CHAPTER VI

THE REFORMER

We have made Miss Nightingale's acquaintance, and are delighted and very much struck by her great gentleness and simplicity, and wonderful, clear, and comprehensive head. I wish we had her at the War Office.--QUEEN VICTORIA (Letter to the Duke of Cambridge, 1856).

"When one reads such twaddling nonsense," wrote Dr. Hall in November 1855 from the Crimea to Dr. Andrew Smith in London, "as that uttered by Mr. Bracebridge, and which was so much lauded in the _Times_ because the garrulous old gentleman talked about Miss Nightingale putting hospitals, containing three or four thousand patients, in order in a couple of days by means of the _Times_ funds, one cannot suppress a feeling of contempt for the man who indulges in such exaggerations, and pity for the ignorant multitude who are deluded by these fairy tales."[125] The contempt and pity of the Inspector-General of the hospitals in the East were not unmixed, I think we may surmise, with a good deal of anger, which, we may also surmise, was shared by his friend, the Director-General of the Medical Department in London. Such feelings were in the course of human nature, and the exaggeration in the statements cited by Dr. Hall is palpable. Miss Nightingale was not a magician. It would be an idle fairy tale to represent that by her exertions, either in a couple of days, or a couple of months, she effected a complete transformation scene. And it would be unfair to attribute solely to Miss Nightingale the gradual improvements which, though largely due to her initiative and resource (as described in preceding chapters), were in fact the result of the exertions of many persons both at home and in the East. "I have an unbounded admiration of Miss Nightingale's qualifications," said a deputy medical inspector, "and of the manner she applies them, but I see dozens of things placed to her credit which I happen to know she had nothing to do with."[126] Such was doubtless the case. Yet though in one sense Dr. Hall was perfectly right, in another he was profoundly wrong. Neither he, however, nor any of the other medical men who shared his views, need be blamed for their misapprehension. The facts of the case can only be fully understood now that access is obtainable to the private correspondence of Miss Nightingale and other actors in the drama.

[125] _Life and Letters of Sir John Hall_, p. 403, where "Bracebridge" is misprinted "Bainbridge."

[126] _Roebuck Committee_, Second Report, p. 723.

She did many things herself, but she was also the inspirer and instigator of more things which were done by others. She was able of her own initiative to institute considerable reforms; but she was a reformer on a larger scale through the influence which she exercised. Though she was in truth no magician, there were men on the spot who, not being able to understand the secret and sources of her power, seemed to find something uncanny in it. Our good friend, Colonel Sterling, who hated the intrusion of petticoats into a campaign, was very much puzzled. The thing seemed to him "ludicrous," as we have heard, but he had to admit that "Miss Nightingale queens it with absolute power"; and elsewhere he speaks of "the Nightingale power" as something mysterious and "fabulous." The secret, however, is simple. "The Nightingale power" was due to causes of which some were inherent in herself and others were adventitious. The inherent strength of her influence lay in the masterful will and practical good sense which gave her dominion over the minds of men. The adventitious sources of her power were that she had both the ear and the confidence of Ministers, and the interest and sympathy of the Court. I have called this accession of influence "adventitious," but it also accrued to her, in a secondary degree, from the inherent force of her character.

The influence of the Court in strengthening, in speeding up, and sometimes in chiding Ministers, especially in military matters, was, during the reign of Victoria, very great, as all readers of memoirs of the time are aware.[127] And from an early period of Miss Nightingale's mission the Court had expressed a lively interest in it, and had intimated a wish that full consideration should be paid to her experiences and impressions. "Would you tell Mrs. Herbert," wrote the Queen to Mr. Sidney Herbert (Dec. 6, 1854), "that I beg she would let me see frequently the accounts she receives from Miss Nightingale or Mrs. Bracebridge, as _I hear no details of the wounded_, though I see so many from officers, etc., about the battlefield, and naturally the former must interest _me_ more than any one. Let Mrs. Herbert also know that I wish Miss Nightingale and the ladies would tell these poor, noble wounded and sick men that _no one_ takes a warmer interest or feels _more_ for their sufferings or admires their courage and heroism _more_ than their Queen. Day and night she thinks of her beloved troops. So does the Prince. Beg Mrs. Herbert to communicate these my words to those ladies, as I know that _our_ sympathy is much valued by these noble fellows." Upon the receipt of the Queen's message, the chaplain went through the wards reading it to the men, and copies of it were also posted on the walls of the several hospitals. "The men were touched," Miss Nightingale reported to Mr. Herbert (Dec. 25). "'It is a very feeling letter,' they said. 'She thinks of us' (said with tears). 'Each man of us ought to have a copy which we will keep till our dying day.' 'To think of her thinking of us,' said another; 'I only wish I could go and fight for her again.'" The Queen's message was followed by more substantial proof of Her Majesty's interest, and here again Miss Nightingale was made the intermediary between the throne and the soldiers. Through Mr. Sidney Herbert, the Queen had ascertained from Miss Nightingale the kind of comforts which would be useful to the wounded, and the following letter was sent to her by the Keeper of the Queen's Purse:--

