Cecil Woodham-Smith
Florence Nightingale has become a symbol of the caring ministration of the sick and wounded. Until Nightingale lit her lamp in the British soldiers’ hospitals in the Crimea, nursing was a disreputable occupation talked of in the same breath as prostitution. The daughter of gentlefolk she went against her family, her class, and the whole of patriarchal Victorian society to become a nurse and then to make something like a profession out of it. Modern nursing and sanitary hospital routine owe much to her actions and her ideals as established in the Crimea, where she arrived with her assistants in November 1854.
At breakfast time the Vectis anchored, and during the morning Lord Stratford de Redcliffe, the British Ambassador at Constantinople, sent across Lord Napier, the Secretary of the Embassy. Lord Napier found Miss Nightingale, exhausted from the effects of prolonged sea-sickness, stretched on a sofa. Fourteen years later he recalled their first meeting: “. . . I was sent by Lord Stratford to salute and welcome you on your first arrival at Scutari . . . and found you stretched on the sofa where I believe you never lay down again. I thought then that it would be a great happiness to serve you.”
The nurses were to go to the hospital at once, for wounded were expected from the Battle of Balaclava. Painted caïques, the gondola-like boats of the Bosphorus, were procured, the nurses were lowered into them with their carpet-bags and umbrellas, and the party was rowed across to Scutari.
(Mr Cobbett then sat down amidst loud acclamations from the spectators in the gallery, which it was with great difficulty the officers could suppress.)
The jury was unable to agree, and Cobbett was acquitted.
The rain having ceased, a few fitful gleams of sunshine lit up the Asian shore, which, as it grew clearer, lost its beauty. The steep slopes to the Barrack Hospital were a sea of mud littered with refuse; there was no firm road, merely a rutted, neglected track. As the caïques approached a rickety landing stage, the nurses shrank at the sight of the bloated carcass of a large grey horse, washing backward and forward on the tide and pursued by a pack of starving dogs, who howled and fought among themselves. A few men, limping and ragged, were helping each other up the steep slope to the hospital, and groups of soldiers stood listlessly watching the dead horse and the starving dogs. A cold wind blew.
The nurses disembarked, climbed the slope, and passed through the enormous gateway of the Barrack Hospital, that gateway over which Miss Nightingale said should have been written: “Abandon hope all ye who enter here.” Dr Menzies and Major Sillery, the Military Commandant, were waiting to receive them. That night Lord Stratford wrote to the Duke of Newcastle: “Miss Nightingale and her brigade of nurses are actually established at Scutari under the same roof with the gallant and suffering objects of their compassion.”
From the European shore of the Bosphorus, from the magnificent house where the British Ambassador lived, the great quadrangle of the Turkish Barracks glimmered golden, magnificent as a giant’s palace. At close quarters, however, romance vanished. Vast echoing corridors with floors of broken tiles and walls streaming damp, empty of any kind of furniture, stretched for miles. Miss Nightingale calculated there were four miles of beds. Everything was filthy; everything was dilapidated. The form of the building was a hollow square with towers at each corner. One side had been gutted in a fire and could not be used. The courtyard in the centre was a sea of mud littered with refuse. Within the vast ramifications of the barracks were a depot for troops, a canteen where spirits were sold, and a stable for cavalry horses. “But it is not a building, it’s a town!” exclaimed a new arrival.
The vast building hid a fatal secret. Sanitary defects made it a pesthouse, and the majority of the men who died there died not of the wounds or sickness with which they arrived, but of disease they contracted as a result of being in the hospital.
When Miss Nightingale entered the Barrack Hospital on November 5, 1854, there were ominous signs of approaching disaster, but the catastrophe had not yet occurred. Food, drugs, medical necessities had already run short, the Barrack Hospital was without equipment, and in the Crimea supply was breaking down. Winter was swiftly advancing, and each week the number of sick sent to Scutari steadily increased.
There were men in the Crimea, there were men in Scutari, there were men at home in England who saw the tragedy approach. They were powerless. The system under which the health of the British Army was administered defeated them. The exactions, the imbecilities of the system killed energy and efficiency, crushed initiative, removed responsibility, and were the death of common sense.
Three departments were responsible for maintaining the health of the British Army and for the organization of its hospitals: the Commissariat, the Purveyor’s Department, and the Medical Department. They were departments which during forty years of economy had been cut down nearer and still nearer the bone.
These departments had no standing. Dr Andrew Smith, Director General of the British Army Medical Service, told the Roebuck Committee that it would have been considered impertinence on his part to approach the Commander in Chief with suggestions as to the health of the army. A commissary officer did not rank as a gentleman, while the Purveyor was despised even by the commissary.
