Monday, 25 July 2016

This appalling horror

Florence Nightingale’s influence in the world of nursing is impossible to quantify. Born in 1820 to a wealthy family, she knew from a young age that caring for the sick and vulnerable was her calling in life, much to the disapproval of her parents. Little did they know, but their daughter would one day become the founder of modern nursing; she would also, most famously, train and take a team of nurses to Turkey in 1854 in order to care for the thousands of soldiers injured during the Crimean War, most of whom were languishing in unspeakably horrific conditions. It was there that she wrote this letter to Dr. William Bowman of King’s College Hospital and described in great detail the “appalling horror.” Such was her impact, Nightingale returned home a hero.

(This letter, and many other fascinating pieces of correspondence, can be found in the bestselling book, More Letters of Note. For more info, visit Books of Note. Image: Wikimedia.)

“I came out, Ma’am, prepared to submit to everything—to be put upon in every way—but there are some things, Ma’am, one can’t submit to. There is caps, Ma’am, that suits one face and some that suits another’s, and if I’d known, Ma’am, about the caps, great as was my desire to come out to nurse at Scutari, I wouldn’t have come, Ma’am.”
- Speech of Mrs Lawfield, 5 November.

Barrack Hospital Scutari,
Asiatic Side
14 November 1854

Dear Sir

Time must be at a discount with the man who can adjust the balance of such an important question as the above—and I, for one, have none, as you will easily suppose when I tell you that, on Thursday last, we had 1715 sick and wounded in this hospital (among whom 120 cholera patients) and 650 severely wounded in the building called the General Hospital, of which we also have charge, when a message came to me to prepare for 570 wounded on our side of the hospital, who were arriving from the dreadful affair of 5 November at Balaclava, where were 1763 wounded and 442 killed, besides 96 officers wounded and 38 killed.

I always expected to end my days as hospital matron, but I never expected to be barrack mistress. We had but half an hour’s notice before they began landing the wounded. Between 1 and 9 o’clock we had the mattresses stuffed, sewn up, laid down, alas! only upon matting on the floors, the men washed and put to bed, and all their wounds dressed. I wish I had time and I would write you a letter dear to a surgeon’s heart, I am as good as a Medical Times.

But oh! you gentlemen of England who sit at home in all the well-earned satisfaction of your successful cases can have little idea from reading the newspapers of the horror and misery (in a military hospital) of operating upon these dying and exhausted men—a London hospital is a garden of flowers to it.

We have had such a sea in the Bosphorus and the Turks, the very men for whom we are fighting, carry our wounded so cruelly that they arrive in a state of agony. One amputated stump died two hours after we received him, one compound fracture just as we were getting him into bed, in all twenty-four cases on the day of landing. The dysentery cases have died at the rate of one in two. Then the day of operations which follows. I have no doubt that Providence is quite right and that the kingdom of hell is the best beginning for the kingdom of heaven, but that this is the kingdom of hell no one can doubt.

We are very lucky in our medical heads. Two of them are brutes and four of them are angels—for this is a work which makes either angels or devils of men, and of women too. As for the assistants, they are all cubs, and will, while a man is breathing his last breath under the knife, lament the “arrogance of being called up from the dinners by such a fresh influx of wounded.” But wicked cubs grow up into good old bears, though I don’t know how—for certain it is the old bears are good.

We have now four miles of beds—and not eighteen inches apart. We have our quarters in one tower of the barrack, and all this fresh influx has been laid down between us and the main guard in two corridors with a line of beds down each side, just room for one man to step between, and four wards.

Yet in the midst of this appalling horror (we are steeped up to our necks in blood) there is good. And I can truly say, like St Peter, “it is good for us to be here,” though I doubt whether, if St Peter had been here, he would have said so.

As I went my night rounds among the newly wounded that first night there was not one murmur, not one groan—the strictest discipline, the most absolute silence and quiet prevailed—only the step of the sentry and I heard one man say, I was dreaming of my friends at home, and another said, And I was thinking of them. These poor fellows bear pain and mutilation with unshrinking heroism, and die or are cut up without a complaint.

