Every great influx of patients was terrible, whether from an epidemic or after a battle; but experience and devotedness made even this comparatively easy before the troops turned homewards. The arrival of a transport was, perhaps, the first intimation of the earlier battles. Then all was hurry-skurry in the hospitals; everybody was willing to help, but the effectual organization was not yet ready.
Of every hundred on board the transport, an average of ten had died since leaving the Crimea. The names and causes of death of these men ought to be recorded; but the surgeons of the transport are wholly occupied in despatching their living charge to the hospital; and the surgeons there have enough to do in receiving them. Attempts are made to obtain the number and names and injuries of the new patients: there may or may not be a list furnished from the ship; and the hospital surgeons inquire from bed to bed: but in such a scene mistakes are sure to arise; and it was found, in fact, that there was always more or less variation between the numbers recorded as received or dead and the proper number. No one could wonder at this who had for a moment looked upon the scene. The poor fellows just arrived had perhaps not had their clothes off since they were wounded or were seized with cholera, and they were steeped in blood and filth, and swarming with vermin. To obtain shirts and towels was hard work, because it had to be proved that they brought none with them. They were laid on the floor in the corridors, as close as they could be packed, thus breathing and contaminating the air which was to have refreshed the wards within. If laid upon so-called sheets, they entreated that the sheets might be taken away; for they were of coarse canvas, intolerable to the skin. Before the miserable company could be fed, made clean, and treated by the surgeons, many were dead; and a too large proportion were never to leave the place more, though struggling for a time with death. It was amidst such a scene that Florence Nightingale refused to despair of five men so desperately wounded as to be set aside by the surgeons. The surgeons were right. As they said, their time was but too little for the cases which were not hopeless. And Florence Nightingale was right in finding time, if she could, to see whether there was really no chance. She ascertained that these five were absolutely given over; and she and her assistants managed to attend to them through the night. She cleaned and comforted them, and had spoonfuls of nourishment ready whenever they could be swallowed. By the morning round of the surgeons, these men were ready to be operated upon; and they were all saved.
It would have been easier work at a later period. Before many months were over, the place was ready for any number to be received in peace and quietness. Instead of being carried from one place to another, because too many had been sent to one hospital and too few to another, the poor fellows were borne in the shortest and easiest way from the boat to their beds. They were found eager for cleanliness; and presently they were clean accordingly, and lying on a good bed, between clean, soft sheets. They did not come in scorbutic, like their predecessors; and they had no reason to dread hospital gangrene or fever. Every floor and every pane in the windows was clean; and the air came in pure from the wide, empty corridors. There was a change of linen whenever it was desired; and the shirts came back from the wash perfectly sweet and fresh. The cleaning of the wards was done in the mornings, punctually, quickly, quietly, and thoroughly. The doctors came round, attended by a nurse who received the orders, and was afterwards steady in the fulfilment of them. The tables of the medicines of the day were hung up in the ward; and the nurse went round to administer them with her own hand. Where she was, there was order and quietness all day, and the orderlies were worth twice as much as before the women came. Their manners were better; and they gave their minds more to their business. The nurse found time to suit each patient who wished it with a book or a newspaper, when gifts of that sort arrived from England. Kind visitors sat by the beds to write letters for the patients, undertaking to see the epistles forwarded to England. When the invalids became able to rise for dinner, it was a turning-point in their case; and they were soon getting into the apartment where there were games and books and meetings of old comrades. As I have said before, those who died at these hospitals were finally scarcely more than those who died in—not the hospitals—but the barracks of the Guards at home.
What were the changes in organization needed to produce such a regeneration as this?
