CHAPTER IV

REAPING THE FRUIT

(1858-1860)

With aching hands, and bleeding feet We dig and heap, lay stone on stone; We bear the burden and the heat Of the long day, and wish 'twere done. Not till the hours of light return, All we have built do we discern. MATTHEW ARNOLD.

"You must now feel," wrote Sir John McNeill to Miss Nightingale (May 13, 1858), when her work for the health of the British soldier at home was beginning to bear fruit, "that you have not laboured in vain, that you have made your talent ten talents, and that to you more than to any other man or woman alive, will henceforth be due the welfare and efficiency of the British Army. Napoleon said that in military affairs the moral are to the physical forces as four to one, but you have shown that he greatly underrated their value. The rapidity with which you have obtained unanimous consent to your principles much exceeds my expectations. I never dared to doubt that truth and justice and mercy would prevail, but I did not hope to live long enough to see their triumph when we first communed here of such things.[272] I thank God that I have lived to see your success." Sir John's thanksgiving was caused by the tone and the result of a debate which had taken place in the House of Commons upon May 11, 1858. Lord Ebrington, prompted by Mr. Herbert and Miss Nightingale, had moved a series of Resolutions with regard to the Health of the Army, founded upon the Report of the Royal Commission. He had laid special stress upon the figures, due to Miss Nightingale's insight and industry, comparing the mortality in the Army and in civil life respectively; he called attention to the horrible state of the Barracks, and his Resolutions concluded thus: "That in the opinion of this House, improvements are imperatively called for not less by good policy and true economy, than by justice and humanity." The Government accepted the Resolutions, and Miss Nightingale's campaign had thus obtained the unanimous approval of the House of Commons.

[272] At Edinburgh in the autumn of 1856; see above, pp. 321, 328.

* * * * *

She had worked indefatigably, and through many channels, and she continued so to work, in order to focus and stimulate public opinion in the sense of Lord Ebrington's Resolutions. By the end of 1857 the Sub-Commissions on Army Medical Reform were making good progress, and the Report of the Royal Commission was about to be published. She devised an effective means of forcing its salient feature upon the attention of every person most concerned in the evils or most influential towards securing the necessary remedies. I have referred already (p. 352) to her diagrams illustrative of the mortality in the British Army. As finally prepared with Dr. Farr's assistance, they showed most effectively at a glance, by means of shaded or coloured squares, circles and wedges, (1) the deaths due to preventable causes in the Hospitals during the Crimean War, and (2) the rate of mortality in the British Army at home: "our soldiers enlist," as she put it, "to Death in the Barracks." She now wrote a memorandum, explaining the diagrams and pointing their moral, and had 2000 copies printed. This anonymous publication--entitled _Mortality of the British Army_--is called in her correspondence _Coxcombs_, primarily from the shape and colours of her diagrams. She had proposed, and Mr. Herbert agreed, that the memorandum and diagrams should be included as an appendix in his Report, in order that her pamphlet might appear as "Reprinted from the Report of the Royal Commission," and thus be given the greater authority. So soon as the Report was issued, she distributed her _Coxcombs_ to the Queen and other members of the Royal Family, to Ministers, to leading members of both Houses of Parliament, and to Medical and Commanding Officers throughout the country, in India and in the colonies. She had a few copies of the diagrams glazed and framed, and three of these she sent to the War Office, the Horse Guards, and the Army Medical Department. I do not know whether these Departments hung up the present. "It is our flank march upon the enemy," she wrote in sending an early copy to Sir John McNeill, "and we might give it the old name of _God's Revenge upon Murder_."

The Report of the Royal Commission appeared at the beginning of February (1858), and the Secretary sent one of the earliest copies to Miss Nightingale. "I like him very much," she replied (Feb. 5); "I think he looks very handsome. Lady Tulloch says I make my pillow of Blue-books. It certainly has been the case with this." She did not sleep over it, however. She was immediately up and doing. Among her papers there is a curious collection of letters and memoranda, partly in her handwriting, partly in that of Mr. and Mrs. Herbert, showing how industriously they set to work to pull wires in the press. The monthly and quarterly Reviews were in those days deemed of great importance in influencing public opinion, and Miss Nightingale drew up and sent for Mr. Herbert's criticism a list of the principal among them, entering against each magazine or review the name of the writer whom she designated as the ideal contributor of an article upon the Report. They had as much trouble in adjusting the parts as a theatrical manager finds in settling his cast. Lord Stanley, for example, promised to write, but he was particular about his place of appearance. It must be the _Westminster Review_ or nowhere, and Miss Nightingale had already allotted that place to the principal star, Mr. Herbert himself.[273] And, moreover, the managers in this instance were drawing up a cast for other people's houses, and the editors did not in all cases prove amenable. Mr. Elwin, the editor of the _Quarterly_, rejected the article submitted to him. But Mr. Reeve, of the _Edinburgh_, was an old friend of Miss Nightingale, and he accepted her nominee, though he displeased her by mangling the article in the Ministerial interest. However, in the dailies, the monthlies and the quarterlies, the Report had, on the whole, "a good press," and, what is no less important for influencing public opinion, a prompt press.

[273] His article appeared in the _Westminster_ for January 1859, and long extracts are given in _Stanmore_, vol. ii. pp. 141-8. Miss Nightingale read it in manuscript and contributed much material.

