III
It was her friend Mr. Milnes who had suggested that Miss Nightingale should go a little outside her “Cabinet” and increase her influence by extending the range of her parliamentary acquaintances. “Before the Estimates come on,” he had written (Feb. 1857), “you should surely have some people in the House who know what you want.” And again: “You should know Lord Stanley; he is the best man you could get in the House in whatever you wish to be done. Come and dine with him here on Sunday.” Mr. Milnes was right about Lord Stanley.[250] His public appreciation of Miss Nightingale has been mentioned already. He was not enthusiastic about many persons or things, but Miss Nightingale and her work were among the number. On now making her personal acquaintance, he sat, as it were, at her feet; he told her that he lived in hopes of being allowed to receive “future instructions” from her; he sent her early copies of papers and bills likely to interest her, and asked questions in the House of Commons which she suggested. When presently he became a Secretary for State they were to be associated in important work.
Miss Nightingale, for all her impetuosity of spirit, had plenty of tact, and knew how to adjust the means to her several ends. In the spring of 1857, an expeditionary force was being dispatched to China, and she was very anxious that the health of her “children,” the British troops, should be better cared for than it was, at sea or on land, in the Crimean Campaign. Her ally, Sir James Clark, was on friendly terms with her opponent, Dr. Andrew Smith. So she used her ally to coax her enemy. “I had a very satisfactory conversation with Dr. Smith,” reported Sir James. “I find he has attended to almost everything I suggested—the ventilation of the ships, the diet of the troops; and they are to have fresh meat and vegetables during the whole voyage and while on the station when it is possible. Nothing seems to be forgotten or neglected on Smith's part, and the Duke of Cambridge backed our recommendations. So that the disasters of the Crimea are already telling for the benefit of the soldiers.”
In the fight over the Netley Hospital, Miss Nightingale was defeated by Lord Panmure on the main issue; but she had some success in minor matters; and, though on the main issue she lost in the particular case, she won the day for the future. She was a pioneer in this country in advocating the “pavilion” system of hospital construction, which she had studied in France. Well-known examples of it are the Herbert Hospital at Woolwich, and St. Thomas's at Westminster. The plans for the Netley Hospital, which Lord Panmure sent her, were laid on the old “corridor” lines, and she instantly condemned the plans on that and other grounds. Into this cause, as into everything that she took up, she flung herself with full energy. She consulted all the best authorities, she collected information at home and abroad, she drew up memoranda, she prepared alternative plans. Lord Panmure did not dispute that her alternative might, in the abstract, be better, but pleaded that in this case the cost of alteration, now that the foundations were already laid, would be too great. Besides, there were susceptibilities—his own and other people's—to be considered. Miss Nightingale thereupon appealed to the Prime Minister. “If Miss Nightingale's suggestions are good,” he wrote to Lord Panmure (Nov. 30, 1856), “it will be worth while to alter our intended arrangement of the building rather than have an imperfect Hospital.”[251] Determining to press her advantage, Miss Nightingale went down to Embley in the Christmas vacation, and dined and slept at Broadlands. How great was the impression she made upon Lord Palmerston is shown by the peremptory letter which he next addressed to Lord Panmure (Jan. 17). It has been printed in extenso elsewhere[252]; and a sentence or two will here suffice. “I am bound to say she has left on my mind at present a conviction that the plan is fundamentally wrong, and that it would be better to pull down and rebuild all that has been built. She brought hither the ground-plan and elevation of the proposed Netley Hospital, and the ground-plan of the last new Military Hospital at Paris, which she says has been adopted as the model for the Hospital at Aldershot.” (The reader will note, I doubt not, Miss Nightingale's diplomatic touch; she only asked Lord Panmure to do at Netley what he himself was doing at Aldershot.) “It seems to me,” continued Lord Palmerston most characteristically, “that at Netley all consideration of what would best tend to the comfort and recovery of the patients has been sacrificed to the vanity of the architect, whose sole object has been to make a building which should cut a dash when looked at from the Southampton River.