Florence Nightingale's Secret War

Roundup: Talking About History

Mark Bostridge, The Times (London), 30 Oct. 2004

The Lady with the Lamp was myth -and Florence Nightingale rarely nursed the Crimea wounded. She was too busy fighting the government and revolutionising protocol. By Mark Bostridge

On the afternoon of October 29, 1854, the P&O paddle steamer Vectis sailed in sight of Sicily on its way, via Malta, to Constantinople. The weather was fine, the wind moderate, but on board ship, the Vectis's cargo of 38 nurses were suffering from seasickness and making"a fine fuss" about it. Florence Nightingale, the 34-year-old leader of the expedition, authorised by the British Government to deliver desperately overdue nursing care to the sick and wounded of the Crimean War, was particularly badly affected by every roll of the vessel.

"She lies quite unable to dress or wash," wrote Charles Bracebridge, an old friend of Nightingale's who, with his wife Selina, was accompanying the party to provide assistance,"& every time she swallows a mouthful is sick directly." Fortunately Bracebridge had found his sea legs and was able to take charge. Seated up on deck under an awning to protect him from the sun, he spied on the three or four nurses free from sickness, who were doing their best to attract the attentions"of the impudent young surgeons" also travelling East.

It was not perhaps the most auspicious start to what would prove a historic mission, though by the time the Vectis anchored on November 4, Nightingale had"wonderfully picked up", and was ready to face whatever horrors lay in store at the Barrack Hospital at Scutari. Scutari (Uskudar today) lies on the Asiatic side of the Bosphorus, opposite Constantinople, and the former Turkish barracks would eventually be one of several hospitals at Scutari adapted to house wounded troops transported across the Black Sea. Nightingale had been prepared for the worst by graphic reports in The Times, detailing the miserable treatment of the troops and the Army's gross neglect of its sick and wounded. The descriptions of its special correspondent, W. H. Russell, reached their climax in the week beginning October 9, and the situation rose to boiling point on October 12 when Thomas Chenery, The Times diplomatic correspondent in Constantinople, reported that there were not enough surgeons, nurses or even bandages to tend to wounded soldiers. Before the Army had embarked for the Crimea, the possibility of employing women to nurse them had been proposed and rejected by the military authorities. Now, with large sections of the British population expressing outrage, the Government had no choice but to reverse the decision.

What Nightingale achieved at Scutari, and subsequently at other hospitals on the Crimean peninsula, is still the stuff of legend, 150 years after her arrival there. Like most, it combines fact with a heady dose of romance. Reaching the makeshift hospital, which resembled little better than a charnel house, Nightingale immediately brought sweeping changes into effect: instituting the cleaning of wards, buying (with money raised in part by Times readers) furniture, linen and medicines to circumvent the breakdown in the purveyance system, obtaining blankets and warm clothing for the soldiers, and reorganising dietary and cooking provisions for them. Early reports in the press, soon swelled by an extraordinary outpouring of verse and song dedicated to the romantic heroine, portrayed her as a ministering angel, a hands-on nurse, personally attending to soldiers as they lay on mile upon mile of mattresses. Yet, although she sometimes spent 10 or 12 hours a day in the first weeks working on the wards, her principal role was administrative, supervising the nurses rather than directly nursing the sick. As her sister Parthenope said:"What F does & what she is, is most faintly conceived of in England. I believe the public there generally imagine her by the soldier's bedside, where doubtless she is often to be found, but as she herself said, how satisfactory, how easy, if that were all. The quantity of writing, the quantity of talking is the weary work, the dealing with the selfish, the mean, the incompetent."

And what of the famous lamp, once described by the historian Raphael Samuel as one of the stock images of our island story? The image of the Lady with the Lamp, immortalised in Longfellow's poem of 1857, first appeared in the Illustrated London News for February 24, 1855, where Nightingale was depicted making her solitary inspections of the wards with a lamp in her hand -though the artist's engraving showed her holding a Grecian lamp rather than the historically accurate, but less romantic, folding Turkish lantern. The lamp, with its strongly Christian connotations, later became an important symbol in nursing education, but there is no evidence that Nightingale saw it as especially significant. In her voluminous surviving correspondence from the war there is only one reference to a lamp, in a description of herself carrying a lantern while chasing a rat.