WINDSOR CASTLE, _December_ 14 [1854]. MADAM--I have received the commands of Her Majesty the Queen to forward by the ship _Eagle_ some packages containing some comforts and useful articles which Her Majesty wishes to be placed in your hands for distribution, as you may think fit, amongst the wounded and sick at Scutari.

Her Majesty has wished to mark by some private contribution from herself her deep personal sympathy for the sufferings of these noble soldiers, and her admiration of the patience and fortitude with which they have suffered both wounds and hardships.

The Queen has directed me to ask you to undertake the distribution and application of these articles, partly because Her Majesty wished you to be made aware that your goodness and self-devotion in giving yourself up to the soothing attendance upon these wounded and sick soldiers had been observed by the Queen with sentiments of the highest approval and admiration; and partly because, as the articles sent did not come within the description of Medical or Government stores, usually furnished, they could not be better entrusted than to one who, by constant personal observation, would form a correct judgment where they would be most usefully employed.

[127] The classical passage in this sense is in the _Life and Correspondence of the Rt. Hon. Hugh C. E. Childers_, 1901, vol. ii. p. 104, where it is said, in relation to the Egyptian Expedition of 1882: "The Queen with her well-known solicitude for the welfare of her Army, wrote many letters at this time to Mr. Childers to satisfy herself that all precautions were being taken for the health and comfort of the troops: one day alone brought seventeen letters from Her Majesty, or her private secretary, Sir Henry Ponsonby."

The Queen sent presents of warm scarves and the like to Miss Nightingale's nurses. The position of Almoner of the Free Gifts and the confidence thus shown by the Sovereign greatly extended the prestige of Miss Nightingale, who was already known to command influence with the Government, to have the favour of the Press, and to be the darling of popular opinion. Officials might feel sore, and old fogeys might grumble, but the fact became palpable that "the Nightingale power" had to be reckoned with.

II

It was, however, behind the scenes that Miss Nightingale's activity as a reformer was most powerfully exercised. In accordance with Her Majesty's command, reports from Miss Nightingale were forwarded to the Queen, and by her were sent on to the Duke of Newcastle. The Duke, writing to the Queen on December 22, 1854, assured Her Majesty that the condition of the Hospitals at Scutari, and the entire want of all method and arrangement in everything which concerns the comfort of the army, were subjects of constant and most painful anxiety to him. "Nothing can be more just," he added, "than all your Majesty's comments upon the state of facts exhibited by these letters, and the Duke of Newcastle has repeatedly, during the last two months, written in the strongest terms respecting them--but hitherto without avail, and with little other result than a denial of charges, the truth of which must now be considered to be substantiated."[128] It remained for Ministers to do what was possible to remedy the evils.

[128] _The Letters of Queen Victoria_, vol. iii. p. 79.

Mr. Sidney Herbert, who (as already stated) had relieved the Duke of Newcastle of hospital matters, needed no compulsion to zeal, and Miss Nightingale's letters to him showed in what directions his zeal could most usefully be employed. The Government of Lord Aberdeen, defeated on the motion appointing the Roebuck Committee, resigned in January 1855, and Lord Palmerston became Prime Minister. The offices of Secretary _for_ War and Secretary _at_ War were amalgamated, and Lord Panmure became Secretary of State in place of the Duke of Newcastle. Mr. Herbert became for a short time Secretary of State for the Colonies, and then resigned. But Mr. Herbert begged Miss Nightingale to continue writing to him, promising to forward her representations to the proper quarters. Lord Palmerston knew her personally, and Lord Panmure paid deference to her wishes and opinions, so that the change of Government did not weaken her position. I have before me copies of a long series of letters addressed by Miss Nightingale to Mr. Herbert between November 1854 and May 1855. He had given her private instructions that she was to act as eye and ear for him in the East. Of her letters a few were printed by Lord Stanmore in his _Memoir of Sidney Herbert_, where also a series of Mr. Herbert's letters, both to her and to various officials concerned, is given. A comparison of the one set with the other shows very clearly how much of the improvements which the Government of Lord Aberdeen and its successor were able to effect was due to the suggestions, the remonstrances, the entreaties of Miss Nightingale. Her letters are written with complete freedom and often in great haste. It would be possible to make isolated extracts from them which would suggest that the writer was a censorious and uncharitable scold. But such a selection would convey a misleading impression. Miss Nightingale wrote unreservedly about individuals, because she saw, as Mr. Herbert himself saw also, that the _personnel_ was at fault, and that the most admirable instructions from home would be useless unless there were men of some initiative and vigour to carry them out on the spot. She wrote in anger, because she saw, what Mr. Herbert soon came to know, that such men were not forthcoming. "I write all this savagery," she said (March 5, 1855), "because of the non-success of your unwearied efforts for the good of these poor Hospitals." And then something must be allowed to the caustic humour which, when Miss Nightingale had a pen in her hand, could not be denied. "I shall make no further remark about him," she writes of a certain individual, "than that he is a fossil of the pure Old Red Sandstone." "Some newspaper has said of me," she writes on another occasion, "that I am the fourth woman (query, Old Woman) that has had to do with the war. Who are the other three?" And she goes on for Mr. Herbert's amusement to nominate three of his principal subordinates for the distinction. It would argue a lack of humour to take such epistolary diversions with no grain of salt. But I do not propose to follow the example of a previous writer, who has had access to these letters, in recording Miss Nightingale's remarks on individuals. I desire rather to illustrate from the letters, and from other sources, first, the practical contributions to reform which Miss Nightingale made in some matters of detail, and then her firm grasp of the large principles of sound administration.

