II
The death of Sidney Herbert was a heavy blow to Miss Nightingale—the heaviest, perhaps, which she ever had to suffer. It meant not only the loss of an old friend and companion, in whose society she had constantly lived and moved for five years. It meant also the interruption of their joint work, which was more to her than life itself. She felt in the severance of their alliance the true bitterness of death:—
(Miss Nightingale to her Father.) Hampstead, Aug. 21 [1861]. Dear Papa—Indeed your sympathy is very dear to me. So few people know in the least what I have lost in my dear master. Indeed I know no one but myself who had it to lose. For no two people pursue together the same object, as I did with him. And when they lose their companion by death, they have in fact lost no companionship. Now he takes my life with him. My work, the object of my life, the means to do it, all in one, depart with him. “Grief fills the room up of my absent” master. I cannot say it “walks up and down” with me. For I don't walk up and down. But it “eats” and sleeps and wakes with me. Yet I can truly say that I see it is better that God should not work a miracle to save Sidney Herbert, altho' his death involves the misfortune, moral and physical, of five hundred thousand men, and altho' it would have been but to set aside a few trifling physical laws to save him.… “The righteous perisheth and no man layeth it to heart.” The Scripture goes on to say “none considering that he is taken away from the evil to come.” I say “none considering that he is taken away from the good he might have done.” Now not one man remains (that I can call a man) of all those whom I began work with, five years ago. And I alone, of all men “most deject and wretched,” survive them all. I am sure I meant to have died.… Ever, dear Papa, your loving child, F.
Her grief was accompanied and intensified by some remorse:—
(Miss Nightingale to Harriet Martineau.) Hampstead, Sept. 24 [1861].… And I, too, was hard upon him. I told him that Cavour's death was a blow to European liberty, but that a greater blow was that Sidney Herbert should be beaten on his own ground by a bureaucracy. I told him that no man in my day had thrown away so noble a game with all the winning cards in his hands. And his angelic temper with me, at the same time that he felt what I said was true, I shall never forget. I wish people to know that what was done was done by a man struggling with death—to know that he thought so much more of what he had not done than of what he had done—to know that all his latter suffering years were filled not by a selfish desire for his own salvation—far less for his own ambition (he hated office, his was the purest ambition I have ever known), but by the struggle of exertion for our benefit.
Happily for her peace of mind there came to her an almost immediate call to be up and doing in the service of her “dear master,” as in her letters of this time she constantly named Sidney Herbert.
The newspapers had at first been somewhat grudging in their obituary notices of him. He had been thought of in connection more with the defects of the War Office during the early months of the Crimean War, than with his services as a reformer. His family and his friends were pained, and on their behalf Mr. Gladstone applied to Miss Nightingale. She did not feel well enough to see him, and, on August 6, he wrote explaining the case, “taking the liberty of intruding upon her for aid and counsel,” and asking “the assistance of her superior knowledge and judgment in a matter which so much interests our feelings.” Miss Nightingale instantly set to work and wrote a Memorandum on Sidney Herbert's work as an Army Reformer. She wrote quickly, but with her usual care in giving chapter and verse for every statement. The Memorandum was anonymous, and was marked “Private and Confidential”; but she had it printed, and circulated it among Lord Herbert's friends and various publicists. Among those who saw it was Abraham Hayward who, when a memorial to Lord Herbert was being mooted a few weeks later, strongly urged that she should be asked to publish the Paper. “No one,” he wrote, “could or would misconstrue her motives. Nothing has been more remarkable in her beneficent and self-sacrificing career than its unobtrusiveness. It has only become famous because its results were too great and good to be shrouded in silence and retirement. Admirably as she writes, she is obviously never thinking about her style; which, for that very reason, is most impressive; and I feel quite sure that the Paper in question would suggest no thought or feeling beyond conviction and sympathy.”[294]
The Memorandum, in so far as it relates to what Sidney Herbert did, has been described and quoted above; but at the end of it, Miss Nightingale was careful to touch upon what he had meant to do and what remained for others to do. “He died before his work was done.” The work on which his heart was set was the preservation of the health, physical and moral, of the British soldiers. “This is the work of his which ought to bear fruit in all future time, and which his death has committed to the guardianship of his country.”
