III. Nurses in Her Majesty’s Hospitals.

Two kinds of Hospital Service for Females.

1. If their introduction is eventually commanded by the Queen’s Government, it will be advisable to consider that their service admits of two distinct kinds.

The one: its Advantages;

2. “Their chief duties” may be “taking charge of the linen and superintending the issue of extras.”

They will thus contribute materially to the comfort and well-being of the sick; the real difficulties which undoubtedly beset the introduction of women into ward service will be avoided; and, an important consideration, not lightly to be discarded, their exclusion from the ward service will materially diminish the opposition of adverse masters, some of whom are also unscrupulous masters.

The other: its Advantages.

3. On the other hand, I suppose, the experience of every woman, admitted to ward service in hospitals where women were not before, is that many lives are actually saved by such admission, which would otherwise, humanly speaking, be lost. In time of war some ciphers may be safely added to the many. Any other great emergency, I suppose, but do not speak from experience, would give the same result.

That the experience of many surgeons is identical, their conduct has proved; no other testimony, under present circumstances, can rationally be expected from them.

Both to be Weighed.

4. It is often right to begin with the smaller and less-opposed good, and to introduce gradually, and, as it pleases God, the remainder. It may be our duty to do this, as to this matter.

Practical Superiority of the Second.

5. Practically, it is of little avail to superintend, ever so carefully, the issue of extras to the sick, unless there is permission and opportunity to pour the nourishment, perhaps in continual drops, down the throat of reluctant agony, or delirium, or stupor. And it is of little avail to have this permission, unless there be also that of raising the decent covering under which cholera, erysipelas, or the oppression of long recumbency, or the discharging wound, or the recent operation lie, and seeing to matters within. It is a further question, whether the painful cleansing of painful wounds, and the important minor dressings, as poulticing, which things, generally speaking, never have been done, and never will be done by surgeons, are best left to nurses, orderlies, or the patients themselves.

Its real and great Difficulties.

6. At the same time, nothing is more pernicious than to under-rate the objections of opponents. There is no doubt that the admission of women to ward service is beset with difficulties. These Naval and Military Hospitals are, and must ever be, peculiar Hospitals, essentially different in important details from the Civil Hospitals.

Sisters of Mercy, as regards the ward service, are decorous and kind, and sometimes inefficient and prudish. Nurses are careful, efficient, often decorous, and always kind, sometimes drunken, sometimes unchaste.

Misconduct of women is far more pernicious in a Military or Naval Hospital than in any other, as regards the result of things—the crime is, of course, equally crime everywhere.

Condense numbers as much as possible.

7. It appears to me desirable to simplify and condense, as much as possible, female service in these Hospitals. Let there be as few women, and these few as efficient and as respectable as can be. Let all that can really be done by men be so done.

Only Head Nurses.

8. Head-nurses are alone, I think, desirable to be employed; I mean persons of the character, responsibility, and efficiency, of head-nurses in other Hospitals.

Classify the Patients.

9. The patients should be distinctly classed, though, of course, this is not the Female Superintendent’s business.

There are many pros and cons to the formation of convalescent wards.

It is a question whether convalescent or chronic patients require female nurses at all.

Of such chronic cases, probably 100 would be efficiently served by one nurse, having orderlies under her. Of acute cases, probably, one nurse should take charge of not more than fifty, possibly not more than forty.

Qualification of Nurses.

10. The nurses should be strong, active women, of not less than thirty, nor, I think, more than sixty years of age, of unblemished character, and should be irreversibly dismissed for the first offence of unchastity, drunkenness, or dishonesty, or proved impropriety of any kind.

Wages.

11. Their wages, I think, the same as those of head-nurses in Civil Hospitals—certainly, not more.

Pensions.

12. Their pension on the same graduated scale.

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.

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.

Means of Steadying them.

15. Give them plenty to do, and great responsibility—two effectual means of steadying women.

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.

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.

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.

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.

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.

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.

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.

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

as exemplified in the last War.

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.

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.

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.

Female Nurses.

The adaptation of Female Nursing to the different systems in the

has now to be noticed.

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.

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.

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.

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.

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 1s. 10d. pay per diem, and an allowance of 4d. 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 2s. 10d. 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.”