The Life of Florence Nightingale Volume I Part 19

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 a.s.sumed 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 reconst.i.tuted 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 quant.i.ty of medical comforts for us, which were so packed under shot and sh.e.l.l 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 n.o.body 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 ma.s.ses of goods were necessarily landed together and stowed away promiscuously for want of time and s.p.a.ce 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 pet.i.tion 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 s.p.a.ce 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 Amba.s.sador 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 dest.i.tution 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 ma.s.se_ 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 circ.u.mstance 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 subst.i.tuted Turkish dressing-gowns from Stamboul (three bales in the pa.s.sage 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 compa.s.sion left even for the wretched Purveyor, swamped amid demands he never expected. But I have no compa.s.sion 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 cla.s.s 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 cla.s.s 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 a.s.sistant 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 cla.s.s, 2s. 6d. per day 2nd cla.s.s--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 subst.i.tute 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:--