The Life of Florence Nightingale, vol. 1 of 2

by Sir Edward Tyas Cook

Farther south of the General Hospital, in the quarter of Haidar Pasha, was what was known as The Palace Hospital, consisting of various buildings belonging to the Sultan's Summer Palace. These were occupied as a hospital in January 1855. Miss Nightingale had no responsibility here; but in the summer of 1855, the female nursing of sick officers, quartered in one of these buildings, was placed under the superintendence of Mrs. Willoughby Moore, the widow of an officer who had died a noble death in the war, and four female nurses, sent out specially from England.

Finally, there were hospitals at Koulali, four or five miles farther north, upon the same Asiatic shore of the Bosphorus. These hospitals were opened in December 1854. The nursing in them was originally under Miss Nightingale's supervision, but she was presently relieved of it (p. [193] n.). The hospitals were broken up in November 1855, when, of the female nursing establishment, a portion went home, and the rest passed under Miss Nightingale into the hospitals at Scutari.

There were also five hospitals in the Crimea, but particulars of these may be deferred till the time comes for following Miss Nightingale upon her expeditions to the front. For the nursing in the Civil Military Hospitals (i.e. hospitals controlled by a civilian medical staff) at Renkioi (on the Dardanelles) and at Smyrna, and for the Naval Hospital at Therapia, Miss Nightingale had no responsibility, though there is voluminous correspondence among her papers showing that she was constantly consulted upon the site and arrangements of these hospitals. The medical superintendent of the hospital at Renkioi was Dr. E. A. Parkes, with whom Miss Nightingale formed a friendship which endured to the end of his life.

II

The state of the hospitals when Miss Nightingale arrived requires some description, which, however, need not be long. The treatment of the sick and wounded during the Crimean War was the subject of Departmental Inquiries, Select Committees, and Royal Commissions, which, when they had finished sitting upon the hospitals, began sitting upon each other. Enormous piles of Blue-books were accumulated, and in the course of my work I have disturbed much dust upon them. The conduct of every department and every individual concerned was the subject of charge, answer, and countercharge innumerable. Each generation deserves, no doubt, the records of mal-administration which it gets; but one generation need not be punished by having to examine in detail the records of another. Some of the details of the Crimean muddle will indeed necessarily be disinterred in the course of our story; but all that need here be collected from the heaps aforesaid are three general conclusions.

The reader must remember, in the first place, that, apart from controverted particulars, it was made abundantly manifest that there was gross neglect in the service of the sick and wounded. The conflict of testimony is readily intelligible. It was easy to give an account based upon the facts of one hospital or of one time which was not applicable to another. At Scutari, for instance, the General Hospital was from the first better ordered than the Barrack Hospital. Then, again, different witnesses had different standards of what was “good” in War Hospitals; to some, anything was good if it was no worse than the standard of the Peninsular War. Of Sir George Brown, who commanded the Light Division in the Crimea, it was said: “As he was thrown into a cart on some straw when shot through the legs in Spain, he thinks the same conveyances admirable now, and hates ambulances as the invention of the Evil One.”[87] Miss Nightingale had much indignant sarcasm for those who seemed content that the soldier in hospital should be placed in the condition of “former wars,” instead of perceiving that he “should be treated with that degree of decency and humanity which the improved feeling of the nineteenth century demands.” But the principal reason for the conflict of testimony was that the very facts of protest and inquiry put all the officials concerned upon the defensive. Any suggestion of default or defect was resented as a personal imputation. There is a curious illustration in the letter which the Head of the Army Medical Department wrote to his Principal Medical Officer in view of the Roebuck Committee. “I beg you to supply me, and that immediately”—with what? with the truth, the whole truth, and nothing but the truth? No—“with every kind of information which you may deem likely to enable me to establish a character for it [the Department], which the public appear desirous to prove that it does not possess.”[88] But though there was much conflict of evidence, the final verdict was decisive. What Greville wrote in his Journal—“the accounts published in the Times turn out to be true”—was established by official inquiry and admitted by Ministers. In consequence of the indictment in the Times, a Commission of Inquiry was dispatched to the East by the Secretary of State. The Commission arrived at Constantinople simultaneously with Miss Nightingale, and four months later it reported to the Duke of Newcastle.[89] I need not trouble the reader here with many particulars of its Report; for they were adopted and confirmed by a Select Committee of the House of Commons a few months later (the famous “Roebuck Committee”), which pronounced succinct sentence that “the state of the hospitals was disgraceful.” The ships which brought the sick and wounded from the Crimea were painfully ill-equipped. The voyage from Balaclava to Scutari usually took eight days and a half. During the first four months of the war, there died on a voyage, no longer than from Tynemouth to London, 74 out of every 1000 embarked. The landing arrangements added to the men's sufferings. To an unpractised eye the buildings used as hospitals at Scutari were imposing and convenient; and this fact accounts for some of the rose-coloured descriptions by which persons in high places were for a time misled. Even the Principal Medical Officer on the spot was naïvely content with whitewash as a preparation to fit the Barrack for use as a hospital. In fact, however, the buildings were pest-houses. Underneath the great structures “were sewers of the worst possible construction, loaded with filth, mere cesspools, in fact, through which the wind blew sewer air up the pipes of numerous open privies into the corridors and wards where the sick were lying.”[90] There was also frightful overcrowding. For many months the space for each patient was one-fourth of what it ought to have been. And there was no proper ventilation. “It is impossible,” Miss Nightingale told the Royal Commission of 1857, “to describe the state of the atmosphere of the Barrack Hospital at night. I have been well acquainted with the dwellings of the worst parts of most of the great cities in Europe, but have never been in any atmosphere which I could compare with it.” Lastly, hospital comforts, and even many hospital necessaries, were deficient.[91] The supply of bedsteads was inadequate. The commonest utensils, for decency as well as for comfort, were lacking. The sheets, said Miss Nightingale, “were of canvas, and so coarse that the wounded men begged to be left in their blankets. It was indeed impossible to put men in such a state of emaciation into those sheets. There was no bedroom furniture of any kind, and only empty beer or wine bottles for candlesticks.” Necessary surgical and medical appliances were often either wanting or not forthcoming. There was no machinery, until Miss Nightingale came, for providing any hospital delicacies. The result of this state of things upon patients arriving after a painful voyage in an extreme state of weakness and emaciation, from wounds, from frost-bite, from dysentery, may be imagined, and it is no wonder that cholera and typhus were rife. In February 1855 the mortality per cent of the cases treated was forty-two. No words are necessary to emphasize so terrible a figure.

Mr. Herbert had not waited for the reports of Commission and Committee to reach the conclusion that things were wrong:—

“I have for some time,” he wrote on December 14, 1854, to the Commandant at Scutari, “been very anxious and very much dissatisfied as to the state of the hospital. I believe that every effort has been made by the medical men, and I hear that you have been indefatigable in the conduct of the immediate business of your department. But there has been evidently a want of co-operation between departments, and a fear of responsibility or timidity, arising from an entire misconception of the wishes of the Government. No expense has been spared at home, and immense stores are sent out, but they are not forthcoming. Some are at Varna, and for some inexplicable reason they are not brought down to Scutari. When stores are in the hospital, they are not issued without forms so cumbrous as to make the issue unavailing through delay. The Purveyor's staff is said to be insufficient. The Commissariat staff is said to be insufficient, your own staff is said to be insufficient,” etc.

By admission, then, and by official sentence, there were things amiss at Scutari which urgently called for amendment. This is the first general conclusion which has to be remembered in relation to Miss Nightingale's work.