On the main issue of Army Medical Reform, Miss Nightingale sought to influence public opinion by the distribution among carefully selected persons of her Notes on Matters affecting the Health, Efficiency and Hospital Administration of the British Army. The Notes were written, and for the most part printed, in the preceding year, and I have already described them. The distribution of them at this time brought her letters of encouragement from many of the most illustrious and influential personages in the land. The Prince Consort, in an autograph letter of thanks, took occasion to assure her once more of “the Queen's high appreciation of her services.” The Princess Royal, then Crown Princess of Prussia, begged for a copy; and Miss Nightingale, in reply (Nov. 9), asked Sir James Clark to express for her how “very gratifying the Princess Royal's kind message was. I cannot tell you the deep interest I feel in that young heart so full of all that is true and good, or with what pleasure I anticipate the benefit to her country and ours from her being what she is.” These two women, between whom there were many points of sympathy, were often to correspond and to meet in later years. The Duke of Cambridge, in a particularly cordial letter, assured Miss Nightingale “that the whole Army is most sensible of the devotion with which you may be said to have sacrificed yourself to its work on a recent memorable occasion, and I cannot but add my personal admiration of your noble conduct on that as on all other occasions.” The Duke added the hope that from time to time he might have it in his power to carry out her “valuable suggestions for the comfort and welfare of the troops.” Miss Nightingale often trounced the Commander-in-Chief in her correspondence. He had so little sympathy with any radical reform that she could not consider his popular title of “The Soldier's Friend” to be really well deserved. Yet she had a certain fondness for him, and was alive to his better qualities. She had seen him first during the Crimean War, and she recalled a characteristic incident. “What makes ‘George’ popular,” she wrote, “is this kind of thing. In going round the Scutari Hospitals at their worst time with me, he recognized a sergeant of the Guards (he has a royal memory, always a great passport to popularity) who had had at least one-third of his body shot away, and said to him with a great oath, calling him by his Christian and surname, ‘Aren't you dead yet?’ The man said to me afterwards, ‘Sa feelin' o' Is Royal Ighness, wasn't it, m'm?’ with tears in his eyes. George's manner is very popular, his oaths are popular, with the army. And he is certainly the best man, both of business and of nature, at the Horse Guards: that, even I admit. And there is no man I should like to see in his place.”[277]
Miss Nightingale was careful to send copies of her Notes to those who, by their pens, could influence public opinion. Among these was Harriet Martineau, to whom Miss Nightingale wrote (Nov. 30): “The Report is in no sense public property. And I have a great horror of its being made use of after my death by Women's Missionaries and those kinds of people. I am brutally indifferent to the wrongs or the rights of my sex. And I should have been equally so to any controversy as to whether women ought or ought not to do what I have done for the Army; though a woman, having the opportunity and not doing it, ought, I think, to be burnt alive.” Miss Martineau, promising to be discreet, asked if she might make use of Miss Nightingale's facts and suggestions. The offer was promptly accepted, and Miss Martineau was supplied with copious powder and shot. Miss Nightingale was probably the more attracted by Miss Martineau's offer to popularise her Notes owing to a very earnest letter from Dean Milman. He had read the Notes “with serious attention and profound interest,” and asked (Dec. 18): “Is all this important knowledge, this strong practical good sense, this result of much toil, thought, experience to be confined to half-averted official ears, to be forced only on the reluctant attention of a few, and most of these too busy and perhaps too opinionated to profit by it? Is it to be buried in that most undisturbed grave of wise thought and useful information, a blue book? that most repulsive, unapproached, unapproachable place of sepulture? Surely you have not lived and laboured your life of devotion, your labour of love, to leave public opinion untouched and unenlightened but by what may creep out, as the general result of your views, or what may be adopted by Government, perhaps imperfectly and parsimoniously? Are the many, who alone by the expression of their judgment and feelings can keep the few up to their work, and encourage them by their approval and co-operation, to remain ignorant of what is of such vital import to the army, to the country, to mankind?” A series of articles by Miss Martineau in The Daily News, and afterwards a popular volume,[278] carried Miss Nightingale's suggestions, at second-hand, into a large circle. Between these two women there was a marked attraction. The correspondence about the illness and death of Miss Martineau's niece, and her reliance upon Miss Nightingale's sympathy, are particularly touching. Each of them had sorrows, each was seriously ill, and each alike at once turned to her public work.
