Read Ebook: Subsidiary Notes as to the Introduction of Female Nursing into Military Hospitals in Peace and War by Nightingale Florence

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Of such chronic cases, probably 100 would be efficiently served by one nurse, having orderlies under her. Of acute cases, probably, one nurse should take charge of not more than fifty, possibly not more than forty.

A very short comparison will here be made between the methods of Female Nursing in the Military Hospitals of Russia, England, France, and Sardinia, as exemplified in the last War.

To do this, a sketch must be partly repeated, which has been already given, of the organic difference between the Hospital Service of each nation.

The essential characteristic of the French is, the importance given in the field to the Divisional Hospital Service over the Regimental.

The Regimental Medical Service treats only those ephemeral cases which are to be exempted from duty for a day or two. Cases of wounds or disease likely to last for a term of weeks are sent to the Divisional Ambulance in the field; those, where disease may possibly last for months, to the General Hospitals at the base of operations.

The Medical Service of the Sardinians closely resembles the above in its formation. In the late War, their General Ambulances were at Balaklava; their General Hospitals at Jeni Koi on the Bosphorus. They had no Divisional or Regimental Hospitals.

In our Army, as is well known, the Regiment establishes its Regimental Hospital wherever it goes. Theoretically, it is exclusively a Regimental system of Hospitals; however much, practically, it breaks down.

The Russian system can scarcely bear a comparison with ours; because their Regiments are Divisions. They had a regular system of transporting the sick and wounded upon the North side of Sebastopol, then upon Mackenzie's Heights, then upon Bakschi-Serai, and lastly upon Simpheropol.

The adaptation of Female Nursing to the different systems in the French, Sardinian, Russian, and English Armies has now to be noticed.

The Sardinians had Sisters of Charity, both in the General Ambulances in the Crimea, and in the General Hospitals on the Bosphorus.

This was still more the case in the French Hospitals, where the "Soeur" in the wards appeared more of a "consolatrice" and an administratrix of extras: although, out of the wards, her admirable housekeeping, both in the kitchen and the linen-store, was predominant.

In these French Hospitals of Constantinople, the "Soeurs" appeared to do all the cooking for the sick Officers and that of the extras for the men.

I do not think that, in either French or Sardinian Hospitals, the care of bed-sores and such like, which can only be done by women, was sufficiently given to the "Soeurs."

I have heard complaints made of this kind both by Officers and men; and "Soeurs," both French and Sardinian, have been to me to look at the way in which we treated bed-sores, and to borrow air-pillows and water-beds.

There is such a difference however in different Hospitals, in time of war and of peace, &c., that I would not be understood to mean that any of these remarks apply absolutely or generally, but only to Hospitals I have seen.

It may be as well to mention that, talking of "French" and "Sardinian" Sisters, they all come from one "Maison M?re," that of the "Filles de la Charit? de S. Vincent de Paule," at Paris. There is a "Maison Succursale," at Turin. But all are of the same Order, and under the same head.

Let me mention Soeur Cordero, the excellent Superioress of all the Sisters employed in the Sardinian Hospitals of the war, with the warmest affection and respect. She was a woman of high rank, of the most captivating manners, but of the utmost simplicity of character, and of unfailing devotion to right and to God.

It remains to mention the Russian system, which, as regards the organization of the duties of the "Sisters," appeared to me by far the best I have known. I am at a loss to conceive what is meant by the following sentence in the Report by two of our Army Medical Officers on the "Russian Medical Department," presented to the House of Commons. Speaking of the Sisters of Mercy, who are generally widows of officers, it is said "their chief duties appeared to be in taking charge of the linen and superintending the issue of extras." This is founded on error of observation--as the Russian system seems to be the only perfectly organized system of female attendance in Military Hospitals, which was developed in the Crimean War. In it, the Sister has charge of all that relates to the bed-side of the patient; she receives the orders from the Medical Officer, attends him in his rounds; he confers with her afterwards; she even reports the "felchers" or dressers, as also the orderlies, as far as regards their discharge of duties at the bed-side of the patient. The orderlies are, of course, under the control of a Non-commissioned Officer, in all that pertains to discipline, clothing, meals, &c. The "felchers" are under a superior "felcher," and under the Medical Officers.

There are female nurses, wives and widows of soldiers, under the "Sisters," who are generally, as has been stated, widows of Officers.

This appears the nearest approach to good organization I have met with.

But again I say there may be much difference among the Russian Military Hospitals. I would not be considered as laying down an absolute experience.

It has been said elsewhere what was the system or no system pursued in the English Military Hospitals, as to Female Nursing. It was a new thing, and no General Order or Warrant was ever issued as to the duties of the nurses. Many duties clearly devolved upon the Female Superintendent-General, as she was afterwards called in "General Orders," which never should devolve upon her again.

But it may be now clearly enunciated what the duties of Female Nurses should be, and many reasons will subsequently be given why there never will be discipline in Military Hospitals till they are as follow:

Women only of the character, efficiency, and responsibility of Head Nurses in other Hospitals should be admitted into Military ones. They should have charge and be responsible for all that pertains to the bed-side of the patient; for his cleanliness, and that of his linen, bed, and utensils; for all the minor dressings, not performed by Surgeons or Dressers; for the administration of medicines, and of the meals; for the obedience of the patient and orderlies to the orders of the Medical Officer. They should receive the orders of the latter, and always attend him in his visits.