Having finished her Memorandum, Miss Nightingale sent it to Mr. Gladstone. She knew how warm had been the friendship between him and Sidney Herbert. She thought that in the friend who remained the saying might perchance come true: uno avulso non deficit alter. At any rate it was her duty to throw out the hint. So she underlined, as it were, the closing words of her Paper by offering to talk with Mr. Gladstone about the unfinished work which, as she knew, was nearest to Sidney Herbert's heart. To this overture, Mr. Gladstone replied in a letter, giving account of his friend's funeral:
(W. E. Gladstone to Florence Nightingale.) 11 Carlton House Terrace, Aug. 10 [1861]. The funeral was very sad but very soothing. Simplicity itself in point of form, it was most remarkable from the number of people gathered together, and especially from their demeanour. Many men were weeping: not one unconcerned face among several thousands could be seen. But it all brings home more and more the immense void that he has left for all who loved, that is for all who knew, him.… I read last night with profound interest your important paper. I see at once that the matter is too high for me to handle. Like you I know that too much would distress him, too little would not. I am in truth ignorant of military administration: and my impressions are distant and vague. It is your knowledge and authority more than that of any living creature that can do him justice, at the proper time, whenever that may be—do him justice, as he would like it, without exaggeration, without defrauding others. I shall return the paper to you: but of it I venture to keep a copy.…
With respect to your making known to me the “three subjects” I will beg you to exercise your own discretion after simply saying this much; my duty is to watch and control on the part of the Treasury rather than to promote officially departmental reforms. To him I could personally suggest: I am not sure that I should be justified in taking the same liberty with Sir G. Lewis, especially new to his work. On the other hand, my desire to promote Herbert's wishes, as his wishes, was not stronger than my confidence in his judgment as an administrator. (If I now seem reluctant to touch that subject it is for fear I should spoil it.) In the conduct of a department he seemed to me very nearly if not quite the first of his generation.—I remain, dear Miss Nightingale, Very sincerely yours, W. E. Gladstone.
On the afternoon of November 28, in Willis's Rooms—in the same place where, in the same month six years before, Mr. Herbert had spoken in support of a memorial to Miss Nightingale's honour, a public meeting was held to promote a memorial to him. “I think you would have been satisfied,” wrote Mr. Gladstone to her on the same evening, “even if a fastidious judge, with the tone and feeling of the meeting to-day. I mean as regards Herbert. As respects yourself, you might have cared little, but could not have been otherwise than pleased. I made no allusion to you in connection with the paper you kindly sent me, although I made some use of the materials. I acted thus after conference with Count Strzelechi,[295] and with his approval. I thought that if I mentioned you along with that paper, I should seem guilty of the assumption to constitute myself your organ.” Miss Nightingale's Paper, summarizing Lord Herbert's services to the health and comfort of the British Army, formed, indeed, the staple of more than one of the speeches,[296] and the long alliance between them in that cause, which has been the subject of preceding chapters in this Memoir, was frequently referred to at the meeting. General Sir John Burgoyne said breezily that Lord Herbert's “hobby was to promote the health and comfort of the soldier, and his pet was Miss Nightingale, who had for many years devoted herself to the same pursuit.” Mr. Gladstone mentioned as Lord Herbert's “fellow-labourer” the “name of Miss Nightingale, a name that had become a talisman to all her fellow-countrymen.” And Lord Palmerston, the Prime Minister, in associating the Commander-in-Chief with the late Minister for War, added that “they did not labour alone. They were not the only two; there was a third engaged in those honourable exertions, and Miss Nightingale, though a volunteer in the service, acted with all the zeal of a volunteer, and was greatly assistant, as I am sure your Royal Highness will bear witness, to the labours of your Royal Highness and Lord Herbert.”
III
The alliance which was dissolved by Lord Herbert's death is probably unique in the history of politics and of friendship. “As for his friendship and mine,” said Miss Nightingale, “I doubt whether the same could ever occur again.”[297] For five years the politician in the public eye, and this woman behind the scenes, were in active co-operation; often seeing each other daily, at all times in uninterrupted communication. There have been other instances in which the same thing has happened, but happened with many differences. There have been statesmen who have made confidantes of their wives, and who have found in them wise counsellors and helpful supporters. Sidney Herbert himself received much help in his public work from his wife, to whom he was devotedly attached. In some pencilled jottings about her friends, Miss Nightingale records a beautiful trait; Sidney Herbert made it a rule, she says, to mark each anniversary of his wedding-day by beginning some new work of kindness towards others. Yet there was room in the ordering of his life, during the five years following the Crimean War, for taking constant counsel from another woman—so constant as, perhaps, in