Читать книгу The Life of Florence Nightingale - Edward Tyas Cook - Страница 74

In all these things Miss Nightingale may be warmly commended, but the officials need not be too hotly condemned. They were but doing their duty, as they had learnt it; and for the rest, it was the system, or want of system, that was at fault. Just as in London there was no co-ordination among the Departments, so at Scutari there was no unity of action, and no clear personal responsibility. “It is a current joke here,” wrote Miss Nightingale from Scutari, “to offer a prize for the discovery of any one willing to take responsibility.” It was never awarded, for Miss Nightingale herself was, I suppose, “barred.” In writing to Mr. Herbert, she called many of the officials at Scutari by very hard names, but in other letters she admitted that the ultimate fault lay elsewhere. “The grand administrative evil,” she said (Dec. 10), “emanates from home—in the existence of a number of departments here, each with its centrifugal and independent action, uncounteracted by any centripetal attraction, viz. a central authority capable of supervising and compelling combined effort for each object at each particular time.” Mr. Herbert might write, but the officials would not act. The force of custom was too strong. Miss Nightingale showed the Purveyor a letter from the Minister. “This is the first time,” he said, “I have had it in writing that I was not to spare expense. I never knew that I might not be thrown overboard.” “Your name,” she had told Mr. Herbert (Nov. 25), “is continually used as a bug-bear. They make a deity of cheapness, and the Secretary at War stands as synonymous here with Jupiter Tonans, whose shafts end only in a brutum fulmen. The cheese-paring system, which sounds unmusical in British ears, is here identified with you by the officers who carry it out. It is in vain to tell the Purveyors that they will get no kudos by this at home.”

It should not be supposed, however, that Miss Nightingale was a spurner of rules, and a despiser of discipline, routine, and subordination. The very reverse is the case. Her whole career makes it probable, the character of her mind suggests it, and the administration of the funds placed at her disposal, with which the present chapter has mainly been concerned, proves it. If she shocked and staggered some official minds by her daring innovations, it was her strictness and insistence upon rules and regulations that was most criticized in unofficial quarters. She explained the matter very clearly in her final Statement to Subscribers. She had been placed by the Government in two positions of trust, each independent of the other. She had been appointed superintendent of the nursing establishment; and she further had received authority, as almoner of the “Free Gifts” (as the Royal Bounty was called), to apply them, and any other gifts derived from private sources, in the War Hospitals. In the second of these capacities, she could, if she had chosen, have administered her stores solely at her personal discretion, and have delegated a like discretion to other superintendents, sisters, or nurses appointed by her. But, except in a few special cases, which it were superfluous to enumerate, she rejected the liberty of personal discretion, and administered her funds only upon the requisition of medical officers. (She lays repeated stress on this fact, but I daresay that she herself was often the originating source of the requisitions. We have seen that in Harley Street she had learnt the art of managing overworked doctors.) Her statement of the reasons which governed her action is characteristic of her good sense. The exercise of personal discretion alone would have been the easier course; but the objections to it were “the abrogation of ordinary rule; the impossibility of preventing irregular issues, or at least of disproving the charge, and the unfitness of a large proportion of the women, who efficiently discharge the duty of the Nurses, to be the judges of the wants of soldiers and distribution of supplies to them; and, farther, the abuse which some would undoubtedly make of the power. To those to whom the charge of dishonesty would not apply, religious partiality either would, or, what in matters of this kind is only less mischievous, would be believed to, apply.” Next, there was the danger of patients being given other food than what the medical officers ordered. “It is needless to state to any sensible person, even without hospital experience, the manifold dangers of issuing to Nurses, whether ‘Ladies, Sisters, or Nurses,’ stores or facilities for procuring stores, to be distributed at their own discretion through the Wards. It is to be remembered that the employment of women in Army Hospitals is recent, that many experienced and able Surgeons are opposed to it, that, among these, some are honestly, and some are unscrupulously prone to find objections to it, and to exaggerate mischiefs arising from it; that the Surgeon can, to a considerable extent, allow the Nurse to be useful, or force her to be comparatively useless, in his Wards; that the War Hospitals are a bad field for investing the Nurse with powers and offices which she never exercises in Civil Hospitals. On these grounds, as strict an adherence to existing rules as was possible appeared to be the only course. … Miss Nightingale exacted and she rendered adherence to rules to a large extent, and she strictly reverted to them when any emergency, during which, at the instance of authorities, she had departed from them, had ceased. A position such as hers necessarily exposes the holder to attacks from different quarters upon opposite grounds. While previously existing authorities are disposed to complain of all novel expenditure as lavish, and tending to the relaxation of discipline by over-indulgence, others, who feel themselves checked or restrained by regulations in the distribution of comforts according to their ideas of benevolence, will naturally object to the obstruction, in their view unnecessarily, interposed to the current of public liberality. While the experience of all who have conducted the operations of any extensive charity proves that the application of the ordinary axioms of business is the only road to success, it also sufficiently shows that such application is surely attended by no small measure of unpopularity.”122

