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Florence Nightingale and the Crimean War
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"You are, I know, well aware of the high sense I entertain of the Christian devotion
which you have displayed during this great and bloody war, and I need hardly repeat
to you how warm my admiration is for your services, which are fully equal to those of
my dear and brave soldiers, whose sufferings you have had the privilege of alleviating
in so merciful a manner. I am, however, anxious of marking my feelings in a manner which
I trust will be agreeable to you and therefore send you with this letter a brooch,
the form and emblems of which commemorate your great and blessed work and which,
I hope, you will wear as a mark of the high approbation of your sovereign!
It will be a very great satisfaction to me, when you return at last to these shores, to make the acquaintance of one who has set so bright an example to our sex. And with every prayer for the preservation of your valuable health, believe me, always, yours sincerely, Victoria R. |
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The British public first became aware of the squalor of the hospitals in Scutari when
William Howard Russell, reporter to the Times, had his first despatch published in the Times
on 9th October 1854. Until then people were unaware of how bad conditions were for the forces
in the Crimea. Further despatches published on 12th and 13th October revealed that the situation
was critical. Around twenty seven thousand British troops had crossed the Black Sea from Varna
to Kalamita Bay, packed into transports filled with cholera victims. Those victims, once dead
were flung overboard, came bobbing to the surface as they decomposed. The men were weak and dying of cholera.
The hospital at Scutari had been given by the Turks to the British to deal with the wounded. This cholera epidemic was the first unforeseen challenge in a hospital lacking beds, furniture. Reports of its day revealed it to be filthy and damp and totally unsuitable to be used as a hospital. |
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The British army at that time was responsible to two people, the Secretary of State for War
and the Secretary of State at War. The latter was Sidney Herbert. He took responsibility for
the chaos and took action to meet the disaster. One of the first things Sidney Herbert did
was to appoint Florence Nightingale. On 21st October 1854, four days after Sidney Herbert's
letter of appointment, Florence Nightingale and thirty eight nurses set off for Scutari.
Nightingale had been told by Dr. Andrew Smith that she would have all the medical supplies she needed. Instead she found the hospital to be in an appalling state and in urgent need of basic equipment. |
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| Ten days before her arrival the battle of Balaclava had seen an influx of wounded soldiers entering the hospital. Yet the hospital was totally incapable of carrying out adequate medical procedures. There was no table in the hospital, not even for operating on, nothing to cook with; the place was full of rats and full of drunken prostitutes. | ||
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Cecil Woodham Smith, wrote about the Barrack's hospital:
"The filth became indescribable. The men in the corridors lay on unwashed rotten floors crawling with vermin. As the Rev. Sidney Godolphin Osborne knelt to take down dying messages his paper became covered thickly in lice. There were no pillows, no blankets; the men lay, with their heads on their boots, wrapped in the blanket or greatcoat stiff with blood and filth which had been their sole covering perhaps for more than a week. There were no screens or operating tables. Amputations had to be performed in the wards in full sight of the patients." Rev. Sidney Godolphin Osborn, himself wrote the following description of the amputation of a thigh:"Done upon boards put on two trestles, I assisted ... during the latter part of the operation the man's position became such from want of a table he was supported by my arm underneath, a surgeon on the other side grasping my wrist." |
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One of the first things Florence Nightingale did was to get a screen from Constantinople so that
patients didn't have to watch operations.
Florence Nightingale began her work by setting her women to work on what linen there was,
and making pillows, stump rests and slings. Nightingale instructed her nurses that no woman was to
set foot in a ward until a doctor invited her. For four days dying men were left untended whilst
the nurses were not invited into the wards.
Next Nightingale turned her attention to feeding arrangements. Many of the sick were starving and those who did eat were poisoned by ill cooked solids when they should have been on an invalid diet. There was chaos as to who held which responsibilities. Soon however, with the barracks full from the battle of Balaclava, Nightingale and her nurses were invited into the wards. In her biography Elizabeth Huxley writes: "It was the arrival of casualties from the battle of Balaclava, fought on 25th October 1854, followed by the repulse of the Russian attack on Inkerman on 5th November that broke the Doctors' resistance to 'the bird' and her flock at Scutari. The trickle of sick and wounded became a flood. These men had endured already perhaps eight or nine days passage from the Crimean peninsula in ill-equipped vessels, rolling about the open decks often without drugs, dressings or even blankets…" Thus Nightingale and her team of nurses were invited into the wards where they helped men suffering from frostbite, dysentery, cholera and exhaustion. |
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In a letter to Sidney Herbert she explained:
"When we came here, there was neither basin, towel, nor soap in the Wards, nor any means of personal
cleanliness for the wounded except for the following. Thirty were bathed every night by Dr.
