The Life of Florence Nightingale Volume I Part 15

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 mainsh.o.r.e our _Vectis_, with steward's cabins and galley torn away, bl.u.s.tering, 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 G.o.ds, 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 Emba.s.sy 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 princ.i.p.al 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-cla.s.s 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 princ.i.p.al 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 s.p.a.ce 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 fort.i.tude and devotion.[86]

[84] _Notes_ (Bibliography A, No. 8), sec. iii. p. x.x.xiii.

[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 n.o.ble 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 sh.o.r.e 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 pa.s.sed 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 friends.h.i.+p 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 acc.u.mulated, 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 princ.i.p.al 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 ill.u.s.tration in the letter which the Head of the Army Medical Department wrote to his Princ.i.p.al 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 p.r.o.nounced succinct sentence that "the state of the hospitals was disgraceful." The s.h.i.+ps 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 Princ.i.p.al Medical Officer on the spot was navely 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 s.p.a.ce 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 coa.r.s.e 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 c.u.mbrous 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 doc.u.ments ent.i.tles 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 n.o.body'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 a.s.sume 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 pa.s.sage 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 grat.i.tude 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 a.s.sumed 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."

CHAPTER IV

THE EXPERT'S TOUCH

Write that, when pride of human skill Fell prostrate with the weight of care, And men pray'd out for some strong will, Some reason 'mid the wild despair,-- The loving heart of Woman rose To guide the hand and clear the eye, Gave hope amid the sternest woes, And saved what man had left to die.

R. M. M.: "A Monument for Scutari,"

_Times_, Sept. 10, 1855.

Miss Nightingale arrived at Scutari, as we have seen, on November 4, and was immediately in the midst of heavy work in nursing. The Battle of Balaclava was fought on October 25; and on the day after her arrival, the Battle of Inkerman.

"Miss N. is decidedly well received," reported Mr. Bracebridge to Mr.

Herbert (Nov. 8). A few days later, the Commander of the Forces, in a letter dated "Before Sevastopol, Nov. 13th, 1854," bade her a hearty welcome, tendering to her a "grateful acknowledgment for thus charitably devoting yourself to those who have suffered in the service of their country, regardless of the painful scenes you may have to witness." With some of the military officers she had difficulties; from the Commander she received nothing but courtesy, sympathy, and support.

"Miss Nightingale cannot but here recall," she wrote after the war, "with deep grat.i.tude and respect, the letters of support and encouragement which she received from the late Lord Raglan, who invariably acknowledged all that was attempted, for the good of his men, with the deepest feeling, as well as with the high courtesy and true manliness of his character. No tinge of petty jealousy against those entrusted with any commission, public or private, connected with the Army under his command, ever alloyed his generous benevolence."[94]

[94] _Statement to Subscribers_, p. vii.