III

Miss Nightingale performed the duties, as we have seen, of a Purveyor to the sick and wounded portion of the British army. The duty was assumed by her only because the home authorities had been deficient in foresight, or the authorities on the spot were inefficient and hampered by official restrictions. Hence her earlier letters to Mr. Herbert were largely filled with urgent suggestions for the sending of Government stores. She begs for "hair mattresses, or even flock, as cheaper." The French hospitals were furnished throughout with hair mattresses; the British soldier was suffering terribly from bed-sores. She pleads for knives and forks: "the men have to tear their meat like wild beasts." She suggests mops, plates, dishes, towelling, disinfectants, and so forth,--obvious requirements, no doubt, but, as Mr. Herbert said, the responsible authorities seem to have shrunk sometimes from making requisitions lest they should thereby confess the inadequacy of their preparations. It was Miss Nightingale, again, who suggested the need of carpenters to do odd jobs in the vast and imperfectly equipped Turkish buildings which served for the British hospitals. She expressed herself most gratefully for an "invaluable reinforcement" of them which Mr. Herbert had sent out; but their arrival necessitated a depletion in one department of her private stores. "These men," she wrote (Feb. 19, 1855), "I had to find with knives, forks, and spoons, in default of the Purveyor, who besides would not provide them with rations unless the Officer of Engineers wrote 'urgent' and asked it 'as a favour.'"

Some building operations, Miss Nightingale, as we have seen, took it upon herself to carry out; and some sanitary reforms she was able, by her personal influence with the orderlies, to effect.[129] "The instruction of the Orderlies in their business was," she said,[130] "one of the main uses of us in the War Hospitals." Other sanitary engineering works, on a larger scale, were ultimately carried out, thanks in part to her urgent and detailed representations to the authorities at home. She had pointed out repeatedly to them that the mere issuing of orders was insufficient; it was essential that executive powers should be placed in the hands of officials directly responsible for immediate action. When the Government was reconstituted after the fall of Lord Aberdeen, with Lord Panmure as Secretary for War, this lesson was taken faithfully to heart, and a Commission of Three--Dr. John Sutherland, Dr. Hector Gavin, and Mr. Robert Rawlinson, C.E.--was sent out to the East with full executive powers. They received their instructions on February 19, 1855, and within three days they sailed. "The tone of the instructions," says Kinglake, "is peculiar, and such as to make one believe that they owed much to feminine impulsion. The diction of the orders is such that, in housekeeper's language, it may be said to have 'bustled the servants.'" The credit for the bustling at home belongs, however, to Lord Shaftesbury, who had pressed the appointment of the Commissioners upon Lord Panmure, and who was employed to draft their instructions.[131] The duties of these Sanitary Commissioners were laid down with a minuteness of detail which Miss Nightingale herself could not have excelled; and they were then told that "the utmost expedition must be used in the execution of all that is necessary at the place of your destination. 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."[132] It is from the Report of the Sanitary Commissioners that I drew many of the statements about the condition of the hospitals given in an earlier chapter. They set about the work of sanitary engineering with great dispatch, and the death-rate in the hospitals fell, as the result of their reforms, with remarkable rapidity.[133] "The sanitary conditions of the hospitals of Scutari," Miss Nightingale told the Royal Commission of 1857, "were inferior in point of crowding, ventilation, drainage, and cleanliness, up to the middle of March 1855, to any civil hospital, or to the poorest homes of the worst parts of the civil population of any large town that I have ever seen. After the sanitary works undertaken at that date were executed (June), I know no buildings in the world which I could compare with them in these points, the original defects of construction of course excepted." It was this Commission, as Miss Nightingale said afterwards to Lord Shaftesbury, that "saved the British Army." In Dr. Sutherland, the head of the Sanitary Commission, Miss Nightingale found a warm admirer and a stout supporter. During his stay at Scutari he acted as her physician. On her return to England she was on terms of intimate friendship with him and his wife; and Dr. Sutherland was, as we shall hear, one of her close allies in the battle for reform in army hygiene. With Mr. (afterwards Sir Robert) Rawlinson she also formed a friendship which lasted to the end of his life. Dr. Gavin died in the Crimea during the work of the Commission.

