A great obstacle with which Miss Nightingale's work in the East had to contend throughout was the scarcity at the time of properly trained nurses. She had long ago formed a resolve to remedy this defect; the seriousness of it was still further enforced upon her mind by painful experience in the Crimean War; and her resolve was the more strengthened. The religious difficulty—demanding that nurses should be selected, to some extent, not qua nurses, but qua sectarians—accentuated the obstacle of inadequate training, which, however, would in any case have existed. The case is excellently put, in terms which doubtless reflect Miss Nightingale's own views, in a letter from Lady Verney to Mrs. Gaskell (May 17, 1855):—
Until women have gone through a real training, it is vain to hope that four or five weeks in a Hospital can fit them for one of the most difficult works that any one can be called on to undertake. I cannot tell you the details, you can guess many of them; but when I hear estimable people talking as if you could turn 40 women of all ranks, degrees of virtue, and intelligence, into a Military Hospital, with drunken orderlies, unmarried Chaplains, young Surgeons, &c., &c., and expect that they are not more likely to be unwise or tempted astray than the R.C. Sisters of Charity, who are bound by well-considered vows, love of their kind and the fear of Hell fire, then we feel that the “estimable people” have very little knowledge of human nature. F.'s form of Sisterhood is infinitely higher, I believe, than the R.C. and will be carried out, I doubt no more than in her own existence, but as it must exist without the checks and safeguards of the other and inferior form, so it requires higher elements in the actors and a more severe training and examination. Instead of which the loosest possible choice takes place by people most excellent but not in the least qualified to choose; goodwill and a “love of nursing” is enough for the Lady class.
It is the fact, though it is not popularly known, that Miss Nightingale was at this time strongly opposed to “lady” nurses. She objected to them, not because they were ladies, but because they were unlikely to be well trained. Pious and benevolent ladies were more given, she said, to “spiritual flirtations with the patients,” than apt at the proper business of surgical nursing. It was the trained hospital nurses that she preferred. There were among the 125 women who passed through her hands in the East more efficient and less, and in so large a flock there were some black sheep. But amongst the band, in all classes and of all denominations, there were devoted and competent women, whose services deserve to be held in grateful remembrance beside those of their Lady-in-Chief. And as I have had to record Miss Nightingale's criticism upon some of the Roman Catholics among her flock, it should be added that of others she wrote to Mr. Herbert: “They are the truest Christians I ever met with—invaluable in their work—devoted, heart and head, to serve God and mankind—not to intrigue for their Church.” To the Reverend Superior, who came out from Bermondsey with the first party of nuns, Miss Nightingale was particularly attached. “She writes,” said Cardinal Wiseman, “that great part of her success is due to Rev. Mother of Bermondsey, without whom it would have been a failure.”[168]
The aspect of Miss Nightingale's work, touched upon in this chapter, adds another to the accumulation of difficulties with which she had to deal. It was the one which troubled her most. “In this sink of misery, in this tussle of life or death,” she felt the bitter futility of personal grievances and religious differences. It is worry, more than work, that kills; and the religious difficulty was perhaps the last straw which caused the Lady-in-Chief to break down, as we shall hear in the next chapter, under her heavy load of responsibility and care.
CHAPTER IX
TO THE CRIMEA—ILLNESS
(May–August 1855)
For myself, I have done my duty. I have identified my fate with that of the heroic dead.—Florence Nightingale (private notes, 1855).
In the spring of 1855 Miss Nightingale decided to leave Scutari for a while in order to visit the hospitals in the Crimea. The conditions at Scutari were now greatly improved. Sanitary works had been executed. The hospitals were better supplied. The pressure in the wards, caused by the terrible winter before Sebastopol, was relieved. There were only 1100 cases in the Barrack Hospital, and of those only 100 were in bed. The rate of mortality had fallen from 42 per cent to 22 per thousand of the cases treated. The siege was likely soon to be accompanied by assaults, and the pressure might rather be in the hospitals at Balaclava, where the sick and wounded were if possible to remain, in order to avoid the sufferings of the sea passage to Scutari.
In the Crimea, besides the regimental hospitals, there were four general hospitals. There was the General Hospital at Balaclava, established after the British occupation in September 1854. There was the Castle Hospital, consisting of huts on the “Genoese heights” above Balaclava, opened in April 1855. There was the Hospital of St. George's Monastery, also consisting of huts, intended for convalescent and ophthalmic cases; and, lastly, there were the Hospitals of the Land Transport Corps, again consisting of huts, near Karani. All these hospitals had a complement of female nurses, though the Monastery Hospital not until December 1855, and the Land Transport Hospitals not until 1856. In the spring of 1855, then, there were already female nurses at the General Hospital and the Castle Hospital, under their own superintendents, but all ultimately responsible to Miss Nightingale—as she apprehended, and as the War Office intended. She was now anxious to inspect these hospitals; to increase the efficiency of the female nursing establishments; and, in particular, to introduce those washing and cooking arrangements which had been productive of so much benefit at Scutari. Her visit of inspection was approved by the War Office; and, by instructions dated April 27, she was invested with full authority as Almoner of the Free Gifts in all the British Hospitals in the Crimea. But in other respects her position was somewhat ambiguous. The original instructions, issued by Mr. Herbert, had named her as Superintendent of the female nurses in all the British military hospitals in Turkey; and these words gave a standing-ground to her opponents in the Crimea. The intention of the War Office was to give her general superintendence, but to relieve her of direct responsibility for the nurses in the Crimea so long as she was at Scutari. The matter was not, however, cleared up till a later date,[169] and the indefiniteness of her position in the Crimea exposed her to infinite worry and intrigues.