the days of his illness and over-work to cause his wife some anxiety. Yet Miss Nightingale was as dear to the wife as she was helpful to the husband, and affectionate friendship between her and Mrs. Herbert was not impaired. There have been many statesmen, again, and many other eminent men, who have found inspiration or support, no less than solace or pleasure, in the friendship of women. But Sidney Herbert's attraction to Miss Nightingale, and hers to him, were on a plane by themselves. She, indeed, was susceptible, as was every man and every woman who knew him, to Sidney Herbert's singular charm and courtesy; she admired the brilliance of his conversation; she felt pleasure in his presence. And he, with his quick perception, must have enjoyed the ready humour which played around Miss Nightingale's wisdom. But they were also comrades or colleagues even as men are. “A woman once told me,” Miss Nightingale said to an old friend, “that my character would be more sympathized with by men than by women. In one sense I don't choose to have that said. Sidney Herbert and I were together exactly like two men—exactly like him and Gladstone.”[298]
The secret of this rare friendship between Sidney Herbert and Miss Nightingale is to be found, first, in the fact that the character and gifts of the one were precisely complementary to those of the other. Though of a sanguine temperament, Sidney Herbert had the politician's caution. Miss Nightingale, though of an eminently practical genius, was eager and full of impelling force. She supplied inspiration which he had the means of translating into political action. Sidney Herbert had the political mind; Miss Nightingale, the administrative. Not indeed that he was deficient in some of the administrative gifts, or she in political instinct. But what was peculiarly characteristic of her was the combination of a firm grasp of general principles with a complete command of detail; and in the particular work in which they were engaged, her experience supplied what he lacked. “I supplied the detail,” she said herself; “the knowledge of the actual working of an army, in which official men are so deficient; he supplied the political weight.”[299] Each was thus indispensable to the other. And they were united by perfect sympathy in the service of high ideals. “He,” wrote Miss Nightingale of Sidney Herbert, “with every possession which God could bestow to make him idly enjoy life, yet ran like a race-horse his noble course, till he fell—and up to the very day fortnight of his death struggled on doing good, not for the love of power or place (he did not care for it), but for the love of mankind and of God.”[300] He was, “in the best sense,” she wrote elsewhere, “a saver of men.”[301] In that honourable record Miss Nightingale deserves an equal place with her friend.
Footnotes:
[222] An expansion, issued in 1862, of a memorandum, privately printed in 1861. See below, p. [408].
[223] In a letter, dated Feb. 9, 1857, of which she kept a copy. To whom addressed does not appear.
[224] Notes, sec. iii. p. viii.
[226] Report of the Commission of Inquiry into the Supplies of the British Army, pp. 2, 3.
[227] Notes on the Army, pp. 249–50, 507–8. The latter passage continues with some words which Miss Nightingale had previously written, and which I have quoted as a motto for the present Part (p. [309]).
[228] Her sister used to describe the disappointment of herself and her mother when Florence refused to accompany them to a garden-party at Chatsworth. The Duke of Devonshire was a great admirer of Miss Nightingale's work, and formed a collection of newspaper cuttings about it, which he presented to the Derby Free Library. He presented Miss Nightingale with a silver owl, in recognition of her wisdom, and in memory of her pet (see above, p. [160]).
[229] Invasion of the Crimea, vol. vi. p. 426 n.
[231] In a letter to Sir John McNeill, May 3, 1857.
[232] Letter to Edwin Chadwick, Oct. 17, 1860. He had urged her to see Mr. Kinglake with a view to indoctrinating him with the true moral of the Crimean muddles.
[233] To Miss Ellen Tollet from Lea Hurst.
[235] Life of the Prince Consort, vol. iii. p. 503.
[236] Panmure, vol. ii. p. 306.
[237] Son of Sir James, whom he succeeded in the baronetcy; married to Charlotte Coltman. There was afterwards a family connection with the Nightingales, as Lady Clark's nephew, Mr. William Coltman, married Miss Nightingale's cousin, Bertha Smith.
[238] Which, however, may not improbably have been suggested to him by the Queen. For Her Majesty's initiative and keen interest in the matter of the Netley Hospital, see Life of the Prince Consort, vol. iii. pp. 227, 491.
[239] Stanmore, vol. ii. p. 121.
[240] Thomas Graham Balfour (1813–1891), M.D. of Edinburgh; compiler of the first four volumes of Statistics of the British Army; assistant-surgeon to the Grenadier Guards.
[241] Mr. Milton had been sent out to Scutari by the War Office to assist the Purveyor-in-Chief, and Miss Nightingale considered that he had dealt only in official “whitewash.”
[242] On this subject, see below, p. [338].
[243] Stanmore, vol. ii. pp. 119–122.
[244] See Stanmore, vol. ii. p. 124.
[245] In chap. ix. of vol. vi. Kinglake accepts the finding of the Chelsea, Board as the last word on the dispute. For the other side, see Sir Alexander Tulloch's Crimean Commission and the Chelsea Board, 2nd ed., with preface by Sir John McNeill (1880).
[247] Preface to Tulloch's Crimean Commission, etc., 1880, p. xiii.
[248] For these addresses, see a pamphlet printed at Edinburgh in 1857, entitled Addresses Presented to Sir John McNeill, G.C.B., and Colonel Tulloch, with their Answers.