They were such as must appear to Americans very simple and easy. The wonder will be rather that they were necessary at last than that they should have been effected with any difficulty. But Americans have never known what it is to have a standing army as a long-established and prominent national institution; and they can therefore hardly conceive of the strength of the class-spirit which grows up in the various departments of the military organization. This jealousy, egotism, and stiffness of prejudice were much aggravated by the long peace, in which a great rusting of the apparatus of the system took place, without at all impairing the complacency of those who formed a part of it. The old medical officers were incapable, pedantic, and jealous; and no proper relation had ever been established between them and the military authorities. The imbecility of the system cost the lives of others than the soldiers who died in hospital. Brave men arose, as in all such crises, to bear the consequences of other men's mistakes, and the burden of exposing them; and several physicians and surgeons died, far from home, in the effort to ameliorate a system which they found unworkable. The greatest benefactor in exhibiting evils and suggesting remedies, Dr. Alexander, lived to return home, and instigate reforms, and receive the honors which were his due; but he soon sank under the consequences of his labors. So did Lord Herbert, the Secretary of War, to whom, in conjunction with Miss Nightingale, the British army, at home, in India, and everywhere, owes its redemption from special sickness and undue mortality. In America the advantages may be enjoyed without tax or drawback. The citizens are accustomed to organize themselves for action of all sorts; and no stiff-necked classes stand in the way of good management. The difficulty in America must rather be to understand how anything so perverse as the management of British military hospitals ten years ago can have existed to so late a date.
It was supposed, ten years since, that there must be nine separate departments in every Military General Hospital, and the officials bore titles accordingly; but there was such an odd confusion in their functions that every one of the nine was often seen doing the business of some other. The medical officers were drawing corks and tasting wines and inspecting provisions, when they should have been by the bedside. The purveyor was counting the soldiers' money, and noting its amount, when he should have been marketing, or ordering the giving out of the provisions for the day. The paymaster could scarcely find time to discharge the bills, so much was his day filled up with doing eternal sums about the stoppages in the pay of the patients. There were thirteen kinds of stoppages in the army, three of which were for the sick in hospital: the paymaster could never be quite certain that he had reckoned rightly with every man to the last penny; the men were never satisfied; and the confusion was endless. The commissariat, the purveyor, and the paymaster were all kept waiting to get their books made up, while soldiers were working the sums,—being called from their proper business to help about the daily task of the stoppages. Why there should not be one uniform stoppage out of the pay of men in hospital no person of modern ideas could see; and the paymaster's toils would have been lessened by more than one-half, if he had had to reckon the deduction from the patients' pay at threepence or fourpence each, all round, instead of having to deal with thousands per day individually, under three kinds of charge upon the pay.
The commandant's post was the hardest,—he being supposed to control every province, and have every official under his orders, and yet being powerless in regard to two or three departments, the business of which he did not understand. The officers of those departments went each his own way; and all unity of action in the establishment was lost. This is enough to say of the old methods.
In the place of them, a far simpler system was proposed at the end of the war. The eternal dispute as to whether the commandant should be military or medical, a soldier or a civilian, was set aside by the decision that he should be simply the ablest administrator that could be found, and be called the Governor, to avoid the military title. Why there should be any military management of men who are sick as men, and not as soldiers, it is difficult to see; and when the patients are about to leave the hospital, a stated supervision from the adjutant-general's department is all that can be required. Thus is all the jealousy between military and medical authority got rid of. The Governor's authority must be supreme, like that of the commandant of a fortress, or the commander of a ship. He will not want to meddle in the doctors' professional business; and in all else he is to be paramount,—being himself responsible to the War-Office. The office, as thus declared, is equivalent to three of the nine old ones, namely, the Commandant, the Adjutant-General, and the Quartermaster-General.
Next to the Governor, the Chief Medical Officer must be the most important man in the establishment. He is to be concerned with professional business only, and to see that all under him are to be devoted in the same way. For this purpose there must be an end to the system of requisitions. There must be a Steward, taking his orders from the Governor alone, and administering a simple and liberal system of diets and appliances of all sorts. It is his business to provide everything for the consumption of the establishment, and to keep the contractors up to their duty. The Treasurer's function speaks for itself. All the accounts and payments under the Governor's warrant are in his charge.
There is one more office, rendered necessary by the various and active service always going on,—the superintendent of that service, or Captain of the Wards. He is to have the oversight of the orderlies, cooks, washers, and storekeepers; he is to keep order throughout the house; and he is to be referred to in regard to everything that is wanted in the wards, except what belongs to the department of the medical officers or the steward.