II

These things had hardly been arranged when there was a political crisis, and this involved Miss Nightingale and her allies in additional work. Lord Palmerston's Government was defeated on the Conspiracy Bill, and resigned. Lord Derby came in (Feb. 25), with General Peel as Secretary for War. Here, then, we say good-bye, for the present, to "the Bison." He had been dilatory to the last. Mr. Herbert had hoped to see the Army Medical School established in January, and had written to Miss Nightingale to nominate suitable men for the various chairs--"not," he added despairingly, "that Panmure would appoint any one even if the Angel Gabriel had offered himself, St. Michael and all angels to fill the different chairs. He is very slow to move." Miss Nightingale took formal leave of Lord Panmure later in the year, in sending him a copy of one of her books. "You shock me," he replied from the Highlands (Nov.), "by telling me I once called you 'a turbulent fellow.' Had any one else said so, I should have denied it, but I must have been vilely rude. Accept my apology now; and to bribe you to do so, I send you a box of grouse." Mr. Herbert at first cherished high hopes of Lord Panmure's successor. Miss Nightingale and Mr. Herbert were particularly anxious upon a personal point. The Army Medical Department had not yet been reformed, and it was known that Sir Andrew Smith would shortly retire. By seniority Sir John Hall would have claims to the post, and his appointment would, the allies considered, be disastrous to the cause of reform; it would be useless, they felt, to frame new regulations without an infusion of new blood. This, therefore, was the first point on which representations were made to Lord Panmure's successor. "I have seen General Peel," wrote Mr. Herbert to Miss Nightingale (Feb. 27), "and he promised to make no appointment nor to take any step in regard to the Medical Department or sanitary measures till he has conferred with me. I think Peel may do well if we can put him well in possession of the case." General Peel duly did what they wanted on this personal issue. "I hope we may assume," wrote Mr. Herbert to Miss Nightingale (May 25), "that Smith is really gone. It is no use trying to realize the enormous importance of such a fact." They must now, he continued, "fix the appointment of Alexander." Three days later he wrote to Dr. Sutherland: "Please tell Miss N. that I warned Peel against the expected recommendation of Sir J. Hall, and he will, I think, be prepared to turn a deaf ear to it. I wrote yesterday to him on another subject and threw in some praise of Alexander." Such is the gentle art of influencing Ministers. On June 11 Dr. T. Alexander was appointed to succeed Sir Andrew Smith. Dr. Alexander unhappily died suddenly at the beginning of 1860, but it was a great thing for the Reformers, at a time when the Army Medical Department was being recast, to have one of themselves at the head of it, instead of a supporter of the _ancien régime_. "I cannot say," wrote Mr. Herbert to Miss Nightingale (Sept. 16, 1858), "how glad I am to have your account of Alexander. Everything _in futuro_ must depend on him. You cannot maintain a commission sitting permanently _in terrorem_ over the Director-General, and Alexander seems able and willing to be his own commission." So the allies had done at least one good stroke of business with General Peel. Another of the new ministers--Lord Stanley, the Colonial Secretary--was also helpful. "He will send the _Coxcombs_ out to the Colonial Governors," wrote Mr. Herbert (March 16); "he offered any service his position can enable him to give to assist our cause, and suggests that a Commission should inspect Colonial barracks, and he proposes to discuss the matter with you." Presently, however, Lord Stanley was moved from the Colonial to the India Office; where Miss Nightingale enlisted his interest in another sanitary campaign, which was thenceforward to fill a large space in her working life, as will appear in a later Part. So, then, the new Government seemed promising; but it soon began to appear that at the War Office the cobwebs were beyond the power of the new broom to sweep away. Some reforms were carried out, but the permanent officials were as obstructive under General Peel as under Lord Panmure. "These War Office Subs.," wrote Mr. Herbert to Miss Nightingale (June 29), "are intolerable--half a dozen fellows sitting down to compose Minutes just for the fun of the thing on a subject which they cannot possibly know anything about! Peel ought not to let these Subs. interfere, spoil and delay as they do. That office wants a thorough recasting, but I doubt whether Peel is the man to do it. He has a clear head and good sense, but I think he is over-powered by the amount of work which Panmure by the simple process of never attempting to do it found so easy."

But alike amid hope and care, amid fear and anger, Mr. Herbert and Miss Nightingale worked away at their reforms unceasingly. Throughout the year 1858 she was in a very weak state of health. She divided her time, as before, between Malvern and Old Burlington Street, travelling backwards and forwards in an invalid carriage, and escorted by Mr. Clough, now sworn to her service. Her aunt, Mrs. Smith, was still in frequent attendance upon her. Her father was with her for a while at Malvern, and, like every one else, enjoined the desirability of rest. "Well, my dear child," he wrote afterwards from Lea Hurst (Sept. 25), "it's no small matter to see your handwriting again, and to make believe that you are a good deal more than half alive. But the worst of it is, that there's no depending upon you for any persistence in curing yourself, while you have so many others to cure. I often wonder how it is that you who care so little for your own life should have such wonderful love for the lives of others." She seldom saw her mother and sister. In June 1858 her sister married. "Thank you very much," wrote Miss Nightingale to Lady McNeill (July 17), "for your congratulations on my sister's marriage, which took place last month. _She_ likes it, which is the main thing. And my father is very fond of Sir Harry Verney, which is the next best thing. He is old and rich, which is a disadvantage. He is active, has a will of his own and four children ready-made, which is an advantage. Unmarried life, at least in our class, takes everything and gives nothing back to this poor earth. It runs no risk, it gives no pledge to life. So, on the whole, I think these reflections tend to approbation." For herself she "thinks," wrote her aunt, "that each day may be the last on which she will have power to work."

And her ally, Mr. Herbert, was also feeling the strain. He had all the four Sub-Commissions at work, and from time to time during this year (1858) he broke down--on one occasion under a sharp attack of pleurisy. It was now Miss Nightingale's turn to lecture him. She wrote to Mrs. Herbert, begging her not to let Sidney call. "I really am not ill," he wrote (March 18), "only washy and weak, while I always recover wonderfully, and paying you a visit to-morrow will do me no harm but the contrary." She wrote to Mr. Herbert himself, suggesting a cure at Malvern. "I should like to come," he said (Sept. 16), "and look at the Place which I have a notion I shall some day go to, and see you episodically, unless you had rather not be seen." But I do not think that either of the allies expected, or desired, the other to take the advice which they interchanged. Well or ill, each of them worked unrestingly.

