« PreviousContinue »
sidered such a bulk of records trouble for extensive use; so that there was some, and ordered them to be burnt! plenty of time for making them clean, Such an act will never be perpetrated airy, warm, and commodious, and for stor. again : but directors will have a more ing them with all conveniences. This manageable mass of documents to deal was not done; and the failure and its with henceforth. With a regular system consequences afford a lesson by which of record, at a central station of observa every people engaged in war should tion, much more may be done with much profit. A mere outline of what was not less fatigue to all parties.
done at Scutari may be an indication of But how is it to be done ? may well what should be done with all convenient be asked. In the hurry and confusion speed elsewhere. of a war, and amidst the pressure of hun There was a catgut manufactory close dreds of new cases in a day, what can at hand, which filled the neighborbood the surgeons of the hospital be expected with stench. Half a dozen dead dogs to do for science, or even for the improve- festered under the windows in the sun; ment of medical and surgical practice ? - and a dead horse lay in the aqueduct for The answer is seen in the new arrange- six weeks. The drain-pipes within the ments in England, where a statistical building were obstructed and had burst, branch has been established in the Army spreading their contents over the floors Medical Department. Of course, no one and walls. The sloping boarded dirans but the practising surgeon or physician in the wards, used for sleeping-places, can furnish the pathological facts in each were found, after the building became individual case; but this is what every crowded, to be a cover for a vast accuactive and earnest practitioner does al- mulation of dead rats, old rags, and the ways and everywhere, when he sees rea dust of years. Like all large stone buildson for it. His note-book or hospital- ings in the East, it was intolerably cold journal provides that raw material which in winter, with its stagnant air, its filthy the statistical department is to arrange damps, and its vaultings and chill floors. and utilize. The result will be that a This wonderful building was very grandflood of light will be cast on matters af- ly reported of to England, for its size fecting the health and life of soldiers and and capacity, its imposing character, and other men, in regard to which we might so forth ; and the English congratulated have gone on groping for centuries among themselves on the luck of the wounded the confusion of regimental records, with in having such a hospital. Yet, in the out getting what we wanted. As to the next January, fourteen hundred and method of proceeding, I may have some eighty were carried out dead. thing to say farther on. Meantime, we It appears that nobody knew how to must turn to the primary object of the go to work. Everybody writes to someinstitution of the Military Hospital, body else to advise them to observe"; the cure of the wounded and sick of the and there are so many assurances that erarmy.
erybody means to “observe," that there In the case of active war, foreign or seems to have been no leisure to effect civil, the General Hospital is usually an anything. One thinks that this, that, or extemporized establishment, the build- the other should be attended to; and an ing a makeshift, and the arrangements other states that the matter is under consuch as the building will admit. In sideration. It was some weeks before Spain, the British obtained any houses anybody got so far in definiteness as to they could get; and the soldiers were propose whitewash. Somebody undersometimes crowded into half a dozen of stood that somebody else was intending them in one town. In the last war, the to have the corridors scoured; and repregreat buildings at Scutari were engaged sentations were to be made to the Turkish three months before they were wanted authorities about getting the drain-pipes
mended. The Turkish authorities wished dispensary planned with a view to the to employ their own workmen in putting utmost saving of time and trouble, so that in the stoves; and on the 18th of Decem- medicines and utensils may be within ber the responsible British officer hoped reach and view, and the freest access althe stoves would be put up immediate- lowed to applicants. The kitchens must ly, but could not be certain, as Turkish have the best stoves and boilers, dressers workmen were in question. This was a and scales, and apparatus of every kind month after large companies of wounded that is known to the time ; for more lives and sick had been sent in from the seat depend on perfect food being adminisof war. Even then, nothing had been tered with absolute punctuality than upon done for ventilation, or, on any sufficient any medical treatment. There must be scale, for putting the poor sufferers com- large and abundant and airy store-places fortably to bed.