The method by which the hospitals were supplied was confused. The Commissariat were the caterers, bankers, carriers, and storekeepers of the army. They bought and delivered the standard daily rations of the men whether they were on duty or in hospital. But the Commissariat did not supply food for men too ill to eat their normal rations. At this point the Purveyor stepped in. All invalid foods, known as “medical comforts”, sago, rice, milk, arrowroot, port wine, were supplied by the Purveyor. Yet he had no authority over their price, suitability, or quality, having to accept what the Commissariat sent unless he could claim the consignment was unfit for human consumption. Mr Benson Maxwell, an eminent lawyer and a member of the Hospitals Commission, declared that though he had spent some weeks in the hospitals he was completely unable to disentangle the respective duties of Commissariat and Purveyor.
Relations between the doctors and the Purveyor were even more obscure. A doctor might order a man a special diet, but it depended on the Purveyor whether the patient received it or not. Having made a requisition on the Purveyor, the doctor was powerless.
Though the system placed executive power in the hands of the Commissariat and the Purveyor, it was only a limited power. Certain goods only might be supplied. Each department had a series of “warrants” naming definite articles.
The result was the extraordinary shortages. When the sick and wounded came down to Scutari from the Crimea, they were in the majority of cases without forks, spoons, knives, or shirts. The regulations of the British Army laid down that each soldier should bring his pack into hospital with him, and his pack contained a change of clothing and utensils for eating. These articles were consequently not on the Purveyor’s warrant. But most of the men who came down to Scutari had abandoned their packs after Calamita Bay, or on the march from the Alma to Balaclava, at the orders of their officers. Nevertheless, the Purveyor refused to consider any requisitions on him for these articles.
No medical officer was permitted to use his discretion. The surgeon on duty had to make as many as six different daily records of the “Diet Roll”, the particulars of food and comforts to be consumed by each patient. “It must be admitted,” the Roebuck Committee agreed, “that Dr Menzies, the Senior Medical Officer, had no time left for what should have been his principal duty, the proper superintendence of these hospitals.”
The Barrack Hospital was the fatal fruit of the system. When the General Hospital was unexpectedly filled with cholera cases and Dr Menzies was abruptly notified that a further large number of patients were on their way, he was instructed to turn the Turkish Barracks into a hospital. The preparation and equipment of a hospital formed no part of his duties, his task being to instruct the Purveyor. How the Purveyor was to produce hospital equipment at a moment’s notice, how he was to collect labour to clean the vast filthy building when no labour existed nearer than Constantinople, was not Dr Menzies’ concern.
The Purveyor also knew the correct procedure. He had no authority to expend sums of money in purchasing goods in the open market, and in any case many of the articles required were not on his warrant. He requisitioned the Commissariat on the proper forms, the Commissariat wrote on the forms “None in store”, and the matter was closed. The wounded arrived and were placed in the building without food, bedding, or medical attention. Having issued the instruction correctly and placed it on record, an official’s duty was done.
The doctors at Scutari received the news of Miss Nightingale’s appointment with disgust. They were under-staffed, overworked; it was the last straw that a youngish society lady should be foisted on them with a pack of nurses. Opinion was divided as to whether she would turn out a well-meaning, well-bred nuisance or a Government spy.
However, on November 5 Miss Nightingale and her party were welcomed into the Barrack Hospital with every appearance of flattering attention and escorted into the hospital with compliments and expressions of good will. When they saw their quarters, the picture abruptly changed. Six rooms, one of which was a kitchen and another a closet ten feet square, had been allotted to a party of forty persons. The same space had previously been allotted to three doctors, and elsewhere the same amount was occupied solely by a major. The rooms were damp, filthy, and unfurnished except for a few chairs. There were no tables; there was no food. Miss Nightingale made no comment, and the officials withdrew. It was a warning, a caution against placing reliance on the flowery promises, the resounding compliments of Lord Stratford de Redcliffe, Viscount Canning.
Lord Stratford had been British Ambassador to Constantinople three times and associated with Turkey since 1807. Physically he was extremely handsome. He lived magnificently and travelled with twenty-five servants and seventy tons of silver forks, knives, dishes, jugs, coffee and teapots, and spoons.
Miss Nightingale described him as bad-tempered, heartless, pompous, and lazy. He was not the man to interest himself in a hospital for common soldiers. In his magnificent palace on the Bosphorus he lived for two years with, said Miss Nightingale, “the British Army perishing within sight of his windows”, and during those two years he visited the hospitals only once, when she “dragged” him there for a visit of only one and a half hours.
Fourteen nurses were to sleep in one room, ten nuns in another; Miss Nightingale and Mrs Bracebridge shared the closet; Mr Bracebridge and the courier-interpreter slept in the office; the cook and her assistant went to bed in the kitchen. There was one more room upstairs, and the eight Sellonites were to sleep there. They went upstairs, and hurried back. The room was still occupied – by the dead body of a Russian general. Mr Bracebridge fetched two men to remove the corpse while the sisters waited. The room was not cleaned, and there was nothing to clean it with; it was days before they could get a broom, and meanwhile the deceased general’s white hairs littered the floor. There was no furniture, no food, no means of cooking food, no beds. While the nurses and sisters unpacked, Miss Nightingale went down into the hospital and managed to procure tin basins of milkless tea. As the party drank it, she told them what she had discovered.