III

Upon the matter of Barracks, Mr. Herbert did the harder work.[274] He inspected barracks and hospitals throughout the Kingdom; he wrote or revised each report upon them. But he or Dr. Sutherland, or Captain Galton, or all of them, reported the results of each inspection to their "Chief," as they sometimes called her, and she was unfailing in suggestions and criticisms. When the London barracks were being overhauled (for General Peel had obtained a substantial grant from the Treasury for immediate improvements), the "woman's touch" came into play. She called into counsel her Crimean colleague, Mr. Soyer, and took the improvement of the kitchens in hand. The work was only just begun when Mr. Soyer died suddenly. "His death," she wrote to Captain Galton (Aug. 28), "is a great disaster. Others have studied cookery for the purposes of gormandizing, some for show, but none but he for the purpose of cooking large quantities of food in the most nutritious manner for great numbers of men. He has no successor. My only comfort is that you were imbued before his death with his doctrines, and that the Barracks Commission will now take up the matter for itself." In the work of the other three Sub-Commissions Miss Nightingale had a large share. Mr. Herbert, Dr. Sutherland, Dr. Farr (Statistics) were in constant consultation with her, personally or by correspondence. There are hundreds of letters to her at this period, full of technical detail. "I give in," writes Mr. Herbert; "your arguments are not to be answered." "I want your help very much." "I send a disagreeable letter I have received from Sir J. Hall. I will call on you to-morrow and talk it over." "I send you a copy of the Instructions." "I want help and advice." At every stage of each transaction the allies were in close co-operation. The correspondence with Dr. Sutherland is sometimes in a lighter vein, and Mrs. Sutherland's letters to Miss Nightingale are deeply affectionate. But the doctor, who was not always very business-like, sometimes tried the patience of the exacting Lady-in-Chief. Her aunt records a day when a tiff with Dr. Sutherland caused her niece a serious attack of palpitation of the heart. Mr. Herbert was ill at the time and was waiting for a draft, which Dr. Sutherland was to prepare, for submission to the Secretary of State. Miss Nightingale was requested to put pressure upon the doctor. At last the draft came, and Mr. Herbert did not like it. He begged Miss Nightingale to use her influence in obtaining some revisions. Dr. Sutherland did not take this move kindly, and declined to call upon her. The quarrel, however, was speedily composed. At a later date, Miss Nightingale spent some weeks in the house of William and Mary Howitt at Highgate. "It is not a mere phrase," wrote Mary Howitt, "when I say that we shall feel as if she had left a blessing behind." I suspect that this visit was in order to enable Miss Nightingale to keep a firmer touch upon the "Big Baby," as she and Mrs. Sutherland sometimes called the doctor. "This is the first day of grouse shooting, Caratina," wrote he, when the Barracks Commissioners were in the north; "but as you will allow none of your 'wives' to go to the moors, the festival has passed off without observance."

[274] The original members of the Barracks and Hospitals Commission were Mr. Herbert, Dr. Sutherland (Miss Nightingale's constant colleague), and Captain Galton (married to her cousin). It was appointed October 1857. Its General Report (presented to Parliament, 1861) was dated April 1861 (see below, p. 388). It had previously issued many interim reports. Reconstituted, it ultimately became a permanent body (vol. ii. p. 64).

Thus, then, the Reformers worked during 1858. Their main labours were interrupted in the middle of the year by a last fight over the Netley Hospital. Lord Panmure had gone ahead with the building in spite of Miss Nightingale's objections and of her conversion of Lord Palmerston to her views (p. 341). But since then, the Report of the Royal Commission had appeared, the Hospitals and Barracks Sub-Commission had presented an _interim_ report against Netley, and there was a new Secretary of State. Mr. Herbert and Miss Nightingale made a hard fight, and she wrote a series of newspaper articles[275] in the hope of stirring up public opinion. But General Peel was actuated by the same motives that governed Lord Panmure. He appointed another Committee to report on the adverse Report, and proceeded with the building. "Unhappily, the country which has led the van in sanitary science," says an impartial authority, "has as its chief military hospital a building far from satisfactory."[276]

[275] See Bibliography A, No. 10.

[276] Professor F. de Chaumont in the 9th ed. of the _Encyclopædia Britannica_. Netley is, however, no longer the chief military hospital.

Miss Nightingale's final defeat on this particular issue suggested to her the importance of instructing public opinion upon the whole question of Hospital Construction. She accordingly contributed two Papers on the subject to the Social Science Congress at Liverpool in October 1858. Her friend, Dr. Farr, who was present, reported the marked attention which the reading of the Papers attracted, and at the request of Lord Shaftesbury, the President of the Congress, Miss Nightingale presented her manuscript to the city of Liverpool as a memento of the occasion. These Papers were the germ of her famous _Notes on Hospitals_, to which we shall come in the next Part of this Memoir.

IV

On the main issue of Army Medical Reform, Miss Nightingale sought to influence public opinion by the distribution among carefully selected persons of her _Notes on Matters affecting the Health, Efficiency and Hospital Administration of the British Army_. The _Notes_ were written, and for the most part printed, in the preceding year, and I have already described them. The distribution of them at this time brought her letters of encouragement from many of the most illustrious and influential personages in the land. The Prince Consort, in an autograph letter of thanks, took occasion to assure her once more of "the Queen's high appreciation of her services." The Princess Royal, then Crown Princess of Prussia, begged for a copy; and Miss Nightingale, in reply (Nov. 9), asked Sir James Clark to express for her how "very gratifying the Princess Royal's kind message was. I cannot tell you the deep interest I feel in that young heart so full of all that is true and good, or with what pleasure I anticipate the benefit to her country and ours from her being what she is." These two women, between whom there were many points of sympathy, were often to correspond and to meet in later years. The Duke of Cambridge, in a particularly cordial letter, assured Miss Nightingale "that the whole Army is most sensible of the devotion with which you may be said to have sacrificed yourself to its work on a recent memorable occasion, and I cannot but add my personal admiration of your noble conduct on that as on all other occasions." The Duke added the hope that from time to time he might have it in his power to carry out her "valuable suggestions for the comfort and welfare of the troops." Miss Nightingale often trounced the Commander-in-Chief in her correspondence. He had so little sympathy with any radical reform that she could not consider his popular title of "The Soldier's Friend" to be really well deserved. Yet she had a certain fondness for him, and was alive to his better qualities. She had seen him first during the Crimean War, and she recalled a characteristic incident. "What makes 'George' popular," she wrote, "is this kind of thing. In going round the Scutari Hospitals at their worst time with me, he recognized a sergeant of the Guards (he has a royal memory, always a great passport to popularity) who had had at least one-third of his body shot away, and said to him with a great oath, calling him by his Christian and surname, 'Aren't you dead yet?' The man said to me afterwards, 'Sa feelin' o' Is Royal Ighness, wasn't it, m'm?' with tears in his eyes. George's manner is very popular, his oaths are popular, with the army. And he is certainly the best man, both of business and of nature, at the Horse Guards: that, even I admit. And there is no man I should like to see in his place."[277]