She saw the value of rules, and respected them, sometimes even when they were ridiculous. On a cold night in January 1856, she was by the bedside of a dying patient; whose feet she found to be stone cold. She requested an orderly to fetch a hot-water bottle immediately. He refused, on the ground that his instructions were to do nothing for a patient without directions from a medical officer. Miss Nightingale stood corrected, and trudged off to find a doctor and make requisition for the bottle in due form. On a night in the following month, there was an unusually cold east wind, with a heavy snowfall. The patients in the ward attended by a civilian doctor were exposed to the wind and complained bitterly of the cold, but the regulation supply of fuel had given out. As the Government store was closed, Miss Nightingale waived the rule about applying first to the Purveyor, and gave the doctor fuel from her private stores. Next day the civilian doctor requisitioned in due form for an extra supply of fuel. He was refused. He carried his case to the Inspector-General. That official pleaded that he could not depart from the regulations which allowed only a certain quantity of wood for each stove. But, urged the civilian, exceptional cold calls for an extra allowance. Possibly, replied the Inspector-General with exemplary gravity, but “a Board must first sit” upon the question. The civilian smiled good-humouredly, and begged the great man to supply the wood first, and let the Board sit upon it when the weather was milder. The Inspector-General consented. These little incidents123 throw a flood of light upon the difficulties through which Miss Nightingale had to thread her way. She was a firm believer in rules; but she was one of those able administrators who have the sense to know, and the courage to act upon the knowledge, that rules sometimes exist only to be broken.

And this was precisely the kind of initiative that the state of things in the hospitals at Scutari demanded. Miss Nightingale's adherence to rules may have brought unpopularity upon her from some of her subordinates or subscribers; but her departure from rules, on due cause of emergency, and her cutting of knots—perhaps even her breaking open of consignments—brought from her official superior, Mr. Sidney Herbert, nothing but commendation and support. One sees this sometimes in his letters to herself, sometimes in those which he addressed to others, and which reflect the impression made upon him by her vigour and resource. “Pray recollect,” he wrote to the senior medical officer (Dec. 1, 1854), “in your demands upon us here, whether for more men, more comforts, or more necessaries, that there is no question of pounds, shillings and pence in such matters, but that whatever can be got must be got.” And to the Purveyor-General he wrote: “This is not a moment for sticking at forms, but for facilitating the rapid and easy transaction of business. There is much mischief done to the public service by the stickling for precedence and dignity between departments.” Thus he wrote to many others also; but he confessed to Mr. Bracebridge that he had “small hopes of these men. I have been writing in this sense before, and in vain; but I trust there is some improvement. They are so saturated with the cheese-paring economy of forty years' peace, that there is no getting them to act up to a great occasion.”124 Miss Nightingale's initiative alone saved the situation.

I have in this chapter separated various illustrations of that initiative from others which, in the preceding chapter, were attributed to “the woman's insight.” But perhaps the separation, though convenient, is imaginary, and all the cases of Miss Nightingale's administrative energy are ascribable to the same cause. Such was Mr. Kinglake's opinion; yet I have always suspected that the exceeding prominence given by him to the woman's touch in Miss Nightingale's work may in part have been caused by a desire to heighten the contrasts, and to barb with deadlier point his brilliant satire upon incompetence in official places. Let those who believe that it is possible to make a sharp delimitation between the “masculine” and the “feminine mind” settle this matter as they may. It seems to me that as there are old women of both sexes, so in both sexes there are men of business. My object in this chapter has been to show that Miss Nightingale brought to bear upon the task which confronted her at Scutari those high powers of the administrative mind, be they masculine or feminine, which, in moments of emergency, are capable of resource, initiative, decision.