The hospital was totally lacking in equipment. It was hopeless to ask for furniture. There was no furniture. There was not even an operating table. There were no medical supplies. There were not even the ordinary necessities of life. For the present the nurses must use their tin basins for everything – washing, eating, and drinking.
The party had to go to bed in darkness, for the shortage of lamps and candles was acute. Sisters and nurses tried to console themselves by thinking how much greater were the sufferings of the wounded in the sick-transports. The rooms were alive with fleas, and rats scurried in the walls all night long. The spirits of all sank.
The doctors ignored Miss Nightingale. She was to be frozen out, and only one doctor would use her nurses and her supplies. She determined to wait until the doctors asked her for help. She would demonstrate that she and her party wished neither to interfere nor attract attention, that they were prepared to be completely subservient to the authority of the doctors.
It was a policy which demanded self-control. The party were to stand by, see the wounded suffer, and do nothing until officially instructed. Though Florence Nightingale could accept the hard fact that the experiments on which she had embarked could never succeed against official opposition, yet she inevitably came into conflict with her nurses.
She made them sort old linen, count packages of provisions. The cries of the men were unanswered while old linen was counted and mended – this was not what they had left England to accomplish. They blamed Miss Nightingale.
On Sunday, November 6, the ships bringing the wounded from Balaclava began to unload at Scutari. As on other occasions, the arrangements were inadequate and the men suffered frightfully.
Still Miss Nightingale would not allow her nurses to throw themselves into the work of attending on these unhappy victims. She allocated twenty-eight nurses to the Barrack Hospital and ten to the General Hospital a quarter of a mile away. All were to sleep in the Barrack Hospital, and all were to wait. No nurse was to enter a ward except at the invitation of a doctor. However piteous the state of the wounded, the doctor must give the order for attention. If the doctors did not choose to employ the nurses, then the nurses had to remain idle.
For nearly a week the party were kept shut up in their detestable quarters, making shirts, pillows, stump rests, and slings – and being observed by her penetrating eye. The time, sighed one of the English Sisters of Mercy, seemed extremely long.
“Our senior medical officer here,” Miss Nightingale wrote to Sidney Herbert in January, 1855, “volunteered to say that my best nurse, Mrs Roberts, dressed wounds and fractures more skilfully than any of the dressers or assistant surgeons. But that it was not a question of efficiency, nor of the comfort of the patients, but of the ‘regulations of the service’.”
She was first able to get a footing in the hospital through the kitchen. To cook anything at the Barrack Hospital was practically impossible. The sole provision for cooking was thirteen Turkish coppers, each holding about 450 pints. There was only one kitchen. There were no kettles, no saucepans; the only fuel was green wood. The tea was made in the coppers in which meat had just been boiled; water was short, the coppers were not cleaned, and the tea was undrinkable.
The meat for each ward was issued to the orderly for the ward. When the orderly had the meat, he tied it up, put some distinguishing marks on it, and dropped it into the pot. Some of the articles used by the orderlies to distinguish their meat included red rags, buttons, old nails, reeking pairs of surgical scissors, and odd bits of uniform. The water did not generally boil; the fires smoked abominably. When the cook considered that sufficient time had been taken up in cooking, the orderlies threw buckets of water on the fires to put them out, and the contents of the coppers were distributed, the cook standing by to see that each man got his own joint. The joints which had been dropped in last were sometimes almost raw. The orderly then carried the meat into the ward and divided it up, usually on his bed, and never less than twenty minutes could elapse between taking it out of the pot and serving it. Not only were the dinners always cold, but the meat was issued with bone and gristle weighed in, and some men got portions which were all bone. Those who could eat meat usually tore it with their fingers – there were almost no forks, spoons, or knives. Men on a spoon diet got the water in which the meat had been cooked, as soup. There were no vegetables except, sometimes, dried peas.
The food was almost uneatable by men in good health; as a diet for cholera and dysentery cases it produced agonies. “I have never seen suffering greater,” wrote one observer.
The day after Miss Nightingale arrived she began to cook “extras”. She had bought arrowroot, wine and beef essences, and portable stoves in Marseilles. On the sixth of November, with the doctors’ permission, she provided pails of hot arrowroot and port wine for the Balaclava survivors, and within a week the kitchen belonging to her quarters had become an extra diet kitchen, where food from her own stores was cooked. For five months this kitchen was the only means of supplying invalid food in the Barrack Hospital. She strictly observed official routine, nothing being supplied from the kitchen without a requisition signed by a doctor. No nurse was permitted to give a patient any nourishment without a doctor’s written directions.