[129] See, on these two points, above, p. 206, and below, p. 242.

[130] In a letter to Colonel Lefroy, Aug. 25, 1856.

[131] Hodder's _Life of Lord Shaftesbury_, pp. 503 _seq_.

[132] _Report of the Sanitary Commission_, March 1857.

[133] For the figures, see below, pp. 254, 314.

In the matter of stores, whatever suggestions or requisitions Miss Nightingale sent home were complied with by Government. But it was one thing to send stores out, and quite another to secure that they should arrive when and where they were wanted. "Sidney," wrote Mrs. Herbert to Mrs. Bracebridge (Nov. 17, '54), "has sent heaps of armchairs, etnas, and other comforts, but is in terrible fear that they may have been carried on with the troops to Balaclava from some blunder." Miss Nightingale's unerring eye for detail and perception of the point saw where the evil lay. First, there was no co-ordination among the departments at home in packing the things. The _Prince_ (the wreck of which in the famous hurricane of November 14 was disastrous to the welfare of the soldiers) "had on board," she wrote, "a quantity of medical comforts for us, which were so packed under shot and shell as that it was found impossible to disembark them here, and they went to Balaclava and were lost." But there was a second obstacle. The army had encamped at Scutari as early as May 1854, but it had occurred to nobody to establish either there or at Constantinople an office for the reception and delivery of goods. Packages, intended for the army or the hospitals, if they arrived in merchant vessels, were detained in the Turkish Custom House, from which they were never extracted without much delay, difficulty, and confusion; many were partially or entirely destroyed; and many abstracted and totally lost. "The Custom House," said Miss Nightingale, "was a bottomless pit, whence nothing ever issued of all that was thrown in." In the case of ships chartered by the Government, great masses of goods were necessarily landed together and stowed away promiscuously for want of time and space for sorting, and were often delayed by an unnecessary trip to Balaclava and back again. There were occasions in which vessels containing hospital stores, as well as munitions of war, made three voyages to and fro before the former were landed at Scutari. Sometimes when Miss Nightingale happened to hear of an incoming vessel betimes, she was able, by special petition to the military authorities, to intercept hospital stores; but she saw (what no one else seems to have done) that the whole system was at fault. "It is absolutely necessary," she wrote, "that there should be a Government Store House, in the shape of a hulk, where stores for the British, from whatever ships, could be received at once from them, and be delivered on the ship-store-keeper's receipt. There are no store-houses to be had by the water's-edge, and porterage is very expensive and slow." In March 1855 Miss Nightingale's solution was adopted.[134]

[134] _Statement to Subscribers_, pp. 9-10, and letter to Sidney Herbert, January 22, 1855.

As Purveyor, Miss Nightingale was directly concerned only with the sick and wounded; but the condition in which the men arrived at Scutari enabled her to learn the state of things at the front, and she urged upon Mr. Herbert the necessity of sending out warm clothing to the army in the Crimea. "The state of the troops who return here, particularly those 500 who were admitted on the 19th, is frost-bitten, demi-nude, starved, ragged. If the troops who work in the trenches are not supplied with warm clothing, Napoleon's Russian campaign will be repeated here." The terrible experiences of the British army before Sebastopol during the winter of 1854-55 were some fulfilment of her prediction. When opportunity offered she similarly sent suggestions to Lord Panmure; then, in reply to a letter of kind inquiries from him about her health (Aug. 1855), she called attention to the disproportionate number of patients which came from the Artillery, and threw out hints for economizing the men's labour.[135] On a matter of the soldiers' pay, she was the means of remedying a hardship which had struck her at Scutari. She pressed earnestly upon Mr. Herbert that hospital stoppages against the daily pay of the _sick_ soldier (9d.) should be made equal to the hospital stoppage against the _wounded_ soldier (4-1/2.), provided that the sickness be incurred while on duty before the enemy. She made this representation in December 1854, not only to Mr. Herbert, but to the Queen. On February 1, 1855, she heard with great satisfaction that her suggestion had been adopted, and that the soldiers' accounts were to be rectified in that sense as from the Battle of the Alma.