The popular representation of Nightingale gliding serenely through the wards does at least capture her utter imperturbability. Undermined at home by a government which restricted her authority and faced by problems of discipline and dissension among her nurses and an obstructive Army medical staff, she worked under unceasing pressure while remaining extraordinarily calm. Sleep was snatched at odd hours, meals eaten in spare moments:"Her breakfast, tea, or supper stands on a chair beside her while she writes. Taking a spoonful between is her way." A weekly vapour bath was her only relaxation, and eventually her health broke down. For decades, historians and biographers accused her of being a neurotic malingerer, though it's now widely accepted that she suffered from chronic brucellosis, an infection probably picked up from drinking goat's milk in the Crimea, which forced her into seclusion for the rest of her life.

At home, the figure of Nightingale, the Crimean heroine, appealed to a middle class eager to highlight the aristocratic mismanagement of the war. For women, the message she embodied was more ambivalent. On the one hand, she represented the conventional"angel in the house", transplanted to a public sphere, but still exercising traditional notions of duty and devotion towards men; on the other, her example was a sign of burgeoning freedom for women everywhere, particularly for women of her own class."Oh Florence, Florence," wrote one female acquaintance,"you will be the destruction of the 'young lady class' in England -& with it of how much suffering." What is recognised less often than it should be is that Nightingale stands as the figurehead for 229 women who nursed in Turkey and the Crimea from 1854 to 1856, most of them in hospitals that stood outside Nightingale's jurisdiction. Of these, only 17 served for the duration; the others were dismissed for a variety of forms of misconduct, including drunkenness, or were invalided out, resigned, or simply died. Nevertheless, these 229 demonstrated that women could play a decisive role in the Army in wartime.

The most contentious issue relating to Nightingale's time at Scutari remains the question of how effective her initial reforms there were in reducing the staggeringly high mortality rate at her hospital, which was considerably higher than in the hospitals in the Crimea. During her first winter at Scutari, 4,077 soldiers died, ten times more from illnesses such as typhus, typhoid and cholera, than from battle wounds. Conditions at Scutari were fatal to the men that Nightingale was trying to nurse: they were packed like sardines into an unventilated building on top of defective sewers. It was only with the arrival of the sanitary commission at Scutari in March 1855, five months after Nightingale's own arrival, that the sewers were flushed out, the ventilation improved, and the mortality rate fell. Nightingale, of course, was not responsible for establishing a hospital on a defective site, and would herself later attribute the fall in mortality to the work of the commission, commenting privately that her own achievement in those first months was to have"pulled this hospital through" and that without her"it would have come to a standstill". However, the realisation that unsanitary conditions had killed so many men was primarily what drove her to preach a gospel of fresh air, cleansed drains and public health for the rest of her campaigning life. She would succeed in reducing unnecessary deaths in the Army in peacetime, before turning her attention to nursing and introducing sanitary concepts in Britain and abroad.

The legend of Florence Nightingale at Scutari is a multi-faceted one. It empowered all her later work. But, partly at Nightingale's own connivance, it has also overshadowed and obscured it. For Lynn McDonald, the editor of a gradually emerging 16-volume edition of Nightingale's collected works, the major significance of Scutari lies in the way it launched her post-Crimean career of social reform, enabling her to expose"the horrible facts of hospital life, workhouse infirmaries, deaths from famine in India, all the needless deaths she could see from the evidence of statistical reports. But she would never have got a hearing on those issues if she had not been the Lady with the Lamp."

For the ordinary soldier, however, to whose survival Nightingale had dedicated herself, the image of the Lady with the Lamp, legendary or not, was of vital importance. When Nightingale fell dangerously ill in the spring of 1855, and rumours abounded that she was about to return to England, a sergeant in the 56th Regiment scribbled a heartfelt note:"All the soldiers was cryin because Miss Nightingale was goin away for sure all their comfort & succour was in her along with the Almighty. And what should they do for Mother when she was gone! I've got a picture of her framed...blue slippers, & her gown comes down close along side 'em. It's beautiful!"

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