Cooking was all she had managed to accomplish when, on November 9, the situation completely changed. A flood of sick poured into Scutari on such a scale that a crisis of terrible urgency arose, and prejudices and resentments were for the moment forgotten.
It was the opening of the catastrophe. The destruction of the British Army had begun. These were the first of the stream of men suffering from dysentery, from scurvy, from starvation and exposure who were to pour down on Scutari all through the terrible winter. Over in the Crimea on the heights above Sebastopol the army was marooned, as completely as if on a lighthouse. Thousands of men possessed only what they stood up in. After the landing at Calamita Bay and after the Battle of the Alma, when the troops were riddled with cholera and the heat was intense, the men had, by their officers’ orders, abandoned their packs.
Seven miles below the heights lay Balaclava, the British base. There had been one good road but the Russians had gained possession of it in the Battle of Balaclava on October 25. There remained a rough track, but it was not put into order before the winter. Men to carry out the work were non-existent. There were no tools. Above all, there was no transport. The army was still without wagons or pack animals.
Balaclava had become a nightmare of filth. Lord Raglan had been attracted by its extraordinary harbour, a landlocked lagoon, calm, clear, and almost tideless, so deep that a large vessel could anchor close inshore. No steps were taken to inspect Balaclava, a fishing village of only 500 inhabitants, before it was occupied, or to keep it in a sanitary condition. The army which marched in was stricken with cholera, and within a few days the narrow street had become a disgusting quagmire. Piles of arms and legs amputated after the Battle of Balaclava, with the sleeves and trousers still on them, had been thrown into the harbour and could be seen dimly through the water. The surface of the once translucent water was covered with brightly coloured scum, and the whole village smelled of hydrogen sulphide.
On November 5 the Russians had attacked at Inkerman, on the heights above Sebastopol. In a grim battle fought in swirling fog the British were victorious. But victory was not reassuring. The British troops were exhausted; their commanders were shaken by the revelation of Russian strength. It was evident that Sebastopol would not fall until the spring.
The British Army was going to winter on the heights before Sebastopol, and the British Army was not only totally destitute of supplies, but without the means of being able to get supplies should they ultimately arrive. Moistened by the dews of autumn, and churned by the wheels of heavy guns, the rough track from Balaclava to the camp had become impassable.
The weather changed rapidly, icy winds blew – and the troops on the heights above Sebastopol had no fuel. Every bush, every stunted tree was consumed, and the men clawed roots out of the sodden earth to gain a little warmth. As it grew colder, they had to live without shelter, without clothing, drenched by incessant driving rain, to sleep in mud, to eat hard dried peas and raw salt meat. The percentage of sickness rose and rose, and the miserable victims began to pour down on Scutari. The authorities were overwhelmed, and at last the doctors turned to Miss Nightingale. Her nurses dropped their sorting of linen and began with desperate haste to seam up great bags and stuff them with straw. These were laid down not only in the wards but in the corridors, a line of stuffed sacks on each side with just room to pass between them.
Day after day the sick poured in until the enormous building was entirely filled. The wards were full; the corridors were lined with men lying on the bare boards because the supply of bags stuffed with straw had given out. Chaos reigned. The doctors were unable even to examine each man. Sometimes men were a fortnight in the Barrack Hospital without seeing a surgeon. Yet the doctors, especially the older men, worked like lions, wrote Miss Nightingale, and were frequently on their feet for twenty-four hours at a time.
The filth became indescribable. The men in the corridors lay on unwashed rotten floors crawling with vermin. There were no pillows, no blankets; the men lay with their heads on their boots, wrapped in the blanket or greatcoat stiff with blood and filth which had been their sole covering perhaps for more than week. There were no screens or operating tables. Amputations had to be performed in the wards in full sight of the patients. One of Miss Nightingale’s first acts was to procure a screen from Constantinople so that men might be spared the sight of the suffering they themselves were doomed to undergo.
She estimated that in the hospital at this time there were more than 1000 men suffering from acute diarrhœa, and only twenty chamber pots. The privies in the towers of the Barrack Hospital had been allowed to become useless; the water pipes which flushed them had been stopped up when the barracks were used for troops, and when the building was converted into a hospital they had never been unstopped. Huge wooden tubs stood in the wards and corridors for the men to use. The orderlies disliked the unpleasant task of emptying these, and they were left unemptied for twenty-four hours on end. “We have erysipelas, fever and gangrene,” she wrote; “. . . the dysentery cases have died at the rate of one in two . . . the mortality of the operations is frightful . . . This is only the beginning of things.” By the end of the second week in November the atmosphere in the Barrack Hospital was so frightful that the stench could be smelled outside the walls.