Macgrigor's orders in slipper-baths, but this does not do more than include a washing once in
eighty days for 2300 men.
(25th November 1854) |
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Over a thousand men were suffering from acute diarrhoea when Nightingale went to Scutari.
There were only twenty chamber pots, the toilets were in such a disgusting state they could not be used.
Mr. Augustus Strafford reported that "There was liquid filth which floated over the floor an inch deep and came out of the privy itself into the ante room." He told the Roebuck committee that had been set up when Aberdeen proved to be inept in handling the conduct of the war. In January 1855 John Arthur Roebuck, MP for Sheffield, proposed a Committee of Inquiry to investigate the conduct of the war. The committee concluded that the state of the hospitals was 'disgraceful' |
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"The majority of the cases at the Barrack hospital were suffering from diarrhoea, they had no slippers, and no shoes and they had to go into this filth so that gradually they did not trouble to go into the lavatory chamber itself" Huge wooden tubs stood in the wards and corridors for the men to use. Understandably, the orderlies disliked the task of emptying the tubs and so they remained unemptied for twenty four hours at a time. In this filth lay the men's food. Florence Nightingale herself reported that she had seen the skinned carcase of a sheep lie in a ward all night. Another crisis occurred on November 14th where a hurricane sank two transports of medical supplies. Florence Nightingale had both the money and authority to help in the increasing disaster. She purchased 200 scrubbing brushes to clean the floors and insisted that the huge wooden tubs be emptied. She organised the washing of the men's clothes. One official had stated that for five weeks after he arrived at Scutari no washing was done at all. Florence Nightingale made arrangements to rent a house outside the barracks and have the washing done by soldiers' wives. Boilers were installed. Cecil Woodham Smith in his famous biography of Florence Nightingale wrote: "By the end of December Miss Nightingale was in fact purveying the hospital. During a period of two months she supplied, on requisition of medical officers, about 6,000 shirts, 2000 socks and 500 pairs of pants. She supplied nightcaps, slippers, plates, tin cups, knives, forks, spoons, trays, tables, forms, clocks, operating tables, scrubbers, towels, soap, screens". |
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In the many letters she wrote to Sidney Herbert, Florence Nightingale documented the progress she was making. In an early letter she explained:
"What we may be considered as having effected:
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As the winter weather worsened, the Scutari hospitals were deluged with severe cases of gangrene,
frostbite, dysentery and many other serious illnesses. There were more men in hospital than there
were in the camps above Sebastol.
Nightingale in one of her many reports to Sidney Herbert described the conditions: "The state of the troops, who return here, particularly those (about 500) who were admitted on the 19th, is frost-bitten, demi-nude, starved, ragged. If the troops, who work in the trenches, are not supplied with warm clothing, Napoleon's Russian Campaign will be repeated here. " (Christmas Day 1854) |
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Nightingale was sure that the Barrack hospital could be made into a centre of excellence.
She insisted that the Purveyor's department should have adequate stores so that the staff and
patients had long term supplies, rather than relying from day to day. She also insisted on the
importance of careful record keeping of exactly how many beds were in all the hospitals, how
many were ready for use, how many patients were arriving, and the regular inspection of patients' diets,
kitchens, laundry and cleaning.
She wrote in a letter to Sidney Herbert: "I am afraid to get back today to my immense first question how this hospt. Is to be purveyed – how, instead of living hand to mouth, -we pouring in stores which are to be renewed again every 4 or 5 weeks, the men having left with all the stores on their backs – we ought to know (1) exactly how many beds there are in the hospital … ready for use, (2) how many are vacant, (3) how many patients to come in, - each ward ought to have its own complement of shirts, socks, bedding, utensils, etc.,etc.,etc. – The new sick succeeding to the old sick things – instead of keeping a Caravanserai (Turkish desert encampment where people and animals sleep together) as we do … I will send you a picture of my caravanserai, into which beasts come in and out. Indeed the vermin might, if they had but 'unity of purpose' carry off the four miles of beds on their backs and march them into the war office" |
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The four mile corridor referred to here by Nightingale, at the barrack hospital was crammed with patients.
