zur
Kreuz-erhöhung. Berlin: 1856”); who are those spoken of at pp. 22, 23,
above.
The Widows were so instituted, about forty years or more ago, by Mary
of Wirtemberg, during so many years the venerated Empress-Mother. It is
quite possible that in the war-pressure their services proved rather
nondescript, they being neither sisters nor nurses, strictly speaking;
or perhaps the sole reason why Professor Pirogoff has not one good word
for them is, that they were not under his orders.
The Sisters of the Elevation of the Cross were a body of secular women,
with a few Sisters of Mercy, formed by the Grand Duchess Helena, and
placed by her under the orders of the famous civilian Surgeon Pirogoff,
to whom the supreme surgical command in Sevastopol was virtually
given. Several things are incidentally mentioned concerning them in
his pamphlet, quite inconsistent with the constitution of an ordinary
religious order.
One or two things in the pamphlet are incongruous enough to English
ideas:--the narrative given, however simply and succinctly, of the
performances of the sisters by name, the publication of the Professor’s
evident disagreement with the first “Oberin,” or Superior, who served
ten months, (the second, whom he so highly praises, had only served
two when he wrote); the improvement, by which the Sisters’ concerns
were “sat upon” by the Comité of Oberin, Chaplain, Doctor, and elder
Sisters, &c., &c.
But the division of Professor Pirogoff’s war-nurses into three
categories is a pregnant hint for future service, please God we yield
it. These three categories consisted of (1) the “Verband-Schwestern,”
or those who assisted the Surgeon in the dressings, and the
“Feld-scherer” (Dresser) in preparing them. (2) The “Apothekerinnen,”
or those who were in charge of all medical appliances for immediate
use, and who superintended the “Feld-scherer” (Dresser) in the
administration of medicines. (3) The “Wirthinnen,” who looked after
the diets, clean linen, &c., of the patients, and the order of the
hospital. Each “category” was responsible for carrying out the orders
of the medical officers. To every Hospital-_Baracke_ (hut) was attached
one sister of each of the above descriptions.
In ordinary service the less nurses know of each other’s wards the
better--in war service it is essential that as few women should serve
as many sick as possible; and it is impossible to attempt assigning to
each nurse the entire supervision of a ward. I think the categories,
modified, of course, and adapted to the Queen’s service, might be most
useful.
Another point usefully proved by Professor Pirogoff’s pamphlet is the
extreme importance, if it be possible, of placing the nurses clearly
under the orders of the Principal Medical Officer, though a further
point is, if possible, to be secured, viz., that of the Principal
Medical Officer being favourable to their service. As women they
should be entirely under the control of their female superior, yet the
Principal Medical Officer should have a certain clear amount of power
in ordering that Superior as to their employment at particular stations
and on particular services.
The _Transport Abtheilung_ of the Russian sisters seems to have been
an admirable, though very unpretending service. We might take a useful
hint from it. Three Sisters accompanied the more numerous[1] convoys of
Sick Transport from Simpheropol to Perekop, and provided the sick with
tea, sugar, clean linen, medical and surgical appliances, &c., on the
way.