Reform of Army Medical Service

WORK ON REFORM OF THE ARMY MEDICAL SERVICE AND THE ROYAL COMMISSION

Florence was concentrating on working for the reform of the Army Medical Services; she wanted to set up a Royal Commission. Dr Sutherland was to become a constant adviser in many problems, which were to be presented to her. She wanted her visit with the Queen to be as successful as possible, and had written to Dr Sutherland for advice. He advised her that her ideas on nursing be carried out gradually. It would be difficult for those who did not understand the details of nursing management, or were prejudiced against it to carry it out. He also recommended that the idea of female nursing in military hospitals was not to be called reform. Dr Sutherland felt that Miss Nightingale should talk openly with Lord Panmure of her experiences in the East,` what he really wants is good reliable information`. He advised her when talking with Lord Panmure to discuss the defects and not to suggest any reform unless she was asked to do so, as there were many different opinions as to what was required to reform the Army Medical Department.
(Letter from Dr Sutherland to Florence Nightingale)

While Florence was in Scotland she inspected barracks and hospitals in Edinburgh and spoke with Sir John McNeil and Colonel Alexander Tulloch, both of who she knew from the Crimea.

On 19th September, 1856 Miss Nightingale left Edinburgh to go to Birk Hall, and on 21st September was commanded to Balmoral to talk with the Queen and Prince Consort. The meeting was informal and lasted for more than two hours. It was a great success. A few days later the Queen spoke again with Miss Nightingale when she visited Birk Hall for tea. Lord Panmure had spoken to Miss Nightingale during her visit to Balmoral, and he agreed that she should submit a full report and recommendations.

Miss Nightingale`s report contained 1,000 pages full of statistics, the fact that much of the sickness was caused by defects in the systems or, lack of systems. Preventing sickness when in hospital by providing proper food, clothing and shelter. Also very important to stop the spread of sickness was cleanliness and general hygiene. Miss Nightingale had discovered that for every man that died in the Crimea from wounds, seven would die from diseases, most of which could be simply prevented. The report also included facts about the peacetime army. Young healthy men were picked; fifteen hundred of these probably killed by neglect in the barracks, with poor unhealthy conditions. Three months into her report Lord Panmure agreed to Miss Nightingale`s Royal Commission. She had daily communication with Sidney Herbert and Dr Sutherland using their expert knowledge, agreed a course of action.

Miss Nightingale`s work was carried out at the Burlington Hotel in cramped uncomfortable conditions. She had one small room opening out of the family sitting room. Miss Nightingale`s mother and sister were staying with her in London. They had nothing to do except to go to parties, receive callers, or talk about their heroic `Flo`. Florence’s only source of income was still the £500 that she received from her father. As her mother was paying the hotel bill, she would charge her daughter her share, sometimes overcharging her. Florence was working very hard visiting several hospitals a day, in addition to the paperwork she was doing. She would go by omnibus or on food, hardly ever take a carriage.

As hard as Miss Nightingale worked herself, she made others. Dr Sutherland often worked with her for many hours. His wife once wrote a note to Miss Nightingale for her husband to be excused, and Miss Nightingale got herself into such a state that Dr Sutherland had to be sent for. If she worked Dr Sutherland hard, then she worked Sidney Herbert even more so. Their work together on the Royal Commission was completed within three months.

Miss Nightingale was determined to get the right people for the commission and she spent many hours consulting with 1856, Florence spoke with Sidney Herbert; she wanted him to be chairman. After a great deal of discussion he agreed that he would accept the chairmanship if it were offered to him. She wanted Dr Thomas Alexander (surgeon to the Light Division) to be on the committee, but Panmure objected. Miss Nightingale used this disappointment to her advantage by making Panmure promise that Dr Hall was not on the committee, as she knew that he would sabotage reforms. On 22nd November 1856 Sidney Herbert was offered chairmanship, and he accepted.

Since Miss Nightingale had returned from the Crimea she had made no public appearance, or spoken in public. She began to feel the Crimea was being forgotten. As her work for the Royal Commission was mainly based on her work and findings in the Crimea, she felt that it also was fading away. She decided to write and publish her experiences in the Crimea, and suggestions for improvement in the Army Medical Service. Lord Panmure agreed to read her report, and strike out inconvenient passages, but omitted to read them until it was too late.

