sidered such a bulk of records troublesome, and ordered them to be burnt! Such an act will never be perpetrated again but directors will have a more manageable mass of documents to deal with henceforth. With a regular system of record, at a central station of observation, much more may be done with much less fatigue to all parties.

But how is it to be done? may well be asked. In the hurry and confusion of a war, and amidst the pressure of hundreds of new cases in a day, what can the surgeons of the hospital be expected to do for science, or even for the improvement of medical and surgical practice? — The answer is seen in the new arrangements in England, where a statistical branch has been established in the Army Medical Department. Of course, no one but the practising surgeon or physician can furnish the pathological facts in each individual case; but this is what every active and earnest practitioner does always and everywhere, when he sees reason for it. His note-book or hospitaljournal provides that raw material which the statistical department is to arrange and utilize. The result will be that a flood of light will be cast on matters affecting the health and life of soldiers and other men, in regard to which we might have gone on groping for centuries among the confusion of regimental records, without getting what we wanted. As to the method of proceeding, I may have something to say farther on. Meantime, we must turn to the primary object of the institution of the Military Hospital,the cure of the wounded and sick of the army.

for extensive use; so that there was plenty of time for making them clean, airy, warm, and commodious, and for storing them with all conveniences. This was not done; and the failure and its consequences afford a lesson by which every people engaged in war should profit. A mere outline of what was not done at Scutari may be an indication of what should be done with all convenient speed elsewhere.

There was a catgut manufactory close at hand, which filled the neighborhood with stench. Half a dozen dead dogs festered under the windows in the sun; and a dead horse lay in the aqueduct for six weeks. The drain-pipes within the building were obstructed and had burst, spreading their contents over the floors and walls. The sloping boarded divans in the wards, used for sleeping-places, were found, after the building became crowded, to be a cover for a vast accumulation of dead rats, old rags, and the dust of years. Like all large stone buildings in the East, it was intolerably cold in winter, with its stagnant air, its filthy damps, and its vaultings and chill floors. This wonderful building was very grandly reported of to England, for its size and capacity, its imposing character, and so forth; and the English congratulated themselves on the luck of the wounded in having such a hospital. Yet, in the next January, fourteen hundred and eighty were carried out dead.

It appears that nobody knew how to go to work. Everybody writes to somebody else to advise them to "observe"; and there are so many assurances that everybody means to "observe," that there seems to have been no leisure to effect anything. One thinks that this, that, or the other should be attended to; and another states that the matter is under consideration. It was some weeks before anybody got so far in definiteness as to propose whitewash. Somebody understood that somebody else was intending to have the corridors scoured; and representations were to be made to the Turkish authorities about getting the drain-pipes

mended. The Turkish authorities wished to employ their own workmen in putting in the stoves; and on the 18th of December the responsible British officer hoped the stoves would be put up immediately, but could not be certain, as Turkish workmen were in question. This was a month after large companies of wounded and sick had been sent in from the seat of war.

Even then, nothing had been done for ventilation, or, on any sufficient scale, for putting the poor sufferers comfortably to bed.

These things confirm the necessity of a regulated cooperation between the sanitary, the medical, and the military officers of an army. The sanitary officer should be secure of the services of engineers enough to render the hospital, as well as the camp, safely habitable. As soon as any building is taken possession of for a hospital, men and their tools should be at command for exploring the drains and making new ones,- for covering or filling up ditches, for clearing and purifying the water-courses, and leading in more water, if needed,- for removing all nuisances for a sufficient distance round, and for improving to the utmost the means of access to the house. There must be ventilating spaces in the roof, and in the upper part of all the wards and passages. Every vaulted space, or other receptacle of stagnant air, should have a current established through it. All decaying wood in the building should be removed, and any portion ingrained with dirt should be planed clean. A due water-supply should be carried up to every story, and provided for the bathrooms, the wash-houses, and the kitchen. Every edifice in America is likely to be already furnished with means of warmth; and the soldiers are probably in no danger of shivering over the uncertain promise of stoves on the 18th of December.

Next comes the consideration of storeplaces, which can be going forward while busy hands are cleaning every inch of ceiling, walls, floors, and windows within. There must be sheds and stables for the transport service; and a surgery and

dispensary planned with a view to the utmost saving of time and trouble, so that medicines and utensils may be within reach and view, and the freest access allowed to applicants. The kitchens must have the best stoves and boilers, dressers and scales, and apparatus of every kind that is known to the time; for more lives depend on perfect food being administered with absolute punctuality than upon any medical treatment. There must be large and abundant and airy store-places for the provisions, and also for such stocks of linen and bedding as perhaps nobody ever dreamed of before the Crimean War.