Not so the officers, but we have nothing to do with the officers. The wounded are now lying up to our very door, and we are landing forty more from the Andes.

I take rank in the army as brigadier general, because forty British females, whom I have with me, are more difficult to manage than 4000 men. Let no lady come out here who is not used to fatigue and privation. For the Devonport sisters, who ought to know what self-denial is, do nothing but complain. Occasionally the roof is torn off our quarters, or the windows blown in, and we are flooded and under water for the night. We have all sick cookery now to do, and have got in four men for the purpose, for the prophet Muhammad does not allow us a female. And we are now able to supply these poor fellows with something besides the government rations. The climate is very good for the healing of wounds.

I wish you would recall me to Dr Bence Jones’s remembrance when you see him, and tell him that I have had but too much occasion to remember him in the constant use of his dreadful presents. Now comes the time of hemorrhage and hospital gangrene, and every ten minutes an orderly runs and we have to go and cram lint into the wound till a surgeon can be sent for and stop the bleeding as well as we can.

In all our corridors I think we have not an average of three limbs per man—and there are two ships more “loading” at the Crimea with wounded—this is our phraseology. Then come the operations and a melancholy, not an encouraging list is this. They are all performed in the wards—no time to move them. One poor fellow, exhausted with hemorrhage, has his leg amputated as a last hope and dies ten minutes after the surgeons have left him. Almost before the breath has left his body it is sewn up in its blanket and carried away—buried the same day. We have no room for corpses in the wards. The surgeons pass on to the next, an excision of the shoulder joint—beautifully performed and going on well—ball lodged just in the head of the joint, and the fracture starred all round. The next poor fellow has two stumps for arms, and the next has lost an arm and leg.

As for the balls, they go in where they like and do as much harm as they can in passing—that is the only rule they have. The next case has one eye put out and paralysis of the iris of the other. He can neither see nor understand.

But all who can walk come in to us for tobacco, but I tell them that we have not a bit to put into our own mouths—not a sponge, nor a rag of linen, not an anything have I left. Everything is gone to make slings and stump pillows and shirts. These poor fellows have not had a clean shirt nor been washed for two months before they came here, and the state in which they arrive from the transport is literally crawling.

I hope in a few days we shall establish a little cleanliness—but we have not a basin nor a towel nor a bit of soap nor a broom. I have ordered 300 scrubbing brushes. But one half the barrack is so sadly out of repair that it is impossible to use a drop of water on the stone floors, which are all laid upon rotten wood, and would give our men fever in no time.

The next case is a poor fellow where the ball went in at the side of the head, put out one eye, made a hole in his tongue and came out in the neck. The wound was doing very nicely when he was seized with agonizing pain and died suddenly, without convulsion or paralysis. At the P.M . an abscess in the anterior part of the head was found as big as my fist—yet the man kept his reasoning faculties till the last. And nature had thrown out a false coat all round it.

I am getting a screen now for the amputations, for when one poor fellow—who is to be amputated tomorrow—sees his comrade today die under the knife, it makes impression, and diminishes his chance. But, anyway, among these exhausted frames the mortality of the operations is frightful.

We have erysipelas, fever and gangrene. And the Russian wounded are the worst. We are getting on nicely though in many ways. They were so glad to see us.

The senior chaplain is a sensible man, which is a remarkable providence. I have not been out of the hospital wards yet. But the most beautiful view in the world lies outside. If you ever see Mr Whitfield, the house apothecary of St Thomas’, will you tell him that the nurse he sent me, Mrs Roberts, is worth her weight in gold.

There was another engagement on the 8th and more wounded, who are coming down to us. The text which heads my letter was expounded thus. Mrs Lawfield was recommended to return home and set her cap, vulgarly speaking, at somewhere else than here, but on begging for mercy, was allowed to make another trial. Mrs Drake is a treasure—the four others are not fit to take care of themselves nor of others in a military hospital. This is my first impression. But it may modify, if I can convince them of the absolute necessity of discipline and propriety in a drunken garrison…

This is only the beginning of things. We are still expecting the assault.