[249] Twenty years later another reparation was made. Sir Theodore Martin, in his Life of the Prince Consort, had taken an unfavourable view of the McNeill-Tulloch report. In the fifth edition he revised the passage. “It is almost more than we could have hoped,” wrote Lady Tulloch, in telling Miss Nightingale of the revision; “I say we, knowing how much interest you took in the matter.” “I give you joy,” replied Miss Nightingale (Feb. 23, 1878); “I give you both joy, for this crowning recognition of one of the noblest labours ever, done on earth. You yourself cannot cling to it more than I do: hardly so much in one sense, for I saw how Sir John McNeill and Sir A. Tulloch's reporting was the salvation of the Army in the Crimea. Without them everything that happened would have been considered ‘all right.’ … I look back upon those twenty years as if they were yesterday, but also as if they were a thousand years. Success be with us and the noble dead.” A copy of this letter was sent to Sir John McNeill, who replied (March 25): “It was kind of you to copy it for me. There is no one, dead or alive, whose testimony I could value so highly with regard to the matters in question as I do Miss Florence Nightingale's. Her favourable opinion is very precious to me, not only because she knew more, and was intellectually more capable of forming a correct judgment than any one else who visited that strange scene, but because my regard and affection for her is such as would make it very painful to me to find that she had reason to think in any degree less favourably of our services than she did formerly. Her letter is very characteristic, and therefore to me very precious.”
[250] Better known to the world as the 15th Earl of Derby; Secretary of State for India (1858–9); Foreign Secretary (1867–8); Foreign Secretary under Disraeli (1874–8); Colonial Secretary under Gladstone (1882–5).
[251] Panmure Papers, vol. ii. p. 321.
[252] Ibid. vol. ii. pp. 332–4.
[253] Ibid. vol. ii. p. 338.
[254] Panmure Papers, vol. ii. pp. 401, 405.
[255] Vol. vi. p. 367.
[256] Perhaps Abraham Hayward; see his opinion of Miss Nightingale's writing, quoted below, p. [408]. The passage read out by Sir J. McNeill may have been that cited above, p. [242]; or perhaps that cited on p. [317].
[257] This opinion is supported by an estimate of the Notes in a paper which came into my hands as this book was going to press. “This work (the Notes) constitutes in my opinion one of the most valuable contributions ever made to hospital organization and administration in time of war. Had the conclusions which she reached been heeded in the Civil War in America or in the Boer War in South Africa, or in the Spanish-American War, hundreds of thousands of lives might have been saved” (Hurd, as cited in Bibliography B, No. 47, p. 76).
[258] See the passage quoted above, p. [288].
[259] Panmure, vol. ii. p. 381, where, in following pages, the Memorandum is also printed.
[260] “Even black-lead is unnecessary, as a varnish now obtainable looks better,” Subsidiary Notes, p. 22.
[263] To a Virtuous Young Lady:—
Lady, that in the prime of earliest youth
Wisely hast shunned the broad way and the green,
And with those few art eminently seen
That labour up the hill of heavenly Truth,
The better part with Mary and with Ruth
Chosen thou hast, etc. etc.
[264] Richard, Lord Airey, Quartermaster-General to Crimean Army, 1854–5, one of the officers vindicated by the Chelsea Board; Quarter-master-General, 1855–65.
[265] Dr. Hall had reported to Dr. Smith from Scutari (Oct. 20, 1854), with “much satisfaction,” that “the whole Hospital establishment has now been put on a very creditable footing,” etc. See Notes, p. 52.
[266] The Army in its Medico-Sanitary Relations, p. 26. Edinburgh, 1859. Reprinted from the Edinburgh Medical Journal. The writer was Dr. Combe, R.A.
[267] The letter is printed in Stanmore, vol. ii. p. 133.
[269] For this pet owl, see above, pp. [89], [160].
[270] “In a grassy hollow, by the side of a bright pool of water, lies a statue of the great Rameses, the most beautiful sculpture we have yet seen. There he lies upon his face, as if he had just laid down weary,” etc. Florence Nightingale's Letters from Egypt, 1854, p. 258.
[271] Augustus Hare's Story of Two Noble Lives, vol. ii. p. 350.
[272] At Edinburgh in the autumn of 1856; see above, pp. 321, 328.
[273] His article appeared in the Westminster for January 1859, and long extracts are given in Stanmore, vol. ii. pp. 141–8. Miss Nightingale read it in manuscript and contributed much material.
[274] The original members of the Barracks and Hospitals Commission were Mr. Herbert, Dr. Sutherland (Miss Nightingale's constant colleague), and Captain Galton (married to her cousin). It was appointed October 1857. Its General Report (presented to Parliament, 1861) was dated April 1861 (see below, p. [388]). It had previously issued many interim reports. Reconstituted, it ultimately became a permanent body (vol. ii. p. 64).
[275] See Bibliography A, No. 10.
[276] Professor F. de Chaumont in the 9th ed. of the Encyclopædia Britannica. Netley is, however, no longer the chief military hospital.
