The Atlantic Monthly, Volume 08, No. 50, December, 1861

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.

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 upon 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 they 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 arrived from England. Kind visitors sat by the beds to write letters for the patients, undertaking to see the epistles forwarded to England. When the invalids became able to rise for dinner, it was a turning-point in their case; and they were soon getting into the apartment where there were games and books and meetings of old comrades. As I have said before, those who died at these hospitals were finally scarcely more than those who died in—not the hospitals—but the barracks of the Guards at home.

What were the changes in organization needed to produce such a regeneration as this?

They were such as must appear to Americans very simple and easy. The wonder will be rather that they were necessary at last than that they should have been effected with any difficulty. But Americans have never known what it is to have a standing army as a long-established and prominent national institution; and they can therefore hardly conceive of the strength of the class-spirit which grows up in the various departments of the military organization. This jealousy, egotism, and stiffness of prejudice were much aggravated by the long peace, in which a great rusting of the apparatus of the system took place, without at all impairing the complacency of those who formed a part of it. The old medical officers were incapable, pedantic, and jealous; and no proper relation had ever been established between them and the military authorities. The imbecility of the system cost the lives of others than the soldiers who died in hospital. Brave men arose, as in all such crises, to bear the consequences of other men's mistakes, and the burden of exposing them; and several physicians and surgeons died, far from home, in the effort to ameliorate a system which they found unworkable. The greatest benefactor in exhibiting evils and suggesting remedies, Dr. Alexander, lived to return home, and instigate reforms, and receive the honors which were his due; but he soon sank under the consequences of his labors. So did Lord Herbert, the Secretary of War, to whom, in conjunction with Miss Nightingale, the British army, at home, in India, and everywhere, owes its redemption from special sickness and undue mortality. In America the advantages may be enjoyed without tax or drawback. The citizens are accustomed to organize themselves for action of all sorts; and no stiff-necked classes stand in the way of good management. The difficulty in America must rather be to understand how anything so perverse as the management of British military hospitals ten years ago can have existed to so late a date.

It was supposed, ten years since, that there must be nine separate departments in every Military General Hospital, and the officials bore titles accordingly; but there was such an odd confusion in their functions that every one of the nine was often seen doing the business of some other. The medical officers were drawing corks and tasting wines and inspecting provisions, when they should have been by the bedside. The purveyor was counting the soldiers' money, and noting its amount, when he should have been marketing, or ordering the giving out of the provisions for the day. The paymaster could scarcely find time to discharge the bills, so much was his day filled up with doing eternal sums about the stoppages in the pay of the patients. There were thirteen kinds of stoppages in the army, three of which were for the sick in hospital: the paymaster could never be quite certain that he had reckoned rightly with every man to the last penny; the men were never satisfied; and the confusion was endless. The commissariat, the purveyor, and the paymaster were all kept waiting to get their books made up, while soldiers were working the sums,—being called from their proper business to help about the daily task of the stoppages. Why there should not be one uniform stoppage out of the pay of men in hospital no person of modern ideas could see; and the paymaster's toils would have been lessened by more than one-half, if he had had to reckon the deduction from the patients' pay at threepence or fourpence each, all round, instead of having to deal with thousands per day individually, under three kinds of charge upon the pay.

The commandant's post was the hardest,—he being supposed to control every province, and have every official under his orders, and yet being powerless in regard to two or three departments, the business of which he did not understand. The officers of those departments went each his own way; and all unity of action in the establishment was lost. This is enough to say of the old methods.

In the place of them, a far simpler system was proposed at the end of the war. The eternal dispute as to whether the commandant should be military or medical, a soldier or a civilian, was set aside by the decision that he should be simply the ablest administrator that could be found, and be called the Governor, to avoid the military title. Why there should be any military management of men who are sick as men, and not as soldiers, it is difficult to see; and when the patients are about to leave the hospital, a stated supervision from the adjutant-general's department is all that can be required. Thus is all the jealousy between military and medical authority got rid of. The Governor's authority must be supreme, like that of the commandant of a fortress, or the commander of a ship. He will not want to meddle in the doctors' professional business; and in all else he is to be paramount,—being himself responsible to the War-Office. The office, as thus declared, is equivalent to three of the nine old ones, namely, the Commandant, the Adjutant-General, and the Quartermaster-General.