A change came over the men. The classification between wounded and sick was broken down. The wounded who had been well before began to catch fevers; “gradually all signs of cheerfulness disappeared, they drew their blankets over their heads and were buried in silence”.
Fate had worse in store. On the night of November 14 it was noticed that the sea in the Bosphorus was running abnormally high, and there was a strange thrumming wind. Within a few days news came that the Crimea had been devastated by the worst hurricane within the memory of man. Tents were reduced to shreds, horses blown helplessly for miles, buildings destroyed, trees uprooted. The marquees which formed the regimental field hospitals vanished, and men were left half buried in mud without coverings of any kind. Most serious of all, every vessel in Balaclava harbour was destroyed, among them a large ship, the Prince, which had entered the harbour the previous day loaded with warm winter clothing and stores for the troops.
Winter now began in earnest with storms of sleet and winds that cut like a knife as they howled across the bleak plateau. Dysentery, diarrhœa, rheumatic fever increased by leaps and bounds. More and more shiploads of sick inundated Scutari. The men came down starved and in rags. They told the nurses to keep away because they were so filthy. “My own mother could not touch me,” said one man to Sister Margaret Goodman. By the end of November the administration of the hospital had collapsed.
And then in the misery, the confusion, a light began to break. Gradually it dawned on harassed doctors and overworked officials that there was one person in Scutari who could take action – who had the money and the authority to spend it – Miss Nightingale.
She had a very large sum at her disposal, derived from various sources and amounting to over £30,000, of which £7,000 had been collected by her personally, and Constantinople was one of the great markets of the world. During the first horrors of November, the gathering catastrophe of December, it became known that whatever was wanted, from a milk pudding to an operating table, the thing to do was to go to Miss Nightingale. Gradually, the doctors ceased to be suspicious and their jealousy disappeared.
One of her first acts was to purchase 200 hard scrubbing brushes and sacking for washing the floors. She insisted on the huge wooden tubs in the wards being emptied, standing quietly and obstinately by the side of each one, sometimes for an hour at a time, never scolding or raising her voice, until the orderlies gave way and the tub was emptied.
By the end of December Miss Nightingale was in fact purveying the hospital. During a period of two months she supplied, on requisition of medical officers, about 6000 shirts, 2000 socks, and 500 pairs of drawers. She supplied nightcaps, slippers, plates, tin cups, knives, forks, spoons in proportion. She procured trays, tables, forms, clocks, operating tables, scrubbers, towels, soap, and screens. She caused an entire regiment which had only tropical clothing to be refitted with warm clothing purchased in the markets of Constantinople when Supply had declared such clothing unprocurable in the time – Supply was compelled to get all its goods from England. “I am a kind of General Dealer,” she wrote to Sidney Herbert on January 4, 1855, “in socks, shirts, knives and forks, wooden spoons, tin baths, tables and forms, cabbages and carrots, operating tables, towels and soap, small tooth combs, precipitate for destroying lice, scissors, bed pans, and stump pillows.”
Outside Sebastopol conditions grew steadily worse. The stores lost in the hurricane were not replaced. Men, sick or well, lay in a foot of water in the mud, covered only by a single blanket. Every root had been burned, and the men had to eat their food raw: meat stiff with salt and dried peas. There was no bread. As the percentage of sick climbed and climbed, double turns of duty were thrown on the survivors.
Men were in the trenches before Sebastopol for thirty-six hours at a stretch, never dry, never warmed, never fed. The sick were brought down to Balaclava strapped to mule-litters lent by the French – there was no British transport of any kind – naked, emaciated, and filthy. After waiting hours without food or shelter in the icy wind or driving sleet at Balaclava, they were piled on to the decks of the sick-transports and brought down to Scutari. And the catastrophe had not yet reached its height.
At the beginning of December, when the Barrack Hospital was filled to overflowing, a letter from Lord Raglan announced the arrival of a further 500 sick and wounded. It was impossible to cram any additional cases into the existing wards and corridors and Miss Nightingale pressed to have put in order the wing of the hospital which had been damaged by fire before the British occupation. It consisted of two wards and a corridor and would accommodate nearly 1000 extra cases. But the cost would be considerable, and no one in the hospital had the necessary authority to put the work in hand. Miss Nightingale took matters into her own hands. She engaged on her own responsibility 200 workmen, and paid for them partly out of her own pocket and partly out of The Times Fund. The wards were repaired and cleaned in time to receive the wounded.
Not only did she repair the wards; she equipped them. The Purveyor could provide nothing. One of the men described his sensation when he at last got off the filthy sick-transport and was received by Miss Nightingale and her nurses with clean bedding and warm food – “We felt we were in heaven,” he said.
The affair caused a sensation. It was the first important demonstration of what men at Scutari called the “Nightingale power”. Respect for the “Nightingale power” was increased when it became known that her action had been officially approved by the War Department and the money she had spent refunded to her.