Fanny Taylor, one of Mary Stanley's ladies, a group of nurses sent against Nightingale's wishes wrote: "It seemed an endless walk and was not easily forgotten. As we slowly passed along, the silence was profound; Very seldom did a moan or cry from those multitudes of deeply suffering ones fall on our ears. A dim light burnt here and there. Miss Nightingale carried her lantern, which she would set down before she bent over any of the patients. I much admired Miss Nightingale's manner to the men – it was so tender and kind... the hospital was crowded to its fullest extent. The building, which has since been reckoned to hold, with comfort, seventeen hundred men, then held between three and four thousand." Equally a soldier in the Barrack hospital wrote: "What a comfort it was to see her pass even. She would speak to one and nod and smile to as many more. But she could not do it all you know. We lay there by hundreds, but we could kiss her shadow as it fell and lay our heads on the pillow again content" |
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Not surprisingly Florence Nightingale has become a romanticised figure as expressed in Longfellow's poem: |
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Whene'er a noble deed is wrought,
Whene'er is spoken a noble thought, our hearts, in glad surprise, to higher levels rise. The tidal wave of deeper souls Into our inmost being rolls, And lifts us unawares Out of all meaner cares. Honor to those whose words or deeds Thus help us in our daily needs, And by their overflow Raise us from what is low! |
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Thus thought I, as by night I read Of the great army of the dead, The trenches cold and damp, The starved and frozen camp, |
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The wounded from the battle-plain,
In dreary hospitals of pain, The cheerless corridors, The cold and stony floors. Lo! in that house of misery A lady with a lamp I see Pass through the glimmering gloom, And flit from room to room. And slow, as in a dream of bliss, The speechless sufferer turns to kiss Her shadow, as it falls Upon the darkening walls. As if a door in heaven should be Opened, and then closed suddenly, The vision came and went, The light shone was spent. On England's annals, through the long Hereafter of her speech and song, That light its rays shall cast From portals of the past. A lady with a lamp shall stand In the great history of the land, A noble type of good, Heroic womanhood. Nor even shall be wanting here The palm, the lily, and the spear, The symbols that of yore Saint Filomena bore. by Henry Wadsworth Longfellow 1857 |
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Although Nightingale was legendary as the lady of the lamp, in reality she promoted some much needed
down to earth reforms. War supplies were often stolen, held up by the Turks, or shipped to the wrong
destinations. Nightingale proposed a government storehouse where goods could be unloaded and
registered a ship to storekeeper's receipt. She devised ways to avoid the chaos of the purveyor's system.
As soon as she was advised that a ship had docked she would petition the military authorities to intercept
the supplies heading for the hospital stores. She knew by now that once they came into the control of
the purveyor she might never see them.
Barbara Montgomery Dossey in her biography 'Florence Nightingale, Mystic, Visionary, Healer' explains how Nightingale had to search the purveyor's store almost daily to get the supplies she needed. Often the necessary supplies were not there. By this time the purveyor's department seemed to have broken down completely. Nightingale bypassed the purveyor and sent her assistants to the Grand Bazaar to purchase supplies or else she ordered them from Marseilles. |
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In addition, Florence Nightingale, proposed reforming the hospital administration according to three specific jobs
i) To provide food ii) To supply hospital furniture and clothing iii)To establish an orderly daily routine Again, these were functions that belonged to the purveyors department but were being neglected. She asked for a Commissariat Officer to stay at the Barrack hospital to organise the correct diet for patients. Alexis Benoit Soyer, renowned chef of the Reform club in London came to Scutari in March 1855 to correct deficiencies in the hospital kitchens. At Nightingale's request he recruited and trained cooks. |
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Once Florence Nightingale felt that the Barrack hospital was in a satisfactory condition she decided to go
to the Crimean hospitals. Nightingale gained approval from the war office in the spring of 1855 to make her
first trip to the Crimea to inspect the hospitals there. During her stay in the Crimea, Nightingale actively
investigated the hospitals and regiments and attended to business matters in connection with the various
nursing groups.
