The course of sanitary improvement, and the results of it, among the civil population cannot be brought to any such definite test; no Indian census was taken till 1872, registration of births and deaths was only beginning and was very imperfect; and India is a country as large as the whole of Europe (without Russia). It was the opinion of a competent authority that the sanitary progress which had been made in India during the years covered by Miss Nightingale's review “had no parallel in the history of the world”;[116] but the progress was relative of course to the almost incredibly insanitary condition of the country when she began her crusade. The progress had been made along many different lines. First, in connection with the health of military stations, the Government of India established committees of military, civil, medical and engineering officers, of local magistrates and village authorities to regulate the sanitary arrangements of the neighbourhood. Sanitary oases for British troops were thus established in the midst of insanitary deserts. Then, sanitary regulations were issued for fairs and pilgrimages—each of these a focus of Indian disease. Institutions in India—hospitals, jails, asylums—had been greatly improved; and the municipalities of the great cities had made some sanitary progress. Ten years before, Miss Nightingale had reported to the Royal Commission that no one of the seats of Presidencies in India had as yet arrived at the degree of sanitary civilization shown in the worst parts of the worst English towns. Now, Calcutta had a pure-water supply and the main drainage of most of the town was complete. Bombay had done less by municipal action, but thanks to a specially vigorous Health Officer, Dr. Hewlett, sanitation had been improved. Madras had improved its water-supply and was successfully applying a part of its sewage to agriculture. The condition of the vast regions of rural India showed that the teaching of the Sanitary Commissioners was beginning to take some effect. Hollows and excavations near villages were being filled up; brushwood and jungle, removed; wells, cleaned. Surface refuse was being removed; and tanks were being provided for sewage, to prevent it going into the drinking-tanks. From reports of particular places, Miss Nightingale drew her favourite moral. There was a village in South India which had suffered very badly from cholera and fever. It was in a foul and wretched state, and had polluted water. Then wells were dug and properly protected; the surface drainage was improved; cleanliness was enforced; trees were planted. The village escaped the next visitation of the scourge. Miss Nightingale had many hours of depression, and many occasions of disappointment, as Health Missionary for India; but in her Paper of 1874 she bore “emphatic witness how great are the sanitary deeds already achieved, or in the course of being achieved, by the gallant Anglo-Indians, as formerly she bore emphatic witness against the then existing neglects.” Only the fringe of the evil had been touched; but at any rate enough had been done to show that the old bogey, “the hopeless Indian climate,” might in course of time be laid by wise precautions. “There is a vast work going on in India,” said Dr. Sutherland; and in this work Miss Nightingale had throughout played a principal, and the inspiring, part. It was the opinion of an unprejudiced expert who, though he admired her devotion, did not always agree with her views or methods, that “of the sanitary improvements in India three-fourths are due to Miss Nightingale.”[117]
But here, as in all things, her gaze was fixed upon the path to perfection. In her own mind she counted less the past advance than the future way. There was an Appendix to her Paper in which she preached the supreme importance of Irrigation—of irrigation, that is, combined with scientific drainage. Only by that means, she held, could yet more people “live and not die in India,” and could the country be raised to its full productive power. A letter which Sir Stafford Northcote sent her (April 29, 1874), in acknowledgment of her Paper on “Life or Death in India,” exactly expressed her own feelings. “How much,” he said, “you have done! and how little you think you have done! After all, the measure of our work depends upon whether we take it by looking backwards or by looking forwards, by looking on what has been accomplished or on what has revealed itself as still to be accomplished. When we have got to the top of the mountain, are we much nearer the stars or not?”
CHAPTER IV
ADVISER-GENERAL ON HOSPITALS AND NURSING
(1868–1872)
We are your Soldiers, and we look for the approval of our Chief.—Miss Agnes Jones (Letter to Miss Nightingale).
From a correspondent in the North of England: “I have got a colliery proprietor here to co-operate with the workmen to build a Hospital for Accidents. Will you kindly give your opinion on the best kind of building?” From a correspondent in London: “We are proposing to form a British Nursing Association. May we ask for your advice and suggestions?” These letters are samples of hundreds which Miss Nightingale received, and to all such applications she readily replied. She constituted herself, or rather she was constituted by her fellow-countrymen, a Central Department for matters pertaining to hospitals and nurses.
From all parts of the country, from British colonies and from some foreign countries, plans of proposed General Hospitals, Cottage Hospitals, Convalescent Homes were submitted to her. She criticised them carefully. When she was consulted at an earlier stage, she often submitted plans of her own. In all such cases, there were experts among her large circle of friends—architects, sanitary engineers, military engineers, hospital superintendents and matrons—to advise and assist her. And here a curiously interesting thing may be noticed. Miss Nightingale had begun her work as a Reformer with the military hospitals. So high was now their standard that she often went to them for models. Many plans for ideal hospitals were drawn for her at this time by Lieutenant W. F. Ommamney, R.E., at the War Office. The improvement of buildings and of nursing went on concurrently, and Miss Nightingale used her influence in each department to improve the other. If she were consulted only about buildings, she would answer: “These plans are all very well, as far as they go; but your Hospital will never be efficient without adequate provision for a supply of properly trained nurses.” If she were asked to furnish a supply of nurses, she would say: “By all means; but you must satisfy me first that your buildings are sanitary.” Thus, when she was asked to send nurses to the Sydney Infirmary, she stipulated that plans of the buildings should be submitted; and when the War Office was negotiating for a supply of nurses for Netley, there was a voluminous correspondence about the improvement of the wards and of the nurses' quarters.
There was a great extension during these years of societies for the training of nurses, and of the introduction of trained nurses into infirmaries and other institutions. All this involved a large addition to Miss Nightingale's correspondence. As the nursing system extended, many questions arose with regard to the relation between the medical and the nursing staffs, and she was constantly referred to for suggestions and advice. She printed a code of “Suggestions” in 1868 dealing with such matters,[118] and three years later she and Dr. Sutherland drew up a Code for Infirmary Nursing which was approved by Mr. Stansfeld, the President of the newly-formed Local Government Board. Her correspondence was as extensive with individuals as with institutions. Hundreds of girls who thought of becoming nurses applied to her, and she generally answered their letters; but the supply of nurses barely kept pace with the demand. Miss Nightingale was impressed in particular by the lack of suitable applicants for the higher posts. There were many women anxious to take up nursing as a profession. There were few who possessed the social standing, the high character, trained intelligence, and personal devotion which were necessary to make them successful Lady Superintendents; and much of Miss Nightingale's correspondence during these years was to friends in various parts of the country who were begged to enlist promising recruits.