The fatal notions of Regimental Hospital management caused infinite misery at Scutari. In entering the Regimental Hospital, the soldier carries his kit, or can step into his quarters for it and the regulations, therefore, suppose him to be supplied with shirts and stockings, towel and soap, brushes and comb. This supposition was obstinately persevered in at Scutari, till private charity had shamed the authorities into providing for the men's wants. When the wounded were brought from the Alma, embarked on crowded transports straight from the battle-field, how could they bring their kits? Miss Nightingale, and benevolent visitors from England, bought up at Constantinople, and obtained from home, vast supplies of body- and bed-linen, towels, basins, and water-cans; and till they did so, the poor patients lay on a single blanket or coarse canvas sheet, in their one shirt, perhaps soaked in blood and dirt. There were some stores in the hospital, though not enough; and endless difficulty was made about granting them, lest any man should have brought his kit, and thus have a double supply. Amidst the emergencies of active war, it seems to be an obvious provision that every General Hospital should have in store, with ample bedding, body-linen enough for as many patients as can occupy the beds, the consideration being kept in view, that, where the sick and wounded are congregated, more frequent changes

of linen are necesssary than under any other circumstances.

The excellent and devoted managers of the hospitals of the Union army need no teaching as to the daily administration of the affairs of the wards. They will never have to do and dare the things that Miss Nightingale had to decide upon, because they have happily had the privilege of arranging their hospitals on their own principles. They will not know the exasperation of seeing sufferers crowded together on a wooden divan (with an under-stratum of dead rats and rotting rags) while there is an out-house full of bedsteads laid up in store under lock and key. Not being disposed to acquiesce in such a state of things, and failing in all attempts to get at the authority which had charge of the locked door, Miss Nightingale called to an orderly or two, and commanded them to break open the door. They stared; but she said she assumed the responsibility; and presently there were as many men in bed as there were bedsteads. Her doctrine and practice have always been,— instant and silent obedience to medical and disciplinary orders, without any qualification whatever; and by her example and teaching in this respect she at length overcame the jealousy and prejudices of authorities, medical and military: but in such a case as the actual presence of necessaries for the sick, sent out by Government or by private charity for their use, she claimed the benefit, and helped her patients to it, when there was no other obstruction in the way than forms and rules never meant to apply to the case.

What the jealousy was appeared through very small incidents. A leading medical officer declared, in giving evidence, that the reason why the patients' meals were sometimes served late and cold, or halfcooked, was, that Miss Nightingale and her nurses were forever in the way in the general kitchen, keeping the cooks from the fire whereas the fact was, that neither Miss Nightingale nor any nurse had ever entered the general kitchen, on any occasion whatever. Their way was

to have a kitchen of their own. The very idea of that kitchen was savory in the wards; for out of it came, always at the right moment, arrowroot, hot and of the pleasantest consistence,―rice puddings, neither hard on the one hand nor clammy on the other, cool lemonade for the feverish, cans full of hot tea for the weary, and good coffee for the faint. When the sinking sufferer was lying with closed eyes, too feeble to make moan or sign, the hospital spoon was put between his lips, with the mouthful of strong broth or hot wine which rallied him till the watchful nurse came round again. The meat from that kitchen was tenderer than any other; the beef-tea was more savory. One thing that came out of it was a lesson on the saving of good cookery. mere circumstance of the boiling water being really boiling there made a difference of two ounces of rice in every four puddings, and of more than half the arrowroot used. The same quantity of arrowroot which made a pint, thin and poor, in the general kitchen, made two pints, thick and good, in Miss Nightingale's.

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Then there was the difference in readiness and punctuality. Owing to cumbrous forms and awkward rules, the orderlies charged with the business were running round almost all day about the food for their wards; and the patients were disgusted with it at last. There were endless orders and details, whenever the monotonous regular diet was departed from; whereas the establishment of several regular diets, according to the classifications in the wards, would have simplified matters exceedingly. When everything for dysentery patients, or for fever patients, or for certain classes of wounded was called "extra diet," there were special forms to be gone through, and orders and contradictions given, which threw everything into confusion, under the name of discipline. The authority of the ward would allow some extra,butter, for instance; and then a higher authority, seeing the butter, and not knowing how it came there, would throw it out of the window, as "spoiling the

men." Between getting the orders, and getting the meat and extras, and the mutual crowding of the messengers, some of the dinners were not put on the fire till an hour or two after the fainting patient should have had his meal: and then, of course, he could not take it. The cold mutton-chop with its opaque fat, the beef with its caked gravy, the arrowroot stiff and glazed, all untouched, might be seen by the bedsides in the afternoons, while the patients were lying back, sinking for want of support. Probably the dinners had been brought up on a tray, cooling all the way up-stairs and along the corridors; and when brought in, there was the cutting up, in full view of the intended eaters, sometimes on the orderly's own bed, when the tables were occupied. Under such a system, what must it have been to see the quick and quiet nurses enter, as the clock struck, with their hot-water tins, hot morsels ready-cut, hot plates, bright knife and fork and spoon, — and all ready for instant eating! This was a strong lesson to those who would learn ; and in a short time there was a great change for the better. The patients who were able to sit at table were encouraged to rise, and dress, and dine in cheerful company, and at the proper hour. It was discovered, that, if an alternation was provided of soups, puddings, fish, poultry, and vegetables, with the regular beef dinner, the great mass of trouble about extras was swept away at once; for these varieties met every case in hospital except the small number which required slops and cordials, or something very unusual. By this clearance, time was saved to such an extent that punctuality became possible, and the refusal of food almost ceased.