[135] See _Panmure_, vol. i. p. 356.

IV

The Queen had asked Miss Nightingale to make suggestions as to what Her Majesty could do "to testify her sense of the courage and endurance so abundantly shown by her sick soldiers." One of the suggestions submitted was the rectification just mentioned. Another suggestion was that a Firman should be immediately asked of the Sultan granting the military cemetery at Scutari to the British, and that Her Majesty should have it enclosed by a stone wall. "There are already, alas!" wrote Miss Nightingale, "about a thousand lying in this cemetery. Nine hundred were reported last week. We have buried one hundred in the last two days only. The spot is beautiful, overlooking the Sea of Marmora, and occupies the space between the General Hospital wall and the edge of the sea-cliff." The suggestion must have gone straight to the Queen's heart, for Miss Nightingale was informed that Her Majesty had written on the subject both to Lord Clarendon, the Secretary of State for Foreign Affairs, and to the British Ambassador to the Porte. The Firman was obtained in due course, and the well-kept British enclosure attracts the attention of travellers to this day by contrast with the Oriental burial-places. It was again at Miss Nightingale's suggestion that a memorial obelisk, far seen in lonely splendour, was erected "by Queen Victoria and her people."[136]

[136] In 1865 Miss Nightingale, after an energetic correspondence with the War Office, secured payment, long before promised, to an English custode.

But I must not linger further over points of detail. Miss Nightingale's eye for detail did not prevent her from taking comprehensive views, and from time to time she sent to Mr. Herbert schemes of reorganization. In the following letter, of January 8, 1855, she exposed the extent and nature of the evil in the hospitals, and the kind of reform which was needed to remedy them:--

As the larger proportion of the army (in which we are told that there are not two thousand sound men) is coming into hospital--as there are therefore thousands of lives at stake--as, in a service where the future of the official servants is dependent upon the personal interest of one man, these cannot be expected to peril that future by getting themselves shelved as innovators.

I feel that this is no time for compliments or false shame; and that you will never hear the whole truth, troublesome as it is, except from one independent of promotion....

I subjoin a rough estimate of what has been given out by me during one month--_the whole at the "requisition" of the Medical Men_--all of which I have by me (merely in order to substantiate the facts of the destitution of these hospitals).

Since the 17th December, we have received 3400 sick, and I have made no sum total as yet of what has been done for these new-comers by us--excepting for one corridor, which I enclose.

(1) Thus the Purveying is _nil_--that is the whole truth, beyond bedding, bread, meat, cold water, fuel.

Beyond the boiling _en masse_ in the great coppers of the general kitchen the meat is not cooked, the water is not boiled except what is done in my subsidiary kitchens. My schedule will show what I have purveyed.

I have refused to go on purveying for the third Hospital, the Sultan's Serail[137]--the demands upon me there having been begun with twelve hundred articles, including shirts, the first night of our occupying it. I refer you to a List of what was _not_ in store, and to a copy of one requisition upon me sent last letter.

[137] This is the "Palace Hospital." See above, p. 174.

(2) The extraordinary circumstance of a whole army having been ordered to abandon its kits, as was done when we landed our men before Alma, has been overlooked entirely in all our system. The fact is, that I am now clothing the British Army. The sick were re-embarked at Balaclava for these Hospitals, without resuming their kits, also half-naked besides. And when discharged from here, they carry off, small blame to them, even my knives and forks--shirts, of course, and Hospital clothing also. The men who were sent to Abydos as convalescents were sent _in their Hospital dresses_, or they must have gone naked. The consequence is that not one single Hospital dress is now left in store, and I have substituted Turkish dressing-gowns from Stamboul (three bales in the passage are marked Hospital Gowns, but have not yet been "_sat upon_"). To purvey this Hospital is like pouring water into a sieve; and will be, till regimental stores have been sent out from England enough to clothe the naked and refill the kit.

I have requisitions for _Uniform trousers_, for each and all of the articles of a kit, sent in to me.

We have not yet heard of boots being sent out; the men come into Hospital half-shod.

In a time of such calamity, unparalleled in the history, I believe, of calamity, I have a little compassion left even for the wretched Purveyor, swamped amid demands he never expected. But I have no compassion for the men who would rather see hundreds of lives lost than waive one scruple of the official conscience.

(3) The Hospital and Army Stores come out in the same vessels--and up go our stores to Balaclava, and down they never come again, or have not yet.