for the provisions, and also for such stocks These things confirm the necessity of a of linen and bedding as perhaps nobody regulated coöperation between the sani- ever dreamed of before the Crimean tary, the medical, and the military offi- War. cers of an army. The sanitary officer The fatal notions of Regimental Hosshould be secure of the services of engi- pital management caused infinite misery neers enough to render the hospital, as at Scutari. In entering the Regimental well as the camp, safely habitable. As Hospital, the soldier carries his kit, or soon as any building is taken possession can step into his quarters for it : and the of for a hospital, men and their tools regulations, therefore, suppose him to be should be at command for exploring the supplied with shirts and stockings, towel drains and making new ones,- for cov
brushes and comb. This supering or filling up ditches, - for clearing position was obstinately persevered in at and purifying the water-courses, and lead- Scutari, till private charity had shamed ing in more water, if needed,- for remov- the authorities into providing for the ing all nuisances for a sufficient distance men's wants. When the wounded were round, - and for improving to the utmost brought from the Alma, embarked on the means of access to the house. There crowded transports straight from the batmust be ventilating spaces in the roof, tle-field, how could they bring their kits ? and in the upper part of all the wards Miss Nightingale, and benevolent visitors and passages. Every vaulted space, or from England, bought up at Constantiother receptacle of stagnant air, should nople, and obtained from home, vast suphave a current established through it. plies of body- and bed-linen, towels, baAll decaying wood in the building should sins, and water-cans; and till they did be removed, and any portion ingrained so, the poor patients lay on a single blanwith dirt should be planed clean. A ket or coarse canvas sheet, in their one due water-supply should be carried up shirt, perhaps soaked in blood and dirt. to every story, and provided for the bath- There were some stores in the hospital, rooms, the wash-houses, and the kitchen.
though not enough; and endless difficulEvery edifice in America is likely to be ty was made about granting them, lest already furnished with means of warmth; any man should have brought his kit, and the soldiers are probably in no dan- and thus have a double supply. Amidst ger of shivering over the uncertain prom- the emergencies of active war, it seems ise of stoves on the 18th of December. to be an obvious provision that every
Next comes the consideration of store- General Hospital should have in store, places, which can be going forward while with ample bedding, body-linen enough busy hands are cleaning every inch of for as many patients as can occupy the ceiling, walls, floors, and windows within. beds, — the consideration being kept in There must be sheds and stables for the view, that, where the sick and wounded transport service; and a surgery and are congregated, more frequent changes
of linen are necesssary than under any to have a kitchen of their own. The other circumstances.
very idea of that kitchen was sarory in The excellent and devoted managers
the wards ; for out of it came, always at of the hospitals of the Union army need the right moment, arrowroot, hot and of no teaching as to the daily administra the pleasantest consistence, - rice pudtion of the affairs of the wards. They dings, neither hard on the one hand nor will never have to do and dare the things clammy on the other, cool lemonade for that Miss Nightingale had to decide up the feverish, cans full of hot tea for the on, because they have happily had the weary, and good coffee for the faint. privilege of arranging their hospitals on When the sinking sufferer was lying with their own principles. They will not closed eyes, too feeble to make moan or know the exasperation of seeing sufferers sign, the hospital spoon was put between crowded together on a wooden divan his lips, with the mouthful of strong broth (with an under-stratum of dead rats and or hot wine which rallied him till the rotting rags) while there is an out-house watchful nurse came round again. The full of bedsteads laid up in store under meat from that kitchen was tenderer than lock and key. Not being disposed to ac any other; the beef-tea was more savory. quiesce in such a state of things, and fail One thing that came out of it was a lesing in all attempts to get at the authority son on the saving of good cookery. The which had charge of the locked door, mere circumstance of the boiling water Miss Nightingale called to an orderly or being really boiling there made a differtwo, and commanded them to break open ence of two ounces of rice in every four the door. They stared; but she said she puddings, and of more than half the arassumed the responsibility ; and present rowroot used. The same quantity of arly there were as many men in bed as rowroot which made a pint, thin and poor, there were bedsteads. Her doctrine and in the general kitchen, made two pints, practice have always been, - instant and thick and good, in Miss Nightingale's. silent obedience to medical and disciplina Then there was the difference in readry orders, without any qualification what- iness and punctuality. Owing to cumever; and by her example and teach brous forms and awkward rules, the oring in this respect she at length overcame derlies charged with the business were the jealousy and prejudices of authorities, running round almost all day about the medical and military: but in such a case food for their wards; and the patients as the actual presence of necessaries for were disgusted with it at last. There the sick, sent out by Government or by were endless orders and details, whenever private charity for their use, she claimed the monotonous regular diet was departed the benefit, and helped her patients to it, from ; whereas the establishment of serwhen there was no other obstruction in eral regular diets, according to the classithe way than forms and rules never meant fications in the wards, would have simplito apply to the case.