[277] Letter to Harriet Martineau, October 8, 1861. Large as were Miss Nightingale's schemes for army reorganization, she never dared to suggest the abolition of the Horse Guards and the retirement of its chief.

Miss Nightingale was careful to send copies of her _Notes_ to those who, by their pens, could influence public opinion. Among these was Harriet Martineau, to whom Miss Nightingale wrote (Nov. 30): "The Report is in no sense public property. And I have a great horror of its being made use of after my death by _Women's Missionaries_ and those kinds of people. I am brutally indifferent to the wrongs or the rights of my sex. And I should have been equally so to any controversy as to whether women ought or ought not to do what I have done for the Army; though a woman, having the opportunity and _not_ doing it, ought, I think, to be burnt alive." Miss Martineau, promising to be discreet, asked if she might make use of Miss Nightingale's facts and suggestions. The offer was promptly accepted, and Miss Martineau was supplied with copious powder and shot. Miss Nightingale was probably the more attracted by Miss Martineau's offer to popularise her _Notes_ owing to a very earnest letter from Dean Milman. He had read the _Notes_ "with serious attention and profound interest," and asked (Dec. 18): "Is all this important knowledge, this strong practical good sense, this result of much toil, thought, experience to be confined to half-averted official ears, to be forced only on the reluctant attention of a few, and most of these too busy and perhaps too opinionated to profit by it? Is it to be buried in that most undisturbed grave of wise thought and useful information, a blue book? that most repulsive, unapproached, unapproachable place of sepulture? Surely you have not lived and laboured your life of devotion, your labour of love, to leave public opinion untouched and unenlightened but by what may creep out, as the general result of your views, or what may be adopted by Government, perhaps imperfectly and parsimoniously? Are the many, who alone by the expression of their judgment and feelings can keep the few up to their work, and encourage them by their approval and co-operation, to remain ignorant of what is of such vital import to the army, to the country, to mankind?" A series of articles by Miss Martineau in _The Daily News_, and afterwards a popular volume,[278] carried Miss Nightingale's suggestions, at second-hand, into a large circle. Between these two women there was a marked attraction. The correspondence about the illness and death of Miss Martineau's niece, and her reliance upon Miss Nightingale's sympathy, are particularly touching. Each of them had sorrows, each was seriously ill, and each alike at once turned to her public work.

[278] _England and her Soldiers_, by Harriet Martineau, 1859. Miss Nightingale's "coxcomb" diagrams were reproduced in this volume. She revised Miss Martineau's MS., supplemented the publisher's fee to the author, and bought £20 worth of the book for presentation to reading-rooms.

At the end of 1858 Miss Nightingale put out one of the most effective of her controversial pieces. Her facts and figures about the mortality of the Army in the East, as printed in her _Notes_ and in the Royal Commission's Report, had not passed unchallenged, and a pamphlet had appeared calling them in question. Mr. Herbert and Miss Nightingale suspected in it the hand of Sir John Hall, and she immediately prepared a reply. This is entitled _A Contribution to the Sanitary History of the British Army during the late War with Russia_. It was published, early in 1859, anonymously, but all her friends detected her "Roman hand." The pamphlet which provoked it is dismissed in a contemptuous footnote: "An obscure pamphlet, circulated without a printer's name, reproduces nearly every possible statistical blunder on this and other points. It purports to be a defence of the defunct Army Medical Department, 'By a Non-Commissioner,' but it is more like a _jeu d'esprit_." The answer contained in the body of Miss Nightingale's brochure is conclusive, and the "coxcombs" were repeated in a yet more telling and attractive form than before. It is the most concise, the most scathing, and the most eloquent of all her accounts of the preventable mortality which she had witnessed in the East. "In a few truthful words," wrote Sir John McNeill, in acknowledging an early copy (Dec. 26), "you have told the whole dreadful story, and I do not think that we shall hear any more of controversial medical statistics. 'Facts are chiels that winna ding and downa be disputed.' So sang Burns, and he was seldom mistaken in his opinions. I have read every word of the _Contribution_, and pondered every column and diagram, and I come to the conclusion that it is complete and unanswerable, but that it would be disparaging to such a work to regard it as controversial. I wish with all my heart that every young officer in the British Army had a copy of it. The old I have little hope of." Miss Nightingale's mastery of the art of marshalling facts to logical conclusions was recognized by her election in 1858 as a member of the Statistical Society.