[277] Letter to Harriet Martineau, October 8, 1861. Large as were Miss Nightingale's schemes for army reorganization, she never dared to suggest the abolition of the Horse Guards and the retirement of its chief.
[278] England and her Soldiers, by Harriet Martineau, 1859. Miss Nightingale's “coxcomb” diagrams were reproduced in this volume. She revised Miss Martineau's MS., supplemented the publisher's fee to the author, and bought £20 worth of the book for presentation to reading-rooms.
[279] For its appointment, see below, p. [405]; and for the successive Committees, etc., in connection with barracks, see the Index, Vol. II. (under [Barrack]).
[280] See above, p. [331]. The School of Cookery at Aldershot is mentioned in the General Report of the Barracks Commission, 1861, p. 114 n.
[281] The Committee on Army Medical Statistics (Mr. Herbert, Sir A. Tulloch, and Dr. Farr) reported in June 1858, and its Report was printed in 1861. In the same year the First Annual Statistical Report on the Health of the Army (issued in March) was printed; it was compiled by Dr. T. Graham Balfour, who was appointed head of the statistical branch of the Army Medical Department.
[282] The story of them may be read in Stanmore, vol. ii. pp. 364–8.
[283] Stanmore, vol. ii. p. 367.
[284] Sir William Aitken (1825–1892), M.D. of Edinburgh; assistant-pathologist to a medical commission during the Crimean War; F.R.S. 1873; knighted, 1887. He held the professorship from 1860 till the year of his death.
[285] Introductory Address at Fort Pitt, Chatham, October 2, 1860, by Deputy-Inspector-General T. Longmore, p. 7.
[286] Introduction, p. 20, to a new edition (1860) of Andrew Combe's Management of Infancy.
[287] It should perhaps be explained that venereal cases are treated in a separate hospital.
[288] This is a department of the College which would not have appealed to Miss Nightingale. She loathed and mocked at inoculation. “Oh, yes, I know,” she once said; “they will give you small-pox or diphtheria or plague or anything you like. You pays your money, and you takes your choice.”
[290] This Committee received its instructions on Feb. 17, and reported on Aug. 24, 1861. The Report (1861) is No. 2867 in the Parliamentary Papers.
[291] It was Lord Herbert, who, on sitting down after his first speech in the House of Lords, and on being asked by a friend beside him whether he had found it difficult, replied, “Difficult! It was like addressing sheeted tombstones by torchlight.”
[292] Army Reform under Lord Herbert, pp. 4–5.
[293] Better known as the Marquis of Ripon, to which rank he was promoted in 1871.
[294] Letter (Nov. 20) to Count Strzelechi, for whom see below, p. [410].
[295] Sir Paul Edmund de Strzelechi, K.C.M.G., C.B., known as Count Strzelechi, Australian explorer, of Polish descent, though a naturalized Englishman, was a great friend of Lord and Lady Herbert, whom he had accompanied on their last journey abroad. He took a prominent part in organizing the Herbert Memorial.
[296] They are collected in a pamphlet (August 1867) entitled Memorial to the Late Lord Herbert.
[297] Letter to Harriet Martineau, September 24, 1861.
[298] Letter to Madame Mohl, Dec. 13, 1861.
[299] Letter to Harriet Martineau, Sept. 24, 1861.
[300] Dublin (Bibliography A., No. 28), p. 8.
[301] Herbert (Bibliography A., No. 29), p. 3.
[PART IV]
HOSPITALS AND NURSING
(1858–1861)
The everyday management of a large ward, let alone of a hospital, the knowing what are the laws of life and death for men, and what the laws of health for wards (and wards are healthy or unhealthy mainly according to the knowledge or ignorance of the nurse), are not these matters of sufficient importance and difficulty to require learning by experience and careful inquiry, just as much as any other art?—Florence Nightingale: Notes on Nursing.
CHAPTER I
THE HOSPITAL REFORMER
(1858–1861)
It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm. It is quite necessary, nevertheless, to lay down such a principle, because the actual mortality in hospitals, especially in those of large crowded cities, is very much higher than any calculation founded on the mortality of the same class of diseases among patients treated out of hospitals would lead us to expect.—Florence Nightingale (1863).
The work for the health of the soldiers, which has been described in the preceding Part, filled the larger part of Miss Nightingale's life during the five years after her return from the Crimean War; and in 1856, 1857, 1858 it occupied nearly the whole of her time. The work lasted for almost exactly five years, from the day of her return from Scutari (August 1856) to the day of Lord Herbert's death (August 1861). But into those strenuous years Miss Nightingale had crowded much other work besides. It has been necessary, for the sake of clearness and coherence, to treat the subject of Army sanitary reform consecutively in a single Part. In the present Part the other main occupations of Miss Nightingale's life during the same period, and more especially during the years 1859, 1860, and 1861, will be described.