… Pray, therefore, for the present, stop all further progress in the work till the matter can be duly considered.” But even the most peremptory of Prime Ministers are not all-powerful. Lord Panmure immediately replied that the step ordered by his Chief “would involve us in great difficulties, as it would entail a rupture of all our extensive contracts, not to mention the reflections which it must cast on all concerned in the planning of those designs on which we have worked.… Many of Miss Nightingale's suggestions in the Report signed by herself and Dr. Sutherland can be carried out by alterations, but the total abandonment of the plan will be a most serious affair.”[253] It appears from Miss Nightingale's papers that the War Office's estimate of the cost was £70,000; and these 70,000 reasons, combined with the argument from amour propre, caused Lord Panmure to win. Though ever reluctant to acknowledge defeat till she had fired her last shot, Miss Nightingale knew when she was finally beaten on one ground and she then made a stand on another. Foiled in her attempt to improve the Hospital root and branch, she used in good part the opportunities which Lord Panmure gave her of patching up “the patient,” as she called it, so far as was still possible. The corridor was thrown more open; more window-space was given to the wards; borrowed lights and odd corners were abolished; the appurtenances were separated; and the ventilation was improved.[254] With regard to the future, Miss Nightingale in her private Report, and in almost identical words the Royal Commission in its public Report, recommended “that all plans for the original construction of Hospitals be submitted to competent sanitary authorities before such plans are finally approved,” and “that all new Hospitals be constructed in separate pavilions, in order to prevent a large number of sick from being agglomerated under one roof.” This recommendation was stoutly opposed by medical officers of the old school. “Poor Andrew Smith,” wrote Mr. Herbert during a sitting of the Royal Commission, “swallowed some bitter pills to-day, including Pavilions.” The bitter pill, administered by Miss Nightingale, is now the recognized prescription in the building of Hospitals.
IV
This fight for the pavilion was only an incident in Miss Nightingale's work during the latter part of 1856 and earlier part of 1857. Her main work was preparation for the Royal Commission. This involved heavy correspondence, many travels, and close application. Until August 1857, she resided principally in London, at the Burlington Hotel; but in the spring she had spent some weeks, within easy distance of London, at Combe Hurst, the home of her uncle and aunt, Mr. and Mrs. Samuel Smith; and in April, a fortnight in Edinburgh, in order to confer with Sir John McNeill. She prepared for the Royal Commission by writing her own Report. The suggestion had been made at Balmoral in October 1856; but Lord Panmure, who seldom did to-day what could be put off till to-morrow, did not write his official instructions until February 1857. In asking her “further assistance and advice,” he said: “Your personal experience and observation, during the late War, must have furnished you with much important information relating not only to the medical care and treatment of the sick and wounded, but also to the sanatory requirements of the Army generally.” She had, it will be observed, carried her point, that the Report was to be of general scope. “I now have the honour to ask you,” continued the letter, “to favour me with the results of that experience, on matters of so much importance to Her Majesty's Army. I need hardly add that, should you do so, they will meet with the most attentive consideration, and that I shall endeavour to further, so far as it lies in my power, the large and generous views which you entertain on this important subject.”