fied matters exceedingly. When everyWhat the jealousy was appeared through thing for dysentery patients, or for fever very small incidents. A leading medical patients, or for certain classes of woundofficer declared, in giving evidence, that ed was called “extra diet," there were the reason why the patients' meals were special forms to be gone through, and sometimes served late and cold, or half orders and contradictions given, which cooked, was, that Miss Nightingale and threw everything into confusion, under her nurses were forever in the way in the name of discipline. The authority the general kitchen, keeping the cooks of the ward would allow some extra, from the fire : whereas the fact was, that butter, for instance; and then a bigher neither Miss Nightingale nor any nurse authority, seeing the butter, and not had ever entered the general kitchen, on knowing how it came there, would throw any occasion whatever. Their way was it out of the window, as "spoiling the
men." Between getting the orders, and · ties, the system of requisitions might suit getting the meat and extras, and the mu- the period and the parties. Amidst the tual crowding of the messengers, some of rapid action and sharp emergencies of the dinners were not put on the fire till war it is out of place. It was found inan hour or two after the fainting patient tolerable that nothing whatever could be should have had his meal: and then, of had, — not a dose of medicine, nor a course, he could not take it. The cold candle, nor a sheet, nor a spoon or dish, mutton-chop with its opaque fat, the beef nor a bit of soap,— without a series of perwith its caked gravy, the arrowroot stiff mits, and applications, and orders, and and glazed, all untouched, might be seen vouchers, which frittered away the preby the bedsides in the afternoons, while cious hours, depressed the sick, worried the patients were lying back, sinking for their nurses, and wasted more of money's want of support. Probably the dinners
worth in official time, paper, and expenhad been brought up on a tray, cooling sive cross-purposes than could possibly all the way up-stairs and along the corri- have been saved by all the ostentatious dors; and when brought in, there was vigilance of the method. The deck-loads the cutting up, in full view of the intend- of vegetables at Balaklava, thrown overed eaters, — sometimes on the orderly's board because they were rotten before own bed, when the tables were occupied. they were drawn, were not the only Under such a system, what must it have stores wasted for want of being asked for. been to see the quick and quiet nurses en- When the Scutari hospitals had become ter, as the clock struck, with their hot-wa- healthy and comfortable, there was a thorter tins, hot morsels ready-cut, hot plates, ough opening-out of all the stores which bright knife and fork and spoon, - and had before been made inaccessible by all ready for instant eating! This was forms. No more bedsteads, no more limea strong lesson to those who would learn; juice; no more rice, no more beer, no and in a short time there was a great more precious medicines were then lockchange for the better. The patients who ed away, out of the reach or the knowlwere able to sit at table were encouraged edge of those who were dying, or seeing to rise, and dress, and dine in cheerful others die, for want of them. company, and at the proper hour. It One miserable consequence of the was discovered, that, if an alternation was cumbrous method was, that there was no provided of soups, puddings, fish, poul- certainty at any hour of some essential try, and vegetables, with the regular beef commodity not falling short. It would dinner, the great mass of trouble about have been a dismal day for the most sufextras was swept away at once ; for these fering of the patients when there was not varieties met every case in hospital ex- fuel enough to cook “extras,” if Miss cept the small number which required Nightingale had not providently bought slops and cordials, or something very un
four boat-loads of wood to meet such a usual. By this clearance, time was saved contingency. It was a dreadful night in to such an extent that punctuality be- the hospital, when, as cholera patients came possible, and the refusal of food al- were brought in by the score, the surmost ceased.