V

The new year (1859) brought an event of great importance to the cause of Army Reform. In March, Lord Derby's stop-gap government was defeated on Mr. Disraeli's Reform Bill, and after a general election Lord Palmerston returned to power. Mr. Sidney Herbert, who for some years had been working at army reform as an outsider, now became Secretary for War. "I must send you a line," he wrote to Miss Nightingale (June 13), "to tell you that I have undertaken the Ministry of War. I have undertaken it because in certain branches of administration I believe that I can be of use, but I do not disguise from myself the severity of the task nor the probability of my proving unequal to it. But I know that you will be pleased to hear of my being there.... I will try to ride down to you to-morrow afternoon. God bless you!" Mr. Herbert's task was not rendered less severe by the appointment of Mr. Gladstone as Chancellor of the Exchequer. They were close and affectionate friends, but public economy was with Mr. Gladstone the greater friend. Much of Mr. Herbert's strength was exhausted in disputes with the Chancellor of the Exchequer over the question of the national defences. Mrs. Herbert sent to Miss Nightingale the current riddle: "Why is Gladstone like a lobster?" "Because he is so good, but he disagrees with everybody." Mr. Herbert could by no means always count upon the Treasury for consent in all his schemes for improving the sanitary and moral condition of the Army. Still he was able, as Secretary of State, to accomplish a great deal; and it will be convenient here,--with some slight anticipation, in certain cases, of chronological order--to summarize shortly the fruits of the long collaboration between Mr. Herbert and Miss Nightingale for the health of the British soldier. She herself wrote such a summary in 1861, in a Paper to which reference has been made already (p. 312), and I often use her own words.

The Barracks and Hospitals Improvement Commission had already done a good deal when he came into office, and he continued the work. Buildings were ventilated and warmed. Drainage was introduced or improved. The water-supply was extended. The kitchens were remodelled. Gas was introduced in place of the couple of "dips," by the light of which it was impossible for the men to read or pursue any occupation except smoking. Structural improvements were made in many cases, and Mr. Herbert, so far as he could extract money from the Treasury, reconstructed buildings which had been condemned by his Commission. This policy was abandoned for many years after his death, and later generations heard in consequence of sanitary scandals in barracks at Windsor and Dublin and elsewhere. The General Report of the Barracks and Hospitals Commission, dated April 1861, was presented to Parliament in that year, and many of Miss Nightingale's friends, on reading it, referred to it as "her book." They were not far wrong, for much of the Report, and especially the long section dealing with the proper principles of Hospital and Barrack Construction, was in large measure her work.

Miss Nightingale, in order to ensure that such principles should be better understood and carried out in the future, induced Mr. Herbert to appoint a special Barracks Works Committee, "to report as to measures to simplify and improve the system under which all works and buildings, other than fortifications, are constructed, repaired, and maintained, in order to give a more direct responsibility to the persons employed in those duties." Of this committee Captain Galton was a member, and the Draft Report was submitted to Miss Nightingale for criticism and suggestion.[279] There are many causes to which the improved health of the Army in our own time may be attributed, but the chief of them has probably been the improvement of barrack accommodation, and for this the name of Florence Nightingale deserves to be held in grateful remembrance by the Army and by the nation.

[279] For its appointment, see below, p. 405; and for the successive Committees, etc., in connection with barracks, see the Index, Vol. II. (_under_ Barrack).

As a supplement to the improvements in barrack kitchens, Mr. Herbert introduced a reform in a direction which Miss Nightingale had pressed upon Lord Panmure's attention[280]; he established a School of Practical Cookery at Aldershot, for the training of regimental and hospital cooks in the art of giving men a wholesome meal. Miss Nightingale had been painfully impressed in the Crimea by the importance of this reform.

[280] See above, p. 331. The School of Cookery at Aldershot is mentioned in the _General Report_ of the Barracks Commission, 1861, p. 114 _n._

The second Sub-Commission was charged with the duty of reorganizing the Army medical statistics. This was one of the requirements of rational reform which had most forcibly struck Miss Nightingale in the East. The emphasis which she laid upon this side of her experience, the persistence with which she pressed the matter, the statistical skill with which she showed the way to a better system, are amongst the most valuable of her services to the cause of Army Reform. When the suggestions of the Sub-Commission were carried out, the British Army Statistics became the best and most useful then obtainable in Europe.[281]

[281] The Committee on Army Medical Statistics (Mr. Herbert, Sir A. Tulloch, and Dr. Farr) reported in June 1858, and its Report was printed in 1861. In the same year the _First Annual Statistical Report on the Health of the Army_ (issued in March) was printed; it was compiled by Dr. T. Graham Balfour, who was appointed head of the statistical branch of the Army Medical Department.