Next to the Governor, the Chief Medical Officer must be the most important man in the establishment. He is to be concerned with professional business only, and to see that all under him are to be devoted in the same way. For this purpose there must be an end to the system of requisitions. There must be a Steward, taking his orders from the Governor alone, and administering a simple and liberal system of diets and appliances of all sorts. It is his business to provide everything for the consumption of the establishment, and to keep the contractors up to their duty. The Treasurer's function speaks for itself. All the accounts and payments under the Governor's warrant are in his charge.

There is one more office, rendered necessary by the various and active service always going on,—the superintendent of that service, or Captain of the Wards. He is to have the oversight of the orderlies, cooks, washers, and storekeepers; he is to keep order throughout the house; and he is to be referred to in regard to everything that is wanted in the wards, except what belongs to the department of the medical officers or the steward.

As for the medical department, there is now a training provided for such soldiers as wish to qualify themselves for hospital duty. Formerly, the hospital was served by such men as the military officers thought fit to spare for the purpose; and they naturally did not send the best. These men knew nothing of either cleaning wards or nursing patients. Their awkwardness in sweeping and scouring and making beds was extreme; and they were helpless in case of anything being wanted to a blister or a sore. One was found, one day, earnestly endeavoring to persuade his patient to eat his poultice. It is otherwise now. The women, where there are any, ought to have the entire charge of the sweeping and cleaning,—the housemaid's work of the wards; and as to the rest, the men of the medical-staff corps have the means of learning how to dress a blister, and poultice a sore, and apply plasters, lint, and bandages, and administer medicine, and how to aid the sick in their ablutions, in getting their meals with the least fatigue, and so on.

Of female nurses it is not necessary to say much in America, any more than in England or France. They are not admissible into Regimental Hospitals, in a general way; but in great military and civil hospitals they are a priceless treasure.

The questions in regard to them are two. Shall their office be confined to the care of the linen and stores, and the supplying of extra diets and comforts? If admitted to officiate in the wards, how far shall that function extend?

In England, there seems to be a strong persuasion that some time must elapse, and perhaps a generation of doctors must pass away, before the ministration of female nurses in military hospitals can become a custom, or even an unquestioned good. No rational person can doubt what a blessing it would be to the patients to have such nurses administer nourishment, when the rough orderlies would not have discernment or patience to give the frequent spoonful when the very life may hang upon it. Nobody doubts that wounds would be cleansed which otherwise go uncleansed,—that much irritation and suffering would be relieved which there are otherwise no hands to undertake. Nobody doubts that many lives would be saved in every great hospital from the time that fevered frames and the flickerings of struggling vitality were put under the charge of the nurses whom Nature made. But the difficulties and risks are great. On the whole, it seems to be concluded by those who know best, that only a few female nurses should be admitted into military and naval hospitals: that they should be women of mature age and ascertained good sense, thoroughly trained to their business: that they should be the women who have been, or who would be, the head nurses in other hospitals, and that they should be paid on that scale: that they should have no responsibility,—being wholly subject to the surgeons in ward affairs, and to their own superintendent in all others: that no enthusiasts or religious devotees should be admitted,—because that very qualification shows that they do not understand the business of nursing: that everything that can be as well done by men should be done by trained orderlies: that convalescents should, generally speaking, be attended on by men,—and if not, that each female nurse of convalescents should have a hundred or so in her charge, whereas of the graver cases forty or fifty are as many as one nurse can manage, with any amount of help from orderlies. These proposals give some idea of what is contemplated with regard to the ordinary nurses in a General Military Hospital. The superintendent of the nurses in each institution must be a woman of high quality and large experience. And she will show her good sense, in the first place, by insisting on a precise definition of her province, that there maybe no avoidable ill-will on the part of the medical officers, and no cause of contention with the captain of service, or whatever the administrator of the interior may be called. She must have a decisive voice in the choice of her nurses; and she will choose them for their qualifications as nurses only, after being satisfied as to their character, health, and temper.