geons found there were no candles to be All these details point to the essential had. In that disease, of all maladies, badness of the system of requisitions. In they had to tend their patients in the the old days, when war was altogether a dark all night; and a more shocking mass of formalities, — and in peace times, scene can scarcely be conceived. when soldiers and their guardians had Every great influx of patients was ternot enough to do, and it was made an rible, whether from an epidemic or after ohject and employment to save the na- a battle; but experience and devotedtional property by hedging round all ex- ness made even this comparatively easy penditure of that property with difficul- before the troops turned homewards.
The arrival of a transport was, perhaps, the cases which were not hopeless. And the first intimation of the earlier battles. Florence Nightingale was right in findThen all was hurry-skurry in the hospi- ing time, if she could, to see whether tals ; everybody was willing to help, but there was really no chance. She ascerthe effectual organization was not yet tained that these five were absolutely ready.
given over; and she and her assistants Of every hundred on board the trans- managed to attend to them through the port, an average of ten had died since night. She cleaned and comforted them, leaving the Crimea. The names and and had spoonfuls of nourishment ready causes of death of these men ought to be whenever they could be swallowed. By recorded; but the surgeons of the trans- the morning round of the surgeons,
these port are wholly occupied in despatching men were ready to be operated upon; their living charge to the hospital ; and and they were all saved. the surgeons there have enough to do in It would have been easier work at a receiving them. Attempts are made to later period. Before many months were obtain the number and names and in- over, the place was ready for any numjuries of the new patients : there may or ber to be received in peace and quietmay not be a list furnished from the ness. Instead of being carried from one ship; and the hospital surgeons inquire place to another, because too many bad from bed to bed : but in such a scene been sent to one hospital and too few to mistakes are sure to arise ; and it was another, the poor fellows were borne in found, in fact, that there was always more the shortest and easiest way from the or less variation between the numbers boat to their beds. They were found recorded as received or dead and the eager for cleanliness; and presently they proper number. No one could wonder were clean accordingly, and lying on a at this who had for a moment looked up good bed, between clean, soft sheets. on the scene. The poor fellows just ar- They did not come in scorbutic, like their rived had perhaps not had their clothes predecessors; and they had no reason to off since they were wounded or were dread hospital gangrene or fever. Every seized with cholera, and they were steep- floor and every pane in the windows was ed in blood and filth, and swarming with clean ; and the air came in pure from vermin. To obtain shirts and towels was the wide, empty corridors. There was hard work, because it had to be proved a change of linen whenever it was desirthat they brought none with them. They ed; and the shirts came back from the were laid on the floor in the corridors, as wash perfectly sweet and fresh. The close as they could be packed, thus breath- cleaning of the wards was done in the ing and contaminating the air which was mornings, punctually, quickly, quietly, to have refreshed the wards within. If and thoroughly. The doctors came round, laid upon so-called sheets, they entreated attended by a nurse who received the that the sheets might be taken away; for orders, and was afterwards steady in the they were of coarse canvas, intolerable fulfilment of them. The tables of the to the skin. Before the miserable com- medicines of the day were hung up in pany could be fed, made clean, and treat- the ward; and the nurse went round to ed by the surgeons, many were dead; administer them with her own hand. and a too large proportion were never to Where she was, there was order and leave the place more, though struggling quietness all day, and the orderlies were for a time with death. It was amidst such worth twice as much as before the woma scene that Florence Nightingale refus- en came. Their manners were better; ed to despair of five men so desperately and they gave their minds more to their wounded as to be set aside by the sur- business. The nurse found time to suit geons. The surgeons were right. As each patient who wished it with a book they said, their time was but too little for newspaper, when gifts of that sort