The Report which Miss Nightingale wrote in response to this request—entitled Notes affecting the Health, Efficiency, and Hospital Administration of the British Army—is, I suppose, the least known, but it is the most remarkable, of her works. It is little known because it was never published. As in the end she extracted a Royal Commission from Lord Panmure, and as the Commission was followed by practical measures, she did not feel the necessity of appealing to the public. The War Office itself did not print her Report, and thus it never became generally known how much of the Report of the subsequent Royal Commission, and how many of the administrative reforms consequent upon it, were in fact the work of Miss Nightingale. But at her own expense she printed the Notes for private circulation among influential people, and upon all who read it the work created, as well it might, a profound impression. Kinglake describes it as “a treasury of authentic statement and wise disquisition, affording a complete elucidation of the causes which had brought about failure, whilst also showing the means by which, in the wars of the future, our country might best hope to compass the truly sacred task of providing for the health of its troops.”[255] Sir John McNeill, who read the proofs of the Notes as they passed through the press, was impressed equally with the vigour of the style and the cogency of the reasoning. “Be assured,” he wrote, “that the Report will detract nothing from your reputation but, on the contrary, that it will greatly add to it, and make it very plain why you have been placed where you stand in the estimation of the country. No other person could have written it.” Of another batch of the proofs, he said: “It flows on so naturally, it gives so clearly the impression of being the genuine expression of earnest conviction, it has so much the character of good, sincere enlightened conversation on a subject which is thoroughly understood and appreciated, and so little the appearance of having been ‘got up’ or of pretension of any kind, literary or artistic, that you ought to be very cautious how you alter it in any respect that would at all detract from the unambitious and perfectly natural, but, at the same time, clear and vigorous, enunciation of important truths and wise propositions.” And again: “It does not signify much what Lord Panmure thinks or proposes or objects to. You have set up a Landmark which neither he nor any other man or body of men can remove. Permanent progress has been made, though but small, and your ideas and plans will be pirated and claimed as their own by men who now disparage them.” When the book was finally printed, and a copy of the volume sent to him, Sir John McNeill thought the same. “A few days ago,” he wrote (Nov. 18, 1858), “I read a passage to one of the most admired essayists of our time[256] without telling him what I was reading from. When I had done he said, ‘That is perfect, whose is that?’ I bade him guess. He said, ‘There are not many men in England who could have done it. I think I know them all, but I cannot quite bring it home with confidence to any of them. It may be some new writer.’ I said it was, and then I told him who it was. So much for the manner of the thing, which you care little about. But for the matter: after a very careful study of the whole, I am fully satisfied that it is a mine of facts and inferences which will furnish materials for every scheme that is likely to be built up on that ground for several generations. No man or woman can henceforth pretend to deal with the subject without mastering these volumes and, if honest, without referring to them.… Regarded as a whole, I think it contains a body of information and instruction, such as no one else so far as I know has ever brought to bear upon any similar subject. I regard it as a gift to the Army, and to the country altogether priceless.”
These estimates, given respectively by the literary historian of the Crimean War and by the man of affairs who had probed most deeply into the Crimean muddle, will be confirmed, I am confident, by any competent reader of Miss Nightingale's Notes.[257] The wide range of the book, and its mastery of detail on a great variety of subjects, are as remarkable as its firm and consistent grasp of general principles. The key-note is struck in the Preface. The question of Army Hospitals is shown to be part of wider questions involving the health and efficiency of the Army at large. Defects, similar to those which occasioned so high a rate of mortality among the sick in Hospital during the war, were the cause why so many healthy men came into Hospital at all. Those who fell before Sebastopol by disease were above seven times the number of those who fell by the enemy. A large number fell from preventable causes; but the causes could only be prevented in the future by the adoption of new systems. The bad health of the British Army in peace was shown to be hardly less appalling than was the mortality during the Crimean War. The only way to prevent a recurrence of such disasters was to improve the sanitary conditions of the soldier's life during peace, and during peace to organize and maintain General Hospitals in practical