The story of her life and work may be divided for convenience into separate Parts; but in her own mind each of the branches of effort into which successively she threw herself were connected parts of a larger whole. Her experiences in the Crimean War, and the emotions which grew out of them, had caused her to throw her first efforts into the cause of reform in the interest of her “children,” the British soldiers. But all the time she saw with entire clearness that the health of the Army was only part of a larger question; namely, the health of the whole population from which the soldiers are drawn. She had made her reputation by work in military hospitals, and her first effort was to improve them, but she saw that the condition of civil hospitals was the larger and the more important matter. And she saw further still that hospitals are at best only a necessary evil; a necessity, as some one has said, in an intermediate stage of civilization. The secret of national health is to be found in the homes of the people. If in a particular town or quarter, for instance, there was excessive infant mortality, the remedy, as she said, was not to be found in building more children's hospitals there. She was famous throughout the world as a war-nurse; but she knew that the difficulties which she had encountered in that sphere were due to the fact that the art of nursing was so ill understood at home. Her vision took wider scope, and her efforts to improve the well-being of the people embraced, as we shall hear, both India and the Colonies. Mr. Disraeli, in a famous speech[302] delivered the saying Sanitas sanitatum, omnia Sanitas, but that was in 1864; it was Miss Nightingale's motto many years before. When the extent of her range and the depth of her influence are considered, the claim made for her by an American writer will not seem exaggerated: she was “the foremost sanitarian of her age.”[303] Our immediate concern is with her life and work, first, as a Hospital Reformer (Chaps. I., II.), and then as the founder of Modern Nursing (Chaps. III., IV.).
Miss Nightingale's authority on the subject of Hospitals ruled paramount in the years following the Crimean War—as the reference of the Netley plans to her has already indicated. Popularity and prestige were confirmed by a practical experience which at the time was probably unique. “Have you,” she was asked by the Royal Commission of 1857, “devoted attention to the organization of civil and military hospitals?” “Yes,” she replied, “for thirteen years. I have visited all the hospitals in London, Dublin, and Edinburgh, many county hospitals, some of the naval and military hospitals in England; all the hospitals in Paris, and studied with the 'sœurs de charité'; the Institution of Protestant Deaconesses at Kaiserswerth, on the Rhine, where I was twice in training as a nurse; the hospitals at Berlin, and many others in Germany, at Lyons, Rome, Alexandria, Constantinople, Brussels; also the war hospitals of the French and Sardinians.” Her authority on the subject was strengthened yet more when her Papers, already mentioned,[304] which were read at Liverpool in October 1858, were, early in the following year, published, with additional matter, as a book. “It appears to me,” wrote Sir James Paget, in acknowledging a copy of the book, Notes on Hospitals, “to be the most valuable contribution to sanitary science in application to medical institutions that I have ever read.” The book has not been reprinted since 1863, and is now, perhaps, forgotten; but, if so, that is the necessary fate of many a notable book. The pioneers of one generation are forgotten when their work has passed into the accepted doctrine and practice of another. In its day Miss Nightingale's Notes on Hospitals revolutionized many ideas, and gave a new direction to hospital construction.
Sir James Paget's words accurately suggest the nature of Miss Nightingale's work in this field. Before she wrote, there was sad need of the application of sanitary science to many of our hospitals. The rate of mortality in them was terribly high. Hospitals created almost as many diseases as they cured; there was hospital gangrene, hospital pyæmia, hospital erysipelas, hospital fever, and so forth. It was even questioned whether great hospitals were not, and must not necessarily be, producers of disease. Miss Nightingale showed that there was no such necessity. By the light of sanitary science, she traced back the excessive mortality in hospitals to its true causes, in original defects in the site, in the agglomeration of a large number of sick under the same roof, in deficiency of space, deficiency of ventilation, deficiency of light. In a second section of her book, going more into detail, she enumerated “Sixteen Sanitary Defects in the Construction of Hospital Wards,” adding to the statement of each defect precise suggestions of a remedy. She added a series of equally detailed hints on hospital construction, illustrating them by careful plans, exterior and interior, of some of the best modern hospitals and of the worst old ones. Some of my readers may be acquainted only with modern hospitals, and it will be well perhaps to describe the defects in the old style of hospital. Many of the hospitals and infirmaries, as they existed when