But to Miss Nightingale herself these victories were only incidental. She never for a moment lost sight of the fact that the object of her mission was to prove the value of women as nurses. But, unhappily, no difficulties with doctors or purveyors were as wearing or as discouraging as her difficulties with her nurses.
“I came out, Ma’am, prepared to submit to everything, to be put on in every way. But there are some things, Ma’am, one can’t submit to. There is the caps, Ma’am, that suits one face and some that suits another. And if I’d known, Ma’am, about the caps, great as was my desire to come out to nurse at Scutari, I wouldn’t have come, Ma’am.” Mrs Roberts from St Thomas’s was worth her weight in gold. Mrs Drake from St John’s House was a treasure, but most of the other hospital nurses were not fit to take care of themselves. To convince any of them, nurses or sisters, of the necessity for discipline was almost impossible. Why should a man who desperately needed stimulating food have to go without because the nurse who had the food could not give it to him until she had been authorized by a doctor? It was felt that Miss Nightingale was callous. It was said that she was determined to increase her own power and cared nothing for the sick.
Reluctance to accept her authority and obey her instructions was constant from the beginning to the end of her mission, and many of her nurses heartily disliked her.
However, she had managed to establish herself, and now her nurses were fully occupied. She had also acquired two new and loyal workers in Dr and Lady Alicia Blackwood, who had come out at their own expense after the Battle of Inkerman.
On December 14 she wrote Sidney Herbert a cheerful letter:
“What we may be considered as having effected:
(1) The kitchen for extra diets now in full action.
(2) A great deal more cleaning of wards, mops, scrubbing brushes, brooms, and combs given out by ourselves.
(3) 2000 shirts, cotton and flannel, given out and washing organized.
(4) Lying-in hospital begun.
(5) Widows and soldiers’ wives relieved and attended to.
(6) A great amount of daily dressing and attention to compound fractures by the most competent of us.
(7) The supervision and stirring-up of the whole machinery generally with the concurrence of the chief medical authority.
(8) The repairing of wards for 800 wounded which would otherwise have been left uninhabitable. (And this I regard as the most important.)”
She never wrote quite so cheerfully again.
In January, 1855, the sufferings of the British Army before Sebastopol began to reach a fearful climax. Still no stores had reached the army. What had happened to them, the Roebuck Committee demanded later? Huge quantities of warm clothing, of preserved foods, of medical comforts and surgical supplies had been sent out – where did they all go? It was never discovered, but Miss Nightingale declared that stores were available all the time the men were suffering, never reaching them through the “regulations of the service”. In January, 1855, when the army before Sebastopol was being ravaged by scurvy, a shipload of cabbages was thrown into the harbour at Balaclava on the ground that it was not consigned to anyone. This happened not once but several times. During November, December, and January 1854–55, when green coffee was being issued to the men, there were 173,000 rations of tea in store at Balaclava; 20,000 pounds of lime juice arrived for the troops on December 10, 1854, but none was issued until February. Why? Because no order existed for the inclusion of tea and lime juice in the daily ration.
Again, at the end of December there were blankets enough in store to have given a third one to every man. But the men lay on the muddy ground with nothing under them and nothing over them since their blankets had been lost in battle or destroyed in the hurricane, because the regulations did not entitle them to replacement.
In January, 1855, there were 12,000 men in hospital and only 11,000 in the camp before Sebastopol; and still the shiploads came pouring down. It was, Miss Nightingale wrote, “calamity unparalleled in the history of calamity”.
In this emergency she became supreme. She was the rock to which everyone clung, even the purveyors. “Nursing,” she wrote on January 4 to Sidney Herbert, “is the least of the functions into which I have been forced.”
Her calmness, her resource, her power to take action raised her to the position of a goddess. The men adored her. “If she were at our head,” they said, “we should be in Sebastopol next week.” The doctors came to be absolutely dependent on her, and a regimental officer wrote home: “Miss Nightingale now queens it with absolute power.”
Sidney Herbert had asked her to write to him privately in addition to the official reports, and during her time in Scutari and the Crimea she wrote him a series of over thirty letters of enormous length, crammed with detailed and practical suggestions for the reform of the existing system. It is almost incredible that in addition to the unceasing labour she was performing, when she was living in the foul atmosphere of the Barrack Hospital incessantly harried by disputes, callers, complaints and overwhelmed with official correspondence which had to be written in her own hand, she should have found time and energy to write this long series of vast, carefully thought-out letters, many as long as a pamphlet. She never lost sight of the main issue.
“This is whether the system or no system which is found adequate in time of peace but wholly inadequate to meet the exigencies of a time of war is to be left as it is – or patched up temporarily, as you give a beggar halfpence – or made equal to the wants not diminishing but increasing of a time of awful pressure.”
