The School was afterwards moved to Netley. It is now in London, is one of the Medical Schools in the University, and is placed in convenient proximity to a military hospital. The Tate Gallery, on the Embankment at Millbank, stands between two buildings which are of peculiar interest to any one concerned in the life and work of Florence Nightingale. To the east of the Gallery is the Royal Alexandra Hospital, a general military hospital for the London district. It is built, of course, on the “pavilion” plan, and in every other respect conforms to Miss Nightingale's ideas of what a hospital should be—with many additions to its resources, which the progress of science has suggested since her day. A complete apparatus for X-ray treatment, capable of being packed into five cases for service in the field, is likely to attract the special attention of a visitor. But in connection with Miss Nightingale there was something else which struck me more. As I went through the surgical wards with the Commandant, the smart “orderlies” (old style, now the trained men of the Army Medical Corps) stood at attention. The Colonel entered into conversation with the Sergeant of a ward. He was awaiting promotion until he had qualified in the hospital, under the Matron, Sisters, and Staff Nurses. Promotion in the Corps is now dependent on an examination plus a certificate from the nursing authorities. Into how great a thing has the introduction of female nursing for the Army, due to Miss Nightingale, grown, and how ironical are some of time's revenges which the development has brought with it! Originally the female nurses occupied the lowest place; sometimes they were little more than superior domestics, often they were amateurs, and their position was always a little nondescript. Now they represent the most highly-trained and professional element, and without a certificate from them no male hospital attendant can win full promotion! And there was another thing that struck me. After a tour of the surgical wards, I inquired about the medical wards; but time was pressing, “and you would find little to see there,” said the Colonel, “for the Army is so healthy in these days that there are few medical cases.”[287]
Florence Nightingale
about 1858
from a photograph by Goodman
On the west of the Tate Gallery stands another, and a larger, pile of buildings. These are occupied by the Royal Army Medical College, through which every Army Medical Officer has now to pass both a preliminary and a post-graduate course. Shortly before I visited the College, I had been reading the large mass of Miss Nightingale's papers which contain her first suggestions for the foundation of the school, with her drafts for its rules and regulations; and which describe the struggles and difficulties of its humble infancy. And then I was taken through the noble institution into which it has developed; equipped with large laboratories which are, I believe, among the best in the country, with smaller laboratories for private research; with a department for those “cultures” which are said to have done so much to preserve the health of the Army in India[288]; with a spacious lecture-theatre, a fine library, a large museum; and with handsome mess-rooms for the comfort and convenience of studious youth. The transition was like a transformation-scene in a pantomime. The Fairy Godmother of the College would have rejoiced to see it. Only one thing seemed to me to be wanting. There are portraits or other memorials of many of the men whose acquaintance we have made in these pages. In the entrance lobby there is a bust of Dr. Thomas Alexander, whose appointment as Director-General Miss Nightingale procured. In the smoking-room there are portraits of the first professors whom she nominated. I noticed no memorial of the two founders to whom the original institution of the College was due—Sidney Herbert and Florence Nightingale.
The last of the four Sub-Commissions—the “wiping” Sub-Commission—had very varied duties assigned to it, and there was no branch of the reform bill which encountered more stubborn opposition from the permanent officials. One of Mr. Herbert's many letters to Miss Nightingale on the subject speaks of the “gross ignorance, and darkness beyond all hope” of the principal obstructive, who maintained that the idea of a sanitary official was all fudge. Some of the work of this Sub-Commission need not be detailed here. It framed a new Army Medical Officers' Warrant (issued by General Peel in 1858), and reorganized the Army Medical Department (1859). These were useful steps at the time, but there have been so many new warrants and so many War Office reorganizations since then that this part of the reforms of Mr. Herbert and Miss Nightingale belongs in any detail only to ancient history. The case is different with the general work of the Wiping Sub-Commission. Here also there have been new developments, and some of the forms have been changed; but in substance, these have all been built upon the foundations laid in the years 1859–60. To Miss Nightingale primarily, and to her more than to any other individual, is due the recognition of a principle which may seem self-evident at the present time, but which was entirely novel in her day—the principle that the Army Medical Department should care for the soldier's health as well as for his sickness. The Sub-Commission—or to go behind the form to the reality, Miss Nightingale and Mr. Herbert—drew up a Code for introducing the sanitary element in the Army, defining the positions of Commanding and Medical Officers and their relative duties regarding the soldier's health, and constituting the regimental surgeon the sanitary adviser of his commanding officer. The same code contained regulations for organizing General Hospitals, and for improving the administration of Regimental Hospitals, both in peace and during war. Formerly, general hospitals in the field had to be improvised, on no defined principles and on no defined personal responsibility. The wonder is, not that they broke down, as they did in all our wars, but that they could be made to stand at all. In all our wars, again, the general hospitals had been signal failures—examples, as during the earlier months at Scutari, of how to kill, not to cure. The general hospital system, devised in the Code—including its governor, principal medical officer, captain of orderlies, female nurses, and their Superintendent (Mrs. Shaw Stewart)—was realized in 1861 in the hospital at Woolwich.
