Читать книгу The Life of Florence Nightingale - Edward Tyas Cook - Страница 67

The state of the hospitals when Miss Nightingale arrived requires some description, which, however, need not be long. The treatment of the sick and wounded during the Crimean War was the subject of Departmental Inquiries, Select Committees, and Royal Commissions, which, when they had finished sitting upon the hospitals, began sitting upon each other. Enormous piles of Blue-books were accumulated, and in the course of my work I have disturbed much dust upon them. The conduct of every department and every individual concerned was the subject of charge, answer, and countercharge innumerable. Each generation deserves, no doubt, the records of mal-administration which it gets; but one generation need not be punished by having to examine in detail the records of another. Some of the details of the Crimean muddle will indeed necessarily be disinterred in the course of our story; but all that need here be collected from the heaps aforesaid are three general conclusions.

The reader must remember, in the first place, that, apart from controverted particulars, it was made abundantly manifest that there was gross neglect in the service of the sick and wounded. The conflict of testimony is readily intelligible. It was easy to give an account based upon the facts of one hospital or of one time which was not applicable to another. At Scutari, for instance, the General Hospital was from the first better ordered than the Barrack Hospital. Then, again, different witnesses had different standards of what was “good” in War Hospitals; to some, anything was good if it was no worse than the standard of the Peninsular War. Of Sir George Brown, who commanded the Light Division in the Crimea, it was said: “As he was thrown into a cart on some straw when shot through the legs in Spain, he thinks the same conveyances admirable now, and hates ambulances as the invention of the Evil One.”87 Miss Nightingale had much indignant sarcasm for those who seemed content that the soldier in hospital should be placed in the condition of “former wars,” instead of perceiving that he “should be treated with that degree of decency and humanity which the improved feeling of the nineteenth century demands.” But the principal reason for the conflict of testimony was that the very facts of protest and inquiry put all the officials concerned upon the defensive. Any suggestion of default or defect was resented as a personal imputation. There is a curious illustration in the letter which the Head of the Army Medical Department wrote to his Principal Medical Officer in view of the Roebuck Committee. “I beg you to supply me, and that immediately”—with what? with the truth, the whole truth, and nothing but the truth? No—“with every kind of information which you may deem likely to enable me to establish a character for it [the Department], which the public appear desirous to prove that it does not possess.”88 But though there was much conflict of evidence, the final verdict was decisive. What Greville wrote in his Journal—“the accounts published in the Times turn out to be true”—was established by official inquiry and admitted by Ministers. In consequence of the indictment in the Times, a Commission of Inquiry was dispatched to the East by the Secretary of State. The Commission arrived at Constantinople simultaneously with Miss Nightingale, and four months later it reported to the Duke of Newcastle.89 I need not trouble the reader here with many particulars of its Report; for they were adopted and confirmed by a Select Committee of the House of Commons a few months later (the famous “Roebuck Committee”), which pronounced succinct sentence that “the state of the hospitals was disgraceful.” The ships which brought the sick and wounded from the Crimea were painfully ill-equipped. The voyage from Balaclava to Scutari usually took eight days and a half. During the first four months of the war, there died on a voyage, no longer than from Tynemouth to London, 74 out of every 1000 embarked. The landing arrangements added to the men's sufferings. To an unpractised eye the buildings used as hospitals at Scutari were imposing and convenient; and this fact accounts for some of the rose-coloured descriptions by which persons in high places were for a time misled. Even the Principal Medical Officer on the spot was naïvely content with whitewash as a preparation to fit the Barrack for use as a hospital. In fact, however, the buildings were pest-houses. Underneath the great structures “were sewers of the worst possible construction, loaded with filth, mere cesspools, in fact, through which the wind blew sewer air up the pipes of numerous open privies into the corridors and wards where the sick were lying.”90 There was also frightful overcrowding. For many months the space for each patient was one-fourth of what it ought to have been. And there was no proper ventilation. “It is impossible,” Miss Nightingale told the Royal Commission of 1857, “to describe the state of the atmosphere of the Barrack Hospital at night. I have been well acquainted with the dwellings of the worst parts of most of the great cities in Europe, but have never been in any atmosphere which I could compare with it.” Lastly, hospital comforts, and even many hospital necessaries, were deficient.91 The supply of bedsteads was inadequate. The commonest utensils, for decency as well as for comfort, were lacking. The sheets, said Miss Nightingale, “were of canvas, and so coarse that the wounded men begged to be left in their blankets. It was indeed impossible to put men in such a state of emaciation into those sheets. There was no bedroom furniture of any kind, and only empty beer or wine bottles for candlesticks.” Necessary surgical and medical appliances were often either wanting or not forthcoming. There was no machinery, until Miss Nightingale came, for providing any hospital delicacies. The result of this state of things upon patients arriving after a painful voyage in an extreme state of weakness and emaciation, from wounds, from frost-bite, from dysentery, may be imagined, and it is no wonder that cholera and typhus were rife. In February 1855 the mortality per cent of the cases treated was forty-two. No words are necessary to emphasize so terrible a figure.