efficiency. The necessity of reorganization, and the application of sanitary science to the Army generally, are the two principles of which Miss Nightingale never loses sight in any of the branches of her subject. There is an Introductory Chapter giving the history of the health of the British armies in previous campaigns, and the book then contains twenty sections. The first six of these deal under different heads with the medical history of the Crimean War. Then come three sections dealing with the organization of Regimental and General Hospitals. The remainder of the book takes wider scope, discussing, in succession, the Need of Sanitary Officials in connection with the Army; the Necessity of a Statistical Department; the Education, Employment and Promotion of Medical Officers; Soldiers' Pay and Stoppages; the Dieting and Cooking of the Army; the Commissariat; Washing and Canteens; Soldiers' Wives; the Construction of Army Hospitals; and the Mortality of Armies in Peace and War. A twentieth section gives, after the manner of Royal Commissions, a summary of Defects and Suggestions. There are also various Appendices, Supplementary Notes, Diagrams and Illustrations. The first volume of the book consists of 830 octavo pages, some numbered in Roman numerals. The pages thus numbered were an after-thought. The main body of the book was ready for press in August 1857, but it was not desirable that the Nightingale Report should forestall, even in private circulation, the publication of the Royal Commission's Report. A final appendix to the latter Report contained a mass of official correspondence on the care of the sick and wounded during the Crimean War. Miss Nightingale pounced upon this, and prefixed to several of her sections a classified abstract of the principal documents. “A masterly analysis,” wrote Sir John McNeill, when she sent him the proofs; “it is conclusive, because it is quite fair, and nothing could be more fatal to false pretension.” Sometimes Miss Nightingale could not deny herself an ironical comment[258]; but the mere collocation of facts and utterances, as she arranged them, in deadly parallel, is more effective even than her sarcasm.
Lord Panmure's instructions to Miss Nightingale of February 1857 were afterwards supplemented by a request that she would submit a Confidential Report on “The Introduction of Female Nursing into Military Hospitals in Peace and in War.” The request had an amusing sequel. “You directed me last week,” she wrote to Lord Panmure (May 3), “to make suggestions to yourself as to the organization of Female Nursing in Army Hospitals. The Director-General, Army Medical Department, directed, last week, the expulsion of all female nurses but two from the Woolwich Artillery Hospitals.… I have a little pencil composition, to be 'dedicated, with permission, to your Lordship,' exhibiting the order emanating from the Secretary of State to introduce nurses, and a simultaneous order from the Army Medical Board to turn them out. I enclose a memorandum (merely tentative and experimental) as to the duties of nurses. I cannot expect the Secretary of State to enter into the details. Perhaps I may ask to hear his decision as to the ultimate steps to be taken.”[259] The tentative memorandum was afterwards expanded into a treatise, forming the second volume (pp. 184) of the Notes. Its title—Subsidiary Notes as to the Introduction of Female Nursing into Military Hospitals in Peace and War—hardly describes the scope of the volume, which is, in fact almost a treatise on Nursing at large. “I read the Subsidiary Notes first,” wrote Mrs. Gaskell (Dec. 31, 1858). “It was so interesting I could not leave it. I finished it at one long morning sitting—hardly stirring between breakfast and dinner. I cannot tell you how much I like it, and for such numbers of reasons. First, because you know of a varnish which is as good or better than black-lead for grates[260] (only I wonder what it is). Next because of the little sentences of real deep wisdom which from their depth and true foundation may be real helps in every direction and to every person; and for the quiet continual devout references to God which make the book a holy one.”
As the work of a single hand, and that the hand of a woman in delicate health, the writing of Miss Nightingale's Notes on the British Army, in the space of six months, is an astonishing tour de force. Only the most intense application, assisted by great power of brain and will, could have accomplished it. She had no staff of secretaries. Mr. Arthur Hugh Clough, then employed in the Education Office, gave her some help, out of office hours, with the proofs; and her faithful Aunt Mai did some copying and correspondence. But for the most part everything was written in her own hand, and not for one moment did she allow herself any relaxation. Nor were the Notes the only work of the same months. She prepared also (with some assistance from Mr. Bracebridge), and issued, in 1857, the masterly Statement to Subscribers which has been quoted frequently in the foregoing Part of this Memoir. “Why do you do all this,” wrote Mr. Herbert (Jan. 16), “with your own hands? I wish you could be turned into a cross-country squire like me for a few weeks.”