The Royal Warrant had not been easy to obtain. There were to be many discussions between Lord Panmure and Miss Nightingale about the members of the commission. Also during this time the Report of the Chelsea Board was set up, its main objective was to go against the Report made by McNeil and Tulloch on the conditions in the Crimea. In February, Lord Panmure had written to Miss Nightingale requesting her for an official report. She had no faith in him, as he had delayed the Royal Warrant for six months already.

On 5th May the Royal Warrant was signed and the commission was started the next day. Miss Nightingale knew now that nothing could be changed one the Queen had initialed it.

The Commission consisted of General Storkes, who first met Miss Nightingale in 1855 in the Crimea, as Military Commandant. He was a great admirer of her. With her help he managed to bring discipline to the Barrack Hospital. Colonel Lefroy, who had arrived in the Crimea in October 1855, with the title of `Confidential Adviser to Secretary of War on Scientific Matters.’ In fact he was to report to Lord Panmure about the state of the hospitals. He had great admiration for Miss Nightingale. Dr A Smith, who Miss Nightingale had first heard of, when he war director of the Army Medical Service, when she was planning to take nurses to Scutari. During the time she was in the Crimea, he had become the Director General of the British Army Medical Service. Dr Martin had been influenced by discussion with Miss Nightingale. He had served in the service of the East India Company, and was an authority on diseases in India and of sanitary matters. He was appointed Inspector General of Army Hospitals on his return to England. Dr Alexander had served in the Crimea and was critical to administration during the campaign. Dr Sutherland had urged Miss Nightingale to make every effort to get him nominated to the Commission. With Dr Balfour as Secretary, he had studied medicine at Edinburgh University, where he took his doctorate of medicine in 1834. He was engaged in the statistical branch of the Army two years later. Dr Sutherland was to attend as sanitary expert. It was to the Commissions advantage to have Sir J Clarke as a member, as he was agreeable to the Queen and it just as well to have him on their side. Also Dr McLachlan

The Commission was to hear evidence of the poor conditions of the Army. In July Miss Nightingale was to give evidence herself. Sidney Herbert had advised her not to mention her experiences in the Crimea, but only speak on Hospital construction. Miss Nightingale could not agree, there was so much she wanted to speak on the subject of conditions, not only construction. It was finally agreed that Miss Nightingale would not appear in public, but would give written answers to questions. This is what would be read before the Commission. It must prove of the most vital importance to the British soldier for ages to come` wrote Sir James Martin, one of the Commissioners.

In August 1857 Sidney Herbert outlined the main points that would come out in the Commissions Report in a letter to Lord Panmure. He advised him that it would be in the Governments best interest to act on these as soon as possible, as questions would be asked when it came before the House.

Miss Nightingale had outlined a plan that would divide the health administration into four sub-commissions.
Sanitary of the barracks.
Statistical Department for the Army.
Army Medical School.
Reconstruct the Army Medical Department.

Hospital Regulations and a new Warrant for the Promotion of Medical Officers.

Lord Panmure agreed in general to the sub commissions, but the reorganisation of the Medical Department had been fought against, Dr Andrew Smith. It took a stormy meeting between Lord Panmure and Sidney Herbert for this sub commission to be agreed.

In December the four sub commissions were set up. On May 11th 1858, Lord Ebrington in the House of Commons moved a series of resolutions on the health of the Army. Sir John McNeil wrote to Miss Nightingale on May 13th, `To you more than to any other man or woman alive will hence forth be due welfare and efficiency of the British Army. I thank God that I have lived to see your success.`

Miss Nightingale could not rest, she had worked so hard and now all she wanted was solitude. In over four years, she had spent not one moment alone. On August 11th she collapsed, it was then she decided to go to Malvern. She took only a footman with her.

Dr Sutherland was very concerned about her and went to Malvern. He found her weak, unable to eat or sleep. Aunt Mai went to look after her, and by September, Florence felt she was ready to return to London. Florence`s mother and sister had returned to Embley. When Florence arrived back in London, Parthe wanted to be with her, but Aunt Mai advised her to stay at Embley.