Mr. Herbert had not waited for the reports of Commission and Committee to reach the conclusion that things were wrong:—

“I have for some time,” he wrote on December 14, 1854, to the Commandant at Scutari, “been very anxious and very much dissatisfied as to the state of the hospital. I believe that every effort has been made by the medical men, and I hear that you have been indefatigable in the conduct of the immediate business of your department. But there has been evidently a want of co-operation between departments, and a fear of responsibility or timidity, arising from an entire misconception of the wishes of the Government. No expense has been spared at home, and immense stores are sent out, but they are not forthcoming. Some are at Varna, and for some inexplicable reason they are not brought down to Scutari. When stores are in the hospital, they are not issued without forms so cumbrous as to make the issue unavailing through delay. The Purveyor's staff is said to be insufficient. The Commissariat staff is said to be insufficient, your own staff is said to be insufficient,” etc.

By admission, then, and by official sentence, there were things amiss at Scutari which urgently called for amendment. This is the first general conclusion which has to be remembered in relation to Miss Nightingale's work.

To what individuals the disgrace of “a disgraceful state of things” attached, it is happily no concern of ours here to inquire. But as I have called Mr. Sidney Herbert as a witness to the fact of the disgrace, I must add my conviction that his own part in the business was wholly beneficent. Some research among the documents entitles me, perhaps, to express entire agreement with Mr. Kinglake's remark upon “what might have been if the Government, instead of appointing a Commission of enquiry on the 23rd of October, had then delegated Mr. Sidney Herbert to go out for a month to the Bosphorus, and there dictate immediate action.” At home, Mr. Herbert was a good man struggling in the toils. The fact is that, though there were some individuals palpably to blame, the real fault was everybody's or nobody's. It was the fault of a vicious system, or rather the vice was that there was no system at all, no co-ordination, but only division of responsibility. The remarks of Mr. Herbert, just quoted, point to the evil, and on every page of the Blue-books it is written large. There were at least eight authorities, working independently of each other, whose co-operation was yet necessary to get anything well done. There was the Secretary of State; there was the War Office (under the Secretary-at-War); there were the Horse Guards, the Ordnance, the Victualling Office, the Transport Office, the Army Medical Department, and the Treasury. The Director-General of the Medical Department in London told the Roebuck Committee that he was under five distinct masters—the Commander-in-Chief, the Secretary of State, the Secretary-at-War, the Master-General of Ordnance, and the Board of Ordnance. The Secretary of State said that he had issued no instructions as to the hospitals; he had left that to the Medical Board. But the Medical Director-General said that it would have been impertinent for him to take the first step.92 If I were writing the history of the Crimean War, or of the Government Offices, other fundamental reasons for the disgraceful state of things in the hospitals—notably the miscalculated plan of military campaign—would have to be taken into account; but I am writing only the life of Miss Nightingale, and all that under this head the reader need be asked to bear in mind is this: That the root of the evils which had to be dealt with was division of responsibility, and reluctance to assume it.

The third conclusion of the official inquiries, which I want to emphasize, is contained in a passage in the Roebuck Committee's Report, which prefaced a reference to Miss Nightingale's mission: “Your Committee in conclusion cannot but remark that the first real improvements in the lamentable condition of the hospitals at Scutari are to be attributed to private suggestions, private exertions, and private benevolence.”

So, then, we see that there were disgraceful evils at Scutari needing amendment, and that in order to amend them what was needed was bold initiative. This it was that Miss Nightingale supplied. The popular voice thought of her only or mainly as the gentle nurse. That, too, she was; and to her self-devotion in applying a woman's insight to a new sphere, a portion of her fame must ever be ascribed. But when men who knew all the facts spoke of her “commanding genius,”93 it was rather of her work as an administrator that they were thinking. “They could scarcely realize without personally seeing it,” Mr. Stafford told the House of Commons, “the heartfelt gratitude of the soldiers, or the amount of misery which had been relieved” by Miss Nightingale and her nurses; and, he added, “it was impossible to do justice, not only to the kindness of heart, but to the clever judgment, the ready intelligence, and the experience displayed by the distinguished lady to whom this difficult mission had been entrusted.” These were the qualities which enabled her to reform, or to be the inspirer and instigator of reforms in, the British system of military hospitals. She began her work, where it lay immediately to her hand, in the Barrack Hospital at Scutari. She did the work in three ways. She applied an expert's touch and a woman's insight to a hospital hitherto managed exclusively by men. She boldly assumed responsibility, and did things herself which she could find no one else ready to do. And, thirdly, she was instant and persistent in suggestion, exhortation, reproaches, addressed to the authorities at home. It will not be possible to keep these three branches of our subject entirely distinct; but in the main they will form the topics successively of the next three chapters.