On January 8, at the height of the calamity, she wrote:
“I have written a plan for the systematic organization of these Hospitals, but deeming so great a change impracticable during the present heavy pressure of calamities here, I refrain from forwarding it, and substitute a sketch of a plan, by which great improvement might be made from within without abandoning the forms under which the service is carried on . . .”
Among her recommendations were the establishment of a medical school at Scutari, and finally she made an urgent plea for medical statistics.
Her facts and figures were freely used by Sidney Herbert and other members of the Cabinet, and important changes made in British Army organization during the course of the Crimean War were based on her suggestions.
In spite of the improvements in the Barrack Hospital, something was horribly wrong. The wards were cleaner, the lavatories unstopped, the food adequate, but still the mortality climbed. The disaster was about to enter its second phase. At the end of December an epidemic broke out, described variously as “Asiatic cholera” or “famine fever”, similar to the cholera brought over by starving Irish immigrants after the Irish potato famine. By the middle of January the epidemic was serious – four surgeons died in three weeks, and three nurses. The officers on their rounds began to be afraid to go into the wards. They could do nothing for the unfortunates perishing within; they knocked on the door and an orderly shouted “All right, sir” from inside.
The snow ceased, and faint warmth came to the bleak plateau before Sebastopol on which the British Army was encamped. The number of men sent down by sick-transports stopped rising. The percentage of sick was still disastrously, tragically high, but it was stationary.
But in the Barrack Hospital the mortality figures continued to rise. The English were unable to bury their dead. A fatigue party could not be mustered whose strength was equal to the task of digging a pit.
In England fury succeeded fury. A great storm of rage, humiliation, and despair had been gathering through the terrible winter of 1854–55. For the first time in history, through reading the dispatches of Russell, the public had realized “with what majesty the British soldier fights”. And these heroes were dead. The men who had stormed the heights at Alma, charged with the Light Brigade at Balaclava, fought the grim battle against overwhelming odds in the fog at Inkerman, had perished of hunger and neglect. Even the horses which had taken part in the Charge of the Light Brigade had starved to death.
On January 26 Mr Roebuck, Radical member for Sheffield, brought forward a motion for the appointment of a committee “to inquire into the condition of the Army before Sebastopol and the conduct of those departments of the Government whose duty it has been to minister to the wants of that Army”. It was a vote of censure on the Government, and Sidney Herbert went out of office. But Miss Nightingale’s position was not weakened. The new Prime Minister was her old friend and supporter, Lord Palmerston. Her reports were regularly forwarded to the Queen and studied by her. Sidney Herbert wrote to assure her that he had no intention of giving up his work for the army because he was out of office. She was still to write to him, and he would see that her reports and suggestions were forwarded to the proper quarters. He would continue to be, she wrote, “our protector in this terrible great work”.
At the end of February, Lord Panmure, the new Secretary at War, sent out a Sanitary Commission to investigate the sanitary state of the building used as hospitals and of the camps both at Scutari and in the Crimea. Miss Nightingale’s name did not appear, but the urgency, the clarity, the forcefulness of the instructions are unmistakably hers. “The utmost expedition must be used in starting your journey . . . On your arrival you will instantly put yourselves into communication with Lord William Paulet . . . It is important that you be deeply impressed with the necessity of not resting content with an order but that you see instantly, by yourselves or your agents, to the commencement of the work and to its superintendence day by day until it is finished.” This Commission, said Miss Nightingale, “saved the British Army”.
The Commissioners landed at Constantinople at the beginning of March and began work instantly. Their discoveries were hair-raising. They described the sanitary defects of the Barrack Hospital as “murderous”. Beneath the magnificent structure were sewers of the worst possible construction, mere cesspools, choked, inefficient, and grossly overloaded. The whole vast building stood in a sea of decaying filth; the very walls, constructed of porous plaster, were soaked in it. Every breeze, every puff of air, blew poisonous gas through the pipes of numerous open privies into the corridors and wards where the sick were lying. The water supply was contaminated and totally insufficient. The Commissioners had the channel opened through which the water flowed, and the water supply for the greater part of the hospital was found to be passing through the decaying carcass of a horse. The courtyard and precincts of the hospital were filthy.
The Commissioners ordered them to be cleared, and during the first fortnight of this work 556 handcarts and large baskets full of rubbish were removed and twenty-four dead animals and two dead horses buried. The Commission began to flush and cleanse the sewers, to limewash the walls and free them from vermin, to tear out the wooden shelves known as Turkish divans which ran round the wards and harboured the rats for which the Barrack Hospital was notorious. The effect was instant. At last the rate of mortality began to fall. In the Crimea spring came with a rush; the bleak plateau before Sebastopol was bathed in sunlight and carpeted with crocuses and hyacinths. The road to Balaclava became passable, the men’s rations improved, and the survivors of the fearful winter lost their unnatural silence and began once more to curse and swear.