Miss Nightingale started her crusade, had been built with no consideration for the sub-soil, and the drainage of them was very imperfect. The wards were sadly overcrowded, often as much as three or four times over, tried by the present standard of the number of cubic feet desirable per bed. Ventilation was defective. The wards were often low. There were frequently more than two beds between the windows. Little attention had been given to the supreme importance of having floors, walls, and ceilings which were non-absorbent. The furniture of the wards, and the utensils, were such as would be condemned to-day as hopelessly insanitary. Miss Nightingale found it necessary to enter in some detail upon the desirability of iron bedsteads, hair mattresses, and glass or earthenware cups, etc. (instead of tin); as also upon that of sanitary forethought in the construction of sinks and other places. Hospital kitchens and laundries at home were not quite so bad as at Scutari; but many of the kitchens were still very primitive, and many of the laundries inspected by Miss Nightingale were “small, dark, wet, unventilated, overcrowded, so full of steam loaded with organic matter that it is hardly possible to see across the room.” All this is now, for the most part, a thing of the past; and the passing of it is due, in large measure, to Miss Nightingale. Coinciding, as her book did, with a movement for increased hospital accommodation, and coming with the prestige of a popular heroine, her Notes on Hospitals opened a new era in hospital reform. There had, it is true, been improvement before her time; and she was not the one and only discoverer of the simple principles which she enunciated, and which are now the A B C of the subject. But the general level of thought or practice does not always rise to the height of the better opinion; it depends too often upon the average opinion of the day. Moreover, in some matters, there was, at the time when she wrote, a conflict of principles, in which the victory was generally given to the wrong side. The beneficial effect of fresh air was not always denied; but the advantage of securing warmth by shutting the windows, and relying upon artificial methods of ventilation, was in practice considered paramount. Miss Nightingale was a pioneer in the consistent emphasis which she gave to the supreme necessity of fresh air, and to the importance of “direct sunlight, not only daylight, except perhaps in certain ophthalmic and a small number of other cases.” She based her contention in these matters on scientific principles; she supported it from her experience and observation in the Crimean War and in foreign hospitals. In many quarters her ideas were new and revolutionary. We have heard already what “a bitter pill” it was to one eminent medical official of her day to swallow the idea of “pavilions” in hospital construction.[305] Lord Palmerston explained in the House of Commons in 1858 that, “strange as it might appear, considering the progress of science in every department, it was only within a few years that mankind has found out that oxygen and pure air were conducive to the well-being of the body.”[306] And in the matter of the curative effect of light, Miss Nightingale cited from an official publication the case of a well-known London physician, who “whenever he enters a sick-room, takes care that the bed shall be turned away from the light.” “An acquaintance of ours,” she added, “passing a barrack one day, saw the windows on the sunny side boarded up in a fashion peculiar to prisons and penitentiaries. He said to a friend who accompanied him, ‘I was not aware that you had a penitentiary in this neighbourhood.’ ‘Oh,’ said he, ‘it is not a penitentiary, it is a military hospital.’”[307] Miss Nightingale's general principles commanded the hearty support of the better medical opinion, and to many medical men her details, drawn from observation in the best foreign hospitals, afforded new and useful hints; while at the same time she commanded in a singular degree the ear of the general public, including town councillors, guardians, and benevolent persons. It was in this way that her book did so much to improve the level of hospital construction and hospital arrangement in this country.
Upon the construction of military hospitals—whether general or attached to particular barracks—Miss Nightingale was consulted constantly and as a matter of course. In 1859, it will be remembered, Mr. Herbert became Secretary for War; and in 1860 Captain Galton was appointed temporary assistant inspector-general of “Fortifications”—a department which included works for barracks and hospitals. She respected Captain Galton's abilities, and liked him personally very much. He and Mr. Herbert took her advice upon all works within her province, and the plans of the new General Hospital at Woolwich in particular owed much to her suggestive ingenuity. She even drew up the heads of the specifications for it. Even where she was not directly consulted or concerned, her influence and the standard she had set up in her book had an effect. Medical officers and military governors sought leave to be able to quote her approval of hospitals under their charge. It would, as one naïvely wrote to her, improve their chances of promotion.