At the end of 1858 Miss Nightingale put out one of the most effective of her controversial pieces. Her facts and figures about the mortality of the Army in the East, as printed in her Notes and in the Royal Commission's Report, had not passed unchallenged, and a pamphlet had appeared calling them in question. Mr. Herbert and Miss Nightingale suspected in it the hand of Sir John Hall, and she immediately prepared a reply. This is entitled A Contribution to the Sanitary History of the British Army during the late War with Russia. It was published, early in 1859, anonymously, but all her friends detected her “Roman hand.” The pamphlet which provoked it is dismissed in a contemptuous footnote: “An obscure pamphlet, circulated without a printer's name, reproduces nearly every possible statistical blunder on this and other points. It purports to be a defence of the defunct Army Medical Department, ‘By a Non-Commissioner,’ but it is more like a jeu d'esprit.” The answer contained in the body of Miss Nightingale's brochure is conclusive, and the “coxcombs” were repeated in a yet more telling and attractive form than before. It is the most concise, the most scathing, and the most eloquent of all her accounts of the preventable mortality which she had witnessed in the East. “In a few truthful words,” wrote Sir John McNeill, in acknowledging an early copy (Dec. 26), “you have told the whole dreadful story, and I do not think that we shall hear any more of controversial medical statistics. ‘Facts are chiels that winna ding and downa be disputed.’ So sang Burns, and he was seldom mistaken in his opinions. I have read every word of the Contribution, and pondered every column and diagram, and I come to the conclusion that it is complete and unanswerable, but that it would be disparaging to such a work to regard it as controversial. I wish with all my heart that every young officer in the British Army had a copy of it. The old I have little hope of.” Miss Nightingale's mastery of the art of marshalling facts to logical conclusions was recognized by her election in 1858 as a member of the Statistical Society.
V
The new year (1859) brought an event of great importance to the cause of Army Reform. In March, Lord Derby's stop-gap government was defeated on Mr. Disraeli's Reform Bill, and after a general election Lord Palmerston returned to power. Mr. Sidney Herbert, who for some years had been working at army reform as an outsider, now became Secretary for War. “I must send you a line,” he wrote to Miss Nightingale (June 13), “to tell you that I have undertaken the Ministry of War. I have undertaken it because in certain branches of administration I believe that I can be of use, but I do not disguise from myself the severity of the task nor the probability of my proving unequal to it. But I know that you will be pleased to hear of my being there.… I will try to ride down to you to-morrow afternoon. God bless you!” Mr. Herbert's task was not rendered less severe by the appointment of Mr. Gladstone as Chancellor of the Exchequer. They were close and affectionate friends, but public economy was with Mr. Gladstone the greater friend. Much of Mr. Herbert's strength was exhausted in disputes with the Chancellor of the Exchequer over the question of the national defences. Mrs. Herbert sent to Miss Nightingale the current riddle: “Why is Gladstone like a lobster?” “Because he is so good, but he disagrees with everybody.” Mr. Herbert could by no means always count upon the Treasury for consent in all his schemes for improving the sanitary and moral condition of the Army. Still he was able, as Secretary of State, to accomplish a great deal; and it will be convenient here,—with some slight anticipation, in certain cases, of chronological order—to summarize shortly the fruits of the long collaboration between Mr. Herbert and Miss Nightingale for the health of the British soldier. She herself wrote such a summary in 1861, in a Paper to which reference has been made already (p. [312]), and I often use her own words.
The Barracks and Hospitals Improvement Commission had already done a good deal when he came into office, and he continued the work. Buildings were ventilated and warmed. Drainage was introduced or improved. The water-supply was extended. The kitchens were remodelled. Gas was introduced in place of the couple of “dips,” by the light of which it was impossible for the men to read or pursue any occupation except smoking. Structural improvements were made in many cases, and Mr. Herbert, so far as he could extract money from the Treasury, reconstructed buildings which had been condemned by his Commission. This policy was abandoned for many years after his death, and later generations heard in consequence of sanitary scandals in barracks at Windsor and Dublin and elsewhere. The General Report of the Barracks and Hospitals Commission, dated April 1861, was presented to Parliament in that year, and many of Miss Nightingale's friends, on reading it, referred to it as “her book.” They were not far wrong, for much of the Report, and especially the long section dealing with the proper principles of Hospital and Barrack Construction, was in large measure her work.
Miss Nightingale, in order to ensure that such principles should be better understood and carried out in the future, induced Mr. Herbert to appoint a special Barracks Works Committee, “to report as to measures to simplify and improve the system under which all works and buildings, other than fortifications, are constructed, repaired, and maintained, in order to give a more direct responsibility to the persons employed in those duties.” Of this committee Captain Galton was a member, and the Draft Report was submitted to Miss Nightingale for criticism and suggestion.[279] There are many causes to which the improved health of the Army in our own time may be attributed, but the chief of them has probably been the improvement of barrack accommodation, and for this the name of Florence Nightingale deserves to be held in grateful remembrance by the Army and by the nation.
As a supplement to the improvements in barrack kitchens, Mr. Herbert introduced a reform in a direction which Miss Nightingale had pressed upon Lord Panmure's attention[280]; he established a School of Practical Cookery at Aldershot, for the training of regimental and hospital cooks in the art of giving men a wholesome meal. Miss Nightingale had been painfully impressed in the Crimea by the importance of this reform.