The third Sub-Commission was to carry out another of Miss Nightingale's favourite ideas: the establishment of an Army Medical School. There were here the most wearisome delays and obstructions,[282] and it was not until Mr. Herbert himself became Secretary of State that he was able to give effect to his Sub-Commission's Report. And even then, as soon as the Minister's personal oversight was averted, the War Office "Subs." set to work to defeat their chief. Mr. Herbert had appointed the staff in 1859, but it was not till September 1860 that the first students arrived at Fort Pitt, Chatham. They promptly came to the conclusion "that the School was a hoax." As well they might, for the School was without fittings or instruments of any kind! The explanation, which may be read elsewhere,[283] is remarkable even in the annals of departmental muddles. There was, apparently, no method known to the red-tape of the routine-men whereby the School could be fitted, and it might have remained empty indefinitely, but that a trenchant letter from Miss Nightingale secured the personal intervention of the Secretary of State. "There! At last!" wrote Mr. Herbert to her, in forwarding the official order at the end of its long travels through departments and sub-departments. The Army Medical School was peculiarly Miss Nightingale's child, and she watched over its early stages with constant solicitude. Mr. Herbert had commissioned her, in consultation with Sir James Clark, to make the Regulations. She had the nomination of the professors. For the chair of Hygiene she nominated Dr. E. A. Parkes, whose acquaintance she had made during the Crimean War. It would be difficult to exaggerate the services which the stimulating teaching of this great sanitarian rendered to the cause of military hygiene. He had much correspondence with Miss Nightingale in connection with the syllabus of his first course of lectures. In every administrative difficulty the professors went to her for help. The correspondence between her and Dr. Aitken[284] is especially voluminous. She had made a successful fight, against much opposition, to have pathology included in the professoriate, and Dr. Aitken was ultimately appointed to the chair. He it was who set Miss Nightingale in motion about the fittings of the School. He often asked her to "give us another push." "Kind thanks," he wrote (March 1861) when a further hitch had arisen, "for placing our train on the proper line." Her intervention at headquarters was necessary even to extract pay for the professors. "I have just received an intimation from the War Office," Dr. Aitken wrote to her (Aug. 7, 1860), "that Sir John Kirkland has been authorised to issue my pay; so I presume the numerous officials concerned have been able to satisfy each other that I am in existence. The 'at once' in this instance is equal to six days--an activity I am inclined to believe is due to your exertions on Sunday." Sunday was the day of the week on which, if on no other, she always saw Mr. Herbert. Dr. Aitken was sarcastic, and not without cause, about the Circumlocution Office; but it is possible that the fault was not always only on one side. Professors are said to be sometimes "children" in matters of business; and on one tale of woe addressed to Miss Nightingale, the docket (in Dr. Sutherland's handwriting, but doubtless at her dictation) is this: "I hope the present difficulty has been got over, but it will be well to bear in mind that the School is so nearly connected with the administrative part of the War Office, that all your future proceedings, whether by minute or otherwise, should be concise and practical." The School survived the perils of its infancy, and introduced a most beneficent reform by affording means of instruction in military hygiene and practice to candidates for the Army Medical Service. "Formerly," as Miss Nightingale wrote, "young men were sent to attend sick and wounded soldiers, who _perhaps_ had never dressed a serious wound, or never attended a bedside, except in the midst of a crowd of students, following in the wake of some eminent lecturer, who _certainly_ had never been instructed in the most ordinary sanitary knowledge, although one of their most important functions was hereafter to be the prevention of disease in climates and under circumstances where _prevention_ is everything, and medical treatment often little or nothing." Miss Nightingale's services as the true founder of the School were publicly acknowledged at the time. Dr. Longmore, the Professor of Military Surgery, told the students that it was she "whose opinion, derived from large experience and remarkable sagacity in observation, exerted an especial influence in originating and establishing this School."[285] "In the Army Medical School just instituted," wrote Sir James Clark, "hygiene will form the most important branch of the young medical officer's instruction. For originating this School we have to thank Miss Nightingale, who, had her long and persevering efforts effected no other improvement in the Army, would have conferred by this alone an inestimable boon upon the British soldier."[286]

[282] The story of them may be read in _Stanmore_, vol. ii. pp. 364-8.

[283] _Stanmore_, vol. ii. p. 367.

[284] Sir William Aitken (1825-1892), M.D. of Edinburgh; assistant-pathologist to a medical commission during the Crimean War; F.R.S. 1873; knighted, 1887. He held the professorship from 1860 till the year of his death.

[285] _Introductory Address at Fort Pitt_, _Chatham_, October 2, 1860, by Deputy-Inspector-General T. Longmore, p. 7.

[286] Introduction, p. 20, to a new edition (1860) of Andrew Combe's _Management of Infancy_.

The School was afterwards moved to Netley. It is now in London, is one of the Medical Schools in the University, and is placed in convenient proximity to a military hospital. The Tate Gallery, on the Embankment at Millbank, stands between two buildings which are of peculiar interest to any one concerned in the life and work of Florence Nightingale. To the east of the Gallery is the Royal Alexandra Hospital, a general military hospital for the London district. It is built, of course, on the "pavilion" plan, and in every other respect conforms to Miss Nightingale's ideas of what a hospital should be--with many additions to its resources, which the progress of science has suggested since her day. A complete apparatus for X-ray treatment, capable of being packed into five cases for service in the field, is likely to attract the special attention of a visitor. But in connection with Miss Nightingale there was something else which struck me more. As I went through the surgical wards with the Commandant, the smart "orderlies" (old style, now the trained men of the Army Medical Corps) stood at attention. The Colonel entered into conversation with the Sergeant of a ward. He was awaiting promotion until he had qualified in the hospital, under the Matron, Sisters, and Staff Nurses. Promotion in the Corps is now dependent on an examination _plus_ a certificate from the nursing authorities. Into how great a thing has the introduction of female nursing for the Army, due to Miss Nightingale, grown, and how ironical are some of time's revenges which the development has brought with it! Originally the female nurses occupied the lowest place; sometimes they were little more than superior domestics, often they were amateurs, and their position was always a little nondescript. Now they represent the most highly-trained and professional element, and without a certificate from them no male hospital attendant can win full promotion! And there was another thing that struck me. After a tour of the surgical wards, I inquired about the medical wards; but time was pressing, "and you would find little to see there," said the Colonel, "for the Army is so healthy in these days that there are few medical cases."[287]

[287] It should perhaps be explained that venereal cases are treated in a separate hospital.

On the west of the Tate Gallery stands another, and a larger, pile of buildings. These are occupied by the Royal Army Medical College, through which every Army Medical Officer has now to pass both a preliminary and a post-graduate course. Shortly before I visited the College, I had been reading the large mass of Miss Nightingale's papers which contain her first suggestions for the foundation of the school, with her drafts for its rules and regulations; and which describe the struggles and difficulties of its humble infancy. And then I was taken through the noble institution into which it has developed; equipped with large laboratories which are, I believe, among the best in the country, with smaller laboratories for private research; with a department for those "cultures" which are said to have done so much to preserve the health of the Army in India[288]; with a spacious lecture-theatre, a fine library, a large museum; and with handsome mess-rooms for the comfort and convenience of studious youth. The transition was like a transformation-scene in a pantomime. The Fairy Godmother of the College would have rejoiced to see it. Only one thing seemed to me to be wanting. There are portraits or other memorials of many of the men whose acquaintance we have made in these pages. In the entrance lobby there is a bust of Dr. Thomas Alexander, whose appointment as Director-General Miss Nightingale procured. In the smoking-room there are portraits of the first professors whom she nominated. I noticed no memorial of the two founders to whom the original institution of the College was due--Sidney Herbert and Florence Nightingale.