Till the above is done by women, the same want of discipline, now to be observed in Military Hospitals, and often already noticed, will continue,--such is my firm belief, the result of much experience.

The first should do the Military part, the second should compound, take charge of Medical and Surgical stores, of Returns and Accounts connected with these; and, where there is no Purveyor, of Purveyor's and Barrack stores, provisions, cooking, washing, diets, and extras, including Returns and Accounts connected with these.

As it is, there is one Hospital Serjeant, who is Ward-Master, Serjeant, Steward, Clerk, Dispenser, Purveyor's Clerk, and Head-Nurse--a kind of "Ma?tre Jacques," as in Moli?re's "Avare."

One man cannot do all these things.

A Female should be the Head-Nurse--a Serjeant should be the Serjeant and Clerk--a Ward-Master the Steward, Dispenser, Ward-Master, and Purveyor's Clerk.

And here I must deplore the confusion unavoidable in these definitions of proposed duties, while we have no separate system for Regimental and General Hospitals.

What Dr. Menzies declared, in his evidence as to the General Hospitals at Scutari, is strictly true, and one great cause of our failure at Scutari:--"I have followed the general rules for Regimental Hospitals, so far as I could."

While Regimental Hospitals are what they are, females never can be admitted there. On the other hand, if General Hospitals be established, one happy consequence will be that the cooking and washing will be taken out of the hands of the Hospital Serjeant, and regularly organized, it is hoped under a Captain-Superintendent of Orderlies. All Purveyor's and Barrack stores, that is, Hospital stores and furniture will, it is hoped, fall under the charge of a Steward; Medical and Surgical stores under that of an Apothecary.

It will only remain to place a female Head-Nurse in charge of all that concerns the bed-side of a patient, and the duties of the Orderlies about the bed-side, and a Ward-Master in charge of everything else belonging to the Orderlies and Patients.

But, if it should be determined to retain everywhere the old Regimental system, it is only just to add this very strong testimony and appeal in favour of the old Hospital Sergeant, who indeed deserves it:--

NOTE IN REGARD TO THE RUSSIAN NURSES EMPLOYED IN THE WAR-HOSPITALS OF THE CRIMEA.

The Russian nurses, in the opinion of their Master, the famous surgeon, Pirogoff, did other things besides what the Army Medical Director-General told the House of Commons they did. But it is to be observed--

In the first place, that much allowance is to be made for the confusion incident to Scotch and Russian surgeons talking French together, and going over many subjects in a very short time.

And in the second, that very likely some extra confusion arose in the minds of our Army Medical Officers from the fact of two entirely different sets of women having served in the Russian War Hospitals, viz.:

The Sisters of the Elevation of the Cross.

The "Frauen des Barmherzigen Wittwen Instituts," ; who are those spoken of at pp. 22, 23, above.

The Widows were so instituted, about forty years or more ago, by Mary of Wirtemberg, during so many years the venerated Empress-Mother. It is quite possible that in the war-pressure their services proved rather nondescript, they being neither sisters nor nurses, strictly speaking; or perhaps the sole reason why Professor Pirogoff has not one good word for them is, that they were not under his orders.

The Sisters of the Elevation of the Cross were a body of secular women, with a few Sisters of Mercy, formed by the Grand Duchess Helena, and placed by her under the orders of the famous civilian Surgeon Pirogoff, to whom the supreme surgical command in Sevastopol was virtually given. Several things are incidentally mentioned concerning them in his pamphlet, quite inconsistent with the constitution of an ordinary religious order.

One or two things in the pamphlet are incongruous enough to English ideas:--the narrative given, however simply and succinctly, of the performances of the sisters by name, the publication of the Professor's evident disagreement with the first "Oberin," or Superior, who served ten months, ; the improvement, by which the Sisters' concerns were "sat upon" by the Comit? of Oberin, Chaplain, Doctor, and elder Sisters, &c., &c.

In ordinary service the less nurses know of each other's wards the better--in war service it is essential that as few women should serve as many sick as possible; and it is impossible to attempt assigning to each nurse the entire supervision of a ward. I think the categories, modified, of course, and adapted to the Queen's service, might be most useful.

Another point usefully proved by Professor Pirogoff's pamphlet is the extreme importance, if it be possible, of placing the nurses clearly under the orders of the Principal Medical Officer, though a further point is, if possible, to be secured, viz., that of the Principal Medical Officer being favourable to their service. As women they should be entirely under the control of their female superior, yet the Principal Medical Officer should have a certain clear amount of power in ordering that Superior as to their employment at particular stations and on particular services.

FOOTNOTES:

According to Professor Pirogoff sick were almost daily sent from Simpheropol to Perekop. They could not, therefore, be always accompanied by Sisters.

SUBSIDIARY NOTES AS TO THE INTRODUCTION OF FEMALE NURSING INTO MILITARY HOSPITALS IN PEACE AND IN WAR.

It is, perhaps, advisable first to speak of some of those difficulties met with in the War Hospitals of the East, in order that such may be prevented for others who may in future be Superintendents-General of Nurses in Military Hospitals whether in peace or in war.

No one ought to undertake a matter of duty of this kind without first obtaining the consent of the War Office to five conditions.

In March 1856 the following appeared in "General Orders." Had it but been seventeen months earlier how much it might have saved! The definition of the Superintendent-General's powers and duties, therein contained, is all that is wanted to prevent irregularities disastrous to the Service.

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