(4) The total inefficiency of the Hospital Orderly System as now is. The French have a permanent system of Orderlies, trained for the purpose, who do not re-enter the ranks. It is too late for us to organize this. But if the convalescents, being good Orderlies, were not sent away to the Crimea as soon as they have learnt their work--if the Commander-in-Chief would call upon the Commanding Officer of each Regiment to select ten men from each as Hospital Orderlies to form a depot here (not young soldiers, but men of good character), this would give some hope of organizing an efficient corps. Above all, that the class of Ward-Master I shall mention should be sent out from England.

We require:--

(1) An effective staff of Purveyors out from England--but beyond this,

(2) _A head_, some one with _authority_ to mash up the departments into uniform and rapid action. He may as well stay at home unless he have power to modify the arrangements of departments made expressly by Sir C. Trevelyan with Mr. Wreford before he came away in May.

(3) We want Medical Officers.

(4) Three Deputy Inspectors-General (whereas we have only one).... It is obvious from what has been said in former letters _who_, if there are two Deputy Inspector-Generals made to these Hospitals, should be made Deputy Inspector-General of this Barrack Hospital, past and present efficiency being considered.

(5) We want discharged Non-Commissioned Officers, not past the meridian of life--not the Ambulance Corps, who all died of delirium tremens or cholera--but the class of men employed as Ward-Masters of Military Prisons, or as Barrack Sergeants, or Hospital Sergeants of the Guards who can be highly recommended.

We want these men as Ward-Masters and Assistant Ward-Masters as Stewards. They must be under the orders of the Senior Medical Officer, removable by him; they must be well paid so as to make it worth their while,--say 5s. per day, 1st class, 2s. 6d. per day 2nd class--for they must be superior men, not the rabble we have now. (_N.B._--There are three Ward-Masters to each division of this Hospital--of which there are three--containing 800 and odd sick in each.)

The book of Hospital regulations, admirable in time of peace, contains nothing for a time of war, much less a time of war like this, unexampled for calamity.

The Hospital Sergeants are, of course, up in the Crimea with their regiments,--and we have nothing but such raw Corporals and Sergeants as can be spared, new to their work, to place in charge of the divisions and wards. And these Lord Raglan complains of our keeping. We must have Hospital Sergeants if there is to be the remotest hope of efficiency among the Orderlies here.

(6) The Orderlies ought to be well paid, well fed, well housed. They are now overworked, ill fed, and underpaid. The sickness and mortality among them is extraordinary--ten took sick in one Division to-night....

I had written a plan for the systematic organization of these Hospitals upon a principle of centralization, under which the component parts might be worked in unison. But, on reconsideration, 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....

This further scheme may, however, be given more shortly from a later letter (Jan. 28):--

As the Purveying seems likely to come to an end of itself, perhaps I shall not be guilty of the murder of the Innocents if I venture to suggest what may take the place of the venerable Wreford. Cornelius Agrippa had a broom-stick which used to fetch water for his use. When the broom-stick was cut in two by the axe of an unwary student, each end of the severed broom, catching up a pitcher, began fetching water with all its might. Were the Purveyor here cut in three, we might conceive some hope of having not only water, but food also, and clothing fetched us. Let there be three distinct offices instead of one indistinct one:--

(1) To provide us with food.

(2) With Hospital furniture and clothing.

(3) To keep the daily routine going.

These are now the three offices of the unfortunate Purveyor; and none of them are performed.

But the Purveyor is _supposed_ to be only the channel through which the Commissariat stores _pass_. Theoretically, but not practically, it is so. (For practically Wreford gets nothing through the Commissary, but employs a contractor.)

Now, why should not the _Commissariat purvey_ the Hospital with food? perform the whole of Purveyor's office, No. 1? The practice of drawing _raw_ rations, as here seen, seems invented on purpose to waste the time of as many Orderlies as possible, who stand at the Purveyor's office from 4 to 9 A.M. drawing the patients' breakfast, from 10 to 12, drawing their dinner--and to make the patients' meals as late as possible--because it is impossible to get the diets, thus drawn, cooked before 3 or 4 o'clock. The scene of confusion, delay, and disappointment where all these raw diets are being weighed out by twos, and threes, and fours, is impossible to conceive, unless one has seen it, as I have, day after day. And one must have been, as I have, at all hours of the day and night in this Hospital to conceive the abuses of this want of system--raw meat, drawn too late to be cooked, standing all night in the wards, etc., etc., etc. Why should not the Commissariat send _at once_ the amount of beef and mutton, etc., etc., required into the kitchens, without passing through this intermediate stage of drawing by Orderlies?