No good nurse can endure any fuss about her work and her merits. Enthusiasts and devotees find immediately that they are altogether out of place in a hospital,—or, as we may now say, they would find this, if they were ever to enter a hospital: for, in fact, they never now arrive there. The preparation brings them to a knowledge of themselves; and the two sorts of women who really and permanently become nurses are those who desire to make a living by a useful and valued and well-paid occupation, and those who benevolently desire to save life and mitigate suffering, with such a temper of sobriety and moderation as causes them to endure hardship and ill-usage with firmness, and to dislike praise and celebrity at least as much as hostility and evil construction. The best nurses are foremost in perceiving the absurdity and disagreeableness of such heroines of romance as flourished in the press seven years ago,—young ladies disappointed in love, who went out to the East, found their lovers in hospital, and went off with them, to be happy ever after, without any anxiety or shame at deserting their patients in the wards without leave or notice. Not of this order was Florence Nightingale, whose practical hard work, personal reserve, and singular administrative power have placed her as high above impeachment for feminine weaknesses as above the ridicule which commonly attends the striking out of a new course by man or woman. Those who most honor her, and most desire to follow her example, are those who most steadily bring their understandings and their hearts to bear upon the work which she began. Her ill-health has withdrawn her from active nursing and administration; but she has probably done more towards the saving of life by working in connection with the War-Office in private than by her best-known deeds in her days of health. Through her, mainly, it is that every nation has already studied with some success the all-important subject of Health in the Camp and in the Hospital. It now lies in the way of American women to take up the office, and, we may trust, to "better the instruction."

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A STORY OF THANKSGIVING-TIME

Old Jacob Newell sat despondent beside his sitting-room fire. Gray-haired and venerable, with a hundred hard lines, telling of the work of time and struggle and misfortune, furrowing his pale face, he looked the incarnation of silent sorrow and hopelessness, waiting in quiet meekness for the advent of the King of Terrors: waiting, but not hoping, for his coming; without desire to die, but with no dread of death.

At a short distance from him, in an ancient straight-backed rocking-chair, dark with age, and clumsy in its antique carvings, sat his wife. Stiffly upright, and with an almost painful primness in dress and figure, she sat knitting rapidly and with closed eyes. Her face was rigid as a mask; the motion in her fingers, as she plied her needles, was spasmodic and machine-like; the figure, though quiet, wore an air of iron repose that was most uneasy and unnatural. Still, through the mask and from the figure there stole the aspect and air of one who had within her deep wells of sweetness and love which only strong training or power of education had thus covered up and obscured. She looked of that stern Puritanical stock whose iron will conquered the severity of New England winters and overcame the stubbornness of its granite hills, and whose idea of a perfect life consisted in the rigorous discharge of all Christian duties, and the banishment, forever and at all times, of the levity of pleasure and the folly of amusement. She could have walked, if need were, with composure to the stake; but she could neither have joined in a game at cards, nor have entered into a romp with little children. All this was plainly to be seen in the stern repose of her countenance and the stiff harshness of her figure.

Upon the stained deal table, standing a little in the rear and partially between the two, reposed an open Bible. Between its leaves lay a pair of large, old-fashioned, silver-bowed spectacles, which the husband had but recently laid there, after reading the usual daily chapter of Holy Writ. He had ceased but a moment before, and had laid them down with a heavy sigh, for his heart to-day was sorely oppressed; and no wonder; for, following his gaze around the room, we find upon the otherwise bare walls five sad mementos of those who had "gone before,"—five coarse and unartistic, but loving tributes to the dead.