There were some other reforms introduced by Mr. Herbert, as Secretary of State, which owed their origin to Miss Nightingale's experiences, observation, and suggestions. In January 1861 Mr. Herbert issued a new Purveyor's Warrant and Regulations. Hitherto “the Purveying Department, like many others, had no well-defined position, duties, or responsibilities. It was efficient or inefficient almost by chance. Like other departments, it broke down when tried by war; and all its defects were visited on the sick and wounded men, for whose special benefit it professed to exist.” The new Code “defined with precision the duties of each class of purveying officers, together with their relation to the Army Medical Department. They provided all necessaries and comforts for men in hospital (both in the field and at home) on fixed scales, instead of requiring sick and wounded men (even in the field) to bring with them into hospital articles for their own use, which they had lost before reaching it.” The reader will remember how largely purveying defects entered into Miss Nightingale's difficulties in the East, and a reference to her letters from Scutari will show that Mr. Herbert's Code was based on the broad lines of her suggestions. As is hardly surprising, since she drafted the Code in consultation with Sir John McNeill.
Mr. Herbert also appointed a Committee to reorganize the Army Hospital Corps (1860). “In former times there were no proper attendants on the sick. For regimental hospitals a steady man was appointed hospital sergeant, and two or three soldiers, fit for nothing else, were sent into the hospital to be under the orders of the medical officer, who, if he were fortunate enough to find one man fit to nurse a patient, was sure to lose him by his being recalled ‘to duty’; sometimes, indeed, men were nominated in rotation over the sick in hospital as they would mount guard over a store. No special training was considered necessary; no one, except the medical officer, who was helpless, had the least idea that attendance on the sick is as much a special business as medical treatment. Unsuccessful attempts had been made to organize a corps of orderlies, unconnected with regiments; the result was most unsatisfactory. Mr. Herbert's Committee proposed to constitute a corps—the members of which, for regimental purposes, were to be carefully selected by the commanding and medical officers—specially trained for their duties, and then attached permanently to the regimental hospital.” This reform, which owed much to Miss Nightingale's suggestions, was carried into effect shortly after Mr. Herbert's death.
Mr. Herbert also took up those questions of the soldier's moral health in which Miss Nightingale had been a pioneer.[289] In 1861 he appointed a Committee[290] to consider how best to provide soldiers' day-rooms and institutes, in order to counteract the moral evils supposed to be inseparable from garrisons and camps. The Committee, of which Miss Nightingale's friends, Colonel Lefroy, Captain Galton, and Dr. Sutherland were members, showed that “the men's barracks can be made more of a home, can be better provided with libraries and reading-rooms; that separate rooms can be attached to barracks, where men can meet their comrades, sit with them, talk with them, have their newspaper and their coffee, if they want it, play innocent games, and write letters; that every barrack, in short, may easily be provided with a kind of soldiers' club, to which the men can resort when off duty, instead of to the everlasting barrack-room or the demoralizing dram-shop; and that in large camps or garrisons, such as Aldershot and Portsmouth, the men may easily have a club of their own out of barracks. The Committee also recommended increased means of occupation, in the way of soldiers' workshops, out-door games and amusements, and rational recreation by lectures and other means. The plan was tried with great success at Gibraltar, Chatham, and Montreal. Mr. Herbert's latest act was to direct an inquiry at Aldershot as to the best means of introducing the system there.” Miss Nightingale, in thus summarizing the case, did not state, what her correspondence shows to have been the fact, that she had been the prime mover in the appointment of the Committee; that, as already related (p. [351]), she had worked hard to obtain a reading-room, etc., at Aldershot; and that, in the case of Gibraltar, the equipment of the room owed much to gifts from her own private purse and to the contributions of personal friends (Mrs. Gaskell among them) whom she had interested in the scheme. Here, as in so many other directions, Miss Nightingale's work as a pioneer has been greatly developed; and no modern barrack is deemed complete without its regimental institute, with recreation room, reading-room, coffee-room, and lecture-room, while means of out-door recreation and shops for various trades are also provided.