Let a Commissariat Officer reside here--let the Ward-Masters make a total from the Diet Rolls of the Medical Men--so many hundred full diets--so many hundred half-diets--so many hundred spoon diets, and give it over to the Commissariat Officer the day before. The next day the _whole_ quantity, the _total_ of all the Ward-Masters' totals, is given into the kitchens direct.

It should be all carved in the kitchens on hot plates, and at meal-times the Orderlies come to fetch it for the patients--carry it through the wards, where an Officer tells it off to every bed, according to the Bed-ticket, on which he reads the Diet, hung up at every bed. The time and confusion thus saved would be incalculable. Punctuality is now impossible; the food is half-raw, and often many hours after time. Some of the portions are all bone, whereas the meat should be boned in the kitchen, according to the plan now proposed, and the portions there carved contain meat only. Pray consider this.

There might be, _besides_, an Extra Diet Kitchen to each division; a teapot, issue of tea, sugar, etc., to every mess, for which stores make the Ward-Master responsible; arrow-root, beef-tea, etc., to be issued from the Extra Diet Kitchens.

But into these details it is needless to enter to you.

(2) The second office of the Purveyor now is to furnish, _upon requisition_, the Hospital with utensils and clothing. But let the Hospital be furnished at once, as has been already described in former letters. If 2000 beds exist, let these 2000 beds have their appropriate complement of furniture and clothing, stationary and fixed. Whether these be originally provided by a Commissary or a storekeeper, let those who are competent decide. The French appear to give as much too much power to their Commissariat, who are the real chiefs of their Hospitals, while the Medical Men are only their slaves, as we give too little. But the Hospital being once furnished, and a store-keeper appointed to each division to supply wear and tear, let the Ward-Masters be responsible. Let an inventory hang on the door of each ward of what _ought_ to be found there. Let the Ward-Masters give up the dirty linen every night and receive the same quantity in clean linen every morning. Let the Patient shed his Hospital clothing like a snake when he goes out of Hospital, be inspected by the Quarter-Master, and receive, if necessary, from Quarter-Master's store what is requisite for his becoming a soldier again. While the next patient succeeds to his bed and its furniture.

(3) The daily routine of the Hospital. This is now performed, or rather _not_ performed by the Purveyor. I am really cook, housekeeper, scavenger (I go about making the Orderlies empty huge tubs), washer-woman, general dealer, store-keeper. The Purveyor is supposed to do all this, but it is physically impossible. And the filth, and the disorder, and the neglect, let those describe who saw it when we first came....

Let us have a Hotel-keeper, a House-steward, who shall take the daily routine in charge--the cooking, washing and cleaning us--the superintending the housekeeping, in short, be responsible for the cleanliness of the wards, now done by one Medical Officer, Dr. M'Grigor, by me, or by no one--inspect the kitchens, the wash-houses, be what a housekeeper ought to be in a private Asylum.

With the French the _chef d'administration_, the Commissary, as we should call him, is the master of the Orderlies. And the Medical Men just come in and prescribe, as London physicians do, and go away again. With us the Medical Officers are everything, and have to do everything, however heterogeneous. The French system is bad, because, though there may be twenty things down on the Carte for the Medical Man to choose his patient's diet from, _nominally_, the Chef d'Administration may have provided only two, and the Patient has no redress.

Whether, in any new plan, the House Stewards have the command of the Orderlies, or the Medical Man, which I am incompetent to determine, whichever it be let us have a Governor of the Hospital. As it is a Military Hospital, a Military Head is probably necessary as Governor.

On September 20, 1855, a Royal Warrant was issued, reorganizing the Medical Staff Corps, "for the better care of the sick and wounded," revising the duties of the several officers, and improving their pay. Any one who cares to refer to this Warrant, and to compare it with Miss Nightingale's letters just given, will see that in large measure her suggestions were adopted by the War Department.

Miss Nightingale was careful, as we have seen, not to interfere with the doctors, and, though she thought that as administrators some of them were ineffective, she bore willing testimony to their skill and devotion (with some few exceptions) in their proper work. But she could not abstain from deploring one great omission, and she offered to subscribe largely towards repairing it:--

"One thing which we much require," she wrote to Mr. Herbert (Feb. 22, 1855), "might easily be done. This is the formation of a Medical School at Scutari. We have lost the finest opportunity for advancing the cause of Medicine and erecting it into a Science which will probably ever be afforded. There is here no operating room, no dissecting room; post-mortem examinations are seldom made, and then in the dead-house (the ablest Staff Surgeon here told me that he considered that he had killed hundreds of men owing to the absence of these) no statistics are kept as to between what ages most deaths occur, as to modes of treatment, appearances of the body after death, etc., etc., etc., and all the innumerable and most important points which contribute to making Therapeutics a means of saving life, and not, as it is here, a formal duty. Our registration generally is so lamentably defective that often the only record kept is--_a man died_ on such a day. There is a kiosk on the Esplanade before the Barrack Hospital, rejected by the Quarter-Master for his stores, which I have asked for and obtained as a School of Medicine. It is not used now for any purpose--£300 or £400 (which I would willingly give) would put it in a state of repair. It is not overlooked and is in every way calculated for the purpose I have named. The Medical teaching duties could not be carried on efficiently with a less staff than two lecturers on Physiology and Pathology, and one lecturer on Anatomy, who will be employed in preparing the subject for demonstration, and performing operations for the information of the Juniors."