There they hang, framed in black, each with its white tomb and overhanging willow, and severally inscribed to the memories of Mark, John, James, Martha, and Mary Newell. All their flock. None left to honor and obey, none to cheer, none to lighten the labor or soothe the cares. All gone, and these two left behind to travel hand in hand, but desolate, though together, to the end of their earthly pilgrimage.

There had, indeed, been one other, but for him there hung no loving memorial. He was the youngest of all, and such a noble, strong, and lusty infant, that the father, in the pride of his heart, and with his fondness for Scriptural names, had christened him Samson. He, too, had gone; but in the dread gallery that hung about the room there was no framed funereal picture "To the Memory of Samson Newell." If in the tomb of his father's or mother's heart he lay buried, no outward token gave note thereof.

So the old couple sat alone before the sitting-room fire. It was not often used, this room,—scarcely ever now, except upon Sunday, or on those two grave holidays that the Newells kept,—Thanksgiving- and Fast-Day. This was Thanksgiving-Day. The snow without was falling thick and fast. It came in great eddies and white whirls, obscuring the prospect from the windows and scudding madly around the corners. It lay in great drifts against the fences, and one large pile before the middle front-window had gathered volume till it reached half up the second row of panes; for it had snowed all night and half the day before. The roads were so blocked by it that they would have been rendered impassable but for the sturdy efforts of the farmers' boys, who drove teams of four and five yokes of oxen through the drifts with heavily laden sleds, breaking out the ways. The sidewalks in the little village were shovelled and swept clean as fast as the snow fell; for, though all business was suspended, according to the suggestion in the Governor's proclamation, and in conformity to old usage, still they liked to keep the paths open on Thanksgiving-Day,—the paths and the roads; for nearly half the families in the place expected sons and daughters from far away to arrive on the train which should have been at the railroad-station on the previous evening, but had been kept back by the snow.

But Jacob and Ruth Newell had neither son nor daughter, grandchild, cousin, relation of any nearness or remoteness, to expect; for the white snow covered with a cold mantle scores of mounds in many graveyards where lay their dead. And they sat this day and thought of all their kindred who had perished untimely,—all save one.

Whether he lived, or whether he had died,—where he lay buried, if buried he were,—or where he rioted, if still in the land of the living, they had no notion. And why should they care?

He had been a strong-willed and wild lad. He had disobeyed the injunctions of his parents while yet a boy. He had not loved the stiff, sad Sabbaths, nor the gloomy Saturday nights. He had rebelled against the austerities of Fast- and Thanksgiving-Days. He had learned to play at cards and to roll tenpins with the village boys. He had smoked in the tavern bar-room of evenings. In vain had his father tried to coerce him into better ways; in vain had his mother used all the persuasions of a maternal pride and fondness that showed themselves only, of all her children, to this brave, handsome, and reckless boy. He had gone from worse to worse, after the first outbreaking from the strict home rules, until he had become at length a by-word in the village, and anxious mothers warned their sons against companionship with wicked Samson Newell,—and this when he was only seventeen years of age.

Perhaps mildness might have worked well with the self-willed boy, but his father knew nothing but stern command and prompt obedience in family management; and so the son daily fell away, until came the inevitable day when his wrong-doing reached a climax and he left his father's roof forever.

It was on a Thanksgiving-Day, fifteen years ago, that the boy Samson, then seventeen years old, was brought home drunk and bleeding. He had passed the previous night at a ball at the tavern, against the express command of his father, who would have gone to fetch him away, but that he could not bear to enter upon a scene he thought so wicked, and especially upon such an errand. When the dance was over, the boy had lingered at the bar, drinking glass after glass, until he got into a fight with the bully of the village, whom he thrashed within an inch of his life, and then he had sat down in a small side-room with a few choice spirits, with the avowed purpose of getting drunk over his victory. He had got drunk, "gloriously drunk" his friends at the tavern styled it, and had been carried in that state home.