ties, the system of requisitions might suit the period and the parties. Amidst the rapid action and sharp emergencies of war it is out of place. It was found intolerable that nothing whatever could be had, not a dose of medicine, nor a candle, nor a sheet, nor a spoon or dish, nor a bit of soap,- without a series of permits, and applications, and orders, and vouchers, which frittered away the precious hours, depressed the sick, worried their nurses, and wasted more of money's worth in official time, paper, and expensive cross-purposes than could possibly have been saved by all the ostentatious vigilance of the method. The deck-loads of vegetables at Balaklava, thrown overboard because they were rotten before they were drawn, were not the only stores wasted for want of being asked for. When the Scutari hospitals had become healthy and comfortable, there was a thorough opening-out of all the stores which had before been made inaccessible by forms. No more bedsteads, no more limejuice, no more rice, no more beer, no more precious medicines were then locked away, out of the reach or the knowledge of those who were dying, or seeing others die, for want of them.

One miserable consequence of the cumbrous method was, that there was no certainty at any hour of some essential commodity not falling short. It would have been a dismal day for the most suffering of the patients when there was not fuel enough to cook "extras," if Miss Nightingale had not providently bought four boat-loads of wood to meet such a contingency. It was a dreadful night in the hospital, when, as cholera patients were brought in by the score, the surgeons found there were no candles to be had. In that disease, of all maladies, they had to tend their patients in the dark all night; and a more shocking scene can scarcely be conceived.

Every great influx of patients was terrible, whether from an epidemic or after a battle; but experience and devotedness made even this comparatively easy before the troops turned homewards.

The arrival of a transport was, perhaps, the first intimation of the earlier battles. Then all was hurry-skurry in the hospitals; everybody was willing to help, but the effectual organization was not yet ready.

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Of every hundred on board the transport, an average of ten had died since leaving the Crimea. The names and causes of death of these men ought to be recorded; but the surgeons of the transport are wholly occupied in despatching their living charge to the hospital; and the surgeons there have enough to do in receiving them. Attempts are made to obtain the number and names and injuries of the new patients: there may or may not be a list furnished from the ship; and the hospital surgeons inquire from bed to bed: but in such a scene mistakes are sure to arise; and it was found, in fact, that there was always more or less variation between the numbers recorded as received or dead and the proper number. No one could wonder at this who had for a moment looked on the scene. The poor fellows just arrived had perhaps not had their clothes off since they were wounded or were seized with cholera, and they were steeped in blood and filth, and swarming with vermin. To obtain shirts and towels was hard work, because it had to be proved that they brought none with them. They were laid on the floor in the corridors, as close as they could be packed, thus breathing and contaminating the air which was to have refreshed the wards within. If laid upon so-called sheets, they entreated that the sheets might be taken away; for they were of coarse canvas, intolerable to the skin. Before the miserable company could be fed, made clean, and treated by the surgeons, many were dead; and a too large proportion were never to leave the place more, though struggling for a time with death. It was amidst such a scene that Florence Nightingale refused to despair of five men so desperately wounded as to be set aside by the surgeons. The surgeons were right. As hey said, their time was but too little for

the cases which were not hopeless. And Florence Nightingale was right in finding time, if she could, to see whether there was really no chance. She ascertained that these five were absolutely given over; and she and her assistants managed to attend to them through the night. She cleaned and comforted them, and had spoonfuls of nourishment ready whenever they could be swallowed. By the morning round of the surgeons, these men were ready to be operated upon; and they were all saved.

It would have been easier work at a later period. Before many months were over, the place was ready for any number to be received in peace and quietness. Instead of being carried from one place to another, because too many had been sent to one hospital and too few to another, the poor fellows were borne in the shortest and easiest way from the boat to their beds. They were found eager for cleanliness; and presently they were clean accordingly, and lying on a good bed, between clean, soft sheets. They did not come in scorbutic, like their predecessors; and they had no reason to dread hospital gangrene or fever. Every floor and every pane in the windows was clean; and the air came in pure from the wide, empty corridors. There was a change of linen whenever it was desired; and the shirts came back from the wash perfectly sweet and fresh. The cleaning of the wards was done in the mornings, punctually, quickly, quietly, and thoroughly. The doctors came round, attended by a nurse who received the orders, and was afterwards steady in the fulfilment of them. The tables of the medicines of the day were hung up in the ward; and the nurse went round to administer them with her own hand. Where she was, there was order and quietness all day, and the orderlies were worth twice as much as before the women came. Their manners were better; and they gave their minds more to their business. The nurse found time to suit each patient who wished it with a book or a newspaper, when gifts of that sort