The emergency was passing, and as it passed opposition to Miss Nightingale awoke again.
Miss Nightingale’s mission falls into two periods. There is first the period of frightful emergency during the winter of 1854–55, when every consideration but that of averting utter catastrophe went by the board, opposition died away, and she became supreme.
But as soon as things had slightly improved, official jealousy reawoke. In the second period, from the spring of 1855 until her return to England in the summer of 1856, gratitude – except the gratitude of the troops – and admiration disappeared, and she was victimized by petty jealousies, treacheries, and misrepresentations. Throughout this second period she was miserably depressed. At the end of it she was obsessed by a sense of failure.
By the spring of 1855 she was physically exhausted. She was a slight woman who had never been robust, who was accustomed to luxury, and was now living in almost unendurable hardship. When it rained, water poured through the roof of her quarters. The food was uneatable; the allowance of water was one pint a head a day; the building was vermin-infested, the atmosphere in the hospital so foul that to visit the wards produced diarrhœa. She never went out except to hurry over the quarter of a mile of refuse-strewn mud which separated the Barrack from the General Hospital.
When a flood of sick came in, she was on her feet for twenty-four hours at a stretch. She was known to pass eight hours on her knees dressing wounds. It was her rule never to let any man who came under her observation die alone. If he was conscious, she herself stayed beside him; if he was unconscious she sometimes allowed Mrs Bracebridge to take her place. She estimated that during that winter she witnessed 2000 deathbeds. The worst cases she nursed herself. One of the nurses described accompanying her on her night rounds.
“It seemed an endless walk . . . As we slowly passed along the silence was profound; very seldom did a moan or cry from those deeply suffering fall on our ears. A dim light burned here and there, Miss Nightingale carried her lantern which she would set down before she bent over any of the patients. I much admired her manner to the men – it was so tender and kind.”
Her influence was extraordinary. She could make the men stop drinking, write home to their wives, submit to pain. “She was wonderful,” said a veteran, “at cheering up anyone who was a bit low.” The surgeons were amazed at her ability to strengthen men doomed to an operation. “The magic of her power over the men was felt,” writes Kinglake, “in the room – the dreaded, the bloodstained room – where operations took place. There perhaps the maimed soldier, if not yet resigned to his fate, might be craving death rather than meet the knife of the surgeon, but when such a one looked and saw that the honoured Lady-in-Chief was patiently standing beside him – and with lips closely set and hands folded – decreeing herself to go through the pain of witnessing pain, he used to fall into the mood of obeying her silent command and – finding strange support in her presence – bring himself to submit and endure.”
The troops worshipped her. “What a comfort it was to see her pass even,” wrote a soldier. “She would speak to one, and nod and smile to as many more; but she could not do it all, you know. We lay there by hundreds; but we could kiss her shadow as it fell and lay our heads on the pillow again content.”
For her sake the troops gave up the bad language which has always been the privilege of the British private soldier. “Before she came,” ran another letter, “there was cussing and swearing but after that it was as holy as a church.”
When the war was over Miss Nightingale wrote:
“. . . The tears come into my eyes as I think how, amidst scenes of loathsome disease and death, there rose above it all the innate dignity, gentleness and chivalry of the men (for never surely was chivalry so strikingly exemplified) shining in the midst of what must be considered the lowest sinks of human misery, and preventing instinctively the use of one expression which could distress a gentlewoman.”
It was work hard enough to have crushed any ordinary woman; yet, she wrote, it was the least of her functions. The crushing burden was the administrative work. Her quarters were called the Tower of Babel. All day long a stream of callers thronged her stairs, asking for everything from writing paper to advice on a sick man’s diet, demanding shirts, splints, bandages, port wine, stoves, and butter.
She slept in the storeroom in a bed behind a screen; in the daytime she saw callers while sitting and writing at a deal table in front of the screen. She wore a black woollen dress, white linen collar and cuffs and apron, and a white cap under a black silk handkerchief. Every time there was a pause she snatched her pen and went on writing.
It was terribly cold, and she hated cold. There was no satisfactory stove in her quarters – one had been sent out from England, but it would not draw and she used it as a table and it was piled with papers. Her breath congealed on the air; the ink froze in the well; rats scampered in the walls and peered out from the wainscoting. Hour after hour she wrote on; the staff of the hospital declared that the light in her room was never put out. She wrote for the men, described their last hours and sent home their dying messages; she told wives of their husbands’ continued affection, and mothers that their sons had died holding her hand. She wrote for the nurses, many of whom had left children behind. She wrote her enormous letters to Sidney Herbert; she wrote official reports, official letters; she kept lists, filled in innumerable requisitions. Papers were piled round her in heaps; they lay on the floor, on her bed, on the chairs. Often in the morning Mrs Bracebridge found her still in her clothes on her bed, where she had flung herself down in a stupor of fatigue.