This suggestion also was in part adopted. An excellent dissecting-room was built, provided with numerous instruments, microscopes and other apparatus.[138]

[138] See _Pincoffs_, p. 55.

V

And so this woman of ideas went on, week by week, month by month, pouring in requisitions, hints, plans, to the Government at home; sometimes getting things done as she wanted, at others making suggestions which, had they been adopted, would still more have conduced to efficiency. Something of that calm and clear sagacity, which impressed Queen Victoria and Prince Albert when they made her personal acquaintance,[139] was reflected in her appearance and demeanour as observed by eye-witnesses at Scutari. "In appearance," wrote Mr. Osborne, "Miss Nightingale is just what you would expect in any other well-bred woman, who may have seen perhaps rather more than thirty years of life; her manner and countenance are prepossessing, and this without the possession of positive beauty; it is a face not easily forgotten, pleasing in its smile, with an eye betokening great self-possession, and giving, when she wishes, a quiet look of firm determination to every feature. Her general demeanour is quiet and rather reserved; still, I am much mistaken if she is not gifted with a very lively sense of the ridiculous. In conversation, she speaks on matters of business with a grave earnestness one would not expect from her appearance. She has evidently a mind disciplined to restrain under the principles of the action of the moment every feeling which would interfere with it. She has trained herself to command, and learned the value of conciliation towards others and constraint over herself. I can conceive her to be a strict disciplinarian; she throws herself into a work as its head. As such she knows well how much success must depend upon literal obedience to her every order."[140]

[139] See the words cited at the head of this chapter, and below, pp. 324, 325.

[140] _Scutari and its Hospitals_, p. 25.

It was soon perceived at Scutari that Miss Nightingale was a power. She mentioned incidentally at a later period a curious fact, which shows the way in which officers appealed to her as a kind of emergency-man. In 1862 she was pressing the War Office to separate the function of Banker from that of Purveyor, and she illustrated the confusion caused by the amalgamation from her own experience. Among the instances was this: "I had at Scutari thousands of sovereigns at a time in my bedroom, entrusted to me by officers who preferred making me their banker because of the perpetual discord. 'Offend the Commissary or Purveyor, and you won't be able to get your money.'"[141] It was soon perceived also that Miss Nightingale was the person who, if any one, could get things done, and any official who had an idea took it to her. In the letters to Sidney Herbert she sometimes bids him know that what she says does not merely come from "poor me," but represents the views "of all the best men here." But she, I think, was the best man of them all.[142] Such was the opinion, at any rate, of a man among men, the redoubtable Sydney Godolphin Osborne. "Every day," he wrote in describing his experience at Scutari, "brought some new complication of misery to be somehow unravelled. Every day had its peculiar trial to one who had taken such a load of responsibility, in an untried field, and with a staff of her own sex, all new to it. Hers was a post requiring the courage of a Cardigan, the tact and diplomacy of a Palmerston, the endurance of a Howard, the cheerful philanthropy of a Mrs. Fry. Miss Nightingale fills that post; and, in my opinion, is the one individual who in this whole unhappy war has shown more than any other what real energy guided by good sense can do to meet the calls of sudden emergency."[143] And hence it was, too, that any official who felt the urgency of some particular need in his own department carried his case to the Lady-in-Chief. Did a surgeon want some point represented with special urgency to the authorities at home? He went to Miss Nightingale. Did a purveyor want some special authority from the military to facilitate his task? He went to Miss Nightingale. The centre of initiative at Scutari was in the Sisters' Tower; and going to Miss Nightingale had something of the magic that in earlier days was found in "going to Mr. Pitt."[144]

[141] Letter to Captain Galton, June 28, 1862. On the general question, see vol. ii. p. 64.

[142] It was a _mot_ of Mr. Stafford's that he had only met two men in the East, Omar Pacha (the Turkish Commander) and Florence Nightingale.

[143] _Scutari and its Hospitals_, p. 27.

[144] See _Kinglake_, vol. vi. pp. 43, 436.