[288] This is a department of the College which would not have appealed to Miss Nightingale. She loathed and mocked at inoculation. "Oh, yes, I know," she once said; "they will give you smallpox or diphtheria or plague or anything you like. You pays your money, and you takes your choice."

The last of the four Sub-Commissions--the "wiping" Sub-Commission--had very varied duties assigned to it, and there was no branch of the reform bill which encountered more stubborn opposition from the permanent officials. One of Mr. Herbert's many letters to Miss Nightingale on the subject speaks of the "gross ignorance, and darkness beyond all hope" of the principal obstructive, who maintained that the idea of a sanitary official was all fudge. Some of the work of this Sub-Commission need not be detailed here. It framed a new Army Medical Officers' Warrant (issued by General Peel in 1858), and reorganized the Army Medical Department (1859). These were useful steps at the time, but there have been so many new warrants and so many War Office reorganizations since then that this part of the reforms of Mr. Herbert and Miss Nightingale belongs in any detail only to ancient history. The case is different with the general work of the Wiping Sub-Commission. Here also there have been new developments, and some of the forms have been changed; but in substance, these have all been built upon the foundations laid in the years 1859-60. To Miss Nightingale primarily, and to her more than to any other individual, is due the recognition of a principle which may seem self-evident at the present time, but which was entirely novel in her day--the principle that the Army Medical Department should care for the soldier's _health_ as well as for his _sickness_. The Sub-Commission--or to go behind the form to the reality, Miss Nightingale and Mr. Herbert--drew up a Code for introducing the sanitary element in the Army, defining the positions of Commanding and Medical Officers and their relative duties regarding the soldier's health, and constituting the regimental surgeon the sanitary adviser of his commanding officer. The same code contained regulations for organizing General Hospitals, and for improving the administration of Regimental Hospitals, both in peace and during war. Formerly, general hospitals in the field had to be improvised, on no defined principles and on no defined personal responsibility. The wonder is, not that they broke down, as they did in all our wars, but that they could be made to stand at all. In all our wars, again, the general hospitals had been signal failures--examples, as during the earlier months at Scutari, of how to kill, not to cure. The general hospital system, devised in the Code--including its governor, principal medical officer, captain of orderlies, female nurses, and their Superintendent (Mrs. Shaw Stewart)--was realized in 1861 in the hospital at Woolwich.

There were some other reforms introduced by Mr. Herbert, as Secretary of State, which owed their origin to Miss Nightingale's experiences, observation, and suggestions. In January 1861 Mr. Herbert issued a new Purveyor's Warrant and Regulations. Hitherto "the Purveying Department, like many others, had no well-defined position, duties, or responsibilities. It was efficient or inefficient almost by chance. Like other departments, it broke down when tried by war; and all its defects were visited on the sick and wounded men, for whose special benefit it professed to exist." The new Code "defined with precision the duties of each class of purveying officers, together with their relation to the Army Medical Department. They provided all necessaries and comforts for men in hospital (both in the field and at home) on fixed scales, instead of requiring sick and wounded men (even in the field) to bring with them into hospital articles for their own use, which they had lost before reaching it." The reader will remember how largely purveying defects entered into Miss Nightingale's difficulties in the East, and a reference to her letters from Scutari will show that Mr. Herbert's Code was based on the broad lines of her suggestions. As is hardly surprising, since she drafted the Code in consultation with Sir John McNeill.

Mr. Herbert also appointed a Committee to reorganize the Army Hospital Corps (1860). "In former times there were no proper attendants on the sick. For regimental hospitals a steady man was appointed hospital sergeant, and two or three soldiers, fit for nothing else, were sent into the hospital to be under the orders of the medical officer, who, if he were fortunate enough to find one man fit to nurse a patient, was sure to lose him by his being recalled 'to duty'; sometimes, indeed, men were nominated in rotation over the sick in hospital as they would mount guard over a store. No special training was considered necessary; no one, except the medical officer, who was helpless, had the least idea that attendance on the sick is as much a special business as medical treatment. Unsuccessful attempts had been made to organize a corps of orderlies, unconnected with regiments; the result was most unsatisfactory. Mr. Herbert's Committee proposed to constitute a corps--the members of which, for regimental purposes, were to be carefully selected by the commanding and medical officers--specially trained for their duties, and then attached permanently to the regimental hospital." This reform, which owed much to Miss Nightingale's suggestions, was carried into effect shortly after Mr. Herbert's death.

Mr. Herbert also took up those questions of the soldier's moral health in which Miss Nightingale had been a pioneer.[289] In 1861 he appointed a Committee[290] to consider how best to provide soldiers' day-rooms and institutes, in order to counteract the moral evils supposed to be inseparable from garrisons and camps. The Committee, of which Miss Nightingale's friends, Colonel Lefroy, Captain Galton, and Dr. Sutherland were members, showed that "the men's barracks can be made more of a home, can be better provided with libraries and reading-rooms; that separate rooms can be attached to barracks, where men can meet their comrades, sit with them, talk with them, have their newspaper and their coffee, if they want it, play innocent games, and write letters; that every barrack, in short, may easily be provided with a kind of soldiers' club, to which the men can resort when off duty, instead of to the everlasting barrack-room or the demoralizing dram-shop; and that in large camps or garrisons, such as Aldershot and Portsmouth, the men may easily have a club of their own out of barracks. The Committee also recommended increased means of occupation, in the way of soldiers' workshops, out-door games and amusements, and rational recreation by lectures and other means. The plan was tried with great success at Gibraltar, Chatham, and Montreal. Mr. Herbert's latest act was to direct an inquiry at Aldershot as to the best means of introducing the system there." Miss Nightingale, in thus summarizing the case, did not state, what her correspondence shows to have been the fact, that she had been the prime mover in the appointment of the Committee; that, as already related (p. 351), she had worked hard to obtain a reading-room, etc., at Aldershot; and that, in the case of Gibraltar, the equipment of the room owed much to gifts from her own private purse and to the contributions of personal friends (Mrs. Gaskell among them) whom she had interested in the scheme. Here, as in so many other directions, Miss Nightingale's work as a pioneer has been greatly developed; and no modern barrack is deemed complete without its regimental institute, with recreation room, reading-room, coffee-room, and lecture-room, while means of out-door recreation and shops for various trades are also provided.