While in London Florence received frequent calls from Sir Harry Verney. He was a widower, and had a large estate in Buckinghamshire. He run the estate from Claydon House. (Tall cedar and cypress trees in the park are said to be grown from seeds Florence brought back from the Crimea.) He had cottages built, founded schools, one of which is at Steeple Claydon which he had restored. He also worked to improve the rural poor; his position as Liberal MP helped him with his reforms. On one of his visits he proposed marriage to Florence, but she refused him. Having no time for ideas of love or marriage. Sir Harry Verney was heartbroken. Florence`s mother invited him to Embley to console him. While at Embley his thoughts of marriage transferred to Parthe. In June 1858, Parthe became Lady Verney.

In November 1857, Florence was sure she was going to die, and wrote her will. She wanted all the money that she would inherit from her father to be used to build a model barracks. Miss Nightingale had no thoughts for her mother, she wrote. `For everyone of my 18,000 children for everyone of those poor tiresome Harley Street creatures. I have expended more motherly feeling and action in a week than my mother has expended for me in 37 years`, although still weak she continued to work.

Throughout 1860 Sidney Herbert`s health was getting worse and by the end of the year he found out that he had an incurable kidney disease. On 5th December 1860, he told Miss Nightingale that if he gave up all public work and returned to Wilton, it was possible that his life might be prolonged. Miss Nightingale knew that if he left the War Office their work would be finished. She realised he must reduce his workload, either, the House of Commons, or the War Office must go. Sidney Herbert had sat in the House of Commons for 28 years, but he hated the War Office. In December 1860, he was given a peerage and became Lord Herbert of Lea.

WAR OFFICE

In January 1861, the scheme for War Office reorganisation was launched. There was to be a pitched battle between the forces of bureaucracy, Sidney Herbert on the one hand, Benjamin Hall on the other. Miss Nightingale was not confident. Sidney Herbert was the pivot, he was the only one who could carry the scheme through, and she knew he was weakening. By March she was frantic declaring that Sidney Herbert was inefficient.

The end came in June, he collapsed and told Miss Nightingale he could struggle no longer and must resign the War Office and retire. She refused to accept his health as an excuse. She told him what his failure meant. Their work was ruined. She cut herself off from him. He was still at the War Office preparing to hand over to his successor. She could not see him or even write to him. In early July 1861, Sidney Herbert`s doctors ordered him to Spa in Belgium. He called at the Burlington to see Miss Nightingale, who had returned there to say good bye to him. Four days later he, his wife and a friend reached the Spa. On 16th September he formerly sent his resignation to Palmerston. He also wrote to Miss Nightingale, a very formal letter about a military hospital at Woolwich, and to his successor George Lewis. They returned to Wilton, on July 25th, where he died on August 2nd at the age of 51. Miss Nightingale was in Hampstead when she heard the news, she hurried down to the Burlington where she collapsed and was seriously ill, for nearly four weeks. He had died of a broken heart, but she never admitted she had done anything towards breaking it. She never felt she was to blame. In September 1861, in a letter to Harriet Martineau she described what passed between them, she felt no more pity than if in fact he had been an inanimate tool.

Miss Nightingale shut herself in her room and did not see anyone. She was requested by Gladstone to write an account of the work that Sidney Herbert had done. (But he did not use it) Many of his obituary notices did not do him justice. This she did and had it privately printed in 1861 as Private and Confidential. Sidney Herbert – on his Services to the Army. In 1882 it was enlarged and printed as Army Sanitary Administration? and its Reform under the late Lord Herbert. Sidney Herbert had died with his work unfinished; most of which was halted at his death or reversed. Many things though had been achieved. The worse barracks had been condemned, and others reconditioned. Gas had been laid one, and kitchen ovens provided. A training school for cooks had also been started. He had been in Office for three years, and the mortality rate in the home army had dropped by half. Miss Nightingale felt her work would be over. While he was alive they would work together, on Army administration, but without his influence and official status this would not continue. But she did have connections with Douglas Galton, who held the post of Inspector General of Fortifications. He was in control of the erection and maintenance of barracks and hospitals for the Army.