Many biographers explain how Nightingale was fearless of contracting disease and again in the Crimea attended to patients who were seriously ill and with dangerous fever. According to Dossey's account when Alexis Soyer expressed distress over the length of time she spent with one infectious soldier, Nightingale said that she had seen too many cases to dread the experience of infection. |
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However, in spite of her confidence, on May 12th she contracted Crimean fever. On March 24th London was informed
that she was out of danger. Although advised to return to England to fully recover she stayed in the east as
she wanted to stay until the last soldier had returned to England. Her aunt Mai was sent for at this time and
wrote about her work :
"She has attained a most wonderful calm. No irritation of temper, no hurry or confusion of manner ever appears for a moment. Food, rest, temperature, never interfere with her work" By August Nightingale was back to work. She spent much time documenting the organisational chaos of the British army, generating an enormous correspondence to Doctors both in the east and back in England and to various government officials. Again her Aunt mai wrote: "..Hers is perplexing brainwork…she habitually write till 1 or 2, sometimes 3 or 4 (AM); has in the last pressure given up three whole nights to it … … she is extremely quick and clear" Back in England Nightingale had become a heroine. In spite of political wrangling in the Crimea, Nightingale was loved at home and she knew it. She said: "There is not an official who would not burn me like Joan of Arc if he could, but they know that the War Office cannot turn me out because the country is with me" Souvenirs were made; race horses and lifeboats were named after her. Money was saved to make a presentation to her but so much was received it was decided to set up a Nightingale fund to help establish an institute for the training of nurses. It was suggested that the soldiers contribute a day's pay to the fund. The troops raised nearly nine thousand pounds. In November 1855 the following resolution was drafted by a committee including the Lord Chief Justice, the Speaker of the House and the Secretary of State for War, Lord Panmure: 1. The noble exertions of Miss Nightingale in the hospitals of the East demand the grateful recognition of the British people. 2. That while it is known that Miss Nightingale would decline any such recognition merely personal to herself it is understood that she will accept it in a form that may enable her, on her return to England to establish a permanent institution for the training, sustenance and protection of nurses and to arrange for their proper instruction and employment in … hospitals. 3. That to accomplish this object on a scale worthy of the nation and honourable to Miss Nightingale herself, a public subscription be opened to which all classes be invited to contribute and application be made for the 'red; (high ranking) of the clergy, the mayors of corporate towns and other available sources of assistance. 4. That the sums thus collected be applied to these objects according to the discretion of Miss Nightingale and under regulations formed by herself, the subscribers have entire confidence in her tried energy and judgement." |
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However, although strongly supported Nightingale also experience strong opposition. Throughout her work in the
Crimea she had encountered various difficulties and her work was made particularly difficult by Dr John Hall.
He was responsible for the army medical services. After a single visit to Scutari back in 1854 he had reported
that "The whole hospital establishment here is on a very creditable footing and nothing is lacking"
At a time when chloroform was coming into general usage Hall was famed for advising his officers that: "The smart use of the knife is a powerful stimulant and it is much better to hear a man bawl lustily than to see him sink silently into the grave" Many officials like Lord Stratford de Redcliffe accepted Hall's recommendations. The Times had gathered a fund for medical supplies for the hospital, but following Hall's optimistic report it was suggested that the fund should be devoted to building an Anglican church in Constantinople instead. Throughout her work Nightingale battle with bureaucracy and had many difficulties that were caused by Hall. Later in 1855 Hall forwarded a report by the Chief purveyor, which accused Nightingale of insubordination and her nurses of dishonesty, extravagance, disobedience, inefficiency and immorality". There followed a long battle of words, letters and meetings between the British government and those trying to blacken Florence Nightingale's name. In 1856 a commission into the supply of the British army in the Crimea put a report before parliament. It confirmed all that Nightingale had reported. On March 16th 1856 a despatch was published stating Florence Nightingale's position of authority: "Miss Nightingale is recognised by her majesty's government as General Superintendent of the female nursing establishment of the military hospitals of the army" Flattering as it was, the accolade was a little late as peace was declared in April 1856. Interestingly John Hall, in spite of a minor defeat in his battle with Nightingale, was awarded the K.C.B – the Knight Commander of Bath. In 1856 Florence Nightingale returned to England as a national heroine. However, she hid from public accolade and attention and quietly continued what she considered to be her priority – ensuring that the government learnt from its mistakes in the war. Shocked by the lack of hygiene and elementary care that the men received in the British Army, Nightingale decided to begin a campaign to improve the quality of nursing in military hospitals. In October, 1856, she had a long interview with Queen Victoria and Prince Albert and the following year gave evidence to the 1857 Sanitary Commission. This eventually resulted in the formation of the Army Medical College. For many biographers, Florence Nightingale's greatest achievement was to raise nursing to the level of a respectable profession for women. The introduction of female nurses to the military hospitals was at its time considered an outstanding success. Equally her reforms have influenced the nature of modern health care and her writings continue to be a resource for nurses, health managers and planners. However, in her own lifetime, she avoided the public adoration that many wanted to give her and spoke of the grim reality of her time in the Crimea: "No one can feel for the army as I do. People must have seen that long dreadful winter to know what it was. I can never forget" |
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Bibliography
Sue M. Goldie. Florence Nightingale, Letters from the Crimea 1854-1856. 1977 Raymond G. Hebert. Florence Nightingale: Saint, Reformer or Rebel? 1981 Barbara Montgomery Dossey. Florence Nightingale Mystic, Visionary, Healer 1999 Cecil Woodham –Smith. Florence Nightingale 1820-1910. Constable London 1950 Pam Brown. Florence Nightingale. Exeley publications 1988 Elspeth Huxley. Florence Nightingale. Wiedenfeld and Nicholson 1975 |
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Web Links :
Florence Nightingale agnesscott.edu/lriddle/women/nitegale clendening.kumc.edu bread_n_roses/Florence Nightingale |
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