The second Sub-Commission was charged with the duty of reorganizing the Army medical statistics. This was one of the requirements of rational reform which had most forcibly struck Miss Nightingale in the East. The emphasis which she laid upon this side of her experience, the persistence with which she pressed the matter, the statistical skill with which she showed the way to a better system, are amongst the most valuable of her services to the cause of Army Reform. When the suggestions of the Sub-Commission were carried out, the British Army Statistics became the best and most useful then obtainable in Europe.[281]
The third Sub-Commission was to carry out another of Miss Nightingale's favourite ideas: the establishment of an Army Medical School. There were here the most wearisome delays and obstructions,[282] and it was not until Mr. Herbert himself became Secretary of State that he was able to give effect to his Sub-Commission's Report. And even then, as soon as the Minister's personal oversight was averted, the War Office “Subs.” set to work to defeat their chief. Mr. Herbert had appointed the staff in 1859, but it was not till September 1860 that the first students arrived at Fort Pitt, Chatham. They promptly came to the conclusion “that the School was a hoax.” As well they might, for the School was without fittings or instruments of any kind! The explanation, which may be read elsewhere,[283] is remarkable even in the annals of departmental muddles. There was, apparently, no method known to the red-tape of the routine-men whereby the School could be fitted, and it might have remained empty indefinitely, but that a trenchant letter from Miss Nightingale secured the personal intervention of the Secretary of State. “There! At last!” wrote Mr. Herbert to her, in forwarding the official order at the end of its long travels through departments and sub-departments. The Army Medical School was peculiarly Miss Nightingale's child, and she watched over its early stages with constant solicitude. Mr. Herbert had commissioned her, in consultation with Sir James Clark, to make the Regulations. She had the nomination of the professors. For the chair of Hygiene she nominated Dr. E. A. Parkes, whose acquaintance she had made during the Crimean War. It would be difficult to exaggerate the services which the stimulating teaching of this great sanitarian rendered to the cause of military hygiene. He had much correspondence with Miss Nightingale in connection with the syllabus of his first course of lectures. In every administrative difficulty the professors went to her for help. The correspondence between her and Dr. Aitken[284] is especially voluminous. She had made a successful fight, against much opposition, to have pathology included in the professoriate, and Dr. Aitken was ultimately appointed to the chair. He it was who set Miss Nightingale in motion about the fittings of the School. He often asked her to “give us another push.” “Kind thanks,” he wrote (March 1861) when a further hitch had arisen, “for placing our train on the proper line.” Her intervention at headquarters was necessary even to extract pay for the professors. “I have just received an intimation from the War Office,” Dr. Aitken wrote to her (Aug. 7, 1860), “that Sir John Kirkland has been authorised to issue my pay; so I presume the numerous officials concerned have been able to satisfy each other that I am in existence. The ‘at once’ in this instance is equal to six days—an activity I am inclined to believe is due to your exertions on Sunday.” Sunday was the day of the week on which, if on no other, she always saw Mr. Herbert. Dr. Aitken was sarcastic, and not without cause, about the Circumlocution Office; but it is possible that the fault was not always only on one side. Professors are said to be sometimes “children” in matters of business; and on one tale of woe addressed to Miss Nightingale, the docket (in Dr. Sutherland's handwriting, but doubtless at her dictation) is this: “I hope the present difficulty has been got over, but it will be well to bear in mind that the School is so nearly connected with the administrative part of the War Office, that all your future proceedings, whether by minute or otherwise, should be concise and practical.” The School survived the perils of its infancy, and introduced a most beneficent reform by affording means of instruction in military hygiene and practice to candidates for the Army Medical Service. “Formerly,” as Miss Nightingale wrote, “young men were sent to attend sick and wounded soldiers, who perhaps had never dressed a serious wound, or never attended a bedside, except in the midst of a crowd of students, following in the wake of some eminent lecturer, who certainly had never been instructed in the most ordinary sanitary knowledge, although one of their most important functions was hereafter to be the prevention of disease in climates and under circumstances where prevention is everything, and medical treatment often little or nothing.” Miss Nightingale's services as the true founder of the School were publicly acknowledged at the time. Dr. Longmore, the Professor of Military Surgery, told the students that it was she “whose opinion, derived from large experience and remarkable sagacity in observation, exerted an especial influence in originating and establishing this School.”[285] “In the Army Medical School just instituted,” wrote Sir James Clark, “hygiene will form the most important branch of the young medical officer's instruction. For originating this School we have to thank Miss Nightingale, who, had her long and persevering efforts effected no other improvement in the Army, would have conferred by this alone an inestimable boon upon the British soldier.”[286]