A more direct result of the publication of Notes on Hospitals was to bring in upon Miss Nightingale copious requests for advice from the committees or officials of civic hospitals and infirmaries throughout the country. To all such requests she readily responded. Writing was with her a means to action; and when she was given any chance of translating “Notes” into deeds, no trouble was too great for her. She had decided views of her own, but in particular cases she often consulted other experts. Dr. Sutherland, one of the leading authorities in such matters, was, as we have seen, constantly with her. To her kinsman by marriage, Captain Galton, she frequently referred; and she sometimes engaged Sir Robert Rawlinson professionally to prepare plans and specifications for her to submit to those who asked her advice. He on his part often consulted her in regard to hospitals and infirmaries on which he had been called in to advise. Her advice was sought both by those who were actually projecting new hospital buildings and by those who were leading crusades for the reconstruction of their local institutions. Among her papers there is a mass of correspondence, specifications, plans, memoranda of all sorts, referring to such matters. Technical details are often relieved by touches of Miss Nightingale's humour. Here are two examples from her letters to Captain Galton—(March 24, 1861): “I understand that Baring[308] won't ventilate the Barracks in summer because the grates are not hot enough in winter. Why are the men to die of foul air in August because they are too cold at Christmas? I think Baring must be an army doctor.” (June 20, 1861): “Is the Architect's ideal the profile of a revolver pistol? If you look at the block plan in this point of view, it is very good. But as he asks my opinion, it is that I would much rather be shot outside than in. As Hospital principles are beginning to be well known, it would be quite enough to engrave this plan on the card of solicitation to stop all subscriptions. No patient will ever get well there. And as I don't approve of the principle of Lock Hospitals, I had much better let it go on.” The correspondence about hospital plans ranges in place and scale from Glasgow, from which city she was asked to advise upon cement for the walls of the Infirmary wards, to Lisbon, where a new institution was to be built according to her ideas. In 1859 the King of Portugal asked Miss Nightingale through the Prince Consort to advise and report upon the plans for a hospital which he desired to build in memory of his wife, the Princess Stephanie of Hohenzollern. This affair occupied some of her attention during two years, and caused her not a little impatience. With Dr. Sutherland's help, she went laboriously through the plans submitted by the King's architect on the assumption that the hospital was intended for adults. It then appeared that what the King wanted was a Children's Hospital. The Prince Consort, through Colonel Phipps, was deeply grieved at “the waste of Miss Nightingale's time and of her strength, so precious.” Dom Pedro V., taking an easier view, did not see that it mattered. A hospital, constructed for adults, but intended for children, would, His Majesty pleasantly suggested, “only give the children more room and more air.” The King had to be given a lesson in the niceties of hospital construction. The architect and Miss Nightingale set to work again on amended plans. Her suggestions were warmly approved, on the Prince Consort's behalf, by Sir James Clark, and Dom Pedro sent her a cordial letter of thanks.
At home she took similar pains with plans for the Bucks County Infirmary at Aylesbury; but here it was easier sailing, for the chairman of the Committee was her brother-in-law, Sir Harry Verney, and it was promptly decided (186o) to rebuild the Infirmary “in accordance with the requirements specified in Miss Nightingale's Notes on Hospitals.” In another county hospital, that at Winchester, she took the more interest, because one of her father's properties (Embley) was in the county. There is a specially voluminous correspondence on the subject, largely with Sir William Heathcote (chairman of the Governors),[309] extending over several years. The old hospital was admittedly bad, but the first idea was to patch it up. Miss Nightingale took infinite pains in working up the case against this course. She studied the report which Sir Robert Rawlinson, the sanitary engineer, had sent in; and she tabulated the statistics of mortality, comparing them with those of well-appointed hospitals on healthy sites. Thus armed, she told the Committee roundly that they were proposing to sink money in patching up a “pest-house, where a number of people are exposed to the risk of fatal illness from a special hospital disease.” Was Hampshire eager, she asked, to emulate the evil fame of Scutari? Then she tackled the financial problem. She compared the estimated cost of “adaptation” with that of building a new hospital on a better site. She submitted plans and details of her estimate. She promised the advice of Dr. Sutherland in the choice of a new site. “I understand,” she wrote, “that Lord Ashburton will give £1000 towards a new hospital, if built upon a new site; if not, nothing.” As Lady Ashburton was one of her dearest friends, this condition was probably not unprompted. On the same condition, she promised contributions from herself and her father. She collected and sent in the opinions of eminent experts—civil engineers and medical officers—on the question. She prodded friends possessing local influence: “Would you please,” she wrote to Captain Galton (Feb. 10, 1861), “devote the first day of every week until further notice in driving nails into Jack Bonham Carter,[310] M.P., about the Winchester Infirmary?” In the end she carried her point, and a new hospital was built by Mr. Butterfield on a higher and healthier site. “It is the greatest pleasure,” the architect wrote to her (Dec. 1863), “to try and work out the views of one who is ably and earnestly endeavouring to make a reformation.” Among other institutions upon which she advised, in this (1860) or immediately ensuing years, were the Birkenhead Hospital, the Chorlton Union Infirmary, the Coventry Hospital, the Guildford (Surrey County) Hospital, the Leeds Infirmary, the Malta (Incurables) Hospital, the Putney Royal Hospital for Incurables, the North Staffordshire Infirmary, and the Swansea Infirmary. Correspondence from foreign countries, and a collection of tracts upon Hospital Construction (1863) sent to her from France and Belgium, show that the “reformation” was widespread. In India also her book was found useful. “It arrived in the nick of time,” wrote Sir Charles Trevelyan, the Governor of Madras (Aug. 10, 1859), “as you will see by the accompanying note from Major Horsley, the engineer entrusted with the preparation of the plan of the addition to our General Hospital.”