[289] See above, p. 281.

[290] This Committee received its instructions on Feb. 17, and reported on Aug. 24, 1861. The Report (1861) is No. 2867 in the Parliamentary Papers.

VI

In recounting Mr. Herbert's reforms, Miss Nightingale brought the results of them, after her usual manner, to the statistical test. She prefixed to her Memoir some coloured diagrams showing how Mr. Herbert found the Army and how he left it. In the three years 1859-60-61, just one-half of the Englishmen who entered the Army died (at home stations) per annum as formerly died. The total mortality at home stations from _all diseases_ had become less than was formerly the mortality from consumption and chest diseases _alone_. The results of comparisons of British armies in the field were equally striking. The China expedition put the reforms to the test. "An expeditionary force was sent to the opposite side of the world, into a hostile country, notorious for its epidemic diseases. Every required arrangement for the preservation of health was made, with the result that the mortality of this force, including wounded, was little more than 3 per cent per annum, while the 'constantly sick' in hospital were about the same as at home. During the first months of the Crimean War the mortality was at the rate of 60 per cent, and the 'constantly sick' in the hospitals were sevenfold those in the war hospitals in China." The improvement in the health of the Army has, in peace at any rate, been progressive. In 1857 the annual rate of mortality in the Army at home was 17·5 per 1000. Forty years later it had fallen to 3·42. In 1911 it was 2·47.

Besides all this, Mr. Herbert undertook in 1859 the chairmanship of the Royal Commission on the Sanitary State of the Indian Army. Other work of his in connection with the Army is well known; and some of it--such as his Fortification Scheme--did not endure, but these matters do not concern us here. His measures for the health and well-being of the soldiers were what Miss Nightingale was interested in; and this joint work of theirs has been of lasting benefit. After Sidney Herbert's death there was an arrest in reform; but the main lines laid down by him have been followed to our own day. In 1896 a friend in the War Office went through Miss Nightingale's Memoir of Sidney Herbert for her, and noted the present state of things in relation to it. The Army Sanitary Committee was still in existence. The School of Cookery at Aldershot was in the Queen's Regulations. The General Military Hospitals were maintained. The Army Medical School had been moved to Netley. The Army Medical Statistics were still published annually. The position of Army Medical Officers had been further improved. There was a regularly organized Medical Staff Corps. The recommendations of the Barracks Works Committee of 1861 had been carried out, with the result that the engineer officers had more individual responsibility, and were better acquainted than formerly with the details of healthy barrack and hospital construction. Soldiers' Institutes had been put up on War Office land at several stations. Recreation and reading-rooms were to be found in most barracks, and no new barrack was erected without them. Such changes as have taken place since 1896 have been for the better, as I have indicated in preceding pages; for the better, and more in line with Miss Nightingale's ideas. Her great work, _Notes on the Army_, contained, as events were to prove, not only the scheme of all Sidney Herbert's reforms (except those relating to defence), but the germ, and often the details, of further reforms (within the same sphere) which have continued to our own day. During the years of her co-operation with Mr. Herbert, Miss Nightingale chafed at obstruction and delay, and after his death she cried out bitterly at the cessation of further progress. But in the end it was as her wise mentor, Sir John McNeill, wrote (March 26, 1859):--"It vexes me greatly to find that you are thwarted and annoyed by such things as you tell me of, but I am not in the least surprised. I did not expect you to accomplish so much in so short a time. Be assured that the progress from a worse to a better system is in almost every department of human affairs a progress slow and interrupted. Do not then be discouraged. If you have not done all that you desired--and who ever did?--you have done more than any one else ever did or could have done, and the good you have done will live after you, growing from generation to generation. I do not remember any instance in which new ideas have made more rapid progress."

The bearing of the new ideas in relation to the Army was pointed out in Miss Nightingale's summary of Mr. Herbert's services. "He will be remembered chiefly," she wrote, "as the first War Minister who ever seriously set himself to the task of saving life, who ever took the trouble to master a difficult subject so wisely and so well as to be able to husband the resources of this country, in which human life is more expensive than in any other, more expensive than anything else, and to preserve the efficiency of its defenders." In this work, during Mr. Herbert's term of office, as in the preceding years, Miss Nightingale was his constant assistant, and often the originator. They conferred personally or by letter almost every day. No move in the sphere of sanitary reform was made by the Minister for War until he had taken her opinion. Every draft was submitted to her criticism and suggestion. When Mr. Herbert took office, his wife wrote (June 16, 1859) to thank Miss Nightingale for her "dear note of congratulations," adding, "He entirely agrees with your suggestions of this morning, and I am copying your Circular Note for the four pundits." In the following month (July 26), he sends her the proposed Sanitary Regulations: "I shall be very much obliged if you will go over the papers with Sutherland." "Sidney is coming to see you to-day (Aug. 13) to talk about the Regulations." Four days later: "Can Miss Nightingale give me the names of some Governors for our new General Hospitals?" In later months, the scheme for the Medical School and the new Regulations for Purveyors were discussed between them. On one occasion a dispatch from Miss Nightingale, enclosed under cover to Mrs. Herbert, followed the Minister to Windsor: "I gave your letter to your 'Sovereign'; it's lucky the real one did not see your cover." The correspondence of 1860 is to like effect. "Here is a dispute which is Hebrew to me; would you look it over with Sutherland?" "I have written in our joint sense," and so forth. Miss Nightingale supplied, however, more than detail--for one thing, persistent stimulus. At the end it was stimulus to a dying man.