On November 12th 1861, Arthur Hugh Clough died, coming so soon after Sidney Herberts death Miss Nightingale was devastated. Two men whom she had pushed so hard to help her in her work had now died. They had both been very devoted to her. She could no longer coape and in December 1861 she collapsed, she would be bed ridden for the next six years. She was living at 32 South Street, which belonged to the Verney’s, they would need their house for the Spring season, she needed to find somewhere to live. Her Father helped her with the expense of finding a new house, a suitable one was found in Chesterfield Square, Mayfair.

George Lewis, was to take Sidney Herberts position as Secretary of State for War. He and Miss Nightingale did not see eye to eye. He had not wanted to take the position, and had no knowledge of army administration. Miss Nightingale had first met him when he was Home Secretary, preparing for the Census in 1861

Miss Nightingale and Sidney Herbert had been working together on the reorganisation of the War Office. She had felt the office of Permanent Under Secretary should be abolished, and the work carried out by two Under Secretaries, each directly responsible to the Secretary of State for War. One Under Secretary would be in charge of purely military work, and the other for the health and sanitary administration of the Army. The later position was to be carried out by a civilian. On may 24th 1861 Douglas Galton was appointed at Assistant Under Secretary for the health and administration of the army and Lord de Grey as Parliamentary Under Secretary. But these two men, although both intelligent and talented, did not have the driving force to push forward the reforms for reorganisation. The War Office was to remain the same.

Although the reorganisation of the War Office did not take place, Miss Nightingale was still to have some influence. On April 13th 1863, George Lewis who was Secretary of State for War, died. He was replaced by Lord de Grey. Miss Nightingale would become advisor to him. She had a vast knowledge of sanitary questions, and knew how Government departments worked. She was now an invalid, and worked from her bed. She drafted minutes, drew op warrants, wrote official memoranda, letters and summaries for the Minister. She worked on question for a Warrant for Apothecaries, Proposals for Equipment of Military Hospitals, the Organisation of Hospitals for Soldiers` Wives, Proposals for the revision of Army Rations, Warrant and Instructions for Staff Surgeons, Instructions for treatment of yellow fever, Proposals for revision of Purveying and Commissariat in the Colonies, Revised diet sheets for Troop-ships, Proposals for appointments at Netley and Chatham, Instructions for Treatment of Cholera. She would carry out this work for the next four years, also continuing the work she started with Sidney Herbert on the improvement of barrack and hospital accommodation, and the reform of the Army Medical Department.

MOVES INTO SOUTH STREET

In 1862 Miss Nightingale returned to the Birlington, then to 32 South Street, but, she had to move out again when the Verney’s wanted to stay. For a while she took furnished rooms or houses in Hampstead and Highgate. The house she had at 9 Chesterfield Street was so dilapidated, she was unable to live there. It was not practical for her to keep moving all her belongings and endless amounts of administration papers each time. Once again her Father helped her out again, and in 1864 bought 35 South Street for her to live in, (The street was later renumbered and No 35 became No 10) she was to live here for the rest of her life. She lived alone, and constantly ill, she saw, her only company was her cats, as many as six, whom she was very fond of. Her friends during this time were Mary Clarke and Benjamin Jowett, both of whom she wrote to constantly. She became very close to Jowett, he had given her a great deal of comfort when Sidney Herbert died. Benjamin Jowett was a fellow and tutor of Balliol and Regius Professor of Greek, they met through her friend Clough, when he sent him a copy of Miss Nightingale’s Suggestions for Thought. Gradually her friends were being taken from her, on September 6th 1865, Hilary Bonham Carter died, they had been very close when they were young and Miss Nightingale had been very fond of her.

By 1866 it was nine years since Miss Nightingale had been home to visit her family. Her mother had been ill, and her eye sight was failing, Parthe had been looking after her, but had become busy running her own affairs. Mrs Nightingale’s sister Julia Smith would come to say for long periods to help out, she had not married, and had no permanent home of her own. As her mother was unable to travel with her husband to Lea Hurst, Miss Nightingale agreed to go and look after her mother at Embley Park. She was to stay from August until the end of November. Most of her time would be spent in her rooms, only leaving to visit her mother.


Death of William Nightingale …

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